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Elbardesy H, Yadav H, Rabea M, Guerin S, Harty J. Femoral head penetration in Vitamin-E polyethylene liner versus conventional liners in total hip arthroplasty: systematic review and meta-analysis of randomised control trials. SICOT J 2021; 7:47. [PMID: 34515633 PMCID: PMC8436949 DOI: 10.1051/sicotj/2021045] [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: 01/15/2021] [Accepted: 08/11/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Debate encompasses the use of Vitamin E Polyethylene or conventional Polyethylene liner in primary hip arthroplasty. Does the Inclusion of Vitamin E in PE give adequate protection from oxidation and maintains lower rates of wear? PATIENTS AND METHODS We performed this study following the Preferred Reporting Items for Systematic Reviews and Meta-analyses Statement (PRISMA) and the Cochrane Handbook for systematic reviews and meta-analysis. Studies were included from any region, written in any language. We had only the randomised control trials comparing the femoral head penetration between Vitamin-E diffused highly cross-linked polyethylene (VEPE) liner and conventional liners in primary total hip arthroplasty. RESULTS We included 10 studies in this meta-analysis. We conducted them using Review Manager V.5.0. We computed the risk ratio to measure the treatment effect, considering the heterogeneity. We used Random-effect models. VEPE had insignificant marginal advantages for FHP within three months post-operative. Additionally, VEPE showed significantly less FHP after two and five years. After one year, it showed significantly less FHP with the VEPE group versus the UHMWPE cohort and a non-significant difference between the VEPE and XLPE group. CONCLUSIONS In terms of FHP, this metanalysis shows less FHP for the VEPE than conventional PE. A longer follow-up period is required to evaluate whether the oxidation protection gained by Vitamin E results in lower wear rates, less osteolysis, and aseptic loosening compared to the conventional PE in the long term.
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Affiliation(s)
- Hany Elbardesy
- Department of Trauma and Orthopaedic, Cork University Hospital, Wilton, Cork T12DFK4, Ireland
| | - Himanshu Yadav
- Department of Trauma and Orthopaedic, Cork University Hospital, Wilton, Cork T12DFK4, Ireland
| | - Mohamed Rabea
- Faculty of Pharmacy, Mansoura University, Mansoura 32216, Egypt
| | - Shane Guerin
- Department of Trauma and Orthopaedic, Cork University Hospital, Wilton, Cork T12DFK4, Ireland
| | - James Harty
- Department of Trauma and Orthopaedic, Cork University Hospital, Wilton, Cork T12DFK4, Ireland
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Rochcongar G, Remazeilles M, Bourroux E, Dunet J, Chapus V, Feron M, Praz C, Buia G, Hulet C. Reduced wear in vitamin E-infused highly cross-linked polyethylene cups: 5-year results of a randomized controlled trial. Acta Orthop 2021; 92:151-155. [PMID: 33263447 PMCID: PMC8158183 DOI: 10.1080/17453674.2020.1852785] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Background and purpose - Vitamin E-infused polyethylene is a relatively new material in joint arthroplasty; there are no long-term reports, and only few mid-term results. Using radiostereometric analysis (RSA), we primarily determined whether vitamin E-infused highly cross-linked polyethylene (HXLPE/VitE) acetabular cups show less wear than ultra-high molecular weight polyethylene (UHMWPE) acetabular cups at 5 years after total hip arthroplasty (THA). We also assessed whether wear rates correlate with increasing cup inclination angles or cup sizes.Patients and methods - This is a 5-year follow-up of our previously reported randomized controlled trial of 62 patients with 3 years' follow-up, who received THA with either an HXLPE/VitE or a UHMWPE acetabular cup. At 5 years, 40 patients were analyzed (22 in the HXLPE/VitE and 18 in the UHMWPE group).Results - HXLPE/VitE cups continued to show less cumulative femoral head penetration than UHMWPE cups (HXLPE/VitE: 0.24 mm, UHMWPE: 0.45 mm; p < 0.001). Distribution of wear was also more even with HXLPE/VitE cups than with UHMWPE cups (p = 0.002). Moreover, the difference in PE wear between 1 and 5 years in both groups showed no statistically significant correlation with increasing cup inclination angles or cup sizes. Finally, no osteolysis and implant loosening occurred, and no revision surgeries were required.Interpretation - Wear rates continue to be lower in HXLPE/VitE cups than in UHMWPE cups at 5 years of follow-up without correlation with increasing cup inclination angles or cup sizes. Finally, HXLPE/VitE cups may have the potential to prevent osteolysis and implant loosening.
