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Saviour CM, Mathai B, Gupta S. Mechanobiochemical bone remodelling around an uncemented acetabular component: influence of bone orthotropy. Med Biol Eng Comput 2024; 62:1717-1732. [PMID: 38353834 DOI: 10.1007/s11517-024-03023-0] [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: 08/17/2023] [Accepted: 01/12/2024] [Indexed: 05/09/2024]
Abstract
Mechanical loosening of an implant is often caused by bone resorption, owing to stress/strain shielding. Adaptive bone remodelling elucidates the response of bone tissue to alterations in mechanical and biochemical environments. This study aims to propose a novel framework of bone remodelling based on the combined effects of bone orthotropy and mechanobiochemical stimulus. The proposed remodelling framework was employed in the finite element model of an implanted hemipelvis to predict evolutionary changes in bone density and associated orthotropic bone material properties. In order to account for variations in load transfer during common daily activities, several musculoskeletal loading conditions of hip joint corresponding to sitting down/up, stairs ascend/descend and normal walking were considered. The bone remodelling predictions were compared with those of isotropic strain energy density (SED)-based, isotropic mechanobiochemical and orthotropic strain-based bone remodelling formulations. Although similar trends of bone resorption were predicted by orthotropic mechanobiochemical (MBC) and orthotropic strain-based models across implanted acetabulum, more volume (10-20%) of bone elements was subjected to bone resorption for the orthotropic MBC model. Higher bone resorption (75-85%) was predicted by the orthotropic strain-based and orthotropic MBC models compared to the isotropic MBC and SED-based models. Higher bone apposition (35-160%) across the implanted acetabulum was predicted by the isotropic MBC model, compared to the SED-based model. The remodelling predictions indicated that a reduction in estrogen level might lead to an increase in bone resorption. The study highlighted the importance of including mechanobiochemical stimulus and bone anisotropy to predict bone remodelling adequately.
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Affiliation(s)
- Ceby Mullakkara Saviour
- Department of Mechanical Engineering, Indian Institute of Technology Kharagpur, Kharagpur, 721 302, West Bengal, India
| | - Basil Mathai
- Department of Mechanical Engineering, Indian Institute of Technology Kharagpur, Kharagpur, 721 302, West Bengal, India
- School of Mechanical Engineering, University of Leeds, Leeds, LS2 9JT, UK
| | - Sanjay Gupta
- Department of Mechanical Engineering, Indian Institute of Technology Kharagpur, Kharagpur, 721 302, West Bengal, India.
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Chen G, Wang CY, Ma Z, Yi HL, Bi NM, Zhu WJ, Han J, Lu SL, Zhang SS, Shen H, Zhang WH, Zhang P, Si Y. A prospective and consecutive study assessing short-term clinical and radiographic outcomes of Chinese domestically manufactured 3D printing trabecular titanium acetabular cup for primary total hip arthroplasty: evaluation of 236 cases. Front Surg 2024; 11:1279194. [PMID: 38601877 PMCID: PMC11004300 DOI: 10.3389/fsurg.2024.1279194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 03/11/2024] [Indexed: 04/12/2024] Open
Abstract
Purpose We prospectively evaluate the short-term clinical and radiographic outcomes of the only Chinese domestically produced trabecular titanium acetabular cup(3D ACT™ cup) in primary total hip arthroplasty (THA), aiming to provide evidence-based support for its clinical application. Methods A total of 236 patients, who underwent primary THA using 3D ACT™ cup in the Department of Joint Surgery at our hospital between January 2017 and June 2019, were included in this study. General patient data, imaging information, functional scores, and complications were collected to evaluate the early clinical efficacy. Results All patients were followed up for 33-52 months, with an average of (42.2 ± 9.2) months. At the last follow-up, the preoperative HHS score increased significantly from 43.7 ± 6.8 to 85.6 ± 9.3 points (P < 0.01). Similarly, the preoperative WOMAC scores showed significant improvement from 59.2 ± 5.8 to 13.1 ± 3.5 points (P < 0.01). 92.3% of the patients expressed satisfaction or high satisfaction with the clinical outcome. Furthermore, 87.7% of the acetabular cups were positioned within the Lewinnek safe zone, achieving successful reconstruction of the acetabular rotation center. The cup survival rate at the last follow-up was 100%. Conclusions The utilization of the only Chinese domestically manufactured 3D printing trabecular titanium acetabular cup in primary THA demonstrated favorable short-term clinical and radiographic outcomes. The acetabular cup exhibits excellent initial stability, high survival rate, and favorable osseointegration, leading to a significant enhancement in pain relief and functional improvement. In the future, larger sample sizes and multicenter prospective randomized controlled trials will be required to validate the long-term safety and effectiveness of this 3D ACT™ cup.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Yan Si
- Department of Geriatric Orthopedics, Sichuan Provincial Orthopedic Hospital, Chengdu, Sichuan, China
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Marin E. Forged to heal: The role of metallic cellular solids in bone tissue engineering. Mater Today Bio 2023; 23:100777. [PMID: 37727867 PMCID: PMC10506110 DOI: 10.1016/j.mtbio.2023.100777] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/21/2023] [Accepted: 08/23/2023] [Indexed: 09/21/2023] Open
Abstract
Metallic cellular solids, made of biocompatible alloys like titanium, stainless steel, or cobalt-chromium, have gained attention for their mechanical strength, reliability, and biocompatibility. These three-dimensional structures provide support and aid tissue regeneration in orthopedic implants, cardiovascular stents, and other tissue engineering cellular solids. The design and material chemistry of metallic cellular solids play crucial roles in their performance: factors such as porosity, pore size, and surface roughness influence nutrient transport, cell attachment, and mechanical stability, while their microstructure imparts strength, durability and flexibility. Various techniques, including additive manufacturing and conventional fabrication methods, are utilized for producing metallic biomedical cellular solids, each offering distinct advantages and drawbacks that must be considered for optimal design and manufacturing. The combination of mechanical properties and biocompatibility makes metallic cellular solids superior to their ceramic and polymeric counterparts in most load bearing applications, in particular under cyclic fatigue conditions, and more in general in application that require long term reliability. Although challenges remain, such as reducing the production times and the associated costs or increasing the array of available materials, metallic cellular solids showed excellent long-term reliability, with high survival rates even in long term follow-ups.
