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Sass JO, Kebbach M, Lork C, Johannsen J, Weinmann M, Stenzel M, Bader R. Computational biomechanical study on hybrid implant materials for the femoral component of total knee replacements. J Mech Behav Biomed Mater 2024; 158:106681. [PMID: 39151255 DOI: 10.1016/j.jmbbm.2024.106681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 06/15/2024] [Accepted: 08/08/2024] [Indexed: 08/19/2024]
Abstract
Multifunctional materials have been described to meet the diverse requirements of implant materials for femoral components of uncemented total knee replacements. These materials aim to combine the high wear and corrosion resistance of oxide ceramics at the joint surfaces with the osteogenic potential of titanium alloys at the bone-implant interface. Our objective was to evaluate the biomechanical performance of hybrid material-based femoral components regarding mechanical stress within the implant during cementless implantation and stress shielding (evaluated by strain energy density) of the periprosthetic bone during two-legged squat motion using finite element modeling. The hybrid materials consisted of alumina-toughened zirconia (ATZ) ceramic joined with additively manufactured Ti-6Al-4V or Ti-35Nb-6Ta alloys. The titanium component was modeled with or without an open porous surface structure. Monolithic femoral components of ATZ ceramic or Co-28Cr-6Mo alloy were used as reference. The elasticity of the open porous surface structure was determined within experimental compression tests and was significantly higher for Ti-35Nb-6Ta compared to Ti-6Al-4V (5.2 ± 0.2 GPa vs. 8.8 ± 0.8 GPa, p < 0.001). During implantation, the maximum stress within the ATZ femoral component decreased from 1568.9 MPa (monolithic ATZ) to 367.6 MPa (Ti-6Al-4V/ATZ), 560.9 MPa (Ti-6Al-4V/ATZ with an open porous surface), 474.9 MPa (Ti-35Nb-6Ta/ATZ), and 648.4 MPa (Ti-35Nb-6Ta/ATZ with an open porous surface). The strain energy density increased at higher flexion angles for all models during the squat movement. At ∼90° knee flexion, the strain energy density in the anterior region of the distal femur increased by 25.7 % (Ti-6Al-4V/ATZ), 70.3 % (Ti-6Al-4V/ATZ with an open porous surface), 43.7 % (Ti-35Nb-6Ta/ATZ), and 82.5% (Ti-35Nb-6Ta/ATZ with an open porous surface) compared to monolithic ATZ. Thus, the hybrid material-based femoral component decreases the intraoperative fracture risk of the ATZ part and considerably reduces the risk of stress shielding of the periprosthetic bone.
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Affiliation(s)
- Jan-Oliver Sass
- Research Laboratory for Biomechanics and Implant Technology, Department of Orthopedics, Rostock University Medical Center, Doberaner Straße 142, D-18057 Rostock, Germany.
| | - Maeruan Kebbach
- Research Laboratory for Biomechanics and Implant Technology, Department of Orthopedics, Rostock University Medical Center, Doberaner Straße 142, D-18057 Rostock, Germany
| | - Cornelia Lork
- ZM Praezisionsdentaltechnik GmbH, Breite Straße 16, D-18055 Rostock, Germany
| | - Jan Johannsen
- Fraunhofer Research Institution for Additive Manufacturing Technologies IAPT, Am Schleusengraben 14, D-21029 Hamburg, Germany
| | | | | | - Rainer Bader
- Research Laboratory for Biomechanics and Implant Technology, Department of Orthopedics, Rostock University Medical Center, Doberaner Straße 142, D-18057 Rostock, Germany
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Hasegawa M, Tone S, Naito Y, Sudo A. Ultra-High-Molecular-Weight Polyethylene in Hip and Knee Arthroplasties. MATERIALS (BASEL, SWITZERLAND) 2023; 16:2140. [PMID: 36984020 PMCID: PMC10054334 DOI: 10.3390/ma16062140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/05/2023] [Accepted: 03/06/2023] [Indexed: 06/18/2023]
Abstract
Ultra-high-molecular-weight polyethylene (UHMWPE) wear and particle-induced osteolysis contribute to the failure of total hip arthroplasty (THA) and total knee arthroplasty (TKA). Highly crosslinked polyethylene (HXLPE) was developed in the late 1990s to reduce wear and has shown lower wear rates and loosening than conventional UHMWPE in THA. The irradiation dose for crosslinking is up to 100 kGy. However, during crosslinking, free radical formation induces oxidation. Using HXLPE in THA, the cumulative revision rate was determined to be significantly lower (6.2%) than that with conventional UHMWPE (11.7%) at a mean follow-up of 16 years, according to the Australian Orthopaedic Association National Joint Replacement Registry. However, HXLPE does not confer to TKA the same advantages it confers to THA. Several alternatives have been developed to prevent the release of free radicals and improve polymer mechanical properties, such as thermal treatment, phospholipid polymer 2-methacryloyloxyethyl phosphorylcholine grafting, remelting, and vitamin E addition. Among these options, vitamin E addition has reported good clinical results and wear resistance similar to that of HXLPE without vitamin E, as shown by short-term clinical studies of THA and TKA. This review aims to provide a comprehensive overview of the development and performance of UHMWPE in THA and TKA.
