Abstract
Porous surfaces are intended to enhance osteointegration of cementless implants. Tantalum has been introduced in an effort to enhance osseointegration potential of uncemented components. We therefore compared the clinical outcome of acetabular components with two different porous surfaces. We retrospectively reviewed 283 patients (295 hips) who underwent cementless revision hip arthroplasty with either an HA-coated titanium cup (207 patients, 214 hips) or porous tantalum cup (79 patients, 81 hips). The minimum followup was 24 months in both groups (titanium: average 51.8 months, range, 24–98 months; tantalum: average, 35.4 months, range, 24–63 months). The titanium and tantalum groups had a mechanical failure rate (clinical plus radiographic) of 8% and 6%, respectively. In hips with minor bone deficiency (type 1, 2A, 2B using the classification of Paprosky et al.), 6% of titanium cups and 4% of tantalum cups failed. In hips with major bone deficiency (type 2C, 3), 24% of titanium cups and 12% of tantalum cups developed failure. In the major bone deficiency group, the tantalum cups had fewer numbers of lucent zones around the cup. Eighty-two percent of titanium cups that failed did so at 6 months postoperatively or later, whereas 80% of tantalum cups that failed did so in less than 6 months. Radiographically in the major group, tantalum cups yielded better fixation.
Level of Evidence: Level III, retrospective comparative study. See the Guidelines for Authors for a complete description of levels of evidence.
Similar content being viewed by others
References
Bobyn JD, Stackpool GJ, Hacking SA, Tanzer M, Krygier JJ. Characteristics of bone ingrowth and interface mechanics of a new porous tantalum biomaterial. J Bone Joint Surg Br. 1999;81:907–914.
Bobyn JD, Toh KK, Hacking SA, Tanzer M, Krygier JJ. Tissue response to porous tantalum acetabular cups: a canine model. J Arthroplasty. 1999;14:347–354.
Boscainos PJ, Kellett CF, Maury AC, Backstein D, Gross AE. Management of periacetabular bone loss in revision hip arthroplasty. Clin Orthop Relat Res. 2007;465:159–165.
Cohen R. A porous tantalum trabecular metal: basic science. Am J Orthop. 2002;31:216–217.
DeLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res. 1976;121:20–32.
Dorairajan A, Reddy RM, Krikler S. Outcome of acetabular revision using an uncemented hydroxyapatite-coated component: two- to five-year results and review. J Arthroplasty. 2005;20:209–218.
Gruen TA, Poggie RA, Lewallen DG, Hanssen AD, Lewis RJ, O’Keefe TJ, Stulberg SD, Sutherland CJ. Radiographic evaluation of a monoblock acetabular component: a multicenter study with 2- to 5-year results. J Arthroplasty. 2005;20:369–378.
Hanssen AD, Lewallen DG. Modular acetabular augments: composite void fillers. Orthopedics. 2005;28:971–972.
Kim WY, Greidanus NV, Duncan CP, Masri BA, Garbuz DS. Porous tantalum uncemented acetabular shells in revision total hip replacement: two to four year clinical and radiographic results. Hip Int. 2008;18:17–22.
Klika AK, Murray TG, Darwiche H, Barsoum W.K. Options for acetabular fixation surfaces. J Long Term Eff Med Implants. 2007;17:187–192.
Kokubo T, Kim HM, Kawashita M. Novel bioactive materials with different mechanical properties. Biomaterials. 2003;24:2161–2175.
Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007;89:780–785.
Levine BR, Sporer S, Poggie RA, Della Valle CJ, Jacobs JJ. Experimental and clinical performance of porous tantalum in orthopedic surgery. Biomaterials. 2006;27:4671–4681.
Malkani AL, Price MR, Crawford CH 3rd, Baker DL. Acetabular component revision using a porous tantalum biomaterial a case series. J Arthroplasty. 2008 Sep 26 [Epub ahead of print].
Matsuno H, Yokoyama A, Watari F, Uo M, Kawasaki T. Biocompatibility and osteogenesis of refractory metal implants, titanium, hafnium, niobium, tantalum and rhenium. Biomaterials. 2001;22:1253–1262.
Miyaza T, Kim HM, Kokubo T, Ohtsuki C, Kato H, Nakamura T. Mechanism of bonelike apatite formation on bioactive tantalum metal in a simulated body fluid. Biomaterials. 2002;23:827–832.
Moore MS, McAuley JP, Young AM, Engh CA, Sr. Radiographic signs of osseointegration in porous-coated acetabular components. Clin Orthop Relat Res. 2006;444:176–183.
Ng TP, Chiu KY. Acetabular revision without cement. J Arthroplasty. 2003;18:435–441.
Paprosky WG, Perona PG, Lawrence JM. Acetabular defect classification and surgical reconstruction in revision arthroplasty. A 6-year follow-up evaluation. J Arthroplasty. 1994;9:33–44.
Reikerås O, Gunderson RB. Failure of HA coating on a gritblasted acetabular cup: 155 patients followed for 7–10 years. Acta Orthop Scand. 2002;73:104–108.
Rodriguez JA. Acetabular fixation options: notes from the other side. J Arthroplasty. 2006;21:93–96.
Siegmeth A, Duncan CP, Masri BA, Kim WY, Garbuz DS. Modular tantalum augments for acetabular defects in revision hip arthroplasty. Clin Orthop Relat Res. 2009;467:199–205.
Sporer SM, Paprosky WG, O’Rourke MR. Managing bone loss in acetabular revision. Instr Course Lect. 2006;55:287–297.
Stiehl JB. Trabecular metal in hip reconstructive surgery. Orthopedics. 2005;28:662–670.
Templeton JE, Callaghan JJ, Goetz DD, Sullivan PM, Johnston RC. Revision of a cemented acetabular component to a cementless acetabular component. A ten to fourteen-year follow-up study. J Bone Joint Surg Am. 2001;83:1706–1711.
Unger AS, Lewis RJ, Gruen T. Evaluation of a porous tantalum uncemented acetabular cup in revision total hip arthroplasty: clinical and radiological results of 60 hips. J Arthroplasty. 2005;20:1002–1009.
Van Kleunen JP, Lee GC, Lementowski PW, Nelson CL, Garino JP. Acetabular revisions using trabecular metal cups and augments. J Arthroplasty. 2009 Mar 31 [Epub ahead of print].
Author information
Authors and Affiliations
Corresponding author
Additional information
Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. Drs. Sharkey and Parvizi are consultant surgeons of Stryker Orthopaedics.
Each author certifies that his or her institution has approved the human protocol for this investigation and 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
Jafari, S.M., Bender, B., Coyle, C. et al. Do Tantalum and Titanium Cups Show Similar Results in Revision Hip Arthroplasty?. Clin Orthop Relat Res 468, 459–465 (2010). https://doi.org/10.1007/s11999-009-1090-5
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11999-009-1090-5