Aktuelle Traumatol 2005; 35(6): 320-327
DOI: 10.1055/s-2005-872995
Originalarbeit

Georg Thieme Verlag KG Stuttgart · New York

Der zementfreie CLS-Titangeradschaft - Langzeitergebnisse, Indikationen und Limitationen

The Uncemented CLS Femoral Component - Long-Term Results, Indications and LimitationsP. R. Aldinger1 , A. W. Jung1 , D. Parsch1 , S. J. Breusch1
  • 1Stiftung Orthopädische Universitätsklinik, Heidelberg
Further Information

Publication History

Publication Date:
02 January 2006 (online)

Zusammenfassung

Seit 1985 wird der zementfreie CLS-Geradschaft implantiert und ist mittlerweile mit über 350 000 Implantationen einer der am häufigsten implantierten zementfreien Schäfte in Europa. Selbst bei schwierigen anatomischen Verhältnissen und in den Händen von verschiedenen Operateuren mit unterschiedlichem Ausbildungsstand hat sich die femorale Versorgung mit diesem System bewährt. In diesem Beitrag sollen die Langzeitergebnisse, Indikationen und Limitationen mit diesem zementfreien, korundgestrahlten Titangeradschaft nach bis zu 20 Jahren dargestellt werden. Die Implantation des zementfreien Geradschaftes ist aus der Sicht der Autoren deutlich einfacher und weniger anfällig für technische Fehler als ein gut zementierter Prothesenschaft und bietet damit verlässlichere und konsistentere Langzeitergebnisse selbst bei schwierigen Deformitäten.

Abstract

The uncemented CLS stem has been in clinical use since 1985. With over 350 000 implantations it has become one of the most frequently implanted uncemented femoral hip stems in Europe. Even in femoral deformities and in the hands of surgeons with differing levels of surgical training the long term results have been demonstrated to be outstanding. In this article the long term results, indications and limitations of a straight corundum blasted titanium femoral component with a follow-up up to 20 years are discussed. The insertion of an uncemented straight femoral component is a lot simpler and susceptible to less sources of error than a well cemented hip stem. It can provide more consistent and durable results even in femoral deformities.

