1
|
Uklejewski R, Winiecki M, Dąbrowski M, Rogala P. Towards the First Generation of Biomimetic Fixation for Resurfacing Arthroplasty Endoprostheses. Biomimetics (Basel) 2024; 9:99. [PMID: 38392145 PMCID: PMC10887084 DOI: 10.3390/biomimetics9020099] [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: 12/21/2023] [Revised: 01/21/2024] [Accepted: 02/06/2024] [Indexed: 02/24/2024] Open
Abstract
This paper presents advances in designs of resurfacing arthroplasty endoprostheses that occurred through their historical generations. The critical characteristics of contemporary generation hip resurfacing arthroplasty endoprostheses are given and the failures resulting from the specific generation cemented and short stem fixation of the femoral component are reviewed. On the background of these failures, the critical need arises for an alternative approach to the fixation of components of resurfacing arthroplasty leading towards the first generation of biomimetic fixation for resurfacing arthroplasty endoprostheses. The state of the art of the completed bioengineering research on the first biomimetic fixation for resurfacing arthroplasty endoprostheses is presented. This new design type of completely cementless and stemless resurfacing arthroplasty endoprostheses of the hip joint (and other joints), where endoprosthesis components are embedded in the surrounding bone via the prototype biomimetic multi-spiked connecting scaffold (MSC-Scaffold), initiates the first at all generations of biomimetic endoprostheses of diarthrodial joints.
Collapse
Affiliation(s)
- Ryszard Uklejewski
- Department of Constructional Materials and Biomaterials, Faculty of Materials Engineering, Kazimierz Wielki University, Jan Karol Chodkiewicz Street 30, 85-064 Bydgoszcz, Poland
| | - Mariusz Winiecki
- Department of Constructional Materials and Biomaterials, Faculty of Materials Engineering, Kazimierz Wielki University, Jan Karol Chodkiewicz Street 30, 85-064 Bydgoszcz, Poland
| | - Mikołaj Dąbrowski
- Adult Spine Orthopaedics Department, Wiktor Dega Orthopaedic and Rehabilitation Clinical Hospital, Poznan University of Medical Sciences, 28 Czerwca 1956 Street 135/147, 61-545 Poznan, Poland
| | - Piotr Rogala
- Institute of Health Sciences, Hipolit Cegielski State College of Higher Education, Card. Stefan Wyszyński Street 38, 62-200 Gniezno, Poland
| |
Collapse
|
2
|
Füssenich W, Seeber GH, van Raaij TM, van Lingen CP, Zuurmond RG, Stevens M, Somford MP. Factors Associated With Nonunion in Arthrodesis of the First Metatarsophalangeal Joint: A Multicenter Retrospective Cohort Study. Foot Ankle Int 2023; 44:508-515. [PMID: 36959744 PMCID: PMC10248293 DOI: 10.1177/10711007231160754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
BACKGROUND Arthrodesis of the first metatarsophalangeal joint is the current treatment of choice for symptomatic advanced hallux rigidus and moderate-to-severe hallux valgus. There are different methods to perform arthrodesis, yet no consensus on the best approach. Therefore, this study aimed to determine the effects of preoperative and postoperative hallux valgus angle (HVA), joint preparation and fixation technique, and postoperative immobilization on the incidence of nonunion. METHODS A retrospective multicenter cohort study was performed that included 794 patients. Univariate and multiple logistic regression was conducted to determine associations between joint preparation, fixation techniques, postoperative immobilization, weightbearing, and pre- and postoperative HVA with nonunion. RESULTS Nonunion incidence was 15.2%, with 11.1% symptomatic and revised. Joint preparation using hand instruments (OR 3.75, CI 1.90-7.42) and convex/concave reamers (OR 2.80, CI 1.52-5.16) were associated with greater odds of a nonunion compared to planar cuts. Joint fixation with crossed screws was associated with greater odds of nonunion (OR 2.00, CI 1.11-3.42), as was greater preoperative HVA (OR 1.02, CI 1.00-1.03). However, the latter effect disappeared after inclusion of postoperative HVA in the model, with a small association identified between residual postoperative HVA and nonunion (OR 1.04, CI 1.01-1.08). Similarly, we found an association between odds of nonunion and higher body weight (OR 1.02, CI 1.01-1.04) but not of body mass index. CONCLUSION Based on our results, first metatarsophalangeal joint arthrodesis with planar cuts and fixation with a plate and interfragmentary screw is associated with the lowest odds of resulting in a nonunion. Higher body weight and greater preoperative HVA were associated with slight increase in rates of nonunion. It is crucial to properly correct the hallux valgus deformity during surgery. LEVEL OF EVIDENCE Level III, retrospective case control study.
