1
|
Marin E. Forged to heal: The role of metallic cellular solids in bone tissue engineering. Mater Today Bio 2023; 23:100777. [PMID: 37727867 PMCID: PMC10506110 DOI: 10.1016/j.mtbio.2023.100777] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/21/2023] [Accepted: 08/23/2023] [Indexed: 09/21/2023] Open
Abstract
Metallic cellular solids, made of biocompatible alloys like titanium, stainless steel, or cobalt-chromium, have gained attention for their mechanical strength, reliability, and biocompatibility. These three-dimensional structures provide support and aid tissue regeneration in orthopedic implants, cardiovascular stents, and other tissue engineering cellular solids. The design and material chemistry of metallic cellular solids play crucial roles in their performance: factors such as porosity, pore size, and surface roughness influence nutrient transport, cell attachment, and mechanical stability, while their microstructure imparts strength, durability and flexibility. Various techniques, including additive manufacturing and conventional fabrication methods, are utilized for producing metallic biomedical cellular solids, each offering distinct advantages and drawbacks that must be considered for optimal design and manufacturing. The combination of mechanical properties and biocompatibility makes metallic cellular solids superior to their ceramic and polymeric counterparts in most load bearing applications, in particular under cyclic fatigue conditions, and more in general in application that require long term reliability. Although challenges remain, such as reducing the production times and the associated costs or increasing the array of available materials, metallic cellular solids showed excellent long-term reliability, with high survival rates even in long term follow-ups.
Collapse
Affiliation(s)
- Elia Marin
- Ceramic Physics Laboratory, Kyoto Institute of Technology, Sakyo-ku, Matsugasaki, 606-8585, Kyoto, Japan
- Department of Dental Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, 602-8566, Japan
- Department Polytechnic of Engineering and Architecture, University of Udine, 33100, Udine, Italy
- Biomedical Research Center, Kyoto Institute of Technology, Sakyo-ku, Matsugasaki, Kyoto, 606-8585, Japan
| |
Collapse
|
2
|
Won H, Baek SH, Kim J, Lee WK, Lee YS, Kim SY. Average 22-Year Results of Total Hip Arthroplasty Using Harris-Galante Prosthesis in Patients under 50 Years. Clin Orthop Surg 2022; 14:335-343. [PMID: 36061837 PMCID: PMC9393279 DOI: 10.4055/cios21176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 11/18/2021] [Accepted: 12/31/2021] [Indexed: 11/06/2022] Open
Abstract
Background The Harris-Galante (HG) prosthesis is a first-generation, cementless total hip arthroplasty (THA) prosthesis. Considering the recent increase in the demand for THA in young patients and their life expectancy, a study with a follow-up duration of longer than 20 years in a young population is needed. Therefore, we evaluated the long-term clinical and radiographic results after cementless THA using the HG prosthesis in patients younger than 50 years. Methods A total of 61 THAs performed using the HG with a minimum follow-up of 10 years were included. There were 38 men and 11 women with an average age of 46 years and the mean follow-up duration was 22 years. Clinical evaluation included modified Harris Hip Score (HHS) and radiographic analysis consisted of cup inclination, anteversion angle, component stability, osteolysis, liner wear rate, wear-through, liner dissociation, and heterotopic ossification. Complications included recurrent dislocation, periprosthetic femoral fracture, and periprosthetic joint infection. Survivorship analysis included cup and stem revision for aseptic loosening, as well as any revision. Results The HHS improved from 46.5 preoperatively to 81.8 postoperatively (p < 0.001). The average linear wear rate was 0.36 mm/yr. A total of 34 hips (56%) were revised: stem revision in 10 (16.4%), cup revision in 9 (14.8%), exchange limited to bearing surface in 8 (13.1%), and revision of all components in 7 (11.5%). Estimated survivorship at 34 years postoperatively was 90.9% for cup revision for aseptic loosening, 80.5% for stem revision for aseptic loosening, and 22.1% for any revision. Conclusions THA using the HG prosthesis showed satisfactory estimated survivorship of the acetabular and femoral components at 34 years postoperatively with good clinical outcomes. Bearing-related problems, such as osteolysis and liner dissociation, accounted for 56% of revision operations and were concerns in patients younger than 50 years.