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Migliorini F, Schenker H, Betsch M, Maffulli N, Tingart M, Hildebrand F, Lecouturier S, Rath B, Eschweiler J. Silica coated high performance oxide ceramics promote greater ossification than titanium implants: an in vivo study. J Orthop Surg Res 2023; 18:31. [PMID: 36631843 PMCID: PMC9832611 DOI: 10.1186/s13018-022-03494-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 12/30/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND This in vitro study investigated the osseointegration and implant integration of high performance oxide ceramics (HPOC) compared to titanium implants in rabbits. METHODS Histomorphometry was conducted around the distal, proximal, medial, and lateral aspects of the HPOC to quantify the amount of mature and immature ossification within the bone interface. Histomorphometry was conducted by a trained musculoskeletal pathologist. The region of interest (ROI) represented the percentage of surrounding area of the implant. The percentage of ROI covered by osteoid implant contact (OIC) and mature bone implant contact (BIC) were assessed. The surrounding presence of bone resorption, necrosis, and/or inflammation were quantitatively investigated. RESULTS All 34 rabbits survived the 6- and 12-week experimental period. All HPOC implants remained in situ. The mean weight difference from baseline was + 647.7 mg (P < 0.0001). The overall OIC of the ceramic group was greater at 6 weeks compared to the titanium implants (P = 0.003). The other endpoints of interest were similar between the two implants at all follow-up points. No difference was found in BIC at 6- and 12-weeks follow-up. No bone necrosis, resorption, or inflammation were observed. CONCLUSION HPOC implants demonstrated a greater osteoid implant contact at 6 weeks compared to the titanium implants, with no difference found at 12 weeks. The percentage of bone implant contact of HPOC implants was similar to that promoted by titanium implants.
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Affiliation(s)
- Filippo Migliorini
- grid.412301.50000 0000 8653 1507Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074 Aachen, Germany ,Department of Orthopaedic and Trauma Surgery, Eifelklinik St. Brigida, 52152 Simmerath, Germany
| | - Hanno Schenker
- grid.412301.50000 0000 8653 1507Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Marcel Betsch
- grid.411668.c0000 0000 9935 6525Department of Orthopedics, University Hospital of Erlangen, 91054 Erlangen, Germany
| | - Nicola Maffulli
- grid.11780.3f0000 0004 1937 0335Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, SA Italy ,grid.9757.c0000 0004 0415 6205Faculty of Medicine, School of Pharmacy and Bioengineering, Keele University, Stoke-on-Trent, ST4 7QB UK ,grid.4868.20000 0001 2171 1133Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Mile End Hospital, 275 Bancroft Road, London, E1 4DG UK
| | | | - Frank Hildebrand
- grid.412301.50000 0000 8653 1507Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Sophie Lecouturier
- grid.412301.50000 0000 8653 1507Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Björn Rath
- grid.459707.80000 0004 0522 7001Department of Orthopaedic Surgery, Klinikum Wels-Grieskirchen, 4600 Wels, Austria
| | - Jörg Eschweiler
- grid.412301.50000 0000 8653 1507Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074 Aachen, Germany
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Bulaïd Y, Djebara AE, Belhaouane R, Havet E, Dehl M, Mertl P. Beneficial effect of a zirconium-nitride-coated implant in total knee arthroplasty revision for suspected metal hypersensitivity. Orthop Traumatol Surg Res 2022; 108:103320. [PMID: 35577273 DOI: 10.1016/j.otsr.2022.103320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 05/03/2021] [Accepted: 05/25/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Revision of total knee arthroplasty (rTKA) for suspicion of metal hypersensitivity (MHS) may require hypoallergenic implants. Results for coated implants have not been reported. The aim of the present study was to assess short-term results and survival of rTKA for MHS using a multilayer implant coating. HYPOTHESIS Multilayer implant coating improves functional results in rTKA, with survival comparable to primary coated implants. MATERIAL AND METHODS A single-center retrospective observational study included 28 patients (30 knees) undergoing rTKA for MHS using a coated implant between May 2011 and November 2016. Exclusion criteria comprised implant malpositioning and history of infection in the affected knee. Clinical and radiological results were assessed on the International Knee Society (IKS) and SF-36 functional scores and Ewald radiological score. Survival was calculated on Kaplan-Meier estimation. RESULTS Mean follow-up was 3.8 years. Mean IKS score increased by 40.2 points (40%) [range, 28.1-52.3] (p<0.05). Mean range of motion increased by 17° [range, 9.5-24.5°] (p<0.05). Mean physical and mental SF-36 components were respectively 44.7 and 46.1. Survivorship was 93%. DISCUSSION There was significant functional improvement after rTKA for MHS. There were no short-term complications related to the zirconium nitrate coating. However, studies with longer follow-up will be needed for confirmation. LEVEL OF EVIDENCE IV; retrospective study.
