Double Cup Arthroplasty Research Articles

Knochen- und Grenzschichtveränderungen nach Implantation von Double-Cup-Arthroplastiken

21 femoral heads of 20 patients with double cup arthroplasty were examined after an implantation period of 1 to 5 years, in one case after 18 years. In 8 cases the hipe socket and in 10 cases the femoral cup became loose. Therefore an operative removal was necessary. 2 patients showed extensive periarticular ossifications. In connection with the metal cup the resected femoral heads were cut in slices of 1 cm. thickness. After taking an X-ray they were embedded without decalcification in methylmetacrylate. The sections were stained with different methods (Goldner, v. Kossa modification). In the group with fixed cup a local osteoporosis is dominating. The fibrous tissue membrane between cement and bone tissue is varying in thickness. It is thicker at the periphery of the cup. In the group with loosened cups large irreparable bone necrosis with included histiocytic granulomas, could be observed. The clinical problems are discussed in accordance to the long term prognosis on the basis of the morphological results.

Endoprosthetic replacement of the metatarsophalangeal joint of the big toe

The article reports on 20 cases of cup-plasties of the first metatarsophalangeal joint. 13 cups were done without, 7 with bone cement. The early results in both groups were promising. One third of all cases showed failure 2 years postoperatively. Fixation with bone cement leads to markedly better results. In cases of failure it is always possible to bring about a result comparable to resection arthroplasty (Brandes' operation) by removal of loose components. The reaction of cancellous bone under the metal cup can be compared with that of the double cup arthroplasty of the hip.

The Uncemented Gerard Bipolar Double-Cup Arthroplasty of the Hip

Between 1978 and 1984, 183 hips in 154 patients with the uncemented Gerard double-cup arthroplasty were resurfaced. The clinical and radiographic results of the 106 original arthroplasties were reviewed after a median follow-up period of 98 months. Although many of these patients had clinically improved immediately, the Harris Hip score decreased significantly in most hips in subsequent years. No correlation was found between the clinical score and radiographic complications. Major revision surgery with removal of the double cup was performed in 54 of 183 patients, making the cumulative success rate after 132 months only 48%. Survival was significantly greater in patients younger than 50 years of age and in patients with a low body weight (Quetelet index less than 25). This high failure rate eliminates the Gerard double-cup arthroplasty, except possibly for the patient with a destructive inflammatory arthropathy for whom there are no other surgical alternatives.

Uncemented bipolar double-cup arthroplasty of the hip in inflammatory arthropathy

From 1979 to 1986, 42 uncemented surface arthroplasties were performed in 27 patients with an inflammatory arthropathy of the hip: median age at operation 40 years (range 19–65 ys), median follow-up period 73 months (range 36–120 mo). After 36 months, in 26 of 42 hips, the mean Harris Hip Score was excellent or good (mean 89, range 80–100). In 14 cases, the mean score was fair (76, range 70–79). Overall, those hips with the longest followup period (60–120m) gradually improved over the years. No correlation was found between the clinical score and radiologic complications such as varus tilting of the femoral component, acetabular protrusion of the cup, or heterotopic ossification. Conversion to a conventional total hip arthroplasty was required in four patients. One patient required a total hip arthroplasty 86 months after the initial operation because of a femoral neck fracture. In two other patients, revision was performed after 60 and 32 months respectively because of a preexistent osteonecrosis and a severe foreign body response to polyethylene debris. Both patients had a varus tilting of the femoral component. In the fourth patient, in whom revision surgery was necessary 28 months after surface replacement there was no explanation for the varus shift of the femoral component. Regarding those problems that can appear after conventional total hip replacement in inflammatory arthropathy, we conclude that the uncemented surface replacement of the hip can be a reasonable alternative

Pseudo-abscess of the psoas bursa in failed double-cup arthroplasty of the hip

Seven psoas bursae filled with purulent fluid and inspissated debris were revealed at revision operations for failed resurfacing hip arthroplasties, an incidence of 5.8% in such revisions. Histological and microbiological investigations demonstrated that the psoas bursa collections resulted from the tissue response to polyethylene wear debris. None was due to infection.

ICLH double-cup arthroplasty, 1980–1987

The results are presented of 92 double-cup arthroplasties modified in light of previously published experience. The review period lasted up to 7 years after operation. Eighty-six had a metal femoral component and six had a ceramic femoral component. Forty metal femoral cups were matched with a cemented acetabulum, while with 46 the acetabular implant was cementless. The overall revision rate for the metal femoral cups was 23.3%, and a further 31.8% demonstrated radiological signs suggestive of loosening. There was no difference between the cemented and uncemented cups in terms of revision rates or clinical results. The clinical results of those hips that have not yet loosened were excellent. A histological study showed that femoral loosening was associated with an erosive cellular response. Surface arthroplasty of the hip with current materials should be abandoned.

