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Schaffler BC, Raymond HE, Black CS, Habibi AA, Ehlers M, Duncan ST, Schwarzkopf R. Two-Year Outcomes of Novel Dual-Mobility Implant in Primary Total Hip Arthroplasty. Adv Orthop 2024; 2024:4125965. [PMID: 38264013 PMCID: PMC10805547 DOI: 10.1155/2024/4125965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 12/11/2023] [Accepted: 01/03/2024] [Indexed: 01/25/2024] Open
Abstract
Introduction Dual-mobility (DM) implants for total hip arthroplasty (THA) have gained popularity due to their potential to reduce hip instability and dislocation events that may lead to revision surgery. These implants consist of a femoral head articulated within a polyethylene liner, which articulates within an outer acetabular shell, creating a dual-bearing surface. Our study aimed to report our observations on the survivorship of a novel DM implant for primary total hip arthroplasty at two years. Methods We conducted a retrospective, multicenter study to assess the clinical outcomes of patients undergoing a THA with a novel DM implant (OR3O acetabular system™, Smith & Nephew, Inc., Memphis, TN) from January 2020 to September 2021. Patient demographics, surgical information, and survivorship data were collected from medical records for patients with a minimum of two years of follow-up. Primary outcomes included overall implant survivorship at two years as well as aseptic survivorship, revision rates of the DM acetabular shell, and average time to revision. Patient-reported outcomes were collected in the form of HOOS JR. Results A total of 250 hips in 245 patients had a minimum two-year follow-up. Primary osteoarthritis (80%) was the most common indication for index THA. The average aseptic survivorship of the DM acetabular components at two years for the cohort was 98.4% and survivorship of the acetabular implants overall was 97.6%. There were a total of four (1.6%) aseptic revisions of the DM acetabular component. Reasons for aseptic acetabular revision included one case of instability, one intraprosthetic dislocation, one periprosthetic acetabular fracture, and one malpositioned acetabular cup resulting in impingement. The mean time of follow-up was 893.9 days. Eighty-seven patients had preoperative and two-year HOOS JR available. HOOS JR improved by an average of 38.5 points. Conclusion This novel DM acetabular implant demonstrates excellent survivorship at two years follow-up with low rates of instability and intraprosthetic dislocation and no episodes of metal-on-metal corrosion. Use of the DM implant demonstrated clinically relevant improvements in patient-reported outcomes at two years.
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Affiliation(s)
| | | | - Collin S. Black
- University of Kentucky, Department of Orthopaedic Surgery, Lexington, KY, USA
| | - Akram A. Habibi
- New York University Langone Orthopedic Hospital, New York, NY, USA
| | - Mallory Ehlers
- New York University Langone Orthopedic Hospital, New York, NY, USA
| | - Stephen T. Duncan
- University of Kentucky, Department of Orthopaedic Surgery, Lexington, KY, USA
| | - Ran Schwarzkopf
- New York University Langone Orthopedic Hospital, New York, NY, USA
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Schulze F, Perino G, Rakow A, Wassilew G, Schoon J. Noninfectious tissue interactions at periprosthetic interfaces. ORTHOPADIE (HEIDELBERG, GERMANY) 2023; 52:186-195. [PMID: 36853395 DOI: 10.1007/s00132-023-04352-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/24/2023] [Indexed: 03/01/2023]
Abstract
The success of hip arthroplasty is based on modern materials in addition to the continuous development of surgical techniques and clinical experience gained over six decades. The biocompatible implant materials used in hip arthroplasty can be textured or coated with biomimetic surfaces to ensure durable component ingrowth and moderate host response. Material integrity plays a critical role in the durability of the stable interface between implant components and periprosthetic tissues. Inflammation at the interfaces due to the release of degradation products from the implant materials is one of the causes of hip arthroplasty failure. This review summarizes the implant materials currently used in hip arthroplasty, their preclinical testing and the postoperative neogenesis of periprosthetic tissues, and the interactions of periprosthetic bone and the implant materials at the periprosthetic interfaces.
