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Wu T, Jiang Y, Shi W, Wang Y, Li T. Comparative postoperative prognosis of ceramic-on-ceramic and ceramic-on-polyethylene for total hip arthroplasty: an updated systematic review and meta-analysis. PeerJ 2024; 12:e18139. [PMID: 39346065 PMCID: PMC11438439 DOI: 10.7717/peerj.18139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 08/30/2024] [Indexed: 10/01/2024] Open
Abstract
Objective To compare the clinical outcomes between ceramic-on-ceramic (CoC) and ceramic-on-polyethylene (CoP) bearing surfaces in patients undergoing total hip arthroplasty (THA) through a pooled analysis and evidence update. Methods We performed a systematic literature search using PubMed, Embase, Cochrane Library and Web of Science up to March 2023 for studies that compared the bearing surfaces of CoC and CoP in patients undergoing THA. The primary outcomes were the incidence of common postoperative complications and the rate of postoperative revision. The secondary outcome was the Harris Hip Score. Results A total of 10 eligible studies involving 1,946 patients (1.192 CoC-THA versus 906 CoP-THA) were included in the evidence synthesis. Pooled analysis showed no significant difference in the rates of common postoperative complications (dislocation, deep vein thrombosis, infection, wear debris or osteolysis) and of revision. After eliminating heterogeneity, the postoperative Harris Hip Score was higher in the CoC group than in the CoP group. However, the strength of evidence was moderate for the Harris Hip Score. Conclusion CoC articulations are more commonly used in younger, healthier, and more active patients. While the performance of conventional polyethylene is indeed inferior to highly cross-linked polyethylene, there is currently a lack of sufficient research comparing the outcomes between highly cross-linked polyethylene and CoC bearing surfaces. This area should be a focal point for future research, and it is hoped that more relevant articles will emerge. Given the limited number of studies included, the heterogeneity and potential bias of those included in the analysis, orthopaedic surgeons should select a THA material based on their experience and patient-specific factors, and large multicentre clinical trials with >15 years of follow-up are needed to provide more evidence on the optimal bearing surface for initial THA.
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Affiliation(s)
- Tingyu Wu
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Yaping Jiang
- Department of Oral Implantology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Weipeng Shi
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Yingzhen Wang
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Tao Li
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
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Perka C, Mohaddes M, Zagra L, Ekkernkamp A, Keller N, Stengel D. May the 4th be with you: mixed-methods best-evidence synthesis on 4th-generation alumina-zirconia ceramic bearings in total hip arthroplasty. EFORT Open Rev 2024; 9:632-645. [PMID: 38949170 PMCID: PMC11297405 DOI: 10.1530/eor-23-0218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/02/2024] Open
Abstract
Purpose To assess utility, benefits, and risks of 4th-generation alumina-zirconia ceramic pairings in elective total hip arthroplasty (THA). Methods A comprehensive mixed-methods best-evidence synthesis using data from systematic reviews, randomized controlled trials (RCTs), prospective and retrospective cohort studies, as well as joint replacement registries, was conducted to estimate overall revision and survival rates, periprosthetic infection, bearing fractures, and noise phenomena with 4th-generation alumina-zirconia ceramic versus other tribological couplings in elective THA. The systematic review part across multiple databases was registered with PROSPERO (CRD42023418076), and individual study data were extracted for statistical re-analysis. Results Twenty overlapping systematic reviews, 7, 17, and 8 references from RCTs, cohort studies, and joint replacement registries form the basis of this work. According to current best evidence, it is (i) 15-33 times more likely that 4th-generation alumina-zirconia pairings avoid a revision for infection than causing a revision for audible noise, (ii) 38-85 times more likely that 4th-generation alumina-zirconia pairings avoid a revision for infection than causing a revision for ceramic head fractures, and (iii) three to six times more likely that 4th-generation alumina-zirconia pairings avoid a revision for infection than cause a revision for ceramic liner fractures. Conclusion Fourth-generation alumina-zirconia pairings in THA show a favorable benefit-risk ratio, with rare compound-specific adverse events and complications significantly outbalanced by long-term advantages, such as a markedly lower incidence of revision for infection.
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Affiliation(s)
- Carsten Perka
- Center for Musculoskeletal Surgery, Charité Medical University Center, Berlin, Germany
| | - Maziar Mohaddes
- Hässleholms Hospital, Region Skåne, Hässleholm, Sweden
- Orthopedics, Faculty of Medicine, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Luigi Zagra
- Hip Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Axel Ekkernkamp
- BG Klinikum Unfallkrankenhaus Berlin gGmbH, Berlin, Germany
- BG Kliniken – Klinikverbund der gesetzlichen Unfallversicherung gGmbH, Berlin, Germany
| | - Niklas Keller
- Harding Center for Risk Literacy, University of Potsdam, Faculty of Health Sciences, Potsdam, Germany
| | - Dirk Stengel
- BG Kliniken – Klinikverbund der gesetzlichen Unfallversicherung gGmbH, Berlin, Germany
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Mani G, Porter D, Collins S, Schatz T, Ornberg A, Shulfer R. A review on manufacturing processes of cobalt-chromium alloy implants and its impact on corrosion resistance and biocompatibility. J Biomed Mater Res B Appl Biomater 2024; 112:e35431. [PMID: 38817036 DOI: 10.1002/jbm.b.35431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 03/23/2024] [Accepted: 05/13/2024] [Indexed: 06/01/2024]
Abstract
Cobalt-Chromium (CoCr) alloys are currently used for various cardiovascular, orthopedic, fracture fixation, and dental implants. A variety of processes such as casting, forging, wrought processing, hot isostatic pressing, metal injection molding, milling, selective laser melting, and electron beam melting are used in the manufacture of CoCr alloy implants. The microstructure and precipitates (carbides, nitrides, carbonitrides, and intermetallic compounds) formed within the alloy are primarily determined by the type of manufacturing process employed. Although the effects of microstructure and precipitates on the physical and mechanical properties of CoCr alloys are well reviewed and documented in the literature, the effects on corrosion resistance and biocompatibility are not comprehensively reviewed. This article reviews the various processes used to manufacture CoCr alloy implants and discusses the effects of manufacturing processes on corrosion resistance and biocompatibility. This review concludes that the microstructure and precipitates formed in the alloy are unique to the manufacturing process employed and have a significant impact on the corrosion resistance and biocompatibility of CoCr alloys. Additionally, a historical and scientific overview of corrosion and biocompatibility for metallic implants is included in this review. Specifically, the failure of CoCr alloys when used in metal-on-metal bearing surfaces of total hip replacements is highlighted. It is recommended that the type of implant/application (orthopedic, dental, cardiovascular, etc.) should be the first and foremost factor to be considered when selecting biomaterials for medical device development.
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Affiliation(s)
- Gopinath Mani
- Global Biocompatibility and Science & Technology Organization, Abbott, St. Paul, Minnesota, USA
| | - Deanna Porter
- Global Biocompatibility and Science & Technology Organization, Abbott, St. Paul, Minnesota, USA
| | - Shell Collins
- Global Biocompatibility and Science & Technology Organization, Abbott, St. Paul, Minnesota, USA
| | - Tim Schatz
- Global Biocompatibility and Science & Technology Organization, Abbott, St. Paul, Minnesota, USA
| | - Andreas Ornberg
- Global Biocompatibility and Science & Technology Organization, Abbott, St. Paul, Minnesota, USA
| | - Robert Shulfer
- Global Biocompatibility and Science & Technology Organization, Abbott, St. Paul, Minnesota, USA
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Sikora H, Gabor J, Roczniok R, Kusz D, Swinarew A. The Measurement of the Oxidative Index of Polyethylene Obtained during Revision Hip Arthroplasty and Assessment of Its Variability Depending on the Degree of Osteolysis, Implantation Time, as Well as the Size and Material of the Utilized Head. J Clin Med 2024; 13:2751. [PMID: 38792292 PMCID: PMC11122221 DOI: 10.3390/jcm13102751] [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: 03/26/2024] [Revised: 04/23/2024] [Accepted: 05/03/2024] [Indexed: 05/26/2024] Open
Abstract
Background/Objectives: Aseptic loosening is the leading cause of late revision in total hip arthroplasty, primarily due to degenerative oxidation of polyethylene components, leading to wear particle formation and periacetabular osteolysis. This study aimed to analyze the oxidation levels in polyethylene liners and cemented cups retrieved from revision surgeries using Fourier-transform infrared spectroscopy (FTIR) and to explore the correlation between oxidation levels and factors such as head size, head material, fixation method, and implant survival time. Methods: Polyethylene liners and cups were analyzed post-revision surgery to assess oxidation levels, which were then compared to periacetabular bone loss measured by the Paprosky classification. This study evaluated the impact of head size (28 mm vs. 32 mm), head material (ceramic vs. metal), and fixation methods on oxidation. The relationship between the mean oxidation index (OI) and implant survival time was also investigated. Results: There was a significant positive correlation between the mean oxidation index of the polyethylene components and the severity of periacetabular osteolysis according to the Paprosky scale. While the mean OI for samples articulating with ceramic heads was lower than for those with metal heads, and the mean OI for samples with a 32 mm head size was lower than for those with a 28 mm size, these differences were not statistically significant. Furthermore, the fixation method did not affect the oxidation index, and no correlation was found between OI and the survival time of the implants. Conclusions: This study confirms a direct correlation between polyethylene oxidation and periacetabular osteolysis in hip replacements, highlighting the importance of material choice and design in potentially reducing the risk of aseptic loosening. Despite the lack of significant differences in oxidation levels based on head material and size, these factors may still play a role in the long-term outcome of hip arthroplasty, warranting further investigation.
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Affiliation(s)
- Hanna Sikora
- Scanmed Sport Clinic, ul. Bankowa 2, 44-244 Żory, Poland
| | - Jadwiga Gabor
- Faculty of Science and Technology, University of Silesia in Katowice, ul. 75 Pułku Piechoty 1A, 41-500 Chorzów, Poland;
| | - Robert Roczniok
- Department of Sport Theory and Practice, The Jerzy Kukuczka Academy of Physical Education in Katowice, ul. Mikołowska 72A, 40-065 Katowice, Poland;
| | - Damian Kusz
- Department of Orthopedics and Traumatology, Medical University of Silesia, ul. Ziołowa 45/47, 40-635 Katowice, Poland;
| | - Andrzej Swinarew
- Faculty of Science and Technology, University of Silesia in Katowice, ul. 75 Pułku Piechoty 1A, 41-500 Chorzów, Poland;
- Department of Swimming and Water Rescue, Institute of Sport Science, The Jerzy Kukuczka Academy of Physical Education, ul. Mikołowska 72A, 40-065 Katowice, Poland
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Jillek B, Szabó P, Kopniczky J, Krafcsik O, Szabó I, Patczai B, Turzó K. Characterizing Surface Morphological and Chemical Properties of Commonly Used Orthopedic Implant Materials and Determining Their Clinical Significance. Polymers (Basel) 2024; 16:1193. [PMID: 38732662 PMCID: PMC11085225 DOI: 10.3390/polym16091193] [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: 03/11/2024] [Revised: 04/14/2024] [Accepted: 04/18/2024] [Indexed: 05/13/2024] Open
Abstract
The goal of the study was to compare the surface characteristics of typical implant materials used in orthopedic surgery and traumatology, as these determine their successful biointegration. The morphological and chemical structure of Vortex plate anodized titanium from commercially pure (CP) Grade 2 Titanium (Ti2) is generally used in the following; non-cemented total hip replacement (THR) stem and cup Ti alloy (Ti6Al4V) with titanium plasma spray (TPS) coating; cemented THR stem Stainless steel (SS); total knee replacement (TKR) femoral component CoCrMo alloy (CoCr); cemented acetabular component from highly cross-linked ultrahigh molecular weight polyethylene (HXL); and cementless acetabular liner from ultrahigh molecular weight polyethylene (UHMWPE) (Sanatmetal, Ltd., Eger, Hungary) discs, all of which were examined. Visualization and elemental analysis were carried out by scanning electron microscopy (SEM), energy dispersive spectroscopy (EDS) and X-ray photoelectron spectroscopy (XPS). Surface roughness was determined by atomic force microscopy (AFM) and profilometry. TPS Ti presented the highest Ra value (25 ± 2 μm), followed by CoCr (535 ± 19 nm), Ti2 (227 ± 15 nm) and SS (170 ± 11 nm). The roughness measured in the HXL and UHMWPE surfaces was in the same range, 147 ± 13 nm and 144 ± 15 nm, respectively. EDS confirmed typical elements regarding the investigated prosthesis materials. XPS results supported the EDS results and revealed a high % of Ti4+ on Ti2 and TPS surfaces. The results indicate that the surfaces of prosthesis materials have significantly different features, and a detailed characterization is needed to successfully apply them in orthopedic surgery and traumatology.
