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Erschienen in: Archives of Orthopaedic and Trauma Surgery 7/2004

01.09.2004 | Original Article

Cemented titanium stems show high migration: transprosthetic drainage system has no advantage over third-generation cementation technique

verfasst von: C. Pabinger, A. Kröner, A. Lange, R. Eyb

Erschienen in: Archives of Orthopaedic and Trauma Surgery | Ausgabe 7/2004

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Abstract

Introduction

A newly developed cemented titanium stem with excellent laboratory results using a transprosthetic drainage system (TDS) was clinically tried for the first time. Prognostic radiographic methods including migration measurement and clinical investigation were performed for up to 7 years.

Materials and methods

Twenty-two patients prospectively and consecutively received total hip replacement using a cemented titanium stem and a threaded Zweymüller cup. Ten stems (CPS) were cemented conventionally with a third-generation cementation technique. In 12 stems (TRIOS) a TDS was used to enhance cement mantle quality. Design of cup and stem was similar in all cases.

Results

More than 50% of all stems showed considerable subsidence (>1 mm at 2 years and >2.5 mm at 5 years) and progressive radiolucent lines ( >1 mm at 2 years). Two patients of the TRIOS group had to be revised at 7 years postoperatively. No significant differences were found in radiological parameters (migration, stem subsidence, tilting, occurrence of radiolucent lines) and clinical outcome between the two cementation techniques. All parameters indicate an unfavourable long-term survival. Use of a TDS did not show any significant advantages over the conventional cementation technique.