Collapse
Affiliation(s)
- Wout Füssenich
- Department of Orthopaedic Surgery,
University of Groningen, University Medical Center Groningen, Groningen, the
Netherlands
| | - Gesine H. Seeber
- Department of Orthopaedic Surgery,
University of Groningen, University Medical Center Groningen, Groningen, the
Netherlands
- University Hospital for Orthopaedics
and Trauma Surgery Pius-Hospital, Medical Campus University of Oldenburg, Oldenburg,
Germany
| | - Tom M. van Raaij
- Department of Orthopaedic Surgery,
Martini Hospital, Groningen, the Netherlands
| | | | | | - Martin Stevens
- Department of Orthopaedic Surgery,
University of Groningen, University Medical Center Groningen, Groningen, the
Netherlands
| | - Matthijs P. Somford
- Department of Orthopaedic Surgery,
Rijnstate Hospital, Arnhem, the Netherlands
| |
Collapse
|
3
|
Füssenich W, Brusse-Keizer MGJ, Somford MP. Severe Hallux Valgus Angle Attended With High Incidence of Nonunion in Arthrodesis of the First Metatarsophalangeal Joint: A Follow-Up Study. J Foot Ankle Surg 2021; 59:993-996. [PMID: 32690233 DOI: 10.1053/j.jfas.2020.05.007] [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] [Received: 05/02/2020] [Accepted: 05/06/2020] [Indexed: 02/03/2023]
Abstract
The incidence of nonunion after first metatarsophalangeal joint (MTP-1) arthrodesis was found to be high in our clinic. By raising awareness for the problem, making a uniform surgical treatment protocol, banning the commonly used convex-concave reamers, and promoting solely the use of hand instruments to prepare the joint for arthrodesis, we tried to decrease the numbers of nonunion. This prospective cohort study included all patients who underwent MTP-1 fusion between January 2018 and March 2019. Patients were treated according to a standardized protocol, using hand instruments to prepare the joint for fusion. Anthropometric and therapy-related data were collected and compared with an earlier 2015-2016 cohort that was retrospectively assessed. Furthermore, the frequency of nonunion between convex-concave reamers and hand instruments was compared. A total of 53 patients underwent MTP-1 fusion surgery. The incidence of nonunion was 3.8%, significantly lower than the 24.1% in 2015 to 2016 (p = .002). Multivariate regression analysis showed a 7.11 times higher risk of nonunion in 2015 to 2016 compared with 2018 to 2019 (95% confidence interval [CI] 1.55 to 32.55) (p = .012). Furthermore, an increase of 10° in HVA showed a 1.52 risk of occurrence of nonunion (95% CI 1.07 to 2.17) (p = .021). The use of convex/concave reamers was univariately associated with a 3.61 times higher risk of nonunion (95% CI 1.14 to 11.43) (p = .029); however, after correction for preoperative HVA, the preparation method was no longer associated with the occurrence of nonunion (p = .108). Patients suffering from severe hallux valgus had nonunion in 32.1% of cases. Incidence of nonunion after MTP-1 arthrodesis was significantly reduced by raising awareness and by standardizing the treatment protocol. There was no significant difference in nonunion frequency between the methods of joint surface preparation. Severe hallux valgus is prone to nonunion, and more research into this indication for MTP-1 fusion and outcome is needed.
Collapse
Affiliation(s)
- Wout Füssenich
- Resident, Department of Orthopedic Surgery, Medisch Spectrum Twente, Enschede, The Netherlands
| | | | - Matthijs P Somford
- Foot and Ankle Surgeon, Department of Orthopedic Surgery, Rijnstate Hospital, Arnhem, The Netherlands.
| |
Collapse
|
4
|
Murphy TA, Mathews JA, Whitehouse MR, Baker RP. Investigation of thermally induced damage to surrounding nerve tissue when using curettage and cementation of long bone tumours, modelled in cadaveric porcine femurs. Arch Orthop Trauma Surg 2019; 139:1033-1038. [PMID: 30715569 PMCID: PMC6647233 DOI: 10.1007/s00402-019-03129-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Curettage with cement augmentation is a technique used in the treatment of bone tumours. Thermal energy released during the cement polymerisation process can damage surrounding tissues. This study aims to record temperature changes at various sites on and around bone during the cementing process. We hypothesised that adjacent structures, such as the radial nerve, may be threatened by this process in the clinical setting. MATERIALS AND METHODS Using 18 porcine femurs as a model of the human humerus, we used thermocouples and a thermal imaging camera to measure changes in temperature during the cementing process. Fractures were created in nine samples to establish whether a discontinuity of the cortex had an effect on thermal conduction. RESULTS Significantly higher temperatures were recorded in samples with a fracture compared to those without a fracture. The site overlying the centre of the cement bolus (hypothetical site of the radial nerve) demonstrated higher temperatures than all other sites on the same cortex. When considering the radial nerve site, over half the samples demonstrated temperatures exceeding 47 °C for over a minute. When a threshold of 50 °C for more than 30 s was considered, three samples without a fracture exceeded this value compared to two with a fracture. CONCLUSION The temperatures recorded were sufficient to cause damage to neural tissue. Limiting thermal exposure to soft tissues is recommended. Increased attention is required when using larger cement boluses, or where bone quality is poor or a fracture, iatrogenic or preexisting, is present.
