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Kiritopoulos D, Nyström A, Hailer NP, Mallmin H, Lazarinis S. Continuous periprosthetic bone loss around the TOP ® cup and inferior survival rate at an 8-year follow-up: a prospective cohort study. BMC Musculoskelet Disord 2024; 25:741. [PMID: 39285412 PMCID: PMC11403771 DOI: 10.1186/s12891-024-07865-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 09/09/2024] [Indexed: 09/22/2024] Open
Abstract
BACKGROUND The trabeculae-oriented pattern (TOP®) cup was designed to minimize acetabular periprosthetic bone loss. In our previous prospective study comprising 30 patients with a two-year follow-up we found a substantial decrease in periprosthetic bone mineral density (pBMD) in the proximal and medial regions of the TOP cup. The present study aims to investigate pBMD changes in the mid-term and how this affects implant survival. METHODS We followed the previous cohort and estimated implant survival by Kaplan-Meier analysis, evaluated pBMD with dual-energy X-ray absorptiometry (DXA) and clinical outcome using the Harris Hip Score (HHS). RESULTS Mean follow-up was 8.6 (range 7.8-9.1) years. The eight-year implant survival rate for cup revision for all reasons was 83% (95% confidence interval {CI}: 70-97) and 86% (CI: 74-99) when cup revision due to aseptic loosening was the endpoint. Mean HHS at eight years was 95 (range 77-100). A further 12% (CI: 5-17) loss in pBMD was detected in the proximal Digas zone 1 and 12% (CI: 7-17) loss in Digas zone 2 also between two and eight years after surgery. pBMD continued to decrease up to 30% (CI: 24-36) in Digas zones 1, 2 and 3 compared to pBMD immediately postoperatively. CONCLUSIONS The TOP cup shows inferior mid-term survival rates compared to other uncemented cups, as well as a continuous decrease in pBMD. Periprosthetic bone loss cannot be prevented by this uncemented cup. CLINICAL TRIAL NUMBER Not applicable.
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Affiliation(s)
- Demostenis Kiritopoulos
- Department of Surgical Sciences, Section of Orthopedics, Uppsala University, Uppsala, Sweden.
| | - Andreas Nyström
- Department of Surgical Sciences, Section of Orthopedics, Uppsala University, Uppsala, Sweden
| | - Nils P Hailer
- Department of Surgical Sciences, Section of Orthopedics, Uppsala University, Uppsala, Sweden
| | - Hans Mallmin
- Department of Surgical Sciences, Section of Orthopedics, Uppsala University, Uppsala, Sweden
| | - Stergios Lazarinis
- Department of Surgical Sciences, Section of Orthopedics, Uppsala University, Uppsala, Sweden
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Axenhus M, Salemyr M, Mukka S, Magnéli M, Sköldenberg O. Long-term follow-up of bone density changes in total hip arthroplasty: comparative analysis from a randomized controlled trial of a porous titanium construct shell vs. a porous coated shell. INTERNATIONAL ORTHOPAEDICS 2024:10.1007/s00264-024-06289-z. [PMID: 39243289 DOI: 10.1007/s00264-024-06289-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Accepted: 08/20/2024] [Indexed: 09/09/2024]
Abstract
PURPOSE Periacetabular bone loss poses a considerable challenge in the longevity and stability of acetabular implants used in total hip arthroplasty (THA). Innovations in implant design, specifically the introduction of three-dimensional (3D) porous titanium constructs, might reduce bone resorption. The purpose of this study was to build upon our previous randomized controlled trial, which found no change in periacetabular bone loss between a 3D porous none-hydroxyapatite coated titanium cup and a standard porous hydroxyapatite coated cup over a two year follow-up period by extending the follow-up duration to ten years post-surgery. METHODS This was a single-centre, long-term follow-up study conducted over a ten year period in patients who had previously participated in a randomized controlled trial comparing a 3D porous titanium construct shell (PTC group) with a standard porous hydroxyapatite coated titanium shell (PC-group). The primary outcome measured was the change in bone mineral density (BMD) within four specific periacetabular zones, alongside overall bone loss, which was assessed through BMD in the lumbar spine at two, six and ten years postoperatively. Secondary outcomes included clinical outcome measures. RESULTS In total, 18 in the PTC and 20 in the PC group were analysed for the primary endpoint up to ten years. The mean bone mineral density in zones 1-4 was 3.7% higher in the PTC group than in the PC group at six years postoperatively and 12.0% higher at ten years. Clinical outcomes, and the frequency of adverse events did not differ between the groups. CONCLUSIONS The PTC group displayed superior long-term bone preservation compared to the PC group while maintaining similar clinical outcomes up to ten years postoperatively. Although with a small sample size, our findings suggest that porous titanium cups have the potential to minimize BMD loss around the cup which could contribute to improving THA outcomes and implant durability.
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Affiliation(s)
- Michael Axenhus
- Division of Orthopaedics, Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Entrévägen 2, 182 88, Danderyd, Stockholm, Sweden.
| | - Mats Salemyr
- Division of Orthopaedics, Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Entrévägen 2, 182 88, Danderyd, Stockholm, Sweden
| | - Sebastian Mukka
- Department of Diagnostics and Intervention (Orthopaedics), Umeå University, Umeå, Sweden
| | - Martin Magnéli
- Division of Orthopaedics, Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Entrévägen 2, 182 88, Danderyd, Stockholm, Sweden
| | - Olof Sköldenberg
- Division of Orthopaedics, Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Entrévägen 2, 182 88, Danderyd, Stockholm, Sweden
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Robertson TS, Pijls BG, Munn Z, Solomon LB, Nelissen RGHH, Callary SA. Change in CT-measured acetabular bone density following total hip arthroplasty: a systematic review and meta-analysis. Acta Orthop 2023; 94:191-199. [PMID: 37114317 PMCID: PMC10140760 DOI: 10.2340/17453674.2023.11635] [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] [Received: 04/26/2022] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND AND PURPOSE Assessing peri-acetabular bone quality is valuable for optimizing the outcomes of primary total hip arthroplasty (THA) as preservation of good quality bone stock likely affects implant stability. The aim of this study was to perform a meta-analysis of peri-acetabular bone mineral density (BMD) changes over time measured using quantitative computer tomography (CT) and, second, to investigate the influence of age, sex, and fixation on the change in BMD over time. METHODS A systematic search of Embase, Scopus, Web of Science, and PubMed databases identified 19 studies that measured BMD using CT following THA. The regions of interest (ROI), reporting of BMD results, and scan protocols were extracted. A meta-analysis of BMD was performed on 12 studies that reported measurements immediately postoperatively and at follow-up. RESULTS The meta-analysis determined that periacetabular BMD around both cemented and uncemented components decreases over time. The amount of BMD loss increased relative to proximity of the acetabular component. There was a greater decrease in cortical BMD over time in females and cancellous BMD for young patients of any sex. CONCLUSION Peri-acetabular BMD decreases at different rates relative to its proximity to the acetabular component. Cancellous BMD decreases more in young patients and cortical bone decreases more in females. Standardized reporting parameters and suggested ROI to measure peri-acetabular BMD are proposed, to enable comparison between implant and patient variables in the future.
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Affiliation(s)
- Thomas S Robertson
- Department of Orthopaedics and Trauma Royal Adelaide Hospital, Adelaide, SA, Australia; Centre for Orthopaedic and Trauma Research, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia.
| | - Bart G Pijls
- Department of Orthopaedics, Leiden University Medical Center, Leiden, Netherlands
| | - Zachary Munn
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA Australia
| | - L Bogdan Solomon
- Department of Orthopaedics and Trauma Royal Adelaide Hospital, Adelaide, SA, Australia; Centre for Orthopaedic and Trauma Research, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, Netherlands
| | - Stuart A Callary
- Department of Orthopaedics and Trauma Royal Adelaide Hospital, Adelaide, SA, Australia; Centre for Orthopaedic and Trauma Research, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
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Klasan A, Bayan A, Holdaway I, Farrington WJ. Liner type has no impact on bone mineral density changes around a 3D printed trabecular titanium acetabular component. Orthop Traumatol Surg Res 2023; 109:103136. [PMID: 34715391 DOI: 10.1016/j.otsr.2021.103136] [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] [Received: 09/01/2020] [Revised: 05/12/2021] [Accepted: 09/02/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Three-dimensional printing of implants allows the ability to produce implants and interfaces which theoretically better mimic "normal" bone behaviour, leading to a possible reduction in stress shielding thus maintaining bone mineral density (BMD). This issue was not investigated in vivo using bone scan and different bearings; therefore, we did a prospective study aiming to answer: 1) is there a loss of BMD around the 3D printed trabecular titanium cup, when compared to the native hip?; 2) does liner type influence the BMD changes around the acetabulum when a 3D printed trabecular titanium cup is used? HYPOTHESIS BMD changes around the acetabulum are not influenced by the liner type, and the cup will be associated with a reduction in BMD when compared to the native hip. MATERIAL AND METHODS This is a prospective observational study of patients receiving a primary total hip arthroplasty. A 3D printed trabecular titanium uncemented acetabular component was used in all cases. All patients received a ceramic femoral head, with either a ceramic or polyethylene acetabular liner. BMD measurements using DXA were performed at 6 weeks, 6, 12 and 24 months after surgery to evaluate remodeling changes. The 3 acetabular regions of interest (ROI) of DeLee and Charnley were used for serial comparisons of peri-acetabular BMD. The study was powered as a non-inferiority study with the principle variables compared using a two-step repeated analysis of variance. RESULTS A total of 48 consecutive patients were included in the study, with all patients completing their 2 year follow-up. There were no failures, revisions or complications within this cohort. We found no statistically significant difference in the BMD change scores between the operated and the native hip in any of the 3 ROI zones. We found no differences in BMD scores when comparing ceramic to polyethylene acetabular liners, head sizes and BMI. DISCUSSION This study shows a similar pattern of BMD behaviour around a 3D printed cup when compared to the contralateral native hip. We were unable to show a clinical or radiological difference between the bearing material, head size, or BMI when used with this type of acetabular component. LEVEL OF EVIDENCE III; prospective comparative study.