Conclusion

It can be concluded that cementing titanium stems of this design cannot be recommended.
Literatur
1.
Zurück zum Zitat Acklin YP, Berli BJ, Frick W, Elke R, Morscher EW (2001) Nine-year results of Muller cemented titanium straight stems in total hip replacement. Arch Orthop Trauma Surg 121:391–398CrossRefPubMed Acklin YP, Berli BJ, Frick W, Elke R, Morscher EW (2001) Nine-year results of Muller cemented titanium straight stems in total hip replacement. Arch Orthop Trauma Surg 121:391–398CrossRefPubMed
2.
3.
Zurück zum Zitat Biedermann R, Krismer M, Stockl B, Mayrhofer P, Ornstein E, Franzen H (1999) Accuracy of EBRA-FCA in the measurement of migration of femoral components of total hip replacement. J Bone Joint Surg Br 81:266–272CrossRefPubMed Biedermann R, Krismer M, Stockl B, Mayrhofer P, Ornstein E, Franzen H (1999) Accuracy of EBRA-FCA in the measurement of migration of femoral components of total hip replacement. J Bone Joint Surg Br 81:266–272CrossRefPubMed
4.
Zurück zum Zitat Biedermann R, Stockl B, Krismer M, Mayrhofer P, Ornstein E, Franzen H (2001) Evaluation of accuracy and precision of bone markers for the measurement of migration of hip prostheses. A comparison of conventional measurements. J Bone Joint Surg Br 83:767–771 Biedermann R, Stockl B, Krismer M, Mayrhofer P, Ornstein E, Franzen H (2001) Evaluation of accuracy and precision of bone markers for the measurement of migration of hip prostheses. A comparison of conventional measurements. J Bone Joint Surg Br 83:767–771
5.
Zurück zum Zitat Bowditch M, Villar R (2001) Is titanium so bad? Medium-term outcome of cemented titanium stems. J Bone Joint Surg Br 83:680–685CrossRefPubMed Bowditch M, Villar R (2001) Is titanium so bad? Medium-term outcome of cemented titanium stems. J Bone Joint Surg Br 83:680–685CrossRefPubMed
6.
Zurück zum Zitat Charnley J (1960) Anchorage of the femoral head prosthesis to the shaft of the femur. J Bone Joint Surg Br 42:28–30 Charnley J (1960) Anchorage of the femoral head prosthesis to the shaft of the femur. J Bone Joint Surg Br 42:28–30
7.
Zurück zum Zitat Freiberg AA, Harris WH (1995) The femoral stent. Surgical technique for a new method of cementing the femoral component in the presence of a large cortical defect. Am J Orthop 24:501–503PubMed Freiberg AA, Harris WH (1995) The femoral stent. Surgical technique for a new method of cementing the femoral component in the presence of a large cortical defect. Am J Orthop 24:501–503PubMed
8.
Zurück zum Zitat Goldberg BA, al Habbal G, Noble PC, Paravic M, Liebs TR, Tullos HS (1998) Proximal and distal femoral centralizers in modern cemented hip arthroplasty. Clin Orthop 355:163–173PubMed Goldberg BA, al Habbal G, Noble PC, Paravic M, Liebs TR, Tullos HS (1998) Proximal and distal femoral centralizers in modern cemented hip arthroplasty. Clin Orthop 355:163–173PubMed
9.
Zurück zum Zitat Gruen TA, McNeice GM, Amstutz HC (1979) ‘Modes of failure’ of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop 317:17–27 Gruen TA, McNeice GM, Amstutz HC (1979) ‘Modes of failure’ of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop 317:17–27
10.
Zurück zum Zitat Hanson PB, Walker RH (1995) Total hip arthroplasty cemented femoral component distal stem centralizer. Effect on stem centralization and cement mantle. J Arthroplasty 10:683–688PubMed Hanson PB, Walker RH (1995) Total hip arthroplasty cemented femoral component distal stem centralizer. Effect on stem centralization and cement mantle. J Arthroplasty 10:683–688PubMed
11.
Zurück zum Zitat Henry JD, Reilly D, Poss R (1993) Two- to four-year experience with cemented, press-fit, and porous coated applications of the profile total hip system. Acta Orthop Belg 59 [Suppl 1]:190–194 Henry JD, Reilly D, Poss R (1993) Two- to four-year experience with cemented, press-fit, and porous coated applications of the profile total hip system. Acta Orthop Belg 59 [Suppl 1]:190–194
12.
