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Foxall-Smith M, Wyatt MC, Frampton C, Kieser D, Hooper G. The 45-year evolution of the Mathys RM monoblock cups: have the paradigm shifts been worthwhile? Hip Int 2023; 33:193-202. [PMID: 35438033 DOI: 10.1177/11207000211067507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The Robert Mathys (RM) monoblock uncemented cup is a design less commonly used in primary total hip replacement. It's purported advantages over modular cemented cups are: (1) its modulus of elasticity approximating bone, thus mimicking load transmission and the biomechanical behaviour of the cup to better match stresses on the acetabulum, leading to bone-preservation; and (2) as a 1-piece cup there is absence of a mobile interface between a liner and shell, preventing backside wear. Since its inception in 1983 there have been 3 major design changes: the RM Classic, the RM Pressfit, and the RM Vitamys with the most modern polyethylene (vitamin E). METHODS In a retrospective cohort study of the New Zealand Joint Registry, all designs of RM acetabular cup were reviewed. Data were included from1998 to 2018. All-cause revision rates, reasons for revision and the Oxford Hip Score (OHS) were assessed. RESULTS In total 13,272 acetabular cups were included. The all-cause revision rates did not differ between the designs. Revision rates for aseptic loosening in the RM Vitamys were lower, but the follow-up was shorter and more larger heads were used. There was no difference in the OHS. CONCLUSION All implant designs were safe. The use of larger heads led to a decrease in revisions due to dislocation. It has to be waited out whether the RM Vitamys performs superior in the long-term due to the highly cross-linked polyethylene.
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Affiliation(s)
| | - Michael C Wyatt
- Department of Trauma and Orthopaedic Surgery, Palmerston North Hospital, Massey University, Manawatu, New Zealand
| | - Christopher Frampton
- Department of Surgery and Musculoskeletal Medicine, University of Otago, New Zealand
| | - David Kieser
- Department of Surgery and Musculoskeletal Medicine, University of Otago, New Zealand
| | - Gary Hooper
- Department of Surgery and Musculoskeletal Medicine, University of Otago, New Zealand
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2
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A Scoping Review of Total Hip Arthroplasty Survival and Reoperation Rates in Patients of 55 Years or Younger: Health Services Implications for Revision Surgeries. Arthroplast Today 2022; 16:247-258.e6. [PMID: 36092132 PMCID: PMC9458900 DOI: 10.1016/j.artd.2022.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 05/03/2022] [Accepted: 05/25/2022] [Indexed: 11/23/2022] Open
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Kenanidis E, Kakoulidis P, Leonidou A, Anagnostis P, Potoupnis M, Tsiridis E. Survival of monoblock RM vitamys compared with modular PINNACLE cups: mid-term outcomes of 200 hips performed by a single surgeon. Hip Int 2021; 31:465-471. [PMID: 31694404 DOI: 10.1177/1120700019885619] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Monoblock cups have theoretical advantages over modular cups; however, their superiority in terms of survival has not been confirmed in comparative studies. METHODS We compared the mid-term survivorship of 107 RM Pressfit vitamys monoblock cups (Mathys Ltd., Bettlach, Switzerland) with 93 modular pressfit Pinnacle cups (DePuy Synthes, Warsaw, IN, USA). All cases were registered in the Arthroplasty Registry Thessaloniki and performed by a senior surgeon through the same approach between 2013 and 2014. The groups were comparable in sex distribution, preoperative diagnosis, follow-up, cup diameter, head diameter, type and use of screws, HOOS and HSS preop scores; the recipients of RM cup were significantly younger. RESULTS 3 sockets were revised. The 6-year survival for any reason was 99.1% for the RM and 97.8 % for the PINNACLE group. There was no difference in survival for aseptic loosening and any reason between groups (log-rank test p = 0.921 and p = 0.483, respectively). The age (95% CI, 0.79-1.1), sex (95% CI, 0.2-45.0), cup diameter (95% CI, 0.18-1.1), head diameter (95% CI, 0.004-6.2), preoperative diagnosis and use of screws (95% CI, 0.02-4.3), did not influence hazard ratio for revision between groups. HHS and HOOS were comparable at the last follow-up. CONCLUSIONS Our study demonstrated that both cup designs had similar revision rates at mid-term follow-up, regardless the fact that the RM vitamys was used in a cohort of younger patients; which according to the literature would have led to earlier failures. Further long-term data are needed to evaluate the superiority of RM vitamys in the clinical setting, especially in the young.
