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Kaszuba SV, Hurley M, Beitler BG, Abraham PF, Tommasini S, Schwarzkopf R, Wiznia DH. A review of the design, manufacture, and outcomes of custom total joint replacement implants available in the United States. J Clin Orthop Trauma 2024; 49:102354. [PMID: 38361508 PMCID: PMC10865390 DOI: 10.1016/j.jcot.2024.102354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 01/31/2024] [Indexed: 02/17/2024] Open
Abstract
Custom total joint replacement (TJA) implants, specifically designed and manufactured for each patient, have emerged as surgeons seek to improve functional outcomes of primary total joint replacement, as well as treat patients with complex primary deformities, bone defects, and revision surgeries. The purpose of this review is to present the various custom total hip and knee arthroplasty implants available in the United States for primary and revision cases, so that surgeons can understand the design considerations and manufacturing processes of custom implants, as well as their performance compared to standard implants.
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Affiliation(s)
- Stephanie V. Kaszuba
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Margaret Hurley
- Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Brian G. Beitler
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Paul F. Abraham
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Steven Tommasini
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Ran Schwarzkopf
- Division of Adult Reconstruction, Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Daniel H. Wiznia
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA
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Bunting AC, Costi K, Chimutengwende-Gordon M, Callary SA, Pannach S, Nelson R, Howie DW, Solomon LB. Staged Revision Hip Arthroplasty With Femoral Impaction Bone Grafting for Prosthetic Joint Infections: Radiostereometric Analyses and Clinical Outcomes at Minimum 5-Year Follow-Up. J Arthroplasty 2023; 38:2716-2723.e1. [PMID: 37321515 DOI: 10.1016/j.arth.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 06/01/2023] [Accepted: 06/03/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND There are ongoing concerns regarding the use of bone graft following prosthetic joint infection and subsequent implant subsidence. The aim of this study was to determine whether the use of a cemented stem combined with femoral impaction bone grafting (FIBG) at second stage revision for infection results in stable femoral stem fixation, determined by accurate methods, and good clinical results. METHODS A prospective cohort of 29 patients underwent staged revision total hip arthroplasty for infection using an interval prosthesis followed by FIBG at the final reconstruction. The mean follow-up was 89 months (range, 8 to 167 months). Femoral implant subsidence was measured with radiostereometric analysis. Clinical outcomes included the Harris Hip Score, Harris Pain score and Société Internationale de Chirurgie Orthopédique et de Traumatologie activity scores. RESULTS At 2-years follow-up the median stem subsidence relative to femur was -1.36 mm (range, -0.31 to -4.98), while the cement subsidence relative to femur was -0.05 mm (range, 0.36 to -0.73). At 5-years follow-up, the median stem subsidence relative to femur was -1.89 mm (range, -0.27 to -6.35), while the cement subsidence relative to femur was -0.06 mm (range, 0.44 to -0.55). There were 25 patients who were confirmed infection-free after the second stage revision with FIBG. The median Harris Hip Score improved from 51 pre-operatively to 79 at 5 years (P = .0130), and Harris Pain score from 20 to 40 (P = .0038). CONCLUSIONS Stable femoral component fixation can be achieved with FIBG when reconstructing the femur after revision for infection without compromising infection cure rates and patient-reported outcomes.
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Affiliation(s)
- Alexandra C Bunting
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia; Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia
| | - Kerry Costi
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia
| | | | - Stuart A Callary
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia; Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia
| | - Susan Pannach
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia
| | - Renjy Nelson
- Department of Infectious Diseases, Royal Adelaide Hospital, Adelaide, South Australia
| | - Donald W Howie
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia; Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia
| | - Lucian Bogdan Solomon
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia; Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia
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Elbardesy H, Anazor F, Mirza M, Aly M, Maatough A. Cemented versus uncemented stems for revision total hip replacement: A systematic review and meta-analysis. World J Orthop 2023; 14:630-640. [PMID: 37662666 PMCID: PMC10473907 DOI: 10.5312/wjo.v14.i8.630] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 06/20/2023] [Accepted: 07/17/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND The popularity of uncemented stems in revision total hip arthroplasty (THA) has increased in the last decade. AIM To assess the outcomes of both cemented and uncemented stems after mid-term follow up. METHODS This study was performed following both the Preferred Reporting Items for Systematic Reviews and Meta-analyses Statement and the Cochrane Handbook for systematic reviews and meta-analysis guidelines. Articles were chosen irrespective of country of origin or language utilized for the article full texts. This paper included studies that reviewed revision THA for both cemented or uncemented long stems. RESULTS Three eligible studies were included in the meta-analysis. Analysis was conducted by using Review Manager version 5.3. We computed the risk ratio as a measure of the treatment effect, taking into account heterogeneity. We used random-effect models. There were no significant differences found for intraoperative periprosthetic fractures [risk ratio (RR) = 1.25; 95% confidence interval (CI): 0.29-5.32; P = 0.76], aseptic loosening (RR = 2.15, 95%CI: 0.81-5.70; P = 0.13), dislocation rate (RR = 0.50; 95%CI: 0.10-2.47; P = 0.39), or infection rate (RR = 0.99, 95%CI: 0.82-1.19; P = 0.89), between the uncemented and the cemented long stems for revision THA after mid-term follow-up. CONCLUSION This study has evaluated the mid-term outcomes of both cemented and uncemented stems at first-time revision THA. In summary, there were no significant differences in the dislocation rate, aseptic loosening, intraoperative periprosthetic fracture and infection rate between the two cohorts.
