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Kaptein BL, Pijls B, Koster L, Kärrholm J, Hull M, Niesen A, Heesterbeek P, Callary S, Teeter M, Gascoyne T, Röhrl SM, Flivik G, Bragonzoni L, Laende E, Sandberg O, Solomon LB, Nelissen R, Stilling M. Guideline for RSA and CT-RSA implant migration measurements: an update of standardizations and recommendations. Acta Orthop 2024; 95:256-267. [PMID: 38819193 PMCID: PMC11141406 DOI: 10.2340/17453674.2024.40709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 04/08/2024] [Indexed: 06/01/2024] Open
Abstract
Opening remarks: These guidelines are the result of discussions within a diverse group of RSA researchers. They were approved in December 2023 by the board and selected members of the International Radiostereometry Society to update the guidelines by Valstar et al. [1]. By adhering to these guidelines, RSA studies will become more transparent and consistent in execution, presentation, reporting, and interpretation. Both authors and reviewers of scientific papers using RSA may use these guidelines, summarized in the Checklist, as a reference. Deviations from these guidelines should have the underlying rationale stated.
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Affiliation(s)
- Bart L Kaptein
- Department of Orthopedics, Leiden University Medical Center, Leiden, The Netherlands.
| | - Bart Pijls
- Department of Orthopedics, Leiden University Medical Center, Leiden, The Netherlands
| | - Lennard Koster
- Department of Orthopedics, Leiden University Medical Center, Leiden, The Netherlands
| | - Johan Kärrholm
- Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Maury Hull
- Orthopedic Surgery Department, University of California, Davis, United States
| | - Abby Niesen
- Orthopedic Surgery Department, University of California, Davis, United States
| | - Petra Heesterbeek
- Orthopedic Research Department, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Stuart Callary
- Department of Orthopedics and Trauma, Royal Adelaide Hospital, Adelaide, Australia
| | - Matthew Teeter
- Department of Medical Biophysics, Western University, London, Canada
| | | | - Stephan M Röhrl
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Gunnar Flivik
- Department of Orthopedics, Skane University Hospital, Lund, Sweden
| | | | - Elise Laende
- Department of Surgery, Dalhousie University, Halifax, Canada
| | | | - L Bogdan Solomon
- Department of Orthopedics and Trauma, Royal Adelaide Hospital, Adelaide, Australia
| | - Rob Nelissen
- Department of Orthopedics, Leiden University Medical Center, Leiden, The Netherlands
| | - Maiken Stilling
- Department of Orthopedics, Aarhus University Hospital, Aarhus, Denmark
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Angelomenos V, Mohaddes M, Kärrholm J, Malchau H, Shareghi B, Itayem R. A prospective randomized study of Refobacin Bone Cement R versus Palacos R + G. Bone Joint J 2024; 106-B:435-441. [PMID: 38688480 DOI: 10.1302/0301-620x.106b5.bjj-2023-0999.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Aims Refobacin Bone Cement R and Palacos R + G bone cement were introduced to replace the original cement Refobacin Palacos R in 2005. Both cements were assumed to behave in a biomechanically similar fashion to the original cement. The primary aim of this study was to compare the migration of a polished triple-tapered femoral stem fixed with either Refobacin Bone Cement R or Palacos R + G bone cement. Repeated radiostereometric analysis was used to measure migration of the femoral head centre. The secondary aims were evaluation of cement mantle, stem positioning, and patient-reported outcome measures. Methods Overall, 75 patients were included in the study and 71 were available at two years postoperatively. Prior to surgery, they were randomized to one of the three combinations studied: Palacos cement with use of the Optivac mixing system, Refobacin with use of the Optivac system, and Refobacin with use of the Optipac system. Cemented MS30 stems and cemented Exceed acetabular components were used in all hips. Postoperative radiographs were used to assess the quality of the cement mantle according to Barrack et al, and the position and migration of the femoral stem. Harris Hip Score, Oxford Hip Score, Forgotten Joint Score, and University of California, Los Angeles Activity Scale were collected. Results Median distal migration (y-axis) at two years for the Refobacin-Optivac system was -0.79 mm (-2.01 to -0.09), for the Refobacin-Optipac system was -0.75 mm (-2.16 to 0.20), and for the Palacos-Optivac system was -1.01 mm (-4.31 to -0.29). No statistically significant differences were found between the groups. Secondary outcomes did not differ statistically between the groups at the two-year follow-up. Conclusion At two years, we found no significant differences in distal migration or clinical outcomes between the three groups. Our data indicate that Refobacin Bone Cement R and Palacos R + G are comparable in terms of stable fixation and early clinical outcomes.
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Affiliation(s)
- Vasileios Angelomenos
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Hand Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Maziar Mohaddes
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Johan Kärrholm
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Henrik Malchau
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Bita Shareghi
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Raed Itayem
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
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Callary SA, Broekhuis D, Barends J, Ramasamy B, Nelissen RGHH, Solomon LB, Kaptein BL. Virtual biomechanical assessment of porous tantalum and custom triflange components in the treatment of patients with acetabular defects and pelvic discontinuity. Bone Joint J 2024; 106-B:74-81. [PMID: 38688495 DOI: 10.1302/0301-620x.106b5.bjj-2023-0852.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Aims The aim of this study was to compare the biomechanical models of two frequently used techniques for reconstructing severe acetabular defects with pelvic discontinuity in revision total hip arthroplasty (THA) - the Trabecular Metal Acetabular Revision System (TMARS) and custom triflange acetabular components (CTACs) - using virtual modelling. Methods Pre- and postoperative CT scans from ten patients who underwent revision with the TMARS for a Paprosky IIIB acetabular defect with pelvic discontinuity were retrospectively collated. Computer models of a CTAC implant were designed from the preoperative CT scans of these patients. Computer models of the TMARS reconstruction were segmented from postoperative CT scans using a semi-automated method. The amount of bone removed, the implant-bone apposition that was achieved, and the restoration of the centre of rotation of the hip were compared between all the actual TMARS and the virtual CTAC implants. Results The median amount of bone removed for TMARS reconstructions was significantly greater than for CTAC implants (9.07 cm3 (interquartile range (IQR) 5.86 to 21.42) vs 1.16 cm3 (IQR 0.42 to 3.53) (p = 0.004). There was no significant difference between the median overall implant-bone apposition between TMARS reconstructions and CTAC implants (54.8 cm2 (IQR 28.2 to 82.3) vs 56.6 cm2 (IQR 40.6 to 69.7) (p = 0.683). However, there was significantly more implant-bone apposition within the residual acetabulum (45.2 cm2 (IQR 28.2 to 72.4) vs 25.5 cm2 (IQR 12.8 to 44.1) (p = 0.001) and conversely significantly less apposition with the outer cortex of the pelvis for TMARS implants compared with CTAC reconstructions (0 cm2 (IQR 0 to 13.1) vs 23.2 cm2 (IQR 16.4 to 30.6) (p = 0.009). The mean centre of rotation of the hip of TMARS reconstructions differed by a mean of 11.1 mm (3 to 28) compared with CTAC implants. Conclusion In using TMARS, more bone is removed, thus achieving more implant-bone apposition within the residual acetabular bone. In CTAC implants, the amount of bone removed is minimal, while the implant-bone apposition is more evenly distributed between the residual acetabulum and the outer cortex of the pelvis. The differences suggest that these implants used to treat pelvic discontinuity might achieve short- and long-term stability through different biomechanical mechanisms.
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Affiliation(s)
- Stuart A Callary
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, Australia
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, Australia
| | - Demien Broekhuis
- Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Boopalan Ramasamy
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, Australia
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, Australia
| | - Rob G H H Nelissen
- Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Lucian B Solomon
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, Australia
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, Australia
| | - Bart L Kaptein
- Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
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Fallahnezhad K, Callary SA, O'Rourke D, Bahl JS, Thewlis D, Solomon LB, Taylor M. Corroboration of coupled musculoskeletal model and finite element predictions with in vivo RSA migration of an uncemented acetabular component. J Orthop Res 2024; 42:373-384. [PMID: 37526382 DOI: 10.1002/jor.25671] [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] [Received: 12/20/2022] [Revised: 06/18/2023] [Accepted: 07/26/2023] [Indexed: 08/02/2023]
Abstract
While finite element (FE) models have been used extensively in orthopedic studies, validation of their outcome metrics has been limited to comparison against ex vivo testing. The aim of this study was to validate FE model predictions of the initial cup mechanical environment against patient-matched in vivo measurements of acetabular cup migration using radiostereometric analysis (RSA). Tailored musculoskeletal and FE models were developed using a combination of three-dimensional (3D) motion capture data and clinical computerized tomography (CT) scans for a cohort of eight individuals who underwent primary total hip replacement and were prospectively enrolled in an RSA study. FE models were developed to calculate the mean modulus of cancellous bone, composite peak micromotion (CPM), composite peak strain (CPS) and percentage area of bone ingrowth. The RSA cup migration at 3 months was used to corroborate the FE output metrics. Qualitatively, all FE-predicted metrics followed a similar rank order as the in vivo RSA 3D migration data. The two cases with the lowest predicted CPM (<20 µm), lowest CPS (<0.0041), and high bone modulus (>917 MPa) were confirmed to have the lowest in vivo RSA 3D migration (<0.14 mm). The two cases with the largest predicted CPM (>80 µm), larger CPS (>0.0119) and lowest bone modulus (<472 MPa) were confirmed to have the largest in vivo RSA 3D migration (>0.78 mm). This study enabled the first corroboration between tailored musculoskeletal and FE model predictions with in vivo RSA cup migration. Investigation of additional patient-matched CT, gait, and RSA examinations may allow further development and validation of FE models.
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Affiliation(s)
- Khosro Fallahnezhad
- Medical Device Research Institute, College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia
| | - Stuart A Callary
- Centre for Orthopaedics and Trauma Research (COTR), The University of Adelaide, Adelaide, South Australia, Australia
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Dermot O'Rourke
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Jasvir S Bahl
- Centre for Orthopaedics and Trauma Research (COTR), The University of Adelaide, Adelaide, South Australia, Australia
| | - Dominic Thewlis
- Centre for Orthopaedics and Trauma Research (COTR), The University of Adelaide, Adelaide, South Australia, Australia
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Lucian B Solomon
- Centre for Orthopaedics and Trauma Research (COTR), The University of Adelaide, Adelaide, South Australia, Australia
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Mark Taylor
- Medical Device Research Institute, College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia
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Christensson A, Nemati HM, Flivik G. Comparison between model-based RSA and an AI-based CT-RSA: an accuracy study of 30 patients. Acta Orthop 2024; 95:39-46. [PMID: 38284788 PMCID: PMC10824248 DOI: 10.2340/17453674.2024.35749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 11/16/2023] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND AND PURPOSE Radiostereometry (RSA) is the current gold standard for evaluating early implant migration. CT-based migration analysis is a promising method, with fewer handling requirements compared with RSA and no need for implanted bone-markers. We aimed to evaluate agreement between a new artificial intelligence (AI)-based CT-RSA and model-based RSA (MBRSA) in measuring migration of cup and stem in total hip arthroplasty (THA). PATIENTS AND METHODS 30 patients with THA for primary osteoarthritis (OA) were included. RSA examinations were performed on the first postoperative day, and at 2 weeks, 3 months, 1, 2, and 5 years after surgery. A low-dose CT scan was done at 2 weeks and 5 years. The agreement between the migration results obtained from MBRSA and AI-based CT-RSA was assessed using Bland-Altman plots. RESULTS Stem migration (y-translation) between 2 weeks and 5 years, for the primary outcome measure, was -0.18 (95% confidence interval [CI] -0.31 to -0.05) mm with MBRSA and -0.36 (CI -0.53 to -0.19) mm with AI-based CT-RSA. Corresponding proximal migration of the cup (y-translation) was 0.06 (CI 0.02-0.09) mm and 0.02 (CI -0.01 to 0.05) mm, respectively. The mean difference for all stem and cup comparisons was within the range of MBRSA precision. The AI-based CT-RSA showed no intra- or interobserver variability. CONCLUSION We found good agreement between the AI-based CT-RSA and MBRSA in measuring postoperative implant migration. AI-based CT-RSA ensures user independence and delivers consistent results.
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Affiliation(s)
- Albin Christensson
- Department of Orthopedics, Skåne University Hospital, Clinical Sciences, Lund University, Lund.
| | | | - Gunnar Flivik
- Department of Orthopedics, Skåne University Hospital, Clinical Sciences, Lund University, Lund
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Hasan S, van Schie P, Kaptein BL, Schoones JW, Marang-van de Mheen PJ, Nelissen RGHH. Biomarkers to discriminate between aseptic loosened and stable total hip or knee arthroplasties: a systematic review. EFORT Open Rev 2024; 9:25-39. [PMID: 38193539 PMCID: PMC10823569 DOI: 10.1530/eor-22-0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2024] Open
Abstract
Background Loosening is a major cause for failure of total hip and total knee arthroplasties (THAs/TKAs). Preemptive diagnostics of asymptomatic loosening could open strategies to prevent gross loosening. A multitude of biomarkers may discriminate between loosened and stable implants, but it is unknown which have the best performance. The present systematic review aimed to assess which biomarkers have shown the most promising results in discriminating between stable and aseptic loosened THAs and TKAs. Methods PubMed, Embase, Web of Science, Cochrane Library, and Academic Search Premier were systematically searched up to January 2020 for studies including THA/TKA and biomarkers to assess loosening. Two reviewers independently screened records, extracted data, and assessed the risk of bias using the ICROMS tool to classify the quality of the studies. Results Twenty-eight (three high-quality) studies were included, reporting on a median of 48 patients (interquartile range 28-69). Serum and urine markers were evaluated in 22 and 10 studies, respectively. Tumor necrosis factor α and osteocalcin were significantly higher in loosened compared with stable implants. Urinary N-terminal telopeptide had significantly elevated levels in loosened prostheses. Conclusion Several serum and urine markers were promising in discriminating between loosened and stable implants. We recommend future studies to evaluate these biomarkers in a longitudinal fashion to assess whether progression of loosening is associated with a change in these biomarkers. In particular, high-quality studies assessing the usability of these biomarkers are needed.
