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Marin E. Forged to heal: The role of metallic cellular solids in bone tissue engineering. Mater Today Bio 2023; 23:100777. [PMID: 37727867 PMCID: PMC10506110 DOI: 10.1016/j.mtbio.2023.100777] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/21/2023] [Accepted: 08/23/2023] [Indexed: 09/21/2023] Open
Abstract
Metallic cellular solids, made of biocompatible alloys like titanium, stainless steel, or cobalt-chromium, have gained attention for their mechanical strength, reliability, and biocompatibility. These three-dimensional structures provide support and aid tissue regeneration in orthopedic implants, cardiovascular stents, and other tissue engineering cellular solids. The design and material chemistry of metallic cellular solids play crucial roles in their performance: factors such as porosity, pore size, and surface roughness influence nutrient transport, cell attachment, and mechanical stability, while their microstructure imparts strength, durability and flexibility. Various techniques, including additive manufacturing and conventional fabrication methods, are utilized for producing metallic biomedical cellular solids, each offering distinct advantages and drawbacks that must be considered for optimal design and manufacturing. The combination of mechanical properties and biocompatibility makes metallic cellular solids superior to their ceramic and polymeric counterparts in most load bearing applications, in particular under cyclic fatigue conditions, and more in general in application that require long term reliability. Although challenges remain, such as reducing the production times and the associated costs or increasing the array of available materials, metallic cellular solids showed excellent long-term reliability, with high survival rates even in long term follow-ups.
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Affiliation(s)
- Elia Marin
- Ceramic Physics Laboratory, Kyoto Institute of Technology, Sakyo-ku, Matsugasaki, 606-8585, Kyoto, Japan
- Department of Dental Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, 602-8566, Japan
- Department Polytechnic of Engineering and Architecture, University of Udine, 33100, Udine, Italy
- Biomedical Research Center, Kyoto Institute of Technology, Sakyo-ku, Matsugasaki, Kyoto, 606-8585, Japan
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Bellova P, Reich MC, Grothe T, Günther KP, Stiehler M, Goronzy J. Treatment of Severe Acetabular Defects With an Antiprotrusio Cage and Trabecular Metal Augments - Clinical and Radiographic Results After a Mean Follow-Up of 6.6 Years. J Arthroplasty 2023; 38:2415-2422. [PMID: 37271233 DOI: 10.1016/j.arth.2023.05.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 05/18/2023] [Accepted: 05/20/2023] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND Large acetabular bone defects present a serious challenge in revision total hip arthroplasty. The off-label use of antiprotrusio cages in combination with tantalum augments is a promising treatment option in these difficult situations. METHODS Between 2008 and 2013, 100 consecutive patients underwent acetabular cup revision with a cage-augment combination in Paprosky 2 and 3 defect types (including pelvic discontinuities). There were 59 patients available for follow-up. The primary endpoint was the explantation of the cage-and-augment construct. The secondary endpoint was acetabular cup revision for any reason. Also, radiographic and functional outcomes (Western Ontario and McMaster Universities Osteoarthritis Index, Harris Hip Score) were evaluated. Implant survival rates were determined using a Kaplan-Meier analysis. The significance level was set at P < .05. RESULTS Explantation-free survivorship of the "Cage-and-Augment" system was 91.9% after a mean follow-up of 6.2 years (range, 0 to 12.8). All 6 explantations were due to periprosthetic joint infection (PJI). The overall revision-free implant survival rate was 85.7%, including 6 additional liner revisions due to instability. In addition, 6 early PJI occurred, which were successfully treated with debridement, irrigation, and implant retention. We did observe one patient who had radiographic loosening of the construct without necessity for treatment. CONCLUSION The combination of an antiprotrusio cage with tantalum augments is a promising technique in treating large acetabular defects. A major risk of PJI and instability due to large bone and soft tissue defects needs special attention.
