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Jelsma J, Acharya M. Recurrent implant fractures in total hip arthroplasty: a yes-you-yan case report. Acta Orthop Belg 2024; 90:135-138. [PMID: 38669663 DOI: 10.52628/90.1.12399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
This case report describes a single patient with recurrent implant fractures of his left total hip replacement. According to our knowledge this is the first patient in literature with recurrent implant fractures. This is a rare phenomenon as reason for revision. Risk factors for implant failure of total hip replacement include a lack of proximal support, a distally well fixed stem with proximal debonding, malalignment of the stem and raised BMI.
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Liebhauser M, Hohenberger G, Lohberger B, Hauer G, Deluca A, Sadoghi P. Implant breakage after shoulder arthroplasty: a systematic review of data from worldwide arthroplasty registries and clinical trials. BMC Musculoskelet Disord 2023; 24:804. [PMID: 37821859 PMCID: PMC10565962 DOI: 10.1186/s12891-023-06922-9] [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: 02/23/2023] [Accepted: 09/25/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Implant breakage after shoulder arthroplasty is a rare complication after aseptic loosening, infection or persistent pain, resulting in malfunction of the components requiring revision surgery. This correlates with a high burden for the patient and increasing costs. Specific data of complication rates and implant breakage are available in detailed arthroplasty registries, but due to the rare occurrence and possibly underestimated value rarely described in published studies. The aim of this systematic review was to point out the frequency of implant breakage after shoulder arthroplasty. We hypothesized that worldwide arthroplasty registry datasets record higher rates of implant breakage than clinical trials. METHODS PubMed, MEDLINE, EMBASE, CINHAL, and the Cochrane Central Register of Controlled Trials database were utilized for this systematic review using the items "(implant fracture/complication/breakage) OR (glenoid/baseplate complication/breakage) AND (shoulder arthroplasty)" according to the PRISMA guidelines on July 3rd, 2023. Study selection, quality assessment, and data extraction were conducted according to the Cochrane standards. Case reports and experimental studies were excluded to reduce bias. The breakage rate per 100,000 observed component years was used to compare data from national arthroplasty registries and clinical trials, published in peer-reviewed journals. Relevant types of shoulder prosthetics were analyzed and differences in implant breakage were considered. RESULTS Data of 5 registries and 15 studies were included. Rates of implant breakage after shoulder arthroplasty were reported with 0.06-0.86% in registries versus 0.01-6.65% in clinical studies. The breakage rate per 100,000 observed component years was 10 in clinical studies and 9 in registries. There was a revision rate of 0.09% for registry data and 0.1% for clinical studies within a 10-year period. The most frequently affected component in connection with implant fracture was the glenoid insert. CONCLUSION Clinical studies revealed a similar incidence of implant failure compared to data of worldwide arthroplasty registries. These complications arise mainly due to breakage of screws and glenospheres and there seems to be a direct correlation to loosening. Periprosthetic joint infection might be associated with loosening of the prosthesis and subsequent material breakage. We believe that this analysis can help physicians to advise patients on potential risks after shoulder arthroplasty. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Martin Liebhauser
- Department of Traumatology, Klinikum Klagenfurt am Wörthersee, Klagenfurt, Austria
| | - Gloria Hohenberger
- Department of Traumatology, State Hospital Feldbach, Fürstenfeld, Austria
| | - Birgit Lohberger
- Department of Orthopedics and Trauma, Medical University of Graz, Graz, Austria
| | - Georg Hauer
- Department of Orthopedics and Trauma, Medical University of Graz, Graz, Austria
| | - Amelie Deluca
- Department of Orthopedic Surgery, SKA Warmbad Villach, Villach, Austria
| | - Patrick Sadoghi
- Department of Orthopedics and Trauma, Medical University of Graz, Graz, Austria.
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Cook SD, Patron LP, Lavernia CJ, Gibian J, Hong T, Bendich I. Fracture of Contemporary Femoral Stems: Common Trends in This Rare Occurrence. J Arthroplasty 2023:S0883-5403(23)00364-9. [PMID: 37086930 DOI: 10.1016/j.arth.2023.04.025] [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] [Received: 11/20/2022] [Revised: 04/10/2023] [Accepted: 04/11/2023] [Indexed: 04/24/2023] Open
Abstract
BACKGROUND Fracture of contemporary femoral stems is a rare occurrence in total hip arthroplasty (THA). A knowledge gap remains regarding manufacturing, patient, and surgeon factors that may contribute to the increased risk of this complication. METHODS We analyzed 13 contemporary fractured porous coated femoral stems of various designs to determine cause and contributing factors of mechanical failure. Cases included 12 men and one woman who had an average age at index surgery of 53 years (range, 34 to 76). There were ten of 13 patients who had a body mass index (BMI) greater than 30 (obese); 3 of the 10 had a BMI greater than 40. The mean time to fracture was 7.6 years (range, 7 months to 12 years). RESULTS There were four titanium alloy stems that fractured an average of 3.6 years post-revision surgery for head/cup exchange, and had associated iatrogenic mechanical and electrocautery damage to the femoral neck at fracture initiation sites. There were six modular stems that failed at the stem-sleeve or stem-neck interfaces with evidence of fretting corrosion. For two stem-neck fractures, mis-matched head/stem combinations from different manufacturers resulted in untested mechanical offsets and loading. There were two proximal neck fractures and one mid-shaft fracture of coated cobalt-chromium alloy stems that occurred in three obese men. The neck fractures (10 to 12 years) were well-fixed stems. Lack of proximal fixation contributed to the mid-shaft fracture (7 months). CONCLUSION While rare, femoral stem fractures pose catastrophic outcomes in primary and revision THA. Manufacturing, patient, and surgical factors contributing to stem failures were identified, including patient obesity, heat-treatment reduction of mechanical properties, iatrogenic implant damage, and mixing of different vendor stems and heads.
