Tapered Titanium Porous Plasma-Sprayed Femoral
Component in Patients Aged 40 Years and Younger
Brad Ellison, MD,* Keith R. Berend, MD,*yz Adolph V. Lombardi Jr, MD, FACS,*yz
and Thomas H. Mallory, MD, FACS*yz
Abstract: Total hip arthroplasty (THA) in patients aged 40 years and younger
requires decades of increased activity demands. Between 1987 and 2000, 249
primary THAs in patients 40 years of age or younger were performed with the
Mallory-Head component. The average age at THA was 34.7 years (range,
20-40 years). Follow-up averaged 91 months with 125 hips having minimum
5-year follow-up and 51 THAs having a minimum of 10 years. Four stems failed the
98.2% overall survivorship. Two stems were revised for loosening for a 99.2% (95%
confidence interval, 96.4%-99.8%) survivorship with aseptic loosening as the end-
point at 18 years. In young patients, this tapered titanium, proximally porous
plasma-sprayed femoral component provides outstanding long-term fixation and
function with significant pain relief into the second decade. Overall stem
survivorship is 98.2% at up to 18 years. Key words: hip arthroplasty, total hip
arthroplasty, young age, avascular necrosis.
n 2006 Published by Elsevier Inc.
Young patients with end-stage hip arthrosis present
a unique challenge to orthopedic surgeons. The
etiology of the patient’s hip disease could be any
source of a broad range of pathology, including
avascular necrosis (AVN), developmental dysplasia,
slipped capital femoral epiphysis, late sequelae of
Legg-Calve-Perthes (LCP) disease, posttraumatic,
infection, inflammatory, or noninflammatory ar-
thritis. Frequently, femoral osteotomy, arthodesis,
or surface arthroplasty are not viable options or
have proven unsuccessful and require revision.
Total hip arthroplasty (THA) can be an acceptable
alternative or salvage procedure in these young
patients. However, the success of THA experienced
with older patients is not equally observed in the
younger population [1-11]. The heightened activ-
ity, lengthened life span, and unique pathophysi-
ology of coxarthrosis in young patients subject THA
to increased demands and may require multiple
revisions in the patient’s lifetime .
Strategies aimed at optimizing cementless fixa-
tion have yielded porous-coated femoral compo-
nents with tapered femoral stem designs. Proximal
circumferential porous-coated femoral compo-
nents have demonstrated early and long-term
stability, as well as effectively sealing off the
effective joint space from wear debris associated
with osteolysis [8,12]. The Mallory-Head prosthe-
sis is a titanium tapered porous plasma-sprayed
femoral stem with a proven clinical record .In
this study, we retrospectively reviewed the clinical
results of a cementless, tapered, titanium femoral
component inserted during THA in patients aged
40 years or younger.
The Journal of Arthroplasty Vol. 21 No. 6 Suppl. 2 2006
From the *The Department of Orthopaedics, The Ohio State
University Medical Center, Columbus, Ohio;
Joint Implant Surgeons,
Inc., New Albany, Ohio; and
The New Albany Surgical Hospital,
New Albany, Ohio.
Submitted January 5, 2006; accepted March 21, 2006.
Benefits or funds were received in partial or total support of
the research material described in this article from Biomet Inc,
Reprint requests: Keith R. Berend, MD, Joint Implant
Surgeons, Inc., 7277 Smith’s Mill Rd, Suite 200, New Albany,
n 2006 Published by Elsevier Inc.