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Development of a new modular titanium femoral prosthesis consisting of a head and shaft component. Indications, operation and optimization of the tapered socket connection

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Summary

The development and clinical indications of a new modular femoral endoprosthesis consisting of a head and shaft component is discribed. Components are available in different lengths and diameters and therefore can be joined individually depending on the patients anatomy and surgery required. Both parts are joined by a unique optimized taper socket with a groove, avoiding fretting and corosion. Fatigue tests showed no loosening of the tapered connection and no prosthesis fracture. The advantage of this new modular prosthesis is diaphyseal stabilization, if necessairy by two distal interlocking screwes. Indications are revisions, pertrochanteric femoral and neoplastic fractures if cementless bridging of boney defects in the calcar region must be achieved. Further indications are femoral neck fraktures and coxarthrosis if stable diaphyseal fixation is required. The material and surface structure as well as the philosophie of the distal fixation are discussed.

Résumé

Les auteurs décrivent une nouvelle prothèse fémorale modulaire associant une prothèse conventionnelle et un clou centro-médullaire. La prothèse est constituée d’une pièce céphalique et d’une partie diaphysaire fixées ensemble par un cône morse. Chaque pièce est modulaire selon les besoins en longueur et en diamètre. L’antéversion de la pièce céphalique est libre. Les pièces diaphysaires ont une courbure sagittale anatomique et sont creuses, permettant l’utilisation d’un guide centro-médullaire. Les pièces diaphysaires longues peuvent être verrouillées. Les pièces céphalique et diaphysaire sont en alliage de titane et la pièce diaphysaire a une surface grenaillée dans sa partie proximale. Le cône morse a été optimisé par l’adjonction d’une rainure qui a diminué l’usure par abrasion lors des tests de fatigue. Aucun démontage de la jonction intraprothétique et aucune fracture dé tige n’a été rencontrée lors de c es tests. La technique opératoire n’offre aucune particularité. Cent vingtquatre prothèses ont été implantées depuis 1990, principalement pour des fractures du col fémoral et des changements de prothèses totales de hanche. Les résultats cliniques sont en cours d’investigation. D’autres indications plus rares ont été choisies : pseudarthrose per-trochantérienne, fracture sur coxarthrose, chirurgie métastatique. Cette prothèse permet un ancrage diaphysaire stable dans les pertes de substance de l’extrémité supérieure du fémur, et autorise ainsi la repousse osseuse dans cette zone, spontanée ou après greffe osseuse, et la fixation proximale secondaire. L’optimisation du cône morse a permis de diminuer de façon considérable l’usure par abrasion. La modularité de la prothèse permet de s’adapter à toutes les morphologies et toutes les situations cliniques.

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Authors and Affiliations

  1. Department of Traumatology, Ludwig-Maximilians-University, Klinikum Grosshadern, Marchioninistraße 15, 81377, Munich, Germany

    H. J. Andress, G. Lob, P. Gierer, J. Landes, M. Schürmann & S. Piltz

  2. Biomet Merck Deutschland GmbH, Gustav-Krone-Str.2, 14167, Berlin

    S. Kahl & C. Kranz

Authors
  1. H. J. Andress
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  2. G. Lob
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  3. S. Kahl
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  4. C. Kranz
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  5. P. Gierer
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  6. J. Landes
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  7. M. Schürmann
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  8. S. Piltz
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Andress, H.J., Lob, G., Kahl, S. et al. Development of a new modular titanium femoral prosthesis consisting of a head and shaft component. Indications, operation and optimization of the tapered socket connection. Eur J Orthop Surg Traumatol 9, 13–18 (1999). https://doi.org/10.1007/BF02427763

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