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Affiliation(s)
- Eustathios Kenanidis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Greece.,Centre of Orthopaedic and Regenerative Medicine (CORE), Centre for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Thessaloniki, Greece
| | - Panagiotis Kakoulidis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Greece.,Centre of Orthopaedic and Regenerative Medicine (CORE), Centre for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Thessaloniki, Greece
| | - Andreas Leonidou
- Centre of Orthopaedic and Regenerative Medicine (CORE), Centre for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Thessaloniki, Greece.,Royal Berkshire NHS Foundation Trust, Reading, UK
| | - Panagiotis Anagnostis
- Centre of Orthopaedic and Regenerative Medicine (CORE), Centre for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Thessaloniki, Greece
| | - Michael Potoupnis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Greece.,Centre of Orthopaedic and Regenerative Medicine (CORE), Centre for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Thessaloniki, Greece
| | - Eleftherios Tsiridis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Greece.,Centre of Orthopaedic and Regenerative Medicine (CORE), Centre for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Thessaloniki, Greece
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Latessa I, Ricciardi C, Jacob D, Jónsson H, Gambacorta M, Improta G, Gargiulo P. Health technology assessment through Six Sigma Methodology to assess cemented and uncemented protheses in total hip arthroplasty. Eur J Transl Myol 2021; 31. [PMID: 33709655 PMCID: PMC8056159 DOI: 10.4081/ejtm.2021.9651] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 02/12/2021] [Indexed: 02/07/2023] Open
Abstract
The purpose of this study is to use Health Technology Assessment (HTA) through the Six Sigma (SS) and DMAIC (Define, Measure, Analyse, Improve, Control) problem-solving strategies for comparing cemented and uncemented prostheses in terms of the costs incurred for Total hip arthroplasty (THA) and the length of hospital stay (LOS). Multinomial logistic regression analysis for modelling the data was also performed. Quantitative parameters extracted from gait analysis, electromyography and computed tomography images were used to compare the approaches, but the analysis did not show statistical significance. The variables regarding costs were studied with the Mann-Whitney and Kruskal-Wallis tests. No statistically significant difference between cemented and uncemented prosthesis for the total cost of LOS was found, but the cost of the surgeon had an influence on the overall expenses, affecting the cemented prosthetic approach. The material costs of surgery for the uncemented prosthesis and the cost of theatre of surgery for the cemented prosthesis were the most influential. Multinomial logistic regression identified the Vastus Lateralis variable as statistically significant. The overall accuracy of the model is 93.0%. The use of SS and DMAIC cycle as tools of HTA proved that the cemented and uncemented approaches for THA have similar costs and LOSy.
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Affiliation(s)
- Imma Latessa
- University Hospital of Naples "Federico II", Department of Public Health, Naples, Italy; Reykjavík University, Institute for Biomedical and Neural Engineering, Reykjavík.
| | - Carlo Ricciardi
- Reykjavík University, Institute for Biomedical and Neural Engineering, Reykjavík, Iceland; University Hospital of Naples 'Federico II', Department of Advanced Biomedical Sciences, Naples.
| | - Deborah Jacob
- Reykjavík University, Institute for Biomedical and Neural Engineering, Reykjavík.
| | - Halldór Jónsson
- University of Iceland, Faculty of Medicine, Reykjavík, Iceland; Landspítali Hospital, Orthopaedic Clinic, Reykjavík.
| | | | - Giovanni Improta
- University Hospital of Naples "Federico II", Department of Public Health, Naples.
| | - Paolo Gargiulo
- Reykjavík University, Institute for Biomedical and Neural Engineering, Reykjavík, Iceland; Landspítali Hospital, Department of Science, Reykjavík.
