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Maier K, Selig M, Haddouche A, Haunschild M, Hauschild O, Khalili I, Kirschberg J, Lutter C, Menges M, Mertl P, Niemeier A, Rubens-Duval B, Mittelmeier W. Vitamin E-enriched medium cross-linked polyethylene in total knee arthroplasty (VIKEP): clinical outcome, oxidation profile, and wear analysis in comparison to standard polyethylene-study protocol for a randomized controlled trial. Trials 2024; 25:27. [PMID: 38183062 PMCID: PMC10768156 DOI: 10.1186/s13063-023-07811-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 11/20/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND The gliding surface of total knee endoprostheses is exposed to high loads due to patient weight and activity. These implant components are typically manufactured from ultra-high molecular weight polyethylene (UHMWPE). Crosslinking of UHMWPE by ionizing radiation results in higher wear resistance but induces the formation of free radicals which impair mechanical properties after contact with oxygen. Medium-crosslinked UHMWPE enriched with vitamin E (MXE) provides a balance between the parameters for a sustainable gliding surface, i.e., mechanical strength, wear resistance, particle size, and oxidation stability. Therefore, a gliding surface for knee endoprostheses made up from this material was developed, certified, and launched. The aim of this study is to compare this new gliding surface to the established predecessor in a non-inferiority design. METHODS This multicenter, binational randomized controlled trial will enroll patients with knee osteoarthritis eligible for knee arthroplasty with the index device. Patients will be treated with a knee endoprosthesis with either MXE or a standard gliding surface. Patients will be blinded regarding their treatment. After implantation of the devices, patients will be followed up for 10 years. Besides clinical and patient-related outcomes, radiological data will be collected. In case of revision, the gliding surface will be analyzed biomechanically and regarding the oxidative profile. DISCUSSION The comparison between MXE and the standard gliding surface in this study will provide clinical data to confirm preceding biomechanical results in vivo. It is assumed that material-related differences will be identified, i.e., that the new material will be less sensitive to wear and creep. This may become obvious in biomechanical analyses of retrieved implants from revised patients and in radiologic analyses. TRIAL REGISTRATION ClinicalTrials.gov, NCT04618016. Registered 27 October 2020, https://clinicaltrials.gov/study/NCT04618016?term=vikep&checkSpell=false&rank=1 . All items from the World Health Organization Trial Registration Data Set can be found in Additional file 1.
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Affiliation(s)
- Kristin Maier
- Medical Scientific Affairs, Aesculap AG, Am Aesculap-Platz, 78532, Tuttlingen, Germany.
| | - Marius Selig
- Medical Scientific Affairs, Aesculap AG, Am Aesculap-Platz, 78532, Tuttlingen, Germany
| | - Andréa Haddouche
- Hopital Sud - CHU Grenoble, Avenue Kimberley, 38130, Echirolles, France
| | - Martin Haunschild
- Klinik Für Allgemeine Orthopädie, Endoprothetik Und Kinderorthopädie, Katholisches Klinikum Koblenz-Montabaur, Kardinal-Krementz-Str. 1-5, Koblenz-Montabaur, 56073, Germany
| | - Oliver Hauschild
- Department for Orthopedic and Trauma Surgery, Park-Klinik Weissensee, Schönstraße 80, Berlin, 13086, Germany
| | - Iman Khalili
- Krankenhaus Reinbek St. Adolf-Stift, Hamburger Straße 41, 21465, Reinbek, Germany
| | - Julia Kirschberg
- Waldkliniken Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany
| | - Christoph Lutter
- Orthopädische Klinik Und Poliklinik, Universitätsmedizin Rostock, Doberaner Str.142, 18057, Rostock, Germany
| | - Michael Menges
- Lukas Krankenhaus, Hindenburgstraße 56, 32257, Bünde, Germany
| | - Patrice Mertl
- CHU Amiens-Picardie, 1 Rond Point du Professeur Christian Cabrol, 80054, CEDEX 1, Amiens, France
| | - Andreas Niemeier
- Krankenhaus Reinbek St. Adolf-Stift, Hamburger Straße 41, 21465, Reinbek, Germany
| | | | - Wolfram Mittelmeier
- Orthopädische Klinik Und Poliklinik, Universitätsmedizin Rostock, Doberaner Str.142, 18057, Rostock, Germany
