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Bormann T, Kraenzler S, Jaeger S, Kluess D, Mittelmeier W, Renkawitz T, Kretzer JP. Stability of ceramic coatings on retrieved knee prostheses. J Mech Behav Biomed Mater 2023; 144:105997. [PMID: 37413893 DOI: 10.1016/j.jmbbm.2023.105997] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/23/2023] [Accepted: 06/25/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND In total knee arthroplasty, femoral components with coated or oxidized surfaces are commonly used as alternative to CoCrMo in metal sensitive patients. Data on the in vivo behaviour of different coating types is, however, rare. Aim of the study was the investigation of coating stability with respect to implant and patient specific parameters. METHODS Coating thickness and coating thickness reduction, respectively, was measured at 37 retrieved femoral components with TiNbN, TiN, ZrN or oxidized zirconium (OxZr) surface by the crater grinding method. The results were correlated to surface type, manufacturer, time in vivo of the implant, patient body weight and patient activity. RESULTS Mean coating thickness reduction in the overall retrieval collection was 0.6 μm ± 0.8 μm. There was no correlation between coating thickness reduction and coating type, time in vivo, patient body weight, and patient activity. If grouped according to manufacturers, implants of one manufacturer showed an increased coating thickness reduction. 10 of 37 retrievals exhibited coating abrasion with exposure of the underlying alloy. TiNbN coatings showed the highest incidence (9/17) of coating abrasion. No coating breakthrough was observed in the ZrN or OxZr surfaces. CONCLUSION Our results indicate that TiNbN coatings should be optimized to improve their wear resistance in the long-term.
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Affiliation(s)
- Therese Bormann
- Laboratory of Biomechanics and Implant Research, Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
| | - Simeon Kraenzler
- Laboratory of Biomechanics and Implant Research, Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Sebastian Jaeger
- Laboratory of Biomechanics and Implant Research, Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Daniel Kluess
- Department of Orthopaedics, Rostock University Medical Center, Doberaner Straße 142, 18057, Rostock, Germany
| | - Wolfram Mittelmeier
- Department of Orthopaedics, Rostock University Medical Center, Doberaner Straße 142, 18057, Rostock, Germany
| | - Tobias Renkawitz
- Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - J Philippe Kretzer
- Laboratory of Biomechanics and Implant Research, Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
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Kelly B, Manes T, Main C. Bilateral Failure of Oxidized Zirconium Implants in Total Knee Arthroplasty. Arthroplast Today 2023; 21:101144. [PMID: 37214318 PMCID: PMC10192679 DOI: 10.1016/j.artd.2023.101144] [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: 07/27/2022] [Revised: 03/21/2023] [Accepted: 04/01/2023] [Indexed: 05/24/2023] Open
Abstract
Oxidized zirconium was first introduced in total hip arthroplasty procedures to merge the strengths of metal and ceramic into one prosthetic. The subsequent adoption of oxidized zirconium (oxinium) for total knee arthroplasty is attributed to the theory of causing less wear on the tibial components compared to the alternative, cobalt chromium. However, the superficial layer of the femoral component is occasionally breached, exposing the softer zirconium substrate. Multiple mechanisms leading to zirconium substrate exposure have been explained, including collateral ligament instability and polyethylene wear. Such a failure may lead to damage to the periprosthetic tissues and often requires a revision procedure. In the current case report, we present a case of bilateral total knee arthroplasty with oxidized zirconium components that resulted in catastrophic failure and subsequent revision with hinged knee prostheses.
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Affiliation(s)
- Brendan Kelly
- Orthopedic Surgery, Des Moines University College of Osteopathic Medicine, Des Moines University, Des Moines, IA, USA
| | - Taylor Manes
- Orthopedic Surgery, Kirksville College of Osteopathic Medicine, A.T. Still University, Kirksville, MO, USA
| | - Chris Main
- Orthopedic Surgery, Midwest Bone and Joint Center, P.C, Macon, MO, USA
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Hasegawa M, Tone S, Naito Y, Sudo A. Ultra-High-Molecular-Weight Polyethylene in Hip and Knee Arthroplasties. MATERIALS (BASEL, SWITZERLAND) 2023; 16:2140. [PMID: 36984020 PMCID: PMC10054334 DOI: 10.3390/ma16062140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/05/2023] [Accepted: 03/06/2023] [Indexed: 06/18/2023]
Abstract
Ultra-high-molecular-weight polyethylene (UHMWPE) wear and particle-induced osteolysis contribute to the failure of total hip arthroplasty (THA) and total knee arthroplasty (TKA). Highly crosslinked polyethylene (HXLPE) was developed in the late 1990s to reduce wear and has shown lower wear rates and loosening than conventional UHMWPE in THA. The irradiation dose for crosslinking is up to 100 kGy. However, during crosslinking, free radical formation induces oxidation. Using HXLPE in THA, the cumulative revision rate was determined to be significantly lower (6.2%) than that with conventional UHMWPE (11.7%) at a mean follow-up of 16 years, according to the Australian Orthopaedic Association National Joint Replacement Registry. However, HXLPE does not confer to TKA the same advantages it confers to THA. Several alternatives have been developed to prevent the release of free radicals and improve polymer mechanical properties, such as thermal treatment, phospholipid polymer 2-methacryloyloxyethyl phosphorylcholine grafting, remelting, and vitamin E addition. Among these options, vitamin E addition has reported good clinical results and wear resistance similar to that of HXLPE without vitamin E, as shown by short-term clinical studies of THA and TKA. This review aims to provide a comprehensive overview of the development and performance of UHMWPE in THA and TKA.
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Oxidized Zirconium Versus Cobalt Chromium for Primary TKA: No Difference in Midterm Revision Rates From the American Joint Replacement Registry. Clin Orthop Relat Res 2023:00003086-990000000-01104. [PMID: 36853864 PMCID: PMC10344518 DOI: 10.1097/corr.0000000000002585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 01/19/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND Cobalt chromium (CoCr) is the most commonly used material in TKA; however, the use of oxidized zirconium (OxZr) implants has increased. The advantages to this material demonstrated in basic science studies have not been borne out in clinical studies to date. QUESTION/PURPOSE In the setting of the American Joint Replacement Registry (AJRR), how do revision rates differ between CoCr and OxZr after primary TKA? METHODS The AJRR was accessed for all primary TKAs performed between 2012 and 2020 for osteoarthritis, resulting in 441,605 procedures (68,506 with OxZr and 373,099 with CoCr). The AJRR is the largest joint replacement registry worldwide and collects procedure-specific details, making it ideal for large-scale comparisons of implant materials in the United States. Competing risk survival analyses were used to evaluate the all-cause revision rates of primary TKAs, comparing CoCr and OxZr implants. Data from the Centers for Medicare and Medicaid Services claims from 2012 to 2017 were also cross-referenced to capture additional revisions from other institutions. Revision rates were tabulated and subclassified by indication. Multivariate Cox regression was used to account for confounding variables such as age, gender, region, and hospital size. RESULTS After controlling for confounding variables, there were no differences between the OxZr and CoCr groups in terms of the rate of all-cause revision at a mean follow-up of 46 ± 23 months and 44 ± 24 months for CoCr and OxZr implants, respectively (hazard ratio 1.055 [95% confidence interval 0.979 to 1.137]; p = 0.16) The univariate analysis demonstrated increased rates of revisions for pain and instability in the OxZr group (p = 0.003 and p < 0.001, respectively). CONCLUSION These findings suggest there is no difference in all-cause revision between OxZr and CoCr implants in the short-term to mid-term. However, further long-term in vivo studies are needed to monitor the safety and all-cause revision rate of OxZr implants compared with those of CoCr implants. OxZr implants may be favorable in patients who have sensitivity to metal. Despite similar short-term to mid-term all-cause revision rates to CoCr implants, because of the limitations of this study, definitive recommendations for or against the use of OxZr cannot be made. LEVEL OF EVIDENCE Level III, therapeutic study.
