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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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Reynolds A, Doyle R, Boughton O, Cobb J, Muirhead-Allwood S, Jeffers J. Dynamics of manual impaction instruments during total hip arthroplasty. Bone Joint Res 2024; 13:193-200. [PMID: 38649151 DOI: 10.1302/2046-3758.134.bjr-2023-0224.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
Abstract
Aims Manual impaction, with a mallet and introducer, remains the standard method of installing cementless acetabular cups during total hip arthroplasty (THA). This study aims to quantify the accuracy and precision of manual impaction strikes during the seating of an acetabular component. This understanding aims to help improve impaction surgical techniques and inform the development of future technologies. Methods Posterior approach THAs were carried out on three cadavers by an expert orthopaedic surgeon. An instrumented mallet and introducer were used to insert cementless acetabular cups. The motion of the mallet, relative to the introducer, was analyzed for a total of 110 strikes split into low-, medium-, and high-effort strikes. Three parameters were extracted from these data: strike vector, strike offset, and mallet face alignment. Results The force vector of the mallet strike, relative to the introducer axis, was misaligned by an average of 18.1°, resulting in an average wasted strike energy of 6.1%. Furthermore, the mean strike offset was 19.8 mm from the centre of the introducer axis and the mallet face, relative to the introducer strike face, was misaligned by a mean angle of 15.2° from the introducer strike face. Conclusion The direction of the impact vector in manual impaction lacks both accuracy and precision. There is an opportunity to improve this through more advanced impaction instruments or surgical training.
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Affiliation(s)
- Adam Reynolds
- Biomechanical Engineering, Imperial College London, London, UK
| | - Ruben Doyle
- Biomechanical Engineering, Imperial College London, London, UK
| | | | - Justin Cobb
- Orthopaedics, Imperial College London, London, UK
| | | | - Jonathan Jeffers
- Department of Mechanical Engineering, Imperial College London, London, UK
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Nam HJ, Lim YW, Jo WL, Bahk JH, Kwon SY, Park HC, AlShammari SM. Is the construct stability of the acetabular cup affected by the acetabular screw configuration in bone defect models? J Orthop Surg Res 2023; 18:354. [PMID: 37173688 PMCID: PMC10176723 DOI: 10.1186/s13018-023-03845-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/08/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND In revision surgery with significant segmental acetabular defects, adequate implant selection and fixation methods are critical in determining successful bony ingrowth. Commercially available total hip prosthesis manufacturers generally offer additional multi-hole options of acetabular shells with identical designs for use in revision THAs where screw holes configurations vary from product to product. This study aims to compare the mechanical stability of the two types of acetabular screw constructs for the fixation of acetabular components: spread-out and pelvic brim-focused configurations. METHODS We prepared 40 synthetic bone models of the male pelvis. In half of the samples with acetabular defects, identical curvilinear bone defects were manually created using an oscillating electrical saw. On the right side, multi-hole-cups in which the direction of the screw holes are centered on the pelvic brim (brim-focused) and, on the left side, multi-hole-cups with the direction of the screw hole spread throughout the acetabulum (spread-out) were implanted into the pelvic synthetic bones. Coronal lever-out and axial torsion tests were performed with a testing machine, measuring load versus displacement. RESULTS The average torsional strengths were significantly higher in the spread-out group over the brim-focused group regardless of the presence of the segmental defect of the acetabulum (p < 0.001). But for the lever-out strength, the spread-out group exhibited significantly higher average strength over the brim-focused group for the intact acetabulum (p = 0.004), whereas the results were reversed in the brim-focused group when the defects were generated (p < 0.001). The presence of acetabular defects reduced the average torsional strengths of the two groups by 68.66% versus 70.86%. In comparison, the decrease in the average lever-out strength was less significant for the brim-focused group than the spread-out group (19.87% vs. 34.25%) (p < 0.001). CONCLUSION Constructs of multi-hole acetabular cups with the spread-out screw holes configuration exhibited statistically better axial torsional strength and coronal lever-out strength. With the presence of posterior segmental bone defects, the spread-out constructs demonstrated significantly better tolerance to axial torsional strength. Still, they exhibited inverted results of higher lever-out strength in the pelvic brim-focused constructs.
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Affiliation(s)
- Ho-Jin Nam
- Asan Catholic Orthopedic Clinic, 13 Baebang-ro, Baebang-eup, Asan-si, Chungcheongnam-do, 31482, South Korea
| | - Young-Wook Lim
- Department of Orthopaedic Surgery, School of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, 06591, Seoul, Korea.
| | - Woo-Lam Jo
- Department of Orthopaedic Surgery, School of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, 06591, Seoul, Korea
| | - Ji Hoon Bahk
- Department of Orthopaedic Surgery, School of Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea, 327, Sosa-ro, Bucheon-si, 14647, Gyeonggi-do, Korea
| | - Soon-Yong Kwon
- Department of Orthopaedic Surgery, School of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, 06591, Seoul, Korea
| | - Hyung Chul Park
- Department of Orthopaedic Surgery, School of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, 06591, Seoul, Korea
| | - Saad Mohammed AlShammari
- Department of Orthopaedic Surgery, King Abdulaziz Air Base Hospital, Ministry of Defence, 75M2+R7R, King Abdel Aziz Air Base, Dhahran, 34641, Saudi Arabia
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Kaplan NB, Barra MF, Jubril A, Knapp E, Awad H, Ginnetti J. Effects of Acetabular Screws on the Initial Stability of Porous Coated Acetabular Implants in Revision Total Hip Arthroplasty. Cureus 2023; 15:e38257. [PMID: 37252568 PMCID: PMC10225166 DOI: 10.7759/cureus.38257] [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] [Accepted: 04/28/2023] [Indexed: 05/31/2023] Open
Abstract
INTRODUCTION Revision total hip arthroplasty in the setting of acetabular bone loss remains a challenging clinical entity. Deficiencies of the acetabular rim, walls, and/or columns may limit the bony surface area and initial acetabular construct stability necessary for osseointegration of cementless components. Press-fit acetabular components with supplemental acetabular screw fixation represent a common technique aimed to minimize implant micromotion and allow for definitive osseointegration. Although acetabular screw fixation is commonly practiced in revision hip arthroplasty, few studies to date have examined the screw properties associated with maximal acetabular construct stability. The purpose of the present report is to examine acetabular screw fixation in a pelvis model mimicking Paprosky IIB acetabular bone loss. METHODS Measuring bone-implant interface micromotion as a surrogate for initial implant stability, experimental models assessed the effect of screw number, screw length, and screw position on construct stability subject to a cyclic loading protocol designed to replicate joint reaction forces of two common daily activities. RESULTS Trends towards increasing stability were demonstrated with increasing screw number, increasing screw length, and concentrating screws in the supra-acetabular dome. All experimental constructs yielded micromotion levels sufficient for bone ingrowth, except when screws in the dome were moved to the pubis and ischium. CONCLUSIONS When using a porous coated revision acetabular implant to treat Paprosky IIB defects, screws should be used, and furthermore, increasing number, length, and position within the acetabular dome may help further stabilize the construct.
