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van Loon J, Sierevelt IN, Spekenbrink-Spooren A, Opdam KTM, Poolman RW, Kerkhoffs GMMJ, Haverkamp D. Higher risk of 2-year cup revision of ceramic-on-ceramic versus ceramic-on-polyethylene bearing: analysis of 33,454 primary press-fit total hip arthroplasties registered in the Dutch Arthroplasty Register (LROI). Hip Int 2023; 33:280-287. [PMID: 34974763 PMCID: PMC9978866 DOI: 10.1177/11207000211064975] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND PURPOSE The influence of bearing on short-term revision in press-fit total hip arthroplasty (THA) remains under-reported. The aim of this study was to describe 2-year cup revision rates of ceramic-on-ceramic (CoC) and ceramic-on-polyethylene (CoPE). PATIENTS AND METHODS Primary press-fit THAs with one of the three most used cups available with both CoC or CoPE bearing recorded in the Dutch Arthroplasty Register (LROI) were included (2007-2019). Primary outcome was 2-year cup revision for all reasons. Secondary outcomes were: reasons for revision, incidence of different revision procedures and use of both bearings over time. RESULTS 2-year Kaplan-Meier cup revision rate in 33,454 THAs (12,535 CoC; 20,919 CoPE) showed a higher rate in CoC (0.67% [95% CI, 0.54-0.81]) compared to CoPE (0.44% [95% CI, 0.34-0.54]) (p = 0.004). Correction for confounders (age, gender, cup type, head size) resulted in a hazard ratio (HR) of 0.64 [95%CI, 0.48-0.87] (p = 0.019). Reasons for cup revision differed only by more cup revision due to loosening in CoC (26.2% vs.1 3.2%) (p = 0.030). For aseptic loosening a revision rate of 0.153% [95% CI, 0.075-0.231] was seen in CoC and 0.058% [95%CI 0.019-0.097] in CoPE (p = 0.007). Correction for head size resulted in a HR of 0.475 [95% CI, 0.197-1.141] (p = 0.096). Incidence of different revision procedures did not differ between bearings. Over time the use of CoPE has increased and CoC decreased. CONCLUSIONS A higher 2-year cup revision rate in press-fit THA was observed in CoC compared to CoPE. Cup loosening was the only significantly different reason for revision and seen more often in CoC and mostly aseptic. Future randomised controlled trials need to confirm causality, since the early cup revision data provided has the potential to be useful when choosing the bearing in press-fit THA, when combined with other factors like bone quality and patient and implant characteristics.
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Affiliation(s)
- Justin van Loon
- Xpert Clinics Orthopedie Amsterdam, The
Netherlands,Department of Orthopaedic Surgery,
Amsterdam Movement Sciences, Amsterdam UMC, Academic Medical Centre, University of
Amsterdam, Amsterdam, The Netherlands,Department of Orthopaedic Surgery,
Tergooi, Hilversum, The Netherlands
| | - Inger N Sierevelt
- Xpert Clinics Orthopedie Amsterdam, The
Netherlands,Department of Orthopaedic Surgery,
Spaarne Gasthuis Academy, TM Hoofddorp, The Netherlands
| | | | - Kim TM Opdam
- Department of Orthopaedic Surgery,
Amsterdam Movement Sciences, Amsterdam UMC, Academic Medical Centre, University of
Amsterdam, Amsterdam, The Netherlands
| | - Rudolf W Poolman
- Department of Orthopaedic Surgery,
Leiden University Medical Centre, Leiden, The Netherlands,Department of Orthopaedic Surgery,
OLVG, Amsterdam, The Netherlands
| | - Gino MMJ Kerkhoffs
- Department of Orthopaedic Surgery,
Amsterdam Movement Sciences, Amsterdam UMC, Academic Medical Centre, University of
Amsterdam, Amsterdam, The Netherlands
| | - Daniël Haverkamp
- Xpert Clinics Orthopedie Amsterdam, The
Netherlands,Daniël Haverkamp, Xpert Clinics Orthopedie
Amsterdam, Laarderhoogtweg 12, Amsterdam, North-Holland, 1101EA, The
Netherlands.
