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De Angelis S, Di Laura A, Ramesh A, Henckel J, Hart A. The role of bone remodeling in measuring migration of custom implants for large acetabular defects. J Orthop Res 2024; 42:1791-1800. [PMID: 38408764 DOI: 10.1002/jor.25818] [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: 11/24/2023] [Revised: 01/15/2024] [Accepted: 01/19/2024] [Indexed: 02/28/2024]
Abstract
In revision total hip arthroplasty, achieving robust fixation is difficult and implant movement may occur over time. Bone may also rearrange around the implant as a result of mechanical loading, making the measurement of migration challenging. The study aimed to quantify changes in bone shape and implant position 1 year following acetabular reconstruction using custom three-dimensional-printed cups. This observational retrospective cohort study involved 23 patients with Paprosky type IIIB defects. Postop computed tomography scans taken within 1 week of surgery and at 1-year postsurgery were co-registered and analyzed. Three co-registration strategies were implemented including bone-to-bone and implant-to-implant. (1) Co-registration of the ipsilateral innominate bone (diseased anatomy) was used to measure changes in implant position. (2) Co-registration of the implant was carried out to quantify changes in the ipsilateral innominate bone shape. (3) Co-registration of the contralateral innominate bone (nondiseased anatomy) was performed to measure changes in the ipsilateral innominate bone shape and implant position. The median centroid distances (interquartile range [IQR]) were 2.3 mm (IQR: 3.7-1.7 mm) for changes in implant position, 2.4 mm (IQR: 3.6-1.6 mm) for changes in ipsilateral innominate bone shape, and 3.7 mm (IQR: 4.6-3.5 mm) for changes in ipsilateral innominate bone shape and implant position. Following acetabular reconstruction, implant movements and periprosthetic bone remodeling are physiological and of a similar extent. Surgeons and engineers should consider this when performing implant monitoring in these patients.
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Affiliation(s)
- Sara De Angelis
- Institute of Mechanical Engineering, University College London, London, UK
| | - Anna Di Laura
- Institute of Mechanical Engineering, University College London, London, UK
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
| | - Angelika Ramesh
- Institute of Mechanical Engineering, University College London, London, UK
| | - Johann Henckel
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
| | - Alister Hart
- Institute of Orthopaedics and Musculoskeletal Science, University College London, London, UK
- Cleveland Clinic London, London, UK
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Szabelski J, Karpiński R, Krakowski P, Jojczuk M, Jonak J, Nogalski A. Analysis of the Effect of Component Ratio Imbalances on Selected Mechanical Properties of Seasoned, Medium Viscosity Bone Cements. MATERIALS (BASEL, SWITZERLAND) 2022; 15:5577. [PMID: 36013714 PMCID: PMC9416016 DOI: 10.3390/ma15165577] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/05/2022] [Accepted: 08/11/2022] [Indexed: 06/15/2023]
Abstract
The paper presents the results of experimental strength tests of specimens made of two commercially available bone cements subjected to compression, that is a typical variant of load of this material during use in the human body, after it has been used for implantation of prostheses or supplementation of bone defects. One of the factors analysed in detail was the duration of cement seasoning in Ringer's solution that simulates the aggressive environment of the human body and material degradation caused by it. The study also focused on the parameters of quantitative deviation from the recommended proportions of liquid (MMA monomer, accelerator and stabiliser) and powder (PMMA prepolymer and initiator) components, i.e., unintentional inaccuracy of component proportioning at the stage of cement mass preparation. Statistical analysis has shown the influence of these factors on the decrease in compressive strength of the cements studied, which may be of significant importance in operational practice.
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Affiliation(s)
- Jakub Szabelski
- Department of Computerization and Production Robotization, Faculty of Mechanical Engineering, Lublin University of Technology, Nadbystrzycka 36, 20-618 Lublin, Poland
| | - Robert Karpiński
- Department of Machine Design and Mechatronics, Faculty of Mechanical Engineering, Lublin University of Technology, Nadbystrzycka 36, 20-618 Lublin, Poland
| | - Przemysław Krakowski
- Chair and Department of Trauma Surgery and Emergency Medicine, Medical University of Lublin, Staszica 11, 20-081 Lublin, Poland
- Orthopaedic Department, Łęczna Hospital, Krasnystawska 52, 21-010 Leczna, Poland
| | - Mariusz Jojczuk
- Chair and Department of Trauma Surgery and Emergency Medicine, Medical University of Lublin, Staszica 11, 20-081 Lublin, Poland
| | - Józef Jonak
- Department of Machine Design and Mechatronics, Faculty of Mechanical Engineering, Lublin University of Technology, Nadbystrzycka 36, 20-618 Lublin, Poland
| | - Adam Nogalski
- Chair and Department of Trauma Surgery and Emergency Medicine, Medical University of Lublin, Staszica 11, 20-081 Lublin, Poland
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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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Rassir R, Nellensteijn JM, Saouti R, Nolte PA. Bilateral massive osteolysis of uncertain origin after total knee arthroplasty: A case report and review of literature. Int J Surg Case Rep 2021; 80:105678. [PMID: 33676292 PMCID: PMC7982495 DOI: 10.1016/j.ijscr.2021.105678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/17/2021] [Accepted: 02/17/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Periprosthetic osteolysis (PPOL) is a common complication after total knee arthroplasty (TKA) and is most commonly caused by wear-induced particles. CASE PRESENTATION We report an unusual case of massive bilateral PPOL in the posterior flanges of the femur and patellae 4 years after bilateral uncemented TKA without patellar resurfacing in a 71-year old female. Bilateral staged revision surgery including polyethylene exchange and allograft morselized bone impaction was performed to treat the osteolytic lesions. There were no signs of implant malalignment, polyethylene wear or component loosening. CLINICAL DISCUSSION Several factors are associated with an increased risk on PPOL (e.g. polyethylene sterilization method, patient age, male gender). Surgical intervention in the context of massive PPOL should include replacement of a potential particle generator (most often polyethylene), correction of potential malalignment, treatment of bone defects and assessment of implant anchorage. CONCLUSION This report highlights the available evidence on clinical presentation, associated risk factors and preferred treatment strategy of massive osteolytic lesions after TKA according to available evidence.
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Affiliation(s)
- Rachid Rassir
- Spaarne Gasthuis, Spaarnepoort 1, 2134 TM Hoofddorp, the Netherlands.
| | - Jorm M Nellensteijn
- Amsterdam UMC, Location VUmc, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands
| | - Rachid Saouti
- Amsterdam UMC, Location VUmc, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands
| | - Peter A Nolte
- Spaarne Gasthuis, Spaarnepoort 1, 2134 TM Hoofddorp, the Netherlands
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Sopata M, Karpiński TM, Jakubowicz J, Sopata M. Development of tantalum with highly hydrophilic surface and antimicrobial properties obtained by micro-arc oxidation process. J Biomed Mater Res B Appl Biomater 2020; 109:829-840. [PMID: 33107130 DOI: 10.1002/jbm.b.34748] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 09/18/2020] [Accepted: 10/12/2020] [Indexed: 11/10/2022]
Abstract
Tantalum (Ta) and its application in biomaterials has been attracting more and more attention recently. It can be considered as a material for hard tissue implants. This study focuses on antimicrobial and surface characterization of micro-arc oxidized (MAO) nanocrystalline Ta compared with its microcrystalline equivalent. For the purposes of the investigation, x-ray diffractometry (XRD), scanning electron microscopy (SEM), atomic force microscopy (AFM), wetting analysis, optical profilometry, corrosion resistance measurement, and antimicrobial tests were performed. Nanocrystalline Ta was fabricated using high-energy ball milling (HEBM) and pulse plasma sintering (PPS). The MAO process done at 250 V results in the formation of a porous oxide surface. An XRD analysis confirmed the presence of a Ta2 O5 oxide layer. Based on the SEM pictures, the obtained oxide layer was approximately 3-4 μm thick for nanocrystalline Ta substrate. For microcrystalline Ta, the oxide layer was thinner, in the range of 0.3-0.6 μm. The analysis of polarization curves showed a significant improvement of corrosion resistance for MAO nanocrystalline Ta (2.62 × 10-8 A/cm2 ) versus not oxidized nanocrystalline Ta (1.20 × 10-5 A/cm2 ). The surface roughness of MAO nanocrystalline Ta proved to be several times higher than that of unoxidized Ta. Wetting analysis showed that the oxide layer on the nanocrystalline substrate is hydrophilic. This research provides detailed information about MAO microcrystalline and MAO nanocrystalline Ta antimicrobial activity against Staphylococcus aureus and Pseudomonas aeruginosa. A significant decrease of S. aureus for MAO nanocrystalline Ta (control 10,435 ± 981 vs. sample 3,453 ± 130) was noticed. No significant difference was noticed for MAO microcrystalline and nanocrystalline Ta tested for P. aeruginosa.
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Affiliation(s)
- Mateusz Sopata
- Institute of Materials Engineering, Poznan University of Technology, Poznan, Poland
| | - Tomasz M Karpiński
- Department of Medical Microbiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Jaroslaw Jakubowicz
- Institute of Materials Engineering, Poznan University of Technology, Poznan, Poland
| | - Maciej Sopata
- Chair and Department of Palliative Medicine, Poznan University of Medical Sciences, Poznan, Poland
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Abstract
Prosthetic loosening has been debated for decades, both in terms of the timing and nature of the triggering events. Multiple radiostereometric studies of hip prostheses have now shown that early migration poses a risk of future clinical failure, but is this enough to explain late clinical loosening?To answer this question, the progression of loosening from initiation to radiographic detection is described; and the need for explanations other than early prosthetic loosening is analysed, such as stress-shielding, particle disease, and metal sensitivity.Much evidence indicates that prosthetic loosening has already been initiated during or shortly after the surgery, and that the subsequent progression of loosening is affected by biomechanical factors, fluid pressure fluctuations and inflammatory responses to necrotic cells and cell fragments, i.e. the concept of late loosening appears to be a misinterpretation of late-detected loosening.Clinical implications: atraumatic surgery and initial prosthetic stability are crucial in ensuring low risk of prosthetic loosening. Cite this article: EFORT Open Rev 2020;5:113-117. DOI: 10.1302/2058-5241.5.190014.
