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Cho CH, Pijls BG, Abrahams JM, Roerink A, Katembwe R, Baker A, Solomon LB, Callary SA. Migration patterns of acetabular cups: a systematic review and meta-analysis of RSA studies. Acta Orthop 2023; 94:626-634. [PMID: 38157007 PMCID: PMC10757199 DOI: 10.2340/17453674.2023.24580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 09/21/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND AND PURPOSE We conducted a systematic review and meta-analysis of RSA studies to investigate the early and long-term migration patterns of acetabular cups and the influence of implant factors on cup migration over time. METHODS We performed a systematic search of PubMed, Embase, and Scopus databases to identify all RSA studies of cup migration following primary total hip replacement (THR). Proximal migration at 3 and 6 months, 1, 2, 5, and 10 years were considered for analysis. Implant factors investigated included fixation type, head size, bearing surface, uncemented coating design, and the decade of RSA introduction. RESULTS 47 studies reported the proximal migration of 83 cohorts (2,328 cups). Besides 1 threaded cup design, no implant factor investigated was found to significantly influence proximal migration. The mean pooled 2-year proximal migration of cemented cups (0.14 mm, 95% confidence interval [CI] 0.08-0.20) was not significantly different from uncemented cups (0.12 mm, CI 0.04-0.19). The mean pooled proximal migration at 6 months was 0.11 mm (CI 0.06-0.16) and there was no significant increase between 6 months and 2 years (0.015 mm, CI 0.000-0.030). 27 of 75 cohorts (36%) reported mean proximal migration greater than 0.2 mm at 2 years, which has previously been identified as a predictor of implants at risk of long-term loosening. CONCLUSION Our meta-analysis demonstrated that the majority of cup migration occurs within the first 6 months. With one exception, no implant factors influenced the 2-year proximal migration of acetabular cups. 36% of studies with 2-year migration were considered at risk of long-term loosening. Further investigation and comparison against long-term survivorship data would validate 6-month and/or 1-year proximal migration measurements as an earlier predictor of long-term loosening than the current 2-year threshold.
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Affiliation(s)
- Chan Hee Cho
- Centre for Orthopaedic and Trauma Research, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia.
| | - Bart G Pijls
- Department of Orthopaedics, Leiden University Medical Centre, Leiden, Netherlands
| | - John M Abrahams
- Centre for Orthopaedic and Trauma Research, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia; Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Anne Roerink
- Department of Orthopaedics, Leiden University Medical Centre, Leiden, Netherlands
| | - Raissa Katembwe
- Centre for Orthopaedic and Trauma Research, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Andrew Baker
- Centre for Orthopaedic and Trauma Research, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Lucian B Solomon
- Centre for Orthopaedic and Trauma Research, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia; Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Stuart A Callary
- Centre for Orthopaedic and Trauma Research, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia; Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, SA, Australia
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Haider H, Weisenburger J, Siskey R, Deans C, Hartman C, Kildow B, Konigsberg B, Garvin K. Do articular surfaces of dual mobility hips have more wear and friction? An in vitro investigation. J Arthroplasty 2023:S0883-5403(23)00390-X. [PMID: 37105329 DOI: 10.1016/j.arth.2023.04.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 04/14/2023] [Accepted: 04/16/2023] [Indexed: 04/29/2023] Open
Abstract
INTRODUCTION Larger head-to-neck ratio of dual mobility (DM) hip arthroplasties provide greater range of motion/less risk of dislocation, but raise concerns for high wear and friction. We measured in vitro, the wear rates of contemporary DM hips with highly-crosslinked Ultra High Molecular Weight Polyethylene (UHWMPE), where it came from, and their frictional torques. METHODS Hip simulators were used to compare the wear of DM to fixed-bearing (FB) designs of two different implants. Each of eight different configurations underwent millions of simulated walking cycle tests, some as full DM, some as FB controls, some DM with the outer-articulation deliberately immobilized, and some the inner. Wear and three-dimensional-frictional torques were measured and friction independent of size was deduced. RESULTS The DM hips produced lower wear and friction-torque than the FB hips. The DM Wear during walking gait comes mostly from the smaller inner articular surface. If the outer surface was immobilized, the wear and torque of the inner alone would be small, but the full DM (inner and outer free-to-move) wear and torque were smallest of all. Friction measurements expectedly showed larger hips having higher frictional torques, but the DM showed the lowest, again because its motion was mostly the smaller inner articulation; smaller than even a modern fixed-bearing hip. CONCLUSION The DM hips appear to combine the benefits of greater range of motion and less impingement of larger hips, with the lower wear and friction of smaller FB hips, with some benefits compromised if the outer or inner articulations are immobilized.
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Affiliation(s)
- Hani Haider
- Department of Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical Center, Omaha, NE, 68198
| | - Joel Weisenburger
- Department of Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical Center, Omaha, NE, 68198
| | - Ryan Siskey
- Exponent: Engineering and Scientific Consulting, 3440 Market Street, Philadelphia, PA, 19104
| | - Christopher Deans
- Department of Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical Center, Omaha, NE, 68198
| | - Curtis Hartman
- Department of Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical Center, Omaha, NE, 68198
| | - Beau Kildow
- Department of Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical Center, Omaha, NE, 68198
| | - Beau Konigsberg
- Department of Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical Center, Omaha, NE, 68198
| | - Kevin Garvin
- Department of Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical Center, 985640 Nebraska Medical Center, Omaha, NE, 68198
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Gromov K, Sillesen NH, Kallemose T, Husted H, Malchau H, Troelsen A. Safety of vitamin E-infused highwall liners for routine use in primary total hip arthroplasty: single centre, short-term follow-up of 1221 cases. Hip Int 2022; 32:56-61. [PMID: 33167730 DOI: 10.1177/1120700020969644] [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] [Indexed: 02/04/2023]
Abstract
BACKGROUND Introduction of new implants should be monitored closely to capture any signs of compromising patient safety. Vitamin E infused highly-crosslinked polyethylene liners (VEPE) offer the potential for reduced wear. Highwall liners have been hypothesised to result in increased wear and potential liner fractures. The aim of this study was to determine the 3-7-year follow-up of highwall VEPE for primary total hip arthroplasty (THA), focusing on liner-related complications. METHODS We included 1221 consecutive THA operations from July 2010 to May 2014 with minimum follow-up of 3 (3.1-6.8) years Data collected included demographics, implant data, complications, reoperations, and deaths. Data were cross-referenced with the Danish Hip Arthroplasty Registry in order to ensure validity and completeness. Acetabular shell position was measured using Martell Hip Analysis Suite in a subgroup of 931 THAs. RESULTS Cumulative stem revision and shell revision at 3-year follow-up was 3.4% and 0.4% respectively. There were no revisions due to liner failure. Reason for revision included 11 dislocations, 15 soft-tissue revisions for infection, 44 stem revisions of which 34 were periprosthetic fractures and 13 shell revisions of which 6 were combined shell and stem revisions. CONCLUSION Early follow-up of VEPE liners for primary THA have not shown any revisions associated with liner failure. Continued monitoring of new materials are necessary to capture any signs of compromised patient safety.
