Failed innovation in total hip replacement: Diagnosis and proposals for a cure

Huiskes, R.

doi:10.3109/17453679308994602

Cited by 208 publications

(117 citation statements)

References 45 publications

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“…The distal part of the cementless stem has even been considered to be unnecessary after bone has grown 'into' the proximal coating of the stem [18]. In 1989 Morrey [33] presented an early series with successful shortstemmed cementless femoral components that had been in restricted use at the Mayo Clinic.…”

Section: Five-year Radiological Resultsmentioning

confidence: 99%

The effects of cementless femoral stem shape and proximal surface texture on ’fit-and-fill' characteristics and on bone remodeling

Laine

Puolakka

Moilanen

et al. 2000

International Orthopaedics

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We measured the post-operative radiological "fit and fill" of two different femoral stem designs, one with a straight proximally porous-coated n=50) and the other with a proximally anatomic, hydroxyapatite-coated and distally over-reamed stem (ABG, n=26). A comparison was then made between the clinical and radiological 5-year follow-up data of these two series and also of the bone remodeling changes around the stems. The observed differences in "fit and fill" parameters in the metaphyseal region were minute. However, in the diaphyseal bone the straight stem had substantially more cortical contact. The clinical results were excellent for both groups. Subsidence (>2 mm) was more frequent with the anatomical ABG stems, although the ABG stems had better bone ingrowth in the lower metaphyseal area. The present results indicate that the anatomical design may improve the fit and fill of a femoral stem in the metaphysis. On the other hand, a looser fill of the diaphyseal bone made the stems of this type more susceptible to subsidence. The straight stem with tight diaphyseal fit showed excellent stability, but the good bone ingrowth and remodeling around the distal part of the stem indicates stress transfer through this region and increased stress shielding of the proximal metaphyseal femur.Résumé Nous avons mesuré l'adaptation et le remplissage radiographique postopératoire de deux modèles diffé-rents de tiges fémorales, une tige droite avec la porosité proximale (BI-Metric, n=50) et une tige proximalement anatomique revêtue d'hydroxyapatite avec un surfaçage distal (ABG, n=26). Nous avons comparé les renseignements cliniques et radiographiques de ces deux séries de données résultant d'un suivi de cinq ans. Le remodelage osseux autour des tiges a été pris en compte. Les diffé-rences observées dans les paramètres de l'adaptation et de remplissage dans la région métaphysaire étaient minimales. Par contre dans la région diaphysaire la tige droite faisait montre de plus de contact cortical et ceci d'une manière significative. Les résultats cliniques sur ces deux groupes furent excellents. L'enfoncement (>2 mm.) de tiges anatomiques ABG était plus fréquent. Les résul-tats présentés indiquent que le modèle anatomique pourrait améliorer l'adaptation et le remplissage de la tige fé-morale dans la région de l'os métaphysaire.

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Section: Five-year Radiological Resultsmentioning

confidence: 99%

The effects of cementless femoral stem shape and proximal surface texture on ’fit-and-fill' characteristics and on bone remodeling

Laine

Puolakka

Moilanen

et al. 2000

International Orthopaedics

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“…Whether this sign is part of a failure scenario might be questioned. The risk of stem fracture and difficulties treating the osteoporotic bone and even bone defects during a subsequent revision procedure has, however, been debated (Engh et al 1992, Huiskes 1993. To avoid these problems, we think it desirable to avoid implants associated with stress bypass due to distal fixation.…”

Section: Discussionmentioning

confidence: 99%

Bone mineral and migratory patterns in uncemented total knee arthroplasties: A randomized 5-year follow-up study of 38 knees

Regnér

Carlsson

Kärrholm

et al. 1999

Acta Orthopaedica Scandinavica

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“…One of the most common failure modes of the cementless acetabular cup is its loosening, which is mostly due to insufficient initial stability after implanting the cup into the pelvis [5,14,15,20]. The hemispherical cementless acetabular cup fixed with multiple screws is one of the most popular approaches in THR [3,7,16,17], with many studies finding that bone screws are very helpful aids for cup fixation [4,8,9,11].…”

Section: Introductionmentioning

confidence: 99%

Effects of screw eccentricity on the initial stability of the acetabular cup

Chang¹,

Zobitz

et al. 2006

International Orthopaedics (SICO

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One of the major failure modes of cementless acetabular components is the loosening of the acetabular cup, which is mostly attributable to insufficient initial stability. A hemispherical cup with a porous coating which is inserted with press-fit fixation and secured with several screws is one of the most widely used approaches. Many studies have found that bone screws are very helpful aids for cup fixation, but the optimal surgical technique for inserting screws has not been clearly reported. In this study, hemispherical cups were fixed into blocks of foam bone with zero to three screws. The effects of three types of screw eccentricity (a 1-mm offset and angular eccentricities of 15°and 25°) on the initial stability of the acetabular cup were evaluated. The experimental results indicate that increasing the number of screws enhances the cup stability in the case of ideal screwing (i.e., with no eccentricity). An angular eccentricity of 15°did not affect the cup stability for fixation with one or two screws. However, the presence of 25°of angular eccentricity significantly reduced the stability of the cup, while 1 mm of offset eccentricity produced an even greater impact. Résumé Les modes les plus fréquents d'échecs des prothèses sans ciment sont le descellement de la cupule acétabulaire. Ce descellement est souvent en relation avec une stabilité initiale insuffisante. La cupule hémisphérique avec revêtement mis en place en press-fit avec vis additionnelles est un des modes opératoires les plus utilisés. De nombreuses études ont montré que l'utilisation de vis permettait de sécuriser la fixation. Pour cette étude, nous avons fixé des cupules hémisphériques dans un bloc d'os artificiel avec 0 à trois vis. Les effets de trois types de vissage ont permis d'évaluer la stabilité initiale de la cupule. Cette étude expérimentale montre que plus les vis sont nombreuses, meilleure est la stabilité. Une fixation excentrique de la cupule à 15°, stabilisée par une à deux vis n'a pas de conséquences néfastes, cependant une excentricité de 25°diminue de façon significative la stabilité de la cupule, de même, en ce qui concerne l'offset avec excentration de 1 mm.

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Failed innovation in total hip replacement: Diagnosis and proposals for a cure

Cited by 208 publications

References 45 publications

The effects of cementless femoral stem shape and proximal surface texture on ’fit-and-fill' characteristics and on bone remodeling

The effects of cementless femoral stem shape and proximal surface texture on ’fit-and-fill' characteristics and on bone remodeling

Bone mineral and migratory patterns in uncemented total knee arthroplasties: A randomized 5-year follow-up study of 38 knees

Effects of screw eccentricity on the initial stability of the acetabular cup

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