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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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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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Savin L, Pinteala T, Mihai DN, Mihailescu D, Miu SS, Sirbu MT, Veliceasa B, Popescu DC, Sirbu PD, Forna N. Updates on Biomaterials Used in Total Hip Arthroplasty (THA). Polymers (Basel) 2023; 15:3278. [PMID: 37571172 PMCID: PMC10422432 DOI: 10.3390/polym15153278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 07/30/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023] Open
Abstract
One of the most popular and effective orthopedic surgical interventions for treating a variety of hip diseases is total hip arthroplasty. Despite being a radical procedure that involves replacing bone and cartilaginous surfaces with biomaterials, it produces excellent outcomes that significantly increase the patient's quality of life. Patient factors and surgical technique, as well as biomaterials, play a role in prosthetic survival, with aseptic loosening (one of the most common causes of total hip arthroplasty failure) being linked to the quality of biomaterials utilized. Over the years, various biomaterials have been developed to limit the amount of wear particles generated over time by friction between the prosthetic head (metal alloys or ceramic) and the insert fixed in the acetabular component (polyethylene or ceramic). An ideal biomaterial must be biocompatible, have a low coefficient of friction, be corrosion resistant, and have great mechanical power. Comprehensive knowledge regarding what causes hip arthroplasty failure, as well as improvements in biomaterial quality and surgical technique, will influence the survivability of the prosthetic implant. The purpose of this article was to assess the benefits and drawbacks of various biomaterial and friction couples used in total hip arthroplasties by reviewing the scientific literature published over the last 10 years.
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Affiliation(s)
- Liliana Savin
- Department of Orthopedics and Traumatology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (L.S.); (D.M.); (M.T.S.); (B.V.); (D.C.P.); (P.D.S.); (N.F.)
- Department of Orthopedics, Clinical Rehabilitation Hospital, 700661 Iasi, Romania;
| | - Tudor Pinteala
- Department of Orthopedics and Traumatology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (L.S.); (D.M.); (M.T.S.); (B.V.); (D.C.P.); (P.D.S.); (N.F.)
- Department of Orthopedics, Clinical Rehabilitation Hospital, 700661 Iasi, Romania;
| | - Dana Nicoleta Mihai
- Department of Orthopedics, Clinical Rehabilitation Hospital, 700661 Iasi, Romania;
- Department of Protheses Technology, Faculty of Dental Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Dan Mihailescu
- Department of Orthopedics and Traumatology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (L.S.); (D.M.); (M.T.S.); (B.V.); (D.C.P.); (P.D.S.); (N.F.)
- Department of Orthopedics, Clinical Rehabilitation Hospital, 700661 Iasi, Romania;
| | - Smaranda Stefana Miu
- Department of Rehabilitation, Clinical Rehabilitation Hospital, 700661 Iasi, Romania;
| | - Mihnea Theodor Sirbu
- Department of Orthopedics and Traumatology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (L.S.); (D.M.); (M.T.S.); (B.V.); (D.C.P.); (P.D.S.); (N.F.)
| | - Bogdan Veliceasa
- Department of Orthopedics and Traumatology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (L.S.); (D.M.); (M.T.S.); (B.V.); (D.C.P.); (P.D.S.); (N.F.)
| | - Dragos Cristian Popescu
- Department of Orthopedics and Traumatology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (L.S.); (D.M.); (M.T.S.); (B.V.); (D.C.P.); (P.D.S.); (N.F.)
| | - Paul Dan Sirbu
- Department of Orthopedics and Traumatology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (L.S.); (D.M.); (M.T.S.); (B.V.); (D.C.P.); (P.D.S.); (N.F.)
- Department of Orthopedics, Clinical Rehabilitation Hospital, 700661 Iasi, Romania;
| | - Norin Forna
- Department of Orthopedics and Traumatology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (L.S.); (D.M.); (M.T.S.); (B.V.); (D.C.P.); (P.D.S.); (N.F.)
- Department of Orthopedics, Clinical Rehabilitation Hospital, 700661 Iasi, Romania;
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4
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Mertz KC, Yang J, Chung BC, Chen X, Mayfield CK, Heckmann ND. Ceramic Femoral Heads Exhibit Lower Wear Rates Compared to Cobalt Chrome: A Meta-Analysis. J Arthroplasty 2023; 38:397-405. [PMID: 36108994 DOI: 10.1016/j.arth.2022.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 09/06/2022] [Accepted: 09/06/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Wear between the femoral head and acetabular liners continues to limit the longevity of total hip arthroplasty implants despite advances in implant materials. The purpose of this meta-analysis was to compare linear wear rates of cobalt-chromium (CoCr) and fourth-generation ceramic femoral heads on highly cross-linked polyethylene (XLPE) liners. METHODS A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted to identify all studies between 2003 and 2020 that examined in vivo wear rates of either fourth-generation ceramics or CoCr femoral heads on XLPE liners. Studies were analyzed in a weighted means analysis of wear rates and a random effects meta-analysis. RESULTS A total of 36 studies met inclusion criteria (1,657 CoCr and 659 ceramic patients). The pooled, weighted mean wear rate was 0.063 mm/year (standard deviation [SD]: 0.061, confidence interval [CI]: 0.049-0.077) for CoCr and 0.047 mm/year (SD: 0.057, CI: 0.033-0.062; P < .01) for ceramic (P < .01). A meta-analysis of 4 studies directly comparing ceramic and CoCr found that CoCr heads demonstrated 0.029 mm/year more wear than ceramic heads (95% CI: 0.026-0.059, P = .306). Mean wear for 32-mm heads was significantly higher for ceramic (P < .01), while mean wear for 36-mm heads was significantly higher for CoCr (P < .01). CONCLUSION Fourth-generation ceramic femoral heads were found to have significantly lower wear rates than CoCr heads. Unlike previous studies, this meta-analysis included only in vivo studies and those with the same generation of highly XLPE liners.
