Cementless Cup Research Articles

Medial Protrusio Technique in Cementless Total Hip Arthroplasty for Developmental Dysplasia of the Hip: A Prospective 6- to 9-Year Follow-Up of 43 Consecutive Patients

BackgroundThe medial protrusio technique may be used during total hip arthroplasty (THA) on patients with developmental dysplasia. However, studies have yet to determine whether a cementless cup can be sufficiently stable to withstand loading forces. This study aimed to assess the clinical and radiographic outcomes of this technique. Furthermore, we sought to determine the relationship between the rate of medial protrusion and the incidence of cup loosening. MethodsThirty-nine patients (43 hips) underwent cementless THA between April 2006 and March 2009 by using the medial protrusio technique. These patients participated in a 6- to 9-year follow-up. Their clinical and radiographic data were gathered prospectively. ResultsThe average Harris Hip Score improved from 43.1 ± 15.4 points preoperatively to 91.9 ± 12.8 points at the final follow-up (P < .001). The mean height of hip center and the distance of hip center medialization were 2.4 ± 0.6 and 2.5 ± 0.9 cm, respectively. The rate of medial protrusion and the rate of cup coverage were 42.1 ± 12.4% and 96.8 ± 5.1%, respectively. The rate of medial protrusion ranged from 18.3% to 58.3% in 38 hips (group A) and from 61.3% to 68.9% in 5 hips (group B). None of the cups in group A loosened or failed, 2 failures occurred in group B (0% vs 40.0%; P = .011). ConclusionsDevelopmental dysplasia was treated through THA using the medial protrusio technique, which easily achieves a sufficient superolateral host bony coverage of the cup and promotes socket reconstruction at the true acetabulum. The rate of medial protrusion of <60% may be necessary to obtain excellent clinical and radiographic midterm results.

1G13 3種類の人工関節セメントレスカップにおける固定性の評価

The cementless cup shape with a fin to the cup outer circumference I've been mainly used. In recent years, cementless cup with a coarser 3D porous shaped cup surfaces are sold, improvement of initial fixation of the surface roughness in addition to the secondary fixation is also expected, but the effect is apparent sounding not. The purpose of this study is to clarify the effect of bringing the surface shape in the initial rotation fixation. The cup of three different surface shapes it was included. Using a digital torque tester measures the torque of the simulated bone and the cup, and were compared statistically. Normal model F group, the P group was significantly higher both for the N group. Group F against P group and the N group in acetabular dysplasia model but was a significantly higher, P group was almost the same as N group. Conclusion In the surface shape of the cementless cup, fin effect was observed in the acquisition of rotation fixed resistance in acetabular dysplasia model

Impaction grafting for acetabular reconstruction in primary and revision hip arthroplasty

Background Acetabular bone stock loss is a major problem in both primary and revision total hip arthroplasty (THA). The loosening of primary cemented and cementless components of THAs is also accompanied by a loss of bone stock. There are several options for reconstruction of the acetabular defects. In 1979, a biologic method was introduced with tightly impacted cancellous allografts in combination with a cemented polyethylene cup for acetabular reconstruction, to restore acetabular bone stock, to restore normal hip biomechanics, and to allow for further revision if needed. Aim of the work In this study, the results of using morcellized impacted bone graft to reconstruct the deficient acetabulum in 54 hips (49 patients) using either cemented or cementless cups are discussed, with a mean follow-up of 36 (6–96) months. Patients and methods Between May 2002 and April 2010, 54 hips (in 49 patients) with deficient bone stock on the acetabular side had undergone total replacement with acetabular reconstruction using morcellized bone impaction grafting; out of the 54 hips, 34 (63%) were primary THA (17 after fracture of the acetabulum, 12 for protrusio acetabuli, three for rheumatoid arthritis, one for dysplastic hip, and one after tuberculosis arthritis) and 20 hips (37%) were revision THA. There were 21 (43%) women (bilateral in three of them) and 28 (57%) men (bilateral in two of them). Average age was 53 years (range 26–98 years). Out of the 54 hips, 14 (26%) were cementless and 40 (74%) were cemented. Mesh was used in 27 (50%) hips to convert a noncontained defect into a contained defect. Octopus ring was used in one hip, and Muller ring was used in another hip to overcome pelvic discontinuity. Results Fifty-four hips in 49 patients were followed up clinically and radiologically, with a mean follow-up of 36 months. In 46 hips (95.8%), the graft showed radiological signs of union to the host bone and no cup loosening. Cup was loose and revised in two patients (4.2%). One patient had octopus ring and morcellized graft in the first operation, and it was revised using a mesh and morcellized graft 8 years later. The other patient had morcellized graft and Muller ring; this failed after 4 years with cup loosening. It was revised using mesh and morcellized graft. Conclusion Acetabular reconstruction is a demanding procedure and needs preoperative planning and armamentarium. Successful results were obtained using the impaction technique for reconstruction. The aim of bone graft is to restore the normal hip mechanics. The union rate of the impacted graft is relatively satisfactory compared with other grafting methods. Augmentation of the grafting technique by mesh or rings added more stability to the cup component. The use of impaction graft in revisions for infected hip did not increase the risk of reinfection.