Collapse
Affiliation(s)
- Heejae Won
- Department of Orthopedic Surgery, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Seung-Hoon Baek
- Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, Korea
- Department of Orthopedic Surgery, Kyungpook National University School of Medicine, Daegu, Korea
| | - Junekyu Kim
- Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Won Kee Lee
- Department of Medical Statistics, Kyungpook National University, Daegu, Korea
| | - Yeon Soo Lee
- Department of Biomedical Engineering, College of Medical Science, Catholic University of Daegu, Gyeongsan, Korea
| | - Shin-Yoon Kim
- Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, Korea
- Department of Orthopedic Surgery, Kyungpook National University School of Medicine, Daegu, Korea
| |
Collapse
|
3
|
Prosthetic femoral head erosion through an acetabular component treated with revision and implant preservation. Arthroplast Today 2020; 6:9-13. [PMID: 32211468 PMCID: PMC7083747 DOI: 10.1016/j.artd.2019.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 12/03/2019] [Accepted: 12/05/2019] [Indexed: 11/20/2022] Open
Abstract
We present a case report of the rare complication of a femoral head prosthesis eroding through the acetabular liner and shell resulting in a clinical presentation of pseudo-dislocation. The patient presented with a 1-month history of progressive anterior and peritrochanteric hip pain without antecedent trauma. Radiographs demonstrated presumed hip dislocation with superior-posterior superimposition of the femoral head over the acetabular component. The patient underwent revision total hip arthroplasty with intraoperative evidence of extensive metallosis, osteolysis, and femoral head erosion through the acetabular polyethylene liner, acetabular shell, and implantation into the ilium. The femoral stem and acetabular shell were well-fixed, allowing for filling of the defect with bone void filler and cementation of a new polyethylene liner into the acetabular shell.
Collapse
|
4
|
Jacquot L, Bonnin MP, Machenaud A, Chouteau J, Saffarini M, Vidalain JP. Clinical and Radiographic Outcomes at 25-30 Years of a Hip Stem Fully Coated With Hydroxylapatite. J Arthroplasty 2018; 33:482-490. [PMID: 29066107 DOI: 10.1016/j.arth.2017.09.040] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 09/12/2017] [Accepted: 09/15/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Little is known about the survival of total hip arthroplasty implants with bioactive coatings beyond the first 20 years. The authors aimed to report survival of a tapered hip stem fully coated with hydroxylapatite (HA) at follow-up of 25-30 years. METHODS Of the original series of 320 patients (347 hips), 12 patients (12 hips) had stem and cup revisions, 54 patients (55 hips) had cup revisions, 17 patients (17 hips) had liner exchange. A total of 207 patients (225 hips) died with stems in place and 21 patients (24 hips) could not be reached. This left a cohort of 80 patients (86 hips) with their original stem for assessment. Survival was analyzed using the Kaplan-Meier (KM) method and cumulative incidence function (CIF). RESULTS Considering stem revision as endpoint, the revision risk calculated using the KM method was 6.3%, whereas using the CIF it was 3.7%. Considering any reoperation as endpoint, the revision risk calculated using the KM method was 41.2%, whereas using the CIF it was 25.9%. The Harris Hip Score for 77 patients (18 hips) was 81.6 ± 15.2. Standard x-rays were available for 52 hips (49 patients), and 10 (19.2%) showed radiolucencies <2 mm thick. CONCLUSION This study is the first to report outcomes of an HA-coated stem beyond 25 years. The survival of stem compares favorably with long-term survival of the Charnley cemented stem, and with shorter-term registry studies. The stem achieved its intended purpose of total osteointegration in the long-term, although the proximolateral region remains susceptible to radiolucencies.
