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Soliman MM, Islam MT, Chowdhury MEH, Alqahtani A, Musharavati F, Alam T, Alshammari AS, Misran N, Soliman MS, Mahmud S, Khandakar A. Advancement in total hip implant: a comprehensive review of mechanics and performance parameters across diverse novelties. J Mater Chem B 2023; 11:10507-10537. [PMID: 37873807 DOI: 10.1039/d3tb01469j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
The UK's National Joint Registry (NJR) and the American Joint Replacement Registry (AJRR) of 2022 revealed that total hip replacement (THR) is the most common orthopaedic joint procedure. The NJR also noted that 10-20% of hip implants require revision within 1 to 10 years. Most of these revisions are a result of aseptic loosening, dislocation, implant wear, implant fracture, and joint incompatibility, which are all caused by implant geometry disparity. The primary purpose of this review article is to analyze and evaluate the mechanics and performance factors of advancement in hip implants with novel geometries. The existing hip implants can be categorized based on two parts: the hip stem and the joint of the implant. Insufficient stress distribution from implants to the femur can cause stress shielding, bone loss, excessive micromotion, and ultimately, implant aseptic loosening due to inflammation. Researchers are designing hip implants with a porous lattice and functionally graded material (FGM) stems, femur resurfacing, short-stem, and collared stems, all aimed at achieving uniform stress distribution and promoting adequate bone remodeling. Designing hip implants with a porous lattice FGM structure requires maintaining stiffness, strength, isotropy, and bone development potential. Mechanical stability is still an issue with hip implants, femur resurfacing, collared stems, and short stems. Hip implants are being developed with a variety of joint geometries to decrease wear, improve an angular range of motion, and strengthen mechanical stability at the joint interface. Dual mobility and reverse femoral head-liner hip implants reduce the hip joint's dislocation limits. In addition, researchers reveal that femoral headliner joints with unidirectional motion have a lower wear rate than traditional ball-and-socket joints. Based on research findings and gaps, a hypothesis is formulated by the authors proposing a hip implant with a collared stem and porous lattice FGM structure to address stress shielding and micromotion issues. A hypothesis is also formulated by the authors suggesting that the utilization of a spiral or gear-shaped thread with a matched contact point at the tapered joint of a hip implant could be a viable option for reducing wear and enhancing stability. The literature analysis underscores substantial research opportunities in developing a hip implant joint that addresses both dislocation and increased wear rates. Finally, this review explores potential solutions to existing obstacles in developing a better hip implant system.
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Affiliation(s)
- Md Mohiuddin Soliman
- Department of Electrical, Electronic and Systems Engineering, Faculty of Engineering & Built Environment, Universiti Kebangsaan Malaysia (UKM), Bangi 43600, Malaysia.
| | - Mohammad Tariqul Islam
- Centre for Advanced Electronic and Communication Engineering, Department of Electrical, Electronic and Systems Engineering, Faculty of Engineering & Built Environment, Universiti Kebangsaan Malaysia (UKM), Bangi 43600, Malaysia.
| | - Muhammad E H Chowdhury
- Department of Electrical Engineering, College of Engineering, Qatar University, Doha 2713, Qatar.
| | - Abdulrahman Alqahtani
- Department of Medical Equipment Technology, College of Applied, Medical Science, Majmaah University, Majmaah City 11952, Saudi Arabia
- Department of Biomedical Technology, College of Applied Medical Sciences in Al-Kharj, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia.
| | - Farayi Musharavati
- Department of Mechanical & Industrial Engineering, Qatar University, Doha 2713, Qatar.
| | - Touhidul Alam
- Pusat Sains Ankasa (ANGKASA), Institut Perubahan Iklim, Universiti Kebangsaan Malaysia (UKM), Bangi 43600, Selangor, Malaysia.
| | - Ahmed S Alshammari
- Department of Electrical Engineering, College of Engineering, University Hail, Hail 81481, Saudi Arabia.
- Department of Electrical Engineering, College of Engineering, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia.
| | - Norbahiah Misran
- Centre for Advanced Electronic and Communication Engineering, Department of Electrical, Electronic and Systems Engineering, Faculty of Engineering & Built Environment, Universiti Kebangsaan Malaysia (UKM), Bangi 43600, Malaysia.
| | - Mohamed S Soliman
- Department of Electrical Engineering, College of Engineering, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia.