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Bormann T, Kraenzler S, Jaeger S, Kluess D, Mittelmeier W, Renkawitz T, Kretzer JP. Stability of ceramic coatings on retrieved knee prostheses. J Mech Behav Biomed Mater 2023; 144:105997. [PMID: 37413893 DOI: 10.1016/j.jmbbm.2023.105997] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/23/2023] [Accepted: 06/25/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND In total knee arthroplasty, femoral components with coated or oxidized surfaces are commonly used as alternative to CoCrMo in metal sensitive patients. Data on the in vivo behaviour of different coating types is, however, rare. Aim of the study was the investigation of coating stability with respect to implant and patient specific parameters. METHODS Coating thickness and coating thickness reduction, respectively, was measured at 37 retrieved femoral components with TiNbN, TiN, ZrN or oxidized zirconium (OxZr) surface by the crater grinding method. The results were correlated to surface type, manufacturer, time in vivo of the implant, patient body weight and patient activity. RESULTS Mean coating thickness reduction in the overall retrieval collection was 0.6 μm ± 0.8 μm. There was no correlation between coating thickness reduction and coating type, time in vivo, patient body weight, and patient activity. If grouped according to manufacturers, implants of one manufacturer showed an increased coating thickness reduction. 10 of 37 retrievals exhibited coating abrasion with exposure of the underlying alloy. TiNbN coatings showed the highest incidence (9/17) of coating abrasion. No coating breakthrough was observed in the ZrN or OxZr surfaces. CONCLUSION Our results indicate that TiNbN coatings should be optimized to improve their wear resistance in the long-term.
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Affiliation(s)
- Therese Bormann
- Laboratory of Biomechanics and Implant Research, Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
| | - Simeon Kraenzler
- Laboratory of Biomechanics and Implant Research, Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Sebastian Jaeger
- Laboratory of Biomechanics and Implant Research, Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Daniel Kluess
- Department of Orthopaedics, Rostock University Medical Center, Doberaner Straße 142, 18057, Rostock, Germany
| | - Wolfram Mittelmeier
- Department of Orthopaedics, Rostock University Medical Center, Doberaner Straße 142, 18057, Rostock, Germany
| | - Tobias Renkawitz
- Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - J Philippe Kretzer
- Laboratory of Biomechanics and Implant Research, Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
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Lodge CJ, Matar HE, Berber R, Radford PJ, Bloch BV. Ceramic Coatings Confer No Survivorship Advantages in Total Knee Arthroplasty-A Single-Center Series of 1641 Knees. Arthroplast Today 2023; 19:101086. [PMID: 36688095 PMCID: PMC9851869 DOI: 10.1016/j.artd.2022.101086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 10/06/2022] [Accepted: 12/08/2022] [Indexed: 01/19/2023] Open
Abstract
Background Ceramic coatings in total knee arthroplasty have been introduced with the aim of reducing wear and consequently improving implant survivorship. We studied both cobalt-chrome-molybdenum (CoCrMo) and ceramic-coated components of the same implant design from a single center to identify if the ceramic coating conferred any benefit. Methods We identified 1641 Columbus total knee arthroplasties (Aesculap AG, Tüttlingen, Germany) from a prospectively collected arthroplasty database. Of the 1641, 983 were traditional CoCrMo, and 659 had the Columbus AS ceramic coating. Patients were followed up until death or revision of any component of the implant. Results There was no significant difference in implant survivorship using any component revision as the endpoint between the CoCrMo femur and the ceramic-coated femur at a mean of 9.2 years in follow-up for the CoCrMo group and 5 years for the ceramic-coated group (37 vs 14; P = .76). There was no reduction in the proportion of components revised for aseptic loosening or infection in the ceramic-coated cohort. Conclusions At midterm follow-up, there was no benefit in terms of implant survivorship in using a ceramic coating.
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Affiliation(s)
| | | | | | | | - Benjamin V. Bloch
- Corresponding author. Consultant Orthopaedic Surgeon, City Hospital Campus, Nottingham, NG5 1PB, UK. Tel.: +44 115 969 1169.
