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Begun A, MacGregor AJ, Pchejetski D, Kulinskaya E. Dynamic early identification of hip replacement implants with high revision rates. Study based on the NJR data from UK during 2004-2012. PLoS One 2020; 15:e0236701. [PMID: 32750091 PMCID: PMC7402470 DOI: 10.1371/journal.pone.0236701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 07/13/2020] [Indexed: 12/02/2022] Open
Abstract
Background Hip replacement and hip resurfacing are common surgical procedures with an estimated risk of revision of 4% over 10 year period. Approximately 58% of hip replacements will last 25 years. Some implants have higher revision rates and early identification of poorly performing hip replacement implant brands and cup/head brand combinations is vital. Aims Development of a dynamic monitoring method for the revision rates of hip implants. Methods Data on the outcomes following the hip replacement surgery between 2004 and 2012 was obtained from the National Joint Register (NJR) in the UK. A novel dynamic algorithm based on the CUmulative SUM (CUSUM) methodology with adjustment for casemix and random frailty for an operating unit was developed and implemented to monitor the revision rates over time. The Benjamini-Hochberg FDR method was used to adjust for multiple testing of numerous hip replacement implant brands and cup/ head combinations at each time point. Results Three poorly performing cup brands and two cup/ head brand combinations have been detected. Wright Medical UK Ltd Conserve Plus Resurfacing Cup (cup o), DePuy ASR Resurfacing Cup (cup e), and Endo Plus (UK) Limited EP-Fit Plus Polyethylene cup (cup g) showed stable multiple alarms over the period of a year or longer. An addition of a random frailty term did not change the list of underperforming components. The model with added random effect was more conservative, showing less and more delayed alarms. Conclusions Our new algorithm is an efficient method for early detection of poorly performing components in hip replacement surgery. It can also be used for similar tasks of dynamic quality monitoring in healthcare.
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Affiliation(s)
- Alexander Begun
- School of Computing Sciences, University of East Anglia, Norwich, United Kingdom
| | | | - Dmitri Pchejetski
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Elena Kulinskaya
- School of Computing Sciences, University of East Anglia, Norwich, United Kingdom
- * E-mail:
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Goto K, Furuya Y, Oda K, Minami R, Sano K, Sugimoto M, Matsuda S. Long-term results of total hip arthroplasty using Charnley Elite-Plus stem and the effect of stem geometry on radiographic distal femoral cortical hypertrophy. J Orthop Sci 2018; 23:365-370. [PMID: 29276040 DOI: 10.1016/j.jos.2017.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 11/23/2017] [Accepted: 12/06/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND The Elite-Plus stem has two shape variations: roundback and flanged. The correlation between the radiographic results and stem geometry has not been previously investigated. The objective of this study was to evaluate the long-term primary total hip arthroplasty results using Elite-Plus stems, and the effect of stem geometry on radiographic distal femoral cortical hypertrophy. METHODS We retrospectively evaluated, radiographically, 156 patients (173 hips) who underwent total hip arthroplasty between April 1998 and November 2005, and were followed up for >5 years, postoperatively. Radiographic factors affecting distal femoral cortical hypertrophy were analysed using multivariable logistic regression analysis. RESULTS The mean follow-up period was 11.6 (5-17.8) years. During follow-up, femoral components were revised in 7 hips; one was revised due to aseptic loosening. Another femoral component was loosened and waiting for revision. The 10- and 15-year survival rates for aseptic stem loosening were 100% and 98.1% (95% CI: 92.5-99.5), respectively. Distal femoral cortical hypertrophy occurred in 23 hips (14.8%), and more often with roundback type (34.1%) than with flanged type (7.2%). Distal femoral cortical hypertrophy was observed in 34.8% of hips with valgus alignment, 11.3% with neutral alignment, and 12.5% with varus alignment. Multivariable logistic regression analysis showed that roundback stem shape and valgus stem alignment significantly affected the occurrence of distal femoral cortical hypertrophy. CONCLUSIONS The Elite-Plus stem has excellent long-term clinical and radiographic results in Japanese patients. The occurrence of distal femoral cortical hypertrophy significantly depends on the shape and alignment of Elite-Plus stems.
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Affiliation(s)
- Koji Goto
- Department of Orthopaedic Surgery, Kyoto University, Kyoto, Japan; Department of Orthopaedic Surgery, Nagahama City Hospital, Shiga, Japan.