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Affiliation(s)
- Frank Schulze
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, F.-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - Giorgio Perino
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, F.-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - Anastasia Rakow
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, F.-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - Georgi Wassilew
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, F.-Sauerbruch-Straße, 17475, Greifswald, Germany.
| | - Janosch Schoon
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, F.-Sauerbruch-Straße, 17475, Greifswald, Germany
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Park JW, Kim HS, Park S, Kim SH, Lee YK, Koo KH. Trends in Surgical Treatment of Femoral Head Osteonecrosis in South Korea: An Analysis Using Nationwide Claims Database. Clin Orthop Surg 2022; 14:500-506. [PMID: 36518932 PMCID: PMC9715925 DOI: 10.4055/cios22027] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 02/16/2022] [Accepted: 02/16/2022] [Indexed: 08/30/2023] Open
Abstract
BACKGROUND Osteonecrosis of the femoral head (ONFH) involves young or middle-aged adults, and its incidence is increasing along with increasing use of steroids in the management of organ transplantation and adjuvant therapy for malignant neoplasms. To date, no pharmacological agent has been proven to prevent or retard the progression of ONFH, and surgical procedures including joint preservation procedures and hip arthroplasties are main treatments for the disease. Although ONFH is the most common or second most common disease for hip arthroplasty in East Asian countries, the trend of surgical procedures in this region remains unknown. Thus, we evaluated trends in surgical treatment of the disease in South Korea. METHODS We identified patients with ONFH from the Korean Health Insurance Review and Assessment (HIRA) database, a nationwide medical claims database of South Korea, between January 2007 and December 2018 and calculated the proportions of following surgical procedures at each year: total hip arthroplasty (THA), hemiarthroplasty (HA), core decompression/multiple drilling, femoral osteotomy, and vascularized bone grafting. RESULTS The total number of procedures increased from 3,824 in 2007 to 6,929 in 2018. Overall, the rate of THA (86%) was far greater than other procedures. From 2007 to 2018, the percentage of THA among the procedures increased from 80% to 91%, while that of joint preservation procedures decreased from 11% to 5%. CONCLUSIONS The total number of surgical procedures performed for ONFH increased and the percentage of THA increased, while that of joint preservation procedures decreased from 2007 to 2018 in South Korea.
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Affiliation(s)
- Jung-Wee Park
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hong-Seok Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Sojeong Park
- Data Science Team, Pharmaceutical. Co., Ltd., Seoul, Korea
| | - Sung Hwa Kim
- Department of Biostatistics, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Young-Kyun Lee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung-Hoi Koo
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
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Kayani B, Baawa-Ameyaw J, Fontalis A, Tahmassebi J, Wardle N, Middleton R, Stephen A, Hutchinson J, Haddad FS. Oxidized zirconium versus cobalt-chrome femoral heads in total hip arthroplasty: a multicentre prospective randomized controlled trial with ten years' follow-up. Bone Joint J 2022; 104-B:833-843. [PMID: 35775177 DOI: 10.1302/0301-620x.104b7.bjj-2021-1673.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS This study reports the ten-year wear rates, incidence of osteolysis, clinical outcomes, and complications of a multicentre randomized controlled trial comparing oxidized zirconium (OxZr) versus cobalt-chrome (CoCr) femoral heads with ultra-high molecular weight polyethylene (UHMWPE) and highly cross-linked polyethylene (XLPE) liners in total hip arthroplasty (THA). METHODS Patients undergoing primary THA were recruited from four institutions and prospectively allocated to the following treatment groups: Group A, CoCr femoral head with XLPE liner; Group B, OxZr femoral head with XLPE liner; and Group C, OxZr femoral head with UHMWPE liner. All study patients and assessors recording outcomes were blinded to the treatment groups. The outcomes of 262 study patients were analyzed at ten years' follow-up. RESULTS Patients in Group C were associated with increased mean liner wear rates compared to patients in Group A (0.133 mm/yr (SD 0.21) vs 0.031 mm/yr (SD 0.07), respectively; p < 0.001) and Group B (0.133 mm/yr (SD 0.21) vs 0.022 mm/yr (SD 0.05), respectively; p < 0.001) at ten years' follow-up. Patients in Group C were also associated with increased risk of osteolysis and aseptic loosening requiring revision surgery, compared with