{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T01:33:40Z","timestamp":1787621620234,"version":"build-2736575974"},"reference-count":23,"publisher":"AVES YAYINCILIK A.\u015e.","issue":"1","license":[{"start":{"date-parts":[[2020,2,6]],"date-time":"2020-02-06T00:00:00Z","timestamp":1580947200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2018,11,29]],"date-time":"2018-11-29T00:00:00Z","timestamp":1543449600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["AOTT"],"abstract":"<jats:p>Abstract\n\nObjective\nThe aim of this study was to analyze the survivorship and clinical outcome of Cementless Spotorno (CLS) stem in young patients.\nMethods\nA total of 99 consecutive hip arthroplasties using CLS stem were performed on 84 patients younger than 50 years of age between 1993 and 2001. 63 patients were available for final follow-up (mean age: 39 \u00b1 7.8 (range: 22\u201350)). Patients' Harris Hip Scores (HHS) and survivorship estimates were calculated. Radiographs were analyzed for acetabular implant status, canal fill index (CFI), stem alignment, osteolysis, and stress shielding.\nResults\nMean follow-up time was 18 years (13\u20133), and mean HHS was 88.7 (58\u2013100). Patients with femoral neck fracture had a more favorable functional outcome (p = 0.027), while those with stems in varus had lower scores (p = 0.017). 31 stems (49%) were undersized and 30 hips (47%) had perifemoral osteolysis. Acetabular impairment was strongly associated with osteolysis in Gruen zones 1 and 7 (p &lt; 0.01). Seventeen of the osteolytic lesions occurred in Gruen zone 1, 4 lesions in zone 2, 9 in zone 6 and 22 in zone 7. Forty nine stems were well aligned, 10 were in varus and 5 in valgus. Six patients presented with grade 1 stress shielding, 42 with grade 2, 9 with grade 3 and 7 with grade 4. Pedestal formation was evident in 13 cases. Kaplan-Meier survivorship estimates at 18 years with revision for any reason as the end point and with septic revisions excluded were 91.2% (95% CI: 83.7%\u201398.7%) and 95.1% (95% CI: 89.5%\u2013100%), respectively. There was no difference between survival estimates of patients with different etiologies.\nConclusion\nCLS stems in young patients have high survival estimates in the long term with good-excellent results. Spotorno stems perform equally well in all etiologies with no difference in terms of survivorship.\n\n\nLevel of Evidence\nLevel IV Therapeutic study.\nER -<\/jats:p>","DOI":"10.1016\/j.aott.2018.11.004","type":"journal-article","created":{"date-parts":[[2018,12,21]],"date-time":"2018-12-21T14:24:14Z","timestamp":1545402254000},"page":"19-23","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":13,"title":["Long term survival analysis of cementless Spotorno femoral stem in young patients"],"prefix":"10.5152","volume":"53","author":[{"given":"Murat","family":"MERT","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cenk","family":"ERMUTLU","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emrah","family":"KOVALAK","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ethem","family":"\u00dcNKAR","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sibel","family":"\u00c7a\u011flar OKUR","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"3111","published-online":{"date-parts":[[2020,2,6]]},"reference":[{"issue":"9597","key":"10.1016\/j.aott.2018.11.004_bib1","doi-asserted-by":"crossref","first-page":"1508","DOI":"10.1016\/S0140-6736(07)60457-7","article-title":"The operation of the century: total hip replacement","volume":"370","author":"Learmonth","year":"2007","journal-title":"Lancet"},{"issue":"13","key":"10.1016\/j.aott.2018.11.004_bib2","doi-asserted-by":"crossref","first-page":"1249","DOI":"10.2106\/JBJS.I.01792","article-title":"Mid-term results of total hip arthroplasty with the CementLessSpotorno (CLS) system","volume":"93","author":"de Witte","year":"2011","journal-title":"J\u00a0Bone Joint Surg Am"},{"issue":"suppl 7","key":"10.1016\/j.aott.2018.11.004_bib3","doi-asserted-by":"crossref","first-page":"S70","DOI":"10.1177\/11207000100200s713","article-title":"Estimated survival probability of the Spotorno total hip arthroplasty after a 15- to 21-year follow-up: one surgeon's