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Related Experiment Videos

The rationale for cementless total hip replacement

D S Hungerford1, L C Jones

  • 1Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.

The Orthopedic Clinics of North America
|October 1, 1993
PubMed
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Current cementing techniques show excellent short-term results, but long-term durability concerns exist for polymethyl methacrylate (PMMA). Bone ingrowth prostheses offer a durable, PMMA-free interface, especially for active patients.

Area of Science:

  • Orthopedic Surgery
  • Biomaterials Science
  • Biomedical Engineering

Background:

  • Current distal cementing techniques using polymethyl methacrylate (PMMA) demonstrate excellent outcomes for over 10 years.
  • However, the long-term physical and aging properties of PMMA raise concerns about durability beyond 20-30 years.
  • Alternative bony ingrowth systems have shown promise for long-term fixation without PMMA.

Purpose of the Study:

  • To evaluate the long-term efficacy and durability of current cementing techniques versus bone ingrowth prostheses.
  • To compare bone remodeling patterns between proximally and distally fixed prostheses.
  • To identify patient profiles that may benefit from specific prosthesis fixation methods.

Main Methods:

  • Review of 15-year experience with bony ingrowth systems.

Related Experiment Videos

  • Analysis of interface characteristics and biologic response to debris.
  • Comparison of bone remodeling around proximally versus distally fixed implants.
  • Assessment of factors contributing to thigh pain.

    • Main Results:

    • Bony ingrowth systems create a durable interface without PMMA, though susceptible to biologic reactions to high-molecular-weight polyethylene (HMWPE) debris.
    • Bone remodeling is more favorable around proximally fixed bone ingrowth prostheses compared to distally fixed ones.
    • Potential softening of the stem tip may decrease thigh pain incidence.

    Conclusions:

    • For patients with high activity levels and a life expectancy exceeding 25 years, proximally fixed bone ingrowth or ongrowth prostheses are strongly recommended.
    • Long-term performance of PMMA requires further investigation.
    • Bone ingrowth fixation presents a viable alternative for durable joint replacement.