Erve, Rudolfus Henricus Goderfridus Petrus van

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   University of GroningenProfile total hip arthroplastyErve, Rudolfus Henricus Goderfridus Petrus vanIMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite fromit. Please check the document version below.Document VersionPublisher's PDF, also known as Version of recordPublication date:2003Link to publication in University of Groningen/UMCG research databaseCitation for published version (APA):Erve, R. H. G. P. V. (2003). Profile total hip arthroplasty: a mid term follow-up study and analysis ofdifferent methods to detect lossening of uncemented total hip prostheses. s.n.CopyrightOther than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of theauthor(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons).The publication may also be distributed here under the terms of Article 25fa of the Dutch Copyright Act, indicated by the “Taverne” license.More information can be found on the University of Groningen website: https://www.rug.nl/library/open-access/self-archiving-pure/taverne-amendment.Take-down policyIf you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediatelyand investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons thenumber of authors shown on this cover page is limited to 10 maximum.Download date: 20-06-2022jk are the Presence of lumbo-related to an overlaP in clinicalÍ clear. That apPears to be theof pathology oÍ the knee in:lative risk for hip revision thannolaints. lt is not clear whether;onsequence of the difficultY inip pathology or the difficultY ofsacral region Írom that of hiPon to revise the prosthesis.re hip is not influenced bY thecations, as we did not find aeterotopic ossifications betweenlteral approach. HeterotoPiclre seen in a frequency thatd a total oÍ 58.4% heterotopic; of up to 90% have beenimportant Brooker 3 and 4Table 26), while Percentages oftt Most of the more extensiververe found in the postero-laterals in this study were not treatedrme form of NSAID; onlY 30.2o/or has proven to satisfactorilYs1e71$ This study coníirmed thatre Brooker 3 and 4 classified: of heterotopic ossificationsdid not receive anY NSAID. There Indometacin users is half thatrf Indometacin i this PoPulationnsidered to be Prone to theit may, if used in all Patients,'en further.bone formation after total hiPsed lndometacin for seven daYs.)n reported 0% ectoPic bone.  14 days. tTat t t  ts3 1e2.1s 7 Whethefbe attributed to the use of,se cannot be deduced from thisudied may have PlaYed a Part in7 SummarvThe idea of total hip prosthesis was born in the 1950s. Later theprosthesis developed into a truly total hip prosthesis with a stem and anacetabular component. Charnley developed his cemented low-frictiontotal hip prosthesis in the early 1960s. This prosthesis is sti l l  the'goldstandard' in prosthetic replacement of the hip. In recent years newtechniques using uncemented prostheses have replaced cementedprostheses, which produced unsatisfactory results, particularly in youngpatients.Total hip arthroplasty is, at present, a well-known and developed techniqueto reduce pain in arthrotic and arthritic hips. One of the latest developmentsin total hip arthroplasty is the uncemented technique with the use ofhydroxylapatite coating. The design of the prosthesis influences theolrtcome of the arthroplasty rn vivo. This includes the fixation method,with or without cement. The applied coating on uncementedprostheses, the used metal for the stem and the design of it areimportant components that determine the outcome of the prosthesis.The surgical technique is an important factor as well. A perfectprosthesis can fail when it is positioned improperly. During implantationof a total hip prosthesis several possibilities exist for problems to occur,think about fractures, faux routes, infections, etcetera. Even after theoperation itself problems like heterotopic ossifications, dislocations andlate infections may occur.Wear is an important factor in failure of prostheses, as is asepticloosening, which is an indication for revision surgery in 1 to 20 % of theprimary total hip adhroplasties. Aseptic loosening of a total hiporosthesis is the result of a combination of biomechanical and chemicalfactors.L Weakening of the bone resulting from bone resorption becauseof particle disease,2. Material strain in the interface of prosthesis and bone,3. Failure of the ingrowth in improperly fitt ing uncementedprostheses;4. Inadequate stress transfer of prosthesis to bone.Osteolysis, which is a result oÍ aseptic loosening, in cemented anduncemented components has different patterns leading to loosening incemented cups and to bone loss without loosening in uncemented cupsand stemsThe bone-prosthesis interface is subject to significant stress, resultingin wear between the prosthesis and the bone. In loosened prosthesesthe amount of wear increases and metal particles could be releasedfrom the orosthesis to the adiacent tissues.169The presence of a loosened hip prosthesis may, through its metal iondissemination, increase the incidence of neoplasms in the proximity ofthe prosthesis. Reintroduction of metal-on-metal hip prostheses needscareful surveil lance for, although the risk of leukaemia and lymphomasis not proven to be higher, it tends to be slightly increased in the earlier(prior to1 973) metal-on-metal prostheses.Several studies have been conducted on the bone density around totalhip prostheses. The two DEXA measuring instruments currently on themarket have been tested in the presence of an uncemented stem of atotal hip prosthesis. This led to different methods of measurement indifferent regions of interest around a total hip arthroplasty.Bone scintigraphy has been used in cemented prostheses to evaluateloosening. In uncemented total hip arthroplasty this is not applicable.As people age, the femoral bone grows more rigid, while the prosthesisdoes not. The prosthesis may become too flexible for the patient. DEXAand bone scintigraphy may not be useful to detect loosening of theprosthesis, but they can be used to evaluate the bone remodell ingprocess around the prosthesis. This remodell ing includes a decrease ofbone density with an increase in bone width. The observed changes inbone mineral content, bone mineral density and bone width over timeare confirmed by the increased activity of the bone on the