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Cementless total hip replacement: past, present, and future.

Harumoto Yamada1, Yasuo Yoshihara, Osamu Henmi

  • 1Department of Orthopaedic Surgery, Fujita Health University, 1-98 Kutsukake, Toyoake, Aichi, 470-1192, Japan.

Journal of Orthopaedic Science : Official Journal of the Japanese Orthopaedic Association
|April 2, 2009
PubMed
Summary

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Cementless total hip replacement (THR) shows good bone ingrowth but risks femur fracture from stress shielding. Cementless cups face challenges with placement and wear, making cemented THR slightly superior in survival rates.

Area of Science:

  • Orthopedic Surgery
  • Biomaterials Science
  • Medical Engineering

Background:

  • Cementless total hip replacement (THR) is increasingly adopted for hip arthritis, demonstrating high bone ingrowth rates (approx. 90% over 10 years) for stable biological fixation.
  • Distal fixation stems in cementless THR can lead to significant femoral bone resorption due to stress shielding, a condition progressing over a decade and potentially increasing fracture risk.

Discussion:

  • Acetabular cup placement in cementless THR presents challenges, particularly with acetabular dysplasia, where bone grafting may reduce bone ingrowth and increase reactive lines.
  • While polyethylene liner thinning occurs in cementless cups, the direct relationship between cup size and wear rate appears absent.
  • Comparative studies suggest cementless THR has higher yearly polyethylene wear rates and osteolysis incidence compared to cemented alternatives.

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Key Insights:

  • Cementless THR achieves robust biological fixation but carries risks of femoral stress shielding and associated bone resorption, necessitating vigilance for complications like fractures.
  • Optimal acetabular cup positioning in cementless THR remains a debate, with a trend towards higher placement without bone grafting despite potential drawbacks.
  • Cementless THR exhibits a higher polyethylene wear rate and osteolysis incidence, impacting long-term outcomes.

Outlook:

  • Further research is needed to mitigate stress shielding effects and optimize acetabular cup design and placement strategies in cementless THR.
  • Investigating advanced biomaterials and surgical techniques can address polyethylene wear and osteolysis concerns, potentially improving cementless THR longevity.
  • Long-term comparative studies are crucial to fully elucidate the survival rates and complication profiles of cementless versus cemented THR.