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Affiliation(s)
- Bertalan Jillek
- Department of Orthopedics, Somogy County Mór Kaposi Teaching Hospital, Tallián Gyula u. 20-32, H-7400 Kaposvár, Hungary
| | - Péter Szabó
- Szentágothai Research Center, Environmental Analytical and Geoanalytical Research Group, Ifjúság útja 20., H-7624 Pécs, Hungary;
| | - Judit Kopniczky
- Department of Optics and Quantum Electronics, University of Szeged, Dóm tér 9., H-6720 Szeged, Hungary;
| | - Olga Krafcsik
- Department of Atomic Physics, Budapest University of Technology and Economics, Budafoki út 8., H-1111 Budapest, Hungary
| | - István Szabó
- Department of Orthopedics, Somogy County Mór Kaposi Teaching Hospital, Tallián Gyula u. 20-32, H-7400 Kaposvár, Hungary
| | - Balázs Patczai
- Department of Traumatology and Hand Surgery, University of Pécs, Ifjúság u. 13., H-7624 Pécs, Hungary;
| | - Kinga Turzó
- Dental School, Medical Faculty, University of Pécs, Tüzér u. 1, H-7623 Pécs, Hungary;
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Sun CWY, Lau LCM, Cheung JPY, Choi SW. Cancer-Causing Effects of Orthopaedic Metal Implants in Total Hip Arthroplasty. Cancers (Basel) 2024; 16:1339. [PMID: 38611017 PMCID: PMC11011042 DOI: 10.3390/cancers16071339] [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: 03/04/2024] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Metal implants have been preferentially used in THA due to its biocompatibility, mechanical stability and durability. Yet concerns have emerged regarding their potential to release metallic ions, leading to long-term adverse effects, including carcinogenicity. This study aimed to investigate the risk of cancer development in patients with orthopaedic metal implants in total hip arthroplasty (THA). METHODS Patients with THA conducted at a local tertiary implant centre from 2001-2008 were linked to the local cancer registry and followed up to the end of 2023. Standardized incidence ratios (SIRs) for cancer incidence and its confidence interval by Poisson distribution were calculated. Survival analysis was depicted using the Kaplan-Meier method, and the log-rank test was used to assess the differences across groups. RESULTS The study cohort included 388 patients and 53 cancers diagnosed during follow-up, at least 5 years post THA. All-site cancer risks were increased in patients with THA (SIR: 1.97; 95% CI: 1.48-2.46), validated with chi-square analysis (chi-square = 15.2551, N = 100,388, p < 0.01). A statistically significant increase in multiple site-specific cancers including haematological cancers were identified. CONCLUSIONS Patients with THA were found to have an increased risk for cancer compared to the general population during a mean follow-up of 16 years.
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Affiliation(s)
| | | | | | - Siu-Wai Choi
- Department of Orthopaedics and Traumatology, School of Clinical Medicine, Faculty of Medicine, The University of Hong Kong, Hong Kong, China; (C.W.Y.S.); (L.C.M.L.); (J.P.Y.C.)
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Singh J, Panahifar A, Chernikov R, Dust WN. Pelvic Pseudotumor Associated With a Ceramic Bearing Total Hip. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202403000-00014. [PMID: 38513193 PMCID: PMC10959560 DOI: 10.5435/jaaosglobal-d-23-00184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 01/19/2024] [Accepted: 02/06/2024] [Indexed: 03/23/2024]
Abstract
Pseudotumors have been well documented to occur most frequently in metal-metal bearing total hip arthroplasties and less frequently in metal-polyethylene bearings. There are few cases in the literature of pseudotumors occurring in ceramic-ceramic articulations. We report a case of a large pelvic pseudotumor in a patient with a ceramic-ceramic bearing articulation in a 67-year-old man. In addition to the usual investigations, we did a detailed wear analysis of the ceramic implants and an examination of the soft tissues for particulate debris. The detailed wear analysis did show evidence of stripe wear; however, the volumetric wear was within the expected range. Synchrotron imaging identified strontium and zirconium debris arising from the ceramic surfaces. Although association does not mean causation, no other cause for the large pseudotumor could be identified and presumably represents an idiosyncratic reaction to ceramic debris.
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Affiliation(s)
- Jaskaran Singh
- From the Department of Orthopedic Surgery Resident, University of Manitoba, Manitoba, Canada (Dr. Singh); Canadian Light Source, University of Saskatchewan, Saskatoon, Canada (Dr. Panahifar and Dr. Chernikov); Department of Surgery, University of Saskatchewan, Saskatoon, Canada (Dr. Dust)
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8
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McIntosh EI, Sarpong NO, Steele JR, Davis E, Muir JM, Canoles HG, Vigdorchik JM. The Hip-spine Assessment of a Novel Surgical Planning Software Provides Acetabular Component Targets That Are Reliable and in Agreement With Current Clinical Recommendations. Arthroplast Today 2024; 25:101288. [PMID: 38292149 PMCID: PMC10825230 DOI: 10.1016/j.artd.2023.101288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/11/2023] [Accepted: 11/04/2023] [Indexed: 02/01/2024] Open
Abstract
Background Spinopelvic immobility has been reported to increase dislocation risk following total hip arthroplasty. Surgically placing acetabular components in a functional orientation has been shown to mitigate risk. The aim of this study was to evaluate the validity and reliability of novel surgical planning software to generate clinically recommended cup targets. Methods Hip-spine assessments were performed retrospectively on 40 patients. Five reviewers, including 3 arthroplasty-trained surgical fellows and 2 clinical research scientists performed the assessments. Hip-spine assessments consisted of measuring anterior pelvic plane tilt, sacral slope, pelvic incidence, and lumbar lordosis on standing anteroposterior pelvis and lateral standing and seated hip-spine images. Generated cup targets and a control group (40°/20° relative to the anterior pelvic plane) were compared to clinically recommended cup targets. Agreement was defined as a cup position within the recommended range or within 3° of a specific target (eg, 40° inclination) when no range was provided. Intraclass correlation coefficients were used to assess interrater and intrarater reliability, and McNemar's chi-square test was used to measure success relative to the control group. Results The intraclass correlation coefficient was 0.88 for delta sacral slope and 0.92 for pelvic incidence-lumbar lordosis mismatch. For patients with spinopelvic risk factors, the generated targets matched the clinical recommendations in 81% of patients compared to only 16% in the control group. Conclusions Excellent interrater and intrarater reliability was achieved using the novel surgical planning software. The resultant target values agreed with clinical recommendations to a greater extent than the control group.
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Affiliation(s)
- Emily I. McIntosh
- Department of Clinical Research, Intellijoint Surgical Inc, Kitchener, ON, Canada
| | - Nana O. Sarpong
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - John R. Steele
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Elizabeth Davis
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Jeffrey M. Muir
- Department of Clinical Research, Intellijoint Surgical Inc, Kitchener, ON, Canada
| | - Haley G. Canoles
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Jonathan M. Vigdorchik
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
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9
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Oliver RA, Wang T, Christou C, Buchman A, Sibony S, Walsh WR. The influence of polyimide MP-1™ wear particles on a rodent closed fracture healing model. J Appl Biomater Funct Mater 2024; 22:22808000241240296. [PMID: 38509449 DOI: 10.1177/22808000241240296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024] Open
Abstract
Joint replacements provide pain free movement for the injured or our aging population. Current prothesis mainly consist of hard metal on metal, or ceramic femoral head on ultra-high-molecular weight polyethylene (UHMWPE). In this study, a rodent fracture model was used to test the influence of wear debris from a high-performance polymer (polyimide MP-1™). Saline, MP-1™ Low Dose in Saline (1%), or MP-1 High Dose (2%) in Saline was injected directly into a standard closed unilateral femoral fracture in 12-week old Sprague Dawley rats (n = 25) for 1, 3 and 6 weeks. Endpoints included radiography, micro-computed tomography, mechanical testing and paraffin histology. No adverse effects from the wear particles were observed from the current study based on radiology, mechanical or histological data. Although the particles were present, histological analysis revealed a progression in healing between the Polyimide treated groups and the non-treated saline control groups over the duration of 1, 3, and 6 weeks, with no inhibition from the particles. The MP-1™ wear debris generated are larger than 1 µm thus are not able to be engulfed by macrophages and cause osteolysis. This family of polymers (polyimides) may be an ideal material to consider for articulating joints and other implants in the human body.
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Affiliation(s)
- Rema A Oliver
- Surgical and Orthopaedic Research Laboratories, UNSW Sydney, School of Clinical Medicine, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Tian Wang
- Surgical and Orthopaedic Research Laboratories, UNSW Sydney, School of Clinical Medicine, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Chris Christou
- Surgical and Orthopaedic Research Laboratories, UNSW Sydney, School of Clinical Medicine, Prince of Wales Hospital, Randwick, NSW, Australia
| | | | | | - William R Walsh
- Surgical and Orthopaedic Research Laboratories, UNSW Sydney, School of Clinical Medicine, Prince of Wales Hospital, Randwick, NSW, Australia
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Migliorini F, Maffulli N, Pilone M, Bell A, Hildebrand F, Konrads C. Risk factors for liner wear and head migration in total hip arthroplasty: a systematic review. Sci Rep 2023; 13:15612. [PMID: 37730762 PMCID: PMC10511625 DOI: 10.1038/s41598-023-42809-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 09/14/2023] [Indexed: 09/22/2023] Open
Abstract
Total hip arthroplasty (THA) is a successful orthopaedic surgical procedure, and its longevity depends on bearing components and implant fixation. Optimizing polyethylene and ceramics has led to improved wear parameters and contributed to improved long-term outcomes. The present systematic review investigated whether time span from implantation, patient characteristics and performance status exert an influence on liner wear and head migration in THA. This study was conducted in conformity to the 2020 PRISMA guidelines. All the clinical investigations which reported quantitative data on the amount of liner wear and head migration in THA were considered. Only studies which reported quantitative data at least on one of the following patient characteristics were suitable: mean age, mean BMI (kg/m2), sex, side, time span between the index THA and the last follow-up (months) were eligible. A multiple linear model regression analysis was employed to verify the association between patient characteristics and the amount of liner wear and/or head migration. The Pearson Product-Moment Correlation Coefficient was used to assess the association between variables. Data from 12,629 patients were considered. The mean length of the follow-up was 90.5 ± 50.9 months. The mean age of patients at surgery was 58.4 ± 9.4 years, and the mean BMI was 27.2 ± 2.5 kg/m2. 57% (7199 of 12,629 patients) were women, and in 44% (5557 of 12,629 patients) THAs were performed on the left. The mean pre-operative Harris hip score was 46.5 ± 6.0 points. There was evidence of a moderate positive association between the amount of liner wear and the time elapsed between the index surgery to the follow-up (P = 0.02). There was evidence of a moderate positive association between the amount of head migration and the time elapsed between the index surgery to the follow-up (P = 0.01). No further statistically significant association was found. The time elapsed between the index surgery to the follow-up was the most important factor which influence the head migration and liner wear in THA. Patients' characteristics and preoperative physical activity did not influence the amount of head migration and liner wear.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany.
