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Singh J, Panahifar A, Chernikov R, Dust WN. Pelvic Pseudotumor Associated With a Ceramic Bearing Total Hip. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202403000-00014. [PMID: 38513193 PMCID: PMC10959560 DOI: 10.5435/jaaosglobal-d-23-00184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 01/19/2024] [Accepted: 02/06/2024] [Indexed: 03/23/2024]
Abstract
Pseudotumors have been well documented to occur most frequently in metal-metal bearing total hip arthroplasties and less frequently in metal-polyethylene bearings. There are few cases in the literature of pseudotumors occurring in ceramic-ceramic articulations. We report a case of a large pelvic pseudotumor in a patient with a ceramic-ceramic bearing articulation in a 67-year-old man. In addition to the usual investigations, we did a detailed wear analysis of the ceramic implants and an examination of the soft tissues for particulate debris. The detailed wear analysis did show evidence of stripe wear; however, the volumetric wear was within the expected range. Synchrotron imaging identified strontium and zirconium debris arising from the ceramic surfaces. Although association does not mean causation, no other cause for the large pseudotumor could be identified and presumably represents an idiosyncratic reaction to ceramic debris.
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Affiliation(s)
- Jaskaran Singh
- From the Department of Orthopedic Surgery Resident, University of Manitoba, Manitoba, Canada (Dr. Singh); Canadian Light Source, University of Saskatchewan, Saskatoon, Canada (Dr. Panahifar and Dr. Chernikov); Department of Surgery, University of Saskatchewan, Saskatoon, Canada (Dr. Dust)
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Reddy H, Zvi Y, Weiser M. An Atypical Adverse Local Tissue Reaction Seen With Metal-On-Metal Total Hip Arthroplasty Utilizing Polyethylene Liners With Metal Inlays. Arthroplast Today 2023; 20:101106. [PMID: 36938349 PMCID: PMC10019987 DOI: 10.1016/j.artd.2023.101106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 01/11/2023] [Accepted: 01/16/2023] [Indexed: 03/21/2023] Open
Abstract
Adverse local tissue reaction (ALTR) is a frequently described, although uncommon, complication of metal-on-metal total hip arthroplasty. Here in we report on 2 patients with unique metal-inlay polyethylene liners who suffered from ALTR that required revision arthroplasty. In 2 of 3 cases the femoral trunnion was noted to have minimal corrosion and the stem was salvaged with a titanium adapter. In one case there was catastrophic femoral stem failure and an extended trochanteric osteotomy was required to remove the unique lateral flare stem. The surgeon must pay special attention when scrutinizing radiographs to identify a metal inlay polyethylene liner and when performing revision arthroplasty to prevent greater trochanter fracture in a patient who likely already has compromised abductor function due to ALTR.
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Affiliation(s)
- Hemant Reddy
- Corresponding author. Department of Orthopedic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, 1250 Waters Place, Tower 2 11th floor, Bronx, NY 10461, USA. Tel.: +1 614 448 8005.
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Williams DF. The plasticity of biocompatibility. Biomaterials 2023; 296:122077. [PMID: 36907003 DOI: 10.1016/j.biomaterials.2023.122077] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 02/19/2023] [Accepted: 03/02/2023] [Indexed: 03/11/2023]
Abstract
Biocompatibility concerns the phenomena that occur within the interactions between biomaterials and human patients, which ultimately control the performance of many facets of medical technology. It involves aspects of materials science, many different forms of engineering and nanotechnology, chemistry, biophysics, molecular and cellular biology, immunology, pathology and a myriad of clinical applications. It is not surprising that an overarching framework of mechanisms of biocompatibility has been difficult to elucidate and validate. This essay discusses one fundamental reason for this; we have tended to consider biocompatibility pathways as essentially linear sequences of events which follow well-understood processes of materials science and biology. The reality, however, is that the pathways may involve a great deal of plasticity, in which many additional idiosyncratic factors, including those of genetic, epigenetic and viral origin, exert influence, as do complex mechanical, physical and pharmacological variables. Plasticity is an inherent core feature of the performance of synthetic materials; here we follow the more recent biological applications of plasticity concepts into the sphere of biocompatibility pathways. A straightforward linear pathway may result in successful outcomes for many patients; we may describe this in terms of classic biocompatibility pathways. In other situations, which usually command much more attention because of their unsuccessful outcomes, these plasticity-driven processes follow alternative biocompatibility pathways; often, the variability in outcomes with identical technologies is due to biological plasticity rather than material or device deficiency.
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Affiliation(s)
- David F Williams
- Wake Forest Institute of Regenerative Medicine, Winston-Salem, North Carolina, USA.
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Do cobalt and chromium blood metal ion levels normalize after revision of failed metal-on-metal total hip replacements? Arch Orthop Trauma Surg 2023; 143:1217-1221. [PMID: 34724103 DOI: 10.1007/s00402-021-04206-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 09/29/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Increased cobalt (Co) and chromium (Cr) serum levels are one reason for revision surgery in metal on metal (MoM) total hip arthroplasty (THA) patients. Dual mobility liners are a simple revision option; however, they preserve the metal shell and stem and it is therefore not clear if metal ion levels will fully normalize after revision surgery. MATERIAL AND METHODS Between April 2013 and December 2017 25 hips (24 patients) underwent revision from a MoM THA to an off-label dual mobility liner. Five patients were lost to follow-up and one patient refused leaving 18 patients (11 men, 7 female, average age 63.9 years) for pre- and postoperative metal ion level blood tests at a minimum follow-up of 2 years. RESULTS Fourteen patients were revised for osteolysis, two for elevated metal ion levels and two for fluid or cysts around the femoral or acetabular component. The average preoperative Co and Cr levels were 8.3 µg/l and 5.0 µg/l, respectively. At a minimum follow-up of 2 years (30-95 months), metal ions dropped to 0.8 µg/l. Harris Hip Score (HHS), Hip Osteoarthritis Outcome Score (HOOS), Visual Analog Scale (VAS) and the UCLA activity score improved non-significantly from pre- to postoperative. There was one postoperative complication in the study cohort. One patient with persisting pain required revision surgery to a standard acetabular component during the follow-up period. CONCLUSION The off-label use of a dual-mobility liner in the current study resulted in normalization of the metal ion levels suggesting that preserving the cobalt-chromium acetabular component has little impact on ion levels. In addition, dual mobility liners have a low complication and revision rate.
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Khodaei T, Schmitzer E, Suresh AP, Acharya AP. Immune response differences in degradable and non-degradable alloy implants. Bioact Mater 2022; 24:153-170. [PMID: 36606252 PMCID: PMC9793227 DOI: 10.1016/j.bioactmat.2022.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 12/13/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
Alloy based implants have made a great impact in the clinic and in preclinical research. Immune responses are one of the major causes of failure of these implants in the clinic. Although the immune responses toward non-degradable alloy implants are well documented, there is a poor understanding of the immune responses against degradable alloy implants. Recently, there have been several reports suggesting that degradable implants may develop substantial immune responses. This phenomenon needs to be further studied in detail to make the case for the degradable implants to be utilized in clinics. Herein, we review these new recent reports suggesting the role of innate and potentially adaptive immune cells in inducing immune responses against degradable implants. First, we discussed immune responses to allergen components of non-degradable implants to give a better overview on differences in the immune response between non-degradable and degradable implants. Furthermore, we also provide potential areas of research that can be undertaken that may shed light on the local and global immune responses that are generated in response to degradable implants.
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Affiliation(s)
- Taravat Khodaei
- Biomedical Engineering, School of Biological and Health System Engineering, Arizona State, University, Tempe, AZ, 85281, USA
| | - Elizabeth Schmitzer
- Biomedical Engineering, School of Biological and Health System Engineering, Arizona State, University, Tempe, AZ, 85281, USA
| | | | - Abhinav P. Acharya
- Biomedical Engineering, School of Biological and Health System Engineering, Arizona State, University, Tempe, AZ, 85281, USA,Biological Design, Arizona State University, Tempe, AZ, 85281, USA,Chemical Engineering, School for the Engineering of Matter, Transport, and Energy, Arizona State, University, Tempe, AZ, 85281, USA,Materials Science and Engineering, School for the Engineering of Matter, Transport, and Energy, Arizona State University, Tempe, AZ, 85281, USA,Center for Immunotherapy, Vaccines and Virotherapy, Arizona State University, Tempe, AZ, 85281, USA,Corresponding author. Biomedical Engineering, School of Biological and Health System Engineering, Arizona State, University, Tempe, AZ, 85281, USA.
