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Jaenisch M, Wirtz DC. Titanium - a Cementable Material for Endoarthroplasty. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2024; 162:296-302. [PMID: 36720242 DOI: 10.1055/a-1975-0687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
As materials for arthroplasty, titanium alloys exhibit the following advantages over conventional steel, cobalt chromium or chromium nickel alloys - good fatigue strength, excellent biocompatibility, low modulus of elasticity, and high corrosion resistance. The previous worse clinical outcome was most likely caused by crevice corrosion and led to reduced use. To warrant safe use, the design should be optimised (sufficient proximal diameter, proximal collar), in order to reduce unwanted deformation in the proximal part of the prosthesis. Additionally, a rough surface (Ra > 2.5 µm) should not be used. Further research in surface treatments (e. g. silicate-silane) could facilitate additional improvement.
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Affiliation(s)
- Max Jaenisch
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Dieter Christian Wirtz
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Bonn, Deutschland
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Oe K, Iida H, Hirata M, Kawamura H, Ueda N, Nakamura T, Okamoto N, Saito T. An atypical periprosthetic fracture in collarless, polished, tapered, cemented stems of total hip arthroplasty: A report of five SC-stem cases and literature review. J Orthop Sci 2023; 28:1422-1429. [PMID: 34045138 DOI: 10.1016/j.jos.2021.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 03/29/2021] [Accepted: 04/02/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Kenichi Oe
- Department of Orthopaedic Surgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka 573-1010, Japan.
| | - Hirokazu Iida
- Department of Orthopaedic Surgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka 573-1010, Japan
| | - Masayuki Hirata
- Department of Orthopaedic Surgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka 573-1010, Japan
| | - Hiroshi Kawamura
- Department of Orthopaedic Surgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka 573-1010, Japan
| | - Narumi Ueda
- Department of Orthopaedic Surgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka 573-1010, Japan
| | - Tomohisa Nakamura
- Department of Orthopaedic Surgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka 573-1010, Japan
| | - Naofumi Okamoto
- Department of Orthopaedic Surgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka 573-1010, Japan
| | - Takanori Saito
- Department of Orthopaedic Surgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka 573-1010, Japan
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Dziaduszewska M, Wekwejt M, Bartmański M, Pałubicka A, Gajowiec G, Seramak T, Osyczka AM, Zieliński A. The Effect of Surface Modification of Ti13Zr13Nb Alloy on Adhesion of Antibiotic and Nanosilver-Loaded Bone Cement Coatings Dedicated for Application as Spacers. MATERIALS (BASEL, SWITZERLAND) 2019; 12:E2964. [PMID: 31547373 PMCID: PMC6766280 DOI: 10.3390/ma12182964] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 09/04/2019] [Accepted: 09/10/2019] [Indexed: 01/09/2023]
Abstract
Spacers, in terms of instruments used in revision surgery for the local treatment of postoperative infection, are usually made of metal rod covered by antibiotic-loaded bone cement. One of the main limitations of this temporary implant is the debonding effect of metal-bone cement interface, leading to aseptic loosening. Material selection, as well as surface treatment, should be evaluated in order to minimize the risk of fraction and improve the implant-cement fixation the appropriate manufacturing. In this study, Ti13Zr13Nb alloys that were prepared by Selective Laser Melting and surface treated were coated with bone cement loaded with either gentamicin or nanosilver, and the effects of such alloy modifications were investigated. The SLM-made specimens of Ti13Zr13Nb were surface treated by sandblasting, etching, or grounding. For each treatment, Scanning Electron Microscope (SEM), contact profilometer, optical tensiometer, and nano-test technique carried out microstructure characterization and surface analysis. The three types of bone cement i.e., pure, containing gentamicin and doped with nanosilver were applied to alloy surfaces and assessed for cement cohesion and its adhesion to the surface by nanoscratch test and pull-off. Next, the inhibition of bacterial growth and cytocompatibility of specimens were investigated by the Bauer-Kirby test and MTS assay respectively. The results of each test were compared to the two control groups, consisting of commercially available Ti13Zr13Nb and untreated SLM-made specimens. The highest adhesion bone cement to the titanium alloy was obtained for specimens with high nanohardness and roughness. However, no explicit relation of adhesion strength with wettability and surface energy of alloy was observed. Sandblasting or etching were the best alloys treatments in terms of the adhesion of either pure or modified bone cements. Antibacterial additives for bone cement affected its properties. Gentamicin and nanosilver allowed for adequate anti-bacterial protection while maintaining the overall biocompatibility of obtained spacers. However, they had different effects on the cement's adhesive capacity or its own cohesion. Furthermore, the addition of silver nanoparticles improved the nanomechanical properties of bone cements. Surface treatment and method of fabrication of titanium affected surface parameters that had a significant impact on cement-titanium fixation.
