Subscribe to RSS
DOI: 10.1055/s-0034-1396762
Principles of Design and Fixation
Publication History
Publication Date:
29 January 2015 (online)
![](https://www.thieme-connect.de/media/smr/201501/lookinside/thumbnails/10.1055-s-0034-1396762-1.jpg)
Abstract
Total joint arthroplasty refers to the restoration of joint function and stability through bony and ligamentous reconstruction. It is considered among the most reliable and reproducible surgical procedures in modern medicine and expected to increase drastically in demand over the next 20 years. This article provides an overview of the rationale behind implant design and how fixation in arthroplasty, specifically total hip arthroplasty, is achieved. The biomechanics of the hip joint and its associated radiologic landmarks are reviewed. This is then followed by a description of the design features of acetabular and femoral components, with concise explanations of why cemented and cementless implants exist, how different implant geometries and porous coatings address specific clinical needs, and how we hope the current innovations in cementless fixation will improve outcomes in revision surgery.
-
References
- 1 Mellon SJ, Liddle AD, Pandit H. Hip replacement: landmark surgery in modern medical history. Maturitas 2013; 75 (3) 221-226
- 2 Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 2007; 89 (4) 780-785
- 3 Gomez PF, Morcuende JA. Early attempts at hip arthroplasty—1700s to 1950s. Iowa Orthop J 2005; 25: 25-29
- 4 Heller MO, Bergmann G, Deuretzbacher G , et al. Musculo-skeletal loading conditions at the hip during walking and stair climbing. J Biomech 2001; 34 (7) 883-893
- 5 Genda E, Iwasaki N, Li G, MacWilliams BA, Barrance PJ, Chao EY. Normal hip joint contact pressure distribution in single-leg standing—effect of gender and anatomic parameters. J Biomech 2001; 34 (7) 895-905
- 6 Wroblewski BM. 15-21-year results of the Charnley low-friction arthroplasty. Clin Orthop Relat Res 1986; (211) 30-35
- 7 García-Cimbrelo E, Munuera L. Early and late loosening of the acetabular cup after low-friction arthroplasty. J Bone Joint Surg Am 1992; 74 (8) 1119-1129
- 8 Kavanagh BF, Wallrichs S, Dewitz M , et al. Charnley low-friction arthroplasty of the hip. Twenty-year results with cement. J Arthroplasty 1994; 9 (3) 229-234
- 9 Rasquinha VJ, Ranawat CS. Durability of the cemented femoral stem in patients 60 to 80 years old. Clin Orthop Relat Res 2004; (419) 115-123
- 10 Callaghan JJ, Kim YS, Brown TD, Pedersen DR, Johnston RC. Concerns and improvements with cementless metal-backed acetabular components. Clin Orthop Relat Res 1995; (311) 76-84
- 11 Illgen II R, Rubash HE. The optimal fixation of the cementless acetabular component in primary total hip arthroplasty. J Am Acad Orthop Surg 2002; 10 (1) 43-56
- 12 Hirschhorn JS, Reynolds JT. Powder metallurgy fabrication of cobalt alloy surgical implant materials. In: Korostoff E, , ed. Research in Dental and Medical Materials. New York, NY: Plenum Press; 1969: 137-151
- 13 Galante J, Rostoker W, Lueck R, Ray RD. Sintered fiber metal composites as a basis for attachment of implants to bone. J Bone Joint Surg Am 1971; 53 (1) 101-114
- 14 Harris WH, Jasty M. Bone ingrowth into porous coated canine acetabular replacements: the effect of pore size, apposition, and dislocation. Hip 1985; 214-234
- 15 Burke D, Bragdon C, Lowenstein J. Mechanical aspects of the bone-porous surface interface under known amounts of implant motion: an in vivo canine study. Thirty Ninth Annual Meeting, Orthopaedic Research Society 1993;18:470