Total Hip Replacement in Patients Younger than Thirty Years 7-10 Years Follow up

Background: Total hip replacement in patients of younger age with higher levels of activity increases the risk of loosening and mechanical failure. Patients and Methods: Fifty patients 34 male and 16 (62 hips) with mean age of 24 years received a primary total hip replacement. The etiology for operation was juvenile rheumatoid arthritis in 10 patients, ankylosing spondylitis in 20, and posttraumatic hip arthritis in 20. Cementless total hip replacement was used in 36 patients (42 hips); hybrid (cementless cup and cemented stem) was used in 14 patients (20 hips). Merle d'Aubigne score was used for clinical evaluation preoperative and at the last follow up. DeLee and Charnley criteria of acetabulum were used to assess the acetabular stability. Gruen et al. zones of femoral stem were recoded to monitor loosening. Results: The mean follow up duration was 9.5 years (range, 7 to 10.5 years). The mean pre-operative Merle d'Aubigne score was significantly improved from 6. 5 (SD 2.34) preoperatively to 16.5 (SD 1.56) 1-year postoperatively (P<0.001). Osteointegration of the stem was noted in 45 cases (57 hips) at the end one year of follow-up. By the end of follow up there were radiolucent lines in two to three of Gruen zones around the stem, and it was progressive in 10 patients without need of revision. Subsidence of more than 5 mm occurred in 8 hips 4 of them had revision and the other 4 were not revised until the end of follow up. Conclusion: Total hip arthroplasty in very patients has an excellent long term results up to 89.7% survival after 10.5 years of follow up. We recommend other prospective studies with homogenous populations with the same pathology and the type of implant.

Three finned press-fit cup: Does its initial fixation strength provide an adequate stability? Clinical midterm results of 685 implants

Introduction: One of the major causes of loosening of cementless acetabular cup implants is insufficient initial stability. A technical proposal to decrease the risk of suboptimal first stability is a circumferential finned design of the cup. This design aims to improve periacetabular bone contact and prevent rotational micromotion of the cup when optimal press-fit cannot be obtained. Materials and Methods: We retrospectively reviewed a group of 712 consecutive patients who underwent total hip arthroplasty from June 2006 to June 2014. In all patients, a titanium cup, characterized by three anti-rotational circumferential fins at the superior pole, was implanted. Results: Five hundred and ninety-two patients, for a total of 685 hips, were evaluated at a mean follow-up of 58 months (range 12-96 months). At 1-year follow-up, the average score increased to 82.90 (range 100-70) and at the final follow-up (58 months, range 12-96 months), it was 80.12 (range 100-66). In 22 cases (3%), screws to obtain a secure primary stability of the cup were used. Nineteen complications (2.6%) needing revision surgery were observed. Survivorship at 10 years was 98.7% (95% confidence interval [CI], 98.7-99.7%) with revision for aseptic cup loosening as an endpoint and 96.7% (95% CI, 98.3-95.1%) with revision for all causes of revision as the second endpoint. Discussion: In our group of patients, we did not observe the cases of very early cup loosening. The only two-cup revision, do to loosening of osteolysis, was observed 26 and 32 months before surgery. Conclusion: Our very low rate of additional screws represents an indirect sign of finned cup first stability. Three-finned cup design clinically confirmed to improve initial cup stability.