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Affiliation(s)
- Elia Marin
- Ceramic Physics Laboratory, Kyoto Institute of Technology, Sakyo-ku, Matsugasaki, 606-8585, Kyoto, Japan
- Department of Dental Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, 602-8566, Japan
- Department Polytechnic of Engineering and Architecture, University of Udine, 33100, Udine, Italy
- Biomedical Research Center, Kyoto Institute of Technology, Sakyo-ku, Matsugasaki, Kyoto, 606-8585, Japan
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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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Cunningham LJ, Walton M, Bale S, Trail IA. A prospective radiostereometric analysis of the stability of a metal-backed glenoid component/autograft composite in reverse shoulder arthroplasty. Bone Joint J 2023; 105-B:912-919. [PMID: 37524346 DOI: 10.1302/0301-620x.105b8.bjj-2022-1280.r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
Aims Reverse total shoulder arthroplasty (rTSA) can be used in complex cases when the glenoid requires reconstruction. In this study, a baseplate with composite bone autograft and a central trabecular titanium peg was implanted, and its migration was assessed for two years postoperatively using radiostereometric analysis (RSA). Methods A total of 14 patients who underwent a rTSA with an autograft consented to participate. Of these, 11 had a primary rTSA using humeral head autograft and three had a revision rTSA with autograft harvested from the iliac crest. The mean age of the patients was 66 years (39 to 81). Tantalum beads were implanted in the scapula around the glenoid. RSA imaging (stereographic radiographs) was undertaken immediately postoperatively and at three, six, 12, and 24 months. Analysis was completed using model-based RSA software. Outcomes were collected preoperatively and at two years postoperatively, including the Oxford Shoulder Score, the American Shoulder and Elbow Score, and a visual analogue score for pain. A Constant score was also obtained for the assessment of strength and range of motion. Results RSA analysis showed a small increase in all translation and rotational values up to six months postoperatively, consistent with settling of the implant. The mean values plateaued by 12 months, with no evidence of further migration. In four patients, there was significant variation outside the mean, which corresponded to postoperative complications. There was a significant improvement in the clinical and patient-reported outcomes from the preoperative values to those at two years postoperatively (p < 0.001). Conclusion These findings show, using RSA, that a glenoid baseplate composite of a trabecular titanium peg with autograft stabilizes within the glenoid about 12 months after surgery, and reinforce findings from a previous study of this implant/graft with CT scans at two years postoperatively, indicating that this type of structural composite results in sound early fixation.
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Affiliation(s)
| | - Mike Walton
- Upper Limb Research Department, Wrightington Hospital, Wrightington, UK
| | - Steve Bale
- Upper Limb Research Department, Wrightington Hospital, Wrightington, UK
| | - Ian A Trail
- Upper Limb Research Department, Wrightington Hospital, Wrightington, UK
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Viswanath A, Newell AK, Cunningham LJ, Walton M, Monga P, Bale S, Trail IA. Survivorship of Allologous Structural Bone Graft at a Minimum of 2 Years When Used to Address Significant Glenoid Bone Loss in Revision Shoulder Arthroplasty: A Computed Tomographic and Clinical Review. J Shoulder Elb Arthroplast 2023; 7:24715492231172371. [PMID: 37197294 PMCID: PMC10184218 DOI: 10.1177/24715492231172371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/29/2023] [Accepted: 04/10/2023] [Indexed: 05/19/2023] Open
Abstract
Background This study assesses outcomes in revision shoulder replacements where the glenoid bone loss was managed using a structural allograft (donated femoral head) in combination with a trabecular titanium (TT) implant. Methods We contacted patients who had undergone revision shoulder arthroplasty using the Lima Axioma TT metal-backed glenoid with an allologous bone graft as a composite who were over 2 years since surgery. Patients underwent computerd tomography evaluation, clinical review, and scoring preoperatively, at 6 months and the latest follow-up. Results Fifteen patients were included with a mean age of 59 (33-76). The average follow-up period was 40.5 months (24-51). 80% showed satisfactory bone graft incorporation and peg integration at the latest follow-up. Three had signs of significant bone graft resorption, although in 2 patients the pegs were still soundly fixed in the host bone. Clinically all patients showed a statistically significant improvement in pain relief, movement, and function. No unusual complications were reported. Conclusion Results show femoral head structural allograft in combination with TT metal-backed glenoid baseplate is a viable option for revision total shoulder replacement in the context of massive glenoid bone loss. We do, however, acknowledge that this resorption rate is higher than in other reported series where autograft is used.