Zurück zum Zitat Hinrichs F, Kuhl M, Boudriot U, Griss P (2003) A comparative clinical outcome evaluation of smooth (10–13 year results) versus rough surface finish (5–8 year results) in an otherwise identically designed cemented titanium alloy stem. Arch Orthop Trauma Surg 123:268–272CrossRefPubMed Hinrichs F, Kuhl M, Boudriot U, Griss P (2003) A comparative clinical outcome evaluation of smooth (10–13 year results) versus rough surface finish (5–8 year results) in an otherwise identically designed cemented titanium alloy stem. Arch Orthop Trauma Surg 123:268–272CrossRefPubMed
13.
Zurück zum Zitat Howie DW (1998) Loosening of matt and polished cemented femoral stems. J Bone Joint Surg Br 80:573–576CrossRefPubMed Howie DW (1998) Loosening of matt and polished cemented femoral stems. J Bone Joint Surg Br 80:573–576CrossRefPubMed
14.
Zurück zum Zitat Ilchmann T, Franzen H, Mjoberg B, Wingstrand H (1992) Measurement accuracy in acetabular cup migration. A comparison of four radiologic methods versus roentgen stereophotogrammetric analysis. J Arthroplasty 7:121–127PubMed Ilchmann T, Franzen H, Mjoberg B, Wingstrand H (1992) Measurement accuracy in acetabular cup migration. A comparison of four radiologic methods versus roentgen stereophotogrammetric analysis. J Arthroplasty 7:121–127PubMed
15.
Zurück zum Zitat Johnston RC, Fitzgerald RH Jr, Harris WH, Poss R, Muller ME, Sledge CB (1990) Clinical and radiographic evaluation of total hip replacement. A standard system of terminology for reporting results. J Bone Joint Surg Am 72:161–168PubMed Johnston RC, Fitzgerald RH Jr, Harris WH, Poss R, Muller ME, Sledge CB (1990) Clinical and radiographic evaluation of total hip replacement. A standard system of terminology for reporting results. J Bone Joint Surg Am 72:161–168PubMed
16.
Zurück zum Zitat Joshi RP, Eftekhar NS, McMahon DJ, Nercessian OA (1998) Osteolysis after Charnley primary low-friction arthroplasty. A comparison of two matched paired groups. J Bone Joint Surg Br 80:585–590CrossRefPubMed Joshi RP, Eftekhar NS, McMahon DJ, Nercessian OA (1998) Osteolysis after Charnley primary low-friction arthroplasty. A comparison of two matched paired groups. J Bone Joint Surg Br 80:585–590CrossRefPubMed
17.
Zurück zum Zitat Kobayashi A, Donnelly WJ, Scott G, Freeman MA (1997) Early radiological observations may predict the long-term survival of femoral hip prostheses. J Bone Joint Surg Br 79:583–589CrossRefPubMed Kobayashi A, Donnelly WJ, Scott G, Freeman MA (1997) Early radiological observations may predict the long-term survival of femoral hip prostheses. J Bone Joint Surg Br 79:583–589CrossRefPubMed
18.
Zurück zum Zitat Koster G, Willert HG, Ernstberger T, Kohler HP (1998) Centralization of the femoral component in cemented hip arthroplasty using guided stem insertion. Arch Orthop Trauma Surg 117:425–429CrossRefPubMed Koster G, Willert HG, Ernstberger T, Kohler HP (1998) Centralization of the femoral component in cemented hip arthroplasty using guided stem insertion. Arch Orthop Trauma Surg 117:425–429CrossRefPubMed
19.
Zurück zum Zitat Köstler G, Willert T, Ernstberger T, Köhler HP (1998) Centralization of the femoral component in cemented hip arthroplasty using guided stem insertion. Arch Orthop Trauma Surg 117:425–429CrossRefPubMed Köstler G, Willert T, Ernstberger T, Köhler HP (1998) Centralization of the femoral component in cemented hip arthroplasty using guided stem insertion. Arch Orthop Trauma Surg 117:425–429CrossRefPubMed
20.
Zurück zum Zitat Krismer M, Bauer R, Tschupik J, Mayrhofer P (1995) EBRA: a method to measure migration of acetabular components. J Biomech 28:1225–1236PubMed Krismer M, Bauer R, Tschupik J, Mayrhofer P (1995) EBRA: a method to measure migration of acetabular components. J Biomech 28:1225–1236PubMed
21.
Zurück zum Zitat Krismer M, Biedermann R, Stockl B, Fischer M, Bauer R, Haid C (1999) The prediction of failure of the stem in THR by measurement of early migration using EBRA-FCA. J Bone Joint Surg Br 81:273–280CrossRefPubMed Krismer M, Biedermann R, Stockl B, Fischer M, Bauer R, Haid C (1999) The prediction of failure of the stem in THR by measurement of early migration using EBRA-FCA. J Bone Joint Surg Br 81:273–280CrossRefPubMed
