Research Article| Volume 27, ISSUE 8, P1554-1561, September 2012

Total Hip Arthroplasty Using Cementless Grit-Blasted Femoral Component

A Minimum 10-Year Follow-Up Study
Published:April 05, 2012DOI:


      The grit-blasted cementless Spotorno (CLS) stem, which has excellent survival rates up to 10 years, is widely used in total hip arthroplasty (THA). We investigated the survivorships of CLS stems in THA at a minimum follow-up of 10 years and sought to identify factors that influence outcomes. A total of 227 hips of 191 patients who underwent cementless THA with a CLS stem were retrospectively reviewed at a mean follow-up of 12.3 years. All patients were evaluated clinically and radiographically according to implant type and surgery-related and patient-related factors. Survivorship was 97.2% when femoral revision for any reason was defined as the end point. Femoral revisions were performed in 3 hips because of periprosthetic fractures. Survivorship for all hips, using revision for any reason as the end point, was 92.6%. Two metal-on-metal THAs were revised because of aseptic loosening or osteolysis around the cup. No significant differences were evident for type of stem, type of bearing surface, stem alignment, or patient-related factors. However, a canal fill index of 80% or less was found to affect cortical remodeling, subsidence, and a change in stem position of 5° or more, which indicates that care must be taken not to undersize stems. In addition, in view of the revisions performed, bearing surfaces appear to importantly influence THA survivorship.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The Journal of Arthroplasty
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Campbell A.C.
        • Rorabeck C.H.
        • Bourne R.B.
        • et al.
        Thigh pain after cementless hip arthroplasty. Annoyance or ill omen.
        J Bone Joint Surg Br. 1992; 74: 63
        • Bourne R.B.
        • Rorabeck C.H.
        • Patterson J.J.
        • et al.
        Tapered titanium cementless total hip replacements: a 10- to 13-year followup study.
        Clin Orthop Relat Res. 2001; 393: 112
        • Reigstad O.
        • Siewers P.
        • Rokkum M.
        • et al.
        Excellent long-term survival of an uncemented press-fit stem and screw cup in young patients: follow-up of 75 hips for 15-18 years.
        Acta Orthop. 2008; 79: 194
        • Biemond J.E.
        • Pakvis D.F.
        • van Hellemondt G.G.
        • et al.
        Long-term survivorship analysis of the cementless spotorno femoral component in patients less than 50 years of age.
        J Arthroplasty. 2010; : 17
        • Aldinger P.R.
        • Jung A.W.
        • Pritsch M.
        • et al.
        Uncemented grit-blasted straight tapered titanium stems in patients younger than fifty-five years of age. Fifteen to twenty-year results.
        J Bone Joint Surg Am. 2009; 91: 1432
        • Min B.W.
        • Song K.S.
        • Bae K.C.
        • et al.
        The effect of stem alignment on results of total hip arthroplasty with a cementless tapered-wedge femoral component.
        J Arthroplasty. 2008; 23: 418
        • Palm L.
        • Jacobsson S.A.
        • Ivarsson I.
        Hydroxyapatite coating improves 8- to 10-year performance of the link RS cementless femoral stem.
        J Arthroplasty. 2002; 17: 172
        • Kroon P.O.
        • Freeman M.A.
        Hydroxyapatite coating of hip prostheses. Effect on migration into the femur.
        J Bone Joint Surg Br. 1992; 74: 518
        • Kim Y.H.
        • Kim J.S.
        • Oh S.H.
        • et al.
        Comparison of porous-coated titanium femoral stems with and without hydroxyapatite coating.
        J Bone Joint Surg Am. 2003; 85-A: 1682
        • Khalily C.
        • Lester D.K.
        Results of a tapered cementless femoral stem implanted in varus.
        J Arthroplasty. 2002; 17: 463
        • Aldinger P.R.
        • Jung A.W.
        • Breusch S.J.
        • et al.
        Survival of the cementless Spotorno stem in the second decade.
        Clin Orthop Relat Res. 2009; 467: 2297
        • Dorr L.D.
        • Wan Z.
        • Song M.
        • et al.
        Bilateral total hip arthroplasty comparing hydroxyapatite coating to porous-coated fixation.
        J Arthroplasty. 1998; 13: 729
        • Mallory T.H.
        • Head W.C.
        • Lombardi Jr., A.V.
        • et al.
        Clinical and radiographic outcome of a cementless, titanium, plasma spray-coated total hip arthroplasty femoral component. Justification for continuance of use.
        J Arthroplasty. 1996; 11: 653
        • Muller L.A.
        • Wenger N.
        • Schramm M.
        • et al.
        Seventeen-year survival of the cementless CLS Spotorno stem.
