Uncemented custom-made femoral components

We present our experience of total hip replacement (THR) in younger patients using a custom-made smooth titanium alloy femoral prosthesis. Measurements made from pre-operative marker radiographs allowed creation of templates and subsequent computer analysis to mill the stem prior to surgery. Fifty-one such cementless implants were carried out in 43 patients between January 1993 and June 1996 with follow-up to an average of 47 months. Sixteen hips have required revision to date; 13 of these operations were for aseptic loosening. Two more were awaiting revision, giving an overall failure rate of 35.3 %. The average duration from primary operation to revision was 47 months. Thus, even though the concept of an uncemented custom-made femoral component is attractive, the failure rate was found to be unacceptably high. This device may achieve "fit and fill", but adequate bone on- or in-growth was not achieved. On the basis of these data we have discontinued the use of this implant since 1996. (Hip International 2002; 4: 365-70).