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Comparison of the uncemented Cone and the cemented Bimetric hip prosthesis in young patients with osteoarthritis: an RSA, clinical and radiographic study.

BACKGROUND: There is no consensus as to whether uncemented or cemented femoral stems should be used in younger patients. We compared the uncemented Cone stem to the cemented Bimetric stem in young patients with osteoarthritis. PATIENTS AND METHODS: We randomized 45 relatively young patients (< 65 years old, mean age 54 years) with osteoarthritis to either an uncemented Cone stem or a cemented Bimetric stem. All patients were followed for 2 years. Outcome was assessed by the Merle d'Aubigné score, conventional radiography and repeated radio-stereometric analysis (RSA). We also followed 81 Cone stems for 8 (7-12) years with revision as endpoint. RESULTS: The clinical outcome was excellent. No patient had postoperative thigh pain. The migration was small. The Bimetric stem was stable during the whole observation period, while the Cone stem subsided and rotated to retroversion during the first 3 months post-operatively, and then remained stable. In the follow-up study of 81 Cone stems, 1 stem was revised. INTERPRETATION: We conclude that both the cemented Bimetric stem and the uncemented Cone stem are stable and give excellent clinical results after 2 years in relatively young patients with osteoarthritis. Although designed for CDH hips, the Cone stem appears to be suitable also for patients with osteoarthitis.

Adult↗

[The value of bone scintigraphy in thigh pain following cementless hip prosthesis].

Persisting postoperative pain of the thigh is a common problem of cementless hip endoprostheses occurring in about 15-20% of the patients. We performed a comparative study including patients with (n = 40) and without (n = 45) pain of the thigh. 85 cementless porous-coated anatomic (PCA) hip endoprostheses in 74 patients were examined. All patients underwent clinical examination including a standardized questionnaire, x-ray, and 3-phase bone scintigraphy. Slight or moderate 99mTc-MDP uptake in the area of the greater and lesser trochanter as well as at the tip was a common finding in PCA prostheses in patients without pain and was not a sign of loosening of the hip. Radiologically, there was no difference between patients with and without pain. However, persisting pain of the thigh in patients with PCA prosthesis corresponded with an increased uptake at the tip and the medial and lateral femur, not being a sign of loosening even in this group. The special biomechanical conditions of cementless prostheses causing inhomogeneous intraosseous stress distribution are supposed to be the reason for that.

Adult↗

[Aseptic dislodgement of total hip prosthesis. Middle- and long-term results with Voorhoeve's net].

The authors present Voorhoeve's net, which is used for the management of dislodgements of total hip prostheses complicated by the lysis of the calcar. They report on the middle- and long-term results in a series of 65 second operations for aseptic dislodgement in which the incidence of lysis was 64%. The biomechanical study of the net, which was carried out according to the finite element method and coupled with experimental measurements, demonstrates the effectiveness of the net for longitudinal and radial stress. Their conclusion is that the net is a good addition to the management of dislodgement associated with necrosis of the calcar.

Adult↗

Clinical experiences with a titanium alloy total hip prosthesis: a posterior approach.

Using a titanium alloy femoral prosthesis (STH Zimmer) and an ultra high molecular weight polyethylene acetabular cup with a posterior surgical approach to the hip joint, 237 consecutive total hip arthroplasties in 215 patients were performed between December 1975 and May 1977. The preliminary results and early postoperative complications suggest that this system can be considered an alternative to total hip arthroplasty using other materials and surgical approaches.

Adult↗

[Load bearing capacity of CFK hip prosthesis with ceramic femoral heads].

Wear of the articulating surfaces of mating components of total hip endoprostheses is the most important technical factor limiting the functional lifetime of the prosthesis. Biolox ceramic femoral heads have been used successfully throughout the world for more than 20 years. In vitro tests and clinical results show that the artificial modular hip joint system employing a Caproman stem and a ball made of Biolox or Biolox -forte is resistant to mechanical failure. The threshold values for burst load and cyclic load prescribed by the FDA are achieved or bettered. Clinical results support those of the in vitro tests. The femoral head made of Biolox or Biolox -forte used in combination with cups and stems made of Caproman thus complies with the required standards.

Biomechanical Phenomena↗

[Influence of implant position of a hip prosthesis on alignment exemplified by the CLS shaft].

We performed a clinical and radiological analysis to evaluate the significance of the stem position of cementless CLS components with respect to function and survival. We used patient material from a multi-center study of 3,732 CLS stems with a mean follow-up of 43 months (range: 12-142 months). The clinical outcome was assessed using Merle D'Aubigné Scores and stem alignment was determined as the deviation of the longitudinal stem axis from the longitudinal femur axis. We found no correlation between stem alignment and function, survival, implant migration or periprosthetic radiolucent lines. In patients with rheumatoid arthritis and hip ankylosis the neutral stem position was less often achieved than in patients with other diagnoses. The results of our study cast doubt on whether the varus position of the femoral component of cementless tapered CLS-type stem designs is as critical as in cemented total hip arthroplasty.

Aged↗