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Aktuelle Rheumatologie 2014; 39(02): 114-119
DOI: 10.1055/s-0034-1372571
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Der Einfluss von biomechanischen Prinzipien und Material auf das Design von Hüftendoprothesen

Influence of Biomechanics and Biomaterials on the Design of Endoprosthetic Components in Total Hip Arthoplasty (THA)
A. P. Krueger
1   Orthopädie, Wilhelmsburger Krankenhaus Groß-Sand, Hamburg
,
G. Singh
2   Orthopädie, Hand- und Rekonstruktive und Mikrochirurgische Einheit, Universität Nationales Gesundheitssystem Singapur
,
C. Lohmann
3   Orthopädischen Universitätsklinik Magdeburg, Magdeburg
› Institutsangaben
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Publikationsverlauf

Publikationsdatum:
28. April 2014 (online)

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Zusammenfassung

Die Hüftendoprothetik entwickelte sich aus der Hüftgelenkresektion über die Interpositionsarthroplastik bis zur modernen Alloarthroplastik (Hüft-Total-Endoprothese). Design, biomechanische Konzepte und Werkstoffeigenschaften waren die limitierenden Faktoren der letzten 50 Jahre. Unterschiedliche Gleitpaarungen und Verankerungskonzepte schufen eine Vielzahl von Formen von Endoprothesen. Verlässlichkeit und Standzeit der Hüftendoprothesen ist bei allen Prinzipien als sehr gut zu bewerten. Quervernetzte Polyethylene in Kombination mit Aluminiumoxidkeramiken stellen heute den Standard der Gleitpaarungen dar. Verbesserte Abriebeigenschaften der quervernetzten Polyethylene ermöglichen dünnere Pe-Liner (Einsätze) im Pfannenersatz. Hart-Hart-Metall-Paarungen konnten die in sie gestellten Erwartungen bislang nicht erfüllen. Vielversprechenden Resultate werden mit Keramik-Keramik-Gleitpaarungen erreicht, die jedoch weniger fehlerverzeihend sind. Zementierte und nicht zementierte Verankerungstechniken sind als gleichwertig anzusehen. Der Trend der letzten Jahre zu gröβeren Köpfen in der Gleitpaaarung konnte seine theoretischen Vorteile klinisch nicht unter Beweis stellen.

Abstract

The treatment of the hip joint has evolved from resection arthroplasty to total hip arthroplasty. Design, biomechanical concepts, and material properties were limiting factors over the past 50 years. Tribology and fixation generated different shapes, with excellent reliability and life of duration after implantation. Cross-linked polyethylenes combined with alumina oxide ceramics are the excellent standard in tribology. Hard-on-hard bearings (metal-metal) did not meet the expectations, however, promising results are obtained with ceramic-on-ceramic articulations. Cemented and uncemented fixation are both well evaluated in THA.

Schlüsselwörter

Design - Total Endoprothese Hüfte HTEP - Biomechanik - Werkstoff - Gleitpaarung

Key words

design - THA total hip arthroplasty - biomechanics - material characteristics - tribology
 

