Long-term results of the metal-cancellous cementless Lübeck total hip arthroplasty: a critical review at 12.8 years

Götze, Christian; Tschugunow, A.; Götze, H. G.; Böttner, Friedrich; Pötzl, Wolfgang; Gosheger, Georg

doi:10.1007/s00402-005-0064-7

Cited by 22 publications

(12 citation statements)

References 29 publications

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“…[7][8][9][10] The fatigue resistance and toughness could minimize the risk of implant fracture. [11][12][13] The metal-free nature of CFR/PEEK prostheses eliminate metal allergy concerns 14 and problems passing through security gates with metal detectors. 15 Furthermore, CT and MRI of areas around the implants can be achieved without artifacts.…”

mentioning

confidence: 99%

Interfacial shear strength of bioactive‐coated carbon fiber reinforced polyetheretherketone after in vivo implantation

Nakahara

Takao

Goto

et al. 2012

Journal Orthopaedic Research

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Despite the excellent osseointegration of carbon-fiber-reinforced polyetheretherketone (CFR/PEEK) with a surface hydroxyapatite (HA) coating, the bone-implant interfacial shear strength of HA-coated CFR/PEEK after osseointegration is unclear. We examined the interfacial shear strength of HA-coated CFR/PEEK implants after in vivo implantation in a rabbit femur-implant pullout test model. HA coating was performed by a newly developed method. Uncoated CFR/PEEK, HA-coated blasted titanium alloy, and uncoated blasted titanium alloy were used as control implants. The implants were inserted into drilled femoral cortex, and pull-out tests were conducted after 6 and 12 weeks of implantation to determine maximum interfacial shear strength. The HA-coated CFR/ PEEK (15.7 AE 4.5 MPa) and HA-coated titanium alloy (14.1 AE 6.0 MPa) exhibited significantly larger interfacial shear strengths than the uncoated CFR/PEEK (7.7 AE 1.8 MPa) and the uncoated titanium alloy (7.8 AE 2.1 MPa) at 6 weeks. At 12 weeks, only the uncoated CFR/PEEK (8.3 AE 3.0 MPa) exhibited a significantly smaller interfacial shear strength, as compared to the HA-coated CFR/PEEK (17.4 AE 3.6 MPa), HA-coated titanium alloy (14.2 AE 4.8 MPa), and uncoated titanium alloy (15.0 AE 2.6 MPa). Surface analysis of the removed implants revealed detachment of the HA layer in both the HA-coated CFR/PEEK and titanium alloy implants Keywords: carbon-fiber-reinforced PEEK; interfacial shear strength; hydroxyapatite; coating adhesion; osseointegration Carbon-fiber-reinforced polyetheretherketone (CFR/ PEEK) is attractive for use in orthopedic implants, 1-4 due to high fatigue strength, high chemical stability, no metal ion release, and excellent biocompatibility with direct cell attachment. 5,6 Moreover, mechanical properties, including strength, toughness, and stiffness, can be easily modified by the arrangement of reinforcing fiber volume and orientation. In cementless hip prostheses, tailoring stiffness can minimize bone resorption of the proximal femur due to stress shielding by designing CFR/PEEK stems with elasticity similar to surrounding cortical bone. 7-10 The fatigue resistance and toughness could minimize the risk of implant fracture. 11-13 The metal-free nature of CFR/PEEK prostheses eliminate metal allergy concerns 14 and problems passing through security gates with metal detectors. 15 Furthermore, CT and MRI of areas around the implants can be achieved without artifacts. 16 Despite these theoretical advantages, CFR/PEEK cementless hip prostheses are not yet practical for clinical applications. In vivo wear resistance and subsequent immunoreaction have not been established when used as a bearing surface. Another issue is implant fixation. Achieving a stable bone-implant interface by osseointegration has been a longstanding problem with carbon-fiber-reinforced polymer materials, including CFR/PEEK. 17,18 To date, studies have focused on wear reduction 4,19 or secure implant fixation 20-27 to develop cementless CFR/PEEK prostheses.Given that CFR/PEEK is...