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Assessing the Clinical Value of Objective and Patient-Reported Audiovestibular Outcome Measures in the Risk Estimation of Systemic Cobalt Toxicity for Patients With a Metal-on-Metal Hip Implant. Ear Hear 2022; 43:1502-1514. [DOI: 10.1097/aud.0000000000001200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Movassaghi K, Patel A, Miller I, Levine BR. An Atypical Adverse Local Tissue Reaction After Ceramic-on-Ceramic Primary Total Hip Arthroplasty. Arthroplast Today 2022; 14:71-75. [PMID: 35252509 PMCID: PMC8889265 DOI: 10.1016/j.artd.2022.01.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 12/11/2021] [Accepted: 01/15/2022] [Indexed: 11/14/2022] Open
Abstract
Adverse local tissue reaction is an uncommon but frequently described complication after total hip arthroplasty (THA). It is most often associated with metal-on-metal hips and less frequently with metal-on-polyethylene implants as part of a mechanically assisted crevice corrosion process. In this report, we describe a rare case of an atypical adverse local tissue reaction in a patient with a ceramic-on-ceramic THA. Abrasive backside liner wear from a prominent screw head, failure of the liner locking mechanism, and liner fragmentation secondary to component-component impingement created an atypical mass and fluid collection leading to THA failure. This case demonstrates the importance of appropriate cup-liner positioning, thorough workup of pain after THA, and the ability of ceramic debris to cause an associated, atypical adverse local tissue reaction.
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Alnaimat FA, Owida HA, Al Sharah A, Alhaj M, Hassan M. Silicone and Pyrocarbon Artificial Finger Joints. Appl Bionics Biomech 2021; 2021:5534796. [PMID: 34188692 PMCID: PMC8195645 DOI: 10.1155/2021/5534796] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 05/23/2021] [Accepted: 05/27/2021] [Indexed: 12/04/2022] Open
Abstract
Artificial finger joint design has been developed through different stages through the past. PIP (proximal interphalangeal) and MCP (metacarpophalangeal) artificial finger joints have come to replace the amputation and arthrodesis options; although, these artificial joints are still facing challenges related to reactive tissues, reduced range of motion, and flexion and extension deficits. Swanson silicone artificial finger joints are still common due to the physician's preferability of silicone with the dorsal approach during operation. Nevertheless, other artificial finger joints such as the pyrocarbon implant arthroplasty have also drawn the interests of practitioners. Artificial finger joint has been classified under three major categories which are constrained, unconstrained, and linked design. There are also challenges such as concerns of infections and articular cartilage necrosis associated with attempted retention of vascularity. In addition, one of the main challenges facing the silicone artificial finger joints is the fracture occurring at the distal stem with the hinge. The aim of this paper is to review the different artificial finger joints in one paper as there are few old review papers about them. Further studies need to be done to develop the design and materials of the pyrocarbon and silicone implants to increase the range of motion associated with them and the fatigue life of the silicone implants.
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Affiliation(s)
- F. A. Alnaimat
- Medical Engineering, Al-Ahliyya Amman University, Al-Saro, Al-Salt, Amman, Jordan
| | - H. A. Owida
- Medical Engineering, Al-Ahliyya Amman University, Al-Saro, Al-Salt, Amman, Jordan
| | - A. Al Sharah
- Computer Engineering, Al-Ahliyya Amman University, Al-Saro, Al-Salt, Amman, Jordan
| | - M. Alhaj
- Computer Engineering, Al-Ahliyya Amman University, Al-Saro, Al-Salt, Amman, Jordan
| | - Mohammad Hassan
- Civil Engineering, Faculty of Engineering, Al-Ahliyya Amman University, Al-Saro, Al-Salt, Amman, Jordan
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Design and analysis of a compliant 3D printed energy harvester housing for knee implants. Med Eng Phys 2021; 88:59-68. [PMID: 33485515 DOI: 10.1016/j.medengphy.2020.12.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 11/18/2020] [Accepted: 12/29/2020] [Indexed: 11/21/2022]
Abstract
Instrumented implants have the potential to detect abnormal loading patterns which could be deleterious to implant longevity, indicating a need for intervention which could reduce the need for more complicated revision surgeries. Reliably powering such devices has been one obstacle preventing widespread usage of instrumented implants in clinical populations. This study presents a 3D-printed titanium interpositional device designed to integrate triboelectric generators (TEGs) into a commercially available total knee replacement (TKR). The device's stiffness, durability, and efficacy as a TEG housing were determined. Surprisingly, the stiffness of the 3D printed prototype was 73% less than what was calculated in a corresponding computational model, and under long-term durability testing failed after approximately 30,000 cycles of simulated gait loading. Under cyclical compressive loading, TEGs embedded in the device were able to generate 10.05 μW of power which is sufficient to run the frontend electronics for a load measurement system. The stiffness discrepancy between the computational and experimental models and the premature fatigue failure are suspected to be a result of internal porosity, unfused material and surface roughness of the 3D printed metal. Further refinements in design and manufacturing of the compliant device are required to improve its durability and TEG power output.
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Mahajan J, Bonner B, Oganesyan R, Yeo I, Klemt C, Kwon YM. MARS MRI Characteristics of Adverse Local Tissue Reactions in Taper Corrosion of Metal-On-Polyethylene THA Differ From Metal-On-Metal THA. J Arthroplasty 2020; 35:3338-3342. [PMID: 32622715 DOI: 10.1016/j.arth.2020.06.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/22/2020] [Accepted: 06/08/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Metal artifact reduction sequence (MARS) magnetic resonance imaging (MRI) has been recommended as a cross-sectional imaging modality in clinical evaluation of adverse local tissue reactions (ALTRs) in metal-on-metal (MoM) patients and metal-on-polyethylene (MoP) patients with taper corrosion. The aim of the study was to compare MARS MRI characteristics of ALTR in MoM total hip arthroplasty (THA) with ALTR in MoP THA with modular taper corrosion. METHODS A total of 197 patients with ALTR were evaluated: 86 patients with MoM THA; 37 MoP patients with head-neck taper corrosion; and 74 MoP patients with neck-stem dual taper corrosion. MARS MRI scans were evaluated to identify location, size, type of ALTR (I-III), and associated ALTR synovitis (cystic, solid, and mixed). RESULTS MARS MRI characteristics of ALTR were significantly different between the MoM and MoP groups (P = .017). The MoP group demonstrated the highest proportion of thick-walled cystic masses type II (56.7% in head-neck taper corrosion MoP and 46.5% in dual taper corrosion MoP vs 28.7% in MoM), whereas the MoM group had the highest proportion of thin-walled cystic masses type I. MoM implants (96.8%) were significantly more likely to have ALTR in multiple locations compared with both MoP groups (P = .001). CONCLUSION This study demonstrates that MARS MRI characteristics of ALTR differ by bearing type with a significantly higher percentage of mixed type and solid type ALTR in the taper corrosion MoP THA compared with MoM THA. This information provides clinically useful information in evaluation of symptomatic MoP and MoM THA patients for ALTRs.
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Affiliation(s)
- John Mahajan
- Center for Metal-on-Metal Hips and Tribocorrosion Evaluation and Treatment, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Bryant Bonner
- Center for Metal-on-Metal Hips and Tribocorrosion Evaluation and Treatment, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Ruben Oganesyan
- Center for Metal-on-Metal Hips and Tribocorrosion Evaluation and Treatment, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Ingwon Yeo
- Center for Metal-on-Metal Hips and Tribocorrosion Evaluation and Treatment, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Christian Klemt
- Center for Metal-on-Metal Hips and Tribocorrosion Evaluation and Treatment, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Young-Min Kwon
- Center for Metal-on-Metal Hips and Tribocorrosion Evaluation and Treatment, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Leyssens L, Vinck B, Van Der Straeten C, Dhooge I, Wuyts FL, Maes LK. The ototoxic potential of cobalt from metal-on-metal hip implants: a pilot study on the patient-reported auditory, vestibular, and general neurological outcome. Int J Audiol 2020; 60:44-53. [PMID: 32687006 DOI: 10.1080/14992027.2020.1789922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE This study aimed to systematically investigate the ototoxic potential of cobalt in patients with a metal-on-metal (MoM) hip implant, using objective auditory and vestibular assessments and a questionnaire. The results of the objective evaluation were published previously, whereas the current study focused on the questionnaire outcome and its relationship to the blood cobalt level. Design and study sample: Twenty patients (33-65 years) with a primary MoM hip implant and 20 non-implanted control subjects, matched for age, gender, and noise exposure, received a questionnaire to evaluate the presence of several hearing and balance symptoms (part 1) and general neurological issues (part 2). RESULTS Concerning part 1, the proportion of auditory-related symptoms in general (p = 0.022) and tinnitus (p = 0.047) was significantly higher in the MoM patient group, whereas no group difference was found for hyperacusis, increased listening effort, and decreased speech understanding. Concerning part 2, no significant group differences were detected. Within the MoM patient group, the questionnaire outcome was not significantly different between the low-exposure and high-exposure subgroups according to the blood Co level. CONCLUSIONS In line with our previous study, these results potentially imply Co-induced impairment to the auditory system, despite the lack of a clear dose-response relationship.
