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Mills ES, Shelby T, Bouz GJ, Hah RJ, Wang JC, Alluri RK. A Decreasing National Trend in Lumbar Disc Arthroplasty. Global Spine J 2023; 13:2271-2277. [PMID: 35180023 PMCID: PMC10538335 DOI: 10.1177/21925682221079571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Retrospective National Database Study. OBJECTIVES The aim of this study was to investigate the national trend of lumbar disc arthroplasty (LDA) utilization from 2005 to 2017. METHODS Patients undergoing primary LDA between 2005 and 2017 were identified in the National Inpatient Sample (NIS) database. Year of the procedure, demographic, socioeconomic, hospital, and cost parameters were analyzed. The data was weighted using provided weights from the NIS database to generate national estimates of LDA procedure incidence. Lastly, we assessed the incidence of cervical disc arthroplasty (CDA) between 2005 and 2017 to serve as a historical comparison. RESULTS An estimated 20 460 patients underwent primary LDA in the United States between 2005 and 2017. There was an initial decrease in LDA procedures between 2005 and 2006 and then a plateau between 2006 and 2009. From 2010 to 2013, there was a significant year-over-year decrease in annual LDA procedures performed, followed by a second plateau from 2014 to 2017. Overall, LDA procedures decreased 82% from 2005 to 2017. Over the same time, the annual incidence of CDA utilization increased 795% from approximately 474 procedures in 2005 to 4245 procedures in 2017 (P < .01). CONCLUSIONS Lumbar disc arthroplasty utilization decreased 82% from 2005 to 2017, with a significant decrease in the rate of utilization noted after 2010. The utilization of LDA to treat selected degenerative lumbar conditions has not paralleled the increasing popularity of CDA, and, in fact, has demonstrated a nearly opposite utilization trend.
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Affiliation(s)
- Emily S. Mills
- School of Medicine, Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA, USA
| | - Tara Shelby
- School of Medicine, Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA, USA
| | - Gabriel J. Bouz
- School of Medicine, Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA, USA
| | - Raymond J. Hah
- School of Medicine, Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA, USA
| | - Jeffrey C. Wang
- School of Medicine, Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA, USA
| | - Ram K. Alluri
- School of Medicine, Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA, USA
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Wahbeh JM, Park SH, Iyer S, Ebramzadeh E, Sangiorgio SN. Observations of bony ongrowth and clinical fixation in two retrieved disc replacements. J Biomed Mater Res B Appl Biomater 2023. [PMID: 37191359 DOI: 10.1002/jbm.b.35263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 04/26/2023] [Accepted: 04/28/2023] [Indexed: 05/17/2023]
Abstract
Total disc replacements utilize textured coatings to maximize bony ongrowth. However, the contribution of direct bony attachment to overall fixation for total disc replacements has not been reported. The goal of the present study was to document the extent of bony attachment to the surfaces of two clinically functional total disc replacements that were securely fixed at the time of revision. Two metal-and-polymeric disc replacements, one cervical and one lumbar, were evaluated following surgical retrieval. The cervical device was retrieved at 8 months and the lumbar device at 28 months post-operative. Both devices were reported well-fixed at the time of removal, with large bone masses attached to one endplate of each device. Visual inspections, non-destructive gravimetric measurements, and surface metrology were performed to assess fixation. These inspections suggested that both devices had been fixed at the time of removal with little in vivo mechanical damage, as surgical extraction damage was noted on both devices and provided imaging showed a lack of device migration. Devices were then embedded and sectioned to evaluate the bone-implant interface. High resolution photographs and contact microradiographs were taken to assess bony attachment. In contrast to initial analysis, these images revealed radiolucent gaps between the endplates and bone masses. Little direct contact between the bone and endplate surface was identified and the original surgical cuts were still visible. Both devices were clinically fixed at the time of removal and neither had complications associated with loosening. However, osseointegration was minimal in one of the devices and altogether absent from the other. The findings of the present study suggest that other factors may influence overall clinical fixation such as the surgical preparation of the vertebral bone or the surface roughness of the treated endplates. Despite the limitations of the present study, this information is unique to the current total disc replacement literature and the ongrowth and fixation of devices should be considered as a topic for future investigation.
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Affiliation(s)
- Jenna M Wahbeh
- The J. Vernon Luck, Sr., M.D. Orthopaedic Research Center, The Luskin Orthopaedic Institute for Children in Alliance with UCLA, Los Angeles, CA, United States
- Department of Bioengineering, University of California, Los Angeles, California, USA
| | - Sang-Hyun Park
- The J. Vernon Luck, Sr., M.D. Orthopaedic Research Center, The Luskin Orthopaedic Institute for Children in Alliance with UCLA, Los Angeles, CA, United States
- Department of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, California, USA
| | - Sumant Iyer
- The J. Vernon Luck, Sr., M.D. Orthopaedic Research Center, The Luskin Orthopaedic Institute for Children in Alliance with UCLA, Los Angeles, CA, United States
| | - Edward Ebramzadeh
- The J. Vernon Luck, Sr., M.D. Orthopaedic Research Center, The Luskin Orthopaedic Institute for Children in Alliance with UCLA, Los Angeles, CA, United States
- Department of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, California, USA
| | - Sophia N Sangiorgio
- The J. Vernon Luck, Sr., M.D. Orthopaedic Research Center, The Luskin Orthopaedic Institute for Children in Alliance with UCLA, Los Angeles, CA, United States
- Department of Bioengineering, University of California, Los Angeles, California, USA
- Department of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, California, USA
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Ceramics in total disc replacements: A scoping review. Clin Biomech (Bristol, Avon) 2022; 100:105796. [PMID: 36435073 DOI: 10.1016/j.clinbiomech.2022.105796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 10/04/2022] [Accepted: 10/07/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Ceramics are used in Total Disc Replacements (1) in articulating surfaces for their wear resistance and biocompatibility and (2) on endplates to promote osseointegration. They furthermore exhibit MRI and CT compatibility. These properties address main challenges associated with non-ceramic Total Disc Replacements i.e. wear, migration and postoperative imaging. While brittleness of ceramics caused fear of fracture in the past, improvements of ceramic materials were made and considerable clinical experience with ceramic Total Disc Replacements was gained. This review aims to assess the evidence on the use of ceramics in Total Disc Replacements and compare safety and effectiveness of ceramic Total Disc Replacements to spinal fusion and Total Disc Replacements in general. METHODS We conducted a scoping review on the use of ceramics in Total Disc Replacements using Scopus, Web of Science and PubMed. The review includes 36 clinical, ex vivo and nonhuman in vivo, tribological and mechanical studies and case reports. FINDINGS Ceramics are used in cervical Total Disc Replacements, with safety and efficacy confirmed in clinical studies, with up to 10 and 3.3 years follow-up, for articulation and osseointegration applications, respectively. Clinical evidence shows that ceramic Total Disc Replacements (alike non-ceramic ones) restore segmental motion and result in non-inferior and possibly superior outcomes to spinal fusion. In vivo studies show osseointegration comparable to non-ceramic devices. Tribological studies suggest appropriate wear properties. INTERPRETATION We found no indications of systematic problems with the use of ceramics in Total Disc Replacements. Ceramics are suitable materials for Total Disc Replacements.
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Zavras AG, Sullivan TB, Singh K, Phillips FM, Colman MW. Failure in cervical total disc arthroplasty: single institution experience, systematic review of the literature, and proposal of the RUSH TDA failure classification system. Spine J 2022; 22:353-369. [PMID: 34419625 DOI: 10.1016/j.spinee.2021.08.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 08/10/2021] [Accepted: 08/13/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Cervical total disc arthroplasty (TDA) is an alternative procedure to anterior cervical discectomy and fusion that facilitates neural decompression while both preserving motion of the spinal unit and decreasing the risk for degenerative changes at adjacent segments. However, due to its more recent introduction in clinical practice and low complication rates, the modes by which TDA may fail remain to be described. PURPOSE This study sought to identify the modes and frequencies of cervical TDA failure in order to propose a novel classification system. STUDY DESIGN Retrospective cohort and systematic review. PATIENT SAMPLE Patients who underwent single or two-level TDA for cervical radiculopathy or myelopathy at a single institution and in the literature of medium and large prospective studies. OUTCOME MEASURES Cervical TDA failure, defined as subsequent surgical intervention at the index segment. METHODS This study retrospectively reviewed patients who underwent single or two-level TDA for cervical radiculopathy or myelopathy at a single institution to identify the potential implant failure modes. A systematic review and meta-analysis of prospective data in the literature was then performed to further supplement failure mode identification and to describe the rates at which the various failure types occurred. Statistical analysis included between-group comparisons of Non-Failed and Failed patients and frequencies of each failure type among Failed patients. RESULTS A retrospective review at our institution of 169 patients (201 levels) identified eight failures, for a failure rate of 4.7%. Additionally, seven patients were revised who had the primary surgery at an outside institution. The systematic review of 3976 patients (4525 levels) identified 165 (4.1%) additional failures. Using this data, six primary failure types were classified, with several subtypes. These include recurrent or persistent index-level stenosis (Type I); migration (Type II) presenting as gross extrusion (A) or endplate failure with subsidence/acute fracture (B); instability (Type III) due to mechanical loosening (A), septic loosening (B), or device fracture (C); device motion loss (Type IV) such as "locking" of the device in kyphosis; implantation error (Type V) due to malposition (A) or improper sizing (B); and wear (Type VI) either without osteolysis (A) or with wear-particle-induced osteolysis (B). Stenosis (Type I) was the most common mode of failure found both through retrospective review and in the literature. CONCLUSIONS Cervical TDA fails through six primary mechanisms. While rates of certain failures requiring subsequent surgical intervention are low, it is possible that these complications may become more prevalent upon further longitudinal observation. Thus, future application and validation of this classification system is warranted to evaluate how failure frequencies change over time and with larger patient samples.
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Affiliation(s)
- Athan G Zavras
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St., Chicago, IL 60612, USA
| | - Thomas Barrett Sullivan
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St., Chicago, IL 60612, USA
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St., Chicago, IL 60612, USA
| | - Frank M Phillips
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St., Chicago, IL 60612, USA
| | - Matthew W Colman
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St., Chicago, IL 60612, USA.
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Yang M, Xiang D, Chen Y, Cui Y, Wang S, Liu W. An Artificial PVA-BC Composite That Mimics the Biomechanical Properties and Structure of a Natural Intervertebral Disc. MATERIALS 2022; 15:ma15041481. [PMID: 35208022 PMCID: PMC8875496 DOI: 10.3390/ma15041481] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/26/2022] [Accepted: 02/11/2022] [Indexed: 02/06/2023]
Abstract
Disc herniation is one of the most ubiquitous healthcare problems in modern cities—severe patients eventually require surgical intervention. However, the existing operations—spinal fusion and artificial disc replacement—alter the biomechanics of the spine, leaving much room for improvement. The appropriateness of polyvinyl alcohol (PVA) for biomedical applications has been recognised due to its high water content, excellent biocompatibility, and versatile mechanical properties. In this study, a newly-designed PVA–bacterial cellulose (PVA-BC) composite was assembled to mimic both the biomechanics and annular structure of natural intervertebral discs (IVDs). PVA-BC composites of various concentrations were fabricated and tested under unconfined compression and compressive creep in order to acquire the values of the normalised compressive stiffness and whole normalised deformation. The normalised compressive stiffness increased considerably with an increasing PVA concentration, spanning from 1.82 (±0.18) to 3.50 (±0.14) MPa, and the whole normalised deformation decreased from 0.25 to 0.13. Formulations of 40% PVA provided the most accurate mimicry of natural human IVDs in normalised whole deformation, and demonstrated higher dimensional stability. The biocompatible results further confirmed that the materials had excellent biocompatibility. The novel bionic structure and formulations of the PVA-BC materials mimicked the biomechanics and structure of natural IVDs, and ensured dimensional stability under prolonged compression, reducing the risk of impingement on the surrounding tissue. The PVA-BC composite is a promising material for third-generation artificial IVDs with integrated construction.
