The Uncemented Bi-Contact Total Hip Arthroplasty
Nitin P. Badhe, MS Orth, Richard C. Quinnell, FRCS, and Peter W. Howard, FRCS
Abstract: We reviewed a consecutive series of 153 uncemented Bi-Contact (Aes-
culap, Tuttlingen, Germany) total hip arthroplasties (THAs) in 138 patients who had
been followed for at least 5years (mean, 6.8 years; range, 5–9 years). The Bi-contact
uncemented THA consists of a straight femoral stem made of titanium alloy. The
proximal portion of the stem is titanium plasma-sprayed. The cup is press-fit with or
without hydroxyapatite coating with a facility for anchoring screws with a snap-fit
polyethylene liner. The mean age of the patients was 70.8 years (range, 41–94 years).
The mean preoperative Harris hip score of 41 (range, 20– 80) improved postopera-
tively to a mean of 92 (range, 56 –96). Three acetabular cups were revised for aseptic
loosening, and 1 cup was revised for recurrent dislocation. To date, none of the stems
have been revised for aseptic loosening. Radiographic evaluation of the remaining
149 hips revealed that the acetabular cup was stable in 146 hips and possibly unstable
in the remaining 3 cases with nonprogressive osteolysis behind the cup. None of the
stems showed any evidence of instability. Using the recommendation of revision as
the endpoint, the cumulative survival for the prosthesis was 97.3% at a mean
follow-up of 6.8 years (95% confidence interval, 95.9 –99.4) , with stem survival of
100%. In the medium-term, these results are comparable to cemented primary THA
and justify the continued use of this prosthesis. Key words: uncemented, total hip
arthroplasty (THA), aseptic loosening.
Copyright 2002, Elsevier Science (USA). All rights reserved.
Uncemented total hip arthroplasty (THA) was de-
veloped with the aim of achieving biologic fixation
of the prosthesis through integration of the cement-
less hip components into prepared bone, increasing
the longevity of the implant [1]. The principle of
uncemented THA is based on the primary goal to
prevent movement at the implant– bone interface.
Cementless stems require not only a high degree of
initial stability, but also proximal stress transfer and
permanent bonding of the implant to the bone.
Initial mechanical stability is a function of the ge-
ometry of the implant, its stress-transferring struc-
tures, and intimacy of the fit achieved between the
implant and the surgically prepared femoral canal.
Biologic stability is provided by ingrowth of cancel-
lous bone and depends on the surface texture and
the transmission of loads from the implant to the
bone. Although preliminary experience with bio-
logic fixation was encouraging, the results have
deteriorated with time [2– 4]. There is now an in-
creased awareness of osteolysis induced by wear
particles. We report the medium-term results of a
retrospective review of 138 patients (153 hips)
treated with the uncemented Bi-Contact (Aesculap,
Tuttlingen, Germany) THA.
Material and Methods
From September 1991 to November 1995, we
used the uncemented Bi-Contact THA in a consec-
utive series of 138 patients with 153 hips (15 bilat-
From the Derbyshire Royal Infirmary, Derby, United Kingdom.
Submitted January 28, 2001; accepted April 30, 2002.
No benefits or funds were received in support of this study.
Reprint requests: Nitin P. Badhe, MS Orth, c/o Richard C.
Quinnell, FRCS, Derbyshire Royal Infirmary, London Road,
Derby DE1 2QY UK. E-mail: nitinbadhe@hotmail.com
Copyright 2002, Elsevier Science (USA). All rights reserved.
0883-5403/02/1707-0001$35.00/0
doi:10.1054/arth.2002.34523
The Journal of Arthroplasty Vol. 17 No. 7 2002
896