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Affiliation(s)
- Aparna Viswanath
- Upper Limb Research Department, Wrightington Hospital, Lancashire, UK
| | - Amy K Newell
- Upper Limb Research Department, Wrightington Hospital, Lancashire, UK
| | | | - Mike Walton
- Upper Limb Research Department, Wrightington Hospital, Lancashire, UK
| | - Puneet Monga
- Upper Limb Research Department, Wrightington Hospital, Lancashire, UK
| | - Steve Bale
- Upper Limb Research Department, Wrightington Hospital, Lancashire, UK
| | - Ian A Trail
- Upper Limb Research Department, Wrightington Hospital, Lancashire, UK
- Ian A. Trail, Upper Limb Research Department, Wrightington Hospital, Hall Lane, Appley Bridge, Wigan, Lancs WN6 9EP, UK.
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Kaneko T, Nakamura S, Hayakawa K, Tokimura F, Miyazaki T. Clinical and radiological outcomes of total hip arthroplasty in octogenarian patients using a three-dimensional porous titanium cup: a retrospective analysis in Japanese patients. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2022:10.1007/s00590-022-03439-0. [PMID: 36414875 DOI: 10.1007/s00590-022-03439-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 11/14/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE Osteointegration of a three-dimensional (3D) porous titanium material has been experimentally proven, but only a few studies have shown the clinical outcomes of a 3D porous titanium cup in the Japanese elderly population. The purpose of this study was to compare the short-and-medium term clinical and radiographic results of total hip arthroplasty (THA) using a 3D porous titanium cup in patients aged ≥ 80 (octogenarians) versus those aged < 80 (younger controls). METHODS A total of 104 hips that underwent THA using a 3D porous titanium cup (SQRUM TT, Kyocera Medical) were enrolled in the study and were divided into two groups according to age: the octogenarian group (≥ 80, n = 42) and the younger control group (< 80, n = 62). Furthermore, we evaluated patient characteristics, clinical outcomes determined by the Japanese Orthopedic Association score, cup alignment, and incidence of radiolucent lines around the cup. RESULTS The mean follow-up period was 4.2 and 4.0 years (p = 0.29) for octogenarians and younger controls, respectively. The clinical outcomes were excellent, and no revision surgery occurred until the last follow-up in both groups. The number of patients with radiolucent lines at the final evaluation was 21 of 62 (33.9%) in younger controls and 16 of 42 (38.1%) in octogenarians. CONCLUSION THA with 3D porous titanium cup for octogenarians had similar clinical outcomes and incidence of radiolucent lines as those of younger controls, suggesting that the 3D porous titanium cup may be useful in THA for octogenarians. Further investigations will confirm its long-term outcomes.
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Affiliation(s)
- Taizo Kaneko
- Department of Orthopaedic Surgery, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Sakae-cho 35- 2, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Shinya Nakamura
- Department of Orthopaedic Surgery, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Sakae-cho 35- 2, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Kentaro Hayakawa
- Department of Orthopaedic Surgery, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Sakae-cho 35- 2, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Fumiaki Tokimura
- Department of Orthopaedic Surgery, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Sakae-cho 35- 2, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Tsuyoshi Miyazaki
- Department of Orthopaedic Surgery, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Sakae-cho 35- 2, Itabashi-ku, Tokyo, 173-0015, Japan.
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Bondarenko S, Filipenko V, Badnaoui AA, Ashukina N, Maltseva V, Lazarenko I, Schwarzkopf R. PERIACETABULAR BONE CHANGES AFTER TOTAL HIP ARTHROPLASTY WITH HIGHLY POROUS TITANIUM CUPS IN PATIENTS WITH LOW BONE MASS. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2022; 75:1629-1633. [PMID: 35962671 DOI: 10.36740/wlek202207103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE The aim: To assess the bone remodeling around highly porous titanium cups TTM in patients with low bone mass one year after total hip arthroplasty (THA). PATIENTS AND METHODS Materials and methods: In this prospective study were included 18 patients (18 hips), whom was performed primary THA with the use of TTM cups. According to T-score of Lumbar Spine, patients were divided into 2 groups: normal bone mineral density (BMD) (n=9) if T-score ≥ -1, and low BMD (n=9) if T-score < -1. According to DeLee and Charnley's model BMD in 3 periacetabular regions were evaluated 1 week and 1 year after THA. RESULTS Results: One year after primary THA, BMD of all 3 periacetabular regions did not differ in patients of both groups comparing with initial data. One week after THA, it was found that BMD R1 and BMD R3 in low BMD group were lower by 1.4 times (p=0.035) and 1.5 times (р=0.001) respectively, BMD R2 did not differ from the normal BMD group. One year after THA it was found that in low BMD group BMD R1 and BMD R2 were lower by 1.5 times (р=0.005) and 1.3 times (р=0.050) respectively, BMD R3 did not differ from the group with normal BMD. CONCLUSION Conclusions: The use of highly porous titanium cups TTM in patients with low bone mass did not lead to a bone loss in DeLee and Charnley periacetabular zones one year after THA. Consequently, the use of these cups in patients with low bone mass undergoing THA is a valuable treatment option.