22.
Zurück zum Zitat Krismer M, Stockl B, Fischer M, Bauer R, Mayrhofer P, Ogon M (1996) Early migration predicts late aseptic failure of hip sockets. J Bone Joint Surg Br 78:422–426 Krismer M, Stockl B, Fischer M, Bauer R, Mayrhofer P, Ogon M (1996) Early migration predicts late aseptic failure of hip sockets. J Bone Joint Surg Br 78:422–426
23.
Zurück zum Zitat Lemaire R, Rodriguez A (1996) Radiological study of the migration of prosthetic implants following hip arthroplasty. Acta Orthop Belg 62 [Suppl 1]:124–131 Lemaire R, Rodriguez A (1996) Radiological study of the migration of prosthetic implants following hip arthroplasty. Acta Orthop Belg 62 [Suppl 1]:124–131
24.
Zurück zum Zitat Lichtinger TK, Schurmann N, Muller RT (2000) Early loosening of a cemented hip endoprosthesis stem of titanium (in German). Unfallchirurg 103:956–960PubMed Lichtinger TK, Schurmann N, Muller RT (2000) Early loosening of a cemented hip endoprosthesis stem of titanium (in German). Unfallchirurg 103:956–960PubMed
25.
Zurück zum Zitat Ling RS (1992) Clinical experience with primary cemented total hip arthroplasty. Chir Organi Mov 77:373–381PubMed Ling RS (1992) Clinical experience with primary cemented total hip arthroplasty. Chir Organi Mov 77:373–381PubMed
26.
Zurück zum Zitat Massoud SN, Hunter JB, Holdsworth BJ, Wallace WA, Juliusson R (1997) Early femoral loosening in one design of cemented hip replacement. J Bone Joint Surg Br 79:603–608PubMed Massoud SN, Hunter JB, Holdsworth BJ, Wallace WA, Juliusson R (1997) Early femoral loosening in one design of cemented hip replacement. J Bone Joint Surg Br 79:603–608PubMed
27.
Zurück zum Zitat McCaskie AW, Barnes MR, Lin E, Harper WM, Gregg PJ (1997) Cement pressurisation during hip replacement. J Bone Joint Surg Br 79:379–384CrossRefPubMed McCaskie AW, Barnes MR, Lin E, Harper WM, Gregg PJ (1997) Cement pressurisation during hip replacement. J Bone Joint Surg Br 79:379–384CrossRefPubMed
28.
Zurück zum Zitat Middleton RG (1998) Effects of design changes on cemented tapered femoral stem fixation. Clin Orthop 355:47–56PubMed Middleton RG (1998) Effects of design changes on cemented tapered femoral stem fixation. Clin Orthop 355:47–56PubMed
29.
Zurück zum Zitat Mjoberg B, Pettersson H, Rosenqvist R, Rydholm A (1984) Bone cement, thermal injury and the radiolucent zone. Acta Orthop Scand 55:597–600PubMed Mjoberg B, Pettersson H, Rosenqvist R, Rydholm A (1984) Bone cement, thermal injury and the radiolucent zone. Acta Orthop Scand 55:597–600PubMed
30.
Zurück zum Zitat Mjoberg B, Rydholm A, Selvik G, Onnerfalt R (1987) Low- versus high-viscosity bone cement. Fixation of hip prostheses analyzed by roentgen stereophotogrammetry. Acta Orthop Scand 58:106–108PubMed Mjoberg B, Rydholm A, Selvik G, Onnerfalt R (1987) Low- versus high-viscosity bone cement. Fixation of hip prostheses analyzed by roentgen stereophotogrammetry. Acta Orthop Scand 58:106–108PubMed
31.
Zurück zum Zitat Noble PC, Collier MB, Maltry JA, Kamaric E, Tullos HS (1998) Pressurization and centralization enhance the quality and reproducibility of cement mantles. Clin Orthop 355:77–89CrossRefPubMed Noble PC, Collier MB, Maltry JA, Kamaric E, Tullos HS (1998) Pressurization and centralization enhance the quality and reproducibility of cement mantles. Clin Orthop 355:77–89CrossRefPubMed
32.
Zurück zum Zitat Noble PC, Collier MB, Maltry JA, Kamaric E, Tullos HS (1998) Pressurization and centralization enhance the quality and reproducibility of cement mantles. Clin Orthop 355:77–89CrossRefPubMed Noble PC, Collier MB, Maltry JA, Kamaric E, Tullos HS (1998) Pressurization and centralization enhance the quality and reproducibility of cement mantles. Clin Orthop 355:77–89CrossRefPubMed
32a.
Zurück zum Zitat Pabinger C, Biedermann R, Stöckl B, Fischer M, Krismer M (2003) Migration of metal-on-metal versus ceramic-on-polyethylene hip prostheses. Clin Orthop Rel Res 412:103–110CrossRef Pabinger C, Biedermann R, Stöckl B, Fischer M, Krismer M (2003) Migration of metal-on-metal versus ceramic-on-polyethylene hip prostheses. Clin Orthop Rel Res 412:103–110CrossRef