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Affiliation(s)
- Nathan B Kaplan
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, USA
| | - Matthew F Barra
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, USA
| | - Ayodeji Jubril
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, USA
| | - Emma Knapp
- Department of Orthopaedics and Rehabilitation/Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, USA
| | - Hani Awad
- Department of Orthopaedics and Rehabilitation/Center for Musculoskeletal Research/Department of Biomedical Engineering, University of Rochester Medical Center, Rochester, USA
| | - John Ginnetti
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, USA
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Woo SH, Shin WC, Han JB, Lee SM, Moon NH, Suh KT. Component Asymmetry in Bilateral Cementless Total Hip Arthroplasty. Clin Orthop Surg 2023; 15:27-36. [PMID: 36778988 PMCID: PMC9880502 DOI: 10.4055/cios22028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/03/2022] [Accepted: 03/03/2022] [Indexed: 11/06/2022] Open
Abstract
Background This study investigated the results of component asymmetry (CA) in bilateral cementless total hip arthroplasty (THA). Methods This study included 300 patients, who underwent bilateral cementless THA between April 2000 and December 2017. They were divided into the component symmetry (CS) and CA groups; CA group was sub-classified into acetabular component asymmetry (ACA) and femoral component asymmetry (FCA). Radiologic and clinical outcomes of the CA group were compared with those of the CS group. Results The incidence of CA was 25.7% (77/300 patients), including 55 patients with ACA, 34 patients with FCA, and 12 with both components asymmetric. The mean time interval between operations in the CA group was significantly longer than that in the CS group (p < 0.001). The mean differences in horizontal and vertical distances from teardrop to the center of rotation of the acetabular component between both hips in the ACA group were significantly larger than those in the CS group (p = 0.033 and p < 0.001, respectively). The mean femoral component alignment angle difference between both hips was significantly larger in the FCA group than in the CS group (p < 0.001). The mean Harris Hip Score at last follow-up of the CA group was similar to that of the CS group. Conclusions CA in patients undergoing bilateral cementless THA was not rare, especially with a longer time interval between operations. Regardless of CA, when stable fixation of the components was achieved, satisfactory radiologic and clinical outcomes were obtained.
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Affiliation(s)
- Seung Hun Woo
- Department of Orthopaedic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Won Chul Shin
- Department of Orthopaedic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jung Bum Han
- Department of Orthopaedic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Sang Min Lee
- Department of Orthopaedic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Nam Hoon Moon
- Department of Orthopaedic Surgery, Pusan National University Hospital, Busan, Korea
| | - Kuen Tak Suh
- Department of Orthopaedic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
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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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7
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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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8
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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: 3] [Impact Index Per Article: 0.8] [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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Burkhart TA, Khadem M, Wood TJ, Dunning CE, Degen R, Lanting BA. Comparison of trans-cortical and cancellous screws to press fit for acetabular shell fixation in total hip arthroplasty: A cadaveric study. Clin Biomech (Bristol, Avon) 2019; 69:34-38. [PMID: 31295668 DOI: 10.1016/j.clinbiomech.2019.06.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 06/24/2019] [Accepted: 06/27/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Total hip arthroplasty complications are associated with mechanical loosening of the acetabular component, which may be attributed to the type of fixation used (press fit, trans-cortical screws, cancellous screws). Therefore, the purpose of this study was to compare trans-cortical and cancellous screws to press fit for fixation of the acetabular shell. METHODS Five cadaveric pelvis specimens were hemisected (N = 10) at the sacroiliac joint. Each hemi-pelvis was initially tested with a press fit cup followed by the left and right pairs being randomized to either a cancellous or trans-cortical screw condition. Each fixation was tested by applying a load to a rod inserted into the centre of the acetabular cup at 0.5 mm/s, until failure occurred. The failure force, failure moment, and the rotation angle of the cup at failure were calculated. FINDINGS The cups fixated with a trans-cortical screw failed at a significantly greater mean [SD] force (1046.20 [386.52] N). The trans-cortical screws also significantly increased the angle of failure 46.29 (16.90) ° compared to the press-fit cups (6.73 [4.59] °). Finally, there was a significant increase in the failure moment, such that, the trans-cortical condition failed at a mean (SD) moment of 53.75 (16.24) Nm compared to 9.59 (1.85) Nm and 32.15 (18.16) Nm for the press fit and cancellous (p = 0.044) conditions, respectively. INTERPRETATION The acetabular shells that were fixated with trans-cortical screws provide greater stability compared to the press-fit cups or cancellous screws.
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Affiliation(s)
- Timothy A Burkhart
- Lawson Health Science Institute, Canada; Department of Mechanical and Materials Engineering, Western University, 1151 Richmond Rd, London, ON N6A 3K7, Canada.
| | - Mehrdad Khadem
- Department of Mechanical and Materials Engineering, Western University, 1151 Richmond Rd, London, ON N6A 3K7, Canada
| | - Thomas J Wood
- Department of Surgery, London Health Sciences Centre, 339 Windermere Road, London, ON N6A 5A5, Canada
| | - Cynthia E Dunning
- Department of Mechanical and Materials Engineering, Western University, 1151 Richmond Rd, London, ON N6A 3K7, Canada
| | - Ryan Degen
- Fowler Kennedy Sports Medicine Clinic, Canada; Department of Surgery, Western University, 1151 Richmond Rd, London, ON N6A 3K7, Canada
| | - Brent A Lanting
- London Health Sciences Centre, Canada; Department of Surgery, 1151 Richmond Rd, London, ON N6A 3K7, Canada
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10
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Wiznia DH, Schwarzkopf R, Iorio R, Long WJ. Factors That Influence Bone-Ingrowth Fixation of Press-Fit Acetabular Cups. JBJS Rev 2019; 7:e2. [DOI: 10.2106/jbjs.rvw.18.00147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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11
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Asai S, Sobue Y, Asai N, Takahashi N, Watanabe T, Matsumoto T, Ishiguro N, Kojima T. Computed tomography evaluation of the periacetabular gap of a porous tantalum acetabular component. NAGOYA JOURNAL OF MEDICAL SCIENCE 2019; 81:159-163. [PMID: 30962665 PMCID: PMC6433632 DOI: 10.18999/nagjms.81.1.159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The periacetabular gap is an inherent consequence of the peripheral rim press-fit of the porous tantalum acetabular component. The circumference of the prosthesis is clearly depicted with computed tomography (CT) images that have been optimised to reduce metal artefacts. This case report highlights the utility of single-energy metal artefact reduction (SEMAR) for CT evaluation of the periacetabular gap by comparing CT images with and without SEMAR. A 70-year-old woman with a 5-year history of rheumatoid arthritis underwent total hip arthroplasty with a porous tantalum modular acetabular component. A periacetabular gap was suspected by plain radiography 2 weeks postoperatively. The metal artefacts rendered evaluation of the circumference of the acetabular component difficult in CT images acquired without SEMAR. In contrast, there were fewer metal artefacts, and a periacetabular gap (depth of 6.5 mm in DeLee and Charnley zone 2) was clearly depicted in CT images with SEMAR 2 weeks postoperatively. The porous surface of the acetabular component was in contact with the anterior and posterior rims of the acetabulum. Gap filling with bone and bone ingrowth into the porous surface were observed on CT images with SEMAR 24 weeks postoperatively. In conclusion, SEMAR reduces metal artefacts and improves CT image quality around the circumference of the acetabular component. The periacetabular gap and its filling with bone are clearly depicted in CT images with SEMAR, but not without SEMAR.
