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Duske K, Turan B, Prinz C, Lenz JH, Stahl F, Warkentin M. Functionality testing of an innovative biomechanically optimized and surface-modified orthodontic mini-screw-a comparative study. J Orofac Orthop 2024:10.1007/s00056-023-00508-9. [PMID: 38224419 DOI: 10.1007/s00056-023-00508-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 10/09/2023] [Indexed: 01/16/2024]
Abstract
PURPOSE The failure rate of orthodontic mini-screws depends strongly on primary stability and, thus, on insertion torque. Further improvement regarding the failure rate might be achieved by modifying the surface coating. Therefore, the aim of the study was to investigate the stability of a newly designed and surface-modified orthodontic mini-screw in beagle dogs. METHODS Newly designed mini-screws coated either with DOTIZE® or DOTIZE®-copper (DOT GmbH, Rostock, Germany; each: n = 24) were inserted in the mandibles of eight beagle dogs for a duration of 8 months. Insertion and removal torque were measured. These data were compared to values generated by using the artificial bone material Sawbones® (Sawbones Europe AB, Malmö, Sweden). Experiments with and without torque limitation (each: n = 5) were run. The bone-to-implant contact rate and the amount of bone between the threads were examined. Statistical significance was set at P < 0.05. RESULTS The success rates of the in vivo study reached high levels with 95.3% for the DOTIZE-coated and 90.5% for the DOTIZE-copper-coated screws, whereas the insertion and removal torque did not differ between the coatings. During insertion, a torque limitation of 20 Ncm was necessary to ensure that the recommended limit was not exceeded. The insertion in Sawbones without torque limitation revealed a significantly higher torque compared to torque-limited insertion (18.2 ± 1.3 Ncm, 23.6 ± 1.3 Ncm). Bending occurred (n = 5) in the thread-free part of the mini-screw. CONCLUSIONS Surface coating might be able to improve the performance of orthodontic mini-screws. The study showed high success rates and stable mini-screws until the end of observation. Further investigations are necessary.
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Affiliation(s)
- Kathrin Duske
- Department of Orthodontics, University Dental School, Rostock University Medical Center, Strempelstr. 13, 18057, Rostock, Germany.
| | - Billan Turan
- Department of Orthodontics, University Dental School, Rostock University Medical Center, Strempelstr. 13, 18057, Rostock, Germany
| | | | - Jan Hendrik Lenz
- Department of Oral and Maxillofacial Surgery, Rostock University Medical Center, Rostock, Germany
| | - Franka Stahl
- Department of Orthodontics, University Dental School, Rostock University Medical Center, Strempelstr. 13, 18057, Rostock, Germany
| | - Mareike Warkentin
- Working Group for Implant Materials, Faculty of Mechanical Engineering and Marine Technologies, University of Rostock, Rostock, Germany
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Bonit Coating Leads to Macroscopic Bone Ingrowth at 8 Weeks After Primary Total Hip Arthroplasty. Arthroplast Today 2022; 16:203-206. [PMID: 35874147 PMCID: PMC9304667 DOI: 10.1016/j.artd.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/04/2022] [Accepted: 06/06/2022] [Indexed: 11/21/2022] Open
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Premkumar A, Nishtala SN, Nguyen JT, Bostrom MPG, Carli AV. The AAHKS Best Podium Presentation Research Award: Comparing the Efficacy of Irrigation Solutions on Staphylococcal Biofilm Formed on Arthroplasty Surfaces. J Arthroplasty 2021; 36:S26-S32. [PMID: 33750633 DOI: 10.1016/j.arth.2021.02.033] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/19/2021] [Accepted: 02/09/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND A diverse array of antibacterial solutions is utilized by orthopedic surgeons in an attempt to disperse bacterial biofilm. Few studies compare these agents against biofilm grown on clinically relevant orthopedic biomaterials, such as plastic, acrylic cement, and porous titanium. METHODS MSSA biofilm was grown on plastic 48-well plates, polymethylmethacrylate cement beads and