International Orthopaedics

, Volume 41, Issue 4, pp 715–722 | Cite as

Early aseptic loosening of cementless monoblock acetabular components

  • Simo S. A. Miettinen
  • Tatu J. Mäkinen
  • Inari Laaksonen
  • Keijo Mäkelä
  • Heini Huhtala
  • Jukka Kettunen
  • Ville Remes
Original Paper

Abstract

Purpose

Early aseptic loosening of cementless monoblock acetabular components is a rare complication of total hip arthroplasty (THA) and hip resurfacing arthroplasty (HRA). The purpose of this study was to evaluate the incidence and risk factors for early aseptic loosening of the cementless monoblock acetabular components.

Methods

This retrospective analysis consisted of 4,043 cementless hip devices (3,209 THAs and 834 HRAs). We identified 41 patients with early aseptic loosening of the acetabular component. A control group of 123 patients without acetabular component loosening was randomly selected. The demographic data and risk factors for loosening of the acetabular component were evaluated. The mean follow-up time was 4.6 years (range, 1.7–7.8). The end-point was acetabular revision.

Results

The incidence of early acetabular component loosening was 1.0 %. Mean time to revision was 1.2 years (SD 1.6, range 0.0–5.4). There was significantly more Dorr type A and C acetabular morphology in patients with early loosening (P = 0.014). The loosened components were implanted to more vertical (P < 0.001) and less anteverted (P = 0.001) position than those of the control group. Presence of acetabular dysplasia or acetabular component type did not associate to early loosening.

Conclusions

Acetabular morphology (Dorr type A and C) and component positioning vertically and less anteverted were more common in patients with early aseptic loosening of cementless acetabular components. Suboptimal cup position most likely reflects challenges to obtain sufficient stability during surgery. We hypothesize that errors in surgical technique are the main reason for early loosening of monoblock acetabular components.

Keywords

Acetabular morphology Aseptic loosening Case–control study Cup positioning Hip arthroplasty 

Supplementary material

264_2016_3254_MOESM1_ESM.docx (15 kb)
ESM 1(DOCX 14 kb)
264_2016_3254_MOESM2_ESM.docx (15 kb)
ESM 2(DOCX 15 kb)
264_2016_3254_MOESM3_ESM.docx (25 kb)
ESM 3(DOCX 25 kb)
264_2016_3254_MOESM4_ESM.docx (32 kb)
ESM 4(DOCX 31 kb)