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Affiliation(s)
- Hany Elbardesy
- Department of Trauma and Orthopaedics, University of Manitoba, Winnipeg MB R3T2N2, Manitoba, Canada
| | - Fitzgerald Anazor
- Nottingham University Hospitals NHS Foundation Trust, Nottingham NG7 2UH, United Kingdom
| | - Mohammad Mirza
- Department of Trauma and Orthopaedics, East Kent University Hospitals NHS Foundation Trust, Ashford TN240LY, Kent, United Kingdom
| | - Mohamed Aly
- Department of Trauma and Orthopaedics, Royal National Orthopaedic Hospital, London HA7 4LP, United Kingdom
| | - Annis Maatough
- Department of Trauma and Orthopaedics, East Kent University Hospitals NHS Foundation Trust, Ashford TN240LY, Kent, United Kingdom
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Li Y, Zhang Y, Yu M, Huang T, Li K, Ye J, Huang H, Yu W. Favorable revision-free survivorship of cemented arthroplasty following failed proximal femoral nail antirotation: a case series with a median follow-up of 10 years. BMC Musculoskelet Disord 2022; 23:1024. [PMID: 36443844 PMCID: PMC9707067 DOI: 10.1186/s12891-022-05995-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 11/17/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Given the ever-increasing rate of failure related to proximal femoral nail antirotation (PFNA), it is expected that an increasing number of PFNA individuals will undergo conversion to total hip arthroplasty (THA). The long-term survivorship of conversion of the initial PFNA to cemented THA is still debated. The aim of this retrospective study was to assess the long-term revision-free survivorship of cemented THAs after initial failures of PFNA in geriatric individuals. METHODS Consecutive geriatric individuals who underwent secondary cemented THA after initial PFNA fixation from July 2005 to July 2018, were retrospectively identified from three medical centres. The primary outcome was revision-free survivorship estimated using the Kaplan-Meier method and Cox proportional hazards regression with revision for any reason as the endpoint; secondary outcomes were functional outcomes and key THA-related complications. Follow-ups occurred at 3 months, 6 months, 12 months and then every 12 months after conversion. RESULTS In total, 186 consecutive patients (186 hips) were available for study inclusion. The median follow-up was 120.7 months (60-180 months) in the cohort. Kaplan-Meier survivorship with revision for any reason as the end point showed that the 10-year revision-free survival rate was 0.852 (95% confidence interval [CI], 0.771-0.890). Good functional outcomes were seen, and the HHS decreased markedly over the 24th month to the final follow-up interval from 92.2 to 75.1 (each p < 0.05). The overall rate of key THA-related complications was 16.1% (30/186). CONCLUSION Cemented THA executed following initial PFNA failure may yield satisfactory revision-free survival and, at least for the initial 10 years after conversion, good functional outcomes and a 16.1% complication rate of key THA-related complications, which supports the trend towards increased use of cemented THA.
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Affiliation(s)
- Yi Li
- Department of Anesthesiology, Wuhan Fourth Hospital, No. 473, Hanzheng Street, Qiaokou District, Wuhan, 430030, China
| | - Yaodong Zhang
- Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China
| | - Minji Yu
- Department of Traditional Chinese Medicine, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China
| | - Tao Huang
- Department of Orthopedics, Wuhan Third Hospital, Tongren Hospital of Wuhan University, No. 241, Pengliuyang Road, Wuchang District, Wuhan, 430060, China
| | - Kunhong Li
- Department of Anesthesiology, Wuhan Fourth Hospital, No. 473, Hanzheng Street, Qiaokou District, Wuhan, China
| | - Junxing Ye
- Department of Orthopedics, The Affiliated Hospital of Jiangnan University, No. 1000, Hefeng Road, Wuxi, 214000, Jiangsu, China
| | - Heng Huang
- Department of Anesthesiology, Wuhan Fourth Hospital, No. 473, Hanzheng Street, Qiaokou District, Wuhan, 430030, China.
| | - Weiguang Yu
- Department of Orthopedics, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China.
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Lequeuche L, Djebara AE, Bulaïd Y, Deh M, Gabrion A, Mertl P. Clinical and radiological results after revision THA with distal locking stem: A cohort study of 44 patients. Orthop Traumatol Surg Res 2022; 108:103267. [PMID: 35288326 DOI: 10.1016/j.otsr.2022.103267] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 02/01/2021] [Accepted: 03/23/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Distal locking stems were developed in response to some complex revision procedures in total hip arthroplasty (THA), providing better axial and rotational stability. The aim of the present study was to assess medium-term clinical and radiological results of treatment with last-generation distal locking stem. HYPOTHESIS Our hypothesis was that this implant provided a high survival rate. MATERIAL AND METHODS A single-center retrospective observational study included all patients who underwent THA revision with distal locking stem between April 2013 and January 2015 in our university hospital. The implant was a curved distal-locking stem fully coated in grit-blasted titanium alloy and hydroxyapatite (HA) with a collar made of TiAlV. This concept is based on primary distal fixation by interlocking screws. The primary endpoint was surgical revision for implant exchange. RESULTS A total of 47 procedures with distal locking stem were performed, 44 of which were included. Minimum follow-up was 5 years. Etiologies of revision comprised 25 femoral loosenings, 13 periprosthetic fractures, 3 infections, and 3 modular taper breakages. Six patients underwent re-revision (13%), with only 1 implant change (98% survival rate). Mean Harris and Oxford Hip scores at last follow-up were respectively 81±13.5 [range, 67.4-94.5] and 26±9⋅2 [range, 16.7-35.2]. Radiologically, no stem subsidence occurred, and bone ingrowth was obtained in all cases. DISCUSSION Fully-coated distal locking stems showed a high survival rate. They provided strong initial fixation, allowing early full weight-bearing in these frail patients. LEVEL OF EVIDENCE IV; retrospective series.