porous Ti-6Al-4V acetabular screw caps. Antibacterial solutions were tested according to manufacturer guidance and included: isotonic saline, vancomycin (1 mg/mL), polymyxin-bacitracin (500,000 U/L-50,000 U/L), povidone-iodine 0.3%, povidone-iodine 10%, a 1:1 combination of povidone-iodine 10% & 4% hydrogen peroxide, polyhexamethylene biguanide (PHMB) and betaine 0.04%, a commercial solution containing chlorhexidine gluconate (CHG) 0.05%, and a commercial solution containing benzalkonium chloride and ethanol. Twenty four and 72-hour biofilms were exposed to solutions for 3 minutes to reproduce intraoperative conditions. Solution efficacy was measured through sonication of treated surfaces followed by counting colony forming units and validated with a resazurin assay to assess cell viability. Experiments were performed in triplicate and repeated at least once. A three-fold log reduction in CFU counts versus controls was considered as a measure of solution efficacy. RESULTS Saline, vancomycin and polymyxin-bacitracin were ineffective compared to other solutions against planktonic MSSA. Povidone-iodine 10% and a 1:1 solution of povidone-iodine 10% and 4% hydrogen peroxide were the only effective solutions against biofilm across all three surfaces and time points. CONCLUSION Commercial antibacterial solutions vary significantly in their efficacy against MSSA biofilm. Efficacy globally decreased as biofilm maturity increased. Increased solution cost did not confer increased efficacy.
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Affiliation(s)
- Ajay Premkumar
- Hospital for Special Surgery, Adult Reconstruction & Joint Replacement, NY
| | | | | | | | - Alberto V Carli
- Hospital for Special Surgery, Adult Reconstruction & Joint Replacement, NY
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Kruijntjens DSMG, van Kuijk SMJ, van Steenbergen LN, Jutten LMC, Arts JJC, ten Broeke RHM. Survival and reasons for revision of the uncemented Symax hip stem: A Dutch Arthroplasty Register study. PLoS One 2021; 16:e0248483. [PMID: 33711061 PMCID: PMC7954353 DOI: 10.1371/journal.pone.0248483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 02/27/2021] [Indexed: 11/19/2022] Open
Abstract
AIMS Previous studies have already shown early proximal ingrowth, fast osseous integration, and a stable fit of the uncemented Symax hip stem, with excellent clinical and radiographic performance. Aims were to evaluate cumulative revision rates and reasons for revision of the Symax hip stem using Dutch Arthroplasty Register (LROI) data and to assess possible associations between patient characteristics and revision rate of the Symax hip stem. PATIENTS AND METHODS All total hip arthroplasties with the uncemented Symax hip stem registered in the LROI between 2007 and 2017 were included (n = 5,013). Kaplan-Meier survival analysis was performed to assess the cumulative 1, 5 and 7-year revision percentages. Cox proportional hazard regression analysis was performed to assess the association between patient and procedural characteristics, and revision arthroplasty of the stem. RESULTS Cumulative 1, 5, and 7-year revision rates (with 95% confidence interval (CI)) for revision of any component were 1.5% (CI 1.2%-1.8%), 3.2% (CI 2.7%-3.7%), and 3.8% (CI 3.1%-4.4%) respectively. Cumulative 1, 5, and 7-year stem revision rates of the Symax hip stem were 0.9% (CI 0.6%-1.1%), 1.5% (CI 1.1%-1.9%), and 1.7% (CI 1.3%-2.1%) respectively. Periprosthetic fractures (n = 35) and loosening of the stem (n = 30) were the most common reasons for revision of the stem. Revision of the stem was associated with acute fracture as primary diagnosis (Hazard Ratio (HR) 2.4 (CI 1.3-4.3)), or history of a previous surgery to the affected hip (HR 2.7 (CI 1.4-5.2)). CONCLUSION This population-based registry study shows revision rates for the Symax hip stem comparable to those for best performing uncemented total hip arthroplasties in the Netherlands. Primary diagnosis of an acute fracture, and history of previous surgery on the affected hip, were significantly associated risk factors for revision of the Symax hip stem, and we discourage the use of the Symax hip stem in these patients.
