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Ralles S, Murphy MP, Farooq H, Grayson W, Hopkinson WJ, Brown NM. Short-term outcomes with routine use of size ≥40 femoral heads in THA: A retrospective cohort study. J Orthop 2025; 59:27-29. [PMID: 39351269 PMCID: PMC11439536 DOI: 10.1016/j.jor.2024.08.001] [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: 07/05/2024] [Revised: 07/28/2024] [Accepted: 08/02/2024] [Indexed: 10/04/2024] Open
Abstract
Background Using larger femoral heads during total hip arthroplasty (THA) may result in a more stable hip. Greater volumetric wear and frictional torque, however, may result in increased postoperative complications. The purpose of this study was to compare outcomes of patients with femoral head size ≥40 mm compared to those with femoral head size <40 mm. Materials and methods A retrospective chart review of 504 THAs performed by a single surgeon at a single institution from 2009 to 2016 was conducted. Following exclusions, 131 THAs were identified with femoral heads ≥40 mm and 348 THAs were identified with femoral heads <40 mm. In addition to demographic data, all postoperative complications were recorded. Plain radiographs were used to rule out/in periprosthetic osteolysis and/or acetabular loosening. Chi-square tests and Student's t-tests were used to compare categorical and continuous variables, respectively. Results Mean follow-up period for the entire cohort was 5.5 years. Complications with ≥40 mm femoral heads included 1 superficial infection and 1 deep periprosthetic joint infection (PJI). There were no cases of dislocation, osteolysis, acetabular loosening, or trunnionosis. In contrast, complications with <40 mm femoral heads included 9 dislocations and 7 PJIs. Conclusion The routine use of large femoral heads (≥40-mm) during THA appears to be a safe option for patients at short-term clinical follow-up. Notably, 0 patients had a clinical course complicated by dislocation, osteolysis, acetabular loosening, or trunnionosis. Level of evidence Level III Retrospective Cohort Study.
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Affiliation(s)
- Steven Ralles
- Loyola University Health System, Department of Orthopaedic Surgery and Rehabilitation, Maywood, IL 60153, USA
| | - Michael P. Murphy
- Loyola University Health System, Department of Orthopaedic Surgery and Rehabilitation, Maywood, IL 60153, USA
| | - Hassan Farooq
- Loyola University Health System, Department of Orthopaedic Surgery and Rehabilitation, Maywood, IL 60153, USA
| | - Whisper Grayson
- Loyola University Health System, Department of Orthopaedic Surgery and Rehabilitation, Maywood, IL 60153, USA
| | - William J. Hopkinson
- Loyola University Health System, Department of Orthopaedic Surgery and Rehabilitation, Maywood, IL 60153, USA
| | - Nicholas M. Brown
- Loyola University Health System, Department of Orthopaedic Surgery and Rehabilitation, Maywood, IL 60153, USA
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Nepple CM, Blackburn AZ, Feder OI, Prasad AK, Bedair HS. Minimum 10-Y Follow-Up of Vitamin-E-Diffused Highly Crosslinked Polyethylene Liners in Total Hip Arthroplasty: A Comparative Evaluation From a Prospective, International, Multicenter Cohort Study. J Arthroplasty 2024:S0883-5403(24)00939-2. [PMID: 39303910 DOI: 10.1016/j.arth.2024.09.002] [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: 04/15/2024] [Revised: 09/02/2024] [Accepted: 09/10/2024] [Indexed: 09/22/2024] Open
Abstract
BACKGROUND Total hip arthroplasty (THA) is a proven and effective treatment for end-stage osteoarthritis. The success of THA is due in part to highly crosslinked polyethylene (XL) implants. In 2007, a new generation of polyethylene liners entered clinical use. The new liners infused polyethylene with vitamin E and became vitamin E infused polyethylene (EP). The EP liner was hypothesized to prevent the loss of mechanical properties caused by oxidation, extending the lifetime of the implant. This international prospective study aimed to quantify the clinical outcomes of a 977 patient cohort receiving EP and XL liners 10 years after surgery. METHODS The prospective cohort study began in 2007, including eight countries and 17 centers. The final cohort included 977 patients (EP liner: n = 520; XL liner: n = 457). Patients were followed preoperatively, postoperatively, and at 1, 3, 5, 7, and 10 years. Each follow-up visit involved clinical evaluation, radiography, and survey collection. The demographics and revisions were also recorded. Mann-Whitney U tests were used to evaluate statistical differences. RESULTS At 10 years following surgery, 534 patients were eligible for follow-up. Of those eligible, 352 patients returned for clinical evaluation (65.9% eligible; 36.0% overall). No statistical differences were found (P > 0.05) in the demographics of the followed-up cohort. The linear wear rates were 0.00338 mm/year for EP liners and 0.0236 mm/year for XL liners using individual regression (P < 0.0001). No significant difference was observed in wear rates using cohort regression. Similarly, surveys suggested no significant outcomes between the EP and XL liner cohorts. The overall incidence of revision was 2.3% for EP and 2.0% for XL liners. CONCLUSIONS The EP liner demonstrated significantly lower wear than its XL counterparts at 10 years after implantation. Results are promising, as vitamin E polyethylene may improve the lifetime performance of THA implants and ensure that arthroplasty innovations reflect the changing patient population.
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Affiliation(s)
- Cecilia M Nepple
- Harris Orthopaedics Laboratory, Massachusetts General Hospital, Boston, Massachusetts
| | - Amy Z Blackburn
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Oren I Feder
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts; Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts
| | - Anoop K Prasad
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts; Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts
| | - Hany S Bedair
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts; Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts
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3
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Migliorini F, Betsch M, Maffulli N, Schäfer L, Hildebrand F, Kubach J, Pasurka M. Rate of revision and wear penetration in different polyethylene liner compositions in total hip arthroplasty: a Bayesian network meta-analysis. Sci Rep 2024; 14:21162. [PMID: 39256531 PMCID: PMC11387631 DOI: 10.1038/s41598-024-71326-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 08/27/2024] [Indexed: 09/12/2024] Open
Abstract
The present Bayesian network meta-analysis compared different types of polyethylene liners in total hip arthroplasty (THA) in terms of wear penetration (mm/year) and rate of revision. The type of liners compared were the crosslinked ultra-high molecular weight polyethylene (CPE/UHMWPE), Vitamin E infused highly cross-linked polyethylene (HXLPE-VEPE), modified cross-linked polyethylene (MXLPE), highly cross-linked polyethylene (HXLPE), Cross-linked polyethylene (XLPE). This study was conducted according to the PRISMA extension statement for reporting systematic reviews incorporating network meta-analyses of healthcare interventions. In June 2024, PubMed, Scopus, Embase, Google Scholar, and Cochrane databases were accessed. A time constraint was set from January 2000. All investigations which compared two or more types of polyethylene liners for THA were accessed. Only studies that clearly stated the nature of the liner were included. Data from 60 studies (37,352 THAs) were collected. 56% of patients were women. The mean age of patients was 60.0 ± 6.6 years, the mean BMI was 27.5 ± 2.0 kg/m2. The mean length of follow-up was 81.6 ± 44.4 months. Comparability was found at baseline between groups. XLPE and HXLPE liners in THA are associated with the lowest wear penetration (mm/year) and the lowest revision rate at approximately 7 years of follow-up.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany.
- Department of Orthopedics and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), 39100, Bolzano, Italy.
- Department of Life Sciences, Health, and Health Professions, Link Campus University, 00165, Rome, Italy.
| | - Marcel Betsch
- Department of Orthopaedics and Trauma Surgery, University Hospital Erlangen, 91054, Erlangen, Germany
| | - Nicola Maffulli
- Department of Medicine and Psychology, University of Rome "La Sapienza", Rome, Italy
- School of Pharmacy and Bioengineering, Faculty of Medicine, Keele University, Stoke on Trent, ST4 7QB, UK
- Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Mile End Hospital, Queen Mary University of London, London, E1 4DG, UK
| | - Luise Schäfer
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Frank Hildebrand
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Joshua Kubach
- Department of Orthopaedics and Trauma Surgery, University Hospital Erlangen, 91054, Erlangen, Germany
| | - Mario Pasurka
- Department of Orthopaedics and Trauma Surgery, University Hospital Erlangen, 91054, Erlangen, Germany
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4
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Wright BH, Hadley ML, Harmer JR, Fruth KM, Sierra RJ, Couch CG. No Revisions Attributable to Wear of Highly Cross-Linked Polyethylene Liners: A Long-Term Follow-Up Study. J Arthroplasty 2024; 39:S347-S352. [PMID: 38964487 DOI: 10.1016/j.arth.2024.06.042] [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: 12/15/2023] [Revised: 06/14/2024] [Accepted: 06/17/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND There is a paucity of data beyond 15 years on the survivorship of total hip arthroplasty since the introduction of highly cross-linked polyethylene (HXLPE) liners. Our aim was to evaluate implant survivorship, liner wear rates, and clinical outcomes after primary total hip arthroplasty using HXLPE liners implanted between 1999 and 2002. METHODS Between 1999 and 2002, 690 primary total hip arthroplasties utilizing 28-mm femoral heads and HXLPE liners of a single design were identified using our institutional total joint registry. Femoral heads were made of metal in 96% of cases and ceramic in 4%. The mean age was 56 years, 48% were women, and the mean body mass index was 30. Survivorship analyses were performed for the outcomes of implant revision, reoperation, and complications for the entire cohort. Linear HXLPE liner wear rates were determined on 197 hips with radiographs with more than 18.5 years of follow-up. RESULTS At 20 years, survivorship free of revision was 94%, free of reoperation was 92%, and free of any complication was 81%. There were no documented wear-related revisions. The linear wear rate at a mean of 20.3 years postoperatively was 0.02 mm/y. There was no statistically significant difference in measured wear observed between the first available postoperative radiographs and those taken at the final follow-up. The use of elevated liners, patient body mass index, age, preoperative diagnosis, acetabular component inclination, and anteversion angles were not associated with increased wear rates. Mean Harris hip scores improved from 52 preoperatively to 90 at greater than 18.5 years CONCLUSIONS: Primary total hip arthroplasties using a single first-generation HXLPE liner demonstrated excellent survivorship and clinical outcomes at long-term follow-up with no wear-related revisions. Wear rates of HXLPE liners at 20 years are exceedingly low and are not significantly impacted by acetabular component position or patient-dependent variables such as BMI. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Breydan H Wright
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Matthew L Hadley
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Joshua R Harmer
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Kristin M Fruth
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Rafael J Sierra
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Cory G Couch
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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5
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Derr T, MacDonald DW, Malkani AL, Klein GR, Kurtz SM. Femoral Head Penetration Rates and Oxidation of Highly Cross-Linked Polyethylene Hip Liners Implanted More Than 10 Years. J Arthroplasty 2024; 39:S286-S291. [PMID: 38754708 DOI: 10.1016/j.arth.2024.05.024] [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: 12/18/2023] [Revised: 05/06/2024] [Accepted: 05/08/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Highly cross-linked polyethylene (HXLPE) was introduced to improve wear in total hip arthroplasty, with manufacturers implementing different thermal treatments to reduce oxidation. It is important to understand how long-term time in vivo affects the wear of these materials. The purpose of this study was to investigate the wear and oxidative performance of first-generation HXLPE hip inserts implanted for greater than 10 years and compare annealed and remelted HXLPE formulations. METHODS There were 49 total hip arthroplasty liners retrieved during routine revision surgery as part of an institutional review board-approved implant retrieval program. Penetration rates for the liners were calculated as the difference between the thickness of the unloaded and loaded regions divided by implantation time. Oxidation indices for the rim, locking mechanism, articulating surface, and backside regions were measured using Fourier-transform infrared spectroscopy according to American Society for Testing and Materials 2102. Mann-Whitney U tests were used to determine the statistical difference between annealed and remelted components. RESULTS The cohort had an average implantation time of 13.1 ± 2.6 years for annealed and 12.1 ± 1.7 years for remelted components. The components were revised most often for polyethylene wear, instability, and loosening. The penetration rate averaged 0.0177 ± 0.014 mm/year for annealed components and 0.015 ± 0.022 mm/year for remelted components. Penetration rates did not differ between the remelted and annealed cohorts (P = .28). Oxidation indices were found to be significantly higher in the annealed cohort for all regions of interest (P < .001). CONCLUSIONS Oxidation was found to be higher in the annealed HXLPE; however, this does not seem to be associated with greater wear as we found the average penetration rates for the cohorts were low, and the penetration rates were similar between the annealed and remelted cohorts.
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Affiliation(s)
- Tabitha Derr
- Implant Research Core, Drexel University, Philadelphia, Pennsylvania
| | | | - Arthur L Malkani
- Department of Orthopaedic Surgery, University of Louisville, Louisville, Kentucky
| | - Gregg R Klein
- Department of Orthopaedic Surgery, Hackensack University Medical Center, Hackensack, New Jersey
| | - Steven M Kurtz
- Implant Research Core, Drexel University, Philadelphia, Pennsylvania
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6
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Muratoglu OK, Asik MD, Nepple CM, Wannomae KK, Micheli BR, Connolly RL, Oral E. Di-cumyl peroxide cross-linked UHMWPE/vitamin-E blend for total joint arthroplasty implants. J Orthop Res 2024; 42:306-316. [PMID: 37593816 DOI: 10.1002/jor.25679] [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: 01/30/2023] [Revised: 07/12/2023] [Accepted: 08/14/2023] [Indexed: 08/19/2023]
Abstract
Majority of ultrahigh molecular weight polyethylene (UHMWPE) medical devices used in total joint arthroplasty are cross-linked using gamma radiation to improve wear resistance. Alternative methods of cross-linking are urgently needed to replace gamma radiation due to rapid decline in its supply. Peroxide cross-linking is a candidate method with widespread industrial applications. Oxidative stability and biocompatibility, which are critical requirements for medical device applications, can be achieved using vitamin-E as an additive and by removing peroxide by-products through high-temperature melting, respectively. We investigated compression molded UHMWPE/vitamin-E/di-cumyl peroxide blends followed by high-temperature melting in inert gas as a material candidate for tibial knee inserts. Wear resistance increased and mechanical properties remained largely unchanged. Oxidation induction time was higher than most of the other clinically available formulations. The material passed the local-end point biocompatibility tests per ISO 10993. Compounds found in exhaustive extraction were of no concern with margin-of-safety values well above the accepted level, indicating a desirable toxicological risk profile. Statement of Clinical Significance: Peroxide cross-linked, vitamin-E stabilized, and high-temperature melted UHMWPE has recently been cleared for clinical use in tibial knee inserts. With all the salient characteristics needed in a material that can provide superior long-term performance in total joint patients, peroxide cross-linking can replace the gamma radiation cross-linking of UHMWPE.
