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Di Laura A, Henckel J, Hart A. Custom 3D-Printed Implants for Acetabular Reconstruction: Intermediate-Term Functional and Radiographic Results. JB JS Open Access 2023; 8:JBJSOA-D-22-00120. [PMID: 37197697 PMCID: PMC10184995 DOI: 10.2106/jbjs.oa.22.00120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/19/2023] Open
Abstract
The management of massive acetabular defects at the time of revision hip surgery is challenging. Severe pelvic bone loss and the heterogeneity and quality of the remaining bone stock can compromise the fixation and mechanical stability of the implant. Methods We reviewed a database of consecutive patients who had undergone acetabular reconstruction with the use of a custom 3D-printed implant with a dual-mobility bearing for the treatment of Paprosky type-3B defects between 2016 and 2019. Functional and radiological outcomes were assessed. Results A total of 26 patients (17 women and 9 men) with a minimum follow-up of 36 months (median, 53 months; range, 36 to 77 months) were identified. The median age at surgery was 69 years (range, 49 to 90 years), and 4 patients had pelvic discontinuity. The cumulative implant survivorship was 100%. The median Oxford Hip Score improved significantly from 8 (range, 2 to 21) preoperatively to 32 (range, 14 to 47) postoperatively (p = 0.0001). One patient had a transient sciatic nerve palsy, 1 hip dislocated 6 months postoperatively and was managed nonoperatively, and 1 infection recurred. No patient had a fracture. Radiographic evaluation showed bone ingrowth at the bone-implant interface in 24 patients (92%) at ≥12 months of follow-up and showed no evidence of implant loosening or migration at the latest follow-up (3 to 6 years). Conclusions Excellent functional improvement, implant survivorship, and osseointegration were recorded in the patient cohort. Accurate preoperative planning and the adoption of custom 3D-printed implants showed promising results in complex revision hip surgery. Level of Evidence Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Anna Di Laura
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, United Kingdom
- Department of Mechanical Engineering, University College London, London, United Kingdom
| | - Johann Henckel
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, United Kingdom
| | - Alister Hart
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, United Kingdom
- Institute of Orthopaedics and Musculoskeletal Science, University College London, London, United Kingdom
- Email for corresponding author:
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2
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Shirogane Y, Homma Y, Yanagisawa N, Higano M, Hirasawa Y, Nakamura S, Baba T, Kaneko K, Taneda H, Ishijima M. Relationship between labral length and symptoms in patients with acetabular dysplasia before rotational acetabular osteotomy. J Hip Preserv Surg 2022; 9:240-251. [PMID: 36908550 PMCID: PMC9993447 DOI: 10.1093/jhps/hnac045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/03/2022] [Accepted: 09/06/2022] [Indexed: 03/14/2023] Open
Abstract
The aim of this study was to investigate the relationship between acetabular labral length and symptoms in patients with acetabular dysplasia. In a retrospective medical record review, 218 patients with acetabular dysplasia who had undergone rotational acetabular osteotomy were identified. After implementing the inclusion and exclusion criteria, 53 patients were analyzed for preoperative symptoms measured by the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ), acetabular bone morphology parameters by anteroposterior pelvic radiographs and labral parameters by radial magnetic resonance imaging. Spearman's correlation coefficients were calculated among JHEQ scores, bone morphologic parameters and labral parameters. Multiple linear regression models to determine the predictive variables of JHEQ score and labral length were obtained. There was no correlation between bone morphologic parameters and JHEQ scores. Labral length measured anteriorly correlated with JHEQ pain {r [95% confidence interval (CI)] = -0.335 (-0.555, -0.071), P = 0.014}, movement subscale [r (95% CI) = -0.398 (-0.603, -0.143), P = 0.003], mental subscale [r (95% CI) = -0.436 (-0.632, -0.188), P = 0.001] and total JHEQ score [r (95% CI) = -0.451 (-0.642, -0.204), P = 0.001]. The multiple linear regression results showed that anterior labral length was independently associated with JHEQ subscales in some models. Meanwhile, age, acetabular head index and total JHEQ score were independently associated with anterior labral length in all models. Labral length, notably in anterosuperior area, in patients with symptomatic acetabular dysplasia was related to patient's symptom. Labral length may be an important objective image finding that can be used to assess the severity of cumulative hip instability.
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Affiliation(s)
- Yuichi Shirogane
- Department of Orthopaedic Surgery, Nishitokyo Chuo General Hospital, 2-4-19 Shibakubocho, Nishitokyo-shi, Tokyo 188-0014,Japan.,Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 133-8421, Japan.,Department of Orthopaedic, Faculty of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-ku, Tokyo 133-8431, Japan
| | - Yasuhiro Homma
- Department of Orthopaedic Surgery, Nishitokyo Chuo General Hospital, 2-4-19 Shibakubocho, Nishitokyo-shi, Tokyo 188-0014,Japan.,Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 133-8421, Japan.,Department of Orthopaedic, Faculty of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-ku, Tokyo 133-8431, Japan
| | - Naotake Yanagisawa
- Clinical Research and Trial Center, Juntendo University, 3-1-3 Hongo, Bunkyo-ku, Tokyo 133-8431, Japan
| | - Masanori Higano
- Department of Orthopaedic Surgery, Nishitokyo Chuo General Hospital, 2-4-19 Shibakubocho, Nishitokyo-shi, Tokyo 188-0014,Japan
| | - Yoichiro Hirasawa
- Department of Orthopaedic Surgery, Nishitokyo Chuo General Hospital, 2-4-19 Shibakubocho, Nishitokyo-shi, Tokyo 188-0014,Japan
| | - Shigeru Nakamura
- Department of Orthopaedic Surgery, Nishitokyo Chuo General Hospital, 2-4-19 Shibakubocho, Nishitokyo-shi, Tokyo 188-0014,Japan
| | - Tomonori Baba
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 133-8421, Japan.,Department of Orthopaedic, Faculty of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-ku, Tokyo 133-8431, Japan
| | - Kazuo Kaneko
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 133-8421, Japan.,Department of Orthopaedic, Faculty of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-ku, Tokyo 133-8431, Japan
| | - Hitoshi Taneda
- Department of Orthopaedic Surgery, Nishitokyo Chuo General Hospital, 2-4-19 Shibakubocho, Nishitokyo-shi, Tokyo 188-0014,Japan
| | - Muneaki Ishijima
