1
|
Meng X, Zhang W, Yuan Z, Chen J, Lyu Z, Wang Y. A partial hemi-resurfacing preliminary study of a novel magnetic resonance imaging compatible polyetheretherketone mini-prosthesis for focal osteochondral defects. J Orthop Translat 2021; 26:67-73. [PMID: 33437625 PMCID: PMC7773958 DOI: 10.1016/j.jot.2020.02.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 02/19/2020] [Accepted: 02/22/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The use of partial articular resurfacing surgery with a mini-implant has been gradually increasing; the implant is mainly made of cobalt-chromium metal material, and cartilage changes cannot be monitored after implantation. Thus, we aimed to develop a novel local articular resurfacing polyetheretherketone (PEEK) mini-implant and investigate its feasibility for postoperative magnetic resonance imaging (MRI) monitoring of implant location, bone changes, and cartilage degeneration without artefacts. METHODS Nine skeletally mature female standardised goats were used and divided into the sham, PEEK, and cobalt-chromium-molybdenum alloy (Co-Cr-Mo) groups. The animals underwent local articular resurfacing operation with Co-Cr-Mo alloy (Co-Cr-Mo group) and PEEK (PEEK group) mini-implants. X-ray, computed tomography, and MRI examinations were performed at 12 weeks postoperatively. The sham group underwent a similar surgical procedure to expose the femoral head but without implantation. Gross necropsy and surface topography measurement of the articular cartilage of the acetabulum were performed after sacrificing the animals. Imaging artefacts and opposing cartilage degeneration in the acetabulum were also examined. RESULTS Cartilage damage occurred in both the Co-Cr-Mo and PEEK groups, and the damaged cartilage area was markedly larger in the Co-Cr-Mo group than in the PEEK group, as assessed by gross necropsy and histological staining. The mean surface roughness of the opposing cartilage was approximately 65.3, 117.4, and 188.4 μm at 12 weeks in the sham, PEEK, and Co-Cr-Mo groups, respectively. The Co-Cr-Mo mini-implant was visualised on radiographs, but computed tomography and MR images were markedly affected by artefacts, whereas the opposing cartilage and surrounding tissue were clear on MR images in the PEEK group. Opposing cartilage damage and subchondral bone marrow oedema could be detected by MRI in the PEEK group. CONCLUSIONS The PEEK mini-implant can be a novel alternative to the Co-Cr-Mo mini-implant in articular resurfacing to treat focal osteochondral defects with less cartilage damage. It is feasible to postoperatively monitor the PEEK implant location, surrounding bone changes, and opposing cartilage degeneration by MRI without artefacts. THE TRANSLATIONAL POTENTIAL OF THIS ARTICLE The use of MRI to monitor changes in the opposing cartilage after prosthesis implantation has not been widely applied because MR images are generally affected by artefacts generated by the metal prosthesis. This study revealed that the PEEK mini-implant can be a novel alternative to the Co-Cr-Mo mini-implant in articular resurfacing to treat focal osteochondral defects, and it is feasible to monitor the PEEK implant location, surrounding bone changes, and opposing cartilage damage/degeneration by MRI without artefacts postoperatively.