- Department of Electrical Engineering, Faculty of Energy Engineering, Aswan University, Aswan, 81528, Egypt
| | - Sakib Mahmud
- Department of Electrical Engineering, College of Engineering, Qatar University, Doha 2713, Qatar.
| | - Amith Khandakar
- Department of Electrical Engineering, College of Engineering, Qatar University, Doha 2713, Qatar.
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Parran KK, Bechtel CP, Moore RD, Gebhart JJ, Reich MS, Kraay MJ, Rimnac CM. Are Radiographic and Direct Measures of Acetabular Polyethylene Wear Comparable? J Arthroplasty 2018; 33:2677-2683. [PMID: 29681493 DOI: 10.1016/j.arth.2018.03.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 02/28/2018] [Accepted: 03/17/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND All polyethylene acetabular liners wear over time, and numerous methods for calculating linear wear rates exist. The objective of this study was to compare 2-dimensional wear rates between direct, micrometer measurements and the computerized, edge-detection method using Hip Analysis Suite (HAS) 8.0.4.3. METHODS Two groups of retrieved acetabular liners from Harris-Galante Prosthesis I and Harris-Galante Prosthesis II implants in situ for more than 10 years were evaluated. Group 1 (n = 18) contained liners with both early postoperative (<6 months) and prerevision radiographs taken within 1 month of explantation. Group 2 (n = 55) included liners with only prerevision X-rays (ie, 1 radiograph for wear assessment). Average and maximum direct linear wear was calculated from thicknesses measured at 6 consistent, well-separated locations (3 in the worn and 3 in the unworn regions) using a calibrated, digital micrometer. HAS 8.0.4.3 was used to calculate 2-dimensional wear from anteroposterior pelvic radiographs. RESULTS Aggregate wear rates calculated by HAS were higher than those calculated by the average of direct measurements for group 1 (P = .020) and group 2 (P < .001). However, comparing the maximum direct micrometer measurements to HAS showed no difference for either group 1 (P = .351) or group 2 (P = .451). Linear regression analysis showed a strong correlation between HAS and both average and maximum direct wear measures for both groups, though the coefficient for the direct maximum measurement comparisons were closer to one, indicating a better one-to-one correspondence between HAS and direct maximum wear. CONCLUSION To our knowledge, this is the first study to compare and validate 2-dimensional wear rates in polyethylene acetabular liners between direct measurements from retrieved components and a radiographic computer-assisted technique (as opposed to comparison against a phantom component). Wear rates determined by direct measurements from retrievals were consistent with computer-assisted 2-dimensional methods when comparing maximum wear measurements. In addition, a single prerevision radiograph appears to be sufficient to assess 2-dimensional in vivo wear.
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Affiliation(s)
- Krista K Parran
- Department of Orthopaedics, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Christopher P Bechtel
- Department of Orthopaedics, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Rebecca D Moore
- Department of Orthopaedics, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Jeremy J Gebhart
- Department of Orthopaedics, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Michael S Reich
- Department of Orthopaedics, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Matthew J Kraay
- Department of Orthopaedics, University Hospitals Cleveland Medical Center, Cleveland, OH; Department of Orthopaedics, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Clare M Rimnac
- Department of Orthopaedics, Case Western Reserve University School of Medicine, Cleveland, OH; Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH
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Weidenhielm L, Olivecrona H, Maguire GQ, Noz ME. Prosthetic liner wear in total hip replacement: a longitudinal 13-year study with computed tomography. Skeletal Radiol 2018; 47:883-887. [PMID: 29362844 PMCID: PMC5915507 DOI: 10.1007/s00256-018-2878-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 01/03/2018] [Accepted: 01/04/2018] [Indexed: 02/02/2023]
Abstract
This case report follows a woman who had a total hip replacement in 1992 when she was 45 years old. Six serial computed tomography (CT) examinations over a period of 13 years provided information that allowed her revision surgery to be limited to liner replacement as opposed to replacement of the entire prosthesis. Additionally, they provided data that ruled out the presence of osteolysis and indeed none was found at surgery. In 2004, when the first CT was performed, the 3D distance the femoral head had penetrated into the cup was determined to be 2.6 mm. By 2017, femoral head penetration had progressed to 5.0 mm. The extracted liner showed wear at the thinnest part to be 5.5 mm, as measured with a micrometer. The use of modern CT techniques can identify problems, while still correctable without major surgery. Furthermore, the ability of CT to assess the direction of wear revealed that the liner wear changed from the cranial to dorsal direction.