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Affiliation(s)
- Orhun K Muratoglu
- Harris Orthopaedics Laboratory, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Mehmet D Asik
- Harris Orthopaedics Laboratory, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Cecilia M Nepple
- Harris Orthopaedics Laboratory, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Keith K Wannomae
- Harris Orthopaedics Laboratory, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Brad R Micheli
- Harris Orthopaedics Laboratory, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Rachel L Connolly
- Harris Orthopaedics Laboratory, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ebru Oral
- Harris Orthopaedics Laboratory, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts, USA
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7
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Takahashi E, Chen M, Kaneuji A, Soma D, Fukui M, Kawahara N. Comparative Study of Highly Cross-Linked Polyethylene Liner Wear by Hip Center Location Using Elevated Hip Center Technique in Crowe I to III Hip Dysplasia: Outcomes for a Minimum of Eighteen Years of Follow-Up. J Arthroplasty 2023; 38:2655-2660. [PMID: 37279849 DOI: 10.1016/j.arth.2023.05.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 05/27/2023] [Accepted: 05/29/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND The literature has reported that supero-lateralization of the femoral head increases the rates of aseptic loosening and prosthesis revision. However, there are few reports on the influence of different hip center positions on liner wear with more than a 15-year follow-up period. METHODS From April 2000 to August 2003, 91 patients underwent 108 total hip arthroplasties using a highly cross-linked polyethylene liner combined with zirconia femoral head and cup components. Pelvic radiographs were used to assess the vertical and horizontal distances to the center of the hip and the amount of liner wear. Mean patient age at the time of surgery was 54 years (range, 33 to 73), and mean follow-up duration was 19 years (range, 18 to 21). RESULTS Average liner wear was 0.221 mm, with average annual wear of 0.012 mm/year. Mean vertical and horizontal distances for the hip center were 24.9 and 31.8 mm, respectively. There was no difference in linear wear between patients who had different hip center heights (<20, 20 to 30, and >30 mm), and quadrant partitioning showed no differences across the 4 quadrant zones. CONCLUSION At a minimum of 18 years of follow-up in patients having developmental dysplasia of the hip who had different Crowe subtypes and different hip centers, elevated hip center and uncemented fixation techniques using a highly cross-linked polyethylene on ceramic components were associated with very low wear rates and excellent functional scores.
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Affiliation(s)
- Eiji Takahashi
- Department of Orthopaedic Surgery, Kanazawa Medical University, Kahoku-gun, Ishikawa, Japan
| | - Mingliang Chen
- Department of Orthopaedic Surgery, Kanazawa Medical University, Kahoku-gun, Ishikawa, Japan
| | - Ayumi Kaneuji
- Department of Orthopaedic Surgery, Kanazawa Medical University, Kahoku-gun, Ishikawa, Japan
| | - Daisuke Soma
- Department of Orthopaedic Surgery, Kanazawa Medical University, Kahoku-gun, Ishikawa, Japan
| | - Makoto Fukui
- Department of Orthopaedic Surgery, Kanazawa Medical University, Kahoku-gun, Ishikawa, Japan
| | - Norio Kawahara
- Department of Orthopaedic Surgery, Kanazawa Medical University, Kahoku-gun, Ishikawa, Japan
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8
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Collins AK, Sauder N, Nepple CM, Blackburn AZ, Prasad AK, Feder OI, Melnic CM, Bedair HS. Minimum 7-Year Follow-Up of Vitamin E-Diffused and Highly Cross-Linked Polyethylene Liners in Total Hip Arthroplasty: Findings From a Prospective, International, Multicenter Study of 977 Patients. J Arthroplasty 2023; 38:2373-2378. [PMID: 37207702 DOI: 10.1016/j.arth.2023.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 05/03/2023] [Accepted: 05/05/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND Vitamin E-diffused highly cross-linked polyethylene (VEPE) acetabular liners for total hip arthroplasty (THA) have shown favorable results in small cohort studies. However, larger studies are warranted to compare its performance to highly cross-linked polyethylene (XLPE) and demonstrate clinical significance in 10-year arthroplasty outcomes. This study compared acetabular liner wear and patient-reported outcome measures (PROMs) between patients treated with VEPE and XLPE liners in a prospective, international, multicenter study with minimum 7-year follow-up. METHODS A total of 977 patients (17 centers; 8 countries) were enrolled from 2007 to 2012. The centers were randomly assigned to implants. At 1-year, 3-year, 5-year, and 7-year postoperative visits, radiographs, PROMs, and incidence of revision were collected. Acetabular liner wear was calculated using computer-assisted vector analysis of serial radiographs. General health, disease progression, and treatment satisfaction reported by patients were scored using 5 validated surveys and compared using Mann-Whitney U tests. At 7 years, 75.4% of eligible patients submitted data. RESULTS The mean acetabular liner wear rate was -0.009 mm/y and 0.024 mm/y for the VEPE and XLPE group, respectively (P = .01). There were no statistically significant differences in PROMs. The overall revision incidence was 1.8% (n = 18). The revision incidence in VEPE and XLPE cohorts were 1.92% (n = 10) versus 1.75% (n = 8), respectively. CONCLUSION We found that VEPE acetabular liners in total hip arthroplasty led to no significant clinical difference in 7-year outcomes as measured by acetabular liner wear rate, PROMs, and revision rate. While VEPE liners showed less wear, the wear rate for both the VEPE and XLPE liners was below the threshold for osteolysis. Therefore, the difference in liner wear may indicate comparative clinical performance at 7 years, as further indicated by the lack of difference in PROMs and the low revision incidence.
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Affiliation(s)
- Austin K Collins
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA
| | - Nicholas Sauder
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA
| | - Cecilia M Nepple
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA
| | - Amy Z Blackburn
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA
| | - Anoop K Prasad
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA; Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA
| | - Oren I Feder
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA; Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA
| | - Christopher M Melnic
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA; Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA
| | - Hany S Bedair
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA; Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA
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9
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Deans CF, Buckner BC, Garvin KL. Wear, Osteolysis, and Aseptic Loosening Following Total Hip Arthroplasty in Young Patients with Highly Cross-Linked Polyethylene: A Review of Studies with a Follow-Up of over 15 Years. J Clin Med 2023; 12:6615. [PMID: 37892754 PMCID: PMC10607435 DOI: 10.3390/jcm12206615] [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: 09/01/2023] [Revised: 09/26/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023] Open
Abstract
Total hip arthroplasty (THA) has in recent years trended toward a younger, more physically demanding patient population. Mid- to long-term studies of all ages of THA patients using highly cross-linked polyethylene (HXLPE) have been favorable, but concerns about its long-term failure and wear-related complications remain for young THA patients. In this narrative review, a search of the PubMed/MEDLINE and Cochrane databases was performed, and we identified six studies with a minimum 15-year follow-up of HXLPE with various femoral head materials. Wear-related revisions were exceedingly low for patients under the age of 55, with variable reports of non-clinically significant osteolysis. Higher activity levels, a larger femoral head size, and femoral head material were not associated with greater long-term wear rates. Young THA with metal or ceramic on HXLPE is exceedingly durable with favorable outcomes at follow-ups of over 15 years.
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Affiliation(s)
| | | | - Kevin L. Garvin
- Department of Orthopaedic Surgery & Rehabilitation, University of Nebraska Medical Center, 985640 Nebraska Medical Center, Omaha, NE 68198, USA
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10
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Peagler CL, Dobek AJ, Tabaie S. Trends in the Use of Total Hip Arthroplasty in the Pediatric Population: A Review of the Literature. Cureus 2023; 15:e43978. [PMID: 37622056 PMCID: PMC10445662 DOI: 10.7759/cureus.43978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2023] [Indexed: 08/26/2023] Open
Abstract
Current literature shows that the utilization of total hip arthroplasty (THA) to address pediatric hip pathology has seen a significant rise worldwide in recent decades. However, performing THA in pediatric patients presents unique challenges due to their increased activity levels, varying skeletal maturity, and diverse medical conditions. These challenges have relegated THA to a secondary option for young patients. Nonetheless, despite these difficulties, recent studies have demonstrated a growing prevalence of THA in pediatrics. Consequently, there is an urgent need for a comprehensive review of the existing literature on this topic. In this study, we examined large database and single-institution studies involving pediatric patients aged 21 years and under who underwent THA. The primary indications for THA in this population were osteoarthritis, osteonecrosis, and inflammatory arthritis. To ensure informed decision-making for pediatric patients, it is crucial to gather consolidated information on trends and outcomes related to THA indications. This review aims to provide insights into these trends and facilitate better decision-making for the treatment of pediatric patients.
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Affiliation(s)
- Correggio L Peagler
- Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, Washington DC, USA
| | - Alexander J Dobek
- Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, Washington DC, USA
| | - Sean Tabaie
- Orthopaedic Surgery, Children's National Hospital, Washington DC, USA
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11
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Nielson T, Owens G, Miller B, Meneghini E, Deckard ER, Meneghini RM. Large Femoral Heads in Total Hip Arthroplasty With Vitamin E Highly Cross-Linked Polyethylene: Head Penetration Rates Compared to Highly Cross-Linked Polyethylene. J Arthroplasty 2022; 37:S685-S691. [PMID: 35227535 DOI: 10.1016/j.arth.2022.01.075] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/20/2022] [Accepted: 01/24/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Highly cross-linked polyethylene with vitamin E (VE-HXLPE) has shown superior tribological properties and has been rapidly adopted in total hip arthroplasty. However, the majority of studies compare VE-HXLPE to conventional or moderately cross-linked polyethylene using standard femoral head sizes. This study's purpose was 2-fold: (1) compare radiographic femoral head penetration (FHP) between VE-HXLPE and HXLPE and (2) evaluate FHP in large femoral heads ≥40 mm. METHODS One hundred forty-two consecutive primary total hip arthroplasties using ceramic femoral heads (n = 84 VE-HXLPE; n = 58 HXLPE) in a single implant system were retrospectively reviewed. FHP was measured radiographically utilizing Martell method at 4-week, 1-year, and latest radiographs. FHP, cup position, and demographic variables were compared between VE-HXLPE and HXLPE liners. RESULTS Median linear FHP was lower for VE-HXLPE compared to HXLPE during the initial "bedding-in" period between 4-week and 1-year (0.383 vs 0.551 mm, P = .650) and between 1-year and latest follow-up (0.131 vs 0.270 mm/y, P = .636) although without statistical significance. Acetabular cup inclination and anteversion did not influence linear or volumetric FHP (P ≥ .204). Large femoral heads (≥40 mm) were predictive of higher FHP during the early bedding-in period (P ≤ .025) but did not have an effect beyond 1 year in multivariate regression with numbers available. No radiographic osteolysis was observed in any case. CONCLUSION These findings support others that VE-HXLPE is the optimal polyethylene bearing surface to minimize FHP during the bedding-in period and beyond. Surprisingly, large ceramic femoral heads appear to influence FHP during the initial bedding-in period but do not increase FHP beyond 1 year. Further longer term follow-up remains warranted. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Trent Nielson
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Garrett Owens
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Brandon Miller
- Department of Mechanical Engineering, Tennessee Tech University, Cookeville, TN
| | - Ethan Meneghini
- IU Health Hip & Knee Center, IU Health Saxony Hospital, Fishers, IN
| | - Evan R Deckard
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - R Michael Meneghini
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN; IU Health Hip & Knee Center, IU Health Saxony Hospital, Fishers, IN
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12
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Sax OC, Douglas SJ, Chen Z, Mont MA, Nace J, Delanois RE. Low Wear at 10-Year Follow-Up of a Second-Generation Highly Cross-Linked Polyethylene in Total Hip Arthroplasty. J Arthroplasty 2022; 37:S592-S597. [PMID: 35210151 DOI: 10.1016/j.arth.2022.01.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/27/2021] [Accepted: 01/06/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Characterizations and factors influencing longer term performance of second-generation sequentially irradiated and annealed highly cross-linked polyethylene (HXLPE) are lacking. We evaluated patients who underwent total hip arthroplasty with HXLPE at mean 10-year follow-up for (1) linear and volumetric wear rates, (2) patient and implant characteristics, (3) implant survivorships, and (4) functional scores. METHODS We evaluated 130 hips (110 patients) that received HXLPE acetabular liners at a single center. The mean age was 56 years (range, 20-79 years), with a mean follow-up of 10 years (range, 8-15). Radiographic linear (millimeters/year) and volumetric (cubic millimeters/year) wear rates were quantified using radiographic analysis. Survivorship was assessed by all-cause and wear-related revision rates. Functional outcomes were assessed by Short Form 12 and modified Harris Hip Scores. RESULTS The mean linear wear rate was 0.02 ± 0.03 mm/y, and the mean volumetric wear rate was 12.6 ± 5.3 mm3/y. Younger age had higher volumetric wear (total and yearly, P = .01). Increasing body mass index trended toward higher total and yearly linear (both, P ≤ .09) and volumetric wear (both, P ≤ .07). Ten patients required revisions, with an all-cause survivorship of 92% and a wear survivorship of 100%. The mean modified Harris Hip Scores was 84, and the mean Short Form 12 scores were 46 (physical) and 55 (mental). CONCLUSION We observed low linear and volumetric wear rates for HXLPE at 10-year mean follow-up. Younger age and higher body mass index at the time of surgery may be important patient characteristics influencing long-term wear. These results illustrate the potential for this second-generation HXLPE to be an appropriate long-term total hip arthroplasty interface.