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Affiliation(s)
- Bengt Mjöberg
- Department of Orthopaedics, Lund University, Lund, Sweden
- Bengt Mjöberg, Västra Vallgatan 29, SE-27135 Ystad, Sweden.
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Goodman SB, Gallo J. Periprosthetic Osteolysis: Mechanisms, Prevention and Treatment. J Clin Med 2019; 8:E2091. [PMID: 31805704 PMCID: PMC6947309 DOI: 10.3390/jcm8122091] [Citation(s) in RCA: 127] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 11/28/2019] [Accepted: 11/29/2019] [Indexed: 02/06/2023] Open
Abstract
Clinical studies, as well as in vitro and in vivo experiments have demonstrated that byproducts from joint replacements induce an inflammatory reaction that can result in periprosthetic osteolysis (PPOL) and aseptic loosening (AL). Particle-stimulated macrophages and other cells release cytokines, chemokines, and other pro-inflammatory substances that perpetuate chronic inflammation, induce osteoclastic bone resorption and suppress bone formation. Differentiation, maturation, activation, and survival of osteoclasts at the bone-implant interface are under the control of the receptor activator of nuclear factor kappa-Β ligand (RANKL)-dependent pathways, and the transcription factors like nuclear factor κB (NF-κB) and activator protein-1 (AP-1). Mechanical factors such as prosthetic micromotion and oscillations in fluid pressures also contribute to PPOL. The treatment for progressive PPOL is only surgical. In order to mitigate ongoing loss of host bone, a number of non-operative approaches have been proposed. However, except for the use of bisphosphonates in selected cases, none are evidence based. To date, the most successful and effective approach to preventing PPOL is usage of wear-resistant bearing couples in combination with advanced implant designs, reducing the load of metallic and polymer particles. These innovations have significantly decreased the revision rate due to AL and PPOL in the last decade.
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Affiliation(s)
- Stuart B. Goodman
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway St. M/C 6342, Redwood City, CA 94063, USA
- Department of Bioengineering, Stanford University, Stanford, CA 94305, USA
| | - Jiri Gallo
- Department of Orthopaedics, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, I. P. Pavlova 6, 779 00 Olomouc, Czech Republic;
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McArthur BA, Scully R, Patrick Ross F, Bostrom MPG, Falghren A. Mechanically Induced Periprosthetic Osteolysis: A Systematic Review. HSS J 2019; 15:286-296. [PMID: 31624485 PMCID: PMC6778158 DOI: 10.1007/s11420-018-9641-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 09/25/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Peri-prosthetic bone loss can result from chemical, biological, and mechanical factors. Mechanical stimulation via fluid pressure and flow at the bone-implant interface may be a significant cause. Evidence supporting mechanically induced osteolysis continues to grow, but there is no synthesis of published clinical and basic science data. QUESTIONS/PURPOSES We sought to review the literature on two questions: (1) What published evidence supports the concept of mechanically induced osteolysis? (2) What is the proposed mechanism of mechanically induced osteolysis, and does it differ from that of particle-induced osteolysis? METHODS A systematic review was performed of the PubMed and Web of Science databases. Additional relevant articles were recommended by the senior authors based on their expert opinion. Abstracts were reviewed and the manuscripts pertaining to the study questions were read in full. Studies showing support of mechanically induced osteolysis were quantified and findings summarized. RESULTS We identified 49 articles of experimental design supporting the hypothesis that mechanical stimulation of peri-prosthetic bone from fluid pressure and flow can induce osteolysis. While the molecular mechanisms may overlap with those implicated in particle-induced osteolysis, mechanically induced osteolysis appears to be mediated by distinct and parallel pathways. CONCLUSIONS The role of mechanical stimuli is increasingly recognized in the pathogenesis of peri-prosthetic osteolysis. Current research aims to elucidate the molecular mechanisms to better target therapeutic interventions.
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Affiliation(s)
- Benjamin A. McArthur
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas, Texas Orthopedics Sports and Rehabilitation Associates, 4215 Benner Road, Ste. 300, Kyle, TX 78640 USA
| | - Ryan Scully
- Department of Orthopedic Surgery, George Washington University, 2300 M Street, NW, Washington, DC, 20037 USA
| | - F. Patrick Ross
- Hospital for Special Surgery, 535 E. 70th Street, New York, NY 10021 USA
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Yasenchuk Y, Marchenko E, Gunther V, Radkevich A, Kokorev O, Gunther S, Baigonakova G, Hodorenko V, Chekalkin T, Kang JH, Weiss S, Obrosov A. Biocompatibility and Clinical Application of Porous TiNi Alloys Made by Self-Propagating High-Temperature Synthesis (SHS). MATERIALS (BASEL, SWITZERLAND) 2019; 12:E2405. [PMID: 31357702 PMCID: PMC6696327 DOI: 10.3390/ma12152405] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 07/23/2019] [Accepted: 07/26/2019] [Indexed: 11/16/2022]
Abstract
Porous TiNi alloys fabricated by self-propagating high-temperature synthesis (SHS) are biomaterials designed for medical application in substituting tissue lesions and they were clinically deployed more than 30 years ago. The SHS process, as a very fast and economically justified route of powder metallurgy, has distinctive features which impart special attributes to the resultant implant, facilitating its integration in terms of bio-mechanical/chemical compatibility. On the phenomenological level, the fact of high biocompatibility of porous SHS TiNi (PTN) material in vivo has been recognized and is not in dispute presently, but the rationale is somewhat disputable. The features of the SHS TiNi process led to a multifarious intermetallic Ti4Ni2(O,N,C)-based constituents in the amorphous-nanocrystalline superficial layer which entirely conceals the matrix and enhances the corrosion resistance of the unwrought alloy. In the current article, we briefly explore issues of the high biocompatibility level on which additional studies could be carried out, as well as recent progress and key fields of clinical application, yet allowing innovative solutions.
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Affiliation(s)
- Yuri Yasenchuk
- Research Institute of Medical Materials, Tomsk State University, Tomsk 634045, Russia
| | - Ekaterina Marchenko
- Research Institute of Medical Materials, Tomsk State University, Tomsk 634045, Russia
| | - Victor Gunther
- Research Institute of Medical Materials, Tomsk State University, Tomsk 634045, Russia
| | - Andrey Radkevich
- Research Institute of Medical Problems of the North, Siberian Branch of the Russian Academy of Sciences, Krasnoyarsk 660017, Russia
| | - Oleg Kokorev
- Research Institute of Medical Materials, Tomsk State University, Tomsk 634045, Russia
| | - Sergey Gunther
- Research Institute of Medical Materials, Tomsk State University, Tomsk 634045, Russia
| | - Gulsharat Baigonakova
- Research Institute of Medical Materials, Tomsk State University, Tomsk 634045, Russia
| | - Valentina Hodorenko
- Research Institute of Medical Materials, Tomsk State University, Tomsk 634045, Russia
| | - Timofey Chekalkin
- Research Institute of Medical Materials, Tomsk State University, Tomsk 634045, Russia.
- Kang and Park Medical Co., R&D Center, Ochang 28119, Korea.
| | - Ji-Hoon Kang
- Kang and Park Medical Co., R&D Center, Ochang 28119, Korea
| | - Sabine Weiss
- Department of Physical Metallurgy and Materials Technology, Brandenburg University of Technology, 03044 Cottbus, Germany
| | - Aleksei Obrosov
- Department of Physical Metallurgy and Materials Technology, Brandenburg University of Technology, 03044 Cottbus, Germany
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Morita D, Seki T, Higuchi Y, Takegami Y, Amano T, Ishiguro N. The influence of early radiolucent lines appearing on femoral head penetration into HXLPE cemented sockets. Hip Int 2018; 28:369-374. [PMID: 29707984 DOI: 10.1177/1120700018754308] [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
INTRODUCTION This study investigates differences in femoral head penetration between highly cross-linked polyethylene (HXLPE) cemented sockets both with and without radiolucent lines (RLLs) in the early postoperative phase and at 5 years follow-up. METHODS There were 35 patients (37 hips), mean age of 66.8 years, who underwent total hip arthroplasty (THA) using highly HXLPE cemented sockets. They were divided into 2 groups based on postoperative the early appearance of RLLs. Femoral head penetrations on both anteroposterior- and Lauenstein-view radiographs were evaluated, and the mean polyethylene (PE) wear rate was calculated based on femoral head penetrations between 2 and 5 years. RESULTS Femoral head penetrations in the proximal direction were 0.075 mm and 0.150 mm in the RLL and non-RLL groups at 1 year postoperatively ( p = 0.019). At 5 years measured penetration was 0.107 mm and 0.125 mm in the RLL and non-RLL groups, respectively ( p = 0.320). The mean PE wear rates in anteroposterior-view were 0.008 mm/year and 0.003 mm/year in the RLL and non-RLL groups ( p = 0.390) and those in Lauenstein-view were 0.010 mm/year and 0.005 mm/year, respectively ( p = 0.239). CONCLUSIONS In the RLL group, the PE bedding-in was less compared with those in the non-RLL group. Additionally, the mean PE wear rate in the RLL group tended to be higher than that in the non-RLL group. The distribution of stress loading through the cement may differ according to whether early RLLs appear.
