Abstract
We reviewed the results of 172 plasma-sprayed, titanium primary total hip arthroplasties inserted without cement and followed 5 to 7 years. Hips were replaced for a wide range of diagnoses and patient ages. No femoral components had been revised nor were any considered unstable. Clinical results have been excellent; 88% of hips had either no or slight amount of pain and only 5% of patients had thigh pain when specifically asked. Radiographically, this femoral component achieved stability after an initial subsidence in 9% of cases. Extensive femoral bone resorption was rare, and distal cortical hypertrophy was commonly seen. Pelvic osteolysis occurred in 16 (9%) cases and was considered major in 10 of these. It was the cause of failure of 3 acetabular components. Femoral endosteal lysis was not observed. We concluded that mechanical stability of the Mallory-Head titanium total hip prostheses is excellent. However, significant pelvic osteolysis had occurred commonly with this implant design, and will continue to pose major reconstructive problems in the future.
Full text
PDF














Images in this article
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Bobyn J. D., Jacobs J. J., Tanzer M., Urban R. M., Aribindi R., Sumner D. R., Turner T. M., Brooks C. E. The susceptibility of smooth implant surfaces to periimplant fibrosis and migration of polyethylene wear debris. Clin Orthop Relat Res. 1995 Feb;(311):21–39. [PubMed] [Google Scholar]
- Bourne R. B., Rorabeck C. H., Burkart B. C., Kirk P. G. Ingrowth surfaces. Plasma spray coating to titanium alloy hip replacements. Clin Orthop Relat Res. 1994 Jan;(298):37–46. [PubMed] [Google Scholar]
- Bourne R. B., Rorabeck C. H., Ghazal M. E., Lee M. H. Pain in the thigh following total hip replacement with a porous-coated anatomic prosthesis for osteoarthrosis. A five-year follow-up study. J Bone Joint Surg Am. 1994 Oct;76(10):1464–1470. doi: 10.2106/00004623-199410000-00005. [DOI] [PubMed] [Google Scholar]
- Brooker A. F., Bowerman J. W., Robinson R. A., Riley L. H., Jr Ectopic ossification following total hip replacement. Incidence and a method of classification. J Bone Joint Surg Am. 1973 Dec;55(8):1629–1632. [PubMed] [Google Scholar]
- Burkart B. C., Bourne R. B., Rorabeck C. H., Kirk P. G. Thigh pain in cementless total hip arthroplasty. A comparison of two systems at 2 years' follow-up. Orthop Clin North Am. 1993 Oct;24(4):645–653. [PubMed] [Google Scholar]
- Callaghan J. J., Dysart S. H., Savory C. F., Hopkinson W. J. Assessing the results of hip replacement. A comparison of five different rating systems. J Bone Joint Surg Br. 1990 Nov;72(6):1008–1009. doi: 10.1302/0301-620X.72B6.2246281. [DOI] [PubMed] [Google Scholar]
- Callaghan J. J. The clinical results and basic science of total hip arthroplasty with porous-coated prostheses. J Bone Joint Surg Am. 1993 Feb;75(2):299–310. doi: 10.2106/00004623-199302000-00020. [DOI] [PubMed] [Google Scholar]
- Cook S. D., Thomas K. A., Barrack R. L., Whitecloud T. S., 3rd Tissue growth into porous-coated acetabular components in 42 patients. Effects of adjunct fixation. Clin Orthop Relat Res. 1992 Oct;(283):163–170. [PubMed] [Google Scholar]
- DeLee J. G., Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res. 1976 Nov-Dec;(121):20–32. [PubMed] [Google Scholar]
- 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 Jun;(231):7–28. [PubMed] [Google Scholar]
- Engh C. A., Glassman A. H., Suthers K. E. The case for porous-coated hip implants. The femoral side. Clin Orthop Relat Res. 1990 Dec;(261):63–81. [PubMed] [Google Scholar]
- Engh C. A., McGovern T. F., Bobyn J. D., Harris W. H. A quantitative evaluation of periprosthetic bone-remodeling after cementless total hip arthroplasty. J Bone Joint Surg Am. 1992 Aug;74(7):1009–1020. [PubMed] [Google Scholar]
- Goetz D. D., Smith E. J., Harris W. H. The prevalence of femoral osteolysis associated with components inserted with or without cement in total hip replacements. A retrospective matched-pair series. J Bone Joint Surg Am. 1994 Aug;76(8):1121–1129. doi: 10.2106/00004623-199408000-00002. [DOI] [PubMed] [Google Scholar]
