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Cemented Total Hip Arthroplasty and Impaction

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Cemented Total Hip Arthroplasty and Impaction CEMENTED HIPTOTAL ARTHROPLASTY AND IMPACTION BONE GRAFTING YOUNGIN - PATIENTS MARLOES SCHMITZW.J.L. 2017 CEMENTED TOTAL HIP ARTHROPLASTY AND IMPACTION BONE GRAFTING IN YOUNG PATIENTS MARLOES W.J.L. SCHMITZ CEMENTED TOTAL HIP ARTHROPLASTY AND IMPACTION BONE GRAFTING IN YOUNG PATIENTS Marloes W.J.L. Schmitz The publication of this thesis was kindly supported by: Radboud Universiteit Nijmegen Nederlandse Orthopaedische Vereniging Stichting OrthoResearch Össur Link & Lima Nederland Annafonds│NOREF BISLIFE Foundation Interactive Studios Livit Orthopedie ChipSoft Colofon Author: Marloes W.J.L. Schmitz Cover design en lay-out: Miranda Dood, Mirakels Ontwerp Printing: Gildeprint - The Netherlands ISBN: 978-90-9030232-4 © Marloes W.J.L. Schmitz, 2017 All rights reserved. No part of this publication may be reproduced or transmitted in any form by any means, without permission of the author. CEMENTED TOTAL HIP ARTHROPLASTY AND IMPACTION BONE GRAFTING IN YOUNG PATIENTS Proefschrift Ter verkrijging van de graad van doctor aan de Radboud Universiteit Nijmegen op gezag van de rector magnificus prof. dr. J.H.J.M. van Krieken, volgens besluit van het college van decanen in het openbaar te verdedigen op woensdag 27 september 2017 om 14:30 uur precies door Marloes Wilhelmina Johanna Louisa Schmitz geboren op 31 augustus 1985, te Blerick Promotor Prof. dr. R.P.H. Veth Copromotoren Dr. B.W. Schreurs Dr. J.W.M. Gardeniers Manuscriptcommissie Prof. dr. W.B. van den Berg Prof. dr. S.J. Bergé Prof. dr. B.J. van Royen (VUmc) TABLE OF CONTENTS Chapter 1 Introduction, general background and thesis outline p.08 Chapter 2 Hip resurfacing in patients under 55 years of age p.30 Nederlands Tijdschrift voor Geneeskunde 2011;155:A3186 Chapter 3 Long-term results of cemented total hip arthroplasty in p.48 patients younger than 30 years and the outcome of subsequent revisions BMC Musculoskeletal Disorders 2013; Jan 22;14:37 Chapter 4 Results of the cemented Exeter femoral component in p.68 patients under 40 years of age. An update at 10 to 20 years follow-up Bone and Joint Journal 2017 feb;99-B(2):192-198 Chapter 5 Acetabular reconstructions with impaction bone-grafting p.88 and a cemented cup in patients younger than fifty years old. A concise follow-up, at twenty-seven to thirty-five years, of a previous report Accepted for publication in the Journal of Bone and Joint Surgery Chapter 6 Clinical and radiological outcome of the cemented p.104 Contemporary acetabular component in patients < 50 years of age Bone and Joint Journal 2013;95-B:1617–25. 6 Chapter 7 Systematic review: lack of evidence for the success of revision p.126 arthroplasty outcome in younger patients Submitted to Hip International Chapter 8 A new approach to improve cemented cup survival in p.144 primary total hip arthroplasty in young patients: acetabular impaction bone grafting A preliminary report with a minimum follow-up of two years Chapter 9 Summary and general discussion p.160 Chapter 10 Nederlandse samenvatting en algemene discussie p.178 Dankwoord p.196 List of publications, presentations and posters p.202 Curriculum Vitae p.207 7 Introduction, general background and thesis outline CHAPTER 1 Cemented total hip arthroplasty and impaction bone grafting in young patients INTRODUCTION 1 Total hip arthroplasty (THA) is one of the most successful and cost effective operations in medicine. It has even been called the operation of the 20th century.1 Throughout the world large numbers of THA are performed annually. In the UK and the USA together over 500.000 THA procedures are performed every year.2 In the Netherlands, according to the Dutch Arthroplasty Registry (LROI), around 28.000 THA were implanted in 2015.3 Approximately 93% of operations are performed for severe osteoarthritis with intractable pain and functional limitations.4 For those patients not responding to conservative measurements, THA is an effective treatment. The survival outcomes in patients over 65 years can be considered excellent.5-7 Patients regain their mobility and their health status improves as result of a decrease in pain and increase in quality of life4, 8, 9. The improvements made in THA over the years have led to high expectations by patients and strict survival criteria as described for example in the criteria of the National institute for Health and Care Excellence (NICE) and the Orthopaedic Data Evaluation Panel (ODEP) ratings.10, 11 Nowadays the long term survival rate of the prosthesis in older patients is expected to be 95% or more after ten years of follow-up. Due to the success of THA in older patients over the past few years, THA are currently offered to younger patients in increasing numbers. These younger patients can