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Silver-Doped Anodic Alumina with Antimicrobial Properties—Synthesis and Characterization. METALS 2022. [DOI: 10.3390/met12030474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The incessant need for the elimination of pathogenic viruses and multi-drug resistant bacteria has been a critical issue during recent decades, and requires the creation of new antimicrobial materials. Our study describes the production of silver-modified anodic alumina substrates by two methods, and estimation of their bactericidal activity. Aluminum oxide coatings were obtained via an anodization process of low-purity aluminum in an acidic bath for different time periods. The realization of silver infiltration into the pores of the alumina layers was carried out employing two different routes—electrochemical deposition, and in situ thermal reduction. The obtained films were characterized using scanning electron microscopy (SEM). Changes in the surface morphology and thickness of the initial oxide structures after hot water sealing procedure were observed. The presence of silver inside the pores of the alumina layers was also assessed. It was found that silver electrodeposition resulted in greater surface saturation. Large silver accumulations were observed on the thinner anodic films which experienced electroplating for longer time periods. Finally, the antibacterial activity of the modified alumina structures against Gram-negative (Escherichia coli) and Gram-positive (Bacillus cereus) bacteria was evaluated. The results demonstrate that silver deposits acquired by the electrochemical technique improve the bactericidal efficiency of the anodic aluminum oxide (AAO) layers. On the contrary, alumina structures with chemically embedded Ag particles did not show significant antibacterial properties. Overall, the present studies demonstrate that biological activity of silver-doped AAO films depends on the techniques used for their modification.
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Outcomes of Ceramic Composite in Total Hip Replacement Bearings: A Single-Center Series. JOURNAL OF COMPOSITES SCIENCE 2021. [DOI: 10.3390/jcs5120320] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Despite the fact that total hip replacement is one of the most successful surgical procedures for treatment of a variety of end-stage hip diseases, the process of osteolysis and implant loosening remains a significant problem, especially in young and high-demand patients. More than 40 years ago, ceramic bearings were introduced due to their mechanical advantage in order to obtain a reduction in wear debris, and due to the conviction that it was possible to minimize friction and wear owing to their mechanical hardness, high chemical stability, surface lubrication by fluids and low friction coefficient. Together with excellent mechanical properties, ceramics have a biological inertness: eventual ceramic debris will lead to a reactive response with a high predominance of fibrocystic cells, rather than macrophagic cells, and absence of giant cells, which is ideal from a biological perspective. As a consequence, they will not trigger the granulomatous reaction necessary to induce periprosthetic osteolysis, and this clearly appears to be of great clinical relevance. In recent years, tribology in manufacturing ceramic components has progressed with significant improvements, owing to the development of the latest generation of ceramic composites that allow for an increased material density and reduced grain size. Currently, ceramic-on-ceramic bearings are considered the attractive counterparts of ceramic- or metal-on-polyethylene ones for patients with a long life expectancy. The aim of this paper is to report the results of total hip replacements performed with a ceramic-on-ceramic articulation made from a ceramic composite in a single center, focusing on its usefulness in specific preoperative diagnosis.
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Incidence, Risk Factors, and Outcome of Ceramic-On-Ceramic Bearing Breakage in Total Hip Arthroplasty. J Arthroplasty 2021; 36:2992-2997. [PMID: 33812710 DOI: 10.1016/j.arth.2021.03.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 03/02/2021] [Accepted: 03/04/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Ceramic-on-ceramic bearing breakage is a rare but significant complication of total hip arthroplasty. This study aimed to identify risk factors for breakage and to determine the outcome of different revision options. METHODS All ceramic-on-ceramic primary total hip arthroplasty procedures reported to the Australian Joint Replacement Registry from September 1999 to December 2019 were included. Procedures were subdivided into alumina or mixed ceramic (alumina/zirconia). All breakages were identified. The association between ceramic type and head size was assessed. Subsequent revision rates were compared and cause of revision assessed. RESULTS There were 23,534 alumina and 71,144 mixed ceramic procedures. Breakage was the reason for 1st revision in 84 alumina (5.27% of all revisions and 0.36% of procedures) and 56 mixed ceramic procedures (2.46% of all revisions; 0.08% of procedures). Alumina had a higher breakage rate than mixed ceramic (HR 2.50 (95% CI 1.75, 3.59), P < .001), and breakage was higher for 36-38mm head sizes using alumina (HR 2.84 (1.52, 5.31), P = .001). 17.8% of 2nd revisions occur by 3 years, due to dislocation, infection, metal-related pathology, and loosening. A neck adapter sleeve did not reduce 2nd revisions. Numbers were too low to compare revision bearing surface options. CONCLUSION Ceramic breakage has reduced with mixed ceramics but has a 0.79/1000 incidence at 15-year follow-up. It is unclear what the risk factors are for modern ceramics with increasing head size a risk for alumina only. Risk of 2nd revision is high and occurs early. The optimal revision option is unknown.
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Lee YK, Kim KC, Yoon BH, Kim TY, Ha YC, Koo KH. Cementless total hip arthroplasty with delta-on-delta ceramic bearing in patients younger than 30 years. Hip Int 2021; 31:181-185. [PMID: 31766869 DOI: 10.1177/1120700019889592] [Citation(s) in RCA: 6] [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 Despite improvements in the mechanical properties of alumina ceramics, the outcome of total hip arthroplasty (THA) with contemporary ceramic bearings in young patients remains a matter of concern. We evaluated the results of cementless THA with the use of the delta ceramic bearing, and determined the prevalence of osteolysis, squeaking, and ceramic fracture in patients aged < 30 years at mid-term. METHODS From March 2008 to January 2012, 76 consecutive patients (91 hips), younger than 30 years, underwent cementless THA with Delta ceramic bearings. In each follow-up, the clinical evaluation including noise and radiological evaluations were recorded. RESULTS Among them, 72 patients (86 THAs) were followed-up for a minimum of 5 years (mean 70.8; 60-95.9 months). There were 44 men (47 hips) and 28 women (39 hips). The mean age at the time of the index arthroplasty was 25.9 (16-30) years and the mean preoperative Harris Hip Score (HHS) was 59.4 (23-79) points. HHS improved to 96.3 (64-100) points at the final follow-up evaluation. 8 hips (9.3%) exhibited grinding or squeaking. No hip had aseptic loosening and no hip was revised. No osteolysis was detected around any acetabular or femoral components. CONCLUSIONS Our results suggest that cementless THA with the use of Delta ceramic bearing provides satisfactory results without osteolysis or ceramic fracture in patients aged <30 years at a mid-term follow-up.Clinical Trials.gov Protocol Registration System (trial no. NCT01838096).
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Affiliation(s)
- Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Ki-Choul Kim
- Department of Orthopaedic Surgery, Dankook University Hospital, Cheonan, South Korea
| | - Byung-Ho Yoon
- Department of Orthopaedic Surgery, Inje University College of Medicine, Seoul Paik Hospital, Seoul, South Korea
| | - Tae-Young Kim
- Department of Orthopaedic Surgery, Konkuk University Medical Centre, Chungju, South Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Kyung-Hoi Koo
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea.,Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
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Protein Adsorption at Nanorough Titanium Oxide Surfaces: The Importance of Surface Statistical Parameters beyond Surface Roughness. NANOMATERIALS 2021; 11:nano11020357. [PMID: 33535535 PMCID: PMC7912717 DOI: 10.3390/nano11020357] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/21/2021] [Accepted: 01/26/2021] [Indexed: 12/15/2022]
Abstract
The nanoscale surface topography of biomaterials can have strong effects on protein adsorption. While there are numerous surface statistical parameters for the characterization of nanorough surfaces, none of them alone provides a complete description of surface morphology. Herein, a selection of nanorough titanium oxide surfaces has been fabricated with root-mean-square roughness (Sq) values below 2.7 nm but very different surface morphologies. The adsorption of the proteins myoglobin (MGB), bovine serum albumin (BSA), and thyroglobulin (TGL) at these surfaces was investigated in situ by ellipsometry to assess the importance of six of the most common surface statistical parameters. For BSA adsorption, both protein film thickness and time constant of adsorption were found to scale linearly with Sq s. For TGL, however, the same adsorption characteristics depend linearly on the surface skewness (Ssk), which we attribute to the rather extreme size of this protein. Finally, a mixed behavior is observed for MGB adsorption, showing different linear correlations with Sq and Ssk. These results demonstrate the importance of a thorough morphological characterization of the surfaces employed in protein adsorption and possibly also cell adhesion studies.
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Goretti C, Polidoro F, Paderni S, Belluati A. Ceramic on ceramic total hip arthroplasty and liner fracture. Two case reports and review of literature. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:192-195. [PMID: 31821308 PMCID: PMC7233715 DOI: 10.23750/abm.v90i12-s.8961] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 10/23/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIM OF THE WORK Ceramic on ceramic bearing surfaces in total hip arthroplasty are rising in number with the purpose of reducing debris osteolysis in young patients. New generation ceramics drastically reduced the well known problem of liner's fracture associated with this material but this still represents a complication. METHODS We present the only two cases of acetabular liner fracture we had in our department, on a total of 252 patients, since we use CoC bearing surfaces in THR (2005-2019) analyzing symptoms and causes of this complication. Review of recent literature focused on symptoms and causes of liners fracture, well matched our cases. RESULTS In line with the analysis of literature, the major cause of liner fracture is neck-cup impingement resulting in the "edge-loading" effect, followed by other factors like prosthesis design, traumas and patient weight. From data also emerge the role of acoustic phenomena (e.g. squeaking) and CT scan in the diagnostic process. CONCLUSIONS Last generation ceramics should be used in CoC THR, implant malposition and prosthesis design have a dominant role in liner fracture, squeaking should always be investigated. CT scan have an important role in diagnosis. Implant revision with substitution of the bearing surfaces is mandatory in case of fracture or impending fracture signs.