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Affiliation(s)
- Yassine Bulaïd
- Service de Chirurgie Orthopédique et Traumatologie, CHU Amiens-Picardie, 80480, Salouël, France
| | - Az-Eddine Djebara
- Service de Chirurgie Orthopédique et Traumatologie, CHU Amiens-Picardie, 80480, Salouël, France.
| | - Ramy Belhaouane
- Service de Chirurgie Orthopédique et Traumatologie, CHU Amiens-Picardie, 80480, Salouël, France
| | - Eric Havet
- Service de Chirurgie Orthopédique et Traumatologie, CHU Amiens-Picardie, 80480, Salouël, France
| | - Massinissa Dehl
- Service de Chirurgie Orthopédique et Traumatologie, CHU Amiens-Picardie, 80480, Salouël, France
| | - Patrice Mertl
- Service de Chirurgie Orthopédique et Traumatologie, CHU Amiens-Picardie, 80480, Salouël, France
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Dahlmann S, Ziegeler K, Mau-Möller A, Mittelmeier W, Bergschmidt P. Patellar Tracking in Total Knee Arthroplasty-Influence on Clinical and Functional Outcome. Diagnostics (Basel) 2022; 12:diagnostics12051082. [PMID: 35626238 PMCID: PMC9139248 DOI: 10.3390/diagnostics12051082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/22/2022] [Accepted: 04/21/2022] [Indexed: 11/16/2022] Open
Abstract
Anterior knee pain is a common problem after primary total knee arthroplasty (TKA). The aim of this study was to find parameters in patellar positioning which influence the clinical and functional outcome after TKA. Included were 59 patients who underwent TKA, of which three patients were treated bilaterally (n = 62 included knees). In a periodical follow-up of up to 5 years, each patient had to answer three questionnaires (HSS, WOMAC, SF-36) and underwent three radiographies of the knee (including merchant view) and a clinical examination, including Range Of Motion (ROM). All radiographs were evaluated by a single observer blinded to clinical data, who collected multiple parameters of sagittal and axial patellar alignment including newly developed methods for measuring patellar shift and tilt. Depending on the measurement results, three groups were built for each parameter and the influence on the outcome was determined. A lateral patellar tilt of more than 4° resulted in lower scores for both the HSS and WOMAC. The rarely investigated patellar facet angle showed a significantly inferior clinical and functional outcome in late follow-up of >24 months if lower than 142°, possibly due to progressive osteosclerotic changes of the patella caused by increased contact stress with corresponding patellar morphology. No significant difference was found for all other parameters. The newly developed method for measuring patellar shift has proven to be a valuable and easy instrument in the postoperative setting.
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Affiliation(s)
- Sebastian Dahlmann
- Department of Radiology, Charité Universitätsmedizin Berlin, Luisenstraße 7, 10117 Berlin, Germany;
- Correspondence:
| | - Katharina Ziegeler
- Department of Radiology, Charité Universitätsmedizin Berlin, Luisenstraße 7, 10117 Berlin, Germany;
| | - Anett Mau-Möller
- Orthopaedic Clinic and Outpatient Department, University Medicine Rostock, Doberaner Straße 142, 18057 Rostock, Germany; (A.M.-M.); (W.M.); (P.B.)
| | - Wolfram Mittelmeier
- Orthopaedic Clinic and Outpatient Department, University Medicine Rostock, Doberaner Straße 142, 18057 Rostock, Germany; (A.M.-M.); (W.M.); (P.B.)
| | - Philipp Bergschmidt
- Orthopaedic Clinic and Outpatient Department, University Medicine Rostock, Doberaner Straße 142, 18057 Rostock, Germany; (A.M.-M.); (W.M.); (P.B.)