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Affiliation(s)
- Laura Leyssens
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium
| | - Bart Vinck
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium.,Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
| | | | - Ingeborg Dhooge
- Department of Ear Nose Throat, Ghent University Hospital, Ghent, Belgium
| | - Floris L Wuyts
- Lab for Equilibrium Investigations and Aerospace, University of Antwerp, Antwerp, Belgium
| | - Leen K Maes
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium
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Hall DJ, Pourzal R, Jacobs JJ. What Surgeons Need to Know About Adverse Local Tissue Reaction in Total Hip Arthroplasty. J Arthroplasty 2020; 35:S55-S59. [PMID: 32005621 PMCID: PMC7239747 DOI: 10.1016/j.arth.2020.01.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 01/07/2020] [Indexed: 02/01/2023] Open
Abstract
Adverse local tissue reactions (ALTRs) were first associated with patients with failed metal-on-metal surface replacements and total hip arthroplasty (THA). However, an increasing number of cases of ALTR in metal-on-polyethylene (MOP) THA patients is being reported. Clinically, ALTR appears as benign, aseptic masses or bursae in the periprosthetic tissues. Histopathologically, ALTRs are distinguished by an intense lymphocyte infiltrate, destruction of the synovial surfaces, widespread necrosis, and fibrin exudate. Tribocorrosion of modular junctions appears to be the cause of ALTR in MOP patients. The various tribocorrosion damage modes occurring at modular junctions produce metal ions and a diversity of particulates in relation to size, chemical composition, and structure. The mechanisms by which these various products of tribocorrosion lead to ALTR are still a matter of considerable research. This review clarifies what constitutes ALTR, its relationship to implant factors, and highlights current methods for diagnosis and management of patients with ALTR in the setting of MOP THA.
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Affiliation(s)
- Deborah J Hall
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL
| | - Robin Pourzal
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL
| | - Joshua J Jacobs
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL
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Abstract
BACKGROUND Modern total hip arthroplasty has seen an unfortunate increase in proportional implant failures secondary to adverse local tissue reactions (ALTRs) secondary to wear of metal-on-metal (MoM) bearings and mechanically assisted crevice corrosion (MACC) related to corrosion at implant junctions and tapers. The purpose of this study is to describe the appropriate choice of metal ion testing and evaluation of those levels to identify failed total hip arthroplasty implants containing cobalt and chromium. METHODS When presented with an arthroplasty of concern, the surgeon must determine what metal ion levels to obtain and then incorporate those levels into a treatment algorithm. Patients with painful hip arthroplasties are evaluated for chromium and cobalt by obtaining whole blood and synovial metal levels. RESULTS Synovial fluid cobalt had the highest correlation with ALTR compared with the other tests, with a threshold of 19.75 ng/ml, with a specificity of 89%, if the cobalt-to-chromium ratio is greater than 1.4 ng/ml in a metal on polyethylene hip, with a sensitivity of 95%. CONCLUSION The interpretation of whole blood metal ions is a key component of the algorithm in treating the symptomatic hip arthroplasty but is not to be used in a vacuum.
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Comparison of Harris Hip Scores and Revision Rates in Metal-on-Metal Versus Non-Metal-on-Metal Total Hip Arthroplasty. J Am Acad Orthop Surg 2020; 28:e422-e426. [PMID: 31415300 DOI: 10.5435/jaaos-d-19-00251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION This study compares functional outcome scores and revision rates between metal-on-metal (MoM) and non-MoM total hip arthroplasty patients. METHODS A cohort of 75 patients who underwent implantation of the same dual modular hip arthroplasty between the years of 2004 and 2010 was enrolled. Patients were subsequently evaluated in 2015 to 2017 for joint revision history and functionality, as measured by the Harris hip score (HHS). Patients requiring a revision arthroplasty were not included in the HHS analysis. RESULTS A total of 49 patients had MoM implants (65.3%), and 26 patients had non-MoM implants (34.8%). At a mean follow-up of 7.6 years, 10.2% (5/49) of MoM prostheses required revision, whereas 3.8% (1/26) of non-MoM prostheses required revision (P = 0.334). The mean HHS in the MoM cohort was 89.8, compared with 88.1 in the non-MoM cohort (P = 0.69). CONCLUSION HHSs were not notably different between cohorts. The MoM cohort had three times as many revisions as the non-MoM cohort, but given the numbers available, this difference did not reach significance. Given the clinical importance of these revision data, further study is warranted to determine survivorship of the MoM versus non-MoM total hip arthroplasty at long-term follow-up.
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Ji B, Li G, Zhang X, Wang Y, Mu W, Cao L. Effective treatment of single-stage revision using intra-articular antibiotic infusion for culture-negative prosthetic joint infection. Bone Joint J 2020; 102-B:336-344. [PMID: 32114816 DOI: 10.1302/0301-620x.102b3.bjj-2019-0820.r1] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
AIMS In the absence of an identified organism, single-stage revision is contraindicated in prosthetic joint infection (PJI). However, no studies have examined the use of intra-articular antibiotics in combination with single-stage revision in these cases. In this study, we present the results of single-stage revision using intra-articular antibiotic infusion for treating culture-negative (CN) PJI. METHODS A retrospective analysis between 2009 and 2016 included 51 patients with CN PJI who underwent single-stage revision using intra-articular antibiotic infusion; these were compared with 192 culture-positive (CP) patients. CN patients were treated according to a protocol including intravenous vancomycin and a direct intra-articular infusion of imipenem and vancomycin alternately used in the morning and afternoon. In the CP patients, pathogen-sensitive intravenous (IV) antibiotics were administered for a mean of 16 days (12 to 21), and for resistant cases, additional intra-articular antibiotics were used. The infection healing rate, Harris Hip Score (HHS), and Hospital for Special Surgery (HSS) knee score were compared between CN and CP groups. RESULTS Of 51 CN patients, 46 (90.2%) required no additional medical treatment for recurrent infection at a mean of 53.2 months (24 to 72) of follow-up. Impaired kidney function occurred in two patients, and one patient had a local skin rash. No significant difference in the infection control rate was observed between CN and CP PJIs (90.2% (46/51) versus 94.3% (181/192); p = 0.297). The HHS of the CN group showed no substantial difference from that of CP cases (79 versus 81; p = 0.359). However, the CN group showed a mean HSS inferior to that of the CP group (76 versus 80; p = 0.027). CONCLUSION Single-stage revision with direct intra-articular antibiotic infusion can be effective in treating CN PJI, and can achieve an infection control rate similar to that in CP patients. However, in view of systemic toxicity, local adverse reactions, and higher costs, additional strong evidence is needed to verify these treatment regimens. Cite this article: Bone Joint J 2020;102-B(3):336-344.
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Affiliation(s)
- Baochao Ji
- Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Guoqing Li
- Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Xiaogang Zhang
- Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yang Wang
- Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Wenbo Mu
- Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Li Cao
- Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
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The Ototoxic Potential of Cobalt From Metal-on-Metal Hip Implants: Objective Auditory and Vestibular Outcome. Ear Hear 2020; 41:217-230. [DOI: 10.1097/aud.0000000000000747] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Thyssen JP, Ahlström MG, Bruze M, Rustemeyer T, Lidén C. Metals. Contact Dermatitis 2020. [DOI: 10.1007/978-3-319-72451-5_35-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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22
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Hallab NJ, Jacobs JJ. Orthopedic Applications. Biomater Sci 2020. [DOI: 10.1016/b978-0-12-816137-1.00070-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Lanting BA, Wood TJ, Young S, Van Citters DW, MacDonald SJ, Howard JL, Teeter MG. The effect of altering head length on corrosion using a material loss method. Hip Int 2019; 29:368-372. [PMID: 29808723 DOI: 10.1177/1120700018779886] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Corrosion at head neck taper junctions in total hip arthroplasty has increasingly been reported in the literature. Debate persists as to the exact causes and clinical significance of corrosion. Increased offset and head length has been correlated with an increased risk of tribocorrosion due to an adverse mechanical environment. The purpose of this study is to assess the effect of head length on corrosion of a metal-on-polyethylene articulation. METHODS Retrievals from a single institution of 28-mm cobalt chromium alloy heads with a 12/14 taper from a single manufacturer were studied. Corrosion of femoral head bores were studied utilising a material loss method. Testing was performed using co-ordinate measuring for maximum linear wear depth. RESULTS 56 heads were examined with lengths of either -3, 0, +4 or +8 mm and all had been in situ for a minimum of 2 years. There were no significant differences in mean maximum linear wear depth (MLWD) (p = 0.6545). There was no correlation found between MLWD and the time implants were in situ (Spearman coefficient -0.1157) and no significant difference seen between high or standard offset stems (p = 0.1336). CONCLUSION In contrast to studies using qualitative methodologies, there was no correlation between head length and material loss when confined to a 28-mm head. Broad application of this outcome should be cautioned against as this study examined 1 taper construct and a metal-on-polyethylene articulation.