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Affiliation(s)
- Oliver C Sax
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD
| | - Scott J Douglas
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD
| | - Zhongming Chen
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD
| | - Michael A Mont
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD
| | - James Nace
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD
| | - Ronald E Delanois
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD
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13
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Gkiatas I, Karasavvidis T, Sharma AK, Xiang W, Malahias MA, Chalmers BP, Sculco PK. Highly cross-linked polyethylene in primary total knee arthroplasty is associated with a lower rate of revision for aseptic loosening: a meta-analysis of 962,467 cases. Arch Orthop Trauma Surg 2022; 142:1177-1184. [PMID: 33847797 DOI: 10.1007/s00402-021-03887-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 03/27/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The evolution in total knee arthroplasty (TKA) includes the highly cross-linked polyethylene (HXLPE) which has been reported as an effective manner to reduce the wear of the polyethylene and the osteolysis. The purpose of the present study is to synthesize the results of comparative studies between HXLPE and conventional polyethylenes and determine their effect in primary TKA. METHODS The US National Library of Medicine (PubMed/MEDLINE) and the Cochrane Database of Systematic Reviews were queried for publications utilizing the following keywords: "cross-linked", "polyethylene", "HXLPE", "conventional", "total knee arthroplasty", "TKA", "total knee replacement" and "TKR" combined with Boolean operators AND and OR. RESULTS Ten studies met the inclusion criteria and were included in the present meta-analysis with 962,467 patients. No significant difference was found regarding the revision rate for any reason between the patients who received HXLPE and those with conventional liner (OR 0.67; 95% CI 0.39-1.18; I2: 97.7%). In addition, there was no difference regarding the radiolucent lines between the two types of liners (OR 0.54; 95% CI 0.20-1.49; I2: 69.4%). However, with data coming from seven studies enrolling a total of 411,543 patients, it was demonstrated that patients who received HXLPE were less likely to be revised due to aseptic loosening compared to the patients with conventional liners (OR 0.35; 95% CI 0.31-0.39; I2: 0.0%). CONCLUSION The present meta-analysis showed that regarding the overall revision rate and radiographic outcomes there was no significant difference between the two types of liners. On the other hand, the significantly less revision rate due to loosening supports the routine continued use of HXLPE in primary TKA.
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Affiliation(s)
- Ioannis Gkiatas
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, 10022, USA.
| | - Theofilos Karasavvidis
- School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Abhinav K Sharma
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, 10022, USA
| | - William Xiang
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, 10022, USA
| | - Michael-Alexander Malahias
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, 10022, USA
| | - Brian P Chalmers
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, 10022, USA
| | - Peter K Sculco
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, 10022, USA
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14
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Tanaka S, Ito H. Wear of a Highly Cross-Linked Polyethylene Liner of the Acetabular Component Placed With Excessive Acetabular Inclination. Orthopedics 2022; 45:e96-e100. [PMID: 35021024 DOI: 10.3928/01477447-20220105-05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Few studies have investigated the influence of excessive acetabular inclination during total hip arthroplasty (THA) on the wear of highly cross-linked polyethylene (HXLPE). The goal of this study was to determine whether excessive acetabular inclination during THA causes prominent wear of the HXLPE liner. We retrospectively evaluated 62 hips of 54 women and 8 men who underwent primary THA with an HXLPE liner between January 2006 and September 2011. Postoperative anteroposterior pelvic radiographs were used to measure acetabular inclination and analyze polyethylene wear. Patients were divided into the following groups: the excessive acetabular inclination group (acetabular inclination angle ≥50°; n=20) and the control group (acetabular inclination angle <50°; n=42). Clinical information and imaging findings were compared and examined between the 2 groups. Further, we evaluated the correlation between the acetabular inclination angle and the polyethylene wear rate. In all cases, mean follow-up duration was 6.3 years. The annual liner wear was 0.00446 and 0.0254 mm/y in the control and excessive acetabular inclination groups, respectively. The excessive acetabular inclination group had significantly higher polyethylene liner wear compared with the control group (P=.00991). A weak correlation was seen between acetabular inclination angle and polyethylene wear rate in all cases (Spearman's rank correlation, r=0.283, P=.0258). Excessive acetabular inclination may increase HXLPE liner wear in the long term. [Orthopedics. 2022;45(2):e96-e100.].
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15
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Analysis of the Risk of Wear on Cemented and Uncemented Polyethylene Liners According to Different Variables in Hip Arthroplasty. MATERIALS 2021; 14:ma14237243. [PMID: 34885400 PMCID: PMC8658086 DOI: 10.3390/ma14237243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 11/23/2021] [Accepted: 11/24/2021] [Indexed: 12/12/2022]
Abstract
Wear debris in total hip arthroplasty is one of the main causes of loosening and failure, and the optimal acetabular fixation for primary total hip arthroplasty is still controversial because there is no significant difference between cemented and uncemented types for long-term clinical and functional outcome. To assess and predict, from a theoretical viewpoint, the risk of wear with two types of polyethylene liners, cemented and uncemented, a simulation using the finite element (FE) method was carried out. The risk of wear was analyzed according to different variables: the polyethylene acetabular component’s position with respect to the center of rotation of the hip; the thickness of the polyethylene insert; the material of the femoral head; and the relationship of the cervical–diaphyseal morphology of the proximal end of the femur to the restoration of the femoral offset. In all 72 simulations studied, a difference was observed in favour of a cemented solution with respect to the risk of wear. With regard to the other variables, the acetabular fixation, the thickness of the polyethylene, and the acetabular component positioning were statistically significant. The highest values for the risk of wear corresponded to a smaller thickness (5.3 mm), and super-lateral positioning at 25 mm reached the highest value of the von Mises stress. According to our results, for the reconstruction of the acetabular side, a cemented insert with a thickness of at least 5 mm should be used at the center of rotation.
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16
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González-Bravo C, Ortega MA, Buján J, de la Torre B, Barrios L. Wear Risk Prevention and Reduction in Total Hip Arthroplasty. A Personalized Study Comparing Cement and Cementless Fixation Techniques Employing Finite Element Analysis. J Pers Med 2021; 11:jpm11080780. [PMID: 34442424 PMCID: PMC8402105 DOI: 10.3390/jpm11080780] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 08/04/2021] [Indexed: 11/16/2022] Open
Abstract
The wear rate on Total Hip Arthroplasty (THA) entails a heavy burden for patients. This becomes more relevant with increased wear risk and its consequences such as osteolysis. In addition, osteolysis has been described in cemented and uncemented acetabular implants, and nowadays, controversy remains as to whether or not to cement the acetabular component. A personalized theoretical study was carried out to investigate which parameters have an influence on wear risk and to determine the best fixation method. Liner wear risk was assessed for two different types of fixation (cemented vs uncemented) through Finite Elements Analysis (FEA). The intraoperative variables used to determine the wear risk (cervical-diaphyseal angle, Center of Rotation positioning -COR-, head material, head size, and liner thickness) are vital parameters in surgical planning. Two types of tridimensional liner models of Ultra High Molecular Weight Polyethene (UHMWPE) were simulated through finite element analysis (FEA-over 216 cases were the core of this research). A significant relationship was found between the cervical-diaphyseal angle and wear risk (p < 0.0001), especially in valgus morphology. The acetabular fixation technique (p < 0.0001) and liner thickness (p < 0.0001) showed a significant relationship with wear risk. According to our study, using a cemented fixation with a thick liner in the right center of rotation appears to be the proper stratagy for preventing polyethylene liner wear.
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Affiliation(s)
- Carlos González-Bravo
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, Ramón y Cajal Institute of Sanitary Research (IRYCIS), University of Alcalá, Alcalá de Henares, 28034 Madrid, Spain; (C.G.-B.); (M.A.O.); (J.B.); (L.B.)
- A+I Architecture and Engineering Ltd., 28224 Madrid, Spain
| | - Miguel A. Ortega
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, Ramón y Cajal Institute of Sanitary Research (IRYCIS), University of Alcalá, Alcalá de Henares, 28034 Madrid, Spain; (C.G.-B.); (M.A.O.); (J.B.); (L.B.)
| | - Julia Buján
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, Ramón y Cajal Institute of Sanitary Research (IRYCIS), University of Alcalá, Alcalá de Henares, 28034 Madrid, Spain; (C.G.-B.); (M.A.O.); (J.B.); (L.B.)
| | - Basilio de la Torre
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, Ramón y Cajal Institute of Sanitary Research (IRYCIS), University of Alcala, Alcala de Henares, 28034 Madrid, Spain
- Department of Orthopedic Surgery, University Hospital Ramón y Cajal, 28034 Madrid, Spain
- Correspondence: ; Tel.: +34-91-885-45-40; Fax: +34-91-885-48-85
| | - Loreto Barrios
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, Ramón y Cajal Institute of Sanitary Research (IRYCIS), University of Alcalá, Alcalá de Henares, 28034 Madrid, Spain; (C.G.-B.); (M.A.O.); (J.B.); (L.B.)
- A+I Architecture and Engineering Ltd., 28224 Madrid, Spain
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Hemmilä M, Laaksonen I, Matilainen M, Eskelinen A, Haapakoski J, Puhto AP, Kettunen J, Pamilo K, Mäkelä KT. Implant survival of 2,723 vitamin E-infused highly crosslinked polyethylene liners in total hip arthroplasty: data from the Finnish Arthroplasty Register. Acta Orthop 2021; 92:316-322. [PMID: 33517823 PMCID: PMC8231410 DOI: 10.1080/17453674.2021.1879513] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - The use of crosslinked polyethylene in total hip arthroplasty (THA) has decreased wear remarkably. It has been suggested that the antioxidative effects of vitamin E may enhance the wear properties of polyethylene even further. This study evaluates revision rates between vitamin E-infused polyethylene liners (E1 and E-poly, ZimmerBiomet, Warsaw, IN, USA) versus moderately crosslinked polyethylene (ModXLPE) liners from the same manufacturer used in primary THA.Patients and methods - We conducted a study based on data from the Finnish Arthroplasty Register. The study group consisted of 2,723 THAs with a vitamin E-infused liner and a reference group of 2,707 THAs with a moderately crosslinked polyethylene liner. Survivorship, revision risk, and re-revision causes were compared between groups.Results - The 7-year survival of the vitamin E-infused polyethylene liner group and of the reference group with revision for any reason as the endpoint was comparable (94% [95% CI 92.9-94.9] and 93% [CI 91.9-93.9], respectively). The adjusted hazard ratio (HR) for any revision was similar between the groups (0.7 [CI 0.4-1.1]). When revision for aseptic loosening was studied as the endpoint, the survival for the study group was 99% (CI 98.6-99.4) and for the reference group 99% (CI 98.7-99.5), and the risk of revision was comparable between the study groups (HR 1.3 [CI 0.7-2.5]).Interpretation - After an observation period of 7 years vitamin E-infused liners shows results equal to results obtained with crosslinked polyethylene liners.
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Affiliation(s)
- Matias Hemmilä
- Department of Orthopaedic Surgery, University of Turku and Turku University Hospital, Turku; ,Correspondence:
| | - Inari Laaksonen
- Department of Orthopaedic Surgery, University of Turku and Turku University Hospital, Turku;
| | - Markus Matilainen
- Turku PET Centre, University of Turku and Turku University Hospital, Turku;
| | - Antti Eskelinen
- Coxa Hospital for Joint Replacement and Faculty of Medicine and Health Technologies, Tampere University, Tampere;
| | | | - Ari-Pekka Puhto
- Division of Operative Care, Department of Orthopaedic and Trauma Surgery, Oulu University Hospital, Oulu;
| | - Jukka Kettunen
- Department of Orthopaedics and Traumatology, Kuopio University Hospital, Kuopio, Finland
| | - Konsta Pamilo
- Coxa Hospital for Joint Replacement and Faculty of Medicine and Health Technologies, Tampere University, Tampere;
| | - Keijo T Mäkelä
- Department of Orthopaedic Surgery, University of Turku and Turku University Hospital, Turku;
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18
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Medley JB. Highly cross‐linked polyethylene is the new ‘gold standard’ bearing material for total hip arthroplasty. BIOSURFACE AND BIOTRIBOLOGY 2021. [DOI: 10.1049/bsb2.12007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Affiliation(s)
- John B. Medley
- Department of Mechanical and Mechatronics Engineering University of Waterloo Waterloo Ontario Canada
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19
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Kretzer JP, Uhler M, Jäger S, Bormann T, Sonntag R, Schonhoff M, Schröder S. [Tribology in hip arthroplasty : Benefits of different materials]. DER ORTHOPADE 2021; 50:259-269. [PMID: 33630110 DOI: 10.1007/s00132-021-04077-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/01/2021] [Indexed: 11/30/2022]
Abstract
When it comes to total hip replacements, choosing the suitable material combination is of clinical relevance. The present review article examines the technical differences in wear and corrosion of the relevant material combinations of ceramics, metals, ceramized metals and various types of polyethylene. The material characteristics, which were often tested under standardized conditions in the laboratory, are compared with clinical results on the basis of evidence-graded clinical studies and on the basis of register studies. This article thus represents an up-to-date snapshot of the expectations and actual clinical outcomes of the present choice of material combinations. It shows that some tendencies from the field of materials research, e.g. with regard to cross-linked polyethylene, coincide with observations from practical clinical experience, while for other materials, a proven technical superiority has not yet been confirmed as an evident advantage in clinical practice.