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Affiliation(s)
- Shuji Asai
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasumori Sobue
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Nobuyuki Asai
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Nobunori Takahashi
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tatsuo Watanabe
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takuya Matsumoto
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Ishiguro
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toshihisa Kojima
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, 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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Noordin S, Lakdawala R, Masri BA. Primary total hip arthroplasty: Staying out of trouble intraoperatively. Ann Med Surg (Lond) 2018; 29:30-33. [PMID: 29692894 PMCID: PMC5911669 DOI: 10.1016/j.amsu.2018.03.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 03/13/2018] [Accepted: 03/31/2018] [Indexed: 02/07/2023] Open
Abstract
Total hip Arthroplasty is one of the most successful and commonly performed procedures in Orthopaedic Surgery. Meticulous preoperative planning allows to surgeon anticipate potential problems to reduce postoperative complications and optimize patient outcomes. Currently, the posterior approach is the most common approach utilized in the United States. In order to prevent errors in stem version, especially with cementless fixation, the entry point should be posterior, and the initial entry point should be aligned in the correct anteversion as this will determine the ultimate version of the stem. Preoperative evaluation should asses for true and apparent lengths. For successful osseointegration of cementless components, bone ingrowth occurs when there is less than 40 μm of motion between the implant and bone. Certain socket conformations such as elliptical versus hemispherical are more prone to generate fractures at the time of impaction.
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Affiliation(s)
- Shahryar Noordin
- Associate Professor, Orthopaedic Surgery, Aga Khan University, Karachi, Pakistan
| | - Riaz Lakdawala
- Associate Professor, Orthopaedic Surgery, Aga Khan University, Karachi, Pakistan
| | - Bassam A Masri
- Professor and Head, Department of Orthopaedics, University of British Columbia, Vancouver, Canada
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14
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Tijou A, Rosi G, Hernigou P, Flouzat-Lachaniette CH, Haïat G. Ex Vivo Evaluation of Cementless Acetabular Cup Stability Using Impact Analyses with a Hammer Instrumented with Strain Sensors. SENSORS 2017; 18:s18010062. [PMID: 29280982 PMCID: PMC5796378 DOI: 10.3390/s18010062] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 12/14/2017] [Accepted: 12/23/2017] [Indexed: 11/16/2022]
Abstract
The acetabular cup (AC) implant stability is determinant for the success of cementless hip arthroplasty. A method based on the analysis of the impact force applied during the press-fit insertion of the AC implant using a hammer instrumented with a force sensor was developed to assess the AC implant stability. The aim of the present study was to investigate the performance of a method using a hammer equipped with strain sensors to retrieve the AC implant stability. Different AC implants were inserted in five bovine samples with different stability conditions leading to 57 configurations. The AC implant was impacted 16 times by the two hammers consecutively. For each impact; an indicator IS (respectively IF) determined by analyzing the time variation of the signal corresponding to the averaged strain (respectively force) obtained with the stress (respectively strain) hammer was calculated. The pull-out force F was measured for each configuration. F was significantly correlated with IS (R² = 0.79) and IF (R² = 0.80). The present method has the advantage of not modifying the shape of the hammer that can be sterilized easily. This study opens new paths towards the development of a decision support system to assess the AC implant stability.
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Affiliation(s)
- Antoine Tijou
- Laboratoire de Modélisation et de Simulation Multi-Echelle, CNRS, UMR CNRS 8208, 61 Avenue du Général de Gaulle, 94010 Créteil, France;
| | - Giuseppe Rosi
- Laboratoire de Modélisation et de Simulation Multi-Echelle, UMR CNRS 8208, Université Paris-Est, 61 Avenue du Général de Gaulle, 94010 Créteil, France;
| | - Philippe Hernigou
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital Henri Mondor AP-HP, CHU Paris 12, Université Paris-Est, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France; (P.H.); (C.-H.F.-L.)
- Équipe 10, Groupe 5, IMRB U955, INSERM/UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Charles-Henri Flouzat-Lachaniette
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital Henri Mondor AP-HP, CHU Paris 12, Université Paris-Est, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France; (P.H.); (C.-H.F.-L.)
- Équipe 10, Groupe 5, IMRB U955, INSERM/UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Guillaume Haïat
- Laboratoire de Modélisation et de Simulation Multi-Echelle, CNRS, UMR CNRS 8208, 61 Avenue du Général de Gaulle, 94010 Créteil, France;
- Correspondence: ; Tel.: +33-1-45-17-14-31
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15
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Surface characteristics of bioactive Ti fabricated by chemical treatment for cartilaginous-integration. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2017; 78:495-502. [DOI: 10.1016/j.msec.2017.03.250] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 03/23/2017] [Accepted: 03/26/2017] [Indexed: 12/23/2022]
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16
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Möbius R, Schleifenbaum S, Grunert R, Löffler S, Werner M, Prietzel T, Hammer N. A pilot trial comparing the tear-out behavior in screw-sockets and cemented polyethylene acetabular components - a cadaveric study. Orthop Traumatol Surg Res 2016; 102:723-8. [PMID: 27478000 DOI: 10.1016/j.otsr.2016.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 06/03/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND The removal of well-fixed acetabular components following THA (total hip arthroplasty) is a difficult operation and could be accompanied by the loss of acetabular bone stock. The optimal method for fixation is still under debate. The aim of this pilot study was to compare the tear-out resistance and failure behavior between osseo-integrated and non-integrated screw cups. Furthermore, we examined whether there are differences in the properties mentioned between screw sockets and cemented polyethylene cups. HYPOTHESIS Tear-out resistance and related mechanical work required for the tear-out of osseo-integrated screw sockets are higher than in non-integrated screw sockets. PATIENTS AND METHODS Ten human coxal bones from six cadavers with osseo-integrated screw sockets (n=4), non-integrated (implanted post-mortem, n=3) screw sockets and cemented polyethylene cups (n=3) were used for tear-out testing. The parameters axial failure load and mechanical work for tear-out were introduced as measures for determining the stability of acetabular components following THA. RESULTS The osseo-integrated screw sockets yielded slightly higher tear-out resistance (1.61±0.26kN) and related mechanical work compared to the non-integrated screw sockets (1.23±0.39kN, P=0.4). The cemented polyethylene cups yielded the lowest tear-out resistance with a failure load of 1.18±0.24kN. Compared to the screw cups implanted while alive, they also differ on a non-significant level (P=0.1). Osseous failure patterns differed especially for the screw sockets compared to the cemented polyethylene cups. DISCUSSION Osseo-integration did not greatly influence the tear-out stability in cementless screw sockets following axial loading. Furthermore, the strength of the bone-implant-interface of cementless screw sockets appears to be similar to cemented polyethylene cups. However, given the high failure load, high mechanical load and because of the related bone failure patterns, removal should not be performed by means of tear-out but rather by osteotomes or other curved cutting devices to preserve the acetabular bone stock. LEVEL OF EVIDENCE Level III, case-control-study.
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Affiliation(s)
- R Möbius
- Institute of anatomy, faculty of medicine, university of Leipzig, 13, Liebigstraße, 04103 Leipzig, Germany
| | - S Schleifenbaum
- Department of orthopedics, trauma surgery and plastic surgery, university hospital of Leipzig, 20, Liebigstraße, 04103 Leipzig, Germany
| | - R Grunert
- Department of orthopedics, trauma surgery and plastic surgery, university hospital of Leipzig, 20, Liebigstraße, 04103 Leipzig, Germany; Fraunhofer institute for machine tools and forming technology, 44, Nöthnitzer Straße, 01187 Dresden, Germany
| | - S Löffler
- Institute of anatomy, faculty of medicine, university of Leipzig, 13, Liebigstraße, 04103 Leipzig, Germany
| | - M Werner
- Fraunhofer institute for machine tools and forming technology, 44, Nöthnitzer Straße, 01187 Dresden, Germany
| | - T Prietzel
- Department of orthopedics, trauma surgery and plastic surgery, university hospital of Leipzig, 20, Liebigstraße, 04103 Leipzig, Germany
| | - N Hammer
- Department of anatomy, university of Otago, Lindo Ferguson Building, 270, Great King St, 9016 Dunedin, New Zealand.