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Kim SC, Lim YW, Jo WL, Park HW, Han SB, Kwon SY, Kim YS. Fourth-generation ceramic-on-ceramic THA results in improvements in midterm outcomes compared to third-generation THA but does not resolve noise problems: a cohort study of a single-hip system. BMC Musculoskelet Disord 2019; 20:263. [PMID: 31142296 PMCID: PMC6542023 DOI: 10.1186/s12891-019-2641-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Accepted: 05/17/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Using data from the Korean Hip Registry, we aimed to investigate mid-term clinical and radiographic outcomes, including the prevalence of periprosthetic joint infection (PJI), osteolysis, and component loosening or dislocation, and to analyze the incidence of bearing-related complications following modern ceramic-on-ceramic (COC) total hip arthroplasty (THA) using a single cementless hip system. METHODS Four hundred eighty-two patients (602 hips) who underwent Forte or Delta COC THAs with a single hip system and had a minimum 5-year follow-up were identified. The sample included 243 (50.4%) women and 239 (49.6%) men with a mean age of 50.6 years (range: 18-83 years). The Forte group comprised 310 hips, and the Delta group comprised 292 hips. The mean follow-up was 6.1 years (range: 5-10.2 years). RESULTS Cup orientation did not differ between groups. No hip had a PJI or osteolysis in either group. All acetabular components and all but two femoral components (in the Delta group) were well fixed. Dislocations occurred in six (1.9%) hips in the Forte group and one (0.3%) hip in the Delta group (p = 0.124). A total of nine (1.5%) revisions were performed. The 5-year survival rates for all-cause revisions were 98.4 and 98.6%, respectively. One (0.3%) ceramic head fracture occurred in the Forte group. Sixteen (5%) hips exhibited clicking and 6 (2%) hips had squeaking in the Forte group; 16 (6%) hips exhibited clicking and 5 (2%) hips had squeaking in the Delta group. Multiple regression analysis revealed that noise generation was unassociated with any factor. CONCLUSIONS From the Korean Hip Registry data, THA with modern ceramic bearings showed encouraging results, with lower risks of PJI, osteolysis, and component loosening. In particular, Delta COC THA resulted in no PJI or ceramic fracture and had a reduced dislocation risk. However, associated noise remains a concern.
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Affiliation(s)
- Seung-Chan Kim
- Department of Orthopaedic Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Young-Wook Lim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Banpo-daero 222, Seocho-gu, Seoul, 137-701, South Korea
| | - Woo-Lam Jo
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Banpo-daero 222, Seocho-gu, Seoul, 137-701, South Korea
| | - Hyun-Woo Park
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Banpo-daero 222, Seocho-gu, Seoul, 137-701, South Korea
| | - Sung-Bin Han
- Department of Orthopaedic Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Soon-Yong Kwon
- Department of Orthopaedic Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Yong-Sik Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Banpo-daero 222, Seocho-gu, Seoul, 137-701, South Korea.
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Revision total hip arthroplasty with metal on metal bearing for ceramic bearing fractures. J Orthop Sci 2019; 24:452-457. [PMID: 30415823 DOI: 10.1016/j.jos.2018.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 09/28/2018] [Accepted: 10/11/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Due to concern of potential metallosis caused by residual microscopic ceramic particles, metal-on-metal (MoM) bearing is deemed undesirable in revision total hip arthroplasty (THA) for ceramic bearing fracture. We determined whether MoM bearing is suitable to be used in revision THA for ceramic fractures and also evaluated whether this treatment increases serum iron levels compared with MoM bearing revision THA for polyethylene failure. METHODS Between 2006 and 2012, 22 patients underwent revision surgery using MoM bearing (28 mm femoral head in 18 hips and 32 mm in 4 hips) for ceramic bearing fracture and followed average 52.1 months. We assessed radiological parameter and functional outcome using Harris hip score (HHS) and WOMAC score. Also, serum cobalt (Co) and chromium (Cr) blood tests were performed and compared with the result obtained from age, sex- and follow-up duration-matched patients with MoM revision THA for failed polyethylene bearing. RESULTS The mean HHS improved from 60.6 preoperatively to 90.3 at final follow-up. There were no changes in cup position, progression of osteolytic lesions, and measurable wear of MoM bearing articulation at final follow-up radiographs. There was one case of recurrent dislocation after surgery, which was treated with greater trochanter distal advancement and one case of deep infection, which underwent two-stage revision. Mean serum Co level (1.7 vs. 1.4 μg/dl; p = 0.211) and Cr level (0.70 vs. 1.01 μg/dl; p = 0.327) showed no significant difference. CONCLUSIONS MoM articulation with liner cementation into the acetabular cup along with total synovectomy can be chosen in revision surgery for ceramic fracture with good midterm follow-up. However, the use of MoM bearing is indicated when the stem and metal shell can be retained and ceramic on ceramic or ceramic on polyethylene bearing cannot be selected. Also long-term outcome needs to be further evaluated.
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Higuchi Y, Seki T, Takegami Y, Osawa Y, Kusano T, Ishiguro N. What factors predict ceramic liner malseating after ceramic-on-ceramic total hip arthroplasty? Orthop Traumatol Surg Res 2019; 105:453-459. [PMID: 30853457 DOI: 10.1016/j.otsr.2019.01.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 01/07/2019] [Accepted: 01/14/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND There is a lack of evidence about the risk factors associated with the malseating of the acetabular liner after ceramic-on-ceramic (CoC) total hip arthroplasty (THA). Therefore, we performed a complementary retrospective case-control study to determine the factors predicting the malseating of the acetabular liner after CoC THA and to evaluate the relationship between malseating and (1) osteoarthritis, (2) particularly in terms of the new radiographic parameter "bone sclerotic length" of the acetabular bone. HYPOTHESIS Osteoarthritis, particularly bone sclerotic length, was an independent risk factor for malseating of ceramic liners. PATIENTS AND METHODS In total, 219 CoC THAs (174 women and 45 men) were evaluated to determine the risk factors influencing the malseating of the acetabular ceramic liner. An average patient age at the time of surgery was 55.9±9.5 years (range, 23 to 75 years). Data on patient background and preoperative radiographs, such as Tönnis grades; Crowe classification; and indices of acetabular osteoarthritis change; including bone cyst, osteophyte and bone sclerosis, were assessed. The bone sclerotic length in patients with osteoarthritis was measured as the slant distance between the bilateral edges of the sclerosis lesion of the acetabulum on the anteroposterior view. RESULTS Preoperative less hip flexion (hazard ratio [HR]: 0.98; 95% CI: 0.97-0.99), osteoarthritis (HR: 3.15; 95% CI: 1.02-9.70) and the bone sclerotic length (HR: 1.83; 95% CI: 1.35-2.48) were independent risk factors determining the malseating of ceramic liners. Receiver operating characteristic curve analysis showed that a bone sclerotic length of 24.6mm was defined as the cut-off point for the malseating of the ceramic liner. DISCUSSION Age, preoperative less flextion, osteoarthritis, and the bone sclerotic were independent risk factors determining malseating of ceramic liners. The acetabular shell can also deform upon insertion of the cup with sclerotic bone of the acetabulum and prevent correct seating of liners. Therefore, these factors must be taken into consideration when seating the ceramic liner. LEVEL OF EVIDENCE Case control study III, case control retrospective design.
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Affiliation(s)
- Yoshitoshi Higuchi
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Japan 466-8550.
| | - Taisuke Seki
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Japan 466-8550
| | - Yasuhiko Takegami
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Japan 466-8550
| | - Yusuke Osawa
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Japan 466-8550
| | - Taiki Kusano
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Japan 466-8550
| | - Naoki Ishiguro
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Japan 466-8550
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Lau YJ, Sarmah S, Witt JD. 3 rd generation ceramic-on-ceramic cementless total hip arthroplasty: a minimum 10-year follow-up study. Hip Int 2018; 28:133-138. [PMID: 29890910 DOI: 10.1177/1120700018768617] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION 3rd generation ceramic bearings were introduced in total hip arthroplasty (THA) with the potential to have better mechanical strength and wear properties than their predecessors. At present, there are few studies looking at the long-term results of this latest generation of ceramic bearings. The purpose of our study was to investigate the long-term clinical and radiographic results of 3rd generation ceramic-on-ceramic THA and the incidence of ceramic specific complications such as squeaking and bearing surface fracture. METHODS The database of the senior author (J.D.W.) was reviewed. A total of 126 hip replacements performed in 108 patients (average age 39.6 years) with an average follow-up of 12.1 years (10-16 years) was identified. Clinical notes and plain radiographs were reviewed. To measure function, patients were contacted and an Oxford Hip Questionnaire was completed. Patients were also directly questioned about the presence of squeaking or any other sounds from the hip. Radiographs were evaluated for signs of wear, osteolysis, loosening and heterotopic ossification. The abduction angle of the acetabular component was measured. RESULTS The average Oxford Hip Score was 39.8 out of 48. Survivorship at 10 years was 94.6% (95% CI) with revision for any cause as the endpoint. There was 1 femoral head fracture, no osteolysis, no squeaking and no detectable wear. CONCLUSIONS The good clinical and radiographic results for this series of patients are similar to other recent long-term studies looking at 3rd generation ceramic-on-ceramic THA. The results compare favourably with other bearing surfaces. The lack of osteolysis associated with this articulation is encouraging and may also make it a good choice for younger patients requiring total hip replacement.
