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Ilo KC, Van Duren BH, Berber R, Matar HE, Manktelow ARJ, Bloch BV. Comparing Trabecular Metal Versus Fiber Mesh Cementless Acetabular Components: A Single-Center Study of 6,563 Hips. J Arthroplasty 2025; 40:1589-1593. [PMID: 39581240 DOI: 10.1016/j.arth.2024.11.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Revised: 11/15/2024] [Accepted: 11/19/2024] [Indexed: 11/26/2024] Open
Abstract
BACKGROUND Trabecular metal is being increasingly used in primary total hip arthroplasty (THA). This study compared medium-term (< 15 years) outcomes of fiber mesh titanium and trabecular metal acetabular components. METHODS This study included 6,563 patients who underwent primary THA with either fiber mesh titanium or trabecular metal-backed acetabular components. Data were sourced from a prospectively maintained local arthroplasty database and linked with the National Joint Registry. RESULTS The 10-year survivorship was 97.3% for fiber mesh and 98.9% for porous tantalum groups (P = 0.009). Multivariate analysis showed no significant variable associated with reduced revision rates. CONCLUSIONS Both fiber mesh titanium and trabecular metal acetabular components demonstrated high survivorship in THA, with trabecular metal showing statistically significant though marginally better survival. Despite the increased cost associated with trabecular metal, its use may be justified in complex primary and revision cases where increased primary stability may be required. Future research should focus on cost analysis and include patient-reported outcomes to guide implant selection further.
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Affiliation(s)
- Kevin C Ilo
- Nottingham Elective Orthopaedic Services, Nottingham University Hospitals, Nottingham, United Kingdom
| | - Bernard H Van Duren
- Nottingham Elective Orthopaedic Services, Nottingham University Hospitals, Nottingham, United Kingdom; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom
| | - Reshid Berber
- Nottingham Elective Orthopaedic Services, Nottingham University Hospitals, Nottingham, United Kingdom
| | - Hosam E Matar
- Nottingham Elective Orthopaedic Services, Nottingham University Hospitals, Nottingham, United Kingdom
| | - Andrew R J Manktelow
- Nottingham Elective Orthopaedic Services, Nottingham University Hospitals, Nottingham, United Kingdom
| | - Benjamin V Bloch
- Nottingham Elective Orthopaedic Services, Nottingham University Hospitals, Nottingham, United Kingdom; University of Nottingham, Nottingham, United Kingdom
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Mirghaderi P, Eraghi MM, Mirghaderi R, Rahimzadeh P, Mortazavi SMJ. Unveiling the link: highly porous tantalum-augmented implants and periprosthetic joint infection in revision total knee arthroplasty-a systematic review and meta-analysis. BMC Musculoskelet Disord 2025; 26:408. [PMID: 40275269 PMCID: PMC12020089 DOI: 10.1186/s12891-025-08640-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 04/09/2025] [Indexed: 04/26/2025] Open
Abstract
BACKGROUND The trend of the literature suggests that tantalum (Ta) may possess antibacterial properties. However, no consensus has been reached on Ta's preventive role in periprosthetic joint infection (PJI) in patients undergoing revision total knee arthroplasty (rTKA). QUESTION What is the PJI incidence rate after rTKA using Ta-augmented implants for both septic and all-cause revision reasons? Is there a difference in the PJI rate following rTKA performed using Ta-augmented implants compared to non-Ta implants? METHODS Using 5 major databases, the authors searched for studies reporting the rate of PJIs following rTKA using Ta-augmented implants until January 2022. The PJI rates for the Ta group were pooled, compared to the control group, and presented as odds ratios (OR) and 95% confidence intervals (CI) using forest plots. RESULTS Thirty eligible studies involving 881 knees were included. The overall PJI rate following rTKA using Ta-augmented implants was 8.1% (CI = 6.6%-9.9%). Specifically, in cases of septic revision, the infection rate was 15.7% (95% CI = 11.7%-20.7%). The comparative analysis indicated a similar PJI rate between the Ta- augmented and non-Ta group across 3 studies, which was found to be similar (OR = 0.52, 95% CI = 0.13-2.0, P = 0.35). CONCLUSION PJI poses a significant risk following both aseptic and septic revision rTKA, even when Ta-augmented implants were administrated. The rate of PJI after rTKA was similar for Ta- augmented implants and non-Ta implants. Further rigorous studies with a high level of evidence are essential to definitively determine the potential impact of Ta derivatives on infection rates following rTKA, particularly in septic revision. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Peyman Mirghaderi