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Lodge CJ, Matar HE, Berber R, Radford PJ, Bloch BV. Ceramic Coatings Confer No Survivorship Advantages in Total Knee Arthroplasty-A Single-Center Series of 1641 Knees. Arthroplast Today 2023; 19:101086. [PMID: 36688095 PMCID: PMC9851869 DOI: 10.1016/j.artd.2022.101086] [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: 07/15/2022] [Revised: 10/06/2022] [Accepted: 12/08/2022] [Indexed: 01/19/2023] Open
Abstract
Background Ceramic coatings in total knee arthroplasty have been introduced with the aim of reducing wear and consequently improving implant survivorship. We studied both cobalt-chrome-molybdenum (CoCrMo) and ceramic-coated components of the same implant design from a single center to identify if the ceramic coating conferred any benefit. Methods We identified 1641 Columbus total knee arthroplasties (Aesculap AG, Tüttlingen, Germany) from a prospectively collected arthroplasty database. Of the 1641, 983 were traditional CoCrMo, and 659 had the Columbus AS ceramic coating. Patients were followed up until death or revision of any component of the implant. Results There was no significant difference in implant survivorship using any component revision as the endpoint between the CoCrMo femur and the ceramic-coated femur at a mean of 9.2 years in follow-up for the CoCrMo group and 5 years for the ceramic-coated group (37 vs 14; P = .76). There was no reduction in the proportion of components revised for aseptic loosening or infection in the ceramic-coated cohort. Conclusions At midterm follow-up, there was no benefit in terms of implant survivorship in using a ceramic coating.
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Affiliation(s)
| | | | | | | | - Benjamin V. Bloch
- Corresponding author. Consultant Orthopaedic Surgeon, City Hospital Campus, Nottingham, NG5 1PB, UK. Tel.: +44 115 969 1169.
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Manescu (Paltanea) V, Antoniac I, Antoniac A, Paltanea G, Miculescu M, Bita AI, Laptoiu S, Niculescu M, Stere A, Paun C, Cristea MB. Failure Analysis of Ultra-High Molecular Weight Polyethylene Tibial Insert in Total Knee Arthroplasty. MATERIALS (BASEL, SWITZERLAND) 2022; 15:7102. [PMID: 36295170 PMCID: PMC9605650 DOI: 10.3390/ma15207102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/09/2022] [Accepted: 10/10/2022] [Indexed: 06/16/2023]
Abstract
Knee osteoarthritis is treated based on total knee arthroplasty (TKA) interventions. The most frequent failure cause identified in surgical practice is due to wear and oxidation processes of the prothesis' tibial insert. This component is usually manufactured from ultra-high molecular weight polyethylene (UHMWPE). To estimate the clinical complications related to a specific prosthesis design, we investigated four UHMWPE tibial inserts retrieved from patients from Clinical Hospital Colentina, Bucharest, Romania. For the initial analysis of the polyethylene degradation modes, macrophotography was chosen. A light stereomicroscope was used to estimate the structural performance and the implant surface degradation. Scanning electron microscopy confirmed the optical results and fulfilled the computation of the Hood index. The oxidation process in UHMWPE was analyzed based on Fourier-transform infrared spectroscopy (FTIR). The crystallinity degree and the oxidation index were computed in good agreement with the existing standards. Mechanical characterization was conducted based on the small punch test. The elastic modulus, initial peak load, ultimate load, and ultimate displacement were estimated. Based on the aforementioned experimental tests, a variation between 9 and 32 was found in the case of the Hood score. The oxidation index has a value of 1.33 for the reference sample and a maximum of 9.78 for a retrieved sample.
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Affiliation(s)
- Veronica Manescu (Paltanea)
- Faculty of Material Science and Engineering, University Politehnica of Bucharest, 313 Splaiul Independentei, District 6, 060042 Bucharest, Romania
- Faculty of Electrical Engineering, University Politehnica of Bucharest, 313 Splaiul Independentei, District 6, 060042 Bucharest, Romania
| | - Iulian Antoniac
- Faculty of Material Science and Engineering, University Politehnica of Bucharest, 313 Splaiul Independentei, District 6, 060042 Bucharest, Romania
- Academy of Romanian Scientists, 54 Splaiul Independentei, 050094 Bucharest, Romania
| | - Aurora Antoniac
- Faculty of Material Science and Engineering, University Politehnica of Bucharest, 313 Splaiul Independentei, District 6, 060042 Bucharest, Romania
| | - Gheorghe Paltanea
- Faculty of Electrical Engineering, University Politehnica of Bucharest, 313 Splaiul Independentei, District 6, 060042 Bucharest, Romania
| | - Marian Miculescu
- Faculty of Material Science and Engineering, University Politehnica of Bucharest, 313 Splaiul Independentei, District 6, 060042 Bucharest, Romania
| | - Ana-Iulia Bita
- Faculty of Material Science and Engineering, University Politehnica of Bucharest, 313 Splaiul Independentei, District 6, 060042 Bucharest, Romania
| | - Stefan Laptoiu
- Faculty of Material Science and Engineering, University Politehnica of Bucharest, 313 Splaiul Independentei, District 6, 060042 Bucharest, Romania
| | - Marius Niculescu
- Faculty of Medicine, Titu Maiorescu University, 67A Gheorghe Petrascu Street, 031593 Bucharest, Romania
- Department of Orthopedics and Trauma I, Colentina Clinical Hospital, 19-21 Soseaua Stefan cel Mare, 020125 Bucharest, Romania
| | - Alexandru Stere
- Medical Ortovit Ltd., 8 Miron Costin Street, 011098 Bucharest, Romania
| | - Costel Paun
- Faculty of Electrical Engineering, University Politehnica of Bucharest, 313 Splaiul Independentei, District 6, 060042 Bucharest, Romania
- National Institute for Research and Development in Microtechnologies IMT-Bucharest, 126A Erou Iancu Nicolae Street, 077190 Bucharest, Romania
| | - Mihai Bogdan Cristea
- Department of Morphological Sciences, Carol Davila University of Medicine and Pharmacy, 37 Dionisie Lupu Street, 020021 Bucharest, Romania
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Kellens J, Berger P, Vandenneucker H. Metal wear debris generation in primary total knee arthroplasty: is it an issue? Acta Orthop Belg 2021; 87:681-695. [PMID: 35172435 DOI: 10.52628/87.4.13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
More durable total knee arthroplasties (TKAs) are needed, due to the rising life expectancy, the higher activity levels of patients and the growing concerns about aseptic loosening being caused by metal hypersensitivity. In response, different hypoallergenic metal coatings have been developed for TKAs. However, possible adverse effects of these different metals (cobalt-chromium-molybdenum, zirconium, titanium and tantalum) have been neglected. The aim was to summarize the local and systemic adverse effects (including metal hypersensitivity), survival ratios, patient-reported outcome measures (PROMs) and the plasma metal ion concentrations of the different TKA coatings. A literature search on PubMed and EMBASE was performed. In total, 15 studies were found eligible. Common adverse effects of TKA were infection, loosening, pain, instability and hyper- coagulation disorders. Serious adverse effects related to TKA implants were not reported. The survival ratios and patient-reported outcome measures seem to confirm these good results. In contrast with chromium and cobalt, no significant differences were reported in the nickel, molybdenum and titanium concentrations. No significant differences between the hypoallergenic and standard TKA implants were found in terms of adverse effects, survival ratios and PROMs. A causal relationship between the common adverse effects and the different metals is unlikely. Due to the heterogeneity of the TKA implants used, no firm conclusions could be made. Further research with longer follow-up studies are needed to find possible adverse effects and differences. Thus far, the hypoallergenic implants seem to perform equal to the standard implants.