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Immunological Responses to Total Hip Arthroplasty. J Funct Biomater 2017; 8:jfb8030033. [PMID: 28762999 PMCID: PMC5618284 DOI: 10.3390/jfb8030033] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 07/19/2017] [Accepted: 07/25/2017] [Indexed: 12/12/2022] Open
Abstract
The use of total hip arthroplasties (THA) has been continuously rising to meet the demands of the increasingly ageing population. To date, this procedure has been highly successful in relieving pain and restoring the functionality of patients’ joints, and has significantly improved their quality of life. However, these implants are expected to eventually fail after 15–25 years in situ due to slow progressive inflammatory responses at the bone-implant interface. Such inflammatory responses are primarily mediated by immune cells such as macrophages, triggered by implant wear particles. As a result, aseptic loosening is the main cause for revision surgery over the mid and long-term and is responsible for more than 70% of hip revisions. In some patients with a metal-on-metal (MoM) implant, metallic implant wear particles can give rise to metal sensitivity. Therefore, engineering biomaterials, which are immunologically inert or support the healing process, require an in-depth understanding of the host inflammatory and wound-healing response to implanted materials. This review discusses the immunological response initiated by biomaterials extensively used in THA, ultra-high-molecular-weight polyethylene (UHMWPE), cobalt chromium (CoCr), and alumina ceramics. The biological responses of these biomaterials in bulk and particulate forms are also discussed. In conclusion, the immunological responses to bulk and particulate biomaterials vary greatly depending on the implant material types, the size of particulate and its volume, and where the response to bulk forms of differing biomaterials are relatively acute and similar, while wear particles can initiate a variety of responses such as osteolysis, metal sensitivity, and so on.
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Lau YJ, Sarmah S, Witt JD. 3rd generation ceramic-on-ceramic cementless total hip arthroplasty: a minimum 10-year follow-up study. Hip Int 2017:0. [PMID: 28777383 DOI: 10.5301/hipint.5000541] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/20/2017] [Indexed: 02/04/2023]
Abstract
INTRODUCTION 3rd generation ceramic bearings were introduced in total hip arthroplasty (THA) with the potential to have better mechanical strength and wear properties than their predecessors. At present, there are few studies looking at the long-term results of this latest generation of ceramic bearings.The purpose of our study was to investigate the long-term clinical and radiographic results of 3rd generation ceramic-on-ceramic THA and the incidence of ceramic specific complications such as squeaking and bearing surface fracture. METHODS The database of the senior author (J.D.W.) was reviewed. A total of 126 hip replacements performed in 108 patients (average age 39.6 years) with an average follow-up of 12.1 years (10-16 years) was identified. Clinical notes and plain radiographs were reviewed. To measure function, patients were contacted and an Oxford Hip Questionnaire was completed. Patients were also directly questioned about the presence of squeaking or any other sounds from the hip. Radiographs were evaluated for signs of wear, osteolysis, loosening and heterotopic ossification. The abduction angle of the acetabular component was measured. RESULTS The average Oxford Hip Score was 39.8 out of 48. Survivorship at 10 years was 94.6% (95% CI) with revision for any cause as the endpoint. There was 1 femoral head fracture, no osteolysis, no squeaking and no detectable wear. CONCLUSIONS The good clinical and radiographic results for this series of patients are similar to other recent long-term studies looking at 3rd generation ceramic-on-ceramic THA. The results compare favourably with other bearing surfaces. The lack of osteolysis associated with this articulation is encouraging and may also make it a good choice for younger patients requiring total hip replacement.
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Lee YK, Ha YC, Yoo JI, Jo WL, Kim KC, Koo KH. Mid-term results of the BIOLOX delta ceramic-on-ceramic total hip arthroplasty. Bone Joint J 2017; 99-B:741-748. [DOI: 10.1302/0301-620x.99b6.bjj-2016-0486.r3] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 01/18/2017] [Indexed: 11/05/2022]
Abstract
Aims We conducted a prospective study of a delta ceramic total hip arthroplasty (THA) to determine the rate of ceramic fracture, to characterise post-operative noise, and to evaluate the mid-term results and survivorship. Patients and Methods Between March 2009 and March 2011, 274 patients (310 hips) underwent cementless THA using a delta ceramic femoral head and liner. At each follow-up, clinical and radiological outcomes were recorded. A Kaplan-Meier analysis was undertaken to estimate survival. Results Four patients (four hips) died and 18 patients (20 hips) were lost to follow-up within five years. The remaining 252 patients (286 hips) were followed for a mean of 66.5 months (60 to 84). There were 144 men (166 hips) and 108 women (120 hips) with a mean age of 49.7 years (16 to 83) at surgery. The mean pre-operative Harris Hip Score of 47.1 points improved to 93.8 points at final follow-up. Six patients reported squeaking in seven hips; however, none were audible. Radiolucent lines involving Gruen zones one and/or seven were seen in 52 hips (18.2%). No hip had detectable wear, focal osteolysis or signs of loosening. One hip was revised because of fracture of the ceramic liner, which occurred due to an undetected malseating of the ceramic liner at the time of surgery. One hip was revised for a periprosthetic fracture of the femur, and one hip was treated for periprosthetic joint infection. The six-year survivorship with re-operation for any reason as the endpoint was 99.0% (95% confidence interval 97.8% to 100%). Discussion The rate of delta ceramic fracture was 0.3% (one of 286). While ceramic head fracture was dominant in previous ceramic-on-ceramic THA, fracture of the delta ceramic liner due to malseating is a concern. Cite this article: Bone Joint J 2017;99-B:741–8.
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Affiliation(s)
- Y. K. Lee
- Seoul National University Bundang Hospital, 82
Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do
463-707, South Korea
| | - Y. C. Ha
- Chung-Ang University College of Medicine, 102
Heukseok-ro, Dongjak-ku, Seoul
156-755, South Korea
| | - J-I. Yoo
- Gyeongsang National University Hospital, 90
Chilamdong, Jinju, Gyeongnamdo
660-702, South Korea
| | - W. L. Jo
- St. Mary’s Hospital, 222, Banpo-daero, Seocho-gu, Seoul, 06591, South
Korea
| | - K-C. Kim
- Dankook University Hospital, 119
Dandae-ro, Dongnam-gu, Cheonan
si, Chungnam 31116, South
Korea
| | - K. H. Koo
- Seoul National University Bundang Hospital, 82
Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do
463-707, South Korea
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15
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García-Rey E, Cruz-Pardos A, García-Cimbrelo E. The evolution of an uncemented acetabular component in alumina-on-alumina total hip arthroplasty has improved clinical outcome. Bone Joint J 2017; 99-B:749-758. [DOI: 10.1302/0301-620x.99b6.bjj-2016-0045.r3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Accepted: 10/05/2016] [Indexed: 11/05/2022]
Abstract
Aims To determine the effect of a change in design of a cementless ceramic acetabular component in fixation and clinical outcome after total hip arthroplasty Patients and Methods We compared 342 hips (302 patients) operated between 1999 and 2005 with a relatively smooth hydroxyapatite coated acetabular component (group 1), and 337 hips (310 patients) operated between 2006 and 2011 using a similar acetabular component with a macrotexture on the entire outer surface of the component (group 2). The mean age of the patients was 53.5 (14 to 70) in group 1 and 53.0 (15 to 70) in group 2. The mean follow-up was 12.7 years (10 to 17) for group 1 and 7.2 years (4 to 10) for group 2. Results No hips were revised due to complications related to bearing fracture or to stem loosening. A total of 15 acetabular components were revised for aseptic loosening in group 1 and two in group 2. The survival rate for acetabular component aseptic loosening at eight years was 96.8% (95% confidence interval (CI) 94.8 to 98.7) for group 1 and 99.2% (95% CI 98.0 to 100) for group 2. The risk for aseptic loosening of the acetabular component was higher in group 1 (p = 0.04, Hazard Ratio (HR) 4.99), dysplastic acetabula (p = 0.01, HR 4.12), components outside Lewinnek´s zone (p < 0.001, HR 6.13) and in those with a hip rotation centre distance greater than 5 mm (p = 0.005, HR 4.09). Conclusion Alumina ceramic-on-ceramic THA is an excellent option for young patients. Although newer components appeared to improve fixation, acetabular reconstruction is essential to obtain a satisfactory outcome. Cite this article: Bone Joint J 2017;99-B:749–58.
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Affiliation(s)
- E. García-Rey
- Hospital La Paz-Idi Paz, Orthopaedics
Department, Madrid, Spain
| | - A. Cruz-Pardos
- Hospital La Paz-Idi Paz, Orthopaedics
Department, Madrid, Spain
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16
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Incidence of Ceramic Liner Malseating After Ceramic-on-Ceramic Total Hip Arthroplasty Associated With Osteolysis: A 5- to 15-Year Follow-Up Study. J Arthroplasty 2017; 32:1641-1646. [PMID: 28012723 DOI: 10.1016/j.arth.2016.11.044] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 11/10/2016] [Accepted: 11/23/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The aim of our study was to evaluate the clinical and radiographic outcomes of malseating of the acetabular liner in ceramic-on-ceramic total hip arthroplasty (THA). METHODS Outcomes for 160 ceramic-on-ceramic THAs, contributed by 116 women and 39 men, were evaluated. Clinical and radiographic measurements were obtained over a 5- to 15-year follow-up for analysis. RESULTS Liner malseating was identified in 20% of cases. Outcomes for 32 cases with liner malseating (group A) were compared to outcomes for 128 joints with correct liner seating (group B). The Harris hip score at the last follow-up was 90.1 for group A and 89.6 for group B. Osteolysis was identified in 5 cases in group A (15.6%), compared to 3 cases in group B (P < .001). No significant between-group differences were identified with regard to ceramic fracture, audible squeaking, loosening of components, and revision THA. The mean annual liner wear rate was comparable between groups, 0.0045 mm/y for group A and 0.0039 mm/y for group B. The 10-year Kaplan-Meier survivorship, based on an end point of revision THA, was 100% for group A and 99.0% for group B. CONCLUSION Over a moderate-length follow-up of 5-15 years, malseating of the acetabular liner was not associated with negative clinical outcomes or THA survivorship. Malseating did increase the incidence of osteolysis, a risk factor for adverse effects. Long-term follow-up studies are needed to fully quantify the effects of malseating of the acetabular liner.