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Finnilä S, Moritz N, SvedströM E, Alm JJ, Aro HT. Increased migration of uncemented acetabular cups in female total hip arthroplasty patients with low systemic bone mineral density. A 2-year RSA and 8-year radiographic follow-up study of 34 patients. Acta Orthop 2016; 87:48-54. [PMID: 26569616 PMCID: PMC4940591 DOI: 10.3109/17453674.2015.1115312] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND PURPOSE Low bone mineral density (BMD) may jeopardize the initial component stability and delay osseointegration of uncemented acetabular cups in total hip arthroplasty (THA). We measured the migration of uncemented cups in women with low or normal BMD. PATIENTS AND METHODS We used radiostereometric analysis (RSA) to measure the migration of hydroxyapatite-coated titanium alloy cups with alumina-on-alumina bearings in THA of 34 female patients with a median age of 64 (41-78) years. 10 patients had normal BMD and 24 patients had low systemic BMD (T-score ≤ -1) based on dual-energy X-ray absorptiometry (DXA). Cup migration was followed with RSA for 2 years. Radiographic follow-up was done at a median of 8 (2-10) years. RESULTS Patients with normal BMD did not show a statistically significant cup migration after the settling period of 3 months, while patients with low BMD had a continuous proximal migration between 3 and 12 months (p = 0.03). These differences in cup migration persisted at 24 months. Based on the perceived risk of cup revision, 14 of the 24 cases were "at risk" (proximal translation of 0.2 to 1.0 mm) in the low-BMD group and 2 of the 10 cases were "at risk" in the normal-BMD group (odds ratio (OR) = 8.0, 95% CI: 1.3-48). The radiographic follow-up showed no radiolucent lines or osteolysis. 2 cups have been revised for fractures of the ceramic bearings, but none for loosening. INTERPRETATION Low BMD contributed to cup migration beyond the settling period of 3 months, but the migrating cups appeared to osseointegrate eventually.
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Affiliation(s)
- Sami Finnilä
- Orthopaedic Research Unit, Turku University Hospital and University of Turku
| | - Niko Moritz
- Orthopaedic Research Unit, Turku University Hospital and University of Turku
| | - Erkki SvedströM
- Department of Diagnostic Radiology, Turku University Hospital, Turku, Finland.
| | - Jessica J Alm
- Orthopaedic Research Unit, Turku University Hospital and University of Turku
| | - Hannu T Aro
- Orthopaedic Research Unit, Turku University Hospital and University of Turku,Correspondence:
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Michel A, Bosc R, Sailhan F, Vayron R, Haiat G. Ex vivo estimation of cementless acetabular cup stability using an impact hammer. Med Eng Phys 2015; 38:80-6. [PMID: 26671784 DOI: 10.1016/j.medengphy.2015.10.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Revised: 08/17/2015] [Accepted: 10/15/2015] [Indexed: 11/29/2022]
Abstract
Obtaining primary stability of acetabular cup (AC) implants is one of the main objectives of press-fit procedures used for cementless hip arthroplasty. The aim of this study is to investigate whether the AC implant primary stability can be evaluated using the signals obtained with an impact hammer. A hammer equipped with a force sensor was used to impact the AC implant in 20 bovine bone samples. For each sample, different stability conditions were obtained by changing the cavity diameter. For each configuration, the inserted AC implant was impacted four times with a maximum force comprised between 2500 and 4500 N. An indicator I was determined based on the partial impulse estimation and the pull-out force was measured. The implant stability and the value of the indicator I reached a maximum value for an interference fit equal to 1 mm for 18 out of 20 samples. When pooling all samples and all configurations, the implant stability and I were significantly correlated (R(2) = 0.83). The AC implant primary stability can be assessed through the analysis of the impact force signals obtained using an impact hammer. Based on these ex vivo results, a medical device could be developed to provide a decision support system to the orthopedic surgeons.
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Affiliation(s)
- Adrien Michel
- CNRS, Laboratoire de Modélisation et de Simulation Multi-Echelle, UMR CNRS 8208,61 Avenue du Général de Gaulle, Créteil 94010, France
| | - Romain Bosc
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital Henri Mondor AP-HP, CHU Paris 12, Université Paris-Est, 51 avenue du Maréchal de Lattre de Tassigny, Créteil 94000, France
| | - Frédéric Sailhan
- Service de Chirurgie Ostéo-articulaire et carcinologique, Clinique Arago, 54, boulevard Saint-Jacques, 75014 Paris, France
| | - Romain Vayron
- CNRS, Laboratoire de Modélisation et de Simulation Multi-Echelle, UMR CNRS 8208,61 Avenue du Général de Gaulle, Créteil 94010, France
| | - Guillaume Haiat
- CNRS, Laboratoire de Modélisation et de Simulation Multi-Echelle, UMR CNRS 8208,61 Avenue du Général de Gaulle, Créteil 94010, France; Ecole de Technologie Superieure, Department of Mechanical Engineering, 1100 Rue Notre-Dame Ouest, Montréal, QC H3C 1K3, Canada.
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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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20
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Lehil MS, Bozic KJ. Trends in total hip arthroplasty implant utilization in the United States. J Arthroplasty 2014; 29:1915-8. [PMID: 25062807 DOI: 10.1016/j.arth.2014.05.017] [Citation(s) in RCA: 113] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 04/29/2014] [Accepted: 05/22/2014] [Indexed: 02/01/2023] Open
Abstract
Total hip arthroplasty (THA) implant usage has evolved as experience has been gained with newer implant designs. The purpose of this study was to characterize trends in THA implant usage between 2001 and 2012. The Orthopedic Research Network, which includes 174 hospitals and ~105,000 THA, was used to evaluate trends in fixation, bearings, acetabular cup and liner, and femoral head usage. In 2012, 93% of THAs were cementless; 56% of THA bearings were metal-HXLPE; and 35% were ceramic-HXLPE. 99% of acetabular cups were modular. 61% of femoral heads were metal, 39% were ceramic, 51% were 36mm, and 28% were 32mm. THA implant usage trends favor cementless fixation, metal-on-polyethylene or ceramic-on-polyethylene bearings, modular acetabular cups, and large diameter femoral heads.