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Affiliation(s)
- Goulven Rochcongar
- Caen Normandy University Hospital Centre, Department of Orthopaedic and Trauma Surgery, 14000, Caen, France
| | - Matthieu Remazeilles
- Caen Normandy University Hospital Centre, Department of Orthopaedic and Trauma Surgery, 14000, Caen, France
| | - Emeline Bourroux
- Caen Normandy University Hospital Centre, Department of Orthopaedic and Trauma Surgery, 14000, Caen, France
| | - Julien Dunet
- Caen Normandy University Hospital Centre, Department of Orthopaedic and Trauma Surgery, 14000, Caen, France
| | - Valentin Chapus
- Caen Normandy University Hospital Centre, Department of Orthopaedic and Trauma Surgery, 14000, Caen, France
| | - Matthieu Feron
- Caen Normandy University Hospital Centre, Department of Orthopaedic and Trauma Surgery, 14000, Caen, France
| | - César Praz
- Caen Normandy University Hospital Centre, Department of Orthopaedic and Trauma Surgery, 14000, Caen, France,Correspondence:
| | - Geoffrey Buia
- Caen Normandy University Hospital Centre, Department of Orthopaedic and Trauma Surgery, 14000, Caen, France
| | - Christophe Hulet
- Caen Normandy University Hospital Centre, Department of Orthopaedic and Trauma Surgery, 14000, Caen, France
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Laende EK, Richardson CG, Dunbar MJ. Migration and Wear of a Dual Mobility Acetabular Construct at 3 Years Measured by Radiostereometric Analysis. J Arthroplasty 2020; 35:1109-1116. [PMID: 31866254 DOI: 10.1016/j.arth.2019.11.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 10/27/2019] [Accepted: 11/07/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The anatomic dual mobility (ADM) acetabular component was introduced because of previously described low dislocation rates for this type of construct. The shape of the anatomic cup and the motion of polyethylene liner may have implications for acetabular cup fixation and polyethylene liner wear; therefore, the purpose of this study was to assess the migration patterns and wear rates of the ADM component using radiostereometric analysis. METHODS Uncemented ADM acetabular components were implanted in 27 patients. Radiostereometric analysis exams were taken at 6 follow-up visits over 3 years. Proximal translation and sagittal rotation of the cup and polyethylene total wear and wear rates were calculated. Oxford 12 Hip scores and satisfaction were recorded. RESULTS Mean proximal translation was below the 0.2 mm threshold at 2 years associated with acceptable long-term survivorship (0.16 mm [standard deviation {SD} 0.31] at 3 years). Mean sagittal rotation was 0.29 degrees (SD 1.03) and was greater in female subjects (P < .001). Following bedding-in, the annual wear rate was 0.02 mm/y, below the 0.1 mm/y threshold. There was no association between cup migration and polyethylene wear. Patient satisfaction at 3 years was 96%. Mean Oxford 12 Hip scores improved from 21 (SD 7) preoperatively to 43 (SD 7) 3 years postoperatively. CONCLUSIONS The ADM cup demonstrated stable migration at 3 years indicating low risk for aseptic loosening. Bedding-in in the first year was followed by low annual wear rates. These finding suggest no increased risk of the dual mobility and anatomic design on fixation or wear.
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Affiliation(s)
- Elise K Laende
- Division of Orthopaedics, Department of Surgery, Dalhousie University and QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada; School of Biomedical Engineering, Dalhousie University, Halifax, Nova Scotia, Canada
| | - C Glen Richardson
- Division of Orthopaedics, Department of Surgery, Dalhousie University and QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Michael J Dunbar
- Division of Orthopaedics, Department of Surgery, Dalhousie University and QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada; School of Biomedical Engineering, Dalhousie University, Halifax, Nova Scotia, Canada
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Abstract
Hip instability following total hip arthroplasty (THA) remains a major challenge and is one of the main causes of revision surgery. Dual mobility (DM) implants have been introduced to try to overcome this problem. The DM design consists of a small femoral head captive and mobile within a polyethylene liner. Numerous studies have shown that DM implants reduce the rate of dislocation compared to fixed-bearing inserts. Early designs for DM implants had problems with wear and intra-prosthetic dislocations, so their use was restricted to limited indications. The results of the latest generation of DM prostheses demonstrate that these problems have been overcome. Given the results of these studies presented in this review, surgeons may now consider DM THA for a wider patient selection.
Cite this article: EFORT Open Rev 2019;4:541-547. DOI: 10.1302/2058-5241.4.180045
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Affiliation(s)
- William G Blakeney
- Department of Surgery, CIUSSS-de-L'Est-de-L'Ile-de-Montréal, Hôpital Maisonneuve Rosemont, Montréal, Québec, Canada.,Department of Surgery, Albany Health Campus, Albany, Australia
| | | | - Pascal-André Vendittoli
- Department of Surgery, Albany Health Campus, Albany, Australia.,Department of Surgery, Université de Montréal, Montréal, Québec, Canada
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Van de Kleut ML, Yuan X, Athwal GS, Teeter MG. Validation of In Vivo Linear and Volumetric Wear Measurement for Reverse Total Shoulder Arthroplasty Using Model-Based Radiostereometric Analysis. J Orthop Res 2019; 37:1620-1627. [PMID: 30977541 DOI: 10.1002/jor.24294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Presently, polyethylene wear measurement of reverse total shoulder arthroplasty (rTSA) is restricted to in vitro, in silico, and retrieval analysis, with no method for the quantification of in vivo wear of well-functioning implants. The purpose of this study was to validate the use of model-based radiostereometric analysis (MBRSA) as a measurement tool for in vivo rTSA wear using a phantom setup. Six additively manufactured polyethylene inserts were fabricated, one unworn control and five to represent known wear patterns, and individually fit within the rTSA components. Each insert was imaged using standard radiostereometric techniques and analyzed using MBRSA. From the position and orientation estimation provided by MBRSA, a micro-computed tomography model of the control insert was virtually placed within the metaphyseal tray. The apparent intersection of the glenosphere into the insert was recorded as wear. This method enables wear measurements with a linear precision of 0.21 mm and a bias of 0.36 ± 0.13 mm, and a volumetric precision of 49.3 mm3 , with a bias of 48.9 ± 24.3 mm3 . This technique allows for the in vivo measurement of polyethylene wear without the requirement of marker beads or baseline radiographs, expanding the potential for in vivo wear measurements to larger populations and retrospective analysis. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:1620-1627, 2019.