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Affiliation(s)
- Shaho Hasan
- Department of Orthopaedics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Peter van Schie
- Department of Orthopaedics, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, The Netherlands
| | - Bart L Kaptein
- Department of Orthopaedics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Jan W Schoones
- Walaeus Library, Leiden University Medical Centre, Leiden, The Netherlands
| | - Perla J Marang-van de Mheen
- Department of Orthopaedics, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Safety & Security Science, Delft University of Technology, Delft, The Netherlands
| | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Centre, Leiden, The Netherlands
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Polus JS, Vasarhelyi EM, Lanting BA, Teeter MG. Acetabular cup fixation with and without screws following primary total hip arthroplasty: migration evaluated by radiostereometric analysis. Hip Int 2024; 34:42-48. [PMID: 37016808 PMCID: PMC10787387 DOI: 10.1177/11207000231164711] [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] [Received: 07/18/2022] [Accepted: 02/25/2023] [Indexed: 04/06/2023]
Abstract
BACKGROUND Early cup migration after total hip arthroplasty (THA) is correlated to late revision due to aseptic loosening. However, the use of screws for increased cup stability remains unclear and debated. The purpose of this study is to assess acetabular migration between cups fixated with and without the use of screws. METHODS Patients underwent primary THA using either a direct anterior (DA) or a direct lateral (DL) approach. The DA surgeon routinely supplemented cup fixation with 1 or 2 screws while the DL surgeon used no screws. At 7 follow-up visits up to 2 years post operation, patients underwent radiostereometric analysis (RSA) imaging for implant migration tracking. The primary outcome was defined as proximal cup migration measured with model-based RSA. RESULTS 68 patients were assessed up to 2 years post operation, n = 43 received screws and n = 25 did not. The use of screws had a significant effect on cup migration (p = 0.018). From 2 weeks to 2 years post operation, the total mean migration was 0.403 ± 0.681 mm and 0.129 ± 0.272 mm (p = 0.319) for cups with and without screws, respectively. The number of screws used also had a significant impact, with cups fixated with 1 screw migrating more than cups fixated with 2 (p = 0.013, mean difference 0.712 mm). CONCLUSIONS Acetabular cups fixated with only 1 screw resulted in greater migration than cups with no screws or 2 screws, though the mean magnitude was well under the 1.0 mm threshold for unacceptable migration. However, 3 of the 24 patients who received only 1 screw exceeded the 1.0 mm threshold for unacceptable migration. Ultimately, the results of this study show that the use of 2 screws to supplement cup fixation can provide good implant stability that is equivalent to a secure press-fit component with no screws.Clinical trial registration: ClinicalTrials.gov (NCT03558217).
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Affiliation(s)
- Jennifer S Polus
- School of Biomedical Engineering, Western University, London, Ontario, Canada
- Imaging Research Laboratories, Robarts Research Institute, Western University, London, Ontario, Canada
- School of Biomedical Engineering, Collaborative Specialization in Musculoskeletal Health Research, and Bone and Joint Institute, Western University, Canada
| | - Edward M Vasarhelyi
- Division of Orthopaedic Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Brent A Lanting
- Division of Orthopaedic Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Matthew G Teeter
- School of Biomedical Engineering, Western University, London, Ontario, Canada
- Imaging Research Laboratories, Robarts Research Institute, Western University, London, Ontario, Canada
- School of Biomedical Engineering, Collaborative Specialization in Musculoskeletal Health Research, and Bone and Joint Institute, Western University, Canada
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Cho CH, Pijls BG, Abrahams JM, Roerink A, Katembwe R, Baker A, Solomon LB, Callary SA. Migration patterns of acetabular cups: a systematic review and meta-analysis of RSA studies. Acta Orthop 2023; 94:626-634. [PMID: 38157007 PMCID: PMC10757199 DOI: 10.2340/17453674.2023.24580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 09/21/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND AND PURPOSE We conducted a systematic review and meta-analysis of RSA studies to investigate the early and long-term migration patterns of acetabular cups and the influence of implant factors on cup migration over time. METHODS We performed a systematic search of PubMed, Embase, and Scopus databases to identify all RSA studies of cup migration following primary total hip replacement (THR). Proximal migration at 3 and 6 months, 1, 2, 5, and 10 years were considered for analysis. Implant factors investigated included fixation type, head size, bearing surface, uncemented coating design, and the decade of RSA introduction. RESULTS 47 studies reported the proximal migration of 83 cohorts (2,328 cups). Besides 1 threaded cup design, no implant factor investigated was found to significantly influence proximal migration. The mean pooled 2-year proximal migration of cemented cups (0.14 mm, 95% confidence interval [CI] 0.08-0.20) was not significantly different from uncemented cups (0.12 mm, CI 0.04-0.19). The mean pooled proximal migration at 6 months was 0.11 mm (CI 0.06-0.16) and there was no significant increase between 6 months and 2 years (0.015 mm, CI 0.000-0.030). 27 of 75 cohorts (36%) reported mean proximal migration greater than 0.2 mm at 2 years, which has previously been identified as a predictor of implants at risk of long-term loosening. CONCLUSION Our meta-analysis demonstrated that the majority of cup migration occurs within the first 6 months. With one exception, no implant factors influenced the 2-year proximal migration of acetabular cups. 36% of studies with 2-year migration were considered at risk of long-term loosening. Further investigation and comparison against long-term survivorship data would validate 6-month and/or 1-year proximal migration measurements as an earlier predictor of long-term loosening than the current 2-year threshold.
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Affiliation(s)
- Chan Hee Cho
- Centre for Orthopaedic and Trauma Research, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia.
| | - Bart G Pijls
- Department of Orthopaedics, Leiden University Medical Centre, Leiden, Netherlands
| | - John M Abrahams
- Centre for Orthopaedic and Trauma Research, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia; Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Anne Roerink
- Department of Orthopaedics, Leiden University Medical Centre, Leiden, Netherlands
| | - Raissa Katembwe
- Centre for Orthopaedic and Trauma Research, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Andrew Baker
- Centre for Orthopaedic and Trauma Research, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Lucian B Solomon
- Centre for Orthopaedic and Trauma Research, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia; Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Stuart A Callary
- Centre for Orthopaedic and Trauma Research, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia; Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, SA, Australia
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El-Sahoury JAN, Kjærgaard K, Ovesen O, Hofbauer C, Overgaard S, Ding M. Vitamin E-diffused liners show less head penetration than cross-linked polyethylene liners in total hip arthroplasty: a ten-year multi-arm randomized trial. Bone Joint J 2023; 105-B:1052-1059. [PMID: 37777211 DOI: 10.1302/0301-620x.105b10.bjj-2023-0115.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/02/2023]
Abstract
Aims The primary outcome was investigating differences in wear, as measured by femoral head penetration, between cross-linked vitamin E-diffused polyethylene (vE-PE) and cross-linked polyethylene (XLPE) acetabular component liners and between 32 and 36 mm head sizes at the ten-year follow-up. Secondary outcomes included acetabular component migration and patient-reported outcome measures (PROMs) such as the EuroQol five-dimension questionnaire, 36-Item Short-Form Health Survey, Harris Hip Score, and University of California, Los Angeles Activity Scale (UCLA). Methods A single-blinded, multi-arm, 2 × 2 factorial randomized controlled trial was undertaken. Patients were recruited between May 2009 and April 2011. Radiostereometric analyses (RSAs) were performed from baseline to ten years. Of the 220 eligible patients, 116 underwent randomization, and 82 remained at the ten-year follow-up. Eligible patients were randomized into one of four interventions: vE-PE acetabular liner with either 32 or 36 mm femoral head, and XLPE acetabular liner with either 32 or 36 mm femoral head. Parameters were otherwise identical except for acetabular liner material and femoral head size. Results A total of 116 patients participated, of whom 77 were male. The median ages of the vE-PE 32 mm and 36 mm groups were 65 (interquartile range (IQR) 57 to 67) and 63 years (IQR 56 to 66), respectively, and of the XLPE 32 mm and 36 mm groups were 64 (IQR 58 to 66) and 61 years (IQR 54 to 66), respectively. Mean total head penetration was significantly lower into vE-PE acetabular liner groups than into XLPE acetabular liner groups (-0.219 mm (95% confidence interval -0.348 to -0.090); p = 0.001). There were no differences in wear according to head size, acetabular component migration, or PROMs, except for UCLA. There were no cases of aseptic loosening or failures requiring revision at long-term follow-up. Conclusion Significantly lower wear was observed in vE-PE acetabular liners than in XLPE acetabular liners. No difference in wear was observed between different head size or PROMs except for the UCLA at ten years.
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Affiliation(s)
- Joseph A N El-Sahoury
- Department of Orthopaedic Surgery and Traumatology, and Department of Clinical Research, Orthopaedic Research Laboratory, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Kristian Kjærgaard
- Department of Orthopaedic Surgery and Traumatology, and Department of Clinical Research, Orthopaedic Research Laboratory, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Ole Ovesen
- Department of Orthopaedic Surgery and Traumatology, and Department of Clinical Research, Orthopaedic Research Laboratory, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | | | - Søren Overgaard
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Orthopaedic Surgery & Traumatology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ming Ding
- Department of Orthopaedic Surgery and Traumatology, and Department of Clinical Research, Orthopaedic Research Laboratory, Odense University Hospital, University of Southern Denmark, Odense, Denmark
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Turgeon TR, Righolt CH, Burnell CD, Gascoyne TC, Hedden DR, Bohm ER. Comparison of two hydroxyapatite-coated femoral components: a randomized clinical trial using radiostereometric analysis. Bone Joint J 2023; 105-B:1045-1051. [PMID: 37782569 DOI: 10.1302/0301-620x.105b10.bjj-2023-0427.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
Aims The primary aim of this trial was to compare the subsidence of two similar hydroxyapatite-coated titanium femoral components from different manufacturers. Secondary aims were to compare rotational migration (anteversion/retroversion and varus/valgus tilt) and patient-reported outcome measures between both femoral components. Methods Patients were randomized to receive one of the two femoral components (Avenir or Corail) during their primary total hip arthroplasty between August 2018 and September 2020. Radiostereometric analysis examinations at six, 12, and 24 months were used to assess the migration of each implanted femoral component compared to a baseline assessment. Patient-reported outcome measures were also recorded for these same timepoints. Overall, 50 patients were enrolled (62% male (n = 31), with a mean age of 65.7 years (SD 7.3), and mean BMI of 30.2 kg/m2 (SD 5.2)). Results The two-year subsidence was similar for Avenir (-0.018 mm (95% confidence interval (CI) -0.053 to 0.018) and Corail (0.000 mm (95% CI -0.027 to 0.026; p = 0.428). Both anteversion/retroversion (Avenir 0.139° (95% CI -0.204 to 0.481°); Corail -0.196° (95% CI -0.445 to 0.053°; p = 0.110) and varus/valgus tilt (Avenir -0.024° (95% CI -0.077 to 0.028); Corail -0.049° (95% CI -0.098 to 0.000°; p = 0.473) were not statistically significantly different. After two years, patients reported similar improvements in EuroQol five-dimension five-level health questionnaire (Avenir 0.22 (SD 0.2); Corail 0.22 (SD 0.18); p = 0.965) and other outcomes scores. Patient satisfaction on a five-point Likert scale was also similar between both groups after two years (Avenir 1.38 (SD 0.88); Corail 1.33 (SD 0.57); p = 0.846). Conclusion The performance of both femoral components was similar in terms of stability and patient outcomes.
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Affiliation(s)
- Thomas R Turgeon
- Concordia Joint Replacement Group, Winnipeg, Canada
- Department of Surgery, University of Manitoba, Winnipeg, Canada
| | - Christiaan H Righolt
- Concordia Joint Replacement Group, Winnipeg, Canada
- Orthopaedic Innovation Centre, Winnipeg, Canada
| | - Colin D Burnell
- Concordia Joint Replacement Group, Winnipeg, Canada
- Department of Surgery, University of Manitoba, Winnipeg, Canada
| | | | - David R Hedden
- Concordia Joint Replacement Group, Winnipeg, Canada
- Department of Surgery, University of Manitoba, Winnipeg, Canada
| | - Eric R Bohm
- Concordia Joint Replacement Group, Winnipeg, Canada
- Department of Surgery, University of Manitoba, Winnipeg, Canada
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11
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Yon CJ, Lee KJ, Choi BC, Suh HS, Min BW. The Validation of Two-Dimensional and Three-Dimensional Radiographic Measurements of Host Bone Coverage in Total Hip Arthroplasty for Hip Dysplasia: A Comparison with Intra-Operative Measurements. J Clin Med 2023; 12:6227. [PMID: 37834870 PMCID: PMC10573884 DOI: 10.3390/jcm12196227] [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: 08/30/2023] [Revised: 09/18/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023] Open
Abstract
Several methods have been introduced to measure the host bone coverage of the acetabular component after total hip arthroplasty (THA). The aims of this study were (1) to validate two-dimensional- and three-dimensional-based host bone coverage measurements by comparing intra-operative measurements, and (2) to determine the minimum host bone coverage for achieving stable cup fixation after THA in hip dysplasia. The clinical outcomes of each patient were evaluated during their final follow-up period using the Harris Hip score (HHS). The coverage of the host bone was analyzed by comparing 2D-based, 3D-based, and intraoperative assessments. The mean HHS was increased significantly from 60.84 ± 14.21 pre-operatively to 93.13 ± 4.59 (p < 0.0001). The host bone coverage ratio measured intraoperatively was 83.67 ± 3.40%, while the ratio measured by 3D CT reconstruction was 82.72 ± 3.59%. There was a strong positive correlation between the intra-operative host bone coverage and the 3D-based one (r = 0.826, p < 0.0001). It is recommended that 3D-based measurements are used to evaluate the host bone coverage after THA in patients with hip dysplasia. In addition, achieving a minimum host bone coverage of 75% is recommended for the attainment of stable cup fixation.
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Affiliation(s)
| | | | | | | | - Byung-Woo Min
- Department of Orthopaedic Surgery, School of Medicine & Institute for Medical Science, Keimyung University, Daegu 42601, Republic of Korea; (C.-J.Y.); (K.-J.L.); (B.-C.C.); (H.-S.S.)
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12
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Broekhuis D, Boyle R, Karunaratne S, Chua A, Stalley P. Custom designed and 3D-printed titanium pelvic implants for acetabular reconstruction after tumour resection. Hip Int 2023; 33:905-915. [PMID: 36408844 PMCID: PMC10486168 DOI: 10.1177/11207000221135068] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 07/26/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Reconstructive procedure following resection of large pelvic tumours around the hip joint remains a complex challenge. METHODS This study presents a retrospective case series of patients presenting with benign or malignant pelvic tumour for which an internal hemipelvectomy including the hip joint and subsequent reconstruction with a custom designed 3-dimensional printed titanium pelvic implant (3DPPI) has been performed between August 2013 and January 2018. RESULTS 15 consecutive patients with a median age of 33.9 years (IQR 26.4-72.2) and a median BMI of 20.7 kg/m2 (IQR 19.0-33.3) were reviewed after median follow-up of 33.8 months (IQR 24.0-78.1). The majority of patients presented with a malignant tumour as their principal diagnosis (n = 13, 86.7%). The median surgical time was 5.5 hours (IQR 4.5-8.5) and median peri-operative blood loss was 5000 ml (IQR 2000-10000). The median MSTS score at follow-up was 63.3% (IQR 51.7-86.7%). The median NRS in rest was 0.0 (IQR 0.0-5.0), the median NRS during activity was 2.0 (IQR 0.5-7.0) and the median HOOS-PS was 76.6% (IQR 67.9-91.0). 4 patients had implant-specific complications (n = 4, 26.6%); 1 hip dislocation (Henderson type 1a), 3 structural complications (type 3a), 1 deep infection (type 4a) and 1 local tumour recurrence (type 5b). At follow-up, 4 out of 15 implants were classified as a failure, resulting in an implant survival rate of 73.3%. CONCLUSIONS Acceptable peri-operative outcomes, functional results, complication rates and short-term implant survival can be achieved in a cohort of complex patients undergoing 3DPPI reconstruction after hemipelvectomy including the acetabulum.