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Affiliation(s)
- Mengying Yang
- Department of Mechanical Engineering, Tsinghua University, Beijing 100084, China; (M.Y.); (Y.C.); (Y.C.)
- State Key Laboratory of Tribology, Tsinghua University, Beijing 100084, China
- Tsinghua Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, China
- Biomechanics and Biotechnology Lab, Research Institute of Tsinghua University in Shenzhen, Shenzhen 518057, China
| | - Dingding Xiang
- State Key Laboratory of Tribology, Tsinghua University, Beijing 100084, China
- Biomechanics and Biotechnology Lab, Research Institute of Tsinghua University in Shenzhen, Shenzhen 518057, China
- School of Mechanical Engineering and Automation, Northeastern University, Shenyang 110819, China
- Correspondence: (D.X.); (S.W.); (W.L.)
| | - Yuru Chen
- Department of Mechanical Engineering, Tsinghua University, Beijing 100084, China; (M.Y.); (Y.C.); (Y.C.)
- Tsinghua Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, China
- Biomechanics and Biotechnology Lab, Research Institute of Tsinghua University in Shenzhen, Shenzhen 518057, China
| | - Yangyang Cui
- Department of Mechanical Engineering, Tsinghua University, Beijing 100084, China; (M.Y.); (Y.C.); (Y.C.)
- Tsinghua Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, China
- Biomechanics and Biotechnology Lab, Research Institute of Tsinghua University in Shenzhen, Shenzhen 518057, China
| | - Song Wang
- Biomechanics and Biotechnology Lab, Research Institute of Tsinghua University in Shenzhen, Shenzhen 518057, China
- Correspondence: (D.X.); (S.W.); (W.L.)
| | - Weiqiang Liu
- Department of Mechanical Engineering, Tsinghua University, Beijing 100084, China; (M.Y.); (Y.C.); (Y.C.)
- Tsinghua Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, China
- Biomechanics and Biotechnology Lab, Research Institute of Tsinghua University in Shenzhen, Shenzhen 518057, China
- Correspondence: (D.X.); (S.W.); (W.L.)
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Prokopienko M, Sobstyl M. Subjective and Objective Quality-of-Life Assessment of Outcome Measures in Cervical Spine Surgery for Degenerative Changes. J Neurol Surg A Cent Eur Neurosurg 2021; 83:275-282. [PMID: 34897625 DOI: 10.1055/s-0041-1739227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Cervical spine diskectomy is a commonly used procedure in degenerative disease of cervical spine surgery. However, it is difficult to assess the quality of life after this widely applied and variously modified procedure. This literature review presents cervical diskectomy results, according to various scales and measures in multidirectional surgical strategies. Using relevant databases, we tried to find the best treatment options for degenerative disk disease and the best method of quality-of-life assessment, searching for modalities that may influence the outcome.
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Affiliation(s)
- Marek Prokopienko
- Department of Neurosurgery, Institute of Psychiatry and Neurology, Warszawa, Poland
| | - Michał Sobstyl
- Department of Neurosurgery, Institute of Psychiatry and Neurology, Warszawa, Poland
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Xin H, Zhang L, Diao H, Jia J, Jin Z. Numerical wear study of metal‐on‐ultrahigh molecular weight polyethylene‐based cervical total disc arthroplasty by coupling finite element analysis and multi‐body dynamics. BIOSURFACE AND BIOTRIBOLOGY 2021. [DOI: 10.1049/bsb2.12026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Hua Xin
- Advance Machinery Surface Technology Research Center College of Mechanical and Electrical Engineering Shaanxi University of Science & Technology Xi'an Shaanxi China
| | - Lei Zhang
- Advance Machinery Surface Technology Research Center College of Mechanical and Electrical Engineering Shaanxi University of Science & Technology Xi'an Shaanxi China
| | - Hao Diao
- School of Mechanical Engineering State Key Laboratory for Manufacturing Systems Engineering Xi'an Jiaotong University Xi'an Shaanxi China
| | - Junhong Jia
- Advance Machinery Surface Technology Research Center College of Mechanical and Electrical Engineering Shaanxi University of Science & Technology Xi'an Shaanxi China
| | - Zhongmin Jin
- School of Mechanical Engineering State Key Laboratory for Manufacturing Systems Engineering Xi'an Jiaotong University Xi'an Shaanxi China
- School of Mechanical Engineering Institute of Medical and Biological Engineering University of Leeds Leeds UK
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The Role of Vertebral Porosity and Implant Loading Mode on Bone-Tissue Stress in the Human Vertebral Body Following Lumbar Total Disc Arthroplasty. Spine (Phila Pa 1976) 2021; 46:E1022-E1030. [PMID: 33660678 DOI: 10.1097/brs.0000000000004023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Micro-computed tomography- (micro-CT-) based finite element analysis of cadaveric human lumbar vertebrae virtually implanted with total disc arthroplasty (TDA) implants. OBJECTIVE (1) Assess the relationship between vertebral porosity and maximum levels of bone-tissue stress following TDA; (2) determine whether the implant's loading mode (axial compression vs. sagittal bending) alters the relationship between vertebral porosity and bone-tissue stress. SUMMARY OF BACKGROUND DATA Implant subsidence may be related to the bone biomechanics in the underlying vertebral body, which are poorly understood. For example, it remains unclear how the stresses that develop in the supporting bone tissue depend on the implant's loading mode or on typical inter-individual variations in vertebral morphology. METHODS Data from micro-CT scans from 12 human lumbar vertebrae (8 males, 4 females; 51-89 years of age; bone volume fraction [BV/TV] = 0.060-0.145) were used to construct high-resolution finite element models (37 μm element edge length) comprising disc-vertebra-implant motion segments. Implants were loaded to 800 N of force in axial compression, flexion-, and extension-induced impingement. For comparison, the same net loads were applied via an intact disc without an implant. Linear regression was used to assess the relationship between BV/TV, loading mode, and the specimen-specific change in stress caused by implantation. RESULTS The increase in maximum bone-tissue stress caused by implantation depended on loading mode (P < 0.001), increasing more in bending-induced impingement than axial compression (for the same applied force). The change in maximum stress was significantly associated with BV/TV (P = 0.002): higher porosity vertebrae experienced a disproportionate increase in stress compared with lower porosity vertebrae. There was a significant interaction between loading mode and BV/TV (P = 0.002), indicating that loading mode altered the relationship between BV/TV and the change in maximum bone-tissue stress. CONCLUSION Typically-sized TDA implants disproportionately increase the bone-tissue stress in more porous vertebrae; this affect is accentuated when the implant impinges in sagittal bending.Level of Evidence: N/A.
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9
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Revision Surgery of Total Lumbar Disk Replacement: Review of 48 Cases. Clin Spine Surg 2021; 34:E315-E322. [PMID: 33797426 DOI: 10.1097/bsd.0000000000001179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 02/24/2021] [Indexed: 12/19/2022]
Abstract
STUDY DESIGN This was a retrospective clinical review. OBJECTIVE The objective of this study was to analyze failure mechanisms after total lumbar disk replacement (TDR) and surgical revision strategies in patients with recurrent low back pain (LBP). SUMMARY AND BACKGROUND DATA Several reports indicate that TDR revision surgery carries a major risk and that it should not be recommended. The clinical results of posterior instrumented fusion using the prosthesis like an interbody cage have not been well analyzed. MATERIALS AND METHODS From 2003 to 2018, 48 patients with recurrent LBP after TDR underwent revision surgery. The average age was 39 years (24-61 y). The mean follow-up was 100.4 months (24.6-207.7 mo). Clinical data, self-assessment of patient satisfaction, and Oswestry Disability Index collected at each clinical control or by phone call for the older files and radiologic assessments were reviewed. The surgical revision strategy included posterior fusion in 41 patients (group A) and TDR removal and anterior fusion in 7 patients (group B), of which 6 patients had an additional posterior fixation. RESULTS Facet joint osteoarthritis was associated with TDR failure in 85%. In 68% the position of the prosthesis was suboptimal. Range of motion was preserved in 25%, limited in extension in 65%, and limited in flexion in 40%. Limited range of motion and facet joint osteoarthritis were significantly related (P=0.0008). The complication rate in group B was 43% including iliac vein laceration. Preoperative and 2-year follow-up Oswestry Disability Index were 25.5 and 22.0, respectively, in group A versus 27.9 and 21.3 in group B. CONCLUSIONS Posterior osteoarthritis was the principal cause of recurrent LBP in failed TDR. The anterior approach for revision carried a major vascular risk, whereas a simple posterior instrumented fusion leads to the same clinical results. LEVEL OF EVIDENCE Level IV.
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10
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Ebinu JO, Ramanathan D, Kurtz SM, Lawandy S, Kim KD. Periprosthetic Osteolysis in Cervical Total Disc Arthroplasty: A Single Institutional Experience. NEUROSURGERY OPEN 2021. [DOI: 10.1093/neuopn/okab013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
ABSTRACT
BACKGROUND
Cervical disc arthroplasty (CDA) affords an excellent alternative to cervical fusion for the treatment of symptomatic patients with degenerative disc disease. As more surgeons perform CDAs, an understanding of the complications associated with this technique is crucial. Periprosthetic osteolysis (PO) is a rare potential complication associated with CDA.
OBJECTIVE
To highlight potential complications associated with CDA.
METHODS
A retrospective chart review of patients who underwent CDA at our institution was performed. Patient outcomes and relevant clinical and radiographical data were analyzed in addition to associated complications. Explanted devices were subjected to macroscopic and microscopic analyses.
RESULTS
A total of 88 patients were included: 68 patients underwent 1-level CDA and 20 patients had 2-level CDA. Implants used in this series included Mobi-C (Zimmer Biomet), Prestige LP (Medtronic), Secure C (Globus), Advent (Orthofix), and ProDisc C (DePuy). One patient demonstrated symptoms of myeloradiculopathy that correlated with radiographical periprosthetic osteolysis and required surgical intervention in the form of disc explantation, corpectomy, and cervical instrumented fusion. Device retrieval analysis demonstrated evidence of elevated oxidation levels and increased wear in the presence of high concentrations of metal ions and debris in the surrounding tissue. The tissue did not exhibit any immune response, infection, or acute inflammation.
CONCLUSION
PO is a potential complication of CDA that occurs irrespective of the type of implant used. We describe its occurrence and management and highlight the importance of being aware of this understated phenomenon.
