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Chung BC, Heckmann ND, Gallo MC, Steck T, Jimenez C, Oakes DA. Trabecular Metal Augments During Complex Primary Total Hip Arthroplasty. Arthroplast Today 2024; 27:101435. [PMID: 38946923 PMCID: PMC11214375 DOI: 10.1016/j.artd.2024.101435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 03/25/2024] [Accepted: 05/01/2024] [Indexed: 07/02/2024] Open
Abstract
Background Trabecular metal augments (TMAs) have been extensively used in revision total hip arthroplasty (THA) to address acetabular bone defects. However, limited data exists regarding TMA utilization during primary THA. This study aims to assess the clinical and radiographic outcomes of TMAs used during primary THA. Methods A single-institution retrospective case series of primary THA patients treated with TMA between 2010 and 2019 was performed. Patient demographics, complications, and revisions were recorded. Cup position, center of rotation, leg length, and radiolucent lines were assessed radiographically. The Kaplan-Meier method was used to compute implant survivorship. Results Twenty-six patients (30 hips) were included with average age of 52.6 ± 15.3 years (range: 22-78) and mean follow-up of 4.1 ± 2.1 years (range: 2.0-8.9). Most TMAs were indicated for developmental dysplasia of the hip (n = 18; 60.0%). On average, hip center of rotation was lowered 1.5 ± 1.3 cm and lateralized 1.2 ± 1.5 cm, while leg length and global offset were increased by 2.4 ± 1.2 cm and 0.4 ± 1.0 cm, respectively. At final follow-up, 3 hips (10.0%) required revision: one (3.3%) for aseptic loosening and 2 (6.7%) for instability. No patients had progressive radiolucent lines at final follow-up. Five-year survival with aseptic loosening and all-cause revision as endpoints was 100% (95% confidence interval: 90.0%-100.0%) and 92.1% (95% confidence interval: 81.3%-100.0%), respectively. One patient required revision for aseptic loosening after the 5-year mark. Conclusions Trabecular metal augmentation during primary THA demonstrates satisfactory early to mid-term outcomes. TMA is a viable option for complex primary THA when bone loss is encountered or secondary support is required. Level of Evidence Level IV.
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Affiliation(s)
- Brian C. Chung
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Nathanael D. Heckmann
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Matthew C. Gallo
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Thomas Steck
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Christian Jimenez
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Daniel A. Oakes
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
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Argyropoulou E, Sakellariou E, Galanis A, Karampinas P, Rozis M, Koutas K, Tsalimas G, Vasiliadis E, Vlamis J, Pneumaticos S. Porous Tantalum Acetabular Cups in Primary and Revision Total Hip Arthroplasty: What Has Been the Experience So Far?-A Systematic Literature Review. Biomedicines 2024; 12:959. [PMID: 38790921 PMCID: PMC11118083 DOI: 10.3390/biomedicines12050959] [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: 03/07/2024] [Revised: 04/15/2024] [Accepted: 04/24/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND The global population, especially in the Western world, is constantly aging and the need for total hip arthroplasties has rocketed, hence there has been a notable increase in revision total hip arthroplasty cases. As time has passed, a considerable developments in science and medicine have been attained which have also resulted in the evolution of both surgical techniques and implants. Continuous improvements have allowed large bore bearings to be utilized which provide an increased range of motion, with ameliorated stability and a very low rate of wear. The trend for almost the last two decades has been the employment of porous tantalum acetabular cups. Several studies exist comparing them with other conventional methods for total hip arthroplasties, exhibiting promising short and midterm results. METHODS The Preferred Reporting Items for Systematic Reviews and a Meta-Analysis (PRISMA) were used to identify published studies in a comprehensive search up to February 2023, and these studies were reviewed by the authors of the article. Specific rigorous pre-determined inclusion and exclusion criteria were implemented. RESULTS Fifty-one studies met our inclusion criteria and were involved in the systematic review. Sixteen studies examined postoperative clinical and radiological outcomes of using a tantalum cup in primary and revision total hip arthroplasty, whilst four biomechanical studies proved the superiority of tantalum acetabular components. Five articles provided a thorough comparison between tantalum and titanium acetabular cups, while the other studies analyzed long-terms results and complication rates. CONCLUSIONS Porous tantalum acetabular cups appear to be a valuable option in revision total hip arthroplasty, providing clinical improvement, radiological stability, and promising long-term outcomes. However, ongoing research, longer follow-up periods, and careful consideration of patient factors are essential to further validate and refine the use of tantalum in various clinical scenarios.
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Affiliation(s)
- Evangelia Argyropoulou
- Department of Orthopaedics and Traumatology, University General Hospital of Patras, 26504 Patras, Greece;
| | - Evangelos Sakellariou
- Department of Orthopaedic Surgery, KAT General Hospital, National & Kapodistrian University of Athens, 14561 Athens, Greece; (E.S.); (A.G.); (P.K.); (M.R.); (G.T.); (E.V.); (J.V.); (S.P.)
| | - Athanasios Galanis
- Department of Orthopaedic Surgery, KAT General Hospital, National & Kapodistrian University of Athens, 14561 Athens, Greece; (E.S.); (A.G.); (P.K.); (M.R.); (G.T.); (E.V.); (J.V.); (S.P.)
| | - Panagiotis Karampinas
- Department of Orthopaedic Surgery, KAT General Hospital, National & Kapodistrian University of Athens, 14561 Athens, Greece; (E.S.); (A.G.); (P.K.); (M.R.); (G.T.); (E.V.); (J.V.); (S.P.)
| | - Meletis Rozis
- Department of Orthopaedic Surgery, KAT General Hospital, National & Kapodistrian University of Athens, 14561 Athens, Greece; (E.S.); (A.G.); (P.K.); (M.R.); (G.T.); (E.V.); (J.V.); (S.P.)
| | - Konstantinos Koutas
- Department of Orthopaedics and Traumatology, University General Hospital of Patras, 26504 Patras, Greece;
| | - George Tsalimas
- Department of Orthopaedic Surgery, KAT General Hospital, National & Kapodistrian University of Athens, 14561 Athens, Greece; (E.S.); (A.G.); (P.K.); (M.R.); (G.T.); (E.V.); (J.V.); (S.P.)
| | - Elias Vasiliadis
- Department of Orthopaedic Surgery, KAT General Hospital, National & Kapodistrian University of Athens, 14561 Athens, Greece; (E.S.); (A.G.); (P.K.); (M.R.); (G.T.); (E.V.); (J.V.); (S.P.)
| | - John Vlamis
- Department of Orthopaedic Surgery, KAT General Hospital, National & Kapodistrian University of Athens, 14561 Athens, Greece; (E.S.); (A.G.); (P.K.); (M.R.); (G.T.); (E.V.); (J.V.); (S.P.)
| | - Spiros Pneumaticos
- Department of Orthopaedic Surgery, KAT General Hospital, National & Kapodistrian University of Athens, 14561 Athens, Greece; (E.S.); (A.G.); (P.K.); (M.R.); (G.T.); (E.V.); (J.V.); (S.P.)
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Özdemir E, de Lange B, Buckens CFM, Rijnen WHC, Visser J. Bone support of a custom triflange acetabular component over time. Bone Joint J 2024; 106-B:359-364. [PMID: 38555950 DOI: 10.1302/0301-620x.106b4.bjj-2023-0668.r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Aims To investigate the extent of bone development around the scaffold of custom triflange acetabular components (CTACs) over time. Methods We performed a single-centre historical prospective cohort study, including all patients with revision THA using the aMace CTAC between January 2017 and March 2021. A total of 18 patients (18 CTACs) were included. Models of the hemipelvis and the scaffold component of the CTACs were created by segmentation of CT scans. The CT scans were performed immediately postoperatively and at least one year after surgery. The amount of bone in contact with the scaffold was analyzed at both times, and the difference was calculated. Results The mean time between the implantation and the second CT scan was two years (1 to 5). The mean age of the patients during CTAC implantation was 75 years (60 to 92). The mean scaffold-bone contact area increased from 16% (SD 12.6) to 28% (SD 11.9). The mean scaffold-bone distance decreased from a mean of 6.5 mm (SD 2.0) to 5.5 mm (SD 1.6). None of the CTACs were revised or radiologically loose. Conclusion There was a statistically significant increase of scaffold-bone contact area over time, but the total contact area of the scaffold in relation to the acetabular bone remained relatively low. As all implants remained well fixed, the question remains to what extend the scaffold contributes to the observed stability, in relation to the screws. A future design implication might be an elimination of the bulky scaffold component. This design modification would reduce production costs and may optimize the primary fit of the implant.
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Affiliation(s)
- Erim Özdemir
- Department of Orthopedics, Radboud University Medical Center, Nijmegen, Netherlands
| | - Bram de Lange
- Department of Orthopedics, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Wim H C Rijnen
- Department of Orthopedics, Radboud University Medical Center, Nijmegen, Netherlands
| | - Jetze Visser
- Department of Orthopedics, Radboud University Medical Center, Nijmegen, Netherlands
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Erdogan YK, Uslu E, Aydınol MK, Saglam ASY, Odabas S, Ercan B. Morphology of Nanostructured Tantalum Oxide Controls Stem Cell Differentiation and Improves Corrosion Behavior. ACS Biomater Sci Eng 2024; 10:377-390. [PMID: 38078685 DOI: 10.1021/acsbiomaterials.3c01277] [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] [Indexed: 01/09/2024]
Abstract
Tantalum is receiving increasing attention in the biomedical field due to its biocompatible nature and superior mechanical properties. However, the bioinert nature of tantalum still poses a challenge and limits its integration into the bone tissue. To address these issues, we fabricated nanotubular (NT), nanocoral (NC), and nanodimple morphologies on tantalum surfaces via anodization. The size of these nanofeatures was engineered to be approximately 30 nm for all anodized samples. Thus, the influence of the anodized nanostructured morphology on the chemical and biological properties of tantalum was evaluated. The NT and NC samples exhibited higher surface roughness, surface energy, and hydrophilicity compared to the nonanodized samples. In addition, the NT samples exhibited the highest corrosion resistance among all of the investigated samples. Biological experiments indicated that NT and NC samples promoted human adipose tissue-derived mesenchymal stem cell (hADMSC) spreading and proliferation up to 5 days in vitro. ALP, COL1A1, and OSC gene expressions as well as calcium mineral synthesis were upregulated on the NT and NC samples in the second and third weeks in vitro. These findings highlight the significance of nanostructured feature morphology for anodized tantalum, where the NT morphology was shown to be a potential candidate for orthopedic applications.
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Affiliation(s)
- Yasar Kemal Erdogan
- Biomedical Engineering Program, Middle East Technical University, Cankaya, Ankara 06800, Turkey
- Department of Biomedical Engineering, Isparta University of Applied Science, Isparta 32260, Turkey
| | - Ece Uslu
- Institute of Bioengineering, School of Engineering, EPFL, Lausanne 1015, Switzerland
- Department of Metallurgical and Materials Engineering, Middle East Technical University, Cankaya, Ankara 06800, Turkey
| | - Mehmet Kadri Aydınol
- Department of Metallurgical and Materials Engineering, Middle East Technical University, Cankaya, Ankara 06800, Turkey
| | - Atiye Seda Yar Saglam
- Department of Medical Biology and Genetics, Faculty of Medicine, Gazi University, Besevler, Ankara 06500, Turkey
| | - Sedat Odabas
- Department of Chemistry, Faculty of Science, Ankara University, Besevler, Ankara 06560, Turkey
- Faculty of Science, Department of Chemistry, Biomaterials and Tissue Engineering Laboratory (BteLAB), Ankara University, Ankara 06100, Turkey
- Interdisciplinary Research Unit for Advanced Materials (INTRAM), Ankara University, Ankara 06560, Turkey
| | - Batur Ercan
- Biomedical Engineering Program, Middle East Technical University, Cankaya, Ankara 06800, Turkey
- Department of Metallurgical and Materials Engineering, Middle East Technical University, Cankaya, Ankara 06800, Turkey
- BIOMATEN, Center of Excellence in Biomaterials and Tissue Engineering, Middle East Technical University, Cankaya, Ankara 06800, Turkey
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Wang Y, Qin X, Lv N, Gao L, Sun C, Tong Z, Li D. Microstructure Optimization for Design of Porous Tantalum Scaffolds Based on Mechanical Properties and Permeability. MATERIALS (BASEL, SWITZERLAND) 2023; 16:7568. [PMID: 38138710 PMCID: PMC10744872 DOI: 10.3390/ma16247568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/02/2023] [Accepted: 12/04/2023] [Indexed: 12/24/2023]
Abstract
Porous tantalum (Ta) implants have important clinical application prospects due to their appropriate elastic modulus, and their excellent bone growth and bone conduction ability. However, porous Ta microstructure designs generally mimic titanium (Ti) implants commonly used in the clinic, and there is a lack of research on the influence of the microstructure on the mechanical properties and penetration characteristics, which will greatly affect bone integration performance. This study explored the effects of different microstructure parameters, including the fillet radius of the middle plane and top planes, on the mechanics and permeability properties of porous Ta diamond cells through simulation, and put forward an optimization design with a 0.5 mm midplane fillet radius and 0.3 mm top-plane fillet radius in order to significantly decrease the stress concentration effect and improve permeability. On this basis, the porous Ta structures were prepared by Laser Powder Bed Fusion (LPBF) technology and evaluated before and after microstructural optimization. The elastic modulus and the yield strength were increased by 2.31% and 10.39%, respectively. At the same time, the permeability of the optimized structure was also increased by 8.25%. The optimized microstructure design of porous Ta has important medical application value.