Collapse
Affiliation(s)
- Laurent Jacquot
- Artro Institute, Annecy Le Vieux, France; Department of Orthopaedic Surgery, Clinique d'Argonay, Centre Le Périclès, Annecy, France
| | - Michel P Bonnin
- Artro Institute, Annecy Le Vieux, France; Ramsay Générale de Santé, Centre Orthopédique Santy, Hôpital PrivéJean Mermoz, Lyon, France
| | - Alain Machenaud
- Artro Institute, Annecy Le Vieux, France; Department of Orthopaedic Surgery, Clinique d'Argonay, Centre Le Périclès, Annecy, France
| | - Julien Chouteau
- Artro Institute, Annecy Le Vieux, France; Department of Orthopaedic Surgery, Clinique d'Argonay, Centre Le Périclès, Annecy, France
| | | | - Jean-Pierre Vidalain
- Artro Institute, Annecy Le Vieux, France; Department of Orthopaedic Surgery, Clinique d'Argonay, Centre Le Périclès, Annecy, France
| |
Collapse
|
5
|
Gwynne-Jones DP, Lash HWR, James AW, Iosua EE, Matheson JA. The Morscher Press-Fit Acetabular Component: An Independent Long-Term Review at 18-22 Years. J Arthroplasty 2017; 32:2444-2449. [PMID: 28343828 DOI: 10.1016/j.arth.2017.02.052] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 01/31/2017] [Accepted: 02/20/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND There are relatively few 20-year results of uncemented acetabular components, and most of these are modular designs. This study reports the 20-year results of a monoblock press-fit acetabular component. METHODS A total of 122 total hip arthroplasties (111 patients) using the Morscher cup were reviewed at a mean of 19.7 years. The average age at implantation was 57.3 years (range, 36-74 years), and 81 (66%) were men. RESULTS Twenty-two patients (25 hips) had died. Seven hips were revised, including 5 acetabular revisions. Six patients (6 hips) declined to participate but were known not to have been revised. The mean Oxford hip score was 41.1 (range, 22-48), and the mean reduced Western Ontario and McMaster Universities Osteoarthritis Index score was 5.7/48 (range, 0-24). Eccentric wear was seen in 13 (15.7%) and major osteolysis in 14 (17%) of 82 surviving hips with radiographs. The all-cause revision rate was 0.32 per 100 observed component years (95% confidence interval [CI], 0.13-0.66). The 20-year Kaplan-Meier survival was 93.4% (CI, 86.6-96.8) for all-cause revisions, 95.5% (CI, 89.4-98.1) for any acetabular revision, and 97.1% (CI, 91.2-99.1) for acetabular aseptic loosening, wear, or osteolysis. CONCLUSION The Morscher acetabular component has continued to perform well at 20 years despite using conventional polyethylene with results that match or surpass other cementless acetabulae.
Collapse
Affiliation(s)
- David P Gwynne-Jones
- Department of Surgical Sciences, Orthopaedic Surgery, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand; Department of Orthopaedic Surgery, Dunedin Hospital, Southern District Health Board, Dunedin, New Zealand
| | - Heath W R Lash
- Department of Orthopaedic Surgery, Dunedin Hospital, Southern District Health Board, Dunedin, New Zealand
| | - Andrew W James
- Department of Orthopaedic Surgery, Dunedin Hospital, Southern District Health Board, Dunedin, New Zealand
| | - Ella E Iosua
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - John A Matheson
- Department of Orthopaedic Surgery, Dunedin Hospital, Southern District Health Board, Dunedin, New Zealand; Mercy Hospital, Dunedin, New Zealand
| |
Collapse
|
6
|
Miles B, Walter WL, Kolos E, Waters T, Appleyard R, Gillies RM, Donohoo S, Ruys AJ. A plasma-sprayed titanium proximal coating reduces the risk of periprosthetic femoral fracture in cementless hip arthroplasty. Biomed Mater Eng 2016; 25:267-78. [PMID: 26407113 DOI: 10.3233/bme-151279] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The design of femoral component used in total hip arthroplasty is known to influence the incidence of periprosthetic femoral fractures (PFFs) in cementless hip arthroplasty. OBJECTIVE This study was undertaken to determine if 2 potential changes to an existing ABG II-standard cementless implant - addition of a roughened titanium plasma-sprayed proximal coating (ABG II-plasma) and lack of medial scales (ABG II-NMS) could decrease the risk of PFF in the intraoperative and early postoperative periods. METHODS Six pairs of human cadaveric femurs were harvested and divided into 2 groups, each receiving either of the altered implants and ABG II-standard (control). Each implant was tested in a biomechanical setup in a single-legged stance orientation. Surface strains were measured in intact femurs, during implant insertion, cyclic loading of the bone with the implant, and loading to failure. Strains with the ABG II-standard and the altered implants were compared. FINDINGS ABG II-plasma showed better load-bearing capacity, with an average 42% greater failure load than that of ABG II-standard. The cortical hoop, axial and mean strains ABG II-plasma were less than those of ABG II-standard, demonstrating decreased tensile behaviour and better load transfer to the proximal femur. The final residual hoop strains in ABG II-plasma were closer to those of intact bone as compared to the standard stem. No differences in strains were observed between the standard stem and ABG II-NMS. CONCLUSION The increased load-bearing capacity and decreased proximal surface strains on femurs implanted with ABG II-plasma stem should reduce the risks of intraoperative and early postoperative PFF.
