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Boccaccio A. A mechano-regulation model to design and optimize the surface microgeometry of titanium textured devices for biomedical applications. J Mech Behav Biomed Mater 2024; 157:106645. [PMID: 38963999 DOI: 10.1016/j.jmbbm.2024.106645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 06/20/2024] [Accepted: 06/29/2024] [Indexed: 07/06/2024]
Abstract
In a technological context where, thanks to the additive manufacturing techniques, even sophisticated geometries as well as surfaces with specific micrometric features can be realized, we propose a mechano-regulation algorithm to determine the optimal microgeometric parameters of the surface of textured titanium devices for biomedical applications. A poroelastic finite element model was developed including a portion of bone, a portion of a textured titanium device and a layer of granulation tissue separating the bone from the device and occupying the space between them. The algorithm, implemented in the Matlab environment, determines the optimal values of the root mean square and the correlation length that the device surface must possess to maximize bone formation in the gap between the bone and the device. For low levels of compression load acting on the bone, the algorithm predicts low values of root mean square and high values of correlation length. Conversely, high levels of load require high values of root mean square and low values of correlation length. The optimal microgeometrical parameters were determined for various thickness values of the granulation tissue layer. Interestingly, the predictions of the proposed computational model are consistent with the experimental results reported in the literature. The proposed algorithm shows promise as a valuable tool for addressing the demands of precision medicine. In this approach, the device or prosthesis is no longer designed solely based on statistical averages but is tailored to each patient's unique anthropometric characteristics, as well as considerations related to their metabolism, sex, age, and more.
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Affiliation(s)
- Antonio Boccaccio
- Dipartimento di Meccanica, Matematica e Management, Politecnico di Bari, Bari, Italy.
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Zhao L, Uchtman M, Aretakis A, Selberg C, McCarthy JJ, Whitlock PW. Maintenance of acetabular correction following PAO: a multicenter study comparing stainless-steel and titanium screws. J Hip Preserv Surg 2024; 11:140-143. [PMID: 39070209 PMCID: PMC11272636 DOI: 10.1093/jhps/hnae008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/10/2024] [Accepted: 02/13/2024] [Indexed: 07/30/2024] Open
Abstract
Stainless-steel screws are commonly used for fragment fixation during periacetabular osteotomy (PAO) at our institutions. Titanium is reserved for patients with documented nickel allergies. Titanium screws possess a significantly lower Young's modulus than stainless steel and, therefore, potentially less resistance to physiologic loading. Thus, we hypothesized that the use of titanium screws might be associated with changes in acetabular correction prior to healing. The aim of this study was to compare the maintenance of acetabular correction following PAO using stainless-steel or titanium screws. A documented nickel allergy was confirmed with an allergy specialist. Patients' age at surgery, gender and BMI were collected. The lateral center-edge angle of Wiberg (LCEA), medial center-edge angle (MCEA), anterior wall index (AWI), posterior wall index (PWI) and Tönnis angle were measured. The delta value for radiographic parameters was calculated as the difference between values immediately post-operation and at 6 months post-operation. Only age at surgery (P < 0.001) and the pre-operative LCEA (P = 0.013) were significantly different between groups (Tables I and II). The remaining pre- and post-operative radiological measurements were similar (Table II). Comparison of delta values at 6 months follow-up indicated no significant differences between screw types (Table III). No patients in the titanium group had a trans-iliac retrograde screw included in their construct (P = 0.003). All patients healed from their osteotomies. The use of titanium screws in patients with an allergy to nickel was not associated with differences in acetabular correction or the rate of osseous union rates despite its lower inherent mechanical properties.
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Affiliation(s)
- Lei Zhao
- Division of Orthopaedic Surgery, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
- Department of Orthopaedic Surgery, College of Medicine, University of Cincinnati, 3230 Eden Avenue, Cincinnati, OH 45267, USA
| | - Molly Uchtman
- Division of Orthopaedic Surgery, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
- Department of Orthopaedic Surgery, College of Medicine, University of Cincinnati, 3230 Eden Avenue, Cincinnati, OH 45267, USA
| | - Alexander Aretakis
- Orthopaedics Institute, Children’s Hospital Colorado, 13123 E 16th Ave, Aurora, Aurora 80045, USA
| | - Courtney Selberg
- Orthopaedics Institute, Children’s Hospital Colorado, 13123 E 16th Ave, Aurora, Aurora 80045, USA
| | - James J McCarthy
- Division of Orthopaedic Surgery, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
- Department of Orthopaedic Surgery, College of Medicine, University of Cincinnati, 3230 Eden Avenue, Cincinnati, OH 45267, USA
| | - Patrick W Whitlock
- Division of Orthopaedic Surgery, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
- Department of Orthopaedic Surgery, College of Medicine, University of Cincinnati, 3230 Eden Avenue, Cincinnati, OH 45267, USA
- Department of Biomedical Engineering, University of Cincinnati, 2901 Woodside Drive, Cincinnati, OH 45219, USA
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Ohta Y, Sugama R, Minoda Y, Mizokawa S, Takahashi S, Ikebuchi M, Nakatsuchi T, Nakamura H. Highly Porous Titanium Cups Frequently Presenting with Radiolucent Lines in Cementless Primary Total Hip Arthroplasty: A Retrospective Cohort Study. J Clin Med 2024; 13:3297. [PMID: 38893007 PMCID: PMC11173321 DOI: 10.3390/jcm13113297] [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: 04/16/2024] [Revised: 05/30/2024] [Accepted: 06/01/2024] [Indexed: 06/21/2024] Open
Abstract
Background/Objectives: A highly porous titanium cup with a three-dimensional metal interface was recently introduced to improve biological fixation and survival. However, radiography has revealed concerns regarding these cups, despite their excellent short- and mid-term clinical outcomes. This study compared the clinical and radiographic results of a highly porous titanium cup with those of a hydroxyapatite-coated porous titanium cup after primary total hip arthroplasty (THA). Methods: Fifty-one primary THAs were investigated. A highly porous titanium cup was used in 17 hips, and a hydroxyapatite-coated porous titanium cup was used in 34 hips. No significant differences in preoperative patient demographic characteristics were observed between the two groups. The 2-year postoperative clinical and radiographic results were compared. Results: Radiolucent lines were observed in 13 (76%) of 17 hips with highly porous titanium cups and in none (0%) of 34 hips with hydroxyapatite-coated porous titanium cups (p < 0.001). In the highly porous titanium cup group, radiolucent lines were observed in five hips (29%) in one zone, two hips (11%) in two zones, and six hips (35%) in three zones. No cup loosening was observed in either group. Conclusions: Radiolucent lines were significantly more frequent in highly porous titanium cups. This study suggests that, compared to the three-dimensional structure of porous titanium, the hydroxyapatite coating of porous titanium had a greater influence on bone ingrowth in the short term. The meaning of these findings in the long-term is unclear yet.
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Affiliation(s)
- Yoichi Ohta
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka 545-8585, Japan; (R.S.); (Y.M.); (S.M.); (S.T.); (M.I.); (H.N.)
| | - Ryo Sugama
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka 545-8585, Japan; (R.S.); (Y.M.); (S.M.); (S.T.); (M.I.); (H.N.)
| | - Yukihide Minoda
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka 545-8585, Japan; (R.S.); (Y.M.); (S.M.); (S.T.); (M.I.); (H.N.)
| | - Shigekazu Mizokawa
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka 545-8585, Japan; (R.S.); (Y.M.); (S.M.); (S.T.); (M.I.); (H.N.)
| | - Shinji Takahashi
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka 545-8585, Japan; (R.S.); (Y.M.); (S.M.); (S.T.); (M.I.); (H.N.)
| | - Mitsuhiko Ikebuchi
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka 545-8585, Japan; (R.S.); (Y.M.); (S.M.); (S.T.); (M.I.); (H.N.)
| | - Tamotsu Nakatsuchi
- Tsuji-geka Rehabilitation Hospital, 3-24 Ikutamamaemachi, Tennnouji-ku, Osaka 543-0072, Japan;
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka 545-8585, Japan; (R.S.); (Y.M.); (S.M.); (S.T.); (M.I.); (H.N.)
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Radtke L, Frandsen JJ, Lancaster AJ, Loughmiller S, Blackburn BE, Soltanolkotabi M, Anderson LA, Gililland JM. Early Radiographic and Clinical Outcomes of an Additive-Manufactured Acetabular Component. Arthroplast Today 2024; 27:101371. [PMID: 38585285 PMCID: PMC10995801 DOI: 10.1016/j.artd.2024.101371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 02/14/2024] [Accepted: 02/28/2024] [Indexed: 04/09/2024] Open
Abstract
Background Additive manufacturing has recently gained popularity and is widely adopted in the orthopaedic industry. However, there is a paucity of literature on the radiographic and clinical outcomes of these relatively novel components. The aim of this study was to assess the 2-year clinical and radiographic outcomes of a specific additive-manufactured acetabular component in primary total hip arthroplasty. Methods We performed a retrospective review of 60 patients who underwent primary total hip arthroplasty with the use of the Stryker's TRIDENT II acetabular component. Evaluation of radiographs was performed at 6 weeks, 1 year, and 2 years postoperatively. Radiographs were evaluated for radiolucencies in Charnley and DeLee zones, signs of biologic fixation, and acetabular inclination and anteversion measurements. Patient-reported outcomes and complications were also obtained. Results There were no cases of component loosening or changes in component position during follow-up, with an average follow-up time of 1.7 years. A radiolucent line was identified in one patient in zone 1 at 6 weeks; this was absent at 1 year. Radiographic signs of cup biologic fixation were present in 85% of cases by final follow-up. The average inclination was 45.1 (SD = 4.0), and the average anteversion was 26.9 (SD = 5.2). Patient-Reported Outcomes Measurement Information System scores significantly increased at the final follow-up, and there were no complications in this cohort. Conclusions This study demonstrated excellent radiographic and clinical outcomes with this novel additive-manufactured acetabular component at early follow-up. Although longer-term follow-up is warranted, this additively manufactured highly porous titanium acetabular component demonstrated excellent biologic fixation and reliable fixation at mid-term follow-up.