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Postler A, Beyer F, Lützner C, Tille E, Lützner J. [The use of knee prostheses with a hypoallergenic coating is safe in the medium term : A randomized controlled study]. DER ORTHOPADE 2021; 51:660-668. [PMID: 34734297 PMCID: PMC9352637 DOI: 10.1007/s00132-021-04186-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/11/2021] [Indexed: 10/25/2022]
Abstract
BACKGROUND In Germany, patients with contact allergy to implant components usually receive coated joint arthroplasties. Whether the treatment using these hypoallergenic implants achieves comparable results to standard treatment with implants consisting of cobalt-chromium alloy (CoCr) implants is controversially discussed internationally and has rarely been investigated in the mid-term. OBJECTIVES Are there differences in blood metal ion concentrations, knee function, and patient-reported outcomes (PROM) between coated and standard implants? MATERIAL AND METHODS 118 patients were randomized to receive either a coated or a standard implant. Knee function as well as patient-reported outcome measures were assessed. Metal ion concentrations in blood samples were additionally determined for chromium, cobalt, molybdenum, and nickel, preoperatively, one and five years after surgery. RESULTS After five years, it was possible to analyse the results of 97 patients. In metal ion concentrations, as well as PRO, consistently good results were seen, without any difference between the groups. While in 13 patients there was an increase in chromium concentration above 2 µg/l one year after surgery, there was no measured value above 1 µg/l after five years. CONCLUSION In our study, similar mid-term results were detected for coated (TiNiN) and standard (CoCr)TKA. With respect to metal ion concentrations and PRO there are no disadvantages in using coated TKA.
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Affiliation(s)
- Anne Postler
- UniversitätsCentrum für Orthopädie, Unfall- und Plastische Chirurgie, Universitätsklinikum Carl Gustav Carus Dresden, TU Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland.
| | - Franziska Beyer
- UniversitätsCentrum für Orthopädie, Unfall- und Plastische Chirurgie, Universitätsklinikum Carl Gustav Carus Dresden, TU Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
| | - Cornelia Lützner
- UniversitätsCentrum für Orthopädie, Unfall- und Plastische Chirurgie, Universitätsklinikum Carl Gustav Carus Dresden, TU Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
| | - Eric Tille
- UniversitätsCentrum für Orthopädie, Unfall- und Plastische Chirurgie, Universitätsklinikum Carl Gustav Carus Dresden, TU Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
| | - Jörg Lützner
- UniversitätsCentrum für Orthopädie, Unfall- und Plastische Chirurgie, Universitätsklinikum Carl Gustav Carus Dresden, TU Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
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Matar HE, Porter PJ, Porter ML. Metal allergy in primary and revision total knee arthroplasty : a scoping review and evidence-based practical approach. Bone Jt Open 2021; 2:785-795. [PMID: 34587776 PMCID: PMC8558451 DOI: 10.1302/2633-1462.210.bjo-2021-0098.r1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Aims Metal allergy in knee arthroplasty patients is a controversial topic. We aimed to conduct a scoping review to clarify the management of metal allergy in primary and revision total knee arthroplasty (TKA). Methods Studies were identified by searching electronic databases: Cochrane Central Register of Controlled Trials, Ovid MEDLINE, and Embase, from their inception to November 2020, for studies evaluating TKA patients with metal hypersensitivity/allergy. All studies reporting on diagnosing or managing metal hypersensitivity in TKA were included. Data were extracted and summarized based on study design, study population, interventions and outcomes. A practical guide is then formulated based on the available evidence. Results We included 38 heterogeneous studies (two randomized controlled trials, six comparative studies, 19 case series, and 11 case reports). The evidence indicates that metal hypersensitivity is a rare complication with some histopathological features leading to pain and dissatisfaction with no reliable screening tests preoperatively. Hypoallergenic implants are viable alternatives for patients with self-reported/confirmed metal hypersensitivity if declared preoperatively; however, concerns remain over their long-term outcomes with ceramic implants outperforming titanium nitride-coated implants and informed consent is paramount. For patients presenting with painful TKA, metal hypersensitivity is a diagnosis of exclusion where patch skin testing, lymphocyte transformation test, and synovial biopsies are useful adjuncts before revision surgery is undertaken to hypoallergenic implants with shared decision-making and informed consent. Conclusion Using the limited available evidence in the literature, we provide a practical approach to metal hypersensitivity in TKA patients. Future national/registry-based studies are needed to identify the scale of metal hypersensitivity, agreed diagnostic criteria, and management strategies. Cite this article: Bone Jt Open 2021;2(10):785–795.
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Affiliation(s)
- Hosam E Matar
- Wrightington Hospital, Wigan, UK.,Nottingham Elective Orthopaedic Services, Nottingham University Hospital NHS Trust, Nottingham, UK
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Bonnheim NB, Van Citters DW, Ries MD, Pruitt LA. Oxidized Zirconium Components Maintain a Smooth Articular Surface Except Following Hip Dislocation. J Arthroplasty 2021; 36:1437-1444. [PMID: 33246784 DOI: 10.1016/j.arth.2020.10.054] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 10/26/2020] [Accepted: 10/29/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Oxidized zirconium (OxZr) offers theoretical advantages in total hip and knee arthroplasty (THA and TKA, respectively) relative to other biomaterials by combining the tribological benefits of ceramics with the fracture toughness of metals. Yet, some studies have found that OxZr does not improve outcomes or wear rates relative to traditional bearing materials such as cobalt-chromium (CoCr). Separately, effacement of the thin ceramic surface layer has been reported for OxZr components, though the prevalence and sequelae are unclear. METHODS To elucidate the in vivo behavior of OxZr implants, the articular surfaces of 94 retrieved THA and TKA femoral components (43 OxZr TKA, 21 OxZr THA, 30 CoCr THA) were analyzed using optical microscopy, non-contact profilometry, and scanning electron microscopy. RESULTS We found that OxZr components maintain a smooth articular surface except following hip dislocation. Three of four OxZr femoral heads revised following dislocation exhibited severe damage to the articular surface, including macroscopic regions of ceramic-layer effacement and exposure of the underlying metal substrate; these components were 23-32 times rougher than pristine OxZr controls. When revised for dislocation, OxZr femoral heads were substantially rougher than CoCr femoral heads (median Sa = 0.431 v. 0.020 μm, P = .03). In contrast, CoCr femoral heads exhibited low overall roughness values regardless of whether they dislocated (median Sa = 0.020 v. 0.008 μm, P = .09, CoCr dislocators v. non-dislocators). CONCLUSIONS Effacement of the ceramic surface layer and substantial articular surface roughening is not atypical following dislocation of OxZr femoral heads, making OxZr much less tolerant than CoCr to hip dislocation.