- Surgical Research Society (SRS), Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Joint Reconstruction Research Center (JRRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Mirahmadi Eraghi
- Surgical Research Society (SRS), Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Joint Reconstruction Research Center (JRRC), Tehran University of Medical Sciences, Tehran, Iran
- Student Research Committee, School of Medicine, Islamic Azad University, Qeshm International Branch, Qeshm, Iran
| | - Reza Mirghaderi
- Surgical Research Society (SRS), Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Joint Reconstruction Research Center (JRRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Payman Rahimzadeh
- Surgical Research Society (SRS), Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Joint Reconstruction Research Center (JRRC), Tehran University of Medical Sciences, Tehran, Iran
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Fraser E, Spence S, Farhan-Alanie OM, Doonan J, Mahendra A, Gupta S. Trabecular metal collars in endoprosthetic replacements: do they osseointegrate? Bone Jt Open 2024; 5:1092-1100. [PMID: 39644918 PMCID: PMC11624915 DOI: 10.1302/2633-1462.512.bjo-2024-0095.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: 12/09/2024] Open
Abstract
Aims Limb salvage surgery (LSS) is the primary treatment option for primary bone malignancy. It involves the removal of bone and tissue, followed by reconstruction with endoprosthetic replacements (EPRs) to prevent amputation. Trabecular metal (TM) collars have been developed to encourage bone ingrowth (osseointegration (OI)) into EPRs. The primary aim of this study was to assess whether OI occurs when TM collars are used in EPRs for tumour. Methods A total of 124 patients from July 2010 to August 2021 who underwent an EPR for tumour under the West of Scotland orthopaedic oncology team were identified. Overall, 81 patients (65%) met the inclusion criteria, and two consultants independently analyzed radiographs at three and 12 months, as well as the last radiograph, using a modified version of the Stanford Radiological Assessment System. Results OI of the TM collar occurred in approximately 65% of patients at last radiograph. The percentage of patients with OI at three months (65.4%) reflected the 12-month (65%) and long-term (64.4%) follow-up. The median amount of OI across all radiographs was one at all three timepoints, with only five cases (11.1%) showing OI in all four zones at last radiograph. Radiolucency at the bone:collar junction was present in 23 cases (28.4%) at three months, but only four (6.7%) showed progression of this at 12 months. The interobserver reliability was found to be highly reliable in all parameters (p < 0.001). Conclusion OI occurs in approximately 65% of TM collars, and is similar at three months, 12 months, and last radiograph. The extent of OI at the bone:collar junction was found to have decreased at longer-term follow-up. Furthermore, radiolucency at the bone-collar impact junction does occur in some patients but only a low number will show radiolucency progression at longer-term follow-up.
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Mirghaderi P, Eshraghi N, Sheikhbahaei E, Razzaghof M, Roustai-Geraylow K, Pouramini A, Eraghi MM, Kafi F, Javad Mortazavi SM. Does Using Highly Porous Tantalum in Revision Total Hip Arthroplasty Reduce the Rate of Periprosthetic Joint Infection? A Systematic Review and Meta-Analysis. Arthroplast Today 2024; 25:101293. [PMID: 38298809 PMCID: PMC10827600 DOI: 10.1016/j.artd.2023.101293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 10/15/2023] [Accepted: 11/05/2023] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Studies suggest tantalum (Ta) implants may have inherent antibacterial properties. However, there is no consensus regarding the effectiveness of Ta in preventing periprosthetic joint infection (PJI) after revision total hip arthroplasty (rTHA). METHODS We searched 5 main databases for articles reporting the rate of PJI following rTHA using Ta implants from inception to February 2022. The PJI rates of the Ta group were meta-analyzed, compared with the control group, and represented as relative risks (RRs) in forest plots. RESULTS We identified 67 eligible studies (28,414 joints) for assessing the prevalence of PJI following rTHA using Ta implants. Among these studies, only 9 compared the Ta implant group with a control group. The overall PJI rate following rTHA using Ta implants was 2.9% (95% confidence interval [CI]: 2.2%-3.8%), while it was 5.7% (95% CI = 4.1%-7.8%) if only septic revisions were considered. Comparing the Ta and control groups showed a significantly lower PJI rate following all-cause rTHA with an RR = 0.80 (95% CI = 0.65-0.98, P < .05). There was a trend toward lower reinfection rates in the Ta group after rTHA in septic cases, although the difference was not statistically significant (RR = 0.75, 95% CI = 0.44-1.29, P = .30). CONCLUSIONS Ta implants are associated with a lower PJI rate following all-cause rTHA but not after septic causes. Despite positive results, the clinical significance of Ta still remains unclear since the PJI rate was only reduced by 20%. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Peyman Mirghaderi