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Affiliation(s)
| | - Richard Boyle
- Department of Orthopaedic Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Sascha Karunaratne
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Alfred Chua
- Department of Anaesthetics, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Paul Stalley
- Department of Orthopaedic Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
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13
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Jørgensen PB, Kaptein BL, Søballe K, Jakobsen SS, Stilling M. Five-year polyethylene cup migration and PE wear of the Anatomic Dual Mobility acetabular construct. Arch Orthop Trauma Surg 2023; 143:5957-5965. [PMID: 36802237 PMCID: PMC9942043 DOI: 10.1007/s00402-023-04774-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 01/07/2023] [Indexed: 02/23/2023]
Abstract
INTRODUCTION Dual mobility implants have been successful in reducing postoperative hip dislocation but mid-term results of cup migration and polyethylene wear are missing in the literature. Therefore, we measured migration and wear at 5-year follow-up using radiostereometric analysis (RSA). MATERIALS AND METHODS A cohort of 44 patients (mean age 73, 36 female) with heterogeneous indications for hip arthroplasty but all with a high risk of hip dislocation received total hip replacement (THA) with The Anatomic Dual Mobility X3 monoblock acetabular construct and a highly crosslinked polyethylene liner. RSA images and Oxford Hip Scores were obtained perioperatively and 1, 2, and 5 years postoperatively. Cup migration and polyethylene wear were calculated using RSA. RESULTS Mean 2-year proximal cup translation was 0.26 mm (95% CI 0.17; 0.36). Proximal cup translation was stable from 1- to 5-year follow-up. Mean 2-year cup inclination (z-rotation) was 0.23° (95% CI - 0.22; 0.68) and was greater in patients with osteoporosis compared to patients without osteoporosis (p = 0.04). Using 1-year follow-up as baseline, the 3D polyethylene wear rate was 0.07 mm/year (0.05; 0.10). Oxford hip scores improved 19 (95% CI 14; 24) points from mean 21 (range 4; 39) at baseline, to 40 (9; 48) 2 years postoperatively. There were no progressive radiolucent lines > 1 mm. There was 1 revision for offset correction. CONCLUSIONS Anatomic Dual Mobility monoblock cups were well-fixed, the polyethylene wear rate was low, and the clinical outcomes were good until 5-year follow-up suggesting good implant survival in patients of different age groups and with heterogeneous indications for THA.
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Affiliation(s)
- Peter Bo Jørgensen
- AutoRSA Research Group, Orthopeadic Research Unit, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200, Aarhus N, Denmark.
| | - Bart L Kaptein
- Biomechanics and Imaging Group, Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
| | - Kjeld Søballe
- AutoRSA Research Group, Orthopeadic Research Unit, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200, Aarhus N, Denmark
- Department of Orthopaedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200, Aarhus N, Denmark
| | - Stig S Jakobsen
- Department of Orthopaedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200, Aarhus N, Denmark
| | - Maiken Stilling
- AutoRSA Research Group, Orthopeadic Research Unit, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200, Aarhus N, Denmark
- Department of Orthopaedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200, Aarhus N, Denmark
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14
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Robertson TS, Pijls BG, Munn Z, Solomon LB, Nelissen RGHH, Callary SA. Change in CT-measured acetabular bone density following total hip arthroplasty: a systematic review and meta-analysis. Acta Orthop 2023; 94:191-199. [PMID: 37114317 PMCID: PMC10140760 DOI: 10.2340/17453674.2023.11635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND AND PURPOSE Assessing peri-acetabular bone quality is valuable for optimizing the outcomes of primary total hip arthroplasty (THA) as preservation of good quality bone stock likely affects implant stability. The aim of this study was to perform a meta-analysis of peri-acetabular bone mineral density (BMD) changes over time measured using quantitative computer tomography (CT) and, second, to investigate the influence of age, sex, and fixation on the change in BMD over time. METHODS A systematic search of Embase, Scopus, Web of Science, and PubMed databases identified 19 studies that measured BMD using CT following THA. The regions of interest (ROI), reporting of BMD results, and scan protocols were extracted. A meta-analysis of BMD was performed on 12 studies that reported measurements immediately postoperatively and at follow-up. RESULTS The meta-analysis determined that periacetabular BMD around both cemented and uncemented components decreases over time. The amount of BMD loss increased relative to proximity of the acetabular component. There was a greater decrease in cortical BMD over time in females and cancellous BMD for young patients of any sex. CONCLUSION Peri-acetabular BMD decreases at different rates relative to its proximity to the acetabular component. Cancellous BMD decreases more in young patients and cortical bone decreases more in females. Standardized reporting parameters and suggested ROI to measure peri-acetabular BMD are proposed, to enable comparison between implant and patient variables in the future.
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Affiliation(s)
- Thomas S Robertson
- Department of Orthopaedics and Trauma Royal Adelaide Hospital, Adelaide, SA, Australia; Centre for Orthopaedic and Trauma Research, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia.
| | - Bart G Pijls
- Department of Orthopaedics, Leiden University Medical Center, Leiden, Netherlands
| | - Zachary Munn
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA Australia
| | - L Bogdan Solomon
- Department of Orthopaedics and Trauma Royal Adelaide Hospital, Adelaide, SA, Australia; Centre for Orthopaedic and Trauma Research, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, Netherlands
| | - Stuart A Callary
- Department of Orthopaedics and Trauma Royal Adelaide Hospital, Adelaide, SA, Australia; Centre for Orthopaedic and Trauma Research, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
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15
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Dwyer A, Korlaet M, Callary SA, Robertson T, Smitham P, Solomon LB. Impact of computed tomography metal artifact reduction protocol on periprosthetic tissue characterization after total hip arthroplasty: A cadaveric study. J Orthop Res 2023; 41:657-662. [PMID: 35652835 DOI: 10.1002/jor.25391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 04/19/2022] [Accepted: 05/14/2022] [Indexed: 02/04/2023]
Abstract
Metal artifact reduction (MAR) has improved computed tomography (CT) imaging of total hip arthroplasty (THA) but the assessment of osteolysis and implant to bone contact relies on the accurate depiction of bone defects, cancellous bone, and cement. This study evaluates the impact of available single and dual-energy protocols on periprosthetic tissue characterization in a cadaveric phantom. Bilateral THA was performed on a fresh frozen cadaveric pelvis with simulated osteolytic cavities. CT acquisitions with projection-based MAR and noise equivalence were performed using single energy 140 kVp, single energy 150 kVp with 0.6 mm tin filtration, and dual-energy at 100/150 kVp with 0.6 mm tin filtration, from which simulated energies were extracted. Image subtraction, segmentation, region of interest histograms, and line profiles were used to characterize tissue density and separation. Tissue densities were heavily dependent on the energy profile of the protocol. Cancellous bone ranged from 182 to 45 HU and cement from 1012 to 131 HU using 140 kVp compared to dual-energy with weighted high energy tube, respectively. Spectral separation between cancellous bone, osteolytic defect, and cement was reduced for all protocols compared with 140 kVp. Spectral overlap was most severe using dual-energy with heavily weighted high-energy tubes. Dual-energy algorithms reduced trabecular contrast within the cancellous bone and cortical edge response. Although the dual-energy acquisition has been proposed as an additive to projection-based MAR techniques in THA, reduced density and contrast in clinically relevant periprosthetic tissue compared to 140 kVp single energy may limit its use in characterizing periprosthetic tissues.
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Affiliation(s)
- Andrew Dwyer
- Clinical & Research Imaging Centre, South Australian Health & Medical Research Institute, Adelaide, South Australia, Australia
| | - Mishelle Korlaet
- Clinical & Research Imaging Centre, South Australian Health & Medical Research Institute, Adelaide, South Australia, Australia
| | - Stuart A Callary
- Department of Orthopedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Centre for Orthopedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia
| | - Thomas Robertson
- Department of Orthopedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Centre for Orthopedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia
| | - Peter Smitham
- Department of Orthopedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Centre for Orthopedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia
| | - Lucian B Solomon
- Department of Orthopedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Centre for Orthopedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia
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16
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Ruhr M, Huber G, Niki Y, Lohner L, Ondruschka B, Morlock MM. Impaction procedure influences primary stability of acetabular press-fit components. Bone Joint J 2023; 105-B:261-268. [PMID: 36854327 DOI: 10.1302/0301-620x.105b3.bjj-2022-1011.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
The aim of the study was to investigate whether the primary stability of press-fit acetabular components can be improved by altering the impaction procedure. Three impaction procedures were used to implant acetabular components into human cadaveric acetabula using a powered impaction device. An impaction frequency of 1 Hz until complete component seating served as reference. Overimpaction was simulated by adding ten strokes after complete component seating. High-frequency implantation was performed at 6 Hz. The lever-out moment of the acetabular components was used as measure for primary stability. Permanent bone deformation was assessed by comparison of double micro-CT (µCT) measurements before and after impaction. Acetabular component deformation and impaction forces were recorded, and the extent of bone-implant contact was determined from 3D laser scans. Overimpaction reduced primary acetabular component stability (p = 0.038) but did not significantly increase strain release after implantation (p = 0.117) or plastic deformations (p = 0.193). Higher press-fits were associated with larger polar gaps for the 1 Hz reference impaction (p = 0.002, R2 = 0.77), with a similar trend for overimpaction (p = 0.082, R2 = 0.31). High-frequency impaction did not significantly increase primary stability (p = 0.170) at lower impaction forces (p = 0.001); it was associated with smaller plastic deformations (p = 0.035, R2 = 0.34) and a trend for increased acetabular component relaxation between strokes (p = 0.112). Higher press-fit was not related to larger polar gaps for the 6 Hz impaction (p = 0.346). Overimpaction of press-fit acetabular components should be prevented since additional strokes can be associated with increased bone damage and reduced primary stability as shown in this study. High-frequency impaction at 6 Hz was shown to be beneficial compared with 1 Hz impaction. This benefit has to be confirmed in clinical studies.
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Affiliation(s)
- Miriam Ruhr
- Institute of Biomechanics, Hamburg University of Technology, Hamburg, Germany
| | - Gerd Huber
- Institute of Biomechanics, Hamburg University of Technology, Hamburg, Germany
| | - Yasaman Niki
- Institute of Biomechanics, Hamburg University of Technology, Hamburg, Germany
| | - Larissa Lohner
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Benjamin Ondruschka
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael M Morlock
- Institute of Biomechanics, Hamburg University of Technology, Hamburg, Germany
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17
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Clarke SG, Logishetty K, Halewood C, Cobb JP. Low dose CT-based spatial analysis (CTSA) to measure implant migration after ceramic hip resurfacing arthroplasty (HRA): A phantom study. Proc Inst Mech Eng H 2023; 237:359-367. [PMID: 36772975 PMCID: PMC10052406 DOI: 10.1177/09544119231153905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Implant migration is a predictor of arthroplasty survivorship. It is crucial to monitor the migration of novel hip prostheses within premarket clinical investigations. RSA is the gold standard method, but requires calibrated radiographs using specialised equipment. A commercial computed tomography micromotion analysis solution is a promising alternative but is not yet available for use with monobloc ceramic implants. This study aimed to develop and validate a CT-based spatial analysis (CTSA) method for use with ceramic implants. A phantom study was undertaken to assess accuracy and precision. A ceramic hip resurfacing arthroplasty (HRA) and 20 tantalum beads were implanted into a synthetic hip model and mounted onto a 6-degree of freedom motion stage. The hip was repeatedly scanned with a low dose CT protocol, with imposed micromovements. Data were interrogated using a semiautomated technique. The effective radiation dose for each scan was estimated to be 0.25 mSv. For the head implant, precision ranged between 0.11 and 0.28 mm for translations and 0.34°-0.42° for rotations. For the cup implant, precision ranged between 0.08 and 0.11 mm and 0.19° and 0.42°. For the head, accuracy ranged between 0.04 and 0.18 mm for translations and 0.28°-0.46° for rotations. For the cup, accuracy ranged between 0.04 and 0.08 mm and 0.17° and 0.43°. This in vitro study demonstrates that low dose CTSA of a ceramic HRA is similar in accuracy to RSA. CT is ubiquitous, and this method may be an alternative to RSA to measure prosthesis migration.
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Affiliation(s)
- Susannah G Clarke
- MSk Lab, Imperial College London, London, UK.,Embody Orthopaedic Limited, London
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18
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Faraj S, de Windt TS, van Hooff ML, van Hellemondt GG, Spruit M. Custom-made acetabular revision arthroplasty for pelvic discontinuity: Can we handle the challenge? : a prospective cohort study. Bone Jt Open 2023; 4:53-61. [PMID: 36718581 PMCID: PMC10011926 DOI: 10.1302/2633-1462.42.bjo-2022-0159.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
AIMS The aim of this study was to assess the clinical and radiological results of patients who were revised using a custom-made triflange acetabular component (CTAC) for component loosening and pelvic discontinuity (PD) after previous total hip arthroplasty (THA). METHODS Data were extracted from a single centre prospective database of patients with PD who were treated with a CTAC. Patients were included if they had a follow-up of two years. The Hip Disability and Osteoarthritis Outcome Score (HOOS), modified Oxford Hip Score (mOHS), EurQol EuroQoL five-dimension three-level (EQ-5D-3L) utility, and Numeric Rating Scale (NRS), including visual analogue score (VAS) for pain, were gathered at baseline, and at one- and two-year follow-up. Reasons for revision, and radiological and clinical complications were registered. Trends over time are described and tested for significance and clinical relevance. RESULTS A total of 18 females with 22 CTACs who had a mean age of 73.5 years (SD 7.7) were included. A significant improvement was found in HOOS (p < 0.0001), mOHS (p < 0.0001), EQ-5D-3L utility (p = 0.003), EQ-5D-3L NRS (p = 0.013), VAS pain rest (p = 0.008), and VAS pain activity (p < 0.0001) between baseline and final follow-up. Minimal clinically important improvement in mOHS and the HOOS Physical Function Short Form (HOOS-PS) was observed in 16 patients (73%) and 14 patients (64%), respectively. Definite healing of the PD was observed in 19 hips (86%). Complications included six cases with broken screws (27%), four cases (18%) with bony fractures, and one case (4.5%) with sciatic nerve paresthesia. One patient with concurrent bilateral PD had revision surgery due to recurrent dislocations. No revision surgery was performed for screw failure or implant breakage. CONCLUSION CTAC in patients with THA acetabular loosening and PD can result in stable constructs and significant improvement in functioning and health-related quality of life at two years' follow-up. Further follow-up is necessary to determine the mid- to long-term outcome.Cite this article: Bone Jt Open 2023;4(2):53-61.
