1
|
Afghanyar Y, Möller JH, Wunderlich F, Dargel J, Rehbein P, Gercek E, Drees P, Kutzner KP. An isoelastic monoblock cup versus a modular metal-back cup: a matched-pair analysis of clinical and radiological results using Einzel-Bild-Röntgen-Analyse software. Arch Orthop Trauma Surg 2024; 144:493-500. [PMID: 37740060 PMCID: PMC10774207 DOI: 10.1007/s00402-023-05058-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 09/01/2023] [Indexed: 09/24/2023]
Abstract
INTRODUCTION Bone preservation and long-term survival are the main challenges in cementless total hip arthroplasty (THA). A good bone stock is especially important for adequate anchorage of the cup in revision cases. However, the optimal acetabular cup design for preserving good bone stock is still unclear. We aimed to compare clinical outcome, radiological alterations, migration, and wear at mid-term for two different cup types. MATERIALS AND METHODS This retrospective matched-pair study was performed using the data for 98 THA cases treated with a monoblock cup composed of vitamin E-blended highly cross-linked polyethylene (VEPE; monoblock group) or a modular cup composed of a highly cross-linked polyethylene (HXLPE) without an antioxidant (modular group). Clinical results were evaluated using the Harris Hip Score (HHS). The obtained radiographs were analyzed for radiological alterations, migration, and wear using Einzel-Bild-Röntgen-Analyse (EBRA) software. RESULTS The mean follow-up duration was 73.2 ± 19.2 months (range: 32-108 months) and 60.5 ± 12.2 months (range: 20-84 months) in the monoblock and modular groups, respectively. HHS improved to 95.7 points in the monoblock group and 97.6 points in the modular group, without significant differences (p = 0.425). EBRA measurements were obtained in all cases. Acetabular bone alterations were not detected on radiological assessments. Mean cup migration was 1.67 ± 0.92 mm (range: 0.46-3.94 mm) and 1.24 ± 0.87 mm (range: 0.22-3.62 mm) in the monoblock and modular groups. The mean wear rate was 0.21 ± 0.18 mm (range: 0.00-0.70 mm) and 0.20 ± 0.13 mm (range: 0.00-0.50 mm) in the monoblock and modular groups. Both migration and wear pattern showed no significant differences (p = 0.741 and 0.243). None of the cases required revision surgery, yielding an implant survival rate of 100% in both groups. CONCLUSION The isoelastic press-fit monoblock VEPE cup and modular metal-back HXLPE cup showed equivalent mid-term wear and cup migration. Long-term studies are required to determine the effects of modularity, isoelasticity, and polyethylene stabilization with vitamin E on cup loosening and survival rates.
Collapse
Affiliation(s)
- Yama Afghanyar
- Department of Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg-University of Mainz, Mainz, Germany.
- Department of Orthopaedics and Traumatology, St. Josefs Hospital Wiesbaden, Wiesbaden, Germany.
| | - Jens Hendrik Möller
- Department of Orthopaedics and Traumatology, St. Josefs Hospital Wiesbaden, Wiesbaden, Germany
| | - Felix Wunderlich
- Department of Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - Jens Dargel
- Department of Orthopaedics and Traumatology, St. Josefs Hospital Wiesbaden, Wiesbaden, Germany
| | - Philipp Rehbein
- Department of Orthopaedics and Traumatology, St. Josefs Hospital Wiesbaden, Wiesbaden, Germany
| | - Erol Gercek
- Department of Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - Philipp Drees
- Department of Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - Karl Philipp Kutzner
- Department of Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg-University of Mainz, Mainz, Germany
- Department of Orthopaedics and Traumatology, St. Josefs Hospital Wiesbaden, Wiesbaden, Germany
| |
Collapse
|
2
|
Synnott PA, Sivaloganathan S, Kiss MO, Binette B, Morcos MW, Vendittoli PA. Monobloc press-fit cups with large-diameter bearings are safe in revision total hip arthroplasty. Orthop Rev (Pavia) 2022; 14:38926. [PMID: 36349354 PMCID: PMC9635988 DOI: 10.52965/001c.38926] [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] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Instability is a major cause of failure of revision total hip arthroplasty (THA) which can be avoided with the use of monobloc press-fit cups with large diameter heads (LDH). OBJECTIVE This consecutive case series analyses whether LDH monobloc components are a safe and clinically beneficial option for revision THA. METHODS This consecutive case series includes 47 revision THA with LDH monobloc acetabular cup. Acetabular bone defects were Paprosky type I (42), type IIA (2) and type IIC (3). The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Forgotten Joint Score (FJS) and the Patient's Joint Perception (PJP) scores were analysed and a radiographic evaluation for signs of implant dysfunction was performed. RESULTS After a mean follow-up of 4.5 years, there were 5 (10.6%) acetabular cup re-revisions: 2 loss of primary fixation and 3 instabilities. Implant survivorship at 4-years was 89.4% (95% CI: 89.3 to 89.5). Recurrent hip dislocation was reported in 1 patient (2.1%) and remains under conservative treatment. The mean WOMAC and FJS were 19.5 (16.8; 0.0 to 58.3) and 57.3 (28.9; 6.3 to 100.0), respectively. Regarding the PJP, 3 (8.8%) patients perceived their hip as natural, 8 (23.5%) as an artificial joint with no restriction, 14 (41.2%) with minor restriction and 9 (26.5%) with major restriction. CONCLUSION In cases of revision THA with limited bone loss, press-fit primary fixation with LDH monobloc acetabular components are valuable options that offer excellent mid-term out-comes with low re-revision and joint instability rates.
