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Maier K, Selig M, Haddouche A, Haunschild M, Hauschild O, Khalili I, Kirschberg J, Lutter C, Menges M, Mertl P, Niemeier A, Rubens-Duval B, Mittelmeier W. Vitamin E-enriched medium cross-linked polyethylene in total knee arthroplasty (VIKEP): clinical outcome, oxidation profile, and wear analysis in comparison to standard polyethylene-study protocol for a randomized controlled trial. Trials 2024; 25:27. [PMID: 38183062 PMCID: PMC10768156 DOI: 10.1186/s13063-023-07811-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 11/20/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND The gliding surface of total knee endoprostheses is exposed to high loads due to patient weight and activity. These implant components are typically manufactured from ultra-high molecular weight polyethylene (UHMWPE). Crosslinking of UHMWPE by ionizing radiation results in higher wear resistance but induces the formation of free radicals which impair mechanical properties after contact with oxygen. Medium-crosslinked UHMWPE enriched with vitamin E (MXE) provides a balance between the parameters for a sustainable gliding surface, i.e., mechanical strength, wear resistance, particle size, and oxidation stability. Therefore, a gliding surface for knee endoprostheses made up from this material was developed, certified, and launched. The aim of this study is to compare this new gliding surface to the established predecessor in a non-inferiority design. METHODS This multicenter, binational randomized controlled trial will enroll patients with knee osteoarthritis eligible for knee arthroplasty with the index device. Patients will be treated with a knee endoprosthesis with either MXE or a standard gliding surface. Patients will be blinded regarding their treatment. After implantation of the devices, patients will be followed up for 10 years. Besides clinical and patient-related outcomes, radiological data will be collected. In case of revision, the gliding surface will be analyzed biomechanically and regarding the oxidative profile. DISCUSSION The comparison between MXE and the standard gliding surface in this study will provide clinical data to confirm preceding biomechanical results in vivo. It is assumed that material-related differences will be identified, i.e., that the new material will be less sensitive to wear and creep. This may become obvious in biomechanical analyses of retrieved implants from revised patients and in radiologic analyses. TRIAL REGISTRATION ClinicalTrials.gov, NCT04618016. Registered 27 October 2020, https://clinicaltrials.gov/study/NCT04618016?term=vikep&checkSpell=false&rank=1 . All items from the World Health Organization Trial Registration Data Set can be found in Additional file 1.
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Affiliation(s)
- Kristin Maier
- Medical Scientific Affairs, Aesculap AG, Am Aesculap-Platz, 78532, Tuttlingen, Germany.
| | - Marius Selig
- Medical Scientific Affairs, Aesculap AG, Am Aesculap-Platz, 78532, Tuttlingen, Germany
| | - Andréa Haddouche
- Hopital Sud - CHU Grenoble, Avenue Kimberley, 38130, Echirolles, France
| | - Martin Haunschild
- Klinik Für Allgemeine Orthopädie, Endoprothetik Und Kinderorthopädie, Katholisches Klinikum Koblenz-Montabaur, Kardinal-Krementz-Str. 1-5, Koblenz-Montabaur, 56073, Germany
| | - Oliver Hauschild
- Department for Orthopedic and Trauma Surgery, Park-Klinik Weissensee, Schönstraße 80, Berlin, 13086, Germany
| | - Iman Khalili
- Krankenhaus Reinbek St. Adolf-Stift, Hamburger Straße 41, 21465, Reinbek, Germany
| | - Julia Kirschberg
- Waldkliniken Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany
| | - Christoph Lutter
- Orthopädische Klinik Und Poliklinik, Universitätsmedizin Rostock, Doberaner Str.142, 18057, Rostock, Germany
| | - Michael Menges
- Lukas Krankenhaus, Hindenburgstraße 56, 32257, Bünde, Germany
| | - Patrice Mertl
- CHU Amiens-Picardie, 1 Rond Point du Professeur Christian Cabrol, 80054, CEDEX 1, Amiens, France
| | - Andreas Niemeier
- Krankenhaus Reinbek St. Adolf-Stift, Hamburger Straße 41, 21465, Reinbek, Germany
| | | | - Wolfram Mittelmeier
- Orthopädische Klinik Und Poliklinik, Universitätsmedizin Rostock, Doberaner Str.142, 18057, Rostock, Germany
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Cho CH, Pijls BG, Abrahams JM, Roerink A, Katembwe R, Baker A, Solomon LB, Callary SA. Migration patterns of acetabular cups: a systematic review and meta-analysis of RSA studies. Acta Orthop 2023; 94:626-634. [PMID: 38157007 PMCID: PMC10757199 DOI: 10.2340/17453674.2023.24580] [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] [Received: 01/10/2023] [Accepted: 09/21/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND AND PURPOSE We conducted a systematic review and meta-analysis of RSA studies to investigate the early and long-term migration patterns of acetabular cups and the influence of implant factors on cup migration over time. METHODS We performed a systematic search of PubMed, Embase, and Scopus databases to identify all RSA studies of cup migration following primary total hip replacement (THR). Proximal migration at 3 and 6 months, 1, 2, 5, and 10 years were considered for analysis. Implant factors investigated included fixation type, head size, bearing surface, uncemented coating design, and the decade of RSA introduction. RESULTS 47 studies reported the proximal migration of 83 cohorts (2,328 cups). Besides 1 threaded cup design, no implant factor investigated was found to significantly influence proximal migration. The mean pooled 2-year proximal migration of cemented cups (0.14 mm, 95% confidence interval [CI] 0.08-0.20) was not significantly different from uncemented cups (0.12 mm, CI 0.04-0.19). The mean pooled proximal migration at 6 months was 0.11 mm (CI 0.06-0.16) and there was no significant increase between 6 months and 2 years (0.015 mm, CI 0.000-0.030). 27 of 75 cohorts (36%) reported mean proximal migration greater than 0.2 mm at 2 years, which has previously been identified as a predictor of implants at risk of long-term loosening. CONCLUSION Our meta-analysis demonstrated that the majority of cup migration occurs within the first 6 months. With one exception, no implant factors influenced the 2-year proximal migration of acetabular cups. 36% of studies with 2-year migration were considered at risk of long-term loosening. Further investigation and comparison against long-term survivorship data would validate 6-month and/or 1-year proximal migration measurements as an earlier predictor of long-term loosening than the current 2-year threshold.