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Affiliation(s)
- Sayf Faraj
- Department of Orthopedic Surgery, Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Tommy S de Windt
- Department of Orthopedic Surgery, Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Miranda L van Hooff
- Department of Research, Sint Maartenskliniek, Nijmegen, the Netherlands.,Department of Orthopedic Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
| | | | - Maarten Spruit
- Department of Orthopedic Surgery, Sint Maartenskliniek, Nijmegen, the Netherlands
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19
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JØRGENSEN PB, TABORI-JENSEN S, MECHLENBURG I, HUMILIUS M, HANSEN TB, STILLING M. Cemented and cementless dual mobility cups show similar fixation, low polyethylene wear, and low serum cobalt-chromium in elderly patients: a randomized radiostereometry study with 6 years' follow-up. Acta Orthop 2022; 93:906-913. [PMID: 36545926 PMCID: PMC9772923 DOI: 10.2340/17453674.2022.5761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND AND PURPOSE Dual mobility (DM) articulation total hip arthroplasty (THA) is used increasingly to reduce dislocation risk. We investigated cup fixation, polyethylene (PE) wear, serum chromium and cobalt ions, and their correlation to physical activity in patients with DM cups at 6-year follow-up. PATIENTS AND METHODS In a patient-blinded RCT, 60 patients with hip osteoarthritis at a median age of 74 years (70-82) were randomly allocated to cemented (n = 30) or cementless hydroxyapatite-coated (n = 30) fixation of Avantage DM THA with a highly-crosslinked vitamin-E PE liner. Cup migration and PE wear were measured with radiostereometric analysis (RSA), chromium and cobalt ions were measured in serum, and physical activity was measured with accelerometers. RESULTS At 6-year follow-up, proximal cup migration was similar: 0.14 mm (95% CI 0.01-0.28) for cemented cups and 0.21 mm (0.02-0.39) for cementless cups. The PE wear rate from 1- to 6-year follow-up was also similar: 0.06 mm/year (0.04-0.09) for cemented cups and 0.07 mm/year (0.04-0.11) for cementless cups. Serum metal ion levels were undetectable or very low. Physical activity was mainly low intensity and did not correlate to PE wear rate or cup migration. CONCLUSION Cemented and cementless DM cups with highly crosslinked vitamin-E infused liners have similar cup migration and PE wear when used for primary THA surgery.
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Affiliation(s)
- Peter Bo JØRGENSEN
- University Clinic for Hand, Hip and Knee Surgery, Department of Orthopaedics, Gødstrup Hospital, Herning,AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus
| | | | - Inger MECHLENBURG
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Morten HUMILIUS
- University Clinic for Hand, Hip and Knee Surgery, Department of Orthopaedics, Gødstrup Hospital, Herning
| | - Torben Bæk HANSEN
- University Clinic for Hand, Hip and Knee Surgery, Department of Orthopaedics, Gødstrup Hospital, Herning,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Maiken STILLING
- University Clinic for Hand, Hip and Knee Surgery, Department of Orthopaedics, Gødstrup Hospital, Herning,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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20
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Otten V, Wästerlund D, Lindbjörn J, Mertens C, Mukka S, Crnalic S, Nilsson KG. Evaluation of a new cemented highly cross-linked all-polyethylene cup: a prospective and randomised study assessing wear and fixation characteristics using radiostereometric analysis. Hip Int 2022; 32:779-786. [PMID: 33566703 PMCID: PMC9726741 DOI: 10.1177/1120700021989991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND PURPOSE The aim of this prospective, randomised and controlled study was to evaluate the wear and fixation properties of a new cemented highly cross-linked all-polyethylene (HXLPE) cup in comparison with a conventional cemented ultra-high molecular weight polyethylene (ConvPE) cup using radiostereometric analysis (RSA). PATIENTS AND METHODS A total of 58 patients (58 hips) with primary osteoarthritis (OA) were enrolled in a randomised controlled trial to receive either a ConvPE cup (control) or HXLPE cup (intervention) with identical geometry. The subjects were randomised in a 1:1 ratio. The primary endpoint was proximal wear measured as femoral head penetration into the cup, secondary outcomes were 3D-wear and annual proximal wear from 1 to 5 years. Cup fixation was measured as movement of the cup in relation to the acetabular bone with proximal migration being the primary outcome measure, 3D-migration and change in inclination as secondary outcomes. The patients were followed for 5 years with RSA performed postoperatively, at 3, 12, 24, and 60 months. RESULTS The HXLPE displayed a lower median proximal femoral head penetration compared to ConvPE, with a median difference at 2 years of -0.07 mm (95% CI, -0.10 to -0.04 mm), and -0.19 mm (95% CI, -0.27 to -0.15 mm) at 5 years. Annual proximal wear between 1 and 5 years was 0.03 mm/year for HXLPE and 0.06 mm/year for ConvPE (mean difference 0.05 mm, [95% CI, 0.03-0.07 mm]). Proximal migration, 3D migration and change in inclination was numerically slightly higher for HXLPE, albeit not statistically significant. CONCLUSIONS Compared to ConvPE, the HXLPE cup displayed significantly lower polyethylene wear. Cup migration was not statistically significant different. CLINICALTRIALS.GOV IDENTIFIER NCT04322799.
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Affiliation(s)
| | | | | | | | | | | | - Kjell G Nilsson
- Kjell G Nilsson, Orthopaedics, Department of Surgical and Perioperative Sciences, Umeå University, Umeå 90185, Sweden.
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21
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Ramasamy B, Abrahams JM, Clothier RJ, Solomon LB, Callary SA. RSA Measurements of Implant Instability in a Paprosky III Pelvic Defect with Discontinuity: A Case Report. JBJS Case Connect 2022; 12:01709767-202212000-00048. [PMID: 36820637 DOI: 10.2106/jbjs.cc.22.00296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 10/14/2022] [Indexed: 02/24/2023]
Abstract
CASE We report a case of acetabular reconstruction for a large defect with pelvic discontinuity that underwent 4 revisions for dislocations over a 3-year period. This allowed assessment of implant stability both on imaging, using measurements on plain radiographs and radiostereometric analysis (RSA) against both ilium and ischium, and direct assessment during each surgery. Only implant stability measured with RSA correlated with intraoperative revision findings. CONCLUSION This case underlines the role of RSA in assessing early acetabular implant stability in pelvic discontinuity and the importance of assessing the stability of the implant against both ilium and ischium.
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Affiliation(s)
- Boopalan Ramasamy
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia.,Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia
| | - John Matthew Abrahams
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia.,Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia
| | - Robyn Janice Clothier
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia.,Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia
| | - Lucian Bogdan Solomon
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia.,Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia
| | - Stuart Adam Callary
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia.,Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia
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22
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Ruhr M, Baetz J, Pueschel K, Morlock MM. Influence of acetabular cup thickness on seating and primary stability in total hip arthroplasty. J Orthop Res 2022; 40:2139-2146. [PMID: 34855229 DOI: 10.1002/jor.25232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/05/2021] [Accepted: 11/20/2021] [Indexed: 02/04/2023]
Abstract
Insufficient primary stability of acetabular hip cups is a complication resulting in early cup loosening. Available cup designs vary in terms of wall thickness, potentially affecting implant fixation. This study investigated the influence of different wall thicknesses on the implantation process and the resulting primary stability using excised human acetabula. Implantations were performed using a powered impaction device providing consistent energy with each stroke. Two different wall thicknesses were compared in terms of seating progress, polar gap remaining after implantation, bone-to-implant contact area, cup deflection, and lever out moment. Thin-walled cups showed higher lever out resistance (p < 0.001) and smaller polar gaps (p < 0.001) with larger bone contact toward the dome of the cup (p < 0.001) compared to thick-walled cups. Small seating steps at the end of the impaction process were observed if a high number of strokes were needed to seat the cup (p = 0.045). A high number of strokes led to a strain release of the cup during the final strokes (p = 0.003). This strain release is indicative for over-impaction of the cup associated with bone damage and reduced primary stability. Adequate cup seating can be achieved with thin-walled cups with lower energy input in comparison to thicker ones. Thin-walled cups showed improved primary stability and enable implantation with lower energy input, reducing the risk of over-impaction and bone damage. Additional strokes should be avoided as soon as no further seating progress has been observed.
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Affiliation(s)
- Miriam Ruhr
- Institute of Biomechanics, Hamburg University of Technology, Hamburg, Germany
| | - Johanna Baetz
- Institute of Biomechanics, Hamburg University of Technology, Hamburg, Germany
| | - Klaus Pueschel
- Department of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael M Morlock
- Institute of Biomechanics, Hamburg University of Technology, Hamburg, Germany
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23
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Miura T, Kijima H, Kimura R, Watanabe J, Okazaki Y, Miyakoshi N. Efficacy and Safety of Acetabular Cup without Screw Fixation in Total Hip Arthroplasty: A Systematic Review and Meta-Analysis. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58081058. [PMID: 36013524 PMCID: PMC9413682 DOI: 10.3390/medicina58081058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/20/2022] [Accepted: 08/02/2022] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Adequate initial fixation of the uncemented acetabular component in total hip arthroplasty is necessary to achieve long-term survival. Although screw fixation contributes to improved cup stability, there is currently no consensus on the use of this method. This study aimed to assess the existing randomized controlled trials (RCTs) on the efficacy and safety of cup fixation in total hip arthroplasty without screws. Materials and Methods: We searched the EMBASE, MEDLINE, Cochrane Central Register of Controlled Trials, World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov databases to identify RCTs published before February 2022. Primary outcomes were reoperation, cup migration, and Harris Hip Score. Secondary outcomes were the presence of a radiolucent line in the acetabular region, translation and rotation movement, and polyethylene wear. We conducted meta-analyses using the random-effects models. The revised Cochrane risk-of-bias tool was used to assess the risk of bias for outcomes of interest; the Grading of Recommendations, Assessment, Development, and Evaluation approach was used to summarize the body of evidence. Results: We included six reports from four studies. Total hip arthroplasty without screw fixation to the acetabular cup had little to no effect on reoperation (pooled relative risk, 0.98; 95% confidence interval, 0.14–6.68; I2 = 0%), cup migration (pooled relative risk, 1.72; 95% confidence interval, 0.29–10.33; I2 = 1%), Harris Hip Score (mean difference, 1.19; 95% confidence interval, −1.31–3.70; I2 = 0%), radiolucent line (pooled relative risk, 5.91; 95% confidence interval, 0.32–109.35), translation and rotation of all axes, and polyethylene wear (mean difference, 0.01; 95% confidence interval, −0.01–0.04; I2 = 0%), with very low certainty of evidence on all measures. Conclusions: The efficacy of acetabular cups without screw fixation in total hip arthroplasty remains uncertain, suggesting the need for prudent clinical application. Further large-scale, well-designed studies with low risk of bias are required.
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Affiliation(s)
- Takanori Miura
- Department of Orthopedic Surgery, Tazawako Hospital 17-1 Ukiyozaka Obonai, Tazawako, Senboku 014-1201, Akita, Japan
- Correspondence: ; Tel.: +81-187-43-1131
| | - Hiroaki Kijima
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Akita, Japan
| | - Ryota Kimura
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Akita, Japan
| | - Jun Watanabe
- Scientific Research Workshop Peer Support Group (SRWS-PSG), Osaka, Osaka, Japan
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke City 329-0498, Tochigi, Japan
- Center for Community Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke City 329-0498, Tochigi, Japan
| | - Yuji Okazaki
- Scientific Research Workshop Peer Support Group (SRWS-PSG), Osaka, Osaka, Japan
- Department of Emergency Medicine, Hiroshima City Hiroshima Citizens Hospital, 7-33, Motomachi, Naka-ku, Hiroshima City 730-8518, Hiroshima, Japan
| | - Naohisa Miyakoshi
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Akita, Japan
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24
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MOSEGAARD SB, JØRGENSEN PB, JAKOBSEN SS, DAUGAARD H, SØBALLE K, STILLING M. Larger 5-year migration but similar polyethylene wear of cementless hemispherical cups with electrochemically applied hydroxyapatite (BoneMaster) coating compared with porous plasma-spray titanium: a randomized 5-year RSA study. Acta Orthop 2022; 93:658-664. [PMID: 35848733 PMCID: PMC9290214 DOI: 10.2340/17453674.2022.3976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE BoneMaster (BM) is a thin electrochemically applied hydroxyapatite (HA) implant coating marketed with expectations of improved osseointegration properties but less polyethylene (PE) wear. We compared the midterm cup migration and PE wear of cementless porous-coated hemispherical cups with and without BM. PATIENTS AND METHODS In this patient-blinded, randomized controlled trial, 53 patients with a mean age of 64 years (55-75) received total hip arthroplasty with a porous-coated (P) or porous and BoneMaster (PBM) coated Exceed cup and ArCom E1 infused PE. Patients were followed with RSA, Hip Osteoarthritis Outcome Score (HOOS), and Euro-Qol-5-3L (EQ-5D) at 3 and 6 months, and 1-, 2-, and 5-year follow-up. RESULTS At 5-year follow-up, total translation and maximum total point motion was 0.28 mm (95% CI 0.08; 0.47) and 0.52 mm (CI 0.12; 0.93) higher in the PBM group than in the P group. PE wear was comparable between PBM and P cups, and 2D wear rate from 1-year follow-up to last follow-up was 0.03 mm (CI 0.02-0.03). The 5-year anterior translation was 0.05 mm (CI -0.10 to 0.21) in the normal BMD group and 0.40 mm (CI 0.22-0.57) in the osteopenia group. INTERPRETATION At 5-year follow-up, Exceed cups in the PBM group migrated more than in the P group but the PE wear rate was low and similar. This study does not indicate any advantage of additional BoneMaster coating compared with porous coating alone on cementless hemispherical cups with regards to migration, polyethylene wear, and clinical outcomes.
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Affiliation(s)
- Sebastian Breddam MOSEGAARD
- AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus;,Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus
| | - Peter Bo JØRGENSEN
- AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus;,Department of Clinical Medicine, Aarhus University, Aarhus
| | | | - Henrik DAUGAARD
- Department of Orthopedics, Slagelse Hospital, Slagelse, Denmark
| | - Kjeld SØBALLE
- Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus;,Department of Clinical Medicine, Aarhus University, Aarhus
| | - Maiken STILLING
- AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus;,Department of Clinical Medicine, Aarhus University, Aarhus
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25
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Jürgens-Lahnstein JH, Petersen ET, Laursen M, Hauskov Iversen C, Kaptein BL, Lindgren L, Stilling M. Development, construction, and validation of a thinner uniplanar calibration cage for radiostereometry. J Orthop Res 2022; 40:1645-1653. [PMID: 34664740 DOI: 10.1002/jor.25193] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 09/15/2021] [Accepted: 09/30/2021] [Indexed: 02/04/2023]
Abstract
Radiostereometric analysis (RSA) is an accurate and precise radiographic method that can be used to measure micromotion of implants and study joint kinematics in vivo. A calibration cage with radiopaque markers is used to calibrate the RSA images; however, the thickness (250 mm) of the calibration cage restricts the available area for the patient and equipment during RSA recordings. A thinner calibration cage would increase the recording area, facilitate handling of the cage, and ease integration of the cage with the RSA system. We developed a thinner calibration cage without compromise of accuracy and precision. First, we performed numerical simulations of an RSA system, and showed that the calibration cage thickness could be decreased to 140 mm maintaining accuracy and precision using 40 fiducial and 30 control markers. Second, we constructed a new calibration cage (NRT cage) according to the simulation results. Third, we validated the new calibration cage against two state-of-the-art calibration cages (Umeaa cage and Leiden cage) in a phantom study. All cages performed similar for marker-based analysis, except for y-rotation, where the Umeaa cage (SD = 0.064 mm) was less precise compared to the NRT (SD = 0.038 mm) and Leiden cages (0.042 mm) (p = .01). For model-based analysis the NRT cage had superior precision for translations (SD ≤ 0.054 mm) over the Leiden cage (SD ≤ 0.118 mm) and Umeaa cage (SD ≤ 0.093 mm) (p < .01). The combined study confirmed that the new and thinner calibration cage maintained accuracy and precision at the level of existing thicker calibration cages.