- Department of Orthopaedic and Trauma Surgery, Academic Hospital of Bolzano, Teaching Hospital of Paracelsus Medical University (PMU), 39100, Bolzano, Italy.
- Department of Orthopaedic and Trauma Surgery, Eifelklinik St.Brigida, Simmerath, Germany.
| | - Nicola Maffulli
- Department of Orthopaedic and Trauma Surgery, Hospital Sant'Andrea, University of Rome La Sapienza, Rome, Italy
- School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Stoke on Trent, ST4 7QB, England
- Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, London, E1 4DG, England
| | - Marco Pilone
- Residency Program in Orthopaedics and Traumatology, University of Milan, 20122, Milan, Italy
| | - Andreas Bell
- Department of Orthopaedic and Trauma Surgery, Eifelklinik St.Brigida, Simmerath, Germany
| | - Frank Hildebrand
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Christian Konrads
- Department of Orthopaedics and Traumatology, Helios Hanseatic Hospital Stralsund, 18435, Stralsund, Germany
- Medical Faculty, University of Tübingen, 72076, Tübingen, Germany
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Döring J, Buchholz A, Herbster M, Gehring J, Betke U, Chodór P, Zabrzyński J, Bertrand J, Lohmann CH, Łapaj Ł. Damage analysis of retrieved Biolox Ⓡdelta components used in hard and soft bearings. Acta Biomater 2023; 158:827-842. [PMID: 36599400 DOI: 10.1016/j.actbio.2022.12.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/21/2022] [Accepted: 12/23/2022] [Indexed: 01/02/2023]
Abstract
This retrieval study included 43 Biolox delta explants (18 CoC, 25 CoP). Implants were examined macroscopically, whereby damage was evaluated using a semi quantitative scoring system. Confocal microscopy was used to examine wear related damage patterns of the articulating surfaces. Scanning electron microscopy (SEM) with energy-dispersive X-ray spectroscopy (EDS) was used to analyze wear marks on the implant surface and wear debris in periprosthetic tissue samples. Raman spectroscopy and X-ray diffraction (XRD) were used to quantify monoclinic zirconia fractions. On all components, in vivo wear resulted predominantly in different damage patterns caused by metal transfer. In CoC bearings stripe wear was additionally detected, and some implants underwent severe damage due to component breakage. The wear scores were higher for CoC components, with no differences between the scores for CoC heads and liners. Wear features caused comparable roughening on implants from CoC and CoP bearings. SEM studies demonstrated that most wear marks were caused by metal debris released from implant components. Grain pull-out was observed in stripe wear regions. Monoclinic phase shift was observed in a similar quantity on components from CoP and CoC bearings. The increase of monoclinic zirconia content around metal deposits was minimal and was more pronounced in areas of stripe wear. The results of this study indicate, that ZTA components in general undergo minimal wear in both, CoC and CoP bearings, however, it is more pronounced in the former. Metal deposits, as the most common wear feature, have no significant effect on monoclinic phase transition. STATEMENT OF SIGNIFICANCE: In this paper, we classify all damage patterns macroscopically according to an established scoring system and assess them regarding surface roughness (confocal microscopy) and monoclinic phase content (Raman spectroscopy) in order to derive the severity for patients. We compare hard-hard and hard-soft bearings and relate damage patterns with metal transfer based on SEM/EDS examinations. Furthermore, we work out correlations between patient-specific data, cause of revision and the physical condition of each individual sample Our cohort consists of 43 Biolox delta retrievals, a comparatively large quantity. In addition, we address current topics such as metal transfer and, based on the classification of damage patterns, provide incentives and/or meaningful focal points for further research.
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Affiliation(s)
- Joachim Döring
- Department of Orthopaedic Surgery, Otto-von-Guericke-University, Magdeburg, Germany.
| | - Adrian Buchholz
- Department of Orthopaedic Surgery, Otto-von-Guericke-University, Magdeburg, Germany
| | - Maria Herbster
- Institute of Materials and Joining Technology, Otto-von-Guericke-University, Magdeburg, Germany
| | - Jennifer Gehring
- Department of Orthopaedic Surgery, Otto-von-Guericke-University, Magdeburg, Germany
| | - Ulf Betke
- Institute of Materials and Joining Technology, Otto-von-Guericke-University, Magdeburg, Germany
| | - Paweł Chodór
- Department of General Orthopaedics, Musculoskeletal Oncology and Trauma Surgery, Poznań, Poland
| | - Jan Zabrzyński
- Faculty of Medicine, Nicolas Copernicus University, Toruń, Collegium Medicum in Bydgoszcz, Poland
| | - Jessica Bertrand
- Department of Orthopaedic Surgery, Otto-von-Guericke-University, Magdeburg, Germany
| | - Christoph H Lohmann
- Department of Orthopaedic Surgery, Otto-von-Guericke-University, Magdeburg, Germany
| | - Łukasz Łapaj
- Department of General Orthopaedics, Musculoskeletal Oncology and Trauma Surgery, Poznań, Poland
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12
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van Loon J, Sierevelt IN, Spekenbrink-Spooren A, Opdam KTM, Poolman RW, Kerkhoffs GMMJ, Haverkamp D. Higher risk of 2-year cup revision of ceramic-on-ceramic versus ceramic-on-polyethylene bearing: analysis of 33,454 primary press-fit total hip arthroplasties registered in the Dutch Arthroplasty Register (LROI). Hip Int 2023; 33:280-287. [PMID: 34974763 PMCID: PMC9978866 DOI: 10.1177/11207000211064975] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND PURPOSE The influence of bearing on short-term revision in press-fit total hip arthroplasty (THA) remains under-reported. The aim of this study was to describe 2-year cup revision rates of ceramic-on-ceramic (CoC) and ceramic-on-polyethylene (CoPE). PATIENTS AND METHODS Primary press-fit THAs with one of the three most used cups available with both CoC or CoPE bearing recorded in the Dutch Arthroplasty Register (LROI) were included (2007-2019). Primary outcome was 2-year cup revision for all reasons. Secondary outcomes were: reasons for revision, incidence of different revision procedures and use of both bearings over time. RESULTS 2-year Kaplan-Meier cup revision rate in 33,454 THAs (12,535 CoC; 20,919 CoPE) showed a higher rate in CoC (0.67% [95% CI, 0.54-0.81]) compared to CoPE (0.44% [95% CI, 0.34-0.54]) (p = 0.004). Correction for confounders (age, gender, cup type, head size) resulted in a hazard ratio (HR) of 0.64 [95%CI, 0.48-0.87] (p = 0.019). Reasons for cup revision differed only by more cup revision due to loosening in CoC (26.2% vs.1 3.2%) (p = 0.030). For aseptic loosening a revision rate of 0.153% [95% CI, 0.075-0.231] was seen in CoC and 0.058% [95%CI 0.019-0.097] in CoPE (p = 0.007). Correction for head size resulted in a HR of 0.475 [95% CI, 0.197-1.141] (p = 0.096). Incidence of different revision procedures did not differ between bearings. Over time the use of CoPE has increased and CoC decreased. CONCLUSIONS A higher 2-year cup revision rate in press-fit THA was observed in CoC compared to CoPE. Cup loosening was the only significantly different reason for revision and seen more often in CoC and mostly aseptic. Future randomised controlled trials need to confirm causality, since the early cup revision data provided has the potential to be useful when choosing the bearing in press-fit THA, when combined with other factors like bone quality and patient and implant characteristics.
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Affiliation(s)
- Justin van Loon
- Xpert Clinics Orthopedie Amsterdam, The
Netherlands,Department of Orthopaedic Surgery,
Amsterdam Movement Sciences, Amsterdam UMC, Academic Medical Centre, University of
Amsterdam, Amsterdam, The Netherlands,Department of Orthopaedic Surgery,
Tergooi, Hilversum, The Netherlands
| | - Inger N Sierevelt
- Xpert Clinics Orthopedie Amsterdam, The
Netherlands,Department of Orthopaedic Surgery,
Spaarne Gasthuis Academy, TM Hoofddorp, The Netherlands
| | | | - Kim TM Opdam
- Department of Orthopaedic Surgery,
Amsterdam Movement Sciences, Amsterdam UMC, Academic Medical Centre, University of
Amsterdam, Amsterdam, The Netherlands
| | - Rudolf W Poolman
- Department of Orthopaedic Surgery,
Leiden University Medical Centre, Leiden, The Netherlands,Department of Orthopaedic Surgery,
OLVG, Amsterdam, The Netherlands
| | - Gino MMJ Kerkhoffs
- Department of Orthopaedic Surgery,
Amsterdam Movement Sciences, Amsterdam UMC, Academic Medical Centre, University of
Amsterdam, Amsterdam, The Netherlands
| | - Daniël Haverkamp
- Xpert Clinics Orthopedie Amsterdam, The
Netherlands,Daniël Haverkamp, Xpert Clinics Orthopedie
Amsterdam, Laarderhoogtweg 12, Amsterdam, North-Holland, 1101EA, The
Netherlands.
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13
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Revision total hip arthroplasty by a ceramic bearing surface after a third- and fourth-generation ceramic head or liner fracture. INTERNATIONAL ORTHOPAEDICS 2023; 47:1197-1202. [PMID: 36808282 DOI: 10.1007/s00264-023-05705-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 01/16/2023] [Indexed: 02/23/2023]
Abstract
PURPOSE Although rare, fractures of ceramic components are difficult to revise, mainly due to the presence of residual ceramic debris that can cause catastrophic wear of the replacement components. Modern ceramic-on-ceramic bearings are suggested to improve outcomes of revision total hip arthroplasty (THA) for ceramic fractures. However, there are few published reports of mid-term outcomes of revision THA using ceramic-on-ceramic bearings. We evaluated clinical and radiographic outcomes of 10 patients who received ceramic-on-ceramic bearings during revision THA for ceramic fractures. METHODS All patients but one received fourth-generation Biolox Delta bearings. Clinical evaluation was performed using the Harris hip score at latest follow-up, and all patients received a radiographic evaluation to analyze the fixation of the acetabular cup and of the femoral stem. Osteolytic lesions and the presence of ceramic debris were noted. RESULTS After a mean follow-up of 8.0 years, there were no complications or implant failures, and all patients reported satisfaction with their implant. The average Harris hip score was 90.6. There was neither osteolysis nor loosening, but despite our extensive synovial debridement, ceramic debris was noted in the radiographs of five patients (50%). CONCLUSION We report excellent mid-term outcomes, with no implant failures after eight years despite ceramic debris being found in a significant proportion of patients. We conclude that modern ceramic-on-ceramic bearings are an advantageous option for the revision of THA due to the fracture of initial ceramic components.
