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Piple AS, Wang JC, Hill W, Chen MS, Gettleman BS, Liu KC, Heckmann ND, Christ AB. Postoperative outcomes and trends in computer-navigated and robotic-assisted total hip arthroplasty. Hip Int 2024; 34:569-577. [PMID: 39114946 DOI: 10.1177/11207000241264256] [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] [Indexed: 09/18/2024]
Abstract
INTRODUCTION As the volume of technology-assisted total hip arthroplasty (THA) increases, there is a need to characterise the outcomes of robotic-assisted (RA) and computer-navigated (CN) THA. The goal of this study was to assess outcomes and opioid consumption following CN-THA and RA-THA compared to conventionally-instrumented (CON) THA. METHODS The Premier Database was queried for all patients who underwent primary, elective THA from 2015-2020. Patients were divided into 3 groups: CN, RA, or CON-THA. Yearly usage trends were assessed. Univariate and multivariate analyses were performed to assess the 90-day risk of postoperative complications. Opioid consumption was reported in morphine milligram equivalents (MME) for postoperative days (POD) 0 and 1. RESULTS Overall, 474,707 elective THAs were identified (95.7% CON, 2.1% CN, 2.2% RA. After accounting for confounders, CN-THA patients were at decreased risk for periprosthetic joint infection (PJI) (aOR: 0.55, p < 0.001) and dislocation (aOR 0.45, p < 0.001), but increased risk for blood transfusion (aOR 1.97, <0.001) compared to CON-THA. RA-THA patients were at decreased risk of dislocation (aOR:0.66, p < 0.001) but increased risk for transfusion (aOR 1.20, p < 0.001), prosthesis breakage (aOR 3.88, p < 0.001), and periprosthetic fracture (aOR 1.72, p < 0.001). Opioid consumption for CN-THA patients was lower on POD1 and lower for RA-THA patients POD0 and 2 compared to CON-THA. DISCUSSION CN-THA was associated with reduced rates of PJI and dislocation, but increased rates of blood transfusion while RA-THA was associated with decreased rates of dislocation, but increased rates of blood transfusion, prosthesis complications, and periprosthetic fracture compared to CON-THA. Technology-assisted THA was associated with lower postoperative opioid consumption.
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Affiliation(s)
- Amit S Piple
- Keck School of Medicine of USC, Los Angeles, CA, USA
| | | | - William Hill
- Keck School of Medicine of USC, Los Angeles, CA, USA
| | | | | | - Kevin C Liu
- Keck School of Medicine of USC, Los Angeles, CA, USA
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Dou X, Liu X, Liu Y, Wang L, Jia F, Shen F, Ma Y, Liang C, Jin G, Wang M, Liu Z, Zhu B, Liu X. Biomimetic Porous Ti6Al4V Implants: A Novel Interbody Fusion Cage via Gel-Casting Technique to Promote Spine Fusion. Adv Healthc Mater 2024:e2400550. [PMID: 39031096 DOI: 10.1002/adhm.202400550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 06/20/2024] [Indexed: 07/22/2024]
Abstract
An interbody fusion cage (Cage) is crucial in spinal decompression and fusion procedures for restoring normal vertebral curvature and rebuilding spinal stability. Currently, these Cages suffer from issues related to mismatched elastic modulus and insufficient bone integration capability. Therefore, a gel-casting technique is utilized to fabricate a biomimetic porous titanium alloy material from Ti6Al4V powder. The biomimetic porous Ti6Al4V is compared with polyetheretherketone (PEEK) and 3D-printed Ti6Al4V materials and their respective Cages. Systematic validation is performed through mechanical testing, in vitro cell, in vivo rabbit bone defect implantation, and ovine anterior cervical discectomy and fusion experiments to evaluate the mechanical and biological performance of the materials. Although all three materials demonstrate good biocompatibility and osseointegration properties, the biomimetic porous Ti6Al4V, with its excellent mechanical properties and a structure closely resembling bone trabecular tissue, exhibited superior bone ingrowth and osseointegration performance. Compared to the PEEK and 3D-printed Ti6Al4V Cages, the biomimetic porous Ti6Al4V Cage outperforms in terms of intervertebral fusion performance, achieving excellent intervertebral fusion without the need for bone grafting, thereby enhancing cervical vertebra stability. This biomimetic porous Ti6Al4V Cage offers cost-effectiveness, presenting significant potential for clinical applications in spinal surgery.
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Affiliation(s)
- Xinyu Dou
- Department of Orthopedics, Peking University Third Hospital, Beijing, 100191, China
| | - Xiao Liu
- Department of Orthopedics, Peking University Third Hospital, Beijing, 100191, China
| | - Yu Liu
- Department of Orthopedics, Peking University Third Hospital, Beijing, 100191, China
| | - Linbang Wang
- Department of Orthopedics, Peking University Third Hospital, Beijing, 100191, China
| | - Fei Jia
- Department of Spine Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250000, China
| | - Fei Shen
- Laboratory Animal Research Center, Peking University Third Hospital, Beijing, 100191, China
| | - Yunlong Ma
- Pain Medical Center, Peking University Third Hospital, Beijing, 100191, China
| | - Chen Liang
- Pain Medical Center, Peking University Third Hospital, Beijing, 100191, China
| | - Gong Jin
- ZhongAoHuiCheng Technology Co., Beijing, 100176, China
| | - Meina Wang
- ZhongAoHuiCheng Technology Co., Beijing, 100176, China
| | - Zhongjun Liu
- Department of Orthopedics, Peking University Third Hospital, Beijing, 100191, China
| | - Bin Zhu
- Department of Orthopaedics, Beijing Friendship Hospital Affiliated to Capital Medical University, Beijing, 100050, China
| | - Xiaoguang Liu
- Department of Orthopedics, Peking University Third Hospital, Beijing, 100191, China
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Constantinescu DS, Costello JP, Yakkanti RR, Vanden Berge DJ, Carvajal Alba JA, Hernandez VH, D'Apuzzo MR. Varying Complication Rates and Increased Costs in Technology-Assisted Total Hip Arthroplasty Versus Conventional Instrumentation in 1,372,300 Primary Total Hips. J Arthroplasty 2024; 39:1771-1776. [PMID: 38103802 DOI: 10.1016/j.arth.2023.12.019] [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: 01/16/2023] [Revised: 12/08/2023] [Accepted: 12/12/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND The use of technology allows surgeons increased precision in component positioning in total hip arthroplasty (THA). The objective of this study was to compare (1) perioperative complications and (2) resource utilizations between robotic-assisted (RA) and computer-navigated (CN) versus conventional instrumenttaion (CI) THA. METHODS A retrospective cohort study was performed using a large national database to identify patients undergoing unilateral, primary elective THA from January 1, 2016 to December 31, 2019 using RA, CN, or CI. There were 1,372,300 total patients identified and included RA (29,735), CN (28,480), and CI (1,314,085) THA. Demographics, complications, lengths of stay, dispositions, and costs were compared between the cohorts. Binary logistic regression analyses were performed. RESULTS The use of RA THA led to lower rates of intraoperative fracture (0.22% versus 0.39%), delirium (0.1% versus 0.2%), postoperative anemia (14.4% versus 16.7%), higher myocardial infarction (0.13% versus 0.08%), renal failure (1.7% versus 1.6%), blood transfusion (2.0% versus 1.9%), and wound dehiscence (0.02% versus 0.01%) compared to CI THA. The use of CN led to lower rates of respiratory complication (0.5% versus 0.8%), renal failure (1.1% versus 1.6%), blood transfusion (1.3% versus 1.9%), and pulmonary embolism (0.02% versus 0.1%) compared to CI THA. Total costs were increased in RA ($17,729 versus $15,977) and CN ($22,529 versus $15,977). Lengths of hospital stay were decreased in RA (1.8 versus 1.9 days) and CN (1.7 versus 1.9 days). CONCLUSIONS Perioperative complication rates vary in technology-assisted THA, with higher rates in RA THA and lower rates in CN THA, relative to CI THA. Both RA THA and CN THA were associated with more costs, shorter postoperative hospital stays, and higher rates of discharge home compared to CI THA.
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Affiliation(s)
- David S Constantinescu
- University of Miami Miller School of Medicine, Department of Orthopedic Surgery, Miami, Florida
| | - Joseph P Costello
- University of Miami Miller School of Medicine, Department of Orthopedic Surgery, Miami, Florida
| | - Ramakanth R Yakkanti
- Rothman Orthopaedic Institute at Jefferson Health, Department of Orthopaedic Surgery, Philadelphia, Pennsylvania
| | - Dennis J Vanden Berge
- University of Miami Miller School of Medicine, Department of Orthopedic Surgery, Miami, Florida
| | - Jaime A Carvajal Alba
- University of Miami Miller School of Medicine, Department of Orthopedic Surgery, Miami, Florida
| | - Victor H Hernandez
- University of Miami Miller School of Medicine, Department of Orthopedic Surgery, Miami, Florida
| | - Michele R D'Apuzzo
- University of Miami Miller School of Medicine, Department of Orthopedic Surgery, Miami, Florida
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Jillek B, Szabó P, Kopniczky J, Krafcsik O, Szabó I, Patczai B, Turzó K. Characterizing Surface Morphological and Chemical Properties of Commonly Used Orthopedic Implant Materials and Determining Their Clinical Significance. Polymers (Basel) 2024; 16:1193. [PMID: 38732662 PMCID: PMC11085225 DOI: 10.3390/polym16091193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/14/2024] [Accepted: 04/18/2024] [Indexed: 05/13/2024] Open
Abstract
The goal of the study was to compare the surface characteristics of typical implant materials used in orthopedic surgery and traumatology, as these determine their successful biointegration. The morphological and chemical structure of Vortex plate anodized titanium from commercially pure (CP) Grade 2 Titanium (Ti2) is generally used in the following; non-cemented total hip replacement (THR) stem and cup Ti alloy (Ti6Al4V) with titanium plasma spray (TPS) coating; cemented THR stem Stainless steel (SS); total knee replacement (TKR) femoral component CoCrMo alloy (CoCr); cemented acetabular component from highly cross-linked ultrahigh molecular weight polyethylene (HXL); and cementless acetabular liner from ultrahigh molecular weight polyethylene (UHMWPE) (Sanatmetal, Ltd., Eger, Hungary) discs, all of which were examined. Visualization and elemental analysis were carried out by scanning electron microscopy (SEM), energy dispersive spectroscopy (EDS) and X-ray photoelectron spectroscopy (XPS). Surface roughness was determined by atomic force microscopy (AFM) and profilometry. TPS Ti presented the highest Ra value (25 ± 2 μm), followed by CoCr (535 ± 19 nm), Ti2 (227 ± 15 nm) and SS (170 ± 11 nm). The roughness measured in the HXL and UHMWPE surfaces was in the same range, 147 ± 13 nm and 144 ± 15 nm, respectively. EDS confirmed typical elements regarding the investigated prosthesis materials. XPS results supported the EDS results and revealed a high % of Ti4+ on Ti2 and TPS surfaces. The results indicate that the surfaces of prosthesis materials have significantly different features, and a detailed characterization is needed to successfully apply them in orthopedic surgery and traumatology.
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Affiliation(s)
- Bertalan Jillek
- Department of Orthopedics, Somogy County Mór Kaposi Teaching Hospital, Tallián Gyula u. 20-32, H-7400 Kaposvár, Hungary
| | - Péter Szabó
- Szentágothai Research Center, Environmental Analytical and Geoanalytical Research Group, Ifjúság útja 20., H-7624 Pécs, Hungary;
| | - Judit Kopniczky
- Department of Optics and Quantum Electronics, University of Szeged, Dóm tér 9., H-6720 Szeged, Hungary;
| | - Olga Krafcsik
- Department of Atomic Physics, Budapest University of Technology and Economics, Budafoki út 8., H-1111 Budapest, Hungary
| | - István Szabó
- Department of Orthopedics, Somogy County Mór Kaposi Teaching Hospital, Tallián Gyula u. 20-32, H-7400 Kaposvár, Hungary
| | - Balázs Patczai
- Department of Traumatology and Hand Surgery, University of Pécs, Ifjúság u. 13., H-7624 Pécs, Hungary;
| | - Kinga Turzó
- Dental School, Medical Faculty, University of Pécs, Tüzér u. 1, H-7623 Pécs, Hungary;
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Barbier O, Rassat R, Caubère A, Dubreuil S, Estour G. Short-stem total hip arthroplasty is equivalent to a standard-length stem procedure in an unselected population at mid-term follow-up. INTERNATIONAL ORTHOPAEDICS 2024; 48:1017-1022. [PMID: 37934276 DOI: 10.1007/s00264-023-06020-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 10/18/2023] [Indexed: 11/08/2023]
Abstract
PURPOSE Limitations of standard-length femoral stems persist, including proximal-distal mismatch, non-ideal load transfer, loss of bone tissue, and perioperative fracture. Symbol® (Dedienne Santé, France) is a metaphyseal-engaging short-stem implant designed to address these issues in total hip arthroplasty (THA). While short stems have been well studied in selected and younger patients, it is unclear whether they offer advantages in an unselected population. We hypothesized that short femoral stems offer similar mid-term survivorship at five year minimum follow-up and function score to standard-length femoral stems, in an unselected patient population. METHODS We retrospectively reviewed a continuous unselected cohort of patients who undergone THA by one surgeon with a standard-length stem between November 2013 and October 2015, and a short stem between November 2015 and March 2017. We compared modified Harris Hip Score and Oxford Scores with a minimum follow-up of five years and procedural factors that could be associated with worse results with a short stem design. RESULTS There was no difference in survival rate between the two groups. Average Harris Hip Score and Oxford Scores at the last follow-up were comparable. A multivariate linear regression was performed to assess the relationship between modified Harrys Hip Score at five years post-operatively and the explanatory variables: age, body mass index, physical status score ASA (American Society of Anesthesiologists), and HHS pre-op. None was associated with the standard-length stem but for the short stem. CONCLUSION Short-stem implants provide good survival rate at mid-term; nevertheless, a steep learning curve is necessary to optimize the metaphyseal filling of the implant, especially for osteoporotic bone.