Technetiumscan.This thesis describes the clinical study of an anatomically shaped,proximally hydroxylapatite-coated, uncemented hip prosthesis with ahemispherical, porous-coated, uncemented acetabular component. Sincethere is no literature addressing this prosthesis, an extensive literaturestudy was conducted, which is described in Part 1.2. Every aspect ofdesign, material and coating of the prosthetic stem and the cup isdescribed. In addition, the eventual short{erm complications, includingfracture, infection and heterotopic ossifications, and long-term sequelae,such as wear, dislocation and loosening, are addressed. Several methodsof evaluating the performance of total hip arthroplasty are available, but notall of them are applicable to every total hip arthroplasty. In the past a rangeof methods was developed to evaluate cemented total hip arthroplasty.Many of these methods are also used to evaluate the performance ofuncemented arthroplasty, although these methods have not been tested fortheir applicabil ity to uncemented total hip arthroplasty This dilemma isaddressed briefly in the literature study.The methods used in this thesis are X-ray analysis, bone densitometry(DEXA), radioisotope study (bone scan) and metal level analysis in bloodand serum. All of the methods are discussed in the literature studvmentioned above.Part 2 shows the results of the clinical and radiological follow-up study, theDEXA study, the ïc-isotope study and the metal study.170The study was desigsurvival of the Profilrused for the evaluatiScore. The radiologicMassin while we userbone reaction aroundThe clinical and radiolcresults of the prosthetkof 0.04o/o. The acetabrwhich is rather high. Ttacetabular position. Thcomponent survival areposition.The DEXA study shorexcept in Gruen zonesan increase in width in iin bone mineral densityAll zones except 3 andis the result of a changeexplain these data.The Tc-scan study shorloosening of this type cfollowed-up by bone scwhich makes the combiThe metal study was deand serum for the detectotal hip arthroplasty pr<the serum samples wsamples. The metal levprosthesis loosens. ïhrthose of well-fixed prostThe prosthesis under crevision rate for the steÍup in the near future be<osteolysis. The methodvaluable. The evaluatiorof future developments It is not known what efíarthroplasties may caus(i  may, through its metal ionnplasms in the proximitY ofnetal hip prostheses needs' leukaemia nd lymPhomasthtly increased in the earlierre bone density around totalinstruments currently on thef an uncemented stem of anethods of measurement inp arthroplasty.nted prostheses to evaluatelsty this is not applicable.'re rigid, while the prosthesis'lexible for the patient. DEXAto detect loosening of theluate the bone remodell ingell ing includes a decrease ofh. The observed changes in.y and bone width over timerhe bone on the Technetiumof an anatomically shaPed,nted hip prosthesis with aacetabular component. Sincehesis, an extensive literaturein Part 1.2. Every asPect ofthetic stem and the cup is:erm complications, includinglns, and long-term sequelae,r addressed. Several methodsruoplasty are available, but notthroplasty. In the past a rangenented total hip arthroPlastY.evaluate the performance ofthods have not been tested forarthroplasty. This dilemma is' analysis, bone densitometrYI metal level analysis in blood.rssed in the literature studYldiological follow-up studY, the:tal study.The study was designed as a prospective study. The medium-termsurvival of the Profile- total hip prosthesis was studied. The methodused for the evaluation of the clinical performance is the Harris HipScore. The radiological follow-up was standardised with the method ofMassin while we used the Gruen and the Delee zones to qualify thebone reaction around the prosthesis.The clinical and radiological analyses of the patient population show goodresults of the prosthetic stem after a mean of 6.3 years with a revision rateof Q.Q4o/o. The acetabular component shows a loosening rate of 13.3%,which is rather high. This depends on several factors, none of which is theacetabular position. The most important factors influencing the acetabularcomponent survival are the femoral canal width and the femoral componentposition.The DEXA study shows a decrease in bone density around the stemexcept in Gruen zones 1 and 3. This decrease in density is combined withan increase in width in all zones except Gruen zones 4 and 5. The changesin bone mineral density and width result in an altered bone mineral content.All zones except 3 and 4 show a decreased mineral content. Whether thisis the result of a change of bone morphology has not been studied, bd mayexplain these data.The Tc-scan study shows that this method is not useful in the evaluation ofloosening of this type oÍ total hip prosthesis if patients are not individuallyfollowed-up by bone scans. There is no correlation with the DEXA scans,which makes the combination of the two technioues not useful either.The metal study was designed to evaluate the use oÍ metal traces in bloodand serum for the detection of prosthetic loosening. Almost all patients withtotal hip arthroplasty proved to have metal traces in their blood and serum;the serum samples were more conducive to analysis than the bloodsamples. The metal levels in neither serum nor blood increased when theprosthesis loosens. The metal levels of loose prostheses are as high asthose of well-fixed prostheses.The prosthesis under consideration has a good survival rate and a lowrevision rate for the stem. The acetabular comoonent needs careful follow-up in the near future because it has a high loosening rate with large centralosteolysis. The methods studied to diagnose loosening proved not to bevaluable. The evaluation of metal traces in serum may be important in lightof future developments to perform total hip arthroplasty in younger patients.It is not known what effects metal traces and accumulation of metals fromarthroplasties may cause in the long term.171

Profile total hip arthroplasty:a mid term follow-up study and analysis of different methods to detect lossening of uncemented total hip prostheses

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Profile total hip arthroplasty:a mid term follow-up study and analysis of different methods to detect lossening of uncemented total hip prostheses

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