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Tian Y, Yang Y, Tang H, Wang J, Li N, Cheng Y, Kang T, Tang J, Zhou M, Chen W, Yu Y, Liu X, Liu X, Xu L, Yin Z, Zang J. An implantable hydrogel-based phononic crystal for continuous and wireless monitoring of internal tissue strains. Nat Biomed Eng 2025:10.1038/s41551-025-01374-z. [PMID: 40229414 DOI: 10.1038/s41551-025-01374-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 03/07/2025] [Indexed: 04/16/2025]
Abstract
Conventional implantable electronic sensors for continuous monitoring of internal tissue strains are yet to match the biomechanics of tissues while maintaining biodegradability, biocompatibility and wireless monitoring capability. Here we present a two-dimensional phononic crystal composed of periodic air columns in soft hydrogel, which was named ultrasonic metagel, and we demonstrate its use as implantable sensor for continuous and wireless monitoring of internal tissue strains. The metagel's deformation shifts its ultrasonic bandgap, which can be wirelessly detected by an external ultrasonic probe. We demonstrate ex vivo the ability of the metagel sensor for monitoring tissue strains on porcine tendon, wounded tissue and heart. In live pigs, we further demonstrate the ability of the metagel to monitor tendon stretching, respiration and heartbeat, working stably during 30 days of implantation, and we loaded the metagel with growth factors to achieve different healing rates in subcutaneous wounds. The metagel results almost completely degraded 12 weeks after implantation. Our finding highlights the clinical potential of the ultrasonic sensor for tendon rehabilitation monitoring and drug delivery efficacy evaluation.
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Affiliation(s)
- Ye Tian
- School of Integrated Circuits and Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, China
| | - Yueying Yang
- School of Integrated Circuits and Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, China
| | - Hanchuan Tang
- School of Integrated Circuits and Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, China.
| | - Jiaxin Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Na Li
- School of Integrated Circuits and Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, China
| | - Yifan Cheng
- School of Integrated Circuits and Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, China
| | - Tianyu Kang
- School of Integrated Circuits and Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, China
| | - Jiarui Tang
- School of Integrated Circuits and Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, China
| | - Mengyuan Zhou
- School of Integrated Circuits and Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Chen
- College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, China
| | - Yan Yu
- School of Integrated Circuits and Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, China
| | - Xinqi Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xurui Liu
- School of Integrated Circuits and Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, China
| | - Liqun Xu
- Chongqing Key Laboratory for Advanced Materials and Technologies of Clean Energies, School of Materials and Energy, Southwest University, Chongqing, China.
| | - Zhouping Yin
- Flexible Electronics Research Center, The State Key Laboratory of Intelligent Manufacturing Equipment and Technology, School of Mechanical Science and Engineering, Huazhong University of Science and Technology, Wuhan, China.
| | - Jianfeng Zang
- School of Integrated Circuits and Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, China.
- The State Intelligent Laboratory of Digital Manufacturing Equipment and Technology, Huazhong University of Science and Technology, Wuhan, China.
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Ugland SH, Ugland TO, Haugeberg G, Pripp AH, Nordsletten L. Periprosthetic bone mineral density, assessed using dual energy x-ray absorptiometry, following arthroplasty in patients with femoral neck fracture: 5-year outcomes of a randomized controlled trial. J Int Med Res 2024; 52:3000605241276491. [PMID: 39268760 PMCID: PMC11403699 DOI: 10.1177/03000605241276491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 07/06/2024] [Indexed: 09/15/2024] Open
Abstract
OBJECTIVE The relationship between the surgical approach used for hemiarthroplasty and periprosthetic bone mineral density (BMD) is not well understood. We have previously described a decrease in BMD 1 year postoperatively. Here, we assessed the medium-term changes in periprosthetic BMD. METHODS We performed a follow-up study of patients with femoral neck fracture (FNF) who underwent uncemented hemiarthoplasty using a direct lateral or anterolateral approach. Dual-energy X-ray absorptiometry (DXA) was used to evaluate the changes in BMD in 23 patients over 5 years. RESULTS A mean 6% loss of total BMD occurred over 1 year, but between 1 and 5 years, BMD was restored to the baseline value. The mean total BMD in the anterolateral group had decreased by 2% after 3 months and 3% after 12 months, and increased by 2% after 5 years, vs. decreases of 7%, 8%, and 3% for the direct lateral group. Between 1 and 5 years, BMD increased in Gruen zones 2, 3, 4, 5, and 6 in both groups. There was a significantly larger increase in zone 4 in the lateral group (4%) than the anterolateral group. CONCLUSION The surgical approach affects periprosthetic BMD in patients with FNF. Furthermore, BMD is restored to the baseline value 5 years postoperatively.ClinicalTrials.gov registration number: NCT03753100.
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Affiliation(s)
- Stein H. Ugland
- Department of Orthopedics, Sorlandet Hospital Kristiansand, Norway
- University of Oslo, Olso, Norway
| | - Terje O. Ugland
- Department of Orthopedics, Sorlandet Hospital Kristiansand, Norway
| | - Glenn Haugeberg
- Department of Rheumatology, Sorlandet Hospital Kristiansand, Norway
- Department of Neurosciences, Rheumatology Division, Norwegian University of Science and Technology, Trondheim, Norway
| | - Are H. Pripp
- Oslo Centre of Biostatistics and Epidemiology, Oslo, Norway
| | - Lars Nordsletten
- Department of Orthopedics, Oslo University Hospital, Ullevål, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Abdelghafour KM, Khaled SA, Abdel-Kader KFM, Azeem HA, Shah NN. Outcomes of a hydroxyapatite ceramic-coated femoral stem in primary total hip arthroplasty: a report of excellent survivorship from a single United Kingdom centre. SICOT J 2024; 10:28. [PMID: 39145666 PMCID: PMC11325862 DOI: 10.1051/sicotj/2024026] [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: 03/27/2024] [Accepted: 07/02/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND Hydroxyapatite (HA) coated femoral stems were introduced to enhance the biological fixation at the implant-bone interface, aiming to increase the longevity and survival of the prostheses. We aimed to assess the long-term outcomes of an HA ceramic (HAC) coated stem in primary total hip arthroplasty (THA), assess the stem survival, and clinically evaluate the patients using patient-reported outcome measures (PROMs) and radiological evaluation of stem osseointegration. PATIENTS AND METHODS This was a prospective evaluation of a retrospective cohort of 385 patients (442 hips) who underwent primary THA between June 2008 and December 2018. The mean age was 63.83 years (range, 30-82 years). During the follow-up duration, 23 patients died, and 36 patients (38 hips) were lost to follow-up. Prospective data collected for 326 patients (381 hips) was used to evaluate stem survival with the Kaplan-Meier method using aseptic loosening or any revision as the endpoint. Clinical evaluation was done using the EuroQol five-dimension (EQ-5D) scoring system and PROMs using the Oxford Hip Score (OHS) and Merle D'Aubigne Postel (MDP) score. Radiological assessments were performed using the Engh radiological criteria for stem osteointegration. RESULTS The mean follow-up duration was 9.39 years (range, 4-14.5 years). The survival of the HAC-coated femoral stem was 100% (95% confidence interval [CI], 96.7-100%) at 14 years with aseptic loosening as the endpoint, and 98.9% (CI, 96.7-100%) at 14 years with stem revision for any reason as the endpoint. The mean OHS was 44.5 (range, 30-48), and the mean MDP score was 15.87 (range, 10-18). Radiological evaluations showed full osseointegration of all stems. CONCLUSION This HAC-coated femoral stem has shown excellent survivorship, functional outcomes, and full osseointegration at the final follow-up.
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Affiliation(s)
- Karim M Abdelghafour
- Worthing Hospital, University Hospitals of Sussex, Lyndhurst Road, Worthing BN112DH, UK - Kasr Alainy School of Medicine Cairo University, Al-Saray Street, El Manial Cairo 11956, Egypt
| | - Sherif A Khaled
- Kasr Alainy School of Medicine Cairo University, Al-Saray Street, El Manial Cairo 11956, Egypt
| | - Khaled F M Abdel-Kader
- Kasr Alainy School of Medicine Cairo University, Al-Saray Street, El Manial Cairo 11956, Egypt
| | - Hazem A Azeem
- Kasr Alainy School of Medicine Cairo University, Al-Saray Street, El Manial Cairo 11956, Egypt
| | - Nirav N Shah
- Worthing Hospital, University Hospitals of Sussex, Lyndhurst Road, Worthing BN112DH, UK
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Ohashi Y, Fukushima K, Tsuchiya M, Saito H, Uchida K, Uchiyama K, Takahira N, Takaso M. Influence of broach surface design of a fully hydroxyapatite coated, double tapered stem on periprosthetic bone mineral density after total hip arthroplasty: a study based on the morphology of the proximal femur. Arch Orthop Trauma Surg 2024; 144:3739-3748. [PMID: 38987502 DOI: 10.1007/s00402-024-05430-2] [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: 09/26/2023] [Accepted: 06/27/2024] [Indexed: 07/12/2024]
Abstract
INTRODUCTION This study aimed to compare the impact of different broach surface designs on post-operative clinical outcomes, bone reactions and changes in bone mineral density (BMD) in patients who underwent total hip arthroplasty (THA) using a fully hydroxyapatite coated and double tapered stem with either compaction shape (COM) or hybrid shape (HYB) broaches. MATERIALS AND METHODS A retrospective analysis was conducted on 76 patients (100 hips) who underwent primary THA using the Avenir complete stem®. Patients were divided into two groups: the COM broach group (50 hips) and HYB broach group (50 hips). We evaluated clinical outcomes using the Japanese Orthopaedic Association hip scores one month before the surgery, and 12 and 24 months after the surgery. Radiographic findings, including stem alignment angles, radiolucent lines, spot welds, and cortical hypertrophy, were assessed. BMD around the stem in Gruen zones 1-7 was evaluated using dual-energy X-ray absorptiometry (DEXA) at 7 days, 12, and 24 months post-operatively. The Dorr classification was used to assess femoral morphology. RESULTS There were no significant differences in clinical outcomes, radiographic findings, or BMD changes between the COM and HYB broach groups in the overall patient cohort. However, in Dorr type A femurs, the COM broach group demonstrated superior BMD superior preservation in zones 1 and 7 after 12 months and in zones 1, 6 and 7 after 24 months. Additionally, in Dorr type B femurs, significant BMD preservation was observed in zone 3 at 24 months in the COM broach group. CONCLUSIONS This study suggests that the broach surface design of fully hydroxyapatite coated stems may influence periprosthetic BMD changes, especially in Dorr type A and B femurs. Surgeons should consider broach selection based on patient-specific femoral morphology to optimize BMD preservation in THA procedures using fully hydroxyapatite coated stems.
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Affiliation(s)
- Yoshihisa Ohashi
- Department of Orthopedic Surgery, Kitasato University School of Medicine, 1-15-1 Minami-Ku, Kitasato, Sagamihara City, Kanagawa, 252-0374, Japan
| | - Kensuke Fukushima
- Department of Orthopedic Surgery, Kitasato University School of Medicine, 1-15-1 Minami-Ku, Kitasato, Sagamihara City, Kanagawa, 252-0374, Japan.
| | - Maho Tsuchiya
- Department of Orthopedic Surgery, Kitasato University School of Medicine, 1-15-1 Minami-Ku, Kitasato, Sagamihara City, Kanagawa, 252-0374, Japan
| | - Hiroki Saito
- Department of Orthopedic Surgery, Kitasato University School of Medicine, 1-15-1 Minami-Ku, Kitasato, Sagamihara City, Kanagawa, 252-0374, Japan
| | - Kentaro Uchida
- Department of Orthopedic Surgery, Kitasato University School of Medicine, 1-15-1 Minami-Ku, Kitasato, Sagamihara City, Kanagawa, 252-0374, Japan
| | - Katsufumi Uchiyama
- Department of Patient Safety and Healthcare Administration, Kitasato University School of Medicine, 1-15-1 Minami-Ku, Kitasato, Sagamihara City, Kanagawa, 252-0374, Japan
| | - Naonobu Takahira
- Department of Rehabilitation, Kitasato University School of Allied Health Sciences, 1-15-1 Minami-Ku, Kitasato, Sagamihara City, Kanagawa, 252-0374, Japan
| | - Masashi Takaso
- Department of Orthopedic Surgery, Kitasato University School of Medicine, 1-15-1 Minami-Ku, Kitasato, Sagamihara City, Kanagawa, 252-0374, Japan
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Yang X, Sun Z, Hu Y, Mi C. Multi-parameter design of triply periodic minimal surface scaffolds: from geometry optimization to biomechanical simulation. Biomed Mater 2024; 19:055005. [PMID: 38917813 DOI: 10.1088/1748-605x/ad5ba8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 06/25/2024] [Indexed: 06/27/2024]
Abstract
This study introduces a multi-parameter design methodology to create triply periodic minimal surface (TPMS) scaffolds with predefined geometric characteristics. The level-set constant and unit cell lengths are systematically correlated with targeted porosity and minimum pore sizes. Network and sheet scaffolds featuring diamond, gyroid, and primitive level-set structures are generated. Three radially graded schemes are applied to each of the six scaffold type, accommodating radial variations in porosity and pore sizes. Computer simulations are conducted to assess the biomechanical performance of 18 scaffold models. Results disclose that diamond and gyroid scaffolds exhibit more expansive design ranges than primitive counterparts. While primitive scaffolds display the highest Young's modulus and permeability, their lower yield strength and mesenchymal stem cell (MSC) adhesion render them unsuitable for bone scaffolds. Gyroid scaffolds demonstrate superior mechanical and permeability performances, albeit with slightly lower MSC adhesion than diamond scaffolds. Sheet scaffolds, characterized by more uniform material distribution, exhibit superior mechanical performance in various directions, despite slightly lower permeability. The higher specific surface area of sheet scaffolds contributes to elevated MSC adhesion. The stimulus factor analysis also revealed the superior differentiation potential of sheet scaffolds over network ones. The diamond sheet type demonstrated the optimal differentiation. Introducing radial gradations enhances axial mechanical performance at the expense of radial mechanical performance. Radially decreasing porosity displays the highest permeability, MSC adhesion, and differentiation capability, aligning with the structural characteristics of human bones. This study underscores the crucial need to balance diverse biomechanical properties of TPMS scaffolds for bone tissue engineering.