patients in Group A (7/133 vs 0/133, respectively; p = 0.007) and Group B (7/133 vs 0/135, respectively; p = 0.007). There was a non-statistically significant trend towards increased mean liner wear rates in Group A compared with Group B (0.031 mm/yr (SD 0.07) vs 0.022 mm/yr (SD 0.05), respectively; p = 0.128). All three groups were statistically comparable preoperatively and at ten years' follow-up when measuring normalized Western Ontario and McMaster Universities Osteoarthritis Index (p = 0.410), 36-Item Short Form Health Survey (p = 0.465 mental, p = 0.713 physical), and pain scale scores (p = 0.451). CONCLUSION The use of UHMWPE was associated with progressively increased annual liner wear rates after THA compared to XLPE. At ten years' follow-up, the group receiving UHMWPE demonstrated an increased incidence of osteolysis and aseptic loosening requiring revision surgery compared to XLPE. Femoral heads composed of OxZr were associated with trend towards reduced wear rates compared to CoCr, but this did not reach statistical significance and did not translate to any differences in osteolysis, functional outcomes, or revision surgery between the two femoral head components. Cite this article: Bone Joint J 2022;104-B(7):833-843.
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Affiliation(s)
- Babar Kayani
- Department of Trauma and Orthopaedics, University College Hospital, London, UK
| | - Joanna Baawa-Ameyaw
- Department of Trauma and Orthopaedics, University College Hospital, London, UK
| | - Andreas Fontalis
- Department of Trauma and Orthopaedics, University College Hospital, London, UK
| | - Jenni Tahmassebi
- Department of Trauma and Orthopaedics, University College Hospital, London, UK
| | - Nick Wardle
- Colchester Hospital University Foundation Trust, Colchester, UK
| | - Robert Middleton
- Department of Trauma and Orthopaedics, Bournemouth University, Bournemouth, UK
| | | | | | - Fares S Haddad
- Department of Trauma and Orthopaedics, University College Hospital, London, UK
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Campbell DG, Callary SA. Highly Crosslinked Polyethylene Liners Have Negligible Wear at 10 Years: A Radiostereometric Analysis Study. Clin Orthop Relat Res 2022; 480:485-491. [PMID: 34596603 PMCID: PMC8846270 DOI: 10.1097/corr.0000000000002002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 09/15/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND The introduction of crosslinked ultra-high molecular weight polyethylene (XLPE) acetabular liners has been very successful, with decreased wear and reduction in the rates of revision hip arthroplasties. XLPE is the preferred articulation for most surgeons; however, there are concerns about the long-term performance of XLPE liners created with different manufacturing processes, which may lead to time-dependent failure, including accelerated wear, after several years. QUESTIONS/PURPOSES (1) What is the amount and rate of wear during the first 10 years using radiostereometric analysis (RSA) measurements of patients who had THAs that included a second-generation XLPE bearing? (2) Does the rate of wear change after 5 years in situ? METHODS This is a brief follow-up of a previous RSA study. In that study, we prospectively enrolled 21 patients with osteoarthritis who underwent primary cementless THA with an XLPE acetabular liner (three cycles of 3Mrad annealed) and 32-mm articulation. That group represented 44% of the 48 THAs performed by the surgeon at the hospital where RSA was available; 16 had cemented hips, leaving 32 who were invited to participate in this study. Of those, 11 lived rurally and declined to participate, leaving 21 patients who were included in the initial study. Since then, three patients died, one developed dementia and could not participate, and one had revision THA for reasons other than wear, leaving 16 patients available for analysis at 10 years. Tantalum markers were inserted during surgery, and all patients had RSA radiographs taken at 1 week, 6 months, and 1, 2, 5, and 10 years postoperatively. Femoral head penetration into the acetabular component was measured with RSA, including bedding-in during the first year and annual wear thereafter. RESULTS The median medial, proximal, anterior, two-dimensional (2D), and three-dimensional (3D) wear rates between 1 and 10 years were -0.001, 0.004, -0.012, 0.000, and 0.002 mm/year, respectively. No patient in this cohort had a proximal or 2D wear rate greater than 0.025 mm/year. The median proximal wear rate between 5 and 10 years (0.002 mm/year) was not greater than wear at 1 to 5 years (0.004 mm/year). CONCLUSION Femoral head penetration in this second-generation XLPE liner remained very low at 10 years and accelerated wear after 5 years in situ did not occur. Concerns about late-onset wear from oxidation of irradiated-annealed XLPE were not observed. The low level of wear remains encouraging for the future clinical performance of this material. LEVEL OF EVIDENCE Level II, therapeutic study.
