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Acetabular Debonding: An Investigation of Porous Coating Delamination in Hip Resurfacing Arthroplasty. Adv Orthop 2018; 2018:5282167. [PMID: 30515334 PMCID: PMC6236702 DOI: 10.1155/2018/5282167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 10/01/2018] [Indexed: 11/21/2022] Open
Abstract
Background To date, there have been no published investigations on the cause of acetabular debonding, a rare failure phenomenon in metal-on-metal hip resurfacing where the acetabular porous coating delaminates from the implant while remaining well fixed to the pelvic bone. Purposes This study aims to summarize the current understanding of acetabular debonding and to investigate the discrepancy in rate of debonding between two implant systems. Patients and Methods To elucidate potential causes of debonding, we retrospectively analyzed a single-surgeon cohort of 839 hip resurfacing cases. Specifically, we compared rate of debonding and manufacturing processes between two implant systems. Results Group 1 experienced significantly more cases of debonding than Group 2 cases (4.0% versus 0.0%, p value<0.0001). Implant manufacturing processes differed in surface coating, heat treatment, postmanufacturing treatment, and apex thickness. Debonded implants were more likely to have missed RAIL guidelines (p=0.04). Conclusions We identified implant system, postoperative time, and acetabular component placement as variables contributing to rate of debonding. We recommend minimizing acetabular inclination angle according to RAIL guidelines. Further, we evaluated manufacturing differences between the two implant systems but did not have access to proprietary data to identify the cause of debonding. Both implants met ASTM standards, yet only the Group 1 implant debonded. This suggests the second implant had greater fatigue shear strength. Because the Group 2 implant achieved a more durable interface that did not debond, we suggest the ASTM F1160 standard for fatigue shear strength be increased to that achieved by its manufacturer. Level of Evidence II A retrospective evaluation of prospectively collected data.
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Day JS, Paxton ES, Lau E, Gordon VA, Abboud JA, Williams GR. Use of reverse total shoulder arthroplasty in the Medicare population. J Shoulder Elbow Surg 2015; 24:766-72. [PMID: 25704826 DOI: 10.1016/j.jse.2014.12.023] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 12/10/2014] [Accepted: 12/23/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Reverse shoulder arthroplasty (RSA) has been Food and Drug Administration approved in the United States since 2004 but did not obtain a unique code until 2010. Therefore, the use of this popular procedure has yet to be reported. The purpose of this study was to examine the use and reimbursement of RSA compared with total shoulder arthroplasty (TSA) and shoulder hemiarthroplasty (SHA). METHODS We analyzed the 100% sample of the 2011 Medicare Part A claims data for patients aged 65 years or older. Patient demographic characteristics, diagnoses, provider information, reimbursements, and lengths of stay were extracted from the claims data. RESULTS In 2011, a total of 31,002 shoulder arthroplasty procedures were performed; 37% were RSAs, 42% were TSAs, and 21% were SHAs. Osteoarthritis was the primary diagnosis code in 91% of TSAs, 37% of SHAs, and 45% of RSAs. A primary diagnosis of osteoarthritis with no secondary code for rotator cuff tear was found in 22% of patients undergoing RSA. The mean length of stay for RSA (2.6 days; SD, 2.1 days) was longer than that for TSA (2.1 days; SD, 1.5 days) and shorter than that for SHA (3.5 days; SD, 3.6 days) (P < .001). Lower-volume surgeons (<10 arthroplasties per year) performed most shoulder arthroplasties: 57% of RSAs, 65% of TSAs, and 97% of SHAs. Seventy percent of RSAs were implanted by surgeons who performed more RSAs than TSAs and SHAs combined. CONCLUSIONS RSA is performed with similar frequency to TSA and almost twice as much as SHA in the Medicare population. Lower-volume surgeons perform most RSAs, and a majority of surgeons perform more RSAs than all anatomic shoulder arthroplasties combined.