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Affiliation(s)
- Brent A Lanting
- 1 Division of Orthopaedic Surgery, Department of Surgery, London Health Sciences Centre University Campus, University of Western Ontario, London, Ontario, Canada
| | - Thomas J Wood
- 1 Division of Orthopaedic Surgery, Department of Surgery, London Health Sciences Centre University Campus, University of Western Ontario, London, Ontario, Canada
| | - Sam Young
- 1 Division of Orthopaedic Surgery, Department of Surgery, London Health Sciences Centre University Campus, University of Western Ontario, London, Ontario, Canada
| | - Douglas W Van Citters
- 2 Department of Surgery, Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
| | - Steven J MacDonald
- 1 Division of Orthopaedic Surgery, Department of Surgery, London Health Sciences Centre University Campus, University of Western Ontario, London, Ontario, Canada
| | - James L Howard
- 1 Division of Orthopaedic Surgery, Department of Surgery, London Health Sciences Centre University Campus, University of Western Ontario, London, Ontario, Canada
| | - Matthew G Teeter
- 3 Department of Surgery, London Health Sciences Centre University Campus, University of Western Ontario, London, Ontario, Canada
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Kovochich M, Finley BL, Novick R, Monnot AD, Donovan E, Unice KM, Fung ES, Fung D, Paustenbach DJ. Understanding outcomes and toxicological aspects of second generation metal-on-metal hip implants: a state-of-the-art review. Crit Rev Toxicol 2019; 48:853-901. [DOI: 10.1080/10408444.2018.1563048] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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25
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Bistolfi A, Cimino A, Lee GC, Ferracini R, Maina G, Berchialla P, Massazza G, Massè A. Does metal porosity affect metal ion release in blood and urine following total hip arthroplasty? A short term study. Hip Int 2018; 28:522-530. [PMID: 29742937 DOI: 10.1177/1120700018762167] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The surface area of exposed metal in a trabecular-titanium acetabular component is wider compared to traditional-titanium implants. The purpose of this study is to establish if this increase in surface area can lead to a significant increase in systemic metal levels. METHODS 19 patients with conventional acetabular component and 19 with trabecular-titanium cup were compared. Aluminum, Vanadium and Titanium in blood and urine were assessed before surgery and at intervals for 2 years. The samples were analysed using an inductively coupled plasma mass spectrometry. RESULTS Patients with trabecular-titanium did not have significantly higher metal ion levels compared to patients with conventional cups up to 2 years. A trend over time was statistically significant in both blood and urine for aluminum and titanium concentrations. CONCLUSIONS The three-dimensionality and the wide surface of the trabecular-titanium acetabular component did not affect metal ion release compared to traditional implants after 2 years.
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Affiliation(s)
- Alessandro Bistolfi
- 1 AO Città della Salute e della Scienza, Department of Orthopeadics, Traumatology and Rehabilitative Medicine, CTO Hospital, Turin, Italy
| | | | - Gwo-Chin Lee
- 3 Hospital of the University of Pennsylvania, Penn Presbyterian Medical Center, Pennsylvania Hospital, PA, USA
| | - Riccardo Ferracini
- 1 AO Città della Salute e della Scienza, Department of Orthopeadics, Traumatology and Rehabilitative Medicine, CTO Hospital, Turin, Italy
| | | | | | - Giuseppe Massazza
- 1 AO Città della Salute e della Scienza, Department of Orthopeadics, Traumatology and Rehabilitative Medicine, CTO Hospital, Turin, Italy.,2 University of the Studies of Turin, Turin, Italy
| | - Alessandro Massè
- 1 AO Città della Salute e della Scienza, Department of Orthopeadics, Traumatology and Rehabilitative Medicine, CTO Hospital, Turin, Italy.,2 University of the Studies of Turin, Turin, Italy
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Avila I, Pantchev K, Holopainen J, Ritala M, Tuukkanen J. Adhesion and mechanical properties of nanocrystalline hydroxyapatite coating obtained by conversion of atomic layer-deposited calcium carbonate on titanium substrate. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2018; 29:111. [PMID: 30019192 DOI: 10.1007/s10856-018-6121-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 07/04/2018] [Indexed: 06/08/2023]
Abstract
The purpose of this study was to evaluate the mechanical properties of nanocrystalline hydroxyapatite coating by tensile adhesion testing and scratch testing. The coating was manufactured on titanium substrate by converting atomic layer-deposited (ALD) calcium carbonate thin film in dilute phosphate solution. The tensile adhesion testing was performed with hydraulic testing device in accordance with ISO 4624 and ISO 16276-1. Scratch testing was done according to SFS-EN 13523-12 with spherical 10 µm scratching tip. Characterization of the samples was done with light and electron microscopy after which they were stained with alizarin red and the failure modes and loadings were analyzed. The highest obtained tensile adhesion value was 6.71 MPa produced with 4000 ALD cycles, converted to hydroxyapatite in alkaline solution, and annealed for 30 min in 700 °C. The annealing improved the adhesion values by approximately 0.8 MPa, but examining the samples with electron microscopy showed intact coating in both annealed and non-annealed samples. Samples produced with 4000 cycles performed better in testing than 2000 cycle samples, and better adhesion was also achieved with alkaline conversion solution compared to neutral solution.
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Affiliation(s)
- Inari Avila
- Department of Anatomy and Cell Biology, Institute of Cancer Research and Translational Medicine, Medical Research Center, University of Oulu, Oulu, Finland.
| | - Konstantin Pantchev
- Department of Anatomy and Cell Biology, Institute of Cancer Research and Translational Medicine, Medical Research Center, University of Oulu, Oulu, Finland
| | - Jani Holopainen
- Department of Chemistry, University of Helsinki, P.O. Box 55, FI-00014, Helsinki, Finland
| | - Mikko Ritala
- Department of Chemistry, University of Helsinki, P.O. Box 55, FI-00014, Helsinki, Finland
| | - Juha Tuukkanen
- Department of Anatomy and Cell Biology, Institute of Cancer Research and Translational Medicine, Medical Research Center, University of Oulu, Oulu, Finland
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Macrophage Biocompatibility of CoCr Wear Particles Produced under Polarization in Hyaluronic Acid Aqueous Solution. MATERIALS 2018; 11:ma11050756. [PMID: 29738506 PMCID: PMC5978133 DOI: 10.3390/ma11050756] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 04/26/2018] [Accepted: 05/02/2018] [Indexed: 02/06/2023]
Abstract
Macrophages are the main cells involved in inflammatory processes and in the primary response to debris derived from wear of implanted CoCr alloys. The biocompatibility of wear particles from a high carbon CoCr alloy produced under polarization in hyaluronic acid (HA) aqueous solution was evaluated in J774A.1 mouse macrophages cultures. Polarization was applied to mimic the electrical interactions observed in living tissues. Wear tests were performed in a pin-on-disk tribometer integrating an electrochemical cell in phosphate buffer solution (PBS) and in PBS supplemented with 3 g/L HA, an average concentration that is generally found in synovial fluid, used as lubricant solution. Wear particles produced in 3 g/L HA solution showed a higher biocompatibility in J774A.1 macrophages in comparison to those elicited by particles obtained in PBS. A considerable enhancement in macrophages biocompatibility in the presence of 3 g/L of HA was further observed by the application of polarization at potentials having current densities typical of injured tissues suggesting that polarization produces an effect on the surface of the metallic material that leads to the production of wear particles that seem to be macrophage-biocompatible and less cytotoxic. The results showed the convenience of considering the influence of the electric interactions in the chemical composition of debris detached from metallic surfaces under wear corrosion to get a better understanding of the biological effects caused by the wear products.
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Tetreault MW, Jacobs JJ, Mahmud W, Nam D. Adverse Local Tissue Reaction After a Metal-on-Metal Total Hip Prosthesis Without Elevated Serum Metal Ion Levels. Orthopedics 2018; 41:e438-e441. [PMID: 29257191 DOI: 10.3928/01477447-20171213-05] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 10/17/2017] [Indexed: 02/03/2023]
Abstract
In the 1990s, metal-on-metal (MoM) bearings were reintroduced in total hip arthroplasty (THA), having the proposed advantages of decreased wear and improved stability. However, catastrophic adverse local tissue reaction (ALTR) secondary to metal debris from both the bearing surface and the head-neck junction is a well-recognized complication. The measurement of metal ion levels in the serum is often a first-line test to identify failure of a MoM bearing. The authors describe a 70-year-old man who presented with a multiply revised MoM THA and a large periprosthetic fluid collection incidentally seen during computed tomography for renal nephrolithiasis. The patient reported painless, progressive swelling over the lateral aspect of the hip. An infectious workup including serum erythrocyte sedimentation rate, C-reactive protein, and intraarticular hip aspiration yielded negative results. Metal ion levels in the serum, including a minimally elevated cobalt level, were unremarkable, and metal-lymphocyte transformation testing yielded negative results. Radiographic imaging revealed progressive osteolysis around the proximal femur, and magnetic resonance imaging showed large fluid collections with irregular wall thickening surrounding the gluteal and iliopsoas musculature. At revision surgery, a large fluid collection and corrosion at the head-neck junction were present. Pathology specimens confirmed the presence of an ALTR. This report presents a previously undescribed case of an ALTR secondary to MoM THA in the absence of elevated serum metal ion levels. This indicates the necessity of considering all aspects of a patient's clinical presentation, imaging modalities, and laboratory testing in the evaluation and diagnosis of a symptomatic MoM THA. [Orthopedics. 2018; 41(3):e438-e441.].