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Affiliation(s)
- J Philippe Kretzer
- Klinik für Orthopädie und Unfallchirurgie, Labor für Biomechanik und Implantatforschung, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland.
| | - Maximilian Uhler
- Klinik für Orthopädie und Unfallchirurgie, Labor für Biomechanik und Implantatforschung, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| | - Sebastian Jäger
- Klinik für Orthopädie und Unfallchirurgie, Labor für Biomechanik und Implantatforschung, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| | - Therese Bormann
- Klinik für Orthopädie und Unfallchirurgie, Labor für Biomechanik und Implantatforschung, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| | - Robert Sonntag
- Klinik für Orthopädie und Unfallchirurgie, Labor für Biomechanik und Implantatforschung, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| | - Mareike Schonhoff
- Klinik für Orthopädie und Unfallchirurgie, Labor für Biomechanik und Implantatforschung, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| | - Stefan Schröder
- Klinik für Orthopädie und Unfallchirurgie, Labor für Biomechanik und Implantatforschung, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
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20
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Vendittoli PA, Shahin M, Rivière C, Barry J, Lavoie P, Duval N. Ceramic-on-ceramic total hip arthroplasty is superior to metal-on-conventional polyethylene at 20-year follow-up: A randomised clinical trial. Orthop Traumatol Surg Res 2021; 107:102744. [PMID: 33316444 DOI: 10.1016/j.otsr.2020.102744] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 10/13/2020] [Accepted: 10/20/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Metal-on-conventional polyethylene (MoPc) bearing wear-related biological reactions in total hip arthroplasty (THA) continue to raise concerns among young, active patients. Ceramic-on-ceramic (CoC) bearings may offer improved outcomes in this patient population. QUESTIONS/PURPOSES The aim of this study was to determine if, more than 20years postoperatively, there is a difference between MoPc and CoC THA in terms of (1) survivorship, (2) related complications, (3) radiographic signs of wear, and (4) functional scores. HYPOTHESIS CoC bearing THAs have superior clinical results compared to MoPc THAs. PATIENTS AND METHODS A total of 140 hips in 116 patients with a mean age of 42years were randomised to receive CoC or MoPc THA between 1996 and 2001. Sixty-nine hips in 58 patients received MoP and 71 hips in 68 patients received CoC. Revision rate, WOMAC score, and radiological signs of osteolysis and loosening were compared at last follow-up. RESULTS After a mean follow-up of 21years (19-23), 40 patients (48 THAs; 34%) had died and 6 patients (6 THAs; 4%) were lost to follow-up. Aseptic revision rate was significantly higher in the MoPc group (17/69; 24.6%) versus CoC (2/71; 2.8%; p<0.001). Kaplan-Meier survivorship estimator with revision for aseptic reasons was 73.6% (95% CI: 63.3-84.9%) for MoPc and 96.9% (95% CI: 92.8-100%) for CoC (p<0.001). On radiographic evaluation, 13% (3/23) MoPc were considered loose versus no CoC, and 61% (14/23) MoPc versus 6% (2/33) CoC showed osteolytic signs (p<0.001). CoC had better mean WOMAC scores than MoPc (11.0 vs. 19.4; p=0.048). No ceramic fracture was observed. CONCLUSION In this RCT, CoC bearings provided excellent results and were safer than MoPc bearings at more than 20-year follow-up. The long-term in vivo behaviour of CoC bearing makes it a great THA option for middle-aged patients and should be compared to newer polyethylene bearings. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Pascal-André Vendittoli
- Hôpital Maisonneuve-Rosemont, Université de Montréal, Département de chirurgie, 5415 boulevard de l'Assomption, Montréal, Québec H1T 2M4, Canada; Personalized Arthroplasty Society, Montreal, Canada; Clinique Orthopédique Duval, Laval, Québec, Canada.
| | - Maged Shahin
- Hôpital Maisonneuve-Rosemont, Université de Montréal, Département de chirurgie, 5415 boulevard de l'Assomption, Montréal, Québec H1T 2M4, Canada
| | - Charles Rivière
- Personalized Arthroplasty Society, Montreal, Canada; MSK Lab - Imperial College de Londres. Sir Michael Uren Hub, White City Campus, 86 Wood Ln, London W12 0BZ, UK; Centre de l'Arthrose, Clinique du Sport, 04-06, rue Georges-Negrevergne, 33700 Mérignac, France
| | - Janie Barry
- Hôpital Maisonneuve-Rosemont, Université de Montréal, Département de chirurgie, 5415 boulevard de l'Assomption, Montréal, Québec H1T 2M4, Canada
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21
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Mehta N, Hall DJ, Pourzal R, Garrigues GE. The Biomaterials of Total Shoulder Arthroplasty: Their Features, Function, and Effect on Outcomes. JBJS Rev 2020; 8:e1900212. [PMID: 32890047 DOI: 10.2106/jbjs.rvw.19.00212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The materials that are used in total shoulder arthroplasty (TSA) implants have been carefully chosen in an attempt to minimize hardware-related complications. The 2 main metal alloys used in TSA implants are Ti-6Al-4V (titanium-aluminum-vanadium) and CoCrMo (cobalt-chromium-molybdenum). Ti alloys are softer than CoCr alloys, making them less wear-resistant and more susceptible to damage, but they have improved osseointegration and osteoconduction properties. Although controversial, metal allergy may be a concern in patients undergoing TSA and may lead to local tissue reaction and aseptic loosening. Numerous modifications to polyethylene, including cross-linking, minimizing oxidation, and vitamin E impregnation, have been developed to minimize wear and reduce complications. Alternative bearing surfaces such as ceramic and pyrolytic carbon, which have strong track records in other fields, represent promising possibilities to enhance the strength and the durability of TSA prostheses.
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Affiliation(s)
- Nabil Mehta
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Deborah J Hall
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Robin Pourzal
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Grant E Garrigues
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
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Wang Q, Eltit F, Garbuz D, Duncan C, Masri B, Greidanus N, Wang R. CoCrMo metal release in metal‐on‐highly crosslinked polyethylene hip implants. J Biomed Mater Res B Appl Biomater 2020; 108:1213-1228. [DOI: 10.1002/jbm.b.34470] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 06/18/2019] [Accepted: 07/29/2019] [Indexed: 01/26/2023]
Affiliation(s)
- Qiong Wang
- Department of Materials EngineeringUniversity of British Columbia Vancouver British Columbia Canada
- School of Biomedical EngineeringUniversity of British Columbia Vancouver British Columbia Canada
- Centre for Hip Health and Mobility Vancouver British Columbia Canada
| | - Felipe Eltit
- Department of Materials EngineeringUniversity of British Columbia Vancouver British Columbia Canada
- School of Biomedical EngineeringUniversity of British Columbia Vancouver British Columbia Canada
- Centre for Hip Health and Mobility Vancouver British Columbia Canada
| | - Donald Garbuz
- Department of OrthopaedicsUniversity of British Columbia Vancouver British Columbia Canada
| | - Clive Duncan
- Department of OrthopaedicsUniversity of British Columbia Vancouver British Columbia Canada
| | - Bassam Masri
- Department of OrthopaedicsUniversity of British Columbia Vancouver British Columbia Canada
| | - Nelson Greidanus
- Department of OrthopaedicsUniversity of British Columbia Vancouver British Columbia Canada
| | - Rizhi Wang
- Department of Materials EngineeringUniversity of British Columbia Vancouver British Columbia Canada
- School of Biomedical EngineeringUniversity of British Columbia Vancouver British Columbia Canada
- Centre for Hip Health and Mobility Vancouver British Columbia Canada
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Klasan A, Neri T, Sen A, El-Zayat BF, Efe T, Lahner M, Heyse TJ. Titanium acetabular cementless cups combined with highly crosslinked polyethylene liner have very low rates of aseptic loosening. Technol Health Care 2019; 28:415-423. [PMID: 31796715 DOI: 10.3233/thc-191896] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is a clear tendency towards cementless acetabular components in primary total hip arthroplasty. OBJECTIVE The aim of this study was to assess the long-term clinical and radiological outcome of titanium cementless acetabular cups when combined with a highly crosslinked polyethylene liner. METHODS This study is a retrospective follow-up of 67 cups in 64 patients. Clinical outcomes were assessed using the Harris Hip Score. Radiolucent lines, osteolysis and loosening were assessed radiologically. Implant survival was determined using the Kaplan-Meier analysis. RESULTS The average Harris Hip Score at follow-up was 80.3 ± 14.5. Signs of osteolysis were observed in 7.1% of the radiographs. No aseptic loosening of the cup was reported. Survival of the cup with aseptic loosening as an endpoint was 100%. A comparison with 19 other studies using the same material combination demonstrated very similar results. All manufacturers with available studies have at least one report of 100% survivorship at 10-year follow-up for their titanium cup and highly crosslinked polyethylene acetabular component combination with aseptic loosening as an endpoint. CONCLUSIONS The data suggests that the rate of aseptic loosening of a titanium cup combined with a highly-crosslinked polyethylene liner at 10-year follow-up could be as low as 0%.
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Affiliation(s)
- Antonio Klasan
- University Hospital Marburg, Center for Orthopedics and Traumatology, Baldingerstrasse, 35043 Marburg, Germany
| | - Thomas Neri
- Department of Orthopaedic Surgery, University Hospital of Saint Etienne, France
| | - Ahmet Sen
- Clinic Jung-Stilling, Department for Trauma, Siegen, Germany
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Dietz MJ, Moushmoush O, Samora WP, Kish VL, Hamlin BR. The Effect Of Increasing Femoral Head Size On The Force Required For Dislocation. Surg Technol Int 2019; 35:426-429. [PMID: 31282981 PMCID: PMC7425607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Alternative bearings allow for the increased utilization of large femoral heads in total hip arthroplasty. This study demonstrated the effect of increasing femoral head size on the force required for dislocation during intraoperative assessment. Using a standard posterior approach, 10 cadaver hips underwent total hip arthroplasty; components were implanted in a standard fashion. The extremity was attached to a custom jig to replicate intraoperative assessment (internal rotation with 90° of hip flexion/neutral adduction). This range of motion (ROM) was repeated in triplicate using femoral head sizes of 28mm, 32mm, 36mm, 40mm, and 44mm. The ROM to dislocation (degrees) and torque (N*m) required were recorded. With increasing head sizes, there was a significant increase in torque required for dislocation (p<0.0001). The least square means torques (N*m) for each femoral head size (28-44mm) were 2.07, 2.15, 2.42, 2.74, and 3.65N*m. The corresponding least square means ROMs prior to dislocation were 43.5°, 46.2°, 50.8°, 54.3°, and 59.5°. There was a significant difference in ROM between nonadjacent head sizes (i.e., 28mm and 44mm) (p<0.0001). Total hip implant stability is multifactorial. Increasing femoral head size may confer stability during intraoperative assessment by increasing both the ROM prior to dislocation and the force required for dislocation.
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Affiliation(s)
- Matthew J Dietz
- Department of Orthopaedics, West Virginia University School of Medicine, Morgantown, West Virgini
| | - Obadah Moushmoush
- West Virginia University, School of Medicine, Morgantown, West Virginia
| | - Walter P Samora
- Nationwide Children's Hospital, Department of Orthopedics, Columbus, Ohio
| | - Vincent L Kish
- Department of Orthopaedics, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Brian R Hamlin
- Bone and Joint Center, Magee Women's Hospital UPMC, Pittsburgh, Pennsylvania
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Hart A, Janz V, Trousdale RT, Sierra RJ, Berry DJ, Abdel MP. Long-Term Survivorship of Total Hip Arthroplasty with Highly Cross-Linked Polyethylene for Osteonecrosis. J Bone Joint Surg Am 2019; 101:1563-1568. [PMID: 31483399 DOI: 10.2106/jbjs.18.01218] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Osteonecrosis of the hip is the underlying etiology for 3% to 12% of total hip arthroplasties (THAs). Compared with patients who undergo THA because of osteoarthritis, those who do so because of osteonecrosis typically are younger, have a greater number of underlying diagnoses, and have inferior clinical outcomes and implant survivorship. The purpose of this study was to compare the long-term implant survivorship (median follow-up, 10 years), functional outcomes, and radiographic results of contemporary THAs with a highly cross-linked polyethylene (HXLPE) liner between patients with osteonecrosis and those with osteoarthritis. METHODS All patients who underwent primary THA with an HXLPE liner from 1999 to 2007 were identified from our institutional total joint registry. Patients with a primary diagnosis of osteonecrosis were matched 1:1, on the basis of age, sex, and body mass index (BMI), to patients with a diagnosis of osteoarthritis. This resulted in 461 hips in 413 patients with osteonecrosis matched to 461 hips in 427 patients with osteoarthritis (mean age, 59 years; 47% female; and mean BMI, 29 kg/m). Long-term implant survivorship, patient-reported outcomes, and radiographic findings were compared. In addition, a subgroup analysis of the osteonecrosis group was performed to see whether certain underlying etiologies portended poor outcomes. The median follow-up was 10 years. RESULTS The 15-year cumulative rates of revision were 6.6% and 4.5% in the osteonecrosis and osteoarthritis groups, respectively (hazard ratio [HR] = 1.8, p = 0.09). The 15-year cumulative rates of any reoperation were 10.5% and 6.4% in the osteonecrosis and osteoarthritis groups, respectively (HR = 2.2, p = 0.008). There were no radiographic signs of component loosening or osteolysis in the entire cohort. Despite a lower median preoperative Harris hip score (HHS) for patients with osteonecrosis, both groups had marked improvements in their scores, which were similar at all time points after surgery. The cumulative rate of reoperations at 15 years was 0% for hips with radiation-induced osteonecrosis, 6.3% for those with alcohol-induced osteonecrosis, 9.0% for those with posttraumatic osteonecrosis, 12.1% for those with steroid-induced osteonecrosis, and 25% for those with idiopathic osteonecrosis. CONCLUSIONS Contemporary THA with an HXLPE liner offers excellent long-term implant survivorship and functional outcomes for patients with osteonecrosis; however, the risk of a reoperation is higher when compared with patients with osteoarthritis. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Adam Hart
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Viktor Janz
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Rafael J Sierra
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Daniel J Berry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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Suraci A, Louati H, Culliton KN, Beaulé PE. Comparing In Vivo Performance of Two Highly Cross-Linked Polyethylene Thermal Treatments: Remelting vs Annealing in Acetabular Liners. J Arthroplasty 2019; 34:1509-1513. [PMID: 30956047 DOI: 10.1016/j.arth.2019.03.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/13/2019] [Accepted: 03/07/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The introduction of highly cross-linked polyethylene (HXLPE) acetabular liners has greatly improved the wear performance of metal-on-PE bearing surfaces used in total hip arthroplasty. Changing the sterilization environment and adding thermal treatments, such as remelting or annealing, were introduced to limit on-shelf and in vivo oxidation of cross-linked liners. This study compares the wear properties of the remelted A-CLASS (MicroPort) HXLPE liner to a sequentially annealed HXLPE. METHODS This retrospective study assessed linear and volumetric wear rates using Martell Hip Analysis Suite, and clinical performance through incidences of revision surgeries. A total of 80 remelted and 53 annealed liners were included in the wear analysis. All hips were reviewed for revisions. RESULTS There were no significant differences in steady-state linear or volumetric wear rates for remelted and annealed liners, 0.01 (-0.07 to 0.14) vs -0.01 (-0.11 to 0.1) mm/y (P = .28) and -1.03 (-30.99 to 45.43) vs -1.31 (-32.23 to 23.70) mm3/y (P = .30), respectively. Both cohorts were below the 0.1 mm/y linear wear threshold. The wear rates for patients with femoral head sizes ≥36 mm were not significantly different than those with 32 and 28 mm femoral head sizes (P = .60). Similarly, wear rates for patients with an excessively vertical acetabular component (>50°) were not significantly different than those with standard acetabular component orientations (P = .97). No hips were revised due to liner-related complications. CONCLUSION The wear rates of the A-CLASS remelted HXLPE acetabular liner wear rates were comparable to those of a sequentially annealed HXLPE. Further long-term studies are required to ensure acceptable resistance to fatigue and in vivo oxidation.