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Affiliation(s)
- Kevin C Mertz
- Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - JaeWon Yang
- University of Washington Medical Center, Seattle, Washington
| | - Brian C Chung
- Keck School of Medicine of the University of Southern California, Los Angeles, California
| | | | - Cory K Mayfield
- Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Nathanael D Heckmann
- Keck School of Medicine of the University of Southern California, Los Angeles, California
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Spir IAZ, Anzai A, Utino A, Katayama H, Tosello G, Nery MM, Anhesini M, Tiezzi OS, Otani P, Bernardo WM. Comparison between ceramic-on-polyethylene versus metal-on-polyethylene prostheses in Total Hip Arthroplasties: a systematic review and meta-analysis. Rev Assoc Med Bras (1992) 2022; 68:1611-1618. [PMID: 36477100 PMCID: PMC9779979 DOI: 10.1590/1806-9282.022d6812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 11/09/2022] [Indexed: 12/12/2022] Open
Abstract
The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field to standardize how to conduct, and to assist in the reasoning and decision-making of doctors. The information provided by this project must be critically evaluated by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical condition of each patient.
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Affiliation(s)
| | - Adriano Anzai
- Unimed, Evidence-Based Medicine Center – Presidente Prudente (SP), Brazil
| | - Armelim Utino
- Unimed, Evidence-Based Medicine Center – Presidente Prudente (SP), Brazil
| | - Haroldo Katayama
- Unimed, Evidence-Based Medicine Center – Presidente Prudente (SP), Brazil
| | - Giuliano Tosello
- Unimed, Evidence-Based Medicine Center – Presidente Prudente (SP), Brazil
| | - Mary Martins Nery
- Unimed, Evidence-Based Medicine Center – Presidente Prudente (SP), Brazil
| | - Mauricio Anhesini
- Unimed, Evidence-Based Medicine Center – Presidente Prudente (SP), Brazil
| | | | - Pericles Otani
- Unimed, Evidence-Based Medicine Center – Presidente Prudente (SP), Brazil
| | - Wanderley Marques Bernardo
- Federação das Unimeds do Estado de São Paulo, Federal Council of Medicine – São Paulo (SP), Brazil.,Corresponding author:
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Salipas A, Poole AS, Teeter MG, Somerville LE, Naudie DD, McCalden RW. A Ten-Year Radiostereometric Analysis of Polyethylene Wear Between Oxidized Zirconium and Cobalt Chrome Articulations in Total Hip Arthroplasty. J Arthroplasty 2022; 37:S692-S696. [PMID: 35245689 DOI: 10.1016/j.arth.2022.02.099] [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: 11/24/2021] [Revised: 02/14/2022] [Accepted: 02/23/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Oxidized zirconium (OxZi) femoral heads combine the decreased abrasive properties of ceramics with the toughness of metal alloys to lower wear and increase the durability of total hip arthroplasty. The purpose of this study was to compare the 10-year polyethylene wear rates between OxZi/XLPE and cobalt chrome (CoCr)/XLPE articulations. METHODS A radiostereometric analysis (RSA) was performed on two cohorts of 23 patients who underwent total hip arthroplasty using either OxZi/XLPE or CoCr/XLPE at a minimum of 10-year follow-up. Cohorts were matched for age, gender, body mass index (BMI), and diagnosis. Polyethylene wear was measured using RSA to determine total and steady-state wear rates for both cohorts. Preoperative and postoperative patient-reported outcome measures (SF12, HHS, and Western Ontario and McMaster Universities Arthritis Index scores) were compared. RESULTS The mean total head penetration rate was found to be statistically different between the entire cohorts (OxZi 0.048 ± 0.021 mm/y, CoCr 0.035 ± 0.017 mm/y, P = .02) but not when 28-mm heads only (OxZi 0.045 ± 0.016 mm/y, CoCr 0.034 ± 0.017 mm/y, P = .066) were directly compared. The mean steady-state wear rate was not significantly different between the entire cohorts (OxZi 0.031 ± 0.021 mm/y, CoCr 0.024 ± 0.019 mm/y, P = .24) or 28-mm head cohorts (OxZi 0.028 ± 0.019 mm/y, CoCr 0.024 ± 0.019 mm/y, P = .574). Outcome measures showed no statistical difference except for the Harris Hip Score where the OxZi cohort demonstrated higher median scores. CONCLUSION Using RSA to evaluate the 10-year in-vivo head penetration, there was no statistically significant difference in steady-state wear rates between OxZi and CoCr articulations. Both bearing combinations demonstrated wear rates well below the threshold for osteolysis.
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Affiliation(s)
- Andrew Salipas
- Division of Orthopaedic Surgery, Department of Surgery, London Health Sciences, London, Ontario, Canada
| | - Andrew S Poole
- Division of Orthopaedic Surgery, Department of Surgery, London Health Sciences, London, Ontario, Canada
| | - Matthew G Teeter
- Division of Orthopaedic Surgery, Department of Surgery, London Health Sciences, London, Ontario, Canada
| | - Lyndsay E Somerville
- Division of Orthopaedic Surgery, Department of Surgery, London Health Sciences, London, Ontario, Canada
| | - Douglas D Naudie
- Division of Orthopaedic Surgery, Department of Surgery, London Health Sciences, London, Ontario, Canada
| | - Richard W McCalden
- Division of Orthopaedic Surgery, Department of Surgery, London Health Sciences, London, Ontario, Canada
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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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8
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Kretzer JP, Uhler M, Jäger S, Bormann T, Sonntag R, Schonhoff M, Schröder S. [Tribology in hip arthroplasty : Benefits of different materials]. DER ORTHOPADE 2021; 50:259-269. [PMID: 33630110 DOI: 10.1007/s00132-021-04077-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/01/2021] [Indexed: 11/30/2022]
Abstract
When it comes to total hip replacements, choosing the suitable material combination is of clinical relevance. The present review article examines the technical differences in wear and corrosion of the relevant material combinations of ceramics, metals, ceramized metals and various types of polyethylene. The material characteristics, which were often tested under standardized conditions in the laboratory, are compared with clinical results on the basis of evidence-graded clinical studies and on the basis of register studies. This article thus represents an up-to-date snapshot of the expectations and actual clinical outcomes of the present choice of material combinations. It shows that some tendencies from the field of materials research, e.g. with regard to cross-linked polyethylene, coincide with observations from practical clinical experience, while for other materials, a proven technical superiority has not yet been confirmed as an evident advantage in clinical practice.