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Affiliation(s)
- Yikai Wang
- State Key Laboratory for Manufacturing System Engineering, School of Mechanical Engineering, Xi’an Jiaotong University, Xi’an 710054, China; (Y.W.); (X.Q.); (N.L.); (Z.T.); (D.L.)
- National Medical Products Administration (NMPA), Key Laboratory for Research and Evaluation of Additive Manufacturing Medical Devices, Xi’an Jiaotong University, Xi’an 710054, China
| | - Xiao Qin
- State Key Laboratory for Manufacturing System Engineering, School of Mechanical Engineering, Xi’an Jiaotong University, Xi’an 710054, China; (Y.W.); (X.Q.); (N.L.); (Z.T.); (D.L.)
- National Medical Products Administration (NMPA), Key Laboratory for Research and Evaluation of Additive Manufacturing Medical Devices, Xi’an Jiaotong University, Xi’an 710054, China
| | - Naixin Lv
- State Key Laboratory for Manufacturing System Engineering, School of Mechanical Engineering, Xi’an Jiaotong University, Xi’an 710054, China; (Y.W.); (X.Q.); (N.L.); (Z.T.); (D.L.)
- National Medical Products Administration (NMPA), Key Laboratory for Research and Evaluation of Additive Manufacturing Medical Devices, Xi’an Jiaotong University, Xi’an 710054, China
| | - Lin Gao
- State Key Laboratory for Manufacturing System Engineering, School of Mechanical Engineering, Xi’an Jiaotong University, Xi’an 710054, China; (Y.W.); (X.Q.); (N.L.); (Z.T.); (D.L.)
- National Medical Products Administration (NMPA), Key Laboratory for Research and Evaluation of Additive Manufacturing Medical Devices, Xi’an Jiaotong University, Xi’an 710054, China
| | - Changning Sun
- State Key Laboratory for Manufacturing System Engineering, School of Mechanical Engineering, Xi’an Jiaotong University, Xi’an 710054, China; (Y.W.); (X.Q.); (N.L.); (Z.T.); (D.L.)
- National Medical Products Administration (NMPA), Key Laboratory for Research and Evaluation of Additive Manufacturing Medical Devices, Xi’an Jiaotong University, Xi’an 710054, China
| | - Zhiqiang Tong
- State Key Laboratory for Manufacturing System Engineering, School of Mechanical Engineering, Xi’an Jiaotong University, Xi’an 710054, China; (Y.W.); (X.Q.); (N.L.); (Z.T.); (D.L.)
- National Medical Products Administration (NMPA), Key Laboratory for Research and Evaluation of Additive Manufacturing Medical Devices, Xi’an Jiaotong University, Xi’an 710054, China
| | - Dichen Li
- State Key Laboratory for Manufacturing System Engineering, School of Mechanical Engineering, Xi’an Jiaotong University, Xi’an 710054, China; (Y.W.); (X.Q.); (N.L.); (Z.T.); (D.L.)
- National Medical Products Administration (NMPA), Key Laboratory for Research and Evaluation of Additive Manufacturing Medical Devices, Xi’an Jiaotong University, Xi’an 710054, China
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Coulomb R, Laborde A, Haignère V, Bauzou F, Marchand P, Kouyoumdjian P. Varus stem positioning does not affect long-term functional outcome in cementless anatomical total hip arthroplasty. Arch Orthop Trauma Surg 2023; 143:511-518. [PMID: 34989837 DOI: 10.1007/s00402-021-04320-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 12/14/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Varus positioning is the most common femoral malposition in total hip arthroplasty (THA). We compared the long-term outcomes of an anatomical cementless femoral stem positioned in varus versus neutral alignment. MATERIALS AND METHODS Data were retrospectively reviewed for all patients receiving a cementless anatomical femoral stem in THA for osteoarthritis between 1998 and 2008. Exclusion criteria were complex cases, incomplete data or follow-up < 1 year. Primary outcome was survival rate with complications and secondary outcomes were clinical scores, thigh pain, radiological score, cortical hypertrophy and filling rate. RESULTS Of the 283 included patients, 127 stems were classified as varus and 156 neutral. Mean follow-up was 10 years. Femoral stem size was smaller in the varus group (4.1 vs. 4.4, p = 0.047). A stem-filling rate < 80% was more frequent in the varus group (p < 0.001). The long-term survival rate without any revision procedure was 94.8% ± 2.3% (95%CI 88.4-98.7) in the varus group and 94.1% ± 2.0% (95%CI 91.3-99.1) in the neutral group (p = 0.55). There was no difference in clinical scores, thigh pain or complication occurrence between groups. The Engh-Massin score was lower in the varus group (p < 0.01) and cortical hypertrophy was higher (p < 0.001). CONCLUSIONS A varus alignment of a cementless anatomic femoral stem does not affect survivorship, clinical outcomes or complication rate on an average follow-up of 10 years, despite increasing stress-shielding rates.
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Affiliation(s)
- Remy Coulomb
- Department of Orthopaedic and Traumatology Surgery and Spine Surgery, Hôpital Universitaire Carémeau, Univ Montpellier, Place du Pr. Robert Debré 30029, CHU de Nîmes, Nîmes Cédex 9, France.
| | - Alexandre Laborde
- Department of Orthopaedic and Traumatology Surgery and Spine Surgery, Hôpital Universitaire Carémeau, Univ Montpellier, Place du Pr. Robert Debré 30029, CHU de Nîmes, Nîmes Cédex 9, France
| | - Vincent Haignère
- Department of Orthopaedic and Traumatology Surgery and Spine Surgery, Hôpital Universitaire Carémeau, Univ Montpellier, Place du Pr. Robert Debré 30029, CHU de Nîmes, Nîmes Cédex 9, France
| | - François Bauzou
- Department of Orthopaedic and Traumatology Surgery and Spine Surgery, Hôpital Universitaire Carémeau, Univ Montpellier, Place du Pr. Robert Debré 30029, CHU de Nîmes, Nîmes Cédex 9, France
| | - Philippe Marchand
- Department of Orthopaedic and Traumatology Surgery and Spine Surgery, Hôpital Universitaire Carémeau, Univ Montpellier, Place du Pr. Robert Debré 30029, CHU de Nîmes, Nîmes Cédex 9, France
| | - Pascal Kouyoumdjian
- Department of Orthopaedic and Traumatology Surgery and Spine Surgery, Hôpital Universitaire Carémeau, Univ Montpellier, Place du Pr. Robert Debré 30029, CHU de Nîmes, Nîmes Cédex 9, France
- Université Montpellier 1, 2 Rue de L'École de Médecine, 34090, Montpellier, France
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McPherson EJ, Stavrakis AI, Chowdhry M, Curtin NL, Dipane MV, Crawford BM. Biphasic bone graft substitute in revision total hip arthroplasty with significant acetabular bone defects : a retrospective analysis. Bone Jt Open 2022; 3:991-997. [PMID: 36545948 PMCID: PMC9783269 DOI: 10.1302/2633-1462.312.bjo-2022-0094.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
AIMS Large acetabular bone defects encountered in revision total hip arthroplasty (THA) are challenging to restore. Metal constructs for structural support are combined with bone graft materials for restoration. Autograft is restricted due to limited volume, and allogenic grafts have downsides including cost, availability, and operative processing. Bone graft substitutes (BGS) are an attractive alternative if they can demonstrate positive remodelling. One potential product is a biphasic injectable mixture (Cerament) that combines a fast-resorbing material (calcium sulphate) with the highly osteoconductive material hydroxyapatite. This study reviews the application of this biomaterial in large acetabular defects. METHODS We performed a retrospective review at a single institution of patients undergoing revision THA by a single surgeon. We identified 49 consecutive patients with large acetabular defects where the biphasic BGS was applied, with no other products added to the BGS. After placement of metallic acetabular implants, the BGS was injected into the remaining bone defects surrounding the new implants. Patients were followed and monitored for functional outcome scores, implant fixation, radiological graft site remodelling, and revision failures. RESULTS Mean follow-up was 39.5 months (36 to 71), with a significant improvement in post-revision function compared to preoperative function. Graft site remodelling was rated radiologically as moderate in 31 hips (63%) and strong in 12 hips (24%). There were no cases of complete graft site dissolution. No acetabular loosening was identified. None of the patients developed clinically significant heterotopic ossification. There were twelve reoperations: six patients developed post-revision infections, three experienced dislocations, two sustained periprosthetic femur fractures, and one subject had femoral component aseptic loosening. CONCLUSION Our series reports bone defect restoration with the sole use of a biphasic injectable BGS in the periacetabular region. We did not observe significant graft dissolution. We emphasize that successful graft site remodelling requires meticulous recipient site preparation.Cite this article: Bone Jt Open 2022;3(12):991-997.
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Affiliation(s)
- Edward J. McPherson
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, California, USA
| | - Alexandra I. Stavrakis
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, California, USA
| | - Madhav Chowdhry
- Nuffield Department of Primary Care Health Sciences & Department of Continuing Education, Kellogg College, University of Oxford, Oxford, UK
| | - Nora L. Curtin
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, California, USA
| | - Matthew V. Dipane
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, California, USA,Correspondence should be sent to Matthew V. Dipane. E-mail:
| | - Brooke M. Crawford
- Department of Orthopedic Surgery, The University of Miami Miller School of Medicine, Miami, Florida, USA
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Takahashi T, Thaker S, Lettieri G, Redmond A, Backhouse MR, Stone M, Pandit H, O'Connor P. Reliability of slice-encoding for metal artefact correction (SEMAC) MRI to identify prosthesis loosening in patients with painful total hip arthroplasty - a single centre, prospective, surgical validation study. Br J Radiol 2022; 95:20210940. [PMID: 35148205 PMCID: PMC9153704 DOI: 10.1259/bjr.20210940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES To validate reliability of slice-encoding for metal artefact correction (SEMAC)-MRI findings in prosthesis loosening detection by comparing them to surgical outcomes (gold standard) in symptomatic patients following hip arthroplasties. To evaluate periprosthetic anatomical structures in symptomatic patients to identify an alternative cause of hip symptoms. METHODS We prospectively followed 47 symptomatic patients (55 hips, 39 painful hips - group P and 16 control hips - group C) at our institution from 2011 to 2016. We acquired 1.5 T MRI conventional and SEMAC-MRI images for all patients. Two consultants scored MRI for osteolysis and marrow oedema zone-wise using predefined signal characteristics and settled scoring variations by consensus. We used Spearman Rank-Order Correlation for correlation analysis and used OMERACT (Outcome Measures in Rheumatology) filter pillars to validate SEMAC-MRI findings. RESULTS Eleven patients needed revision surgery, all from group P. None from group C required revision surgery. Remaining 28 hips in the group P were managed conservatively pain completely resolved in 21 hips, eight hips had trochanteric bursitis, eight had extraarticular cause and the remaining five hips had spontaneous pain resolution. We found moderate-to-weak correlation between SEMAC-MRI findings for prosthesis loosening and revision surgery outcomes. Sensitivity, Specificity, PPV and NPV in Group P were (72.7, 64.3, 44.4, 85.7%) in T1W-SEMAC, (90.9, 46.4, 40.0, 92.9%) in STIR-SEMAC and (36.3, 78.5, 40.0, 75.8%) in PDW-SEMAC. CONCLUSION Negative SEMAC-MRI results can effectively exclude prosthesis loosening confirmed on revision surgery and SEMAC-MRI can detect alternative cause of hip pain accurately. ADVANCES IN KNOWLEDGE Negative SEMAC-MRI in painful THA patients can effectively exclude prosthesis loosening as a cause.
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Affiliation(s)
| | - Siddharth Thaker
- Chapel Allerton Hospital, Leeds Teaching Hospital NHS Trust, Leeds, UK
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Wear analysis of the first-generation cross-linked polyethylene at minimum 10 years follow-up after THA: no significant effect of sports participation. J Artif Organs 2021; 25:140-147. [PMID: 34708284 DOI: 10.1007/s10047-021-01297-x] [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: 06/17/2021] [Accepted: 10/04/2021] [Indexed: 10/20/2022]
Abstract
The impact of sports on long-term wear of highly cross-linked polyethylene (XLPE) after total hip arthroplasty (THA) is not fully understood. We investigated (1) the wear performance of the first-generation XLPE, and (2) whether sports participation influences the steady wear rate of XLPE. The femoral head penetration into the cup was measured digitally on radiographs of hips undergoing THA with XLPE. We retrospectively reviewed data that included age, gender, body mass index, follow-up period, preoperative diagnosis, types of XLPE, ball diameter, head material, inclination of the cup, physical function score, and sports participation. Statistical analyses were applied to determine whether sports affect the wear of XLPE and which factors were associated with the steady wear rate. Creep and steady wear rate were found to be 0.18 mm and 0.005 mm/year, respectively. Sports participation, regardless of impact, provided no significant difference in the steady wear rate. Multiple regression analysis demonstrated that sports did not increase the steady wear rate. Our findings showed excellent wear performance of the first-generation XLPE at a minimum of ten years after THA, without significant effect of sports participation on the liner wear.
