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      Fixation of an Anatomically Designed Cementless Stem in Total Hip Arthroplasty

      Advances in Orthopedics

      Hindawi Limited

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          Abstract

          Purpose . The Anatomic Fiber Metal plus stem (Zimmer) is one of the anatomically designed cementless stems to achieve stable fixation by metaphyseal fit. We studied outcomes of cementless total hip arthroplasty using this stem and possible effects of metaphyseal fit on outcomes. Methods . The cementless total hip arthroplasty using this stem was performed for 155 hips. One hundred and thirty-seven hips of 122 patients were followed for 5 to 16 (mean, 9.7) years and entered into the study. The metaphyseal fit was defined as good or poor in an anteroposterior radiograph after surgery. We studied the fixation of the stem and bone reaction on an anteroposterior radiograph at the final followup. Results . Twelve hips had revision, six acetabular components and six acetabular liners. No stem was revised. The biological fixation of the stem was bone ingrown fixation for 136 hips and unstable for one. The metaphyseal fit was good for 83 hips and poor for 54 hips. There were no differences for stem fixation and bone reaction between the two groups. Conclusions . The fixation of the stem was stable at a mean followup of 9.7 years independently from metaphyseal fit.

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          Most cited references 17

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          Radiological demarcation of cemented sockets in total hip replacement.

           J G DeLee,  J Charnley (2015)
          The frequency of radiological demarcation of the cement-bone junction in the acetabulum after total hip replacement has been examined in 141 Charnley low-friction arthroplasties followed for an average of 10.1 years. Sixty-nine per cent showed demarcation of various degrees and 9.2 per cent of the series showed evidence of progressive migration of the socket. The vast majority of cases with demarcation were symptomless. In most cases where demarcation was accompanied by migration the operation notes suggested a technical explanation and in three cases low-grade sepsis was responsible. The fact that nearly 30 per cent of cases showed no demarcation even after 10 years supports the idea that there is no fundamental defect in the principle of employing cement in the acetabulum. Better surgical technique may increase the number of cases showing no demarcation.
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            "Modes of failure" of cemented stem-type femoral components: a radiographic analysis of loosening.

            In view of the increasing incidence of stem-type femoral component loosening, a detailed retrospective radiographic zonal analysis of 389 total hip replacements indicated a 19.5% incidence (76 hips) of radiological evidences of mechanical looseness, i.e., fractured acrylic cement and/or a radiolucent gap at the stem-cement or cement-bone interfaces. Detailed serial radiographic examination demonstrated progressive loosening in 56 of the 76 hips and these were categorized into mechanical modes of failure. The 4 modes of failure characterizing stem-type component progressive loosening mechanisms consisted of stem pistoning within the acrylic (3.3%), cement-embedded stem pistoning with the femur (5.1%), medial midstem pivot (2.5%), calcar pivot (0.7%) and bending (fatigue) cantilever (3.3%).
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              Porous-coated hip replacement. The factors governing bone ingrowth, stress shielding, and clinical results

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                Author and article information

                Journal
                10.1155/2012/912058

                http://creativecommons.org/licenses/by/3.0/

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