Langfristiger Einfluss der anatomisch angepassten spongiösen Endoprothese auf den periprothetischen Knochen

Abstract

The anatomically shaped, cementless total hip replacement (THR) (S and G, ESKA Lübeck) has a fully porous coating for secondary osseointegration. The aim of the present study was to analyse the long-term effect of the prosthesis on periprosthetic bone remodelling. 137 THR in 117 patients were analysed clinically and radiographically 12.8 years (10-14.9 years) postoperatively. The average age at the last follow-up was 71.8 years (range: 34-87 years). Osteodensitometric DEXA measurements of the periprosthetic bone in comparison to the contralateral non-operated femora were performed. Cumulative survival rates of all implanted THR (n = 231) at 14.9 years were 86.2 % (+/-5.3 %) for the fully porous coated stem and 90.1 % (+/- 8 %) for the cup. Five stem fractures (3.6 %) at the middle part were recorded. The Harris hip score of the non-revised THR at the last follow-up averaged 88.3 (34-100) points. Bony atrophy in the proximal periprosthetic femora in Gruen zones I (16.8 %) and VII (34.6 %) confirmed a proximal stress-shielding. Osteodensitometric analyses demonstrated in comparison to the contralateral femora (BMD 1.3 g/cm (2)) a significantly reduced bone density at the calcar femoris (BMD 0.9 g/cm (2)) (p < 0.001). The original goal of a physiological load transfer has not been realised with this fully porous, cementless THR. The anatomic S & G stem will mainly be osseointegrated by distal load transfer.