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Affiliation(s)
- Madeleine L Van de Kleut
- Imaging Research Laboratories, Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,School of Biomedical Engineering, Western University, London, Ontario, Canada.,Lawson Health Research Institute, St. Joseph's Health Care, London, Ontario, Canada
| | - Xunhua Yuan
- Imaging Research Laboratories, Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - George S Athwal
- Lawson Health Research Institute, St. Joseph's Health Care, London, Ontario, Canada.,Department of Surgery, Division of Orthopaedic Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Matthew G Teeter
- Imaging Research Laboratories, Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,School of Biomedical Engineering, Western University, London, Ontario, Canada.,Lawson Health Research Institute, St. Joseph's Health Care, London, Ontario, Canada.,Department of Surgery, Division of Orthopaedic Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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6
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Deckard ER, Azzam KA, Meneghini RM. Contemporary Dual Mobility Head Penetration at Five Years: Concern for the Additional Convex Bearing Surface? J Arthroplasty 2018; 33:S280-S284. [PMID: 29602536 DOI: 10.1016/j.arth.2018.02.061] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 01/28/2018] [Accepted: 02/15/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Dual mobility (DM) bearings are increasingly popular and second-generation designs contain highly cross-linked polyethylene. The purpose of this study is to report head penetration rates in modern DM bearings. METHODS A review of 63 consecutive DM bearings was performed. Radiographs were analyzed for head penetration using Martell methodology at regular postoperative intervals. RESULTS Thirty-four DM bearings were analyzed. Mean linear head penetration was 1.59 mm/y at 1 year, 1.07 mm/y at 2 years, and 0.27 mm/y at 5 years following an exponential regression model (R2 = 0.999). Mean volumetric wear was 783 mm3/y at 1 year, 555 mm3/y at 2 years, and 104 mm3/y at 5 years following an exponential regression model (R2 = 0.986). CONCLUSION Initial head penetration of DM bearings is larger than contemporary cross-linked polyethylene bearings; however, rates approach steady state after 2 years, analogous to traditional bearings. The larger "bedding-in" head penetration may be due to the additional convex bearing surface, creating 2 surfaces for deformation/wear.
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Affiliation(s)
- Evan R Deckard
- Indiana University School of Medicine, Department of Orthopaedic Surgery, Indianapolis, Indiana
| | - Khalid A Azzam
- Indiana University School of Medicine, Department of Orthopaedic Surgery, Indianapolis, Indiana; Indiana University Health Physicians, Orthopedics & Sports Medicine, IU Health Hip & Knee Center, Fishers, Indiana
| | - R Michael Meneghini
- Indiana University School of Medicine, Department of Orthopaedic Surgery, Indianapolis, Indiana; Indiana University Health Physicians, Orthopedics & Sports Medicine, IU Health Hip & Knee Center, Fishers, Indiana
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Taniguchi N, Jinno T, Takada R, Koga D, Ando T, Okawa A, Haro H. Do screws and screw holes affect osteolysis in cementless cups using highly crosslinked polyethylene? A 7 to 10-year follow-up case-control study. Orthop Traumatol Surg Res 2018; 104:307-315. [PMID: 29355741 DOI: 10.1016/j.otsr.2017.12.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 12/18/2017] [Accepted: 12/19/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND The use of screws and the presence of screw holes may cause acetabular osteolysis and implant loosening in cementless total hip arthroplasty (THA) using conventional polyethylene. In contrast, this issue is not fully understood using highly crosslinked polyethylene (HXLPE), particularly in large comparative study. Therefore, we performed a case-control study to assess the influence of screw usage and screw holes on: (1) implant fixation and osteolysis and (2) polyethylene steady-state wear rate, using cases with HXLPE liners followed up for 7-10 years postoperatively. HYPOTHESIS The screw usage and screw holes adversely affect the implant fixation and incidence of wear-related osteolysis in THA with HXLPE. PATIENTS AND METHODS We reviewed 209 primary cementless THAs performed with 26-mm cobalt-chromium heads on HXLPE liners. To compare the effects of the use of screws and the presence of screw holes, the following groups were established: (1) with-screw (n=140); (2) without-screw (n=69); (3) no-hole (n=27) and (4) group in which a cup with screw holes, but no screw was used (n=42). Two adjunct groups (no-hole cups excluded) were established to compare the differences in the two types of HXLPE: (5) remelted group (n=100) and (6) annealed group (n=82). Implant stability and osteolysis were evaluated by plain radiography and computed tomography. The wear rate from 1 year to the final evaluation was measured using plain X-rays and PolyWare Digital software. RESULTS All cups and stems achieved bony fixation. On CT-scan, no acetabular osteolysis was found, but there were 3 cases with a small area of femoral osteolysis. The mean steady-state wear rate of each group was (1) 0.031±0.022, (2) 0.033±0.035, (3) 0.031±0.024, (4) 0.029±0.018, (5) 0.030±0.018 and (6) 0.034±0.023mm/year, respectively. A comparison of the effects of screw usage or screw holes found no significant between-group differences in the implant stability, prevalence of osteolysis [no acetabular osteolysis and 3/209 at femoral side (1.4%)] and steady-state wear rate. DISCUSSION This study suggests that there are no adverse effects on the results of THA with HXLPE from the use of cups with screw holes and the use of screws for cup fixation. LEVEL OF EVIDENCE Level III retrospective case-control study.