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Affiliation(s)
- Stephen D Cook
- Fellowship of Orthopaedic Researchers, 320 Metairie-Hammond Hwy, Suite 406, Metairie, LA 70005.
| | - Laura P Patron
- Fellowship of Orthopaedic Researchers, 320 Metairie-Hammond Hwy, Suite 406, Metairie, LA 70005
| | | | - Joseph Gibian
- Washington University in St. Louis School of Medicine, 660 S. Euclid Avenue, St. Louis, MO 63110
| | - Thomas Hong
- Washington University in St. Louis School of Medicine, 660 S. Euclid Avenue, St. Louis, MO 63110
| | - Ilya Bendich
- Washington University in St. Louis School of Medicine, 660 S. Euclid Avenue, St. Louis, MO 63110
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[Particle disease and its effects on periarticular tissue]. ORTHOPADIE (HEIDELBERG, GERMANY) 2023; 52:196-205. [PMID: 36867226 DOI: 10.1007/s00132-023-04348-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/12/2023] [Indexed: 03/04/2023]
Abstract
Particle disease is the condition caused by wear debris on surrounding tissues and influences the well-being of arthroplasty patients. This condition is multifactorial due to the type of bearing couple, head size and implant position. Subsequent periprosthetic osteolysis and soft tissue reactions, can lead to revision THA surgery. The periprosthetic synovial membrane (synovial-like interface membrane, SLIM) is used in diagnostics when the cause of implant failure is uncertain. Detailed analysis of synovial fluid and bone marrow could improve the diagnostic procedure and strengthen the cases for revision surgery and the underlying biology. A large number of research approaches on this topic have evolved and continue to be utilized in the clinic.
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Tresgallo-Parés R, Torres-Lugo NJ, Rosado-Hernández E, Olivella G, Ramírez N, Otero-López A. Adverse Soft-Tissue Reaction After Ceramic-On-Ceramic Bearing Fracture Mimicking a Periprosthetic Joint Infection. Arthroplast Today 2022; 13:93-97. [PMID: 35106343 PMCID: PMC8784301 DOI: 10.1016/j.artd.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 11/29/2021] [Accepted: 12/02/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
- Ruben Tresgallo-Parés
- Department of Orthopaedic Surgery, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Norberto J. Torres-Lugo
- Department of Orthopaedic Surgery, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
- Corresponding author. Department of Orthopaedic Surgery, University of Puerto Rico, PO Box 365067, San Juan, Puerto Rico 00936. Tel.: 1-787-764-5095.
| | - Edwin Rosado-Hernández
- Department of Orthopaedic Surgery, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Gerardo Olivella
- Department of Orthopaedic Surgery, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Norman Ramírez
- Department of Pediatric Orthopaedic Surgery, Mayaguez Medical Center, Mayaguez, Puerto Rico
| | - Antonio Otero-López
- Department of Orthopaedic Surgery, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
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Malhotra R, Gautam D, Gupta S. A New Type of Periprosthetic Fracture: Is It the Time to Update the Unified Classification System? Indian J Orthop 2021; 55:1277-1285. [PMID: 34629498 PMCID: PMC8487673 DOI: 10.1007/s43465-021-00538-8] [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: 06/11/2021] [Accepted: 09/27/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Increased number of primary and revision arthroplasties performed globally has led to a surge in the numbers of periprosthetic fractures. The Unified Classification System (UCS) advocated a rational approach towards the classification of periprosthetic fractures. We present here an update to the UCS with addition of new fracture pattern encountered in orthopedic practice. METHODS A retrospective study was conducted to review the service arthroplasty register for the cases with unique fracture pattern where the periprosthetic fracture around total hip arthroplasty was also associated with fracture of the prosthetic component. The details were retrieved from the medical record and the patients were called for a review. The radiological assessment was done with X-rays and clinical assessment with Harris Hip Scores at the latest follow-up. RESULTS Between 2012 and 2019, 11 patients (7 males and 4 females) were operated for peri-prosthetic fracture with a unique pattern where the fracture of femur was associated with fracture of the femoral stem as well. The mean age of the patient at the time of fracture was 56.8 years (range 42-71 years). All patients were managed with revision hip surgery. One patient died due to malignancy after 7 years of revision surgery. All the surviving patients are doing well with a mean Harris Hip Score of 86.8 at the latest follow-up of 2-9 years (mean 5.0 years). CONCLUSION With emergence of this new fracture pattern, it is recognition as a separate entity would help in better understanding and augmentation of the existing classification system of periprosthetic fractures.