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14
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van Loon J, de Graeff JJ, Sierevelt IN, Opdam KTM, Poolman RW, Kerkhoffs GMMJ, Haverkamp D. Revision in Ceramic-on-Ceramic and Ceramic-on-Polyethylene Bearing in Primary Total Hip Arthroplasty with Press-fit Cups: A Systematic Review and Meta-analysis of Different Methodological Study Designs. THE ARCHIVES OF BONE AND JOINT SURGERY 2022; 10:916-936. [PMID: 36561219 PMCID: PMC9749123 DOI: 10.22038/abjs.2022.59354.2933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 04/28/2022] [Indexed: 12/24/2022]
Abstract
Background The influence of bearing on revision, especially in press-fit modular cup total hip arthroplasty (THA), remains underexposed. Methods A systematic literature review was conducted in PubMed, Embase, Cochrane Library, and ClinicalTrials.gov in line with the PRISMA guidelines. The primary outcome was overall revision between ceramic-on-ceramic (CoC) and all sorts of ceramic-on-polyethylene (CoPE) bearings. As secondary outcomes complications and reasons for revision were compared between bearings. Outcomes were presented in subgroups based on study design (randomized controlled trials (RCT), non-randomized comparative, and registry studies). The quality of evidence was assessed using the GRADE. The risk of bias was assessed using the Cochrane collaboration's tool and the MINORS criteria. Results This meta-analysis included twelve RCTs, three non-randomized comparative studies and two registry studies, including 38,772 THAs (10,909 CoPE and 27,863 CoC). Overall revision showed a lower risk in CoPE compared to CoC in the two registry studies (HR 0.71 (95%CI 0.53; 0.99)) (very low-quality GRADE evidence). In RCTs and non-randomized comparative studies, no difference was observed (low-quality GRADE evidence). Loosening, dislocation, infection, and postoperative periprosthetic fracture showed no significant differences in risk ratio for all designs. Conclusion The lower risk of overall revision in registry studies of primary THA with a press-fit modular cup using CoPE bearing compared to CoC should be considered preliminary since this outcome was just slightly significant, based on very low-quality GRADE evidence and based on only two studies with several limitations. Since no difference was observed in the other methodological designs and the separate reasons for revision showed no significant difference in all designs either, no preference for CoC or CoPE can be expressed, and therefore both seem suitable options based on the available literature. More comparative long-term studies are needed to confirm the potential advantages of wear-reduction of both bearings since the currently available literature is limited.
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Affiliation(s)
- Justin van Loon
- Amsterdam University Medical Centres, location Academic Medical Center, University of Amsterdam, Department of Orthopaedic Surgery, Amsterdam Movement Sciences Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands,Xpert Clinics Orthopedie, Laarderhoogtweg 12, 1101EA Amsterdam, The Netherlands,Tergooi, department of Orthopaedic Surgery, Van Riebeeckweg 212, 1213 XZ, Hilversum, The Netherlands
| | - Jan Jaap de Graeff
- Leiden University Medical Center, department of Orthopaedic Surgery, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Inger Nicoline Sierevelt
- Xpert Clinics Orthopedie, Laarderhoogtweg 12, 1101EA Amsterdam, The Netherlands,Spaarne Gasthuis, Spaarne Gasthuis Academy, Spaarnepoort 1, 2134 TM Hoofddorp, The Netherlands
| | - Kim Theresia Maria Opdam
- Amsterdam University Medical Centres, location Academic Medical Center, University of Amsterdam, Department of Orthopaedic Surgery, Amsterdam Movement Sciences Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Rudolf Wilhelm Poolman
- Leiden University Medical Center, department of Orthopaedic Surgery, Albinusdreef 2, 2333 ZA Leiden, The Netherlands,OLVG, department of Orthopaedic Surgery, Oosterpark 9, 1091 AC Amsterdam, The Netherlands
| | - Gino Matheus Melanie Johannes Kerkhoffs
- Amsterdam University Medical Centres, location Academic Medical Center, University of Amsterdam, Department of Orthopaedic Surgery, Amsterdam Movement Sciences Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Daniël Haverkamp
- Xpert Clinics Orthopedie, Laarderhoogtweg 12, 1101EA Amsterdam, The Netherlands
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15
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Bitzer A, Rondinelli S, Hurwit DJ, Sonnenfeld JJ, Hong IS, Connor PM. Conversion of anatomic total shoulder arthroplasty to reverse shoulder arthroplasty using a unique hybrid glenoid component: technique and preliminary results. JSES REVIEWS, REPORTS, AND TECHNIQUES 2022; 2:155-163. [PMID: 37587957 PMCID: PMC10426665 DOI: 10.1016/j.xrrt.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Background Degenerative arthritis of the shoulder is a common condition that is successfully treated with anatomic total shoulder arthroplasty (TSA). Rotator cuff disease has evolved as a leading cause of failure of anatomic TSA, requiring revision to reverse shoulder arthroplasty (RSA). This revision procedure can be extremely complex, particularly if removal of a well-fixed glenoid component is necessary. This case series outlines the technique and preliminary clinical results of conversion of anatomic TSA to RSA utilizing both modular humeral and hybrid glenoid components. Methods From July 2017 to December 2019, the senior author (PMC) performed 84 consecutive anatomic TSA procedures utilizing a modular humeral arthroplasty system and a unique hybrid glenoid component. Three cases (3/84, or 3.6%) required conversion from anatomic TSA to RSA because of postoperative traumatic rotator cuff failure. All modular revision cases were performed without humeral stem removal and with utilization of the existing, well-fixed hybrid glenoid central titanium peg as the foundation for glenoid component revision. Preoperative and postoperative American Shoulder and Elbow Surgeons scores, visual analog scale pain scores, forward flexion, and patient satisfaction were analyzed in this modular revision group. In addition, several perioperative variables including operative time, blood loss, and length of stay were compared between this modular revision group and a nonmodular anatomic TSA to RSA revision comparative cohort. Results At an average follow-up of 24 months, average active forward flexion, postoperative American Shoulder and Elbow Surgeons scores, and visual analog scale pain scores improved significantly compared with preoperative scores in the modular revision group. All three patients were satisfied with their outcome. The average total operative time (109 minutes vs. 154 minutes, P = .02), blood loss (183 cc vs. 500 cc, P = .08), and length of hospital stay (26.3 hours vs. 36.6 hours P < .05) were lower in the modular revision group than those in a nonmodular revision cohort. Conclusion Revision of anatomic TSA to RSA utilizing a modular humeral system and a convertible hybrid glenoid component that does not require removal of a well-fixed central titanium peg which serves as the foundation for glenoid component revision was performed efficiently, safely, and successfully in three cases. This technique results in significantly improved clinical outcomes when revision to RSA is needed while potentially decreasing perioperative complications in the revision setting.
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Affiliation(s)
| | | | | | | | - Ian S. Hong
- OrthoCarolina – Sports Medicine Center, Charlotte, NC, USA
- Atrium Health – Musculoskeletal Institute, Charlotte, NC, USA
| | - Patrick M. Connor
- OrthoCarolina – Sports Medicine Center, Charlotte, NC, USA
- Atrium Health – Musculoskeletal Institute, Charlotte, NC, USA
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16
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Li L, Fu J, Xu C, Ni M, Chai W, Hao L, Zhou Y, Chen J. Fourth‐Generation Ceramic‐on‐Ceramic THA
in Patients with Ankylosing Spondylitis: A Minimum
10‐Year Follow‐Up. Orthop Surg 2022; 14:860-867. [PMID: 35434922 PMCID: PMC9087442 DOI: 10.1111/os.13259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 02/05/2022] [Accepted: 02/18/2022] [Indexed: 11/30/2022] Open
Abstract
Objective To report the long‐term outcomes of total hip arthroplasty (THA) with fourth‐generation ceramic‐on‐ceramic (CoC) bearing in patients with ankylosing spondylitis (AS). Methods We retrospectively identified 180 primary THAs performed in 110 patients with AS, including 100 (90.9%) men and 10 women (9.1%), from 2009 to 2011.The mean age of the patients at surgery was 33 years (range, 16 to 65 years). Cementless prostheses with fourth‐generation CoC bearings were used in all patients. Survivorship of the implants and postoperative complications were calculated. Functional improvement was assessed by the hip flexion‐extension range of motion (ROM) and Harris hip score (HHS). A special noise assessment questionnaire was performed at the last follow‐up. The cumulative incidence of noise was calculated by the Kaplan–Meier method with 95% confidence intervals (CIs). Clinical characteristics and functional outcomes were compared in the hips with noise to those without noise. Results The mean follow‐up was 11 years (range, 10 to 12 years), and survivorship of the implants was 99.4% at the most recent follow‐up. The complications included dislocation (one hip, 0.6%), periprosthetic joint infection (one hip, 0.6%), mild to moderate pain (five hips, 2.8%), heterotopic ossification (12 hips, 6.7%), and noise (52 hips, 28.9%). The flexion‐extension ROM improved significantly with a median from 10° (range, 0 ~ 130°) to 100° (30 ~ 130°) after THA (p < 0.001), and the HHS increased significantly from 41 ± 20 to 90 ± 8 (p < 0.001). The cumulative incidence of noise at 0.5, 5, and 10 years was 6.1% (95% CI, 2.6 ~ 9.6), 16.7% (95% CI, 11.2 ~ 22.1), and 28.9% (95% CI, 22.2 ~ 35.5), respectively, and that of squeaking at 0.5, 5, and 10 years was 4.4% (95% CI, 1.4 ~ 7.4), 13.3% (95% CI, 8.4 ~ 18.3), and 23.9% (95% CI, 17.6 ~ 30.1), respectively. None of the patients with noise generation in the hip reported it affecting daily activities or causing dissatisfaction. No differences in age, sex, BMI, disease duration, bilateral THA, the frequency of bony ankylosis, the proportion of using a 36‐mm‐diameter femoral head, pre/postoperative flexion‐extension ROM, or pre/postoperative HHS were found between hips with noise and those without noise (p > 0.05). Conclusion THAs with fourth‐generation CoC bearings exhibit excellent long‐term survival and clinical outcomes in patients with AS, with a very low dislocation rate. The incidence of noise associated with CoC bearings in THA performed in patients increases over time, but it does not affect postoperative hip function or daily activities.
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Affiliation(s)
- Liangliang Li
- Medical School of Chinese PLA Beijing China
- Department of Orthopeadics, The First Medical Centre Chinese PLA General Hospital Beijing China
- Department of Orthopeadics The Second Hospital of Shanxi Medical University Taiyuan China
| | - Jun Fu
- Department of Orthopeadics, The First Medical Centre Chinese PLA General Hospital Beijing China
| | - Chi Xu
- Department of Orthopeadics, The First Medical Centre Chinese PLA General Hospital Beijing China
| | - Ming Ni
- Department of Orthopeadics, The First Medical Centre Chinese PLA General Hospital Beijing China
| | - Wei Chai
- Department of Orthopeadics, The First Medical Centre Chinese PLA General Hospital Beijing China
| | - Libo Hao
- Department of Orthopeadics, The First Medical Centre Chinese PLA General Hospital Beijing China
| | - Yonggang Zhou
- Department of Orthopeadics, The First Medical Centre Chinese PLA General Hospital Beijing China
| | - Jiying Chen
- Department of Orthopeadics, The First Medical Centre Chinese PLA General Hospital Beijing China
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17
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Shim BJ, Park SJ, Park CH. The Wear Rate and Survivorship in Total Hip Arthroplasty Using a Third-generation Ceramic Head on a Conventional Polyethylene Liner: A Minimum of 15-year Follow-up. Hip Pelvis 2022; 34:115-121. [PMID: 35800129 PMCID: PMC9204242 DOI: 10.5371/hp.2022.34.2.115] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 01/14/2022] [Accepted: 01/29/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose Materials and Methods Results Conclusion
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Affiliation(s)
- Bum-Jin Shim
- Department of Orthopedic Surgery, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Korea
| | - Sung-Jin Park
- Department of Orthopedic Surgery, Yeungnam University Medical Center, Daegu, Korea
| | - Chan Ho Park
- Department of Orthopedic Surgery, Yeungnam University Medical Center, Daegu, Korea
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18
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Corradi N, Caruso G, Martini I, Massari L. Hip Replacement after Proximal Femur Failed Osteosynthesis: our experience. ACTA BIO-MEDICA : ATENEI PARMENSIS 2022; 93:e2022028. [PMID: 35315425 PMCID: PMC8972852 DOI: 10.23750/abm.v93i1.10853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 11/05/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIM failure of proximal femur fixation is a rare but challenging complication. Hip replacement could be a safe and optimal salvage treatment option. However, serious complications could occur. The aim of our study is to retrospectively review all hip replacement performed after proximal femur fixation failure and to evaluate functional and radiographic outcomes. METHODS we reviewed all Total Hip Arthroplasty and Hemiarthroplasty performed from 2013 to 2020 in Our Departement. We evaluated latest follow-up x-rays for stem subsidence, varus-valgus stem position (>5°), limb lenght inequality (>1cm), dislocation, component loosening, heterotopic calcification classified according to Brooker, cement leakage. Harris Hip Score (HHS) and Hip WOMAC score were perfomed at the latest follow-up to estimate functional outcome. RESULTS 14 THA had no complications with mean HHS 86.5 and WOMAC score 91,68. 1 periprosthetic infection was reported on THA, however after 2-stages revision functional and radiographic otucomes were satisfactory. 5 HA had rated mean HHS 65.8 and WOMAC score 70.18. 2 HA experienced dislocations which required surgical revision and conversion to THA. CONCLUSIONS as a salvage surgery for failure of proximal femur fixation, Hip Replacement is safe and recommendable. THA reported better results than HA. Nonetheless, every patient should be carefully evaluated before undergoing surgery to detect possible complication risk factors.
