Whiteside L A, White S E, Engh C A, Head W
DePaul Biomechanical Research Laboratory, St. Louis, MO 63044.
J Arthroplasty. 1993 Apr;8(2):147-55. doi: 10.1016/s0883-5403(06)80055-0.
Early retrieval prior to gross failure of implants can provide valuable information for critical issues in total joint arthroplasty. To evaluate fixation of the femoral component in total hip arthroplasty, two femoral specimens--one Mallory-Head (Biomet, Warsaw, IN) specimen and one AML (DePuy, Warsaw, IN) specimen--were retrieved after 2-8 years of successful use in active patients. Radiographs were made and evaluated for trabecular apposition to the porous-coated areas of the stem, then torsional and axial load tests were performed for each specimen to determine micromotion and displacement at the bone-implant interface. Both implants had radiographic signs of bone ingrowth. No permanent rotational displacement was found in either specimen during torsional load testing, but rotational and axial micromotion were found in both. These findings indicate excellent fixation of implant to bone, and no slippage at the bone-implant interface. The Mallory-Head implant had much greater elastic displacement than the AML, and histological examination showed cancellous bone ingrowth into the porous-coated portion of the Mallory-Head stem. The AML implant, which withstood much higher torsional loads, was found upon histological evaluation to have dense cortical-cancellous bone ingrowth. Strength of attachment of the metal implant to bone was good in both specimens, and neither had slippage at this interface. Differences in mechanical behavior can be attributed to the type of bone supporting the implant. The Mallory-Head implant had a severely worn titanium femoral head, so the joint was full of particulate metal debris.(ABSTRACT TRUNCATED AT 250 WORDS)
在植入物出现严重故障之前尽早取出,可为全关节置换术中的关键问题提供有价值的信息。为了评估全髋关节置换术中股骨部件的固定情况,在两名活跃患者成功使用2至8年后,取出了两个股骨标本——一个是马洛里-黑德(Biomet公司,印第安纳州华沙)标本,另一个是AML(迪普伊公司,印第安纳州华沙)标本。拍摄X线片并评估骨小梁与柄部多孔涂层区域的贴合情况,然后对每个标本进行扭转和轴向载荷测试,以确定骨-植入物界面处的微动和位移。两种植入物均有骨长入的影像学迹象。在扭转载荷测试中,两个标本均未发现永久性旋转位移,但两者均发现有旋转和轴向微动。这些发现表明植入物与骨的固定良好,骨-植入物界面处无滑动。马洛里-黑德植入物的弹性位移比AML大得多,组织学检查显示松质骨长入马洛里-黑德柄部的多孔涂层部分。AML植入物承受的扭转载荷要高得多,组织学评估发现其有致密的皮质-松质骨长入。两个标本中金属植入物与骨的附着强度均良好,且在该界面处均无滑动。力学行为的差异可归因于支撑植入物的骨的类型。马洛里-黑德植入物的钛制股骨头严重磨损,因此关节内充满了颗粒状金属碎屑。(摘要截取自250字)