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Affiliation(s)
- Alison Suraci
- Division of Orthopaedic Surgery, The Ottawa Hospital, General Campus, Ottawa, Ontario, Canada
| | - Hakim Louati
- Orthopaedic Biomechanics Laboratory, Division of Orthopaedic Surgery, The Ottawa Hospital Research Institute, Civic Campus, Ottawa, Ontario, Canada
| | - Kathryn N Culliton
- Orthopaedic Biomechanics Laboratory, Division of Orthopaedic Surgery, The Ottawa Hospital Research Institute, Civic Campus, Ottawa, Ontario, Canada
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, The Ottawa Hospital, General Campus, Ottawa, Ontario, Canada; Faculty of Medicine, The University of Ottawa, Ottawa, Ontario, Canada
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Rames RD, Stambough JB, Pashos GE, Maloney WJ, Martell JM, Clohisy JC. Fifteen-Year Results of Total Hip Arthroplasty With Cobalt-Chromium Femoral Heads on Highly Cross-Linked Polyethylene in Patients 50 Years and Less. J Arthroplasty 2019; 34:1143-1149. [PMID: 30808529 DOI: 10.1016/j.arth.2019.01.071] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 01/25/2019] [Accepted: 01/28/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Highly cross-linked polyethylene (HXLPE) is the most commonly used bearing surface in total hip arthroplasty (THA) because of its superior wear properties, but long-term results in young patients are limited. Mid-term survivorship has been promising; however, polyethylene wear rates and need for revision surgeries remain a concern in this population. The purpose of our study is to investigate polyethylene wear rates, implant survivorship, wear-related revisions, and patient-reported outcomes in a young patient cohort at 15-year follow-up. METHODS We performed a retrospective study of a prospective longitudinal cohort of 82 consecutive patients (89 hips) who underwent primary THA with an HXLPE acetabular liner and a cobalt-chromium femoral head. The mean age at the time of surgery for the cohort was 38.8 years (range 12-50). All patients received HXLPE liners with a cementless acetabular component coupled with a cobalt-chrome femoral head through a posterior approach with a cementless femoral component. All components were from a single manufacturer. We recorded University of California, Los Angeles Activity, and modified Harris Hip Scores. Wear calculations were made using the Martell Hip Analysis Suite (Version 8.0.4.3). RESULTS At average 15 years (range 13.1-18.5), there was a revision-free survivorship of 97.8% in our HXLPE group with no wear-related revisions. We observed a linear wear rate of 0.0185 mm/y (standard deviation 0.05) after accounting for a 1-year bedding-in period. The volumetric wear rate was found to be 12.80 mm3/y (standard deviation 22.69). These numbers are registered as clinically undetectable and are comparable to steady state wear rates in the same cohort of patients at earlier time points. We found no radiographic changes concerning osteolysis. We observed excellent patient-reported outcomes at this time point with improvements in modified Harris Hip Scores (35.3 [22.5], P < .0001) and University of California, Los Angeles Activity Scores (median 6.0, P < .0001). CONCLUSION At 15-year follow-up, we demonstrated that HXLPE bearings in this young cohort had excellent wear properties, maintained superior clinical improvements, and underwent no wear-related revision operations. The HXLPE and cobalt-chrome bearing couple continues to be extremely effective 15 years after primary THA in patients less than 50 years. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Richard D Rames
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO
| | - Jeffrey B Stambough
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Gail E Pashos
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO
| | - William J Maloney
- Department of Orthopedic Surgery, Stanford Medicine Outpatient Center, Redwood City, CA
| | - John M Martell
- Department of Orthopaedic Surgery and Rehabilitation Medicine, Orthopaedic Biomedical Institute, University of Chicago Medicine & Biological Sciences, Chicago, IL
| | - John C Clohisy
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO
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Femoral Head Penetration Rates of Second-Generation Sequentially Annealed Highly Cross-Linked Polyethylene at Minimum Five Years. J Arthroplasty 2019; 34:781-788. [PMID: 30609952 DOI: 10.1016/j.arth.2018.12.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 11/19/2018] [Accepted: 12/04/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Highly cross-linked polyethylene (HXLPE) liners in total hip arthroplasty (THA) have demonstrated decreased wear rates, resilience to cup orientation, and reduced osteolysis compared to conventional polyethylene. Sequential irradiation and annealing below the melting temperature is unique compared to most HXLPE which is irradiated and remelted. This study purpose is to provide minimum 5-year femoral head penetration rates of sequentially annealed HXLPE in primary THA. METHODS A retrospective review of a prospectively collected database identified 198 consecutive, cementless primary THAs utilizing sequentially annealed HXLPE (X3; Stryker, Mahwah, NJ). Operative technique was standardized. Radiographs were analyzed utilizing the Martell method with minimum 5-year and 1-year radiographs as baseline to minimize the initial bedding-in period. RESULTS Seventy-seven hips with minimum 5-year follow-up were analyzed. Mean steady state linear and volumetric head penetration rates were 0.095 mm/y and 76 mm3/y, respectively. Volumetric head penetration was significantly less for 32-mm compared to 36-mm (P = .028). In addition, less head penetration was observed for ceramic 32-mm heads at nearly half the rate compared to cobalt-chromium 36-mm heads (P ≥ .092). No correlations existed between penetration rates and age, body mass index, University of California Los Angeles Activity Level, polyethylene thickness, cup inclination, or anteversion (P ≥ .10). No radiographic osteolysis was observed. CONCLUSION Surprisingly, linear head penetration rates of sequentially annealed HXLPE were nearly identical to the osteolysis threshold for conventional polyethylene and greater than reports of irradiated and remelted HXLPE. Furthermore, these data corroborate reports that HXLPE is resilient to cup orientation and demographic variables. Longer term follow-up is recommended.
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Evaluation and Treatment of Patients With Acetabular Osteolysis After Total Hip Arthroplasty. J Am Acad Orthop Surg 2019; 27:e258-e267. [PMID: 30325878 DOI: 10.5435/jaaos-d-16-00685] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
As the demand for total hip arthroplasty (THA) continues to increase, the burden of revision THA is also expected to increase. Although the quality of polyethylene has improved markedly, osteolysis continues to be a risk for older designs and younger, active patients. Although progressive but typically asymptomatic in early stages, osteolysis can result in component failure and complicate revision surgery. Serial radiographs are paramount for monitoring progression. Although select cases may be treated with observation, surgery should be considered based on age, activity level, and projected life span. Well-fixed, noncemented modular acetabular components may be treated with curettage and bone grafting, as well as having to bear liner exchange with retention of the acetabular shell. However, in the setting of osteolysis, it is controversial whether bone grafting and component retention is superior to cup revision. This review explores the pathophysiology of osteolysis after THA and provides a comprehensive analysis of the evaluation and treatment of patients with osteolysis.
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Thangaraj R, Kuiper J, Perkins RD. Low failure rate at short term for 40 mm heads and second generation triple annealed HCLPE liners in hybrid hip replacements. J Clin Orthop Trauma 2019; 10:350-357. [PMID: 30828207 PMCID: PMC6383141 DOI: 10.1016/j.jcot.2017.12.008] [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: 10/24/2017] [Revised: 12/19/2017] [Accepted: 12/21/2017] [Indexed: 10/18/2022] Open
Abstract
INTRODUCTION 40 mm large diameter heads offer the advantages of lesser dislocation rates and better stability while highly cross linked polyethylene have lower wear rates than ultra high molecular weight polyethylene. Studies of the survivorship of 40 mm heads in hybrid hip replacements with Exeter stem and second generation highly cross linked polyethylene are limited. The purpose of the study is to report the short term of survivorship of the large diameter heads (40 mm) with Exeter stem with the secondary aim being the survival analysis of the thinnest second generation highly cross linked polyethylene. METHODS Retrospective case series of survivorship of patients with hybrid hip replacements of Exeter stems with 40 mm heads articulating with second generation triple annealed highly cross linked polyethylene liner on a uncemented acetabular shell was performed. As a subset, survival of thinnest second generation highly cross linked polyethylene survival (3.8 mm) at short term was assessed. Survival of the implants was confirmed from the hospital records and National joint registry as of 2015. Revision for any cause was taken as end point. RESULTS 324 hybrid hip replacements with 40 mm heads had been performed for primary hip osteoarthritis. Of the 324 hip replacements, 154 hip replacements had thinnest second generation highly cross linked polyethylene (3.8 mm). Two patients had revision of components, one for periprosthetic fracture and one for deep infection. Mean age of the patients was 70.5 years (range 42-88 years, median 71, SD 8.3 years). None of the patients had revision due to trunion wear or loosening of components. The overall 5-year implant survival probability of hips with 40 mm heads was 99.4% (95% CI 98 to 100%) while the subset group of hip replacements with thinnest second generation highly cross linked polyethylene (3.8 mm) had 5-year implant survival probability of 99.3% (95% CI 97.1 to 100%). CONCLUSION Short term survivorship does not show significant evidence of early failure or higher rate of revision in our series of hybrid hip replacements with large diameter heads and second generation triple annealed highly cross linked polyethylene. Dislocation rate at the short term is none. Results from this series have to be carefully interpreted due to the relatively short follow up but so far results are encouraging. Long term follow up is required to conclude whether there is early or higher rate of failure. It is our intention to follow up this cohort and further publish our results at longer term.
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Affiliation(s)
- Rajkumar Thangaraj
- Princess Royal Hospital, Telford, United Kingdom,Corresponding author at: Department of Orthopaedics, Princess Royal Hospital, Apley Castle, Telford, TF1 6TF, United Kingdom.
| | - Jan Kuiper
- ISTM, Keele University, Keele, ST5 5BG, United Kingdom,Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, United Kingdom
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Abstract
BACKGROUND MRI is predictive of adverse local tissue reactions (ALTRs) after THA but how MRI directly relates to implant surface wear, fretting, and trunnion corrosion at different articulations between implant components remains unclear. MRI generates high-contrast images to display soft tissues around arthroplasty and may provide a surgeon the means to distinguish and differentiate host-related synovial patterns as a response to either polyethylene wear or metal wear and corrosion products. QUESTIONS/PURPOSES The purposes of this study were (1) to correlate findings from MRI in patients who have undergone THA with direct assessment of implant wear, corrosion, and fretting from retrieved components; and (2) to distinguish the unique synovial responses on MRI in patients who have undergone THA based on bearing materials. METHODS In this prospective study, patients undergoing THA (181 patients, 187 hips) with metal-on-metal (MoM), hip resurfacing (HRA), metal-on-polyethylene (MoP), ceramic-on-polyethylene, ceramic-on-ceramic, or modular neck designs having revision surgery (between October 2013 and June 2017) underwent preoperative MRI. A single reader blinded to the bearing surface made an assessment of the synovial response (Gwet's AC1, 0.65-0.97); these data were compared with semiquantitative histology of tissue samples by a single reader (Gwet's AC1, 0.92) and semiquantitative wear, corrosion, and fretting analysis of retrieved components using Goldberg scoring (Gwet's AC1, 0.60-0.79). Direct noncontact measurements of implant wear were also made. Correlations and analyses of variance were used to assess associations between metrics and differences by implant type, respectively. RESULTS Correlations were found between MRI synovial thickness with severity of fretting and corrosion damage of the female head-neck trunnion of femoral stems in modular designs (ρ = 0.26 [95% confidence interval {CI}, 0.12-0.39]; p = 0.015, n = 185) and ALTR grade and volumetric wear in MoM bearings (ρ = 0.93 [95% CI, 0.72-0.98]; p < 0.001, n = 10). MRI synovial thickness was highest in patients identified with aseptic lymphocyte-dominated vasculitis-associated lesions and diffuse tissue necrosis. On MRI, MoP hips demonstrated a distinct polymeric synovial response, whereas HRA, MoM, and modular hips more commonly demonstrated ALTR. Hips classified as having a polymeric synovial response on MRI had a greater number of particles present in tissue samples. CONCLUSIONS In this study, we demonstrated that MRI of THA can distinguish synovial responses that reflect the bearing type of the implanted THA and correlate to direct measurements of implant wear, corrosion, and fretting and histologic assessment of wear particles in periprosthetic tissues. MRI provides a means of direct, noninvasive visualization of the host-generated synovial response. Patients presenting with painful arthroplasties may be evaluated for the cause of their discomfort, specifically highlighting any concerning synovial reactions that would warrant more prompt surgical intervention. Future studies would benefit from a prospective evaluation of different implants to assess the natural longitudinal history of arthroplasty complications, including the development and prevalence of ALTR across bearing constructs. LEVEL OF EVIDENCE Level III, diagnostic study.
