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Lizcano JD, Marei S, Sharkey PF, Higuera-Rueda CA, Moskal JT, Clyburn TA, Suleiman LI, McGrory BJ. Does the Type of Femoral Stem and/or Femoral Head Influence the Rate of Adverse Local Tissue Reactions After Primary Total Hip Arthroplasty? J Arthroplasty 2024:S0883-5403(24)01066-0. [PMID: 39426440 DOI: 10.1016/j.arth.2024.10.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2024] [Revised: 10/08/2024] [Accepted: 10/11/2024] [Indexed: 10/21/2024] Open
Affiliation(s)
- Juan D Lizcano
- Department of Orthopaedics Cleveland Clinic, Weston, Florida
| | - Sameh Marei
- Menoufia Orthopedic Surgery Department, Menoufia University Hospitals, Menoufia, Egypt
| | | | | | - Joseph T Moskal
- Department of Orthopaedics Carilion Clinic, Roanoke, Virginia
| | - Terry A Clyburn
- Department of Orthopaedics Houston Methodists, Houston, Texas
| | - Linda I Suleiman
- Department of Orthopaedics Northwestern Feinberg School of Medicine, Chicago, Illinois
| | - Brian J McGrory
- Department of Orthopaedics Tufts University School of Medicine, Boston, Massachusetts
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2
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Cerchiaro M, Trovarelli G, Angelini A, Pala E, Berizzi A, Biz C, Ruggieri P. When Is a Two-Stage Surgical Procedure Indicated in the Treatment of Pseudotumors of the Hip? A Retrospective Study of 21 Cases and a Review of the Literature. J Clin Med 2024; 13:815. [PMID: 38337510 PMCID: PMC10856725 DOI: 10.3390/jcm13030815] [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: 01/15/2024] [Revised: 01/26/2024] [Accepted: 01/26/2024] [Indexed: 02/12/2024] Open
Abstract
(1) Background: A pseudotumor of the hip is a sterile, non-neoplastic soft tissue mass associated with total hip arthroplasties. Pseudotumors may mimic soft tissue tumors or infections, and thus a differential diagnosis is crucial, and biopsy is recommended. The purpose of this study was to compare the complications and functional results between one-stage and two-stage procedures. (2) Methods: We retrospectively analyzed 21 patients surgically treated at our institution with "pseudotumors" associated with hip prosthesis (8 male, 13 female with a mean age of 69 years). One-stage revision was performed in 10 cases and two-stage reversion in 10, with excision only in 1 case. Complications were classified as major and minor and functional results assessed using the Harris Hip Score (HHS). (3) Results: Five patients (24%) reported major complications. The survival rate for all complications was 75%. The overall survival rate was 95% at 5 years. The mean HHS ranged from 35 pre-op to 75 post-op, highlighting improved functional results in all cases. We recorded no differences in complications or functional outcomes between the one- and two-stage procedures. (4) Conclusions: In our experience, the two-stage surgical approach is preferable in cases with major bone defects and larger pseudotumor sizes. The use of custom-made 3D-printed prostheses is increasing and is a further reason to prefer two-stage revision.
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Affiliation(s)
| | | | | | | | | | | | - Pietro Ruggieri
- Department of Orthopedics and Orthopedic Oncology, DISCOG, University of Padova, Via Giustiniani 3, 35128 Padova, Italy; (M.C.); (G.T.); (A.A.); (E.P.); (A.B.); (C.B.)
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3
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Abstract
» Metallosis is a rare but significant complication that can occur after total hip arthroplasty (THA) for a variety of reasons but most commonly in patients with metal-on-metal implants.» It is characterized by the visible staining, necrosis, and fibrosis of the periprosthetic soft tissues, along with the variable presence of aseptic cysts and solid soft tissue masses called pseudotumors secondary to the corrosion and deposition of metal debris.» Metallosis can present with a spectrum of complications ranging from pain and inflammation to more severe symptoms such as osteolysis, soft tissue damage, and pseudotumor formation.» Workup of metallosis includes a clinical evaluation of the patient's symptoms, imaging studies, serum metal-ion levels, and intraoperative visualization of the staining of tissues. Inflammatory markers such as erythrocyte sedimentation rate and C-reactive protein along with intraoperative frozen slice analysis may be useful in certain cases to rule out concurrent periprosthetic joint infection.» Management depends on the severity and extent of the condition; however, revision THA is often required to prevent rapid progression of bone loss and tissue necrosis.