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Affiliation(s)
| | - Gaetano Caruso
- Department of Orthopaedic and Traumatology, University of Ferrara, Ferrara, Italy.
| | - Ilaria Martini
- Department of Orthopaedic and Traumatology, University of Ferrara, Ferrara, Italy.
| | - Leo Massari
- Department of Orthopaedic and Traumatology, University of Ferrara, Ferrara, Italy.
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Fang Y, Shang X. Comparison of Ceramic-on-Ceramic vs. Ceramic-on-Polyethylene for Primary Total Hip Arthroplasty: A Meta-Analysis of 15 Randomized Trials. Front Surg 2021; 8:751121. [PMID: 34977138 PMCID: PMC8716688 DOI: 10.3389/fsurg.2021.751121] [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: 07/31/2021] [Accepted: 11/15/2021] [Indexed: 12/02/2022] Open
Abstract
Objective: This meta-analysis aimed to compare ceramic-on-ceramic (COC) components and ceramic-on-polyethylene (COP) components during total hip arthroplasty (THA). Settings: A meta-analysis of randomized controlled trials (RCTs) comparing COC and COP during primary THA was conducted. Electronic searches were current to March 2021. Participants: Trials were included for meta-analysis if they compared at least the bearing surfaces of COC and COP for patients undergoing primary THA and if they reported the outcomes of THA after a certain period of follow-up and only RCTs in English were included. Primary and Secondary Outcome Measures: The primary endpoints consist of audible noise, prosthesis fracture, and revision. Secondary endpoints include dislocation, deep infection, osteolysis, and prosthesis loosening. Extracted data were statistically analyzed with the Stata11.0. Results: A total of 15 RCTs containing 2,702 patients (2,813 hips) were included in this study. The audible noise [odds ratio (OR) = 5.919; 95% CI: 2.043, 17.146; p ≤ 0.001] and prosthesis fracture (OR = 35.768; 95% CI: 8.957, 142.836; p = 0.001) were significantly higher in the COC group. Hip function, revision rate, dislocation rate, deep infection rate, osteolysis rate, and prosthesis loosening rate were comparable between these two groups, while the wear rate was higher in the COP group. Conclusion: This study indicated comparable outcomes of COC and COP bearing surfaces in primary THA; high-quality RCTs with a long-term follow-up are still urgently needed to provide more evidence on the optimal bearing surfaces in primary THA.
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Affiliation(s)
- Yan Fang
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaobin Shang
- Department of Orthopaedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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20
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Similar Biomechanical Behavior in Gait Analysis between Ceramic-on-Ceramic and Ceramic-on-XLPE Total Hip Arthroplasties. Life (Basel) 2021; 11:life11121366. [PMID: 34947897 PMCID: PMC8704359 DOI: 10.3390/life11121366] [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: 10/29/2021] [Revised: 12/03/2021] [Accepted: 12/04/2021] [Indexed: 12/02/2022] Open
Abstract
In vitro measurements are widely used to implement gait kinematic and kinetic parameters to predict THA wear rate. Clinical tests of materials and designs are crucial to prove the accuracy and validate such measurements. This research aimed to examine the effect of CoC and CoXLPE kinematics and kinetics on wear during gait, the essential functional activity of humans, by comparing in vivo data to in vitro results. Our study hypothesis was that both implants would present the same hip joint kinematics and kinetics during gait. In total, 127 unilateral primary cementless total hip arthroplasties were included in the research. There were no statistically significant differences observed at mean peak abduction, flexion, and extension moments and THA kinematics between the two groups. THA gait kinematics and kinetics are crucial biomechanical inputs associated with implant wear. In vitro studies report less wear in CoC than CoXLPE when tested in a matched gait kinematic protocol. Our findings confirm that both implants behave identically in terms of kinematics in a clinical environment, thus strengthening CoC advantage in in vitro results. Correlated to all other significant factors that affect THA wear, it could address in a complete prism the wear on CoC and CoXLPE.
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21
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Outcomes of Ceramic Composite in Total Hip Replacement Bearings: A Single-Center Series. JOURNAL OF COMPOSITES SCIENCE 2021. [DOI: 10.3390/jcs5120320] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Despite the fact that total hip replacement is one of the most successful surgical procedures for treatment of a variety of end-stage hip diseases, the process of osteolysis and implant loosening remains a significant problem, especially in young and high-demand patients. More than 40 years ago, ceramic bearings were introduced due to their mechanical advantage in order to obtain a reduction in wear debris, and due to the conviction that it was possible to minimize friction and wear owing to their mechanical hardness, high chemical stability, surface lubrication by fluids and low friction coefficient. Together with excellent mechanical properties, ceramics have a biological inertness: eventual ceramic debris will lead to a reactive response with a high predominance of fibrocystic cells, rather than macrophagic cells, and absence of giant cells, which is ideal from a biological perspective. As a consequence, they will not trigger the granulomatous reaction necessary to induce periprosthetic osteolysis, and this clearly appears to be of great clinical relevance. In recent years, tribology in manufacturing ceramic components has progressed with significant improvements, owing to the development of the latest generation of ceramic composites that allow for an increased material density and reduced grain size. Currently, ceramic-on-ceramic bearings are considered the attractive counterparts of ceramic- or metal-on-polyethylene ones for patients with a long life expectancy. The aim of this paper is to report the results of total hip replacements performed with a ceramic-on-ceramic articulation made from a ceramic composite in a single center, focusing on its usefulness in specific preoperative diagnosis.
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Ten-year survival of ceramic-on-ceramic total hip arthroplasty in patients younger than 60 years: a systematic review and meta-analysis. J Orthop Surg Res 2021; 16:679. [PMID: 34794457 PMCID: PMC8600788 DOI: 10.1186/s13018-021-02828-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 11/03/2021] [Indexed: 01/10/2023] Open
Abstract
Background Total hip arthroplasty (THA) with ceramic-on-ceramic (CoC) was created to minimise wear debris and aseptic loosening. A decade ago, a meta-analysis showed a 10-year survival rate of just 89%. Based on the excellent tribology of the current CoC, significant improvement of implant survivorship is expected. In patients younger than 60, we conducted a meta-analysis to assess 10-year survival and complications after using current primary CoC THA. Materials and methods PubMed, Scopus, EMBASE, Virtual Health Library, and Cochrane Library were used to scan for published trials that met the inclusion criteria until January 2019. The qualified studies were subjected to a systematic review and proportional analysis, and the randomised controlled trials (RCTs) were included in a comparison meta-analysis. Results Thirteen studies were included 156 findings. The total number of hips was 2278. Nine studies were cohort, and four were RCTs between ceramic and polyethylene cups. The analysis revealed an average age of 44 years (range 24–54). The 10-year survival 96% (95% CI; 95.4–96.8%), aseptic loosening rate 0.516. (95% CI; 0.265–0.903), ceramic fracture rate 0.620 (95% CI; 0.34–1.034) and squeaking rate 2.687 (95% CI; 1.279–4.593). A comparison meta-analysis revealed the risk ratio (RR) for revision was 0.27 (95% CI; 0.15–0.47), and for aseptic loosening 0.15 (0.03–0.70) favouring CoC, while RR for component fracture was 1.62 (95% CI; 0.27–9.66) favouring the polyethylene. Conclusion In patients under sixty, current CoC THAs are correlated with better 10-year outcomes than before and have high survivorship rates. Level of evidence: Level I.
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Manjunath V, Badhe RV, McCoy M, Rynne J, Bhatti A, Segu A, Oral E, Jacobs JJ, Chastain P, Bijukumar D, Mathew MT. The role of Vitamin E in hip implant-related corrosion and toxicity: Initial outcome. J Mech Behav Biomed Mater 2021; 123:104769. [PMID: 34412025 PMCID: PMC10559727 DOI: 10.1016/j.jmbbm.2021.104769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 07/27/2021] [Accepted: 08/07/2021] [Indexed: 10/20/2022]
Abstract
In orthopedic healthcare, Total Hip Replacement (THR) is a common and effective solution to hip-related bone and joint diseases/fracture; however, corrosion of the hip implant and the release of degradation metal ions/particles can lead to early implant failure and pose potential toxicity risk for the surrounding tissues. The main objective of this work was to investigate the potential role of Vitamin E to minimize corrosion-related concerns from CoCrMo hip implants. The study focused on two questions (i) Can Vitamin E inhibit CoCrMo corrosion? and (ii) Does Vitamin E moderate the toxicity associated with the CoCrMo implant particles? In the study (i) the electrochemical experiments (ASTM G61) with different concentrations of Vitamin E (1, 2, 3 mg/ml against the control) were performed using normal saline and simulated synovial fluid (Bovine calf serum-BCS, 30 g/L protein, pH 7.4) as electrolytes. The polished CoCrMo disc (Ra 50 nm) was the working electrode. The findings suggested that both Vitamin E-Saline (45 ± 0.9%) and Vitamin E-BCS (91 ± 3%) solutions protected against implant corrosion at a Vitamin E concentration of 3 mg/ml, but Vitamin E-BCS showed protection at all Vitamin E (1-3 mg/ml) concentration levels. These results suggested that the Vitamin E and the protein present in the BCS imparted additive effects towards the electrochemical inhibition. In the study (ii) the role of Vitamin E in cytotoxicity inhibition was studied using a mouse neuroblastoma cell line (N2a) for CoCrMo particles and Cr ions separately. The CoCrMo particles were generated from a custom-built hip simulator. The alamarBlue assay results suggested that Vitamin E provides significant protection (85% and 75% proliferation) to N2a cells against CoCrMo particles and Cr ions, respectively at 1 μg/ml concentration, as compared to the control group. However, the results obtained from ROS expression and DNA fiber staining suggest that Vitamin E is only effective against CoCrMo degradation particles and not against Cr ions. In summary, the findings show that Vitamin E can minimize the corrosion processes and play a role in minimizing the potential toxicity associated with implants.
