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Holland C, Cochrane N, Hinton Z, Wellman S, Seyler T, Bolognesi M, Ryan S. Dual Mobility Articulation in Total Hip Arthroplasty: Mixed Femoral and Acetabular Components are a Feasible Option. J Arthroplasty 2024; 39:S178-S182. [PMID: 38220027 DOI: 10.1016/j.arth.2024.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/26/2023] [Accepted: 01/09/2024] [Indexed: 01/16/2024] Open
Abstract
BACKGROUND The utilization of a different manufacturer for the prosthetic femoral head and the polyethylene insert in dual mobility (DM) for total hip arthroplasty (THA) may be necessary, especially in the revision setting. However, there is no data in the literature about this application. This study evaluated the outcomes of mixed manufacturer components, with the hypothesis that there would be no difference in measured outcomes compared to matched components. METHODS The DM articulations implanted during THA revision were retrospectively reviewed from 2011 to 2017. The study group was then stratified into 2 cohorts: matching components or mixed components. Of 130 hips included in the study with DM articulations with average follow-up of 7 years, 103 had mixed and 27 had matching manufacturer components. Rates of all cause reoperation and revision, intraprosthetic dislocation, dislocation, and aseptic loosening were compared using Chi-squared and Fisher's exact test; survival analysis was also performed. RESULTS Matched and mixed manufacturer implants had no significant difference between all cause reoperation (33 versus 25.2%), dislocation (14.8 versus 7.7%), and aseptic loosening (3.7 versus 3.9%), respectively. Higher rates of intraprosthetic dislocation (11 versus 0.97%) were observed in the matching component cohort. Survival analysis showed similar outcomes at 2, 5, and 10 years. CONCLUSIONS Mixed-component DM articulations show similar results compared to matching components. The off-label use of mixed manufacture DM articulation in THA is a feasible and safe option in the correct patient. Furthermore, when encountering a well-fixed femoral stem or acetabular shell, the use of a mixed component DM articulations may reduce the morbidity for the patient and prevent revision of all components.
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Affiliation(s)
- Christopher Holland
- Campbell Clinic Orthopaedics, University of Tennessee Health Science Center, College of Medicine, Department of Orthopaedic Surgery and Biomedical Engineering
| | - Niall Cochrane
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Zoe Hinton
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Samuel Wellman
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Thorsten Seyler
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Michael Bolognesi
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Sean Ryan
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
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2
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Oosterhoff JHF, de Hond AAH, Peters RM, van Steenbergen LN, Sorel JC, Zijlstra WP, Poolman RW, Ring D, Jutte PC, Kerkhoffs GMMJ, Putter H, Steyerberg EW, Doornberg JN. Machine Learning Did Not Outperform Conventional Competing Risk Modeling to Predict Revision Arthroplasty. Clin Orthop Relat Res 2024; 482:1472-1482. [PMID: 38470976 PMCID: PMC11272341 DOI: 10.1097/corr.0000000000003018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 02/01/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Estimating the risk of revision after arthroplasty could inform patient and surgeon decision-making. However, there is a lack of well-performing prediction models assisting in this task, which may be due to current conventional modeling approaches such as traditional survivorship estimators (such as Kaplan-Meier) or competing risk estimators. Recent advances in machine learning survival analysis might improve decision support tools in this setting. Therefore, this study aimed to assess the performance of machine learning compared with that of conventional modeling to predict revision after arthroplasty. QUESTION/PURPOSE Does machine learning perform better than traditional regression models for estimating the risk of revision for patients undergoing hip or knee arthroplasty? METHODS Eleven datasets from published studies from the Dutch Arthroplasty Register reporting on factors associated with revision or survival after partial or total knee and hip arthroplasty between 2018 and 2022 were included in our study. The 11 datasets were observational registry studies, with a sample size ranging from 3038 to 218,214 procedures. We developed a set of time-to-event models for each dataset, leading to 11 comparisons. A set of predictors (factors associated with revision surgery) was identified based on the variables that were selected in the included studies. We assessed the predictive performance of two state-of-the-art statistical time-to-event models for 1-, 2-, and 3-year follow-up: a Fine and Gray model (which models the cumulative incidence of revision) and a cause-specific Cox model (which models the hazard of revision). These were compared with a machine-learning approach (a random survival forest model, which is a decision tree-based machine-learning algorithm for time-to-event analysis). Performance was assessed according to discriminative ability (time-dependent area under the receiver operating curve), calibration (slope and intercept), and overall prediction error (scaled Brier score). Discrimination, known as the