1
|
Pechancová R, Gallo J, Baron D, Milde D, Antal P, Slobodová Z, Lemr K, Pluháček T. Detailed insight into chromium species released from failed CoCrMo implants: Ex vivo periprosthetic tissues study. J Biomed Mater Res B Appl Biomater 2023; 111:271-283. [PMID: 36507699 DOI: 10.1002/jbm.b.35149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 07/26/2022] [Accepted: 08/01/2022] [Indexed: 12/15/2022]
Abstract
This unique study provides information on Cr species and their distribution in periprosthetic tissues of patients with metal-on-polyethylene joint implants. Co-Cr-Mo alloy has been widely used in joint replacement and represents a source of metal derived species. In the case of chromium, previous studies on periprosthetic tissues revealed mainly Cr(III) distribution, whereas the potential release of carcinogenic Cr(VI) species has been still a subject of debate. Here, an analytical approach utilizing speciation and fractionation was developed to analyze periprosthetic tissue samples collected from wide range of patients with failed total hip or knee replacements. The results reveal that Cr(III) is mainly released in the form of insoluble CrPO4 and Cr2 O3 particles. The highest Cr contents were found in periprosthetic tissues of patients suffering from aseptic loosening and having more Cr-based implants in the body. Cr species penetrated tissue layers, but their levels decreased with the distance from an implant. The detailed speciation/fractionation study carried out using the set of consecutive periprosthetic tissues of a patient with extensive metallosis showed the presence of trace amounts of free Cr(III), nanoparticles, and metal-protein complexes, but the majority of Cr still occurred in CrPO4 form. Carcinogenic Cr(VI) species were not detected. Up to date, there is no published human tissue study focused on the detailed speciation of both soluble and insoluble Cr-based species in the context of failing total hip and knee replacements.
Collapse
Affiliation(s)
- Radka Pechancová
- Department of Analytical Chemistry, Faculty of Science, Palacký University Olomouc, Olomouc, Czech Republic
| | - Jiří Gallo
- Department of Orthopedics, Faculty of Medicine and Dentistry, Palacký University Olomouc, University Hospital Olomouc, Olomouc, Czech Republic
| | - Daniel Baron
- Department of Analytical Chemistry, Faculty of Science, Palacký University Olomouc, Olomouc, Czech Republic
| | - David Milde
- Department of Analytical Chemistry, Faculty of Science, Palacký University Olomouc, Olomouc, Czech Republic
| | - Peter Antal
- Department of Inorganic Chemistry, Faculty of Science, Palacký University Olomouc, Olomouc, Czech Republic
| | - Zuzana Slobodová
- Department of Clinical and Molecular Pathology, Faculty of Medicine and Dentistry, Palacký University Olomouc, Olomouc, Czech Republic
| | - Karel Lemr
- Department of Analytical Chemistry, Faculty of Science, Palacký University Olomouc, Olomouc, Czech Republic.,Institute of Microbiology of the Czech Academy of Sciences, Prague, Czech Republic
| | - Tomáš Pluháček
- Department of Analytical Chemistry, Faculty of Science, Palacký University Olomouc, Olomouc, Czech Republic
| |
Collapse
|
2
|
Wolf S, Johannessen AC, Ellison P, Furnes O, Hallan G, Rogg K, Skarstein K, Høl PJ. Inflammatory tissue reactions around aseptically loose cemented hip prostheses: A retrieval study of the Spectron EF stem with Reflection All-Poly acetabular cup. J Biomed Mater Res B Appl Biomater 2022; 110:1624-1636. [PMID: 35099116 PMCID: PMC9303329 DOI: 10.1002/jbm.b.35023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 11/09/2021] [Accepted: 01/15/2022] [Indexed: 12/27/2022]
Abstract
The cemented Spectron EF stem in combination with the cemented non‐crosslinked Reflection All‐Poly cup showed a high rate of mid‐term aseptic loosening. However, the failure mechanisms are not fully known. We assessed the inflammatory tissue reactions and wear particles in periprosthetic tissues, implant wear and blood metal ion levels in 28 patients with failed implants. Histological analysis showed a macrophage pre‐dominant pattern with randomly distributed lymphocytes, with various amounts of neutrophils and giant cells. The number of different cell types in the tissue samples from patients in the cup group and in the stem group was similar. Wear particles, mainly ZrO2, CoCrMo, and polyethylene particles of different sizes and shapes, were associated with macrophages/giant cells, and total particle load/mm2 was higher in cases of stem loosening. The Spectron EF stems were heavily worn, abraded, and polished. Stem abrasion correlated with metal ion concentrations in blood. The median polyethylene wear rate of the Reflection cups was 0.23 mm/year. The high proximal roughness of the Spectron EF stem resulted in excessive cement wear during loosening. The resulting inflammatory tissue responses to the degradation products both from the cup and the stem led to massive osteolysis and subsequent implant loosening.