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Affiliation(s)
- N Taniguchi
- Department of Orthopaedic Surgery, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi 409-3898, Japan; Department of Orthopaedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - T Jinno
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan; Department of Rehabilitation Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan.
| | - R Takada
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - D Koga
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - T Ando
- Department of Orthopaedic Surgery, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi 409-3898, Japan
| | - A Okawa
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - H Haro
- Department of Orthopaedic Surgery, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi 409-3898, Japan
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8
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Rochcongar G, Buia G, Bourroux E, Dunet J, Chapus V, Hulet C. Creep and Wear in Vitamin E-Infused Highly Cross-Linked Polyethylene Cups for Total Hip Arthroplasty: A Prospective Randomized Controlled Trial. J Bone Joint Surg Am 2018; 100:107-114. [PMID: 29342060 DOI: 10.2106/jbjs.16.01379] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Aseptic loosening, the most common indication for revision surgery in total hip arthroplasty, can result from osteolysis caused by polyethylene (PE) wear particles. PE wear is increased by age-related oxidation of PE and free radicals emerging during irradiation cross-linking. Diffusion of vitamin E into PE stabilizes free radicals to maintain the biomechanical properties of PE. The purpose of this study was to determine whether vitamin E-infused highly cross-linked PE cups could reduce wear rates. METHODS We performed a prospective randomized controlled trial, in which 62 patients were allocated to 2 groups: a study group that received a vitamin E-infused highly cross-linked PE (HXLPE/VitE) cup and a control group that received an ultra-high molecular weight PE (UHMWPE) cup. Using radiostereometric analysis, we measured the penetration of the femoral head into the cup 7 days after surgery (baseline) and then again at 6 months and at 1, 2, and 3 years later. RESULTS Baseline variables did not differ significantly between the groups. At 1, 2, and 3 years after surgery, the HXLPE/VitE cup showed significantly less cumulative penetration (creep and wear) than the UHMWPE cup (p = 0.004, p < 0.0001, and p < 0.0001, respectively). The cumulative penetration after 3 years was 0.200 mm for the HXLPE/VitE cup versus 0.317 mm for the UHMWPE cup (p < 0.0001). From 1 to 3 years after surgery, after creep had stabilized and further penetration was mainly due to wear, the mean penetration increased only 0.04 mm in the HXLPE/VitE cup and 0.116 mm in the UHMWPE cup. CONCLUSIONS Our results confirm that wear rates over the first 3 years following surgery were lower in HXLPE/VitE cups than in UHMWPE cups. This suggests that HXLPE/VitE cups may prevent osteolysis, implant loosening, and eventually revision surgery. Long-term follow-up data continue to be collected to confirm these findings. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- G Rochcongar
- Department of Orthopedics and Traumatology, Caen University Hospital, Caen, France
| | - G Buia
- Department of Orthopedics and Traumatology, Caen University Hospital, Caen, France
| | - E Bourroux
- Department of Orthopedics and Traumatology, Caen University Hospital, Caen, France
| | - J Dunet
- Department of Orthopedics and Traumatology, Caen University Hospital, Caen, France
| | - V Chapus
- Department of Orthopedics and Traumatology, Caen University Hospital, Caen, France
| | - C Hulet
- Department of Orthopedics and Traumatology, Caen University Hospital, Caen, France
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Stentz-Olesen K, Nielsen ET, De Raedt S, Jørgensen PB, Sørensen OG, Kaptein BL, Andersen MS, Stilling M. Validation of static and dynamic radiostereometric analysis of the knee joint using bone models from CT data. Bone Joint Res 2017; 6:376-384. [PMID: 28600383 PMCID: PMC5492337 DOI: 10.1302/2046-3758.66.bjr-2016-0113.r3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 03/13/2017] [Indexed: 11/05/2022] Open
Abstract
Objectives Static radiostereometric analysis (RSA) using implanted markers is considered the most accurate system for the evaluation of prosthesis migration. By using CT bone models instead of markers, combined with a dynamic RSA system, a non-invasive measurement of joint movement is enabled. This method is more accurate than current 3D skin marker-based tracking systems. The purpose of this study was to evaluate the accuracy of the CT model method for measuring knee joint kinematics in static and dynamic RSA using the marker method as the benchmark. Methods Bone models were created from CT scans, and tantalum beads were implanted into the tibia and femur of eight human cadaver knees. Each specimen was secured in a fixture, static and dynamic stereoradiographs were recorded, and the bone models and marker models were fitted to the stereoradiographs. Results Results showed a mean difference between the two methods in all six degrees of freedom for static RSA to be within -0.10 mm/° and 0.08 mm/° with a 95% limit of agreement (LoA) ranging from ± 0.49 to 1.26. Dynamic RSA had a slightly larger range in mean difference of -0.23 mm/° to 0.16 mm/° with LoA ranging from ± 0.75 to 1.50. Conclusions In a laboratory-controlled setting, the CT model method combined with dynamic RSA may be an alternative to previous marker-based methods for kinematic analyses. Cite this article: K. Stentz-Olesen, E. T. Nielsen, S. De Raedt, P. B. Jørgensen, O. G. Sørensen, B. L. Kaptein, M. S. Andersen, M. Stilling. Validation of static and dynamic radiostereometric analysis of the knee joint using bone models from CT data. Bone Joint Res 2017;6:376–384. DOI: 10.1302/2046-3758.66.BJR-2016-0113.R3.