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Affiliation(s)
- Chan Hee Cho
- Centre for Orthopaedic and Trauma Research, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia.
| | - Bart G Pijls
- Department of Orthopaedics, Leiden University Medical Centre, Leiden, Netherlands
| | - John M Abrahams
- Centre for Orthopaedic and Trauma Research, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia; Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Anne Roerink
- Department of Orthopaedics, Leiden University Medical Centre, Leiden, Netherlands
| | - Raissa Katembwe
- Centre for Orthopaedic and Trauma Research, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Andrew Baker
- Centre for Orthopaedic and Trauma Research, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Lucian B Solomon
- Centre for Orthopaedic and Trauma Research, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia; Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Stuart A Callary
- Centre for Orthopaedic and Trauma Research, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia; Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, SA, Australia
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Do MU, Moon NH, Suh KT, Kim JS, Lee SM, Shin WC. Safety of using a large femoral head on thin polyethylene for total hip arthroplasty based on different types of polyethylene. Sci Rep 2023; 13:22769. [PMID: 38123795 PMCID: PMC10733297 DOI: 10.1038/s41598-023-50217-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 12/16/2023] [Indexed: 12/23/2023] Open
Abstract
The use of a large femoral head in total hip arthroplasty (THA) to stabilize and reduce the incidence of dislocation is on the increase, but concerns arise when combining them with small acetabular components due to potential mechanical failures in thin polyethylene (PE) liners. A single-institution, retrospective cohort study was conducted on 116 patients with minimum 2-year follow-up who received 36-mm femoral heads and acetabular components ≤ 52 mm, using either remelted highly cross-linked polyethylene (remelted HXLPE) or vitamin E-infused HXLPE (VEPE). Osteolysis and implant loosening were not observed in either group. Although a fracture of the PE liner was observed in each group (1.7%), the clinical outcomes were excellent, as the mean modified Harris Hip Score (mHHS) at the last follow-up was 93.5. Moreover, the mean linear wear rates measured by digital imaging software in both groups were low, with 0.035 mm/y in remelted HXLPE and 0.030 mm/y in VEPE. In conclusion, The use of a large femoral head on a thin PE liner can be a viable treatment option in patients who need to prioritize stability; however, careful attention should be paid to mechanical fractures of the PE liner.
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Affiliation(s)
- Min Uk Do
- Department of Orthopedic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, 20 Geumo-ro, Mulgeum-eup, Yangsan, Gyeongsangnam-do, 626-770, Republic of Korea
| | - Nam Hoon Moon
- Department of Orthopedic Surgery, Pusan National University Hospital, Busan, Republic of Korea
| | - Kuen Tak Suh
- Department of Orthopedic Surgery, Sehung Hospital, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Jung Shin Kim
- Department of Orthopedic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, 20 Geumo-ro, Mulgeum-eup, Yangsan, Gyeongsangnam-do, 626-770, Republic of Korea
| | - Sang-Min Lee
- Department of Orthopedic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, 20 Geumo-ro, Mulgeum-eup, Yangsan, Gyeongsangnam-do, 626-770, Republic of Korea
| | - Won Chul Shin
- Department of Orthopedic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, 20 Geumo-ro, Mulgeum-eup, Yangsan, Gyeongsangnam-do, 626-770, Republic of Korea.
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Naito Y, Hasegawa M, Tone S, Wakabayashi H, Sudo A. Minimum 7-year results of cementless total hip arthroplasty with vitamin E-diffused and 2-methacryloyloxyethyl phosphorylcholine-grafted highly cross-linked polyethylene. Medicine (Baltimore) 2023; 102:e36257. [PMID: 38050300 PMCID: PMC10695485 DOI: 10.1097/md.0000000000036257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/01/2023] [Indexed: 12/06/2023] Open
Abstract
The purpose of this study was to evaluate the mid-term clinical results and polyethylene wear of vitamin E-diffused highly cross-linked polyethylene (HXLPE) and 2-methacryloyloxyethyl phosphorylcholine (MPC)-grafted HXLPE in cementless total hip arthroplasty (THA). Thirty-four THAs with vitamin E-diffused HXLPE (VEPE) and 32-mm cobalt-chromium head, and 116 THAs with MPC-grafted HXLPE and 32-mm alumina head were evaluated. The Merle d'Aubigné and Postel scores were administered. Kaplan-Meier survivorship was analyzed. Annual radiographs were analyzed using computerized method and linear steady-state wear rate was measured. The mean duration of follow-up was 9 years (range, 7-11 years) in VEPE group and 8 years (range, 7-10 years) in MPC group. The mean Merle d'Aubigné and Postel scores improved postoperatively in both groups. Kaplan-Meier survivorship with endpoint of revision was 100% (95% confidence interval, 100%-100%) in VEPE group and 98.3% (95% confidence interval, 93.4%-99.6%) in MPC group at 10 years (P = .44). The mean steady-state wear rate was 0.007 mm/year in VEPE group and 0.006 mm/year in MPC group (P = .60). The clinical results of both groups were good and wear rates of both liners were very low.