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Afghanyar Y, Joser S, Tecle J, Drees P, Dargel J, Rehbein P, Kutzner KP. The concept of a cementless isoelastic monoblock cup made of highly cross-linked polyethylene infused with vitamin E: radiological analyses of migration and wear using EBRA and clinical outcomes at mid-term follow-up. BMC Musculoskelet Disord 2021; 22:107. [PMID: 33485345 PMCID: PMC7827971 DOI: 10.1186/s12891-021-03981-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 01/17/2021] [Indexed: 11/10/2022] Open
Abstract
Background The newest generation of cementless titanium-coated, isoelastic monoblock cup with vitamin E-blended highly cross-linked polyethylene (HXLPE) was introduced to the market in 2009. The aim of the present study was to obtain mid-term follow-up data including migration and wear analyses. Methods This prospective study investigated 101 primary total hip arthroplasty (THA) cases in 96 patients treated at a single institution. Patients were allowed full weight-bearing on the first day postoperatively. Harris hip score (HHS) and pain and satisfication on a visual analogue scale (VAS) were assessed at a mean follow-up of 79.0 months. Migration and wear were assessed using Einzel-Bild-Roentgen-Analyse (EBRA) software. Radiological acetabular bone alterations and complications were documented. Results At mid-term follow-up (mean 79.0 months, range: 51.8–101.7), 81 cases with complete clinical and radiological data were analyzed. Utilisable EBRA measurements were obtained for 42 hips. The mean HHS was 91.1 (range 38.0–100.0), VAS satisfaction was 9.6 (range 6.0–10.0), VAS rest pain was 0.2 (range 0.0–4.0), and VAS load pain was 0.6 (range 0.0–9.0). Mean migration was 0.86 mm (range: 0.0–2.56) at 24 months and 1.34 mm (range: 0.09–3.14) at 5 years, and the mean annual migration rate was 0.22 (range: − 0.24–1.34). The mean total wear was 0.4 mm (range: 0.03–1.0), corresponding to a mean annual wear rate of 0.06 mm per year (range: 0.0–0.17). Radiographic analysis did not reveal any cases of osteolysis, and no revision surgeries had to be performed. Conclusions After using vitamin-E blended HXLPE in cementless isoelastic monoblock cups, there were no obvious signs of osteolysis or aseptic loosening occurred. No patients required revision surgery after mid-term follow-up. Cup migration and wear values were well below the benchmarks considered predictive for potential future failure. Trial registration The trial registration number on ClinicalTrials.gov: NCT04322916 (retrospectively registered at 26.03.2020). Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-03981-8.
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Affiliation(s)
- Yama Afghanyar
- Department of Orthopaedic Surgery, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany.
| | - Sebastian Joser
- Department of Orthopaedic Surgery, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany
| | - Jonas Tecle
- Department of Orthopaedic Surgery, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany
| | - Philipp Drees
- Department of Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg-University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Jens Dargel
- Department of Orthopaedic Surgery, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany
| | - Philipp Rehbein
- Department of Orthopaedic Surgery, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany
| | - Karl Philipp Kutzner
- Department of Orthopaedic Surgery, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany.,Department of Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg-University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
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Massier JRA, Van Erp JHJ, Snijders TE, Gast ADE. A vitamin E blended highly cross-linked polyethylene acetabular cup results in less wear: 6-year results of a randomized controlled trial in 199 patients. Acta Orthop 2020; 91:705-710. [PMID: 32835560 PMCID: PMC8023918 DOI: 10.1080/17453674.2020.1807220] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Survivorship of total hip arthroplasty (THA) with the ultra-high molecular weight polyethylene (UHMWPE) monoblock cup has been limited due to periprosthetic osteolysis and aseptic loosening, secondary to wear of the UHMWPE. In response, a vitamin E blended highly cross-linked polyethylene (HXLPE) cup was developed. This study set out to compare the wear and clinical 6-year outcomes of vitamin E blended HXLPE with UHMWPE in an isoelastic monoblock cup in patients with hip osteoarthritis who underwent uncemented THA. The 2-year results have been reported previously. Patients and methods - For this randomized controlled trial 199 patients were included. 102 patients received the vitamin E blended HXLPE uncemented acetabular cup and 97 patients the uncemented UHMWPE monoblock cup. Clinical and radiographic parameters were obtained preoperatively, directly postoperatively, and at 3, 12, 24, and 72 months. Wear rates were compared using the femoral head penetration (FHP) rate. Results - 173 patients (87%) completed the 6-year follow-up. The mean NRS scores for rest pain, load pain, and patient satisfaction were 0.3 (SD 1), 0.6 (SD 1), and 8.6 (SD 1) respectively. The mean Harris Hip Score was 93 (SD 12). The FHP rate was lower in the vitamin E blended HXLPE cup (0.028 mm/year) compared with the UHMWPE cup (0.035 mm/year) (p = 0.002). No adverse reactions associated with the clinical application of vitamin E blended HXLPE were observed. 15 complications occurred, equally distributed between the two cups. The 6-year survival to revision rate was 98% for both cups. There was no aseptic loosening. Interpretation - This study shows the superior performance of the HXLPE blended with vitamin E acetabular cup with clinical and radiographic results similar to the UHMWPE acetabular cup.