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Affiliation(s)
- K Stentz-Olesen
- Orthopaedic Research Group, Department of Orthopaedic Surgery, Aarhus University Hospital, Tage-Hansens Gade 2, Building 10A, Office 15, 8000 Aarhus C, Denmark
| | - E T Nielsen
- Orthopaedic Research Group, Department of Orthopaedic Surgery, Aarhus University Hospital, Tage-Hansens Gade 2, Building 10A, Office 15, 8000 Aarhus C, Denmark
| | - S De Raedt
- Nordisk Røntgen Teknik, Birkegårdsvej 16, 8361 Hesselager, Denmark
| | - P B Jørgensen
- Orthopaedic Research Group, Department of Orthopaedic Surgery, Aarhus University Hospital, Tage-Hansens Gade 2, Building 9A, 8000 Aarhus C, Denmark
| | - O G Sørensen
- Orthopaedic Research Group, Department of Orthopaedic Surgery, Aarhus University Hospital, Tage-Hansens Gade 2, Building 10A, Office 15, 8000 Aarhus C, Denmark
| | - B L Kaptein
- Biomechanics and Imaging Group, Department of Orthopaedic Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherland
| | - M S Andersen
- Department of Mechanical Engineering and Manufacturing, Aalborg University, Fibigerstræde 16, 9220 Aalborg East, Denmark
| | - M Stilling
- Orthopaedic Research Group, Departments of Orthopaedic Surgery and Clinical Medicine, Aarhus University Hospital, University of Aarhus, Tage-Hansens Gade 2, Building 10A, 8000 Aarhus C, Denmark
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10
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The linear penetration rate is not relevant for evaluating wear of dual mobility cups: an explant study. INTERNATIONAL ORTHOPAEDICS 2017; 41:599-603. [PMID: 28124104 DOI: 10.1007/s00264-017-3406-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 01/13/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE The linear penetration rate (LPR) has been used to estimate volumetric wear ever since metal-on-polyethylene bearings were first introduced. Annual volumetric wear and osteolysis are interrelated. The use of dual mobility cups has increased; however, the presence of two bearings needs paraclinical monitoring of wear to anticipate potential wear-related complications. Is LPR correlated to volumetric wear? METHODS Ninety-eight dual mobility liner retrievals were mapped in three-dimensions (3D) with a fully automatic stripe light scanner. Martell's method was applied to 3D maps of the explants to determine how much the centres of the inner and outer bearings had shifted in the three planes, and in particular, penetration of the femoral head in the "z" axis. The total, inner and outer wear volumes were then compared to the shift in the centres of rotation (COR) and the pre-operative X-rays. RESULTS There was no relationship between wear and head penetration into the liner. There was a statistically significant relationship between the 3D centre of rotation shift and inner wear or total wear. Wear was multidirectional. CONCLUSIONS LPR is ineffective for estimating wear of dual mobility inserts, since its wear not two-dimensional. In the future, a 3D imaging method with very thin slices could be used to monitor the wear of dual mobility inserts by measuring the shift in the centres of rotation, once artifacts are overcome.
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11
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Röhner E, Matziolis G. [Use of dual mobility cups for revision hip arthroplasty]. DER ORTHOPADE 2017; 46:114-120. [PMID: 28097416 DOI: 10.1007/s00132-016-3383-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The dual mobility cup (DMC) is an increasingly important tool not only in primary but also in revision total hip arthroplasty to prevent dislocation and eventually reduce postoperative complication rates. Various studies have shown survival rates with DMCs of up to 100% with an average dislocation rate of less than 1.5% after primary hip arthroplasty and a follow-up of 10 years. In revision surgery, survival rates of up to 99% were reported with dislocation rates between 0 and 10% after an average of 5 years after implantation. This article is intended to provide an overview of the principle and function of DMCs. Furthermore, indications as well as complications are presented.
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Affiliation(s)
- E Röhner
- Orthopädische Klinik des Universitätsklinikums Jena am Campus Eisenberg, Waldkrankenhaus "Rudolf Elle" GmbH, Klosterlausnitzer Straße 81, 07607, Eisenberg, Deutschland.