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17
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Lee YK, Kim KC, Jo WL, Ha YC, Parvizi J, Koo KH. Effect of Inner Taper Angle of Acetabular Metal Shell on the Malseating and Dissociation Force of Ceramic Liner. J Arthroplasty 2017; 32:1360-1362. [PMID: 28007373 DOI: 10.1016/j.arth.2016.11.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 10/26/2016] [Accepted: 11/01/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Malseating of ceramic liner appeared as a matter of concern in multibearing metal, although multibearing cup can be coupled with hard liners as well as polyethylene liner. In this metal shell, the inner taper angle should be 10° for the modularity, while standard metal shells for ceramic liner have an inner taper angle of 18°. However, there has been no study in the effect of taper angle to the risk of malseating. We evaluated whether the taper angle of metal shell might affect the malseating of ceramic liner, and dissociation force of ceramic liner from metal shell. METHODS Three surgeons manually inserted ceramic liners into two designs of metal shell with different tapers angles (10° and 18°). We compared malseating rates of ceramic liners and push-out strengths, which means dissociation force of the ceramic liner from the metal shell, between these two metal shell designs. RESULTS The malseating rates in 10° metal shell were higher than those in 18° metal shell (23.3% vs 0%, P < .05). The mean dissociation force (1148.8 ± 46.7 N) in 10° taper cup was higher than that (389.7 ± 108.3 N) in 18° taper cup (P < .01). CONCLUSION Our results suggest that surgeon should be cautious about malseating of ceramic liner when using multi-bearing metal shell with inner taper angle of 10°. CLINICAL RELEVANCE When surgeon use multi-bearing metal shell with inner taper angle of 10°, our results suggest that surgeon should be cautious about malseating of ceramic liner.
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Affiliation(s)
- Young-Kyun Lee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Ki-Chul Kim
- Department of Orthopedic Surgery, Dankook University Hospital, Cheonan, Chungcheongnam-do, Republic of Korea
| | - Woo-Lam Jo
- Department of Orthopedic Surgery, Catholic University of Korea School of Medicine, Seoul, Seoul, Republic of Korea
| | - Yong-Chan Ha
- Department of Orthopedic Surgery, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Javad Parvizi
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Kyung-Hoi Koo
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
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18
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Schmidt-Braekling T, Renner L, Mintz DN, Waldstein W, Endo Y, Boettner F. Do Changes in the Production Process Affect the Outcome of Ceramic Liners: A 3-Year Follow-Up Study. J Arthroplasty 2017; 32:1314-1317. [PMID: 27876256 DOI: 10.1016/j.arth.2016.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 09/24/2016] [Accepted: 10/09/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND In 2011, the current liner was withdrawn from the market because of the potential risk for liner fracture secondary to increased pressures used to assemble the metal locking ring. The present study provides a short-term follow-up of patients with this implant. METHODS We retrospectively evaluated 63 consecutive hips in 53 patients operated by a single surgeon using a recalled ceramic-on-ceramic bearing. There were 30 women and 23 men with an average age of 50.6 years (range 20.3-63.5 years). The mean follow-up was 36.8 months. RESULTS Six hips in 6 patients were revised (9.5%) because of a liner-fracture during the follow-up period. All liner fractures were identified on computer tomography imaging. Nine patients had self-reported episodes of squeaking (14.3%). All 6 patients that underwent revision surgery for liner fracture described squeaking before revision. There were no revisions for other causes. Two of the revised patients had a subsequent dislocation (33%). CONCLUSION The recalled ceramic liner lots have an increased liner fracture rate. Patients with mechanical symptoms or squeaking should undergo computer tomography to rule out liner facture.
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Affiliation(s)
- Tom Schmidt-Braekling
- Adult Reconstruction & Joint Replacement Division, Hospital for Special Surgery, New York, New York; Department of Orthopedics and Tumor Orthopedics, University of Muenster, Muenster, Germany
| | - Lisa Renner
- Adult Reconstruction & Joint Replacement Division, Hospital for Special Surgery, New York, New York
| | - Douglas N Mintz
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York
| | - Wenzel Waldstein
- Adult Reconstruction & Joint Replacement Division, Hospital for Special Surgery, New York, New York; Department of Orthopedics, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Yoshimi Endo
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York
| | - Friedrich Boettner
- Adult Reconstruction & Joint Replacement Division, Hospital for Special Surgery, New York, New York
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19
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No YJ, Li JJ, Zreiqat H. Doped Calcium Silicate Ceramics: A New Class of Candidates for Synthetic Bone Substitutes. MATERIALS (BASEL, SWITZERLAND) 2017; 10:E153. [PMID: 28772513 PMCID: PMC5459133 DOI: 10.3390/ma10020153] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 01/30/2017] [Accepted: 02/04/2017] [Indexed: 02/06/2023]
Abstract
Doped calcium silicate ceramics (DCSCs) have recently gained immense interest as a new class of candidates for the treatment of bone defects. Although calcium phosphates and bioactive glasses have remained the mainstream of ceramic bone substitutes, their clinical use is limited by suboptimal mechanical properties. DCSCs are a class of calcium silicate ceramics which are developed through the ionic substitution of calcium ions, the incorporation of metal oxides into the base binary xCaO-ySiO₂ system, or a combination of both. Due to their unique compositions and ability to release bioactive ions, DCSCs exhibit enhanced mechanical and biological properties. Such characteristics offer significant advantages over existing ceramic bone substitutes, and underline the future potential of adopting DCSCs for clinical use in bone reconstruction to produce improved outcomes. This review will discuss the effects of different dopant elements and oxides on the characteristics of DCSCs for applications in bone repair, including mechanical properties, degradation and ion release characteristics, radiopacity, and biological activity (in vitro and in vivo). Recent advances in the development of DCSCs for broader clinical applications will also be discussed, including DCSC composites, coated DCSC scaffolds and DCSC-coated metal implants.
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Affiliation(s)
- Young Jung No
- Biomaterials and Tissue Engineering Research Unit, School of AMME, University of Sydney, Sydney 2006, Australia.
| | - Jiao Jiao Li
- Biomaterials and Tissue Engineering Research Unit, School of AMME, University of Sydney, Sydney 2006, Australia.
| | - Hala Zreiqat
- Biomaterials and Tissue Engineering Research Unit, School of AMME, University of Sydney, Sydney 2006, Australia.
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20
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Higuchi Y, Hasegawa Y, Komatsu D, Seki T, Ishiguro N. Survivorship Between 2 Different Ceramic-on-Ceramic Total Hip Arthroplasty With or Without a Metal-Backed Titanium Sleeve Bearing: A 5- to 14-Year Follow-Up Study. J Arthroplasty 2017; 32:155-160. [PMID: 27452136 DOI: 10.1016/j.arth.2016.06.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 05/31/2016] [Accepted: 06/06/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The aim of the study was to compare the clinical and radiographic results of consecutive ceramic-on-ceramic bearings with and without a metal-backed titanium sleeve in patients undergoing total hip arthroplasty. METHODS Eighty-five patients (64 women and 21 men; average age 55.2 years) were included in the A group without sleeve while 147 patients (116 women and 31 men; average age 54.2 years) were included in the B group with sleeve. Clinical and radiologic measurements at follow-up (range, 5-14 years; average, 8.1 years) were analyzed. RESULTS The mean latest postoperative Harris Hip Score was 89.1 for patients from both groups. One joint (1.2%) in the A group displayed ceramic liner fracture, while no incidences of liner fracture occurred in the B group. Audible squeaking was observed in 1 joint (1.2%) in the A group and 1 (0.7%) in the B group. The mean annual liner rate of wear was 0.0049 and 0.0046 mm/y for the A group and B group, respectively. Three joints in the A group (3.5%) required revision total hip arthroplasty because of individual episodes of aseptic cup loosening, ceramic liner fracture, and infection. One joint in the B group (0.7%) required revision because of progressive osteolysis of the proximal femur. Ten-year Kaplan-Meier survivorship, based on an end point of component loosening and bearing failure, was 97.6% for the A group and 99.3% for the B group. CONCLUSION There were no clinical, radiographic, or survivorship differences between groups.
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Affiliation(s)
- Yoshitoshi Higuchi
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yukiharu Hasegawa
- Department of Hip and Knee Reconstructive Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Daigo Komatsu
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Taisuke Seki
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Ishiguro
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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21
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Lee JM. The Current Concepts of Total Hip Arthroplasty. Hip Pelvis 2016; 28:191-200. [PMID: 28097108 PMCID: PMC5240313 DOI: 10.5371/hp.2016.28.4.191] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 12/08/2016] [Accepted: 12/08/2016] [Indexed: 12/15/2022] Open
Affiliation(s)
- Joong-Myung Lee
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea
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22
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Scholl L, Longaray J, Raja L, Lee R, Faizan A, Herrera L, Thakore M, Nevelos J. Friction in modern total hip arthroplasty bearings: Effect of material, design, and test methodology. Proc Inst Mech Eng H 2016; 230:50-7. [PMID: 26721426 DOI: 10.1177/0954411915619452] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to characterize the effect of a group of variables on frictional torque generated by acetabular components as well as to understand the influence of test model. Three separate test models, which had been previously used in the literature, were used to understand the effect of polyethylene material, bearing design, head size, and material combinations. Each test model differed by the way it simulated rotation of the head, the type of frictional torque value it reported (static vs. dynamic), and the type of motion simulated (oscillating motion vs. continuous motion). It was determined that not only test model may impact product ranking of fictional torque generated but also static frictional torque may be significantly larger than a dynamic frictional torque. In addition to test model differences, it was discovered that the frictional torque values for conventional and highly cross-linked polyethylenes were not statistically significantly different in the more physiologically relevant test models. With respect to bearing design, the frictional torque values for mobile bearing designs were similar to the 28-mm diameter inner bearing rather than the large diameter outer liner. Testing with a more physiologically relevant rotation showed that frictional torque increased with bearing diameter for the metal on polyethylene and ceramic on polyethylene bearings but remained constant for ceramic on ceramic bearings. Finally, ceramic on ceramic bearings produced smaller frictional torque values when compared to metal on polyethylene and ceramic on polyethylene groups.