area under the receiver operating characteristic curve, measures the model's ability to distinguish patients who achieved the outcomes from those who did not and ranges from 0.5 to 1.0, with 1.0 indicating the highest discrimination score and 0.50 the lowest. Calibration plots the predicted versus the observed probabilities; a perfect plot has an intercept of 0 and a slope of 1. The Brier score calculates a composite of discrimination and calibration, with 0 indicating perfect prediction and 1 the poorest. A scaled version of the Brier score, 1 - (model Brier score/null model Brier score), can be interpreted as the amount of overall prediction error. RESULTS Using machine learning survivorship analysis, we found no differences between the competing risks estimator and traditional regression models for patients undergoing arthroplasty in terms of discriminative ability (patients who received a revision compared with those who did not). We found no consistent differences between the validated performance (time-dependent area under the receiver operating characteristic curve) of different modeling approaches because these values ranged between -0.04 and 0.03 across the 11 datasets (the time-dependent area under the receiver operating characteristic curve of the models across 11 datasets ranged between 0.52 to 0.68). In addition, the calibration metrics and scaled Brier scores produced comparable estimates, showing no advantage of machine learning over traditional regression models. CONCLUSION Machine learning did not outperform traditional regression models. CLINICAL RELEVANCE Neither machine learning modeling nor traditional regression methods were sufficiently accurate in order to offer prognostic information when predicting revision arthroplasty. The benefit of these modeling approaches may be limited in this context.
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Affiliation(s)
- Jacobien H. F. Oosterhoff
- Amsterdam UMC, University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, Amsterdam, the Netherlands
- Department of Engineering Systems and Services, Faculty of Technology Policy and Management, Delft University of Technology, Delft, the Netherlands
| | - Anne A. H. de Hond
- Clinical AI Implementation and Research Lab, Leiden University Medical Center, Leiden, the Netherlands
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Rinne M. Peters
- Department of Orthopaedic Surgery, Medical Center Leeuwarden, Leeuwarden, the Netherlands
| | | | - Juliette C. Sorel
- Department of Orthopaedic Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - Wierd P. Zijlstra
- Department of Orthopaedic Surgery, Medical Center Leeuwarden, Leeuwarden, the Netherlands
| | - Rudolf W. Poolman
- Department of Orthopaedic Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas, Austin, TX, USA
| | - Paul C. Jutte
- Department of Orthopaedic and Trauma Surgery, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Gino M. M. J. Kerkhoffs
- Amsterdam UMC, University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, Amsterdam, the Netherlands
| | - Hein Putter
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Ewout W. Steyerberg
- Clinical AI Implementation and Research Lab, Leiden University Medical Center, Leiden, the Netherlands
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Job N. Doornberg
- Department of Orthopaedic and Trauma Surgery, University Medical Center Groningen, University of Groningen, the Netherlands
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3
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Warwick H, Kwong JW, Namiri NK, Kayupov E, Maher P, Hansen EN. Revision Dual Mobility Constructs With Unmatched Acetabular and Femoral Components Do Not Increase Failure Rate. J Arthroplasty 2024; 39:1044-1047. [PMID: 37914035 DOI: 10.1016/j.arth.2023.10.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/22/2023] [Accepted: 10/23/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Dual mobility (DM) constructs for revision total hip arthroplasty (THA) have continued to grow in popularity to mitigate instability. This benefit comes at the cost of potential unique modes of failure, and there are theoretical concerns that combining femoral and acetabular components from different manufacturers could lead to increased failure rates. We aimed to investigate rates of reoperation between matched and unmatched DM implants used in revision THA. METHODS We retrospectively reviewed 217 revision THAs performed with DM constructs between July 2012 and September 2021 at a single institution. Dual mobility (DM) constructs were classified as "matched" if the acetabular and femoral components were manufactured by the same company. They were classified as "unmatched" if the acetabular and femoral components were manufactured by different companies. The primary outcome was reoperation for any reason. RESULTS There were 136 matched DM constructs and 81 unmatched constructs. Average follow-up was 4.6 years (range, 2.0 to 9.6 years). There was no difference in reoperation rate between matched and unmatched groups (11.0 versus 13.6%, P = .576). The most common reasons for reoperation in both groups were instability and periprosthetic joint infection. There was 1 revision for intraprosthetic dislocation in the matched group. CONCLUSIONS The use of unmatched DM components in revision THA was common and did not increase the risk of reoperation at an average of 4.6-year follow-up. This information can be helpful in operative planning, but further research on long-term survival will be necessary.
