Total hip arthroplasty with a low-modulus porous-coated femoral component.

Tullós, Hugh S.; McCaskill, B; Dickey, Ryan M.; Davidson, J. A.

doi:10.2106/00004623-198466060-00009

Cited by 55 publications

(22 citation statements)

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“…Similar studies with fewer patients and a shorter follow-up time have reported clinical failures in 58%, 36%, 12% and 8% of cases (Tullos et al 1984, Keet and Runne 1989, Maathuis and Visser 1996. According to the criteria of Engh et al (1990), 96% of the hips were rated as unstable and were considered to be loose.…”

Section: Discussionmentioning

confidence: 70%

“…In animal studies, a rapid ingrowth and a ready adherence to the surrounding tissue was observed (Homsey et al 1972). Despite the possible theoretical benefits, mid-term clinical results on uncemented femoral components with a Proplast coating were not favorable (Sadr and Arden 1977, Bryan et al 1981, Tullos et al 1984, Maathuis and Visser 1996. Because of these reports, the low modulus system was considered to be a failure and was abandoned by our clinic in the mid-1990s.…”

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confidence: 99%

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Long-term results of a soft interface- (Proplast-) coated femoral stem

et al. 2006

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Background Mid-term clinical results of uncemented femoral components with a Proplast coating have been unfavorable and the low modulus system was abandoned in the mid-1990s. There are, however, still substantial numbers of patients with a Proplast-coated prosthesis in situ. We evaluated the clinical and radiographic results in patients with 8-13 year follow-up.Methods We evaluated the survival rate, Harris Hip score and radiographic features of 82 hips in 69 patients. Mean age at operation was 58 (35-72) years.Results With respect to the Harris Hip score (HHS), 21% of the hips were considered to be clinical failures (HHS < 70) at final follow-up, mainly because of excessive thigh pain. Osteolysis was observed in one or more Gruen zones in one-third of the hips. According to the criteria of Engh, 79/82 stems were unstable. 11 hips were eventually revised due to aseptic loosening. Survival of the femoral component of the original cohort at final follow-up was 84% (95% CI: 75-93) in a standard-case scenario.Interpretation Extensive signs of loosening were observed in almost all hips, while not all hips were considered to be clinical failures. Thus, all patients should be thoroughly screened for radiographic progressive osteolysis or the occurrence of thigh pain. Thigh pain or progressive osteolysis warrants revision of the Proplastcoated femoral stem.

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Section: Discussionmentioning

confidence: 70%

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confidence: 99%

Long-term results of a soft interface- (Proplast-) coated femoral stem

et al. 2006

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“…Other materials, including porous stainless steel as an implant in bone [18] as well as porous polymers as prosthetic coatings [87][88][89] were investigated as potential materials for improved bone ingrowth, however certain shortcomings prohibited their widespread clinical applications. While stainless steel porous coatings provided rigid fixation and pore sizes adequate for osseous integration, the material was found to undergo excessive in vivo corrosion.…”

Section: Brief History Of Porous Orthopaedic Implantsmentioning

confidence: 99%

“…While stainless steel porous coatings provided rigid fixation and pore sizes adequate for osseous integration, the material was found to undergo excessive in vivo corrosion. Similarly, several porous polymers, including porous polysulfone, porous polyethylene and Proplast (a Teflon/graphite fiber material composite) were found to have inadequate strength, unacceptable wear, and high failure rates [87][88][89].…”

Section: Brief History Of Porous Orthopaedic Implantsmentioning

confidence: 99%

Modern Porous Coatings in Orthopaedic Applications

Frank

Fabi

Levine

2013

Biological and Medical Physics, Biomedical Engineering

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The development of porous metals and coatings for orthopaedic applications has revolutionized the medical field. The ability to bond metallic implants to bone has spawned the advancements in total joint arthroplasty we have experienced over the last 4 decades. Early success was obtained as factors (pore size, coefficient of friction, modulus of elasticity) necessary for osseointegration were just being discovered. Despite good results, initial implant designs were fabricated utilizing traditional coatings (i.e. sintered beads, fiber metal, plasma spray), which have several inherent limitations, including relatively high moduli of elasticity, low coefficient of frictions and intermediate porosity. In order to improve upon these limitations and capitalize on modern techniques for implant fabrication several new porous metals have been recently introduced in orthopaedics. Tritanium (Stryker, Mahwah, NJ), Regenerex (Biomet, Warsaw, IN), StikTite (Smith and Nephew, Memphis, TN), Gription (Depuy, Warsaw, IN), Biofoam (Wright Medical, Arlington, TX), and Trabecular Metal (Zimmer, Warsaw, IN) are currently available for orthopaedic surgery applications. These materials have moved us into the era metallic foams that possess a characteristic appearance similar to cancellous bone. The open-cell internal structure of these metals afford several interesting biomaterial properties, including; high volumetric porosity (60-80 %), low modulus of elasticity and high surface frictional characteristics. The following chapter reviews the mode of fabrication, properties and applications in orthopaedic surgery for this new class of highly porous metals.

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“…Numerous composite stems made of polymer materials reinforced by a central metallic core, carbon fiber, or a flexible metallic construct were tried in a few studies [7,12,17,21,27,29,30,38,41,43,51,52] and also in revisions [25,31]. Even if some of these stems reduced postoperative loss of proximal femoral bone mineral density (BMD), most of them failed clinically as a result of poor fixation.…”

Section: Introductionmentioning

confidence: 99%

Fixation and Bone Remodeling Around a Low Stiffness Stem in Revision Surgery

Kärrholm¹,

Razaznejad²

2008

Clinical Orthopaedics &Amp; Related Research

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Femoral stems with reduced stiffness have the potential of decreasing stress shielding and could be an alternative in revision surgery when restoration of bone stock is required. We retrospectively reviewed 38 patients (40 stems) with a central core of cobalt-chromium surrounded by a polymer and an outer titanium mesh layer containing a proximal coating of hydroxyapatite/tricalcium phosphate; 30 of the 38 patients (32 hips) had a minimum 2-year followup. We impacted morselized allograft around the stem in 28 of 32 revisions. Repeated radiostereometric examinations showed medial, distal, and posterior migration (median, 0.21 mm, 0.17 mm, and 0.96 mm, respectively) of the femoral head center for up to 6 months followed by stabilization. Measurements of bone mineral density in the seven Gruen zones at 6 months revealed either a decrease (down to a median of 3%), no change, or a slight increase (up to 5%) followed by a further increase up to 2 years in three of the regions (2, 3, and 5). Conventional radiography at 2 years demonstrated graft remodeling and incomplete radiolucent lines in 19 hips, mainly in Regions 1 and 7. Two hips were reoperated on as a result of dislocation, but none of the stems had been revised.

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Total hip arthroplasty with a low-modulus porous-coated femoral component.

Cited by 55 publications

References 0 publications

Long-term results of a soft interface- (Proplast-) coated femoral stem

Long-term results of a soft interface- (Proplast-) coated femoral stem

Modern Porous Coatings in Orthopaedic Applications

Fixation and Bone Remodeling Around a Low Stiffness Stem in Revision Surgery

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