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Lübbeke A, Barea C, Zingg M, Lauper N, Hannouche D, Garavaglia G. Radiographic signs and hip pain 5 years after THA with a cemented stem predict future revision for aseptic loosening: a prospective cohort study. Acta Orthop 2024; 95:32-38. [PMID: 38284749 PMCID: PMC10823869 DOI: 10.2340/17453674.2023.26190] [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: 03/18/2023] [Accepted: 11/02/2023] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND AND PURPOSE We aimed to evaluate the long-term predictive value of radiographic abnormality and/or hip pain assessed 5 years following primary total hip arthroplasty (THA) and the occurrence of revision for aseptic loosening between 5 and 25 years postoperatively. PATIENTS AND METHODS We included all primary THAs performed between 1996 and 2011 (same uncemented cup, polyethylene-ceramic bearing, 28 mm head, cemented stem) and prospectively enrolled in the institutional registry, for whom baseline and follow-up radiographs were available. At 5 years radiographically we assessed femoral osteolysis and/or stem migration. Pain was evaluated with the Harris Hip pain subscore. Kaplan-Meier survival and Cox regression analyses were performed. RESULTS 1,317 primary THAs were included. 25 THAs (2%) were revised for aseptic stem loosening. Any abnormal radiographic sign at 5 years was present in 191 THAs (14%). Occasional hip pain was reported by 20% and slight to severe pain by 12% of patients at 5 years. In patients < 60 years, 10 of the 12 later revised for aseptic stem loosening had abnormal radiographs at 5 years vs. 5 of the 13 later revised in those ≥ 60 years. Hazard ratios (HR) were 34 (95% confidence interval [CI] 7-155) in younger vs. 4 (CI 1-11) in the older group. HR for association of hip pain at 5 years with future revision was 3 (CI 1-5). CONCLUSION The presence of abnormal radiographic signs 5 years after THA was strongly associated with later revision for aseptic stem loosening, especially in patients < 60 years. The association between pain at 5 years and future revision was much weaker.
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Affiliation(s)
- Anne Lübbeke
- Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals, University of Geneva, Faculty of Medicine, Geneva, Switzerland; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
| | - Christophe Barea
- Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals, University of Geneva, Faculty of Medicine, Geneva, Switzerland
| | - Matthieu Zingg
- Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals, University of Geneva, Faculty of Medicine, Geneva, Switzerland
| | - Nicolas Lauper
- Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals, University of Geneva, Faculty of Medicine, Geneva, Switzerland
| | - Didier Hannouche
- Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals, University of Geneva, Faculty of Medicine, Geneva, Switzerland
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Marin E. Forged to heal: The role of metallic cellular solids in bone tissue engineering. Mater Today Bio 2023; 23:100777. [PMID: 37727867 PMCID: PMC10506110 DOI: 10.1016/j.mtbio.2023.100777] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/21/2023] [Accepted: 08/23/2023] [Indexed: 09/21/2023] Open
Abstract
Metallic cellular solids, made of biocompatible alloys like titanium, stainless steel, or cobalt-chromium, have gained attention for their mechanical strength, reliability, and biocompatibility. These three-dimensional structures provide support and aid tissue regeneration in orthopedic implants, cardiovascular stents, and other tissue engineering cellular solids. The design and material chemistry of metallic cellular solids play crucial roles in their performance: factors such as porosity, pore size, and surface roughness influence nutrient transport, cell attachment, and mechanical stability, while their microstructure imparts strength, durability and flexibility. Various techniques, including additive manufacturing and conventional fabrication methods, are utilized for producing metallic biomedical cellular solids, each offering distinct advantages and drawbacks that must be considered for optimal design and manufacturing. The combination of mechanical properties and biocompatibility makes metallic cellular solids superior to their ceramic and polymeric counterparts in most load bearing applications, in particular under cyclic fatigue conditions, and more in general in application that require long term reliability. Although challenges remain, such as reducing the production times and the associated costs or increasing the array of available materials, metallic cellular solids showed excellent long-term reliability, with high survival rates even in long term follow-ups.
