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Fokter SK, Gubeljak N, Punzón-Quijorna E, Pelicon P, Kelemen M, Vavpetič P, Predan J, Ferlič L, Novak I. Total Knee Replacement with an Uncemented Porous Tantalum Tibia Component: A Failure Analysis. MATERIALS 2022; 15:ma15072575. [PMID: 35407908 PMCID: PMC8999729 DOI: 10.3390/ma15072575] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/22/2022] [Accepted: 03/30/2022] [Indexed: 11/16/2022]
Abstract
Porous tantalum has been extensively used in orthopaedic surgery, including uncemented total knee arthroplasty (TKA). Favourable results were reported with earlier monobloc tibial components and the design evolved to modular implants. We aimed to analyse possible causes for extensive medial tibia bone loss, resulting in modular porous tantalum tibia baseplate fracture after primary TKA. Retrieved tissue samples were scanned with 3 MeV focused proton beam for Proton-Induced X-ray Emission (micro-PIXE) elemental analysis. Fractographic and microstructural analysis were performed by stereomicroscopy. A full 3D finite-element model was made for numerical analysis of stress-strain conditions of the tibial baseplate. Histological examination of tissue underneath the broken part of the tibial baseplate revealed dark-stained metal debris, which was confirmed by micro-PIXE to consist of tantalum and titanium. Fractographic analysis and tensile testing showed that the failure of the tibial baseplate fulfilled the criteria of a typical fatigue fracture. Microstructural analysis of the contact surface revealed signs of bone ingrowth in 22.5% of the surface only and was even less pronounced in the medial half of the tibial baseplate. Further studies are needed to confirm the responsibility of metal debris for an increased bone absorption leading to catastrophic tibial tray failure.
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Affiliation(s)
- Samo K. Fokter
- Department of Orthopaedics, University Medical Centre Maribor, Ljubljanska 5, 2000 Maribor, Slovenia;
- Correspondence: ; Tel.: +386-41-772102
| | - Nenad Gubeljak
- Faculty of Mechanical Engineering, University of Maribor, Smetanova 17, 2000 Maribor, Slovenia; (N.G.); (J.P.); (L.F.)
| | - Esther Punzón-Quijorna
- Department of Low and Medium Energy Physics F2, Jožef Stefan Institute, Jamova 39, 1000 Ljubljana, Slovenia; (E.P.-Q.); (P.P.); (M.K.); (P.V.)
| | - Primož Pelicon
- Department of Low and Medium Energy Physics F2, Jožef Stefan Institute, Jamova 39, 1000 Ljubljana, Slovenia; (E.P.-Q.); (P.P.); (M.K.); (P.V.)
| | - Mitja Kelemen
- Department of Low and Medium Energy Physics F2, Jožef Stefan Institute, Jamova 39, 1000 Ljubljana, Slovenia; (E.P.-Q.); (P.P.); (M.K.); (P.V.)
| | - Primož Vavpetič
- Department of Low and Medium Energy Physics F2, Jožef Stefan Institute, Jamova 39, 1000 Ljubljana, Slovenia; (E.P.-Q.); (P.P.); (M.K.); (P.V.)
| | - Jožef Predan
- Faculty of Mechanical Engineering, University of Maribor, Smetanova 17, 2000 Maribor, Slovenia; (N.G.); (J.P.); (L.F.)
| | - Luka Ferlič
- Faculty of Mechanical Engineering, University of Maribor, Smetanova 17, 2000 Maribor, Slovenia; (N.G.); (J.P.); (L.F.)