- Surgical Research Society (SRS), Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Joint Reconstruction Research Center (JRRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Nasim Eshraghi
- Surgical Research Society (SRS), Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Erfan Sheikhbahaei
- Surgical Research Society (SRS), Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Razzaghof
- Joint Reconstruction Research Center (JRRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Kiarash Roustai-Geraylow
- Surgical Research Society (SRS), Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Pouramini
- Surgical Research Society (SRS), Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Mirahmadi Eraghi
- Surgical Research Society (SRS), Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Kafi
- Surgical Research Society (SRS), Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Su Q, Wan X, Wang D, Zhou Z. A commentary on "Trabecular metal versus non-trabecular metal acetabular components for acetabular revision surgery: A systematic review and meta-analysis" (Int J Surg 2022;100:106597). Int J Surg 2022; 103:106660. [PMID: 35568307 DOI: 10.1016/j.ijsu.2022.106660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 05/05/2022] [Indexed: 02/08/2023]
Affiliation(s)
- Qiang Su
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, 37# Wuhou Guoxue Road, Chengdu, PR China.
| | - Xufeng Wan
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, 37# Wuhou Guoxue Road, Chengdu, PR China.
| | - Duan Wang
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, 37# Wuhou Guoxue Road, Chengdu, PR China.
| | - Zongke Zhou
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, 37# Wuhou Guoxue Road, Chengdu, PR China.
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Shen X, Qin Y, Li Y, Tang X, Xiao J. Trabecular metal versus non-trabecular metal acetabular components for acetabular revision surgery: A systematic review and meta-analysis. Int J Surg 2022; 100:106597. [DOI: 10.1016/j.ijsu.2022.106597] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/30/2021] [Accepted: 03/08/2022] [Indexed: 01/08/2023]
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Cruz-Pardos A, García-Rey E, Fernandez-Fernández R, Ortega-Chamarro J. Do trabecular metal cups achieve better results when compared to hemispherical porous titanium cups in acetabular revision surgery? Hip Int 2021; 31:774-781. [PMID: 32363969 DOI: 10.1177/1120700020919943] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Trabecular metal (TM) cups were introduced in order to achieve better ingrowth and stability of the cup in acetabular revision surgery. As their use has evolved over time, we have queried whether TM cups would improve results in terms of the rate of aseptic loosening when compared to historical uncemented porous titanium cups used in revision surgery for acetabular bone loss in Hospital La Paz (Madrid, Spain). METHODS We retrospectively reviewed 197 acetabular revisions performed between 1991 and 2015. Titanium cups were used in 81 cases and TM cups in 116. The mean follow-up was 8.1 years (range 1-15); 12.0 ± 7.8 for titanium group and 5.4 ± 3.1 for TM group. The most common reason for revision was aseptic loosening. A Kaplan-Meier analysis was used to determine the survival of the cup, with radiological failure and re-revision due to aseptic loosening as the endpoints. Cox multivariate regression analyses were performed to assess different risk factors for failure. RESULTS 1 TM cup and 1 titanium cup were re-revised due to aseptic loosening (p = 0.61). Radiological cup loosening was observed in 4 TM cups and 2 titanium cups (p = 1.0). At 6 years, the probability of not having radiological cup loosening was 97.4% (95% CI, 93.9-100) for the titanium cups and 95.1% for the TM cups (95% CI, 90.1-99.9) (p = 0.59). Another 5 cups were re-revised due to dislocation. Hips with a greater Paprosky defect showed a higher risk of loosening (p < 0.05, hazard risk (HR) 3.04; 95% CI, 0.97-9.54). CONCLUSIONS This study shows there was no significant difference in re-revision due to aseptic loosening or radiological loosening between titanium and TM cups in revision surgery for acetabular bone loss. Both types of cups demonstrate excellent results with a low failure rate and minimal complications.