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Affiliation(s)
- Lou Lequeuche
- Service de Chirurgie Orthopédique et Traumatologie, CHU Amiens-Picardie, 80480, Salouël, France
| | - Az-Eddine Djebara
- Service de Chirurgie Orthopédique et Traumatologie, CHU Amiens-Picardie, 80480, Salouël, France.
| | - Yassine Bulaïd
- Service de Chirurgie Orthopédique et Traumatologie, CHU Amiens-Picardie, 80480, Salouël, France
| | - Massinissa Deh
- Service de Chirurgie Orthopédique et Traumatologie, CHU Amiens-Picardie, 80480, Salouël, France
| | - Antoine Gabrion
- Service de Chirurgie Orthopédique et Traumatologie, CHU Amiens-Picardie, 80480, Salouël, France
| | - Patrice Mertl
- Service de Chirurgie Orthopédique et Traumatologie, CHU Amiens-Picardie, 80480, Salouël, France
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Yu M, Yu M, Zhang Y, Cheng H, Zeng X, Li S, Yu W. Implant survival of cemented arthroplasty following failed fixation of proximal femoral fractures in patients aged 30-60 years: a retrospective study with a median follow-up of 10 years. BMC Musculoskelet Disord 2022; 23:637. [PMID: 35787266 PMCID: PMC9252004 DOI: 10.1186/s12891-022-05587-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 06/27/2022] [Indexed: 12/14/2022] Open
Abstract
Background Given the unremitting growth in the volume of failed fixations of proximal femoral fractures (PFFs) in recent years, it is predictable that total hip replacements (THRs) will be the preferred surgical procedure. The long-term survival of cemented THR (CTHR) revisions remains controversial in patients aged 30–60 years. The goal of this retrospective review was to evaluate the 10-year survival of CTHRs following prior failed primary fixations of PFFs in patients aged 30–60 years. Methods We retrospectively identified CTHR revisions implemented at four medical centres during 2008–2017 for a failed primary fixation of PFFs in consecutive patients aged 30–60 years. The primary endpoint was implant survival calculated using the Kaplan–Meier method with 95% confidence intervals (CIs); secondary endpoints included functional scores assessed by Harris hip scores (HHS) and main revision-related orthopaedic complications. Follow-up was executed at 1, 2, 3, and 8 years following revision and then at 1-year intervals until the revision, death, or study deadline, whichever occurred first. Results In total, 120 patients (120 hips) who met the eligibility criteria were eligible for follow-up. The median follow-up was 10.2 years (range, 8–12 years). Kaplan–Meier survivorship showed that implant survival with revision for any reason as the endpoint was 95% at 5 years (CI: 93–97%), 89% at 8 years (CI: 86–92%), and 86% at 10 years (CI: 83–89%). Patients treated with three hollow screws had better revision-free survival than patients treated with proximal femoral nail antirotation (PFNA), dynamic hip screw (DHS) or titanium plate plus screws (three p < 0.05). Functional scores were apt to decrease gradually, and at the final follow-up, the mean HHS was 76.9 (range, 67.4–86.4). The overall rate of main revision-related orthopaedic complications was 18.3% (22/120). Conclusion CTHR implemented following prior failed primary fixations of PFFs tends to afford an acceptable 10-year survival, along with advantageous HHS and a low rate of main revision-related orthopaedic complications, which may support an inclination to follow the utilisation of CTHRs, especially in revision settings for intracapsular fractures.
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Affiliation(s)
- Mingliang Yu
- Department of Anesthesiology, Wuhan Fourth Hospital, No.473, Hanzheng Street, Qiaokou District, Wuhan, 430033, China
| | - Minji Yu
- Department of Traditional Chinese Medicine, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China
| | - Yaodong Zhang
- Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China
| | - Huihui Cheng
- Department of Anaesthesiology, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei, China
| | - Xianshang Zeng
- Department of Orthopaedics, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China
| | - Si Li
- Department of Anesthesiology, Wuhan Fourth Hospital, No.473, Hanzheng Street, Qiaokou District, Wuhan, 430033, China.
| | - Weiguang Yu
- Department of Orthopaedics, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China.