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Affiliation(s)
- Antonio Klasan
- North Shore Hospital, 124, Shakespeare Road, Takapuna, 0620 Auckland, New Zealand; Kepler University Hospital Linz, Krankenhausstr. 9, 4020 Linz, Austria; Johannes-Kepler University Linz, Altenbergerstr. 69, 4040 Linz, Austria.
| | - Ali Bayan
- North Shore Hospital, 124, Shakespeare Road, Takapuna, 0620 Auckland, New Zealand
| | - Ian Holdaway
- Auckland City Hospital, 2, Park Road, Grafton, 1023 Auckland, New Zealand
| | - William J Farrington
- North Shore Hospital, 124, Shakespeare Road, Takapuna, 0620 Auckland, New Zealand
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Brodt S, Jacob B, Nowack D, Zippelius T, Strube P, Matziolis G. An Isoelastic Monoblock Cup Retains More Acetabular and Femoral Bone Than a Modular Press-Fit Cup: A Prospective Randomized Controlled Trial. J Bone Joint Surg Am 2021; 103:992-999. [PMID: 33617161 DOI: 10.2106/jbjs.19.00787] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND For cup revision after total hip arthroplasty, sufficiently good periacetabular bone stock is a prerequisite for fixation of the revision implant. Cementless cups can lead to a relevant reduction of peri-implant bone mineral density (BMD) through stress-shielding. METHODS Fifty patients were included in this prospective randomized controlled trial. Group 1 (RM group) received an isoelastic monoblock cup (RM Pressfit vitamys; Mathys). Group 2 (IT group) received a modular titanium cup (Allofit-S IT Alloclassic with a polyethylene liner; Zimmer). Periacetabular BMD was determined and subdivided into 4 regions of interest by dual x-ray absorptiometry at 1 week (baseline) and at 4 years postoperatively. Our primary outcome was reduction in periacetabular BMD. RESULTS Periacetabular BMD was reduced by an average of 15.1% in the RM group and 16.5% in the IT group at 4 years postoperatively. No significant difference was found between the 2 groups over the periacetabular structure as a whole. However, the decrease of BMD in the polar region was significantly different in the RM group (4.9% ± 10.0%) compared with the IT group (15.9% ± 14.9%, p = 0.005). Use of the isoelastic RM cup showed significantly less bone loss than the modular IT cup. CONCLUSIONS Relevant loss of BMD at 4 years after surgery was identified in the periacetabular region in both groups. No differences between the 2 cup systems were found when looking at the overall periacetabular region. As a secondary outcome, less postoperative periacetabular bone loss occurred in the polar region when an isoelastic cup was used. Longer follow-up is required to allow for conclusions to be drawn about the long-term course of the 2 cup systems. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Steffen Brodt
- Department of Orthopedics, Jena University Hospital, Campus Eisenberg, Germany
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Kleim BD, Garving C, Brunner UH. Cementless curved short stem shoulder prostheses with a proximal porous coating: ingrowth properties at 2-5 years of radiological follow-up with clinical correlation. J Shoulder Elbow Surg 2020; 29:2299-2307. [PMID: 32666922 DOI: 10.1016/j.jse.2020.02.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 02/16/2020] [Accepted: 02/20/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Little is known about the way the newest generation of stems integrate into the proximal humerus and their effect on the surrounding bone. Factors that may influence ingrowth have not been investigated. METHODS A consecutive cohort study was conducted that examined 74 anatomical, reverse, or pyrocarbon hemiprostheses, using a curved modular short stem with a proximal porous coating 2-5 years postoperatively (mean 35 months). X-rays were reviewed by 2 examiners independently. Bone loss was scored with 1 point per zone with partial and 2 points per zone with complete resorption (10 zones). The Constant score was used for clinical correlation. Multiple linear regression was employed to investigate correlations between variables. RESULTS No subsidence or shift of the stems occurred. Two of 74 patients showed 1 zone of periprosthetic lucency of 1 mm. The filling ratio averaged 0.54 (range: 0.36-0.75). Thirty patients (40.5%) displayed bone resorption, first seen at 16.6 months (range: 3-40 months), commonly in zones 1 and 5. A total of 22 patients had ≥1 zone with partial resorption, and 8 (10.8%) developed full thickness resorption after 32 (range: 10-49) months.One new finding was that female sex and older age accounted for 51% of the variation of the filling ratio. A high filling ratio, especially when >0.55, correlated with bone resorption (P < .001). Age, sex, and prosthesis type did not directly predict bone resorption. Bony sclerosis correlated with a high filling ratio (P = .019) and thereby indirectly with resorption. A direct correlation between sclerosis and resorption was narrowly insignificant (P = .058) once correcting for the filling ratio. Reverse shoulder prosthesis had a higher filling ratio than total shoulder prosthesis patients (P < .001), resulting indirectly in more bone resorption. The preoperative diagnosis did not significantly correlate with the filling ratio (P = .59) or the resorption score (P = .69). A varus or valgus alignment did not predict resorption (P = .21) or the formation of sclerotic lines (P = .93). Bone loss did not correlate with clinical results. CONCLUSIONS These short stems are firmly anchored 2-5 years postoperatively. However, significant bone loss, linked to a high filling ratio (>0.55), is observed proximally around these stems. The development of sclerotic lines around the stem indicates oversizing. Other factors were not found to have a significant effect on stem ingrowth. The implantation of stems with a large filling ratio is more common in older females and in patients receiving reverse shoulder prosthesis. Autologous impaction bone grafting could downsize the required stem. If adequate hold is not afforded by a suitably small stem, cementation is advisable.
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Affiliation(s)
- Benjamin D Kleim
- Trauma and Orthopaedic Surgery, Krankenhaus Agatharied, Hausham, Bavaria, Germany
| | - Christina Garving
- Trauma and Orthopaedic Surgery, Krankenhaus Agatharied, Hausham, Bavaria, Germany
| | - Ulrich H Brunner
- Trauma and Orthopaedic Surgery, Krankenhaus Agatharied, Hausham, Bavaria, Germany.
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Stigbrand H, Brown K, Olivecrona H, Ullmark G. Implant migration and bone mineral density measured simultaneously by low-dose CT scans: a 2-year study on 17 acetabular revisions with impaction bone grafting. Acta Orthop 2020; 91:571-575. [PMID: 32452289 PMCID: PMC8023911 DOI: 10.1080/17453674.2020.1769295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Early postoperative implant migration predicts failure of joint replacements. Bone mineral density reflects bone quality and bone-graft incorporation. Implant migration and bone densitometry analysis usually require special equipment. We investigated cup migration and bone mineral density changes simultaneously with low-dose CT scans after acetabular revision hip arthroplasty using impaction bone grafting.Patients and methods - We performed a low-dose CT postoperatively, after 6 weeks, and after 2 years in 17 patients, all revised using impaction bone grafting and a graft-compressing titanium shell in the acetabulum. 6 patients had combined segmental and cavitary acetabular defects. Cup migration was analyzed using CT-based micromotion analysis (CTMA). Bone mineral density was determined in the graft and in surrounding native bone using volumetric quantitative computed tomography (QCT). The bone graft volume was calculated from 3D reconstructions.Results - At 2 years, the translations were 1.5 (95% CI 0.4-2.6) mm in proximal direction, -0.6 (CI -1.6 to 0.4) in the medial direction and 0.3 (CI 0.0-0.6) in the anterior direction. The mean volume of impacted bone graft was 40 cm³ (CI 28-52). In the graft bone mineral density increased 14% after 6 weeks and 23% after 2 years. There was 1 mechanical failure.Interpretation - Proximal migration of the acetabular component was low and comparable to previous reports. There was a rapid increase of bone mineral density in the bone graft. Low-dose CT scans make migration analysis and bone densitometry measurements possible in the same setting, offering great diagnostic potential for hip arthroplasty patients.
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Affiliation(s)
- Hampus Stigbrand
- Department of Orthopedics Gävle Hospital, Center for Research & Development, Uppsala University/County Council of Gävleborg, Sweden; ,Department of Surgical Sciences/Orthopedics, Uppsala University, Sweden; ,Correspondence:
| | | | - Henrik Olivecrona
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Gösta Ullmark
- Department of Orthopedics Gävle Hospital, Center for Research & Development, Uppsala University/County Council of Gävleborg, Sweden; ,Department of Surgical Sciences/Orthopedics, Uppsala University, Sweden;
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Tabori-Jensen S, Mosegaard SB, Hansen TB, Stilling M. Inferior stabilization of cementless compared with cemented dual-mobility cups in elderly osteoarthrosis patients: a randomized controlled radiostereometry study on 60 patients with 2 years' follow-up. Acta Orthop 2020; 91:246-253. [PMID: 32024400 PMCID: PMC8023886 DOI: 10.1080/17453674.2020.1720978] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Elderly patients may benefit from a dislocation low-risk dual-mobility (DM) articulation in total hip arthroplasty, but the best cup fixation method is unknown. We compared cup migration for cemented and cementless DM cups using radiostereometry.Patients and methods - In a patient-blinded randomized trial, 60 patients (33 female) with osteoarthritis were allocated to cemented (n = 30) or cementless (n = 30) Avantage DM cup fixation. Criteria were age above 70 years, and T-score above -4. We investigated cup migration, periprosthetic bone mineral density (BMD), and patient-reported outcome measures (PROMs) until 24 months postoperative follow-up.Results - At 24 months mean proximal cup migration was 0.11 mm (95% CI 0.00-0.23) for cemented cups and 0.09 mm (CI -0.09 to 0.28) for cementless cups. However, cementless cups generally migrated more than cemented cups at 12 and 24 months. Cemented cups had no measurable migration from 3 months' follow-up, while cementless cups had not yet stabilized at 24 months in all rotations. Cementless cups showed statistically significantly more maximum total point motion (MTPM) at 12- and 24-month follow-up compared with cemented cups in patients with low systemic BMD (p = 0.01). Periprosthetic BMD changes did not statisticially significantly correlate to proximal migration in either cup fixation group (p > 0.05). PROMs improved similarly in both groups.Interpretation - Cemented cups were well fixed at 3 months. The cementless cups migrated more in patients with low BMD, showed an inconsistent pattern of migration, and migrated in different directions during the first and second year without tendency to stabilization. Cemented fixation of the Avantage DM cup seems safer in elderly patients.
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Affiliation(s)
- Steffan Tabori-Jensen
- University Clinic for Hand, Hip and Knee Surgery, Regional Hospital West Jutland, Holstebro;; ,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Sebastian Breddam Mosegaard
- University Clinic for Hand, Hip and Knee Surgery, Regional Hospital West Jutland, Holstebro;; ,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Torben B Hansen
- University Clinic for Hand, Hip and Knee Surgery, Regional Hospital West Jutland, Holstebro;; ,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Maiken Stilling
- University Clinic for Hand, Hip and Knee Surgery, Regional Hospital West Jutland, Holstebro;; ,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark,Correspondence:
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Coupry A, Rony L, Ducellier F, Hubert L, Chappard D. Texture analysis of trabecular bone around RM-Pressfit cementless acetabulum in a series of 46 patients during a 5 year period. Orthop Traumatol Surg Res 2019; 105:1283-1287. [PMID: 31477444 DOI: 10.1016/j.otsr.2019.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 05/27/2019] [Accepted: 06/06/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Cementless total hip arthroplasty (THA) is a common procedure producing excellent clinical results. Their long-term survival is nevertheless burdened by loosening of the acetabular part caused by changes in the distribution of strains around the cup. In this context the RM-Pressfit® cup has been developed, resulting in a more harmonious distribution of the strains. HYPOTHESIS Texture analysis of X-ray films can evaluate the evolution of trabecular bone micro-architecture during the five years following THA with a RM-Pressfit® cup. MATERIAL AND METHOD A monocentric series of 46 hips was reviewed regularly within five years post- surgery. Radiographic evaluation of the operated hip was done on frontal digitized radiographs of the pelvis to follow evolution of bone micro-architecture in the #2 zone of De Lee and Charnley. Texture analysis using fractal algorithms was done at D0, 6 months, 1, 2 and 5 years post-THA. The fractal methods used included the skyscrapers and the dynamic blanket methods with 3 different structuring elements (a cross, a horizontal and a vertical vector). RESULTS The RM-Pressfit® caused significant changes in the distribution of strains around the acetabulum that preserved the bone volume over a 5-year period post-surgery. This corresponds to an improvement of the trabecular micro-architecture around the acetabular cups. CONCLUSION A statistically significant increase in the four fractal dimensions considered corresponded to an improved trabecular bone micro-architecture revealed by texture analysis, a non-invasive method that can be used on digitized X-ray images. LEVEL OF EVIDENCE IIIb, Case control study, retrospective design.
