Second-generation Modular Acetabular Components Provide Fixation at 10 to 16 Years
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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.
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?
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.
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.
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.
- Archibeck, MJ, Berger, RA, Jacobs, JJ, Quigley, LR, Gitelis, S, Rosenberg, AG, Galante, JO (2001) Second-generation cementless total hip arthroplasty. Eight to eleven-year results. J Bone Joint Surg Am. 83: pp. 1666-1673
- Barrack, RL, Lavernia, C, Szuszczewicz, ES, Sawhney, J (2001) Radiographic wear measurements in a cementless metal-backed modular cobalt-chrome acetabular component. J Arthroplasty. 16: pp. 820-828 CrossRef
- Bojescul, JA, Xenos, JS, Callaghan, JJ, Savory, CG (2003) 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. 85: pp. 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: pp. 177-182 CrossRef
- Crowther, JD, Lachiewicz, PF (2002) 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. 84: pp. 729-735 CrossRef
- DeLee, JG, Charnley, J (1976) Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res. 121: pp. 20-32
- Della Valle, AG, Ruzo, PS, Li, S, Pellicci, P, Sculco, TP, Salvati, EA (2001) Dislodgement of polyethylene liners in first and second generation Harris-Galante acetabular components. J Bone Joint Surg Am. 83: pp. 553-559
- Della Valle, AG, Su, E, Zoppi, A, Sculco, TP, Salvati, EA (2004) Wear and periprosthetic osteolysis in a match-paired study of modular and nonmodular uncemented acetabular cups. J Arthroplasty. 19: pp. 972-977 CrossRef
- Della Valle, AG, Zoppi, A, Peterson, MG, Salvati, EA (2004) Clinical and radiographic results associated with a modern cementless modular cup design in total hip arthroplasty. J Bone Joint Surg Am. 86: pp. 1998-2004
- Della Valle, CJ, Berger, RA, Shott, S, Rosenberg, AG, Jacobs, JJ, Quigley, L, Galante, JO (2004) Primary total hip arthroplasty with a porous-coated acetabular component. A concise follow-up of a previous report. J Bone Joint Surg Am. 86: pp. 1217-1222
- Firestone, DE, Callaghan, JJ, Liu, SS, Goetz, DD, Sullivan, PM, Vittetoe, DA, Johnston, RC (2007) Total hip arthroplasty with a cemented, collared femoral stem and a cementless acetabular component. J Bone Joint Surg Am. 89: pp. 126-132 CrossRef
- Gaffey, JL, Callaghan, JJ, Pederson, DR, Goetz, DD, Sullivan, PM, Johnston, RC (2004) Cementless acetabular fixation at fifteen years. A comparison with the same surgeon’s results following acetabular fixation with cement. J Bone Joint Surg Am. 86: pp. 257-261
- Garcia-Rey, E, Garcia-Cimbrelo, E, Cordero-Ampuero, J (2009) 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 91: pp. 327-332 CrossRef
- Grobler, GP, Learmonth, ID, Bernstein, BP, Dower, BJ (2005) Ten-year results of a press-fit, porous-coated acetabular component. J Bone Joint Surg Br. 87: pp. 786-789 CrossRef
- Harris, WH (1969) 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. 51: pp. 737-755
- Hui, AJ, McCalden, RW, Martell, JM, MacDonald, SJ, Bourne, RB, Rorabeck, CH (2003) Validation of two and three-dimensional radiographic techniques for measuring wear after total hip arthroplasty. J Bone Joint Surg Am. 85: pp. 505-511
- Kawamura, H, Dunbar, MJ, Murray, P, Bourne, RB, Rorabeck, CH (2001) 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. 83: pp. 1333-1338
- Kelley, SS, Lachiewicz, PF, Hickman, JM, Paterno, SM (1998) Relationship of femoral head and acetabular size to the prevalence of dislocation. Clin Orthop Relat Res. 355: pp. 163-170 CrossRef
- Lachiewicz, PF, Hubbard, JB, Soileau, ES (2008) Polyethylene wear and osteolysis with a new modular titanium acetabular component. Results at 7 to 13 years. J Arthroplasty 23: pp. 971-976 CrossRef
- Latimer, HA, Lachiewicz, PF (1996) Porous-coated acetabular components with screw fixation. J Bone Joint Surg Am. 78: pp. 975-981
- Livermore, J, Ilstrup, D, Morrey, B (1990) Effect of femoral head size on wear of the polyethylene acetabular component. J Bone Joint Surg Am. 72: pp. 518-528
- Maloney, WJ, Herzwurm, P, Paprosky, W, Rubash, HE, Engh, CA (1997) 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. 79: pp. 1628-1634
- Martell, JM, Berkson, E, Berger, R, Jacobs, J (2003) Comparison of two and three-dimensional wear analysis after total hip arthroplasty. J Bone Joint Surg Am. 85: pp. 1111-1117
- Massin, P, Schmidt, L, Engh, CA (1989) Evaluation of cementless acetabular component migration. An experimental study. J Arthroplasty. 4: pp. 245-251 CrossRef
- Min, BW, Song, KS, Kang, CH, Won, YY, Koo, KH (2005) Polyethylene liner failure in second-generation Harris-Galante acetabular components. J Arthroplasty. 20: pp. 717-722 CrossRef
- Parvizi, J, Sullivan, T, Duffy, G, Cabanela, ME (2004) Fifteen-year clinical survivorship of Harris-Galante total hip arthroplasty. J Arthroplasty. 19: pp. 672-677 CrossRef
- Rohrl, SM, Nivbrant, B, Snorrason, F, Karrholm, J, Nilsson, KG (2006) Porous-coated cups fixed with screws. A 12-year clinical and radiostereometric follow-up study of 50 hips. Acta Orthop 77: pp. 393-401 CrossRef
- Soto, MO, Rodriguez, JA, Ranawat, CS (2000) Clinical and radiographic of the Harris-Galante cup. Incidence of wear and osteolysis at 7 to 9 years follow-up. J Arthroplasty 15: pp. 139-145 CrossRef
- Sychterz, CJ, Yang, AM, McAuley, JP, Engh, CA (1999) Two-dimensional versus three-dimensional radiographic measurements of polyethylene wear. Clin Orthop Relat Res. 365: pp. 117-123 CrossRef
- Udomkiat, P, Dorr, LD, Wan, Z (2002) Cementless hemispheric porous-coated sockets implanted with press-fit technique without screws: average ten-year follow-up. J Bone Joint Surg Am. 84: pp. 1195-1200
- Werle, J, Goodman, S, Schurman, D, Lannin, J (2002) Polyethylene liner dissociation in Harris-Galante acetabular components. A report of 7 cases. J Arthroplasty 17: pp. 78-81 CrossRef
- Second-generation Modular Acetabular Components Provide Fixation at 10 to 16 Years
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