Collapse
Affiliation(s)
- Brad Miles
- Biomedical Engineering, AMME, University of Sydney, Sydney, NSW, Australia
| | | | - Elizabeth Kolos
- Biomedical Engineering, AMME, University of Sydney, Sydney, NSW, Australia
| | - Tim Waters
- Specialist Orthopedic Group, Sydney, NSW, Australia
| | - Richard Appleyard
- The Australian School of Advanced Medicine, Macquarie University, Sydney, NSW, Australia
| | - R Mark Gillies
- Medical Device Research Australia, Sydney, NSW, Australia.,Murray Maxwell Biomechanics Laboratory, Kolling Institute, Sydney University, Sydney, NSW, Australia
| | - Shane Donohoo
- WorelyParsons Advanced Analysis, Sydney, NSW, Australia
| | - Andrew J Ruys
- Biomedical Engineering, AMME, University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
7
|
Kawamura H, Mishima H, Sugaya H, Nishino T, Shimizu Y, Miyakawa S. The 21- to 27-year results of the Harris-Galante cementless total hip arthroplasty. J Orthop Sci 2016; 21:342-7. [PMID: 26970833 DOI: 10.1016/j.jos.2016.02.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 01/03/2016] [Accepted: 02/09/2016] [Indexed: 02/09/2023]
Abstract
BACKGROUND The Harris-Galante total hip arthroplasty (THA) is a first-generation cementless THA with a porous coating for biological fixation of the implant. Many studies report excellent long-term results for the acetabular cup, but few long-term studies exist for the femoral stem because of relatively poor short-term and midterm results. Here we present the 21- to 27-year results of the cup and the stem of the Harris-Galante THA. METHODS From 1985 to 1991, 102 Harris-Galante THAs were inserted in 82 patients. At the time of the THA, the mean patient age was 54 years (range, 20-78 years). The primary diagnosis was secondary osteoarthritis due to developmental hip dysplasia (69 [68%] hips). The Japanese Orthopaedic Association (JOA) hip score and thigh pain were measures of clinical outcome. Radiographic review was performed retrospectively. Implant survival was evaluated by Kaplan-Meier analysis. RESULTS Of 102 hips, 35 hips were from 31 deceased patients, 5 patients (6 hips) were lost to follow-up, 12 hips were revised, and 49 hips were from patients living at the latest follow-up. Among the living patients, 36 hips had a clinical evaluation and 42 hips had a radiograph obtained more than 21 years. The JOA hip score improved from 42 points preoperatively to 83.5 points at the latest follow-up. Thigh pain was reported in 13 hips. One cup and four stems were loose at the latest radiographic review. Most cup revisions were related to acetabular osteolysis. Fifteen hips showed severe stress shielding. Kaplan-Meier analysis of survivorship with any revision, acetabular reoperation, stem revision, and stem loosening as the end point was 87.0%, 90.3%, 95.7% and 86.4%, respectively, at 24.6 years. CONCLUSIONS Long-term implant survival and clinical results of the Harris-Galante THA were good. Acetabular osteolysis-related cup loosening was a problem of the cup. Loosening, thigh pain, and stress shielding were problems of the stem.
Collapse
Affiliation(s)
- Haruo Kawamura
- Department of Orthopaedic Surgery, Tsukuba University Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki 305-8576, Japan.
| | - Hajime Mishima
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
| | - Hisashi Sugaya
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
| | - Tomofumi Nishino
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
| | - Yukiyo Shimizu
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
| | - Shumpei Miyakawa
- Faculty of Health and Sports Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8574, Japan.