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Affiliation(s)
- Noah B Bonnheim
- Department of Mechanical Engineering, University of California, Berkeley, CA
| | | | | | - Lisa A Pruitt
- Department of Mechanical Engineering, University of California, Berkeley, CA
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Grimberg AW, Grupp TM, Elliott J, Melsheimer O, Jansson V, Steinbrück A. Ceramic Coating in Cemented Primary Total Knee Arthroplasty is Not Associated With Decreased Risk of Revision due to Early Prosthetic Joint Infection. J Arthroplasty 2021; 36:991-997. [PMID: 33012599 DOI: 10.1016/j.arth.2020.09.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/31/2020] [Accepted: 09/08/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Prosthetic joint infection (PJI) is one of the most frequent and devastating causes of short-term revision total knee arthroplasty (TKA). In vitro evidence suggests ceramic surfaces demonstrate resistance to biofilm, but the clinical effect of bearing surface modifications on the risk of PJI remains unclear. This premier registry-based study examines the influence of ceramic bearing surface coatings on the outcome in cemented primary TKA. METHODS In total, 117,660 cemented primary TKAs in patients with primary osteoarthritis recorded in the German arthroplasty registry since 2012 were followed up for a maximum of 3 years. The primary endpoint was risk of revision for PJI on ceramic coated and uncoated cobalt-chromium-molybdenum femoral components. Propensity score matching for age, gender, obesity, diabetes mellitus, depression and Elixhauser comorbidity index, and substratification on common design twins with and without coating was performed. RESULTS In total, 4637 TKAs (85.1% female) with a ceramic-coated femoral component were identified, 42 had been revised for PJI and 122 for other reasons at 3 years. No survival advantage due to the risk of revision for PJI could be determined for ceramic-coated components. Revision for all other reasons demonstrated a significant higher rate for TKAs with ceramic-coated components. However, the results of this were confounded by a strong prevalence (20.7% vs 0.3%) of metal sensitivity in the ceramic-coated group. CONCLUSION No evidence of reduced risk for PJI due to ceramic-coated implants in cemented primary TKA was found. Further analysis for revision reasons other than PJI is required.
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Affiliation(s)
- Alexander W Grimberg
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Munich, Germany; German Arthroplasty Registry (EPRD Deutsche Endoprothesenregister gGmbH), Berlin, Germany
| | - Thomas M Grupp
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Munich, Germany; German Arthroplasty Registry (EPRD Deutsche Endoprothesenregister gGmbH), Berlin, Germany
| | - Johanna Elliott
- German Arthroplasty Registry (EPRD Deutsche Endoprothesenregister gGmbH), Berlin, Germany; Department of Orthopaedic Surgery and Traumatology, St Vinzenz Hospital, Dinslaken, Germany
| | - Oliver Melsheimer
- German Arthroplasty Registry (EPRD Deutsche Endoprothesenregister gGmbH), Berlin, Germany
| | - Volkmar Jansson
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Munich, Germany; German Arthroplasty Registry (EPRD Deutsche Endoprothesenregister gGmbH), Berlin, Germany
| | - Arnd Steinbrück
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Munich, Germany; German Arthroplasty Registry (EPRD Deutsche Endoprothesenregister gGmbH), Berlin, Germany; Orthopaedic Surgical Competence Center Augsburg (OCKA), Augsburg, Germany
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Rossi SMP, Perticarini L, Mosconi M, Ghiara M, Benazzo F. Ten-year outcomes of a nitrided Ti-6Al-4V titanium alloy fixed-bearing total knee replacement with a highly crosslinked polyethylene-bearing in patients with metal allergy. Knee 2020; 27:1519-1524. [PMID: 33010769 DOI: 10.1016/j.knee.2020.08.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/24/2020] [Accepted: 08/04/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Metal hypersensitivity in patients with a total knee arthroplasty (TKA) is a rare condition and a very controversial topic. Despite the lack of data concerning the real effective impact of allergy on TKA failures, most of the manufactures offer the choice of 'non-allergenic' implants both for primary and revision TKA, some of which provide the same designs and surgical techniques as the conventional ones. Only a few studies are available on outcomes on these 'hypersensitivity-friendly' implants and even fewer specifically on allergic patients with a mid- to long-term follow-up. METHODS Between 2007 and 2015, we enrolled 72 patients (57 females, 15 males), who underwent TKA treated with a non-allergenic posterior-stabilized (PS) total knee implant for a declared and proven metal allergy. Patients were followed clinically and radiographically for a mean 10 years of follow-up. RESULTS With revision as an endpoint the Kaplan-Meier survival estimate showed a survival rate of 97.2% at five years and 95.1% at 10 years. Significant improvements in range of motion (ROM), Knee Society Scoring (KSS) and Hospital for Special Surgery (HSS) knee scores were registered at final follow-up (P < 0.0001). At final follow-up validated Patient-Reported Outcome Measures (PROMs) showed the following scores: Oxford Knee Score (OKS) 42.1, EQ5D 0.80, EQ VAS 80.1, Forgotten Joint Score 71.2. CONCLUSIONS This nitrided Ti-6Al-4V titanium alloy fixed-bearing total knee replacement with a highly crosslinked polyethylene-bearing showed interesting results and survival rates in patients with metal allergy at mid- to long-term follow-up.
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Affiliation(s)
- Stefano Marco Paolo Rossi
- Sezione di Chirurgia Protesica ad Indirizzo Robotico - Unità di Traumatologia dello Sport, U. O Ortopedia e Traumatologia Fondazione Poliambulanza, Brescia, Italy.
| | - Loris Perticarini
- Sezione di Chirurgia Protesica ad Indirizzo Robotico - Unità di Traumatologia dello Sport, U. O Ortopedia e Traumatologia Fondazione Poliambulanza, Brescia, Italy
| | - Mario Mosconi
- Clinica Ortopedica e Traumatologia, Fondazione IRCCS Policlinico San Matteo - Pavia, Italy; Università degli Studi di Pavia, Pavia, Italy
| | - Matteo Ghiara
- Clinica Ortopedica e Traumatologia, Fondazione IRCCS Policlinico San Matteo - Pavia, Italy
| | - Francesco Benazzo
- Sezione di Chirurgia Protesica ad Indirizzo Robotico - Unità di Traumatologia dello Sport, U. O Ortopedia e Traumatologia Fondazione Poliambulanza, Brescia, Italy; Clinica Ortopedica e Traumatologia, Fondazione IRCCS Policlinico San Matteo - Pavia, Italy; Università degli Studi di Pavia, Pavia, Italy
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13
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Law JI, Morris MJ, Hurst JM, Berend KR, Lombardi AV, Crawford DA. Early Outcomes of an Alternative Bearing Surface in Primary Total Knee Arthroplasty in Patients with Self-reported Metal Allergy. Arthroplast Today 2020; 6:639-643. [PMID: 32875011 PMCID: PMC7451939 DOI: 10.1016/j.artd.2020.07.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 06/25/2020] [Accepted: 07/10/2020] [Indexed: 01/27/2023] Open
Abstract
Background Most implants for total knee arthroplasty (TKA) are comprised of alloys that contain nickel. Controversy exists whether metal allergies produce negative effects and affect clinical outcomes. The purpose of this study was to retrospectively review a minimum 2-year follow-up with an ion-bombarded titanium TKA implant in patients with reported metal sensitivity. Methods A retrospective review of patients who underwent primary TKA with the ion-bombarded titanium Vanguard (Zimmer Biomet, Warsaw, IN) implant with 2-year minimum follow-up was performed from 2008 through 2017. The query revealed 346 patients (451 knees) with minimum 2-year follow-up. The mean age was 64.7 years, the mean body mass index was 35.1 kg/m2, and 95% of patients were women. Results The mean follow-up was 4.6 years. The mean range of motion improved from 109° to 112° (P = .03), University of California Los Angeles activity scale from 4.1 to 5.1 (P < .001), Knee Society Clinical scores from 36 to 89 (P < .001), and Knee Society Functional scores from 48 to 73 (P < .001). There were 5 (1.1%) revisions: 2 infections (2-staged exchange), 1 tibial revision for aseptic loosening after a fall, and 2 bearing exchanges for instability. Other surgeries were open reduction internal fixation of periprosthetic fracture, 1 arthroscopic release of snapping popliteus, and 4 local wound incision and debridement (2 superficial infections and 2 nonhealing wounds). Manipulation under anesthesia was required in 27 (6%) patients. Conclusions These early results are encouraging for the use of alternative metal titanium alloy implants in metal-sensitive patients undergoing primary TKA. At 4.6 years of mean follow-up, patients had substantial improvement in the range of motion and clinical outcomes with a low frequency of revision.
