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Updated: Nov 28, 2025
Individualized Stem-positioning in Calcar-guided Short-stem Total Hip Arthroplasty
Published on: February 27, 2018
Straight stem and threaded cup in patients under 60 years of age: 28.8-30.2 years of follow-up
L Pisecky1,2, J Allerstorfer3,4, B Schauer5,6
1Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstraße 9, 4020, Linz, Austria. Lorenz.pisecky@kepleruniklinikum.at.
Insights
Total hip arthroplasty with a straight uncemented stem and threaded cup shows excellent 30-year outcomes in patients under 60. Revisions for polyethylene liner wear were more common than in older patients.
Area of Science:
- Orthopedic Surgery
- Biomaterials Science
- Geriatric Medicine
Background:
- Total hip arthroplasty (THA) is a common procedure for hip joint degeneration.
- Assessing long-term outcomes of THA in younger patient populations is crucial for optimizing implant longevity.
- Uncemented implants, including straight stems and threaded cups, are frequently used in THA.
Purpose of the Study:
- To evaluate the ultra-long-term (30-year) outcomes of total hip arthroplasty in patients younger than 60 years.
- To assess the efficacy and survival rates of a specific uncemented implant combination (straight stem and threaded cup).
Main Methods:
- Retrospective observational study of a single cohort of 75 patients (75 hips) implanted between 1986-1987.
- Patients were younger than 60 years at the time of primary total hip arthroplasty.
- Clinical and radiographic evaluations were performed at a mean follow-up of 29.5 years.
Main Results:
- Overall survival rate at 30 years was 97.3% for aseptic loosening.
- Revision for any reason was required in 29.4% of cases (70.6% survival rate).
- Polyethylene liner wear necessitating head and liner exchange occurred in 11 patients, averaging 21.4 years post-implantation.
Conclusions:
- The combination of the Alloclassic straight stem and CSF threaded cup demonstrates excellent 30-year outcomes in young patients (<60 years).
- While implant survival is high, polyethylene liner wear is a significant factor for revision in this younger cohort.
- This study highlights the durability of uncemented THA components but underscores the need for wear-resistant materials in younger, more active patients.
Purpose:
The aim of this retrospective observational study of one cohort was to evaluate the long-term outcome in patients younger than 60 years after total hip arthroplasty using a straight uncemented stem and an uncemented threaded cup.
Methods:
Between 1986 and 1987, 75 hips of 75 patients (mean age, 53.35 ± 6.17 years) were consecutively implanted with an Alloclassic Zweymüller/Alloclassic SL stem and an Alloclassic CSF cup. Forty-four patients had died over the last 30 years. The remaining 31 patients (mean age, 82.9 ± 6.4 years) were reinvited for follow-up examinations. Clinical and radiographic evaluations were carried out.
Results:
At a mean follow-up of 29.5 (28.8-30.2), 4 patients (5.3%) were lost to follow-up. For the endpoint aseptic loosening (defined as the removal of stem or the cup for 2 cases), the overall survival rate is 97.3%. For the endpoint revision for any reason (22 patients), the survival rate is 70.6%. Eleven patients needed an exchange of head and liner, caused by wear. The average time from implantation until change of head and liner was 21.44 years (SD 5.92). Other reasons for revision surgery were septic loosening (3 cases), aseptic loosening of stem and cup (1 case), aseptic loosening of stem (1 case), periprosthetic calcification (2 cases), implant fracture (1 case), periprosthetic fracture (1 case), intraoperative fissure of stem (1 case), and total wear of liner including cup (1 case).
Conclusion:
The combination of a straight stem (Alloclassic) and a screw cup (CSF) shows excellent results in young patients under the age of 60 at ultra-long-term follow-up at 30 years. Revisions due to wear of the polyethylene liner are more likely than in the older patients.