References

  1. 1.
    Krantz N, Miletic B, Migaud H, Girard J (2012) Hip resurfacing in patients under thirty years old: an attractive option for young and active patients. Int Orthop 36:1789–1794CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Carcia-Rey E, Carcia-Cimbrelo E, Cruz-Pardos A (2012) Cup press fit in uncemented THA depends on sex, acetabular shape, and surgical technique. Clin Orthop Relat Res 470:3014–3023CrossRefGoogle Scholar
  3. 3.
    Fadi D, Levine B, Paprosky W, Della Valle C, Sporer S, Klein G, Levine H, Hartzband M (2012) Metal-on-metal total hip arthroplasty: causes and high incidence of early failure. Orthopedics 35:e1009–e1016CrossRefGoogle Scholar
  4. 4.
    Dorr LD, Bechtol CO, Watkins RG, Wan Z (2000) Radiographic anatomic structure of the arthritic acetabulum and its influence on total hip arthroplasty. J Arthroplasty 15:890–900CrossRefPubMedGoogle Scholar
  5. 5.
    Pakvis D, van Hellemondt G, de Visser E, Jacobs W, Spruit M (2011) Is there evidence for a superior method of socket fixation in hip arthroplasty? A systematic review. Int Orthop 35:1109–1118CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    McBryde CW, Theivendran K, Thomas AMC, Treacy RBC, Pynsent PB (2010) The influence of head size and sex on the outcome of Birmingham hip resurfacing. J Bone Joint Surg Am 92A:105–112CrossRefGoogle Scholar
  7. 7.
    Bicanic G, Delimar D, Delimar M, Pecina M (2009) Influence of the acetabular cup position on hip load during arthroplasty in hip dysplasia. Int Orthop 33:397–402CrossRefPubMedGoogle Scholar
  8. 8.
    Schofer MD, Pressel T, Heyse T, Schmitt J, Boudriot U (2010) Radiological determination of the anatomic hip centre from pelvic landmarks. Acta Orthop Belgica 76:479–485Google Scholar
  9. 9.
    Crowe JF, Mani VJ, Ranawat CS (1979) Total hip replacement in congenital dislocation and dysplasia of the hip. J Bone Joint Surg Am 61A:15–23CrossRefGoogle Scholar
  10. 10.
    Wiberg G (1939) Studies on dysplastic acetabula and congenital subluxation of the hip joint with special reference to the complication of osteoarthritis. Acta Chir Scand 83:7–135Google Scholar
  11. 11.
    Sharp IK (1961) Acetabular dysplasia. The acetabular angle. J Bone Joint Surg (Br) 43-B:268–272Google Scholar
  12. 12.
    Cooperman DR, Wallensten R, Stulberg SD (1983) Acetabular dysplasia in the adult. Clin Orthop Relat Res 175:79–85Google Scholar
  13. 13.
    Heyman CH, Herndon CH (1950) Legg-Perthes disease; a method for the measurement of the roentgenographic result. J Bone Joint Surg Am 32A:767–778CrossRefGoogle Scholar
  14. 14.
    Fessy MH, N’diaye A, Carret JP, Fischer LP (1999) Locating the center of rotation of the hip. Surg Radiol Anat 21:247–250CrossRefPubMedGoogle Scholar
  15. 15.
    Widmer KH (2004) A simplified method to determine acetabular cup anteversion from plain radiographs. J Arthroplasty 19:387–390CrossRefPubMedGoogle Scholar
  16. 16.
    Murray DW (1993) The definition and measurement of acetabular orientation. J Bone Joint Surg (Br) 75B:228–232Google Scholar
  17. 17.
    Craiovan B, Renkawitz T, Weber M, Grifka J, Nolte L, Zhneg G (2014) Is the acetabular cup orientation after total hip arthroplasty on a two dimension of three dimension model accurate? Int Orthop 38:2009–2015CrossRefPubMedGoogle Scholar
  18. 18.
    Sarmiento A, Ebramzadeh E, Gogan WJ, McKellop HA (1990) Cup containment and orientation in cemented total hip arthroplasties. J Bone Joint Surg (Br) 72-B:996–1002Google Scholar
  19. 19.
    DeLee JG, Charnley J (1976) Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res 121:20–32Google Scholar
  20. 20.
    Mäkelä KT, Matilainen M, Pulkkinen P, Fenstad AM, Havelin L, Engesaeter L, Furnes O, Pedersen AB, Overgaarg S, Kärrholm J, Malchau H, Garellick G, Ranstam J, Eskelinen A (2014) Failure rate of cemented and uncemented total hip replacements: register study of combined Nordic database of four nations. BMJ 348:f7592CrossRefPubMedGoogle Scholar
  21. 21.
    Lee PY, Rachala M, Teoh KH, Woodnutt DJ (2016) Long-term results with Atlas IIIp elastic cementless acetabular component in total hip replacement. Int Orthop. 2016 Jan 12 [Epub ahead of print]Google Scholar
  22. 22.
    Volkmann R, Schneider MA, Bretschneider C, Weise K (1999) More failures of uncemented acetabular screw-rings than of cemented polyethylene cups in total hip arthroplasties. Int Orthop 23:138–139CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Ni SH, Guo L, Jiang TL, Zhao J, Zhao YG (2014) Press-fit cementless acetabular fixation with and without screws. Int Orthop 38:7–12CrossRefPubMedGoogle Scholar
  24. 24.
    Smith TO, Nichols R, Donell ST, Hing CB (2010) The clinical and radiological outcomes of hip resurfacing versus total hip arthroplasty: a meta-analysis and systematic review. Arch Orthop 81:684–695Google Scholar
  25. 25.
    Stocks GW, Freeman MA, Evans SJ (1995) Acetabular cup migration. Prediction of aseptic loosening. J Bone Joint Surg (Br) 77-B:853–861Google Scholar
  26. 26.
    Stihsen C, Rath C, Radl R, Saalabian AA, Materna W, Rehak P, Windhaer R (2013) Early migration characteristics of a 180° porous-coated cups with 1-mm press fit. Arch Orthop Trauma Surg 133:707–712CrossRefPubMedGoogle Scholar
  27. 27.
    Mjoberg B (1991) Fixation and loosening of hip prostheses. Rev Acta Orthop Scand 62:500–508CrossRefGoogle Scholar
  28. 28.
    Pellici PM, Salvati EA, Robinson HJ (1979) Mechanical failures in total hip replacement requiring reoperation. J Bone Joint Surg Am 61-A:28–36CrossRefGoogle Scholar

Copyright information

© SICOT aisbl 2016

Authors and Affiliations

  • Simo S. A. Miettinen
    • 1
  • Tatu J. Mäkinen
    • 2
  • Inari Laaksonen
    • 3
  • Keijo Mäkelä
    • 3
  • Heini Huhtala
    • 4
  • Jukka Kettunen
    • 1
  • Ville Remes
    • 2
    • 5
  1. 1.Department of Orthopaedics, Traumatology and Hand SurgeryKuopio University HospitalKuopioFinland
  2. 2.Department of Orthopaedics and TraumatologyHelsinki University Hospital and University of HelsinkiVantaaFinland
  3. 3.Department of Orthopaedics and TraumatologyTurku University Central HospitalTurkuFinland
  4. 4.School of Health SciencesUniversity of TampereTampereFinland
  5. 5.Pihlajalinna OyHelsinkiFinland

Personalised recommendations