Five-year results of two cemented hip stem models each made of two different alloys

Schweizer, Andreas; Lüem, M.; Riede, Ulf; Lindenlaub, Philippe; Ochsner, P. E.

doi:10.1007/s00402-004-0772-4

Cited by 7 publications

(4 citation statements)

References 25 publications

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“…The 20-year survival of the original MSS (Co) exceeds 86% with aseptic loosening as the endpoint, and is comparable to that of other successful cemented implants (Clauss et al 2009). However, later developments in the stem design have been proven to reduce short- and mid-term survival instead of bringing about further improvements as expected (Maurer et al 2001, Schweizer et al 2005). …”

Section: Discussionmentioning

confidence: 99%

“…The patients had a clinical and radiographic follow-up after 1, 2, 5, 10, and 15 years. After 5 years of follow-up, survival analysis showed inferior results for Ti stems with the SL design compared to the Co stems with the MSS design (Schweizer et al 2005). Analyzing the Ti stems after 10 years, Maurer et al (2001) found male sex, age of < 65 years, a small stem, and the SL design to be risk factors for aseptic loosening.…”

Section: Methodsmentioning

confidence: 99%

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Risk factors for aseptic loosening of Müller-type straight stems

Clauss¹,

Gersbach²,

Butscher³

et al. 2013

Acta Orthopaedica

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Background and purpose Even small differences in design variables for the femoral stem may influence the outcome of a hip arthroplasty. We performed a risk factor analysis for aseptic loosening of 4 different versions of cemented Müller-type straight stems with special emphasis on design modifications (2 shapes, MSS or SL, and 2 materials, CoNiCrMo (Co) or Ti-6Al-7Nb (Ti)).Methods We investigated 828 total hip replacements, which were followed prospectively in our in-house register. All stems were operated in the same setup, using Sulfix-6 bone cement and a second-generation cementing technique. Demographic and design-specific risk factors were analyzed using an adjusted Cox regression model.Results The 4 versions showed marked differences in 15-year stem survival with aseptic loosening as the endpoint: 94% (95% CI: 89–99) for MSS Co, 83% (CI: 75–91) for SL Co, 81% (CI: 76–87) for MSS Ti and 63% (CI: 56–71) for SL Ti. Cox regression analysis showed a relative risk (RR) for aseptic loosening of 3 (CI: 2–5) for stems made of Ti and of 2 (CI: 1–2) for the SL design. The RR for aseptic stem loosening increased to 8 (CI: 4–15) when comparing the most and the least successful designs (MSS Co and SL Ti).Interpretation Cemented Müller-type straight stems should be MSS-shaped and made of a material with high flexural strength (e.g. cobalt-chrome). The surface finish should be polished (Ra < 0.4 µm). These technical aspects combined with modern cementing techniques would improve the survival of Müller-type straight stems. This may be true for all types of cemented stems.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Risk factors for aseptic loosening of Müller-type straight stems

Clauss¹,

Gersbach²,

Butscher³

et al. 2013

Acta Orthopaedica

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“…The differences are huge between metals (CoCrMo and stainless steel) and cement or cortical bone, which is likely to cause debonding and subsidence. However, subsidence of titanium alloy stem is only 0.14-2 mm, and the incidence of survival of titanium alloy stem is higher than that of CoCrMo and stainless steel (Akiyama et al, 2011;Schweizer et al, 2005). Similarly, additional clinical and radiological studies of other cemented titanium stems have also shown good survival results, with Ultima straight collarless titanium stems having 97% survival after 7.5 years, BiCONTACT and Müller straight titanium stems 97% survival after 11 years, and Müller straight collarless titanium stems coated with titanium oxide 96.8% survival after 9 years (Bowditch, 2001;Eingartner et al, 2007).…”

Section: Discussionmentioning

confidence: 98%

Contact damage failure analyses of fretting wear behavior of the metal stem titanium alloy–bone cement interface

Zhang

Liu

et al. 2015

Journal of the Mechanical Behavior of Biomedical Materials

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Although cemented titanium alloy is not favored currently in the Western world for its poor clinical and radiography outcomes, its lower modulus of elasticity and good biocompatibility are instrumental for its ability supporting and transforming physical load, and it is more suitable for usage in Chinese and Japanese populations due to their lower body weights and unique femoral characteristics. Through various friction tests of different cycles, loads and conditions and by examining fretting hysteresis loops, fatigue process curves and wear surfaces, the current study investigated fretting wear characteristics and wear mechanism of titanium alloy stem-bone cement interface. It was found that the combination of loads and displacement affected the wear quantity. Friction coefficient, which was in an inverse relationship to load under the same amplitude, was proportional to amplitudes under the same load. Additionally, calf serum was found to both lubricate and erode the wear interface. Moreover, cement fatigue contact areas appeared black/oxidative in dry and gruel in 25% calf serum. Fatigue scratches were detected within contact areas, and wear scars were found on cement and titanium surfaces, which were concave-shaped and ring concave/ convex-shaped, respectively. The coupling of thermoplastic effect and minimal torque damage has been proposed to be the major reason of contact damage. These data will be important for further studies analyzing metal-cement interface failure performance and solving interface friction and wear debris production issues.

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“…Some studies have shown that titanium stems reduce loosening and proximal bone loss when compared with cobalt-chrome stems, whereas others show higher rates of early clinical failure. 14,16,[22][23][24] One concern about titanium femoral stems is that their increased flexibility can increase cement stresses, resulting in failure. 14,15,22 Another concern is that titanium femoral stems have been susceptible to corrosion.…”

Section: Discussionmentioning

confidence: 99%