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Kellens J, Berger P, Vandenneucker H. Metal wear debris generation in primary total knee arthroplasty: is it an issue? Acta Orthop Belg 2021; 87:681-695. [PMID: 35172435 DOI: 10.52628/87.4.13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
More durable total knee arthroplasties (TKAs) are needed, due to the rising life expectancy, the higher activity levels of patients and the growing concerns about aseptic loosening being caused by metal hypersensitivity. In response, different hypoallergenic metal coatings have been developed for TKAs. However, possible adverse effects of these different metals (cobalt-chromium-molybdenum, zirconium, titanium and tantalum) have been neglected. The aim was to summarize the local and systemic adverse effects (including metal hypersensitivity), survival ratios, patient-reported outcome measures (PROMs) and the plasma metal ion concentrations of the different TKA coatings. A literature search on PubMed and EMBASE was performed. In total, 15 studies were found eligible. Common adverse effects of TKA were infection, loosening, pain, instability and hyper- coagulation disorders. Serious adverse effects related to TKA implants were not reported. The survival ratios and patient-reported outcome measures seem to confirm these good results. In contrast with chromium and cobalt, no significant differences were reported in the nickel, molybdenum and titanium concentrations. No significant differences between the hypoallergenic and standard TKA implants were found in terms of adverse effects, survival ratios and PROMs. A causal relationship between the common adverse effects and the different metals is unlikely. Due to the heterogeneity of the TKA implants used, no firm conclusions could be made. Further research with longer follow-up studies are needed to find possible adverse effects and differences. Thus far, the hypoallergenic implants seem to perform equal to the standard implants.
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Alipour H, Hamedani A, Alahyarizadeh G, Jahanzadeh A. First principle study on the mechanical response of ZrC and ZrN at high-pressure conditions: anisotropy perspective. MOLECULAR SIMULATION 2021. [DOI: 10.1080/08927022.2021.1957881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- H. Alipour
- Faculty of Engineering, Shahid Beheshti University, Tehran, Iran
| | - A. Hamedani
- Faculty of Engineering, Shahid Beheshti University, Tehran, Iran
| | | | - A. Jahanzadeh
- Electronic Department, Faculty of Electrical, Electronics and Marine Telecommunications, Imam Khomeini University of Noshahr, Noshahr, Iran
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Schwiesau J, Fritz B, Bergmann G, Puente Reyna AL, Schilling C, Grupp TM. Influence of radiation conditions on the wear behaviour of Vitamin E treated UHMWPE gliding components for total knee arthroplasty after extended artificial aging and simulated daily patient activities. J Mech Behav Biomed Mater 2021; 122:104652. [PMID: 34246078 DOI: 10.1016/j.jmbbm.2021.104652] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 06/08/2021] [Accepted: 06/16/2021] [Indexed: 10/21/2022]
Abstract
The long term performance of total knee arthroplasty (TKA) with regards to the bearing materials is related to the aging behaviour of these materials. The use of highly crosslinked materials in hip arthroplasty improved the clinical outcome. Nevertheless, the outcome for these materials compared to conventional UHMWPE (ultra-high molecular weight polyethylene) remains controversial in TKA and alternative bearing materials may be advantageous to improve its outcome in the second and third decade. The aim of this study is the evaluation of the influence of radiation conditions on the wear behaviour of Vitamin E blended UHMWPE gliding components for TKA by simulation of extended aging and high demanding daily patient activities. For a medium radiation dose (30 kGy), the influence of the irradiation type (E-beam or Gamma radiation) and the thermal conditions (room temperature (RT) or heated to 115 °C) are evaluated in comparison to non-irradiated material. Significant influences on the wear behaviour were found for the radiation source and temperature during irradiation. Furthermore, no relevant degradation of the tested materials was observed after extended artificial aging. There was a good correspondence between the wear pattern in this study and retrievals.
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Affiliation(s)
- Jens Schwiesau
- Aesculap AG Research & Development, Tuttlingen, Germany; Ludwig Maximilians University Munich Department of Orthopaedic Surgery, Physical Medicine & Rehabilitation, Campus Grosshadern, Munich, Germany.
