Custom stems for femoral deformity in patients less than 40 years of age: 70 hips followed for an average of 14 years

Abstract

Background and purpose: Femoral deformity associated with osteoarthritis is a challenge for both the surgeon and the implant. Many of the patients with these deformities are young. Standard implants can be difficult to fit into these femurs. We prospectively evaluated the outcome of custom uncemented femoral stems in young patients. Methods: 61 consecutive patients (72 hips) underwent surgery for osteoarthritis because of femoral deformity at a mean age of 35 (22-40) years. The patients received a CT3D-A custom-made femoral stem and an uncemented cup. The mean follow-up time was 14 (10-16) years. 2 patients died at 7 and 8 years after surgery, otherwise, none of the patients were lost to follow-up. Results: At follow-up, the femoral prosthesis had not been revised in 59 patients (70 hips). 3 patients (3 hips) had required revision surgery due to loosening of the acetabular component; 2 hips were awaiting revision surgery for loosening of the acetabular cup. There were no cases of dislocation or infection. At review, all stems were considered stable according to the radiographic criteria. No migration or subsidence was observed on plain radiographs. Interpretation: Our results are comparable to published results of custom stems regarding survival and outcome. Considering the young age and the deformities in this series of uncemented custom femoral stems, and the fact that there was follow-up of up to 16 years, the survival is remarkable. This technique appears to be a reasonable alternative in younger patients with femoral deformities.