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Affiliation(s)
- Petri Bellova
- Center of Orthopaedics and Traumatology, University Hospital Carl Gustav Carus, Dresden, Germany
| | | | - Tim Grothe
- Center of Orthopaedics and Traumatology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Klaus-Peter Günther
- Center of Orthopaedics and Traumatology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Maik Stiehler
- Center of Orthopaedics and Traumatology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Jens Goronzy
- Center of Orthopaedics and Traumatology, University Hospital Carl Gustav Carus, Dresden, Germany
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On-Growth and In-Growth Osseointegration Enhancement in PM Porous Ti-Scaffolds by Two Different Bioactivation Strategies: Alkali Thermochemical Treatment and RGD Peptide Coating. Int J Mol Sci 2022; 23:ijms23031750. [PMID: 35163682 PMCID: PMC8835960 DOI: 10.3390/ijms23031750] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 01/25/2022] [Accepted: 01/30/2022] [Indexed: 02/01/2023] Open
Abstract
A lack of primary stability and osteointegration in metallic implants may result in implant loosening and failure. Adding porosity to metallic implants reduces the stress shielding effect and improves implant performance, allowing the surrounding bone tissue to grow into the scaffold. However, a bioactive surface is needed to stimulate implant osteointegration and improve mechanical stability. In this study, porous titanium implants were produced via powder sintering to create different porous diameters and open interconnectivity. Two strategies were used to generate a bioactive surface on the metallic foams: (1) an inorganic alkali thermochemical treatment, (2) grafting a cell adhesive tripeptide (RGD). RGD peptides exhibit an affinity for integrins expressed by osteoblasts, and have been reported to improve osteoblast adhesion, whereas the thermochemical treatment is known to improve titanium implant osseointegration upon implantation. Bioactivated scaffolds and control samples were implanted into the tibiae of rabbits to analyze the effect of these two strategies in vivo regarding bone tissue regeneration through interconnected porosity. Histomorphometric evaluation was performed at 4 and 12 weeks after implantation. Bone-to-implant contact (BIC) and bone in-growth and on-growth were evaluated in different regions of interest (ROIs) inside and outside the implant. The results of this study show that after a long-term postoperative period, the RGD-coated samples presented higher quantification values of quantified newly formed bone tissue in the implant's outer area. However, the total analyzed bone in-growth was observed to be slightly greater in the scaffolds treated with alkali thermochemical treatment. These results suggest that both strategies contribute to enhancing porous metallic implant stability and osteointegration, and a combination of both strategies might be worth pursuing.
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Fonseca Neto CEBRD, Lima MMS, Rabello BT, Sena LDS, Zacaron Júnior LC, Viana MT. Radiographic evaluation of 19 patients with Paprosky 3A and 3B submitted to acetabular review with trabecular metal wedge. Rev Bras Ortop 2018; 53:94-100. [PMID: 29367913 PMCID: PMC5771787 DOI: 10.1016/j.rboe.2017.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 01/24/2017] [Indexed: 11/26/2022] Open
Abstract
Objective This study is aimed at evaluating the fixation of trabecular metal wedges in patients who underwent revision of total hip arthroplasty with large acetabular bone defects. Methods The radiographs of 19 patients (21 hips), who underwent revision of total hip arthroplasty using trabecular metal wedges from September 2010 to December 2014 were evaluated. This study included only cases of Paprosky 3A and 3B. Preoperative and postoperative images were analyzed. Non-fixation of the implant was defined by the presence of angular variation of the component higher 10 degrees or displacement greater than 6 mm. Patients with follow-up times of less than 24 months or who did not attend the last two appointments were excluded from the study. Results The mean follow-up time was 39.4 months (25–61). Fixation was achieved in all cases despite its complexity. There was only one case of dislocation that was treated with open reduction. One case developed infection, and was surgically approached on two occasions, with extensive debridement and intravenous antibiotics following protocol, with good evolution. Conclusion The implanted trabecular metal wedges showed excellent results in the short- and medium-term and may represent another option in the reconstruction of large acetabular defects, sometimes replacing bone reconstruction that uses bone tissue banks or autologous graft.
