Total hip arthroplasty

Current Opinion in Rheumatology

Volumn 8, Issue 2, 1996, Pages 148-153

  Thomas, Bert J ^a   Saa, Jose ^b   Lane, Joseph M ^b  

^a UNIVERSITY OF CALIFORNIA   (United States)

^b NONE

Author keywords

[No Author keywords available]

Indexed keywords

BONE CEMENT; CHROMIUM; COBALT; TITANIUM;

BIOMECHANICS; BIOMEDICAL ENGINEERING; ENDOPROSTHESIS LOOSENING; HIP PROSTHESIS; HUMAN; METAL IMPLANTATION; PRIORITY JOURNAL; REVIEW; TOTAL HIP PROSTHESIS;

EID: 0030007494     PISSN: 10408711     EISSN: None     Source Type: Journal    
DOI: 10.1097/00002281-199603000-00010     Document Type: Review

References (15)

1. Wroblewski BM, Taylor GW, Siney P: Charnley low friction arthroplasty: 19-25 year results. Orthopedics 1992, 15:421.
2. Hirose I, Capello WN, Feinberg JR, Shirer RM: Primary cemented total hip arthroplasty: five to twelve year clinical and radiographic follow-up. Iowa Orthop J 1995, 15:43-7. One hundred thirty-one cases were followed for a minimum of 5 years. Acetabular components failed at a rate of 18.4%, whereas femoral components failed in only 3.1% of cases. The failure rate was higher for rheumatoid arthritis than for primary osteoarthritis. No difference was noted in the failure rate for metal-backed versus non-metal-backed acetabular cups. All femoral failures occurred in patients whose proximal medial cement mantle was less than 5 mm. The authors recommend the use of hybrid total hip arthroplasty.
3. Dorr LD, Kane TJ III, Conaty JP: Long-term results of cemented total hip arthroplasty in patients 45 years old or younger: a 16-year follow-up study. J Arthroplasty 1994, 94:53-456. Forty-nine cemented total hip arthroplasties in patients younger than 45 years of age were reviewed. Average follow-up was 16.2 years. Twenty-seven percent of patients maintained satisfactory results at this follow-up, compared with 78% at 4.5 years and 58% at 9.2 years. Sixty-seven percent of patients required revision by 16.2 years of follow-up, compared with 33% at 9.2 years and 12% at 4.5 years follow-up. In the subset of patients younger than 30 years of age at the time of index arthroplasty, 82% required revision compared with 56% for those over 30 years of age. Radiologically, impending failure was thought to be present in 81% of the 16 unrevised hips at 16.2 years. In patients younger than 30 years, Charnley categories A or B with a diagnosis of osteonecrosis or osteoarthritis have the worst clinical results.
4. Tompkins GS, Lackiewicz PF, DeMasi R: A prospective study of a titanium femoral component for cemented total hip arthroplasty. J Arthroplasty 1994, 9:623-630. One hundred sixteen cemented total hips using a titanium alloy femoral stem with cobalt chrome alloy head were followed for a mean period of 4.8 years (range, 2 to 8 years). Thirteen femoral components (11%) were radiographically loose according to the criteria of Harris. Debonding or separation at the cement-prosthesis interface was thought to be the initial cause of failure. Because of the high incidence of femoral loosening, the authors do not recommend cementing titanium alloy femoral components.
5. Hashemi-Nejad A, Birch NC, Goddard NJ: Current attitudes to cementing techniques in British hip surgery. Ann R Coll Surg Engl 1994, 76:396-400. Six hundred sixty-eight British surgeons were surveyed, who between them performed 43,680 hip arthroplasties per year. Forty-eight percent of the hips implanted were Charnley type; 46% used Palacos cement (Kulzer GmbH, Bad Homburg, Germany) with gentamicin for both the femur and acetabulum. Forty-four percent of surgeons removed all cancellous bone from the femur. Forty percent used pulsatile lavage. Fifty-nine percent used a brush to clear debris. Ninety-four percent dried the femur. Ninety-seven percent plugged the femur. Seventy-six percent used a cement gun, and 70% pressurized the cement. For the acetabulum, 88% retained the subchondral bone. Forty percent used pulsatile lavage. One hundred percent dried the acetabulum. Twenty-two percent used hypotensive anesthesis, and 58% pressurized the cement. Over all, only 26% of hip implantations were performed with "modern" cementing techniques.