Collapse
Affiliation(s)
| | - Sivan Sivaloganathan
- University of Montreal, Hôpital Maisonneuve-Rosemont; Surgery Department, Montreal University
| | - Marc-Olivier Kiss
- University of Montreal, Hôpital Maisonneuve-Rosemont; Surgery Department, Montreal University; Clinique Orthopédique Duval, Laval, Canada
| | - Benoit Binette
- University of Montreal, Hôpital Maisonneuve-Rosemont; Surgery Department, Montreal University
| | - Mina W. Morcos
- University of Montreal, Hôpital Maisonneuve-Rosemont; Surgery Department, Montreal University
| | - Pascal-André Vendittoli
- University of Montreal, Hôpital Maisonneuve-Rosemont; Surgery Department, Montreal University; Clinique Orthopédique Duval, Laval, Canada; Personalized Arthroplasty Society, Georgia, USA
| |
Collapse
|
3
|
Nicholson AD, Mathew JI, Koch CN, Kontaxis A, Wright T, Taylor SA, Blaine TA, Dines JS, Dines DM, Fu MC, Warren RF, Gulotta LV. Backside polyethylene wear in reverse shoulder arthroplasty. J Shoulder Elbow Surg 2022; 31:545-552. [PMID: 34619352 DOI: 10.1016/j.jse.2021.09.002] [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: 07/12/2021] [Revised: 09/01/2021] [Accepted: 09/06/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Aseptic loosening from implant-associated osteolysis in reverse shoulder arthroplasty (RSA) may contribute to premature implant failure. Although articular side polyethylene (PE) damage has been well documented in the literature, no studies to date have investigated backside wear in RSA. The aims of this investigation were to (1) document and compare the damage between the backside and articular surface in explanted RSA components, (2) assess whether certain quadrants have a greater propensity for damage, and (3) report the most common mode(s) of backside PE damage. METHODS Twenty-one RSA humeral liners retrieved during revision procedures between 2005 and 2014 were included for analysis. The mean time between implantation and extraction was 16 months (10 days-88 months). Diagnoses at the time of revision included dislocation (10), infection (4), mechanical failure (3), loosening (2), and unknown (2). Liners were examined under light microscopy (×10-30 magnification) and damage on the articular and backside of the liner surface was graded using the modified Hood score. The location and damage modality were compared between the articular side and backside of the implant. RESULTS Damage was noted on the articular surfaces of all 21 liners and on the backside surface of 20 liners. The total damage in all the quadrants was higher on the articular surface than on the backside of the component, with a mean difference in total quadrant damage scores of 11.74 ± 3.53 (P < .001). There was no difference in damage among the quadrants on the backside (P = .44) or the articular surface (P = .08). The articular side exhibited greater scratching, abrasion, and surface deformation than the backside (P < .001). CONCLUSIONS This short-term retrieval study demonstrated that backside PE damage occurs on the humeral component of RSA implants. There was greater damage to the articular side of the liner but wear to the backside was present in almost all liners. The clinical importance of backside wear in RSA and its overall contribution to PE particulate disease and osteolysis needs further investigation.
Collapse
|
4
|
Fischman D, Mahatma MM, Slullitel P, Farzi M, Grammatopoulos G, Poitras S, Wilkinson JM, Beaulé PE. Does a Monoblock Acetabular Component With a Ceramic Liner Cause More Pelvic Bone Loss Than a Conventional Modular Cementless Acetabular Component? A 2-Year Randomized Clinical Trial. J Arthroplasty 2022; 37:75-82. [PMID: 34649747 DOI: 10.1016/j.arth.2021.08.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/19/2021] [Accepted: 08/30/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Ceramic-on-ceramic bearings permit the use of large femoral head size while maintaining a favorable effect on wear rates. However, because of increased device rigidity, periprosthetic bone quality could be negatively affected due to stress shielding. The purpose of this study is to assess pelvic periprosthetic bone remodeling around a monoblock ceramic-on-ceramic acetabular component compared to that around a conventional modular metal-on-polyethylene device. METHODS Participants were randomized to receive hip replacement using either a porous-coated, modular metal-on-polyethylene acetabular component (n = 46) or a hydroxyapatite and titanium-coated monoblock shell with an integrated ceramic-on-ceramic bearing (n = 40). Radiographic assessments were completed preoperatively and postoperatively, and measurements of bone mineral density (BMD) using dual-energy X-ray absorptiometry with region free analysis were performed postoperatively and over 2-years of follow-up. RESULTS There was no significant difference in BMD between the 2 groups at baseline or over the following 2 years. At follow-up, complete shell-to-bone contact without a radiolucent line was observed in 26 (67%) of the modular devices and in 37 (93%) of monoblock (P < .001). The modular device was an independent predictor of radiolucent lines (odds ratio 19.1, P = .007). No cases underwent revision surgery for acetabular loosening. CONCLUSION Both the porous-coated modular and hydroxyapatite-coated monoblock acetabular components showed successful clinical results at short-term follow-up with no difference in pixel-level BMD. Using a large head monoblock device does not appear to be associated with an adverse effect on the local bone environment when compared to a modular device. NCT: NCT01558752.