33.
Zurück zum Zitat Pitto RP, Koessler M, Kuehle JW (1999) Comparison of fixation of the femoral component without cement and fixation with use of a bone-vacuum cementing technique for the prevention of fat embolism during total hip arthroplasty. A prospective, randomized clinical trial. J Bone Joint Surg Am 81:831–843PubMed Pitto RP, Koessler M, Kuehle JW (1999) Comparison of fixation of the femoral component without cement and fixation with use of a bone-vacuum cementing technique for the prevention of fat embolism during total hip arthroplasty. A prospective, randomized clinical trial. J Bone Joint Surg Am 81:831–843PubMed
34.
Zurück zum Zitat Robinson RP, Lovell TP, Green TM, Bailey GA (1989) Early femoral component loosening in DF-80 total hip arthroplasty. J Arthroplasty 4:55–64PubMed Robinson RP, Lovell TP, Green TM, Bailey GA (1989) Early femoral component loosening in DF-80 total hip arthroplasty. J Arthroplasty 4:55–64PubMed
35.
Zurück zum Zitat Schmidt J, Specht R, Steür G (1996) Advantage of the transprothetic drainage system (TDS) for application in cemented hip arthroplasty—a standardized experimental comparison with other cementing techniques. Arch Orthop Trauma Surg 115:153–157PubMed Schmidt J, Specht R, Steür G (1996) Advantage of the transprothetic drainage system (TDS) for application in cemented hip arthroplasty—a standardized experimental comparison with other cementing techniques. Arch Orthop Trauma Surg 115:153–157PubMed
36.
Zurück zum Zitat Soballe K, Toksvig-Larsen S, Gelineck J, Fruensgaard S, Hansen ES, Ryd L, Lucht U, Bunger C (1993) Migration of hydroxyapatite coated femoral prostheses. A roentgen stereophotogrammetric study. J Bone Joint Surg Br 75:681–687PubMed Soballe K, Toksvig-Larsen S, Gelineck J, Fruensgaard S, Hansen ES, Ryd L, Lucht U, Bunger C (1993) Migration of hydroxyapatite coated femoral prostheses. A roentgen stereophotogrammetric study. J Bone Joint Surg Br 75:681–687PubMed
37.
Zurück zum Zitat Suominen S, Antti-Poika I, Tallroth K, Santavirta S, Voutilainen P, Lindholm TS (1996) Femoral component fixation with and without intramedullary plug. A 6- year follow-up. Arch Orthop Trauma Surg 115:276–279PubMed Suominen S, Antti-Poika I, Tallroth K, Santavirta S, Voutilainen P, Lindholm TS (1996) Femoral component fixation with and without intramedullary plug. A 6- year follow-up. Arch Orthop Trauma Surg 115:276–279PubMed
38.
Zurück zum Zitat Welch RB, McGann WA, Rasmussen L (1990) Femoral stem fixation. The case for cement. Clin Orthop 339:134–139 Welch RB, McGann WA, Rasmussen L (1990) Femoral stem fixation. The case for cement. Clin Orthop 339:134–139
39.
Zurück zum Zitat Willert HG, Broback LG, Buchhorn GH, Jensen PH, Koster G, Lang I, Ochsner P, Schenk R (1996) Crevice corrosion of cemented titanium alloy stems in total hip replacements. Clin Orthop 351:51–75CrossRef Willert HG, Broback LG, Buchhorn GH, Jensen PH, Koster G, Lang I, Ochsner P, Schenk R (1996) Crevice corrosion of cemented titanium alloy stems in total hip replacements. Clin Orthop 351:51–75CrossRef
40.
Zurück zum Zitat Witt JD, Swann M (1991) Metal wear and tissue response in failed titanium alloy total hip replacements. J Bone Joint Surg Br 73:559–563PubMed Witt JD, Swann M (1991) Metal wear and tissue response in failed titanium alloy total hip replacements. J Bone Joint Surg Br 73:559–563PubMed
Metadaten
Titel
Cemented titanium stems show high migration: transprosthetic drainage system has no advantage over third-generation cementation technique
verfasst von
C. Pabinger
A. Kröner
A. Lange
R. Eyb
Publikationsdatum
01.09.2004
Verlag
Springer-Verlag
Erschienen in
Archives of Orthopaedic and Trauma Surgery / Ausgabe 7/2004
Print ISSN: 0936-8051
Elektronische ISSN: 1434-3916
DOI
https://doi.org/10.1007/s00402-004-0705-2

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