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Affiliation(s)
- Logan Radtke
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Jeffrey J. Frandsen
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Alex J. Lancaster
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Shanna Loughmiller
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Brenna E. Blackburn
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Maryam Soltanolkotabi
- Department of Radiology and Imaging Services, University of Utah, Salt Lake City, UT, USA
| | - Lucas A. Anderson
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Jeremy M. Gililland
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
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Familiari F, Barone A, De Gori M, Banci L, Palco M, Simonetta R, Gasparini G, Mercurio M, Calafiore G. Short- to Mid-Term Clinical and Radiological Results of Selective Laser Melting Highly Porous Titanium Cup in Primary Total Hip Arthroplasty. J Clin Med 2024; 13:969. [PMID: 38398281 PMCID: PMC10889807 DOI: 10.3390/jcm13040969] [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: 12/13/2023] [Revised: 01/16/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024] Open
Abstract
(1) Background: The aim of this study was to evaluate short- to mid-term clinical and radiological results in patients undergoing primary total hip arthroplasty (THA) with the use of a Selective Laser Melting 3D-printed highly porous titanium acetabular cup (Jump System Traser®, Permedica Orthopaedics). (2) Methods: We conducted a retrospective study and collected prospective data on 125 consecutive patients who underwent primary THA with the use of highly porous titanium cup. Each patient was evaluated preoperatively and postoperatively with a clinical and radiological assessment. (3) Results: The final cohort consisted of 104 patients evaluated after a correct value of 52 (38-74) months. The median Harris Hip Score (HHS) significantly improved from 63.7 (16-95.8) preoperatively to 94.8 (38.2-95.8) postoperatively (p < 0.001), with higher improvement associated with higher age at surgery (β = 0.22, p = 0.025). On postoperative radiographs, the average acetabular cup inclination and anteversion were 46° (30°-57°) and 15° (1°-32°), respectively. All cups radiographically showed signs of osseointegration with no radiolucency observed, or component loosening. (4) Conclusions: The use of this highly porous acetabular cup in primary THA achieved excellent clinical, functional, and radiological results at mid-term follow-up. A better clinical recovery can be expected in older patients. The radiological evaluation showed excellent osseointegration of the cup with complete absence of periprosthetic radiolucent lines.
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Affiliation(s)
- Filippo Familiari
- Department of Orthopaedic and Trauma Surgery, Magna Graecia University, 88100 Catanzaro, Italy
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, Magna Graecia University, 88100 Catanzaro, Italy
| | - Alessandro Barone
- Department of Orthopaedic and Trauma Surgery, Magna Graecia University, 88100 Catanzaro, Italy
| | | | - Lorenzo Banci
- Clinical Department, Permedica Orthopaedics, 23807 Merate, Italy
| | - Michelangelo Palco
- Division of Orthopaedic and Trauma Surgery, Villa del Sole Clinic, 88100 Catanzaro, Italy
| | - Roberto Simonetta
- Division of Orthopaedic and Trauma Surgery, Villa del Sole Clinic, 88100 Catanzaro, Italy
| | - Giorgio Gasparini
- Department of Orthopaedic and Trauma Surgery, Magna Graecia University, 88100 Catanzaro, Italy
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, Magna Graecia University, 88100 Catanzaro, Italy
| | - Michele Mercurio
- Department of Orthopaedic and Trauma Surgery, Magna Graecia University, 88100 Catanzaro, Italy
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, Magna Graecia University, 88100 Catanzaro, Italy
| | - Giuseppe Calafiore
- Clinica Città di Parma, 43123 Parma, Italy
- IRCSS Humanitas Research Hospital, 20089 Rozzano, Italy
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Marchand RC, Marchand K, Taylor K, Guerrieo Z, Hameed D, Bains SS, Dubin JA, Sodhi N, Mont MA. Patient-reported and radiographic outcomes of a porous-coated acetabular cup in robotic assisted total hip arthroplasty at 2-year follow up. J Orthop 2023; 46:78-82. [PMID: 37969228 PMCID: PMC10643097 DOI: 10.1016/j.jor.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 09/14/2023] [Accepted: 10/04/2023] [Indexed: 11/17/2023] Open
Abstract
Introduction Several implant manufacturers have developed ultra-porous metal substrate acetabular components recently. Despite this, data on clinical and radiographic outcomes remain limited. Our study evaluated postoperative patient-reported outcome measures (PROMs) and radiographic analyses in patients fitted with a novel acetabular porous-coated component. Methods A total of 152 consecutive patients underwent a total hip arthroplasty by a single orthopaedic surgeon. All patients underwent surgery utilizing the same CT-scan based robotic-assisted device with the same porous cementless acetabular shell. They received standardized postoperative physical therapy, rehabilitation, and pain protocols. Preoperatively, first postoperative visit, 6-months, 1-year, and 2-years, patients were evaluated based on Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain, physical function, and total scores; 2) Patient-Reported Outcomes Measurement Information System (PROMIS)-10 physical and mental scores; 3) Hip Disability and Osteoarthritis Outcome Score (HOOS)-Jr scores; as well as 4) acetabular component positions and 5) evidence of acetabular component loosening. Results Significant improvements were observed by 6 months in WOMAC pain, physical function, and total scores (p < 0.05), maintained at 1 and 2 years. PROMIS-10 physical scores also improved significantly from preoperative to 6 months postoperative and remained so at 1 and 2 years postoperative (p < 0.05). No significant changes were found in PROMIS-10 mental scores. HOOS-Jr scores significantly improved from preoperative to 6 months postoperative and remained so through 2 years (p < 0.05). At 6 months, slight changes were noted in abduction angle and horizontal and vertical offset. Radiolucencies, initially found in 3 shells, reduced to 1 shell with 2 new radiolucencies by 6 months, and remained stable with no subsequent operative interventions. At 1 year and 2 years, no radiographic abnormalities were noted, including complete resolution of prior radiolucencies as well as stable components. Conclusion This porous cementless acetabular shell, implanted with CT-scan-based robotic-assisted techniques, demonstrated excellent postoperative PROMs at 2 years. Stable radiolucencies suggest good component stability. The early stable clinical and radiographic results suggest promising long-term outcomes with this device. Level of evidence III (retrospective cohort study).
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Affiliation(s)
- Robert C. Marchand
- South County Orthopaedics, Orthopaedics Rhode Island, Wakefield, RI, USA
| | - Kevin Marchand
- Northwell Health Orthopedics, Lenox Hill Hospital, New York, NY, USA
| | - Kelly Taylor
- South County Orthopaedics, Orthopaedics Rhode Island, Wakefield, RI, USA
| | - Zachary Guerrieo
- South County Orthopaedics, Orthopaedics Rhode Island, Wakefield, RI, USA
| | - Daniel Hameed
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Sandeep S. Bains
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Jeremy A. Dubin
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Nipun Sodhi
- Department of Orthopaedic Surgery, Lenox Hill Hospital Northwell Health, New York, NY, USA
| | - Michael A. Mont
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
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Bingham JS, Hinckley NB, Deckey DG, Hines J, Spangehl MJ. Primary Tritanium acetabular components have increased rates of radiolucency associated with inferior clinical outcomes at short-term follow-up. Hip Int 2022; 32:724-729. [PMID: 33566724 DOI: 10.1177/1120700020988723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Cementless fixation is the standard for acetabular fixation in primary total hip arthroplasty (THA). There are various surface finishes thought to improve osteointegration, although literature regarding the long-term survival of some of these surfaces is limited. Regardless of design, primary stability is essential to allow for osteointegration. Previous studies have suggested an increased rate of radiolucency and compromised short-term functional outcomes using the Tritanium primary acetabular component (Stryker, Mahwah, NJ). The purpose of this study was to compare the primary Tritanium acetabular component to another contemporary acetabular component as a control group with an established clinical record. METHODS 444 consecutive, primary THAs performed by a single surgeon from 2008 to 2012 were reviewed. Patients were included if they had a minimum 1-year follow-up. Implant survivorship and modified Harris Hip Scores (mHHS) were recorded for all patients at final follow-up. Radiographs were evaluated by 2 surgeons at 6 weeks, 1 year, and the most recent follow-up for evidence of radiolucency and migration. Components were considered to have evidence of radiographic lucency if they had radiolucency in 2 or more DeLee zones. RESULTS 198 patients met criteria for inclusion (96 Pinnacle, 102 Tritanium). Average follow-up was 28 (12-72) months. At final follow-up 6.2% of the Pinnacle cups and 29.4% of the Tritanium cups had radiographic evidence of loosening (p < 0.01). The average mHHS for the Tritanium group was 83.1, and 88.4 for the Pinnacle group (p < 0.01). Radiographic evidence of loosening also correlated with a lower mHHS: 75.5 versus 86.4 (p < 0.01). In patients that received Tritanium cups without screw fixation 44.6% showed radiographic evidence of loosening versus 8% that received screw fixation (p < 0.01). In total, 6 patients in the Tritanium group required revision for aseptic loosening of the acetabular component. CONCLUSIONS The 30% rate of radiographic loosening in the Tritanium group was significantly higher than the Pinnacle group and correlated with an inferior clinical outcome. Interestingly the use of screw augmentation was protective against radiographic evidence of loosening. This suggests that the Tritanium component may be prone to fibrous in-growth because of inadequate primary stability.
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Affiliation(s)
- Joshua S Bingham
- Department of Orthopaedics, Mayo Clinic Arizona, Phoenix, AZ, USA
| | | | - David G Deckey
- Department of Orthopaedics, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Jeremy Hines
- Department of Orthopaedics, Mayo Clinic Rochester, Rochester, MN, USA
| | - Mark J Spangehl
- Department of Orthopaedics, Mayo Clinic Arizona, Phoenix, AZ, USA
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Mirulla AI, Muccioli GMM, Fratini S, Zaffagnini S, Ingrassia T, Bragonzoni L, Innocenti B. Analysis of different geometrical features to achieve close-to-bone stiffness material properties in medical device: A feasibility numerical study. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 221:106875. [PMID: 35588661 DOI: 10.1016/j.cmpb.2022.106875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 05/09/2022] [Accepted: 05/10/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVE In orthopedic medical devices, elasto-plastic behavior differences between bone and metallic materials could lead to mechanical issues at the bone-implant interface, as stress shielding. Those issue are mainly related to knee and hip arthroplasty, and they could be responsible for implant failure. To reduce mismatching-related adverse events between bone and prosthesis mechanical properties, modifying the implant's internal geometry varying the bulk stiffness and density could be the right approach. Therefore, this feasibility study aims to assess which in-body gap geometry improves, by reducing, the bulk stiffness. METHODS Using five finite element models, a uniaxial compression test in five cubes with a 20 mm thickness was simulated and analyzed. The displacements, strain and Young Modulus were calculated in four cubes, each containing internal prismatic gaps with different transversal sections (squared, hexagonal, octagonal, and circular). Those were compared with a fifth full-volume cube used as control. RESULTS The most significant difference have been achieved in displacement values, in cubes containing internal gaps with hexagonal and circular transversal sections (82 µm and 82.5 µm, respectively), when compared to the full-volume cube (69.3 µm). CONCLUSIONS This study suggests that hexagonal and circular shape of the gaps allows obtaining the lower rigidity in a size range of 4 mm, offering a starting approach to achieve a "close-to-bone" material, with a potential use in prosthetic devices with limited thickness.
