1
|
Do MU, Moon NH, Suh KT, Kim JS, Lee SM, Shin WC. Safety of using a large femoral head on thin polyethylene for total hip arthroplasty based on different types of polyethylene. Sci Rep 2023; 13:22769. [PMID: 38123795 PMCID: PMC10733297 DOI: 10.1038/s41598-023-50217-x] [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: 09/25/2023] [Accepted: 12/16/2023] [Indexed: 12/23/2023] Open
Abstract
The use of a large femoral head in total hip arthroplasty (THA) to stabilize and reduce the incidence of dislocation is on the increase, but concerns arise when combining them with small acetabular components due to potential mechanical failures in thin polyethylene (PE) liners. A single-institution, retrospective cohort study was conducted on 116 patients with minimum 2-year follow-up who received 36-mm femoral heads and acetabular components ≤ 52 mm, using either remelted highly cross-linked polyethylene (remelted HXLPE) or vitamin E-infused HXLPE (VEPE). Osteolysis and implant loosening were not observed in either group. Although a fracture of the PE liner was observed in each group (1.7%), the clinical outcomes were excellent, as the mean modified Harris Hip Score (mHHS) at the last follow-up was 93.5. Moreover, the mean linear wear rates measured by digital imaging software in both groups were low, with 0.035 mm/y in remelted HXLPE and 0.030 mm/y in VEPE. In conclusion, The use of a large femoral head on a thin PE liner can be a viable treatment option in patients who need to prioritize stability; however, careful attention should be paid to mechanical fractures of the PE liner.
Collapse
Affiliation(s)
- Min Uk Do
- Department of Orthopedic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, 20 Geumo-ro, Mulgeum-eup, Yangsan, Gyeongsangnam-do, 626-770, Republic of Korea
| | - Nam Hoon Moon
- Department of Orthopedic Surgery, Pusan National University Hospital, Busan, Republic of Korea
| | - Kuen Tak Suh
- Department of Orthopedic Surgery, Sehung Hospital, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Jung Shin Kim
- Department of Orthopedic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, 20 Geumo-ro, Mulgeum-eup, Yangsan, Gyeongsangnam-do, 626-770, Republic of Korea
| | - Sang-Min Lee
- Department of Orthopedic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, 20 Geumo-ro, Mulgeum-eup, Yangsan, Gyeongsangnam-do, 626-770, Republic of Korea
| | - Won Chul Shin
- Department of Orthopedic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, 20 Geumo-ro, Mulgeum-eup, Yangsan, Gyeongsangnam-do, 626-770, Republic of Korea.
| |
Collapse
|
2
|
Yakkanti RR, Ocksrider JL, Patel AA, Kolevar MP, Moore RD, Rimnac CM, Kraay MJ, Wright TM, Baral EC, Robinson RP. Unexpected Wear of a Uniquely Designed Moderately Cross-Linked Polyethylene in Total Hip Arthroplasty. J Arthroplasty 2022; 37:1130-1135. [PMID: 35131388 DOI: 10.1016/j.arth.2022.01.093] [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: 10/17/2021] [Revised: 01/26/2022] [Accepted: 01/31/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND A uniquely designed, non-heat-treated moderately cross-linked acetabular polyethylene liner used in total hip arthroplasty (THA) demonstrated excessive wear during routine follow-up, prompting an evaluation of the linear wear rate. METHODS All THAs were performed by the senior author. The study group included 38 THAs using the uniquely designed polyethylene in question, compared to a control group of 21 THAs using another moderately cross-linked polyethylene with good 10-year outcomes. Two-dimensional linear head penetration wear measurements were obtained using the Martell Hip Analysis Suite, and retrieval analysis was performed on two liners. RESULTS The study group had a significantly higher average penetration rate of 0.089 mm/y than the control group average rate of 0.047 mm/y (P = .04). Forty-five percent of the study group had a wear rate above the osteolysis threshold (0.1 mm/y), compared to 24% in the control group. Macroscopic analysis of two retrieved liners validated the radiographic findings. CONCLUSION The data suggest unexpectedly higher wear rates for a moderately cross-linked polyethylene design, with nearly half of the study group at risk for osteolysis. Further registry or database analyses of this particular moderately cross-linked polyethylene are warranted.
Collapse
Affiliation(s)
- Ramakanth R Yakkanti
- Department of Orthopaedic Surgery, University of Miami / Jackson Memorial Health System, Miami, FL
| | - Justin L Ocksrider
- Department of Orthopaedic Surgery, University of Miami / Jackson Memorial Health System, Miami, FL
| | - Anand A Patel
- Summit Medical Group of New Jersey, Florham Park, NJ
| | | | | | | | | | | | | | - Raymond P Robinson
- Department of Orthopaedic Surgery, University of Miami / Jackson Memorial Health System, Miami, FL
| |
Collapse
|
3
|
Díaz-Dilernia F, Lattore M, Zanotti G, Comba F, Piccaluga F, Buttaro M. Gait instability may indicate liner failure in patients with total hip arthroplasty. A report of three cases. Ann R Coll Surg Engl 2021; 103:e298-e304. [PMID: 34414774 DOI: 10.1308/rcsann.2021.0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Total hip arthroplasty is one of the most common and successful orthopaedic procedures performed worldwide. Uncemented modular acetabular components and highly cross-linked polyethylene liners are the implants of choice for most arthroplasty surgeons. However, despite their well-known benefits, highly cross-linked polyethylene liners are not without complications, such as rim fracture, rupture and dissociation. We report three patients with gait instability and radiographic subluxation due to highly cross-linked polyethylene liner failures evidenced during stage one revision surgery. The three patients were symptoms free, with no new instability episodes, and the radiographs showed no evidence of implant loosening at the most recent follow-up. Although it is a rare complication, these three cases highlight the importance of suspecting and evaluating highly cross-linked polyethylene liner failures in patients referred for gait instability with no history of previous trauma.
Collapse
Affiliation(s)
| | - M Lattore
- Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - G Zanotti
- Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - F Comba
- Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - F Piccaluga
- Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - M Buttaro
- Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| |
Collapse
|
4
|
Jasqui Remba S, Esquivel Gomez R, Gutiérrez Ambriz L, Portman Santos D, Baley Amiga I. Catastrophic wear in uncemented acetabular cups after Total Hip Arthroplasty. A case series. Int J Surg Case Rep 2021; 81:105846. [PMID: 33887869 PMCID: PMC8049991 DOI: 10.1016/j.ijscr.2021.105846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/25/2021] [Accepted: 03/25/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Catastrophic wear is a rare outcome following Total Hip Arthroplasty (THA), documented to happen in less than 0.5% of THA. We present 5 cases of revision THA performed successfully on 5 patients presenting Catastrophic wear, following Total Hip Arthroplasty (THA). Specifically, Catastrophic wear cases were selected, emphasizing differential diagnosis, and a revision THA was performed in all of them and resulted in a good long-term outcome. The purpose of this case series is to contribute to the literature in evaluating both the causes of implant failure as well as the outcomes after their revisions. METHODS We evaluated 5 patients that presented Catastrophic rupture of acetabular implants in a 3-week period in our prosthesis center. RESULTS The 5 patients were females, the mean age was 56 years (44-65), the mean post-surgery time was 20 years (17-23), 4/5 of the coupling wear was ceramic-polyethylene and only one case was metal-polyethylene; 4/5 had bilateral total hip replacement. In the 5 cases a revision THA was performed, all with a successful outcome. CONCLUSION Catastrophic failure is an unusual entity; however, when a patient with a prosthesis presents with sudden pain, an immediate image study is indicated, with careful attention to the differential diagnosis, so as to accurately advice receiving a revision THA. The main causes of implant failure are implant duration, volumetric wear and subsequent rupture. Patients with Catastrophic wear and implant rupture, treated with a revision THA, usually have a good long-term outcome.