| |
Collapse
|
8
|
Erivan R, Villatte G, Khelif YR, Pereira B, Galvin M, Descamps S, Boisgard S. The Müller self-locking cemented total hip prosthesis with polyethylene liner: After twenty years, what did they become? INTERNATIONAL ORTHOPAEDICS 2016; 41:47-54. [DOI: 10.1007/s00264-016-3191-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 03/31/2016] [Indexed: 11/29/2022]
|
9
|
Abstract
Avascular necrosis (AVN) of the hip may have extensive involvement of the proximal femur which may affect boney ingrowth into cementless femoral stems. From 1994 to 2004, 182 total hip arthroplasties (in 144 patients, 117 AVN hips and 65 non-AVN hips) were performed using hydroxyapatite coated femoral stems. All patients were followed up prospectively. Mean age was 51 years and mean follow-up 14.7 years (range 9.7-19.1 years). Four stems were revised because of aseptic loosening, 3 in AVN group and 1 in non-AVN group. The overall mechanical failure rate was 2.2%, the mechanical failure rate in AVN and non-AVN group was 2.6% and 1.5% respectively (p = 1). The 19.1 year survival using revision for aseptic loosening as an endpoint for AVN and non-AVN patients were 97.1% and 96.2% respectively (p = 0.654). Stable boney ingrowth was present in 99.5% hips. This study represents 1 of the largest series reporting the long-term follow-up of the use of cementless femoral stems in treating AVN of the hip. We report excellent long-term survival of cementless total hip arthroplasty used in managing AVN of the hip and is comparable to that seen in non-AVN total hip arthroplasty.
Collapse
|
10
|
Tan TL, Le Duff MJ, Ebramzadeh E, Bhaurla SK, Amstutz HC. Long-Term Outcomes of Liner Cementation into a Stable Retained Shell: A Concise Follow-up of a Previous Report. J Bone Joint Surg Am 2015; 97:920-4. [PMID: 26041853 DOI: 10.2106/jbjs.n.01045] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
UNLABELLED Liner cementation into a preexisting stable socket may reduce the morbidity of revision hip arthroplasty and preserve acetabular bone. However, the long-term outcomes of this technique remain unknown. The purpose of this report was to analyze the long-term results of a previously reported cohort of patients. Cementation of thirty-two liners (seventeen polyethylene and fifteen metal liners) into preexisting sockets was performed during revision hip arthroplasty, and the patients were followed for a minimum of two years. A retrospective chart review was performed to investigate the complications and survivorship. The mean duration of follow-up was 12.7 years (range, 2.1 to 19.1 years), with ten hips requiring rerevision at a mean of 6.4 years (range, 1.0 to 15.5 years). Nine patients experienced posterior dislocations, and two hips required rerevision for instability. Liner dissociation from the shell occurred in two patients. Survivorship analysis, with rerevision as the end point, demonstrated ten and fifteen-year survivorship of 77.3% and 68.8%, respectively. Dissociation of the cemented liner from the acetabular shell was an infrequent cause of failure despite long-term follow-up. Given the high rate of dislocations in this study, careful patient selection and surgical technique should be considered. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Timothy L Tan
- The J. Vernon Luck, Sr., M.D. Orthopaedic Research Center, Orthopaedic Institute for Children and UCLA Department of Orthopaedic Surgery, 403 West Adams Boulevard, Los Angeles, CA 90007
| | - Michel J Le Duff
- Joint Replacement Institute at St. Vincent Medical Center, 2200 West Third Street, Suite 400, Los Angeles, CA 90057. E-mail address for H.C. Amstutz:
| | - Edward Ebramzadeh
- The J. Vernon Luck, Sr., M.D. Orthopaedic Research Center, Orthopaedic Institute for Children and UCLA Department of Orthopaedic Surgery, 403 West Adams Boulevard, Los Angeles, CA 90007
| | - Sandeep K Bhaurla
- Joint Replacement Institute at St. Vincent Medical Center, 2200 West Third Street, Suite 400, Los Angeles, CA 90057. E-mail address for H.C. Amstutz:
| | - Harlan C Amstutz
- Joint Replacement Institute at St. Vincent Medical Center, 2200 West Third Street, Suite 400, Los Angeles, CA 90057. E-mail address for H.C. Amstutz:
| |
Collapse
|
11
|
