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Meinders E, Pizzolato C, Gonçalves B, Lloyd DG, Saxby DJ, Diamond LE. Activation of the deep hip muscles can change the direction of loading at the hip. J Biomech 2022; 135:111019. [DOI: 10.1016/j.jbiomech.2022.111019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 01/27/2022] [Accepted: 02/21/2022] [Indexed: 11/28/2022]
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2
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Karunaseelan KJ, Dandridge O, Muirhead-Allwood SK, van Arkel RJ, Jeffers JRT. Capsular ligaments provide a passive stabilizing force to protect the hip against edge loading. Bone Joint Res 2021; 10:594-601. [PMID: 34555959 PMCID: PMC8479567 DOI: 10.1302/2046-3758.109.bjr-2020-0536.r1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIMS In the native hip, the hip capsular ligaments tighten at the limits of range of hip motion and may provide a passive stabilizing force to protect the hip against edge loading. In this study we quantified the stabilizing force vectors generated by capsular ligaments at extreme range of motion (ROM), and examined their ability to prevent edge loading. METHODS Torque-rotation curves were obtained from nine cadaveric hips to define the rotational restraint contributions of the capsular ligaments in 36 positions. A ligament model was developed to determine the line-of-action and effective moment arms of the medial/lateral iliofemoral, ischiofemoral, and pubofemoral ligaments in all positions. The functioning ligament forces and stiffness were determined at 5 Nm rotational restraint. In each position, the contribution of engaged capsular ligaments to the joint reaction force was used to evaluate the net force vector generated by the capsule. RESULTS The medial and lateral arms of the iliofemoral ligament generated the highest inbound force vector in positions combining extension and adduction providing anterior stability. The ischiofemoral ligament generated the highest inbound force in flexion with adduction and internal rotation (FADIR), reducing the risk of posterior dislocation. In this position the hip joint reaction force moved 0.8° inbound per Nm of internal capsular restraint, preventing edge loading. CONCLUSION The capsular ligaments contribute to keep the joint force vector inbound from the edge of the acetabulum at extreme ROM. Preservation and appropriate tensioning of these structures following any type of hip surgery may be crucial to minimizing complications related to joint instability. Cite this article: Bone Joint Res 2021;10(9):594-601.
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Affiliation(s)
| | - Oliver Dandridge
- Department of Mechanical Engineering, Imperial College London, London, UK
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Emara AK, Samuel LT, Acuña AJ, Kuo A, Khlopas A, Kamath AF. Robotic-arm assisted versus manual total hip arthroplasty: Systematic review and meta-analysis of radiographic accuracy. Int J Med Robot 2021; 17:e2332. [PMID: 34528372 DOI: 10.1002/rcs.2332] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 08/14/2021] [Accepted: 09/14/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND We systematically reviewed the radiological outcomes of studies comparing robotic-assisted (RA-THA) and manual total hip arthroplasty (mTHA). METHODS The PubMed, Embase, and Cochrane databases were queried from 1994-2021 for articles comparing radiographic outcomes between RA-THA and mTHA cohorts. A meta-analysis was conducted whenever sufficient data was present for common outcomes. RESULTS Our analysis included 20 articles reporting on 4140 patients (RA-THA: n = 1228; mTHA: n = 2912). No differences were demonstrated for acetabular inclination or anteversion. However, RA-THA demonstrated higher rates of cup orientation within the Lewinnek and Callanan safe zones, improved femoral stem alignment, and lower global offset difference (GOD) and limb length discrepancy (all p-values <0.05). Superior femoral canal fill and combined offset were seen among RA-THA patients. CONCLUSION Our review found that the use of RA-THA yields superior radiographic outcomes compared to mTHA counterparts. This information can inform healthcare systems considering investing in and implementing these technologies.
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Affiliation(s)
- Ahmed K Emara
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, 44195, USA
| | - Linsen T Samuel
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, 44195, USA
| | - Alexander J Acuña
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, 44195, USA
| | - Andy Kuo
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, 44195, USA
| | - Anton Khlopas
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, 44195, USA
| | - Atul F Kamath
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, 44195, USA
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Zheng N, Hu X, Dimitriou D, Dai K, Guo T, Tsai TY. Well-Placed Acetabular Component Oriented Outside the Safe Zone During Weight-Bearing Daily Activities. Front Bioeng Biotechnol 2021; 9:664907. [PMID: 34178961 PMCID: PMC8222599 DOI: 10.3389/fbioe.2021.664907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 04/19/2021] [Indexed: 11/13/2022] Open
Abstract
Background: A comprehensive and thorough understanding of functional acetabular component orientation is essential for optimizing the clinical outcome after total hip arthroplasty (THA). This study aimed to quantify the functional acetabular anteversion and inclination of unilateral THA patients during walking and static standing and to determine whether the functional acetabular orientation falls within the Lewinnek safe zone. Methods: Seventeen patients with unilateral THA received a CT scan and dual fluoroscopic imaging during level walking and static standing to evaluate in vivo hip kinematics. The pelvic functional coordinate system of the 3D CT-based computer model was defined by the line of gravity and anterior pelvic plane (APP) to measure functional acetabular anteversion and inclination in different postures. The Lewinnek safe zone was used to determine the acetabular malposition during functional activities. Results: The THA side demonstrated an average of 10.1° (± 9.6°, range -7.5° to 29.9°) larger functional anteversion and 16.0° (± 9.2°, range -7.2° to 29.9°) smaller inclination than native hips during level walking. Functional acetabular anteversion in the THA side during level walking and static standing was significantly larger than anatomical measurements (p < 0.05). Acetabular orientation of most well-placed THA components anatomically in the Lewinnek safe zone fell outside the safe zone during more than half of the gait cycle and static standing. Conclusion: The current study revealed that an anatomically well-placed acetabular cup does not guarantee a well-functional orientation during daily activities. The in vivo mechanical performance and loading conditions of the THA component during other weight-bearing activities should be investigated in further studies.