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Affiliation(s)
- Augustin Coupry
- Département de chirurgie osseuse, CHU-Angers, 49033 Angers, France
| | - Louis Rony
- Département de chirurgie osseuse, CHU-Angers, 49033 Angers, France; Groupe Etudes Remodelage Osseux et bioMatériaux, GEROM, EA-4658, SFR-4208, Univ-Angers, IRIS-IBS Institut de Biologie en Santé, CHU-Angers, 49933 Angers, France
| | | | - Laurent Hubert
- Département de chirurgie osseuse, CHU-Angers, 49033 Angers, France; Groupe Etudes Remodelage Osseux et bioMatériaux, GEROM, EA-4658, SFR-4208, Univ-Angers, IRIS-IBS Institut de Biologie en Santé, CHU-Angers, 49933 Angers, France
| | - Daniel Chappard
- Groupe Etudes Remodelage Osseux et bioMatériaux, GEROM, EA-4658, SFR-4208, Univ-Angers, IRIS-IBS Institut de Biologie en Santé, CHU-Angers, 49933 Angers, France.
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Lindalen E, Thoen PS, Nordsletten L, Høvik Ø, Röhrl SM. Low wear rate at 6-year follow-up of vitamin E-infused cross-linked polyethylene: a randomised trial using 32- and 36-mm heads. Hip Int 2019; 29:355-362. [PMID: 30227721 DOI: 10.1177/1120700018798790] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Free radicals formed in the cross-linking process may over time alter the mechanical properties of highly cross-linked polyethylene. Vitamin E-infused highly cross-linked polyethylene was therefore developed to achieve low wear-rate and good mechanical properties in the long term. AIM To present 6-year results from the initial randomised controlled trial. PATIENTS AND METHODS We measured wear and periacetabular bone remodelling in cementless total hip arthroplasty; 32- or 36-mm Biolox Delta heads and vitamin E-infused highly cross-linked polyethylene (E-Poly) were used. Markerless radiosterometric analysis measured the in vivo wear and dual energy x-ray absorptiometry was used to analyse bone remodelling in 40 hips at 6-year follow-up. RESULTS In the proximal direction the wear for 32- and 36-mm heads was 0.15 mm (95% confidence interval [CI], 0.08-0.21) and 0.06 mm (95% CI, -0.002-0.12), respectively (p = 0. 015). However, between 3 months and 6 years (excluding the period of "bedding in"), the proximal wear for 32- and 36-mm heads was 0.10 mm (95% CI, 0.05-0.15) and 0.05 mm (95% CI, -0.01-0.11), respectively (p = 0.12). The annual proximal wear rate for 32- and 36-mm heads from 3 months to 6 years was 0.02 mm and 0.01 mm, respectively. There was no difference in bone remodelling around the cup from baseline to 6 years for the total material and no differences between study groups. CONCLUSION Wear of this vitamin E-infused highly cross-linked polyethylene is still low at 6-year follow-up, with no significant difference in wear from 3 months to 6 years between 32- and 36-mm heads.
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Affiliation(s)
- Einar Lindalen
- 1 Department of Orthopaedic Surgery, Lovisenberg Deaconal Hospital, Oslo, Norway
| | - Peder S Thoen
- 1 Department of Orthopaedic Surgery, Lovisenberg Deaconal Hospital, Oslo, Norway
| | - Lars Nordsletten
- 2 Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,3 Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Øystein Høvik
- 1 Department of Orthopaedic Surgery, Lovisenberg Deaconal Hospital, Oslo, Norway
| | - Stephan M Röhrl
- 2 Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
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Gerhardt DM, Smolders JM, Roovers EA, Rijnders TA, van Susante JL. Changes in periacetabular bone mineral density five years after resurfacing hip arthroplasty versus conventional total hip arthroplasty. Hip Int 2019; 29:153-160. [PMID: 30426791 DOI: 10.1177/1120700018808023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION: We studied whether acetabular bone mineral density (BMD) is better preserved after resurfacing hip arthroplasty (RHA) versus small diameter metal-on-metal total hip arthroplasty (THA). METHODS: This randomised controlled trial included 82 patients. BMD was measured in 5 periprosthetic regions of interest (ROI) with dual-energy absorptiometry (DEXA) preoperatively, at 3 and 6 months, 1, 2, 3 and 5 years postoperative. 34 RHA and 26 THA had a complete 5 years follow-up. 1 RHA and 1 THA were revised due to pseudotumour formation, 2 THA were revised because of recurrent dislocations and 1 RHA for avascular necrosis. RESULTS: Overall an initial decrease in BMD was observed for both implants, stabilising after 2 years. 5 years after RHA a BMD change of +1% in upper cranial, -4% ( p < 0.01) in cranial, -8% ( p < 0.01) in craniomedial, -7% ( p < 0.01) in medial and +4% in caudal ROI compared to baseline values was seen. 5 years after THA a BMD change of -3% ( p = 0.01), -13% ( p < 0.01), -21% ( p < 0.01), -11% ( p < 0.01) and -2% for each respective ROI. The observed BMD decrease in different regions was structurally favouring the RHA-cup, with significantly higher levels in the cranial and craniomedial ROI. CONCLUSION: Acetabular BMD is better preserved behind a rigid press-fit convex cup in RHA compared to a titanium threaded cup in conventional THA in the cranial and craniomedial ROI. Despite of a theoretical higher stress-shielding behind the stiff acetabular component in RHA, compared to the more elastic threaded titanium THA-cup, bone depletion behind the RHA component does not seem to be of major concern. REGISTRATION: EudraCT (2006-005610-12).
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Affiliation(s)
- Davey Mjm Gerhardt
- 1 Department of Orthopaedics, Rijnstate Hospital, Arnhem, The Netherlands
| | - José Mh Smolders
- 1 Department of Orthopaedics, Rijnstate Hospital, Arnhem, The Netherlands
| | - Elisabeth A Roovers
- 2 Department of Orthopedics/Research, Rijnstate Hospital, Arnhem, The Netherlands
| | - Ton Ajm Rijnders
- 3 Department of Nuclear Medicine, Rijnstate Hospital, Arnhem, The Netherlands
| | - Job Lc van Susante
- 1 Department of Orthopaedics, Rijnstate Hospital, Arnhem, The Netherlands
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12
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Gerhardt DMJM, De Visser E, Hendrickx BW, Schreurs BW, Van Susante JLC. Bone mineral density changes in the graft after acetabular impaction bone grafting in primary and revision hip surgery. Acta Orthop 2018; 89:302-307. [PMID: 29635970 PMCID: PMC6055772 DOI: 10.1080/17453674.2018.1460776] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Impaction bone grafting (IBG) is an established method in hip revision surgery to reconstruct loss of bone stock. There is limited knowledge concerning the actual bone remodelling process within the allograft. We investigated with repeated bone mineral density (BMD) measurements the biological process of bone remodelling in the allograft in vivo. We hypothesized that an initial decrease in BMD would be followed by an increase towards baseline values. Patients and methods - Dual-energy X-ray absorptiometry (DXA) was used to measure BMD values in 3 regions of interest (ROI) in 20 patients (average age at surgery 70 years, 11 males) after an acetabular reconstruction with IBG and a cemented cup. A postoperative DXA was used as baseline and DXA was repeated at 3 and 6 months and at 1 and 2 years. The Oxford Hip Score (OHS), the 12-Item Short Form Health Survey (SF12), and a 0 to 100 mm visual analogue scale (VAS) for pain and satisfaction were obtained simultaneously. Results - The overall mean BMD in the IBG regions increased significantly by 9% (95% CI 2-15) at 2 years' follow-up. In the cranial ROI BMD increased 14% (CI 6-22), whereas the BMD in the medial and caudal ROI showed an increase of 10% (CI 1-18) and 4% (CI -6-16), respectively. The OHS, SF12-mental, and VAS for pain all improved statistically significantly 2 years after surgery, with a mean VAS for satisfaction of 77 (CI 63-90) out of 100 points. The SF12-physical showed non-significant improvement. Interpretation - The BMD in the allograft gradually increased after IBG for acetabular reconstruction arthroplasties, particularly in the cranial ROI. An initial decrease in the BMD was not encountered. These BMD changes, as proxy measurements for bone remodeling, may indicate progressive apposition of vital new host bone in the grafted area.
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Affiliation(s)
| | | | | | - Berend W Schreurs
- Department of Orthopedics, Radboud University Medical Center, Nijmegen, The Netherlands
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13
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Periacetabular bone densitometry after total hip arthroplasty with highly porous titanium cups: a 2-year follow-up prospective study. Hip Int 2017; 27:551-557. [PMID: 28708200 DOI: 10.5301/hipint.5000509] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/01/2017] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Trabecular Titanium is an advanced cellular solid structure, composed of regular multiplanar hexagonal interconnected cells that mimic the morphology of the trabecular bone. This biomaterial demonstrated improved mechanical properties and enhanced osteoinduction and osteoconduction in several in vitro and in vivo studies. The aim of this study was to assess Trabecular Titanium osseointegration by measuring periacetabular changes in bone mineral density (BMD) with dual-emission X-ray absorptiometry (DEXA). METHODS 89 patients (91 hips) underwent primary total hip arthroplasty (THA) with acetabular Trabecular Titanium cups. Clinical (Harris Hip Score (HHS), SF-36) and radiographic assessment were performed preoperatively, and postoperatively at 7 days and at 3, 6, 12 and 24 months. DEXA analysis was performed only postoperatively, using the BMD values measured at 7 days as baselines. RESULTS After an initial decrease from baseline to 6 months, BMD increased and progressively stabilised in all 3 regions of interest (ROIs). Median (IQR) HHS and SF-36 increased from 48 (39-62) and 49 (37-62) preoperatively to 99 (96-100) and 86 (79-92) at 24 months, indicating a considerable improvement in terms of pain relief, functional recovery and quality of life. BMD patterns and radiographic evaluation showed evident signs of periacetabular bone remodelling and osseointegration; all cups were stable at the final follow-up without radiolucent lines, loosening or osteolysis. No revisions were performed. CONCLUSIONS After an initial reduction in periacetabular BMD, all 3 ROIs exhibited stabilisation or slight recovery. Although clinical outcomes and functional recovery proved satisfactory, longer follow-ups are necessary to assess this cup long-term survivorship.