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Affiliation(s)
- Anderson Lee
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, California
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4
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Mikkelsen RT, Schou M, Torfing T, Graumann O, Overgaard S, Varnum C. Sensitivity and specificity for detecting pseudotumors in patients with hip resurfacing arthroplasty, metal-on-metal or metal-on-polyethylene total hip arthroplasty-MRI versus ultrasonography performed by an orthopedic surgery resident. Acta Radiol Open 2023; 12:20584601231152396. [PMID: 36776533 PMCID: PMC9909072 DOI: 10.1177/20584601231152396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 04/02/2023] [Indexed: 02/10/2023] Open
Abstract
Background Metal artifact reduction sequence magnetic resonance imaging (MRI) scan is a common method to detect adverse reaction to metal debris in total hip arthroplasty (THA). It might be quicker and cheaper if ultrasonography (US) could screen for the need for an MRI. However, both require trained personnel. Purpose We aimed to investigate the sensitivity and specificity of US for detecting pseudotumors (PT) when performed by an orthopedic surgery resident compared to MRI. We also investigated the sensitivity and specificity of US to detect PTs in obese and non-obese patients. Material and methods We examined 205 patients with hip resurfacing arthroplasty, metal-on-metal or metal-on-polyethylene THA with both MRI and US. US was performed by an orthopedic surgery resident who was trained according to a standardized training program in musculoskeletal US. Results from MRI were used as gold standard. Results US had a sensitivity of 0.92 (95% CI 0.81-0.98) and specificity of 0.94 (95% CI 0.89-0.97) for detecting PT. It had a positive predictive value of 0.84 (95% CI 0.73-0.91) and a negative predictive value of 0.97 (95% CI 0.93-0.99). US performed similarly in obese and non-obese patients. Conclusions US had a high sensitivity and specificity for detecting PT when performed by an orthopedic surgery resident. Trained orthopedic surgeons could screen for the need of an MRI scan when searching PTs.
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Affiliation(s)
- Rasmus T Mikkelsen
- Department of Orthopedic Surgery, Lillebaelt Hospital, Vejle, Denmark,Department of Regional Health Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark,Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark,Rasmus T Mikkelsen, Lillebaelt Hospital, Department of Orthopedic Surgery, Beriderbakken 4 7100, Vejle, Denmark.
| | - Martin Schou
- Department of Emergency Medicine, Holbaek Hospital, Holbaek, Denmark
| | - Trine Torfing
- Department of Radiology, Odense University Hospital, Odense, Denmark
| | - Ole Graumann
- Department of Radiology, Odense University Hospital, Odense, Denmark,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Søren Overgaard
- Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark,Department of Clinical Research, University of Southern Denmark, Odense, Denmark,Department of Orthopaedic Surgery and Traumatology, Copenhagen University Hospital, Bispebjerg, Denmark,University of Copenhagen, Department of Clinical Medicine, Faculty of Health and Medical Sciences, Kobenhavn, Denmark
| | - Claus Varnum
- Department of Orthopedic Surgery, Lillebaelt Hospital, Vejle, Denmark,Department of Regional Health Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
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5
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Wang HP, Wang MY, Lan YP, Tang ZD, Tao QF, Chen CY. Application of 3D-printed prosthesis in revision surgery with large inflammatory pseudotumour and extensive bone defect: A case report. World J Clin Cases 2022; 10:13388-13395. [PMID: 36683616 PMCID: PMC9851003 DOI: 10.12998/wjcc.v10.i36.13388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 11/05/2022] [Accepted: 12/08/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Hip revision surgery is the final treatment option for the failure of artificial hip joints, but it is more difficult than the initial operation. For patients with hip joint loosening around the prosthesis combined with large inflammatory pseudotumours and large segment bone defects, hip revision is even more difficult, and clinical reports are rare.