Early Clinical Outcomes with a 3-D Porous Titanium Acetabular Cup

Cementless acetabular components are associated with a significant incidence of polyethylene wear and secondary osteolysis. 3-dimentional (3-D) porous coating and enhanced shell to a liner fixation are expected to reduce the polyethylene wear and to increase the longevity of an acetabular cup. The authors report the early clinical outcome with a cementless acetabular cup, Regenerex Ringloc+ (Zimmer Biomet, Warsaw, IN) for total hip arthroplasty. Between 2007 and 2013, the registry with 476 hip joints was reviewed retrospectively. There were 210 (48.4%) female and 224 (51.6%) male patients. The average age of the patients at the surgery was 63.9 (± 12.0) years and the average follow-up period was 2.6 years [0.5, 6.5]. At the final follow-up, there was no loosening or cup failure. There were 2 infections, 1 dislocation and 1 liner fracture, resulting in revision hip surgery. Average Harris hip score improved from 53.9 preoperatively to 91.4 postoperatively. The survivorship of Regenerex Ring Loc+ cup and the low complication rate is comparable with previous studies using other 3-D porous metal prostheses. Although this short-term outcome from the institute is very encouraging, a longer follow-up study is required.

Densitometric evaluation of bone-prosthetic counterface in hip and knee arthroplasty with modern implants.

Recent acquisitions of the complex mechanisms of osseointegration between implants and host bone have gained attention, accordingly to the methods of evaluation of these interactions. DEXA analysis is considered an useful tool to assess such phenomena, in order to analyse in a quantitative manner the local metabolic activity of the bone, and to evaluate over the time the integration between host bone and prosthetic components. The purpose of the present study is to report about a preliminary experience in the analysis of osseointegration processes of patients undergoing a primary Total Hip Arthroplasty (THA) or a revision Total Knee Arthroplasty (rTKA). Thirty patients undergoing THA and nineteen undergoing rTKA were included in this study. In fifteen cases of THA a standard cementless stem was used; in the other fifteen a short cementless stem was chosen. In all cases a cementless cup was implanted. In all patients undergoing rTKA, all implants had pressfit femoral and tibial diaphyseal stems; only the femoral component and the tibial plateau were cemented. DEXA evaluation was performed preoperatively, and at 3, 6, 12, and 24 months postoperatively for rTKA, and at 6 and 12 months for THA. DEXA in THA showed a significant decrease at the femoral ROIs 1 and 7, and an increase in ROI 4. In rTKA a reduction of femoral BMD in R1, R7, and R4 was found, with maximum values of -13.6% in R1 and -11.89% in R7 at 24 months and a value of -2.55% in R4 at 12 months. On the tibial side, an increase in BMD R4 (with values of 2.18% still at 24 months), and a reduction in R7 (progressively lesser over the time) and in R1 (progressively higher) were found. After a joint replacement a full adhesion of the prosthetic surface to the host bone should be achieved through a local biological process named osseointegration. In some cases this process may not fully realize, so the secondary stability of the implant may fail. DXA is a valuable tool to follow over time the bone remodelling at the bone-prosthesis counterface in THA and in rTKA, in order to early detect any alterations of such phenomenon.

A cemented cup with acetabular impaction bone grafting is more cost-effective than an uncemented cup in patients under 50 years.

Acetabular deficiencies in young patients can be restored in several ways during total hip arthroplasty. Currently, cementless cups are most frequently used. Impaction bone grafting of acetabular defects is a more biological approach, but is it cost-effective in young patients on the long term? We designed a decision model for a cost-utility analysis of a cemented cup with acetabular impaction bone grafting versus an uncemented cup, in terms of cost per quality-adjusted life year (QALY) for the young adult with acetabular bone deficiency, in need for a primary total hip arthroplasty. Outcome probabilities and effectiveness were derived from the Radboud University Nijmegen Medical Centre and the Norwegian Hip Register. Multiple sensitivity analyses were used to assess the contribution of the included variables in the model's outcome. Cemented cups with impaction bone grafting were more cost-effective compared to the uncemented option in terms of costs per QALY. A scenario suggesting equal primary survival rates of both cemented and uncemented cups still showed an effect gain of the cemented cup with impaction bone grafting, but at higher costs. Based on this model, the first choice of treatment of the acetabular bone deficient osteoarthritic hip in a young patient is reconstruction with impaction bone grafting and a cemented cup.