Marshall DA, Pykerman K, Werle J, Lorenzetti D, Wasylak T, Noseworthy T, Dick DA, O'Connor G, Sundaram A, Heintzbergen S, Frank C. Hip resurfacing versus total hip arthroplasty: a systematic review comparing standardized outcomes. Clin Orthop Relat Res 2014; 472:2217-30. [PMID: 24700446 PMCID: PMC4048407 DOI: 10.1007/s11999-014-3556-3] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 02/25/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND Metal-on-metal hip resurfacing was developed for younger, active patients as an alternative to THA, but it remains controversial. Study heterogeneity, inconsistent outcome definitions, and unstandardized outcome measures challenge our ability to compare arthroplasty outcomes studies. QUESTIONS/PURPOSES We asked how early revisions or reoperations (within 5 years of surgery) and overall revisions, adverse events, and postoperative component malalignment compare among studies of metal-on-metal hip resurfacing with THA among patients with hip osteoarthritis. Secondarily, we compared the revision frequency identified in the systematic review with revisions reported in four major joint replacement registries. METHODS We conducted a systematic review of English language studies published after 1996. Adverse events of interest included rates of early failure, time to revision, revision, reoperation, dislocation, infection/sepsis, femoral neck fracture, mortality, and postoperative component alignment. Revision rates were compared with those from four national joint replacement registries. Results were reported as adverse event rates per 1000 person-years stratified by device market status (in use and discontinued). Comparisons between event rates of metal-on-metal hip resurfacing and THA are made using a quasilikelihood generalized linear model. We identified 7421 abstracts, screened and reviewed 384 full-text articles, and included 236. The most common study designs were prospective cohort studies (46.6%; n = 110) and retrospective studies (36%; n = 85). Few randomized controlled trials were included (7.2%; n = 17). RESULTS The average time to revision was 3.0 years for metal-on-metal hip resurfacing (95% CI, 2.95-3.1) versus 7.8 for THA (95% CI, 7.2-8.3). For all devices, revisions and reoperations were more frequent with metal-on-metal hip resurfacing than THA based on point estimates and CIs: 10.7 (95% CI, 10.1-11.3) versus 7.1 (95% CI, 6.7-7.6; p = 0.068), and 7.9 (95% CI, 5.4-11.3) versus 1.8 (95% CI, 1.3-2.2; p = 0.084) per 1000 person-years, respectively. This difference was consistent with three of four national joint replacement registries, but overall national joint replacement registries revision rates were lower than those reported in the literature. Dislocations were more frequent with THA than metal-on-metal hip resurfacing: 4.4 (95% CI, 4.2-4.6) versus 0.9 (95% CI, 0.6-1.2; p = 0.008) per 1000 person-years, respectively. Adverse event rates change when discontinued devices were included. CONCLUSIONS Revisions and reoperations are more frequent and occur earlier with metal-on-metal hip resurfacing, except when discontinued devices are removed from the analyses. Results from the literature may be misleading without consistent definitions, standardized outcome metrics, and accounting for device market status. This is important when clinicians are assessing and communicating patient risk and when selecting which device is most appropriate for individual patients.
Collapse
Affiliation(s)
- Deborah A Marshall
- Department of Community Health Sciences, University of Calgary, Health Research Innovation Centre, Calgary, AB, Canada,
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Tan TL, Ebramzadeh E, Campbell PA, Al-Hamad M, Amstutz HC. Long-term outcome of a metal-on-polyethylene cementless hip resurfacing. J Arthroplasty 2014; 29:802-7. [PMID: 24090660 DOI: 10.1016/j.arth.2013.08.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 07/30/2013] [Accepted: 08/16/2013] [Indexed: 02/01/2023] Open
Abstract
Due to the well-documented problems surrounding metal-on-metal bearings, the use of hip resurfacing has declined. Since the potential benefits of hip resurfacing remain desirable, it may be beneficial to investigate the long-term outcome of hip resurfacings using metal-on-polyethylene in the 1980's. We report the long-term survivorship and modes of failure of a cementless metal-on-polyethylene resurfacing (n = 178) with different porous ingrowth surfaces. While acetabular loosening was absent, a high incidence of femoral failures (femoral loosening = 18.1%, osteolytic neck fracture = 21%) occurred despite using the same ingrowth surface for both components. Ongoing developments using the lessons learned from these previous generation components and utilizing modern low wear materials, e.g., cross-linked polyethylene, may lead to improved implants for future hip resurfacings.