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Affiliation(s)
- Vikas Manjunath
- Department of Biomedical Sciences, University of Illinois College of Medicine at Rockford, Rockford, IL, USA
| | - Ravindra V Badhe
- Department of Biomedical Sciences, University of Illinois College of Medicine at Rockford, Rockford, IL, USA
| | - Maureen McCoy
- Department of Biochemistry, University of Illinois, Urbana-Champaign, IL, USA
| | - Josiah Rynne
- Department of Mechanical Science and Engineering, University of Illinois, Urbana-Champaign, IL, USA
| | - Aisha Bhatti
- Department of Biomedical Sciences, University of Illinois College of Medicine at Rockford, Rockford, IL, USA
| | - Abhijith Segu
- Department of Biomedical Sciences, University of Illinois College of Medicine at Rockford, Rockford, IL, USA
| | - Ebru Oral
- Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, USA
| | - Joshua J Jacobs
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Paul Chastain
- Department of Biomedical Sciences, University of Illinois College of Medicine at Rockford, Rockford, IL, USA
| | - Divya Bijukumar
- Department of Biomedical Sciences, University of Illinois College of Medicine at Rockford, Rockford, IL, USA
| | - Mathew T Mathew
- Department of Biomedical Sciences, University of Illinois College of Medicine at Rockford, Rockford, IL, USA.
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Does Pelvic Orientation Influence Wear Measurement of the Acetabular Cup in Total Hip Arthroplasty—An Experimental Study. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app112110014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Roentgen stereophotogrammetric analysis (RSA) is the gold standard to detect in vivo material wear of the bearing couples in hip arthroplasty. Some surgical planning tools offer the opportunity to detect wear by using standard a.p. radiographs (2Dwear), whilst RSA (3Dwear) needs a special radiological setup. The aims of this study are to prove the interchangeable applicability of a 2Dwear approach next to RSA and to assess the influence of different pelvic positions on measurement outcomes. An implant-bone model was used to mimic three different wear scenarios in seven pelvic-femur alignment positions. RSA and a.p. radiographs of the reference and a follow-up (simulated wear) pose were acquired. Accuracy and precision were worse for the 2Dwear approach (0.206 mm; 0.159 mm) in comparison to the 3Dwear approach (0.043 mm; 0.017 mm). Changing the pelvic position significantly influenced the 2Dwear results (4 of 7, p < 0.05), whilst 3Dwear results showed almost no change. The 3Dwear is superior to the 2Dwear approach, as it is less susceptible to changes in pelvic position. However, the results suggest that a 2Dwear approach may be an alternative method if the wear present is in the range of 100–500 µm and a.p. radiographs are available with the pelvis projected in a neutral position.
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Wagner M, Schönthaler H, Endstrasser F, Neururer S, Leitner H, Brunner A. Survivorship of Ceramic-on-Ceramic Total Hip Arthroplasty With Metal-Backed Acetabular Liners at 10 Years. J Arthroplasty 2021; 36:3507-3512. [PMID: 34176691 DOI: 10.1016/j.arth.2021.05.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/22/2021] [Accepted: 05/27/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Ceramic-on-ceramic bearings are becoming increasingly popular in primary total hip arthroplasty (THA). To enhance ceramic-on-ceramic liner exchange in case of revision surgery, metal-backed liner systems have been proposed. Little is known about the clinical performance of these implants. The purpose of this study is to evaluate a metal-backed liner implant system for primary THA. METHODS A total of 422 patients (with 468 consecutive THAs) were followed over a mean period of 10 years. All arthroplasties were performed with a cementless stem, a press-fit cup, and a metal-backed liner system. Surgical and clinical data, complications, and revisions were analyzed. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) before surgery and at 1 and 10 years after surgery were compared. RESULTS The overall 10-year implant survival rate was 93.8%. The survival rate was 97.0% for heads and liners, 97.5% for stem, and 99.3% for acetabular cup. The most common reason for revision was ceramic breakage (2.4%) of the third-generation (BIOLOX forte) acetabular liner. Mean WOMAC score improved significantly from 50.1 before surgery to 13.2 at 1 year after surgery. There was no difference in WOMAC scores between surgical approach and type of bearing at 1 and 10 years after surgery. CONCLUSION THA using cementless stem, press-fit cup, and metal-backed liner system provides satisfactory long-term outcomes, with revision rate comparable to that with other systems available in the market. The metal-backed liner system has low risk of mal-seating. Third-generation ceramic liners should be avoided as they seem to be more prone to breakage.
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Affiliation(s)
- Moritz Wagner
- Department of Orthopaedics and Traumatology, Bezirkskrankenhaus St. Johann in Tirol, St. Johann in Tirol, Tyrol, Austria
| | - Hannes Schönthaler
- Department of Orthopaedics and Traumatology, Bezirkskrankenhaus St. Johann in Tirol, St. Johann in Tirol, Tyrol, Austria
| | - Franz Endstrasser
- Department of Orthopaedics and Traumatology, Bezirkskrankenhaus St. Johann in Tirol, St. Johann in Tirol, Tyrol, Austria
| | - Sabrina Neururer
- Department of Clinical Epidemiology, Tirol Kliniken GmbH, Innsbruck, Tyrol, Austria
| | - Hermann Leitner
- Department of Clinical Epidemiology, Tirol Kliniken GmbH, Innsbruck, Tyrol, Austria
| | - Alexander Brunner
- Department of Orthopaedics and Traumatology, Bezirkskrankenhaus St. Johann in Tirol, St. Johann in Tirol, Tyrol, Austria
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Biomaterial Properties of Femur Implant on Acetabulum Erosion: A Review. JOURNAL OF BIOMIMETICS BIOMATERIALS AND BIOMEDICAL ENGINEERING 2021. [DOI: 10.4028/www.scientific.net/jbbbe.51.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The hip is one in every of the various joint at intervals the body. The correct operating of this joint is essential. For the aim once the hip is injured whole, a substitution procedure of the entire joint ought to be done to reinstate its operating, that is known as absolute hip surgical process. It is finished with the assistance of inserts of various biomaterials, as an example, polymers, metals, and pottery. The primary issues with regard to the utilization of various biomaterials are the reaction of the body's instrument to wear trash. Throughout this audit, biomaterials that are developing is talked regarding aboard the wear and tear and tear conduct and instrument. To boot, the numerous properties of the biomaterials are talked regarding aboard the expected preferences and drawbacks of their utilization. Further, the blends of various biomaterials at intervals the articulating surfaces are cleft and so the problems regarding their utilization are assessed. This paper hopes to passes away an in depth review of the trauma fringe of bearing surfaces of hip prosthetic devices. Additionally, this paper can offer AN ordered blueprint of the materials nearby their favorable circumstances and detriments and besides the conceivable outcomes of use. Keywords: - Hip implant; Biomaterials; Wear mechanism; Bearing surfaces; Polymers
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Crawford DA, Passias BJ, Adams JB, Berend KR, Lombardi AV. Impact of perivascular lymphocytic infiltration in aseptic total knee revision. Bone Joint J 2021; 103-B:145-149. [PMID: 34053288 DOI: 10.1302/0301-620x.103b6.bjj-2020-2051.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS A limited number of investigations with conflicting results have described perivascular lymphocytic infiltration (PVLI) in the setting of total knee arthroplasty (TKA). The purpose of this study was to determine if PVLI found in TKAs at the time of aseptic revision surgery was associated with worse clinical outcomes and survivorship. METHODS A retrospective review was conducted on 617 patients who underwent aseptic TKA revision who had histological analysis for PVLI at the time of surgery. Clinical and radiological data were obtained pre- and postoperatively, six weeks postoperatively, and then every year thereafter. RESULTS Within this cohort, 118 patients (19.1%) were found to have PVLI on histological analysis. Re-revision was performed on 83 patients (13.4%) with no significant differences in all-cause or aseptic revisions between groups. A higher incidence of PVLI was noted in female patients (p = 0.037). There was no significant difference in improvement in the range of motion (p = 0.536), or improvement of KSC (p = 0.66), KSP (p = 0.61), or KSF (p = 0.3) clinical outcome scores between PVLI and no PVLI sub-groups. There was a higher incidence of a preoperative diagnosis of pain in the PVLI group compared with patients without PVLI (p = 0.002) present. CONCLUSION PVLI found on large-scale histological analysis in TKAs at aseptic revision surgery was not associated with worse clinical outcomes or rates of re-revision. Cite this article: Bone Joint J 2021;103-B(6 Supple A):145-149.
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Affiliation(s)
| | | | | | - Keith R Berend
- Joint Implant Surgeons, Inc, New Albany, Ohio, USA.,Mount Carmel Health System, New Albany, Ohio, USA
| | - Adolph V Lombardi
- Joint Implant Surgeons, Inc, New Albany, Ohio, USA.,Mount Carmel Health System, New Albany, Ohio, USA.,Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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The reasons for ceramic-on-ceramic revisions between the third- and fourth-generation bearings in total hip arthroplasty from multicentric registry data. Sci Rep 2021; 11:5539. [PMID: 33692436 PMCID: PMC7946907 DOI: 10.1038/s41598-021-85193-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 12/21/2020] [Indexed: 12/27/2022] Open
Abstract
This study aimed to evaluate (1) the overall reasons for first revision in CoC THAs; (2) whether the reasons for revision differ between third-generation and fourth-generation CoC THAs; and (3) the specific factors associated with bearing-related problems as the reason for revision. We retrospectively reviewed 2045 patients (2194 hips) who underwent first revision THA between 2004 and 2013, among which 146 hips with CoC bearings underwent revision. There were 92 hips with third-generation ceramic bearings and 54 hips with fourth-generation ceramic bearings. The major reasons for CoC THA revisions were ceramic fracture and loosening of the cup or stem. When ceramic fracture, squeaking, incorrect ceramic insertion, and unexplained pain were defined as directly related or potentially related to ceramic use, 28.8% (42/146) of CoC revisions were associated with bearing-related problems. Among the third-generation ceramic bearings, revision was performed in 41.3% (38/92) of cases owing to bearing-related problems whereas revisions were performed for only 7.4% (4/54) of cases with fourth-generation ceramic bearings owing to bearing-related problems (p < 0.001). Younger age, lower American Society of Anesthesiologists (ASA) grade, and preoperative diagnosis of osteonecrosis were factors related to CoC THA revisions due to bearing-related problems.
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Agarwal N, To K, Khan W. Cost effectiveness analyses of total hip arthroplasty for hip osteoarthritis: A PRISMA systematic review. Int J Clin Pract 2021; 75:e13806. [PMID: 33128841 DOI: 10.1111/ijcp.13806] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 10/28/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Healthcare services are facing economic constraints globally with an increasingly elderly population, and greater burdens of osteoarthritis. Because of the chronic nature of osteoarthritis and the costs associated with surgery, arthroplasty is seen as potentially cost saving. There have been no systematic reviews conducted on cost effectiveness analysis (CEA) studies of total hip arthroplasty (THA) in the management of osteoarthritis. The aim of this systematic review was to evaluate CEAs conducted on THA for osteoarthritis to determine if THA is a cost-effective intervention. MATERIALS AND METHODS A systematic review was conducted using five databases to identify all clinical CEAs of THA for osteoarthritis conducted after 1 January 1997. Twenty-eight studies were identified that met the inclusion criteria. The Quality of Health Economic Analysis (QHES) checklist was employed to assess the quality of the studies. RESULTS The average QHES score was 86 indicating high quality studies. All studies reviewed concluded that THA was a cost-effective intervention. In younger patients, cementless THA and ceramic on polyethylene implants were found to be most cost effective. Hybrid THA and metal on polyethylene implants had the greatest cost utility in older patients. In patients with acetabular defects, cemented cup with impaction bone grafting was most cost effective, while dual mobility THA was most cost effective in patients with high risk of dislocation. CONCLUSION We have shown that THA is a cost-effective treatment for hip osteoarthritis. These findings should be implemented into clinical practice to improve cost utility in health services across the world.
