Poor intermediate-term survival of the uncemented Optan anatomically adapted femoral component

PURPOSE We evaluated the 5-year survival of the uncemented Optan anatomically adapted femoral stem, with revision for aseptic loosening as the endpoint. METHODS Between January 2004 and March 2007, 432 total hip arthroplasties (THAs) were performed in 432 patients. After follow-up for a mean time of 5 years, the patients were evaluated using the WOMAC questionnaire and plain radiography. Patients who were unable to attend the follow-up visit were contacted by telephone to determine whether they had had any revision surgery of their THA. RESULTS Within 5 years, 39 patients (9%) had died of unrelated causes and 63 patients (15%) had been lost to follow-up. Of the remaining cohort, 224 patients (68%) had full follow-up while 88 patients (27%) were evaluated with WOMAC only and 18 patients (5%) were evaluated with radiography only. The mean WOMAC score of all evaluated patients was 21 (10-100). At 5-year follow-up, there were 26 stem revisions reported (6%), 14 hips (3%) showed aseptic loosening, and 12 hips (3%) had had a periprosthetic femoral fracture. The 5-year survival to revision for any reason was 94%. Worst-case analysis yielded a 5-year survival of 79%. INTERPRETATION The 5-year survival for aseptic loosening of the Optan anatomically adapted femoral component was disappointing. Radiographic evaluation showed evidence of proximal radiolucencies and distal cortical bone hypertrophy, which we attribute to insufficient proximal bone in-growth and increased load transfer at the tip of the stem. We do not recommend the use of the Optan femoral stem.