Progressive Osteolysis after Porous-Coated Anatomic (PCA) Uncemented Total Hip Arthroplasty Ten-Year Results in 32 Consecutive Cases

Thirty-two primary non-cemented first generation Porous-Coated Anatomic (PCA) total hip prostheses in 31 patients were followed prospectively. The average follow-up period was 10.3 years. The median age at surgery was 53 years (range 21–65). All operations were performed by one surgeon.

Preoperatively, all cases had a poor Harris Hip Score. Ten years after surgery, 95% were rated good or excellent.

Progressive roentgenographical changes were observed. In particular there was severe femoral osteolysis in zones 1, 2 and 7, and extensive wear of the polyethylene liner at the two latest follow-up examinations. Wear of the polyethylene liner, up to 0.4 mm/year, was significantly correlated with osteolysis after seven years (p=0.003). Aseptic cup loosening was the reason for six of the eight failures. At 10.3 years after surgery the survival with revision as end-point was 72%.

We stopped using the 1^st generation PCA prosthesis after five years due to worrying roentgenographic changes. The seven and ten years results have confirmed that this prosthesis cannot be recommended for implantation.