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Melnikova G, Kuznetsova T, Lapitskaya V, Petrovskaya A, Chizhik S, Zykova A, Safonov V, Aizikovich S, Sadyrin E, Sun W, Yakovin S. Nanomechanical and Nanotribological Properties of Nanostructured Coatings of Tantalum and Its Compounds on Steel Substrates. NANOMATERIALS 2021; 11:nano11092407. [PMID: 34578722 PMCID: PMC8467422 DOI: 10.3390/nano11092407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/07/2021] [Accepted: 09/13/2021] [Indexed: 11/16/2022]
Abstract
The present paper addresses the problem of identification of microstructural, nanomechanical, and tribological properties of thin films of tantalum (Ta) and its compounds deposited on stainless steel substrates by direct current magnetron sputtering. The compositions of the obtained nanostructured films were determined by energy dispersive spectroscopy. Surface morphology was investigated using atomic force microscopy (AFM). The coatings were found to be homogeneous and have low roughness values (<10 nm). The values of microhardness and elastic modulus were obtained by means of nanoindentation. Elastic modulus values for all the coatings remained unchanged with different atomic percentage of tantalum in the films. The values of microhardness of the tantalum films were increased after incorporation of the oxygen and nitrogen atoms into the crystal lattice of the coatings. The coefficient of friction, CoF, was determined by the AFM method in the "sliding" and "plowing" modes. Deposition of the coatings on the substrates led to a decrease of CoF for the coating-substrate system compared to the substrates; thus, the final product utilizing such a coating will presumably have a longer service life. The tantalum nitride films were characterized by the smallest values of CoF and specific volumetric wear.
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Affiliation(s)
- Galina Melnikova
- Laboratory of Nanoprocesses and Technologies, A.V. Luikov Heat and Mass Transfer Institute of the National Academy of Sciences of Belarus, 15 P. Brovki Str., 220072 Minsk, Belarus; (G.M.); (T.K.); (V.L.); (A.P.); (S.C.)
| | - Tatyana Kuznetsova
- Laboratory of Nanoprocesses and Technologies, A.V. Luikov Heat and Mass Transfer Institute of the National Academy of Sciences of Belarus, 15 P. Brovki Str., 220072 Minsk, Belarus; (G.M.); (T.K.); (V.L.); (A.P.); (S.C.)
| | - Vasilina Lapitskaya
- Laboratory of Nanoprocesses and Technologies, A.V. Luikov Heat and Mass Transfer Institute of the National Academy of Sciences of Belarus, 15 P. Brovki Str., 220072 Minsk, Belarus; (G.M.); (T.K.); (V.L.); (A.P.); (S.C.)
| | - Agata Petrovskaya
- Laboratory of Nanoprocesses and Technologies, A.V. Luikov Heat and Mass Transfer Institute of the National Academy of Sciences of Belarus, 15 P. Brovki Str., 220072 Minsk, Belarus; (G.M.); (T.K.); (V.L.); (A.P.); (S.C.)
| | - Sergei Chizhik
- Laboratory of Nanoprocesses and Technologies, A.V. Luikov Heat and Mass Transfer Institute of the National Academy of Sciences of Belarus, 15 P. Brovki Str., 220072 Minsk, Belarus; (G.M.); (T.K.); (V.L.); (A.P.); (S.C.)
| | - Anna Zykova
- National Science Center “Kharkov Institute of Physics and Technology”, 1 Akademicheskaya Str., 61108 Kharkov, Ukraine; (A.Z.); (V.S.)
- V.N. Karazin Kharkiv National University, 4 Svobody Sq., 61022 Kharkov, Ukraine;
| | - Vladimir Safonov
- National Science Center “Kharkov Institute of Physics and Technology”, 1 Akademicheskaya Str., 61108 Kharkov, Ukraine; (A.Z.); (V.S.)
- V.N. Karazin Kharkiv National University, 4 Svobody Sq., 61022 Kharkov, Ukraine;
| | - Sergei Aizikovich
- Research and Education Center “Materials”, Don State Technical University, 1 Gagarin Sq., 344003 Rostov-on-Don, Russia
- Correspondence: (S.A.); (E.S.); Tel.: +7-863-238-15-58 (S.A. & E.S.)
| | - Evgeniy Sadyrin
- Research and Education Center “Materials”, Don State Technical University, 1 Gagarin Sq., 344003 Rostov-on-Don, Russia
- Correspondence: (S.A.); (E.S.); Tel.: +7-863-238-15-58 (S.A. & E.S.)
| | - Weifu Sun
- State Key Laboratory of Explosion Science and Technology, Beijing Institute of Technology, Beijing 100081, China;
- Beijing Institute of Technology Chongqing Innovation Center, Chongqing 401120, China
| | - Stanislav Yakovin
- V.N. Karazin Kharkiv National University, 4 Svobody Sq., 61022 Kharkov, Ukraine;
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11
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Huang G, Pan ST, Qiu JX. The Clinical Application of Porous Tantalum and Its New Development for Bone Tissue Engineering. MATERIALS (BASEL, SWITZERLAND) 2021; 14:2647. [PMID: 34070153 PMCID: PMC8158527 DOI: 10.3390/ma14102647] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/06/2021] [Accepted: 05/13/2021] [Indexed: 12/13/2022]
Abstract
Porous tantalum (Ta) is a promising biomaterial and has been applied in orthopedics and dentistry for nearly two decades. The high porosity and interconnected pore structure of porous Ta promise fine bone ingrowth and new bone formation within the inner space, which further guarantee rapid osteointegration and bone-implant stability in the long term. Porous Ta has high wettability and surface energy that can facilitate adherence, proliferation and mineralization of osteoblasts. Meanwhile, the low elastic modulus and high friction coefficient of porous Ta allow it to effectively avoid the stress shield effect, minimize marginal bone loss and ensure primary stability. Accordingly, the satisfactory clinical application of porous Ta-based implants or prostheses is mainly derived from its excellent biological and mechanical properties. With the advent of additive manufacturing, personalized porous Ta-based implants or prostheses have shown their clinical value in the treatment of individual patients who need specially designed implants or prosthesis. In addition, many modification methods have been introduced to enhance the bioactivity and antibacterial property of porous Ta with promising in vitro and in vivo research results. In any case, choosing suitable patients is of great importance to guarantee surgical success after porous Ta insertion.
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Affiliation(s)
| | | | - Jia-Xuan Qiu
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Nanchang University, Nanchang 330006, China; (G.H.); (S.-T.P.)
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12
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Bondarenko S, Filipenko V, Karpinsky M, Karpinska O, Ivanov G, Maltseva V, Badnaoui AA, Schwarzkopf R. Osseointegration of porous titanium and tantalum implants in ovariectomized rabbits: A biomechanical study. World J Orthop 2021; 12:214-222. [PMID: 33959485 PMCID: PMC8082506 DOI: 10.5312/wjo.v12.i4.214] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 02/01/2021] [Accepted: 03/11/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Today, biological fixation of uncemented press-fit acetabular components plays an important role in total hip arthroplasty. Long-term stable fixation of these implants depends on the osseointegration of the acetabular cup bone tissue into the acetabular cup implant, and their ability to withstand functional loads.
AIM To compare the strength of bone-implant osseointegration of four types of porous metal implants in normal and osteoporotic bone in rabbits.
METHODS The study was performed in 50 female California rabbits divided into non-ovariectomized (non-OVX) and ovariectomized groups (OVX) at 6 mo of age. Rabbits were sacrificed 8 wk after the implantation of four biomaterials [TTM, CONCELOC, Zimmer Biomet's Trabecular Metal (TANTALUM), and ATLANT] in a 5-mm diameter defect created in the left femur. A biomechanical evaluation of the femur was carried out by testing implant breakout force. The force was gradually increased until complete detachment of the implant from the bone occurred.
RESULTS The breakout force needed for implant detachment was significantly higher in the non-OVX group, compared with the OVX group for all implants (TANTALUM, 194.7 ± 6.1 N vs 181.3 ± 2.8 N; P = 0.005; CONCELOC, 190.8 ± 3.6 N vs 180.9 ± 6.6 N; P = 0.019; TTM, 186.3 ± 1.8 N vs 172.0 N ± 11.0 N; P = 0.043; and ATLANT, 104.9 ± 7.0 N vs 78.9 N ± 4.5 N; P = 0.001). In the OVX group, The breakout forces in TANTALUM, TTM, and CONCELOC did not differ significantly (P = 0.066). The breakout force for ATLANT in the OVX group was lower by a factor of 2.3 compared with TANTALUM and CONCELOC, and by 2.2 compared with TTM (P = 0.001). In the non-OVX group, the breakout force for ATLANT was significantly different from all other implants, with a reduction in fixation strength by a factor of 1.9 (P = 0.001).
CONCLUSION TANTALUM, TTM, and CONCELOC had equal bone-implant osseointegration in healthy and in osteoporotic bone. ATLANT had significantly decreased osseointegration (P = 0.001) in healthy and in osteoporotic bone.
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Affiliation(s)
- Stanislav Bondarenko
- Department of Joint Pathology, Sytenko Institute of Spine and Joint Pathology, Kharkiv 61124, Ukraine
| | - Volodymyr Filipenko
- Department of Joint Pathology, Sytenko Institute of Spine and Joint Pathology, Kharkiv 61124, Ukraine
| | - Michael Karpinsky
- Department of Biomechanics, Sytenko Institute of Spine and Joint Pathology, Kharkiv 61124, Ukraine
| | - Olena Karpinska
- Department of Biomechanics, Sytenko Institute of Spine and Joint Pathology, Kharkiv 61124, Ukraine
| | - Gennadiy Ivanov
- Department of Experimental Pathology, Sytenko Institute of Spine and Joint Pathology, Kharkiv 61124, Ukraine
| | - Valentyna Maltseva
- Morphology of Connective Tissue Department, Sytenko Institute of Spine and Joint Pathology, Kharkiv 61124, Ukraine
| | - Ahmed Amine Badnaoui
- Department of Joint Pathology, Sytenko Institute of Spine and Joint Pathology, Kharkiv 61124, Ukraine
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, Hospital for Joint Diseases, New York, NY 10003, United States
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13
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Lovati AB, Lopa S, Bottagisio M, Talò G, Canciani E, Dellavia C, Alessandrino A, Biagiotti M, Freddi G, Segatti F, Moretti M. Peptide-Enriched Silk Fibroin Sponge and Trabecular Titanium Composites to Enhance Bone Ingrowth of Prosthetic Implants in an Ovine Model of Bone Gaps. Front Bioeng Biotechnol 2020; 8:563203. [PMID: 33195126 PMCID: PMC7604365 DOI: 10.3389/fbioe.2020.563203] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 09/21/2020] [Indexed: 12/18/2022] Open
Abstract
Osteoarthritis frequently requires arthroplasty. Cementless implants are widely used in clinics to replace damaged cartilage or missing bone tissue. In cementless arthroplasty, the risk of aseptic loosening strictly depends on implant stability and bone–implant interface, which are fundamental to guarantee the long-term success of the implant. Ameliorating the features of prosthetic materials, including their porosity and/or geometry, and identifying osteoconductive and/or osteoinductive coatings of implant surfaces are the main strategies to enhance the bone-implant contact surface area. Herein, the development of a novel composite consisting in the association of macro-porous trabecular titanium with silk fibroin (SF) sponges enriched with anionic fibroin-derived polypeptides is described. This composite is applied to improve early bone ingrowth into the implant mesh in a sheep model of bone defects. The composite enables to nucleate carbonated hydroxyapatite and accelerates the osteoblastic differentiation of resident cells, inducing an outward bone growth, a feature that can be particularly relevant when applying these implants in the case of poor osseointegration. Moreover, the osteoconductive properties of peptide-enriched SF sponges support an inward bone deposition from the native bone towards the implants. This technology can be exploited to improve the biological functionality of various prosthetic materials in terms of early bone fixation and prevention of aseptic loosening in prosthetic surgery.