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Affiliation(s)
- Daigo Morita
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Showa-ku, Japan
| | - Taisuke Seki
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Showa-ku, Japan
| | - Yoshitoshi Higuchi
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Showa-ku, Japan
| | - Yasuhiko Takegami
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Showa-ku, Japan
| | - Takafumi Amano
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Showa-ku, Japan
| | - Naoki Ishiguro
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Showa-ku, Japan
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Vilardell AM, Cinca N, Garcia-Giralt N, Dosta S, Cano IG, Nogués X, Guilemany JM. Osteoblastic cell response on high-rough titanium coatings by cold spray. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2018; 29:19. [PMID: 29392501 DOI: 10.1007/s10856-018-6026-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 01/10/2018] [Indexed: 06/07/2023]
Abstract
Highly rough and porous commercially pure titanium coatings have been directly produced for first time by the cold spray technology, which is a promising technology in front of the vacuum plasma spray for oxygen sensitive materials. The wettability properties as well as the biocompatibility evaluation have been compared to a simply sand blasted Ti6Al4V alloy substrate. Surface topographies were analysed using confocal microscopy. Next, osteoblast morphology (Phalloidin staining), proliferation (MTS assay), and differentiation (alkaline phosphatase activity) were examined along 1, 7 and 14 days of cell culture on the different surfaces. Finally, mineralization by alizarin red staining was quantified at 28 days of cell culture. The contact angle values showed an increased hydrophilic behaviour on the as-sprayed surface with a good correlation to the biological response. A higher cell viability, proliferation and differentiation were obtained for highly rough commercial pure titanium coatings in comparison with sand blasted substrates. Cell morphology was similar in all coatings tested; at 14 days both samples showed extended filopodia. A higher amount of calcium-rich deposits was detected on highly rough surfaces. In summary, in-vitro results showed an increase of biological properties when surface roughness increases.
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Affiliation(s)
- A M Vilardell
- Centre de Projecció Tèrmica (CPT), Dpt. Ciència dels Materials i Enginyeria Metal.lúrgica, Universitat de Barcelona, Martí i Franquès 1, 08028, Barcelona, Spain.
| | - N Cinca
- Centre de Projecció Tèrmica (CPT), Dpt. Ciència dels Materials i Enginyeria Metal.lúrgica, Universitat de Barcelona, Martí i Franquès 1, 08028, Barcelona, Spain
| | - N Garcia-Giralt
- IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), RETICEF, Doctor Aiguader 88, 08003, Barcelona, Spain
| | - S Dosta
- Centre de Projecció Tèrmica (CPT), Dpt. Ciència dels Materials i Enginyeria Metal.lúrgica, Universitat de Barcelona, Martí i Franquès 1, 08028, Barcelona, Spain
| | - I G Cano
- Centre de Projecció Tèrmica (CPT), Dpt. Ciència dels Materials i Enginyeria Metal.lúrgica, Universitat de Barcelona, Martí i Franquès 1, 08028, Barcelona, Spain
| | - X Nogués
- IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), RETICEF, Doctor Aiguader 88, 08003, Barcelona, Spain
| | - J M Guilemany
- Centre de Projecció Tèrmica (CPT), Dpt. Ciència dels Materials i Enginyeria Metal.lúrgica, Universitat de Barcelona, Martí i Franquès 1, 08028, Barcelona, Spain
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13
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Malfroy Camine V, Terrier A, Pioletti DP. Micromotion-induced peri-prosthetic fluid flow around a cementless femoral stem. Comput Methods Biomech Biomed Engin 2017; 20:730-736. [PMID: 28271719 DOI: 10.1080/10255842.2017.1296954] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Micromotion-induced interstitial fluid flow at the bone-implant interface has been proposed to play an important role in aseptic loosening of cementless implants. High fluid velocities are thought to promote aseptic loosening through activation of osteoclasts, shear stress induced control of mesenchymal stem cells differentiation, or transport of molecules. In this study, our objectives were to characterize and quantify micromotion-induced fluid flow around a cementless femoral stem using finite element modeling. With a 2D model of the bone-implant interface and full-factorial design, we first evaluated the relative influence of material properties, and bone-implant micromotion and gap on fluid velocity. Transverse sections around a femoral stem were built from computed tomography images, while boundary conditions were obtained from experimental measurements on the same femur. In a second step, a 3D model was built from the same data-set to estimate the shear stress experienced by cells hosted in the peri-implant tissues. The full-factorial design analysis showed that local micromotion had the most influence on peak fluid velocity at the interface. Remarkable variations in fluid velocity were observed in the macrostructures at the surface of the implant in the 2D transverse sections of the stem. The 3D model predicted peak fluid velocities extending up to 2.2 mm/s in the granulation tissue and to 3.9 mm/s in the trabecular bone. Peak shear stresses on the cells hosted in these tissues ranged from 0.1 to 12.5 Pa. These results offer insight into mechanical stimuli encountered at the bone-implant interface.
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Affiliation(s)
- Valérie Malfroy Camine
- a Laboratory of Biomechanical Orthopedics , Ecole Polytechnique Fédérale de Lausanne , Lausanne , Switzerland
| | - Alexandre Terrier
- a Laboratory of Biomechanical Orthopedics , Ecole Polytechnique Fédérale de Lausanne , Lausanne , Switzerland
| | - Dominique P Pioletti
- a Laboratory of Biomechanical Orthopedics , Ecole Polytechnique Fédérale de Lausanne , Lausanne , Switzerland
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Acklin YP, Jenni R, Bereiter H, Thalmann C, Stoffel K. Prospective clinical and radiostereometric analysis of the Fitmore short-stem total hip arthroplasty. Arch Orthop Trauma Surg 2016; 136:277-84. [PMID: 26739137 DOI: 10.1007/s00402-015-2401-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Uncemented short, curved femoral stems may help save proximal bone stock during total hip arthroplasty (THA) and facilitate insertion in minimal invasive surgery. The aim of this 2 year, prospective, single-center study was to examine the stability and migration of the Fitmore (®) stem in THA using model-based radiostereometric analysis (RSA), and thus predict the implant's long-term survival. In addition, we evaluated the stem's clinical performance using standard clinical measures. PATIENTS AND METHODS We conducted a prospective cohort study of 34 THA patients who received the short Fitmore Hip Stem (Zimmer, Winterthur, Switzerland). At 3, 6, 12 and 24 months postoperatively, the patients underwent clinical evaluation and radiostereometric analysis (RSA) to measure stem migration. RESULTS RSA analysis revealed a mean subsidence of -0.39 mm (95 % CI -0.60 to -0.18) at 3 months with no further migration after 2 years. Mean internal rotation along the longitudinal axis was 1.09° (95 % CI 0.52-1.66) at 2 years, versus 0.85° (95 % CI 0.44-1.26) at 3 months. The Harris hip score improved from 60 (range 30-80) preoperatively to 99 (range 83-100) after 2 years. Three patients underwent revision due to deep infection, non-specific thigh pain and aseptic loosening in one case. CONCLUSION We conclude that the Fitmore Hip Stem stabilizes after 3 months and achieves good short-term clinical results in most cases.
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Affiliation(s)
- Yves P Acklin
- Orthopedic Surgery, Kantonsspital Graubünden, Loestrasse 99, 7000, Chur, Switzerland.
| | - Raphael Jenni
- Orthopedic Surgery, Kantonsspital Graubünden, Loestrasse 99, 7000, Chur, Switzerland
| | - Heinz Bereiter
- Orthopedic Surgery, Kantonsspital Graubünden, Loestrasse 99, 7000, Chur, Switzerland
| | - Caroline Thalmann
- Orthopedic Surgery, Kantonsspital Graubünden, Loestrasse 99, 7000, Chur, Switzerland
| | - Karl Stoffel
- Orthopedic Surgery, Kantonsspital Baselland, Rheinstrasse 26, Liestal, Switzerland
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15
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Yang X, Ricciardi BF, Dvorzhinskiy A, Brial C, Lane Z, Bhimani S, Burket JC, Hu B, Sarkisian AM, Ross FP, van der Meulen MCH, Bostrom MPG. Intermittent Parathyroid Hormone Enhances Cancellous Osseointegration of a Novel Murine Tibial Implant. J Bone Joint Surg Am 2015; 97:1074-83. [PMID: 26135074 PMCID: PMC4574908 DOI: 10.2106/jbjs.n.01052] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Long-term fixation of uncemented joint implants requires early mechanical stability and implant osseointegration. To date, osseointegration has been unreliable and remains a major challenge in cementless total knee arthroplasty. We developed a murine model in which an intra-articular proximal tibial titanium implant with a roughened stem can be loaded through the knee joint. Using this model, we tested the hypothesis that intermittent injection of parathyroid hormone (iPTH) would increase proximal tibial cancellous osseointegration. METHODS Ten-week-old female C57BL/6 mice received a subcutaneous injection of PTH (40 μg/kg/day) or a vehicle (n = 45 per treatment group) five days per week for six weeks, at which time the baseline group was killed (n = 6 per treatment group) and an implant was inserted into the proximal part of the tibiae of the remaining mice. Injections were continued until the animals were killed at one week (n = 7 per treatment group), two weeks (n = 14 per treatment group), or four weeks (n = 17 per treatment group) after implantation. Outcomes included peri-implant bone morphology as analyzed with micro-computed tomography (microCT), osseointegration percentage and bone area fraction as shown with backscattered electron microscopy, cellular composition as demonstrated by immunohistochemical analysis, and pullout strength as measured with mechanical testing. RESULTS Preimplantation iPTH increased the epiphyseal bone volume fraction by 31.6%. When the data at post-implantation weeks 1, 2, and 4 were averaged for the iPTH-treated mice, the bone volume fraction was 74.5% higher in the peri-implant region and 168% higher distal to the implant compared with the bone volume fractions in the same regions in the vehicle-treated mice. Additionally, the trabecular number was 84.8% greater in the peri-implant region and 74.3% greater distal to the implant. Metaphyseal osseointegration and bone area fraction were 28.1% and 70.1% higher, respectively, in the iPTH-treated mice than in the vehicle-treated mice, and the maximum implant pullout strength was 30.9% greater. iPTH also increased osteoblast and osteoclast density by 65.2% and 47.0%, respectively, relative to the values in the vehicle group, when the data at post-implantation weeks 1 and 2 were averaged. CONCLUSIONS iPTH increased osseointegration, cancellous mass, and the strength of the bone-implant interface. CLINICAL RELEVANCE Our murine model is an excellent platform on which to study biological enhancement of cancellous osseointegration.
