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The CLS Stem

  • L. Spotorno
  • G. Grappiolo
  • A. Mumenthaler

Abstract

We have to face the fact that the prosthetic replacement of a hip joint using cement is still considered a standard procedure for the stem. Some authors even hold the opinion — whether right or wrong - that this system is still unsurpassable. The tendency for human beings to search for improvements and innovations has induced numerous researchers to investigate the so called biological anchorage. We were and still are protagonists of this idea. The search for a cementless anchorage began in 1976. Around 2000 stems of various manufacture were implanted before the CLS stem, which is still in clinical service, began to be used in December 1983. It is obvious that the stability of a cemented system is assured by the extensive bone cement surface and, in particular, because the cement with its very fine proturbances can claw into the cancellous bone structures. It is thus self-evident that with an uncemented prosthesis the reverse of this phenomenon was considered as the primum movens. Consequently, it is a question of trying to promote the growth of new bone formations of the trabecular structure onto the rough or macrostructured surfaces of the implant. From the very beginning, the idea of the porous coating was a popular solution and it is still widely supported today [8].

Keywords

Acetabular Fracture Fibrous Membrane Polyethylene Insert Ball Head Lucent Line 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Blaha JD, Spotorno L, Romagnoli S (1991) CLS press-fit total hip arthroplasty, Techn Orthop 6 3: 80–86CrossRefGoogle Scholar
  2. 2.
    Bobyn JD, Mortimer ES, Glassman AH, Engh CA, Miller JE, Brooks CE (1992) Producing and avoiding stress shielding Clin Orthop 274: 79–96Google Scholar
  3. 3.
    Bombelli R, Santore R (1983) The morphology and classification of osteoarthritis: an anatomical and biomechanical perspective. J Rheumatol [supp] 9: 10Google Scholar
  4. 4.
    Buser D, Schenk RK, Steinemann S, Fiorellini JP, Fox CH, Stich H (1991) Influence of surface characteristics on bone integration of titanium implants. A histomorphometric study in miniature pigs. J Biomed Mater Res 25 (7). 889–902PubMedCrossRefGoogle Scholar
  5. 5.
    Christel PS (1992) Biocompatibility of surgical-grade dense polycrystalline alumina. Clin Orthop 282: 10PubMedGoogle Scholar
  6. 6.
    Door LD, Faugere MC, Mackel AM, Gruen TA, Bognar B, Malluche HH (1993) Structural and cellular assessment of bone quality of proximal femur. Bone 14: 231–242CrossRefGoogle Scholar
  7. 7.
    Eggli PS, Mulier W, Schenk RK (1988) Porous hydroxyapatite and tricalcium phosphate cylinders with two different pore size ranges implanted in the cancellous bone of rabbits. A comparative histomorphometric and histologic study of bony ingrowth and implant substitution. Clin Orthop 232: 127–38Google Scholar
  8. 8.
    Engh CA, Bobyn JD, Glassmann AH (1987) Porous-coated hip replacement. J Bone Joint Surg [Br] 69: 45–55Google Scholar
  9. 9.
    Engh CA, McGovern TF, Bobyn JD, Harris WH (1992) Quantitative evaluation of peri- prosthetic bone - remodeling after cementless total hip arthroplasty. J Bone Joint Surg [Am] 74: 1009–1020Google Scholar
  10. 10.
    Gruen TA (1987) Radiographic criteria for the clinical performance of uncemented total joint replacements. In: Lemous JE (ed) Quantitative characterization and performance of porous implants for hard tissue application. ASTM STP 953. American Society for Testing and Materials, Philadelphia, pp 207–218CrossRefGoogle Scholar
  11. 11.
    Harris HW (1969) Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. J Bone Joint Surg [Am] 51: 737–755Google Scholar
  12. 12.
    Haynes DR, Rogers SD, Hay S, Pearcy MJ, Howie DW (1993) The difference in toxicity and release of bone resorbing mediators induced by titanium and cobalt–chromium–alloy wear particles. J Bone Joint Surg [Am] 6: 825–834Google Scholar
  13. 13.
    Hodge WA, Carlson KL, Rijan RS, Brugess RG, Riley PO, Harris WH, Mann RW (1989) Contact pressures from an instrumented hip endoprosthesis. J Bone Joint Surg [Am] 71 9: 1378–1386Google Scholar
  14. 14.
    Huggler AH, Schreiber A, Dietschi C, Jacob H (1974) Experimentelle Untersuchungen iiber das Deformationsverhalten des Hiiftazetabulums unter Belastung. Z Orthop 112– 144Google Scholar
  15. 15.
    Hunt JA, Remes A, Williams DF (1992) Stimulation of neutrophil movement by metal ions. J Biomed Mater Res 26 6: 819–828PubMedCrossRefGoogle Scholar
  16. 16.
    Jacobs JJ, Skipor AK, Black J, Urban RM, Galante JO (1992) Release and excretion of metal in patients who have a total hip-replacement component made of titanium-base alloy. J Bone Joint Surg [Am] 73 10: 1431–1432Google Scholar
