Clinical Review of the Zweymuller Femoral Stem
This review summarizes published literature from a range of reputable sources regarding hip prostheses (stems) utilized currently in cementless Total Hip Arthroplasty. The critical review of published clinical studies shows Zweymuller style (Alloclassic and SL-Plus) stems in all critical characteristics.
Since the introduction of cementless total hip arthroplasty in the 1970s, a range of design philosophies for femoral and acetabular components have demonstrated variable clinical success1,3. Recently cementless components have been yielding clinical results on par and in some cases even surpassing their cemented predecessors2,4,6. As a result, cementless THA is gaining in popularity1,7. The short-term results of four of the best cementless femoral components recorded in the Norwegian Arthroplasty Register as described by Havelin et al, included the Corail, lMT, Profile and Zweymuller stems with revision for loosening <1% at 4.5 years which was comparable to cemented counterparts.
P. Drury et al., National Joint Registry for England and Wales 4th Annual Report. 2007.
L. I. Havelin, B. Espehaug, S. E. Vollset, and L. B. Engesaeter, “Early Aseptic Loosening of Uncemented Femoral Components in Primary Total Hip Replacement,” Journal of Bone & Joint Surgery, British Volume, vol. 77, pp. 11-7, 1995.
G. Hallan, S. a Lie, O. Furnes, L. B. Engesaeter, S. E. Vollset, and L. I. Havelin, “Medium- and long-term performance of 11,516 uncemented primary femoral stems from the Norwegian arthroplasty register.,” The Journal of bone and joint surgery. British volume, vol. 89, no. 12, pp. 1574-80, Dec. 2007.
A. Suckel, F. Geiger, L. Kinzl, N. Wulker, and M. Garbrecht, “Long-term results for the uncemented Zweymuller/Alloclassic hip endoprosthesis. A 15-year minimum follow-up of 320 hip operations.,” The Journal of arthroplasty, vol. 24, no. 6, pp. 846-53, Sep. 2009.
O. Reigstad, P. Siewers, M. Røkkum, and B. Espehaug, “Excellent long-term survival of an uncemented press-fit stem and screw cup in young patients: follow-up of 75 hips for 15-18 years.,” Acta orthopaedica, vol. 79, no. 2, pp. 194-202, Apr. 2008.
P. Korovessis and T. Repantis, “High medium-term survival of Zweymüller SLR-plus stem used in femoral revision.,” Clinical orthopaedics and related research, vol. 467, no. 8, pp. 2032-40, Aug. 2009.
Register of Orthopedic Prosthetic Implantology, Overall data Emilia-Romagna Region Hip and knee prostheses, no. 2000. 2002.
C. Delaunay, C. Cazeau, and A. I. Kapandji, “Cementless primary total hip replacement. Four to eight year results with the Zweymüller-Alloclassic prosthesis.,” International orthopaedics, vol. 22, no. 1, pp. 1-5, Jan. 1998.
T. V. Swanson, “The tapered press fit total hip arthroplasty: a European alternative.,” The Journal of arthroplasty, vol. 20, no. 4 Suppl 2, pp. 63-7, Jun. 2005.
M. Wick and D. K. Lester, “Radiological changes in second- and third-generation Zweymüller stems,” The Journal of bone and joint surgery. British volume, vol. 86, no. 8, pp. 1108-1114, Nov. 2004.
T. Vervest, P. Anderson, F. Vanhout, F. Wapstra, R. Louwerse, and J. Koetsier, “Ten to Twelve-Year Results With the Zweymuller Cementless Total Hip Prosthesis,” The Journal of Arthroplasty, vol. 20, no. 3, pp. 362-368, Apr. 2005.
P. Korovessis, T. Repantis, and A. Zafiropoulos, “High medium-term survivorship and durability of Zweymüller-Plus total hip arthroplasty.,” Archives of orthopaedic and trauma surgery, Aug. 2010.