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Affiliation(s)
- Hunter Warwick
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California
| | - Jeffrey W Kwong
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California
| | - Nikan K Namiri
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California
| | - Erdan Kayupov
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California
| | - Patrick Maher
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California
| | - Erik N Hansen
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California
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4
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Cook SD, Patron LP, Lavernia CJ, Gibian J, Hong T, Bendich I. Fracture of Contemporary Femoral Stems: Common Trends in This Rare Occurrence. J Arthroplasty 2023:S0883-5403(23)00364-9. [PMID: 37086930 DOI: 10.1016/j.arth.2023.04.025] [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: 11/20/2022] [Revised: 04/10/2023] [Accepted: 04/11/2023] [Indexed: 04/24/2023] Open
Abstract
BACKGROUND Fracture of contemporary femoral stems is a rare occurrence in total hip arthroplasty (THA). A knowledge gap remains regarding manufacturing, patient, and surgeon factors that may contribute to the increased risk of this complication. METHODS We analyzed 13 contemporary fractured porous coated femoral stems of various designs to determine cause and contributing factors of mechanical failure. Cases included 12 men and one woman who had an average age at index surgery of 53 years (range, 34 to 76). There were ten of 13 patients who had a body mass index (BMI) greater than 30 (obese); 3 of the 10 had a BMI greater than 40. The mean time to fracture was 7.6 years (range, 7 months to 12 years). RESULTS There were four titanium alloy stems that fractured an average of 3.6 years post-revision surgery for head/cup exchange, and had associated iatrogenic mechanical and electrocautery damage to the femoral neck at fracture initiation sites. There were six modular stems that failed at the stem-sleeve or stem-neck interfaces with evidence of fretting corrosion. For two stem-neck fractures, mis-matched head/stem combinations from different manufacturers resulted in untested mechanical offsets and loading. There were two proximal neck fractures and one mid-shaft fracture of coated cobalt-chromium alloy stems that occurred in three obese men. The neck fractures (10 to 12 years) were well-fixed stems. Lack of proximal fixation contributed to the mid-shaft fracture (7 months). CONCLUSION While rare, femoral stem fractures pose catastrophic outcomes in primary and revision THA. Manufacturing, patient, and surgical factors contributing to stem failures were identified, including patient obesity, heat-treatment reduction of mechanical properties, iatrogenic implant damage, and mixing of different vendor stems and heads.
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Affiliation(s)
- Stephen D Cook
- Fellowship of Orthopaedic Researchers, 320 Metairie-Hammond Hwy, Suite 406, Metairie, LA 70005.