Collapse
Affiliation(s)
- Daniel Fischman
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Canada
| | - Mohit M Mahatma
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Pablo Slullitel
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Canada; Institute of Orthopaedics 'Carlos E. Ottolenghi', Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Mohsen Farzi
- Centre for Computational Imaging and Simulation Technologies in Bioscience, University of Leeds, Leeds, UK
| | | | - Stéphane Poitras
- School of Rehabilitation, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - J Mark Wilkinson
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Canada
| |
Collapse
|
5
|
Kenanidis E, Kakoulidis P, Leonidou A, Anagnostis P, Potoupnis M, Tsiridis E. Survival of monoblock RM vitamys compared with modular PINNACLE cups: mid-term outcomes of 200 hips performed by a single surgeon. Hip Int 2021; 31:465-471. [PMID: 31694404 DOI: 10.1177/1120700019885619] [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] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Monoblock cups have theoretical advantages over modular cups; however, their superiority in terms of survival has not been confirmed in comparative studies. METHODS We compared the mid-term survivorship of 107 RM Pressfit vitamys monoblock cups (Mathys Ltd., Bettlach, Switzerland) with 93 modular pressfit Pinnacle cups (DePuy Synthes, Warsaw, IN, USA). All cases were registered in the Arthroplasty Registry Thessaloniki and performed by a senior surgeon through the same approach between 2013 and 2014. The groups were comparable in sex distribution, preoperative diagnosis, follow-up, cup diameter, head diameter, type and use of screws, HOOS and HSS preop scores; the recipients of RM cup were significantly younger. RESULTS 3 sockets were revised. The 6-year survival for any reason was 99.1% for the RM and 97.8 % for the PINNACLE group. There was no difference in survival for aseptic loosening and any reason between groups (log-rank test p = 0.921 and p = 0.483, respectively). The age (95% CI, 0.79-1.1), sex (95% CI, 0.2-45.0), cup diameter (95% CI, 0.18-1.1), head diameter (95% CI, 0.004-6.2), preoperative diagnosis and use of screws (95% CI, 0.02-4.3), did not influence hazard ratio for revision between groups. HHS and HOOS were comparable at the last follow-up. CONCLUSIONS Our study demonstrated that both cup designs had similar revision rates at mid-term follow-up, regardless the fact that the RM vitamys was used in a cohort of younger patients; which according to the literature would have led to earlier failures. Further long-term data are needed to evaluate the superiority of RM vitamys in the clinical setting, especially in the young.
Collapse
Affiliation(s)
- Eustathios Kenanidis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Greece.,Centre of Orthopaedic and Regenerative Medicine (CORE), Centre for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Thessaloniki, Greece
| | - Panagiotis Kakoulidis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Greece.,Centre of Orthopaedic and Regenerative Medicine (CORE), Centre for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Thessaloniki, Greece
| | - Andreas Leonidou
- Centre of Orthopaedic and Regenerative Medicine (CORE), Centre for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Thessaloniki, Greece.,Royal Berkshire NHS Foundation Trust, Reading, UK
| | - Panagiotis Anagnostis
- Centre of Orthopaedic and Regenerative Medicine (CORE), Centre for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Thessaloniki, Greece
| | - Michael Potoupnis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Greece.,Centre of Orthopaedic and Regenerative Medicine (CORE), Centre for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Thessaloniki, Greece
| | - Eleftherios Tsiridis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Greece.,Centre of Orthopaedic and Regenerative Medicine (CORE), Centre for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Thessaloniki, Greece
| |
Collapse
|
6
|
Long G, Chao C, Ming-Sheng T, Ping Y. Low Grip Strength Associated with Clinical Outcomes after Total Hip Arthroplasty - A Prospective Case-Control Study. Orthop Surg 2021; 13:1488-1495. [PMID: 34080763 PMCID: PMC8313166 DOI: 10.1111/os.13007] [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: 01/08/2021] [Revised: 02/14/2021] [Accepted: 03/11/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To assess whether low grip strength (GS) is associated with clinical outcomes after total hip arthroplasty (THA). METHODS A prospective case-control study was designed to assess 231 cases of primary THA between January 1, 2015 to May 1, 2018, at an urban tertiary care hospital. Patients were placed into two cohorts based on preoperative GS levels. Low GS in the present study was defined as GS lower than 26 kg for men and 16 kg for women in the dominant hand. Baseline data were prospectively collected and included patient demographics (age, sex, body mass index [BMI]), the surgeon's diagnoses, medical history, length of stay, and American Society of Anaesthesiologists' (ASA) score. Clinical outcomes included surgery- and prosthesis-related variables. The Harris hip score (HHS) and the Short Form Health Survey (SF-12) were completed at the baseline visit and at 1 and 2 years postoperatively in the outpatient department to assess the hip's function and quality of life. Differences in baseline data, length of study (LOS), 90-day postoperative complications, and hospital readmissions were compared. Besides, the correlations between GS and Harris hip score (HHS) and Short Form score (SF-12) were tested. RESULTS A total of 202 participants have completed records for analysis finally. The patients were followed up for an average of 24.8 months postoperatively (24-26 months). Eighty-two patients (40.6%) had low GS before THA. Patients with low GS were more likely to be female, older, fracture of femoral head or neck as the primary cause, albumin <3.5 g/dL, and have a lower BMI, higher ASA score, increased rates of the pressure sore, blood transfusion, and LOS compared to normal GS (all P < 0.05). Also, patients in the low GS cohort showed a statistically significant increased unplanned hospital readmissions and decreased discharge home compared to normal GS (both P < 0.05). There was an increasing rate of complications between the two cohorts, for cardiac complications, pressure sore after THA, respiratory complications, urinary tract infection, stroke, and DVT (all P < 0.05). A partial correlation test by controlling medical comorbidities and demographic factors was used to determine the correlation between GS and HHS. There was a significant correlation between them (r = -0.673; P = 0.002). A similar condition was detected in the correlation between GS and SF-12 (r = 0.645; P = 0.001). CONCLUSIONS Clinicians should be encouraged to include GS assessment in their evaluation of patients who planned to undergo THA in order to optimize the treatment of high-risk individuals.