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Affiliation(s)
- Dennis S. M. G. Kruijntjens
- Department of Orthopaedic Surgery, Research School Caphri, Maastricht University Medical Centre, Maastricht, The Netherlands
- * E-mail:
| | - Sander M. J. van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Liza N. van Steenbergen
- Dutch Arthroplasty Register (Landelijke Registratie Orthopedische Implantaten), ‘s Hertogenbosch, The Netherlands
| | - Liesbeth M. C. Jutten
- Department of Orthopaedic Surgery, Research School Caphri, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - J. J. Chris Arts
- Department of Orthopaedic Surgery, Research School Caphri, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - René H. M. ten Broeke
- Department of Orthopaedic Surgery, Research School Caphri, Maastricht University Medical Centre, Maastricht, The Netherlands
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Aro HT, Nazari-Farsani S. RSA of the Symax hip stem. Acta Orthop 2020; 91:497-499. [PMID: 32396420 PMCID: PMC8023896 DOI: 10.1080/17453674.2020.1763042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Affiliation(s)
- Hannu T Aro
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands,E-mail:
| | - Sanaz Nazari-Farsani
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
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Kruijntjens DSMG, Koster L, Kaptein BL, Jutten LMC, Arts JJ, Ten Broeke RHM. Early stabilization of the uncemented Symax hip stem in a 2-year RSA study. Acta Orthop 2020; 91:159-164. [PMID: 31928120 PMCID: PMC7144261 DOI: 10.1080/17453674.2019.1709956] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - The uncemented Symax hip stem has shown early proximal ingrowth as result of the BONIT-hydroxyapatite (HA) coating and the distal DOTIZE surface treatment. We evaluated 2-year postoperative radiostereometric analysis (RSA) migration of the Symax hip stem in THA patients. We also investigated the correlation between migration at 4 weeks and clinical outcomes after 2 years.Patients and methods - Patients in a 2-year clinical follow-up single-centre RSA randomized controlled trial were randomized to 2 different cup designs. All 45 patients received a Symax hip stem. RSA migration patterns of the Symax hip stem is presented here as a single cohort. RSA examinations were performed postoperatively, but before weight-bearing, and subsequently after 1, 3, 6, 12, and 24 months. Clinical outcomes and radiographic evaluations were assessed 3, 6, 12, and 24 months postoperatively.Results - During the first 4 weeks, the Symax hip stem subsided, rotated into retroversion, and translated posteriorly, after which the migration ceased and the prosthesis stabilized. All clinical outcomes improved from preoperatively to 2 years. There was no clinically or statistically significant correlation between subsidence and retroversion at 4 weeks and clinical outcomes after 2 years.Interpretation - RSA evaluation of the uncemented Symax hip stem confirms that the design principles and coating properties lead to early stabilization of the stem, as early as 4 weeks postoperatively. There was no correlation between subsidence and retroversion at 4 weeks and clinical outcomes after 2 years. Based on the predictive potential of the RSA technique, we anticipate excellent long-term survival of this hip stem.