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 133-8421, Japan.,Department of Orthopaedic, Faculty of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-ku, Tokyo 133-8431, Japan
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Motomura G, Mashima N, Imai H, Sudo A, Hasegawa M, Yamada H, Morita M, Mitsugi N, Nakanishi R, Nakashima Y. Effects of porous tantalum on periprosthetic bone remodeling around metaphyseal filling femoral stem: a multicenter, prospective, randomized controlled study. Sci Rep 2022; 12:914. [PMID: 35042918 PMCID: PMC8766592 DOI: 10.1038/s41598-022-04936-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 11/23/2021] [Indexed: 11/09/2022] Open
Abstract
Periprosthetic bone loss due to adaptive bone remodeling is an important unresolved issue in cementless total hip arthroplasty (THA). The use of porous tantalum on the proximal surface of the femoral stem is expected to decrease postoperative bone loss around the prosthesis through early fixation. We conducted a multicenter randomized controlled study to determine if porous tantalum could reduce periprosthetic bone loss after THA. From October 2012 to September 2014, 118 patients (mean age, 61.5 years; 107 females and 11 males) were prospectively enrolled and were randomly allocated at a ratio of 1:1 to either a metaphyseal filling stem with a proximal porous tantalum coating (Trabecular Metal) or a conventional metaphyseal filling stem with fiber mesh coating (VerSys). Patients underwent dual-energy x-ray absorptiometry scans within 1 week after surgery (baseline) and at 6, 12, and 24 months after surgery to assess periprosthetic bone mineral density (BMD) in the 7 Gruen zones. In addition, the Japanese Orthopaedic Association hip score was assessed before surgery and at 6, 12, and 24 months after surgery. In the proximal periprosthetic region (zones 1 and 7), the Trabecular Metal group had significantly smaller reductions in BMD than the VerSys group throughout the study period. In the VerSys group, significant reductions in BMD compared to baseline were seen at each measurement point in all regions, except in zone 6 at 24 months. In the Trabecular Metal group, no significant reductions in BMD relative to baseline were seen in zones 1, 5, or 6 throughout the study period. Both groups demonstrated similar improvement in Japanese Orthopaedic Association hip scores over the study period. This study demonstrated that a proximally coated stem with porous tantalum has superior results over a conventional stem with titanium fiber mesh in terms of periprosthetic bone remodeling.
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Affiliation(s)
- Goro Motomura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Naohiko Mashima
- Department of Regeneration of Community Medicine, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Hiroshi Imai
- Department of Orthopaedic Surgery, Graduate School of Medicine, Ehime University, Shitsukawa, Toon, 791-0295, Japan
| | - Akihiro Sudo
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
| | - Masahiro Hasegawa
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
| | - Harumoto Yamada
- Department of Orthopaedic Surgery, Fujita Health University, Toyoake, Aichi, 470-1192, Japan
- Department of Orthopedic Surgery, Nisshin Orido Hospital, 110, Nishidamen, Orido-cho, Nisshin, Aichi, 470-0115, Japan
| | - Mitsuhiro Morita
- Department of Orthopaedic Surgery, Fujita Health University, Toyoake, Aichi, 470-1192, Japan
| | - Naoto Mitsugi
- Department of Orthopedic Surgery, Yokohama City University Medical Center, 4-57, Urafune-cho, Minami, Yokohama, Kanagawa, 232-0024, Japan
- Department of Orthopedic Surgery, Osada Hospital, 2-10, Maruyamadai, Minatominami-ku, Yokohama, Kanagawa, 233-0013, Japan
| | - Ryosuke Nakanishi
- Department of Orthopaedic Surgery, Showa University Fujigaoka Hospital, Showa University School of Medicine, 1-30 Fujigaoka Aobaku, Yokohama, 227-8501, Japan
- Department of Orthopedic Surgery, Shizuoka Medical Center, 762-1, Nagasawa, Shimizu-cho, Sunto District, Shizuoka, 411-8611, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
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Miyagawa T, Matsumoto K, Komura S, Akiyama H. Total hip arthroplasty using a three-dimensional porous titanium acetabular cup: an examination of micromotion using subject-specific finite element analysis. BMC Musculoskelet Disord 2021; 22:308. [PMID: 33771146 PMCID: PMC8004441 DOI: 10.1186/s12891-021-04174-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/15/2021] [Indexed: 11/30/2022] Open
Abstract
Background We investigated the mid-term clinical and radiological results of total hip arthroplasty (THA) using a three-dimensional (3D) porous titanium cup and analyzed the micromotion at the interface of the cup using subject-specific finite element (FE) analysis. Methods We evaluated 73 hips of 65 patients (6 men and 59 women; mean age at the time of surgery, 62.2 years; range, 45–86 years) who had undergone THA using a 3D porous titanium cup. Clinical evaluations were performed using the Japanese Orthopaedic Association (JOA) hip score system. We assessed the fixation of the acetabular component based on the presence of radiolucent lines and cup migration using anteroposterior radiographs. Subject-specific FE models were constructed from computed tomography data. Results The JOA score improved from a preoperative mean of 52.2 (range, 23–82) to a mean of 87.8 (range, 71–100) at the final follow-up. None of the patients underwent revisions during the follow-up period. Radiolucent lines were observed in 26 cases (35.6%) and frequently appeared at DeLee and Charnley Zone 3. Following the FE analysis, the micromotion at DeLee and Charnley Zone 3 was significantly larger than that at Zone 2. Furthermore, micromotion was large in the groups in which radiolucent lines appeared at Zone 3. Conclusions The mid-term clinical outcome of THA using a 3D porous titanium cup was excellent. However, radiolucent lines frequently appeared at DeLee and Charnley Zone 3. FE analysis indicated that micromotion was large at the same site, strongly suggesting that it contributes to the emergence of radiolucent lines. The 3D porous titanium cups are useful in THA, and with improvements focused on micromotion, we anticipate better long-term outcomes.
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Affiliation(s)
- Takaki Miyagawa
- Department of Orthopaedic Surgery, Gifu University School of Medicine, Yanagido 1-1, Gifu, 501-1194, Japan
| | - Kazu Matsumoto
- Department of Orthopaedic Surgery, Gifu University School of Medicine, Yanagido 1-1, Gifu, 501-1194, Japan
| | - Shingo Komura
- Department of Orthopaedic Surgery, Gifu University School of Medicine, Yanagido 1-1, Gifu, 501-1194, Japan
| | - Haruhiko Akiyama
- Department of Orthopaedic Surgery, Gifu University School of Medicine, Yanagido 1-1, Gifu, 501-1194, Japan.