Collapse
Affiliation(s)
- Gong Long
- Department of Orthopaedic, China-Japan Friendship Hospital, Beijing, China.,Peking Union Medical College, Chinese Academy of Medical College, Beijing, China
| | - Chen Chao
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Tan Ming-Sheng
- Department of Orthopaedic, China-Japan Friendship Hospital, Beijing, China.,Peking Union Medical College, Chinese Academy of Medical College, Beijing, China
| | - Yi Ping
- Department of Orthopaedic, China-Japan Friendship Hospital, Beijing, China.,Peking Union Medical College, Chinese Academy of Medical College, Beijing, China
| |
Collapse
|
7
|
Gong L, Zhang YY, Yang N, Qian HJ, Zhang LK, Tan MS. Raloxifene Prevents Early Periprosthetic Bone Loss for Postmenopausal Women after Uncemented Total Hip Arthroplasty: A Randomized Placebo-Controlled Clinical Trial. Orthop Surg 2020; 12:1074-1083. [PMID: 32686337 PMCID: PMC7454213 DOI: 10.1111/os.12696] [Citation(s) in RCA: 4] [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: 12/17/2019] [Revised: 04/15/2020] [Accepted: 04/16/2020] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To examine the results of raloxifene for prevention of periprosthetic bone loss around the femoral stem in patients undergoing total hip arthroplasty (THA). METHODS Between January 2015 and May 2017, 240 female patients between 55 and 80 years underwent primary THA and were randomly allocated to receive 60 mg raloxifene hydrochloride per day (treatment group, TG, n = 120) or placebo (control group, CG, n = 120) orally at bedtime using computer-generated randomization sequence generation. Baseline data, the Western Ontario McMaster Universities Osteoarthritis Index (WOMAC), women's quality of life (QoL) score, bone mineral density (BMD) around the prosthesis, and adverse events were compared between the two groups. The measuring range of BMD around the prosthesis was divided into seven regions of interest (ROI). The sample size was calculated to detect a mean difference in BMD of 0.15 g/cm2 with a standard deviation (SD) of 0.3. The error was set at 0.05 and the power level at 90% with additional compensation for a possible dropout rate of 20%. RESULTS A total of 240 participants in the study up to 24 months after THA. There were no significant differences in the mean BMD of all the zones between groups before surgery (all P > 0.05). However, there were significant differences in the BMD of Gruen zones 4 and 7 between groups at 6 months postoperatively (both P < 0.05); there were significant differences in Gruen zones 1, 4, 6, and 7 at 12 months postoperatively (all P < 0.01); there were significant differences in Gruen zones 1, 2, 4, 6, and 7 at 24 months postoperatively (all P < 0.001). Patients taking raloxifene reported higher QoL scores, with better improvement in BMD in all areas except in zones 3 and 5 compared with the control group. There were no significant differences in WOMAC pain (P = 0.4045), WOMAC function (P = 0.4456) and women's QoL scores (P = 0.5983) between groups before surgery. However, WOMAC pain, WOMAC function and women's QoL score in the treatment group were significantly better at all time points (all P < 0.05). Patients in the treatment group showed no increased adverse events, including cardiac events, stroke, venous thromboembolism, and gynecological cancer (all P > 0.05), but did show decreased odds of breast cancer in comparison with those using a placebo (P = 0.0437). CONCLUSION Raloxifene can help inhibit bone loss around the prosthesis and improve the QoL of postmenopausal women after THA with no increased adverse events, and can even decrease the odds of breast cancer.
