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[Implant failure after total hip replacement. Comparison of patients with primary coxarthrosis, rheumatoid arthritis
B Schüle1, H Schroeder-Boersch, P Arnold
1Orthopädische Universitäts-Klinik Mannheim.
Insights
Acetabular components are the primary failure point in total hip replacement (THR), with cementless cups showing higher midterm failure rates. Stem performance is generally good, but specific patient factors and fixation methods impact outcomes.
Area of Science:
- Orthopedic surgery
- Biomaterials engineering
- Medical device analysis
Background:
- Total hip replacement (THR) is a common procedure to address hip joint degeneration.
- Acetabular component failure remains a significant challenge in THR longevity.
- Midterm analysis is crucial for understanding implant survival rates and identifying failure modes.
Purpose of the Study:
- To analyze failure modes in total hip replacement (THR) components.
- To compare midterm failure rates of cemented versus cementless acetabular cups.
- To evaluate factors influencing the success of cementless acetabular fixation and stem performance.
Main Methods:
- Retrospective analysis of total hip replacement (THR) failures.
- Comparison of failure rates between acetabular cups (cemented vs. cementless) and stems.
- Evaluation of patient-specific factors (age, diagnosis) and fixation techniques (threaded vs. press-fit) on implant survival.
Main Results:
- Acetabular components demonstrate higher failure rates than stems in THR.
- Cementless acetabular cups exhibit a slightly higher midterm failure rate compared to cemented cups.
- Factors like rheumatoid arthritis, age over 70, and threaded cup fixation negatively impact cementless cup success.
Conclusions:
- Acetabular component design and fixation remain critical areas for improvement in THR.
- Cementless fixation shows promise for stems, particularly in younger patients (<60) with adequate weight-bearing capacity.
- Further investigation into implant design and patient selection is warranted to optimize THR outcomes.
Abstract:
The analysis of THR-failures showed that the acetabular component still is the main problem of total hip replacement. The acetabular cup fails more often than the stem. In the midterm analysis the failure rate is a little bit higher in cementless than in cement fixed cups. The known effect that the failure rate of cups fixed with cement increases exponentially 8 to 10 years after implantation, could of course not be seen in this study. The success of the cementless fixation was negatively influenced by the diagnosis rheumatoid arthritis, age over 70 and the fixation manner: the failure rate of threaded cups was higher than the one of press-fit cups although the Zweymüller-cup as well as the Link type V-cup showed good results. The midterm results of the stem were very good for the cementless as for the cemented technique. Some implants showed compared to others significantly worse results. The further implantation should be thought of, what partially has already happened. The results of cementless stem fixation in patients with rheumatoid arthritis, osteoarthrosis and dysplastic osteoarthritis is comparable, so that cementless fixation should be thought of in case of adequate conditions (ability of partial weight bearing for some weeks, age under 60).