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Affiliation(s)
- Mandeep S Lehil
- School of Medicine, University of California, San Francisco, San Francisco, California
| | - Kevin J Bozic
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California; Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California
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Scemama C, David B, Bensidhoum M, Hamadouche M. Osseointegration of polyethylene implants coated with titanium and biomimetically or electrochemically deposited hydroxyapatite in a rabbit model. INTERNATIONAL ORTHOPAEDICS 2014; 38:1739-44. [PMID: 24859898 DOI: 10.1007/s00264-014-2364-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 04/21/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study was to evaluate the osseointegration of a new coating directly deposited on PE at room temperature. METHODS Thirty-six (36) male New Zealand rabbits were randomly assigned to receive one out of three types of implants: two tested implants, i.e. PE implant coated with TiPVD and biomimetic HA (biomimetic), PE implant coated with TiPVD and electrolytic HA (electrolytic), and positive control made of massive microrough titanium coated with plasma sprayed HA (TiHAPS). Osseointegration was evaluated by histomorphometry (bone tissue in contact [BIC]), mineralized bone area [MBA]) and mechanical testing (push-out test, interfacial shear strength [ISS]) at six and 12 weeks in the distal femurs. RESULTS For BIC there were no differences between the groups at six (p = 0.98) and 12 weeks (p = 0.13). For MBA, no statistically significant difference was measured between groups at six (p = 0.52) and 12 weeks (p = 0.57). At six weeks, interfacial shear strength (ISS) was significantly higher (p = 0.01) for TiHAPs implants compared to biomimetic and electrolytic implants. This difference was not significant at 12 weeks (p = 0.92). CONCLUSION The osseointegration of biomimetic and electrolytic implants was equivalent to a positive control at 12 weeks.
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Ros V, Martínez Alvarez M, Fernández S, Girvent R, Carballo A, Gili G, Torner P. High short-term loosening rates with the Wagner Standard Cup. J Arthroplasty 2014; 29:172-5. [PMID: 23643713 DOI: 10.1016/j.arth.2013.03.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Revised: 02/27/2013] [Accepted: 03/24/2013] [Indexed: 02/01/2023] Open
Abstract
The stability of prosthetic fixation is to a large extent dependent on component design. The purpose of this study is to analyze the short-term radiological results obtained with the Wagner Standard Cup in primary hip arthroplasty. An assessment was made of one hundred primary hip arthroplasties. The radiological evaluation revealed bone ingrowth in 37 of cases, fibrous integration in 49 and loosening in 14. In summary, osseointegration of the Wagner Standard Cup was unsuccessful in a high percentage of cases. This finding, which was unrelated to the type of stem or bearing surface used, bore a statistically significant relation (P<0.05) with an observed poor bone coverage of the acetabular component. Although insufficient bone coverage could arguably be attributable to a poor surgical technique, we would tend to agree with other authors that it is rather likely to result from a flawed implant design that impedes osseointegration.
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Affiliation(s)
- Vanesa Ros
- Orthopaedic Department, Hospital Universitario Parc Taulí, Sabadell 08208, Barcelona, Spain
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Safir O, Lin C, Kosashvili Y, Mayne IP, Gross AE, Backstein D. Limitations of conventional radiographs in the assessment of acetabular defects following total hip arthroplasty. Can J Surg 2013; 55:401-7. [PMID: 22992397 DOI: 10.1503/cjs.000511] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Conventional radiographs are routinely used to evaluate acetabular bone loss as part of the follow-up in patients who undergo total hip arthroplasty (THA). The objective of this study was to examine the accuracy and specificity of conventional radiographs reviewed by arthroplasty surgeons in detecting acetabular bone loss in patients with prior THA. METHODS Using a cadaveric pelvic model, a defined percentage of bone was incrementally removed from the posterior acetabular column, followed by implantation of uncemented cups into both acetabula. Ten orthopedic arthroplasty surgeons, blinded to the defect sizes, assessed the percentage of bone defect using standard anteroposterior, Judet and oblique conventional radiographs. RESULTS Observers were unable to accurately grade bone defects using conventional radiographs. For defects less than 50%, observers reported on average a defect of 11%. Although observer estimates of defects 50% or more increased, these treatment-altering bone deficiencies remained grossly underestimated, with a sensitivity and specificity of 36.6% and 97.6%, respectively. CONCLUSION Conventional radiographs reviewed by experienced arthroplasty surgeons do not reliably detect small bone lesions (< 50%). Although more successful in detecting larger bone lesions, surgeons tend to underestimate actual bone loss. Computed tomography scanning may be indicated if accurate estimation of acetabular bone loss is required in patients who have undergone previous THA.
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Affiliation(s)
- Oleg Safir
- The Arthroplasty Division, Orthopedic Department, Mount Sinai Hospital, Toronto, Ont
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Cemented all-polyethylene acetabular implants vs other forms of acetabular fixation: a systematic review and meta-analysis of randomized controlled trials. J Arthroplasty 2012; 27:1544-1553.e10. [PMID: 22333867 DOI: 10.1016/j.arth.2011.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Accepted: 12/10/2011] [Indexed: 02/01/2023] Open
Abstract
The cost of primary total hip replacement products approaches 65% of the total reimbursement. Durability of total hip replacement resides with the acetabular component. This systematic review and meta-analysis determined if the outcomes of durability, function, and adverse events associated with cemented all-polyethylene acetabular components was similar to other acetabular designs, holding other variables constant. Randomized controlled trials only were evaluated. Two independent reviewers collected the data from 6 randomized controlled trials. Appropriate statistical analysis was performed. There was no statistical difference in regard to the outcomes at various time points (≤3, 4-8, and ≥10 years) in the 907 implants evaluated. There does, however, appear to be a trend toward abject failure with cemented all-polyethylene acetabular component implants consistent with findings of increased radiolucencies more than 10 years out. The issue of increased radiolucencies over time and failure with these types of implants bears closer scrutiny.
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Abstract
Over the past three decades, alumina ceramic, now in its third/fourth generation, has been markedly improved in terms of its mechanical properties, including purity, grain microstructure, and burst strength. In the clinic, it is particularly suitable for young and for very active patients. This paper discusses the development and characteristics of different kinds of ceramics. In addition, ceramics in the third/fourth generation which are used in total hip arthroplasty clinically are reviewed in detail.
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Affiliation(s)
- You-zhi Cai
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Johanson NA, Litrenta J, Zampini JM, Kleinbart F, Goldman HM. Surgical treatment options in patients with impaired bone quality. Clin Orthop Relat Res 2011; 469:2237-47. [PMID: 21384210 PMCID: PMC3126955 DOI: 10.1007/s11999-011-1838-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Bone quality should play an important role in decision-making for orthopaedic treatment options, implant selection, and affect ultimate surgical outcomes. The development of decision-making tools, currently typified by clinical guidelines, is highly dependent on the precise definition of the term(s) and the appropriate design of basic and clinical studies. This review was performed to determine the extent to which the issue of bone quality has been subjected to this type of process. QUESTIONS/PURPOSES We address the following issues: (1) current methods of clinically assessing bone quality; (2) emerging technologies; (3) how bone quality connects with surgical decision-making and the ultimate surgical outcome; and (4) gaps in knowledge that need to be closed to better characterize bone quality for more relevance to clinical decision-making. METHODS PubMed was used to identify selected papers relevant to our discussion. Additional sources were found using the references cited by identified papers. RESULTS Bone mineral density remains the most commonly validated clinical reference; however, it has had limited specificity for surgical decision-making. Other structural and geometric measures have not yet received enough study to provide definitive clinical applicability. A major gap remains between the basic research agenda for understanding bone quality and the transfer of these concepts to evidence-based practice. CONCLUSIONS Basic bone quality needs better definition through the systematic study of emerging technologies that offer a more precise clinical characterization of bone. Collaboration between basic scientists and clinicians needs to improve to facilitate the development of key questions for sound clinical studies.