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Affiliation(s)
- Lars Weidenhielm
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden.
| | - Henrik Olivecrona
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Gerald Q Maguire
- School of Information and Communication Technology, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Marilyn E Noz
- Department of Radiology, New York University, New York, NY, USA
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Krakow L, Klockow A, Roehner E, Brodt S, Eijer H, Bossert J, Matziolis G. A simple method of measuring the wear of explanted acetabular component inserts. Bone Joint Res 2017; 6:530-534. [PMID: 28899855 PMCID: PMC5630993 DOI: 10.1302/2046-3758.69.bjr-2016-0249.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 07/06/2017] [Indexed: 11/17/2022] Open
Abstract
Objectives The determination of the volumetric polyethylene wear on explanted material requires complicated equipment, which is not available in many research institutions. Our aim in this study was to present and validate a method that only requires a set of polyetheretherketone balls and a laboratory balance to determine wear. Methods The insert to be measured was placed on a balance, and a ball of the appropriate diameter was inserted. The cavity remaining between the ball and insert caused by wear was filled with contrast medium and the weight of the contrast medium was recorded. The volume was calculated from the known density of the liquid. The precision, inter- and intraobserver reliability, were determined by four investigators on four days using nine inserts with specified wear (0.094 ml to 1.626 ml), and the intra-class correlation coefficient was calculated. The feasibility of using this method in routine clinical practice and the time required for measurement were tested on 84 explanted inserts by one investigator. Results In order to get the mean for all investigators and determinations, the deviation between the measured and specified wear was -0.08 ml (sd 0.12; -0.21 to 0.11). The interobserver reliability was 0.989 ml (95% confidence interval (CI) 0.964 to 0.997) and the intraobserver reliability was 0.941 for observer 1 (95% CI 0.846 to 0.985), 0.983 for observer 2 (95% CI 0.956 to 0.995), 0.939 for observer 3 (95% CI 0.855 to 0.984), and 0.934 for observer 4 (95% CI 0.790 to 0.984). The mean time required to examine the samples was two minutes (sd 2; 1 to 5). Conclusion The method presented here was shown to be sufficiently precise for many settings and is a cost-effective and quick method of determining the volumetric wear of explanted acetabular components. However, the measurement of wear for scientific purposes will probably continue to involve more accurate and dedicated laboratory equipment. Cite this article: L. Krakow, A. Klockow, E. Roehner, S. Brodt, H. Eijer, J. Bossert, G. Matziolis. A simple method of measuring the wear of explanted acetabular component inserts. Bone Joint Res 2017;6:530–534. DOI: 10.1302/2046-3758.69.BJR-2016-0249.R1
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Affiliation(s)
- L Krakow
- Orthopedic Department, University Hospital Jena, Campus Eisenberg, Germany
| | - A Klockow
- Development Hip, Mathys AG, Bettlach, Switzerland
| | - E Roehner
- Orthopedic Department, University Hospital Jena, Campus Eisenberg, Germany
| | - S Brodt
- Orthopedic Department, University Hospital Jena, Campus Eisenberg, Germany
| | - H Eijer
- Orthopedic Department, Spital Emmental, Switzerland
| | - J Bossert
- Friedrich-Schiller-University Jena, Otto-Schott-Institute for Material Science, Germany
| | - G Matziolis
- Orthopedic Department, University Hospital Jena, Campus Eisenberg, Germany
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Boettner F, Sculco P, Lipman J, Renner L, Faschingbauer M. A novel method to measure femoral component migration by computed tomography: a cadaver study. Arch Orthop Trauma Surg 2016; 136:857-63. [PMID: 26983723 DOI: 10.1007/s00402-016-2442-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Radiostereometric analysis (RSA) is the most accurate technique to measure implant migration. However, it requires special equipment, technical expertise and analysis software and has not gained wide acceptance. The current paper analyzes a novel method to measure implant migration utilizing widely available computer tomography (CT). METHODS Three uncemented total hip replacements were performed in three human cadavers and six tantalum beads were inserted into the femoral bone similar to RSA. Six different 28 mm heads (-3, 0, 2.5, 5.0, 7.5 and 10 mm) were added to simulate five reproducible translations (maximum total point migration) of the center of the head. Implant migration was measured in a 3-D analysis software (Geomagic Studio 7). Repeat manual reconstructions of the center of the head were performed by two investigators to determine repeatability and accuracy. RESULTS The accuracy of measurements between the centers of two head sizes was 0.11 mm with a CI 95 % of 0.22 mm. The intra-observer repeatability was 0.13 mm (CI 95 % 0.25 mm). The interrater-reliability was 0.943. CONCLUSION CT based measurement of head displacement in a cadaver model were highly accurate and reproducible.