Collapse
Affiliation(s)
- Susann Wolf
- Biomatlab, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway.,National Institute of Occupational Health, Oslo, Norway
| | - Anne Christine Johannessen
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Pathology, Haukeland University Hospital, Bergen, Norway
| | - Peter Ellison
- Biomatlab, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Ove Furnes
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Geir Hallan
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Katharina Rogg
- Biomatlab, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Kathrine Skarstein
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Pathology, Haukeland University Hospital, Bergen, Norway
| | - Paul Johan Høl
- Biomatlab, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| |
Collapse
|
3
|
Junnila M, Laaksonen I, Eskelinen A, Pulkkinen P, Ivar Havelin L, Furnes O, Marie Fenstad A, Pedersen AB, Overgaard S, Kärrholm J, Garellick G, Malchau H, Mäkelä KT. Implant survival of the most common cemented total hip devices from the Nordic Arthroplasty Register Association database. Acta Orthop 2016; 87:546-553. [PMID: 27550058 PMCID: PMC5119435 DOI: 10.1080/17453674.2016.1222804] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Background and purpose - According to previous Nordic Arthroplasty Register Association (NARA) data, the 10-year implant survival of cemented total hip arthroplasties (THAs) is 94% in patients aged 65-74 and 96% in patients aged 75 or more. Here we report a brand-level comparison of cemented THA based on the NARA database, which has not been done previously. Patients and methods - We determined the rate of implant survival of the 9 most common cemented THAs in the NARA database. We used Kaplan-Meier analysis with 95% CI to study implant survival at 10 and 15 years, and Cox multiple regression to assess survival and hazard ratios (HRs), with revision for any reason as endpoint and with adjustment for age, sex, diagnosis, and femoral head material. Results - Spectron EF THA (89.9% (CI: 89.3-90.5)) and Elite THA (89.8% (CI: 89.0-90.6)) had the lowest 10-year survivorship. Lubinus (95.7% survival, CI: 95.5-95.9), MS 30 (96.6%, CI: 95.8-97.4), and C-stem THA (95.8%, CI: 94.8-96.8) had a 10-year survivorship of at least 95%. Lubinus (revision risk (RR) = 0.77, CI: 0.73-0.81), Müller (RR =0.83, CI: 0.70-0.99), MS-30 (RR =0.73, CI: 0.63-0.86), C-stem (RR =0.70, CI: 0.55-0.90), and Exeter Duration THA (RR =0.84, CI: 0.77-0.90) had a lower risk of revision than Charnley THA, the reference implant. Interpretation - The Spectron EF THA and the Elite THA had a lower implant survival than the Charnley, Exeter, and Lubinus THAs. Implant survival of the Müller, MS 30, CPT, and C-stem THAs was above the acceptable limit for 10-year survival.