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Affiliation(s)
- Yohei Naito
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Masahiro Hasegawa
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Shine Tone
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Hiroki Wakabayashi
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Akihiro Sudo
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
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Matsuoka T, Takahashi Y, Ishida T, Tateiwa T, Shishido T, Yamamoto K. In vivo creep and wear performance of vitamin-E-diffused highly crosslinked polyethylene in total hip arthroplasty. Arch Orthop Trauma Surg 2023; 143:7195-7203. [PMID: 37438580 DOI: 10.1007/s00402-023-04972-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 06/26/2023] [Indexed: 07/14/2023]
Abstract
INTRODUCTION An acetabular liner thickness of around 6 mm remains the "gold standard" in total hip arthroplasty. Some surgeons have been recommending the use of the thickest possible liner because contact stress and strain in articulating surfaces decrease with increasing the wall thickness. The purpose of this study was to determine whether in vivo creep and wear performance could be enhanced using a thicker liner over the standard thickness in vitamin-E-diffused highly crosslinked polyethylene (HXLPE). MATERIALS AND METHODS One hundred and twenty-two hips were allocated to age-matched, sex-matched, and body mass index-matched two subgroups implanted either with a 6.8- or 8.9-mm-thick vitamin-E-diffused HXLPE liner against 28-mm cobalt-chrome femoral head, and followed-up for 7 years. Linear and volumetric penetration of femoral head into the liners attributed to creep and wear were analyzed for each group. RESULTS Compressive creep strain generated at the initial 6 months was significantly larger in the 6.8-mm group (2.6%) than in the 8.9-mm group (2.2%). The linear steady-state wear observed after 2 years was 0.0019 and 0.0015 mm/year, whereas the volumetric steady-state wear was 0.54 and 0.45 mm3/years in the 6.8- and 8.9-mm-thick groups, respectively. Although less strain in the thicker group resulted in a slightly less wear, it did not reach significant differences in the steady-state wear rates between the groups. CONCLUSION No clinical significance for using a thicker liner over the standard thickness (6.8 mm → 8.9 mm) was confirmed in the vitamin-E-diffused HXLPE according to the 7-year follow-up. The wear rates for both thicknesses were very low enough to prevent osteolysis, and no mechanical failure was observed at any follow-up interval. Nevertheless, since the significantly higher strain was seen in the thinner liner, further follow-up is needed to compare the longer term wear and the incidence of osteolysis and component fracture.
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Affiliation(s)
- Tsunehiro Matsuoka
- Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1, Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Yasuhito Takahashi
- Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1, Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
- Department of Bone and Joint Biomaterial Research, Tokyo Medical University, 6-7-1, Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
| | - Tsunehito Ishida
- Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1, Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Toshiyuki Tateiwa
- Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1, Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Takaaki Shishido
- Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1, Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Kengo Yamamoto
- Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1, Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
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Merfort R, Maffulli N, Hofmann UK, Hildebrand F, Simeone F, Eschweiler J, Migliorini F. Head, acetabular liner composition, and rate of revision and wear in total hip arthroplasty: a Bayesian network meta-analysis. Sci Rep 2023; 13:20327. [PMID: 37989863 PMCID: PMC10663607 DOI: 10.1038/s41598-023-47670-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 11/16/2023] [Indexed: 11/23/2023] Open
Abstract
Total hip arthroplasty (THA) is a common procedure for patients suffering from hip pain e.g. from osteoarthritis, osteonecrosis, or hip fractures. The satisfaction of patients undergoing THA is influenced by the choice of implant type and material, with one key factor being the selection of the appropriate material combination for the bearing surface. In this Bayesian network meta-analysis, we investigated the impact of material combinations for the bearing surface on the longevity of hip implants. The wear penetration rate per year and the total wear penetration in the liner resulting from different material combinations, as well as the survival rate at last follow-up, were examined. We analyzed a total of 663,038 THAs, with 55% of patients being women. Mean patient age was 59.0 ± 8.1 years and mean BMI 27.6 ± 2.6 kg/m2. The combination of an aluminium oxide (Al2O3) head and an Al2O3 liner demonstrated the lowest wear penetration at last follow-up and the lowest rate of wear penetration per year. Additionally, the combination of a crosslinked polyethylene (XLPE) liner and a zircon oxide (ZrO2) head demonstrated the lowest rate of revision at last follow-up. These findings underscore the importance of careful material selection for hip implant bearing surfaces to optimize their longevity and patient satisfaction after THA.
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Affiliation(s)
- Ricarda Merfort
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, 52074, Aachen, Germany
| | - Nicola Maffulli
- Department of Medicine and Psicology, University La Sapienza, Rome, Italy
- Faculty of Medicine, School of Pharmacy and Bioengineering, Keele University, Thornburrow Drive, Stoke-on-Trent, England, UK
- Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, England, UK
| | - Ulf Krister Hofmann
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, 52074, Aachen, Germany
| | - Frank Hildebrand
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, 52074, Aachen, Germany
| | - Francesco Simeone
- Department of Orthopaedic and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical University, 39100, Bolzano, Italy
| | - Jörg Eschweiler
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, 52074, Aachen, Germany
| | - Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, 52074, Aachen, Germany.