| | - G Matziolis
- Orthopädische Klinik des Universitätsklinikums Jena am Campus Eisenberg, Waldkrankenhaus "Rudolf Elle" GmbH, Klosterlausnitzer Straße 81, 07607, Eisenberg, Deutschland
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Wear of dual-mobility cups: a review article. INTERNATIONAL ORTHOPAEDICS 2016; 41:625-633. [DOI: 10.1007/s00264-016-3326-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 10/17/2016] [Indexed: 12/26/2022]
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Figueras G, Planell RV, Fernàndez RS, Biayna JC. Revision of Metal-on-metal Hip Arthroplasty with Well Fixed and Positioned Acetabular Component Using a Dual-mobility Head and Review of Literature. Open Orthop J 2016; 10:512-521. [PMID: 27857822 PMCID: PMC5093867 DOI: 10.2174/1874325001610010512] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 09/20/2016] [Accepted: 10/05/2016] [Indexed: 02/08/2023] Open
Abstract
Background: As a consequence of use of metal-on-metal hip arthroplasties some patients have precised revision for pain or metal hipersensivity reactions among other causes. We propose to salvage monoblock acetabular component and femoral component using a dual-mobility head and perform a lower morbidity operation in young patients preserving host bone stock in cases with well fixed and positioned components. Objective: (1) What clinical problems have been reported in patients with Metal-on-metal hip arthroplasties? (2) Could the tribocorrosion potentially cause a fracture of neck femoral component? (3) Can be the dual-mobility head a recourse in metal-on-metal hip revision? Methods: Ten patients were revised for pain or/and raised Cobalt/Chromium levels between August 2012 and December 2015. In three cases femoral neck component was fractured and femoral revision was necessary. In four hips, acetabular and femoral components could be maintained. Age, body index mass, ion levels, acetabular position, size of acetabular component and femoral head, approach, blood transfunsion and time of hospitalization were analized. Results: At a mean follow-up of 25,6 months (6 to 45) the mean postoperative HHS was 92. It was not statistically significant because several patients were low sintomatic before surgery, but had raised Cobalt/Chromium levels in the blood. All patients had near-normal levels of Cobalt/Chromium during the first 6 months after revision surgery. No relevant complications were reported. Conclusion: The use of dual-mobility head can be an acceptable option to revise metal-on-metal arthroplasties correctly oriented with abscence of loosening or infection signs and keeping bone stock in young patients.
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Affiliation(s)
- Guillem Figueras
- Fundació Althaia, Xarxa Assistencial Universitària de Manresa, Traumatology and Orthopedic Surgery Department, C/Dr Joan Soler S/N 08243 Manresa, (93-8759300), Spain
| | - Ramón Vives Planell
- Fundació Althaia, Xarxa Assistencial Universitària de Manresa, Traumatology and Orthopedic Surgery Department, C/Dr Joan Soler S/N 08243 Manresa, (93-8759300), Spain
| | - Ramón Serra Fernàndez
- Fundació Althaia, Xarxa Assistencial Universitària de Manresa, Traumatology and Orthopedic Surgery Department, C/Dr Joan Soler S/N 08243 Manresa, (93-8759300), Spain
| | - Joan Camí Biayna
- Fundació Althaia, Xarxa Assistencial Universitària de Manresa, Traumatology and Orthopedic Surgery Department, C/Dr Joan Soler S/N 08243 Manresa, (93-8759300), Spain
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Snir N, Park BK, Garofolo G, Marwin SE. Revision of Failed Hip Resurfacing and Large Metal-on-Metal Total Hip Arthroplasty Using Dual-Mobility Components. Orthopedics 2015; 38:369-74. [PMID: 26091212 DOI: 10.3928/01477447-20150603-04] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 02/25/2015] [Indexed: 02/03/2023]
Abstract
Revision of metal-on-metal (MoM) total hip arthroplasty (THA) or hip resurfacing is associated with high complication rates. The authors propose dual-mobility components as a surgical option and present short- to mid-term results of MoM hips revised with dual-mobility components. Eighteen consecutive hips that underwent revision of MoM THA or hip resurfacing using dual-mobility components were identified. At final follow-up (mean, 17.5 months), the visual analog scale, modified Harris Hip Score, and SF-12 scores had all improved (P<.05, P<.01, and P<.05, respectively). There were no dislocations or other complications. Revision of failed MoM THA or hip resurfacing using a dual-mobility device is an effective strategy.
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Epinette JA. Clinical outcomes, survivorship and adverse events with mobile-bearings versus fixed-bearings in hip arthroplasty-a prospective comparative cohort study of 143 ADM versus 130 trident cups at 2 to 6-year follow-up. J Arthroplasty 2015; 30:241-8. [PMID: 25449593 DOI: 10.1016/j.arth.2014.09.022] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 08/18/2014] [Accepted: 09/22/2014] [Indexed: 02/01/2023] Open
Abstract
The principle of dual mobility cups, often called "tripolar", has been developed to overcome the problem of instability following primary hip arthroplasty. We prospectively compared two cohorts which differed only by the type of bearings, i.e." mobile bearing hip" (MBH) in a 143-study cohort of ADM cups versus "fixed bearing hip" (FBH) of 130 Trident PSL cups, at a follow-up at 2-6years. The survival rates at 4.13-years, with instability as endpoint was significantly (P=0.0176) in favor of mobile bearings at 100% with no dislocation reported, versus 94.8% with fixed bearings. These mobile bearings, matching both "modern" dual mobility cups and annealed highly crossed polyethylene, would appear to offer at longer follow-up a valuable solution to clinical outcomes in acetabular arthroplasty.