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Affiliation(s)
- Dennis S M G Kruijntjens
- Department of Orthopaedic Surgery, Research School Caphri, Maastricht University Medical Centre, Maastricht; ,Correspondence:
| | - Lennard Koster
- Department of Orthopaedic Surgery, RSAcore, Leiden University Medical Centre, Leiden, the Netherlands
| | - Bart L Kaptein
- Department of Orthopaedic Surgery, RSAcore, Leiden University Medical Centre, Leiden, the Netherlands
| | - Liesbeth M C Jutten
- Department of Orthopaedic Surgery, Research School Caphri, Maastricht University Medical Centre, Maastricht;
| | - Jacobus J Arts
- Department of Orthopaedic Surgery, Research School Caphri, Maastricht University Medical Centre, Maastricht;
| | - René H M Ten Broeke
- Department of Orthopaedic Surgery, Research School Caphri, Maastricht University Medical Centre, Maastricht;
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5-year clinical and radiographic follow-up of the uncemented Symax hip stem in an international study. J Orthop Surg Res 2018; 13:191. [PMID: 30064453 PMCID: PMC6069703 DOI: 10.1186/s13018-018-0888-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 07/11/2018] [Indexed: 11/23/2022] Open
Abstract
Background The uncemented Symax hip stem is developed through optimization of the uncemented Omnifit hip stem. The Symax stem design combines an anatomical anteverted proximal geometry with a straight distal section. The proximal part is coated with a biomimetic hydroxyapatite (HA) coating for improved osseointegration to enhance load transfer and to minimize proximal bone loss. The distal part is treated with an anodization surface treatment in order to prevent distal bone apposition, which is expected to prevent distal loading and reduce proximal stress shielding. Aim of this study is to report mid-term clinical performance and evaluate whether the radiographic features are in line with the design principles of the Symax hip. Methods The biomimetic hydroxyapatite-coated uncemented Symax hip stem was evaluated in 80 patients during a 5-year prospective clinical international study. Harris Hip Score (HHS), Oxford Hip Score (OHS), and Western Ontario and McMaster Universities Arthritis Index (WOMAC) were performed preoperatively and postoperatively at 6 months and 1, 2, 3 and 5 years. Anteroposterior radiographs of the pelvis and axial radiographs of the operated hips were evaluated immediately postoperative and at follow-up 6 months and 1, 2, 3, and 5 years. Wilcoxon signed-rank test was used to analyse whether clinical outcome scores changed statistically significant over time. The overall percentage of agreement between two radiology assessment teams was used to evaluate observer agreement of radiology results. The Cohen’s Kappa was evaluated as a measure of reliability to quantify the agreement between raters, corrected for chance agreement. Results Clinical outcome scores were excellent at 5 years with mean HHS of 98.1, mean OHS of 16.2 and mean WOMAC of 6.9. Only 2.7% of the patients had pain at rest or on weight-bearing, and mid-thigh pain was reported by 1.4% of the patients after 5 years. The percentage of agreement between radiology assessment teams was 94 to 100%, except for distal line formation (48%). Radiographic evaluation showed stable stems and signs of excellent progressive proximal fixation and favourable bone remodeling. Conclusions The excellent mid-term clinical and radiographic performances are in line with the design principles and coating properties of this new implant and earlier published results. Trial registration http://ClinicalTrials.gov, NCT03469687. Registered 19 March 2018 – Retrospectively registered.
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Abstract
INTRODUCTION The design of the cementless Symax-HA femoral stem is based on geometrical analysis of human femoral anatomy to optimise the fit within the femur. The stem combines an anatomical proximal section enabling a metaphyseal anchorage with a straight distal section. This results in an improved proximal load transfer. We aimed to determine the overall survival of total hip arthroplasty (THA) in patients operated at our institution with the Symax stem. Secondly, we investigated the cause of revision for patients having THA including the Symax stem. METHODS The study is a registry study with results from a single centre, Vejle Hospital. From the Danish Hip -Arthroplasty Registry, we identified all THAs operated with the Symax stem. The primary outcome was revision. The secondary outcomes were aseptic loosening, periprosthetic fracture, and all other causes for revision. RESULTS In total, 1,055 THAs were performed in 875 patients. The median 6.5-year survival rate was 97.5% (95% confidence interval [CI]: 96.6%-98.3%). 29 THAs had undergone revision due to the following causes: periprosthetic fracture (n = 11); aseptic loosening of the cup (n = 1); infection (n = 5); dislocation (n = 10); and component failure (n = 2). There was no revision due to aseptic loosening of the stem. CONCLUSIONS From the Danish Hip Arthroplasty Registry, we identified the overall 6.5-year survival rate to be 95% for cementless THAs. In the present study, the Symax stem has a median 6.5-year survival rate at 97.5% (96.6%-98.3%). No revisions were due to aseptic loosening but the stem had a relative high prevalence of periprosthetic fractures.