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Affiliation(s)
- Julie R A Massier
- Clinical Orthopedic Research Center – mN, Zeist,Department of Orthopedic Surgery, Diakonessenhuis, Utrecht, the Netherlands
| | - Joost H J Van Erp
- Clinical Orthopedic Research Center – mN, Zeist,Department of Orthopedic Surgery, Diakonessenhuis, Utrecht, the Netherlands,Correspondence:
| | | | - Arthur DE Gast
- Clinical Orthopedic Research Center – mN, Zeist,Department of Orthopedic Surgery, Diakonessenhuis, Utrecht, the Netherlands
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Mei XY, Gong YJ, Safir O, Gross A, Kuzyk P. Long-term outcomes of total hip arthroplasty in patients younger than 55 years: a systematic review of the contemporary literature. Can J Surg 2020; 62:249-258. [PMID: 31348632 DOI: 10.1503/cjs.013118] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background Total hip arthroplasty (THA) is increasingly performed in younger patients despite the lack of comprehensive assessment of long-term outcomes. We systematically reviewed the contemporary literature to assess the 1) indications, 2) implant selection and long-term survivorship, 3) complication and reoperation rates and 4) radiographic and functional outcomes of primary THA in patients younger than 55 years. Methods We searched the Embase and MEDLINE databases for English-language articles published between 2000 and 2018 that reported outcomes of primary THA in patients younger than 55 years with a minimum follow-up duration of 10 years. Results Thirty-two studies reporting on 3219 THA procedures performed in 2434 patients met our inclusion criteria. The most common preoperative diagnoses were avascular necrosis (1044 [32.4%]), osteoarthritis (870 [27.0%]) and developmental dysplasia of the hip (627 [19.5%]). Modular implants (3001 [93.2%]), cementless fixation (2214 [68.8%]) and metal-on-polyethylene bearings (1792 [55.7%]) were frequently used. The mean 5- and 10-year survival rates were 98.7% and 94.6%, respectively. Data on survival beyond 10 years were heterogeneous, with values of 27%–99.5% at 10–14 years, 59%–84% at 15–19 years, 70%–77% at 20–24 years and 60% at 25–30 years. Rates of dislocation, deep infection and reoperation for any reason were 2.4%, 1.2% and 16.3%, respectively. The mean Harris Hip Score improved from 43.6/100 to 91.0/100. Conclusion Total hip arthroplasty in patients younger than 55 years provides reliable outcomes at up to 10 years. Future studies should evaluate the outcomes of THA in this population at 15–20 years’ follow-up.