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Affiliation(s)
- Nikhil Agarwal
- Institute of Applied Health Sciences, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, UK
| | - Kendrick To
- Division of Trauma and Orthopaedics, Department of Surgery Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Wasim Khan
- Division of Trauma and Orthopaedics, Department of Surgery Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
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Abstract
BACKGROUND Total ankle replacements (TARs) have higher rates of osteolysis than hip or knee replacements. It is unclear whether this is a pathologic immunologic process in response to wear debris, or expansion of pre-existing osteoarthritic bone cysts. We aimed to determine the incidence of bone cysts in patients with end-stage ankle arthritis prior to surgery and review the literature on bone cysts and osteolysis in relation to TAR. METHODS This is a descriptive/prevalence study in which all patients with end-stage ankle arthritis underwent plain radiographic imaging and computed tomographic (CT) scans prior to TAR surgery. Their imaging was assessed for the presence of cysts, measured on sagittal, axial, and coronal slices of the CT scan at the widest diameter. All cysts that would be removed as a result of the bone resection for the implant were excluded using digital analysis software. We assessed 120 consecutive patients with mean age of 63.4 years. RESULTS Seventeen patients (14%) did not have any bone cysts based on CT images. Ten patients (8%) had cysts that would have been completely removed by surgery, leaving 93 patients for analysis (78%). In 60% of these cases, the cysts were not seen on the plain radiographs. In 39 patients (33%), the cysts were greater than 5 mm in size. The medial (36%) and lateral malleoli (33%) were the most common location for the cysts (mean diameter 4.6±2.0 and 4.2±2.3 mm, respectively). CONCLUSION Bone cysts outside of the resection margins for a TAR were present in 78% of patients with ankle arthritis prior to undergoing surgery. In 30% of cases, cysts were greater than 5 mm in size. In 60% of cases, the cysts were not seen on plain radiographs. Preoperative 3-dimensional imaging can provide a foundation to observe and quantify cyst presence, expansion, and time of onset in the postoperative setting. LEVEL OF EVIDENCE Level IIc, diagnostic/prevalence study.
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Affiliation(s)
- Ali-Asgar Najefi
- UCL Institute of Orthopaedics & Musculoskeletal Research, Royal National Orthopaedic Hospital, Stanmore, Middlesex, United Kingdom.,East & North Hertfordshire NHS Trust, Lister Hospital, Stevenage, United Kingdom
| | - Yaser Ghani
- Foot & Ankle Unit, Royal National Orthopaedic Hospital NHS Trust, Stanmore, Middlesex, United Kingdom
| | - Andrew J Goldberg
- UCL Institute of Orthopaedics & Musculoskeletal Research, Royal National Orthopaedic Hospital, Stanmore, Middlesex, United Kingdom.,The London Ankle Arthritis Centre, Wellington Hospital, London, United Kingdom
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D'Apolito R, Bandettini G, Jacquot FMP, Zagra L. Modular dual-mobility cups using ceramic liners: an original solution for selected indications? Hip Int 2020; 30:59-65. [PMID: 33267689 DOI: 10.1177/1120700020964976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Dual mobility (DM) has been shown to improve stability both in primary and revision total hip arthroplasty (THA) and is increasingly used in patients at high risk of dislocation and in the treatment of THA instability. The introduction of modular liners has helped to overcome some of the limitations of monoblock DM cups. In this context, the use of a ceramic liner would avoid the conventional cobalt-chromium liner in the titanium shell, which can be problematic in some situations. The aim of this paper is to report the outcomes of a consecutive series of patients undergoing revision THA using a modular DM cup with a ceramic liner instead of the conventional metal one, and to clarify the rationale for this currently "off-label" use. PATIENTS AND METHODS This is a retrospective series of patients who received this new DM bearing in a single institution. Patients were followed up clinically and radiologically at 1 month, 3 months, 6 months and yearly thereafter. RESULTS 5 patients received the ceramic liner in the study period (2014-2019). The indications were instability or high risk of dislocation in ceramic liner fracture and ARMD with soft tissue damage after MoM THA. The mean age at surgery was 74 (63-82) years, the mean follow-up was 36 (12-72) months. No dislocation occurred, and no adverse events related to the implant were recorded. CONCLUSIONS The use of a ceramic liner in a modular DM cup offers several advantages in selected patients, and the results of our cohort are encouraging. However, caution is needed in introducing this new bearing because knowledge is currently limited. Further studies on a larger number of patients and with longer follow-ups are needed to confirm these findings and before widespread use of the device.
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Affiliation(s)
- Rocco D'Apolito
- IRCCS Istituto Ortopedico Galeazzi, Hip Department, Milan, Italy
| | - Guido Bandettini
- IRCCS Istituto Ortopedico Galeazzi, Hip Department, Milan, Italy
| | | | - Luigi Zagra
- IRCCS Istituto Ortopedico Galeazzi, Hip Department, Milan, Italy
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Taterra D, Skinningsrud B, Pękala PA, Tomaszewska IM, Marycz K, Radomski MW, Tomaszewski KA. In vitro effects of cobalt and chromium nanoparticles on human platelet function. Nanotoxicology 2020; 15:52-65. [PMID: 33147415 DOI: 10.1080/17435390.2020.1841845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Nanoparticles (NPs) are released from orthopedic and neurosurgical prostheses and can interact with a number of blood components once in the bloodstream. Potential toxic effects of Co and Cr NPs on blood platelets have not been thoroughly investigated. The aim of this study was to analyze the effect of Co and Cr NPs on platelet function in vitro. The ability of the tested NPs to induce platelet activation and aggregation was measured using light transmission aggregometry, flow cytometry, and quartz crystal balance with dissipation (QCM-D). This was confirmed by transmission electron microscopy (TEM), scanning electron microscopy, and optical and immunofluorescence microscopy. Perfusion of QCM-D sensor crystals with platelet-rich-plasma in the presence of Co 28 nm, CoO 50 nm, Co2O3 50 nm, Co3O4 30-50nm, Cr 35-45nm, Cr2O3 60 nm NPs (0.5-5.0 µg/mL) resulted in significant changes in frequency and dissipation, indicating that these NPs caused platelet microaggregation. Transmission electron microscopy also revealed that Cr NPs led to platelet swelling and lysis. Our study shows that both Co and Cr NPs affect platelet function in vitro with two distinct mechanisms. While Co NPs result in standard platelet aggregation, Cr NPs cause both platelet aggregation and decreased platelet membrane integrity and lysis. Based on these findings, monitoring serum NP levels and platelet-mediated hemostasis can be advised in patients with metal-on-metal Co-Cr prostheses.
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Affiliation(s)
- Dominik Taterra
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland.,International Evidence-Based Anatomy Working Group, Krakow, Poland
| | - Bendik Skinningsrud
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland.,International Evidence-Based Anatomy Working Group, Krakow, Poland
| | - Przemysław A Pękala
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland.,International Evidence-Based Anatomy Working Group, Krakow, Poland
| | - Iwona M Tomaszewska
- Department of Medical Education, Jagiellonian University Medical College, Krakow, Poland
| | - Krzysztof Marycz
- International Institute of Translational Medicine, Malin, Poland.,Faculty of Biology and Animal Science, Department of Experimental Biology, University of Environmental and Life Sciences Wroclaw, Wroclaw, Poland.,Faculty of Veterinary Medicine, Clinic for Horses - Department for Surgery, Justus-Liebig-University, Gießen, Germany
| | - Marek W Radomski
- Department of Anatomy, Physiology and Pharmacology, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Krzysztof A Tomaszewski
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland.,Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland.,Scanmed St. Raphael Hospital, Krakow, Poland
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Abstract
Choice of articulating materials, head size and the design of the articulation will become decisive for the long-term performance of a total hip arthroplasty (THA) and especially in terms of risk for dislocation and wear-related problems. Here we account for common alternatives based on available studies and the evidence that can be derived from them.Metal or ceramic femoral heads articulating against a liner or cup made of highly cross-linked polyethylene and ceramic-on-ceramic articulations have about similar risk for complications leading to revision, whereas the performance of metal-on-metal articulations, especially with use of big heads, is inferior. The clinical significance of problems related to ceramic-on-ceramic articulations such as squeaking remains unclear. With use of current technology ceramic fractures are rare.Large femoral heads have the potential to increase the range of hip movement before impingement occurs and are therefore expected to reduce dislocation rates. On the other hand, issues related to bearing wear, corrosion at the taper-trunnion junction and groin pain may arise with larger heads and jeopardize the longevity of THA. Based on current knowledge, 32-mm heads seem to be optimal for metal-on-polyethylene bearings. Patients with ceramic-on-ceramic bearings may benefit from even larger heads such as 36 or 40 mm, but so far there are no long-term reports that confirm the safety of bearings larger than 36 mm.Assessment of lipped liners is difficult because randomized studies are lacking, but retrospective clinical studies and registry data seem to indicate that this liner modification will reduce the rate of dislocation or revision due to dislocation without clear evidence of clinically obvious problems due to neck-liner impingement.The majority of studies support the view that constrained liners and dual mobility cups (DMC) will reduce the risk of revision due to dislocation both in primary and revision THA, the latter gaining increasing popularity in some countries. Both these devices suffer from implant-specific problems, which seem to be more common for the constrained liner designs. The majority of studies of these implants suffer from various methodological problems, not least selection bias, which calls for randomized studies preferably in a multi-centre setting to obtain sufficient power. In the 2020s, the orthopaedic profession should place more effort on such studies, as has already been achieved within other medical specialties, to improve the level of evidence in the choice of articulation when performing one of the most common in-hospital surgical procedures in Europe. Cite this article: EFORT Open Rev 2020;5:763-775. DOI: 10.1302/2058-5241.5.200002.
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Affiliation(s)
- Georgios Tsikandylakis
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Orthopaedics, Gothenburg, Sweden
| | - Soren Overgaard
- The Danish Hip Arthroplasty Register, Aarhus, Denmark
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Luigi Zagra
- Hip Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Johan Kärrholm
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Orthopaedics, Gothenburg, Sweden
- The Swedish Hip Arthroplasty Register, Gothenburg, Sweden
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Haschke H, Falkenberg A, Morlock MM, Huber G. Do SiNx coatings bear the potential to reduce the risk of micromotion in modular taper junctions? Proc Inst Mech Eng H 2020; 234:897-908. [PMID: 32507037 DOI: 10.1177/0954411920930616] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Fretting corrosion is one contributor to the clinical failure of modular joint arthroplasty. It is initiated by micromotion in metal junctions exposed to fluids. Omitting metal-on-metal contacts could help to reduce the corrosion risk. The coating of one metal taper partner with a ceramic-based silicon nitride (SiNx) coating might provide this separation. The aim of the study was to identify whether a SiNx coating of the male taper component influences the micromotion within a taper junction. Hip prosthesis heads made of CoCr29Mo6 (Aesculap) and Ti6Al4V (Peter Brehm) were assembled (2000 N) to SiNx-coated and uncoated stem tapers made of Ti6Al4V and CoCr29Mo6 (2×2×2 combinations, each n = 4). Consecutive sinusoidal loading representing three daily activities was applied. Contactless relative motion in six degrees of freedom was measured using six eddy-current sensors. Micromotion in the junction was determined by compensating for the elastic deformation derived from additional monoblock measurements. After pull-off, the taper surfaces were microscopically inspected. Micromotion magnitude reached up to 8.4 ± 0.8 µm during loading that represented stumbling. Ti6Al4V stems showed significantly higher micromotion than those made of CoCr29Mo6, while taper coating had no influence. Statistical differences in pull-off forces were found for none of the taper junctions. Microscopy revealed CoCr29Mo6 abrasion from the head taper surface if combined with coated stem tapers. Higher micromotion of Ti6Al4V tapers was probably caused by the lower Young's modulus. Even in the contact areas, the coating was not damaged during loading. The mechanics of coated tapers was similar to uncoated prostheses. Thus, the separation of the two metal surfaces with the objective to reduce in vivo corrosion appears to be achievable if the coating is able to withstand in vivo conditions. However, the hard ceramic-based stem coating lead to undesirable debris from the CoCr29Mo6 heads during loading.
