Good short-term outcome of primary total hip arthroplasty with cementless bioactive glass ceramic bottom-coated implants: 109 hips followed for 3–9 years

The Exosome-Mediated Bone Regeneration: An Advanced Horizon Toward the Isolation, Engineering, Carrying Modalities, and Mechanisms

Exosomes, nanoparticles secreted by various cells, composed of a bilayer lipid membrane, and containing bioactive substances such as proteins, nucleic acids, metabolites, etc., have been intensively investigated in tissue engineering owing to their high biocompatibility and versatile biofunction. However, there is still a lack of a high-quality review on bone defect regeneration potentiated by exosomes. In this review, the biogenesis and isolation methods of exosomes are first introduced. More importantly, the engineered exosomes of the current state of knowledge are discussed intensively in this review. Afterward, the biomaterial carriers of exosomes and the mechanisms of bone repair elucidated by compelling evidence are presented. Thus, future perspectives and concerns are revealed to help devise advanced modalities based on exosomes to overcome the challenges of bone regeneration. It is totally believed this review will attract special attention from clinicians and provide promising ideas for their future works.

Long-term outcome of primary total hip arthroplasty with cementless bioactive glass ceramic bottom-coated implants and highly cross-linked polyethylene: A minimum 10-year analysis

BACKGROUND

Cementless glass ceramics containing apatite and wollastonite (AW-GC) bottom-coated titanium hip implants were developed; early excellent clinical and radiographic results have been reported previously. This study aimed to investigate the long-term clinical and radiographic outcomes in detail, and the wear rate of HXLPE.

METHODS

We retrospectively evaluated 99 patients (117 hips) between November 2001 and December 2007. The survival rate was estimated using the Kaplan-Meier method. Hip joint function was evaluated using the Japanese Orthopaedic Association (JOA) score. The extent of radiographic signs was determined from the radiographs performed at the last follow-up. Polyethylene wear was measured using Martell's Hip Analysis Suite. We assessed the possible factors affecting the steady-state linear wear rate.

RESULTS

The mean follow-up period was 14.8 ± 2.1 (10-18.6) years. The mean JOA score improved to 88.7 ± 9.4 (59-100) at the final follow-up from 47.8 ± 12.5 (17-76) before surgery. The overall survival rate with the end point of all-cause revision and wear-related revision was 99% and 100% respectively. There was no osteolysis or loosening of either the acetabular or femoral component. All hips were classified as having bone ingrowth fixation. The mean steady-state wear rate was 0.008 ± 0.025 mm/year. We found no significant correlation between the wear rate and age, body weight, body mass index, cup inclination and femoral head size.

CONCLUSION

The combination of AW-GC bottom-coated implants and HXLPE showed excellent implant survival and wear resistance for 15 years.

Minimum 10-Year Wear Analysis of Highly Cross-Linked Polyethylene in Cementless Total Hip Arthroplasty

Fifty-four patients (64 hips) underwent cementless total hip arthroplasty between 2000 and 2003 with a 22-mm zirconia ceramic bearing on highly cross-linked polyethylene, and were evaluated with a mean 11.9-year postoperative follow-up (range, 10-14 years). Linear wear was measured on the anteroposterior radiograph of the hip. No evidence of osteolysis and loosening was found on the final radiograph in any of the cases, and the steady-state linear wear rate was 0.017±0.018 mm/year. No significant correlation was found between the linear wear rate and age, body weight, cup inclination angle, or polyethylene thickness. Highly cross-linked polyethylene showed excellent wear resistance for >10 years when used in combination with 22-mm zirconia heads.

Short-term outcome of ceramic-on-ceramic total hip replacement in young adult patients

Background: Ceramic-on-ceramic (CoC) total hip replacement (THR) was developed to minimize debris and osteolytic reaction. The major concern is its brittleness. The aim of this study was to evaluate the short-term outcome of CoC THR in young adult patients. Methods: 11 patients, 13 THR procedures, were followed up until six months after surgery in Cipto Mangunkusumo Hospital. Evaluation included Harris hip score (HHS), visual analog scale (VAS), patients’ complaint, short form-36 (SF-36), and acetabular and femoral component angles. Data were analyzed using Wilcoxon signed rank test, paired t-test, and Spearman test. Results: The average age of the patients was 33.6 years old and 55% of them were female. Systemic lupus erythematosus was the main causative disease for THR. The VAS average decreased before surgery and after six months of surgery (5 to 1). Pre- and post-operative HHS and SF-36 increased significantly by (25 to 92) and (21 to 54) respectively. Squeaking sound was reported by two patients. No correlation was found between acetabular and femoral component and squeaking incidence.Conclusion: CoC THR showed excellent short term outcome for young adult patients. With proper indications, CoC THR ensures excellent clinical outcomes and promising survivorship.