| | - Igor Novak
- Department of Orthopaedics, University Medical Centre Maribor, Ljubljanska 5, 2000 Maribor, Slovenia;
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Baral EC, Trivellas M, Vigdorchik JM, Ricciardi BF, Wright TM, Padgett DE. Porous Coatings in Retrieved Acetabular Components. J Arthroplasty 2020; 35:2254-2258. [PMID: 32307292 DOI: 10.1016/j.arth.2020.03.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 03/18/2020] [Accepted: 03/20/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND We evaluated bone volume fraction in retrieved acetabular shells with 2 types of porous coatings: (1) titanium fiber mesh (HG) components and (2) tantalum metal coating (TM) components. METHODS Eight HG shells were matched to 8 TM shells for patient age, body mass index, and gender. The mean age at index surgery was 69 (51-82) years, mean body mass index was 28 (21-40), and patients were evenly divided between male and female (4:4). The length of implantation was 40 (16-96) months for the TM group and 156 (108-216) months for the HG group. Shells were embedded and two 5-mm thick cross-sections were cut through the apex of each component for backscatter scanning electron microscopy assessment. Backscatter scanning electron microscopy images were segmented to threshold for metal, bone, and available space for ingrowth. Slices were assessed regionally for ingrowth at the rim, equator, and pole of the acetabular shell. Differences were assessed using general estimating equations, and P values were adjusted for multiple comparisons using the Holm-Bonferroni step-down procedure. RESULTS The mean bone volume fraction was 21 ± 17% for the HG shell and 7 ± 4% for the TM shell (P < .0001). The rim and pole regions both had less bone ingrowth than the equator. No association was found between bone ingrowth and length of implantation for either design. CONCLUSION Adequate bone ingrowth is a requirement for successful biological fixation, but the amount of ingrowth may not be a driving factor. Both implants studied had successful outcomes and long-term fixation despite the observation of low amounts of ingrowth.
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Affiliation(s)
- Elexis C Baral
- Department of Biomechanics, Hospital for Special Surgery, New York, NY
| | - Myra Trivellas
- Department of Biomechanics, Hospital for Special Surgery, New York, NY
| | - Jonathan M Vigdorchik
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY
| | - Benjamin F Ricciardi
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY
| | - Timothy M Wright
- Department of Biomechanics, Hospital for Special Surgery, New York, NY
| | - Douglas E Padgett
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY
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Scully WF, Deren ME, Bloomfield MR. Catastrophic tibial baseplate failure of a modern cementless total knee arthroplasty implant. Arthroplast Today 2019; 5:446-452. [PMID: 31886388 PMCID: PMC6920728 DOI: 10.1016/j.artd.2019.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/18/2019] [Accepted: 09/03/2019] [Indexed: 12/30/2022] Open
Abstract
Tibial baseplate fracture following primary total knee arthroplasty is a rare complication, particularly with modern implants and surgical techniques. This case details the first known report of mid-range follow-up catastrophic failure of a cementless modular, trabecular metal tibial baseplate. This failure highlights the importance of continued follow-up for novel implants, to include cementless knee arthroplasty designs, particularly if new symptoms arise or periarticular bone loss is identified on radiograph.
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Affiliation(s)
| | - Matthew E Deren
- University of Massachusetts Medical School, Worcester, MA, USA
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Carpenter RD, Klosterhoff BS, Torstrick FB, Foley KT, Burkus JK, Lee CSD, Gall K, Guldberg RE, Safranski DL. Effect of porous orthopaedic implant material and structure on load sharing with simulated bone ingrowth: A finite element analysis comparing titanium and PEEK. J Mech Behav Biomed Mater 2019; 80:68-76. [PMID: 29414477 DOI: 10.1016/j.jmbbm.2018.01.017] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Revised: 01/15/2018] [Accepted: 01/17/2018] [Indexed: 12/29/2022]
Abstract
Osseointegration of load-bearing orthopaedic implants, including interbody fusion devices, is critical to long-term biomechanical functionality. Mechanical loads are a key regulator of bone tissue remodeling and maintenance, and stress-shielding due to metal orthopaedic implants being much stiffer than bone has been implicated in clinical observations of long-term bone loss in tissue adjacent to implants. Porous features that accommodate bone ingrowth have improved implant fixation in the short term, but long-term retrieval studies have sometimes demonstrated limited, superficial ingrowth into the pore layer of metal implants and aseptic loosening remains a problem for a subset of patients. Polyether-ether-ketone (PEEK) is a widely used orthopaedic material with an elastic modulus more similar to bone than metals, and a manufacturing process to form porous PEEK was recently developed to allow bone ingrowth while