| | - Yuki Furuya
- Department of Orthopaedic Surgery, Nagahama City Hospital, Shiga, Japan
| | - Kazuhiro Oda
- Department of Orthopaedic Surgery, Nagahama City Hospital, Shiga, Japan
| | - Ryosuke Minami
- Department of Orthopaedic Surgery, Nagahama City Hospital, Shiga, Japan
| | - Kaori Sano
- Department of Orthopaedic Surgery, Nagahama City Hospital, Shiga, Japan
| | - Masayuki Sugimoto
- Department of Orthopaedic Surgery, Nagahama City Hospital, Shiga, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Kyoto University, Kyoto, Japan
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Glyn-Jones S, Thomas GER, Garfjeld-Roberts P, Gundle R, Taylor A, McLardy-Smith P, Murray DW. The John Charnley Award: Highly crosslinked polyethylene in total hip arthroplasty decreases long-term wear: a double-blind randomized trial. Clin Orthop Relat Res 2015; 473:432-8. [PMID: 25123239 PMCID: PMC4294892 DOI: 10.1007/s11999-014-3735-2] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The use of highly crosslinked polyethylene (HXLPE) is now commonplace for total hip arthroplasty. Hip simulator studies and short-term in vivo measurements suggest that the wear rate of some types of HXLPE is significantly less than conventional ultrahigh-molecular-weight polyethylene (UHMWPE). However, there are few long-term data to support its use. QUESTIONS/PURPOSES The aim of this study was to measure the long-term steady-state wear of HXLPE compared with UHMWPE liners in a prospective, double-blind, randomized controlled trial using radiostereometric analysis. METHODS Fifty-four patients were randomized to receive hip arthroplasties with either UHMWPE liners or HXLPE liners. Complete followup was available on 39 of these patients (72%). All patients received the same cemented stem and an uncemented acetabular component. Three-dimensional penetration of the head into the socket was determined at 10 years using a radiostereometric analysis system, which has an in vivo accuracy of <0.1 mm. Oxford Hip Scores were compared between the groups. RESULTS At 10 years there was significantly less wear of HXLPE (0.003 mm/year; 95% confidence interval [CI], ±0.010; SD 0.023; range, -0.057 to 0.074) compared with UHMWPE (0.030 mm/year; 95% CI, ±0.012; p<0.001; SD 0.0.27; range, -0.001 to 0.164). The volumetric penetration from 1 to 10 years for the UHMWPE group was 98 mm3 (95% CI, ±46 mm3; SD 102 mm3; range, -4 to 430 mm3) compared with 14 mm3 (95% CI, ±40 mm3; SD 91 mm3; range, -189 to 242 mm3) for the HXLPE group (p=0.01). CONCLUSIONS This study demonstrates that HXLPE has little detectable steady-state in vivo wear. This may result in fewer reoperations from loosening; however, careful clinical followup into the second decade still needs to be performed. LEVEL OF EVIDENCE Level I, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Siôn Glyn-Jones
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, NIHR Musculoskeletal Biomedical Research Unit, Nuffield Orthopaedic Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD UK
| | - Geraint E. R. Thomas
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, NIHR Musculoskeletal Biomedical Research Unit, Nuffield Orthopaedic Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD UK
| | - Patrick Garfjeld-Roberts
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, NIHR Musculoskeletal Biomedical Research Unit, Nuffield Orthopaedic Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD UK
| | - Roger Gundle
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, NIHR Musculoskeletal Biomedical Research Unit, Nuffield Orthopaedic Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD UK
| | - Adrian Taylor
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, NIHR Musculoskeletal Biomedical Research Unit, Nuffield Orthopaedic Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD UK
| | - Peter McLardy-Smith
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, NIHR Musculoskeletal Biomedical Research Unit, Nuffield Orthopaedic Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD UK
| | - David W. Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, NIHR Musculoskeletal Biomedical Research Unit, Nuffield Orthopaedic Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD UK
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Inokoshi M, Vanmeensel K, Zhang F, De Munck J, Eliades G, Minakuchi S, Naert I, Van Meerbeek B, Vleugels J. Aging resistance of surface-treated dental zirconia. Dent Mater 2015; 31:182-94. [PMID: 25572860 DOI: 10.1016/j.dental.2014.11.018] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 07/19/2014] [Accepted: 11/28/2014] [Indexed: 02/01/2023]
Abstract
UNLABELLED The influence of surface treatment on the low-temperature degradation (LTD) of tetragonal zirconia polycrystalline (TZP) is still unclear. OBJECTIVES The effect of surface treatments on the LTD behavior of zirconia was investigated. METHODS Fully-sintered specimens of seven commercial dental zirconia (Aadva, GC; In-CeramYZ, VITA; IPS e.max ZirCAD, Ivoclar Vivadent; LAVA Frame and LAVA Plus, 3M ESPE; NANOZR, Panasonic; ZirTough, Kuraray Noritake) were provided by the manufacturers with specimen dimensions of approximately 10mm×5mm×3mm. For each zirconia grade, samples were kept 'as sintered' (untreated) or were subjected to one of the three surface treatments: rough polished, sandblasted with Al2O3, tribochemical silica sandblasted (n=3/group). The tetragonal to monoclinic transformation was evaluated by X-ray diffraction at several intervals during LTD testing up to 40h in steam in an autoclave (134°C, 2bar). RESULTS The five yttria-stabilized TZP (Y-TZP: Aadva, In-CeramYZ, IPS e.max ZirCAD, LAVA Frame, LAVA Plus) zirconia showed a similar trend in LTD behavior. The Al2O3 sandblasted zirconia showed the highest monoclinic volume fraction. The as sintered (untreated) zirconia degraded faster than the surface-treated zirconia. Although the surface-treated ceria-stabilized TZP/alumina (Ce-TZP/Al2O3: NANOZR) zirconia had a higher initial monoclinic volume fraction compared to the Y-TZP zirconia, it showed a stronger aging resistance. The as sintered (untreated) Y-TZP/alumina (Y-TZP/Al2O3: ZirTough) zirconia showed a strong aging resistance, whereas the surface-treated Y-TZP/Al2O3 zirconia degraded slightly. SIGNIFICANCE Surface treatment improved the aging resistance of Y-TZP zirconia. Surface treatment did not affect the LTD behavior of Ce-TZP/Al2O3 zirconia, while surface treatment decreased the aging resistance of Y-TZP/Al2O3 zirconia.