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Affiliation(s)
| | - Emil Toft Petersen
- Department of Orthopaedics, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Mogens Laursen
- Department of Orthopaedics, Aalborg University Hospital, Aalborg, Denmark
| | | | - Bart L Kaptein
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
| | - Lars Lindgren
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Maiken Stilling
- Department of Orthopaedics, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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26
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Mjöberg B. Hip prosthetic loosening and periprosthetic osteolysis: A commentary. World J Orthop 2022; 13:574-577. [PMID: 35949708 PMCID: PMC9244959 DOI: 10.5312/wjo.v13.i6.574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 06/02/2022] [Accepted: 06/14/2022] [Indexed: 02/06/2023] Open
Abstract
Prosthetic loosening and periprosthetic osteolysis have been debated for decades, both in terms of the timing and nature of the triggering events. The hypothesis of wear-particle-induced loosening states that wear particles cause a foreign-body response leading to periprosthetic osteolysis and ultimately to late prosthetic loosening, i.e., that the osteolysis precedes the loosening. The theory of early loosening, on the other hand, postulates that the loosening is already initiated during or shortly after surgery, i.e., that the osteolysis is secondary to the loosening. This commentary focuses on the causal relationship between prosthetic loosening and periprosthetic osteolysis.
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Affiliation(s)
- Bengt Mjöberg
- Department of Orthopedics, Lund University, Lund SE-221 00, Sweden
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27
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Rilby K, Nauclér E, Mohaddes M, Kärrholm J. No difference in outcome or migration but greater loss of bone mineral density with the Collum Femoris Preserving stem compared with the Corail stem: a randomized controlled trial with five-year follow-up. Bone Joint J 2022; 104-B:581-588. [PMID: 35491578 DOI: 10.1302/0301-620x.104b5.bjj-2021-1539.r1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The aim of this study was to compare the mid-term patient-reported outcome, bone remodelling, and migration of a short stem (Collum Femoris Preserving; CFP) with a conventional uncemented stem (Corail). METHODS Of 81 patients who were initially enrolled, 71 were available at five years' follow-up. The outcomes at two years have previously been reported. The primary outcome measure was the clinical result assessed using the Oxford Hip Score (OHS). Secondary outcomes were the migration of the stem, measured using radiostereometric analysis (RSA), change of bone mineral density (BMD) around the stem, the development of radiolucent lines, and additional patient-reported outcome measures (PROMs). RESULTS There were no statistically significant differences between the groups regarding PROMs (median OHS (CFP 45 (interquartile range (IQR) 35 to 48); Corail 45 (IQR 40 to 48); p = 0.568). RSA showed stable stems in both groups, with little or no further subsidence between two and five years. Resorption of the femoral neck was evident in nine patients in the CFP group and in none of the 15 Corail stems with a collar that could be studied. Dual X-ray absorbiometry showed a significantly higher loss of BMD in the proximal Gruen zones in the CFP group (mean changes in BMD: Gruen zone 1, CFP -9.5 (95% confidence interval (CI) -14.8 to -4.2), Corail 1.0 (95% CI 3.4 to 5.4); Gruen zone 7, CFP -23.0 (95% CI -29.4 to -16.6), Corail -7.2 (95% CI -15.9 to 1.4). Two CFP stems were revised before two years' follow-up due to loosening, and one Corail stem was revised after two years due to chronic infection. CONCLUSION The CFP stem has a similar clinical outcome and subsidence pattern when compared with the Corail stem. More pronounced proximal stress-shielding was seen with the CFP stem, suggesting diaphyseal fixation, and questioning its femoral neck-sparing properties in the long term. Cite this article: Bone Joint J 2022;104-B(5):581-588.
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Affiliation(s)
- Karin Rilby
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Emma Nauclér
- Swedish Hip Arthroplasty Register, Gothenburg, Sweden
| | - Maziar Mohaddes
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Johan Kärrholm
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Swedish Hip Arthroplasty Register, Gothenburg, Sweden
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28
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Balesar VV, Koster LA, Kaptein BL, Keizer SB. Five-Year Prospective Roentgen Stereophotogrammetric and Clinical Outcomes of the BioPro MTP-1 Hemiarthroplasty. Foot Ankle Int 2022; 43:637-645. [PMID: 34962173 DOI: 10.1177/10711007211061366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Mixed results for functional outcomes and long-term fixation have been reported for first metatarsophalangeal arthroplasty. This prospective study was designed to evaluate the migration of the BioPro metatarsophalangeal-1 (MTP-1) joint hemiprosthesis with Roentgen stereophotogrammetric analysis (RSA). Migration patterns of the prosthesis, prosthesis-induced erosion of the metatarsal bone, and clinical outcomes were evaluated sequentially to 5 years postoperation (PO). METHODS Eleven female patients received the BioPro-1 hemiprosthesis. Prosthesis translation and metatarsal erosion were measured with RSA at immediately PO, 6 weeks, and 3, 6, 12, 36, and 60 months postoperatively. Clinical assessment was done by patient questionnaires. RESULTS RSA data of 9 patients were available for analysis. Median (range) number of markers used in RSA analysis, condition number, and mean error of markers around the prosthesis were 4 (3-7), 320 (208-862), and 0.13 (0.02-0.28), respectively. Progressive subsidence was seen up to 3 years PO (mean 2.1 mm, SE 0.32). Progressive metatarsal erosion was found from 1 year PO (mean 0.49 mm, SE 0.15). Pain, function, and quality scores improved after surgery and did not deteriorate at later follow-up moments. CONCLUSION Model-based RSA of the BioPro-1 prosthesis shows nonstabilizing medial and distal translation and metatarsal erosion. Despite the measured migration and erosion, clinical outcomes improved and remained similar up to 5 years postoperation. LEVEL OF EVIDENCE Level II, prospective analysis of MTP-1 hemiprosthesis.
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Affiliation(s)
| | | | - Bart L Kaptein
- Leiden Universitair Medisch Centrum, Leiden, the Netherlands
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29
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KLAASSEN AD, SCHÄFFER EA, WILLIGENBURG NW, VAN BEERS LWAH, SCHOLTES VAB, VAN DER HULST VPM, KOSTER LA, KAPTEIN BL, MOOJEN DJF, POOLMAN RW. Comparison of early migration patterns between a ceramic and polyethylene liner in uncemented Trabecular Titanium cups: a 2-year randomized controlled trial of 52 hips using radiostereometric analysis. Acta Orthop 2022; 93:451-458. [PMID: 35485295 PMCID: PMC9052219 DOI: 10.2340/17453674.2022.2267] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Ceramic liners may reduce early stability of uncemented acetabular components due to higher stiffness. However, the bone ingrowth capacities of porous trabecular titanium might compensate for this effect. This prospective randomized trial quantifies migration patterns of the Delta-TT cup, and compares polyethylene and ceramic liners. PATIENTS AND METHODS Patients undergoing primary uncemented total hip arthroplasty with the Delta-TT cup and femoral stem with ceramic head were randomized to a polyethylene (n = 25) or ceramic (n = 28) liner. Radiostereometric analysis (RSA) radiographs, patient-reported hip function (HOOS-PS, OHS), and quality of life (EQ5D) were collected at baseline and 1.5, 3, 6, 12, and 24 months postoperatively. Model-based RSA was used to calculate 3D cup translation and rotation, and mixed models were used to compare effects over time between groups. RESULTS At 2 years follow-up, Delta-TT cups showed similar mean proximal translation of 0.56 mm (95% CI 0.38-0.75) in the ceramic (CE) group and 0.54 mm (0.30-0.77) in the polyethylene (PE) group, with a between group effect of 0.02 mm (-0.20-0.23). Most cup migration occurred in the first 1.5 to 3 months, stabilizing within 6 months. Any between-group effects were ≤ 0.30 mm for translation and ≤ 0.45° for rotation. Improvements in patient-reported hip function and quality of life were similar in both groups. INTERPRETATION Regardless of liner type, Delta-TT cups showed some initial migration and stabilized within 6 months, which seems promising for long-term fixation in both cup-liner constructs.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Rudolf W POOLMAN
- Department of Orthopedic Surgery, OLVG, Amsterdam,Department of Orthopedic Surgery, LUMC, Leiden, The Netherlands
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30
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ANGELOMENOS V, MOHADDES M, ITAYEM R, SHAREGHI B. Precision of low-dose CT-based micromotion analysis technique for the assessment of early acetabular cup migration compared with gold standard RSA: a prospective study of 30 patients up to 1 year. Acta Orthop 2022; 93:459-465. [PMID: 35478261 PMCID: PMC9047498 DOI: 10.2340/17453674.2022.2528] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Computed tomography micromotion analysis (CTMA) can be used to determine implant micro-movements using low-dose CT scans. By using CTMA, a non-invasive measurement of joint implant movement is enabled. We evaluated the precision of CTMA in measuring early cup migration. Standard marker-based radiostereometric analysis (RSA) was used as reference. We hypothesised that CTMA can be used as an alternative to RSA in assessing implant micromotions. PATIENTS AND METHODS We included 30 patients undergoing total hip arthroplasty (THA). Acetabular cup migration at 1 year was measured with RSA and CTMA. To determine the precision of both methods, 20 double examinations (postoperatively) with repositioning of the patients were performed. The precision was calculated from zero by assuming that there was no motion of the prosthesis between the 2 examinations. RESULTS The precision of RSA ranged from 0.06 to 0.15 mm for translations and 0.21° to 0.63° for rotations. Corresponding values for CTMA were 0.06 to 0.13 mm and 0.23° to 0.35°. A good level of agreement was found between the methods regarding cup migration and rotation at 1 year. INTERPRETATION The precision of CTMA in measuring acetabular cup migration and rotation is comparable to marker-based RSA. CTMA could possibly thus be used as an alternative method to detect early implant migration.
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Affiliation(s)
- Vasileios ANGELOMENOS
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg,Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Maziar MOHADDES
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg,Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Raed ITAYEM
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg,Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Bita SHAREGHI
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg,Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden
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31
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Van de Kleut ML, Yuan X, Athwal GS, Teeter MG. Are short press-fit stems comparable to standard-length cemented stems in reverse shoulder arthroplasty? A prospective, randomized clinical trial. J Shoulder Elbow Surg 2022; 31:580-590. [PMID: 34968694 DOI: 10.1016/j.jse.2021.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 11/10/2021] [Accepted: 11/16/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The literature comparing humeral implants in reverse shoulder arthroplasty is sparse. With minimal supporting literature, there has been a trend away from standard-length cemented humeral implants to press-fit stems and, recently, to shorter-stem implants. It is known that early implant migration, within the first 2 years postoperatively, is predictive of later implant loosening and possible revision surgery. Therefore, the purpose of this study was to compare clinical outcomes and implant migration between cemented standard-length humeral stems and press-fit short stems using model-based radiostereometric analysis. METHODS After a power analysis, 41 shoulders were prospectively randomized to receive either a cemented standard-length or press-fit short humeral stem for primary reverse shoulder arthroplasty between July 2017 and June 2019. Following surgery, participants were imaged with stereo radiographs acquired at 6 weeks (baseline), 3 months, 6 months, 1 year, and 2 years. Migration of the humeral stem at each time point was compared with baseline, with differences in migration between cohorts assessed using a mixed-effects model with the Bonferroni test for multiple comparisons. Patient-reported outcome measures (Subjective Shoulder Value; American Shoulder and Elbow Surgeons shoulder score; Simple Shoulder Test score; Disabilities of the Arm, Shoulder and Hand score; and Constant score) were also compared. RESULTS At 6 months (P = .025), 1 year (P = .004), and 2 years (P = .001) postoperatively, press-fit short stems migrated significantly more than cemented stems along the superior-inferior translation axis; in addition, they showed greater total translation at 2 years (P = .003). Mean total translation (± standard deviation) at 2 years was 0.4 ± 0.2 mm and 1.0 ± 1.1 mm for the cemented and press-fit cohorts, respectively. Mean migration between the 1- and 2-year time points was minimal for both stem fixation groups along all axes (<0.1 mm and 0.6°). There was no difference in active range of motion, pain, or validated outcome measures between the cohorts at 2 years (P ≥ .170). CONCLUSION This randomized clinical trial shows that press-fit short humeral stems subside substantially more than standard-length cemented stems but ultimately achieve stability from 1 year through 2 years. Conversely, no significant differences were observed in clinical outcomes between cohorts.
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Affiliation(s)
- Madeleine L Van de Kleut
- Imaging Research Laboratories, Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada; School of Biomedical Engineering, Western University, London, ON, Canada; Lawson Health Research Institute, London, ON, Canada
| | - Xunhua Yuan
- Imaging Research Laboratories, Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - George S Athwal
- Lawson Health Research Institute, London, ON, Canada; Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada; Roth
- McFarlane Hand and Upper Limb Centre, St Joseph's Health Care, London, ON, Canada
| | - Matthew G Teeter
- Imaging Research Laboratories, Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada; Lawson Health Research Institute, London, ON, Canada; Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada; Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
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BRODÉN C, REILLY P, KHANNA M, POPAT R, OLIVECRONA H, GRIFFITHS D, SKÖLDENBERG O, EMERY R. CT-based micromotion analysis method can assess early implant migration and development of radiolucent lines in cemented glenoid components: a clinical feasibility study. Acta Orthop 2022; 93:277-283. [PMID: 35113169 PMCID: PMC8808478 DOI: 10.2340/17453674.2022.1976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE CT micromotion analysis (CTMA) has been considered as an alternative to radiostereometry (RSA) for assessing early implant migration of orthopedic implants. We investigated the feasibility of CTMA to assess early migration and the progression of radiolucent lines in shoulder arthroplasties over 24 months using sequential low-dose CT scans. PATIENTS AND METHODS 7 patients were included and underwent 9 primary total shoulder arthroplasties. We made CT scans preoperatively, within 1 week postoperatively, and after 3, 6, 12, and 24 months. At each follow-up, postoperative glenoid migration and any development of radiolucent lines were assessed. Clinical outcomes were recorded at all time points except within 1 week postoperatively. RESULTS For the glenoid component, the median translation and median rotation were 0.00-0.10 mm and -1.53° to 1.05° at 24 months. Radiolucent lines could be observed around all glenoid components. The radiolucent lines developed from the periphery to the center of the implant for 6 glenoid components during follow-up. The Constant Score improved from a mean of 30 (21-51) preoperatively to 69 (41-88) at 24 months. INTERPRETATION CTMA can be used to identify early migration and the development of radiolucent lines over time in glenoid components. Clinical trials with a larger sample size and longer follow-up are needed to establish the relationship between migration, radiolucent lines, loosening, and clinical outcome.