Collapse
Affiliation(s)
- Xiangchao Meng
- Department of Bone and Joint Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Wei Zhang
- Department of Bone and Joint Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Zhiguo Yuan
- Department of Bone and Joint Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Jun Chen
- Department of Head and Neck Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Zhuocheng Lyu
- Department of Bone and Joint Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - You Wang
- Department of Bone and Joint Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| |
Collapse
|
2
|
Zhang W, Yuan Z, Meng X, Zhang J, Long T, Yaochao Z, Yang C, Lin R, Yue B, Guo Q, Wang Y. Preclinical evaluation of a mini-arthroplasty implant based on polyetheretherketone and Ti6AI4V for treatment of a focal osteochondral defect in the femoral head of the hip. ACTA ACUST UNITED AC 2020; 15:055027. [PMID: 32498062 DOI: 10.1088/1748-605x/ab998a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A mini or partial arthroplasty may offer the advantages of reduced pain, shorter hospital stay, and increased range of motion, which are beneficial for the treatment of large-sized focal osteochondral defects. We aimed to evaluate the in vivo histologic response and function of our nonresorbable, composite structure implant, developed using polyetheretherketone (PEEK) and Ti6AI4V alloy, as a treatment for full-thickness osteochondral defects in the femoral head of the hip using a goat model. The gross and imaging appearance and histologic results were compared to those of a similar size cobalt-chromium-molybdenum (CoCrMo) alloy implant placed in a defect in the femoral head and evaluated up to 12 weeks. The X radiographs showed that there was no evidence of loosening of the implants for both the PEEK-Ti6AI4V and CoCrMo groups. Magnetic resonance imaging results showed no inflammatory signal findings in both PEEK-Ti6AI4V and CoCrMo implants. Macroscopically and histologically, there was lesser cartilage degeneration in the PEEK-Ti6AI4V implant than in the CoCrMo implant. The modified macroscopic articular evaluation score was lower in the PEEK-Ti6AI4V group than in the CoCrMo group (p < 0.05), and the histological score of the periprosthetic and acetabular cartilage was lower in the PEEK-Ti6AI4V group than in the CoCrMo group (P < 0.05). The micro-computed tomography results showed that the uncemented PEEK-Ti6AI4V implant has better osseointegration and higher bone-implant contact than the cemented CoCrMo implant. The peri-implant bone mass was higher in the PEEK-Ti6AI4V implant(p < 0.05). Meanwhile, the optical profile analytical results showed that the surface roughness of the cartilage in the acetabulum was higher in the CoCrMo group. In conclusion, the mini-arthroplasty implant based on PEEK-Ti6AI4V was superior to an identical CoCrMo alloy implant as a treatment for local osteochondral defect in the femoral head, owing to its in vivo cartilage protection and better osseointegration.
Collapse
Affiliation(s)
- Wei Zhang
- Department of Bone and Joint Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, People's Republic of China
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
3
|
Waewsawangwong W, Ruchiwit P, Huddleston JI, Goodman SB. Hip arthroplasty for treatment of advanced osteonecrosis: comprehensive review of implant options, outcomes and complications. Orthop Res Rev 2016; 8:13-29. [PMID: 30774467 PMCID: PMC6209358 DOI: 10.2147/orr.s35547] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Surgical treatment for late stage (post-collapse) osteonecrosis of the femoral head is controversial. In these situations, the outcome of joint preservation procedures is poor. There are several arthroplasty options for late-stage disease. The clinical outcomes of hemiarthroplasty and hemiresurfacing are unpredictable because of progressive acetabular cartilage degeneration. Total hip resurfacing may be associated with further vascular insult to the femoral head and early failure of the implant. Total hip replacement with metal-on-conventional polyethylene bearing surfaces has been the gold standard, but implant survivorship is limited in young active patients due to wear and osteolysis. Newer alternative bearing surfaces may have improved wear characteristics, but their durability must be confirmed in longer-term studies.
Collapse
Affiliation(s)
| | - Pirapat Ruchiwit
- Department of Orthopedic Surgery, Stanford University, Stanford, CA, USA,
| | - James I Huddleston
- Department of Orthopedic Surgery, Stanford University, Stanford, CA, USA,
| | - Stuart B Goodman
- Department of Orthopedic Surgery, Stanford University, Stanford, CA, USA,
| |
Collapse
|
4
|
Beckmann J, Roth A, Niethard C, Mauch F, Best R, Maus U. [Bone marrow edema and atraumatic necrosis of the femoral head : Therapy]. DER ORTHOPADE 2016; 44:662-671. [PMID: 26245631 DOI: 10.1007/s00132-015-3146-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND An increase in interstitial bony fluid occurs in bone-marrow edema (BME). The exact pathogenetic processes still remain unknown. BME is an unspecific finding that can occur on its own or accompany multiple diseases and pathologies. GOAL Literature review and presentation of new guidelines. MATERIAL AND METHODS This is a narrative literature review followed by current advice for the therapy of atraumatic osteonecrosis of the hip, based on the recently published S3-guidelines for this disease. RESULTS AND DISCUSSION The differentiation of at least 3 different etiologies is proposed (mechanic, reactive and ischemic). Difficult, but important, is the distinction between the mostly painful, but benign entities (BME syndrome, bone bruise) and the progressive pathologies (osteonecrosis, arthritis, CRPS, tumour). Treatment options are dependent on etiology and clinic and can often be symptomatic. Core decompression is the surgical gold standard, leading to immediate pressure relief and therefore reduction in pain. Recently, it was shown that intravenous administration of Iloprost and bisphosphonates are also effective in achieving a reduction of BME and pain, with considerable improvement in the accompanying symptoms. The combination of core decompression and infusion seems to be another possible optimization ofthe therapy, in particular in the treatment of osteonecrosis.