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Affiliation(s)
- J Philippe Kretzer
- Klinik für Orthopädie und Unfallchirurgie, Labor für Biomechanik und Implantatforschung, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland.
| | - Maximilian Uhler
- Klinik für Orthopädie und Unfallchirurgie, Labor für Biomechanik und Implantatforschung, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| | - Sebastian Jäger
- Klinik für Orthopädie und Unfallchirurgie, Labor für Biomechanik und Implantatforschung, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| | - Therese Bormann
- Klinik für Orthopädie und Unfallchirurgie, Labor für Biomechanik und Implantatforschung, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| | - Robert Sonntag
- Klinik für Orthopädie und Unfallchirurgie, Labor für Biomechanik und Implantatforschung, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| | - Mareike Schonhoff
- Klinik für Orthopädie und Unfallchirurgie, Labor für Biomechanik und Implantatforschung, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| | - Stefan Schröder
- Klinik für Orthopädie und Unfallchirurgie, Labor für Biomechanik und Implantatforschung, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
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9
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Cushnie DW, Lanting BA, McCalden R, Naudie DD, Howard JL. Midterm outcomes of total hip arthroplasty with a modular Birmingham head. Hip Int 2021; 31:103-108. [PMID: 31530026 DOI: 10.1177/1120700019877389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Birmingham Hip Resurfacing (BHR) implants may be combined with a conventional femoral stem to create a modular metal-on-metal total hip arthroplasty (BHR MoM THA). There is little outcome data regarding this construct. This study examines midterm outcomes of BHR MoM THA compared to oxidised zirconium total hip arthroplasty (THA). METHODS A retrospective institutional review identified all patients receiving BHR MoM THA between April 2005 and February 2011 and a matched control cohort of zirconium THA patients. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Harris Hip Score (HHS), and SF-12 Health status scores were obtained. Revisions and complications were collected from clinical records. Radiographs were assessed for evidence of component malposition, loosening, osteolysis, or heterotopic ossification. RESULTS 63 modular BHR MoM THA were identified in 61 patients (36 with BHR cups, 27 with R3 cups) and 63 zirconium THA in 58 matched controls. Mean follow-up was 58 months. 14 BHR MoM THA hips (22.2%) were revised (4 infections, 1 dislocation, 9 soft tissue reactions) compared to 3 (4.8%) zirconium THA (all infections). At latest follow-up, 18.4% of surviving BHR MoM THA hips were painful compared to 0.5% of zirconium THA controls (p < 0.001). WOMAC, HHS, and SF-12 did not differ significantly between surviving members of the 2 groups. DISCUSSION BHR MoM THA demonstrated a high revision rate, largely for adverse local soft tissue reaction and pain. Among those not revised, many reported some residual pain despite similar quality of life measures to those who received zirconium THA.
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Affiliation(s)
- Duncan W Cushnie
- Division of Orthopaedic Surgery, London Health Sciences Centre and Western University, London, Canada.,Department of Surgery, McMaster University, Hamilton, Canada
| | - Brent A Lanting
- Division of Orthopaedic Surgery, London Health Sciences Centre and Western University, London, Canada
| | - Richard McCalden
- Division of Orthopaedic Surgery, London Health Sciences Centre and Western University, London, Canada
| | - Douglas Dr Naudie
- Division of Orthopaedic Surgery, London Health Sciences Centre and Western University, London, Canada
| | - James L Howard
- Division of Orthopaedic Surgery, London Health Sciences Centre and Western University, London, Canada
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10
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Bergvinsson H, Sundberg M, Flivik G. Polyethylene Wear With Ceramic and Metal Femoral Heads at 5 Years: A Randomized Controlled Trial With Radiostereometric Analysis. J Arthroplasty 2020; 35:3769-3776. [PMID: 32763006 DOI: 10.1016/j.arth.2020.06.057] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/15/2020] [Accepted: 06/18/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND A common bearing combination in total hip arthroplasty today is a metal femoral head articulating with polyethylene in the cup. Ceramic heads are thought to be more resistant to third-body damage, and have better wettability and decreased surface roughness, which taken together have been suggested to result in less polyethylene wear. The purpose of this study is to compare the initial creep deformation and follow wear pattern, using radiostereometric analysis, of ceramic and metal femoral heads that articulate with a modern highly cross-linked polyethylene cup liner. METHODS Fifty patients with primary osteoarthritis and scheduled for an uncemented total hip arthroplasty were randomized 1:1 to either a ceramic (BIOLOX delta) or a metal (CoCr) femoral head. The patients were followed up for 5 years with repeated radiostereometric analysis examinations (postoperatively, then at 14 days, 3, 12, 24, and 60 months), as well as a hip-specific outcome questionnaire. RESULTS During the first 3 months both groups showed expected creep within the liner of 0.12 mm (standard deviation 0.03) for the ceramic and 0.08 mm (standard deviation 0.02) for the metal heads. Between 3 months and 5 years there was very little wear of the liner in either group, corresponding to 0.003 mm/y for ceramic and 0.007 mm/y for metal heads. There was no difference in cup migration or clinical outcome between the groups and no cups were revised. CONCLUSION With the introduction of modern highly cross-linked polyethylene, the ceramic head demonstrates no superiority when it comes to either early deformation or polyethylene wear compared with the metal head.