Collapse
Affiliation(s)
- Salomon Jasqui Remba
- Unidad Médica De Alta Especialidad Hospital De Traumatología Y Ortopedia "Lomas Verdes", Mexico City, Mexico.
| | - Ricardo Esquivel Gomez
- Unidad Médica De Alta Especialidad Hospital De Traumatología Y Ortopedia "Lomas Verdes", Mexico City, Mexico
| | - Luis Gutiérrez Ambriz
- Unidad Médica De Alta Especialidad Hospital De Traumatología Y Ortopedia "Lomas Verdes", Mexico City, Mexico
| | - Daniel Portman Santos
- Unidad Médica De Alta Especialidad Hospital De Traumatología Y Ortopedia "Lomas Verdes", Mexico City, Mexico
| | - Isaac Baley Amiga
- Unidad Médica De Alta Especialidad Hospital De Traumatología Y Ortopedia "Lomas Verdes", Mexico City, Mexico
| |
Collapse
|
5
|
Kahlenberg CA, Menken L, Ranawat AS, Rodriguez JA. Early failure of a modern moderately cross-linked polyethylene acetabular liner. Arthroplast Today 2020; 6:224-226. [PMID: 32577467 PMCID: PMC7303480 DOI: 10.1016/j.artd.2020.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 02/03/2020] [Accepted: 02/05/2020] [Indexed: 11/28/2022] Open
Abstract
Modern polyethylene components for total hip arthroplasty have shown excellent long-term wear properties. However, among 204 primary total hip arthroplasty procedures performed by one surgeon using the Exactech Connexion GXL Liner, we identified 5 cases of severe polyethylene wear and osteolysis which occurred within 5 years of the index surgery. Among the 5 cases, all patients had a size 36 head with an acetabular component from size 52 to 56 mm. All patients had a UCLA activity scale score of at least 6 at the time that the osteolysis was detected. The average wear rate was 0.265 mm ± 0.207 mm per year. This review of 5 cases of catastrophic early polyethylene wear demonstrates a concerning trend with the use of the Exactech Connexion GXL liner. Further investigation is warranted to evaluate material characteristics which may have caused this accelerated wear and to prevent recurrences of this complication in the future.
Collapse
Affiliation(s)
- Cynthia A Kahlenberg
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
| | - Luke Menken
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
| | - Amar S Ranawat
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
| | - Jose A Rodriguez
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
| |
Collapse
|
6
|
Langlois J, Hamadouche M. Recent update on crosslinked polyethylene in total hip arthroplasty. SICOT J 2020; 6:13. [PMID: 32412408 PMCID: PMC7227368 DOI: 10.1051/sicotj/2020013] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 04/23/2020] [Indexed: 02/02/2023] Open
Abstract
More than two decades after their clinical introduction, crosslinked polyethylenes (XLPE) have been widely adopted. Though concerns were initially raised regarding oxidation and brittleness, on a large scale, the first generation of XLPE continues to be highly effective 15 years after the surgery, even in a young and active population. Remelted XLPE might display lower wear rates than annealed XLPE. Second generation XLPEs, not only including sequentially irradiated and annealed but also associated with antioxidants, demonstrate encouraging short- to mid-term results. Registry data support clinical trial reports. Even in less favorable settings (lipped liners, dual mobility cups, revision surgery, hip resurfacing) results are promising. However, failures (fractures) have already been described. Therefore, a high level of surveillance remains crucial.
Collapse
Affiliation(s)
- Jean Langlois
-
Centre Orthopédique Santy 24, avenue Paul Santy 69008 Lyon France
-
Hôpital Privé Jean-Mermoz 55, avenue Jean-Mermoz 69008 Lyon France
| | - Moussa Hamadouche
-
Département de Chirurgie Orthopédique, Université Paris-Descartes, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin 27, rue du Faubourg Saint-Jacques 75014 Paris France
| |
Collapse
|
7
|
Zheng X, Wu K, Wang J, Ma L, Yu J, Xu J. Mechanical characteristics of medical grade UHMWPE under dynamic compression. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2019; 30:50. [PMID: 31004245 DOI: 10.1007/s10856-019-6254-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 04/11/2019] [Indexed: 06/09/2023]
Abstract
The mechanical properties of medical grade ultrahigh molecular weight polyethylene (UHMWPE) are critical for the safety and integrity of UHMWPE implantation. Accordingly, the mechanical features of UHMWPE are tested under repeated stress-controlled and strain-controlled compression at room temperature. Some important effect factors, such as stress rate, mean stress, stress amplitude, strain rate, mean strain, strain range and multiple load steps are further considered in detail. Results indicate that the lower stress rate causes the greater accumulated plastic strain and the accumulated plastic strain rate becomes increasingly lower with increasing number of cycles. The strain range and accumulated plastic strain rate decrease rapidly in the first stage, and then become almost steady during the second stage. Especially, the accumulated plastic strain rate per cycle for each case is less than 0.01 %/cycle after the initial 100 cycles. This means that the plastic strain accumulates very slowly and the shakedown behavior always occurs. Moreover, obvious cyclic softening and stress relaxation behaviors can be observed under cyclic strain-controlled compression during the first 50 cycles. This indicates that the accumulated plastic stain in the initial 100 cycles and the cyclic stress relaxation during the first 50 cycles should be assessed for the functionality of UHMWPE implantation.
Collapse
Affiliation(s)
- Xiaotao Zheng
- Hubei Provincial Key Laboratory of Chemical Equipment Intensification and Intrinsic Safety, School of Mechanical and Electrical Engineering, Wuhan Institute of Technology, Wuhan, 430205, P. R. China.
| | - Kewei Wu
- Hubei Provincial Key Laboratory of Chemical Equipment Intensification and Intrinsic Safety, School of Mechanical and Electrical Engineering, Wuhan Institute of Technology, Wuhan, 430205, P. R. China
| | - Jiqiang Wang
- Hubei Provincial Key Laboratory of Chemical Equipment Intensification and Intrinsic Safety, School of Mechanical and Electrical Engineering, Wuhan Institute of Technology, Wuhan, 430205, P. R. China
| | - Linwei Ma
- Hubei Provincial Key Laboratory of Chemical Equipment Intensification and Intrinsic Safety, School of Mechanical and Electrical Engineering, Wuhan Institute of Technology, Wuhan, 430205, P. R. China
| | - Jiuyang Yu
- Hubei Provincial Key Laboratory of Chemical Equipment Intensification and Intrinsic Safety, School of Mechanical and Electrical Engineering, Wuhan Institute of Technology, Wuhan, 430205, P. R. China
| | - Jianmin Xu
- Hubei Provincial Key Laboratory of Chemical Equipment Intensification and Intrinsic Safety, School of Mechanical and Electrical Engineering, Wuhan Institute of Technology, Wuhan, 430205, P. R. China
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
Partridge S, Buckley P, de Boer G, Williams S. A novel method to measure rim deformation in UHMWPE acetabular liners. Med Eng Phys 2018; 59:56-62. [PMID: 30057256 DOI: 10.1016/j.medengphy.2018.04.023] [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: 01/03/2018] [Revised: 03/27/2018] [Accepted: 04/30/2018] [Indexed: 10/28/2022]
Abstract
Fluoroscopy studies of total hip replacement (THR) have shown that the femoral head and acetabular cup can separate in vivo, causing edge loading on the rim of the cup. Pre-clinical testing of THR involves ISO standard motion and loading parameters that are representative of a standard walking gait. However, a requirement for more robust testing of THR has been identified and protocols for edge loading in hip simulators have been developed. This technical note describes a method to measure rim wear and deformation on ultra-high molecular weight polyethylene acetabular liners using 2D contacting profilometry and Matlab® analysis. The method is demonstrated on liners that have been subjected to edge loading in hip simulator tests and that have been retrieved at revision surgery. A quantitative and qualitative evaluation of the rim deformation was performed with good repeatability using the method.