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Affiliation(s)
- Xin Yu Mei
- From the Department of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, Ont. (Mei, Safir, Gross, Kuzyk); and the Department of Family Medicine, Queen’s University, Kingston, Ont. (Gong)
| | - Ying Jia Gong
- From the Department of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, Ont. (Mei, Safir, Gross, Kuzyk); and the Department of Family Medicine, Queen’s University, Kingston, Ont. (Gong)
| | - Oleg Safir
- From the Department of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, Ont. (Mei, Safir, Gross, Kuzyk); and the Department of Family Medicine, Queen’s University, Kingston, Ont. (Gong)
| | - Allan Gross
- From the Department of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, Ont. (Mei, Safir, Gross, Kuzyk); and the Department of Family Medicine, Queen’s University, Kingston, Ont. (Gong)
| | - Paul Kuzyk
- From the Department of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, Ont. (Mei, Safir, Gross, Kuzyk); and the Department of Family Medicine, Queen’s University, Kingston, Ont. (Gong)
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The Survivorship of the Uncemented Iso-Elastic Monoblock Acetabular Component at a Mean of 6-Year Follow-up. HSS J 2020; 16:15-22. [PMID: 32015736 PMCID: PMC6973989 DOI: 10.1007/s11420-018-09658-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 11/22/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Aseptic loosening, caused by wear and osteolysis, is the most frequent reason for hip replacement revision in the UK. To prevent aseptic loosening, an acetabular component with vitamin E added to irradiated highly cross-linked polyethylene (HXLPE) was developed to reduce oxidative degradation. QUESTIONS/PURPOSES A prior study of the vitamin E-blended HXLPE acetabular component after 2 years of follow-up reported no adverse reactions or abnormal mechanical behavior. To further examine this hypothesis of reducing wear and osteolysis, we sought to evaluate outcomes after 6-year follow-up. METHODS A cohort of 95 of the 112 initial patients (84.2%) completed the 6 years of follow-up after receiving a vitamin E-blended HXLPE acetabular component. Evaluation was performed in terms of clinical (visual analog scale [VAS] score, VAS score with weight-bearing, VAS score for satisfaction, and Harris Hip Score) and radiological (inclination, polar gap, radiolucencies, migration, and 2-D linear femoral head penetration rate) assessment. RESULTS The mean VAS score for patient satisfaction was 8.75 and the mean Harris Hip Score was 91.8. There were two revisions because of deep infections and one because of a peri-prosthetic femoral fracture. Two acetabular components migrated initially; however, delayed acetabular stabilization occurred. Both patients had good clinical scores at 72 months. The mean femoral head penetration rate was 0.036 mm/year. CONCLUSIONS This prospective cohort study has shown no adverse reactions concerning the vitamin E additive, promising wear rates, no signs of osteolysis, a 100% survival rate for aseptic loosening, and an all-cause survivorship percentage of 97.4% at 6 years of follow-up.
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Coupry A, Rony L, Ducellier F, Hubert L, Chappard D. Texture analysis of trabecular bone around RM-Pressfit cementless acetabulum in a series of 46 patients during a 5 year period. Orthop Traumatol Surg Res 2019; 105:1283-1287. [PMID: 31477444 DOI: 10.1016/j.otsr.2019.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 05/27/2019] [Accepted: 06/06/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Cementless total hip arthroplasty (THA) is a common procedure producing excellent clinical results. Their long-term survival is nevertheless burdened by loosening of the acetabular part caused by changes in the distribution of strains around the cup. In this context the RM-Pressfit® cup has been developed, resulting in a more harmonious distribution of the strains. HYPOTHESIS Texture analysis of X-ray films can evaluate the evolution of trabecular bone micro-architecture during the five years following THA with a RM-Pressfit® cup. MATERIAL AND METHOD A monocentric series of 46 hips was reviewed regularly within five years post- surgery. Radiographic evaluation of the operated hip was done on frontal digitized radiographs of the pelvis to follow evolution of bone micro-architecture in the #2 zone of De Lee and Charnley. Texture analysis using fractal algorithms was done at D0, 6 months, 1, 2 and 5 years post-THA. The fractal methods used included the skyscrapers and the dynamic blanket methods with 3 different structuring elements (a cross, a horizontal and a vertical vector). RESULTS The RM-Pressfit® caused significant changes in the distribution of strains around the acetabulum that preserved the bone volume over a 5-year period post-surgery. This corresponds to an improvement of the trabecular micro-architecture around the acetabular cups. CONCLUSION A statistically significant increase in the four fractal dimensions considered corresponded to an improved trabecular bone micro-architecture revealed by texture analysis, a non-invasive method that can be used on digitized X-ray images. LEVEL OF EVIDENCE IIIb, Case control study, retrospective design.
