Zimmer hip replacement

About the manufacturer

Previously, these products were produced by the Swedes under the trademark Sulzer Calciteck. However, since 2003, the production of Zimmer implants has been owned by an American company.

But the production of dental structures is not the only advantage of the brand. Instruments are also produced for the neurosurgical industry, traumatology and other segments of medicine.

The company has established itself as a manufacturer of high-quality, reliable products. It was Zimmer who was the creator of an innovative prosthetic system, creating implants with a trabecular surface.

Initially, parts were created for orthopedics, especially hip reconstruction. After the successful implementation of the system in traumatology, a dental implant with identical data for fastening was developed.

Design Features

The company is the only one in the world that produces implants from a unique material – tantan.

The material has a number of undoubted advantages relative to traditional titanium:

• the quality of biocompatibility is one step higher;
• completely hypoallergenic;
• corrosion is absolutely excluded;
• installation takes place without complications, the product takes root 100%;
• a structure due to which bone tissue grows surprisingly quickly.

Another feature of Zimmer dental implants is their spongy surface. Bone tissue grows into a real porous structure and forms a single mechanism. Thanks to this technology, the risk of foreign body rejection is zero.

Attention! The company’s systems also have exceptional quality: they hold tightly, eliminating the possibility of unwinding. This is achieved through an innovative fastening method using small teeth on the upper end of the product.

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Dental implantation with ZIMMER trabecular implants

Zimmer trabecular implants are a new unique technology; today it has no analogues in the world.

As you know, the American company Zimmer has been specializing in the production of joint implants for many years. And in this “role” the company is known by many orthopedic surgeons from all developed countries. To ensure that the fixation of the hip implant is reliable even in the most difficult cases (for example, bone fracture), the company’s specialists have created special trabecular implants.

Trabecular means divided into cells by trabeculae, that is, thick connective tissue bridges. Simply put, they have a spongy structure.

After a huge number of successful operations, the technology was used in dental implants and was recognized as a breakthrough in the field of dental prosthetics.

What are the main features of Zimmer implants?

Firstly, this is the material itself. Zimmer implants are the only ones that are made of tantalum, which has a number of advantages over conventional titanium:

• higher level of biocompatibility;
• absolute non-allergenic;
• corrosion resistance;
• 100% survival rate;
• ideal integration into bone tissue “without consequences”;
• active work at the molecular level: tantalum forms a structure that allows bone tissue and blood vessels to grow as quickly as possible.

Secondly, it has a spongy (porous) structure. Porous implants copy the structural structure of the jawbone and quickly fuse with the bone because the body does not try to reject them as a foreign element.

Video – The Zimmer Trabecular Metal Dental Implant

It should be noted that in this case we mean the spongy structure of the entire implant, not just the outer surface. Some time after implantation, the bone begins to grow (literally) through the implant, which gradually becomes an integral part of the jaw.

Also, the undeniable advantages of Zimmer implants include

1. Elimination of untwisting under chewing load: an innovative connection method is used, when teeth are located at the outer end of the implant, forming, together with the special shape of the surface, an extremely reliable connection
2. Excellent primary and secondary fixation
3. A very wide range of abutments with the possibility of selection for any patient: different sizes, shapes and inclinations

Indications and contraindications

What Zimmer differentiates is that they fit where other implants fail. Thus, there is a wide range of indications for implantation:

• with minimal bone volume;
• with bruxism, these are the only systems that provide such an opportunity;
• to minimize the healing time, the prosthesis can be fixed after 2.5 months;
• in case of pathologies and other exceptional cases;
• If you previously had a bad experience and the engraftment failed, this is not possible with implants from Zimmer.

There are no contraindications to implantation of products of this particular brand. Relative prohibitions with an individual approach are completely eliminated .

However, it is worth noting that there are absolute prohibitions on the installation of orthopedic structures in general:

• diabetes mellitus 1 degree;
• autoimmune diseases;
• endocrine problems with the thyroid gland;
• age of the patient (individual condition is taken into account).

Clinical benefits of Zimmer prostheses

The use of innovative developments makes it possible to create structures with excellent compatibility with living tissues and the fastest possible engraftment.