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5
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Lovati AB, Lopa S, Bottagisio M, Talò G, Canciani E, Dellavia C, Alessandrino A, Biagiotti M, Freddi G, Segatti F, Moretti M. Peptide-Enriched Silk Fibroin Sponge and Trabecular Titanium Composites to Enhance Bone Ingrowth of Prosthetic Implants in an Ovine Model of Bone Gaps. Front Bioeng Biotechnol 2020; 8:563203. [PMID: 33195126 PMCID: PMC7604365 DOI: 10.3389/fbioe.2020.563203] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 09/21/2020] [Indexed: 12/18/2022] Open
Abstract
Osteoarthritis frequently requires arthroplasty. Cementless implants are widely used in clinics to replace damaged cartilage or missing bone tissue. In cementless arthroplasty, the risk of aseptic loosening strictly depends on implant stability and bone–implant interface, which are fundamental to guarantee the long-term success of the implant. Ameliorating the features of prosthetic materials, including their porosity and/or geometry, and identifying osteoconductive and/or osteoinductive coatings of implant surfaces are the main strategies to enhance the bone-implant contact surface area. Herein, the development of a novel composite consisting in the association of macro-porous trabecular titanium with silk fibroin (SF) sponges enriched with anionic fibroin-derived polypeptides is described. This composite is applied to improve early bone ingrowth into the implant mesh in a sheep model of bone defects. The composite enables to nucleate carbonated hydroxyapatite and accelerates the osteoblastic differentiation of resident cells, inducing an outward bone growth, a feature that can be particularly relevant when applying these implants in the case of poor osseointegration. Moreover, the osteoconductive properties of peptide-enriched SF sponges support an inward bone deposition from the native bone towards the implants. This technology can be exploited to improve the biological functionality of various prosthetic materials in terms of early bone fixation and prevention of aseptic loosening in prosthetic surgery.
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Affiliation(s)
- Arianna B Lovati
- IRCCS Istituto Ortopedico Galeazzi, Cell and Tissue Engineering Laboratory, Milan, Italy
| | - Silvia Lopa
- IRCCS Istituto Ortopedico Galeazzi, Cell and Tissue Engineering Laboratory, Milan, Italy
| | - Marta Bottagisio
- IRCCS Istituto Ortopedico Galeazzi, Laboratory of Clinical Chemistry and Microbiology, Milan, Italy
| | - Giuseppe Talò
- IRCCS Istituto Ortopedico Galeazzi, Cell and Tissue Engineering Laboratory, Milan, Italy
| | - Elena Canciani
- Ground Sections Laboratory, Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Claudia Dellavia
- Ground Sections Laboratory, Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | | | | | | | | | - Matteo Moretti
- IRCCS Istituto Ortopedico Galeazzi, Cell and Tissue Engineering Laboratory, Milan, Italy.,Regenerative Medicine Technologies Lab, Ente Ospedaliero Cantonale, Lugano, Switzerland
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6
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Lu Y, Wu Z, Tang X, Gu M, Hou B. Effect of articular capsule repair on postoperative dislocation after primary total hip replacement by the anterolateral approach. J Int Med Res 2019; 47:4787-4797. [PMID: 31366266 PMCID: PMC6833405 DOI: 10.1177/0300060519863526] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Objective Artificial hip dislocation is one of the most serious complications following total hip replacement. This study was performed to assess articular capsule repair in primary total hip replacement with the anterolateral approach (Watson-Jones incision) and its effect on postoperative dislocation. Methods Patients who underwent primary total hip replacement by the anterolateral approach in Tongren Hospital of Shanghai Jiao Tong University School of Medicine from June 2007 to June 2014 were retrospectively analyzed. The patients were divided into the repair and dissection groups based on the articular capsule repair status during surgery. Postoperative dislocation rates were compared between the two groups using the chi-squared test. Results The repair and dissection groups comprised 137 and 248 patients, respectively. All patients were followed up for 6 months to 5 years (average, 3.75 years). The mean age, sex, disease composition, and follow-up time were not significantly different between the two groups. Early postoperative dislocation occurred in 1 hip (0.7%) in the repair group and 13 hips (5.2%) in the dissection group. Conclusions During the anterolateral approach for primary total hip replacement, articular capsule repair may reduce the occurrence of early postoperative dislocation of the hip joint.
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Affiliation(s)
- Yiran Lu
- Department of Orthopaedics, the Tongren Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zongming Wu
- Department of Orthopaedics, the Tongren Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xianzhong Tang
- Department of Orthopaedics, the Tongren Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mengzhen Gu
- Department of Orthopaedics, the Tongren Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bo Hou
- Department of Orthopaedics, the Tongren Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Wan L, Wu G, Cao P, Li K, Li J, Zhang S. Curative effect and prognosis of 3D printing titanium alloy trabecular cup and pad in revision of acetabular defect of hip joint. Exp Ther Med 2019; 18:659-663. [PMID: 31281446 PMCID: PMC6580106 DOI: 10.3892/etm.2019.7621] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 04/25/2019] [Indexed: 11/17/2022] Open
Abstract
Curative effect and prognosis of 3D printing titanium alloy trabecular cup and pad in revision of acetabular defect of hip joint were investigated. Forty-two patients who underwent acetabular revision in the Second Affiliated Hospital of Luohe Medical College were divided into observation and control groups according to different methods of acetabular revision and revision materials. 3D printed titanium alloy trabecular cups and pads were used in the observation group, and non-3D printed titanium trabecular cups and pads were used in the control group. Preoperative and postoperative pain visual analog scale (VAS score), hip Harris scores and quality of life Health Survey Scale (SF-36) scores were compared between the groups. At 3, 6 and 12 months after operation, Harris score and SF-36 score of the observation group were significantly higher than those of the control group, and VAS score was significantly lower than that of the control group (P<0.05). Stability and bone ingrowth of prosthesis in the observation group were better than those in the control group. Revision of the hip prosthesis with 3D printed titanium trabecular metal cups and pads resulted in satisfactory outcomes. Short-term prognosis is satisfactory but the long-term prognosis remains to be further investigated.
