One hundred and forty-nine patients (162 hips) had a standard primary
total hip arthroplasty with a grit-blasted femoral component and use of
so-called second-generation cementing techniques. No patient was lost to
follow up. Fifty-one patients (sixty hips) died within fourteen years after
the index operation. The remaining ninety patients (102 hips) were followed
for a minimum of fourteen years. Of the fifty-one patients (sixty hips) who
died within fourteen years, three patients (three hips; 5 per cent) had had
a revision: one, because of aseptic loosening of the acetabular component;
one, because of aseptic loosening of the femoral component; and one because
of aseptic loosening of both components. Of the ninety patients (102 hips)
who were alive fourteen years or more (average duration of follow-up,
fifteen years) after the arthroplasty, one patient (two hips; 2 per cent)
had a revision because of bilateral aseptic loosening of the femoral
component. In seven patients (seven hips; 7 per cent), the femoral
component loose according to radiographic criteria but was not revised. For
the entire group of 162 hips, four femoral components (2 per cent) were
revised because of aseptic loosening. In contrast, the rate of aseptic
loosening of the acetabular component was higher and continued to increase.
Of the eighty-one hips with an all-polyethylene acetabular component in the
patients who were alive at fourteen years or more, eight (10 per cent) had
a revision because of aseptic loosening. In addition, twenty-eight (42 per
cent) of the sixty-seven all-polyethylene acetabular components that were
in place after fourteen years or more, and for which there were current
radiographs, were loose. Femoral components implanted with the use of
second-generation cementing techniques appear to have fared much better
than acetabular components that were inserted with similar techniques in
this series of patients. A thin (less than one-millimeter) mantle of cement
around the femoral component and defects in the mantle of cement were
associated with increased loosening of the femoral component.