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Hu CY, Yoon TR. Recent updates for biomaterials used in total hip arthroplasty. Biomater Res 2018; 22:33. [PMID: 30534414 PMCID: PMC6280401 DOI: 10.1186/s40824-018-0144-8] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 10/03/2018] [Indexed: 12/23/2022] Open
Abstract
Background Total hip arthroplasty (THA) is probably one of the most successful surgical interventions performed in medicine. Through the revolution of hip arthroplasty by principles of low friction arthroplasty was introduced by Sir John Charnley in 1960s. Thereafter, new bearing materials, fixation methods, and new designs has been improved. The main concern regarding failure of THA has been the biological response to particulate polyethylene debris generated by conventional metal on polyethylene bearing surfaces leading to osteolysis and aseptic loosening of the prosthesis. To resolve these problems, the materials of the modern THA were developed since then. Methods A literature search strategy was conducted using various search terms in PUBMED. The highest quality articles that met the inclusion criteria and best answered the topics of focus of this review were selected. Key search terms included ‘total hip arthroplasty’, ‘biomaterials’, ‘stainless steel’, ‘cobalt-chromium’, ‘titanium’, ‘polyethylene’, and ‘ceramic’. Results The initial search retrieved 6921 articles. Thirty-two articles were selected and used in the review. Conclusion This article introduces biomaterials used in THA and discusses various bearing materials in currentclinical use in THA as well as the newer biomaterials which may even further decrease wear and improve THA survivorship.
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Affiliation(s)
- Chang Yong Hu
- Center for Joint Disease, Chonnam National University Hwasun Hospital, 160, Ilsim-Ri, Hwasun-Eup, Hwasun-Gun, Jeonnam 519-809 South Korea
| | - Taek-Rim Yoon
- Center for Joint Disease, Chonnam National University Hwasun Hospital, 160, Ilsim-Ri, Hwasun-Eup, Hwasun-Gun, Jeonnam 519-809 South Korea
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Popoola OO, Orozco Villasenor DA, Fryman JC, Mimnaugh K, Rufner A. High cycle in vitro hip wear of and in vivo biological response to vitamin E blended highly crosslinked polyethylene. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.biotri.2018.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Lambert B, Neut D, van der Veen HC, Bulstra SK. Effects of vitamin E incorporation in polyethylene on oxidative degradation, wear rates, immune response, and infections in total joint arthroplasty: a review of the current literature. INTERNATIONAL ORTHOPAEDICS 2018; 43:1549-1557. [PMID: 30470866 DOI: 10.1007/s00264-018-4237-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 11/14/2018] [Indexed: 02/04/2023]
Abstract
Highly cross-linked ultrahigh molecular weight polyethylene (UHMWPE) was introduced to decrease wear debris and osteolysis. During cross-linking, free radicals are formed, making highly cross-linked polyethylene vulnerable to oxidative degradation. In order to reduce this process, anti-oxidant vitamin E can be incorporated in polyethylene. This review provides an overview of the effects of vitamin E incorporation on major complications in total joint arthroplasty: material failure due to oxidative degradation, wear debris and subsequent periprosthetic osteolysis, and prosthetic joint infections. Secondly, this review summarizes the first clinical results of total hip and knee arthroplasties with vitamin E incorporated highly cross-linked polyethylene. Based on in vitro studies, incorporation of vitamin E in polyethylene provides good oxidative protection and preserves low wear rates. Incorporation of vitamin E may have the beneficial effect of reduced inflammatory response to its wear particles. Some microorganisms showed reduced adherence to vitamin E-incorporated UHMWPE; however, clinical relevance is doubtful. Short-term clinical studies of total hip and knee arthroplasties with vitamin E-incorporated highly cross-linked UHMWPE reported good clinical results and wear rates similar to highly cross-linked UHMWPE without vitamin E.
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Affiliation(s)
- Bart Lambert
- Department of Orthopedic Surgery, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Daniëlle Neut
- Department of Biomedical Engineering, University of Groningen, University Medical Center Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, The Netherlands
| | - Hugo C van der Veen
- Department of Orthopedic Surgery, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands.
| | - Sjoerd K Bulstra
- Department of Orthopedic Surgery, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
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Singh G, Klassen R, Howard J, Naudie D, Teeter M, Lanting B. Manufacturing, oxidation, mechanical properties and clinical performance of highly cross-linked polyethylene in total hip arthroplasty. Hip Int 2018; 28:573-583. [PMID: 29998768 DOI: 10.1177/1120700018780677] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Ultra-high molecular weight polyethylene (UHMWPE) continues to be the gold standard bearing surface in total hip arthroplasty (THA) for nearly 5 decades. Highly cross-linked UHMWPE (HXLPE) was adapted for routine use in the early 2000s to reduce the revision rates related to wear, osteolysis, and aseptic loosening resulting from conventional UHMWPE wear. Since its inception, consistent evidence showing reduced wear rates and osteolysis supports the use of HXLPE in THA. High quality studies demonstrating the advantage in long term survivorship of HXLPE over conventional UHMWPE are emerging. Though retrieval studies have demonstrated evidence of in vivo oxidation and fatigue related damage at the rim of the first generation HXLPE liners, clinical significance of this remains to be seen. Second-generation sequentially annealed and vitamin E containing HXLPE liners demonstrate improved mechanical properties, resistance to oxidation, and equivalent wear rates in comparison to their first-generation counterparts, but long term success remains to be seen.
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Affiliation(s)
- Gurpreet Singh
- 1 Joint Replacement Institute, London Health Science Center (LHSC), University Hospital, Schulich School of Medicine, Western University, London, Ontario, Canada
| | - Robert Klassen
- 2 Department of Mechanical and Materials Engineering, Western University, London, Ontario, Canada
| | - James Howard
- 1 Joint Replacement Institute, London Health Science Center (LHSC), University Hospital, Schulich School of Medicine, Western University, London, Ontario, Canada
| | - Douglas Naudie
- 1 Joint Replacement Institute, London Health Science Center (LHSC), University Hospital, Schulich School of Medicine, Western University, London, Ontario, Canada
| | - Matthew Teeter
- 3 Joint Replacement Institute, LHSC, University Hospital, Department of Medical Biophysics, Western University, Surgical Innovation Program, Lawson Health Research Institute, London, Ontario, Canada
| | - Brent Lanting
- 1 Joint Replacement Institute, London Health Science Center (LHSC), University Hospital, Schulich School of Medicine, Western University, London, Ontario, Canada
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Kurcz B, Lyons J, Sayeed Z, Anoushiravani AA, Iorio R. Osteolysis as it Pertains to Total Hip Arthroplasty. Orthop Clin North Am 2018; 49:419-435. [PMID: 30224004 DOI: 10.1016/j.ocl.2018.06.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Osteolysis is a long-term complication of total hip arthroplasty (THA). As the projected number of THAs performed annually increases, osteolysis will likely continue to occur. However, because of advancements in prosthesis design, metallurgy, and enhanced bearing surfaces, fewer revision THAs will be linked to osteolysis and aseptic loosening. Despite these improvements, no preventative therapies are currently available for the management of osteolysis other than removing and replacing the source of bearing wear.
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Affiliation(s)
- Brian Kurcz
- Division of Orthopaedic Surgery, Southern Illinois University, 701 North 1st Street, Springfield, IL 62781, USA
| | - Joseph Lyons
- Department of Surgery, Chicago Medical School, 3333 Green Bay Road, North Chicago, IL 60064, USA
| | - Zain Sayeed
- Department of Orthopaedic Surgery, Detroit Medical Center, 4201 Saint Antoine, Detroit, MI 48201, USA
| | - Afshin A Anoushiravani
- Division of Orthopaedic Surgery, Albany Medical Center, 43 New Scotland, Albany, NY, USA
| | - Richard Iorio
- Division of Orthopaedic Surgery, Albany Medical Center, 43 New Scotland, Albany, NY, USA.
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de Steiger R, Lorimer M, Graves SE. Cross-Linked Polyethylene for Total Hip Arthroplasty Markedly Reduces Revision Surgery at 16 Years. J Bone Joint Surg Am 2018; 100:1281-1288. [PMID: 30063590 DOI: 10.2106/jbjs.17.01221] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Total hip arthroplasty (THA) is an effective operation for the management of end-stage hip osteoarthritis, but long-term success can be limited by wear of the polyethylene bearing surface. Cross-linking conventional polyethylene has resulted in lower wear rates and a reduction in bone lysis in both laboratory and clinical studies. The aim of this study was to compare the rates of revision between cross-linked polyethylene (XLPE) and conventional non-cross-linked polyethylene (CPE) at 16 years after THAs performed for the treatment of osteoarthritis. METHODS We performed an observational study of data, from a national registry, on all patients who underwent THA for osteoarthritis in Australia from 1999 through December 31, 2016. The outcomes of THAs performed with CPE were compared with those of THAs performed with XLPE, along with an analysis of the effect of age, sex, femoral head size, the method of acetabular and femoral component fixation, and the reasons and types of revision. The principal outcome measure was the time to the first revision, determined using Kaplan-Meier estimates of survivorship. RESULTS CPE was used in 41,171 procedures, and XLPE was used in 199,131. The mean ages of the men and women treated with CPE were 70.0 years (standard deviation [SD] = 9.9 years) and 72.5 years (SD = 9.7 years), respectively, whereas the men and women who received XLPE were slightly younger (mean age, 68.6 years [SD = 10.3 years] and 70.7 years [SD = 9.9 years], respectively. XLPE was associated with a lower rate of revision than CPE at 6 months, and this difference became more apparent with time. The 16-year cumulative percentage of revisions of the primary THAs was 11.7% (95% confidence interval [CI] = 11.1% to 12.3%]) in the CPE group and 6.2% (95% CI = 5.7% to 6.7%) in the XLPE group. The hazard ratio at 9 years was 3.02 (p = 0.001). CONCLUSIONS The use of XLPE has resulted in a significant reduction in the rate of revision at 16 years following THA for osteoarthritis. This evidence suggests that the longevity of THA is likely to be improved, which may enable younger patients to undergo surgery, confident of a reduced need for revision in the long term. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- R de Steiger
- Australian Orthopaedic Association National Joint Replacement Registry, SAHMRI, Adelaide, South Australia, Australia.,School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - M Lorimer
- Australian Orthopaedic Association National Joint Replacement Registry, SAHMRI, Adelaide, South Australia, Australia
| | - S E Graves
- Australian Orthopaedic Association National Joint Replacement Registry, SAHMRI, Adelaide, South Australia, Australia
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Jain S, Magra M, Dube B, Veysi VT, Whitwell GS, Aderinto JB, Emerton ME, Stone MH, Pandit HG. Reverse hybrid total hip arthroplasty. Bone Joint J 2018; 100-B:1010-1017. [PMID: 30062952 DOI: 10.1302/0301-620x.100b8.bjj-2017-1297.r1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims This study aimed to evaluate implant survival of reverse hybrid total hip arthroplasty (THA) at medium-term follow-up. Patients and Methods A consecutive series of 1082 THAs in 982 patients with mean follow-up of 7.9 years (5 to 11.3) is presented. Mean age was 69.2 years (21 to 94). Of these, 194 (17.9%) were in patients under 60 years, 663 (61.3%) in female patients and 348 (32.2%) performed by a trainee. Head size was 28 mm in 953 hips (88.1%) or 32 mm in 129 hips (11.9%). Survival analysis was performed and subgroups compared using log rank tests. Results Ten-year survival (122 hips at risk) was 97.2% (95% confidence interval (CI) 95.77 to 98.11) for all-cause revision. There was no difference in survival by age (p = 0.50), gender (p = 0.78), head size (p = 0.63) or surgeon grade (p = 0.36). No acetabular components underwent revision for aseptic loosening in the entire series. Four (0.4%) aseptic stem failures occurred early at a mean of 2.5 years (0.6 to 4.8) and were associated with age under 60 years (p = 0.015). There was no difference in survival by gender (p = 0.12), head size (p = 0.43) or surgeon grade (p = 0.77) for stem revision. Conclusion This is the largest reported study into reverse hybrid THA and it confirms successful outcomes, irrespective of age, gender, head size and surgeon grade. Cite this article: Bone Joint J 2018;100-B:1010-17.
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Affiliation(s)
- S Jain
- Department of Orthopaedic Surgery, Chapel Allerton Hospital, Leeds, UK
| | - M Magra
- Department of Orthopaedic Surgery, Chapel Allerton Hospital, Leeds, UK
| | - B Dube
- University of Leeds, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital
| | - V T Veysi
- Department of Orthopaedic Surgery, Chapel Allerton Hospital, Leeds, UK
| | - G S Whitwell
- Department of Orthopaedic Surgery, Chapel Allerton Hospital, Leeds, UK
| | - J B Aderinto
- Department of Orthopaedic Surgery, Chapel Allerton Hospital, Leeds, UK
| | - M E Emerton
- Department of Orthopaedic Surgery, Chapel Allerton Hospital, Leeds, UK
| | - M H Stone
- Department of Orthopaedic Surgery, Chapel Allerton Hospital, Leeds, UK
| | - H G Pandit
- University of Leeds, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, Leeds, UK
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Abstract
Hip instability after total joint arthroplasty is a devastating complication. Appropriate management of instability is a challenge. Three components that are commonly used in these challenging scenarios are constrained liners, constrained tripolar components, and nonconstrained tripolar components. The biomaterials and biomechanics of these devices vary. Surgeons must take into account the risks associated with each of these components and some surgical pearls for their use. A thorough review of the recent literature allows comparison of results addressing the short-, medium-, and long-term survival of each component. Constraining devices are a good option when used in salvage procedures in elderly and/or low-demand patients with hip instability. However, constraining devices should not be used to correct deficiencies in surgical technique or implant placement.