Cementless Total Hip Arthroplasty With a High Hip Center for Hartofilakidis Type B Developmental Dysplasia of the Hip: Results of Midterm Follow-Up

BackgroundAcetabular reconstruction in adults with Hartofilakidis type B developmental dysplasia of the hip is a major technical challenge. The purpose of this retrospective study was to evaluate hip function and radiographic outcomes regarding high hip center at midterm follow-up. MethodsFrom January 1, 2007 to December 31, 2009, 37 patients who had Hartofilakidis type B developmental dysplasia of the hip underwent a primary total hip arthroplasty using a high hip center technique. Functional, radiographic, and survivorship outcomes were evaluated. ResultsOf the 37 patients, 31 patients (83.8%) were available for the mean follow-up of 6.1 years (range, 1.5-7.6 years). Thirty-one cementless cups were located at an average vertical distance of 38.1 ± 3.3 mm and at a mean horizontal distance of 35.5 ± 3.4 mm. The mean ratio of the height of the hip center was 2.4% (range, 2.0%-2.9%). The Harris Hip Scores were improved from 50.3 points (range, 38-63 points) preoperatively to 92.3 points (range, 85-100 points) at the final follow-up (P < .001). Four patients continued to present with Trendelenburg gait pattern at the last follow-up. With use of revision for any reason and aseptic loosening as the end point, the 5-year survival rates were 90.3% (95% CI, 79.9%-100%) and 93.3% (95% CI, 84.3%-100%), respectively. ConclusionsThe high hip center technique in conjunction with a cementless acetabular component seems to be a valuable alternative to achieve satisfactory midterm outcomes for Hartofilakidis type B developmental dysplasia of the hip.

Can a Conical Implant Successfully Address Complex Anatomy in Primary THA? Radiographs and Hip Scores at Early Followup.

Total hip arthroplasty (THA) in patients with small or abnormal proximal femoral anatomy is challenging as a result of complex anatomic deformities in the hip. It is unclear which stem is the most appropriate for these patients. One possible implant design that may help meet this need is the modified Wagner Cone prosthesis, whose design consists of monoblock cone with splines; however, to our knowledge, no clinical results have been published using this implant. We evaluated the hip scores and radiographic results (including signs of osseointegration and subsidence) of complex primary THA using the modified Wagner Cone cementless femoral component in patients with small or abnormal proximal femoral anatomic proportions. Between 2006 and 2011, we performed 59 THAs on patients whose femoral geometry precluded the use of standard-sized implants. Of these, 49 (83%) received the modified Wagner Cone prosthesis. During this time, our indications for use of the Wagner Cone implant in such patients included: femoral neck retroversion, excessive anteversion of the femoral neck, or small proximal femora not suitable for standard implants. Of those, 40 patients with 49 THAs were available for radiographic and clinical followup at a minimum of 3 years, and no patients were lost to followup. The diagnosis included developmental dysplasia of hip (22 patients, 28 hips), secondary trauma or posttuberculosis osteoarthritis (nine patients, 10 hips), and hip disease secondary to other disorders (eight patients, nine hips) and osteonecrosis (one patients, two hips). Two versions of the stem with 135° (28 hips) or 125° (21 hips) neck angle versions were used to reestablish normal hip biomechanics. Version angle was chosen based on preoperative templating. Cementless cups with screws were used for the acetabulum. Mean followup was 4 years (range, 3-7 years). Study endpoints were the Harris hip score and radiographic evaluations by a surgeon not involved in the clinical care of the patients (QZ); radiographic analysis included evaluating for the presence or absence of signs of osseointegration (including Engh's criteria) and subsidence. The Harris hip score improved from a mean of 41 ± 9 preoperatively to a mean of 85 ± 10 at last followup (p < 0.01). The mean vertical subsidence was 1.5 ± 1.1 mm. Radiographic evaluation demonstrated stability (no further subsidence) of all implants at last followup. Endosteal spot welds were found in 32 hips (65%). No progressive radiolucencies were observed. One patient (one hip) underwent revision surgery as a result of late infection; no other revisions were performed. The modified Wagner Cone femoral stem has provided improvements in hip scores and promising short-term radiographic results at short-term followup in complex cementless THA associated with abnormal or small femoral anatomical proportions in which standard implants are inappropriate. Longer followup will be needed to see if these results endure. Randomized trials are needed to determine the optimal stem design for these patients. Level IV, therapeutic study.

High failure rate of a new pressfit cup in mid-term follow-up.