        Arch Orthop Trauma Surg. 2010; 130: 269
        • Aldinger P.R.
        • Breusch S.J.
        • Lukoschek M.
        • et al.
        A ten- to 15-year follow-up of the cementless spotorno stem.
        J Bone Joint Surg Br. 2003; 85: 209
        • Dorr L.D.
        • Faugere M.C.
        • Mackel A.M.
        • et al.
        Structural and cellular assessment of bone quality of proximal femur.
        Bone. 1993; 14: 231
        • Gruen T.A.
        • McNeice G.M.
        • Amstutz H.C.
        “Modes of failure” of cemented stem-type femoral components: a radiographic analysis of loosening.
        Clin Orthop Relat Res. 1979; 141: 17
        • DeLee J.G.
        • Charnley J.
        Radiological demarcation of cemented sockets in total hip replacement.
        Clin Orthop Relat Res. 1976; 121: 20
        • Engh C.A.
        • Bobyn J.D.
        • Glassman A.H.
        Porous-coated hip replacement. The factors governing bone ingrowth, stress shielding, and clinical results.
        J Bone Joint Surg Br. 1987; 69: 45
        • Bourne R.B.
        • Rorabeck CH
        A critical look at cementless stems. Taper designs and when to use alternatives.
        Clin Orthop Relat Res. 1998; 355: 212
        • Parvizi J.
        • Sullivan T.
        • Duffy G.
        • et al.
        Fifteen-year clinical survivorship of Harris-Galante total hip arthroplasty.
        J Arthroplasty. 2004; 19: 672
        • Kim Y.H.
        Long-term results of the cementless porous-coated anatomic total hip prosthesis.
        J Bone Joint Surg Br. 2005; 87: 623
        • Duffy G.P.
        • Berry D.J.
        • Rowland C.
        • et al.
        Primary uncemented total hip arthroplasty in patients <40 years old: 10- to 14-year results using first-generation proximally porous-coated implants.
        J Arthroplasty. 2001; 16: 140
        • Belmont Jr., P.J.
        • Powers C.C.
        • Beykirch S.E.
        • et al.
        Results of the anatomic medullary locking total hip arthroplasty at a minimum of twenty years. A concise follow-up of previous reports.
        J Bone Joint Surg Am. 2008; 90: 1524
        • McLaughlin J.R.
        • Lee K.R.
        Total hip arthroplasty with an uncemented femoral component. Excellent results at ten-year follow-up.
        J Bone Joint Surg Br. 1997; 79: 900
        • Andreas S.
        • Friedrich G.
        • Lothar K.
        • et al.
        Long-term results for the uncemented Zweymuller/Alloclassic hip endoprosthesis: a 15-year minimum follow-up of 320 hip operations.
        J Arthroplasty. 2009; 24: 846
        • Siebold R.
        • Scheller G.
        • Schreiner U.
        • et al.
        Long-term results with the cement-free Spotorno CLS shaft.
        Orthopade. 2001; 30: 317
        • Schreiner U.
        • Scheller G.
        • Herbig J.
        • et al.
        Mid-term results of the cementless CLS stem. A 7- to 11-year follow-up study.
        Arch Orthop Trauma Surg. 2001; 121: 321
        • Schramm M.
        • Keck F.
        • Hohmann D.
        • et al.
        Total hip arthroplasty using an uncemented femoral component with taper design: outcome at 10-year follow-up.
        Arch Orthop Trauma Surg. 2000; 120: 407
        • Bhalodiya H.P.
        • Singh S.P.
        Results with the cementless Spotorno stem in total hip arthroplasty.
        J Arthroplasty. 2009; 24: 1188
        • Coathup M.J.
        • Blunn G.W.
        • Flynn N.
        • et al.
        A comparison of bone remodelling around hydroxyapatite-coated, porous-coated and grit-blasted hip replacements retrieved at post-mortem.
        J Bone Joint Surg Br. 2001; 83: 118
        • Vresilovic E.J.
        • Hozack W.J.
        • Rothman R.H.
        Radiographic assessment of cementless femoral components. Correlation with intraoperative mechanical stability.
        J Arthroplasty. 1994; 9: 137
        • Spotorno L.
        • Romagnoli S.
        • Ivaldo N.
        • et al.
        The CLS system. Theoretical concept and results.
        Acta Orthop Belg. 1993; 59: 144
        • Spotorno L.
        • Schenk R.K.
        • Dietschi C.
        • et al.
        Personal experiences with uncemented prostheses.
        Orthopade. 1987; 16: 225
        • Engh C.A.
        • Massin P.
        • Suthers K.E.
        Roentgenographic assessment of the biologic fixation of porous-surfaced femoral components.
        Clin Orthop Relat Res. 1990; 257: 107
        • Mulliken B.D.
        • Bourne R.B.
        • Rorabeck C.H.
        • et al.
        A tapered titanium femoral stem inserted without cement in a total hip arthroplasty. Radiographic evaluation and stability.
        J Bone Joint Surg Am. 1996; 78: 1214