Cementless Total Hip Arthroplasty

Abstract

The differences between prostheses fixed with and without cement are mainly in the design and nature of the surface implant. The shapes of the sockets to be implanted without cement show a wide variety: cylinder, square, conus, and ellipsoid with and without threads. The hemispheric shape, however, which was chosen for the acetabular component of the isoelastic hip joint, does not disturb the natural form and function of the hip joint since the outer surface is closely adapted to the original subchondral bone layer. The noncemented cup is secured by threads, pegs, screws, etc., and by ingrowth of bony tissue in the grooves of the surfaces. Most femoral stems are based on the self-locking principle. All prosthetic models incorporate attempts to increase the surface of the stem (ribs, wings, corrugations, rims, etc.). There is a tendency to use less rigid elastic implants instead of the well known rigid metallic prostheses. The aim is to overcome the problems of stress protection and stress concentration observed with rigid implants. For the biomechanical integration of an implant, the properties of the surface, especially macroporosity and microporosity, are important. Most European models of noncemented endoprostheses are based on macroporosity (porometal, madreporic, etc.). The increase in implant surface area achieved with macroscopic perforations and recesses is relatively minor compared with the possibilities offered by microporosity ("alumine fritée," Proplast, fiber-metal, etc.). The best indication for use of a cementless hip endoprosthesis is in revision arthroplasty. The lost bone stock is replaced by bone grafts, thereby creating a situation comparable with that of a primary arthroplasty. Clinical experience with noncemented hip endoprostheses is, to date, promising, although the observation time for most models is short.