Ehhancement of fixation of porous-coated implants in the presence of interface gaps when treated with autograft, freeze dried allograft and fibrin glue

Abstract

This study examined the long-term outcome of a single institution’s experience with 4,289 primary total hip arthroplasties using hemispheric porous-coated cups. Initial fixation was achieved with spikes (255 AML TriSpike cups), by press-fitting with rim screws (427 Arthropor cups) or by press-fitting the component (83 Harris-Galante, 391 ACS Triloc+, 2,537 Duraloc, and 596 Pinnacle cups). Among 203 revised hips, only 18 cups were found to be loose at the time of revision. Using revision for any reason as an end point, 15-year survivorship was 82.9% ± 5.6% (95% confidence interval) for spiked components, 71.6% ± 8.5% for press-fit cups with adjunctive rim screws, and 72.0% ± 12.6% for press-fit components (P<.001, log rank). Using revision for aseptic loosening as an end point, 15-year survivorship was 94.7% ± 3.4% for spiked cups, 98.4% ± 1.9% for press-fit cups with screws and 100% ± 0.1% for press-fit cups. Despite an increasing incidence of polyethylene wear-related revisions, porous-coated acetabular components have demonstrated excellent long-term fixation.