- Department for Orthopaedic Surgery, Trauma Surgery and Hand Surgery, Südstadt Hospital Rostock, Südring 81, 18059 Rostock, Germany
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Sayah SM, Karunaratne S, Beckenkamp PR, Horsley M, Hancock MJ, Hunter DJ, Herbert RD, de Campos TF, Steffens D. Clinical Course of Pain and Function Following Total Knee Arthroplasty: A Systematic Review and Meta-Regression. J Arthroplasty 2021; 36:3993-4002.e37. [PMID: 34275710 DOI: 10.1016/j.arth.2021.06.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 05/17/2021] [Accepted: 06/17/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) is widely considered a successful intervention for osteoarthritis and other degenerative knee diseases. This study addresses the need for a high-quality meta-analysis that outlines the clinical course of pain and function post-TKA. METHODS The review included prospective cohort studies assessing pain or function of patients undergoing primary TKA at baseline (preoperatively) and at least 2 additional time points including one at least 12 months postoperatively. Two reviewers independently screened references, extracted data, and assessed risk of bias using the Quality in Prognosis Studies tool. The time course of recovery of pain and function was modeled using fractional polynomial meta-regression. RESULTS In total, 191 studies with 59,667 patients were included, most with low risk of bias. The variance-weighted mean pain score (/100, 0 = no pain) was 64.0 (95% confidence interval [CI] 60.2-67.7) preoperatively, 24.1 (95% CI 20.3-27.9) at 3 months, 20.4 (95% CI 16.7-24.0) at 6 months, and 16.9 (95%CI 13.6-20.3) at 12 months, and remained low (10.1; 95% CI 4.8-15.4) at 10 years postoperatively. The variance-weighted mean function score (/100, 0 = worst function) was 47.1 (95% CI 45.7-48.4) preoperatively, 72.8 (95% CI 71.3-74.4) at 3 months, 76.3 (95% CI 74.7-77.8) at 6 months, and 78.1 (95%CI 76.4-79.7) at 12 months. Function scores were good (79.7; 95% CI 77.9-81.5) at 10 years postoperatively. CONCLUSION Patients undergoing primary TKA can expect a large and rapid but incomplete recovery of pain and function in the first postoperative year. At 10 years, the gains in pain scores may still remain while there is an improvement in function.
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Affiliation(s)
- Said Mohamad Sayah
- Surgical Outcomes Resource Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Sydney, New South Wales, Australia; Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Sascha Karunaratne
- Surgical Outcomes Resource Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Sydney, New South Wales, Australia; Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Paula R Beckenkamp
- Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Mark Horsley
- Department of Orthopaedic Surgery, Royal Prince Alfred Hospital (RPAH), Sydney, New South Wales, Australia
| | - Mark J Hancock
- Department of Health Professions, Macquarie University, Sydney, New South Wales, Australia
| | - David J Hunter
- Institute of Bone and Joint Research, The University of Sydney, Sydney, New South Wales, Australia; Rheumatology Department, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Robert D Herbert
- Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia
| | - Tarcisio F de Campos
- Department of Health Professions, Macquarie University, Sydney, New South Wales, Australia
| | - Daniel Steffens
- Surgical Outcomes Resource Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Sydney, New South Wales, Australia; Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
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Two-year fixation and ten-year clinical outcomes of total knee arthroplasty inserted with normal-curing bone cement and slow-curing bone cement: A randomized controlled trial in 54 patients. Knee 2021; 33:110-124. [PMID: 34619515 DOI: 10.1016/j.knee.2021.08.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 05/12/2021] [Accepted: 08/25/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The normal-curing Refobacin® Bone Cement R (RR) and slow-curing Refobacin® Plus Bone Cement (RP) were introduced after discontinuation of the historically most used bone cement, Refobacin®-Palacos® R, in 2005. The aim of this study was to compare total knee arthroplasty component fixation with the two bone cements. METHODS 54 patients with primary knee osteoarthritis were randomized to either RR (N = 27) or RP (N = 27) bone cement and followed for two years with radiostereometric analysis of tibial and femoral component migration and dual-energy x-ray absorptiometry measured periprosthetic bone mineral density (BMD). Further, patients were followed up at ten years with clinical outcome scores (OKS and KOOS). RESULTS At two-years follow-up, tibial total translation was 0.31 mm (95% CI: 0.19 - 0.42) for the RP group and 0.56 mm (95% CI: 0.45 - 0.67) (p < 0.01) for the RR group. There was continuous tibial component migration from one to two years follow-up (MTPM > 0.2 mm) in 13/27 patients from the RR and in 12/26 patients from the RP group. There was no difference between groups in BMD baseline values or changes during follow-up, as well as no correlation between change in BMD and tibial component migration. At ten-years follow-up, the improvement in the clinical outcome scores was similar between groups. There were no prosthesis related complications during the 10-year follow-up. CONCLUSION At two years, tibial total translation was lower in the RP compared with the RR cement group, but BMD changes were similar. At ten years, no components were revised and clinical outcome scores were similar between groups.