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Affiliation(s)
- Olivier Barbier
- Service de chirurgie orthopédique, HIA Sainte Anne, 2 boulevard Sainte Anne, 83000, Toulon, France.
| | - Robin Rassat
- Service de chirurgie orthopédique, HIA Sainte Anne, 2 boulevard Sainte Anne, 83000, Toulon, France
| | - Alexandre Caubère
- Service de chirurgie orthopédique, HIA Sainte Anne, 2 boulevard Sainte Anne, 83000, Toulon, France
| | - Sonia Dubreuil
- MEDI'CONSULTING, 4 rue du Couvent, 73240, Saint-Genix-sur-Guier, France
| | - Gilles Estour
- Médipôle de Savoie, 300 Av. des Massettes, 73190, Challes-les-Eaux, France
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Yee AHF, Chan VWK, Fu H, Chan PK, Chiu KY. Long-term follow-up of an uncemented proximally hydroxyapatite-coated femoral stem in total hip arthroplasty. Bone Joint J 2024; 106-B:110-114. [PMID: 38423107 DOI: 10.1302/0301-620x.106b3.bjj-2023-0844.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Aims The aim of this study was to evaluate the survival of a collarless, straight, hydroxyapatite-coated femoral stem in total hip arthroplasty (THA) at a minimum follow-up of 20 years. Methods We reviewed the results of 165 THAs using the Omnifit HA system in 138 patients, performed between August 1993 and December 1999. The mean age of the patients at the time of surgery was 46 years (20 to 77). Avascular necrosis was the most common indication for THA, followed by ankylosing spondylitis and primary osteoarthritis. The mean follow-up was 22 years (20 to 31). At 20 and 25 years, 113 THAs in 91 patients and 63 THAs in 55 patients were available for review, respectively, while others died or were lost to follow-up. Kaplan-Meier analysis was performed to evaluate the survival of the stem. Radiographs were reviewed regularly, and the stability of the stem was evaluated using the Engh classification. Results A total of seven stems (4.2%) were revised during the study period: one for aseptic loosening, three for periprosthetic fracture, two for infection, and one for recurrent dislocation. At 20 years, survival with revision of the stem for any indication and for aseptic loosening as the endpoint was 96.0% (95% confidence interval (CI) 92.6 to 99.5) and 98.4% (95% CI 96.2 to 100), respectively. At 25 years, the corresponding rates of survival were 94.5% (95% CI 89.9 to 99.3) and 98.1% (95% CI 95.7 to 99.6), respectively. There was radiological evidence of stable bony fixation in 86 stems (76.1%) and evidence of loosening in four (3.5%) at 20 years. All patients with radiological evidence of loosening were asymptomatic. Conclusion The Omnifit HA femoral stem offered promising long-term survival into the third decade.
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Affiliation(s)
- Andy H F Yee
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong, Hong Kong
- Department of Orthopaedics and Traumatology, School of Clinical Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong
| | - Vincent W K Chan
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong, Hong Kong
- Department of Orthopaedics and Traumatology, School of Clinical Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong
| | - Henry Fu
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong, Hong Kong
- Department of Orthopaedics and Traumatology, School of Clinical Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong
| | - Ping-Keung Chan
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong, Hong Kong
- Department of Orthopaedics and Traumatology, School of Clinical Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong
| | - Kwong Y Chiu
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong, Hong Kong
- Department of Orthopaedics and Traumatology, School of Clinical Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong
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Di Martino A, Ferri R, Bordini B, Brunello M, Rossomando V, Digennaro V, Traina F, Faldini C. Long-term survival and complication rate of cementless prosthetic stems in primary total hip arthroplasty categorized by types according to Mont classification: a regional registry-based study on 53,626 implants. Arch Orthop Trauma Surg 2024; 144:1423-1435. [PMID: 38112778 DOI: 10.1007/s00402-023-05144-x] [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: 08/05/2023] [Accepted: 11/11/2023] [Indexed: 12/21/2023]
Abstract
INTRODUCTION The purpose of this retrospective registry-based study is to assess survival and causes of failure of cementless stem implants used in total hip arthroplasty (THAs), to ascertain if there are differences when these are categorized according to the six types described by Mont. METHODS Data collected from the regional registry regarding all primary THAs performed from 2000 to 2019 were analyzed. Femoral prosthetic stems were divided into the six types of Mont classification. For each stem type, number of implants, survival and causes of failure were evaluated and compared. RESULTS The most frequently implanted stem type was the 3c type (53.4%). Type 1 had the lowest stem failure rate (1.6%), and type 6 showed the highest (3.9%). Periprosthetic fracture was the most frequent complication in type 6, accounting for 34.5% of failures. Aseptic loosening was the main complication in type 2 stems, accounting for 36.4% of failures. Pairwise comparisons showed significant higher survival of type 1 compared to type 3c (p = 0.000026) and type 6 (p = 0.000076), and between type 3a compared to type 3c (p = 0.03) and type 6 (p = 0.026). CONCLUSION Significant variations in implant survival rates were found among the six Mont-types of cementless stems. These findings emphasize the paramount importance of stem design and fixation area in determining long-term survival, providing a guidance for orthopedic surgeons in the selection of the most appropriate stem for primary THA, contributing to our understanding of cementless stem performance, presenting invaluable insights to further improve patient outcomes in THA surgery.
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Affiliation(s)
- Alberto Di Martino
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy.
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40136, Bologna, Italy.
| | - Riccardo Ferri
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40136, Bologna, Italy
| | - Barbara Bordini
- Medical Technology Lab, IRCCS - Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli, 1, 40136, Bologna, Italy
| | - Matteo Brunello
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40136, Bologna, Italy
| | - Valentino Rossomando
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40136, Bologna, Italy
| | - Vitantonio Digennaro
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Francesco Traina
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40136, Bologna, Italy
- Ortopedia, Traumatologia e Chirurgia Protesica e dei Reimpianti di Anca e Ginocchio, IRCCS Istituto Ortopedico Rizzoli, 40136, Bologna, Italy
| | - Cesare Faldini
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40136, Bologna, Italy
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Meißner N, Halder AM, Schrednitzki D. Cemented and hybrid total hip arthroplasty lead to lower blood loss in primary total hip arthroplasty: a retrospective study. Arch Orthop Trauma Surg 2023; 143:6447-6451. [PMID: 37036500 PMCID: PMC10088768 DOI: 10.1007/s00402-023-04851-9] [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: 12/25/2022] [Accepted: 03/18/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND Little scientific evidence exists on blood loss and transfusion rates depending on the fixation technique. The hypothesis of this study was that the blood loss and transfusion rate are lower in cemented and hybrid total hip arthroplasty (THA) compared to cementless THA. METHODS We retrospectively compared a total of 1500 patients who received either cementless, cemented, hybrid or reverse hybrid THA. All patients underwent THA in 2021 at a single orthopedic center in Germany. RESULTS The lowest blood loss was found in patients who received a fully cemented THA (695 ± 74 ml). Hybrid THA with a cemented stem showed a blood loss of 845 ± 30 ml and reverse hybrid THA showed the highest blood loss with an average of 994 ± 74 ml. Cementless THA caused an average blood loss of 957 ± 16 ml. There was a significant difference between cementless THA, hybrid THA (cemented stem), and fully cemented THA (p < 0.05). Transfusion rates ranged from 1.3% (cementless THA) to 7.9% (cemented THA) between the groups with a transfusion rate of 2.5% overall. CONCLUSION We found significantly lower blood loss in cemented THA and hybrid THA compared to cementless THA. Although blood loss was lower in cemented and hybrid THA, this did not result in lower transfusion rates. This could be due to other confounders such as age, comorbidities, and preoperative anemia.
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Affiliation(s)
- Nils Meißner
- Department of Orthopaedic Surgery, Sana Kliniken Sommerfeld, Waldhausstr. 44, 16766, Kremmen, Germany.
| | - Andreas M Halder
- Department of Orthopaedic Surgery, Sana Kliniken Sommerfeld, Waldhausstr. 44, 16766, Kremmen, Germany
| | - Daniel Schrednitzki
- Department of Orthopaedic Surgery, Sana Kliniken Sommerfeld, Waldhausstr. 44, 16766, Kremmen, Germany
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Davey MS, Doyle TR, Murphy E, Fenelon C, Murphy CG, Cassar-Gheiti AJ. Battle of the titans: Survivorship analysis of the 3 most common types of uncemented femoral stems used across national registries. J Orthop 2023; 43:41-47. [PMID: 37564704 PMCID: PMC10409998 DOI: 10.1016/j.jor.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 07/16/2023] [Indexed: 08/12/2023] Open
Abstract
Background Although many institutions utilize uncemented stems as routine in performing total hip arthroplasty (THA), many surgeons continue to rely on outcomes reported in the literature in the form of small cohorts and patient series when analyzing survivorship for specific implants. The purpose of this study was to identify and analyze the survivorship of the 3 most common uncemented stem types (as opposed to brands) used across multiple national joint registries. Methods A review of data available from all national joint registries was carried out in July 2022. Analysis of each individual registry and classified uncemented implants into the seven different uncemented stem types. The 3 most common stem types were identified, and average cumulative revision rates calculated. Metal on metal bearings surface implants were excluded from this study due to high revision rates across all implant types. Results Our detailed review identified 6 out of 13 (NJR, AOANJRR, LROI, EPRD, MARCQI and the NZJR) international registries reporting implant specific survivorship on uncemented femoral stems; including 960,328 uncemented stems across all registries. The most common type of stem used was type 3c, accounting for 61% (583,724), followed by type 1 stems with 23% (217,897) and type 2 stems with 8% (79,257). Cumulative revision rates at 13 years follow-up for these stems ranged from 6.9% to 7.9%. Conclusion Although all stem types have comparable revision rates across all registries, the most common uncemented stem reported was the type 3c, tapered rectangular fully coated stem. Furthermore, out of all type 3c, the Müller design philosophy with full hydroxyapatite coating seems to be the most sought after worldwide. In this study we can conclude, thus far, that there does not appear to clinical or statistical differences in revision rates between the different stem types. Level of evidence III.
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Affiliation(s)
- Martin S. Davey
- Royal College of Surgeons in Ireland, Dublin, Ireland
- Galway University Hospitals, Galway, Ireland
| | | | - Evelyn Murphy
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Colin G. Murphy
- Galway University Hospitals, Galway, Ireland
- University of Galway, Galway, Ireland
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Alexander JS, Lombardi AV, Berend KR, Houserman DJ, Adams JB, Crawford DA. Minimum 25-Year Results of a Tapered Titanium Porous Plasma Spray Coated Femoral Component. J Arthroplasty 2023; 38:1802-1807. [PMID: 36924856 DOI: 10.1016/j.arth.2023.03.021] [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: 08/29/2022] [Revised: 03/06/2023] [Accepted: 03/09/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Previous studies have reported excellent results with tapered, titanium, porous plasma-sprayed components in patients undergoing uncemented primary total hip arthroplasty (THA). The purpose of this study was to examine survival and clinical results at a minimum 25-year follow-up. METHODS We reviewed all patients who underwent primary THA at our center through 1995 with a specific femoral component that was essentially unchanged since its 1984 introduction, except porous coating was continued circumferentially in 1987, a hydroxyapatite-coated option was offered in 1988, and an offset option was added in 1999. There were 332 patients (396 THA) who had a minimum 25-year follow-up (range, 25 to 37). Mean age at surgery was 48 years (range, 21 to 70 years). Mean follow-up in nonfailed patients was 29 years (range, 25 to 37 years). RESULTS There were 31 femoral revisions (7.8%): 9 infections, 3 failures of ingrowth, 5 aseptic loosening, 8 osteolysis well-fixed, 2 periprosthetic fractures, 2 polyethylene wear with trochanteric avulsion, 1 component breakage, and 1 malalignment well-fixed. Kaplan-Meier survival with the endpoint of all-cause stem revision was 94.8% (95% confidence interval: ±0.9%) at 37 years, and with the endpoint of aseptic loosening/failure of ingrowth was 98.7% (95% confidence interval: ±0.5) at 37 years. Harris hip scores improved significantly from 43 preoperatively to 76 most recently. CONCLUSION This tapered, titanium, porous plasma spray-coated femoral component continues to demonstrate high long-term survival with a low rate of femoral component revision for any reason or aseptic loosening/failure of ingrowth.
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11
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Wahbeh JM, Park SH, Iyer S, Ebramzadeh E, Sangiorgio SN. Observations of bony ongrowth and clinical fixation in two retrieved disc replacements. J Biomed Mater Res B Appl Biomater 2023. [PMID: 37191359 DOI: 10.1002/jbm.b.35263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 04/26/2023] [Accepted: 04/28/2023] [Indexed: 05/17/2023]
Abstract
Total disc replacements utilize textured coatings to maximize bony ongrowth. However, the contribution of direct bony attachment to overall fixation for total disc replacements has not been reported. The goal of the present study was to document the extent of bony attachment to the surfaces of two clinically functional total disc replacements that were securely fixed at the time of revision. Two metal-and-polymeric disc replacements, one cervical and one lumbar, were evaluated following surgical retrieval. The cervical device was retrieved at 8 months and the lumbar device at 28 months post-operative. Both devices were reported well-fixed at the time of removal, with large bone masses attached to one endplate of each device. Visual inspections, non-destructive gravimetric measurements, and surface metrology were performed to assess fixation. These inspections suggested that both devices had been fixed at the time of removal with little in vivo mechanical damage, as surgical extraction damage was noted on both devices and provided imaging showed a lack of device migration. Devices were then embedded and sectioned to evaluate the bone-implant interface. High resolution photographs and contact microradiographs were taken to assess bony attachment. In contrast to initial analysis, these images revealed radiolucent gaps between the endplates and bone masses. Little direct contact between the bone and endplate surface was identified and the original surgical cuts were still visible. Both devices were clinically fixed at the time of removal and neither had complications associated with loosening. However, osseointegration was minimal in one of the devices and altogether absent from the other. The findings of the present study suggest that other factors may influence overall clinical fixation such as the surgical preparation of the vertebral bone or the surface roughness of the treated endplates. Despite the limitations of the present study, this information is unique to the current total disc replacement literature and the ongrowth and fixation of devices should be considered as a topic for future investigation.