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Vio War AS, Kumar N, Chanda S. Does preclinical analysis based on static loading underestimate post-surgery stem micromotion in THA as opposed to dynamic gait loading? Med Biol Eng Comput 2023; 61:1473-1488. [PMID: 36763232 DOI: 10.1007/s11517-023-02801-6] [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: 09/21/2022] [Accepted: 01/31/2023] [Indexed: 02/11/2023]
Abstract
The success of cementless hip stems depends on the primary stability of the implant quantified by the amount of micromotion at the bone-stem interface. Most finite element (FE)-based preclinical studies on post-surgery stem stability rely on static analysis. Hence, the effect of dynamic gait loading on bone-stem relative micromotion remains virtually unexplored. Furthermore, there is a paucity of research on the primary stability of grooved stems as opposed to plain stem design. The primary aim of this FE study was to understand whether transient dynamic gait had any incremental effect on the net micromotion results and to further draw insights into the effects of grooved texture vis-à-vis a plain model on micromotion and proximal load transfer in host bone. Two musculoskeletal loading regimes corresponding to normal walking (NW) and stair climbing (SC) were considered. Although marginally improved load transfer was predicted proximally for the grooved construct under static loading, the micromotion values (max: NW ~ 7 μm; SC ~ 10 μm) were found to be considerably less in comparison to plain stem (max: NW ~ 50 μm; SC ~ 20 μm). For both physiological load cases, a significant surge in micromotion values was predicted in dynamic analyses as opposed to static analyses for the grooved stem (~ 390% greater). For the plain model, the increase in these values from static to dynamic loading is relatively moderate yet clinically significant (~ 230% greater). This suggests that the qualitative similarities notwithstanding, there were significant dissimilarities in the quantitative trends of micromotion for different cases under both analyses.
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Affiliation(s)
- Adeline S Vio War
- Department of Biosciences and Bioengineering, Indian Institute of Technology Guwahati, Guwahati, 781 039, Assam, India
| | - Neeraj Kumar
- Department of Biosciences and Bioengineering, Indian Institute of Technology Guwahati, Guwahati, 781 039, Assam, India
| | - Souptick Chanda
- Department of Biosciences and Bioengineering, Indian Institute of Technology Guwahati, Guwahati, 781 039, Assam, India.
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Ding Z, Wang J, Wang Y, Zhang X, Huan Y, Zhang D. Bionic reconstruction of tension trabeculae in short-stem hip arthroplasty: a finite element analysis. BMC Musculoskelet Disord 2023; 24:89. [PMID: 36732725 PMCID: PMC9893650 DOI: 10.1186/s12891-023-06205-3] [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: 11/06/2022] [Accepted: 01/30/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Short-stem hip arthroplasty (SHA) is characterized by metaphyseal load transfer that effectively preserves the bone stock, but still suffers from stress shielding in the proximal femur. We designed a tension screw to mimic tension trabeculae in the new bionic collum femoris preserving (BCFP) short stem for bionic reconstruction, aiming to restore the biomechanics of hip joint. METHODS Native femur finite element model was constructed to investigate the biomechanics of hip joint based on computed tomography (CT) data. The maximum absolute principal stress/strain cloud chart allowed the direction of stress/strain to be assessed. Six BCFP models with different screw angles (5°, 10°, 15°, 20°, 25°, and 30°) and the Corail model were created. The stress/strain distribution and overall stiffness were compared between each of the BCFP and Corail implanted models. RESULTS The native model visualized the transfer pathways of tensile and compressive stress. The BCFP stems showed significantly higher stress and strain distribution in the greater trochanteric region compared to conventional total hip arthroplasty (THA). In particular, the BCFP-5° stem demonstrated the highest average strain in both medial and lateral regions and the overall stiffness was closest to the intact femur. CONCLUSIONS Stress transfer pathways of trabecular architecture provide biomechanical insight that serves as the basis for bionic reconstruction. The tension screw improves load transfer pattern in the proximal femur and prevents stress reduction in the greater trochanteric region. The BCFP-5° stem minimizes the stress shielding effect and presents a more bionic mechanical performance.
