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Related Experiment Videos

Proximally coated ingrowth prostheses. A review

M A Mont1, D S Hungerford

  • 1Johns Hopkins University School of Medicine, Baltimore, MD 21239, USA.

Clinical Orthopaedics and Related Research
|December 31, 1997
PubMed
Summary

Proximally coated femoral stems for cementless hip replacement show promise. Second-generation designs offer improved stability and reduced complications, though long-term osteolysis risks require further study.

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Area of Science:

  • Orthopedic Surgery
  • Biomaterials Engineering
  • Medical Device Design

Background:

  • Cementless total hip replacement (THR) initially faced proximal stress shielding issues with extensively coated femoral components.
  • Proximally coated femoral stems were developed in the 1980s to mitigate stress shielding.
  • Early designs encountered problems including instability, thigh pain, and osteolysis.

Purpose of the Study:

  • To evaluate the long-term viability of proximally coated femoral stems in cementless THR.
  • To analyze current device performance against historical data.
  • To detail the evolution and modifications of these implants in response to early failures.

Main Methods:

  • Review of clinical outcomes and literature on proximally coated femoral stems.

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  • Analysis of implant design evolution and modifications.
  • Comparison of first-generation device failures with second-generation device results.

    • Main Results:

    • First-generation devices had issues with stability, thigh pain, and osteolysis.
    • Second-generation devices (with >5 years follow-up) demonstrate low aseptic loosening rates (1-3%) and reduced thigh pain (<5%).
    • Improved geometry, instrumentation, and technique contribute to initial implant stability.

    Conclusions:

    • The concept of proximally coated cementless femoral stems is viable with design improvements.
    • Circumferential proximal coating is crucial to prevent diaphyseal debris.
    • Rigid initial stability is a key requirement for successful outcomes, but long-term osteolysis data is still pending.