results","volume":"20","author":"Terr\u00e9","year":"2010","journal-title":"Hip Int"},{"issue":"4","key":"10.1016\/j.aott.2018.11.004_bib4","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1302\/0301-620X.96B4.32607","article-title":"Performance of the CLS Spotorno uncemented stem in the third decade after implantation","volume":"96-B","author":"Evola","year":"2014","journal-title":"Bone Joint J"},{"issue":"3","key":"10.1016\/j.aott.2018.11.004_bib5","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1080\/00016470308540837","article-title":"Cementless Spotorno tapered titanium stems: excellent 10-15-year survival in 141 young patients","volume":"74","author":"Aldinger","year":"2003","journal-title":"Acta Orthop Scand"},{"issue":"2","key":"10.1016\/j.aott.2018.11.004_bib6","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1007\/s00402-009-0969-7","article-title":"Seventeen-year survival of the cementless CLS Spotorno stem","volume":"130","author":"M\u00fcller","year":"2010","journal-title":"Arch Orthop Trauma Surg"},{"issue":"1 supple A","key":"10.1016\/j.aott.2018.11.004_bib7","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1302\/0301-620X.99B1.BJJ-2016-0269.R1","article-title":"Not all cementless femoral stems are created equal but the results may be comparable","volume":"99-B","author":"Carlson","year":"2017","journal-title":"Bone Joint J"},{"issue":"1","key":"10.1016\/j.aott.2018.11.004_bib8","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1007\/s00264-016-3226-z","article-title":"Thirteen year follow-up of a cementless femoral stem and a threaded acetabular cup in patients younger than fifty years of age","volume":"41","author":"Schmolders","year":"2017","journal-title":"Int Orthop"},{"issue":"6","key":"10.1016\/j.aott.2018.11.004_bib9","doi-asserted-by":"crossref","first-page":"1275","DOI":"10.1016\/j.arth.2015.12.026","article-title":"Total hip arthroplasty with an uncemented tapered femoral component in patients younger than 50 Years of age: a minimum 20-year follow-up study","volume":"31","author":"McLaughlin","year":"2016","journal-title":"J\u00a0Arthroplasty"},{"issue":"2","key":"10.1016\/j.aott.2018.11.004_bib10","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1302\/0301-620X.97B2.34926","article-title":"Survivorship of the cementless Spotorno femoral component in patients under 50 years of age at a mean follow-up of 18.4 years","volume":"97-B","author":"Biemond","year":"2015","journal-title":"Bone Joint J"},{"issue":"23","key":"10.1016\/j.aott.2018.11.004_bib11","doi-asserted-by":"crossref","first-page":"2153","DOI":"10.2106\/JBJS.L.00011","article-title":"Cementless total hip arthroplasty in patients fifty years of age or younger: a minimum ten-year follow-up","volume":"94","author":"Takenaga","year":"2012","journal-title":"J\u00a0Bone Joint Surg Am"},{"issue":"4","key":"10.1016\/j.aott.2018.11.004_bib12","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1302\/0301-620X.93B4.26149","article-title":"Comparison of total hip replacement with and without cement in patients younger than 50 years of age: the results at 18 years","volume":"93","author":"Kim","year":"2011","journal-title":"J\u00a0Bone Joint Surg Br"},{"issue":"6","key":"10.1016\/j.aott.2018.11.004_bib13","doi-asserted-by":"crossref","first-page":"1432","DOI":"10.2106\/JBJS.H.00297","article-title":"Uncemented grit-blasted straight tapered titanium stems in patients younger than fifty-five years of age. Fifteen to twenty-year results","volume":"91","author":"Aldinger","year":"2009","journal-title":"J\u00a0Bone Joint Surg Am"},{"issue":"7","key":"10.1016\/j.aott.2018.11.004_bib14","doi-asserted-by":"crossref","first-page":"1009","DOI":"10.2106\/00004623-199274070-00007","article-title":"A\u00a0quantitative evaluation of periprosthetic bone-remodeling after cementless total hip arthroplasty","volume":"74","author":"Engh","year":"1992","journal-title":"J\u00a0Bone Joint Surg Am"},{"issue":"141","key":"10.1016\/j.aott.2018.11.004_bib15","first-page":"17","article-title":"\u201cModes of failure\u201d of cemented stem-type femoral components: a radiographic analysis of loosening","author":"Gruen","year":"1979","journal-title":"Clin Orthop Relat