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Komnos G, Banios K, Kolonia K, Poultsides LA, Petinaki E, Sarrou S, Zintzaras E, Karachalios T. Do trabecular metal and cancellous titanium implants reduce the risk of late haematogenous infection? An experimental study in rabbits. Hip Int 2021; 31:766-773. [PMID: 32460572 DOI: 10.1177/1120700020928891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
AIM This study evaluated the late resistance to haematogenous contamination by microbial pathogens of implants and bone-implant interface and the development of late clinical infection when cementless components with different surface or structural properties are implanted. MATERIAL AND METHODS 50 adult male New Zealand white rabbits were divided into 5 groups of 10 animals each. In Group A smooth titanium, in Group B grit blasted titanium, in Group C HA-coated titanium, in Group D trabecular metal and in group E cancellous titanium rods were implanted in the right proximal tibia. Four weeks later, 1 ml of inoculum of a standardised CA-MRSA strain (3 × 108 cfu/ml) was injected through a femoral artery catheter (groups B, C, D, E) while in group A, 1 ml of sterile saline was injected in a similar way (control group). Subjects were killed 8 weeks after the initial procedure and 3 samples of each tibial specimen were subjected to conventional cultures and PCR studies. RESULTS The number of the specimens (conventional cultures and PCR studies) contaminated by the standardized pathogen was as follows: Group A: 0/10, Group B: 7/10, Group C: 6/10, Group D; 5/10 and Group E: 5/10. Comparing the number of colony form units isolated from the implant samples, Group B (GB titanium) showed statistically significantly higher values (Mann-Whitney test) compared to Group C (p = 0.044), Group D (p = 0.040) and Group E (p = 0.038). Local active infection was observed in 6 animals: 3 in Group B; 1 in Group C, 1 in Group D, and 1 in Group E. CONCLUSIONS Modern cementless implants (trabecular metal and cancellous titanium) showed a lower risk of implant contamination and late clinical haematogenous infection.
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Affiliation(s)
- George Komnos
- Orthopaedic Department, School of Health Sciences, Faculty of Medicine of University of Thessalia, University General Hospital, Larissa, Greece
| | - Konstantinos Banios
- Orthopaedic Department, School of Health Sciences, Faculty of Medicine of University of Thessalia, University General Hospital, Larissa, Greece
| | | | | | - Efthimia Petinaki
- Microbiology Department, School of Health Sciences, Faculty of Medicine of University of Thessalia, University General Hospital, Larissa, Greece
| | - Styliani Sarrou
- Microbiology Department, School of Health Sciences, Faculty of Medicine of University of Thessalia, University General Hospital, Larissa, Greece
| | - Elias Zintzaras
- Department of Biostatistics and Clinical Bioinformatics, School of Health Sciences, Faculty of Medicine of University of Thessalia, University General Hospital, Larissa, Greece
| | - Theofilos Karachalios
- Orthopaedic Department, School of Health Sciences, Faculty of Medicine of University of Thessalia, University General Hospital, Larissa, Greece
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Abstract
Implant-associated infections (IAIs) are among the most intractable and costly complications in implant surgery. They can lead to surgery failure, a high economic burden, and a decrease in patient quality of life. This manuscript is devoted to introducing current antimicrobial strategies for additively manufactured (AM) titanium (Ti) implants and fostering a better understanding in order to pave the way for potential modern high-throughput technologies. Most bactericidal strategies rely on implant structure design and surface modification. By means of rational structural design, the performance of AM Ti implants can be improved by maintaining a favorable balance between the mechanical, osteogenic, and antibacterial properties. This subject becomes even more important when working with complex geometries; therefore, it is necessary to select appropriate surface modification techniques, including both topological and chemical modification. Antibacterial active metal and antibiotic coatings are among the most commonly used chemical modifications in AM Ti implants. These surface modifications can successfully inhibit bacterial adhesion and biofilm formation, and bacterial apoptosis, leading to improved antibacterial properties. As a result of certain issues such as drug resistance and cytotoxicity, the development of novel and alternative antimicrobial strategies is urgently required. In this regard, the present review paper provides insights into the enhancement of bactericidal properties in AM Ti implants.
