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Rames RD, Hillen TJ, Pashos GE, Maloney WJ, Clohisy JC. Incidence and Characteristics of Osteolysis in HXLPE THA at 16-Year Follow up in Patients 50 Years and Less. J Arthroplasty 2021; 36:641-646. [PMID: 32948423 DOI: 10.1016/j.arth.2020.08.048] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/12/2020] [Accepted: 08/23/2020] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Young patients present a challenge for total hip arthroplasty (THA) survivorship. Highly cross-linked polyethylene (HXLPE) liners have decreased the prevalence of osteolysis; however, concerns exist regarding the biologic activity of wear particles. The purpose of this study was to determine the incidence and characteristics of osteolytic lesions in young HXLPE THA patients at an average 16-year follow up and determine the ability to detect osteolysis. METHODS We performed a retrospective study involving 22 patients (26 THA) under age 50 at primary THA receiving HXLPE liners coupled with cobalt-chrome (CoCr) femoral heads. Computed tomography (CT) scans were reviewed for osteolysis. Chi-squared analysis was used for categorical variables and unpaired Kruskal-Wallis rank-sum test for continuous variables. Logistic regression was used to compare wear rates between those patients with and without osteolysis. RESULTS The mean age at surgery was 38.5 years. The mean time from surgery to CT scan was sixteen years (range 14.25-19.5 years). Nine of the 26 THA showed osteolysis. The mean volume of the lesions was 2.8 cm3. Linear (mean 0.008 mm/y) and volumetric (mean 4.5 mm3/year) wear rates were negligible. One-third of osteolytic lesions were visible on radiographs. Logistic regression failed to demonstrate a correlation between wear rates or UCLA activity score and osteolysis. CONCLUSION We observed osteolysis in 35% of HXLPE THA in young patients at mean 16-year follow up despite zero revisions for wear-related problems and clinically insignificant wear rates. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Richard D Rames
- Department of Orthopaedic Surgery, Washington University School of Medicine, Campus Box 8233, St. Louis, MO
| | - Travis J Hillen
- Division of Musculoskeletal Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO
| | - Gail E Pashos
- Department of Orthopaedic Surgery, Washington University School of Medicine, Campus Box 8233, St. Louis, MO
| | - William J Maloney
- Department of Orthopedic Surgery, Stanford Medicine Outpatient Center, Redwood City, CA
| | - John C Clohisy
- Department of Orthopaedic Surgery, Washington University School of Medicine, Campus Box 8233, St. Louis, MO
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Shon WY, Park BY, R RN, Park PS, Im JT, Yun HH. Total Hip Arthroplasty: Past, Present, and Future. What Has Been Achieved? Hip Pelvis 2019; 31:179-189. [PMID: 31824872 PMCID: PMC6892902 DOI: 10.5371/hp.2019.31.4.179] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 09/03/2019] [Accepted: 09/16/2019] [Indexed: 01/27/2023] Open
Abstract
In the 1960s, Sir John Charnley introduced to clinical practice his concept of low-friction total hip arthroplasty (THA). Although early designs were plagued by poor performance and even failure, there have been steady advances in implant designs, biomaterials, surgical techniques and an understanding of the biomechanical restoration of the hip; these advances have contributed to improvements in implant survival and clinical outcomes of THA in the past three decades. With improved wear resistance and mechanical reliability, a potential to last for at least 25 to 30 years are now available for THA. In this review, we focus on the evolution of THA and review current controversies and future directions of this procedure based on a single surgeon's 29-year of experience at a single institution.