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Affiliation(s)
- Nan Zheng
- Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China.,Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Orthopaedic Implants and Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiangjun Hu
- Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China.,Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Orthopaedic Implants and Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dimitris Dimitriou
- Department of Orthopaedics Bürgerspital Solothurn, Solothurn, Switzerland
| | - Kerong Dai
- Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China.,Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Orthopaedic Implants and Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tao Guo
- Department of Orthopaedics, Guizhou Provincial People's Hospital, Guiyang, China
| | - Tsung-Yuan Tsai
- Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China.,Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Orthopaedic Implants and Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Akhbari B, Morton AM, Shah KN, Molino J, Moore DC, Weiss APC, Wolfe SW, Crisco JJ. In vivo articular contact pattern of a total wrist arthroplasty design. J Biomech 2021; 121:110420. [PMID: 33895657 PMCID: PMC8130596 DOI: 10.1016/j.jbiomech.2021.110420] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 02/26/2021] [Accepted: 03/25/2021] [Indexed: 11/20/2022]
Abstract
Total wrist arthroplasty (TWA) designs suffer from relatively high complication rates when compared to other arthroplasties. Understanding the contact pattern of hip and knee replacement has improved their design and function; however, the in vivo contact pattern of TWA has not yet been examined and is thus the aim of this study. We hypothesized that the center of contact (CoC) is located at the geometric centers of the carpal component and radial component in the neutral posture and that the CoC moves along the principal arcs of curvature throughout primary anatomical motions. Wrist motion and implant kinematics of six patients with the Freedom® total wrist implant were studied during various tasks using biplanar videoradiography. The location of the CoC of the components was investigated by calculating distance fields between the articular surfaces. We found the CoC at the neutral posture was not at the geometric centers but was located 3.5 mm radially on the carpal component and 1.2 mm ulnarly on the radial component. From extension to flexion, the CoC moved 10.8 mm from dorsal to volar side on the carpal component (p < 0.0001) and 7.2 mm from volar to dorsal on the radial component (p = 0.0009). From radial to ulnar deviation, the CoC moved 12.4 mm from radial to ulnar on the carpal component (p < 0.0001), and 5.6 mm from ulnar to radial on the radial component (p = 0.009). The findings of this study may eventually improve TWA success by advancing future designs through a more accurate understating of their kinematic performance in vivo.
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Affiliation(s)
- Bardiya Akhbari
- Center for Biomedical Engineering and School of Engineering, Brown University, Providence, RI 02912, United States.
| | - Amy M Morton
- Department of Orthopedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI 02903, United States.
| | - Kalpit N Shah
- Department of Orthopedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI 02903, United States.
| | - Janine Molino
- Department of Orthopedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI 02903, United States.
| | - Douglas C Moore
- Department of Orthopedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI 02903, United States.
| | - Arnold-Peter C Weiss
- Department of Orthopedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI 02903, United States; Division of Hand, Upper Extremity & Microvascular Surgery, Department of Orthopaedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI 02912, United States.
| | - Scott W Wolfe
- Hand and Upper Extremity Center, Hospital for Special Surgery, New York, NY 10021, United States; Weill Medical College of Cornell University, New York, NY 10021, United States.
| | - Joseph J Crisco
- Center for Biomedical Engineering and School of Engineering, Brown University, Providence, RI 02912, United States; Department of Orthopedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI 02903, United States.
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DeCook CA, LaCour MT, Nachtrab JK, Khasian M, Dessinger GM, Komistek RD. In Vivo Determination and Comparison of Total Hip Arthroplasty Kinematics for Normal, Preoperative Degenerative, and Postoperative Implanted Hips. J Arthroplasty 2020; 35:588-596. [PMID: 31543419 DOI: 10.1016/j.arth.2019.08.057] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 08/21/2019] [Accepted: 08/26/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The study objective is to analyze subjects having a normal hip and compare in vivo kinematics to subjects before and after receiving a total hip arthroplasty. METHODS Twenty subjects, 10 with a normal hip and 10 with a preoperative, degenerative hip were analyzed performing normal walking on level ground while under fluoroscopic surveillance. Seven preoperative subjects returned after receiving a total hip arthroplasty using the anterior surgical approach by a single surgeon. Using 3-dimensional to 2-dimensional registration techniques, joint models were overlayed on fluoroscopic images to obtain transformation matrices in the image space. From these images, displacements of the femoral head and acetabulum centers were computed, as well as changes in contact patches between the 2 surfaces throughout the gait cycle. RESULTS Implanted hips experienced the least amount of separation, compression, and overall sliding throughout the entire gait cycle, but they did show signs of edge loading contact patterns. Conversely, the degenerative hips experienced the most compression, sliding, and separation, with the maximum amount of sliding being 6.9 mm. The normal group ranged in the middle, with the maximum amount of sliding being 1.75 mm. CONCLUSION Current analysis revealed trends that degenerative hips experience more abnormal hip kinematics that leads to higher articulating surface forces and stresses within the acetabulum. None of the implanted hips experienced hip separation.
