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Pratt NL, Cicuttini FM, Wang Y, Graves SE. No increased risk of cancer associated with metal-on-metal or ceramic-on-ceramic procedures compared to other bearing surfaces in patients with total hip arthroplasty: A nationwide linked registry cohort analysis of 167,837 patients. PLoS One 2022; 17:e0278241. [PMID: 36449468 PMCID: PMC9710777 DOI: 10.1371/journal.pone.0278241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 11/14/2022] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES Studies have identified increased cancer risk among patients undergoing total hip arthroplasty (THA) compared to the general population. However, evidence of all-cause and site-specific cancer risk associated with different bearing surfaces has varied, with previous studies having short latency periods with respect to use of modern Metal-on-Metal (MoM) bearings. Using the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) linked to Australasian Association of Cancer Registries data, our aim was to evaluate risk of all-cause and site-specific cancer according to bearing surfaces in patients undergoing THA for osteoarthritis and whether risk increased with MoM bearings. METHODS Standardized incidence ratios (SIRs) and 95% confidence intervals (CIs) were calculated by comparing number of observed cancer cases to expected number based on incidence rate in the Australian population. All-cause and site-specific cancer rates were calculated for all conventional stemmed THA (csTHA) and resurfacing THA (rsTHA) procedures performed for osteoarthritis. Cox proportional hazards models were used to compare cancer rates for MoM, ceramic-on-ceramic (CoC) and resurfacing procedures with a comparison group comprising metal-on-polyethylene (MoP) or ceramic-on-polyethylene (CoP) procedures. RESULTS There were 156,516 patients with csTHA procedures and 11,321 with rsTHA procedures for osteoarthritis performed between 1999 and 2012. Incidence of all-cause cancer was significantly higher for csTHA (SIR 1.24, 95% CI 1.22-1.26) and rsTHA (SIR 1.74, 95% CI 1.39-2.04) compared to the Australian population. For csTHA, there was no significant difference in all-site cancer rates for MoM (Hazard Ratio (HR) 1.01, 95%CI 0.96-1.07) or CoC (HR 0.98, 95%CI 0.94-1.02) compared to MoP and CoP bearings. Significantly increased risk of melanoma, non-Hodgkins lymphoma, myeloma, leukaemia, prostate, colon, bladder and kidney cancer was found for csTHA and, prostate cancer, melanoma for rsTHA procedures when compared to the Australian population, although risk was not significantly different across bearing surfaces. CONCLUSIONS csTHA and rsTHA procedures were associated with increased cancer incidence compared to the Australian population. However, no excess risk was observed for MoM or CoC procedures compared to other bearing surfaces.
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Affiliation(s)
- Nicole L. Pratt
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
- * E-mail:
| | - Flavia M. Cicuttini
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Yuanyuan Wang
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Stephen E. Graves
- Australian Orthopaedic Association National Joint Replacement Registry, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
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Ben Braham M, Trunfio-Sfarghiu AM, Brizuela L, Mebarek S, Essefi I, Geringer J, Berthier Y, Hamza S. Nano/micro implant debris affect osteogenesis by chondrocytes: Comparison between ceramic and UHMWPE from hip walking simulator. J Biomed Mater Res B Appl Biomater 2021; 110:338-349. [PMID: 34289232 DOI: 10.1002/jbm.b.34910] [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: 05/15/2020] [Revised: 05/07/2021] [Accepted: 07/08/2021] [Indexed: 11/05/2022]
Abstract
A new generation of ceramic on ceramic (BIOLOX ®delta) bearings has emerged more than 10 years ago proving a high resistance to wear and good clinical results. However, biological reactions to wear debris, particularly the nanoparticles, need to be evaluated. The first originality of this study is to start from real wear particles obtained by the hip walking simulator (CERsim). These particles were compared with particles obtained by usual methods to assess the biocompatibility of materials: press machine (CERpress). Two ranges of ceramic particles were thus observed: ceramic particles with micron (intergranular fractures) and nano sizes (intragranular fractures), and characterized compared to ultra-high molecular weight polyethylene (UHMWPE). The second originality of this work is to assess the cellular reaction using the primary joint chondrocyte cultures simulating the osteogenesis process and not the cell lines, which are used to simulate the biological reaction of osteolysis. The first results showed a significant difference in cell viability between the cells in contact with particles from the walking simulator and those obtained with the press machine. On the other hand, it was found that the way of extraction of the particles from the lubricant could significantly affect the biological reaction. More interestingly, nano-sized ceramic particles showed a significant impact on the secretion of functional inflammatory mediators, agreeing with recent results in vivo. These novel methods of characterizing the osteogenic impact of UHMWPE and ceramic wear debris can complement the conventional expertise method focusing previously on the osteolysis aspect.