International Organization for Standardization, “ISO 5832-3 Implants for Surgery - Metallic Materials - Part 3: Wrought titanium 6-aluminium 4-vanadium alloy,” International Organization. 1996.
H. Schmotzer and J. D. Clausen, “Primary stability - the first step in successful cementless total hip replacement,” in 25 Years of Biologic Fixation, S. Heck, Ed. Munich: Elsevier GmbH, 2007, pp. 113-118.
E. Garcia-Cimbrelo, A. Cruz-Pardos, R. Madero, and M. Ortega-Andreu, “Total hip arthroplasty with use of the cementless Zweymüller Alloclassic system. A ten to thirteen-year follow-up study.,” The Journal of bone and joint surgery. American volume, vol. 85-A, no. 2, pp. 296-303, Feb. 2003.
C. P. Delaunay and A. I. Kapandji, “Primary total hip arthroplasty with the Karl Zweymüller first-generation cementless prosthesis. A 5- to 9-year retrospective study.,” The Journal of arthroplasty, vol. 11, no. 6, pp. 643-52, Sep. 1996.
C. Delaunay, F. Bonnomet, J. North, D. Jobard, C. Cazeau, and J. F. Kempf, “Grit-blasted titanium femoral stem in cementless primary total hip arthroplasty: a 5- to 10-year multi-center study.,” The Journal of arthroplasty, vol. 16, no. 1, pp. 47-54, Jan. 2001.
M. Svehla, P. Morberg, B. Zicat, W. Bruce, D. Sonnabend, and W. R. Walsh, “Morphometric and mechanical evaluation of titanium implant integration: comparison of five surface structures.,” Journal of biomedical materials research, vol. 51, no. 1, pp. 15-22, Jul. 2000.
A. Grübl, C. Chiari, M. Gruber, A. Kaider, and F. Gottsauner-Wolf, “Cementless total hip arthroplasty with a tapered, rectangular titanium stem and a threaded cup: a minimum ten-year follow-up.,” The Journal of bone and joint surgery. American volume, vol. 84-A, no. 3, pp. 425-31, Mar. 2002.
A. Grübl et al., “Cementless total hip arthroplasty with the rectangular titanium Zweymuller stem. A concise follow-up, at a minimum of fifteen years, of a previous report.,” The Journal of bone and joint surgery. American volume, vol. 88, no. 10, pp. 2210-5, Oct. 2006.
W. Steens, a G. Schneeberger, R. Skripitz, P. Fennema, and C. Goetze, “Bone remodeling in proximal HA-coated versus uncoated cementless SL-Plus femoral components: a 5-year follow-up study.,” Archives of orthopaedic and trauma surgery, vol. 130, no. 7, pp. 921-6, Jul. 2010.
T. Karachalios, “The long-term clinical relevance of calcar atrophy caused by stress shielding in total hip arthroplastyA 10-year, prospective, randomized study1,” The Journal of Arthroplasty, vol. 19, no. 4, pp. 469-475, Jun. 2004.
M. Pospischill and K. Knahr, “Cementless total hip arthroplasty using a threaded cup and a rectangular tapered stem. Follow-up for ten to 17 years.,” The Journal of bone and joint surgery. British volume, vol. 87, no. 9, pp. 1210-5, Sep. 2005.
L. Turchetto, “Experience with the SL-PLUS system in special conditions,” in 25 Years of Biologic Fixation, S. Heck, Ed. Munich: Elsevier GmbH, 2007, pp. 107-111.
M. Flören and D. K. Lester, “Durability of implant fixation after less-invasive total hip arthroplasty.,” The Journal of arthroplasty, vol. 21, no. 6, pp. 783-90, Sep. 2006.
M. H. Huo, R. P. Martin, L. E. Zatorski, and K. J. Keggi, “Total hip arthroplasty using the Zweymuller stem implanted without cement. A prospective study of consecutive patients with minimum 3-year follow-up period.,” The Journal of arthroplasty, vol. 10, no. 6, pp. 793-9, Dec. 1995.