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Affiliation(s)
- Charles A DeCook
- Arthritis and Total Joint Specialists, Northside Hospital Atlanta, Atlanta, GA
| | - Michael T LaCour
- MABE Department, Center for Musculoskeletal Research, University of Tennessee, Knoxville, TN
| | - Jarrod K Nachtrab
- MABE Department, Center for Musculoskeletal Research, University of Tennessee, Knoxville, TN
| | - Milad Khasian
- MABE Department, Center for Musculoskeletal Research, University of Tennessee, Knoxville, TN
| | - Garett M Dessinger
- MABE Department, Center for Musculoskeletal Research, University of Tennessee, Knoxville, TN
| | - Richard D Komistek
- MABE Department, Center for Musculoskeletal Research, University of Tennessee, Knoxville, TN
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Uddin MS, Chan GWC. Reducing stress concentration on the cup rim of hip implants under edge loading. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2019; 35:e3149. [PMID: 30161296 DOI: 10.1002/cnm.3149] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 08/24/2018] [Accepted: 08/25/2018] [Indexed: 06/08/2023]
Abstract
High stress concentration under edge loading on the cup rim contact due to micro-separation causes accelerated striping wear, fracture, and fatigue in hip implant components. While continuous effort is devoted into improving bearing design and surgical procedure to tackle the problem, the concern still has remained forcing biomedical engineers to seek for new and alternative solutions. The current paper aims to investigate the effect of a new geometry "spline" introduced at the cup's rim corner to minimise stress concentration under edge loading. Three-dimensional finite element modelling of a metal-on-metal hip implant is developed, where contact pressure, von Mises stress, and strain are predicted for three spline geometries, ie, equivalent characteristic arc radius (R = 0.5, 1.0, and 1.5 mm) at four micro-separations (of 1.0, 1.5, 2.0, and 2.5 mm) simulating edge loading on the rim contact via the application of a constant vertical load of 3 kN. The efficacy of the spline is compared with that of circular arc and sharp corner (ie, no arc) geometries. Overall, the spline outperforms both sharp corner and circular arc in reducing contact pressure, stress, and strain. The benefit of the spline over the circular arc is quite promising at larger micro-separation but fairly marginal at smaller arc radius and micro-separation. The findings indicate that, as an alternative to the circular fillet, the spline can be considered a potential geometry to be incorporated at the rim corner of the cup.
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Affiliation(s)
- Mohammad Sharif Uddin
- School of Engineering, University of South Australia, Mawson Lakes, SA, 5095, Australia
- Future Industries Institute, University of South Australia, Mawson Lakes, SA, 5095, Australia
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8
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Lu Z, Ebramzadeh E. Origins of material loss in highly worn acetabular cups of metal-on-metal total hip replacements. J Orthop Res 2019; 37:143-150. [PMID: 30198576 DOI: 10.1002/jor.24139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 08/24/2018] [Indexed: 02/04/2023]
Abstract
Excessive wear has been one of the major failure modes of metal-on-metal hip implants. From a collection of 541 retrieved ASR metal-on-metal implants, we selected those head-cup pairs with combined wear >100 mm3 , (N = 42) to assess the distributions of wear volume on cups, and non-conformance in the worn areas at the head-cup interfaces. All 42 had severe cup edge wear (average maximum wear depth 500 μm). On average, 58% of wear volume of cups occurred at the edge areas, whereas 42% occurred well inside the socket, indicating that substantial wear volume of cups was generated well inside the socket. Particularly, in eight cups, more than half of the wear volume occurred well inside the socket. The head-cup conformance in the worn areas was deteriorated. On average, in worn areas, head-cup clearance was approximately eight times greater than in unworn areas, and the sphericity of heads and cups was approximately 36 times and 84 times higher, respectively, than in unworn areas. The radius of curvature of the worn surfaces of heads and cups varied widely, with an average variation of 3 mm (0.6-7 mm) and 11 mm (2-47 mm) for heads and cups, respectively. The severely deteriorated conformance at the edge areas and the areas well inside the socket, due to edge contact, could be the major factor for excessive wear of these 42 pairs. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.
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Affiliation(s)
- Zhen Lu
- The J. Vernon Luck, Sr, MD Orthopaedic Research Center, Orthopaedic Institute for Children and UCLA Department of Orthopaedic Surgery, 403 West Adams Boulevard, Los Angeles, California, 90007
| | - Edward Ebramzadeh
- The J. Vernon Luck, Sr, MD Orthopaedic Research Center, Orthopaedic Institute for Children and UCLA Department of Orthopaedic Surgery, 403 West Adams Boulevard, Los Angeles, California, 90007
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9
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Li Z, Chen ZF, Liu JX, Liu F. Comparative Mid-term Follow-up Study of Primary Total Hip Arthroplasty with Metal-on-metal and Metal-on-polyethylene Bearings. Orthop Surg 2018; 10:312-320. [PMID: 30485684 DOI: 10.1111/os.12408] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 04/10/2018] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To compare mid-term clinical results of total hip arthroplasty (THA) with metal-on-metal (MoM) and metal-on-polyethylene (MoP) bearings and to evaluate the biological safety of the two kinds of prostheses. METHODS Thirty-two patients who received a primary THA with an MoM articulation between January 2008 and December 2010 were selected to form the MoM group retrospectively. The MoP group consisted of 32 patients who received a THA with an MoP prosthesis during the same period. Clinical assessments, imaging examinations, laboratory tests, and metal ion concentration detections were conducted on each patient. Another 32 healthy volunteers were recruited as the control group. RESULTS Twenty-seven patients in the MoM group and 28 patients in the MoP group completed the follow-up, with a mean follow-up time of 74.6 and 75.9 months, respectively. The mean Harris score at the latest follow-up was 91.5 ± 5.1 in the MoM group versus 88.9 ± 4.0 in the MoP group (P = 0.22). The MoM group showed a better range of motion in flexion, abduction, and external rotation. Co and Cr levels in the MoM group were 2.5-fold and 2.0-fold of these in the MoP group. A mild change of liver function was observed in both groups, while the values of renal function and humoral immunity stayed static. Elevated proportions of Th1 and Th17 cells and decreased proportion of Th2 cells were observed in the MoM group. The occurrence rate of pseudotumors in the MoM and MoP groups was 40.74% ± 9.45% and 14.28% ± 6.61%, respectively (P < 0.05). CONCLUSION At the mid-term follow-up, clinical results were satisfied in both groups. MoM prosthesis could result in elevated serum metal ion levels and there is a higher risk of pseudotumor. Long follow-up is needed to evaluate the safety of MoM prostheses.