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Affiliation(s)
- Magda Dziaduszewska
- Biomaterials Division, Department of Materials Engineering and Bonding, Gdańsk University of Technology, 80-233 Gdańsk, Poland.
| | - Marcin Wekwejt
- Biomaterials Division, Department of Materials Engineering and Bonding, Gdańsk University of Technology, 80-233 Gdańsk, Poland
| | - Michał Bartmański
- Biomaterials Division, Department of Materials Engineering and Bonding, Gdańsk University of Technology, 80-233 Gdańsk, Poland
| | - Anna Pałubicka
- Department of Laboratory Diagnostics and Microbiology with Blood Bank, Specialist Hospital in Kościerzyna, 83-400 Kościerzyna, Poland
- Department of Surgical Oncology, Medicial University of Gdańsk, 80-210 Gdańsk, Poland
| | - Grzegorz Gajowiec
- Biomaterials Division, Department of Materials Engineering and Bonding, Gdańsk University of Technology, 80-233 Gdańsk, Poland
| | - Tomasz Seramak
- Biomaterials Division, Department of Materials Engineering and Bonding, Gdańsk University of Technology, 80-233 Gdańsk, Poland
| | - Anna M Osyczka
- Department of Biology and Cell Imaging, Institute of Zoology and Biomedical Research, Faculty of Biology, Jagiellonian University, 30-387 Kraków, Poland
| | - Andrzej Zieliński
- Biomaterials Division, Department of Materials Engineering and Bonding, Gdańsk University of Technology, 80-233 Gdańsk, Poland
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Khandaker M, Riahinezhad S, Sultana F, Vaughan MB, Knight J, Morris TL. Peen treatment on a titanium implant: effect of roughness, osteoblast cell functions, and bonding with bone cement. Int J Nanomedicine 2016; 11:585-94. [PMID: 26893563 PMCID: PMC4745826 DOI: 10.2147/ijn.s89376] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Implant failure due to poor integration of the implant with the surrounding biomaterial is a common problem in various orthopedic and orthodontic surgeries. Implant fixation mostly depends upon the implant surface topography. Micron to nanosize circular-shaped groove architecture with adequate surface roughness can enhance the mechanical interlock and osseointegration of an implant with the host tissue and solve its poor fixation problem. Such groove architecture can be created on a titanium (Ti) alloy implant by laser peening treatment. Laser peening produces deep, residual compressive stresses in the surfaces of metal parts, delivering increased fatigue life and damage tolerance. The scientific novelty of this study is the controlled deposition of circular-shaped rough spot groove using laser peening technique and understanding the effect of the treatment techniques for improving the implant surface properties. The hypothesis of this study was that implant surface grooves created by controlled laser peen treatment can improve the mechanical and biological responses of the implant with the adjoining biomaterial. The objective of this study was to measure how the controlled laser-peened groove architecture on Ti influences its osteoblast cell functions and bonding strength with bone cement. This study determined the surface roughness and morphology of the peen-treated Ti. In addition, this study compared the osteoblast cell functions (adhesion, proliferation, and differentiation) between control and peen-treated Ti samples. Finally, this study measured the fracture strength between each kind of Ti samples and bone cement under static loading. This study found that laser peen treatment on Ti significantly changed the surface architecture of the Ti, which led to enhanced osteoblast cell adhesion and differentiation on Ti implants and fracture strength of Ti–bone cement interfaces compared with values of untreated Ti samples. Therefore, the laser peen treatment method has the potential to improve the biomechanical functions of Ti implants.