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Affiliation(s)
- Arianna B Lovati
- IRCCS Istituto Ortopedico Galeazzi, Cell and Tissue Engineering Laboratory, Milan, Italy
| | - Silvia Lopa
- IRCCS Istituto Ortopedico Galeazzi, Cell and Tissue Engineering Laboratory, Milan, Italy
| | - Marta Bottagisio
- IRCCS Istituto Ortopedico Galeazzi, Laboratory of Clinical Chemistry and Microbiology, Milan, Italy
| | - Giuseppe Talò
- IRCCS Istituto Ortopedico Galeazzi, Cell and Tissue Engineering Laboratory, Milan, Italy
| | - Elena Canciani
- Ground Sections Laboratory, Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Claudia Dellavia
- Ground Sections Laboratory, Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | | | | | | | | | - Matteo Moretti
- IRCCS Istituto Ortopedico Galeazzi, Cell and Tissue Engineering Laboratory, Milan, Italy.,Regenerative Medicine Technologies Lab, Ente Ospedaliero Cantonale, Lugano, Switzerland
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14
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Howie DW, Holubowycz OT, Callary SA, Robertson TS, Solomon LB. Highly Porous Tantalum Acetabular Components Without Ancillary Screws Have Similar Migration to Porous Titanium Acetabular Components With Screws at 2 Years: A Randomized Controlled Trial. J Arthroplasty 2020; 35:2931-2937. [PMID: 32593487 DOI: 10.1016/j.arth.2020.05.049] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 05/17/2020] [Accepted: 05/20/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND It is proposed that highly porous coatings on acetabular components, such as a porous tantalum coating, provide adequate fixation without ancillary screw fixation in primary total hip arthroplasty (THA). However, tantalum acetabular components have been associated with higher rates of revision than other uncemented components in national registries. The aim of this randomized controlled trial is to determine whether the early migration of a solid-backed tantalum acetabular component was no greater than that of a titanium acetabular component with ancillary screw fixation that has proven good clinical results. METHODS Sixty-six patients aged 40 to 64 years, with osteoarthritis and Charnley grade A or B activity grade and who underwent primary THA, were recruited into the trial. Patients were randomized intraoperatively to receive either the tantalum or titanium acetabular component. All patients received the same cemented polished tapered femoral stem, 28-mm cobalt-chromium femoral head, and highly cross-linked polyethylene liner. Acetabular component migration was measured using radiostereometric analysis at 4-6 days postoperatively and at 6 weeks, 3 months, 1 and 2 years following THA. RESULTS The mean proximal migration at 2 years for the tantalum cohort was 0.17 mm (95% confidence interval, 0.09-0.24) which was no greater than that of the titanium cohort which was 0.19 mm (0.07-0.32). Harris hip scores and functional activity scores were similar between groups. CONCLUSION These results demonstrate that early stability can be achieved without ancillary screw fixation through the use of a highly porous high friction coating on a solid-backed modular acetabular component. LEVEL OF EVIDENCE Level I.
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Affiliation(s)
- Donald W Howie
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia
| | - Oksana T Holubowycz
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia
| | - Stuart A Callary
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia
| | - Thomas S Robertson
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia
| | - Lucian B Solomon
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia
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15
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Tsikandylakis G, Mortensen KR, Gromov K, Troelsen A, Malchau H, Mohaddes M. The Use of Porous Titanium Coating and the Largest Possible Head Do Not Affect Early Cup Fixation: A 2-Year Report from a Randomized Controlled Trial. JB JS Open Access 2020; 5:e20.00107. [PMID: 33376932 PMCID: PMC7757840 DOI: 10.2106/jbjs.oa.20.00107] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Cups are more frequently revised than stems after uncemented total hip arthroplasty, which warrants the development of cup surfaces that provide long-lasting, stable fixation. Large heads have become popular with the aim of reducing dislocation rates, but they generate greater frictional torque that may compromise cup fixation. We aimed to investigate (1) if a novel porous titanium surface provides superior cup fixation when compared with a porous plasma spray (PPS) surface and (2) if the use of the largest possible head compromises cup fixation when compared with a 32-mm head. METHODS Ninety-six patients were randomized to receive either a cup with a porous titanium coating (PTC) or a cup with PPS. A second randomization was performed to either the largest possible (36 to 44-mm) or a 32-mm head in metal-on-vitamin-E-infused polyethylene bearings. Roentgen stereophotogrammetric analysis (RSA) examinations were obtained postoperatively at 3, 12, and 24 months. The primary outcome was proximal cup migration when comparing the 2 cup surfaces and also when comparing the largest possible head with the 32-mm head. The patients were followed for 2 years. RESULTS The median (and interquartile range) proximal cup migration was 0.15 mm (0.02 to 0.32 mm) for the PTC cup and 0.21 mm (0.11 to 0.34 mm) for the PPS cup. The largest possible head had a proximal cup migration of 0.15 mm (0.09 to 0.31 mm), and the 32-mm head had a proximal cup migration of 0.20 mm (0.04 to 0.35 mm). There were no significant differences between the cup surface (p = 0.378) or the head size (p = 0.693) groups. CONCLUSIONS Early cup fixation was not superior with the novel PTC cup; the use of the largest possible head (36 to 44 mm) did not compromise early cup fixation. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Georgios Tsikandylakis
- Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kristian R.L. Mortensen
- Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kirill Gromov
- Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anders Troelsen
- Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Malchau
- Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Maziar Mohaddes
- Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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16
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Baecker H, Hardt S, Abdel MP, Perka C. Tantalum Augments Combined with Antiprotrusio Cages for Massive Acetabular Defects in Revision Arthroplasty. Arthroplast Today 2020; 6:704-709. [PMID: 32923554 PMCID: PMC7475075 DOI: 10.1016/j.artd.2020.07.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/23/2020] [Accepted: 07/25/2020] [Indexed: 01/16/2023] Open
Abstract
Background Tantalum components have gained popularity for the management of Paprosky type IIIA and IIIB defects during revision total hip arthroplasty. Although the use of antiprotrusio cages solely shows suboptimal results, there are certain defects that still require their use. We hypothesized that combining tantalum augments and an antiprotrusio cage would (1) improve radiographic stability, (2) enhance survivorship, (3) decrease complications, and (4) improve clinical outcomes. Methods We retrospectively reviewed 20 patients with Paprosky type IIIA or IIIB defects who underwent revision of the acetabular component with a highly porous tantalum augment and an antiprotrusio cage combination. Preoperative and postoperative radiographs, survivorship free from aseptic component revision, and the Harris Hip Score, Western Ontario and McMaster Universities Osteoarthritis Index, and Short Form-36 scores were analyzed. The mean follow-up was 2.8 years. Results At the most recent follow-up, no antiprotrusio cages had migrated and all tantalum augments had radiographic evidence of osseointegration. In addition, only 2 components were revised for aseptic etiologies and only 1 was loose. Both were revised secondary to failures of the inferior flange of the antiprotrusio cage. All clinical outcome scores significantly improved postoperatively. Finally, the risk of major postoperative complications was noted to be 10%. Conclusions In summary, a tantalum augment combined with an antiprotrusio cage in Paprosky IIIA and IIIB defects with divergent anatomy not amenable to a hemispherical socket provides a reliable technique to restore the anatomic hip center and prevent superior migration and provides a bony ingrowth surface. Longer term follow-up is required before the technique is widely adapted. Level of Evidence Level IV, therapeutic studies.
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Affiliation(s)
- Hinnerk Baecker
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Department of Trauma and Orthopedic Surgery, BG University Hospital Bergmannsheil, Ruhr-University Bochum, RUB, Bochum, Germany
| | - Sebastian Hardt
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Carsten Perka
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
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17
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Cui Y, Li Z, Wan Q, Wang X, Li S, Ren Z, Wang Z, Yang F, Liu H, Wu D. [Clinical application of three-dimensional printed metal prosthesis in joint surgery]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:774-777. [PMID: 31198009 DOI: 10.7507/1002-1892.201901022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To summarize the application progress of three-dimensional (3D) printed metal prosthesis in joint surgery. Methods The related literature was extensively reviewed. The effectiveness of 3D printed metal prosthesis in treatment of joint surgery diseases were discussed and summarized, including the all key issues in prosthesis transplantation such as prosthesis stability, postoperative complications, bone ingrowth, etc. Results 3D printed metal prosthesis has good matching degree, can accurately reconstruct and restore joint function, reduce operation time, and achieve high patient satisfaction in short- and medium-term follow-up. Its application in joint surgery has made good progress. Conclusion The personalized microporous structure prostheses of different shapes produced by 3D printing can solve the problem of poor personalized matching of joints for special patients existing in traditional prostheses. Therefore, 3D printing technology is full of hope and will bring great potential to the reform of orthopedic practice in the future.
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Affiliation(s)
- Yutao Cui
- Orthopaedic Medical Center, the Second Hospital of Jilin University, Changchun Jilin, 130041, P.R.China
| | - Zuhao Li
- Orthopaedic Medical Center, the Second Hospital of Jilin University, Changchun Jilin, 130041, P.R.China
| | - Qian Wan
- Orthopaedic Medical Center, the Second Hospital of Jilin University, Changchun Jilin, 130041, P.R.China;Clinical Medical College of Jilin University, Changchun Jilin, 130041, P.R.China
| | - Xianggang Wang
- Orthopaedic Medical Center, the Second Hospital of Jilin University, Changchun Jilin, 130041, P.R.China;Clinical Medical College of Jilin University, Changchun Jilin, 130041, P.R.China
| | - Shengyang Li
- Orthopaedic Medical Center, the Second Hospital of Jilin University, Changchun Jilin, 130041, P.R.China
| | - Zhenxiao Ren
- Orthopaedic Medical Center, the Second Hospital of Jilin University, Changchun Jilin, 130041, P.R.China;Clinical Medical College of Jilin University, Changchun Jilin, 130041, P.R.China
| | - Zhonghan Wang
- Orthopaedic Medical Center, the Second Hospital of Jilin University, Changchun Jilin, 130041, P.R.China
| | - Fan Yang
- Orthopaedic Medical Center, the Second Hospital of Jilin University, Changchun Jilin, 130041, P.R.China
| | - He Liu
- Orthopaedic Medical Center, the Second Hospital of Jilin University, Changchun Jilin, 130041,
| | - Dankai Wu
- Orthopaedic Medical Center, the Second Hospital of Jilin University, Changchun Jilin, 130041,
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18
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Reina N, Salib CG, Perry KI, Hanssen AD, Berry DJ, Abdel MP. Mild Coronal Stem Malalignment Does Not Negatively Impact Survivorship or Clinical Results in Uncemented Primary Total Hip Arthroplasties With Dual-Tapered Implants. J Arthroplasty 2019; 34:1127-1131. [PMID: 30773361 DOI: 10.1016/j.arth.2019.01.055] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 11/28/2018] [Accepted: 01/22/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Proper component positioning in total hip arthroplasty (THA) is crucial for implant fixation and hip stability. The purpose of this study is to assess if neutral coronal stem alignment (0° ± 3°) improved long-term survivorship in uncemented femoral components. METHODS Between 2005 and 2010, 1028 primary THAs were performed with 2 contemporary dual-tapered, proximally coated uncemented stem types. Alignment was measured immediately postoperatively and at most recent follow-up. In total, 978 femoral stems (95%) were within 0° ± 3° of the neutral anatomic coronal axis, and the 50 stems (5%) outside that range were considered outliers (3.1° of valgus to 4.8° of varus). Outcomes analyzed included implant survivorship, Harris Hip Scores, and incidence of dislocation. Mean follow-up was 5 years. RESULTS Survivorship free of aseptic femoral component loosening was 99.3% and 98.2% at 5 and 8 years in the neutral group vs 100% at 5 and 8 years in the outlier group (P = .98). Survivorship free of femoral component revision for any reason was 99.1% and 97.3% at 5 and 8 years vs 100% at 5 and 8 years, respectively (P = .80). Harris Hip Scores were similar (89 in both groups; P = .84) at most recent follow-up. The incidence of mild to moderate thigh pain was also similar in both groups (6.1% vs 6%, P = .85). The incidence of dislocation was 1.5% at 8 years, and similar between both groups (P = .77). CONCLUSION Slight malalignment of contemporary dual-tapered uncemented THA femoral components does not appear to negatively impact survivorship or clinical outcomes, which is in contrast to cemented femoral components. LEVEL OF EVIDENCE III Case-control study.
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Affiliation(s)
- Nicolas Reina
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | | | - Kevin I Perry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Arlen D Hanssen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Daniel J Berry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
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Liska WD, Israel SK, Poteet BA. Polar gap after cementless total hip replacement in dogs. Vet Surg 2019; 48:321-335. [DOI: 10.1111/vsu.13179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 09/26/2018] [Accepted: 10/29/2018] [Indexed: 11/29/2022]
Affiliation(s)
| | - Sarah K. Israel
- South Texas Veterinary Specialists ‐ Bluepearl Stone Oak San Antonio Texas
| | - Brian A. Poteet
- VitalRads Veterinary Teleradiology Consultants Cypress Texas
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Belt M, Gliese B, Muharemovic O, Malchau H, Husted H, Troelsen A, Gromov K. Sensitivity and specificity of post-operative interference gap assessment on plain radiographs after cementless primary THA. Clin Imaging 2019; 54:103-107. [PMID: 30612032 DOI: 10.1016/j.clinimag.2018.12.009] [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: 05/14/2018] [Revised: 12/13/2018] [Accepted: 12/27/2018] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Implant performance of cementless THA is often evaluated by radiolucency on plain radiographs, often classified as interference gaps on direct post-operative radiographs. However, the diagnostic performance is unknown. The aim was to evaluate the diagnostic performance of radiographic assessment of post-operative gaps after primary THA by comparing it with CT confirmed gaps, and secondary to define optimal cut-off criteria for assessing gaps on plain radiographs compared with CT. MATERIAL AND METHODS Patients (N = 40) with a primary cementless THA performed between July 2015 and March 2016 were enrolled in the study. Radiolucency was assessed on post-operative AP pelvic digital radiographs by two observers independently. Maximum width and percentage of coverage per zone were reported. Gap volume was measured by manual segmentation on CT images. RESULTS When defining a gap as a radiolucency extending through >50% of a zone, the interrater agreement Kappa was 0.241. Sensitivity was 65.8% for observer 1 (Kappa = 0.432), and 86.8% for observer 2 (Kappa = 0.383). When defining a gap as a radiolucency with a width >1 mm, the interrater agreement Kappa was 0.302. Sensitivity was 55.3% and 50% for observer 1 and observer 2, respectively. The ROC-curve resulted in an optimal threshold of 0.65 mm (AUROC = 0.888) and 0.31 mm (AUROC = 0.961) for the two observers. CONCLUSION The diagnostic performance of observers detecting interference gaps on radiographs showed low sensitivity. Further on, the inter-rater agreement is too low to do a general recommendation about thresholds for defining gaps. Evaluating progression of radiolucency on radiographs should be performed in the light of these findings.
