A Comparative Study of Bipolar Hemiarthroplasty for Intertrochanteric Fracture: Direct Anterior Approach versus Conventional Posterolateral Approach.

Purpose: The aim of this study was to compare short-term results from use of the direct anterior approach (DAA) and the conventional posterolateral approach (PLA) in performance of bipolar hemiarthroplasty for treatment of femoral intertrochanteric fractures in elderly patients. Materials and Methods: A retrospective review of 100 patients with intertrochanteric fractures who underwent bipolar hemiarthroplasty was conducted. The PLA was used in 50 cases from 2016 to 2019; since that time we have used the DAA in 50 cases from 2019 to 2021. Measurements of mean operative time, blood loss, hospitalization period, and ambulation status, greater trochanter (GT) migration and stem subsidence were performed. And the incidence of complications was examined. Results: Operative time was 73.60±14.56 minutes in the PLA group and 79.80±8.89 minutes in the DAA group (P<0.05). However, after experiencing 20 cases using DAA, there was no statistically difference in operative time between two groups (P=0.331). Blood loss was 380.76±180.67 mL in the PLA group and 318.14±138.51 mL in the DAA group (P<0.05). The hospitalization was 23.76±11.89 days in the PLA group and 21.45±4.18 days in the DAA group (P=0.207). In both groups, there were no progressive GT migration, intraoperative fractures or dislocations, although there was one case of infection in the PLA group. Conclusion: Although use of the DAA in performance of bipolar hemiarthroplasty required slightly more time in the beginning compared with the PLA, the DAA may well be an alternative, safe surgical technique as a muscle preserving procedure in elderly patients with intertrochanteric fractures.

The Effects of COVID-19 Pandemic on the Recovery of Hip Fracture Patients.

Purpose: To figure out how complete control of family visits to prevent infection of coronavirus disease 2019 (COVID-19) affected the activity recovery of hip fracture patients admitted to nursing hospitals. Materials and Methods: Eighty-one patients with hip surgery in the two years prior to COVID-19 pandemic were classified as Group A, and 103 patients in the next two years were designated as Group B. The subjects' walking ability was evaluated by using the modified Koval index (MKI). In order to analyze the impact of the family visit control to the subjects, each group was classified into two different groups: (1) inpatients group who admitted to nursing hospitals and (2) home-treated patients. Additionally, statistical elements were processed in consideration of other factors that may affect the results of the experiment. Results: The MKI evaluated at 6 months postoperative was 3.31±1.79 in Group A and 2.77±1.91 in Group B, and it was meaningfully low after the pandemic (P=0.04). There was significantly low among both of Group A 2.74±1.76 and Group B 1.93±1.81 after the pandemic (P=0.03) among those treated at the nursing hospital. The rate of deterioration of the MKI was 35 (43.2%) in Group A and 57 (55.3%) in Group B, which increased by 12.1% after the pandemic. Conclusion: The pandemic had a negative effect on the recovery of postoperative activities of elderly hip fracture patients who admitted to nursing hospitals when family access was completely restricted to prevent infection.

Hemiarthroplasty through Direct Anterior Approach for Unstable Femoral Intertrochanteric Fractures in the Elderly: Analysis of Early Cases.

Purpose: The purpose of this study was to determine whether the direct anterior approach (DAA) can be applied to hemiarthroplasty for treatment of unstable femoral intertrochanteric fractures in elderly patients. Materials and Methods: We conducted a retrospective review of 34 cases (34 patients) who underwent bipolar hemiarthroplasty using a DAA from February 2019 to April 2020. The mean age of the patients was 82.68 years (range, 67-95 years). A cementless distal fixation hip system was used in all cases. Operation time, total amount of blood loss, intraoperative and postoperative fractures, infections, and reoperations were measured. The patients performed weight-bearing walking as tolerated immediately after surgery. Measurement of migration of the greater trochanter (GT) and progressive subsidence of the femoral stem was performed using follow-up radiographs. Results: The mean operative time was 83.50 minutes (range, 60-120 minutes). The mean amount of bleeding was 263.53 mL (range, 112-464 mL). Walking started a mean of 3-03 days (range, 3-4 days) after surgery. There was no case of progressive migration of the GT more than 5 mm even though it was not fixed. There were no cases of infection, dislocation, or reoperation. Conclusion: Bipolar hemiarthroplasty using the DAA for treatment of unstable femoral intertrochanteric fractures could be considered a useful option that provides many advantages in elderly patients.