In addition, prostheses differ:

• Possibility of independent adjustment of limb length, inclination angle and offset. This allows you to optimize the kinematics and functionality of the joint.
• Reduced geometry and a wide range of modular necks for effective impact prevention and increased range of motion. This significantly reduces the risk of dislocation and slows down the wear of the implant.
• A wide range of head centers, which makes it possible to match the anatomical features of patients, taking into account their gender and anthropometric characteristics, thereby preventing the need for deep osteotomy.
• Flat shape, which facilitates the introduction of femoral components and minimizes trauma to soft tissues.

The unique Kinectiv technology is a system that allows the surgeon to completely recreate the anatomy of a joint during surgery through independent control of limb length, offset and inclination. Now the doctor does not need to grind the femur to fit the implant.

The lineup

The company's dental products are divided into three main types: standard, thin and mini implants. The former are used in standard cases that do not have exceptional structural features.

The latter are prescribed when there is very thin bone tissue. The internal part of such rods is narrowed and allows you to easily install the base without the risk of transformation.

Mini implants are used for a one-step procedure. The operation is carried out immediately after the removal of your own tooth, which allows you to reduce drilling or completely eliminate it. A characteristic feature is the root of the structure, fused with the abutment.

Attention! You can only find out which implant is suitable in a particular case by consulting a specialist. Often in expensive private clinics, where the patient agrees to install the expensive Zimmer system, the consultation is free.

Installation sequence

After the consultation, the dentist reports on the installation progress and its sequence. The operation is performed only after the preparatory part and complete elimination of all contraindications.

The time required to secure the implant is from 30 to 50 minutes, depending on the specific case. Implantation can take place either under general anesthesia or local anesthesia.

Tolerable pain after fixing the structure is quite normal, since surgical intervention took place in the bony part of the jaw.

After a few days or a week, the discomfort will disappear. However, if the pain symptoms do not go away on the 10th day, it is imperative to consult the doctor who performed the installation.

Preparation

Preparatory procedures include:

• identifying contraindications through conversation with the patient;
• the general condition of the oral cavity and the condition of the teeth in the immediate vicinity of the necessary are studied;
• An X-ray or computed tomography scan of the jaw is required to determine the density and thickness of the tissue for implantation;
• It is imperative to treat other unhealthy teeth and gums before surgery to avoid possible complications.

Also, a week before the implantation procedure, it is necessary to maintain complete oral hygiene. In addition to standard brushing of teeth, it is recommended to rinse with special antiseptic solutions.

Elimination of relative contraindications

Elimination of relative prohibitions on the installation of structures is carried out solely on the basis of the individual characteristics of the organism.

Zimmer implants are universal and do not have their own contraindications, but common problems must be eliminated before surgery.

For example, gum inflammation, herpes and other changes in the oral cavity are considered a minor obstacle. However, before the operation, you must undergo a course of treatment and completely get rid of them. To do this, the dentist himself prescribes treatment or sends you to another more competent doctor.

Diseases such as caries, periodontitis, periodontitis and periodontal disease must be eliminated. Also, when replacing old structures with new ones, it is necessary to thoroughly study the compatibility of materials in order to avoid corrosion.

Implantation surgery

The operation to install one implant takes about 10 minutes. The rest of the time is preparatory work and a short break after.

A classic operation without complications and bone grafting is performed according to the following scheme:

• the gums and periosteum are retracted to expose the bone;
• a bed for the structure is formed in the jaw in the right place using a special machine;
• the implant is inserted into the bone and securely fixed;
• then the gums return to their normal state; if necessary, the soft tissues are cut and stitched back together at the end of the operation.

Interesting! To prevent the bone tissue from overheating due to the speed of drilling, the machine is equipped with a system with a special irrigation liquid. Therefore, the implantation takes place with an assistant to remove excess solution that obscures the view.

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Recovery period

During the rehabilitation period, maximum attention is paid to oral hygiene. You should always brush your teeth on time. To do this, it is recommended to use medium-hard brushes. Antiseptic rinsing solutions should not be neglected.

Food during recovery should certainly be soft. Fatty, sour and spicy foods are excluded - foods can serve as a catalyst for the development of infections, which will lead to complications. It is also recommended to avoid very hot or cold drinks, coffee and soda.