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Chen Z, Chen W, Yu W, Zhao M, Lin J, Zhou C, Chen H, Ye J, Zeng X, Zhuang J. Mid-term outcomes of uncemented or cemented arthroplasty revision following metal-on-metal total hip arthroplasty failure: a retrospective observational study. J Int Med Res 2021; 48:300060520932051. [PMID: 32600087 PMCID: PMC7328484 DOI: 10.1177/0300060520932051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To retrospectively compare the mid-term outcomes of uncemented or cemented total hip arthroplasty (THA) revision for prior primary metal-on-metal (MoM) THA failure. Methods Data from 278 patients (278 hips) who underwent uncemented THA (UTHA) or cemented THA (CTHA) for prior primary MoM-THA failure from 2006 to 2016 were retrospectively analysed. Follow-up was performed 6 months, 1 year, 2 years, and then every 2 years after conversion. The mean follow-up time was 96 months (range, 64–128 months). The primary endpoint was the modified Harris hip score (HHS). The secondary endpoint was the major orthopaedic complication rate. Results The HHS showed significantly greater differences in the CTHA than UTHA group 12 months after conversion. From the 12th month after conversion to the final follow-up, CTHA yielded better functional outcomes than UTHA. There were significant differences between the UTHA and CTHA groups in the rates of re-revision (14.4% vs. 4.9%, respectively), aseptic loosening (17.3% vs. 6.8%, respectively), and periprosthetic fracture (11.5% vs. 3.9%, respectively). Conclusion CTHA has more advantages than UTHA in terms of improving functional outcomes and decreasing the major orthopaedic complication rate.
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Affiliation(s)
- Zhao Chen
- Department of Pediatric Orthopaedics, Fujian Children's Hospital, Fuzhou, Fujian Province, China
| | - Wenli Chen
- Department of Neurosurgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Weiguang Yu
- Department of Orthopaedics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Mingdong Zhao
- Department of Neurosurgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jinluan Lin
- Department of Orthopaedics, Jinshan Hospital, Fudan University, Shanghai, China
| | - Chaoming Zhou
- Department of Orthopaedics, Jinshan Hospital, Fudan University, Shanghai, China
| | - Hui Chen
- Department of Orthopaedics, Jinshan Hospital, Fudan University, Shanghai, China
| | - Junxing Ye
- Department of Orthopaedics, Jinshan Hospital, Fudan University, Shanghai, China
| | - Xianshang Zeng
- Department of Orthopaedics, Jinshan Hospital, Fudan University, Shanghai, China
| | - Jintao Zhuang
- Department of Orthopaedics, Jinshan Hospital, Fudan University, Shanghai, China
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Akram F, Kunze KN, Kerzner B, Gonzalez A, Palacios A, Levine BR. Mid-Term Survivorship, Performance, and Predictors of Outcome in Primary Total Hip Arthroplasty With a Porous Tantalum Femoral Prosthesis. J Arthroplasty 2021; 36:1688-1694. [PMID: 33454150 DOI: 10.1016/j.arth.2020.12.001] [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: 10/13/2020] [Revised: 11/28/2020] [Accepted: 12/01/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Femoral stem subsidence is a known cause of early implant failure, increasing the risk for aseptic loosening and periprosthetic fracture. Overall survivorship and subsidence in a novel porous tantalum-coated femoral prosthesis have not been well-studied. METHODS Consecutive patients undergoing primary total hip arthroplasty with a porous tantalum-coated femoral prosthesis between January 2008 and January 2015 with minimum 5-year follow-up were included. Clinical and radiographic data were obtained from hospital and office records. Multivariate logistic regression analyses were used to determine predictors of subsidence and clinical outcomes. Kaplan-Meier survivorship curves were performed to illustrate primary failure endpoints of (1) all-cause revision and (2) femoral prosthesis revision. RESULTS A total of 398 patients with a mean (±standard deviation) age of 61.0 ± 11.5 years, body mass index (BMI) 32.8 ± 8.0 kg/m2, and follow-up of 6.9 (range 5.0-11.2 years) were included. Survivorship at 5 years was 94.9% for all-cause revision and 98.0% for femoral component revision. Average subsidence was 1.8 ± 1.3 mm (range 0-15.5), with 8.1% patients experiencing subsidence >5 mm. Statistically significant mean improvements were observed at latest follow-up in the Hip Disability and Osteoarthritis Outcome Score Joint Replacement (40.6 ± 11.5 vs 85.2 ± 10.1, P < .001), Harris Hip Score (38.0 ± 12.0 vs 79.5 ± 12.8, P < .001), and hip flexion (92.8° ± 15.3° vs 103.3° ± 10.3°, P < .001). Multivariate logistic regression analyses revealed that greater BMI (odds ratio [OR] 1.17, P < .001), non-white/Caucasian race (OR 2.0, P = .036), and female gender (OR 2.4; P = .005) conferred a higher likelihood of subsidence >3 mm. BMI was a statistically significant and independent predictor of subsidence >5 mm (OR 1.25, P < .001) and subsidence >7 mm (OR 1.25, P < .001). CONCLUSION The trabecular metal taper femoral prosthesis conferred excellent clinical outcome improvement and survivorship. Increasing BMI was independently associated with an increased risk of subsidence in these patients and caution is recommended in utilizing this implant in obese, morbidly obese, and super morbidly obese populations.