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Affiliation(s)
- Won Yong Shon
- Department of Orthopedic Surgery, Bumin Hospital, Busan, Korea
| | | | - Rajsankar N R
- Department of Orthopedic Surgery, Bumin Hospital, Busan, Korea
| | - Phil Sun Park
- Department of Orthopedic Surgery, Veterans Health Service Medical Center, Seoul, Korea
| | - Jung Taek Im
- Department of Orthopedic Surgery, Veterans Health Service Medical Center, Seoul, Korea
| | - Ho Hyun Yun
- Department of Orthopedic Surgery, Veterans Health Service Medical Center, Seoul, Korea
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Kim KW, Yoo JJ, Kim MN, Kim HJ. Isolated Acetabular Liner Exchange for Polyethylene Wear and Osteolysis with Well-Fixed Metal Shell. Clin Orthop Surg 2019; 11:270-274. [PMID: 31475046 PMCID: PMC6695327 DOI: 10.4055/cios.2019.11.3.270] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 03/30/2019] [Indexed: 11/15/2022] Open
Abstract
Background The isolated liner and head exchange procedure has been an established treatment method for polyethylene wear and osteolysis when the acetabular component remains well fixed. In this study, the mid-term results of this procedure were evaluated retrospectively. Methods Among the consecutive patients operated on from September 1995, two patients (three hips) were excluded because of inadequate follow-up, and the results of remaining 34 patients (34 hips) were evaluated. There were 20 men and 14 women with a mean age of 49 years. A conventional polyethylene liner was used in 26 cases and a highly cross-linked polyethylene liner was used in eight cases. In three cases, the liner was cemented in a metal shell because a compatible liner could not be used. Results After a follow-up of 5 to 20.2 years, re-revision surgery was necessary in 10 cases (29.4%): in eight for wear and osteolysis at 55 to 101 months after liner exchange and in two for acetabular loosening at 1 and 1.5 years after liner exchange. Re-revision surgery included all component revision (four cases), cup revision (four cases), and liner exchange (two cases). In all re-revision cases, a conventional polyethylene liner was used initially. There was no failure in the cases in which a highly cross-linked polyethylene liner was used. Conclusions The results of this study suggest that isolated acetabular liner exchange is a reasonable option for wear and osteolysis when the metal shell is well fixed. More promising long-term results are expected with the use of highly cross-linked polyethylene liners.
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Affiliation(s)
- Kyung Wook Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Jeong Joon Yoo
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Min Nyun Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Hee Joong Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
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Evaluation and Treatment of Patients With Acetabular Osteolysis After Total Hip Arthroplasty. J Am Acad Orthop Surg 2019; 27:e258-e267. [PMID: 30325878 DOI: 10.5435/jaaos-d-16-00685] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
As the demand for total hip arthroplasty (THA) continues to increase, the burden of revision THA is also expected to increase. Although the quality of polyethylene has improved markedly, osteolysis continues to be a risk for older designs and younger, active patients. Although progressive but typically asymptomatic in early stages, osteolysis can result in component failure and complicate revision surgery. Serial radiographs are paramount for monitoring progression. Although select cases may be treated with observation, surgery should be considered based on age, activity level, and projected life span. Well-fixed, noncemented modular acetabular components may be treated with curettage and bone grafting, as well as having to bear liner exchange with retention of the acetabular shell. However, in the setting of osteolysis, it is controversial whether bone grafting and component retention is superior to cup revision. This review explores the pathophysiology of osteolysis after THA and provides a comprehensive analysis of the evaluation and treatment of patients with osteolysis.
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Matuszak SJ, Galea VP, Connelly JW, Christiansen J, Muratoglu O, Malchau H. Periprosthetic acetabular radiolucency progression in mid-term follow-up of the articular surface replacement hip system. Arch Orthop Trauma Surg 2018; 138:1021-1028. [PMID: 29869689 DOI: 10.1007/s00402-018-2962-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Recent registry studies show that aseptic loosening secondary to osteolysis is the second leading cause of hip implant failure in patients implanted with metal-on-metal (MoM) bearings. The primary aim of our study was to report on the progression of acetabular osteolysis during mid-term follow-up in patients treated with MoM hip resurfacing arthroplasty (HRA) and MoM total hip arthroplasty (THA). The secondary aim was to identify independent predictors of osteolytic lesion progression. MATERIALS AND METHODS A total of 805 patients (805 hips) were included in this study (541 MoM HRA, 264 MoM THA) from a prospective, international clinical registry of the Articular Surface Replacement Hip System. Patients were enrolled a median of 6.6 years from surgery. Osteolytic lesion progression was defined either as any lesion developing de novo, or as an existing lesion progressing from radiolucency to osteolysis during the study period (range 0.5-4.3 years). RESULTS The number of cases with any osteolysis or radiolucency was 21 (3.9%) for ASR HRA and 29 (11.0%) for ASR XL THA at enrollment and increased to 69 (12.8%) for ASR HRA and 41 (15.5%) for ASR XL THA after follow-up. Osteolytic lesion progression was found in 66 (12.2%) ASR HRA patients and 31 (11.7%) ASR XL THA patients. Multivariate models determined that lower acetabular version angle (OR 0.963, p = 0.011) and elevated whole blood chromium (OR 1.110, p = 0.044) were independent predictors of osteolytic lesion progression in ASR HRA. CONCLUSION We suggest that physicians of patients implanted with ASR HRA implants closely monitor patients with higher chromium levels and lower version angles, as they are at increased risk for osteolytic lesion progression, and we recommend annual radiographic follow-up on all patients with ASR implants.