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Affiliation(s)
- Agostino Igor Mirulla
- Department of Engineering, University of Palermo, Viale delle Scienze Ed.8, Palermo 90128, Italy; Department for Life Quality Studies, University of Bologna, Rimini 47921, Italy.
| | - Giulio Maria Marcheggiani Muccioli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna 40136, Italy; 2nd Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna 40136, Italy
| | - Stefano Fratini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna 40136, Italy
| | - Stefano Zaffagnini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna 40136, Italy; 2nd Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna 40136, Italy
| | - Tommaso Ingrassia
- Department of Engineering, University of Palermo, Viale delle Scienze Ed.8, Palermo 90128, Italy
| | - Laura Bragonzoni
- Department for Life Quality Studies, University of Bologna, Rimini 47921, Italy
| | - Bernardo Innocenti
- BEAMS Department (Bio Electro and Mechanical Systems), Université Libre de Bruxelles, Bruxelles 1050, Belgium
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Hoskins W, Rainbird S, Holder C, Graves SE, Bingham R. Revision for Aseptic Loosening of Highly Porous Acetabular Components in Primary Total Hip Arthroplasty: An Analysis of 20,993 Total Hip Replacements. J Arthroplasty 2022; 37:312-315. [PMID: 34699913 DOI: 10.1016/j.arth.2021.10.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/14/2021] [Accepted: 10/18/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Highly porous-coated titanium acetabular components have a high coefficient of friction and ultraporous surfaces to enhance bone ingrowth and osseointegration in total hip arthroplasty (THA). There have been concerns with the development of early radiolucent lines and aseptic loosening of highly porous acetabular components. It is unclear whether these concerns relate to a specific implant or the entire class. The aim of this study is to compare the revision rates for aseptic loosening of highly porous acetabular combinations in primary THA using data from a large joint replacement registry. METHODS Data were retrieved from the Australian Orthopedic Association National Joint Replacement Registry for the study period September 1999 to December 2019. All primary THA procedures recorded and performed for osteoarthritis using the most common combinations for each highly porous acetabular component with highly cross-linked polyethylene and a 32-mm or 36-mm femoral head were included. The primary outcome measure was revision for aseptic loosening of the acetabular component. Results were adjusted for patient age and gender. RESULTS There were 20,993 primary THA procedures performed for osteoarthritis using a highly porous acetabular component across 6 combinations. Relative to the POLARSTEM/R3 (StikTite), the Exeter V40/Tritanium had a significantly higher risk of revision for aseptic loosening of the acetabular component (hazard ratio 0.21, 95% confidence interval 0.06-0.74, P = .014). There was no difference between any other highly porous acetabular component combination and no late revisions for aseptic loosening. CONCLUSION Highly porous-coated titanium acetabular components have low rates of aseptic loosening with long-term follow-up. A difference between components may exist. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Wayne Hoskins
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia; Traumaplasty. Melbourne, East Melbourne, Victoria, Australia
| | - Sophia Rainbird
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia
| | - Carl Holder
- Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, South Australia Australia
| | - Stephen E Graves
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia
| | - Roger Bingham
- Traumaplasty. Melbourne, East Melbourne, Victoria, Australia
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Tamaki Y, Goto T, Takasago T, Wada K, Hamada D, Sairyo K. Clinical and radiological outcomes of total hip arthroplasty using a highly porous titanium cup or a conventional hydroxyapatite-coated titanium cup: A retrospective study in Japanese patients. J Orthop Sci 2022; 27:163-168. [PMID: 33341353 DOI: 10.1016/j.jos.2020.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/04/2020] [Accepted: 11/07/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND A highly porous titanium cup has a unique structure that mimics human trabecular bone and is expected to achieve better outcomes due to rigid fixation and extensive bone ingrowth. Several manufacturers have developed a highly porous titanium cup; however, some have shown a high incidence of radiolucent lines (RLLs) on early postoperative radiographs. In this study, we compared the clinical and radiological outcomes of total hip arthroplasty (THA) using a highly porous titanium cup (OsseoTi, Zimmer Biomet) with those after THA using a conventional hydroxyapatite-coated titanium cup (Trident HA, Stryker). METHODS A total of 201 hips that underwent THA using an OsseoTi cup (n = 101) or Trident cup (n = 100) were enrolled in the study. Patient characteristics, cup alignment, clinical outcome (determined by the Japanese Orthopedic Association [JOA] score), and incidence of RLLs around the cup were evaluated at 3, 6, 12, and 24 months postoperatively. RESULTS The clinical outcome was excellent in both groups. The incidence of RLLs was 12.9% at 3 months, 20.8% at 6 months, 23.8% at 12 months, and 22.8% at 24 months after surgery in the OsseoTi group; there were no cases of RLL at any time after surgery in the Trident group. The RLLs were mainly distributed in zone 2. Despite the high rate of RLL in the OsseoTi group, the RLL were narrow and only 5% had a width of >1 mm at 24 months postoperatively. There were no cases with RLLs in all three zones. CONCLUSIONS Despite excellent clinical outcomes in both study groups, the incidence of RLLs was higher in the OsseoTi group than in the Trident group. Although none of our cases with RLL have required revision surgery for aseptic loosening so far, these patients require careful follow-up.
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Affiliation(s)
- Yasuaki Tamaki
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima, 770-8503, Japan
| | - Tomohiro Goto
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima, 770-8503, Japan.
| | - Tomoya Takasago
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima, 770-8503, Japan
| | - Keizo Wada
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima, 770-8503, Japan
| | - Daisuke Hamada
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima, 770-8503, Japan
| | - Koichi Sairyo
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima, 770-8503, Japan
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11
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Bondarenko S, Filipenko V, Karpinsky M, Karpinska O, Ivanov G, Maltseva V, Badnaoui AA, Schwarzkopf R. Osseointegration of porous titanium and tantalum implants in ovariectomized rabbits: A biomechanical study. World J Orthop 2021; 12:214-222. [PMID: 33959485 PMCID: PMC8082506 DOI: 10.5312/wjo.v12.i4.214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 02/01/2021] [Accepted: 03/11/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Today, biological fixation of uncemented press-fit acetabular components plays an important role in total hip arthroplasty. Long-term stable fixation of these implants depends on the osseointegration of the acetabular cup bone tissue into the acetabular cup implant, and their ability to withstand functional loads.
AIM To compare the strength of bone-implant osseointegration of four types of porous metal implants in normal and osteoporotic bone in rabbits.
METHODS The study was performed in 50 female California rabbits divided into non-ovariectomized (non-OVX) and ovariectomized groups (OVX) at 6 mo of age. Rabbits were sacrificed 8 wk after the implantation of four biomaterials [TTM, CONCELOC, Zimmer Biomet's Trabecular Metal (TANTALUM), and ATLANT] in a 5-mm diameter defect created in the left femur. A biomechanical evaluation of the femur was carried out by testing implant breakout force. The force was gradually increased until complete detachment of the implant from the bone occurred.
RESULTS The breakout force needed for implant detachment was significantly higher in the non-OVX group, compared with the OVX group for all implants (TANTALUM, 194.7 ± 6.1 N vs 181.3 ± 2.8 N; P = 0.005; CONCELOC, 190.8 ± 3.6 N vs 180.9 ± 6.6 N; P = 0.019; TTM, 186.3 ± 1.8 N vs 172.0 N ± 11.0 N; P = 0.043; and ATLANT, 104.9 ± 7.0 N vs 78.9 N ± 4.5 N; P = 0.001). In the OVX group, The breakout forces in TANTALUM, TTM, and CONCELOC did not differ significantly (P = 0.066). The breakout force for ATLANT in the OVX group was lower by a factor of 2.3 compared with TANTALUM and CONCELOC, and by 2.2 compared with TTM (P = 0.001). In the non-OVX group, the breakout force for ATLANT was significantly different from all other implants, with a reduction in fixation strength by a factor of 1.9 (P = 0.001).
CONCLUSION TANTALUM, TTM, and CONCELOC had equal bone-implant osseointegration in healthy and in osteoporotic bone. ATLANT had significantly decreased osseointegration (P = 0.001) in healthy and in osteoporotic bone.