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Affiliation(s)
- Xiaoshuai Yang
- Jiangsu Key Laboratory of Mechanical Analysis for Infrastructure and Advanced Equipment, School of Civil Engineering, Southeast University, Nanjing, Jiangsu 210096, People's Republic of China
| | - Zhongwei Sun
- Jiangsu Key Laboratory of Mechanical Analysis for Infrastructure and Advanced Equipment, School of Civil Engineering, Southeast University, Nanjing, Jiangsu 210096, People's Republic of China
| | - Yuanbin Hu
- Department of Orthopaedics, Yangzhou Hospital of TCM, Yangzhou, Jiangsu 225127, People's Republic of China
| | - Changwen Mi
- Jiangsu Key Laboratory of Mechanical Analysis for Infrastructure and Advanced Equipment, School of Civil Engineering, Southeast University, Nanjing, Jiangsu 210096, People's Republic of China
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Mao M, Chen J, Liu F, Kong L, Han Y, Zhang L. Reduced corrosion of Zn alloy by HA nanorods for enhancing early bone regeneration. Biomater Sci 2024; 12:1055-1068. [PMID: 38226492 DOI: 10.1039/d3bm01690k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
Zinc alloys have emerged as promising materials for bone regeneration due to their moderate biodegradation rates. However, the blast release of Zn2+ from Zn alloy substrates affects cell behaviors and the subsequent osseointegration quality, retarding their early service performance. To address this issue, extracellular matrix-like hydroxyapatite (HA) nanorods were prepared on Zn-1Ca (ZN) by a combined hydrothermal treatment (HT). HA nanoclusters nucleate on the presetting ZnO layer and grow into nanorods with prolonged HT. HA nanorods protect the ZN substrate from serious corrosion and the corrosion rate is reduced by dozens of times compared with the bare ZN, resulting in a significantly decreased release of Zn2+ ions. The synergistic effect of HA nanorods and appropriate Zn2+ endow ZN implants with obviously improved behaviors of osteoblasts and endothelial cells (e.g. adhesion, proliferation and differentiation) in vitro and new bone formation in vivo. Our work opens up a promising avenue for Zn-based alloys to improve bone regeneration in clinics.
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Affiliation(s)
- Mengting Mao
- State-Key Laboratory for Mechanical Behavior of Materials, Xi'an Jiaotong University, Xi'an 710049, China.
| | - Jun Chen
- Department of Osteology, Xi'an People's Hospital (Xi'an No. 4 Hospital), Xi'an 710100, China
| | - Fuwei Liu
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Shaanxi Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, School of Stomatology, Fourth Military Medical University, China
| | - Liang Kong
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Shaanxi Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, School of Stomatology, Fourth Military Medical University, China
| | - Yong Han
- State-Key Laboratory for Mechanical Behavior of Materials, Xi'an Jiaotong University, Xi'an 710049, China.
- Bioinspired Engineering and Biomechanics Center, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an 710049, China
| | - Lan Zhang
- State-Key Laboratory for Mechanical Behavior of Materials, Xi'an Jiaotong University, Xi'an 710049, China.
- National Center for Translational Medicine (Shanghai) SHU Branch, Shanghai University, 200444, Shanghai, China
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Vio War AS, Kumar N, Chanda S. Does preclinical analysis based on static loading underestimate post-surgery stem micromotion in THA as opposed to dynamic gait loading? Med Biol Eng Comput 2023; 61:1473-1488. [PMID: 36763232 DOI: 10.1007/s11517-023-02801-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 01/31/2023] [Indexed: 02/11/2023]
Abstract
The success of cementless hip stems depends on the primary stability of the implant quantified by the amount of micromotion at the bone-stem interface. Most finite element (FE)-based preclinical studies on post-surgery stem stability rely on static analysis. Hence, the effect of dynamic gait loading on bone-stem relative micromotion remains virtually unexplored. Furthermore, there is a paucity of research on the primary stability of grooved stems as opposed to plain stem design. The primary aim of this FE study was to understand whether transient dynamic gait had any incremental effect on the net micromotion results and to further draw insights into the effects of grooved texture vis-à-vis a plain model on micromotion and proximal load transfer in host bone. Two musculoskeletal loading regimes corresponding to normal walking (NW) and stair climbing (SC) were considered. Although marginally improved load transfer was predicted proximally for the grooved construct under static loading, the micromotion values (max: NW ~ 7 μm; SC ~ 10 μm) were found to be considerably less in comparison to plain stem (max: NW ~ 50 μm; SC ~ 20 μm). For both physiological load cases, a significant surge in micromotion values was predicted in dynamic analyses as opposed to static analyses for the grooved stem (~ 390% greater). For the plain model, the increase in these values from static to dynamic loading is relatively moderate yet clinically significant (~ 230% greater). This suggests that the qualitative similarities notwithstanding, there were significant dissimilarities in the quantitative trends of micromotion for different cases under both analyses.
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Affiliation(s)
- Adeline S Vio War
- Department of Biosciences and Bioengineering, Indian Institute of Technology Guwahati, Guwahati, 781 039, Assam, India
| | - Neeraj Kumar
- Department of Biosciences and Bioengineering, Indian Institute of Technology Guwahati, Guwahati, 781 039, Assam, India
| | - Souptick Chanda
- Department of Biosciences and Bioengineering, Indian Institute of Technology Guwahati, Guwahati, 781 039, Assam, India.
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Bigach SD, Kolevar MP, Moore RD, Adavi P, Rimnac CM, Kraay MJ. Dual-Energy X-Ray Absorptiometry (DEXA) Evaluation of the Bone Remodeling Effects of a Low-Modulus Composite Hip Stem After 2 Decades of Follow-Up. HSS J 2023; 19:69-76. [PMID: 36776510 PMCID: PMC9837405 DOI: 10.1177/15563316221108182] [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: 03/03/2022] [Accepted: 05/06/2022] [Indexed: 02/14/2023]
Abstract
Background: The Epoch FullCoat Hip Stem (Zimmer) was an isoelastic composite femoral stem developed to address stem stiffness concerns. Purpose: We sought to evaluate the long-term bone mineral density (BMD) of a cohort of patients who underwent total hip arthroplasty (THA) using the Epoch isoelastic stem and having more than 2-decade follow-up. Methods: We conducted a retrospective chart review of all patients who were study subjects at our institution in a multicenter prospective trial for the Food and Drug Administration of the Epoch implant in the mid-1990s. Through this, we identified 16 patients who had dual-energy X-ray absorptiometry (DEXA) scans, with which we could determine BMD preoperatively and at 3 points postoperatively. Of these, 5 agreed to participate in the study (the others were deceased, unable or declined to participate, or were lost to follow-up) with mean follow-up of 22 years. These participants underwent clinical and radiographic evaluation consisting of a Harris hip score, anteroposterior (AP) pelvis and AP and lateral hip X-rays, and DEXA evaluation of both hips. BMD in the 7 Gruen zones at last follow-up was compared with immediate postoperative and 2-year follow-up. Results: At last follow-up, all stems were well-fixed with signs of extensive osteointegration. In proximal Gruen zones 1 and 7, patients underwent a decrease in BMD with more modest losses in Gruen zone 1. All patients demonstrated an increase in BMD in zones 2 through 6 at latest follow-up, except for 1 patient in Gruen zone 6. BMD changes were not limited to the first 2 years of follow-up. Conclusion: This small follow-up cohort study found excellent long-term clinical results, no plain radiographic signs of notable stress shielding, and general maintenance of BMD at a follow-up of over 20 years for this isoelastic stem. Long-term bone remodeling after implantation of the isoelastic stem resulted in increased BMD in Gruen zones 2 through 6, suggesting that composite implant designs may still have a role in THA.
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Affiliation(s)
- Stephen D. Bigach
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Matthew P. Kolevar
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Rebecca D. Moore
- Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, OH, USA
| | - Pranav Adavi
- Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, OH, USA
| | - Clare M. Rimnac
- Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, OH, USA
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Matthew J. Kraay
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, OH, USA
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Kamel Shehata MEM, Mustapha K, Shehata E. Finite Element and Multivariate Random Forests Modelling for Stress Shield Attenuation in Customized Hip Implants. FORCES IN MECHANICS 2022. [DOI: 10.1016/j.finmec.2022.100151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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10
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Takamura KM, McCarty CP, Ho NC, Diehl J, Longjohn DB, Ebramzadeh E, Sangiorgio SN. The insidious risk of periprosthetic fracture in clinically functional total hip arthroplasties: A biomechanical study of willed joints. J Orthop Res 2022; 40:1943-1952. [PMID: 34694639 DOI: 10.1002/jor.25203] [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: 02/27/2021] [Revised: 09/05/2021] [Accepted: 10/19/2021] [Indexed: 02/04/2023]
Abstract
Femoral bone quality is a major risk factor of periprosthetic fracture after total hip arthroplasty (THA), which has mortality similar to native hip fractures but higher short-term morbidity. The goal of this study was to quantify cortical strains at the site of expected Vancouver Type-B periprosthetic fracture as a function of bone mineral density, femoral stem material, and fixation method using a series of 29 autopsy-retrieved, clinically asymptomatic hip joints with THA. Periprosthetic bone mineral content and density was assessed using dual-energy X-ray absorptiometry by Gruen Zone. Specimens then underwent combined cyclic axial and torsional loading, increasing incrementally from 100 N and ±1 Nm to peaks of 700 N and ±5 Nm. All specimens experienced significantly higher strains on the lateral surface than on the anterior surface, indicating that the bending loads in the frontal plane, rather than axial/torsional loads, had the predominant effect. Multiple significant relationships (p = 0.04, p = 0.02) were found between predicted periprosthetic strains calculated from radiographic measurements and observed principal strains. Though THA in the present study were in successful clinical service, the produced results indicated that some femurs with rigid cemented or noncemented implants were potentially at high risk for Vancouver Type-B fractures, which may be predicted radiographically.
