The Cementless Fixation of Hip Endoprostheses

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2 The Cementless Fixation of Hip Endoprostheses Edited by E. Morscher With 230 Figures Springer-Verlag Berlin Heidelberg New York Tokyo 1984

3 Prof. Dr. Erwin Morscher Orthopadische Universitatsklinik Felix-Platter-Spital, Burgfelderstr Basel/Switzerland ISBN-13: DOT: / e-isbn-13: This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically those of translation, reprinting, re-use ofiiiustrations, broadcasting, reproduction by photocopying machine or similar means, and storage in data banks. Under 54 of the German Copyright Law where copies are made for other than private use, a fee is payable to "VerwertungsgeseIIschaft Wort", Munich. by Springer-Verlag Berlin Heidelberg 1984 Softcover reprint of the hardcover 1 st edition 1984 The use of registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Product Liability: The publisher can give no guarantee for information about drug dosage and application thereof contained in this book. In every individual case the respective user must check its accuracy by consulting other pharmaceutical literature. 2124/

4 Preface The main problem with regard to alloplastic joints is the loosening of the implant. Twenty years ago, Charnley first introduced bone cement to hip surgery, enabling total hip replacement to be practised on a larger scale. There is no question, however, that new approaches must be found to solving the problems of implant loosening, either by developing a new type of cement or by directly anchoring the implant without using cement. Much research has been done in this direction in recent years. The methods which have already been tested or are currently being tested were presented and discussed at a symposium on Cementless Fixation of Endoprostheses organized by the Orthopaedic Clinic of the University of Basel and held on June Various possible approaches which might be realized in practice were discussed in a relaxed atmosphere. In addition to the biomechanical bases of cementless fixation of endoprostheses, the various models were discussed, with special regard to their biocompatibility, physical characteristics, design, clinical applicability, and previous clinical experience. This book contains the papers delivered at this symposium. June 1983 E. Morscher, Basel v

5 Table of Contents Introduction I E. Morscher, Basel Introduction II: Hip Joint Prostheotoplasty I. S. Leinbach, St. Petersburg/Florida The Bone Cement Cuff in Hip Endoprostheses: Results of 80 Postmortem Studies A. Gachter, Basel Remodeling of the Femur in Conventionally-Implanted Hip Prostheses H. Kusswetter, E. Gabriel, T. Stuhler and L. T6pfer, Wurzburg.. 17 Causal Histogenesis (Pauwels, Kummer) and Related Biomechanical Discoveries as a Basis for the Cementless Fixation of Hip Endoprostheses A. Engelhardt, Frankfurt Biocompatibility of Endoprosthetic Materials H.-G. Willert and G. H. Buchorn, G6ttingen 29 The Introduction of Bone Resorption by Prosthetic Loosening S. M. Perren, Davos The Biochemistry ofimplantation: Bonding of Living Bone to Stress-Bearing Endoprosthetic Components - A Survey G. P. Zoephel and A. Engelhardt, Frankfurt Possibilities and Limitations of the Cementless Fixation of Endoprosthetic Components K. Draenert and Y. Draenert, Munich Histologic Studies on the Incorporation of Un cemented Implants R. K. Schenk and W. Herrmann, Bern Metallic Implant Materials for Hip Joint Endoprostheses Designed for Cemented and Cementless Fixation M. Semlitsch, Winterthur The Use of Polymers for Endoprosthetic Components R. Mathys and R. Mathys Jr., Bettlach VII

6 The Use of Carbon as an Implant Material W. Huttner and K. J. Huttinger, Karlsruhe/GieBen Ceramic Materials for Implants A. Zeibig, Lauf an der Pegnitz A Metal-Ceramic Composite Designed for Cementless Fixation to Bone H. Scharbach, Schwetzingen Titanium and Titanium Alloy Prostheses with Porous Fiber Metal Coatings P. Ducheyne, M. Martens, P. De Meester and J. C. Mulier, Leuven. 109 Tissue-Ingrowth Implant Fixation by a Soft Porous Coating C. A. Homsy, Houston The Uncemented Thrust-Plate Hip Prosthesis A. H. Huggler and H. A. C. Jacob, Chur 125 First Results with the "Thrust Plate" Total Hip Prosthesis A. Schreiber, H. A. C. Jacob, Y. Suezawa and A. H. Huggler, Chur. 130 Uncemented, Ceramic-Coated, Electrically-Nonconductive Implants with Physiologic Stress Transfer A. Engelhardt, Frankfurt Experience with the Lord Prosthesis G. Rupp, Vocklabruck Experience with the Lord Total Hip Replacement: Biomechanics and Clinical Results H. Seidel, Hamburg Early Results of Judet Total Hip Replacement Arthroplasty D. SchOllner and K. H. Elsner, Cologne First Clinical Experience with an Uncemented Modular Femoral Prosthesis System with a Wrought Ti-6 Al-4 V Stem and an Al 20 3 Ceramic Head K. Zweymuller, Vienna Cementless Implantation of a Modified Mueller Straight-Stem Prosthesis D. Parpan and R. Ganz, Bern Radiologic and Clinical Follow-Ups of Un cemented Femoral Endoprostheses with and Without Collars M. Salzer, K. Knahr and P. Frank, Vienna Fiber Titanium: Animal Studies and Clinical Trials A. Gachter and J. Galante, Basel/Chicago 168 VIII 156