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Granchi D, Savarino LM, Ciapetti G, Baldini N. Biological effects of metal degradation in hip arthroplasties. Crit Rev Toxicol 2017; 48:170-193. [PMID: 29130357 DOI: 10.1080/10408444.2017.1392927] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Metals and metal alloys are the most used materials in orthopedic implants. The focus is on total hip arthroplasty (THA) that, though well tolerated, may be associated with local and remote adverse effects in the medium-long term. This review aims to summarize data on the biological consequences of the metal implant degradation that have been attributed predominantly to metal-on-metal (MoM) THA. Local responses to metals consist of a broad clinical spectrum ranging from small asymptomatic tissue lesions to severe destruction of bone and soft tissues, which are designated as metallosis, adverse reactions to metal debris (ARMD), aseptic lymphocytic vasculitis associated lesion (ALVAL), and pseudotumors. In addition, the dissemination of metal particles and ions throughout the body has been associated with systemic adverse effects, including organ toxicity, cancerogenesis, teratogenicity, and immunotoxicity. As proved by the multitude of studies in this field, metal degradation may increase safety issues associated with THA, especially with MoM hip systems. Data collection regarding local, systemic and long-term effects plays an essential role to better define any safety risks and to generate scientifically based recommendations.
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Affiliation(s)
- Donatella Granchi
- a Orthopedic Pathophysiology and Regenerative Medicine Unit , Rizzoli Orthopedic Institute , Bologna , Italy
| | - Lucia Maria Savarino
- a Orthopedic Pathophysiology and Regenerative Medicine Unit , Rizzoli Orthopedic Institute , Bologna , Italy
| | - Gabriela Ciapetti
- a Orthopedic Pathophysiology and Regenerative Medicine Unit , Rizzoli Orthopedic Institute , Bologna , Italy
| | - Nicola Baldini
- a Orthopedic Pathophysiology and Regenerative Medicine Unit , Rizzoli Orthopedic Institute , Bologna , Italy.,b Department of Biomedical and Neuromotor Science , University of Bologna , Bologna , Italy
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Carlson BC, Bryan AJ, Carrillo-Villamizar NT, Sierra RJ. The Utility of Metal Ion Trends in Predicting Revision in Metal-on-Metal Total Hip Arthroplasty. J Arthroplasty 2017; 32:S214-S219. [PMID: 28320566 DOI: 10.1016/j.arth.2017.02.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 02/03/2017] [Accepted: 02/11/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND There is a paucity of data examining metal ion levels over time. METHODS We retrospectively reviewed 59 patients (69 hips) with an articular surface replacement total hip arthroplasty. We reviewed prerevision cobalt and chromium concentrations over time. RESULTS Seventy-one percent of patients who were revised and had multiple ion measurements (12/17) demonstrated increasing cobalt ion levels or elevated ion levels over time. There was a trend toward an elevated risk of revision for increasing cobalt and chromium levels starting at 12 and 4 ppb, respectively; this was significant for chromium levels above 7 ppb (hazard ratio 22.35, P = .001). Similarly, there was a trend toward an elevated risk of pseudotumor formation for increasing cobalt and chromium levels starting at 5 and 2.5 ppb, respectively; this was significant for cobalt levels above 7 ppb (hazard ratio 6.88, P = .027). CONCLUSION In this paper, cobalt and chromium levels levels above 5 and 2.5 ppb started to demonstrate an increased risk of ARMD, and should be considered as a lower cutoff for discussion with patients about the potential for future revision.
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Affiliation(s)
- Bayard C Carlson
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Andrew J Bryan
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Rafael J Sierra
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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Single-Stage Revision for Chronic Fungal Periprosthetic Joint Infection: An Average of 5 Years of Follow-Up. J Arthroplasty 2017; 32:2523-2530. [PMID: 28478188 DOI: 10.1016/j.arth.2017.03.030] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 02/25/2017] [Accepted: 03/13/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Periprosthetic infections caused by fungal pathogens are a rare entity, and there exist no definite guidelines according to which these infections can be successfully managed. In these situations, we wondered whether patients could be treated successfully for their fungal infections with single-stage revision. METHODS A retrospective analysis between January 2004 and October 2014 included 11 patients (4 hips and 7 knees) with chronic fungal periprosthetic joint infection who underwent single-stage revision, including aggressive soft-tissue debridement, thorough removal of infected components and cement, pouring powdered vancomycin into the medullary cavity and direct intra-articular injection of fungus-sensitive antibiotics, and a reasonable combination of antifungal agents and antibacterial medications. Recurrence of infection and clinical outcomes were evaluated. The average follow-up was 5 years (range, 2-10 years). RESULTS There were 3 failures during the study period; 1 patient died during the perioperative period because of acute heart failure on the eighth postoperative day. Of the 11 patients, 7 patients had satisfactory outcomes and required no additional surgical or medical treatment for recurrence of infection. The mean postoperative Harris hip score and Hospital for Special Surgery knee score was 77 points (67-88 points; P < .05) and 78 points (73-84 points; P < .05), respectively, at the most recent assessment. CONCLUSION Treatment of chronic fungal periprosthetic joint infection with single-stage revision can be fairly effective for achieving acceptable functional outcomes, which indicated that this may be a feasible alternative strategy in selected patients.
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Heat Generation on Implant Surface During Abutment Preparation at Different Elapsed Time Intervals. IMPLANT DENT 2017; 26:700-705. [PMID: 28475499 DOI: 10.1097/id.0000000000000600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to evaluate heat generation at the implant surface caused by abutment preparation using a diamond bur in a high-speed dental turbine in vitro at 2 different water-coolant temperatures. MATERIALS AND METHODS Thirty-two titanium-alloy abutments were connected to a titanium-alloy implant embedded in an acrylic resin placed within a water bath at a controlled temperature of 37°C. The specimens were equally distributed into 2 groups (16 each). Group 1: the temperature was maintained at 20 ± 1°C; and group 2: the temperature was maintained at 32 ± 1°C. Each abutment was prepared in the axial plane for 1 minute and in the occlusal plane for 1 minute. The temperature of the heat generated from abutment preparation was recorded and measured at 3 distinct time intervals. RESULTS Water-coolant temperature (20°C vs 32°C) had a statistically significant effect on the implant's temperature change during preparation of the abutment (P < 0.0001). CONCLUSION The use of water-coolant temperature of 20 ± 1°C during preparation of the implant abutment decreased the temperature recorded at the implant surface to 34.46°C, whereas the coolant temperature of 32 ± 1°C increased the implant surface temperature to 40.94°C.
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Caicedo MS, Solver E, Coleman L, Jacobs JJ, Hallab NJ. Females with Unexplained Joint Pain Following Total Joint Arthroplasty Exhibit a Higher Rate and Severity of Hypersensitivity to Implant Metals Compared with Males: Implications of Sex-Based Bioreactivity Differences. J Bone Joint Surg Am 2017; 99:621-628. [PMID: 28419029 DOI: 10.2106/jbjs.16.00720] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Recent studies indicate that females demonstrate an increased risk of experiencing adverse local tissue reactions, aseptic loosening, and revision after primary metal-on-metal hip resurfacing arthroplasty compared with males; the underlying biological mechanisms responsible for sex discrepancies in implant failure remain unclear. In addition to anatomical and biomechanical sex differences, there may be inherent immunological disparities that predispose females to more aggressive adaptive immune reactivity to implant debris, i.e., metal sensitivity. METHODS In this retrospective study, we analyzed sex-associated rates and levels of metal sensitization in 1,038 male and 1,575 female subjects with idiopathic joint pain following total joint arthroplasty (TJA) who were referred for in vitro metal-sensitivity testing. RESULTS Females demonstrated a significantly higher rate and severity of metal sensitization compared with males. The median lymphocyte stimulation index (SI) among males was 2.8 (mean, 5.4; 95% confidence interval [CI], 4.9 to 6.0) compared with 3.5 (mean, 8.2; 95% CI, 7.4 to 9.0) among females (p < 0.05). Forty-nine percent of females had an SI of ≥4 (reactive) compared with 38% of males, and the implant-related level of pain was also significantly (p < 0.0001) higher among females (mean, 6.8; 95% CI, 6.6 to 6.9) compared with males (mean, 6.1; 95% CI, 6.0 to 6.3). CONCLUSIONS In a select group of patients who had joint pain following TJA and no evidence of infection and who were referred for metal-sensitivity testing, females exhibited a higher level of pain and demonstrated a higher rate and severity (as measured by lymphocyte SI) of metal sensitization compared with males. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Marco S Caicedo
- 1Orthopedic Analysis, Chicago, Illinois 2Departments of Orthopedic Surgery (J.J.J. and N.J.H.) and Immunology (N.J.H.), Rush University Medical Center, Chicago, Illinois
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Luo S, Jiang T, Yang Y, Yang X, Zhao J. Combination therapy with vancomycin-loaded calcium sulfate and vancomycin-loaded PMMA in the treatment of chronic osteomyelitis. BMC Musculoskelet Disord 2016; 17:502. [PMID: 28007027 PMCID: PMC5178069 DOI: 10.1186/s12891-016-1352-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Accepted: 11/24/2016] [Indexed: 11/17/2022] Open
Abstract
Background Chronic post-traumatic and postoperative osteomyelitis is a refractory disease which results in significant morbidity and mortality. The effect of combination therapy with vancomycin-loaded calcium sulfate and vancomycin-loaded polymethyl methacrylate (PMMA) was unknown. Methods Fifty-one patients suffering from chronic post-traumatic or postoperative osteomyelitis of the lower extremities were included in the retrospective investigation. The patients were assigned to the study group of the combination therapy with antibiotic-loaded calcium sulfate and antibiotic-loaded PMMA or the control group of the antibiotic-loaded PMMA. Hematological parameters, eradication of infection, rate of infection recurrence and reoperation rate were evaluated during the follow-up. Results The cases were followed up for an average of 24 months (range, 15–48 months) after the first-stage surgical operation. In the study group, all the patients revealed complete calcium sulfate resorption at an average of 6 weeks (range, 30–60 days). In the study group, infection was primarily eradicated in 92.31% (24 of 26) of patients and re-operation rate of 7.69% (2 of 26) after the first-stage surgery. Two patients underwent further surgical operation in the study group. One case achieved infection eradication in the recurrent two cases, with a secondary infection eradication rate of 96.15% (25 of 26). There was no persistent infection in the study group. In the control group, infection was eradicated in 64.00% (16 of 25) of patients and re-operation rate was 36.00% (9 of 25) after the first-stage surgery. Nine patients in the control group underwent further surgical operation. Two case achieved infection eradication in these cases who suffered from persistent or recurrent infection, with a secondary infection eradication rate of 72.00% (18 of 25). There was more re-operation rate in the control group (PMMA group, 9 vs combination therapy group, 2; P = 0.034). Conclusion The combination therapy with vancomycin-loaded calcium sulfate and vancomycin-loaded PMMA possibly achieved more effective control of infection in the treatment of osteomyelitis through synergistic effect. The immediate structural stabilization and higher concentration of antibiotic at the local site of infection may be achieved through the combination of biodegradable and non-biodegradable devices in the treatment of chronic post-traumatic and postoperative osteomyelitis. The study was retrospectively registered at 11/16/2016 (TRN: NCT02968693).