Collapse
Affiliation(s)
- Long Gong
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Peking Union Medical College, Chinese Academy of Medical College, Beijing, China
| | - Yao-Yao Zhang
- Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, Chengdu, China
| | - Na Yang
- Bao Ding Maternal and Children Hospital, Baoding, China
| | - Huan-Juan Qian
- Department of Orthopedics Surgery, 81 Group Military Hospital of Chinese PLA, Baoding, China
| | - Ling-Kun Zhang
- Department of Orthopedics Surgery, 81 Group Military Hospital of Chinese PLA, Baoding, China
| | - Ming-Sheng Tan
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Peking Union Medical College, Chinese Academy of Medical College, Beijing, China
| |
Collapse
|
8
|
|
9
|
Wiznia DH, Schwarzkopf R, Iorio R, Long WJ. Factors That Influence Bone-Ingrowth Fixation of Press-Fit Acetabular Cups. JBJS Rev 2019; 7:e2. [DOI: 10.2106/jbjs.rvw.18.00147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|
10
|
Kurcz B, Lyons J, Sayeed Z, Anoushiravani AA, Iorio R. Osteolysis as it Pertains to Total Hip Arthroplasty. Orthop Clin North Am 2018; 49:419-435. [PMID: 30224004 DOI: 10.1016/j.ocl.2018.06.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Osteolysis is a long-term complication of total hip arthroplasty (THA). As the projected number of THAs performed annually increases, osteolysis will likely continue to occur. However, because of advancements in prosthesis design, metallurgy, and enhanced bearing surfaces, fewer revision THAs will be linked to osteolysis and aseptic loosening. Despite these improvements, no preventative therapies are currently available for the management of osteolysis other than removing and replacing the source of bearing wear.
Collapse
Affiliation(s)
- Brian Kurcz
- Division of Orthopaedic Surgery, Southern Illinois University, 701 North 1st Street, Springfield, IL 62781, USA
| | - Joseph Lyons
- Department of Surgery, Chicago Medical School, 3333 Green Bay Road, North Chicago, IL 60064, USA
| | - Zain Sayeed
- Department of Orthopaedic Surgery, Detroit Medical Center, 4201 Saint Antoine, Detroit, MI 48201, USA
| | - Afshin A Anoushiravani
- Division of Orthopaedic Surgery, Albany Medical Center, 43 New Scotland, Albany, NY, USA
| | - Richard Iorio
- Division of Orthopaedic Surgery, Albany Medical Center, 43 New Scotland, Albany, NY, USA.
| |
Collapse
|
11
|
Solid Cup vs Cluster Hole in Total Hip Arthroplasty: A 10-Year Randomized Control Trial. J Arthroplasty 2018; 33:1113-1119. [PMID: 29289446 DOI: 10.1016/j.arth.2017.10.058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 10/26/2017] [Accepted: 10/30/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Acetabular osteolysis is a major complication of total hip arthroplasty. It is caused in part by wear debris. It has been suggested that this debris can migrate through screw holes in the acetabular component. Solid-backed components have been used to prevent this migration and reduce osteolysis. Newer materials, however, have reduced wear debris. This study aimed to evaluate whether using solid-backed instead of cluster-hole components actually reduces osteolysis. This could open up the possibility of screws being used for greater stability where required. METHODS This prospective trial randomized 100 patients undergoing cementless total hip arthroplasty to receive either cluster-hole or solid-backed acetabular components. A cementless cup and highly cross-linked polyethylene was used in all patients. Computed tomography, performed at 5 and 10 years after surgery, was assessed by a blinded radiologist for the presence of osteolysis. RESULTS Of the 100 patients, 14 required screws for stability, and so were moved into a third "screw" group for per-protocol analysis. At 10 years after surgery, osteolytic lesions were discovered in 18.2% of patients. There was no difference in incidence or volume of osteolysis between patients with cluster-hole acetabular components and those with solid-backed components. CONCLUSION This study reveals a low number of patients with osteolytic lesions 10 years after total hip arthroplasty performed with a modern cup design and highly cross-linked polyethylene liner. There was no clear benefit to using solid-backed acetabular components. Cluster-hole components, however, offer the option of screw augmentation when required.
Collapse
|
12
|
Survivorship of a Porous Tantalum Monoblock Acetabular Component in Primary Hip Arthroplasty With a Mean Follow-Up of 18 Years. J Arthroplasty 2017; 32:3680-3684. [PMID: 28734611 DOI: 10.1016/j.arth.2017.06.049] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Revised: 06/12/2017] [Accepted: 06/28/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The use of porous tantalum for the acetabular component in primary total hip arthroplasty (THA) has demonstrated excellent short-term and midterm results. However, long-term data are scarce. The purpose of this prospective study is to report the long-term clinical and radiologic outcome following use of an uncemented porous tantalum acetabular component in primary THA with a minimum follow-up of 17.5 years, in a previously studied cohort of patients. METHODS We prospectively followed 128 consecutive primary THAs in 140 patients, between November 1997 and June 1999. A press-fit porous tantalum monoblock acetabular component was used in all cases. All patients were followed clinically and radiographically for a mean of 18.1 years (range, 17.5-19 years). RESULTS Mean age of patients at the time of operation was 60.4 years. Harris hip score, Oxford hip score, and range of motion were dramatically improved in all cases (P < .001). At last follow-up, all cups were radiographically stable with no evidence of migration, gross polyethylene wear, progressive radiolucencies, osteolytic lesions, or acetabular fractures. The survivorship with reoperation for any reason as end point was 92.8% and the survivorship for aseptic loosening as an end point was 100%. CONCLUSION The porous tantalum monoblock cup in primary THA demonstrated excellent clinical and radiographic outcomes with no failures because of aseptic loosening at a mean follow-up of 18.1 years.
