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Cementless total hip replacement: a prospective clinical study of the early functional and radiological outcomes of three different hip stems

  • Orthopaedic Outcome Assessment
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Abstract

Introduction

Optimal fixation of cementless total hip stems is essential for long-term survival rates.

Aim

The purpose of this prospective study was to evaluate the early clinical and radiological outcomes of two new total hip stems with metaphyseal (Symax®) and predominantly diaphyseal (Hipstar®) anchoring principles in comparison to the well-established straight Zweymueller (SL-Plus®) stem.

Method

Clinical and radiological evaluations of 74 patients were undertaken preoperatively as well as at 6 and 12 months postoperatively using the Harris Hip Score (HHS) and Western Ontario and McMaster Universities-Score.

Results

During follow-up no stem had to be revised. The mean preoperative HHS of the three study groups amounted to 54.6 ± 15.7 points. At the 12 months follow-up the mean HHS in the SL-Plus group (n = 22) was 88.3 ± 10.5 points, in the Hipstar group (n = 25) 83.3 ± 15.0 and the in Symax group (n = 27) 83.6 ± 15.1. Due to stress shielding the straight Hipstar stem revealed radiolucent lines in the proximal Gruen zones of about 60%, whereas the SL-Plus stem showed significantly more radiolucent lines (87%). However, subsequent long-term studies must be carried out in order to clarify if the progression of radiolucent lines may influence the clinical result and implant longevity.

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References

  1. Nercessian OA, Wu WH, Sarkissian H (2001) Clinical and radiological results of cementless AML total hip arthroplasty in young patients. J Arthroplasty 16:312–216

    Google Scholar 

  2. Nourbash PS, Paprosky WG (1988) Cementless femoral design concerns. Rationale for extensive porous coating. Clin Orthop Relat Res 355:189–199

    Article  Google Scholar 

  3. Kircher J, Bergschmidt P, Bader R, Kluess D, Besser-Mahuzir E, Leder A, Mittelmeier W (2007) The importance of wear couples for younger endoprosthesis patients. Orthopade 36:337–346

    Article  CAS  PubMed  Google Scholar 

  4. Racey SN, McCaskie AW, Jones E, Birch MA (2004) Iron and alumina grit blasted TMFZ alloys differentially regulate bone formation in vitro. Eur Cell Mater 7(Suppl 1):81

    Google Scholar 

  5. Schuh A, Uter W, Holzwarth U, Kachler W, Goske Raab B, Knetsch T (2005) Residual particle-free rough surfaces after rough blasting with steel grit in total hip arthroplasty. Biomed Tech 50:404–407

    Article  CAS  Google Scholar 

  6. Antonio JA, Capello WN, Manley MT, Geesink R (2001) Hydroxyapatite femoral stems for total hip arthroplasty: 10- to 13-year follow-up. Clin Orthop Relat Res 393:101–111

    Article  PubMed  Google Scholar 

  7. Diehl P, Hantke B, Hennig M, Tschesche H, Mittelmeier W, Schmitt M, Muehlenweg B (2004) Protein expression of MMP-13, uPA, and PAI-1 in pseudocapsular and interface tissue around implants of loose artificial hip joints and in osteoarthritis. Int J Mol Med 13:711–715

    CAS  PubMed  Google Scholar 

  8. Siebold R, Scheller G, Schreiner U, Jani L (2001) Long-term results with the cement-free Spotorno CLS stem. Orthopade 30:317–322

    Article  CAS  PubMed  Google Scholar 

  9. Traulsen FC, Hassenpflug J, Hahne HJ (2001) Long-term results with cement-free total hip prosthesis (Zweymüller). Z Orthop Ihre Grenzgeb 139:206–211

    Article  CAS  PubMed  Google Scholar 

  10. Schramm M, Keck F, Hohmann D, Pitto RP (2000) Total hip arthroplasty using an uncemented femoral component with a taper design: outcome at 10-year follow-up. Arch Orthop Trauma Surg 120:407–412

    Article  CAS  PubMed  Google Scholar 

  11. Zweymueller K, Lintner F, Semlitsch M (1988) Biologic fixation of a press-fit titanium hip joint endoprosthesis. Clin Orthop Relat Res 235:195–206