Collapse
Affiliation(s)
- Timothy L Tan
- David Geffen School of Medicine, University of California, Los Angeles; J. Vernon Luck, Sr., MD Orthopaedic Research Center at Los Angeles Orthopaedic Hospital, in Alliance with UCLA Department of Orthopaedic Surgery
| | - Edward Ebramzadeh
- J. Vernon Luck, Sr., MD Orthopaedic Research Center at Los Angeles Orthopaedic Hospital, in Alliance with UCLA Department of Orthopaedic Surgery
| | - Patricia A Campbell
- J. Vernon Luck, Sr., MD Orthopaedic Research Center at Los Angeles Orthopaedic Hospital, in Alliance with UCLA Department of Orthopaedic Surgery
| | | | | |
Collapse
|
13
|
Streit MR, Innmann MM, Merle C, Bruckner T, Aldinger PR, Gotterbarm T. Long-term (20- to 25-year) results of an uncemented tapered titanium femoral component and factors affecting survivorship. Clin Orthop Relat Res 2013; 471:3262-9. [PMID: 23670671 PMCID: PMC3773148 DOI: 10.1007/s11999-013-3033-4] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 04/25/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Uncemented femoral components in primary total hip arthroplasty (THA) are commonly used today, but few studies have evaluated their survival into the third decade. QUESTIONS/PURPOSES We evaluated (1) survivorship using femoral revision for any reason as the end point; (2) survivorship using femoral revision for aseptic loosening as the end point; and (3) patient-related and surgical risk factors for aseptic stem loosening at a minimum 20-year followup with an uncemented tapered titanium stem. METHODS We reviewed the clinical and radiographic results of 354 THAs in 326 patients performed between January 1985 and December 1989 using an uncemented grit-blasted, tapered titanium femoral stem. Mean age at surgery was 57 years (range, 13-81 years). Kaplan-Meier survivorship analysis was used to estimate long-term survival. Minimum followup evaluation was 20 years (mean, 22 years; range, 20-25 years); at that time, 120 patients (127 hips) had died, and four patients (five hips) were lost to followup. Multivariate survival analysis using a Cox regression model was performed. RESULTS Survivorship at 22 years with revision of the femoral component for any reason as the end point was 86% (95% confidence interval [CI], 81%-90%). Survivorship for femoral revision for aseptic loosening as the end point was 93% at 22 years (95% CI, 90%-96%). Undersized stems (canal fill index≤80%) and stems in hips with cup revision were at higher risk for aseptic loosening (hazard ratio, 4.2 and 4.3, respectively). There was a high rate of acetabular revision in this series (38%), mostly related to smooth-threaded, cementless sockets. CONCLUSIONS Uncemented femoral fixation was reliable into the third decade. Age, male sex, and diagnosis were not associated with a higher risk of aseptic loosening. LEVEL OF EVIDENCE Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Marcus R. Streit
- />Department of Orthopaedic and Trauma Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany
| | - Moritz M. Innmann
- />Department of Orthopaedic and Trauma Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany
| | - Christian Merle
- />Department of Orthopaedic and Trauma Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany
| | - Thomas Bruckner
- />Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Peter R. Aldinger
- />Department of Orthopaedic and Trauma Surgery, Orthopädische Klinik Paulinenhilfe, Stuttgart, Germany
| | - Tobias Gotterbarm
- />Department of Orthopaedic and Trauma Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany
| |
Collapse
|
14
|
Schwarzkopf R, Olivieri P, Jaffe WL. Simultaneous bilateral total hip arthroplasty with hydroxyapatite-coated implants: a 20-year follow-up. J Arthroplasty 2012; 27:1364-9. [PMID: 22177794 DOI: 10.1016/j.arth.2011.10.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Accepted: 10/24/2011] [Indexed: 02/01/2023] Open
Abstract
Bilateral hip arthroplasty has been reported to be a safe and effective way to treat bilateral hip arthritis in a selective group of patients. We report a follow-up of 30 patients who underwent simultaneous bilateral total hip arthroplasty with hydroxyapatite implants and were followed for an average of 19.4 years. Patients had an average Harris Hip Score of 90 at the latest follow-up (range, 78-99). The average Western Ontario and McMaster Universities Arthritis Index questionnaire index score was 12 (range, 0-41), with high functional results on the 12-Item Short Form Health Survey (SF-12) and Oxford 12 questioners. Using the Kaplan-Meier survivorship analysis, with revision for any reason as an end point, survivorship was 94% at 12 years, 88% at 15 years, 74% at 18 years, and 61% at 23 years. All revisions were for the acetabular component, and the survivorship for the femoral component was 100% throughout the 23-year period. We conclude that bilateral uncemented total hip arthroplasty can provide satisfactory long-term clinical, radiological, and functional outcomes in patients even with older-generation polyethylene liners and stem designs.
Collapse
Affiliation(s)
- Ran Schwarzkopf
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, USA
| | | | | |
Collapse
|