Proximal cement fixation in total hip arthroplasty--first results with a new stem design

Stem loosening and stress-shielding are problems encountered in cemented hip arthroplasty. Could proximal stem fixation by partial cementing solve the problem? More physiological transmission of forces with only proximal cement fixation seems to be possible with this recent development (Z-stem, Option 3000, Mathys Orthopaedics, Bettlach, Switzerland). In a prospective clinical trial, this new implant was used for total hip arthroplasty in human patients. One hundred and thirty-three (133) total hip replacements in 123 patients were performed between April 1996 and January 2003. All of them were followed up regularly; 53 were analysed with the EBRA-FCA method (Einzel Bild Röntgen Analyse--femoral component analysis), whereas the rest were analysed using conventional follow-up X-rays. Eighty-six (86) patients with 95 hips could be examined in August 2004 to obtain mid-term results. At this stage, the mean follow-up time was 61 months (5.08 years), with a maximum of 100 months (8.33 years). Up to October 2004, nine cases needed a revision. The clinical data collected reported an average Harris Hip Score of 89.3 (good). The EBRA-FCA analysis reported a mean subsidence of less than 1.5 mm after the first two years, under the EBRA threshold of predicted loosening. At the latest follow-up (at an average of 61 months), there was an average stable subsidence of 2.4 mm in general. Eight (8) patients presented with subsidence of more than 5 mm. The results of the new implant seem to be encouraging. Finally, comparing our results to other fixation concepts will require longer follow-up periods.