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Affiliation(s)
- Rajesh Malhotra
- Department of Orthopedics, All India Institute of Medical Sciences (AIIMS), New Delhi, New Delhi, 110029 India
| | - Deepak Gautam
- Department of Orthopedics, All India Institute of Medical Sciences (AIIMS), New Delhi, New Delhi, 110029 India
| | - Saurabh Gupta
- Department of Orthopedics, All India Institute of Medical Sciences (AIIMS), New Delhi, New Delhi, 110029 India
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Thompson JW, Corbett J, Bye D, Jones A, Tissingh EK, Nolan J. Analysis of the Exeter V40 femoral stem prosthesis fracture : systematic review and single centre case series. Bone Jt Open 2021; 2:443-456. [PMID: 34176335 PMCID: PMC8244800 DOI: 10.1302/2633-1462.26.bjo-2021-0025.r1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aims The Exeter V40 cemented polished tapered stem system has demonstrated excellent long-term outcomes. This paper presents a systematic review of the existing literature and reports on a large case series comparing implant fractures between the Exeter V40 series; 125 mm and conventional length stem systems. Methods A systematic literature search was performed adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. In parallel, we performed a retrospective single centre study of Exeter V40 femoral stem prosthetic fractures between April 2003 and June 2020. Results There are 25 reported cases of such prosthetic fractures confined to small case series and case reports within the literature. We report an additional 19 cases to the literature (mean age 66.3 years (SD 11.7); 12 (63%) females; BMI 32.9 kg/m2 (SD 5.9)). The mean time from index procedure to fracture was 7.8 years (SD 3.6; 2.5 to 16.3). Exeter V40 stem fracture incidence was 0.15% and 1.21% for primary and revision arthroplasty, respectively. Incidence was significantly higher in revision arthroplasty (p < 0.001) and 125 mm length stems compared to ≥ 150 mm length stems (1.25% vs 0.13%, respectively; p < 0.001). When comparing different stem length cohorts, 125 mm short-stems were associated with stem-body fractures (92% vs 29%; p = 0.0095), earlier time to fracture (6.2 years vs 11.0 years; p = 0.0018), younger patient age at time of fracture (62.7 years vs 72.6 years; p = 0.037), and female sex (75% vs 43%; p = 0.326). Conclusion This complication remains rare, although we report a significantly higher incidence at up to 17 years follow-up than in the literature. Short 125 mm length Exeter V40 stems undoubtedly have a role in restoring anatomy and biomechanics in smaller femoral geometries, although the surgeon has to appreciate the higher risk of stem fracture and the associated predisposing factors which may necessitate particular attention to surgical technique and planning. Cite this article: Bone Jt Open 2021;2(6):443–456.
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Affiliation(s)
- Joshua W Thompson
- Department of Trauma and Orthopaedic Surgery, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, Norfolk, UK
| | - James Corbett
- Department of Trauma and Orthopaedic Surgery, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, Norfolk, UK
| | - Daniel Bye
- Department of Trauma and Orthopaedic Surgery, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, Norfolk, UK
| | - Adrian Jones
- Department of Trauma and Orthopaedic Surgery, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, Norfolk, UK
| | - Elizabeth K Tissingh
- Department of Trauma and Orthopaedic Surgery, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, Norfolk, UK
| | - John Nolan
- Department of Trauma and Orthopaedic Surgery, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, Norfolk, UK
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8
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Busch A, Wassenaar D, Zinser W, Jäger M. A bicentric approach evaluating the combination of a hemispheric cup with a novel ceramic head in total hip arthroplasty. Orthop Rev (Pavia) 2021; 13:8794. [PMID: 33953887 PMCID: PMC8077281 DOI: 10.4081/or.2021.8794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 10/24/2020] [Indexed: 12/27/2022] Open
Abstract
Medical ceramics are frequently used biomaterials as a liner in total hip arthroplasty. Strong efforts have been made to improve material properties over the last decades. Alumina toughened zirconia ceramics seem to be promising alternatives to further reduce fracture rates and squeaking phenomena. To answer the question if alumina toughened zirconia ceramic liners in combination with a cementless, hemispheric cup are able to reduce squeaking phenomena and fracture rates, we initiated a bicentric, mid-term trial. Noise phenomena will be recorded using MONA Score (Melbourne Orthopaedic Noise Assessment). Functional outcome (Harris Hip Score, University of California-Los Angeles, Forgotten Joint Score, EQ-5D Score, Visual Analogue Scale) and radiographic parameters will serve as secondary parameters. The study has been set up for 5 years, with follow-ups after 6-14 weeks, 12, 24 and 60 months.
