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Online ISSN 1827-1707
Comba F. 1, González Della Valle A. 2,3, Salvati E. A. 4
1 Institute of Orthopaedics Carlos E. Ottolenghi Hospital Italiano de Buenos Aires Buenos Aires, Argentina
2 Hospital for Special Surgery, New York, NY, USA
3 Unit of Orthopaedic Surgery, Weill Medical College of Cornell University, New York, NY, USA
4 Hip and Knee Service Hospital for Special Surgery, New York, NY, USA
In modern cemented total hip arthroplasty, surgeons implant femoral stems with a wide variety of surface finish and textures which are supported by contrasting philosophies of fixation. Laboratory data indicate that the ability of bone cement to adhere to the implant surface is particularly dependent on the surface finish of the implant. Stems with a rough surface finish require greater force to disrupt their interface with cement than do stems with a smooth or polished surface. However, when micromotion occurs at the cement-metal interface, the fretting of a smoother surface implant results in less cement and metallic abrasion, than that observed with an implant with a rougher surface. This review presents the history and rationale for changes in surface finish, the micro and macro surface finish mechanics, the clinical and operative implications of surface finish, the retrieval studies, and most importantly, the clinical evidence that examine the consequences of changes in surface finish in the survivorship of cemented femoral stems for total hip arthroplasty. Current data and our own experience support the use of cemented femoral stems with a smooth or polished surface finish.