Is there still a place for the cemented titanium femoral stem?

Figures & data

Figure 1. The Titan cemented femoral stem.

Table 1. Patient characteristics and femoral stem epidemiology

	1987–1995	1996–2000	2001–2008
No. of hips	2,895	2,635	4,483
No. of hospitals with > 100 hips in the period	8	8	8
Patient age (median, range)	73.8	74.7	74.7
Sex (% males)	28	26	27
Diagnosis (% osteoarthritis)	70	74	78
Stem size (%)
T ≤ 11	29	32	39
T = 12–13	45	48	44
T ≥ 14	26	20	17
Stem offset (% lateralized stems)	4.5	5.1	9.4
Femoral head size (%)
28 mm	26	95	100
32 mm	74	5	0
Femoral head material (%)
Steel	80	52	0
Cobalt chrome	0	44	95
Others	20	7	4
Bone cement (%)
Palacos	16	4	0
Palacos with Gentamycin	79	95	61
Refobacin Palacos	0	0	5
Palacos R+G	0	0	17
Refobacin Bone Cement R	0	0	14
Simplex	4	0	0
Others/Missing ^a	1	1	3

^aSimplex-Erythromycine/Colistin, Palacos E-Flow, Simplex with Tobramycine, Cemex with Gentamycin, SmartSet HV, Cemex Systeme Genta Fast, Optipac Refobacine Bonecement.

Table 2. Kaplan-Meier survival and Cox regression analysis with adjustments made for age, sex, and diagnosis. The endpoint was revision of the stem for aseptic loosening

	Relative risk of revision (95% CI)	p-value	Survival at 7 years (95% CI)
1987–1995	1.3 (0.8–2.1)	0.1	99.0 (98.6–99.4)
1996–2000 (ref.)	1	–	99.0 (98.6–99.5)
2001–2008	4.7 (3.0–7.4)	< 0.001	95.7 (94.6–96.8)

Figure 2. Survival of the stem in stratified time periods. The endpoint was revision of the stem for aseptic loosening.

Figure 3. Example of a revision case 3 years after surgery (A), and 5 years after surgery showing extensive osteolysis (B and C). Another case at 2 years (D) and 6 years (E) with a similar appearance.

Table 3. Cox regression analysis with adjustments for time period and diagnosis. The impact of age, sex, neck option, femoral stem size, and femoral head size. The endpoint was stem revision for aseptic loosening

	Relative risk of revision (95% CI)	p-value
Age	0.9 (0.9–1.0)	< 0.001
Sex ^a	2.5 (1.9–3.4)	< 0.001
Neck option: standard (ref.)	1	–
lateralized	3.3 (2.3–4.8)	< 0.00 1
Stem size:
≤ 11	2.2 (1.4–3.5)	< 0.001
12–13	1.1 (0.7–1.8)	0.7
≥ 14 (ref.)	1	–
Femoral head size:
32 mm (ref.)	1	–
28 mm	0.9 (0.5–1.6)	0.8

^a Female sex was the reference group (RR = 1).

Figure 4. Survival of the stem according to femoral offset (standard vs. lateralized). The endpoint was stem revision for any reason.

Table 4. The total offset (stem type and head/neck length) stratified into 5 groups. Relative risk (RR) of stem revision for aseptic stem loosening (Cox, adjusted for sex, age, stem size, and femoral head size)

Total offset	No. of hips	No. of standard stems	No. of lateralized stems	RR (95% CI)
≤ 3 mm	2,969	2,969	0	–
3–5 mm	4,391	4,391	0	1.6 (1.1–2.5)
5–7 mm	1,411	1,411	0	1.4 (0.8–2.4)
7–9 mm	495	238	257	5.1 (3.0–8.9)
> 9 mm	504	86	418	3.9 (2.2–6.9)

Figure 5. Survival of the stem according to stem size. The endpoint was stem revision for any reason.