Undoubtedly, you need to take antimicrobial drugs, which are necessarily prescribed by your doctor. Often, for the first time after the procedure, it is recommended to treat the gums with special ointments for speedy healing.

Prosthetics

In the best case, prosthetics are performed 2 months after installing the implant on the lower jaw, and after 4-6 months on the upper jaw . These deadlines are maintained to minimize the risk of rejection.

There are methods of instantaneous loading (everything is fixed at once). And in three days you can get a finished prosthesis, but in this case the possibility of infection or further rejection increases several times.

The installation of a crown can be either permanent or conditionally removable prosthetics. One differs from the other mainly in the preparation of implants and teeth located nearby. The second method is used only if the patient has complete absence of teeth.

Important! If the implant “scrolls” before or during prosthetic surgery, it is entirely the dentist’s fault. You should not listen to explanations about “organism factors.”

In private clinics, a similar situation is immediately specified in the contract, and most often the clinic performs a repeat operation at its own expense or returns the money.

The video shows the protocol for installing Zimmer implants.

Knee replacement with Zimmer implants

In recent years, the Russian joint endoprosthesis market has seen both a significant increase in the choice of implants from leading Western and domestic companies and a significant increase in product quality (3, 4, 5, 7). Most of them comply with European and international standards ISO and others (2, 6). The implants used for endoprosthetics are made of high-quality modern materials, but they differ in design features, design, and application technology. (4, 5) Surgeons often have problems with the optimal choice of implant for a particular patient, taking into account the individual characteristics of the pathology and anatomical situation.

In this regard, we want to share the results obtained in a period of 1 to 10 years during primary hip replacement with Trilogy, ZCA, VerSys ET, Alloclassic, CPT designs from Zimmer (USA).

Purpose of the study.

To study the technical characteristics of hip joint implants Trilogy, ZCA, VerSys ET, Alloclassic, CPT from Zimmer (USA), the immediate and medium-term results of their use.

Materials and methods.

Under our supervision there were 503 patients with various pathologies of the hip joint, who underwent 555 total hip replacement operations. 52 patients were operated on on both sides. There were 219 men and 284 women treated. The age of the patients ranged from 18 to 82 years. Of these, 24 are under 25 years of age; from 26 to 40 years old – 117; from 41 to 60 years 232; and over 60 years old - 130 people. Cementless fixation of implants was used in 196 cases. Including the combination Trilogy + VerSys ET in 156 operations, and Trilogy + Alloclassic in 40 operations. Reverse hybrid fixation (ZCA + VerSys ET) was used in 297 patients and fully cemented (ZCA + CPT) in 62 cases. The choice of implant fixation method depended on the patient’s age, the severity of osteoporosis, changes in the acetabulum and proximal femur, as well as a number of other factors. Indications for surgery and their number are presented in table. 1.

Table 1 Nosological forms and number of operations performed

From the analysis of table. Table 1 shows that patients with injuries and consequences of injuries to the proximal femur underwent 221 primary hip replacement operations, which amounted to 39.8% of all operations. For diseases of the hip joint, 334 primary endoprosthetics were performed - 50.2%, respectively.

Technical characteristics of Zimmer hip joint endoprostheses.

VerSys ET cementless stem. Flat wedge-shaped leg with proximal fixation system. (Fig. 1) Material - Ti-6Al-4V alloy. Manufactured by isothermal forging from a titanium alloy that does not contain the allergenic vanadium and complies with the international standard ISO-5832-2. The stem provides both a standard (neck-shaft angle 145°) and lateralized (neck-shaft angle 135°) version. Structurally, the leg has a three-dimensional wedge-shaped shape with pointed ribs (2.5 mm each) in the proximal part, increasing its anti-rotation stability and increasing the area of ​​osseointegration. There are four ribs in the anterior, posterior and lateral regions, their height increases from the medial part of the implant to the lateral. With increasing standard size, the length of the neck of the endoprosthesis does not increase. Primary fixation of the stem occurs using the press-fit method, mainly in the proximal part of the femur, secondary fixation occurs due to osseointegration. VerSys ET legs are available in 7 standard sizes with increasing offset and leg length from size to size (110, 120, 130, 140, 150, 170 and 190 mm). The surface of the leg has a rough structure, without a collar and a Eurocone - 12/14.