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Affiliation(s)
- Norman A. Johanson
- Department of Orthopaedic Surgery, Drexel University College of Medicine, 245 N 15th Street, MS 420, Philadelphia, PA 19102 USA
| | - Jody Litrenta
- Drexel University College of Medicine, Philadelphia, PA USA
| | - Jay M. Zampini
- Department of Orthopaedic Surgery, Drexel University College of Medicine, 245 N 15th Street, MS 420, Philadelphia, PA 19102 USA
| | - Frederic Kleinbart
- Department of Orthopaedic Surgery, Drexel University College of Medicine, 245 N 15th Street, MS 420, Philadelphia, PA 19102 USA
| | - Haviva M. Goldman
- Department of Orthopaedic Surgery, Drexel University College of Medicine, 245 N 15th Street, MS 420, Philadelphia, PA 19102 USA ,Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA USA
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Stamenkov RB, Howie DW, Neale SD, McGee MA, Taylor DJ, Findlay DM. Distribution of periacetabular osteolytic lesions varies according to component design. J Arthroplasty 2010; 25:913-9. [PMID: 19775854 DOI: 10.1016/j.arth.2009.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2008] [Accepted: 08/01/2009] [Indexed: 02/01/2023] Open
Abstract
Using computed tomography, the volume, location, and number of osteolytic lesions were determined adjacent to 38 Harris-Galante 1 (HG-1) acetabular components fixed with screws and 19 porous-coated anatomic (PCA) acetabular components press-fitted without screws. The median implantation times were 16 and 15 years, respectively. The mean total lesion volumes were similar: 11.1 cm(3) (range, 0.7-49 cm(3)) and 9.8 cm(3) (range, 0.4-52 cm(3)), respectively, for hips with HG-1 and PCA components (P = .32). There was a significant difference in the proportion of rim-related, screw or screw hole-related, and combined lesions between the 2 component designs (P < .0001). HG-1 components had more screw and screw hole-related lesions, and PCA components had more rim-related lesions. Although there are concerns regarding screw and screw hole-associated osteolysis, these findings suggest that peripheral fixation may be well maintained in the long term with the use of multiple-hole acetabular components with screw fixation.
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Affiliation(s)
- Roumen B Stamenkov
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia
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Bjørgul K, Novicoff WM, Andersen ST, Brevig K, Thu F, Wiig M, Ahlund O. No differences in outcomes between cemented and uncemented acetabular components after 12-14 years: results from a randomized controlled trial comparing Duraloc with Charnley cups. J Orthop Traumatol 2010; 11:37-45. [PMID: 20198405 PMCID: PMC2837808 DOI: 10.1007/s10195-010-0082-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2009] [Accepted: 01/16/2010] [Indexed: 01/16/2023] Open
Abstract
Background Even though there are multiple studies documenting the outcome of the Charnley low-friction arthroplasty as well as abundant studies on uncemented arthroplasties, there is a dearth of comparative studies of the uncemented acetabular component and a cemented component. In this study we aimed to document the long-term clinical and radiographic outcome as well as component survival in a randomized controlled trial. Materials and methods Two hundred fifteen patients (240 hips) were randomly allocated to receive a cemented Charnley cup or uncemented Duraloc 1200 cup. All patients received cemented Charnley stems and were evaluated clinically and radiographically after 6 months, and 2, 5, and 10 years. Results Harris Hip Scores improved from 48.3 [95% confidence interval (CI) 45.0–51.6] to 90.2 [95% CI 87.9–92.6] in the Charnley group and from 49.3 [95% CI 86.9–91.3] in the Duraloc group at 6 months. After 10 years, the Charnley group’s Harris Hip Score was 89.8 [95% confidence interval (CI) 87.0–92.6], and the Duraloc group’s score was 87.3 (95% CI 84.1–90.6). In the radiographic analysis after 10 years, there was no statistical difference in the prevalence of radiographic signs of loosening. Nine cups were revised in the Charnley group, and five cups were removed in the Duraloc group. The difference was not statistically significant. There was no statistical difference between the cups when aseptic loosening was the end-point, nor in survival analyses. Conclusions There is no statistically significant difference in clinical or radiological outcome between the Charnley cup and the Duraloc after 10 years, and no difference in implant survival after 12–14 years. The uncemented Duraloc cup is as good as the cemented Charnley cup after 10 years.
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Affiliation(s)
- Kristian Bjørgul
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, 22908-0159, USA.
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29
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Zenz P, Stiehl JB, Knechtel H, Titzer-Hochmaier G, Schwagerl W. Ten-year follow-up of the non-porous Allofit cementless acetabular component. ACTA ACUST UNITED AC 2009; 91:1443-7. [DOI: 10.1302/0301-620x.91b11.22368] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Cementless acetabular fixation has demonstrated superior long-term durability in total hip replacement, but most series have studied implants with porous metal surfaces. We retrospectively evaluated the results of 100 consecutive patients undergoing total hip replacement where a non-porous Allofit component was used for primary press-fit fixation. This implant is titanium alloy, grit-blasted, with a macrostructure of forged teeth and has a biradial shape. A total of 81 patients (82 hips) were evaluated at final follow-up at a mean of 10.1 years (8.9 to 11.9). The Harris Hip Score improved from a mean 53 points (23 to 73) pre-operatively to a mean of 96 points (78 to 100) at final review. The osseointegration of all acetabular components was radiologically evaluated with no evidence of loosening. The survival rate with revision of the component as the endpoint was 97.5% (95% confidence interval 94 to 100) after 11.9 years. Radiolucency was found in one DeLee-Charnley zone in four acetabular components. None of the implants required revision for aseptic loosening. Two patients were treated for infection, one requiring a two-stage revision of the implant. One femoral stem was revised for osteolysis due to the production of metal wear debris, but the acetabular shell did not require revision. This study demonstrates that a non-porous titanium acetabular component with adjunct surface fixation offers an alternative to standard porous-coated implants.
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Affiliation(s)
- P. Zenz
- Orthopaedic Centre, OttoWagnerSpital, Sanatoriumstrass 2, A-1140 Wien, Austria
| | - J. B. Stiehl
- St. Mary’s Hospital, Centralia Illinois, 4573, CJ Heck Road, Salem, Illinois 62881, USA
| | - H. Knechtel
- Orthopaedic Centre, OttoWagnerSpital, Sanatoriumstrass 2, A-1140 Wien, Austria
| | - G. Titzer-Hochmaier
- Orthopaedic Centre, OttoWagnerSpital, Sanatoriumstrass 2, A-1140 Wien, Austria
| | - W. Schwagerl
- Orthopaedic Centre, OttoWagnerSpital, Sanatoriumstrass 2, A-1140 Wien, Austria
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30
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Mayman DJ, González Della Valle A, Lambert E, Anderson J, Wright T, Nestor B, Sculco TP, Salvati EA. Late fiber metal shedding of the first and second-generation Harris Galante acetabular component. A report of 5 cases. J Arthroplasty 2007; 22:624-9. [PMID: 17562426 DOI: 10.1016/j.arth.2006.05.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2005] [Accepted: 05/21/2006] [Indexed: 02/01/2023] Open
Abstract
Five patients presented with fiber metal mesh shedding of a Harris Galante II acetabular cup detected between 11 and 15 years after implantation. All patients presented with hip pain and 4 demonstrated gross acetabular loosening and fiber metal separation on preoperative radiographs. The remaining patient underwent revision surgery because of a liner dislodgment and had a radiographically well fixed shell. Loosening and fiber metal separation were detected intraoperatively. Scanning electron microscopy of the retrieved shells demonstrated isolated diffusion bonding marks in the areas where the mesh separated from the substrate and no evidence of corrosion. Progressive osteolysis in the iliac bone was evident in 4 of our cases. Progressive iliac osteolysis may lead to loss of bone support in well-fixed cups and excessive stresses transferred to the interface between the fiber metal mesh and the titanium substrate leading to the separation of the 2 layers. Fiber metal separation may contribute to long-term loosening in the Harris Galante acetabular component.