7 The Current Status of Un cemented Tantalum and Niobium Femoral Endoprostheses H. Plenk Jr., G. PflUger, S. Schider, N. Bohler and F. Grundschober, Vienna 174 First Experience with the PM Prosthesis K. Walcher, Bayreuth.... First Experience with the PM Prosthesis A. Reichelt and K. Blasius, Freiburg Nine Years' Experience with Isoelastic Hip Endoprostheses Made of Plastic Material E. Morscher, Basel Experimental and Early Clinical Experience with an Uncemented UHMW Polyethylene Acetabular Prosthesis M. Endler, Jr., F. Endler and H. Plenk, Jr., Vienna Cementless Fixation ofa Polyethylene Acetabular Component E. Morscher and W. Dick, Basel Experience with Uncemented Polyethylene Acetabular Prostheses K. Knahr, M. Salzer and P. Frank, Vienna Cementless, Isoelastic Total Hip Replacement: Preliminary Report on the First 215 Consecutive Cases R. Bombelli, Busto Arsizio Four- to Eight-Year Postoperative Results of the Partially Uncemented Lindenhof-Type Ceramic Hip Endoprosthesis P. Griss, Mannheim.... Total Hip Replacement with the Autophor Cement-Free Ceramic Prosthesis H. Mittelmeier, Homburg A Screw-Anchored Intramedullary Hip Prosthesis G. Bousquet and F. Bornand, Lausanne.... Experimental and Clinical Experience with Carbon Hip Endoprostheses H. Rettig and U. Weber, GieBen Results of Animal Studies on the Use of Carbon Fiber-Reinforced Plastic Prostheses 1. Harms, H. Mittelmeier and E. Mausle, Karlsbad-Langensteinbach/ Homburg/Saar Regeneration of the Femoral Shaft Following Revision Arthroplasties with Uncemented Plastic Prostheses B. Stormer and G. Hierholzer, Duisburg IX

8 Six Years' Experience in Revision Total Hip Arthroplasties with Uncemented Ceramic Prostheses K. E. Brinkmann and J. Harms, Karlsbad-Langensteinbach 257 Revision Arthroplasties with the Isoelastic Total Hip Replacement w. Dick, H. Jenny and E. Morscher, Basel Y2 Years' Results of Lord Primary Total Hip Arthroplasties and 1 Y2 Years' Experience with Revision Arthroplasties for Loose Cemented Prostheses o. Stampfel, W. Pommer, R. Trauner and V. Santner, Graz 265 Experience with Revision Arthroplasties for Failed Cemented Total Hip Replacements Using Uncemented Lord and PM Prostheses R. Parhofer and W. Manch, Memmingen Revision Arthroplasty with the Screw-Anchored Intramedullary Hip Prosthesis G. Bousquet and F. Bornand, Lausanne Subject Index x

9 List of Contributors Dr. K. Blasius, Orthopiidische Abteilung der Universitatsklinik, HugstetterstraBe 55, Freiburg Prof. Dr. Renato Bombelli, Via Lampugnani, Legnano (Milano) Dr. N. Bohler, Labor fur Knochenforschung, Histologisch Embryologisches Institut, SchwarzspanierstraBe 17, A-1090 Wien Dr. F. Bornand, Avenue Eglantine 5, CH-1006 Lausanne Prof. Dr. G. Bousquet, F-St. Etienne Dr. K. E. Brinkmann, Leitender Arzt der Orthopadie-Traumatologie, Rehabilitations-Krankenhaus, Karlsbad-Langensteinbach Dr. G. H. Buchhorn, Orthopiidische Universitatsklinik, Robert-Koch-StraBe 46, Gottingen Dr. P. De Meester, Department of Metallurgy and Division of Orthopaedic Surgery, Katholieke Universiteit, B-3030 Leuven Dr. W. Dick, Kinderspital, CH-4058 Basel Dr. K. und Y. Draenert, Histo-Morphologische Arbeitsgruppe der Orthopadischen Klinik Rechts der Isar der Technischen Universitat, Alte LandstraBe 26, Ottobrunn Prof. Dr. P. Ducheyne, Department of Metallurgy and Division of Orthopaedic Surgery, Katholieke Universiteit, B-3030 Leuven Dr. K. H. Elsner, Orthopadische Abteilung des Krankenhauses der Augustinerinnen, JakobstraBe 27, Koln 1 Prof. Dr. F. Endler, ehemals Primarius der Orthopadischen Station d~r KFA und des Gottfried-von-Preyerschen-Kinderspitales, Wiedner HauptstraBe 36, A-1040 Wien Doz. Dr. M. Endler jun., Wiedner HauptstraBe 36, A-1040 Wien Dr. A. Engelhardt, Facharzt fur Orthopadie, DonnersbergstraBe 42, FrankfurtiM. XI