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Affiliation(s)
- Jenna M Wahbeh
- The J. Vernon Luck, Sr., M.D. Orthopaedic Research Center, The Luskin Orthopaedic Institute for Children in Alliance with UCLA, Los Angeles, CA, United States
- Department of Bioengineering, University of California, Los Angeles, California, USA
| | - Sang-Hyun Park
- The J. Vernon Luck, Sr., M.D. Orthopaedic Research Center, The Luskin Orthopaedic Institute for Children in Alliance with UCLA, Los Angeles, CA, United States
- Department of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, California, USA
| | - Sumant Iyer
- The J. Vernon Luck, Sr., M.D. Orthopaedic Research Center, The Luskin Orthopaedic Institute for Children in Alliance with UCLA, Los Angeles, CA, United States
| | - Edward Ebramzadeh
- The J. Vernon Luck, Sr., M.D. Orthopaedic Research Center, The Luskin Orthopaedic Institute for Children in Alliance with UCLA, Los Angeles, CA, United States
- Department of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, California, USA
| | - Sophia N Sangiorgio
- The J. Vernon Luck, Sr., M.D. Orthopaedic Research Center, The Luskin Orthopaedic Institute for Children in Alliance with UCLA, Los Angeles, CA, United States
- Department of Bioengineering, University of California, Los Angeles, California, USA
- Department of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, California, USA
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12
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Lim YW, Song JH, Kwon SY, Kim YS, Byun YS, Lee SW. Minimum 10-year follow-up of micro-arc oxidation coating on a cementless grit-blasted tapered-wedge stem of total hip arthroplasty: a multicentre study. Hip Int 2022; 32:501-509. [PMID: 33253016 DOI: 10.1177/1120700020977465] [Citation(s) in RCA: 1] [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
BACKGROUND Recently, a femoral stem treated with grit-blasting and micro-arc oxidation (MAO) coating has commercialised but medium-term follow-up studies are lacking. The aim of this study was to report the outcome of a grit-blasted and MAO-coated femoral component designed as a straight, double-wedged, tapered stem with a rectangular cross-section with minimum 10 years follow-up. METHODS Between March 2006 and December 2008, 309 primary total hip arthroplasties using a grit-blasted and MAO-coated femoral component were performed by 3 experienced hip surgeons in 3 hospitals. At minimum 10 years after index THA, 299 hips were living, 10 hips were deceased, and 65 hips were lost to follow-up or had a follow-up period <10 years. Finally, 234 hips were enrolled in this study. RESULTS Mean duration of clinical follow-up was 129.6 months. The mean Harris Hip Score was improved from 46.9 to 88.4 at the final follow-up. 4 hips were revised for 2 aseptic femoral loosening, 1 aseptic acetabular cup loosening and 1 late infection. 3 hips were revised for a periprosthetic femoral fracture requiring a femoral component revision. The average time to revision was 51.6 (range 0-148) months. Kaplan-Meier survivorship analysis with an end point of revision for any reason demonstrated a survival rate of 97.4% at 10 years. Survival was 98.7% with revision for aseptic loosening as the endpoint. CONCLUSIONS The outcomes of a cementless grit-blasted and MAO-coated tapered-wedge stem of THA were excellent to satisfactory after a follow-up of at least 10 years.
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Affiliation(s)
- Young-Wook Lim
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Joo-Hyoun Song
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Department of Orthopaedic Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Gyeonggi-do, Republic of Korea
| | - Soon-Yong Kwon
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Department of Orthopaedic Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yong-Sik Kim
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young-Seol Byun
- Department of Orthopaedic Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Se-Won Lee
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Department of Orthopaedic Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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13
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Ryan JC, Duensing IM, Novicoff WM, Browne JA. Are We Training Surgeons to Cement a Femoral Component in Hip Arthroplasty? The Trainees' Perspective. J Arthroplasty 2022; 37:S536-S539. [PMID: 35276274 DOI: 10.1016/j.arth.2022.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/13/2022] [Accepted: 03/02/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The importance of surgical technique is widely recognized when cementing a femoral component in hip arthroplasty. Concern exists that surgeon trainees in the United States are not being adequately trained in cement technique. The purpose of this study is to describe recent trainees' perceived experience with their training in this skill. METHODS Orthopedic graduate candidates attending a national board review course were polled with an anonymous 15-question survey regarding their experiences during training with cemented femoral components. Means and standard deviations were calculated for Likert scale questions, and univariate statistics were used to compare answers for select questions. RESULTS A total of 152 surveys were completed. Ninety percent of respondents anticipated that they would be performing hemiarthroplasty for fracture in their future practice, 99% of whom anticipated using cement for stem fixation in at least some of these cases. Only a minority of respondents planned further training in an adult reconstruction fellowship (21%). Only 37% of residents perceived their training in cement technique to be comprehensive or very comprehensive, with 17% reporting that their training was inadequate or nonexistent. Forty percent reported being less than satisfied with their training. Although 96% of residents felt prepared to implant a cementless femoral component, only 82% felt adequately trained to properly cement a femoral implant. Feeling prepared to perform a well done cemented femoral stem correlated with higher percentage of cemented stems in training and higher satisfaction with training (both P = .001). CONCLUSION Although most trainees feel prepared to cement a femoral component, many young surgeons do not perceive that they are receiving adequate training in femoral cement technique.
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Affiliation(s)
- J Conner Ryan
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - Ian M Duensing
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - Wendy M Novicoff
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - James A Browne
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
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14
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Kato S, Nozawa M, Kim S, Sakamoto Y, Ochi H, Ishijima M. Comparison of the 5-Year Outcomes Between Standard and Short Fit-and-Fill Stems in Japanese Populations. Arthroplast Today 2022; 15:108-114. [PMID: 35774886 PMCID: PMC9237240 DOI: 10.1016/j.artd.2022.03.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 03/12/2022] [Accepted: 03/25/2022] [Indexed: 11/19/2022] Open
Abstract
Background Fit-and-fill stems are known to have excellent outcomes; however, severe stress shielding has been reported in Japanese populations. Short fit-and-fill stems were modified for Asians; however, there have been no previous reports of its outcome. In this study, we compared the 5-year (mean 68-month) outcomes of 2 fit-and-fill stems with different lengths (standard or short). Material and methods We reviewed 100 total hip arthroplasties in each standard- or short-stem group. Radiographs were evaluated for femoral morphology, stress shielding, bone remodeling, and fixation. Clinical evaluation was performed using the Japanese Orthopaedic Association (JOA) scores. Results There was no difference in the degree of stress shielding between the 2 groups. Significant differences were observed in radiolucent lines in zone 4 (P = .005) and cortical hypertrophy in zone 3 (P < .0001) and 5 (P = .048) between the 2 groups. The canal flare index (P < .0003), cortical index (P < .0003), height (P < .0345), and stem size (P < .0081) individually affected stress shielding in the standard-stem group. In contrast, the cortical index (P < .0107) was the only relative factor in the short-stem group. All stems were judged to have bone ingrowth. The JOA score improved significantly (P < .0001); however, there were no significant differences between the 2 groups. Conclusion The outcomes of both standard and short fit-and-fill stems were favorable. There were no significant differences in the stress shielding or JOA scores. Although there were a few differences in bone remodeling and factors affecting stress shielding, stem length reduction has been achieved without adverse effects with the Japanese femur.
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Affiliation(s)
- Suguru Kato
- Department of Orthopaedic Surgery, Juntendo University Nerima Hospital, Tokyo, Japan
- Corresponding author. Department of Orthopaedic Surgery, Juntendo University Nerima Hospital, 3-1-10 Takanodai, Nerima-ku, Tokyo 177-8521, Japan. Tel.: +81 3 5923 3111.
| | - Masahiko Nozawa
- Department of Orthopaedic Surgery, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Sungon Kim
- Department of Orthopaedic Surgery, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Yuko Sakamoto
- Department of Orthopaedic Surgery, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Hironori Ochi
- Department of Orthopaedic Surgery, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Muneaki Ishijima
- Department of Orthopaedic Surgery, Juntendo University, Tokyo, Japan
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15
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Yoon JY, Seo WY, Kim HJ, Yoo JJ. The Relationship between Femoral Stem Tilt and Stem Length in Total Hip Arthroplasty: A Retrospective Case-Control Study. Clin Orthop Surg 2022; 14:184-190. [PMID: 35685972 PMCID: PMC9152893 DOI: 10.4055/cios21042] [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: 03/12/2021] [Revised: 07/28/2021] [Accepted: 07/28/2021] [Indexed: 11/06/2022] Open
Affiliation(s)
- Jae Youn Yoon
- Department of Orthopedics, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Won Young Seo
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Hee Joong Kim
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Joon Yoo
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
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16
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Korber S, Antonios JK, Sivasundaram L, Mayfield CK, Kang HP, Chung BC, Oakes DA, Heckmann ND. Utilization of technology-assisted total hip arthroplasty in the United States from 2005 to 2018. Arthroplast Today 2021; 12:36-44. [PMID: 34761092 PMCID: PMC8567325 DOI: 10.1016/j.artd.2021.08.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/21/2021] [Accepted: 08/30/2021] [Indexed: 11/21/2022] Open
Abstract
Background Successful outcomes in total hip arthroplasty (THA) rely in part on accurate component positioning, which may be optimized through the use of computer navigation and robot-assistance. Therefore, we queried a large national database to characterize national trends in technology-assisted THA utilization, determine whether these technologies were associated with increased hospital charges, and identify demographic factors associated with technology-assisted THA. Methods Using the Nationwide Inpatient Sample database, patients that underwent conventional THA, computer-navigated THA, and robot-assisted THA from 2005 to 2018 were identified. Patient and hospital demographics, charge data, and payer characteristics were collected. Temporal trends in utilization were reported. Univariate analyses were performed to compare differences between groups with multiple logistic regression analysis to account for confounders. Results In total, 3,428,208 patients undergoing THA from 2005 to 2018 were identified, of which 63,136 (1.8%) used computer navigation and 32,660 (1.0%) used robot-assistance. National utilization of computer navigation in THA increased from 0.1% to 1.9% between 2005 and 2018, while utilization of robot-assisted THA increased from <0.1% to 2.1% from 2008 to 2018. On multivariate analysis, technology-assisted THA was most commonly performed in urban hospitals in the Northeastern United States. Median hospital charges were increased for technology-assisted THAs relative to conventional THAs ($66,089 ± $254 vs $55,418 ± $43). Conclusions Computer navigation and robot-assistance in THA demonstrated a consistent increase in utilization during the period examined, representing 4.0% of THAs performed in 2018. Patient and hospital characteristics including risk of mortality, geographic region, and teaching status were associated with increased utilization. Utilization of computer navigation was associated with increased hospital charges.
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Affiliation(s)
- Shane Korber
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Joseph K Antonios
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Lakshmanan Sivasundaram
- Department of Orthopaedic Surgery, University Hospitals, Case Western Reserve University, Cleveland, OH, USA
| | - Cory K Mayfield
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Hyunwoo Paco Kang
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Brian C Chung
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Daniel A Oakes
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Nathanael D Heckmann
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
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17
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Ten-Year Survivorship and Risk of Periprosthetic Fracture of a Cementless Tapered Stem. Orthop Clin North Am 2021; 52:317-321. [PMID: 34538344 DOI: 10.1016/j.ocl.2021.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This article is a retrospective review of a consecutive series of 401 primary total hip arthroplasties with the use of cementless, ream and broach Synergy stem (Smith & Nephew, Memphis, TN, USA) with minimal 10-year follow-up. We report an overall 10-year survivorship of 99.6% with a total of 15 fractures during the study period. Six of these fractures occurred intraoperatively. This is the largest series to our knowledge reporting greater than 10-year follow-up. This stem has excellent survivorship with overall low risk of periprosthetic fracture.
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18
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Outcomes of dual mobility articulation total hip arthroplasty in ipsilateral residual poliomyelitis. INTERNATIONAL ORTHOPAEDICS 2021; 46:489-496. [PMID: 34580745 DOI: 10.1007/s00264-021-05222-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 09/14/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Patients with poliomyelitis underwent total hip arthroplasty (THA) are known to be at higher risk of dislocation on account of muscular atrophy. This study aimed to investigate clinical outcomes, radiographic outcomes, complication rates, and survivorship of dual mobility THA in displaced femoral neck fractures of elderly with poliomyelitis. MATERIALS AND METHODS We retrospectively included 17 patients (17 hips) with residual poliomyelitis who underwent THA with dual mobility articulation. Clinical outcomes were assessed with the visual analog scale (VAS) pain score, Oxford hip score, and University of California Los Angeles activity (UCLA) score. Radiographic outcomes were examined by radiographs. Complications and re-operations following THA were recorded. RESULTS The mean follow-up period was 77.05 months. The mean VAS, Oxford hip score, and UCLA score were improved significantly. In all but one patient, no complications were occurred. Re-operation was carried out in one patient due to posterior dislocation. The Kaplan-Meier survivorship with an end point of re-operation for any reason was 94.1%. CONCLUSIONS THA with dual mobility system is proved to be effective in strengthening stability and reducing the risk of dislocation, which is suitable for patients with neuromuscular disease. Hence, in elderly with residual poliomyelitis, dual mobility THA is a valid choice as a treatment for displaced femoral neck fractures.
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19
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Hayama T, Otani T, Fujii H, Kawaguchi Y, Abe T, Takahashi M, Saito M. Clinical results of a short stem with flat tapered wedge design in primary total hip arthroplasty for hip dysplasia in Asians. J Orthop Surg (Hong Kong) 2021; 28:2309499020956742. [PMID: 33034250 DOI: 10.1177/2309499020956742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Cementless femoral reconstruction is challenging in hip dysplasia due to deformity of the proximal femur causing insufficient stem fixation and/or inadequate neck anteversion. Strategies to address these problems include the use of a modular stem or a distal fixation stem, but both stems have some characteristic disadvantages. METHODS We studied the postoperative clinical outcomes in primary total hip arthroplasty in 257 hips using the flat tapered wedge short femoral stem for hip dysplasia in an Asian population (postoperative follow-up period: 2 years to 6 years and 11 months; mean 4 years and 5 months). We took advantage of the characteristic of high flexibility in stem placement because of its low volume, positioning it while performing some varus/valgus and rotational alignment adjustments. RESULTS Favorable clinical functional outcomes were obtained, including the radiographic outcome of biological fixation achieved in all stems. Regarding complications, there was no case of split fracture of the femoral calcar region during stem insertion, and the rate of postoperative dislocation was also low at 0.4% (1 case). In the pre- and postoperative computed tomography measurements, the variability in stem anteversion postoperatively was significantly reduced compared to preoperative anatomical anteversion. CONCLUSION This flat-shaped short low-volume stem likely has high flexibility in positioning in cases of hip dysplasia and can be easily positioned to avoid fractures while still achieving secure fixation.