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Affiliation(s)
- Karren M Takamura
- Department of Orthopaedic Surgery, David Geffen School of Medicine, Los Angeles Orthopaedic Center, University of California, Los Angeles, California, USA
| | - Colin P McCarty
- The J. Vernon Luck, Sr., M.D. Orthopaedic Research Center, Orthopaedic Institute for Children and the UCLA Department of Orthopaedic Surgery, Los Angeles, California, USA
| | - Nathan C Ho
- The J. Vernon Luck, Sr., M.D. Orthopaedic Research Center, Orthopaedic Institute for Children and the UCLA Department of Orthopaedic Surgery, Los Angeles, California, USA
| | - Jennifer Diehl
- The J. Vernon Luck, Sr., M.D. Orthopaedic Research Center, Orthopaedic Institute for Children and the UCLA Department of Orthopaedic Surgery, Los Angeles, California, USA
| | - Donald B Longjohn
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California Health Sciences Campus, Los Angeles, California, USA
| | - Edward Ebramzadeh
- Department of Orthopaedic Surgery, David Geffen School of Medicine, Los Angeles Orthopaedic Center, University of California, Los Angeles, California, USA.,The J. Vernon Luck, Sr., M.D. Orthopaedic Research Center, Orthopaedic Institute for Children and the UCLA Department of Orthopaedic Surgery, Los Angeles, California, USA
| | - Sophia N Sangiorgio
- Department of Orthopaedic Surgery, David Geffen School of Medicine, Los Angeles Orthopaedic Center, University of California, Los Angeles, California, USA.,The J. Vernon Luck, Sr., M.D. Orthopaedic Research Center, Orthopaedic Institute for Children and the UCLA Department of Orthopaedic Surgery, Los Angeles, California, USA
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Motomura G, Mashima N, Imai H, Sudo A, Hasegawa M, Yamada H, Morita M, Mitsugi N, Nakanishi R, Nakashima Y. Effects of porous tantalum on periprosthetic bone remodeling around metaphyseal filling femoral stem: a multicenter, prospective, randomized controlled study. Sci Rep 2022; 12:914. [PMID: 35042918 PMCID: PMC8766592 DOI: 10.1038/s41598-022-04936-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 11/23/2021] [Indexed: 11/09/2022] Open
Abstract
Periprosthetic bone loss due to adaptive bone remodeling is an important unresolved issue in cementless total hip arthroplasty (THA). The use of porous tantalum on the proximal surface of the femoral stem is expected to decrease postoperative bone loss around the prosthesis through early fixation. We conducted a multicenter randomized controlled study to determine if porous tantalum could reduce periprosthetic bone loss after THA. From October 2012 to September 2014, 118 patients (mean age, 61.5 years; 107 females and 11 males) were prospectively enrolled and were randomly allocated at a ratio of 1:1 to either a metaphyseal filling stem with a proximal porous tantalum coating (Trabecular Metal) or a conventional metaphyseal filling stem with fiber mesh coating (VerSys). Patients underwent dual-energy x-ray absorptiometry scans within 1 week after surgery (baseline) and at 6, 12, and 24 months after surgery to assess periprosthetic bone mineral density (BMD) in the 7 Gruen zones. In addition, the Japanese Orthopaedic Association hip score was assessed before surgery and at 6, 12, and 24 months after surgery. In the proximal periprosthetic region (zones 1 and 7), the Trabecular Metal group had significantly smaller reductions in BMD than the VerSys group throughout the study period. In the VerSys group, significant reductions in BMD compared to baseline were seen at each measurement point in all regions, except in zone 6 at 24 months. In the Trabecular Metal group, no significant reductions in BMD relative to baseline were seen in zones 1, 5, or 6 throughout the study period. Both groups demonstrated similar improvement in Japanese Orthopaedic Association hip scores over the study period. This study demonstrated that a proximally coated stem with porous tantalum has superior results over a conventional stem with titanium fiber mesh in terms of periprosthetic bone remodeling.
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Affiliation(s)
- Goro Motomura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Naohiko Mashima
- Department of Regeneration of Community Medicine, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Hiroshi Imai
- Department of Orthopaedic Surgery, Graduate School of Medicine, Ehime University, Shitsukawa, Toon, 791-0295, Japan
| | - Akihiro Sudo
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
| | - Masahiro Hasegawa
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
| | - Harumoto Yamada
- Department of Orthopaedic Surgery, Fujita Health University, Toyoake, Aichi, 470-1192, Japan
- Department of Orthopedic Surgery, Nisshin Orido Hospital, 110, Nishidamen, Orido-cho, Nisshin, Aichi, 470-0115, Japan
| | - Mitsuhiro Morita
- Department of Orthopaedic Surgery, Fujita Health University, Toyoake, Aichi, 470-1192, Japan
| | - Naoto Mitsugi
- Department of Orthopedic Surgery, Yokohama City University Medical Center, 4-57, Urafune-cho, Minami, Yokohama, Kanagawa, 232-0024, Japan
- Department of Orthopedic Surgery, Osada Hospital, 2-10, Maruyamadai, Minatominami-ku, Yokohama, Kanagawa, 233-0013, Japan
| | - Ryosuke Nakanishi
- Department of Orthopaedic Surgery, Showa University Fujigaoka Hospital, Showa University School of Medicine, 1-30 Fujigaoka Aobaku, Yokohama, 227-8501, Japan
- Department of Orthopedic Surgery, Shizuoka Medical Center, 762-1, Nagasawa, Shimizu-cho, Sunto District, Shizuoka, 411-8611, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
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12
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Nyström A, Kiritopoulos D, Mallmin H, Lazarinis S. Continuous periprosthetic bone loss but preserved stability for a collum femoris-preserving stem: follow-up of a prospective cohort study of 21 patients with dualenergy X-ray absorptiometry and radiostereometric analysis with minimum 8 years of follow-up. Acta Orthop 2022; 93:206-211. [PMID: 34984482 PMCID: PMC8815616 DOI: 10.2340/17453674.2021.1080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Indexed: 01/31/2023] Open
Abstract
Background and purpose - We previously described a decrease in bone mineral density (BMD) in the calcar region 2 years after insertion of the collum femoris-preserving (CFP) stem, but the implants were stable. Now we have examined the long-term changes in periprosthetic BMD and stability of the CFP stem. Patients and methods - We conducted a minimum 8-year follow-up of 21 patients from our original investigation. We examined periprosthetic BMD by dual-energy X-ray absorptiometry (DEXA) and implant stability by radiostereometric analysis (RSA). Results - Between 2 and 8 years 1 stem was revised due to aseptic loosening. Between 2 and 8 years we found a 14% (95% confidence interval [CI] 9-19) reduction in BMD in Gruen zone 6 and 17% (CI 6-28) in Gruen zone 7. From baseline the reduction in BMD was 30% (CI 23-36) in Gruen zone 6, 39% (CI 31-47) in Gruen zone 7, and 19% (CI 14-23) in Gruen zone 2. Between 2 and 8 years, RSA (n = 17) showed a mean translation along the stem axis of 0.02mm (CI -0.02 to 0.06) and a mean rotation around the stem axis of 0.08° (CI -0.26 to 0.41). From baseline mean subsidence was 0.07 mm (CI -0.16 to 0.03) and mean rotation around the stem axis was 0.23° (CI -0.23 to 0.68) at 8 years. Interpretation - There was continuous loss of proximomedial BMD at 8 years while the CFP stem remained stable. Proximal periprosthetic bone loss cannot be prevented by this stem.
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Affiliation(s)
- Andreas Nyström
- Department of Surgical Sciences/Section of Orthopaedics, Uppsala University, Uppsala, Sweden.
| | - Demostenis Kiritopoulos
- Department of Surgical Sciences/Section of Orthopaedics, Uppsala University, Uppsala, Sweden.
| | - Hans Mallmin
- Department of Surgical Sciences/Section of Orthopaedics, Uppsala University, Uppsala, Sweden.
| | - Stergios Lazarinis
- Department of Surgical Sciences/Section of Orthopaedics, Uppsala University, Uppsala, Sweden.
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13
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Luo Y, Zhang C, Wang J, Liu F, Chau KW, Qin L, Wang J. Clinical translation and challenges of biodegradable magnesium-based interference screws in ACL reconstruction. Bioact Mater 2021; 6:3231-3243. [PMID: 33778201 PMCID: PMC7966853 DOI: 10.1016/j.bioactmat.2021.02.032] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 02/07/2021] [Accepted: 02/23/2021] [Indexed: 12/27/2022] Open
Abstract
As one of the most promising fixators developed for anterior cruciate ligament (ACL) reconstruction, biodegradable magnesium (Mg)-based interference screws have gained increasing attention attributed to their appropriate modulus and favorable biological properties during degradation after surgical insertion. However, its fast degradation and insufficient mechanical strength have also been recognized as one of the major causes to limit their further application clinically. This review focused on the following four parts. Firstly, the advantages of Mg or its alloys over their counterparts as orthopaedic implants in the fixation of tendon grafts in ACL reconstruction were discussed. Subsequently, the underlying mechanisms behind the contributions of Mg ions to the tendon-bone healing were introduced. Thirdly, the technical challenges of Mg-based interference screws towards clinical trials were discussed, which was followed by the introduction of currently used modification methods for gaining improved corrosion resistance and mechanical properties. Finally, novel strategies including development of Mg/Titanium (Ti) hybrid fixators and Mg-based screws with innovative structure for achieving clinically customized therapies were proposed. Collectively, the advancements in the basic and translational research on the Mg-based interference screws may lay the foundation for exploring a new era in the treatment of the tendon-bone insertion (TBI) and related disorders.
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Affiliation(s)
- Ying Luo
- School of Biomedical Engineering, Sun Yat-sen University, Guangzhou, 510006, China
| | - Chao Zhang
- School of Biomedical Engineering, Sun Yat-sen University, Guangzhou, 510006, China
| | - Jue Wang
- Hanglok-Tech Co., Ltd., Hengqin New Area, China
| | - Fangfei Liu
- State Key Laboratory for Advanced Metals and Materials, University of Science and Technology Beijing, Beijing, 100083, China
| | - Kelvin Wingho Chau
- Musculoskeletal Research Laboratory, Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong, China
| | - Ling Qin
- Musculoskeletal Research Laboratory, Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong, China
| | - Jiali Wang
- School of Biomedical Engineering, Sun Yat-sen University, Guangzhou, 510006, China
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14
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García-Rey E. The fate of sagittal alignment in tapered uncemented femoral components in total hip arthroplasty: 889 hips followed for a minimum of 10 years. Hip Int 2021; 31:472-481. [PMID: 31908180 DOI: 10.1177/1120700019895983] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE Aseptic loosening is rare after primary total hip arthroplasty (THA) with mostly uncemented tapered stems; however, different factors can modify the results. We question whether 3 different current femoral components and/or the surgical technique affect the clinical and radiological outcome after a minimum follow-up of 10 years. METHODS 889 uncemented tapered stems implanted from 1999 to 2007 were evaluated for a minimum follow-up of 10 years. Group 1 (273 hips) shared a conical shape and a porous-coated surface, group 2 (286 hips) a conical splined shape and group 3 (330 hips) a rectangular grit-blasted stem. Groups 1 and 2 were implanted through a posterolateral approach and group 3 using an anterolateral approach. Clinical outcomes and anteroposterior and sagittal radiographic analyses were compared. RESULTS No thigh pain was reported in unrevised patients. Mean Harris Hip score was lower for patients in group 3 for pain and function at all intervals. 14-year implant survival for aseptic loosening was 98.2% (95% confidence interval [CI] 96.2-100) in group 3. No revision for aseptic loosening was found with the other designs. A stem position outside neutral limits in the sagittal alignment (p = 0.001, hazard ratio: 6.17, 95% CI, 2.05-18.61) was associated with aseptic loosening in group 3. CONCLUSIONS Most current uncemented straight tapered femoral components can provide adequate bone fixation in primary THA after 10 years. Conical stems inserted through a posterolateral approach are more reliable than rectangular ones inserted through an anterolateral approach.
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Affiliation(s)
- Eduardo García-Rey
- Orthopaedic Surgery Department, Hospital La Paz-Idi Paz, Madrid, Spain.,Biomedical Research Centre in Bioengineering, Biomaterials and Nanomedicine Network, CIBER-BBN, Spain
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15
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Patients Undergoing Surgery for Hip Fractures Suffer from Severe Oxidative Stress as Compared to Patients with Hip Osteoarthritis Undergoing Total Hip Arthroplasty. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2021; 2021:5542634. [PMID: 34211626 PMCID: PMC8208875 DOI: 10.1155/2021/5542634] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/10/2021] [Accepted: 05/20/2021] [Indexed: 12/26/2022]
Abstract
Hip fractures are associated with the highest degree of morbidity and mortality of all fractures in elderly patients and pose a major risk for subsequent fractures. Patients with hip fractures also present accelerated bone turnover despite early stable fracture fixation and early mobilization. We aimed to evaluate oxidative stress in two groups of patients (25 patients each, matched for age, side, and BMI) who underwent internal fixation of hip fractures and total hip arthroplasty for hip osteoarthritis. Blood samples were taken from all patients during admission, the day of surgery, the 4th postoperative day, and the 15th postoperative day. Reduced (GSH) and oxidized (GSSG) glutathione, GSH/GSSG, catalase (CAT), thiobarbituric acid reactive substances (TBARS), protein carbonyls (PC), and total antioxidant capacity (TAC) as a widely used battery of redox biomarkers were recorded from blood samples. Patients with hip fractures who undergo fixation surgery, compared to those with hip osteoarthritis, suffer significant oxidative stress with an active but insufficient first line of oxidative defense, an intensive first line reaction, a very active second line of oxidative defense, and a low plasma antioxidant capacity. Surgery worsened already present lipid- and protein-related tissue damage. The severe oxidative stress observed may explain high morbidity and mortality rates and high bone turnover status, as well as the high incidence of refractures. Furthermore, the question of whether antioxidant therapy measures should be introduced in the management of hip fracture patients is raised.
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16
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Li Y, Felländer-Tsai L. The bone anchored prostheses for amputees - Historical development, current status, and future aspects. Biomaterials 2021; 273:120836. [PMID: 33894405 DOI: 10.1016/j.biomaterials.2021.120836] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 03/28/2021] [Accepted: 04/14/2021] [Indexed: 12/27/2022]
Abstract
In the past 50 years, bone anchored prostheses have evolved from a concept for experimental treatment to a rapidly developing area in orthopedics and traumatology. Up to date, there are dozens of centers in the world providing osseointegration amputation reconstructions and more than a thousand patients using the bone anchored prostheses. Compared with conventional socket prostheses, the bone anchored prosthesis by osseointegration avoids the debilitating problems related with soft tissues. It also provides physiological weight bearing, improved range of motion, and sensory feedback, all of which contribute to the improvement on quality of life for amputees. The present article briefly reviews the historical development of osseointegration surgery for amputation reconstruction and the current challenges. The implant design characters and surgical techniques of the two types of implants; the screw-type implant (presented by the OPRA system), and the press-fit implants (presented by EEP and OPL systems) are described. The major complications, infections and mechanical failures, are discussed in detail based on the latest evidence. Future aspects and experimental trials aiming to overcome the current challenges are presented.