Collapse
Affiliation(s)
- Susan Partridge
- School of Mechanical Engineering, University of Leeds, LS2 9JT, UK.
| | - Paige Buckley
- School of Mechanical Engineering, University of Leeds, LS2 9JT, UK
| | - Greg de Boer
- School of Mechanical Engineering, University of Leeds, LS2 9JT, UK
| | - Sophie Williams
- School of Mechanical Engineering, University of Leeds, LS2 9JT, UK
| |
Collapse
|
10
|
Sirimamilla PA, Rimnac CM, Furmanski J. Viscoplastic crack initiation and propagation in crosslinked UHMWPE from clinically relevant notches up to 0.5mm radius. J Mech Behav Biomed Mater 2018; 77:73-77. [PMID: 28888935 PMCID: PMC5696038 DOI: 10.1016/j.jmbbm.2017.08.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 08/23/2017] [Accepted: 08/28/2017] [Indexed: 11/21/2022]
Abstract
Highly crosslinked UHMWPE is now the material of choice for hard-on-soft bearing couples in total joint replacements. However, the fracture resistance of the polymer remains a design concern for increased longevity of the components in vivo. Fracture research utilizing the traditional linear elastic fracture mechanics (LEFM) or elastic plastic fracture mechanics (EPFM) approach has not yielded a definite failure criterion for UHMWPE. Therefore, an advanced viscous fracture model has been applied to various notched compact tension specimen geometries to estimate the fracture resistance of the polymer. Two generic crosslinked UHMWPE formulations (remelted 65kGy and remelted 100kGy) were analyzed in this study using notched test specimens with three different notch radii under static loading conditions. The results suggest that the viscous fracture model can be applied to crosslinked UHMWPE and a single value of critical energy governs crack initiation and propagation in the material. To our knowledge, this is one of the first studies to implement a mechanistic approach to study crack initiation and propagation in UHMWPE for a range of clinically relevant stress-concentration geometries. It is believed that a combination of structural analysis of components and material parameter quantification is a path to effective failure prediction in UHMWPE total joint replacement components, though additional testing is needed to verify the rigor of this approach.
Collapse
Affiliation(s)
| | - Clare M Rimnac
- Mechanical and Aerospace Engineering Department, Case Western Reserve University, Cleveland, OH 44106, United States
| | - Jevan Furmanski
- Mechanical and Aerospace Engineering Department, Case Western Reserve University, Cleveland, OH 44106, United States
| |
Collapse
|
11
|
Partridge S, Tipper JL, Al-Hajjar M, Isaac GH, Fisher J, Williams S. Evaluation of a new methodology to simulate damage and wear of polyethylene hip replacements subjected to edge loading in hip simulator testing. J Biomed Mater Res B Appl Biomater 2017; 106:1456-1462. [DOI: 10.1002/jbm.b.33951] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 05/24/2017] [Accepted: 06/15/2017] [Indexed: 12/13/2022]
Affiliation(s)
- Susan Partridge
- Institute of Medical and Biological Engineering; School of Mechanical Engineering, University of Leeds; Leeds United Kingdom
| | - Joanne L. Tipper
- Institute of Medical and Biological Engineering; School of Mechanical Engineering, University of Leeds; Leeds United Kingdom
| | - Mazen Al-Hajjar
- Institute of Medical and Biological Engineering; School of Mechanical Engineering, University of Leeds; Leeds United Kingdom
| | - Graham H. Isaac
- Institute of Medical and Biological Engineering; School of Mechanical Engineering, University of Leeds; Leeds United Kingdom
- DePuy Synthes Joint Reconstruction; Leeds United Kingdom
| | - John Fisher
- Institute of Medical and Biological Engineering; School of Mechanical Engineering, University of Leeds; Leeds United Kingdom
| | - Sophie Williams
- Institute of Medical and Biological Engineering; School of Mechanical Engineering, University of Leeds; Leeds United Kingdom
| |
Collapse
|
12
|
Abstract
Total hip arthroplasty (THA) surgery has shown dramatic changes in terms of increased number of procedures and of technical development in recent years. It has been described as “the operation of the 20th century” for the excellent results, the high satisfaction of the patients and the improvement of the quality of life. A lot of variations have been introduced over the last few decades in THA especially in terms of indications (both in younger and older patients), techniques and devices (approaches, tissue preservation, biomaterials and industrial finishing), per-operative management (blood loss and pain control) and post-operative protocols (the so called “fast track” surgery). Looking at all these advances the emerging question is: have all of them been justified both in terms of improvement of the results for the patients and of the cost/benefit ratio from an economical point of view? The purpose of this paper is to critically analyse the advantages and the disadvantages of the theoretically proposed “advances in hip arthroplasty” and attempt to understand which are justified of such “advances” nowadays, based on the international and the European perspective with a focus on the author’s personal clinical experience.
Cite this article: EFORT Open Rev 2017;2. DOI: 10.1302/2058-5241.2.170008. Originally published online at www.efortopenreviews.org
Collapse
Affiliation(s)
- Luigi Zagra
- Hip Department, IRCCS Istituto Ortopedico Galeazzi, Milan Italy
| |
Collapse
|
13
|
Gaudin G, Ferreira A, Gaillard R, Prudhon JL, Caton JH, Lustig S. Equivalent wear performance of dual mobility bearing compared with standard bearing in total hip arthroplasty: in vitro study. INTERNATIONAL ORTHOPAEDICS 2016; 41:521-527. [PMID: 27878334 DOI: 10.1007/s00264-016-3346-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 11/10/2016] [Indexed: 01/18/2023]
Abstract
PURPOSE Osteolysis in total hip arthroplasty (THA) depends on polyethylene wear and dictates the survival of the prosthesis. Dual mobility in THAs, which is claimed to reduce dislocation risk, has very good long-term clinical results. However, little is known about how the liner wears in this design, compared to the standard single mobility model. METHODS A comparative study looking at wear of a conventional ultra-high-molecular-weight polyethylene liner, using gravimetric measurement, between dual mobility implants and standard implants, was performed on a simulator in accordance with a normed protocol based on the same dimensions, environmental conditions and stresses. A linear regression test was employed. RESULTS Under the same conditions (loading, cycles, sterilization, material and surface roughness), the gravimetric wear (for conventional polyethylene) is comparable between a standard and a dual mobility cup. This correlates to ten year follow-up results of dual mobility cup. DISCUSSION - CONCLUSION This in vitro equivalent wear serves to confirm the very good long-term clinical results observed with dual mobility bearing, whose use should not be restricted by concerns about increased polyethylene wear.