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Affiliation(s)
- Kirill Gromov
- Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Nanna H Sillesen
- Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Thomas Kallemose
- Clinical Research Centre, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Henrik Husted
- Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Henrik Malchau
- Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.,Harris Orthopaedic Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Anders Troelsen
- Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
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Li Z, Xiang S, Wu C, Wang Y, Weng X. Vitamin E highly cross-linked polyethylene reduces mid-term wear in primary total hip replacement: a meta-analysis and systematic review of randomized clinical trials using radiostereometric analysis. EFORT Open Rev 2021; 6:759-770. [PMID: 34667647 PMCID: PMC8489480 DOI: 10.1302/2058-5241.6.200072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Vitamin E incorporation into highly cross-linked polyethylene (HXLPE) has been introduced to improve wear resistance, and vitamin E incorporated HXLPE (VEPE) has been used in total hip arthroplasty. The aim of this meta-analysis was to investigate the wear properties of VEPE in clinical practice by synthesizing the data provided in randomized clinical trials. The effects on implant stability, functional outcomes and revision rate of VEPE were also compared with those of HXPLE or ultra-high molecular weight polyethylene (UHMWPE). Literature searches were conducted on 1 January 2020 using MEDLINE, EMBASE, Cochrane and ClinicalTrials.gov databases. Randomized controlled trials (RCTs) comparing the aforementioned parameters between VEPE and standard HXPLE/UHMWPE liners were included. Methodological quality and the bias of the included studies were analysed. Meta-analyses were performed using the Review Manager software. Nine RCTs met the eligibility criteria and were included. At early and mid-term follow-up, the vertical penetration and the total penetration of the femoral head were both significantly reduced in the VEPE group. The steady state wear rate of the VEPE group was also remarkably lower. However, at two-year follow-up, significantly increased cup migration was observed in the VEPE group. Moreover, the mid-term clinical outcomes of the VEPE group were worse, while the total revision rates between the two groups were not significantly different. The limited number of included studies may compromise our conclusion regarding clinical outcomes of the VEPE bearing surface. More RCTs with longer follow-up periods are needed to further investigate the effects of VEPE in total hip arthroplasty.
Cite this article: EFORT Open Rev 2021;6:759-770. DOI: 10.1302/2058-5241.6.200072
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Affiliation(s)
- Zeng Li
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong, China.,Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China.,These authors contributed equally to the manuscript
| | - Shuai Xiang
- Department of Joint Surgery, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.,These authors contributed equally to the manuscript
| | - Cuijiao Wu
- Department of Histology & Embryology, Qingdao University Medical School, Qingdao, Shandong, China
| | - Yingzhen Wang
- Department of Joint Surgery, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Xisheng Weng
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China
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Tsikandylakis G, Mortensen KRL, Gromov K, Mohaddes M, Malchau H, Troelsen A. Does the use of the largest possible metal head increase the wear of vitamin E-doped cross-linked polyethylene? Two-year results from a randomized controlled trial. Bone Joint J 2021; 103-B:1206-1214. [PMID: 34192938 DOI: 10.1302/0301-620x.103b7.bjj-2020-2064.r1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS We aimed to investigate if the use of the largest possible cobalt-chromium head articulating with polyethylene acetabular inserts would increase the in vivo wear rate in total hip arthroplasty. METHODS In a single-blinded randomized controlled trial, 96 patients (43 females), at a median age of 63 years (interquartile range (IQR) 57 to 69), were allocated to receive either the largest possible modular femoral head (36 mm to 44 mm) in the thinnest possible insert or a standard 32 mm head. All patients received a vitamin E-doped cross-linked polyethylene insert and a cobalt-chromium head. The primary outcome was proximal head penetration measured with radiostereometric analysis (RSA) at two years. Secondary outcomes were volumetric wear, periacetabular radiolucencies, and patient-reported outcomes. RESULTS At two years, 44 patients in each group were available for RSA assessment. The median total two-year proximal head penetration was -0.02 mm (IQR -0.09 to 0.07; p = 0.548) for the largest possible head and -0.01 mm (IQR -0.07 to 0.10; p = 0.525) for 32 mm heads. Their difference was not statistically significant (p = 0.323). Neither group demonstrated a bedding-in period. The median steady-state volumetric wear rates were 6.1 mm3/year (IQR -59 to 57) and 3.5 mm3/year (-21 to 34) respectively, and did not differ between the groups (p = 0.848). There were no statistically significant differences in periacetabular radiolucencies or patient-reported outcomes. CONCLUSION The use of the largest possible metal head did not increase vitamin E-doped cross-linked polyethylene wear compared with 32 mm heads at two years. Linear wear was negligible and volumetric wear rates were very low in both head size groups. There was a tendency towards higher values of volumetric wear in large heads that warrants longer-term evaluation before any definite conclusions about the association between head size and wear can be drawn. Cite this article: Bone Joint J 2021;103-B(7):1206-1214.
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Affiliation(s)
- Georgios Tsikandylakis
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Orthopaedics, University of Gothenburg, Sahlgrenska Academy, Institute of Clinical Sciences, Gothenburg, Sweden
| | - Kristian R L Mortensen
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kirill Gromov
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark
| | - Maziar Mohaddes
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Orthopaedics, University of Gothenburg, Sahlgrenska Academy, Institute of Clinical Sciences, Gothenburg, Sweden
| | - Henrik Malchau
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Orthopaedics, University of Gothenburg, Sahlgrenska Academy, Institute of Clinical Sciences, Gothenburg, Sweden.,Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Harvard University, Boston, Massachusetts, USA
| | - Anders Troelsen
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark
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Hemmilä M, Laaksonen I, Matilainen M, Eskelinen A, Haapakoski J, Puhto AP, Kettunen J, Pamilo K, Mäkelä KT. Implant survival of 2,723 vitamin E-infused highly crosslinked polyethylene liners in total hip arthroplasty: data from the Finnish Arthroplasty Register. Acta Orthop 2021; 92:316-322. [PMID: 33517823 PMCID: PMC8231410 DOI: 10.1080/17453674.2021.1879513] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - The use of crosslinked polyethylene in total hip arthroplasty (THA) has decreased wear remarkably. It has been suggested that the antioxidative effects of vitamin E may enhance the wear properties of polyethylene even further. This study evaluates revision rates between vitamin E-infused polyethylene liners (E1 and E-poly, ZimmerBiomet, Warsaw, IN, USA) versus moderately crosslinked polyethylene (ModXLPE) liners from the same manufacturer used in primary THA.Patients and methods - We conducted a study based on data from the Finnish Arthroplasty Register. The study group consisted of 2,723 THAs with a vitamin E-infused liner and a reference group of 2,707 THAs with a moderately crosslinked polyethylene liner. Survivorship, revision risk, and re-revision causes were compared between groups.Results - The 7-year survival of the vitamin E-infused polyethylene liner group and of the reference group with revision for any reason as the endpoint was comparable (94% [95% CI 92.9-94.9] and 93% [CI 91.9-93.9], respectively). The adjusted hazard ratio (HR) for any revision was similar between the groups (0.7 [CI 0.4-1.1]). When revision for aseptic loosening was studied as the endpoint, the survival for the study group was 99% (CI 98.6-99.4) and for the reference group 99% (CI 98.7-99.5), and the risk of revision was comparable between the study groups (HR 1.3 [CI 0.7-2.5]).Interpretation - After an observation period of 7 years vitamin E-infused liners shows results equal to results obtained with crosslinked polyethylene liners.