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confidence: 99%

Interfacial shear strength of bioactive‐coated carbon fiber reinforced polyetheretherketone after in vivo implantation

Nakahara

Takao

Goto

et al. 2012

Journal Orthopaedic Research

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“…In our series, there were five patients with greater trochanter resorption (Gruen zone 1). A previous study of over 10 years followup of normal total hip arthroplasty has shown that the resorption of the proximal femur was always observed in the Gruen zones 1 and 7 2425. Lee et al 19.…”

Section: Discussionmentioning

confidence: 95%

Uncemented allograft-prosthetic composite reconstruction of the proximal femur

Peng

Duan

et al. 2014

IJOO

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Background:Allograft–prosthetic composite can be divided into three groups names cemented, uncemented, and partially cemented. Previous studies have mainly reported outcomes in cemented and partially cemented allograft–prosthetic composites, but have rarely focused on the uncemented allograft–prosthetic composites. The objectives of our study were to describe a surgical technique for using proximal femoral uncemented allograft–prosthetic composite and to present the radiographic and clinical results.Materials and Methods:Twelve patients who underwent uncemented allograft–prosthetic composite reconstruction of the proximal femur after bone tumor resection were retrospectively evaluated at an average followup of 24.0 months. Clinical records and radiographs were evaluated.Results:In our series, union occurred in all the patients (100%; range 5-9 months). Until the most recent followup, there were no cases with infection, nonunion of the greater trochanter, junctional bone resorption, dislocation, allergic reaction, wear of acetabulum socket, recurrence, and metastasis. But there were three periprosthetic fractures which were fixed using cerclage wire during surgery. Five cases had bone resorption in and around the greater trochanter. The average Musculoskeletal Tumor Society (MSTS) score and Harris hip score (HHS) were 26.2 points (range 24-29 points) and 80.6 points (range 66.2-92.7 points), respectively.Conclusions:These results showed that uncemented allograft–prosthetic composite could promote bone union through compression at the host–allograft junction and is a good choice for proximal femoral resection. Although this technology has its own merits, long term outcomes are yet not validated.

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“…Achieving rigid fixation at the distal part of traditional metal stems causes concerns for proximal bone resorption caused by stress shielding12 or stem fracture due to stress concentration 13, 14. Previous finite element and in vitro studies indicated that reduction of bone resorption was expected using isoelastic CFR/PEEK stems,10, 36 but evaluation of bone resorption after in vivo implantation is necessary.…”

Section: Discussionmentioning

confidence: 99%

“…As CFR/PEEK can be designed with an elastic modulus similar to the surrounding cortical bone, bone resorption of the proximal femur caused by stress shielding can be potentially minimized in hip arthroplasty 9–12. The high fatigue resistance and toughness of CFR/PEEK could minimize the risk of implant fracture 13–15. Moreover, CFR/PEEK prostheses cause no artifacts on computed tomography (CT) or MR imaging, potentially allowing more lucid interpretation of the periprosthetic interface 16.…”

mentioning

confidence: 99%

In vivo implant fixation of carbon fiber‐reinforced PEEK hip prostheses in an ovine model

Nakahara

Takao

Bandoh³

et al. 2012

Journal Orthopaedic Research

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Carbon fiber-reinforced polyetheretherketone (CFR/PEEK) is theoretically suitable as a material for use in hip prostheses, offering excellent biocompatibility, mechanical properties, and the absence of metal ions. To evaluate in vivo fixation methods of CFR/ PEEK hip prostheses in bone, we examined radiographic and histological results for cementless or cemented CFR/PEEK hip prostheses in an ovine model with implantation up to 52 weeks. CFR/PEEK cups and stems with rough-textured surfaces plus hydroxyapatite (HA) coatings for cementless fixation and CFR/PEEK cups and stems without HA coating for cement fixation were manufactured based on ovine computed tomography (CT) data. Unilateral total hip arthroplasty was performed using cementless or cemented CFR/PEEK hip prostheses. Five cementless cups and stems and six cemented cups and stems were evaluated. On the femoral side, all cementless stems demonstrated bony ongrowth fixation and all cemented stems demonstrated stable fixation without any gaps at both the bonecement and cement-stem interfaces. All cementless cases and four of the six cemented cases showed minimal stress shielding. On the acetabular side, two of the five cementless cups demonstrated bony ongrowth fixation. Our results suggest that both cementless and cemented CFR/PEEK stems work well for fixation. Cup fixation may be difficult for both cementless and cemented types in this ovine model, but bone ongrowth fixation on the cup was first seen in two cementless cases. Cementless fixation can be achieved using HA-coated CFR/PEEK implants, even under load-bearing conditions.

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Long-term results of the metal-cancellous cementless Lübeck total hip arthroplasty: a critical review at 12.8 years

Cited by 22 publications

References 29 publications

Interfacial shear strength of bioactive‐coated carbon fiber reinforced polyetheretherketone after in vivo implantation

Interfacial shear strength of bioactive‐coated carbon fiber reinforced polyetheretherketone after in vivo implantation

Uncemented allograft-prosthetic composite reconstruction of the proximal femur

In vivo implant fixation of carbon fiber‐reinforced PEEK hip prostheses in an ovine model

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