Unacceptably high rates of loosening of a novel cementless cup system (Mathys, SeleXys TH+) have been reported. In this study, our mid-term-results with the SeleXys TH+ cup are compared with an established pressfit cup (Ceraver, Cerafit-R). Between 2008 and 2011, a total of 407 implantations, 19 of them bilaterally, were conducted on 388 patients with the implants in question. A total of 280 cups were available for follow-up. Of these, 160 SeleXys TH+ cups and 120 Cerafit-R cups had been used. The mean follow-up period was 48.6 months (min. 28, max. 75). A total of 18 cases of loosening were found in the SeleXys TH+ group. Of these, one was of a traumatic nature and one was of septic origin. This left 16 cases of aseptic, atraumatic loosening (10% loosening rate). In the Cerafit-R group, only two cases (1.7%) of loosening were seen over the same period. Both were of traumatic origin. No cases of aseptic, atraumatic loosening were seen in the follow-up period. Further, significantly more cases of loosening were observed in women than in men with the SeleXys cup. The SeleXys TH+ cup shows an unacceptably high failure rate after six years. The time of revision is not limited to the first months after implantation, which means that close clinical and radiological controls will continue to be necessary in future in patients treated with SeleXys TH+ cups. Level of Evidenve: III (retrospective cohort study).

Does osteoporosis reduce the primary tilting stability of cementless acetabular cups?

BackgroundCementless hip cups need sufficient primary tilting stability to achieve osseointegration. The aim of the study was to assess differences of the primary implant stability in osteoporotic bone and in bone with normal bone density. To assess the influence of different cup designs, two types of threaded and two types of press-fit cups were tested.MethodsThe maximum tilting moment for two different cementless threaded cups and two different cementless press-fit cups was determined in macerated human hip acetabuli with reduced (n=20) and normal bone density (n=20), determined using Q-CT. The tilting moments for each cup were determined five times in the group with reduced bone density and five times in the group with normal bone density, and the respective average values were calculated.ResultsThe mean maximum extrusion force of the threaded cup Zintra was 5670.5 N (max. tilting moment 141.8 Nm) in bone with normal density and.5748.3 N (max. tilting moment 143.7 Nm) in osteoporotic bone. For the Hofer Imhof (HI) threaded cup it was 7681.5 N (192.0 Nm) in bone with normal density and 6828.9 N (max. tilting moment 170.7 Nm) in the group with osteoporotic bone. The mean maximum extrusion force of the macro-textured press-fit cup Metallsockel CL was 3824.6 N (max. tilting moment 95.6 Nm) in bone with normal and 2246.2 N (max. tilting moment 56.2 Nm) in osteoporotic bone. For the Monoblock it was 1303.8 N (max. tilting moment 32.6 Nm) in normal and 1317 N (max. tilting moment 32.9 Nm) in osteoporotic bone. There was no significance. A reduction of the maximum tilting moment in osteoporotic bone of the ESKA press-fit cup Metallsockel CL was noticed.ConclusionResults on macerated bone specimens showed no statistically significant reduction of the maximum tilting moment in specimens with osteoporotic bone density compared to normal bone, neither for threaded nor for the press-fit cups. With the limitation that the results were obtained using macerated bone, we could not detect any restrictions for the clinical indication of the examined cementless cups in osteoporotic bone.

Total hip replacement and surface replacement for the treatment of pain and disability resulting from end-stage arthritis of the hip (review of technology appraisal guidance 2 and 44): systematic review and economic evaluation.

Total hip replacement and surface replacement for the treatment of pain and disability resulting from end-stage arthritis of the hip (review of technology appraisal guidance 2 and 44): systematic review and economic evaluation.

Reconstruction of femoro-acetabular offsets using a short-stem.