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Affiliation(s)
- Julius O Ebinu
- Department of Neurological Surgery, University of California, Davis, Sacramento, California, USA
| | - Dinesh Ramanathan
- Department of Neurological Surgery, University of California, Davis, Sacramento, California, USA
| | - Steven M Kurtz
- School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia, Pennsylvania, USA
| | - Shokry Lawandy
- School of Medicine, California University of Science and Medicine, Riverside, California, USA
| | - Kee D Kim
- Department of Neurological Surgery, University of California, Davis, Sacramento, California, USA
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Kandemir G, Pitsika M, Nissen JJ, Bowey A, Joyce TJ. Retrieval analysis of an explanted Mobi-C cervical disc replacement: A case study. Med Eng Phys 2021; 90:54-65. [PMID: 33781480 DOI: 10.1016/j.medengphy.2021.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 02/05/2021] [Accepted: 02/17/2021] [Indexed: 11/19/2022]
Abstract
Ex vivo analysis of artificial discs is essential to better understand their ability to replace degenerated intervertebral discs. The Mobi-C differs from some other contemporary disc designs in that it has a mobile polyethylene insert that is sandwiched between superior and inferior cobalt chromium endplates. While some studies claim the Mobi-C to have restored normal cervical spinal biomechanics, others have noted high levels of migration. Our objective was to contribute to this debate by, for the first time, analysing an explanted Mobi-C cervical disc which was removed due to worsening myelopathy at the nano and macro scales. Intraoperatively, the insert was found to have excessively migrated and it compressed the spinal cord. Roughness was measured as 0.016 ± 0.006 μm (Sa) and 0.055 ± 0.020 μm (Sa) for the superior and inferior plates, and 1.210 ± 0.154 μm (Sa) and 0.446 ± 0.083 μm (Sa) for the superior and inferior surfaces of the insert. Compared to unworn surfaces, the roughness increased for the superior and inferior plates and decreased for both surfaces of the insert. However, the only statistically significant change occurred on the articulating surface of the inferior plate (p = 0.04). At the nanoscale, valleys dominated the articulating surfaces. The superior plate had a burnished appearance whereas the inferior plate appeared matt. Impingement was observed on the endplates. The insert was severely damaged, burnished and had scratches. Additionally, subsurface whitening and internal cracking were observed on the insert.
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Affiliation(s)
- Göksu Kandemir
- School of Engineering, Newcastle University, Newcastle Upon Tyne, United Kingdom.
| | - Marina Pitsika
- Department of Neurosurgery, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Justin J Nissen
- Department of Neurosurgery, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Andrew Bowey
- Department of Spinal Surgery, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Thomas J Joyce
- School of Engineering, Newcastle University, Newcastle Upon Tyne, United Kingdom
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Kandemir G, Smith S, Andrews J, Bowey A, Joyce TJ. Retrieval analysis of an explanted NuNec cervical disc: A case report. ACTA ACUST UNITED AC 2020. [DOI: 10.1016/j.biotri.2020.100150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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13
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Vanaclocha-Saiz A, Atienza CM, Vanaclocha V, Belloch V, Santabarbara JM, Jordá-Gómez P, Vanaclocha L. ICR in human cadaveric specimens: An essential parameter to consider in a new lumbar disc prosthesis design. NORTH AMERICAN SPINE SOCIETY JOURNAL 2020; 2:100016. [PMID: 35141586 PMCID: PMC8820058 DOI: 10.1016/j.xnsj.2020.100016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/29/2020] [Accepted: 07/15/2020] [Indexed: 06/14/2023]
Abstract
STUDY DESIGN Biomechanical study in cadaveric specimens. BACKGROUND The commercially available lumbar disc prostheses do not reproduce the intact disc's Instantaneous centre of Rotation (ICR), thus inducing an overload on adjacent anatomical structures, promoting secondary degeneration. AIM To examine biomechanical testing of cadaveric lumbar spine specimens in order to evaluate and define the ICR of intact lumbar discs. MATERIAL AND METHODS Twelve cold preserved fresh human cadaveric lumbosacral spine specimens were subjected to computerized tomography (CT), magnetic resonance imaging (MRI) and biomechanical testing. Kinematic studies were performed to analyse range of movements in order to determine ICR. RESULTS Flexoextension and lateral bending tests showed a positive linear correlation between the angle rotated and the displacement of the ICR in different axes. DISCUSSION ICR has not been taken into account in any of the available literature regarding lumbar disc prosthesis. Considering our results, neither the actual ball-and-socket nor the withdrawn elastomeric nucleus models fit the biomechanics of the lumbar spine, which could at least in part explain the failure rates of the implants in terms of postoperative failed back syndrome (low back pain). It is reasonable to consider then that an implant should also adapt the equations of the movement of the intact ICR of the joint to the post-surgical ICR. CONCLUSIONS This is the first cadaveric study on the ICR of the human lumbar spine. We have shown that it is feasible to calculate and consider this parameter in order to design future prosthesis with improved clinical and biomechanical characteristics.
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Affiliation(s)
| | - Carlos M Atienza
- Instituto de Biomecánica (IBV) Universitat Politècnica de Valencia, Valencia, Spain
- Instituto de Biomecánica de Valencia-CIBER BBN, Grupo de Tecnología Sanitaria (GTS-IBV), Valencia, Spain
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Zhou C, Willing R. Sensitivities of lumbar segmental kinematics and functional tissue loads in sagittal bending to design parameters of a ball-in-socket total disc arthroplasty prosthesis. Comput Methods Biomech Biomed Engin 2020; 23:536-547. [DOI: 10.1080/10255842.2020.1745783] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Chaochao Zhou
- Department of Mechanical Engineering, State University of New York at Binghamton, Binghamton, NY, USA
| | - Ryan Willing
- Department of Mechanical Engineering, State University of New York at Binghamton, Binghamton, NY, USA
- Department of Mechanical and Materials Engineering, Western University, London, Ontario, Canada
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15
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Bonnheim NB, Keaveny TM. Load-transfer in the human vertebral body following lumbar total disc arthroplasty: Effects of implant size and stiffness in axial compression and forward flexion. JOR Spine 2020; 3:e1078. [PMID: 32211590 PMCID: PMC7084059 DOI: 10.1002/jsp2.1078] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 11/07/2022] Open
Abstract
Adverse clinical outcomes for total disc arthroplasty (TDA), including subsidence, heterotopic ossification, and adjacent-level vertebral fracture, suggest problems with the underlying biomechanics. To gain insight, we investigated the role of size and stiffness of TDA implants on load-transfer within a vertebral body. Uniquely, we accounted for the realistic multi-scale geometric features of the trabecular micro-architecture and cortical shell. Using voxel-based finite element analysis derived from a micro-computed tomography scan of one human L1 vertebral body (74-μm-sized elements), a series of generic elliptically shaped implants were analyzed. We parametrically modeled three implant sizes (small, medium [a typical clinical size], and large) and three implant materials (metallic, E = 100 GPa; polymeric, E = 1 GPa; and tissue-engineered, E = 0.01 GPa). Analyses were run for two load cases: 800 N in uniform compression and flexion-induced anterior impingement. Results were compared to those of an intact model without an implant and loaded instead via a disc-like material. We found that TDA implantation increased stress in the bone tissue by over 50% in large portions of the vertebra. These changes depended more on implant size than material, and there was an interaction between implant size and loading condition. For the small implant, flexion increased the 98th-percentile of stress by 32 ± 24% relative to compression, but the overall stress distribution and trabecular-cortical load-sharing were relatively insensitive to loading mode. In contrast, for the medium and large implants, flexion increased the 98th-percentile of stress by 42 ± 9% and 87 ± 29%, respectively, and substantially re-distributed stress within the vertebra; in particular overloading the anterior trabecular centrum and cortex. We conclude that TDA implants can substantially alter stress deep within the lumbar vertebra, depending primarily on implant size. For implants of typical clinical size, bending-induced impingement can substantially increase stress in local regions and may therefore be one factor driving subsidence in vivo.
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Affiliation(s)
- Noah B. Bonnheim
- Department of Mechanical EngineeringUniversity of CaliforniaBerkeleyCalifornia
| | - Tony M. Keaveny
- Department of Mechanical EngineeringUniversity of CaliforniaBerkeleyCalifornia
- Department of BioengineeringUniversity of CaliforniaBerkeleyCalifornia
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16
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Zhou C, Willing R. Multiobjective Design Optimization of a Biconcave Mobile-Bearing Lumbar Total Artificial Disk Considering Spinal Kinematics, Facet Joint Loading, and Metal-on-Polyethylene Contact Mechanics. J Biomech Eng 2019; 142:1046996. [DOI: 10.1115/1.4045048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Indexed: 12/30/2022]
Abstract
Abstract
Total disk arthroplasty (TDA) using an artificial disk (AD) is an attractive surgical technique for the treatment of spinal disorders, since it can maintain or restore spinal motion (unlike interbody fusion). However, adverse surgical outcomes of contemporary lumbar TDAs have been reported. We previously proposed a new mobile-bearing AD design concept featuring a biconcave ultrahigh-molecular-weight polyethylene (UHMWPE) mobile core. The objective of this study was to develop an artificial neural network (NN) based multiobjective optimization framework to refine the biconcave-core AD design considering multiple TDA performance metrics, simultaneously. We hypothesized that there is a tradeoff relationship between the performance metrics in terms of range of motion (ROM), facet joint force (FJF), and polyethylene contact pressure (PCP). By searching the resulting three-dimensional (3D) Pareto frontier after multiobjective optimization, it was found that there was a “best-tradeoff” AD design, which could balance all the three metrics, without excessively sacrificing each metric. However, for each single-objective optimum AD design, only one metric was optimal, and distinct sacrifices were observed in the other two metrics. For a commercially available biconvex-core AD design, the metrics were even worse than the poorest outcomes of the single-objective optimum AD designs. Therefore, multiobjective design optimization could be useful for achieving native lumbar segment biomechanics and minimal PCPs, as well as for improving the existing lumbar motion-preserving surgical treatments.
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Affiliation(s)
- Chaochao Zhou
- Department of Mechanical Engineering, State University of New York at Binghamton, Binghamton, NY 13902-6000
| | - Ryan Willing
- Department of Mechanical Engineering, State University of New York at Binghamton, Binghamton, NY 13902-6000; Department of Mechanical and Materials Engineering, Western University, Thompson Engineering Building, Room TEB 363, London, ON N6A 5B9, Canada
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17
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Liu Z, Wang J, Gao H, Gao L. Biaxial fatigue crack propagation behavior of ultrahigh molecular weight polyethylene reinforced by carbon nanofibers and hydroxyapatite. J Biomed Mater Res B Appl Biomater 2019; 108:1603-1615. [PMID: 31633296 DOI: 10.1002/jbm.b.34507] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 09/11/2019] [Accepted: 10/06/2019] [Indexed: 12/17/2022]
Abstract
Ultrahigh molecular weight polyethylene (UHMWPE) artificial joint has remained the preferred polymer component in total joint replacement surgery. However, more and more concerns have been raised about the failure of UHMWPE components due to the initiation and propagation of cracks at the notches with fixed functions. For this reason, biaxial fatigue crack growth (FCG) experiments of UHMWPE reinforced by carbon nanofibers (CNF) and hydroxyapatite (HA) were carried out using elastic-plastic fracture mechanics theory. The FCG resistance of UHMWPE, UHMWPE/CNF, and UHMWPE/HA was compared, and the effects of stress ratio (R) value and phase difference on FCG rate were investigated. At the same time, the influence of loading path was considered, and the corresponding crack path was analyzed. Results suggest that UHMWPE/CNF has better FCG resistance and the FCG rate increases with the increase of R value and the existence of 180° phase difference. In addition, crack bifurcation behavior is not observed under nonproportional loading conditions. The findings in this study will provide experimental validation and data support for better clinical application of UHMWPE-modified materials.