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Affiliation(s)
- David J Mayman
- Hospital for Special Surgery, Weill Medical College, Cornell University, New York, New York 10021, USA
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31
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Hamilton WG, Calendine CL, Beykirch SE, Hopper RH, Engh CA. Acetabular fixation options: first-generation modular cup curtain calls and caveats. J Arthroplasty 2007; 22:75-81. [PMID: 17570283 DOI: 10.1016/j.arth.2006.12.115] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2006] [Accepted: 12/24/2006] [Indexed: 02/01/2023] Open
Abstract
This study reviewed the outcome of a single institution's experience with 910 primary total hip arthroplasties using 3 different types of modular, first-generation, hemispheric porous-coated cups. The population included 433 Arthopor, 394 ACS Triloc+, and 83 Harris-Galante components. Among 168 total hip arthroplasties that have undergone acetabular revision, aseptic loosening has occurred in 20 cases. Using liner or cup revision for any reason as an end point, we found that 15-year survivorship was 74.9% +/- 6.2% (95% confidence interval) for the Arthopor cups, 70.1% +/- 7.0% for the ACS Triloc+ components, and 89.3% +/- 10.3% for the Harris-Galante cups (P = .02, log rank). Despite a high incidence of revision for polyethylene wear-related complications and occasional late porous-coating delamination, survivorship using revision for aseptic loosening as an end point exceeded 95% at 15 years for all 3 cup designs.
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Affiliation(s)
- William G Hamilton
- Anderson Orthopaedic Research Institute, Alexandria, Virginia 22307, USA
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32
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Romero F, Amirouche F, Aram L, Gonzalez MH. Experimental and analytical validation of a modular acetabular prosthesis in total hip arthroplasty. J Orthop Surg Res 2007; 2:7. [PMID: 17506882 PMCID: PMC1891272 DOI: 10.1186/1749-799x-2-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2006] [Accepted: 05/16/2007] [Indexed: 11/10/2022] Open
Abstract
A finite element model has been developed to predict in vivo micro motion between a modular acetabular cup and liner after cement less total hip arthroplasty. The purpose of this study is to experimentally validate the model. Six LVDT sensors were used to monitor the micromotion of the liner when subjected to loading conditions ranging from 250 N to 5000 N. Deformations at points of interest for both the experiment and FEM were compared. Results of the FEM with different coefficient of friction between the liner and the cup were investigated to correlate with the experimental results.
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Affiliation(s)
- Francisco Romero
- Department of Mechanical Engineering, Biomechanics Laboratory, University of Illinois at Chicago, 842 W. Taylor Street, Room 1039, Chicago, Illinois 60607, USA
| | - Farid Amirouche
- Department of Mechanical Engineering, Biomechanics Laboratory, University of Illinois at Chicago, 842 W. Taylor Street, Room 1039, Chicago, Illinois 60607, USA
- Department of Orthopaedic Surgery, University of Illinois at Chicago, 1801 W. Taylor Street, Chicago, Illinois, USA
| | - Luke Aram
- Department of Mechanical Engineering, Biomechanics Laboratory, University of Illinois at Chicago, 842 W. Taylor Street, Room 1039, Chicago, Illinois 60607, USA
| | - Mark H Gonzalez
- Department of Mechanical Engineering, Biomechanics Laboratory, University of Illinois at Chicago, 842 W. Taylor Street, Room 1039, Chicago, Illinois 60607, USA
- Department of Orthopaedic Surgery, University of Illinois at Chicago, 1801 W. Taylor Street, Chicago, Illinois, USA
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33
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Hsu JT, Lai KA, Chen Q, Zobitz ME, Huang HL, An KN, Chang CH. The relation between micromotion and screw fixation in acetabular cup. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2006; 84:34-41. [PMID: 16971018 DOI: 10.1016/j.cmpb.2006.08.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2005] [Revised: 07/05/2006] [Accepted: 08/05/2006] [Indexed: 05/11/2023]
Abstract
One of the major causes inducing loosening in the cementless acetabular cup implanting is its insufficient initial stability. In this study, three-dimensional finite element models of the pelvis and acetabular components were developed to investigate the relationship between relative micromotion, initial stability, and screw fixation under six daily activity loadings. A commercial available hemispheric cup with five screw holes was used as the target acetabular cup. The simulation results showed that if screws were placed closed together, when the screw number increased from 1 to 5, the peak micromotion decreased less than 14%, from 126.5 to 108.8 microm, while the stable region, micromotion less than 28 microm, enlarged only by 40%, from 46.1% to 64.7%. However, if the screw could be placed near the cup rim, a single rim screw, 202.1 microm micromotion, could provide better stability than that of four dome screws, 209.6 microm micromotion, placed closed together. To conclude, multiple cup screws should be placed near cup rim and as separate as possible to enlarge the stable region and reduce the peak micromotion between cup and acetabulum.
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Affiliation(s)
- Jui-Ting Hsu
- Institute of Biomedical Engineering, National Cheng Kung University, Tainan 701, Taiwan, ROC
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34
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Merican AM, Randle R. Early clinical and radiographic analysis of the Fitmore cup. J Arthroplasty 2006; 21:846-51. [PMID: 16950037 DOI: 10.1016/j.arth.2005.09.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2004] [Accepted: 09/09/2005] [Indexed: 02/01/2023] Open
Abstract
The Fitmore titanium mesh cementless acetabular component in 115 hip arthroplasties was reviewed at an average of 33 months of follow-up. None were revised nor had infection. One hip dislocated 4 years postoperatively. Two femoral components were revised. The average Harris Hip Score at the last follow-up was 90 points. In the 96 sets of radiographs available, there was no loosening or new radiolucency. One hip had nonprogressive osteolysis adjacent to a screw. This press-fit cup has its polar region flattened and is rim loading. Noncontact (gaps) at the acetabular floor is expected and is not critical for fixation. In all but 6 hips, these gaps filled. In 5 hips, a minimal gap (<or=0.5 mm) remained in part of the equatorial region. The Fitmore cup osseointegrates successfully.