Collapse
|
13
|
Gwynne-Jones DP, Lash HWR, James AW, Iosua EE, Matheson JA. The Morscher Press-Fit Acetabular Component: An Independent Long-Term Review at 18-22 Years. J Arthroplasty 2017; 32:2444-2449. [PMID: 28343828 DOI: 10.1016/j.arth.2017.02.052] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 01/31/2017] [Accepted: 02/20/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND There are relatively few 20-year results of uncemented acetabular components, and most of these are modular designs. This study reports the 20-year results of a monoblock press-fit acetabular component. METHODS A total of 122 total hip arthroplasties (111 patients) using the Morscher cup were reviewed at a mean of 19.7 years. The average age at implantation was 57.3 years (range, 36-74 years), and 81 (66%) were men. RESULTS Twenty-two patients (25 hips) had died. Seven hips were revised, including 5 acetabular revisions. Six patients (6 hips) declined to participate but were known not to have been revised. The mean Oxford hip score was 41.1 (range, 22-48), and the mean reduced Western Ontario and McMaster Universities Osteoarthritis Index score was 5.7/48 (range, 0-24). Eccentric wear was seen in 13 (15.7%) and major osteolysis in 14 (17%) of 82 surviving hips with radiographs. The all-cause revision rate was 0.32 per 100 observed component years (95% confidence interval [CI], 0.13-0.66). The 20-year Kaplan-Meier survival was 93.4% (CI, 86.6-96.8) for all-cause revisions, 95.5% (CI, 89.4-98.1) for any acetabular revision, and 97.1% (CI, 91.2-99.1) for acetabular aseptic loosening, wear, or osteolysis. CONCLUSION The Morscher acetabular component has continued to perform well at 20 years despite using conventional polyethylene with results that match or surpass other cementless acetabulae.
Collapse
Affiliation(s)
- David P Gwynne-Jones
- Department of Surgical Sciences, Orthopaedic Surgery, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand; Department of Orthopaedic Surgery, Dunedin Hospital, Southern District Health Board, Dunedin, New Zealand
| | - Heath W R Lash
- Department of Orthopaedic Surgery, Dunedin Hospital, Southern District Health Board, Dunedin, New Zealand
| | - Andrew W James
- Department of Orthopaedic Surgery, Dunedin Hospital, Southern District Health Board, Dunedin, New Zealand
| | - Ella E Iosua
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - John A Matheson
- Department of Orthopaedic Surgery, Dunedin Hospital, Southern District Health Board, Dunedin, New Zealand; Mercy Hospital, Dunedin, New Zealand
| |
Collapse
|
14
|
Melatonin attenuates titanium particle-induced osteolysis via activation of Wnt/β-catenin signaling pathway. Acta Biomater 2017; 51:513-525. [PMID: 28088671 DOI: 10.1016/j.actbio.2017.01.034] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 01/05/2017] [Accepted: 01/10/2017] [Indexed: 12/28/2022]
Abstract
Wear debris-induced inhibition of bone regeneration and extensive bone resorption were common features in peri-prosthetic osteolysis (PPO). Here, we investigated the effect of melatonin on titanium particle-stimulated osteolysis in a murine calvariae model and mouse-mesenchymal-stem cells (mMSCs) culture system. Melatonin inhibited titanium particle-induced osteolysis and increased bone formation at osteolytic sites, confirmed by radiological and histomorphometric data. Furthermore, osteoclast numbers decreased dramatically in the low- and high-melatonin administration mice, as respectively, compared with the untreated animals. Melatonin alleviated titanium particle-induced depression of osteoblastic differentiation and mineralization in mMSCs. Mechanistically, melatonin was found to reduce the degradation of β-catenin, levels of which were decreased in presence of titanium particles both in vivo and in vitro. To further ensure whether the protective effect of melatonin was mediated by the Wnt/β-catenin signaling pathway, ICG-001, a selective β-catenin inhibitor, was added to the melatonin-treated groups and was found to attenuate the effect of melatonin on mMSC mineralization. We also demonstrated that melatonin modulated the balance between receptor activator of nuclear factor kappa-B ligand and osteoprotegerin via activation of Wnt/β-catenin signaling pathway. These findings strongly suggest that melatonin represents a promising candidate in the treatment of PPO. STATEMENT OF SIGNIFICANCE Peri-prosthetic osteolysis, initiated by wear debris-induced inhibition of bone regeneration and extensive bone resorption, is the leading cause for implant failure and reason for revision surgery. In the current study, we demonstrated for the first time that melatonin can induce bone regeneration and reduce bone resorption at osteolytic sites caused by titanium-particle stimulation. These effects might be mediated by activating Wnt/β-catenin signaling pathway and enhancing osteogenic differentiation. Meanwhile, the ability of melatonin to modulate the balance between receptor activator of nuclear factor kappa-B ligand and osteoprotegerin mediated by Wnt/β-catenin signaling pathway, thereby suppressing osteoclastogenesis, may be implicated in the protective effects of melatonin on titanium-particle-induced bone resorption. These results suggested that melatonin can be considered as a promising therapeutic agent for the prevention and treatment of peri-prosthetic osteolysis.