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23
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Gillespie JA, Kennedy JW, Patil SR, Meek DRM. Noise production in ceramic-on-ceramic total hip arthroplasty is associated with lower patient satisfaction and hip scores. J Orthop 2016; 13:282-4. [PMID: 27408504 DOI: 10.1016/j.jor.2016.06.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 06/23/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Ceramic-on-ceramic total hip arthroplasties (THA) are commonly implanted. We investigated the incidence of noise in ceramic-on-ceramic and determined any association with patient satisfaction and hip scores. METHODS We recruited 140 THA. Questionnaires were completed to assess the incidence and frequency of noise, and satisfaction level. Hip and SF-12 scores were recorded. RESULTS Forty-two patients (30%) were aware of noise production. Patients with noise production had lower satisfaction, mean hip and SF-12 scores than those with silent hips. CONCLUSION Given the high incidence of noise in ceramic-on-ceramic THA, patients should be counselled on this risk pre-operatively.
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Affiliation(s)
- James A Gillespie
- Department of Trauma and Orthopaedics, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow G51 4TF, UK
| | - John W Kennedy
- Department of Trauma and Orthopaedics, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow G51 4TF, UK
| | - Sanjeev R Patil
- Department of Trauma and Orthopaedics, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow G51 4TF, UK
| | - Dominic R M Meek
- Department of Trauma and Orthopaedics, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow G51 4TF, UK
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24
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Waewsawangwong W, Ruchiwit P, Huddleston JI, Goodman SB. Hip arthroplasty for treatment of advanced osteonecrosis: comprehensive review of implant options, outcomes and complications. Orthop Res Rev 2016; 8:13-29. [PMID: 30774467 PMCID: PMC6209358 DOI: 10.2147/orr.s35547] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Surgical treatment for late stage (post-collapse) osteonecrosis of the femoral head is controversial. In these situations, the outcome of joint preservation procedures is poor. There are several arthroplasty options for late-stage disease. The clinical outcomes of hemiarthroplasty and hemiresurfacing are unpredictable because of progressive acetabular cartilage degeneration. Total hip resurfacing may be associated with further vascular insult to the femoral head and early failure of the implant. Total hip replacement with metal-on-conventional polyethylene bearing surfaces has been the gold standard, but implant survivorship is limited in young active patients due to wear and osteolysis. Newer alternative bearing surfaces may have improved wear characteristics, but their durability must be confirmed in longer-term studies.
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Affiliation(s)
| | - Pirapat Ruchiwit
- Department of Orthopedic Surgery, Stanford University, Stanford, CA, USA,
| | - James I Huddleston
- Department of Orthopedic Surgery, Stanford University, Stanford, CA, USA,
| | - Stuart B Goodman
- Department of Orthopedic Surgery, Stanford University, Stanford, CA, USA,
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25
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Piriou P, Ouenzerfi G, Migaud H, Renault E, Massi F, Serrault M. A numerical model to reproduce squeaking of ceramic-on-ceramic total hip arthroplasty. Influence of design and material. Orthop Traumatol Surg Res 2016; 102:S229-34. [PMID: 27033843 DOI: 10.1016/j.otsr.2016.03.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 02/24/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Modern ceramic (CoC) bearings for hip arthroplasty (THA) have been used in younger patients who expect improved survivorship. However, audible squeaking produced by the implant is an annoying complication. Previous numerical simulations were not able to accurately reproduce in vitro and in vivo observations. Therefore, we developed a finite element model to: (1) reproduce in vitro squeaking and validate the model by comparing it with in vivo recordings, (2) determine why there are differences between in vivo and in vitro squeaking frequencies, (3) identify the stem's role in this squeaking, (4) predict which designs and materials are more likely to produce squeaking. HYPOTHESIS A CoC THA numerical model can be developed that reproduces the squeaking frequencies observed in vivo. MATERIAL AND METHODS Numerical methods (finite element analysis [ANSYS]) and experimental methods (using a non-lubricated simulated hip with a cementless 32mm CoC THA) were developed to reproduce squeaking. Numerical analysis was performed to identify the frequencies that cause vibrations perceived as an acoustic emission. The finite element analysis (FEA) model was enhanced by adjusting periprosthetic bone and soft tissue elements in order to reproduce the squeaking frequencies recorded in vivo. A numerical method (complex eigenvalue analysis) was used to find the acoustic frequencies of the squeaking noise. The frequencies obtained from the model and the hip simulator were compared to those recorded in vivo. RESULTS The numerical results were validated by experiments with the laboratory hip simulator. The frequencies obtained (mean 2790Hz with FEA, 2755Hz with simulator, decreasing to 1759Hz when bone and soft tissue were included in the FEA) were consistent with those of squeaking hips recorded in vivo (1521Hz). The cup and ceramic insert were the source of the vibration, but had little influence on the diffusion of the noise required to make the squeaking audible to the human ear. The FEA showed that diffusion of squeaking was due to an unstable vibration of the stem during frictional contact. The FEA predicted a higher rate of squeaking (at a lower coefficient of friction) when TZMF™ alloy is used instead of Ti6Al4V and when an anatomic press-fit stem is used instead of straight self-locking designs. DISCUSSION The current FEA model is reliable; it can be used to assess various stem designs and alloys to predict the different rates of squeaking that certain stems will likely produce. LEVEL OF EVIDENCE Level IV in vitro study.
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Affiliation(s)
- P Piriou
- Clinique du parc, 6, avenue du Morvan, 71400 Autun, France
| | - G Ouenzerfi
- Institut National des Sciences Appliquées de Lyon (INSA), Laboratoire de Mécanique des Contacts et des Structures, bâtiment Jean-d'Alembert, 18-20, rue des Sciences, 69621 Villeurbanne cedex, France
| | - H Migaud
- Université de Lille, Département Universitaire de Chirurgie Orthopédique et de Traumatologie, place de Verdun, 59000 Lille, France.
| | - E Renault
- Tornier, 161, rue Lavoisier, 38334 Montbonnot, France
| | - F Massi
- Institut National des Sciences Appliquées de Lyon (INSA), Laboratoire de Mécanique des Contacts et des Structures, bâtiment Jean-d'Alembert, 18-20, rue des Sciences, 69621 Villeurbanne cedex, France
| | - M Serrault
- Clinique Saint-Dominique, 99, rue de Messei, 61100 Flers, France
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26
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Lee YK, Ha YC, Jo WL, Kim TY, Jung WH, Koo KH. Could larger diameter of 4th generation ceramic bearing decrease the rate of dislocation after THA? J Orthop Sci 2016; 21:327-31. [PMID: 26876620 DOI: 10.1016/j.jos.2016.01.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 12/15/2015] [Accepted: 01/07/2016] [Indexed: 02/09/2023]
Abstract
BACKGROUND Fourth generation (Delta) ceramic bearing was developed to reduce dislocation after total hip arthroplasty (THA) by increasing the head diameter. We tested a hypothesis that 32/36 mm Delta ceramic bearing decreases the dislocation rate. We also evaluated ceramic-related complications and early outcome of this thin liner-on-large head ceramic bearing. METHODS We performed a prospective study on patients who underwent THA with use of 32/36 mm Delta ceramic bearing. The dislocation rate was compared with the historical dislocation rate of third generation 28 mm ceramic bearing. We also evaluated ceramic fracture, squeak, short-term results and survival. Follow-up period was minimum 2 years. RESULTS Between April 2010 and February 2012, we enrolled 250 consecutive patients (278 hips). All patients received cementless prostheses. Four patients (4 hips) who received metal shells ≤ 46 mm and 28 mm heads were excluded. Three patients died and 2 patients were lost within 2 years. The remaining 241 patients (269 hips) were followed for 24-46 months. There were 142 men (161 hips) and 99 women (108 hips) with a mean age of 53.7 years (range, 17-75 years) at the index operation. Dislocation occurred in three hips (1.1%). An old age was a risk factor for dislocation. Ceramic fracture and squeaking did not occur in any patient. Mean Harris hip score was 90.3 points at the latest follow-up. All acetabular and femoral components had bone-ingrowth stability. No hip had detectable wear or osteolysis. The survival was 99.3% in the best case scenario and 97.8% in the worst at 48 months. CONCLUSIONS Total hip arthroplasty with use of 32/36 mm Delta ceramic bearing showed lower incidence of hip dislocation compared with 28 mm third generation ceramic bearing. A caution should be paid to prevent a fall in senile patients even though a large head is used. The short-term results of THA with this type of ceramic articulation are encouraging and we did not find any ceramic-related complications.
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Affiliation(s)
- Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, South Korea.
| | - Woo-Lam Jo
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Tae-Young Kim
- Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Anyang, South Korea
| | - Woon-Hwa Jung
- Department of Orthopaedic Surgery, Murup Hospital, Masan, South Korea
| | - Kyung-Hoi Koo
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
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27
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Chappard D, Bizot P, Mabilleau G, Hubert L. Aluminum and bone: Review of new clinical circumstances associated with Al(3+) deposition in the calcified matrix of bone. Morphologie 2016; 100:95-105. [PMID: 26762722 DOI: 10.1016/j.morpho.2015.12.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 12/01/2015] [Accepted: 12/07/2015] [Indexed: 11/26/2022]
Abstract
Several decades ago, aluminum encephalopathy associated with osteomalacia has been recognized as the major complication of chronic renal failure in dialyzed patients. Removal of aluminum from the dialysate has led to a disappearance of the disease. However, aluminum deposit occurs in the hydroxyapatite of the bone matrix in some clinical circumstances that are presented in this review. We have encountered aluminum in bone in patients with an increased intestinal permeability (coeliac disease), or in the case of prolonged administration of aluminum anti-acid drugs. A colocalisation of aluminum with iron was also noted in cases of hemochromatosis and sickle cell anemia. Aluminium was also identified in a series of patients with exostosis, a frequent benign bone tumor. Corrosion of prosthetic implants composed of grade V titanium (TA6V is an alloy containing 6% aluminum and 4% vanadium) was also observed in a series of hip or knee revisions. Aluminum can be identified in undecalcified bone matrix stained by solochrome azurine, a highly specific stain allowing the detection of 0.03 atomic %. Colocalization of aluminum and iron does not seem to be the fruit of chance but the cellular and molecular mechanisms are still poorly understood. Histochemistry is superior to spectroscopic analyses (EDS and WDS in scanning electron microscopy).
