Skip to main content
SpringerLink
Log in

Porous titanium construct cup compared to porous coated titanium cup in total hip arthroplasty. A randomised controlled trial

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

The purpose of this study was to determine if a new titanium cup with increased porosity resulted in different periacetabular bone loss and migration compared to a porous coated cup.

Methods

Fifty-one patients with primary hip osteoarthritis were randomized to either a cup with porous titanium construct backside (porous titanium group, n = 25) or a conventional porous coated titanium cup (control group, n = 26). The primary outcome variable was change in periacetabular bone mineral density two years after surgery measured with dual energy X-ray absorptiometry (DXA). Secondary outcomes were implant fixation measured with radiostereometry (RSA) and clinical outcome scores.

Results

The pattern of bone remodelling was similar in the two groups with almost complete restoration to baseline values. BMD diminished in the two proximal zones and increased in the two distal zones. After minimal migration up to six months all implants in both groups became stable. We found no difference between the two groups in clinical outcome scores.

Conclusions

In this prospective, randomized, controlled trial on a new porous titanium cup we found, compared to the control group, no clinically relevant differences regarding periacetabular bone preservation, implant fixation or clinical outcome up to two years postoperatively.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Thanner J, Karrholm J, Malchau H, Herberts P (1999) Poor outcome of the PCA and Harris-Galante hip prostheses. Randomized study of 171 arthroplasties with 9-year follow-up. Acta Orthop Scand 70(2):155–162

    Article  CAS  PubMed  Google Scholar 

  2. Hallan G, Lie SA, Havelin LI (2006) High wear rates and extensive osteolysis in 3 types of uncemented total hip arthroplasty: a review of the PCA, the Harris Galante and the Profile/Tri-Lock Plus arthroplasties with a minimum of 12 years median follow-up in 96 hips. Acta Orthop 77(4):575–584. doi:10.1080/17453670610012638

    Article  PubMed  Google Scholar 

  3. Lim L, Bobyn JD, Bobyn KM, Lefebvre LP, Tanzer M (2012) The Otto Aufranc Award: Demineralized bone matrix around porous implants promotes rapid gap healing and bone ingrowth. Clin Orthop Relat Res 470(2):357–365. doi:10.1007/s11999-011-2011-y

    Article  PubMed Central  PubMed  Google Scholar 

  4. Schulz KF, Altman DG, Moher D (2010) CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. BMJ 340:c332

    Article  PubMed Central  PubMed  Google Scholar 

  5. Dorr LD, Faugere MC, Mackel AM, Gruen TA, Bognar B, Malluche HH (1993) Structural and cellular assessment of bone quality of proximal femur. Bone 14(3):231–242

    Article  CAS  PubMed  Google Scholar 

  6. Moore AT (1957) The self-locking metal hip prosthesis. J Bone Joint Surg Am 39-A(4):811–827

    CAS  PubMed  Google Scholar 

  7. Wilkinson JM, Peel NF, Elson RA, Stockley I, Eastell R (2001) Measuring bone mineral density of the pelvis and proximal femur after total hip arthroplasty. J Bone Joint Surg (Br) 83(2):283–288

    Article  CAS  Google Scholar 

  8. Laursen MB, Nielsen PT, Soballe K (2005) DXA scanning of acetabulum in patients with cementless total hip arthroplasty. J Clin Densitom 8(4):476–483

    Article  PubMed  Google Scholar 

  9. Borlin N, Rohrl SM, Bragdon CR (2006) RSA wear measurements with or without markers in total hip arthroplasty. J Biomech 39(9):1641–1650

    Article  PubMed  Google Scholar 

  10. Valstar ER, Gill R, Ryd L, Flivik G, Börlin N, Kärrholm J (2005) Guidelines for standardization of radiostereometry (RSA) of implants. Acta Orthop 76(4):563–572. doi:10.1080/17453670510041574

    Article  PubMed  Google Scholar 

  11. Lazarinis S, Milbrink J, Mattsson P, Mallmin H, Hailer NP (2014) Bone loss around a stable, partly threaded hydroxyapatite-coated cup: a prospective cohort study using RSA and DXA. Hip Int 24(2):155–166. doi:10.5301/hipint.5000104

    Article  PubMed  Google Scholar 

  12. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW (1988) Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 15(12):1833–1840

    CAS  PubMed  Google Scholar 

  13. Rabin R, de Charro F (2001) EQ-5D: a measure of health status from the EuroQol Group. Ann Med 33(5):337–343

    Article  CAS  PubMed  Google Scholar 

  14. Baad-Hansen T, Kold S, Nielsen PT, Laursen MB, Christensen PH, Soballe K (2011) Comparison of trabecular metal cups and titanium fiber-mesh cups in primary hip arthroplasty: a randomized RSA and bone mineral densitometry study of 50 hips. Acta Orthop 82(2):155–160. doi:10.3109/17453674.2011.572251

    Article  PubMed Central  PubMed  Google Scholar 

  15. Rahmy AI, Gosens T, Blake GM, Tonino A, Fogelman I (2004) Periprosthetic bone remodelling of two types of uncemented femoral implant with proximal hydroxyapatite coating: a 3-year follow-up study addressing the influence of prosthesis design and preoperative bone density on periprosthetic bone loss. Osteoporos Int 15(4):281–289