Collapse
Affiliation(s)
- J Beckmann
- Sportklinik Stuttgart, Taubenheimstr. 8, 70372, Stuttgart, Deutschland.
| | - A Roth
- Bereich Endoprothetik/Orthopädie, Klinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universität Leipzig AöR, Leipzig, Deutschland
| | - C Niethard
- Orthopädische Gemeinschaftspraxis, Heinsberg, Deutschland
| | - F Mauch
- Sportklinik Stuttgart, Taubenheimstr. 8, 70372, Stuttgart, Deutschland
| | - R Best
- Sportklinik Stuttgart, Taubenheimstr. 8, 70372, Stuttgart, Deutschland
| | - U Maus
- Universitätsklinik für Orthopädie und Unfallchirurgie, Klinik für Orthopädie und spezielle orthopädische Chirurgie, Pius-Hospital Oldenburg, Oldenburg, Deutschland
| |
Collapse
|
5
|
Bilge O, Doral MN, Yel M, Karalezli N, Miniaci A. Treatment of osteonecrosis of the femoral head with focal anatomic-resurfacing implantation (HemiCAP): preliminary results of an alternative option. J Orthop Surg Res 2015; 10:56. [PMID: 25924980 PMCID: PMC4423414 DOI: 10.1186/s13018-015-0199-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 04/15/2015] [Indexed: 12/21/2022] Open
Abstract
Background The optimal treatment of osteonecrosis of the femoral head has not been established yet. The aim of this study was to report preliminary clinical results of focal anatomic-resurfacing implantation for the treatment of osteonecrosis of the femoral head. Methods Five patients (four male, one female) with seven surgical procedures, ages between 37 and 52 with an average age of 45.2 (+/− 7.2), diagnosed as femoral head avascular necrosis and who were unresponsive to conservative management or had failed previous surgical treatments were treated with a focal anatomic femoral head resurfacing between the years 2011–2012 and were retrospectively reviewed. Five patients with at least two years of follow-up, one left hip, two right hips, and two patients with bilateral hip surgery were included in this review. After safe surgical dislocation of the hip, full exposure of the femoral head was established. A focal-resurfacing implant matching patient anatomy and femoral head curvature was performed accordingly. Neither intraoperative or postoperative complications nor revision ensued. Visual analogue scores and Harris Hip Scores were recorded both preoperatively and at postoperative 2 years for all seven surgeries. Results The mean follow-up period was 26.6 +/− 3.8 months, with a range between 24–33 months. The mean visual analogue scores were 8.9 +/− 0.9 preoperatively and 2.3 +/− 1.0 postoperatively at year two (p = 0.017). Harris Hip Scores at postoperative follow-up were found to improve significantly from good to excellent scores (86.0 +/− 7.9), compared with preoperative poor scores (26.7 +/− 11.8) (p = 0.018). The clinical improvements in visual analogue scores (VAS) and Harris Hip Scores were also found to correlate with each other (p < 0.05). Conclusions In the present study, the alternative technique of focal anatomic hip resurfacing with HemiCAP® yielded preliminary successful results for the treatment of osteonecrosis of the femoral head. To the best of our knowledge, this is the first case series in the literature, reporting functional clinical results with the use of a focal anatomic-resurfacing implant for the treatment of focal femoral head osteonecrosis.