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Olivecrona H, Maguire GQ, Noz ME, Zeleznik MP, Kesteris U, Weidenhielm L. A CT method for following patients with both prosthetic replacement and implanted tantalum beads: preliminary analysis with a pelvic model and in seven patients. J Orthop Surg Res 2016; 11:27. [PMID: 26911571 PMCID: PMC4766687 DOI: 10.1186/s13018-016-0360-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 02/17/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Radiostereometric analysis (RSA) is often used for evaluating implanted devices over time. Following patients who have had tantalum beads implanted as markers in conjunction with joint replacements is important for longitudinal evaluation of these patients and for those with similar implants. As doing traditional RSA imaging is exacting and limited to specialized centers, it is important to consider alternative techniques for this ongoing evaluation. This paper studies the use of computed tomography (CT) to evaluate over time tantalum beads which have been implanted as markers. METHODS The project uses both a hip model implanted with tantalum beads, acquired in several orientations, at two different CT energy levels, and a cohort of seven patients. The model was evaluated twice by the same observer with a 1-week interval. All CT volumes were analyzed using a semi-automated 3D volume fusion (spatial registration) tool which provides landmark-based fusion of two volumes, registering a target volume with a reference volume using a rigid body 3D algorithm. The mean registration errors as well as the accuracy and repeatability of the method were evaluated. RESULTS The mean registration error, maximum value of repeatability, and accuracy for the relative movement in the model were 0.16 mm, 0.02° and 0.1 mm, and 0.36° and 0.13 mm for 120 kVp and 0.21 mm, 0.04° and 0.01 mm, and 0.39° and 0.12 mm for 100 kVp. For the patients, the mean registration errors per patient ranged from 0.08 to 0.35 mm. These results are comparable to those in typical clinical RSA trials. This technique successfully evaluated two patients who would have been lost from the cohort if only RSA were used. CONCLUSIONS The proposed technique can be used to evaluate patients with tantalum beads over time without the need for stereoradiographs. Further, the effective dose associated with CT is decreasing.
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Affiliation(s)
- Henrik Olivecrona
- Department of Molecular Medicine and Surgery, Karolinska Institutet, SE-17176, Stockholm, Sweden.
| | - Gerald Q Maguire
- School of Information and Communication Technology, KTH Royal Institute of Technology, Stockholm, Sweden.
| | - Marilyn E Noz
- Department of Radiology, New York University School of Medicine, 560 First Avenue, New York, NY, 10016, USA.
| | - Michael P Zeleznik
- School of Computing, College of Engineering, University of Utah, Salt Lake City, UT, USA.
| | - Uldis Kesteris
- Department of Orthopedics, Skåne University Hospital, Lund, Sweden.
| | - Lars Weidenhielm
- Department of Molecular Medicine and Surgery, Karolinska Institutet, SE-17176, Stockholm, Sweden.
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Iannotti JP, Ricchetti ET, Rodriguez EJ, Bryan JA. Development and validation of a new method of 3-dimensional assessment of glenoid and humeral component position after total shoulder arthroplasty. J Shoulder Elbow Surg 2013; 22:1413-22. [PMID: 23473609 DOI: 10.1016/j.jse.2013.01.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 12/24/2012] [Accepted: 01/07/2013] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS This study evaluates the intrarater and inter-rater reliability of 3-dimensional (3D) computed tomography (CT) measurements of component position and alignment after total shoulder arthroplasty (TSA). MATERIALS AND METHODS Two patients and one whole-body cadaver with anatomic TSA implants underwent CT scans of the shoulder with a 0.6-mm slice thickness in two different arm positions (supine arm down or lateral decubitus arm up) on the same day. Test-retest reliability of component measurements within and between 5 observers was determined, as were any differences in measurements based on arm position. Precision and 95% confidence intervals were determined for the following measurements: glenoid component position (anterior-posterior, superior-inferior, and medial-lateral), glenoid component orientation (version, inclination, and roll), and humeral-glenoid alignment (HGA). HGA was defined in the anterior-posterior and superior-inferior dimensions. RESULTS The range of precision for measurement of the position of the glenoid implant across observers was between 0.2 and 0.5 mm, and for orientation, it was between 1.2° and 1.5°. The range of precision for measurement of HGA across observers was between 0.7 and 1.2 mm. There was no significant difference in the precision of measurements between the two imaged arm positions. DISCUSSION AND CONCLUSION The described method of 3-dimensional CT imaging can provide very precise and reproducible assessment of component position after TSA. Ultimately, correlation of these measurements with clinical outcome, anatomic factors, prosthetic design, and surgical factors will allow for better understanding of the causes of implant failure.
