Nonmodular Flexible Press-Fit Cup in Primary Total Hip Arthroplasty

Berli, B.; Gu, Ping; Dick, W.; Morscher, E

doi:10.1097/blo.0b013e3180592a79

Cited by 31 publications

(30 citation statements)

References 39 publications

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“…24 These reaming variations may affect the initial amount of bone-implant apposition, which will in turn affect the amount of pinching deformation. Aside from the surface preparation variations, cup designs also affect the bony support behind the cup [27][28][29] and the overall deformation of the cup. Although previous in vivo, in vitro, and foam block experiments described shell deformations ranging from 0 to 0.57 mm (diametrical), bounce-back was observed for these cups upon removal, 11 indicating that the deformations were not permanent.…”

Section: Discussionmentioning

confidence: 99%

Biomechanical modeling of acetabular component polyethylene stresses, fracture risk, and wear rate following press‐fit implantation

Ong

Rundell

Liepins

et al. 2009

Journal Orthopaedic Research

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Press-fit implantation may result in acetabular component deformation between the ischial-ilial columns (''pinching''). The biomechanical and clinical consequences of liner pinching due to press-fit implantation have not been well studied. We compared the effects of pinching on the polyethylene fracture risk, potential wear rate, and stresses for two different thickness liners using computational methods. Line-to-line (''no pinch'') reaming and 2 mm underreaming press fit (''pinch'') conditions were examined for Trident cups with X3 TM polyethylene liner wall thicknesses of 5.9 mm (36E) and 3.8 mm (40E). Press-fit cup deformations were measured from a foam block configuration. A hybrid material model, calibrated to experimentally determined stress-strain behavior of sequentially annealed polyethylene, was applied to the computational model. Molecular chain stretch did not exceed the fracture threshold in any cases. Nominal shell pinch of 0.28 mm was estimated to increase the volumetric wear rate by 70% for both cups and peak contact stresses by 140 and 170% for the 5.9 and 3.8 mm-thick liners, respectively. Although pinching increases liner stresses, polyethylene fracture is highly unlikely, and the volumetric wear rates are likely to be low compared to conventional polyethylene. ß

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Section: Discussionmentioning

confidence: 99%

Biomechanical modeling of acetabular component polyethylene stresses, fracture risk, and wear rate following press‐fit implantation

Ong

Rundell

Liepins

et al. 2009

Journal Orthopaedic Research

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“…The cup is designed with a flattened pole geometry with bi-radial eccentricity, providing optimal press-fit fixation and achieving intrinsic primary stability without the use of additional screw fixation [10,11]. The porous surface is achieved by using titanium mesh layers bonded directly to the outer polyethylene (PE) surface, thus eliminating modularity and favouring bony in-growth.…”

Section: Methodsmentioning

confidence: 99%

“…Up to now only the inventor's group, the Australian National Joint Replacement Registry and very recently a group from New Zealand have published outcome data of this acetabular cup [10][11][12][13]. The objective of this study was to assess our clinical and radiological outcomes, patient satisfaction and complications at ten years in a larger cohort.…”

Section: Introductionmentioning

confidence: 99%

Ten-year results with the Morscher press-fit cup: an uncemented, non-modular, porous-coated cup inserted without screws

Garavaglia

Lübbeke

Baréa

et al. 2010

International Orthopaedics (SICOT)

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Total hip arthroplasty (THA) with well designed cementless acetabular implants has shown excellent results. The purpose of this study was to assess our clinical and radiological outcomes using an uncemented cup. We conducted a prospective cohort study including all consecutive primary THAs performed with the Morscher press-fit cup, an uncemented non-modular acetabular component, between March 1996 and December 1998. Patients were evaluated at ten years with clinical and radiological followup, patient satisfaction and questionnaire assessment using the Harris hip score (HHS), Merle d'Aubigné and Postel score, the UCLA score, the 12-item short-form health survey (SF-12) and a visual analog scale. Five hundred sixty-one THAs were performed in 518 patients. At 120 months (± 7.3 months), 303 patients with 335 THAs were still available for follow-up. None of the patients had required cup revision for aseptic loosening. At ten years, the cup survivorship was 98.8% (95% CI 97.4-99.5) with cup revision for any cause as an endpoint. No radiolucencies were seen around the cups, but osteolytic defects involved 21 stems (8.3%). Mean total linear polyethylene wear was 0.9 mm. The Morscher acetabular replacement cup provides excellent results at ten years. There were no revisions for aseptic loosening of the cup, and no osteolytic defects were found around the cup. Patient satisfaction was high and the clinical results were very good.