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Affiliation(s)
- Halldor Bergvinsson
- Department of Orthopedics, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
| | - Martin Sundberg
- Department of Orthopedics, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
| | - Gunnar Flivik
- Department of Orthopedics, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
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11
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Abstract
Choice of articulating materials, head size and the design of the articulation will become decisive for the long-term performance of a total hip arthroplasty (THA) and especially in terms of risk for dislocation and wear-related problems. Here we account for common alternatives based on available studies and the evidence that can be derived from them.Metal or ceramic femoral heads articulating against a liner or cup made of highly cross-linked polyethylene and ceramic-on-ceramic articulations have about similar risk for complications leading to revision, whereas the performance of metal-on-metal articulations, especially with use of big heads, is inferior. The clinical significance of problems related to ceramic-on-ceramic articulations such as squeaking remains unclear. With use of current technology ceramic fractures are rare.Large femoral heads have the potential to increase the range of hip movement before impingement occurs and are therefore expected to reduce dislocation rates. On the other hand, issues related to bearing wear, corrosion at the taper-trunnion junction and groin pain may arise with larger heads and jeopardize the longevity of THA. Based on current knowledge, 32-mm heads seem to be optimal for metal-on-polyethylene bearings. Patients with ceramic-on-ceramic bearings may benefit from even larger heads such as 36 or 40 mm, but so far there are no long-term reports that confirm the safety of bearings larger than 36 mm.Assessment of lipped liners is difficult because randomized studies are lacking, but retrospective clinical studies and registry data seem to indicate that this liner modification will reduce the rate of dislocation or revision due to dislocation without clear evidence of clinically obvious problems due to neck-liner impingement.The majority of studies support the view that constrained liners and dual mobility cups (DMC) will reduce the risk of revision due to dislocation both in primary and revision THA, the latter gaining increasing popularity in some countries. Both these devices suffer from implant-specific problems, which seem to be more common for the constrained liner designs. The majority of studies of these implants suffer from various methodological problems, not least selection bias, which calls for randomized studies preferably in a multi-centre setting to obtain sufficient power. In the 2020s, the orthopaedic profession should place more effort on such studies, as has already been achieved within other medical specialties, to improve the level of evidence in the choice of articulation when performing one of the most common in-hospital surgical procedures in Europe. Cite this article: EFORT Open Rev 2020;5:763-775. DOI: 10.1302/2058-5241.5.200002.
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Affiliation(s)
- Georgios Tsikandylakis
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Orthopaedics, Gothenburg, Sweden
| | - Soren Overgaard
- The Danish Hip Arthroplasty Register, Aarhus, Denmark
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Luigi Zagra
- Hip Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Johan Kärrholm
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Orthopaedics, Gothenburg, Sweden
- The Swedish Hip Arthroplasty Register, Gothenburg, Sweden
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12
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Parashin S, Gascoyne T, Zarrabian M. A phantom and cadaveric study of radiostereometric analysis in posterior cervical and lumbar spinal fusion. Spine J 2020; 20:1333-1343. [PMID: 32272254 DOI: 10.1016/j.spinee.2020.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 03/26/2020] [Accepted: 03/27/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Detecting pseudarthrosis following spinal fusion is important for accurate diagnosis and treatment. Current diagnostic measures hold certain drawbacks. Radiostereometric analysis (RSA) is a radiographic technique with the capability to measure intervertebral segment changes and may be a novel way of assessing fusion. PURPOSE The purpose of this work was to measure the accuracy and precision of RSA in instrumented posterior cervical and lumbar spinal fusion for measuring intervertebral movement. Further, to gain surgical practice with RSA in spine and determine optimal bead placements. STUDY DESIGN Artificial bone and cadaveric spine models were used to simulate a 3-level cervical (C3-C6) and a 2-level (L4-S1) lumbosacral posterior spinal fusion to analyze bead placements and to measure RSA accuracy and precision. METHODS Preliminary RSA bead placements were planned and measured in the artificial model. Secondary bead placements were adjusted slightly in the cadaveric model to consider additional fusion scenarios. Bead spread, detectability, and stability were measured to determine optimal placements. Translational and rotational precision of both models were measured. Accuracy was measured in the artificial spine model. Model-based RSA software was used for analysis. RESULTS Optimal bead placements were found to be throughout the lateral mass of C3-C6 and in the spinous process, transverse process, and within the screw canal of L4-S1. Detectability was high among all segments. Spread was greater in L4-S1 than C3-C6 due to bead collinearity along the transverse axis of the cervical vertebrae. Translational and rotational RSA accuracy in cervical and lumbosacral regions ranged between 0.005 to 0.014 mm and 0.058 to 0.208°. Translational and rotational precision measured in the phantom models ranged 0.017 to 0.131 mm and 0.058 to 0.394° in C3-C6, and 0.086 to 0.191 mm and 0.200 to 0.369° in L4-S1. Translational and rotational precision measured in the cadaveric models ranged 0.054 to 0.548 mm and 0.148 to 1.386° in C3-C6, and 0.068 to 0.164 mm and 0.100 to 0.270° in L4-S1. CONCLUSIONS RSA was found to be a feasible radiographic technique in C3-C6 and L4-S1 spinal fusion when measured in artificial and cadaveric models. Optimal bead placements were determined. Bead spread was shown to be better throughout the lumbar region than the cervical region due to anatomical size variations. RSA accuracy and precision were within acceptable RSA criteria. CLINICAL SIGNIFICANCE The results from this work contribute to the accuracy, precision, and bead placements for studying RSA in cervical and lumbar spinal fusions. This work may further support the development of clinical studies to assess spinal fusion by evaluating postoperative intervertebral movement using RSA.
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Affiliation(s)
- Sara Parashin
- The Orthopaedic Innovation Centre, Suite 320-1155 Concordia Avenue, Winnipeg, Manitoba, Canada, R2K 2M9.
