Rationale of a Flexible Press Fit Cup in Total Hip Replacement; 5-Year Followup in 280 Procedures

Morscher, E; Berli, B.; Jockers, W.; Schenk, Robert K.

doi:10.1097/00003086-199708000-00008

Cited by 47 publications

(38 citation statements)

References 22 publications

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“…The bony tissue will adapt to the forces transmitted from the implant, finally resulting in equilibrium between bone apposition and resorption (Schenk 1995). When press-fit cups are loaded, they close and are compressed together from the side, which will transmit forces sideways to the periphery (Morscher et al 1997, Wright et al 2001. Cemented cups, being more elastic, may distribute the load to a wider area.…”

Section: Roi Groupsmentioning

confidence: 99%

Different loss of BMD using uncemented press-fit and whole polyethylene cups fixed with cement: Repeated DXA studies in 96 hips randomized to 3 types of fixation

2006

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Background In cemented THA, aseptic loosening of the cup is more common than loosening of the stem, while periprosthetic osteolysis of the socket resulting in difficult reconstruction problems has emerged as the most significant problem with cementless cup fixation.Patients and methods 90 patients (96 hips) scheduled for THA were stratified in three groups according to the method of fixation of the acetabular component: acrylic bone cement with fluoride (Cemex-F), porous-coated press-fit cup with ceramic coating (Trilogy, uncemented) and acrylic cement with gentamicin (Palacos). All patients received the Spectron EF stem. Acetabular bone mineral density was measured with dual-energy X-ray absorptiometry (DXA) 1 week postoperatively, and after 12 and 24 months. The periprosthetic BMD was evaluated in 5 ROIs positioned around the acetabular component.Results In the uncemented sockets, the BMD had decreased proximally and medially to the cup after 2 years. The difference was significant in the proximal region as compared to the control group (Palacos). No difference was noted between the 2 groups with cemented components after 2 years. Stepwise linear regression analysis showed that loss of periprosthetic BMD in the proximal high-pressure region after 2 years increased with higher postoperative BMD and when the uncemented design had been used. Interpretation Contrary to previous studies of cemented stems, the use of fluoride cement did not influence the periprosthetic BMD 2 years after the examination. Increased loss of BMD with use of uncemented press-fit cups in the region in which osteolytic lesions are commonly found suggests that stress shielding may initiate the development of this complication. Longer

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Section: Roi Groupsmentioning

confidence: 99%

Different loss of BMD using uncemented press-fit and whole polyethylene cups fixed with cement: Repeated DXA studies in 96 hips randomized to 3 types of fixation

2006

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“…Press-fit fixation of uncemented acetabular components is increasingly being used for acetabular replacement in all age groups [6][7][8]. Despite the good results obtained in terms of implant survival, there has been some concern about high rates of pelvic osteolysis associated with polyethylene (PE) wear [9].…”

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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“…In confirmation of this concept, the radiological results of a consecutive series of 280 flexible pressfit cups in primary THRs after 5 to 8 years showed only one case needing revision for aseptic loosening, 7 cases with radiolucency only in zone 1, and 9 cases with radiolucencies only in zone 3 (50).…”

Section: Principles Of Progressmentioning

confidence: 78%

Failures and Successes in Total HIP Replacement-Why Good Ideas May Not Work

2003

Scand J Surg

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The course of development of total hip replacement (THR) is neither harmonious nor linear. Progress and set-backs alternate. Progress in THR manifests itself through reductions in the number and the severity of complications (infection, aseptic loosening, prematurely worn components, etc.).Innovation is the motor of progress. However, today's innovation may well be tomorrow's revision! Progress has been achieved in part through new implant materials and designs that provide improvements in such things as stress distribution in surrounding bone, tissue compatibility and osseointegration, and resistance to both wear and cyclic fatigue. Of at least equal importance, however, are improvements achieved in operative procedures (e.g., cementing technique) and finally, in clinical quality control: more complete documentation of implant and patient variables, establishment of implant registers, and utilization of outcome studies to guide the course of further development.Causes of failure in THR are numerous. However, unexpected side effects of innovations are the most frequent cause. An innovation may solve one problem, but also creates new ones. Problems in innovation which can lead to failures include: over-generalization of expected patient responses, ignoring past experience or assigning wrong causes to encountered problems, and finally, ignoring the dynamic nature of the living system (which can be described as using "necro-" instead of biomechanical thinking).Quality control in both manufacturing and clinical practice has to be improved. The pioneer times have come to an end. Today's patients should have the right to be operated on by a well trained surgeon and to be provided with well tested, well-understood implant materials and devices.Progress in endoprosthetics has led to the present high level of clinical success. Paradoxically, however, success is the greatest obstacle to further progress. This is because the curve of progress as a result of effort expended has turned asymptotic in endoprosthetics, as it does in many endeavors. In such situations the more a product (e.g., surgical implant and procedure, automobile design, computer program) becomes successful, the more efforts (and finances) are needed for further progress. On the other hand, the "scissors"

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Rationale of a Flexible Press Fit Cup in Total Hip Replacement; 5-Year Followup in 280 Procedures

Cited by 47 publications

References 22 publications

Different loss of BMD using uncemented press-fit and whole polyethylene cups fixed with cement: Repeated DXA studies in 96 hips randomized to 3 types of fixation

Different loss of BMD using uncemented press-fit and whole polyethylene cups fixed with cement: Repeated DXA studies in 96 hips randomized to 3 types of fixation

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

Failures and Successes in Total HIP Replacement-Why Good Ideas May Not Work

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