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Affiliation(s)
- Zhentao Ding
- grid.411634.50000 0004 0632 4559Department of Orthopedics and Trauma, Peking University People’s Hospital, Beijing, 100044 China ,grid.411634.50000 0004 0632 4559National Centre for Trauma Medicine, Peking University People’s Hospital, Beijing, 100044 China ,grid.419897.a0000 0004 0369 313XKey Laboratory of Trauma and Neural Regeneration (Peking University), Ministry of Education, Beijing, 100044 China
| | - Jun Wang
- grid.9227.e0000000119573309State Key Laboratory of Nonlinear Mechanics (LNM), Institute of Mechanics, Chinese Academy of Sciences, Beijing, 100190 China ,grid.410726.60000 0004 1797 8419School of Engineering Science, University of Chinese Academy of Sciences, Beijing, 100049 China
| | - Yanhua Wang
- grid.411634.50000 0004 0632 4559Department of Orthopedics and Trauma, Peking University People’s Hospital, Beijing, 100044 China ,grid.411634.50000 0004 0632 4559National Centre for Trauma Medicine, Peking University People’s Hospital, Beijing, 100044 China ,grid.419897.a0000 0004 0369 313XKey Laboratory of Trauma and Neural Regeneration (Peking University), Ministry of Education, Beijing, 100044 China
| | - Xiaomeng Zhang
- grid.411634.50000 0004 0632 4559Department of Orthopedics and Trauma, Peking University People’s Hospital, Beijing, 100044 China ,grid.411634.50000 0004 0632 4559National Centre for Trauma Medicine, Peking University People’s Hospital, Beijing, 100044 China ,grid.419897.a0000 0004 0369 313XKey Laboratory of Trauma and Neural Regeneration (Peking University), Ministry of Education, Beijing, 100044 China
| | - Yong Huan
- grid.9227.e0000000119573309State Key Laboratory of Nonlinear Mechanics (LNM), Institute of Mechanics, Chinese Academy of Sciences, Beijing, 100190 China ,grid.410726.60000 0004 1797 8419School of Engineering Science, University of Chinese Academy of Sciences, Beijing, 100049 China
| | - Dianying Zhang
- grid.411634.50000 0004 0632 4559Department of Orthopedics and Trauma, Peking University People’s Hospital, Beijing, 100044 China ,grid.411634.50000 0004 0632 4559National Centre for Trauma Medicine, Peking University People’s Hospital, Beijing, 100044 China ,grid.419897.a0000 0004 0369 313XKey Laboratory of Trauma and Neural Regeneration (Peking University), Ministry of Education, Beijing, 100044 China
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van Loon J, de Graeff JJ, Sierevelt IN, Opdam KTM, Poolman RW, Kerkhoffs GMMJ, Haverkamp D. Revision in Ceramic-on-Ceramic and Ceramic-on-Polyethylene Bearing in Primary Total Hip Arthroplasty with Press-fit Cups: A Systematic Review and Meta-analysis of Different Methodological Study Designs. THE ARCHIVES OF BONE AND JOINT SURGERY 2022; 10:916-936. [PMID: 36561219 PMCID: PMC9749123 DOI: 10.22038/abjs.2022.59354.2933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 04/28/2022] [Indexed: 12/24/2022]
Abstract
Background The influence of bearing on revision, especially in press-fit modular cup total hip arthroplasty (THA), remains underexposed. Methods A systematic literature review was conducted in PubMed, Embase, Cochrane Library, and ClinicalTrials.gov in line with the PRISMA guidelines. The primary outcome was overall revision between ceramic-on-ceramic (CoC) and all sorts of ceramic-on-polyethylene (CoPE) bearings. As secondary outcomes complications and reasons for revision were compared between bearings. Outcomes were presented in subgroups based on study design (randomized controlled trials (RCT), non-randomized comparative, and registry studies). The quality of evidence was assessed using the GRADE. The risk of bias was assessed using the Cochrane collaboration's tool and the MINORS criteria. Results This meta-analysis included twelve RCTs, three non-randomized comparative studies and two registry studies, including 38,772 THAs (10,909 CoPE and 27,863 CoC). Overall revision showed a lower risk in CoPE compared to CoC in the two registry studies (HR 0.71 (95%CI 0.53; 0.99)) (very low-quality GRADE evidence). In RCTs and non-randomized comparative studies, no difference was observed (low-quality GRADE evidence). Loosening, dislocation, infection, and postoperative periprosthetic fracture showed no significant differences in risk ratio for all designs. Conclusion The lower risk of overall revision in registry studies of primary THA with a press-fit modular cup using CoPE bearing compared to CoC should be considered preliminary since this outcome was just slightly significant, based on very low-quality GRADE evidence and based on only two studies with several limitations. Since no difference was observed in the other methodological designs and the separate reasons for revision showed no significant difference in all designs either, no preference for CoC or CoPE can be expressed, and therefore both seem suitable options based on the available literature. More comparative long-term studies are needed to confirm the potential advantages of wear-reduction of both bearings since the currently available literature is limited.