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“…Therefore, it is not feasible to draw conclusions on the difference in frequency of osteolysis between monoblock and modular cups. Moreover, substantially different rates of osteolysis were reported on different monoblock cups in noncomparative case series, ranging from 0% to 15% reported for monoblock cups with 10 to 20 years of followup [4,7,9,11,12,21,24,27]. As noted earlier, the different designs and material properties of monoblock cups from different brands could be confounding factors, having different degrees of radiodensity, different mechanical properties, and different ways of osseointergration (osseous in-or ongrowth).…”

Section: Discussionmentioning

confidence: 97%

“…The Swedish Hip Arthroplasty Register Annual Report 2010 indicates that the 10-year survival of all uncemented implants is 97.7% with revision for aseptic loosening as the end point [33]. Long-term results from uncontrolled (noncomparative) case series that have been published on several monoblock cups of the current generation (ie, the titanium-coated RM cup, the Morscher cup, and the Trabecular Metal cup) show a 10-year survival for aseptic loosening within the range or higher than the survival reported in the Swedish Hip Arthroplasty Register [4,7,9,11,12,14,21,24,27,33]. Those studies represent the potentially good clinical results with the use monoblock cups in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Do Monoblock Cups Improve Survivorship, Decrease Wear, or Reduce Osteolysis in Uncemented Total Hip Arthroplasty?

Halma

Charles

Dhert

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Monoblock acetabular components used in uncemented total hip arthroplasty (THA) have certain mechanical characteristics that potentially reduce acetabular osteolysis and polyethylene wear. However, the degree to which they achieve this goal is not well documented. Questions/purposes The purpose of this study was to use a systematic review of controlled trials to test the hypothesis that monoblock cups have superior (1) polyethylene wear rate; (2) frequency of cup migration; (3) frequency of acetabular osteolysis; and (4) frequency of aseptic loosening compared with modular components used in uncemented THA.Methods A systematic search was conducted in the Medline, Embase, and Cochrane electronic databases to assemble all controlled trials comparing monoblock with modular uncemented acetabular components in primary THA. Included studies were considered ''best evidence'' if the quality score was either C 50% on the Cochrane Back Review Group checklist or C 75% the Newcastle-Ottawa quality assessment scale. A total of seven publications met our inclusion criteria. Results Best evidence analysis showed no difference in polyethylene wear rate, the frequency of cup migration, and aseptic loosening between monoblock and modular acetabular components. No convincing evidence was found for the claim that lower frequencies of acetabular osteolysis are observed with the use of monoblock cups compared with modular uncemented cups. Conclusions The purported benefits of monoblock cups were not substantiated by this systematic review of controlled studies in that polyethylene wear rates and frequencies of cup failure and acetabular osteolysis were similar to those observed with modular implants. Other factors should therefore drive implant selection in cementless THA. Level of Evidence Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Nonmodular Flexible Press-Fit Cup in Primary Total Hip Arthroplasty

Cited by 31 publications

References 39 publications

Biomechanical modeling of acetabular component polyethylene stresses, fracture risk, and wear rate following press‐fit implantation

Biomechanical modeling of acetabular component polyethylene stresses, fracture risk, and wear rate following press‐fit implantation

Ten-year results with the Morscher press-fit cup: an uncemented, non-modular, porous-coated cup inserted without screws

Do Monoblock Cups Improve Survivorship, Decrease Wear, or Reduce Osteolysis in Uncemented Total Hip Arthroplasty?

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