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Affiliation(s)
- Cyrus BRODÉN
- Department of Surgery and Cancer, Imperial College London, St Mary’s Hospital, London, UK,Section of Orthopaedics, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden,Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Orthopaedics, Stockholm, Sweden
| | - Peter REILLY
- Department of Bioengineering, Imperial College London, London, UK
| | - Monica KHANNA
- Department of Clinical Imaging, Imperial College Healthcare NHS Trust, London, UK
| | - Ravi POPAT
- Department of Bioengineering, Imperial College London, London, UK
| | - Henrik OLIVECRONA
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Dylan GRIFFITHS
- Trauma & Orthopaedic Department, Imperial NHS Trust, London, UK
| | - Olof SKÖLDENBERG
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Orthopaedics, Stockholm, Sweden
| | - Roger EMERY
- Department of Surgery and Cancer, Imperial College London, St Mary’s Hospital, London, UK
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Ten Brinke B, Hesseling B, Eygendaal D, Hoelen MA, Mathijssen NMC. Early fixation of the humeral component in stemless total shoulder arthroplasty : a radiostereometric and clinical study with 24-month follow-up. Bone Joint J 2022; 104-B:76-82. [PMID: 34969283 DOI: 10.1302/0301-620x.104b1.bjj-2021-0945.r1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Stemless humeral implants have been developed to overcome stem-related complications in total shoulder arthroplasty (TSA). However, stemless implant designs may hypothetically result in less stable initial fixation, potentially affecting long-term survival. The aim of this study is to investigate early fixation and migration patterns of the stemless humeral component of the Simpliciti Shoulder System and to evaluate clinical outcomes. METHODS In this prospective cohort study, radiostereometric analysis (RSA) radiographs were obtained in 24 patients at one day, six weeks, six months, one year, and two years postoperatively. Migration was calculated using model-based RSA. Clinical outcomes were evaluated using the visual analogue scale (VAS), the Oxford Shoulder Score (OSS), the Constant-Murley Score (CMS), and the Disabilities of the Arm, Shoulder and Hand (DASH) score. RESULTS At two years, median translation along the x-, y-, and z-axis was -0.12 mm (interquartile range (IQR) -0.18 to 0.02), -0.17 mm (IQR -0.27 to -0.09), and 0.09 mm (IQR 0.02 to 0.31). Median rotation around the x-, y-, and z-axis was 0.12° (IQR -0.50 to 0.57), -0.98° (IQR -1.83 to 1.23), and 0.09° (IQR -0.76 to 0.30). Overall, 20 prostheses stabilized within 12 months postoperatively. Four prostheses showed continuous migration between 12 and 24 months. At two-year follow-up, with the exception of one revised prosthesis, all clinical scores improved significantly (median VAS difference at rest: -3.0 (IQR -1.5 to -6.0); OSS 22.0 (IQR 15.0 to 25.0); CMS 29.5 (IQR 15.0 to 35.75); and DASH -30.0 (IQR -20.6 to -41.67) (all p < 0.001)) with the exception of one revised prosthesis. CONCLUSION In conclusion, we found that 20 out of 24 implants stabilized within 12 months postoperatively. The significance of continuous migration in four implants is unclear and future research on the predictive value of early migration for future loosening in TSA is required. Clinical results revealed a clinically relevant improvement. Cite this article: Bone Joint J 2022;104-B(1):76-82.
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Affiliation(s)
- Bart Ten Brinke
- Department of Orthopaedic Surgery, Reinier de Graaf Hospital, Delft, Netherlands
| | - Brechtje Hesseling
- Department of Orthopaedic Surgery, Reinier de Graaf Hospital, Delft, Netherlands
| | - Denise Eygendaal
- Department of Orthopaedic Surgery, Erasmus Medical Center, Delft, Netherlands
| | - Max A Hoelen
- Department of Orthopaedic Surgery, Reinier de Graaf Hospital, Delft, Netherlands
| | - Nina M C Mathijssen
- Department of Orthopaedic Surgery, Reinier de Graaf Hospital, Delft, Netherlands
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Fraser AN, Bøe B, Fjalestad T, Madsen JE, Röhrl SM. Stable glenoid component of reverse total shoulder arthroplasty at 2 years as measured with model-based radiostereometric analysis (RSA). Acta Orthop 2021; 92:644-650. [PMID: 34196600 PMCID: PMC8635662 DOI: 10.1080/17453674.2021.1943932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Reverse total shoulder arthroplasty (TSA) is used for treating cuff arthropathy, displaced proximal humeral fractures (PHF), and in revision shoulder surgery, despite sparse evidence on long-term results. We assessed stability of the glenoid component in reverse TSA, using model-based RSA.Patients and methods - 20 patients (mean age 76 years, 17 female), operated on with reverse TSA at Oslo University Hospital, in 2015-2017 were included. Indications for surgeries were PHFs, malunion, cuff arthropathy, and chronic shoulder dislocation. RSA markers were placed in the scapular neck, the coracoid, and the acromion. RSA radiographs were conducted postoperatively, at 3 months, 1 year, and 2 years. RSA analysis was performed using RSAcore with Reversed Engineering (RE) modality, with clinical precision < 0.25 mm for all translations (x, y, z) and < 0.7° for rotations (x, z). Scapular "notching" was assessed in conventional radiographs.Results - 1 patient was excluded due to revision surgery. More than half of the patients displayed measurable migration at 2 years: 6 patients with linear translations below 1 mm and 8 patients who showed rotational migration. Except for one outlier, the measured rotations were below 2°. The migration pattern suggested implant stability at 2 years. 10 patients showed radiolographic signs of "notching", and the mean Oxford Shoulder Score (OSS) at 2 years was 29 points (15-36 points).Interpretation - Stability analysis of the glenoid component of reversed total shoulder arthroplasty using reversed engineering (RE) model-based RSA indicated component stability at 2 years.
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Affiliation(s)
- Alexander Nilsskog Fraser
- Institute of Clinical Medicine; University of Oslo,Diakonhjemmet Hospital,Norway,Correspondence: Alexander Nilsskog FRASER,
| | - Berte Bøe
- Division of Orthopaedic Surgery, Oslo University Hospital
| | - Tore Fjalestad
- Division of Orthopaedic Surgery, Oslo University Hospital
| | - Jan Erik Madsen
- Division of Orthopaedic Surgery, Oslo University Hospital,Institute of Clinical Medicine; University of Oslo
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Peng Z, Jia Y, Li J, Wang G. Diagnostic Performance of Single-Photon Emission Computed Tomography/Computed Tomography in Aseptic Loosening: A Systematic Review and Meta-Analysis. J Arthroplasty 2021; 36:4003-4012.e3. [PMID: 34275709 DOI: 10.1016/j.arth.2021.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 06/04/2021] [Accepted: 06/17/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The aim of this study is to evaluate the diagnostic value and clinical applicability of single-photon emission computed tomography/computed tomography (SPECT/CT) in aseptic loosening (AL) of prostheses by meta-analysis. METHOD Literature on the diagnostic value of SPECT/CT in AL of prostheses was obtained by computer and manual review. The quality of the included studies was evaluated according to the Quality Assessment Diagnostic Accuracy Studies 2. Pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and other indicators were calculated, and a forest map and summary receiver operating characteristic were drawn to calculate the area under the curve. Meta-regression analysis was performed to identify the sources of heterogeneity and corresponding subgroup analysis was performed. A Fagan plot, likelihood ratio point plot, and Deek's funnel plot were drawn and analyzed. RESULTS A total of 15 studies were included. The meta-analysis results showed that the pooled sensitivity and specificity of SPECT/CT for the diagnosis of aseptic prosthetic loosening were 0.94, 95% confidence interval [CI] (0.90-0.96) and 0.89, 95% CI (0.78-0.95), respectively while the pooled positive likelihood ratio and pooled negative likelihood ratio were 8.65, 95% CI (4.18-17.90) and 0.07, 95% CI (0.04-0.11), respectively. The pooled diagnostic odds ratio was 130.36, 95% CI (45.18-376.19), and the area under the curve was 0.97, 95% CI (0.95-0.98). CONCLUSION As a diagnostic method for AL, SPECT/CT has high diagnostic sensitivity and specificity as well as high diagnostic efficiency. It has good clinical application value and should be a primary choice in the diagnosis of AL after joint replacement.
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Affiliation(s)
- Zhan Peng
- Department of Orthopaedic Surgery, Affiliated Baoan Hospital of Shenzhen, Southern Medical University, Shenzhen, People's Republic of China; Clinical Teaching Department, the Second School of Clinical Medicine, Southern Medical University, Shenzhen, People's Republic of China
| | - Yukun Jia
- Department of Orthopaedic Surgery, Affiliated Baoan Hospital of Shenzhen, Southern Medical University, Shenzhen, People's Republic of China; Clinical Teaching Department, the Second School of Clinical Medicine, Southern Medical University, Shenzhen, People's Republic of China
| | - Jin Li
- Department of Orthopaedic Surgery, Affiliated Baoan Hospital of Shenzhen, Southern Medical University, Shenzhen, People's Republic of China; Clinical Teaching Department, the Second School of Clinical Medicine, Southern Medical University, Shenzhen, People's Republic of China
| | - Guangye Wang
- Department of Orthopaedic Surgery, Affiliated Baoan Hospital of Shenzhen, Southern Medical University, Shenzhen, People's Republic of China; Clinical Teaching Department, the Second School of Clinical Medicine, Southern Medical University, Shenzhen, People's Republic of China
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Kelly GA, Hill JC, O'Brien S, McChesney J, Dennison J, Stevenson M, Beverland DE. Ten-year outcomes following a cohort of ASR XL total hip arthroplasties. Hip Int 2021; 31:759-765. [PMID: 32233664 DOI: 10.1177/1120700020913863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
AIMS To determine the outcome at 10 years of a cohort of ASR XL total hip arthroplasties (THAs) and reasons for revision. METHODS Between November 2005 and May 2007, 122 ASR XL THAs were implanted. All patients had a routine review at 6 weeks and 1 year, followed by a review in 2009 because of clinical concern and thereafter annual review up to 10 years with MRI. Review also included functional scores, radiographs, pain scores and blood metal ions. RESULTS 67 (54.9%) ASR XLs had been revised by 11.1 years. Reasons for revision included pain (89.6%), high levels of cobalt and chromium ions (50.7%) and radiographic or MRI changes (80.6%). All 3 factors were present in 23 (34.3%). Pain at 1 year did not predict revision, but pain at the 2009 review did. At 10 years the revised patients had an average Oxford Hip Score (OHS) of 25.38 (12-42) and the non-revised 23.61 (2-21), the difference was not significant (p = 0.48). 3 patients (4.5%) have had a further revision; 2 for a previously unrevised stem and the other for instability. CONCLUSIONS Our arthroplasty care practitioner service allowed us to identify increased pain and stop using the ASR XL over 3 years before the implant was recalled. The revised patients had similar functional outcome to those unrevised. Poorly performing implants need to be identified earlier.
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Affiliation(s)
| | - Janet C Hill
- Primary Joint Unit, Musgrave Park Hospital, Belfast, UK
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Bergvinsson H, Zampelis V, Sundberg M, Flivik G. Highly cross-linked polyethylene still outperforms conventional polyethylene in THA: 10-year RSA results. Acta Orthop 2021; 92:568-574. [PMID: 34139928 PMCID: PMC8519538 DOI: 10.1080/17453674.2021.1932140] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Cup wear in total hip arthroplasty (THA) can be affected by different manufacturing processes of the polyethylene (PE). We report the long-term wear pattern differences, as well as early creep behavior, between conventional PE and highly cross-linked PE (HXLPE) liners, as measured with radiostereometry (RSA) up to 10 years. We also compare migration and clinical outcome of 2 similar uncemented cups with different backside surface roughness.Patients and methods - We included 45 patients with primary osteoarthritis. 23 received a conventional liner and 22 an HXLPE liner in a similar uncemented cup, but with a slightly rougher surface. The patients were followed up with RSA and hip-specific outcome questionnaire (HOOS) at 3 months, 1, 2, 5, and 10 years.Results - During the first 3 months both liners showed expected deformation with mean proximal head penetration of 0.39 mm (conventional PE) and 0.21 mm (HXLPE). Between 3 months and 10 years there was a difference in annual wear with 0.12 mm/year for the conventional liner and 0.02 mm/year for the HXLPE liner. The cup with rougher surface had less initial migration but both types had stabilized after 3 months. The HOOS scores improved after surgery and remained high for both groups throughout the study period.Interpretation - Up to 10 years the HXLPE has consistent lower annual wear, possibly contributing to longer survival of the THA, compared with conventional PE. All patients reported good results regardless of liner type.
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Affiliation(s)
- Halldor Bergvinsson
- Department of Orthopedics, Skåne University Hospital, Clinical Sciences, Lund University, Lund, Sweden,Correspondence:
| | - Vasilis Zampelis
- Department of Orthopedics, Skåne University Hospital, Clinical Sciences, Lund University, Lund, Sweden
| | - Martin Sundberg
- Department of Orthopedics, Skåne University Hospital, Clinical Sciences, Lund University, Lund, Sweden
| | - Gunnar Flivik
- Department of Orthopedics, Skåne University Hospital, Clinical Sciences, Lund University, Lund, Sweden
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38
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Mjöberg B. Hip prosthetic loosening: A very personal review. World J Orthop 2021; 12:629-639. [PMID: 34631447 PMCID: PMC8472441 DOI: 10.5312/wjo.v12.i9.629] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 05/03/2021] [Accepted: 08/03/2021] [Indexed: 02/06/2023] Open
Abstract
Hip prosthetic loosening is often difficult to detect at an early stage, and there has been uncertainty for a long time as to when the loosening occurs and thus to the basic causes. By comparing different diagnostic methods, we found that loosening is best defined as prosthetic migration and measured by radiostereometric analysis. Convincing evidence indicates that poor interlock, poor bone quality, and resorption of a necrotic bone bed may initiate loosening during or shortly after surgery; this forms the basis of the theory of early loosening. Biomechanical factors do affect the subsequent progression of loosening, which may increase subclinically during a long period of time. Eventually, the loosening may be detected on standard radiographs and may be interpreted as late loosening but should to be interpreted as late detection of loosening. The theory of early loosening explains the rapid early migration, the development of periprosthetic osteolysis and granulomas, the causality between wear and loosening, and largely the epidemiology of clinical failure of hip prostheses. Aspects discussed are definition of loosening, the pattern of early migration, the choice of migration threshold, the current understanding of loosening, a less exothermic bone cement, cemented taper-slip stems, a new exciting computed tomography-based technique for simpler implant migration studies, and research suggestions.