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Affiliation(s)
- Zhi Li
- Department of Orthopaedic Surgery, Geriatric Hospital, Nanjing Medical University, Nanjing, China
| | - Zhe-Feng Chen
- Department of Orthopaedic Surgery, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Jiu-Xiang Liu
- Department of Orthopaedic Surgery, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Feng Liu
- Department of Orthopaedic Surgery, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
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Liu F, Feng L, Wang J. A computational parametric study on edge loading in ceramic-on-ceramic total hip joint replacements. J Mech Behav Biomed Mater 2018; 83:135-142. [PMID: 29704828 DOI: 10.1016/j.jmbbm.2018.04.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 03/24/2018] [Accepted: 04/19/2018] [Indexed: 10/17/2022]
Abstract
Edge loading in ceramic-on-ceramic total hip joint replacement is an adverse condition that occurs as the result of a direct contact between the head and the cup rim. It has been associated with translational mismatch in the centres of rotation of the cup and head, and found to cause severe wear and early failure of the implants. Edge loading has been considered in particular in relation to dynamic separation of the cup and head centres during a gait cycle. Research has been carried out both experimentally and computationally to understand the mechanism including the influence of bearing component positioning on the occurrence and severity of edge loading. However, it is experimentally difficult to measure both the load magnitude and duration of edge loading as it occurs as a short impact within the tight space of hip joints. Computationally, a dynamic contact model, for example, developed using the MSC ADAMS software for a multi-body dynamics simulation can be particularly useful for calculating the loads and characterising the edge loading. The aim of the present study was to further develop the computational model, and improve the predictions of contact force and the understanding of mechanism in order to provide guidance on design and surgical factors to avoid or to reduce edge loading and wear. The results have shown that edge loading can be avoided for a low range of translational mismatch in the centres of rotation of the cup and head during gait at the level of approximately 1.0 mm for a cup at 45° inclination, keeping a correct cup inclination at 45° is important to reduce the edge loading severity, and edge loading can be avoided for a certain range of translational mismatch of the cup and head centres with an increased swing phase load.
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Affiliation(s)
- Feng Liu
- School of Mechanical Engineering, North University of China, PR China.
| | - Li Feng
- School of Mechanical Engineering, North University of China, PR China
| | - Junyuan Wang
- School of Mechanical Engineering, North University of China, PR China
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11
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Myers CA, Laz PJ, Shelburne KB, Judd DL, Huff DN, Winters JD, Stevens-Lapsley JE, Rullkoetter PJ. The impact of hip implant alignment on muscle and joint loading during dynamic activities. Clin Biomech (Bristol, Avon) 2018; 53:93-100. [PMID: 29482087 PMCID: PMC5890933 DOI: 10.1016/j.clinbiomech.2018.02.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 01/09/2018] [Accepted: 02/12/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Component alignment is an important consideration in total hip arthroplasty. The impact of changes in alignment on muscle forces and joint contact forces during dynamic tasks are not well understood, and have the potential to influence surgical decision making. The objectives of this study were to assess the impact of femoral head/stem and cup component placement on hip muscle and joint contact forces during tasks of daily living and to identify which alignment parameters have the greatest impact on joint loading. METHODS Using a series of strength-calibrated, subject-specific musculoskeletal models of patients performing gait, sit-to-stand and step down tasks, component alignments were perturbed and joint contact and muscle forces evaluated. FINDINGS Based on the range of alignments reported clinically, variation in head/stem anteversion-retroversion had the largest impact of any degree of freedom throughout all three tasks; average contact forces 413.5 (319.1) N during gait, 262.7 (256.4) N during sit to stand, and 572.7 (228.1) N during the step down task. The sensitivity of contact force to anteversion-retroversion of the head/stem was 31.5 N/° for gait, which was similar in magnitude to anterior-posterior position of the cup (34.6 N/m for gait). Additionally, superior-inferior cup alignment resulted in 16.4 (4.9)° of variation in the direction of the hip joint contact force across the three tasks, with the most inferior cup placements moving the force vector towards the cup equator at the point of peak joint contact force. INTERPRETATION A quantitative understanding of the impact and potential tradeoffs when altering component alignment is valuable in supporting surgical decision making.
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Affiliation(s)
- Casey A Myers
- Center for Orthopaedic Biomechanics, University of Denver, Denver, CO, USA.
