The Thrust Plate Hip Prosthesis Springer Berlin Heidelberg New York Barcelona Budapest Hong Kong London Milan Paris Santa Clara Singapore Tokyo A.H. Huggler H.A.C. Jacob (Eds.) The Thrust Plate Hip Prosthesis· With 96 Figures, Some in Colour, and 5 Tables Springer ARNOLD H. HUGGLER, M.D. Orthopaedic Department Canton Hospital Loestrasse 170 7000 Chur Switzerland HILAIRE A.C. JACOB, Ph.D. Biomechanic Unit Department of Orthopaedic Surgery Balgrist University of Zurich Forchstrasse 348 8008 Zurich Switzerland ISBN-13: 978-3-642-64433-7 e-ISBN-13: 978-3-642-60502-4 DOl: 10.1007/978-3-642-60502-4 Library of Congress Cataloging-in-Publication Data. The thrust plate hip prosthesis/A.H. Huggler, H.A.C. Jacob (eds.). p. cm. Based on an international symposium held in Zurich in 1994. Includes bibliographical references and index.ISBN-13: 978-3-642-64433-7(Hardcover:alk. paper} 1. Artificial hip joints - Congresses. I. Huggler, Arnold H. II. Jacob, Hilaire A.C. [DNLM: 1. Hip Prosthesis - congresses. 2. HIP Joint-surgery - congresses. WE 860 T531 1997] RD549. T537 1997 617.5'810592-dc20 DNLM/DLC for Library of Congress 96-34374 This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilm or in any other way, and storage in data banks. Duplication of this publication or parts thereof is permitted only under the provisions of the German Copyright Law of September 9, 1965, in its current version, and permission for use must always be obtained from Springer-Verlag. 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Cover design: Design & Production GmbH, Heidelberg Typesetting: Scientific Publishing Services (P) Ltd, Madras SPIN: 10465325 24/3135/SPS - 5 4 3 2 1 0 - Printed on acid-free paper Preface As is probably the case with all successful innovations, the unique design of the thrust plate prosthesis (TPP) was not born of a sudden fancy for a radically different hip joint replacement, but emerged from elaborate biomechanical investigations on the loosening of conventional, intramedullarly anchored hip prosthesis shafts. In the 1970s, hip revisions due to loosening of the prostheses became a burden to patients not only physically and psychologically but also economically. This meant that it also became a matter of daily concern to the orthopaedic surgeon, who then had to cope with new, previously unknown problems. Loosening processes were de- tected within 5 years of implantation in up to 25% of cases. While implant loosenings were considered to be the result of incorrect handling of materials, we felt that a number of details still had to be considered in regard to the behavior of the entire bone-prosthesis complex and the action of mechanical forces. Our initial step in developing the TPP was therefore based both on long-term clinical experience with hip prostheses and also on the results of experimental stress analyses. These drew our attention to the unphysiological manner in which the bone is loaded by in- tramedullarly anchored prostheses. Here we were guided by the observations of Hermann von Meyer (1815-1892), Karl Culmann (1821-1881), and Julius Wolff (1836-1902), who were the first to observe the relationship between the architecture of bone and the mechanical forces that act on the bone structure, and were also led by the findings of Friedrich Pauwels (1885-1980). We designed a prosthesis that transmits the hip force to the bone in a more phys- iological manner by means of a thrust plate placed on the resected neck of the femur. Hey Groves (1922), Wiles (1938), the brothers Robert and Jean Judet (1946), McKee (1950), and Picchio (1957) among others, in- troduced cementless prostheses which were attached to the femur without intramedullary fixation. These prostheses may show some similarities to the TPP at a quick glance, but they differ basically from it in that they do not take into account the specific function of the cortical bone at the proximal end of the femur. Also, the mate- rials used could not fulfill all the requirements demanded. VI Preface When we first conceived the TPP in 1976, manufacturers showed little interest in it. Neither the first prototypes made for experimental testing nor the two prototypes of the TPP subjected to clinical trial in Chur in 1978 would have been possible without the active support provided by Mr. Hermann Straehl and Mr. Max Briner of Sulzer Brothers Ltd. Through Prof. Adam Schreiber (former Chairman of the Depart- ment of Orthopaedic Surgery, Balgrist, University of Zurich), the Ida-Herzog-Egli Foundation raised the required funds in 1980 to manufacture the first limited series of prostheses, 64 of which were implanted between 1980 and 1985. This pilot study was a joint venture with the Department of Orthopaedic Surgery, Balgrist, University of Zurich, following approval by the ethical commission of the Balgrist hospital, allowing initially 20 prostheses to be im- planted. The remaining 44 were implanted in the Orthopaedic De- partment of the Canton Hospital in Chur. Since we were dealing with an unconventional new hip prosthesis, it was especially beneficial that the Orthopaedic University Clinic was participating in the pilot field study. This was important not only to confirm that the TPP can be a preferable alternative to the conventional hip prostheses but especially to identify possible weaknesses of the prosthesis with the assistance of a second authority. Weare very grateful to Prof. Adam Schreiber for this collaboration. We are very indebted to Mr. Andre