Klinische und radiologische Ergebnisse einer «isoelastischen» Pfanne
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1 Klinische und radiologische Ergebnisse einer «isoelastischen» Pfanne Martin Beck, Prof. Dr.med. Klinik für Orthopädie und Unfallchirurgie Luzerner Kantonsspital
2 resorption of acetabular bone can be observed and is attributed to stress shielding
3 significance of weak acetabular bone stock > may predispose to migration > early mechanical failure > may facilitate migration of wear particles > problems in revision surgery > no evidence based clinical relevance Mueller LA et al. Acta Orthop 77:380, 2006 Kress AM. JBJS-A, 93-A:1152-7, 2011
4 a possible solution RM pressfit > Elastic cup design (no stress shielding) > Ti-particle coating for stable osseointegration > Maximum PE-thickness results in low wear
5 Material and Methods > First implantation: > prospective multicenter study (CH, NZL, A, NL, D, UK) > 1105 cases included 162 patients in Luzern > Prospective data collection (preop., 6 wks, 6 mth, and 1, 2 and 5 yrs HHS, patient satisfaction complications radiographic analysis inclination, anteversion lucent lines, osteolysis, ectopic bone formation
6 Demographics (Luzern) > n = 162 > m : f = 82 : 80 > R : L = 77 : 85 > mean age 67,2 (range 38 to 88) > mean BMI 27 (range 17 47) > diagnosis: 142 OA 5 AVN 2 fracture 3 DDH
7 Results (Luzern) 162 patients included 7 only clinical 14 lost 3 deceased 135 patients at 2 years (completed) 1 only clinical 2 lost 3 deceased 73 of 129 patients at 5 yrs (follow up on-going)
8 HHS & patient satisfaction VAS 10 HHS VAS satisfaction 162 patients included 61 ± 13 3,8 ± 2,2 135 pts at 2 years (completed) 97 ± 5 9,5 ± 1,2 73 of 129 at 5 yrs 94 ± 6 9,4 ± 1,3
9 Complications (n=162) > intraoperative 1x fissure of femur 2x fissure of greater trochanter 1x cup tilted during reduction of hip revised next day and secured with screws > postoperative follow - up 4x hematoma 1x deep infection resolved with debridement and AB 1x periprosthetic fracture of femur after fall conservative treatment 1x transient femoral nerve palsy 6 weeks 2 yrs
10 Radiographic parameters > cup inclination (n = 162) n < > 55 inclination in > cup anteversion (n = 162) n < > 15 anteversion in
11 Radiographic follow-up 2 yrs 5 yrs lucent lines 0 0 osteolysis 0 0 > linear subchondral sclerosis in 3 hips 2 yrs
12 Radiographic follow-up ectopic ossifications Brooker 2 years 5 years I II - III yrs IV 1 1
13 Complications: cup revision # 1 > 1x cup tilted during reduction of hip > observed on postop radiograph 6 weeks 2 yrs 5 yrs
14 Complications: cup revision # 2 > Psoas impingement 1. open revision after one year 2. re-revised after 21 month: cup revision
15 aim of implant: reduce stress shielding behind implant
16 Stepniewski AS et al. J Arthroplasty 23: , 2008, Analysis of periacetabular bone loss with CT/DEXA n=5 > on average only minimal bone loss (n.s.) compared to contralateral hip > bone loss with stiffest cup (CoCr) had greatest change 37% medially 28.6% at level % level 2
17 Is there a progression of BMD decrease? > most studies cover a time period of 1 to 3 years decrease BMD 8 33% > prospective 10 year follow-up, uncemented metal back Kress AM. JBJS-A, 93-A:1152-7, 2011 most important loss after 1 year, stabilizes after 3 years, no further decrease controlateral side decrease of BMD cortical 3%, cancellous 6% at ten years
18 Retrospective study on cup ingrowth (n=50, 1 year f/u) > Methods visual analysis bone density increase rarification trabeculae sclerosis > Results increase of bone density (zone DeLee) 26 hips: zone I 18 hips: zone I and II 0 hips: zone III no increase 13 hips III II I Kastius et al. Poster SGOT 2011
19 > linear periacetabular sclerosis > 6 patients > CT scan show complete osteointegration > radiologic phenomenon
20 Observations behaviour of acetabular bone > isoelastic cup > expect no or little decrease in bone mineral density preop postop 2 yrs 5 yrs
21 > filling up gaps preop 6 weeks 2 yrs 5 yrs
22 > resolution of hypersclerosis postop 12 month 5 years
23 Vitamys cup for difficult hips preop 6 weeks 2 years
24 Summary > clinical and radiographic results of the RM Vitamys cup at 5 years are excellent > from a theoretical and clinical point of view the implantation of an isolelastic acetabular cup may overcome problems such as stress shielding and acetabular bone loss. > supported by the literature Hooper N et al. CORR 2015 > radiographic results support the concept of bone preservation
25 Is periacetabular bone preservation necessary? 60 yrs male patient THA for > 20 yrs bicycle fall on right side 1 year
26 Thank you
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