Development of a femoral stem providing strong anchorage and facilitated removal

K. Harboe; C. H. Enoksen; N. R. Gjerdet; E. Sudmann

doi:10.3415/VCOT-11-02-0032

Veterinary and Comparative Orthopaedics and Traumatology, Table of Contents

Vet Comp Orthop Traumatol 2012; 25(02): 95-101
DOI: 10.3415/VCOT-11-02-0032

Original Research

Schattauer GmbH

Development of a femoral stem providing strong anchorage and facilitated removal

An experimental study in goats

K. Harboe

¹Stavanger University Hospital, Orthopaedic Department, Stavanger, Norway

,

C. H. Enoksen

¹Stavanger University Hospital, Orthopaedic Department, Stavanger, Norway

,

N. R. Gjerdet

²University of Bergen, Department of Clinical Dentistry, Faculty of Medicine and Dentistry, Bergen, Norway

,

E. Sudmann

³University of Bergen, Department of Surgical Sciences, Bergen, Norway

› Author Affiliations

Abstract

Summary

Objective: Prosthetic elements must be securely anchored to bone. Should revision surgery be necessary, preservation of bone stock is crucial. The goal of this study was to develop and assess a femoral stem combining secure anchorage and facilitated removal in a goat model.

Methods: The development of the uncemented femoral stem was part of an innovation process to fulfill the combined requirements. The stem was designed with two longitudinal semicircular grooves to accommodate a drill bit to unanchor the stem. These grooves were interconnected by canals, each 1 mm in diameter. The surface was partly coated with hydroxyapatite (HA). The stems were inserted in the left hip of 35 goats. Perioperatively, the grooves were filled with autologous bone grafts, and standard cemented canine acetabular component and head were used. The pull-out force was measured six months postoperatively. Following randomization, 11 animals had the grooves of the stem drilled to remove anchoring tissue. Twelve animals were left undrilled (controls).

Results: There was a significant difference in mean pull-out force between the group that had been drilled (1526 N) compared with the controls (2033 N, p = 0.028). Most of the HA had been resorbed.

Clinical significance: The stems had a high retention force. The procedure for un-anchoring by drilling significantly reduced the pullout force.

Keywords

Total hip replacement - goat - experimental - uncemented - stem extraction

Full Text

References

References
1 Furnes O, Havelin L, Espehaug B. et al. The Norwegian Arthroplasty Register - Annual report. Bergen, Norway: 2009. [Cited on 2011 January 20]. Available at: http://nrlweb.ihelse.net/eng/default.htm.
2 Capello WN, D'Antonio JA, Feinberg JR. et al. 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: 85-A.
3 Hennessy DW, Callaghan JJ, Liu SS. Second-generation extensively porous-coated THA stems at minimum 10-year followup. Clin Orthop Relat Res 2009; 467: 2290-2296.
4 Kurtz S, Ong K, Lau E. et al. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 2007; 89: 780-785.
5 Hallan G, Lie SA, Furnes O. et al. Medium- and long-term performance of 11,516 uncemented primary femoral stems from the Norwegian arthroplasty register. J Bone Joint Surg Br 2007; 89: 1574-1580.
6 Piermattei D. An Atlas of Surgical Approaches to the Bones and Joints of the Dog and Cat. Philadelphia: W. B. Saunders Company; 1993
7 Peters A. Postoperatieve fixatiewagen voor grote dieren [Postoperative fixation device for larger animals]. Biotechniek 1990; 1990: 79-80.
8 de Waal MJ, Slooff TJ, Huiskes R. et al. Vascular changes following hip arthroplasty. The femur in goats studied with and without cementation. Acta Orthop Scand 1988; 59: 643-649.
9 Anseth SD, Pulido PA, Adelson WS. et al. Fifteen-year to twenty-year results of cementless Harris-Galante porous femoral and Harris-Galante porous I and II acetabular components. J Arthroplasty 2010; 25: 687-691.
10 The classic. Metal hip joint. A case report. By Austin T. Moore and Harold R. Bohlman 1943 Clin Orthop Relat Res 1983: 3-6.
11 Geesink RG, de Groot K, Klein CP. Chemical implant fixation using hydroxyl-apatite coatings. The development of a human total hip prosthesis for chemical fixation to bone using hydroxyl-apatite coatings on titanium substrates. Clin Orthop Relat Res 1987; 147-170.
12 Stephenson PK, Freeman MA, Revell PA. et al. The effect of hydroxyapatite coating on ingrowth of bone into cavities in an implant. J Arthroplasty 1991; 6: 51-58.
13 Chambers B, St Clair SF, Froimson MI. Hydroxyapatite-coated tapered cementless femoral components in total hip arthroplasty. J Arthroplasty 2007; 22: 71-74.
14 Lai KA, Shen WJ, Chen CH. et al. Failure of hydroxyapatite-coated acetabular cups. Ten-year follow-up of 85 Landos Atoll arthroplasties. J Bone Joint Surg Br 2002; 84: 641-646.
15 Morscher EW, Hefti A, Aebi U. Severe osteolysis after third-body wear due to hydroxyapatite particles from acetabular cup coating. J Bone Joint Surg Br 1998; 80: 267-272.
16 Røkkum M, Brandt M, Bye K. et al. Polyethylene wear, osteolysis and acetabular loosening with an HA-coated hip prosthesis. A follow-up of 94 consecutive arthroplasties. J Bone Joint Surg Br 1999; 81: 582-589.
17 Røkkum M, Reigstad A, Johansson CB. HA particles can be released from well-fixed HA-coated stems: histopathology of biopsies from 20 hips 2-8 years after implantation. Acta Orthop Scand 2002; 73: 298-306.
18 Austin MS, Klein GR, Pollice PF. Previously unreported complication of trephine reamers in revision total hip arthroplasty. J Arthroplasty 2006; 21: 299-300.
19 Bhamra MS, Rao GS, Robson MJ. Hydroxyapatite-coated hip prostheses: difficulties with revision in 4 cases. Acta Orthop Scand 1996; 67: 49-52.
20 Pierson JL, Jasty M, Harris WH. Techniques of extraction of well-fixed cemented and cementless implants in revision total hip arthroplasty. Orthop Rev 1993; 22: 904-916.
21 Wirth T, Syed Ali MM, Wilke A. et al. Loosening of a fenestrated femoral prosthesis: a case report with histomorphologic analysis. J Arthroplasty 2000; 15: 802-805.
22 Demey G, Fary C, Lustig S. et al. Does a collar improve the immediate stability of uncemented femoral hip stems in total hip arthroplasty? A bilateral comparative cadaver study. J Arthroplasty 2011; 26: 1549-1555.
23 Oh I, Harris WH. Proximal strain distribution in the loaded femur. An in vitro comparison of the distributions in the intact femur and after insertion of different hip-replacement femoral components. J Bone Joint Surg Am 1978; 60: 75-85.