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Affiliation(s)
- Faisal Akram
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL; Department of Orthopaedic Surgery, Spectrum Health, Michigan State University, Grand Rapids, MI
| | - Kyle N Kunze
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Benjamin Kerzner
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | | | - Arnold Palacios
- College of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Brett R Levine
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
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Perticarini L, Rossi SMP, Medetti M, Benazzo F. Clinical and radiological outcomes of acetabular revision surgery with trabecular titanium cups in Paprosky type II and III bone defects. J Orthop Traumatol 2021; 22:9. [PMID: 33675431 PMCID: PMC7937008 DOI: 10.1186/s10195-021-00571-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 02/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This prospective study aims to evaluate the mid-term clinical outcomes and radiographic stability of two different types of cementless trabecular titanium acetabular components in total hip revision surgery. METHODS Between December 2008 and February 2017, 104 cup revisions were performed using trabecular titanium revision cups. Mean age of patients was 70 (range 29-90; SD 11) years. The majority of revisions were performed for aseptic loosening (86 cases, 82.69%), but in all the other diagnoses (18 cases), a significant bone loss (Paprosky type II or III) was registered preoperatively. Bone defects were classified according to Paprosky acetabular classification. We observed 53 type II defects and 42 type III defects. Cups were chosen according to the type of defect. RESULTS Average follow-up was 91 (range 24-146) months. Mean Harris Hip Score (HHS) improved from 43.7 (range 25-70; SD 9) preoperatively to 84.4 (range 46-99; SD 7.56) at last follow-up. One (1.05%) cup showed radiographic radiolucent lines inferior to 2 mm and was clinically asymptomatic. One (1.05%) cup was loose and showed periacetabular allograft reabsorption. Kaplan-Meier survivorship was assessed to be 88.54% (95% CI 80.18-93.52%) at 71 months, with failure of the cup for any reason as the endpoint. CONCLUSION Trabecular titanium revision cups showed good clinical and radiographic results at mid-term follow-up in Paprosky type II and III bone defects. LEVEL OF EVIDENCE Level IV prospective case series.
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Affiliation(s)
- Loris Perticarini
- Sezione Di Chirurgia Protesica Ad Indirizzo Robotico - Unità Di Traumatologia Dello Sport, U.O. Ortopedia e Traumatologia Fondazione Poliambulanza, Via Bissolati 57, 25124, Brescia, Italy
| | - Stefano Marco Paolo Rossi
- Sezione Di Chirurgia Protesica Ad Indirizzo Robotico - Unità Di Traumatologia Dello Sport, U.O. Ortopedia e Traumatologia Fondazione Poliambulanza, Via Bissolati 57, 25124, Brescia, Italy.
| | - Marta Medetti
- Clinica Ortopedica e Traumatologica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Francesco Benazzo
- Sezione Di Chirurgia Protesica Ad Indirizzo Robotico - Unità Di Traumatologia Dello Sport, U.O. Ortopedia e Traumatologia Fondazione Poliambulanza, Via Bissolati 57, 25124, Brescia, Italy.,Università Degli Studi Di Pavia, Pavia, Italy
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Qian H, Lei T, Ye Z, Hu Y, Lei P. From the Performance to the Essence: The Biological Mechanisms of How Tantalum Contributes to Osteogenesis. BIOMED RESEARCH INTERNATIONAL 2020; 2020:5162524. [PMID: 32802853 PMCID: PMC7403943 DOI: 10.1155/2020/5162524] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 07/16/2020] [Indexed: 12/14/2022]
Abstract
Despite the brilliant bioactive performance of tantalum as an orthopedic biomaterial verified through laboratory researches and clinical practice in the past decades, scarce evidences about the essential mechanisms of how tantalum contributes to osteogenesis were systematically discussed. Up to now, a few studies have uncovered preliminarily the biological mechanism of tantalum in osteogenic differentiation and osteogenesis; it is of great necessity to map out the panorama through which tantalum contributes to new bone formation. This minireview summarized current advances to demonstrate the probable signaling pathways and underlying molecular cascades through which tantalum orchestrates osteogenesis, which mainly contain Wnt/β-catenin signaling pathway, BMP signaling pathway, TGF-β signaling pathway, and integrin signaling pathway. Limits of subsistent studies and further work are also discussed, providing a novel vision for the study and application of tantalum.