| | | | - Georg Bergmann
- Julius Wolff Institute, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Thomas M Grupp
- Aesculap AG Research & Development, Tuttlingen, Germany; Ludwig Maximilians University Munich Department of Orthopaedic Surgery, Physical Medicine & Rehabilitation, Campus Grosshadern, Munich, Germany
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Egloff C, Hirschmann MT, Moret C, Henle P, Ellenrieder M, Tischer T. [Total knee arthroplasty in the young patient-an update]. DER ORTHOPADE 2021; 50:395-401. [PMID: 33834286 PMCID: PMC8081686 DOI: 10.1007/s00132-021-04104-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/12/2021] [Indexed: 11/01/2022]
Abstract
The absolute number of total knee arthroplasties (TKA) continues to rise every year. About 10% of the patients are less than 55 years of age, although it is known that functional results and patient satisfaction are lower combined with an increased likelihood of revision compared to older patients. Higher physical activity and patient expectations are a major challenge in this age group. At the same time, the incidence of posttraumatic/postoperative alterations is high, including ligamentous or bony deficiencies, which can make the surgical procedure challenging. In view of these facts conservative treatments and joint sparing procedures should always be considered first. The potential correction of lower-limb deformities and unicompartmental knee arthroplasties need to be carefully evaluated before considering total knee arthroplasty. Only in advanced cases of osteoarthritis in more than one compartment of the knee of with combined ligamentous instability, can a TKA provide satisfactory results in the young patient. However, the strongest predictor of satisfaction is a realistic expectation.
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Affiliation(s)
- Christian Egloff
- Department of Orthopaedic Surgery and Traumatology, University Hospital Basel, Spitalstrasse 21/Petersgraben 4, 4031, Basel, Schweiz.
- University of Basel, Basel, Schweiz.
| | - Michael T Hirschmann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101, Bruderholz, Schweiz
- University of Basel, Basel, Schweiz
| | - Céline Moret
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101, Bruderholz, Schweiz
- University of Basel, Basel, Schweiz
| | | | - Martin Ellenrieder
- Orthopädische Klinik und Poliklinik, Universitätsmedizin Rostock, Doberaner Straße 142, 18057, Rostock, Deutschland
| | - Thomas Tischer
- Orthopädische Klinik und Poliklinik, Universitätsmedizin Rostock, Doberaner Straße 142, 18057, Rostock, Deutschland
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Grimberg AW, Grupp TM, Elliott J, Melsheimer O, Jansson V, Steinbrück A. Ceramic Coating in Cemented Primary Total Knee Arthroplasty is Not Associated With Decreased Risk of Revision due to Early Prosthetic Joint Infection. J Arthroplasty 2021; 36:991-997. [PMID: 33012599 DOI: 10.1016/j.arth.2020.09.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/31/2020] [Accepted: 09/08/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Prosthetic joint infection (PJI) is one of the most frequent and devastating causes of short-term revision total knee arthroplasty (TKA). In vitro evidence suggests ceramic surfaces demonstrate resistance to biofilm, but the clinical effect of bearing surface modifications on the risk of PJI remains unclear. This premier registry-based study examines the influence of ceramic bearing surface coatings on the outcome in cemented primary TKA. METHODS In total, 117,660 cemented primary TKAs in patients with primary osteoarthritis recorded in the German arthroplasty registry since 2012 were followed up for a maximum of 3 years. The primary endpoint was risk of revision for PJI on ceramic coated and uncoated cobalt-chromium-molybdenum femoral components. Propensity score matching for age, gender, obesity, diabetes mellitus, depression and Elixhauser comorbidity index, and substratification on common design twins with and without coating was performed. RESULTS In total, 4637 TKAs (85.1% female) with a ceramic-coated femoral component were identified, 42 had been revised for PJI and 122 for other reasons at 3 years. No survival advantage due to the risk of revision for PJI could be determined for ceramic-coated components. Revision for all other reasons demonstrated a significant higher rate for TKAs with ceramic-coated components. However, the results of this were confounded by a strong prevalence (20.7% vs 0.3%) of metal sensitivity in the ceramic-coated group. CONCLUSION No evidence of reduced risk for PJI due to ceramic-coated implants in cemented primary TKA was found. Further analysis for revision reasons other than PJI is required.