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Affiliation(s)
- Shanchao Luo
- Department of Orthopaedics Trauma and Hand Surgery, The First Affiliated Hospital of Guangxi Medical University, 530021, Nanning, Guangxi, China.,Yulin Orthopedics Hospital of Chinese and Western Medicine, 537000, Yulin, Guangxi, China
| | - Tongmeng Jiang
- Department of Orthopaedics Trauma and Hand Surgery, The First Affiliated Hospital of Guangxi Medical University, 530021, Nanning, Guangxi, China.,Guangxi Engineering Center in Biomedical Materials for Tissue and Organ Regeneration, Guangxi Medical University, 530021, Nanning, Guangxi, China
| | - Yingnian Yang
- Yulin Orthopedics Hospital of Chinese and Western Medicine, 537000, Yulin, Guangxi, China
| | - Xiaoping Yang
- Yulin Orthopedics Hospital of Chinese and Western Medicine, 537000, Yulin, Guangxi, China
| | - Jinmin Zhao
- Department of Orthopaedics Trauma and Hand Surgery, The First Affiliated Hospital of Guangxi Medical University, 530021, Nanning, Guangxi, China. .,Guangxi Engineering Center in Biomedical Materials for Tissue and Organ Regeneration, Guangxi Medical University, 530021, Nanning, Guangxi, China. .,Collaborative Innovation Center of Guangxi Biological Medicine, Guangxi Medical University, 530021, Nanning, Guangxi, China. .,Guangxi Key Laboratory of Regenerative Medicine, Guangxi Medical University, 530021, Nanning, Guangxi, China.
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Grammatopoulos G, Munemoto M, Inagaki Y, Tanaka Y, Athanasou NA. The Diagnosis of Infection in Metal-on-Metal Hip Arthroplasties. J Arthroplasty 2016; 31:2569-2573. [PMID: 27235328 DOI: 10.1016/j.arth.2016.03.064] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 03/15/2016] [Accepted: 03/29/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Distinction of aseptic from septic hip arthroplasty failure can be challenging. Some studies report an increased incidence of septic failure with metal-on-metal (MoM) hip arthroplasties. The Musculoskeletal Infection Society (MSIS) have formulated criteria to facilitate the diagnosis of periprosthetic joint infection (PJI). In this study, we determined the prevalence and histologic features of septic MoM hip failure. METHODS Overall, 104 cases of failed MoM hip arthroplasty, classified as septic or aseptic by MSIS microbiological criteria, were analyzed. The overall prevalence of septic failure was determined and the nature of the causative organisms noted. The extent of the neutrophil polymorph (NP) infiltrate in periprosthetic tissue in all cases was analyzed by hematoxylin-eosin and chloroacetate esterase staining. RESULTS The prevalence of septic MoM hip arthroplasty failure was 6.7%. Infective organisms were coagulase-negative Staphylococcus in 4 cases; Staphylococcus aureus, Streptococcus, and Propionibacterium species were isolated in the remaining cases. Chloroacetate esterase staining facilitated identification of NPs. All cases of PJI contained more than 5 NPs per high-power field (HPF) on average. Four cases of aseptic MoM implant failure contained scanty or scattered NPs (less than 5 per HPF on average). CONCLUSION The prevalence of PJI as a cause of MoM hip arthroplasty failure was relatively high compared to other hip bearing combinations; however, the organisms responsible were similar. Histologically, a minority of aseptic MoM implant failures contained some NPs, but the MSIS criteria for the histologic diagnosis of PJI (>5 NPs/HPF) correctly identified all microbiologically confirmed cases of septic failure.
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Affiliation(s)
- George Grammatopoulos
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal and Clinical Laboratory Services (NDORMS), University of Oxford, Nuffield Orthopaedic Centre, Oxford, United Kingdom
| | - Mitsuru Munemoto
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal and Clinical Laboratory Services (NDORMS), University of Oxford, Nuffield Orthopaedic Centre, Oxford, United Kingdom; Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Yusuke Inagaki
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal and Clinical Laboratory Services (NDORMS), University of Oxford, Nuffield Orthopaedic Centre, Oxford, United Kingdom; Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Yasuhito Tanaka
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Nicholas A Athanasou
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal and Clinical Laboratory Services (NDORMS), University of Oxford, Nuffield Orthopaedic Centre, Oxford, United Kingdom
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A preliminary evaluation of immune stimulation following exposure to metal particles and ions using the mouse popliteal lymph node assay. Toxicol Appl Pharmacol 2016; 308:77-90. [DOI: 10.1016/j.taap.2016.07.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 06/17/2016] [Accepted: 07/26/2016] [Indexed: 01/22/2023]
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Tischler EH, Plummer DR, Chen AF, Della Valle CJ, Parvizi J. Leukocyte Esterase: Metal-on-Metal Failure and Periprosthetic Joint Infection. J Arthroplasty 2016; 31:2260-3. [PMID: 27094243 DOI: 10.1016/j.arth.2016.03.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 03/01/2016] [Accepted: 03/07/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Adverse local tissue reactions (ALTRs) and periprosthetic joint infection can occur after metal-on-metal total hip arthroplasty (THA), both potentially generating purulent synovial fluid (SF) and elevated white cell count. This makes it difficult to distinguish between diagnoses; therefore, we evaluated leukocyte esterase (LE) strip test's reliability in ruling out periprosthetic joint infection in ALTR revision THA. METHODS Sixty-one patients with ALTRs and an LE strip test were evaluated, excluding 15 cases with SF metallic debris. LE strip tests were classified -/trace, + (mildly positive), and ++ (strongly positive). RESULTS LE strip tests were ++, +, -/trace in 8 patients (13.1%), 14 (23.0%), and 39 (63.9%), respectively. Means and ranges of SF white cell count and polymorphonuclear percentage were 1291.4 (0-10,886 cells/μL), and 46.1% (0%-94%), respectively. CONCLUSION ++ LE strip test, in conjunction with preoperative work-ups, reliably rules out infection in 92.9% of patients undergoing THA revision secondary to ALTR.
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Affiliation(s)
- Eric H Tischler
- Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | - Antonia F Chen
- Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | - Javad Parvizi
- Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
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Allergy to Surgical Implants. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 3:683-95. [PMID: 26362550 DOI: 10.1016/j.jaip.2015.07.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 07/06/2015] [Accepted: 07/07/2015] [Indexed: 01/26/2023]
Abstract
Surgical implants have a wide array of therapeutic uses, most commonly in joint replacements, but also in repair of pes excavatum and spinal disorders, in cardiac devices (stents, patches, pacers, valves), in gynecological implants, and in dentistry. Many of the metals used are immunologically active, as are the methacrylates and epoxies used in conjunction with several of these devices. Allergic responses to surgical components can present atypically as failure of the device, with nonspecific symptoms of localized pain, swelling, warmth, loosening, instability, itching, or burning; localized rash is infrequent. Identification of the specific metal and cement components used in a particular implant can be difficult, but is crucial to guide testing and interpretation of results. Nickel, cobalt, and chromium remain the most common metals implicated in implant failure due to metal sensitization; methacrylate-based cements are also important contributors. This review will provide a guide on how to assess and interpret the clinical history, identify the components used in surgery, test for sensitization, and provide advice on possible solutions. Data on the pathways of metal-induced immune stimulation are included. In this setting, the allergist, the dermatologist, or both have the potential to significantly improve surgical outcomes and patient care.