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Affiliation(s)
- Xu Yang
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for X. Yang:
| | - Benjamin F Ricciardi
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for X. Yang:
| | - Aleksey Dvorzhinskiy
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for X. Yang:
| | - Caroline Brial
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for X. Yang:
| | - Zachary Lane
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for X. Yang:
| | - Samrath Bhimani
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for X. Yang:
| | - Jayme C Burket
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for X. Yang:
| | - Bin Hu
- Department of Biomaterials and Biomimetics, New York University College of Dentistry, 345 East 24th Street, New York, NY 10010
| | - Alexander M Sarkisian
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for X. Yang:
| | - F Patrick Ross
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for X. Yang:
| | | | - Mathias P G Bostrom
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for X. Yang:
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16
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Flivik G, Kristiansson I, Ryd L. Positive effect of removal of subchondral bone plate for cemented acetabular component fixation in total hip arthroplasty: a randomised RSA study with ten-year follow-up. Bone Joint J 2015; 97-B:35-44. [PMID: 25568411 DOI: 10.1302/0301-620x.97b1.34391] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We hypothesised that the removal of the subchondral bone plate (SCBP) for cemented acetabular component fixation in total hip arthroplasty (THA) offers advantages over retention by improving the cement-bone interface, without jeopardising implant stability. We have previously published two-year follow-up data of a randomised controlled trial (RCT), in which 50 patients with primary osteoarthritis were randomised to either retention or removal of the SCBP. The mean age of the retention group (n = 25, 13 males) was 70.0 years (sd 6.8). The mean age in the removal group (n = 25, 16 males) was 70.3 years (sd 7.9). Now we have followed up the patients at six (retention group, n = 21; removal group, n = 20) and ten years (retention group: n = 17, removal group: n = 18), administering clinical outcome questionnaires and radiostereometric analysis (RSA), and determining the presence of radiolucent lines (RLLs) on conventional radiographs. RSA demonstrated similar translation and rotation patterns up to six years. Between six and ten years, proximal acetabular component migration and changes of inclination were larger in the retention group, although the mean differences did not reach statistical significance. Differences in migration were driven by two patients in the SCBP retention group with extensive migration versus none in the SCBP removal group. The significant difference (p < 0.001) in the development of radiolucent lines in the retention group, previously observed at two years, increased even further during the course of follow-up (p < 0.001). While recognising SCBP removal is a more demanding technique, we conclude that, wherever possible, the SCBP should be removed to improve the cement-bone interface in order to maximise acetabular component stability and longevity.
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Affiliation(s)
- G Flivik
- Department of Orthopaedics, Skåne University Hospital, Clinical Sciences, Lund University, Lund S-221 85, Sweden
| | - I Kristiansson
- Department of Orthopaedics, Skåne University Hospital, Clinical Sciences, Lund University, Lund S-221 85, Sweden
| | - L Ryd
- Department of Orthopaedics, Skåne University Hospital, Clinical Sciences, Lund University, Lund S-221 85, Sweden
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17
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Johanson PE, Digas G, Herberts P, Thanner J, Kärrholm J. Highly crosslinked polyethylene does not reduce aseptic loosening in cemented THA 10-year findings of a randomized study. Clin Orthop Relat Res 2012; 470:3083-93. [PMID: 22669546 PMCID: PMC3462851 DOI: 10.1007/s11999-012-2400-x] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Polyethylene (PE) wear particles are believed to cause aseptic loosening and thereby impair function in hip arthroplasty. Highly crosslinked polyethylene (XLPE) has low short- and medium-term wear rates. However, the long-term wear characteristics are unknown and it is unclear whether reduced wear particle burden improves function and survival of cemented hip arthroplasty. QUESTIONS/PURPOSES We asked whether XLPE wear rates remain low up to 10 years and whether this leads to improved implant fixation, periprosthetic bone quality, and clinical function compared to conventional PE. METHODS We randomized 60 patients (61 hips) to receive either PE or XLPE cemented cups combined with a cemented stem. At 10 years postoperatively, 51 patients (52 hips) were evaluated for polyethylene wear and component migration estimation by radiostereometry, for radiolucent lines, bone densitometry, and Harris hip and pain scores. Revisions were recorded. RESULTS XLPE cups had a lower mean three-dimensional wear rate between 2 and 10 years compared to conventional PE hips: 0.005 mm/year versus 0.056 mm/year. We found no differences in cup migration, bone mineral density, radiolucencies, functional scores, and revision rate. There was a trend toward improved stem fixation in the XLPE group. The overall stem failure rate was comparably high, without influencing wear rate in XLPE hips. CONCLUSIONS XLPE displayed a low wear rate up to 10 years when used in cemented THA, but we found no clear benefits in any other parameters. Further research is needed to determine whether cemented THA designs with XLPE are less prone to stem loosening. LEVEL OF EVIDENCE Level I, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Per-Erik Johanson
- Department of Orthopaedics, Institution of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 413 45 Gothenburg, Sweden.
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18
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Alidousti H, Taylor M, Bressloff NW. Do capsular pressure and implant motion interact to cause high pressure in the periprosthetic bone in total hip replacement? J Biomech Eng 2012; 133:121001. [PMID: 22206418 DOI: 10.1115/1.4005455] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
When there is a debonding at the bone-implant interface, the difference in stiffness between the implant and the bone can result in micromotion, allowing existing gaps to open further or new gaps to be created during physiological loading. It has been suggested that periprosthetic fluid flow and high pressure may play an important role in osteolysis development in the proximity of these gaps. To explain this phenomenon, the concepts of "effective joint space" and "pumping stem" have been cited in many studies. However, there is no clear understanding of the factors causing, or contributing to, these mechanisms. It is likely that capsular pressure, gap dimensions, and micromotion of the gap during cyclic loading of an implant can play a defining role in inducing periprosthetic flow. In order to obtain a better understanding of the main influences on periprosthetic flows and the development of osteolysis, steady state and transient 2D computational fluid dynamic simulations were performed for the joint capsule of the lateral side of a stem-femur system, and a gap in communication with the capsule and the surrounding bone. It was shown that high capsular pressure may be the main driving force for high fluid pressure and flow in the bone surrounding the gap, while micromotion of only very long and narrow gaps can cause significant pressure and flow in the bone. At low capsular pressure, micromotion induced large flows in the gap region; however, the flow in the bone tissue was almost unaffected. The results also revealed the existence of high velocity spikes in the bone region at the bottom of the gap. These velocity spikes can exert excessive fluid shear stress on the bone cells and disturb the local biological balance of the surrounding interstitial fluid which can result in osteolysis development. High capsular pressure was observed to be the main cause of these velocity spikes whereas, at low capsular pressure, gap micromotion of only very long and narrow gaps generated significant velocity spikes in the bone at the bottom of the gaps.
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Affiliation(s)
- Hamidreza Alidousti
- School of Engineering Sciences, University of Southampton, Highfield, Southampton, UK
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19
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De Jong PT, Tigchelaar W, Van Noorden CJF, Van der Vis HM. Polyethylene wear particles do not induce inflammation or gelatinase (MMP-2 and MMP-9) activity in fibrous tissue interfaces of loosening total hip arthroplasties. Acta Histochem 2011; 113:556-63. [PMID: 20656340 DOI: 10.1016/j.acthis.2010.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2010] [Revised: 06/06/2010] [Accepted: 06/08/2010] [Indexed: 11/19/2022]
Abstract
In vitro and in vivo studies have suggested that polyethylene wear particles are the main cause for osteolysis in prosthetic loosening. Elevated amounts of proteases including gelatinases (or matrix metalloproteinases MMP-2 and MMP-9) have been found in fibrous tissue interfaces of loosened total hip arthroplasties suggesting that proteolysis plays a role in osteolysis. The presence of proteases does not mean that they are active, because activity of proteases is highly regulated at the post-translational level. We investigated whether the activity of two major proteases that are active extracellularly and have been associated with loosening, MMP-2 and MMP-9, is involved in loosening of non-cemented hip implants with polyethylene acetabular components. Eight interface tissues retrieved during revision were studied with light and electron microscopy and by in situ zymography to localize MMP-2 and MMP-9 activity in combination with immunohistochemistry to localize MMP-2 and MMP-9 proteins. All interface tissues contained large amounts of polyethylene wear particles, either in large accumulations or dispersed in the extracellular matrix or intracellularly in fibroblasts. Particles were not encountered in association with MMP-2 or MMP-9 activity or leukocytes. Inflammation was never found. MMP-9 activity was restricted to macrophages and MMP-2 activity was restricted to microvascular endothelial cells mainly outside areas where particles were present. Our data indicate that wear particles do not induce activation of leukocytes or MMP-2 or MMP-9 activity. Therefore, aseptic loosening may not be particle induced but initiated by other mechanisms such as mechanical stress.
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Affiliation(s)
- Pieter T De Jong
- Department of Orthopedics, St. Jansdal Ziekenhuis, Harderwijk, The Netherlands
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20
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Ørskov M, Abdulghani S, McCarthy I, Søballe K, Flivik G. Comparison of flanged and unflanged acetabular cup design. An experimental study using ceramic and cadaveric acetabuli. Acta Orthop 2010; 81:556-62. [PMID: 20860522 PMCID: PMC3214743 DOI: 10.3109/17453674.2010.519167] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Adequate depth of cement penetration and cement mantle thickness is important for the durability of cemented cups. A flanged cup, as opposed to unflanged, has been suggested to give a more uniform cement mantle and superior cement pressurization, thus improving the depth of cement penetration. This hypothesis was tested experimentally. MATERIALS AND METHODS The same cup design with and without flange (both without cement spacers) was investigated regarding intraacetabular pressure, cement mantle thickness, and depth of cement penetration. With machine control, the cups were inserted into open-pore ceramic acetabular models (10 flanged, 10 unflanged) and into paired cadaver acetabuli (10 flanged, 10 unflanged) with prior pressurization of the cement. RESULTS No differences in intraacetabular pressures during cup insertion were found, but unflanged cups tended to migrate more towards the acetabular pole. Flanged cups resulted in thicker cement mantles because of less bottoming out, whereas no differences in cement penetration into the bone were observed. INTERPRETATION Flanged cups do not generate higher cementation pressure or better cement penetration than unflanged cups. A possible advantage of the flange, however, may be to protect the cup from bottoming out, and there is possibly better closure of the periphery around the cup, sealing off the cement-bone interface.