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Szarek A, Stradomski G, Łukomska-Szarek J, Rydz D, Wolański W, Joszko K. Wear Morphology on the Surfaces of CoCrMo Unicompartmental Knee Joint Endoprostheses as Elements of Metal-Metal Friction Nodes. MATERIALS (BASEL, SWITZERLAND) 2020; 13:E2689. [PMID: 32545611 PMCID: PMC7345842 DOI: 10.3390/ma13122689] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 06/05/2020] [Accepted: 06/09/2020] [Indexed: 01/17/2023]
Abstract
The article assesses the strength and structural parameters of load-bearing layers of metal biobearings made of CoCrMo alloy. The research material consisted of unicompartmental knee joint endoprostheses used in the human body, removed due to excessive wear. No patient participated in the examinations. The endoprostheses used as research material underwent the liquidation procedures in the hospital, which has all necessary permissions and certifications to perform endoprosthetic procedures. Endoprostheses selected for the examinations had been used for 6 to 12 years at similar load conditions as declared by the patients, i.e., body weight of F = 835 N, declared activity expressed as the number of load cycles up to 100 thousand/year, and no artificial joint infections. To assess the homogeneity of the research material, the analysis of chemical composition using a Joel scanning electron microscope with EDS (Energy-dispersive X-ray spectroscopy) was made to exclude endoprostheses with various alloying additives. Microscopic examinations were performed using the Phenom XL microscope, while the wear surface was examined using a Keyence VHX-900F microscope. Several experimental tests were also carried out on load-bearing surfaces to assess changes in strength parameters of the base material after a known life cycle and load conditions. Material hardness using the Vickers method, yield point, critical value of stress intensity coefficient, and the coefficient of friction µ were evaluated. The examinations allowed for the systematization of wear in the knee and femoral components of unicompartmental hip endoprostheses. The statistical evaluation of the number and costs of hip joint replacement surgeries in Poland was also made.
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Affiliation(s)
- Arkadiusz Szarek
- Faculty of Mechanical Engineering and Computer Science, Department of Technology and Automation, Czestochowa University of Technology, 21 Armii Krajowej Av., 42-201 Czestochowa, Poland;
| | - Grzegorz Stradomski
- Faculty of Production Engineering and Materials Technology, Czestochowa University of Technology, 19 Armii Krajowej Av., 42-201 Czestochowa, Poland; (G.S.); (D.R.)
| | - Justyna Łukomska-Szarek
- Faculty of Management, Czestochowa University of Technology, 19 B Armii Krajowej Av., 42-201 Czestochowa, Poland;
| | - Dariusz Rydz
- Faculty of Production Engineering and Materials Technology, Czestochowa University of Technology, 19 Armii Krajowej Av., 42-201 Czestochowa, Poland; (G.S.); (D.R.)
| | - Wojciech Wolański
- Faculty of Biomedical Engineering, Department of Biomechatronics, Silesian University of Technology, 40 Roosevelta Av., 41-800 Zabrze, Poland;
| | - Kamil Joszko
- Faculty of Biomedical Engineering, Department of Biomechatronics, Silesian University of Technology, 40 Roosevelta Av., 41-800 Zabrze, Poland;
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Pobloth AM, Mersiowsky MJ, Kliemt L, Schell H, Dienelt A, Pfitzner BM, Burgkart R, Detsch R, Wulsten D, Boccaccini AR, Duda GN. Bioactive coating of zirconia toughened alumina ceramic implants improves cancellous osseointegration. Sci Rep 2019; 9:16692. [PMID: 31723174 PMCID: PMC6853946 DOI: 10.1038/s41598-019-53094-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 10/27/2019] [Indexed: 01/16/2023] Open
Abstract
Bioactive coatings have the potential to improve the bony integration of mechanically loaded orthopedic ceramic implants. Using the concept of mimicking the natural bone surface, four different coatings of varying thickness on a zirconia toughened alumina (ZTA) ceramic implant were investigated regarding their osseointegration in a drill-hole model in sheep. The hypothesis that a bioactive coating of ZTA ceramics would facilitate cancellous bone integration was investigated. The bioactive coatings consisted of either a layer of covalently bound multi phosphonate molecules (chemical modification = CM), a nano hydoxyapatite coating (HA), or two different bioactive glass (BG) coatings in micrometer thickness, forming a hydroxyl-carbonate apatite layer on the implant surface in vivo (dip-coated 45S5 = DipBG; sol-gel 70S30C = SGBG). Coated surfaces were characterized by scanning electron microscopy and X-ray photoelectron spectroscopy. After 12 weeks, osseointegration was evaluated via mechanical push-out testing and histology. HA enhanced the maximum push-out force (HA: mean 3573.85 ± 1119.91 N; SGBG: mean 1691.57 ± 986.76 N; p = 0.046), adhesive shear strength (HA: mean 9.82 ± 2.89 MPA; SGBG: mean 4.57 ± 2.65 MPA; p = 0.025), and energy release rate (HA: mean 3821.95 ± 1474.13 J/mm2; SGBG: mean 1558.47 ± 923.47 J/mm2; p = 0.032) compared to SGBG. The implant-bone interfacial stiffness increased by CM compared to SGBG coating (CM: mean 6258.06 ± 603.80 N/mm; SGBG: mean 3565.57 ± 1705.31 n/mm; p = 0.038). Reduced mechanical osseointegration of SGBG coated implants could be explained histologically by a foreign body reaction surrounding the implants.