Collapse
Affiliation(s)
- T. A. Murphy
- Avon Orthopaedic Centre, Southmead Hospital, North Bristol NHS Trust, Brunel Building, Southmead Road, Bristol, BS10 5NB UK
| | - J. A. Mathews
- Avon Orthopaedic Centre, Southmead Hospital, North Bristol NHS Trust, Brunel Building, Southmead Road, Bristol, BS10 5NB UK
| | - M. R. Whitehouse
- Avon Orthopaedic Centre, Southmead Hospital, North Bristol NHS Trust, Brunel Building, Southmead Road, Bristol, BS10 5NB UK ,Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, Southmead Hospital, 1st Floor Learning and Research Building, Bristol, BS10 5NB UK ,National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - R. P. Baker
- Avon Orthopaedic Centre, Southmead Hospital, North Bristol NHS Trust, Brunel Building, Southmead Road, Bristol, BS10 5NB UK
| |
Collapse
|
5
|
Posterolateral vs Direct Anterior Approach in Total Hip Arthroplasty (POLADA Trial): A Randomized Controlled Trial to Assess Differences in Serum Markers. J Arthroplasty 2017; 32:3652-3658.e1. [PMID: 28780222 DOI: 10.1016/j.arth.2017.07.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 06/17/2017] [Accepted: 07/06/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The direct anterior approach (DAA) for total hip arthroplasty has claimed to be a true tissue-sparing minimally invasive approach that has less tissue damage and a faster recovery when compared to the posterolateral approach (PLA). The aim of this randomized controlled trial is to measure the differences in serum markers and functional outcomes between the DAA and PLA for total hip arthroplasty. METHODS Forty-six patients were prospectively included and randomized for either the DAA (n = 23) or PLA (n = 23). All surgical procedures were performed by 3 well-trained orthopedic surgeons. The degree of tissue damage was assessed by measuring creatine kinase (CK) and C-reactive protein levels (CRP) preoperatively and 2 hours, 1 day, 2 weeks, and 6 weeks postoperatively. Generalized linear mixed models analyses were used to assess differences between serum markers over time; correction for possible confounding factors was performed. The Hip disability and Osteoarthritis Outcome Score and the Harris Hip Score were assessed preoperatively and 6 weeks postoperatively. RESULTS There were no differences in patient demographics. The DAA had a longer operative time (P = .001). CK and CRP levels increased postoperatively, but no significant differences between the groups were found on any of the time points. Functional outcomes were also similar in both approaches. CONCLUSION No difference in tissue damage measured with serum markers CK and CRP were found between the DAA and PLA for total hip arthroplasty.
Collapse
|
6
|
Chughtai M, Piuzzi NS, Khlopas A, Jones LC, Goodman SB, Mont MA. An evidence-based guide to the treatment of osteonecrosis of the femoral head. Bone Joint J 2017; 99-B:1267-1279. [PMID: 28963146 DOI: 10.1302/0301-620x.99b10.bjj-2017-0233.r2] [Citation(s) in RCA: 117] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 06/09/2017] [Indexed: 12/24/2022]
Abstract
Non-traumatic osteonecrosis of the femoral head is a potentially devastating condition, the prevalence of which is increasing. Many joint-preserving forms of treatment, both medical and surgical, have been developed in an attempt to slow or reverse its progression, as it usually affects young patients. However, it is important to evaluate the best evidence that is available for the many forms of treatment considering the variation in the demographics of the patients, the methodology and the outcomes in the studies that have been published, so that it can be used effectively. The purpose of this review, therefore, was to provide an up-to-date, evidence-based guide to the management, both non-operative and operative, of non-traumatic osteonecrosis of the femoral head. Cite this article: Bone Joint J 2017;99-B:1267-79.
Collapse
Affiliation(s)
| | | | - A Khlopas
- Cleveland Clinic, Cleveland, Ohio, USA
| | - L C Jones
- Johns Hopkins University, Baltimore, Maryland, USA
| | - S B Goodman
- Stanford University, Stanford, California, USA
| | - M A Mont
- Cleveland Clinic, Cleveland, Ohio, USA
| |
Collapse
|
7
|
Adams MK, Lescun TB, Mechem AS, Johnson WR, Griffin TH, Main RP. Comparison of insertion characteristics of tapered and cylindrical transfixation pins in third metacarpal bones of equine cadavers. Am J Vet Res 2017; 78:1200-1209. [PMID: 28945124 DOI: 10.2460/ajvr.78.10.1200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare heat generation and mechanical bone damage for tapered and cylindrical transfixation pins during drilling, tapping, and pin insertion in equine third metacarpal bones. SAMPLE 16 pairs of cadaveric equine third metacarpal bones. PROCEDURES For cylindrical pin insertion, a 6.2-mm hole was drilled and tapped with a cylindrical tap, and then a standard 6.3-mm pin was inserted. For tapered pin insertion, a 6.0-mm hole was drilled, reamed with a tapered reamer, and tapped with a tapered tap, and then a 6.3-mm tapered pin was inserted. Paired t tests and 1-way ANOVAs were used to compare heat generation (measured by use of thermocouples and thermography), macrodamage (assessed by use of stereomicroscopy), and microdamage (assessed by examination of basic fuchsin-stained histologic specimens) between cylindrical and tapered pins and between tapered pins inserted to various insertion torques. RESULTS Tapered pin insertion generated less heat but resulted in more bone damage than did cylindrical pin insertion when pins were inserted to the same insertion torque. Insertion of tapered pins to increasing insertion torques up to 16 N•m resulted in increased heat generation and bone damage. CONCLUSIONS AND CLINICAL RELEVANCE Tapered pin insertion resulted in lower heat production than did cylindrical pin insertion. However, tapered pin insertion resulted in greater bone damage, which likely was attributable to differences in the tapered and cylindrical taps. A tapered pin may be preferable to a cylindrical pin for insertion in equine cortical bone provided that improvements in tap design can reduce bone damage during insertion.
