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Journal of Long-Term Effects of Medical Implants

Published 4 issues per year

ISSN Print: 1050-6934

ISSN Online: 1940-4379

SJR: 0.184 SNIP: 0.485 CiteScore™:: 1.1 H-Index: 39

Indexed in

Options for Acetabular Fixation Surfaces

Volume 17, Issue 3, 2007, pp. 187-192
DOI: 10.1615/JLongTermEffMedImplants.v17.i3.20
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ABSTRACT

Aseptic loosening is the most common cause for revision total hip arthro-plasty (THA). Due to poor long-term results with cemented acetabular components, ce-mentless implants that rely on biologic fixation became popular in the United States for both primary and revision procedures in the early 1980s. Cementless acetabular components used in THA have been reported to have superior radiographic performance compared with cemented fixation, although the optimal method of acetabular fixation remains controversial. Cementless acetabular components require initial implant stability to allow for bone ingrowth and remodeling into the acetabular shell, providing long-term durability of the prosthesis. Many improved implant materials are available to facilitate bone growth and remodeling, including the 3 most common surface treatments; fibermesh, sintered beads, and plasma spray coatings. Recently added to these are porous metal surfaces, which have increased porosity and optimal pore sizes when compared with titanium fibermesh. The most studied of these materials is the titanium fibermesh fixation surface, which has demonstrated a mechanical failure rate of 1% at 10 to 15 years. This technology utilizes the diffusion bonding process to attach fiber metal pads to a titanium substrate using heat and pressure. The sintered bead fixation surface offers a porous coating of various sizes of spherical beads, achieved by the sintering process, and has been shown to provide long-term fixation. While there are less long-term published data regarding the titanium plasma spray surface, its early results have provided evidence of its durability, even in the face of significant osteolysis. The most recently added alternative fixation surface is porous tantalum metal, which offers potentially greater bone ingrowth and bone graft incorporation due to its high porosity (80%) and low modulus of elasticity (3 MPa). Porous tantalum implants have shown early favorable clinical results and have been reported to have excellent bone graft incorporation of the acetabular component based on serial radiograph data at a minimum 1-year follow-up. Tritanium is a porous metal, which has emerged as a promising new surface technology for acetabular shells. While no clinical data are yet available, basic science research has demonstrated enhanced bone ingrowth and mechanical strength.

CITED BY
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  16. Wang Wen-Tao, Guo Chi-Hua, Duan Kun, Ma Min-Jie, Jiang Yong, Liu Tuan-Jiang, Liu Ji-Jun, Hao Ding-Jun, Dual pitch titanium-coated pedicle screws improve initial and early fixation in a polyetheretherketone rod semi-rigid fixation system in sheep, Chinese Medical Journal, 132, 21, 2019. Crossref

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  18. Banerjee Samik, Issa Kimona, Kapadia Bhaveen H., Pivec Robert, Khanuja Harpal S., Mont Michael A., Highly-porous metal option for primary cementless acetabular fixation. What is the evidence?, HIP International, 23, 6, 2013. Crossref

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