- 16 Peters C, Dunn H. The cementless acetabular component. In: Callaghan J, Rosenberg A, Rubash H, , eds. The Adult Hip. Vol 2. Philadelphia, PA: Lippincott-Raven; 1998: 993-1016
- 17 Schmalzried TP, Wessinger SJ, Hill GE, Harris WH. The Harris-Galante porous acetabular component press-fit without screw fixation. Five-year radiographic analysis of primary cases. J Arthroplasty 1994; 9 (3) 235-242
- 18 Ng FY, Zhu Y, Chiu KY. Cementless acetabular component inserted without screws—the effect of immediate weight-bearing. Int Orthop 2007; 31 (3) 293-296
- 19 Werle J, Goodman S, Schurman D, Lannin J. Polyethylene liner dissociation in Harris-Galante acetabular components: a report of 7 cases. J Arthroplasty 2002; 17 (1) 78-81
- 20 Dearborn JT, Murray WR. Arthopor 2 acetabular component with screw fixation in primary hip arthroplasty: a 7- to 9-year follow-up study. J Arthroplasty 1998; 13 (3) 299-310
- 21 Chen CJ, Xenos JS, McAuley JP, Young A, Engh Sr CA. Second-generation porous-coated cementless total hip arthroplasties have high survival. Clin Orthop Relat Res 2006; 451 (451) 121-127
- 22 Tradonsky S, Postak PD, Froimson AI, Greenwald AS. A comparison of the disassociation strength of modular acetabular components. Clin Orthop Relat Res 1993; (296) 154-160
- 23 Imai H, Mashima N, Takahashi T, Yamamoto H. The relationship between increased hip range of motion, wear, and locking mechanism failure in the Harris-Galante acetabular component. J Arthroplasty 2009; 24 (6) 892-897
- 24 Bozic KJ, Kurtz S, Lau E , et al. The epidemiology of bearing surface usage in total hip arthroplasty in the United States. J Bone Joint Surg Am 2009; 91 (7) 1614-1620
- 25 Bragdon CR, Kwon YM, Geller JA , et al. Minimum 6-year followup of highly cross-linked polyethylene in THA. Clin Orthop Relat Res 2007; 465 (465) 122-127
- 26 Tower SS, Currier JH, Currier BH, Lyford KA, Van Citters DW, Mayor MB. Rim cracking of the cross-linked longevity polyethylene acetabular liner after total hip arthroplasty. J Bone Joint Surg Am 2007; 89 (10) 2212-2217
- 27 Furmanski J, Anderson M, Bal S , et al. Clinical fracture of cross-linked UHMWPE acetabular liners. Biomaterials 2009; 30 (29) 5572-5582
- 28 D'Antonio JA, Capello WN, Naughton M. Ceramic bearings for total hip arthroplasty have high survivorship at 10 years. Clin Orthop Relat Res 2012; 470 (2) 373-381
- 29 Manley MT, Sutton K. Bearings of the future for total hip arthroplasty. J Arthroplasty 2008; 23 (7, Suppl): 47-50
- 30 Lehil MS, Bozic KJ. Trends in total hip arthroplasty implant utilization in the United States. J Arthroplasty 2014; 29 (10) 1915-1918
- 31 De Smet K, De Haan R, Calistri A , et al. Metal ion measurement as a diagnostic tool to identify problems with metal-on-metal hip resurfacing. J Bone Joint Surg Am 2008; 90 (4) (Suppl. 04) 202-208
- 32 Campbell P, Ebramzadeh E, Nelson S, Takamura K, De Smet K, Amstutz HC. Histological features of pseudotumor-like tissues from metal-on-metal hips. Clin Orthop Relat Res 2010; 468 (9) 2321-2327
- 33 Pandit H, Glyn-Jones S, McLardy-Smith P , et al. Pseudotumours associated with metal-on-metal hip resurfacings. J Bone Joint Surg Br 2008; 90 (7) 847-851
- 34 Shimmin A, Beaulé PE, Campbell P. Metal-on-metal hip resurfacing arthroplasty. J Bone Joint Surg Am 2008; 90 (3) 637-654
- 35 Charnley J. Arthroplasty of the hip. A new operation. Lancet 1961; 1 (7187) 1129-1132
- 36 Stinchfield FE, White ES. Total hip replacement. Ann Surg 1971; 174 (4) 655-662
- 37 Morscher EW, Wirz D. Current state of cement fixation in THR. Acta Orthop Belg 2002; 68 (1) 1-12