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Affiliation(s)
| | - E Scott Paxton
- Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA; Warren Alpert Medical School of Brown University, Providence, RI, USA
| | | | - Victoria A Gordon
- Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Joseph A Abboud
- Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Gerald R Williams
- Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
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Pezzotti G, Yamamoto K. Artificial hip joints: The biomaterials challenge. J Mech Behav Biomed Mater 2014; 31:3-20. [DOI: 10.1016/j.jmbbm.2013.06.001] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 05/29/2013] [Accepted: 06/06/2013] [Indexed: 12/21/2022]
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Dickinson A, Taylor A, Browne M. Implant–bone interface healing and adaptation in resurfacing hip replacement. Comput Methods Biomech Biomed Engin 2012; 15:935-47. [DOI: 10.1080/10255842.2011.567269] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Clarke SG, Phillips ATM, Bull AMJ, Cobb JP. A hierarchy of computationally derived surgical and patient influences on metal on metal press-fit acetabular cup failure. J Biomech 2012; 45:1698-704. [PMID: 22513086 DOI: 10.1016/j.jbiomech.2012.03.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Revised: 02/20/2012] [Accepted: 03/14/2012] [Indexed: 10/28/2022]
Abstract
The impact of anatomical variation and surgical error on excessive wear and loosening of the acetabular component of large diameter metal-on-metal hip arthroplasties was measured using a multi-factorial analysis through 112 different simulations. Each surgical scenario was subject to eight different daily loading activities using finite element analysis. Excessive wear appears to be predominantly dependent on cup orientation, with inclination error having a higher influence than version error, according to the study findings. Acetabular cup loosening, as inferred from initial implant stability, appears to depend predominantly on factors concerning the area of cup-bone contact, specifically the level of cup seating achieved and the individual patient's anatomy. The extent of press fit obtained at time of surgery did not appear to influence either mechanism of failure in this study.
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Affiliation(s)
- S G Clarke
- Structural Biomechanics, Department of Civil and Environmental Engineering, Imperial College London, Skempton Building, South Kensington Campus, London SW7 2AZ, UK.
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Martelli S, Taddei F, Schileo E, Cristofolini L, Rushton N, Viceconti M. Biomechanical robustness of a new proximal epiphyseal hip replacement to patient variability and surgical uncertainties: A FE study. Med Eng Phys 2012; 34:161-71. [DOI: 10.1016/j.medengphy.2011.07.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Revised: 06/08/2011] [Accepted: 07/11/2011] [Indexed: 11/27/2022]
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Martelli S, Taddei F, Cristofolini L, Schileo E, Rushton N, Viceconti M. A new hip epiphyseal prosthesis: Design revision driven by a validated numerical procedure. Med Eng Phys 2011; 33:1203-11. [DOI: 10.1016/j.medengphy.2011.05.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Revised: 05/13/2011] [Accepted: 05/16/2011] [Indexed: 11/30/2022]
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Gross TP, Liu F. Comparison of fully porous-coated and hybrid hip resurfacing: a minimum 2-year follow-up study. Orthop Clin North Am 2011; 42:231-9, viii-ix. [PMID: 21435497 DOI: 10.1016/j.ocl.2010.12.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The purpose of this study was to compare clinical and radiological outcomes of the first 191 fully porous-coated hip resurfacing arthroplasties with 96 hybrid hip resurfacing arthroplasties performed during the same period at a minimum 2-year follow-up to evaluate the initial fixation of uncemented femoral resurfacing components. The results of this study indicate that fully porous-coated femoral resurfacing components can routinely achieve reliable fixation and provide similar initial results as have been achieved with cemented fixation. Long-term results are needed to determine which type of fixation is superior for the femoral hip resurfacing component.
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Day JS, Lau E, Ong KL, Williams GR, Ramsey ML, Kurtz SM. Prevalence and projections of total shoulder and elbow arthroplasty in the United States to 2015. J Shoulder Elbow Surg 2010; 19:1115-20. [PMID: 20554454 DOI: 10.1016/j.jse.2010.02.009] [Citation(s) in RCA: 534] [Impact Index Per Article: 38.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Accepted: 02/22/2010] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS This study examined national trends and projections of procedure volumes and prevalence rates for shoulder and elbow arthroplasty in the United States (U.S.). This study hypothesized that the growth in demand for upper extremity arthroplasty will be greater than the growth in demand for hip and knee arthroplasty and that demand for these procedures will continue to grow in the immediate future. MATERIALS AND METHODS The Nationwide Inpatient Sample (1993-2007) was used with U.S. Census data to quantify primary arthroplasty rates as a function of age, race, census region, and gender. Poisson regression was used to evaluate procedure rates and determine year-to-year trends in primary and revision arthroplasty. Projections were derived based on historical procedure rates combined with population projections from 2008 to 2015. RESULTS Procedure volumes and rates increased at annual rates of 6% to 13% from 1993 to 2007. Compared with 2007 levels, projected procedures were predicted to further increase by between 192% and 322% by 2015. The revision burden increased from approximately 4.5% to 7%. During the period studied, the hospital length of stay decreased by approximately 2 days for total and hemishoulder procedures. Charges, in 2007 Consumer Price Index-adjusted dollars, increased for all 4 procedural types at annual rates of $900 to $1700. CONCLUSION The growth rates of upper extremity arthroplasty were comparable to or higher than rates for total hip and knee procedures. Of particular concern was the increased revision burden. The rising number of arthroplasty procedures combined with increased charges has the potential to place a financial strain on the health care system.