Direct Anterior Approach for Total Hip Arthroplasty in the Elderly with Femoral Neck Fractures: Comparison with Conventional Posterolateral Approach.

BACKGROUND: The aim of this study was to determine if it was feasible and safe to perform total hip arthroplasty (THA) using the direct anterior approach (DAA) when compared with the conventional posterolateral approach (PA) in patients with femoral neck fractures. The time required to start walking was investigated to identify advantages of the muscle-sparing approach. Safety of the approach was judged based on the incidence and nature of all complications. METHODS: We retrospectively reviewed 67 THA cases due to femoral neck fractures from October 2015 to January 2019. The PA was used in 31 cases, and the DAA was used in 36 cases. The average operative time and amount of bleeding were evaluated. Cup inclination, anteversion, and leg length discrepancy (LLD) were also measured on radiographs. The time to start walking and complications (e.g., intraoperative fracture, infection, and dislocation) were recorded. RESULTS: The mean operative time was 84.35 ± 13.95 minutes in PA group and 99.22 ± 20.33 minutes in DAA group (p = 0.010). But after experiencing 20 cases using the DAA, there was no statistically significant difference in the operative time between the groups. The mean volume of bleeding was 428.73 ± 207.26 mL in the PA group and 482.47 ± 150.14 mL in the DAA group. There was no difference in the acetabular cup position between two groups. Ambulation was started at 3.94 days after surgery on average in the PA group and 3.14 days in the DAA group, showing a statistically significant difference. Intraoperative fracture and infection were not observed in either group. The incidence of LLD was 1 in each group. The dislocation rate was 3.2% (1 case) in the PA group and 5.5% (2 cases) in the DAA group. CONCLUSIONS: Although the DAA for THA was similar to the PA in terms of operative time, volume of bleeding, and complications, the DAA showed a great advantage in early rehabilitation as a muscle-sparing procedure in the elderly with femoral neck fractures.

Safety of a single intra-articular injection of LBSA0103 hyaluronic acid in patients with osteoarthritis of the knee: a multicenter, single-arm, prospective, cohort study.

OBJECTIVE: LBSA0103 is a recently developed high-molecular-weight, cross-linked, non-animal hyaluronic acid (HA). The safety of LBSA0103 has been investigated only in a limited number of patients, therefore this prospective study was designed. This study sought to assess the safety including injection-site reactions and adverse drug reactions after a single intra-articular injection of LBSA0103 in patients with osteoarthritis (OA) of the knee joint. METHODS: This study was a multicenter, single-arm, prospective cohort study. After screening, eligible patients with OA of the knee joint (Kellgren-Lawrence grades I-III) were enrolled, received a single intra-articular HA (LBSA0103) injection, and were followed up for two weeks. Any adverse events including injection-site reactions and adverse drug reactions were evaluated by the investigators. RESULTS: A total of 1949 subjects (2976 knee joints) was enrolled, all of whom received a single intra-articular injection of LBSA0103. Injection-site reactions occurred in 5.59% of enrolled subjects (109/1949), and the most frequently reported injection-site reaction was pain (4.87%), followed by swelling (1.03%). Most of the injection-site reactions were transient and resolved within 14 days without additional treatment. The incidence of adverse drug reactions other than injection-site reactions was 0.67% (13/1949). Most adverse events were of mild severity. No serious adverse events related to the study drug were reported. CONCLUSIONS: A single intra-articular injection of LBSA0103 in patients with OA of the knee joint was safe, and no significant safety concerns were observed. As such, LBSA0103 could be safely applied as an intra-articular injection for the management of knee OA. TRIAL REGISTRATION: The study was registered at ClinicalTrials.gov (identifier: NCT04369261).

Early Experience of Direct Anterior Approach Total Hip Arthroplasty: Analysis of the First 53 Cases.