preserving strength for load-bearing applications. To investigate the biomechanical implications of porous PEEK compared to porous metals, we analyzed finite element (FE) models of the pore structure-bone interface using two clinically available implants with high (> 60%) porosity, one being constructed from PEEK and the other from electron beam 3D-printed titanium (Ti). The objective of this study was to investigate how porous PEEK and porous Ti mechanical properties affect load sharing with bone within the porous architectures over time. Porous PEEK substantially increased the load share transferred to ingrown bone compared to porous Ti under compression (i.e. at 4 weeks: PEEK = 66%; Ti = 13%), tension (PEEK = 71%; Ti = 12%), and shear (PEEK = 68%; Ti = 9%) at all time points of simulated bone ingrowth. Applying PEEK mechanical properties to the Ti implant geometry and vice versa demonstrated that the observed increases in load sharing with PEEK were primarily due to differences in intrinsic elastic modulus and not pore architecture (i.e. 4 weeks, compression: PEEK material/Ti geometry = 53%; Ti material/PEEK geometry = 12%). Additionally, local tissue energy effective strains on bone tissue adjacent to the implant under spinal load magnitudes were over two-fold higher with porous PEEK than porous Ti (i.e. 4 weeks, compression: PEEK = 784 ± 351 microstrain; Ti = 180 ± 300 microstrain; and 12 weeks, compression: PEEK = 298 ± 88 microstrain; Ti = 121 ± 49 microstrain). The higher local strains on bone tissue in the PEEK pore structure were below previously established thresholds for bone damage but in the range necessary for physiological bone maintenance and adaptation. Placing these strain magnitudes in the context of literature on bone adaptation to mechanical loads, this study suggests that porous PEEK structures may provide a more favorable mechanical environment for bone formation and maintenance under spinal load magnitudes than currently available porous 3D-printed Ti, regardless of the level of bone ingrowth.
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Affiliation(s)
- R Dana Carpenter
- Department of Mechanical Engineering, University of Colorado Denver, Denver, CO, USA.
| | - Brett S Klosterhoff
- Parker H. Petit Institute for Bioengineering & Bioscience, Georgia Institute of Technology, Atlanta, GA, USA; George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - F Brennan Torstrick
- Parker H. Petit Institute for Bioengineering & Bioscience, Georgia Institute of Technology, Atlanta, GA, USA; George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Kevin T Foley
- Departments of Neurosurgery, Orthopaedic Surgery, and Biomedical Engineering, University of Tennessee Health Sciences Center, Memphis, TN, USA; Semmes-Murphey Neurologic & Spine Institute, Memphis, TN, USA
| | | | | | - Ken Gall
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC, USA; Vertera Inc., Atlanta, GA, USA; MedShape Inc., Atlanta, GA, USA
| | - Robert E Guldberg
- Parker H. Petit Institute for Bioengineering & Bioscience, Georgia Institute of Technology, Atlanta, GA, USA; George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
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Kelly CN, Evans NT, Irvin CW, Chapman SC, Gall K, Safranski DL. The effect of surface topography and porosity on the tensile fatigue of 3D printed Ti-6Al-4V fabricated by selective laser melting. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2019; 98:726-736. [PMID: 30813077 DOI: 10.1016/j.msec.2019.01.024] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 01/02/2019] [Accepted: 01/07/2019] [Indexed: 10/27/2022]
Abstract
Additive manufacturing (3D printing) is emerging as a key manufacturing technique in medical devices. Selective laser melted (SLM) Ti-6Al-4V implants with interconnected porosity have become widespread in orthopedic applications where porous structures encourage bony ingrowth and the stiffness of the implant can be tuned to reduce stress shielding. The SLM technique allows high resolution control over design, including the ability to introduce porosity with spatial variations in pore size, shape, and connectivity. This study investigates the effect of construct design and surface treatment on tensile fatigue behavior of 3D printed Ti-6Al-4V. Samples were designed as solid, solid with an additional surface porous layer, or fully porous, while surface treatments included commercially available rotopolishing and SILC cleaning. All groups were evaluated for surface roughness and tested in tension to failure under monotonic and cyclic loading profiles. Surface treatments were shown to reduce surface roughness for all sample geometries. However, only fatigue behavior of solid samples was improved for treated as compared to non-treated surfaces Irrespective of surface treatment and resulting surface roughness, the fatigue strength of 3D printed samples containing bulk or surface porosity was approximately 10% of the ultimate tensile strength of identical 3D printed porous material. This study highlights the relative effect of surface treatment in solid and porous printed samples and the inherent decrease in fatigue properties of 3D printed porous samples designed for osseointegration.