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Affiliation(s)
- Sean J Matuszak
- Harris Orthopaedic Laboratory, Orthopaedic Department, Massachusetts General Hospital, 55 Fruit St. GRJ 1231, Boston, MA, 02114-2696, USA
| | - Vincent P Galea
- Harris Orthopaedic Laboratory, Orthopaedic Department, Massachusetts General Hospital, 55 Fruit St. GRJ 1231, Boston, MA, 02114-2696, USA
| | - James W Connelly
- Harris Orthopaedic Laboratory, Orthopaedic Department, Massachusetts General Hospital, 55 Fruit St. GRJ 1231, Boston, MA, 02114-2696, USA
| | - Janus Christiansen
- Harris Orthopaedic Laboratory, Orthopaedic Department, Massachusetts General Hospital, 55 Fruit St. GRJ 1231, Boston, MA, 02114-2696, USA.,Department of Orthopaedic Surgery, Harvard Medical School, 25 Shattuck St., Boston, MA, 02115, USA
| | - Orhun Muratoglu
- Harris Orthopaedic Laboratory, Orthopaedic Department, Massachusetts General Hospital, 55 Fruit St. GRJ 1231, Boston, MA, 02114-2696, USA.,Department of Orthopaedic Surgery, Harvard Medical School, 25 Shattuck St., Boston, MA, 02115, USA
| | - Henrik Malchau
- Harris Orthopaedic Laboratory, Orthopaedic Department, Massachusetts General Hospital, 55 Fruit St. GRJ 1231, Boston, MA, 02114-2696, USA. .,Department of Orthopaedic Surgery, Harvard Medical School, 25 Shattuck St., Boston, MA, 02115, USA.
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Minto B, Brandão C, Pereira G, Babicsak V, Vulcano L, Rossetto V. Avaliação radiográfica e tomográfica de cães submetidos à artroplastia coxofemoral total híbrida. ARQ BRAS MED VET ZOO 2016. [DOI: 10.1590/1678-4162-8784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO A artroplastia total da articulação coxofemoral é a técnica cirúrgica mais efetiva para o tratamento da displasia coxofemoral canina grave. Na atualidade, o exame radiográfico é o método mais utilizado para se avaliar esse procedimento em cães, porém possui algumas limitações. Já o exame tomográfico por meio de tomografia computadorizada possibilita a aquisição de imagens sem sobreposições e, dessa forma, a determinação do posicionamento dos componentes protéticos com maior precisão. A presente pesquisa teve como objetivo avaliar, por meio de exames radiográficos e tomográficos, a utilização de uma prótese total modular híbrida da articulação coxofemoral desenvolvida e confeccionada no Brasil, aplicada experimentalmente em cães sadios. Foram utilizados seis cães esqueleticamente maduros, previamente submetidos ao procedimento cirúrgico da articulação coxofemoral esquerda. Os cães foram submetidos ao exame tomográfico aos 360 dias e três anos após a cirurgia. Todos os animais apresentaram bom posicionamento dos componentes protéticos e redução articular adequada. Ao exame tomográfico, entretanto, foram detectadas áreas de preenchimento irregular em alguns animais. Adicionalmente, o exame tomográfico permitiu a detecção e monitoração de áreas de reabsorção óssea ao redor do componente acetabular. Assim, o exame tomográfico mostrou-se útil na avaliação das articulações protéticas, com a vantagem de apresentar ótima definição das imagens e permitir quantificar alterações periprotéticas e mensurar relações articulares, fundamentais para o acompanhamento pós-cirúrgico tardio.