| | - Peter J Laz
- Center for Orthopaedic Biomechanics, University of Denver, Denver, CO, USA
| | - Kevin B Shelburne
- Center for Orthopaedic Biomechanics, University of Denver, Denver, CO, USA
| | - Dana L Judd
- Physical Therapy Program, University of Colorado, Aurora, CO, USA
| | | | - Joshua D Winters
- Physical Therapy Program, University of Colorado, Aurora, CO, USA
| | - Jennifer E Stevens-Lapsley
- Physical Therapy Program, University of Colorado, Aurora, CO, USA; Geriatric Research Education and Clinical Center, VA Eastern Colorado Healthcare System, Denver, CO, USA
| | - Paul J Rullkoetter
- Center for Orthopaedic Biomechanics, University of Denver, Denver, CO, USA
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12
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Acetabular Cups in 60 mm Metal-on-Metal Bearings Subjected to Dynamic Edge-Loading with 70° Peak-Inclination in 10-Million Cycle Simulator Study. LUBRICANTS 2017. [DOI: 10.3390/lubricants6010001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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13
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Hjorth MH, Egund N, Mechlenburg I, Gelineck J, Jakobsen SS, Soballe K, Stilling M. Does a titanium sleeve reduce the frequency of pseudotumors in metal-on-metal total hip arthroplasty at 5-7years follow-up? Orthop Traumatol Surg Res 2016; 102:1035-1041. [PMID: 28341265 DOI: 10.1016/j.otsr.2016.08.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 08/11/2016] [Accepted: 08/23/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Little is known about pseudotumor frequency and risk factors for pseudotumor formation among different types of metal-on-metal (MoM) hip arthroplasties. A lower release of chromium and cobalt have been reported in MoM hip arthroplasties with a titanium sleeve compared to MoM designs without a titanium sleeve, but yet it is unknown whether a titanium sleeve reduces the pseudotumor frequency. We conducted a cross-sectional study to investigate: 1) pseudotumor frequency, 2) risk factors of pseudotumor formation 3) and correlations between pseudotumors, serum metal-ions, implant position, and clinical symptoms. HYPOTHESIS We expected a lower pseudotumor frequency in MoM hip articulation with a titanium sleeve than reported in MoM hip articulation designs using chromium-cobalt sleeve. MATERIALS AND METHOD A consecutive series of 41 patients/49 hips (31 males), mean age 52 (28-68) years, participated in a 5.5±0.5 (4-6.5) year follow-up study of their M2a_Magnum hip articulation (Biomet Inc., Warsaw, Indiana, USA). Patients were evaluated with magnetic resonance imaging (MRI), measurements of serum metal-ions, plain radiographs, and clinical outcome measures of Harris Hip Score (HHS) and Oxford Hip Score (OHS). RESULTS Eighteen of 47 hips (38%) had MRI-verified pseudotumors, all cystic, with a mean dimension of 10.6×25.6×41mm. Digital measurements on plain radiographs revealed a higher cup anteversion in patients with a pseudotumor of mean 28.4°±5.05° compared to mean 23.5°±6.5° in patients without a pseudotumor (P=0.009). Serum metal-ion concentrations, acetabular cup inclination and measures of HHS and OHS were similar between patients with and without a pseudotumor (P>0.46). CONCLUSION At 5.5±0.5years after surgery, MRI-verified cystic pseudotumors were frequently observed in M2a_Magnum hip articulations despite the use of titanium sleeves. The pseudotumors were related to high cup anteversion angles but not related to high serum metal-ions or clinical symptoms. LEVEL OF EVIDENCE IV: cross-sectional study.
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Affiliation(s)
- M H Hjorth
- Department of Orthopaedics, Aarhus University Hospital, Tage-Hansens Gade 2, 8000 Aarhus C, Denmark.
| | - N Egund
- Department of Radiology, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark
| | - I Mechlenburg
- Department of Orthopaedics, Aarhus University Hospital, Tage-Hansens Gade 2, 8000 Aarhus C, Denmark; Centre of Research in Rehabilitation (CORIR), Department of Clinical Medicine, Aarhus University, Denmark
| | - J Gelineck
- Department of Radiology, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark
| | - S S Jakobsen
- Department of Orthopaedics, Aarhus University Hospital, Tage-Hansens Gade 2, 8000 Aarhus C, Denmark
| | - K Soballe
- Department of Orthopaedics, Aarhus University Hospital, Tage-Hansens Gade 2, 8000 Aarhus C, Denmark; Orthopaedic Research Unit, Aarhus University Hospital, Tage-Hansens Gade 2, 8000 Aarhus C, Denmark
| | - M Stilling
- Orthopaedic Research Unit, Aarhus University Hospital, Tage-Hansens Gade 2, 8000 Aarhus C, Denmark; Department of Clinical Medicine, Aarhus University, Denmark
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The contact mechanics and occurrence of edge loading in modular metal-on-polyethylene total hip replacement during daily activities. Med Eng Phys 2016; 38:518-25. [DOI: 10.1016/j.medengphy.2016.03.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 01/05/2016] [Accepted: 03/06/2016] [Indexed: 12/12/2022]
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Wesseling M, Meyer C, De Groote F, Corten K, Simon JP, Desloovere K, Jonkers I. Gait alterations can reduce the risk of edge loading. J Orthop Res 2016; 34:1069-76. [PMID: 26632197 DOI: 10.1002/jor.23120] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 11/28/2015] [Indexed: 02/04/2023]
Abstract
Following metal-on-metal hip arthroplasty, edge loading (i.e., loading near the edge of a prosthesis cup) can increase wear and lead to early revision. The position and coverage angle of the prosthesis cup influence the risk of edge loading. This study investigates the effect of altered gait patterns, more specific hip, and pelvis kinematics, on the orientation of hip contact force and the consequent risk of antero-superior edge loading using muscle driven simulations of gait. With a cup orientation of 25° anteversion and 50° inclination and a coverage angle of 168°, many gait patterns presented risk of edge loading. Specifically at terminal double support, 189 out of 405 gait patterns indicated a risk of edge loading. At this time instant, the high hip contact forces and the proximity of the hip contact force to the edge of the cup indicated the likelihood of the occurrence of edge loading. Although the cup position contributed most to edge loading, altering kinematics considerably influenced the risk of edge loading. Increased hip abduction, resulting in decreasing hip contact force magnitude, and decreased hip extension, resulting in decreased risk on edge loading, are gait strategies that could prevent edge loading. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1069-1076, 2016.