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Increase in physical activity after resurfacing hip arthroplasty is associated with calcar and acetabular bone mineral density changes. Hip Int 2017; 27:140-146. [PMID: 28218380 DOI: 10.5301/hipint.5000433] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/17/2016] [Indexed: 02/04/2023]
Abstract
PURPOSE Bone preservation is an important advantage of the resurfacing hip arthroplasty (RHA) concept. We hypothesised that patients' increase in physical activity level after RHA would positively relate with periprosthetic bone mineral density (BMD) changes and thus facilitate bone preservation. METHODS BMD-changes were prospectively recorded in 38 patients after RHA. Dual-energy absorptiometry was used to quantify BMD-changes in 6 periprosthetic regions of interest preoperatively, at 6 months, 1, 2 and 3 years postoperative. The effect estimates of patients' physical activity, according to their Harris Hip Score (HHS) and University of California at Los Angeles (UCLA) Activity Score, on these BMD changes were assessed in linear mixed models. RESULTS The UCLA (coefficient = 0.02 (95% CI, 0.010-0.034); p<0.001) and HHS (coefficient = 0.002 (95% CI, 0.001-0.003); p<0.001) were associated with the BMD in the calcar region. As for BMD changes in the femoral neck only the HHS was associated (coefficient = 0.0006 (95% CI, <0.0001-0.001); p = 0.04). Both the UCLA and the HHS were inversely associated with BMD in the medial acetabular region (UCLA: coefficient = -0.02 (95% CI, -0.038 to -0.007); p = 0.005, HHS: coefficient = -0.002 (95% CI, -0.003 to -0.001), the same accounted for the HHS to BMD-change cranial to the acetabulum (-0.001 [95% CI, -0.0018 to -0.0001]; p = 0.03). For the caudal acetabular and femoral subtrochanteric region no relation with BMD-changes was found. CONCLUSIONS The increase in activity scores after RHA was indeed associated with an increase in BMD in the calcar region, however unexpectedly also with a BMD decrease on the acetabular side. Stress shielding from the implant is the most likely causative factor.
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Pakvis DFM, Heesterbeek PJC, Severens M, Spruit M. Cancellous and cortical bone mineral density around an elastic press-fit socket in total hip arthroplasty. Acta Orthop 2016; 87:583-588. [PMID: 27659074 PMCID: PMC5119440 DOI: 10.1080/17453674.2016.1237439] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - The acetabular component has remained the weakest link in hip arthroplasty for achievement of long-term survival. One of the possible explanatory factors for acetabular failure has been acetabular stress shielding. For this, we investigated the effects of a cementless elastic socket on acetabular bone mineral density (BMD). Patients and methods - During 2008-2009, we performed a single-center prospective cohort trial on 25 patients (mean age 64 (SD 4), 18 females) in whom we implanted a cementless elastic press-fit socket. Using quantitative BMD measurements on CT, we determined the change in BMD surrounding the acetabular component over a 2-year follow-up period. Results - We found a statistically significant decrease in cancellous BMD (-14% to -35%) and a stable level of cortical BMD (5% to -5%) surrounding the elastic press-fit cup during the follow-up period. The main decrease was seen during the first 6 months after implantation. During the second year, cancellous BMD showed a further decrease in the medial and lower acetabular regions. Interpretation - We found no evidence that an elastic press-fit socket would prevent acetabular stress shielding during a 2-year follow-up.
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Affiliation(s)
- Dean F M Pakvis
- Department of Orthopaedic surgery, Sint Maartenskliniek;,Correspondence:
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16
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Finnilä S, Moritz N, SvedströM E, Alm JJ, Aro HT. Increased migration of uncemented acetabular cups in female total hip arthroplasty patients with low systemic bone mineral density. A 2-year RSA and 8-year radiographic follow-up study of 34 patients. Acta Orthop 2016; 87:48-54. [PMID: 26569616 PMCID: PMC4940591 DOI: 10.3109/17453674.2015.1115312] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND PURPOSE Low bone mineral density (BMD) may jeopardize the initial component stability and delay osseointegration of uncemented acetabular cups in total hip arthroplasty (THA). We measured the migration of uncemented cups in women with low or normal BMD. PATIENTS AND METHODS We used radiostereometric analysis (RSA) to measure the migration of hydroxyapatite-coated titanium alloy cups with alumina-on-alumina bearings in THA of 34 female patients with a median age of 64 (41-78) years. 10 patients had normal BMD and 24 patients had low systemic BMD (T-score ≤ -1) based on dual-energy X-ray absorptiometry (DXA). Cup migration was followed with RSA for 2 years. Radiographic follow-up was done at a median of 8 (2-10) years. RESULTS Patients with normal BMD did not show a statistically significant cup migration after the settling period of 3 months, while patients with low BMD had a continuous proximal migration between 3 and 12 months (p = 0.03). These differences in cup migration persisted at 24 months. Based on the perceived risk of cup revision, 14 of the 24 cases were "at risk" (proximal translation of 0.2 to 1.0 mm) in the low-BMD group and 2 of the 10 cases were "at risk" in the normal-BMD group (odds ratio (OR) = 8.0, 95% CI: 1.3-48). The radiographic follow-up showed no radiolucent lines or osteolysis. 2 cups have been revised for fractures of the ceramic bearings, but none for loosening. INTERPRETATION Low BMD contributed to cup migration beyond the settling period of 3 months, but the migrating cups appeared to osseointegrate eventually.
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Affiliation(s)
- Sami Finnilä
- Orthopaedic Research Unit, Turku University Hospital and University of Turku
| | - Niko Moritz
- Orthopaedic Research Unit, Turku University Hospital and University of Turku
| | - Erkki SvedströM
- Department of Diagnostic Radiology, Turku University Hospital, Turku, Finland.
| | - Jessica J Alm
- Orthopaedic Research Unit, Turku University Hospital and University of Turku
| | - Hannu T Aro
- Orthopaedic Research Unit, Turku University Hospital and University of Turku,Correspondence:
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17
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Clarke A, Pulikottil-Jacob R, Grove A, Freeman K, Mistry H, Tsertsvadze A, Connock M, Court R, Kandala NB, Costa M, Suri G, Metcalfe D, Crowther M, Morrow S, Johnson S, Sutcliffe P. Total hip replacement and surface replacement for the treatment of pain and disability resulting from end-stage arthritis of the hip (review of technology appraisal guidance 2 and 44): systematic review and economic evaluation. Health Technol Assess 2015; 19:1-668, vii-viii. [PMID: 25634033 DOI: 10.3310/hta19100] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Total hip replacement (THR) involves the replacement of a damaged hip joint with an artificial hip prosthesis. Resurfacing arthroplasty (RS) involves replacement of the joint surface of the femoral head with a metal surface covering. OBJECTIVES To undertake clinical effectiveness and cost-effectiveness analysis of different types of THR and RS for the treatment of pain and disability in people with end-stage arthritis of the hip, in particular to compare the clinical effectiveness and cost-effectiveness of (1) different types of primary THR and RS for people in whom both procedures are suitable and (2) different types of primary THR for people who are not suitable for hip RS. DATA SOURCES Electronic databases including MEDLINE, EMBASE, The Cochrane Library, Current Controlled Trials and UK Clinical Research Network (UKCRN) Portfolio Database were searched in December 2012, with searches limited to publications from 2008 and sample sizes of ≥ 100 participants. Reference lists and websites of manufacturers and professional organisations were also screened. REVIEW METHODS Systematic reviews of the literature were undertaken to appraise the clinical effectiveness and cost-effectiveness of different types of THR and RS for people with end-stage arthritis of the hip. Included randomised controlled trials (RCTs) and systematic reviews were data extracted and risk of bias and methodological quality were independently assessed by two reviewers using the Cochrane Collaboration risk of bias tool and the Assessment of Multiple Systematic Reviews (AMSTAR) tool. A Markov multistate model was developed for the economic evaluation of the technologies. Sensitivity analyses stratified by sex and controlled for age were carried out to assess the robustness of the results. RESULTS A total of 2469 records were screened of which 37 were included, representing 16 RCTs and eight systematic reviews. The mean post-THR Harris Hip Score measured at different follow-up times (from 6 months to 10 years) did not differ between THR groups, including between cross-linked polyethylene and traditional polyethylene cup liners (pooled mean difference 2.29, 95% confidence interval -0.88 to 5.45). Five systematic reviews reported evidence on different types of THR (cemented vs. cementless cup fixation and implant articulation materials) but these reviews were inconclusive. Eleven cost-effectiveness studies were included; four provided relevant cost and utility data for the model. Thirty registry studies were included, with no studies reporting better implant survival for RS than for all types of THR. For all analyses, mean costs for RS were higher than those for THR and mean quality-adjusted life-years (QALYs) were lower. The incremental cost-effectiveness ratio for RS was dominated by THR, that is, THR was cheaper and more effective than RS (for a lifetime horizon in the base-case analysis, the incremental cost of RS was £11,284 and the incremental QALYs were -0.0879). For all age and sex groups RS remained clearly dominated by THR. Cost-effectiveness acceptability curves showed that, for all patients, THR was almost 100% cost-effective at any willingness-to-pay level. There were age and sex differences in the populations with different types of THR and variations in revision rates (from 1.6% to 3.5% at 9 years). For the base-case analysis, for all age and sex groups and a lifetime horizon, mean costs for category E (cemented components with a polyethylene-on-ceramic articulation) were slightly lower and mean QALYs for category E were slightly higher than those for all other THR categories in both deterministic and probabilistic analyses. Hence, category E dominated the other four categories. Sensitivity analysis using an age- and sex-adjusted log-normal model demonstrated that, over a lifetime horizon and at a willingness-to-pay threshold of £20,000 per QALY, categories A and E were equally likely (50%) to be cost-effective. LIMITATIONS A large proportion of the included studies were inconclusive because of poor reporting, missing data, inconsistent results and/or great uncertainty in the treatment effect estimates. This warrants cautious interpretation of the findings. The evidence on complications was scarce, which may be because of the absence or rarity of these events or because of under-reporting. The poor reporting meant that it was not possible to explore contextual factors that might have influenced study results and also reduced the applicability of the findings to routine clinical practice in the UK. The scope of the review was limited to evidence published in English in 2008 or later, which could be interpreted as a weakness; however, systematic reviews would provide summary evidence for studies published before 2008. CONCLUSIONS Compared with THR, revision rates for RS were higher, mean costs for RS were higher and mean QALYs gained were lower; RS was dominated by THR. Similar results were obtained in the deterministic and probabilistic analyses and for all age and sex groups THR was almost 100% cost-effective at any willingness-to-pay level. Revision rates for all types of THR were low. Category A THR (cemented components with a polyethylene-on-metal articulation) was more cost-effective for older age groups. However, across all age-sex groups combined, the mean cost for category E THR (cemented components with a polyethylene-on-ceramic articulation) was slightly lower and the mean QALYs gained were slightly higher. Category E therefore dominated the other four categories. Certain types of THR appeared to confer some benefit, including larger femoral head sizes, use of a cemented cup, use of a cross-linked polyethylene cup liner and a ceramic-on-ceramic as opposed to a metal-on-polyethylene articulation. Further RCTs with long-term follow-up are needed. STUDY REGISTRATION This study is registered as PROSPERO CRD42013003924. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Aileen Clarke
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Amy Grove
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry, UK
| | - Karoline Freeman
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry, UK
| | - Hema Mistry
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Martin Connock
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry, UK
| | - Rachel Court
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Matthew Costa
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry, UK
| | - Gaurav Suri
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry, UK
| | - David Metcalfe
- Warwick Orthopaedics, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Michael Crowther
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Sarah Morrow
- Oxford Medical School, University of Oxford, Oxford, UK
| | - Samantha Johnson
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry, UK
| | - Paul Sutcliffe
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry, UK
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Bone loss around a stable, partly threaded hydroxyapatite-coated cup: a prospective cohort study using RSA and DXA. Hip Int 2014; 24:155-66. [PMID: 24500826 DOI: 10.5301/hipint.5000104] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/21/2013] [Indexed: 02/04/2023]
Abstract
STUDY PURPOSE Aseptic loosening of the acetabular component is the most common reason for revision after primary THA, and periprosthetic demineralisation has been described as a potential cause for this process. The trabeculae-oriented pattern (TOP)-cup is a flat, hydroxyapatite (HA)-coated titanium shell with a threaded rim that was developed in order to minimise periprosthetic bone loss. We hypothesised that this cup provides good primary stability and improves preservation of periprosthetic bone mineral density (BMD). BASIC PROCEDURES A prospective cohort study on 30 patients receiving the TOP cup was carried out. Preoperative total hip BMD and postoperative periprosthetic BMD in five periprosthetic regions of interest were investigated by dual energy radiographic absorptiometry (DXA), cup migration was analysed by radiostereometry (RSA), and the Harris hips score (HHS) was determined. MAIN FINDINGS Mean HHS increased from 49 (24-79) preoperatively to 99 (92-100) after two years. DXA after one year demonstrated substantial BMD loss in the proximal periprosthetic zones 1 (-18%), zone 2 (-16 %) and zone 3 (-9%, all p<0.001 when compared with baseline BMD determined immediately postoperatively). The bone loss in these regions did not recover after two years. RSA (performed on 16 patients) showed that only very limited micromotion of the implant occurred: Mean cranial migration was 0.01 mm (95% confidence interval (CI): -0.09-0.12) and mean inclination decreased by 0.02º (CI: -0.43-0.39) after two years. CONCLUSION We conclude that the TOP cup provides good primary stability in the short-term. However, substantial BMD loss in proximal periprosthetic areas indicates that the design of this cup cannot prevent periprosthetic bone loss that has also been observed around other uncemented cups.