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Affiliation(s)
- Jean-Alain Epinette
- Orthopaedic Research and Imaging Centre in Arthroplasty, Clinique Médico-Chirurgicale, Bruay-Labuissière, France
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Hassani H, Cherix S, Ek ET, Rüdiger HA. Comparisons of preoperative three-dimensional planning and surgical reconstruction in primary cementless total hip arthroplasty. J Arthroplasty 2014; 29:1273-7. [PMID: 24502952 DOI: 10.1016/j.arth.2013.12.033] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 12/15/2013] [Accepted: 12/30/2013] [Indexed: 02/01/2023] Open
Abstract
Reconstruction of important parameters such as femoral offset and torsion is inaccurate, when templating is based on plain x-rays. We evaluate intraoperative reproducibility of pre-operative CT-based 3D-templating in a consecutive series of 50 patients undergoing primary cementless THA through an anterior approach. Pre-operative planning was compared to a postoperative CT scan by image fusion. The implant size was correctly predicted in 100% of the stems, 94% of the cups and 88% of the heads (length). The difference between the planned and the postoperative leg length was 0.3 + 2.3 mm. Values for overall offset, femoral anteversion, cup inclination and anteversion were 1.4 mm ± 3.1, 0.6° ± 3.3°, -0.4° ± 5° and 6.9° ± 11.4°, respectively. This planning allows accurate implant size prediction. Stem position and cup inclination are accurately reproducible.
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Affiliation(s)
- Hassen Hassani
- Department of Orthopaedics Hôpital Orthopédique-Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland
| | - Stéphane Cherix
- Department of Orthopaedics Hôpital Orthopédique-Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland
| | - Eugene T Ek
- Melbourne Orthopaedic Group and Department of Orthopaedic Surgery, Monash University, Dandenong Hospital, Melbourne, Australia
| | - Hannes A Rüdiger
- Department of Orthopaedics Hôpital Orthopédique-Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland.
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Leclercq S, Benoit JY, de Rosa JP, Tallier E, Leteurtre C, Girardin PH. Evora® chromium-cobalt dual mobility socket: results at a minimum 10 years' follow-up. Orthop Traumatol Surg Res 2013; 99:923-8. [PMID: 24176671 DOI: 10.1016/j.otsr.2013.07.017] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Revised: 07/01/2013] [Accepted: 07/11/2013] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The Evora chromium-cobalt alloy dual mobility socket claims to display a large articulation tribology different from that of stainless steel models, limiting the risk of intraprosthetic dislocation and wear. The present study reports a minimum of 10years' follow-up in a multicenter prospective series of 200 sockets previously reported on at 5years. HYPOTHESIS The use of chromium-cobalt in dual mobility sockets provides a low rate of failure at 10years, especially as regards to osteolysis and intraprosthetic dislocation. MATERIALS AND METHODS Two hundred hydroxyapatite-coated molded chromium-cobalt sockets without titanium interface were implanted without cement in 194 patients with a mean age of 70 years (range, 32-91 years). Clinical results were assessed on Postel Merle d'Aubigné and Harris scores, plain radiographs and survival analysis. RESULTS At a mean 11 years' follow-up (10-13 years), 56 patients had died and 31 were lost to follow-up. Four underwent surgical revision (3 femoral components, and 1 socket for migration at 9 years with complete disappearance of the hydroxyapatite). A total of 109 implants were analyzable in 107 patients with a mean age of 81 years (55-93 years). At follow-up, the mean Harris score was 90 (75-96) and the PMA score 16.3 (14-18). There were no cases of loosening (except for the case reoperated on at 9 years) and no acetabular radiolucency or cysts. There were 2 cases of non-evolutive femoral radiolucency and 10 of femoral granuloma, involving head size > 22 mm (P<0.0001) and a cemented titanium stem (P=0.004) as risk factors. There were no dislocations in the large or small articulation. Ten-year survival was 99% (95% CI: 97.3%-100%) with socket revision as censorship criterion. DISCUSSION The absence of dislocation in both small and large articulations confirmed the efficacy of the dual mobility concept and suggested an advantage for chromium-cobalt sockets in reducing the rate of intraprosthetic dislocation and preventing blockage of the large articulation by a better performance in the friction couple. Granulomas were associated with wear in cemented titanium stems and with heads greater than 22 mm in diameter. Ten-year survival was 99% (censorship criterion: revision for socket failure); there was, however, one case of socket loosening with disappearance of the hydroxyapatite, indicating that surveillance should be continued in this cohort.
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Affiliation(s)
- S Leclercq
- Centre Hospitalier Saint-Martin, 18, rue des Roquemonts, 14050 Caen, France.
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Verhelst LA, Van der Bracht H, Vanhegan IS, Van Backlé B, De Schepper J. Revising the well-fixed, painful resurfacing using a double-mobility head: a new strategy to address metal-on-metal complications. J Arthroplasty 2012; 27:1857-62. [PMID: 22770851 DOI: 10.1016/j.arth.2012.05.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Accepted: 05/06/2012] [Indexed: 02/01/2023] Open
Abstract
Isolated revision of the femoral component of hip resurfacings to metal-on-metal (MoM) total hip arthroplasties has shown inferior results. We present a case series of well-fixed, painful MoM hips with elevated chromium and cobalt levels. An isolated femoral revision using a noncemented femoral component and a double-mobility head was performed. Patients were followed up for 6 months and showed excellent improvements in visual analog score and Hip dysfunction and Osteoarthritis Outcome Score (HOOS). Cobalt and chromium levels dropped at 6 weeks and were normal at 6 months. Although our follow-up is short, we feel that it is important to highlight this as a potential treatment strategy. This revision is less aggressive than traditional methods, eliminates the concerns from MoM bearings, and results in a stable construct.