K. Zweymuller, M. S. Schwarzinger, and M. S. Steindl, “Radiolucent lines and osteolysis along tapered straight cementless titanium hip stems: A comparison of 6-year and 10-year follow-up results in 95 patients,” in 25 Years of Biologic Fixation, S. Heck, Ed. Munich: Elsevier GmbH, 2007, pp. 53-59.
T. M. J. S. Vervest, W. H. J. C. van Heeswijk, P. G. Anderson, and J. van Limbeek, “Decreased bone mineral density at the calcar region 10 years after a zweymuller cementless stem prosthesis,” in 25 Years of Biologic Fixation, S. Heck, Ed. Munich: Elsevier GmbH, 2007, pp. 125-129.
R. M. Christ, P. Fennema, S. Kortemeier, and F.-W. Hagena, “Is hydroxyapatite coating necessary in primaries? Optimization of osseous integration of the SL-PLUS stem with a proximal hydroxyapatite coating,” in 25 Years of Biologic Fixation, S. Heck, Ed. Munich: Elsevier GmbH, 2007, pp. 149-154.
R. P. Robinson, G. R. Deysine, and T. M. Green, “Uncemented total hip arthroplasty using the CLS stem: a titanium alloy implant with a corundum blast finish. Results at a mean 6 years in a prospective study.,” The Journal of arthroplasty, vol. 11, no. 3, pp. 286-92, Apr. 1996.
C. Perka, U. Fischer, W. R. Taylor, and G. Matziolis, “Developmental hip dysplasia treated with total hip arthroplasty with a straight stem and a threaded cup.,” The Journal of bone and joint surgery. American volume, vol. 86-A, no. 2, pp. 312-9, Feb. 2004.
K. J. Keggi, M. H. Huo, and L. E. Zatorski, “Anterior Approach to total hip replacement: surgical technique and clinical results of our first one thousand cases using non-cemented prostheses,” Yale Journal of Biology and Medicine, vol. 66, no. 243, 1993.
R. E. Zwartelé, P. G. M. Olsthoorn, R. G. Pöll, R. Brand, and H. C. Doets, “Primary total hip arthroplasty with a flattened press-fit acetabular component in osteoarthritis and inflammatory arthritis: a prospective study on 416 hips with 6-10 years follow-up.,” Archives of orthopaedic and trauma surgery, vol. 128, no. 12, pp. 1379-86, Dec. 2008.
C. Delaunay and A. I. Kapandji, “Survival analysis of cementless grit-blasted titanium total hip arthroplasties.,” The Journal of bone and joint surgery. British volume, vol. 83, no. 3, pp. 408-13, Apr. 2001.
J. Girard, D. Bocquet, G. Autissier, N. Fouilleron, D. Fron, and H. Migaud, “Metal-on-metal hip arthroplasty in patients thirty years of age or younger.,” The Journal of bone and joint surgery. American volume, vol. 92, no. 14, pp. 2419-26, Oct. 2010.
G. Pflüger, S. Junk-Jantsch, and V. Schöll, “Minimally invasive total hip replacement via the anterolateral approach in the supine position.,” International orthopaedics, vol. 31 Suppl 1, pp. S7-11, Aug. 2007.
T. V. Swanson, “Benefits of posterior single-incision less-invasive THA using the SL-PLUS cementless stem,” in 25 Years of Biologic Fixation, S. Heck, Ed. Munich: Elsevier GmbH, 2007, pp. 179-190.
F. Higuchi, “A mini-incision anterolateral approach for total hip arthroplasty using the SL-PLUS stem,” in 25 Years of Biologic Fixation, S. Heck, Ed. Munich: Elsevier GmbH, 2007, pp. 191-195.