Collapse
|
8
|
Experimental determination of the emissivity of bone. Med Eng Phys 2016; 38:1136-8. [DOI: 10.1016/j.medengphy.2016.06.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 04/13/2016] [Accepted: 06/09/2016] [Indexed: 11/17/2022]
|
9
|
Uklejewski R, Rogala P, Winiecki M, Tokłowicz R, Ruszkowski P, Wołuń-Cholewa M. Biomimetic Multispiked Connecting Ti-Alloy Scaffold Prototype for Entirely-Cementless Resurfacing Arthroplasty Endoprostheses-Exemplary Results of Implantation of the Ca-P Surface-Modified Scaffold Prototypes in Animal Model and Osteoblast Culture Evaluation. MATERIALS 2016; 9:ma9070532. [PMID: 28773652 PMCID: PMC5456909 DOI: 10.3390/ma9070532] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 06/07/2016] [Accepted: 06/23/2016] [Indexed: 12/02/2022]
Abstract
We present here—designed, manufactured, and tested by our research team—the Ti-alloy prototype of the multispiked connecting scaffold (MSC-Scaffold) interfacing the components of resurfacing arthroplasty (RA) endoprostheses with bone. The spikes of the MSC-Scaffold prototype mimic the interdigitations of the articular subchondral bone, which is the natural biostructure interfacing the articular cartilage with the periarticular trabecular bone. To enhance the osteoinduction/osteointegration potential of the MSC-Scaffold, the attempts to modify its bone contacting surfaces by the process of electrochemical cathodic deposition of Ca-P was performed with further immersion of the MSC-Scaffold prototypes in SBF in order to transform the amorphous calcium-phosphate coating in hydroxyapatite-like (HA-like) coating. The pilot experimental study of biointegration of unmodified and Ca-P surface-modified MSC-Scaffold prototypes was conducted in an animal model (swine) and in osteoblast cell culture. On the basis of a microscope-histological method the biointegration was proven by the presence of trabeculae in the interspike spaces of the MSC-Scaffold prototype on longitudinal and cross-sections of bone-implant specimens. The percentage of trabeculae in the area between the spikes of specimen containing Ca-P surface modified scaffold prototype observed in microCT reconstructions of the explanted joints was visibly higher than in the case of unmodified MSC-Scaffold prototypes. Significantly higher Alkaline Phosphatase (ALP) activity and the cellular proliferation in the case of Ca-P-modified MSC-Scaffold pre-prototypes, in comparison with unmodified pre-prototypes, was found in osteoblast cell cultures. The obtained results of experimental implantation in an animal model and osteoblast cell culture evaluations of Ca-P surface-modified and non-modified biomimetic MSC-Scaffold prototypes for biomimetic entirely-cementless RA endoprostheses indicate the enhancement of the osteoinduction/osteointegration potential by the Ca-P surface modification of the Ti-alloy MSC-Scaffold prototype. Planned further research on the prototype of this biomimetic MSC-Scaffold for a new generation of RA endoprostheses is also given.
Collapse
Affiliation(s)
- Ryszard Uklejewski
- Department of Medical Bioengineering Fundamentals, Institute of Technology, Casimir the Great University, Karola Chodkiewicza Street 30, Bydgoszcz 85-064, Poland.
- Department of Process Engineering, Institute of Technology and Chemical Engineering, Poznan University of Technology, Marii Sklodowskiej-Curie 2, Poznan 60-965, Poland.
| | - Piotr Rogala
- Department of Spine Surgery, Oncologic Orthopaedics and Traumatology, Poznan University of Medical Sciences, 28 Czerwca 1956 135/147, Poznan 61-545, Poland.
| | - Mariusz Winiecki
- Department of Medical Bioengineering Fundamentals, Institute of Technology, Casimir the Great University, Karola Chodkiewicza Street 30, Bydgoszcz 85-064, Poland.
- Department of Process Engineering, Institute of Technology and Chemical Engineering, Poznan University of Technology, Marii Sklodowskiej-Curie 2, Poznan 60-965, Poland.
| | - Renata Tokłowicz
- Department of Process Engineering, Institute of Technology and Chemical Engineering, Poznan University of Technology, Marii Sklodowskiej-Curie 2, Poznan 60-965, Poland.
| | - Piotr Ruszkowski
- Department of Pharmacology, Poznan University of Medical Sciences, Rokietnicka 5A, Poznan 60-806, Poland.
| | - Maria Wołuń-Cholewa
- Department of Cell Biology, Poznan University of Medical Sciences, Rokietnicka 5D, Poznan 60-806, Poland.
| |
Collapse
|
10
|
Manoogian S, Lee AK, Widmaier JC. Measuring temperature rise during orthopaedic surgical procedures. Med Eng Phys 2016; 38:1016-20. [PMID: 27246667 DOI: 10.1016/j.medengphy.2016.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 03/23/2016] [Accepted: 05/08/2016] [Indexed: 11/24/2022]
Abstract
A reliable means for measuring temperatures generated during surgical procedures is needed to recommend best practices for inserting fixation devices and minimizing the risk of osteonecrosis. Twenty four screw tests for three surgical procedures were conducted using the four thermocouples in the bone and one thermocouple in the screw. The maximum temperature rise recorded from the thermocouple in the screw (92.7±8.9°C, 158.7±20.9°C, 204.4±35.2°C) was consistently higher than the average temperature rise recorded in the bone (31.8±9.3°C, 44.9±12.4°C, 77.3±12.7°C). The same overall trend between the temperatures that resulted from three screw insertion procedures was recorded with significant statistical analyses using either the thermocouple in the screw or the average of several in-bone thermocouples. Placing a single thermocouple in the bone was determined to have limitations in accurately comparing temperatures from different external fixation screw insertion procedures. Using the preferred measurement techniques, a standard screw with a predrilled hole was found to have the lowest maximum temperatures for the shortest duration compared to the other two insertion procedures. Future studies evaluating bone temperature increase need to use reliable temperature measurements for recommending best practices to surgeons.