Collapse
Affiliation(s)
- Gaël Gaudin
- Centre Albert Trillat, Hôpital de la Croix-Rousse, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France
| | - André Ferreira
- Clinique du Parc, 155 Ter Boulevard de Stalingrad, 69006, Lyon, France
| | - Romain Gaillard
- Centre Albert Trillat, Hôpital de la Croix-Rousse, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France
| | - Jean Louis Prudhon
- Centre Ostéo-articulaire des Cèdres, 5 rue des tropiques, 38130, Echirolles, France
| | - Jacques H Caton
- Institut d'orthopédie, 103 rue Coste, 69300, Caluire et Cuire, France
| | - Sébastien Lustig
- Centre Albert Trillat, Hôpital de la Croix-Rousse, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France.
| |
Collapse
|
14
|
Malatray M, Roux JP, Gunst S, Pibarot V, Wegrzyn J. Highly crosslinked polyethylene: a safe alternative to conventional polyethylene for dual mobility cup mobile component. A biomechanical validation. INTERNATIONAL ORTHOPAEDICS 2016; 41:507-512. [PMID: 27837329 DOI: 10.1007/s00264-016-3334-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 10/31/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE Dual mobility cup (DMC) consists of a cobalt-chromium (CoCr) alloy cup articulated with a polyethylene (PE) mobile component capturing the femoral head in force using a snap-fit technique. This biomechanical study was the first to evaluate and compare the generation of cracks in the retentive area of DMC mobile components made of highly crosslinked PE (XLPE) or conventional ultra-high molecular weight PE (UHMWPE). METHODS Eighty mobile components designed for a 52-mm diameter Symbol® DMC (Dedienne Santé, Mauguio, France) and a 28-mm diameter femoral head were analyzed. Four groups of 20 mobile components were constituted according to the PE material: raw UHMWPE, sterilized UHMWPE, annealed XLPE and remelted XLPE. Ten mobile components in each group were impacted with a 28-mm diameter CoCr femoral head using a snap-fit technique. The occurrence, location and area of the cracks in the retentive area were investigated using micro-CT (Skyscan 1176®, Bruker, Aarsellar, Belgium) with a 35 μm nominal isotropic voxel size by two observers blinded to the PE material and impaction or not of the mobile components. RESULTS Compared to conventional UHMWPE, the femoral head snap-fit did not generate more or wider cracks in the retentive area of annealed or remelted XLPE mobile components. CONCLUSION This biomechanical study suggests that XLPE in DMC could be a safe alternative to conventional UHMWPE regarding the generation of cracks in the retentive area related to the femoral head snap-fit.
Collapse
Affiliation(s)
- Matthieu Malatray
- Department of Orthopedic Surgery - Pavillon T, Hôpital Edouard Herriot, Hospices Civils de Lyon, 5, place d'Arsonval, 69437, Lyon, France
- INSERM UMR 1033, Université de Lyon, Lyon, France
| | | | - Stanislas Gunst
- Department of Orthopedic Surgery - Pavillon T, Hôpital Edouard Herriot, Hospices Civils de Lyon, 5, place d'Arsonval, 69437, Lyon, France
| | - Vincent Pibarot
- Department of Orthopedic Surgery - Pavillon T, Hôpital Edouard Herriot, Hospices Civils de Lyon, 5, place d'Arsonval, 69437, Lyon, France
| | - Julien Wegrzyn
- Department of Orthopedic Surgery - Pavillon T, Hôpital Edouard Herriot, Hospices Civils de Lyon, 5, place d'Arsonval, 69437, Lyon, France.
- INSERM UMR 1033, Université de Lyon, Lyon, France.
| |
Collapse
|
15
|
Thirteen-Year Evaluation of Highly Cross-Linked Polyethylene Articulating With Either 28-mm or 36-mm Femoral Heads Using Radiostereometric Analysis and Computerized Tomography. J Arthroplasty 2016; 31:269-76. [PMID: 27436500 DOI: 10.1016/j.arth.2016.02.076] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 01/30/2016] [Accepted: 02/03/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The objective of this 13-year prospective evaluation of highly cross-linked ultra high molecular weight polyethylene (HXLPE) was to (1) assess the long-term wear of HXLPE articulating with 2 femoral head sizes using radiostereometric analysis (RSA) and to (2) determine if osteolysis is a concern with this material through the use of plain radiographs and computerized tomography (CT). METHODS All patients received a Longevity HXLPE liner with tantalum beads and either a 28-mm or 36-mm femoral head. Twelve patients (6 in each head size group) agreed to return for 13-year RSA, plain radiograph, and CT follow-up. The 1-year and 13-year plain radiographs as well as the CT scans were analyzed for the presence of osteolysis. RESULTS The 13-year mean ± standard error steady-state wear was 0.05 ± 0.02 mm with no significant increase over time or between the 2 head size groups. Two patients' CT scans showed radiolucent regions in the acetabulum of 4.51 cm(3) and 11.25 cm(3), respectively. In one patient, this area corresponded to a partially healed degenerative cyst treated with autograft during surgery. The second patient had an acetabular protrusio treated with autograft, and the CT scan revealed areas of remodeling of this graft. One patient's 13-year plain radiographs showed evidence of cup loosening and linear radiolucencies in zones 2 and 3. CONCLUSION There was no evidence of significant wear over time using RSA. The CT scans did not show evidence of osteolysis due to wear particles. These results suggest that this material has reduced wear compared to conventional polyethylene, irrespective of head size.
Collapse
|
16
|
Ansari F, Gludovatz B, Kozak A, Ritchie RO, Pruitt LA. Notch fatigue of ultrahigh molecular weight polyethylene (UHMWPE) used in total joint replacements. J Mech Behav Biomed Mater 2016; 60:267-279. [DOI: 10.1016/j.jmbbm.2016.02.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 02/03/2016] [Accepted: 02/05/2016] [Indexed: 10/22/2022]
|
17
|
Nebergall AK, Troelsen A, Rubash HE, Malchau H, Rolfson O, Greene ME. Five-Year Experience of Vitamin E-Diffused Highly Cross-Linked Polyethylene Wear in Total Hip Arthroplasty Assessed by Radiostereometric Analysis. J Arthroplasty 2016; 31:1251-1255. [PMID: 26777551 DOI: 10.1016/j.arth.2015.12.023] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 11/17/2015] [Accepted: 12/01/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Vitamin E-diffused highly cross-linked polyethylene (VEPE) was developed to reduce oxidation without compromising mechanical strength. The purpose of this study was to evaluate VEPE in vivo using radiostereometric analysis (RSA) and patient-reported outcome measures (PROMs). METHODS Fifty-one hips were enrolled. Each patient received a VEPE liner, a porous titanium shell, and an uncemented stem with a 32-mm cobalt-chrome femoral head. Tantalum beads were inserted into the VEPE to measure femoral head penetration using RSA. RSA radiographs and PROMs were obtained preoperatively immediately after surgery, 6 months, 1, 2, 3, and 5 years after surgery. RESULTS Forty-seven hips returned at 3 years, and 42 hip at 5 years. The mean ± standard error of the mean proximal head penetration into the polyethylene was 0.06 ± 0.01 at 5 years. The amount of head penetration did not change significantly with increasing time in vivo. The mean ± standard error of the mean Harris Hip Score was 58 ± 2 preoperatively, which improved significantly to 93 ± 2 at 5 years (P < .001). CONCLUSION The head penetration into VEPE liners was low compared with non-VEPE at 5 years. After settling of the liners in the early period, no significant head penetration occurred from 2- to 5-year follow-up. All PROMs improved significantly from preoperative to postoperative and remained very favorable at 5 years. This study documents the longest-term evaluation of in vivo wear performance of VEPE.