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Affiliation(s)
- André Busch
- Department of Orthopaedics, Trauma and Reconstructive Surgery, Marienhospital Mülheim an der Ruhr, University of Duisburg-Essen
| | - Dennis Wassenaar
- Department of Orthopaedics, Trauma and Reconstructive Surgery, Marienhospital Mülheim an der Ruhr, University of Duisburg-Essen
| | - Wolfgang Zinser
- Department of Orthopaedics and Trauma Surgery, St. Vinzenz Hospital Dinslaken, Germany
| | - Marcus Jäger
- Department of Orthopaedics, Trauma and Reconstructive Surgery, Marienhospital Mülheim an der Ruhr, University of Duisburg-Essen
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Nijenhuis TA, Bolink SAAN, Brokelman RBG. Fatigue fracture of an uncemented Zweymüller femoral stem at the neck-shoulder junction. BMJ Case Rep 2020; 13:13/11/e236328. [PMID: 33257368 DOI: 10.1136/bcr-2020-236328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A fracture through the neck of the femoral stem in total hip arthroplasty is extremely rare. We report a neck fracture of a cementless Zweymüller stem, one of the most implanted stems worldwide. According to our knowledge, this is the first thorough case description of a neck fracture of a cementless Zweymüller stem. The case concerns a 53-year-old man, with a body weight of 103 kg and a body mass index of 31. We consider potential risk factors for a femoral stem fracture, such as patient-related factors, suboptimal implant positioning, surgical technique and implant characteristics.
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10
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Nezwek TA, Rothy AC, Chapman RM, Van Citters DW, Koenig K. Bilateral Femoral Component Fractures After Primary Total Knee Arthroplasty With Cruciate-Retaining Femoral Component. Arthroplast Today 2020; 6:496-501. [PMID: 32695866 PMCID: PMC7363632 DOI: 10.1016/j.artd.2020.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/18/2020] [Accepted: 06/01/2020] [Indexed: 11/25/2022] Open
Abstract
A 69-year-old male presented with atraumatic bilateral femoral component fractures at different time intervals after simultaneous bilateral total knee arthroplasty using the cemented Biomet Ascent Knee System. The right and left knee implant fractures occurred 12 and 17 years after primary arthroplasty, respectively. This patient was notably tall (190.5 cm, 98th percentile) and maintained an active lifestyle before implant fractures. Sequential, bilateral knee implant fractures in a system with a previously acceptable track record suggest that biomechanics, patient characteristics, and surgical factors can significantly influence the risks for fracture of an implant.
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Affiliation(s)
| | - Alexander C Rothy
- Department of Surgery and Perioperative Care, The University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Ryan M Chapman
- Dartmouth College Thayer School of Engineering, Hanover, NH, USA
| | | | - Karl Koenig
- Department of Surgery and Perioperative Care, The University of Texas at Austin Dell Medical School, Austin, TX, USA
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11
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Rickman MS, Lewis PL, Chou DT, Donnelly W, Graves SE, Lorimer M. Risk factors for femoral stem breakage: an analysis of the AOANJRR results. Hip Int 2020; 30:319-326. [PMID: 30945555 DOI: 10.1177/1120700019839206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Breakage of the femoral stem component of a total hip replacement is now uncommon but continues to be seen with certain stem designs and in certain patient groups. Data previously published on this topic has been limited, either gathered from a single surgeon or centre, or included only a single stem design. METHODS We reviewed the data from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), identified and analysed 143 stem breakages over a period of 16 years, covering 44 different stem designs. RESULTS Our data confirms previously published findings that risk factors for stem breakage include patient age at implantation of under 70, male gender, as well as the use of exchangeable necks. We found no association with initial diagnosis, or type of acetabular component implanted. We did however also find, excluding exchangeable neck designs, that after 4.5 years a cemented stem had a significantly higher risk of breakage then a cementless stem. DISCUSSION To our knowledge this is the 1st paper to suggest cemented fixation as a specific risk factor for stem breakage. The analysis of rare complications such as stem breakage is only possible through large data collection systems such as the AOANJRR. Whilst there have been recent advances in materials and manufacturing techniques, we recommend that surgeons are aware of all the specific risks when considering implant choices for individual patients.