- Department of Orthopaedic and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical University, 39100, Bolzano, Italy.
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El-Sahoury JAN, Kjærgaard K, Ovesen O, Hofbauer C, Overgaard S, Ding M. Vitamin E-diffused liners show less head penetration than cross-linked polyethylene liners in total hip arthroplasty: a ten-year multi-arm randomized trial. Bone Joint J 2023; 105-B:1052-1059. [PMID: 37777211 DOI: 10.1302/0301-620x.105b10.bjj-2023-0115.r1] [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: 10/02/2023]
Abstract
Aims The primary outcome was investigating differences in wear, as measured by femoral head penetration, between cross-linked vitamin E-diffused polyethylene (vE-PE) and cross-linked polyethylene (XLPE) acetabular component liners and between 32 and 36 mm head sizes at the ten-year follow-up. Secondary outcomes included acetabular component migration and patient-reported outcome measures (PROMs) such as the EuroQol five-dimension questionnaire, 36-Item Short-Form Health Survey, Harris Hip Score, and University of California, Los Angeles Activity Scale (UCLA). Methods A single-blinded, multi-arm, 2 × 2 factorial randomized controlled trial was undertaken. Patients were recruited between May 2009 and April 2011. Radiostereometric analyses (RSAs) were performed from baseline to ten years. Of the 220 eligible patients, 116 underwent randomization, and 82 remained at the ten-year follow-up. Eligible patients were randomized into one of four interventions: vE-PE acetabular liner with either 32 or 36 mm femoral head, and XLPE acetabular liner with either 32 or 36 mm femoral head. Parameters were otherwise identical except for acetabular liner material and femoral head size. Results A total of 116 patients participated, of whom 77 were male. The median ages of the vE-PE 32 mm and 36 mm groups were 65 (interquartile range (IQR) 57 to 67) and 63 years (IQR 56 to 66), respectively, and of the XLPE 32 mm and 36 mm groups were 64 (IQR 58 to 66) and 61 years (IQR 54 to 66), respectively. Mean total head penetration was significantly lower into vE-PE acetabular liner groups than into XLPE acetabular liner groups (-0.219 mm (95% confidence interval -0.348 to -0.090); p = 0.001). There were no differences in wear according to head size, acetabular component migration, or PROMs, except for UCLA. There were no cases of aseptic loosening or failures requiring revision at long-term follow-up. Conclusion Significantly lower wear was observed in vE-PE acetabular liners than in XLPE acetabular liners. No difference in wear was observed between different head size or PROMs except for the UCLA at ten years.
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Affiliation(s)
- Joseph A N El-Sahoury
- Department of Orthopaedic Surgery and Traumatology, and Department of Clinical Research, Orthopaedic Research Laboratory, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Kristian Kjærgaard
- Department of Orthopaedic Surgery and Traumatology, and Department of Clinical Research, Orthopaedic Research Laboratory, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Ole Ovesen
- Department of Orthopaedic Surgery and Traumatology, and Department of Clinical Research, Orthopaedic Research Laboratory, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | | | - Søren Overgaard
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Orthopaedic Surgery & Traumatology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ming Ding
- Department of Orthopaedic Surgery and Traumatology, and Department of Clinical Research, Orthopaedic Research Laboratory, Odense University Hospital, University of Southern Denmark, Odense, Denmark
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Migliorini F, Maffulli N, Pilone M, Bell A, Hildebrand F, Konrads C. Risk factors for liner wear and head migration in total hip arthroplasty: a systematic review. Sci Rep 2023; 13:15612. [PMID: 37730762 PMCID: PMC10511625 DOI: 10.1038/s41598-023-42809-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 09/14/2023] [Indexed: 09/22/2023] Open
Abstract
Total hip arthroplasty (THA) is a successful orthopaedic surgical procedure, and its longevity depends on bearing components and implant fixation. Optimizing polyethylene and ceramics has led to improved wear parameters and contributed to improved long-term outcomes. The present systematic review investigated whether time span from implantation, patient characteristics and performance status exert an influence on liner wear and head migration in THA. This study was conducted in conformity to the 2020 PRISMA guidelines. All the clinical investigations which reported quantitative data on the amount of liner wear and head migration in THA were considered. Only studies which reported quantitative data at least on one of the following patient characteristics were suitable: mean age, mean BMI (kg/m2), sex, side, time span between the index THA and the last follow-up (months) were eligible. A multiple linear model regression analysis was employed to verify the association between patient characteristics and the amount of liner wear and/or head migration. The Pearson Product-Moment Correlation Coefficient was used to assess the association between variables. Data from 12,629 patients were considered. The mean length of the follow-up was 90.5 ± 50.9 months. The mean age of patients at surgery was 58.4 ± 9.4 years, and the mean BMI was 27.2 ± 2.5 kg/m2. 57% (7199 of 12,629 patients) were women, and in 44% (5557 of 12,629 patients) THAs were performed on the left. The mean pre-operative Harris hip score was 46.5 ± 6.0 points. There was evidence of a moderate positive association between the amount of liner wear and the time elapsed between the index surgery to the follow-up (P = 0.02). There was evidence of a moderate positive association between the amount of head migration and the time elapsed between the index surgery to the follow-up (P = 0.01). No further statistically significant association was found. The time elapsed between the index surgery to the follow-up was the most important factor which influence the head migration and liner wear in THA. Patients' characteristics and preoperative physical activity did not influence the amount of head migration and liner wear.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany.
