Osteologic standardization of human coxarthrosis using histomorphometry and its relevance for HIP alloarthroplasty

Oettmeier, R.; Babisch, J.

doi:10.1016/s0344-0338(11)80068-3

Cited by 6 publications

(4 citation statements)

References 2 publications

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“…Rheumatoid arthritis (RA) strongly affects the properties of bone [1–3], while in addition bone metabolism is influenced by the intake of medication by RA patients [4, 5]. The compromising biomechanical changes in rheumatic bone could increase the risk of mechanical complications in cementless implants, such as peri-prosthetic fractures, insufficient initial implant stability and insufficient osseous integration causing early implant failure.…”

Section: Introductionmentioning

confidence: 99%

Cementless total hip arthroplasty in rheumatoid arthritis: a systematic review of the literature

Zwartelé

Witjes

Doets

et al. 2011

Arch Orthop Trauma Surg

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BackgroundCompromised rheumatic bone is a potential risk factor for mechanical complications in cementless total hip arthroplasty (THA) in cases of rheumatoid arthritis (RA). Increased rates of intra-operative fractures, component migration and (early) aseptic loosening are to be expected. Despite this, cementless THA is performed in cases of RA.MethodsA literature search on cementless THA in RA was performed in EMBASE (1993–2011), Medline (1966–2011) and the Cochrane Library. A systematic review was conducted with a special emphasis on mechanical complications.ResultsTwenty-three case series and five studies of implant registries were included. Acetabular fractures and/or migration of the cup were reported in 9 out of 22 studies of the cup. Proximal femoral fractures and/or subsidence of the stem were reported in 14 out of 20 studies of the stem. Six studies compared failure rates of uncemented and cemented components due to aseptic loosening. The overall failure rate ratio (uncemented/cemented) for the cup was 0.6 (95% CI: 0.14–2.60) and for the stem 0.71 (95% CI: 0.06–8.55), both favoring uncemented fixation. The failure rates in case series without a control group were compared to the NICE criteria (failure rate/1). The overall failure rate for the cup was 0.97 (95% CI: 0.50–1.88) and for the stem 0.79 (95% CI: 0.44–1.41). Failure rates of aseptic loosening of higher than 1 (favoring cemented fixation) were reported in 6 out of 26 studies of the cup and in 2 out of 25 studies of the stem. In all these studies, the inferior implant designs were blamed, and not the type of fixation or the quality of the bone.ConclusionsDespite substantial rates of mechanical stem complications, no evidence was found to establish that cementless components perform less well than cemented components. The results justify the use of cementless THA in RA patients.

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Section: Introductionmentioning

confidence: 99%

Cementless total hip arthroplasty in rheumatoid arthritis: a systematic review of the literature

Zwartelé

Witjes

Doets

et al. 2011

Arch Orthop Trauma Surg

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“…However, RA is associated with altered biological and mechanical bone properties [1,3,4,20,21,23]. This raises several potential complications when cementless prostheses are being used in RA patients.…”

Section: Introductionmentioning

confidence: 99%

Long-term results of cementless primary total hip arthroplasty with a threaded cup and a tapered, rectangular titanium stem in rheumatoid arthritis and osteoarthritis

Zwartelé

Peters

Brouwers

et al. 2007

International Orthopaedics (SICO

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The aim of this study was to assess the outcome of primary cementless total hip arthroplasty in rheumatoid arthritis patients and to compare the results with osteoarthritis patients. Sixty-four patients (77 hips) with rheumatoid arthritis and 120 patients (135 hips) with osteoarthritis had a conical-shaped Zweymueller threaded cup and a tapered, rectangular Zweymueller stem implanted and were assessed after an average of 12.5 years. The endpoints for survival analysis were failure of one or both components due to radiographic loosening or revision. Revision was defined as exchange of cup, stem or both. When the PE-insert or the ceramic ball head were exchanged leaving cup and stem in place, e.g. for PE-wear or dislocation, this was not considered a revision but a re-intervention. No differences were found in survival rates; however, in the rheumatoid arthritis group there was an increased rate of malposition of the cup, avulsions of the greater trochanter, and increased bone resorption in the trochanteric region. This study shows that despite altered biomechanical properties of rheumatoid bone, mechanical stability and osseous integration of cementless prosthesis are not compromised and, although a higher complication rate did occur, long-term survival is excellent.

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“…A number of factors may contribute to this phenomenon. Stable initial fixation is a prerequisite for successful osseointegration of cementless prostheses, but the periacetabular bone stock in rheumatoid patients is known to be osteopenic with a greater proportion of unmineralized bone (Oettmeier andBabisch, 1992, Onsten et al 1995). Furthermore, the possibility of ongoing inflammatory resorption of bone around the implant and an adverse effect of protrusio acetabuli (Sutherland et al 1982) have been implicated in implant loosening.…”

Section: Discussionmentioning

confidence: 99%

“…Patients undergoing THA for rheumatoid arthritis (RA) have higher rates of clinical loosening of both cemented (Snorrason and Karrholm 1990) and cementless acetabular components (Hernandez-Vaquero et al 1996). It has been attributed to the osteopenic periacetabular bone stock (Baldursson et al 1980, Oettmeier andBabisch 1992 ) with a greater amount of unmineralized matrix, increased bone turnover and resorptive activity in the acetabular region (Akesson et al 1994 ).…”

Section: Martin Krismes and Gabriele Wo1fl3mentioning

confidence: 99%

Different cup migration in rheumatoid arthritis and arthrosis: A radiographic analysis of 127 uncemented acetabular cups

Dominkus¹,

Wanivenhaus²,

Morscher³

et al. 1998

Acta Orthopaedica Scandinavica

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Osteologic standardization of human coxarthrosis using histomorphometry and its relevance for HIP alloarthroplasty

Cited by 6 publications

References 2 publications

Cementless total hip arthroplasty in rheumatoid arthritis: a systematic review of the literature

Cementless total hip arthroplasty in rheumatoid arthritis: a systematic review of the literature

Long-term results of cementless primary total hip arthroplasty with a threaded cup and a tapered, rectangular titanium stem in rheumatoid arthritis and osteoarthritis

Different cup migration in rheumatoid arthritis and arthrosis: A radiographic analysis of 127 uncemented acetabular cups

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