  • Literatur

  • 1 Wolff J. Über die innere Architektur der Knochen und ihre Bedeutung für die Frage von Knochenwachstum. Virchows Arch A Pathol Anat Histopathol 1870; 50: 389-450
    PubMedSuche in Google Scholar
  • 2 Pauwels F. Der Schenkelhalsbruch – ein mechanisches Problem. Ferdinand Enke; Stuttgart: 1935
    Suche in Google Scholar
  • 3 Reimers TC. Zur geschichtlichen Entwicklung gelenkplastischer Eingriffe. Chir Plast Reconstr 7: 2
    PubMed
  • 4 Gluck, Themistocles . Referat über die durch das moderne chirurgische Experiment gewonnenen positiven Resultate, betreffend die Naht und den Ersatz von Defecten höherer Gewebe. Langenbecks Archiv für klinische Chirurgie. Band 41 1891; 6: 15
    PubMedSuche in Google Scholar
  • 5 Hey Groves EW. Some Contributions to the Reconstructive Surgery of the Hip. Br J Surg 1927; Vol XIV 55 486-517
    PubMedSuche in Google Scholar
  • 6 Law WA. Hip joint reconstruction by vitallium mould arthroplasty. Rheumatism 1948; 3: 157-161
    PubMedSuche in Google Scholar
  • 7 Charnley J. Total hip replacement by low-friction arthroplasty. Clin Orthop Relat Res 1970; 72: 7-21
    PubMedSuche in Google Scholar
  • 8 The swedish hip arthroplasty register. Annual report 2011
    PubMed
  • 9 Adelani MA, Keeney JA, Palisch A et al. Has total hip arthroplasty in patients 30 years or younger improved? A systematic review. Clin Orthop Relat Res 2013; 471: 2595-2601
    CrossrefPubMedSuche in Google Scholar
  • 10 Reimeringer M, Nuño N, Desmarais-Trépanier C et al. The influence of uncemented femoral stem length and design on its primary stability: a finite element analysis. Comput Methods Biomech Biomed Engin 2013; 16: 1221-1231
    CrossrefPubMedSuche in Google Scholar
  • 11 Lintner F, Zweymüller K, Brand G. Tissue reactions to titanium endoprostheses. Autopsy studies in four cases. J Arthroplasty 1986; 1: 183-195
    CrossrefPubMedSuche in Google Scholar
  • 12 Goodman SB, Yao Z, Keeney M et al. The future of biologic coatings for orthopaedic implants. Biomaterials 2013; epub
    PubMedSuche in Google Scholar
  • 13 LeGeros RZ. Properties of osteoconductive biomaterials: calcium phosphates. Clin Orthop Relat Res 2002; 81-98
    PubMedSuche in Google Scholar
  • 14 Otani T, Whiteside LA. Failure of cementless fixation of the femoral component in total hip arthroplasty. Orthop Clin North Am 1992; 23: 335-346
    PubMedSuche in Google Scholar
  • 15 Khanuja HS, Vakil JJ, Goddard MS et al. Cementless femoral fixation in total hip arthroplasty. J Bone Joint Surg Am 2011; 93: 500-509
    CrossrefPubMedSuche in Google Scholar
  • 16 McMinn D, Treacy R, Lin K et al. Metal on metal surface replacement of the hip. Experience of the McMinn prothesis. Clin Orthop Relat Res 1996; (329 Suppl) S89-S98
    PubMedSuche in Google Scholar
  • 17 Cross MB, Nam D, Mayman DJ. Ideal femoral head size in total hip arthroplasty balances stability and volumetric wear. HSS J 2012; 8: 270-274
    CrossrefPubMedSuche in Google Scholar
  • 18 Smith AJ, Dieppe P, Vernon K et al. Failure rates of stemmed metal-on-metal hip replacements: analysis of data from the National Joint Registry of England and Wales. Lancet 2012; 379: 1199-1204
    CrossrefPubMedSuche in Google Scholar
  • 19 Orthopaedic and Rehabilitation Devices Panel of the Medical Devices Advisory Committee Meeting Announcement. Food and Drug Administration. 27 March 2012. FDA-2012-N-0293. Retrieved 20 May 2012
    PubMed
  • 20 Singh G, Meyer H, Ruetschi M et al. Large-diameter metal-on-metal total hip arthroplasties: a page in orthopedic history?. J Biomed Mater Res A 2013; 101: 3320-3326
    PubMedSuche in Google Scholar
  • 21 Hosny HA, Srinivasan SC, Keenan J et al. Midterm results with Birmingham Hip Resurfacing/Synergy stem modular metal-on-metal total hip arthroplasty. Acta Orthop Belg 2013; 79: 386-391
    PubMedSuche in Google Scholar
  • 22 Langton DJ, Sidaginamale RP, Joyce TJ et al. The clinical implications of elevated blood metal ion concentrations in asymptomatic patients with MoM hip resurfacings: a cohort study. BMJ Open 2013; 3
    PubMedSuche in Google Scholar
  • 23 Johnson AJ, Le Duff MJ, Yoon JP et al. Metal Ion Levels in Total Hip Arthroplasty Versus Hip Resurfacing. J Arthroplasty 2013;
    PubMedSuche in Google Scholar