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Risk factors for failure after cementless femoral revision THA: a consecutive series of 105 cases. Arch Orthop Trauma Surg 2022; 142:763-768. [PMID: 33389020 DOI: 10.1007/s00402-020-03723-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 12/06/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Cementless femoral revision total hip arthroplasty (RTHA) after periprosthetic fracture, aseptic loosening or infection is a challenging surgical procedure. The aim of this study was to evaluate the incidence and reasons for failure after two-stage septic revision, periprosthetic fracture or aseptic loosening that may reveal a rationale for cementless RTHA in two-stage revisions. MATERIALS AND METHODS A consecutive series of 105 cases using cementless femoral revision prostheses were evaluated retrospectively. Indications for revision were 39 two-stage revisions after infection, 49 aseptic loosenings, and 17 periprosthetic fractures. A Kaplan-Meier analysis was performed using infection with or without removal of the implant as an endpoint. RESULTS Incidence of infection with or without implant removal was significantly higher in patients treated for periprosthetic fractures compared to two-stage revisions or aseptic loosening (log-rank P < 0.0001). The mean follow-up period was 6.4 (2.0-13.7) years. Using infection with or without implant removal as the endpoint, 12 patients were diagnosed after the index operation resulting in a cumulative risk after 13.7 years of 29.9% (95% CI 0-61.2). CONCLUSION Cementless revision using a modular tapered device is reliable with respect to reinfection risk in two-stage procedures.
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Liu W, Lin H, Zeng X, Chen M, Tang W, Zhou T, Yu W, Liu Q, Xu G. Uncemented versus cemented arthroplasty after metal-on-metal total hip replacement in patients with femoral neck fractures: a retrospective study. J Int Med Res 2021; 49:3000605211012210. [PMID: 33969721 PMCID: PMC8113965 DOI: 10.1177/03000605211012210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To compare the clinical outcomes of primary metal-on-metal total hip replacement (MoM-TR) converted to uncemented total hip replacement (UTR) or cemented total hip replacement (CTR) in patients with femoral neck fractures (AO/OTA: 31B/C). METHODS Patient data of 234 UTR or CTR revisions after primary MoM-TR failure from March 2007 to January 2018 were retrospectively identified. Clinical outcomes, including the Harris hip score (HHS) and key orthopaedic complications, were collected at 3, 6, and 12 months following conversion and every 12 months thereafter. RESULTS The mean follow-up was 84.12 (67-100) months for UTR and 84.23 (66-101) months for CTR. At the last follow-up, the HHS was better in the CTR- than UTR-treated patients. Noteworthy dissimilarities were correspondingly detected in the key orthopaedic complication rates (16.1% for CTR vs. 47.4% for UTR). Statistically significant differences in specific orthopaedic complications were also detected in the re-revision rate (10.3% for UTR vs. 2.5% for CTR), prosthesis loosening rate (16.3% for UTR vs. 5.9% for CTR), and periprosthetic fracture rate (12.0% for UTR vs. 4.2% for CTR). CONCLUSION In the setting of revision of failed primary MoM-TR, CTR may demonstrate advantages over UTR in improving functional outcomes and reducing key orthopaedic complications.
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Affiliation(s)
- Wenlu Liu
- Department of Rehabilitation Medicine, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, No. 26, Shengli Street, Jiang'an District, Wuhan, China
| | - Huanyi Lin
- Department of Urinary Surgery, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, China
| | - Xianshang Zeng
- Department of Orthopaedics, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, China
| | - Meiji Chen
- Department of Pediatrics, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, China
| | - Weiwei Tang
- Department of Ultrasound Medicine, The Affiliated Hospital of Xiangnan University, No. 25, Renmin West Road, Beihu District, Chenzhou, China
| | - Ting Zhou
- Department of Rehabilitation Medicine, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, No. 26, Shengli Street, Jiang'an District, Wuhan, China
| | - Weiguang Yu
- Department of Orthopaedics, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, China
| | - Qilong Liu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, China
| | - Guixing Xu
- Department of Neurosurgery, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, China
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Lin J, Huang C, Yu W, Han G, Liu X, Zeng X. Revision of failed metal-on-metal total hip arthroplasty using cemented arthroplasty: a mean 10-year follow-up of 157 consecutive patients. J Int Med Res 2021; 49:300060520969478. [PMID: 33435780 PMCID: PMC7809321 DOI: 10.1177/0300060520969478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE This study was performed to assess the outcomes of Asian patients who underwent conversion from metal-on-metal total hip arthroplasty (MoM-THA) to cemented THA (CTHA). METHODS One hundred and fifty-seven consecutive patients (157 hips) who underwent CTHA following primary MoM-THA from January 2005 to February 2015 were retrospectively analysed. The primary endpoints were the clinical outcomes. Follow-ups occurred at 3 months, 6 months, 1 year, 2 years, and then every 2 years following revision of MoM-THA. RESULTS The mean follow-up after conversion was 10 years (range, 5-14 years). Statistically significant improvements in the mean Harris hip score were observed between the preoperative and final follow-up evaluations (62.71 ± 13.85 vs. 84.03 ± 16.21, respectively). The major orthopaedic complication rate was 16.5% (26/157). Six (3.8%) patients underwent revision at a mean of 3.5 ± 1.3 years after conversion, predominantly because of prosthesis loosening or recurrent dislocation. Nine (5.7%) patients developed prosthesis loosening at a mean of 2.6 ± 1.1 years following conversion, two of whom requested revision surgery. Eleven (7.0%) patients developed prosthesis dislocation, four of whom requested revision surgery. CONCLUSION CTHA may yield favourable functional outcomes and a reduced rate of major orthopaedic complications.