Alloclassic cementless stem. Flat, tetrahedral-shaped leg with a proximal fixation system. (Fig. 2) The special design of the Alloclassic leg, its fixation in the bone by means of four edges, ensures rotational stability and less disrupts endosteal blood flow than when implanting legs that completely serve as the bone marrow canal. This allows stable implantation of a cementless stem even in porous bone. The leg is made by isothermal forging, from titanium alloy Ti6AL7Nb, with titanium plasma coating, high porosity up to 200 microns and complies with the international standard ISO-5832-2. The stem has a self-centering shape with a rough surface, with a cone of 12/14 mm, and 12 standard sizes from 01 to 10 with a neck-shaft angle of 131°. In the proximal part of the stalk in the lateral zone there are four openings. As the standard size increases, the length of the neck of the endoprosthesis also increases. The implant is fixed by first “wedging” the cone of the endoprosthesis stem into the medullary canal of the femur with the edges of the endoprosthesis supported on the cortical layer of the proximal femur.

Cement stem CPT Wedge-shaped, flat stem in three planes without a collar (Fig. 3). Has 6 standard sizes. Material - stainless steel or cobalt - chrome (ISO 5832-01..1997). The surface of the leg is smooth and polished. The leg has 2 offsets - 42 and 37.5 mm. The neck-shaft angle is 135?. Neck cone type - 6?. The stem is equipped with a distal centralizer made of PMMA. As the size of the leg increases, its length remains unchanged and is 130 mm. There are 3 standard sizes of heads available for the SRT stem.

ZCA cement cup The acetabular component is made of high molecular weight polyethylene 6 mm thick with a radiopaque ring along the periphery and protrusions along the outer surface to create an even layer of the cement mantle (Fig. 4). The upper edge of the cup has a 3 mm rim, which ensures uniform pressure of the cement. The cup has a standard and anti-luxation version, 8 standard sizes, as well as three 3 mm cement mantle thickness limiters.

Trilogy Cementless Cup The acetabular component (cup and liner) consists of a metal cup and liner made of high molecular weight polyethylene UHMWPE (ISO 5834-2.. 1998). The cup is made of Ti-6Al-4V alloy (ISO 5832-3..1996), has a hemispherical shape and is coated with titanium wire for bone ingrowth. The range of cup sizes is from 44mm to 66mm, in addition, there are mini (from 36mm) and maxi (up to 80mm) sizes, but they rarely enter the Russian market. The original locking mechanism of the cup is made in the form of a sliding ring, allowing intraoperative replacement of the liner without damaging it. The cup fixation method is press-fit with the possibility of inserting at least three derotational screws. The liner made of high molecular weight polyethylene has a centralizing post and scalloped edges to ensure derotation, 2 types: with 0° and 10° elevation.

The head is made of co-chromium alloy in accordance with the ISO 5832-6..1996 standard, 4 standard sizes in diameter: 22, 26, 28 and 32 mm and at least 5 standard sizes in neck length - 3.5 mm; + 0 mm; + 3.5 mm; + 7 mm; + 10.5 mm with neck taper - 12/14 mm.

Clinical analysis.