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Affiliation(s)
- D Chappard
- Groupe études remodelage osseux et biomatériaux (GEROM), LHEA, IRIS-IBS institut de biologie en santé, CHU d'Angers, LUNAM université Nantes Angers Le Mans, 49933 Angers cedex, France; Service commun d'imagerie et analyses microscopiques (SCIAM), IRIS-IBS institut de biologie en santé, CHU d'Angers, LUNAM université, 49933 Angers cedex, France.
| | - P Bizot
- Département de chirurgie osseuse, CHU d'Angers, 49933 Angers cedex, France
| | - G Mabilleau
- Groupe études remodelage osseux et biomatériaux (GEROM), LHEA, IRIS-IBS institut de biologie en santé, CHU d'Angers, LUNAM université Nantes Angers Le Mans, 49933 Angers cedex, France; Service commun d'imagerie et analyses microscopiques (SCIAM), IRIS-IBS institut de biologie en santé, CHU d'Angers, LUNAM université, 49933 Angers cedex, France
| | - L Hubert
- Département de chirurgie osseuse, CHU d'Angers, 49933 Angers cedex, France
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Rahman S, Atkins GJ, Findlay DM, Losic D. Nanoengineered drug releasing aluminium wire implants: a model study for localized bone therapy. J Mater Chem B 2015; 3:3288-3296. [PMID: 32262323 DOI: 10.1039/c5tb00150a] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A needle puncture approach using nanoengineered aluminium (Al) wires as drug-releasing implants is explored for localized drug delivery in bone using an ex vivo bone reactor. The wire implants were prepared by electrochemical anodization with the formation of a thin nanoporous alumina (NPA) layer on their surface and pore diameters of 30-35 nm and pore lengths of 10-60 μm. An in vitro drug release study of a model drug from the implants, prepared with different thicknesses of NPA layers (pore lengths), showed a considerable influence on drug release characteristics. The results confirmed that by controlling the pore length it is possible to tune the drug releasing performance of the implants and achieve a sustained release for an extended period. The biocompatibility study of the implants evaluated using human osteoblast cell culture showed strong growth of cells, their spreading and their adhesion to the implant surface. The drug loaded wire implants inserted inside bone by a needle puncture approach are evaluated for ex vivo drug release inside bone using a bone reactor (Zetos). The results demonstrated consistent and slow drug release from implants and distribution inside bone monitored in situ using a live imaging technique. The cross-sectional study of inserted wire implants after an extended period of release confirmed stable and unchanged NPA morphology. Histology of bone in contact with implants indicates the presence of viable osteocytes along the inserted area indicating that this method is a reliable approach and NPA wire implants are harmless devices. Overall, this study demonstrates that needle guided implantation of nanoengineered and drug loaded porous wires could be used as a new drug releasing implants for localized bone therapy and treatment of bone disease such as bacterial infection, healing, and potentially bone cancer.
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Affiliation(s)
- Shafiur Rahman
- School of Chemical Engineering, The University of Adelaide, SA 5005, Australia.
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Kang BJ, Ha YC, Ham DW, Hwang SC, Lee YK, Koo KH. Third-generation alumina-on-alumina total hip arthroplasty: 14 to 16-year follow-up study. J Arthroplasty 2015; 30:411-5. [PMID: 25449586 DOI: 10.1016/j.arth.2014.09.020] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 09/16/2014] [Accepted: 09/23/2014] [Indexed: 02/01/2023] Open
Abstract
Ceramic-on-ceramic articulation has the lowest wear with little osteolysis. However, the wear and osteolysis in long-term follow-up are not known. Another concern is ceramic fracture, which might occur after repeated stress during a long period. Ninety hips (76 patients with a mean age of 47 years) that underwent cementless total hip arthroplasty using third-generation ceramic-on-ceramic articulation were followed for 14-16 years. At final follow-up, there was no measurable ceramic wear and no periprosthetic osteolysis was identified. No ceramic fracture occurred during the follow-up. One hip was revised because of late infection. All prostheses were bone-ingrown. Two patients experienced a grinding sensation. However, no patient had squeak. The mean Harris hip score at the final evaluation was 89 points and the survival rate was 98.9%.
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Affiliation(s)
- Bun-Jung Kang
- Department of Orthopaedic Surgery, Gyeongsang National University School of Medicine, Jinju, South Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Dae-Woong Ham
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Sun-Chul Hwang
- Department of Orthopaedic Surgery, Gyeongsang National University School of Medicine, Jinju, South Korea
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Kyung-Hoi Koo
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
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Abstract
BACKGROUND Ceramic-on-ceramic bearing surfaces were developed to provide an alternate to metal-on-polyethylene to decrease wear-induced osteolysis in total hip arthroplasty patients. In an effort to decrease the risk of ceramic acetabular component fracture or damage during implantation, a raised metal rim was added. QUESTIONS/PURPOSES How many fractures or impingements have occurred in our population of patients with ceramic liners with raised rims? METHODS With IRB-approved consent, a case series was reviewed from a single center registry and 4 of 169 patients were identified who had revision hip surgery with the ceramic liner with a raised metal rim: one for ceramic liner fracture and three for metallosis, pain, and squeaking. Implant alignment and operative findings were reviewed. RESULTS One ceramic liner fracture and three cases of metallosis from impingement of the femoral neck on the posterior elevated metal rim of the acetabular liner were observed at revision. The femoral neck in each patient had a divot that corresponded to a divot in the posterosuperior liner rim. Three of the four patients had audible squeaking or clicking prior to revision. A total of 3% of patients in this series had clinically significant impingement with this implant type. CONCLUSION Acoustic phenomenon in a ceramic on ceramic bearing surface should be investigated with a cross-table lateral radiograph to evaluate component position. If symptomatic impingement is demonstrated, revision should be considered to avoid failure from metallosis or fracture.
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Rahman S, Ormsby R, Santos A, Atkins GJ, Findlay DM, Losic D. Nanoengineered drug-releasing aluminium wire implants: comparative investigation of nanopore geometry, drug release and osteoblast cell adhesion. RSC Adv 2015. [DOI: 10.1039/c5ra10418a] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
In this study, drug-releasing aluminium (Al) wire implants featuring nanoporous alumina (NPA) layers produced by different anodization approaches are systematically investigated as potential platforms for localized drug delivery and bone therapy.
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Affiliation(s)
- Shafiur Rahman
- School of Chemical Engineering
- The University of Adelaide
- Australia
| | - Renee Ormsby
- Centre for Orthopaedics and Trauma Research
- School of Medicine The University of Adelaide
- Australia
| | - Abel Santos
- School of Chemical Engineering
- The University of Adelaide
- Australia
| | - Gerald J. Atkins
- Centre for Orthopaedics and Trauma Research
- School of Medicine The University of Adelaide
- Australia
| | - David M. Findlay
- Centre for Orthopaedics and Trauma Research
- School of Medicine The University of Adelaide
- Australia
| | - Dusan Losic
- School of Chemical Engineering
- The University of Adelaide
- Australia
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Nanoporous Anodic Alumina for Drug Delivery and Biomedical Applications. NANOPOROUS ALUMINA 2015. [DOI: 10.1007/978-3-319-20334-8_11] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Lee YK, Ha YC, Koo KH. Comparison between 28 mm and 32 mm ceramic-on-ceramic bearings in total hip replacement. Bone Joint J 2014; 96-B:1459-63. [DOI: 10.1302/0301-620x.96b11.34358] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Large femoral heads have become popular in total hip replacement (THR) as a method of reducing the risk of dislocation. However, if large heads are used in ceramic-on-ceramic THR, the liner must be thinner, which may increase the risk of fracture. To compare the rates of ceramic fracture and dislocation between 28 mm and 32 mm ceramic heads, 120 hips in 109 patients (51 men and 58 women, mean age 49.2 years) were randomised to THR with either a 28 mm or a 32 mm ceramic articulation. A total of 57/60 hips assigned to the 28 mm group and 55/60 hips assigned to the 32 mm group were followed for at least five years. No ceramic component fractures occured in any patient in either group. There was one dislocation in the 32 mm group and none in the 28 mm group (p = 0.464). No hip had detectable wear, focal osteolysis or prosthetic loosening. In our small study the 32 mm ceramic articulation appeared to be safe in terms of ceramic liner fracture. Cite this article: Bone Joint J 2014;96-B:1459–63.
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Affiliation(s)
- Y. K. Lee
- Department of Orthopaedic Surgery, Seoul
National University Bundang Hospital, 82 Gumi-ro, 173
beon-gil, Bundang-gu, Seongnam
463-707, South Korea
| | - Y. C. Ha
- Department of Orthopaedic Surgery, Chung-Ang
University College of Medicine, 221 Heukseok-dong, Dongjak-gu, Seoul, 156-756, South
Korea
| | - K. H. Koo
- Department of Orthopaedic Surgery, Seoul
National University Bundang Hospital, 82 Gumi-ro, 173
beon-gil, Bundang-gu, Seongnam
463-707, South Korea
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Lee YK, Lee JC, Ha YC, Koo KH. Effect of neck length on third-generation ceramic head failure; finite element and retrieval analysis. J Orthop Sci 2014; 19:587-97. [PMID: 24789359 DOI: 10.1007/s00776-014-0573-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 04/13/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Optimized design using finite element analysis (FEA) has considerably increased the longevity of ceramic implants in total hip arthroplasty. Unlike previous FEA studies, a 28-mm head with a short neck was found to be prone to failure, even with third-generation ceramic. We conducted a finite element analysis of the third-generation ceramic head failure according to neck lengths and a retrieval analysis of the four fractured ceramic heads. METHODS Models of real specimens were created for short-, medium-, and long-neck heads made of alumina, based on data given by the manufacturer and reverse engineering design. Static loading was simulated in a series of five steps to 46 kN, and fatigue loading consisting of 10(7) cycles was simulated in walking (4.3 kN) and high-impact (10 kN) conditions to determine the safety factor. RESULTS Although the maximum principal stress of the long-neck design was the greatest, consistent with a previous FEA study, the safety factor was the lowest at the inner corner between the roof and tapered bore of the ceramic head with the short-neck design in both fatigue-loading conditions. Furthermore, surface analysis of one head revealed that the fracture was propagated from the inner corner between the roof and tapered bore into the base of the ceramic head. CONCLUSION Our results suggest that the short-neck design with a 28-mm ceramic head has a greater potential risk of ceramic failure than other designs.