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Affiliation(s)
- Zhenduo Liu
- Department of Process Equipment and Control Engineering, School of Chemical Engineering and Technology, Tianjin University, Tianjin, China
| | - Jianhai Wang
- Department of Process Equipment and Control Engineering, School of Chemical Engineering and Technology, Tianjin University, Tianjin, China
| | - Hong Gao
- Department of Process Equipment and Control Engineering, School of Chemical Engineering and Technology, Tianjin University, Tianjin, China
| | - Lilan Gao
- Department of Process Equipment and Control Engineering, School of Mechanical Engineering, Tianjin University of Technology, Tianjin, China
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18
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Zhou C, Willing R. Development of a Biconcave Mobile-Bearing Lumbar Total Disc Arthroplasty Concept Using Finite Element Analysis and Design Optimization. J Orthop Res 2019; 37:1805-1816. [PMID: 31042323 DOI: 10.1002/jor.24315] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 04/04/2019] [Indexed: 02/04/2023]
Abstract
Total disc arthroplasty (TDA) is a motion-preserving surgical treatment for spinal disorders. However, adverse surgical outcomes, such as abnormal kinematics, facet joint (FJ) overloading, and polyethylene (PE) failures, have limited wide application of lumbar TDAs. The objectives of this computational study were to elucidate how implant design and FJ articulation both influence metal-on-polyethylene (MoP) motion and contact mechanics, as well as to propose and refine a new mobile-bearing TDA concept which enhanced postoperative performance. Simulation results show that abnormal motions (lift-off and/or unsymmetrical motion) are alleviated in fixed-/mobile-bearing TDA-treated segments, as the FJ gap increases. It clearly demonstrates that FJ articulation guides segmental motion and interferes with intended MoP articulation. For an existing biconvex mobile-bearing design, component impingement leads to a peak PE stress of 20.8 MPa (yield stress: 13 MPa), indicating a high risk of PE creep/fracture. Therefore, we proposed a new TDA concept featuring a biconcave PE core with a smooth shape, in order to strengthen the PE rim and mitigate edge-loading. Furthermore, the biconcave-core TDA was optimally designed to promote normal segmental range of motion (ROM), or to minimize polyethylene contact pressure (PCP). In extension (the severest loading scenario), the biconvex-core TDA design caused a ROM 3.6° (+88%) greater than the intact segment and a peak PCP of 116.5 MPa. In contrast, ROM-optimal or PCP-optimal biconcave-core TDA designs decreased the ROM difference to 0.0° or the peak PCP to 24.3 MPa. Therefore, this new TDA design can potentially reduce the incidence of hypermotion and PE damage. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:1805-1816, 2019.
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Affiliation(s)
- Chaochao Zhou
- Department of Mechanical Engineering, State University of New York at Binghamton, Binghamton, New York
| | - Ryan Willing
- Department of Mechanical Engineering, State University of New York at Binghamton, Binghamton, New York.,Department of Mechanical and Materials Engineering, Western University, London, Ontario, Canada
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Sirimamilla A, Rimnac CM. Crack initiation from a clinically relevant notch in a highly-crosslinked UHMWPE subjected to static and cyclic loading. J Mech Behav Biomed Mater 2018; 91:366-372. [PMID: 30658250 DOI: 10.1016/j.jmbbm.2018.12.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 12/05/2018] [Indexed: 10/27/2022]
Abstract
Crosslinked Ultra High Molecular Weight Polyethylene (UHMWPE), which is used as a bearing material in total joint replacement components, is subjected to static and cyclic loads in vivo. Resistance to crack initiation from a notch as a function of static and cyclic loads is not well understood for crosslinked UHMWPE. This study estimated the resistance of crosslinked UHMWPE (crosslinked with 100 kGy gamma radiation and remelted to extinguish free radicals) to crack initiation for a clinically relevant notch under both static and cyclic loading conditions. For cyclic loading, four frequencies were applied with a sine waveform and two frequencies were applied with a square waveform to independently estimate the effect of frequency and rate of loading on crack initiation. Crack initiation time and cycles to crack initiation were determined. Crack initiation time for fatigue loading conditions was substantially lower compared to static loading conditions. Crack initiation time decreased with an increase in test frequency. A square wave resulted in shorter crack initiation time compared to a sine wave. The results suggest that crosslinked UHMWPE is more resistant to crack initiation from a notch under static loading conditions compared to fatigue loading conditions.
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Affiliation(s)
- Abhi Sirimamilla
- Microsoft Hardware Group, One Microsoft Way, Redmond, WA 98052, United States.
| | - Clare M Rimnac
- Mechanical and Aerospace Engineering Department, Case Western Reserve University, Cleveland, OH 44106, United States.
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20
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Gullbrand SE, Ashinsky BG, Bonnevie ED, Kim DH, Engiles JB, Smith LJ, Elliott DM, Schaer TP, Smith HE, Mauck RL. Long-term mechanical function and integration of an implanted tissue-engineered intervertebral disc. Sci Transl Med 2018; 10:eaau0670. [PMID: 30463917 PMCID: PMC7380504 DOI: 10.1126/scitranslmed.aau0670] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 10/31/2018] [Indexed: 01/09/2023]
Abstract
Tissue engineering holds great promise for the treatment of advanced intervertebral disc degeneration. However, assessment of in vivo integration and mechanical function of tissue-engineered disc replacements over the long term, in large animal models, will be necessary to advance clinical translation. To that end, we developed tissue-engineered, endplate-modified disc-like angle ply structures (eDAPS) sized for the rat caudal and goat cervical spines that recapitulate the hierarchical structure of the native disc. Here, we demonstrate functional maturation and integration of these eDAPS in a rat caudal disc replacement model, with compressive mechanical properties reaching native values after 20 weeks in vivo and evidence of functional integration under physiological loads. To further this therapy toward clinical translation, we implanted eDAPS sized for the human cervical disc space in a goat cervical disc replacement model. Our results demonstrate maintenance of eDAPS composition and structure up to 8 weeks in vivo in the goat cervical disc space and maturation of compressive mechanical properties to match native levels. These results demonstrate the translational feasibility of disc replacement with a tissue-engineered construct for the treatment of advanced disc degeneration.
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Affiliation(s)
- Sarah E Gullbrand
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA 19104, USA
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Beth G Ashinsky
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA 19104, USA
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- School of Biomedical Sciences, Drexel University, Philadelphia, PA 19104, USA
| | - Edward D Bonnevie
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA 19104, USA
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Dong Hwa Kim
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA 19104, USA
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Julie B Engiles
- Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19348, USA
| | - Lachlan J Smith
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA 19104, USA
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Dawn M Elliott
- Department of Biomedical Engineering, University of Delaware, Newark, DE 19716, USA
| | - Thomas P Schaer
- Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19348, USA
| | - Harvey E Smith
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA 19104, USA.
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Robert L Mauck
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA 19104, USA.
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104, USA
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21
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Kovač V. Failure of lumbar disc surgery: management by fusion or arthroplasty? INTERNATIONAL ORTHOPAEDICS 2018; 43:981-986. [DOI: 10.1007/s00264-018-4228-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 11/01/2018] [Indexed: 02/06/2023]
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22
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Gullbrand SE, Smith LJ, Smith HE, Mauck RL. Promise, progress, and problems in whole disc tissue engineering. JOR Spine 2018; 1:e1015. [PMID: 31463442 PMCID: PMC6686799 DOI: 10.1002/jsp2.1015] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 04/28/2018] [Accepted: 04/29/2018] [Indexed: 12/19/2022] Open
Abstract
Intervertebral disc degeneration is frequently implicated as a cause of back and neck pain, which are pervasive musculoskeletal complaints in modern society. For the treatment of end stage disc degeneration, replacement of the disc with a viable, tissue-engineered construct that mimics native disc structure and function is a promising alternative to fusion or mechanical arthroplasty techniques. Substantial progress has been made in the field of whole disc tissue engineering over the past decade, with a variety of innovative designs characterized both in vitro and in vivo in animal models. However, significant barriers to clinical translation remain, including construct size, cell source, culture technique, and the identification of appropriate animal models for preclinical evaluation. Here we review the clinical need for disc tissue engineering, the current state of the field, and the outstanding challenges that will need to be addressed by future work in this area.
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Affiliation(s)
- Sarah E. Gullbrand
- Translational Musculoskeletal Research CenterCorporal Michael J. Crescenz VA Medical CenterPhiladelphiaPennsylvania
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvania
| | - Lachlan J. Smith
- Translational Musculoskeletal Research CenterCorporal Michael J. Crescenz VA Medical CenterPhiladelphiaPennsylvania
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvania
- Department of NeurosurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvania
| | - Harvey E. Smith
- Translational Musculoskeletal Research CenterCorporal Michael J. Crescenz VA Medical CenterPhiladelphiaPennsylvania
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvania
- Department of NeurosurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvania
| | - Robert L. Mauck
- Translational Musculoskeletal Research CenterCorporal Michael J. Crescenz VA Medical CenterPhiladelphiaPennsylvania
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvania
- Department of BioengineeringUniversity of PennsylvaniaPhiladelphiaPennsylvania
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Are Controversial Issues in Cervical Total Disc Replacement Resolved or Unresolved?: A Review of Literature and Recent Updates. Asian Spine J 2018; 12:178-192. [PMID: 29503699 PMCID: PMC5821925 DOI: 10.4184/asj.2018.12.1.178] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 07/17/2017] [Accepted: 08/12/2017] [Indexed: 12/17/2022] Open
Abstract
Since the launch of cervical total disc replacement (CTDR) in the early 2000s, many clinical studies have reported better outcomes of CTDR compared to those of anterior cervical discectomy and fusion. However, CTDR is still a new and innovative procedure with limited indications for clinical application in spinal surgery, particularly, for young patients presenting with soft disc herniation with radiculopathy and/or myelopathy. In addition, some controversial issues related to the assessment of clinical outcomes of CTDR remain unresolved. These issues, including surgical outcomes, adjacent segment degeneration (ASD), heterotopic ossification (HO), wear debris and tissue reaction, and multilevel total disc replacement (TDR) and hybrid surgeries are a common concern of spine surgeons and need to be resolved. Among them, the effect of CTDR on patient outcomes and ASD is theoretically and clinically important; however, this issue remains disputable. Additionally, HO, wear debris, multilevel TDR, and hybrid surgery tend to favor CTDR in terms of their effects on outcomes, but the potential of these factors for jeopardizing patients' safety postoperatively and/or to exert harmful effects on surgical outcomes in longer-term follow-up cannot be ignored. Consequently, it is too early to determine the therapeutic efficacy and cost-effectiveness of CTDR and will require considerable time and studies to provide appropriate answers regarding the same. For these reasons, CTDR requires longer-term follow-up data.
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Park CK. Lumbar total disc replacement: does it still need further follow-up? JOURNAL OF SPINE SURGERY (HONG KONG) 2017; 3:460-462. [PMID: 29057357 DOI: 10.21037/jss.2017.06.24] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Chun-Kun Park
- Department of Neurosurgery, College of Medicine, the Catholic University of Korea, Seoul, Korea.,Department of Neurosurgery, Good Doctor Teun Teun Hospital, Anyang, Korea
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Abstract
STUDY DESIGN A retrospective review of prospectively collected data. OBJECTIVE To determine why artificial disk replacements (ADRs) fail by examining results of 91 patients in FDA studies performed at a single investigational device exemption (IDE) site with minimum 2-year follow-up. SUMMARY OF BACKGROUND DATA Patients following lumbar ADR generally achieve their 24-month follow-up results at 3 months postoperatively. MATERIALS AND METHODS Every patient undergoing ADR at 1 IDE site by 2 surgeons was evaluated for clinical success. Failure was defined as <50% improvement in ODI and VAS or any additional surgery at index or adjacent spine motion segment. Three ADRs were evaluated: Maverick, 25 patients; Charité, 31 patients; and Kineflex, 35 patients. All procedures were 1-level operations performed at L4-L5 or L5-S1. Demographics and inclusion/exclusion criteria were similar and will be discussed. RESULTS Overall clinical failure occurred in 26% (24 of 91 patients) at 2-year follow-up. Clinical failure occurred in: 28% (Maverick) (7 of 25 patients), 39% (Charité) (12 of 31 patients), and 14% (Kineflex) (5 of 35 patients). Causes of failure included facet pathology, 50% of failure patients (12 of 24). Implant complications occurred in 5% of total patients and 21% of failure patients (5 of 24). Only 5 patients went from a success to failure after 3 months. Only 1 patient went from a failure to success after a facet rhizotomy 1 year after ADR. CONCLUSIONS Seventy-four percent of patients after ADR met strict clinical success after 2-year follow-up. The clinical success versus failure rate did not change from their 3-month follow-up in 85 of the 91 patients (93%). Overall clinical success may be improved most by patient selection and implant type.