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Affiliation(s)
- Luk A Verhelst
- AZ Groeninge Kortrijk, Burgemeester Vercruysselaan 5, 8500 Kortrijk, Belgium
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Grazioli A, Ek ETH, Rüdiger HA. Biomechanical concept and clinical outcome of dual mobility cups. INTERNATIONAL ORTHOPAEDICS 2012; 36:2411-8. [PMID: 23073926 DOI: 10.1007/s00264-012-1678-3] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2012] [Accepted: 10/01/2012] [Indexed: 12/23/2022]
Abstract
Dual mobility cup systems in total hip arthroplasty consist of a metal back with a non-constrained liner, in which a constrained standard head articulates. While superior stability of such implants in comparison with standard total hip replacements is assumed, it is the purpose of this study to outline the biomechanical concept of dual mobility cups and to describe implant survival and dislocation rate based on the series published in the English-speaking and Francophone literature. A growing body of evidence indicates reduced dislocation rates in primary and revision total hip arthroplasty and in selected tumour cases. The limited availability of studies evaluating long-term implant survival and existing concerns with regard to increased wear rates and aseptic loosening, leads to the conclusion that such implants have to be used with prudence, particularly in standard primary hip arthroplasty and in young patients.
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Affiliation(s)
- Aron Grazioli
- Department of Orthopaedics and Traumatology, Centre Hospitalier Universitaire Vaudois CHUV, Av Pierre Decker 4, 1011, Lausanne, Switzerland
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Stilling M, Kold S, de Raedt S, Andersen NT, Rahbek O, Søballe K. Superior accuracy of model-based radiostereometric analysis for measurement of polyethylene wear: A phantom study. Bone Joint Res 2012; 1:180-91. [PMID: 23610688 PMCID: PMC3626226 DOI: 10.1302/2046-3758.18.2000041] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Accepted: 06/29/2012] [Indexed: 12/17/2022] Open
Abstract
Objectives The accuracy and precision of two new methods of model-based
radiostereometric analysis (RSA) were hypothesised to be superior
to a plain radiograph method in the assessment of polyethylene (PE)
wear. Methods A phantom device was constructed to simulate three-dimensional
(3D) PE wear. Images were obtained consecutively for each simulated
wear position for each modality. Three commercially available packages
were evaluated: model-based RSA using laser-scanned cup models (MB-RSA),
model-based RSA using computer-generated elementary geometrical
shape models (EGS-RSA), and PolyWare. Precision (95% repeatability
limits) and accuracy (Root Mean Square Errors) for two-dimensional
(2D) and 3D wear measurements were assessed. Results The precision for 2D wear measures was 0.078 mm, 0.102 mm, and
0.076 mm for EGS-RSA, MB-RSA, and PolyWare, respectively. For the
3D wear measures the precision was 0.185 mm, 0.189 mm, and 0.244
mm for EGS-RSA, MB-RSA, and PolyWare respectively. Repeatability
was similar for all methods within the same dimension, when compared between
2D and 3D (all p > 0.28). For the 2D RSA methods, accuracy was below
0.055 mm and at least 0.335 mm for PolyWare. For 3D measurements,
accuracy was 0.1 mm, 0.2 mm, and 0.3 mm for EGS-RSA, MB-RSA and
PolyWare respectively. PolyWare was less accurate compared with
RSA methods (p = 0.036). No difference was observed between the
RSA methods (p = 0.10). Conclusions For all methods, precision and accuracy were better in 2D, with
RSA methods being superior in accuracy. Although less accurate and
precise, 3D RSA defines the clinically relevant wear pattern (multidirectional).
PolyWare is a good and low-cost alternative to RSA, despite being
less accurate and requiring a larger sample size.
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Affiliation(s)
- M Stilling
- Aarhus University Hospital, Department of Orthopaedics, Tage-Hansens Gade 2, 8000 Aarhus C, Denmark
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Vielpeau C, Lebel B, Ardouin L, Burdin G, Lautridou C. The dual mobility socket concept: experience with 668 cases. INTERNATIONAL ORTHOPAEDICS 2010; 35:225-30. [PMID: 21184223 DOI: 10.1007/s00264-010-1156-8] [Citation(s) in RCA: 126] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Revised: 10/25/2010] [Accepted: 10/26/2010] [Indexed: 12/24/2022]
Abstract
Long-term results of a retrospective series of primary arthroplasty with the original cementless dual mobility socket (A) and the midterm results with the second generation (B) are reported. In series A (follow-up 16.5 years) 437 total hip arthroplasties (THA) were included and in series B (follow-up five years) 231 hips. The 15-year survival rate was 84.4 ± 4.5% (revision for any reason as endpoint); 30 hips (6.8%) were revised for aseptic loosening. Five THA were revised for dislocation: two early and three after ten years or more. With the second generation socket neither dislocation nor revision for mechanical reasons were observed. The survival rate was 99.6 ± 0.4% (revision for any reason). The prevalence of revision for dislocation was very low in our series. This concept does not avoid wear and aseptic loosening, especially in young active patients, but the long-term stability has been confirmed. Dual mobility can be recommended for patients over 70 years of age and for younger patients with high risk of dislocation.
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