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Affiliation(s)
- Stanislav Bondarenko
- Department of Joint Pathology, Sytenko Institute of Spine and Joint Pathology, Kharkiv 61124, Ukraine
| | - Volodymyr Filipenko
- Department of Joint Pathology, Sytenko Institute of Spine and Joint Pathology, Kharkiv 61124, Ukraine
| | - Michael Karpinsky
- Department of Biomechanics, Sytenko Institute of Spine and Joint Pathology, Kharkiv 61124, Ukraine
| | - Olena Karpinska
- Department of Biomechanics, Sytenko Institute of Spine and Joint Pathology, Kharkiv 61124, Ukraine
| | - Gennadiy Ivanov
- Department of Experimental Pathology, Sytenko Institute of Spine and Joint Pathology, Kharkiv 61124, Ukraine
| | - Valentyna Maltseva
- Morphology of Connective Tissue Department, Sytenko Institute of Spine and Joint Pathology, Kharkiv 61124, Ukraine
| | - Ahmed Amine Badnaoui
- Department of Joint Pathology, Sytenko Institute of Spine and Joint Pathology, Kharkiv 61124, Ukraine
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, Hospital for Joint Diseases, New York, NY 10003, United States
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12
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Oishi K, Yamamoto Y, Harada Y, Inoue R, Sasaki E, Ishibashi Y. Radiographic assessment of radiolucent lines around a highly porous titanium cup (Tritanium) using digital tomosynthesis, after total hip arthroplasty. J Orthop Surg Res 2021; 16:266. [PMID: 33858459 PMCID: PMC8048064 DOI: 10.1186/s13018-021-02396-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 04/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The objectives of this study were to assess radiolucent lines around a highly porous titanium cup (Tritanium) using digital tomosynthesis and to investigate the clinical and radiographic factors associated with radiolucent lines on tomosynthesis. METHODS Fifty-five patients underwent total hip arthroplasty using a Tritanium cup, and digital tomosynthesis and plain radiography were performed at 1 week, 6 months, 1 year, and 2 years after surgery. The radiolucent lines around the cup were measured on both DTS and plain radiography at each postoperative period. Clinical evaluations were performed by the Japanese Orthopaedic Association hip disease evaluation questionnaire (JHEQ), and revision surgeries were examined. Based on the presence of radiolucent lines on digital tomosynthesis at 2 years postoperatively, patients were divided into RL (+) and RL (-) groups and investigated for related factors. RESULTS There were 20 cases in the RL (+) group and 35 cases in the RL (-) group, and no revision surgeries were required. Statistically, there were more cases with radiolucent lines on digital tomosynthesis (45.4% at 1 week and 36.3% at 2 years) than on plain radiography (9.1% at 1 week and 9.1% at 2 years) at each postoperative point. Logistic analysis showed no significant associations between the presence of radiolucent lines at 2 years on digital tomosynthesis, and the JHEQ parameters of pain (p = 0.937), movement (p = 0.266), or mental status (p = 0.404). CONCLUSION In a short-term evaluation up to 2 years, digital tomosynthesis detected more radiolucent lines around the titanium cups than plain radiography. The occurrence of radiolucent lines was not related to the postoperative clinical evaluation.
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Affiliation(s)
- Kazuki Oishi
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan.
| | - Yuji Yamamoto
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Yoshifumi Harada
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Ryo Inoue
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Eiji Sasaki
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Yasuyuki Ishibashi
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
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13
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Alamanda VK, Demartino I, Potter HG, Koff MF, Lin B, Muskat A, Westrich GH. Multiacquisition Variable-Resonance Image Combination Magnetic Resonance Imaging Used to Study Detailed Bone Apposition and Fixation of an Additively Manufactured Cementless Acetabular Shell. Arthroplast Today 2020; 6:694-698. [PMID: 32923552 PMCID: PMC7475047 DOI: 10.1016/j.artd.2020.07.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/29/2020] [Accepted: 07/11/2020] [Indexed: 01/01/2023] Open
Abstract
Background The ability to utilize magnetic resonance imaging (MRI) to assess bony fixation in 3 dimensions may allow a better understanding of the implant design and bony integration. We hypothesized that a new 3-dimensionally printed cementless highly porous acetabular component (Stryker Trident II TritaniumTM) would show better fixation than an earlier cup from the same manufacturer as assessed by the noninvasive technique of multispectral MRI. Methods Multiacquisition variable-resonance image combination selective metal suppression MRI was performed in 19 patients implanted with a new 3-dimensionally printed cup and 20 patients who had received a previous-generation cup from the same manufacturer at 1-year follow-up. Each cup was graded globally as well as by 9 specific zones. Integration grades were performed for each zone: 0, full bone integration; 1, fibrous membrane present; 2, osteolysis; and 3, fluid present. A mixed-effects logistic regression model was used to compare fixation between the 2 groups. Results All cups in both cohorts showed greater than 90% estimated global bony integration (3-dimensionally printed cups, 99.4%; regular cups 91.6%) with no osteolysis or fluid observed in any cup. The 3-dimensionally printed cup had 1 of 171 zones (0.6%) graded as fibrous membrane present, while the 2-dimensional group had 15 of 180 zones (8.3%) graded as fibrous. Of note, screw hole regions were omitted but may be read as fibrous membrane areas. Conclusion Using multiacquisition variable-resonance image combination selective MRI, our analysis showed greater osteointegration and less fibrous membrane formation in the 3-dimensionally printed cups than the control group at 1-year follow-up.
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Affiliation(s)
- Vignesh K Alamanda
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Ivan Demartino
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Hollis G Potter
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Matthew F Koff
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Bin Lin
- Department of Biostatistics, Hospital for Special Surgery, New York, NY, USA
| | - Ahava Muskat
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Geoffrey H Westrich
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
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14
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Evaluation of the bone morphology around four types of porous metal implants placed in distal femur of ovariectomized rats. J Orthop Surg Res 2020; 15:296. [PMID: 32746931 PMCID: PMC7398357 DOI: 10.1186/s13018-020-01822-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 07/28/2020] [Indexed: 12/13/2022] Open
Abstract
Background To compare structural features of the femoral bone of ovariectomized and non-ovariectomized rats after implantation of porous materials (TANTALUM, CONCELOC, TTM, ATLANT). Methods Experiments were carried out on 56 white laboratory female rats aged 6 months. Rats were randomly assigned into groups: sham-operated control group (SH) or ovariectomy group (OVX). Four different commercial implant materials (TTM, CONCELOC, TANTALUM, ATLANT) were placed into the defects (diameter 2.5 mm, depth 3.0 mm) in the distal metaphysis of femurs. Rats were sacrificed 45 days after surgery. Histological study was performed and the percentage of the bone area (BA%) around the implant at a distance of 500 μm in the cancellous area was measured. Results Formation of mature bone tissue of varying degrees around all of the implants was detected. In OVX rats cancellous bone defect zone was characterized by a high density of osteocytes on the surface. In the SH group, no differences in BA% among implant materials were found. In OVX rats, the BA% around ATLANT implants was 1.5-time less (p = 0.002) than around TANTALUM. The BA% around the rest of the materials was not statistically different. Conclusions Bone formation around the studied porous titanium and tantalum materials in the osteoporosis model was lower than in normal bone. There were differences in bone formation around the different materials in the osteoporosis model, while in the normal bone model, these differences were absent.
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15
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Palomäki A, Hemmilä M, Laaksonen I, Matilainen M, Eskelinen A, Haapakoski J, Puhto AP, Kettunen J, Manninen M, Mäkelä KT. Implant Survival of 6,080 Tritanium Cups in Primary Total Hip Arthroplasty: Data from the Finnish Arthroplasty Register from 2009 to 2017. J Bone Joint Surg Am 2020; 102:1177-1185. [PMID: 32618925 DOI: 10.2106/jbjs.19.00874] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND To enhance osseointegration in total hip arthroplasty (THA), ultraporous or highly porous-coated cups were introduced. Implant survival data on these new devices have been scarce. The aim of our study was to assess the survivorship of ultraporous Tritanium cups (Stryker) in a population-based register study. METHODS In this study, we collected data on 6,080 primary THAs using a Tritanium cup and 25,670 THAs using a conventional cup (control group) from the Finnish Arthroplasty Register; these procedures were performed from January 1, 2009, to December 31, 2017. We calculated the Kaplan-Meier survival estimates with 95% confidence intervals (CIs). The end point was revision for any reason or for aseptic loosening of the cup. The revision risks were assessed with use of the Cox multiple regression model. The variables assessed in the Cox model were femoral head size, age group, involved side, operation year, sex, diagnosis, and fixation of the stem. The proportional hazards assumption of the Cox model was not fulfilled, so the follow-up time was divided into 3 time periods: 0 to 2 years, >2 to 4 years, and >4 years. RESULTS When comparing the 2 groups with regard to revision for any reason, the 5-year Kaplan-Meier survivorship of the Tritanium group (94.7% [95% CI, 94.0% to 95.4%]) was inferior to that of the control group (96.0% [95% CI, 95.7% to 96.3%]). In the Cox regression analysis of the 2 groups for the time period of >4 years, the Tritanium group had an increased risk of revision for any reason compared with the control group (hazard ratio [HR], 3.12 [95% CI, 1.82 to 5.35]; p < 0.001). With regard to revision for aseptic loosening of the cup, the Tritanium group had an increased risk of revision compared with the control group for both 0 to 2 years (HR, 3.80 [95% CI, 1.76 to 8.24]; p < 0.001) and >2 to 4 years (HR, 11.2 [95% CI, 3.28 to 38.0]; p < 0.001). CONCLUSIONS There was no advantage to using the ultraporous-coated Tritanium cup for primary THA compared with conventional uncemented cups. However, wide CIs for some HR estimates may point to a lack of precision. Therefore, further research on subject is needed. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Antton Palomäki
- Department of Orthopaedic Surgery (A.P., M.H., I.L., and K.T.M.) and the Turku PET Centre (M. Matilainen), University of Turku and Turku University Hospital, Turku, Finland
| | - Matias Hemmilä
- Department of Orthopaedic Surgery (A.P., M.H., I.L., and K.T.M.) and the Turku PET Centre (M. Matilainen), University of Turku and Turku University Hospital, Turku, Finland
| | - Inari Laaksonen
- Department of Orthopaedic Surgery (A.P., M.H., I.L., and K.T.M.) and the Turku PET Centre (M. Matilainen), University of Turku and Turku University Hospital, Turku, Finland
| | - Markus Matilainen
- Department of Orthopaedic Surgery (A.P., M.H., I.L., and K.T.M.) and the Turku PET Centre (M. Matilainen), University of Turku and Turku University Hospital, Turku, Finland
| | | | | | - Ari-Pekka Puhto
- Division of Operative Care, Department of Orthopaedic and Trauma Surgery, Oulu University Hospital, Oulu, Finland
| | - Jukka Kettunen
- Department of Orthopaedics and Traumatology, Kuopio University Hospital, Kuopio, Finland
| | | | - Keijo T Mäkelä
- Department of Orthopaedic Surgery (A.P., M.H., I.L., and K.T.M.) and the Turku PET Centre (M. Matilainen), University of Turku and Turku University Hospital, Turku, Finland
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16
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Malahias MA, Kostretzis L, Greenberg A, Nikolaou VS, Atrey A, Sculco PK. Highly Porous Titanium Acetabular Components in Primary and Revision Total Hip Arthroplasty: A Systematic Review. J Arthroplasty 2020; 35:1737-1749. [PMID: 32070658 DOI: 10.1016/j.arth.2020.01.052] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 12/13/2019] [Accepted: 01/20/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND A number of papers have been published reporting on the clinical performance of highly porous coated titanium acetabular cups in primary and revision total hip arthroplasty (THA). However, no systematic review of the literature has been published to date. METHODS The US National Library of Medicine (PubMed/MEDLINE), Embase, and the Cochrane Database of Systematic Reviews were queried for publications utilizing the following keywords: "tritanium" OR "highly-porous" AND "titanium" OR "acetabular" AND "trabecular" AND "titanium". RESULTS Overall, 16 studies were included in this review (11,366 cases; 60% females, 2-7 years mean follow-up). The overall survival rate of highly porous titanium acetabular components in primary cases was 99.3% (10,811 of 10,886 cases), whereas the rate of aseptic loosening was 0.1%. The overall survival rate of the highly porous titanium acetabular components in revision THA cases was 93.5% (449 of 480 cases), whereas the rate of aseptic loosening was 2.1%. CONCLUSION There was moderate quality evidence to show that the use of highly porous titanium acetabular components in primary and revision THA cases is associated with satisfactory clinical outcomes in the short- and medium-term, without showing any evidence of cup migration or radiolucency. Taking into consideration that there is no evidence yet regarding the long-term survivorship of these components, we feel that further research of higher quality is required to generate more evidence-based conclusions regarding the longevity of highly porous titanium acetabular implants compared with conventional titanium counterparts.