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Affiliation(s)
- Masanao Inokoshi
- KU Leuven BIOMAT, Department of Oral Health Sciences, KU Leuven (University of Leuven) & Dentistry, University Hospitals Leuven, Kapucijnenvoer 7, blok a bus 7001, B-3000 Leuven, Belgium
| | - Kim Vanmeensel
- Department of Materials Engineering, KU Leuven (University of Leuven), Kasteelpark Arenberg 44, B-3001 Heverlee, Belgium
| | - Fei Zhang
- Department of Materials Engineering, KU Leuven (University of Leuven), Kasteelpark Arenberg 44, B-3001 Heverlee, Belgium
| | - Jan De Munck
- KU Leuven BIOMAT, Department of Oral Health Sciences, KU Leuven (University of Leuven) & Dentistry, University Hospitals Leuven, Kapucijnenvoer 7, blok a bus 7001, B-3000 Leuven, Belgium
| | - George Eliades
- Department of Biomaterials, University of Athens, 2 Thivon Str., Goudi, 115 27 Athens, Greece
| | - Shunsuke Minakuchi
- Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo 113-8549, Japan
| | - Ignace Naert
- KU Leuven BIOMAT, Department of Oral Health Sciences, KU Leuven (University of Leuven) & Dentistry, University Hospitals Leuven, Kapucijnenvoer 7, blok a bus 7001, B-3000 Leuven, Belgium
| | - Bart Van Meerbeek
- KU Leuven BIOMAT, Department of Oral Health Sciences, KU Leuven (University of Leuven) & Dentistry, University Hospitals Leuven, Kapucijnenvoer 7, blok a bus 7001, B-3000 Leuven, Belgium.
| | - Jozef Vleugels
- Department of Materials Engineering, KU Leuven (University of Leuven), Kasteelpark Arenberg 44, B-3001 Heverlee, Belgium
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Madanat R, Mäkinen TJ, Aro HT, Bragdon C, Malchau H. Adherence of hip and knee arthroplasty studies to RSA standardization guidelines. A systematic review. Acta Orthop 2014; 85:447-55. [PMID: 24954489 PMCID: PMC4164860 DOI: 10.3109/17453674.2014.934187] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Guidelines for standardization of radiostereometry (RSA) of implants were published in 2005 to facilitate comparison of outcomes between various research groups. In this systematic review, we determined how well studies have adhered to these guidelines. METHODS We carried out a literature search to identify all articles published between January 2000 and December 2011 that used RSA in the evaluation of hip or knee prosthesis migration. 2 investigators independently evaluated each of the studies for adherence to the 13 individual guideline items. Since some of the 13 points included more than 1 criterion, studies were assessed on whether each point was fully met, partially met, or not met. RESULTS 153 studies that met our inclusion criteria were identified. 61 of these were published before the guidelines were introduced (2000-2005) and 92 after the guidelines were introduced (2006-2011). The methodological quality of RSA studies clearly improved from 2000 to 2011. None of the studies fully met all 13 guidelines. Nearly half (43) of the studies published after the guidelines demonstrated a high methodological quality and adhered at least partially to 10 of the 13 guidelines, whereas less than one-fifth (11) of the studies published before the guidelines had the same methodological quality. Commonly unaddressed guideline items were related to imaging methodology, determination of precision from double examinations, and also mean error of rigid-body fitting and condition number cutoff levels. INTERPRETATION The guidelines have improved methodological reporting in RSA studies, but adherence to these guidelines is still relatively low. There is a need to update and clarify the guidelines for clinical hip and knee arthroplasty RSA studies.
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Affiliation(s)
- Rami Madanat
- Helsinki University Central Hospital, Helsinki,Harris Orthopaedic Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Hannu T Aro
- Turku University Hospital and University of Turku, Turku, Finland
| | - Charles Bragdon
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Henrik Malchau
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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6
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Inokoshi M, Zhang F, De Munck J, Minakuchi S, Naert I, Vleugels J, Van Meerbeek B, Vanmeensel K. Influence of sintering conditions on low-temperature degradation of dental zirconia. Dent Mater 2014; 30:669-78. [DOI: 10.1016/j.dental.2014.03.005] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 02/25/2014] [Accepted: 03/07/2014] [Indexed: 10/25/2022]
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Affiliation(s)
- Ole Reigstad
- Hand- and Microsurgery section Orthopaedic department OUS-Rikshospitalet Postboks 4950 Nydalen 0424 Oslo Norway
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8
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Abstract
Total hip arthroplasty continues to be one of the most effective surgical procedures currently available. The longevity of this otherwise very successful procedure is compromised by the wear of the bearing surface. In recent years, great advances have been made in the design of bearing surfaces that poise to offer extended performance to these artificial joints. The purpose of this review is to discuss the recent technologic advances in bearing surfaces and offer an insight to the potential benefits and concerns with the alternative bearing surfaces.