PURPOSE: To determine if it is feasible and safe for a surgeon to transition from using the posterolateral approach to direct anterior approach (DAA) by evaluating the first 53 cases of total hip arthroplasty using a DAA. MATERIALS AND METHODS: A retrospective review of 52 patients who underwent THA using a DAA between July 2017 and December 2018. Reasons for THA were: femoral neck fracture (n=34), avascular necrosis (n=13), and arthritis (n=6). The mean age was 70 years old. An assessment of feasibility was made by analyzing mean operative time and blood loss. Cup inclination, anteversion, and leg length discrepancy (LLD) were measured using postoperative radiology. Safety of the DAA was judged using the incidence and nature of all complications. RESULTS: The mean operative time was 112 minutes. 135 minutes for the 1st 10 cases, 100 minutes for 2nd 10 cases, 113 minutes for 3rd 10 cases, 119 minutes for 4th 10 cases, and 91 minutes for the final 13 cases. The mean blood loss was 724 mL. Average cup inclination was 40.27°; 2 cases were out of safety angle. Mean anteversion was 16.18°. No intraoperative fractures or infections were observed. LLD was detected in 3 cases, one of which underwent revision due to walking difficulty. Dislocation occurred in 3 cases, all within the first 20 cases, however, there was no recurrent dislocation. CONCLUSION: DAA for THA was deemed to be feasible and safe based on an assessment of operative time, blood loss and complications.

Selecting Arthroplasty Fixation Approach Based on Greater Trochanter Fracture Type in Unstable Intertrochanteric Fractures.

PURPOSE: To evaluate the success rate of fixation approaches for greater trochanter (GT) fracture types in those with unstable intertrochnateric fractures. MATERIALS AND METHODS: Forty-four patients who underwent arthroplasty for unstable intertrochanteric fractures between January 2015 and November 2017 and followed-up more than six months were included in this study. The fractures of GT were classified into one of four types (i.e., A, B, C, and D) and fixed using either figure-8 wiring or cerclage wiring according to fracture type. Fractures were type A (n=7), type B (n=20), type C (n=6), and type D (n=11). Type A and B, which are fractures located above the inferior border of GT were fixed using figure-8 wiring and/or adding cerclage wiring. On the other hand, all type C and D fractures, which were located below the inferior border, were fixed using cerclage wiring. Fixation failure was defined as breakage of wire and progressive migration of GT fragment greater than 5 mm on follow-up radiographs. RESULTS: The most common GT fracture types were B and D, both of which are longitudinal fractures. The success rates of fixation were 85.7% (6 out of 7 cases) for the treatment of type A, 90.0% (18 out of 20 cases) for the treatment of type B, and 100% for the treatment of types C (6 out of 6 cases) and D (11 out of 11 cases). CONCLUSION: We note high success rates following fixation methods were selected based on the GT fracture type.

Total Hip Arthroplasty Using Ceramic-on-ceramic Bearing Surfaces: Long-term Assessment of Squeaking Sounds.

PURPOSE: This study was performed to characterize the natural history of squeaking sounds that occur following total hip arthroplasty (THA) using ceramic-on-ceramic bearing surfaces and its potential correlation with clinical and/or radiological results. MATERIALS AND METHODS: This study included 47 patients who underwent THA between April 1999 and April 2005, and had at least 10 years of follow up from the time of the operation. Squeaking sounds were detected in 10 out of the 47 cases (21.3%). Squeaking-associated factors (i.e., cause, time of onset, inducing motions, and continuity of the sound) were assessed. RESULTS: Squeaking sounds: i) were detected an average of 46.2 months after operation, ii) occurred more frequently in patients with a high body mass index (BMI) compared to those with low BMI, and iii) most frequently detected when deep flexion of hip joint followed extension. In all 10 cases, the squeaking sound remained through the follow up period; 6 cases experienced no change in frequency and pitch, 4 cases experienced a decrease in frequency and pitch over time. The cause(s) of changes to squeaking sounds could not be determined. CONCLUSION: The frequency and pitch of the squeaking sounds changed over time in a subset of patients. The squeaking sound did not appear to correlate with clinical results or survival of the prosthesis.

Measuring the Impact of Femoral Head Size on Dislocation Rates Following Total Hip Arthroplasty.