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Affiliation(s)
- David G. Campbell
- Wakefield Orthopaedic Clinic, Adelaide, Australia
- Centre for Orthopaedic and Trauma Research, University of Adelaide, Adelaide, Australia
| | - Stuart A. Callary
- Centre for Orthopaedic and Trauma Research, University of Adelaide, Adelaide, Australia
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, Australia
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Karaismailoglu B, Karaismailoglu TN. Femoral Head Perforation After Primary Hip Arthroplasty: Unseen Complication of Ceramic-on-Ceramic Interface: A Case Report. JBJS Case Connect 2021; 11:01709767-202109000-00045. [PMID: 34319929 DOI: 10.2106/jbjs.cc.20.00551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 33-year-old woman, who underwent bilateral ceramic-on-ceramic total hip arthroplasty 3 years previously, presented with right groin pain and mechanical grinding without a history of trauma. Radiographs revealed luxation of the femoral head, and computerized tomography showed perforation of the ceramic femoral head. The patient underwent revision with a metal-on-polyethylene articulation and retained femoral stem. Two years of follow-up yielded good clinical outcome with no evidence of osteolysis or polyethylene wear. CONCLUSION The perforation of a ceramic femoral head should be kept in mind as one of the possible implant failure mechanisms after primary hip arthroplasty.
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Affiliation(s)
- Bedri Karaismailoglu
- Orthopaedics and Traumatology Department, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, İstanbul, Turkey
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Toh SMS, Ashkanfar A, English R, Rothwell G. Computational method for bearing surface wear prediction in total hip replacements. J Mech Behav Biomed Mater 2021; 119:104507. [PMID: 33862425 DOI: 10.1016/j.jmbbm.2021.104507] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/22/2021] [Accepted: 04/01/2021] [Indexed: 11/30/2022]
Abstract
Total hip replacement (THR) is a revolutionary treatment when a hip joint becomes severely damaged. Wear is known as one of the main reasons for THR failure. Current experimental techniques to investigate the wear at the bearing surfaces of THRs are time-consuming, complicated and expensive. In this study, an in-house fretting wear algorithm has been further developed to investigate the wear damage that occurs on bearing surfaces of THRs and its consequence on the longevity of the implants. A 3D finite element model has been created with a 36 mm diameter Cobalt-Chromium femoral head and a 4 mm thick cross-linked polyethylene bearing liner. A gait loading cycle was used to simulate walking for up to 5 million cycles (Mc). The wear algorithm extracts relative displacements and contact shear stresses from the finite element package to predict the linear and volumetric wear rates. This method is shown to have modelled the evolution of wear effectively and found it to be similar to those from experimental analyses. The linear and volumetric wear per million cycles predicted in this study were 0.0375mm/Mc and 33.6mm3/Mc which are comparable to those measured in-vivo THRs. The wear patterns obtained from this study are also comparable to the wear patterns shown on available conventional polyethylene liners. This method can be used to further aid in the design and clinical technique to reduce wear rate in THRs.