6. Lee IY, Skinner HB, Keyak JH: Effects of variation of prosthesis size on cement stress at the tip of a femoral implant. J Biomed Mater Res 1994, 28:1055-1060. A three-dimensional finite-element analysis model was used to assess the stresses at the tip of the femoral prosthesis. Increasing cement thickness from 2 to 5 mm by reducing the prosthesis diameter from 15 to 9 mm reduced stress significantly in the cement mantle surrounding a femoral implant. The peak tensile stresses were reduced by 45%, and peaked von Mises and shear stresses were reduced by 40%. The authors suggest that surgeons should allow for a 5-mm cement mantle near the tip of the prosthesis.
7. Grosland N, Kim JK, Park JB: Reinforcement of bone cement around prostheses by pre-coated wire coil: a finite element model study. Biomed Mater Eng 1995, 5:29-36. A simple coil made of stainless steel wire was placed around a tapered stem in a simulated cement mantle to counteract the radial and hoop stresses created by stem loading. Two-dimensional axis-symmetric finite-element analysis was performed to assess the level of stress both with and without the wire coil. Peak stresses were reduced by more than half with the incorporation of a wire coil. Mechanical test results showed an average fracture load of 3.7 ± 1.13 kN for pure bone cement compared with 9.02 ± 1.54 kN for wire-reinforced specimens. The authors conclude that enhanced fatigue life of the bone cement mantle may be achieved with the incorporation of a simple stainless steel wire coil in the cement surrounding the femoral stem tip.
8. Delaunay C, Kapandji AI: Acetabular screw rings and surface effects: apropos of a continuous series of 115 primary implantations of Karl Zweymuller's acetabular screw rings after a follow-up of an average of 5.8 years. Rev Chir Orthop Reparatrice Appar Mot 1994, 80:388-402. One hundred acetabular screw rings were retrospectively studied with 5.8 years average follow-up. Clinical results were excellent or good in 97%, fair in one, and poor in two. Only one threaded component failed.
9. Hwang SK, Park JS: Cementless total hip arthroplasty with AML, PCA and HGP prostheses. Int Orthop 1995, 19:77-83. Two hundred seventy cementless hip arthroplasties were followed for 2 to 8 years. The overall clinical results were similar for the porous-coated anatomic, Anatomic Medullary Locking (DuPuy, Warsaw, IN), and Harris Galante (Zimmer, Warsaw, IN) prostheses. Radiologic findings were similar for the three prostheses; however, bony ingrowth was greater with the Anatomic Medullary Locking prosthesis.
10. Sotereanos NG, Engh CA, Glassman AH, Macalino GE, Engh CA Jr: Cementless femoral components should be made from cobalt chrome. Clin Orthop 1995, 313:146-53. Two hundred ninety-three primary total hip arthroplasties were reviewed, 122 performed before 1982 and 171 performed between 1982 and 1984. Of the cases performed before 1982, two femoral prostheses were revised for late symptomatic loosening, two for stem fracture, and one for infection. In the 1982 to 1984 group, one stem (0.6%) was revised for symptomatic loosening. Large osteolytic femoral lesions developed in three patients and were associated with a large amount of polyethylene wear of their acetabular components. Three patients were treated with exchange of polyethylene liners and allografting of the osteolytic lesions. One hundred ninety-three revision hip arthroplasties performed before 1987 were reviewed. These were performed with an extensively porous-coated cobalt chrome femoral stem. Ten patients (5.7%) required re-revision of the femoral component; six of the 10 re-revisions were performed because of symptomatic loosening. In the revision series, 89% of patients were free of pain and functioned better than preoperatively.
