Before the advent of cement and the enthusiasm it generated, all implants were uncemented like the Moore’s prosthesis
All prostheses were then cemented and even compulsory in the US in 1972

The cementedstem adventure, begins withthe Charnley stem in 1962, but a series of differents stems followed, in the late’60s and early’ 70s.
About 10 yearslater, many cases of prosthesis loosening appeared.
Radiographically and intraoperatively, it was found that often the cement was broken and there was osteolysis, more or less extensive around the stem.
An interposition membrane was the macroscopic witness of this loosening.
At the time, the cement was considered as the main cause.
It was also at this time, that the primary anchorage was developed by Maurice E. Müller in Switzerland in 1977, and named « The Self Locking »
His concept was a fundamental basis  which influences designs of hip cementlessstem until today.

Following the failure of cemented stems, came the idea of stems without cement in the early 70s.

Between 1970 and 1980 different proposals for cement less femoral stem fixation were born: by Judet in France (1971); Lord in England(1974); Engh in the United States (1977); Zweimüller in Austria(1979)

At first the idea was to find the right coating for osteo-integration.

The coating Porometal of Judet or Madreporique of Lord allowed the integration of bone, but were quickly abandoned because they were no-removable

In the 1980s, type SL, Lord 2, and Bousquet stems, were relatively massive, to get, either a support or an anchor screwed into the cortical bone.

From ‘Porous-coated hip replacement’, C.A. ENGH, J.D. BOBYN, A.H. GLASSMAN JBJS Br, Vol69-B, N°1, January1987

But the major problem of all these uncemented stems were thigh pains due to micro-motion and distal fixation, inducing proximal stress shielding.

Most of the first designs were beaded blasted and HA free.

Stems were often long, thick and round as you can see on the X-rays.

AML, Depuy

PCA, Depuy

LSF, Implant Technology

From ‘A comparison of 3 varieties of  non cemented porous-coated hip replacement’, R.J. Haddad, S. D. COOK, M. R. BRINKER, JBJS Br, Vol 72-B, N°1, January1990

To avoid these problems, some of the appearing new designs integrated a partially coated proximal part,  but still literature reported a rate of about 30% of thigh pain for the AML and the PCA associated to distal migration for the collarless PCA

At the end of the Eighties, beginning nineties, some new designs proposed more anatomical stems with proximal coating only.

In our group we have some experience with these different stem designs.

Here you can see some retrievals revised only due to thigh pain.

I like to add that we have recognized this phenomena on anatomical as well as on straight stem designs.

One of my colleagues in Group Giles, reports 10 revisions on 400 cases only due to thigh pain.

The Corailstem comes in 1986

It is a fully coated straight stem.

In Group Giles we have implanted a very big number of this kind of stem, and revisions due to thigh pain, disappeared for all of us.

Anyhow, we met some problems, which were not linked to the stems anchorage.

So in the 2000s the cementless stem has evolved again

They have further improved the fixation, but especially tried to restore the offset of the hip, facilitate the mini-approach, the DDA and the implementation in narrow femoral diaphyses with thick cortical

It will be a synthesis:

From the fully coated straight stemof Corail

And the self locking stem of Muller

Chapitre suivant : Historique du développement et de la conception de la Polarstem