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Affiliation(s)
- Elia Marin
- Ceramic Physics Laboratory, Kyoto Institute of Technology, Sakyo-ku, Matsugasaki, 606-8585, Kyoto, Japan
- Department of Dental Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, 602-8566, Japan
- Department Polytechnic of Engineering and Architecture, University of Udine, 33100, Udine, Italy
- Biomedical Research Center, Kyoto Institute of Technology, Sakyo-ku, Matsugasaki, Kyoto, 606-8585, Japan
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Huang L, Han W, Qi W, Zhang X, Lv Z, Lu Y, Zou D. Early unrestricted vs. partial weight bearing after uncemented total hip arthroplasty: a systematic review and meta-analysis. Front Surg 2023; 10:1225649. [PMID: 38033533 PMCID: PMC10684916 DOI: 10.3389/fsurg.2023.1225649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 10/31/2023] [Indexed: 12/02/2023] Open
Abstract
Background The choice of postoperative weight bearing protocol after uncemented total hip arthroplasty (THA) remains controversial. The aim of this study was to assess the efficacy and safety of immediate unrestricted weight bearing (UWB) compared with partial weight bearing (PWB) in patients undergoing uncemented THA. Methods Relevant articles were retrieved from electronic databases. Both randomized controlled trials (RCTs) and non-RCTs were included but analyzed separately. All functional and clinical outcomes with at least 2 independent study outcomes were meta-analyzed. Results A total of 17 studies were investigated. No adverse effect was found regarding micromotion of the femoral stem with immediate UWB following uncemented THA. There was also no correlation between immediate UWB and failure of ingrowth fixation and higher risks of femoral stem subsidence and surgical revision in RCTs. Harris hip score was better in patients with immediate UWB than those with PWB at 1 year post surgery, but the difference was not statistically significant. Conclusions Immediate UWB did not have extra harm compared with PWB in patients undergoing uncemented THA. UWB was not superior to PWB. Considering the improvement of Harris score and the compliance of patients, UWB can be encouraged in THA rehabilitation.
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Affiliation(s)
- Li Huang
- Department of Joint and Orthopedics, Orthopedic Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Weiyu Han
- Department of Joint and Orthopedics, Orthopedic Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Weizhong Qi
- Department of Joint and Orthopedics, Orthopedic Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaomeng Zhang
- Department of Joint and Orthopedics, Orthopedic Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Zhou Lv
- Department of Joint and Orthopedics, Orthopedic Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Yao Lu
- Department of Joint and Orthopedics, Orthopedic Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Danfeng Zou
- Huiqiao Medical Center, Nanfang Hospital of Southern Medical University, Guangzhou, China
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Foxall-Smith M, Wyatt MC, Frampton C, Kieser D, Hooper G. The 45-year evolution of the Mathys RM monoblock cups: have the paradigm shifts been worthwhile? Hip Int 2023; 33:193-202. [PMID: 35438033 DOI: 10.1177/11207000211067507] [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
INTRODUCTION The Robert Mathys (RM) monoblock uncemented cup is a design less commonly used in primary total hip replacement. It's purported advantages over modular cemented cups are: (1) its modulus of elasticity approximating bone, thus mimicking load transmission and the biomechanical behaviour of the cup to better match stresses on the acetabulum, leading to bone-preservation; and (2) as a 1-piece cup there is absence of a mobile interface between a liner and shell, preventing backside wear. Since its inception in 1983 there have been 3 major design changes: the RM Classic, the RM Pressfit, and the RM Vitamys with the most modern polyethylene (vitamin E). METHODS In a retrospective cohort study of the New Zealand Joint Registry, all designs of RM acetabular cup were reviewed. Data were included from1998 to 2018. All-cause revision rates, reasons for revision and the Oxford Hip Score (OHS) were assessed. RESULTS In total 13,272 acetabular cups were included. The all-cause revision rates did not differ between the designs. Revision rates for aseptic loosening in the RM Vitamys were lower, but the follow-up was shorter and more larger heads were used. There was no difference in the OHS. CONCLUSION All implant designs were safe. The use of larger heads led to a decrease in revisions due to dislocation. It has to be waited out whether the RM Vitamys performs superior in the long-term due to the highly cross-linked polyethylene.
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Affiliation(s)
| | - Michael C Wyatt
- Department of Trauma and Orthopaedic Surgery, Palmerston North Hospital, Massey University, Manawatu, New Zealand
| | - Christopher Frampton
- Department of Surgery and Musculoskeletal Medicine, University of Otago, New Zealand
| | - David Kieser
- Department of Surgery and Musculoskeletal Medicine, University of Otago, New Zealand
| | - Gary Hooper
- Department of Surgery and Musculoskeletal Medicine, University of Otago, New Zealand
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Reichel H, Fuchs M. [Acetabular cup replacement]. DER ORTHOPADE 2021; 50:832-834. [PMID: 34476542 DOI: 10.1007/s00132-021-04146-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/02/2021] [Indexed: 11/25/2022]
Affiliation(s)
- H Reichel
- Orthopädische Universitätsklinik am RKU, Universitätsklinikum Ulm, Oberer Eselsberg 45, 89081, Ulm, Deutschland.