Collapse
Affiliation(s)
- Audrey K Nebergall
- Department of Orthopaedics, Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts
| | - Anders Troelsen
- Department of Orthopaedics, Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts; Department of Orthopaedics, Copenhagen University Hvidovre Hospital, Hvidovre, Denmark
| | - Harry E Rubash
- Department of Orthopaedics, Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts
| | - Henrik Malchau
- Department of Orthopaedics, Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts
| | - Ola Rolfson
- Department of Orthopaedics, Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts; Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Meridith E Greene
- Department of Orthopaedics, Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts
| |
Collapse
|
18
|
An experimental approach to determining fatigue crack size in polyethylene tibial inserts. J Mech Behav Biomed Mater 2016; 54:106-14. [DOI: 10.1016/j.jmbbm.2015.09.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Revised: 09/16/2015] [Accepted: 09/21/2015] [Indexed: 11/30/2022]
|
19
|
Abstract
BACKGROUND Although it is understood that backside damage occurs in polyethylene acetabular liners, the effect of highly crosslinked polyethylene, which has completely replaced conventional polyethylene, has yet to be examined. QUESTIONS/PURPOSES The purpose of this study was to answer the following questions: (1) With conventional polyethylene (CPE), did the acetabular design make a difference in backside wear? (2) Is there a difference in backside damage between CPE and crosslinked polyethylene (XLPE) liners? (3) With XLPE, is the difference in backside wear between designs still present? (4) Is there any difference in backside damage in various zones on backside of individual liners? METHODS This single-institution retrieval analysis involved visual damage scoring on the backside of 233 polyethylene liners implanted between 2002 and 2011. The liners were retrieved from either polished/dovetail cups (PD) or roughened/wire cups (RW) made by two different manufacturers. The inserts were divided into four groups: PD-CPE (n = 105), PD-XLPE (n = 16), RW-CPE (n = 99), and RW-XLPE (n = 13). Aseptic loosening and polyethylene wear were the predominant reasons for revision of CPE liners, whereas instability and infection were the common reasons for revision of XLPE liners. The time in situ (TIS) was shorter for the XLPE liners as compared with the CPE liners (PD-CPE: 8.5 years [SD 4.4]; RD-CPE: 9.5 [SD 4.8]; PD-CPE: 3.8 [SD 3.7]; RD-XLPE: 4.0 [SD 4.3]). The backside of each liner was divided into five zones and graded initially from a scale of 0 to 3 for seven different damage modes by one observer. There was substantial interobserver (kappa 0.769) and intraobserver (0.736) reliability on repeat scoring. To compare the effects of crosslinking, a subset of the conventional polyethylene liners was matched to the crosslinked liners based on TIS, resulting in 16 per group for the two PD types and 13 per group for the two RW types. RESULTS Total damage scores in the RW-CPE (19 ± 7) group were greater (p < 0.001) than the PD-CPE group (8 ± 4). Damage was reduced with XLPE (p = 0.02) only for the RW-XLPE (9 ± 9) versus RW-CPE-type sockets (4 ± 4). There was no difference (p = 0.16) between the RW-XLPE group and the PD-XLPE group. Damage scores in the peripheral zone of the locking mechanisms were higher for RW-CPE (4 ± 3) compared with PD-CPE (1.4 ± 1.0, p < 0.001) and RW-XLPE (1.3 ± 1.3, p = 0.02). Damage was greater (p < 0.001) within the superior zones (7 ± 4) compared with the inferior zones (3.0 ± 2.8) of all liners. CONCLUSIONS The current study shows greater backside damage for CPE in the roughened, wire lock cups. XLPE was shown to be more resistant to backside damage for both socket designs. CLINICAL RELEVANCE Although the polished/dovetail cups seem to cause less backside damage in the CPE liners than roughened/wire cups, the use of XLPE liners has been shown to protect the liner from backside damage in either cup design. If an acetabular shell has a functional locking mechanism, surgeons should not worry about cup design when undertaking isolated liner revision using XLPE liners.
Collapse
|
20
|
Yee MA, O'Keefe TJ, Winter S. Incarcerated fracture fragments of Longevity polyethylene liners after total hip arthroplasty. Arthroplast Today 2016; 2:6-10. [PMID: 28326389 PMCID: PMC4957170 DOI: 10.1016/j.artd.2015.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 12/15/2015] [Accepted: 12/15/2015] [Indexed: 11/25/2022] Open
Abstract
Highly cross-linked polyethylene liners are widely used in total hip arthroplasty because they experience lower wear rates than conventional polyethylene liners. However, the cross-linking process does decrease the resistance of polyethylene to fatigue failure and fracture. This report describes 2 cases of highly cross-linked polyethylene liner fracture occurring in association with hip dislocation and unsuccessful closed reduction consequent to blockage by an incarcerated liner fragment. These cases highlight the known polyethylene fracture risk factors of thin and unsupported polyethylene and large bearing sizes. They also reinforce the importance of a careful evaluation of postreduction radiographs for the presence of a concentric reduction and provide a possible explanation for postoperative hip instability, multiple dislocations, and incomplete seating of the femoral head on attempts at closed reduction.
Collapse
Affiliation(s)
- Michael A Yee
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Thomas J O'Keefe
- Department of Orthopaedic Surgery, St. Joseph Mercy Health System, Ann Arbor, MI, USA
| | - Suzanne Winter
- Department of Orthopaedic Surgery, St. Joseph Mercy Health System, Ann Arbor, MI, USA
| |
Collapse
|
21
|
Ansari F, Ries MD, Pruitt L. Effect of processing, sterilization and crosslinking on UHMWPE fatigue fracture and fatigue wear mechanisms in joint arthroplasty. J Mech Behav Biomed Mater 2016; 53:329-340. [DOI: 10.1016/j.jmbbm.2015.08.026] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 08/16/2015] [Indexed: 10/23/2022]
|
22
|
Murtha AS, Roy ME, Whiteside LA, Tilden DS, Schmitt KL. Thin-Walled Cross-Linked Acetabular Liners Need Not Exhibit Reduced Locking Strength. Orthopedics 2015; 38:e727-32. [PMID: 26270761 DOI: 10.3928/01477447-20150804-62] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 11/24/2014] [Indexed: 02/03/2023]
Abstract
Use of larger diameter femoral heads has emerged as a promising strategy to reduce the risk of dislocation after total hip arthroplasty, but thinning the walls of cross-linked ultra-high-molecular-weight polyethylene (UHMWPE) acetabular liners to accommodate these larger heads may compromise the locking mechanism of the liner. The purpose of this study was to test the mechanical integrity of the locking mechanism in cross-linked and re-melted UHMWPE acetabular components with reduced wall thickness. The locking mechanism of cross-linked (100 kGy/re-melted) acetabular liners in sizes 50/28, 50/36, and 52/36 mm of 1 design was evaluated by lever-out tests and torsion tests. Torsion tests were performed at 2 angles to isolate the liner's locking tabs independent of the contribution of its central post. Lever-out testing demonstrated nominally reduced failure strength in 50/36-mm liners (13.3 N · m) compared with 50/28-mm liners (12.3 N · m; P=.0502), whereas the lever-out strength of 52/36-mm liners was 12.2±0.94 N · m. Failure torques were similar between 50/28- and 50/36-mm liners at 45° and 90°, but the failure torque of size 52/36-mm liners was significantly higher at each angle. The use of larger diameter femoral heads does not compromise the locking mechanism of thinned MicroSeal (Signal Medical Corp, Marysville, Michigan) acetabular liners. Use of a cross-linked UHMWPE acetabular liner, with a locking mechanism that is not compromised when the liner is thinned to a thickness of at least 2.86 mm, appears to be a biomechanically sound construct when articulated with large diameter femoral heads.