Collapse
Affiliation(s)
- Mika Junnila
- Department of Orthopaedics and Traumatology, Turku University Hospital, Turku;,Correspondence:
| | - Inari Laaksonen
- Department of Orthopaedics and Traumatology, Turku University Hospital, Turku
| | - Antti Eskelinen
- Coxa Hospital for Joint Replacement, Tampere;,The Finnish Arthroplasty Register
| | - Pekka Pulkkinen
- Department of Public Health, Helsinki University, Helsinki, Finland
| | - Leif Ivar Havelin
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen;,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Ove Furnes
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen;,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Anne Marie Fenstad
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen
| | - Alma B Pedersen
- Competence Centre for Clinical Epidemiology and Biostatistics, North, Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus;,The Danish Hip Arthroplasty Register, Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Søren Overgaard
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, and Institute of Clinical Research, University of Southern Denmark, Odense;,The Danish Hip Arthroplasty Register, Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Johan Kärrholm
- The Swedish Hip Arthroplasty Register, Department of Orthopaedics, Institute of Surgical Sciences, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Göran Garellick
- The Swedish Hip Arthroplasty Register, Department of Orthopaedics, Institute of Surgical Sciences, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Henrik Malchau
- The Swedish Hip Arthroplasty Register, Department of Orthopaedics, Institute of Surgical Sciences, Sahlgrenska University Hospital, Gothenburg, Sweden;,Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA;,Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA
| | - Keijo T Mäkelä
- Department of Orthopaedics and Traumatology, Turku University Hospital, Turku;,The Finnish Arthroplasty Register
| |
Collapse
|
4
|
Shearwood-Porter N, Browne M, Milton JA, Cooper MJ, Palmer MR, Latham JM, Wood RJK, Cook RB. Damage mechanisms at the cement-implant interface of polished cemented femoral stems. J Biomed Mater Res B Appl Biomater 2016; 105:2027-2033. [DOI: 10.1002/jbm.b.33739] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 05/10/2016] [Accepted: 06/06/2016] [Indexed: 11/05/2022]
Affiliation(s)
| | - Martin Browne
- Bioengineering Science Research Group; University of Southampton; Southampton UK
| | - James A. Milton
- School of Ocean and Earth Science; University of Southampton, National Oceanography Centre; Southampton UK
| | - Matthew J. Cooper
- School of Ocean and Earth Science; University of Southampton, National Oceanography Centre; Southampton UK
| | - Martin R. Palmer
- School of Ocean and Earth Science; University of Southampton, National Oceanography Centre; Southampton UK
| | - Jeremy M. Latham
- Southampton Orthopaedic Centre for Arthroplasty and Revision Surgery (SOCARS); Southampton General Hospital; Southampton UK
| | - Robert J. K. Wood
- National Centre for Advanced Tribology at Southampton (nCATS); University of Southampton; Highfield, Southampton UK
| | - Richard B. Cook
- National Centre for Advanced Tribology at Southampton (nCATS); University of Southampton; Highfield, Southampton UK
| |
Collapse
|
5
|
Severe Periprosthetic Metallosis and Polyethylene Liner Failure Complicating Total Hip Replacement: The Cloud Sign. Radiol Case Rep 2015; 2:115. [PMID: 27303496 PMCID: PMC4895867 DOI: 10.2484/rcr.v2i4.115] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
We present a case of an 85-year-old woman with extensive metallosis of the left hip joint secondary to prosthetic polyethelene liner dislocation and wear. Radiographs demonstrated amorphous cloudy radiodensities surrounding the prosthesis, a feature we have called the “cloud sign.” The presence of amorphous cloudy radiodensities as a radiographic sign of metallosis has not been previously described to our knowledge.