PURPOSE: The purpose of this study was to evaluate if the femoral head's size has an impact on dislocation rates following total hip arthroplasty (THA). MATERIALS AND METHODS: Five hundreds forty-three THA performed using a posterolateral approach in our hospital and followed up more than 6 months were included in this study. We evaluated dislocation rates based on the size of femoral head (28 mm vs. over 32 mm) and further investigated the dislocation rates classified into primary and revision surgery. Patient-related and surgical factors were reviewed to evaluate risk factors impacting dislocation rates. RESULTS: Dislocation occurred in 9.6% of cases (n=52; 32 males and 20 females). Of this dislocation group, 36 were treated with femoral heads 28 mm in diameter (9.8% of all patients treated with 28 mm femoral heads) and 16 were treated with femoral heads 32 mm and over (9.1% of all patients treated with femoral heads of at least 32 mm). The percentages of patients experiencing dislocation were not significantly different among the two groups (i.e., 28 mm vs. ≥32 mm). However, after revision surgery, the dislocation rate in the 28-mm group was significantly higher than the ≥32-mm group (P<0.05). In a case-control study comparing dislocation and non-dislocation groups, the risk of dislocation was 6 times higher in patients with habitual alcohol intake, and 9.2 times higher in patients with a neuropsychiatric disorder (P<0.05). CONCLUSION: Patient factors are considered to have a more significant impact on dislocation rates following THA than the size of femoral head.

Outcomes of Surgical Treatment of Periprosthetic Femoral Fractures in Cementless Hip Arthroplasty.

PURPOSE: We aimed to evaluate the results of surgical treatment of periprosthetic femoral fractures in cementless total hip arthroplasty (THA). MATERIALS AND METHODS: From June 2002 to May 2012, 40 patients who could be followed-up for more than 1 year after surgery were enrolled in this study. The mean duration of follow-up was 28.5 months (range, 15-97 months) and the average age at the time of surgery was 71.5 years (range, 38-89 years). The fracture types were determined by using the Vancouver classification. Among intraoperative fractures, there were type A in 3 hips, type B2 in 2 hips and type B3 in one. Among postoperative fractures, type AG was present in 5 hips, type AL in 2 hips, type B1 in 15 hips, type B2 in 6 hips, type B3 in 3 hips, and type C in 3 hips. Evaluation of the results was based on bony union, stability of the prosthesis, postoperative complications, and Harris hip score at the final follow-up. RESULTS: Bony union was achieved in all but one case and the average time for bony union was 21 weeks. The mean Harris hip score was 86 at the final follow-up. Clinical results were above good in 34 of 40 hips (85.0%). Stem loosening occurred in one patient with a type B1 fracture treated with open reduction and plate fixation. Nonunion was observed in 1 patient with an AG type fracture. CONCLUSION: Open reduction and fixation using a plate with a screw and cerclage wiring provided good results for periprosthetic fractures in patients who had a stable femoral stem without bone defects. Revision surgery with a cementless long stem should be considered in patients with an unstable stem or suspected stability in B1 type of THA using a proximal fixation type.

Total Hip Arthroplasty Using Metal Head on a Highly Cross-linked Polyethylene Liner.

PURPOSE: This retrospective study was performed to evaluate the clinical results and measure polyethylene liner wear in total hip arthroplasty (THA) with highly cross-linked polyethylene. MATERIALS AND METHODS: Except for patients who had died or were unable to have follow-up at least 2 years, 60 of 78 hips that underwent THA were included this study. The mean age was 64.5 years (range, 25-81 years) and the mean body mass index (BMI) was 23.0 kg/m(2) (18.1-32.3 kg/m(2)). Diagnosis at the time of the operation was osteonecrois of the femoral head in 28 hips, primary osteoarthritis in 14, hip fracture in 13, and other diseases in 5. The mean follow-up period was 3.8 years (2.1-7.1 years). Harris hip score (HHS) was reviewed before THA and at the last follow-up. On the anteroposterior pelvic radiographs, acetabular cup inclination and ante-version were also measured. The annual linear wear rate was measured using Livermore's method on the radiographs. RESULTS: The mean HHS was 60.1 (28-94) before operation and 90.4 (47-100) at the last follow-up. In the immediate post-operation, the average inclination and anteversion angles of the acetabular cups were 46.3° (standard deviation, ±6.7°) and, 21.4°(±10.1°) respectively. The mean of the annual linear polyethylene wear was 0.079 mm/year (0.001-0.291 mm/year). Age, gender and BMI were not statistically related to linear polyethylene wear but the period of follow-up and the acetabular cup's inclination showed significant negative and positive correlation respectively. CONCLUSION: The wear rate of a highly cross-linked polyethylene was shown to correlate negatively with duration of follow-up. However, our study was based on a short-term follow-up, so a long-term follow-up study is necessary in the future.

Internal fixation of femoral head fractures (Pipkin I) using hip arthroscopy.