Collapse
Affiliation(s)
- Onur Bilge
- Department of Orthopaedics and Traumatology, Konya Necmettin Erbakan University, Meram Faculty of Medicine, Meram, 42080, Konya, Turkey.
| | - Mahmut Nedim Doral
- Department of Orthopaedics and Traumatology, Hacettepe University, Faculty of Medicine, 06230, Ankara, Turkey.
| | - Mustafa Yel
- Department of Orthopaedics and Traumatology, Konya Necmettin Erbakan University, Meram Faculty of Medicine, Meram, 42080, Konya, Turkey.
| | - Nazim Karalezli
- Department of Orthopaedics and Traumatology, Konya Necmettin Erbakan University, Meram Faculty of Medicine, Meram, 42080, Konya, Turkey.
| | - Anthony Miniaci
- Cleveland Clinic Sports Health Center, 5555 Transportation Blvd, Garfield Heights, Ohio, 44125, USA.
| |
Collapse
|
6
|
Cho YJ, Nam DC, Jung K. Arthroplasty in Femoral Head Osteonecrosis. Hip Pelvis 2014; 26:65-73. [PMID: 27536561 PMCID: PMC4971118 DOI: 10.5371/hp.2014.26.2.65] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 02/26/2014] [Accepted: 03/17/2014] [Indexed: 12/14/2022] Open
Abstract
Osteonecrosis of the femoral head is a destructive joint disease requiring early hip arthroplasty. The polyethylene-metal design using a 22-mm femoral head component, introduced by Charnley in 1950, has been widely used for over half a century. Since then, different materials with the capacity to minimize friction between bearing surfaces and various cement or cementless insert fixations have been developed. Although the outcome of second and third generation designs using better bearing materials and technologies has been favorable, less favorable results are seen with total hip arthroplasty in young patients with osteonecrosis. Selection of appropriate materials for hip arthroplasty is important for any potential revisions that might become inevitable due to the limited durability of a prosthetic hip joint. Alternative hip arthroplasties, which include hemiresurfacing arthroplasty and bipolar hemiarthroplasty, have not been found to have acceptable outcomes. Metal-on-metal resurfacing has recently been suggested as a feasible option for young patients with extra physical demands; however, concerns about complications such as hypersensitivity reaction or pseudotumor formation on metal bearings have emerged. To ensure successful long-term outcomes in hip arthroplasty, factors such as insert stabilization and surfaces with less friction are essential. Understanding these aspects in arthroplasty is important to selection of proper materials and to making appropriate decisions for patients with osteonecrosis of the femoral head.
Collapse
Affiliation(s)
- Yoon Je Cho
- Department of Orthopedic Surgery, Kyung Hee University School of Medicine, Seoul, Korea
| | - Dong Cheol Nam
- Department of Orthopedic Surgery, Kyung Hee University School of Medicine, Seoul, Korea
| | - Kwangyoung Jung
- Department of Orthopedic Surgery, Kyung Hee University School of Medicine, Seoul, Korea
| |
Collapse
|
7
|
M Takamura K, Maher P, Nath T, Su EP. Survivorship of standard versus modified posterior surgical approaches in metal-on-metal hip resurfacing. Bone Joint Res 2014; 3:150-4. [PMID: 24842931 PMCID: PMC4037883 DOI: 10.1302/2046-3758.35.2000282] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objectives Metal-on-metal hip resurfacing (MOMHR) is available as an alternative
option for younger, more active patients. There are failure modes
that are unique to MOMHR, which include loosening of the femoral
head and fractures of the femoral neck. Previous studies have speculated
that changes in the vascularity of the femoral head may contribute
to these failure modes. This study compares the survivorship between
the standard posterior approach (SPA) and modified posterior approach
(MPA) in MOMHR. Methods A retrospective clinical outcomes study was performed examining
351 hips (279 male, 72 female) replaced with Birmingham Hip Resurfacing
(BHR, Smith and Nephew, Memphis, Tennessee) in 313 patients with
a pre-operative diagnosis of osteoarthritis. The mean follow-up
period for the SPA group was 2.8 years (0.1 to 6.1) and for the
MPA, 2.2 years (0.03 to 5.2); this difference in follow-up period
was statistically significant (p < 0.01). Survival analysis was
completed using the Kaplan–Meier method. Results At four years, the Kaplan–Meier survival curve for the SPA was
97.2% and 99.4% for the MPA; this was statistically significant
(log-rank; p = 0.036). There were eight failures in the SPA and
two in the MPA. There was a 3.5% incidence of femoral head collapse
or loosening in the SPA and 0.4% in the MPA, which represented a
significant difference (p = 0.041). There was a 1.7% incidence of
fractures of the femoral neck in the SPA and none in the MPA (p
= 0.108). Conclusion This study found a significant difference in survivorship at
four years between the SPA and the MPA (p = 0.036). The clinical
outcomes of this study suggest that preserving the vascularity of
the femoral neck by using the MPA results in fewer vascular-related
failures in MOMHRs. Cite this article: Bone Joint Res 2014;3:150–4
Collapse
Affiliation(s)
- K M Takamura
- UCLA David Geffen School of Medicine, 10833 Le Conte Avenue, Los Angeles, California 90095, USA
| | - P Maher
- Weill Cornell Medical College, 1300 York Ave, New York, New York 10021, USA
| | - T Nath