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Affiliation(s)
- Yan Li
- Division of Orthopaedics and Biotechnology, Department of Clinical Science Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden; Theme Trauma and Reparative Medicine, Department of Orthopedics and Traumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Li Felländer-Tsai
- Division of Orthopaedics and Biotechnology, Department of Clinical Science Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden; Theme Trauma and Reparative Medicine, Department of Orthopedics and Traumatology, Karolinska University Hospital, Stockholm, Sweden.
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17
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Murchio S, Dallago M, Zanini F, Carmignato S, Zappini G, Berto F, Maniglio D, Benedetti M. Additively manufactured Ti-6Al-4V thin struts via laser powder bed fusion: Effect of building orientation on geometrical accuracy and mechanical properties. J Mech Behav Biomed Mater 2021; 119:104495. [PMID: 33831659 DOI: 10.1016/j.jmbbm.2021.104495] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 03/02/2021] [Accepted: 03/22/2021] [Indexed: 01/26/2023]
Abstract
Porous metal lattice structures have a very high potential in biomedical applications, setting as innovative new generation prosthetic devices. Laser powder bed fusion (L-PBF) is one of the most widely used additive manufacturing (AM) techniques involved in the production of Ti6Al4V lattice structures. The mechanical and failure behavior of lattice structures is strongly affected by geometrical imperfections and defects occurring during L-PBF process. Due to the influence of multiple process parameters and to their combined effect, the mechanical properties of these structures are not yet properly understood. Despite the major commitment to characterize and better comprehend lattice structures, little attention has been paid to the impact that single struts have on the overall lattice properties. In this work, the authors have investigated the tensile strength and fatigue behavior of thin L-PBF Ti6Al4V lattice struts at different building orientations (0°, 15°, 45°, and 90°). This investigation has been focused on the effect that microstructural defects (particularly porosity) and actual surface geometry (including surface texture and geometrical errors such as varying cross-section shape and size) have on the mechanical performances of the struts in relation to their building direction. The results have shown that there is a tendency, particularly for low printing angles, of fatigue life to decrease with decreasing of the building angle. This is mainly due to the surge in surface texture and loss in cross-sectional regularity. On the other hand, the monotonic tensile test results have shown a low sensitivity to these factors. The strut failure behavior has been examined employing dynamic digital image correlation (DIC) of tensile tests and scanning electron imaging (SEM) of the fracture surfaces.
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Affiliation(s)
- S Murchio
- Department of Industrial Engineering - DII, University of Trento, Trento, Italy; BIOtech Research Center, University of Trento, Trento, Italy.
| | - M Dallago
- Department of Industrial Engineering - DII, University of Trento, Trento, Italy
| | - F Zanini
- Department of Management and Engineering, University of Padua, Vicenza, Italy
| | - S Carmignato
- Department of Management and Engineering, University of Padua, Vicenza, Italy
| | - G Zappini
- Lincotek Medical Trento, Pergine Valsugana, Italy
| | - F Berto
- Department of Mechanical and Industrial Engineering, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
| | - D Maniglio
- Department of Industrial Engineering - DII, University of Trento, Trento, Italy; BIOtech Research Center, University of Trento, Trento, Italy
| | - M Benedetti
- Department of Industrial Engineering - DII, University of Trento, Trento, Italy
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18
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Bone remodelling, around an anatomical hip stem: A one year prospective study using DEXA. Rev Esp Cir Ortop Traumatol (Engl Ed) 2021. [DOI: 10.1016/j.recote.2020.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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19
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Toniolo I, Fontanella CG, Foletto M, Carniel EL. Biomechanical Investigation of the Stomach Following Different Bariatric Surgery Approaches. Bioengineering (Basel) 2020; 7:bioengineering7040159. [PMID: 33317122 PMCID: PMC7764040 DOI: 10.3390/bioengineering7040159] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 12/02/2020] [Accepted: 12/07/2020] [Indexed: 12/15/2022] Open
Abstract
Background: The stomach is a hollow organ of the gastrointestinal tract, on which bariatric surgery (BS) is performed for the treatment of obesity. Even though BS is the most effective treatment for severe obesity, drawbacks and complications are still present because the intervention design is largely based on the surgeon’s expertise and intraoperative decisions. Bioengineering methods can be exploited to develop computational tools for more rational presurgical design and planning of the intervention. Methods: A computational mechanical model of the stomach was developed, considering the actual complexity of the biological structure, as the nonhomogeneous and multilayered configuration of the gastric wall. Mechanical behavior was characterized by means of an anisotropic visco-hyperelastic constitutive formulation of fiber-reinforced conformation, nonlinear elastic response, and time-dependent behavior, which assume the typical features of gastric wall mechanics. Model applications allowed for an analysis of the influence of BS techniques on stomach mechanical functionality through different computational analyses. Results: Computational results showed that laparoscopic sleeve gastrectomy and endoscopic sleeve gastroplasty drastically alter stomach capacity and stiffness, while laparoscopic adjustable gastric banding modestly affects stomach stiffness and capacity. Moreover, the mean elongation strain values, which are correlated to the mechanical stimulation of gastric receptors, were elevated in laparoscopic adjustable gastric banding compared to other procedures. Conclusions: The investigation of stomach mechanical response through computational models provides information on different topics such as stomach capacity and stiffness and the mechanical stimulation of gastric receptors, which interact with the brain to control satiety. These data can provide reliable support to surgeons in the presurgical decision-making process.
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Affiliation(s)
- Ilaria Toniolo
- Department of Industrial Engineering, University of Padova, Via Venezia 1, 35131 Padova, Italy; (I.T.); (E.L.C.)
| | - Chiara Giulia Fontanella
- Department of Industrial Engineering, University of Padova, Via Venezia 1, 35131 Padova, Italy; (I.T.); (E.L.C.)
- Centre for Mechanics of Biological Materials, University of Padova, Via F. Marzolo 9, 35131 Padova, Italy;
- Correspondence: ; Tel.: +39-049-8276754
| | - Mirto Foletto
- Centre for Mechanics of Biological Materials, University of Padova, Via F. Marzolo 9, 35131 Padova, Italy;
- IFSO Bariatric Center of Excellence, Padova University Hospital, Via Ospedale Civile, 35121 Padova, Italy
| | - Emanuele Luigi Carniel
- Department of Industrial Engineering, University of Padova, Via Venezia 1, 35131 Padova, Italy; (I.T.); (E.L.C.)
- Centre for Mechanics of Biological Materials, University of Padova, Via F. Marzolo 9, 35131 Padova, Italy;
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20
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Bone remodeling, around an anatomical hip stem: a one year prospective study using DEXA. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020; 65:31-40. [PMID: 33177012 DOI: 10.1016/j.recot.2020.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 07/24/2020] [Accepted: 09/28/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The loss of bone mass, as a consequence of bone remodelling, in the proximal third of the femur, is a factor that contributes to the failure of hip prostheses in the medium to long term. This periprosthetic remodelling occurs mainly during the first 12 months after the operation. The aim is to evaluate the behaviour at one year of a new anatomical stem, the ANATO® stem (2015-Stryker®), which is a redesign of its predecessor (ABG-ii®-Stryker stem) by means of bone densitometry. METHOD Prospective, controlled study in which the changes in bone mineral density (BMD) observed around the seven areas of Gruen in a group of 61 patients affected by primary coxarthrosis, in whom an ANATO® stem was implanted, are analysed densitometrically. The healthy hip was taken as the control group. The existence of differences in the remodelling pattern according to sex, age and body mass index (BMI) was compared. The follow-up was during the first year after the intervention. RESULTS After one year of follow-up, decreases of bone mineral density in zone seven of -5.9% were observed, being this decrease statistically significant. No differences were found in the remodelling pattern according to age, sex and body mass index. CONCLUSION The ANATO® stem allows an efficient transmission of loads from the stem to the proximal femur. Only in zone seven significant bone atrophy is observed. Differences in age, BMI and sex do not seem to influence the bone remodelling around this new stem.
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21
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Flatøy B, Dahl J, Röhrl SM, Nordsletten L. Does radiopaque cement conceal periprosthetic bone loss around femoral stems? Hip Int 2020; 30:731-738. [PMID: 31359800 DOI: 10.1177/1120700019863352] [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: 02/04/2023]
Abstract
BACKGROUND Periprosthetic bone remodelling may increase fracture risk and deplete bone stock around hip implants. These changes are in part caused by implant design, advocating an early evaluation of bone remodelling properties of new implants. This can be done by repeated dual-energy x-ray absorptiometry (DXA) measurements. We know that radiopaque cement falsely elevates bone mineral density (BMD) in single measurements, however, its impact on repeated measurements, i.e. BMD changes is unexplored. We have therefore investigated whether the presence of radiopaque cement affect repeated BMD measurements. METHODS 33 patients eligible for total hip replacement were randomly assigned to either radiopaque or radiolucent cement. BMD changes up to 12 months were measured by DXA, in addition to Harris Hip Score, plain radiographs and radiostereometric analysis (RSA). RESULTS Periprosthetic BMD declined during the first 3-6 months in all zones in both groups. The greatest reduction (14%) was seen in the proximal Gruen zones (1 and 7). We found a significant difference in Gruen zones 1 and 2, where the measured bone loss was higher in the radiolucent cement group. CONCLUSIONS The presence of radiopaque agents in bone cement may influence DXA measurements of bone remodelling.ClinicalTrials.gov identifier NCT00473421.
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Affiliation(s)
- Bernhard Flatøy
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,University of Oslo, Oslo, Norway
| | - Jon Dahl
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | | | - Lars Nordsletten
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,University of Oslo, Oslo, Norway
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22
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Kheir MM, Drayer NJ, Chen AF. An Update on Cementless Femoral Fixation in Total Hip Arthroplasty. J Bone Joint Surg Am 2020; 102:1646-1661. [PMID: 32740265 DOI: 10.2106/jbjs.19.01397] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Michael M Kheir
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Nicholas J Drayer
- Department of Orthopaedic Surgery, Madigan Army Medical Center, Tacoma, Washington
| | - Antonia F Chen
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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23
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Kayaalp ME, Can A, Erdogan F, Ozsahin MK, Aydingoz O, Kaynak G. Clinical and Radiological Results of Crowe Type 3 or 4 Dysplasia Patients Operated on With Total Hip Arthroplasty Using a Cementless Rectangular Femoral Component Without Fixating or Grafting the Transverse Osteotomy Site. J Arthroplasty 2020; 35:2537-2542. [PMID: 32418747 DOI: 10.1016/j.arth.2020.04.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 04/06/2020] [Accepted: 04/16/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Total hip arthroplasty (THA) involving shortening osteotomy for patients with Crowe type 3 or 4 dysplasia is a challenging surgical procedure. This study aims to demonstrate that rectangular femoral component use in anatomical reconstructions with THA and transverse shortening osteotomy yields successful results without the use of bone graft or any fixation material at the osteotomy site. METHODS Fifty hips from 41 patients were identified retrospectively as per study objectives. All patients were evaluated using the Harris Hip Score and Visual Analog Scale for pain. Complications were reported. Radiological evaluation criteria were then evaluated, including leg length discrepancy, degree of trochanter caudalization and stem subsidence, radiolucent and radiodense lines for both components and bone atrophy or hypertrophy around the stem according to Gruen zones, and the canal fill ratio of the stem. RESULTS Postoperative Harris Hip Score was excellent for 68% of patients. No patient had poor results. Complication rate was 32%. One patient had nonunion (2%). The mean postoperative leg length discrepancy was 0.8(±0.6) cm. No patient had a subsidence of more than 5 mm. Radiolucent and radiodense lines were present in up to 34% of patients, and bone atrophy was present in the proximal femur in up to 96% of patients. No patient had osteolysis or loosening in neither component. CONCLUSION Successful clinical and radiological results can be obtained from Crowe type 3 and 4 dysplastic hips operated on with THA using a rectangular femoral component and transverse shortening osteotomy technique. The use of graft or any fixation material at the osteotomy site is not mandatory.