A hip arthroscopy technique for the reduction and internal fixation of a displaced femoral head fracture is presented. Open treatment is often required for femoral head fractures. However, it is shown below how large fragments of a femoral head fracture-dislocation were reduced and internally fixated using hip arthroscopy. This was performed in the supine position using skeletal traction. The accessory distal anterior portal was used for internal fixation when a hip was positioned in abduction with external rotation. A satisfactory outcome was reported. Recovery was immediate and cosmetics were excellent. We conclude that hip arthroscopy is a valuable option for managing femoral head fracture-dislocations (Pipkin I).

The Effect of Hydroxyapatite Coating on Long-term Results of Total Hip Arthroplasty with Hydroxyapatite-coated Anatomic Femoral Stem.

PURPOSE: To evaluate the clinical and radiological results, as well as the survival rate, associated with total hip arthroplasty using a hydroxyapatite (HA)-coated anatomical femoral stem at a follow-up of ≥12 years. MATERIALS AND METHODS: From April 1992 to May 1997, 86 patients (102 hips) underwent total hip arthroplasty with a HA-coated ABG I (Anatomical Benoist Giraud; Howmedica) hip prosthesis. The average age at the time of surgery was 53.4 years and the mean duration of follow-up was 17.1 years (range, 12.1-21.0 years). The Harris hip score (HHS) and radiographic assessments of thigh pain were used to evaluate the clinical results. We observed osteointegration, cortical hypertrophy, reactive line, calcar resorption and osteolysis around the femoral stems. The survival rate of the femoral stems was evaluated by using the span of time to a revision operation for any reasons was defined as the end point. RESULTS: The mean HHS was 50.5 preoperatively and 84.2 at the time of last follow-up. Osteolysis only around the HA-coated proximal portion of the femoral stem was observed in 72 hips, cortical hypertrophy all around the distal portion of the femoral stem was observed in 38 hips, and calcar resorption was observed in 44 hips. A reactive line was observed in 13 hips, but was unrelated to component loosening. Stem revision operations were performed in 24 (23%) hips due to osteolysis (14 hips), fracture (5 hips) and infection (5 hips). The femoral stem survival rate was 75% over the mean duration of follow-up. CONCLUSION: Total hip arthroplasty using a HA-coated anatomical femoral stem showed necessitated a high rate of revision operations due to osteolysis around the femoral stem in this long term follow-up study.

Total hip arthroplasty using two-incision technique.

BACKGROUND: To evaluate the effectiveness of minimally invasive surgery total hip arthroplasty (THA) using the two-incision technique as described by Mears. METHODS: From January 2003 to December 2006, sixty-four patients underwent total hip arthroplasty using the one-incision (group I) and two-incision (group II) technique by one surgeon. There were 34 hips in group I and 30 hips in group II. There was no difference in age, gender, and causes of THA between the two groups. We evaluated the operation time, bleeding amount, incision length, ambulation, hospital stay, and complications between the two groups. RESULTS: There was no difference in the bleeding amount between the two groups. Operation time was longer in the two-incision group than in the one-incision group. Operation time of the two-incision technique could be reduced after 15 cases. Patients started ambulation after surgery earlier in group II than group I, and the hospital stay was shorter in group II than in group I. There was no difference in clinical results between the two groups. There was no difference in component position of the acetabular cup and femoral stem between the two groups. Intraoperative periprosthetic fracture occurred in four cases (13.3%) in group II. CONCLUSIONS: Two-incision THA has the advantage of rapid recovery and shorter hospital stay. However, longer operation time and a high complication rate compared to one-incision are problems that need to be solved in the two-incision technique.

Squeaking sound in total hip arthroplasty using ceramic-on-ceramic bearing surfaces.

PURPOSE: To evaluate the causes and frequency of the squeaking sound in ceramic-on-ceramic THA. MATERIALS AND METHODS: This study included 61 hips of 50 patients who underwent ceramic-on-ceramic THA in our hospital from March 1999 to April 2005. The average age at the time of operation was 57.6 years. The average duration of follow-up was 69.5 months. Three different acetabular components were used: Osteonics (Stryker, USA: 24 cases), Bicontact (Aesculap, Germany: 27 cases) and ABG (Howmedica, UK: 10 cases). RESULTS: Fourteen (22.9%) of the 61 cases had a squeaking sound, and this sound started a mean of 47.57 months after the operation. Except in one case, the squeaking sound remained until the last follow-up. There was no difference in acetabular component position between the squeaking and nonsqueaking groups. The squeaking sound was found to be related to the BMI (body mass index) and cup design. It occurred frequently in patients with high BMI who had received a total hip arthroplasty using an Osteonics cup. Among 11 of the patients, squeaking occurred while squatting, and in 3 patients while walking. Six patients suffered from mild restrictions on their activities of daily living, and 8 had more than moderate restrictions with squeaking sounds. CONCLUSION: A squeaking sound in THA using ceramic-on-ceramic surfaces is not a rare complication, and often affects the patient's behavior.

