KMID : 0386720080200040258
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Journal of the Korean Hip Society 2008 Volume.20 No. 4 p.258 ~ p.264
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The Retrieval Study of the Rough Blasted Surface Finish Cement Stem in Metal on Metal Total Hip Arthroplasty
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Park Myung-Sik
Lee Ju-Hong Park Jong-Hyuk Kim Young-Sin Lee Sang-Hong
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Abstract
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Purpose: This study investigated the possible etiologic role of stem loosening and osteolysis by examining the surface of a rough blast retrieval cement stem and physical activity in second generation metal-on-metal (MOM) total hip arthroplasty (THA)
Materials and Methods: Forty one patients (43 hips) were analyzed retrospectively from Jan. 1996 to Dec.1998. Of the femoral stem, a rough blasted (Ra=1.6 um) cement stem and a cementless Ti-alloy stem was used in 18 and 25 hips, respectively. The mean follow-up duration was 10.15 years. Each patient was evaluated clinically by the HSS and radiographically by Engh¡¯s method. Scanning electron microscopy was used to observe the retrieved femoral stem and histology studies were performed.
Results: The mean Harris hip score improved from 56.2 points before surgery to 92.6 points after surgery. All the cementless stems and cups showed excellent results at the last follow-up. Eight of the rough blast cement stems were revised. Seven showed loosening and one was a recurrent dislocation. Cross-validation evaluation revealed osteolysis to be associated with a rough surface cement stem of metal on metal THAs (p=0.001). In addition, patients who underwent strenuous activity had a higher incidence of osteolysis (p=0.031).
Conclusion: These findings suggest that a rough blast surface cement stem is associated with early osteolysis and loosening in patients with a metal-on-metal hip replacement. A prospective study with a large group of patients and multiple diagnostic methods will be needed to determine if there is a causal relationship between metal hypersensitivity and osteolysis. These results suggest that a cement stem with a rough blasted surface should be considered in metal-on-metal total hip arthroplasty.
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KEYWORD
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Hip, Metal on metal total hip arthroplasty, Rough blasted surface finish cement stem
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