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Affiliation(s)
- Mahmut Enes Kayaalp
- Department of Orthopedics and Traumatology, Istanbul Taksim Training and Research Hospital, Istanbul, Turkey
| | - Ata Can
- Nisantasi Orthopaedics Center, Istanbul, Turkey
| | | | - Mahmut Kursat Ozsahin
- Department of Orthopaedics and Traumatology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Onder Aydingoz
- Department of Orthopaedics and Traumatology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Gokhan Kaynak
- Department of Orthopaedics and Traumatology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Tatani I, Megas P, Panagopoulos A, Diamantakos I, Nanopoulos P, Pantelakis S. Comparative analysis of the biomechanical behavior of two different design metaphyseal-fitting short stems using digital image correlation. Biomed Eng Online 2020; 19:65. [PMID: 32814586 PMCID: PMC7437017 DOI: 10.1186/s12938-020-00806-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 08/04/2020] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The progressive evolution in hip replacement research is directed to follow the principles of bone and soft tissue sparing surgery. Regarding hip implants, a renewed interest has been raised towards short uncemented femoral implants. A heterogeneous group of short stems have been designed with the aim to approximate initial, post-implantation bone strain to the preoperative levels in order to minimize the effects of stress shielding. This study aims to investigate the biomechanical properties of two distinctly designed femoral implants, the TRI-LOCK Bone Preservation Stem, a shortened conventional stem and the Minima S Femoral Stem, an even shorter and anatomically shaped stem, based on experiments and numerical simulations. Furthermore, finite element models of implant-bone constructs should be evaluated for their validity against mechanical tests wherever it is possible. In this work, the validation was performed via a direct comparison of the FE calculated strain fields with their experimental equivalents obtained using the digital image correlation technique. RESULTS Design differences between Trilock BPS and Minima S femoral stems conditioned different strain pattern distributions. A distally shifting load distribution pattern as a result of implant insertion and also an obvious decrease of strain in the medial proximal aspect of the femur was noted for both stems. Strain changes induced after the implantation of the Trilock BPS stem at the lateral surface were greater compared to the non-implanted femur response, as opposed to those exhibited by the Minima S stem. Linear correlation analyses revealed a reasonable agreement between the numerical and experimental data in the majority of cases. CONCLUSION The study findings support the use of DIC technique as a preclinical evaluation tool of the biomechanical behavior induced by different implants and also identify its potential for experimental FE model validation. Furthermore, a proximal stress-shielding effect was noted after the implantation of both short-stem designs. Design-specific variations in short stems were sufficient to produce dissimilar biomechanical behaviors, although their clinical implication must be investigated through comparative clinical studies.
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Affiliation(s)
- I Tatani
- Orthopaedic Department, University Hospital of Patras, Papanikolaou 1, Rio-Patra, 26504, Patras, Greece.
| | - P Megas
- Orthopaedic Department, University Hospital of Patras, Papanikolaou 1, Rio-Patra, 26504, Patras, Greece
| | - A Panagopoulos
- Orthopaedic Department, University Hospital of Patras, Papanikolaou 1, Rio-Patra, 26504, Patras, Greece
| | - I Diamantakos
- Laboratory of Technology and Strength of Materials, Department of Mechanical Engineering and Aeronautics, University of Patras, Patras, Greece
| | - Ph Nanopoulos
- Department of Computer Engineering & Informatics, University of Patras, Patras, Greece
| | - Sp Pantelakis
- Laboratory of Technology and Strength of Materials, Department of Mechanical Engineering and Aeronautics, University of Patras, Patras, Greece
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Abstract
There is a high prevalence of osteoporosis in patients undergoing total hip arthroplasty. There are several clinically relevant questions related to the management of such cases: the effect of ageing; the initial osseointegration of implants, especially when cementless THA is used; the effect of medical osteoporosis treatment on bone-implant interface; the incidence of intraoperative and late periprosthetic fractures, and the long-term survival of both cemented and cementless total hip arthroplasty performed for proximal femoral fractures and hip osteoarthritis. A critical review of the literature is presented in an attempt to draw practical conclusions.
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Affiliation(s)
- Theofilos S Karachalios
- Orthopaedic Department, University General Hospital of Larissa, Larissa, Hellenic Republic (Greece).,School of Health Sciences, Faculty of Medicine, University of Thessalia, Biopolis Mezourlo Region, Larissa, Hellenic Republic (Greece)
| | - Antonios A Koutalos
- Orthopaedic Department, University General Hospital of Larissa, Larissa, Hellenic Republic (Greece)
| | - George A Komnos
- Orthopaedic Department, University General Hospital of Larissa, Larissa, Hellenic Republic (Greece)
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26
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Willburger RE, Heukamp M, Lindenlaub P, Efe T, Peterlein CD, Schüttler KF. Excellent midterm survival and functional outcomes of a fully hydroxyapatite-coated cementless stem: first results of a prospective multicenter study. Arthroplast Today 2020; 6:201-205. [PMID: 32577462 PMCID: PMC7303481 DOI: 10.1016/j.artd.2020.01.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 01/10/2020] [Accepted: 01/21/2020] [Indexed: 11/21/2022] Open
Abstract
Background The Polarstem (Smith & Nephew, Baar, Switzerland) is a tapered straight stem, an implant with an excellent survival rate. Although the most recent annual report of the National Joint Registry in the United Kingdom also reports excellent survivorship for the cementless Polarstem, no prospective studies have been published focusing on both its efficacy and clinical performance. Therefore, the present study was designed to prospectively evaluate its functional and radiographic outcomes at midterm. Methods This prospective observational study conducted at 3 independent orthopaedic hospitals was designed to collect data in patients undergoing cementless primary total hip arthroplasty (THA). A total of 225 total hip arthroplasties (75 at each site) were performed. The predominant diagnosis was primary osteoarthritis. Anteroposterior and lateral radiographs were obtained at each follow-up (3 months, and 1, 3, and 5 years). Survivorship and the Harris Hip Score (HHS) and Western Ontario and McMaster Universities Index (WOMAC) were calculated. Results Subjects experienced statistically significant improvements from baseline in mean HHS (48.5 to 88.0, P < .01) and WOMAC scores (58.6 to 9.3, P < .01) at all intervals through 5 years. The stem survivorship was 99.6% at 5 years with stem revision due to any reason. There were no observed cases of mechanical failure of the stem or signs of radiographic loosening. Conclusions A revision rate of the femoral stem for any reason of 0.4%, as well as good clinical results based on HHS and WOMAC scores, was noted at 5-year follow-up. Therefore, safety and efficacy of the cementless Polarstem at midterm follow-up is confirmed.
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Affiliation(s)
| | | | | | - Turgay Efe
- Orthopedicum Lich, Lich, Germany.,Center for Orthopedics and Trauma Surgery, Giessen and Marburg University Hospital, Marburg Campus, Marburg, Germany
| | - Christian-D Peterlein
- Center for Orthopedics and Trauma Surgery, Giessen and Marburg University Hospital, Marburg Campus, Marburg, Germany
| | - Karl-F Schüttler
- Center for Orthopedics and Trauma Surgery, Giessen and Marburg University Hospital, Marburg Campus, Marburg, Germany
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Long-term follow-up of bone remodelling after cementless hip arthroplasty using different stems. Sci Rep 2020; 10:10143. [PMID: 32576922 PMCID: PMC7311465 DOI: 10.1038/s41598-020-67189-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 05/13/2020] [Indexed: 11/26/2022] Open
Abstract
The present paper is concerned with the investigation of the phenomenon of long-term bone remodelling on cementless hip replacements. Changes in bone density in the periprosthetic region around the stem, measured by dual X–ray absorptiometry (DXA), were used as a measure of the osseous adaptation reaction. A postoperative follow-up of the use of four different types of prostheses of varying design after on average 13.3 (11.4–14.5) years. Specifically, the prostheses assessed in this study were the CLS/Spotorno stem with the Allofit cup by Zimmer, the Vision 2000 stem with the Duraloc cup by DePuy Synthes, the AlphaFit stem with the AlphaLock cup by Corin and the Mayo stem with the Trilogy cup by Zimmer. For the DXA measurement, the femur was divided into the zones suggested by Gruen et al. On the femur, there was a significant reduction in bone mineral density (BMD) in the proximal Region Of Interest (ROI) 1 (p = 0.003) and 7 (p < 0.001), whilst there was a significant increase in ROI 4 (p = 0.03). A greater degree of bone atrophy was seen in patients aged 60 years and older and in female patients. A remarkable finding when comparing the stems was a significantly greater reduction in BMD in ROI 6 (p = 0.003) in the case of the Vision 2000 stem and a markedly, but not statistically significantly smaller reduction in BMD in ROI 7 (p = 0.18) in the case of the short-stem Mayo-type prosthesis. The best clinical results were found with the use of the latter. The investigations provide a starting point for establishing a differential indication in the choice of prosthesis types, depending on age and sex, the use of short-stem prostheses, as well as the administration of bone-effective drugs for the prevention of stress shielding.
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Thalmann C, Horn Lang T, Bereiter H, Clauss M, Acklin YP, Stoffel K. An excellent 5-year survival rate despite a high incidence of distal femoral cortical hypertrophy in a short hip stem. Hip Int 2020; 30:152-159. [PMID: 31010329 DOI: 10.1177/1120700019834336] [Citation(s) in RCA: 5] [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
BACKGROUND Although reported results on short stems sound very promising, the occurrence of distal femoral cortical hypertrophy is often observed. The aim of the present study was to report 5-year survival data of a commercially available trochanter sparing short stem and investigate the clinical impact of distal femoral cortical hypertrophy on the outcome. METHODS 123 total hip arthroplasties were performed on 120 patients from April 2008 to May 2010 (mean age 62, range 29-89 years; 71 hips from male patients, 58%). Clinical and radiological data were collected preoperative, at 6 weeks, 1, 2, 3, and 5 years postoperative to assess the outcome. Radiographs taken immediately postoperative as well as 1 and 5 years postoperative were used to identify and assess cortical hypertrophy. RESULTS 1 stem had to be revised due to aseptic loosening, resulting in a Kaplan-Meier survival analysis with endpoint for stem revision of 99.2% (95% Confidence Interval 94.1-99.9) at 5 years. 96 radiological and 95 clinical follow-ups were analysed 5 years postoperative. 68 (71%) hips showed distal femoral cortical hypertrophy after 5 years. The average Harris Hip Score and Oxford Hip Score improved 33 (standard deviation (SD) 15.1, range 2-70), 18 (SD 12.1, range -10-43) points, respectively. Overall 16% of the patients reported thigh pain, unrelated to the presence of cortical hypertrophy. DISCUSSION This short stem shows an excellent 5-year survival rate and good clinical outcome despite a high incidence of cortical hypertrophy. However, the question of the mechanism of load transfer arises.
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Affiliation(s)
| | - Tamara Horn Lang
- Clinic for Orthopaedic and Trauma Surgery, Kantonsspital Baselland, Bruderholz, Switzerland
| | - Heinz Bereiter
- Orthopaedic Surgery, Kantonsspital Graubünden, Chur, Switzerland
| | - Martin Clauss
- Clinic for Orthopaedic and Trauma Surgery, Kantonsspital Baselland, Bruderholz, Switzerland
| | - Yves P Acklin
- Clinic for Orthopaedic and Trauma Surgery, Kantonsspital Baselland, Bruderholz, Switzerland
| | - Karl Stoffel
- Clinic for Orthopaedic and Trauma Surgery, Kantonsspital Baselland, Bruderholz, Switzerland
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Influence of Hydroxyapatite Coating for the Prevention of Bone Mineral Density Loss and Bone Metabolism after Total Hip Arthroplasty: Assessment Using 18F-Fluoride Positron Emission Tomography and Dual-Energy X-Ray Absorptiometry by Randomized Controlled Trial. BIOMED RESEARCH INTERNATIONAL 2020; 2020:4154290. [PMID: 32185203 PMCID: PMC7060431 DOI: 10.1155/2020/4154290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 01/22/2020] [Accepted: 01/31/2020] [Indexed: 11/17/2022]
Abstract
Background Hydroxyapatite- (HA-) coated implants tend to achieve good osteoinductivity and stable clinical results; however, the influence of the coating on the prevention of bone mineral density (BMD) loss around the implant is unclear. The purpose of this randomized controlled trial was to evaluate the effectiveness of HA-coated implants for preventing BMD loss and to determine the status of bone remodeling after total hip arthroplasty (THA), making comparisons with non-HA-coated implants. Methods A total of 52 patients who underwent primary THA were randomly allocated to HA and non-HA groups. BMD was measured by dual-energy X-ray absorptiometry (DEXA) at 1 week postoperation to form a baseline measurement, and then 24 weeks and 48 weeks after surgery. The relative change in BMD was evaluated for regions of interest (ROIs) based on the Gruen zone classifications. 18F-fluoride positron emission tomography (PET) was performed at 24 weeks postsurgery, and the maximum standardized uptake values (SUVmax) were evaluated in the proximal (HA-coated) and distal (non-HA-coated) areas in both groups. Results There were significant differences in BMD loss in ROIs 3 and 6 (p = 0.03), while no significant difference was observed in ROI 7 at either 24 or 48 weeks postsurgery. There was no significant correlation between PET uptake and BMD (24 or 48 weeks) in either group. Conclusion The influence of a HA coating in terms of BMD preservation is limited. No significant correlation was found between BMD and SUVmax measured by PET, either with or without the use of a HA coating.