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Affiliation(s)
- Cambre N Kelly
- Department of Biomedical Engineering, Duke University, United States of America
| | - Nathan T Evans
- School of Materials Science and Engineering, Georgia Institute of Technology, United States of America
| | - Cameron W Irvin
- School of Materials Science and Engineering, Georgia Institute of Technology, United States of America; Renewable Bioproducts Institute, Georgia Institute of Technology, United States of America
| | - Savita C Chapman
- Department of Biomedical Engineering, Georgia Institute of Technology, United States of America
| | - Ken Gall
- Department of Mechanical Engineering and Materials Science, Duke University, United States of America
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Shi LY, Wang A, Zang FZ, Wang JX, Pan XW, Chen HJ. Tantalum-coated pedicle screws enhance implant integration. Colloids Surf B Biointerfaces 2017; 160:22-32. [PMID: 28915498 DOI: 10.1016/j.colsurfb.2017.08.059] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 08/23/2017] [Accepted: 08/29/2017] [Indexed: 12/21/2022]
Abstract
Because titanium alloy (Ti) has the natural advantage of a low elastic modulus, it has become the most commonly used material for the manufacturing of pedicle screws. However, its poor shear strength and osteogenic ability are undesirable properties. The superior osteoinductivity demonstrated by tantalum (Ta) in oral and maxillofacial surgery and joint surgery leads us to assume that the tantalum-coated pedicle screws may have better osteogenic properties and bone anchoring strength. To verify this hypothesis, MC3T3-E1 cells and human mesenchymal stem cells (hBMSCs) were seeded on the surface of Ta and Ti disks to compare the effects of two different metals on cell adhesion, proliferation, and differentiation. At the same time, we observed the inhibitory effect of Ta on osteoclasts. As an in vivo study, conventional Ti pedicle screws and Ta-coated screws were implanted in bilateral pedicles of Bama pigs. The results showed that compared to titanium, tantalum promoted greater cell adhesion and proliferation and improved the level of hBMSC mineralization, and Ta-coated screws exerted an inhibitory effect on osteoclasts. More importantly, we found that the effect of tantalum on osteogenic differentiation was mediated through the Wnt/β-catenin and TGF-β/smad signaling pathways. Ta-coated screws significantly promoted trabecular bone growth compared with Ti as evidenced by micro-CT, histology and biomechanical examination. Our study clearly indicated that tantalum was a superior promoter of osteogenesis and proved that tantalum coating is an effective improvement for titanium alloy implants.
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Affiliation(s)
- Liang-Yu Shi
- Department of Orthopedics, the Seventh Affiliated Hospital of Zhongshan University, Sun Yat-sen University, Shenzhen 518007, China
| | - An Wang
- Department of Orthopedics, Changzheng Hospital, The Second Military Medical University, Shanghai 200003, China
| | - Fa-Zhi Zang
- Department of Orthopedics, Changzheng Hospital, The Second Military Medical University, Shanghai 200003, China
| | - Jian-Xi Wang
- Department of Orthopedics, Changzheng Hospital, The Second Military Medical University, Shanghai 200003, China
| | - Xian-Wei Pan
- Department of Orthopedics, Changzheng Hospital, The Second Military Medical University, Shanghai 200003, China
| | - Hua-Jiang Chen
- Department of Orthopedics, Changzheng Hospital, The Second Military Medical University, Shanghai 200003, China.
