Noncemented Acetabular Fixation in Primary Total Hip Replacement

Morscher, E.

doi:10.1007/978-3-642-79306-6_11

Cited by 9 publications

(4 citation statements)

References 124 publications

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“…Její povrch vykazuje dobrou osteointegraci k vlastní kosti. Jamka zachovává biotrofiku periprotetické kosti a přispívá k pozitivní remodelaci kosti pod jamkou -vymizení cyst a sklerotické kosti, zmírnění osteoporózy a zlepšení kvality kosti (21). Využíváme ji proto jak u případů s menší kvalitou kosti, tak u případů s tenkou či defektní mediální stěnou acetabula nebo s kavitárními defekty.…”

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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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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“…Střednědobým a dlouhodobým výsledkům je však věnováno v naší literatuře minimum prací. Jak se v poslední době ukázalo, řada z těchto implantátů se ve velkém počtu uvolňuje v horizontu 6 a více let (7,8,11,20,22). Proto by bylo vhodné zaměřit se právě na tyto implantáty a častěji je kontrolovat.…”

Section: Diskuseunclassified

Mid-Term Results of Cementless Ultima Cups in Primary Total Hip Replacement

Hrubina¹,

Behounek²,

Skoták³

2008

Acta Chir. orthop. Traum. Cech.

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PURPOSE OF THE STUDYTo present the results of primary total hip arthroplasty (THA) with use of the hemispheric threaded Ultima cup at 8.5-year follow-up. MATERIALBetween 1996 and 1999, a total of 40 Ultima acetabular components were used in 33 patients (15 men and 18 women). The average age at the time of surgery was 61.2 years (range, 45 to 71). By the end of 2006, 36 cups were assessed. Indications for the primary THA procedure included primary arthritis in 32 hips, post-traumatic arthritis in three, post-dysplastic arthritis in two, femoral neck fracture in two and rheumatoid arthritis in one. METHODSThe average follow-up was 8.5 years (range, 7 to 10). The indication criteria for primary implantation were evaluated, i.e., body mass index, patients' activity and their age. THA outcome was evaluated on the basis of clinical rating (Harris hip score) and pain assessment and on radiographic findings on which the acetabulum before and cup position after THA were compared, and potential changes in cup position, acetabular cup loosening or para-articular ossifications were observed. RESULTSGood outcomes were found in 88.9 % of the hips. In most, cup position was satisfactory. One acetabular component was implanted in a varus position (34°). An intraoperative complication included fracture of the greater trochanter, which was left untreated for spontaneous healing.The early-postoperative complications were one dislocation, two wounds with serous secretion not requiring revision surgery, and one large haematoma. Stem fracture as a late complication was recorded in two THAs. Radiolucencies were found in six hips and paraarticular ossifications in four. Migration of the cup with protrusion into the acetbulum occured in one patient 3 years after THA. Four cups showed aseptic loosening within 3 to 7 years of surgery. No infection was recorded in this THA group. DISCUSSIONInformation on mid-and long-term outcomes of the use of cementless acetabular cups in the relevant literature is sparse. The Ultima cup is dealt with only in the report by Pazdírek et al., whose results are in agreement with ours, but involve a lower number of implanted cups and a shorter follow-up. In this study, loosening was recorded only in cups larger than 32 mm in diameter. In comparison with our group of cementless BMT acetabular components, the use of cementless Ultima cups gives better results at mid-term follow-up. CONCLUSIONSAt 8.5-year follow-up, 88.9 % of the Ultima acetabular components were without radiographic signs of loosening. Attention should be paid primarily to THA patients with a thin wall acetabulum requiring a larger cup and a 32-mm liner.

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“…Calcium phosphate coatings consist of hydroxyapatite (Ca(POJ^) that possesses osteoconductive properties to stimulate osseointegration [35,52,98,202,209]. Hydroxyapatite coatings are manufactured by the plasma-spray method, which means that under high-speed and high temperature conditions, the molten hydroxyapatite granules are sprayed on to the metal.…”

Section: Implant Stabilitymentioning

confidence: 99%

“…After good initial results, the polyethylene caused tremendous osteolysis, with subsequent loosening. The use of this type of cup prosthesis was then abandoned [109,166,174,175,209,252,277,287,288].…”

Section: General Introductionmentioning

confidence: 99%

Zweymüller cementless total hip arthroplasty with two designs of titanium rectangular stem and a titanium threaded cup : a clinical, radiological and DEXA study

Vervest¹

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Noncemented Acetabular Fixation in Primary Total Hip Replacement

Cited by 9 publications

References 124 publications

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

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

Mid-Term Results of Cementless Ultima Cups in Primary Total Hip Replacement

Zweymüller cementless total hip arthroplasty with two designs of titanium rectangular stem and a titanium threaded cup : a clinical, radiological and DEXA study

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