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Affiliation(s)
- Morshed Khandaker
- Department of Engineering & Physics, University of Central Oklahoma, Edmond, OK, USA; Center for Interdisciplinary Biomedical Education and Research, University of Central Oklahoma, Edmond, OK, USA
| | - Shahram Riahinezhad
- Department of Engineering & Physics, University of Central Oklahoma, Edmond, OK, USA
| | - Fariha Sultana
- Department of Engineering & Physics, University of Central Oklahoma, Edmond, OK, USA
| | - Melville B Vaughan
- Department of Biology, University of Central Oklahoma, Edmond, OK, USA; Center for Interdisciplinary Biomedical Education and Research, University of Central Oklahoma, Edmond, OK, USA
| | - Joshua Knight
- Department of Biology, University of Central Oklahoma, Edmond, OK, USA
| | - Tracy L Morris
- Department of Mathematics and Statistics, University of Central Oklahoma, Edmond, OK, USA; Center for Interdisciplinary Biomedical Education and Research, University of Central Oklahoma, Edmond, OK, USA
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Ellison P, Hallan G, Høl PJ, Gjerdet NR, Havelin LI. Coordinating retrieval and register studies improves postmarket surveillance. Clin Orthop Relat Res 2012; 470:2995-3002. [PMID: 22723244 PMCID: PMC3462873 DOI: 10.1007/s11999-012-2430-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The relative risk of revision of the Titan(®) femoral stem due to aseptic loosening increased after 2000; however, the reasons for this have not been established. A retrieval analysis was initiated with the aim of delineating the failure mechanism. QUESTIONS/PURPOSES We asked whether aseptic loosening in stems after 2000 was associated with (1) appearance of osteolytic lesions, (2) wear particle exposure, (3) stem damage, or (4) changes to the implant or surgical instrumentation. METHODS Femoral stems, cement, tissue, and radiographs were collected from 28 patients. We assessed the development of osteolytic lesions in 17 patients. Exposure to wear particles was quantified in 18 patients. Stem damage was assessed in 15 patients. We observed differences in the implants by examination of 24 retrieved stems. Information concerning changes to instrumentation was requested from the manufacturer. RESULTS We found osteolysis in all patients receiving implants after 2000, which was associated with a median dose of cement and stem particles of 14,726/mm(2). Abrasion covered 59% of the surface of stems implanted from 1999. We identified geometric changes to the stem, the percent weight of aluminum in the stem's oxide layer decreased from 25% to 14% after 1997 and the rasp used to prepare the femoral cavity changed to a broach in 1999. CONCLUSIONS Stems implanted from 2000 failed through osteolysis induced by particles released from the cement and implant. Changes to implant geometry, surface oxide layer, and surgical tools occurred in the same time frame as the reduction in survivorship.
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Affiliation(s)
- Peter Ellison
- Biomaterials, Department of Surgical Sciences, University of Bergen, Bergen, Hordaland 5021 Norway
| | - Geir Hallan
- Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Paul Johan Høl
- Biomaterials, Department of Surgical Sciences, University of Bergen, Bergen, Hordaland 5021 Norway
| | - Nils Roar Gjerdet
- Biomaterials, Department of Clinical Dentistry, University of Bergen, Bergen, Norway
| | - Leif I. Havelin
- Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
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Waanders D, Janssen D, Mann KA, Verdonschot N. The behavior of the micro-mechanical cement-bone interface affects the cement failure in total hip replacement. J Biomech 2011; 44:228-34. [PMID: 21036358 PMCID: PMC3019267 DOI: 10.1016/j.jbiomech.2010.10.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Accepted: 10/13/2010] [Indexed: 11/30/2022]
Abstract
In the current study, the effects of different ways to implement the complex micro-mechanical behavior of the cement-bone interface on the fatigue failure of the cement mantle were investigated. In an FEA-model of a cemented hip reconstruction the cement-bone interface was modeled and numerically implemented in four different ways: (I) as infinitely stiff, (II) as infinitely strong with a constant stiffness, (III) a mixed-mode failure response with failure in tension and shear, and (IV) realistic mixed mode behavior obtained from micro-FEA models. Case II, III, and IV were analyzed using data from a stiff and a compliant micro-FEA model and their effects on cement failure were analyzed. The data used for Case IV was derived from experimental specimens that were tested previously. Although the total number of cement cracks was low for all cases, the compliant Case II resulted in twice as many cracks as Case I. All cases caused similar stress distributions at the interface. In all cases, the interface did not display interfacial softening; all stayed the elastic zone. Fatigue failure of the cement mantle resulted in a more favorable stress distribution at the cement-bone interface in terms of less tension and lower shear tractions. We conclude that immediate cement-bone interface failure is not likely to occur, but its local compliancy does affect the formation of cement cracks. This means that at a macro-level the cement-bone interface should be modeled as a compliant layer. However, implementation of interfacial post-yield softening does seems to be necessary.