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Affiliation(s)
- Matias Hemmilä
- Department of Orthopaedic Surgery, University of Turku and Turku University Hospital, Turku; ,Correspondence:
| | - Inari Laaksonen
- Department of Orthopaedic Surgery, University of Turku and Turku University Hospital, Turku;
| | - Markus Matilainen
- Turku PET Centre, University of Turku and Turku University Hospital, Turku;
| | - Antti Eskelinen
- Coxa Hospital for Joint Replacement and Faculty of Medicine and Health Technologies, Tampere University, Tampere;
| | | | - Ari-Pekka Puhto
- Division of Operative Care, Department of Orthopaedic and Trauma Surgery, Oulu University Hospital, Oulu;
| | - Jukka Kettunen
- Department of Orthopaedics and Traumatology, Kuopio University Hospital, Kuopio, Finland
| | - Konsta Pamilo
- Coxa Hospital for Joint Replacement and Faculty of Medicine and Health Technologies, Tampere University, Tampere;
| | - Keijo T Mäkelä
- Department of Orthopaedic Surgery, University of Turku and Turku University Hospital, Turku;
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Rochcongar G, Remazeilles M, Bourroux E, Dunet J, Chapus V, Feron M, Praz C, Buia G, Hulet C. Reduced wear in vitamin E-infused highly cross-linked polyethylene cups: 5-year results of a randomized controlled trial. Acta Orthop 2021; 92:151-155. [PMID: 33263447 PMCID: PMC8158183 DOI: 10.1080/17453674.2020.1852785] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Background and purpose - Vitamin E-infused polyethylene is a relatively new material in joint arthroplasty; there are no long-term reports, and only few mid-term results. Using radiostereometric analysis (RSA), we primarily determined whether vitamin E-infused highly cross-linked polyethylene (HXLPE/VitE) acetabular cups show less wear than ultra-high molecular weight polyethylene (UHMWPE) acetabular cups at 5 years after total hip arthroplasty (THA). We also assessed whether wear rates correlate with increasing cup inclination angles or cup sizes.Patients and methods - This is a 5-year follow-up of our previously reported randomized controlled trial of 62 patients with 3 years' follow-up, who received THA with either an HXLPE/VitE or a UHMWPE acetabular cup. At 5 years, 40 patients were analyzed (22 in the HXLPE/VitE and 18 in the UHMWPE group).Results - HXLPE/VitE cups continued to show less cumulative femoral head penetration than UHMWPE cups (HXLPE/VitE: 0.24 mm, UHMWPE: 0.45 mm; p < 0.001). Distribution of wear was also more even with HXLPE/VitE cups than with UHMWPE cups (p = 0.002). Moreover, the difference in PE wear between 1 and 5 years in both groups showed no statistically significant correlation with increasing cup inclination angles or cup sizes. Finally, no osteolysis and implant loosening occurred, and no revision surgeries were required.Interpretation - Wear rates continue to be lower in HXLPE/VitE cups than in UHMWPE cups at 5 years of follow-up without correlation with increasing cup inclination angles or cup sizes. Finally, HXLPE/VitE cups may have the potential to prevent osteolysis and implant loosening.
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Affiliation(s)
- Goulven Rochcongar
- Caen Normandy University Hospital Centre, Department of Orthopaedic and Trauma Surgery, 14000, Caen, France
| | - Matthieu Remazeilles
- Caen Normandy University Hospital Centre, Department of Orthopaedic and Trauma Surgery, 14000, Caen, France
| | - Emeline Bourroux
- Caen Normandy University Hospital Centre, Department of Orthopaedic and Trauma Surgery, 14000, Caen, France
| | - Julien Dunet
- Caen Normandy University Hospital Centre, Department of Orthopaedic and Trauma Surgery, 14000, Caen, France
| | - Valentin Chapus
- Caen Normandy University Hospital Centre, Department of Orthopaedic and Trauma Surgery, 14000, Caen, France
| | - Matthieu Feron
- Caen Normandy University Hospital Centre, Department of Orthopaedic and Trauma Surgery, 14000, Caen, France
| | - César Praz
- Caen Normandy University Hospital Centre, Department of Orthopaedic and Trauma Surgery, 14000, Caen, France,Correspondence:
| | - Geoffrey Buia
- Caen Normandy University Hospital Centre, Department of Orthopaedic and Trauma Surgery, 14000, Caen, France
| | - Christophe Hulet
- Caen Normandy University Hospital Centre, Department of Orthopaedic and Trauma Surgery, 14000, Caen, France
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Parekh A, Sood A, Monsef JB, Hamouda M, Hussain A, Gonzalez M. Second-Generation Highly Cross-Linked Polyethylene in Total Hip Arthroplasty. JBJS Rev 2021; 9:e20.00065. [PMID: 33982980 DOI: 10.2106/jbjs.rvw.20.00065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Amit Parekh
- Department of Orthopaedic Surgery, University of Illinois, Chicago, Illinois
| | - Anshum Sood
- Department of Orthopaedic Surgery, University of Illinois, Chicago, Illinois
| | - Jad Bou Monsef
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Awais Hussain
- Department of Orthopaedic Surgery, University of Illinois, Chicago, Illinois
| | - Mark Gonzalez
- Department of Orthopaedic Surgery, University of Illinois, Chicago, Illinois