    Article  CAS  PubMed  Google Scholar 

  16. Skoldenberg OG, Salemyr MO, Boden HS, Ahl TE, Adolphson PY (2011) The effect of weekly risedronate on periprosthetic bone resorption following total hip arthroplasty: a randomized, double-blind, placebo-controlled trial. J Bone Joint Surg Am 93(20):1857–1864. doi:10.2106/JBJS.J.01646

    Article  PubMed  Google Scholar 

  17. Alm JJ, Makinen TJ, Lankinen P, Moritz N, Vahlberg T, Aro HT (2009) Female patients with low systemic BMD are prone to bone loss in Gruen zone 7 after cementless total hip arthroplasty. Acta Orthop 80 (5):531–537. doi:10.3109/17453670903316801 [pii] 10.3109/17453670903316801

  18. Brodner W, Bitzan P, Lomoschitz F, Krepler P, Jankovsky R, Lehr S, Kainberger F, Gottsauner-Wolf F (2004) Changes in bone mineral density in the proximal femur after cementless total hip arthroplasty a five-year longitudinal study. J Bone Joint Surg Br 86(1):20–26

    CAS  PubMed  Google Scholar 

  19. Laursen MB, Nielsen PT, Soballe K (2007) Bone remodelling around HA-coated acetabular cups : a DEXA study with a 3-year follow-up in a randomised trial. Int Orthop 31(2):199–204. doi:10.1007/s00264-006-0148-1

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  20. Penny JO, Brixen K, Varmarken JE, Ovesen O, Overgaard S (2012) Changes in bone mineral density of the acetabulum, femoral neck and femoral shaft, after hip resurfacing and total hip replacement: Two-year results from a randomised study. J Bone Joint Surg (Br) 94(8):1036–1044

    Article  CAS  Google Scholar 

  21. Digas G, Kärrholm J, Thanner J (2006) Different loss of BMD using uncemented press-fit and whole polyethylene cups fixed with cement: repeated DXA studies in 96 hips randomized to 3 types of fixation. Acta Orthop 77(2):218–226

    Article  PubMed  Google Scholar 

  22. Schmidt R, Kress AM, Nowak M, Forst R, Nowak TE, Mueller LA (2012) Periacetabular cortical and cancellous bone mineral density loss after press-fit cup fixation: a prospective 7-year follow-up. J Arthroplasty 27(7):1358–1363. doi:10.1016/j.arth.2011.09.031

    Article  PubMed  Google Scholar 

  23. Karrholm J, Borssen B, Lowenhielm G, Snorrason F (1994) Does early micromotion of femoral stem prostheses matter? 4–7-year stereoradiographic follow-up of 84 cemented prostheses. J Bone Joint Surg (Br) 76(6):912–917

    CAS  Google Scholar 

  24. Karrholm J (2012) Radiostereometric analysis of early implant migration—a valuable tool to ensure proper introduction of new implants. Acta Orthop 83(6):551–552. doi:10.3109/17453674.2012.745352

    Article  PubMed Central  PubMed  Google Scholar 

  25. Pijls BG, Nieuwenhuijse MJ, Fiocco M, Plevier JW, Middeldorp S, Nelissen RG, Valstar ER (2012) Early proximal migration of cups is associated with late revision in THA: a systematic review and meta-analysis of 26 RSA studies and 49 survival studies. Acta Orthop 83(6):583–591. doi:10.3109/17453674.2012.745353

    Article  PubMed Central  PubMed  Google Scholar 

  26. Wolf O, Mattsson P, Milbrink J, Larsson S, Mallmin H (2012) The effects of different weight-bearing regimes on press-fit cup stability: a randomised study with five years of follow-up using radiostereometry. Int Orthop 36(4):735–740. doi:10.1007/s00264-011-1413-5

    Article  PubMed Central  PubMed  Google Scholar 

  27. Zhou ZK, Li MG, Borlin N, Wood DJ, Nivbrant B (2006) No increased migration in cups with ceramic-on-ceramic bearing: an RSA study. Clin Orthop Relat Res 448:39–45. doi:10.1097/01.blo.0000223999.10389.c9

Download references

Acknowledgments

We gratefully acknowledge help in funding from these foundations: Ulla and Gustaf Ugglas Stiftelse, Åke Wiberg Stiftelse, Loo and Hans Ostermans Stiftelse, Sven Norén Foundation, and the regional agreement on medical training and clinical research (ALF) between Stockholm County Council and Karolinska Institutet.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Unit of Orthopaedics, Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, 182 88, Stockholm, Sweden

    Mats Salemyr, Olle Muren, Thomas Eisler, Henrik Bodén, Ghazi Chammout, André Stark & Olof Sköldenberg

Authors
  1. Mats Salemyr
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Olle Muren
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Thomas Eisler
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Henrik Bodén
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ghazi Chammout
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. André Stark
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Olof Sköldenberg
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Olof Sköldenberg.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Salemyr, M., Muren, O., Eisler, T. et al. Porous titanium construct cup compared to porous coated titanium cup in total hip arthroplasty. A randomised controlled trial. International Orthopaedics (SICOT) 39, 823–832 (2015). https://doi.org/10.1007/s00264-014-2571-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-014-2571-z

Keyword

Search

Navigation