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Affiliation(s)
- Bengt Mjöberg
- Department of Orthopedics, Lund University, Lund SE-221 00, Sweden
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Brodén C, Sandberg O, Olivecrona H, Emery R, Sköldenberg O. Precision of CT-based micromotion analysis is comparable to radiostereometry for early migration measurements in cemented acetabular cups. Acta Orthop 2021; 92:419-423. [PMID: 33821746 PMCID: PMC8381926 DOI: 10.1080/17453674.2021.1906082] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - CT (computed tomography) based methods have lately been considered an alternative to radiostereometry (RSA) for assessing early implant migration. However, no study has directly compared the 2 methods in a clinical setting. We estimated the precision and effective radiation dose of a CT-based method and compared it with marker-based RSA in 10 patients with hip arthroplasty.Patients and methods - We included 10 patients who underwent total hip replacement with a cemented cup. CT and RSA double examinations were performed postoperatively, and precision and effective dose data were compared. The CT data was analyzed with CT micromotion analysis (CTMA) software both with and without the use of bone markers. The RSA images were analyzed with RSA software with the use of bone markers.Results - The precision of CTMA with bone markers was 0.10-0.16 mm in translation and 0.31°-0.37° in rotation. Without bone markers, the precision of CTMA was 0.10-0.16 mm in translation and 0.21°-0.31° in rotation. In comparison, the precision of RSA was 0.09-0.26 mm and 0.43°-1.69°. The mean CTMA and RSA effective dose was estimated at 0.2 mSv and 0.04 mSv, respectively.Interpretation - CTMA, with and without the use of bone markers, had a comparable precision to RSA. CT radiation doses were slightly higher than RSA doses but still at a considerably low effective dose.
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Affiliation(s)
- Cyrus Brodén
- Department of Surgery and Cancer, Imperial College London, St Mary’s Hospital, London, UK
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Division of Orthopaedics, Stockholm, Sweden
| | | | - Henrik Olivecrona
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Roger Emery
- Department of Surgery and Cancer, Imperial College London, St Mary’s Hospital, London, UK
| | - Olof Sköldenberg
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Division of Orthopaedics, Stockholm, Sweden
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Kuyl EV, Shu F, Sosa BR, Lopez JD, Qin D, Pannellini T, Ivashkiv LB, Greenblatt MB, Bostrom MPG, Yang X. Inhibition of PAD4 mediated neutrophil extracellular traps prevents fibrotic osseointegration failure in a tibial implant murine model : an animal study. Bone Joint J 2021; 103-B:135-144. [PMID: 34192911 DOI: 10.1302/0301-620x.103b7.bjj-2020-2483.r1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
AIMS Aseptic loosening is a leading cause of uncemented arthroplasty failure, often accompanied by fibrotic tissue at the bone-implant interface. A biological target, neutrophil extracellular traps (NETs), was investigated as a crucial connection between the innate immune system's response to injury, fibrotic tissue development, and proper bone healing. Prevalence of NETs in peri-implant fibrotic tissue from aseptic loosening patients was assessed. A murine model of osseointegration failure was used to test the hypothesis that inhibition (through Pad4-/- mice that display defects in peptidyl arginine deiminase 4 (PAD4), an essential protein required for NETs) or resolution (via DNase 1 treatment, an enzyme that degrades the cytotoxic DNA matrix) of NETs can prevent osseointegration failure and formation of peri-implant fibrotic tissue. METHODS Patient peri-implant fibrotic tissue was analyzed for NETs biomarkers. To enhance osseointegration in loose implant conditions, an innate immune system pathway (NETs) was either inhibited (Pad4-/- mice) or resolved with a pharmacological agent (DNase 1) in a murine model of osseointegration failure. RESULTS NETs biomarkers were identified in peri-implant fibrotic tissue collected from aseptic loosening patients and at the bone-implant interface in a murine model of osseointegration failure. Inhibition (Pad4-/- ) or resolution (DNase 1) of NETs improved osseointegration and reduced fibrotic tissue despite loose implant conditions in mice. CONCLUSION This study identifies a biological target (NETs) for potential noninvasive treatments of aseptic loosening by discovering a novel connection between the innate immune system and post-injury bone remodelling caused by implant loosening. By inhibiting or resolving NETs in an osseointegration failure murine model, fibrotic tissue encapsulation around an implant is reduced and osseointegration is enhanced, despite loose implant conditions. Cite this article: Bone Joint J 2021;103-B(7 Supple B):135-144.
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Affiliation(s)
- Emile-Victor Kuyl
- Arthroplasty Research Laboratory, Research Institute, Hospital for Special Surgery, New York, New York, USA
| | - Fei Shu
- Arthroplasty Research Laboratory, Research Institute, Hospital for Special Surgery, New York, New York, USA
| | - Branden R Sosa
- Arthroplasty Research Laboratory, Research Institute, Hospital for Special Surgery, New York, New York, USA.,Weill Cornell Medicine, New York, New York, USA
| | - Juan D Lopez
- Arthroplasty Research Laboratory, Research Institute, Hospital for Special Surgery, New York, New York, USA.,Weill Cornell Medicine, New York, New York, USA
| | - Di Qin
- Arthroplasty Research Laboratory, Research Institute, Hospital for Special Surgery, New York, New York, USA.,Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Tania Pannellini
- Research Institute and Precision Medicine Laboratory, Hospital for Special Surgery, New York, New York, USA
| | - Lionel B Ivashkiv
- Research Institute and David Z. Rosensweig Genomics Research Center, Hospital for Special Surgery, New York, New York, USA
| | - Matthew B Greenblatt
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA.,Research Institute, Hospital for Special Surgery, New York, New York, USA
| | - Mathias P G Bostrom
- Arthroplasty Research Laboratory, Research Institute, Hospital for Special Surgery, New York, New York, USA.,Weill Cornell Medicine, New York, New York, USA.,Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Xu Yang
- Arthroplasty Research Laboratory, Research Institute, Hospital for Special Surgery, New York, New York, USA
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Schierjott RA, Hettich G, Baxmann M, Morosato F, Cristofolini L, Grupp TM. Primary stability of a press-fit cup in combination with impaction grafting in an acetabular defect model. J Orthop Res 2021; 39:929-940. [PMID: 32691903 DOI: 10.1002/jor.24810] [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: 03/02/2020] [Revised: 06/15/2020] [Accepted: 07/13/2020] [Indexed: 02/04/2023]
Abstract
The objectives of this study were to (a) assess primary stability of a press-fit cup in a simplified acetabular defect model, filled with compacted cancellous bone chips, and (b) to compare the results with primary stability of a press-fit cup combined with two different types of bone graft substitute in the same defect model. A previously developed acetabular test model made of polyurethane foam was used, in which a mainly medial contained defect was implemented. Three test groups (N = 6 each) were prepared: Cancellous bone chips (bone chips), tricalciumphosphate tetrapods + collagen matrix (tetrapods + coll), bioactive glass S53P4 + polyethylene glycol-glycerol matrix (b.a.glass + PEG). Each material was compacted into the acetabulum and a press-fit cup was implanted. The specimens were loaded dynamically in the direction of the maximum resultant force during level walking. Relative motion between cup and test model was assessed with an optical measurement system. At the last load step (3000 N), inducible displacement was highest for bone chips with median [25th percentile; 75th percentile] value of 113 [110; 114] µm and lowest for b.a.glass + PEG with 91 [89; 93] µm. Migration at this load step was highest for b.a.glass + PEG with 868 [845; 936] µm and lowest for tetrapods + coll with 491 [487; 497] µm. The results show a comparable behavior under load of tetrapods + coll and bone chips and suggest that tetrapods + coll could be an attractive alternative to bone chips. However, so far, this was found for one specific defect type and primary stability should be further investigated in additional/more severe defects.
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Affiliation(s)
- Ronja A Schierjott
- Research & Development Department, Aesculap AG, Tuttlingen, Germany.,Department of Orthopaedic Surgery, Physical Medicine & Rehabilitation, Campus Grosshadern, Ludwig-Maximilians University Munich, Munich, Germany
| | - Georg Hettich
- Research & Development Department, Aesculap AG, Tuttlingen, Germany
| | - Marc Baxmann
- Research & Development Department, Aesculap AG, Tuttlingen, Germany
| | - Federico Morosato
- Department of Industrial Engineering, Alma Mater Studiorum-Università di Bologna, Bologna, Italy
| | - Luca Cristofolini
- Department of Industrial Engineering, Alma Mater Studiorum-Università di Bologna, Bologna, Italy
| | - Thomas M Grupp
- Research & Development Department, Aesculap AG, Tuttlingen, Germany.,Department of Orthopaedic Surgery, Physical Medicine & Rehabilitation, Campus Grosshadern, Ludwig-Maximilians University Munich, Munich, Germany
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Ten Brinke B, Mathijssen NMC, Blom IF, Koster LA, Kraan GA. A radiostereometric and clinical long-term follow-up study of the surface replacement trapeziometacarpal joint prosthesis. BMC Musculoskelet Disord 2021; 22:148. [PMID: 33546653 PMCID: PMC7866696 DOI: 10.1186/s12891-021-03957-8] [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: 11/04/2020] [Accepted: 12/30/2020] [Indexed: 11/16/2022] Open
Abstract
Background The aim of this study was to determine long-term survival and clinical outcomes of the surface replacement trapeziometacarpal joint prosthesis (SR™TMC) and to evaluate implant migration using radiostereometric analysis (RSA). Methods In this clinical long-term follow-up study outcomes of ten patients who received the SR™TMC joint prosthesis were evaluated using DASH and Nelson scores, Visual Analogue Scale (VAS) of pain, and key pinch strength. RSA-radiographs were obtained direct postoperatively and 6 months, 1, 5 and 10 years postoperatively and were analyzed using model-based RSA software. Results During follow-up, two early revisions took place. Mean pre-operative DASH and Nelson scores were 54 (SD 15) and 54 (SD 17), improved significantly after 6 months (DASH 25 (SD 20), Nelson 75 (SD 18)) and remained excellent during long-term follow-up in all patients with a stable implant. At final follow-up, clinical scores deteriorated clearly in two patients with a loose implant in situ. Conclusions Long-term survival of the SR™TMC joint prosthesis is relatively poor. However, clinical outcomes improved significantly in the short-term and remained excellent in the long-term in those patients with a stable implant, but deteriorated clearly in case of loosening. The role of RSA in TMC joint arthroplasty is potentially valuable but needs to be further investigated. Several challenges of RSA in the TMC joint have been addressed by the authors and suggestions to optimize RSA-data are given. Trial registration This study was registered in the Netherlands Trial Register (NL7126).
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Affiliation(s)
- Bart Ten Brinke
- Department of Orthopaedic Surgery, Reinier de Graaf Groep, P.O. Box 5011, 2600, GA, Delft, The Netherlands.
| | - Nina M C Mathijssen
- Department of Orthopaedic Surgery, Reinier de Graaf Groep, P.O. Box 5011, 2600, GA, Delft, The Netherlands
| | - Ian F Blom
- Department of Radiology, Reinier de Graaf Groep, P.O. Box 5011, 2600, GA, Delft, The Netherlands
| | - Lennard A Koster
- Department of Orthopaedic Surgery, Leids Universitair Medisch Centrum, P.O. Box 5011, 2300, RC, Leiden, The Netherlands
| | - Gerald A Kraan
- Department of Orthopaedic Surgery, Reinier de Graaf Groep, P.O. Box 5011, 2600, GA, Delft, The Netherlands
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Zampelis V, Flivik G. Custom-made 3D-printed cup-cage implants for complex acetabular revisions: evaluation of pre-planned versus achieved positioning and 1-year migration data in 10 patients. Acta Orthop 2021; 92:23-28. [PMID: 32928018 PMCID: PMC7919918 DOI: 10.1080/17453674.2020.1819729] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - The use of custom-made 3D-printed titanium implants for the reconstruction of large acetabular defects has been successively introduced in the last decade. In an observational cohort study we evaluated the agreement between preoperatively planned and actually achieved cup-cage position as well as 1-year follow-up migration of the cup-cage component.Patients and methods - 10 patients with Paprosky III defects underwent revision surgery using a custom-made 3D-printed cup-cage. The position of the implant on postoperative CT scan was compared with the preoperative plan and the postoperative CT scan was compared with the 1-year follow-up CT scan.Results - There was a median deviation in postoperative position versus planned in inclination of 3.6° (IQR 1.0-5.4), in anteversion of -2.8° (IQR -7.5 to 1.2), and in rotation of -1.2° (IQR -3.3 to 0.0). The median deviation in position of the center of rotation (COR) was -0.5 mm (IQR 2.9 to 0.7) in the anteroposterior (AP) plane, -0.6 mm (IQR -1.8 to -0.1) in the mediolateral (ML) plane, and 1.1 mm (IQR -1.6 to 2.8) in the superoinferior (SI) plane. The migration between postoperative and 1-year follow-up caused a mean change in inclination of 0.04° (IQR -0.06 to 0.09), in anteversion of -0.13° (IQR -0.23 to -0.06), and in rotation of 0.05° (IQR -0.46 to 1.4). The migration of COR was -0.08 mm (IQR -0.18 to -0.04) in the AP plane, 0.14 mm (IQR -0.08 to 0.22) in the ML plane, and 0.06 mm (IQR -0.02 to 0.35) in the SI plane. There was no re-revision.Interpretation - The early results show good agreement between planned and achieved cup-cage position and small measured migration values of the cup-cage component at the 1-year follow-up.
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Affiliation(s)
- Vasileios Zampelis
- Department of Orthopedics, Skane University Hospital, Clinical Sciences, Lund University, Lund, Sweden,Correspondence:
| | - Gunnar Flivik
- Department of Orthopedics, Skane University Hospital, Clinical Sciences, Lund University, Lund, Sweden
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Thillemann JK, Dremstrup L, Hansen TB, Stilling M. The mechanical fixation of a cementless conical cup in cortical versus cancellous trapezial bone: an experimental study. J Hand Surg Eur Vol 2021; 46:146-153. [PMID: 33079604 DOI: 10.1177/1753193420963255] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
In a pig bone model mimicking the human trapezium, we assessed the cementless fixation of trapezial cups in cancellous and cortical bone. Thirty-two saddle-shaped pig forefoot bones were prepared for cup fixation. Conical Konos cups (Beznoska, Kladno, Czech Republic) size 9 mm or 10 mm diameter were impacted. Cup migration was evaluated with repeated radiostereometry after intervals of cyclic-load tests. Migration increased for every load-interval up to 750 N and was higher with cancellous bone fixation than with cortical bone fixation. In cancellous bone, 9 mm cups migrated more than 10 mm cups. At the highest load (1050 N), the cumulative implant survival was 88% for 10 mm cups with cortical bone fixation and 13% for 9 mm cups with cancellous bone fixation. We conclude that mechanical fixation of conical Konos cups was better in cortical than in cancellous bone. Our results further suggest that the largest possible cup diameter should be used.