Collapse
|
6
|
High failure rates of the Spectron EF stem at a minimum of 10 year's follow-up. J Arthroplasty 2014; 29:1956-60. [PMID: 24927867 DOI: 10.1016/j.arth.2014.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 04/16/2014] [Accepted: 05/05/2014] [Indexed: 02/01/2023] Open
Abstract
We prospectively followed 112 hips, undergoing THA with a Spectron EF stem. At mean follow-up of 11.2years, 21 patients had died. We obtained radiological follow-up in 99% and clinical follow-up in 100% of the surviving 91 hips. Fifty-four percent demonstrated osteolysis in at least one Gruen zone. Twenty-two hips required revision for all causes, with a further five stems radiologically loose. With endpoint being stem revision for aseptic loosening or radiological failure, survivorship at 11years was 0.783. We believe the addition of a rougher surface finish has contributed to the high levels of osteolysis and stem failure seen with the Spectron EF.
Collapse
|
7
|
Buchhorn GH, Bersebach P, Stauch T, Schultz W, Köster G. Interface abrasion between rough surface femoral stems and PMMA cement results in extreme wear volumes--a retrieval study and failure analysis. J Biomed Mater Res B Appl Biomater 2014; 103:229-41. [PMID: 24820132 DOI: 10.1002/jbm.b.33202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 03/28/2014] [Accepted: 04/21/2014] [Indexed: 11/11/2022]
Abstract
During the loosening cascade of cemented rough femoral stems, the destruction of the mantle and the production of cement and metal wear debris occur after the loss of constraint at the interface. Two-dimensional (2D) measurements (light microscopy based morphometry on fragments of mantles and vertical scanning interferometry of femoral stems) permitted mathematical 3D-extrapolations to estimate the wear volumes. Fragments of the cement mantles available lost volumes from 0.85 mm(3) to 494.10 mm(3) (median amount of bone cement wear = 178,426 mg). The harder metal surfaces lost between 1.459 mm(3) and 5.688 mm(3) of material (the median amount of metal wear per surface = 1.504 mg/100 mm(2)). Compared to the loss of material due to the fretting of stems, the abrasion of metal, and cement in defective cement mantles produced wear volumes sufficiently high to induce osteolysis. Though the design of the femoral stem and the handling of bone cement do not represent contemporary design and clinical practice, respectively, an extremely high number of joint replacements still in daily use may be impacted by this study because of possible predicted failures. Once the processes of fragmentation, abrasion, and osteolysis have been realized, the time until revision surgery should not be unduly prolonged.
Collapse
Affiliation(s)
- Gottfried Hans Buchhorn
- Department of Orthopaedic Surgery, Fachklinik Lorsch, Waldstrasse 13, 64653, Lorsch, Germany
| | | | | | | | | |
Collapse
|
8
|
Hutt J, Hazlerigg A, Aneel A, Epie G, Dabis H, Twyman R, Cobb A. The effect of a collar and surface finish on cemented femoral stems: a prospective randomised trial of four stem designs. INTERNATIONAL ORTHOPAEDICS 2014; 38:1131-7. [PMID: 24474088 DOI: 10.1007/s00264-013-2256-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 12/09/2013] [Indexed: 10/25/2022]
Abstract
PURPOSE The optimal design for a cemented femoral stem remains a matter of debate. Over time, the shape, surface finish and collar have all been modified in various ways. A clear consensus has not yet emerged regarding the relative merits of even the most basic design features of the stem. We undertook a prospective randomised trial comparing surface finish and the effect of a collar on cemented femoral component subsidence, survivorship and clinical function. METHODS One hundred and sixty three primary total hip replacement patients were recruited prospectively and randomised to one of four groups to receive a cemented femoral stem with either a matt or polished finish, and with or without a collar. RESULTS At two years, although there was a trend for increased subsidence in the matt collarless group, this was not statistically significant (p = 0.18). At a mean of 10.1 years follow-up, WOMAC scores for the surviving implants were good, (Range of means 89-93) without significant differences. Using revision or radiographic loosening as the endpoint, survivorship of the entire cohort was 93 % at 11 yrs, (CI 87-97 %). There were no significant differences in survivorship between the two groups with polished stems or the two groups with matt stems. A comparison of the two collarless stems demonstrated a statistically significant difference in survivorship between polished (100 %) and matt (88 %) finishes (p = 0.02). CONCLUSIONS In the presence of a collar, surface finish did not significantly affect survivorship or function. Between the two collarless groups a polished surface conferred an improved survivorship.