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Affiliation(s)
- Jinluan Lin
- Department of Orthopaedics, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Chunlong Huang
- Department of Orthopaedics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Weiguang Yu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Guowei Han
- Department of Hepatobiliary Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiangzhen Liu
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xianshang Zeng
- Department of Orthopaedics, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
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Open reduction and internal fixation might be a valuable alternative to stem revision in Vancouver B2 periprosthetic femoral fractures, irrespective of the stem's design. Arch Orthop Trauma Surg 2021; 141:871-878. [PMID: 32778919 DOI: 10.1007/s00402-020-03568-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 08/02/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The purpose of this study was to compare the clinical and radiological outcomes following open reduction and internal fixation (ORIF) of Vancouver B2 periprosthetic femoral fractures versus stem revision (SR) surgery. METHODS Between 2004 and 2018, 39 patients were treated with SR and 31 with ORIF for a Vancouver type B2. Mean follow-up was 40.4 months for the ORIF group and 43.5 months for the SR group. 22 of 31 stems in the ORIF group were uncemented, of which 7 (23%) were short stems. Perioperative complications, intraoperative blood loss, revision rate, and mortality were recorded. Functional outcomes included Harris Hip Score, Parker Mobility Score and hip abductor strength. RESULTS Both groups did not differ in the American Society of Anesthesiologists (ASA) score, Charlson comorbidity index, body mass index, age, and sex. Compared to SR, patients treated with ORIF had a decreased blood loss, transfusion rate, operation duration, and mortality. Total complication and re-operation rates were similar. The relative risk for complication and re-operation was 0.5 and 0.7, respectively, in favour of ORIF. CONCLUSIONS ORIF might be a valuable alternative to SR in the treatment of Vancouver type B2 periprosthetic fractures with shorter operation duration, lower blood loss and similar complication rate compared to SR. Moreover, re-stabilization seems possible irrespective of stem's design or fixation technique. LEVEL OF EVIDENCE Level III.
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Romagnoli S, Marullo M, Corbella M, Zero E, Parente A, Bargagliotti M. Conical Primary Cementless Stem in Revision Hip Arthroplasty: 94 Consecutive Implantations at a Mean Follow-Up of 12.7 years. J Arthroplasty 2021; 36:1080-1086. [PMID: 33187858 DOI: 10.1016/j.arth.2020.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 10/01/2020] [Accepted: 10/07/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Revision of a failed total hip arthroplasty (THA) poses technical challenges. The use of primary stems for revision can be advantageous for maintaining bone stock and reducing complications: small case series have reported promising results in the short-term to mid-term follow-up. The aim of this study was to evaluate the long-term clinical and functional results and survivorship of a consecutive series of THA femoral component revisions using a conical primary cementless stem (PCS). METHODS Ninety-four stem revisions with a preoperative Paprosky I or II defect were analyzed at an average follow-up of 12.7 ± 5.4 years. Aseptic loosening was the reason for revision in 92.5% of cases. Twenty patients were lost to follow-up. Two subgroups were created: Group 1 (n = 59) underwent isolated stem revision; Group 2 (n = 15) underwent complete THA revision. All were evaluated preoperatively and postoperatively based on the Harris Hip Score (HHS), the Western Ontario and McMaster Universities Index (WOMAC) score, and the visual analog scale for pain (VAS). Residual trochanteric pain and length discrepancies were recorded. Radiographic evaluation included signs of osteolysis, subsidence, loosening, and heterotopic ossification. RESULTS PCS survivorship was 100% at 5 years and 95.9% at 10 years. Overall, significant postoperative improvements (P < .01) were observed on the HHS (44.3 vs 86.9), WOMAC (42.8 vs 82.8), and VAS (7.0 vs 3.0). Postoperative scores on all scales were higher for Group 1 (P < .01). Three patients (4.1%) underwent further stem revision. Demarcation lines (1 mm) were found in 12 (16.2%) patients and significant heterotopic ossifications in 22 (29.7%). CONCLUSION The use of PCS for stem revision in failed THA with a limited femoral bone defect is a reliable option for both isolated stem revision and concomitant cup revision in well-selected patients.
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Affiliation(s)
- Sergio Romagnoli
- Joint Replacement Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Matteo Marullo
- Joint Replacement Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Michele Corbella
- Joint Replacement Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Enrico Zero
- Department of Informatics, Bioengineering, Robotics and System Engineering of the University of Genoa, Genoa, Italy
| | - Andrea Parente
- Orthopedics and Traumatology Department, University of Milan, Milan, Italy
| | - Marco Bargagliotti
- Joint Replacement Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
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Pommepuy T, Putman S, May O, Miletic B, Ramos-Pascual S, Migaud H. Influence of Geometry and Extent of Coating on Survival of Cementless Distal-Locking Revision Stems at 7 to 18 Years. J Arthroplasty 2020; 35:3703-3709. [PMID: 32768257 DOI: 10.1016/j.arth.2020.06.090] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/30/2020] [Accepted: 06/30/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND We aimed to compare the long-term clinical outcomes, complications, and survival of 2 revision stems with different geometries, extents of coating, and distal-locking mechanisms. METHODS We retrospectively compared outcomes at a minimum of 7 years following revision THA using 2 proximally coated distal-locking stems: 98 Ultime first-generation (G1) and 116 Linea second-generation (G2) stems. Ten-year Kaplan-Meier survival was assessed considering stem re-revision for any reason and for aseptic reasons. At final follow-up, Harris Hip Score and Oxford Hip Score were collected, and any thigh pain or complications were noted. RESULTS Considering re-revision for any reason, survival was 69% for G1 stems and 91% for G2 stems. Considering re-revision for aseptic reasons, survival was 77% for G1 stems and 92% for G2 stems. Re-revisions were due to fracture of 6 G1 stems but no G2 stems. Complications that required reoperation without stem or cup removal occurred in 3 of the G1 stems and 1 of the G2 stems. Compared to the G1 stems, the G2 stems resulted in better Harris Hip Score (83 vs 71, P = .001), Oxford Hip Score (22 vs 27, P = .019), less thigh pain (4% vs 39%, P < .001), and fewer nonoperated complications (9% vs 15%). CONCLUSION The second-generation stem had significantly better survival and clinical outcomes than the first-generation stem. The differences in survival and clinical outcomes could be attributed to the larger coated surface of the G2 stem and to the fact that the G1 stem was originally intended as a temporary implant to be followed by de-escalation.