CASE SUMMARY Male, 59 years old. The patient underwent left hip replacement 35 years ago and was now admitted to hospital due to massive masses in the left thigh, shortening of the left lower extremity, and pain and lameness of the left hip joint. X-ray, computed tomography and magnetic resonance imaging revealed prosthesis loosening, left acetabular bone defect (Parprosky IIIB type), and a bone defect of the left proximal femur (Parprosky IIIA type). Inflammatory pseudotumours were seen in the left hip and left thigh. Hip revision surgery was performed using a 3D-printed custom acetabular prosthesis was used for hip revision surgery, which was produced by Arcam Electron Beam Melting system with Electron Beam Melting technology. The operation was successful, and the patient was followed up regularly after the operation. The custom-made acetabular prosthesis was well matched, the inflammatory pseudotumour was completely removed, the postoperative hip prosthesis was stable, and the old greater trochanter fracture was well reduced and fixed. The patient was partially weight-bearing with crutches 3 mo after the operation and walked with full weight-bearing after 6 mo. The hip prosthesis was stable, and there was no recurrence of inflammatory pseudotumours at the last follow-up. The Visual Analogue Scale was 3, and the Harris hip score was 90.
CONCLUSION The use of 3D-printed personalized custom prostheses for complex hip revision surgery has satisfactory surgical results and has great clinical application value.
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Affiliation(s)
- Hong-Ping Wang
- Department of Orthopaedics, Panzhihua Municipal Central Hospital, Panzhihua 617000, Sichuan Province, China
| | - Ming-You Wang
- Department of Clinical Medicine, Dali University, Dali 671000, Yunnan Province, China
| | - Yu-Ping Lan
- Department of Orthopaedics, Panzhihua Municipal Central Hospital, Panzhihua 617000, Sichuan Province, China
| | - Zhuo-Dong Tang
- Department of Orthopaedics, Panzhihua Municipal Central Hospital, Panzhihua 617000, Sichuan Province, China
| | - Qi-Feng Tao
- Department of Orthopaedics, Panzhihua Municipal Central Hospital, Panzhihua 617000, Sichuan Province, China
| | - Chun-Yu Chen
- Department of Orthopaedics, Panzhihua Municipal Central Hospital, Panzhihua 617000, Sichuan Province, China
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6
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Mastel M, Boisvert A, Moore R, Sutherland F, Powell J. Metallosis following hip arthroplasty: two case reports. J Med Case Rep 2022; 16:115. [PMID: 35317840 PMCID: PMC8941771 DOI: 10.1186/s13256-022-03336-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 02/18/2022] [Indexed: 11/10/2022] Open
Abstract
Background There has been increasing recognition of local and systemic adverse events associated with the release of metal ions and nanoparticles from hip arthroplasty components. Adverse local tissue reactions to metal ion debris can include periprosthetic solid and cystic masses known as pseudotumors. These masses can result in pain, swelling, extensive destruction to surrounding hip soft-tissues, and compression syndromes on neurovascular, gastrointestinal, and genitourinary structures. As reports of pseudotumors requiring multidisciplinary excision are limited, we present two pseudotumor cases that were excised through a combined approach. Case presentations The first case involves a 60-year-old Caucasian female with a large pseudotumor with intrapelvic and vascular involvement associated with a metal-on-polyethylene total hip arthroplasty, excised with contributions from general surgery, vascular surgery, and orthopedic surgery. Pseudotumor excision was followed by a revision total hip reconstruction in addition to an abductor mechanism reconstruction with tendo-Achilles allograft. The second case is that of a 64-year-old Caucasian female with a pseudotumor in close relationship to the femoral vessels following a metal-on-metal hip resurfacing, excised with a combination of vascular surgery and orthopedic surgery, with subsequent revision total hip reconstruction. Conclusions There remains a lack of literature to support the extensiveness of pseudotumor excision required in complex cases with significant intrapelvic or vascular involvement. Given the potential for significant adverse effects of large masses, the authors’ preference is to involve a multidisciplinary team to achieve a more comprehensive excision while minimizing the risk of potential complications.