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Affiliation(s)
- Jesua I Law
- Joint Implant Surgeons, Inc., New Albany, OH, USA.,Mount Carmel Health System, New Albany, OH, USA
| | - Micael J Morris
- Joint Implant Surgeons, Inc., New Albany, OH, USA.,Mount Carmel Health System, New Albany, OH, USA
| | - Jason M Hurst
- Joint Implant Surgeons, Inc., New Albany, OH, USA.,Mount Carmel Health System, New Albany, OH, USA
| | - Keith R Berend
- Joint Implant Surgeons, Inc., New Albany, OH, USA.,Mount Carmel Health System, New Albany, OH, USA
| | - Adolph V Lombardi
- Joint Implant Surgeons, Inc., New Albany, OH, USA.,Mount Carmel Health System, New Albany, OH, USA.,Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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14
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Demcoe AR, Bohm ER, Hedden DR, Burnell CD, Turgeon TR. Does oxidized zirconium make a difference? Midterm cohort survivorship of symmetric posterior condyle posterior-stabilized total knee arthroplasty. Can J Surg 2019; 62:118-122. [PMID: 30907992 DOI: 10.1503/cjs.007518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background A novel symmetric posterior condylar design and option of a femoral component with an outer zirconium oxide layer were introduced to a successful asymmetric condylar total knee arthroplasty system in 2005. Given the paucity of information on this modified design, we performed a study to determine its early to midterm survivorship and performance. Methods Patients who received the Genesis II Symmetric Posterior Condyle or Legion Primary total knee (cobalt–chromium [CoCr] or oxidized zirconium–niobium [OxZr]) (Smith & Nephew) implanted at the study centre between March 2007 and
December 2013 were enrolled into a prospective database. We retrospectively reviewed the database and performed survival analysis using Kaplan–Meier techniques. Results There were 2178 patients (1359 women [62.4%]; mean age 64.6 yr; mean body mass index 35.0) with 2815 knee replacements available for analysis. Survival rates were 98.2% (95% confidence interval [CI] 97.6%–98.7%) for failure for any reason at 2 years and 96.8% (95% CI 96.0%–97.7%) at 5 years. Age (hazard ratio [HR] 0.97, 95% CI 0.94–0.997) and female sex (HR 0.45, 95% CI 0.27–0.75) were protective, whereas body mass index (HR 1.02, 95% CI 0.99–1.05) and OxZr implant (HR 1.11, 95% CI 0.57–2.18) did not influence survivorship. Oxford Knee Score values improved from a mean of 40.2 to 21.8 by 2 years (p < 0.001), with no difference between the CoCr and OxZr groups. Conclusion The symmetric posterior condylar posterior-stabilized knee offers excellent midterm survivorship. Implant bearing surface did not have an influence on survivorship to 5 years, and, thus, use of OxZr implants may not be justified.
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Affiliation(s)
- A. Ross Demcoe
- From Kelowna Orthopedics, Kelowna, BC (Demcoe); and the Concordia Hip and Knee Institute, Division of Orthopaedic Surgery, University of Manitoba, Winnipeg, Man. (Bohm, Hedden, Burnell, Turgeon)
| | - Eric R. Bohm
- From Kelowna Orthopedics, Kelowna, BC (Demcoe); and the Concordia Hip and Knee Institute, Division of Orthopaedic Surgery, University of Manitoba, Winnipeg, Man. (Bohm, Hedden, Burnell, Turgeon)
| | - David R. Hedden
- From Kelowna Orthopedics, Kelowna, BC (Demcoe); and the Concordia Hip and Knee Institute, Division of Orthopaedic Surgery, University of Manitoba, Winnipeg, Man. (Bohm, Hedden, Burnell, Turgeon)
| | - Colin D. Burnell
- From Kelowna Orthopedics, Kelowna, BC (Demcoe); and the Concordia Hip and Knee Institute, Division of Orthopaedic Surgery, University of Manitoba, Winnipeg, Man. (Bohm, Hedden, Burnell, Turgeon)
| | - Thomas R. Turgeon
- From Kelowna Orthopedics, Kelowna, BC (Demcoe); and the Concordia Hip and Knee Institute, Division of Orthopaedic Surgery, University of Manitoba, Winnipeg, Man. (Bohm, Hedden, Burnell, Turgeon)
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15
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Roussot MA, Haddad FS. The evolution of patellofemoral prosthetic design in total knee arthroplasty: how far have we come? EFORT Open Rev 2019; 4:503-512. [PMID: 31538000 PMCID: PMC6719608 DOI: 10.1302/2058-5241.4.180094] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Total knee arthroplasty (TKA) has evolved into a successful, cost-effective treatment for end-stage knee arthrosis.The patellofemoral articulation in TKA has largely been ignored during its development despite being an important determinant of outcome.New technologies still need further development to incorporate the patella in TKA surgical planning and operative technique.Alternative approaches to alignment in TKA will have a secondary impact on patellofemoral mechanics and possibly future implant designs.Technologies that assist with precise implant positioning may alter our understanding and overall practice of TKA. Cite this article: EFORT Open Rev 2019;4:503-512. DOI: 10.1302/2058-5241.4.180094.
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Affiliation(s)
- Mark Anthony Roussot
- University College London Hospitals NHS Foundation Trust, London, UK.,Department of Orthopaedic Surgery, University of Cape Town, SA
| | - Fares Sami Haddad
- University College London Hospitals NHS Foundation Trust, London, UK
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16
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Erivan R, Fadlallah E, Villatte G, Mulliez A, Descamps S, Boisgard S. Fifteen-year survival of the Cedior™ total knee prosthesis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 29:1709-1717. [PMID: 31280367 DOI: 10.1007/s00590-019-02491-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 07/02/2019] [Indexed: 11/28/2022]
Abstract
Total knee arthroplasty (TKA) is an effective treatment for advanced osteoarthritis of the knee. No large and long-term follow-up study has been done about Cedior® prosthesis. The study hypothesis was that 15-year survival for the Cedior™ prosthesis is at least as good as rates reported for other models. A continuous retrospective single-center study included patients managed by Cedior™ TKA with at least 15-year follow-up. The main endpoint was prosthesis survival; secondary objectives were to identify factors for implant revision and to assess functional scores at 15 years. In the present series, 15-year all-cause survival for the Cedior® knee prosthesis was 93.03%; comparable to rates in the literature, posterior-stabilized implants showed higher revision rates. No other factors for revision emerged. These findings are comparable with those of the literature.
