Clinical and biological assessment of cemented titanium femoral stems: an 11-year experience

Abstract

This study prospectively assessed the outcome of 134 cemented titanium stems and serum ion levels. The stems were polished (0.1 μm Ra) with circular cross section. At the end point, only one stem revision was performed for aseptic loosening, and two were planned due to subsidence greater than 5 mm. Non-progressive radiolucencies in zones 1 and 7 were observed in 16 hips at the cement-bone interface without osteolysis. Median serum titanium concentrations were below the detection limit (30 nmol/l) except in patients with failed stems. The overall stem survival rate was 97.7% at nine years, which is comparable to other series of cemented stems. The protective layer of titanium oxide coating the stem and a thick cement mantle may help resist aseptic loosening. In addition, satisfactory monitoring of the stem was reached using titanium serum level determination.Résumé Cette étude rapporte le suivi clinique prospectif d'une série de 134 tiges fémorales titane cimentées et l'évolution des taux de titane sérique. Les implants étaient en titane anodisé, lisses (0.1-microm Ra) et de section circulaire. Au recul moyen de 9 ans, le taux de survie était de 97,7%, ce qui est comparable aux autres séries de tiges cimentées. On notait une reprise pour descellement et deux révisions prévisibles pour un enfoncement supérieur à 5 mm. Des liserés non évolutifs étaient observés en zones 1 et 7 pour 16 hanches sans ostéolyse. La médiane du titane sérique était inférieure à la limite de détection (30 nmol/l) à l'exception des 3 échecs où les taux sont étaient nettement plus élevés. La couche protectrice d'oxyde de titane et l'épaisseur du manteau de ciment peuvent expliquer la résistance au descellement aseptique. Le taux de titane sérique semble intéressant pour la surveillance des tiges titanes cimentées.

Outcome and serum ion determination up to 11 years after implantation of a cemented metal-on-metal hip prosthesis

“…We did not find any evidence to support these hypotheses, however. First of all, the performance of the stem was excellent, with 99% survivorship at the last review; these results are in accordance with the results of previously published studies ( Nich et al 2003 , Boyer et al 2008 ). The only elevated serum titanium levels were the result of stem loosening due to poor cementing technique or to neck impingement (in the 2 cases of dislocation).…”

Analysis of soluble or titanium dioxide derived titanium levels in human whole blood: consensus from an inter-laboratory comparison

“…In short, it is advantageous to have fit-for-purpose, accurate analytical techniques for Ti in whole blood to allow monitoring of exposures. As can be seen in Table 1, most commonly, inductively coupled plasma mass spectrometry (ICP-MS) has been used for such measurements 1,14, 17 -64 although ICP optical emission spectrometry (ICP-OES) 23,26,62,63,[65][66][67][68][69] and non-ICP techniques like graphite furnace atomic absorption spectrometry (GFAAS) have also been applied 24, 35, 69 -73 . In such analyses whole blood may be diluted and analysed directly or digested before analysis albeit, as noted above, only HF and hot sulphuric acid are likely to provide complete digestion of TiO 2 12 .…”

Coordinating Retrieval and Register Studies Improves Postmarket Surveillance

“…Historically, the performance of cemented titanium alloy femoral stems has been mixed. They are generally considered to perform unsatisfactorily; however, some designs have survivorship ranging from 97.7% at 9 years to 95.4% at 13 years [3,4,11]. In 2008, surgeons identified a change in the performance of the Titan 1 stem, and the NAR later reported a drop in survivorship due to aseptic loosening from about 2000 [5].…”