- Center for Hip Preservation, 535 East 70th Street, New York, New York 10021, USA
| | - E P Su
- Hospital for Special Surgery, 535 East 70th street, New York, New York 10021, USA
| |
Collapse
|
8
|
Johnson AJ, Mont MA, Tsao AK, Jones LC. Treatment of femoral head osteonecrosis in the United States: 16-year analysis of the Nationwide Inpatient Sample. Clin Orthop Relat Res 2014; 472:617-23. [PMID: 23943529 PMCID: PMC3890194 DOI: 10.1007/s11999-013-3220-3] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Many surgical interventions are used to treat osteonecrosis of the femoral head. The instance and distribution of these various procedures may give some insight into the practicing community's understanding of the efficacy of these treatments. We therefore sought to determine trends in the types and numbers of procedures performed for atraumatic osteonecrosis from 1992 through 2008 in the United States. QUESTIONS/PURPOSES (1) How has the overall incidence of surgical treatment for atraumatic osteonecrosis changed over this time period; and (2) how has the percentage of THA performed for osteonecrosis (compared with joint-preserving procedures) changed over this time period? METHODS The Nationwide Inpatient Sample database was used to collect information for all patients who had an International Classification of Diseases, 9(th) Revision diagnosis of hip osteonecrosis between 1992 and 2008. Procedures were collated according to frequency, and trends were analyzed for joint-preserving and joint-replacing procedures. RESULTS The total number of procedures performed over this time period for osteonecrosis of the hip increased from 3570 procedures to 6400 procedures per year. In 1992, 75% (n = 2678) of the procedures performed to treat osteonecrosis of the hip were THA, which increased to 88% (n = 5632) in 2008. The percentage of joint-preserving procedures consequently decreased from 25% to 12% over this period. CONCLUSIONS Previously, THA was believed to have poor survivorship and clinical results for the treatment of osteonecrosis of the hip, but reports since 1993 have suggested improved survivorship of these reconstructions. Our study suggests that surgeons have incorporated this into their practice patterns, in that an increasing percentage of patients with this diagnosis are treated with THA. Additionally, the total number of procedures performed for osteonecrosis has increased, which may reflect an improved awareness of this disease and more aggressive approaches to diagnosis and treatment.
Collapse
Affiliation(s)
- Aaron J. Johnson
- />Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD USA
| | - Michael A. Mont
- />Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD USA
| | | | - Lynne C. Jones
- />Johns Hopkins Orthopaedics at Good Samaritan Hospital, The Johns Hopkins University School of Medicine, 5601 Loch Raven Boulevard, Baltimore, MD 21239 USA
| |
Collapse
|
9
|
Nakasone S, Takao M, Sakai T, Nishii T, Sugano N. Does the extent of osteonecrosis affect the survival of hip resurfacing? Clin Orthop Relat Res 2013; 471:1926-34. [PMID: 23397316 PMCID: PMC3706687 DOI: 10.1007/s11999-013-2833-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 01/29/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND The effect of the extent of osteonecrosis on the survival of hip resurfacing for osteonecrosis of the femoral head (ONFH) has not been well documented, but is a potentially important variable in the decision to perform resurfacing. QUESTIONS/PURPOSES We examined (1) the relationship between the volume of osteonecrosis in the femoral head before surgery and the extent of the residual necrotic bone after femoral head machining, (2) how the extent of the residual necrotic bone relative to the resurfaced femoral head (after femoral head machining) affected the survival of total hip resurfacing for patients with ONFH, and (3) how the extent of the necrotic bone relative to the entire femoral head (before femoral head machining) affected the survival and clinical outcome scores of patients who underwent total hip resurfacing. METHODS Thirty-three patients (39 hips) who underwent hip resurfacing were reviewed after a mean followup of 8 years. The extent of osteonecrosis in the femoral head and residual osteonecrosis in the implant bony bed after femoral head machining were estimated using a three-dimensional MRI-based templating system. RESULTS There was a statistically significant difference in the extent of osteonecrosis before and after femoral head machining, although the two were well correlated (r = 0.97). The mean percentage of osteonecrosis in the implant bony bed after femoral head machining was 5% smaller than that relative to the entire femoral head (range, -9% to 15%). There were no significant differences in implant survival between groups with small and large osteonecrosis classified by either the total amount of osteonecrosis before surgery or residual osteonecrosis after femoral head machining. CONCLUSION The extent of osteonecrosis in the femoral head significantly decreased after femoral head machining. Neither the residual osteonecrosis volume in the implant bony bed after femoral head machining nor the total amount of osteonecrosis before femoral head machining had significant influence on the survival of hip resurfacing.