- 38 Ebramzadeh E, Sarmiento A, McKellop HA, Llinas A, Gogan W. The cement mantle in total hip arthroplasty. Analysis of long-term radiographic results. J Bone Joint Surg Am 1994; 76 (1) 77-87
- 39 Mulroy WF, Estok DM, Harris WH. Total hip arthroplasty with use of so-called second-generation cementing techniques. A fifteen-year-average follow-up study. J Bone Joint Surg Am 1995; 77 (12) 1845-1852
- 40 Madey SM, Callaghan JJ, Olejniczak JP, Goetz DD, Johnston RC. Charnley total hip arthroplasty with use of improved techniques of cementing. The results after a minimum of fifteen years of follow-up. J Bone Joint Surg Am 1997; 79 (1) 53-64
- 41 Maloney WJ, Jasty M, Rosenberg A, Harris WH. Bone lysis in well-fixed cemented femoral components. J Bone Joint Surg Br 1990; 72 (6) 966-970
- 42 Scheerlinck T, Casteleyn P-P. The design features of cemented femoral hip implants. J Bone Joint Surg Br 2006; 88 (11) 1409-1418
- 43 Wroblewski BM, Siney PD, Fleming PA. Triple taper polished cemented stem in total hip arthroplasty: rationale for the design, surgical technique, and 7 years of clinical experience. J Arthroplasty 2001; 16 (8) (Suppl. 01) 37-41
- 44 Shen G. Femoral stem fixation. An engineering interpretation of the long-term outcome of Charnley and Exeter stems. J Bone Joint Surg Br 1998; 80 (5) 754-756
- 45 Huiskes R, Verdonschot N, Nivbrant B. Migration, stem shape, and surface finish in cemented total hip arthroplasty. Clin Orthop Relat Res 1998; (355) 103-112
- 46 Della Valle AG, Zoppi A, Peterson MG, Salvati EA. A rough surface finish adversely affects the survivorship of a cemented femoral stem. Clin Orthop Relat Res 2005; (436) 158-163
- 47 Collis DK, Mohler CG. Comparison of clinical outcomes in total hip arthroplasty using rough and polished cemented stems with essentially the same geometry. J Bone Joint Surg Am 2002; 84-A (4) 586-592
- 48 Firestone DE, Callaghan JJ, Liu SS , et al. Total hip arthroplasty with a cemented, polished, collared femoral stem and a cementless acetabular component. A follow-up study at a minimum of ten years. J Bone Joint Surg Am 2007; 89 (1) 126-132
- 49 Williams HD, Browne G, Gie GA, Ling RS, Timperley AJ, Wendover NA. The Exeter universal cemented femoral component at 8 to 12 years. A study of the first 325 hips. J Bone Joint Surg Br 2002; 84 (3) 324-334
- 50 Goldberg VM, Ninomiya J, Kelly G, Kraay M. Hybrid total hip arthroplasty: a 7- to 11-year followup. Clin Orthop Relat Res 1996; (333) 147-154
- 51 Clohisy JC, Harris WH. Primary hybrid total hip replacement, performed with insertion of the acetabular component without cement and a precoat femoral component with cement. An average ten-year follow-up study. J Bone Joint Surg Am 1999; 81 (2) 247-255
- 52 Stefanovich-Lawbuary NS, Parry MC, Whitehouse MR, Blom AW. Cement in cement revision of the femoral component using a collarless triple taper: a midterm clinical and radiographic assessment. J Arthroplasty 2014; 29 (10) 2002-2006
- 53 Te Stroet MA, Moret-Wever SG, de Kam DC, Gardeniers JW, Schreurs BW. Cement-in-cement femoral revisions using a specially designed polished short revision stem; 24 consecutive stems followed for five to seven years. Hip Int 2014; 24 (5) 428-433
- 54 Pellicci PM, Wilson Jr PD, Sledge CB , et al. Long-term results of revision total hip replacement. A follow-up report. J Bone Joint Surg Am 1985; 67 (4) 513-516
- 55 Katz RP, Callaghan JJ, Sullivan PM, Johnston RC. Results of cemented femoral revision total hip arthroplasty using improved cementing techniques. Clin Orthop Relat Res 1995; (319) 178-183
