13-Jahres-Ergebnisse der CLS-Spreizpfanne in der primären Hüftendoprothetik

Kendoff, Daniel; Strobel, Catrin; Krettek, Christian; Gerich, T.

doi:10.1007/s00113-006-1076-7

Cited by 4 publications

(5 citation statements)

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“…By eliminating impaction forces, Radial implantation might offer a more gentle insertion method and thereby reduce the risk of intraoperative damage to tissues in frail patients, and of component mal‐positioning . Radially expandable cups have already shown some clinical success . Radial implantation would require new designs, as well as patient‐specific pre‐operative planning.…”

Section: Discussionmentioning

confidence: 99%

“…26 Radially expandable cups have already shown some clinical success. 29,30,31 Radial implantation would require new designs, as well as patient-specific pre-operative planning.…”

Section: Position-defined Implantationmentioning

confidence: 99%

“…Furthermore, cup orientation has been shown to be more variable for uncemented impaction than for cemented implantation (without impaction), suggesting that impaction could be related to mal‐positioning of implants . Radially expanding implants eliminate the necessity of impaction forces and have been used with some success to anchor acetabular shells . Such implants tend to employ sharp, macro‐scale, surface features that interdigitate with the bony bed, once the implant has been positioned and radially expanded.…”

mentioning

confidence: 99%

“…[26][27][28] Radially expanding implants eliminate the necessity of impaction forces and have been used with some success to anchor acetabular shells. [29][30][31] Such implants tend to employ sharp, macro-scale, surface features that interdigitate with the bony bed, once the implant has been positioned and radially expanded. The use of radial expansion with standard micro-scale porous coatings might provide adequate stability in a design in which less radial expansion is necessary than that for a macroscale feature.…”

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confidence: 99%

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Influence of trabecular bone quality and implantation direction on press‐fit mechanics

Damm

Morlock

Bishop

2016

Journal Orthopaedic Research

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Achieving primary stability of uncemented press-fit prostheses in patients with poor quality bone can involve axial implantation forces large enough to cause bone fracture. Radial implantation eliminates intraoperative impaction forces and could prevent this damage. Platens of two commercial implant surfaces ("Beaded" and "Flaked") were implanted onto trabecular bone specimens of varying quality in a press-fit simulator. Samples were implanted with varying interference, either axially (shear) or radially (normal). Push-in and pull-out forces were measured to assess stability. Microstructural changes in the bone were determined from μCT analysis. For force-defined implantation analysis, push-in and pull-out forces both increased proportionally with increasing radial force, independent of implantation direction, bone quality or implant surface. For position-defined implantation analysis, pull-out forces were generally found to increase with interference and to be greater for radial than axial implantation direction, and to be lower for poor quality bone. Bone density increased locally at the tested interface due to implantation, in particular for the Beaded surface under axial implantation. If a safe radial stress can be determined for cortical bone in a particular patient, the associated implantation force, and pull-out force which represents primary stability, can be directly derived, regardless of implantation direction, bone quality or implant surface. Radial implantation delivers primary stability that is no worse than that for axial implantation and may eliminate potentially damaging impaction forces. Development of implant designs based on this principal might improve implant fixation. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:224-233, 2017.

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Section: Discussionmentioning

confidence: 99%

“…26 Radially expandable cups have already shown some clinical success. 29,30,31 Radial implantation would require new designs, as well as patient-specific pre-operative planning.…”

Section: Position-defined Implantationmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Influence of trabecular bone quality and implantation direction on press‐fit mechanics

Damm

Morlock

Bishop

2016

Journal Orthopaedic Research

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“…Výhodný přenos sil u CLS jamky umožňuje docílit dobré výsledky jak u primárních, tak i u revizních náhrad kyčle (2,14,16,18,19,23,28). CLS jamka Spotorno se nám osvědčuje podobně jako jiné necementované jamky u postdysplastické koxartrózy (10,25).…”

Section: Diskuseunclassified

Long-Term Results of the CLS Acetabular Cup in Primary Total Hip Replacement

Rozkydal¹,

Janíček²,

Tomás³

et al. 2009

Acta Chir. orthop. Traum. Cech.