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Affiliation(s)
- Michael-Alexander Malahias
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York NY
| | - Lazaros Kostretzis
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York NY
| | - Alex Greenberg
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York NY
| | - Vasileios S Nikolaou
- 2(nd) Orthopaedic Department, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Amit Atrey
- Division of Orthopaedics, St Michaels Hospital, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Peter K Sculco
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York NY
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17
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Beckmann NA, Bitsch RG, Schonhoff M, Siebenrock KA, Schwarze M, Jaeger S. Comparison of the Primary Stability of Porous Tantalum and Titanium Acetabular Revision Constructs. MATERIALS 2020; 13:ma13071783. [PMID: 32290103 PMCID: PMC7179011 DOI: 10.3390/ma13071783] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 12/12/2022]
Abstract
Adequate primary stability of the acetabular revision construct is necessary for long-term implant survival. The difference in primary stability between tantalum and titanium components is unclear. Six composite hemipelvises with an acetabular defect were implanted with a tantalum augment and cup, using cement fixation between cup and augment. Relative motion was measured at cup/bone, cup/augment and bone/augment interfaces at three load levels; the results were compared to the relative motion measured at the same interfaces of a titanium cup/augment construct of identical dimensions, also implanted into composite bone. The implants showed little relative motion at all load levels between the augment and cup. At the bone/augment and bone/cup interfaces the titanium implants showed less relative motion than tantalum at 30% load (p < 0.001), but more relative motion at 50% (p = n.s.) and 100% (p < 0001) load. The load did not have a significant effect at the augment/cup interface (p = 0.086); it did have a significant effect on relative motion of both implant materials at bone/cup and bone/augment interfaces (p < 0.001). All interfaces of both constructs displayed relative motion that should permit osseointegration. Tantalum, however, may provide a greater degree of primary stability at higher loads than titanium. The clinical implication is yet to be seen
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Affiliation(s)
- Nicholas A. Beckmann
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, 69118 Heidelberg, Germany;
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, 3010 Bern, Switzerland;
- Correspondence: or
| | - Rudi G. Bitsch
- National Joint Center, ATOS Clinics, 69115 Heidelberg, Germany;
| | - Mareike Schonhoff
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, 69118 Heidelberg, Germany; (M.S.); (S.J.)
| | - Klaus-Arno Siebenrock
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, 3010 Bern, Switzerland;
| | - Martin Schwarze
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, 69118 Heidelberg, Germany;
| | - Sebastian Jaeger
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, 69118 Heidelberg, Germany; (M.S.); (S.J.)
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18
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Han Q, Wang C, Chen H, Zhao X, Wang J. Porous Tantalum and Titanium in Orthopedics: A Review. ACS Biomater Sci Eng 2019; 5:5798-5824. [PMID: 33405672 DOI: 10.1021/acsbiomaterials.9b00493] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Porous metal is metal with special porous structures, which can offer high biocompatibility and low Young's modulus to satisfy the need for orthopedic applications. Titanium and tantalum are the most widely used porous metals in orthopedics due to their excellent biomechanical properties and biocompatibility. Porous titanium and tantalum have been studied and applied for a long history until now. Here in this review, various manufacturing methods of titanium and tantalum porous metals are introduced. Application of these porous metals in different parts of the body are summarized, and strengths and weaknesses of these porous metal implants in clinical practice are discussed frankly for future improvement from the viewpoint of orthopedic surgeons. Then according to the requirements from clinics, progress in research for clinical use is illustrated in four aspects. Various creative designs of microporous and functionally gradient structure, surface modification, and functional compound systems of porous metal are exhibited as reference for future research. Finally, the directions of orthopedic porous metal development were proposed from the clinical view based on the rapid progress of additive manufacturing. Controllable design of both macroscopic anatomical bionic shape and microscopic functional bionic gradient porous metal, which could meet the rigorous mechanical demand of bone reconstruction, should be developed as the focus. The modification of a porous metal surface and construction of a functional porous metal compound system, empowering stronger cell proliferation and antimicrobial and antineoplastic property to the porous metal implant, also should be taken into consideration.
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Affiliation(s)
- Qing Han
- Department of Orthopedics, Second Hospital of Jilin University, Changchun, 130000 Jilin Province, China
| | - Chenyu Wang
- Department of Orthopedics, Second Hospital of Jilin University, Changchun, 130000 Jilin Province, China
| | - Hao Chen
- Department of Orthopedics, Second Hospital of Jilin University, Changchun, 130000 Jilin Province, China
| | - Xue Zhao
- Department of Endocrine and Metabolism, The First Hospital of Jilin University, Changchun, 130000 Jilin Province, China
| | - Jincheng Wang
- Department of Orthopedics, Second Hospital of Jilin University, Changchun, 130000 Jilin Province, China
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19
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Kaur M, Singh K. Review on titanium and titanium based alloys as biomaterials for orthopaedic applications. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2019; 102:844-862. [PMID: 31147056 DOI: 10.1016/j.msec.2019.04.064] [Citation(s) in RCA: 396] [Impact Index Per Article: 79.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 02/20/2019] [Accepted: 04/20/2019] [Indexed: 02/07/2023]
Abstract
Variety of implant materials have been employed in various disciplines of medical science depending on the requirement of a particular application. Metals, alloys, ceramics, and polymers are the commonly used biomaterials. The main focus of this study is to review the various structural and microstructural properties of titanium and titanium based alloys used as orthopaedic implants. Orthopaedic implants need to possess certain important qualities to ensure their safe and effective use. These properties like the biocompatibility, relevant mechanical properties, high corrosion and wear resistance and osseointegration are summarized in this review. Various attempts to improve upon these properties like different processing routes, surface modifications have also been inculcated in the paper to provide an insight into the extent of research and effort that has been put into developing a highly superior titanium orthopaedic implant.
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Affiliation(s)
- Manmeet Kaur
- School of Physics and Materials Science, Thapar Institute of Engineering and Technology, Patiala, Punjab 147004, India
| | - K Singh
- School of Physics and Materials Science, Thapar Institute of Engineering and Technology, Patiala, Punjab 147004, India.
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Castagnini F, Bordini B, Stea S, Calderoni PP, Masetti C, Busanelli L. Highly porous titanium cup in cementless total hip arthroplasty: registry results at eight years. INTERNATIONAL ORTHOPAEDICS 2019; 43:1815-1821. [PMID: 30141142 DOI: 10.1007/s00264-018-4102-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 08/08/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE Highly porous cups were developed to improve osseointegration and reduce the rate of aseptic loosening. Highly porous titanium cups could mix the reliability of titanium metal with an enhanced porosity, improving the bony ingrowth. The aim of this report was to assess the survival rates and reasons for revision of a highly porous titanium cup, Fixa Ti-Por (Adler Ortho, Milan, Italy), fabricated using an additive manufacturing. METHODS The Registry of Prosthetic Orthopedic Implants (RIPO), the Emilia-Romagna region arthroplasty registry, was enquired about cementless cups, implanted since July 2007. Ti-Por cups were compared to all the other cementless sockets, acting as a control group. The survival rates and reasons for revision were evaluated and compared. Comparisons with the same articular couplings were also provided. RESULTS When all the articular couplings were included, Ti-Por performed better, achieving a statistically higher survival rate than the control group (98.7% vs 97.9%) and a statistically lower incidence of cup aseptic loosening. In case of ceramic on polyethylene couplings, Ti-Por achieved similar survival rate: cup aseptic loosening in Ti-Por group was 0.2%, whereas the control group rated 0.4%. In ceramic-on-ceramic implants, the survival rate was similar in the two groups, Ti-Por achieving a cup aseptic loosening rate of 0.1% (vs 0.14% in the control group). CONCLUSION Highly porous titanium cups showed trustworthy results at eight years, reducing the rate of aseptic loosening. Longer follow-ups, ion analyses, and pre-clinical in vivo studies would be helpful to better define the reliability of these devices and their advantages.