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Affiliation(s)
- Mariska Wesseling
- Department of Kinesiology, Human Movement Biomechanics, KU Leuven, Heverlee, Belgium
| | - Christophe Meyer
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Friedl De Groote
- Division PMA, Department of Mechanical Engineering, KU Leuven, Heverlee, Belgium
| | - Kristoff Corten
- Department of Orthopaedic, Ziekenhuis Oost-Limburg, Hip Unit, Genk, Belgium
| | - Jean-Pierre Simon
- Department of UZ Pellenberg Orthopedic, University Hospitals Leuven, Pellenberg, Belgium
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Ilse Jonkers
- Department of Kinesiology, Human Movement Biomechanics, KU Leuven, Heverlee, Belgium
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Panagiotidou A, Meswania J, Osman K, Bolland B, Latham J, Skinner J, Haddad FS, Hart A, Blunn G. The effect of frictional torque and bending moment on corrosion at the taper interface : an in vitro study. Bone Joint J 2015; 97-B:463-72. [PMID: 25820883 DOI: 10.1302/0301-620x.97b4.34800] [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] [Indexed: 12/13/2022]
Abstract
The aim of this study was to assess the effect of frictional torque and bending moment on fretting corrosion at the taper interface of a modular femoral component and to investigate whether different combinations of material also had an effect. The combinations we examined were 1) cobalt-chromium (CoCr) heads on CoCr stems 2) CoCr heads on titanium alloy (Ti) stems and 3) ceramic heads on CoCr stems. In test 1 increasing torque was imposed by offsetting the stem in the anteroposterior plane in increments of 0 mm, 4 mm, 6 mm and 8 mm when the torque generated was equivalent to 0 Nm, 9 Nm, 14 Nm and 18 Nm. In test 2 we investigated the effect of increasing the bending moment by offsetting the application of axial load from the midline in the mediolateral plane. Increments of offset equivalent to head + 0 mm, head + 7 mm and head + 14 mm were used. Significantly higher currents and amplitudes were seen with increasing torque for all combinations of material. However, Ti stems showed the highest corrosion currents. Increased bending moments associated with using larger offset heads produced more corrosion: Ti stems generally performed worse than CoCr stems. Using ceramic heads did not prevent corrosion, but reduced it significantly in all loading configurations.
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Affiliation(s)
- A Panagiotidou
- University College London, Gower Street, London WC1E 6BT, UK
| | - J Meswania
- University College London, Gower Street, London WC1E 6BT, UK
| | - K Osman
- University College London Hospitals NHS Foundation Trust, 170 Tottenham Court Road, London W1T 7HA, UK
| | - B Bolland
- Musgrove Park Hospital, Taunton, Somerset, TA1 5DA, UK
| | - J Latham
- University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK
| | - J Skinner
- Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP, UK
| | - F S Haddad
- University College London Hospitals, 235 Euston Road, London NW1 2BU, UK
| | - A Hart
- Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP, UK
| | - G Blunn
- University College London, Gower Street, London WC1E 6BT, UK
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17
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Tsai TY, Dimitriou D, Li JS, Kwon YM. Does haptic robot-assisted total hip arthroplasty better restore native acetabular and femoral anatomy? Int J Med Robot 2015; 12:288-95. [PMID: 25906764 DOI: 10.1002/rcs.1663] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 02/08/2015] [Accepted: 03/17/2015] [Indexed: 11/12/2022]
Abstract
BACKGROUND The objective was to evaluate whether total hip arthroplasty (THA) using haptic robot assistance restores hip geometry better than the free-hand technique. METHODS Twelve robot-assisted and 14 free-hand unilateral THA patients underwent CT scan for three-dimensional (3D) hip models. The anteversion, inclination and hip joint centre locations of the native and implanted hips in each patient were quantified and compared. RESULTS Significant increase of combined anteversion by 19.1 ± 11.7° and 23.5 ± 23.6° and decrease of cup inclination by 16.5 ± 6.0° and 10.2 ± 6.8° were observed in the robot-assisted and the free-hand THAs, respectively. Less variation in the difference of the component orientations (max 11.1 vs 18.3°) and the femoral head centre (max 4.5 vs 6.3 mm) were found in the robot-assisted group. CONCLUSION This study demonstrated that neither robot-assisted nor free-hand THAs had fully restored native hip geometry. However, the higher precision of the robot-assisted THA suggested that it has potential utility in restoring the native hip geometry. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Tsung-Yuan Tsai
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Dimitris Dimitriou
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jing-Sheng Li
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Young-Min Kwon
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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18
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Halim T, Clarke IC, Burgett-Moreno MD, Donaldson TK, Savisaar C, Bowsher JG. A simulator study of adverse wear with metal and cement debris contamination in metal-on-metal hip bearings. Bone Joint Res 2015; 4:29-37. [PMID: 25736072 PMCID: PMC4381692 DOI: 10.1302/2046-3758.43.2000332] [Citation(s) in RCA: 7] [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] [Indexed: 11/07/2022] Open
Abstract
Objectives Third-body wear is believed to be one trigger for adverse results
with metal-on-metal (MOM) bearings. Impingement and subluxation
may release metal particles from MOM replacements. We therefore
challenged MOM bearings with relevant debris types of cobalt–chrome
alloy (CoCr), titanium alloy (Ti6Al4V) and polymethylmethacrylate
bone cement (PMMA). Methods Cement flakes (PMMA), CoCr and Ti6Al4V particles (size range
5 µm to 400 µm) were run in a MOM wear simulation. Debris allotments
(5 mg) were inserted at ten intervals during the five million cycle
(5 Mc) test. Results In a clean test phase (0 Mc to 0.8 Mc), lubricants retained their
yellow colour. Addition of metal particles at 0.8 Mc turned lubricants
black within the first hour of the test and remained so for the
duration, while PMMA particles did not change the colour of the
lubricant. Rates of wear with PMMA, CoCr and Ti6Al4V debris averaged
0.3 mm3/Mc, 4.1 mm3/Mc and 6.4 mm3/Mc,
respectively. Conclusions Metal particles turned simulator lubricants black with rates
of wear of MOM bearings an order of magnitude higher than with control
PMMA particles. This appeared to model the findings of black, periarticular
joint tissues and high CoCr wear in failed MOM replacements. The
amount of wear debris produced during a 500 000-cycle interval of
gait was 30 to 50 times greater than the weight of triggering particle
allotment, indicating that MOM bearings were extremely sensitive
to third-body wear. Cite this article: Bone Joint Res 2015;4:29–37.