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Affiliation(s)
- Tetsuo Hayama
- Department of Orthopaedic Surgery, 12839The Jikei University School of Medicine, Tokyo, Japan
| | - Takuya Otani
- Department of Orthopaedic Surgery, 12839The Jikei University School of Medicine, Tokyo, Japan
| | - Hideki Fujii
- Department of Orthopaedic Surgery, 12839The Jikei University School of Medicine, Tokyo, Japan
| | - Yasuhiko Kawaguchi
- Department of Orthopaedic Surgery, 12839The Jikei University School of Medicine, Tokyo, Japan
| | - Toshiomi Abe
- Department of Orthopaedic Surgery, 12839The Jikei University School of Medicine, Tokyo, Japan
| | - Motoi Takahashi
- Department of Orthopaedic Surgery, 12839The Jikei University School of Medicine, Tokyo, Japan
| | - Mitsuru Saito
- Department of Orthopaedic Surgery, 12839The Jikei University School of Medicine, Tokyo, Japan
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20
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Ferreño Márquez DM, Dauder Gallego C, Bebea Zamorano FNG, Sebastián Pérez V, Montejo Sancho J, Martínez Martín J. Long-Term Outcomes of 496 Anatomical Cementless Modular Femoral Stems: Eleven to Twenty Years of Follow-Up. J Arthroplasty 2021; 36:2087-2099. [PMID: 33610406 DOI: 10.1016/j.arth.2021.01.057] [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: 10/02/2020] [Revised: 01/16/2021] [Accepted: 01/19/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The aim of the study is to assess the long-term outcomes of this specific stem (anatomical cementless modular stem ESOP), to review the survivorship, complication rate, and radiographic and clinical outcomes. METHODS Descriptive and analytical retrospective longitudinal observational study of patients was operated on total hip arthroplasty between 1998 and 2007. Four hundred ninety-six prostheses corresponding to 447 patients were reviewed, mean age was 65.8 years (standard deviation [SD] ±11.6 years), and median follow-up time was 13.4 years (range 1-20). The most used cups were cementless (75.8%). The most frequent friction pairs were metal-polyethylene (53.1%) and ceramic-polyethylene (24.2%). Main variables analyzed were stem survival, subsidence, coronal orientation, osteolysis, reintervention, and Oxford Hip Score. RESULTS From 496 implants, there were 22 lost to follow-up (4.4%). Stem revision was performed in 51 patients: 26 periprosthetic joint infections (2-stage revision), 16 periprosthetic fractures, and 8 one-stage revisions (6 real aseptic loosening with negative culture after revision). The stem survivorship at more than 15 years for any reason was 89.2% and for aseptic loosening 97.97%. No specific complications were found due to modularity. The mean subsidence and orientation was 2.06 mm (SD ±5.11 mm) and 0.41° varus (SD ±2.20°) respectively. Subsidence >5 mm or varus >5° was associated with a higher revision rate. Osteolysis was found in 110 patients (zone I = 79, VII = 57), associated with zirconium-polyethylene, without relationship to the stem revision rate or Oxford Hip Score. CONCLUSION To our knowledge, this study represents the largest series of this stem, revealing an excellent survival rate and long-term clinical outcomes similar to the best results of classical cementless stems published in the literature.
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Affiliation(s)
| | | | | | | | - Jorge Montejo Sancho
- Department of Orthopaedic Surgery, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Javier Martínez Martín
- Department of Orthopaedic Surgery, Hospital Universitario Fundación Alcorcón, Madrid, Spain
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21
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Guo J, Tan J, Peng L, Song Q, Kong HR, Wang P, Shen HY. Comparison of Tri-Lock Bone Preservation Stem and the Conventional Standard Corail Stem in Primary Total Hip Arthroplasty. Orthop Surg 2021; 13:749-757. [PMID: 33675168 PMCID: PMC8126948 DOI: 10.1111/os.12946] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 11/16/2020] [Accepted: 01/16/2021] [Indexed: 02/05/2023] Open
Abstract
Objective To compare the clinical and radiographic outcomes between the Tri‐Lock Bone Preservation Stem (BPS) and the conventional standard Corail stem in primary total hip arthroplasty (THA). Methods From March 2012 to May 2014, we retrospectively reviewed 84 patients (104 hips) who received Tri‐Lock (BPS) and 84 patients (115 hips) who received conventional standard Corail stem in THA. Their mean ages were 53.12 ± 2.32 years and 52.00 ± 2.11 years, respectively. The clinical outcomes were assessed by Western Ontario and McMaster University Osteoarthritis Index (WOMAC), Pain Visual Analogue Scale (VAS) and Harris Hip Score (HHS). The radiological outcomes were evaluated by the radiological examination. Accordingly, Intraoperative and postoperative complications were observed as well. Results The mean follow‐up time was 48.23 ± 2.91 months in the Tri‐Lock (BPS) group and 49.11 ± 2.11 months in the Corail group, respectively. The bleeding volumes in two groups were comparable (169.22 ± 58.11 mL vs 179.30 ± 59.14 mL, P = 0.003), with more bleeding volume in Corail group patients, while no statistically significance with respect to operation time was observed (65.41 ± 6.24 min vs 63.99 ± 6.33 min, P = 0.567). The rates of intraoperative fracture was 8% for the Corail group while 1% for the Tri‐Lock (BPS) group (8% vs 1%, P = 0.030). At final follow‐up, no statistical differences in regard to HHS, WOMAC, and Pain VAS were revealed between the two groups (P > 0.05). The rate of thigh pain was higher in Corail group than in Tri‐lock (BPS) group (5% vs 0%, P = 0.043). However, incidence of stress shielding in grade 1 was higher in Tri‐Lock (BPS) than in the Corail group (76% vs 23%, P < 0.01), while those in grade 2 and 3 were lower compared to the Corail stem (15% vs 28%, P < 0.01; 9% vs 16%, P = 0.008, respectively). Intriguingly, other assessments in relation to radiographic outcomes and postoperative complications were not comparable between the two groups. The Kaplan–Meier survival rate (revision surgery performed for any reason was defined as the end point) was similar between the two groups (P = 0.57), with 98.8% (95% confidence interval, 92.3%–100%) in Tri‐lock (BPS) group and 97.6% (95% confidence interval, 94.6%–100%) in Corail group. Conclusions The Tri‐Lock (BPS) has similar clinic performances compared to the Corail stem. Furthermore, the Tri‐lock (BPS) stem has some advantages in achieving lower incidence of thigh pain, stress shielding and intra‐operative fracture. Therefore, we recommend the Tri‐lock (BPS) stem as a good alternative in primary total hip arthroplasty, especially taking into account patient factors, including bone deficiency and convenience of extraction of the stem in hip revision.
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Affiliation(s)
- Jiang Guo
- Department of Orthopaedics, The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China.,Department of Orthopaedics, The Second Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jie Tan
- Department of Orthopaedic Surgery & Orthopeadic Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Lei Peng
- Department of Orthopaedics, The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China.,Department of Orthopaedics, The Second Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qian Song
- Department of Osteology, Tianjin Hospital, Tianjin, China
| | - Hao-Ran Kong
- Department of Orthopaedics, The Second Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Peng Wang
- Department of Orthopaedics, The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China.,Department of Orthopaedics, The Second Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hui-Yong Shen
- Department of Orthopaedics, The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China.,Department of Orthopaedics, The Second Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Homma Y, Kawakita S, Baba T, Watari T, Kaneko K. Diagnosis of and Early Revision Surgery for Biological Fixation Failure Due to Proximal-Distal Mismatch of Proximally Coated Tapered Cementless Stem. Arthroplast Today 2020; 6:914-918. [PMID: 33204788 PMCID: PMC7649110 DOI: 10.1016/j.artd.2020.09.007] [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: 07/30/2020] [Revised: 09/13/2020] [Accepted: 09/20/2020] [Indexed: 11/28/2022] Open
Abstract
The diagnosis of and decision-making for early revision surgery to treat failure of biological fixation with a proximally coated cementless stem are challenging. A 73-year-old woman was referred to our hospital with thigh pain 2 years after the initial total hip arthroplasty. Although a plain radiograph showed no signs indicating biological fixation failure, digital tomosynthesis showed a highly radiodense line along the proximal part, and bone scintigraphy showed uptake at the distal part. With the diagnosis of biological fixation failure due to the proximal-distal mismatch, the cementless stem was revised to a cemented stem, and the thigh pain was improved after the revision surgery. Digital tomosynthesis and bone scintigraphy can be helpful for the diagnosis of biological fixation failure due to proximal-distal mismatch.
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Affiliation(s)
- Yasuhiro Homma
- Department of Orthopaedic Surgery, Juntendo University school of medicine, Tokyo, Japan
| | - So Kawakita
- Department of Orthopaedic Surgery, Juntendo University school of medicine, Tokyo, Japan
| | - Tomonori Baba
- Department of Orthopaedic Surgery, Juntendo University school of medicine, Tokyo, Japan
| | - Taiji Watari
- Department of Orthopaedic Surgery, Juntendo University school of medicine, Tokyo, Japan
| | - Kazuo Kaneko
- Department of Orthopaedic Surgery, Juntendo University school of medicine, Tokyo, Japan
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Eachempati KK, Dannana CS, Apsingi S, Ponnala VK, Boyapati G, Parameswaran A. Trunnion fracture of femoral prosthesis following a large metal-on-metal uncemented total hip arthroplasty: a case report. ARTHROPLASTY 2020; 2:32. [PMID: 35236457 PMCID: PMC8796406 DOI: 10.1186/s42836-020-00055-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 10/14/2020] [Indexed: 01/22/2023] Open
Abstract
Background Trunnion fracture of the femoral prosthesis is an extremely rare complication following Total Hip Arthroplasty (THA). There are very few reports in literature on trunnion fracture. All previously reported cases are of prostheses with smaller heads, unlike the large metal-on-metal articulation in our case, which is unique. Case presentation A 29-year-old male patient with juvenile idiopathic arthropathy presented to us with a fracture of the trunnion of his left THA, with no history of trauma. He had undergone staged bilateral THA for avascular necrosis of the hips 10 years ago (with AML-A stem and large metal-on-metal articulation bilaterally). We revised the THA and exchanged both femoral and acetabular components. He had a good functional outcome at 3 years’ follow up. Conclusion The primary reason for the trunnion fracture in our case was the faulty stem design of the AML [with a small (9/10) taper, and a large head], causing excessive bending moment at the trunnion, worsening the cantilever effect and leading to subsequent cyclic fatigue failure. Whilst gross trunnion failure (GTF) with dissociation of the head from the taper is commonly reported, trunnion fracture per se is a rare and devastating complication. The AML-A stem has since been recalled by the company and there is a need to constantly monitor these patients for potential trunnion-related complications.
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Gholson JJ, Wallace SS, Akram F, Gonzalez A, Kunze KN, Levine BR. Wagner Cone Midterm Survivorship and Outcomes. J Arthroplasty 2020; 35:2155-2160. [PMID: 32279943 DOI: 10.1016/j.arth.2020.03.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 02/23/2020] [Accepted: 03/06/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Total hip arthroplasty (THA) in patients with abnormal proximal femoral anatomy requires an individualized treatment approach to prevent complications. Metaphyseal engaging stems in this population risk fracture, size/offset mismatch, and aseptic loosening. The Wagner conical femoral implant is a short diaphyseal engaging femoral stem that could improve treatment success in this difficult patient population. METHODS We identified 302 consecutive patients undergoing THA using the Wagner cone femoral prosthesis between January 2010 and January 2017. Clinical, radiographic, and patient-reported outcomes were obtained through chart review and radiographic measurements of postoperative X-rays. We used multivariate analysis to determine predictors of poor outcomes. Kaplan-Meier curves were created to demonstrate implant survivorship with reoperation and revision as endpoints. The average follow-up was 3.2 years, with a minimum of 2 years. RESULTS The implant retention survival rate during the 3.2-year study period was 98.7%. The overall reoperation rate was 4.2%, with infection followed by fracture being the most common reasons for reoperation. No patients were revised for aseptic loosening, and no patients were revised for subsidence. The average subsidence was 1.1 mm. The Harris Hip Score improved from 48.6 ± 7.3 (range, 28-64) preoperatively to 86.1 ± 8.5 (range, 66-100) at latest follow-up. The patient-reported satisfaction rate was 98.3%. CONCLUSION The Wagner cone femoral prosthesis demonstrated excellent clinical, radiographic, and patient-reported functional outcomes at midterm follow-up. We recommend use of the Wagner cone in THA patients with challenging proximal femoral anatomy, small femoral diameter, or poor metaphyseal bone quality.
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Affiliation(s)
- J Joseph Gholson
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Sara S Wallace
- Department of Orthopaedic Surgery, University of Chicago, Chicago, IL
| | - Faisal Akram
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Alejandro Gonzalez
- Department of Orthopaedic Surgery, University of Illinois at Chicago, College of Medicine, Chicago, IL
| | - Kyle N Kunze
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Brett R Levine
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
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Tyrpenou E, Khoshbin A, Mohammad S, Schemitsch EH, Waddell JP, Atrey A. A Large-Scale Fifteen-Year Minimum Survivorship of a Cementless Triple Tapered Femoral Stem. J Arthroplasty 2020; 35:2161-2166. [PMID: 32284208 DOI: 10.1016/j.arth.2020.03.028] [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: 02/02/2020] [Revised: 03/12/2020] [Accepted: 03/15/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND This study reports the long-term outcomes of a metaphyseal fit-and-fill cementless femoral component in total hip arthroplasty (THA) with a follow-up of 15-19 years. METHODS We conducted a retrospective review of 376 consecutive THAs (345 patients), using a triple tapered stem performed between 2000 and 2003 with a view to assessing survivorship and radiological and functional outcomes. Images were assessed for initial alignment, terminal osteolysis, or subsidence, while clinical outcomes were assessed using the St Michael's Hip Score. RESULTS Forty-five (11.9%) hips were lost to follow-up, 20 (5.31%) had died before our 15-year cutoff follow-up, and 4 (1.06%) had declined follow-up early on, leaving 307 hips (81.64%, 276 patients) available for both clinical and radiological follow-up at a minimum of 15 years (range 15-19). The mean age at the time of operation was 49.6 years (range 19-71) and the cohort included 131 (42.67%) male and 145 (47.23%) female patients. Seven stems (2.28%) were revised: 4 due to periprosthetic fractures, 2 for periprosthetic joint infection, and 1 for adverse reaction to metal debris at the trunnion. The St Michael's Hip Score improved from 14.2 (range 9-23) preoperatively to 22.3 (range 13 to 25) at the last documented follow-up (P = .000). Kaplan-Meier survivorship with stem revision for any reason as the end point was 97.70%. Worst-case scenario Kaplan-Meier survivorship, where all lost to follow-up are considered as failures, was 85.3%. No stem was revised for aseptic loosening. CONCLUSION This triple tapered stem in THA shows excellent survivorship beyond a minimum of 15 years.