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Affiliation(s)
- Marwa Ben Braham
- Univ Lyon, INSA-Lyon, CNRS UMR5259, LaMCoS, Villeurbanne, France.,University of Tunis El Manar, National Engineering School of Tunis, Tunis, Tunisia.,University of Carthage, National Institute of Applied Sciences and Technology, UR17ES22, Tunis, Tunisia
| | | | - Leyre Brizuela
- University of Lyon 1, Institute of Molecular and Supramolecular Chemistry and Biochemistry (ICBMS), UMR CNRS 5246, Villeurbanne, France
| | - Saida Mebarek
- University of Lyon 1, Institute of Molecular and Supramolecular Chemistry and Biochemistry (ICBMS), UMR CNRS 5246, Villeurbanne, France
| | - Ines Essefi
- Univ Lyon, INSA-Lyon, CNRS UMR5259, LaMCoS, Villeurbanne, France
| | - Jean Geringer
- Mines Saint-Etienne, Center for Health and Engineering, Inserm U1059, Saint-Etienne, France
| | - Yves Berthier
- Univ Lyon, INSA-Lyon, CNRS UMR5259, LaMCoS, Villeurbanne, France
| | - Samir Hamza
- University of Carthage, National Institute of Applied Sciences and Technology, UR17ES22, Tunis, Tunisia
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Jelsma J, Schotanus MG, Senden R, Heyligers IC, Grimm B. Metal ion concentrations after metal-on-metal hip arthroplasty are not correlated with habitual physical activity levels. Hip Int 2019; 29:638-646. [PMID: 30479165 DOI: 10.1177/1120700018814225] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Metal-on-metal (MoM) hip arthroplasties have shown high clinical failure rates with many patients at risk for a revision and under surveillance for high metal ion concentrations. Implant wear releasing such ions is assumed to be a function of use, i.e. the patient's physical activity. This study aimed to assess whether habitual physical activity levels of MoM patients are correlated with metal ion concentrations and are higher in patients with high (at risk) than in patients with low (safe) metal ion concentrations. METHODS A cohort study was conducted of patients with any type of MoM hip prosthesis. Metal ion concentrations were determined using ICP-MS. Habitual physical activity of subjects was measured in daily living using an acceleration-based activity monitor. Outcome consisted of quantitative and qualitative activity parameters. RESULTS In total, 62 patients were included. Mean age at surgery was 60.8 ± 9.3 years and follow-up was 6.3 ± 1.4 years. Cobalt concentrations were highly elevated overall (112.4 ± 137.9 nmol/L) and significantly more in bilateral (184.8 ± 106.5 nmol/L) than in unilateral cases (87.8 ± 139.4 nmol/L). No correlations were found between physical activity parameters and metal ion concentrations. Subgroup analysis of patients with low versus high cobalt concentration showed no significant differences in habitual physical activity. DISCUSSION No correlation was found between physical activity levels and metal ion concentrations. Implant use by normal habitual activities of daily living seems not to influence metal ion concentrations.
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Affiliation(s)
- Jetse Jelsma
- Department of Orthopaedics, Zuyderland Medical Centre, Sittard-Geleen/Heerlen, The Netherlands
| | - Martijn Gm Schotanus
- Department of Orthopaedics, Zuyderland Medical Centre, Sittard-Geleen/Heerlen, The Netherlands
| | - Rachel Senden
- Department of Orthopaedics, Zuyderland Medical Centre, Sittard-Geleen/Heerlen, The Netherlands
| | - Ide C Heyligers
- Department of Orthopaedics, Zuyderland Medical Centre, Sittard-Geleen/Heerlen, The Netherlands
| | - Bernd Grimm
- Department of Orthopaedics, Zuyderland Medical Centre, Sittard-Geleen/Heerlen, The Netherlands
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Kovochich M, Finley BL, Novick R, Monnot AD, Donovan E, Unice KM, Fung ES, Fung D, Paustenbach DJ. Understanding outcomes and toxicological aspects of second generation metal-on-metal hip implants: a state-of-the-art review. Crit Rev Toxicol 2019; 48:853-901. [DOI: 10.1080/10408444.2018.1563048] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Goodman SB, Mihalko WM, Anderson PA, Sale K, Bozic KJ. Introduction of New Technologies in Orthopaedic Surgery. JBJS Rev 2018; 4:01874474-201605000-00005. [PMID: 27490218 DOI: 10.2106/jbjs.rvw.o.00067] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The introduction of new devices, biologics, and combination products to the orthopaedic marketplace is increasing rapidly. The majority of these new technologies obtain clearance to market by demonstrating substantial equivalence to a predicate (previously approved device) according to the U.S. Food and Drug Administration (FDA) 510(k) process. Surgeons play a critical role in the introduction of new technologies to patients and must take a leadership role in promoting safe, efficacious, appropriate, and cost-effective care, especially for operative procedures. Surgeons should monitor and document their patients' clinical outcomes and adverse events when using new technology, to ensure that the new technology is performing as desired.