Res"},{"key":"10.1016\/j.aott.2018.11.004_bib16","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1097\/00003086-199009000-00013","article-title":"Osteolysis in alloarthroplasty of the hip. The role of ultra-high molecular weight polyethylene wear particles","volume":"258","author":"Willert","year":"1990","journal-title":"Clin Orthop Relat Res"},{"issue":"3","key":"10.1016\/j.aott.2018.11.004_bib17","doi-asserted-by":"crossref","first-page":"432","DOI":"10.2106\/00004623-199503000-00013","article-title":"Patterns of osteolysis around total hip components inserted with and without cement","volume":"77","author":"Zicat","year":"1995","journal-title":"J\u00a0Bone Joint Surg Am"},{"issue":"2","key":"10.1016\/j.aott.2018.11.004_bib18","doi-asserted-by":"crossref","first-page":"161","DOI":"10.2106\/00004623-199072020-00002","article-title":"Clinical and radiographic evaluation of total hip replacement. A standard system of terminology for reporting results","volume":"72","author":"Johnston","year":"1990","journal-title":"J\u00a0Bone Joint Surg Am"},{"issue":"1","key":"10.1016\/j.aott.2018.11.004_bib19","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1302\/0301-620X.69B1.3818732","article-title":"Porous-coated hip replacement. The factors governing bone ingrowth, stress shielding, and clinical results","volume":"69","author":"Engh","year":"1987","journal-title":"J\u00a0Bone Joint Surg Br"},{"key":"10.1016\/j.aott.2018.11.004_bib20","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1097\/01.blo.0000150103.75134.10","article-title":"Variables affecting initial stability of impaction grafting for hip revision","volume":"432","author":"Gokhale","year":"2005","journal-title":"Clin Orthop Relat Res"},{"issue":"4","key":"10.1016\/j.aott.2018.11.004_bib21","doi-asserted-by":"crossref","first-page":"518","DOI":"10.2106\/00004623-199072040-00008","article-title":"Effect of femoral head size on wear of the polyethylene acetabular component","volume":"72","author":"Livermore","year":"1990","journal-title":"J\u00a0Bone Joint Surg Am"},{"issue":"2","key":"10.1016\/j.aott.2018.11.004_bib22","doi-asserted-by":"crossref","first-page":"171","DOI":"10.2106\/00004623-200202000-00002","article-title":"Twenty-five-year survivorship of two thousand consecutive primary Charnley total hip replacements: factors affecting survivorship of acetabular and femoral components","volume":"84-A","author":"Berry","year":"2002","journal-title":"J\u00a0Bone Joint Surg Am"},{"issue":"6","key":"10.1016\/j.aott.2018.11.004_bib23","doi-asserted-by":"crossref","first-page":"1129","DOI":"10.1007\/s00264-011-1399-z","article-title":"High survival in young patients using a second generation uncemented total hip replacement","volume":"36","author":"Streit","year":"2012","journal-title":"Int Orthop"}],"container-title":["Acta Orthopaedica et Traumatologica Turcica"],"original-title":[],"link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1017995X17306739?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1017995X17306739?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/aott.org.tr\/index.php\/pub\/article\/download\/3421\/3367","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2025,11,18]],"date-time":"2025-11-18T11:31:55Z","timestamp":1763465515000},"score":1,"resource":{"primary":{"URL":"https:\/\/aott.org.tr\/index.php\/pub\/article\/view\/3421"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,2,6]]},"references-count":23,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2019,1,1]]}},"URL":"https:\/\/doi.org\/10.1016\/j.aott.2018.11.004","relation":{},"ISSN":["2589-1294","1017-995X"],"issn-type":[{"value":"2589-1294","type":"electronic"},{"value":"1017-995X","type":"print"}],"subject":[],"published":{"date-parts":[[2020,2,6]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Long term survival analysis of cementless Spotorno femoral stem in young patients","name":"articletitle","label":"Article Title"},{"value":"Acta Orthopaedica et Traumatologica Turcica","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.aott.2018.11.004","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2018 Turkish Association of Orthopaedics and Traumatology. Publishing services by Elsevier B.V.","name":"copyright","label":"Copyright"}]}}