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Affiliation(s)
- Hu Qian
- Department of Orthopedics, Xiangya Hospital of Central South University, 87 Xiangya Road, Changsha, Hunan 410008, China
- Xiangya School of Medicine, Central South University, 172 Tongzipo Road, Changsha, 410008 Hunan, China
| | - Ting Lei
- Department of Orthopedics, Xiangya Hospital of Central South University, 87 Xiangya Road, Changsha, Hunan 410008, China
| | - Zhimin Ye
- Xiangya School of Medicine, Central South University, 172 Tongzipo Road, Changsha, 410008 Hunan, China
| | - Yihe Hu
- Department of Orthopedics, Xiangya Hospital of Central South University, 87 Xiangya Road, Changsha, Hunan 410008, China
| | - Pengfei Lei
- Department of Orthopedics, Xiangya Hospital of Central South University, 87 Xiangya Road, Changsha, Hunan 410008, China
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CORR Insights®: Do Trabecular Metal Acetabular Components Reduce the Risk of Rerevision After Revision THA Performed for Periprosthetic Joint Infection? A Study Using the NJR Data Set. Clin Orthop Relat Res 2019; 477:1390-1391. [PMID: 31136439 PMCID: PMC6554134 DOI: 10.1097/corr.0000000000000598] [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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Matharu GS, Judge A, Murray DW, Pandit HG. Do Trabecular Metal Acetabular Components Reduce the Risk of Rerevision After Revision THA Performed for Periprosthetic Joint Infection? A Study Using the NJR Data Set. Clin Orthop Relat Res 2019; 477:1382-1389. [PMID: 31136438 PMCID: PMC6554127 DOI: 10.1097/corr.0000000000000570] [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] [Received: 06/29/2018] [Accepted: 10/22/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND A single-center study of 144 THAs revised specifically for periprosthetic joint infection (PJI) observed that trabecular metal (TM) acetabular components had a reduced risk of rerevision for subsequent infection compared with non-TM implants. It was suggested that TM was protective against infection after revision and that TM may be useful when revising THAs for PJI. Three registry studies have subsequently assessed the effect of TM on future infection. In the National Joint Registry (NJR) for England and Wales, we earlier reported lower revision rates for infection when TM (versus non-TM) was used in primary THA, but no difference in rerevision rates for infection when TM was used for all-cause revision THAs. The latter findings in all-cause revisions were also confirmed in a study from the Swedish and Australian registries. It is possible that TM only reduces the risk of infection when it is specifically used for PJI revisions (rather than all-causes). However, to date, the registry analyses have not had large enough cohorts of such cases to assess this meaningfully. QUESTIONS/PURPOSES (1) In revision THAs performed for PJI, are rerevision rates for all-cause acetabular indications lower with TM acetabular components compared with non-TM designs? (2) In revision THAs performed for PJI, are rerevision rates of any component for infection lower with TM acetabular components compared with non-TM designs? METHODS A retrospective observational study was performed using NJR data from England and Wales, which is the world's largest arthroplasty registry and contains details of over two million joint replacement procedures. The registry achieves high levels of patient consent (92%) and linked procedures (ability to link serial procedures performed on the same patient and hip; 94%). Furthermore, recent validation studies have demonstrated that when revision procedures have been captured within the NJR, the data completion and accuracy were excellent. Of 11,988 revisions performed for all causes, 794 were performed for PJI in which the same cementless acetabular component produced by one manufacturer was used. Acetabular components were either TM (n = 541) or non-TM (n = 253). At baseline the two groups were comparable for sex, age, body mass index, and American Society of Anesthesiologists (ASA) grade. Outcomes after revision THA (rerevision for all-cause acetabular indications and rerevision of any component for infection) were compared between the groups using Fine and Gray regression analysis, which considers the competing mortality risk. Regression models were adjusted for the propensity score, with this score summarizing many of the potential patient and surgical confounding factors (age, sex, ASA grade, surgeon grade, approach, and