- Department of Orthopaedic and Trauma Surgery, Academic Hospital of Bolzano, Teaching Hospital of Paracelsus Medical University (PMU), 39100, Bolzano, Italy.
- Department of Orthopaedic and Trauma Surgery, Eifelklinik St.Brigida, Simmerath, Germany.
| | - Nicola Maffulli
- Department of Orthopaedic and Trauma Surgery, Hospital Sant'Andrea, University of Rome La Sapienza, Rome, Italy
- School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Stoke on Trent, ST4 7QB, England
- Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, London, E1 4DG, England
| | - Marco Pilone
- Residency Program in Orthopaedics and Traumatology, University of Milan, 20122, Milan, Italy
| | - Andreas Bell
- Department of Orthopaedic and Trauma Surgery, Eifelklinik St.Brigida, Simmerath, Germany
| | - Frank Hildebrand
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Christian Konrads
- Department of Orthopaedics and Traumatology, Helios Hanseatic Hospital Stralsund, 18435, Stralsund, Germany
- Medical Faculty, University of Tübingen, 72076, Tübingen, Germany
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Hasegawa M, Tone S, Naito Y, Sudo A. Ultra-High-Molecular-Weight Polyethylene in Hip and Knee Arthroplasties. MATERIALS (BASEL, SWITZERLAND) 2023; 16:2140. [PMID: 36984020 PMCID: PMC10054334 DOI: 10.3390/ma16062140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/05/2023] [Accepted: 03/06/2023] [Indexed: 06/18/2023]
Abstract
Ultra-high-molecular-weight polyethylene (UHMWPE) wear and particle-induced osteolysis contribute to the failure of total hip arthroplasty (THA) and total knee arthroplasty (TKA). Highly crosslinked polyethylene (HXLPE) was developed in the late 1990s to reduce wear and has shown lower wear rates and loosening than conventional UHMWPE in THA. The irradiation dose for crosslinking is up to 100 kGy. However, during crosslinking, free radical formation induces oxidation. Using HXLPE in THA, the cumulative revision rate was determined to be significantly lower (6.2%) than that with conventional UHMWPE (11.7%) at a mean follow-up of 16 years, according to the Australian Orthopaedic Association National Joint Replacement Registry. However, HXLPE does not confer to TKA the same advantages it confers to THA. Several alternatives have been developed to prevent the release of free radicals and improve polymer mechanical properties, such as thermal treatment, phospholipid polymer 2-methacryloyloxyethyl phosphorylcholine grafting, remelting, and vitamin E addition. Among these options, vitamin E addition has reported good clinical results and wear resistance similar to that of HXLPE without vitamin E, as shown by short-term clinical studies of THA and TKA. This review aims to provide a comprehensive overview of the development and performance of UHMWPE in THA and TKA.
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10
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Zheng C, Xu J, Wu L, Wu Y, Liu Y, Shen B. Comparisons of Different Bearing Surfaces in Cementless Total Hip Arthroplasty: A Systematic Review and Bayesian Network Analysis. J Arthroplasty 2023; 38:600-609. [PMID: 36265721 DOI: 10.1016/j.arth.2022.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/06/2022] [Accepted: 10/11/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND We aimed to make comparisons of different bearing surfaces in patients after cementless total hip arthroplasty. METHODS The network meta-analysis was guided by the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guideline. The primary outcomes were implant survival and Harris hip score (HHS). Secondary outcomes included linear wear rates and serum level of metal ions. Subgroup analyses were performed by: (1) classifying head sizes as small and large; (2) femoral heads as ceramic and metal; and (3) liners as metal, ceramic, polyethylene, highly cross-linked polyethylene (HXP), or vitamin E-infused highly cross-linked polyethylene (HXPE). A total of 64 eligible RCTs with different bearings were assessed. Overall inconsistency and heterogeneity were acceptable. RESULTS In the 10 years follow-up, metal-on-polythene and ceramic-on-polythene bearings with small heads showed higher risk for revisions compared with metal-on-HXP and ceramic-on-HXP bearings with small heads. Similarly, only metal or ceramic-on-polythene bearings with small heads showed inferiority in HHS compared with other bearings. Conventional polyethylene liners showed higher linear wear rates compared with HXP, HXPE, and ceramic liners at 5 and 10 years after surgery, while metal-on-metal and ceramic-on-metal bearings showed higher serum level of cobalt and chromium. CONCLUSION Bearings containing HXP, HXPE, and ceramic liners showed comparable survivorship and hip function at follow-up of 5 and 10 years. Hard-on-hard bearings containing metal had higher serum level of metal ions than others. Bearings containing conventional polyethylene had worse performance in terms of implant survival, hip function, and wear rates. LEVEL OF EVIDENCE Level I.