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Affiliation(s)
| | | | | | | | | | - Iurii Lazarenko
- MILITARY MEDICAL CLINICAL CENTER OF THE CENTRAL REGION, VINNYTSIA, UKRAINE
| | - Ran Schwarzkopf
- NYU LANGONE ORTHOPEDIC HOSPITAL, HOSPITAL FOR JOINT DISEASES, NYU, UNITED STATES
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Anderl C, Steinmair M, Hochreiter J. Bone Preservation in Total Hip Arthroplasty. J Arthroplasty 2022; 37:1118-1123. [PMID: 35121089 DOI: 10.1016/j.arth.2022.01.077] [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] [Received: 11/14/2021] [Revised: 12/27/2021] [Accepted: 01/22/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Preserving bone stock in younger and more active patients after total hip arthroplasty (THA) is important for future revision. Newer prosthesis designs, including short femoral stems and isoelastic acetabular cups, are likely to preserve more bone stock. However, long-term follow-up studies on bone remodeling after short-stem THA with an isoelastic monoblock acetabular cup are few. Therefore, we evaluated bone preservation after THA using these prostheses at a 5-year follow-up. METHODS This prospective observational study is a 5-year follow-up of our previously reported 2-year observational study on the same cohort of patients. We included 45 patients with primary osteoarthritis treated with a calcar-guided femoral short-stem prosthesis and a monoblock press-fit acetabular cup. We evaluated bone mineral density (BMD) around the prostheses using dual-energy X-ray absorptiometry and reported functional outcomes preoperatively and at 3, 12, 24, and 60 months postoperatively. All complications were recorded. RESULTS At the final follow-up, the BMD was comparable with that at 24 months in Gruen zones 3, 4, 5, 6, and 7, whereas it significantly differed in Gruen zones 1 (P < .0001) and 2 (P < .004). On the acetabular side, the BMD leveled off similarly in all DeLee and Charnley zones between 24 and 60 months (P > .05). Moreover, all measured clinical outcomes significantly improved (P < .001). One perioperative dislocation was reported. CONCLUSION Patients undergoing THA with a calcar-guided femoral short-stem prosthesis and a monoblock acetabular cup can expect preservation of bone stock over a longer follow-up with excellent clinical outcomes and few complications.
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Affiliation(s)
- Conrad Anderl
- Department of Orthopaedic Surgery, Ordensklinikum Barmherzige Schwestern, Vinzenz Gruppe, Center of Orthopaedic Excellence, Teaching Hospital of the Paracelsus Medical University Salzburg, Linz, Austria
| | - Martin Steinmair
- Department of Orthopaedic Surgery, Ordensklinikum Barmherzige Schwestern, Vinzenz Gruppe, Center of Orthopaedic Excellence, Teaching Hospital of the Paracelsus Medical University Salzburg, Linz, Austria
| | - Josef Hochreiter
- Department of Orthopaedic Surgery, Ordensklinikum Barmherzige Schwestern, Vinzenz Gruppe, Center of Orthopaedic Excellence, Teaching Hospital of the Paracelsus Medical University Salzburg, Linz, Austria
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KLAASSEN AD, SCHÄFFER EA, WILLIGENBURG NW, VAN BEERS LWAH, SCHOLTES VAB, VAN DER HULST VPM, KOSTER LA, KAPTEIN BL, MOOJEN DJF, POOLMAN RW. Comparison of early migration patterns between a ceramic and polyethylene liner in uncemented Trabecular Titanium cups: a 2-year randomized controlled trial of 52 hips using radiostereometric analysis. Acta Orthop 2022; 93:451-458. [PMID: 35485295 PMCID: PMC9052219 DOI: 10.2340/17453674.2022.2267] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Ceramic liners may reduce early stability of uncemented acetabular components due to higher stiffness. However, the bone ingrowth capacities of porous trabecular titanium might compensate for this effect. This prospective randomized trial quantifies migration patterns of the Delta-TT cup, and compares polyethylene and ceramic liners. PATIENTS AND METHODS Patients undergoing primary uncemented total hip arthroplasty with the Delta-TT cup and femoral stem with ceramic head were randomized to a polyethylene (n = 25) or ceramic (n = 28) liner. Radiostereometric analysis (RSA) radiographs, patient-reported hip function (HOOS-PS, OHS), and quality of life (EQ5D) were collected at baseline and 1.5, 3, 6, 12, and 24 months postoperatively. Model-based RSA was used to calculate 3D cup translation and rotation, and mixed models were used to compare effects over time between groups. RESULTS At 2 years follow-up, Delta-TT cups showed similar mean proximal translation of 0.56 mm (95% CI 0.38-0.75) in the ceramic (CE) group and 0.54 mm (0.30-0.77) in the polyethylene (PE) group, with a between group effect of 0.02 mm (-0.20-0.23). Most cup migration occurred in the first 1.5 to 3 months, stabilizing within 6 months. Any between-group effects were ≤ 0.30 mm for translation and ≤ 0.45° for rotation. Improvements in patient-reported hip function and quality of life were similar in both groups. INTERPRETATION Regardless of liner type, Delta-TT cups showed some initial migration and stabilized within 6 months, which seems promising for long-term fixation in both cup-liner constructs.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Rudolf W POOLMAN
- Department of Orthopedic Surgery, OLVG, Amsterdam,Department of Orthopedic Surgery, LUMC, Leiden, The Netherlands
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Castagnini F, Caternicchia F, Biondi F, Masetti C, Faldini C, Traina F. Off-the-shelf 3D printed titanium cups in primary total hip arthroplasty. World J Orthop 2021; 12:376-385. [PMID: 34189075 PMCID: PMC8223718 DOI: 10.5312/wjo.v12.i6.376] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 04/02/2021] [Accepted: 05/22/2021] [Indexed: 02/06/2023] Open
Abstract
Three-dimensional (3D)-printed titanium cups used in primary total hip arthroplasty (THA) were developed to combine the benefits of a low elastic modulus with a highly porous surface. The aim was to improve local vascularization and bony ingrowth, and at the same time to reduce periprosthetic stress shielding. Additive manufacturing, starting with a titanium alloy powder, allows serial production of devices with large interconnected pores (trabecular titanium), overcoming the drawbacks of tantalum and conventional manufacturing techniques. To date, 3D-printed cups have achieved dependable clinical and radiological outcomes with results not inferior to conventional sockets and with good rates of osseointegration. No mechanical failures and no abnormal ion release and biocompatibility warnings have been reported. In this review, we focused on the manufacturing technique, cup features, clinical outcomes, open questions and future developments of off-the-shelf 3D-printed titanium shells in THA.