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Affiliation(s)
- Mark S Rickman
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, Australia.,Discipline of Orthopaedics and Trauma, University of Adelaide, Australia
| | - Peter L Lewis
- Wakefield Orthopaedic Clinic, Adelaide, Australia.,AOA (Australian Orthopaedic Association) National Joint Replacement Registry, SAHMRI (South Australia Health and Research Institute), Adelaide, Australia
| | - Daud Ts Chou
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, Australia.,Discipline of Orthopaedics and Trauma, University of Adelaide, Australia
| | | | - Stephen E Graves
- AOA (Australian Orthopaedic Association) National Joint Replacement Registry, SAHMRI (South Australia Health and Research Institute), Adelaide, Australia
| | - Michelle Lorimer
- AOA (Australian Orthopaedic Association) National Joint Replacement Registry, SAHMRI (South Australia Health and Research Institute), Adelaide, Australia
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12
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Falkenberg A, Dickinson EC, Morlock MM. Adapter sleeves are essential for ceramic heads in hip revision surgery. Clin Biomech (Bristol, Avon) 2020; 71:1-4. [PMID: 31671337 DOI: 10.1016/j.clinbiomech.2019.10.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 10/11/2019] [Accepted: 10/17/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Removing a head during isolated acetabular revision surgery can cause damage to the stem taper surface from extraction tool contact. Implanting a ceramic head on the damaged stem taper might elevate the fracture risk, which can be mitigated with the use of titanium adapter sleeves. The aim of this study was to investigate whether the improved fracture strength of modern generation ceramic heads allows the direct implantation on damaged stem tapers without an adapter sleeve. METHODS Finite element models of taper junctions with and without adapter sleeve were generated. Different stem taper damages were modelled to investigate the influence on the ceramic head fracture load under axial compression. FINDINGS Heads without adapter sleeves exhibited slightly higher or equal fracture strengths compared with sleeved heads for most scenarios. However, a small metal elevation on the stem taper caused a drastic decrease of the fracture strength if no adapter sleeve was used (-96%). The sleeved head was not influenced by the metal elevation damage. INTERPRETATION Adapter sleeves are essential to ensure patient safety and prosthesis longevity whenever implanting ceramic heads on used stem tapers.
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Affiliation(s)
- Adrian Falkenberg
- Institute of Biomechanics, TUHH Hamburg University of Technology, Hamburg, Germany.
| | - Emilie C Dickinson
- Institute of Biomechanics, TUHH Hamburg University of Technology, Hamburg, Germany
| | - Michael M Morlock
- Institute of Biomechanics, TUHH Hamburg University of Technology, Hamburg, Germany
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13
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Kusk MW. Artefact or hip prosthetic fracture on multislice CT? The importance of correct positioning when scanning metal implants. Radiography (Lond) 2019; 25:e75-e77. [PMID: 31301795 DOI: 10.1016/j.radi.2018.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 11/27/2018] [Accepted: 12/03/2018] [Indexed: 11/16/2022]
Affiliation(s)
- M W Kusk
- Hospital of Southwest Jutland, Department of Radiology and Nuclear Medicine, Finsensgade 35, 6700 Esbjerg, Denmark.
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14
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Sonntag R, Gibmeier J, Pulvermacher S, Mueller U, Eckert J, Braun S, Reichkendler M, Kretzer JP. Electrocautery Damage Can Reduce Implant Fatigue Strength: Cases and in Vitro Investigation. J Bone Joint Surg Am 2019; 101:868-878. [PMID: 31094978 DOI: 10.2106/jbjs.18.00259] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The risk of femoral stem fracture after total hip replacement is low and can often be associated with a specific implant system or other factors that may reduce the fatigue strength. Additionally, damage to a metal component during revision surgery by an electrocautery device may further affect the fatigue behavior. METHODS Two clinical cases of stem failure after revision of fractured ceramic components are presented; the retrieved components were analyzed for the cause of failure. In vitro cyclic load-to-failure testing of titanium alloy femoral stems after electrocautery application at 2 different locations (at the base and about midway on the femoral neck) was performed using a stepwise increase in load until implant fracture occurred. In addition, a detailed characterization of the local material structure around the electrocautery marks was performed. RESULTS Superficial discoloration and melting marks were found on the retrieved components, including at the location of crack initiation in the anterolateral region, which may have reduced the fatigue strength of the material. In addition, elemental analysis indicated material transfer from the electrocautery tip. Damage to the surface by the electrocautery device significantly reduced the in vitro load to failure by up to 47% compared with that of undamaged femoral neck specimens. Material analysis revealed a relevant modification in microstructure, with an extension of approximately 2.7 mm and a depth of 550 µm, which could be divided in 3 structural zones. CONCLUSIONS Intraoperative electrocautery device contact with the implant during surgical revision of a total hip replacement cannot always be avoided. However, on the basis of our findings, the risk of implant failure is increased due to a change in microstructure and a potential reduction of the implant's fatigue strength. Surgeons and manufacturers of electrocautery devices should be aware of this concern. CLINICAL RELEVANCE During revision surgery, contact between an electrocautery device and the femoral component should be avoided to reduce the chance of subsequent femoral neck fracture.