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Grant ML, Karp JK, Palladino M, Le N, Hall N, Herman JH. Does therapeutic plasma exchange have a role in the treatment of prosthetic hip–associated cobalt toxicity? A case report and literature review. Transfusion 2016; 56:2368-73. [DOI: 10.1111/trf.13720] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 05/04/2016] [Accepted: 05/23/2016] [Indexed: 12/25/2022]
Affiliation(s)
- Michelle L. Grant
- Department of Pathology, Anatomy, and Cell BiologyThomas Jefferson University HospitalPhiladelphia Pennsylvania
| | - Julie K. Karp
- Department of Pathology, Anatomy, and Cell BiologyThomas Jefferson University HospitalPhiladelphia Pennsylvania
| | - Michele Palladino
- Department of Pathology, Anatomy, and Cell BiologyThomas Jefferson University HospitalPhiladelphia Pennsylvania
| | - Nguyet Le
- Department of Pathology, Anatomy, and Cell BiologyThomas Jefferson University HospitalPhiladelphia Pennsylvania
| | - Nancy Hall
- Department of Pathology, Anatomy, and Cell BiologyThomas Jefferson University HospitalPhiladelphia Pennsylvania
| | - Jay H. Herman
- Department of Pathology, Anatomy, and Cell BiologyThomas Jefferson University HospitalPhiladelphia Pennsylvania
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Thomas P, Weik T, Roider G, Summer B, Thomsen M. Influence of Surface Coating on Metal Ion Release: Evaluation in Patients With Metal Allergy. Orthopedics 2016; 39:S24-30. [PMID: 27219723 DOI: 10.3928/01477447-20160509-08] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 02/03/2016] [Indexed: 02/03/2023]
Abstract
Nickel, chromium, and cobalt in stainless steel and Cobalt-chrome-molybdenum (CoCrMo) alloys may induce allergy. The objectives of this study were to evaluate surface coating regarding ion release, patch test reactivity, and arthroplasty performance. Materials and methods included patch test in 31 patients with metal allergy and 30 patients with no allergy to stainless steel and CoCrMo disks that are uncoated or coated by titanium nitride/zirconium nitride (TiN/ZrN). Assessment include atomic absorption spectrometry of released nickel, cobalt, and chromium from the disks after exposure to distilled water, artificial sweat and culture medium. Results showed that both coatings reduced the nickel and chromium release from stainless steel and CoCrMo disks and mostly the cobalt release from the disks (maximally 11.755 µg/cm(2)/5 d to 1.624 by Ti-N and to 0.442 by ZrN). Six of the 31 patients with metal allergy reacted to uncoated disks, but none reacted to the coated disks. The current authors report on exemplary patients with metal allergy who had symptom relief by revision with surface-coated arthroplasty. The authors concluded that the surface coating may prevent cutaneous and peri-implant allergic reactions. [Orthopedics. 2016; 39(3):S24-S30.].
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Salvage of Monoblock Metal-on-Metal Acetabular Components Using a Dual-Mobility Bearing. J Arthroplasty 2016; 31:846-9. [PMID: 26404847 DOI: 10.1016/j.arth.2015.08.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 08/17/2015] [Accepted: 08/18/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Large-diameter, monoblock acetabular components have been used for both hip resurfacing arthroplasty and metal-on-metal (MoM) total hip arthroplasty (THA). If revision is required, one solution is to retain the shell and use a dual-mobility bearing. METHODS We reviewed the results of 25 revision THAs including 11 hip resurfacing arthroplasty and 14 MoM THAs where a monoblock acetabular component was mated to a dual-mobility bearing. RESULTS At a mean of 29 months, there was one failure, an intraprosthetic dislocation of the dual-mobility bearing. There was a significant decrease in serum metal ion levels postoperatively. CONCLUSION Retention of a well-fixed, monoblock MoM acetabular shell and mating it to a dual-mobility bearing in the setting of revision surgery seems to be a reasonable, low-morbidity option at short-term follow-up in appropriately positioned cups.
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42
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Fage SW, Muris J, Jakobsen SS, Thyssen JP. Titanium: a review on exposure, release, penetration, allergy, epidemiology, and clinical reactivity. Contact Dermatitis 2016; 74:323-45. [PMID: 27027398 DOI: 10.1111/cod.12565] [Citation(s) in RCA: 131] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Revised: 02/07/2016] [Accepted: 02/08/2016] [Indexed: 11/29/2022]
Abstract
Exposure to titanium (Ti) from implants and from personal care products as nanoparticles (NPs) is common. This article reviews exposure sources, ion release, skin penetration, allergenic effects, and diagnostic possibilities. We conclude that human exposure to Ti mainly derives from dental and medical implants, personal care products, and foods. Despite being considered to be highly biocompatible relative to other metals, Ti is released in the presence of biological fluids and tissue, especially under certain circumstances, which seem to be more likely with regard to dental implants. Although most of the studies reviewed have important limitations, Ti seems not to penetrate a competent skin barrier, either as pure Ti, alloy, or as Ti oxide NPs. However, there are some indications of Ti penetration through the oral mucosa. We conclude that patch testing with the available Ti preparations for detection of type IV hypersensitivity is currently inadequate for Ti. Although several other methods for contact allergy detection have been suggested, including lymphocyte stimulation tests, none has yet been generally accepted, and the diagnosis of Ti allergy is therefore still based primarily on clinical evaluation. Reports on clinical allergy and adverse events have rarely been published. Whether this is because of unawareness of possible adverse reactions to this specific metal, difficulties in detection methods, or the metal actually being relatively safe to use, is still unresolved.
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Affiliation(s)
- Simon W Fage
- Department of Dermato-Venereology, Aarhus University Hospital, 8000 Aarhus, Denmark
| | - Joris Muris
- Department of Dental Materials Science, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, Gustav Mahlerlaan 3004, 1081 LA, Amsterdam, The Netherlands
| | - Stig S Jakobsen
- Department of Orthopaedic Surgery, Aarhus University Hospital, 8000 Aarhus, Denmark
| | - Jacob P Thyssen
- National Allergy Research Centre, Department of Dermato-Allergology, Copenhagen University Hospital Herlev-Gentofte, 2900 Hellerup, Denmark
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Chalmers BP, Perry KI, Taunton MJ, Mabry TM, Abdel MP. Diagnosis of adverse local tissue reactions following metal-on-metal hip arthroplasty. Curr Rev Musculoskelet Med 2016; 9:67-74. [PMID: 26816329 PMCID: PMC4762796 DOI: 10.1007/s12178-016-9321-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Metal-on-metal (MOM) bearing surfaces in hip arthroplasty have distinct advantages that led to the increase in popularity in North America in the early 2000s. However, with their increased use, concerns such as local cytotoxicity and hypersensitivity reactions leading to soft tissue damage and cystic mass formation (known collectively as adverse local tissue reactions (ALTR)) became apparent. The clinical presentation of ALTR is highly variable. The diagnosis of ALTR in MOM articulations in hip arthroplasty can be challenging and a combination of clinical presentation, physical examination, implant track record, component positioning, serum metal ion levels, cross-sectional imaging, histopathologic analysis, and consideration of alternative diagnoses are essential.
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Affiliation(s)
- Brian P Chalmers
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W, Rochester, MN, 55905, USA.
| | - Kevin I Perry
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W, Rochester, MN, 55905, USA.
| | - Michael J Taunton
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W, Rochester, MN, 55905, USA.
| | - Tad M Mabry
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W, Rochester, MN, 55905, USA.
| | - Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W, Rochester, MN, 55905, USA.
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Metal-on-Metal Total Hip Arthroplasty: Patient Evaluation and Treatment. J Am Acad Orthop Surg 2015; 23:724-31. [PMID: 26493972 DOI: 10.5435/jaaos-d-14-00183] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Accepted: 05/10/2015] [Indexed: 02/01/2023] Open
Abstract
Metal-on-metal (MoM) hip articulations were thought to represent a biologic and biomechanically favorable alternative to conventional metal-on-polyethylene total hip arthroplasty implants. However, concerns emerged when registry data reported significantly higher failure rates associated with MoM implants compared with other contemporary hip implants. These high implant failure rates have been attributed to the release of metal particles into the periprosthetic space, creating macroscopic necrosis; corrosive osteolysis; large, sterile hip effusions; and periprosthetic solid and cystic masses (ie, pseudotumors)-a spectrum of findings termed adverse reaction to metal debris. A thorough clinical history and physical examination, along with laboratory data and imaging surveillance of these patients, is critical for appropriate diagnosis and treatment. The decision to perform revision hip arthroplasty of a metal-on-metal implant is multifactorial and should be based on documented, objective clinical indications. A systematic and objective approach to this evaluation and treatment is essential to optimize the care of patients who undergo total hip arthroplasty with MoM implants.