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Affiliation(s)
- Francesco Castagnini
- Department of Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti di Anca e Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Bologna 40136, Italy
| | - Filippo Caternicchia
- Department of Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti di Anca e Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Bologna 40136, Italy
| | - Federico Biondi
- Department of Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti di Anca e Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Bologna 40136, Italy
| | - Claudio Masetti
- Department of Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti di Anca e Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Bologna 40136, Italy
| | - Cesare Faldini
- Department of Clinica I di Ortopedia e Traumatologia, Rizzoli Orthopedic Institute, University of Bologna, Bologna 40136, Italy
- Department of DIBINEM Scienze Biomediche e Neuromotorie, Alma Mater Studiorum Università di Bologna, Bologna 40139, Italy
| | - Francesco Traina
- Department of Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti di Anca e Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Bologna 40136, Italy
- Department of DIBINEM Scienze Biomediche e Neuromotorie, Alma Mater Studiorum Università di Bologna, Bologna 40139, Italy
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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: 4] [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: 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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A New Additive-Manufactured Cementless Highly Porous Titanium Acetabular Cup for Primary Total Hip Arthroplasty-Early Two-Year Follow Up. Surg Technol Int 2021; 38:393-398. [PMID: 33724435 DOI: 10.52198/21.sti.38.os1398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Additive-manufacturing technologies are increasingly being used, not only to create acetabular components with porous coating architecture very similar to the complex trabecular structure of cancellous bone, but also for producing the entire implant in a single step. The aim of this study is to assess two-year clinical and radiological outcomes of a new additive-manufactured cup in primary total hip arthroplasty (THA). MATERIALS AND METHODS We reviewed 266 primary THAs (254 patients) performed in our institution between December 2016 and December 2018 using a new highly porous titanium acetabulum shell fabricated via additive manufacturing. Clinical and functional outcomes were measured using SF/VR-12 and HOOS JR to determine patient satisfaction with surgery. Radiographs were assessed to determine the presence of migration, radiolucency, and loosening. Patients records were reviewed to assess cup survivorship in terms of all-cause revisions and revision for aseptic cup loosening. RESULTS At a minimum of two-year follow up (range: 2-3.45 years), the patient cohort demonstrated significant improvement in postoperative functional scores (hip disability and osteoarthritis outcome score for joint replacement [HOOS JR.] and clinical scores (12-item short-form health survey [SF/VR-12]) (p<0.001). One cup developed progressive radiolucent lines at the prosthesis-bone interface consistent with loosening and was revised. The overall acetabular component two-year survivorship free of all-cause failure was 97.4% (95% confidence interval [CI]: 95.5-99.4%). When aseptic loosening of the acetabular component was used as the failure endpoint, the two-years survivorship rate was 99.6% (95% CI: 98.9-100%). CONCLUSION Highly porous titanium cementless acetabular cups produced via additive-manufacturing showed promising early clinical and radiological results in primary THA with low rates of aseptic loosening. Further follow-up studies are needed to assess the long-term survivorship and outcomes of this new acetabular component.
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Huang Y, Zhou YX, Tian H, Wang JW, Liu WG, Li H. Minimum 7-year Follow-up of A Porous Coated Trabecular Titanium Cup Manufactured with Electron Beam Melting Technique in Primary Total Hip Arthroplasty. Orthop Surg 2021; 13:817-824. [PMID: 33728818 PMCID: PMC8126901 DOI: 10.1111/os.12846] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 09/04/2020] [Accepted: 09/28/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To investigate the cup survivorship, patient satisfaction level, clinical function, and radiographic outcomes of patients who underwent total hip arthroplasty (THA) using electron beam melting (EBM)-produced porous coated titanium cups at mid-term follow up. METHODS A total of 32 patients (32 hips) from five hospitals in China who underwent primary THA using EBM-produced trabecular titanium cups between May and December 2012 were retrospectively reviewed. The inclusion criteria were: (i) patients who underwent THA with the use of EBM-produced cups with possible 7-year follow up; and (ii) patients with follow-up information, including the cup survivorship, patient satisfaction level, and clinical outcomes such as Harris hip score. The exclusion criteria were: (i) patients with neuropathic diseases; and (ii) patients who underwent THA due to neoplastic disease. Five (15.6%) patients were lost to follow up before the 7-year follow-up and, thus, were excluded; none of these patients died due to disease associated with the THA or had undergone removal of their cups as of our last evaluation. The mean age and body mass index of the patients were 59.37 (range: 38.00-69.00) years and 24.51 (range: 16.50-34.10) kg/m2 , respectively. Thirteen (48.1%) of the patients were female. RESULTS The average duration of follow-up was 93.48 (range: 89.00-99.00) months. The median Harris hip score improved from 42.00 (interquartile range: 37.00-49.00) to 97.00 (interquartile range: 92.00-97.00) at the latest follow up (P < 0.001). A total of 18 (66.7%) patients rated their satisfaction level as very satisfied, 6 (22.2%) as satisfied, 2 (7.4%) as neutral and 1 (3.7%) as dissatisfied. No intraoperative or postoperative complications were identified. At the latest follow up, all cups were considered to have achieved osteointegration fixation, with three or more of the five signs evident in the most recent X-ray. However, three cups revealed radiolucent lines with a width of less than 1 mm. The median vertical and horizontal distances between the latest postoperative center of rotation relative to the anatomic center of rotation were 2.50 (interquartile range: -3.10, 6.94) mm superiorly and 3.26 (interquartile range: -8.12, 2.38) mm medially, respectively, at the most recent postoperative follow up. Kaplan-Meier survivorship analysis of cups, with the endpoint defined as postoperative radiolucent lines of less than 1 mm in width in at least two zones, reveals that the 8.25-year survival was 96.3% (95% confidence interval: 76.49%-99.47%). CONCLUSION The mid-term follow-up of patients who underwent primary THA using EBM-produced porous coated titanium cups demonstrated favorable patient satisfaction, good clinical function, excellent survivorship, and adequate biological fixation.