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Synthetic bone: Design by additive manufacturing. Acta Biomater 2019; 97:637-656. [PMID: 31394295 DOI: 10.1016/j.actbio.2019.07.049] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 07/22/2019] [Accepted: 07/26/2019] [Indexed: 12/11/2022]
Abstract
A broad range of synthetic trabecular-like metallic lattices are 3D printed, to study the extra design freedom conferred by this new manufacturing process. The aim is to propose new conceptual types of implant structures for superior bio-mechanical matching and osseo-integration: synthetic bone. The target designs are 3D printed in Ti-6Al-4V alloy using a laser-bed process. Systematic evaluation is then carried out: (i) their accuracy is characterised at high spatial resolution using computed X-ray tomography, to assess manufacturing robustness with respect to the original geometrical design intent and (ii) the mechanical properties - stiffness and strength - are experimentally measured, evaluated, and compared. Finally, this new knowledge is synthesised in a conceptual framework to allow the construction of so-called implant design maps, to define the processing conditions of bone tailored substitutes, with focus on spine fusion devices. The design criteria emphasise the bone stiffness-matching, preferred range of pore structure for bone in-growth, manufacturability of the device and choice of inherent materials properties which are needed for durable implants. Examples of the use of such maps are given with focus on spine fusion devices, emphasising the stiffness-matching, osseo-integration properties and choice of inherent materials properties which are needed for durable implants. STATEMENT OF SIGNIFICANCE: We present a conceptual bio-engineering design methodology for new biomedical lattices produced by additive manufacturing, which addresses some of the critical points in currently existing porous implant materials. Amongst others: (i) feasibility and accuracy of manufacturing, (ii) design to the elastic properties of bone, and (iii) sensible pores sizes for osseointegration. This has inspired new and novel geometrical latticed designs which aim at improving the properties of intervertebral fusion devices. In their fundamental form, these structures are here fabricated and tested. When integrated into medical devices, these concepts could offer superior medical outcomes.
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Magnesium matrix nanocomposites for orthopedic applications: A review from mechanical, corrosion, and biological perspectives. Acta Biomater 2019; 96:1-19. [PMID: 31181263 DOI: 10.1016/j.actbio.2019.06.007] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 05/28/2019] [Accepted: 06/05/2019] [Indexed: 02/06/2023]
Abstract
Magnesium (Mg) and some of its alloys have attracted extensive interests for biomedical applications as they exhibit biodegradability and low elastic modulus that is closer to natural bones than the currently used metallic implant materials such as titanium (Ti) and its alloys, stainless steels, and cobalt-chromium (Co-Cr) alloys. However, the rapid degradation of Mg alloys and loss of their mechanical integrity before sufficient bone healing impede their clinical application. Our literature review shows that magnesium matrix nanocomposites (MMNCs) reinforced with nanoparticles possess enhanced strength, high corrosion resistance, and good biocompatibility. This article provides a detailed analysis of the effects of nanoparticle reinforcements on the mechanical properties, corrosion behavior, and biocompatibility of MMNCs as promising biodegradable implant materials. The governing equations to quantitatively predict the mechanical properties and underlying synergistic strengthening mechanisms in MMNCs are elucidated. The potential, recent advances, challenges and future research directions in relation to nanoparticles reinforced MMNCs are highlighted. STATEMENT OF SIGNIFICANCE: Critically reviewing magnesium metal matrix nanocomposites (MMNCs) for the biomedical application. Clear definitions of strengthening mechanisms using reinforcement particle in the magnesium matrix, as there were controversial in governing equations of strengthening parameters. Providing better understanding of the effect of particle size, volume fraction, interfacial bonding, and uniform dispersion of reinforcement particles on MMNCs.
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32
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Drosos GI, Touzopoulos P. Short stems in total hip replacement: evidence on primary stability according to the stem type. Hip Int 2019; 29:118-127. [PMID: 30569737 DOI: 10.1177/1120700018811811] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND: As the prevalence of total hip replacement is increasing in younger patients, less invasive implants (short stems) are becoming more favourable. However, despite the advantages of these stems, clinical results with a follow-up of more than 10 years are limited to a very few stem designs. There has been an increase in publications recently - mechanical and clinical studies - concerning the primary stability of short stems. Primary stem stability is an important factor as it reflects final stem stabilisation and is related to the clinical results of the prosthesis. METHOD: We conducted a systematic review of the literature to retrieve evidence concerning primary implant stability in short stems - as expressed by implant micromotion and stem subsidence - according to our previously proposed short-stem classification. RESULTS: Mechanical in vitro studies on stem micromotion are very few and limited to type 2 "partial collum" short stems. The results are comparable to those of stems with a known long-term excellent clinical course. Clinical results concerning stem migration patterns are also limited to some of the commercially available short stems. Although comparative studies are very few, the results for most of the short stems are similar to those of standard stems. CONCLUSION: There are promising results concerning biomechanical studies of the initial micromotion of short stems, as well as clinical results of stem migration patterns. Long-term clinical studies are needed in order to confirm these findings. The existing literature concerns very few of the many commercially available implants.
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Affiliation(s)
- Georgios I Drosos
- 1 Department of Orthopaedic Surgery, University General Hospital of Alexandroupolis, Alexandroupolis, Greece.,2 Democritus University of Thrace, Komotini, Greece
| | - Panagiotis Touzopoulos
- 1 Department of Orthopaedic Surgery, University General Hospital of Alexandroupolis, Alexandroupolis, Greece
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33
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Heyland M, Checa S, Kendoff D, Duda GN. Anatomic grooved stem mitigates strain shielding compared to established total hip arthroplasty stem designs in finite-element models. Sci Rep 2019; 9:482. [PMID: 30679467 PMCID: PMC6345751 DOI: 10.1038/s41598-018-36503-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 11/19/2018] [Indexed: 01/30/2023] Open
Abstract
Aseptic loosening remains a major problem for uncemented femoral components in primary total hip arthroplasty (THA). Ideally, bone adaptation after THA manifests minimally and local bone density reduction is widely avoided. Different design features may help to approximate initial, post-THA bone strain to levels pre-THA. Strain-shielding effects of different SP-CL stem design features are systematically analyzed and compared to CLS Spotorno and CORAIL using finite element models and physiological musculoskeletal loading conditions. All designs show substantial proximal strain-shielding: 50% reduced medial surface strain, 40–50% reduction at lateral surface, >120 µm/m root mean square error (RMSE) compared to intact bone in Gruen zone 1 and >60 µm/m RMSE in Gruen zones 2, 6, and 7. Geometrical changes (ribs, grooves, cross sections, stem length, anatomic curvature) have a considerable effect on strain-shielding; up to 20%. Combinations of reduced stem stiffness with larger proximal contact area (anatomically curved, grooves) lead to less strain-shielding compared to clinically established implant designs. We found that only the combination of a structurally flexible stem with anatomical curvature and grooves improves strain-shielding compared to other designs. The clinical implications in vivo of this initial strain-shielding difference are currently under evaluation in an ongoing clinical analysis.
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Affiliation(s)
- Mark Heyland
- Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt - Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
| | - Sara Checa
- Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt - Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Berlin-Brandenburg School for Regenerative Therapies, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt - Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | | | - Georg N Duda
- Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt - Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Berlin-Brandenburg Center for Regenerative Therapies, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt - Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Berlin-Brandenburg School for Regenerative Therapies, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt - Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Karachalios T, Palaiochorlidis E, Komnos G. Clinical relevance of bone remodelling around conventional and conservative (short-stem) total hip arthroplasty implants. Hip Int 2019; 29:4-6. [PMID: 30421637 DOI: 10.1177/1120700018810846] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Based on data from the existing literature, we can safely suggest that bone mineral changes around cementless and cemented conventional femoral stems, and conservative femoral stems, are not predictive of either satisfactory or unsatisfactory total hip arthroplasty long term clinical outcomes. Additionally, studies with a follow up shorter than 5-10 years are perhaps clinically irrelevant. These observations may be helpful in interpreting the existing literature.
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35
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Peitgen DS, Innmann MM, Merle C, Gotterbarm T, Moradi B, Streit MR. Periprosthetic Bone Mineral Density Around Uncemented Titanium Stems in the Second and Third Decade After Total Hip Arthroplasty: A DXA Study After 12, 17 and 21 Years. Calcif Tissue Int 2018; 103:372-379. [PMID: 29858615 DOI: 10.1007/s00223-018-0438-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 05/28/2018] [Indexed: 10/14/2022]
Abstract
Implant failure and periprosthetic fractures because of periprosthetic bone loss are a major concern in total hip arthroplasty (THA). Hardly any clinical data exist on the long-term evolution of bone mineral density (BMD) around uncemented femoral implants. The question to address is whether relevant bone loss continues into third decade around well-fixed uncemented femoral implants. BMD around stable uncemented straight titanium femoral implants was assessed in a longitudinal cohort study. We included 142 hips of 128 patients and measured the development of the periprosthetic BMD using dual-energy X-ray absorptiometry. The baseline measurement was 12 years (t1) after the implantation of an uncemented femoral stem. Follow-up-measurements were performed at 17 (t2) and at 21 years (t3) after primary THA. The regions of interest (ROI) were selected conforming to Gruen et al. We acquired complete data including three consecutive measurements (t1, t2, t3) for 42 patients (49 hips). Performing radiographic evaluation at t1, t2 and t3, we found a regular bone-implant interface present in all cases. Significant decrease in BMD could be shown in ROI 1 (p = 0.0001; - 7.8%), 4 (p = 0.024; - 2.4%), 6 (p = 0.001; - 5.5%) and 7 (p < 0.0001; - 11.7%) between t1 and t3 and in ROI 1 (p = 0.002; - 3.7%), 2 (p = 0.046; - 3.6%), 4 (p = 0.002; - 2.7%) and 7 (p < 0.0001; - 8.0%) between t2 and t3. There were significant differences in overall bone density (netavg) between t1 and t3 (p = 0.001; - 3.6%) and between t2 and t3 (p = 0.020; - 2.1%). The data indicate clinically relevant changes of BMD especially in the proximal Gruen zones in the long-term after uncemented THA. Loss of periprosthetic BMD might be a risk factor for periprosthetic fractures.
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Affiliation(s)
- David S Peitgen
- Clinic of Orthopaedic and Trauma Surgery, Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Moritz M Innmann
- Clinic of Orthopaedic and Trauma Surgery, Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Christian Merle
- Clinic of Orthopaedic and Trauma Surgery, Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Tobias Gotterbarm
- Clinic of Orthopaedic and Trauma Surgery, Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Babak Moradi
- Clinic of Orthopaedic and Trauma Surgery, Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Marcus R Streit
- Clinic of Orthopaedic and Trauma Surgery, Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
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Rivière C, Grappiolo G, Engh CA, Vidalain JP, Chen AF, Boehler N, Matta J, Vendittoli PA. Long-term bone remodelling around 'legendary' cementless femoral stems. EFORT Open Rev 2018; 3:45-57. [PMID: 29657845 PMCID: PMC5890130 DOI: 10.1302/2058-5241.3.170024] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Bone remodelling around a stem is an unavoidable long-term physiological process highly related to implant design. For some predisposed patients, it can lead to periprosthetic bone loss secondary to severe stress-shielding, which is thought to be detrimental by contributing to late loosening, late periprosthetic fracture, and thus rendering revision surgery more complicated.However, these concerns remain theoretical, since late loosening has yet to be documented among bone ingrowth cementless stems demonstrating periprosthetic bone loss associated with stress-shielding.Because none of the stems replicate the physiological load pattern on the proximal femur, each stem design is associated with a specific load pattern leading to specific adaptive periprosthetic bone remodelling. In their daily practice, orthopaedic surgeons need to differentiate physiological long-term bone remodelling patterns from pathological conditions such as loosening, sepsis or osteolysis.To aid in that process, we decided to clarify the behaviour of the five most used femoral stems. In order to provide translational knowledge, we decided to gather the designers' and experts' knowledge and experience related to the design rationale and the long-term bone remodelling of the following femoral stems we deemed 'legendary' and still commonly used: Corail (Depuy); Taperloc (Biomet); AML (Depuy); Alloclassic (Zimmer); and CLS-Spotorno (Zimmer). Cite this article: EFORT Open Rev 2018;3:45-57. DOI: 10.1302/2058-5241.3.170024.
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Affiliation(s)
- Charles Rivière
- MSK Lab, Imperial College London, UK; South West London Elective Orthopaedic Centre, UK
| | - Guido Grappiolo
- Unit of Hip Diseases and Joint Replacement Surgery, Humanitas Clinical and Research Center, Italy
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Buttaro MA, Oñativia JI, Slullitel PA, Andreoli M, Comba F, Zanotti G, Piccaluga F. Metaphyseal debonding of the Corail collarless cementless stem: report of 18 cases and case-control study. Bone Joint J 2017; 99-B:1435-1441. [PMID: 29092981 DOI: 10.1302/0301-620x.99b11.bjj-2017-0431.r1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 06/22/2017] [Indexed: 11/05/2022]
Abstract
AIMS The Corail stem has good long-term results. After four years of using this stem, we have detected a small group of patients who have presented with symptomatic metaphyseal debonding. The aim of this study was to quantify the incidence of this complication, to delineate the characteristics of patients presenting with this complication and to compare these patients with asymptomatic controls to determine any important predisposing factors. PATIENTS AND METHODS Of 855 Corail collarless cementless stems implanted for osteoarthritis, 18 presented with symptomatic metaphyseal debonding. A control group of 74 randomly selected patients was assembled. Clinical and radiological parameters were measured and a logistic regression model was created to evaluate factors associated with metaphyseal debonding. RESULTS The prevalence of this complication was 2.1% in our series. In the multivariable model, the presence of a Dorr B-type proximal femur was associated with metaphyseal debonding (odds ratio (OR) 10.73, 95% confidence interval (CI) 2.31 to 49.97, p = 0.002), as was a body mass index > 25 kg/m2 (OR 6.85, 95% CI 1.06 to 44.28, p = 0.04). Smaller stems and the use of a polyethylene acetabular liner appeared to be protective when compared with metal and ceramic setting hard-on-hard bearings. CONCLUSION We have described an uncommon but important mode of failure of the Corail stem. Surgeons should be aware of this phenomenon; overweight patients with Dorr B-type femurs and in whom hard bearings are used appear to be particularly at risk. Cite this article: Bone Joint J 2017;99-B:1435-41.