Buchel, Director of Sulzer Medica, Dr. Walter Kaiser (former Director of Allo Pro Ltd.), and Mr. Erwin Locher, Director of Allo Pro Ltd., who supported this project. We express our appreciation as well to Mr. Hans-Ruedi Lotscher (former Director of Allo Pro Ltd.) who encouraged us in the early developmental stages. Weare also indebted to all those from Allo Pro Ltd. and Sulzer Medical Technology Ltd. who contributed with their valuable help in realizing this project. We are particularly obligated to Mr. Urs Lack and Dr. Martin Schmidt of Allo Pro Ltd. (now Sulzer Orthopedics) and to Springer- Verlag for the competent management which made this monograph possible. The favourable clinical results of the TPP which we obtained to- gether with the Orthopaedic University Clinic Balgrist, has further strengthened our firm belief in this concept. It also led us to include other orthopaedic specialists in an extended field study to gain a wider range of experience before presenting the TPP to a still larger orthopaedic community. This presentation took place at an inter- national symposium held in Zurich in 1994, organized by Allo Pro Ltd., at the Orthopaedic University Clinic Balgrist, which extended its hospitality to all the participants. We know of no other prosthesis which has been evaluated clini- cally for more than 12 years before being released for general use. Preface VII The symposium in Zurich encouraged us to publish the personal contributions of the participants and to relate our experiences in detail. This volume provides the opportunity to present individual viewpoints both by the orthopaedic surgeons who first carried the TPP into the clinical field and by the manufacturers whose interest has been expressed in this prosthesis. Throughout these years they have contributed valuable suggestions toward materializing the clinical use of the TPP and in the design of the implantation in- struments, which are almost as important as the implant itself. To guarantee its reliability, a great number of details must be considered meticulously regarding the clinical feasibility and tech- nical quality of the TPP. The increasing demand for the TPPcon- firms its value, and we are therefore not surprised to see a gr~wing number of imitators. While imitation may be interpreted positively, one must recognize that the imitations themselves do not necessarily reflect the potential of experience built into the original; neither do they display the same quality of material, which is an absolute pre- requisite. The viewpoints and opinions expressed in the contributions presented here are those of the respective authors. They do not necessarily reflect the opinions of the editors or the publishers. Maienfeld ARNOLD H. HUGGLER Winterthur HILAIRE A.C. JACOB May 1996 Contents The Thrust Plate Prosthesis: A New Experience in Hip Surgery A.H. HUGGLER ................................ . 2 Biomechanical Principles and Design Details of the Thrust Plate Prosthesis H.A.C. JACOB ................................. 25 3 Finite Element Investigations of the Proximal Femur After Implantation of the Thrust Plate Prosthesis Compared with Findings in a Post-mortem Histological Specimen and in Radiological Follow-Up Examinations H. BEREITER, M. BURGI, and R. SCHENK ............... 48 4 Histology of the Thrust Plate-Bone Interface R.K. SCHENK, R. HAUSER, A.H. HUGGLER, and H.A.C. JACOB. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 5 The First-Generation Thrust Plate Prosthesis: Long-Term Results of a Clinical Pilot Study of 20 Cases R. HAUSER and T. KUHN ......................... 74 6 The Second-Generation Thrust Plate Prosthesis from 1988 to 1992 S. KERN. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 7 Special Indications and Complications with the Implantation of the Thrust Plate Prosthesis U. SCHWARZENBACH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91 8 Bone Remodelling of the Proximal Femur After Implantation of a Thrust Plate Prosthesis M. MENGE................................... 98 9 The Thrust Plate Prosthesis in Osteological Disorders W. RUTHER, B. FINK, T. SCHNEIDER, and E. KORNELY . . . . .. 107 x Contents 10 The Limits of Indications for the Thrust Plate Prosthesis G. GRUBER and H. STURZ . . . . . . . . . . . . . . . . . . . . . . . .. 119 11 Our Experience with the Thrust Plate Prosthesis J.I. ABAD RICO ................................ 128 12 Chemical Reactions at Titanium Surfaces M. SCHMIDT .................................. 133 13 Material Combinations with Polyethylene and Metasul for Articulating Implants R.M. STREICHER. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 139 list of Contributors ABAD RICO, J.I. Hospital Regional Carlos Haya, Av da. de Carlos Haya, 29106 Malaga, Spain BEREITER, H. Rhatisches Kantonsspital, LoestraBe 170, 7000 Chur, Switzerland BURGI, M. Abteilung flir Biomechanik, Sulzer Orthopadie, 8400 Winterthur, Switzerland FINK, B. Heinrich-Heine-Universitat, MoorenstraBe 5,40001 Dusseldorf, Germany GRUBER, G. Orthop. Universitatsklinik, Paul-MeimbergstraBe 3, 35385 GieBen, Germany HAUSER, R. Spital Neumunster, Trichtenhauserstrasse 12, 8125 Zollikerberg, Switzerland HUGGLER, A.H. Rhatisches Kantonsspital, LoestraBe 170, 7000 Chur, Switzerland JACOB, H.A.C. Orthopadische Universitatsklinik Balgrist, Forchstrasse 340, 8008 Zurich, Switzerland KERN, S. Spital Limmattal, Urdorferstrasse 100, 8952 Schlieren, Switzerland KORNELY, E. Heinrich-Heine-Universitat, MoorenstraBe 5, 40001 Dusseldorf, Germany