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Affiliation(s)
- Anne-Marie Pobloth
- Julius Wolff Institut, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Max J Mersiowsky
- Julius Wolff Institut, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Luisa Kliemt
- Julius Wolff Institut, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Hanna Schell
- Julius Wolff Institut, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Anke Dienelt
- Julius Wolff Institut, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.,Berlin-Brandenburg Center for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Berit M Pfitzner
- Institut für Pathologie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Rainer Burgkart
- Clinic of Orthopedics and Sports Orthopedics, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Straße 22, D-81675, München, Germany
| | - Rainer Detsch
- Institute of Biomaterials, University of Erlangen-Nuremberg, Cauerstr. 6, 91058, Erlangen, Germany
| | - Dag Wulsten
- Julius Wolff Institut, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Aldo R Boccaccini
- Institute of Biomaterials, University of Erlangen-Nuremberg, Cauerstr. 6, 91058, Erlangen, Germany
| | - Georg N Duda
- Julius Wolff Institut, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.,Berlin-Brandenburg Center for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.,Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
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10
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Trieb K, Glinz J, Reiter M, Kastner J, Senck S. Non-Destructive Testing of Ceramic Knee Implants Using Micro-Computed Tomography. J Arthroplasty 2019; 34:2111-2117. [PMID: 31200988 DOI: 10.1016/j.arth.2019.05.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 04/22/2019] [Accepted: 05/02/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Because of the accumulated numbers and the increasing rate of knee replacement surgeries larger numbers of revision cases are likely. Although the success rate of knee arthroplasties is high, complications like the loosening of the implant necessitate subsequent treatments. Therefore, new concepts such as metal-free ceramic implants are necessary, for example, using zirconium dioxide (ZrO2). Several studies showed that the strength of ceramic ZrO2 implants is equivalent to cobalt-chromium components. METHODS Non-destructive testing remains challenging due to the high density (6 g/cm³) of ZrO2. In this feasibility study, we investigated 8 tibial and 8 femoral implants respectively using an industrial X-ray micro-computed tomography (XCT) system at a voxel size of 100 μm. We established a non-destructive testing protocol for ceramic knee implants optimizing scanning parameters and sample orientation using CT simulations. Finally, we used an iterative artifact reduction procedure for beam hardening correction. RESULTS The results show that corrected image data enable the non-destructive inspection of high-density components. In this sample, none of the investigated components show any internal defects like pores or cracks. In general, XCT is a major imaging method that is able to provide a 3-dimensional representation of higher dense objects that allows the inspection of metal or ceramic knee implants. Even though we established an optimized scanning routine for tibial and femoral ceramic components, it is not possible to completely eliminate scanning artifacts of XCT. CONCLUSION Altogether, after visual inspection, none of the beam-hardening corrected XCT data sets for femoral and tibial implants showed any defects, that is, no inclusions, cracks, or pores were detected. XCT test is therefore an essential addition to the fatigue testing since it is the only non-destroying testing method.
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Affiliation(s)
- Klemens Trieb
- Computed Tomography Research Group, University of Applied Sciences Upper Austria, Wels, Austria; Department of Orthopaedics, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Jonathan Glinz
- Computed Tomography Research Group, University of Applied Sciences Upper Austria, Wels, Austria
| | - Michael Reiter
- Computed Tomography Research Group, University of Applied Sciences Upper Austria, Wels, Austria
| | - Johann Kastner
- Computed Tomography Research Group, University of Applied Sciences Upper Austria, Wels, Austria
| | - Sascha Senck
- Computed Tomography Research Group, University of Applied Sciences Upper Austria, Wels, Austria
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11
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Bahraminasab M, Bozorg M, Ghaffari S, Kavakebian F. Corrosion of Al 2O 3-Ti composites under inflammatory condition in simulated physiological solution. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2019; 102:200-211. [PMID: 31146991 DOI: 10.1016/j.msec.2019.04.047] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 03/12/2019] [Accepted: 04/14/2019] [Indexed: 12/21/2022]
Abstract
Alumina-titanium composites have shown good mechanical properties which makes them promising for orthopedic applications. The placement of an orthopedic implant involves an invasive procedure which stimulates a localized inflammatory response causing an acidic environment around the implant. This makes the study on corrosion more critical. Therefore, the aim of the present paper was to study the corrosion behavior of the composites with 75 vol% and 50 vol% Ti content (with alumina balance) fabricated by Spark Plasma Sintering under acidic condition representing inflammation and in two elapsed times (1 h and 1-day) using polarization and electrochemical impedance spectroscopy tests. For comparison, the experiments were also conducted in normal physiological solution after 1 h, and pure Ti (100vol%Ti) was fabricated by the same process and analyzed, similarly. Furthermore, behavior of the samples was studied after 48 days of immersion in the acidic and normal solutions using SEM, ATR-FTIR, AFM, and ICP-OES. The results of corrosion tests showed very good passivation behavior of 100vol%Ti and the composite containing 75vol.%Ti. The superiority of the 75vol.%Ti composite in corrosion characteristics in both solutions was also found. Its corrosion resistance was 20.3 MΩcm2 under the inflammatory condition after 1-day, which was 39% higher than that of 100vol.%Ti under the same condition. The results of SEM indicated both corroded and mineral deposition zones on all materials' surfaces and the ATR-FTIR results revealed additional adsorbed bands related to water adsorption, OH and carbonate groups after immersion. The AFM analysis showed rougher morphology, particularly for 75 vol% Ti where the Rq was increased about 50 nm, and the ICP-OES results indicated 65.87% and 61.94% deposition of solution calcium on 75vol.%Ti and 50vol.%Ti, respectively. The acidic/inflammatory condition influenced the corrosion processes of all materials. Lower pH caused the passivation to occur sooner and the corrosion resistance to be higher.