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Affiliation(s)
| | - Saba Abdulghani
- Biomaterials and Biomechanics Laboratory, Department of Orthopedics, Lund University and Skåne University Hospital, Lund, Sweden
| | - Ian McCarthy
- Biomaterials and Biomechanics Laboratory, Department of Orthopedics, Lund University and Skåne University Hospital, Lund, Sweden
| | - Kjeld Søballe
- Department of Orthopaedics, Aarhus University Hospital, Denmark
| | - Gunnar Flivik
- Biomaterials and Biomechanics Laboratory, Department of Orthopedics, Lund University and Skåne University Hospital, Lund, Sweden
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21
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Flivik G. Fixation of the cemented acetabular component in hip arthroplasty. ACTA ORTHOPAEDICA. SUPPLEMENTUM 2010. [DOI: 10.1080/03008820510040685] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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22
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White CA, Beaulé PE. Femoral Head Vascularity. Impact and Implications for Hip Resurfacing Arthroplasty. Tech Orthop 2010. [DOI: 10.1097/bto.0b013e3181d1e4ae] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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23
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Hansson U, Toksvig-Larsen S, Ryd L, Aspenberg P. Once-weekly oral medication with alendronate does not prevent migration of knee prostheses: A double-blind randomized RSA study. Acta Orthop 2009; 80:41-5. [PMID: 19297788 PMCID: PMC2823246 DOI: 10.1080/17453670902804968] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [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 Early migration of joint replacements is an effect of poor fixation and can predict late loosening. By reducing the bone resorption after implantation of a joint replacement, it should be possible to enhance the initial fixation of the implant. We studied the effect of once-weekly treatment with alendronate after knee replacement. PATIENTS AND METHODS We recruited 60 patients (60 knees) with gonarthrosis who were scheduled for a total knee replacement. They were operated on with identical implants and uncemented fixation. 30 patients were treated with a bisphosphonate (alendronate) and 30 patients underwent placebo treatment. The treatment started postoperatively and continued on a weekly basis for 6 months. The fixation of the implants was measured with repeated radiostereometry for 2 years. RESULTS There was no difference in migration of implants between the two groups. CONCLUSION With uncemented fixation of knee implants, no benefit of once-weekly treatment with alendronate, starting postoperatively, could be seen during a 2-year follow-up period.
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Affiliation(s)
- Ulrik Hansson
- 1Department of Orthopedics, Lund University HospitalLundSweden
| | | | - Leif Ryd
- 2Department of Orthopedics, Karolinska University HospitalHuddingeSweden
| | - Per Aspenberg
- 3Department of Orthopedics, Linköping University HospitalLinköpingSweden
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24
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Bartlett G, Beard D, Murray D, Gill H. The femoral stem pump in cemented hip arthroplasty: An in vitro model. Med Eng Phys 2008; 30:1042-8. [DOI: 10.1016/j.medengphy.2007.12.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2007] [Revised: 12/19/2007] [Accepted: 12/22/2007] [Indexed: 02/06/2023]
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25
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Hoenders CSM, Harmsen MC, van Luyn MJA. The local inflammatory environment and microorganisms in “aseptic” loosening of hip prostheses. J Biomed Mater Res B Appl Biomater 2008; 86:291-301. [DOI: 10.1002/jbm.b.30992] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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26
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The B, Hosman A, Kootstra J, Kralj-Iglic V, Flivik G, Verdonschot N, Diercks R. Association between contact hip stress and RSA-measured wear rates in total hip arthroplasties of 31 patients. J Biomech 2007; 41:100-5. [PMID: 17942102 DOI: 10.1016/j.jbiomech.2007.07.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2007] [Revised: 06/23/2007] [Accepted: 07/11/2007] [Indexed: 02/08/2023]
Abstract
BACKGROUND The main concern in the long run of total hip replacements is aseptic loosening of the prosthesis. Optimization of the biomechanics of the hip joint is necessary for optimization of long-term success. A widely implementable tool to predict biomechanical consequences of preoperatively planned reconstructions still has to be developed. A potentially useful model to this purpose has been developed previously. The aim of this study is to quantify the association between the estimated hip joint contact force by this biomechanical model and RSA-measured wear rates in a clinical setting. METHODS Thirty-one patients with a total hip replacement were measured with RSA, the gold standard for clinical wear measurements. The reference examination was done within 1 week of the operation and the follow-up examinations were done at 1, 2 and 5 years. Conventional pelvic X-rays were taken on the same day. The contact stress distribution in the hip joint was determined by the computer program HIPSTRESS. The procedure for the determination of the hip joint contact stress distribution is based on the mathematical model of the resultant hip force in the one-legged stance and the mathematical model of the contact stress distribution. The model for the force requires as input data, several geometrical parameters of the hip and the body weight, while the model for stress requires as input data, the magnitude and direction of the resultant hip force. The stress distribution is presented by the peak stress-the maximal value of stress on the weight-bearing area (p(max)) and also by the peak stress calculated with respect to the body weight (p(max)/W(B)) which gives the effect of hip geometry. Visualization of the relations between predicted values by the model and the wear at different points in the follow-up was done using scatterplots. Correlations were expressed as Pearson r values. RESULTS The predicted p(max) and wear were clearly correlated in the first year post-operatively (r = 0.58, p = 0.002), while this correlation is weaker after 2 years (r = 0.19, p = 0.337) and 5 years (r = 0.24, p = 0.235). The wear values at 1, 2 and 5 years post-operatively correlate with each other in the way that is expected considering the wear velocity curve of the whole group. The correlation between the predicted p(max) values of two observers who were blinded for each other's results was very good (r = 0.93, p < 0.001). CONCLUSION We conclude that the biomechanical model used in this paper provides a scientific foundation for the development of a new way of constructing preoperative biomechanical plans for total hip replacements.
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Affiliation(s)
- Bertram The
- Orthopaedic Surgery, University Medical Center Groningen, Hanzeplein 1, Postbus 30.001, 9700 RB Groningen, The Netherlands.
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Abstract
Preserving femoral head vascularity during hip resurfacing may avoid femoral neck fractures and late femoral loosening. The posterior approach and notching of the femoral neck influence femoral head perfusion. However, it is not known if standard preparation of the femoral head during hip resurfacing can disrupt blood flow. Ten patients (10 hips) with advanced osteoarthritis having metal-on-metal hip resurfacing by means of a vascular-preserving surgical approach had femoral head blood flow measurements using laser Doppler flowmetry. Nine hips had a mean decrease of 70% in femoral head blood flow after standard reaming and preparation. The data suggest femoral head reaming during hip resurfacing substantially impacts blood flow to the femoral head and infers the extra osseous blood supply is still important in the arthritic femoral head. To avoid damaging the retinacular vessels, surgeons should direct the cylindrical reamer superolaterally staying as close as possible to the inferomedial neck.
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Affiliation(s)
- Paul E Beaulé
- Division of Orthopaedic Surgery. University of Ottawa, Ottawa Hospital. General Campus, Canada.
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28
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Beaulé PE, Campbell P, Lu Z, Leunig-Ganz K, Beck M, Leunig M, Ganz R. Vascularity of the arthritic femoral head and hip resurfacing. J Bone Joint Surg Am 2006; 88 Suppl 4:85-96. [PMID: 17142438 DOI: 10.2106/jbjs.f.00592] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Paul E Beaulé
- Division of Orthopaedic Surgery, University of Ottawa, 501 Smyth Road, Suite 5004, Ottawa Hospital, General Campus, Ottawa, ON K1H 8L6, Canada.
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Peers WJ, Wright-Charlesworth DD, Miskioglu I. Pin-on-disc evaluation of self-reinforced composite poly(methyl methacrylate) for total joint replacements. J Biomed Mater Res B Appl Biomater 2006; 79:16-24. [PMID: 16544304 DOI: 10.1002/jbm.b.30506] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Femoral components of hip replacements are commonly anchored in the femur with bone cement or poly(methyl methacrylate) (PMMA). Wear or fracture of bone cement can lead to loosening of the femoral component, which drastically affects the success and longevity of hip replacements. Self-reinforced composite PMMA (SRC-PMMA) has been previously developed for potential use, as a precoat material for hip replacements. The composite consists of high strength fibers that have been shown to have greatly improved mechanical properties over bulk PMMA. The goal of this work was to examine SRC-PMMA for improved wear properties, as a function of processing temperature. Pin-on-disc tests were used to characterize and rank the wear rates of SRC-PMMA and PMMA. Composites made with higher processing temperatures had significantly lower wear rates than do PMMA at a significance level of p < or = 0.05. The lowest wear rate was 8.2 microg/m, at a processing temperature of 136 degrees C, compared to a wear rate for PMMA of 13.3 microg/m. At the lowest processing temperature (105 degrees C), a wear rate higher than PMMA was found, and failure was dominated by fiber delamination. In the more completely processed samples (122 degrees C < or = T < or = 150 degrees C), wear rates were equivalent to or better than PMMA, and smoother and more homogenous wear was noted in wear tracks. Fatigue cracks were prominent at higher processing temperatures or when the wear pin was riding orthogonal to fibers. Wear particles were collected and examined. Wear particle diameter and aspect ratio showed no correlation to processing temperature, but were similar to particles retrieved from human tissue samples.