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Affiliation(s)
- Stuart B Goodman
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California
| | - William M Mihalko
- Department of Orthopaedic Surgery & Biomedical Engineering, Campbell Clinic, Memphis, Tennessee
| | - Paul A Anderson
- Department of Orthopaedic Surgery, University of Wisconsin, Madison, Wisconsin
| | - Katherine Sale
- Department of Research and Scientific Affairs, American Academy of Orthopaedic Surgeons, Rosemont, Illinois
| | - Kevin J Bozic
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Austin, Texas
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Is There a Cardiotoxicity Associated With Metallic Head Hip Prostheses? A Cohort Study in the French National Health Insurance Databases. Clin Orthop Relat Res 2018; 476:1441-1451. [PMID: 29698302 PMCID: PMC6259674 DOI: 10.1097/01.blo.0000533617.64678.69] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There are four distinguishable types of THA devices in wide use, as defined by the femoral and acetabular bearing surfaces: metal-on-polyethylene (MoP), ceramic-on-polyethylene (CoP), metal-on-metal (MoM), and ceramic-on-ceramic (CoC). Metallic head THAs (MoP and MoM) can potentially induce cardiac toxicity because cobalt species, generated at the head-neck trunnion, and in the case of MoM devices, at the articular surface as well, can be absorbed systemically. However, studies have provided inconsistent results. QUESTIONS/PURPOSES The purpose of this study was to assess the risk of dilated cardiomyopathy (DCM) or heart failure (HF) associated with metallic head THAs using data from the French national health insurance databases. METHODS Between 2008 and 2011 in France, 399,968 patients ≥ 55 years had a first THA. A total of 127,481 were excluded after we applied the exclusion criteria regarding arthroplasty and 17,137 as a result of a history of DCM/HF, recorded in the French national health insurance reimbursement databases, between January 1, 2006, and the date of inclusion. The final cohort included 255,350 individuals (43% men; mean age 72 ± 9 years). Of them, 93,581 (37%) had been implanted with MoP, 58,095 (23%) with CoP, 11,298 (4%) with MoM, and 92,376 (36%) with CoC THAs. Patients were followed until December 2015. Patients with incident DCM/HF were identified by a new entitlement to the long-term disease scheme or a first hospitalization with a diagnosis of DCM or HF. MoP and CoP THAs are generally implanted in old patients, whereas MoM and CoC are mostly indicated in young, active male patients. Thus, to consider the specific indications of the bearing couples, analyses were separately performed in two distinct subcohorts, one comprising patients with MoP or CoP and one comprising patients with MoM or CoC THA. In each subcohort, the DCM/HF risk was compared between patients with metallic head versus nonmetallic head THAs (MoP versus CoP, MoM versus CoC). Hazard ratios (adjusted HRs) of incident DCM/HF were estimated using Cox models adjusted for baseline sex, age, THA characteristics (fixation technique with cement, use of a modular femoral neck), and comorbidities at baseline. Cox models were stratified by sex and age. RESULTS The crude incidence of DCM/HF per 100 person-years was 2.4 in patients with MoP, 1.8 with CoP, 1.2 with MoM, and 1.1 with CoC THAs. Overall, metallic head THAs were associated with a slight increase in DCM/HF risk (MoP versus CoP: adjusted HR, 1.08; 95% confidence interval [CI], 1.05-1.12; p < 0.001; MoM versus CoC: adjusted HR, 1.11; 95% CI, 1.03-1.19; p = 0.007). In the MoM-CoC subcohort, the risk tended to be more pronounced with MoM versus CoC THAs in women (MoM versus CoC: adjusted HR, 1.20; 95% CI, 1.07-1.35; p = 0.002) and patients aged ≥ 75 years (MoM versus CoC: adjusted HR, 1.16; 95% CI, 1.04-1.29; p = 0.009). CONCLUSIONS Metallic head THAs were associated with a slightly increased DCM/HF risk, especially with MoM in women and older patients. Some caveats should be mentioned: severity of DCM or HF was not available and residual confounding cannot be ruled out despite considering many covariates. Our findings suggest that cardiac function should be regularly monitored in patients with metallic head THAs. Further investigations should be planned on large international cohorts. LEVEL OF EVIDENCE Level III, therapeutic study.
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Abstract
Total hip arthroplasty (THA) is a very satisfactory surgical procedure for end-stage hip disorders. Implant modifications, such as large femoral heads to improve stability, porous metals to enhance fixation and alternative bearings to improve wear, have been introduced over the last decade in order to decrease the rate of early and late failures. There is a changing pattern of THA failure modes. The relationship between failure modes and patient-related factors, and the time and type of revision are important for understanding and preventing short and late failure of implants. The early adoption of innovations in either technique or implant design may lead to an increased risk of early failure.
Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.170068
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Affiliation(s)
- Theofilos Karachalios
- School of Health Sciences, Faculty of Medicine, University of Thessalia, University General Hospital of Larissa, Mezourlo Region, 41110 Larissa, Greece
| | - George Komnos
- Orthopaedic Department, University General Hospital of Larissa, Greece
| | - Antonios Koutalos
- Orthopaedic Department, University General Hospital of Larissa, Greece
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8
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Asri RIM, Harun WSW, Samykano M, Lah NAC, Ghani SAC, Tarlochan F, Raza MR. Corrosion and surface modification on biocompatible metals: A review. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2017; 77:1261-1274. [PMID: 28532004 DOI: 10.1016/j.msec.2017.04.102] [Citation(s) in RCA: 197] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 04/18/2017] [Indexed: 12/12/2022]
Abstract
Corrosion prevention in biomaterials has become crucial particularly to overcome inflammation and allergic reactions caused by the biomaterials' implants towards the human body. When these metal implants contacted with fluidic environments such as bloodstream and tissue of the body, most of them became mutually highly antagonistic and subsequently promotes corrosion. Biocompatible implants are typically made up of metallic, ceramic, composite and polymers. The present paper specifically focuses on biocompatible metals which favorably used as implants such as 316L stainless steel, cobalt-chromium-molybdenum, pure titanium and titanium-based alloys. This article also takes a close look at the effect of corrosion towards the implant and human body and the mechanism to improve it. Due to this corrosion delinquent, several surface modification techniques have been used to improve the corrosion behavior of biocompatible metals such as deposition of the coating, development of passivation oxide layer and ion beam surface modification. Apart from that, surface texturing methods such as plasma spraying, chemical etching, blasting, electropolishing, and laser treatment which used to improve corrosion behavior are also discussed in detail. Introduction of surface modifications to biocompatible metals is considered as a "best solution" so far to enhanced corrosion resistance performance; besides achieving superior biocompatibility and promoting osseointegration of biocompatible metals and alloys.
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Affiliation(s)
- R I M Asri
- Institute of Postgraduate Studies, Universiti Malaysia Pahang, Lebuhraya Tun Razak, Gambang, 26300 Kuantan, Pahang, Malaysia
| | - W S W Harun
- Green Research for Advanced Materials Laboratory, Human Engineering Group, Faculty of Mechanical Engineering, Universiti Malaysia Pahang, 26600 Pekan, Pahang, Malaysia.
| | - M Samykano
- Structural and Material Degradation Group, Faculty of Mechanical Engineering, Universiti Malaysia Pahang, 26600 Pekan, Pahang, Malaysia
| | - N A C Lah
- Structural and Material Degradation Group, Faculty of Mechanical Engineering, Universiti Malaysia Pahang, 26600 Pekan, Pahang, Malaysia
| | - S A C Ghani
- Green Research for Advanced Materials Laboratory, Human Engineering Group, Faculty of Mechanical Engineering, Universiti Malaysia Pahang, 26600 Pekan, Pahang, Malaysia
| | - F Tarlochan
- Department of Mechanical and Industrial Engineering, College of Engineering, Qatar University, Doha, Qatar
| | - M R Raza
- Department of Mechanical Engineering, COMSATS Institute of Information Technology, Sahiwal 57000, Pakistan
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Amanatullah DF, Sucher MG, Bonadurer GF, Pereira GC, Taunton MJ. Metal in Total Hip Arthroplasty: Wear Particles, Biology, and Diagnosis. Orthopedics 2016; 39:371-379. [PMID: 27459144 DOI: 10.3928/01477447-20160719-06] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 06/13/2016] [Indexed: 02/03/2023]
Abstract
Total hip arthroplasty (THA) has been performed for nearly 50 years. Between 2006 and 2012, more than 600,000 metal-on-metal THA procedures were performed in the United States. This article reviews the production of metal wear debris in a metal-on-metal articulation and the interaction of cobalt and chromium ions that ultimately led to a dramatic decline in the use of metal-on-metal THA articulations. Additionally, the article reviews mechanisms of metal wear, the biologic reaction to cobalt and chromium ions, the clinical presentation of failing metal-on-metal articulations, and current diagnostic strategies. Further, the article discusses the use of inflammatory markers, metal ion levels, radiographs, metal artifact reduction sequence magnetic resonance imaging, and ultrasound for failed metal-on-metal THA procedures. When adopting new technologies, orthopedic surgeons must weigh the potential increased benefits against the possibility of new mechanisms of failure. Metal-on-metal bearings are a prime example of the give and take between innovation and clinical results, especially in the setting of an already successful procedure such as THA. [Orthopedics. 2016; 39(6):371-379.].