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Comtesse S, de Gast A, Rehbein P, French G, Helmy N, Becker R, Dominkus M, Beck M. Wear and migration are not influenced by head size in a vitamin E-infused highly cross-linked polyethylene acetabular cup. Orthop Traumatol Surg Res 2021; 107:102644. [PMID: 33384276 DOI: 10.1016/j.otsr.2020.03.030] [Citation(s) in RCA: 4] [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: 06/04/2019] [Revised: 03/19/2020] [Accepted: 03/24/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Aseptic loosening and periprosthetic osteolysis are frequent complications in total hip arthroplasty requiring revision surgery. Highly cross-linked polyethylene (HXLPE) implants have improved wear resistance, permitting larger femoral heads. However, such implants may experience surface cracking, mechanical failure, and oxidative damage. Vitamin E-infused HXLPE (VEPE) implants were therefore developed to reduce oxidation without compromising mechanical strength. We addressed the following questions: (1) Does femoral head size affect the midterm annual polyethylene wear rates of VEPE acetabular cups? (2) Does femoral head size affect the midterm migration rates of VEPE acetabular cups? (3) Are clinical outcomes affected by femoral head size? HYPOTHESIS Annual wear rate, migration rate, and clinical outcomes of VEPE acetabular cups are independent of femoral head size. PATIENTS AND METHODS This was a prospective, multicentre, observational study of patients that underwent total hip arthroplasty. Hips were grouped according to the size of femoral head implanted (28 mm, 32 mm, and 36 mm). We determined annual wear rate and migration rate of VEPE acetabular cups using the Einzel-Bild-Röntgen-Analyse software. Clinically, we assessed the Harris Hip Score and visual analog score for pain and satisfaction. RESULTS We followed 253 patients (267 hips) for a mean of 55.0±20.6 months in the 28 mm, 46.2±21.4 months in the 32 mm, and 43.8±22.6 months in the 36 mm group. The annual wear rate was 0.025 mm per year from 1 year to the last follow-up and remained similar between the groups (p>0.05). Also, mean two-dimensional migration rates did not exceed 0.05 mm from 2 years to the last follow-up and remained similar between the groups (p=0.355). Finally, clinical outcomes also did not differ between the groups (p>0.05). Two patients required revision surgery. DISCUSSION Femoral head size did not influence midterm annual wear rate, migration rate, and clinical outcomes of VEPE acetabular cups. Furthermore, wear and cup migration rates were below the reported values leading to osteolysis and aseptic loosening. Nevertheless, studies with extended follow-up periods will be necessary to confirm these results in the long term. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Simon Comtesse
- Mathys Ltd Bettlach, Robert-Mathys Strasse 5, 2544 Bettlach, Switzerland
| | - Arthur de Gast
- Diakonessenhuis Utrecht, Bosboomstraat 1, 3582 KE Utrecht, Netherlands; Clinical Orthopedic Research Centre midden-Nederland, Diakonessenhuis Zeist, Jagersingel 1, 3707 HL Zeist, Netherlands
| | - Philipp Rehbein
- St. Josefs-Hospital Wiesbaden, Beethovenstraße 20, 65189 Wiesbaden, Germany
| | - Gary French
- Ormiston Hospital, 125, Ormiston Road, Flat Bush, 2016 Manukau, New Zealand
| | - Naeder Helmy
- Bürgerspital Solothurn, Schöngrünstrasse 42, 4500 Solothurn, Switzerland
| | - Roland Becker
- Zentrum für Orthopädie und Unfallchirurgie, Endoprothesenzentrum West-Brandenburg, Medizinische Hochschule Theodor Fontane, 14776 Brandenburg/Havel, Germany
| | - Martin Dominkus
- Orthopädisches Spital Speising, Speisinger Straße 109, 1130 Wien, Austria; Sigmund-Freud University, Campus Prater Freudplatz 1, 1020 Wien, Austria
| | - Martin Beck
- Luzerner Kantonsspital, Spitalstrasse, 6000 Luzern, Switzerland.
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10
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Vitamin E-blended highly cross-linked polyethylene liners in total hip arthroplasty: a randomized, multicenter trial using virtual CAD-based wear analysis at 5-year follow-up. Arch Orthop Trauma Surg 2020; 140:1859-1866. [PMID: 32048017 DOI: 10.1007/s00402-020-03358-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Progressive oxidation of highly cross-linked ultra-high molecular weight (UHMPWE-X) liners is considered to be a risk factor for material failure in THA. Antioxidants such as vitamin E (alpha-tocopherol) (UHMWPE-XE) were supplemented into the latest generation of polyethylene liners. To prevent inhomogenous vitamin E distribution within the polymer, blending was established as an alternative manufacturing process to diffusion. The purpose of the present study was to investigate the in vivo wear behavior of UHMWPE-XE in comparison with conventional UHMWPE-X liners using virtual CAD-based radiographs. METHODS Until now, 94 patients from a prospective, randomized, controlled, multicenter study were reviewed at 5-year follow-up. Of these, 51 (54%) received UHMWPE-XE and 43 (46%) UHMWPE-X liners. Anteroposterior pelvic radiographs were made immediately after surgery and at 1 and 5 years postoperatively. The radiographs were analyzed using the observer-independent analysis software RayMatch® (Raylytic GmbH, Leipzig, Germany). RESULTS The mean wear rate was measured to be 23.6 μm/year (SD 13.7; range 0.7-71.8 μm). There were no significant differences between the two cohorts (UHMWPE-X: 23.2 μm/year vs. UHMWPE-XE: 24.0 μm/year, p = 0.73). Cup anteversion significantly changed within the 1st year after implantation independent from the type of polyethylene liner [UHMWPE-X: 18.2-23.9° (p = 0.0001); UHMWPE-XE: 21.0-25.5° (p = 0.002)]. No further significant changes of cup anteversion in both groups were found between year 1 and 5 after implantation [UHMWPE-X (p = 0.46); UHMWPE-XE (p = 0.56)]. CONCLUSION The present study demonstrates that the addition of vitamin E does not adversely affect the midterm wear behavior of UHMWPE-X. The antioxidative benefit of vitamin E is expected to become evident in long-term follow-up. Cup anteversion increment by 5° within the 1st year is likely a result of the released hip flexion contracture resulting in an enhanced posterior pelvic tilt. Therefore, a reassessment of target values in acetabular cup placement might be considered.