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Acetabular bone density and metal ions after metal-on-metal versus metal-on-polyethylene total hip arthroplasty; short-term results. Hip Int 2014; 24:136-43. [PMID: 24186673 DOI: 10.5301/hipint.5000087] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/04/2013] [Indexed: 02/04/2023]
Abstract
Information on periprosthetic acetabular bone density is lacking for metal-on-metal total hip arthroplasties. These bearings use cobalt-chromium instead of titanium acetabular components, which could lead to stress shielding and hence periprosthetic bone loss. Cobalt and chromium ions have detrimental effects on bone. It is unknown whether serum metal ion levels affect bone density clinically. We compared cementless large femoral head (mean 48 mm) metal-on-metal total hip arthroplasties (M2a-Magnum, Biomet) to cementless 28 mm metal-on-polyethylene total hip arthroplasties (Mallory-Head, Biomet) in a randomised clinical trial. We evaluated periprosthetic acetabular bone density and serum metal ion levels at 1 year postoperatively. Acetabular bone density was analyzed with dual energy x-ray absorptiometry in four horizontal regions of interest in 70 patients. After one year, acetabular bone density decreased (-3.5% to -7.8%) in three of four regions of interest in metal-on-polyethylene patients, but was retained in metal-on-metal patients. Bone density preservation was most pronounced superior to the metal-on-metal cup (+1% versus -3.7%). Serum cobalt, chromium and titanium ion levels were not related to bone density, nor to acetabular inclination or femoral head size. Oxford and Harris hip scores were similar in both groups. Contrary to our hypothesis, acetabular bone density was retained with metal-on-metal total hip arthroplasty, compared to metal-on-polyethylene arthroplasty. Bone preservation was most pronounced in the area superior to the cup. This could be a benefit during future revision surgery.
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20
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Risedronate does not enhance fixation or BMD in revision cups: randomised study with three years follow-up. Hip Int 2014; 24:49-55. [PMID: 24186676 DOI: 10.5301/hipint.5000081] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/21/2013] [Indexed: 02/04/2023]
Abstract
BACKGROUND Bisphosphonates may improve implant fixation by inhibition of bone resorption and stimulation of osteoblasts by up regulation of BMP-2. However, there are few clinical studies in this area. QUESTIONS/PURPOSE Does treatment with oral bisphosphonates improve implant fixation and bone remodelling around the acetabular component after revision arthroplasty with or without use of morselised allograft? PATIENTS AND METHODS Fifty-three patients received university pharmacy blinded medication for three months: 5 mg risedronate or placebo one dosage and 1 g calcium carbonate and 800IE cholecalciferol per day. Forty-one patients were operated upon with revision of the cup. The revisions were performed with an uncemented (Trilogy, Zimmer, Warsaw, USA) or a cemented (Ogee, Depuy Int, England) cup. Radiostereometric analysis was obtained within one week after the operation, at three and six months, and after one, two and three years to study cup migration. Bone mineral density was measured postoperatively, at six months, one and two years, using DEXA. The presence and extension of radiolucent lines and graft remodelling were studied on conventional radiography. RESULTS The risendronate group revealed less anterior-posterior rotation at 6 months. We found no significant differences in migration at three years, change in bone mineral density, or graft remodelling and radiolucent lines formation between groups. CONCLUSIONS We could not demonstrate any beneficial effects of oral administration of risedronate on the fixation, bone mineral density or bone remodelling of revision cups using various amount of bone graft.
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Salemyr M, Muren O, Eisler T, Bodén H, Chammout G, Stark A, Sköldenberg O. Porous titanium construct cup compared to porous coated titanium cup in total hip arthroplasty. A randomised controlled trial. INTERNATIONAL ORTHOPAEDICS 2014; 39:823-32. [PMID: 25338110 DOI: 10.1007/s00264-014-2571-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 10/08/2014] [Indexed: 02/04/2023]
Abstract
PURPOSE The purpose of this study was to determine if a new titanium cup with increased porosity resulted in different periacetabular bone loss and migration compared to a porous coated cup. METHODS Fifty-one patients with primary hip osteoarthritis were randomized to either a cup with porous titanium construct backside (porous titanium group, n = 25) or a conventional porous coated titanium cup (control group, n = 26). The primary outcome variable was change in periacetabular bone mineral density two years after surgery measured with dual energy X-ray absorptiometry (DXA). Secondary outcomes were implant fixation measured with radiostereometry (RSA) and clinical outcome scores. RESULTS The pattern of bone remodelling was similar in the two groups with almost complete restoration to baseline values. BMD diminished in the two proximal zones and increased in the two distal zones. After minimal migration up to six months all implants in both groups became stable. We found no difference between the two groups in clinical outcome scores. CONCLUSIONS In this prospective, randomized, controlled trial on a new porous titanium cup we found, compared to the control group, no clinically relevant differences regarding periacetabular bone preservation, implant fixation or clinical outcome up to two years postoperatively.
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Affiliation(s)
- Mats Salemyr
- Unit of Orthopaedics, Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, 182 88, Stockholm, Sweden
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Rienstra W, van der Veen HC, van den Akker Scheek I, van Raay JJAM. Clinical outcome, survival and polyethylene wear of an uncemented total hip arthroplasty: a 10- to 12-year follow-up study of 81 hips. J Arthroplasty 2013; 28:1362-6. [PMID: 23523211 DOI: 10.1016/j.arth.2012.10.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Revised: 10/04/2012] [Accepted: 10/08/2012] [Indexed: 02/01/2023] Open
Abstract
A complete 10- to 12-year follow-up of an uncemented total hip arthroplasty (THA) was performed regarding survival, clinical outcome, polyethylene wear and influencing factors on wear. Seventy-two patients (75 Mallory Head uncemented THA) with primary osteoarthritis operated on in 1999 or 2000 were included in the survival study. Mean age at the time of operation was 57.9 years (range 37-70). The survival rate after 11.9 years was 96% (95% CI 0.89-1.01). In three cases the acetabular component was revised because of extensive polyethylene wear. Fifty-four patients with 57 THAs were available for clinical and radiological analysis. At a mean follow-up time of 10.7 years (range 10-12) the clinical outcome can be considered comparable to other uncemented THA. Mean polyethylene wear was 1.8mm (range 0.4-3.8) with an annual wear rate of 0.15 mm/y. There was a significant correlation between polyethylene wear and inclination of the cup as well as male gender.
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Affiliation(s)
- Wietske Rienstra
- Department of Orthopaedic Surgery, Medical Center Leeuwarden, Leeuwarden, the Netherlands
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Smolders JMH, Pakvis DF, Hendrickx BW, Verdonschot N, van Susante JLC. Periacetabular bone mineral density changes after resurfacing hip arthroplasty versus conventional total hip arthroplasty. A randomized controlled DEXA study. J Arthroplasty 2013; 28:1177-84. [PMID: 23219623 DOI: 10.1016/j.arth.2012.08.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Revised: 08/15/2012] [Accepted: 08/17/2012] [Indexed: 02/08/2023] Open
Abstract
A randomized controlled trial was performed to evaluate acetabular bone mineral density (BMD) changes after hip resurfacing (RHA) versus an established conventional total hip arthroplasty (THA). A total of 71 patients were allocated randomly to receive either an RHA press-fit cobalt-chromium cup (n=38) or a THA with a threaded titanium cup and polyethylene-metal-inlay insert (n=33). The BMD in five separate periacetabular regions of interest (ROI) was prospectively quantified preoperative until 24 months. We conclude that, in contrast to our hypothesis, periacetabular BMD was better preserved after RHA than after placement of a conventional THA. Long term follow-up studies are necessary to see whether this benefit in bone preservation sustains over longer time periods and whether it is turned into clinical benefits at future revision surgery.
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Affiliation(s)
- José M H Smolders
- Department of Orthopaedics, Rijnstate Hospital, Arnhem, The Netherlands
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Magnan B, Bondi M, Maluta T, Samaila E, Schirru L, Dall'Oca C. Acrylic bone cement: current concept review. Musculoskelet Surg 2013; 97:93-100. [PMID: 23893506 DOI: 10.1007/s12306-013-0293-9] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 07/17/2013] [Indexed: 01/29/2023]
Abstract
Acrylic bone cement has had for years an important role in orthopedic surgery. Polymethylmethacrylate (PMMA) has been extended from the ophthalmological and dental fields to orthopedics, as acrylic cement used for fixation of prosthetic implants, for remodeling osteoporotic, neoplastic and vertebral fractures repair. The PMMA bone cement is a good carrier for sustained antibiotic release in the site of infection. Joint prostheses chronic infection requires surgical removal of the implant, in order to eradicate the infection process. This can be performed in the same surgical time (one-stage procedure) or in two separate steps (two-stage procedure, which involves the use of an antibiotic-loaded cement spacer). The mechanical and functional characteristics of the spacers allow a good joint range of motion, weight-bearing in selected cases and a sustained release of antibiotic at the site of infection. The improvement of fixation devices in recent years was not accompanied by the improvement of elderly bone quality. Some studies have tested the use of PMMA bone cement or calcium phosphate as augmentation support of internal fixation of these fractures. Over the past 20 years, experimental study of acrylic biomaterials (bone cement, bioglass ceramic, cement additives, absorbable cement, antibiotic spacers) has been of particular importance, offering numerous models and projects.