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10
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Midterm Results of Delta Ceramic-on-Ceramic Total Hip Arthroplasty. J Arthroplasty 2015; 30:110-5. [PMID: 26122108 DOI: 10.1016/j.arth.2015.02.047] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 02/09/2015] [Accepted: 02/11/2015] [Indexed: 02/01/2023] Open
Abstract
This study reports mid-term results of Delta ceramic on ceramic (COC) in total hip arthroplasty (THA). Subjects received Delta COC THA in a prospective multi-center study with either 28 mm (n=177) or 36 mm (n=168) articulations. Annual clinical and radiographic evaluations were performed, and patients were asked about hip noises. At mean 5.3-year follow-up there were 3 (0.9%) post-operative liner fractures. Nine revisions were performed (2 liner fracture, 4 stem loosening, 3 deep infection). Kaplan-Meier survivorship at 6 years was 96.9% (94.0-98.4). Twenty-six (7.5%) subjects reported squeaking, of whom none were revised. One (0.3%) subject could reproduce a sound in clinic. More patients reported squeaking with a 36 mm bearing (28 mm: 7/177, 36 mm: 19/168, P=0.013).
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Reigstad O, Røkkum M. Wrist arthroplasty: where do we stand today? A review of historic and contemporary designs. ACTA ACUST UNITED AC 2014; 19:311-22. [PMID: 24875525 DOI: 10.1142/s0218810414300034] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Earlier generations of wrist arthroplasty were limited to low demand patients. Bone fixation problems, excessive wear, and adverse designs resulting in loosening, imbalance, and dislocation led to the withdrawal of a number of models. Contemporary wrist prostheses aim at replacing wrist arthrodesis in the majority of patients with radiocarpal destruction, including high demand cases. Contraindications are wrist imbalance, insufficient soft tissue, or bone stock and infection. Various designs, fixation principles, bearing materials, and articulations have been employed. Some of the devises (RE-MOTION™, Motec(®)) demonstrate promising short- to midterm results, and calls for cautious optimism.
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Affiliation(s)
- Ole Reigstad
- Hand- and Microsurgery Section, Orthopedic Department, OUS-Rikshospitalet, Box 4950 Nydalen, N-0424 Oslo, Norway
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Topolovec M, Cör A, Milošev I. Metal-on-metal vs. metal-on-polyethylene total hip arthroplasty tribological evaluation of retrieved components and periprosthetic tissue. J Mech Behav Biomed Mater 2014; 34:243-52. [DOI: 10.1016/j.jmbbm.2014.02.018] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 02/12/2014] [Accepted: 02/15/2014] [Indexed: 11/27/2022]
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13
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Owen DH, Russell NC, Smith PN, Walter WL. An estimation of the incidence of squeaking and revision surgery for squeaking in ceramic-on-ceramic total hip replacement: a meta-analysis and report from the Australian Orthopaedic Association National Joint Registry. Bone Joint J 2014; 96-B:181-7. [PMID: 24493182 DOI: 10.1302/0301-620x.96b2.32784] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Squeaking arising from a ceramic-on-ceramic (CoC) total hip replacement (THR) may cause patient concern and in some cases causes patients to seek revision surgery. We performed a meta-analysis to determine the incidence of squeaking and the incidence of revision surgery for squeaking. A total of 43 studies including 16,828 CoC THR that reported squeaking, or revision for squeaking, were entered into the analysis. The incidence of squeaking was 4.2% and the incidence of revision for squeaking was 0.2%. The incidence of squeaking in patients receiving the Accolade femoral stem was 8.3%, and the incidence of revision for squeaking in these patients was 1.3%.
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Affiliation(s)
- D H Owen
- Trauma and Orthopaedic Research Unit, Building 6 Level 1, The Canberra Hospital, PO Box 11, Woden ACT, 2606, and Australian National University Medical School, Level 2, Peter Baume Building 42, Linnaeus Way, Canberra, ACT, 0200, Australia
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14
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Affiliation(s)
- Ole Reigstad
- Hand- and Microsurgery section Orthopaedic department OUS-Rikshospitalet Postboks 4950 Nydalen 0424 Oslo Norway
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15
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Zywiel MG, Mont MA. Orthopedic implant approval: achieving the right balance. Expert Rev Med Devices 2014; 8:405-8. [DOI: 10.1586/erd.11.38] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Topolovec M, Milošev I. A comparative study of four bearing couples of the same acetabular and femoral component: a mean follow-up of 11.5 years. J Arthroplasty 2014; 29:176-80. [PMID: 23639386 DOI: 10.1016/j.arth.2013.03.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 02/27/2013] [Accepted: 03/29/2013] [Indexed: 02/01/2023] Open
Abstract
We present a retrospective evaluation of 1369 hip arthroplasties performed using the Bicon-Plus cups and SL-Plus stems, differing only in the bearing combination. Four bearing combination groups were used: metal-on-polyethylene (MoP) group with 587 hips, ceramic-on-polyethylene (CoP) group with 161 hips, metal-on-metal (MoM) group with 322 hips and ceramic-on-ceramic (CoC) group with 299 hips. The mean follow-up was 11.5 years (4.1 to 15.0). Radiological evaluation was performed on implants failed due to aseptic loosening. The survival for prosthesis with revision for any reason at ten years was 96.1% (95% confidence interval (CI) 94.3 to 97.9) for MoP, 98.1% (CI 95.9 to 100) for CoP, 90.2% (CI 86.8 to 93.6) for MoM, and 95.6% (CI 93.0 to 98.2) for CoC. Survival for aseptic loosening was also determined.
