Advanced

Positive effect of removal of subchondral bone plate for cemented acetabular component fixation in total hip arthroplasty: a randomised RSA study with ten-year follow-up.

Flivik, Gunnar LU ; Kristiansson, I and Ryd, L (2015) In The Bone & Joint Journal 97B(1). p.35-44
Abstract
We hypothesised that the removal of the subchondral bone plate (SCBP) for cemented acetabular component fixation in total hip arthroplasty (THA) offers advantages over retention by improving the cement-bone interface, without jeopardising implant stability. We have previously published two-year follow-up data of a randomised controlled trial (RCT), in which 50 patients with primary osteoarthritis were randomised to either retention or removal of the SCBP. The mean age of the retention group (n = 25, 13 males) was 70.0 years (sd 6.8). The mean age in the removal group (n = 25, 16 males) was 70.3 years (sd 7.9). Now we have followed up the patients at six (retention group, n = 21; removal group, n = 20) and ten years (retention group: n =... (More)
We hypothesised that the removal of the subchondral bone plate (SCBP) for cemented acetabular component fixation in total hip arthroplasty (THA) offers advantages over retention by improving the cement-bone interface, without jeopardising implant stability. We have previously published two-year follow-up data of a randomised controlled trial (RCT), in which 50 patients with primary osteoarthritis were randomised to either retention or removal of the SCBP. The mean age of the retention group (n = 25, 13 males) was 70.0 years (sd 6.8). The mean age in the removal group (n = 25, 16 males) was 70.3 years (sd 7.9). Now we have followed up the patients at six (retention group, n = 21; removal group, n = 20) and ten years (retention group: n = 17, removal group: n = 18), administering clinical outcome questionnaires and radiostereometric analysis (RSA), and determining the presence of radiolucent lines (RLLs) on conventional radiographs. RSA demonstrated similar translation and rotation patterns up to six years. Between six and ten years, proximal acetabular component migration and changes of inclination were larger in the retention group, although the mean differences did not reach statistical significance. Differences in migration were driven by two patients in the SCBP retention group with extensive migration versus none in the SCBP removal group. The significant difference (p < 0.001) in the development of radiolucent lines in the retention group, previously observed at two years, increased even further during the course of follow-up (p < 0.001). While recognising SCBP removal is a more demanding technique, we conclude that, wherever possible, the SCBP should be removed to improve the cement-bone interface in order to maximise acetabular component stability and longevity. Cite this article: Bone Joint J 2015;97-B:35-44. (Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
The Bone & Joint Journal
volume
97B
issue
1
pages
35 - 44
publisher
British Editorial Society of Bone & Joint Surgery
external identifiers
  • pmid:25568411
  • wos:000347463200007
  • scopus:84925356843
ISSN
2049-4408
DOI
10.1302/0301-620X.97B1.34391
language
English
LU publication?
yes
id
3ec816f6-3538-42de-b3d3-10d7e6f66003 (old id 5040953)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/25568411?dopt=Abstract
date added to LUP
2015-02-02 20:46:11
date last changed
2017-01-01 03:47:18
@article{3ec816f6-3538-42de-b3d3-10d7e6f66003,
  abstract     = {We hypothesised that the removal of the subchondral bone plate (SCBP) for cemented acetabular component fixation in total hip arthroplasty (THA) offers advantages over retention by improving the cement-bone interface, without jeopardising implant stability. We have previously published two-year follow-up data of a randomised controlled trial (RCT), in which 50 patients with primary osteoarthritis were randomised to either retention or removal of the SCBP. The mean age of the retention group (n = 25, 13 males) was 70.0 years (sd 6.8). The mean age in the removal group (n = 25, 16 males) was 70.3 years (sd 7.9). Now we have followed up the patients at six (retention group, n = 21; removal group, n = 20) and ten years (retention group: n = 17, removal group: n = 18), administering clinical outcome questionnaires and radiostereometric analysis (RSA), and determining the presence of radiolucent lines (RLLs) on conventional radiographs. RSA demonstrated similar translation and rotation patterns up to six years. Between six and ten years, proximal acetabular component migration and changes of inclination were larger in the retention group, although the mean differences did not reach statistical significance. Differences in migration were driven by two patients in the SCBP retention group with extensive migration versus none in the SCBP removal group. The significant difference (p &lt; 0.001) in the development of radiolucent lines in the retention group, previously observed at two years, increased even further during the course of follow-up (p &lt; 0.001). While recognising SCBP removal is a more demanding technique, we conclude that, wherever possible, the SCBP should be removed to improve the cement-bone interface in order to maximise acetabular component stability and longevity. Cite this article: Bone Joint J 2015;97-B:35-44.},
  author       = {Flivik, Gunnar and Kristiansson, I and Ryd, L},
  issn         = {2049-4408},
  language     = {eng},
  number       = {1},
  pages        = {35--44},
  publisher    = {British Editorial Society of Bone & Joint Surgery},
  series       = {The Bone & Joint Journal},
  title        = {Positive effect of removal of subchondral bone plate for cemented acetabular component fixation in total hip arthroplasty: a randomised RSA study with ten-year follow-up.},
  url          = {http://dx.doi.org/10.1302/0301-620X.97B1.34391},
  volume       = {97B},
  year         = {2015},
}