Data from a clinical and radiological examination of 261 patients (293 endoprosthetics) operated on from 1 year to 10 years were analyzed. 11.6% of patients were observed for up to 1 year, 17.4% for 1 to 3 years, 57.7% for 3 to 8 years, and 13.3% for more than 8 years. The analyzed group included 174 women and 87 men. 35 patients were operated on for idiopathic coxarthrosis, and 52 patients were operated on for dysplastic coxarthrosis. There were 54 people with aseptic necrosis of the femoral head, 49 people with fractures of the head and neck of the femur, and 71 with pseudarthrosis and nonunion of the femoral neck. Cementless implant fixation (Trilogy + VerSys ET) was used in 79 cases, reverse hybrid (ZCA + VerSys ET) - in 179 patients and completely cemented (ZCA + CPT) in 35 operations. Clinical assessment of treatment results was carried out using the Harris Hip Evaluation Scale (Harris: Evaluation System of the Hip). This assessment method allows one to evaluate outcomes after hip arthroplasty (Harris WH, 1969). The Harris system involves assessing 4 categories: pain, function, deformity, range of motion. For each category a certain number of points is scored. The maximum score is 100. A score of 100 to 90 is assessed as excellent joint function, 89 to 80 as good, 79 to 70 as satisfactory, and less than 70 as unsatisfactory (8). We used radiographic assessment of treatment results according to Ewald based on the analysis of radiographs in two projections, as modified by O.A. Kudinova, V.I. Nuzhdina et al. (1). The authors distinguish four degrees of stability of fixation: I degree - no migration of implant components, no zones of osteolysis - stable position of the implant with high-quality cement fixation or osseointegration in the case of using a cementless technique; II degree - absence of migration of components, non-progressive nature of clearing lines with their total width in zones not exceeding 5 mm - stable fibrous fixation; III degree - absence of migration of components or their displacement is no more than 2°, the total width of osteolysis in zones is 5-10 mm - a state of threatening instability; IV degree - implant migration is more than 2°, the total width of osteolysis in zones is more than 10 mm - obvious instability.

Research results.

Postoperative complications included complications of a purulent-inflammatory nature, postoperative dislocations of the head of the endoprosthesis, periprosthetic fractures, neuropathies, and thromboembolic complications (Table 2).

Table 2 Postoperative complications after primary hip replacement

Analyzing the nature of complications after primary endoprosthetics with Zimmer implants, it can be noted: the most common were purulent-inflammatory complications - 1.4% and dislocations of the endoprosthesis head - 2.2%. All complications of a purulent-inflammatory nature were noted in the period from 6 months. up to 2 years after surgery and occurred in patients with a complicated medical history (diabetes mellitus, systemic diseases, previous hip surgery). Dislocations of the head of the endoprosthesis are associated with impaired motor behavior by patients in the early postoperative period; they were eliminated conservatively and did not affect the outcome of treatment. A periprosthetic fracture occurred in one patient, which required repeated osteosynthesis surgery. Other complications were noted in isolated cases and were treated conservatively with a positive outcome.

The frequency of development of aseptic instability of Zimmer endoprostheses was analyzed separately (Table 3). This table includes only cases of severe instability - grades III - IV (1), for which revision endoprosthetics were performed.

Table 3 Aseptic instability of components after primary hip replacement

From the analysis of Table 3, it can be seen that instability of the acetabular component was most often noted, and in all cases when using a ZCA cement cup. Instability of the femoral component (Versys stem) occurred in 4 patients at 6, 8 and 9 years after surgery. It should be noted that in the early period after hip replacement (from 1 to 3 years), aseptic instability of the acetabular component was noted only in 2 cases (0.7%). During the same period, we did not observe any patients with instability of the femoral component. Of the 9 patients who underwent revision arthroplasty due to aseptic instability of the endoprosthesis components, four suffered from rheumatoid arthritis, and another two underwent primary arthroplasty for post-traumatic coxarthrosis with defects of the acetabulum.

Clinical assessment of treatment results was carried out using the Harris hip joint rating scale (Table 4).

Table 4 Results of treatment of patients after primary hip arthroplasty according to Harris (absolute numbers/%)

Analyzing the clinical and functional results of treatment of patients with pathology of the hip joint in a period of 1 to 10 years who underwent primary endoprosthetics, it was found that good and excellent results within the above periods were obtained in 87.0% of patients, satisfactory in 8.1% and unsatisfactory results occurred in 4.9% of cases. In the treatment of idiopathic coxarthrosis, excellent, good and satisfactory results were obtained in 97.2% of patients; dysplastic coxarthrosis in 94.2% of patients; aseptic necrosis of the femoral head in 98.2%; for fractures of the head and neck of the femur in 91.9% and for pseudarthrosis and nonunion of the femoral neck in 94.4%.

Discussion.