Collapse
Affiliation(s)
- Sarah Manoogian
- Mechanical Engineering, Bucknell University, 1 Dent Drive, Lewisburg, PA 17837, USA .
| | - Adam K Lee
- Geisinger Health System, 100 N Academy Ave, Danville, PA 17822, USA
| | - James C Widmaier
- Geisinger Health System, 100 N Academy Ave, Danville, PA 17822, USA
| |
Collapse
|
11
|
Tawy GF, Rowe PJ, Riches PE. Thermal Damage Done to Bone by Burring and Sawing With and Without Irrigation in Knee Arthroplasty. J Arthroplasty 2016; 31:1102-8. [PMID: 26718777 DOI: 10.1016/j.arth.2015.11.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 10/29/2015] [Accepted: 11/02/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Heat from bone resecting tools used in knee surgery can induce thermal osteonecrosis, potentially causing aseptic implant loosening. This study compared oscillating saws to burrs in terms of temperature generation and histologic damage. Use of irrigation to reduce bone temperature was also investigated. METHODS Temperatures were recorded during sawing and burring with or without irrigation (uncooled or cooled). Histologic analyses were then carried out. Differences between groups were tested statistically (α = 0.05). RESULTS On average, burring produced higher temperatures than sawing (P < .001). When uncooled irrigation was used, bone temperatures were significantly lower in sawed bone than in burred bone (P < .001). Irrigation lowered temperatures and thermal damage depths and increased osteocyte viability (P < .001). CONCLUSION These results suggest that irrigating bone during resection could prevent osteonecrosis onset.
Collapse
Affiliation(s)
- Gwenllian F Tawy
- The Department of Biomedical Engineering, University of Strathclyde, Wolfson Centre, Glasgow, United Kingdom
| | - Philip J Rowe
- The Department of Biomedical Engineering, University of Strathclyde, Wolfson Centre, Glasgow, United Kingdom
| | - Philip E Riches
- The Department of Biomedical Engineering, University of Strathclyde, Wolfson Centre, Glasgow, United Kingdom
| |
Collapse
|
12
|
Sellani G, Fernandes D, Nahari A, de Oliveira MF, Valois C, Pereira WCA, Machado CB. Assessing heating distribution by therapeutic ultrasound on bone phantoms and in vitro human samples using infrared thermography. J Ther Ultrasound 2016; 4:13. [PMID: 27051520 PMCID: PMC4820859 DOI: 10.1186/s40349-016-0058-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 03/29/2016] [Indexed: 11/17/2022] Open
Abstract
Background Bioheat models have been proposed to predict heat distribution in multilayered biological tissues after therapeutic ultrasound (TUS) stimulation. However, evidence on its therapeutic benefit is still controversial for many clinical conditions. The aim of this study was to evaluate and to compare the TUS heating distribution on commercially available bone phantoms and in vitro femur and tibia human samples, at 1 MHz and several ultrasonic pulse regimens, by means of a thermographic image processing technique. Methods An infrared camera was used to capture an image after each 5-min 1-MHz TUS stimulation on bone phantoms, as well as in vitro femur and tibia samples (N = 10). An intensity-based processing algorithm was applied to estimate temperature distribution. Sections of five femurs in the coronal plane were also used for the evaluation of heat distribution inside the medullar canal. Results Temperature increased up to 8.2 and 9.8 °C for the femur and tibia, respectively. Moreover, the temperature increased up to 10.8 °C inside the medullar canal. Although temperature distributions inside the region of interest (ROI) were significantly different (p < 0.001), the average and standard deviation values for bone phantoms were more similar to the femur than to the tibia samples. Pulsed regimens caused lower increments in temperature than continuous sonication, as expected. Conclusions Commercially available bone phantoms could be used in research focusing on thermal effects of ultrasound. Small differences in mean and standard deviation temperatures were observed between bone samples and phantoms. Temperature can reach more than 10 °C inside the medullar canal on a fixed probe position which may lead to severe cellular damage.
Collapse
Affiliation(s)
- Gabriella Sellani
- Biomedical Ultrasound Laboratory (Applied Research Department), Estácio de Sá University, Rua do Bispo, n. 83 - Block F, Rio Comprido, Rio de Janeiro 20261-063 Brazil
| | - Dalila Fernandes
- Biomedical Ultrasound Laboratory (Applied Research Department), Estácio de Sá University, Rua do Bispo, n. 83 - Block F, Rio Comprido, Rio de Janeiro 20261-063 Brazil
| | - Abigail Nahari
- Biomedical Ultrasound Laboratory (Applied Research Department), Estácio de Sá University, Rua do Bispo, n. 83 - Block F, Rio Comprido, Rio de Janeiro 20261-063 Brazil
| | - Melissa Fabrício de Oliveira
- Biomedical Ultrasound Laboratory (Applied Research Department), Estácio de Sá University, Rua do Bispo, n. 83 - Block F, Rio Comprido, Rio de Janeiro 20261-063 Brazil
| | - Christiana Valois
- Globus Sports and Health Technology, Via Vittorio Veneto, 52, 31013 Codognè, TV Itália
| | - Wagner C A Pereira
- Biomedical Engineering Program, COPPE/Federal University of Rio de Janeiro, Av. Horácio Macedo, 2030. Technology Center, Block H - Room H327, Cidade Universitária, Rio de Janeiro, 21941-914 Brazil
| | - Christiano B Machado
- Biomedical Ultrasound Laboratory (Applied Research Department), Estácio de Sá University, Rua do Bispo, n. 83 - Block F, Rio Comprido, Rio de Janeiro 20261-063 Brazil
| |
Collapse
|
13
|
Mont MA, Cherian JJ, Sierra RJ, Jones LC, Lieberman JR. Nontraumatic Osteonecrosis of the Femoral Head: Where Do We Stand Today? A Ten-Year Update. J Bone Joint Surg Am 2015; 97:1604-27. [PMID: 26446969 DOI: 10.2106/jbjs.o.00071] [Citation(s) in RCA: 308] [Impact Index Per Article: 34.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
➤ Although multiple theories have been proposed, no one pathophysiologic mechanism has been identified as the etiology for the development of osteonecrosis of the femoral head. However, the basic mechanism involves impaired circulation to a specific area that ultimately becomes necrotic.➤ A variety of nonoperative treatment regimens have been evaluated for the treatment of precollapse disease, with varying success. Prospective, multicenter, randomized trials are needed to evaluate the efficacy of these regimens in altering the natural history of the disease.➤ Joint-preserving procedures are indicated in the treatment of precollapse disease, with several studies showing successful outcomes at mid-term and long-term follow-up.➤ Studies of total joint arthroplasty, once femoral head collapse is present, have described excellent outcomes at greater than ten years of follow-up, which is a major advance and has led to a paradigm shift in treating these patients.➤ The results of hemiresurfacing and total resurfacing arthroplasty have been suboptimal, and these procedures have restricted indications in patients with osteonecrosis of the femoral head.