High revision rate of hydroxyapatite-coated ABG-I prosthesis.

BACKGROUND: The aim of this study was to investigate the causes of the high revision rate of the hydroxyapatite-coated Anatomique Benoist Girard (ABG-I) prosthesis. METHODS: We performed 204 total hip arthroplasties (THAs) at our hospital between March 1992 and December 1996. Of the 204 THA patients, 129 were followed up; the mean duration of follow-up was 12.2 years (range 10.0-14.5 years). There were 113 male patients and 16 female patients, with an average age of 53 years (30-83 years) at the time of surgery. The reasons for THA were avascular necrosis in 119 hips, acetabular dysplasia in 8 hips, and traumatic arthritis in 2 hips. RESULTS: The Harris hip score was 47.3 preoperatively and 86.4 at the last follow-up. The linear polyethylene wear was an average of 0.29 mm/year. Acetabular osteolysis was seen in 113 cases (88%). Altogether, 61 (47.2%) acetabular cups were revised for aseptic loosening in 38 hips, polyethylene wear and osteolysis in 20 hips, recurrent dislocation in 2 hips, and deep infection in 1 hip. Femoral osteolysis was observed in 100 cases (77.5%). The femoral stem was revised in 4 hips (3.1%). CONCLUSION: We observed that the fatal detriment to ABG-I acetabular cup survival in long-term follow-up was periacetabular osteolysis followed by aseptic loosening.

Measurement of extent of bone ongrowth and hydroxyapatite absorption in retrieved acetabular cups.

BACKGROUND: To understand why hydroxyapatite (HA)-coated acetabular cups did not produce satisfactory results, we measured the extent of bone ongrowth and HA absorption of the retrieved cups. METHODS: Between March 1992 and June 1998, a total of 289 patients underwent total hip arthroplasty with an HA-coated ABG (Anatomical Benoist Giraud) prosthesis in our hospital. We revised 71 cups in our hospital, 43 of which were included in this study. The cups were in situ for an average of 80.4 months. We revised 21 cups for polyethylene wear and osteolysis, 20 for loosening, and 2 for recurrent dislocation. The outer surfaces of the cups were subdivided by two circular grooves into three areas: central, middle, peripheral. Bone ongrowth and HA absorption was measured in terms of area and thickness. The areas were graphically calculated using a computer imaging analysis system. The thickness of the HA coating remaining on the retrieved cup was measured by an x-ray coating thickness measurement instrument. RESULTS: Of the 43 cups, 37 had bone ongrowth. Bone ongrowth was observed on the central surface in 23 cups, on the middle surface in 27 cups, and on the peripheral surface in 15 cups; 6 of the 37 cups had bone ongrowth only in the groove. Altogether, 37 cups showed bone ongrowth on 6.43% of the outer acetabular surface. HA absorption appeared in all 43 cups, and an average 63.21% of the HA coating area was absorbed. there was a proportional relation between the rate of HA absorption and implantation duration, but there was no consistent trend between the thickness of the HA coating and implantation duration. CONCLUSIONS: We suggest that progressive HA absorption and minimal bone ongrowth are related to the failure of HA-coated acetabular cups at long-term follow-up after total hip arthroplasty.

Improved results using extensively coated THA stems at minimum 5-year followup.

The Prodigy femoral component was extensively coated along its entire length, except for a smooth bullet-shaped distal tip. At a minimum 5 year followup we compared the results of that stem to those of a proximally coated first generation femoral component at comparable followup to address the question of which design performed better. For the extensively coated cohort, 86 patients (100 hips) underwent total hip arthroplasty by a single surgeon. At final followup, no patients were lost to followup and no hips were revised for aseptic loosening. Clinically, 3% of patients reported thigh pain (versus 15% in the proximally coated group). Radiographically, all hips had evidence of bone ingrowth (versus 94% in the PCA group). As expected with an extensively coated device there were fewer radiolucencies around the lower half of the prosthesis as well as less distal femoral lysis compared to the proximally coated stem.