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Tsikandylakis G, Mortensen KR, Gromov K, Troelsen A, Malchau H, Mohaddes M. The Use of Porous Titanium Coating and the Largest Possible Head Do Not Affect Early Cup Fixation: A 2-Year Report from a Randomized Controlled Trial. JB JS Open Access 2020; 5:e20.00107. [PMID: 33376932 PMCID: PMC7757840 DOI: 10.2106/jbjs.oa.20.00107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Cups are more frequently revised than stems after uncemented total hip arthroplasty, which warrants the development of cup surfaces that provide long-lasting, stable fixation. Large heads have become popular with the aim of reducing dislocation rates, but they generate greater frictional torque that may compromise cup fixation. We aimed to investigate (1) if a novel porous titanium surface provides superior cup fixation when compared with a porous plasma spray (PPS) surface and (2) if the use of the largest possible head compromises cup fixation when compared with a 32-mm head. METHODS Ninety-six patients were randomized to receive either a cup with a porous titanium coating (PTC) or a cup with PPS. A second randomization was performed to either the largest possible (36 to 44-mm) or a 32-mm head in metal-on-vitamin-E-infused polyethylene bearings. Roentgen stereophotogrammetric analysis (RSA) examinations were obtained postoperatively at 3, 12, and 24 months. The primary outcome was proximal cup migration when comparing the 2 cup surfaces and also when comparing the largest possible head with the 32-mm head. The patients were followed for 2 years. RESULTS The median (and interquartile range) proximal cup migration was 0.15 mm (0.02 to 0.32 mm) for the PTC cup and 0.21 mm (0.11 to 0.34 mm) for the PPS cup. The largest possible head had a proximal cup migration of 0.15 mm (0.09 to 0.31 mm), and the 32-mm head had a proximal cup migration of 0.20 mm (0.04 to 0.35 mm). There were no significant differences between the cup surface (p = 0.378) or the head size (p = 0.693) groups. CONCLUSIONS Early cup fixation was not superior with the novel PTC cup; the use of the largest possible head (36 to 44 mm) did not compromise early cup fixation. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Georgios Tsikandylakis
- Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kristian R.L. Mortensen
- Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kirill Gromov
- Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anders Troelsen
- Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Malchau
- Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Maziar Mohaddes
- Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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12
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Hameister R, Kaur C, Dheen ST, Lohmann CH, Singh G. Reactive oxygen/nitrogen species (ROS/RNS) and oxidative stress in arthroplasty. J Biomed Mater Res B Appl Biomater 2020; 108:2073-2087. [PMID: 31898397 DOI: 10.1002/jbm.b.34546] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 11/19/2019] [Accepted: 12/08/2019] [Indexed: 12/16/2022]
Abstract
The interplay between implant design, biomaterial characteristics, and the local microenvironment adjacent to the implant is of utmost importance for implant performance and success of the joint replacement surgery. Reactive oxygen and nitrogen species (ROS/RNS) are among the various factors affecting the host as well as the implant components. Excessive formation of ROS and RNS can lead to oxidative stress, a condition that is known to damage cells and tissues and also to affect signaling pathways. It may further compromise implant longevity by accelerating implant degradation, primarily through activation of inflammatory cells. In addition, wear products of metallic, ceramic, polyethylene, or bone cement origin may also generate oxidative stress themselves. This review outlines the generation of free radicals and oxidative stress in arthroplasty and provides a conceptual framework on its implications for soft tissue remodeling and bone resorption (osteolysis) as well as implant longevity. Key findings derived from cell culture studies, animal models, and patients' samples are presented. Strategies to control oxidative stress by implant design and antioxidants are explored and areas of controversy and challenges are highlighted. Finally, directions for future research are identified. A better understanding of the host-implant interplay and the role of free radicals and oxidative stress will help to evaluate therapeutic approaches and will ultimately improve implant performance in arthroplasty.
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Affiliation(s)
- Rita Hameister
- Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Charanjit Kaur
- Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Shaikali Thameem Dheen
- Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Christoph H Lohmann
- Department of Orthopaedic Surgery, Otto-von-Guericke University, Magdeburg, Germany
| | - Gurpal Singh
- Centre for Orthopaedics Pte Ltd, Singapore, Singapore
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13
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Oral E, Doshi BN, Fung K, O'Brien C, Wannomae KK, Muratoglu OK. Chemically Cross-Linked UHMWPE With Superior Toughness. J Orthop Res 2019; 37:2182-2188. [PMID: 31206815 DOI: 10.1002/jor.24393] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 05/23/2019] [Indexed: 02/04/2023]
Abstract
Radiation cross-linked ultra-high-molecular-weight polyethylenes (UHMWPEs) are clinically used extensively in total joint arthroplasty due to their high wear resistance. Peroxide cross-linking of UHMWPE has been proposed to achieve this high level of wear resistance by simultaneously consolidating and cross-linking in the melt state. High temperature melting of uncross-linked and cross-linked UHMWPEs have further shown to improve the toughness. Here, we report on the wear and mechanical properties of a peroxide cross-linked and high-temperature melted UHMWPE as a function of vitamin E concentration for oxidative stabilization, peroxide concentration for cross-linking and high temperature melting temperature for toughness improvement. This method, combining consolidation and cross-linking in one step, presents an opportunity to manufacture highly wear and oxidation-resistant joint implant-bearing surfaces with much improved toughness. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2182-2188, 2019.
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Affiliation(s)
- Ebru Oral
- Department of Orthopaedic Surgery, Harris Orthopedic Laboratory, Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts, 02114.,Department of Orthopedic Surgery, Harvard Medical School, Boston, Massachusetts
| | - Brinda N Doshi
- Department of Orthopaedic Surgery, Harris Orthopedic Laboratory, Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts, 02114
| | - Katharina Fung
- Department of Orthopaedic Surgery, Harris Orthopedic Laboratory, Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts, 02114
| | - Caitlin O'Brien
- Department of Orthopaedic Surgery, Harris Orthopedic Laboratory, Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts, 02114
| | - Keith K Wannomae
- Department of Orthopaedic Surgery, Harris Orthopedic Laboratory, Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts, 02114
| | - Orhun K Muratoglu
- Department of Orthopaedic Surgery, Harris Orthopedic Laboratory, Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts, 02114.,Department of Orthopedic Surgery, Harvard Medical School, Boston, Massachusetts
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14
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Lindalen E, Thoen PS, Nordsletten L, Høvik Ø, Röhrl SM. Low wear rate at 6-year follow-up of vitamin E-infused cross-linked polyethylene: a randomised trial using 32- and 36-mm heads. Hip Int 2019; 29:355-362. [PMID: 30227721 DOI: 10.1177/1120700018798790] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Free radicals formed in the cross-linking process may over time alter the mechanical properties of highly cross-linked polyethylene. Vitamin E-infused highly cross-linked polyethylene was therefore developed to achieve low wear-rate and good mechanical properties in the long term. AIM To present 6-year results from the initial randomised controlled trial. PATIENTS AND METHODS We measured wear and periacetabular bone remodelling in cementless total hip arthroplasty; 32- or 36-mm Biolox Delta heads and vitamin E-infused highly cross-linked polyethylene (E-Poly) were used. Markerless radiosterometric analysis measured the in vivo wear and dual energy x-ray absorptiometry was used to analyse bone remodelling in 40 hips at 6-year follow-up. RESULTS In the proximal direction the wear for 32- and 36-mm heads was 0.15 mm (95% confidence interval [CI], 0.08-0.21) and 0.06 mm (95% CI, -0.002-0.12), respectively (p = 0. 015). However, between 3 months and 6 years (excluding the period of "bedding in"), the proximal wear for 32- and 36-mm heads was 0.10 mm (95% CI, 0.05-0.15) and 0.05 mm (95% CI, -0.01-0.11), respectively (p = 0.12). The annual proximal wear rate for 32- and 36-mm heads from 3 months to 6 years was 0.02 mm and 0.01 mm, respectively. There was no difference in bone remodelling around the cup from baseline to 6 years for the total material and no differences between study groups. CONCLUSION Wear of this vitamin E-infused highly cross-linked polyethylene is still low at 6-year follow-up, with no significant difference in wear from 3 months to 6 years between 32- and 36-mm heads.