Collapse
Affiliation(s)
- Jonathan Hutt
- Department of Trauma and Orthopaedics, Epsom General Hospital, Dorking Road, Epsom, Surrey, KT18 7EG, UK,
| | | | | | | | | | | | | |
Collapse
|
9
|
Suh DH, Yun HH, Chun SK, Shon WY. Fifteen-year results of precoated femoral stem in primary hybrid total hip arthroplasty. Clin Orthop Surg 2013; 5:110-7. [PMID: 23730474 PMCID: PMC3664669 DOI: 10.4055/cios.2013.5.2.110] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Accepted: 02/01/2013] [Indexed: 11/22/2022] Open
Abstract
Background There has been controversy whether methylmethacrylate precoating of the cemented femoral stem is a solution for aseptic loosening or rather contributes to increased failure rates in cemented total hip arthroplasties. Methods On a retrospective basis, we analyzed 76 primary hybrid total hip arthroplasties from 63 patients with precoated, cemented femoral stems between October 1990 and December 1995. The mean age of the patients was 46.8 years (range, 22 to 77 years) with a minimum follow-up of 14 years (mean, 15.5 years; range, 14 to 19.5 years). Third generation cementing techniques were employed in all cases. Results Twenty-four out of 76 cases (31.6%) showed aseptic loosening of the femoral stems, of which 23 stems were revised at an average revision time of 8 years (range, 3 to 14.8 years). The main mode of loosening was cement-stem interface failure in 22 hips (91.7%). Twenty-one out of 24 failed hips (87.5%) demonstrated C2 cementing grades (p < 0.001). Kaplan-Meier survivorship analysis using radiographic aseptic loosening of the femoral stem as the endpoint for failure showed survival rates of 76.5% at 10 years (95% confidence interval [CI], 71.4 to 81.6) and 63.2% at 19 years (95% CI, 57.3 to 69.1). Conclusions An early failure of the precoated femoral stem in this study was mainly due to an insufficient cementing technique. Achievement of good cement mantle may improve the survival rates.
Collapse
Affiliation(s)
- Dong Hun Suh
- Department of Orthopaedic Surgery, Korea University Ansan Hospital, Ansan, Korea
| | | | | | | |
Collapse
|
10
|
Head material influences survival of a cemented total hip prosthesis in the Norwegian Arthroplasty Register. Clin Orthop Relat Res 2012; 470:3007-13. [PMID: 22644422 PMCID: PMC3462857 DOI: 10.1007/s11999-012-2396-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND High prosthesis survival is reported for total hip prostheses with metal and alumina heads, but direct comparisons of a single prosthesis design with one of two different head materials has seldom been studied. Prostheses with zirconia heads are less commonly used than metal and alumina heads, and the few reports suggest variable results with zirconia heads. QUESTIONS/PURPOSES We therefore asked: (1) Would metal heads provide better survival of a cemented total hip arthroplasty (THA) than alumina heads? (2) Would metal heads provide better survival of a cemented THA than zirconia heads? METHODS We searched in the Norwegian Arthroplasty Register for cemented primary THA cup/stem combinations that simultaneously had been used with different head materials. The only THA that fulfilled these inclusion criteria was the cemented Reflection All-Poly/Spectron EF (cup/stem) that had during 2001 to 2006 been used both with alumina (n = 448) and cobalt-chromium (n = 5229) heads; that implant had also been used with zirconia (n = 275) and cobalt-chromium heads (n = 3195) during 1997 to 2003, and we included patients with this THA from these two time intervals in the study. All cups were conventional polyethylene. We estimated prosthesis survival and relative revision risks adjusting for age, sex, and diagnosis. The followup in the two study materials was until December 2010. RESULTS The survival at 8 years of the Spectron EF/Reflection THAs, inserted with alumina and cobalt-chromium heads during 2001 to 2006, was 92.3% and 94.0%, respectively. The Reflection/Spectron EF THA had inferior survival with zirconia heads compared with cobalt-chromium heads (relative risk, 1.7). At 12 years, the survival rate was 88.1% with cobalt-chromium heads and 74.8% with zirconia heads. CONCLUSIONS Alumina femoral heads provided no advantage over cobalt-chromium heads on midterm prosthesis survival. THAs with zirconia heads had inferior survival. LEVEL OF EVIDENCE Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Collapse