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Affiliation(s)
- Janni K Thillemann
- Department of Orthopeadics, University Clinic for Hand, Hip and Knee Surgery, Hospital Unit West, Holstebro, Denmark.,Department of Clinical Medicine, Aarhus University, Skejby, Denmark
| | - Lene Dremstrup
- Department of Orthopeadics, University Clinic for Hand, Hip and Knee Surgery, Hospital Unit West, Holstebro, Denmark
| | - Torben B Hansen
- Department of Orthopeadics, University Clinic for Hand, Hip and Knee Surgery, Hospital Unit West, Holstebro, Denmark.,Department of Clinical Medicine, Aarhus University, Skejby, Denmark
| | - Maiken Stilling
- Department of Clinical Medicine, Aarhus University, Skejby, Denmark.,Department of Orthopaedics, Aarhus University Hospital, Skejby, Denmark
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45
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Comtesse S, de Gast A, Rehbein P, French G, Helmy N, Becker R, Dominkus M, Beck M. Wear and migration are not influenced by head size in a vitamin E-infused highly cross-linked polyethylene acetabular cup. Orthop Traumatol Surg Res 2021; 107:102644. [PMID: 33384276 DOI: 10.1016/j.otsr.2020.03.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 03/19/2020] [Accepted: 03/24/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Aseptic loosening and periprosthetic osteolysis are frequent complications in total hip arthroplasty requiring revision surgery. Highly cross-linked polyethylene (HXLPE) implants have improved wear resistance, permitting larger femoral heads. However, such implants may experience surface cracking, mechanical failure, and oxidative damage. Vitamin E-infused HXLPE (VEPE) implants were therefore developed to reduce oxidation without compromising mechanical strength. We addressed the following questions: (1) Does femoral head size affect the midterm annual polyethylene wear rates of VEPE acetabular cups? (2) Does femoral head size affect the midterm migration rates of VEPE acetabular cups? (3) Are clinical outcomes affected by femoral head size? HYPOTHESIS Annual wear rate, migration rate, and clinical outcomes of VEPE acetabular cups are independent of femoral head size. PATIENTS AND METHODS This was a prospective, multicentre, observational study of patients that underwent total hip arthroplasty. Hips were grouped according to the size of femoral head implanted (28 mm, 32 mm, and 36 mm). We determined annual wear rate and migration rate of VEPE acetabular cups using the Einzel-Bild-Röntgen-Analyse software. Clinically, we assessed the Harris Hip Score and visual analog score for pain and satisfaction. RESULTS We followed 253 patients (267 hips) for a mean of 55.0±20.6 months in the 28 mm, 46.2±21.4 months in the 32 mm, and 43.8±22.6 months in the 36 mm group. The annual wear rate was 0.025 mm per year from 1 year to the last follow-up and remained similar between the groups (p>0.05). Also, mean two-dimensional migration rates did not exceed 0.05 mm from 2 years to the last follow-up and remained similar between the groups (p=0.355). Finally, clinical outcomes also did not differ between the groups (p>0.05). Two patients required revision surgery. DISCUSSION Femoral head size did not influence midterm annual wear rate, migration rate, and clinical outcomes of VEPE acetabular cups. Furthermore, wear and cup migration rates were below the reported values leading to osteolysis and aseptic loosening. Nevertheless, studies with extended follow-up periods will be necessary to confirm these results in the long term. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Simon Comtesse
- Mathys Ltd Bettlach, Robert-Mathys Strasse 5, 2544 Bettlach, Switzerland
| | - Arthur de Gast
- Diakonessenhuis Utrecht, Bosboomstraat 1, 3582 KE Utrecht, Netherlands; Clinical Orthopedic Research Centre midden-Nederland, Diakonessenhuis Zeist, Jagersingel 1, 3707 HL Zeist, Netherlands
| | - Philipp Rehbein
- St. Josefs-Hospital Wiesbaden, Beethovenstraße 20, 65189 Wiesbaden, Germany
| | - Gary French
- Ormiston Hospital, 125, Ormiston Road, Flat Bush, 2016 Manukau, New Zealand
| | - Naeder Helmy
- Bürgerspital Solothurn, Schöngrünstrasse 42, 4500 Solothurn, Switzerland
| | - Roland Becker
- Zentrum für Orthopädie und Unfallchirurgie, Endoprothesenzentrum West-Brandenburg, Medizinische Hochschule Theodor Fontane, 14776 Brandenburg/Havel, Germany
| | - Martin Dominkus
- Orthopädisches Spital Speising, Speisinger Straße 109, 1130 Wien, Austria; Sigmund-Freud University, Campus Prater Freudplatz 1, 1020 Wien, Austria
| | - Martin Beck
- Luzerner Kantonsspital, Spitalstrasse, 6000 Luzern, Switzerland.
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46
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van Loon J, Vervest AMJS, van der Vis HM, Sierevelt IN, Baas DC, Opdam KTM, Kerkhoffs GMMJ, Haverkamp D. Ceramic-on-ceramic articulation in press-fit total hip arthroplasty as a potential reason for early failure, what about the survivors: a ten year follow-up. INTERNATIONAL ORTHOPAEDICS 2021; 45:1447-1454. [PMID: 33459828 PMCID: PMC8178149 DOI: 10.1007/s00264-020-04895-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 12/03/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE In press-fit total hip arthroplasty (THA), primary stability is needed to avoid micromotion and hereby aseptic loosening, the main reason for early revision. High aseptic loosening revision rates of the seleXys TH+ cup (Mathys Medical) with Ceramys ceramic-on-ceramic (CoC) bearing are seen in literature. Since CoC is presumed to overcome long-term wear-related revisions, the reason for early failure of this cup is important to clarify. The aim is to investigate its ten year outcomes and differentiate between potential causes and identify risk factors for aseptic loosening. METHODS Retrospective screening of a prospectively documented series of 315 THAs was performed. Primary outcome was cumulative incidence of cup revision due to aseptic loosening. Secondary outcomes were component revision and reoperation. Additionally, potential predictive factors for aseptic loosening were evaluated. RESULTS At the median follow-up of 9.7 years [IQR 4.4; 10.3], 48 TH+ (15.2%) were revised due to aseptic loosening. Competing risk analysis showed a ten year cumulative incidence of cup revision due to aseptic loosening of 15.6% (95% CI 12.0-20.2). Stabilization of early revision rates was observed, following a high rate of respectively 81.3% (n = 39) and 95.8% (n = 46) within the first two and three years. No significant predictive factors for aseptic loosening were found. CONCLUSION The ten year results of seleXys TH+ cup with Ceramys CoC bearing showed an unacceptable high aseptic loosening rate, which stabilized over time after a high early failure incidence. This could be attributed to a problem with osseointegration during the transition of primary to definitive stability.
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Affiliation(s)
- J van Loon
- Department of Orthopedic Surgery, Xpert Clinics/SCORE (Specialized Center of Orthopedic Research and Education), Laarderhoogtweg 12, 1101EA, Amsterdam, The Netherlands.,Department of Orthopaedic Surgery, Amsterdam University Medical Centers, location Academic Medical Center, Meibergdreef 15, 1105, AZ, Amsterdam, The Netherlands.,Department of Orthopaedic Surgery, Tergooi, Van Riebeeckweg 212, 1213, XZ, Hilversum, The Netherlands
| | - A M J S Vervest
- Department of Orthopaedic Surgery, Tergooi, Van Riebeeckweg 212, 1213, XZ, Hilversum, The Netherlands
| | - H M van der Vis
- Department of Orthopedic Surgery, Xpert Clinics/SCORE (Specialized Center of Orthopedic Research and Education), Laarderhoogtweg 12, 1101EA, Amsterdam, The Netherlands
| | - I N Sierevelt
- Department of Orthopedic Surgery, Xpert Clinics/SCORE (Specialized Center of Orthopedic Research and Education), Laarderhoogtweg 12, 1101EA, Amsterdam, The Netherlands.,Department of Orthopaedic Surgery, Spaarne Gasthuis, Spaarnepoort 1, 2134, TM, Hoofddorp, The Netherlands
| | - D C Baas
- Department of Orthopaedic Surgery, Tergooi, Van Riebeeckweg 212, 1213, XZ, Hilversum, The Netherlands
| | - K T M Opdam
- Department of Orthopaedic Surgery, Amsterdam University Medical Centers, location Academic Medical Center, Meibergdreef 15, 1105, AZ, Amsterdam, The Netherlands
| | - G M M J Kerkhoffs
- Department of Orthopaedic Surgery, Amsterdam University Medical Centers, location Academic Medical Center, Meibergdreef 15, 1105, AZ, Amsterdam, The Netherlands
| | - D Haverkamp
- Department of Orthopedic Surgery, Xpert Clinics/SCORE (Specialized Center of Orthopedic Research and Education), Laarderhoogtweg 12, 1101EA, Amsterdam, The Netherlands.
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Sandberg O, Tholén S, Carlsson S, Wretenberg P. The anatomical SP-CL stem demonstrates a non-progressing migration pattern in the first year: a low dose CT-based migration study in 20 patients. Acta Orthop 2020; 91:654-659. [PMID: 33063555 PMCID: PMC8023890 DOI: 10.1080/17453674.2020.1832294] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Background and purpose - RSA is the gold standard for evaluation of early implant migration. We report the results of a new CT-based method Sectra CT micromotion analysis (CTMA) applied to assess the migration pattern in 20 patients in the 1st year after surgery, both with and without the use of tantalum beads in the bone. The patients had an SP-CL anatomical stem that uses an S-shape, designed to better fit the curvature of the femur. Patients and methods - 20 THA patients (mean age 61 years, 10 female) received SP-CL stems, tantalum markers in the femur, and low-dose CT scans at 1 day, 3 months and 12 months postoperatively. In addition, precision as well as inter- and intra-observer variability of the 12-month migration was measured. Results - The 3-month subsidence was median 0.5 mm (95% CI 0.3-1.0) and the internal rotation 1.8° (CI 0.9-2.6). At 12 months the corresponding values were 0.6 (CI 0.3-1.6) mm and 1.9° (CI 0.8-2.4). Precision was 0.1 to 0.3 mm and 0.1° to 0.4° at 3 and 12 months. Intra- and inter- observer variability yielded R-values averaging 0.96 and 0.98. Interpretation - The migration mainly took place during the 1st 3 months, in line with other uncemented stems. The number of patients with subsidence over 2 mm in the first year (5) might be due to the design of the prosthesis with an anatomical shape. Alternatively, our results might indicate a challenge when choosing the correct size for these new anatomical stems. CTMA provided precise and highly repeatable measurements of migration without the need for tantalum markers.
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Affiliation(s)
| | - Simon Tholén
- Department of Radiology, Lindesberg Hospital, Örebro University Hospital
| | - Sofia Carlsson
- Department of Radiology, Lindesberg Hospital, Örebro University Hospital
| | - Per Wretenberg
- Department of Medical Sciences, Section of Orthopaedics, Örebro University Hospital, Sweden
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48
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Affiliation(s)
- Stephan M Röhrl
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway,
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49
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Rahman L, Ibrahim MS, Somerville L, Teeter MG, Naudie DD, McCalden RW. Minimum ten-year follow-up of a randomized trial comparing acetabular component fixation of two porous in-growth surfaces using radiosteriometric analysis. Bone Jt Open 2020; 1:653-662. [PMID: 33215098 PMCID: PMC7659663 DOI: 10.1302/2633-1462.110.bjo-2020-0118.r1] [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] [Indexed: 11/25/2022] Open
Abstract
Aims To compare the in vivo long-term fixation achieved by two acetabular components with different porous ingrowth surfaces using radiostereometric analysis (RSA). Methods This was a minimum ten-year follow-up of a prospective randomized trial of 62 hips with two different porous ingrowth acetabular components. RSA exams had previously been acquired through two years of follow-up. Patients returned for RSA examination at a minimum of ten years. In addition, radiological appearance of these acetabular components was analyzed, and patient-reported outcome measures (PROMs) obtained. Results In all, 15 hips were available at ten years. There was no statistically significant difference in PROMS between the two groups; PROMs were improved at ten years compared to preoperative scores. Conventional radiological assessment revealed well-fixed components. There was minimal movement for both porous surfaces in translation (X, Y, Z, 3D translation in mm (median and interquartile range (IQR)), StikTite (Smith and Nephew, Memphis, Tennessee, USA): 0.03 (1.08), 0.12 (0.7), 0.003 (2.3), 0.37 (0.30), and Roughcoat (Smith and Nephew): -0.6 (0.59),–0.1 (0.49), 0.1 (1.12), 0.48 (0.38)), and rotation (X, Y, Z rotation in degrees (median and IQR), (Stiktite: -0.4 (3), 0.28 (2), -0.2 (1), and Roughcoat: - 0.4 (1),–0.1 (1), 0.2 (2)). There was no statistically significant difference between the two cohorts (p-value for X, Y, Z, 3D translation - 0.54, 0.46, 0.87, 0.55 and for X, Y, Z rotation - 0.41, 0.23, 0.23 respectively) at ten years. There was significant correlation between two years and ten years 3D translation for all components (r = 0.81(p =< 0.001)). Conclusion Both porous ingrowth surfaces demonstrated excellent fixation on plain radiographs and with RSA at ten years. Short-term RSA data are good predictors for long-term migration data.
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Affiliation(s)
- Luthfur Rahman
- London Health Sciences Centre, University of Western Ontario, The Rorabeck-Bourne Joint Replacement Institute, London, Ontario, Canada.,Department of Orthopaedics, University College London Hospitals NHS Foundation Trust, London, UK
| | - Mazin S Ibrahim
- London Health Sciences Centre, University of Western Ontario, The Rorabeck-Bourne Joint Replacement Institute, London, Ontario, Canada
| | - Lyndsay Somerville
- London Health Sciences Centre, University of Western Ontario, The Rorabeck-Bourne Joint Replacement Institute, London, Ontario, Canada
| | - Matthew G Teeter
- Department of Surgery, Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Douglas D Naudie
- London Health Sciences Centre, University of Western Ontario, The Rorabeck-Bourne Joint Replacement Institute, London, Ontario, Canada
| | - Richard W McCalden
- London Health Sciences Centre, University of Western Ontario, The Rorabeck-Bourne Joint Replacement Institute, London, Ontario, Canada
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50
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[Early assessment of the risk of later implantloosening using Roentgen Sterophotogrammetric Analysis (RSA)]. DER ORTHOPADE 2020; 49:1042-1048. [PMID: 33108489 DOI: 10.1007/s00132-020-04027-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Aseptic implant loosening is the most common cause of implant revisions in total hip and total knee arthroplasty. Roentgen Stereophotogrammetric Analysis (RSA) represents the current gold standard for the in-vivo assessment of implant fixation. PRESENT SITUATION Long-term clinical trials have shown that continuous implant migration within the first two postoperative years correlates strongly with a later aseptic loosening. Thus, the implant migration measured with RSA can be regarded as a reliable surrogate marker for later implant loosening. Over the past 40 years, RSA has been continuously further developed, and the model-based RSA approach has reduced the effort involved since markers attached to implant are no longer needed. PERSPECTIVES The RSA method is gaining importance in the certification process of new orthopaedic implants-for example, the Dutch Orthopedic Society has recommended phased-introduction and RSA studies for new hip implants. Furthermore, in the context of the new EU Medical Device Regulation (MDR), which took effect in May 2017, RSA gained relevance for investigating clinically unproven implants. Critics who associate MDR with hindering innovation can be countered in that the RSA method provides a predictive assessment of implant fixation after only two years of follow-up, which is significantly shorter than standard long-term clinical trials.
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