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Affiliation(s)
- Judd S Day
- Biomechanics Practice, Exponent Inc, Philadelphia, PA 19104, USA.
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Zhang W, Titze M, Cappi B, Wirtz DC, Telle R, Fischer H. Improved mechanical long-term reliability of hip resurfacing prostheses by using silicon nitride. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2010; 21:3049-3057. [PMID: 20725769 DOI: 10.1007/s10856-010-4144-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2009] [Accepted: 08/03/2010] [Indexed: 05/29/2023]
Abstract
Although ceramic prostheses have been successfully used in conventional total hip arthroplasty (THA) for many decades, ceramic materials have not yet been applied for hip resurfacing (HR) surgeries. The objective of this study is to investigate the mechanical reliability of silicon nitride as a new ceramic material in HR prostheses. A finite element analysis (FEA) was performed to study the effects of two different designs of prostheses on the stress distribution in the femur-neck area. A metallic (cobalt-chromium-alloy) Birmingham hip resurfacing (BHR) prosthesis and our newly designed ceramic (silicon nitride) HR prosthesis were hereby compared. The stresses induced by physiologically loading the femur bone with an implant were calculated and compared with the corresponding stresses for the healthy, intact femur bone. Here, we found stress distributions in the femur bone with the implanted silicon nitride HR prosthesis which were similar to those of healthy, intact femur bone. The lifetime predictions showed that silicon nitride is indeed mechanically reliable and, thus, is ideal for HR prostheses. Moreover, we conclude that the FEA and corresponded post-processing can help us to evaluate a new ceramic material and a specific new implant design with respect to the mechanical reliability before clinical application.
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Affiliation(s)
- Wen Zhang
- Department of Ceramics and Refractory Materials, RWTH Aachen University, Mauerstrasse 5, 52064 Aachen, Germany.
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Schnurr C, Nessler J, Koebke J, Michael JW, Eysel P, König DP. [Imageless computer navigation of hip resurfacing arthroplasty]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2010; 22:307-16. [PMID: 20676824 DOI: 10.1007/s00064-010-9023-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Precise implantation of hip resurfacing arthroplasty by imageless computer navigation. Hence a malalignment of the femoral component, leading to early loss of the implant, can safely be avoided. INDICATIONS Coxarthrosis in patients with normal bone mineral density; only minor deformity of the femoral head that enables milling around the femoral neck without notching. CONTRAINDICATIONS Osteoporosis; large necrosis of the femoral head; metal allergy; small acetabular seat and corresponding wide femoral neck, leading to needless acetabular bone loss; pregnancy, lactation. SURGICAL TECHNIQUE Hip joint exposure by a standard surgical approach, bicortical placement of a Schanz screw for the navigation array in the lesser trochanter. Referencing of the epicondyles, the four planes around the femoral neck and head by use of the navigation pointer. Planning of the desired implant position on the touchscreen of the navigation device; a guide wire is inserted into the femoral head and neck using the navigated drill guide; navigated depth drilling is performed. The femoral head is milled using the standard instruments. The acetabular bone stock is prepared with the conventional instrumentation; high-viscosity cement is finger-packed on the reamed head and the femoral component is inserted. Hammer blows should be avoided to prevent microfractures. Verification of the implant position by the navigation device; displacement of the Schanz screw; joint reposition and closure of the wound. POSTOPERATIVE MANAGEMENT Standard postoperative management after hip arthroplasty. RESULTS The comparison of 40 navigated and 32 conventionally implanted ASR prostheses resulted in a significant reduction of outliers by use of computer navigation (navigated procedures: one outlier, conventional procedure: nine outliers; p<0.001). Accuracy of the navigation device was tested by analysis of planned and verified implant position: CCD angle accuracy was 1 degrees , antetorsion accuracy was 1 degrees , and offset accuracy was 1.5 mm. An ongoing computed tomography-based anatomic study proved a varus-valgus accuracy of the navigation device of 1 degrees .