Collapse
Affiliation(s)
- Michael A Mont
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215. E-mail address for M.A. Mont:
| | - Jeffrey J Cherian
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215. E-mail address for M.A. Mont:
| | - Rafael J Sierra
- Mayo Clinic, 200 First Street S.W., Gonda 14 South, Rochester, MN 55905
| | - Lynne C Jones
- Department of Orthopaedic Surgery, Johns Hopkins University, 601 North Caroline Street, JHOC 5245, Baltimore, MD 21287
| | - Jay R Lieberman
- Keck Medical Center of University of Southern California, 1520 San Pablo Street, Suite 2000, Los Angeles, CA 90033
| |
Collapse
|
14
|
Livingston A, Wang T, Christou C, Pelletier MH, Walsh WR. The Effect of Saline Coolant on Temperature Levels during Decortication with a Midas Rex: An in Vitro Model Using Sheep Cervical Vertebrae. Front Surg 2015; 2:37. [PMID: 26284253 PMCID: PMC4521100 DOI: 10.3389/fsurg.2015.00037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 07/17/2015] [Indexed: 11/13/2022] Open
Abstract
Decortication of bone with a high-speed burr in the absence of coolant may lead to local thermal necrosis and decreased healing ability, which may negatively impact clinical outcome. Little data are available on the impact of applying a coolant during the burring process. This study aims to establish an in vitro model to quantitatively assess peak temperatures during endplate preparation with a high-speed burr. Six sheep cervical vertebrae were dissected and mounted. Both end plates were used to give a total of 12 sites. Two thermocouples were inserted into each vertebra, 2 mm below the end plate surface and a thermal camera set up to measure surface temperature. A 3 mm high-pneumatic speed burr (Midas Rex, Medtronic, Fort Worth, TX, USA) was used to decorticate the bone in a side to side sweeping pattern, using a matchstick burr (M-8/9MH30) with light pressure. This procedure was repeated while dripping saline onto the burr and bone. Data were compared between groups using a Student's t-test. Application of coolant at the bone-burr interface during decortication resulted in a significant decrease in final temperature. Without coolant, maximum temperatures 2 mm from the surface were not sufficient to cause thermal osteonecrosis, although peak surface temperatures would cause local damage. The use of a high-speed burr provides a quick and an effective method of vertebral end plate preparation. Thermal damage to the bone can be minimized through the use of light pressure and saline coolant. This has implications for any bone preparation performed with a high-speed burr.
Collapse
Affiliation(s)
- Asher Livingston
- Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical School, University of New South Wales , Sydney, NSW , Australia
| | - Tian Wang
- Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical School, University of New South Wales , Sydney, NSW , Australia
| | - Chris Christou
- Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical School, University of New South Wales , Sydney, NSW , Australia
| | - Matthew H Pelletier
- Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical School, University of New South Wales , Sydney, NSW , Australia
| | - William R Walsh
- Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical School, University of New South Wales , Sydney, NSW , Australia
| |
Collapse
|
15
|
Rashad A, Sadr-Eshkevari P, Heiland M, Smeets R, Hanken H, Gröbe A, Assaf AT, Köhnke RH, Mehryar P, Riecke B, Wikner J. Intraosseous heat generation during sonic, ultrasonic and conventional osteotomy. J Craniomaxillofac Surg 2015; 43:1072-7. [PMID: 26116310 DOI: 10.1016/j.jcms.2015.05.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 05/23/2015] [Accepted: 05/26/2015] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVES To assess heat generation in osteotomies during application of sonic and ultrasonic saws compared to conventional bur. METHODS Two glass-fiber isolated nickel-chromium thermocouples, connected to a recording device, were inserted into fresh bovine rib bone blocks and kept in 20 ± 0.5 °C water at determined depths of 1.5 mm (cortical layer) and 7 mm (cancellous layer) and 1.0 mm away from the planned osteotomy site. Handpieces, angulated 24-32°, were mounted in a vertical drill stand, and standardized weights were attached to their tops to exert loads of 5, 8, 15 and 20 N. Irrigation volumes of 20, 50 and 80 ml/min were used for each load. Ten repetitions were conducted using new tips each time for each test condition. The Mann-Whitney-U test was used for statistical analysis (p < 0.05). RESULTS Both ultrasonic and sonic osteotomies were associated with significantly lower heat generation than conventional osteotomy (p < 0.01). Sonic osteotomy showed non-significantly lower heat generation than ultrasonic osteotomy. Generated heat never exceeded the critical limit of 47 °C in any system. Variation of load had no effect on heat generation in both bone layers for all tested systems. An increased irrigation volume resulted in lower temperatures in both cortical and cancellous bone layers during all tested osteotomies. CONCLUSION Although none of the systems under the conditions of the present study resulted in critical heat generation, the application of ultrasonic and sonic osteotomy systems was associated with lower heat generation compared to the conventional saw osteotomy. Copious irrigation seems to play a critical role in preventing heat generation in the osteotomy site.
