Hip Pelvis.  2013 Mar;25(1):14-20. 10.5371/hp.2013.25.1.14.

Cementless Implant in Total Hip Arthroplasty

• Yoon TR
• Park KS
• Lim HA

• KMID: 1425031
• DOI: http://doi.org/10.5371/hp.2013.25.1.14

Abstract

The various implants used in total hip arthroplasty can be classified according to the design and the fixation type. In general, they can be divided into two groups; cemented and cementless types. The surgeon's decision regarding which type of implant to use should be based on the goal of the arthroplasty operation, the bony deformity of the patient, the function of the involved hip joint, and the experience of the operator. When using cementless implants, primary fixation, survival rate, and successful fixation on long-term follow-up depend on the material of the implant, the bone quality, and, ultimately, the interaction between the implant and the bone. Cementless implants have shown a high success rate in primary total hip arthroplasty and relatively fine outcomes on long-term follow-up. In comparison of the two implant types, superiority has yet to be determined, however, a choice made based on the objective of the surgery, the function of the joint, the quality of the bone, and the surgeon's experience will result in a good outcome. Therefore, we reviewed the qualities of cementless implants, the application, and the various procedures involving the implant.

Keyword

Total hip arthroplasty; Cemented implant; Cementless implant

MeSH Terms

Arthroplasty
Congenital Abnormalities
Follow-Up Studies
Hip
Hip Joint
Humans
Joints
Survival Rate

Figure

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  Fig. 1 (A-C) Photographs of cementless acetabular cups with different type. (A) Threaded acetabular component - Zweymuller cup (Zimmer, Warsaw, IN, USA), (B) expansion acetabular component - CLS expansion cup (Zimmer, Warsaw, IN, USA) and (C) hemispherical acetabular component Trilogy cup (Zimmer, Warsaw, IN, USA).

Reference

1. Welch RB, Charnley J. Low friction arthroplasty of the hip in rheumatoid arthritis and ankylosing spondylitis. Clin Orthop Relat Res. 1970. 72:22–32.

2. Götze C, Steens W, Vieth V, Poremba C, Claes L, Steinbeck J. Primary stability in cementless femoral stems: custom-made versus conventional femoral prosthesis. Clin Biomech (Bristol, Avon). 2002. 17:267–273.

3. Petersen MB, Poulsen IH, Thomsen J, Solgaard S. The hemispherical Harris-Galante acetabular cup, inserted without cement. The results of an eight to eleven-year follow-up of one hundred and sixty-eight hips. J Bone Joint Surg Am. 1999. 81:219–224.

4. Ochs U, Eingartner C, Volkmann R, et al. Prospective long-term follow-up of the cementless bicontact hip stem with plasmapore coating. Z Orthop Unfall. 2007. 145:Suppl 1. S3–S8.

5. Costa CR, Johnson AJ, Mont MA. Use of cementless, tapered femoral stems in patients who have a mean age of 20 years. J Arthroplasty. 2012. 27:497–502.

6. Keisu KS, Orozco F, Sharkey PF, Hozack WJ, Rothman RH, McGuigan FX. Primary cementless total hip arthroplasty in octogenarians. Two to eleven-year follow-up. J Bone Joint Surg Am. 2001. 83-A:359–363.

7. Kim YH, Kim JS, Park JW, Joo JH. Contemporary total hip arthroplasty with and without cement in patients with osteonecrosis of the femoral head: a concise follow-up, at an average of seventeen years, of a previous report. J Bone Joint Surg Am. 2011. 93:1806–1810.

8. Labek G. Outcome of the cementless Taperloc stem. Acta Orthop. 2011. 82:633–634.

9. Sakalkale DP, Eng K, Hozack WJ, Rothman RH. Minimum 10-year results of a tapered cementless hip replacement. Clin Orthop Relat Res. 1999. (362):138–144.

10. Hur CI, Yoon TR, Park KS, Cho SG, Yim JH. Minimally invasive two-incision total hip arthroplasty for treating acute displaced femoral neck fractures in active elderly patients. J Korean Orthop Assoc. 2008. 43:643–650.

11. Callaghan JJ. The clinical results and basic science of total hip arthroplasty with porous-coated prostheses. J Bone Joint Surg Am. 1993. 75:299–310.

12. Haddad RJ Jr, Cook SD, Thomas KA. Biological fixation of porous-coated implants. J Bone Joint Surg Am. 1987. 69:1459–1466.

