Change search
ReferencesLink to record
Permanent link

Direct link
Porous-coated cups fixed with screws.: A 12-year clinical and radiostereometric follow-up study of 50 hips.
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
Show others and affiliations
2006 (English)In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 77, no 3, 393-401 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Excellent mid-term results have stimulated the use of hemispherical porous-coated cups in hip replacement. With longer follow-up, there have been problems related to polyethylene wear and liner fixation, and osteolysis has been documented in reports of selected cases. We evaluated the clinical and radiographic results of 50 patients followed for 12 years. PATIENTS AND METHODS: 58 consecutive patients (58 hips), mean age 55 years, were operated with Harris-Galante (HG) I or II cups using line-to-line fit and additional screw fixation. Polyethylene linersgamma-sterilized in air and 32-mm ceramic heads were used. 8 patients died within 12 years, leaving 50 patients with a complete 12 year follow-up. 23 of the cups were also evaluated with radiostereometry (RSA) for migration, liner stability, and wear. RESULTS: All metal shells were still in situ after 12 years. 4 hips had been revised due to femoral loosening. In these revisions, the liner had been exchanged due to wear and/or instability, resulting in a cup survival rate of 89%. 28 cups displayed osteolytic lesions, mainly in relation to screws. RSA revealed minimum translations, but in many cases there were pronounced liner rotations suggesting unstable liners within the metal shell. The annual proximal wear was 0.09 mm and the three-dimensional wear was 0.16 mm. INTERPRETATION: RSA can predict the long-term performance of cup fixation. Low migration during the initial years after implantation indicates excellent long-term results regarding fixation of the metal shell. The main problem with this design appears to be liner instability and osteolysis, factors that are probably interrelated. Because these phenomena are clinically silent, we recommend regular follow-up of patients with HG cups to avoid sudden loosening and complicated revisions.

Place, publisher, year, edition, pages
2006. Vol. 77, no 3, 393-401 p.
National Category
Medical and Health Sciences
URN: urn:nbn:se:umu:diva-10306DOI: 10.1080/17453670610046316PubMedID: 16819677OAI: diva2:149977
Available from: 2008-08-11 Created: 2008-08-11 Last updated: 2016-02-09Bibliographically approved
In thesis
1. Wear and Fixation of the acetabular component: in vivo evaluation of different polyethylenes and modes of fixation in total hip arthroplasty
Open this publication in new window or tab >>Wear and Fixation of the acetabular component: in vivo evaluation of different polyethylenes and modes of fixation in total hip arthroplasty
2004 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[de]
Verschleiβ und Verankerung der Pfanne von Hüftendoprothesen : In vivo Beurteilung von unterschiedlichen Polyethylenen und Fixationsarten
Abstract [en]

Polyethylene wear and micromotion of the implant play an important role in multifactorial etiology of osteolysis leading to aseptic loosening of the acetabular components. Despite excellent results in primary total hip arthoplasty in a 10-15 year perspective there are still unsolved problems. The weakest link is the longevity of the actabular component. Young and active patients have a clearly worse outcome than older patients. Consequences of polyehtylene wear and ways to reduce wear have therefore been in focus during recent years. Radiostereometry (RSA) is the golden standard in measuring in vivo micromotions. In 4 clinical studies including 332 patients we used therefore RSA to record the efficacy of fixation of cemented and uncemented cups. The amount of wear of old and newly designed polyethylenes (PE) was related to cup stability and radiological and clinical measures of outcome.

This study showed that cementless cups inserted with pressfit technique do not need additional augmentation. Screws and pegs increase the risk for radiolucencies and osteolystic lesions but are helpful tools in cases where primary stability is jeopardized. In the second decade clinically silent osteolysis is common for the porous coated Harris Galante cup with unsealed screw holes. The locking mechanism of the PE liner in this cup is unsatisfactory and an increase of liner dissociations is expected. EtO sterilized PE displayed high in vivo wear and we do not recommend its continued use but close monitoring of patients with earlier inserted EtO sterilized implants. The substantially reduced wear in cemented highly cross-linked PE cups without any negative in vivo tradeoffs might have a substantial impact on choice of material and operating technique in the near future. However, we still recommend its restrained use in controlled series until longer follow-up data is available. Nevertheless, the short term in vivo results of modern highly cross-linked PE look promising and ight improve the outcome of cemented and uncemented hip arthroplasties by reducing complication and revisions.

150 p.
Umeå University medical dissertations, ISSN 0346-6612 ; 879
Surgery, total hip arthroplasty, acetabular component, wear, fixation, osteolysis, Radiostereometry, RSA, Kirurgi
National Category
Research subject
urn:nbn:se:umu:diva-230 (URN)91-7305-614-6 (ISBN)
Public defence
2004-04-29, Betula Sal, 6M, Norrlands Universitetssjukhus, 901 85 Umeå, 13:00
Available from: 2004-04-13 Created: 2004-04-13 Last updated: 2010-08-11Bibliographically approved

Open Access in DiVA

No full text

Other links

Publisher's full textPubMed

Search in DiVA

By author/editor
Röhrl, Stephan MNilsson, Kjell G
By organisation
In the same journal
Acta Orthopaedica
Medical and Health Sciences

Search outside of DiVA

GoogleGoogle Scholar
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

Altmetric score

Total: 24 hits
ReferencesLink to record
Permanent link

Direct link