Collapse
Affiliation(s)
- Ashkan Rashad
- Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Dr. Max Heiland; MD, DMD, PhD), University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Pooyan Sadr-Eshkevari
- Department of Neuroanatomy and Molecular Brain Research, Ruhr-University Bochum, Germany
| | - Max Heiland
- Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Dr. Max Heiland; MD, DMD, PhD), University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Ralf Smeets
- Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Dr. Max Heiland; MD, DMD, PhD), University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Henning Hanken
- Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Dr. Max Heiland; MD, DMD, PhD), University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Alexander Gröbe
- Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Dr. Max Heiland; MD, DMD, PhD), University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Alexandre T Assaf
- Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Dr. Max Heiland; MD, DMD, PhD), University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Robert H Köhnke
- Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Dr. Max Heiland; MD, DMD, PhD), University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Pouyan Mehryar
- Department of Neuroanatomy and Molecular Brain Research, Ruhr-University Bochum, Germany
| | - Björn Riecke
- Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Dr. Max Heiland; MD, DMD, PhD), University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Johannes Wikner
- Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Dr. Max Heiland; MD, DMD, PhD), University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| |
Collapse
|
16
|
Dolan EB, Vaughan TJ, Niebur GL, Casey C, Tallon D, McNamara LM. How bone tissue and cells experience elevated temperatures during orthopaedic cutting: an experimental and computational investigation. J Biomech Eng 2014; 136:021019. [PMID: 24317222 DOI: 10.1115/1.4026177] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 12/09/2013] [Indexed: 11/08/2022]
Abstract
During orthopaedic surgery elevated temperatures due to cutting can result in bone injury, contributing to implant failure or delayed healing. However, how resulting temperatures are experienced throughout bone tissue and cells is unknown. This study uses a combination of experiments (forward-looking infrared (FLIR)) and multiscale computational models to predict thermal elevations in bone tissue and cells. Using multiple regression analysis, analytical expressions are derived allowing a priori prediction of temperature distribution throughout bone with respect to blade geometry, feed-rate, distance from surface, and cooling time. This study offers an insight into bone thermal behavior, informing innovative cutting techniques that reduce cellular thermal damage.
Collapse
|
17
|
Baker RP, Whitehouse MR, Maclean A, Blom AW, Bannister GC. The thermal effects of lavage on 57 ox femoral heads prepared for hip resurfacing arthroplasty. Acta Orthop 2013; 84:448-52. [PMID: 24079554 PMCID: PMC3822128 DOI: 10.3109/17453674.2013.845812] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Previously, we have documented surface temperatures recorded by thermography great enough to cause osteonecrosis of the femoral head during hip resurfacing. We now performed an in vitro investigation with 3 questions: (1) whether water irrigation reduced bone surface temperature, (2) whether external bone temperatures were similar to core temperatures, and (3) whether blunting of the reamer affected temperature generation. METHODS Using an ox-bone model, 57 femoral heads were peripherally reamed. The surface temperatures of bone were measured using a thermal camera and internal bone temperatures were measured using 2 theromocouples. We measured the effects of cooling with water at room temperature and with ice-cooled water. Progressive blunting of reamers was assessed over the 57 experiments. RESULTS Mean and maximum temperatures generated during peripheral reaming were greater when no irrigation was used. Ice-cold saline protected femoral heads from thermal damage. External bone temperatures were much greater than internal temperatures, which were not sufficiently elevated to cause osteonecrosis regardless of lavage. Blunting of the reamer was not found to have a statistically significant effect in this study. INTERPRETATION Cooling with ice-cooled water is recommended. Internal bone temperatures are not elevated despite the high surface temperatures reached during femoral head resurfacing.
Collapse
Affiliation(s)
- Richard P Baker
- The Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK
| | | | - Angus Maclean
- The Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK
| | - Ashley W Blom
- The Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK
| | | |
Collapse
|
18
|
McCann PA, Sarangi PP, Baker RP, Blom AW, Amirfeyz R. Thermal damage during humeral reaming in total shoulder resurfacing. INTERNATIONAL JOURNAL OF SHOULDER SURGERY 2013; 7:100-4. [PMID: 24167401 PMCID: PMC3807943 DOI: 10.4103/0973-6042.118910] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Total shoulder resurfacing (TSR) provides a reliable solution for the treatment of glenohumeral arthritis. It confers a number of advantages over traditional joint replacement with stemmed humeral components, in terms of bone preservation and improved joint kinematics. This study aimed to determine if humeral reaming instruments produce a thermal insult to subchondral bone during TSR. PATIENTS AND METHODS This was tested in vivo on 13 patients (8 with rheumatoid arthritis and 5 with osteoarthritis) with a single reaming system and in vitro with three different humeral reaming systems on saw bone models. Real-time infrared thermal video imaging was used to assess the temperatures generated. RESULTS Synthes (Epoca) instruments generated average temperatures of 40.7°C (SD 0.9°C) in the rheumatoid group and 56.5°C (SD 0.87°C) in the osteoarthritis group (P = 0.001). Irrigation with room temperature saline cooled the humeral head to 30°C (SD 1.2°C). Saw bone analysis generated temperatures of 58.2°C (SD 0.79°C) in the Synthes (Epoca) 59.9°C (SD 0.81°C) in Biomet (Copeland) and 58.4°C (SD 0.88°C) in the Depuy Conservative Anatomic Prosthesis (CAP) reamers (P = 0.12). CONCLUSION Humeral reaming with power driven instruments generates considerable temperatures both in vivo and in vitro. This paper demonstrates that a significant thermal effect beyond the 47°C threshold needed to induce osteonecrosis is observed with humeral reamers, with little variation seen between manufacturers. Irrigation with room temperature saline cools the reamed bone to physiological levels and should be performed regularly during this step in TSR.
