Clin Orthop Surg.  2016 Sep;8(3):237-242. 10.4055/cios.2016.8.3.237.

Total Hip Arthroplasty around the Inception of the Interface Bioactive Bone Cement Technique

• Oonishi H
• Ohashi H
• Kawahara I

• KMID: 2374267
• DOI: http://doi.org/10.4055/cios.2016.8.3.237

Abstract

BACKGROUND
To augment cement-bone fixation, Dr. Hironobu Oonishi attempted additional physicochemical bonding through interposition of osteoconductive crystal hydroxyapatite (HA) granules at the cement-bone interface in 1982. He first used the interface bioactive bone cement (IBBC) technique in 12 selected patients (12 hips) in 1982 (first stage) and followed them for 2 years. In 1985, the technique was applied in 25 total hip arthroplasty (THA) patients (second stage) and the effects were investigated by comparing the side with the IBBC technique and the other side without the IBBC technique. He has employed this technique in all THA patients since 1987 (third stage).
METHODS
In the IBBC technique, HA granules (2 to 3 g) were smeared on the bone surface just before the acetabular and femoral components were cemented. In the first stage, 12 hips were operated using the IBBC technique in 1982. In the second stage, THA was performed without the IBBC technique on one side and with the IBBC technique on the other side within 1 year in 25 patients. In the third stage, THA was performed with the IBBC technique in 285 hips in 1987.
RESULTS
In the first stage patients, implant loosening was not detected at 30 years after operation. In the second stage patients, revision was required in 7 hips without the IBBC technique due to cup loosening (5 hips) and stem loosening (2 hips), whereas no hip was revised after THA with the IBBC technique at 26 years after operation. In the third stage patients, the incidence of radiolucent lines and osteolysis was very few at 25 years after operation.
CONCLUSIONS
The long-term follow-up of THA performed around the inception of the IBBC technique has revealed low incidences of radiolucent lines, osteolysis, and revision surgery.

Keyword

Total hip arthroplasty; Hydroxyapatites; Bone-cement interface; Bioactive bone cement

MeSH Terms

Adult
Aged
Aged, 80 and over
*Arthroplasty, Replacement, Hip/adverse effects/instrumentation/methods
*Bone Cements/adverse effects/therapeutic use
Bone-Implant Interface/physiology
Follow-Up Studies
Hip/diagnostic imaging/surgery
Humans
Hydroxyapatites/therapeutic use
Middle Aged
Young Adult
Bone Cements
Hydroxyapatites

Figure

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  Fig. 1 Radiograph taken 30 years after operation (first stage).

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  Fig. 2 Radiograph taken 29 years after operation (second stage).

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  Fig. 3 The left hip was operated without the interface bioactive bone cement (IBBC) technique 26 years ago. The right hip was operated with the IBBC technique 25 years ago.

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  Fig. 4 Incidence of radiolucent lines in hips with interface bioactive bone cement (IBBC) technique (A) and non-IBBC technique (B) in the second stage.

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  Fig. 5 Incidence of osteolysis in hips with interface bioactive bone cement (IBBC) technique (A) and non-IBBC technique (B) in the second stage.

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  Fig. 6 Incidences of radiolucent lines (A) and osteolysis (B) in hips with the interface bioactive bone cement technique in the third stage.

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  Fig. 7 Radiograph taken 26 years after operation (third stage). The interface between bone and bone cement was intact even with the existence of polyethylene wear.

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