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Affiliation(s)
- Maartje Belt
- Dept. of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Copenhagen, Denmark.
| | - Bjørn Gliese
- Dept. of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Copenhagen, Denmark
| | - Omar Muharemovic
- Department of Radiology, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Denmark
| | - Henrik Malchau
- Dept. of Orthopaedic Surgery, Sahlgrenska University Hospital, Mölndal, Gothenburg, Sweden; The Harris Orthopaedic Laboratory, Orthopedic Department, Massachusetts General Hospital, Boston, USA
| | - Henrik Husted
- Dept. of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Copenhagen, Denmark
| | - Anders Troelsen
- Dept. of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Copenhagen, Denmark
| | - Kirill Gromov
- Dept. of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Copenhagen, Denmark
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Hefni EK, Bencharit S, Kim SJ, Byrd KM, Moreli T, Nociti FH, Offenbacher S, Barros SP. Transcriptomic profiling of tantalum metal implant osseointegration in osteopenic patients. BDJ Open 2018; 4:17042. [PMID: 30479835 PMCID: PMC6251902 DOI: 10.1038/s41405-018-0004-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 07/16/2018] [Accepted: 07/18/2018] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES The long-term success of dental implants is established by literature. Although clinically well defined, the complex genetic pathways underlying osseointegration have not yet been fully elucidated. Furthermore, patients with osteopenia/osteoporosis are considered to present as higher risk for implant failure. Porous tantalum trabecular metal (PTTM), an open-cell porous biomaterial, is suggested to present enhanced biocompatibility and osteoconductivity. The goal of this study was to evaluate the expression patterns of a panel of genes closely associated with osteogenesis and wound healing in osteopenic patients receiving either traditional titanium (Ti) or PTTM cylinders to assess the pathway of genes activation in the early phases of osseointegration. MATERIAL AND METHODS Implant cylinders made of Ti and PTTM were placed in osteopenic volunteers. At 2- and 4 weeks of healing, one Ti and one PTTM cylinder were removed from each subject for RT-PCR analysis using osteogenesis PCR array. RESULTS Compared to Ti, PTTM-associated bone displayed upregulation of bone matrix proteins, BMP/TGF tisuperfamily, soluble ligand and integrin receptors, growth factors, and collagen genes at one or both time points. Histologically, PTTM implants displayed more robust osteogenesis deposition and maturity when compared to Ti implants from the same patient. CONCLUSIONS Our results indicate that PTTM properties could induce an earlier activation of genes associated with osteogenesis in osteopenic patients suggesting that PTTM implants may attenuate the relative risk of placing dental implants in this population.
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Affiliation(s)
- E. K. Hefni
- Department of Periodontology, School of Dentistry, University of North Carolina, Chapel Hill, NC USA
| | - S. Bencharit
- Department of General Practice, School of Dentistry, Virginia Commonwealth University, Richmond, VA USA
| | - S. J. Kim
- Department of Periodontology, School of Dentistry, University of North Carolina, Chapel Hill, NC USA
| | - K. M. Byrd
- Department of Periodontology, School of Dentistry, University of North Carolina, Chapel Hill, NC USA
| | - T. Moreli
- Department of Periodontology, School of Dentistry, University of North Carolina, Chapel Hill, NC USA
| | - F. H. Nociti
- Department of Periodontology, School of Dentistry, State University of Campinas, Campinas, Brazil
| | - S. Offenbacher
- Department of Periodontology, School of Dentistry, University of North Carolina, Chapel Hill, NC USA
| | - S. P. Barros
- Department of Periodontology, School of Dentistry, University of North Carolina, Chapel Hill, NC USA
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Li Z, Wang C, Li C, Wang Z, Yang F, Liu H, Qin Y, Wang J. What we have achieved in the design of 3D printed metal implants for application in orthopedics? Personal experience and review. RAPID PROTOTYPING JOURNAL 2018; 24:1365-1379. [DOI: 10.1108/rpj-10-2017-0205] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
PurposeThis paper aims to review the latest applications in terms of three-dimensional printed (3DP) metal implants in orthopedics, and, importantly, the design of 3DP metal implants through a series of cases operated at The Second Hospital of Jilin University were presented.Design/methodology/approachThis paper is available to practitioners who are use 3DP implants in orthopedics. This review began with the deficiency of traditional prostheses and basic concepts of 3DP implants. Then, representative 3DP clinical cases were summarized and compared, and the experiences using customized prostheses and directions for future potential development are also shown.FindingsThe results obtained from the follow-up of clinical applications of 3DP implants show that the 3D designed and printed metal implants could exhibit good bone defect matching, quick and safe joint functional rehabilitation as well as saving time in surgery, which achieved high patient satisfaction collectively.Originality/valueSingle center experiences of 3DP metal implants design were shared and the detailed technical points between various regions were compared and analyzed. In conclusion, the 3DP technology is infusive and will present huge potential to reform future orthopedic practice.
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Analysis of Tantalum Implants used for Avascular Necrosis of the Femoral Head: A Review of Five Retrieved Specimens. J Appl Biomater Funct Mater 2018; 10:29-36. [DOI: 10.5301/jabfm.2012.9273] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2011] [Indexed: 11/20/2022] Open
Abstract
Aim The effective results shown in the porous systems of tantalum employed for the use of osseointegrates has been demonstrated by means of animal experimentation. However, there is a total lack of any research studies on the osseointegration of tantalum implants from retrieval of the same after a period of time whereby the material had been implanted within the human body. Materials and Methods For this study, five rod implants used for the treatment of avascular necrosis of the femoral head were retrieved following collapse of the femoral head and conversion to total hip arthroplasty. The time of implantation ranged between six weeks and twenty months. Results Observation during this study has confirmed the effectiveness of osseointegration within this period of time. New bone was observed around and within the porous system of the on rod devices at retrieval date. The bone ingrowth, however, proved to be slower and less intense than that resulting within animal species during the first few months after implantation. Conclusions The results obtained in the quantitative assessment of this process proved to be similar to those results achieved by other authors in previous experimental work studies.
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Tritanium Acetabular Cup in Revision Hip Replacement: A Six to Ten Years of Follow-Up Study. J Arthroplasty 2018; 33:2566-2570. [PMID: 29685709 DOI: 10.1016/j.arth.2018.03.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 03/05/2018] [Accepted: 03/17/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The use of highly porous acetabular components has shown to produce good results in revision acetabular surgery. Their surface characteristics enhance initial fixation and bone ingrowth which are prerequisites for adequate osseointegration. The purpose of this study is to analyze the mid-term to long-term survival, clinical and radiological outcomes using the Tritanium cup (Stryker, Mahwah, NJ) in revision hip surgery. METHODS This is a retrospective review of all patients who underwent acetabular revision surgery using "Tritanium revision cup" between April 2007 and November 2010 at our institution. Sixty-two patients were included with a mean age of 67.5 years (32-86). According to Paprosky classification, 10 patients had type I defect, 8 had type IIA, 27 had type IIB, 7 had type IIC, and 10 suffered from type IIIA defect. A Kaplan-Meier analysis was used to determine the survival of the cup. Functional outcomes were assessed using Oxford Hip Score. Plain radiographs were performed to assess implant fixation and osseointegration. RESULTS The acetabular cup aseptic survivorship was 98.4% at a mean follow-up of 87.6 months. The mean Oxford Hip Score improved from 14.5 (3-31) preoperatively to 38.5 (12-48) at the final follow-up. Two cups were revised (3.2%): 1 for aseptic loosening and 1 for infection. CONCLUSION Tritanium revision acetabular cup has shown excellent mid-term to long-term clinical and radiographic results with low failure rate and minimal complications. Longer term follow-up would be of value to assess the ongoing survival of this implant construct.
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López-Torres II, Sanz-Ruíz P, Sánchez-Pérez C, Andrade-Albarracín R, Vaquero J. Clinical and radiological outcomes of trabecular metal systems and antiprotrusion cages in acetabular revision surgery with severe defects: a comparative study. INTERNATIONAL ORTHOPAEDICS 2018; 42:1811-1818. [PMID: 29484473 DOI: 10.1007/s00264-018-3801-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 01/23/2018] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Acetabular revision surgery poses a challenge due to the increased frequency of severe defects and poor quality of the remaining bone. We compare the clinical and radiological outcomes, complications, and survival of two systems commonly used in complex acetabular revisions (AAOS types II, III, and IV): trabecular metal system (TM) and Burch-Schneider antiprotrusion cages (BS). METHODS Eighty-four patients underwent acetabular revision surgery with TM or BS in our centre between 2008 and 2014. Comparison was made of demographic and clinical characteristics, satisfaction, radiographic parameters, complications, and survival of the implants. A BS was implanted in 30.9% of the patients, while 69.1% received a TM implant. The mean follow-up was 4.77 years. RESULTS The BS group required a significantly greater number of constrained implants (p = 0.001) and more walking aids (p = 0.04). The mean satisfaction (p = 0.02) and HHS scores at the end of the follow-up were higher in the TM group (p = 0.003). No differences were observed in the incidence of complications, though the only two cases of implant rupture corresponded to the BS group. The overall survival rate was 88.1% after 7.5 years. CONCLUSION TM implants afforded better clinical outcomes and greater patient satisfaction than antiprotrusion cages in the treatment of severe acetabular defects.
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Affiliation(s)
- Irene Isabel López-Torres
- Department of Orthopaedic Surgery, Hospital General Universitario Gregorio Marañón, C/ Doctor Esquerdo 46, 28007, Madrid, Spain.
| | - Pablo Sanz-Ruíz
- Department of Orthopaedic Surgery, Hospital General Universitario Gregorio Marañón, C/ Doctor Esquerdo 46, 28007, Madrid, Spain
- Universidad Complutense de Madrid, Av. Séneca 2, 28040, Madrid, Spain
| | - Coral Sánchez-Pérez
- Department of Orthopaedic Surgery, Hospital General Universitario Gregorio Marañón, C/ Doctor Esquerdo 46, 28007, Madrid, Spain
| | - Ricardo Andrade-Albarracín
- Department of Orthopaedic Surgery, Hospital General Universitario Gregorio Marañón, C/ Doctor Esquerdo 46, 28007, Madrid, Spain
| | - Javier Vaquero
- Department of Orthopaedic Surgery, Hospital General Universitario Gregorio Marañón, C/ Doctor Esquerdo 46, 28007, Madrid, Spain
- Universidad Complutense de Madrid, Av. Séneca 2, 28040, Madrid, Spain
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Sodhi N, Izant T, Diana J, Del Gaizo D, Baratz M, Levine A, Campbell D, Harwin SF, Mont MA. Three-Year Outcomes of a Highly Porous Acetabular Shell in Primary Total Hip Arthroplasty. Orthopedics 2018; 41:e154-e157. [PMID: 29120008 DOI: 10.3928/01477447-20171102-03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 10/06/2017] [Indexed: 02/03/2023]
Abstract
This multicenter study evaluated survivorship, functional outcomes, complications, and radiographic outcomes for patients who underwent total hip arthroplasty using a newly developed highly porous 3-dimensional titanium implant. Excellent aseptic (99.6%) and all-cause (98%) survivorship and functional outcomes were found at 3-year follow-up. This highly porous acetabular shell holds promise in total hip arthroplasty. [Orthopedics. 2018; 41(1):e154-e157.].
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Survivorship of a Porous Tantalum Monoblock Acetabular Component in Primary Hip Arthroplasty With a Mean Follow-Up of 18 Years. J Arthroplasty 2017; 32:3680-3684. [PMID: 28734611 DOI: 10.1016/j.arth.2017.06.049] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Revised: 06/12/2017] [Accepted: 06/28/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The use of porous tantalum for the acetabular component in primary total hip arthroplasty (THA) has demonstrated excellent short-term and midterm results. However, long-term data are scarce. The purpose of this prospective study is to report the long-term clinical and radiologic outcome following use of an uncemented porous tantalum acetabular component in primary THA with a minimum follow-up of 17.5 years, in a previously studied cohort of patients. METHODS We prospectively followed 128 consecutive primary THAs in 140 patients, between November 1997 and June 1999. A press-fit porous tantalum monoblock acetabular component was used in all cases. All patients were followed clinically and radiographically for a mean of 18.1 years (range, 17.5-19 years). RESULTS Mean age of patients at the time of operation was 60.4 years. Harris hip score, Oxford hip score, and range of motion were dramatically improved in all cases (P < .001). At last follow-up, all cups were radiographically stable with no evidence of migration, gross polyethylene wear, progressive radiolucencies, osteolytic lesions, or acetabular fractures. The survivorship with reoperation for any reason as end point was 92.8% and the survivorship for aseptic loosening as an end point was 100%. CONCLUSION The porous tantalum monoblock cup in primary THA demonstrated excellent clinical and radiographic outcomes with no failures because of aseptic loosening at a mean follow-up of 18.1 years.