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Affiliation(s)
- Richard Tuli
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA 19107, USA
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9
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Sakellariou VI, Sculco P, Poultsides L, Wright T, Sculco TP. Highly cross-linked polyethylene may not have an advantage in total knee arthroplasty. HSS J 2013; 9:264-9. [PMID: 24426878 PMCID: PMC3772158 DOI: 10.1007/s11420-013-9352-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 07/16/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Long-term results after total knee replacement (TKR) with conventional and compression-molded polyethylene (PE) have been excellent. The introduction of highly cross-linked polyethylene (XLPE), which has demonstrated superior wear properties in total hip replacement (THR), has led to its recent use in TKR. However, the knee has a unique biomechanical environment characterized by large contact stresses and shear forces and differs from the highly conforming articulation (and primarily abrasive and adhesive wear) found in THR. For this reason, XLPE, with its decreased fatigue resistance and toughness compared to PE, may not be the best material to withstand these unique forces. QUESTIONS This review and evaluation of the literature aims to answer the following questions. What are the advantages and disadvantages of XLPE in TKR? Does its success in THR ensure a favorable outcome in TKR? Does the increased cost of XLPE justify its use in TKR? METHODS A systematic literature review of MEDLINE, Science Direct, and Google Scholar databases was performed searching for advantages and disadvantages of XLPE in TKR. We found 18 biomechanical in vitro investigations and 3 clinical studies comparing conventional and XLPEs. We included levels I through IV published articles in peer-reviewed journals in English language. RESULTS Several in vitro studies found XLPE to have significantly better wear properties compared to conventional PE. However, the two clinical investigations that directly compared conventional PE and XLPE found no difference in clinical or radiographic outcomes. Additionally, clinical studies with long-term follow-up on TKR with conventional PE did not find wear-induced osteolysis to be a major cause of failure. Four studies did find cost to be significantly higher for XLPE compared to conventional PE. CONCLUSIONS Based on our review, we concluded that (1) the material properties of XLPE reduce adhesive and abrasive wear, but not the risk of crack propagation, deformation, pitting, and delamination found in TKR; (2) wear-induced osteolysis in TKR has not been found to be a major cause of failure at long-term follow-up; (3) mid-term follow-up studies show no difference in any recorded outcome measure between conventional PE and XLPE; and (4) XLPE is two to four times the cost of conventional PE without an improvement in clinical or radiographic outcomes. For these reasons, we currently cannot recommend the use of XLPE in TKR. Conventional compression-molded polyethylene with its outstanding long-term results should remain the material of choice in TKR.
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Affiliation(s)
| | - Peter Sculco
- Hospital for Special Surgery, 535 East 70th street, New York, NY 10021 USA
| | - Lazaros Poultsides
- Hospital for Special Surgery, 535 East 70th street, New York, NY 10021 USA
| | - Timothy Wright
- Hospital for Special Surgery, 535 East 70th street, New York, NY 10021 USA
| | - Thomas P. Sculco
- Hospital for Special Surgery, 535 East 70th street, New York, NY 10021 USA
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Medium-term result of Elite Plus hip arthroplasty: the second modular evolution of the original Charnley low-friction arthroplasty. J Orthop Sci 2012; 17:699-704. [PMID: 22956048 DOI: 10.1007/s00776-012-0296-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Accepted: 08/10/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND The Elite Plus total hip arthroplasty (THA) system was introduced as the second modular evolution of the original Charnley low-friction arthroplasty. However, the results of the Elite Plus THA are currently considered to be inconsistent. The aim of this study was to clarify the medium-term results and the factors affecting the results of Elite Plus THA. METHODS The results of 97 Elite Plus THAs in 87 patients at 5 years or more postoperatively were reviewed. The patients' mean age was 65 years, and follow-up averaged 8.0 years. The Elite Plus stem was used in all hips, and three designs of socket, Hylamer Ogee in 40 hips, Wroblewski Offset Bore in 38, and Charnley Ogee in 19, were implanted. The survival rates with loosening and revision as endpoints were analyzed. To clarify the risk factors affecting the survival rates, Charnley's functional classification, Bombelli's classification, Crowe's classification, structural bone grafting of the acetabulum, cup design, stem position, and grading of the cement mantle were evaluated. CONCLUSIONS The results of Elite Plus stem THA were excellent in the medium term. The cup design was a potential confounding factor for acetabular loosening, and the Hylamer Ogee socket was associated with a poor result.
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Zywiel MG, Sayeed SA, Johnson AJ, Schmalzried TP, Mont MA. State of the art in hard-on-hard bearings: how did we get here and what have we achieved? Expert Rev Med Devices 2011; 8:187-207. [PMID: 21627555 DOI: 10.1586/erd.10.75] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Total hip arthroplasty has shown excellent results in decreasing pain and improving function in patients with degenerative disease of the hip. Improvements in prosthetic materials, designs and implant fixation have now resulted in wear of the bearing surface being the limitation of this technology, and a number of hard-on-hard couples have been introduced to address this concern. The purpose of this article is to review the origins, development, survival rates and potential advantages and disadvantages of the following hard-on-hard bearings for total hip arthroplasty: metal-on-metal standard total hip arthroplasty; metal-on-metal hip resurfacing arthroplasty, ceramic-on-ceramic total hip arthroplasty; and ceramic-on-metal bearings. Improvements in the manufacturing of metal-on-metal bearings over the past 50 years have resulted in implants that provide low wear rates and allow for the use of large femoral heads. However, concerns remain regarding elevated serum metal ion levels, potential teratogenic effects and potentially devastating adverse local tissue reactions, whose incidence and pathogenesis remains unclear. Modern total hip resurfacing has shown excellent outcomes over 10 years in the hands of experienced surgeons. Current ceramic-on-ceramic bearings have demonstrated excellent survival with exceptionally low wear rates and virtually no local adverse effects. Concerns remain for insertional chipping, in vivo fracture and the variable incidence of squeaking. Contemporary ceramic-on-metal interfaces are in the early stages of clinical use, with little data reported to date. Hard-on-hard bearings for total hip arthroplasty have improved dramatically over the past 50 years. As bearing designs continue to improve with new and modified materials and improved manufacturing techniques, it is likely that the use of hard-on-hard bearings will continue to increase, especially in young and active patients.
