Abstract
Background
First-generation modular titanium fiber-metal-coated acetabular components had high rates of wear, pelvic osteolysis, and liner dissociation. Second-generation components were designed to reduce the incidence of these problems but it is unclear whether the changes achieved these goals.
Questions/purposes
We asked the following questions: (1) Is the risk of revision surgery for loosening, wear, or liner dissociation low with the second-generation acetabular component? (2) Is the rate of pelvic osteolysis low? (3) Can the liner be exchanged without bone cement?
Methods
We retrospectively reviewed prospectively collected data from 99 patients (118 hips) undergoing THAs with one second-generation modular titanium acetabular component with routine screw fixation and conventional polyethylene. The minimum followup was 10 years (mean, 12 years; range, 10–16 years). We obtained Harris hip scores and examined radiographs for loosening and osteolysis.
Results
At last followup, all acetabular components were well fixed and no titanium shell had been revised or removed. No liner had dissociation. At most recent followup, the mean Harris hip score was 89. We observed pelvic osteolysis in eight hips (7%). There were three reoperations for dislocation (head-liner exchange only) and three loose femoral components revised. Two liners (at 11 and 14 years) were exchanged for wear-pelvic osteolysis.
Conclusions
This second-generation modular titanium fiber-metal-coated acetabular component with screw fixation had no loosening, no liner dissociation, and a low rate of pelvic osteolysis at 10 to 16 years. Liner exchange is practical without use of cement. We continue to use this component with highly crosslinked polyethylene liners.
Level of Evidence
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Similar content being viewed by others
References
Archibeck MJ, Berger RA, Jacobs JJ, Quigley LR, Gitelis S, Rosenberg AG, Galante JO. Second-generation cementless total hip arthroplasty. Eight to eleven-year results. J Bone Joint Surg Am. 2001;83:1666–1673.
Barrack RL, Lavernia C, Szuszczewicz ES, Sawhney J. Radiographic wear measurements in a cementless metal-backed modular cobalt-chrome acetabular component. J Arthroplasty. 2001;16:820–828.
Bojescul JA, Xenos JS, Callaghan JJ, Savory CG. Results of porous-coated anatomic total hip arthroplasty without cement at fifteen years. A concise follow-up of a previous report. J Bone Joint Surg Am. 2003;85:1079–1083.
Claus AM, Sychterz CJ, Hopper RH, Engh CA (2001) Pattern of osteolysis around two different cementless metal-backed cups Retrospective, radiographic analysis at minimum 10-year follow-up. J Arthroplasty 16(1):177–182.
Crowther JD, Lachiewicz PF. Survival and polyethylene wear of porous-coated acetabular components in patients less than fifty years old: results at nine to fourteen years. J Bone Joint Surg Am. 2002;84:729–735.
DeLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res. 1976;121:20–32.
Della Valle AG, Ruzo PS, Li S, Pellicci P, Sculco TP, Salvati EA. Dislodgement of polyethylene liners in first and second generation Harris-Galante acetabular components. J Bone Joint Surg Am. 2001; 83:553–559.
Della Valle AG, Su E, Zoppi A, Sculco TP, Salvati EA. Wear and periprosthetic osteolysis in a match-paired study of modular and nonmodular uncemented acetabular cups. J Arthroplasty. 2004;19:972–977.
Della Valle AG, Zoppi A, Peterson MG, Salvati EA. Clinical and radiographic results associated with a modern cementless modular cup design in total hip arthroplasty. J Bone Joint Surg Am. 2004;86:1998–2004.
Della Valle CJ, Berger RA, Shott S, Rosenberg AG, Jacobs JJ, Quigley L, Galante JO. Primary total hip arthroplasty with a porous-coated acetabular component. A concise follow-up of a previous report. J Bone Joint Surg Am. 2004;86:1217–1222.
Firestone DE, Callaghan JJ, Liu SS, Goetz DD, Sullivan PM, Vittetoe DA, Johnston RC. Total hip arthroplasty with a cemented, collared femoral stem and a cementless acetabular component. J Bone Joint Surg Am. 2007;89:126–132.
Gaffey JL, Callaghan JJ, Pederson DR, Goetz DD, Sullivan PM, Johnston RC. Cementless acetabular fixation at fifteen years. A comparison with the same surgeon’s results following acetabular fixation with cement. J Bone Joint Surg Am. 2004;86:257–261.
Garcia-Rey E, Garcia-Cimbrelo E, Cordero-Ampuero J. Outcome of a hemispherical porous-coated acetabular component with a proximally hydroxyapatite-coated anatomical femoral component. A 12- to 15-year follow-up study. J Bone Joint Surg Br. 2009;91:327–332.