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Affiliation(s)
- Roger Erivan
- CNRS, SIGMA Clermont, ICCF, CHU Clermont-Ferrand, Université Clermont Auvergne, 63000, Clermont-Ferrand, France.
| | - Edouard Fadlallah
- CHU Clermont-Ferrand, Université Clermont Auvergne, 63000, Clermont-Ferrand, France
| | - Guillaume Villatte
- CNRS, SIGMA Clermont, ICCF, CHU Clermont-Ferrand, Université Clermont Auvergne, 63000, Clermont-Ferrand, France
| | - Aurélien Mulliez
- CHU Clermont-Ferrand, Délégation à la Recherche Clinique et aux Innovations (DRCI), 63000, Clermont-Ferrand, France
| | - Stéphane Descamps
- CNRS, SIGMA Clermont, ICCF, CHU Clermont-Ferrand, Université Clermont Auvergne, 63000, Clermont-Ferrand, France
| | - Stéphane Boisgard
- CNRS, SIGMA Clermont, ICCF, CHU Clermont-Ferrand, Université Clermont Auvergne, 63000, Clermont-Ferrand, France
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17
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Park CH, Kang SG, Bae DK, Song SJ. Mid-term clinical and radiological results do not differ between fixed- and mobile-bearing total knee arthroplasty using titanium-nitride-coated posterior-stabilized prostheses: a prospective randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 2019; 27:1165-1173. [PMID: 30088030 DOI: 10.1007/s00167-018-5095-z] [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] [Received: 03/18/2018] [Accepted: 08/03/2018] [Indexed: 01/31/2023]
Abstract
PURPOSE This study was performed to prospectively compare the clinical and radiographic results between mobile-bearing (MB) and fixed-bearing (FB) TKAs using ceramic titanium nitride (TiN)-coated prostheses. METHODS Seventy MB and 70 FB TKAs using TiN-coated prostheses (ACS®) were prospectively evaluated. There were no differences in demographic characteristics between the two groups. Clinically, the Knee Society knee and function scores, WOMAC, and range of motion (ROM) were compared. Considering the possibility of a kinematic change in the polyethylene (PE) insert and a decrease in ROM following MB TKA, serial changes in the ROM were also compared. The thickness of the PE insert was compared according to the size of the femoral component. Radiographically, the alignment and positions of the components were compared. RESULTS There were no differences between the two groups in clinical scores or ROM (n.s.). The maximum flexion increased from 133.5° ± 8.3° to 137.6° ± 5.5° across all time points in the MB group. The serial maximum flexion angles did not differ between the two groups over time (n.s.). The average thickness of the PE insert was greater in the MB group (12.0 ± 1.9 vs. 11.2 ± 1.6 mm, respectively, p = 0.008), especially when a large femoral component was used (12.7 ± 1.9 vs. 11.0 ± 1.5 mm, p = 0.005). The pre- and postoperative mechanical axes and positions of the components did not differ between the two groups (n.s.). CONCLUSIONS TiN-coated MB TKA showed no significant advantage over FB TKA. The selection of bearing design would be clinically insignificant when using the TiN-coated TKA prosthesis. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Cheol Hee Park
- Department of Medicine, Graduate School, Kyung Hee University, 24 Kyunghee-daero, Dongdaemun-gu, Seoul, 02453, South Korea
| | - Se Gu Kang
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, 24 Kyunghee-daero, Dongdaemun-gu, Seoul, 02453, South Korea
| | - Dae Kyung Bae
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, 24 Kyunghee-daero, Dongdaemun-gu, Seoul, 02453, South Korea
| | - Sang Jun Song
- Department of Medicine, Graduate School, Kyung Hee University, 24 Kyunghee-daero, Dongdaemun-gu, Seoul, 02453, South Korea. .,Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, 24 Kyunghee-daero, Dongdaemun-gu, Seoul, 02453, South Korea.
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18
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Nečas D, Sadecká K, Vrbka M, Gallo J, Galandáková A, Křupka I, Hartl M. Observation of lubrication mechanisms in knee replacement: A pilot study. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.biotri.2019.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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19
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CORR Insights®: The 2018 Mark Coventry, MD Award: Does a Ceramic Bearing Improve Pain, Function, Wear, or Survivorship of TKA in Patients Younger Than 55 Years of Age? A Randomized Trial. Clin Orthop Relat Res 2019; 477:58-59. [PMID: 29846200 PMCID: PMC6345280 DOI: 10.1097/corr.0000000000000360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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20
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Kim YH, Park JW, Kim JS. The 2018 Mark Coventry, MD Award: Does a Ceramic Bearing Improve Pain, Function, Wear, or Survivorship of TKA in Patients Younger Than 55 Years of Age? A Randomized Trial. Clin Orthop Relat Res 2019; 477:49-57. [PMID: 30794228 PMCID: PMC6345322 DOI: 10.1007/s11999.0000000000000271] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Methods to reduce the revision rate of total knee prostheses because of wear-related issues are important to examine, particularly because younger patients have a disproportionately high risk of revision. QUESTIONS/PURPOSES (1) Are long-term Knee Society knee and function scores better in younger patients with an oxidized zirconium (OxZr) TKA compared with those with a cobalt-chrome (CoCr) TKA? (2) Are there differences in radiographic signs of loosening or CT findings of osteolysis between OxZr TKAs and CoCr TKAs? (3) Are there fewer polyethylene wear particles in the OxZr TKA than CoCr TKA? (4) Do the groups differ in terms of survivorship free from revision surgery at 13 years? METHODS From April 2003 to January 2007, we enrolled 110 patients younger than 55 years of age in this randomized, double-blind, prospective trial. Each patient served as his or her own control and each received an OxZr femoral component in one knee and a CoCr femoral component in the other. The minimum followup was 10 years (mean, 13 years; range, 10-14 years); two died and nine were lost to followup before that time, leaving 99 patients (198 knees) for analysis. There were 28 men and 71 women with a mean age of 53 ± 6 years (range, 40-55 years). We obtained Knee Society knee scores for each knee, but Knee Society function scores, WOMAC scores, and UCLA activity scores were obtained for each patient preoperatively and at each followup. Additionally, we performed radiographic examination preoperatively and at each followup. At a minimum of 10 years (mean, 13 years) followup, we obtained CT scans in all patients. Polyethylene wear particles in the synovial fluid were analyzed at the final followup using thermogravimetric methods and scanning electron microscopy. Survivorship was ascertained using the Kaplan-Meier calculator. A sample size calculation determined that to detect a difference in the Knee Society knee score of 5 points, assuming a SD of 5 points, with an α = 0.05 and β = 0.80, a total of 90 patients would be needed in each group. RESULTS At the most recent followup, the mean Knee Society knee scores (92 versus 93 points; p = 0.857), function scores (85 versus 85 points; p = 1.000), WOMAC scores (23 versus 23 points; p = 1.000), UCLA activity scores (6.5 versus 6.5 points; p = 1.000), and range of knee motion (125° versus 127°; p = 0.365) were not different between the two groups. There was no radiographic evidence of loosening and no osteolysis visible on CT scan in either group. The weight of polyethylene wear particles produced at the bearing surface was 0.046 ± 0.010 g in 1 g of synovial fluid in patients with an OxZr femoral component and 0.0448 ± 0.0108 g in patients with a CoCr femoral component (p = 0.583). Kaplan-Meier survivorship free from revision was 97% for the OxZr group (95% confidence interval [CI], 93-100) and 98% for the CoCr group (95% CI, 93-100) at 13 years after surgery (p = 0.918). CONCLUSIONS Given the absence of demonstrated superiority of either the CoCr implant or the OxZr implant, we recommend that surgeons and healthcare systems can reasonably choose the less expensive device for routine use, unless there is some compelling reason in an individual patient to choose one over the other (such as severe, documented metal sensitivity). LEVEL OF EVIDENCE Level I, therapeutic study.