Despite the fact that new and modern short-stems allow bone sparing and saving of soft-tissue and muscles, we still face the challenge of anatomically reconstructing the femoro-acetabular offset and leg length. Therefore a radiological and clinical analysis of a short-stem reconstruction of the femoro-acetabular offset and leg length was performed. Using an antero-lateral approach, the optimys short-stem (Mathys Ltd, Bettlach, Switzerland) was implanted in 114 consecutive patients in combination with a cementless cup (Fitmore, Zimmer, Indiana, USA; vitamys RM Pressfit, Mathys Ltd, Bettlach, Switzerland). Pre- and postoperative X-rays were done in a standardized technique. In order to better analyse and compare X-ray data a special double coordinate system was developed for measuring femoral- and acetabular offset. Harris hip score was assessed before and six weeks after surgery. Visual analogue scale (VAS) satisfaction, leg length difference and the existence of gluteal muscle insufficiency were also examined. Postoperative femoral offset was significantly increased by a mean of 5.8 mm. At the same time cup implantation significantly decreased the acetabular offset by a mean of 3.7 mm, which resulted in an increased combined femoro-acetabular offset of 2.1 mm. Postoperatively, 81.7% of patients presented with equal leg length. The maximum discrepancy was 10 mm. Clinically, there were no signs of gluteal insufficiency. No luxation occurred during hospitalization. The Harris hip score improved from 47.3 before to 90.1 points already at six weeks after surgery while the mean VAS satisfaction was 9.1. The analysis showed that loss of femoro-acetabular offset can be reduced with an appropriate stem design. Consequently, a good reconstruction of anatomy and leg length can be achieved. In the early postoperative stage the clinical results are excellent.

Mid-Term Clinical and Radiographic Outcomes of Porous Tantalum Modular Acetabular Components for Hip Dysplasia

It is still challenging to perform successful cementless cup fixation during total hip arthroplasty for hip dysplasia. In this multicenter study we evaluated the clinical results of porous tantalum modular acetabular cups (TM cups) in 45 dysplastic hips with a mean follow-up period of 9.8 years. The mean Japanese Orthopaedic Association hip score improved from 48.2 preoperatively to 92.1 at the most recent follow-up. All of the cups were radiographically stable with no evidence of progressive radiolucencies or osteolysis regardless of bone grafting. Sixteen hips with bone grafts showed the integration of grafted bone without any radiolucencies. There were no revisions of TM cups. The use of TM cups for dysplastic hips provided satisfactory 10-year clinical and radiographic results.

Modular Versus Monoblock Cementless Acetabular Cups in Primary Total Hip Arthroplasty- A Review

AIM: The evolution of cup designs have indeed contributed to better long term results in hip arthroplasty. This article aims to address the evolution of the modern day cups, pros and cons,literature review with regards to outcome and survivorship of monoblock and modular cementless cups in primary total hip arthroplasty. Methods: We conducted a systematic literature search on Pubmed,Medline and Cochrane database and enlisted Randomised Controlled trials (Level 1/II evidence)/Retrospective comparative study, (level III evidence) and case series (Level IV evidence) of Modular and Monoblock cups over the past 15 years from Jan 1998 to May 2013. Details with reference to cup revision, aseptic loosening, osteolysis, migration, liner wear and survivorship were enlisted. Results: Modular acetabular cups have shown excellent long term results in majority of the studies. Issues of liner breakage and liner dissociation have largely been resolved by the evolution of third generation cups with improved locking mechanism. Concerns of aseptic loosening and retroacetabular osteolysis prevail especially in the second decade. Monoblock cups have shown excellent results in most of the studies largely in the midterm followup. Conclusion: Both Modular and monoblock cups have shown consistent good results. Literature review has shown a paucity of Level 1 studies in this regard and more Randomised controlled trials are to be called for. As of this day there is no evidence to demonstrate a clear advantage of use of one over the other.

Theoretical Model for Calculating the Rotation in Cementless Acetabular Cup Prosthesis Implanted by Press Fit into a Hip of Canines

The aseptic loosening of the cementless acetabular cup prosthesis implanted by press fit into a hip is a fault caused by the application of an excessive load, which creates the rotation of the cup on the hip [1]. This rotation of the cup on the hip disables the prosthesis, and a new surgical intervention to place correctly the cup in the hip housing is required. The aseptic loosening of the cementless acetabular cup has been studied during decades mainly through experiments and numerical methods [2,3,4]. This paper shows the development of a theoretical model for calculating the maximum load that the cup of the prosthesis can support as well as the angle and direction of the net load. The model proposed is based on the hertz laws [5], which considers the interface between the cup and hip as two spheres between which there is a coefficient of static friction (μ), and is applied on a acetabular cups [6] implanted in artificial bone [7].

Total hip replacement for the treatment of end stage arthritis of the hip: a systematic review and meta-analysis.