An analysis of the results of primary total hip arthroplasty was performed in 261 patients (293 operations) using endoprostheses from Zimmer (USA). To assess the statistical reliability of the obtained data, methodological approaches based on the evaluation of the ?2 criterion were used, and the probability of error of the Fisher test was calculated, which was significantly less than the specified accepted confidence probability. Clinical and functional results of treatment of patients with pathology of the hip joint in periods from 1 to 10 years, who underwent primary endoprosthetics, showed that significant differences in groups with different nosologies are quite insignificant and the differences between them are unreliable. Thus, an excellent result in the above periods was observed in 68.2% of patients, a good result occurred in 18.8% of patients, satisfactory in 8.1% of patients and unsatisfactory in 4.9%, respectively. The incidence of aseptic instability of Zimmer endoprostheses occurred in 3.1% of operated patients (9 patients). Of these, instability of the acetabular component (ZCA cement cups) was noted in 5 patients, femoral (VerSys ET) - in 2 cases, and total instability - also in 2 cases (ZCA + VerSys ET).

Analyzing the nature of complications after primary endoprosthetics with Zimmer implants, it can be noted that the most common were purulent-inflammatory complications - 1.4% and dislocations of the endoprosthesis head - 2.2%. All complications of a purulent-inflammatory nature were noted in the period from 6 months. up to 1.5 years after surgery and occurred in patients with a complicated medical history (diabetes mellitus, systemic diseases, previous hip surgery). Dislocations of the head of the endoprosthesis are associated with impaired motor behavior by patients in the early postoperative period; they were eliminated conservatively and did not affect the outcome of treatment. A periprosthetic fracture occurred in one patient, which required repeated osteosynthesis surgery. Other complications were noted in isolated cases and were treated conservatively with a positive outcome.

Clinical example.

Patient S., 45 years old (IB No. 4955), was admitted to the orthopedic department of the SarOKB on 03/05/2006. Diagnosis: stage 2. dysplastic coxarthrosis grade 3, 2-sided adduction contracture with shortening of the left lower limb by 2 cm. Rheumatoid polyarthritis. But. On 03/09/2006 an operation was performed - total endoprosthesis of the left hip joint according to Zimmer with a hybrid endoprosthesis (ZCA + VerSys ET), and on 03/21/06 an operation was performed - total endoprosthesis of the right hip joint according to Zimmer with a hybrid endoprosthesis (ZCA + VerSys ET) (Fig. 5). The postoperative period proceeded smoothly. The patient became active on the 2nd day after each operation. Discharge on the 10th day after the 2nd operation. By this time, the patient was fully adapted to walking on crutches, including stairs. Homeostasis indicators at the time of discharge were quite satisfactory. Monitoring the patient for 4 years after surgery. Pain in the hip joints does not bother me, the function is quite satisfactory. The patient works as a local therapist, walks a lot, lives in rural areas, and is actively involved in farming. I am satisfied with the results of the operation. Harris score: 92 points.

Thus, based on the number of complications of various types in the early and mid-term postoperative periods, revision surgeries for severe aseptic instability of endoprosthetic components, and functional results of the operation, it is quite difficult to determine priorities in the use of certain implants in primary hip replacement. Of course, the amount of cement and hybrid fixation of endoprosthesis components should increase progressively with the age of patients, the degree of osteoporosis, and in some cases complex primary hip replacement. However, in many young patients, when using the ZCA cement cup for up to 10 years, good and excellent results were obtained on the Harris scale; no signs of instability (even in the initial stage) were noted. The subjective factor often plays an important role in choosing an implant, when the priority is not medical indications, but the financial capabilities of the patient or the medical institution where endoprosthetics is performed.

Conclusions:

1. Primary total hip replacement according to Zimmer, using Trilogy, Alloclassic, CPT, ZCA, VerSys ET implants is a high-tech operation that allows you to quickly obtain a positive and long-term effect in severe diseases and injuries of the hip joint.
2. Hip joint endoprostheses with cemented and cementless fixation from Zimmer are effective implants that allow endoprosthetics to be performed at a high level, including in complex clinical cases, and the number of complications and unsatisfactory results in both the immediate and long-term periods does not differ from similar indicators when using endoprostheses from other leading global manufacturers.

Price

The cost of Zimmer dental implants is not even in the middle segment of this market. But the high price for the product has several influencing factors:

• the cost of the material itself;
• installation specialists are trained only in the USA;
• The production of prostheses is almost individual.

Due to the fact that products are ordered abroad, their cost in rubles depends on the current exchange rate. However, a complete installation from A to Z is estimated at 100 thousand rubles and more.