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Bergemann C, Zaatreh S, Wegner K, Arndt K, Podbielski A, Bader R, Prinz C, Lembke U, Nebe JB. Copper as an alternative antimicrobial coating for implants - An in vitro study. World J Transplant 2017; 7:193-202. [PMID: 28698836 PMCID: PMC5487309 DOI: 10.5500/wjt.v7.i3.193] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 04/10/2017] [Accepted: 05/15/2017] [Indexed: 02/05/2023] Open
Abstract
AIM To investigate osteoconductive and antimicrobial properties of a titanium-copper-nitride (TiCuN) film and an additional BONIT® coating on titanium substrates.
METHODS For micro-structuring, the surface of titanium test samples was modified by titanium plasma spray (TPS). On the TPS-coated samples, the TiCuN layer was deposited by physical vapor deposition. The BONIT® layer was coated electrochemically. The concentration of copper ions released from TiCuN films was measured by atomic absorption spectrometry. MG-63 osteoblasts on TiCuN and BONIT® were analyzed for cell adhesion, viability and spreading. In parallel, Staphylococcus epidermidis (S. epidermidis) were cultivated on the samples and planktonic and biofilm-bound bacteria were quantified by counting of the colony-forming units.
RESULTS Field emission scanning electron microscopy (FESEM) revealed rough surfaces for TPS and TiCuN and a special crystalline surface structure on TiCuN + BONIT®. TiCuN released high amounts of copper quickly within 24 h. These release dynamics were accompanied by complete growth inhibition of bacteria and after 2 d, no planktonic or adherent S. epidermidis were found on these samples. On the other hand viability of MG-63 cells was impaired during direct cultivation on the samples within 24 h. However, high cell colonization could be found after a 24 h pre-incubation step in cell culture medium simulating the in vivo dynamics closer. On pre-incubated TiCuN, the osteoblasts span the ridges and demonstrate a flattened, well-spread phenotype. The additional BONIT®coating reduced the copper release of the TiCuN layer significantly and showed a positive effect on the initial cell adhesion.
CONCLUSION The TiCuNcoating inhibits the formation of bacterial biofilms on orthopedic implants by influencing the “race for the surface” to the advantage of osteoblasts.
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Sun Q, Yang Y, Luo W, Zhao J, Zhou Y. The Influence of Electrolytic Concentration on the Electrochemical Deposition of Calcium Phosphate Coating on a Direct Laser Metal Forming Surface. Int J Anal Chem 2017; 2017:8610858. [PMID: 28250771 PMCID: PMC5303588 DOI: 10.1155/2017/8610858] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 12/31/2016] [Accepted: 01/10/2017] [Indexed: 02/05/2023] Open
Abstract
A calcium phosphate (CaP) coating on titanium surface enhances its biocompatibility, thus facilitating osteoconduction and osteoinduction with the inorganic phase of the human bone. Electrochemical deposition has been suggested as an effective means of fabricating CaP coatings on porous surface. The purpose of this study was to develop CaP coatings on a direct laser metal forming implant using electrochemical deposition and to investigate the effect of electrolytic concentration on the coating's morphology and structure by X-ray diffraction, scanning electron microscopy, water contact angle analysis, and Fourier transform infrared spectroscopy. In group 10-2, coatings were rich in dicalcium phosphate, characterized to be thick, layered, and disordered plates. In contrast, in groups 10-3 and 10-4, the relatively thin and well-ordered coatings predominantly consisted of granular hydroxyapatite. Further, the hydrophilicity and cell affinity were improved as electrolytic concentration increased. In particular, the cells cultured in group 10-3 appeared to have spindle morphology with thick pseudopodia on CaP coatings; these spindles and pseudopodia strongly adhered to the rough and porous surface. By analyzing and evaluating the surface properties, we provided further knowledge on the electrolytic concentration effect, which will be critical for improving CaP coated Ti implants in the future.