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Affiliation(s)
- Augustin Coupry
- Département de chirurgie osseuse, CHU-Angers, 49033 Angers, France
| | - Louis Rony
- Département de chirurgie osseuse, CHU-Angers, 49033 Angers, France; Groupe Etudes Remodelage Osseux et bioMatériaux, GEROM, EA-4658, SFR-4208, Univ-Angers, IRIS-IBS Institut de Biologie en Santé, CHU-Angers, 49933 Angers, France
| | | | - Laurent Hubert
- Département de chirurgie osseuse, CHU-Angers, 49033 Angers, France; Groupe Etudes Remodelage Osseux et bioMatériaux, GEROM, EA-4658, SFR-4208, Univ-Angers, IRIS-IBS Institut de Biologie en Santé, CHU-Angers, 49933 Angers, France
| | - Daniel Chappard
- Groupe Etudes Remodelage Osseux et bioMatériaux, GEROM, EA-4658, SFR-4208, Univ-Angers, IRIS-IBS Institut de Biologie en Santé, CHU-Angers, 49933 Angers, France.
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Danilyak VV, Klyuchevsky VV, Molodov MA, Goryunov EV, Marchenkova KV. Long-Term Results of Total Hip Arthroplasty with RM Classic Cups. TRAUMATOLOGY AND ORTHOPEDICS OF RUSSIA 2019. [DOI: 10.21823/2311-2905-2019-25-3-25-33] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Relevance. The RM Classic monoblock titanium-coated polyethylene cup is widely used in the total hip arthroplasty. However, so far in Russia there has been no analysis of follow-up over 10 years for a limited number of patients in a single hospital. The aim of the study was to evaluate the long-term outcomes of total hip replacement with RM Classic acetabular component. Materials and Methods. The outcomes of 328 total hip arthroplasties (289 patients operated in the period from 1997 to 2007) with RM Classic cups were evaluated in a monocentral retrospective clinical study. The average follow-up period was 14.4 years. Revision procedure due to aseptic loosening, polyethylene wear or osteolysis was considered as the end point of the study. Results. 9 revisions during the short and medium follow-up periods (up to 10 years) were associated with malpositioning of RM Classic components and errors in surgical technique. The indications for later revision THA (19 cases) were polyethylene wear and aseptic loosening. Only in one case they were combined with pelvic bone osteolysis with the formation of III a defect according to W.G. Paprosky classification. Within 15 years the Kaplan-Meier survivorship of RM Classic cup was 92.5%. There was a statistically significant difference of the survival curves in the ceramic-on-poly against metal-on-poly bearings: 94.9% and 79.4%, respectively. The average Harris Hip Score was 88.6. Conclusion. RM Classic uncemented monoblock cup has proven its high efficiency and survival in 15 years follow-up period and over.
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Halma JJ, Eshuis R, Vogely HC, van Gaalen SM, de Gast A. An uncemented iso-elastic monoblock acetabular component: preliminary results. J Arthroplasty 2015; 30:615-21. [PMID: 25496930 DOI: 10.1016/j.arth.2014.11.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 10/29/2014] [Accepted: 11/10/2014] [Indexed: 02/01/2023] Open
Abstract
Little is known about the clinical application of highly cross-linked polyethylene (HXLPE) blended with vitamin E. This study evaluates an uncemented iso-elastic monoblock cup with vitamin E blended HXLPE. 112 patients were followed up for 2years. 95.5% completed the follow-up. The mean VAS score for patient satisfaction was 8.8 and the mean Harris Hip Score was 94.2. In 7 cases initial gaps behind the cup were observed, which disappeared completely during follow-up in 6 cases. The mean femoral head penetration rate was 0.055mm/year. No adverse reactions or abnormal mechanical behavior was observed with the short term use of vitamin E blended HXLPE. This study shows the promising performance of this cup and confirms the potential of vitamin E blended HXLPE.