BackgroundEvolvements in the design, fixation methods, size, and bearing surface of implants for total hip replacement (THR) have led to a variety of options for healthcare professionals to consider. The need to determine the most optimal combinations of THR implant is warranted. This systematic review evaluated the clinical effectiveness of different types of THR used for the treatment of end stage arthritis of the hip.MethodsA comprehensive literature search was undertaken in major health databases. Randomised controlled trials (RCTs) and systematic reviews published from 2008 onwards comparing different types of primary THR in patients with end stage arthritis of the hip were included.ResultsFourteen RCTs and five systematic reviews were included. Patients experienced significant post-THR improvements in Harris Hip scores, but this did not differ between impact types. There was a reduced risk of implant dislocation after receiving a larger femoral head size (36 mm vs. 28 mm; RR = 0.17, 95% CI: 0.04, 0.78) or cemented cup (vs. cementless cup; pooled odds ratio: 0.34, 95% CI: 0.13, 0.89). Recipients of cross-linked vs. conventional polyethylene cup liners experienced reduced femoral head penetration and revision. There was no impact of femoral stem fixation and cup shell design on implant survival rates. Evidence on mortality and complications (aseptic loosening, femoral fracture) was inconclusive.ConclusionsThe majority of evidence was inconclusive due to poor reporting, missing data, or uncertainty in treatment estimates. The findings warrant cautious interpretation given the risk of bias (blinding, attrition), methodological limitations (small sample size, low event counts, short follow-up), and poor reporting. Long-term pragmatic RCTs are needed to allow for more definitive conclusions. Authors are encouraged to specify the minimal clinically important difference and power calculation for their primary outcome(s) as well CONSORT, PRISMA and STROBE guidelines to ensure better reporting and more reliable production and assessment of evidence.

Bone defect determines acetabular revision surgery.

Cup revision can be a highly complex operation depending on the bone defect. In acetabular defects of less than 30% (Paprosky types 1 and 2), porous hemispherical cementless cups fixed with screws give good results. Modern trabecular metal designs improve these good results. Morsellised allografts are useful for filling cavitary defects. In acetabular defects greater than 30% (Paprosky types 3A and 3B), impacted morsellised allografts with a cemented cup technique produce good results. Difficult cases with pelvic discontinuity require reconstruction of the acetabulum with acetabular plates or large cup-cages to solve these difficult problems.

Combined cementless acetabular reconstruction with bone grafting in total hip replacement after acetabular fractures treated nonoperatively

BackgroundAcetabular fractures are serious and challenging orthopedic injuries. Many of these fractures may potentially result in late complications that can occur with or without initial surgical treatment. Such complications usually end in post-traumatic arthritis. Once symptomatic post-traumatic arthritis has developed, options for salvage are generally limited to total hip arthroplasty (THA) and arthrodesis. Whether initial nonoperative or operative treatment was used to manage acute and highly displaced acetabular fractures, formidable problems such as nonunion, malunion, bone defect, and heterotopic bone may complicate the arthroplasty. More recent studies have evaluated the techniques of THA after an acetabular fracture initially managed by a nonoperative or an operative course. Various reconstructive strategies have been assessed in an attempt to advice improvements in the surgical protocol.AimThe aim of the work was to evaluate the early results of THA using cementless acetabular components combined with bone grafting in the reconstruction of the hip joint in patients with post-traumatic arthritis after an old nonoperatively treated acetabular fracture or fracture dislocation.Patients and methodsThis prospective study included 12 patients who had end-stage arthritis. All patients had old acetabular fractures either with or without hip dislocation. All patients had a nonoperative treatment for their fractures 1-5 years before presentation for total hip replacement. Clinical, laboratory, and radiological evaluations before surgery were performed. In all patients, conventional cementless cups combined with bone graft from their own femoral heads were used to fill defects and reconstruct the acetabulum. The duration of the follow-up period ranged from 1 to 3 years.ResultsClinically, there was marked improvement in the Harris Hip Score (satisfactory results in 83.33% of the study group at the last follow-up) with special concern to postoperative pain relief, the range of hip movement, and the walking distance. Radiologically, all cups were placed in the normal hip center with no early signs of cup loosening, migration, or position change with good integration of the bone graft.ConclusionThe results were very satisfactory and significantly in favor of using this technique using conventional cementless cups combined with autogenous bone grafting to reconstruct the acetabulum in certain cases of old united fractures of the acetabulum saving the extra costs of metallic augments, special cups, or modular reconstructions using cages or rings and achieving a superior biological and biomechanical reconstruction.