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Affiliation(s)
- Qianyue Sun
- Department of Dental Implantology, School and Hospital of Stomatology, Jilin University, Changchun, Jilin Province 130021, China
- Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Stomatology Hospital of Guangzhou Medical University, Guangzhou 510140, China
| | - Yuhui Yang
- Department of Orthopaedics, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province 130033, China
| | - Wenjing Luo
- Department of Dental Implantology, School and Hospital of Stomatology, Jilin University, Changchun, Jilin Province 130021, China
| | - Jinghui Zhao
- Department of Dental Implantology, School and Hospital of Stomatology, Jilin University, Changchun, Jilin Province 130021, China
| | - Yanmin Zhou
- Department of Dental Implantology, School and Hospital of Stomatology, Jilin University, Changchun, Jilin Province 130021, China
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Harboe K, Gjerdet NR, Sudmann E, Indrekvam K, Søreide K. Assessment of retention force and bone apposition in two differently coated femoral stems after 6 months of loading in a goat model. J Orthop Surg Res 2014; 9:69. [PMID: 25127722 PMCID: PMC4237892 DOI: 10.1186/s13018-014-0069-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 07/18/2014] [Indexed: 12/02/2022] Open
Abstract
Background Since the introduction of uncemented hip implants, there has been a search for the best surface coating to enhance bone apposition in order to improve retention. The surface coating of the different stems varies between products. The aim was to assess the retention force and bone adaption in two differently coated stems in a weight-bearing goat model. Materials and methods Hydroxyapatite (HA) and electrochemically deposited calcium phosphate (CP; Bonit®) on geometrically comparable titanium-based femoral stems were implanted into 12 (CP group) and 35 (HA group) goats. The animal model included physiological loading of the implants for 6 months. The pull-out force of the stems was measured, and bone apposition was microscopically evaluated. Results After exclusion criteria were applied, the number of available goats was 4 in the CP group and 11 in the HA group. The CP-coated stems had significantly lower retention forces compared with the HA-coated ones after 6 months (CP median 47 N, HA median 1,696 N, p = 0.003). Bone sections revealed a lower degree of bone apposition in the CP-coated stems, with more connective tissue in the bone/implant interface compared with the HA group. Conclusion In this study, HA had better bone apposition and needed greater pull-out force in loaded implants. The application of CP on the loaded titanium surface to enhance the apposition of bone is questioned.
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Affiliation(s)
- Knut Harboe
- Department of Orthopaedic Surgery, Stavanger University Hospital, Stavanger 4068, Norway.
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Scemama C, David B, Bensidhoum M, Hamadouche M. Osseointegration of polyethylene implants coated with titanium and biomimetically or electrochemically deposited hydroxyapatite in a rabbit model. INTERNATIONAL ORTHOPAEDICS 2014; 38:1739-44. [PMID: 24859898 DOI: 10.1007/s00264-014-2364-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 04/21/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study was to evaluate the osseointegration of a new coating directly deposited on PE at room temperature. METHODS Thirty-six (36) male New Zealand rabbits were randomly assigned to receive one out of three types of implants: two tested implants, i.e. PE implant coated with TiPVD and biomimetic HA (biomimetic), PE implant coated with TiPVD and electrolytic HA (electrolytic), and positive control made of massive microrough titanium coated with plasma sprayed HA (TiHAPS). Osseointegration was evaluated by histomorphometry (bone tissue in contact [BIC]), mineralized bone area [MBA]) and mechanical testing (push-out test, interfacial shear strength [ISS]) at six and 12 weeks in the distal femurs. RESULTS For BIC there were no differences between the groups at six (p = 0.98) and 12 weeks (p = 0.13). For MBA, no statistically significant difference was measured between groups at six (p = 0.52) and 12 weeks (p = 0.57). At six weeks, interfacial shear strength (ISS) was significantly higher (p = 0.01) for TiHAPs implants compared to biomimetic and electrolytic implants. This difference was not significant at 12 weeks (p = 0.92). CONCLUSION The osseointegration of biomimetic and electrolytic implants was equivalent to a positive control at 12 weeks.
