Klika Alison K, Murray Trevor G, Darwiche Hussein, Barsoum Wael K
Department of Orthopaedic Surgery, Cleveland Clinic, 9500 Euclid Ave, A41, Cleveland, OH 44195, USA.
J Long Term Eff Med Implants. 2007;17(3):187-92. doi: 10.1615/jlongtermeffmedimplants.v17.i3.20.
Aseptic loosening is the most common cause for revision total hip arthroplasty (THA). Due to poor long-term results with cemented acetabular components, cementless 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.
无菌性松动是全髋关节置换术（THA）翻修的最常见原因。由于骨水泥型髋臼假体长期效果不佳，依赖生物固定的非骨水泥型植入物在20世纪80年代初在美国的初次和翻修手术中开始流行。据报道，THA中使用的非骨水泥型髋臼假体与骨水泥固定相比，具有更好的影像学表现，尽管髋臼固定的最佳方法仍存在争议。非骨水泥型髋臼假体需要初始植入稳定性，以允许骨长入并重塑髋臼杯，从而提供假体的长期耐用性。有许多改良的植入材料可促进骨生长和重塑，包括3种最常见的表面处理；纤维网、烧结珠和等离子喷涂涂层。最近又增加了多孔金属表面，与钛纤维网相比，其孔隙率更高且孔径最佳。这些材料中研究最多的是钛纤维网固定表面，在10至15年时其机械故障率为1%。该技术利用扩散粘结工艺，通过加热和加压将纤维金属垫附着到钛基体上。烧结珠固定表面提供各种尺寸球形珠的多孔涂层，通过烧结工艺实现，已证明可提供长期固定。虽然关于钛等离子喷涂表面的长期公开数据较少，但其早期结果已证明了其耐用性，即使面对严重的骨溶解也是如此。最新增加的替代固定表面是多孔钽金属，由于其高孔隙率（80%）和低弹性模量（3MPa），它可能具有更大的骨长入和骨移植融合能力。多孔钽植入物已显示出早期良好的临床效果，并且根据至少1年随访的系列X线片数据，据报道髋臼假体的骨移植融合情况极佳。Tritanium是一种多孔金属，已成为髋臼杯一种有前景的新表面技术。虽然尚无临床数据，但基础科学研究已证明其骨长入和机械强度得到增强。