Literatur

  • 1 Aldinger P R. et al . A ten- to 15-year follow-up of the cementless spotorno stem.  J Bone Joint Surg [Br]. 2003;  85 209-214
  • 2 Aldinger P R. et al .Sinn und Unsinn der Individualprothese. Endoprothetik Forum Münster. 2005
  • 3 Aldinger P R. et al . Pattern of periprosthetic bone remodeling around stable uncemented tapered hip stems: a prospective 84-month follow-up study and a median 156-month cross-sectional study with DXA.  Calcif Tissue Int. 2003;  73 115-121
  • 4 Aldinger P R. et al . Long-term fate of uncemented, threaded acetabular components with smooth surface treatment: minimum 10-year follow-up of two different designs.  Arch Orthop Trauma Surg. 2004;  124 469-475
  • 5 Aldinger P R. et al . Cementless Spotorno tapered titanium stems: excellent 10 - 15-year survival in 141 young patients.  Acta Orthop Scand. 2003;  74 253-258
  • 6 Birrell F, Johnell O, Silman A. Projecting the need for hip replacement over the next three decades: influence of changing demography and threshold for surgery.  Ann Rheum Dis. 1999;  58 569-572
  • 7 Blasius K. et al . CLS Multicenter Studie - 8-Jahres-Ergebnisse.  Z Orthop Ihre Grenzgeb. 1993;  131 547-552
  • 8 Bourne R B. The planning and implementation of the Canadian Joint Replacement Registry.  Bull Hosp Jt Dis. 1999;  58 128-132
  • 9 Bourne R B, Rorabeck C H. Assessing the outcomes: what really works?.  Orthopedics. 1999;  22 823-825
  • 10 Bourne R B. et al . Tapered titanium cementless total hip replacements: a 10- to 13-year follow-up study.  Clin Orthop Relat Res. 2001;  112-120
  • 11 Breusch S J. et al . Verankerungsprinzipien in der Hüftendoprothetik. I: Der Hüftschaft.  Unfallchirurg. 2000;  103 918-931
  • 12 Breusch S J. et al . Ten-year results of uncemented hip stems for failed intertrochanteric osteotomy.  Arch Orthop Trauma Surg. 2005;  125 304-309
  • 13 Britton A R. et al . Pain levels after total hip replacement: their use as endpoints for survival analysis.  J Bone Joint Surg [Br]. 1997;  79 93-98
  • 14 Callaghan J J. et al . Charnley total hip arthroplasty with cement. Minimum twenty-five-year follow-up.  J Bone Joint Surg [Am]. 2000;  82 487-497
  • 15 Capello W N. 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 885-889
  • 16 Capello W N. et al . Hydroxyapatite in total hip arthroplasty. Clinical results and critical issues.  Clin Orthop Relat Res. 1998;  200-211
  • 17 Charnley J. The long-term results of low-friction arthroplasty of the hip performed as a primary intervention.  J Bone Joint Surg [Br]. 1972;  54 61-76
  • 18 Clohisy J C, Harris W H. The Harris-Galante porous-coated acetabular component with screw fixation. An average ten-year follow-up study.  J Bone Joint Surg [Am]. 1999;  81 66-73
  • 19 Clohisy J C, Harris W H. The Harris-Galante uncemented femoral component in primary total hip replacement at 10 years.  J Arthroplasty. 1999;  14 915-917
  • 20 Clohisy J C, Harris W H. Primary hybrid total hip replacement, performed with insertion of the acetabular component without cement and a precoat femoral component with cement. An average ten-year follow-up study.  J Bone Joint Surg [Am]. 1999;  81 247-255
  • 21 D'Antonio J A. et al . Hydroxyapatite femoral stems for total hip arthroplasty: 10- to 13-year followup.  Clin Orthop Relat Res. 2001;  101-111
  • 22 Della Valle C J, Paprosky W G. The middle-aged patient with hip arthritis: the case for extensively coated stems.  Clin Orthop Relat Res. 2002;  101-107
  • 23 Duffy G P. et al . Primary uncemented total hip arthroplasty in patients < 40 years old: 10- to 14-year results using first-generation proximally porous-coated implants.  J Arthroplasty. 2001;  16 140-144
  • 24 Effenberger H. et al . Anatomically adapted, HA coated SBG stem - ten years of successful implantation.  Biomed Tech (Berl). 2004;  49 290-294
  • 25 Emery D. et al . The Stanmore total hip arthroplasty. A 15- to 20-year follow-up study.  J Arthroplasty. 1997;  12 728-735