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Affiliation(s)
- Matevž Topolovec
- Valdoltra Orthopedic Hospital, Jadranska c. 31, SI-6280, Ankaran, Slovenia
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Brandt JM, Gascoyne TC, Guenther LE, Allen A, Hedden DR, Turgeon TR, Bohm ER. Clinical failure analysis of contemporary ceramic-on-ceramic total hip replacements. Proc Inst Mech Eng H 2013; 227:833-46. [DOI: 10.1177/0954411913489803] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The present study investigates the performance of ceramic-on-ceramic total hip replacements by combining a retrieval analysis with a survivorship analysis to elucidate mechanisms that led to clinical failure. Semiquantitative surface damage assessment, contact profilometry, contour measurements, and scanning electron microscopy were performed to characterize the types and quantify the extent of surface damage on the retrieved ceramic components. The implantation period was positively correlated with both damage scores of the femoral heads (R = 0.573, p < 0.001) and the acetabular cups (R = 0.592, p < 0.001). Increased maximal out-of-roundness values of the femoral heads correlated with both increased metal transfer damage score (R = 0.384, p = 0.023) and increased stripe damage score (R = 0.729, p ≤ 0.001) of the acetabular liners. The damage rate (damage score/year) for both the retrieved heads and acetabular liners was at least 2.2-fold greater at inclination angles of >45° than the damage rate at inclination angles of ≤45°. For the retrieved femoral heads only, the linear wear rate of 25.5 ± 21.3 µm/year at inclination angles of >45° was 6-fold greater than the linear wear rate of 4.2 ± 2.3 µm/year at inclination angles of ≤45°. Metal transfer on the ceramic bearing surface could possibly contribute to fluid-film starvation and, in combination with an increased inclination angle, may facilitate an adhesive wear mechanism associated with stripe surface damage. At our institution, the clinical survivorship of ceramic-on-ceramic total hip replacements was 98.9% (a total of 9 out of 815 patients were revised within 10 years after total hip arthroplasty) with revision as the end point, suggesting their safe use in younger patients.
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Affiliation(s)
- Jan-M Brandt
- Concordia Joint Replacement Group, Winnipeg, MB, Canada
| | | | | | - Andrew Allen
- School of Biomedical Engineering, Dalhousie University, Halifax, NS, Canada
| | | | - Thomas R Turgeon
- Concordia Joint Replacement Group, Winnipeg, MB, Canada
- Orthopaedic Innovation Centre, Inc., Winnipeg, MB, Canada
| | - Eric R Bohm
- Concordia Joint Replacement Group, Winnipeg, MB, Canada
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Jack CM, Molloy DO, Walter WL, Zicat BA, Walter WK. The use of ceramic-on-ceramic bearings in isolated revision of the acetabular component. Bone Joint J 2013; 95-B:333-8. [PMID: 23450016 DOI: 10.1302/0301-620x.95b3.30084] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The practice of removing a well-fixed cementless femoral component is associated with high morbidity. Ceramic bearing couples are low wearing and their use minimises the risk of subsequent further revision due to the production of wear debris. A total of 165 revision hip replacements were performed, in which a polyethylene-lined acetabular component was revised to a new acetabular component with a ceramic liner, while retaining the well-fixed femoral component. A titanium sleeve was placed over the used femoral trunnion, to which a ceramic head was added. There were 100 alumina and 65 Delta bearing couples inserted. The mean Harris hip score improved significantly from 71.3 (9.0 to 100.0) pre-operatively to 91.0 (41.0 to 100.0) at a mean follow up of 4.8 years (2.1 to 12.5) (p < 0.001). No patients reported squeaking of the hip. There were two fractures of the ceramic head, both in alumina bearings. No liners were seen to fracture. No fractures were observed in components made of Delta ceramic. At 8.3 years post-operatively the survival with any cause of failure as the endpoint was 96.6% (95% confidence interval (CI) 85.7 to 99.3) for the acetabular component and 94.0% (95% CI 82.1 to 98.4) for the femoral component. The technique of revising the acetabular component in the presence of a well-fixed femoral component with a ceramic head placed on a titanium sleeve over the used trunnion is a useful adjunct in revision hip practice. The use of Delta ceramic is recommended.