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Affiliation(s)
- Che Zheng
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Jiawen Xu
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Liming Wu
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Yuangang Wu
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Yuan Liu
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Bin Shen
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
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11
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Spece H, Yarbrough RV, Kurtz SM. In Vivo Performance of Vitamin E Stabilized Polyethylene Implants for Total Hip Arthroplasty: A Review. J Arthroplasty 2022; 38:970-979. [PMID: 36481286 DOI: 10.1016/j.arth.2022.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 10/28/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Vitamin E stabilization was introduced to improve the oxidative stability, wear resistance, and mechanical properties of highly crosslinked polyethylene (HXLPE). In this literature review, we asked: (1) How has vitamin E-stabilized HXLPE (VEPE) performed in vivo for total hip arthroplasty (THA) and how does it compare with conventional ultra-high molecular weight polyethylene (UHMWPE) and HXLPE without vitamin E; and (2) Is there an apparent difference in the clinical performance of VEPE created by blending versus diffusion? METHODS We performed a systematic search of the literature according to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines using PubMed and Embase. Included studies reported the in vivo behavior of VEPE in THA. We reviewed 41 studies. RESULTS For all studies that compared polyethylene with and without VE stabilization, outcomes for VEPE were either equivalent or superior to the control group (for HXLPE without VE and conventional UHMWPE controls, respectively). Hip insert wear rates were generally less than 0.1 mm/year and in most cases were less than 0.05 mm/year. No VEPE components were revised for osteolysis or adverse outcomes specific to VE incorporation. CONCLUSION Across the literature, we found that VEPE was reported to be clinically effective for THA applications, with much of the research indicating positive clinical outcomes and lower or equivalent wear rates compared to conventional UHMWPE and HXLPE controls without VE. Instances of early component fracture were reported, but have multiple potential causes. There is a gap in the literature for comparison of blended and diffused components, so the in vivo impact of VE incorporation method remains to be seen. Overall, this study provides a comprehensive summary of VEPE clinical performance for THA and may serve as a resource for future investigations.
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Affiliation(s)
- Hannah Spece
- Implant Research Core, School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA; Gyroid, LLC, Haddonfield, NJ
| | | | - Steven M Kurtz
- Implant Research Core, School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA; Gyroid, LLC, Haddonfield, NJ
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12
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García-Rey E, Cruz-Pardos A, Saldaña L. New polyethylenes in total hip arthroplasty : a 20- to 22-year follow-up study. Bone Joint J 2022; 104-B:1032-1038. [PMID: 36047028 DOI: 10.1302/0301-620x.104b9.bjj-2022-0434.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 A significant reduction in wear at five and ten years was previously reported when comparing Durasul highly cross-linked polyethylene with nitrogen-sterilized Sulene polyethylene in total hip arthroplasty (THA). We investigated whether the improvement observed at the earlier follow-up continued, resulting in decreased osteolysis and revision surgery rates over the second decade. METHODS Between January 1999 and December 2001, 90 patients underwent surgery using the same acetabular and femoral components with a 28 mm metallic femoral head and either a Durasul or Sulene liner. A total of 66 hips of this prospective randomized study were available for a minimum follow-up of 20 years. The linear femoral head penetration rate was measured at six weeks, one year, and annually thereafter, using the Dorr method on digitized radiographs with a software package. RESULTS In the Durasul group, no patients underwent revision due to loosening or showed radiological evidence of osteolysis. In the Sulene group, four patients (four hips) were revised due to femoral component loosening. The 20-year cumulative failure incidence in the presence of the competing event of death for revision surgery was 4.5% (95% confidence interval (CI) 0.8 to 13.6) in the Durasul group, and 8.9% (95% CI 2.8 to 19.5) in the Sulene group. The mean wear one year after surgery was 0.09 mm (SD 0.007) in the Durasul group and 0.24 (SD 0.015) in the Sulene group (p < 0.001). From one to 20 years after surgery, the mean total penetration was 0.32 mm (SD 0.045) in the Durasul group and 1.07 mm (SD 0.13) in the Sulene group (p < 0.001). Mean femoral head penetration at 20 years was approximately 70.0% less in the Durasul group than the Sulene group. CONCLUSION The significant reduction in femoral head penetration obtained with the Durasul compared with Sulene in uncemented THA resulted in lower osteolysis and revision rates after 20 years.Cite this article: Bone Joint J 2022;104-B(9):1032-1038.