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Shon WY, Santhanam SS, Choi JW. Acetabular Reconstruction in Total Hip Arthroplasty. Hip Pelvis 2016; 28:1-14. [PMID: 27536638 PMCID: PMC4972873 DOI: 10.5371/hp.2016.28.1.1] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 01/23/2016] [Accepted: 02/01/2016] [Indexed: 11/24/2022] Open
Abstract
The difficulties encountered in dealing with the bone deficient acetabulum are amongst the greatest challenges in hip surgery. Acetabular reconstruction in revision total hip arthroplasty can successfully be achieved with hemispherical components featuring a porous or roughened ingrowth surface and options for placement of multiple screws for minor acetabular defect. Acetabular component selection is mostly based on the amount of bone loss present. In the presence of combined cavitary and segmental defects without superior acetabular coverage, reconstructions with a structural acetabular allograft protected by a cage or a custom-made triflange cage have been one of preferred surgical options. The use of a cage or ring over structural allograft bone for massive uncontained defects in acetabular revision can restore host bone stock and facilitate subsequent rerevision surgery to a certain extent. But high complication rates have been reported including aseptic loosening, infection, dislocation and metal failure. On the other hand, recent literature is reporting satisfactory outcomes with the use of modular augments combined with a hemispherical shell for major acetabular defect. Highly porous metals have been introduced for clinical use in arthroplasty surgery over the last decade. Their higher porosity and surface friction are ideal for acetabular revision, optimizing biological fixation. The use of trabecular metal cups in acetabular revision has yielded excellent clinical results. This article summarizes author's experience regarding revision acetabular reconstruction options following failed hip surgery including arthroplasty.
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Affiliation(s)
- Won Yong Shon
- Department of Orthopedic Surgery, Korea University Guro Hospital, Seoul, Korea
| | | | - Jung Woo Choi
- Department of Orthopedic Surgery, Korea University Guro Hospital, Seoul, Korea
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Takada R, Jinno T, Koga D, Yamauchi Y, Asou Y, Muneta T, Okawa A. Limited significance of screening computed tomography after cementless total hip arthroplasty with highly cross-linked polyethylene at 7-10 years of follow-up. Mod Rheumatol 2015; 26:757-60. [PMID: 26708312 DOI: 10.3109/14397595.2015.1131136] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES The purpose of this retrospective study is to report the incidence of osteolysis and evaluate the significance of screening computed tomography (CT) compared to plain radiography in detecting osteolysis after total hip arthroplasty with metal-on-highly cross-linked polyethylene bearings. METHODS We retrospectively reviewed 264 primary cementless total hip arthroplasties of 211 patients, 24 males, 187 females, who received postoperative screening CT scan in addition to radiography at postoperative 7-10 years (average 8.2 years). First-generation highly cross-linked polyethylene was used in all cases. RESULTS On the plain radiographs, no acetabular osteolysis (0%) and two cases of femoral osteolysis (0.8%) were found in the follow-up period. No osteolysis was newly found by screening CT scan. CONCLUSIONS Very low incidence of osteolysis after total hip arthroplasty with highly cross-linked polyethylene at postoperative 7-10 years was confirmed, and routine screening CT scan for detecting osteolysis in this setting was not supported from this study.
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Affiliation(s)
- Ryohei Takada
- a Department of Orthopaedic Surgery , Medical Hospital, Tokyo Medical and Dental University , Tokyo , Japan
| | - Tetsuya Jinno
- a Department of Orthopaedic Surgery , Medical Hospital, Tokyo Medical and Dental University , Tokyo , Japan
| | - Daisuke Koga
- a Department of Orthopaedic Surgery , Medical Hospital, Tokyo Medical and Dental University , Tokyo , Japan
| | - Yuki Yamauchi
- a Department of Orthopaedic Surgery , Medical Hospital, Tokyo Medical and Dental University , Tokyo , Japan
| | - Yoshinori Asou
- a Department of Orthopaedic Surgery , Medical Hospital, Tokyo Medical and Dental University , Tokyo , Japan
| | - Takeshi Muneta
- a Department of Orthopaedic Surgery , Medical Hospital, Tokyo Medical and Dental University , Tokyo , Japan
| | - Atsushi Okawa
- a Department of Orthopaedic Surgery , Medical Hospital, Tokyo Medical and Dental University , Tokyo , Japan
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