- 56 Mulroy WF, Harris WH. Revision total hip arthroplasty with use of so-called second-generation cementing techniques for aseptic loosening of the femoral component. A fifteen-year-average follow-up study. J Bone Joint Surg Am 1996; 78 (3) 325-330
- 57 Savory C, Hamilton W, Engh Sr C, Della Valle C, Rosenberg A, Galante J. Hip designs. In: Barrack R, Booth Jr R, Lonner J, McCarthy J, Mont M, Rubash HE, , eds. Orthopaedic Knowledge Update: Hip and Knee Reconstruction 3. Chicago, IL: American Academy of Orthopaedic Surgeons; 2006: 355
- 58 Bourne RB, Rorabeck CH, Patterson JJ, Guerin J. Tapered titanium cementless total hip replacements: a 10- to 13-year followup study. Clin Orthop Relat Res 2001; (393) 112-120
- 59 Kim Y-H. Long-term results of the cementless porous-coated anatomic total hip prosthesis. J Bone Joint Surg Br 2005; 87 (5) 623-627
- 60 Capello WN, D'Antonio JA, Feinberg JR, Manley MT. Ten-year results with hydroxyapatite-coated total hip femoral components in patients less than fifty years old. A concise follow-up of a previous report. J Bone Joint Surg Am 2003; 85-A (5) 885-889
- 61 Dunbar MJ. Cemented femoral fixation: the North Atlantic divide. Orthopedics 2009; 32 (9) 662
- 62 Albrektsson T, Brånemark P-I, Hansson H-A, Lindström J. Osseointegrated titanium implants. Requirements for ensuring a long-lasting, direct bone-to-implant anchorage in man. Acta Orthop Scand 1981; 52 (2) 155-170
- 63 Zweymüller KA, Lintner FK, Semlitsch MF. Biologic fixation of a press-fit titanium hip joint endoprosthesis. Clin Orthop Relat Res 1988; (235) 195-206
- 64 Engh CA, Massin P, Suthers KE. Roentgenographic assessment of the biologic fixation of porous-surfaced femoral components. Clin Orthop Relat Res 1990; (257) 107-128
- 65 Kwon DG, Lee TJ, Kang JS, Moon KH. Correlation between stress shielding and clinical outcomes after total hip arthroplasty with extensively porous coated stems. J Arthroplasty 2013; 28 (10) 1728-1730
- 66 Bugbee WD, Culpepper II WJ, Engh Jr CA, Engh Sr CA. Long-term clinical consequences of stress-shielding after total hip arthroplasty without cement. J Bone Joint Surg Am 1997; 79 (7) 1007-1012
- 67 Khanuja HS, Vakil JJ, Goddard MS, Mont MA. Cementless femoral fixation in total hip arthroplasty. J Bone Joint Surg Am 2011; 93 (5) 500-509
- 68 Engh CA, Hooten Jr JP, Zettl-Schaffer KF, Ghaffarpour M, McGovern TF, Bobyn JD. Evaluation of bone ingrowth in proximally and extensively porous-coated anatomic medullary locking prostheses retrieved at autopsy. J Bone Joint Surg Am 1995; 77 (6) 903-910
- 69 Sinha RK, Dungy DS, Yeon HB. Primary total hip arthroplasty with a proximally porous-coated femoral stem. J Bone Joint Surg Am 2004; 86-A (6) 1254-1261
- 70 Luites JW, Spruit M, Hellemondt GG, Horstmann WG, Valstar ER. Failure of the uncoated titanium ProxiLock femoral hip prosthesis. Clin Orthop Relat Res 2006; 448 (448) 79-86
- 71 Gilmour L, Jones B, Dickinson J. Mechanical properties of a sintered asymmetric particle ingrowth coating. Paper presented at: Medical Device Materials V: Proceedings of the Materials & Processes for Medical Devices Conference; August 10–12, 2009; Minneapolis, MN
- 72 Cohen R. A porous tantalum trabecular metal: basic science. Am J Orthop 2002; 31 (4) 216-217
- 73 Siegmeth A, Duncan CP, Masri BA, Kim WY, Garbuz DS. Modular tantalum augments for acetabular defects in revision hip arthroplasty. Clin Orthop Relat Res 2009; 467 (1) 199-205
- 74 Bobyn J. Biologic response to implants. In: Glassman A, Lachiewicz P, Tanzer M, , eds. Orthopaedic Knowledge Update: Hip and Knee Reconstruction 4. Chicago, IL: American Academy of Orthopaedic Surgeons; 2011: 45