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Affiliation(s)
- Marjan Bahraminasab
- Nervous System Stem Cells Research Center, Semnan University of Medical Sciences, Semnan, Iran; Department of Tissue Engineering and Applied Cell Sciences, School of Medicine, Semnan University of Medical Sciences, Semnan, Iran.
| | - Mansoor Bozorg
- Department of Chemical & Materials Engineering, Shahrood University of Technology, Shahrood 3619995161, Iran
| | - Somaye Ghaffari
- Department of Ceramics, Materials and Energy Research Center, P.O. Box 31787316, Karaj, Alborz, Iran
| | - Fatemeh Kavakebian
- Nervous System Stem Cells Research Center, Semnan University of Medical Sciences, Semnan, Iran
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12
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Xiang S, Zhao Y, Li Z, Feng B, Weng X. Clinical outcomes of ceramic femoral prosthesis in total knee arthroplasty: a systematic review. J Orthop Surg Res 2019; 14:57. [PMID: 30782186 PMCID: PMC6381750 DOI: 10.1186/s13018-019-1090-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 02/05/2019] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Ceramic bearings have been widely used in total hip arthroplasty (THA), which resulted in satisfactory clinical outcomes due to the excellent tribological characteristics of the implants. However, ceramic components are not commonly used in total knee arthroplasty (TKA) because of brittleness. This study aimed to gather and analyze information regarding the clinical outcomes (including survival without revision, causes of revision, functional outcome, and incidence of loosening) and reach a definitive conclusion about the use of ceramic femoral components in total knee arthroplasty. METHODS MEDLINE, EMBASE, Cochrane, and ClinicalTrials.gov databases were searched for studies that reported the clinical and/or radiological outcomes with or without survival data of ceramic TKA implants and that included more than 10 patients with a minimum of 1 year follow-up. RESULTS From an initial sample of 147, there were 14 studies that met the inclusion criteria. Overall, there was a notable enhancement of joint function after the procedure, with a satisfactory mid- and long-term survival of the ceramic components, which is comparable to that of the conventional alloy components reported previously. In addition, the revision rate was reported to be between 0% and 14.37% according to the included studies. However, revision due to aseptic loosening, wear, and component fracture appeared to be rare, demonstrating the safety of in vivo use of ceramic bearings in the TKA procedure. CONCLUSIONS Ceramic TKA implants show similar post-operative clinical results and survival rate compared to their conventional metallic counterparts. Our results confirmed the safety of in vivo use of ceramic bearings in TKA, with rare implant breakage and aseptic loosening. Considering the excellent characteristics of the tribology of ceramics, the clinical use of ceramic prostheses in TKA could be promising.
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Affiliation(s)
- Shuai Xiang
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, 100730, China
| | - Yan Zhao
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, 100730, China
| | - Zeng Li
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, 100730, China
| | - Bin Feng
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, 100730, China
| | - Xisheng Weng
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, 100730, China.