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Affiliation(s)
- Eduardo García-Rey
- Orthopaedics Department, Hospital Universitario La Paz-Idi Paz, Madrid, Spain.,Bioengineering, Biomaterials and Nanomedicine, Biomedical Research Networking Center, Madrid, Spain
| | - Ana Cruz-Pardos
- Orthopaedics Department, Hospital Universitario La Paz-Idi Paz, Madrid, Spain
| | - Laura Saldaña
- Bioengineering, Biomaterials and Nanomedicine, Biomedical Research Networking Center, Madrid, Spain.,Bone Pathophysiology and Biomaterials Group, Hospital Universitario La Paz-Idi Paz, Madrid, Spain
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13
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Nielson T, Owens G, Miller B, Meneghini E, Deckard ER, Meneghini RM. Large Femoral Heads in Total Hip Arthroplasty With Vitamin E Highly Cross-Linked Polyethylene: Head Penetration Rates Compared to Highly Cross-Linked Polyethylene. J Arthroplasty 2022; 37:S685-S691. [PMID: 35227535 DOI: 10.1016/j.arth.2022.01.075] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/20/2022] [Accepted: 01/24/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Highly cross-linked polyethylene with vitamin E (VE-HXLPE) has shown superior tribological properties and has been rapidly adopted in total hip arthroplasty. However, the majority of studies compare VE-HXLPE to conventional or moderately cross-linked polyethylene using standard femoral head sizes. This study's purpose was 2-fold: (1) compare radiographic femoral head penetration (FHP) between VE-HXLPE and HXLPE and (2) evaluate FHP in large femoral heads ≥40 mm. METHODS One hundred forty-two consecutive primary total hip arthroplasties using ceramic femoral heads (n = 84 VE-HXLPE; n = 58 HXLPE) in a single implant system were retrospectively reviewed. FHP was measured radiographically utilizing Martell method at 4-week, 1-year, and latest radiographs. FHP, cup position, and demographic variables were compared between VE-HXLPE and HXLPE liners. RESULTS Median linear FHP was lower for VE-HXLPE compared to HXLPE during the initial "bedding-in" period between 4-week and 1-year (0.383 vs 0.551 mm, P = .650) and between 1-year and latest follow-up (0.131 vs 0.270 mm/y, P = .636) although without statistical significance. Acetabular cup inclination and anteversion did not influence linear or volumetric FHP (P ≥ .204). Large femoral heads (≥40 mm) were predictive of higher FHP during the early bedding-in period (P ≤ .025) but did not have an effect beyond 1 year in multivariate regression with numbers available. No radiographic osteolysis was observed in any case. CONCLUSION These findings support others that VE-HXLPE is the optimal polyethylene bearing surface to minimize FHP during the bedding-in period and beyond. Surprisingly, large ceramic femoral heads appear to influence FHP during the initial bedding-in period but do not increase FHP beyond 1 year. Further longer term follow-up remains warranted. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Trent Nielson
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Garrett Owens
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Brandon Miller
- Department of Mechanical Engineering, Tennessee Tech University, Cookeville, TN
| | - Ethan Meneghini
- IU Health Hip & Knee Center, IU Health Saxony Hospital, Fishers, IN
| | - Evan R Deckard
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - R Michael Meneghini
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN; IU Health Hip & Knee Center, IU Health Saxony Hospital, Fishers, IN
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14
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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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15
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Revision Risk of Total Hip Arthroplasty With Vitamin E Doped Liners: Results From the Danish Hip Arthroplasty Register. J Arthroplasty 2022; 37:1136-1142. [PMID: 35149169 DOI: 10.1016/j.arth.2022.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/03/2022] [Accepted: 02/03/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Vitamin E-doped cross-linked polyethylene (VEPE) liners were introduced in total hip arthroplasty (THA) to reduce wear and risk of aseptic loosening and liner fracture. We report this nationwide population-based study to investigate the safety of VEPE liners for THA compared to cross-linked annealed or remelted polyethylene (XLPE). METHODS We included THAs from The Danish Hip Arthroplasty Register from January 1, 2008 to June 30, 2019, with uncemented cup, VEPE or XLPE liner, and metal or ceramic head. The outcome was revision due to (1) polyethylene-related endpoints (aseptic loosening, granuloma, osteolysis, or liner fractures) and (2) other endpoints. RESULTS A total of 110,803 THAs were assessed for eligibility and 53,842 THAs (46,645 patients) were included in the study: 5069 (9.4%) THAs with a VEPE liner and 48,773 (91.6%) with a XLPE liner. Median observation time was 5.48 (interquartile range 3.80-7.15) years for VEPE and 4.85 (interquartile range 2.68-7.76) for XLPE. VEPE had a lower risk of revision for polyethylene-related endpoints compared to XLPE (hazard ratio [HR] 0.60, 95% confidence interval 0.36-0.98) during complete follow-up. THAs with VEPE liners were associated with increased risk of any revision within the first 3 months (HR 1.62, 1.36-1.94), revision recorded as aseptic loosening within 3 months (HR 4.46, 2.26-8.80), and periprosthetic fracture within 3 months (HR 2.57, 1.98, 3.33). CONCLUSION VEPE liners had a lower risk of revision due to polyethylene-related endpoints, but a higher risk of all-cause revision within 3 months.