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Avaliação radiográfica de 19 pacientes Paprosky 3 A e 3 B submetidos à revisão acetabular com cunha de metal trabeculado. Rev Bras Ortop 2018. [DOI: 10.1016/j.rbo.2017.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Clement RGE, Ray AG, MacDonald DJ, Wade FA, Burnett R, Moran M. Trabecular Metal Use in Paprosky Type 2 and 3 Acetabular Defects: 5-Year Follow-Up. J Arthroplasty 2016; 31:863-7. [PMID: 26711861 DOI: 10.1016/j.arth.2015.10.033] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 10/12/2015] [Accepted: 10/23/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The reconstructive challenge of achieving a stable acetabulum in revision total hip arthroplasties in the presence of major osteolytic lesions has led to debate about the most appropriate surgical strategy to minimize implant-related failures. Trabecular metal (TM) implants have become popular but ongoing surveillance of their performance is required. METHODS We reviewed the clinical and radiological outcome of a consecutive series of 52 patients (55 hips) who had undergone revision total hip arthroplasty for Paprosky type 2 or 3 acetabular defects with TM revision acetabular shells between 2002 and 2008. RESULTS Four implant failures occurred (2 infections and 2 dislocations). Eleven patients from this cohort died (representing 12 hips) before the 5-year follow-up period giving us a follow-up of 78.2%. Implant survival at 5 years was 92% (95% confidence interval: 80.2%-96.9%). There were no cases of radiological loosening. The mean Oxford hip score was 34 (range, 5-48) at a mean follow-up of 63 months (range, 34-105 months). CONCLUSIONS We conclude that the use of TM revision shells for complex acetabular reconstruction yields satisfactory results.
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Affiliation(s)
- Rhys G E Clement
- Department of Trauma and Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Andrew G Ray
- Department of Trauma and Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Deborah J MacDonald
- Department of Trauma and Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Frazer A Wade
- Department of Trauma and Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Richard Burnett
- Department of Trauma and Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Matthew Moran
- Department of Trauma and Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
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Daivajna S, Duncan C, Masri B, Garbuz D. Highly porous metal shells and augments in revision hip surgery: Big hopes for big holes. ACTA ACUST UNITED AC 2015. [DOI: 10.1053/j.sart.2015.09.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Callado VM, de Sandes Kimura O, de Carvalho Leal D, Teixeira de Sousa Filho PG, Cury Fernandes MB, Carvalho de Almendra Freitas EH. Evaluation of the fixation of the trabecular metal wedge in patients undergoing revision of total hip arthroplasty. Rev Bras Ortop 2014; 49:364-9. [PMID: 26229828 PMCID: PMC4511618 DOI: 10.1016/j.rboe.2014.04.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 07/30/2013] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE this study aimed to evaluate the fixation of the trabecular metal wedge in patients undergoing revision of total hip arthroplasty. METHODS twenty-three cases with minimum grading of Paprosky II-B that were operated between July 2008 and February 2013 were evaluated. These cases were evaluated based on radiographs before the operation, immediately after the operation and later on after the operation. Loss of fixation was defined as a change in the abduction angle of the component greater than 10° or any mobilization greater than 6 mm. RESULTS it was found that there was 100% fixation of the acetabula after a mean of 29.5 months. One case underwent removal of the implanted components due to infection. CONCLUSIONS there is still no consensus regarding the best option for reconstructing hips with bone loss. However, revision using a trabecular metal wedge has presented excellent short- and medium-term results. This qualifies it as an important tool for achieving a fixed and stable acetabular component.