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Affiliation(s)
- Robert Sonntag
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Jens Gibmeier
- Institute of Applied Materials, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Samuel Pulvermacher
- Institute of Applied Materials, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Ulrike Mueller
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Johannes Eckert
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Steffen Braun
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Markus Reichkendler
- Department of Orthopedic and Trauma Surgery, District Hospital Schwaz, Schwaz, Austria
| | - J Philippe Kretzer
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
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Barrow JA, Divecha HM, Panchani S, Boden R, Chitre A, Gambhir A, Porter ML, Board TN. Is patient satisfaction related to patient reported sounds from ceramic on ceramic total hip arthroplasty? A study of 265 hips. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 29:1243-1251. [DOI: 10.1007/s00590-019-02426-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 03/26/2019] [Indexed: 12/12/2022]
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Howard DP, Wall PDH, Fernandez MA, Parsons H, Howard PW. Ceramic-on-ceramic bearing fractures in total hip arthroplasty. Bone Joint J 2017; 99-B:1012-1019. [DOI: 10.1302/0301-620x.99b8.bjj-2017-0019.r1] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 04/24/2017] [Indexed: 12/23/2022]
Abstract
Aims Ceramic-on-ceramic (CoC) bearings in total hip arthroplasty (THA) are commonly used, but concerns exist regarding ceramic fracture. This study aims to report the risk of revision for fracture of modern CoC bearings and identify factors that might influence this risk, using data from the National Joint Registry (NJR) for England, Wales, Northern Ireland and the Isle of Man. Patients and Methods We analysed data on 223 362 bearings from 111 681 primary CoC THAs and 182 linked revisions for bearing fracture recorded in the NJR. We used implant codes to identify ceramic bearing composition and generated Kaplan-Meier estimates for implant survivorship. Logistic regression analyses were performed for implant size and patient specific variables to determine any associated risks for revision. Results A total of 222 852 bearings (99.8%) were CeramTec Biolox products. Revisions for fracture were linked to seven of 79 442 (0.009%) Biolox Delta heads, 38 of 31 982 (0.119%) Biolox Forte heads, 101 of 80 170 (0.126%) Biolox Delta liners and 35 of 31 258 (0.112%) Biolox Forte liners. Regression analysis of implant size revealed smaller heads had significantly higher odds of fracture (chi-squared 68.0, p < 0.001). The highest fracture risk was observed in the 28 mm Biolox Forte subgroup (0.382%). There were no fractures in the 40 mm head group for either ceramic type. Liner thickness was not predictive of fracture (p = 0.67). Body mass index (BMI) was independently associated with revision for both head fractures (odds ratio (OR) 1.09 per unit increase, p = 0.031) and liner fractures (OR 1.06 per unit increase, p = 0.006). Conclusions We report the largest independent study of CoC bearing fractures to date. The risk of revision for CoC bearing fracture is very low but previous studies have underestimated this risk. There is good evidence that the latest generation of ceramic has greatly reduced the odds of head fracture but not of liner fracture. Small head size and high patient BMI are associated with an increased risk of ceramic bearing fracture. Cite this article: Bone Joint J 2017;99-B:1012–19.
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Affiliation(s)
- D. P. Howard
- University Hospitals Leicester NHS Trust, Gwendolen
Road, Leicester LE5 4PW, UK
| | - P. D. H. Wall
- University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry, UK
| | - M. A. Fernandez
- University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry, UK
| | - H. Parsons
- University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry, UK
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Napier RJ, Shimmin AJ. Ceramic-on-ceramic bearings in total hip arthroplasty: “The future is now”. ACTA ACUST UNITED AC 2016. [DOI: 10.1053/j.sart.2017.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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19
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Gilg MM, Zeller CW, Leitner L, Leithner A, Labek G, Sadoghi P. The incidence of implant fractures after knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2016; 24:3272-3279. [PMID: 27154281 DOI: 10.1007/s00167-016-4160-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 04/27/2016] [Indexed: 11/27/2022]
Abstract
PURPOSE This study aimed to evaluate the incidence of "implant" fractures after knee arthroplasty using clinical literature and worldwide arthroplasty registers. The hypothesis was that register datasets report higher rates of these rare complications than clinical studies. METHODS Calculations were based on the pooled incidence of revision operations after fractures of knee arthroplasties, comparing clinical studies published in MEDLINE-listed journals and annual reports from worldwide arthroplasty registers in a structured literature analysis based on a standardized methodology. RESULTS Twelve clinical studies and datasets from six worldwide registers were included. Rates of fractures of knee arthroplasties were reported from 0.2 to 2.5 % in clinical studies versus 0.02-0.17 % in worldwide arthroplasty registers. CONCLUSIONS Fractures of knee arthroplasty systems are rare complications, with clinical studies showing higher incidence rates than worldwide arthroplasty registries. Unicompartmental knee arthroplasty (UKA) implanted before 2000, constrained primary or revision constrained total knee arthroplasties, and patellar replacements showed the highest incidence of implant fracture. The results of this analysis can help clinicians to counsel patients on potential complications following knee arthroplasty. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Magdalena M Gilg
- Department of Orthopedic Surgery, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Christian W Zeller
- Department of Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93042, Regensburg, Germany
| | - Lukas Leitner
- Department of Orthopedic Surgery, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Andreas Leithner
- Department of Orthopedic Surgery, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Gerold Labek
- Department of Orthopedic Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Patrick Sadoghi
- Department of Orthopedic Surgery, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria.