13. Peters CL, Dunn HK. Callaghan JJ, Rosenberg AG, Rubash HE, editors. The cementless acetabular component. The adult hip. 1998. 1st ed. Philadelphia: Lippincott-Raven;993–1016.

14. Robinson RP, Deysine GR, Green TM. Uncemented total hip arthroplasty using the CLS stem: a titanium alloy implant with a corundum blast finish. Results at a mean 6 years in a prospective study. J Arthroplasty. 1996. 11:286–292.

15. Pilliar RM. Porous surfaced metallic implants for orthopaedic applications. J Biomed Mater Res. 1987. 21:1–33.

16. Bourne RB, Rorabeck CH, Burkart BC, Kirk PG. Ingrowth surfaces. Plasma spray coating to titanium alloy hip replacements. Clin Orthop Relat Res. 1994. (298):37–46.

17. Hahn H, Palich W. Preliminary evaluation of porous metal surfaced titanium for orthopaedic implants. J Biomed Mater Res. 1970. 4:571–577.

18. Spotorno L, Romagnoli S, Ivaldo N, et al. The CLS system. Theoretical concept and results. Acta Orthop Belg. 1993. 59:Suppl 1. 144–148.

19. Vervest TM, Anderson PG, Van Hout F, Wapstra FH, Louwerse RT, Koetsier JW. Ten to twelve-year results with the Zweymuller cementless total hip prosthesis. J Arthroplasty. 2005. 20:362–368.

20. Bliss JM, Law PL, Patil SS, Colwell CW Jr. Hydroxyapatite-coated femoral stem/porous-coated acetabulum survivorship at 15 years. J Arthroplasty. 2011. 26:972–975.

21. Oonishi H, Tamamoto M, Ishimaru H, et al. The effect of hydroxyapatite coating on bone growth into porous titanium alloy implants. J Bone Joint Surg Br. 1989. 71:213–216.

22. Schimmel JW, Huiskes R. Primary fit of the Lord cementless total hip. A geometric study in cadavers. Acta Orthop Scand. 1988. 59:638–642.

23. Annaz B, Hing KA, Kayser M, Buckland T, Di Silvio L. Porosity variation in hydroxyapatite and osteoblast morphology: a scanning electron microscopy study. J Microsc. 2004. 215:100–110.

24. Nishiguchi S, Kato H, Fujita H, et al. Titanium metals form direct bonding to bone after alkali and heat treatments. Biomaterials. 2001. 22:2525–2533.

25. Ong KL, Lehman J, Notz WI, Santner TJ, Bartel DL. Acetabular cup geometry and bone-implant interference have more influence on initial periprosthetic joint space than joint loading and surgical cup insertion. J Biomech Eng. 2006. 128:169–175.

26. Effenberger H, Ramsauer T, Dorn U, Imhof H. Factors influencing the revision rate of Zweymuller acetabular cup. Int Orthop. 2004. 28:155–158.

27. Bigsby E, Whitehouse MR, Bannister GC, Blom AW. The medium term outcome of the Omnifit constrained acetabular cup. Hip Int. 2012. 22:505–510.

28. Ruben RB, Fernandes PR, Folgado J. On the optimal shape of hip implants. J Biomech. 2012. 45:239–246.

29. Purtill JJ, Rothman RH, Hozack WJ, Sharkey PF. Total hip arthroplasty using two different cementless tapered stems. Clin Orthop Relat Res. 2001. (393):121–127.

30. Berry DJ, Pellicci PM, Tria AJ, Garving KL. Pellicci PM, Tria AJ, Garvin KL, editors. Hip Society. Knee Society. American Academy of Orthopaedic Surgeons. Evolution of uncemented femoral component design. Orthopaedic knowledge update: hip and knee reconstruction, 2. 2000. Rosemont, IL: American Academy of Orthopaedic Surgeons;117–127.

31. Khanuja HS, Vakil JJ, Goddard MS, Mont MA. Cementless femoral fixation in total hip arthroplasty. J Bone Joint Surg Am. 2011. 93:500–509.

32. Engh CA, Hooper RH Jr. The odyssey of porous-coated fixation. J Arthroplasty. 2002. 17:102–107.

33. Chiu KY, Tang WM, Ng TP, Poon KC, Ho WY, Lee KM. Cementless total hip arthroplasty in young Chinese patients: a comparison of 2 different prostheses. J Arthroplasty. 2001. 16:863–870.

34. Ellison B, Berend KR, Lombardi AV Jr, Mallory TH. Tapered titanium porous plasma-sprayed femoral component in patients aged 40 years and younger. J Arthroplasty. 2006. 21:32–37.