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Affiliation(s)
- William J Peers
- Department of Mechanical Engineering-Engineering Mechanics, 1400 Townsend Drive, Michigan Technological University, Houghton, Michigan 49931, USA
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Hallan G, Lie SA, Havelin LI. High wear rates and extensive osteolysis in 3 types of uncemented total hip arthroplasty: a review of the PCA, the Harris Galante and the Profile/Tri-Lock Plus arthroplasties with a minimum of 12 years median follow-up in 96 hips. Acta Orthop 2006; 77:575-84. [PMID: 16929433 DOI: 10.1080/17453670610012638] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND High wear rates and femoral and acetabular osteolysis have been-and still are-the main problems in uncemented total hip replacement. We reviewed 96 consecutive cementless total hip replacements of 4 different designs. PATIENTS AND METHODS 21 PCA, 25 Harris Galante Porous/Harris Galante I (stem/cup), 25 Profile pressfit/ Tri-Lock Plus (stem/cup) and 25 Profile HA-coated/Tri-Lock Plus (stem/cup) prostheses were included. The operations were performed in the period 1984-1991. Median follow-up ranged from 12-16 years. Wear and osteolysis were measured. RESULTS Mean linear wear rates ranged from 0.17 to 0.21 mm/year in the 4 groups, and there were no statistically significant differences between the groups (p = 0.9, ANOVA). Moderate or extensive osteolysis was found in 46 of the 96 hips included. The association between high and low wear rates (more or less than 0.20 mm/ year) and extent of osteolysis was statistically significant (p < 0.001, t-test). We found poor 12-year survival of the primary prostheses in all 4 groups (50-70%), mainly due to revisions because of wear of the polyethylene liner and/or osteolysis. The infrequently documented Profile/Tri-Lock Plus systems did not perform differently from the PCA and the HG. INTERPRETATION The poor long-term results with these uncemented total hip arthroplasties illustrate the necessity of regular radiographic evaluation in order to detect osteolysis and liner failure, which are both generally asymptomatic until catastrophic failure appears.
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Affiliation(s)
- Geir Hallan
- Department of Orthopaedic Surgery, Haukeland University Hospital. Bergen. Norway.
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Flivik G, Kristiansson I, Kesteris U, Ryd L. Is removal of subchondral bone plate advantageous in cemented cup fixation? A randomized RSA study. Clin Orthop Relat Res 2006; 448:164-72. [PMID: 16826112 DOI: 10.1097/01.blo.0000203479.27044.d3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
UNLABELLED There is uncertainty regarding whether and how the subchondral bone plate should be treated during acetabular preparation for cemented cup fixation in a total hip arthroplasty. We hypothesized that removing the bone plate would improve the cement-bone interface without jeopardizing the initial cup stability, and therefore, be advantageous to long-term cup survival. We randomized 50 patients with primary osteoarthritis into two groups, one for removal and one for retention of the subchondral bone plate. The patients were evaluated during 2 years followup using repeated radiostereometric examinations, analyses of radiolucent lines, and clinical followups. Patient scoring was done using the Western Ontario and McMaster Universities Osteoarthritis Index, the Short Form-12, and the Harris hip score. Removal of the subchondral bone plate resulted in a superior cement-bone interface with less development of radiolucent lines. The radiostereometry results showed small migrations in both groups. We found no differences in cup stability between groups, although a difference was observed in rotational behavior with the removal group stabilizing in a slightly vertical position whereas the retention group showed slight but progressive rotation into a more horizontal position. No differences were found during clinical followups. Removing the subchondral bone plate, where possible, improves the cement-bone interface without jeopardizing the stability, implying better long-term cup survival. However, it is a more demanding surgical technique. LEVEL OF EVIDENCE Therapeutic study, Level I (high quality randomized controlled trial with statistically significant difference or no statistically significant difference but narrow confidence intervals). See the Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Gunnar Flivik
- Department of Orthopedics, Lund University Hospital, Sweden.
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Sundfeldt M, Carlsson LV, Johansson CB, Thomsen P, Gretzer C. Aseptic loosening, not only a question of wear: a review of different theories. Acta Orthop 2006; 77:177-97. [PMID: 16752278 DOI: 10.1080/17453670610045902] [Citation(s) in RCA: 384] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Today, aseptic loosening is the most common cause of revision of major arthroplasties. Aseptic loosening accounts for more than two-thirds of hip revisions and almost one-half of knee revisions in Sweden. Several theories on the cause of aseptic loosening have been proposed. Most of these theories, however, are based on empiric observations, experimental animal models or anecdotal cases. In this review, we discuss the most common theories concerning aseptic loosening. It emerges from this review that aseptic loosening has a multifactorial etiology and cannot be explained by a single theory.
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Affiliation(s)
- Mikael Sundfeldt
- Department of Biomaterials/Handicap Research, Sahlgrenska University Hospital, University of Gothenburg, Sweden.
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33
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Beaulé PE, Krismer M, Mayrhofer P, Wanner S, Le Duff M, Mattesich M, Stoeckl B, Amstutz HC, Biedermann R. EBRA-FCA for measurement of migration of the femoral component in surface arthroplasty of the hip. ACTA ACUST UNITED AC 2005; 87:741-4. [PMID: 15855382 DOI: 10.1302/0301-620x.87b5.15377] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Studies on the migration of an implant may be the only way of monitoring the early performance of metal-on-metal prostheses. The Ein Bild Roentgen Analyse--femoral component analysis (EBRA-FCA) method was adapted to measure migration of the femoral component in a metal-on-metal surface arthroplasty of the hip using standard antero-posterior radiographs. In order to determine the accuracy and precision of this method a prosthesis was implanted into cadaver bones. Eleven series of radiographs were used to perform a zero-migration study. After adjustment of the femoral component to simulate migration of 3 mm the radiographs were repeated. All were measured independently by three different observers. The accuracy of the method was found to be +/- 1.6 mm for the x-direction and +/- 2 mm for the y-direction (95% percentile). The method was validated using 28 hips with a minimum follow-up of 3.5 years after arthroplasty. Seventeen were sound, but 11 had failed because of loosening of the femoral component. The normal (control) group had a different pattern of migration compared with that of the loose group. At 29.2 months, the control group showed a mean migration of 1.62 mm and 1.05 mm compared with 4.39 mm and 4.05 mm in the failed group, for the centre of the head and the tip of the stem, respectively (p = 0.001). In the failed group, the mean time to migration greater than 2 mm was earlier than the onset of clinical symptoms or radiological evidence of failure, 19.1 versus 32.2 months (p = 0.001) and 24.8 months (p = 0.012), respectively. EBRA-FCA is a reliable and valid tool for measuring migration of the femoral component after surface arthroplasty and can be used to predict early failure of the implant. It may be of value in determining the long-term performance of surface arthroplasty.
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Affiliation(s)
- P E Beaulé
- Joint Replacement Institute, Orthopaedic Hospital, Los Angeles, California 90007, USA.
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34
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Fowble VA, Schuh A, Hoke R, Bitsch RG, Beaulé PE. Clinical correlation of femoral component migration in hip resurfacing arthroplasty analyzed by Einzel-Bild-Röntgen-analyze-femoral component analysis. Orthop Clin North Am 2005; 36:243-50, x. [PMID: 15833462 DOI: 10.1016/j.ocl.2005.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Hip resurfacing arthroplasty using metal-on-metal bearings has become increasingly popular. Wear of these bearings has been imperceptible on plain radiographs. Migration analysis studies may represent the opportunity to detect early failures and evaluate long-term prosthetic survival. The authors retrospectively reviewed 29 hips in a consecutive series of metal-on-metal hip resurfacing arthroplasties with a long-term clinical follow-up (average 8.7 years) to analyze the femoral component migration pattern by means of Einzel-Bild-Röntgen-Analyze-femoral component analysis (EBRA-FCA). Femoral component migrations at 2 years and latest follow-up were compared with the known clinical outcomes. The authors' findings add validity to EBRA-FCA as a means to monitor femoral component migration and the clinical outcome of metal-on-metal hip resurfacing arthroplasty.
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Affiliation(s)
- Vincent A Fowble
- Joint Replacement Institute at Orthopaedic Hospital, 2400 S. Flower Street, Los Angeles, CA 90007, USA
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35
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Ebramzadeh E, Billi F, Sangiorgio SN, Mattes S, Schmoelz W, Dorr L. Simulation of Fretting Wear at Orthopaedic Implant Interfaces. J Biomech Eng 2005; 127:357-63. [PMID: 16060342 DOI: 10.1115/1.1894121] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Osteolysis due to wear debris is a primary cause of failure of total joint replacements. Although debris produced by the joint articulating surfaces has been studied and simulated extensively, fretting wear debris, produced at nonarticulating surfaces, has not received adequate attention. We developed a three-station fretting wear simulator to reproduce in vivo motion and stresses at the interfaces of total joint replacements. The simulator is based on the beam bending theory and is capable of producing cyclic displacement from 3to1000microns, under varying magnitudes of contact stresses. The simulator offers three potential advantages over previous studies: The ability to control the displacement by load, the ability to produce very small displacements, and dynamic normal loads as opposed to static. A pilot study was designed to test the functionality of the simulator, and verify that calculated displacements and loads produced the predicted differences between two commonly used porous ingrowth titanium alloy surfaces fretting against cortical bone. After 1.5 million cycles, the simulator functioned as designed, producing greater wear of bone against the rougher plasma-sprayed surface compared to the fiber-mesh surface, as predicted. A novel pin-on-disk apparatus for simulating fretting wear at orthopaedic implant interfaces due to micromotion is introduced. The test parameters measured with the fretting wear simulator were as predicted by design calculations, and were sufficient to measure differences in the height and weight of cortical bone pins rubbing against two porous ingrowth surfaces, plasma-sprayed titanium and titanium fiber mesh.
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Affiliation(s)
- Edward Ebramzadeh
- Biomechanics Laboratory, J. Vernon Luck, Sr, M.D. Orthopaedic Research Center, Los Angeles Orthopaedic Hospital/UCLA, The Dorr Arthritis Institute of Centinela Hospital, Inglewood, California, USA.