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Affiliation(s)
- Lei Wan
- Department of Osteology, The Second Affiliated Hospital of Luohe Medical College, Luohe, Henan 462300, P.R. China
| | - Guangliang Wu
- Department of Osteology, The Second Affiliated Hospital of Luohe Medical College, Luohe, Henan 462300, P.R. China
| | - Pengke Cao
- Department of Osteology, The Second Affiliated Hospital of Luohe Medical College, Luohe, Henan 462300, P.R. China
| | - Kui Li
- Department of Osteology, The Second Affiliated Hospital of Luohe Medical College, Luohe, Henan 462300, P.R. China
| | - Junming Li
- Department of Osteology, The Second Affiliated Hospital of Luohe Medical College, Luohe, Henan 462300, P.R. China
| | - Shaoan Zhang
- Department of Osteology, The Second Affiliated Hospital of Luohe Medical College, Luohe, Henan 462300, P.R. China
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Zhu H, Ji X, Guan H, Zhao L, Zhao L, Liu C, Cai C, Li W, Tao T, Reseland JE, Haugen HJ, Xiao J. Tantalum nanoparticles reinforced polyetheretherketone shows enhanced bone formation. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2019; 101:232-242. [PMID: 31029316 DOI: 10.1016/j.msec.2019.03.091] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 03/23/2019] [Accepted: 03/24/2019] [Indexed: 11/18/2022]
Abstract
Polyetheretherketone (PEEK) has been used in orthopedic surgery for several decades. Numerous methods were invented to alter the properties of PEEK. By adding nanoparticles, fibers, etc., elastic modulus and strength of PEEK can be changed to meet certain demand. In this study, tantalum (Ta), a promising metal, was introduced to modify the properties of PEEK, in which PEEK was reinforced with different contents of tantalum nanoparticles (from 1 wt% to 9 wt%). Mechanical properties and biological functions (both in vitro and in vivo) were then investigated. The highest elastic modulus and compressive strength were observed in 3%Ta-PEEK. Cell experiments as cell adhesion, collagen secretion, biomineralization and osteogenesis related gene expression showed preferable results in 3%Ta-PEEK and 5%Ta-PEEK. Improved bone integration was shown in 3%Ta-PEEK and 5%Ta-PEEK in vivo. Above all, enhanced mechanical properties and promoted bone formation were proved for 3%Ta-PEEK and 5%Ta-PEEK compared to others groups both in vitro and in vivo, suggesting that the addition of tantalum nanoparticles modified the osseointegration ability of PEEK. This composite of tantalum and PEEK could have a clinical potential for orthopedic implants.
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Affiliation(s)
- Hao Zhu
- Department of Orthopedic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan 430030, China; Department of Biomaterials, Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, P.O. Box 1109, Blindern, NO-0317 Oslo, Norway.
| | - Xiongfa Ji
- Department of Orthopedic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan 430030, China.
| | - Hanfeng Guan
- Department of Orthopedic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan 430030, China.
| | - Liming Zhao
- Department of Orthopedic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan 430030, China.
| | - Libo Zhao
- Department of Orthopedic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan 430030, China
| | - Changyu Liu
- Department of Orthopedic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan 430030, China
| | - Cong Cai
- Department of Orthopedic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan 430030, China
| | - Weijing Li
- Department of Orthopedic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan 430030, China
| | - Tenghui Tao
- Department of Orthopedic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan 430030, China.
| | - Janne Elin Reseland
- Department of Biomaterials, Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, P.O. Box 1109, Blindern, NO-0317 Oslo, Norway.
| | - Håvard Jostein Haugen
- Department of Biomaterials, Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, P.O. Box 1109, Blindern, NO-0317 Oslo, Norway.
| | - Jun Xiao
- Department of Orthopedic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan 430030, China.
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9
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Belt M, Gliese B, Muharemovic O, Malchau H, Husted H, Troelsen A, Gromov K. Sensitivity and specificity of post-operative interference gap assessment on plain radiographs after cementless primary THA. Clin Imaging 2019; 54:103-107. [PMID: 30612032 DOI: 10.1016/j.clinimag.2018.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 12/13/2018] [Accepted: 12/27/2018] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Implant performance of cementless THA is often evaluated by radiolucency on plain radiographs, often classified as interference gaps on direct post-operative radiographs. However, the diagnostic performance is unknown. The aim was to evaluate the diagnostic performance of radiographic assessment of post-operative gaps after primary THA by comparing it with CT confirmed gaps, and secondary to define optimal cut-off criteria for assessing gaps on plain radiographs compared with CT. MATERIAL AND METHODS Patients (N = 40) with a primary cementless THA performed between July 2015 and March 2016 were enrolled in the study. Radiolucency was assessed on post-operative AP pelvic digital radiographs by two observers independently. Maximum width and percentage of coverage per zone were reported. Gap volume was measured by manual segmentation on CT images. RESULTS When defining a gap as a radiolucency extending through >50% of a zone, the interrater agreement Kappa was 0.241. Sensitivity was 65.8% for observer 1 (Kappa = 0.432), and 86.8% for observer 2 (Kappa = 0.383). When defining a gap as a radiolucency with a width >1 mm, the interrater agreement Kappa was 0.302. Sensitivity was 55.3% and 50% for observer 1 and observer 2, respectively. The ROC-curve resulted in an optimal threshold of 0.65 mm (AUROC = 0.888) and 0.31 mm (AUROC = 0.961) for the two observers. CONCLUSION The diagnostic performance of observers detecting interference gaps on radiographs showed low sensitivity. Further on, the inter-rater agreement is too low to do a general recommendation about thresholds for defining gaps. Evaluating progression of radiolucency on radiographs should be performed in the light of these findings.
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Affiliation(s)
- Maartje Belt
- Dept. of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Copenhagen, Denmark.
| | - Bjørn Gliese
- Dept. of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Copenhagen, Denmark
| | - Omar Muharemovic
- Department of Radiology, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Denmark
| | - Henrik Malchau
- Dept. of Orthopaedic Surgery, Sahlgrenska University Hospital, Mölndal, Gothenburg, Sweden; The Harris Orthopaedic Laboratory, Orthopedic Department, Massachusetts General Hospital, Boston, USA
| | - Henrik Husted
- Dept. of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Copenhagen, Denmark
| | - Anders Troelsen
- Dept. of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Copenhagen, Denmark
| | - Kirill Gromov
- Dept. of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Copenhagen, Denmark
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10
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Imai H, Miyawaki J, Kamada T, Maruishi A, Takeba J, Miura H. Radiolucency around highly porous sockets and hydroxyapatite-coated porous sockets in total hip arthroplasty for hip dysplasia. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 29:611-618. [PMID: 30488136 PMCID: PMC6422951 DOI: 10.1007/s00590-018-2351-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 11/25/2018] [Indexed: 02/07/2023]
Abstract
Studies over the past decade have reported that the use of highly porous sockets in total hip arthroplasty (THA) results in osseointegration and long-term implant stability. However, some reports have raised concerns regarding radiographic evidence of poor osseointegration with features of fibrous tissue ingrowth. The purpose of this study was to compare clinical and radiographic assessments of highly porous sockets with those of hydroxyapatite (HA)-coated porous sockets in THA for hip dysplasia (DDH) at least 1 year after surgery. A total of 127 patients (136 hips) were recruited for the study. Of these, 94 patients (101 hips) received highly porous sockets with clustered screws, while 33 patients (35 hips) received HA-coated porous sockets with clustered screws. There was no difference in clinical outcomes between the two types of sockets. All HA-coated porous sockets were radiographically stable, without radiolucent lines. Fifteen hips had radiolucent lines in two or three DeLee and Charnley zones, accompanied by sclerotic lines along the circumferences of the highly porous sockets. A significant difference in the height of the preoperative osteophyte of the anterior acetabular wall was observed between 86 hips with one or no radiolucent lines and 15 hips with two or three radiolucent lines. In cases of DDH with atrophic bone remodeling pattern, highly porous sockets with multiple screws may be used, while HA-coated porous sockets with clustered screws result in better sealing of the bone–component interface.