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Affiliation(s)
- Francesco Castagnini
- Ortopedia-Traumatologia e Chirurgia protesica e dei reimpianti d'anca e di ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy.
| | - Barbara Bordini
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy
| | - Susanna Stea
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy
| | - Pierina Paola Calderoni
- Ortopedia-Traumatologia e Chirurgia protesica e dei reimpianti d'anca e di ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - Claudio Masetti
- Ortopedia-Traumatologia e Chirurgia protesica e dei reimpianti d'anca e di ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - Luca Busanelli
- Ortopedia-Traumatologia e Chirurgia protesica e dei reimpianti d'anca e di ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
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Castagnini F, Bordini B, Yorifuji M, Giardina F, Natali S, Pardo F, Traina F. Highly Porous Titanium Cups versus Hydroxyapatite-Coated Sockets: Midterm Results in Metachronous Bilateral Total Hip Arthroplasty. Med Princ Pract 2019; 28:559-565. [PMID: 31079112 PMCID: PMC6944922 DOI: 10.1159/000500876] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 05/12/2019] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE Highly porous titanium cups have been recently introduced, with contradictory outcomes. A retrospective consecutive case series involving bilateral metachronous total hip arthroplasties (THA) performed with 2 different cups, i.e., Fixa (F) and Fixa Ti-Por (T) (Adler Ortho, Milan, Italy), and the same stem, was evaluated. T sockets, manufactured using electron beam melting, were supposed to prove superior in terms of clinical results, survival rates, and radiographic parameters in comparison to hydroxyapatite-coated F cups with conventional porosity. SUBJECTS AND METHODS Twenty-four bilateral metachronous THAs with an F cup on one side and a T socket on the other side were evaluated. Preoperative and postoperative Harris hip scores (HHS) were collected for every patient. Radiographic signs of loosening were assessed. The radiographic signs of osseointegration (radiolucent lines, superolateral buttress, inferomedial buttress, radial trabeculae, and stress shielding) were evaluated. RESULTS No intraoperative complications occurred. The mean HHS score was excellent and comparable in both groups. At the mean follow-up of 134 months (F) and 79 months (T), no cup or liner revisions were performed. No radiographic signs of loosening were reported. All of the patients revealed 3 parameters of good bony ingrowth at least. Both groups showed similar radiographic parameters regarding osseointegration, which were stable over the time. Stress shielding was more evident in the T cohort (p =0.07). CONCLUSION Highly porous titanium cups produced using an additive manufacturing and electron beam melting technology achieved reliable midterm clinical and radiographic results not inferior to those of second-generation cups.
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Affiliation(s)
- Francesco Castagnini
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d'Anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy,
| | - Barbara Bordini
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Makiko Yorifuji
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Federico Giardina
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d'Anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Simone Natali
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d'Anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Francesco Pardo
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d'Anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Francesco Traina
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d'Anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Malhotra R, Gautam D. Acute total hip arthroplasty in acetabular fractures using modern porous metal cup. J Orthop Surg (Hong Kong) 2019; 27:2309499019855438. [PMID: 31221006 PMCID: PMC6669984 DOI: 10.1177/2309499019855438] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 04/26/2019] [Accepted: 05/09/2019] [Indexed: 11/17/2022] Open
Abstract
PURPOSE The aim of this study was to report the clinical and radiological outcome of using the modern porous metal cup in patients undergoing acute total hip arthroplasty (THA) for selected subset of acetabular fractures. PATIENT AND METHODS Eighteen patients with acetabular fracture underwent acute THA with modern porous metal cup from a single manufacturer. Fifteen males and three females with a mean age of 46.4 years (range 21-57 years) were ambispectively followed up for a minimum period of 48 months. All patients were evaluated clinically with Harris Hip Scores (HHS) and radiographically with serial X-rays. RESULTS No patient was lost to follow-up. The HHS was excellent in nine patients, good in six patients, fair in two patients, and poor in one patient. All the fractures were united and the cups were well integrated. There was no lucent line seen in any acetabular zones on the X-rays. One patient had infection, which resolved with debridement. There was one dislocation following fall, which was reduced by closed means and remained stable. One of the two patients with heterotopic ossification had restricted movement of hip but not restricting the activities of daily living. No failures of acetabular component were seen in the study. CONCLUSION The current study showed that the modern porous metal cup provides sufficient primary stability and appear suitable for primary THA in acute acetabular fractures at mid-term follow-up: (i) In selected fractures, acute THA can be extended to young adult patients as well. (ii) Modern porous metal cup may provide sufficient stability with or without additional fixation required.
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Affiliation(s)
- Rajesh Malhotra
- Department of Orthopedics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Deepak Gautam
- Department of Orthopedics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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Yoshioka S, Nakano S, Kinoshita Y, Nakamura M, Goto T, Hamada D, Sairyo K. Comparison of a highly porous titanium cup (Tritanium) and a conventional hydroxyapatite-coated porous titanium cup: A retrospective analysis of clinical and radiological outcomes in hip arthroplasty among Japanese patients. J Orthop Sci 2018; 23:967-972. [PMID: 30055877 DOI: 10.1016/j.jos.2018.06.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 05/18/2018] [Accepted: 06/05/2018] [Indexed: 02/09/2023]
Abstract
BACKGROUND The use of 3-dimensional highly porous acetabular cups is increasing. Their structure and mechanical properties mimic those of natural bone; therefore, they should promote stronger biological fixation. In our experience with total hip arthroplasty, radiolucent lines are observed when a 3-dimensional highly porous cup (Stryker Tritanium) is used. We compared the clinical and radiographic results between a Tritanium cup and a conventional cup (Stryker Trident HA) over a short time period. METHOD We retrospectively compared consecutive cases of primary total hip arthroplasty using a Tritanium cup (130 cases in 118 patients) and a matched cohort using a Trident cap (130 cases in 130 patients) between January 2011 and December 2014. RESULTS The mean follow-up duration was 41.3 and 38.1 months (p = 0.06) for the Tritanium and Trident groups, respectively. There were significant differences between the groups for radiolucent lines, cup abduction angle, and cup-center-edge angle. There were no significant differences in the clinical results. Radiolucent lines increased in the Tritanium group (36.1% at 3 months and 60.7% at final follow-up), whereas they decreased in the Trident group (2.5% at 3 months and 0.8% at final follow-up). The occurrence of radiolucent lines was significantly higher in the Tritanium group than in the Trident group at each follow-up period. Radiolucent lines were seen in 36.1% of patients in the Tritanium group during follow-up, without initial gaps. One cup loosening in the Tritanium group was identified at the final follow-up evaluation. CONCLUSION Both groups showed successful clinical results over short-term follow-up; however, the Tritanium group had a significantly higher rate of radiolucent line occurrence around the cups than did the Trident group. Thus, radiolucent lines can occur when using highly porous titanium cups; these lines indicate the possibility of future cup loosening. Longer follow-up and assessment of the results of using this implant are necessary.
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Affiliation(s)
| | | | | | | | - Tomohiro Goto
- Department of Orthopedics, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan
| | - Daisuke Hamada
- Department of Orthopedics, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan
| | - Koichi Sairyo
- Department of Orthopedics, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan
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Bondarenko S, Dedukh N, Filipenko V, Akonjom M, Badnaoui AA, Schwarzkopf R. Comparative analysis of osseointegration in various types of acetabular implant materials. Hip Int 2018; 28:622-628. [PMID: 29742946 DOI: 10.1177/1120700018759314] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND There is a lack of comparative data on osseointegration (BIC) of acetabular cup surfaces in hip arthroplasty in both normal bone mineral density and in conditions of osteoporosis. AIM To compare osseointegration of acetabular implants with various types of surfaces in an animal model with normal and osteoporotic bone tissue. MATERIAL AND METHODS The study was performed on 60 rats. To simulate osteoporosis ovariectomy was performed in 30 animals. Thirty healthy rats served as controls. In standardised defects of the distal metadiaphysis of the femur we implanted: porous tantalum Trabecular Metal (A), Trabecular Titanium (B), Titanium with Gription coating (C), Stiktite (D), and Tritanum (E). Bone apposition (osseointegration) was defined as all areas of direct "bone-to-implant contact" (BIC). RESULTS No qualitative morphological differences in the evaluation of BIC around different implant types was seen in normal rats and rats with osteoporosis. Connective tissue areas around implants were larger in rats with osteoporosis. Morphometric studies showed that the highest BIC were seen in implants A and B, both in healthy animals ([72.00 ± 3.48]% and [67.46 ± 1.69]%) and ones with osteoporosis ([59.19 ± 2.10]% and [53.36 ± 2.57]%). BIC was (60.10 ± 2.05)%, (60.26 ± 2.36)%, and (61.78 ± 2.27)% around implants C, D and E in healthy rats, respectively. BIC in osteoporosis was (45.39 ± 2.37)%, (47.81 ± 2.41)% and (42.10 ± 1.44)%, respectively. CONCLUSION Our study showed that the evaluated implants have good BIC features. Furthermore, based on histomorthometry and histology, Porous tantalum Trabecular Metal (A) and Trabecular Titanium (B) implants exhibit higher BIC with bone tissue.
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Affiliation(s)
- Stanislav Bondarenko
- 1 Sytenko Institute of Spine and Joint Pathology National Academy of Medical Science of Ukraine, Kharkiv, Ukraine
| | - Ninel Dedukh
- 1 Sytenko Institute of Spine and Joint Pathology National Academy of Medical Science of Ukraine, Kharkiv, Ukraine
| | - Volodymyr Filipenko
- 1 Sytenko Institute of Spine and Joint Pathology National Academy of Medical Science of Ukraine, Kharkiv, Ukraine
| | - Mandus Akonjom
- 1 Sytenko Institute of Spine and Joint Pathology National Academy of Medical Science of Ukraine, Kharkiv, Ukraine
| | - Ahmed Amine Badnaoui
- 1 Sytenko Institute of Spine and Joint Pathology National Academy of Medical Science of Ukraine, Kharkiv, Ukraine
| | - Ran Schwarzkopf
- 2 NYU Langone Medical Center, Hospital for Joint Diseases, New York, NY
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Tritanium Acetabular Cup in Revision Hip Replacement: A Six to Ten Years of Follow-Up Study. J Arthroplasty 2018; 33:2566-2570. [PMID: 29685709 DOI: 10.1016/j.arth.2018.03.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 03/05/2018] [Accepted: 03/17/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The use of highly porous acetabular components has shown to produce good results in revision acetabular surgery. Their surface characteristics enhance initial fixation and bone ingrowth which are prerequisites for adequate osseointegration. The purpose of this study is to analyze the mid-term to long-term survival, clinical and radiological outcomes using the Tritanium cup (Stryker, Mahwah, NJ) in revision hip surgery. METHODS This is a retrospective review of all patients who underwent acetabular revision surgery using "Tritanium revision cup" between April 2007 and November 2010 at our institution. Sixty-two patients were included with a mean age of 67.5 years (32-86). According to Paprosky classification, 10 patients had type I defect, 8 had type IIA, 27 had type IIB, 7 had type IIC, and 10 suffered from type IIIA defect. A Kaplan-Meier analysis was used to determine the survival of the cup. Functional outcomes were assessed using Oxford Hip Score. Plain radiographs were performed to assess implant fixation and osseointegration. RESULTS The acetabular cup aseptic survivorship was 98.4% at a mean follow-up of 87.6 months. The mean Oxford Hip Score improved from 14.5 (3-31) preoperatively to 38.5 (12-48) at the final follow-up. Two cups were revised (3.2%): 1 for aseptic loosening and 1 for infection. CONCLUSION Tritanium revision acetabular cup has shown excellent mid-term to long-term clinical and radiographic results with low failure rate and minimal complications. Longer term follow-up would be of value to assess the ongoing survival of this implant construct.