| | - Trevor Gascoyne
- The Orthopaedic Innovation Centre, Suite 320-1155 Concordia Avenue, Winnipeg, Manitoba, Canada, R2K 2M9
| | - Mohammad Zarrabian
- Department of Surgery, Faculty of Medicine, AE 101-820 Sherbrook Street, University of Manitoba, Winnipeg, Manitoba, Canada, R3A 1R9
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13
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Carli AV, Patel AR, Cross MB, Mayman DJ, Carroll KM, Pellicci PM, Jerabek SA. Long-term performance of oxidized zirconium on conventional and highly cross-linked polyethylene in total hip arthroplasty. SICOT J 2020; 6:10. [PMID: 32378510 PMCID: PMC7204272 DOI: 10.1051/sicotj/2020010] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 04/16/2020] [Indexed: 11/14/2022] Open
Abstract
Introduction: Polyethylene wear and subsequent osteolysis remain obstacles to the long-term survivorship of total hip arthroplasty (THA). Highly cross-linked polyethylene (XLPE) with radical quenching represents a massive leap forward with dramatically improved wear rates compared to ultra-high molecular weight polyethylene (UHMWPE). In this study we evaluate the wear of UHMWPE and XLPE coupled with oxidized zirconium (OxZr) femoral heads. Methods: A longitudinal, retrospective analysis was performed identifying consecutive patients who received a 28-mm OxZr-on-polyethylene primary THA from 2003 to 2004 by a single, high-volume arthroplasty surgeon. Patients were divided into two groups: those that received (1) UHMWPE liner and (2) a highly XLPE liner. Patients were included if clinical follow-up was complete to 2014 or later. Radiographic analysis was performed by two blinded observers. Measures included cup position, annual linear wear rate, and presence of osteolysis. Pairwise comparisons, correlations, and inter-rater reliability were calculated. Results: Eighty patients were in the UHMWPE group with an average follow-up of 10 ± 1.23 years and 88 patients in the XLPE group with an average of 10 ± 1.03-year follow-up. Average age (68) was similar between groups (p = 0.288). Observer reliability was excellent for cup abduction (ICC = 0.940), anteversion (ICC = 0.942), and detection of osteolysis (ICC = 0.811). Annual linear wear rates were significantly higher (p = 1 × 10−19) with UHMWPE (0.21 ± 0.12 mm/year) compared to XLPE (0.05 ± 0.03 mm/year). Linear wear rate was significantly correlated to decreasing acetabular abduction (p = 0.035). Osteolysis was noted only in the UHMWPE group, with 17 patients (21.2%) exhibiting acetabular osteolysis and 37 (46.3%) patients exhibiting femoral osteolysis. Conclusions: OxZr coupled with XLPE showed minimal wear and no osteolysis at 10-year follow up. The yearly linear penetration rate is similar to that seen in other studies of XLPE THA. A careful longitudinal follow-up will be required to determine if advanced bearings such as OxZr or ceramic can show improved performance in the second decade of implantation.
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Affiliation(s)
- Alberto V Carli
- Hospital for Special Surgery, 535 E 70th St., New York, 10021 NY, USA
| | - Anay R Patel
- Fondren Orthopedic Group, 7401 Main St., Houston, 77030 TX, USA
| | - Michael B Cross
- Hospital for Special Surgery, 535 E 70th St., New York, 10021 NY, USA
| | - David J Mayman
- Hospital for Special Surgery, 535 E 70th St., New York, 10021 NY, USA
| | - Kaitlin M Carroll
- Hospital for Special Surgery, 535 E 70th St., New York, 10021 NY, USA
| | - Paul M Pellicci
- Hospital for Special Surgery, 535 E 70th St., New York, 10021 NY, USA
| | - Seth A Jerabek
- Hospital for Special Surgery, 535 E 70th St., New York, 10021 NY, USA
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14
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Vajapey SP, Morris J, Li D, Greco NG, Li M, Spitzer AI. Outcome Reporting Patterns in Total Hip Arthroplasty. JBJS Rev 2020; 8:e0197. [DOI: 10.2106/jbjs.rvw.19.00197] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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15
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Malahias MA, Atrey A, Gu A, Chytas D, Nikolaou VS, Waddell JP. Is Oxidized Zirconium Femoral Head Superior to Other Bearing Types in Total Hip Arthroplasty? A Systematic Review and Meta-Analysis. J Arthroplasty 2019; 34:1844-1852. [PMID: 31010775 DOI: 10.1016/j.arth.2019.03.072] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 03/10/2019] [Accepted: 03/26/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Oxidized zirconium (OxZi) is a relatively new type of material that combines the strength of a metal with the surface/wears properties of a ceramic. Our aim was to investigate whether OxZi femoral heads lead to lower polyethylene wear, higher survival rate, and better clinical outcomes than the other bearing types in patients treated with total hip arthroplasty (THA). METHODS Two reviewers independently conducted a systematic search according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses using the MEDLINE/PubMed database and the Cochrane Database of Systematic Reviews. These databases were queried with the terms: a. "oxidized" AND "zirconium" AND "total" AND "hip" AND "arthroplasty"; b. "oxinium" AND "total" AND "hip" AND "arthroplasty". The primary outcome measures were the survival rate of the bearing surfaces as well as the polyethylene wear. RESULTS The vast majority (85.7%) of the studies, which reported the mean polyethylene wear rate, showed that there was not any significant difference between OxZi and cobalt-chrome (CoCr) femoral heads (rate ratio: 0.836; 95% confidence interval: 0.362-1.928; P = .674). All studies comparing the survival rate of OxZi and CoCr femoral heads illustrated almost excellent survivorship with both implants. CONCLUSION OxZi femoral heads did not lead to lower polyethylene wear rate or higher survival rate, when compared with CoCr femoral heads in patients treated with THA. On the basis of these results and taking into account the higher cost of these implants, we would not recommend the routine use of OxZi femoral heads in primary THAs. LEVEL OF EVIDENCE Systematic review and meta-analysis of therapeutic studies I-III.