Grobler GP, Learmonth ID, Bernstein BP, Dower BJ. Ten-year results of a press-fit, porous-coated acetabular component. J Bone Joint Surg Br. 2005;87:786–789.
Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end result study using a new method of result evaluation. J Bone Joint Surg Am. 1969;51:737–755.
Hui AJ, McCalden RW, Martell JM, MacDonald SJ, Bourne RB, Rorabeck CH. Validation of two and three-dimensional radiographic techniques for measuring wear after total hip arthroplasty. J Bone Joint Surg Am. 2003; 85:505–511.
Kawamura H, Dunbar MJ, Murray P, Bourne RB, Rorabeck CH. The porous coated anatomic total hip replacement. A ten to fourteen-year follow-up study of a cementless total hip arthroplasty. J Bone Joint Surg Am. 2001;83:1333–1338.
Kelley SS, Lachiewicz PF, Hickman JM, Paterno SM. Relationship of femoral head and acetabular size to the prevalence of dislocation. Clin Orthop Relat Res. 1998;355:163–170.
Lachiewicz PF, Hubbard JB, Soileau ES. Polyethylene wear and osteolysis with a new modular titanium acetabular component. Results at 7 to 13 years. J Arthroplasty. 2008;23:971–976.
Latimer HA, Lachiewicz PF. Porous-coated acetabular components with screw fixation. Five to ten-year results. J Bone Joint Surg Am. 1996;78:975–981.
Livermore J, Ilstrup D, Morrey B. Effect of femoral head size on wear of the polyethylene acetabular component. J Bone Joint Surg Am. 1990;72:518–528.
Maloney WJ, Herzwurm P, Paprosky W, Rubash HE, Engh CA. Treatment of pelvic osteolysis associated with a stable acetabular component inserted without cement as part of a total hip replacement. J Bone Joint Surg Am. 1997;79:1628–1634.
Martell JM, Berkson E, Berger R, Jacobs J. Comparison of two and three-dimensional wear analysis after total hip arthroplasty. J Bone Joint Surg Am. 2003;85:1111–1117.
Massin P, Schmidt L, Engh CA. Evaluation of cementless acetabular component migration. An experimental study. J Arthroplasty. 1989;4:245–251.
Min BW, Song KS, Kang CH, Won YY, Koo KH. Polyethylene liner failure in second-generation Harris-Galante acetabular components. J Arthroplasty. 2005;20:717–722.
Parvizi J, Sullivan T, Duffy G, Cabanela ME. Fifteen-year clinical survivorship of Harris-Galante total hip arthroplasty. J Arthroplasty. 2004;19:672–677.
Rohrl SM, Nivbrant B, Snorrason F, Karrholm J, Nilsson KG. Porous-coated cups fixed with screws. A 12-year clinical and radiostereometric follow-up study of 50 hips. Acta Orthop. 2006;77:393–401.
Soto MO, Rodriguez JA, Ranawat CS. Clinical and radiographic of the Harris-Galante cup. Incidence of wear and osteolysis at 7 to 9 years follow-up. J Arthroplasty. 2000;15:139–145.
Sychterz CJ, Yang AM, McAuley JP, Engh CA. Two-dimensional versus three-dimensional radiographic measurements of polyethylene wear. Clin Orthop Relat Res. 1999;365:117–123.
Udomkiat P, Dorr LD, Wan Z. Cementless hemispheric porous-coated sockets implanted with press-fit technique without screws: average ten-year follow-up. J Bone Joint Surg Am. 2002;84:1195–1200.
Werle J, Goodman S, Schurman D, Lannin J. Polyethylene liner dissociation in Harris-Galante acetabular components. A report of 7 cases. J Arthroplasty. 2002;17:78–81.
Acknowledgments
We thank Dr John Hubbard for assistance with radiographic measurements, Mr Rich Sloane for performing the survival analysis, and Mr Stephen Perlman for assistance with the literature search.
Author information
Authors and Affiliations
Corresponding author
Additional information
One of the authors (PFL) is a member of the speakers’ bureau of Zimmer, and his institution received research support from Zimmer for a different study.
Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.
About this article
Cite this article
Lachiewicz, P.F., Soileau, E.S. Second-generation Modular Acetabular Components Provide Fixation at 10 to 16 Years. Clin Orthop Relat Res 470, 366–372 (2012). https://doi.org/10.1007/s11999-011-1950-7
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11999-011-1950-7