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Affiliation(s)
- T Halim
- Loma Linda University, 900 E Washington St, Suite 200, Colton, 92324, California, USA
| | - I C Clarke
- Loma Linda University, 900 E Washington St, Suite 200, Colton, 92324, California, USA
| | - M D Burgett-Moreno
- Loma Linda University, 900 E Washington St, Suite 200, Colton, 92324, California, USA
| | - T K Donaldson
- Loma Linda University, 900 E Washington St, Suite 200, Colton, 92324, California, USA
| | - C Savisaar
- Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, Maryland 20993-0002, USA
| | - J G Bowsher
- Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, Maryland 20993-0002, USA
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Abstract
The use of ceramics bearings in total hip joint replacement (THR) has increased markedly in the last ten years thanks to the optimum wear behaviour of ceramic-on-ceramic bearings and of the high biological safety of ceramic wear debris. As the number of ceramic THR bearings is increasing, also the number of implants that experience off-normal working conditions, e.g. edge loading, third bodies in the joint, soft tissues laxity, dislocation/subluxation of the joint, increases. Under all such conditions the surface of the bearing can be damaged to variable extent, leading eventually to a limitation of the expected performances of the implant.
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20
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Hua X, Li J, Wang L, Jin Z, Wilcox R, Fisher J. Contact mechanics of modular metal-on-polyethylene total hip replacement under adverse edge loading conditions. J Biomech 2014; 47:3303-9. [PMID: 25218504 PMCID: PMC4199141 DOI: 10.1016/j.jbiomech.2014.08.015] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Revised: 08/06/2014] [Accepted: 08/18/2014] [Indexed: 11/15/2022]
Abstract
Edge loading can negatively impact the biomechanics and long-term performance of hip replacements. Although edge loading has been widely investigated for hard-on-hard articulations, limited work has been conducted for hard-on-soft combinations. The aim of the present study was to investigate edge loading and its effect on the contact mechanics of a modular metal-on-polyethylene (MoP) total hip replacement (THR). A three-dimensional finite element model was developed based on a modular MoP bearing. Different cup inclination angles and head lateral microseparation were modelled and their effect on the contact mechanics of the modular MoP hip replacement were examined. The results showed that lateral microseparation caused loading of the head on the rim of the cup, which produced substantial increases in the maximum von Mises stress in the polyethylene liner and the maximum contact pressure on both the articulating surface and backside surface of the liner. Plastic deformation of the liner was observed under both standard conditions and microseparation conditions, however, the maximum equivalent plastic strain in the liner under microseparation conditions of 2000 µm was predicted to be approximately six times that under standard conditions. The study has indicated that correct positioning the components to avoid edge loading is likely to be important clinically even for hard-on-soft bearings for THR.
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Affiliation(s)
- Xijin Hua
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, UK.
| | - Junyan Li
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, UK
| | - Ling Wang
- State Key Laboratory for Manufacturing System Engineering, Xi'an Jiaotong University, Xi'an, Shanxi, China
| | - Zhongmin Jin
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, UK; State Key Laboratory for Manufacturing System Engineering, Xi'an Jiaotong University, Xi'an, Shanxi, China
| | - Ruth Wilcox
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, UK
| | - John Fisher
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, UK
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Tsai TY, Dimitriou D, Li G, Kwon YM. Does total hip arthroplasty restore native hip anatomy? three-dimensional reconstruction analysis. INTERNATIONAL ORTHOPAEDICS 2014; 38:1577-83. [PMID: 24966079 DOI: 10.1007/s00264-014-2401-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Accepted: 05/29/2014] [Indexed: 12/01/2022]
Abstract
PURPOSE Component orientations and positions in total hip arthroplasty (THA) are important parameters in restoring hip function. However, measurements using plain radiographs and 2D computed tomography (CT) slices are affected by patient position during imaging. This study used 3D CT to determine whether contemporary THA restores native hip geometry. METHODS Fourteen patients with unilateral THA underwent CT scan for 3D hip reconstruction. Hip models of the nonoperated side were mirrored with the implanted side to quantify the differences in hip geometry between sides. RESULTS The study demonstrated that combined hip anteversion (sum of acetabular and femoral anteversion) and vertical hip offset significantly increased by 25.3° ± 29.3° (range, -25.7° to 55.9°, p = 0.003) and 4.1 ± 4.7 mm (range, -7.1 to 9.8 mm, p = 0.009) in THAs. CONCLUSIONS These data suggest that hip anatomy is not fully restored following THA compared with the contralateral native hip.
