R�sultats � long terme de deux composants cotylo�diens non ciment�s dans les proth�ses totales de hanche

Schmitt, D.; Bigard, Olivier; Bresler, F.; Molé, Daniel; Bernard, P

doi:10.1007/bf00180454

International Orthopaedics

1993

DOI: 10.1007/bf00180454

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R�sultats � long terme de deux composants cotylo�diens non ciment�s dans les proth�ses totales de hanche

D. Schmitt

Olivier Bigard

F. Bresler

et al.

Abstract: We have followed up 227 total hip replacements using a cementless minimadreporic prosthesis for an average of 9 1/2 years. Special attention was paid to the acetabular component, of which 2 types were used; 77 incorporated screw rings and 134 were stabilised by spikes. The screw prostheses were evaluated at an average of 8 1/2 years from operation; one third showed radiological evidence of migration, and revision because of this was required in 12.6% of cases. The spiked cups were followed up for an average of… Show more

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Cited by 5 publications

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Impacted acetabular cups

Dambreville

1996

Eur J Orthop Surg Traumatol

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The failure modes of impacted acetabular cups are: deterioration of the polyethylene insert, disassembly of the modular components, excessive polyethylene wear, severe peri-prosthetic osteolysis. These failures can be explained; solutions are suggested.Primary stability: Screws are pathways for polyethylene debris; impacting elastic cups increases the press-fit effect in order to provide stability without screw fixation.Polyethylene thickness: by increasing polyethylene thickness from a minimum 8 to 10 mm, the risk of insert deterioration is decreased and so too is creep of the core which can induce micromotion between the insert and its metal backing.Liner stability: Tilting of the liner is the most common mecanism of disassembly in two-piece acetabular cups. The solution we suggest is to use a liner with a cylindrical periphery.Polyethylene wear: Excess polyethylene wear in metal backed acetabular cups was reported. Conversly, other authors concluded to no excess wear in impacted cups. This may be due to differences in prosthetic components, as well as patient selection. We noticed no significant wear in our series (0.10 mm per year). Studies are contradictory and it is not obvious that excessive wear in impacted cups has to be feared.Osteointegration is mandatory for obtaining long term stability and is provided by porous coating. The osteoconductive properties of hydroxyapatite have been demonstrated by a large number of studies, including fundamental research, animal experiments and clinical applications. Within a few weeks, hydroxyapatite brings about bonding with the host bone without any intervening fibrous tissue layer. We expect hydroxyapatite-induced osteointegration to prevent particulate migration. Biodegradation of the hydroxyapatite coating occurs after 5 to 10 years. Bone ingrowth later relies on the surface roughness of the substrate.In conclusion, we suggest that the combination of impacted elastic acetabular cups with a thick polyethylene liner and bioactive coating can provide long term durability.

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Impacted acetabular cups

Dambreville

1996

Eur J Orthop Surg Traumatol

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Résultat à long terme d’une série de prothèses totales de hanche sans ciment chez les sujets âgés de moins de 50 ans

Schmitt

Bresler

Nicolay

et al. 1996

Eur J Orthop Surg Traumatol

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With more than 20 years follow-up for the older cases, the concept of the biological fixation of an implant by bony ingrowth using surface treatment seems to be very reliable.The experience of this long term study argues for the thickness of polyethylene to be at least 10 mm for all metal back acetabular component and the future of this kind of implant seems to lie in modularisation made possible by the morse cone which would allow the replacement of the bearing surfaces.

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Radiographic evaluation of the Duraloc cup after 4 years

Stoeckl

Brabec

Wanner

et al. 2004

International Orthopaedics (SICOT)

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We implanted 71 metal-backed, porous-coated, hemispheric, press-fit Duraloc-100 cups in 68 consecutive patients. In 61 patients, the femoral stem was a cementless Spotorno and in ten a cemented Lubinus SP II. A 28-mm Biolox ceramic head was used with both stems. After an average follow-up of 4 (3.7-5.9) years, we examined 67 hips. Radiolucencies were described in three zones according to DeLee and Charnley, and migration was measured on serial radiographs using the computerassisted EBRA method. Total migration of more than 1 mm within the first 2 years occurred in 22/62 cups. Nine cups showed more than 1.5 mm total migration within the first 2 years and more than 2 mm within the whole period. The presence of post-operative radiolucencies correlated significantly with a total migration value of more than 2 mm within the first 2 years (p=0.02). Post-operative radiolucencies in zone 1 correlated with a total migration value of more than 2 mm within the first 2 years (p=0.027) and more than 2.5 mm within the whole period (p=0.051). These correlation values might reflect the quality of operative technique, particularly reaming, and implant selection.Résumé Nous avons implanté 71 cupules métal-back hémisphérique press-fit, revêtement poreux, Duraloc-100 chez 68 malades consécutifs. Pour 61 malades la tige fémorale était une Spotorno sans ciment et,pour dix, un tige cimenté Lubinus SP II. Un tête céramique Biolox 28 mm a été utilisée avec les deux tiges. Après une moyenne de suivi de 4 ans (3.7-5.9) nous avons examiné 67 hanches. Les liserés radiologiques ont été décrits dans les trois zones de DeLee et Charnley, et la migration a été mesurée sur des radiographies sérielles en utilisant la méthode EBRA assistée par ordinateur.

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R�sultats � long terme de deux composants cotylo�diens non ciment�s dans les proth�ses totales de hanche

Cited by 5 publications

References 11 publications

Impacted acetabular cups

Impacted acetabular cups

Résultat à long terme d’une série de prothèses totales de hanche sans ciment chez les sujets âgés de moins de 50 ans

Radiographic evaluation of the Duraloc cup after 4 years

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