| | - Laura P Patron
- Fellowship of Orthopaedic Researchers, 320 Metairie-Hammond Hwy, Suite 406, Metairie, LA 70005
| | | | - Joseph Gibian
- Washington University in St. Louis School of Medicine, 660 S. Euclid Avenue, St. Louis, MO 63110
| | - Thomas Hong
- Washington University in St. Louis School of Medicine, 660 S. Euclid Avenue, St. Louis, MO 63110
| | - Ilya Bendich
- Washington University in St. Louis School of Medicine, 660 S. Euclid Avenue, St. Louis, MO 63110
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5
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Trebše R, Valič M, Savarin D, Milošev I, Levašič V. Survival rate of total hip replacements with matched and with mixed components with 10.7 years mean follow-up. Hip Int 2022; 32:32-38. [PMID: 33213223 DOI: 10.1177/1120700020972710] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Mixing and matching components from different manufacturers in total hip arthroplasty is a frequently used off-label praxis. The clinical consequences of this procedure have not been studied in detail. METHODS 860 patients with matched and 1067 patients with mixed primary total hip replacement (THR) components carried out between 1 January 2002 and 31 December 2004, were selected from our Institution registry. The analysis endpoint was set at 1 January 2016. THRs with poorly performing components were excluded from study groups. Kaplan-Meier survival curves for both groups were calculated and compared using the Log-Rank test and the demographic data using the chi-square test. Correlations between demographic data and revisions were calculated using bivariate correlation. RESULTS 28 revisions were carried out in the matched group and 67 in the mixed group. The 14-year overall survival probability was significantly better in the former (96.0%) than in the mixed group (92.7%) (p = 0.002). Survival, free of aseptic and septic failures, was statistically, significantly higher in the matched group (p = 0.026 and p = 0.007, respectively).The survival of the mixed subgroup with heads and stems from the same manufacturer did not differ statistically from that of the matched group (p = 0.079). CONCLUSIONS In contrast to the results listed in the National Joint Registry and the New Zealand Joint Registry, the survival probability in our study was, statistically, significantly higher in total hip replacements using components of the same manufacturer. Importantly, mixing and matching the components of different manufacturers led to similar survival providing the head and the stem were from the same manufacturer.
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Affiliation(s)
- Rihard Trebše
- Valdoltra Orthopaedic Hospital, Ankaran, Slovenia.,Faculty of Medicine, University of Ljubljana, Slovenia
| | - Matej Valič
- Valdoltra Orthopaedic Hospital, Ankaran, Slovenia
| | | | - Ingrid Milošev
- Valdoltra Orthopaedic Hospital, Ankaran, Slovenia.,Jožef Stefan Institute, Ljubljana, Slovenia
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6
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Tucker K, Günther KP, Kjaersgaard-Andersen P, Lützner J, Kretzer JP, Nelissen RGHH, Lange T, Zagra L. EFORT recommendations for off-label use, mix & match and mismatch in hip and knee arthroplasty. EFORT Open Rev 2021; 6:982-1005. [PMID: 34909220 PMCID: PMC8631244 DOI: 10.1302/2058-5241.6.210080] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Off-label use is frequently practiced in primary and revision arthroplasty, as there may be indications for the application of implants for purposes outside the one the manufacturers intended. Under certain circumstances, patients may benefit from selective application of mix & match. This can refer to primary hip arthroplasty (if evidence suggests that the combination of devices from different manufacturers has superior results) and revision hip or knee arthroplasty (when the exchange of one component only is necessary and the invasiveness of surgery can be reduced). Within the EFORT ‘Implant and Patient Safety Initiative’, evidence- and consensus-based recommendations have been developed for the safe application of off-label use and mix & match in primary as well as revision hip and knee arthroplasty. Prior to the application of a medical device for hip or knee arthroplasty off-label and within a mix & match situation, surgeons should balance the risks and benefits to the patient, obtain informed consent, and document the decision process appropriately. Nevertheless, it is crucial for surgeons to only combine implants that are compatible. Mismatch of components, where their sizes or connections do not fit, may have catastrophic effects and is a surgical mistake. Surgeons must be fully aware of the features of the components that they use in off-label indications or during mix & match applications, must be appropriately trained and must audit their results. Considering the frequent practice of off-label and mix & match as well as the potential medico-legal issues, further research is necessary to obtain more data about the appropriate indications and outcomes for those procedures.
Cite this article: EFORT Open Rev 2021;6:982-1005. DOI: 10.1302/2058-5241.6.210080
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Affiliation(s)
- Keith Tucker
- Orthopaedic Data Evaluation Panel (ODEP), Norwich, UK
| | - Klaus-Peter Günther
- University Centre of Orthopedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Germany
| | | | - Jörg Lützner
- University Centre of Orthopedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Germany
| | - Jan Philippe Kretzer
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, Netherlands
| | - Toni Lange
- Center for Evidence-based Healthcare, University Hospital Carl Gustav Carus and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Luigi Zagra
- IRCCS Istituto Ortopedico Galeazzi, Hip Department, Milan, Italy
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7
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Medico-Legal Issues Related to Hip and Knee Arthroplasty: A Literature Review Including the Indian Scenario. Indian J Orthop 2021; 55:1286-1294. [PMID: 33814596 PMCID: PMC8009269 DOI: 10.1007/s43465-021-00398-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 03/22/2021] [Indexed: 02/04/2023]
Abstract
Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are commonly performed surgeries worldwide. The number of joint replacement surgeries being performed has increased considerably over the past two decades, but it has also seen an increase in litigation associated with it. The purpose of our study was to review and consolidate literature regarding medico-legal issues pertaining to THA and TKA cases. We looked at the causes of litigation, medico legal aspects of pre-operative requirements, optimisation of medical condition, indications and contraindications for arthroplasty, informed consent, implants, mixing of components from different manufacturers and post-operative rehabilitation. We also wanted to analyse available literature and legal proceedings regarding these cases in India specifically.