|
11
|
Johanson PE, Digas G, Herberts P, Thanner J, Kärrholm J. Highly crosslinked polyethylene does not reduce aseptic loosening in cemented THA 10-year findings of a randomized study. Clin Orthop Relat Res 2012; 470:3083-93. [PMID: 22669546 PMCID: PMC3462851 DOI: 10.1007/s11999-012-2400-x] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Polyethylene (PE) wear particles are believed to cause aseptic loosening and thereby impair function in hip arthroplasty. Highly crosslinked polyethylene (XLPE) has low short- and medium-term wear rates. However, the long-term wear characteristics are unknown and it is unclear whether reduced wear particle burden improves function and survival of cemented hip arthroplasty. QUESTIONS/PURPOSES We asked whether XLPE wear rates remain low up to 10 years and whether this leads to improved implant fixation, periprosthetic bone quality, and clinical function compared to conventional PE. METHODS We randomized 60 patients (61 hips) to receive either PE or XLPE cemented cups combined with a cemented stem. At 10 years postoperatively, 51 patients (52 hips) were evaluated for polyethylene wear and component migration estimation by radiostereometry, for radiolucent lines, bone densitometry, and Harris hip and pain scores. Revisions were recorded. RESULTS XLPE cups had a lower mean three-dimensional wear rate between 2 and 10 years compared to conventional PE hips: 0.005 mm/year versus 0.056 mm/year. We found no differences in cup migration, bone mineral density, radiolucencies, functional scores, and revision rate. There was a trend toward improved stem fixation in the XLPE group. The overall stem failure rate was comparably high, without influencing wear rate in XLPE hips. CONCLUSIONS XLPE displayed a low wear rate up to 10 years when used in cemented THA, but we found no clear benefits in any other parameters. Further research is needed to determine whether cemented THA designs with XLPE are less prone to stem loosening. LEVEL OF EVIDENCE Level I, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Per-Erik Johanson
- Department of Orthopaedics, Institution of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 413 45 Gothenburg, Sweden.
| | | | | | | | | |
Collapse
|
12
|
Kadar T, Hallan G, Aamodt A, Indrekvam K, Badawy M, Havelin LI, Stokke T, Haugan K, Espehaug B, Furnes O. A randomized study on migration of the Spectron EF and the Charnley flanged 40 cemented femoral components using radiostereometric analysis at 2 years. Acta Orthop 2011; 82:538-44. [PMID: 21895504 PMCID: PMC3242949 DOI: 10.3109/17453674.2011.618914] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE We performed a randomized study to determine the migration patterns of the Spectron EF femoral stem and to compare them with those of the Charnley stem, which is regarded by many as the gold standard for comparison of implants due to its extensive documentation. PATIENTS AND METHODS 150 patients with a mean age of 70 years were randomized, single-blinded, to receive either a cemented Charnley flanged 40 monoblock, stainless steel, vaquasheen surface femoral stem with a 22.2-mm head (n = 30) or a cemented Spectron EF modular, matte, straight, collared, cobalt-chrome femoral stem with a 28-mm femoral head and a roughened proximal third of the stem (n = 120). The patients were followed with repeated radiostereometric analysis for 2 years to assess migration. RESULTS At 2 years, stem retroversion was 2.3° and 0.7° (p < 0.001) and posterior translation was 0.44 mm and 0.17 mm (p = 0.002) for the Charnley group (n = 26) and the Spectron EF group (n = 74), respectively. Subsidence was 0.26 mm for the Charnley and 0.20 mm for the Spectron EF (p = 0.5). INTERPRETATION The Spectron EF femoral stem was more stable than the Charnley flanged 40 stem in our study when evaluated at 2 years. In a report from the Norwegian arthroplasty register, the Spectron EF stem had a higher revision rate due to aseptic loosening beyond 5 years than the Charnley. Initial stability is not invariably related to good long-term results. Our results emphasize the importance of prospective long-term follow-up of prosthetic implants in clinical trials and national registries and a stepwise introduction of implants.