Collapse
Affiliation(s)
- Satoshi Nakasone
- />Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Yamadaoka 2-2, Suita, Osaka 565-0871 Japan
- />Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, Uehara, Nishihara, Okinawa Japan
| | - Masaki Takao
- />Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Yamadaoka, Suita, Osaka Japan
| | - Takashi Sakai
- />Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Yamadaoka, Suita, Osaka Japan
| | - Takashi Nishii
- />Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Yamadaoka 2-2, Suita, Osaka 565-0871 Japan
| | - Nobuhiko Sugano
- />Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Yamadaoka 2-2, Suita, Osaka 565-0871 Japan
| |
Collapse
|
10
|
Sayeed SA, Johnson AJ, Stroh DA, Gross TP, Mont MA. Hip resurfacing in patients who have osteonecrosis and are 25 years or under. Clin Orthop Relat Res 2011; 469:1582-8. [PMID: 20963531 PMCID: PMC3094641 DOI: 10.1007/s11999-010-1629-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Young patients with osteonecrosis (ON) treated with THA often have suboptimal function and radiographic failure with eventual revision. Resurfacing may be an option because of potentially increased functionality and decreased radiographic failure, although neither has been confirmed in the literature. QUESTIONS/PURPOSES We therefore compared the clinical scores and radiographic failures of resurfacing patients 25 years or younger with osteonecrosis with those for patients with ON treated with THA. METHODS We identified 17 patients (20 resurfaced hips) who were 25 years or younger and treated by resurfacing for ON. Mean followup was 62 months (range, 32-103 months). This group was matched by gender, age, BMI, and followup to 16 patients (20 hips) treated with THA with a mean 61 month followup (range, 34-88 months). Additionally, the group was compared to 78 patients (87 hips) with ON over age 25 who underwent resurfacing during the same time with a mean followup of 61 months (range, 27-112 months). RESULTS The mean Harris score improved from 48 points preoperatively to 93 points with a 100% 7.5 year survivorship in the young resurfacing group. In the THA cohort, the mean score improved from 44 points preoperatively to 94 points postoperatively, with a 93.3% 7.5 year survivorship; similar to the results for all resurfacing patients. Radiographs did not reveal malalignment or progressive radiolucencies in any cohort. CONCLUSION At approximately 5 year followup, young resurfacing patients were similar to other resurfacing patients and standard THA patients regarding clinical ratings and radiographic failures.
Collapse
Affiliation(s)
- Siraj A. Sayeed
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Reconstruction, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215 USA
| | - Aaron J. Johnson
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Reconstruction, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215 USA
| | - D. Alex Stroh
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Reconstruction, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215 USA
| | | | - Michael A. Mont
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Reconstruction, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215 USA
| |
Collapse
|
11
|
deSouza RM, Parsons NR, Oni T, Dalton P, Costa M, Krikler S. Metal ion levels following resurfacing arthroplasty of the hip. ACTA ACUST UNITED AC 2010; 92:1642-7. [DOI: 10.1302/0301-620x.92b12.24654] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
We report serum metal ion level data in patients with unilateral and bilateral hip resurfacing over a ten-year period. In these patients there is an increase in both cobalt and chromium levels above the accepted reference ranges during the first 18 months after operation. Metal ion levels remain elevated, but decline slowly for up to five years. However, the levels then appear to start rising again in some patients up to the ten-year mark. There was no significant difference in cobalt or chromium levels between men and women. These findings appear to differ from much of the current literature. The clinical significance of a raised metal ion level remains under investigation.