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Veruva SY, Lanman TH, Isaza JE, Freeman TA, Kurtz SM, Steinbeck MJ. Periprosthetic UHMWPE Wear Debris Induces Inflammation, Vascularization, and Innervation After Total Disc Replacement in the Lumbar Spine. Clin Orthop Relat Res 2017; 475:1369-1381. [PMID: 27488379 PMCID: PMC5384906 DOI: 10.1007/s11999-016-4996-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The pathophysiology and mechanisms driving the generation of unintended pain after total disc replacement (TDR) remain unexplored. Ultrahigh-molecular-weight polyethylene (UHMWPE) wear debris from TDRs is known to induce inflammation, which may result in pain. QUESTIONS/PURPOSES The purpose of this study was to determine whether (1) periprosthetic UHMWPE wear debris induces immune responses that lead to the production of tumor necrosis factor-α (TNFα) and interleukin (IL)-1ß, the vascularization factors, vascular endothelial growth factor (VEGF) and platelet-derived growth factor-bb (PDGFbb), and the innervation/pain factors, nerve growth factor (NGF) and substance P; (2) the number of macrophages is associated with the production of the aforementioned factors; (3) the wear debris-induced inflammatory pathogenesis involves an increase in vascularization and associated innervation. METHODS Periprosthetic tissues from our collection of 11 patients with contemporary TDRs were evaluated using polarized light microscopy to quantify UHMWPE wear particles. The major reason for revision (mean implantation time of 3 years [range, 1-6 years]) was pain. For control subjects, biopsy samples from four patients with degenerative disc disease with severe pain and autopsy samples from three normal patients with no history of back pain were also investigated. Immunohistochemistry and histology were used to identify secretory factors, macrophages, and blood vessels. Immunostained serial sections were imaged at ×200 magnification and using MATLAB and NIH ImageJ, a threshold was determined for each factor and used to quantify positive staining normalized to tissue sectional area. The Mann-Whitney U test was used to compare results from different patient groups, whereas the Spearman Rho test was used to determine correlations. Significance was based on p < 0.05. RESULTS The mean percent area of all six inflammatory, vascularization, and innervation factors was higher in TDR tissues when compared with normal disc tissues. Based on nonparametric data analysis, those factors showing the most significant increase included TNFα (5.17 ± 1.76 versus 0.05 ± 0.03, p = 0.02), VEGF (3.02 ± 1.01 versus 0.02 ± 0.002, p = 0.02), and substance P (4.15 ± 1.01 versus 0.08 ± 0.04, p = 0.02). The mean percent area for IL-1ß (2.41 ± 0.66 versus 0.13 ± 0.13, p = 0.01), VEGF (3.02 ± 1.01 versus 0.34 ± 0.29, p = 0.04), and substance P (4.15 ± 1.01 versus 1.05 ± 0.46, p = 0.01) was also higher in TDR tissues when compared with disc tissues from patients with painful degenerative disc disease. Five of the factors, TNFα, IL-1ß, VEGF, NGF, and substance P, strongly correlated with the number of wear particles, macrophages, and blood vessels. The most notable correlations included TNFα with wear particles (p < 0.001, ρ = 0.63), VEGF with macrophages (p = 0.001, ρ = 0.71), and NGF with blood vessels (p < 0.001, ρ = 0.70). Of particular significance, the expression of PDGFbb, NGF, and substance P was predominantly localized to blood vessels/nerve fibers. CONCLUSIONS These findings indicate wear debris-induced inflammatory reactions can be linked to enhanced vascularization and associated innervation/pain factor production at periprosthetic sites around TDRs. Elucidating the pathogenesis of inflammatory particle disease will provide information needed to identify potential therapeutic targets and treatment strategies to mitigate pain and potentially avoid revision surgery. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Sai Y Veruva
- Implant Research Center, Drexel University, 3401 Market Street, Suite 345, Philadelphia, PA, 19104, USA
| | - Todd H Lanman
- Department of Neurosurgery, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | | | - Theresa A Freeman
- Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Steven M Kurtz
- Implant Research Center, Drexel University, 3401 Market Street, Suite 345, Philadelphia, PA, 19104, USA
- Exponent, Inc, Philadelphia, PA, USA
| | - Marla J Steinbeck
- Implant Research Center, Drexel University, 3401 Market Street, Suite 345, Philadelphia, PA, 19104, USA.
- Department of Orthopaedic Surgery, Drexel University College of Medicine, Philadelphia, PA, USA.
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Siskey R, Peck J, Mehta H, Kosydar A, Kurtz S, Hill G. Development of a clinically relevant impingement test method for a mobile bearing lumbar total disc replacement. Spine J 2016; 16:1133-42. [PMID: 27179625 DOI: 10.1016/j.spinee.2016.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 04/13/2016] [Accepted: 05/07/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Total disc arthroplasty is an alternative therapy to spinal fusion for the treatment of neck or low back pain and is hypothesized to reduce the risk of disease progression to the adjacent spinal levels. Radiographic and retrieval analyses of various total disc replacements (TDRs) have shown evidence of impingement damage. Impingement of TDRs can occur when the device reaches the limits of its functional range of motion, causing contact between peripheral regions of the device. PURPOSE Impingement can be associated with increased wear and mechanical damage; however, impingement conditions are not simulated in current standardized mechanical bench test methods. This study explored the test conditions necessary to apply clinically relevant impingement loading to a lumbar TDR in vitro. STUDY DESIGN An experimental protocol was developed and evaluated using in vivo retrievals for qualitative and quantitative validation. METHODS Retrieval analysis was conducted on a set of 11 size 3 retrieved Charité devices using American Society for Testing and Materials F561 as a guide. The impingement range of motion was determined using a combination of modeling and experiments, and was used as an input in vitro testing. A 1-million cycle in vitro test was then conducted, and the in vitro samples were characterized using methods similar to the retreived devices. RESULTS All in vitro tested samples exhibited impingement regions and damage patterns consistent with retrieved devices. Consistent with the retrievals, the impingement damage on the rim was a combination of abrasive wear and plastic deformation. Micro computed tomography (microCT) was used to quantitatively assess rim damage due to impingement. Rim penetration was statistically lower in the retrievals when compared with both in vitro groups. Rim elongation was comparable among all groups. The simulated-facet group had statistically greater angular rim deformations than the retrieval group and the no-facet group. CONCLUSIONS Results demonstrate that clinically relevant impingement seen on mobile bearings of lumbar TDRs can be replicated on the bench.
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Affiliation(s)
- Ryan Siskey
- Exponent, Inc., Philadelphia, PA, USA; Drexel University, Philadelphia, PA, USA.
| | - Jonathan Peck
- US Food and Drug Administration, White Oak, Building 66, 10903 New Hampshire Avenue, Silver Spring, MD 20993, USA
| | - Hitesh Mehta
- US Food and Drug Administration, White Oak, Building 66, 10903 New Hampshire Avenue, Silver Spring, MD 20993, USA
| | - Allison Kosydar
- Exponent, Inc., Philadelphia, PA, USA; Drexel University, Philadelphia, PA, USA
| | - Steven Kurtz
- Exponent, Inc., Philadelphia, PA, USA; Drexel University, Philadelphia, PA, USA
| | - Genevieve Hill
- US Food and Drug Administration, White Oak, Building 66, 10903 New Hampshire Avenue, Silver Spring, MD 20993, USA
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Sawatzke AB, Bollinger AJ, Butler PD, Roberts KC. Rim Fracture of a Tibial Base-Plate Due to Retained Cement as a Cause of Catastrophic Failure of Unicompartmental Knee Arthroplasty: A Case Report. JBJS Case Connect 2016; 6:e73. [PMID: 29252650 DOI: 10.2106/jbjs.cc.15.00131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE We report a case of catastrophic implant failure due to fatigue fracture of a well-functioning unicompartmental knee arthroplasty at 7 years in an active 55-year-old man, who presented with sudden onset of atraumatic knee pain and effusion. The patient underwent revision to total knee arthroplasty. Intraoperative findings included a metallic fragment fractured off the rim of the tibial base-plate and cement retained in the tibial tray. CONCLUSION Retained cement in the tibial tray resulted in increased tibial tray contact stresses and fatigue fracture of the rim of the tray, creating a free metallic loose body that produced symptoms.
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Affiliation(s)
- Alexander B Sawatzke
- Department of Orthopaedic Surgery, Grand Rapids Medical Education Partners, Grand Rapids, Michigan.,Department of Orthopaedic Surgery, College of Human Medicine, Michigan State University, Grand Rapids, Michigan
| | - Alexander J Bollinger
- Department of Orthopaedic Surgery, Grand Rapids Medical Education Partners, Grand Rapids, Michigan.,Department of Orthopaedic Surgery, College of Human Medicine, Michigan State University, Grand Rapids, Michigan
| | - Paul D Butler
- Department of Orthopaedic Surgery, Grand Rapids Medical Education Partners, Grand Rapids, Michigan.,Department of Orthopaedic Surgery, College of Human Medicine, Michigan State University, Grand Rapids, Michigan
| | - Karl C Roberts
- Department of Orthopaedic Surgery, Grand Rapids Medical Education Partners, Grand Rapids, Michigan.,Spectrum Health, Grand Rapids, Michigan
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SHANKAR S, KESAVAN D. WEAR PREDICTION OF THE LUMBAR TOTAL DISC REPLACEMENT USING FINITE ELEMENT METHOD. J MECH MED BIOL 2016. [DOI: 10.1142/s0219519416500044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Wear in the total disc replacement (TDR) is a significant clinical concern which reduces the lifetime of prosthesis. It induces the formation of potentially harmful debris and involves the risks of a new surgical operation. The objective of this paper is to estimate the wear using finite element (FE) concepts considering various combination of materials: metal-polymer, ceramic–ceramic and metal–metal bearing couples for lumbar total disc replacement (LTDR). The FE model was subjected to wear testing protocols according to loading profile of International Standards Organization (ISO) 18192 standards up to 10 million cycles. The present study revealed that, Alumina–Alumina (Al2O3–Al2O3) bearing pair is suitable one for the TDR process because of less volumetric wear, hence it could be considered in LTDR designs.
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Affiliation(s)
- S. SHANKAR
- Department of Mechatronics Engineering, Kongu Engineering College, Erode, Tamilnadu 638052, India
- Department of Mechanical Engineering, Kongu Engineering College, Erode, Tamilnadu 638052, India
| | - D. KESAVAN
- Department of Mechatronics Engineering, Kongu Engineering College, Erode, Tamilnadu 638052, India
- Department of Mechanical Engineering, Kongu Engineering College, Erode, Tamilnadu 638052, India
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Moghadas P, Mahomed A, Shepherd DET, Hukins DWL. Wear of the Charité® lumbar intervertebral disc replacement investigated using an electro-mechanical spine simulator. Proc Inst Mech Eng H 2016; 229:264-8. [PMID: 25834002 PMCID: PMC4456431 DOI: 10.1177/0954411915576537] [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] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The Charité® lumbar intervertebral disc replacement was subjected to wear testing in an electro-mechanical spine simulator. Sinusoidally varying compression (0.6–2 kN, frequency 2 Hz), rotation (±2°, frequency 1 Hz), flexion–extension (6° to −3°, frequency 1 Hz) and lateral bending (±2°, frequency 1 Hz) were applied out of phase to specimens immersed in diluted calf serum at 37 °C. The mass of the ultra-high-molecular weight polyethylene component of the device was measured at intervals of 0.5, 1, 2, 3, 4 and 5 million cycles; its volume was also measured by micro-computed tomography. Total mass and volume losses were 60.3 ± 4.6 mg (mean ± standard deviation) and 64.6 ± 6.0 mm3. Corresponding wear rates were 12.0 ± 1.4 mg per million cycles and 12.8 ± 1.2 mm3 per million cycles; the rate of loss of volume corresponds to a mass loss of 11.9 ± 1.1 mg per million cycles, that is, the two sets of measurements of wear agree closely. Wear rates also agree closely with measurements made in another laboratory using the same protocol but using a conventional mechanical spine simulator.