10 Dr. P. Frank, Orthopadisches Krankenhaus Wien-Gersthof, Wielemansgasse 2S, A-llSO Wien Dr. E. Gabriel, Orthopadische Klinik der Universitat, BrettreichstraBe 11, D-S700 Wurzburg Prof. Dr. J. Galante, Rush-Presbyterian-St. Luke's Medical Center, 1753 W. Congress Parkway, Chicago, IL 606l2lUSA Priv.-Doz. Dr. A. Gachter, Orthopadische Universitatsklinik, Kantonsspital, CH-403l Basel Prof. Dr. R. Ganz, Direktor der Klinik und Poliklinik fur Orthop. Chirurgie, Inselspital, CH-3010 Bern Priv.-Doz. Dr. P. Griss, Oberarzt, Orthopadische Klinik Lindenhof, D-6S00 Mannheim Dr. F. Grundschober, Labor fur Knochenforschung, Histologisch Embryologisches Institut, SchwarzspanierstraBe 17, A-1090 Wien Prof. Dr. J. Harms, Leitender Arzt, Orthopadie-Traumatologie I, Rehabilitationskrankenhaus, D-75l6 Karlsbad-Langensteinbach Dr. W. W. Herrmann, Anatomisches Institut, Abteilung fur Systematische Anatomie, BuhlstraBe 26, CH-30l2 Bern Prof. Dr. G. Hierholzer, Arztlicher Direktor, BG-Unfallklinik, Grossenbaumer Allee 250, D-4100 Duisburg 2S Dr. Ch. A. Homsy, Direktor Prosthesis Research Labor, Fondren Orthopedic Center, The Methodist Hospital, 6560 Fannin, Houston, Texas 77030/USA Prof. Dr. K. J. Huttinger, Institut fur Chemische Technik der Universitat, KaiserstraBe 12, D-7500 Karlsruhe 1 Dr. W. Huttner, c/o Fa. Schunk & Ebe GmbH, Postfach 64, D-6300 GieBen Prof. Dr. A. Huggler, Leitender Arzt der. Orthopadischen Klinik, Kantonsspital, LoestraBe 170, CH-7000 Chur Dr. H. A. C. Jacob, Klinik Balgrist, ForchstraBe 240, CH-SOOS Zurich Dr. H. Jenny, Orthopadische Universitatsklinik, Felix-Platter-Spital, CH-4055 Basel Doz. Dr. K. Knahr, Orthopadisches Krankenhaus Wien-Gersthof, Wielemansgasse 2S, A-IISO Wien XII