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Affiliation(s)
- Justin van Loon
- Amsterdam University Medical Centres, location Academic Medical Center, University of Amsterdam, Department of Orthopaedic Surgery, Amsterdam Movement Sciences Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands,Xpert Clinics Orthopedie, Laarderhoogtweg 12, 1101EA Amsterdam, The Netherlands,Tergooi, department of Orthopaedic Surgery, Van Riebeeckweg 212, 1213 XZ, Hilversum, The Netherlands
| | - Jan Jaap de Graeff
- Leiden University Medical Center, department of Orthopaedic Surgery, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Inger Nicoline Sierevelt
- Xpert Clinics Orthopedie, Laarderhoogtweg 12, 1101EA Amsterdam, The Netherlands,Spaarne Gasthuis, Spaarne Gasthuis Academy, Spaarnepoort 1, 2134 TM Hoofddorp, The Netherlands
| | - Kim Theresia Maria Opdam
- Amsterdam University Medical Centres, location Academic Medical Center, University of Amsterdam, Department of Orthopaedic Surgery, Amsterdam Movement Sciences Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Rudolf Wilhelm Poolman
- Leiden University Medical Center, department of Orthopaedic Surgery, Albinusdreef 2, 2333 ZA Leiden, The Netherlands,OLVG, department of Orthopaedic Surgery, Oosterpark 9, 1091 AC Amsterdam, The Netherlands
| | - Gino Matheus Melanie Johannes Kerkhoffs
- Amsterdam University Medical Centres, location Academic Medical Center, University of Amsterdam, Department of Orthopaedic Surgery, Amsterdam Movement Sciences Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Daniël Haverkamp
- Xpert Clinics Orthopedie, Laarderhoogtweg 12, 1101EA Amsterdam, The Netherlands
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Coulomb R, Mansour J, Essig J, Asencio G, Kouyoumdjian P. Clinical results at 10 years of minimum follow-up with the ABG 2 hip arthroplasty, matched with ceramic-on-ceramic bearings. SICOT J 2022; 8:32. [PMID: 35969123 PMCID: PMC9377216 DOI: 10.1051/sicotj/2022032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/27/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction: The current study aimed as a primary goal is to assess the results of a ceramic-on-ceramic (CoC) bearing hip system matched with ABG (Anatomic Benoist Girard) 2 components in terms of survivorship. Secondary objectives addressed specifically ceramic-related complications as well as specific patterns at the bone-implant interface. Material and methods: This is a retrospective bicentric continuous series involving 147 patients (95 males vs. 52 females) who underwent ABG 2 arthroplasties with CoC bearings. One hundred and twenty-five hips were closely followed-up at a mean period of 11.3 years. Results and discussion: With a mean follow-up of 11.3 years, nine cases (5.7%) underwent revision surgery, four caused by acetabular aseptic loosening, three by deep infections, one ceramic head fracture, and one femoro-acetabular impingement. The global survivorship was 92.2% at 12.7 years. The Harris Hip Score (HHS) mean scores increased post-operatively from 50.1 up to 96.1 points (p < 0.001). All stems featured patterns of radiological osseous integration onto the hydroxyapatite (HA)-coated zones. No radiological wear or osteolysis of ceramic bearings was demonstrated however, five patients reported hip squeaking using this bearing. This study demonstrated excellent results at mid-term follow-up in patients younger than 70 years of age using cementless ABG 2 components coupled with CoC bearings with no increase in complication rate.