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Affiliation(s)
- M Mastel
- Division of Orthopedic Surgery, Department of Surgery, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada.,Section of Orthopedic Surgery, Department of Surgery, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
| | - A Boisvert
- Section of Vascular Surgery, Department of Surgery, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
| | - R Moore
- Section of Vascular Surgery, Department of Surgery, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
| | - F Sutherland
- Section of General Surgery, Department of Surgery, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
| | - J Powell
- Section of Orthopedic Surgery, Department of Surgery, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada.
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7
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Wight CM, Whyne CM, Bogoch ER, Zdero R, Chapman RM, van Citters DW, Walsh WR, Schemitsch E. Effect of head size and rotation on taper corrosion in a hip simulator. Bone Jt Open 2021; 2:1004-1016. [PMID: 34825826 PMCID: PMC8636299 DOI: 10.1302/2633-1462.211.bjo-2021-0147.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: 01/16/2023] Open
Abstract
AIMS This study investigates head-neck taper corrosion with varying head size in a novel hip simulator instrumented to measure corrosion related electrical activity under torsional loads. METHODS In all, six 28 mm and six 36 mm titanium stem-cobalt chrome head pairs with polyethylene sockets were tested in a novel instrumented hip simulator. Samples were tested using simulated gait data with incremental increasing loads to determine corrosion onset load and electrochemical activity. Half of each head size group were then cycled with simulated gait and the other half with gait compression only. Damage was measured by area and maximum linear wear depth. RESULTS Overall, 36 mm heads had lower corrosion onset load (p = 0.009) and change in open circuit potential (OCP) during simulated gait with (p = 0.006) and without joint movement (p = 0.004). Discontinuing gait's joint movement decreased corrosion currents (p = 0.042); however, wear testing showed no significant effect of joint movement on taper damage. In addition, 36 mm heads had greater corrosion area (p = 0.050), but no significant difference was found for maximum linear wear depth (p = 0.155). CONCLUSION Larger heads are more susceptible to taper corrosion; however, not due to frictional torque as hypothesized. An alternative hypothesis of taper flexural rigidity differential is proposed. Further studies are necessary to investigate the clinical significance and underlying mechanism of this finding. Cite this article: Bone Jt Open 2021;2(11):1004-1016.
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Affiliation(s)
- Christian M. Wight
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Cari M. Whyne
- Orthopaedic Biomechanics Laboratory, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Earl R. Bogoch
- Department of Surgery, University of Toronto, Brookfield Chair in Fracture Prevention, Toronto, Ontario, Canada
| | - Radovan Zdero
- London Health Science Centre, Western University, London, Ontario, Canada
| | - Ryan M. Chapman
- London Health Science Centre, Western University, London, Ontario, Canada
| | - Douglas W. van Citters
- Thayer School of Engineering at Dartmouth College, Western University, Hanover, New Hampshire, USA
| | - William R. Walsh
- Surgical and Orthopaedic Research Laboratory, UNSW Prince of Wales Clinical School, Randwick, New South Wales, Australia
| | - Emil Schemitsch
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
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8
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Abstract
Metallosis is defined as the accumulation and deposition of metallic particles secondary to abnormal wear from prosthetic implants that may be visualized as abnormal macroscopic staining of periprosthetic soft tissues. This phenomenon occurs secondary to the release of metal ions and particles from metal-on-metal hip implants in patients with end-stage osteoarthritis. Ions and particles shed from implants can lead to local inflammation of surrounding tissue and less commonly, very rare systemic manifestations may occur in various organ systems. With the incidence of total hip arthroplasty increasing as well as rates of revisions due to prosthesis failure from previous metal-on-metal implants, metallosis has become an important area of research. Bodily fluids are electrochemically active and react with biomedical implants. Particles, especially cobalt and chromium, are released from implants as they abrade against one another into the surrounding tissues. The body’s normal defense mechanism becomes activated, which can elicit a cascade of events, leading to inflammation of the immediate surrounding tissues and eventually implant failure. In this review, various mechanisms of metallosis are explored. Focus was placed on the atomic and molecular makeup of medical implants, the