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Affiliation(s)
- Young-Kyun Lee
- Department of Orthopedic Surgery, Seoul National University Bundnag Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 463-707, South Korea
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Lee TH, Moon YW, Lim SJ, Park YS. Meta-analysis of the Incidence and Risk Factors for Squeaking after Primary Ceramic-on-ceramic Total Hip Arthroplasty in Asian Patients. Hip Pelvis 2014; 26:92-8. [PMID: 27536565 PMCID: PMC4971122 DOI: 10.5371/hp.2014.26.2.92] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 05/08/2014] [Accepted: 05/30/2014] [Indexed: 12/12/2022] Open
Abstract
Purpose The purpose of this study was to assess the squeaking incidence and risk factors after primary ceramic-on-ceramic total hip arthroplasty (THA) in Asian patients using meta-analysis. Materials and Methods We performed a meta-analysis of published data on the squeaking incidence and risk factors from 2000 to 2013. Eight studies in Asians were analyzed for both squeaking incidence and risk factors and 25 studies in Western patients were analyzed for squeaking incidence. The data collected were: patient factors, surgical factors and implantation factors. Results The overall incidence of hip squeaking was 2.7% in Asians and 3.1% in Westerners. This difference was not statistically significant. The only significant risk factor was an increase in the acetabular cup abduction angle. Of the factors, the cup abduction angle was the only significant risk factor for the occurrence rate of squeaking, and the occurrence rate tended to increase with increasing angle. Conclusion The incidence of squeaking in Asians after primary ceramic-on-ceramic THA is 2.7% and is similar to that in Westerners. The increased cup abduction angle is associated with squeaking; therefore, surgeons should be careful not to implant the cup at a too steep abduction angle.
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Affiliation(s)
- Tae-Hun Lee
- Department of Orthopedic Surgery, Pohang St. Mary's Hospital, Pohang, Korea
| | - Young-Wan Moon
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung-Jae Lim
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Youn-Soo Park
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Abstract
BACKGROUND AND PURPOSE Ceramic-on-ceramic (CoC) bearings have been in use in total hip replacement (THR) for more than 40 years, with excellent long-term survivorship. Although there have been several simulator studies describing the performance of these joints, there have only been a few retrieval analyses. The aim of this study was to investigate the wear patterns, the surface properties, and friction and lubrication regimes of explanted first-generation alumina bearings. MATERIALS AND METHODS We studied 9 explanted CoC bearings from Autophor THRs that were revised for aseptic loosening after a mean of 16 (range 7-19) years. The 3D surface roughness profiles of the femoral heads and acetabular cups (Srms, Sa, and Ssk) were measured to determine the microscopic wear. The bearings were imaged using an atomic-force microscope in contact mode, to produce a topographical map of the surfaces of the femoral heads. Friction tests were performed on the bearing couples to determine the lubrication regime under which they were operating during the walking cycle. The diametral clearances were also measured. RESULTS 3 femoral heads showed stripe wear and the remaining 6 bearings showed minimal wear. The femoral heads with stripe wear had significantly higher surface roughness than the minimally worn bearings (0.645 vs. 0.289, p = 0.04). High diametral clearances, higher than expected friction, and mixed/boundary lubrication regimes prevailed in these retrieved bearings. INTERPRETATION Despite the less than ideal tribological factors, these first-generation CoC bearings still showed minimal wear in the long term compared to previous retrieval analyses.
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Affiliation(s)
- Muhammad Korim
- University Hospitals of Leicester, Leicester General Hospital, Leicester
| | - Susan Scholes
- School of Mechanical and Systems Engineering, Newcastle University, Newcastle
| | - Anthony Unsworth
- School of Engineering and Computing Sciences, Durham University, Durham, UK.
| | - Richard Power
- University Hospitals of Leicester, Leicester General Hospital, Leicester
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Failure analysis of sandwich-type ceramic-on-ceramic hip joints: A spectroscopic investigation into the role of the polyethylene shell component. J Mech Behav Biomed Mater 2014; 31:55-67. [DOI: 10.1016/j.jmbbm.2013.01.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 01/14/2013] [Indexed: 11/23/2022]
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D’Antonio JA, Capello WN, Naughton M. High survivorship with a titanium-encased alumina ceramic bearing for total hip arthroplasty. Clin Orthop Relat Res 2014; 472:611-6. [PMID: 23543419 PMCID: PMC3890188 DOI: 10.1007/s11999-013-2943-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although ceramic-on-ceramic bearings for total hip arthroplasty (THA) show promising results in terms of bearing-surface wear, fracture of the bearing, insertional chips, and squeaking remain a concern. QUESTIONS/PURPOSES Our primary objective of this report was to determine overall survivorship of a titanium-encased ceramic-on-ceramic bearing couple. Our secondary objectives were to evaluate for ceramic fracture, insertional chips, osteolysis, and device squeaking. METHODS Six surgeons at six institutions implanted 194 patients (209 hips) with an average age of 52 years with cementless hips and alumina ceramic bearings. One hundred thirty-seven patients (146 hips) have 10-year followup (70%). We determined Kaplan-Meier survivorship of the bearing surface and implant system and collected radiographic and clinical data to evaluate for osteolysis and squeaking. RESULTS Survivorship using revision for any reason as the end point was 97% at 10 years and survivorship end point bearing surface failure or aseptic loosening of 99%. There was one ceramic insert fracture (0.5%), there were no insertional chips, there was no visible osteolysis on AP and lateral radiographs, and there was a 1% patient-self-reported incidence of squeaking at the last clinical followup. Six hips underwent revision (3.7%). CONCLUSIONS Ceramic bearings for THA with a titanium-encased insert have high survivorship at 10 years followup and a fracture risk of 0.5%. We found at last followup on routine radiographs no evidence of osteolysis, and no patient has been revised for squeaking or has reported dissatisfaction with the clinical result because of noise. IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- James A. D’Antonio
- Greater Pittsburgh Orthopaedics Association, 725 Cherrington Parkway, Suite 200, Moon Township, PA 15108 USA
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Guillemot F. Recent advances in the design of titanium alloys for orthopedic applications. Expert Rev Med Devices 2014; 2:741-8. [PMID: 16293101 DOI: 10.1586/17434440.2.6.741] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
To increase an orthopedic implant's lifetime, research trends have included the development of new titanium alloys made of nontoxic elements with suitable mechanical properties (low Young's modulus - high fatigue strength), good workability and corrosion resistance. In accordance with the background on titanium and metallic biomaterials, recent interesting developments in titanium-based biomaterials are reported in this review, with a special emphasis on the design of new metastable beta-titanium alloys for orthopedic applications. In addition, as the concept of titanium alloys can now be regarded as relatively old, having emerged at the beginning of the 1980s, the author suggests some future directions that would permit the emergence of a new generation of titanium implants.
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Affiliation(s)
- Fabien Guillemot
- INSERM U-577 Biomatériaux et Réparation Tissulaire, Université Victor Segalen Bordeaux 2, 146 rue Léo Saignat, 33076 Bordeaux Cedex, France.
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Revision of ceramic head fracture after third generation ceramic-on-ceramic total hip arthroplasty. J Arthroplasty 2014; 29:214-8. [PMID: 23683525 DOI: 10.1016/j.arth.2013.04.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 04/09/2013] [Accepted: 04/11/2013] [Indexed: 02/01/2023] Open
Abstract
We performed 24 revisions of fractures of third generation ceramic heads. The stem was not changed in 20 revisions; a new ceramic-on-ceramic bearing was used in four and a metal-on-polyethylene bearing in 16. The stem was changed in four revisions; a new ceramic-on-ceramic bearing was used in three and a metal-on-polyethylene bearing in one. During the follow-up of 57.5 months, complications occurred in five hips among the 20 stem retained revisions: a fracture of the new ceramic head in two, metallosis with pseudocyst in two, and femoral osteolysis with stem loosening in one. However, there were no complications in the four revisions where the stem was changed. Revision surgery after ceramic head fracture shows high rates of early complications. We recommend stem revision in cases of THA failure due to fracture of a modern ceramic head.
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Garino JP. The reliability of modern alumina bearings in total hip arthroplasty—Update to a 2006 report. ACTA ACUST UNITED AC 2013. [DOI: 10.1053/j.sart.2014.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
Total hip arthroplasty is an effective treatment option for advanced hip arthritis in elderly patients. Studies in young patients have traditionally shown less durable results. With current implants, surgical technique, and cementless fixation methods, the durability of total hip arthroplasty may now be related to the wear performance of the bearing surfaces. To improve implant longevity, there are several bearing surface choices currently available for this demanding group of patients. Alternatives must be evaluated in terms of the risks and benefits associated with each articulation, and all new technologies must be carefully monitored over the long term.