Collapse
|
15
|
Backside Wear Analysis of Retrieved Acetabular Liners with a Press-Fit Locking Mechanism in Comparison to Wear Simulation In Vitro. BIOMED RESEARCH INTERNATIONAL 2016; 2016:8687131. [PMID: 27722174 PMCID: PMC5045999 DOI: 10.1155/2016/8687131] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 08/18/2016] [Indexed: 11/17/2022]
Abstract
Backside wear due to micromotion and poor conformity between the liner and its titanium alloy shell may contribute to the high rates of retroacetabular osteolysis and consequent aseptic loosening. The purpose of our study was to understand the wear process on the backside of polyethylene liners from two acetabular cup systems, whose locking mechanism is based on a press-fit cone in combination with a rough titanium conical inner surface on the fixation area. A direct comparison between in vitro wear simulator tests (equivalent to 3 years of use) and retrieved liners (average 13.1 months in situ) was done in order to evaluate the backside wear characteristics and behavior of these systems. Similar wear scores between in vitro tested and retrieved liners were observed. The results showed that this locking mechanism did not significantly produce wear marks at the backside of the polyethylene liners due to micromotion. In all the analyzed liners, the most common wear modes observed were small scratches at the cranial fixation zone directly below the rough titanium inner surface of the shell. It was concluded that most of the wear marks were produced during the insertion and removal of the liner, rather than during its time in situ.
Collapse
|
16
|
Long-Term Clinical and Radiographic Outcomes of Porous Tantalum Monoblock Acetabular Component in Primary Hip Arthroplasty: A Minimum of 15-Year Follow-Up. J Arthroplasty 2016; 31:110-4. [PMID: 26781387 DOI: 10.1016/j.arth.2015.12.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 11/18/2015] [Accepted: 12/01/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The porous tantalum monoblock cup has demonstrated excellent short-term and midterm clinical and radiographic outcomes in primary THA, but longer follow-up is necessary to confirm the durability of these results into the second decade. The purpose of this study is to report the clinical and radiographic outcomes for this monoblock cup with a minimum 15-year follow-up. METHODS From June 1998 to December 1999, 61 consecutive patients (63 hips) underwent primary THA with a tantalum monoblock acetabular component. All patients were followed clinically and radiographically for a minimum of 15 years. At a mean of 15.6 years (range, 15-16 years) of follow-up, 5 patients had died, and 4 had been lost to follow-up, leaving 52 patients (54 hips) for analysis. The underlying diagnosis that led to the primary THA was primary osteoarthritis in 43 hips, avascular necrosis in 4, developmental hip dysplasia in 3, rheumatoid arthritis in 3 and post-traumatic osteoarthritis in 1. RESULTS One cup was revised for deep infection; at surgery, the cup showed osseointegration. At a mean follow-up of 15.6 years (range, 15-16 years), the survivorship with cup revision for aseptic loosening as end point was 100%. There was no radiographic evidence of loosening, migration, or gross polyethylene wear at last follow-up. The mean Harris Hip Scores improved from 47 points preoperatively to 94 points. CONCLUSION The porous tantalum monoblock cup in primary THA demonstrated excellent clinical and radiographic outcomes with no failures because of osteolysis or loosening at a minimum follow-up of 15 years.
Collapse
|
17
|
Seehra J, Pandis N, Koletsi D, Fleming PS. Use of quality assessment tools in systematic reviews was varied and inconsistent. J Clin Epidemiol 2015; 69:179-84.e5. [PMID: 26151664 DOI: 10.1016/j.jclinepi.2015.06.023] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Revised: 06/21/2015] [Accepted: 06/26/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To assess the use of quality assessment tools among a cross-section of systematic reviews (SRs) and to further evaluate whether quality was used as a parameter in the decision to include primary studies within subsequent meta-analysis. STUDY DESIGN AND SETTING We searched PubMed for SRs (interventional, observational, and diagnostic) published in Core Clinical Journals between January 1 and March 31, 2014. RESULTS Three hundred nine SRs were identified. Quality assessment was undertaken in 222 (71.8%) with isolated use of the Cochrane risk of bias tool (26.1%, n = 58) and the Newcastle-Ottawa Scale (15.3%, n = 34) most common. A threshold level of primary study quality for subsequent meta-analysis was used in 12.9% (40 of 309) of reviews. Overall, fifty-four combinations of quality assessment tools were identified with a similar preponderance of tools used among observational and interventional reviews. Multiple tools were used in 11.7% (n = 36) of SRs overall. CONCLUSION We found that quality assessment tools were used in a majority of SRs; however, a threshold level of quality for meta-analysis was stipulated in just 12.9% (n = 40). This cross-sectional analysis provides further evidence of the need for more active or intuitive editorial processes to enhance the reporting of SRs.