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PURPOSE OF THE STUDYTo evaluate the results of primary total hip replacement with the CLS acetabular cup at a minimum of 15 years of follow-up. MATERIAL AND METHODSA total of 105 patients, with 112 hips, undergoing hip arthroplasty with the use of CLS acetabular cup between 1991 and 1993 were evaluated. The group comprised of 33 men and 72 women with an average age of 51.3 years (range, 28 to 66) at the time of surgery. All patients received the CLS expansion cup with a polyethylene Sulen-type liner. Cemented femoral stems were used in 75 hips and uncemented CLS stems were implanted in 37 hips. Ceramic heads of the femoral component were used in 86 hips and metal heads were used in 26 hips. The clinical outcome was assessed by the Merle d'Aubigné and Postel score and the Harris hip score, and the radiological results were evaluated on anterior posterior X-ray films of the pelvis and the affected hip. RESULTSThe average follow-up was 16.2 years (range, 15 to 17). The average Merle d'Aubigné and Postel score increased from 8.1 (range, 5.7 to 9.8) pre-operatively to 14.6 (range, 14.1 to 16.8) post-operatively. The average Harris hip score improved from 42 to 86 points (range, 71 to 99). The complications requiring revision arthroplasty included aseptic loosening in two hips, fracture of the CLS shell in three, dislocation in three and replacement of the liner due to high wear in two hips. The cumulative proportion of clinical survivorship with revision for any reason was 92 %. Fixation by bone ingrowth, assessed by the method of Engh et al. occurred in 98 cases, fibrous tissue fixation was found in ten hips. Unstable fixation was recorded in four hips (two with aseptic loosening and two with fracture of the shell). There were no signs of rarefaction of bone along acetabular shell in 98 hips. No noticeable migration was found in the stable cups. Only in ten cups from 112, polyethylene wear exceeded 4 mm. Cumulative probability of radiological survivorship of the CLS acetabular cup with any radiological sign of loosening was 86.6 %. DISCUSSIONThe causes of fracture of the CLS cup can be explained by insufficient bone support or bone resorption in the proximallateral part of the acetabulum in patients with developmental hip dysplasia, by low bone quality due to severe osteoporosis or by insufficient primary stability of the cup. The advantages of the CLS cup include removal of a small amout of bone and favourable force distribution in circumferential anchorage. The cup showed good osteointegration even in a bone of lower quality and with defects of the acetabular bottom. CONCLUSIONSThe CLS acetabular cup shows good results at 16-year follow-up period. No increase in fractures of the shell, migration or radiolucent lines, or in bone rarefaction or osteolysis was recorded with time. The reliability of this implant has been recently increased with the use of cross-linked polyethylene (Durasul).

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Estimated survival probability of the Spotorno total hip arthroplasty after a 15- to 21-year follow-up: one surgeon's results

Terré

2010

HIP International

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We retrospectively assess 171 consecutive total hip arthroplasties (THAs) with a Spotorno CLS uncemented prosthesis implanted through a Hardinge approach. The mean follow-up was 17.9 years. All consecutive operations were performed by 1 surgeon. Eight patients had been lost to follow-up, and 77 had died for unrelated causes. Overall, 4 stems and 19 cups underwent revision. The cumulative survival rate at 21 years was 79.02% (95% confidence interval [95% CI], 45.98–100.00%) for the acetabular component and 96.71% (95% CI, 60.71–100.00%) for the stem. We can conclude that failure of the Spotorno CLS THA is mainly due to its acetabular component (relative risk 4.5). Survival results for the Spotorno CLS stem exceed the patients' life expectancies in the 60- to 70-year-old population in our area. Loosening with or without fatigue fracture of the component and the learning curve for proper implantation have been the main causes for the expansion cup failure.

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13-Jahres-Ergebnisse der CLS-Spreizpfanne in der primären Hüftendoprothetik

Abstract: The CLS expansion cup provides excellent clinical results after 13 years in hybrid total hip arthroplasty. Time-correlative polyethylene wear and the extremely high rate of stem loosening have no consequences for the cup stability in our patient group. Acetabular osteolysis is rare.

Cited by 4 publications

References 24 publications

Influence of trabecular bone quality and implantation direction on press‐fit mechanics

Influence of trabecular bone quality and implantation direction on press‐fit mechanics

Long-Term Results of the CLS Acetabular Cup in Primary Total Hip Replacement

Estimated survival probability of the Spotorno total hip arthroplasty after a 15- to 21-year follow-up: one surgeon's results

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