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Affiliation(s)
- Hiroshi Imai
- Department of Bone and Joint Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan.
| | - Joji Miyawaki
- Department of Bone and Joint Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Tomomi Kamada
- Department of Bone and Joint Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Akira Maruishi
- Department of Bone and Joint Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Jun Takeba
- Department of Bone and Joint Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Hiromasa Miura
- Department of Bone and Joint Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
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11
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Li Z, Wang C, Li C, Wang Z, Yang F, Liu H, Qin Y, Wang J. What we have achieved in the design of 3D printed metal implants for application in orthopedics? Personal experience and review. RAPID PROTOTYPING JOURNAL 2018; 24:1365-1379. [DOI: 10.1108/rpj-10-2017-0205] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
PurposeThis paper aims to review the latest applications in terms of three-dimensional printed (3DP) metal implants in orthopedics, and, importantly, the design of 3DP metal implants through a series of cases operated at The Second Hospital of Jilin University were presented.Design/methodology/approachThis paper is available to practitioners who are use 3DP implants in orthopedics. This review began with the deficiency of traditional prostheses and basic concepts of 3DP implants. Then, representative 3DP clinical cases were summarized and compared, and the experiences using customized prostheses and directions for future potential development are also shown.FindingsThe results obtained from the follow-up of clinical applications of 3DP implants show that the 3D designed and printed metal implants could exhibit good bone defect matching, quick and safe joint functional rehabilitation as well as saving time in surgery, which achieved high patient satisfaction collectively.Originality/valueSingle center experiences of 3DP metal implants design were shared and the detailed technical points between various regions were compared and analyzed. In conclusion, the 3DP technology is infusive and will present huge potential to reform future orthopedic practice.
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12
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Komiyama K, Fukushi JI, Motomura G, Hamai S, Ikemura S, Fujii M, Nakashima Y. Does high hip centre affect dislocation after total hip arthroplasty for developmental dysplasia of the hip? INTERNATIONAL ORTHOPAEDICS 2018; 43:2057-2063. [DOI: 10.1007/s00264-018-4154-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 09/10/2018] [Indexed: 01/10/2023]
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13
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Imai H, Miyawaki J, Kamada T, Maruishi A, Takeba J, Miura H. Preoperative Planning and Operative Techniques of the Shorter Tapered Stem Compared to the Metaphyseal Fit Stem in Cementless Total Hip Arthroplasty. J Arthroplasty 2017; 32:1192-1199. [PMID: 27913129 DOI: 10.1016/j.arth.2016.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 10/12/2016] [Accepted: 11/01/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND In order to prevent postoperative dislocation due to prosthetic impingement as a result of total hip arthroplasty (THA), the combined anteversion (CA) theory, which combines the anteversion of the femoral stem and the acetabular socket, has been revised in recent years. Particularly, it is necessary to keep CA within the target zone. METHODS The aim of this study was to investigate whether postoperative CA can be kept within the target zone while using the operative technique which prepares the socket first in cementless THA, by estimating the anteversion of the metaphyseal fit stem or the shorter, tapered wedge stem using preoperative 3-dimensional computerized planning, and by adjusting the anteversion of the socket using a navigation system that considers CA. One hundred fourteen patients (118 hips) were recruited for the study. RESULTS Postoperative CA in THA using the metaphyseal fit stem was kept within the target zone for 56 of the 60 hips (93.3%). Using the shorter, tapered wedge stem, 49 of the 58 hips (84.4%) were within the target zone. No postoperative dislocations were observed in any hips. CONCLUSION We found that the metaphyseal fit stem worked better than the shorter, tapered wedge stem in terms of meeting the planned CA. The shorter, tapered wedge stems were flexible in rotation according to the anatomical configuration of the proximal femur. Therefore, the stem could be placed second with the metaphyseal fit stem, but we recommend placing the stem first with the shorter, tapered wedge stem.
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Affiliation(s)
- Hiroshi Imai
- Department of Bone and Joint Surgery, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Joji Miyawaki
- Department of Bone and Joint Surgery, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Tomomi Kamada
- Department of Bone and Joint Surgery, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Akira Maruishi
- Department of Bone and Joint Surgery, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Jun Takeba
- Department of Bone and Joint Surgery, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Hiromasa Miura
- Department of Bone and Joint Surgery, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
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Wei X, Zhao D, Wang B, Wang W, Kang K, Xie H, Liu B, Zhang X, Zhang J, Yang Z. Tantalum coating of porous carbon scaffold supplemented with autologous bone marrow stromal stem cells for bone regeneration in vitro and in vivo. Exp Biol Med (Maywood) 2016; 241:592-602. [PMID: 26843518 DOI: 10.1177/1535370216629578] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 01/04/2016] [Indexed: 01/23/2023] Open
Abstract
Porous tantalum metal with low elastic modulus is similar to cancellous bone. Reticulated vitreous carbon (RVC) can provide three-dimensional pore structure and serves as the ideal scaffold of tantalum coating. In this study, the biocompatibility of domestic porous tantalum was first successfully tested with bone marrow stromal stem cells (BMSCs) in vitro and for bone tissue repair in vivo. We evaluated cytotoxicity of RVC scaffold and tantalum coating using BMSCs. The morphology, adhesion, and proliferation of BMSCs were observed via laser scanning confocal microscope and scanning electron microscopy. In addition, porous tantalum rods with or without autologous BMSCs were implanted on hind legs in dogs, respectively. The osteogenic potential was observed by hard tissue slice examination. At three weeks and six weeks following implantation, new osteoblasts and new bone were observed at the tantalum-host bone interface and pores. At 12 weeks postporous tantalum with autologous BMSCs implantation, regenerated trabecular equivalent to mature bone was found in the pore of tantalum rods. Our results suggested that domestic porous tantalum had excellent biocompatibility and could promote new bone formation in vivo. Meanwhile, the osteogenesis of porous tantalum associated with autologous BMSCs was more excellent than only tantalum implantation. Future clinical studies are warranted to verify the clinical efficacy of combined implantation of this domestic porous tantalum associated with autologous BMSCs implantation and compare their efficacy with conventional autologous bone grafting carrying blood vessel in patients needing bone repairing.