Collapse
|
23
|
Shen J, Gao G, Liu X, Fu J. Natural polyphenols enhance stability of crosslinked UHMWPE for joint implants. Clin Orthop Relat Res 2015; 473:760-6. [PMID: 25106800 PMCID: PMC4317458 DOI: 10.1007/s11999-014-3850-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Radiation-crosslinked UHMWPE has been used for joint implants since the 1990s. Postirradiation remelting enhances oxidative stability, but with some loss in strength and toughness. Vitamin E-stabilized crosslinked UHMWPE has shown improved strength and stability as compared with irradiated and remelted UHMWPE. With more active phenolic hydroxyl groups, natural polyphenols are widely used in the food and pharmaceutical industries as potent stabilizers and could be useful for oxidative stability in crosslinked UHMWPE. QUESTIONS/PURPOSES We asked whether UHMWPE blended with polyphenols would (1) show higher oxidation resistance after radiation crosslinking; (2) preserve the mechanical properties of UHMWPE after accelerated aging; and (3) alter the wear resistance of radiation-crosslinked UHMWPE. METHODS The polyphenols, gallic acid and dodecyl gallate, were blended with medical-grade UHMWPE followed by consolidation and electron beam irradiation at 100 kGy. Radiation-crosslinked virgin and vitamin E-blended UHMWPEs were used as reference materials. The UHMWPEs were aged at 120 °C in air with oxidation levels analyzed by infrared spectroscopy. Tensile (n = 5 per group) and impact (n = 3 per group) properties before and after aging as per ASTM F2003 were evaluated. The wear rates were examined by pin-on-disc testing (n = 3 per group). The data were reported as mean ± SDs. Statistical analysis was performed by using Student's t-test for a two-tailed distribution with unequal variance for tensile and impact data obtained with n ≥ 3. A significant difference is defined with p < 0.05. RESULTS The oxidation induction time of 100 kGy UHMWPE was prolonged to 144 hours with 0.05 wt% dodecyl gallate and 192 hours with 0.05 wt% gallic acid compared with 48 hours for 0.05 wt% vitamin E-blended UHMWPE. Accelerated aging of these polyphenol-blended UHMWPEs resulted in ultimate tensile strength of 50.4 ± 1.4 MPa and impact strength of 53 ± 5 kJ/m(2) for 100 kGy-irradiated UHMWPE with 0.05 wt% dodecyl gallate, for example, in comparison to 51.2 ± 0.7 MPa (p = 0.75) and 58 ± 5 kJ/m(2) (p = 0.29) before aging. The pin-on-disc wear rates of 100 kGy-irradiated UHMWPE with 0.05 wt% dodecyl gallate and 0.05 wt% gallic acid were 2.29 ± 0.31 and 1.65 ± 0.32 mg/million cycles, comparable to 1.68 ± 0.25 and 2.05 ± 0.22 mg/million cycles for 100 kGy-irradiated virgin and 0.05 wt% vitamin E-blended UHMWPE. CONCLUSIONS Based on the sample numbers tested in this study, polyphenols appear to effectively enhance the oxidation stability without altering the mechanical properties or pin-on-disc wear rate of radiation-crosslinked UHMWPE. CLINICAL RELEVANCE Crosslinked UHMWPE with natural polyphenols with improved oxidative stability and low wear may find clinical application in joint implants.
Collapse
Affiliation(s)
- Jie Shen
- />Ningbo Key Laboratory of Polymer Materials, Polymers and Composites Division, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, 1219 Zhongguan West Road, Zhenhai District, Ningbo, 315201 People’s Republic of China
- />Faculty of Materials Science and Chemical Engineering, Ningbo University, Ningbo, Zhejiang Province, People’s Republic of China
| | - Guorong Gao
- />Ningbo Key Laboratory of Polymer Materials, Polymers and Composites Division, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, 1219 Zhongguan West Road, Zhenhai District, Ningbo, 315201 People’s Republic of China
| | - Xincai Liu
- />Faculty of Materials Science and Chemical Engineering, Ningbo University, Ningbo, Zhejiang Province, People’s Republic of China
| | - Jun Fu
- />Ningbo Key Laboratory of Polymer Materials, Polymers and Composites Division, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, 1219 Zhongguan West Road, Zhenhai District, Ningbo, 315201 People’s Republic of China
| |
Collapse
|
24
|
Abstract
BACKGROUND AND PURPOSE We previously reported on a randomized controlled trial (RCT) that examined the effect of adding tobramycin to bone cement after femoral stem migration. The present study examined femoral head penetration into both conventional and highly crosslinked polyethylene acetabular liners in the same group of RCT patients, with a minimum of 5 years of postoperative follow-up. PATIENTS AND METHODS Linear penetration of the femoral head into an X3 (Stryker) crosslinked polyethylene (XLPE) liner was measured in 18 patients (19 hips) using radiostereometric analysis (RSA). Femoral head penetration was also measured in 6 patients (6 hips) with a conventional polyethylene liner (CPE), which served as a control group. RESULTS The median proximal femoral head penetration in the XLPE group after 5.5 years was 0.025 mm with a steady-state penetration rate of 0.001 mm/year between year 1 and year 5. The CPE liner showed a median proximal head penetration of 0.274 mm after 7.2 years, at a rate of 0.037 mm/year. INTERPRETATION The Trident X3 sequentially annealed XLPE liner shows excellent in vivo wear resistance compared to non-crosslinked CPE liners at medium-term implantation. The rate of linear head penetration in the XLPE liners after > 5 years of follow-up was 0.001 mm/year, which is in close agreement with the results of previous studies.
Collapse
Affiliation(s)
| | | | - Thomas R Turgeon
- Orthopaedic Innovation Centre,Concordia Joint Replacement Group, Concordia Hip and Knee Institute,Department of Surgery, Section of Orthopaedics, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Eric R Bohm
- Orthopaedic Innovation Centre,Concordia Joint Replacement Group, Concordia Hip and Knee Institute,Department of Surgery, Section of Orthopaedics, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| |
Collapse
|
25
|
Saito N, Haniu H, Usui Y, Aoki K, Hara K, Takanashi S, Shimizu M, Narita N, Okamoto M, Kobayashi S, Nomura H, Kato H, Nishimura N, Taruta S, Endo M. Safe clinical use of carbon nanotubes as innovative biomaterials. Chem Rev 2014; 114:6040-79. [PMID: 24720563 PMCID: PMC4059771 DOI: 10.1021/cr400341h] [Citation(s) in RCA: 140] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Indexed: 02/06/2023]
Affiliation(s)
- Naoto Saito
- Institute
for Biomedical Sciences, Shinshu University, Asahi 3-1-1, Matsumoto 390-8621, Japan
| | - Hisao Haniu
- Department
of Orthopaedic Surgery, Shinshu University
School of Medicine, Asahi
3-1-1, Matsumoto 390-8621, Japan
| | - Yuki Usui
- Department
of Orthopaedic Surgery, Shinshu University
School of Medicine, Asahi
3-1-1, Matsumoto 390-8621, Japan
- Research Center for Exotic Nanocarbons, and Faculty of Engineering, Shinshu University, Wakasato 4-17-1, Nagano 380-8553, Japan
| | - Kaoru Aoki
- Department
of Orthopaedic Surgery, Shinshu University
School of Medicine, Asahi
3-1-1, Matsumoto 390-8621, Japan
| | - Kazuo Hara
- Department
of Orthopaedic Surgery, Shinshu University
School of Medicine, Asahi
3-1-1, Matsumoto 390-8621, Japan
| | - Seiji Takanashi
- Department
of Orthopaedic Surgery, Shinshu University
School of Medicine, Asahi
3-1-1, Matsumoto 390-8621, Japan
| | - Masayuki Shimizu
- Department
of Orthopaedic Surgery, Shinshu University
School of Medicine, Asahi
3-1-1, Matsumoto 390-8621, Japan
| | - Nobuyo Narita
- Department
of Orthopaedic Surgery, Shinshu University
School of Medicine, Asahi
3-1-1, Matsumoto 390-8621, Japan
| | - Masanori Okamoto
- Department
of Orthopaedic Surgery, Shinshu University
School of Medicine, Asahi
3-1-1, Matsumoto 390-8621, Japan
| | - Shinsuke Kobayashi
- Department
of Orthopaedic Surgery, Shinshu University
School of Medicine, Asahi
3-1-1, Matsumoto 390-8621, Japan
| | - Hiroki Nomura
- Department
of Orthopaedic Surgery, Shinshu University
School of Medicine, Asahi
3-1-1, Matsumoto 390-8621, Japan
| | - Hiroyuki Kato
- Department
of Orthopaedic Surgery, Shinshu University
School of Medicine, Asahi
3-1-1, Matsumoto 390-8621, Japan
| | - Naoyuki Nishimura
- R&D
Center, Nakashima Medical Co. Ltd., Haga 5322, Kita-ku, Okayama 701-1221, Japan