- Gruen T. A., McNeice G. M., Amstutz H. C. "Modes of failure" of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res. 1979 Jun;(141):17–27. [PubMed] [Google Scholar]
- Harris W. H. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am. 1969 Jun;51(4):737–755. [PubMed] [Google Scholar]
- Haynes D. R., Rogers S. D., Hay S., Pearcy M. J., Howie D. W. The differences in toxicity and release of bone-resorbing mediators induced by titanium and cobalt-chromium-alloy wear particles. J Bone Joint Surg Am. 1993 Jun;75(6):825–834. doi: 10.2106/00004623-199306000-00004. [DOI] [PubMed] [Google Scholar]
- Heekin R. D., Callaghan J. J., Hopkinson W. J., Savory C. G., Xenos J. S. The porous-coated anatomic total hip prosthesis, inserted without cement. Results after five to seven years in a prospective study. J Bone Joint Surg Am. 1993 Jan;75(1):77–91. doi: 10.2106/00004623-199301000-00011. [DOI] [PubMed] [Google Scholar]
- Johnston R. C., Fitzgerald R. H., Jr, Harris W. H., Poss R., Müller M. E., Sledge C. B. Clinical and radiographic evaluation of total hip replacement. A standard system of terminology for reporting results. J Bone Joint Surg Am. 1990 Feb;72(2):161–168. [PubMed] [Google Scholar]
- Lombardi A. V., Jr, Mallory T. H., Vaughn B. K., Drouillard P. Aseptic loosening in total hip arthroplasty secondary to osteolysis induced by wear debris from titanium-alloy modular femoral heads. J Bone Joint Surg Am. 1989 Oct;71(9):1337–1342. [PubMed] [Google Scholar]
- Maloney W. J., Peters P., Engh C. A., Chandler H. Severe osteolysis of the pelvic in association with acetabular replacement without cement. J Bone Joint Surg Am. 1993 Nov;75(11):1627–1635. doi: 10.2106/00004623-199311000-00007. [DOI] [PubMed] [Google Scholar]
- Maric Z., Karpman R. R. Early failure of noncemented porous coated anatomic total hip arthroplasty. Clin Orthop Relat Res. 1992 May;(278):116–120. [PubMed] [Google Scholar]
- Martell J. M., Pierson R. H., 3rd, Jacobs J. J., Rosenberg A. G., Maley M., Galante J. O. Primary total hip reconstruction with a titanium fiber-coated prosthesis inserted without cement. J Bone Joint Surg Am. 1993 Apr;75(4):554–571. doi: 10.2106/00004623-199304000-00010. [DOI] [PubMed] [Google Scholar]
- Massin P., Schmidt L., Engh C. A. Evaluation of cementless acetabular component migration. An experimental study. J Arthroplasty. 1989 Sep;4(3):245–251. doi: 10.1016/s0883-5403(89)80020-8. [DOI] [PubMed] [Google Scholar]
- Nasser S., Campbell P. A., Kilgus D., Kossovsky N., Amstutz H. C. Cementless total joint arthroplasty prostheses with titanium-alloy articular surfaces. A human retrieval analysis. Clin Orthop Relat Res. 1990 Dec;(261):171–185. [PubMed] [Google Scholar]
- Santavirta S., Hoikka V., Eskola A., Konttinen Y. T., Paavilainen T., Tallroth K. Aggressive granulomatous lesions in cementless total hip arthroplasty. J Bone Joint Surg Br. 1990 Nov;72(6):980–984. doi: 10.1302/0301-620X.72B6.2246301. [DOI] [PubMed] [Google Scholar]
- Schmalzried T. P., Guttmann D., Grecula M., Amstutz H. C. The relationship between the design, position, and articular wear of acetabular components inserted without cement and the development of pelvic osteolysis. J Bone Joint Surg Am. 1994 May;76(5):677–688. doi: 10.2106/00004623-199405000-00008. [DOI] [PubMed] [Google Scholar]
- Schmalzried T. P., Jasty M., Harris W. H. Periprosthetic bone loss in total hip arthroplasty. Polyethylene wear debris and the concept of the effective joint space. J Bone Joint Surg Am. 1992 Jul;74(6):849–863. [PubMed] [Google Scholar]
- Singh M., Nagrath A. R., Maini P. S. Changes in trabecular pattern of the upper end of the femur as an index of osteoporosis. J Bone Joint Surg Am. 1970 Apr;52(3):457–467. [PubMed] [Google Scholar]
- Tanzer M., Maloney W. J., Jasty M., Harris W. H. The progression of femoral cortical osteolysis in association with total hip arthroplasty without cement. J Bone Joint Surg Am. 1992 Mar;74(3):404–410. [PubMed] [Google Scholar]








