The middle-aged patient with hip arthritis: the case for extensively coated stems.

Younger patients with a long life expectancy and higher activity levels who require total hip arthroplasty present a unique challenge to the reconstructive surgeon. To improve the longevity of total hip arthroplasty, particularly in younger, more active patients, femoral components inserted without cement have been used in an attempt to create a more durable reconstruction. Extensively-coated implants are an attractive option because they are associated with excellent initial implant stability and contact a large area of strong cortical bone in the femoral diaphysis where bony ingrowth reliably occurs. In a cohort of 304 patients (348 hips) who were between 45 and 65 years at the time of surgery and who were followed up for a mean of 14.2 years, 99.4% of the femoral reconstructions were stable with no cases of late failure secondary to loosening and a 96% rate of good to excellent clinical results. Although stress shielding, thigh pain, and difficulty of removal have been cited as problems with the use of these devices, in the current authors' experience they have not proved to be clinically relevant issues that limit the successfulness of total hip arthroplasty in this patient population.