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Affiliation(s)
- Alexander W Grimberg
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Munich, Germany; German Arthroplasty Registry (EPRD Deutsche Endoprothesenregister gGmbH), Berlin, Germany
| | - Thomas M Grupp
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Munich, Germany; German Arthroplasty Registry (EPRD Deutsche Endoprothesenregister gGmbH), Berlin, Germany
| | - Johanna Elliott
- German Arthroplasty Registry (EPRD Deutsche Endoprothesenregister gGmbH), Berlin, Germany; Department of Orthopaedic Surgery and Traumatology, St Vinzenz Hospital, Dinslaken, Germany
| | - Oliver Melsheimer
- German Arthroplasty Registry (EPRD Deutsche Endoprothesenregister gGmbH), Berlin, Germany
| | - Volkmar Jansson
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Munich, Germany; German Arthroplasty Registry (EPRD Deutsche Endoprothesenregister gGmbH), Berlin, Germany
| | - Arnd Steinbrück
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Munich, Germany; German Arthroplasty Registry (EPRD Deutsche Endoprothesenregister gGmbH), Berlin, Germany; Orthopaedic Surgical Competence Center Augsburg (OCKA), Augsburg, Germany
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Maale G, Mohammadi D, Kennard N, Srinivasaraghavan A. Early Failures of Total Knee Patients with Nickel Allergies Secondary to Carbon Fiber Debris. Open Orthop J 2020. [DOI: 10.2174/1874325002014010161] [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] [Indexed: 02/22/2023] Open
Abstract
Aim:
Currently, there are not many studies on the long-term outcomes of the specific implants used in patients with metal hypersensitivities. The purpose of this study is to report a significant number of TKA revision failures with the CFR-PEEK prosthetic knee implant with an anatomic hinge.
Background:
Patients can experience multiple issues following a primary Total Knee Arthroplasty (TKA). A growing body of research is finding a correlation between primary TKA failure and metal hypersensitivity, most commonly with nickel and cobalt. Because of this, knee prosthetics are being made from hypoallergenic metals, such as zirconium nitride (ZrN), to minimize the number of failures due to metal allergy. Given the relatively new development of the hypoallergenic prostheses, there is sparse data about their overall success.
Objective:
The purpose of this study is to report a significant number of TKA revision failures with the CFR-PEEK prosthetic knee implant with an anatomic hinge.
Methods:
In this study, we analyzed the sequelae of 84 patients between May 2015 to June 2020 who received a total knee revision due to a failed primary TKA with metal hypersensitivity. These patients were revised with the rotating anatomic hinge knee system, which consisted of Carbon Fiber Reinforced Poly-Ether-Ether-Ketone (CFR-PEEK implant) coated with a ZrN, Zirconium, and Chrome Nitride multi-layer surface coating with 30% polyacrylonitrile fiber content. The patients requiring an additional revision operation presented with increasing pain that showed evidence of osteolysis on plain radiographs, CT imaging, positive indium labeled WBC scans and increased uptake on bone scan. Intraoperatively, an open incisional biopsy of the surgical bed was obtained, followed by radical debridement and implantation of porex knee prosthesis. In addition, intraoperative findings included black debris that grossly stained the surrounding synovial tissue black, indicative of wear and debris from carbon fiber bearings and the anatomic hinge. Histology of the intraoperative biopsy showed the accumulation of black debris in the histiocyte, fibrosis, and perivascular cuffing of lymphocytes and multinucleated giant cells stained with black debris.
Results:
Of the 84 patients, 22 failed, requiring an additional revision procedure, equating to a 26 percent failure rate of the CFR-PEEK implant, averaging 25 months to failure.
Conclusion:
This study was meant to report the extremely high failure rate of the anatomic hinge secondary to carbon fiber debris. Perhaps carbon fiber-laden implants are not as good an option for total knee revision prosthesis because of the high failure rate compared to those with polyethylene in their hinge mechanism.