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Choy WS, Kim KJ, Lee SK, Bae KW, Hwang YS, Park CK. Ceramic-on-ceramic total hip arthroplasty: minimum of six-year follow-up study. Clin Orthop Surg 2013; 5:174-9. [PMID: 24009902 PMCID: PMC3758986 DOI: 10.4055/cios.2013.5.3.174] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 03/26/2013] [Indexed: 11/28/2022] Open
Abstract
Background This study examines the clinical and radiologic results of ceramic-on-ceramic total hip arthroplasties with regard to wear, osteolysis, and fracture of the ceramic after a minimum follow-up of six years. Methods We evaluated the results of a consecutive series of 148 primary ceramic-on-ceramic total hip arthroplasties that had been performed between May 2001 and October 2005 in 142 patients. The mean age was 57.2 years (range, 23 to 81 years). The mean follow-up period was 7.8 years (range, 6.1 to 10.1 years). Preoperative diagnosis was avascular necrosis in 77 hips (52%), degenerative arthritis in 36 hips (24.3%), femur neck fracture in 18 hips (12.2%), rheumatoid arthritis in 15 hips (10.1%), and septic hip sequelae in 2 hips (1.4%). Clinical results were evaluated with the Harris hip score, and the presence of postoperative groin or thigh pain. Radiologic analysis was done with special attention in terms of wear, periprosthetic osteolysis, and ceramic failures. Results The mean Harris hip score improved from 58.3 (range, 10 to 73) to 92.5 (range, 79 to 100) on the latest follow-up evaluation. At final follow-up, groin pain was found in 4 hips (2.7%), and thigh pain was found in 6 hips (4.1%). Radiologically, all femoral stems demonstrated stable fixations without loosening. Radiolucent lines were observed around the stem in 25 hips (16.9%), and around the cup in 4 hips (2.7%). Endosteal new bone formation was observed around the stem in 95 hips (64.2%) and around the cup in 88 hips (59.5%). No osteolysis was observed around the stem and cup. There were 2 hips (1.4%) of inclination changes of acetabular cup, 2 hips (1.4%) of hip dislocation, 1 hip (0.7%) of ceramic head fracture, and 1 hip (0.7%) of squeaking. The Kaplan-Meier survival rate of the prostheses was 98.1% at postoperative 7.8 years. Conclusions The ceramic-on-ceramic total hip arthroplasty produced excellent clinical results and implant survival rates with no detectable osteolysis on a minimum six-year follow-up study. The ceramic-on-ceramic couplings could be a reasonable option of primary total hip arthroplasty for variable indications.
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Affiliation(s)
- Won-Sik Choy
- Department of Orthopaedic Surgery, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
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Treccani L, Yvonne Klein T, Meder F, Pardun K, Rezwan K. Functionalized ceramics for biomedical, biotechnological and environmental applications. Acta Biomater 2013; 9:7115-50. [PMID: 23567940 DOI: 10.1016/j.actbio.2013.03.036] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 03/21/2013] [Accepted: 03/23/2013] [Indexed: 12/12/2022]
Abstract
Surface functionalization has become of paramount importance and is considered a fundamental tool for the development and design of countless devices and engineered systems for key technological areas in biomedical, biotechnological and environmental applications. In this review, surface functionalization strategies for alumina, zirconia, titania, silica, iron oxide and calcium phosphate are presented and discussed. These materials have become particularly important concerning the aforementioned applications, being not only of great academic, but also of steadily increasing human and commercial, interest. In this review, special emphasis is given to their use as biomaterials, biosensors, biological targets, drug delivery systems, implants, chromatographic supports for biomolecule purification and analysis, and adsorbents for toxic substances and pollutants. The objective of this review is to provide a broad picture of the enormous possibilities offered by surface functionalization and to identify particular challenges regarding surface analysis and characterization.
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Affiliation(s)
- Laura Treccani
- University of Bremen, Advanced Ceramics, Am Biologischen Garten 2, 28359 Bremen, Germany.
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45
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Liudahl AA, Liu SS, Goetz DD, Mahoney CR, Callaghan JJ. Metal on metal total hip arthroplasty using modular acetabular shells. J Arthroplasty 2013; 28:867-71. [PMID: 23489729 DOI: 10.1016/j.arth.2012.10.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Revised: 07/27/2012] [Accepted: 10/26/2012] [Indexed: 02/01/2023] Open
Abstract
Metal on metal bearings were reintroduced into the United States for use in total hip arthroplasty approximately a decade ago. We evaluated a consecutive series cohort of 148 patients with 169 hips who underwent THR using a metal on metal bearing surface with a modular acetabular shell that had fixation augmentation with dome screws. At 3 to 8 year follow-up, average 4.7 years, only one component was revised (for femoral loosening). 3 hips demonstrated proximal femoral osteolysis and 3 hips demonstrated pelvic osteolysis. The average follow-up Harris Hip Score was 94 (range, 57-100). Although the results have been excellent, we continue to closely monitor these hips for any long term failures, or concerns.
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Affiliation(s)
- Adam A Liudahl
- University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242, USA
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Esposito C, Maclean F, Campbell P, Walter WL, Walter WK, Bonar SF. Periprosthetic tissues from third generation alumina-on-alumina total hip arthroplasties. J Arthroplasty 2013; 28:860-6. [PMID: 23489720 DOI: 10.1016/j.arth.2012.10.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 10/22/2012] [Accepted: 10/23/2012] [Indexed: 02/01/2023] Open
Abstract
The histological features of periprosthetic tissues are related to the bioreactivity of particles generated by the prosthesis. This study analyzed synovial-like pseudocapsules collected from 21 patients with alumina ceramic-on-ceramic hip arthroplasties and correlated histological features with wear of the ceramic bearings, duration of implantation and clinical factors such as neck-to-rim impingement. A histopathological classification system was developed for this purpose. The pseudocapsules were viable, with few foreign body type giant cells and occasional lymphocytes. This differs from tissues in polyethylene containing hip arthroplasties which often have extensive foreign body type inflammatory changes or from metal-on-metal hip arthroplasties in which extensive necrosis is common. Soft-tissue inflammation was not associated with failure of the hip arthroplasties, and may be clinically insignificant in alumina-on-alumina total hip arthroplasties.
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Large diameter metal on metal articulations. Comparison of total hip arthroplasty and hip resurfacing arthroplasty. J Arthroplasty 2013; 28:650-3. [PMID: 23140992 DOI: 10.1016/j.arth.2012.07.032] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2012] [Revised: 06/18/2012] [Accepted: 07/05/2012] [Indexed: 02/01/2023] Open
Abstract
The use of large diameter metal bearing total hip arthroplasty (THA) and hip resurfacing arthroplasty (HRA) increased in popularity in the last decade. More recent literature has highlighted the effect of head size in patient outcomes. Data was obtained from the Australian Orthopaedic Association National Joint Replacement Registry (AOA-NJRR) to evaluate the Birmingham (MoM) bearing surface when used with THA and HRA. There is no difference in the overall rate of revision between the THA and HRA but head size has a significant effect on revision rate. The data show that small diameter metal bearings in HRA (below 50mm) have a higher rate of revision than large diameter metal bearings in HRA (equal to and above 50mm) (P<.001). Conversely the large diameter metal bearings in THA have a higher rate of revision than the small diameter metal bearings in THA (P=.027). The revision rate for large diameter HRA compared to small diameter THA is not significantly different P=.670. We recommend caution when choosing either a large diameter (≥50mm) metal on metal THA or small diameter (<50mm) HRA.
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In-situ electrochemical study of interaction of tribology and corrosion in artificial hip prosthesis simulators. J Mech Behav Biomed Mater 2012. [PMID: 23182693 DOI: 10.1016/j.jmbbm.2012.08.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The second generation Metal-on-Metal (MoM) hip replacements have been considered as an alternative to commonly used Polyethylene-on-Metal (PoM) joint prostheses due to polyethylene wear debris induced osteolysis. However, the role of corrosion and the biofilm formed under tribological contact are still not fully understood. Enhanced metal ion concentrations have been reported widely from hair, blood and urine samples of patients who received metal hip replacements and in isolated cases when abnormally high levels have caused adverse local tissue reactions. An understanding of the origin of metal ions is really important in order to design alloys for reduced ion release. Reciprocating pin-on-plate wear tester is a standard instrument to assess the interaction of corrosion and wear. However, more realistic hip simulator can provide a better understanding of tribocorrosion process for hip implants. It is very important to instrument the conventional hip simulator to enable electrochemical measurements. In this study, simple reciprocating pin-on-plate wear tests and hip simulator tests were compared. It was found that metal ions originated from two sources: (a) a depassivation of the contacting surfaces due to tribology (rubbing) and (b) corrosion of nano-sized wear particles generated from the contacting surfaces.
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Cai P, Hu Y, Xie J. Large-diameter Delta ceramic-on-ceramic versus common-sized ceramic-on-polyethylene bearings in THA. Orthopedics 2012; 35:e1307-13. [PMID: 22955394 DOI: 10.3928/01477447-20120822-14] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The higher failure rate of total hip arthroplasty (THA) in young, active patients remains a challenge for surgeons. Recently, larger-diameter femoral heads combined with an alumina matrix composite ceramic (BIOLOX Delta; CeramTec AG, Plochingen, Germany) articulation was developed to improve implant longevity and meet patients' activity demands while reducing the risk of component-related complications. The purpose of this study was to determine whether this new device may provide advantages for young, active patients. A prospective, randomized, controlled trial was conducted on 93 patients (113 THAs) with more than 3 years of follow-up. Patients were randomly divided into a study group (51 THAs) with a 36-mm Delta ceramic-on-ceramic (COC) articulation and a control group (62 THAs) with a common-sized alumina ceramic head on polyethylene liner (COP) articulation. Clinical and radiographic results were collected to compare the outcomes and complications, including implant-related failures, osteolysis, and noises. The large-diameter Delta COC articulation provided greater range of motion improvement (6.1° more), similar Harris Hip Scores, and similar complication rates compared with the alumina COP articulation. This study suggests that in the short term, the large-diameter Delta COC articulation results in better range of motion with no higher complication rates; however, mid-term (8-10 years) or longer follow-up is necessary to determine its superiority in young, active patients.
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Affiliation(s)
- Pengde Cai
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
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Abstract
Over the past three decades, alumina ceramic, now in its third/fourth generation, has been markedly improved in terms of its mechanical properties, including purity, grain microstructure, and burst strength. In the clinic, it is particularly suitable for young and for very active patients. This paper discusses the development and characteristics of different kinds of ceramics. In addition, ceramics in the third/fourth generation which are used in total hip arthroplasty clinically are reviewed in detail.
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Affiliation(s)
- You-zhi Cai
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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