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Affiliation(s)
- Remy Coulomb
- University Hospital of Nîmes, Rue du Pr. Robert Debré, 30029 Nimes cedex 9, France
| | - Jad Mansour
- University Hospital of Nîmes, Rue du Pr. Robert Debré, 30029 Nimes cedex 9, France
| | - Jérome Essig
- Clinique Médipole-Garonne, 45, rue Gironis, 31036 Toulouse cedex 1, France
| | - Gérard Asencio
- University Hospital of Nîmes, Rue du Pr. Robert Debré, 30029 Nimes cedex 9, France
| | - Pascal Kouyoumdjian
- University Hospital of Nîmes, Rue du Pr. Robert Debré, 30029 Nimes cedex 9, France - Laboratory of Mechanics and Civil Engineering (LMGC), CNRS-UM1, 860 Rue de St-Priest, 34090 Montpellier, France - Université Montpellier 1, 2 Rue de l'École de Médecine, 34090 Montpellier, France
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KLAASSEN AD, SCHÄFFER EA, WILLIGENBURG NW, VAN BEERS LWAH, SCHOLTES VAB, VAN DER HULST VPM, KOSTER LA, KAPTEIN BL, MOOJEN DJF, POOLMAN RW. Comparison of early migration patterns between a ceramic and polyethylene liner in uncemented Trabecular Titanium cups: a 2-year randomized controlled trial of 52 hips using radiostereometric analysis. Acta Orthop 2022; 93:451-458. [PMID: 35485295 PMCID: PMC9052219 DOI: 10.2340/17453674.2022.2267] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Ceramic liners may reduce early stability of uncemented acetabular components due to higher stiffness. However, the bone ingrowth capacities of porous trabecular titanium might compensate for this effect. This prospective randomized trial quantifies migration patterns of the Delta-TT cup, and compares polyethylene and ceramic liners. PATIENTS AND METHODS Patients undergoing primary uncemented total hip arthroplasty with the Delta-TT cup and femoral stem with ceramic head were randomized to a polyethylene (n = 25) or ceramic (n = 28) liner. Radiostereometric analysis (RSA) radiographs, patient-reported hip function (HOOS-PS, OHS), and quality of life (EQ5D) were collected at baseline and 1.5, 3, 6, 12, and 24 months postoperatively. Model-based RSA was used to calculate 3D cup translation and rotation, and mixed models were used to compare effects over time between groups. RESULTS At 2 years follow-up, Delta-TT cups showed similar mean proximal translation of 0.56 mm (95% CI 0.38-0.75) in the ceramic (CE) group and 0.54 mm (0.30-0.77) in the polyethylene (PE) group, with a between group effect of 0.02 mm (-0.20-0.23). Most cup migration occurred in the first 1.5 to 3 months, stabilizing within 6 months. Any between-group effects were ≤ 0.30 mm for translation and ≤ 0.45° for rotation. Improvements in patient-reported hip function and quality of life were similar in both groups. INTERPRETATION Regardless of liner type, Delta-TT cups showed some initial migration and stabilized within 6 months, which seems promising for long-term fixation in both cup-liner constructs.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Rudolf W POOLMAN
- Department of Orthopedic Surgery, OLVG, Amsterdam,Department of Orthopedic Surgery, LUMC, Leiden, The Netherlands
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Comment to "Ceramic-on-ceramic articulation in press-fit total hip arthroplasty as a potential reason for early failure, what about the survivors: a ten year follow-up". INTERNATIONAL ORTHOPAEDICS 2021; 45:1379-1380. [PMID: 33725129 DOI: 10.1007/s00264-021-05001-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 03/08/2021] [Indexed: 10/21/2022]
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Ji W, Shen J. Letter to the editor regarding "Ceramic-on-ceramic articulation in press-fit total hip arthroplasty as a potential reason for early failure, what about the survivors: a ten year follow-up" by Loon et al. INTERNATIONAL ORTHOPAEDICS 2021; 45:1653-1654. [PMID: 33675415 DOI: 10.1007/s00264-021-04996-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 02/24/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Weifeng Ji
- Orthopedics Department, Zhejiang Chinese Medical University Affiliated Guangxing Hospital: Hangzhou Hospital of Traditional Chinese Medicine, 54 Tiyuchang Road, HangZhou, ZheJiang, People's Republic of China
| | - Jing Shen
- Orthopedics Department, Zhejiang Chinese Medical University Affiliated Guangxing Hospital: Hangzhou Hospital of Traditional Chinese Medicine, 54 Tiyuchang Road, HangZhou, ZheJiang, People's Republic of China.
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