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Affiliation(s)
- Parshia Moghadas
- School of Mechanical Engineering, University of Birmingham, Birmingham, UK
| | - Aziza Mahomed
- School of Mechanical Engineering, University of Birmingham, Birmingham, UK
| | | | - David W L Hukins
- School of Mechanical Engineering, University of Birmingham, Birmingham, UK
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Park CK. Total Disc Replacement in Lumbar Degenerative Disc Diseases. J Korean Neurosurg Soc 2015; 58:401-11. [PMID: 26713139 PMCID: PMC4688308 DOI: 10.3340/jkns.2015.58.5.401] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 08/11/2015] [Accepted: 08/12/2015] [Indexed: 02/07/2023] Open
Abstract
More than 10 years have passed since lumbar total disc replacement (LTDR) was introduced for the first time to the world market for the surgical management of lumbar degenerative disc disease (DDD). It seems like the right time to sum up the relevant results in order to understand where LTDR stands on now, and is heading forward to. The pathogenesis of DDD has been currently settled, but diagnosis and managements are still controversial. Fusion is recognized as golden standard of surgical managements but has various kinds of shortcomings. Lately, LTDR has been expected to replace fusion surgery. A great deal of LTDR reports has come out. Among them, more than 5-year follow-up prospective randomized controlled studies including USA IDE trials were expected to elucidate whether for LTDR to have therapeutic benefit compared to fusion. The results of these studies revealed that LTDR was not inferior to fusion. Most of clinical studies dealing with LTDR revealed that there was no strong evidence for preventive effect of LTDR against symptomatic degenerative changes of adjacent segment disease. LTDR does not have shortcomings associated with fusion. However, it has a potentiality of the new complications to occur, which surgeons have never experienced in fusion surgeries. Consequently, longer follow-up should be necessary as yet to confirm the maintenance of improved surgical outcome and to observe any very late complications. LTDR still may get a chance to establish itself as a substitute of fusion both nominally and virtually if it eases the concerns listed above.
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Affiliation(s)
- Chun Kun Park
- Department of Neurosurgery, The Catholic University of Korea College of Medicine, Seoul, Korea. ; Good Doctor Teun Teun Hospital, Anyang, Korea
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Hyde PJ, Fisher J, Hall RM. Wear characteristics of an unconstrained lumbar total disc replacement under a range of in vitro test conditions. J Biomed Mater Res B Appl Biomater 2015; 105:46-52. [PMID: 26411540 PMCID: PMC5215667 DOI: 10.1002/jbm.b.33456] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 02/20/2015] [Accepted: 04/07/2015] [Indexed: 12/22/2022]
Abstract
The effect of kinematics, loading and centre of rotation on the wear of an unconstrained total disc replacement have been investigated using the ISO 18192‐1 standard test as a baseline. Mean volumetric wear rate and surface morphological effects were reported. Changing the phasing of the flexions to create a low (but finite) amount of crossing path motion at the bearing surfaces resulted in a significant fall in wear volume. However, the rate of wear was still much larger than previously reported values under zero cross shear conditions. Reducing the load did not result in a significant change in wear rate. Moving the centre of rotation of the disc inferiorly did significantly increase wear rate. A phenomenon of debris re‐attachment on the UHMWPE surface was observed and hypothesised to be due to a relatively harsh tribological operating regime in which lubricant replenishment and particle migration out of the bearing contact zone were limited. © 2015 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 46–52, 2017.
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Affiliation(s)
- Philip J Hyde
- Institute of Medical and Biological Engineering, University of Leeds, Leeds, UK
| | - John Fisher
- Institute of Medical and Biological Engineering, University of Leeds, Leeds, UK
| | - Richard M Hall
- Institute of Medical and Biological Engineering, University of Leeds, Leeds, UK
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Carpenter S, Pinkas D, Newton MD, Kurdziel MD, Baker KC, Wiater JM. Wear rates of retentive versus nonretentive reverse total shoulder arthroplasty liners in an in vitro wear simulation. J Shoulder Elbow Surg 2015; 24:1372-9. [PMID: 25842031 DOI: 10.1016/j.jse.2015.02.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 02/10/2015] [Accepted: 02/16/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although short-term outcomes of reverse total shoulder arthroplasty (rTSA) remain promising, the most commonly cited complication remains prosthetic instability. A retentive rTSA liner is commonly used to increase system constraint; however, no studies have evaluated the rate of polyethylene wear. Our hypothesis was that more constrained retentive liners would have higher wear rates than nonretentive liners. METHODS Six nonretentive and six retentive rTSA non-cross-linked polyethylene liners were subjected to 4.5 million cycles of alternating cycles of abduction-adduction and flexion-extension motion loading profiles. The rTSA liners were assessed for gravimetric wear loss, 3-dimensional volumetric loss by novel micro-computed tomography analysis, and particulate wear debris analysis. RESULTS Volumetric wear rates were significant at 7 specific time points (1.0, 2.0, 2.5, 3.25, 3.75, 4.0, and 4.5 million cycles) throughout testing between nonretentive and retentive liners; however, overall mean volumetric wear rate was not statistically significant (P = .076). Total volume loss between liner test groups was found to be significant starting after 3.5 million cycles of testing. Maximum and mean surface deviations were found to be larger for retentive liners vs. nonretentive liners by micro-computed tomography analysis across the entire articulation surface. DISCUSSION AND CONCLUSION Retentive liners undergo significantly greater volume loss and greater surface deviation compared with nonretentive liners, most notably at later time points representing extended implantation times. Additional stability afforded by retentive liners should be balanced against the potential for increased wear and potential for subsequent polyethylene wear-induced aseptic loosening.
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Affiliation(s)
- Shannon Carpenter
- Department of Orthopaedic Surgery, Beaumont Health System, Royal Oak, MI, USA
| | - Daphne Pinkas
- Department of Orthopaedic Surgery, Beaumont Health System, Royal Oak, MI, USA
| | - Michael D Newton
- Department of Orthopaedic Research, Beaumont Health System, Royal Oak, MI, USA
| | - Michael D Kurdziel
- Department of Orthopaedic Research, Beaumont Health System, Royal Oak, MI, USA; Department of Surgery, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Kevin C Baker
- Department of Orthopaedic Research, Beaumont Health System, Royal Oak, MI, USA; Department of Surgery, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - J Michael Wiater
- Department of Orthopaedic Surgery, Beaumont Health System, Royal Oak, MI, USA; Department of Surgery, Oakland University William Beaumont School of Medicine, Rochester, MI, USA.
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Wu W, Lyu J, Liu H, Rong X, Wang B, Hong Y, Gong Q, Li T, Liu L, Song Y, Cai Y, Xu W. Wear assessments of a new cervical spinal disk prosthesis: Influence of loading and kinematic patterns during in vitro wear simulation. Proc Inst Mech Eng H 2015; 229:619-28. [PMID: 26163521 DOI: 10.1177/0954411915594829] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Accepted: 06/01/2015] [Indexed: 02/05/2023]
Abstract
Surgical treatment is one of the effective methods of treatment in cervical spondylosis. The traditional method of operation is decompression fusion; however, this surgery results in restricted movement of cervical vertebra and adjacent segment degeneration. Due to the deficiency of traditional surgery, scholars have widely carried out artificial cervical disk replacement surgery and have achieved good clinical effects. Comparing to the characteristics of the common artificial cervical disk which is used frequently, we developed a new artificial cervical intervertebral disk prosthesis. The purpose of this study was to determine the wear behavior in a cervical total disk replacement system. The total disk replacement system tested consists of a ultra-high-molecular-weight polyethylene inlay articulating between a Ti6Al4V alloy superior plate and an inferior plate, using a spine wear simulator, per the ISO 18192-1:2011 standard test methods. Three rotations and axial force were applied on each station. The specimens were removed at 5 × 10(5) and 10(6) cycles and at intervals of 10(6) cycles thereafter to determine the actual mass loss. The serum was replaced every 5 × 10(5) cycles. The specimens were changed periodically among the different stations. A mean ultrahigh molecular weight polyethylene inlay wear rate of 0.53 mg per million cycles (standard = 0.13 mg per 10(6) cycles) was found after 10(7) cycles. All inferior plates showed slight scratching after 10(7) cycles. The impingement wear simulation introduced here proved to be suitable to predict in vivo impingement behavior in regard to the contact pattern seen on retrieved devices of the Pretic-I disk arthroplasty design in a preclinical test.
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Affiliation(s)
- Wenjie Wu
- Spine Center of Orthopaedic Department, West Hospital, Chengdu, China
| | - Jingtong Lyu
- Spine Center of Orthopaedic Department, West Hospital, Chengdu, China
| | - Hao Liu
- Spine Center of Orthopaedic Department, West Hospital, Chengdu, China
| | - Xin Rong
- Spine Center of Orthopaedic Department, West Hospital, Chengdu, China
| | - Beiyu Wang
- Spine Center of Orthopaedic Department, West Hospital, Chengdu, China
| | - Ying Hong
- Operating Room Chengdu, West China Hospital, Chengdu, China
| | - Quan Gong
- Spine Center of Orthopaedic Department, West Hospital, Chengdu, China
| | - Tao Li
- Spine Center of Orthopaedic Department, West Hospital, Chengdu, China
| | - Limin Liu
- Spine Center of Orthopaedic Department, West Hospital, Chengdu, China
| | - Yueming Song
- Spine Center of Orthopaedic Department, West Hospital, Chengdu, China
| | - Yong Cai
- The Chuang Sheng Medical (China) of Yangtze River Test Center, Changzhou, China
| | - Wenli Xu
- The Chuang Sheng Medical (China) of Yangtze River Test Center, Changzhou, China
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Showalter BL, Elliott DM, Chen W, Malhotra NR. Evaluation of an In Situ Gelable and Injectable Hydrogel Treatment to Preserve Human Disc Mechanical Function Undergoing Physiologic Cyclic Loading Followed by Hydrated Recovery. J Biomech Eng 2015; 137:081008. [PMID: 25950273 DOI: 10.1115/1.4030530] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Indexed: 12/21/2022]
Abstract
Despite the prevalence of disc degeneration and its contributions to low back problems, many current treatments are palliative only and ultimately fail. To address this, nucleus pulposus replacements are under development. Previous work on an injectable hydrogel nucleus pulposus replacement composed of n-carboxyethyl chitosan, oxidized dextran, and teleostean has shown that it has properties similar to native nucleus pulposus, can restore compressive range of motion in ovine discs, is biocompatible, and promotes cell proliferation. The objective of this study was to determine if the hydrogel implant will be contained and if it will restore mechanics in human discs undergoing physiologic cyclic compressive loading. Fourteen human lumbar spine segments were tested using physiologic cyclic compressive loading while intact, following nucleotomy, and again following treatment of injecting either phosphate buffered saline (PBS) (sham, n = 7) or hydrogel (implant, n = 7). In each compressive test, mechanical parameters were measured immediately before and after 10,000 cycles of compressive loading and following a period of hydrated recovery. The hydrogel implant was not ejected from the disc during 10,000 cycles of physiological compression testing and appeared undamaged when discs were bisected following all mechanical tests. For sham samples, creep during cyclic loading increased (+15%) from creep during nucleotomy testing, while for implant samples creep strain decreased (-3%) toward normal. There was no difference in compressive modulus or compressive strains between implant and sham samples. These findings demonstrate that the implant interdigitates with the nucleus pulposus, preventing its expulsion during 10,000 cycles of compressive loading and preserves disc creep within human L5-S1 discs. This and previous studies provide a solid foundation for continuing to evaluate the efficacy of the hydrogel implant.
