[Is the implantation of titanium stems in hip prostheses really obsolete?].
OBJECTIVE
Due to several bad results of studies, titanium is no longer used as an implant material in cemented total hip arthroplasty. This study attempts figure out by means of a meta-analysis if the material titanium itself was responsible for the bad results of some studies or if specific implant characteristics contributed to implant failure, independent of titanium.


METHODS
Studies between 1960 and July 2002 were analysed concerning failure rates of cemented titanium total hip arthroplasties regarding their specific implant characteristics.


RESULTS
Specific implant characteristics such as roughness of the surface and geometrical features led to significantly different failure rates. Stems of titanium with a dull surface and a wide proximal geometry could achieve such good results as those of the cobalt-chromium stems published in the study results of Malchau.


CONCLUSIONS
Titanium is justified as a cementable material in total hip arthroplasty. By respecting specific implant characteristics, very good failure rates can be achieved. The high failure rates, published in several studies, are based upon implant characteristics which are not suitable for cementing techniques and not upon the implant material titanium itself.
Orthopädische Abteilung Universitätsklinik Aachen. mneuss@ukaachen.de
M
M
Neuss
S
S
Clemens
R
R
Marx
M
M
Weber
M
M
Weisskopf
D C
DC
Wirtz
D019644:Arthroplasty, Replacement, Hip / Q000295:instrumentation* / Q000706:statistics & numerical data*; D002484:Cementation / Q000706:statistics & numerical data*; D019544:Equipment Failure Analysis / Q000379:methods*; D006622:Hip Prosthesis / Q000145:classification* / Q000706:statistics & numerical data*; D006801:Humans; D008422:Materials Testing; D011475:Prosthesis Failure; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D014025:Titanium
D014025:Titanium