Histopathologic Evaluation in Failed Gerard Double Cup Arthroplasty

Fifteen femoral head remnants were removed at revision of an uncemented double cup arthroplasty and were investigated by histological methods. Nine showed resorption of the head, partly due to osteoporosis by stress protection, preexistent pseudocysts, or osteonecrosis. Necrosis was frequently seen in the apicocranial area, and in six cases extended into deeper areas. One failure was attributed to synovitis caused by polyethylene debris. A smooth collagenous membrane developed at both the femoral head and the acetabular interfaces. In some cases metaplasia into cartilage and osteophytes developed at the cup rim.

Mechanical failure in double cup arthroplasty of the hip.

Mechanical complications of double cup arthroplasty of the hip are common, particularly loosening of the components. This paper describes a series of 26 such operations with an average follow-up of 67 months. There was a failure rate or 53.8% and these hips had to be revised with another type of replacement. Our results are compared with other reported series.

Gerard Cup Arthroplasty in Inflammatory Arthropathy of the Hip

Sixteen hips in 11 patients with an inflammatory hip arthropathy were treated with an uncemented, double-cup arthroplasty (Gerard design). The results were good in ten patients after a mean follow-up period of 4.1 years.

Cemented double cup arthroplasty of the hip: experimental design and clinical application.

From February 1980 to October 1981, we have performed double cup arthroplasty of the hip in 10 cases successfully. Here is a report of our experience in clinical application of the double cup we designed and fabricated. Test of wear and tear of several different kinds of material of artificial joint was made. We observed 100 specimens of human dry femur and 80 specimens of acetabulum and reviewed femoral radiographs of 20 normal adults. Important data were obtained on measuring the length and width of the femur and the acetabulum.

Histomorphological investigations of coxa femoral ends following double-cup arthroplasty according to freeman

Of 20 shell prostheses inserted in cases of early coxarthrosis in our clinic during the period from mid-1976 to the end of 1978, three had to be removed. Morphological examinations, employing different techniques, were made of the coxa femoral ends which were removed. The foreign body reaction of the bone tissue beneath the cement within the prosthetic shell and the biomechanical response were investigated on the basis of macroscopic and microscopic structural analyses. Dependent upon the time elapsed, the exposed spongiosa surface was observed to have become remodeled to a thin cortical protective layer. Independent of time between insertion and removal of the prosthetic shell, a continuous wide layer, consisting of cellular and fibrous tissue, was formed between the bone and the cement (which remained intact) even after the formation of the above-mentioned cortical bone substrate.

Cemented Double Cup Arthroplasty of the Hip

The ICLH (Imperial College-London Hospital) total hip arthroplasty is a procedure in which a metal femoral component caps the proximal femur and a polyethylene acetabular component resurfaces the acetabulum with both components cemented in place. Between June, 1972, and November, 1974, changes were made in prosthetic design and in operative technique in response to 2 specific problems encountered. The loosening rate was high until the original polyethylene femoral component was redesigned so that it was metal. The incidence of femoral neck fractures was unacceptable until trochanteric osteotomy was discontinued. Since November, 1974, 116 hips have been replaced and neither the prosthesis nor the operative technique has changed. Pain relief has been comparable to that obtained with conventional Charnley-type hip replacement. All patients walk out of doors and no patient's walking capacity is limited by pain in the operated hip. No hip has lost motion and 36% have an effectively full range. No deterioration in the quality of these results is suggested when the first postoperative assessment is compared to those at 2 years and longer postoperative. Technical errors to be recognized and avoided are varus placement of the femoral component and excessive vertical placement of the acetabular component.

ICLH cemented double cup hip replacement

The ICLH (Imperial College-London Hospital) double cup hip replacement as it exists today consists of a metal femoral component which caps the femur and a polyethylene acetabular component which resurfaces the acetabulum. Both components are cemented in place. The first prosthesis was inserted in 1972 and during the following two years complications emerged which necessitated changes in the prosthesis and the operative technique. Since November 1974 there have been no changes in the prosthetic design or operative procedure and complications have been infrequent. An approach has been developed whereby trochanteric osteotomy is not necessary. Up to December 1977 159 hips were replaced in 154 patients. Clinically, the results of a successful double cup arthroplasty are similar to those obtained by conventional hip replacement. No deterioration in the quality of the results is suggested when early results are compared with those of patients who are now two years and longer since surgery. Technical errors to be avoided are varus placement of the femoral component and excessive vertical placement of the acetabular component. Conclusions drawn are tentative due to the fact that to date the follow-up period is inadequate.