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36
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Tsukeoka T, Suzuki M, Ohtsuki C, Tsuneizumi Y, Miyagi J, Sugino A, Inoue T, Michihiro R, Moriya H. Enhanced fixation of implants by bone ingrowth to titanium fiber mesh: Effect of incorporation of hydroxyapatite powder. J Biomed Mater Res B Appl Biomater 2005; 75:168-76. [PMID: 16025466 DOI: 10.1002/jbm.b.30282] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Tight fixation between bone and implant materials is of great importance for a successful outcome of procedures such as total knee arthroplasty (TKA) and total hip arthroplasty (THA). Titanium fiber mesh is an attractive structure for the establishment of tight fixation between bone and implant by bone ingrowth into the spaces among the fibers. Enhancement of bone ingrowth is desired not only for tight fixation but also for a fast recovery. Our hypothesis is that just the presence of hydroxyapatite (HA) particles ensures improved bone ingrowth, and that long-term stability can be obtained by mechanical anchoring of bone in the spaces among titanium fibers. In this study, we examine our hypothesis by in vivo experiment using dog femur. HA particles were incorporated in titanium fiber mesh coated on titanium alloy rod by dipping in a slurry of HA with hydroxy-propyl-cellulose in an ethanol solution. Specimens were implanted for 3, 5, and 8 weeks, and were then compared with the results from specimens without the use of HA. Bonding strength was evaluated by push-out test, and histomorphometric measurements were made with analysis software to calculate the average value of bone ingrowth. A significantly higher bonding strength was observed for the specimens with HA-incorporated implant at 3 and 5 weeks, and larger bone ingrowth deep inside the titanium fiber mesh was measured at 3 weeks. Our proposed method has the additional advantage of not requiring a high temperature that may result in changes in characters of HA powder such as phase transition, grain growth, and decomposition. Moreover, this technique of HA powder incorporation without high-temperature treatment allows the use of several types of metallic fiber mesh, as well as the application to fiber mesh made of organic polymers. We conclude that this simple modification of titanium fiber mesh with HA powder can improve the fixation of implant to bone in the initial stage after operation.
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Affiliation(s)
- Tadashi Tsukeoka
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba 260-8677, Japan
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37
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Wright-Charlesworth DD, Peers WJ, Miskioglu I, Loo LL. Nanomechanical properties of self-reinforced composite poly(methyl methacrylate) as a function of processing temperature. J Biomed Mater Res A 2005; 74:306-14. [PMID: 15973727 DOI: 10.1002/jbm.a.30226] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Understanding the wear characteristics of bone cement and its alternatives is critical to improving the quality and longevity of hip replacements. A novel composite material, self-reinforced composite poly(methyl methacrylate), has been previously developed for potential use as a pre-coat material for hip implants. The goal of this work was to examine the properties of self-reinforced composite poly(methyl methacrylate) as a function of processing temperature. Nanoindentation tests were performed to measure hardness and modulus of self-reinforced composite poly(methyl methacrylate) at the nanoscale. Nanoscratch tests were performed parallel, orthogonal, and longitudinal to composite fibers to measure residual scratch depths. Significant differences were found in the hardness, modulus, and residual scratch depth as a function of processing temperature when compared to poly(methyl methacrylate). As processing temperature is increased, hardness decreased and residual scratch depths increased. Data also showed that fiber orientation plays a critical role in scratch resistance. Scratching orthogonal to fiber orientation produced the least residual scratch depth ranging from 524 nm at 105 degrees C to 838 nm at 150 degrees C, compared to a residual scratch depth for poly(methyl methacrylate) of 842 nm.
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38
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Flivik G, Wulff K, Sanfridsson J, Ryd L. Improved acetabular pressurization gives better cement penetration: in vivo measurements during total hip arthroplasty. J Arthroplasty 2004; 19:911-8. [PMID: 15483809 DOI: 10.1016/j.arth.2004.06.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
During total hip arthroplasty, the intraoperative cementation pressure was measured inside one of the acetabular anchorage holes. Patients were randomized to pressurization of cement with either a conventional pressurizer or a sequential method including individual pressurization of each anchorage hole. The pressure was correlated to the cement penetration measured on digital radiographs. The early peak pressures were higher for the sequential method, resulting in a significantly better penetration of 2.8 mm compared with 0.7 mm with the conventional pressurizer. We found a strong correlation between early peak cementation pressures and cement penetration into the cancellous bone of the anchoring holes, indicating a cause-effect relationship at this early stage. The highest peak pressures were achieved during the later cup insertion, but these pressures did not correlate with the cement penetration. We conclude that conventional methods for cement pressurization in the acetabulum may not be optimal.
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Affiliation(s)
- Gunnar Flivik
- Department of Orthopaedics, Lund University Hospital, Sweden
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39
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Beaulé PE, Griffin DB, Matta JM. The Levine anterior approach for total hip replacement as the treatment for an acute acetabular fracture. J Orthop Trauma 2004; 18:623-9. [PMID: 15448452 DOI: 10.1097/00005131-200410000-00008] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The treatment of acetabular fractures in part relies on the selection of a specific surgical approach that allows for accurate reduction of fracture fragments. Moreover, these acetabular approaches were not developed for the insertion of a total hip replacement. Therefore, if a total hip arthroplasty is to be the treatment of an acute acetabular fracture, a single incision that permits reduction of the acetabular fracture fragments and ease of insertion of the arthroplasty components would be desirable. The Levine anterior approach provides both accesses to the anterior wall/column for reduction and fixation and to the femoral shaft for insertion of a total hip replacement. This paper describes that surgical technique and our initial clinical experience with this approach for acute acetabular fractures. A consecutive group of 10 patients with acetabular fractures, all involving the anterior wall/column with articular impaction (>50% of the acetabular roof) including 2 cases with an associated posterior hemitrans-verse component, were reviewed. After fracture reduction and fixation, a hybrid total hip replacement was implanted in all cases with an average acetabular component size of 56 mm (range 52-64). At a mean follow-up of 36 months (range 24-53), all fractures united, and all acetabular components remained fixed with no evidence of migration or loosening. There were 2 complications, a Brooker grade II heterotopic ossification and 1 postoperative anterior dislocation treated successfully with closed reduction and spica cast immobilization. The average Merle d'Aubigné hip score at latest follow-up was 16 (range 13-18). The Levine anterior approach is a reliable, safe, and efficient technique that permits early mobilization of patients with anterior wall/column acetabular fractures requiring a total hip replacement.
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Affiliation(s)
- Paul E Beaulé
- Joint Replacement Institute at Orthopaedic Hospital, Los Angeles, CA 90007, USA.
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40
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Digas G, Thanner J, Anderberg C, Kärrholm J. Bioactive cement or ceramic/porous coating vs. conventional cement to obtain early stability of the acetabular cup. Randomised study of 96 hips followed with radiostereometry. J Orthop Res 2004; 22:1035-43. [PMID: 15304276 DOI: 10.1016/j.orthres.2003.09.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2003] [Accepted: 09/01/2003] [Indexed: 02/04/2023]
Abstract
Ninety patients (96 hips) scheduled for THA were stratified to fixation of the acetabular component in three main groups of about equal size. Fluoride cement, porous coated press-fit cup with ceramic coating or Palacos cum Gentamicin cement were used. All patients received Spectron EF stem. The migration of the cups and the femoral head penetration into the socket were measured with radiostereometric analysis. At 2 years the choice of fixation did not influence the migration or rotation of the cup. Patients with compromised bone quality showed increased three-dimensional (3D or total) migration. Proximal and 3D penetration rates were increased in cemented compared with the uncemented cups (p<0.001), which probably not could be related to the choice of fixation. Appearance of radiolucent lines was almost equal in the two cemented groups. Uncemented cups had less radiolucent lines at 2 years. Fluoride containing cement or uncemented fixation did not improve the early postoperative stability of the socket.
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Affiliation(s)
- Georgios Digas
- Department of Orthopaedics, Sahlgrenska University Hospital, S-41345 Göteborg, Sweden.
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41
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Greenfield EM, Bi Y, Ragab AA, Goldberg VM, Nalepka JL, Seabold JM. Does endotoxin contribute to aseptic loosening of orthopedic implants? ACTA ACUST UNITED AC 2004; 72:179-85. [PMID: 15449253 DOI: 10.1002/jbm.b.30150] [Citation(s) in RCA: 117] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Aseptic loosening of orthopedic implants caused by wear particles is a major clinical problem. This review examines the hypothesis that bacterial endotoxin contributes to aseptic loosening. Clinical findings support this hypothesis: bacterial biofilms exist on many implants from patients with aseptic loosening and antibiotics in bone cement reduce the rate of aseptic loosening. Three approaches were used to demonstrate that adherent endotoxin increases bioactivity of titanium particles. These experiments measured cytokine production and osteoclast differentiation in vitro and murine calvarial osteolysis in vivo. First, removal of >99.9% of the adherent endotoxin from titanium particles significantly ablates their biological activity. Second, adding lipopolysaccharide back to these "endotoxin-free" particles restores their biological activity. Third, cells or mice that are genetically hyporesponsive to endotoxin are significantly less responsive to titanium particles than are wild-type controls. Other investigators have confirmed and extended these results to include virtually all orthopedically relevant types of particles, including authentic titanium alloy particles retrieved from patients with loosening. Our recent studies suggest that adherent endotoxin on orthopedic implants may also inhibit initial osseointegration of the implants. Taken together, these studies suggest that bacterial endotoxin may have a significant role in induction of aseptic loosening.
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Affiliation(s)
- Edward M Greenfield
- Department of Orthopaedics, Case Western Reserve University, University Hospitals of Cleveland, Cleveland, OH 44106-5000, USA.