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Long WJ, Nayyar S, Chen KK, Novikov D, Davidovitch RI, Vigdorchik JM. Early aseptic loosening of the Tritanium primary acetabular component with screw fixation. Arthroplast Today 2018; 4:169-174. [PMID: 29896547 PMCID: PMC5994600 DOI: 10.1016/j.artd.2017.11.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 11/21/2017] [Accepted: 11/28/2017] [Indexed: 10/31/2022] Open
Abstract
Ultraporous acetabular components were developed to improve osseointegration and fit for increased longevity and better outcomes after total hip arthroplasty. There is a paucity of literature detailing this acetabular component's clinical performance, with even less detailing those with screw fixation. We identify 5 patients at our institution who underwent revision total hip arthroplasty for early aseptic acetabular cup loosening of an ultraporous acetabular component known as the Tritanium primary cup with secondary screw fixation. They all presented with groin and hip pain after index surgery and underwent follow-up radiographic examination consistent with component loosening requiring revision surgery. This case series reports on the risk of early acetabular cup loosening and its associated clinical presentation, workup, and surgical management in patients with the Tritanium primary cup augmented with screws.
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Affiliation(s)
- William J. Long
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
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27
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Beckmann NA, Jaeger S, Janoszka MB, Klotz MC, Bruckner T, Bitsch RG. Comparison of the Primary Stability of a Porous Coated Acetabular Revision Cup With a Standard Cup. J Arthroplasty 2018; 33:580-585. [PMID: 29108792 DOI: 10.1016/j.arth.2017.09.023] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 08/24/2017] [Accepted: 09/11/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The number of revision hip arthroplasty procedures has been increasing substantially, with the acetabular component requiring component revision in over half of the cases. New porous implant designs attempt to improve outcomes due to improved osseointegration; however, sufficient primary stability is paramount for good osseointegration. METHODS We compared 2 revision cups of the same geometry, yet different surface properties in an in vitro scenario: a porous titanium surface and a conventional sintered-bead titanium surface. These were tested in 10 cadaveric pelvises under a physiologic cyclic partial weight-bearing scenario. Each side was randomly implanted with one of the implants. Relative motion between the bone and cup was measured using an optical measuring device. Statistical evaluation was carried out descriptively using a covariance analysis with repeated measures and a test of fixed effects, with significance determined as P < .05. RESULTS The conventional cup displayed an average relative motion of 28.02 μm; and the porous implant displayed an average relative motion of 33.42 μm. There was no statistically significant difference between the two with regard to the resultant relative motion (P = .2649). The bone mineral density does have a significant influence on resultant relative motion (P = .0406), with higher bone mineral density correlating with less relative motion in both implants. CONCLUSION The porous implant provides similar primary stability to the conventional implant in the tested scenario; the motion of both implants relative to the bone was within safe limits for osseointegration. Bone stock must be considered when choosing implant type and postoperative care.
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Affiliation(s)
- Nicholas A Beckmann
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Sebastian Jaeger
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Maciej B Janoszka
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Matthias C Klotz
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Thomas Bruckner
- Institute for Medical Biometrics and Informatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Rudi G Bitsch
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
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Sodhi N, Izant T, Diana J, Del Gaizo D, Baratz M, Levine A, Campbell D, Harwin SF, Mont MA. Three-Year Outcomes of a Highly Porous Acetabular Shell in Primary Total Hip Arthroplasty. Orthopedics 2018; 41:e154-e157. [PMID: 29120008 DOI: 10.3928/01477447-20171102-03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 10/06/2017] [Indexed: 02/03/2023]
Abstract
This multicenter study evaluated survivorship, functional outcomes, complications, and radiographic outcomes for patients who underwent total hip arthroplasty using a newly developed highly porous 3-dimensional titanium implant. Excellent aseptic (99.6%) and all-cause (98%) survivorship and functional outcomes were found at 3-year follow-up. This highly porous acetabular shell holds promise in total hip arthroplasty. [Orthopedics. 2018; 41(1):e154-e157.].
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Comparative survival analysis of porous tantalum and porous titanium acetabular components in total hip arthroplasty. Hip Int 2017; 27:505-508. [PMID: 28165603 DOI: 10.5301/hipint.5000479] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/25/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Porous tantalum acetabular components (PoTa) are well-studied, but less is known about widely used porous titanium (PoTi) acetabular components. We performed a comparative survival analysis between PoTi and PoTa acetabular components. METHODS Primary or revision THA performed using PoTi (n = 2,976) or PoTa (n = 184) acetabular components with minimum 2-year follow-up (PoTi n = 1,539; PoTa n = 157) were analysed. Univariate and multivariate logistic regression were performed to test the effect of porous metal acetabular component type on revision surgery for aseptic cup loosening. Multivariate model was adjusted for acetabular defect severity according to the Paprosky Classification. RESULTS Only PoTi components used in revision THA failed. Survival of the PoTi acetabular component was 98.6% when used in revision THA at mean 48.3-month follow-up. After adjusting for severity of acetabular defect, there was no difference in survival between PoTi and PoTa acetabular components when used in primary or revision THA. CONCLUSIONS After adjusting for acetabular defect severity, both PoTa and PoTi acetabular components had excellent survival at mean 44.4-month (range 4.3-91.5 months) follow-up when used in primary and revision THA.
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30
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Delanois RE, Gwam CU, Mohamed N, Khlopas A, Chughtai M, Malkani AL, Mont MA. Midterm Outcomes of Revision Total Hip Arthroplasty With the Use of a Multihole Highly-Porous Titanium Shell. J Arthroplasty 2017; 32:2806-2809. [PMID: 28456559 DOI: 10.1016/j.arth.2017.03.065] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 03/22/2017] [Accepted: 03/28/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND We are reporting on the minimum 5-year outcomes of patients who underwent revision total hip arthroplasty (THA) using a specific highly-porous titanium shell. We assessed (1) aseptic and all-cause survivorship; (2) functional outcomes; (3) complications; and (4) radiographic outcomes. METHODS Two hospital databases were evaluated for patients who underwent revision THA due to component instability or aseptic loosening using a cementless highly-porous titanium shell between September 2006 and December 2011. This yielded 35 patients who had a mean age of 61 years (range 14-88 years). Patients had a mean follow-up of 6 years (minimum 5 years). All-cause and aseptic survivorship of the shell was calculated. Functional outcomes were assessed using the Harris Hip Score. We determined the incidence of postoperative complications and performed radiographic evaluation of pelvic radiographs from regular office visits. RESULT The aseptic survivorship of the acetabular component was 97% (95% confidence interval; 8.1-9.5). The all-cause survivorship of the acetabular component was 91% (95% confidence interval; 7.3-8.1). One patient had an aseptic failure and 2 patients had septic failures. The mean postoperative Harris Hip Score was 76 points (range, 61-91 points). Excluding the aseptic and septic failures, there was no osteolysis or progressive radiolucencies present on radiographic evaluation at final follow-up. CONCLUSION At a minimum of 5-year follow-up, the highly-porous titanium acetabular revision shell has excellent survivorship and functional outcomes. Although long-term follow-up is needed to further monitor these implants, the results are promising and demonstrate that this prosthesis may be an excellent option for patients undergoing revision THA.
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Affiliation(s)
- Ronald E Delanois
- Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Chukwuweike U Gwam
- Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Nequesha Mohamed
- Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Anton Khlopas
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Morad Chughtai
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Arthur L Malkani
- Department of Orthopaedic Surgery, University of Louisville, Louisville, Kentucky
| | - Michael A Mont
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
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31
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Faizan A, Chuang P, Aponte C, Moretti V, Sharkey PF. Radiolucencies surrounding acetabular components with three-dimensional coatings: artifact or real? Arthroplast Today 2017; 3:269-274. [PMID: 29204495 PMCID: PMC5712042 DOI: 10.1016/j.artd.2017.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 06/20/2017] [Accepted: 06/20/2017] [Indexed: 11/30/2022] Open
Abstract
Background Several 2-dimensional and 3-dimensional surfaces are available for cementless acetabular fixation. Plain radiographs are used to assess osseointegration; however, the radiographs are limited by their inability to capture the bone fixation process occurring over the 3-dimensional cup surface. In this cadaveric study, we compared the bone apposition between 2-dimensional and 3-dimensional cups. Methods Both types of cups were implanted in 6 cadavers and pelvic radiographs obtained. Each cup was resected from the pelvis with adequate bone around it, and subsequently embedded in a polymer. Six sections of each cup were obtained to examine the metal and bone interface. Photographs and contact radiograph images were obtained for each section, and these were graded to arrive at percent metal-bone contact values for the cups. Results On average, <30% of the cups' areas displayed radiolucencies on the pelvic radiographs for both cup types. For the section images and radiographs, there was about 80% aggregate contact between the cups and surrounding bone in both cup types. In the 3-dimensional cups group, some inconsistencies were found between the section photographs and the corresponding radiograph images. The radiolucencies observed on the section radiograph could not always be correlated with metal to bone gap on the section photograph. Conclusions Good metal-bone contact (75% + contact area) was observed on both cup types. The inconsistencies found in the 3-dimensional cup group may be because of the interaction of radiographs with the unique porous cup surface resulting in artifactual radiolucencies.