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Woiczinski M, Schröder C, Paulus A, Kistler M, Jansson V, Müller PE, Weber P. Varus or valgus positioning of the tibial component of a unicompartmental fixed-bearing knee arthroplasty does not increase wear. Knee Surg Sports Traumatol Arthrosc 2020; 28:3016-3021. [PMID: 31690992 DOI: 10.1007/s00167-019-05761-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 10/15/2019] [Indexed: 12/15/2022]
Abstract
PURPOSE Higher revision rates were shown in varus- or valgus-positioned tibias in unicompartmental knee arthroplasty (UKA), but more than 15% of UKA prostheses are implanted with more than 5° of varus or valgus. This study aimed to analyze the wear rate in UKA when implanting the tibial component in either varus or valgus position versus a neutral placement at 90° to the tibial anatomical axis. The study hypothesized that a 5° varus or valgus positioning of the tibial plateau will generate less wear compared to a neutral alignment. METHODS Wear was experimentally analyzed on a medial anatomical fixed-bearing unicompartmental knee prosthesis (Univation, Aesculap, Germany) in vitro with a customized, four-station, servohydraulic knee wear simulator, reproducing the walking cycle. The forces, loading and range of motion were applied as specified in the ISO 14243-1:2002, 5 million cycles were analyzed. The tibial components of the medial prostheses were inserted in a neutral position, with 5° varus, and 5° valgus (n = 3, each group). RESULTS The wear rate decreased significantly with a 5° varus positioning (6.30 ± 1.38 mg/million cycles) and a 5° valgus positioning (4.96 ± 2.47 mg/million cycles) compared to the neutral position (12.16 ± 1.26 mg/million cycles) (p < 0.01 for the varus and the valgus position). The wear area on the inlay was slightly reduced in the varus and valgus group. CONCLUSION A varus or valgus "malpositioning" up to 5° will not lead to an increased wear. Wear was even less because of the reduced articulating contact area between the inlay and the femur. A slight varus positioning of the tibial component (parallel to the anatomical joint line) positioning can be advocated from a point of wear. LEVEL OF EVIDENCE Experimental study.
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Affiliation(s)
- Matthias Woiczinski
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital, Ludwig-Maximilians-University (LMU), Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Christian Schröder
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital, Ludwig-Maximilians-University (LMU), Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Alexander Paulus
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital, Ludwig-Maximilians-University (LMU), Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Manuel Kistler
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital, Ludwig-Maximilians-University (LMU), Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Volkmar Jansson
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital, Ludwig-Maximilians-University (LMU), Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Peter E Müller
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital, Ludwig-Maximilians-University (LMU), Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Patrick Weber
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital, Ludwig-Maximilians-University (LMU), Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany. .,ECOM-Excellent Center of Medicine, Arabellastr, 17, 81925, Munich, Germany.
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Mihalko WM, Haider H, Kurtz S, Marcolongo M, Urish K. New materials for hip and knee joint replacement: What's hip and what's in kneed? J Orthop Res 2020; 38:1436-1444. [PMID: 32437026 DOI: 10.1002/jor.24750] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 04/24/2020] [Accepted: 05/01/2020] [Indexed: 02/04/2023]
Abstract
Over the last three decades there have been significant advancements in the knee and hip replacement technology that has been driven by an issue in the past concerning adverse local tissue reactions, aseptic and septic loosening. The implants and the materials we utilize have improved over the last two decades and in knee and hip replacement there has been a decrease in the failures attributed to wear and osteolysis. Despite these advancements there are still issues with patient satisfaction and early revisions due to septic and aseptic loosening in knee replacement patients. This article reviews the state of current implant material technology in hip and knee replacement surgery, discusses some of the unmet needs we have in biomaterials, and reviews some of the current biomaterials and technology that may be able to solve the most common issues in the knee and hip replacement surgery.
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Affiliation(s)
- William M Mihalko
- Department of Orthopaedic Surgery and Biomedical Engineering, Campbell Clinic Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Hani Haider
- Orthopaedic Biomechanics and Advanced Surgical Technologies Laboratory, Department of Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical Center, Omaha, Nebraska
| | - Steven Kurtz
- Exponent Inc., Drexel University, Philadelphia, Pennsylvania
| | - Michele Marcolongo
- Department of Materials Science and Engineering, Drexel University, Philadelphia, Pennsylvania
| | - Kenneth Urish
- Department of Orthopaedic Surgery, Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Bioengineering, Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, Pennsylvania
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Mott R, Priefer R. Multilayering as a solution to medical device failure. Colloids Surf B Biointerfaces 2020; 193:111154. [PMID: 32485578 DOI: 10.1016/j.colsurfb.2020.111154] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/18/2020] [Accepted: 05/23/2020] [Indexed: 11/29/2022]
Abstract
There are three main problems associated with medical device implants: biofilm, wear and corrosion, and bio rejection. A potential solution to these problems is multilayering. Polyelectrolyte multilayered films composed of polyallylamine hydrochloride and poly(4-vinylphenol) have been demonstrated to inhibit Staphylococcus epidermidis growth. Another study examined the wear behavior of polyelectrolyte multilayer coated orthopedic surfaces composed of poly(acrylic acid) and poly(allylamine hydrochloride) and found coated systems resulted in 33 % less wear than uncoated systems. Additionally, a heparin/collagen anti-CD34 antibody ((HEP/COL)5-CD34) multilayer system provided accelerated adhesion of endothelial cells with a significant number of endothelial cells attaching in the first 5 min. This allowed for re-endothelialization to occur possibly reducing cardiac stent bio rejection. This review explores various ways multilayering has been utilized to prolong medical device use and decrease the number of complications associated with them.