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Affiliation(s)
- Yong Huang
- Department of Orthopaedics, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
| | - Yi-Xin Zhou
- Department of Orthopaedics, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
| | - Hua Tian
- Orthopaedic Department, Peking University Third Hospital, Beijing, China
| | - Jun-Wen Wang
- Department of Orthopaedics and Traumatology, Wuhan Fourth Hospital (Puai Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wen-Guang Liu
- Department of Joint Surgery and Sports Medicine, The Second Hospital of Shandong University, Jinan, China
| | - Hu Li
- Department of Orthopaedic Surgery, Peking University People's Hospital, Beijing, China
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Survivorship of autologous structural bone graft at a minimum of 2 years when used to address significant glenoid bone loss in primary and revision shoulder arthroplasty: a computed tomographic and clinical review. J Shoulder Elbow Surg 2021; 30:668-678. [PMID: 32650067 DOI: 10.1016/j.jse.2020.06.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 06/09/2020] [Accepted: 06/15/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Severe glenoid bone loss remains a challenge in patients requiring shoulder arthroplasty and often requires autogenous bone grafting. The purpose of this study was to assess the integrity of the bone graft at 2 years in a series of primary and revision shoulder replacements where glenoid bone loss was managed using a structural autograft (humeral head or iliac crest bone graft) in combination with a trabecular titanium (TT) implant. METHODS Ethical approval was sought, and the study has a portfolio study status by the NIHR (17/YH/0318). We contacted patients who had primary and revision shoulder arthroplasty with Lima Axioma TT metal-back glenoid with autologous bone graft and were more than 2 years since their operation. All eligible patients underwent computed tomographic evaluation, clinical review, and scoring. Early failures of composite fixation and patients who had revision procedures were excluded (2 patients). RESULTS Forty-one patients (43 shoulders) with a mean age of 65 years (range 33-85 years) were reviewed. There were 24 women and 17 men. The average follow-up period was 40 months (range 24-59 months). Primary arthroplasty was performed in 24 shoulders, whereas 19 shoulders had revision arthroplasty. Twenty-five shoulders had reverse shoulder replacement and 18 had anatomic shoulder replacement. Twenty-four shoulders had graft taken from the humeral head, and 19 had iliac crest bone graft, reflecting the number of revisions. We used Wrightington classification for porous metal implant and bone graft incorporation. Satisfactory bone graft incorporation (>50%) was seen in 40 shoulders, and only 3 patients had <50% graft incorporation. The scans at 2 years or later showed no significant deterioration in the bone graft from the early postoperative scans. Average forward elevation improved from 50° (preoperative) to 98° (range 35°-150°). The mean improvement in mean Oxford Shoulder Score was 16 (preoperative, 15; postoperative, 31) and the mean improvement in Constant score improvement was 36 (preoperative, 12; postoperative, 48). The mean postoperative American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score was 64 (range 30-85). CONCLUSION The use of TT in conjunction with autologous bone graft provides a reliable method of addressing glenoid bone defects in primary and revision shoulder arthroplasty. This graft-trabecular metal composite has been shown to integrate well and remain largely unchanged over a 2-year period. A stable baseplate is essential in difficult primary and revision arthroplasty situations. The stability of this construct in our series is reflected in the satisfactory outcomes.
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16
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Bistolfi A, Linari A, Aprato A, Fusini F, Cravero E, Papotti M, Ferracini R, Massè A. Histological evaluation of acetabular bone quality during revision hip arthroplasty. Hip Int 2020; 30:66-71. [PMID: 33267687 DOI: 10.1177/1120700020966803] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE Aim of this study was to evaluate acetabular bone vitality during revision hip arthroplasty and to compare the bone quality between revision and primary acetabular arthroplasty. METHODS During primary and revision total hip arthroplasty surgeries, biopsies were taken from the acetabulum after reaming. The samples (osteochondral cylinders of approximately ⩽1 cm long and 3 mm thickness), after removing the mineral component, were cut longitudinally with a thickness section of 5 µm and colored with hematoxylin-eosin dichromic dye and then evaluated histologically by optical microscopy with 40× magnification. Preoperative radiographs were evaluated. RESULTS According to inclusion and exclusion criteria, 14 patients formed the revision group patients (mean age: 67.9 years, average time before revision 8.8 years, SD ± 7.06) and 5 patients formed the control primary group (mean age: 61.4 years). The bone quality of the revision group was generally poorer than the primary group, while similar vitality and bone quality has been found between septic and aseptic group. Variables such as age, gender and BMI did not significantly contribute to define bone quality classes. CONCLUSIONS The study confirms the differences in quality and bone vitality between cases and controls and the necessity to find strategies to improve the osteointegrative processes in revision arthroplasties.