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Bonutti PM, Mesko JW, Ramakrishnan R. Long-term Wear Data From a Prospective Multicenter Study of Second-Generation Highly Cross-linked Polyethylene Inserts in Total Hip Arthroplasty. Orthopedics 2018; 41:e529-e533. [PMID: 29771397 DOI: 10.3928/01477447-20180511-03] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 02/26/2018] [Indexed: 02/03/2023]
Abstract
In a prospective multicenter trial on highly cross-linked polyethylene inserts in patients undergoing total hip arthroplasty, 118 patients consented to 10-year follow-up. Medium-term follow-up results showed low wear at 5 and 7 years after surgery. The current study focuses on long-term data at 10 years. Patients were followed up by either phone or office visit to collect long-term clinical data including Harris hip score and adverse events. There were 2 deaths and 2 revisions, 1 at 6.5 years for pelvic cyst and severe pain and another at 8.0 years for recurrent dislocation. For wear analysis, suitable radiographic images for 48 patients (52 hips) at minimum 10-year follow-up were available. Mean age of the cohort was 62.5 years (62% female). Femoral head penetration was measured using Martell's method from the radiographic images between the 6-week and the subsequent follow-ups. Polyethylene wear rate was calculated from the penetration data. Descriptive statistics were performed. There was no evidence of significant oxidation or locking mechanism failure. Mean Harris hip score of the group was 94.3. No osteolysis was noted by an independent radiographic reviewer. The slope of the bestfit regression line to the femoral head penetration data, which represents the overall linear wear rate of the polyethylene, was 0.014 mm/y. The wear rate was significantly below the 0.100 mm/y critical threshold for development of osteolysis. Volumetric wear rate was calculated to be 11.6 mm3/y. The second-generation highly cross-linked polyethylene acetabular inserts had low wear in the long term (10.3 years) with no incidence of osteolysis. [Orthopedics. 2018; 41(4):e529-e533.].
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Abstract
INTRODUCTION We have investigated the revision rates of all bearing surface combinations for primary total hip replacement (THR) registered on the New Zealand Joint Registry (NZJR) to determine which coupling has been the most durable and successful over the last 16 years. METHODS There were 106,139 primary THRs registered, resulting in 4,960 revisions for any cause. We examined all-cause revision rates, reasons for revision and performed survival analyses. RESULTS Ceramic-on-highly cross-linked polyethylene (CoPx) had the lowest all-cause revision rate of 0.54/100-component-years (cys) (95% confidence interval 0.48 to 0.61). This was superior to all other hard-on-soft bearing combinations in unadjusted analysis. Furthermore, the age of patients receiving CoPx was significantly lower than for metal-on-polyethylene (mean 62.9; standard deviation [SD] 10.1 vs. 69.1; SD 9.6; p<0.001). Acetabular loosening was the reason for revision in 14.5% of CoPx, compared to 33% of MoP THRs (p<0.001). Metal-on-metal bearings had the highest revision rate of 1.43/100 cys and were significantly inferior to CoPx (p<0.001). Kaplan-Meier analysis and Cox regression analyses were performed and we adjusted the analyses to control for age, femoral head size, surgical approach and fixation. CONCLUSIONS CoPx remained the most durable and successful coupling used in primary THR in New Zealand irrespective of age, gender or size of femoral head.
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Lachiewicz PF, O'Dell JA, Martell JM. Large Metal Heads and Highly Cross-Linked Polyethylene Provide Low Wear and Complications at 5-13 Years. J Arthroplasty 2018; 33:2187-2191. [PMID: 29588121 DOI: 10.1016/j.arth.2018.02.063] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 01/31/2018] [Accepted: 02/15/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Highly cross-linked polyethylene (XLPE) is reported to have low rates of linear and volumetric wear at 10-14 years. In a prior study, larger (36 and 40 mm) femoral heads were associated with more volumetric wear, but there were only 12 hips with these heads. METHODS We evaluated 107 hips (93 patients, with a mean age of 76 years) with one design of uncemented acetabular component, a 36 (90 hips) or 40 mm (17 hips) metal femoral head, and one electron beam 100 kGy irradiated and remelted XLPE at a mean follow-up of 8 years (range 5-13 years). Selection of these femoral heads was based on several factors, including the perceived risk of dislocation, the outer diameter size of the acetabular component, and liner availability. Measurements of linear and volumetric wear were performed in one experienced laboratory by the Martell method and analyzed using the first-to-last method. Standard radiographs, with additional Judet views, were used to detect periprosthetic osteolysis. Clinical records were used to determine the complications of dislocation, liner fracture, and painful trunnion corrosion. RESULTS For the entire cohort, the median linear wear rate was 0.041 mm/y (95% confidence interval, 0.031-0.057) and the median volumetric wear rate was 34.6 mm3/y (95% confidence interval, 31.4-53.5). With the numbers available, there was no difference in linear or volumetric wear between the 36 and 40 mm head sizes. Small, asymptomatic osteolytic lesions were noted in 3 hips (2%). There were 3 patients (3%) with dislocation (2 early and 1 late), but these have not had a revision. There were no revisions for loosening, no liner fracture, and no patient with symptomatic trunnion corrosion. CONCLUSION This acetabular component and XLPE with large metal heads had low rates of linear and volumetric wear. Large metal femoral heads did not lead to liner fracture, loosening, or symptomatic trunnion corrosion in this patient population. However, we recommend longer clinical follow-up studies and caution in the routine use of larger metal femoral heads in other, younger patient populations.
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Affiliation(s)
| | - Jane A O'Dell
- Chapel Hill Orthopedics Surgery & Sports Medicine, Chapel Hill, NC
| | - John M Martell
- Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago Medical Center, Chicago, IL
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Teeter MG, MacLean CJ, Somerville LE, Howard JL, McCalden RW, Lanting BA, Vasarhelyi EM. Wear performance of cobalt chromium, ceramic, and oxidized zirconium on highly crosslinked polyethylene at mid-term follow-up. J Orthop 2018; 15:620-623. [PMID: 29881207 DOI: 10.1016/j.jor.2018.05.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 05/06/2018] [Indexed: 10/17/2022] Open
Abstract
Patients with THA using a ceramic head and using an OxZr head were each matched to patients with a CoCr head. Mean implantation time was 5 years. There was no difference in steady state wear rate between the ceramic (0.066 ± 0.050 mm/year) and CoCr match groups (0.052 ± 0.041 mm/year), or between the OxZr (0.022 ± 0.029 mm/year) and CoCr match groups (0.048 ± 0.071 mm/year). Follow-up into the second decade will be necessary before any changes in THA wear rate from using ceramic or OxZr bearings may be appreciated clinically with available imaging techniques.
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Affiliation(s)
- Matthew G Teeter
- Department of Surgery, Schulich School of Medicine & Dentistry, Western University and London Health Sciences Centre, London, Ontari, Canada.,Surgical Innovation Program, Lawson Health Research Institute, London, Ontario, Canada.,Imaging Research Laboratories, Robarts Research Institute, London, Ontario, Canada
| | - Colin J MacLean
- Department of Surgery, Schulich School of Medicine & Dentistry, Western University and London Health Sciences Centre, London, Ontari, Canada
| | - Lyndsay E Somerville
- Department of Surgery, Schulich School of Medicine & Dentistry, Western University and London Health Sciences Centre, London, Ontari, Canada
| | - James L Howard
- Department of Surgery, Schulich School of Medicine & Dentistry, Western University and London Health Sciences Centre, London, Ontari, Canada
| | - Richard W McCalden
- Department of Surgery, Schulich School of Medicine & Dentistry, Western University and London Health Sciences Centre, London, Ontari, Canada
| | - Brent A Lanting
- Department of Surgery, Schulich School of Medicine & Dentistry, Western University and London Health Sciences Centre, London, Ontari, Canada
| | - Edward M Vasarhelyi
- Department of Surgery, Schulich School of Medicine & Dentistry, Western University and London Health Sciences Centre, London, Ontari, Canada
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Otto Aufranc Award: Crosslinking Reduces THA Wear, Osteolysis, and Revision Rates at 15-year Followup Compared With Noncrosslinked Polyethylene. Clin Orthop Relat Res 2018; 476. [PMID: 29529656 PMCID: PMC6259699 DOI: 10.1007/s11999.0000000000000036] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Crosslinked polyethylene (XLPE) liners used for primary THA have demonstrated lower wear rates than noncrosslinked, conventional polyethylene (CPE) liners through the first decade of clinical service. However, little high-quality evidence is currently available regarding the second decade performance of these implants and it remains uncertain whether the onset of osteolysis has simply been delayed or if the wear associated with XLPE liners will remain low enough that osteolysis will not occur. It is also unknown how the potential reductions in wear and osteolysis will influence long-term revision rates. QUESTIONS/PURPOSES Do patients who underwent THA with XLPE liners demonstrate (1) a lower rate of revision for wear-related complications; (2) a reduced wear rate; and (3) a lower frequency of osteolysis compared with those with CPE liners? METHODS Over an 18-month period from 1999 to 2000, 226 patients who had 236 primary THAs consented to participate in a randomized controlled trial conducted at one institution. To be eligible for intraoperative randomization, patients had to be implanted with a 28-mm cobalt-chrome alloy femoral head, a 4-mm lateralized liner, and the same cup and stem design. Six patients with six THAs were excluded intraoperatively because they did not receive study components for reasons unrelated to the liner material. The remaining 230 THAs among 220 patients were randomized to XLPE liners or CPE liners. The mean age at surgery was 62 ± 11 years and there were no differences in age, gender, or body mass index among the groups. There was no differential loss to followup between the study groups; among patients not known to be deceased or having undergone revision, minimum 14-year radiographic followup is available for 85 THAs including 46 with XLPE and 39 with CPE liners. Polyethylene wear was measured radiographically using Martell's Hip Analysis Suite and areas of osteolysis were evaluated before revision or at most recent followup. Revision rates at 15 years using reoperation for any reason and revision for wear or osteolysis were calculated using cumulative incidence considering patient death as a competing risk. RESULTS The cumulative incidence of revision at 15 years using reoperation for wear-related complications as an endpoint was lower in the XLPE group than the CPE group (0%, 95% confidence interval [CI], 0%-0% versus 12%, 95% CI, 7%-19%; p < 0.001). Among unrevised THAs with minimum 14-year radiographic followup, the mean steady-state linear wear rate for THAs with XLPE liners was lower than the mean linear wear rate for the THAs with CPE liners (0.03 ± 0.05 versus 0.17 ± 0.09 mm/year; mean difference, 0.14; 95% CI, 0.11-0.17; p < 0.001). Osteolysis of any size was noted among 9% (four of 46) of the hips in the XLPE group and 46% (18 of 39) of the hips in the CPE group (odds ratio, 0.19; 95% CI, 0.07-0.51; p < 0.001). CONCLUSIONS This randomized study with followup into the second decade demonstrated reductions in revision, wear, and osteolysis associated with the use of XLPE. The low wear rates and absence of any mechanical failures among the XLPE liners at long-term followup affirm the durability of these components that did not incorporate antioxidants. Although osteolysis has not been eliminated, it occurs infrequently and has not caused any clinical problems to date. LEVEL OF EVIDENCE Level I, therapeutic study.
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Long-term Results of Primary Hip Arthroplasty with Cup Inclination Angle Bigger than Fifty Degrees. J Clin Orthop Trauma 2018; 9:133-136. [PMID: 29896015 PMCID: PMC5995005 DOI: 10.1016/j.jcot.2017.03.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Most of studies suggest the cup inclination angle is controversial. All of the studies previous have not control the prosthesis type and head diameter, it is difficult to determine relative or synergistic effects of cup angle. METHODS We retrospectively reviewed 54 patients (61 hips) with primary total hip arthroplasties which cup inclination angle bigger than 500 after a mean 11.8 years follow-up. All the prosthesis are noncemented cup with a 28 mm metal head(Trilogy Acetabular Shell, Zimmer). The cup inclination was divided into three groups, 50-550 in 26 hips, 55-600 in 21 hips, and bigger than 600 in 14 hips. An immediate postoperative radiograph was compared with a follow-up radiograph. The polyethylene wear rates and abduction of the acetabular cups was measured in all of the patients. RESULTS The preoperative mean Harris hip score improved from 47.36 to 94.3 points at 10 years. The survivorship of the cup was 100% at 10 years. The mean rate of liner wear was 0.144 ± 0.031 mm/y (0.105-0.178 mm/y) in cup inclination angle between 500-550, and 0.260 ± 0.043 mm/y (0.215-0.394 mm/y) in angle between 550-600, 0. 403 ± 0.016 mm/y (0.378-0.423 mm/y) in angle bigger than 600. The different cup inclination groups are different with liner and volumetric wear. CONCLUSION For the metal-on-polyethylene prostheses, the liner wear obvious correlate with cup inclination after angle bigger than 500. It can be concluded that the ideal abduction angle for metal-on-polyethylene prostheses should be less than 55° in hip total replacement.