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Affiliation(s)
- Jelle J Halma
- Clinical Orthopedic Research Center-midden Nederland (CORC-mN) Department of Orthopedics, Diakonessenhuis Hospital, Utrecht, The Netherlands
| | - Rienk Eshuis
- Clinical Orthopedic Research Center-midden Nederland (CORC-mN) Department of Orthopedics, Diakonessenhuis Hospital, Utrecht, The Netherlands
| | - H Charles Vogely
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Steven M van Gaalen
- Clinical Orthopedic Research Center-midden Nederland (CORC-mN) Department of Orthopedics, Diakonessenhuis Hospital, Utrecht, The Netherlands
| | - Arthur de Gast
- Clinical Orthopedic Research Center-midden Nederland (CORC-mN) Department of Orthopedics, Diakonessenhuis Hospital, Utrecht, The Netherlands
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Lafon L, Moubarak H, Druon J, Rosset P. Cementless RM Pressfit Cup: a clinical and radiological study of 91 cases with at least four years follow-up. Orthop Traumatol Surg Res 2014; 100:S225-9. [PMID: 24703794 DOI: 10.1016/j.otsr.2014.03.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
UNLABELLED Cementless metal-back acetabular cups have good long-term results, but some problems have appeared due to the shell's stiffness, modularity and required bearing surfaces. The RM Pressfit Cup is a single-piece polyethylene cementless acetabular cup that is covered by a thin layer of titanium. This allows for bone integration without limitations related to the stiffness of a metal-back shell. There is very little published information about this new, innovative implant design. The purpose of this study was to evaluate the clinical and radiological results from a continuous series of 91 cups (85 patients) with a follow-up of at least 4 years. No patients were lost to follow-up. The Harris Hip Score (HHS) was used to assess the clinical outcome. To assess the radiological outcomes, digital X-rays were used to evaluate the cup position and integration; wear was measured using Livermore's technique. The clinical results were excellent: the mean HHS was 94 and 82% of cases had good or excellent scores. Three of the cups had to be revised because of dislocation brought on by incorrect positioning. X-rays revealed that three implants had shifted during the first 6 weeks, but had stabilized afterwards. Bone integration on X-rays was satisfactory in all cases with no signs of osteolysis. The configuration of the bone trabeculae showed that loads between the implant and peri-acetabular cancellous bone were evenly distributed. The wear of the polyethylene cup-ceramic head bearing was 0.07 mm/year. The results of this series are consistent with recent published studies with the RM Pressfit Cup. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- L Lafon
- Orthopaedic Surgery Department 2, Tours CHRU, Université François-Rabelais de Tours, PRES Centre-Val de Loire Université, Tours, France
| | - H Moubarak
- Orthopaedic Surgery Department 2, Tours CHRU, Université François-Rabelais de Tours, PRES Centre-Val de Loire Université, Tours, France
| | - J Druon
- Orthopaedic Surgery Department 2, Tours CHRU, Université François-Rabelais de Tours, PRES Centre-Val de Loire Université, Tours, France
| | - P Rosset
- Orthopaedic Surgery Department 2, Tours CHRU, Université François-Rabelais de Tours, PRES Centre-Val de Loire Université, Tours, France.
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Halma JJ, Vogely HC, Dhert WJ, Van Gaalen SM, de Gast A. Do monoblock cups improve survivorship, decrease wear, or reduce osteolysis in uncemented total hip arthroplasty? Clin Orthop Relat Res 2013; 471:3572-80. [PMID: 23913339 PMCID: PMC3792292 DOI: 10.1007/s11999-013-3144-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 06/25/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Monoblock acetabular components used in uncemented total hip arthroplasty (THA) have certain mechanical characteristics that potentially reduce acetabular osteolysis and polyethylene wear. However, the degree to which they achieve this goal is not well documented. QUESTIONS/PURPOSES The purpose of this study was to use a systematic review of controlled trials to test the hypothesis that monoblock cups have superior (1) polyethylene wear rate; (2) frequency of cup migration; (3) frequency of acetabular osteolysis; and (4) frequency of aseptic loosening compared with modular components used in uncemented THA. METHODS A systematic search was conducted in the Medline, Embase, and Cochrane electronic databases to assemble all controlled trials comparing monoblock with modular uncemented acetabular components in primary THA. Included studies were considered "best evidence" if the quality score was either ≥ 50% on the Cochrane Back Review Group checklist or ≥ 75% the Newcastle-Ottawa quality assessment scale. A total of seven publications met our inclusion criteria. RESULTS Best evidence analysis showed no difference in polyethylene wear rate, the frequency of cup migration, and aseptic loosening between monoblock and modular acetabular components. No convincing evidence was found for the claim that lower frequencies of acetabular osteolysis are observed with the use of monoblock cups compared with modular uncemented cups. CONCLUSIONS The purported benefits of monoblock cups were not substantiated by this systematic review of controlled studies in that polyethylene wear rates and frequencies of cup failure and acetabular osteolysis were similar to those observed with modular implants. Other factors should therefore drive implant selection in cementless THA.