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Affiliation(s)
- Evangelos Tyrpenou
- Division of Orthopaedics, University of Toronto, Saint Michael's Hospital, Toronto, Ontario, Canada
| | - Amir Khoshbin
- Division of Orthopaedics, University of Toronto, Saint Michael's Hospital, Toronto, Ontario, Canada
| | - Shoaib Mohammad
- School of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Emil H Schemitsch
- Department of Surgery, University of Western Ontario, London Health Sciences Centre - University Hospital, London, Ontario, Canada
| | - James P Waddell
- Division of Orthopaedics, University of Toronto, Saint Michael's Hospital, Toronto, Ontario, Canada
| | - Amit Atrey
- Division of Orthopaedics, University of Toronto, Saint Michael's Hospital, Toronto, Ontario, Canada
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Cao Z, Liu S, Lei P, Lv Y, Wu R, Ma F, Wang H, Luo R. Fast and Effective Nonsuture Anastomosis of Magnetic Artificial Blood Vessel Transplantation for Caval Reconstruction in Canines. Ann Vasc Surg 2020; 68:487-496. [PMID: 32428647 DOI: 10.1016/j.avsg.2020.04.062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 04/10/2020] [Accepted: 04/25/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND The resection and reconstruction of the vena cava is frequently needed in tumor resection. The goal of this study was to evaluate the performance of the magnetic compression anastomosis (MCA) device for fast nonsuture anastomosis of caval reconstruction with artificial blood vessel transplantation after resection in canines. METHODS The MCA device consisted of paired neodymium-ferrum-boron (Nd-Fe-B) magnetic rings that were coated with titanium nitride and embedded in a polypropylene shell. Artificial blood vessel transplantation procedure was performed in sixteen canines and then they were divided into 2 groups: MCA group (n = 8), in which the novel magnetic pinned-ring device was used, and the traditional manual suture group (n = 8). In situ artificial blood vessel anastomoses were performed in the inferior vena cava (IVC). The anastomosis time and anastomotic patency and quality were investigated through ultrasonographic scans, angiographic, gross observation, histological staining, and scanning electron microscopy at 24 weeks postoperatively. RESULTS The IVC anastomoses were reconstructed successfully in all canines and all animals survived. In the MCA group, the operation time for IVC anastomosis with artificial blood vessel was significantly shorter than that in the tradition manual suture group (P < 0.05). Vena cava angiography and ultrasound showed good blood patency. The scanning electron microscope showed the re-endothelialization was smooth and endothelial cells were arranged regularly at the anastomotic site. Histological examination confirmed that the MCA group was associated with infiltration of inflammatory cells compared with the manual suture group. CONCLUSIONS The MCA device combined with artificial blood vessels is applicable in reconstruction of large vessels after resection. The magnetic pinned-ring device offers a simple, fast, reliable, and effective technique for nonsuture artificial blood vessel anastomosis of caval reconstruction in canines, and the anastomosis is functionally better than the traditional sutured anastomosis.
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Affiliation(s)
- Zhuping Cao
- Department of Nursing, The Affiliated Northwest Women's and Children's Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Shiqi Liu
- Department of Neonatal Surgery, The Children Hospital of Xi'an City, Xi'an, Shaanxi, China
| | - Peng Lei
- Department of Hepatobiliary Surgery, General Hospital of Ningxia Medical University, Ying Chuan City, Ningxia Province, China
| | - Yi Lv
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an City, Shanxi, China.
| | - Rongqian Wu
- Health Science Center (HSC) of Xi'an Jiaotong University, Xi'an, Shanxi, China
| | - Feng Ma
- Health Science Center (HSC) of Xi'an Jiaotong University, Xi'an, Shanxi, China
| | - Haohua Wang
- Health Science Center (HSC) of Xi'an Jiaotong University, Xi'an, Shanxi, China
| | - Ruixue Luo
- The Corrosion & Protection Research Lab (CPRL) in Northwest Institute for Nonferrous Metal Research (NIN), Xi'an, Shanxi, China
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Walsh WR, Pelletier MH, Bertollo N, Lovric V, Wang T, Morberg P, Parr WCH, Bergadano D. Bone ongrowth and mechanical fixation of implants in cortical and cancellous bone. J Orthop Surg Res 2020; 15:177. [PMID: 32408885 PMCID: PMC7227327 DOI: 10.1186/s13018-020-01696-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 05/05/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND What is the right surface for an implant to achieve biological fixation? Surface technologies can play important roles in encouraging interactions between the implant surface and the host bone to achieve osseointegration. Preclinical animal models provide important insight into in vivo performance related to bone ongrowth and implant fixation. METHODS A large animal model was used to compare the in vivo response of HA and plasma-sprayed titanium coatings in a well-reported adult ovine model to evaluate bone ongrowth in terms of mechanical properties in cortical sites, and histology and histomorphometry in cortical and cancellous sites at 4 and 12 weeks. RESULTS Titanium plasma-sprayed surfaces outperformed the HA-coated samples in push-out testing in cortical sites while both surfaces supported new bone ongrowth and remodeling in cortical and cancellous sites. CONCLUSIONS While both HA and Ti plasma provided an osteoconductive surface for bone ongrowth, the Ti plasma provided a more robust bone-implant interface that ideally would be required for load transfer and implant stability in the longer term.
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Affiliation(s)
- William Robert Walsh
- Surgical and Orthopaedic Research Laboratories (SORL), Prince of Wales Clinical School, UNSW Sydney, Kensington, Australia.
| | - Matthew Henry Pelletier
- Surgical and Orthopaedic Research Laboratories (SORL), Prince of Wales Clinical School, UNSW Sydney, Kensington, Australia
| | - Nicky Bertollo
- Surgical and Orthopaedic Research Laboratories (SORL), Prince of Wales Clinical School, UNSW Sydney, Kensington, Australia
| | - Vedran Lovric
- Surgical and Orthopaedic Research Laboratories (SORL), Prince of Wales Clinical School, UNSW Sydney, Kensington, Australia
| | - Tian Wang
- Surgical and Orthopaedic Research Laboratories (SORL), Prince of Wales Clinical School, UNSW Sydney, Kensington, Australia
| | - Per Morberg
- Department of Surgical and Perioperative Sciences, Umea University, Umea, Sweden
| | - William Chase Harington Parr
- Surgical and Orthopaedic Research Laboratories (SORL), Prince of Wales Clinical School, UNSW Sydney, Kensington, Australia
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Dikmen G, Ozden VE, Gulagaci F, Tozun IR. Long-term results of cementless total hip arthroplasty for the treatment of ankylosed hip. J Orthop Surg (Hong Kong) 2020; 27:2309499019858038. [PMID: 31262219 DOI: 10.1177/2309499019858038] [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: 11/15/2022] Open
Abstract
PURPOSE The purpose of this study was to report the long-term results of total hip arthroplasty (THA) for the treatment of ankylosed hip. METHODS Twenty-nine consecutive THAs were performed in 26 patients. The mean age of the patients at the time of the operation was 43.3 years (range, 19-69 years). We used cementless fixation in all hips and the mean duration of follow-up was 10.1 years (range, 4.5-20 years). Radiological evaluation of components, osteolysis, radiolucent lines and loosening were assessed. The Harris Hip Score (HHS), range of motion (ROM), limb-length discrepancy and walking capacity with or without any support were used preoperatively and at final follow-up for clinical evaluation. Survivorship analysis was conducted using the Kaplan-Meier method using second revision for any reason as the endpoint. RESULTS The mean HHS was 85.6 (range, 55-98) points and mean ROM was 110.5° for flexion. The mean limb-length discrepancy improved from 4.1 cm to 1.1 cm. Positive Trendelenburg sign was recorded in 31% of the patients and 24% of patients needed any support for walking postoperatively. We observed surgical complications related to abductor arm in 25% of the patients. Radiolucency on the acetabular side was seen on one or more zones in 15 patients (16 hips). One aseptic acetabular component loosening was observed. On the femoral side, 11 patients demonstrated non-progressive radiolucent lines and osteolysis around the stem was seen in four hips but there was no aseptic stem loosening. The Kaplan-Meier survival rate considering revision for any reason as the endpoint was 81.5%, for aseptic loosening 91.3%, for a worst-case scenario of 66.4% at 10 years. CONCLUSION Cementless fixation showed good to excellent results at 10 years. Preoperative and postoperative abductor status of the patient is critical for patient satisfaction.
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Affiliation(s)
- Goksel Dikmen
- Department of Orthopaedic Surgery and Traumatology, Acibadem School of Medicine, Acibadem Maslak Hospital, Sarıyer/Istanbul, Turkey
| | - Vahit Emre Ozden
- Department of Orthopaedic Surgery and Traumatology, Acibadem School of Medicine, Acibadem Maslak Hospital, Sarıyer/Istanbul, Turkey
| | - Fırat Gulagaci
- Department of Orthopaedic Surgery and Traumatology, Acibadem School of Medicine, Acibadem Maslak Hospital, Sarıyer/Istanbul, Turkey
| | - I Remzi Tozun
- Department of Orthopaedic Surgery and Traumatology, Acibadem School of Medicine, Acibadem Maslak Hospital, Sarıyer/Istanbul, Turkey
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Kim CH, Lee SJ, Aditya K, Kim HY, Yoon KS, Yoon PW. Incidence of a stem sitting proud of a proximally coated cementless tapered wedge stem. J Orthop Translat 2019; 19:118-125. [PMID: 31844619 PMCID: PMC6896482 DOI: 10.1016/j.jot.2019.02.002] [Citation(s) in RCA: 1] [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: 09/12/2018] [Accepted: 02/07/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND/OBJECTIVE A stem sitting proud (SP) or that above the final rasp position remains in some patients who undergo hip replacement using proximally coated tapered wedge stems. Surgeons may face challenges providing the best fit because of unpredictable SP of proximally coated tapered wedge stems. Zimmer Inc. introduced a new rasp to solve this issue but the clinical results of this rasp have not yet been published. Therefore, our aim was to address the following: (1) What is the stem SP incidence using a proximally coated cementless tapered wedge stem? (2) Does the new rasp system (0-mm rasp) improve seating height? and (3) What are the risk factors of stem SP? METHODS We performed a retrospective study with 338 hips, in which Tri-Lock Bone Preservation Stem (BPS) was used in 181 hips and M/L Taper stem was used in 157 hips (82 hips before and 75 hips after 0-mm rasp use). A positive stem SP was defined as a stem proud height of >2 mm. We analysed and compared SP incidence in two stems and M/L Taper stems before and after the 0-mm rasp use. RESULTS An incidence of stem SP was 13% in the Tri-Lock BPS and 15% in the M/L Taper stem before the 0-mm rasp use. Stem SP incidence in the M/L Taper stem substantially decreased after the 0-mm rasp use (4%). The significant risk factor for stem SP was use of the high offset option in Tri-Lock BPS. CONCLUSION The proximally coated tapered wedge stems present potential problems related to stem SP. The new rasp of the M/L Taper stem showed significant improvement in initial seating height. THE TRANSLATIONAL POTENTIAL OF THIS ARTICLE This study was conducted to understand "stem sitting proud" in proximally coated tapered wedge stem as one of the most popular designs nowadays in adult hip joint arthroplasty field. In this study, we aimed to address the incidence of stem proud, investigated the risk factor and introduced the effect of new rasp system which improve stem seating height.
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Affiliation(s)
- Chul-Ho Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro, 43-gil, Songpa-gu, Seoul 05505, South Korea
| | - Soong Joon Lee
- Department of Orthopedic Surgery, Seoul National University Boramae Hospital, 20 Boramae-Ro 5-gil, Dongjak-gu, Seoul 156-707, South Korea
| | - Kekatpure Aditya
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro, 43-gil, Songpa-gu, Seoul 05505, South Korea
| | - Ho Yeon Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro, 43-gil, Songpa-gu, Seoul 05505, South Korea
| | - Kang Sup Yoon
- Department of Orthopedic Surgery, Seoul National University Boramae Hospital, 20 Boramae-Ro 5-gil, Dongjak-gu, Seoul 156-707, South Korea
| | - Pil Whan Yoon
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro, 43-gil, Songpa-gu, Seoul 05505, South Korea
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Venter RG, Burger MC, Ikram A, Lamberts RP. Bony anatomy of the third metacarpal and relationship with the capitate: a computed tomography study. Surg Radiol Anat 2019; 41:1319-1324. [PMID: 31250137 DOI: 10.1007/s00276-019-02272-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 06/21/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE The purpose of this study was to accurately establish the anatomical variability of the third metacarpal, its medullary canal, and the relationship with the capitate in the context of high rates of component loosening still seen in total wrist arthroplasty. METHODS CT scans of a 100 hands (age: 41 ± 14 years (range: 16-71 years); male/female ratio: 53/47) were studied to establish the detailed anatomy of the third metacarpal and the capitate. RESULTS Although the shape of the third metacarpal and the angles formed with the capitate were highly variable, the third metacarpal length was longer in males (p < 0.001), the proximal cortical bone was thicker (p < 0.001) and the sagittal metacarpal-capitate axis offset was greater (p = 0.01). A relationship was found between the total length of the metacarpal and the distance to the isthmus from the base (r = 0.63; p < 0.0001) which was unaffected by gender. No age-related relationships were significant. CONCLUSION The anatomy of the third metacarpal and capitate varies considerably more than has been alluded to in current wrist arthroplasty literature. Differences between males and females can likely be attributed to hand size. The distance of the isthmus from the base can be predicted from the total length of the metacarpal with a standard error of 1.9 mm.
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Affiliation(s)
- Rudolph G Venter
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Clinical Building, 4th Floor, Tygerberg Campus, Tygerberg, Cape Town, 7505, South Africa
| | - Marilize C Burger
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Clinical Building, 4th Floor, Tygerberg Campus, Tygerberg, Cape Town, 7505, South Africa
| | - Ajmal Ikram
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Clinical Building, 4th Floor, Tygerberg Campus, Tygerberg, Cape Town, 7505, South Africa
| | - Robert P Lamberts
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Clinical Building, 4th Floor, Tygerberg Campus, Tygerberg, Cape Town, 7505, South Africa.
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Attenello J, Chan S, Naito K, Saruwatari M, Saito S, Andrews S, Nakasone C. Early perioperative complication rates and subsidence with the Tribute ® short cementless, tapered stem in primary total hip arthroplasty. J Orthop 2019; 16:118-122. [PMID: 30723362 DOI: 10.1016/j.jor.2019.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 01/08/2019] [Indexed: 12/28/2022] Open
Abstract
This study examined early perioperative complications and subsidence following total hip arthroplasty (THA) with a short femoral stem. A retrospective review of 207 consecutive patients (247 hips) having undergone THA via the direct anterior approach produced only six perioperative complications: two intraoperative fractures, three perioperative femur fractures and one dislocation. Subsidence greater than 5 mm was observed in four hips but subsidence did not progress greater than 3 mm at the latest follow-up. Based on these results, cementless THA though the direct anterior approach with a short femoral stem provides a clinical and radiographic advantage while maintaining low complication rates.