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Falzarano G, Piscopo A, Rollo G, Medici A, Grubor P, Bisaccia M, Pipola V, Cioffi R, Nobile F, Meccariello L. Tantalum in type IV and V Paprosky periprosthetic acetabular fractures surgery in Paprosky type IV and V periprosthetic acetabular fractures surgery. Musculoskelet Surg 2017; 102:87-92. [PMID: 28965314 DOI: 10.1007/s12306-017-0503-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 09/18/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Periprosthetic acetabular fractures represent a growing and serious complication of total hip arthroplasty (THA). The purpose of the study is to report our experience in the use of tantalum for the treatment of Paprosky type IV and V periprosthetic acetabular fractures. METHOD We analyzed 24 patients with type IV and V periprosthetic acetabular fractures. Patients were treated with a revision surgery using tantalum components, in some cases in association with posterior plating. Outcomes were evaluated using VAS, Harris hip score and considering the average time of integration of the acetabulum and the number of complications. The endpoint evaluation was established at 24 months. RESULT Results show that the average time of integration of the neoacetabulum in tantalum was 12.3 months (range 6-18 months). The average VAS pain is 8.7/10 cm at time 0 and gradually returns to basic pre-injury values in the following months. The average value of HHS at time 0 is 13.5 points. This value tends to increase progressively until reaching a mean score of 89.3 points at 24 months, higher than the average pre-trauma value of 84.3 points. CONCLUSION Periprosthetic fractures of the acetabulum with bone loss are a rare but potentially disastrous complication of total hip prostheses. Their management and therapeutic choice will test the ability of the orthopedic surgeon. It is important to determine the type of fracture and characteristics in order to pursue an adequate therapeutic strategy. The modern biomaterials, such as porous tantalum, offer a greater potential in replacing bone loss, promoting bone regrowth and obtaining a stable implant.
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Affiliation(s)
- G Falzarano
- U.O.C. Orthopedics and Traumatology, Azienda Ospedaliera Gaetano Rummo, Benevento, Italy
| | - A Piscopo
- U.O.C. Orthopedics and Traumatology, Hospital Sacro Cuore di Gesù Fatebenefratelli, Benevento, Italy
| | - G Rollo
- Department of Orthopedics and Traumatology, U.O.C. Orthopedics and Traumatology, Vito Fazzi Hospital, Via Ada Cudazzo, Block: A- Floor: V, Lecce, Italy
| | - A Medici
- U.O.C. Orthopedics and Traumatology, Azienda Ospedaliera Gaetano Rummo, Benevento, Italy
| | - P Grubor
- Clinic of Traumatology, University Hospital Clinical Center, Banja Luka, Bosnia and Herzegovina
| | - M Bisaccia
- Division of Orthopedics and Trauma Surgery, University of Perugia, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - V Pipola
- Rizzoli Orthopedic Institute, Bologna, Italy
| | - R Cioffi
- Division of Orthopedics and Trauma Surgery, University of L'Aquila, L'Aquila, Italy
| | - F Nobile
- U.O.C. Orthopedics and Traumatology, Hospital Santa Maria alla Gruccia, Montevarchi, Arezzo, Italy
| | - L Meccariello
- Department of Orthopedics and Traumatology, U.O.C. Orthopedics and Traumatology, Vito Fazzi Hospital, Via Ada Cudazzo, Block: A- Floor: V, Lecce, Italy.
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Delanois RE, Gwam CU, Mohamed N, Khlopas A, Chughtai M, Malkani AL, Mont MA. Midterm Outcomes of Revision Total Hip Arthroplasty With the Use of a Multihole Highly-Porous Titanium Shell. J Arthroplasty 2017; 32:2806-2809. [PMID: 28456559 DOI: 10.1016/j.arth.2017.03.065] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 03/22/2017] [Accepted: 03/28/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND We are reporting on the minimum 5-year outcomes of patients who underwent revision total hip arthroplasty (THA) using a specific highly-porous titanium shell. We assessed (1) aseptic and all-cause survivorship; (2) functional outcomes; (3) complications; and (4) radiographic outcomes. METHODS Two hospital databases were evaluated for patients who underwent revision THA due to component instability or aseptic loosening using a cementless highly-porous titanium shell between September 2006 and December 2011. This yielded 35 patients who had a mean age of 61 years (range 14-88 years). Patients had a mean follow-up of 6 years (minimum 5 years). All-cause and aseptic survivorship of the shell was calculated. Functional outcomes were assessed using the Harris Hip Score. We determined the incidence of postoperative complications and performed radiographic evaluation of pelvic radiographs from regular office visits. RESULT The aseptic survivorship of the acetabular component was 97% (95% confidence interval; 8.1-9.5). The all-cause survivorship of the acetabular component was 91% (95% confidence interval; 7.3-8.1). One patient had an aseptic failure and 2 patients had septic failures. The mean postoperative Harris Hip Score was 76 points (range, 61-91 points). Excluding the aseptic and septic failures, there was no osteolysis or progressive radiolucencies present on radiographic evaluation at final follow-up. CONCLUSION At a minimum of 5-year follow-up, the highly-porous titanium acetabular revision shell has excellent survivorship and functional outcomes. Although long-term follow-up is needed to further monitor these implants, the results are promising and demonstrate that this prosthesis may be an excellent option for patients undergoing revision THA.
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Affiliation(s)
- Ronald E Delanois
- Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Chukwuweike U Gwam
- Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Nequesha Mohamed
- Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Anton Khlopas
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Morad Chughtai
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Arthur L Malkani
- Department of Orthopaedic Surgery, University of Louisville, Louisville, Kentucky
| | - Michael A Mont
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
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30
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Huang DY, Zhang L, Zhou YX, Zhang CY, Xu H, Huang Y. Total Hip Arthroplasty Using Modular Trabecular Metal Acetabular Components for Failed Treatment of Acetabular Fractures: A Mid-term Follow-up Study. Chin Med J (Engl) 2017; 129:903-8. [PMID: 27064033 PMCID: PMC4831523 DOI: 10.4103/0366-6999.179793] [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] [Indexed: 11/25/2022] Open
Abstract
Background: Porous-coated cups have been widely used in acetabular reconstruction after failed treatment of acetabular fractures, and good results have been reported with the use of these cups; however, the durability and functionality of modular trabecular metal (TM) acetabular components in acetabular reconstruction after failed treatment of acetabular fractures remain unclear. This study aimed to examine the radiographic and clinical outcomes associated with the use of modular TM acetabular components for failed treatment of acetabular fractures to assess the durability and functionality of these components in acetabular reconstruction after failed treatment of acetabular fractures. Methods: A total of 41 patients (41 hips) underwent total hip arthroplasty (THA) using modular TM acetabular components for failed treatment of acetabular fractures at our hospital between January 2007 and December 2012. Among these patients, two were lost to follow-up. Therefore, 39 patients (39 hips) were finally included in this study. The Harris hip score before and after the surgery, satisfaction level of the patients, and radiographic results were assessed. Results: The mean Harris hip score increased from 34 (range, 8–52) before surgery to 91 (range, 22–100) at the latest follow-up examination (P < 0.001). The results were excellent for 28 hips, good for six, fair for three, and poor for two. Among the 39 patients, 25 (64%) and 10 (26%) were very satisfied and somewhat satisfied, respectively. All cups were found to be fully incorporated, and no evidence of cup migration or periacetabular osteolysis was noted. Conclusions: Despite the technically demanding nature of the procedure, THA using modular TM acetabular components showed good durability and functionality and may be an effective reconstruction option for failed treatment of acetabular fractures.
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Affiliation(s)
| | | | - Yi-Xin Zhou
- Department of Orthopedics, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing 100035, China
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Outcome of Revision Total Hip Arthroplasty in Management of Failed Metal-on-Metal Hip Arthroplasty. J Arthroplasty 2016; 31:2559-2563. [PMID: 27378637 DOI: 10.1016/j.arth.2016.04.033] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 04/03/2016] [Accepted: 04/26/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND This is a retrospective review of the functional outcomes and complications of revision total hip arthroplasty (THA) of failed metal-on-metal (MoM) hip arthroplasty. METHODS A total of 20 revision THAs were performed in 19 patients. Of them, 2 cases were failed hip resurfacing, and 18 cases were failed (MoM) THA. The mean age at revision (THA) was 59.35 years (standard deviation [SD] 9.83). RESULTS The mean follow-up was 45 months (SD 13.98). The indications of revision were aseptic loosening of acetabular component without adverse local tissue reaction (ALTR; 10 hips), aseptic loosening of the acetabular and femoral components without ALTR (1 hip), painful hip associated with ALTR (6 hips), iliopsoas impingement associated with a large-diameter femoral head or malpositioned acetabular component (3 hips). The acetabular components were revised in 18 hips using Trabecular Metal Modular cups. The femoral components were revised in 3 hips. A constrained acetabular liner was used in 5 hips. The Harris hip score significantly improved from 48.4 (SD 12.98) to 83.25 (SD 10.08). There were 2 complications (1 foot drop and 1 superficial infection) and 1 failure (recurrent dislocation) that required revision to a constrained liner. CONCLUSION Early results of revision THA of failed MoM hip arthroplasty showed improvement in pain and functional outcome. No case of failed bone ingrowth was noted with the use of Trabecular Metal Modular cups. Extensive soft tissue and abductor muscles dysfunctions were common. A constrained acetabular component with repair of the hip abductors might be beneficial.
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32
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De Martino I, De Santis V, Sculco PK, D'Apolito R, Poultsides LA, Gasparini G. Long-Term Clinical and Radiographic Outcomes of Porous Tantalum Monoblock Acetabular Component in Primary Hip Arthroplasty: A Minimum of 15-Year Follow-Up. J Arthroplasty 2016; 31:110-114. [PMID: 26781387 DOI: 10.1016/j.arth.2015.12.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 11/18/2015] [Accepted: 12/01/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The porous tantalum monoblock cup has demonstrated excellent short-term and midterm clinical and radiographic outcomes in primary THA, but longer follow-up is necessary to confirm the durability of these results into the second decade. The purpose of this study is to report the clinical and radiographic outcomes for this monoblock cup with a minimum 15-year follow-up. METHODS From June 1998 to December 1999, 61 consecutive patients (63 hips) underwent primary THA with a tantalum monoblock acetabular component. All patients were followed clinically and radiographically for a minimum of 15 years. At a mean of 15.6 years (range, 15-16 years) of follow-up, 5 patients had died, and 4 had been lost to follow-up, leaving 52 patients (54 hips) for analysis. The underlying diagnosis that led to the primary THA was primary osteoarthritis in 43 hips, avascular necrosis in 4, developmental hip dysplasia in 3, rheumatoid arthritis in 3 and post-traumatic osteoarthritis in 1. RESULTS One cup was revised for deep infection; at surgery, the cup showed osseointegration. At a mean follow-up of 15.6 years (range, 15-16 years), the survivorship with cup revision for aseptic loosening as end point was 100%. There was no radiographic evidence of loosening, migration, or gross polyethylene wear at last follow-up. The mean Harris Hip Scores improved from 47 points preoperatively to 94 points. CONCLUSION The porous tantalum monoblock cup in primary THA demonstrated excellent clinical and radiographic outcomes with no failures because of osteolysis or loosening at a minimum follow-up of 15 years.
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Affiliation(s)
- Ivan De Martino
- Adult Reconstruction and Joint Replacement Division, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Vincenzo De Santis
- Orthopedic Surgery Division, Department of Geriatrics, Neurosciences, and Orthopedics, Catholic University of the Sacred Heart, Agostino Gemelli University Hospital, Roma, Lazio, Italy
| | - Peter K Sculco
- Adult Reconstruction and Joint Replacement Division, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Rocco D'Apolito
- Orthopedic Surgery Division, Department of Geriatrics, Neurosciences, and Orthopedics, Catholic University of the Sacred Heart, Agostino Gemelli University Hospital, Roma, Lazio, Italy
| | - Lazaros A Poultsides
- Adult Reconstruction and Joint Replacement Division, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Giorgio Gasparini
- Orthopedic Surgery Division, Department of Medical and Surgical Sciences, University of Catanzaro Magna Græcia, Catanzaro, Calabria, Italy
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Hamai S, Nakashima Y, Mashima N, Yamamoto T, Kamada T, Motomura G, Imai H, Fukushi JI, Miura H, Iwamoto Y. Comparison of 10-year clinical wear of annealed and remelted highly cross-linked polyethylene: A propensity-matched cohort study. J Mech Behav Biomed Mater 2015; 59:99-107. [PMID: 26751705 DOI: 10.1016/j.jmbbm.2015.12.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Revised: 12/15/2015] [Accepted: 12/17/2015] [Indexed: 10/22/2022]
Abstract
No previous studies comparing the clinical wear rates of the two different kinds of cross-linked ultra-high-molecular-weight polyethylene (XLPE), annealed and remelted, are available. We compared the creep and steady wear rates of 36 matched pairs (72 hips in total) adjusting for baseline characteristics with propensity score matching techniques. Zirconia femoral heads with 26-mm diameter were used in all cases. The femoral-head cup penetration was measured digitally on radiographs. Significantly greater creep (p=0.006) was detected in the remelted (0.234mm) than annealed (0.159mm) XLPE. However, no significant difference (p=0.19) was found between the steady wear rates (0.003 and 0.008mm/year, respectively) of the annealed and remelted XLPE. Multiple regression analyses showed that remelted XLPE is significant independent variable (p<0.001) that is positively associated with creep. However, the patient age and body weight, cup size, the liner thickness, cup inclination, follow-up periods, and postoperative Merle d'Aubigné hip score had no significant effects (p>0.05) on the steady wear rates. No patients exhibited above the osteolysis threshold of 0.1mm/year, progressive radiolucencies, osteolysis, or polyethylene fracture. This propensity-matched cohort study document no significant difference in wear resistant performances of annealed and remelted XLPE over an average period of 10 years.