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Affiliation(s)
- Michael G Zywiel
- Division of Orthopaedic Surgery, University of Toronto, 100 College Street Room 302, Toronto, Ontario M5G 1L5, Canada
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12
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Real time monitoring of progressive damage during loading of a simplified total hip stem construct using embedded acoustic emission sensors. Med Eng Phys 2011; 33:395-406. [DOI: 10.1016/j.medengphy.2010.10.025] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2010] [Revised: 10/12/2010] [Accepted: 10/20/2010] [Indexed: 11/19/2022]
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13
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Fukui K, Kaneuji A, Sugimori T, Ichiseki T, Kitamura K, Matsumoto T. Wear comparison between a highly cross-linked polyethylene and conventional polyethylene against a zirconia femoral head: minimum 5-year follow-up. J Arthroplasty 2011; 26:45-9. [PMID: 20097032 DOI: 10.1016/j.arth.2009.11.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2009] [Accepted: 11/12/2009] [Indexed: 02/01/2023] Open
Abstract
Highly cross-linked polyethylene (HXLPE) was developed to reduce wear of articular bearing surface in total hip arthroplasty patients. Several studies have shown reduced wear of HXLPE compared with conventional polyethylene; however, these studies had used HXLPE in combination with a Co-Cr metal head. The purpose of this study was to compare the 5-year in vivo wear of HXLPE with that of conventional PE using a zirconia femoral head. Forty-five hips with a Trilogy HXLPE (Zimmer, Warsaw, Ind) were matched and compared with a control group of 20 conventional Trilogy PE hips. The 2-dimensional linear wear rate was significantly less in the HXLPE group between 1 and 5 years postoperation (P < .001). The results show that HXLPE reduces short-term polyethylene wear against not only a Co-Cr head but also a zirconia head.
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Affiliation(s)
- Kiyokazu Fukui
- Department of Orthopedics Surgery, Kanazawa Medical University, Kahokugun, Japan
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14
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Campbell DG, Field JR, Callary SA. Second-generation highly cross-linked X3™ polyethylene wear: a preliminary radiostereometric analysis study. Clin Orthop Relat Res 2010; 468:2704-9. [PMID: 20151231 PMCID: PMC3049610 DOI: 10.1007/s11999-010-1259-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2009] [Accepted: 01/27/2010] [Indexed: 01/31/2023]
Abstract
BACKGROUND First-generation highly cross-linked polyethylene liners have reduced the incidence of wear particle-induced osteolysis. However, failed acetabular liners have shown evidence of surface cracking, mechanical failure, and oxidative damage. This has led to the development of second-generation highly cross-linked polyethylene, which has improved wear and mechanical properties and resistance to oxidation in vitro. Owing to its recent introduction, there are no publications describing its clinical performance. QUESTIONS/PURPOSES We assessed early clinical wear of a second-generation highly cross-linked polyethylene liner and compared its clinical performance with the published results of hip simulator tests and with first-generation highly cross-linked polyethylene annealed liners. PATIENTS AND METHODS Twenty-one patients were enrolled in a prospective cohort study. Clinical outcome and femoral head penetration were measured for 19 patients at 6 months and 1 and 2 years postoperatively. RESULTS The median proximal head penetration was 0.009 mm and 0.024 mm at 1 and 2 years, respectively. The median two-dimensional (2-D) head penetration was 0.083 mm and 0.060 mm at 1 and 2 years, respectively. The median proximal wear rate between 1 and 2 years was 0.015 mm/year. CONCLUSIONS The wear rate calculated was similar to the in vitro wear rate reported for this material; however, it was less than the detection threshold for this technique. Although longer followup is required for wear to reach a clinically quantifiable level, this low level of wear is encouraging for the future clinical performance of this material. LEVEL OF EVIDENCE Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- David G. Campbell
- Wakefield Orthopaedic Clinic, 270 Wakefield Street, Adelaide, SA 5000 Australia
| | - John R. Field
- CORe: Comparative Orthopaedic Research Surgical Facility, Flinders University, Adelaide, SA Australia
| | - Stuart A. Callary
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital and University of Adelaide, Adelaide, SA Australia
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Stilling M, Larsen K, Andersen NT, Søballe K, Kold S, Rahbek O. The final follow-up plain radiograph is sufficient for clinical evaluation of polyethylene wear in total hip arthroplasty. A study of validity and reliability. Acta Orthop 2010; 81:570-8. [PMID: 20860443 PMCID: PMC3214745 DOI: 10.3109/17453674.2010.506632] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2010] [Accepted: 04/13/2010] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Radiostereometric analysis (RSA) is a highly accurate tool for assessment of polyethylene (PE) wear in total hip arthroplasty (THA); however, PE wear measurements in clinical studies are often limited to plain radiographs. We evaluated the agreement between PE wear measured with PolyWare software, which uses plain radiographs, and by model-based RSA, which uses stereo radiographs. METHODS Measurements of PE wear postoperatively and at final follow-up (after mean 6 years) on plain radiographs of 12 patients after cementless THA were evaluated with PolyWare software and the results were compared with those from RSA as the gold standard (Model-based RSA using elementary geometrical shape models; EGS-RSA). With PolyWare, we either used the final radiographic follow-up (PW1) only or both the postoperative follow-up and the final follow-up (PW2). RESULTS The 2D mean wear measured (in mm) was 0.80, 1.07, and 0.60 for the PW2, PW1, and RSA method. 2D intra-method repeatability was similar for PW1 and RSA with limits of agreement (LOAs, in mm) of ± 0.22, and ± 0.23, respectively. 2D inter-method concurrent validity was best between PW1 and EGS-RSA with LOAs of ± 0.55. For 2D linear wear measurements, the PW1 method had a clinical repeatability similar to that of RSA. INTERPRETATION PW1 is sufficient for retrospective determination of 2D wear from medium-term wear measurements above 0.5 mm, It alleviates the need for baseline plain radiographs, has a clinical precision similar to that of RSA, and is easy and inexpensive to use.