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Affiliation(s)
- Einar Lindalen
- 1 Department of Orthopaedic Surgery, Lovisenberg Deaconal Hospital, Oslo, Norway
| | - Peder S Thoen
- 1 Department of Orthopaedic Surgery, Lovisenberg Deaconal Hospital, Oslo, Norway
| | - Lars Nordsletten
- 2 Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,3 Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Øystein Høvik
- 1 Department of Orthopaedic Surgery, Lovisenberg Deaconal Hospital, Oslo, Norway
| | - Stephan M Röhrl
- 2 Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
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15
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Takemura S, Minoda Y, Sugama R, Ohta Y, Nakamura S, Ueyama H, Nakamura H. Comparison of a vitamin E-infused highly crosslinked polyethylene insert and a conventional polyethylene insert for primary total knee arthroplasty at two years postoperatively. Bone Joint J 2019; 101-B:559-564. [PMID: 31039001 DOI: 10.1302/0301-620x.101b5.bjj-2018-1355.r1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
AIMS The use of vitamin E-infused highly crosslinked polyethylene (HXLPE) in total knee prostheses is controversial. In this paper we have compared the clinical and radiological results between conventional polyethylene and vitamin E-infused HXLPE inserts in total knee arthroplasty (TKA). PATIENTS AND METHODS The study included 200 knees (175 patients) that underwent TKA using the same total knee prostheses. In all, 100 knees (77 patients) had a vitamin E-infused HXLPE insert (study group) and 100 knees (98 patients) had a conventional polyethylene insert (control group). There were no significant differences in age, sex, diagnosis, preoperative knee range of movement (ROM), and preoperative Knee Society Score (KSS) between the two groups. Clinical and radiological results were evaluated at two years postoperatively. RESULTS Differences in postoperative ROM and KSS were not statistically significant between the study and control groups. No knee exhibited osteolysis, aseptic loosening, or polyethylene failure. Additionally, there was no significant difference in the incidence of a radiolucent line between the two groups. One patient from the study group required irrigation and debridement, due to deep infection, at six months postoperatively. CONCLUSION Clinical results were comparable between vitamin E-infused HXLPE inserts and conventional polyethylene inserts at two years after TKA, without any significant clinical failure. Cite this article: Bone Joint J 2019;101-B:559-564.
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Affiliation(s)
- S Takemura
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Y Minoda
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - R Sugama
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Y Ohta
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - S Nakamura
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - H Ueyama
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - H Nakamura
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
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16
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Castagnini F, Bordini B, Yorifuji M, Giardina F, Natali S, Pardo F, Traina F. Highly Porous Titanium Cups versus Hydroxyapatite-Coated Sockets: Midterm Results in Metachronous Bilateral Total Hip Arthroplasty. Med Princ Pract 2019; 28:559-565. [PMID: 31079112 PMCID: PMC6944922 DOI: 10.1159/000500876] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 05/12/2019] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE Highly porous titanium cups have been recently introduced, with contradictory outcomes. A retrospective consecutive case series involving bilateral metachronous total hip arthroplasties (THA) performed with 2 different cups, i.e., Fixa (F) and Fixa Ti-Por (T) (Adler Ortho, Milan, Italy), and the same stem, was evaluated. T sockets, manufactured using electron beam melting, were supposed to prove superior in terms of clinical results, survival rates, and radiographic parameters in comparison to hydroxyapatite-coated F cups with conventional porosity. SUBJECTS AND METHODS Twenty-four bilateral metachronous THAs with an F cup on one side and a T socket on the other side were evaluated. Preoperative and postoperative Harris hip scores (HHS) were collected for every patient. Radiographic signs of loosening were assessed. The radiographic signs of osseointegration (radiolucent lines, superolateral buttress, inferomedial buttress, radial trabeculae, and stress shielding) were evaluated. RESULTS No intraoperative complications occurred. The mean HHS score was excellent and comparable in both groups. At the mean follow-up of 134 months (F) and 79 months (T), no cup or liner revisions were performed. No radiographic signs of loosening were reported. All of the patients revealed 3 parameters of good bony ingrowth at least. Both groups showed similar radiographic parameters regarding osseointegration, which were stable over the time. Stress shielding was more evident in the T cohort (p =0.07). CONCLUSION Highly porous titanium cups produced using an additive manufacturing and electron beam melting technology achieved reliable midterm clinical and radiographic results not inferior to those of second-generation cups.
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Affiliation(s)
- Francesco Castagnini
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d'Anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy,
| | - Barbara Bordini
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Makiko Yorifuji
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Federico Giardina
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d'Anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Simone Natali
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d'Anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Francesco Pardo
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d'Anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Francesco Traina
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d'Anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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17
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Galea VP, Connelly JW, Shareghi B, Kärrholm J, Sköldenberg O, Salemyr M, Laursen MB, Muratoglu O, Bragdon C, Malchau H. Evaluation of in vivo wear of vitamin E-diffused highly crosslinked polyethylene at five years. Bone Joint J 2018; 100-B:1592-1599. [DOI: 10.1302/0301-620x.100b12.bjj-2018-0371.r1] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Aims The primary aim of this study was to compare the wear properties of vitamin E-diffused, highly crosslinked polyethylene (VEPE) and one formulation of moderately crosslinked and mechanically annealed ultra-high molecular weight polyethylene (ModXLPE) in patients five years after primary total hip arthroplasty (THA). The secondary aim was to assess the clinical results of patients treated with VEPE by evaluating patient-reported outcome measures (PROMs), radiological evidence of fixation, and the incidence of mechanical failure. Patients and Methods A total of 208 patients (221 THAs) from four international centres were recruited into a prospective study involving radiostereometric analysis (RSA) and the assessment of clinical outcomes. A total of 193 hips (87%) were reviewed at the five-year follow-up. Of these, 136 (70%) received VEPE (vs ModXLPE) liners and 68 (35%) received ceramic (vs metal) femoral heads. PROMs and radiographs were collected preoperatively and at one, two, and five years postoperatively. In addition, RSA images were collected to measure PE wear postoperatively and at one, two, and five years after surgery. Results We observed similar bedding in one year postoperatively and wear two years postoperatively between the two types of liner. However, there was significantly more penetration of the femoral head in the ModXLPE cohort compared with the VEPE cohort five years postoperatively (p < 0.001). The only variables independently predictive of increased wear were ModXLPE (vs VEPE) liner type (β = 0.22, p = 0.010) and metal (vs ceramic) femoral head (β = 0.21, p = 0.013). There was no association between increased wear and the development of radiolucency (p = 0.866) or PROMs. No patient had evidence of osteolysis. Conclusion Five years postoperatively, patients with VEPE (vs ModXLPE) and ceramic (vs metal) femoral heads had decreased wear. The rates of wear for both liners were very low and have not led to any osteolysis or implant failure due to aseptic loosening.