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Affiliation(s)
- Xiaowei Wei
- Department of Orthopaedic Laboratory, Zhongshan Hospital of Dalian University, Dalian 116001, China
| | - Dewei Zhao
- Department of Orthopaedic Laboratory, Zhongshan Hospital of Dalian University, Dalian 116001, China
| | - Benjie Wang
- Department of Orthopaedic Laboratory, Zhongshan Hospital of Dalian University, Dalian 116001, China
| | - Wei Wang
- Department of Orthopaedic Laboratory, Zhongshan Hospital of Dalian University, Dalian 116001, China
| | - Kai Kang
- Department of Orthopaedic Laboratory, Zhongshan Hospital of Dalian University, Dalian 116001, China
| | - Hui Xie
- Department of Orthopaedic Laboratory, Zhongshan Hospital of Dalian University, Dalian 116001, China
| | - Baoyi Liu
- Department of Orthopaedic Laboratory, Zhongshan Hospital of Dalian University, Dalian 116001, China
| | - Xiuzhi Zhang
- Department of Orthopaedic Laboratory, Zhongshan Hospital of Dalian University, Dalian 116001, China
| | - Jinsong Zhang
- Institute of Metal Research, Chinese Academy of Sciences, Shenyang 110016, China
| | - Zhenming Yang
- Institute of Metal Research, Chinese Academy of Sciences, Shenyang 110016, China
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Bone bonding strength of diamond-structured porous titanium-alloy implants manufactured using the electron beam-melting technique. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2016; 59:1047-1052. [DOI: 10.1016/j.msec.2015.11.025] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 10/23/2015] [Accepted: 11/09/2015] [Indexed: 01/10/2023]
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Hamai S, Nakashima Y, Mashima N, Yamamoto T, Kamada T, Motomura G, Imai H, Fukushi JI, Miura H, Iwamoto Y. Comparison of 10-year clinical wear of annealed and remelted highly cross-linked polyethylene: A propensity-matched cohort study. J Mech Behav Biomed Mater 2015; 59:99-107. [PMID: 26751705 DOI: 10.1016/j.jmbbm.2015.12.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Revised: 12/15/2015] [Accepted: 12/17/2015] [Indexed: 10/22/2022]
Abstract
No previous studies comparing the clinical wear rates of the two different kinds of cross-linked ultra-high-molecular-weight polyethylene (XLPE), annealed and remelted, are available. We compared the creep and steady wear rates of 36 matched pairs (72 hips in total) adjusting for baseline characteristics with propensity score matching techniques. Zirconia femoral heads with 26-mm diameter were used in all cases. The femoral-head cup penetration was measured digitally on radiographs. Significantly greater creep (p=0.006) was detected in the remelted (0.234mm) than annealed (0.159mm) XLPE. However, no significant difference (p=0.19) was found between the steady wear rates (0.003 and 0.008mm/year, respectively) of the annealed and remelted XLPE. Multiple regression analyses showed that remelted XLPE is significant independent variable (p<0.001) that is positively associated with creep. However, the patient age and body weight, cup size, the liner thickness, cup inclination, follow-up periods, and postoperative Merle d'Aubigné hip score had no significant effects (p>0.05) on the steady wear rates. No patients exhibited above the osteolysis threshold of 0.1mm/year, progressive radiolucencies, osteolysis, or polyethylene fracture. This propensity-matched cohort study document no significant difference in wear resistant performances of annealed and remelted XLPE over an average period of 10 years.
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Affiliation(s)
- Satoshi Hamai
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan; Department of Artificial Joints and Biomaterials, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
| | - Naohiko Mashima
- Department of Bone and Joint Surgery, Graduate School of Medicine, Ehime University, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Takuaki Yamamoto
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Tomomi Kamada
- Department of Bone and Joint Surgery, Graduate School of Medicine, Ehime University, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Goro Motomura
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Hiroshi Imai
- Department of Bone and Joint Surgery, Graduate School of Medicine, Ehime University, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Jun-Ichi Fukushi
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Hiromasa Miura
- Department of Bone and Joint Surgery, Graduate School of Medicine, Ehime University, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Yukihide Iwamoto
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
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Yoshimoto K, Nakashima Y, Yamamoto T, Fukushi JI, Motomura G, Ohishi M, Hamai S, Iwamoto Y. Dislocation and its recurrence after revision total hip arthroplasty. INTERNATIONAL ORTHOPAEDICS 2015; 40:1625-1630. [DOI: 10.1007/s00264-015-3020-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 10/11/2015] [Indexed: 10/22/2022]
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18
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Kanazawa M, Nakashima Y, Ohishi M, Hamai S, Motomura G, Yamamoto T, Fukushi JI, Ushijima T, Hara D, Iwamoto Y. Pelvic tilt and movement during total hip arthroplasty in the lateral decubitus position. Mod Rheumatol 2015; 26:435-40. [PMID: 26375057 DOI: 10.3109/14397595.2015.1092914] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Total hip arthroplasty (THA) is often performed in the lateral decubitus (lateral) position. In this position, the pelvis may have various degrees of tilt leading to implant malposition. We sought to quantify the pelvic tilt in lateral position and further pelvic movement during surgery. METHODS In 95 cases with primary THA, three-dimensional pelvic tilts were quantified by superimposing images reconstructed from CT data onto antero-posterior radiographs taken in lateral position at set-up and after cup placement. Pelvises were fixed with a device compressing anterior superior iliac spines and sacrum. RESULTS Various degrees of pelvic tilt occurred compared to the supine position; sagittal: -3.1° (-25.5° to 10.2°), axial: 3.9° (-8.4° to 17°), coronal: 0.9° (-11.9° to 13.2°). Absolute changes more than 5° were observed 43%, 47%, and 12% in the sagittal, axial, and coronal planes, respectively. The more preoperative posterior pelvic tilt resulted in the more change in the sagittal plane. Further pelvic movement of about 3° in three planes were observed ranging from -11° to 20° after cup placement. CONCLUSION This study showed various pelvic tilt and movement during THA. As pelvic tilt directly alters the cup orientation, its changes should be well understood. Improved tools for positioning and holding the pelvis are required.
