Effenberger H, Imhof M, Witzel U, Rehart S.
Optimal fixation of cementless stems is a precondition for long-lasting stability. Thus, anchorage, stabilizers, material and surface are of essential importance. To achieve primary stability, good rotational, tilting and axial stability is necessary. Stabilizers such as fins and ribs optimize stability. The CCD-angle and length of neck-axis determine the offset (laterality), leg-length and center of rotation. The stem, is responsible for the fixation of the prosthesis and for transmitting forces to the bone. The types of fixation are epiphyseal (the femoral head is covered by a cup prosthesis), metaphyseal and meta-diaphyseal (with straight or anatomically shaped monoblock-prostheses of different lengths, modular and custom-made prostheses) and diaphyseal (using predominantly modular systems). Titanium alloys are the predominate material for cementless stems. The surfaces are generally corundum-blasted or plasma sprayed. For metaphyseal and meta-diaphyseal stems, survival rates from 95 to 98% have been reached after 15 years. Diaphyseal-fixed stems have mid-term survival-rates of 92-99%.
Orthopade. 2005 May;34(5):477-502.