component/surgical associated factors, cellular responses, wear, tribocorrosion, joint loading, and fluid pressure associated with implantation. Current treatment guidelines for failed implants include revision surgery. An alternative treatment could be chelation therapy, which may drive future studies. Arthroplasty is an invasive procedure which disrupts surrounding joint tissues, and can greatly perturb the joint’s immune homeostasis. In some instances, this may pose a difficult challenge to implant integration. Particles released from implants into the surrounding joint tissues activate the body’s defense mechanism, eliciting a cascade of events, which leads to biotribocorrosion and electrochemical attacks on the implant. This process may lead to the release of even more particles. Besides, implant makeup and designs, frictions between bearing surfaces, corrosion of non-moving parts with modular junctions, surgical mistakes, patient factor, comorbidities, and loosened components can alter the expected function of implants. High accumulations of these ions and particulates result in metallosis, with accompanying adverse complications. Current recommended treatment for failed prosthesis is revision surgeries. However, chelation therapy as a prophylactic intervention may be useful in future efforts but more investigation is required.
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9
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Ilo KC, Aboelmagd K, Hothi HS, Asaad A, Skinner JA, Hart AJ. Does modularity of metal-on-metal hip implants increase cobalt: chromium ratio? Hip Int 2021; 31:109-114. [PMID: 31496282 DOI: 10.1177/1120700019873637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Blood metal ion levels are used in the surveillance of metal-on-metal (MoM) hip implants. Modular implants contain an extra source of metal debris that may affect the ratio of metal ions in the blood. METHODS This was a retrospective study of 503 patients with hip replacements made by a single manufacturer (Smith & Nephew, Warwick, UK) with the same bearing surface. There were 54 total hip arthroplasties, 35 Birmingham Mid-Head Resections and 414 hip resurfacings. Whole blood metal ion levels and their ratios were analysed to investigate the effect of a modular junction. RESULTS The cobalt:chromium ratios were greater in the total hip arthroplasty group (mean 2.3:1) when compared to the resurfacings group (mean 1.3:1, p = <0.05) and Birmingham Mid-Head Resection group (mean 1.1:1, p = 0.11). CONCLUSIONS This study demonstrated a trend for a higher cobalt:chromium ratio in patients with MoM total hip replacement that may be due to metal debris from the modular stem-head junction. Further work is required to correlate clinical data with retrieval analysis to confirm the effect of taper material loss on the cobalt:chromium ratio.
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Affiliation(s)
- Kevin C Ilo
- Institute of Orthopaedics and Musculoskeletal Science (University College London), Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
| | - Karim Aboelmagd
- Institute of Orthopaedics and Musculoskeletal Science (University College London), Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
| | - Harry S Hothi
- Institute of Orthopaedics and Musculoskeletal Science (University College London), Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
| | - Asaad Asaad
- Institute of Orthopaedics and Musculoskeletal Science (University College London), Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
| | - John A Skinner
- Institute of Orthopaedics and Musculoskeletal Science (University College London), Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
| | - Alister J Hart
- Institute of Orthopaedics and Musculoskeletal Science (University College London), Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
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10
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Ishida T, Tateiwa T, Takahashi Y, Nishikawa Y, Shishido T, Masaoka T, Sano K, Yamamoto K. Do Polyethylene Supra-Macroparticles Lead to Pseudotumor Formation in Metal-on-Polyethylene Total Hip Arthroplasty? Arthroplast Today 2020; 6:526-531. [PMID: 32743035 PMCID: PMC7387676 DOI: 10.1016/j.artd.2020.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 01/07/2023] Open
Abstract
We describe 2 cases of pseudotumors induced by an unusual size of polyethylene wear particle after metal-on-polyethylene total hip arthroplasty (MoP THA). The supra-macroparticles of size >100 μm originated from a polyethylene liner with relatively small cup anteversion, potentially leading to excessive loading and increased wear of the anterior edge of the polyethylene liner. Histopathology showed a foreign-body reaction to the polyethylene particles without an adverse reaction to metal debris and with no severe signs of corrosion at the head-neck junction, which have been noted in past reports of pseudotumors in MoP THA. It has been suggested that the large polyethylene wear particles might be the cause of pseudotumor formation in MoP THA.