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Affiliation(s)
- Maiken Stilling
- Department of Orthopedics, Aarhus University Hospital, Denmark.
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Girard J, Migaud H. Re: Metal on metal: is it worth the risk? J Arthroplasty 2010; 25:661-2; author reply 662. [PMID: 20434871 DOI: 10.1016/j.arth.2010.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Accepted: 03/21/2010] [Indexed: 02/01/2023] Open
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Abstract
BACKGROUND AND PURPOSE The Charnley Elite-Plus stem was introduced in 1993 as a presumed improvement of the flanged Charnley stem. We started this study in 1996 to investigate the migratory pattern of the Elite-Plus stem. PATIENTS AND METHODS We followed 114 patients with osteoarthritis and a primary total hip replacement with the Elite-Plus stem. Mean age at the time of operation was 64 (50-76) years. The mean follow-up time was 6.5 (2-7) years. Radiographs were evaluated with respect to cementing technique, migration, and wear measured by radiostereometry (RSA). RESULTS The stem survival was 98% (CI: 96-100) at 7 years and 92% (CI: 86-97) at 10 years. Mean migration of the femoral head was 0.35 mm (SD 0.3) medially, 0.51 mm (SD 0.6) distally, and 1.1 mm (SD 1.8) in the dorsal direction. Mean total point motion was 1.7 mm (SD 1.7). The migration of the stems stabilized after 5 years in the medial and dorsal directions, but continued to subside slightly. Migration along any of the axes was higher if the cementing technique was inferior. INTERPRETATION Patients with a Charnley Elite-Plus stem and defects in the cement mantle or other signs of inferior implantation technique should be carefully monitored.
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Affiliation(s)
- Thord von Schewelov
- Department of Orthopedics, Lund University, Malmö University Hospital, MalmöSweden
| | - Lennart Sanzén
- Department of Orthopedics, Lund University, Malmö University Hospital, MalmöSweden
| | - Jack Besjakov
- Department of Orthopedics, Lund University, Malmö University Hospital, MalmöSweden
| | - Åke Carlsson
- Department of Orthopedics, Lund University, Malmö University Hospital, MalmöSweden
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18
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Schemitsch EH, Bhandari M, Boden SD, Bourne RB, Bozic KJ, Jacobs JJ, Zdero R. The evidence-based approach in bringing new orthopaedic devices to market. J Bone Joint Surg Am 2010; 92:1030-7. [PMID: 20360530 DOI: 10.2106/jbjs.h.01532] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Emil H Schemitsch
- St. Michael's Hospital, 55 Queen Street East, Suite 800, Toronto, ON M5C 1R6, Canada
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Abstract
BACKGROUND AND PURPOSE Two-dimensional computerized radiographic techniques are frequently used to measure in vivo polyethylene (PE) wear after total hip arthroplasty (THA), and several variables in the clinical set-up may influence the amount of wear that is measured. We compared the repeatability and concurrent validity of linear PE wear on plain radiographs using the same software but a different number of radiographs. METHODS We used either 1, 2, or 6 anteroposterior (AP) hip radiographs of 11 patients from a clinical THA series with 12 years of follow-up, and measured the PE wear with the software PolyWare 3D Pro. Repeatability within and concurrent validity between the different numbers of radiograph strategies were assessed using limits of agreement (LOAs) and bias. RESULTS Observed median wear (range) in mm was 3.4 (1.6-4.6), 2.3 (0.7-4.9), and 4.0 (2.6-6.2) for the 1-, 2-, and 6-radiograph strategies. For repeatability, no bias (p > 0.41) was observed. LOAs around the bias were + or - 0.6, + or - 0.4, and + or - 1.2 mm for the 1-, 2-, and 6-radiograph strategies. For concurrent validity, a bias (+ or - LOA) between all pairwise comparisons was observed (p < 0.02) with 0.8 mm (+ or - 2.5) between the 1- and 2-radiograph strategies, 1.0 mm (+ or - 2.2) between the 1- and 6-radiograph strategies, and 1.8 mm (+ or - 1.2) between the 2- and 6-radiograph strategies. INTERPRETATION The number of radiographs used for wear measurement with a shadow-casting analysis method on plain AP radiographs influences the amount of linear wear measured. Results of PE wear obtained with PolyWare in studies using a different number of radiographs are not comparable.