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Affiliation(s)
- John Attenello
- Department of Orthopaedic Surgery, University of Hawai'i, Honolulu, HI, USA
| | - Sean Chan
- John A. Burns School of Medicine, University of Hawaii, 651 Ilalo St, Honolulu, HI, 96813, USA
| | - Kelvin Naito
- Department of Orthopedics, Straub Clinic & Hospital, 888 S King Street, Honolulu, HI, 96813, USA
| | - Michele Saruwatari
- John A. Burns School of Medicine, University of Hawaii, 651 Ilalo St, Honolulu, HI, 96813, USA
| | - Sean Saito
- John A. Burns School of Medicine, University of Hawaii, 651 Ilalo St, Honolulu, HI, 96813, USA
| | - Samantha Andrews
- Department of Orthopedics, Straub Clinic & Hospital, 888 S King Street, Honolulu, HI, 96813, USA
| | - Cass Nakasone
- Department of Orthopaedic Surgery, University of Hawai'i, Honolulu, HI, USA.,Department of Orthopedics, Straub Clinic & Hospital, 888 S King Street, Honolulu, HI, 96813, USA
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Vijayvargiya M, Shetty V, Makwana K, Suri HS. Mid-term results of an uncemented tapered femoral stem and various factors affecting survivorship. J Clin Orthop Trauma 2019; 10:368-373. [PMID: 30828210 PMCID: PMC6383067 DOI: 10.1016/j.jcot.2018.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 02/03/2018] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE CLS stem is commonly used today in primary hip arthroplasty, but only a few studies have evaluated their outcome in young high demanding patients. In Indian scenario, many patients require squatting and sitting cross-legged as part of their daily activities placing excessive load on the joint. We evaluated (I) Mid-long term functional and radiological results (II) Influence of age, gender, diagnosis, stem alignment, Canal fill index (CFI) on the outcome (III) Kaplan-Meier survivorship using revision for any reason or for aseptic loosening as an endpoint. METHODS Retrospective evaluation of 64 THA in 54 patients operated between July 2000 to July 2011 using CLS stem was done. Mean follow-up was 10.3 years (5-14.9 years) with 5 patients lost to follow-up and 4 patients died. Mean age at surgery was 46.8 years (18-78 years). RESULTS Mean Harris hip score was 89.4 (72-100). Thigh pain was present in 4 hips which were not associated with the sizing of the stem (p = .489). Stable fixation by bony ingrowth was seen in 53 hips (96.4%) and by fibrous ingrowth in 2 cases (3.6%) with no case of loosening seen. Stress shielding was seen as Grade II in 17 hips (30.9%), Grade III in 3 hips (5.4%). Pedestal formation was seen in 9 hips (16.4%) which were statistically associated with varus alignment and CFI < 80. No stem revision was performed with stem survivorship of 100%. CONCLUSION The mid-term survival rates and good clinical-radiological outcomes of CLS stem in high demanding Indian population were excellent.
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Affiliation(s)
| | - Vivek Shetty
- Corresponding author at: Hinduja Clinic Building, 1st floor Wing 4, P.D. Hinduja National Hospital, Veer Savarkar Marg, Mahim (W), Mumbai-16, India.
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Fourteen-year experience with short cemented stems in total hip replacement. INTERNATIONAL ORTHOPAEDICS 2018; 43:55-61. [PMID: 30411248 DOI: 10.1007/s00264-018-4205-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 10/12/2018] [Indexed: 12/12/2022]
Abstract
PURPOSE The age of the population requiring total hip replacement (THR) is increasing and this may lead to a return of cemented stems. Advantages of a short cemented femoral device include preservation of metaphyseal bone, easier insertion, and easier cement removal in case of revision. The purpose of this study is to describe the rationale and assess midterm results of unique innovative short cemented double-tapered polished stem applied with contemporary cementing techniques. METHODS Our experience with this short cemented stem includes two different groups of elderly patients. Group 1 (prototype version of the short stem) from January 2005 to January 2008 counts 43 THR. Group 2 (final commercial version of the short stem) from January 2013 to January 2015 counts 54 THR. The average age in groups 1 and 2 was 79 and 75 respectively. Patients underwent clinical follow-up with the Harris Hip Score (HHS) and completed radiographic evaluation. RESULTS Thirty-one patients of group 1 had died for reasons unrelated to their THR. The surviving 9 hips have a follow-up of 11.2 years. In group 2, eight patients died for reasons unrelated to their THR. Follow-up for the surviving 40 patients is 4.6 years. HHS improved in both groups. In 34/43 hips of group 1 and in 41/54 of group 2 we observed a Barrack grade A cement mantle. Survival with revision of the stem for aseptic loosening as the endpoint was 100%. CONCLUSIONS This study confirms the effectiveness of a short, polished, collarless, tapered cemented stem implanted with contemporary cementing techniques which appears as successful as the standard sized components.
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Shin T, Lim D, Kim YS, Kim SC, Jo WL, Lim YW. The biological response to laser-aided direct metal-coated Titanium alloy (Ti6Al4V). Bone Joint Res 2018; 7:357-361. [PMID: 29922456 PMCID: PMC5987684 DOI: 10.1302/2046-3758.75.bjr-2017-0222.r1] [Citation(s) in RCA: 1] [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] [Indexed: 11/24/2022] Open
Abstract
Objectives Laser-engineered net shaping (LENS) of coated surfaces can overcome the limitations of conventional coating technologies. We compared the in vitro biological response with a titanium plasma spray (TPS)-coated titanium alloy (Ti6Al4V) surface with that of a Ti6Al4V surface coated with titanium using direct metal fabrication (DMF) with 3D printing technologies. Methods The in vitro ability of human osteoblasts to adhere to TPS-coated Ti6Al4V was compared with DMF-coating. Scanning electron microscopy (SEM) was used to assess the structure and morphology of the surfaces. Biological and morphological responses to human osteoblast cell lines were then examined by measuring cell proliferation, alkaline phosphatase activity, actin filaments, and RUNX2 gene expression. Results Morphological assessment of the cells after six hours of incubation using SEM showed that the TPS- and DMF-coated surfaces were largely covered with lamellipodia from the osteoblasts. Cell adhesion appeared similar in both groups. The differences in the rates of cell proliferation and alkaline phosphatase activities were not statistically significant. Conclusions The DMF coating applied using metal 3D printing is similar to the TPS coating, which is the most common coating process used for bone ingrowth. The DMF method provided an acceptable surface structure and a viable biological surface. Moreover, this method is automatable and less complex than plasma spraying. Cite this article: T. Shin, D. Lim, Y. S. Kim, S. C. Kim, W. L. Jo, Y. W. Lim. The biological response to laser-aided direct metal-coated Titanium alloy (Ti6Al4V). Bone Joint Res 2018;7:357–361. DOI: 10.1302/2046-3758.75.BJR-2017-0222.R1.
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Affiliation(s)
- T Shin
- Department of Mechanical Engineering, Sejoing University; Corentec, Central R&D Center, Seoul, South Korea
| | - D Lim
- Department of Mechanical Engineering, Sejoing University, Seoul, South Korea
| | - Y S Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, School of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - S C Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, School of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - W L Jo
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, School of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Y W Lim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, School of Medicine, The Catholic University of Korea, Seoul, South Korea
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DeDeugd CM, Perry KI, Trousdale WH, Taunton MJ, Lewallen DG, Abdel MP. Total hip arthroplasty in patients affected by poliomyelitis. Bone Joint J 2018; 100-B:733-739. [DOI: 10.1302/0301-620x.100b6.bjj-2018-0127.r1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims The aims of this study were to determine the clinical and radiographic outcomes, implant survivorship, and complications of patients with a history of poliomyelitis undergoing total hip arthroplasty (THA) in affected limbs and unaffected limbs of this same population. Patients and Methods A retrospective review identified 51 patients (27 male and 24 female, 59 hips) with a mean age of 66 years (38 to 88) and with the history of poliomyelitis who underwent THA for degenerative arthritis between 1970 and 2012. Immigrant status, clinical outcomes, radiographic results, implant survival, and complications were recorded. Results In all, 32 THAs (63%) were performed on an affected limb, while 27 (37%) were performed on an unaffected limb. The overall ten-year survivorship free from aseptic loosening, any revision, or any reoperation were 91% (95% CI 0.76 to 0.99), 91% (95% CI 0.64 to 0.97) and 87% (95% CI 0.61 to 0.95), respectively. There were no revisions for prosthetic joint infection. There were no significant differences in any of the above parameters if THA was on the affected or unaffected control limbs. Conclusion Patients with a history of poliomyelitis who undergo THA on the affected or unaffected limbs have similar results with overall survivorship and complication rates to those reported results in patients undergoing THA for osteoarthritis. At long-term follow-up, previous clinical concerns about increased hip instability due to post-polio abductor weakness were not observed. Cite this article: Bone Joint J 2018;100-B:733–9.
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Affiliation(s)
- C. M. DeDeugd
- Department of Orthopedic Surgery, Mayo
Clinic, Rochester, Minnesota, USA
| | - K. I. Perry
- Department of Orthopedic Surgery, Mayo
Clinic, Rochester, Minnesota, USA
| | - W. H. Trousdale
- Department of Orthopedic Surgery, Mayo
Clinic, Rochester, Minnesota, USA
| | - M. J. Taunton
- Department of Orthopedic Surgery, Mayo
Clinic, Rochester, Minnesota, USA
| | - D. G. Lewallen
- Department of Orthopedic Surgery, Mayo
Clinic, Rochester, Minnesota, USA
| | - M. P. Abdel
- Department of Orthopedic Surgery, Mayo
Clinic, Rochester, Minnesota, USA
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36
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Fernández-Fernández R, Martínez-Miranda JM, Gil-Garay E. Comparison of an Uncemented Tapered Stem Design in Cobalt-Chrome vs Titanium at 15-Year Follow-Up. J Arthroplasty 2018; 33:1139-1143. [PMID: 29221842 DOI: 10.1016/j.arth.2017.11.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 10/29/2017] [Accepted: 11/12/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Cobalt-chromium (Co-Cr) and titanium (Ti) have been the most popular materials employed for cementless implants. The purpose of this study was to compare clinical and radiological results of a single stem design with both alloys at long-term follow-up. METHODS Two hundred consecutive uncemented stems implanted in 171 patients (100 Co-Cr and 100 Ti implants) between 1999 and 2002 were studied. Mean age of the patients was 60.9 years (range, 20-84). Clinical results were evaluated using the Harris hip score. The presence of thigh pain was also analyzed. Stem fixation was graded according to Engh criteria. Radiolucent lines, osteolysis, and stem subsidence were also analyzed. RESULTS At 15-year follow-up, no stems had been revised. Both groups showed similar clinical results with mean Harris hip score of 93.4 (Co-Cr) vs 93.9 (Ti). There was no difference in the rate of thigh pain (11 vs 8.3, respectively, P = .507). Radiolucent lines were more frequent in the Co-Cr group (63.6% vs 35.6%, P < .001). CONCLUSION Ti stems showed better osteointegration than Co-Cr stems, with a significantly lower incidence of radiolucent lines. However, this did not affect the clinical results or the appearance of thigh pain.
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Affiliation(s)
| | | | - Enrique Gil-Garay
- Department of Orthopaedic Surgery, University Hospital La Paz, Madrid, Spain
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37
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Vilardell AM, Cinca N, Garcia-Giralt N, Dosta S, Cano IG, Nogués X, Guilemany JM. Osteoblastic cell response on high-rough titanium coatings by cold spray. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2018; 29:19. [PMID: 29392501 DOI: 10.1007/s10856-018-6026-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 01/10/2018] [Indexed: 06/07/2023]
Abstract
Highly rough and porous commercially pure titanium coatings have been directly produced for first time by the cold spray technology, which is a promising technology in front of the vacuum plasma spray for oxygen sensitive materials. The wettability properties as well as the biocompatibility evaluation have been compared to a simply sand blasted Ti6Al4V alloy substrate. Surface topographies were analysed using confocal microscopy. Next, osteoblast morphology (Phalloidin staining), proliferation (MTS assay), and differentiation (alkaline phosphatase activity) were examined along 1, 7 and 14 days of cell culture on the different surfaces. Finally, mineralization by alizarin red staining was quantified at 28 days of cell culture. The contact angle values showed an increased hydrophilic behaviour on the as-sprayed surface with a good correlation to the biological response. A higher cell viability, proliferation and differentiation were obtained for highly rough commercial pure titanium coatings in comparison with sand blasted substrates. Cell morphology was similar in all coatings tested; at 14 days both samples showed extended filopodia. A higher amount of calcium-rich deposits was detected on highly rough surfaces. In summary, in-vitro results showed an increase of biological properties when surface roughness increases.
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Affiliation(s)
- A M Vilardell
- Centre de Projecció Tèrmica (CPT), Dpt. Ciència dels Materials i Enginyeria Metal.lúrgica, Universitat de Barcelona, Martí i Franquès 1, 08028, Barcelona, Spain.
| | - N Cinca
- Centre de Projecció Tèrmica (CPT), Dpt. Ciència dels Materials i Enginyeria Metal.lúrgica, Universitat de Barcelona, Martí i Franquès 1, 08028, Barcelona, Spain
| | - N Garcia-Giralt
- IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), RETICEF, Doctor Aiguader 88, 08003, Barcelona, Spain
| | - S Dosta
- Centre de Projecció Tèrmica (CPT), Dpt. Ciència dels Materials i Enginyeria Metal.lúrgica, Universitat de Barcelona, Martí i Franquès 1, 08028, Barcelona, Spain
| | - I G Cano
- Centre de Projecció Tèrmica (CPT), Dpt. Ciència dels Materials i Enginyeria Metal.lúrgica, Universitat de Barcelona, Martí i Franquès 1, 08028, Barcelona, Spain
| | - X Nogués
- IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), RETICEF, Doctor Aiguader 88, 08003, Barcelona, Spain
| | - J M Guilemany
- Centre de Projecció Tèrmica (CPT), Dpt. Ciència dels Materials i Enginyeria Metal.lúrgica, Universitat de Barcelona, Martí i Franquès 1, 08028, Barcelona, Spain
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38
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Jacquot L, Bonnin MP, Machenaud A, Chouteau J, Saffarini M, Vidalain JP. Clinical and Radiographic Outcomes at 25-30 Years of a Hip Stem Fully Coated With Hydroxylapatite. J Arthroplasty 2018; 33:482-490. [PMID: 29066107 DOI: 10.1016/j.arth.2017.09.040] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 09/12/2017] [Accepted: 09/15/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Little is known about the survival of total hip arthroplasty implants with bioactive coatings beyond the first 20 years. The authors aimed to report survival of a tapered hip stem fully coated with hydroxylapatite (HA) at follow-up of 25-30 years. METHODS Of the original series of 320 patients (347 hips), 12 patients (12 hips) had stem and cup revisions, 54 patients (55 hips) had cup revisions, 17 patients (17 hips) had liner exchange. A total of 207 patients (225 hips) died with stems in place and 21 patients (24 hips) could not be reached. This left a cohort of 80 patients (86 hips) with their original stem for assessment. Survival was analyzed using the Kaplan-Meier (KM) method and cumulative incidence function (CIF). RESULTS Considering stem revision as endpoint, the revision risk calculated using the KM method was 6.3%, whereas using the CIF it was 3.7%. Considering any reoperation as endpoint, the revision risk calculated using the KM method was 41.2%, whereas using the CIF it was 25.9%. The Harris Hip Score for 77 patients (18 hips) was 81.6 ± 15.2. Standard x-rays were available for 52 hips (49 patients), and 10 (19.2%) showed radiolucencies <2 mm thick. CONCLUSION This study is the first to report outcomes of an HA-coated stem beyond 25 years. The survival of stem compares favorably with long-term survival of the Charnley cemented stem, and with shorter-term registry studies. The stem achieved its intended purpose of total osteointegration in the long-term, although the proximolateral region remains susceptible to radiolucencies.
