The uncemented Bicontact total hip arthroplasty in octogenarians. Medium-term results

Uncemented total hip arthroplasty was developed on the principle of biological fixation to enhance longevity of the prosthesis. Though the role of uncemented total hip replacement as an alternative is well accepted in young patients, its role in elderly remains controversial. We reviewed a consecutive series of 60 uncemented Bicontact total hip arthroplasties in 51 octogenarian patients with a mean follow-up of 7 (range 5-9) years. Mean patient age was 87.8 (range 80-97) years. Mean preoperative Harris hip score of 48 (range 32-65) improved postoperatively to a mean of 88 (range 58-94). There were 26 hydroxyapatite (HA) and 34 non-HA plasma pore-coated acetabular cups; one cup was revised for recurrent dislocation. Radiological evaluation revealed no unstable cups; however, two were "probably unstable" (one non-HA and one infection in an HA-coated cup) and two "possibly unstable" (one HA and one non-HA cup) ( P <0.05). None of these cups were clinically symptomatic. Two femoral stems were considered "possibly unstable" and one stem "fibrous stable", while the remaining stems were "osseo-integrated". There were no revisions of either femoral stem or cup for aseptic loosening. Using the recommendation of revision as the end point, cumulative prosthesis survival rate was 98.4% at a mean follow-up of 7 years (95%CI: 95.9-99.4%). However, cumulative survival with revision being the end point for aseptic loosening was 100% for the Bicontact prosthesis. Results of our series are encouraging and justify the continued use of this prosthesis in the elderly.