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Nithyaprakash R, Shankar S, Uddin MS. Computational wear assessment of hard on hard hip implants subject to physically demanding tasks. Med Biol Eng Comput 2017; 56:899-910. [PMID: 29094238 DOI: 10.1007/s11517-017-1739-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 10/04/2017] [Indexed: 12/29/2022]
Abstract
Hip implants subject to gait loading due to occupational activities are potentially prone to failures such as osteolysis and aseptic loosening, causing painful revision surgeries. Highly risky gait activities such as carrying a load, stairs up or down and ladder up or down may cause excessive loading at the hip joint, resulting in generation of wear and related debris. Estimation of wear under the above gait activities is thus crucial to design and develop a new and improved implant component. With this motivation, this paper presents an assessment of wear generation of PCD-on-PCD (poly crystalline diamond) hip implants using finite element (FE) analysis. Three-dimensional (3D) FE model of hip implant along with peak gait and peak flexion angle for each activity was used to estimate wear of PCD for 10 million cycles. The maximum and minimum initial contact pressures of 206.19 MPa and 151.89 MPa were obtained for carrying load of 40 kg and sitting down or getting up activity. The simulation results obtained from finite element model also revealed that the maximum linear wear of 0.585 μm occurred for the patients frequently involved in sitting down or getting up gait activity and maximum volumetric wear of 0.025 mm3 for ladder up gait activity. The stair down activity showed the least linear and volumetric wear of 0.158 μm and 0.008 mm3, respectively, at the end of 10 million cycles. Graphical abstract Computational wear assessment of hip implants subjected to physically demanding tasks.
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Affiliation(s)
- R Nithyaprakash
- Department of Mechatronics Engineering, Kongu Engineering College, Erode, Tamil Nadu, 638052, India.
| | - S Shankar
- Department of Mechatronics Engineering, Kongu Engineering College, Erode, Tamil Nadu, 638052, India
| | - M S Uddin
- School of Engineering, University of South Australia, Mawson Lakes Campus, Mawson Lakes, SA, 5095, Australia
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Haggart J, Newton MD, Hartner S, Ho A, Baker KC, Kurdziel MD, Wiater JM. Neer Award 2017: wear rates of 32-mm and 40-mm glenospheres in a reverse total shoulder arthroplasty wear simulation model. J Shoulder Elbow Surg 2017; 26:2029-2037. [PMID: 28893545 DOI: 10.1016/j.jse.2017.06.036] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 06/14/2017] [Accepted: 06/19/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Larger glenosphere diameters have been used recently to increase prosthesis stability and impingement-free range of motion in reverse total shoulder arthroplasty. The goal of this study was to evaluate the rate of polyethylene wear for 32-mm and 40-mm glenospheres. METHODS Glenospheres (32 mm and 40 mm, n = 6/group) and conventional polyethylene humeral liners underwent a 5-million cycle (MC) wear simulation protocol. Abduction-adduction and flexion-extension motion profiles were alternated every 250,000 cycles. At each interval, mass loss was determined and converted to volume loss and wear rate. At 0, 2.5 MC, and 5 MC, liners were imaged using micro-computed tomography to determine surface deviation. White light interferometry was performed on liners and glenospheres at 0 and 5 MC to quantify surface roughness. Wear particle morphology was characterized by environmental scanning electron microscopy. RESULTS Total volume loss was significantly higher in 40-mm liners from 1.5 MC onward (P < .05). Overall, volumetric wear rate was significantly higher in 40-mm liners compared with 32-mm glenospheres (81.7 ± 23.9 mm3/MC vs. 68.0 ± 18.9 mm3/MC; P < .001). However, micro-computed tomography surface deviation results demonstrated increased linear penetration on 32-mm glenospheres compared with 40-mm glenospheres (0.36 ± 0.03 µm vs. 0.28 ± 0.01 µm; P = .002). Surface roughness measurements showed no difference for liners; however, increased roughness was noted for 40-mm glenospheres at 5 MC compared with 32 mm (P < .05). CONCLUSION Larger glenospheres underwent significantly greater polyethylene volume loss and volumetric wear rates, whereas smaller glenospheres underwent greater polyethylene surface deviations. The enhanced stability provided by larger glenospheres must be weighed against the potential for increased polyethylene wear.
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Affiliation(s)
- John Haggart
- Department of Orthopaedic Surgery, Beaumont Health System, Royal Oak, MI, USA
| | - Michael D Newton
- Department of Orthopaedic Research, Beaumont Health System, Royal Oak, MI, USA
| | - Samantha Hartner
- Department of Orthopaedic Research, Beaumont Health System, Royal Oak, MI, USA
| | - Anthony Ho
- Department of Orthopaedic Surgery, Beaumont Health System, Royal Oak, MI, USA
| | - Kevin C Baker
- Department of Orthopaedic Research, Beaumont Health System, Royal Oak, MI, USA; Department of Surgery, Oakland University-William Beaumont School of Medicine, Rochester, MI, USA
| | - Michael D Kurdziel
- Department of Orthopaedic Research, Beaumont Health System, Royal Oak, MI, USA; Department of Surgery, Oakland University-William Beaumont School of Medicine, Rochester, MI, USA
| | - J Michael Wiater
- Department of Orthopaedic Surgery, Beaumont Health System, Royal Oak, MI, USA; Department of Surgery, Oakland University-William Beaumont School of Medicine, Rochester, MI, USA.
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48
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Rajpura A, Board TN, Siney PD, Wynn Jones H, Williams S, Dabbs L, Wroblewski BM. A 28-year clinical and radiological follow-up of alumina ceramic-on-crosslinked polyethylene total hip arthroplasty: a follow-up report and analysis of the oxidation of a shelf-aged acetabular component. Bone Joint J 2017; 99-B:1286-1289. [PMID: 28963148 DOI: 10.1302/0301-620x.99b10.bjj-2017-0105.r1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 06/02/2017] [Indexed: 11/05/2022]
Abstract
AIMS Our aim in this study was to describe a continuing review of 11 total hip arthroplasties using 22.225 mm Alumina ceramic femoral heads on a Charnley flanged femoral component, articulating against a silane crosslinked polyethylene. PATIENTS AND METHODS Nine patients (11 THAs) were reviewed at a mean of 27.5 years (26 to 28) post-operatively. Outcome was assessed using the d'Aubigne and Postel, and Charnley scores and penetration was recorded on radiographs. In addition, the oxidation of a 29-year-old shelf-aged acetabular component was analysed. RESULTS The mean clinical outcome scores remained excellent at final follow-up. The mean total penetration remained 0.41 mm (0.40 to 0.41). There was no radiographic evidence of acetabular or femoral loosening or osteolysis. There was negligible oxidation in the shelf-aged sample despite gamma irradiation and storage in air. CONCLUSION These results highlight the long-term stability and durability of this type of crosslinked, antioxidant containing polyethylene when used in combination with a small diameter alumina ceramic femoral head. Cite this article: Bone Joint J 2017;99-B:1286-9.
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Affiliation(s)
- A Rajpura
- Wrightington Hospital, Hall Lane, Appley Bridge, Wigan WN6 9EP, UK
| | - T N Board
- Wrightington Hospital, Hall Lane, Appley Bridge, Wigan WN6 9EP, UK
| | - P D Siney
- Wrightington Hospital, Hall Lane, Appley Bridge, Wigan WN6 9EP, UK
| | - H Wynn Jones
- Wrightington Hospital, Hall Lane, Appley Bridge, Wigan WN6 9EP, UK
| | - S Williams
- University of Leeds, Woodhouse Ln, Leeds LS2 9JT, UK
| | - L Dabbs
- Orthoplastics Ltd, Grove Mill/Todmorden Rd, Bacup OL13 9EF, UK
| | - B M Wroblewski
- Wrightington Hospital, Hall Lane, Appley Bridge, Wigan WN6 9EP, UK
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Moro T, Takatori Y, Tanaka S, Ishihara K, Oda H, Kim YT, Umeyama T, Fukatani E, Ito H, Kyomoto M, Oshima H, Tanaka T, Kawaguchi H, Nakamura K. Clinical safety and wear resistance of the phospholipid polymer-grafted highly cross-linked polyethylene liner. J Orthop Res 2017; 35:2007-2016. [PMID: 27813260 DOI: 10.1002/jor.23473] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 10/28/2016] [Indexed: 02/04/2023]
Abstract
To reduce the production of wear particles and subsequent aseptic loosening, we created a human articular cartilage-mimicked surface for a highly cross-linked polyethylene liner, whose surface grafted layer consisted of a biocompatible phospholipid polymer, poly(2-methacryloyloxyethyl phosphorylcholine). Although our previous in vitro findings showed that poly(2-methacryloyloxyethyl phosphorylcholine)-grafted particles were biologically inert and caused no subsequent bone resorptive responses, and poly(2-methacryloyloxyethyl phosphorylcholine) grafting markedly decreased wear in hip joint simulator tests, the clinical safety, and in vivo wear resistance of poly(2-methacryloyloxyethyl phosphorylcholine)-grafted highly cross-linked polyethylene liners remained open to question. Therefore, in the present study, we evaluated clinical and radiographic outcomes of poly(2-methacryloyloxyethyl phosphorylcholine)-grafted highly cross-linked polyethylene liners 5 years subsequent to total hip replacement in 68 consecutive patients. No reoperation was required for any reason, and no adverse events were associated with the implanted liners. The average Harris Hip Score increased from 38.6 preoperatively to 96.5 5 years postoperatively, and health-related quality of life, as indicated by the Short Form 36 Health Survey, improved. Radiographic analyses showed no periprosthetic osteolysis or implant migration. Between 1 and 5 years postoperatively, the mean steady-state wear rate was 0.002 mm/year, which represented a marked reduction relative to other highly cross-linked polyethylene liners, and appeared to be unaffected by patient-related or surgical factors. Although longer follow up is required, poly(2-methacryloyloxyethyl phosphorylcholine)-grafted highly cross-linked polyethylene liners improved mid-term clinical outcomes. The clinical safety and wear-resistance results are encouraging with respect to the improvement of long-term clinical outcomes with poly(2-methacryloyloxyethyl phosphorylcholine)-grafted highly cross-linked polyethylene liners. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2007-2016, 2017.
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Affiliation(s)
- Toru Moro
- Division of Science for Joint Reconstruction, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.,Sensory and Motor System Medicine, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yoshio Takatori
- Division of Science for Joint Reconstruction, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Sakae Tanaka
- Sensory and Motor System Medicine, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kazuhiko Ishihara
- Department of Materials Engineering, School of Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8656, Japan
| | - Hiromi Oda
- Department of Orthopaedic Surgery, Saitama Medical University School of Medicine, 38 Morohongo Moroyama-machi, Iruma-gun, Saitama, 350-0495, Japan
| | - Yoon Taek Kim
- Department of Orthopaedic Surgery, Saitama Medical University School of Medicine, 38 Morohongo Moroyama-machi, Iruma-gun, Saitama, 350-0495, Japan
| | - Takashige Umeyama
- Department of Orthopedic Surgery, NTT Medical Center Tokyo, 5-9-22 Higashigotanda, Shinagawa-ku, Tokyo, 141-0022, Japan
| | - Eisei Fukatani
- Department of Orthopaedic Surgery, JR Tokyo General Hospital, 2-1-3 Yoyogi, Shibuya-ku, Tokyo, 151-8528, Japan
| | - Hideya Ito
- Department of Orthopaedic Surgery, Japan Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan
| | - Masayuki Kyomoto
- Division of Science for Joint Reconstruction, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.,Department of Materials Engineering, School of Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8656, Japan.,Department of Research, KYOCERA Medical Corporation, 3-3-31 Miyahara, Yodogawa-ku, Osaka, 532-0003, Japan
| | - Hirofumi Oshima
- Division of Science for Joint Reconstruction, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.,Sensory and Motor System Medicine, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Takeyuki Tanaka
- Sensory and Motor System Medicine, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hiroshi Kawaguchi
- Japan Community Healthcare Organization, Tokyo Shinjuku Medical Center, Spine Center, 5-1 Tsukudo, Shinjuku-ku, Tokyo, 162-8543, Japan
| | - Kozo Nakamura
- Sensory and Motor System Medicine, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.,Rehabilitation Services Bureau, National Rehabilitation Center for Persons With Disabilities, 4-1, Namiki, Tokorozawa, Saitama, 359-8555, Japan
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50
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Kayandan S, Doshi BN, Oral E, Muratoglu OK. Surface cross-linked ultra high molecular weight polyethylene by emulsified diffusion of dicumyl peroxide. J Biomed Mater Res B Appl Biomater 2017; 106:1517-1523. [PMID: 28741857 DOI: 10.1002/jbm.b.33957] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 06/13/2017] [Accepted: 07/04/2017] [Indexed: 11/06/2022]
Abstract
Cross-linking improves the wear resistance of ultrahigh molecular weight polyethylene (UHMWPE) used in hip and knee implants. Free radicals, generated by ionizing radiation or chemically, react to form cross-links. Limiting cross-linking to the articulating surface of the implant is desirable to enable high wear resistance on the surface and higher strength and toughness in the bulk. We investigated the diffusion of emulsified dicumyl peroxide (DCP) into vitamin E-blended UHMWPE (0.1 and 0.3 wt. % vitamin-E) with subsequent thermal decomposition in situ to obtain surface cross-linking with the objective of achieving surface wear rate equivalent or lower than that of current clinically available materials. We diffused emulsified DCP at 100°C followed by in situ decomposition at 150°C. We also assessed the effect of having vitamin-E in the DCP emulsion. The oxidative stability of the treated samples increased with increasing vitamin E concentration in the blend and by incorporating vitamin E into the peroxide emulsion. The impact strength of a surface cross-linked, 0.3 wt% vitamin E blended UHMWPE prepared using this method was superior to a clinically available irradiated and melted highly cross-linked UHMWPE while the wear resistance was comparable. These results showed the feasibility of surface cross-linking using emulsified peroxide diffusion as a method of making tough and wear resistant joint implant bearing surfaces. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 1517-1523, 2018.
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Affiliation(s)
- Sanem Kayandan
- Harris Orthopaedic Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, 02114
| | - Brinda N Doshi
- Harris Orthopaedic Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, 02114
| | - Ebru Oral
- Harris Orthopaedic Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, 02114.,Department of Orthopedic Surgery, Harvard Medical School, Boston, MA
| | - Orhun K Muratoglu
- Harris Orthopaedic Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, 02114.,Department of Orthopedic Surgery, Harvard Medical School, Boston, MA
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