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Affiliation(s)
- Alessandro Bistolfi
- Department of Orthopaedics, Traumatology and Rehabilitation, AOU City of Health and Science, Turin, Italy
| | - Alessandra Linari
- Department of Pathology, AOU City of Health and Science, Turin, Italy
| | - Alessandro Aprato
- Department of Orthopaedics, Traumatology and Rehabilitation, AOU City of Health and Science, Turin, Italy
| | | | | | - Mauro Papotti
- Department of Pathology, AOU City of Health and Science, Turin, Italy.,University of Turin, Italy
| | | | - Alessandro Massè
- Department of Orthopaedics, Traumatology and Rehabilitation, AOU City of Health and Science, Turin, Italy.,University of Turin, Italy
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17
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Anderl C, Mattiassich G, Ortmaier R, Steinmair M, Hochreiter J. Peri-acetabular bone remodelling after uncemented total hip arthroplasty with monoblock press-fit cups: an observational study. BMC Musculoskelet Disord 2020; 21:652. [PMID: 33023553 PMCID: PMC7539379 DOI: 10.1186/s12891-020-03675-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 09/24/2020] [Indexed: 11/23/2022] Open
Abstract
Background Bone stock preservation in total hip replacement is essential to allow for later revisions in an increasingly younger and fitter index patient population. While contemporary modular press-fit acetabular cups lead to rigid fixation with equatorial stress and central osteolysis, more elastic fixation may cause different peri-acetabular bone remodelling. The purpose of this study was to investigate changes in peri-acetabular bone mineral density (BMD) in uncemented elastic fixation with monoblock press-fit cups. Methods This prospective observational study included 45 patients with monoblock cups. We evaluated peri-acetabular BMD using dual-energy X-ray absorptiometry and reported functional outcomes and complications. Results At a mean follow-up of 24.2 ± 2.2 months, we found that BMD stabilised in DeLee and Charnley zones I and III and recovered to baseline value in zone II. The mean Harris Hip Scores improved significantly from 56.9 ± 20.0 to 97.2 ± 4.0 (p < 0001). Other than one peri-operative dislocation, we saw no post-operative complications. Conclusions We found favourable adaptive bone changes with BMD stabilisation in the equatorial zones and recovery to pre-operative values in the central zone. Additionally, excellent clinical outcomes and few prosthesis-related complications strengthened the favourable results of monoblock acetabular cups. Trial registration Registration number DRKS00017076.
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Affiliation(s)
- Conrad Anderl
- Department of Orthopaedic Surgery, Ordensklinikum Barmherzige Schwestern, Vinzenz Gruppe, Center of Orthopaedic Excellence, Teaching Hospital of the Paracelsus Medical University Salzburg, Seilerstätte 4, 4020, Linz, Austria.
| | - Georg Mattiassich
- Department of Orthopaedic Surgery, Ordensklinikum Barmherzige Schwestern, Vinzenz Gruppe, Center of Orthopaedic Excellence, Teaching Hospital of the Paracelsus Medical University Salzburg, Seilerstätte 4, 4020, Linz, Austria.,Ludwig-Boltzmann Institute for Experimental and Clinical Traumatology, Donaueschingenstrasse 13, 1200, Vienna, Austria
| | - Reinhold Ortmaier
- Department of Orthopaedic Surgery, Ordensklinikum Barmherzige Schwestern, Vinzenz Gruppe, Center of Orthopaedic Excellence, Teaching Hospital of the Paracelsus Medical University Salzburg, Seilerstätte 4, 4020, Linz, Austria.,Research Unit of Orthopedic Sports Medicine and Injury Prevention, Institute for Sports Medicine, Alpine Medicine and Health Tourism (ISAG), UMIT, Eduard-Wallnöfer-Zentrum 1, 6060, Hall in Tirol, Austria
| | - Martin Steinmair
- Department of Orthopaedic Surgery, Ordensklinikum Barmherzige Schwestern, Vinzenz Gruppe, Center of Orthopaedic Excellence, Teaching Hospital of the Paracelsus Medical University Salzburg, Seilerstätte 4, 4020, Linz, Austria
| | - Josef Hochreiter
- Department of Orthopaedic Surgery, Ordensklinikum Barmherzige Schwestern, Vinzenz Gruppe, Center of Orthopaedic Excellence, Teaching Hospital of the Paracelsus Medical University Salzburg, Seilerstätte 4, 4020, Linz, Austria
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18
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Geng X, Li Y, Li F, Wang X, Zhang K, Liu Z, Tian H. A new 3D printing porous trabecular titanium metal acetabular cup for primary total hip arthroplasty: a minimum 2-year follow-up of 92 consecutive patients. J Orthop Surg Res 2020; 15:383. [PMID: 32887636 PMCID: PMC7487482 DOI: 10.1186/s13018-020-01913-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 08/24/2020] [Indexed: 02/07/2023] Open
Abstract
Background Aseptic cup loosening is still one of the main reasons leading to acetabular cup failures. 3D printing porous trabecular titanium metal acetabular cup may provide good initial stability and secondary fixation because of its highly interconnected, porous structure. Few large sample studies have reported the clinical outcomes of electron beam melting (EBM) porous titanium acetabular cup in Chinese population. Methods We retrospectively collected and analyzed the clinical data of a total of 92 consecutive patients between January 2013 and November 2017, with an average follow-up of 48.2 ± 3.6 months. Clinical outcomes included Harris Hip Score (HHS), the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index, satisfaction rate, and cup survival rate were evaluated. Radiographic assessments were conducted to evaluate osteointegration. Results HHS scores improved significantly while the WOMAC score decreased significantly at the latest follow-up (p < 0.001). The satisfaction rate (prevalence of satisfied or very satisfied) was 91.3%. No acetabular cup failures occurred. Radiolucent lines appeared in 15 cases (18 hips) and disappeared in 6 months. No cup loosening signs found until the last follow-up. The overall survival rate of implantation is 99.1% (cup survival rate 100%). Conclusion The new EBM-produced 3D ACT™ cup demonstrated us its favorable short- to mid-term clinical outcomes in Chinese THA patients. It can provide high acetabular cup survival rate, great clinical improvements and excellent biological fixation. Further investigations are needed to confirm its long-term outcomes.