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Affiliation(s)
- Jelle J Halma
- Clinical Orthopedic Research Center-midden Nederland (CORC-mN), Department of Orthopaedics, Diakonessenhuis Hospital, PO Box 80250, 3508 TG, Utrecht, The Netherlands,
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Wyss T, Kägi P, Mayrhofer P, Nötzli H, Pfluger D, Knahr K. Five-year results of the uncemented RM pressfit cup clinical evaluation and migration measurements by EBRA. J Arthroplasty 2013; 28:1291-6. [PMID: 23523483 DOI: 10.1016/j.arth.2012.11.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Revised: 10/15/2012] [Accepted: 11/01/2012] [Indexed: 02/01/2023] Open
Abstract
This was a prospective consecutive, study of 50 patients (mean age 72 years, 56% males) treated unilaterally for primary osteoarthrosis using the uncemented, isoelastic, monoblock RM Pressfit Cup. Migration and wear were assessed using the EBRA (Ein-Bild-Röntgen-Analyse) software (201 radiographs from 36 patients). Mean migration was 0.82 mm after 2 years and 1.25 mm after 5 years. A decreasing migration rate over the period was observed. The mean annual wear rate was 0.09 mm/y. Five years after surgery, 84% of patients reached good or excellent Harris hip score values. No revisions related to the acetabular component were necessary. All cups appeared to have high primary stability.
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Affiliation(s)
- Tobias Wyss
- Department of Orthopaedic Surgery, Sonnenhof, Berne, Switzerland
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Abstract
BACKGROUND The acetabular component has remained the weakest link in hip arthroplasty regarding achievement of long-term survival. Primary fixation is a prerequisite for long-term performance. For this reason, we investigated the stability of a unique cementless titanium-coated elastic monoblock socket and the influence of supplementary screw fixation. PATIENT AND METHODS During 2006-2008, we performed a randomized controlled trial on 37 patients (mean age 63 years (SD 7), 22 females) in whom we implanted a cementless press-fit socket. The socket was implanted with additional screw fixation (group A, n = 19) and without additional screw fixation (group B, n = 18). Using radiostereometric analysis with a 2-year follow-up, we determined the stability of the socket. Clinically relevant migration was defined as > 1 mm translation and > 2º rotation. Clinical scores were determined. RESULTS The sockets without screw fixation showed a statistically significantly higher proximal translation compared to the socket with additional screw fixation. However, this higher migration was below the clinically relevant threshold. The numbers of migratory sockets were not significantly different between groups. After the 2-year follow-up, there were no clinically relevant differences between groups A and B regarding the clinical scores. 1 patient dropped out of the study. In the others, no sockets were revised. INTERPRETATION We found that additional screw fixation is not necessary to achieve stability of the cementless press-fit elastic RM socket. We saw no postoperative benefit or clinical effect of additional screw fixation.
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Affiliation(s)
- Dean Pakvis
- Department Orthopaedic and Trauma Surgery, Orthopaedic Centre OCON, Hengelo
| | - Joan Luites
- Departments of Research, Development and Education
| | | | - Maarten Spruit
- Orthopaedic Surgery, Sint Maartenskliniek, Nijmegen, the Netherlands
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