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Affiliation(s)
- Joseph P Iannotti
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA; Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, OH, USA.
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Yun HH, Shon WY, Yoon JR, Yang JH, Lim DS. Reliability of a PowerPoint method for wear measurement after total hip arthroplasty: a retrieval study using 3-dimensional laser scanning. J Arthroplasty 2012; 27:1530-7. [PMID: 22503331 DOI: 10.1016/j.arth.2011.12.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Accepted: 12/23/2011] [Indexed: 02/01/2023] Open
Abstract
The purpose of this study was to evaluate the reliability of the PowerPoint (PP) (2007 Version; Microsoft, Redmond, Wash) method for measuring polyethylene liner wear after total hip arthroplasty. Seventeen retrieved polyethylene liners were included in this study. Wear volumes were calculated using the PP, the Dorr and Wan, and 3-dimensional (3D) laser scanning methods. Spearman correlation coefficients for wear volume results indicated strong correlations between the PP and 3D laser scanning methods (range, 0.89-0.93). On the other hand, Spearman correlation analysis revealed only moderate correlations between the Dorr and Wan and 3D laser scanning methods (range, 0.67-0.77). The PP method can be used to monitor linear wear after total hip arthroplasty and could serve as an alternative method when computerized methods are not available.
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Affiliation(s)
- Ho Hyun Yun
- Department of Orthopaedic Surgery, Seoul Veterans Hospital, Seoul, Korea
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Jedenmalm A, Nilsson F, Noz ME, Green DD, Gedde UW, Clarke IC, Stark A, Maguire GQ, Zeleznik MP, Olivecrona H. Validation of a 3D CT method for measurement of linear wear of acetabular cups. Acta Orthop 2011; 82:35-41. [PMID: 21281259 PMCID: PMC3229995 DOI: 10.3109/17453674.2011.552777] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [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 We evaluated the accuracy and repeatability of a 3D method for polyethylene acetabular cup wear measurements using computed tomography (CT). We propose that the method be used for clinical in vivo assessment of wear in acetabular cups. MATERIAL AND METHODS Ultra-high molecular weight polyethylene cups with a titanium mesh molded on the outside were subjected to wear using a hip simulator. Before and after wear, they were (1) imaged with a CT scanner using a phantom model device, (2) measured using a coordinate measurement machine (CMM), and (3) weighed. CMM was used as the reference method for measurement of femoral head penetration into the cup and for comparison with CT, and gravimetric measurements were used as a reference for both CT and CMM. Femoral head penetration and wear vector angle were studied. The head diameters were also measured with both CMM and CT. The repeatability of the method proposed was evaluated with two repeated measurements using different positions of the phantom in the CT scanner. RESULTS The accuracy of the 3D CT method for evaluation of linear wear was 0.51 mm and the repeatability was 0.39 mm. Repeatability for wear vector angle was 17°. INTERPRETATION This study of metal-meshed hip-simulated acetabular cups shows that CT has the capacity for reliable measurement of linear wear of acetabular cups at a clinically relevant level of accuracy.