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Affiliation(s)
- Laurent Jacquot
- Artro Institute, Annecy Le Vieux, France; Department of Orthopaedic Surgery, Clinique d'Argonay, Centre Le Périclès, Annecy, France
| | - Michel P Bonnin
- Artro Institute, Annecy Le Vieux, France; Ramsay Générale de Santé, Centre Orthopédique Santy, Hôpital PrivéJean Mermoz, Lyon, France
| | - Alain Machenaud
- Artro Institute, Annecy Le Vieux, France; Department of Orthopaedic Surgery, Clinique d'Argonay, Centre Le Périclès, Annecy, France
| | - Julien Chouteau
- Artro Institute, Annecy Le Vieux, France; Department of Orthopaedic Surgery, Clinique d'Argonay, Centre Le Périclès, Annecy, France
| | | | - Jean-Pierre Vidalain
- Artro Institute, Annecy Le Vieux, France; Department of Orthopaedic Surgery, Clinique d'Argonay, Centre Le Périclès, Annecy, France
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39
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Colacchio ND, Robbins CE, Aghazadeh MS, Talmo CT, Bono JV. Total Hip Intraoperative Femur Fracture: Do the Design Enhancements of a Second-Generation Tapered-Wedge Stem Reduce the Incidence? J Arthroplasty 2017. [PMID: 28648706 DOI: 10.1016/j.arth.2017.05.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Intraoperative femur fracture (IFF) is a well-known complication in primary uncemented total hip arthroplasty (THA). Variations in implant instrumentation design and operative technique may influence the risk of IFF. This study investigates IFF between a standard uncemented tapered-wedge femoral stem and its second-generation successor with the following design changes: size-specific medial curvature, proportional incremental stem growth, modest reduction in stem length, and distal lateral relief. METHODS A single experienced surgeon's patient database was retrospectively queried for IFF occurring during primary uncemented THA using a standard tapered-wedge femoral stem system or a second-generation stem. All procedures were performed using soft tissue preserving anatomic capsule repair and posterior approach. The primary outcome measure was IFF. A z-test of proportions was performed to determine significant difference between the 2 stems with respect to IFF. Patient demographics, Dorr classification, and implant characteristics were also examined. RESULTS Forty-one of 1510 patients (2.72%) who received a standard tapered-wedge femoral stem sustained an IFF, whereas 5 of 800 patients (0.63%) using the second-generation stem incurred an IFF. No other significant associations were found. CONCLUSION A standard tapered-wedge femoral stem instrumentation system resulted in greater than 4 times higher incidence of IFF than its second-generation successor used for primary uncemented THA. Identifying risk factors for IFF is necessary to facilitate implant system improvements and thus maximize patient outcomes.
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Affiliation(s)
- Nicholas D Colacchio
- Department of Orthopedic Surgery, New England Baptist Hospital, Boston, Massachusetts
| | - Claire E Robbins
- Department of Orthopedic Surgery, New England Baptist Hospital, Boston, Massachusetts
| | - Mehran S Aghazadeh
- Department of Orthopedic Surgery, New England Baptist Hospital, Boston, Massachusetts
| | - Carl T Talmo
- Department of Orthopedic Surgery, New England Baptist Hospital, Boston, Massachusetts
| | - James V Bono
- Department of Orthopedic Surgery, New England Baptist Hospital, Boston, Massachusetts
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40
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Schilcher J, Ivarsson I, Perlbach R, Palm L. No Difference in Periprosthetic Bone Loss and Fixation Between a Standard-Length Stem and a Shorter Version in Cementless Total Hip Arthroplasty. A Randomized Controlled Trial. J Arthroplasty 2017; 32:1220-1226. [PMID: 27993496 DOI: 10.1016/j.arth.2016.11.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 10/27/2016] [Accepted: 11/09/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Cementless femoral stems in total hip arthroplasty provide dependable clinical and radiographic results in the treatment of osteoarthritis. Stem length might affect the preservation of proximal bone stock and stability. We hypothesized that a shorter stem decreases proximal bone loss without affecting implant stability. METHODS We randomly assigned 60 patients aged between 50 and 70 years to either a standard cementless femoral stem or a 35-mm shorter version. Patients were followed with dual-energy X-ray absorptiometry, radiostereometric analysis, Harris hip score, Western Ontario and McMaster Universities Osteoarthritis Index score, and clinical follow-up at 3, 6, 12, and 24 months. The trial is registered on ClinicalTrials.gov/. RESULTS After 24 months, short stems had on average 3.8% (95% confidence interval, 1.2%-8.9%) more bone loss in zone 1 compared to standard stems (P = .14). In zone 7, the bone loss was on average 6.5% (95% confidence interval, 6.6%-19.7%) higher compared to standard stems (P = .33). After 24 months, standard stems had migrated 0.93 mm (range, 0.25-4.66 mm) and short stems 0.93 mm (range, 0.17-2.96 mm; Student t-test after log transformation, P = .3). Patient-reported outcome measures were similar in both groups. One patient in the standard stem group was diagnosed with infection, one with a posterior dislocation, and one with a deep venous thrombosis. No stems were revised. CONCLUSION There were no statistically significant differences in periprosthetic bone loss or fixation between the stems at 24 months.
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Affiliation(s)
- Jörg Schilcher
- Department of Experimental and Clinical Medicine and the Department of Orthopedics, Faculty of Health Science, Linköping University, Linköping, Sweden
| | - Ingemar Ivarsson
- Department of Experimental and Clinical Medicine and the Department of Orthopedics, Faculty of Health Science, Linköping University, Linköping, Sweden
| | - Rico Perlbach
- Department of Experimental and Clinical Medicine and the Department of Orthopedics, Faculty of Health Science, Linköping University, Linköping, Sweden
| | - Lars Palm
- Department of Experimental and Clinical Medicine and the Department of Orthopedics, Faculty of Health Science, Linköping University, Linköping, Sweden
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Morohashi I, Iwase H, Kanda A, Sato T, Homma Y, Mogami A, Obayashi O, Kaneko K. Acoustic pattern evaluation during cementless hip arthroplasty surgery may be a new method for predicting complications. SICOT J 2017; 3:13. [PMID: 28186872 PMCID: PMC5302878 DOI: 10.1051/sicotj/2016049] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 12/09/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Although surgeons must perform implantation of the cementless stem during total hip arthroplasty (THA) without complications, assessment is left to the surgeon's intuitive judgement, which could contain inter/intra-observer bias variety. We therefore asked (1) whether the sound created during the stem implantation could be evaluated objectively and (2) whether those sounds are correlate to the complication specific to the cementless stems. Our hypothesis is that the sounds produced during stem insertion could be quantified and related to the complications. PATIENTS AND METHOD In 71 THAs, we quantified the sound produced during stem insertion and investigated the relationship between these sounds and the occurrence of intraoperative fracture and subsidence. RESULTS The sound data were divided into two patterns: Patterns A and B. The difference between the peak value (dB) at the most common frequency (near 7 kHz) and the second most common frequency (near 4 kHz) of strikes during the final phase of implantation in Patterns A and B showed a significant difference. Adverse events on intraoperative fracture and subsidence were significantly less common in patients with Pattern A than in those with Pattern B (six of 42 hips with Pattern A and 13 of 29 hips with Pattern B, p = 0.004). Pattern A in predicting a clinical course without those adverse events was 69.2% and the specificity was 68.4%. Positive and negative predictive values were 85.7% and 44.8%, respectively. CONCLUSION The sound generated during stem insertion was quantified. Those sound patterns were associated with complications.
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Affiliation(s)
- Itaru Morohashi
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Department of Orthopaedic Surgery, Juntendo University Shizuoka Hospital 1129 Nagaoka Izunokuni Shizuoka
410-2295 Japan
| | - Hideaki Iwase
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Department of Bio-Engineering, Juntendo University Institute of Casualty Center 1129 Nagaoka Izunokuni Shizuoka
410-2295 Japan
| | - Akio Kanda
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Department of Orthopaedic Surgery, Juntendo University Shizuoka Hospital 1129 Nagaoka Izunokuni Shizuoka
410-2295 Japan
| | - Taichi Sato
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Department of Host Defense and Biochemical Research, Tokyo Denki University 5 Senju Asahi-cho Adachi-ku Tokyo
120-8551 Japan
| | - Yasuhiro Homma
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Department of Orthopaedics, Juntendo University 2-1-1 Hongo Bunkyo-ku Tokyo
113-8421 Japan
| | - Atsuhiko Mogami
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Department of Orthopaedic Surgery, Juntendo University Shizuoka Hospital 1129 Nagaoka Izunokuni Shizuoka
410-2295 Japan
| | - Osamu Obayashi
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Department of Orthopaedic Surgery, Juntendo University Shizuoka Hospital 1129 Nagaoka Izunokuni Shizuoka
410-2295 Japan
| | - Kazuo Kaneko
-
Department of Orthopaedics, Juntendo University 2-1-1 Hongo Bunkyo-ku Tokyo
113-8421 Japan
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De Martino I, De Santis V, D'Apolito R, Sculco PK, Cross MB, Gasparini G. The Synergy cementless femoral stem in primary total hip arthroplasty at a minimum follow-up of 15 years. Bone Joint J 2017; 99-B:29-36. [PMID: 28053254 DOI: 10.1302/0301-620x.99b1.bjj-2016-0231.r1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 09/05/2016] [Indexed: 11/05/2022]
Abstract
AIMS We report on the outcome of the Synergy cementless femoral stem with a minimum follow-up of 15 years (15 to 17). PATIENTS AND METHODS A retrospective review was undertaken of a consecutive series of 112 routine primary cementless total hip arthroplasties (THAs) in 102 patients (112 hips). There were 60 female and 42 male patients with a mean age of 61 years (18 to 82) at the time of surgery. A total of 78 hips in the 69 patients remain in situ; nine hips in eight patients died before 15 years, and 16 hips in 16 patients were revised. Clinical outcome scores and radiographs were available for 94 hips in 85 patients. RESULTS In all, four stems were revised. One stem was revised for aseptic loosening; two stems because of deep infection; and one because of periprosthetic femoral fracture. There was a significant improvement in all components of the Western Ontario and McMaster Universities Osteoarthritis Index score at the final follow-up (total: p < 0.001, pain: p < 0.001, stiffness: p < 0.001, function: p < 0.001). The mean Harris Hip Scores improved from 47 points (27 to 59) pre-operatively to 89 points (65 to 100) at the latest follow-up (p < 0.001). Kaplan-Meier survivorship, with stem revision for aseptic loosening as the endpoint, was 98.9% at 15 years (95% confidence interval (CI) 96.9 to 100, number at risk at 15 years: 90) and with stem revision for any reason was 95.7% (95% CI 91.7 to 99.8, number at risk at 15 years: 90). CONCLUSION The Synergy cementless femoral stem demonstrates excellent survivorship and functional outcomes at 15 years. Cite this article: Bone Joint J 2017;99-B:29-36.
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Affiliation(s)
- I De Martino
- Hospital for Special Surgery, Complex Joint Reconstruction Center, Department of Orthopaedic Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - V De Santis
- Catholic University of the Sacred Heart, Agostino Gemelli University Hospital, Orthopaedic Surgery Division, Department of Geriatrics, Neurosciences and Orthopaedics, Largo Agostino Gemelli 8, Rome, 00168, Italy
| | - R D'Apolito
- Catholic University of the Sacred Heart, Agostino Gemelli University Hospital, Orthopaedic Surgery Division, Department of Geriatrics, Neurosciences and Orthopaedics, Largo Agostino Gemelli 8, Rome, 00168, Italy
| | - P K Sculco
- Hospital for Special Surgery, Adult Reconstruction and Joint Replacement Division, Department of Orthopaedic Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - M B Cross
- Hospital for Special Surgery, Adult Reconstruction and Joint Replacement Division, Department of Orthopaedic Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - G Gasparini
- University of Catanzaro Magna Græcia, Orthopaedic Surgery Division, Department of Medical and Surgical Sciences, Viale Europa, Localitá Germaneto, Catanzaro, 88100, Italy
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Carlson SW, Liu SS, Callaghan JJ. Not all cementless femoral stems are created equal but the results may be comparable. Bone Joint J 2017; 99-B:14-17. [PMID: 28042113 DOI: 10.1302/0301-620x.99b1.bjj-2016-0269.r1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 07/27/2016] [Indexed: 11/05/2022]
Abstract
AIMS The aim of this study was to compare the survivorship and radiographic outcomes at ten-year follow-up of three prospective consecutive series of patients each of which received a different design of cementless femoral components for total hip arthroplasty (THA). PATIENTS AND METHODS In Cohort 1, 91 consecutive patients (100 hips) underwent THA with a cementless porous-coated anatomic femoral stem (PCA) between October 1983 and January 1986. In Cohort 2, 86 consecutive patients (100 hips) underwent THA with an extensively porous-coated cementless femoral stem (Prodigy) between June 1994 and October 1997. In Cohort 3, 88 consecutive patients (100 hips) underwent THA with a proximally porous-coated triple-tapered cementless stem (Summit) between April 2002 and October 2003. All three groups underwent prospective clinical and radiographic evaluation. RESULTS Kaplan-Meier survivorship analysis of Cohort 1 was 91% (95% confidence interval (CI) 88 to 94) with an endpoint of revision for any reason and 97% (95% CI 95 to 99) with aseptic loosening as the endpoint. Survivorship of Cohort 2 was 88% (95% CI 79 to 97) for revision for any reason and 100% for aseptic loosening. Survivorship of Cohort 3 was 95% (95% CI 91 to 99) for revision for any reason and 100% with aseptic loosening as the endpoint. CONCLUSION With revision for aseptic loosening of the femoral component as the endpoint, the three femoral components with different design philosophies demonstrated excellent survivorship, ranging from 97% to 100% at ten years. Cite this article: Bone Joint J 2017;99-B(1 Supple A):14-17.