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Abstract
STUDY DESIGN Descriptive. OBJECTIVE The purpose of this study was to determine the in vivo kinematics of functional spinal units, during gait, in individuals with a single-level lumbar total disc replacement (TDR). SUMMARY OF BACKGROUND DATA TDR is a motion preservation technology that offers an alternative to spinal fusion for treatment of degenerative disc disease. The aim of TDRs is to replicate motion of the functional spinal units, which may protect adjacent intervertebral discs against accelerated degeneration. At present, there is limited understanding of the in vivo motion of TDRs, particularly during dynamic activities such as gait. Such information is important for understanding the wear characteristics of TDRs and furthering design rationale of future implants. METHODS TDR motions were obtained from 24 participants who underwent implantation with single-level L4-L5 or L5-S1 CHARITÉ or In Motion TDRs. Video fluoroscopy was used to obtain measurements in the frontal and sagittal planes during fixed speed treadmill walking. RESULTS The mean range of motion between the upper and lower lumbar TDR endplates during walking was 1.6° and 2.4° in the frontal and sagittal planes, respectively. These values were significantly different from zero and corresponded to 19% of the maximum static range of motion in each plane. CONCLUSION Lumbar TDRs provide a degree of motion preservation at the operative level during moderate speed walking. The distribution of lumbar TDR motions during walking presented here will inform relevant standards for conducting standardized tests of lumbar TDRs, particularly wear assessments, and, hence, enable more realistic mechanical and computer-based wear simulations to be performed. LEVEL OF EVIDENCE N/A.
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Veruva SY, Lanman TH, Isaza JE, MacDonald DW, Kurtz SM, Steinbeck MJ. UHMWPE wear debris and tissue reactions are reduced for contemporary designs of lumbar total disc replacements. Clin Orthop Relat Res 2015; 473:987-98. [PMID: 25367112 PMCID: PMC4317415 DOI: 10.1007/s11999-014-4029-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Lumbar total disc replacement (L-TDR) is a procedure used to relieve back pain and maintain mobility. Contemporary metal-on-polyethylene (MoP) L-TDRs were developed to address wear performance concerns about historical designs, but wear debris generation and periprosthetic tissue reactions for these newer implants have not been determined. QUESTIONS/PURPOSES The purpose of this study was to determine (1) whether periprosthetic ultrahigh-molecular-weight polyethylene (UHMWPE) wear debris and biological responses were present in tissues from revised contemporary MoP L-TDRs that contain conventional cores fabricated from γ-inert-sterilized UHMWPE; (2) how fixed- versus mobile-bearing design affected UHMWPE wear particle number, shape, and size; and (3) how these wear particle characteristics compare with historical MoP L-TDRs that contain cores fabricated from γ-air-sterilized UHMWPE. METHODS We evaluated periprosthetic tissues from 11 patients who received eight fixed-bearing ProDisc-L and four mobile-bearing CHARITÉ contemporary L-TDRs with a mean implantation time of 4.1 and 2.7 years, respectively. Histologic analysis of tissues was performed to assess biological responses and polarized light microscopy was used to quantify number and size/shape characteristics of UHMWPE wear particles from the fixed- and mobile-bearing devices. Comparisons were made to previously reported particle data for historical L-TDRs. RESULTS Five of seven (71%) fixed-bearing and one of four mobile-bearing L-TDR patient tissues contained at least 4 particles/mm(2) wear with associated macrophage infiltration. Tissues with wear debris were highly vascularized, whereas those without debris were more necrotic. Given the samples available, the tissue around mobile-bearing L-TDR was observed to contain 87% more, 11% rounder, and 11% less-elongated wear debris compared with tissues around fixed-bearing devices; however, there were no significant differences. Compared with historical L-TDRs, UHMWPE particle number and circularity for contemporary L-TDRs were 99% less (p = 0.003) and 50% rounder (p = 0.003). CONCLUSIONS In this preliminary study, short-term results suggest there was no significant influence of fixed- or mobile-bearing designs on wear particle characteristics of contemporary L-TDRs, but conventional UHMWPE has notably improved the wear resistance of these devices compared with historical UHMWPE.
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Affiliation(s)
- Sai Y. Veruva
- />Implant Research Center, Drexel University, 3401 Market Street, Suite 345, Philadelphia, PA 19104 USA
| | - Todd H. Lanman
- />Department of Surgery, University of California Los Angeles, Los Angeles, CA USA
| | | | - Daniel W. MacDonald
- />Implant Research Center, Drexel University, 3401 Market Street, Suite 345, Philadelphia, PA 19104 USA
| | - Steven M. Kurtz
- />Implant Research Center, Drexel University, 3401 Market Street, Suite 345, Philadelphia, PA 19104 USA
- />Exponent, Inc, Philadelphia, PA USA
| | - Marla J. Steinbeck
- />Implant Research Center, Drexel University, 3401 Market Street, Suite 345, Philadelphia, PA 19104 USA
- />Department of Orthopaedic Surgery, Drexel University College of Medicine, Philadelphia, PA USA
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Veruva SY, Lanman TH, Hanzlik JA, Kurtz SM, Steinbeck MJ. Rare complications of osteolysis and periprosthetic tissue reactions after hybrid and non-hybrid total disc replacement. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 24 Suppl 4:S494-501. [PMID: 25163549 DOI: 10.1007/s00586-014-3535-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 08/21/2014] [Accepted: 08/22/2014] [Indexed: 01/19/2023]
Abstract
PURPOSE Few complications have been reported for lumbar total disc replacement (TDR) and hybrid TDR fixations. This study evaluated retrieved implants and periprosthetic tissue reactions for two cases of osteolysis following disc arthroplasty with ProDisc-L prostheses. METHODS Implants were examined for wear and surface damage, and tissues for inflammation, polyethylene wear debris (polarized light microscopy) and metal debris (energy-dispersive X-ray spectroscopy). RESULTS Despite initial good surgical outcomes, osteolytic cysts were noted in both patients at vertebrae adjacent to the implants. For the hybrid TDR case, heterotopic ossification and tissue necrosis due to wear-induced inflammation were observed. In contrast, the non-hybrid implant showed signs of abrasion and impingement, and inflammation was observed in tissue regions with metal and polyethylene wear debris. CONCLUSIONS In both cases, wear debris and inflammation may have contributed to osteolysis. Surgeons using ProDisc prostheses should be aware of these rare complications.
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Affiliation(s)
- Sai Y Veruva
- School of Biomedical Engineering and Health Sciences, Drexel University, 3401 Market St, Suite 345, Philadelphia, PA, 19104, USA
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Grupp TM, Yue JJ, Garcia R, Kaddick C, Fritz B, Schilling C, Schwiesau J, Blömer W. Evaluation of impingement behaviour in lumbar spinal disc arthroplasty. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 24:2033-46. [DOI: 10.1007/s00586-014-3381-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 05/10/2014] [Accepted: 05/12/2014] [Indexed: 12/22/2022]
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Circumferential dynamic stabilization of the lumbar spine: a biomechanical analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 23:2330-9. [DOI: 10.1007/s00586-014-3286-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 03/16/2014] [Accepted: 03/25/2014] [Indexed: 10/25/2022]
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Papageorgiou I, Marsh R, Tipper JL, Hall RM, Fisher J, Ingham E. Interaction of micron and nano-sized particles with cells of the dura mater. J Biomed Mater Res B Appl Biomater 2014; 102:1496-505. [PMID: 24604838 PMCID: PMC4336564 DOI: 10.1002/jbm.b.33129] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 01/20/2014] [Accepted: 02/18/2014] [Indexed: 12/12/2022]
Abstract
Intervertebral total disc replacements (TDR) are used in the treatment of degenerative spinal disc disease. There are, however, concerns that they may be subject to long-term failure due to wear. The adverse effects of TDR wear have the potential to manifest in the dura mater and surrounding tissues. The aim of this study was to investigate the physiological structure of the dura mater, isolate the resident dural epithelial and stromal cells and analyse the capacity of these cells to internalise model polymer particles. The porcine dura mater was a collagen-rich structure encompassing regularly arranged fibroblastic cells within an outermost epithelial cell layer. The isolated dural epithelial cells had endothelial cell characteristics (positive for von Willebrand factor, CD31, E-cadherin and desmoplakin) and barrier functionality whereas the fibroblastic cells were positive for collagen I and III, tenascin and actin. The capacity of the dural cells to take up model particles was dependent on particle size. Nanometer sized particles readily penetrated both types of cells. However, dural fibroblasts engulfed micron-sized particles at a much higher rate than dural epithelial cells. The study suggested that dural epithelial cells may offer some barrier to the penetration of micron-sized particles but not nanometer sized particles.
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Affiliation(s)
- Iraklis Papageorgiou
- Institute of Medical & Biological Engineering (IMBE), Faculty of Biological Sciences, University of Leeds, Leeds, LS2 9JT, UK
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Very late complications of cervical arthroplasty: results of 2 controlled randomized prospective studies from a single investigator site. Spine (Phila Pa 1976) 2013; 38:2223-6. [PMID: 24335628 DOI: 10.1097/brs.0000000000000060] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective, single-site, randomized, Food and Drug Administration-approved investigational device exemption clinical trials of 2 cervical arthroplasty (CA) devices. OBJECTIVE To evaluate complications with CA occurring more than 4 years after the surgical procedure in Food and Drug Administration clinical trials of the Bryan and Prestige LP arthroplasty devices. SUMMARY OF BACKGROUND DATA Reports of several randomized clinical studies have shown CA to be a safe and effective alternative to anterior cervical fusion in the treatment of degenerative cervical disc disorders. A majority include follow-up intervals of 4 years or less. METHODS Between 2002 and 2006, 94 patients were enrolled in Food and Drug Administration studies of the Bryan and Prestige LP cervical disc devices. Charts, imaging studies, and hospital records were reviewed for those who underwent arthroplasty and returned more than 4 years after their surgical procedure with neck-related pain or dysfunction. RESULTS Excluding adjacent segment disease that occurred with a similar rate for patients who underwent fusion and arthroplasty, 5 patients, all treated with arthroplasty, returned for evaluation of neck and arm symptoms between 48 and 72 months after surgery. Four patients had peridevice vertebral body bone loss. One patient had posterior device migration and presented with myelopathy. Three required revision surgery and 2 were observed. Four patients maintained follow-up and reported stabilization or improvement in symptoms. CONCLUSION Despite their similarities, CA and fusion are not equivalent procedures in this study in regard to very late complications. Similar to large joint arthroplasty, delayed device-related complications may occur with CA. These complications commenced well beyond the time frame for complications associated with more traditional cervical spine procedures. Both patients and surgeons should be aware of the potential for very late device-related complications occurring with CA and the need for revision surgery. LEVEL OF EVIDENCE 1.