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Affiliation(s)
- Renee Mott
- Massachusetts College of Pharmacy and Health Sciences University, BOSTON, MA, United States
| | - Ronny Priefer
- Massachusetts College of Pharmacy and Health Sciences University, BOSTON, MA, United States.
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Preliminary results of the tribological performance of new modular temporary knee spacer antibiotic-impregnated. J Mech Behav Biomed Mater 2019; 95:205-209. [DOI: 10.1016/j.jmbbm.2019.04.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 04/04/2019] [Accepted: 04/11/2019] [Indexed: 01/28/2023]
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Li J, Li Z, Tu J, Jin G, Li L, Wang K, Wang H. In vitro and in vivo investigations of a-C/a-C:Ti nanomultilayer coated Ti6Al4V alloy as artificial femoral head. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2019; 99:816-826. [PMID: 30889756 DOI: 10.1016/j.msec.2019.02.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 01/15/2019] [Accepted: 02/06/2019] [Indexed: 12/13/2022]
Abstract
Hydrogen-free a-C/a-C:Ti nanomultilayer (a-C NM) films were deposited on medical Ti6Al4V by the magnetron sputtering technique under bias-graded voltage. Cell tests and implantations were performed for the a-C NM films coated Ti6Al4V with the uncoated Ti6Al4V as the control. The canine total hip arthroplasty (THA) surgeries were conducted for 12 dogs using the coated femoral heads, with the CoCr heads as the control. Results of cell tests showed that the coated Ti6Al4V had no cytotoxicity, and there was no statistical difference of the cell attachment rates between the coated and uncoated sample (P = 0.091). No significant difference of the tissue response around the coated and uncoated implants were observed after the intramuscular (P = 0.679) and intraosseous implantations (P = 0.122). After two years of successful canine THA, the polyethylene wear particles isolated from periprosthetic soft tissue showed similar sizes, shapes and counts in the two groups (all of the P values >0.05). The retrieved femoral heads showed slightly change of the surface roughness, but no statistical differences between groups (P = 0.696). However, the systemic metal ion analysis indicated that the content of Co and Cr ions released in the coated group (Co: 0.71 ± 0.06 μg/L, Cr: 0.52 ± 0.05 μg/L) were significant lower than that in the control (Co: 1.98 ± 0.16 μg/L, Cr: 1.17 ± 0.19 μg/L) (both P < 0.005). Histological analysis of the periprosthetic tissue in CoCr group showed a severer histiocyte response than that in the coated group (P = 0.029). The head-taper interfaces showed galvanic corrosion attack in the CoCr group, but not in the coated Ti6Al4V group. Therefore, the a-C NM films coated Ti6Al4V exhibited good biocompatibility as an implant material. Compared with the CoCr, the coated Ti6Al4V femoral head could provide comparable in vivo wear properties, release less harmful metal ions and reduce the inflammatory response in periprosthetic tissue, which may help to prolong the longevity of prostheses.
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Affiliation(s)
- Ji Li
- Department of Orthopedics, General Hospital of PLA, No. 28 Fuxing Road, Haidian District, Beijing 100853, China
| | - Zhongli Li
- Department of Orthopedics, General Hospital of PLA, No. 28 Fuxing Road, Haidian District, Beijing 100853, China.
| | - Jiangping Tu
- State Key Laboratory of Materials and Department of Materials Science and Engineering, Zhejiang University, Hangzhou 310027, China
| | - Gong Jin
- ZhongAoHuiCheng Technology Co., No. 20 Kechuang Road, Economic and Technological Development Zone, Beijing 100176, China
| | - Lingling Li
- State Key Laboratory of Materials and Department of Materials Science and Engineering, Zhejiang University, Hangzhou 310027, China
| | - Ketao Wang
- Department of Orthopedics, General Hospital of PLA, No. 28 Fuxing Road, Haidian District, Beijing 100853, China
| | - Haoran Wang
- Department of Orthopedics, General Hospital of PLA, No. 28 Fuxing Road, Haidian District, Beijing 100853, China
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