11. Keavenly TM, Bartel DL: Mechanical consequences of bone ingrowth in a hip prosthesis inserted without cement. J Bone Joint Surg Am 1995, 77:911-23. Finite-element analysis and composite beam theory were used to determine the dependence of proximal loading of the bone and the risk of fatigue fracture of the stem on the diameter of the stem, the diameter of the periosteal bone, and the material from which the prosthesis was made. The risk of fatigue fracture of the stem increased with decreased diameters of the stem and the periosteal bone and with increased modulus of the stem. Maximum risk of fracture was found in active patients in whom a cobalt chrome alloy stem with a small diameter had been implanted in a bone with small diameter.
12. Bankston AB, Ritter MA, Keating EM, Faris PM: Measurement of polyethylene thickness in total hip arthroplasty: a technique analysis. J Arthroplasty 1994, 9:533-538. Twenty-one acetabular components treated as revision surgeries were studied. Measurement of polyethylene wear was performed on radiographs taken within 2 months of revision surgery. Measurement of the area of greatest polyethylene wear was compared with direct measurement of the retrieved component. The average difference between radiographic and direct measurements was 0.18 mm. A regression model demonstrated no significant difference between these measurements, and radiographic measurement of acetabular component thickness is thus thought to be accurate within 0.18 mm using the authors' technique.
13. Sugano N, Nishii T, Nakata K, Masuhara K, Takaoka K: Polyethylene sockets and alumina ceramic heads in cemented total hip arthroplasty: a ten-year study. J Bone Joint Surg Br 1995, 77:548-556. Fifty-seven total hip arthroplasties implanted with alumina ceramic heads and polyethylene sockets were followed for a mean of 11.1 years. The mean age of patients at index surgery was 53 years. Clinical success was noted in 77% of cases. Radiologic loosening occurred in three femoral (5%) and 16 acetabular (28%) components. The mean polyethylene wear was 1.1 mm, and the mean wear rate was 0.1 mm per year.
14. McKellop HA, Campbell P, Park SH, Schmalzried TP, Grigoris P, Amstutz HC, Sarmiento A: The origin of submicron polyethylene wear debris in total hip arthroplasty. Clin Orthop 1995, 311:3-20. Polyethylene particles isolated from the serum lubricants of hip-simulated wear tests were evaluated with scanning electron microscopy. The particles were submicron in size and were either rounded or elongated. The mean dimensions of the particles generated in vitro were slightly smaller than in vivo particles that had been retrieved from periprosthetic tissues at revision surgery. The overall morphology, however, was similar in the two groups, suggesting that similar lubrication and wear processes occur in the hip simulator as in vivo.
15. Bobyn JD, Jacobs JJ, Tanzer M, Urban RM, Aribindi R, Sumner DR, Turner TM, Brooks CE: The susceptibility of smooth implant surfaces to periimplant fibrosis and migration of polyethylene wear debris. Clin Orthop 1995, 311:21-39. Split cylindrical implants with one half of each implant porous and one half smooth surfaced were placed into the distal femur and proximal tibia of four dogs. Four control implants and 10 test implants that were chronically exposed to polyethylene debris with a mean size of 4.7 μm were examined histologically up to 30 weeks after surgery. Bone ingrowth was found at the porous implant surface as well as a fibrous interface around the smooth surface portion of the implants. Polyethylene debris was found to preferentially migrate along the smooth implant surfaces. In canine and human hip arthroplasty retrievals, polyethylene particles in the micron size range were found within histiocytes, and larger particles (up to 100 μm in diameter) were found within foreign body giant cells. In general, the peri-implant cavities around the smooth surfaces were not detectable radiographically. The authors believe that smooth implant surfaces are more susceptible than porous surfaces due to migration of polyethylene wear debris.