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Affiliation(s)
- Tsunehito Ishida
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Toshiyuki Tateiwa
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Yasuhito Takahashi
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan.,Department of Bone and Joint Biomaterial Research, Tokyo Medical University, Tokyo, Japan
| | - Yohei Nishikawa
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Takaaki Shishido
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Toshinori Masaoka
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Keiji Sano
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Kengo Yamamoto
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
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11
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McGrory BJ, Jacobs JJ, Kwon YM, Fillingham Y. Standardizing terms for tribocorrosion-associated adverse local tissue reaction in total hip arthroplasty. Arthroplast Today 2020; 6:196-200. [PMID: 32577461 PMCID: PMC7303482 DOI: 10.1016/j.artd.2020.01.008] [Citation(s) in RCA: 8] [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] [Received: 01/04/2020] [Revised: 01/19/2020] [Accepted: 01/21/2020] [Indexed: 02/08/2023] Open
Abstract
Recognizing and adopting standardized terms for adverse local tissue reaction associated with tribocorrosion in total hip arthroplasty are essential for clear scientific discourse and clinical communication. Our goal was to develop terms that can be broadly applied to characterize the local tissue response to tribocorrosion debris, based on current evidence regarding the etiology of this failure mode and its consequences. The proposed standardized terms will improve the understanding and interpretation of analytical tests, advance diagnostic and treatment algorithms, and reduce confusion in research by maintaining consistent nomenclature.
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Affiliation(s)
- Brian J. McGrory
- Corresponding author. Department of Orthopaedic Surgery, Tufts University School of Medicine, Boiston, MA, USA; Maine Medical Center Division of Joint Replacements, Portland, ME, USA. Tel.: +1 207 781 1551.
| | - Joshua J. Jacobs
- Department of Orthopaedic Surgery, Tufts University School of Medicine, Boston, MA, USA
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Young-Min Kwon
- Department of Orthopaedic Surgery, Tufts University School of Medicine, Boston, MA, USA
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Yale Fillingham
- Department of Orthopaedic Surgery, Tufts University School of Medicine, Boston, MA, USA
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
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12
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Goodman SB, Gallo J, Gibon E, Takagi M. Diagnosis and management of implant debris-associated inflammation. Expert Rev Med Devices 2020; 17:41-56. [PMID: 31810395 PMCID: PMC7254884 DOI: 10.1080/17434440.2020.1702024] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 12/04/2019] [Indexed: 02/07/2023]
Abstract
Introduction: Total joint replacement is one of the most common, safe, and efficacious operations in all of surgery. However, one major long-standing and unresolved issue is the adverse biological reaction to byproducts of wear from the bearing surfaces and modular articulations. These inflammatory reactions are mediated by the innate and adaptive immune systems.Areas covered: We review the etiology and pathophysiology of implant debris-associated inflammation, the clinical presentation and detailed work-up of these cases, and the principles and outcomes of non-operative and operative management. Furthermore, we suggest future strategies for prevention and novel treatments of implant-related adverse biological reactions.Expert opinion: The generation of byproducts from joint replacements is inevitable, due to repetitive loading of the implants. A clear understanding of the relevant biological principles, clinical presentations, investigative measures and treatments for implant-associated inflammatory reactions and periprosthetic osteolysis will help identify and treat patients with this issue earlier and more effectively. Although progressive implant-associated osteolysis is currently a condition that is treated surgically, with further research, it is hoped that non-operative biological interventions could prolong the lifetime of joint replacements that are otherwise functional and still salvageable.