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Affiliation(s)
- V. P. Galea
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - J. W. Connelly
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - B. Shareghi
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - J. Kärrholm
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - O. Sköldenberg
- Department of Clinical Sciences, Danderyd Hospital, Division of Orthopaedics, Karolinska Institutet, Stockholm, Sweden
| | - M. Salemyr
- Department of Clinical Sciences, Danderyd Hospital, Division of Orthopaedics, Karolinska Institutet, Stockholm, Sweden
| | - M. B. Laursen
- Department of Orthopaedics, Aalborg University Hospital, Aalborg, Denmark
| | - O. Muratoglu
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts, USA; Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - C. Bragdon
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts, USA; Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - H. Malchau
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts, USA; Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts, USA
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18
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Popoola OO, Orozco Villasenor DA, Fryman JC, Mimnaugh K, Rufner A. High cycle in vitro hip wear of and in vivo biological response to vitamin E blended highly crosslinked polyethylene. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.biotri.2018.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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19
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Lambert B, Neut D, van der Veen HC, Bulstra SK. Effects of vitamin E incorporation in polyethylene on oxidative degradation, wear rates, immune response, and infections in total joint arthroplasty: a review of the current literature. INTERNATIONAL ORTHOPAEDICS 2018; 43:1549-1557. [PMID: 30470866 DOI: 10.1007/s00264-018-4237-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 11/14/2018] [Indexed: 02/04/2023]
Abstract
Highly cross-linked ultrahigh molecular weight polyethylene (UHMWPE) was introduced to decrease wear debris and osteolysis. During cross-linking, free radicals are formed, making highly cross-linked polyethylene vulnerable to oxidative degradation. In order to reduce this process, anti-oxidant vitamin E can be incorporated in polyethylene. This review provides an overview of the effects of vitamin E incorporation on major complications in total joint arthroplasty: material failure due to oxidative degradation, wear debris and subsequent periprosthetic osteolysis, and prosthetic joint infections. Secondly, this review summarizes the first clinical results of total hip and knee arthroplasties with vitamin E incorporated highly cross-linked polyethylene. Based on in vitro studies, incorporation of vitamin E in polyethylene provides good oxidative protection and preserves low wear rates. Incorporation of vitamin E may have the beneficial effect of reduced inflammatory response to its wear particles. Some microorganisms showed reduced adherence to vitamin E-incorporated UHMWPE; however, clinical relevance is doubtful. Short-term clinical studies of total hip and knee arthroplasties with vitamin E-incorporated highly cross-linked UHMWPE reported good clinical results and wear rates similar to highly cross-linked UHMWPE without vitamin E.
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Affiliation(s)
- Bart Lambert
- Department of Orthopedic Surgery, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Daniëlle Neut
- Department of Biomedical Engineering, University of Groningen, University Medical Center Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, The Netherlands
| | - Hugo C van der Veen
- Department of Orthopedic Surgery, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands.
| | - Sjoerd K Bulstra
- Department of Orthopedic Surgery, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
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20
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Rochcongar G, Buia G, Bourroux E, Dunet J, Chapus V, Hulet C. Creep and Wear in Vitamin E-Infused Highly Cross-Linked Polyethylene Cups for Total Hip Arthroplasty: A Prospective Randomized Controlled Trial. J Bone Joint Surg Am 2018; 100:107-114. [PMID: 29342060 DOI: 10.2106/jbjs.16.01379] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Aseptic loosening, the most common indication for revision surgery in total hip arthroplasty, can result from osteolysis caused by polyethylene (PE) wear particles. PE wear is increased by age-related oxidation of PE and free radicals emerging during irradiation cross-linking. Diffusion of vitamin E into PE stabilizes free radicals to maintain the biomechanical properties of PE. The purpose of this study was to determine whether vitamin E-infused highly cross-linked PE cups could reduce wear rates. METHODS We performed a prospective randomized controlled trial, in which 62 patients were allocated to 2 groups: a study group that received a vitamin E-infused highly cross-linked PE (HXLPE/VitE) cup and a control group that received an ultra-high molecular weight PE (UHMWPE) cup. Using radiostereometric analysis, we measured the penetration of the femoral head into the cup 7 days after surgery (baseline) and then again at 6 months and at 1, 2, and 3 years later. RESULTS Baseline variables did not differ significantly between the groups. At 1, 2, and 3 years after surgery, the HXLPE/VitE cup showed significantly less cumulative penetration (creep and wear) than the UHMWPE cup (p = 0.004, p < 0.0001, and p < 0.0001, respectively). The cumulative penetration after 3 years was 0.200 mm for the HXLPE/VitE cup versus 0.317 mm for the UHMWPE cup (p < 0.0001). From 1 to 3 years after surgery, after creep had stabilized and further penetration was mainly due to wear, the mean penetration increased only 0.04 mm in the HXLPE/VitE cup and 0.116 mm in the UHMWPE cup. CONCLUSIONS Our results confirm that wear rates over the first 3 years following surgery were lower in HXLPE/VitE cups than in UHMWPE cups. This suggests that HXLPE/VitE cups may prevent osteolysis, implant loosening, and eventually revision surgery. Long-term follow-up data continue to be collected to confirm these findings. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- G Rochcongar
- Department of Orthopedics and Traumatology, Caen University Hospital, Caen, France
| | - G Buia
- Department of Orthopedics and Traumatology, Caen University Hospital, Caen, France
| | - E Bourroux
- Department of Orthopedics and Traumatology, Caen University Hospital, Caen, France
| | - J Dunet
- Department of Orthopedics and Traumatology, Caen University Hospital, Caen, France
| | - V Chapus
- Department of Orthopedics and Traumatology, Caen University Hospital, Caen, France
| | - C Hulet
- Department of Orthopedics and Traumatology, Caen University Hospital, Caen, France
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21
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Abstract
Metal-on-highly cross-linked polyethylene is considered the preferred bearing surface for conventional total hip arthroplasty because of its safety profile and excellent results in the first 10 to 15 years of use. However, with younger patient age, activity expectations increase, and the life expectancy of patients with total hip arthroplasty also has increased, so interest remains in other bearing couples. These other options include the use of various ceramic composites for the femoral head on highly cross-linked polyethylene, the so-called second-generation antioxidant polyethylenes, and ceramic acetabular liners. Several of these bearing couples have shown excellent wear rates in vitro, and short-term clinical studies have demonstrated favorable wear and safety results. It is uncertain whether any of these bearing couples should be adopted at present. Understanding the unique properties and possible complications of these bearing couples is critical for appropriate implant selection.