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ten Broeke RHM, Tarala M, Arts JJ, Janssen DW, Verdonschot N, Geesink RGT. Improving peri-prosthetic bone adaptation around cementless hip stems: a clinical and finite element study. Med Eng Phys 2013; 36:345-53. [PMID: 24378381 DOI: 10.1016/j.medengphy.2013.12.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 11/20/2013] [Accepted: 12/01/2013] [Indexed: 10/25/2022]
Abstract
This study assessed whether the Symax™ implant, a modification of the Omnifit(®) stem (in terms of shape, proximal coating and distal surface treatment), would yield improved bone remodelling in a clinical DEXA study, and if these results could be predicted in a finite element (FE) simulation study. In a randomized clinical trial, 2 year DEXA measurements between the uncemented Symax™ and Omnifit(®) stem (both n=25) showed bone mineral density (BMD) loss in Gruen zone 7 of 14% and 20%, respectively (p<0.05). In contrast, the FE models predicted a 28% (Symax™) and 26% (Omnifit(®)) bone loss. When the distal treatment to the Symax™ was not modelled in the simulation, bone loss of 35% was predicted, suggesting the benefit of this surface treatment for proximal bone maintenance. The theoretical concept for enhanced proximal bone loading by the Symax™, and the predicted remodelling pattern were confirmed by DEXA-results, but there was no quantitative match between clinical and FE findings. This was due to a simulation based on incomplete assumptions concerning the yet unknown biological and mechanical effects of the new coating and surface treatment. Study listed under ClinicalTrials.gov with number NCT01695213.
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Affiliation(s)
- René H M ten Broeke
- Department of Orthopaedic Surgery, Caphri Research Institute, Maastricht University Medical Centre, 6202 AZ Maastricht, The Netherlands.
| | - Maria Tarala
- Orthopaedic Research Laboratory, Radboud University Medical Centre, 6500 HB Nijmegen, The Netherlands
| | - Jacobus J Arts
- Department of Orthopaedic Surgery, Caphri Research Institute, Maastricht University Medical Centre, 6202 AZ Maastricht, The Netherlands
| | - Dennis W Janssen
- Orthopaedic Research Laboratory, Radboud University Medical Centre, 6500 HB Nijmegen, The Netherlands
| | - Nico Verdonschot
- Orthopaedic Research Laboratory, Radboud University Medical Centre, 6500 HB Nijmegen, The Netherlands; Laboratory for Biomechanical Engineering, University of Twente, 7522 NB Enschede, The Netherlands
| | - Rudolph G T Geesink
- Department of Orthopaedic Surgery, Caphri Research Institute, Maastricht University Medical Centre, 6202 AZ Maastricht, The Netherlands
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So K, Kaneuji A, Matsumoto T, Matsuda S, Akiyama H. Is the bone-bonding ability of a cementless total hip prosthesis enhanced by alkaline and heat treatments? Clin Orthop Relat Res 2013; 471:3847-55. [PMID: 23539125 PMCID: PMC3825883 DOI: 10.1007/s11999-013-2945-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Cementless total hip arthroplasty (THA) implants using alkaline and heat treatments were developed to enhance bone bonding. Although bone-bonding ability of the alkali- and heat-treated titanium surface has been demonstrated in animal studies, it remains unknown whether it enhances or provides durable bone bonding in humans. QUESTIONS/PURPOSES We therefore (1) determined long-term survivorship, function, and radiographic signs of failure of fixation of alkali- and heat-treated THA implants; and (2) histologically examined their bone-bonding ability in two human retrievals. METHODS We retrospectively reviewed 58 patients who underwent 70 primary THAs, of whom 67 were available for minimum followup of 8 years (average, 10 years; range, 8-12 years). Survival rate was calculated. Hip function was evaluated using the Japan Orthopaedic Association (JOA) hip scores, and radiographic signs of implant failure were determined from anteroposterior radiographs. Two retrieved implants were investigated histologically. RESULTS Using revision for any reason as the end point, the overall survival rate was 98% (95% confidence interval, 96%-100%) at 10 years. The patients' average JOA hip scores improved from 47 points preoperatively to 91 points at the time of the last followup. No implant had radiographic signs of loosening. Histologically we observed bone in the pores 2 weeks after implantation in one specimen and apparently direct bonding between bone and the titanium surface in its deep pores 8 years after implantation. CONCLUSIONS Cementless THA implants with alkaline and heat treatments showed a high survival rate. Further study is required to determine whether the treatment enhances direct bone bonding.