Collapse
Affiliation(s)
- Philip A. McCann
- Department of Trauma and Orthopaedics, Bristol Royal Infirmary, Upper Maudlin Street, Bristol, BS2 8HW, UK
| | - Partha P. Sarangi
- Department of Trauma and Orthopaedics, Bristol Royal Infirmary, Upper Maudlin Street, Bristol, BS2 8HW, UK
| | - Richard P. Baker
- The Avon Orthopaedic Centre, Southmead Hospital, Bristol, BS10 5NB, UK
| | - Ashley W. Blom
- The Avon Orthopaedic Centre, Southmead Hospital, Bristol, BS10 5NB, UK
| | - Rouin Amirfeyz
- Department of Trauma and Orthopaedics, Bristol Royal Infirmary, Upper Maudlin Street, Bristol, BS2 8HW, UK
| |
Collapse
|
19
|
Smith AJ, Dieppe P, Howard PW, Blom AW. Failure rates of metal-on-metal hip resurfacings: analysis of data from the National Joint Registry for England and Wales. Lancet 2012; 380:1759-66. [PMID: 23036895 DOI: 10.1016/s0140-6736(12)60989-1] [Citation(s) in RCA: 207] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Implant survival after conventional total hip replacement (THR) is often poor in younger patients, so alternatives such as hip resurfacing, with various sizes to fit over the femoral head, have been explored. We assessed the survival of different sizes of metal-on-metal resurfacing in men and women, and compared this survival with those for conventional stemmed THRs. METHODS We analysed the National Joint Registry for England and Wales (NJR) for primary THRs undertaken between 2003 and 2011. Our analysis involved multivariable flexible parametric survival models to estimate the covariate-adjusted cumulative incidence of revision adjusting for the competing risk of death. FINDINGS The registry included 434,560 primary THRs, of which 31,932 were resurfacings. In women, resurfacing resulted in worse implant survival than did conventional THR irrespective of head size. Predicted 5-year revision rates in 55-year-old women were 8·3% (95% CI 7·2-9·7) with a 42 mm resurfacing head, 6·1% (5·3-7·0) with a 46 mm resurfacing head, and 1·5% (0·8-2·6) with a 28 mm cemented metal-on-polyethylene stemmed THR. In men with smaller femoral heads, resurfacing resulted in poor implant survival. Predicted 5-year revision rates in 55-year-old men were 4·1% (3·3-4·9) with a 46 mm resurfacing head, 2·6% (2·2-3·1) with a 54 mm resurfacing head, and 1·9% (1·5-2·4) with a 28 mm cemented metal-on-polyethylene stemmed THR. Of male resurfacing patients, only 23% (5085 of 22076) had head sizes of 54 mm or above. INTERPRETATION Hip resurfacing only resulted in similar implant survivorship to other surgical options in men with large femoral heads, and inferior implant survivorship in other patients, particularly women. We recommend that resurfacing is not undertaken in women and that preoperative measurement is used to assess suitability in men. Before further new implant technology is introduced we need to learn the lessons from resurfacing and metal-on-metal bearings. FUNDING National Joint Registry for England and Wales.
Collapse
Affiliation(s)
- Alison J Smith
- Orthopaedic Surgery, Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | | | | | | |
Collapse
|
20
|
Abstract
BACKGROUND Metal-on-metal bearing with cemented femoral component and cementless acetabular fixation is the current standard in surface replacement arthroplasty (RSA) of the hip. Because of concerns about the long-term survivorship of cemented stems in conventional hip arthroplasty, it seems logical to achieve cementless fixation on the femoral side with RSA. QUESTIONS/PURPOSES The goals of this review were to evaluate clinical and radiological data reported from previously published cementless RSA series. In addition, we intend to review author's preliminary experience with Conserve Plus cementless devices specifically assessing the clinical outcomes, the complications rate, the survivorship, and the metallic ions levels measured in follow-up. METHODS A references search was done with PubMed using the key words "cementless hip resurfacing", "cementless hip resurfacing prosthesis", and "femoral cementless hip resurfacing". Additionally, the clinical outcomes, the complications rate, the survivorship, and the metallic ions levels were measured in 94 cementless Conserve Plus(©) devices in 90 patients (68 males and 22 females) with a mean age of 41.1 years (18-59). Mean follow-up was 13.1 months (8-16). RESULTS No revision was performed during the observed follow-up. Neither radiological signs of loosening nor neck narrowing >10% were evident. Chromium and cobalt levels in whole blood samples rose respectively from 0.53 μg/l (0.1-1.7) to 1.7 μg/l (0.6-2.9) and from 0.54 μg/l (0.1-1.4) to 1.98 μg/l (0.1-2.8). CONCLUSIONS Cementless "fit and fill" femoral-side fixation, which seems to be potentially evolved and design-related, should be considered for future hip-resurfacing device generations.
Collapse
Affiliation(s)
- Julien Girard
- Department of Orthopaedic Surgery, Roger Salengro Hospital, University of Lille, 2 avenue Oscar Lambret, Lille, France
- Department of Sports Medicine, University of Lille 2, Lille cedex, 59037 France
| |
Collapse
|