  • 26 Engh C A, Bobyn J D. The influence of stem size and extent of porous coating on femoral bone resorption after primary cementless hip arthroplasty.  Clin Orthop Relat Res. 1988;  231 7-28
  • 27 Engh C A, Bobyn J D, Glassman A H. Porous-coated hip replacement. The factors governing bone ingrowth, stress shielding, and clinical results.  J Bone Joint Surg [Br]. 1987;  69 45-55
  • 28 Engh C A. et al . Porous-coated total hip replacement.  Clin Orthop Relat Res. 1994;  298 89-96
  • 29 Engh Jr C A, Hopper R H. The odyssey of porous-coated fixation.  J Arthroplasty. 2002;  17 102-107
  • 30 Engh Jr C A. et al . Long-term results using the anatomic medullary locking hip prosthesis.  Clin Orthop Relat Res. 2001;  393 137-146
  • 31 Frankel S. et al . Population requirement for primary hip-replacement surgery: a cross-sectional study.  Lancet. 1999;  353 1304-1309
  • 32 Garcia-Cimbrelo E. et al . Total hip arthroplasty with use of the cementless Zweymuller Alloclassic system. A ten to thirteen-year follow-up study.  J Bone Joint Surg [Am]. 2003;  85 296-303
  • 33 Grant P, Nordsletten L. Total hip arthroplasty with the Lord prosthesis. A long-term follow-up study.  J Bone Joint Surg [Am]. 2004;  86 2636-2641
  • 34 Grubl A. et al . Cementless total hip arthroplasty with a tapered, rectangular titanium stem and a threaded cup: a minimum ten-year follow-up.  J Bone Joint Surg [Am]. 2002;  84 425-431
  • 35 Grubl A. et al . 6 - 10 Jahresergebnisse der Alloclassic Hüftendoprothese - eine Multicenterstudie.  Z Orthop Ihre Grenzgeb. 2003;  141 303-308
  • 36 Haddad Jr R J. et al . Clinical and roentgenographic evaluation of noncemented porous-coated anatomic medullary locking (AML) and porous-coated anatomic (PCA) total hip arthroplasties.  Clin Orthop Relat Res. 1990;  176-182
  • 37 Harris W H. Aseptic loosening in total hip arthroplasty secondary to osteolysis induced by wear debris from titanium-alloy modular femoral heads.  J Bone Joint Surg [Am]. 1991;  73 470-472
  • 38 Jasty M. et al . Etiology of osteolysis around porous-coated cementless total hip arthroplasties.  Clin Orthop Relat Res. 1994;  111-126
  • 39 Jasty M. et al . Wear of polyethylene acetabular components in total hip arthroplasty. An analysis of one hundred and twenty-eight components retrieved at autopsy or revision operations.  J Bone Joint Surg [Am]. 1997;  79 349-358
  • 40 Karrholm J. et al . Does early micromotion of femoral stem prostheses matter? 4 - 7-year stereoradiographic follow-up of 84 cemented prostheses.  J Bone Joint Surg [Br]. 1994;  76 912-917
  • 41 Kim Y G. et al . Uncemented Harris-Galante total hip arthroplasty in patients with osteonecrosis of the femoral head. A 10 - 16-year follow-up study.  Acta Orthop Scand. 2005;  76 42-48
  • 42 Kim Y H, Kim J S, Cho S H. Primary total hip arthroplasty with a cementless porous-coated anatomic total hip prosthesis: 10- to 12-year results of prospective and consecutive series.  J Arthroplasty. 1999;  14 538-548
  • 43 Kim Y H, Kim J S, Cho S H. Primary total hip arthroplasty with the AML total hip prosthesis.  Clin Orthop Relat Res. 1999;  147-158
  • 44 Kim Y H. et al . Comparison of porous-coated titanium femoral stems with and without hydroxyapatite coating.  J Bone Joint Surg [Am]. 2003;  85 1682-1688
  • 45 Krismer M. et al . The prediction of failure of the stem in THR by measurement of early migration using EBRA‐FCA. Einzel-Bild-Roentgen-Analyse - femoral component analysis.  J Bone Joint Surg [Br]. 1999;  81 273-280
  • 46 Mallory T H. et al . Minimal 10-year results of a tapered cementless femoral component in total hip arthroplasty.  J Arthroplasty. 2001;  16 (Suppl) 49-54
  • 47 McAuley J P. et al . Total hip arthroplasty in patients 50 years and younger.  Clin Orthop Relat Res. 2004;  418 119-125
  • 48 McLaughlin J R, Lee K R. Total hip arthroplasty in young patients. 8- to 13-year results using an uncemented stem.  Clin Orthop Relat Res. 2000;  373 153-163
  • 50 McNally S A. et al . The results at nine to twelve years of the use of a hydroxyapatite-coated femoral stem.  J Bone Joint Surg [Br]. 2000;  82 378-382