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Affiliation(s)
- Stuart B. Goodman
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA, USA
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Jiri Gallo
- Department of Orthopaedics, Palacký University Olomouc, Olomouc, Czech Republic
| | - Emmanuel Gibon
- Department of Orthopaedic Surgery, University of Florida, Gainesville, FL, USA
| | - Michiaki Takagi
- Department of Orthopaedic Surgery, Yamagata University, Yamagata, Japan
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13
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Bhalekar RM, Smith SL, Joyce TJ. Hip simulator testing of the taper-trunnion junction and bearing surfaces of contemporary metal-on-cross-linked-polyethylene hip prostheses. J Biomed Mater Res B Appl Biomater 2019; 108:156-166. [PMID: 30924612 DOI: 10.1002/jbm.b.34374] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 02/18/2019] [Accepted: 03/11/2019] [Indexed: 12/28/2022]
Abstract
Adverse reaction to metal debris released from the taper-trunnion junction of modular metal-on-polyethylene (MoP) total hip replacements (THRs) is an issue of contemporary concern. Therefore, a hip simulator was used to investigate material loss, if any, at both the articulating and taper-trunnion surfaces of five 32-mm metal-on-cross-linked-polyethylene THRs for 5 million cycles (Mc) with a sixth joint serving as a dynamically loaded soak control. Commercially available cobalt-chromium-molybdenum femoral heads articulating against cross-linked polyethylene (XLPE) acetabular liners were mounted on 12/14 titanium (Ti6Al4V) trunnions. Weight loss (mg) was measured gravimetrically and converted into volume loss (mm3 ) for heads, liners, and trunnions at regular intervals. Additionally, posttest volumetric wear measurements of the femoral tapers were obtained using a coordinate measuring machine (CMM). The surface roughness (Sa) of femoral tapers was measured posttest. After 5 Mc, the mean volumetric wear rate for XLPE liners was 2.74 ± 0.74 mm3 /Mc. The CMM measurements confirmed material loss from the femoral taper with the mean volumetric wear rate of 0.045 ± 0.024 mm3 /Mc. The Sa on the worn area of the femoral taper showed a significant increase (p < 0.001) compared with the unworn area. No other long-term hip simulator tests have investigated wear from the taper-trunnion junction of contemporary MoP THRs. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 108B:156-166, 2020.
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Affiliation(s)
- Rohan M Bhalekar
- School of Engineering, Newcastle University, Newcastle upon Tyne, NE1 7RU, England, UK
| | - Simon L Smith
- School of Engineering, Newcastle University, Newcastle upon Tyne, NE1 7RU, England, UK
| | - Thomas J Joyce
- School of Engineering, Newcastle University, Newcastle upon Tyne, NE1 7RU, England, UK
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Connelly JW, Galea VP, Laaksonen I, Matuszak SJ, Madanat R, Muratoglu O, Malchau H. Response to Letter to the Editor on "Indications for MARS-MRI in Patients Treated With Articular Surface Replacement XL Total Hip Arthroplasty". J Arthroplasty 2019; 34:606-607. [PMID: 30528135 DOI: 10.1016/j.arth.2018.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 10/08/2018] [Indexed: 02/01/2023] Open
Affiliation(s)
- James W Connelly
- Department of Orthopaedic Surgery, Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts
| | - Vincent P Galea
- Department of Orthopaedic Surgery, Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts
| | - Inari Laaksonen
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts; Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts
| | - Sean J Matuszak
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts
| | - Rami Madanat
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts; Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts; Department of Orthopaedics and Traumatology, Helsinki University Hospital, Helsinki, Finland
| | - Orhun Muratoglu
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts; Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts
| | - Henrik Malchau
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts; Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts
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