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Affiliation(s)
| | - Fritjof Nilsson
- Department of Fiber and Polymer Technology, School of Chemical Science and Engineering, Royal Institute of Technology, Stockholm, Sweden
| | - Marilyn E Noz
- Department of Radiology, New York University School of Medicine, New York, NY, USA
| | - Douglas D Green
- Orthopaedic Research Center, Loma Linda University, Loma Linda, CA, USA
| | - Ulf W Gedde
- Department of Fiber and Polymer Technology, School of Chemical Science and Engineering, Royal Institute of Technology, Stockholm, Sweden
| | - Ian C Clarke
- Orthopaedic Research Center, Loma Linda University, Loma Linda, CA, USA
| | - Andreas Stark
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Gerald Q Maguire
- School of Information and Communication Technology, Royal Institute of Technology, Stockholm, Sweden
| | | | - Henrik Olivecrona
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
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Vandenbussche E, Saffarini M, Hansen U, Taillieu F, Mutschler C, Augereau B, Gregory TM. Measurement of femoral head penetration in polyethylene using a 3-dimensional CT-scan technique. Acta Orthop 2010; 81:563-9. [PMID: 20860445 PMCID: PMC3214744 DOI: 10.3109/17453674.2010.519163] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Current techniques for measuring in vivo polyethylene wear suffer from a range of problems, resulting in an unacceptable lack of repeatability and/or insufficient accuracy when they are used to measure the low wear rates associated with new, highly crosslinked polyethylene. We describe an improved CT method for measurement of 3D femoral head penetration in PE acetabular cups that has sufficient accuracy and repeatability to allow assessment of the wear potential of modern implants. METHOD The accuracy and repeatability of the CT-scan method was determined by blindly repeating measurements on a precisely calibrated 28-mm prosthetic head and by comparing them with direct metrological measurements on 10 acetabular specimens with in vitro wear from machining, and on 8 explanted acetabular specimens with in vivo wear. RESULTS The intra- and interobserver errors in femoral head diameter were 0.036 mm (SD 0.044) and 0.050 mm (SD 0.022), respectively. CT estimated femoral head penetration in both all-poly and metal-backed acetabular components with accuracy ranging from 0.009 to 0.245 mm (mean 0.080; SD 0.067). INTERPRETATION We found that the CT method is rapid, is accurate, and has repeatability and ease of availability. Using a slice thickness of 0.0625 mm, this method can detect wear—and also the threshold for the wear rate that causes osteolysis—much earlier than previous methods.
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Affiliation(s)
- Eric Vandenbussche
- Department of Orthopaedic Surgery, Université Paris Descartes, Assistance Publique – Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | | | - Ulrich Hansen
- Department of Mechanical Engineering, Imperial College, London, UK
| | - Fabienne Taillieu
- Department of Radiology, Université Paris Descartes, Assistance Publique – Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Céline Mutschler
- Department of Radiology, Université Paris Descartes, Assistance Publique – Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Bernard Augereau
- Department of Orthopaedic Surgery, Université Paris Descartes, Assistance Publique – Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
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Weiss RJ, Strömwall F, Beckman MO, Hansson KA, Stark A. Distal femoral stem-bone anchorage of a cementless revision total hip arthroplasty: evaluation of 14 patients by CT. Acta Orthop 2009; 80:298-302. [PMID: 19593722 PMCID: PMC2823214 DOI: 10.3109/17453670903039403] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [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 According to the manual of the cementless Link MP reconstruction prosthesis, a distal femoral stem-bone anchorage of at least 80 mm is necessary to gain implant stability. There have been no in vivo studies showing that this distance is either achieved in clinical practice or needed for clinically satisfying results. Thus, we assessed the femoral stem-bone anchorage of the MP prosthesis using CT. METHODS 14 patients with the MP stem were evaluated by CT scans at a median follow-up time of 12 months postoperatively. Femoral stem-bone anchorage was defined as adequate if 50% of the stem flutes or more had cortical bone contact. The length of anchorage was derived from the number of slices with adequate anchorage. Clinical outcome was assessed with VAS for pain and Harris hip score (HHS), both at 1 and 5 years of follow-up. RESULTS The median length of stem-bone anchorage was 33 mm (interquartile range 10-60), which was shorter than recommended (p = 0.002). Still, at the 1-year control, all patients were fully weight-bearing and only 1/14 complained about mild thigh pain. 7/14 patients did not experience any pain in the affected hip. The patients had a median of 85 points in the HHS. The clinical outcome at 5 years was unchanged. INTERPRETATION We found that it can be difficult to achieve a stem-bone anchorage of at least 80 mm for the MP Link prosthesis. However, this does not appear to be necessary to obtain stability and to achieve clinically satisfying results.
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Affiliation(s)
- Rüdiger J Weiss
- Section of Orthopaedics and Sports Medicine, StockholmSweden
| | | | - Mats O Beckman
- Section of Radiology, Department of Molecular Medicine and Surgery, Karolinska InstitutetStockholmSweden
| | - Karl A Hansson
- Section of Radiology, Department of Molecular Medicine and Surgery, Karolinska InstitutetStockholmSweden
| | - André Stark
- Section of Orthopaedics and Sports Medicine, StockholmSweden
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