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Affiliation(s)
- M A Buttaro
- Institute of Orthopaedics "Carlos E. Ottolenghi" Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - J I Oñativia
- Institute of Orthopaedics "Carlos E. Ottolenghi" Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - P A Slullitel
- Institute of Orthopaedics "Carlos E. Ottolenghi" Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - M Andreoli
- Institute of Orthopaedics "Carlos E. Ottolenghi" Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - F Comba
- Institute of Orthopaedics "Carlos E. Ottolenghi" Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - G Zanotti
- Institute of Orthopaedics "Carlos E. Ottolenghi" Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - F Piccaluga
- Institute of Orthopaedics "Carlos E. Ottolenghi" Italian Hospital of Buenos Aires, Buenos Aires, Argentina
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Monitoring the osseointegration process in porous Ti6Al4V implants produced by additive manufacturing: an experimental study in sheep. J Appl Biomater Funct Mater 2017; 16:68-75. [PMID: 29147992 DOI: 10.5301/jabfm.5000385] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND This study investigated the design and osseointegration process of transitive porous implants that can be used in humans and all trabecular and compact bone structure animals. The aim was to find a way of forming a strong and durable tissue bond on the bone-implant interface. METHODS Massive and transitive porous implants were produced on a direct metal laser sintering machine, surgically implanted into the skulls of sheep and kept in place for 12 weeks. At the end of the 12-week period, the Massive and porous implants removed from the sheep were investigated by scanning electron microscopy (SEM) to monitor the osseointegration process. RESULTS In the literature, each study has selected standard sizes for pore diameter in the structures they use. However, none of these involved transitional porous structures. In this study, as opposed to standard pores, there were spherical or elliptical pores at the micro level, development channels and an inner region. Bone cells developed in the inner region. Transitive pores grown gradually in accordance with the natural structure of the bone were modeled in the inner region for cells to develop. Due to this structure, a strong and durable tissue bond could be formed at the bone-implant interface. CONCLUSIONS Osseointegration processes of Massive vs. porous implants were compared. It was observed that cells were concentrated on the surface of Massive implants. Therefore, osseointegration between implant and bone was less than that of porous implants. In transitive porous implants, as opposed to Massive implants, an outer region was formed in the bone-implant interface that allowed tissue development.
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Ait Moussa A, Yadav R. Optimization of a Functionally Graded Material Stem in the Femoral Component of a Cemented Hip Arthroplasty: Influence of Dimensionality of FGM. J Med Eng 2017; 2017:3069351. [PMID: 28717644 PMCID: PMC5499240 DOI: 10.1155/2017/3069351] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 01/09/2017] [Accepted: 05/22/2017] [Indexed: 12/14/2022] Open
Abstract
The longevity of hip prostheses is contingent on the stability of the implant within the cavity of the femur bone. The cemented fixation was mostly adopted owing to offering the immediate stability from cement-stem and cement-bone bonding interfaces after implant surgery. Yet cement damage and stress shielding of the bone were proven to adversely affect the lifelong stability of the implant, especially among younger subjects who tend to have an active lifestyle. The geometry and material distribution of the implant can be optimized more efficiently with a three-dimensional realistic design of a functionally graded material (FGM). We report an efficient numerical technique for achieving this objective, for maximum performance stress shielding and the rate of early accumulation of cement damage were concurrently minimized. Results indicated less stress shielding and similar cement damage rates with a 2D-FGM implant compared to 1D-FGM and Titanium alloy implants.
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Affiliation(s)
- Abdellah Ait Moussa
- Department of Engineering and Physics, University of Central Oklahoma, Edmond, OK 73034, USA
| | - Rohan Yadav
- Department of Engineering and Physics, University of Central Oklahoma, Edmond, OK 73034, USA
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Reikerås O. Total Hip Arthroplasty With a Fully Hydroxyapatite-Coated Stem: A Cohort Study During 23-28 Years. J Arthroplasty 2017; 32:1543-1546. [PMID: 28043711 DOI: 10.1016/j.arth.2016.12.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 12/01/2016] [Accepted: 12/08/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Long-term results of a hydroxyapatite (HA)-coated stem are sparse. We have followed a cohort of patients operated with a grit-blasted titanium stem designed for press-fit insertion and entirely plasma-sprayed with HA up to 28 years. METHODS In the years 1988-1993, we performed 323 primary total hip arthroplasties in 276 patients (189 women). Their mean age was 48 (15-79) years. During the following years, 83 patients with 88 hips have died, and 18 patients did not attend the follow-up examination, but had no major symptoms according to telephone interviews and control examination. Thus, 212 patients (255 hips) were followed up for more than 20 years. RESULTS Three patients were revised because of late periprosthetic infection, 1 because of a fall with periprosthetic fracture, and 2 stems were revised due to mechanical failure. Osteolysis was significantly associated with wear, and wear was significantly associated with the size of the femoral head. We found a small amount of proximal bone loss and a low incidence of distal hypertrophy of the bone. The bone changes confirmed a well-fixed femoral component in asymptomatic patients. CONCLUSION Our findings indicate an essentially physiological weight distribution from the stem to the femoral bone with no significant thigh pain. The changes in the bone confirmed that the femoral component was well-fixed, and we conclude that a fully HA-coated titanium stem designed for press-fit insertion lasts for 23-28 years.
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Affiliation(s)
- Olav Reikerås
- Orthopedic Department, Oslo University Hospital, Rikshospitalet, Oslo, Norway
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Ait Moussa A, Fischer J, Yadav R, Khandaker M. Minimizing Stress Shielding and Cement Damage in Cemented Femoral Component of a Hip Prosthesis through Computational Design Optimization. Adv Orthop 2017; 2017:8437956. [PMID: 28348892 PMCID: PMC5350403 DOI: 10.1155/2017/8437956] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 11/10/2016] [Accepted: 01/05/2017] [Indexed: 11/18/2022] Open
Abstract
The average life expectancy of many people undergoing total hip replacement (THR) exceeds twenty-five years and the demand for implants that increase the load-bearing capability of the bone without affecting the short- or long-term stability of the prosthesis is high. Mechanical failure owing to cement damage and stress shielding of the bone are the main factors affecting the long-term survival of cemented hip prostheses and implant design must realistically adjust to balance between these two conflicting effects. In the following analysis we introduce a novel methodology to achieve this objective, the numerical technique combines automatic and realistic modeling of the implant and embedding medium, and finite element analysis to assess the levels of stress shielding and cement damage and, finally, global optimization, using orthogonal arrays and probabilistic restarts, were used. Applications to implants, fabricated using a homogeneous material and a functionally graded material, were presented.
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Affiliation(s)
- Abdellah Ait Moussa
- Department of Engineering and Physics, University of Central Oklahoma, Edmond, OK, USA
| | - Justin Fischer
- Department of Engineering and Physics, University of Central Oklahoma, Edmond, OK, USA
| | - Rohan Yadav
- Department of Engineering and Physics, University of Central Oklahoma, Edmond, OK, USA
| | - Morshed Khandaker
- Department of Engineering and Physics, University of Central Oklahoma, Edmond, OK, USA
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Sun Q, Yang Y, Luo W, Zhao J, Zhou Y. The Influence of Electrolytic Concentration on the Electrochemical Deposition of Calcium Phosphate Coating on a Direct Laser Metal Forming Surface. Int J Anal Chem 2017; 2017:8610858. [PMID: 28250771 PMCID: PMC5303588 DOI: 10.1155/2017/8610858] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 12/31/2016] [Accepted: 01/10/2017] [Indexed: 02/05/2023] Open
Abstract
A calcium phosphate (CaP) coating on titanium surface enhances its biocompatibility, thus facilitating osteoconduction and osteoinduction with the inorganic phase of the human bone. Electrochemical deposition has been suggested as an effective means of fabricating CaP coatings on porous surface. The purpose of this study was to develop CaP coatings on a direct laser metal forming implant using electrochemical deposition and to investigate the effect of electrolytic concentration on the coating's morphology and structure by X-ray diffraction, scanning electron microscopy, water contact angle analysis, and Fourier transform infrared spectroscopy. In group 10-2, coatings were rich in dicalcium phosphate, characterized to be thick, layered, and disordered plates. In contrast, in groups 10-3 and 10-4, the relatively thin and well-ordered coatings predominantly consisted of granular hydroxyapatite. Further, the hydrophilicity and cell affinity were improved as electrolytic concentration increased. In particular, the cells cultured in group 10-3 appeared to have spindle morphology with thick pseudopodia on CaP coatings; these spindles and pseudopodia strongly adhered to the rough and porous surface. By analyzing and evaluating the surface properties, we provided further knowledge on the electrolytic concentration effect, which will be critical for improving CaP coated Ti implants in the future.
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Affiliation(s)
- Qianyue Sun
- Department of Dental Implantology, School and Hospital of Stomatology, Jilin University, Changchun, Jilin Province 130021, China
- Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Stomatology Hospital of Guangzhou Medical University, Guangzhou 510140, China
| | - Yuhui Yang
- Department of Orthopaedics, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province 130033, China
| | - Wenjing Luo
- Department of Dental Implantology, School and Hospital of Stomatology, Jilin University, Changchun, Jilin Province 130021, China
| | - Jinghui Zhao
- Department of Dental Implantology, School and Hospital of Stomatology, Jilin University, Changchun, Jilin Province 130021, China
| | - Yanmin Zhou
- Department of Dental Implantology, School and Hospital of Stomatology, Jilin University, Changchun, Jilin Province 130021, China
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Radiographic alterations in short-stem total hip arthroplasty: a 2-year follow-up study of 216 cases. Hip Int 2016; 26:278-83. [PMID: 27102556 DOI: 10.5301/hipint.5000339] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/30/2015] [Indexed: 02/04/2023]
Abstract
INTRODUCTION In recent years a variety of short-stems have been introduced. Stable osteointegration is a key factor for a satisfactory long-term result. The purpose of this study was to evaluate postoperative radiological alterations and subsidence, as a result of using a newly developed device, over a 2-year follow-up. METHODS 216 short-stems were implanted in combination with a cementless cup. Patients were allowed full weight-bearing on the first day postoperatively. Pre- and postoperative x-rays were done using a standardised technique. Radiological alterations, such as bone resorption, radiolucency, osteolysis and cortical hypertrophy were detected and located using modified Gruen zones, and subsidence was measured via a conventional digital technique over a 2-year follow-up. In addition, Harris Hip Score (HHS), rest pain and load pain on the visual analogue scale (VAS) were assessed respectively. RESULTS At 2-year follow-up 6 stems (2.9%) showed nonprogressive radiolucent lines with a maximum width of 2 mm. Resorption of femoral bone stock was detected in a total of 8 cases (3.9%). Femoral cortical hypertrophy was seen in a total of 9 hips (4.4%). No patient showed osteolysis. A measureable subsidence of at least 2 mm was observed in a total of 15.7% (32 cases) after 6 weeks, corresponding to an initial settlement given full weight-bearing ambulation. Only 1.1% (2 cases) showed further progression at the 6-month follow-up, whereas at the 1- and 2-year follow-ups no further subsidence was observed. After 2 years HHS was 98.1 (65.0-100.0), rest pain on the VAS was 0.2 (0.0-7.0) while load pain was 0.4 (0.0-7.0). CONCLUSIONS The results of this radiographic analysis give support to the principle of using metaphyseal anchoring, calcar guided short-stems. The low incidence of bony alterations after a follow-up of 2 years indicates a physiological load distribution. After mild initial subsidence a stable osteointegration can be achieved over time.