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MESH Headings
- Adult
- Arthralgia/diagnosis
- Arthralgia/etiology
- Arthralgia/prevention & control
- Arthroplasty, Replacement, Knee/adverse effects
- Arthroplasty, Replacement, Knee/instrumentation
- Awards and Prizes
- Biomechanical Phenomena
- Ceramics/chemistry
- Chromium Alloys/chemistry
- Female
- Humans
- Knee Joint/diagnostic imaging
- Knee Joint/physiopathology
- Knee Joint/surgery
- Knee Prosthesis
- Male
- Middle Aged
- Osteoarthritis, Knee/diagnostic imaging
- Osteoarthritis, Knee/physiopathology
- Osteoarthritis, Knee/surgery
- Oxidation-Reduction
- Pain Measurement
- Pain, Postoperative/diagnosis
- Pain, Postoperative/etiology
- Pain, Postoperative/prevention & control
- Prospective Studies
- Prosthesis Design
- Prosthesis Failure
- Recovery of Function
- Risk Factors
- Stress, Mechanical
- Time Factors
- Tomography, X-Ray Computed
- Treatment Outcome
- Zirconium/chemistry
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Affiliation(s)
- Young-Hoo Kim
- Y.-H. Kim, The Joint Replacement Center, Seoul SeoNam Hospital, Seoul, Republic of Korea J.-W. Park, J.-S. Kim, The Joint Replacement Center, Ewha Womans University, MokDong Hospital, Seoul, Republic of Korea
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21
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Postler A, Beyer F, Lützner C, Tille E, Lützner J. Similar outcome during short-term follow-up after coated and uncoated total knee arthroplasty: a randomized controlled study. Knee Surg Sports Traumatol Arthrosc 2018; 26:3459-3467. [PMID: 29616285 DOI: 10.1007/s00167-018-4928-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 03/28/2018] [Indexed: 12/27/2022]
Abstract
PURPOSE Patients with known hypersensitivity to metals often require hypoallergenic TKA implants. Coating of a standard implant is a common solution, and although in vitro tests have demonstrated reduction of polyethylene wear for these coatings, it is still unknown whether these implants have any clinical benefit. This study was initiated to investigate metal ion concentrations, knee function and patient-reported outcome (PRO) after coated and uncoated TKA. METHODS One hundred and twenty-two (122) patients were randomized to receive a coated or a standard TKA and, after exclusions, 59 patients were included in each group. Knee function and PRO were assessed with validated scores up to 3 years after surgery. Metal ion concentrations in blood samples were determined for chromium, cobalt, molybdenum and nickel, preoperatively and 1 year after surgery. RESULTS Chromium concentrations in patient plasma increased from a median of 0.25 to 1.30 µg/l in the standard TKA group, and from 0.25 to 0.75 µg/l in the coated TKA group (p = 0.012). Thirteen patients (3 coated, 10 standard TKA) had chromium concentrations above 2 µg/l. The concentrations of cobalt, molybdenum and nickel did not change. Patient-reported outcome measures (PROM) demonstrated a substantial improvement after TKA, without any differences between the groups. CONCLUSION The increase in chromium concentration in the standard group needs further investigation. If surgeons use coated implants, they can be confident that these implants perform as well as standard implants. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Anne Postler
- University Center of Orthopaedics and Traumatology, University Medicine Carl Gustav Carus Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Franziska Beyer
- University Center of Orthopaedics and Traumatology, University Medicine Carl Gustav Carus Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Cornelia Lützner
- University Center of Orthopaedics and Traumatology, University Medicine Carl Gustav Carus Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Eric Tille
- University Center of Orthopaedics and Traumatology, University Medicine Carl Gustav Carus Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Jörg Lützner
- University Center of Orthopaedics and Traumatology, University Medicine Carl Gustav Carus Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
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22
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Pitta M, Esposito CI, Li Z, Lee YY, Wright TM, Padgett DE. Failure After Modern Total Knee Arthroplasty: A Prospective Study of 18,065 Knees. J Arthroplasty 2018; 33:407-414. [PMID: 29079167 PMCID: PMC5794604 DOI: 10.1016/j.arth.2017.09.041] [Citation(s) in RCA: 136] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 09/16/2017] [Accepted: 09/18/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND We sought is to determine the mechanism of failure among primary total knee arthroplasties (TKAs) performed at a single high-volume institution by asking the following research questions: (1) What are the most common failure modes for modern TKA designs? and (2) What are the preoperative risk factors for failure following primary TKA? METHODS From May 2007 to December 2012, 18,065 primary TKAs performed on 16,083 patients at a single institution were recorded in a prospective total joint arthroplasty registry with a minimum of 5-year follow-up. We retrospectively reviewed patient charts to determine a cause of failure for primary TKAs. A cox proportional hazard model was used to determine the risk of revision surgery following primary TKA. RESULTS The most common reasons for failure within 2 years after TKA were infection and stiffness. The multivariable regression identified the following preoperative risk factors for TKA failure: history of drug abuse (hazard ratio [HR] 4.68; P = 0.03), deformity/mechanical preoperative diagnosis (HR 3.52; P < .01), having a constrained condylar knee implant over posterior-stabilized implant (HR 1.99; P < .01), post-traumatic/trauma preoperative diagnosis (HR 1.78; P = .03), and younger age (HR 0.61; P < .01) CONCLUSION: These findings add to the growing data that primary TKAs are no longer failing from polyethylene wear-related issues. This study identified preoperative risk factors for failure of primary TKAs, which may be useful information for developing strategies to improve outcomes following TKA.