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45
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De Martino I, Assini JB, Elpers ME, Wright TM, Westrich GH. Corrosion and Fretting of a Modular Hip System: A Retrieval Analysis of 60 Rejuvenate Stems. J Arthroplasty 2015; 30:1470-5. [PMID: 25817187 DOI: 10.1016/j.arth.2015.03.010] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 02/18/2015] [Accepted: 03/07/2015] [Indexed: 02/08/2023] Open
Abstract
Femoral stems with dual-taper modularity were introduced to allow independent control of length, offset, and version. Corrosion and fretting related to micromotion at the neck-stem junction are thought to stimulate an adverse local tissue reaction (ALTR). Analysis of 60 consecutively retrieved modular-neck stem implants (Rejuvenate, Stryker) revised primarily for ALTR was done to determine the variables influencing corrosion and fretting patterns at the neck-stem interface. Taper damage evaluation was performed with stereomicrocopic analysis with two observers. Evidence of fretting and corrosion was seen at the neck-stem taper in all implants, including three implants revised for periprosthetic fractures within four weeks of the index surgery indicating that this process starts early. Femoral stems paired with the long overall neck lengths had significantly higher corrosion scores. Correlation of the corrosion severity at particular locations with the length of implantation suggests that the neck-stem junction experiences cyclic cantilever bending in vivo. The positive correlation between the length of implantation and fretting/corrosion scores bodes poorly for patients who still have this implant. Scanning electron microscopy on a subset of specimens was also performed to evaluate the black corrosion material. We strongly urge frequent follow-up exams for every patient with this particular modular hip stem.
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Affiliation(s)
- Ivan De Martino
- Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, New York; Department of Biomechanics, Hospital for Special Surgery, New York, New York
| | - Joseph B Assini
- Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, New York
| | - Marcella E Elpers
- Department of Biomechanics, Hospital for Special Surgery, New York, New York
| | - Timothy M Wright
- Department of Biomechanics, Hospital for Special Surgery, New York, New York
| | - Geoffrey H Westrich
- Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, New York
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Toxicology of wear particles of cobalt-chromium alloy metal-on-metal hip implants Part I: Physicochemical properties in patient and simulator studies. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2015; 11:1201-15. [DOI: 10.1016/j.nano.2014.12.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 11/19/2014] [Accepted: 12/03/2014] [Indexed: 12/27/2022]
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Bregnbak D, Johansen JD, Jellesen MS, Zachariae C, Menné T, Thyssen JP. Chromium allergy and dermatitis: prevalence and main findings. Contact Dermatitis 2015; 73:261-80. [DOI: 10.1111/cod.12436] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 05/12/2015] [Accepted: 05/12/2015] [Indexed: 12/14/2022]
Affiliation(s)
- David Bregnbak
- Department of Dermato-Allergology; National Allergy Research Centre, Copenhagen University Hospital Gentofte; Hellerup 2900 Denmark
| | - Jeanne D. Johansen
- Department of Dermato-Allergology; National Allergy Research Centre, Copenhagen University Hospital Gentofte; Hellerup 2900 Denmark
| | - Morten S. Jellesen
- Materials and Surface Engineering, Department of Mechanical Engineering; Technical University of Denmark; DK-2800 Lyngby Denmark
| | - Claus Zachariae
- Department of Dermato-Allergology; Gentofte University Hospital; Hellerup 2900 Denmark
| | - Torkil Menné
- Department of Dermato-Allergology; National Allergy Research Centre, Copenhagen University Hospital Gentofte; Hellerup 2900 Denmark
| | - Jacob P. Thyssen
- Department of Dermato-Allergology; National Allergy Research Centre, Copenhagen University Hospital Gentofte; Hellerup 2900 Denmark
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48
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Clinical manifestations in ten patients with asymptomatic metal-on-metal hip arthroplasty with very high cobalt levels. Hip Int 2015; 23:441-4. [PMID: 23813157 DOI: 10.5301/hipint.5000054] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2013] [Indexed: 02/04/2023]
Abstract
Reports of adverse reactions to metal particle debris with metal-on-metal (MoM) hip arthroplasty have increased recently. Apart from the formation of pseudotumours and higher revision rates, another major cause for concern are the systemic effects of metal ions. Several effects of elevated systemic cobalt ions have been reported (e.g., myocardial and neurological effects, hypothyroidism). All 643 patients who underwent a stemmed large head MoM total hip replacement in our clinic were screened with repeated whole blood samples of metal ions (cobalt, chromium). We included ten asymptomatic unrevised patients with the highest cobalt concentrations, determined at a minimum of three years after implantation. These patients were subjected to an extensive neurological and cardiological screening protocol. In addition, blood samples were taken to assess renal and thyroid function. Ten patients with a cobalt level of 18-153 µg/L (mean 46.8 µg/L) were included. Nine patients were female, mean age was 65 years (range 56-75). The mean follow-up period was 4.2 years (range 3.0-6.1). Seven patients had bilateral stemmed MoM hip arthroplasty. No signs or symptoms of neurological dysfunction, cardiomyopathy, or renal or thyroid dysfunction could be identified or attributed to elevated cobalt levels. The clinical relevance of this study is that after short-term follow-up highly elevated blood cobalt levels do not cause systemic effects in our population. Hence in asymptomatic patients metal ions appear not to be a significant factor in the decision of when to revise a MoM large head total hip replacement.
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Khanna R, Kokubo T, Matsushita T, Nomura Y, Nose N, Oomori Y, Yoshida T, Wakita K, Takadama H. Novel artificial hip joint: A layer of alumina on Ti-6Al-4V alloy formed by micro-arc oxidation. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2015; 55:393-400. [PMID: 26117770 DOI: 10.1016/j.msec.2015.05.021] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 03/23/2015] [Accepted: 05/07/2015] [Indexed: 01/27/2023]
Abstract
In many hip replacement surgeries, monolithic alumina is used as a femoral head due to its high wear resistance. However, it is liable to fracture under load bearing operations in artificial joints. We propose a promising way to overcome this limitation by forming a dense alumina layer onto a relatively tough substrate such as Ti-6Al-4V alloy to obtain high wear resistance on a material that can sustain relatively high toughness. For this purpose, Al metal powders were deposited onto Ti-6Al-4V alloy by cold spraying in N2 atmosphere. Interfacial adhesion between Al and the Ti alloy was improved by the formation of a reaction layer of Al3Ti between them by heating at 640 °C for 1h in air. Subsequently, micro-arc oxidation treatment was performed to oxidize Al. The oxidized layer was composed of an outer porous layer of γ-alumina and inner-most dense layer of α-alumina. The α-alumina layer was almost fully densified and exhibited high Vickers hardness almost equal to that of alumina ceramics used as the femoral head. Thus, the newly developed dense alumina/Ti alloy can be potentially used to produce the reliable bearing surfaces of artificial hip joint.
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Affiliation(s)
- Rohit Khanna
- Department of Biomedical Sciences, College of Life & Health Sciences, Chubu University, 1200 Matsumoto cho, Kasugai, Aichi 487-8501, Japan.
| | - Tadashi Kokubo
- Department of Biomedical Sciences, College of Life & Health Sciences, Chubu University, 1200 Matsumoto cho, Kasugai, Aichi 487-8501, Japan
| | - Tomiharu Matsushita
- Department of Biomedical Sciences, College of Life & Health Sciences, Chubu University, 1200 Matsumoto cho, Kasugai, Aichi 487-8501, Japan
| | - Yuuji Nomura
- Taiyo Nippon Sanso, Inc., 1-3-26, Koyama, Shinagawa 142-8558, Tokyo, Japan
| | - Norihiro Nose
- Taiyo Nippon Sanso, Inc., 1-3-26, Koyama, Shinagawa 142-8558, Tokyo, Japan
| | - Yoshiyuki Oomori
- Taiyo Nippon Sanso, Inc., 1-3-26, Koyama, Shinagawa 142-8558, Tokyo, Japan
| | - Takuya Yoshida
- Graduate School of Electrical and Electronics Engineering, Chubu University, Kasugai, Aichi 487-8501, Japan
| | - Koichi Wakita
- Graduate School of Electrical and Electronics Engineering, Chubu University, Kasugai, Aichi 487-8501, Japan
| | - Hiroaki Takadama
- Department of Biomedical Sciences, College of Life & Health Sciences, Chubu University, 1200 Matsumoto cho, Kasugai, Aichi 487-8501, Japan
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Abstract
Use of large-head metal-on-metal (MoM) bearing surfaces in total hip arthroplasty (THA) has created new and unique modes of failure for this type of articulation. These unique modes are in addition to the traditional modes of failure seen in conventional THA, which include instability, osteolysis, infection, iliopsoas tendinitis, aseptic loosening, and periprosthetic fracture. Ion levels and cross-sectional imaging are helpful when evaluating a MoM patient in the identification of adverse local tissue reactions. Unique modes of failure in MoM THA include tissue necrosis, metallosis-induced osteolysis, skin hypersensitivity reactions, and rarely systemic cobaltism. This article outlines the evaluation and treatment of modes of failure in MoM THA.
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Affiliation(s)
- Keith A Fehring
- Department of Orthopaedic Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
| | - Thomas K Fehring
- Ortho Carolina Hip and Knee Center, 2001 Vail Avenue, Charlotte, NC 28209, USA
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