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Affiliation(s)
- Satoshi Hamai
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan; Department of Artificial Joints and Biomaterials, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
| | - Naohiko Mashima
- Department of Bone and Joint Surgery, Graduate School of Medicine, Ehime University, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Takuaki Yamamoto
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Tomomi Kamada
- Department of Bone and Joint Surgery, Graduate School of Medicine, Ehime University, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Goro Motomura
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Hiroshi Imai
- Department of Bone and Joint Surgery, Graduate School of Medicine, Ehime University, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Jun-Ichi Fukushi
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Hiromasa Miura
- Department of Bone and Joint Surgery, Graduate School of Medicine, Ehime University, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Yukihide Iwamoto
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
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Craiovan B, Wörner M, Maderbacher G, Grifka J, Renkawitz T, Keshmiri A. Difference in periprosthetic acetabular bone mineral density: Prior total hip arthroplasty: Osteonecrosis of the femoral head versus primary osteoarthritis. Orthop Traumatol Surg Res 2015; 101:797-801. [PMID: 26454412 DOI: 10.1016/j.otsr.2015.08.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Revised: 08/14/2015] [Accepted: 08/25/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Total hip arthroplasty (THA) could be associated with a higher failure rate in patients after osteonecrosis of the femoral head (ONFH) compared to a patient population with primary osteoarthritis prior THA, especially regarding the acetabular component. One major reason could be the compromised acetabular bone quality. Therefore, we performed a retrospective case matched study to assess: 1) Is there a difference in periprosthetic bone mineral density between patients with an ONFH prior THA and controls? 2) Do patients with an ONFH prior THA have a lower bone mineral density compared to controls? 3) Which region in the periprosthetic bone stock is more likely to present differences in periprosthetic bone mineral density between both groups? HYPOTHESIS We hypothesized that there is a poorer bone mineral density (BMD) in the periacetabular bone stock in patients with an ONFH prior THA compared to controls receiving a THA due to primary osteoarthritis. PATIENTS AND METHODS We compared the BMD of 50 patients with ONFH to 50 controls with primary osteoarthritis prior THA using the same implant in mean 5 years after surgery by means of dual energy X-ray absorptiometry (DXA). We analysed 3 acetabular ROIs according to DeLee and Charnley in a modified measurement technique. RESULTS In ROI 3, representing acetabulum's upper aspect, statistically significant lower BMD values for the ONFH group could be found (P < 0.05). No difference was found for the modified ROIs 1 and 2 (respectively medial and lower acetabulum). DISCUSSION The results indicate a poorer periacetabular BMD in patients with ONFH prior THA, which might be responsible for premature loosening of the acetabular cup in THA. Due to a lack of literature, further clinical investigations are required to confirm our results. LEVEL OF EVIDENCE III: retrospective case-control study.
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Affiliation(s)
- B Craiovan
- Department of Orthopaedic Surgery, University of Regensburg, Kaiser-Karl-V Allee 3, 93077 Bad Abbach, Germany
| | - M Wörner
- Department of Orthopaedic Surgery, University of Regensburg, Kaiser-Karl-V Allee 3, 93077 Bad Abbach, Germany
| | - G Maderbacher
- Department of Orthopaedic Surgery, University of Regensburg, Kaiser-Karl-V Allee 3, 93077 Bad Abbach, Germany
| | - J Grifka
- Department of Orthopaedic Surgery, University of Regensburg, Kaiser-Karl-V Allee 3, 93077 Bad Abbach, Germany
| | - T Renkawitz
- Department of Orthopaedic Surgery, University of Regensburg, Kaiser-Karl-V Allee 3, 93077 Bad Abbach, Germany
| | - A Keshmiri
- Department of Orthopaedic Surgery, University of Regensburg, Kaiser-Karl-V Allee 3, 93077 Bad Abbach, Germany.
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Wegrzyn J, Kaufman KR, Hanssen AD, Lewallen DG. Performance of Porous Tantalum vs. Titanium Cup in Total Hip Arthroplasty: Randomized Trial with Minimum 10-Year Follow-Up. J Arthroplasty 2015; 30:1008-13. [PMID: 25765132 DOI: 10.1016/j.arth.2015.01.013] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 01/05/2015] [Accepted: 01/11/2015] [Indexed: 02/01/2023] Open
Abstract
Porous tantalum monoblock cups have been proposed to improve survivorship of cementless primary THA. However, there are few direct comparative trials to established implants such as porous-coated titanium cups. 113 patients were randomized into two groups according to the cup: a porous tantalum monoblock cup (TM) or a porous-coated titanium monoblock cup (control). At a mean of 12 years after THA, no implants migrated in both groups. Two TM patients (4%) and 13 control patients (33%) presented with radiolucency around the cup (P<0.001). In the control group, 1 cup (2%) was revised for aseptic loosening. At 12 years post-implantation, porous tantalum monoblock cups demonstrated 100% survivorship, and significantly less radiolucency as compared to porous-coated titanium monoblock cups.
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Affiliation(s)
- Julien Wegrzyn
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Kenton R Kaufman
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Arlen D Hanssen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - David G Lewallen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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Kamada T, Mashima N, Nakashima Y, Imai H, Takeba J, Miura H. Mid-term clinical and radiographic outcomes of porous tantalum modular acetabular components for hip dysplasia. J Arthroplasty 2015; 30:607-10. [PMID: 25443360 DOI: 10.1016/j.arth.2014.11.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Revised: 10/15/2014] [Accepted: 11/01/2014] [Indexed: 02/01/2023] Open
Abstract
It is still challenging to perform successful cementless cup fixation during total hip arthroplasty for hip dysplasia. In this multicenter study we evaluated the clinical results of porous tantalum modular acetabular cups (TM cups) in 45 dysplastic hips with a mean follow-up period of 9.8 years. The mean Japanese Orthopaedic Association hip score improved from 48.2 preoperatively to 92.1 at the most recent follow-up. All of the cups were radiographically stable with no evidence of progressive radiolucencies or osteolysis regardless of bone grafting. Sixteen hips with bone grafts showed the integration of grafted bone without any radiolucencies. There were no revisions of TM cups. The use of TM cups for dysplastic hips provided satisfactory 10-year clinical and radiographic results.
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Affiliation(s)
- Tomomi Kamada
- Department of Bone and Joint Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, Japan
| | - Naohiko Mashima
- Department of Bone and Joint Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Kyushu University School of Medicine, 1-3-3 Maidashi, Higashi-ku, Fukuoka, Japan
| | - Hiroshi Imai
- Department of Bone and Joint Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, Japan
| | - Jun Takeba
- Department of Bone and Joint Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, Japan
| | - Hiromasa Miura
- Department of Bone and Joint Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, Japan
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Loures EDA, Simoni LF, Leite ICG, Loures DN, Loures CN. Análise preliminar do componente acetabular de titânio plasma‐spray MD‐4®. Rev Bras Ortop 2015. [DOI: 10.1016/j.rbo.2014.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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de Araújo Loures E, Simoni LF, Leite ICG, Loures DN, Loures CN. Preliminary analysis on the MD-4® plasma-sprayed titanium acetabular component. REVISTA BRASILEIRA DE ORTOPEDIA (ENGLISH EDITION) 2015; 50:206-13. [PMID: 26229918 PMCID: PMC4519615 DOI: 10.1016/j.rboe.2015.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 02/24/2014] [Indexed: 11/22/2022]
Abstract
Objectives To evaluate the short-term performance of a type of implant manufactured in Brazil. Methods This study analyzed a cohort of 60 patients who underwent implantation of MD-4® acetabular components during primary hip arthroplasty procedures performed between January 1, 2010, and August 1, 2012. The patients were studied retrospectively with regard to clinical behavior, stability and radiological osseointegration. The patients were followed up for a minimum of 12 months and a maximum of 42 months (mean: 27) and were evaluated by means of the Harris Hip Score, SF-36 questionnaire and serial conventional radiographs. Results All the components were radiologically stable, without evidence of migration or progressive radiolucency lines. On average, the Harris Hip Score evolved from 36.1 to 92.1 (p < 0.001) and the SF-36 showed significant increases in all its domains (p < 0.001). No differences were observed among patients with osteoarthrosis, osteonecrosis, hip dysplasia or other conditions. Conclusions The short-term results showed clinical and radiological signs of stability and osseointegration of the implants, which may represent a predictive factor regarding medium-term survival of this acetabular component.
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Goriainov V, Cook R, M. Latham J, G. Dunlop D, Oreffo RO. Bone and metal: an orthopaedic perspective on osseointegration of metals. Acta Biomater 2014; 10:4043-57. [PMID: 24932769 DOI: 10.1016/j.actbio.2014.06.004] [Citation(s) in RCA: 116] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 06/02/2014] [Accepted: 06/04/2014] [Indexed: 12/12/2022]
Abstract
The area of implant osseointegration is of major importance, given the predicted significant rise in the number of orthopaedic procedures and an increasingly ageing population. Osseointegration is a complex process involving a number of distinct mechanisms affected by the implant bulk properties and surface characteristics. Our understanding and ability to modify these mechanisms through alterations in implant design is continuously expanding. The following review considers the main aspects of material and surface alterations in metal implants, and the extent of their subsequent influence on osseointegration. Clinically, osseointegration results in asymptomatic stable durable fixation of orthopaedic implants. The complexity of achieving this outcome through incorporation and balance of contributory factors is highlighted through a clinical case report.
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Schlee M, Pradies G, Mehmke W, Beneytout A, Stamm M, Meda RG, Kamm T, Poiroux F, Weinlich F, Canto Pingarron M, Crichton E, Poulet J, Bousquet P. Prospective, Multicenter Evaluation of Trabecular Metal‐Enhanced Titanium Dental Implants Placed in Routine Dental Practices: 1‐Year Interim Report From the Development Period (2010 to 2011). Clin Implant Dent Relat Res 2014; 17:1141-53. [DOI: 10.1111/cid.12232] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Markus Schlee
- Private Practice in Periodontology and Oral Implantology Forcheim Germany
| | - Guillermo Pradies
- Faculty of Dentistry Complutense University Madrid Spain
- Private Practice in Prosthodontics and Oral Implantology Madrid Spain
| | | | - Arnaud Beneytout
- Private Practice in Oral Surgery, Periodontology, and Oral Implantology Bordeaux France
| | - Matthais Stamm
- Private Practice in Oral Implantology and Periodontology Overath Germany
| | | | - Torsten Kamm
- Private Practice in Esthetic Dentistry, Periodontology, and Oral Implantology Baden‐Baden Germany
| | - Francois Poiroux
- Private Practice in Periodontology and Oral Implantology La Rochelle France
| | - Franz Weinlich
- Private Practice in General Dentistry and Oral Implantology Neu‐Isenburg Germany
| | | | - Eric Crichton
- Private Practice in Periodontology and Oral Implantology Houilles France
| | | | - Philippe Bousquet
- Periodontology and Implantology Montpellier University Béziers France
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Nunag P, Vun SH, Atiya S, Pillai A, Kurdy N. Surgical tip: Titanium foam blocks can simplify fusion of failed total ankle replacements. Foot (Edinb) 2014; 24:111-5. [PMID: 24994679 DOI: 10.1016/j.foot.2014.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Revised: 05/19/2014] [Accepted: 06/09/2014] [Indexed: 02/04/2023]
Abstract
Ankle arthrodesis following failed ankle replacements is a technically challenging task because of the large defect left behind after the prosthesis is removed. The usual practice is to use bulk grafts which are either autografts or allografts to fill the defect. We report our experience with the use of a titanium foam block specifically designed for fusion of failed ankle replacements. This particular method was chosen to avoid the technical difficulties and morbidities associated with the use of bulk autografts and allografts. We describe the surgical technique and early results in the first two cases performed in our unit. The satisfactory clinical and radiologic results in the two cases demonstrate the ability of the titanium foam block to simplify an otherwise complex procedure without compromising the outcome.