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Affiliation(s)
- Michael Pitta
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021
| | | | - Zhichang Li
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. Arthritis Clinic and Research Center, Peking University People’s Hospital, Beijing, China
| | - Yuo-yu Lee
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021
| | - Timothy M. Wright
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021
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23
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Vertullo CJ, Lewis PL, Peng Y, Graves SE, de Steiger RN. The Effect of Alternative Bearing Surfaces on the Risk of Revision Due to Infection in Minimally Stabilized Total Knee Replacement: An Analysis of 326,603 Prostheses from the Australian Orthopaedic Association National Joint Replacement Registry. J Bone Joint Surg Am 2018; 100:115-123. [PMID: 29342061 DOI: 10.2106/jbjs.17.00269] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The effect of alternative bearing materials on the risk of revision due to infection after total knee replacement remains uncertain. By reducing the immunomodulating polyethylene wear-particle burden and with different substrate bacterial adhesion properties, Oxinium oxidized zirconium and cross-linked polyethylene (XLPE) could alter infection risk. The purpose of the current study was to analyze the risk of revision for infection in 3 comparisons of bearing combinations. METHODS To evaluate the risk of revision for infection with XLPE, cobalt-chromium (CoCr) on XLPE was compared with CoCr on non-cross-linked polyethylene (NXLPE). To evaluate Oxinium, Oxinium-NXLPE was compared with CoCr-NXLPE, and to evaluate the possibility of an additional beneficial effect of Oxinium on XLPE, Oxinium-XLPE was compared with CoCr-XLPE. The cumulative percent revision (CPR) and hazard ratio (HR) for revision for infection in primary total knee replacement for osteoarthritis were determined from registry data from September 1, 1999, to December 31, 2015. Revisions within 6 months following the primary surgery were censored from the analysis, while procedures with posterior stabilized or fully stabilized total knee replacements as well as prostheses with a known higher risk of revision were excluded. Analyses were stratified by age, sex, and fixation type. RESULTS Of the 326,603 included primary total knee replacements, 1,511 (0.46%) were revised for infection. The risk of revision for infection was lower for CoCr-XLPE compared with CoCr-NXLPE (HR = 0.74; 95% confidence interval [CI] = 0.65 to 0.84; p < 0.001). This effect was apparent for both male and female patients overall, all fixation types, antibiotic cement use, those <65 years of age, and male patients ≥65 years of age. However, for female patients ≥65 years of age, there was no difference. Overall, Oxinium-NXLPE had the same revision risk as CoCr-NXLPE regardless of fixation; however, for cemented fixation, subanalysis showed a lower risk for Oxinium-NXLPE compared with CoCr-NXLPE (HR = 0.69; 95% CI = 0.51 to 0.94; p = 0.018). Oxinium-XLPE had the same revision risk for infection as CoCr-XLPE overall, among male patients, and when cemented fixation had been used. CONCLUSIONS In this registry analysis, CoCr-XLPE had a 26% lower risk of revision for infection than CoCr-NXLPE, suggesting a reduction of wear particle-induced immunomodulation with XLPE. Oxinium-XLPE had the same risk as CoCr-XLPE. Overall, Oxinium did not reduce the infection risk. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Christopher J Vertullo
- Knee Research Australia, Gold Coast, Queensland, Australia.,Menzies Health Institute, Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Peter L Lewis
- Australian Orthopaedic Association National Joint Replacement Registry, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Yi Peng
- Australian Orthopaedic Association National Joint Replacement Registry, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Stephen E Graves
- Australian Orthopaedic Association National Joint Replacement Registry, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Richard N de Steiger
- Australian Orthopaedic Association National Joint Replacement Registry, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
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Granchi D, Savarino LM, Ciapetti G, Baldini N. Biological effects of metal degradation in hip arthroplasties. Crit Rev Toxicol 2017; 48:170-193. [PMID: 29130357 DOI: 10.1080/10408444.2017.1392927] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Metals and metal alloys are the most used materials in orthopedic implants. The focus is on total hip arthroplasty (THA) that, though well tolerated, may be associated with local and remote adverse effects in the medium-long term. This review aims to summarize data on the biological consequences of the metal implant degradation that have been attributed predominantly to metal-on-metal (MoM) THA. Local responses to metals consist of a broad clinical spectrum ranging from small asymptomatic tissue lesions to severe destruction of bone and soft tissues, which are designated as metallosis, adverse reactions to metal debris (ARMD), aseptic lymphocytic vasculitis associated lesion (ALVAL), and pseudotumors. In addition, the dissemination of metal particles and ions throughout the body has been associated with systemic adverse effects, including organ toxicity, cancerogenesis, teratogenicity, and immunotoxicity. As proved by the multitude of studies in this field, metal degradation may increase safety issues associated with THA, especially with MoM hip systems. Data collection regarding local, systemic and long-term effects plays an essential role to better define any safety risks and to generate scientifically based recommendations.
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Affiliation(s)
- Donatella Granchi
- a Orthopedic Pathophysiology and Regenerative Medicine Unit , Rizzoli Orthopedic Institute , Bologna , Italy
| | - Lucia Maria Savarino
- a Orthopedic Pathophysiology and Regenerative Medicine Unit , Rizzoli Orthopedic Institute , Bologna , Italy
| | - Gabriela Ciapetti
- a Orthopedic Pathophysiology and Regenerative Medicine Unit , Rizzoli Orthopedic Institute , Bologna , Italy
| | - Nicola Baldini
- a Orthopedic Pathophysiology and Regenerative Medicine Unit , Rizzoli Orthopedic Institute , Bologna , Italy.,b Department of Biomedical and Neuromotor Science , University of Bologna , Bologna , Italy
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25
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Kennard E, Scholes SC, Sidaginamale R, Gangadharan R, Weir DJ, Holland J, Deehan D, Joyce TJ. A comparative surface topographical analysis of explanted total knee replacement prostheses: Oxidised zirconium vs cobalt chromium femoral components. Med Eng Phys 2017; 50:59-64. [PMID: 29042144 DOI: 10.1016/j.medengphy.2017.10.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 09/07/2017] [Accepted: 10/02/2017] [Indexed: 11/16/2022]
Abstract
It has been proposed that an increased surface roughness of the femoral components of Total Knee Replacements (TKRs) may be a contributing factor to the accelerated wear of the polyethylene (PE) bearing and ultimately prosthesis failure. Oxidised Zirconium was introduced to the orthopaedic market in an attempt to reduce PE wear associated failures and increase the longevity of the prosthesis. In this study, non-contacting profilometry was used to measure the surface roughness of the femoral components of 6 retrieved TKRs (3 Oxidised Zirconium (OxZr) and 3 Cobalt Chromium alloy (CoCr) femoral components) and 2 as-manufactured femoral components (1 OxZr and 1 CoCr). A semi-quantitative method was used to analyse the damage on the retrieved PE components. The Sa values for the retrieved OxZr femoral components (Sa = 0.093 µm ± 0.014) and for the retrieved CoCr femoral components (Sa = 0.065 µm ± 0.005) were significantly greater (p < .05) than the roughness values for the as-manufactured femoral components (OxZr Sa = 0.061 µm ± 0.004 and CoCr Sa = 0.042 µm ± 0.003). No significant difference was seen between the surface roughness parameters of the retrieved OxZr and retrieved CoCr femoral components. There was no difference between the PE component damage scores for the retrieved OxZr TKRs compared to the retrieved CoCr TKRs. These results agree with other studies that both OxZr and CoCr femoral components roughen during time in vivo but the lack of difference between the surface roughness measurements of the two materials is in contrast to previous topographical reports. Further analysis of retrieved OxZr TKRs is recommended so that a fuller appreciation of their benefits and limitations be obtained.
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Affiliation(s)
- Emma Kennard
- Bioengineering Group, School of Engineering, Newcastle University, Stephenson Building, NE1 7RU Newcastle upon Tyne, England, United Kingdom.
| | - Susan C Scholes
- Bioengineering Group, School of Engineering, Newcastle University, Stephenson Building, NE1 7RU Newcastle upon Tyne, England, United Kingdom
| | - Raghavendra Sidaginamale
- Bioengineering Group, School of Engineering, Newcastle University, Stephenson Building, NE1 7RU Newcastle upon Tyne, England, United Kingdom
| | | | - David J Weir
- Freeman Hospital, NE1 7DN Newcastle upon Tyne, England, United Kingdom
| | - James Holland
- Freeman Hospital, NE1 7DN Newcastle upon Tyne, England, United Kingdom
| | - David Deehan
- Freeman Hospital, NE1 7DN Newcastle upon Tyne, England, United Kingdom
| | - Thomas J Joyce
- Bioengineering Group, School of Engineering, Newcastle University, Stephenson Building, NE1 7RU Newcastle upon Tyne, England, United Kingdom
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