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Affiliation(s)
- B Magnan
- Orthopaedic Department, Surgical Center, P. Confortini, University of Verona, Piazzale A. Stefani 1, 37126, Verona, Italy
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Aubault M, Druon J, Le Nail L, Rosset P. Outcomes at least 10 years after cemented PF® (Zimmer) total hip arthroplasty: 83 cases. Orthop Traumatol Surg Res 2013; 99:S235-9. [PMID: 23628004 DOI: 10.1016/j.otsr.2013.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Cementless total hip arthroplasty (TKA) is gaining ground over cemented TKA. The objective of this study was to assess survival rates of a cemented THA implant (PF(®), Zimmer), after at least 10 years and to assess changes in acetabular bone structure. MATERIAL AND METHODS Eighty-three ceramic-on-polyethylene THA prostheses were implanted between 1998 and 2001. Clinical outcomes were assessed using the Harris hip score and Postel Merle d'Aubigné score. For each hip, radiographs were examined for acetabular radiolucent lines, geodes, and granulomas; in addition, changes in bone structure and trabeculae were assessed comparatively to the other hip and classified from no change to severe osteolysis. Changes in trabeculae served to assess the loads applied to the bone. Polyethylene wear was assessed using the Livermore method. RESULTS A single patient was lost to follow-up. At last follow-up, 16 patients had died and six were contacted and had not required revision surgery; the remaining 52 patients (59 THAs) were re-evaluated and none had evidence of loosening. The Harris hip score at last evaluation was 91.6 compared to 60.5 preoperatively. No hips had evidence of acetabular osteolysis. For two hips, the radiographs showed complete acetabular radiolucent lines less than 2mm in width, with no mobilisation. Trabecular distribution was homogeneous with no stress shielding. Mean annual rate of wear was 0.08mm. No instances of femoral component loosening were recorded; granulomas involving no more than five Gruën zones were seen in three cases. DISCUSSION This study confirms the reliability of cemented THA, with a 12-year survival rate of 98.3%, in keeping with earlier data. Thus, our results establish that cemented ceramic-on-polyethylene prostheses remain valid options for THA. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- M Aubault
- Services de chirurgie orthopédique et traumatologique 1 & 2, hôpital Trousseau, CHRU de Tours, Tours cedex 9, France
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Three-year prospective clinical and radiological results of a new flexible horseshoe acetabular cup. Hip Int 2013; 22:598-606. [PMID: 23233172 DOI: 10.5301/hip.2012.10291] [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] [Accepted: 05/29/2012] [Indexed: 02/04/2023]
Abstract
We report the three-year results of a new flexible, horseshoe-shaped acetabular cup, with a carbon fibre reinforced polyetheretherketone (CFR-PEEK) bearing surface. The 3 mm thick composite cup is designed to conserve acetabular bone stock and reproduce a near-physiological stress distribution to the adjacent bone. The cup is intended to articulate against a large diameter ceramic femoral head to produce a low-wear bearing couple that generates minimal wear debris. A prospective, two-centre clinical study of the MITCH PCR cup was started in January 2007, to verify its safety and performance. Twenty-five MITCH PCR cups were implanted by three surgeons. There were 12 men and 13 women, with a mean age of 67.9 years (range 57.4 to 74.9). The mean Oxford hip score improved from 19.6 (SD 7.5) preoperatively to 43.5 (SD 7) at 3 years. The mean Harris hip score improved from 52.9 (SD 7) to 91.4 (SD 13.8) and the Euroqol-5D score increased from 62.6 (SD 18.4) to 82.8 (SD 19). One revision of the acetabular cup was undertaken at 21 months for squeaking. This has been investigated and modification of the articular geometry has resolved the problem, on in-vitro testing. Radiological analysis showed good early osseointegration of the MITCH PCR cup. However at three years, five cases of acetabular component migration and calcar resorption were observed. Three patients have subsequently undergone revision of the acetabular cup, at 41, 42 and 50 months respectively. The cause of the osteolysis is the subject of on-going investigation.
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Lindalen E, Dahl J, Nordsletten L, Snorrason F, Høvik Ø, Röhrl S. Reverse hybrid and cemented hip replacement compared using radiostereometry and dual-energy X-ray absorptiometry: 43 hips followed for 2 years in a prospective trial. Acta Orthop 2012; 83:592-8. [PMID: 23116437 PMCID: PMC3555444 DOI: 10.3109/17453674.2012.742393] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Total hip replacement (THR) with a reverse hybrid (RH), a combination of a cemented polyethylene cup and a cementless femoral stem, has been increasingly used in Scandinavia. In a randomized trial, we compared an RH THR with a proximal hydroxyapatite- (HA-) coated stem to a conventional cemented THR. Both groups received the same polyethylene cup. PATIENTS AND METHODS 51 patients (52 hips) were included. Radiostereometry (RSA) and dual-energy X-ray absorptiometry (DEXA) were performed postoperatively and after 6, 12, and 24 months. 42 patients (43 hips) were followed for 2 years. RESULTS Mean cup rotation around the x-axis was 0.13° for the cemented group and -0.24° for the RH group (p = 0.03). Cup migration in the other axes, and stem migration and wear were similar between the 2 study groups. Bone remodeling around the cup was also similar between the groups. Bone loss in Gruen zone 1 was 18% for the cementless stems, as compared to an increase of 1.4% for the cemented ones (p < 0.001). Bone loss was similar in the other Gruen zones. Harris hip score and Oxford hip score were similar pre- and postoperatively in the 2 groups. INTERPRETATION In the present study, RH THR with a cementless hydroxyapatite-coated stem and conventional cemented THR did not show any major differences regarding stem migration and bone loss after 2 years of follow-up.
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Affiliation(s)
- Einar Lindalen
- Department of Orthopaedics, Lovisenberg Deaconal Hospital, Oslo
| | - Jon Dahl
- Department of Orthopaedics, Oslo University Hospital, Oslo
| | - Lars Nordsletten
- Department of Orthopaedics, Oslo University Hospital, Oslo,University of Oslo, Oslo, Norway
| | | | - Øystein Høvik
- Department of Orthopaedics, Lovisenberg Deaconal Hospital, Oslo
| | - Stephan Röhrl
- Department of Orthopaedics, Oslo University Hospital, Oslo
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Johanson PE, Digas G, Herberts P, Thanner J, Kärrholm J. Highly crosslinked polyethylene does not reduce aseptic loosening in cemented THA 10-year findings of a randomized study. Clin Orthop Relat Res 2012; 470:3083-93. [PMID: 22669546 PMCID: PMC3462851 DOI: 10.1007/s11999-012-2400-x] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Polyethylene (PE) wear particles are believed to cause aseptic loosening and thereby impair function in hip arthroplasty. Highly crosslinked polyethylene (XLPE) has low short- and medium-term wear rates. However, the long-term wear characteristics are unknown and it is unclear whether reduced wear particle burden improves function and survival of cemented hip arthroplasty. QUESTIONS/PURPOSES We asked whether XLPE wear rates remain low up to 10 years and whether this leads to improved implant fixation, periprosthetic bone quality, and clinical function compared to conventional PE. METHODS We randomized 60 patients (61 hips) to receive either PE or XLPE cemented cups combined with a cemented stem. At 10 years postoperatively, 51 patients (52 hips) were evaluated for polyethylene wear and component migration estimation by radiostereometry, for radiolucent lines, bone densitometry, and Harris hip and pain scores. Revisions were recorded. RESULTS XLPE cups had a lower mean three-dimensional wear rate between 2 and 10 years compared to conventional PE hips: 0.005 mm/year versus 0.056 mm/year. We found no differences in cup migration, bone mineral density, radiolucencies, functional scores, and revision rate. There was a trend toward improved stem fixation in the XLPE group. The overall stem failure rate was comparably high, without influencing wear rate in XLPE hips. CONCLUSIONS XLPE displayed a low wear rate up to 10 years when used in cemented THA, but we found no clear benefits in any other parameters. Further research is needed to determine whether cemented THA designs with XLPE are less prone to stem loosening. LEVEL OF EVIDENCE Level I, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Per-Erik Johanson
- Department of Orthopaedics, Institution of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 413 45 Gothenburg, Sweden.
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Abstract
BACKGROUND AND PURPOSE Coating of acetabular revision implants with hydroxyapatite (HA) has been proposed to improve ingrowth and stability. We investigated whether HA coating of revision cups can reduce the risk of any subsequent re-revision. METHODS We studied uncemented cups either with or without HA coating that were used at a primary acetabular revision and registered in the Swedish Hip Arthroplasty Register (SHAR). 2 such cup designs were identified: Harris-Galante and Trilogy, both available either with or without HA coating. These cups had been used as revision components in 1,780 revisions of total hip arthroplasties (THA) between 1986 and 2009. A Cox proportional hazards model including the type of coating, age at index revision, sex, cause of cup revision, cup design, the use of bone graft at the revision procedure, and the type of cup fixation at primary THA were used to calculate adjusted risk ratios (RRs with 95% CI) for re-revision for any reason or due to aseptic loosening. RESULTS 71% of the cups were coated with HA and 29% were uncoated. At a mean follow-up time of 6.9 (0-24) years, 159 (9%) of all 1,780 cups had been re-revised, mostly due to aseptic loosening (5%), dislocation (2%), or deep infection (1%). HA coating had no significant influence on the risk of re-revision of the cup for any reason (RR = 1.4, CI: 0.9-2.0) or due to aseptic loosening (RR = 1.1, 0.6-1.9). In contrast, HA coating was found to be a risk factor for isolated liner re-revision for any reason (RR = 1.8, CI: 1.01-3.3). Age below 60 years at the index cup revision, dislocation as the cause of the index cup revision, uncemented cup fixation at primary THA, and use of the Harris-Galante cup also increased the risk of re-revision of the cup. In separate analyses in which isolated liner revisions were excluded, bone grafting was found to be a risk factor for re-revision of the metal shell due to aseptic loosening (RR = 2.1, CI: 1.05-4.2). INTERPRETATION We found no evidence to support the notion that HA coating improves the performance of the 2 studied cup designs in revision arthroplasty. In contrast, patient-related factors such as younger age and dislocation as the reason for cup revision, and technical factors such as the choice of revision cup were found to influence the risk of subsequent re-revision of the cup. The reason for inferior results after revision of uncemented cups is not known, but it is possible that these hips more often had pronounced bone loss at the index cup revision.
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Affiliation(s)
- Stergios Lazarinis
- Department of Orthopaedics, Institute of Surgical Sciences, Uppsala University Hospital, Uppsala
| | - Johan Kärrholm
- Department of Orthopaedics, Institute of Surgical Science, Sahlgrenska University Hospital, Göteborg University, Mölndal, Sweden
| | - Nils P Hailer
- Department of Orthopaedics, Institute of Surgical Sciences, Uppsala University Hospital, Uppsala
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Cemented all-polyethylene acetabular implants vs other forms of acetabular fixation: a systematic review and meta-analysis of randomized controlled trials. J Arthroplasty 2012; 27:1544-1553.e10. [PMID: 22333867 DOI: 10.1016/j.arth.2011.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Accepted: 12/10/2011] [Indexed: 02/01/2023] Open
Abstract
The cost of primary total hip replacement products approaches 65% of the total reimbursement. Durability of total hip replacement resides with the acetabular component. This systematic review and meta-analysis determined if the outcomes of durability, function, and adverse events associated with cemented all-polyethylene acetabular components was similar to other acetabular designs, holding other variables constant. Randomized controlled trials only were evaluated. Two independent reviewers collected the data from 6 randomized controlled trials. Appropriate statistical analysis was performed. There was no statistical difference in regard to the outcomes at various time points (≤3, 4-8, and ≥10 years) in the 907 implants evaluated. There does, however, appear to be a trend toward abject failure with cemented all-polyethylene acetabular component implants consistent with findings of increased radiolucencies more than 10 years out. The issue of increased radiolucencies over time and failure with these types of implants bears closer scrutiny.