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Avaliação da fixação da cunha de metal trabeculado em pacientes submetidos à revisão de artroplastia total de quadril. Rev Bras Ortop 2014. [DOI: 10.1016/j.rbo.2014.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Modulare Defektrekonstruktion beim Pfannenwechsel mit Abstützschale und metallischen Augmenten. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2014; 26:141-55. [DOI: 10.1007/s00064-013-0271-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 10/16/2013] [Accepted: 10/16/2013] [Indexed: 10/25/2022]
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Banerjee S, Issa K, Kapadia BH, Pivec R, Khanuja HS, Mont MA. Systematic review on outcomes of acetabular revisions with highly-porous metals. INTERNATIONAL ORTHOPAEDICS 2013; 38:689-702. [PMID: 24178061 DOI: 10.1007/s00264-013-2145-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 09/25/2013] [Indexed: 12/28/2022]
Abstract
PURPOSE The purpose of this study was to systematically review the literature and report the clinical and radiographic outcomes of highly-porous acetabular cups in revision settings. METHOD A literature search of four electronic databases of EMBASE, CINAHL-plus, PubMed, and SCOPUS yielded 25 studies reporting the outcomes of 2,083 revision procedures with highly-porous acetabular components. There was lack of high quality evidence (level I and level II studies) and only two studies with level III evidence, while the remainder were all level IV studies. In addition, a majority of the studies had small sample sizes and had short to mid-term follow-up. The mean age of the patients was 65 years (range, 58-72 years) and the mean follow-up was 3.6 years (range, two to six years). Outcomes evaluated were aseptic survivorship, Harris hip scores, migration rates, incidence of peri-acetabular radiolucencies and radiographic restoration of the hip centre. RESULTS The mean aseptic survivorship was 97.2% (range, 80-100%). The Harris hip scores improved from a mean pre-operative score of 42 points, (range, 29-75 points), to a mean postoperative score of 79 points (range, 69-94 points). The mean incidence of cup migration and prevalence of peri-acetabular radiolucencies was 2.4% (range, 0-8.8%) and 4.6% (range, 0-19%), respectively, at final follow-up. The vertical hip centre-of-rotation was restored significantly from a mean of 39.2 mm (range, 27.6-50 mm) pre-operatively, to a mean of 24.1 mm (range, 7.4-47 mm), postoperatively. CONCLUSION The short-term clinical and radiographic results of highly-porous metals in revision hip arthroplasty are excellent with a low rate of loosening in the presence of both major and minor bone loss.
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Affiliation(s)
- Samik Banerjee
- Department of Orthopaedic Surgery, Rubin Institute for Advanced Orthopaedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, MD, USA
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Abstract
BACKGROUND Smoking is considered a risk factor for surgical complications in total hip arthroplasty (THA) and has been linked to a higher rate of aseptic loosening in uncemented acetabular components. Acetabular reconstruction with newer ultraporous metals in both complex primary and revision THA has increased survivorship but it is unclear whether smoking affects survival of these implants. QUESTIONS/PURPOSES We reviewed our early experience with THA using ultraporous acetabular components to assess the incidence and etiology of early failure and examine if any preoperative variables, including smoking, related to failure. METHODS We used ultraporous acetabular components in 498 patients (534 hips), beginning with one case each in 1999 and 2004, 17 in 2005, and the majority from 2006 through March 2010. There were 159 complex primary and 375 revision cases. Of these patients, 17% were smokers (averaging 35 pack-years), 31% previous smokers (averaging 29 pack-years), 41% nonsmokers, and 1% unknown. Failure modes possibly related to smoking were infection, aseptic loosening, or periacetabular fracture and unrelated were dislocation and implant breakage. Minimum followup was 1 month (average, 32 months; range, 1-78 months). RESULTS There were 34 cup failures (6%): 17 infections, 14 aseptic loosening, and one each liner breakage, dislocation, and periacetabular fracture. The failure rate (uncontrolled for potentially confounding variables) was 10% in both current (9 of 89) and prior smokers (17 of 167) and 3% in nonsmokers 8 of 271). CONCLUSION With ultraporous metal technology in complex primary and revision THA, smoking, both past and current, may be a risk factor for early failure. LEVEL OF EVIDENCE Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Sternheim A, Abolghasemian M, Safir OA, Backstein D, Gross AE, Kuzyk PR. A long-term survivorship comparison between cemented and uncemented cups with shelf grafts in revision total hip arthroplasty after dysplasia. J Arthroplasty 2013; 28:303-8. [PMID: 22854344 DOI: 10.1016/j.arth.2012.06.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Accepted: 06/07/2012] [Indexed: 02/01/2023] Open
Abstract
Long-term outcomes of cemented and uncemented cups were compared in patients with hip dysplasia who had undergone revision hip arthroplasty. Patients had uncontained superolateral acetabular defects reconstructed with a structural allograft. This retrospective study compared 18 cemented acetabular cups to 27 uncemented acetabular cups. Average follow-up was 216 months (range, 96-312). Nineteen acetabular cups (42%) failed due to loosening and were revised. The 10- and 20-year cup survival was 88% and 76% in the uncemented group and 67% and 36% in the cemented group. Log rank analysis showed this difference to be significant (P = .0077). Uncemented acetabular cups performed significantly better than cemented cups.
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Affiliation(s)
- Amir Sternheim
- Division of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada.
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