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Affiliation(s)
- Masayuki Kanazawa
- a Department of Orthopaedic Surgery , Kyushu University , Higashi-Ku , Fukuoka , Japan
| | - Yasuharu Nakashima
- a Department of Orthopaedic Surgery , Kyushu University , Higashi-Ku , Fukuoka , Japan
| | - Masanobu Ohishi
- a Department of Orthopaedic Surgery , Kyushu University , Higashi-Ku , Fukuoka , Japan
| | - Satoshi Hamai
- a Department of Orthopaedic Surgery , Kyushu University , Higashi-Ku , Fukuoka , Japan
| | - Goro Motomura
- a Department of Orthopaedic Surgery , Kyushu University , Higashi-Ku , Fukuoka , Japan
| | - Takuaki Yamamoto
- a Department of Orthopaedic Surgery , Kyushu University , Higashi-Ku , Fukuoka , Japan
| | - Jun-Ichi Fukushi
- a Department of Orthopaedic Surgery , Kyushu University , Higashi-Ku , Fukuoka , Japan
| | - Takahiro Ushijima
- a Department of Orthopaedic Surgery , Kyushu University , Higashi-Ku , Fukuoka , Japan
| | - Daisuke Hara
- a Department of Orthopaedic Surgery , Kyushu University , Higashi-Ku , Fukuoka , Japan
| | - Yukihide Iwamoto
- a Department of Orthopaedic Surgery , Kyushu University , Higashi-Ku , Fukuoka , Japan
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Ayers DC, Greene M, Snyder B, Aubin M, Drew J, Bragdon C. Radiostereometric analysis study of tantalum compared with titanium acetabular cups and highly cross-linked compared with conventional liners in young patients undergoing total hip replacement. J Bone Joint Surg Am 2015; 97:627-34. [PMID: 25878306 PMCID: PMC4391964 DOI: 10.2106/jbjs.n.00605] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Radiostereometric analysis provides highly precise measurements of component micromotion relative to the bone that is otherwise undetectable by routine radiographs. This study compared, at a minimum of five years following surgery, the micromotion of tantalum and titanium acetabular cups and femoral head penetration in highly cross-linked polyethylene liners and conventional (ultra-high molecular weight polyethylene) liners in active patients who had undergone total hip replacement. METHODS This institutional review board-approved prospective, randomized, blinded study involved forty-six patients. Patients were randomized into one of four cohorts according to both acetabular cup and polyethylene liner. Patients received either a cementless cup with a titanium mesh surface or a tantalum trabecular surface and either a highly cross-linked polyethylene liner or an ultra-high molecular weight polyethylene liner. Radiostereometric analysis examinations and Short Form-36 Physical Component Summary, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), University of California Los Angeles (UCLA) activity, and Harris hip scores were obtained preoperatively, postoperatively, at six months, and annually thereafter. RESULTS All patients had significant improvement (p < 0.05) in Short Form-36 Physical Component Summary, WOMAC, UCLA activity, and Harris hip scores postoperatively. On radiostereometric analysis examination, highly cross-linked polyethylene liners showed significantly less median femoral head penetration at five years (p < 0.05). Steady-state wear rates from one year to five years were 0.04 mm per year for ultra-high molecular weight polyethylene liners and 0.004 mm per year for highly cross-linked polyethylene liners. At the five-year follow-up, the median migration (and standard error) was 0.05 ± 0.20 mm proximally for titanium cups and 0.21 ± 0.05 mm for tantalum cups. CONCLUSIONS In this young population who had undergone total hip replacement, radiostereometric analysis showed significantly less femoral head penetration in the highly cross-linked polyethylene liners compared with that in the conventional ultra-high molecular weight polyethylene liners. Penetration rates were one order of magnitude less in highly cross-linked polyethylene liners compared with ultra-high molecular weight polyethylene liners. There was no significant difference in proximal migration between the tantalum and titanium acetabular cups through the five-year follow-up (p > 0.19).
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Affiliation(s)
- David C. Ayers
- Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Medical School, UMass Memorial Health Care, 55 Lake Avenue North, Worcester, MA 01655. E-mail address for D. Ayers:
| | - Meridith Greene
- The Harris Orthopaedic Laboratory, Massachusetts General Hospital, 55 Fruit Street, GRJ 1126, Boston, MA 02114
| | - Benjamin Snyder
- Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Medical School, UMass Memorial Health Care, 55 Lake Avenue North, Worcester, MA 01655. E-mail address for D. Ayers:
| | - Michelle Aubin
- Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Medical School, UMass Memorial Health Care, 55 Lake Avenue North, Worcester, MA 01655. E-mail address for D. Ayers:
| | - Jacob Drew
- Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Medical School, UMass Memorial Health Care, 55 Lake Avenue North, Worcester, MA 01655. E-mail address for D. Ayers:
| | - Charles Bragdon
- The Harris Orthopaedic Laboratory, Massachusetts General Hospital, 55 Fruit Street, GRJ 1126, Boston, MA 02114
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Kamada T, Mashima N, Nakashima Y, Imai H, Takeba J, Miura H. Mid-term clinical and radiographic outcomes of porous tantalum modular acetabular components for hip dysplasia. J Arthroplasty 2015; 30:607-10. [PMID: 25443360 DOI: 10.1016/j.arth.2014.11.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Revised: 10/15/2014] [Accepted: 11/01/2014] [Indexed: 02/01/2023] Open
Abstract
It is still challenging to perform successful cementless cup fixation during total hip arthroplasty for hip dysplasia. In this multicenter study we evaluated the clinical results of porous tantalum modular acetabular cups (TM cups) in 45 dysplastic hips with a mean follow-up period of 9.8 years. The mean Japanese Orthopaedic Association hip score improved from 48.2 preoperatively to 92.1 at the most recent follow-up. All of the cups were radiographically stable with no evidence of progressive radiolucencies or osteolysis regardless of bone grafting. Sixteen hips with bone grafts showed the integration of grafted bone without any radiolucencies. There were no revisions of TM cups. The use of TM cups for dysplastic hips provided satisfactory 10-year clinical and radiographic results.