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Affiliation(s)
- Michael-Alexander Malahias
- 2nd Orthopaedic Department, National & Kapodistrian University of Athens, School of Medicine, Nea Ionia, Athens, Greece
| | - Amit Atrey
- Division of Orthopaedics, Department of Surgery, St Michaels Hospital, University of Toronto, Canada, Toronto, Ontario, Canada
| | - Alex Gu
- George Washington School of Medicine and Health Sciences, Washington DC
| | - Dimitrios Chytas
- 2nd Orthopaedic Department, National & Kapodistrian University of Athens, School of Medicine, Nea Ionia, Athens, Greece
| | - Vasileios S Nikolaou
- 2nd Orthopaedic Department, National & Kapodistrian University of Athens, School of Medicine, Nea Ionia, Athens, Greece
| | - James P Waddell
- 2nd Orthopaedic Department, National & Kapodistrian University of Athens, School of Medicine, Nea Ionia, Athens, Greece
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16
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Lindalen E, Thoen PS, Nordsletten L, Høvik Ø, Röhrl SM. Low wear rate at 6-year follow-up of vitamin E-infused cross-linked polyethylene: a randomised trial using 32- and 36-mm heads. Hip Int 2019; 29:355-362. [PMID: 30227721 DOI: 10.1177/1120700018798790] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Free radicals formed in the cross-linking process may over time alter the mechanical properties of highly cross-linked polyethylene. Vitamin E-infused highly cross-linked polyethylene was therefore developed to achieve low wear-rate and good mechanical properties in the long term. AIM To present 6-year results from the initial randomised controlled trial. PATIENTS AND METHODS We measured wear and periacetabular bone remodelling in cementless total hip arthroplasty; 32- or 36-mm Biolox Delta heads and vitamin E-infused highly cross-linked polyethylene (E-Poly) were used. Markerless radiosterometric analysis measured the in vivo wear and dual energy x-ray absorptiometry was used to analyse bone remodelling in 40 hips at 6-year follow-up. RESULTS In the proximal direction the wear for 32- and 36-mm heads was 0.15 mm (95% confidence interval [CI], 0.08-0.21) and 0.06 mm (95% CI, -0.002-0.12), respectively (p = 0. 015). However, between 3 months and 6 years (excluding the period of "bedding in"), the proximal wear for 32- and 36-mm heads was 0.10 mm (95% CI, 0.05-0.15) and 0.05 mm (95% CI, -0.01-0.11), respectively (p = 0.12). The annual proximal wear rate for 32- and 36-mm heads from 3 months to 6 years was 0.02 mm and 0.01 mm, respectively. There was no difference in bone remodelling around the cup from baseline to 6 years for the total material and no differences between study groups. CONCLUSION Wear of this vitamin E-infused highly cross-linked polyethylene is still low at 6-year follow-up, with no significant difference in wear from 3 months to 6 years between 32- and 36-mm heads.
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Affiliation(s)
- Einar Lindalen
- 1 Department of Orthopaedic Surgery, Lovisenberg Deaconal Hospital, Oslo, Norway
| | - Peder S Thoen
- 1 Department of Orthopaedic Surgery, Lovisenberg Deaconal Hospital, Oslo, Norway
| | - Lars Nordsletten
- 2 Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,3 Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Øystein Høvik
- 1 Department of Orthopaedic Surgery, Lovisenberg Deaconal Hospital, Oslo, Norway
| | - Stephan M Röhrl
- 2 Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
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17
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Teeter MG, MacLean CJ, Somerville LE, Howard JL, McCalden RW, Lanting BA, Vasarhelyi EM. Wear performance of cobalt chromium, ceramic, and oxidized zirconium on highly crosslinked polyethylene at mid-term follow-up. J Orthop 2018; 15:620-623. [PMID: 29881207 DOI: 10.1016/j.jor.2018.05.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 05/06/2018] [Indexed: 10/17/2022] Open
Abstract
Patients with THA using a ceramic head and using an OxZr head were each matched to patients with a CoCr head. Mean implantation time was 5 years. There was no difference in steady state wear rate between the ceramic (0.066 ± 0.050 mm/year) and CoCr match groups (0.052 ± 0.041 mm/year), or between the OxZr (0.022 ± 0.029 mm/year) and CoCr match groups (0.048 ± 0.071 mm/year). Follow-up into the second decade will be necessary before any changes in THA wear rate from using ceramic or OxZr bearings may be appreciated clinically with available imaging techniques.
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Affiliation(s)
- Matthew G Teeter
- Department of Surgery, Schulich School of Medicine & Dentistry, Western University and London Health Sciences Centre, London, Ontari, Canada.,Surgical Innovation Program, Lawson Health Research Institute, London, Ontario, Canada.,Imaging Research Laboratories, Robarts Research Institute, London, Ontario, Canada
| | - Colin J MacLean
- Department of Surgery, Schulich School of Medicine & Dentistry, Western University and London Health Sciences Centre, London, Ontari, Canada
| | - Lyndsay E Somerville
- Department of Surgery, Schulich School of Medicine & Dentistry, Western University and London Health Sciences Centre, London, Ontari, Canada
| | - James L Howard
- Department of Surgery, Schulich School of Medicine & Dentistry, Western University and London Health Sciences Centre, London, Ontari, Canada
| | - Richard W McCalden
- Department of Surgery, Schulich School of Medicine & Dentistry, Western University and London Health Sciences Centre, London, Ontari, Canada
| | - Brent A Lanting
- Department of Surgery, Schulich School of Medicine & Dentistry, Western University and London Health Sciences Centre, London, Ontari, Canada
| | - Edward M Vasarhelyi
- Department of Surgery, Schulich School of Medicine & Dentistry, Western University and London Health Sciences Centre, London, Ontari, Canada
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18
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CORR Insights®: Polyethylene Wear Increases in Liners Articulating With Scratched Oxidized Zirconium Femoral Heads. Clin Orthop Relat Res 2018; 476:193-195. [PMID: 29389783 PMCID: PMC6259724 DOI: 10.1007/s11999.0000000000000122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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19
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Carli A, Koch CN, Esposito CI, Wright TM, Padgett DE. Polyethylene Wear Increases in Liners Articulating With Scratched Oxidized Zirconium Femoral Heads. Clin Orthop Relat Res 2018; 476:182-192. [PMID: 29389782 PMCID: PMC6259683 DOI: 10.1007/s11999.0000000000000040] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Oxidized zirconium (OxZr) femoral heads were introduced in hip arthroplasty to reduce wear of the polyethylene compared with metallic heads and to reduce fracture risk compared with ceramic heads. Severe scratches have been reported on OxZr heads in patients undergoing revision for instability, but whether these scratches contribute to increased acetabular polyethylene wear remains unclear. QUESTIONS/PURPOSES (1) How is the polyethylene of the acetabular liner affected by damage on the opposing OxZr head? (2) How does damage to the head affect the degree of polyethylene wear? METHODS We assessed damage and deformation on all retrieved highly crosslinked liners that had articulated against OxZr heads collected at one institution between 2006 and 2013. Two observers used a visual subjective scoring system to assess polyethylene damage on the surface of the 42 retrieved liners. Polyethylene components were also laser scanned to measure dimensional changes to the liner. These outcomes were compared with the severity of scratching on the surface of the articulating OxZr head. We also used a 12-station hip simulator to measure wear over five million cycles (MCs) of pristine liners articulating against nine retrieved OxZr heads with varying degrees of scratching representing a spectrum of little to severe damage and three retrieved ceramic heads with severe metal transfer. RESULTS Seventeen of the OxZr heads showed severe damage, of which 14 heads had been revised for dislocation. The retrieved liners that had articulated with these heads had greater damage scores for abrasion (mean score 0.4 versus 1.6; p = 0.008) and embedded debris (mean score 0.4 versus 1.4; p = 0.006) compared with liners that had articulated with less damaged heads. Four severely damaged OxZr heads wore at a higher rate than the others in the study with weight loss of 37.7 mg, 30.0 mg, 14.4 mg, and 2.6 mg after the first MC and a steady increase through testing to 5 MCs. Conversely, neither OxZr heads with less damage nor ceramic heads with severe metal transfer produced appreciable wear. CONCLUSIONS Surface scratching of OxZr heads from recurrent dislocation and reduction maneuvers leads to increased wear of the crosslinked polyethylene used as a bearing surface. CLINICAL RELEVANCE Patients in whom such instability occurs in the presence of an OxZr head should be followed closely for the possibility of more severe wear.
