Which one is better for Hip Replacement? - LCU (cementless) or Corail

Hello @tonycn, Welcome to Connect. It is good to do some research before undergoing any kind of surgery. You will notice we changed the title of your discussion a little to hopefully bring more members into the discussion who may have experience or information to share. @sueinmn @contentandwell and others may have some thoughts on which type of hardware may be better for a hip replacement.

Here is some information that I found on the topic that may be helpful.

"Which is better cemented or uncemented hip replacement? -- Modern fixation techniques and implants using cement have resulted in better outcome than older cemented and historical uncemented series. However, uncemented devices over the past 30 years have shown improved stability equal, in many cases, to cemented fixation." -- (2017) The Relative Merits of Cemented and Uncemented Prostheses in Total Hip Arthroplasty: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5525518/

-- Comparison of periprosthetic bone remodeling after implantation of anatomic and tapered cementless femoral stems in total hip arthroplasty: A prospective cohort study protocol: https://www.researchgate.net/figure/LCU-cementless-tapered-femoral-stem-LCU-Hip-system-Waldemar-Link-Hamburg-Germany_fig2_327958211
-- Differences in subsidence rate between alternative designs of a commonly used uncemented femoral stem: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4939397/
-- The Actis and Corail Femoral Stems Provide for Similar Clinical and Radiographic Outcomes in Total Hip Arthroplasty: https://pubmed.ncbi.nlm.nih.gov/33380975/

Are you leaning toward one or the other of choices?

Good morning @tonycn, John has provided you with some great reading to help you make your decision.

First, I would like to address your question of choosing a doctor, and it has only a little to do with the prosthetic used.
My usual approach, which I ignored on my very first replacement, resulted in allowing the surgeon to use an implant that had already been banned in the UK and EU...followed 5 years later by numerous health issues, loosening prosthesis, and 3 revision surgeries.

At 53, and thinking I had bursitis and would be getting an injection, I was totally unprepared to hear "You have the hips of an 85 year old. They both need to be replaced." In shock, I did not ask enough questions, I did not do enough research, I did not check his post-op infection rate, I did not ask about post-op physical therapy, I did not listen to the little voice in my head that said he was arrogant and wouldn't listen to his patients. Surgery went well, but the hip was neve as stable as I expected. After two years, I had a lot of muscle pain along the side of the leg, and the doctor actually tried to convince me it was either "normal" or "imagined" - when in reality, he knew the hips were recalled, and he should be recommending replacement.

When I required revision due to breakdown of the implant used, I switched! To a doctor who explained everything, took a cautious approach, was open about why he was using the approach and materials he chose, answered all our questions patiently, and adamant that PT was mandatory for the best outcome. Ten years later, I have no problems with my "new new" hips, great mobility, and an on-going relationship with the orthopedist for other joint issues.

As for cement vs cementless, I was never a candidate due to family history of osteoporosis and degenerative arthritis, and a small bone structure making precise positioning crucial. Here is a comparison showing the loss in bone density with cementless implants at least 11 years after surgery. https://www.nature.com/articles/s41598-020-67189-x The takeaway - some cementless implants are better than others, and bone loss is less in men than women.

So, I guess that part of the decision is up to you, but it appears that there is no clear advantage of cementless prosthetics in the long term.

Here is a highly technical post-op comparison of the two implants you asked about: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7006600/

I hope you are not overwhelmed by all of this. My bottom line - do your research, choose the best doc you can and follow their advice.
Good luck, and come back if you have more questions.
Sue

Hi, @tonycn
Welcome to Connect. Unfortunately I know nothing about hip replacements, I have only had knee replacements. I don't even know if knee replacements can be cementless.