| | - Seiichi Taruta
- Research Center for Exotic Nanocarbons, and Faculty of Engineering, Shinshu University, Wakasato 4-17-1, Nagano 380-8553, Japan
| | - Morinobu Endo
- Research Center for Exotic Nanocarbons, and Faculty of Engineering, Shinshu University, Wakasato 4-17-1, Nagano 380-8553, Japan
| |
Collapse
|
26
|
Ansari F, Chang J, Huddleston J, Van Citters D, Ries M, Pruitt L. Fractography and oxidative analysis of gamma inert sterilized posterior-stabilized tibial insert post fractures: report of two cases. Knee 2013; 20:609-13. [PMID: 24220187 DOI: 10.1016/j.knee.2013.04.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 03/30/2013] [Accepted: 04/04/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND Highly crosslinked ultra-high molecular weight polyethylene (UHMWPE) has shown success in reducing wear in hip arthroplasty but there remains skepticism about its use in Total Knee Replacement (TKR) inserts that are known to experience fatigue loading and higher local cyclic contact stresses. METHODS Two Legacy Posterior-Stabilized (LPS) Zimmer NexGen tibial implants sterilized by gamma irradiation in an inert environment with posts that fractured in vivo were analyzed. Failure mechanisms were determined using optical and scanning electron microscopy along with oxidative analysis via Fourier Transform Infra-Red (FTIR) spectroscopy. RESULTS Micrographs of one retrieval revealed fatigue crack initiation on opposite sides of the post and quasi-brittle micromechanisms of crack propagation. FTIR of this retrieval revealed no oxidation. The fracture surface image of the second retrieval indicated a brittle fracture process and FTIR revealed oxidation in the explant. CONCLUSIONS These two cases suggest that crosslinking of UHMWPE as a manufacturing process or sterilization method in conjunction with designs that incorporate high stress concentrations, such as the tibial post, may reduce material strength. Moreover, free radicals generated from ionizing radiation can render the polymer susceptible to oxidative embrittlement. CLINICAL RELEVANCE Our findings suggest that tibial post fractures may be the results of in vivo oxidation and low level crosslinking. These and previous reports of fractured crosslinked UHMWPE devices implores caution when used with high stress concentrations, particularly when considering the potential for in vivo oxidation in TKR.
Collapse
Affiliation(s)
- Farzana Ansari
- University of California, Berkeley, Berkeley, California, 2521 Hearst Avenue, Etcheverry Hall Rm#2121, Berkeley, CA 94709, United States.
| | | | | | | | | | | |
Collapse
|
27
|
Lam L, Drew T, Boscainos P. Effect of acetabular orientation on stress distribution of highly cross-linked polyethylene liners. Orthopedics 2013; 36:e1346-52. [PMID: 24200436 DOI: 10.3928/01477447-20131021-13] [Citation(s) in RCA: 5] [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
Several case reports have documented the fracture of highly cross-linked polyethylene (HCLPE) liners used in total hip arthroplasty (THA). Although uncommon, fractured liners result in considerable morbidity for patients and require revision surgery. One postulated mechanism that leads to this type of implant failure is malorientation of the acetabular component. The purpose of this study was to investigate the effect of acetabular orientation on the stress distribution of HCLPE liners used in THA by means of finite element analysis. Three-dimensional models of a commonly used HCLPE liner were created corresponding to 12 different acetabular component orientations (inclination ranging from 20° to 70° and version ranging from 20° of retroversion to 40° of anteversion). A static stress analysis of the finite element models was performed under conditions simulating peak gait loads. The results of the analysis revealed that excessive inclination and extremes of version were associated with an increase in peak stress magnitudes. The locations of peak stress also were found to lie within the rim notch and locking ring groove regions, which were consistent with the fracture locations reported in published case reports. Therefore, the acetabular component should be oriented carefully during implantation to reduce the risk of rim loading and subsequent liner fracture. In addition, an alternative liner design may further help reduce stress risers and risk of fracture.
Collapse
|
28
|
Pruitt LA, Ansari F, Kury M, Mehdizah A, Patten EW, Huddlestein J, Mickelson D, Chang J, Hubert K, Ries MD. Clinical trade-offs in cross-linked ultrahigh-molecular-weight polyethylene used in total joint arthroplasty. J Biomed Mater Res B Appl Biomater 2013; 101:476-84. [PMID: 23436567 DOI: 10.1002/jbm.b.32887] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Revised: 08/15/2012] [Accepted: 11/18/2012] [Indexed: 11/09/2022]
Abstract
Highly cross-linked formulations of ultrahigh-molecular-weight polyethylene (XLPE) offer exceptional wear resistance for total joint arthroplasty but are offset with a reduction in postyield and fatigue fracture properties in comparison to conventional ultrahigh-molecular-weight polyethylene (UHMWPE). Oxidation resistance is also an important property for the longevity of total joint replacements (TJRs) as formulations of UHMWPE or XLPE utilizing radiation methods are susceptible to free radical generation and subsequent embrittlement. The balance of oxidation, wear, and fracture properties is an enduring concern for orthopedic polymers used as the bearing surface in total joint arthroplasty. Optimization of material properties is further challenged in designs that make use of locking mechanisms, notches, or other stress concentrations that can render the polymer susceptible to fracture due to elevated local stresses. Clinical complications involving impingements, dislocations, or other biomechanical overloads can exacerbate stresses and negate benefits of improved wear resistance provided by XLPE. This work examines trade-offs that factor into the use of XLPE in TJR implants.
Collapse
Affiliation(s)
- Lisa A Pruitt
- Department of Mechanical Engineering, University of California, Berkeley, California, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Ríos R, Puértolas JA, Martínez-Nogués V, Martínez-Morlanes MJ, Pascual FJ, Cegoñino J, Medel FJ. Mechanical behavior, microstructure and thermooxidation properties of sequentially crosslinked ultrahigh molecular weight polyethylenes. J Appl Polym Sci 2013. [DOI: 10.1002/app.38956] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
30
|
Sirimamilla PA, Furmanski J, Rimnac CM. Application of viscoelastic fracture model and non-uniform crack initiation at clinically relevant notches in crosslinked UHMWPE. J Mech Behav Biomed Mater 2012; 17:11-21. [PMID: 23127638 DOI: 10.1016/j.jmbbm.2012.07.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2012] [Revised: 07/20/2012] [Accepted: 07/22/2012] [Indexed: 11/18/2022]
Abstract
The mechanism of crack initiation from a clinically relevant notch is not well-understood for crosslinked ultra high molecular weight polyethylene (UHMWPE) used in total joint replacement components. Static mode driving forces, rather than the cyclic mode conditions typically associated with fatigue processes, have been shown to drive crack propagation in this material. Thus, in this study, crack initiation in a notched specimen under a static load was investigated. A video microscope was used to monitor the notch surface of the specimen and crack initiation time was measured from the video by identifying the onset of crack initiation at the notch. Crack initiation was considered using a viscoelastic fracture theory. It was found that the mechanism of crack initiation involved both single layer and a distributed multi-layer phenomenon and that multi-layer crack initiation delayed the crack initiation time for all loading conditions examined. The findings of this study support that the viscoelastic fracture theory governs fracture mechanics in crosslinked UHMWPE. The findings also support that crack initiation from a notch in UHMWPE is a more complex phenomenon than treated by traditional fracture theories for polymers.