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Affiliation(s)
- Perrico Nunag
- University Hospital of South Manchester, UHSM, Department of Orthopaedics and Trauma, Foot and Ankle Surgery, Southmoor Road, Wythenshawe, Manchester M23 9LT, United Kingdom.
| | - Shen Hwa Vun
- University Hospital of South Manchester, UHSM, Department of Orthopaedics and Trauma, Foot and Ankle Surgery, Southmoor Road, Wythenshawe, Manchester M23 9LT, United Kingdom
| | - Sami Atiya
- University Hospital of South Manchester, UHSM, Department of Orthopaedics and Trauma, Foot and Ankle Surgery, Southmoor Road, Wythenshawe, Manchester M23 9LT, United Kingdom
| | - Anand Pillai
- University Hospital of South Manchester, UHSM, Department of Orthopaedics and Trauma, Foot and Ankle Surgery, Southmoor Road, Wythenshawe, Manchester M23 9LT, United Kingdom
| | - Nasser Kurdy
- University Hospital of South Manchester, UHSM, Department of Orthopaedics and Trauma, Foot and Ankle Surgery, Southmoor Road, Wythenshawe, Manchester M23 9LT, United Kingdom
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Outcome of porous tantalum acetabular components for Paprosky type 3 and 4 acetabular defects. J Arthroplasty 2014; 29:1318-22. [PMID: 24405625 DOI: 10.1016/j.arth.2013.12.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 11/26/2013] [Accepted: 12/04/2013] [Indexed: 02/01/2023] Open
Abstract
Porous tantalum acetabular implants provide a potential solution for dealing with significant acetabular bone loss. This study reviews 24 acetabular revisions using tantalum implants for Paprosky type 3 and 4 defects. The mean Harris Hip Score improved from 35 ± 19 (range, 4-71) to 88 ± 14 (range, 41-100), p < 0.0001. Postoperative radiographs showed radiolucent lines in 14 hips with a mean width of 1.3 ± 1.0 mm (range, 0.27-4.37 mm). No gaps enlarged and 71% of them disappeared at a mean of 13 ± 10 months (range, 3-29 months). At a mean follow-up of 37 ± 14 months (range, 24-66 months), 22 reconstructions showed radiograpic evidence of osseointegration (92%). The two failures were secondary to septic loosening. When dealing with severe acetabular bone loss, porous tantalum acetabular components show promising short-term results.
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Goriainov V, Jones A, Briscoe A, New A, Dunlop D. Do the cup surface properties influence the initial stability? J Arthroplasty 2014; 29:757-62. [PMID: 24269067 DOI: 10.1016/j.arth.2013.07.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 06/14/2013] [Accepted: 07/04/2013] [Indexed: 02/01/2023] Open
Abstract
This project tests the relationship between the acetabular cup surface characteristics and their initial stability by comparing uncemented (Trabecular Metal (TM) and Trilogy) and cemented polyethylene shells. We hypothesised that different surface properties of uncemented cups will influence the cup stability. Mounted directly onto host bone, TM and cemented cups were significantly more stable than Trilogy cups (P < 0.01), with minimal difference between TM and cemented cups (P > 0.1). On 100% graft bed, there was marginal difference between all three cup types (P > 0.1). Incremental cavitary and segmental defects resulted in reducing stability, with cemented cups being minimally more stable (P > 0.1). TM cups possess satisfactory initial stability in bone graft constructs. This study demonstrates that TM shells are marginally less stable than cemented cups in the absence of significant host bone contact.
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Affiliation(s)
| | - Andrew Jones
- Great Western Hospital, Swindon; University of Southampton
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Noiseux NO, Long WJ, Mabry TM, Hanssen AD, Lewallen DG. Uncemented porous tantalum acetabular components: early follow-up and failures in 613 primary total hip arthroplasties. J Arthroplasty 2014; 29:617-20. [PMID: 23993435 DOI: 10.1016/j.arth.2013.07.037] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 06/27/2013] [Accepted: 07/26/2013] [Indexed: 02/01/2023] Open
Abstract
Uncemented tantalum acetabular components were introduced in 1997. The purpose was to determine the 2- to 10-year results with this implant material in primary total hip arthroplasty. Our registry identified all primary total hip cases with porous tantalum cups implanted from 1997 to 2004. Clinical outcomes and radiographs were studied. 613 cases were identified. Seventeen percent of patients were lost to follow-up. Twenty-five reoperations were performed (4.4%). Acetabular cup removal occurred in 6 cases (1.2%). No cups were revised for aseptic loosening. Incomplete radiolucent lines were found on 9.3% of initial postoperative radiographs. At 2 years, 67% had resolved. Zero new radiolucent lines were detected. Two- to 10-year results of porous tantalum acetabular components for primary total hip arthroplasty demonstrate high rates of initial stability and apparent ingrowth.
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Schlee M, van der Schoor WP, van der Schoor ARM. Immediate loading of trabecular metal-enhanced titanium dental implants: interim results from an international proof-of-principle study. Clin Implant Dent Relat Res 2013; 17 Suppl 1:e308-20. [PMID: 23899206 DOI: 10.1111/cid.12127] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES A 3-year proof-of-principle study was initiated to evaluate the clinical efficacy of immediately loading titanium dental implants with surfaces enhanced with porous tantalum trabecular metal (PTTM). First-year interim results are presented. MATERIALS AND METHODS Healthy, partially edentulous patients (n = 30) were enrolled and treated per protocol (minimum insertion torque: ≥35 Ncm) with 37 implants placed in one or two premolar or molar locations in either jaw (study group). Implants were immediately provisionalized out of occlusion with single acrylic crowns. After 7 to 14 days of soft tissue healing, implants were definitively restored in occlusion with ceramometal crowns. Because most study group implants (54.1%, n = 20) had less than 1 year of clinical follow-up, this interim analysis was limited to the first 22 consecutively placed implants in 17 subjects (10 women and 7 men) who completed 1 year of clinical follow-up to date (focus group). RESULTS To date, one implant failed to integrate in the study group (survival = 97.3%, n = 36/37). Focus group implants achieved 100% (n = 22/22) survival with 0.43 ± 0.41 mm of mean marginal bone loss. There were no serious complications. CONCLUSION Early clinical findings indicated that immediate loading of PTTM implants was safe and effective under the controlled study conditions.
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Affiliation(s)
- Marcus Schlee
- Private practice in implantology and periodontology, Forchheim, Germany; Department of Oral Surgery, Goethe University, Frankfurt, Germany
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Naziri Q, Issa K, Pivec R, Harwin SF, Delanois RE, Mont MA. Excellent results of primary THA using a highly porous titanium cup. Orthopedics 2013; 36:e390-4. [PMID: 23590774 DOI: 10.3928/01477447-20130327-10] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Cementless acetabular cups for primary total hip arthroplasty have had excellent results, with failure rates typically less than 5% at up to 10-year follow-up. Tritanium is a 3-dimensional metal interface that has been used for porous biological fixation. The purpose of this study was to review the clinical and radiographic results of the use of Tritanium cups (Stryker Orthopaedics, Mahwah, New Jersey) for primary total hip arthroplasty. Two hundred eighty-eight total hip arthroplasties performed using a porous titanium acetabular cup in 252 patients between 2008 and 2010 were reviewed. One hundred thirty-three men and 119 women with a mean age of 58 years (range, 18-88 years) were included. Mean follow-up was 36 months (range, 24-56 months). Outcomes evaluated were implant survivorship, Harris Hip Score, complications, and radiographic outcomes. At final follow-up, no cup failures had occurred. Mean Harris Hip Score improved from 53 points (range, 33-82 points) preoperatively to 91 points (range, 64-100 points) postoperatively. One complication occurred; a 64-year-old woman with recurrent postoperative effusions underwent hip exploration and required abductor mechanism repair. On radiologic evaluation, no signs existed of progressive radiolucencies or changes in cup position. The survivorship of the Tritanium cup and the low complication rate is comparable with previous studies using other porous-metal prostheses. Longer follow-up study is needed and assessment of the results of using this implant in the revision setting is important.
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Affiliation(s)
- Qais Naziri
- Center for Joint Preservation and Reconstruction, Rubin Institute for Advanced Orthopedics, Sinai Hospital, Baltimore, MD 21215, USA
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Small SR, Berend ME, Howard LA, Rogge RD, Buckley CA, Ritter MA. High initial stability in porous titanium acetabular cups: a biomechanical study. J Arthroplasty 2013; 28:510-6. [PMID: 23142455 DOI: 10.1016/j.arth.2012.07.035] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Revised: 06/08/2012] [Accepted: 07/27/2012] [Indexed: 02/06/2023] Open
Abstract
Initial stability with limited micromotion in uncemented total hip arthroplasty acetabular components is essential for bony attachment and long-term biomechanical fixation. This study compared porous titanium fixation surfaces to clinically established, plasma-sprayed designs in terms of interface stability and required seating force. Porous plasma-sprayed modular and metal-on-metal (MOM) cups were compared to a modular, porous titanium designs. Cups were implanted into polyurethane blocks with1-mm interference fit and subsequently edge loaded to failure. Porous titanium cups exhibited 23% to 65% improvement in initial stability when compared to plasma-sprayed cup designs (P=.01): a clinically significant increase, based on experience and prior literature. The results of this study indicate increased interface stability in porous titanium-coated cups without significantly increasing the necessary force and energy required for full seating.
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Affiliation(s)
- Scott R Small
- Joint Replacement Surgeons of Indiana Foundation, Inc., Mooresville, Indiana, USA
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Gomes B, Olsen M, Donnelly M, Kumar A, Schemitsch EH. Should we worry about periacetabular interference gaps in hip resurfacing? Clin Orthop Relat Res 2013; 471. [PMID: 23179114 PMCID: PMC3549186 DOI: 10.1007/s11999-012-2665-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Press-fit acetabular component seating in hip resurfacing can be challenging as a strong interference fit is required. It has not been established whether reducing the acetabular underream minimizes incomplete component seating or leads to increased acetabular loosening. QUESTIONS/PURPOSES We examined (1) the incidence and natural history of postoperative interference gaps in hip resurfacing and (2) whether reduction of the acetabular underream from 2 mm to 1 mm reduces the incidence of periacetabular interference gaps. METHODS Of 327 Birmingham Hip™ Resurfacings (Smith & Nephew Inc, Memphis, TN, USA) performed by a single surgeon from 2005 to 2010, we evaluated 306 hips with a minimum 1-year radiographic followup. Postoperative periacetabular interference gaps were monitored for radiographic gap resolution at latest followup. The frequency of incomplete component seating was compared between acetabula prepared with 1- and 2-mm underream techniques. Minimum followup was 1 year (mean, 2.7 years; range, 1-6 years). RESULTS Fifty-one percent of the postoperative radiographs demonstrated the presence of a periacetabular interference gap. At latest followup, 96% of these gaps were no longer visible. We observed a reduction in the number of interference gaps identified when acetabular preparation changed from a 2-mm underream (63%) to a 1-mm underream (39%). There were no revisions due to acetabular failure. CONCLUSIONS Periacetabular interference gaps were common in this series but not associated with acetabular component failure. The use of a 1-mm underream is sufficient for adequate short-term press-fit fixation of the acetabular component in Birmingham Hip™ Resurfacing arthroplasty. LEVEL OF EVIDENCE Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Bruno Gomes
- />Division of Orthopaedic Surgery, Department of Surgery, St Michael’s Hospital, Room 800, 55 Queen Street East, Toronto, ON M5C1R6 Canada
| | - Michael Olsen
- />Martin Orthopaedic Biomechanics Laboratory, St Michael’s Hospital, University of Toronto, Li Ka Shing Knowledge Institute, Toronto, ON Canada
| | - Michael Donnelly
- />Division of Orthopaedic Surgery, Department of Surgery, St Michael’s Hospital, Room 800, 55 Queen Street East, Toronto, ON M5C1R6 Canada
| | - Ashesh Kumar
- />Division of Orthopaedic Surgery, Department of Surgery, St Michael’s Hospital, Room 800, 55 Queen Street East, Toronto, ON M5C1R6 Canada
| | - Emil H. Schemitsch
- />Division of Orthopaedic Surgery, Department of Surgery, St Michael’s Hospital, Room 800, 55 Queen Street East, Toronto, ON M5C1R6 Canada
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Abstract
BACKGROUND Smoking is considered a risk factor for surgical complications in total hip arthroplasty (THA) and has been linked to a higher rate of aseptic loosening in uncemented acetabular components. Acetabular reconstruction with newer ultraporous metals in both complex primary and revision THA has increased survivorship but it is unclear whether smoking affects survival of these implants. QUESTIONS/PURPOSES We reviewed our early experience with THA using ultraporous acetabular components to assess the incidence and etiology of early failure and examine if any preoperative variables, including smoking, related to failure. METHODS We used ultraporous acetabular components in 498 patients (534 hips), beginning with one case each in 1999 and 2004, 17 in 2005, and the majority from 2006 through March 2010. There were 159 complex primary and 375 revision cases. Of these patients, 17% were smokers (averaging 35 pack-years), 31% previous smokers (averaging 29 pack-years), 41% nonsmokers, and 1% unknown. Failure modes possibly related to smoking were infection, aseptic loosening, or periacetabular fracture and unrelated were dislocation and implant breakage. Minimum followup was 1 month (average, 32 months; range, 1-78 months). RESULTS There were 34 cup failures (6%): 17 infections, 14 aseptic loosening, and one each liner breakage, dislocation, and periacetabular fracture. The failure rate (uncontrolled for potentially confounding variables) was 10% in both current (9 of 89) and prior smokers (17 of 167) and 3% in nonsmokers 8 of 271). CONCLUSION With ultraporous metal technology in complex primary and revision THA, smoking, both past and current, may be a risk factor for early failure. LEVEL OF EVIDENCE Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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