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Schmidt R, Kress AM, Nowak M, Forst R, Nowak TE, Mueller LA. Periacetabular cortical and cancellous bone mineral density loss after press-fit cup fixation: a prospective 7-year follow-up. J Arthroplasty 2012; 27:1358-1363.e1. [PMID: 22226614 DOI: 10.1016/j.arth.2011.09.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2010] [Revised: 04/10/2011] [Accepted: 09/01/2011] [Indexed: 02/01/2023] Open
Abstract
The impact of total hip arthroplasty on strain adaptive bone remodeling has been extensively analyzed by dual-energy x-ray absorptiometry. In this study, we present a prospective computed tomography-assisted study of periacetabular cortical and cancellous bone mineral density (in milligrams of calcium hydroxyapatite [CaHA] per milliliter, or mgCaHA/mL) changes 10 days and 1, 3, and 7 years after press-fit cup implantation for 38 hips in vivo. Cancellous bone mineral density decreased by Ø -63% ventral and Ø -85% dorsal to the cup; cortical bone mineral density, by Ø -22% ventral and Ø -18% dorsal to the cup. The presented periacetabular strain adaptive bone mineral density data are the most extensive of the current literature. Even the measured extensive cancellous bone mineral density loss was thus far of no clinical relevance because all cups showed radiographic signs of stable ingrowth.
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Affiliation(s)
- Rainer Schmidt
- Department of Orthopaedic Surgery, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
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Supra acetabular bone mineral density measurements after hip resurfacing arthroplasty at short term follow up. Hip Int 2011; 21:468-74. [PMID: 21818746 DOI: 10.5301/hip.2011.8573] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/01/2011] [Indexed: 02/04/2023]
Abstract
Implantation of a cementless press-fit acetabular cup during hip arthroplasty alters stress transfer to the periacetabular bone, resulting in stress shielding of cancellous bone and enhanced load transfer to cortical bone. Theoretically, the thicker, stiffer and larger acetabular cup of a hip resurfacing may increase periacetabular bone stress shielding. We attempted to assess the matter (at a minimum of 2 years after surgery) by measuring any difference in supra acetabular bone mineral density (BMD) between the side implanted with a thick monoblock cobalt-chromium (Co-Cr) acetabular component during hip resurfacing (HR) and the opposite non-operated side. We retrospectively recruited 44 patients who had undergone metal-on-metal hybrid hip resurfacing for unilateral osteoarthritis of the hip joint . BMD of the supra acetabular bone of both hips was measured using a dual energy X-ray absorptiometry (DEXA) scan. The BMD measured in Zone 2 was not different on the operated side (1.69 g/cm2 ± 0.48) compared with the non-operated side (1.70 g/cm2 ±0.49) (p=0.904). Contrary to our expectations, implantation of a monoblock Co-Cr acetabular component during HR did not cause significant stress-shielding of supra acetabular cancellous bone.
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Periasamy K, Watson WS, Mohammed A, Murray H, Walker B, Patil S, Meek RMD. A randomised study of peri-prosthetic bone density after cemented versus trabecular fixation of a polyethylene acetabular component. ACTA ACUST UNITED AC 2011; 93:1033-44. [PMID: 21768625 DOI: 10.1302/0301-620x.93b8.26233] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The ideal acetabular component is characterised by reliable, long-term fixation with physiological loading of bone and a low rate of wear. Trabecular metal is a porous construct of tantalum which promotes bony ingrowth, has a modulus of elasticity similar to that of cancellous bone, and should be an excellent material for fixation. Between 2004 and 2006, 55 patients were randomised to receive either a cemented polyethylene or a monobloc trabecular metal acetabular component with a polyethylene articular surface. We measured the peri-prosthetic bone density around the acetabular components for up to two years using dual-energy x-ray absorptiometry. We found evidence that the cemented acetabular component loaded the acetabular bone centromedially whereas the trabecular metal monobloc loaded the lateral rim and behaved like a hemispherical rigid metal component with regard to loading of the acetabular bone. We suspect that this was due to the peripheral titanium rim used for the mechanism of insertion.
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Affiliation(s)
- K Periasamy
- Hairmyres Hospital, Eaglesham Road, East Kilbride G75 8RG, UK.
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Early periprosthetic bone remodelling around cemented and uncemented custom-made femoral components and their uncemented acetabular cups. Arch Orthop Trauma Surg 2011; 131:941-8. [PMID: 21246378 DOI: 10.1007/s00402-010-1239-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2009] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Periprosthetic bone remodelling after total hip replacement may contribute to aseptic loosening of the prosthesis. The selection between cemented and uncemented fixation of the stem is mainly determined by patient's age, general constitution and CT scan-estimated bone quality; intra-operative observation may ultimately influence the choice of the fixation method. The influence of cemented versus uncemented stem fixation on periprosthetic bone remodelling around the uncemented cup has, to our knowledge, never been studied until now. METHODS A total of 75 patients received intra-operatively manufactured stem prostheses and a standard hydroxy apatite-coated pinnacle cup. The pre-operative CT scans provides guidance for the bone quality and hence the type of stem fixation: cemented or uncemented. The influence of either type of stem fixation on periprosthetic bone remodelling around the cup and the stem was measured by bone mineral density at 6 weeks, and 3, 6 and 12 months after surgery. RESULTS Early changes in bone mineral density were noted. The type of stem fixation had an influence on the bone remodelling of the femur and also of the pelvis. The caudal part of the acetabulum was subject to a greater loss in BMD at 12 months in the group with cemented stem fixation. Changes at 12 months correlated with the changes measured at any time point. CONCLUSIONS The selection of the stem implant and its type of fixation in the femoral cavity (cemented or uncemented fixation) seems to have an impact on the bone mineral density of the acetabulum. Long-term clinical follow-up is required to draw conclusions regarding the influence on prosthesis survival.
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Kress AM, Schmidt R, Vogel T, Nowak TE, Forst R, Mueller LA. Quantitative computed tomography-assisted osteodensitometry of the pelvis after press-fit cup fixation: a prospective ten-year follow-up. J Bone Joint Surg Am 2011; 93:1152-7. [PMID: 21776552 DOI: 10.2106/jbjs.j.01097] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND As a follow-up of a previously reported three-year study, we analyzed the periprosthetic acetabular cortical and cancellous bone density changes at ten years after implantation of a press-fit cup. METHODS Prospective clinical, radiographic, and quantitative computed tomography examinations were performed within ten days and at mean periods of one, three, and ten years after total hip arthroplasty with a press-fit cup, a femoral stem with a tapered design, and alumina-alumina pairing. Periacetabular cortical and cancellous bone density (mg CaHA/mL) in the cranial, ventral, and dorsal regions about the cup were measured for twenty-four hips in vivo. RESULTS All acetabular cups showed radiographic signs of stable ingrowth, and no acetabular component had to be revised. The loss of periacetabular cancellous bone density about the cup was as much as -37% cranially, -60% ventrally, and -71% dorsally; the decrease was progressive between the one-year and three-year examinations only. In contrast, cortical bone density above the dome of the acetabular cup remained constant throughout the ten-year follow-up. A moderate change in cortical bone density of -5% to -18% was seen at the level of the cup ten years postoperatively. CONCLUSIONS Both periacetabular cortical and cancellous bone density changes were nonprogressive between the three-year and ten-year examinations after press-fit cup fixation.
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Affiliation(s)
- Alexander M Kress
- Department of Orthopaedic Surgery, Friedrich-Alexander-University of Erlangen-Nuremberg, Rathsberger Strasse 57, Erlangen, Germany
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Is there evidence for a superior method of socket fixation in hip arthroplasty? A systematic review. INTERNATIONAL ORTHOPAEDICS 2011; 35:1109-18. [PMID: 21404024 DOI: 10.1007/s00264-011-1234-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Accepted: 02/16/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE Total hip arthroplasty has been a very succesful orthopaedic procedure. The optimal fixation method of the acetabular component however, has not yet been defined. METHODS We performed a systematic review using the Medline and Embase databases to find evidence for the superiority of cemented or cementless acetabular components on short- and long-term clinical and radiological parameters. Methodological quality for randomised trials was assessed using the van Tulder checklist, and for the non randomised studies we used the Newcastle-Ottawa quality assessment scale. RESULTS Our search strategy revealed 16 randomised controlled trials (RCT) and 19 non RCT studies in which cemented and cementless acetabular components are compared. A best evidence analysis for complications, wear, osteolysis, migration and clinical scores showed no superiority for either cemented or cementless socket in the RCTs. A best evidence analysis for non RCT studies revealed better osteolysis, migration properties and aseptic loosening survival for cementless sockets; however, wear and overall survival favoured the cemented sockets. CONCLUSIONS We recommend that an orthopaedic surgeon should choose an established cemented or cementless socket for hip replacement based on patient characteristics, knowledge, experience and preference.
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Zingler K, Haeberle L, Kress A, Holzwarth U, Forst R, Mueller LA, Schmidt R. Comparison of cortical and cancellous bone remodeling of the pelvis after press-fit cup total hip arthroplasty dependent on patient and prosthesis-specific characteristics: a computed tomography-assisted osteodensitometry study in vivo. ACTA ACUST UNITED AC 2011; 56:267-75. [DOI: 10.1515/bmt.2011.105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Meneghini RM, Ford KS, McCollough CH, Hanssen AD, Lewallen DG. Bone remodeling around porous metal cementless acetabular components. J Arthroplasty 2010; 25:741-7. [PMID: 19473807 DOI: 10.1016/j.arth.2009.04.025] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2008] [Accepted: 04/18/2009] [Indexed: 02/01/2023] Open
Abstract
Bone remodeling around cementless acetabular components after total hip arthroplasty has not been well characterized. A randomized, prospective study of total hip arthroplasty was performed comparing 2 cementless acetabular implants: a solid titanium and a more elastic porous tantalum design. Seventeen hips (9 porous tantalum, 8 titanium) underwent quantitative computed tomography at mean of 7.7 years, and adjacent bone mineral density (BMD) was calculated. The absolute and relative decrease in BMD from preoperative level was less in zones 9 to 15 mm adjacent to the porous tantalum compared to the titanium component (P <or= .02) and predominated posterosuperiorly. The relative BMD increased in all regions adjacent to the porous tantalum component from 5% to 40% over the control. This data demonstrates stress-shielding likely occurs less around a highly porous metal implant of material with an elastic modulus similar to bone.