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Affiliation(s)
- Alberto Carli
- Alberto Carli MD, Chelsea N. Koch BS, Christina I. Esposito PhD, Timothy M. Wright PhD, Douglas E. Padgett MD, Hospital for Special Surgery, New York, NY, USA
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20
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Yao BJ, He XQ, Lin YH, Dai WJ. Cardioprotective effects of anisodamine against myocardial ischemia/reperfusion injury through the inhibition of oxidative stress, inflammation and apoptosis. Mol Med Rep 2017; 17:1253-1260. [PMID: 29115503 DOI: 10.3892/mmr.2017.8009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Accepted: 07/12/2017] [Indexed: 11/05/2022] Open
Abstract
The aim of the present study was to investigate the cardioprotective effects of anisodamine against myocardial ischemia/reperfusion (I/R) injury and the molecular mechanisms involved. The present results demonstrated that anisodamine attenuated myocardial infarct sizes, decreased the levels of creatine kinase and lactate dehydrogenase, whereas it increased the left ventricular (LV) systolic pressure, the LV end‑diastolic pressure, and the LV pressure maximum rising and falling rates in a myocardial I/R rat model. In addition, anisodamine was revealed to suppress oxidative stress, inflammatory factor production and myocardial cell apoptosis, as demonstrated by the downregulation of caspase‑3 and apoptosis regulator BAX protein expression. The production of reactive oxygen species was decreased and the protein expression of inducible nitric oxide synthase (iNOS) was downregulated, whereas the expression of endothelial NOS was enhanced. In addition, the activity of nicotinamide‑adenine dinucleotide phosphate oxidase (Nox) was suppressed and the expression of Nox4 was downregulated in rats with myocardial I/R injury. In conclusion, the results of the present study suggested that anisodamine exerted a cardioprotective effect against myocardial I/R injury in rats, through the inhibition of oxidative stress, the suppression of inflammatory processes and the inhibition of myocardial cell apoptosis.
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Affiliation(s)
- Bao-Ju Yao
- Department of Cardiology, The First People's Hospital of Huainan, Huainan, Anhui 232007, P.R. China
| | - Xiao-Qing He
- Department of Cardiology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510150, P.R. China
| | - Yu-Hui Lin
- Department of Cardiology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510150, P.R. China
| | - Wen-Jun Dai
- Department of Cardiology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510150, P.R. China
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21
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Simpson AHRW, Howie CR, Norrie J. Surgical trial design - learning curve and surgeon volume: Determining whether inferior results are due to the procedure itself, or delivery of the procedure by the surgeon. Bone Joint Res 2017; 6:194-195. [PMID: 28377379 PMCID: PMC5415901 DOI: 10.1302/2046-3758.64.bjr-2017-0051] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- A H R W Simpson
- University of Edinburgh, Editor-in-Chief, Bone & Joint Research, 22 Buckingham Street, London WC2N 6ET, UK
| | - C R Howie
- Department of Orthopaedic Surgery, University of Edinburgh, Edinburgh, E16, 4SA, UK
| | - J Norrie
- Usher Institute of Population Health Sciences and Informatics, Nine Edinburgh BioQuater, 9 Little France Road, Edinburgh, EH16 4UX, and Director, Clinical Trials Unit, University of Edinburgh, Outpatients Building, Floor Two, Room D36, Western General Hospital, Crewe Road South, Edinburgh, EH4 2XU, UK
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22
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Clinical outcomes of ceramicized ball heads in total hip replacement bearings: a literature review. J Appl Biomater Funct Mater 2017; 15:e1-e9. [PMID: 28009420 DOI: 10.5301/jabfm.5000330] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2016] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Metallic ball heads for total hip replacement (THR) bearings with ceramicized surfaces were introduced in orthopedics during the second half of the 1980s, with the aim of decreasing the wear of polyethylene cups. METHODS An analysis was made of the literature regarding outcomes for metallic ball heads with ceramicized surfaces now in clinical use (TiN, TiNbN, ZrN, monoclinic ZrO2), as well as carbon coatings (pyrolytic carbon, diamond-like carbon) and silicon nitride as coatings in ball heads for THR bearings. RESULTS Notwithstanding the diffusion of ceramicized ball heads in THRs, there are few reports about their clinical outcomes in hip arthroplasty. In addition, several clinical studies and some registry data are putting under scrutiny the clinical advantages of ceramicized ball heads over cobalt chrome (CoCr) alloy and ceramic ball heads. CONCLUSIONS The wear of THR bearings with ceramicized ball heads looks like it depends more on the behavior of the polyethylene cups than on the treatment of the ball head surface. The risk of coating damage and of its consequences has to be taken into account in selecting this type of bearing.