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Affiliation(s)
| | | | | | - Vincent Moretti
- The Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Peter F Sharkey
- The Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
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Carli AV, Warth LC, de Mesy Bentley KL, Nestor BJ. Short to Midterm Follow-Up of the Tritanium Primary Acetabular Component: A Cause for Concern. J Arthroplasty 2017; 32:463-469. [PMID: 27642044 DOI: 10.1016/j.arth.2016.07.024] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 07/13/2016] [Accepted: 07/27/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Several acetabular components utilizing novel ultraporous metal substrates have been introduced over the past decade. Collectively by design, they have a lower modulus of elasticity to reduce stress shielding, a higher coefficient of friction to enhance interference fit, and ultraporous surfaces to enhance osseointegration. However, little literature exists regarding their clinical performance. METHODS This study compared the clinical and radiographic results of 109 hips in 95 patients using a Tritanium primary cup (Stryker, Mahwah, NJ) to an age, body mass index, and gender-matched cohort of 100 patients that received a contemporary cup (Stryker Trident PSL HA). RESULTS At an average 4.24 + 1.49 years, implant survivorship of the Tritanium primary cup was 98.2%, with 2 cups revised for failure of osseointegration. One-year radiographs revealed radiolucent and radiosclerotic lines in 2 or more DeLee zones in 30.3% of cups and 3 zone involvement in 8.2%. These proportions increased (40.0% and 17.1%, respectively) at minimum 5-year follow-up. A comparison of 1 year and last follow-up radiographs revealed progression in 13.8%. Tritanium primary components with radiolucency in 2 or more zones exhibited significantly lower HHS at 2 years compared to all Trident peripheral self-locking (PSL) components (P < .0001) and Tritanium primary components with 1 zone or no radiolucency (P = .026). Scanning electron microscopy of a retrieved cup revealed local inflammatory reaction and no evidence of osseointegration. CONCLUSION Despite adequate implant survivorship, over one third of Tritanium primary cups had 2 or more zone radiolucency at minimum 5-year follow-up with associated lower Harris hip scores.
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Affiliation(s)
- Alberto V Carli
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Lucian C Warth
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Karen L de Mesy Bentley
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, New York
| | - Bryan J Nestor
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
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Ranawat AS, Meftah M, Thomas AO, Thippanna RK, Ranawat CS. Use of Oversized Highly Porous Cups in Acetabular Revision. Orthopedics 2016; 39:e301-6. [PMID: 26913762 DOI: 10.3928/01477447-20160222-03] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 08/17/2015] [Indexed: 02/03/2023]
Abstract
This study assessed the efficacy of highly porous cups in revision total hip arthroplasty for Paprosky types II and III acetabular bone loss. The authors identified 33 acetabular revisions in 29 patients from a prospective database (66% type III, 7 with pelvic dissociation). Initial stability was achieved with interference fit between the anterior inferior iliac spine, pubis, and ischium with cups that were 2 to 4 mm larger than the reamed acetabulum and augmented with multiple screw fixations without allograft or wedges. At mean follow-up of 6 years (range, 2.7-7.7 years) after revision surgery, no dislocation, infection, or reoperation was noted. Mean satisfaction score was 6±3.2. Mean anteversion and abduction angles were 43°±4.6° and 21.5°±4.4°, respectively. Complications included limp in 13% of patients, wound issues in 10%, and heterotopic ossification in 17%. Osteointegration was seen in all cups, without any migration. Mean overall osteointegration, based on the average percentage of the 3 zones in both views, was 55%±21% (range, 25%-95%). The most osteointegration was seen in zone I (superior) and zone VI (posterior), and the least osseointegration was seen in zone II (medial) and zone IV (anterior). This method can provide reproducible results in acetabular revision arthroplasty.
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Perticarini L, Zanon G, Rossi SMP, Benazzo FM. Clinical and radiographic outcomes of a trabecular titanium™ acetabular component in hip arthroplasty: results at minimum 5 years follow-up. BMC Musculoskelet Disord 2015; 16:375. [PMID: 26634830 PMCID: PMC4669605 DOI: 10.1186/s12891-015-0822-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 11/19/2015] [Indexed: 01/01/2023] Open
Abstract
Background Aim of this prospective study was to evaluate mid-term clinical and radiographic outcomes in total hip arthroplasty using an acetabular cup made of an innovative biomaterial, Trabecular Titanium™, whose highly porous structure and mechanical properties have been designed to mimic those of the natural bone, thus promoting a more physiological load transfer and a more durable fixation. Methods Between September 2007 and November 2009, 134 total hip replacements and eight revisions were carried out using DELTA-TT primary cups (Lima Corporate, Villanova di San Daniele del Friuli, Italy) in 133 consecutive patients. Mean age was 57.5 ± 14.7 SD (18–92) years. Diagnosis was primarily hip osteoarthritis in 85 (63 %) cases, developmental dysplasia of the hip (DDH) in 24 (18 %) and hip avascular necrosis (AVN) in 10 (7 %). All the revision procedures were due to aseptic loosening of the original implant. Approval of the Institutional Review Board of the IRCCS Policlinico San Matteo in Pavia was obtained for this study. Results Mean follow-up was 72.7 ± 7.9 SD (60–86) months. Average Harris Hip Score (HHS) significantly increased from 44.2 ± 5.4 SD (35–52) preoperatively to 95.9 ± 3.5 SD (88–100) at the last follow-up. No major post-operative complications were observed. 99.3 % of the acetabular components were radiographically stable at the last follow-up, without any radiolucent lines, sclerotic areas or periprosthetic osteolysis. Kaplan-Meier survival rate was 99.3 % at 5 years (95 % confidence interval). Conclusions This first account on the mid-term clinical performance of the DELTA-TT cup shows primary and secondary stability, thus representing an optimal solution for patients with high demands or affected by severe hip conditions.
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Affiliation(s)
- Loris Perticarini
- Clinica Ortopedica e Traumatologica, Università degli Studi di Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Viale Camillo Golgi 19, 27100, Pavia, Italy.
| | - Giacomo Zanon
- Clinica Ortopedica e Traumatologica, Università degli Studi di Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Viale Camillo Golgi 19, 27100, Pavia, Italy.
| | - Stefano Marco Paolo Rossi
- Clinica Ortopedica e Traumatologica, Università degli Studi di Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Viale Camillo Golgi 19, 27100, Pavia, Italy.
| | - Francesco M Benazzo
- Clinica Ortopedica e Traumatologica, Università degli Studi di Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Viale Camillo Golgi 19, 27100, Pavia, Italy.
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John TK, Ghosh G, Ranawat CS, Ranawat AS, Meftah M. Performance of Non-Cemented, Hemispherical, Rim-Fit, Hydroxyapatite Coated Acetabular Component. J Arthroplasty 2015; 30:2233-6. [PMID: 26235521 DOI: 10.1016/j.arth.2015.06.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 05/31/2015] [Accepted: 06/16/2015] [Indexed: 02/01/2023] Open
Abstract
The purpose of this study was to assess the durability of a non-cemented, hemispherical rim-fit, hydroxyapatite coated cup with a highly cross-linked polyethylene in 223 total hip arthroplasties. At 6-years follow-up (range, 5-9), there were no cup revisions for osteolysis or loosening. Radiologic evidence of osseointegration was based on presence of Stress Induced Reactive Cancellous Bone and radial trabeculae, seen in 47% and 93% of cups, respectively; both were most prevalent in Zone 1. There was no interference demarcation in any zones. Two cups were revised (0.9%): one for dislocation and another for infection. The Kaplan-Meier survivorship for cup revision for any failure (infection, dislocation) was 99% and for mechanical failure (osteolysis, loosening) was 100%. This design has excellent safety, efficacy and durability.
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Affiliation(s)
- Thomas K John
- Active Orthopedics and Sports Medicine, Hackensack University Medical Center, Hackensack, New Jersey
| | - Gaurav Ghosh
- Weill Cornell Medical College, Hospital for Special Surgery, New York, New York
| | | | | | - Morteza Meftah
- NYU Langone Medical Center, Hospital for Joint Disease, New York, New York
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Jauregui JJ, Banerjee S, Cherian JJ, Elmallah RK, Pierce TP, Mont MA. Early Outcomes of Titanium-Based Highly-Porous Acetabular Components in Revision Total Hip Arthroplasty. J Arthroplasty 2015; 30:1187-90. [PMID: 25720855 DOI: 10.1016/j.arth.2015.02.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 02/02/2015] [Accepted: 02/11/2015] [Indexed: 02/01/2023] Open
Abstract
Titanium-based highly-porous metal cups have been introduced as a relatively new alternative for enhanced acetabular fixation during revision THA; limited number of studies have evaluated its outcomes. We aimed to assess the clinical, functional, and patient-reported outcomes following the use of new generation highly-porous titanium acetabular implants in the revision setting. Seventy-one revisions were (1:1) matched to a conventional porous-coated cohort and were followed-up clinically and radiographically for at least 2-years. Non-significant differences in overall aseptic-survivorship were found across all types of acetabular defects comparing both cohorts (P=0.3). The overall HHS, UCLA, and SF-36 scores were similar between both cohorts. It remains to be seen if the great potential for enhanced osseointegration translates into improved long-term survivorship compared to conventional-porous devices.
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Affiliation(s)
- Julio J Jauregui
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Samik Banerjee
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Jeffrey J Cherian
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Randa K Elmallah
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Todd P Pierce
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Michael A Mont
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
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Abstract
Symptomatic hip osteonecrosis is a disabling condition with a poorly understood aetiology and pathogenesis. Numerous treatment options for hip osteonecrosis are described, which include non-operative management and joint preserving procedures, as well as total hip replacement (THR). Non-operative or joint preserving treatment may improve outcomes when an early diagnosis is made before the lesion has become too large or there is radiographic evidence of femoral head collapse. The presence of a crescent sign, femoral head flattening, and acetabular involvement indicate a more advanced-stage disease in which joint preserving options are less effective than THR. Since many patients present after disease progression, primary THR is often the only reliable treatment option available. Prior to the 1990s, outcomes of THR for osteonecrosis were poor. However, according to recent reports and systemic reviews, it is encouraging that with the introduction of newer ceramic and/or highly cross-linked polyethylene bearings as well as highly-porous fixation interfaces, THR appears to be a reliable option in the management of end-stage arthritis following hip osteonecrosis in this historically difficult to treat patient population. Cite this article: Bone Joint J 2013;95-B, Supple A:46–50.
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Affiliation(s)
- K. Issa
- Sinai Hospital of Baltimore, 2401
W Belvedere Ave Baltimore, Maryland 21215, USA
| | - R. Pivec
- Sinai Hospital of Baltimore, 2401
W Belvedere Ave Baltimore, Maryland 21215, USA
| | - B. H. Kapadia
- Sinai Hospital of Baltimore, 2401
W Belvedere Ave Baltimore, Maryland 21215, USA
| | - S. Banerjee
- Sinai Hospital of Baltimore, 2401
W Belvedere Ave Baltimore, Maryland 21215, USA
| | - M. A. Mont
- Sinai Hospital of Baltimore, 2401
W Belvedere Ave Baltimore, Maryland 21215, USA
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