Collapse
Affiliation(s)
- R. M. deSouza
- University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - N. R. Parsons
- Clinical Science Research Institute, University of Warwick, Coventry CV4 7AL, UK
| | - T. Oni
- University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - P. Dalton
- Queen Elizabeth II Jubilee Hospital, Private Mail Bag 2, Acacia Ridge, Brisbane, Queensland 4110, Australia
| | - M. Costa
- University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - S. Krikler
- University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK
| |
Collapse
|
12
|
Abstract
Osteonecrosis of the femoral head is a condition that affects upwards of 10,000 individuals in the USA each year. The peak incidence is in the fourth decade of life, and overall, there is a male preponderance. The condition accounts for up to 12% of total hip arthroplasties performed in developed countries. The etiology can be traumatic or non-traumatic, with 90% of atraumatic cases attributed to corticosteroid therapy or excess alcohol consumption. Osteonecrosis of the femoral head reflects the final common pathway of a range of insults to the blood supply and ultimately results in femoral head collapse, acetabular involvement, and secondary osteoarthritis. Currently, conservative treatment options, which aim to correct pathophysiologic features allowing revascularization and new bone formation, appear to be able to delay but not halt the progression of this condition. As a consequence of femoral head osteonecrosis, many individuals undergo surgical treatments including: core decompression, osteotomy, non-vascularized bone matrix grafting, free vascularized fibular grafts, limited femoral resurfacing, total hip resurfacing, and total hip arthroplasty.
Collapse
Affiliation(s)
- Thomas W. Hamilton
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal, Science University of Oxford John Radcliffe Hospital, Headley Way, Headington Oxford, OX3 9DU USA
| | - Susan M. Goodman
- Department of Medicine, Hospital for Special Surgery, New York, NY USA
| | - Mark Figgie
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY USA
| |
Collapse
|
13
|
Schnurr C, Nessler J, Meyer C, Schild HH, Koebke J, König DP. Is a valgus position of the femoral component in hip resurfacing protective against spontaneous fracture of the femoral neck?: a biomechanical study. ACTA ACUST UNITED AC 2009; 91:545-51. [PMID: 19336820 DOI: 10.1302/0301-620x.91b4.21355] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The aim of our study was to investigate whether placing of the femoral component of a hip resurfacing in valgus protected against spontaneous fracture of the femoral neck. We performed a hip resurfacing in 20 pairs of embalmed femora. The femoral component was implanted at the natural neck-shaft angle in the left femur and with a 10 degrees valgus angle on the right. The bone mineral density of each femur was measured and CT was performed. Each femur was evaluated in a materials testing machine using increasing cyclical loads. In specimens with good bone quality, the 10 degrees valgus placement of the femoral component had a protective effect against fractures of the femoral neck. An adverse effect was detected in osteoporotic specimens. When resurfacing the hip a valgus position of the femoral component should be achieved in order to prevent fracture of the femoral neck. Patient selection remains absolutely imperative. In borderline cases, measurement of bone mineral density may be indicated.
Collapse
Affiliation(s)
- C Schnurr
- Rheinische Klinik für Orthopädie, Horionstrasse 2, 41749 Viersen, Germany.