H. Hourlier, “A modified, direct-lateral, minimally invasive approach to the hip. Surgical technique and preliminary results of 103 cases,” Interactive Surgery, vol. 1, no. 1-4, pp. 27-32, Nov. 2006.
C. Perka et al., “Surgical Approach Influences Periprosthetic Femoral Bone Density,” Clinical Orthopaedics and Related Research, vol. &NA;, no. 432, pp. 153-159, Mar. 2005.
R. B. Bourne and C. H. Rorabeck, “A critical look at cementless stems. Taper designs and when to use alternatives.,” Clinical orthopaedics and related research, no. 355, pp. 212-23, Oct. 1998.
K.-H. Widmer, M. Majewski, W. Muller, and N. F. Friedrich, “Sport activities in patients with total hip replacements,” in 25 Years of Biologic Fixation, S. Heck, Ed. Munich: Elsevier GmbH, 2007, pp. 119-123.
K. Hu, X. Zhang, J. Zhu, C. Wang, W. Ji, and X. Bai, “Periprosthetic fractures may be more likely in cementless femoral stems with sharp edges.,” Irish journal of medical science, vol. 179, no. 3, pp. 417-21, Sep. 2010.
H. Pieringer, V. Auersperg, and N. Böhler, “Long-term results of the cementless ALLOCLASSIC hip arthroplasty system using a 28-mm ceramic head: with a retrospective comparison to a 32-mm head.,” The Journal of arthroplasty, vol. 21, no. 7, pp. 967-74, Oct. 2006.
M. Porter, M. Borroff, P. Gregg, P. Howard, A. MacGregor, and K. Tucker, National Joint Registry for England and Wales 7th Annual Report, vol. 1450, no. 2009. 2010.
D. Davidson et al., Australian Orthopaedic Association National Joint Registry Hip and Knee Arthroplasty Annual Report 2010. 2010.
P. Korovessis, G. Petsinis, and M. Repanti, “Medium-term clinical results, radiology and histology of metal-metal hips,” in 25 Years of Biologic Fixation, S. Heck, Ed. Munich: Elsevier GmbH, 2007, pp. 19-28.
W. Janda, M. Hübl, B. Stöckl, M. Thaler, and G. Labek, “Performance of the Zweymüller total hip arthroplasty system: a literature review including arthroplasty register data,” European Orthopaedics and Traumatology, vol. 1, no. 1, pp. 9-15, Apr. 2010.
Depuy Orthopaedics Inc., “C-Stem AMT Articul/EZE Mini Taper Design Rationale.” 2005.
R. D. Reitman, R. Emerson, L. Higgins, and W. Head, “Thirteen Year Results of Total Hip Arthroplasty Using a Tapered Titanium Femoral Component Inserted Without Cement in Patients With Type C Bone,” Journal of Arthroplasty, vol. 18, no. 7, pp. 116-121, 2003.
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A. Kroell, P. Beaulé, M. Krismer, H. Behensky, B. Stoeckl, and R. Biedermann, “Aseptic stem loosening in primary THA: migration analysis of cemented and cementless fixation.,” International orthopaedics, vol. 33, no. 6, pp. 1501-5, Dec. 2009.
Y.-H. Kim, “The results of a proximally-coated cementless femoral component in total hip replacement: a five- to 12-year follow-up.,” The Journal of bone and joint surgery. British volume, vol. 90, no. 3, pp. 299-305, Mar. 2008.
L. I. Havelin, B. Espehaug, S. A. Lie, L. B. Engesæter, O. Furnes, and S. E. Vollset, Propsective Studies of Hip Prostheses and Cements. A Presentation of the Norwegian Arthroplasty Regist 1987-1999. 2000, pp. 1-8.
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Copyright (c) 2014 Christian Wright, BS, Dale Lambert, BS, Declan Brazil, PhD, Kristaps Keggi, MD, John Keggi, MD, Timothy McTighe, Dr. H.S. (hc)
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