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20
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Farhat S, Gilliam M, Samaniego C, Dwarshuis N, Carson J, Peterson B, Zand A. Plasma engineered surfaces for orthopedic devices. JOURNAL OF BIOMATERIALS SCIENCE-POLYMER EDITION 2016; 27:839-53. [DOI: 10.1080/09205063.2016.1164551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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21
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Schwartz BE, Piponov HI, Helder CW, Mayers WF, Gonzalez MH. Revision total hip arthroplasty in the United States: national trends and in-hospital outcomes. INTERNATIONAL ORTHOPAEDICS 2016; 40:1793-802. [PMID: 26830782 DOI: 10.1007/s00264-016-3121-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 01/14/2016] [Indexed: 12/21/2022]
Abstract
PURPOSE With the increasing number of primary total hip arthroplasties (THA) being performed, the frequency of revision surgery is also expected to increase. We analysed the immediate in-hospital complications and epidemiologic data of 3,469 revision and 18,186 primary THA cases. METHODS The National Hospital Discharge Survey (NHDS) was evaluated between 2001 and 2010 for patients who underwent revision and primary THA. Patients were identified and included in our retrospective study based on ICD-9 procedure codes. RESULTS The number of primary and revision THAs increased steadily from 2001 to 2010. The revision burden decreased for the same studied period (r = -0.92) to reach 13.9 % in 2010. The South region had higher revision burden of 17.4 % (p < 0.001). The primary THA group was more likely to be obese, morbidly obese, and have hypertension (p < 0.001). The revision THA group had an increased rate of blood transfusions (p < 0.001), deep venous thrombosis (p = 0.008), post-operative sepsis (p < 0.001), and wound complications (p < 0.001). The in-hospital mortality rate was also higher for the revision THA group (0.6 % versus 0.2 %, p < 0.001). CONCLUSIONS The revision burden has undergone a steady decrease over the ten years studied and the reason for this is likely multifactorial. The South region had a significantly higher revision burden when compared to the rest of the United States. Larger hospitals tend to perform relatively more revisions. Revision THA patients are associated with longer hospital stay, higher complications rate, and higher in-hospital mortality rate.
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Affiliation(s)
- Brian E Schwartz
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, IL, USA
| | - Hristo I Piponov
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, IL, USA.
| | - Cory W Helder
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, IL, USA
| | - William F Mayers
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, IL, USA
| | - Mark H Gonzalez
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, IL, USA
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Abstract
The leading indication for revision total hip arthroplasty (THA) remains aseptic loosening owing to wear. The younger, more active patients currently undergoing THA present unprecedented demands on the bearings. Ceramic-on-ceramic (CoC) bearings have consistently shown the lowest rates of wear. The recent advances, especially involving alumina/zirconia composite ceramic, have led to substantial improvements and good results in vitro. Alumina/zirconia composite ceramics are extremely hard, scratch resistant and biocompatible. They offer a low co-efficient of friction and superior lubrication and lower rates of wear compared with other bearings. The major disadvantage is the risk of fracture of the ceramic. The new composite ceramic has reduced the risk of fracture of the femoral head to 0.002%. The risk of fracture of the liner is slightly higher (0.02%). Assuming that the components are introduced without impingement, CoC bearings have major advantages over other bearings. Owing to the superior hardness, they produce less third body wear and are less vulnerable to intra-operative damage. The improved tribology means that CoC bearings are an excellent choice for young, active patients requiring THA. Cite this article: Bone Joint J 2016;98-B(1 Suppl A):14–17.
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Affiliation(s)
- U. Sentuerk
- Charité University Hospital Berlin, Charitéplatz
1, 10117 Berlin, Germany
| | - P. von Roth
- Charité University Hospital Berlin, Charitéplatz
1, 10117 Berlin, Germany
| | - C. Perka
- Charité University Hospital Berlin, Charitéplatz
1, 10117 Berlin, Germany
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Teng S, Yi C, Krettek C, Jagodzinski M. Bisphosphonate Use and Risk of Implant Revision after Total Hip/Knee Arthroplasty: A Meta-Analysis of Observational Studies. PLoS One 2015; 10:e0139927. [PMID: 26444555 PMCID: PMC4596810 DOI: 10.1371/journal.pone.0139927] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 09/19/2015] [Indexed: 01/08/2023] Open
Abstract
Objective Several studies investigated the association between bisphosphonate use and the risk of implant revision after total hip or knee arthroplasty (THA or TKA); However, the findings were inconsistent. We performed this meta-analysis to evaluate the overall relative risk of such an event. Methods We searched the PubMed, EMBASE and Cochrane library databases to identify relevant publications on April 22, 2015. To calculate the pooled risk ratios (RRs) with 95% confidential intervals (CIs), a fixed- or random-effects model was applied based on the heterogeneity across studies. Results Three cohort studies and one case-control study were included in this meta-analysis. Compared with the bisphosphonate nonusers, the patients who used bisphosphonates for a long period of time had a significantly decreased risk of implant revision after THA/TKA (summary adjusted RR = 0.48, 95% CI: 0.38–0.61), and the summary adjusted RRs for the users who underwent THA and those who underwent TKA were 0.47 (95% CI: 0.36–0.61) and 0.45 (95% CI: 0.21–0.95), respectively. Conclusions Long-term use of bisphosphonates is correlated with a significantly decreased risk of implant revision after THA/TKA. However, due to limited number of the included studies, the findings of the present study should be treated with caution. More well-designed studies are required to further confirm our findings.