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Affiliation(s)
- Thomas Pommepuy
- Département Universitaire de Chirurgie Orthopédique et Traumatologique, Univ. Lille, CHU Lille, Lille, France; Service d'orthopédie C, Hôpital Roger Salengro, Centre Hospitalier Régional Universitaire de Lille, Lille, France; Clinique d'Arcachon, La Teste de Buch, France
| | - Sophie Putman
- Département Universitaire de Chirurgie Orthopédique et Traumatologique, Univ. Lille, CHU Lille, Lille, France; Service d'orthopédie C, Hôpital Roger Salengro, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Olivier May
- Département Universitaire de Chirurgie Orthopédique et Traumatologique, Univ. Lille, CHU Lille, Lille, France; Service d'orthopédie C, Hôpital Roger Salengro, Centre Hospitalier Régional Universitaire de Lille, Lille, France; Clinique Médipole-Garonne, Toulouse, France
| | - Bruno Miletic
- Département Universitaire de Chirurgie Orthopédique et Traumatologique, Univ. Lille, CHU Lille, Lille, France; Service d'orthopédie C, Hôpital Roger Salengro, Centre Hospitalier Régional Universitaire de Lille, Lille, France; Clinique la Louviere, Rue de la Louvière, Lille, France
| | | | - Henri Migaud
- Département Universitaire de Chirurgie Orthopédique et Traumatologique, Univ. Lille, CHU Lille, Lille, France; Service d'orthopédie C, Hôpital Roger Salengro, Centre Hospitalier Régional Universitaire de Lille, Lille, France
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Yoon JY, Moon JK, Kim CH, Lee S, Yoon PW. Korean epidemiology and trends in hip joint replacements. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2020. [DOI: 10.5124/jkma.2020.63.8.462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
This study aimed to analyze the epidemiologic characteristics of patients who underwent hip arthroplasty using the Korean nationwide database and investigate the recent trends in implant fixation methods and bearing surface selection. We aimed to compare clinical characteristics and differences with the results from the registry of other western countries. We analyzed the data collected by the Health Insurance Review and Assessment Service database of Korea from 2007 to 2011 and the Main Surgery Statistical Yearbook from 2014 to 2018, published by the National Health Insurance Service. The number and rate of patients who underwent hip joint arthroplasty per 10,000 persons have been steadily increasing since 2007. There was a big difference in mean age and preoperative diagnosis of patients between the bipolar hemiarthroplasty and total hip arthroplasty groups. Most patients underwent surgery using a cementless biological fixation method, and the cemented fixation method was selectively used for a small portion of old aged osteoporotic patients. In relation to the use of bearing surfaces, the registry data showed that ceramic-ceramic bearings were used at an overwhelmingly high rate (81%) in Korea compared to other countries. The reason was attributable to various factors, such as patient’s age or economic status, differences in the health insurance system between countries, and recently reported complications, such as ceramic fracture or noise.
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14
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Hasler J, Flury A, Dimitriou D, Finsterwald M, Helmy N, Antoniadis A. Is revision total hip arthroplasty through the direct anterior approach feasible? Arch Orthop Trauma Surg 2020; 140:1125-1132. [PMID: 32385577 DOI: 10.1007/s00402-020-03469-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND To date, only limited literature exists regarding revision of total hip arthroplasty (THA) through the direct anterior approach (DAA). However, as the popularity of the DAA for primary surgery is increasing, surgeons will be confronted with the challenge of performing revision surgery through the DAA. The aim of this study was to review the potential of the DAA in the revision setting and to report the clinical results, radiologic outcomes and complication rates of 63 patients undergoing revision THA through the DAA. METHODS From 01/2009 to 08/2017, 63 patients underwent revision THA through the DAA. Depending on the performed procedure, patients were separated into 4 groups: liner and head exchange (21 patients), revision of the acetabular cup (26 patients), revision of the femoral stem (13 patients) or revision of both components (3 patients). Postoperative complications as well as the clinical and radiological outcome were assessed retrospectively. RESULTS At a mean follow-up of 18 months, the overall complication and re-operation rates were 14.3% and 12.7%, respectively. Specifically, the complication and re-operation rates were 14.2% and 9.5% after liner and head exchange, 15.4% after revision of the acetabular cup, 15.3% after revision of the femoral stem and 0% after revision of both components. The mean postoperative HHS at 1 year postoperatively was 91 (range 74-100). CONCLUSION The DAA offers appropriate exposure for exchange of mobile liners and acetabular cup revision. In selected cases with appropriate stem design, femoral stem revision through the DAA is feasible. However, surgeons should be aware of the technical difficulties related to femoral revision and be prepared to extend the approach distally or perform a trochanteric osteotomy.