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8
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Peters RM, Hiemstra JT, Zijlstra WP, Bulstra SK, Stevens M. To mix or not to mix? Medicolegal implications of mixed components in total hip arthroplasty. Acta Orthop 2020; 91:624-626. [PMID: 32964760 PMCID: PMC8023968 DOI: 10.1080/17453674.2020.1822066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Affiliation(s)
- Rinne M Peters
- Department of Orthopedic Surgery, Medical Center Leeuwarden; ,Department of Orthopedic Surgery, University of Groningen, University Medical Center Groningen; ,Correspondence:
| | - Jantina T Hiemstra
- Hausfeld Advocaten, Amsterdam; ,Department of Private law, University of Groningen, The Netherlands
| | | | - Sjoerd K Bulstra
- Department of Orthopedic Surgery, University of Groningen, University Medical Center Groningen;
| | - Martin Stevens
- Department of Orthopedic Surgery, University of Groningen, University Medical Center Groningen;
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9
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van Doesburg PG, van Langelaan EJ, Apachitei I, Bénard MR, Verdegaal SHM. Femoral prosthesis neck fracture following total hip arthroplasty - a systematic review. ARTHROPLASTY 2020; 2:28. [PMID: 35236443 PMCID: PMC8796592 DOI: 10.1186/s42836-020-00047-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 09/17/2020] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Head-neck modularity was introduced into total hip arthroplasty to provide more intraoperative surgical options. However, modularity led to new problems, such as trunnionosis and fractures of the femoral prosthesis neck. The purpose of this study was to identify risk factors for hip neck fractures and to provide recommendations to prevent damage and fractures of the neck. METHODS A systematic review of the literature was performed according to the PRISMA guidelines. RESULTS Thirty-three case studies were included. Methodologically, most included studies were of moderate or good quality. The 80 neck fractures included in the review took place, on average, 7 years after stem placement. Male gender, high body weight, obesity, previous revision surgery, mixing components from different manufacturers, use of long skirted heads, cobalt-chromium (large size) heads were identified as potential risk factors. CONCLUSION Hip neck fractures occur on average 7 years after stem placement. The etiology of hip neck fractures is multifactorial. This review revealed several preventable implant- and surgeon-related risk factors.
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Affiliation(s)
- P G van Doesburg
- Department of Orthopaedic Surgery, Alrijne Hospital Leiderdorp, Simon Smitweg 1, 2353GA, Leiderdorp, The Netherlands.