  • 24 Meyer H, Mueller T, Goldau G et al. Corrosion at the cone/taper interface leads to failure of large-diameter metal-on-metal total hip arthroplasties. Clin Orthop Relat Res 2012; 470: 3101-3108
    CrossrefPubMedSuche in Google Scholar
  • 25 Kadar A, Ankory R, Sherman H et al. Clinical and radiographic outcomes of 139 hips with articular surface replacement total hip arthroplasty*. Isr Med Assoc J 2013; 15: 505-509
    PubMedSuche in Google Scholar
  • 26 Chang EY, McAnally JL, Van Horne JR et al. Relationship of plasma metal ions and clinical and imaging findings in patients with ASR XL metal-on-metal total hip replacements. J Bone Joint Surg Am 2013; 95: 2015-2020
    CrossrefPubMedSuche in Google Scholar
  • 27 Patel RM, Smith MC, Woodward CC et al. Stable fixation of short-stem femoral implants in patients 70 years and older. Clin Orthop Relat Res 2012; 470: 442-449
    CrossrefPubMedSuche in Google Scholar
  • 28 Hannemann F, Hartmann A, Schmitt J et al. European multidisciplinary consensus statement on the use and monitoring of metal-on-metal bearings for total hip replacement and hip resurfacing. Orthop Traumatol Surg Res 2013; 99: 263-271
    CrossrefPubMedSuche in Google Scholar
  • 29 Stulberg SD, Patel RM. The short stem: promises and pitfalls. Bone Joint J 2013; 95-B: 57-62
    CrossrefPubMedSuche in Google Scholar
  • 30 Hutt J, Harb Z, Gill I et al. Ten year results of the collum femoris preserving total hip replacement: a prospective cohort study of seventy five patients. Int Orthop 2013;
    PubMedSuche in Google Scholar
  • 31 Wittenberg RH, Steffen R, Windhagen H et al. Five-year results of a cementless short-hip-stem prosthesis. Orthop Rev (Pavia) 2013; 5: e4
    CrossrefPubMedSuche in Google Scholar
  • 32 Rometsch E, Bos PK, Koes BW. Survival of short hip stems with a „modern“, trochanter-sparing design – a systematic literature review. Hip Int 2012; 22: 344-354
    CrossrefPubMedSuche in Google Scholar
  • 33 Zenz P, Stiehl JB, Knechtel H et al. Ten-year follow-up of the non-porous Allofit cementless acetabular component. J Bone Joint Surg Br 2009; 91: 1443-1447
    PubMedSuche in Google Scholar
  • 34 Lohmann CH, Nuechtern JV, Willert HG et al. Hypersensitivity reactions in total hip arthroplasty. Orthopedics 2007; 30: 760-761
    PubMedSuche in Google Scholar
  • 35 Gravius S, Wirtz DC, Siebert CH et al. In vitro interface and cement mantle analysis of different femur stem designs. J Biomech 2008; 41: 2021-2028
    CrossrefPubMedSuche in Google Scholar
  • 36 Fowler JL, Gie GA, Lee AJ et al. Experience with the Exeter total hip replacement since 1970. Orthop Clin North Am 1988; 19: 477-489 Erratum in: Orthop Clin North Am 1989; 20: proceeding 519
    PubMedSuche in Google Scholar
  • 37 Wiles P. The surgery of the osteoarthritic hip. Br J Surg 1958; 45: 488-489
    CrossrefPubMedSuche in Google Scholar
  • 38 Rajpura A, Kendoff D, Board TN. The current state of bearing surfaces in total hip replacement. Bone Joint J 2014; 96-B: 147-156
    CrossrefPubMedSuche in Google Scholar
  • 39 Su EP, Barrack RL. Cementless femoral fixation: not all stems are created equally. Bone Joint J 2013; 95-B: 53-56
    CrossrefPubMedSuche in Google Scholar
  • 40 Oral E, Muratoglu OK. Vitamin E diffused, highly crosslinked UHMWPE: a review. Int Orthop 2011; 35: 215-223
    CrossrefPubMedSuche in Google Scholar
  • 41 Rodriguez JA, Rathod PA. Large diameter heads: is bigger always better?. J Bone Joint Surg Br 2012; 94 (11 Suppl A) 52-54
    CrossrefPubMedSuche in Google Scholar
  • 42 Fa. Ceramtec, Stuttgart http://www.ceramtec.de/werkstoff/biolox/delta/
    PubMed
  • 43 Lang JE, Whiddon DR, Smith EL et al. Use of ceramics in total hip replacement. J Surg Orthop Adv 2008; 17: 51-57 Review
    PubMedSuche in Google Scholar
  • 44 Lohmann CH, Dean DD, Köster G et al. Ceramic and PMMA particles differentially affect osteoblast phenotype. Biomaterials 2002; 23: 1855-1863
    CrossrefPubMedSuche in Google Scholar
  • 45 Brandt JM, Gascoyne TC, Guenther LE et al. Clinical failure analysis of contemporary ceramic-on-ceramic total hip replacements. Proc Inst Mech Eng H 2013; 227: 833-846
    PubMedSuche in Google Scholar
  • 46 Al-Hajjar M, Fisher J, Tipper JL et al. Wear of 36-mm BIOLOX(R) delta ceramic-on-ceramic bearing in total hip replacements under edge loading conditions. Proc Inst Mech Eng H 2013; 227: 535-534
    CrossrefPubMedSuche in Google Scholar