Cementless fixation of the femoral stem
Uncemented fixation of the femur has become widely accepted as an excellent option for select groups of patients requiring total hip arthroplasty. This article reviews recent clinical series, animal studies, and basic science research on cementless femoral components. Despite clear biomechanical differences between chromium cobalt and titanium implants, clinical superiority of one over the other has not been demonstrated. The optimal type and extent of surface enhancement is also not known, although it has been universally accepted that noncircumferential coatings lead to early failure by promoting distal femoral particulate wear. High rates of bone ingrowth and excellent clinical results are reported for femoral components with a wide variety of geometries, despite differences in stress shielding and periprosthetic bone remodeling. Cementless femoral implant characteristics have evolved to address earlier shortcomings that caused unacceptable rates of loosening and thigh pain. However, long-term polyethylene wear and associated osteolysis remains problematic. © 2001 Lippincott Williams & Wilkins, Inc.
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