11 Prof Dr. W. Kusswetter, Orthopadische Klinik der Universitat, BrettreichstraBe 11, D-S700 Wurzburg Dr. M. Martens, Department of Metallurgy and Division of Orthopaedic Surgery, Katholieke Universiteit, B-3030 Leuven Dr. h.c. R. Mathys und R. Mathys jun., Fabrik fur Chirurgie Instrumente, CH-2544 Bettlach Prof. Dr. E. Mausle, Institut fur Pathologie der Universitat des Saarlandes, D-6650 Homburg/Saar Prof. Dr. H. Mittelmeier, Direktor der Orthopadischen Universitatsklinik und Poliklinik, D-6650 Homburg/Saar Dr. W. Monch, Stadtkrankenhaus, Chirurgische Abteilung, D-S940 Memmingen Prof Dr. E. Morscher, Vorsteher der Orthopadischen Universitatsklinik, Felix-Platter-Spital, CH-4055 Basel Dr. J. C. Mulier, Department of Metallurgy and Division of Orthopaedic Surgery, Katholike Universiteit, B-3030 Leuven Dr. R. Parhofer, Chefarzt, Chirurgische Abteilung Stadtkrankenhaus, BismarckstraBe, D-S940 Memmingen Dr. D. Parpan, Klinik fur Orthopadie, Inselspital, CH-3010 Bern Prof Dr. Sr. M. Perren, M. E. Muller-Institut fur Biomechanik der Universitat, MurtenstraBe 35, CH-300S Bern Univ.-Doz. Dr. H. Plenkjun., Labor fur Knochenforschung, Histologisch- Embryologisches Institut, SchwarzspanierstraBe 17, A-1090 Wien Dr. G. Pfluger, Labor fur Knochenforschung, Histologisch Embryologisches Institut, SchwarzspanierstraBe 17, A-1090 Wien Dr. W. Pommer, Universitatsklinik fur Chirurgie, Landeskrankenhaus, Auenbruggerplatz, A-S036 Graz Prof Dr. A. Reichelt, Direktor der Orthopadischen Abteilung, Universitatsklinik, HugstetterstraBe 55, D-7S00 Freiburg Prof Dr. H. Rettig, Direktor der Orthopadischen Universitatsklinik, Klinikum der Justus-Liebig-Universitat, FreiligrathstraBe 2, D-6300 GieBen XIII

12 Prim. Dr. G. Rupp, A.o. Landeskrankenhaus, Unfallabteilung, A-4S40 Vocklabruck Prof. Dr. M. Salzer, Vorsteher des Orthopadischen Krankenhauses Wien-Gersthof, Wielemansgasse 2S, A-IISO Wien Dr. R. F. Santore, Via Lampugnani, Legnano (Milano) Dr. V. Santner, Universitatsklinik fur Chirurgie, Landeskrankenhaus, Auenbruggerplatz, A-S036 Graz Dipl.-Chem. H. Scharbach, c/o Pfaudler-Werke AG, ScheffelstraBe 55, D-6S30 Schwetzingen Prof. R. Schenk, Anatomisches Institut, Abteilung fur Systematische Anatomie, BuhlstraBe 26, CH Bern Dr. S. Schider, Labor fur Knochenforschung, Histologisch Embryologisches Institut, SchwarzspanierstraBe 17, A-1090 Wien Prof. Dr. D. Schollner, Chefarzt der Orthopadischen Abteilung, Krankenhaus der Augustinerinnen, lakobstrabe 27, D-5000 Koln 1 Prof. Dr. A. Schreiber, Direktor der Orthopadischen Universitatsklinik, Balgrist, ForchstraBe 340, CH-SOOS Zurich Dr. H. Seidel, Chefarzt der Chirurgischen Abteilung, Hafenkrankenhaus, Zirkusweg 11, D-2000 Hamburg 4 Dr. M. Semlitsch, c/o Gebr. Sulzer AG, CH-S401 Winterthur Priv.-Doz. Dr. Y. Suezawa, KEnik Balgrist, ForchstraBe 340, CH-SOOS Zurich Dr. O. Stampfel, Oberarzt, Universitatsklinik fur Chirurgie, Landeskrankenhaus, Auenbruggerplatz, A-S036 Graz Dr. B. Stormer, BG-Unfallklinik, Grossenbaumer Allee 250, D-4100 Duisburg Dr. T. Stuhler, Orthopadische Klinik der Universitat, BrettreichstraBe 11, D-S700 Wurzburg Dr. L. Topfer, Orthopadische Klinik der Universitat, BrettreichstraBe 11, D-S700 Wurzburg Dr. R. Trauner, Universitatsklinik fur Chirurgie, Landeskrankenhaus, Auenbruggerplatz, A-S036 Graz XIV

13 Prof. Dr. K. Walcher, Chefarzt der Chirurgischen Klinik II der Stadt. Krankenanstalten, Kulmbacher StraBe 23, D-8580 Bayreuth Priv.-Doz. Dr. U. Weber, Facharzt fur Chirurgie, Oberarzt der Orthopadischen Universitatsklinik, FreiligrathstraBe 2, D-6300 GieBen Prof. Dr. H.-G. Willert, Direktor der Orthopadischen Universitatsklinik, Robert-Koch-StraBe 46, D-3400 Gottingen Dr. A. Zeibig, Rosenthal Stemag Technische Keramik AG, D-8560 Lauf an der Pegnitz Dr. P. Zoephel, BafB, Ostend 29, D-6103 Griesheim b. Darmstadt Doz. K. Zweymiiller, Orthopadische Universitatsklinik, Allgemeines Krankenhaus, Garnisonsgasse 13, A-1090 Wien xv