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Affiliation(s)
- C M Jack
- Specialist Orthopaedic Group, North Sydney, New South Wales 2060, Australia.
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Hug KT, Watters TS, Vail TP, Bolognesi MP. The withdrawn ASR™ THA and hip resurfacing systems: how have our patients fared over 1 to 6 years? Clin Orthop Relat Res 2013; 471:430-8. [PMID: 22926492 PMCID: PMC3549196 DOI: 10.1007/s11999-012-2547-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The Articular Surface Replacement™ (ASR™) metal-on-metal hip arthroplasty system (DePuy Orthopaedics, Inc, Warsaw, IN, USA) reportedly has a higher than anticipated early failure rate leading to a voluntary recall. This prompted us to evaluate all ASR™ components implanted at our center. QUESTIONS/PURPOSES In all ASR™ components, we reported (1) revision rate, (2) blood metal ion levels, and (3) intraoperative findings for revisions related to adverse reaction to metal debris (ARMD). METHODS We retrospectively reviewed all 172 patients (190 hips) who underwent THA (149 hips) or hip resurfacing (41 hips) with the ASR™ system. We determined failure rates. We obtained blood metal ion concentrations from 93 patients at last followup. We evaluated MRI studies and intraoperative histopathology. Minimum followup was 12 months (mean, 40 months; range, 12-74 months). RESULTS At latest followup, we had revised 24 of 190 hips (13%): in 18 patients with THA and five patients with resurfacing. Mean time to revision was 45 months (range, 12-75 months). Mean blood concentrations were 13 μg/L (range, 0-150 μg/L) for cobalt and 6 μg/L (range, 0-87 μg/L) for chromium. Mean prerevision blood metal ion levels were higher in the revised group (cobalt: 48 μg/L; chromium: 18 μg/L) than in the nonrevised group (cobalt: 5 μg/L; chromium: 2 μg/L). ARMD was present in 14 of the 24 hips revised in this study. CONCLUSIONS Surgeons must have a low threshold for concern for ARMD in patients with ASR™ systems. Blood metal ion levels and MRI can be used to evaluate patients with underperforming implants. Intraoperative histopathologic analysis and joint fluid cytology can help diagnose ARMD at the time of revision. LEVEL OF EVIDENCE Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Kevin T. Hug
- />Department of Orthopaedic Surgery, Duke University Medical Center, Box 3269, Durham, NC 27710 USA
| | - Tyler S. Watters
- />Department of Orthopaedic Surgery, Duke University Medical Center, Box 3269, Durham, NC 27710 USA
| | - Thomas P. Vail
- />Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA USA
| | - Michael P. Bolognesi
- />Department of Orthopaedic Surgery, Duke University Medical Center, Box 3269, Durham, NC 27710 USA
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20
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Zywiel MG, Brandt JM, Overgaard CB, Cheung AC, Turgeon TR, Syed KA. Fatal cardiomyopathy after revision total hip replacement for fracture of a ceramic liner. Bone Joint J 2013; 95-B:31-7. [DOI: 10.1302/0301-620x.95b1.30060] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Symptomatic cobalt toxicity from a failed total hip replacement is a rare but devastating complication. It has been reported following revision of fractured ceramic components, as well as in patients with failed metal-on-metal articulations. Potential clinical findings include fatigue, weakness, hypothyroidism, cardiomyopathy, polycythaemia, visual and hearing impairment, cognitive dysfunction, and neuropathy. We report a case of an otherwise healthy 46-year-old patient, who developed progressively worsening symptoms of cobalt toxicity beginning approximately six months following synovectomy and revision of a fractured ceramic-on-ceramic total hip replacement to a metal-on-polyethylene bearing. The whole blood cobalt levels peaked at 6521 µg/l. The patient died from cobalt-induced cardiomyopathy. Implant retrieval analysis confirmed a loss of 28.3 g mass of the cobalt–chromium femoral head as a result of severe abrasive wear by ceramic particles embedded in the revision polyethylene liner. Autopsy findings were consistent with heavy metal-induced cardiomyopathy. We recommend using new ceramics at revision to minimise the risk of wear-related cobalt toxicity following breakage of ceramic components. Cite this article: Bone Joint J 2013;95-B:31–7.