type of revision procedure performed). RESULTS There was no difference in 5-year cumulative acetabular component survival rates between TM (96.3%; 95% confidence interval [CI], 94%-98%) and non-TM components (94.4%, 95% CI, 90%-97%; subhazard ratio, 0.78, 95% CI, 0.37-1.65; p = 0.509). There was no difference in 5-year cumulative implant survival rates free from infection between TM (94.8%; 95% CI, 92%-97%) and non-TM components (94.4%, 95% CI, 90%-97%; subhazard ratio, 0.97, 95% CI, 0.48-1.96; p = 0.942). CONCLUSIONS We found no evidence to support the notion that TM acetabular components used for PJI revisions reduced the subsequent risk of all-cause rerevision or the risk of rerevision for infection compared with non-TM implants from the same manufacturer. We therefore advise caution against recent claims that TM components may protect against infection. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Gulraj S Matharu
- G. S. Matharu, A. Judge, D. W. Murray, H. G. Pandit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Oxford, UK G. S. Matharu, A. Judge, Musculoskeletal Research Unit, Department of Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK H. G. Pandit, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, Leeds, UK
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Wiznia DH, Schwarzkopf R, Iorio R, Long WJ. Factors That Influence Bone-Ingrowth Fixation of Press-Fit Acetabular Cups. JBJS Rev 2019; 7:e2. [DOI: 10.2106/jbjs.rvw.18.00147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Theil C, Schmidt-Braekling T, Gosheger G, Moellenbeck B, Schwarze J, Dieckmann R. A single centre study of 41 cases on the use of porous tantalum metal implants in acetabular revision surgery. BMC Musculoskelet Disord 2019; 20:238. [PMID: 31113411 PMCID: PMC6530026 DOI: 10.1186/s12891-019-2626-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 05/14/2019] [Indexed: 12/21/2022] Open
Abstract
Background This study aims at investigating cup survival of porous tantalum revision cups and identifies risk factors for failure. Methods We retrospectively reviewed 41 patients treated between 2010 and 2012. Main indications were aseptic loosening in 83% and two-stage exchange after periprosthetic joint infection in 17% of cases. Mean follow-up period was 72 months. Femoral megaprostheses were used in 13% of cases. Most defects were classified as Paprosky 3b (29%). Function was assessed using the Harris Hip score. Results Aseptic cup survivorship was 80% at 104 months (95% Confidence Interval 67.4–92.4). Overall implant survival was 73%. Major bone loss defects (Paprosky types 2c to 3b) were associated with a significantly higher rate of failure than minor defects (P = 0.002). There were eight cases of aseptic loosening (19.5%) and two of infection (4.9%). Previous surgeries, indication for acetabular revision, patient-related risk factors and use of megaprostheses did not significantly influence implant survival. The Harris Hip Score improved from a median of 40 (Interquartile range 31–45) to 82 (interquartile range 65–88) postoperative (P < 0.0001). Conclusions In summary, the use of porous tantalum metal implants in acetabular revision surgery achieves good to excellent short- term and mid-term functional results and an acceptable complication rate relative to the extent of defect and previous surgery. However, one should be aware of potential limitations of the implants in addressing large defects and discontinuity.
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Affiliation(s)
- Christoph Theil
- Department of Orthopaedics and Tumour Orthopaedics, Muenster University Hospital, Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany.
| | - Tom Schmidt-Braekling
- Department of Orthopaedics and Tumour Orthopaedics, Muenster University Hospital, Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - Georg Gosheger
- Department of Orthopaedics and Tumour Orthopaedics, Muenster University Hospital, Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - Burkhard Moellenbeck
- Department of Orthopaedics and Tumour Orthopaedics, Muenster University Hospital, Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - Jan Schwarze
- Department of Orthopaedics and Tumour Orthopaedics, Muenster University Hospital, Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - Ralf Dieckmann
- Department of Orthopaedics and Tumour Orthopaedics, Muenster University Hospital, Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
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