| | - M Fuchs
- Orthopädische Universitätsklinik am RKU, Universitätsklinikum Ulm, Oberer Eselsberg 45, 89081, Ulm, Deutschland
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Gwynne-Jones DP, Gray AR. Cemented or uncemented acetabular fixation in combination with the Exeter Universal cemented stem. Bone Joint J 2020; 102-B:414-422. [PMID: 32228075 DOI: 10.1302/0301-620x.102b4.bjj-2019-0656.r1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS To compare long-term survival of all-cemented and hybrid total hip arthroplasty (THA) using the Exeter Universal stem. METHODS Details of 1,086 THAs performed between 1999 and 2005 using the Exeter stem and either a cemented (632) or uncemented acetabular component (454) were collected from local records and the New Zealand Joint Registry. A competing risks regression survival analysis was performed with death as the competing risk with adjustments made for age, sex, approach, and bearing. RESULTS There were 61 revisions (9.7%; 0.82 revisions/100 observed component years, (OCYs)) in the all-cemented group and 18 (4.0%; 0.30/100 OCYs) in the hybrid group. The cumulative incidence of revision at 18 years was 12.1% for cemented and 5.2% for hybrids. There was a significantly greater risk of revision for all-cemented compared with hybrids (unadjusted sub-hazard ratio (SHR) 2.44; p = 0.001), and of revision for loosening, wear, or osteolysis (unadjusted SHR 3.77; p < 0.001). After adjustment, the increased risk of all-cause revision did not reach significance at age 70 years and above. The advantage for revision for loosening, wear, and osteolysis remained at all ages. CONCLUSION This study supports the use of uncemented acetabular fixation when used in combination with the Exeter stem with improved survivorship for revision for aseptic loosening, wear, and osteolysis at all ages and for all-cause revision in patients less than 70 years. Cite this article: Bone Joint J 2020;102-B(4):414-422.
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Affiliation(s)
- David P Gwynne-Jones
- Centre for Musculoskeletal Outcomes Research, Section of Orthopaedic Surgery, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.,Consultant Orthopaedic Surgeon, Dunedin Public Hospital, Southern District Health Board, Great King Street, Dunedin, New Zealand
| | - Andrew R Gray
- Centre for Biostatistics, Division of Health Sciences, University of Otago, Dunedin, New Zealand
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Fowler AK, Gray AR, Gwynne-Jones DP. Hybrid Fixation for Total Hip Arthroplasty Showed Improved Survival Over Cemented and Uncemented Fixation: A Single-Center Survival Analysis of 2156 Hips at 12-18 Years. J Arthroplasty 2019; 34:2711-2717. [PMID: 31301914 DOI: 10.1016/j.arth.2019.06.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 06/10/2019] [Accepted: 06/13/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Despite increased use of uncemented and hybrid fixation, there is little evidence of their superiority over cemented implants. The aim of this study is to compare the long-term survivorship of cemented, hybrid and uncemented total hip arthroplasty (THA) at varying ages. METHODS A total of 2156 hips (1315 cemented, 324 uncemented, and 517 hybrid) were performed in a single center between 1999 and 2005 with follow-up through to 2017. Registry and local databases were used to determine revision rates and cause. Unadjusted and adjusted competing risk survival analysis was performed. RESULTS The cumulative incidence of all-cause revision at 18 years was cemented 10.9%, uncemented 8.9%, and hybrid 6.5%. Cemented fixation had a statistically significant higher risk of all-cause revision than hybrid in the adjusted model for all ages to 65 years (subhazard ratios [SHRs], 2.28-4.67) and a higher risk of revision for loosening, wear, or osteolysis at all ages (SHRs, 3.25-6.07). Uncemented fixation showed no advantage over hybrid fixation at any age, but did show advantages over cemented at younger ages (≤60 years) for all-cause revision (SHRs, 2.3-4.3). CONCLUSION Hybrid fixation with conventional polyethylene shows an advantage over cemented hips at all ages. Uncemented THA showed improved survival over cemented only at younger ages and no advantage over hybrid THA.
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Affiliation(s)
- Anna-Kate Fowler
- Department of Orthopaedic Surgery, Dunedin Public Hospital, Southern District Health Board, Dunedin, New Zealand
| | - Andrew R Gray
- Division of Health Sciences, Centre for Biostatistics, University of Otago, Dunedin, New Zealand
| | - David P Gwynne-Jones
- Department of Orthopaedic Surgery, Dunedin Public Hospital, Southern District Health Board, Dunedin, New Zealand; Department of Surgical Sciences, Centre for Musculo-skeletal Outcomes Research, Section of Orthopaedic Surgery, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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