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Affiliation(s)
- M. G. Zywiel
- University of Toronto, Banting
Institute, Division of Orthopaedic Surgery, 100
College Street Room 302, Toronto, Ontario M5G
1L5, Canada
| | - J-M. Brandt
- University of Manitoba, Concordia
Joint Replacement Group, Suite 310-1155 Concordia
Ave, Winnipeg, Manitoba
R2K 2M9, Canada
| | - C. B. Overgaard
- Toronto General Hospital, University
Health Network, EN North 232, 200
Elizabeth Street, Toronto, Ontario
M5G 2C4, Canada
| | - A. C. Cheung
- University of Toronto, University
Health Network, Toronto Western Hospital, 8
MP Room 326, 399 Bathurst Street, Toronto, Ontario
M5T 2S8, Canada
| | - T. R. Turgeon
- University of Manitoba, Concordia
Joint Replacement Group, Suite 310-1155 Concordia
Ave, Winnipeg, Manitoba
R2K 2M9, Canada
| | - K. A. Syed
- University of Toronto, University
Health Network, Toronto Western Hospital, 399
Bathurst Street, 446, 1 East Wing, Toronto, Ontario
M5T 2S8, Canada
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Rajaee SS, Trofa D, Matzkin E, Smith E. National trends in primary total hip arthroplasty in extremely young patients: a focus on bearing surface usage. J Arthroplasty 2012; 27:1870-8. [PMID: 22658430 DOI: 10.1016/j.arth.2012.04.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Accepted: 04/04/2012] [Indexed: 02/01/2023] Open
Abstract
The purpose of this study was to present national trends in primary total hip arthroplasty (THA) and bearing surface usage for patients 30 years and younger. Using the Healthcare-Cost-and-Utilization-Project Nationwide Inpatient Sample for the years 2006 to 2009, 8919 primary THA discharges (4454 coded by bearing surface) were identified in patients 30 years and younger. The most commonly used bearing surface was metal-on-metal (MoM), representing 37.6% of cases, followed by ceramic-on-ceramic (CoC) (24.6%), metal-on-polyethylene (MoP) (22.1%) and ceramic-on-polyethylene (15.7%). From 2006 to 2009, the percentage of THAs that used hard-on-hard bearing surfaces decreased (MoM: 42.9%-29.4%; CoC: 34.0%-19.7%).This decrease in hard-on-hard bearing surface usage presents a challenge for surgeons treating young patients to find other acceptable durable bearings that do not have the potential problems associated with MoM or CoC.
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Affiliation(s)
- Sean S Rajaee
- Department of Orthopedics, Tufts Medical Center/Tufts University School of Medicine, Boston, MA 02111, USA
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22
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Long-term results of cementless hip arthroplasty with ceramic-on-ceramic articulation. INTERNATIONAL ORTHOPAEDICS 2012; 36:2225-9. [PMID: 22903410 PMCID: PMC3479287 DOI: 10.1007/s00264-012-1639-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2012] [Accepted: 07/28/2012] [Indexed: 12/19/2022]
Abstract
PURPOSE The goal of the study was to evaluate long-term results of hip arthroplasty in patients with ceramic-on-ceramic articulation. METHODS The follow-up involved 220 primary total hip arthroplasty procedures (188 patients, 101 women and 87 men) after implantation of the Mittelmeier cementless hip endoprosthesis. The mean age of patients at surgery was 44.5 years and the mean follow-up was 19.6 years, with a minimum of 12.3 years. Dysplastic, idiopathic and post-traumatic coxarthrosis were the most frequent forms of degenerative hip changes. The Merle d'Aubigné and Postel classification, as modified by Charnley, was used for clinical evaluation. RESULTS Very good results were obtained in 39.5 % of the patients, good results in 43.6 %, satisfactory results in 9.1 % and poor results in 7.8 %. Twelve-year survival for the whole prosthesis was 86.36 %, for the acetabulum 89.99 % and for the stem 91.36 %. CONCLUSIONS Long-term results of hip arthroplasty using the Mittelmeier prosthesis are fairly encouraging with their low incidence of loosened prosthesis components after surgery.
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23
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Zmistowski B, Parvizi J. Identification and treatment of infected total hip arthroplasty. Expert Rev Anti Infect Ther 2012; 10:509-18. [PMID: 22512759 DOI: 10.1586/eri.12.19] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Periprosthetic joint infection (PJI) in the hip following prosthetic joint placement is a devastating outcome of an otherwise often successful surgical treatment (total-hip arthroplasty). Management of PJI is dependent upon accurate diagnosis and successful treatment, both of which are challenging. Recently, great strides have been made in improving the diagnosis of PJI, which has no 'gold standard' diagnostic tool. Proper diagnosis is essential as untreated or undetected PJI can quickly lead to biofilm formation on the implant surface depending upon the infecting organism. Upon complete biofilm formation, successful treatment requires prosthetic resection with immediate or delayed reimplantation. Even with the most aggressive surgical treatment, PJI eradication currently has a success rate of approximately 80%. Unfortunately, technologies to improve the local delivery of antibiotics are not expected to be available in the near future.
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Affiliation(s)
- Benjamin Zmistowski
- The Rothman Institute of Orthopaedics at Thomas Jefferson University Hospital, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107, USA
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