Collapse
Affiliation(s)
- P Abhiram Sirimamilla
- Mechanical and Aerospace Engineering Department, Case Western Reserve University, Cleveland, OH, USA
| | | | | |
Collapse
|
31
|
Paterson NR, Teeter MG, Macdonald SJ, McCalden RW, Howard JL, Naudie DDR. Highly cross-linked vs conventional polyethylene: no differences in rim notching from micromotion on retrieved acetabular liners. J Arthroplasty 2012; 27:1616-1621.e1. [PMID: 22608684 DOI: 10.1016/j.arth.2012.03.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Accepted: 03/18/2012] [Indexed: 02/01/2023] Open
Abstract
Previous literature suggested highly cross-linked acetabular liners demonstrated notching patterns that may be a point of crack origin and rim failure. We examined (1) whether notching patterns and rim cracks existed and demonstrated similar morphological properties in retrieved highly cross-linked and non-cross-linked liners and (2) whether the dimensions of these notches correlated with their duration of implantation. We retrieved a series of 14 identical liners out to an average of 2.03 years. Liners were microscopically examined and then scanned using microcomputed tomography. All liners demonstrated identical notching patterns. Microcomputed tomographic scans demonstrated no signs of crack initiation or rim failure but were able to accurately quantify the notch dimensions. The notching patterns were likely caused by liner-cup micromotion and are better characterized as creep deformation because they did not progress markedly over longer durations of implantation.
Collapse
Affiliation(s)
- Nicholas R Paterson
- Division of Orthopaedic Surgery, London Health Sciences Centre, London, Ontario, Canada
| | | | | | | | | | | |
Collapse
|
32
|
Kraay MJ, Rowbottom JS, Razek MG. The Acetabular Component in Primary Total Hip Arthroplasty. ACTA ACUST UNITED AC 2012. [DOI: 10.1053/j.sart.2012.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
33
|
Early failure of a non-cemented femoral stem after minimal-invasive total hip arthroplasty: cause analysis and classification. Musculoskelet Surg 2012; 98:77-80. [PMID: 22562648 DOI: 10.1007/s12306-012-0202-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Accepted: 04/14/2012] [Indexed: 10/28/2022]
Abstract
In this paper, we present a 77-year-old female patient with an early failure of a non-cemented femoral stem 6 months after implantation. We evaluate possible reasons for the implant failure in our case against the literature. Risk factors for stem failure include a BMI >30, varus implantation, a high femoral canal cortex ratio, and a small implant. It should be distinguished between modular and non-modular stems as well as cemented and non-cemented. Early failure would be <1 year postoperatively, late failure >1 year postoperatively. A classification of stem failure differentiating time and cause is suggested as this seems to be missing in the literature.
Collapse
|
34
|
Brockett CL, Jennings LM, Hardaker C, Fisher J. Wear of moderately cross-linked polyethylene in fixed-bearing total knee replacements. Proc Inst Mech Eng H 2012; 226:529-35. [DOI: 10.1177/0954411912445265] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Cross-linked polyethylene has been introduced into total joint replacement to improve wear resistance. Although the performance of highly cross-linked polyethylene is well documented clinically and experimentally for total hip replacements, the reduction in mechanical properties with increasing irradiation is of concern for application to total knee replacement. The aim of this study was to investigate the wear performance of a moderately cross-linked polyethylene material in a fixed-bearing total knee replacement. The study was conducted using two femoral geometries, a conventional cruciate-retaining femoral and a high-flexion femoral geometry. The femoral geometry appeared to have no effect on the wear of the knee replacement under standard gait conditions. A significant reduction in wear volume was measured with the moderately cross-linked polyethylene compared with the conventional polyethylene over a six-million-cycle wear study. This study indicates the use of a moderately cross-linked polyethylene in a fixed-bearing total knee replacement may provide a low wearing option for total knee replacement.
Collapse
Affiliation(s)
| | | | | | - John Fisher
- School of Mechanical Engineering, University of Leeds, UK
| |
Collapse
|
35
|
Clement ND, Biant LC, Breusch SJ. Total hip arthroplasty: to cement or not to cement the acetabular socket? A critical review of the literature. Arch Orthop Trauma Surg 2012; 132:411-27. [PMID: 22134618 DOI: 10.1007/s00402-011-1422-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Indexed: 12/12/2022]
Abstract
The optimal method for acetabular socket fixation remains controversial. We present a critical analysis of the current evidence from a systemic literature review of comparative studies, long-term case series, prior literature reviews, meta-analysis, and national arthroplasty registry data for cemented and uncemented acetabular components to determine the respective survivorship rates, overall risk of re-operation, dislocation rates, and wear-related complications. Using contemporary techniques, both cemented and uncemented sockets can yield good long-term results, but our evaluation suggests that the overall/all cause re-operation risk is lower for cemented fixation. Until and unless crosslinked polyethylene (PE) liners or alternative bearings can prove to yield superior outcome in the future, the cemented PE cup remains the gold standard, in all age groups, by which every acetabular component should be compared.
Collapse
Affiliation(s)
- N D Clement
- Department of Orthopaedics and Trauma, Royal Infirmary of Edinburgh, Little France, Edinburgh, UK.
| | | | | |
Collapse
|
36
|
Furmanski J, Rimnac CM. Crack propagation resistance is similar under static and cyclic loading in crosslinked UHMWPE: a pilot study. Clin Orthop Relat Res 2011; 469:2302-7. [PMID: 21128033 PMCID: PMC3126950 DOI: 10.1007/s11999-010-1712-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Recent work suggests crack phenomena (eg, crack initiation and propagation) in UHMWPE do not depend on cyclic damage mechanisms. Materials for which crack phenomena occur in static (noncyclic) mode should exhibit similar crack propagation behavior under static and cyclic loading conditions. QUESTIONS/PURPOSES Do cracks in UHMWPE stably propagate from acute notches under static loading with a velocity dependent on crosslink density? Are material-ranking evaluations for crack propagation resistance similar under static and cyclic loading conditions? Does time to failure for a notched specimen under static loads yield the same material rankings as crack propagation data? METHODS Notched compact tension specimens were machined from UHMWPE gamma-irradiated with a 0-, 50-, 75-, or 100-kGy dose and subsequently remelted. Static loads were applied until failure occurred or 2 weeks had elapsed. Crack propagation rates and time to failure were recorded and compared to data from cyclic experiments. RESULTS Static and cyclic loading both produced stable crack propagation and similar performance rankings of material groups, except in the case of the unirradiated material, which did not fail under static loads. Normalized measures of crack propagation velocities generally showed quantitative agreement between the two methods. Normalized time to failure under static loading also agreed well with crack propagation velocity. CONCLUSIONS Crack propagation under static loading produced qualitatively and quantitatively similar performance results as those under cyclic loading. Time to failure under static loads corresponded closely with the crack propagation velocity and may itself be a robust metric of crack propagation resistance. CLINICAL RELEVANCE Total joint arthroplasties may experience superficial cracking in the UHMWPE bearing surface or catastrophic fracture. Quantifying resistance to crack phenomena in UHWMPE is important to design engineers and to clinicians using crosslinked UHMWPE materials under challenging mechanical conditions.
Collapse
Affiliation(s)
- Jevan Furmanski
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, 414 Glennan, 10900 Euclid Avenue, Cleveland, OH 44106, USA.
| | | |
Collapse
|