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Affiliation(s)
- Kazutaka So
- Department of Orthopaedic Surgery, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo, Kyoto 606-8507 Japan
| | - Ayumi Kaneuji
- Department of Orthopaedic Surgery, Kanazawa Medical University, Ishikawa, Japan
| | - Tadami Matsumoto
- Department of Orthopaedic Surgery, Kanazawa Medical University, Ishikawa, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo, Kyoto 606-8507 Japan
| | - Haruhiko Akiyama
- Department of Orthopaedic Surgery, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo, Kyoto 606-8507 Japan
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Wedemeyer C, Kauther MD, Bülbül M, Jäger M, Peppmüller R, Bredendiek T. Cementless second-generation hydroxyapatite CaP-coated tibial component: an 8.7-year follow-up. Arch Orthop Trauma Surg 2012; 132:1759-64. [PMID: 22933052 DOI: 10.1007/s00402-012-1608-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND This is the first study that reports on the mid-term results of 81 patients suffering from arthritis of the knee, treated with a cementless second-generation hydroxyapatite calcium phosphate (CaP)-coated tibial component. MATERIALS AND METHODS Seventy-six knees with osteoarthritis were evaluated according to the Knee Society clinical, functional and radiological score, the Hospital for Special Surgery Rating System and the Patella Score. The clinical and radiological parameters were assessed preoperatively and after a mean follow-up of 8.7 years. RESULTS All the three score systems revealed excellent clinical outcomes after the follow-up period. The mean preoperative Knee Society clinical Score was 124.41 ± 12.99 and the mean postoperative score was 187.07 ± 14.59 at the time of the final consultation (p = 0.0008). The survival rate was 97.5 %. Radiolucency of <1 mm around the uncemented hydroxyapatite CaP-coated tibial component without accompanying pain symptoms was seen in fewer than 6 % of cases. In two cases, a medial cyst, also without other clinical symptoms, was observed beside the tip of the tibial fixation screw. CONCLUSION These findings indicate that the uncemented second-generation hydroxyapatite CaP-coated tibial component performed well at mid-term follow-up, and provides sufficiently stable bone ingrowth fixation.
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Affiliation(s)
- Christian Wedemeyer
- Department of Orthopedic and Trauma Surgery, St. Barbara Hospital, Barbara Str. 1, 45964 Gladbeck, Germany.
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16
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Abstract
For assessment of bone remodelling around total hip arthroplasty using dual-emission X-ray absorptiometry (DEXA), a variety of different systems to identify regions of interest (ROI) have been used, making comparisons between stem designs difficult. The Gruen zones are now widely used for this purpose. We present the results of a randomised clinical trial comparing 2 uncemented stem designs with proximal coating, using a modification of the Gruen zones to allow improved representation of the effect of the implant on bone mineral density (BMD) over time. DEXA-data were used in a randomised trial with 2 years follow up, comparing the uncemented Symax(TM) (n=25) and Omnifit(®) (n=24) stems. The effect on BMD was determined using the 'standard' adapted Gruen zones, and a modification which studied an equal length and position for zones 1 and 7 around both stems, assuring that the same regions in terms of cancellous and cortical bone were compared. The 'modified' regions of interest give lower BMD values around the Omnifit(®) than using the 'standard' Gruen zones (3.6 % in zone 7, p<0.05). The difference with the Symax(TM) BMD values, which had been concealed using the standard Gruen zones, became statistically significant in favour of the Symax(TM) implant. This adaptation can detect a statistically significant difference in bone preservation in zone 7 between stems that would otherwise not have been revealed. We recommend the use of 'modified' Gruen zones for more valid comparison of remodelling caused by different implant designs.
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