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Craiovan B, Woerner M, Winkler S, Springorum HR, Grifka J, Renkawitz T, Keshmiri A. Decreased femoral periprosthetic bone mineral density: a comparative study using DXA in patients after cementless total hip arthroplasty with osteonecrosis of the femoral head versus primary osteoarthritis. Arch Orthop Trauma Surg 2016; 136:709-13. [PMID: 26891850 DOI: 10.1007/s00402-016-2423-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Trabecular properties in osteonecrosis of the femoral head (ONFH) are altered for bone volume and structure in the femoral head and proximal femoral canal. We analysed the periprosthetic bone mineral density (BMD) as a correlate to bony ingrowth in patients with ONFH who received a cementless THA. MATERIALS AND METHODS We performed a matched-pair analysis of 100 patients with ONFH (n = 50) and primary osteoarthritis (n = 50) who received the same, unilateral cementless THA. We compared the periprosthetic BMD 5 years after surgery by means of dual energy X-ray absorptiometry (DXA) analysing the seven femoral regions of interest (ROIs) according to Gruen. RESULTS Within the ONFH group, significantly lower BMD values were found in the ROI 1 and 7 (p < 0.05). No statistically significant difference was found for ROIs 2-6. CONCLUSIONS An altered periprosthetic bone stock in the proximal femur in patients with prior ONFH might be a possible risk factor for premature loosening of the femoral stem in THA. Surgeons need to consider coating and fixation philosophy of cementless implants when choosing the right stem for patients with ONFH.
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Affiliation(s)
- Benjamin Craiovan
- Department of Orthopedic Surgery, Regensburg University Medical Center, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Germany.
| | - Michael Woerner
- Department of Orthopedic Surgery, Regensburg University Medical Center, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Germany
| | - Sebastian Winkler
- Department of Orthopedic Surgery, Regensburg University Medical Center, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Germany
| | - Hans-Robert Springorum
- Department of Orthopedic Surgery, Regensburg University Medical Center, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Germany
| | - Joachim Grifka
- Department of Orthopedic Surgery, Regensburg University Medical Center, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Germany
| | - Tobias Renkawitz
- Department of Orthopedic Surgery, Regensburg University Medical Center, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Germany
| | - Armin Keshmiri
- Department of Orthopedic Surgery, Regensburg University Medical Center, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Germany
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Mechanical properties of regular porous biomaterials made from truncated cube repeating unit cells: Analytical solutions and computational models. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2016; 60:163-183. [DOI: 10.1016/j.msec.2015.11.001] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 10/16/2015] [Accepted: 11/03/2015] [Indexed: 11/19/2022]
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Goshulak P, Samiezadeh S, Aziz MS, Bougherara H, Zdero R, Schemitsch EH. The biomechanical effect of anteversion and modular neck offset on stress shielding for short-stem versus conventional long-stem hip implants. Med Eng Phys 2016; 38:232-40. [DOI: 10.1016/j.medengphy.2015.12.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Revised: 10/22/2015] [Accepted: 12/06/2015] [Indexed: 12/22/2022]
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Clarke A, Pulikottil-Jacob R, Grove A, Freeman K, Mistry H, Tsertsvadze A, Connock M, Court R, Kandala NB, Costa M, Suri G, Metcalfe D, Crowther M, Morrow S, Johnson S, Sutcliffe P. Total hip replacement and surface replacement for the treatment of pain and disability resulting from end-stage arthritis of the hip (review of technology appraisal guidance 2 and 44): systematic review and economic evaluation. Health Technol Assess 2015; 19:1-668, vii-viii. [PMID: 25634033 DOI: 10.3310/hta19100] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Total hip replacement (THR) involves the replacement of a damaged hip joint with an artificial hip prosthesis. Resurfacing arthroplasty (RS) involves replacement of the joint surface of the femoral head with a metal surface covering. OBJECTIVES To undertake clinical effectiveness and cost-effectiveness analysis of different types of THR and RS for the treatment of pain and disability in people with end-stage arthritis of the hip, in particular to compare the clinical effectiveness and cost-effectiveness of (1) different types of primary THR and RS for people in whom both procedures are suitable and (2) different types of primary THR for people who are not suitable for hip RS. DATA SOURCES Electronic databases including MEDLINE, EMBASE, The Cochrane Library, Current Controlled Trials and UK Clinical Research Network (UKCRN) Portfolio Database were searched in December 2012, with searches limited to publications from 2008 and sample sizes of ≥ 100 participants. Reference lists and websites of manufacturers and professional organisations were also screened. REVIEW METHODS Systematic reviews of the literature were undertaken to appraise the clinical effectiveness and cost-effectiveness of different types of THR and RS for people with end-stage arthritis of the hip. Included randomised controlled trials (RCTs) and systematic reviews were data extracted and risk of bias and methodological quality were independently assessed by two reviewers using the Cochrane Collaboration risk of bias tool and the Assessment of Multiple Systematic Reviews (AMSTAR) tool. A Markov multistate model was developed for the economic evaluation of the technologies. Sensitivity analyses stratified by sex and controlled for age were carried out to assess the robustness of the results. RESULTS A total of 2469 records were screened of which 37 were included, representing 16 RCTs and eight systematic reviews. The mean post-THR Harris Hip Score measured at different follow-up times (from 6 months to 10 years) did not differ between THR groups, including between cross-linked polyethylene and traditional polyethylene cup liners (pooled mean difference 2.29, 95% confidence interval -0.88 to 5.45). Five systematic reviews reported evidence on different types of THR (cemented vs. cementless cup fixation and implant articulation materials) but these reviews were inconclusive. Eleven cost-effectiveness studies were included; four provided relevant cost and utility data for the model. Thirty registry studies were included, with no studies reporting better implant survival for RS than for all types of THR. For all analyses, mean costs for RS were higher than those for THR and mean quality-adjusted life-years (QALYs) were lower. The incremental cost-effectiveness ratio for RS was dominated by THR, that is, THR was cheaper and more effective than RS (for a lifetime horizon in the base-case analysis, the incremental cost of RS was £11,284 and the incremental QALYs were -0.0879). For all age and sex groups RS remained clearly dominated by THR. Cost-effectiveness acceptability curves showed that, for all patients, THR was almost 100% cost-effective at any willingness-to-pay level. There were age and sex differences in the populations with different types of THR and variations in revision rates (from 1.6% to 3.5% at 9 years). For the base-case analysis, for all age and sex groups and a lifetime horizon, mean costs for category E (cemented components with a polyethylene-on-ceramic articulation) were slightly lower and mean QALYs for category E were slightly higher than those for all other THR categories in both deterministic and probabilistic analyses. Hence, category E dominated the other four categories. Sensitivity analysis using an age- and sex-adjusted log-normal model demonstrated that, over a lifetime horizon and at a willingness-to-pay threshold of £20,000 per QALY, categories A and E were equally likely (50%) to be cost-effective. LIMITATIONS A large proportion of the included studies were inconclusive because of poor reporting, missing data, inconsistent results and/or great uncertainty in the treatment effect estimates. This warrants cautious interpretation of the findings. The evidence on complications was scarce, which may be because of the absence or rarity of these events or because of under-reporting. The poor reporting meant that it was not possible to explore contextual factors that might have influenced study results and also reduced the applicability of the findings to routine clinical practice in the UK. The scope of the review was limited to evidence published in English in 2008 or later, which could be interpreted as a weakness; however, systematic reviews would provide summary evidence for studies published before 2008. CONCLUSIONS Compared with THR, revision rates for RS were higher, mean costs for RS were higher and mean QALYs gained were lower; RS was dominated by THR. Similar results were obtained in the deterministic and probabilistic analyses and for all age and sex groups THR was almost 100% cost-effective at any willingness-to-pay level. Revision rates for all types of THR were low. Category A THR (cemented components with a polyethylene-on-metal articulation) was more cost-effective for older age groups. However, across all age-sex groups combined, the mean cost for category E THR (cemented components with a polyethylene-on-ceramic articulation) was slightly lower and the mean QALYs gained were slightly higher. Category E therefore dominated the other four categories. Certain types of THR appeared to confer some benefit, including larger femoral head sizes, use of a cemented cup, use of a cross-linked polyethylene cup liner and a ceramic-on-ceramic as opposed to a metal-on-polyethylene articulation. Further RCTs with long-term follow-up are needed. STUDY REGISTRATION This study is registered as PROSPERO CRD42013003924. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Aileen Clarke
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Amy Grove
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry, UK
| | - Karoline Freeman
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry, UK
| | - Hema Mistry
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Martin Connock
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry, UK
| | - Rachel Court
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Matthew Costa
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry, UK
| | - Gaurav Suri
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry, UK
| | - David Metcalfe
- Warwick Orthopaedics, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Michael Crowther
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Sarah Morrow
- Oxford Medical School, University of Oxford, Oxford, UK
| | - Samantha Johnson
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry, UK
| | - Paul Sutcliffe
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry, UK
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No difference in clinical outcome, bone density and polyethylene wear 5-7 years after standard navigated vs. conventional cementfree total hip arthroplasty. Arch Orthop Trauma Surg 2015; 135:723-30. [PMID: 25801810 DOI: 10.1007/s00402-015-2201-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Indexed: 02/09/2023]
Abstract
INTRODUCTION The purpose of this investigation was to compare clinical outcome, component loosening, polyethylene cup wear and periprosthetic bone mineral density between "cup first" navigated and conventional cementless total hip arthroplasty (THA) 5-7 years after surgery. MATERIALS AND METHODS Fifty patients who received THA with (n = 25) or without (n = 25) the use of an image-free navigation system by a single surgeon were investigated after a mean follow-up of 6.4 (4.8-7.4) years. The Hip Osteoarthritis Outcome Score (HOOS) and the Harris Hip Score (HHS) were obtained; range-of-motion (ROM) was evaluated by a blinded examiner. Radiographic cup inclination, signs of radiographic loosening and polyethylene wear were analysed with the help of digital analysis software on anterio-posterior radiographs by a blinded examiner. Acetabular and femoral periprosthetic bone density was evaluated with the help of dual-energy X-ray absorptiometry. RESULTS We were unable to find any statistical significant or clinically relevant difference for the HOOS, HHS, ROM and polyethylene wear between the navigated and the conventional THA group 5-7 years after surgery. Cup inclination was more precise in the navigated THA group in relation to the target value of 45°. CONCLUSIONS Standard "cup first" THA navigation does not improve mid-term functional outcome, bony ingrowth and/or polyethylene wear. New concepts in computer-assisted THA, considering cup and stem as coupled biomechanical partners are needed to justify the effort of navigation in routine operations.
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Sumner DR. Long-term implant fixation and stress-shielding in total hip replacement. J Biomech 2014; 48:797-800. [PMID: 25579990 DOI: 10.1016/j.jbiomech.2014.12.021] [Citation(s) in RCA: 146] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2014] [Indexed: 11/16/2022]
Abstract
Implant fixation implies a strong and durable mechanical bond between the prosthetic component and host skeleton. Assuming the short-term impediments to implant fixation are successfully addressed and that longer-term issues such as late infection and mechanical failure of the components are avoided, the biological response of the host tissue to the presence of the implant is critical to long-term success. In particular, maintenance of adequate peri-prosthetic bone stock is a key factor. Two major causes of bone loss in the supporting bone are adverse bone remodeling in response to debris shed from the implant and stress-shielding. Here, I review some of the major lessons learned from studying stress-shielding-induced bone loss. It is well known that stress-shielding can be manipulated by altering implant design, but less well appreciated that the development of bone anabolic agents may make it possible to reduce the severity of stress-shielding and the associated bone loss by augmenting the host skeleton through the use of locally or systemically delivered agents. In most cases, mechanical, material and biological factors do not act in isolation, emphasizing that it is often not possible to optimize all boundary conditions.
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Affiliation(s)
- D R Sumner
- Departments of Anatomy and Cell Biology and Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612, United States.
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Fokter SK, Sarler T, Strahovnik A, Repše-Fokter A. Results of total hip arthroplasty using a bionic hip stem. INTERNATIONAL ORTHOPAEDICS 2014; 39:1065-71. [PMID: 25488512 DOI: 10.1007/s00264-014-2623-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 11/26/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE The trabecular-orientated bionic hip stem was designed to mimic the natural force transmission through the femur in total hip arthroplasty, resulting in supposedly longer prosthesis survivability. The aim of this study was to compare the second-generation bionic hip stem to a standard uncemented hip stem. METHODS A group of 18 patients (21 hips) who underwent total hip arthroplasty with a bionic stem (bionic group) was compared with a historic group of 12 patients (12 hips) treated with standard anatomic hip stem (control group). During the first year after the procedure, the densitometric measurements of the bone around the prosthesis were taken. Radiographic and clinical assessments were additionally performed preoperatively and at the three month, six month, one year and three year follow-ups in the bionic group. RESULTS In the bionic group, one patient was revised for aseptic loosening and 16 patients (19 hips) were available to the final follow-up. A significant decrease of bone mineral density was found in Gruen zones 3, 4 and 5 in the bionic group, and in zone 7 in both groups. The bionic group had a significantly higher bone mineral density in Gruen zone 1 at the one year follow-up. At the final follow-up, all prostheses were radiologically stable in both groups. CONCLUSIONS Provided that a good implant position is achieved, comparable short-term results can be obtained using a bionic stem. Still, a decrease of bone mineral density in Gruen zone 7 occurred in both groups. Further studies are required to determine survivability of the bionic stem.
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Affiliation(s)
- Samo K Fokter
- Department of Orthopaedics, University Clinical Centre, Ljubljanska 5, 2000, Maribor, Slovenia,
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