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Affiliation(s)
- R Michael Meneghini
- Department of Orthopaedic Surgery, New England Musculoskeletal Institute, University of Connecticut Health Center, Farmington, Connecticut 06034-4037, USA
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Abstract
BACKGROUND Hydroxyapatite (HA) is the main inorganic component of bone, and HA coating is widely used on acetabular cups in hip arthroplasty. It has been suggested that this surface finish improves cup survival. METHODS All patients registered in the Swedish Hip Arthroplasty Register between 1992 and 2007 with an uncemented acetabular implant that was available either with or without HA coating were identified. 8,043 total hip arthroplasties (THAs) with the most common cup types (Harris-Galante, Romanus, and Trilogy) were investigated. A Cox regression model including type of coating, age, sex, primary diagnosis, cup type, and type of stem fixation was used to calculate adjusted risk ratios (RRs) for the risk of revision. RESULTS HA coating was a risk factor for cup revision due to aseptic loosening (adjusted RR 1.7; 95% CI: 1.3-2). Age at primary arthroplasty of < 50 years, a diagnosis of pediatric hip disease, the use of a cemented stem, and the Romanus and Harris-Galante cup types were also associated with statistically significantly increased risk of cup revision due to aseptic loosening. INTERPRETATION Our findings question the routine use of HA-coated cups in primary total hip arthroplasty. With some designs, this practice may even increase the risk of loosening-resulting in revision surgery.
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Affiliation(s)
- Stergios Lazarinis
- Department of Orthopaedics, Institute of Surgical Sciences, Uppsala University HospitalUppsala
| | - Johan Kärrholm
- Department of Orthopaedics, Institute of Surgical Science, Sahlgrenska University Hospital, Göteborg University, MölndalSweden
| | - Nils P Hailer
- Department of Orthopaedics, Institute of Surgical Sciences, Uppsala University HospitalUppsala
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García-Rey E, García-Cimbrelo E, Cordero-Ampuero J. Outcome of a hemispherical porous-coated acetabular component with a proximally hydroxyapatite-coated anatomical femoral component. ACTA ACUST UNITED AC 2009; 91:327-32. [DOI: 10.1302/0301-620x.91b3.20947] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
We reviewed 111 hemispherical Duraloc series-500 acetabular components with a minimum follow-up of 12 years. The mean clinical and radiological follow-up was 13.4 years (12 to 15). A Profile hydroxyapatite-coated anatomical femoral component was used in each case. Six patients had a late dislocation, for whom the polyethylene liner was exchanged. Each acetabular component was well fixed and all femoral components showed signs of bone ingrowth. The mean rate of femoral head penetration was 0.10 mm/year (0.021 to 0.481). The probability of not developing femoral cortical hypertrophy and proximal osteopenia by 12 years was 80.2% (95% confidence interval, 72.7 to 87.6) and 77.5% (95% confidence interval, 69.7 to 85.2), respectively. Despite these good clinical results, further follow-up is needed to determine whether these prostheses will loosen with time.
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Affiliation(s)
- E. García-Rey
- Hospital La Paz, P° Castellana 261, 28046 Madrid, Spain
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Mueller LA, Schmidt R, Ehrmann C, Nowak TE, Kress A, Forst R, Pfander D. Modes of periacetabular load transfer to cortical and cancellous bone after cemented versus uncemented total hip arthroplasty: a prospective study using computed tomography-assisted osteodensitometry. J Orthop Res 2009; 27:176-82. [PMID: 18752277 DOI: 10.1002/jor.20742] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Stress-shielding and periprosthetic bone loss after total hip arthroplasty (THA) may be clinically relevant for high-demand patients. Analysis of cortical and cancellous bone density (BD) changes in vivo after THA is of interest to basic science researchers and joint reconstruction surgeons. An insufficient periprosthetic bone stock may predispose to migration, early mechanical failure, and major problems in revision surgery. We used computed tomography (CT)-assisted osteodensitometry in two prospectively analyzed cohorts after cemented (n = 21) versus noncemented (n = 23) cup fixation. Periacetabular BD (mgCaHa/mL) was determined in five CT scans cranial and five CT scans at the level of the cup 10 days and 26 months postoperatively. For press-fit cups BD decreased significantly in all CT cans except in four out of the five scans of cortical bone cranial to the cup. The decrease was highest for cancellous bone ventral to the cup (-45 to -53%). After cemented cup fixation, significant cortical BD decrease was seen ventral to the cup (-11 to -20%). Cancellous BD decrased only ventral (-21 to -31%) and in two scans cranial (-11 and -12%) to the cup. The modes of load transfer between cemented and uncemented cups differ fundamentally. Cemented cups especially prevent the loss of cancellous bone of the acetabulum while also cortical BD loss was significantly lower in most CT scans surrounding the cemented cup compared to the press-fit component. Long-term results are required to prove whether third-generation cementing technique protects periprosthetic BD and thereby improve implant survival.
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Affiliation(s)
- Lutz Arne Mueller
- Department of Orthopaedic Surgery, Friedrich-Alexander-University of Erlangen-Nuremberg, Erlangen, Germany
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Haverkamp D, De Man FHR, Slegt R, Besselaar PP, Marti RK. Cemented hip revision surgery in severe acetabular defects using a semirigid acetabular reinforcement ring--a 5- to 25-year follow-up study. J Arthroplasty 2009; 24:246-55. [PMID: 18834699 DOI: 10.1016/j.arth.2008.07.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2007] [Revised: 05/25/2008] [Accepted: 07/01/2008] [Indexed: 02/01/2023] Open
Abstract
Between 1978 and 1998, a total of 38 consecutive acetabular component revisions were performed in 38 patients. Average age was 67 years, and 87% of patients had severe uncontained segmental acetabular defects of more than 50%. We describe the operative technique of acetabular component revisions performed with bone grafting and a steel, semirigid acetabular reinforcement ring (Eichler), and long-term results are presented. After an average of 11.2 years follow-up, 1 cup was revised after 0.8 years for mechanical loosening, but the ring remained stably fixed. Remodeling (partial) of autografts occurred in all cases. The average HHS was 72.5. The Eichler reinforcement ring is a viable option for segmental acetabular defects in revision hip surgery, allows for restoration of pelvic bone, and makes future revisions feasible.
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Affiliation(s)
- Daniël Haverkamp
- Academic Medical Centre, Orthopaedic Research Centre Amsterdam, The Netherlands
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Lavigne M, Rama RKBS, Ganapathi M, Nuño N, Winzenrieth R, Vendittoli PA. Factors affecting acetabular bone loss during primary hip arthroplasty--a quantitative analysis using computer simulation. Clin Biomech (Bristol, Avon) 2008; 23:577-83. [PMID: 18295383 DOI: 10.1016/j.clinbiomech.2008.01.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2007] [Revised: 12/24/2007] [Accepted: 01/03/2008] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although, various factors may affect the degree of acetabular bone loss during primary hip arthroplasty, they have not been quantified previously. METHODS We assessed the influence of using various reamer diameters, designs and reaming depth on the amount of bone removed during acetabular preparation by simulated reaming in a three-dimensional pelvic model, using computer software. FINDINGS The least amount of bone loss (6185 mm3) providing optimal bone contact with the acetabular articular surface occurred with a 165 degrees reamer design. Increase in reamer diameter, reaming depth and subtending angle of the reamer resulted in disproportionately large increase in the amount of bone resected compared to the relatively small increase in the reamer-bone contact area. INTERPRETATION Surgeons must be aware of the relative influence of the reaming technique and the implant design on the amount of acetabular bone resection to optimize acetabular bone preservation during primary hip arthroplasty.
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Affiliation(s)
- Martin Lavigne
- Department of Surgery, University of Montreal, Maisonneuve-Rosemont Hospital, 5345 Boul L'Assomption, Suite 55 Montréal, Québec, Canada H1T 4B3.
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Pitto RP, Bhargava A, Pandit S, Munro JT. Retroacetabular stress-shielding in THA. Clin Orthop Relat Res 2008; 466:353-8. [PMID: 18196417 PMCID: PMC2505128 DOI: 10.1007/s11999-007-0043-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2007] [Accepted: 11/01/2007] [Indexed: 01/31/2023]
Abstract
We conducted a randomized clinical trial to compare periacetabular bone density changes after total hip arthroplasty using press-fit components with soft and hard liner materials. Bone density changes were assessed using quantitative computed tomography-assisted osteodensitometry. Twenty press-fit cups with alumina ceramic liners and 20 press-fit cups with highly cross-linked polyethylene liners were included; the nonoperated contralateral side was used as the control. Computed tomography scans were performed postoperatively and 1 year after the index operation. At the 1-year followup, we found no differences of periacetabular bone density changes between the alumina and polyethylene liner cohorts. However, we observed marked periacetabular cancellous bone density loss (up to -34%) in both cohorts. In contrast, we observed only moderate cortical bone density changes. The decrease of periacetabular cancellous bone density with retention of cortical bone density after THA suggests stress transfer to the cortical bone.
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Affiliation(s)
- Rocco P. Pitto
- Department of Orthopaedic Surgery, Middlemore Hospital, South Auckland Clinical School, University of Auckland, Auckland, New Zealand ,Bioengineering Institute, University of Auckland, Level 5, 70 Symonds Street, Auckland, New Zealand
| | - Akanksha Bhargava
- Department of Orthopaedic Surgery, Middlemore Hospital, South Auckland Clinical School, University of Auckland, Auckland, New Zealand
| | - Salil Pandit
- Department of Orthopaedic Surgery, Middlemore Hospital, South Auckland Clinical School, University of Auckland, Auckland, New Zealand
| | - Jacob T. Munro
- Department of Orthopaedic Surgery, Middlemore Hospital, South Auckland Clinical School, University of Auckland, Auckland, New Zealand
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Streicher RM, Schmidt M, Fiorito S. Nanosurfaces and nanostructures for artificial orthopedic implants. Nanomedicine (Lond) 2008; 2:861-74. [PMID: 18095851 DOI: 10.2217/17435889.2.6.861] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Nanomaterials and structures, such as nanoparticles, nanofibers, nanosurfaces, nanocoatings, nanoscaffolds and nanocomposites, are considered for various applications in orthopedics and traumatology. This review looks at proposed nanotechnology inspired applications for implants from the perspective of the orthopedic industry. Investigations support consistently the theory that most nanomaterials in various physical forms are able to enhance the cell response selectively for biological tissue integration or increase the strength and wear resistance of current orthopedic materials. At this stage, most of the studies are at the laboratory scale or in early in vivo testing. Significant basic and applied research and development is needed to realize their full clinical potential and biological, manufacturing, economic and regulatory issues have to be addressed. Nevertheless, a crucial factor for success is well-coordinated multimethod and multidiscipline teamwork with profound industrial and medical expertise.
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Histologic findings at 14 and 18 years after cemented total hip arthroplasty with interface bioactive bone cement technique. J Arthroplasty 2007; 22:1067-9. [PMID: 17920483 DOI: 10.1016/j.arth.2007.05.047] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2007] [Accepted: 05/29/2007] [Indexed: 02/01/2023] Open
Abstract
To augment cement-bone bonding in total hip arthroplasty, we interposed hydroxyapatite (HA) granules at the interface. We report the histologic findings of 2 cases 14 and 18 years after cemented total hip arthroplasty with this technique. We found that a thick bony layer was observed where rich layers of HA granules existed. In areas without HA granules, the trabeculae did not form a thick bony layer. These bony layers around HA granules were observed at the interface of non-weight-bearing and weight-bearing areas in 2 acetabula after long-term follow-up.
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