Collapse
Affiliation(s)
| | - Geir Hallan
- Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen
| | | | | | - Mona Badawy
- Hagevik Hospital, Haukeland University Hospital, Hagavik
| | | | - Terje Stokke
- Department of Radiology, Haukeland University Hospital, Bergen
| | - Kristin Haugan
- Department of Orthopaedic Surgery, Trondheim University Hospital, Trondheim
| | - Birgitte Espehaug
- Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen
| | | |
Collapse
|
13
|
Espehaug B, Furnes O, Engesæter LB, Havelin LI. 18 years of results with cemented primary hip prostheses in the Norwegian Arthroplasty Register: concerns about some newer implants. Acta Orthop 2009; 80:402-12. [PMID: 19857178 PMCID: PMC2823190 DOI: 10.3109/17453670903161124] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Few studies have compared the long-term survival of cemented primary total hip arthroplasties (THAs), and several prostheses have been used without adequate knowledge of their endurance. We studied long-term outcome based on data in the Norwegian Arthroplasty Register. PATIENTS AND METHODS The 10 most used prosthesis brands in 62,305 primary Palacos or Simplex cemented THAs reported to the Register from 1987 through 2007 were included. Survival analyses with revision as endpoint (for any cause or for aseptic loosening) were performed using Kaplan-Meier and multiple Cox regression with time-dependent covariates. Revision rate ratios (RRs) were estimated for the follow-up intervals: 0-5, 6-10, and > 10 years. RESULTS 5 prosthesis brands (cup/stem combinations) (Charnley, Exeter, Titan, Spectron/ITH, Link IP/Lubinus SP; n = 24,728) were investigated with 0-20 year follow-up (inserted 1987-1997). After 18 years, 11% (95% CI: 10.6-12.1) were revised for any cause and 8.4% (7.7-9.1) for aseptic loosening. Beyond 10 years of follow-up, the Charnley cup had a lower revision rate due to aseptic loosening than Exeter (RR = 1.8) and Spectron (RR = 2.4) cups. For stems, beyond 10 years we did not find statistically significant differences comparing Charnley with Titan, ITH, and SP stems, but the Exeter stem had better results (RR = 05). 10 prosthesis brands (9 cups in combination with 6 stems; n = 37,577) were investigated with 0-10 years of follow-up (inserted from 1998 through 2007). The Charnley cup had a lower revision rate due to aseptic loosening than all cups except the IP. Beyond 5 years follow-up, the Reflection All-Poly cup had a 14 times higher revision rate. For stems, beyond 5 years the Spectron-EF (RR = 6.1) and Titan (RR = 5.5) stems had higher revision rates due to aseptic loosening than Charnley. The analyses also showed a marked improvement in Charnley results between the periods 1987-1997 and 1998-2007. INTERPRETATION We observed clinically important differences between cemented prosthesis brands and identified inferior results for previously largely undocumented prostheses, including the commonly used prosthesis combination Reflection All-Poly/ Spectron-EF. The results were, however, satisfactory according to international standards.