suffer from primary end-stage osteoarthritis, however, end- stage secondary osteoarthritis is a more common diagnosis. In the Netherlands, common causes of end-stage secondary osteoarthritis in patients receiving a THA at an age of under 50 are for example developmental dysplasia of the hip (DDH), osteonecrosis of the femoral head, rheumatoid arthritis and post-Perthes’ disease.3 Literature shows comparable early results of THA in patients younger than 50 compared to older patients. This is in contrast to the long-term results which still are inferior in young patients.3, 5-7, 12-20 This less successful survival and the fact that many young patients will outlive their primary total hip implant due to their longer life expectancy both contribute to inevitably higher numbers of revision procedures in these younger patients21.Therefore these young patients must be treated with specific attention. We must focus on techniques and materials that can guarantee durable solutions in order to facilitate inevitable future revisions. It is imperative that patients need to be informed on their long-term expected survival, their chances on facing future revisions and the expected outcome of these revisions.22-26 10 CHAPTER 1 Introduction, general background and thesis outline This thesis focuses on THA in this specific category of patients who are younger than 50 years at the moment of their primary THA implantation. It is aimed at investigating 1 the long-term results of the cemented THA, the importance and technique of subsequent revisions in young patients and improving the survival and possibilities to revise by using a biological approach during the primary THA. THE HISTORY OF CEMENTED THA Sir John Charnley introduced the concept of a cemented THA as early as 1959 and used polymethylmethacrylate bone cement to fill the gaps between the implant and bone in order to create stability of the prosthesis.27 This was a few decades after the introduction of the total hip arthroplasty in 1923, when Smith-Petersen performed his first trial of a hip replacement using a glass cup between the femoral head and the acetabulum.28 The concept of cemented fixation in orthopedic implants came from Haoush who used dental cement for prosthetic fixation.29, 30 Unfortunately, the results were not successful. In retrospect, his unsuccessful results were known to be caused by the designs of his used implants. Charnley introduced a new design and replaced the polytetrafluorethylene initially used for the acetabular cup by polyethylene in 1963, because of a high wear rate of the polytetrafluorethylene. This concept is still the base for many new cemented designs that have been developed throughout the last decades. Cementing technique The developments in the technique of cementing have been well described by Breusch and Malchau.31 The first generation cementing techniques already emphasized the importance of pressurizing the cement into the bone in an attempt to create an adequate cement pressure. This was done by means of ‘thumbing’ down the cement from proximal to distal in the femur, the so called ‘finger-packing’ technique. The cement mixing technique consisted of hand mixing the two components in an open bowl. The cement was stuffed into the femoral canal and in the prepared acetabulum by hand. The second generation cementing technique included the use of a distal intramedullary cement restrictor, which allowed for cement containment and better pressurization. The cement gun added the possibility to fill the femoral canal in a retrograde manner, to create higher 11 Cemented total hip arthroplasty and impaction bone grafting in young patients cement pressure distally than proximally. By introducing pressurization a method was 1 found to overcome blood pressure and consequently blood entrapment into the cement- bone interface was prevented which improved the results of cemented THA.32 Bone lavage prior to cementation was introduced after the observation that it aided the cement penetration into the bone. New concepts were pulsatile lavage, stem centralizing devices and vacuum mixing of the cement, which have shown to reduce the long-term revision risk. The procedure that includes all these steps is called the third generation cementing technique (Table I). Figure 1 illustrates some differences between the first and third cementing technique that can be seen on a anteroposterior radiograph of the hip. Long- term result studies reporting on the outcome in younger patients often include the first and second generation cementing techniques.33, 34 This demands for careful evaluation of long-term results when comparing different types of fixation techniques, as the results of the cemented prosthesis have greatly improved with the abovementioned developments. TABLE I. Description of the different generation cementing techniques
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