Collapse
Affiliation(s)
- Jadbinder Seehra
- Dental Institute Kings College London, Department of Orthodontics, Denmark Hill, London, SE5 9RS, United Kingdom.
| | - Nikolaos Pandis
- Department of Orthodontics and Dentofacial Orthopedics, Dental School/Medical Faculty, University of Bern, Freiburgstrasse 7 CH-3010, Bern, Switzerland
| | - Despina Koletsi
- Department of Orthodontics, Dental School, University of Athens and Private Practice, 2 Thivon str, 11527 Goudi, Athens, Greece
| | - Padhraig S Fleming
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Turner St., London E1 2 AD, United Kingdom
| |
Collapse
|
18
|
Halma JJ, Eshuis R, Vogely HC, van Gaalen SM, de Gast A. An uncemented iso-elastic monoblock acetabular component: preliminary results. J Arthroplasty 2015; 30:615-21. [PMID: 25496930 DOI: 10.1016/j.arth.2014.11.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 10/29/2014] [Accepted: 11/10/2014] [Indexed: 02/01/2023] Open
Abstract
Little is known about the clinical application of highly cross-linked polyethylene (HXLPE) blended with vitamin E. This study evaluates an uncemented iso-elastic monoblock cup with vitamin E blended HXLPE. 112 patients were followed up for 2years. 95.5% completed the follow-up. The mean VAS score for patient satisfaction was 8.8 and the mean Harris Hip Score was 94.2. In 7 cases initial gaps behind the cup were observed, which disappeared completely during follow-up in 6 cases. The mean femoral head penetration rate was 0.055mm/year. No adverse reactions or abnormal mechanical behavior was observed with the short term use of vitamin E blended HXLPE. This study shows the promising performance of this cup and confirms the potential of vitamin E blended HXLPE.
Collapse
Affiliation(s)
- Jelle J Halma
- Clinical Orthopedic Research Center-midden Nederland (CORC-mN) Department of Orthopedics, Diakonessenhuis Hospital, Utrecht, The Netherlands
| | - Rienk Eshuis
- Clinical Orthopedic Research Center-midden Nederland (CORC-mN) Department of Orthopedics, Diakonessenhuis Hospital, Utrecht, The Netherlands
| | - H Charles Vogely
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Steven M van Gaalen
- Clinical Orthopedic Research Center-midden Nederland (CORC-mN) Department of Orthopedics, Diakonessenhuis Hospital, Utrecht, The Netherlands
| | - Arthur de Gast
- Clinical Orthopedic Research Center-midden Nederland (CORC-mN) Department of Orthopedics, Diakonessenhuis Hospital, Utrecht, The Netherlands
| |
Collapse
|
19
|
Mihalko WM, Wimmer MA, Pacione CA, Laurent MP, Murphy RF, Rider C. How have alternative bearings and modularity affected revision rates in total hip arthroplasty? Clin Orthop Relat Res 2014; 472:3747-58. [PMID: 25070918 PMCID: PMC4397767 DOI: 10.1007/s11999-014-3816-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Total hip arthroplasty (THA) continues to be one of the most successful surgical procedures in the medical field. However, over the last two decades, the use of modularity and alternative bearings in THA has become routine. Given the known problems associated with hard-on-hard bearing couples, including taper failures with more modular stem designs, local and systemic effects from metal-on-metal bearings, and fractures with ceramic-on-ceramic bearings, it is not known whether in aggregate the survivorship of these implants is better or worse than the metal-on-polyethylene bearings that they sought to replace. QUESTIONS/PURPOSES Have alternative bearings (metal-on-metal and ceramic-on-ceramic) and implant modularity decreased revision rates of primary THAs? METHODS In this systematic review of MEDLINE and EMBASE, we used several Boolean search strings for each topic and surveyed national registry data from English-speaking countries. Clinical research (Level IV or higher) with ≥ 5 years of followup was included; retrieval studies and case reports were excluded. We included registry data at ≥ 7 years followup. A total of 32 studies (and five registry reports) on metal-on-metal, 19 studies (and five registry reports) on ceramic-on-ceramic, and 20 studies (and one registry report) on modular stem designs met inclusion criteria and were evaluated in detail. Insufficient data were available on metal-on-ceramic and ceramic-on-metal implants, and monoblock acetabular designs were evaluated in another recent systematic review so these were not evaluated here. RESULTS There was no evidence in the literature that alternative bearings (either metal-on-metal or ceramic-on-ceramic) in THA have decreased revision rates. Registry data, however, showed that large head metal-on-metal implants have lower 7- to 10-year survivorship than do standard bearings. In THA, modular exchangeable femoral neck implants had a lower 10-year survival rate in both literature reviews and in registry data compared with combined registry primary THA implant survivorship. CONCLUSIONS Despite improvements in implant technology, there is no evidence that alternative bearings or modularity have resulted in decreased THA revision rates after 5 years. In fact, both large head metal-on-metal THA and added modularity may well lower survivorship and should only be used in select cases in which the mission cannot be achieved without it. Based on this experience, followup and/or postmarket surveillance studies should have a duration of at least 5 years before introducing new alternative bearings or modularity on a widespread scale.
Collapse
Affiliation(s)
- William M Mihalko
- Campbell Clinic Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee, 956 Court Avenue, Suite E226, Memphis, TN, 38163, USA,
| | | | | | | | | | | |
Collapse
|