Table Of ContentThe Cementless
Fixation of
Hip Endoprostheses
Edited by E. Morscher
With 230 Figures
Springer-Verlag
Berlin Heidelberg New York Tokyo 1984
Prof. Dr. Erwin Morscher
Orthopadische Universitatsklinik
Felix-Platter-Spital, Burgfelderstr. 101
4001 Basel/Switzerland
ISBN-13: 978-3-642-69008-2 e-ISBN-13: 978-3-642-69006-8
DOT: 10.1007/978-3-642-69006-8
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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 ce
ment. 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 24-26 June 1982. Various possible ap
proaches which might be realized in practice were discussed in a relaxed
atmosphere. In addition to the biomechanical bases of cementless fixa
tion 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
Table of Contents
Introduction I
E. Morscher, Basel
Introduction II: Hip Joint Prostheotoplasty
I. S. Leinbach, St. Petersburg/Florida 9
The Bone Cement Cuff in Hip Endoprostheses: Results
of 80 Postmortem Studies
A. Gachter, Basel . . . . . . . . . . . . . . . . . . . 11
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 Biomechani
cal Discoveries as a Basis for the Cementless Fixation of Hip Endo
prostheses
A. Engelhardt, Frankfurt . . . . . . . . . . . . . . . . . . . .. 21
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 . . . . . . . . . . . . . . . . . . . . 39
The Biochemistry ofImplantation: Bonding of Living Bone
to Stress-Bearing Endoprosthetic Components - A Survey
G. P. Zoephel and A. Engelhardt, Frankfurt ....... 42
Possibilities and Limitations of the Cementless Fixation
of Endoprosthetic Components
K. Draenert and Y. Draenert, Munich .............. 46
Histologic Studies on the Incorporation of Un cemented Implants
R. K. Schenk and W. Herrmann, Bern ............. 52
Metallic Implant Materials for Hip Joint Endoprostheses Designed
for Cemented and Cementless Fixation
M. Semlitsch, Winterthur . . . . . . . . . . . . . . . 59
The Use of Polymers for Endoprosthetic Components
R. Mathys and R. Mathys Jr., Bettlach ....... . 71
VII
The Use of Carbon as an Implant Material
W. Huttner and K. J. Huttinger, Karlsruhe/GieBen 81
Ceramic Materials for Implants
A. Zeibig, Lauf an der Pegnitz 95
A Metal-Ceramic Composite Designed for Cementless Fixation
to Bone
H. Scharbach, Schwetzingen 102
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 . . . . . . . . . . . . . . . . . . . 118
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 . . . . . . . . . . . . . . . . . . 133
Experience with the Lord Prosthesis
G. Rupp, Vocklabruck . . . . . . . . 139
Experience with the Lord Total Hip Replacement: Biomechanics
and Clinical Results
H. Seidel, Hamburg . . . . . . . . . . . . . . . . . . . . 144
Early Results of Judet Total Hip Replacement Arthroplasty
D. SchOllner and K. H. Elsner, Cologne ........... 146
First Clinical Experience with an Uncemented Modular Femoral
Prosthesis System with a Wrought Ti-6 Al-4 V Stem and an Al 0
2 3
Ceramic Head
K. Zweymuller, Vienna . . . . . . . . . . . . . . . . . . . . 150
Cementless Implantation of a Modified Mueller Straight-Stem
Prosthesis
D. Parpan and R. Ganz, Bern 156
Radiologic and Clinical Follow-Ups of Un cemented Femoral
Endoprostheses with and Without Collars
M. Salzer, K. Knahr and P. Frank, Vienna ...... 161
Fiber Titanium: Animal Studies and Clinical Trials
A. Gachter and J. Galante, Basel/Chicago 168
VIII
The Current Status of Unc emented 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 ........ . 178
First Experience with the PM Prosthesis
A. Reichelt and K. Blasius, Freiburg 181
Nine Years' Experience with Isoelastic Hip Endoprostheses Made
of Plastic Material
E. Morscher, Basel . . . . . . . . . . . . . . . . . . . . . . .. 184
Experimental and Early Clinical Experience with an Uncemented
UHMW Polyethylene Acetabular Prosthesis
M. Endler, Jr., F. Endler and H. Plenk, Jr., Vienna . . . . . . . . 191
Cementless Fixation ofa Polyethylene Acetabular Component
E. Morscher and W. Dick, Basel ............... 200
Experience with Uncemented Polyethylene Acetabular Prostheses
K. Knahr, M. Salzer and P. Frank, Vienna ............. 205
Cementless, Isoelastic Total Hip Replacement: Preliminary Report
on the First 215 Consecutive Cases
R. Bombelli, Busto Arsizio 211
Four- to Eight-Year Postoperative Results of the Partially
Uncemented Lindenhof-Type Ceramic Hip Endoprosthesis
P. Griss, Mannheim .................. . 220
Total Hip Replacement with the Autophor Cement-Free Ceramic
Prosthesis
H. Mittelmeier, Homburg . . . . . . . . . . . . . 225
A Screw-Anchored Intramedullary Hip Prosthesis
G. Bousquet and F. Bornand, Lausanne ..... . 242
Experimental and Clinical Experience with Carbon Hip
Endoprostheses
H. Rettig and U. Weber, GieBen 247
Results of Animal Studies on the Use of Carbon Fiber-Reinforced
Plastic Prostheses
1. Harms, H. Mittelmeier and E. Mausle, Karlsbad-Langensteinbach/
Homburg/Saar . . . . . . . . . . . . . . . . . . . . . . . 249
Regeneration of the Femoral Shaft Following Revision Arthro
plasties with Uncemented Plastic Prostheses
B. Stormer and G. Hierholzer, Duisburg ............ 252
IX
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 ......... 259
3Y2 Years' Results of Lord Primary Total Hip Arthroplasties
and 1Y 2 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 ............ 275
Revision Arthroplasty with the Screw-Anchored Intramedullary
Hip Prosthesis
G. Bousquet and F. Bornand, Lausanne ............. 279
Subject Index . . . . . . . . . . 283
x
List of Contributors
Dr. K. Blasius, Orthopiidische Abteilung der Universitatsklinik,
HugstetterstraBe 55, 0-7800 Freiburg
Prof. Dr. Renato Bombelli, Via Lampugnani, 1-20025 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, 0-7516 Karlsbad-Langensteinbach
Dr. G. H. Buchhorn, Orthopiidische Universitatsklinik,
Robert-Koch-StraBe 46, 0-3400 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, 0-8012 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 27,0-5000 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,
0-6000 FrankfurtiM.
XI
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