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Martelli S, Taddei F, Cristofolini L, Gill HS, Viceconti M. Extensive Risk Analysis of Mechanical Failure for an Epiphyseal Hip Prothesis: A Combined Numerical—Experimental Approach. Proc Inst Mech Eng H 2010; 225:126-40. [DOI: 10.1243/09544119jeim728] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
There has been recent renewed interest in proximal femur epiphyseal replacement as an alternative to conventional total hip replacement. In many branches of engineering, risk analysis has proved to be an efficient tool for avoiding premature failures of innovative devices. An extensive risk analysis procedure has been developed for epiphyseal hip prostheses and the predictions of this method have been compared to the known clinical outcomes of a well-established contemporary design, namely hip resurfacing devices. Clinical scenarios leading to revision (i.e. loosening, neck fracture and failure of the prosthetic component) were associated with potential failure modes (i.e. overload, fatigue, wear, fibrotic tissue differentiation and bone remodelling). Driving parameters of the corresponding failure mode were identified together with their safe thresholds. For each failure mode, a failure criterion was identified and studied under the most relevant physiological loading conditions. All failure modes were investigated with the most suitable investigation tool, either numerical or experimental. Results showed a low risk for each failure scenario either in the immediate postoperative period or in the long term. These findings are in agreement with those reported by the majority of clinical studies for correctly implanted devices. Although further work is needed to confirm the predictions of this method, it was concluded that the proposed risk analysis procedure has the potential to increase the efficacy of preclinical validation protocols for new epiphyseal replacement devices.
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Affiliation(s)
- S Martelli
- Laboratorio di Tecnologia Medica, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - F Taddei
- Laboratorio di Tecnologia Medica, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - L Cristofolini
- Laboratorio di Tecnologia Medica, Istituto Ortopedico Rizzoli, Bologna, Italy
- Engineering Faculty, University of Bologna, Italy
| | - H S Gill
- Nuffield Department Of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK
| | - M Viceconti
- Laboratorio di Tecnologia Medica, Istituto Ortopedico Rizzoli, Bologna, Italy
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Acetabular Component Deformation under Rim Loading Using Digital Image Correlation and Finite Element Methods. ACTA ACUST UNITED AC 2010. [DOI: 10.4028/www.scientific.net/amm.24-25.275] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Total hip replacement is a highly successful operation; restoring function and reducing pain in arthritis patients. In recent years, thinner resurfacing acetabular cups have been introduced in order to preserve bone stock and reduce the risk of dislocation. However concerns have been raised that deformation of these cups could adversely affect the lubrication regime of the bearing; leading to equatorial and edge contact, possibly causing the implants to jam. This study aims to assess the amount of deformation which occurs due to the tight peripheral fit experienced during press-fit by applying rim loading to three different designs of acetabular cup: a clinically successful cobalt chrome resurfacing cup, a prototype composite resurfacing cup and a clinically successful polyethylene monobloc cup.
Digital Image Correlation (DIC) was used to measure the deformation and to validate Finite Element (FE) models. DIC provided a non-contacting method to measure displacement; meaning the load could be increased continuously rather than in steps as in previous studies.
The physical testing showed that the cobalt chrome cups were significantly stiffer than the composite prototype and polyethylene cups. The FE models were in good agreement with the experimental results for all three cups and were able to predict the deformation to within 10%. FE models were also created to investigate the effect of cup outside diameter and wall thickness on stiffness under rim loading. Increasing outside diameter resulted in a linear reduction in stiffness for all three materials. Increasing the wall thickness resulted in an exponential increase in cup stiffness.
Rim loading an acetabular shell does not accurately simulate the in vivo conditions; however it does provide a simple method for comparing cups made of different materials.
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Nall A, Robin J. Spontaneous recurrent dislocation after primary Birmingham hip resurfacing: a rare complication in a 44-year-old man. J Arthroplasty 2010; 25:658.e23-7. [PMID: 19464846 DOI: 10.1016/j.arth.2009.03.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2008] [Accepted: 03/23/2009] [Indexed: 02/01/2023] Open
Abstract
Dislocation is a rare complication of hip resurfacing in young people. This is thought to be due to the stability imposed by a large-diameter head [Stulberg BN, Trier KK, Naughton M, et al. Results and Lessons Learned from a United States Hip Resurfacing Investigational Device Exemption Trial. J Bone Joint Surg Am 2008;90:21]. We report an isolated case 1 week post-Birmingham hip resurfacing in a 44-year-old man without any history of trauma or infection. We note that due to massive periacetabular and femoral neck osteophyte formation and loss of normal bony anatomical landmarks, the version of the acetabular component may have been slightly retroverted. Due to marked narrowing of the femoral neck and head proximally, a cone-shaped proximal femur was found and felt to be unsuitable for direct resurfacing without prior shortening to allow fitting of the appropriate-sized Birmingham hip resurfacing femoral component. This was done successfully, but resulted in slightly reduced femoral neck offset of approximately 10 mm, compared to the native hip. We suspect this reduced offset contributed significantly to the 2 dislocations. We recommend careful preoperative planning and case selection to avoid this complication in similar patients.
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Affiliation(s)
- Amy Nall
- Department of Orthopaedics, Austin Health, Heidelberg, Victoria, Australia
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