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22
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Nebergall AK, Greene ME, Laursen MB, Nielsen PT, Malchau H, Troelsen A. Vitamin E diffused highly cross-linked polyethylene in total hip arthroplasty at five years: a randomised controlled trial using radiostereometric analysis. Bone Joint J 2017; 99-B:577-584. [PMID: 28455465 DOI: 10.1302/0301-620x.99b5.37521] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 01/10/2017] [Indexed: 01/10/2023]
Abstract
AIMS The objective of this five-year prospective, blinded, randomised controlled trial (RCT) was to compare femoral head penetration into a vitamin E diffused highly cross-linked polyethylene (HXLPE) liner with penetration into a medium cross-linked polyethylene control liner using radiostereometric analysis. PATIENTS AND METHODS Patients scheduled for total hip arthroplasty (THA) were randomised to receive either the study E1 (32 patients) or the control ArComXL polyethylene (35 patients). The median age (range) of the overall cohort was 66 years (40 to 76). RESULTS The five-year median (interquartile range) proximal femoral head penetration into the E1 was -0.05 mm (-0.13 to -0.02) and 0.07 mm (-0.03 to 0.16) for ArComXL. At three and five years, the penetration was significantly greater in the ArComXL group compared with the E1 group (p = 0.029 and p = 0.019, respectively). All patient-reported outcomes (PROs) improved significantly from the pre-operative interval compared with those at one year, and remained favourable at five years. There were no differences between the two groups at any interval. CONCLUSION The five-year results showed that E1 polyethylene does not wear more than the control, ArComXL. This is the longest-term RCT comparing the wear performance and clinical outcome of vitamin E diffused HXLPE with a previous generation of medium cross-linked polyethylene. Cite this article: Bone Joint J 2017;99-B:577-84.
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Affiliation(s)
- A K Nebergall
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - M E Greene
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - M B Laursen
- Aalborg University Hospital, Hobrovej 18-22, Aalborg, Denmark
| | - P T Nielsen
- Aalborg University Hospital, Hobrovej 18-22, Aalborg, Denmark
| | - H Malchau
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - A Troelsen
- Copenhagen University Hospital Hvidovre, Kettegård Alle 30, 2650, Hvidovre, Denmark
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23
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24
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Abstract
Articulating components should minimise the generation of wear particles in order to optimize long-term survival of the prosthesis. A good understanding of tribological properties helps the orthopaedic surgeon to choose the most suitable bearing for each individual patient. Conventional and highly cross-linked polyethylene articulating either with metal or ceramic, ceramic-on-ceramic and metal-on-metal are the most commonly used bearing combinations. All combinations of bearing surface have their advantages and disadvantages. An appraisal of the individual patient’s objectives should be part of the assessment of the best bearing surface.
Cite this article: Rieker CB. Tribology of total hip arthroplasty prostheses: what an orthopaedic surgeon should know. EFORT Open Rev 2016;1:52-57. DOI: 10.1302/2058-5241.1.000004.
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25
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Meneghini RM, Lovro LR, Wallace JM, Ziemba-Davis M. Large Metal Heads and Vitamin E Polyethylene Increase Frictional Torque in Total Hip Arthroplasty. J Arthroplasty 2016; 31:710-4. [PMID: 26482682 DOI: 10.1016/j.arth.2015.09.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 09/01/2015] [Accepted: 09/22/2015] [Indexed: 02/01/2023] Open
Abstract
PURPOSE Trunnionosis has reemerged in modern total hip arthroplasty for reasons that remain unclear. Bearing frictional torque transmits forces to the modular head-neck interface, which may contribute to taper corrosion. The purpose of this study is to compare frictional torque of modern bearing couples in total hip arthroplasty. METHODS Mechanical testing based on in vivo loading conditions was used to measure frictional torque. All bearing couples were lubricated and tested at 1 Hz for more than 2000 cycles. The bearing couples tested included conventional, highly crosslinked (XLPE) and vitamin E polyethylene, CoCr, and ceramic femoral heads and dual-mobility bearings. Statistical analysis was performed using Student t test for single-variable and analysis of variance for multivariant analysis. P ≤ .05 was considered statistically significant. RESULTS Large CoCr metal heads (≥36 mm) substantially increased frictional torque against XLPE liners (P = .01), a finding not observed in ceramic heads. Vitamin E polyethylene substantially increased frictional torque compared with XLPE in CoCr and ceramic heads (P = .001), whereas a difference between conventional and XLPE was not observed (P = .69) with the numbers available. Dual-mobility bearing with ceramic inner head demonstrated the lowest mean frictional torque of all bearing couples. CONCLUSION In this simulated in vivo model, large-diameter CoCr femoral heads and vitamin E polyethylene liners are associated with increased frictional torque compared with smaller metal heads and XLPE, respectively. The increased frictional torque of vitamin E polyethylene and larger-diameter femoral heads should be considered and further studied, along with reported benefits of these modern bearing couples.
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Affiliation(s)
- R Michael Meneghini
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Fishers, Indiana; Orthopedics and Sports Medicine, Indiana University Health Physicians, Fishers, Indiana
| | - Luke R Lovro
- Orthopedics and Sports Medicine, Indiana University Health Physicians, Fishers, Indiana
| | - Joseph M Wallace
- Department of Biomedical Engineering, Purdue School of Engineering and Technology at Indiana University-Purdue University, Indianapolis, Indiana
| | - Mary Ziemba-Davis
- Orthopedics and Sports Medicine, Indiana University Health Physicians, Fishers, Indiana
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26
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D’Antonio JA. CORR Insights(®): Wear and Osteolysis of Highly Crosslinked Polyethylene at 10 to 14 Years: The Effect of Femoral Head Size. Clin Orthop Relat Res 2016; 474:372-3. [PMID: 26024579 PMCID: PMC4709322 DOI: 10.1007/s11999-015-4365-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 05/18/2015] [Indexed: 01/31/2023]
Affiliation(s)
- James A. D’Antonio
- Greater Pittsburgh Orthopaedic Associates, 725 Cherrington Parkway, Suite 200, Moon Township, PA 15108 USA
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27
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Gigante A, Bottegoni C, Ragone V, Banci L. Effectiveness of Vitamin-E-Doped Polyethylene in Joint Replacement: A Literature Review. J Funct Biomater 2015; 6:889-900. [PMID: 26371052 PMCID: PMC4598683 DOI: 10.3390/jfb6030889] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 07/24/2015] [Accepted: 08/08/2015] [Indexed: 12/25/2022] Open
Abstract
Since polyethylene is one of the most frequently used biomaterials, such as in bearing components in joint arthroplasty, strong efforts have been made to improve the design and material properties over the last decades. Antioxidants, such as vitamin-E, seem to be a promising alternative to further increase durability and reduce polyethylene wear and degradation in the long-term. Nevertheless, even if several promising in vitro results are available, there is yet no clinical evidence that vitamin-E polyethylenes show these advantages in vivo. The aim of this paper was to provide a comprehensive overview on the current knowledge regarding the biological and mechanical proprieties of this biomaterial, underlying the in vitro and in vivo evidence for effectiveness of vitamin-E-doped polyethylene in joint arthroplasty.
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Affiliation(s)
- Antonio Gigante
- Clinical Orthopaedics, Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, via Tronto 10/A, 60126 Ancona, Italy.
| | - Carlo Bottegoni
- Clinical Orthopaedics, Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, via Tronto 10/A, 60126 Ancona, Italy.
| | - Vincenza Ragone
- Research and Development Department, Permedica S.p.A., via Como 38, 23807 Merate (LC), Italy.
| | - Lorenzo Banci
- Research and Development Department, Permedica S.p.A., via Como 38, 23807 Merate (LC), Italy.
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