Collapse
Affiliation(s)
- Birgitte Espehaug
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University HospitalBergenNorway
| | | | | | | |
Collapse
|
14
|
Mäkelä K, Eskelinen A, Pulkkinen P, Paavolainen P, Remes V. Cemented total hip replacement for primary osteoarthritis in patients aged 55 years or older: results of the 12 most common cemented implants followed for 25 years in the Finnish Arthroplasty Register. ACTA ACUST UNITED AC 2008; 90:1562-9. [PMID: 19043125 DOI: 10.1302/0301-620x.90b12.21151] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
We have analysed from the Finnish Arthroplasty Register the long-term survivorship of the 12 most commonly-used cemented implants between 1980 and 2005 in patients aged 55 years or older with osteoarthritis. Only two designs of femoral component, the Exeter Universal and the Müller Straight femoral component had a survivorship of over 95% at ten years with revision for aseptic loosening as the endpoint. At 15 years of the femoral and acetabular component combinations, only the Exeter Universal/Exeter All-poly implant had a survival rate of over 90% with revision for aseptic loosening as the endpoint. In the subgroup of patients aged between 55 and 64 years, survivorship overall was less than 90% at ten years. The variation in the long-term rates of survival of different cemented hip implants was considerable in patients aged 55 years or older. In those aged between 55 and 64 years, none of the cemented prostheses studied yielded excellent long-term survival rates (> or = 90% at 15 years).
Collapse
Affiliation(s)
- K Mäkelä
- Department of Orthopaedics and Traumatology, Turku University Central Hospital, Rauhankatu 24 D 32, 20100 Turku, Finland.
| | | | | | | | | |
Collapse
|
15
|
What are the guidelines for the surgical and nonsurgical treatment of periprosthetic osteolysis? J Am Acad Orthop Surg 2008; 16 Suppl 1:S20-5. [PMID: 18612009 DOI: 10.5435/00124635-200800001-00006] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Periprosthetic osteolysis is most often diagnosed by plain radiographs. Because these radiographs routinely underestimate the extent of the lesion, three-dimensional imaging should be used early in the evaluation process to confirm the presenting extent of disease. If the osteolytic process is asymptomatic, scheduled regular follow-up should be instituted until the lesion can be confirmed to be stable or until the decision is made to proceed with surgery. Nonsurgical management with pharmacologic agents has not proved to be effective. If surgery is contemplated, a three-dimensional evaluation with magnetic resonance imaging or helical computed tomography can assist in preoperative planning. Surgical intervention requires complete débridement of the lesional membrane and removal of the wear-generator--with or without component removal and with or without bone grafting, depending on the individual circumstances. A standardized follow-up evaluation mechanism for all patients should be a part of total joint arthroplasty management.
Collapse
|
16
|
|
17
|
González Della Valle A, Comba F, Zoppi A, Salvati EA. Favourable mid-term results of the VerSys CT polished cemented femoral stem for total hip arthroplasty. INTERNATIONAL ORTHOPAEDICS 2006; 30:381-6. [PMID: 16575608 PMCID: PMC3172773 DOI: 10.1007/s00264-006-0077-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2005] [Revised: 01/02/2006] [Accepted: 01/05/2006] [Indexed: 10/24/2022]
Abstract
We evaluated the mid-term clinical and radiographical performance of a cohort of patients who underwent primary total hip replacement with a modern, forged cobalt-chrome, polished cemented femoral stem with proximal and distal centralisation. Sixty-seven patients with 73 hybrid total hip replacements were followed up clinically and radiographically for an average of 6.1 years (4-8.5). No patient was lost. No hips required revision, and all stems are radiographically well-fixed. Four hips developed localised osteolysis: one at the site of a proximal periprosthetic fracture, another at the level of a lateral femoral window of a previous core decompression, the third at the mid third of the femoral component, and the fourth on the greater trochanter, associated with accelerated polyethylene wear. This modern polished stem yielded excellent, predictable clinical and radiographic results at an intermediate follow-up.
Collapse
|