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Affiliation(s)
- Henning Haschke
- Institute of Biomechanics, Hamburg University of Technology (TUHH), Hamburg, Germany
| | - Adrian Falkenberg
- Institute of Biomechanics, Hamburg University of Technology (TUHH), Hamburg, Germany
| | - Michael M Morlock
- Institute of Biomechanics, Hamburg University of Technology (TUHH), Hamburg, Germany
| | - Gerd Huber
- Institute of Biomechanics, Hamburg University of Technology (TUHH), Hamburg, Germany
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What Is the Risk of THA Revision for ARMD in Patients with Non-metal-on-metal Bearings? A Study from the Australian National Joint Replacement Registry. Clin Orthop Relat Res 2020; 478:1244-1253. [PMID: 32345846 PMCID: PMC7319380 DOI: 10.1097/corr.0000000000001277] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There are increasing reports of corrosion between the femoral head and trunnion in primary conventional THA, resulting in metal particulate release often termed trunnionosis. There may be heightened awareness of this condition because of severe soft-tissue reactions initially thought to be solely attributable to prostheses with a metal-on-metal (MoM) bearing surface. It is unclear what percentage of revisions for THA with non-MoM bearing surfaces can be attributed to trunnionosis and to what extent adverse reaction to metal debris (ARMD) seen with MoM bearings may also be seen with other bearing surfaces in THA. QUESTIONS/PURPOSES We analyzed data from a large national registry to ask: (1) What is the revision risk for the indication of ARMD in patients with conventional THA and modern non-MoM bearing surfaces such as metal or ceramic-on-cross-linked polyethylene (XLPE) or ceramic-on-ceramic? (2) What prosthesis factors are associated with an increased risk of such revision? (3) What is the relative revision risk for ARMD in THAs with large-head MoM bearings, small-head MoM bearings, and non-MoM modern bearing surfaces? METHODS The Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) longitudinally maintains data on all primary and revision joint arthroplasties, with nearly 100% capture. The study population included all THAs using modern bearing surfaces (defined as metal or ceramic heads-on-XLPE and ceramic-on-ceramic bearing couples) revised because of ARMD between September 1999 and December 2018. Prostheses with modular necks were excluded. The cumulative percent revision (CPR) because of ARMD was determined. The study group consisted of 350,027 THAs with a modern bearing surface, 15,184 THAs with a large-head MoM bearing (≥ 36 mm), and 5474 THAs with a small head MoM bearing (≤ 32 mm). The patients in the group who received the modern bearing surfaces were slightly older than the patients in the groups who received the large- and small-head bearing surfaces, with a mean age 68 years (SD 12) versus a mean age 63 years (SD 12), and a mean age 62 years (SD 11), respectively. There was a higher proportion of women in the modern bearing surface group; 55% (193,312 of 350,027), compared with 43% (6497 of 15,184) in the large-head MoM group and 50% (2716 of 5474) in the small-head MoM group. The outcome measure was the CPR, which was defined using Kaplan-Meier estimates of survivorship to describe the time to the first revision for ARMD at 17 years. Hazard ratios (HR) from Cox proportional hazards models, adjusting for age and sex, were performed to compare the revision rates among groups. The registry defines a revision as a reoperation of a previous hip arthroplasty in which one or more of the prosthetic components is replaced or removed, or one or more components is added. RESULTS The CPR for ARMD for patients with a modern bearing surface at 17 years was 0.1% (95% confidence interval 0.0 to 0.1). After controlling for age and sex, we found that cobalt chrome heads, two specific prostheses (Accolade® I and M/L Taper), and head sizes ≥ 36 mm were associated with an increased risk of revision for ARMD. Metal-on-XLPE had a higher risk of revision for ARMD than ceramic-on-ceramic or ceramic-on-XLPE (HR 3.4 [95% CI 1.9 to 6.0]; p < 0.001). The Accolade 1 and the M/L Taper stems had a higher risk of revision than all other stems (HR, 8.3 [95% CI 4.7 to 14.7]; p < 0.001 and HR 14.4 [95% CI 6.0 to 34.6]; p < 0.001, respectively). Femoral stems with head sizes ≥ 36 mm had a higher rate of revision for ARMD than stems with head sizes ≤ 32 mm (HR 3.2 [95% CI 1.9 to 5.3]; p < 0.001).Large-head MoM bearings had a greater increase in revision for ARMD compared with modern bearing surfaces. The CPR for patients with a large-head MoM bearing at 17 years for ARMD was 15.5% (95% CI 14.5 to 16.6) and it was 0.1% for modern bearing surfaces (HR 340 [95% CI 264.2 to 438.0]; p < 0.001). Modern bearing surfaces likewise had a lower HR for revision for ARMD than did THAs with small-head MoM bearings, which had a 0.9% (95% CI 0.7 to 1.4) CPR compared with modern bearings from 0 to 9 years (HR 10.5 [95% CI 6.2 to 17.7]; p < 0.001). CONCLUSIONS The revision risk for ARMD with modern bearing surfaces in THA is low. The Accolade 1 and the M/L Taper stem have a higher risk of revision for ARMD and cobalt-chrome heads, and head sizes ≥ 36 mm have a higher rate of revision than ≤ 32 mm head sizes. ARMD is a rare failure mode for THA with non-MoM bearings, but in patients presenting with unexplained pain with no other obvious cause, this diagnosis should be considered and investigated further. LEVEL OF EVIDENCE Level III, therapeutic study.
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Olmedo-Garcia NI, Zagra L. High risk of complications using metal heads after ceramic fracture in total hip arthroplasty. Hip Int 2019; 29:373-378. [PMID: 30501527 DOI: 10.1177/1120700018813978] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND There is some uncertainty about the bearing to be used to substitute a broken ceramic. Using metal components (head or liner) may lead to catastrophic wear of the metal. AIM The purpose of this article is to describe the long-term follow-up result of ceramic fracture replaced with metal-on-polyethylene (MoP). METHODS We report 3 cases of ceramic head fracture after ceramic-on-ceramic (CoC) total hip arthroplasty (THA) in which the broken ceramic was replaced with MoP. RESULTS All cases developed severe complications due to gross wear of the metal head: one developed a pseudotumour after a few months while the other 2 had significant local metallosis and toxic blood metal levels. CONCLUSIONS When there is a fracture of a ceramic component, we advise caution with the use of metal heads, as small ceramic fragments can cause 3rd-body wear with massive metal debris and severe local and general complications.
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Affiliation(s)
| | - Luigi Zagra
- 2 IRCCS Galeazzi Othopaedic Institute, Milan, Italy
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Solarino G, Zagra L, Piazzolla A, Morizio A, Vicenti G, Moretti B. Results of 200 Consecutive Ceramic-on-Ceramic Cementless Hip Arthroplasties in Patients Up To 50 Years of Age: A 5-24 Years of Follow-Up Study. J Arthroplasty 2019; 34:S232-S237. [PMID: 30777621 DOI: 10.1016/j.arth.2019.01.057] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 01/02/2019] [Accepted: 01/24/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Ceramic-on-ceramic (CoC) bearings due to their mechanical properties can be used in primary total hip arthroplasty (THA) especially in young patients requiring a long-lasting implant. The goal of this study is to analyze the results of a series of 200 consecutive CoC THAs in patients aged 50 years or less at the time of surgery. METHODS A retrospective study was conducted on the first 200 consecutive CoC arthroplasties performed using the direct lateral approach on 105 females and 81 males (14 bilateral cases) with an average age of 44.2 (16-50) years. The diagnosis was primary or post-traumatic osteoarthritis in 94 cases, avascular necrosis of the femoral head in 47, displaced intracapsular femoral neck fracture in 29, osteoarthritis secondary to developmental dysplasia of the hip/Legg-Calvè-Perthes disease/slipped capital femoral epiphysis in 20, and rheumatic diseases in 10 cases. The preoperative Harris Hip Score was 32.5 on average (range 15-55). All the implants were cementless. In 177 THAs the coupling was alumina-on-alumina, and in 23 cases the coupling was AMC-on-AMC (alumina matrix composite). RESULTS Twenty-five patients with 28 THAs were lost at the final follow-up, 2 stems were revised due to subsidence, 1 cup was revised due to malposition, 1 femoral head was changed because of impingement, and 1 THA was revised for periprosthetic infection. Three patients sustained a Vancouver B1 periprosthetic femoral fracture. At the final follow-up (mean 14.9 years; minimum 5 years to maximum 24 years), 172 THAs were eligible for clinical and radiographic evaluation: none was revised for wear and/or breakage of the ceramic components. Harris Hip Score rose up to a mean value of 90.1 (52-100). CONCLUSION The present report demonstrates that CoC coupling offers excellent long-term results in THA performed in young patients with very low wear and no adverse effects caused by the material.
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Affiliation(s)
- Giuseppe Solarino
- Department of Basic Medical Sciences, Neuroscience and Organs of Sense, School of Medicine, AOU Policlinico Consorziale, Università di Bari "Aldo Moro", Bari, Italy
| | - Luigi Zagra
- Hip Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Andrea Piazzolla
- Department of Basic Medical Sciences, Neuroscience and Organs of Sense, School of Medicine, AOU Policlinico Consorziale, Università di Bari "Aldo Moro", Bari, Italy
| | - Arcangelo Morizio
- Department of Basic Medical Sciences, Neuroscience and Organs of Sense, School of Medicine, AOU Policlinico Consorziale, Università di Bari "Aldo Moro", Bari, Italy
| | - Giovanni Vicenti
- Department of Basic Medical Sciences, Neuroscience and Organs of Sense, School of Medicine, AOU Policlinico Consorziale, Università di Bari "Aldo Moro", Bari, Italy
| | - Biagio Moretti
- Department of Basic Medical Sciences, Neuroscience and Organs of Sense, School of Medicine, AOU Policlinico Consorziale, Università di Bari "Aldo Moro", Bari, Italy
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Zhang X, Shi G, Sun X, Zheng W, Lin X, Chen G. Factors Influencing the Outcomes of Artificial Hip Replacements. Cells Tissues Organs 2019; 206:254-262. [DOI: 10.1159/000500518] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 04/16/2019] [Indexed: 11/19/2022] Open
Abstract
Hip replacement is one of the most successful surgeries in the clinic for the removal of painful joints. Hip osteoarthritis and femoral head necrosis are the 2 main reasons for hip replacement. Several factors are associated with the outcomes of surgery. Nonsurgical factors include gender, age, body mass index, prosthetic material, and risk factors. Surgical factors are anesthesia, postoperative complications, and rehabilitation. Considering the increasing demand for hip arthroplasty and the rise in the number of revision operations, it is imperative to understand factor-related progress and how modifications of these factors promotes recovery following hip replacement. In this review, we first summarize recent findings regarding crucial factors that influence the outcomes of artificial hip replacement surgery. These findings not only show the time-specific effect for the treatment and recovery from hip arthroplasty in the clinic, but also provide suitable choices for different individuals for clinicians to consider. This, in turn, will help to develop the best possible postoperative program for specific patients.
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