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13
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Saccomanno MF, Sircana G, Masci G, Cazzato G, Florio M, Capasso L, Passiatore M, Autore G, Maccauro G, Pola E. Allergy in total knee replacement surgery: Is it a real problem? World J Orthop 2019; 10:63-70. [PMID: 30788223 PMCID: PMC6379738 DOI: 10.5312/wjo.v10.i2.63] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 12/26/2018] [Accepted: 01/06/2019] [Indexed: 02/06/2023] Open
Abstract
Total knee arthroplasty is a common procedure, with extremely good clinical results. Despite this success, it produces 20% unsatisfactory results. Among the causes of these failures is metal hypersensitivity. Metal sensitization is higher in patients with a knee arthroplasty than in the general population and is even higher in patients undergoing revision surgery. However, a clear correlation between metal sensitization and symptomatic knee after surgery has not been ascertained. Surely, patients with a clear history of metal allergy must be carefully examined through dermatological and laboratory testing before surgery. There is no globally accepted diagnostic algorithm or laboratory test to diagnose metal hypersensitivity or metal reactions. The patch test is the most common test to determine metal hypersensitivity, though presenting some limitations. Several laboratory assays have been developed, with a higher sensitivity compared to patch testing, yet their clinical availability is not widespread, due to high costs and technical complexity. Symptoms of a reaction to metal implants present across a wide spectrum, ranging from pain and cutaneous dermatitis to aseptic loosening of the arthroplasty. However, although cutaneous and systemic hypersensitivity reactions to metals have arisen, thereby increasing concern after joint arthroplasties, allergies against implant materials remain quite rare and not a well-known problem. The aim of the following paper is to provide an overview on diagnosis and management of metal hypersensitivity in patients who undergo a total knee arthroplasty in order clarify its real importance.
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Affiliation(s)
- Maristella F Saccomanno
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Italy
| | - Giuseppe Sircana
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Italy
| | - Giulia Masci
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Italy
| | - Gianpiero Cazzato
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Italy
| | - Michela Florio
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Italy
| | - Luigi Capasso
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Italy
| | - Marco Passiatore
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Italy
| | - Giovanni Autore
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Italy
| | - Giulio Maccauro
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Italy
| | - Enrico Pola
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Italy
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Trieb K. A novel ceramic tibial component is as safe as its metal counterpart. ACTA ACUST UNITED AC 2018; 63:327-332. [DOI: 10.1515/bmt-2016-0231] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 07/03/2017] [Indexed: 11/15/2022]
Abstract
Abstract
Failure rates of 2–10% provide evidence for further development in knee arthroplasty. The purpose of our study was to examine the safety of the tibial component of a novel all-ceramic total knee replacement (TKR) (BPK-S Integration ceramic) consisting of BIOLOX®delta ceramic. The standards ISO 14879-1 and ASTM F1800-07 describe the test set-up for the experimental strength verification with a significantly increased maximum load of 5300 N (900 N are required) and post-fatigue burst strength testing. All specimens were able to prove their mechanical strength against fracture in the alternating load test. There was no material fracture in any of the included tibial components. The subsequent post-fatigue burst strength testing revealed the maximum strength against fracture of all specimens. With at least 9.7 kN for size 3 and at least 12.1 kN for size 6, all specimens showed relatively large strength reserves to the stress in the alternating load test. So far we simulated an in vivo lifetime of 10 years for the tibial component. Further studies should be conducted in which longer in vivo lifetimes of the components are simulated to investigate possible fatigue of the used material over a longer period of time.
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Long-Term Durability of Ceramic Tri-Condylar Knee Implants: A Minimum 15-Year Follow-Up. J Arthroplasty 2017; 32:1874-1879. [PMID: 28209274 DOI: 10.1016/j.arth.2017.01.016] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 12/25/2016] [Accepted: 01/12/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Ceramic bearings are not commonly used in total knee arthroplasty (TKA). So far, little information is available about whether long-term survivorship and good clinical outcomes can be ensured with ceramic knee implants. The purposes of the present study were to evaluate the clinical and radiological outcomes, and to assess the long-term durability of a ceramic tri-condylar implant. METHODS A total of 507 consecutive TKAs were carried out using a ceramic tri-condylar femoral implant. The posterior cruciate ligament was sacrificed, and all components were fixed with bone cement. Clinical outcomes were assessed retrospectively with the Knee Society scoring system. Kaplan-Meier survivorship was calculated to determine the cumulative survival rate. RESULTS One hundred sixty-seven knees (114 patients) were available for clinical outcomes. The average range of flexion improved from 118.1° preoperatively to 123.7° at a minimum 15-year follow-up (P < .001). The average Knee Society knee score improved from 39.1 to 92.8 (P < .001). The functional score also improved from 36.0 to 47.0 (P < .001). With revision for any surgery or radiographic failure as the end point, Kaplan-Meier survivorship at 15 years was 94.0%. With revision of any component as the end point, the corresponding survivorship was 96.2%. CONCLUSION Clinically, the postoperative knee flexion range and Knee Society scores were good after long-term follow-up. The survivorship of the ceramic knee implant was excellent over the 15-year follow-up, and long-term durability was achieved, making ceramic a promising alternative material for the femoral component in TKA.
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