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42
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Park K, Park J. Investigation of interfacial strength and its structure on the development of a new design of UHMWPE acetabular component. JOURNAL OF BIOMEDICAL MATERIALS RESEARCH 2003; 63:363-72. [PMID: 12115770 DOI: 10.1002/jbm.10234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Previous studies associated with the development of a new ultra-high-molecular-weight polyethylene (UHMWPE) acetabular component have shown high interfacial tensile strengths through chemical and mechanical bonds between virgin UHMWPE or polymethylmethacrylate (PMMA) and PMMA/methylmethacrylate (MMA) monomer treated UHMWPE. Along with the interfacial strength, the mechanism of interfacial strength development has been investigated, correlating the interfacial strength to its structure, with the different molding temperatures or amount of PMMA in the treated UHMWPE. Of three different fracture patterns-adhesive, mixed, and cohesive-most fractures occurred in the mixed or cohesive mode, indicating either a strong interface or a weak bulk phase. Load-displacement plots from the interfacial tensile tests represented two distinct fracture patterns, suggesting the nature of interfacial structure. Comparison of theoretical and real interfacial strength showed a close match between the two strengths for the interface between PMMA and treated UHMWPE, but a large difference for the interface between UHMWPE and treated UHMWPE. This result hints that although the PMMA/treated UHMWPE interface develops its interfacial strength in a relatively simple mechanism of direct chemical bonds, the UHMWPE/treated-UHMWPE interface builds its strength in a complex way.
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Affiliation(s)
- Kwideok Park
- 330ET, Department of Biomedical Engineering, The University of Memphis, Tennessee 38152, USA.
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43
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Skoglund B, Aspenberg P. PMMA particles and pressure--a study of the osteolytic properties of two agents proposed to cause prosthetic loosening. J Orthop Res 2003; 21:196-201. [PMID: 12568949 DOI: 10.1016/s0736-0266(02)00150-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Amongst the wear debris particles implicated in the particle hypothesis for prosthetic loosening are polymethylmethacrylate (PMMA), and particularly PMMA with barium sulphate contrast agent. Another suggested cause for loosening is hydrostatic pressure. PMMA particles were combined with hydrostatic pressure in a study to investigate whether there could be a synergistic or additive effect between these two factors. Titanium plates were fastened onto tibiae of 59 rats. After osseointegration, PMMA particles with barium sulphate were administered to the bone-implant interface. Further, PMMA particles were introduced into a previously published model for hydrostatic pressure induced osteolysis. There was measurable resorption in response to the PMMA particles but no additive or synergistic effect from introducing particles to the pressure model, and the effect of pressure was far greater than that of particles. These results suggest that, whereas particles can be shown to elicit an osteolytic response, the much less studied osteolytic effects of pressure could be far more important.
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Affiliation(s)
- Björn Skoglund
- Department of Neuroscience and Locomotion/Division of Orthopaedics and Sports Medicine, INR, Faculty of Health Sciences, Linköping University, SE-58185 Linköping, Sweden
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Abstract
Long-term clinical studies of total hip replacement suggest a direct relationship between bearing wear and periprosthetic osteolysis, particularly if polyethylene wear is greater than a threshold value of 0.1 mm per year. The current clinical trend to cross-linked polyethylene and hard-to-hard bearings attempts to ensure that bearing wear remains below this threshold. Fluid pressure generated in the hip during patient activity also has been implicated in the formation of periprosthetic lesions. Pressure fluctuation measured during manipulation of the hip at revision, or the identification of modular components that pump fluid during loading, suggest cyclic pressure may be a causative factor in bone resorption. Animal studies show the adverse effect of direct pressure on osteocytes. At more than 10 years followup, the low incidence of osteolytic lesions in retrospective reviews of successful cemented and cementless implant designs suggest that osteolysis is not an inevitable consequence of particle or pressure generation in the hip. If the quality of implant fixation prohibits fluid access to the surrounding bone, the rate of osteolysis is minimal. It is evident that whether the active factor in osteolysis is pressure, wear particles, or both, adverse periprosthetic effects can be minimized if access to the fixation interfaces in the hip is denied.
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45
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Sundfeldt M, Widmark M, Johansson CB, Campbell P, Carlsson LV. Effect of submicron polyethylene particles on an osseointegrated implant: an experimental study with a rabbit patello-femoral prosthesis. ACTA ORTHOPAEDICA SCANDINAVICA 2002; 73:416-24. [PMID: 12358115 DOI: 10.1080/00016470216314] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In a rabbit model of a weight bearing, articulating prosthetic joint we repeatedly injected submicron particles of Ultra-High-Molecular-Weight-Polyethylene (UHMWPE) produced in a hip simulator. The contralateral knee with the same prosthesis was injected with carrier (NaCl) without UHMWPE. Histomorphometrical studies on undecalcified cut and ground sections at 26 and 42 weeks involved quantifications of the entire bone to metal contact and the bone area around each implant. We found no statistically significant differences between test and control groups, and the UHMWPE debris did not induce any significant osteolysis, indicating that an osseointegrated implant with a sealed interface may not be affected by UHMWPE debris or progress to aseptic loosening.
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46
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47
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Park KD, Park JB. Interfacial strength of compression-molded specimens between PMMA powder and PMMA/MMA monomer solution-treated ultra-high molecular weight polyethylene (UHMWPE) powder. JOURNAL OF BIOMEDICAL MATERIALS RESEARCH 2001; 53:737-47. [PMID: 11074434 DOI: 10.1002/1097-4636(2000)53:6<737::aid-jbm17>3.0.co;2-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The interface between bone cement and ultra-high molecular weight polyethylene (UHMWPE) has been considered a weak link of cemented UHMWPE acetabular cup in total hip replacement (THR). For the improvement of this weak interface, adhesion between the UHMWPE acetabular cup and bone cement made of polymethylmethacrylate (PMMA) has been investigated in our laboratory. Virgin UHMWPE powders were treated with methyl methacrylate (MMA) monomer and PMMA/MMA solution. The treated UHMWPE powders were then compression-molded with virgin UHMWPE powders or PMMA powders, creating two different interfaces, i. e., treated/virgin UHMWPE powder and treated UHMWPE/PMMA powder. For the present study, the interfacial strengths between PMMA powder and the treated UHMWPE power were investigated following the same protocol previously set. The maximum interfacial strength was 17.0 +/- 0.25MPa with the same molding condition of 166.5 degrees C, 38.7 MPa and l h. In addition to the molding condition, we tested the strengths for the treated UHMWPE powders, which have different ratios between PMMA/MMA solution and MMA-treated UHMWPE powders. Significant differences on the interfacial strengths resulted due to the ratio change; more PMMA in the PMMA/MMA solution-treated UHMWPE powder exhibited higher interfacial strength. Scanning electron microscopic (SEM) pictures showed that the interface is composed of three major portions: PMMA powder, UHMWPE, and coated PMMA, indicating strong mechanical interlocking of UHMWPE and PMMA powder matrix and chemical bonding between PMMA powder and the precoated PMMA onto the UHMWPE. In addition, another interfacial strength between PMMA powder, which is equivalent to the outermost part of the cup, and bone cement was investigated. The average strength reached up to 42.4 +/- 3.6 MPa, close to the tensile strength of bone cement itself.
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Affiliation(s)
- K D Park
- Department of Biomedical Engineering, University of Iowa, Iowa City, Iowa 52242-1527, USA
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48
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Abstract
A total of 51 patients with bilateral simultaneous Charnley total hip arthroplasties were studied for wear behavior. The mean observation time was 14.7 years. Fourteen hips had been revised during follow-up. The mean wear rate was 0.071 mm/y for left hips and 0.081 mm/y for right hips. There were considerable side differences for individual patients and little agreement between the wear measurements of left and right hips. Linear wear was increased in men, in patients with high body weight. Linear wear after hip arthroplasty is not side related.
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Affiliation(s)
- A Joshi
- Centre for Hip Surgery, Wrightington Hospital, Wigan, Lancashire, England
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49
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Hilding M, Ryd L, Toksvig-Larsen S, Aspenberg P. Clodronate prevents prosthetic migration: a randomized radiostereometric study of 50 total knee patients. ACTA ORTHOPAEDICA SCANDINAVICA 2000; 71:553-7. [PMID: 11145380 DOI: 10.1080/000164700317362163] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In a double-blind study, we randomized 50 patients to receive peroral clodronate medication or placebo from 3 weeks before until 6 months after a total knee replacement with a cemented NexGen implant. Migration of the tibial components was measured by radiostereometry at 1 year. Clodronate reduced prosthetic migration, as measured by maximum total point motion, from 0.40 mm to 0.29 mm (p = 0.01). This confirms that the early postoperative migration is related to bone resorption and thus the biology of the bone bed. Since early migration is related to late loosening, 6 months of clodronate medication might reduce the risk of loosening.
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Affiliation(s)
- M Hilding
- Department of Orthopedics and Center for Clinical Research, Uppsala University, Central Hospital of Västerås, Sweden.
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50
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Baleani M, Cristofolini L, Toni A. Initial stability of a new hybrid fixation hip stem: experimental measurement of implant-bone micromotion under torsional load in comparison with cemented and cementless stems. JOURNAL OF BIOMEDICAL MATERIALS RESEARCH 2000; 50:605-15. [PMID: 10756320 DOI: 10.1002/(sici)1097-4636(20000615)50:4<605::aid-jbm17>3.0.co;2-p] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A new hybrid fixation stem, named cemented-locked uncemented (CLU), for total hip arthroplasty was developed to achieve good initial stability. Primary stability is guaranteed by the cement which is injected into two pockets in the lateral area. This leaves a large surface available for long-term biologic fixation (direct bone attachment on implant). This study evaluates in vitro the initial stability of the CLU prototype under torsional load, in comparison with cemented and cementless stems. The results show that the CLU stem is very stable in simulated stair climbing. Its micromotions are comparable to those of a cemented prosthesis, and significantly less (80-90% lower) than those for a cementless stem. These findings confirm the optimal initial stability expected from the CLU prototype. This new design, which employs hybrid fixation, should improve bone formation on the implant and reduce the risk of stem loosening.
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Affiliation(s)
- M Baleani
- Laboratorio di Tecnologia Medica, Istituti Ortopedici Rizzoli, via Di Barbiano 1/10, Bologna 40136, Italy
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