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Affiliation(s)
- Daan Waanders
- Orthopaedic Research Laboratory, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Effect of undersizing on the long-term stability of the Exeter hip stem: A comparative in vitro study. Clin Biomech (Bristol, Avon) 2010; 25:899-908. [PMID: 20659780 DOI: 10.1016/j.clinbiomech.2010.07.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Revised: 06/22/2010] [Accepted: 07/05/2010] [Indexed: 02/07/2023]
Abstract
BACKGROUND Even for clinically successful hip stems such as the Exeter-V40 occasional failures are reported. It has been reported that sub-optimal pre-operative planning, leading to implant undersizing and/or thin cement mantle, can explain such failures. The scope of this study was to investigate whether stem undersizing and a thin cement mantle are sufficient to cause implant loosening. METHODS A comparative in vitro study was designed to compare hip implants prepared with optimal and smaller than optimal stem size. Exeter-V40, a highly polished cemented hip stem, was used in both cases. Tests were carried out simulating 24 years of activity of active hip patients. A multifaceted approach was taken: inducible and permanent micromotions were recorded throughout the test; cement micro-cracks were quantified using dye penetrants and statistically analyzed. FINDINGS The implants with an optimal stem size withstood the entire mechanical test, with low and stable inducible micromotions and permanent migrations during the test, and with moderate fatigue damage in the cement mantle after test completion. Conversely, the undersized specimens showed large and increasing micromotions, and failed after few loading cycles, because of macroscopic cracks in the proximal part of the cement mantle. While results for the optimal stem size are typical for stable hip stems, those for the undersize stem indicate a critical scenario. INTERPRETATION These results confirm that even a clinically successful hip prosthesis such as the Exeter-V40 is prone to early loosening if a stem smaller than the optimal size is implanted.
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Abstract
Polymethylmethacrylate (PMMA) has been used in orthopaedics since the 1940s. Despite the development and popularity of new biomaterials, PMMA remains popular. Although its basic components remain the same, small proprietary and environmental changes create variations in its properties. PMMA can serve as a spacer and as a delivery vehicle for antibiotics, and it can be placed to eliminate dead space. Endogenous and exogenous variables that affect its performance include component variables, air, temperature, and handling and mixing. PMMA is used in hip arthroplasty and vertebral augmentation, notably, vertebroplasty and kyphoplasty. Cardiopulmonary complications have been reported.
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Ramos A, Simões J. The influence of cement mantle thickness and stem geometry on fatigue damage in two different cemented hip femoral prostheses. J Biomech 2009; 42:2602-10. [DOI: 10.1016/j.jbiomech.2009.06.037] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2008] [Revised: 06/24/2009] [Accepted: 06/25/2009] [Indexed: 10/20/2022]
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Abstract
INTRODUCTION The cementing technique is one of the various speculated factors that might contribute to the failures of resurfacing arthroplasty of the hip. The influence of bony preparation by jet lavage or lavage only in combination with different cementing techniques and cements of different viscosity in a study on fresh human femoral heads has not been evaluated so far. MATERIALS AND METHODS Sixty fresh human femoral heads were prepared for resurfacing following manufacturers' instructions and divided into 12 groups. The different groups received either syringe lavage or jet lavage and either a low-, medium- or high-viscosity cement with either packing or quarter filling of the implant with recess of the femoral stem in each case. Application of the implant was standardized. After polymerization, the femoral heads were cut into quarters and polished. Cement penetration was assessed using a square millimeter grid under optical zoom. RESULTS Manual packing with high viscosity cement is a reproducible method in resurfacing arthroplasty. Syringe lavage and jet lavage mainly showed comparable cement penetration patterns when applied same cementing techniques. The penetration depth ranged from a mean of 0.6 to 3.2 mm with 0.4 being the lowest and 4.0 being the deepest. The mantle thickness ranged from 0.8 to 2.4 mm with statistically significant thicker mantles with filling, compared to packing. CONCLUSION Our results showed distinct less penetration depth than previously reported and that just medium viscosity cement reached reliable results in the supposed range of penetration depth and cement mantle thickness. Jet lavage should be recommended for the low-viscosity cement but avoided in combination with a cement filling technique of lower viscosity cements. Filling of the implant caused the greatest penetration depth and a higher number of incomplete seatings and should therefore be avoided.
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