| | | | | | | | | | | |
Collapse
|
14
|
Nunley RM, Della Valle CJ, Barrack RL. Is patient selection important for hip resurfacing? Clin Orthop Relat Res 2009; 467:56-65. [PMID: 18941859 PMCID: PMC2601008 DOI: 10.1007/s11999-008-0558-z] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2008] [Accepted: 09/23/2008] [Indexed: 01/31/2023]
Abstract
UNLABELLED The optimal implant option for hip arthroplasty in the young, active patient remains controversial. There has been renewed interest for metal-on-metal hip resurfacing due to improved design and manufacturing of implants, better materials, enhanced implant fixation, theoretical advantages over conventional total hip arthroplasty, and recent Food and Drug Administration approval of two devices. Recent studies indicate satisfactory short- and midterm clinical results (1- to 10-year followup) with low complication rates, but there is a learning curve associated with this procedure, a more extensive surgical approach is necessary, and long-term results have yet to be determined. Proper patient selection may help avoid complications and improve patient outcomes. Patient selection criteria in the literature appear based predominantly on theoretical considerations without any consensus on stratifying patient risk. The most commonly reported complications encountered with hip resurfacing include femoral neck fracture, acetabular component loosening, metal hypersensitivity, dislocation, and nerve injury. At the time of clinical evaluation, patient age; gender; diagnosis; bone density, quality, and morphology; activity level; leg lengths; renal function; and metal hypersensitivity are important factors when considering a patient for hip resurfacing. Based on our review, we believe the best candidates for hip resurfacing are men under age 65 with osteoarthritis and relatively normal bony morphology. LEVEL OF EVIDENCE Level V, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Ryan M. Nunley
- Department of Orthopaedic Surgery, Washington University, 660 S. Euclid Avenue, Campus Box 8233, St Louis, MO 63130-4899
USA
| | - Craig J. Della Valle
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL USA
| | - Robert L. Barrack
- Department of Orthopaedic Surgery, Washington University, 660 S. Euclid Avenue, Campus Box 8233, St Louis, MO 63130-4899
USA
| |
Collapse
|
15
|
Imageless navigation of hip resurfacing arthroplasty increases the implant accuracy. INTERNATIONAL ORTHOPAEDICS 2007; 33:365-72. [PMID: 18157534 DOI: 10.1007/s00264-007-0494-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2007] [Accepted: 10/18/2007] [Indexed: 10/22/2022]
Abstract
Surface arthroplasty of the hip is increasingly popular. Optimising the position of the femoral component is essential to avoid early implant failures such as femoral neck fractures. Sixty hip surface replacements were retrospectively analysed. In 30 patients imageless navigation was used, and 30 patients were operated upon using conventional jigs. Accuracy, implant position, operating time, and complications have been recorded. The navigation device improved the implant position with high accuracy. Implant-shaft angles <130 degrees and uncovered cancellous bone of the superior femoral neck could be safely avoided. After a significant learning curve, navigation took 15 minutes longer than conventional implantation. No complications were found in either group. Computer-assisted navigation allowed accurate implantation of the femoral component avoiding pitfalls of hip surface replacement. From our point of view the optimal placement of the femoral component outweighs the disadvantage of a longer operating time.
Collapse
|
16
|
Krüger S, Zambelli PY, Leyvraz PF, Jolles BM. Computer-assisted placement technique in hip resurfacing arthroplasty: improvement in accuracy? INTERNATIONAL ORTHOPAEDICS 2007; 33:27-33. [PMID: 17717664 PMCID: PMC2899204 DOI: 10.1007/s00264-007-0440-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2007] [Accepted: 06/17/2007] [Indexed: 11/28/2022]
Abstract
Freehand positioning of the femoral drill guide is difficult during hip resurfacing and the surgeon is often unsure of the implant position achieved peroperatively. The purpose of this study was to find out whether, by using a navigation system, acetabular and femoral component positioning could be made easier and more precise. Eighteen patients operated on by the same surgeon were matched by sex, age, BMI, diagnosis and ASA score (nine patients with computer assistance, nine with the regular ancillary). Pre-operative planning was done on standard AP and axial radiographs with CT scan views for the computer-assisted operations. The final position of implants was evaluated by the same radiographs for all patients. The follow-up was at least 1 year. No difference between both groups in terms of femoral component position was observed (p > 0.05). There was also no difference in femoral notching. A trend for a better cup position was observed for the navigated hips, especially for cup anteversion. There was no additional operating time for the navigated hips. Hip navigation for resurfacing surgery may allow improved visualisation and hip implant positioning, but its advantage probably will be more obvious with mini-incisions than with regular incision surgery.
Collapse
Affiliation(s)
- S. Krüger
- Hôpital Orthopédique de la Suisse Romande, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
| | - P. Y. Zambelli
- Hôpital Orthopédique de la Suisse Romande, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
| | - P.-F. Leyvraz
- Hôpital Orthopédique de la Suisse Romande, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
| | - B. M. Jolles
- Hôpital Orthopédique de la Suisse Romande, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
- Hôpital Orthopédique de la Suisse Romande, 4, Avenue Pierre Decker, 1005 Lausanne, Switzerland
| |
Collapse
|