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Pegg EC, Murray DW, Pandit HG, O’Connor JJ, Gill HS. Fracture of mobile unicompartmental knee bearings: A parametric finite element study. Proc Inst Mech Eng H 2013; 227:1213-23. [DOI: 10.1177/0954411913494326] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cases of fractured mobile unicompartmental knee bearings have recently been reported. The purpose of this study was to understand the mechanics behind these fractures and to examine the influence of different design modifications. A parametric finite element model was used to examine the influence of different geometrical factors on the stresses within the bearing. Crack initiation occurred clinically in the centre of the bearing; this correlated with the position of the maximum von Mises stress. Tensile stresses, thought to propagate the fatigue crack, were maximal at the medial–lateral sides of the bearing, and the tensile vectors were normal to the fracture direction observed clinically. Fully congruent femoral articulation on the bearing, use of a thicker bearing size, and minimising wear of the component reduced the risk of fracture. For example, an unworn 6.5-mm-thick bearing (no clinical fractures reported) had 21.6% lower medial–lateral tensile stress compared to an unworn 3.5 mm bearing (five clinical fractures reported). In turn, an unworn 3.5 mm bearing had 34.3% lower tensile stress compared to a 3.5 mm bearing after 1.9 mm wear (average linear wear reported for clinically fractured bearings). The fracture risk was also reduced when the radio-opaque marker wire was positioned further from the centre of the bearing, and when marker balls were used instead of marker wires (19% reduction in tensile stress in some regions). These results indicate the importance of minimising component wear; the data also support the current component design which uses posterior marker balls instead of marker wires, and the continuing use of a congruous femoral component.
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Affiliation(s)
- Elise C Pegg
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Oxford, UK
| | - David W Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Oxford, UK
| | - Hemant G Pandit
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Oxford, UK
| | - John J O’Connor
- Department of Engineering Science, University of Oxford, Oxford, UK
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Baxter RM, MacDonald DW, Kurtz SM, Steinbeck MJ. Severe impingement of lumbar disc replacements increases the functional biological activity of polyethylene wear debris. J Bone Joint Surg Am 2013; 95:e751-9. [PMID: 23780545 PMCID: PMC3748985 DOI: 10.2106/jbjs.k.00522] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Wear, oxidation, and particularly rim impingement damage of ultra-high molecular weight polyethylene total disc replacement components have been observed following surgical revision. However, neither in vitro testing nor retrieval-based evidence has shown the effect(s) of impingement on the characteristics of polyethylene wear debris. Thus, we sought to determine (1) differences in polyethylene particle size, shape, number, or biological activity that correspond to mild or severe rim impingement and (2) in an analysis of all total disc replacements, regardless of impingement classification, whether there are correlations between the extent of regional damage and the characteristics of polyethylene wear debris. METHODS The extent of dome and rim damage was characterized for eleven retrieved polyethylene cores obtained at revision surgery after an average duration of implantation of 9.7 years (range, 4.6 to 16.1 years). Polyethylene wear debris was isolated from periprosthetic tissues with use of nitric acid and was imaged with use of environmental scanning electron microscopy. Subsequently, particle size, shape, number, biological activity, and chronic inflammation scores were determined. RESULTS Grouping of particles by size ranges that represented high biological relevance (<0.1 to 1-μm particles), intermediate biological relevance (1 to 10-μm particles), and low biological relevance (>10-μm particles) revealed an increased volume fraction of particles in the <0.1 to 1-μm and 1 to 10-μm size ranges in the mild-impingement cohort as compared with the severe-impingement cohort. The increased volume fractions resulted in a higher specific biological activity per unit particle volume in the mild-impingement cohort than in the severe-impingement cohort. However, functional biological activity, which is normalized by particle volume (mm3/g of tissue), was significantly higher in the severe-impingement cohort. This increase was due to a larger volume of particles in all three size ranges. In both cohorts, the functional biological activity correlated with the chronic inflammatory response, and the extent of rim penetration positively correlated with increasing particle size, number, and functional biological activity. CONCLUSIONS The results of this study suggest that severe rim impingement increases the production of biologically relevant particles from motion-preserving lumbar total disc replacement components. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Ryan M. Baxter
- Implant Research Center, School of Biomedical Engineering, Science & Health Systems, Drexel University, 3401 Market Street, Suite 345, Philadelphia, PA 19104. E-mail address for M.J. Steinbeck:
| | - Daniel W. MacDonald
- Implant Research Center, School of Biomedical Engineering, Science & Health Systems, Drexel University, 3401 Market Street, Suite 345, Philadelphia, PA 19104. E-mail address for M.J. Steinbeck:
| | - Steven M. Kurtz
- Implant Research Center, School of Biomedical Engineering, Science & Health Systems, Drexel University, 3401 Market Street, Suite 345, Philadelphia, PA 19104. E-mail address for M.J. Steinbeck:
| | - Marla J. Steinbeck
- Implant Research Center, School of Biomedical Engineering, Science & Health Systems, Drexel University, 3401 Market Street, Suite 345, Philadelphia, PA 19104. E-mail address for M.J. Steinbeck:
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The challenge and advancement of annulus fibrosus tissue engineering. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2013; 22:1090-100. [PMID: 23361531 DOI: 10.1007/s00586-013-2663-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Revised: 12/26/2012] [Accepted: 01/07/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Intervertebral disc degeneration, a main cause of back pain, is an endemic problem and a big economic burden for the health care system. Current treatments are symptom relieving but do not address underlying problems-biological and structural deterioration of the disc. Tissue engineering is an emerging approach for the treatment of intervertebral disc degeneration since it restores the functionality of native tissues. Although numerous studies have focused on the nucleus pulposus tissue engineering and achieved successes in laboratory settings, disc tissue engineering without annulus fibrosus for the end stage of disc degeneration is deemed to fail. The purpose of this article is to review the advancement of annulus fibrosus tissue engineering. MATERIAL AND METHODS Relevant articles regarding annulus fibrosus tissue engineering were identified in PubMed and Medline databases. RESULTS The ideal strategy for disc regeneration is to restore the function and integrity of the disc by using biomaterials, native matrices, growth factors, and cells that producing matrices. In the past decades there are tremendous advancement in annulus fibrosus tissue engineering including cell biology, biomaterials, and whole disc replacement. The recent promising results on whole disc tissue engineering-a composite of annulus fibrosus and nucleus pulposus-make the tissue engineering approach more appealing. CONCLUSION Despite the promising results in disc tissue engineering, there is still much work to be done regarding the clinical application.
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Kurtz SM, Ciccarelli L, Harper ML, Siskey R, Shorez J, Chan FW. Comparison of in vivo and simulator-retrieved metal-on-metal cervical disc replacements. Int J Spine Surg 2012; 6:145-56. [PMID: 25694884 PMCID: PMC4300870 DOI: 10.1016/j.ijsp.2012.03.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background Cervical disc arthroplasty is regarded as a promising treatment for myelopathy and radiculopathy as an alternative to cervical spine fusion. On the basis of 2-year clinical data for the PRESTIGE® Cervical Disc (Medtronic, Memphis, Tennessee), the Food and Drug Administration recommended conditional approval in September 2006 and final approval in July 2007; however, relatively little is known about its wear and damage modes in vivo. The main objective was to analyze the tribological findings of the PRESTIGE® Cervical Disc. This study characterized the in vivo wear patterns of retrieved cervical discs and tested the hypothesis that the total disc replacements exhibited similar surface morphology and wear patterns in vitro as in vivo. Methods Ten explanted total disc replacements (PRESTIGE®, PRESTIGE® I, and PRESTIGE® II) from 10 patients retrieved after a mean of 1.8 years (range, 0.3–4.1 years) were analyzed. Wear testing included coupled lateral bending ( ±4.7°) and axial rotation ( ±3.8°) with a 49 N axial load for 5 million cycles followed by 10 million cycles of flexion-extension ( ±9.7°) with 148 N. Implant surfaces were characterized by the use of white-light interferometry, scanning electron microscopy, and energy dispersive spectroscopy. Results The explants generally exhibited a slightly discolored, elliptic wear region of varying dimension centered in the bearing center, with the long axis oriented in the medial-lateral direction. Abrasive wear was the dominant in vivo wear mechanism, with microscopic scratches generally oriented in the medial-lateral direction. Wear testing resulted in severe abrasive wear in a curvilinear fashion oriented primarily in the medial-lateral direction. All retrievals showed evidence of an abrasive wear mechanism. Conclusions This study documented important similarity between the wear mechanisms of components tested in vitro and explanted PRESTIGE® Cervical Discs; however, the severity of wear was much greater during the in vitro test compared with the retrievals.
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Affiliation(s)
- Steven M. Kurtz
- Exponent, Inc., Philadelphia, PA
- Drexel University, Philadelphia, PA
- Corresponding author: Steven M. Kurtz, PhD., Exponent, Inc., 3401 Market St, Ste 300, Philadelphia, PA 19104; Tel: 215-594-8800; Fax: 215-594-8899. E-mail address:
| | | | | | - Ryan Siskey
- Exponent, Inc., Philadelphia, PA
- Drexel University, Philadelphia, PA
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Halverson PA, Bowden AE, Howell LL. A compliant-mechanism approach to achieving specific quality of motion in a lumbar total disc replacement. Int J Spine Surg 2012; 6:78-86. [PMID: 25694875 PMCID: PMC4300886 DOI: 10.1016/j.ijsp.2012.02.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background The current generation of total disc replacements achieves excellent short- and medium-term results by focusing on restoring the quantity of motion. Recent studies indicate that additional concerns (helical axes of motion, segmental torque-rotation behavior) may have important implications in the health of adjacent segments as well as the health of the surrounding tissue of the operative level. The objective of this article is to outline the development, validation, and biomechanical performance of a novel, compliant-mechanism total disc replacement that addresses these concerns by including them as essential design criteria. Methods Compliant-mechanism design techniques were used to design a total disc replacement capable of replicating the moment-rotation response and the location and path of the helical axis of motion. A prototype was evaluated with the use of bench-top testing and single-level cadaveric experiments in flexion-extension, lateral bending, and axial torsion. Results Bench-top testing confirmed that the moment-rotation response of the disc replacement matched the intended design behavior. Cadaveric testing confirmed that the moment-rotation and displacement response of the implanted segment mimicked those of the healthy spinal segment. Conclusions Incorporation of segmental quality of motion into the foundational stages of the design process resulted in a total disc replacement design that provides torque-rotation and helical axis–of–motion characteristics to the adjacent segments and the operative-level facets that are similar to those observed in healthy spinal segments.
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Affiliation(s)
- Peter A Halverson
- Crocker Spinal Technologies, Salt Lake City, UT ; Department of Mechanical Engineering, Brigham Young University, Provo, UT
| | - Anton E Bowden
- Department of Mechanical Engineering, Brigham Young University, Provo, UT
| | - Larry L Howell
- Department of Mechanical Engineering, Brigham Young University, Provo, UT
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The effects of different articulate curvature of artificial disc on loading distribution. J Appl Biomater Funct Mater 2012; 10:107-12. [PMID: 22798234 DOI: 10.5301/jabfm.2012.9258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2011] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Deeper insights into the mechanical behavior of lumbar disc prostheses are required. Prior studies on the biomechanical performance of artificial discs were mostly performed with finite element analyses, but this has never been analyzed with altering articulate curvature. This study aimed to ascertain the influence of the geometry of a ball-and-socket disc prosthesis for the lumbar spine. MATERIALS AND METHODS Three-dimensional finite element model of human L4-L5 was reconstructed. Convex, concave, and elliptic artificial disc models were also established with Computer-Aided-Design software. Simulations included: (1) three articulate types of polyethylene (PE) insert were implanted inferiorly and (2) concave and convex PE inserts were implanted on the superior or inferior sides in flexion/extension, lateral bending, and axial rotation in the lumbar spine. Shear stresses and von Mises stresses on PE insert were assessed for their loading distributions. RESULTS High shear stresses of all articulate types occurred in flexion, and convex PE insert performed the maximum stress of 23.81 MPa. Under all conditions, stresses on concave PE inserts were distributed more evenly and lower than those on the convex type. Elliptic geometry enabled confining the rotation of the motion unit. The shear force on the convex PE insert on the inferior side could induce transverse crack because the shear stress exceeded yielding shear stress. CONCLUSIONS The concave PE insert on the inferior side not only decreased loading concentration but had relatively low stress. Such a design may be applicable for artificial discs.
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