International Orthopaedics - 2026-04-21 - Journal Article
Conversion of fused hips to cementless total hip arthroplasty long-term (23.5 years) functional outcome, survival and patient satisfaction.
Kim YH, Park JW
Topics
Key Takeaway
Conversion of hip fusion to cementless metaphyseal-fitting THA yields 97% acetabular and 91% femoral component survival at mean 23.5 years, with a mean Harris Hip Score of 91.2.
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Summary
This single-surgeon retrospective study evaluated long-term outcomes of hip fusion conversion to cementless metaphyseal-fitting THA (third-generation Biolox Forte 28mm CoC bearing) via posterolateral approach in 88 patients (mean age 42.3 years). At mean 23.5-year follow-up, mean HHS was 91.2, mean hip flexion was 89°, and Kaplan-Meier survivorship was 97% for the acetabular component and 91% for the femoral component. Three acetabular (3%) and five femoral (5%) components required revision, with 70–80% of patients reporting overall satisfaction and 66% reporting marked QOL improvement.
Key Limitation
Single-surgeon, single-implant series with no control group prevents determination of whether outcomes reflect implant design, surgical technique, or patient selection.
Original Abstract
PURPOSE
Our retrospective study focused on long-term outcomes of converting a fused hip to a cementless metaphyseal-fitting anatomic hip system including: (1) validated clinical scores; (2) radiographic assessment; (3) impact on neighbouring joints; (4) osteolysis and revision rates; (5) complication profiles; (6) implant survivorship; and (7) patient satisfaction.
METHODS
We reviewed 96 THAs in 88 patients (mean age, 42.3 years [range, 21 to 74]) who underwent conversion of fused hip through a posterolateral approach to a cementless a metaphyseal-fitting anatomic cementless total hip system, performed by one surgeon. The third generation Biolox Forte at 28 mm as the bearing surface was used in all hips. The mean follow-up was 23.5 years (range, 14 to 30 years).
RESULTS
At the final follow-up, the mean Harris hip score was 91.2 points (range, 52 to 100 points). Mean hip flexion was 89° (range, 70° to 120°). Three acetabular (3%) and five femoral components (5%) that were revised. About 70 to 80% of patients expressed overall satisfaction and 66% of patients reported marked improvement in quality of life. A Kaplan-Meier survivorship analysis at 23.5 years showed a 97% survival rate (95% CI, 93 to100%) for the acetabular component and 91% (95% CI, 89 to 98%) for the femoral component.
CONCLUSIONS
Conversion of hip fusion to THA using metaphyseal-fitting anatomic cementless hip system appears to provide good long-term outcomes. The risk for postoperative complication including abductor dysfunction and nerve injury should be carefully discussed with patients prior to surgery.