  17. 17.
    Kilgus DJ, Shimaoka EE, Tipton JS, Eberle RW (1993) Dual-energy X-ray absorptiometry measurement of bone mineral density around porous-coated cementless femoral implants. J Bone Joint Surg [Br] 75: 279–287Google Scholar
  18. 18.
    Linder L (1989) Osseointegration of metallic implants. I. Light microscopy in the rabbit. Acta Orthop Scand 60 2: 129–134PubMedCrossRefGoogle Scholar
  19. 19.
    Lord G, Bancel P (1983) The madreporic cementless total hip arthroplasty Clin Orthop 176: 67–76Google Scholar
  20. 20.
    Marchant RE, Anderson JM, Dillingham EO (1986) In vivo biocompatibility studies. VII. Inflammatory response to polyethylene and to a cytotoxic polyvinylchloride. J Biomed Mater Res 20 1: 37–50PubMedCrossRefGoogle Scholar
  21. 21.
    McCarthy CK, Steinberg GG, Agren M, Leahey D, Wyman E, Baran DT (1991) Quanti-fying bone loss from the proximal femur after total hip arthroplasty. J Bone Joint Surg [Br] 73: 774–778Google Scholar
  22. 22.
    Morscher EW (1992) Current status of acetabular fixation in primary total hip arthroplasty. Clin Orthop 274: 172–193PubMedGoogle Scholar
  23. 23.
    Pauwels F (1976) Biomechanics of the normal and diseased hip. Theoretical foundation, technique and results of treatment. Springer, Berlin Heidelberg New YorkGoogle Scholar
  24. 24.
    Ganz R, Perren SM, Rueter A (1975) Mechanische Induktion der Knochenresorption. Fortschr. Kiefer Gesichtschir 48–48Google Scholar
  25. 25.
    Poss R, Walker P, Spector M, Reilly DT, Robertson DD, Sledge CB (1988) Strategies for improving fixation of femoral components in total hip arthroplasty. Clin Orthop 235: 181–194PubMedGoogle Scholar
  26. 26.
    Johnston RC, Brand RA, Crowninshield RD (1979) Reconstruction of the hip. A mathematical approach to determine optimum geometric relationship. J Bone Joint Surg [Am] 61 5: 639–652Google Scholar
  27. 27.
    Santavirta S, Konttinen YT, Bergroth V, Gromblad M (1991) Lack of immune response to methyl methacrylate in lymphocyte cultures. Acta Orthop Scand 62 1: 29–32PubMedCrossRefGoogle Scholar
  28. 28.
    Santavirta S, Nordstrom D, Ylinen P, Konttinen YT, Silvennoinen T, Rokkanen P (1991) Biocompatibility of hydroxyapatite–coated hip prostheses. Arch Orthop Trauma Surg 110 6: 288–292PubMedCrossRefGoogle Scholar
  29. 29.
    Santavirta S, Gristina A, Konttinen YT (1992) Cemented versus cementless hip arthroplasty. A review of prosthetic biocompatibility. Acta Orthop Scand 63 2: 225–232PubMedCrossRefGoogle Scholar
  30. 30.
    Sarmiento A, Gruen TA (1985) Roentgenographic analysis of 323 STH total hip prostheses (a low modulus titanium alloy femoral component). A two to six year follow up. J Bone Joint Surg [Am] 67 1: 48–56Google Scholar
  31. 31.
    Semlitsch M (1989) Twenty years of Sulzer experience with artificial hip joint materials. Proc Inst Mech Eng 203 3: 159–165Google Scholar
  32. 32.
    Spotorno L, Schenk RK, Dietschi C, Romagnoli S, Mumenthaler A (1987) Unsere Erfah- rungen mit nicht-zementierten Prothesen. Orthopade 16: 225–238PubMedGoogle Scholar
  33. 33.
    Spotorno L, Romagnoli S, Ivaldo N (1990) The Cementless CLS stem. In: Kusswetter W (ed) Noncemented total hip replacement. International Symposium Tubingen. 198–212Google Scholar
  34. 34.
    Spotorno L, Romagnoli S, Ivaldo N, Grappiolo G, Bibbiani E (1992) La crescita ossea nella protesi non cementata. Atti I Congresso Nazionale A.I.S.O., 79–82, Ott. 1992Google Scholar
  35. 35.
    Spotorno L, Morasso V, Romagnoli S, Ivaldo N, Grappiolo G, Bibiani E, Blaha DJ, Gruen TA (1993) The CLS system theoretical concept and results. Acta Orthop Belg 59 [Suppl]: 144–148PubMedGoogle Scholar
  36. 36.
    Van Syckle PB, Walker PS (1980) Parametric analysis of design for acetabular components of surface replacement hip devices. Trans Orthop Res Soc 5: 292Google Scholar
  37. 37.
    Vasu R, Carter DR, Harris WH (1982) Stress distributions in the acetabular region-i. before and the after total joint replacement. Joint Biomech 15: 155–164CrossRefGoogle Scholar
  38. 38.
    Weinans H, Huiskes R, Grootenboer HJ (1990) Trends of mechanical consequences and modeling of a fibrous membrane around femoral hip prostheses. J Biomech 23 10: 991– 1000Google Scholar
  39. 39.
    Zweymüller KA, Lintner FK, Semlitsch MF (1988) Biologic fixation of a press-fit titanium hip joint endoprosthesis. Clin Orthop 235: 195–206PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1995

Authors and Affiliations

  • L. Spotorno
  • G. Grappiolo
  • A. Mumenthaler

There are no affiliations available

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