I do agree wholeheartedly with @sueinmn though. Do your research about the doctor. If the doctor is excellent and highly regarded I think you can pretty much rely on his judgment. I was in so much pain when I had my first knee replacement that I didn't do much research, I was pretty uninformed about the whole thing. I chose a well-rated doctor and that knee does not give me problems but it's never been as good as the second knee I had replaced by a fabulous doctor. I also discovered that the first doctor was using the same knee that he had been using for 30 years. I have to think that in 30 years there had been improvements. As I said though, I don't have any real problems, it just tends to hurt more quickly than my other knee when I do a lot of exercise, and it doesn't flex quite as well.

With knee replacements there are many different brands, some leave people happier than others. I presume there is similar information available for hip replacements.

Good luck with your research and proceeding forward. I hope you have an excellent experience, most people I know with hip replacements have been very happy with them and had great recoveries so I hope the same for you. Stick with your post-surgery physical therapy and I'm sure your outcome will be great.
JK

Thank you,John.These information is very helpful.Actually I have noticed Zimmer and Depuy are much more used than Link.The study about LCU mainly based in Asia,and LCU may likely lead to thigh pain.

Hi, Sue.Thank you very much for sharing your experience.Im 34 years old, it must more than once THR in my life, so cementless maybe better for me.
Wish u all the best.

Thank you,JK. Glad to hear that u have good recovery now.my doctor is excellent and highly regarded here,but unfortunately the hopital only have product of Link.If I insist on using others(Depuy or ZIMMER), I must choose other hospital and also other doctor.
Wish u all the best.

@tonycn. I think all doctors only do a couple of different brands of replacements so that’s not unusual. When you think of it, that allows the doctor to be very familiar with that hip or knee so he or she can do a better job. Working with too many would make it more difficult to be the best with each type.
The doctor who did my second knee gave me two options to choose from. I choose a custom made knee, Conformis, because I had heard excellent things about it, plus he was one of the developers of it so of course he would the knee to be a success. The other knee he offered was Depuy.
JK

Hi, i’m due to hip replacement soon, and i have done all my research about the different approaches and implants, and seen couple of doctors and both suggested ceramic on ceramic, one doctor suggested depuy summit uncemented and the other one suggested depuy corail uncemented,
My question is does anyone know which one is better for a 34yo female? Which one has better success rate with no squeaking sound or risk of fracture?

Thank you

@sarah90s Hello, and welcome to Mayo Connect. You are very young to be facing a total hip replacement, so the recommendations you will receive are very different than a "typical" 60-70 year old person.
My hip replacement journey began in my 50's, and I am on my second set which are ceramic to polymer.
I too am a researcher, and as far as I can tell, follow-up studies show there is a 2-5% chance of squeaking, no matter the implant...
There are no hip implants that have no risk of fracture or dislocation (with the latter being more common.) Your weight and how you treat your implant are most important once you have healed. Failures and premature wear are most common in people with high BMI and in those who try to believe the implant is a durable as the original.
Here is what makes the most difference - the very best surgeon you can find, one who does many hips a year, in a surgical center that likewise does many hips and has the latest and best tools for positioning the implant with accuracy. During my first implant, it turned out I needed a pediatric part due to my small size. In another location, this may have led the surgeon to "force" the wrong piece to work, but this was a large metro hospital with a Peds OR as well, so it only took a short delay to find what was needed. Also, a low infection rate - post-surgical infection is your worst enemy!

As for the difference between implants - there are 3 pieces - the femoral stem which is fitted into the femur, the head, and the acetabular cup. The 2 surgeons are recommending different femoral stems, one of which (Corail) is designed specifically for the anterior surgical approach. Do you know which head and cup is recommended?
Sue

Hi Sue
Thank you for your response and information.
I have spoken to two surgeons and one of them suggested CoC uncemented depuy corail and pinnacle with direct superior approach.

The other surgeon suggested CoC uncemented depuy summit and pinnacle with posterior approach.

And both are supposed to be minimal invasive.

I’m contemplating which one would be best for me? As i dont want to have surgery every now and then, and also if i shall actually go with ceramic on ceramic or ceramic on poly because of the risk of ceramic fracture.

I look forward to your advice.