Whatʼs New in Hip Arthroplasty

Huo, Michael H.; Gilbert, Nathan F.

doi:10.2106/jbjs.e.00474

Cited by 20 publications

(2 citation statements)

References 184 publications

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“…Die steigende Lebenserwartung der Bevölkerung einhergehend mit einem zunehmenden Aktivitätslevel im hohen Lebensalter auch nach endoprothetischem Hüftgelenksersatz führen zu neuen, deutlich höheren Anforderungen an die implantierten Hüftendoprothesen. Heute stellen der Abrieb und die resultierenden Osteolysen weiterhin die wesentliche Ursache für die Durchführung von Revisionseingriffen in der Hüftendoprothetik dar [1][2][3][4][5]. Insbesondere die biologischen Reaktionen, welche nach konventionellem Polyethylenabrieb beobachtet wurden, haben das Interesse an alternativen Gleitpaarungen wachsen lassen.…”

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“…Insbesondere letztere haben aber deutlich gemacht, dass das Abriebvolumen zwar ein wesentlicher Faktor ist, den es aus medizinischer Sicht zu beurteilen gilt. Jedoch sind die biologischen Reaktionen auf diese Abriebpartikel, welche wesentlich von den Eigenschaften der Partikel abhängen und daher bei den unterschiedlichen Gleitpaarungen deutliche Differenzen aufweisen, zumindest genauso von Bedeutung [1].…”

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Keramik-Keramik-Gleitpaarungen in der primären Hüftendoprothetik

Sentürk

Perka

2015

Z Orthop Unfall

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The main reason for total hip arthroplasty (THA) revision is the wear-related aseptic loosening. Younger and active patients after total joint replacement create high demands, in particular, on the bearings. The progress, especially for alumina ceramic-on-ceramic bearings and mixed ceramics have solved many problems of the past and lead to good in vitro results. Modern ceramics (alumina or mixed ceramics containing alumina) are extremely hard, scratch-resistant, biocompatible, offer a low coefficient of friction, superior lubrication and have the lowest wear rates in comparison to all other bearings in THA. The disadvantage of ceramic is the risk of material failure, i.e., of ceramic fracture. The new generation of mixed ceramics (delta ceramic), has reduced the risk of head fractures to 0.03-0.05 %, but the risk for liner fractures remains unchanged at about 0.02 %. Assuming a non-impinging component implantation, ceramic-on-ceramic bearings have substantial advantages over all other bearings in THA. Due to the superior hardness, ceramic bearings produce less third body wear and are virtually impervious to damage from instruments during the implantation process. A specific complication for ceramic-on-ceramic bearings is "squeaking". The high rate of reported squeaking (0.45 to 10.7 %) highlights the importance of precise implant positioning and the stem and patient selection. With precise implant positioning this problem is rare with many implant designs and without clinical relevance. The improved tribology and the presumable resulting implant longevity make ceramic-on-ceramic the bearing of choice for young and active patients.

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Keramik-Keramik-Gleitpaarungen in der primären Hüftendoprothetik

Sentürk

Perka

2015

Z Orthop Unfall

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Tribology in Total Hip Arthroplasty

Knahr¹

2011

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Effect of the initial implant fitting on the predicted secondary stability of a cementless stem

Viceconti

Pancanti

Dotti

et al. 2004

Med. Biol. Eng. Comput.

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A numerical model able to investigate the influence of biomechanical factors on the long-term secondary stability of implants would be extremely useful for the design of new cementless prosthetic devices. A purely biomechanical model of osseo-integration has been developed, formulated as a rule-based adaptation scheme. Due to its complexity, the problem was divided into three steps: preliminary implementation of the model (proof of concept); implementation of the complete model and investigation of the model solution; and model validation. The paper describes the first of these three steps. The model was implemented as a discrete-states machine, and the few parameters required were derived from the literature. It was then applied to a real clinical case. The study was conducted using the frictional contact finite element model of a human femur implanted with a cementless anatomical stem. A stable solution was achieved after between three and 15 iterations for all initial positions considered. Similar initial conditions yielded similar final configurations. The model predicted all initial configurations, with the exception of a partial osseo-integration, ranging between 62% (distal fit) and 78% (proximal fit) of the viable interface. This is in good agreement with the values reported in the literature that never exceed 75%, even in the best conditions, and report better clinical results for proximal fit. For the varus configuration, which lacks cortical support, the algorithm predicted a completed loosening.

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Whatʼs New in Hip Arthroplasty

Cited by 20 publications

References 184 publications

Keramik-Keramik-Gleitpaarungen in der primären Hüftendoprothetik

Keramik-Keramik-Gleitpaarungen in der primären Hüftendoprothetik

Tribology in Total Hip Arthroplasty

Effect of the initial implant fitting on the predicted secondary stability of a cementless stem

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