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7
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Wang H, Li Q, Wang Q, Zhang H, Shi W, Gan H, Song H, Wang Z. Enhanced repair of segmental bone defects in rabbit radius by porous tantalum scaffolds modified with the RGD peptide. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2017; 28:50. [PMID: 28197822 DOI: 10.1007/s10856-017-5860-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 01/30/2017] [Indexed: 06/06/2023]
Abstract
Fast and stable repair of segmental bone defects remains a challenge for clinical orthopedic surgery. In recent years, porous tantalum has been widely applied in clinical orthopedics for low modulus of elasticity, with three-dimensional microstructures similar to cancellous bone and excellent biocompatibility. To further improve bone the repairing ability of porous tantalum, the cyclo(-RGDfK-) peptide was coated on the surface of porous tantalum scaffolds. A model of 15 mm segmental defect was made at the midshaft of right radius in New Zealand White rabbits. In the experimental group, defects were implanted (press-fit) using porous tantalum scaffolds modified with cyclo(-RGDfK-) peptide. Control animals were implanted with non-modified porous tantalum scaffolds or xenogeneic cancellous bone scaffolds, respectively. No implant was provided for the blank group. Bone repair was assessed by X-ray and histological observations at 4, 8, and 16 weeks post-operation, with biomechanical tests and micro-computed tomography performed at 16 weeks post-surgery. The results showed that bone formation was increased at the interface and inside the inner pores of modified porous tantalum scaffolds than those of non-modified porous tantalum scaffolds; biomechanical properties in the modified porous tantalum group were superior to those of the non-modified porous tantalum and xenogeneic cancellous bone groups, while new bone volume fractions using micro-computed tomography analysis were similar between the modified porous tantalum and xenogeneic cancellous bone groups. Our findings suggested that modified porous tantalum scaffolds had enhanced repairing ability in segmental bone defect in rabbit radius, and may serve as a potential material for repairing large bone defects.
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Affiliation(s)
- Hui Wang
- Hand Surgery Department, Tangshan orthopaedic hospital affiliated, North China University of Science and Technology, Tangshan, Hebei, 063000, P.R. China
| | - Qijia Li
- Experimental Center, North China University of Science and Technology, Tangshan, Hebei, 063000, P.R. China
| | - Qian Wang
- Department of Anatomy, Basic Medical College, North China University of Science and Technology, Tangshan, Hebei, 063000, P.R. China
| | - Hui Zhang
- Department of Joint Surgery, Tangshan orthopaedic hospital affiliated, North China University of Science and Technology, Tangshan, Hebei, 063000, P.R. China
| | - Wei Shi
- Department of Orthopaedics, Affiliated Hospital, North China University of Science and Technology, Tangshan, Hebei, 063000, P.R. China
| | - Hongquan Gan
- Department of Orthopaedics, Affiliated Hospital, North China University of Science and Technology, Tangshan, Hebei, 063000, P.R. China
| | - Huiping Song
- Department of Orthopaedics, Affiliated Hospital, North China University of Science and Technology, Tangshan, Hebei, 063000, P.R. China
| | - Zhiqiang Wang
- Department of Orthopaedics, Affiliated Hospital, North China University of Science and Technology, Tangshan, Hebei, 063000, P.R. China.
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Hall DJ, Urban RM, Pourzal R, Turner TM, Skipor AK, Jacobs JJ. Nanoscale surface modification by anodic oxidation increased bone ingrowth and reduced fibrous tissue in the porous coating of titanium-alloy femoral hip arthroplasty implants. J Biomed Mater Res B Appl Biomater 2015; 105:283-290. [PMID: 26477322 DOI: 10.1002/jbm.b.33554] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 09/14/2015] [Accepted: 10/03/2015] [Indexed: 02/05/2023]
Abstract
Hip arthroplasty femoral stems coated with Ti6Al4V beads were treated by anodic oxidation in H3 PO4 for enhanced bioactivity and were studied in a 6-month canine model to determine the effects of the treated surface on the ingrowth of bone and soft tissues. The area fractions of bone, marrow, and fibrous tissue in the porous coating of seven treated and seven untreated control implants were determined using histomorphological techniques. The area fraction of bone within the porous coating was greater for anodic oxide treated (23.6 ± 8.3%) compared to control implants (l2.7 ± 4.7%) (p = 0.013), and there was less fibrous tissue in the treated implants (18.0 ± 9.5%) compared to the controls (33.1 ± 7.9%) (p = 0.006). XPS, XRD, TEM, and SEM analyses of the treated implants revealed a 400 nm-thick titanium oxide layer of low crystallinity with an undulating surface, populated with more than 25 nm-size pores per square micrometer. There was no detectable increase in serum titanium or in generation of particulates locally compared to the control implants. Micro and nanoscale surface modification by anodic oxidation increased bone ingrowth and reduced fibrous tissue, which may extend the longevity of fixation, limiting pathways for particle migration, and impeding the progression of osteolysis and aseptic loosening of arthroplasty components. © 2015 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 283-290, 2017.
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Affiliation(s)
- Deborah J Hall
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Robert M Urban
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Robin Pourzal
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Thomas M Turner
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Anastasia K Skipor
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Joshua J Jacobs
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
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