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Affiliation(s)
- Tsung-Yuan Tsai
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital/Harvard Medical School, 55 Fruit St., GRJ-1215, Boston, MA, 02114, USA
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22
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Clarke IC, Lazennec JY, Brusson A, Savisaar C, Bowsher JG, Burgett M, Donaldson TK. Risk of impingement and third-body abrasion with 28-mm metal-on-metal bearings. Clin Orthop Relat Res 2014; 472:497-508. [PMID: 24297107 PMCID: PMC3890183 DOI: 10.1007/s11999-013-3399-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Concerns have been raised about the sequelae of metal-on-metal (MoM) bearings in total hip arthroplasty (THA). However, retrieval studies, which offer the best insight into the clinically relevant mechanisms of MoM wear, have followed predictable trends to date such as indicting cobalt-chromium (CoCr) metallurgy, cup design, high conformity between the head and cup, "steep cups," "microseparation," and "edge wear." QUESTIONS/PURPOSES We wished to evaluate a set of retrieved 28-mm MoM THA for signs of (1) cup-to-stem impingement; (2) normal wear pattern and concomitant stripe damage on femoral heads that would signify adverse wear mechanics; and (3) well-defined evidence of third-body scratches on bearings that would indicate large abrasive particles had circulated the joint space. METHODS Ten 28-mm MOM retrievals were selected on the basis that femoral stems were included. Revision surgeries at 3 to 8 years were for pain, osteolysis, and cup loosening. CoCr stems and the MoM bearings were produced by one vendor and Ti6Al4V stems by a second vendor. All but two cases had been fixed with bone cement. We looked for patterns of normal wear and impingement signs on femoral necks and cup rims. We looked for adverse wear defined as stripe damage that was visually apparent on each bearing. Wear patterns were examined microscopically to determine the nature of abrasions and signs of metal transfer. Graphical models recreated femoral neck and cup designs to precisely correlate impingement sites on femoral necks to cup positions and head stripe patterns. RESULTS The evidence revealed that all CoCr cup liners had impinged on either anterior or posterior facets of femoral necks. Liner impingement at the most proximal neck notch occurred with the head well located and impingement at the distal notch occurred with the head rotated 5 mm out of the cup. The hip gained 20° motion by such a subluxation maneuver with this THA design. All heads had stripe wear, the basal and polar stripes coinciding with cup impingement sites. Analysis of stripe damage revealed 40 to 100-μm wide scratches created by large particles ploughing across bearing surfaces. The association of stripe wear with evidence of neck notching implicated impingement as the root cause, the outcome being the aggressive third-body wear. CONCLUSIONS We found consistent evidence of impingement, abnormal stripe damage, and evidence of third-body abrasive wear in a small sample of one type of 28-mm MoM design. Impingement models demonstrated that 28-mm heads could lever 20° out of the liners. Although other studies continue to show good success with 28-mm MoM bearings, their use has been discontinued at La Pitie Hospital.
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Affiliation(s)
- Ian C. Clarke
- Department of Orthopaedics, Loma Linda University, Loma Linda, CA USA ,DARF Center, 900E Washington Street #200, Colton, CA 92324 USA
| | - Jean-Yves Lazennec
- Department of Orthopaedics, La Pitie Hospital, UPMC University, Paris, France
| | - Adrien Brusson
- Department of Orthopaedics, La Pitie Hospital, UPMC University, Paris, France
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van Arkel RJ, Modenese L, Phillips ATM, Jeffers JRT. Hip abduction can prevent posterior edge loading of hip replacements. J Orthop Res 2013; 31:1172-9. [PMID: 23575923 PMCID: PMC3736148 DOI: 10.1002/jor.22364] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 03/11/2013] [Indexed: 02/04/2023]
Abstract
Edge loading causes clinical problems for hard-on-hard hip replacements, and edge loading wear scars are present on the majority of retrieved components. We asked the question: are the lines of action of hip joint muscles such that edge loading can occur in a well-designed, well-positioned acetabular cup? A musculoskeletal model, based on cadaveric lower limb geometry, was used to calculate for each muscle, in every position within the complete range of motion, whether its contraction would safely pull the femoral head into the cup or contribute to edge loading. The results show that all the muscles that insert into the distal femur, patella, or tibia could cause edge loading of a well-positioned cup when the hip is in deep flexion. Patients frequently use distally inserting muscles for movements requiring deep hip flexion, such as sit-to-stand. Importantly, the results, which are supported by in vivo data and clinical findings, also show that risk of edge loading is dramatically reduced by combining deep hip flexion with hip abduction. Patients, including those with sub-optimally positioned cups, may be able to reduce the prevalence of edge loading by rising from chairs or stooping with the hip abducted.
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Affiliation(s)
- Richard J van Arkel
- Medical Engineering, Department of Mechanical Engineering, Imperial College LondonLondon, SW7 2AZ, United Kingdom
| | - Luca Modenese
- Structural Biomechanics, Department of Civil and Environmental Engineering, Imperial College LondonLondon, United Kingdom,Centre for Musculoskeletal Research, Griffith Health Institute, Griffith University, Gold CoastQueensland, Australia
| | - Andrew TM Phillips
- Structural Biomechanics, Department of Civil and Environmental Engineering, Imperial College LondonLondon, United Kingdom
| | - Jonathan RT Jeffers
- Medical Engineering, Department of Mechanical Engineering, Imperial College LondonLondon, SW7 2AZ, United Kingdom
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Modenese L, Gopalakrishnan A, Phillips ATM. Application of a falsification strategy to a musculoskeletal model of the lower limb and accuracy of the predicted hip contact force vector. J Biomech 2013; 46:1193-200. [PMID: 23427941 DOI: 10.1016/j.jbiomech.2012.11.045] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Revised: 11/22/2012] [Accepted: 11/25/2012] [Indexed: 12/01/2022]
Abstract
In the literature, lower limb musculoskeletal models validated against in vivo measured hip contact forces (HCFs) exhibit a tendency to overestimate the HCFs magnitude and predict inaccurate components of the HCF vector in the transverse plane. In order to investigate this issue, a musculoskeletal model was forced to produce HCFs identical to those measured and the resulting joint equilibrium equations were studied through both a general approach and a static optimization framework. In the former case, the existence of solutions to the equilibrium equations was investigated and the effect of varying the intersegmental moments and the muscle tetanic stress assessed: for a value of 100 N/cm(2) and moments calculated from an inverse dynamics analysis on average only 62% of analyzed frames were solvable for level walking and 70% for stair climbing. In the static optimization study, the model could reproduce the experimental HCFs but the recruited muscles were unable to simultaneously equilibrate the hip intersegmental moments without the contribution of reserve moment actuators. Without constraints imposed on the HCFs, the predicted HCF vectors presented maximum angle deviations up to 22° for level walking and 33° for stair climbing during the gait stance phase. The influence of the medio-lateral HCF component on the solvability of the equilibrium equations and the muscle recruitment alteration when the model was forced to produce the experimental HCFs suggest that a more accurate geometrical representation of the gluteal muscles is mandatory to improve predictions of the HCF vector yielded by the static optimization technique.
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Affiliation(s)
- L Modenese
- Structural Biomechanics, Department of Civil and Environmental Engineering, Imperial College London, UK.
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