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Affiliation(s)
| | - Kjeld Søballe
- Department of Orthopaedics, Aarhus University Hospital
| | | | - Kristian Larsen
- Orthopedic Research Unit, Department of Orthopedics, Hospital Unit West, Holstebro, Denmark
| | - Ole Rahbek
- Department of Orthopaedics, Aarhus University Hospital
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Yoshitomi H, Shikata S, Ito H, Nakayama T, Nakamura T. Manufacturers affect clinical results of THA with zirconia heads: a systematic review. Clin Orthop Relat Res 2009; 467:2349-55. [PMID: 19184615 PMCID: PMC2866928 DOI: 10.1007/s11999-009-0709-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2008] [Accepted: 01/08/2009] [Indexed: 01/31/2023]
Abstract
In the 1980s, zirconia was introduced for THA with the expectation of lower polyethylene wear and better clinical results. However, several studies have reported poor survivorship of zirconia-polyethylene THA. We performed a systematic review and meta-analysis of zirconia-polyethylene THA to confirm or refute the theoretical advantages of this combination. Of 163 studies identified by a comprehensive search, seven met our selection criteria. These involved 769 hips of 586 patients with a mean age of 56.8 years and a minimum followup of 60 months (mean, 89.2 months; range, 60-155 months). The consolidated revision rate of zirconia-polyethylene THA at 89.2 months was higher than that of nonzirconia-polyethylene THA by 5% (risk difference, 0.05; 95% confidence interval, 0.02-0.08). Subgroup meta-analysis suggested THAs with zirconia heads from Ceraver had more revision surgery than nonzirconia heads (risk difference, 0.08; 95% confidence interval, 0.03-0.14), whereas zirconia heads from DePuy did not (risk difference, 0.02; 95% confidence interval, -0.01-0.06). The meta-analysis for annual linear polyethylene wear (which did not involve zirconia heads from Ceraver because of insufficient descriptions) showed no difference between zirconia and control groups. Collectively, THAs with high-quality zirconia heads appear to have prosthesis survivorship and polyethylene wear equivalent to those of THAs with traditional materials, but differing quality among zirconia heads could lead to poor survivorship of prostheses.
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Affiliation(s)
- Hiroyuki Yoshitomi
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507 Japan
| | - Satoru Shikata
- Department of Surgery, Soseikai General Hospital, Kyoto, Japan
| | - Hiromu Ito
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507 Japan
| | - Takeo Nakayama
- Department of Health Informatics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takashi Nakamura
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507 Japan
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21
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Digas G. New polymer materials in total hip arthroplasty. ACTA ORTHOPAEDICA. SUPPLEMENTUM 2009. [DOI: 10.1080/17453674078540521] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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22
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Wear of a highly cross-linked polyethylene liner: a preliminary RSA study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2009. [DOI: 10.1007/s00590-009-0486-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Piconi C, Maccauro G, Angeloni M, Rossi B, Learmonth ID. Zirconia heads in perspective: a survey of zirconia outcomes in total hip replacement. Hip Int 2007; 17:119-30. [PMID: 19197856 DOI: 10.1177/112070000701700301] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Zirconia ball heads have been implanted successfully from the late 1980s, but reports of wear and fractures have raised concerns about this ceramic biomaterial. This paper reviews the literature on clinical wear of zirconia-polyethylene bearings, zirconia head degradation and fractures, analysing the different factors that have led to clinical failure, such as material source, manufacturing process and type of polyethylene. The results underline the need for more homogeneous clinical series. Careful follow-up of patients with zirconia-polyethylene bearings is recommended.
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Affiliation(s)
- C Piconi
- Orthopaedic Department, Catholic University of Rome, Rome, Italy
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24
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Stiehl JB, Mahfouz MR. Catastrophic failure of a modular revision total hip polyethylene insert. J Arthroplasty 2007; 22:143-7. [PMID: 17197323 DOI: 10.1016/j.arth.2006.02.077] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2005] [Accepted: 02/02/2006] [Indexed: 02/01/2023] Open
Abstract
Early catastrophic failure of a modular polyethylene component is a potential problem after revision total hip arthroplasty. We describe an unusual case of polyethylene failure that occurred within 18 months of implantation in which no obvious technical error or mechanical failure was identified. The acetabular polyethylene insert was prepared with gas plasma sterilization, and the shelf life was 4 months. Radiographic evaluation used generalized Hough transforms to assess the cup articulation. We identified cup penetration of 2.8 mm before revision and catastrophic destruction of the polyethylene liner at the time of revision. Possible factors implicated for failure included a thin polyethylene liner, increased hip separation, femoral head mismatch, and the high activity level of a younger patient. We believe that this case report highlights the need for future investigations of these subtle factors.
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Affiliation(s)
- James Bowen Stiehl
- Department of Orthopedic Surgery, Medical College of Wisconsin, Columbia St Mary's Hospital, Milwaukee, Wisconsin, USA
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25
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Clarke IC. Metastable Nature of Zirconia Femoral Heads From a 20-Year Perspective Of Clinical and Simulator Wear Studies. ACTA ACUST UNITED AC 2006. [DOI: 10.1053/j.sart.2006.09.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Pérez MA, García-Aznar JM, Doblaré M, Seral B, Seral F. A comparative FEA of the debonding process in different concepts of cemented hip implants. Med Eng Phys 2006; 28:525-33. [PMID: 16257253 DOI: 10.1016/j.medengphy.2005.09.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2005] [Revised: 07/26/2005] [Accepted: 09/28/2005] [Indexed: 11/20/2022]
Abstract
Debonding of the stem-cement interface and damage accumulation in the cement mantle are basic events that contribute to the long-term failure of cemented hip reconstructions. In this work, a numerical study with these two processes coupled is presented. On the one hand, debonding of the stem-cement interface was simulated by means of a cohesive surface theory that was implemented into an interface finite element. This interface model includes a tensile-shear behavior law, the fatigue failure of the interface, and the friction evolution between both surfaces. On the other hand, damage accumulation in the cement was formulated through the theory of continuum damage mechanics, considering cement damage due to tension, creep under compression, crack closure effects, non-linear damage accumulation and cement residual stresses appearing during polymerisation. This methodology was applied to simulate and compare the degradation process of the cement and stem-cement interface in four different concepts of design: Exeter, Charnley, Elite Plus and ABG II stems. As the actual mechanical properties of the surface of each specific prosthesis are not known, we assumed the same for all of them, distinguishing between polished and matt surfaces. With this assumption, the predicted results showed that the debonding process is very different for each implant depending on the stem geometry. Lower cement deterioration was obtained for the Exeter and ABG II stems, while the lowest stem-cement interface debonding was produced in the Exeter and the Elite Plus stems.