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Broberg JS, Yuan X, Teeter MG. Investigation of imaging magnification in radiostereometric analysis. Proc Inst Mech Eng H 2016; 231:92-95. [PMID: 27913629 DOI: 10.1177/0954411916676850] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Radiostereometric analysis is a highly accurate imaging technique. A recent advance in radiostereometric analysis is the use of flat panel digital radiography, which provides the opportunity for quick analysis using radiostereometric analysis. However, such a setup is expensive. Using large cassettes for small joints could minimize the cost. In this article, we investigated the influence of cassette size for small joint examinations with a biplanar radiostereometric analysis setup. Our results indicated that there is no significant difference in the precision when using large cassettes over small cassettes, whether or not imaging magnification is applied.
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Affiliation(s)
- Jordan S Broberg
- 1 Department of Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Xunhua Yuan
- 2 Imaging Research Laboratories, Robarts Research Institute, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Matthew G Teeter
- 1 Department of Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.,2 Imaging Research Laboratories, Robarts Research Institute, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.,3 Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.,4 Surgical Innovation Program, Lawson Health Research Institute, London, ON, Canada
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Haddad FS. A positive end to 2016. Bone Joint J 2016; 98-B:1569-1570. [PMID: 27909115 DOI: 10.1302/0301-620x.98b12.38083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 10/31/2016] [Indexed: 11/05/2022]
Affiliation(s)
- F S Haddad
- The Bone & Joint Journal, 22 Buckingham Street, London, WC2N 6ET and NIHR University College London Hospitals Biomedical Research Centre, UK
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Junnila M, Laaksonen I, Eskelinen A, Pulkkinen P, Ivar Havelin L, Furnes O, Marie Fenstad A, Pedersen AB, Overgaard S, Kärrholm J, Garellick G, Malchau H, Mäkelä KT. Implant survival of the most common cemented total hip devices from the Nordic Arthroplasty Register Association database. Acta Orthop 2016; 87:546-553. [PMID: 27550058 PMCID: PMC5119435 DOI: 10.1080/17453674.2016.1222804] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [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 - According to previous Nordic Arthroplasty Register Association (NARA) data, the 10-year implant survival of cemented total hip arthroplasties (THAs) is 94% in patients aged 65-74 and 96% in patients aged 75 or more. Here we report a brand-level comparison of cemented THA based on the NARA database, which has not been done previously. Patients and methods - We determined the rate of implant survival of the 9 most common cemented THAs in the NARA database. We used Kaplan-Meier analysis with 95% CI to study implant survival at 10 and 15 years, and Cox multiple regression to assess survival and hazard ratios (HRs), with revision for any reason as endpoint and with adjustment for age, sex, diagnosis, and femoral head material. Results - Spectron EF THA (89.9% (CI: 89.3-90.5)) and Elite THA (89.8% (CI: 89.0-90.6)) had the lowest 10-year survivorship. Lubinus (95.7% survival, CI: 95.5-95.9), MS 30 (96.6%, CI: 95.8-97.4), and C-stem THA (95.8%, CI: 94.8-96.8) had a 10-year survivorship of at least 95%. Lubinus (revision risk (RR) = 0.77, CI: 0.73-0.81), Müller (RR =0.83, CI: 0.70-0.99), MS-30 (RR =0.73, CI: 0.63-0.86), C-stem (RR =0.70, CI: 0.55-0.90), and Exeter Duration THA (RR =0.84, CI: 0.77-0.90) had a lower risk of revision than Charnley THA, the reference implant. Interpretation - The Spectron EF THA and the Elite THA had a lower implant survival than the Charnley, Exeter, and Lubinus THAs. Implant survival of the Müller, MS 30, CPT, and C-stem THAs was above the acceptable limit for 10-year survival.
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Affiliation(s)
- Mika Junnila
- Department of Orthopaedics and Traumatology, Turku University Hospital, Turku;,Correspondence:
| | - Inari Laaksonen
- Department of Orthopaedics and Traumatology, Turku University Hospital, Turku
| | - Antti Eskelinen
- Coxa Hospital for Joint Replacement, Tampere;,The Finnish Arthroplasty Register
| | - Pekka Pulkkinen
- Department of Public Health, Helsinki University, Helsinki, Finland
| | - Leif Ivar Havelin
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen;,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Ove Furnes
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen;,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Anne Marie Fenstad
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen
| | - Alma B Pedersen
- Competence Centre for Clinical Epidemiology and Biostatistics, North, Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus;,The Danish Hip Arthroplasty Register, Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Søren Overgaard
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, and Institute of Clinical Research, University of Southern Denmark, Odense;,The Danish Hip Arthroplasty Register, Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Johan Kärrholm
- The Swedish Hip Arthroplasty Register, Department of Orthopaedics, Institute of Surgical Sciences, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Göran Garellick
- The Swedish Hip Arthroplasty Register, Department of Orthopaedics, Institute of Surgical Sciences, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Henrik Malchau
- The Swedish Hip Arthroplasty Register, Department of Orthopaedics, Institute of Surgical Sciences, Sahlgrenska University Hospital, Gothenburg, Sweden;,Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA;,Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA
| | - Keijo T Mäkelä
- Department of Orthopaedics and Traumatology, Turku University Hospital, Turku;,The Finnish Arthroplasty Register
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Affiliation(s)
- F S Haddad
- The Bone & Joint Journal, 22 Buckingham Street, London, WC2N 6ET and NIHR University College London Hospitals Biomedical Research Centre, UK
| | - L Zagra
- Istituto Ortopedico Galeazzi IRCCS, Via R. Galeazzi 4, 20161, Milan, Italy
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27
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Affiliation(s)
- F S Haddad
- The Bone & Joint Journal, 22 Buckingham Street, London, WC2N 6ET, and NIHR University College London Hospitals Biomedical Research Centre, UK
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