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Affiliation(s)
- S W Carlson
- University of Iowa, University of Iowa College of Medicine, 01073 JPP, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - S S Liu
- University of Iowa, University of Iowa College of Medicine, 01073 JPP, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - J J Callaghan
- University of Iowa, University of Iowa College of Medicine, 01073 JPP, 200 Hawkins Drive, Iowa City, IA 52242, USA
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Itabashi T, Narita K, Ono A, Wada K, Tanaka T, Kumagai G, Yamauchi R, Nakane A, Ishibashi Y. Bactericidal and antimicrobial effects of pure titanium and titanium alloy treated with short-term, low-energy UV irradiation. Bone Joint Res 2017; 6:108-112. [PMID: 28246094 PMCID: PMC5331176 DOI: 10.1302/2046-3758.62.2000619] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 01/17/2017] [Indexed: 11/25/2022] Open
Abstract
Objectives The surface of pure titanium (Ti) shows decreased histocompatibility over time; this phenomenon is known as biological ageing. UV irradiation enables the reversal of biological ageing through photofunctionalisation, a physicochemical alteration of the titanium surface. Ti implants are sterilised by UV irradiation in dental surgery. However, orthopaedic biomaterials are usually composed of the alloy Ti6Al4V, for which the antibacterial effects of UV irradiation are unconfirmed. Here we evaluated the bactericidal and antimicrobial effects of treating Ti and Ti6Al4V with UV irradiation of a lower and briefer dose than previously reported, for applications in implant surgery. Materials and Methods Ti and Ti6Al4V disks were prepared. To evaluate the bactericidal effect of UV irradiation, Staphylococcus aureus 834 suspension was seeded onto the disks, which were then exposed to UV light for 15 minutes at a dose of 9 J/cm2. To evaluate the antimicrobial activity of UV irradiation, bacterial suspensions were seeded onto the disks 0, 0.5, one, six, 24 and 48 hours, and three and seven days after UV irradiation as described above. In both experiments, the bacteria were then harvested, cultured, and the number of colonies were counted. Results No colonies were observed when UV irradiation was performed after the bacteria were added to the disks. When the bacteria were seeded after UV irradiation, the amount of surviving bacteria on the Ti and Ti6Al4V disks decreased at 0 hours and then gradually increased. However, the antimicrobial activity was maintained for seven days after UV irradiation. Conclusion Antimicrobial activity was induced for seven days after UV irradiation on both types of disk. Irradiated Ti6Al4V and Ti had similar antimicrobial properties. Cite this article: T. Itabashi, K. Narita, A. Ono, K. Wada, T. Tanaka, G. Kumagai, R. Yamauchi, A. Nakane, Y. Ishibashi. Bactericidal and antimicrobial effects of pure titanium and titanium alloy treated with short-term, low-energy UV irradiation. Bone Joint Res 2017;6:108–112. DOI: 10.1302/2046-3758.62.2000619.
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Affiliation(s)
- T Itabashi
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - K Narita
- Department of Microbiology and Immunology, Hirosaki University Graduate School of Medicine, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - A Ono
- Department of Orthopaedic Surgery, Hirosaki Memorial Hospital, 59-1, Sakaizeki, Nishida, Hirosaki, Aomori, 036-8076, Japan
| | - K Wada
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - T Tanaka
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - G Kumagai
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - R Yamauchi
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - A Nakane
- Department of Microbiology and Immunology, Hirosaki University Graduate School of Medicine, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Y Ishibashi
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
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Hochreiter J, Hejkrlik W, Emmanuel K, Hitzl W, Ortmaier R. Blood loss and transfusion rate in short stem hip arthroplasty. A comparative study. INTERNATIONAL ORTHOPAEDICS 2016; 41:1347-1353. [PMID: 27942850 DOI: 10.1007/s00264-016-3365-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 11/28/2016] [Indexed: 12/17/2022]
Abstract
PURPOSE Little scientific evidence on blood loss and transfusion rates after short-stem hip arthroplasty exists. The hypothesis of this study was that the blood loss and transfusion rate is lower in short stems compared to straight stems. METHODS We compared 124 patients who underwent total hip arthroplasty (THA) using a short-stem design (group 1) and 141 patients using a straight-stem design (group 2). All patients were operated on by the same surgeon, and both groups were similar in age, gender, affected side, body mass index, and ASA score. RESULTS The calculated blood loss was 1139 ml in group 1 and 1358 ml in group 2 (p < 0.001). The transfusion rate was 8% in group 1 and 15.6% in group 2 (p < 0.001). There was no significant difference between groups 1 and 2 regarding complications and operation time (p > 0.05). CONCLUSION Compared to patients after straight stem THA, both blood loss and blood transfusion rates were lower in patients after short stem THA.
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Affiliation(s)
- Josef Hochreiter
- Department of Orthopaedic Surgery, St. Vincent Hospital Linz, Seilerstätte 4, A-4020, Linz, Austria
| | - Wilfried Hejkrlik
- Department of Orthopaedic Surgery, St. Vincent Hospital Linz, Seilerstätte 4, A-4020, Linz, Austria
| | - Katja Emmanuel
- Department of Orthopaedic Surgery, St. Vincent Hospital Linz, Seilerstätte 4, A-4020, Linz, Austria
- Department of Orthopaedics and Traumatology, Paracelsus Medical University, Müllner Hauptstraße 48, A-5020, Salzburg, Austria
| | - Wolfgang Hitzl
- Department of Biostatistics, Paracelsus Medical University, Müllner Hauptstraße 48, A-5020, Salzburg, Austria
| | - Reinhold Ortmaier
- Department of Orthopaedic Surgery, St. Vincent Hospital Linz, Seilerstätte 4, A-4020, Linz, Austria.
- Department of Orthopaedics and Traumatology, Paracelsus Medical University, Müllner Hauptstraße 48, A-5020, Salzburg, Austria.
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Clinical Faceoff: Where Are We Going With Femoral Stem Fixation in THA? Clin Orthop Relat Res 2016; 474:2349-2353. [PMID: 27020428 PMCID: PMC5052184 DOI: 10.1007/s11999-016-4799-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 03/13/2016] [Indexed: 01/31/2023]
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Nazari-Farsani S, Finnilä S, Moritz N, Mattila K, Alm JJ, Aro HT. Is Model-based Radiostereometric Analysis Suitable for Clinical Trials of a Cementless Tapered Wedge Femoral Stem? Clin Orthop Relat Res 2016; 474:2246-53. [PMID: 27334320 PMCID: PMC5014820 DOI: 10.1007/s11999-016-4930-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 06/06/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND In clinical trials of THA, model-based radiostereometric analysis (RSA) techniques may be less precise than conventional marker-based RSA for measurement of femoral stem rotation. We verified the accuracy and clinical precision of RSA based on computer-aided design models of a cementless tapered wedge femoral stem. QUESTIONS We asked: (1) Is the accuracy of model-based RSA comparable to that of marker-based RSA? (2) What is the clinical precision of model-based RSA? METHODS Model-based RSA was performed using combined three-dimensional computer-aided design models of the stem and head provided by the implant manufacturer. The accuracy of model-based RSA was compared with that of marker-based RSA in a phantom model using micromanipulators for controlled translation in three axes (x, y, z) and rotation around the y axis. The clinical precision of model-based RSA was evaluated by double examinations of patients who had arthroplasties (n = 24) in an ongoing trial. The clinical precision was defined as being at an acceptable level if the number of patients needed for a randomized trial would not differ from a trial done with conventional marker-based RSA (15-25 patients per group). RESULTS The accuracy of model-based RSA was 0.03 mm for subsidence (translation along the y axis) (95% CI for the difference between RSA measurements and actual displacement measured with micrometers, -0.03-0.00) and 0.39° for rotation around the y axis (95% CI, -0.41 to -0.06). The accuracy of marker-based RSA was 0.06 mm for subsidence (95% CI, -0.04-0.01; p = 0.728 compared with model-based RSA) and 0.18° for the y axis rotation (95% CI, -0.23 to -0.07; p = 0.358). The clinical precision of model-based RSA was 0.14 mm for subsidence (95% CI for the difference between double examinations, -0.02-0.04) and 0.79° for the y axis rotation (95% CI, -0.16-0.18). CONCLUSIONS The accuracy of model-based RSA for measurement of the y axis rotation was not quite as high as that of marker-based RSA, but its clinical precision is at an acceptable level. CLINICAL RELEVANCE Model-based RSA may be suitable for clinical trials of cementless tapered wedge femoral stem designs.
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Affiliation(s)
- Sanaz Nazari-Farsani
- Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, University of Turku and Turku University Hospital, T-hospital, PL 52, 20521, Turku, Finland
| | - Sami Finnilä
- Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, University of Turku and Turku University Hospital, T-hospital, PL 52, 20521, Turku, Finland
| | - Niko Moritz
- Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, University of Turku and Turku University Hospital, T-hospital, PL 52, 20521, Turku, Finland
| | - Kimmo Mattila
- Medical Imaging Centre of Southwest Finland, Turku University Hospital, Kiinamyllynkatu 4-8, 20520, Turku, Finland
| | - Jessica J Alm
- Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, University of Turku and Turku University Hospital, T-hospital, PL 52, 20521, Turku, Finland
| | - Hannu T Aro
- Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, University of Turku and Turku University Hospital, T-hospital, PL 52, 20521, Turku, Finland.
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Carlson SW, Goetz DD, Liu SS, Greiner JJ, Callaghan JJ. Minimum 10-Year Follow-Up of Cementless Total Hip Arthroplasty Using a Contemporary Triple-Tapered Titanium Stem. J Arthroplasty 2016; 31:2231-6. [PMID: 27339824 DOI: 10.1016/j.arth.2016.04.037] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 04/26/2016] [Accepted: 04/28/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND There is extensive variation in design and insertion technique of cementless tapered femoral stems. The purpose of our study was to evaluate a consecutive series of contemporary tapered cementless femoral stems inserted with a ream-and-broach technique at a minimum 10-year follow-up in patients undergoing total hip arthroplasty (THA). METHODS One hundred consecutive THAs (88 patients) performed by a single surgeon were followed for a minimum of 10 years. Hips were evaluated clinically for revision status, Western Ontario and McMaster Universities Osteoarthritis Index, 36-item Short Form Health Survey, Harris Hip Score, and University of California, Los Angeles, and Tegner Activity Scores. Radiographic evaluation included assessment for loosening, osteolysis, and stress shielding. Kaplan-Meier survivorship analysis included end points for revision and radiographic evidence of femoral component loosening. RESULTS At minimum 10-year follow-up, 66 patients (74 hips) were living, 20 patients (24 hips) were deceased, and 2 patients (2 hips) were lost to follow-up. Four hips required reoperation, but no femoral components were revised for aseptic loosening. One femoral component (1%) was revised due to a postoperative periprosthetic fracture. Radiographic evaluation demonstrated bone ingrowth of all stems without evidence of component loosening and 1 case of severe stress shielding. Kaplan-Meier survivorship at 10 years was 100% for the end points of femoral revision for loosening or femoral radiographic loosening. CONCLUSION This contemporary, cementless titanium-tapered femoral component inserted with ream-and-broach technique demonstrated excellent results in terms of outcomes and clinical durability as well as osteointegration on radiographs at minimum 10-year follow-up. This study corroborates, with level 2 and level 3 data, level 1 data reported in national registries.
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Affiliation(s)
- Samuel W Carlson
- Department of Orthopaedic Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Devon D Goetz
- Des Moines Orthopaedic Surgeons, West Des Moines, Iowa
| | - Steve S Liu
- Department of Orthopaedic Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Justin J Greiner
- Department of Orthopaedic Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - John J Callaghan
- Department of Orthopaedic Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
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Abstract
INTRODUCTION Total hip replacement is a successful procedure with long survival records compared to other joint arthroplasties. Cemented implants have been available for many years, however the complications associated with loosening and, ultimately, failure over time has led to the development of cementless stems and implants.The ideal prosthesis should recreate a biomechanically normal hip joint, allow pain-free function and last the patient's life span without requiring revision. Optimal results with uncemented femoral stems rely on obtaining initial stability, osseointegration, biological fixation, and uniform stress transfer to the proximal bone.There are a multitude of factors that can affect the integration, stability and fixation of these stems into bone, and understanding these factors is the key to choosing the appropriate implant for a specific femur. METHODS This article aims to discuss cementless prostheses based on evidence-based practice. Geometry, roughness, stem coating, technique and bone quality are among the factors discussed. This was achieved through a review of the current literature. CONCLUSIONS Uncemented femoral stems have shown good, long-term survivorship and functional outcome, with promising results in younger patients.Limitations in the current literature make it difficult to assess and compare different designs to determine optimal indications for each type.Biological fixation, in which the prosthesis is directly fixed to the bone, is the preferred fixation method.Future studies of cementless implants should consistently address patient age, activity level, bone type, and deformities so that more definitive conclusions can be drawn about when to use each design.
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Prospective evaluation of short and mid-term outcomes of total hip arthroplasty using the Accolade™ stem. Hip Int 2016; 25:447-51. [PMID: 25907390 DOI: 10.5301/hipint.5000238] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/03/2015] [Indexed: 02/04/2023]
Abstract
PURPOSE Cementless press-fit total hip arthroplasty (THA) with the Accolade stem (Stryker AccoladeTM TMZF, Mahwah, New Jersey) has demonstrated variable implant survivorship and outcomes. The purpose of this study was to analyse the: 1) implant survivorship; 2) complications; 3) functional outcomes; 4) overall quality of life; and 5) patient expectations and satisfaction following THA with this particular press-fit stem. METHODS A prospectively collected database of 222 patients who underwent THA at 7 institutions between 2006 and 2009 using the Accolade stem (Stryker Inc. Mahwah, New Jersey) was evaluated. Harris Hip Score (HHS) and SF-12 were used to assess the outcomes at 2- and 5-year follow-up. Kaplan-Meier survivorship was calculated at 5 years of follow-up. RESULTS The 5-year aseptic and all-cause survivorship rates were 99.4% (95% CI, 96.3 to 99.9%) and 97.9% (95% CI, 94.6 to 99.2%), respectively. At 2 and 5 years postoperatively, the patients demonstrated a mean HHS of approximately 89 points and 92 points, respectively. The mental and physical components of the SF-12 mean score increased with the physical component having a more marked increase. The mental and physical components of the SF-12 score increased to a mean of 46 and 45 points at 2 and 5 years, respectively. At 2-year follow-up, over 90% of patients were satisfied with their outcome in a majority of areas surveyed. DISCUSSION Our results suggest that the use of this press-fit construct results in tremendous improvements in functional and quality of life outcomes, along with excellent survivorship at short- and mid-term follow-up.
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