    Google Scholar 

  12. Garcia-Cimbrello E, Cruz-Pardos A, Madero R, Ortega-Andreu M (2003) Total hip arthroplasty with use of the cementless Zweymüller Alloclassic system. J Bone Joint Surg 85A:296–303

    Google Scholar 

  13. Zweymueller K (1986) A cementless titanium hip endoprosthesis system based on press-fit fixation: basic research and clinical results. Instr Course Lect 35:203–225

    Google Scholar 

  14. Prymka M, Vogiatzis M, Hassenpflug J (2004) Primary rotatory stability of hip endoprostheses stems after manual and robot assisted implantation. Z Orthop 142:303–308

    Article  CAS  PubMed  Google Scholar 

  15. Harris WH (1969) Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. J Bone Joint Surg 51A:737–755

    Google Scholar 

  16. Bellamy N, Buchanan W, 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 and the knee. J Rheumatol 15:1833–1840

    CAS  PubMed  Google Scholar 

  17. Bergschmidt P, Bader R, Finze S, Ansorge S, Kundt G, Mittelmeier W (2008) Bicondylar knee arthroplasty—influence of preoperative functional restriction on early functional postoperative outcome. Z Orthop Unfall 146:344–351

    Article  CAS  PubMed  Google Scholar 

  18. Gruen TA, McNeice GM, Amstutz HC (1979) Modes of failure of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res 141:17–27

    PubMed  Google Scholar 

  19. Brooker AF, Bowerman JW, Robinson RA, Riley LH (1973) Ectopic ossification following total hip arthroplasty. Incidence and method of classification. J Bone Joint Surg 55:1629–1632

    CAS  PubMed  Google Scholar 

  20. Engh CA, Bohyn JD (1978) Porous coated hip replacement: the factors governing bone ingrowth, stress shielding, and clinical results. J Bone Joint Surg 69B:45–55

    Google Scholar 

  21. Bülow JU, Scheller G, Arnold P, Synatschke M, Jani L (1996) Follow-up (6–9 years) results of the uncemented CLS spotorno stem. Arch Orthop Trauma Surg 115:190–194

    Article  PubMed  Google Scholar 

  22. Nilsdotter AK, Petersson IF, Roos EM, Lohmander LS (2003) Predictors of patient relevant outcome after total hip replacement for osteoarthritis: a prospective study. Ann Rheum Dis 62:923–930

    Article  PubMed  Google Scholar 

  23. Aarons H, Hall G, Hughes S, Salmon P (1996) Short-term recovery from hip and knee arthroplasty. J Bone Joint Surg 78B:555–558

    Google Scholar 

  24. van der Wal BC, de Kramer BJ, Grimm B, Vencken W, Heyligers IC, Tonino BJ (2008) Femoral fit in ABG-II hip stems, influence on clinical outcome and bone remodeling: a radiographic study. Arch Orthop Trauma Surg 128(10):1065–1072

    Article  PubMed  Google Scholar 

  25. Huiskes R (1993) Stress shielding and bone resorption in THA: clinical versus computer-stimulation studies. Acta Orthop Belg 59:118–129

    PubMed  Google Scholar 

  26. Bugbee WD, Culpepper WJII, Engh CA Jr, Engh CA Sr (1997) Long-term clinical consequences of stress-shielding after total hip arthroplasty without cement. J Bone Joint Surg 79A:1007–1012

    Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedics, University of Rostock, Doberaner Strasse 142, 18057, Rostock, Germany

    Philipp Bergschmidt, Rainer Bader, Susanne Finze, Alexander Gankovych & Wolfram Mittelmeier

  2. Department of Medical Informatics and Biometry, University of Rostock, Rembrandtstrasse 16/17, 18057, Rostock, Germany

    Guenther Kundt

Authors
  1. Philipp Bergschmidt
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  2. Rainer Bader
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  3. Susanne Finze
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  4. Alexander Gankovych
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  5. Guenther Kundt
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  6. Wolfram Mittelmeier
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Correspondence to Philipp Bergschmidt.

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Bergschmidt, P., Bader, R., Finze, S. et al. Cementless total hip replacement: a prospective clinical study of the early functional and radiological outcomes of three different hip stems. Arch Orthop Trauma Surg 130, 125–133 (2010). https://doi.org/10.1007/s00402-009-0907-8

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  • DOI: https://doi.org/10.1007/s00402-009-0907-8

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