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16
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Fontalis A, Haddad FS. Roentgen stereophotogrammetric analysis: still a very valuable tool in the orthopaedic research armamentarium. Bone Joint Res 2022; 11:210-213. [PMID: 35369732 PMCID: PMC9057520 DOI: 10.1302/2046-3758.114.bjr-2021-0593.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Andreas Fontalis
- Division of Surgery & Interventional Science, University College London, London, UK.,Department of Trauma and Orthopaedics, University College London Hospitals NHS Foundation Trust, London, UK
| | - Fares S Haddad
- Division of Surgery & Interventional Science, University College London, London, UK.,Department of Trauma and Orthopaedics, University College London Hospitals NHS Foundation Trust, London, UK.,Institute of Sport, Exercise and Health, London, UK.,The Bone & Joint Journal , The British Editorial Society of Bone & Joint Surgery, London, UK
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17
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Scott CEH, Clement ND, Davis ET, Haddad FS. Modern total hip arthroplasty: peak of perfection or room for improvement? Bone Joint J 2022; 104-B:189-192. [PMID: 35094584 DOI: 10.1302/0301-620x.104b2.bjj-2022-0007] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Chloe E H Scott
- Royal Infirmary of Edinburgh, Edinburgh, UK.,The Bone & Joint Journal , London, UK.,Bone & Joint Research , London, UK.,University of Edinburgh, Edinburgh, UK
| | | | | | - Fares S Haddad
- The Bone & Joint Journal , London, UK.,University College London Hospitals, The Princess Grace Hospital, and The NIHR Biomedical Research Centre at UCLH, London, UK
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18
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Bergvinsson H, Zampelis V, Sundberg M, Tjörnstrand J, Flivik G. Vitamin E infused highly cross-linked cemented cups in total hip arthroplasty show good wear pattern and stabilize satisfactorily: a randomized, controlled RSA trial with 5-year follow-up. Acta Orthop 2022; 93:249-255. [PMID: 35048993 PMCID: PMC8788680 DOI: 10.2340/17453674.2022.1517] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Indexed: 01/31/2023] Open
Abstract
Background and purpose - Vitamin E infused highly cross-linked polyethylene (VEPE) was introduced in order to enhance oxidative resistance in highly cross-linked polyethylene cups in total hip arthroplasty (THA). We have, with a follow-up of 5 years, evaluated wear characteristics of 2 identically designed cemented cups with the only difference being the material, VEPE or ultra-high molecular weight polyethylene (UHMWPE). Furthermore, we report cup migration and clinical outcome. Patients and methods - 48 patients with primary osteoarthritis were randomized to either UHMWPE or VEPE cups. Patients were followed with radiostereometric analysis (RSA) from the first postoperative day, at 3 months, 1, 2, and 5 years as well as with hip-specific outcome questionnaires. Results - At 3 months the mean proximal head penetration for UHMWPE was 0.07 mm (95% CI 0.03-0.11) and for VEPE 0.06 mm (-0.01 to 0.13). Thereafter, there was a continuous annual wear of 0.08 mm/year, up to 0.46 mm (0.36-0.57) at 5 years, for the UHMWPE cup. The VEPE cup showed low annual wear of 0.01 mm/year, up to 0.09 mm (0.02-0.16) at 5 years. In the first 3 months the UHMWPE cup migrated cranially 0.08 mm (0.03-0.13) whereas the VEPE cup migrated 0.17 mm (0.10-0.24), Thereafter, they showed similar migration patterns with stabilization between 2 and 5 years up to 0.21 mm (0.04-0.39) and 0.24 mm (0.13-0.36) respectively. The HOOS remained good up to 5 years, and no cup was revised. Interpretation - Compared with otherwise identical UHMWPE cups the cemented VEPE cup shows statistically significant reduction of wear up to 5 years and both cup types stabilize well with good clinical outcome.
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Affiliation(s)
- Halldor Bergvinsson
- Department of Orthopedics, Skåne University Hospital, Clinical Sciences, Lund University, Lund, Sweden.
| | - Vasilis Zampelis
- Department of Orthopedics, Skåne University Hospital, Clinical Sciences, Lund University, Lund, Sweden.
| | - Martin Sundberg
- Department of Orthopedics, Skåne University Hospital, Clinical Sciences, Lund University, Lund, Sweden.
| | - Jon Tjörnstrand
- Department of Orthopedics, Skåne University Hospital, Clinical Sciences, Lund University, Lund, Sweden.
| | - Gunnar Flivik
- Department of Orthopedics, Skåne University Hospital, Clinical Sciences, Lund University, Lund, Sweden.
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Vitamin E-Enhanced Liners in Primary Total Hip Arthroplasty: A Systematic Review and Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2021; 2021:3236679. [PMID: 34912888 PMCID: PMC8668289 DOI: 10.1155/2021/3236679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 11/05/2021] [Indexed: 01/10/2023]
Abstract
Objective Adding vitamin E to highly cross-linked polyethylene liners is frequently performed in clinical practice, aiming at reducing liner wear, increasing liner survival, and delaying revision surgery. This study is aimed at evaluating the revision rate, total femoral head penetration, and postoperative clinical function of highly cross-linked polyethylene liners with and without vitamin E in total hip arthroplasty. Methods We conducted a systematic literature search to identify the use of highly cross-linked vitamin E liners compared to other liners in patients who received total hip arthroplasty (THA) before April 2021. The study quality assessment and data collection were conducted by two independent reviewers. Studies were artificially grouped, and vitamin E-enhanced liners (VE-PE) were compared with vitamin E-free liners (non-VE-PE). Analyses were executed using Review Manager version 5.4.1. Results From the preliminary screening of 568 studies, fourteen studies met the research criteria. Compared to non-VE-PE, using VE-PE reduced the all-cause revision rate (odds ratio = 0.54; 95% confidence interval (CI) 0.40, 0.73; P < 0.0001). The total femoral head penetration of the VE-PE was lower than that of the non-VE-PE (mean difference = −0.10; 95% CI -0.17, -0.03; P = 0.007). However, there was no difference in clinical function, including the Harris Hip Score and EuroQol Five-Dimension Questionnaire scores. Conclusion Compared to the liners without vitamin E, the addition of vitamin E to liners could reduce the all-cause revision rate by approximately 46% in the short-term follow-up. In addition, even though addition of vitamin E could also slow down femoral head penetration, there is no contribution to clinical function.
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20
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Affiliation(s)
- Patrick Morgan
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota
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21
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Rossiter ND, Chesser TJS, Costa ML. The Canadian Orthopaedic Trauma Society: 30 years of randomized controlled trials. Bone Joint J 2021; 103-B:807-808. [PMID: 33934655 DOI: 10.1302/0301-620x.103b5.bjj-2021-0231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | | | - Matt L Costa
- Oxford Trauma, NDORMS, University of Oxford, Oxford, UK
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