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Effect of augmented cup fixation on stability, wear and osteolysis: a 5-year follow-up of total hip arthroplasty with RSA
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.ORCID iD: 0000-0002-8818-3408
2004 (English)In: The Journal of Arthroplasty, ISSN 0883-5403, E-ISSN 1532-8406, Vol. 19, no 8, 962-971 p.Article in journal (Refereed) Published
Abstract [en]

To evaluate different modes of cementless fixation of hemispherical cups, we operated on 87 hips in 81 patients using 4 different means of cup fixation. The hips were randomly assigned to fixation with press-fit technique only (PF), or with augmentation with screws (S), pegs (P), or hydroxyapatite (HA) coating. The patients were evaluated with radiostereometric analysis (RSA) for cup migration and wear, conventional radiography for osteolysis, and Harris Hip Score for clinical outcome over 5 years. The fixation of the cups did not differ between the groups, but HA showed a tendency to decrease proximal migration. HA-coated cups displayed the best interface with hardly any signs of radiolucent lines, indicating a superior sealing effect of the HA coating. Cups with screws or pegs had more radiolucent lines and osteolytic lesions than the other groups. Radiolucent lines were correlated to higher proximal migration, young age, and female gender (r2=.2). The wear rate of the ethylene oxide-sterilized polyethylene liner was high (0.2 mm/y) but did not differ between the groups. Two cups with a perioperative fracture of the acetabular rim showed large initial migration but stabilized thereafter.

Place, publisher, year, edition, pages
2004. Vol. 19, no 8, 962-971 p.
Keyword [en]
hip arthroplasty, fixation, cup
National Category
Medical and Health Sciences
URN: urn:nbn:se:umu:diva-23496DOI: 10.1016/j.arth.2004.06.024PubMedID: 15586331OAI: diva2:224779
Available from: 2009-06-22 Created: 2009-06-22 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

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Röhrl, Stephan MNilsson, Kjell G
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