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Affiliation(s)
- Songsong Teng
- Department of Orthopedics, Shanghai First People's Hospital, Shanghai Jiao Tong University, Shanghai, P. R. China
- Department of Orthopedic Trauma, Hannover Medical School, Hanover, Germany
| | - Chengqing Yi
- Department of Orthopedics, Shanghai First People's Hospital, Shanghai Jiao Tong University, Shanghai, P. R. China
- * E-mail:
| | - Christian Krettek
- Department of Orthopedic Trauma, Hannover Medical School, Hanover, Germany
| | - Michael Jagodzinski
- Department of Orthopedic Trauma, Agaplesion ev. Hospital Bethel, Bückeburg, Germany
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Chun YS, Juh HS, Cho YJ, Rhyu KH. Fracture of Fully-coated Femoral Stem after Primary Total Hip Arthroplasty for Nonunion of Intertrochanteric Fracture: A Case Report. Hip Pelvis 2015; 27:179-82. [PMID: 27536622 PMCID: PMC4972723 DOI: 10.5371/hp.2015.27.3.179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 08/04/2015] [Accepted: 08/04/2015] [Indexed: 12/03/2022] Open
Abstract
Femoral stem fracture is an uncommon reason for the failure of total hip arthroplasty, with only 16 cases of fully coated stem fractures reported to date. Here we report a case in which a fully coated primary femoral stem fracture occurred after conversion to total hip arthroplasty for the non-union of an intertrochanteric fracture of the femur. Metallurgic evaluation of the etiology and mechanism revealed that the fracture was initiated by fatigue-related failure and completed by ductile failure on the posterior side of the fracture. Considering the recent trend of treating an intertrochanteric fracture with hip arthroplasty, possible stem failure should be considered, since most patients will have at least one of the known risk factors for stem fracture.
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Affiliation(s)
- Young Soo Chun
- Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Hyung Suk Juh
- Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Yoon Je Cho
- Department of Orthopaedic Surgery, Kyung Hee University Hospital, Seoul, Korea
| | - Kee Hyung Rhyu
- Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Korea
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25
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[Damage to implants due to high-frequency electrocautery : analysis of four fractured hip endoprostheses shafts]. DER ORTHOPADE 2015; 43:1106-10. [PMID: 25270081 DOI: 10.1007/s00132-014-3023-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
In revision surgery of joints, high-frequency electrocauterization instruments are used for homeostasis and dissection of soft tissue. If there is contact of these instruments with the metal implants, flashover can occur. This can lead to thermal microstructural changes in the material and as a consequence may reduce the fatigue strength of the implant. Four cases of hip revision surgeries were analysed. In all cases flashovers occurred and secondarily, the titanium hip endoprosthesis stem broke in the neck section of the prosthesis. The conducted investigations showed that contact between the high-frequency instrument and the anterolateral aspect of the endoprosthesis neck had occurred. Electrothermal implant damage was found in the broken area. If in hip revision surgery the stem is not to be replaced, contact between high-frequency instruments and the metal implant should be avoided.
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Heiner AD, Mahoney CR. Fracture of a BIOLOX Delta Ceramic Femoral Head Articulating Against a Polyethylene Liner: A Case Report. JBJS Case Connect 2014; 4:e97. [PMID: 29252765 DOI: 10.2106/jbjs.cc.n.00040] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
CASE A forty-five-year-old woman underwent primary total hip arthroplasty with a 36-mm BIOLOX delta ceramic femoral head articulating against a polyethylene liner. She presented with hip pain at eighteen months postoperatively, two months after being in a bicycle accident; fracture of the femoral head was diagnosed. CONCLUSION The possibility of a ceramic femoral head fracture should be decreased with use of the latest generation of ceramic material, a ceramic-on-polyethylene articulation rather than a ceramic-on-ceramic articulation, and a larger head size, all of which applied to this case. Taper-trunnion compatibility and correct intraoperative handling of the components are also essential.
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Affiliation(s)
- Anneliese D Heiner
- Department of Orthopaedics and Rehabilitation and Department of Biomedical Engineering, Orthopaedic Biomechanics Laboratory, University of Iowa, 2181 Westlawn Building, Iowa City, IA 52242-1100.
| | - Craig R Mahoney
- Iowa Orthopaedic Center, 450 Laurel Street, Des Moines, IA 50314
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