  • 51 Meding J B. et al . Minimum ten-year follow-up of a straight-stemmed, plasma-sprayed, titanium-alloy, uncemented femoral component in primary total hip arthroplasty.  J Bone Joint Surg [Am]. 2004;  86 92-97
  • 52 Morscher E. Experiences, requirements and development of cement-free hip endoprostheses.  Orthopäde. 1987;  16 185-196
  • 53 Murray D W, Carr A J, Bulstrode C J. Which primary total hip replacement?.  J Bone Joint Surg [Br]. 1995;  77 520-527
  • 54 Nercessian O A, Wu W H, Sarkissian H. Clinical and radiographic results of cementless AML total hip arthroplasty in young patients.  J Arthroplasty. 2001;  16 312-316
  • 55 Neumann L, Freund K G, Sorenson K H. Long-term results of Charnley total hip replacement. Review of 92 patients at 15 to 20 years.  J Bone Joint Surg [Br]. 1994;  76 245-251
  • 56 Nunn D. et al . The measurement of migration of the acetabular component of hip prostheses.  J Bone Joint Surg [Br]. 1989;  71 629-631
  • 57 Parvizi J. et al . Primary total hip arthroplasty with an uncemented femoral component: a long-term study of the Taperloc stem.  J Arthroplasty. 2004;  19 151-156
  • 58 Parvizi J. et al . Fifteen-year clinical survivorship of Harris-Galante total hip arthroplasty.  J Arthroplasty. 2004;  19 672-677
  • 59 Reitman R D. et al . Thirteen year results of total hip arthroplasty using a tapered titanium femoral component inserted without cement in patients with type C bone.  J Arthroplasty. 2003;  18 116-121
  • 60 Robinson R P, Lovell T P, Green T M. Hip arthroplasty using the cementless CLS stem. A 2 - 4-year experience.  J Arthroplasty. 1994;  9 177-192
  • 61 Romagnoli S. Press-fit hip arthroplasty: a European alternative.  J Arthroplasty. 2002;  17 108-112
  • 62 Schramm M. et al . Total hip arthroplasty using an uncemented femoral component with taper design: outcome at 10-year follow-up.  Arch Orthop Trauma Surg. 2000;  120 407-412
  • 63 Siebold R. et al . Langzeitergebnisse mit dem zementfreien Spotornoschaft.  Orthopäde. 2001;  30 317-322
  • 64 Singh S, Trikha S P, Edge A J. Hydroxyapatite ceramic-coated femoral stems in young patients. A prospective ten-year study.  J Bone Joint Surg [Br]. 2004;  86 1118-1123
  • 65 Smith S E, Estok 2nd D M. 20-year experience with cemented primary and conversion total hip arthroplasty using so-called second-generation cementing techniques in patients aged 50 years or younger.  J Arthroplasty. 2000;  15 263-273
  • 66 Spotorno L. et al . The CLS system. Theoretical concept and results.  Acta Orthop Belg. 1993;  59 144-148
  • 67 Spotorno L. et al . Persönliche Ergebnisse mit zementfreien Prothesen.  Orthopäde. 1987;  16 225-238
  • 68 Sutherland C J. et al . A ten-year follow-up of one hundred consecutive Muller curved-stem total hip-replacement arthroplasties.  J Bone Joint Surg [Am]. 1982;  64 970-982
  • 69 Teloken M A. et al . Ten to fifteen-year follow-up after total hip arthroplasty with a tapered cobalt-chromium femoral component (tri-lock) inserted without cement.  J Bone Joint Surg [Am]. 2002;  84-A 2140-2144
  • 70 Willert H G, Bertram H, Buchhorn G H. Osteolysis in alloarthroplasty of the hip. The role of bone cement fragmentation.  Clin Orthop Relat Res. 1990;  258 108-121
  • 71 Willert H G, Bertram H, Buchhorn G H. Osteolysis in alloarthroplasty of the hip. The role of ultra-high molecular weight polyethylene wear particles.  Clin Orthop Relat Res. 1990;  258 95-107
  • 72 Williams H D. et al . The Exeter universal cemented femoral component at 8 to 12 years. A study of the first 325 hips.  J Bone Joint Surg [Br]. 2002;  84 324-334
  • 73 Zweymuller K. A cementless titanium hip endoprosthesis system based on press-fit fixation: basic research and clinical results.  Instr Course Lect. 1986;  35 203-225

Dr. med. Peter R. Aldinger

Stiftung Orthopädische Universitätsklinik

Schlierbacher Landstraße 200 a

69118 Heidelberg

Phone: 06221/968870

Fax: 06221/966347

Email: peter.aldinger@ok.uni-heidelberg.de