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Affiliation(s)
- M A Pérez
- Group of Structural Mechanics and Material Modelling, Aragón Institute of Engineering Research (I3A), University of Zaragoza, María de Luna 3, 50015 Zaragoza, Spain
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27
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Tsukamoto R, Chen S, Asano T, Ogino M, Shoji H, Nakamura T, Clarke IC. Improved wear performance with crosslinked UHMWPE and zirconia implants in knee simulation. Acta Orthop 2006; 77:505-11. [PMID: 16819693 DOI: 10.1080/17453670610046479] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Suggestions for improved wear performance of total knee replacements have included replacement of standard CoCr femoral components with ceramic and replacement of 3.5-Mrad ultra-high molecular weight polyethylene (UHMWPE) inserts with 5- or 7-Mrad UHMWPE inserts. The ceramic materials used clinically have included alumina, zirconia ceramic and oxidized zirconium. PATIENTS AND METHOD We compared both CoCr and zirconia versions of the Bi-Surface knee replacement in a 6-station knee simulator using alpha calf serum for lubrication (20 mg protein per mL) to evaluate the relative bearing performance. RESULTS We studied the 4-way knee simulation of implant materials: zirconia ceramic, CoCr, 3.5-Mrad UHMWPE, and 7-Mrad UHMWPE. With CoCr femoral components, the 7-Mrad UHMWPE resulted in a 5- to 8-fold reduction in wear compared to the 3.5-Mrad insert. With the 3.5-Mrad insert, the zirconia bearing provided approximately 4-fold wear reduction compared to CoCr. These wear rates with standard UHMWPE were similar to published wear studies on entire knees. With the exception of the CoCr/7-Mrad and ZrO2/3.5-Mrad combinations, the wear differences were statistically significant. INTERPRETATION The ZrO2/7-Mrad UHMWPE combination gave the best performance, with no measurable wear over the 5.5 million cycle test duration.
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Affiliation(s)
- Riichiro Tsukamoto
- Department of Orthopedics, Loma Linda University Medical Center. Loma Linda, CA, USA
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28
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Rieker CB. Tribology considerations for hip joint articulations in relation to the "new orthopaedic patient". Hip Int 2006; 16 Suppl 4:12-6. [PMID: 19219823 DOI: 10.1177/112070000601604s04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The purpose of this review is to examine alternative bearings used in total hip arthroplasty (THA) and discuss the specific tribologic needs of the "New Orthopaedic Patient". As orthopaedic patients today are younger and more active, there is a clear need for hip joint implants and articulations minimising the amount of wear and guarantying better stability. Recent modern developments in tribology with highly cross-linked polyethylenes and hard-on-hard bearings allow the safe and effective use of larger diameter articulations in THA.
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Abstract
BACKGROUND Cross-linked polyethylene was developed to reduce volumetric wear in prosthetic joints. Hip simulator studies have shown promising results with regard to wear reduction. This study evaluated the short-term in vivo wear of a moderately cross-linked polyethylene. METHODS Linear head penetration, as an assessment of in vivo polyethylene wear, was measured in two groups of patients after total hip replacement. Twenty-four hips received a conventional polyethylene insert and thirty-four, a cross-linked polyethylene liner; both inserts were manufactured by the same company. Linear and volumetric wear rates were measured on radiographs with use of a validated computer-assisted technique and were adjusted for patient-related factors. Patient activity was assessed by a computerized two-dimensional accelerometer worn on the ankle. RESULTS Patients with a conventional polyethylene insert showed a mean linear wear rate of 0.13 mm per year and a mean volumetric wear rate of 87.6 mm(3) per year. The group with a cross-linked polyethylene liner showed a mean linear wear rate of 0.02 mm per year and a mean volumetric wear rate of 17.0 mm(3) per year. Wear in the group with cross-linked polyethylene was 81% lower than that in the group with conventional polyethylene (p < 0.00001). Accounting for differences in patient activity, the adjusted wear rates per million cycles for a patient weight of 70 kg were 53 mm(3) per million cycles for conventional polyethylene and 15 mm(3) per million cycles for cross-linked polyethylene, a 72% reduction (p = 0.0002). No factor, other than the type of polyethylene, was found to influence the difference in wear rates between the two groups. CONCLUSIONS The results of this study are promising. The in vivo wear reduction with this cross-linked polyethylene is consistent with the predictions of hip simulator studies.
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Affiliation(s)
- Christian Heisel
- Joint Replacement Institute at Orthopaedic Hospital, 2400 South Flower Street, Los Angeles, CA 90007
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30
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Clarke IC, Manaka M, Green DD, Williams P, Pezzotti G, Kim YH, Ries M, Sugano N, Sedel L, Delauney C, Nissan BB, Donaldson T, Gustafson GA. Current status of zirconia used in total hip implants. J Bone Joint Surg Am 2003; 85-A Suppl 4:73-84. [PMID: 14652396 DOI: 10.2106/00004623-200300004-00009] [Citation(s) in RCA: 181] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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