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Affiliation(s)
- Julian Hasler
- Department of Orthopedics and Traumatology, Bürgerspital Solothurn, Schöngrünstrasse 42, 4500, Solothurn, Switzerland.
| | - Andreas Flury
- Department of Orthopedics and Traumatology, Bürgerspital Solothurn, Schöngrünstrasse 42, 4500, Solothurn, Switzerland
| | - Dimitris Dimitriou
- Department of Orthopedics and Traumatology, Bürgerspital Solothurn, Schöngrünstrasse 42, 4500, Solothurn, Switzerland
| | - Michael Finsterwald
- Department of Orthopedics and Traumatology, Bürgerspital Solothurn, Schöngrünstrasse 42, 4500, Solothurn, Switzerland
| | - Naeder Helmy
- Department of Orthopedics and Traumatology, Bürgerspital Solothurn, Schöngrünstrasse 42, 4500, Solothurn, Switzerland
| | - Alexander Antoniadis
- Department of Orthopedics and Traumatology, Bürgerspital Solothurn, Schöngrünstrasse 42, 4500, Solothurn, Switzerland
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15
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Kildow BJ, Della-Valle CJ, Springer BD. Single vs 2-Stage Revision for the Treatment of Periprosthetic Joint Infection. J Arthroplasty 2020; 35:S24-S30. [PMID: 32046827 DOI: 10.1016/j.arth.2019.10.051] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 10/27/2019] [Accepted: 10/27/2019] [Indexed: 02/01/2023] Open
Abstract
Periprosthetic joint infection (PJI) is one of the most devastating complications following total joint arthroplasty, accounting for a projected 10,000 revision surgeries per year by 2030. Chronic PJI is complicated by the presence of bacterial biofilm, requiring removal of components, thorough debridement, and administration of antibiotics for effective eradication. Chronic PJI is currently managed with single-stage or 2-stage revision surgery. To date, there are no randomized, prospective studies available evaluating eradication rates and functional outcomes between the 2 techniques. In this review, both treatment options are described with the most current literature to guide effective surgical decision-making that is cost-effective while decreasing patient morbidity.
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Affiliation(s)
- Beau J Kildow
- OrthoCarolina Hip and Knee Center, Charlotte, North Carolina
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Clauss M, Hunkeler C, Manzoni I, Sendi P. Debridement, Antibiotics and Implant Retention for Hip Periprosthetic Joint Infection: Analysis of Implant Survival after Cure of Infection. J Bone Jt Infect 2020; 5:35-42. [PMID: 32117688 PMCID: PMC7045527 DOI: 10.7150/jbji.40924] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 01/27/2020] [Indexed: 12/23/2022] Open
Abstract
Background: Debridement, antibiotics and implant retention (DAIR) is a valuable option for treating early and acute periprosthetic joint infection (PJI). The inflammation caused by the infection and the surgical intervention during DAIR may influence the long-term stability of the implant. In this study, we analyzed the sequelae of DAIR on implant survival in hip PJI after cure of infection. Methods: Total hip arthroplasties (THAs) from our database implanted between 1992 and 2016 were included in a retrospective double-cohort study. THAs were exposed (DAIR cohort) or not exposed to DAIR (control cohort). The control cohort comprised patients matched 3:1 to the DAIR cohort. The outcome was implant failure over time. It was evaluated for (i) revision for any reason, (ii) aseptic loosening of any component, and (iii) radiographic evidence of loosening. Results: 57 THAs (56 patients) were included in the DAIR cohort and 170 THAs (168 patients) in the control cohort. The mean follow-up periods in the DAIR and control cohorts were 6.1 and 7.8 years, respectively. During follow-up, 20 (36%) patients in the DAIR cohort and 54 (32%) in the control cohort died after a mean of 4.1 and 7.2 years, respectively. Revision for any reason was performed in 9 (16%) THAs in the DAIR cohort and in 10 (6%) THAs (p=0.03) in the control cohort, and revision for aseptic loosening of any component in 5 (9%) and 8 (5%) THAs (p=0.32), respectively. Radiological analysis included 56 THAs in the DAIR cohort and 168 THAs in the control cohort. Two (4%) stems and 2 (4%) cups in the DAIR cohort and 7 (4%) and 1 (0.6%) in the control cohort, respectively, demonstrated radiological signs of failure (p=1). Conclusions: THAs exposed to DAIR were revised for any reason more frequently than were THAs in the control cohort. The difference was mainly caused by septic failures. After cure of PJI, the difference in revisions for aseptic loosening was not significant. There was no significant difference in radiographic evidence of loosening of any component between cohorts. These data suggest that cured hip PJI previously exposed to DAIR do not fail more frequently for aseptic reasons than do THAs not exposed to DAIR.