| | - E J van Langelaan
- Biomechanical Engineering Department Biomaterials & Tissue Biomechanics Section, Delft University of Technology, Delft, The Netherlands
| | - I Apachitei
- Biomechanical Engineering Department Biomaterials & Tissue Biomechanics Section, Delft University of Technology, Delft, The Netherlands
| | - M R Bénard
- Department of Orthopaedic Surgery, Alrijne Hospital Leiderdorp, Simon Smitweg 1, 2353GA, Leiderdorp, The Netherlands
| | - S H M Verdegaal
- Department of Orthopaedic Surgery, Alrijne Hospital Leiderdorp, Simon Smitweg 1, 2353GA, Leiderdorp, The Netherlands
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van den Hout JA, Koenraadt KL, Wagenmakers R, Bolder SB. The Accolade TMZF stem fulfils the demands of modern stem design: Minimum 5-year survival in a cohort of 937 patients. J Orthop Surg (Hong Kong) 2019; 26:2309499018807747. [PMID: 30352541 DOI: 10.1177/2309499018807747] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
PURPOSE Modern hip stem design includes a prosthesis that has a predictable outcome in all total hip arthroplasty (THA) patients, regardless of approach, surgeon or patient characteristics. Introduction without a learning curve and, in cases of problems, the possibility for a simple revision are other prerequisites. The purpose of this study is to evaluate whether the Accolade TMZF stem (Stryker Orthopedics, Mahwah, New Jersey, USA) is suitable to fulfil these demands. We report our mid-term survival of the Accolade TMZF hip stem in all patients from the first implantation at our institute. METHODS From the start of using the Accolade TMZF stem (March 2009) until February 2011, 937 THA were performed by 12 surgeons using a posterolateral or anterolateral approach. Survival of the stem was calculated using Kaplan-Meier analysis. Effect of approach, patient age and comorbidity were analysed with a Cox proportional hazards' model. The learning effect was determined by comparing the number of revisions in the surgeons' first 20 THAs with their next 30 THAs and the subsequent THAs. RESULTS At 5 years, cumulative stem survival was 97.9% based on revisions for all reasons and 98.8% with aseptic loosening as endpoint. We found no effect of surgical approach, patient age or comorbidity on stem survival. No learning effect was found. CONCLUSION The Accolade TMZF stem fulfilled the demands of modern stem design.
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Affiliation(s)
| | - Koen Lm Koenraadt
- 2 Foundation for Orthopedic Research, Care and Education, Amphia Hospital, Breda, The Netherlands
| | - Robert Wagenmakers
- 1 Department of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands
| | - Stefan Bt Bolder
- 1 Department of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands
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11
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Peters RM, Van Steenbergen LN, Stevens M, Rijk PC, Bulstra SK, Zijlstra WP. The effect of bearing type on the outcome of total hip arthroplasty. Acta Orthop 2018; 89:163-169. [PMID: 29160130 PMCID: PMC5901513 DOI: 10.1080/17453674.2017.1405669] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [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 - Alternative bearing surfaces such as ceramics and highly crosslinked polyethylene (HXLPE) were developed in order to further improve implant performance of total hip arthroplasties (THAs). Whether these alternative bearing surfaces result in increased longevity is subject to debate. Patients and methods - Using the Dutch Arthroplasty Register (LROI), we identified all patients with a primary, non-metal-on-metal THA implanted in the Netherlands in the period 2007-2016 (n = 209,912). Cumulative incidence of revision was calculated to determine differences in survivorship of THAs according to bearing type: metal-on-polyethylene (MoPE), metal-on-HXLPE (MoHXLPE), ceramic-on-polyethylene (CoPE), ceramic-on-HXLPE (CoHXLPE), ceramic-on-ceramic (CoC), and oxidized-zirconium-on-(HXL)polyethylene (Ox(HXL)PE). Multivariable Cox proportional hazard regression ratios (HRs) were used for comparisons. Results - After adjustment for confounders, CoHXLPE, CoC, and Ox(HXL)PE resulted in a statistically significantly lower risk of revision compared with MoPE after 9 years follow-up (HR =0.8-0.9 respectively, compared with HR =1.0). For small (22-28 mm) femoral head THAs, lower revision rates were found for CoPE and CoHXLPE (HR =0.9). In the 36 mm femoral head subgroup, CoC-bearing THAs had a lower HR compared with MoHXLPE (HR =0.7 versus 1.0). Crude revision rates in young patients (< 60 years) for CoHXLPE, CoC, and Ox(HXL)PE (HR =0.7) were lower than MoPE (HR =1.0). However, after adjustment for case mix and confounders these differences were not statistically significant. Interpretation - We found a mid-term lower risk of revision for CoHXLPE, CoC, and Ox(HXL)PE bearings compared with traditional MoPE-bearing surfaces.