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Affiliation(s)
- Azhar M Merican
- Department of Orthopaedic Surgery, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
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35
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Capello WN, D'Antonio JA, Manley MT, Feinberg JR. Arc-deposited hydroxyapatite-coated cups: results at four to seven years. Clin Orthop Relat Res 2005; 441:305-12. [PMID: 16331019 DOI: 10.1097/01.blo.0000191276.88151.84] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
UNLABELLED A second-generation arc-deposited hydroxyapatite-coated acetabular component was developed after detailed analysis of a failed first-generation grit-blasted hydroxyapatite-coated cup. In our prospective multicenter study we aimed to compare clinical results and survivorship of the newly designed cup to the previous cup and to a similarly designed porous-coated cup during the same time period. The effect of bearing surface-alumina-on-alumina to polyethylene-on-metal-was analyzed. Consecutive patients were assigned randomly to one of three groups: arc-deposited hydroxyapatite-coated cup with alumina-on-alumina bearing surface; porous-coated cup with alumina-on-alumina bearing surface; or porous-coated cup with polyethylene-on-metal bearing surface. A fourth comparison group with a grit-blasted hydroxyapatite-coated cup and polyethylene-on-metal bearing surface was culled from a previous study. Acetabular mechanical failure rate is 0.0%, 0.0%, 1.9%, and 11.2% for the arc-deposited hydroxyapatite-coated, porous-coated with alumina bearing surface, porous-coated with polyethylene-on-metal bearing, and grit-blasted hydroxyapatite-coated cup, respectively, at 4- to 7-years' followup. There are no cases of acetabular osteolysis or femoral neck scalloping and no radiolucent lines in any zone with the arc-deposited hydroxyapatite-coated cup. The cups with the alumina-on-alumina bearing surface had less scalloping of the femoral neck than those with a polyethylene-on-metal bearing surface. Early results with this second-generation arc-deposited hydroxyapatite-coated cup are promising. LEVEL OF EVIDENCE Therapeutic study, Level I (high-quality randomized trial with statistically significant difference or no statistically significant difference but narrow confidence intervals). See the Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- William N Capello
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN 46202-5111, USA
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36
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Howard JL, Hui AJ, Bourne RB, Holdsworth DW. Computed tomographic analysis of bone support for three acetabular cup designs. Clin Orthop Relat Res 2005:163-9. [PMID: 15864047 DOI: 10.1097/01.blo.0000151442.60652.ac] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The initial stability and long-term survivorship of cementless acetabular components is partially dependent on bone-prosthesis contact patterns. This study addresses the question: What are the differences in contact patterns for hemispheric, dual geometry, and spiked designs? Quantitative and qualitative assessment of contact patterns was achieved using a novel, nondestructive computed tomography-based analysis. Eighteen cadaveric hemipelvis specimens were randomly assigned to receive one of three cup designs. The mean amount of cup contact was 48.6% in the hemisphere group, 31.9% in the dual geometry group, and 35.1 percent in the spiked group. The hemispheric design showed more contact and a more uniform contact pattern than the dual geometry design. The dual geometry design featured a tight fit at the rim of the implant. In the spiked group, the amount of bone-prosthesis contact was affected by the distance that the spikes advanced into the pelvic bone. This nondestructive imaging technique has potential future uses in in vitro and in vivo studies.
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Affiliation(s)
- James L Howard
- Division of Orthopaedic Surgery, London Health Sciences Centre-University Campus, London, Ontario, Canada.
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37
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Shimmin AJ, Bare J, Back DL. Complications associated with hip resurfacing arthroplasty. Orthop Clin North Am 2005; 36:187-93, ix. [PMID: 15833456 DOI: 10.1016/j.ocl.2005.01.002] [Citation(s) in RCA: 138] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Hip resurfacing arthroplasty is an old orthopedic concept that has undergone a resurgence of interest in the past decade. Because of the rapid increase in the number of procedures being performed, previously recognized complications have begun to recur. This article focuses on complications that are related to the hip resurfacing procedure such as femoral neck fractures, avascular necrosis, raised metal ion levels, and sound initial and durable long-term fixation of an all-metal monoblock cobalt/chrome acetabular component. Dislocation rates after resurfacing and other complications are briefly discussed.
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Affiliation(s)
- A J Shimmin
- The Melbourne Orthopaedic Group, 33 The Avenue Windsor, 3181 Melbourne, Australia.
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38
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Diks MJF, van den Broek CM, Anderson PG, van Limbeek J, Spruit M. The uncemented, titanium-coated rm cup: Survival and analyses of failures. Hip Int 2005; 15:71-77. [PMID: 28224571 DOI: 10.1177/112070000501500202] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This study evaluates the incidence of revision of the monoblock, uncemented, titanium-coated RM (Robert Mathys) cup (Mathys Medical, Bettlach, Switzerland) in primary total hip arthroplasty. Between 1991 and 1995 a total of 630 RM cups were implanted in 462 patients. A Kaplan-Meier survival analysis was performed with failure defined as acetabular revision for any reason. The mean follow-up was 8.2 years. A total of 34 acetabular revisions (5%) were carried out: 15 for recurrent dislocation due to cup malposition, nine for wear caused by impingement of a loose femoral component, five for aseptic loosening, only one cup was revised for articular polyethylene wear, and four for other causes. The cumulative survival rate of the RM cup is 91% at 10.7 years, with a worst case scenario of 87%. The cumulative survival rate for aseptic loosening was calculated: 99% at 10.7 years. The titanium-coated RM cup shows an impressive survival rate with revision for aseptic loosening as endpoint. Correct cup positioning is the key to success and requires experience and meticulous surgical technique. (Hip International 2005; 15: 71-7).
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Affiliation(s)
- M J F Diks
- Department of Orthopaedics, IJsselland Ziekenhuis, Capelle a/d IJssel - The Netherlands
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39
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Dorairajan A, Reddy RM, Krikler S. Outcome of acetabular revision using an uncemented hydroxyapatite-coated component: two- to five-year results and review. J Arthroplasty 2005; 20:209-18. [PMID: 15902860 DOI: 10.1016/j.arth.2004.09.049] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
This is a retrospective review of 50 uncemented acetabular revisions with porous, hydroxyapatite-coated cups. The acetabulum alone was revised in 22 hips and both components were revised in 28 hips. The majority of hips (26) had type 2A (Paprosky) acetabular bone loss. All the revisions were carried out through a posterior approach. The mean duration of follow-up was 32 months (range, 24-52 months). Clinically, there was significant improvement in pain and moderate improvement in movement and mobility, and there is no radiological sign of failure of any cup so far. Re-revision was performed in 3 hips (6%) for recurrent dislocation. Our early results favor the use of this type of cup in acetabular revisions with moderate bone loss, but longer-term follow-up will be required. Key words: acetabulum, hydroxyapatite, revision, bone deficiency, complications.
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Affiliation(s)
- Armugam Dorairajan
- Department of Trauma and Orthopaedic Surgery, University Hospitals, Coventry and Warwickshire NHS Trust, Coventry, UK
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40
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Röhrl SM, Nivbrant B, Ström H, Nilsson KG. Effect of augmented cup fixation on stability, wear, and osteolysis: a 5-year follow-up of total hip arthroplasty with RSA. J Arthroplasty 2004; 19:962-71. [PMID: 15586331 DOI: 10.1016/j.arth.2004.06.024] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
To evaluate different modes of cementless fixation of hemispherical cups, we operated on 87 hips in 81 patients using 4 different means of cup fixation. The hips were randomly assigned to fixation with press-fit technique only (PF), or with augmentation with screws (S), pegs (P), or hydroxyapatite (HA) coating. The patients were evaluated with radiostereometric analysis (RSA) for cup migration and wear, conventional radiography for osteolysis, and Harris Hip Score for clinical outcome over 5 years. The fixation of the cups did not differ between the groups, but HA showed a tendency to decrease proximal migration. HA-coated cups displayed the best interface with hardly any signs of radiolucent lines, indicating a superior sealing effect of the HA coating. Cups with screws or pegs had more radiolucent lines and osteolytic lesions than the other groups. Radiolucent lines were correlated to higher proximal migration, young age, and female gender (r2=.2). The wear rate of the ethylene oxide-sterilized polyethylene liner was high (0.2 mm/y) but did not differ between the groups. Two cups with a perioperative fracture of the acetabular rim showed large initial migration but stabilized thereafter.
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Affiliation(s)
- Stephan M Röhrl
- Department of Surgery and Perioperative Science, Umed University Hospital, Umeå, Sweden
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