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Affiliation(s)
- Martin Clauss
- Interdisciplinary Septic Surgical Unit, Clinic for Orthopedic and Trauma Surgery, Kantonsspital Baselland, Liestal, Switzerland.,Center for Muscular-Skeletal Infections, Department of Orthopedics and Traumatology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Christof Hunkeler
- Interdisciplinary Septic Surgical Unit, Clinic for Orthopedic and Trauma Surgery, Kantonsspital Baselland, Liestal, Switzerland.,Medical Faculty, University of Basel, Basel, Switzerland
| | - Isabella Manzoni
- Interdisciplinary Septic Surgical Unit, Clinic for Orthopedic and Trauma Surgery, Kantonsspital Baselland, Liestal, Switzerland
| | - Parham Sendi
- Center for Muscular-Skeletal Infections, Department of Orthopedics and Traumatology, University Hospital Basel, University of Basel, Basel, Switzerland.,Department of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University Basel, Basel, Switzerland.,Institute for Infectious Diseases, University of Bern, Bern, Switzerland
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17
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Born P, Manzoni I, Ilchmann T, Clauss M. Is cemented revision total hip arthroplasty a reasonable treatment option in an elderly population? Orthop Rev (Pavia) 2019; 11:8263. [PMID: 31616553 PMCID: PMC6790558 DOI: 10.4081/or.2019.8263] [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: 07/31/2019] [Accepted: 08/25/2019] [Indexed: 12/03/2022] Open
Abstract
Revision THA is increasingly performed especially in the elderly population. The surgeon’s challenge is to provide a solution that supports immediate full weight-bearing, despite poor bone quality. Shape-closed revision stems facilitate that by combining cement fixation with additional press-fit anchoring. The design tolerates varying cement mantle thickness and inconsistent cancellous bone lining of the femoral canal. Following that philosophy, we present our mid-term results using a long version of a cemented Charnley- Kerboull type stem. From 2010 to 2017, 38 long Charnley-Kerboull revision stems (Centris®, Mathys European Orthopaedics, Bettlach, Switzerland) were implanted and followed prospectively. Surgery was performed via a Hardinge approach in supine position with a third generation cementing technique. Patients were mobilized using full-weight bearing as early as possible. Survival was determined for stem revision for aseptic loosening and stem and/or cup revision for any reason. 20 stems had a minimum follow-up (f/u) of 2 years and were included for further radiological analysis. Detailed subsidence analysis as an early predictor for later aseptic loosening was performed using EBRA-FCA software. Further, the presence of osteolysis and cement debonding was evaluated. Mean follow- up was 4 years. No patient was lost to f/u.18 died of causes unrelated to THA. Stem survival was 100%. Survival for any re-operation was 82.2% (two early infections, one soft-tissue debridement, one cup exchange for recurrent dislocations). None of the cases revised for septic loosening showed signs of persistent infection at final f/u. EBRA-FCA revealed two oligosymptomatic cases of subsidence of 5mm and 6mm over a course of 2 and 12 months, respectively, with stable implants thereafter. Neither required revision. There was no development of osteolysis or debonding. The stem provides a reliable early fullweight bearing solution for revision THA with excellent mid-term survival in an elderly population. Even in two cases where subsidence was present, mobility was not impaired and re-revision could be avoided.
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Affiliation(s)
- Philipp Born
- Clinic for Orthopedic and Trauma Surgery, Kantonsspital Baselland, Liestal
| | - Isabella Manzoni
- Clinic for Orthopedic and Trauma Surgery, Kantonsspital Baselland, Liestal
| | - Thomas Ilchmann
- Clinic for Orthopedic and Trauma Surgery, Kantonsspital Baselland, Liestal.,Hirslanden Klinik Birshof, Münchenstein
| | - Martin Clauss
- Clinic for Orthopedic and Trauma Surgery, Kantonsspital Baselland, Liestal.,Department of Orthopedics and Traumatology, University Hospital Basel, University of Basel, Switzerland
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Seasoning Polymethyl Methacrylate (PMMA) Bone Cements with Incorrect Mix Ratio. MATERIALS 2019; 12:ma12193073. [PMID: 31547178 PMCID: PMC6804204 DOI: 10.3390/ma12193073] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 09/03/2019] [Accepted: 09/18/2019] [Indexed: 02/07/2023]
Abstract
Cemented joint prostheses are widely used in orthopaedic surgery; however, implants/bone bonds are known to be susceptible to aseptic loosening, particularly in the case of long-term performance. The exact mechanism of this failure is under constant examination. One of the critical factors to the final mechanical functionality of bone cement can be an incorrect mix ratio of a two-component material (powdered polymer and liquid monomer). It can result in the deterioration of the final mechanical strength properties. The paper presents the results from an experimental study on the effects of the deviation from the correct mix ratio on the moisture uptake and the compression strength of cement depending on the seasoning time in Ringer's solution. The results were subjected to statistical analysis and a mathematical model was developed.
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Affiliation(s)
- M Clauss
- Kantonsspital Baselland, Liestal, Switzerland; Head, Hip and Septic Surgical Unit, University Hospital Basel, Basel, Switzerland
| | - S J Breusch
- Royal Infirmary of Edinburgh, Edinburgh, UK; Honorary Senior Lecturer, University of Edinburgh, Edinburgh, UK
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