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Affiliation(s)
- Rinne M Peters
- Department of Orthopedic Surgery, Medical Center Leeuwarden,Department of Orthopedic Surgery, University of Groningen, University Medical Center Groningen,Correspondence:
| | - Liza N Van Steenbergen
- Dutch Arthroplasty Register (Landelijke Registratie Orthopedische Implantaten), ‘s Hertogenbosch, The Netherlands
| | - Martin Stevens
- Department of Orthopedic Surgery, University of Groningen, University Medical Center Groningen
| | - Paul C Rijk
- Department of Orthopedic Surgery, Medical Center Leeuwarden
| | - Sjoerd K Bulstra
- Department of Orthopedic Surgery, University of Groningen, University Medical Center Groningen
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Mueller U, Panzram B, Braun S, Sonntag R, Kretzer JP. Mixing of Head-Stem Components in Total Hip Arthroplasty. J Arthroplasty 2018; 33:945-951. [PMID: 29174405 DOI: 10.1016/j.arth.2017.10.047] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 10/17/2017] [Accepted: 10/21/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Implant manufacturers proclaim that the tapers of modular total hip arthroplasty are not standardized and can vary from manufacturer to manufacturer. That is why the combination of various components from different manufacturers ("Mix and Match") is not permitted. In this study, different taper combinations were investigated experimentally to assess the effect of "Mix and Match" regarding the taper connection strength. METHODS Torque-off tests using hip stems and metal femoral heads from 6 different implant manufacturers were performed. First the components were tested as intended and afterwards the stems were combined with metal heads from other manufacturers. RESULTS There was no significant difference in taper connection strength when stems from the manufacturers Link, Smith & Nephew, and Zimmer were combined with heads from other manufacturers. The Biomet stems showed a significantly reduced taper connection strength if femoral heads of Aesculap, DePuy, or Smith & Nephew were used. On the contrary, the DePuy stems in combination with the originally intended femoral heads showed a significantly lower taper connection strength compared to the use of heads from Link, Biomet, and Zimmer. The same was observed for the Aesculap stems in combination with Zimmer heads. CONCLUSION The results of this study suggest that mixing components from different manufacturers may affect the taper connection strength and could reduce the stability. As safety should be a high priority in patient treatment, any potential risks should be avoided. Therefore, mixing and matching of heads and femoral stems from different manufacturers cannot be recommended.
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Affiliation(s)
- Ulrike Mueller
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Benjamin Panzram
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Steffen Braun
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Robert Sonntag
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - J Philippe Kretzer
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
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Taylor JW, Frampton C, Rothwell AG. Long-Term Survival of Total Hip Arthroplasty Using Implants From Different Manufacturers. J Arthroplasty 2018; 33:491-495. [PMID: 29102074 DOI: 10.1016/j.arth.2017.09.047] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 09/16/2017] [Accepted: 09/19/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Total hip arthroplasty (THA) can be performed using either femoral and acetabular components provided by the same manufacturer (matched components) or components from different manufacturers (unmatched components). We hypothesized that there would be no difference in outcomes following the use of unmatched compared to matched components. METHODS Data from a nationwide joint registry, the New Zealand Joint Registry (NZJR), were analyzed to assess long-term outcomes of using unmatched implants in THA. RESULTS The NZJR has recorded a total of 108,613 primary THAs. We excluded combinations with less than 50 implantations, leaving 99,732 arthroplasties (90.5%). The unmatched group consisted of 24,537 (24.6%) THAs. Revision procedures were required in 3434 (4.6%) of the matched group, at a rate of 0.72/100 component years and 1078 (4.4%) of the unmatched group, a rate of 0.69/100 component years (P = .049). THAs with metal-on-metal or ceramic-on-metal bearings were overrepresented in the matched group. When analysis was repeated with these implants excluded, there was no longer a difference in revision rate between groups (4.0% revisions, 0.65/100 component years and 4.3% revisions, 0.67/100 component years [P = .742]). Survival analysis showed 17-year survival for matched components and unmatched to be within 95% confidence intervals at all time points. There was a small, statistically significant improvement in Oxford Hip Scores for the unmatched group compared with the matched group. CONCLUSION Data from the NZJR confirm that the use of unmatched components in THA has no adverse effect on outcomes.
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Affiliation(s)
- James W Taylor
- Christchurch Hospital Orthopaedic Department, Canterbury District Health Board, Christchurch, New Zealand
| | - Chris Frampton
- Christchurch Hospital Orthopaedic Department, Canterbury District Health Board, Christchurch, New Zealand
| | - Alastair G Rothwell
- Christchurch Hospital Orthopaedic Department, Canterbury District Health Board, Christchurch, New Zealand
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