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Affiliation(s)
- Shawn Ming Song Toh
- School of Engineering, Liverpool John Moores University, Byrom Street, Liverpool, L3 3AF, UK.
| | - Ariyan Ashkanfar
- School of Engineering, Liverpool John Moores University, Byrom Street, Liverpool, L3 3AF, UK
| | - Russell English
- School of Engineering, Liverpool John Moores University, Byrom Street, Liverpool, L3 3AF, UK
| | - Glynn Rothwell
- School of Engineering, Liverpool John Moores University, Byrom Street, Liverpool, L3 3AF, UK
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Kretzer JP, Uhler M, Jäger S, Bormann T, Sonntag R, Schonhoff M, Schröder S. [Tribology in hip arthroplasty : Benefits of different materials]. DER ORTHOPADE 2021; 50:259-269. [PMID: 33630110 DOI: 10.1007/s00132-021-04077-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/01/2021] [Indexed: 11/30/2022]
Abstract
When it comes to total hip replacements, choosing the suitable material combination is of clinical relevance. The present review article examines the technical differences in wear and corrosion of the relevant material combinations of ceramics, metals, ceramized metals and various types of polyethylene. The material characteristics, which were often tested under standardized conditions in the laboratory, are compared with clinical results on the basis of evidence-graded clinical studies and on the basis of register studies. This article thus represents an up-to-date snapshot of the expectations and actual clinical outcomes of the present choice of material combinations. It shows that some tendencies from the field of materials research, e.g. with regard to cross-linked polyethylene, coincide with observations from practical clinical experience, while for other materials, a proven technical superiority has not yet been confirmed as an evident advantage in clinical practice.
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Affiliation(s)
- J Philippe Kretzer
- Klinik für Orthopädie und Unfallchirurgie, Labor für Biomechanik und Implantatforschung, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland.
| | - Maximilian Uhler
- Klinik für Orthopädie und Unfallchirurgie, Labor für Biomechanik und Implantatforschung, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| | - Sebastian Jäger
- Klinik für Orthopädie und Unfallchirurgie, Labor für Biomechanik und Implantatforschung, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| | - Therese Bormann
- Klinik für Orthopädie und Unfallchirurgie, Labor für Biomechanik und Implantatforschung, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| | - Robert Sonntag
- Klinik für Orthopädie und Unfallchirurgie, Labor für Biomechanik und Implantatforschung, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| | - Mareike Schonhoff
- Klinik für Orthopädie und Unfallchirurgie, Labor für Biomechanik und Implantatforschung, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| | - Stefan Schröder
- Klinik für Orthopädie und Unfallchirurgie, Labor für Biomechanik und Implantatforschung, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
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Batailler C, Caton J, Lustig S. Global perspective of Innovation in Hip and Knee Replacement in 2020. SICOT J 2020; 6:E1. [PMID: 33320807 PMCID: PMC7738158 DOI: 10.1051/sicotj/2020043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 10/12/2020] [Indexed: 01/11/2023] Open
Affiliation(s)
- Cécile Batailler
- FIFA Medical Center of Excellence, Orthopaedic Surgery and Sports Medicine Department, Croix Rousse Hospital, Civil Hospices of Lyon, 69004 Lyon, France - LBMC UMR T 9406, Laboratory of Chock Mechanics and Biomechanics, Claude Bernard Lyon 1 University, 69003 Lyon, France
| | - Jacques Caton
- Groupe Lépine, 175 rue Jacquard - CS 50307, 69727 Genay Cedex, France
| | - Sébastien Lustig
- FIFA Medical Center of Excellence, Orthopaedic Surgery and Sports Medicine Department, Croix Rousse Hospital, Civil Hospices of Lyon, 69004 Lyon, France - LBMC UMR T 9406, Laboratory of Chock Mechanics and Biomechanics, Claude Bernard Lyon 1 University, 69003 Lyon, France
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