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Affiliation(s)
- Tomomi Kamada
- Department of Bone and Joint Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, Japan
| | - Naohiko Mashima
- Department of Bone and Joint Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Kyushu University School of Medicine, 1-3-3 Maidashi, Higashi-ku, Fukuoka, Japan
| | - Hiroshi Imai
- Department of Bone and Joint Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, Japan
| | - Jun Takeba
- Department of Bone and Joint Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, Japan
| | - Hiromasa Miura
- Department of Bone and Joint Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, Japan
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Mas-Moruno C, Garrido B, Rodriguez D, Ruperez E, Gil FJ. Biofunctionalization strategies on tantalum-based materials for osseointegrative applications. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2015; 26:109. [PMID: 25665847 PMCID: PMC4323513 DOI: 10.1007/s10856-015-5445-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 11/24/2014] [Indexed: 06/04/2023]
Abstract
The use of tantalum as biomaterial for orthopedic applications is gaining considerable attention in the clinical practice because it presents an excellent chemical stability, body fluid resistance, biocompatibility, and it is more osteoconductive than titanium or cobalt-chromium alloys. Nonetheless, metallic biomaterials are commonly bioinert and may not provide fast and long-lasting interactions with surrounding tissues. The use of short cell adhesive peptides derived from the extracellular matrix has shown to improve cell adhesion and accelerate the implant's biointegration in vivo. However, this strategy has been rarely applied to tantalum materials. In this work, we have studied two immobilization strategies (physical adsorption and covalent binding via silanization) to functionalize tantalum surfaces with a cell adhesive RGD peptide. Surfaces were used untreated or activated with either HNO3 or UV/ozone treatments. The process of biofunctionalization was characterized by means of physicochemical and biological methods. Physisorption of the RGD peptide on control and HNO3-treated tantalum surfaces significantly enhanced the attachment and spreading of osteoblast-like cells; however, no effect on cell adhesion was observed in ozone-treated samples. This effect was attributed to the inefficient binding of the peptide on these highly hydrophilic surfaces, as evidenced by contact angle measurements and X-ray photoelectron spectroscopy. In contrast, activation of tantalum with UV/ozone proved to be the most efficient method to support silanization and subsequent peptide attachment, displaying the highest values of cell adhesion. This study demonstrates that both physical adsorption and silanization are feasible methods to immobilize peptides onto tantalum-based materials, providing them with superior bioactivity.
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Affiliation(s)
- Carlos Mas-Moruno
- Biomaterials, Biomechanics and Tissue Engineering Group, Department of Materials Science and Metallurgical Engineering, Technical University of Catalonia (UPC), ETSEIB, Av. Diagonal 647, 08028, Barcelona, Spain,
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Liu Y, Bao C, Wismeijer D, Wu G. The physicochemical/biological properties of porous tantalum and the potential surface modification techniques to improve its clinical application in dental implantology. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2015; 49:323-329. [PMID: 25686956 DOI: 10.1016/j.msec.2015.01.007] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Revised: 12/11/2014] [Accepted: 01/04/2015] [Indexed: 02/05/2023]
Abstract
More rapid restoration and more rigid functionality have been pursued for decades in the field of dental implantology. Under such motivation, porous tantalum has been recently introduced to design a novel type of dental implant. Porous tantalum bears interconnected porous structure with pore size ranging from 300 to 600μm and a porosity of 75-85%. Its elastic modulus (1.3-10GPa) more closely approximates that of natural cortical (12-18GPa) and cancellous bone (0.1-0.5GPa) in comparison with the most commonly used dental materials, such as titanium and titanium alloy (106-115GPa). Porous tantalum is highly corrosion-resistant and biocompatible. It can significantly enhance the proliferation and differentiation of primary osteoblasts derived from elderly people than titanium. Porous tantalum can allow bone ingrowth and establish not only osseointegration but also osseoincorporation, which will significantly enhance the secondary stability of implants in bone tissue. In this review, we summarize the physicochemical, mechanical and biological properties of porous tantalum. We further discuss the performance of current tantalum dental implants and present the methodologies of surface modifications in order to improve their biological performance.
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Affiliation(s)
- Yindong Liu
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Chongyun Bao
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
| | - Daniel Wismeijer
- Department of Oral Implantology and Prosthetic Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), MOVE Research Institute Amsterdam, VU University Amsterdam and University of Amsterdam, Amsterdam, The Netherlands
| | - Gang Wu
- Department of Oral Implantology and Prosthetic Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), MOVE Research Institute Amsterdam, VU University Amsterdam and University of Amsterdam, Amsterdam, The Netherlands.
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Takazawa M, Nakamura J, Abe I, Ohtori S, Watanabe A, Sato Y, Sasho T, Orita S, Suzuki M, Motoori K, Masuda Y, Takahashi K, Kishida S. Predictive factors for acetabular labral lesions in osteoarthritis of the hip with radial magnetic resonance imaging – A cross-sectional study. Mod Rheumatol 2014; 24:974-9. [DOI: 10.3109/14397595.2014.886542] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Results at a minimum of 10 years of follow-up for AMS and PerFix HA-coated cementless total hip arthroplasty: impact of cross-linked polyethylene on implant longevity. J Orthop Sci 2013; 18:962-8. [PMID: 23963589 DOI: 10.1007/s00776-013-0456-4] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 07/30/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE The purpose of this study was to report results at a minimum of 10 years for hydroxyapatite (HA) coating on the titanium arc-sprayed cementless total hip arthroplasty (THA) and to evaluate the impact of cross-linked polyethylene (XLPE) on implant longevity. METHODS A total of 131 consecutive primary THAs in 123 patients using an AMS acetabular cup and a PerFix HA stem were retrospectively reviewed. Conventional PE was used for 62 hips (CPE group) and cross-linked PE for 69 hips (XLPE group), with mean follow-up periods of 13 and 11.5 years, respectively. These patients were reviewed using the Japanese Orthopaedic Association (JOA) Hip Score and evaluated in terms of PE wear, osteolysis, and implant survival. RESULTS The JOA score improved from 42.6 to 83.9 points at the final follow-up. The mean wear rate of 0.12 mm/year in the CPE group was significantly greater than that of XLPE at 0.007 mm/year. In the CPE group, ten (16.1 %) and two (3.2 %) hips, respectively, underwent PE exchange due to severe wear and acetabular revision due to loosening associated with osteolysis. Three patients had revision in the XLPE group: one cup for aseptic loosening, one PE for recurrent dislocation, and one stem for neck fracture. No evident osteolysis was seen in the XLPE group. Kaplan-Meier survivorship with any revision as the end point shows that the 12-year survival rate was 97.7 % for cups, 93.8 % for PE liners, and 99.2 % for stems. Multivariate analysis revealed that the use of XLPE significantly reduced the risk of revision, with the odds ratio (OR) of 4.3. CONCLUSIONS AMS and PerFix HA components in this series show excellent implant fixation; however, high rates of PE wear and subsequent osteolysis were limiting factors in long-term success. Low wear rates with XLPE suggest improved implant longevity.
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