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Affiliation(s)
- Xiao Geng
- Department of Orthopaedics, Peking University Third Hospital, No. 49 North Garden Road, Beijing, 100191, China
| | - Yang Li
- Department of Orthopaedics, Peking University Third Hospital, No. 49 North Garden Road, Beijing, 100191, China
| | - Feng Li
- Department of Orthopaedics, Peking University Third Hospital, No. 49 North Garden Road, Beijing, 100191, China
| | - Xinguang Wang
- Department of Orthopaedics, Peking University Third Hospital, No. 49 North Garden Road, Beijing, 100191, China
| | - Ke Zhang
- Department of Orthopaedics, Peking University Third Hospital, No. 49 North Garden Road, Beijing, 100191, China
| | - Zhongjun Liu
- Department of Orthopaedics, Peking University Third Hospital, No. 49 North Garden Road, Beijing, 100191, China
| | - Hua Tian
- Department of Orthopaedics, Peking University Third Hospital, No. 49 North Garden Road, Beijing, 100191, China.
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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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Abstract
Three-dimensional (3D) printed titanium orthopaedic implants have recently revolutionized the treatment of massive bone defects in the pelvis, and we are on the verge of a change from conventional to 3D printed manufacture for the mass production of millions of off-the-shelf (non-personalized) implants. The process of 3D printing has many adjustable variables, which taken together with the possible variation in designs that can be printed, has created even more possible variables in the final product that must be understood if we are to predict the performance and safety of 3D printed implants. We critically reviewed the clinical use of 3D printing in orthopaedics, focusing on cementless acetabular components used in total hip arthroplasty. We defined the clinical and engineering rationale of 3D printed acetabular cups, summarized the key variables involved in the manufacturing process that influence the properties of the final parts, together with the main limitations of this technology, and created a classification according to end-use application to help explain the controversial and topical issues. Whilst early clinical outcomes related to 3D printed cups have been promising, in-depth robust investigations are needed, partly because regulatory approval systems have not fully adapted to the change in technology. Analysis of both pristine and retrieved cups, together with long-term clinical outcomes, will help the transition to 3D printing to be managed safely.
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21
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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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Bistolfi A, Cimino A, Lee GC, Ferracini R, Maina G, Berchialla P, Massazza G, Massè A. Does metal porosity affect metal ion release in blood and urine following total hip arthroplasty? A short term study. Hip Int 2018; 28:522-530. [PMID: 29742937 DOI: 10.1177/1120700018762167] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The surface area of exposed metal in a trabecular-titanium acetabular component is wider compared to traditional-titanium implants. The purpose of this study is to establish if this increase in surface area can lead to a significant increase in systemic metal levels. METHODS 19 patients with conventional acetabular component and 19 with trabecular-titanium cup were compared. Aluminum, Vanadium and Titanium in blood and urine were assessed before surgery and at intervals for 2 years. The samples were analysed using an inductively coupled plasma mass spectrometry. RESULTS Patients with trabecular-titanium did not have significantly higher metal ion levels compared to patients with conventional cups up to 2 years. A trend over time was statistically significant in both blood and urine for aluminum and titanium concentrations. CONCLUSIONS The three-dimensionality and the wide surface of the trabecular-titanium acetabular component did not affect metal ion release compared to traditional implants after 2 years.
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Affiliation(s)
- Alessandro Bistolfi
- 1 AO Città della Salute e della Scienza, Department of Orthopeadics, Traumatology and Rehabilitative Medicine, CTO Hospital, Turin, Italy
| | | | - Gwo-Chin Lee
- 3 Hospital of the University of Pennsylvania, Penn Presbyterian Medical Center, Pennsylvania Hospital, PA, USA
| | - Riccardo Ferracini
- 1 AO Città della Salute e della Scienza, Department of Orthopeadics, Traumatology and Rehabilitative Medicine, CTO Hospital, Turin, Italy
| | | | | | - Giuseppe Massazza
- 1 AO Città della Salute e della Scienza, Department of Orthopeadics, Traumatology and Rehabilitative Medicine, CTO Hospital, Turin, Italy.,2 University of the Studies of Turin, Turin, Italy
| | - Alessandro Massè
- 1 AO Città della Salute e della Scienza, Department of Orthopeadics, Traumatology and Rehabilitative Medicine, CTO Hospital, Turin, Italy.,2 University of the Studies of Turin, Turin, Italy
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