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Jelsma J, van Kuijk SMJ, Spekenbrink-Spooren A, Grimm B, Heyligers IC, Schotanus MGM. Outcome of revised metal-on-metal hip arthroplasties: a Dutch arthroplasty register study. Arch Orthop Trauma Surg 2022; 142:4025-4032. [PMID: 34846589 DOI: 10.1007/s00402-021-04257-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 11/12/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Preliminary results of metal-on-metal (MoM) hip arthroplasty were satisfactory, but since 2004 data showed high failure rates. National joint replacement registries are multi-centre databases comprised of thousands of subjects and implants which allow for identifying variables predictive of implant failure. The aim of the current study was to estimate re-revision rates after revision of a primary MoM hip arthroplasty in the Dutch Arthroplasty Register (LROI) and to assess potential predictor variables of re-revision of these MoM hip arthroplasties. METHODS Eligible procedures were those with a revision for any reason except infection, after an initial primary surgery with a hip resurfacing (HRA) or large-head MoM (LH-MoM) total hip arthroplasty (THA). The probability of re-revision for both types of MoM hip arthroplasty over time was estimated using the cumulative incidence function taking mortality as a competing risk into account. A proportional sub-distribution hazards regression model was used to assess potential predictor variables of re-revision of these MoM hip arthroplasties. RESULTS A total of 3476 records of revised implants were included, of which 873 (25.2%) were MoM implants. Over the course of follow-up, 101 (11.5%) MoM implants were re-revised. During follow-up 36 (4.3%) patients who received a MoM-implant at primary arthroplasty and a revision afterwards had died. The regression model showed that for primary MoM implants a MoM articulation after revision (HR 2.48; 95% CI 1.53-4.03, p < 0.001), femoral-only revisions (HR 3.20; 95% CI 2.06-4.99, p < 0.001) and periprosthetic fractures (HR 1.98; 95% CI 1.03-3.82, p = 0.042) as reason for the first revision were statistically significant risk factors for re-revision. CONCLUSION Both types of large-head MoM hip arthroplasties have shown high revision and re-revision rates; risk factors were identified. The outcome of this study can be helpful in managing expectations of patients and orthopaedic surgeons.
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Affiliation(s)
- Jetse Jelsma
- Department of Orthopedic Surgery and Traumatology, Zuyderland Medical Centre, Dr. H. van der Hoffplein 1, Sittard, 6162 BG, Geleen, The Netherlands.
| | - S M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht, The Netherlands
| | - A Spekenbrink-Spooren
- Dutch Arthroplasty Register (LROI), Bruistensingel 230, 5232 AD, 's-Hertogenbosch, The Netherlands
| | - B Grimm
- Luxembourg Institute Health, Human Motion, Orthopedics, Sports Medicine, Digital Methods (HOSD), Luxembourg, Luxembourg
| | - I C Heyligers
- Department of Orthopedic Surgery and Traumatology, Zuyderland Medical Centre, Dr. H. van der Hoffplein 1, Sittard, 6162 BG, Geleen, The Netherlands.,School of Health Professions Education (SHE), Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - M G M Schotanus
- Department of Orthopedic Surgery and Traumatology, Zuyderland Medical Centre, Dr. H. van der Hoffplein 1, Sittard, 6162 BG, Geleen, The Netherlands.,Faculty of Health, Medicine and Life Sciences, School of Care and Public Health Research Institute (CAPHRI), Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands
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Jelsma J, Schotanus MGM, Buil ITAF, van Kuijk SMJ, Heyligers IC, Grimm B. Patients with hip resurfacing arthroplasty are not physically more active than those with a stemmed total hip. Acta Orthop 2020; 91:576-580. [PMID: 32496841 PMCID: PMC8023970 DOI: 10.1080/17453674.2020.1771652] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Hip resurfacing arthroplasty (HRA) was designed for the highly active patient because of the various theoretical advantages compared with stemmed total hip arthroplasty (THA), but has shown high failure rates. Physical activity (PA) after arthroplasty is frequently determined with the use of questionnaires, which are known for their subjective nature, recall bias, and ceiling effect. These disadvantages are not applicable to physical activity monitoring (AM) using sensors. We compared objectively measured PA at long-term follow-up in a matched cohort of HRA and stemmed THA subjects.Patients and methods - We compared 2 groups of 16 patients (12 males) in each group, one having received unilateral HRA (median age 56 years at surgery) and a matched group having received unilateral stemmed THA with a small diameter femoral head (28 mm) on conventional polyethylene (median age 60 years at surgery) with osteoarthritis as indication for surgery, 10 years after surgery. Groups were matched by sex, age at surgery, and BMI. The daily habitual PA was measured over 4 consecutive days in daily living using a 3-axis accelerometer, gyroscope, and magnetometer. Both quantitative parameters (time standing, sitting, walking, number of steps, and sit-stand transfers) and qualitative parameters (walking cadence) were determined.Results - The AM was worn for a median 13 (11-16) hours per day. The median daily step count was 5,546 (2,274-9,966) for the HRA group and 4,583 (1,567-11,749) for the stemmed THA-group with 39 (21-74) versus 37 (24-62) daily sit-stand transfers respectively. The other PA parameters were also similar in both groups.Interpretation - We found similar median PA levels and also identical ranges. While short-term effects may exist, ageing and related behavioral adaptations or other effects seem to render the theoretical activity benefits from HRA irrelevant at longer follow-up.
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Affiliation(s)
- Jetse Jelsma
- Department of Orthopedic Surgery and Traumatology, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands
| | - Martijn G M Schotanus
- Department of Orthopedic Surgery and Traumatology, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands
| | - Ivo T A F Buil
- Department of Innovation and Funding, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht, The Netherlands
| | - Ide C Heyligers
- Department of Orthopedic Surgery and Traumatology, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands
- School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
| | - Bernd Grimm
- Luxembourg Institute of Health, Human Motion, Orthopedics, Sports Medicine, Digital Methods (HOSD), Luxembourg, Luxembourg
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Acetabular Debonding: An Investigation of Porous Coating Delamination in Hip Resurfacing Arthroplasty. Adv Orthop 2018; 2018:5282167. [PMID: 30515334 PMCID: PMC6236702 DOI: 10.1155/2018/5282167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 10/01/2018] [Indexed: 11/21/2022] Open
Abstract
Background To date, there have been no published investigations on the cause of acetabular debonding, a rare failure phenomenon in metal-on-metal hip resurfacing where the acetabular porous coating delaminates from the implant while remaining well fixed to the pelvic bone. Purposes This study aims to summarize the current understanding of acetabular debonding and to investigate the discrepancy in rate of debonding between two implant systems. Patients and Methods To elucidate potential causes of debonding, we retrospectively analyzed a single-surgeon cohort of 839 hip resurfacing cases. Specifically, we compared rate of debonding and manufacturing processes between two implant systems. Results Group 1 experienced significantly more cases of debonding than Group 2 cases (4.0% versus 0.0%, p value<0.0001). Implant manufacturing processes differed in surface coating, heat treatment, postmanufacturing treatment, and apex thickness. Debonded implants were more likely to have missed RAIL guidelines (p=0.04). Conclusions We identified implant system, postoperative time, and acetabular component placement as variables contributing to rate of debonding. We recommend minimizing acetabular inclination angle according to RAIL guidelines. Further, we evaluated manufacturing differences between the two implant systems but did not have access to proprietary data to identify the cause of debonding. Both implants met ASTM standards, yet only the Group 1 implant debonded. This suggests the second implant had greater fatigue shear strength. Because the Group 2 implant achieved a more durable interface that did not debond, we suggest the ASTM F1160 standard for fatigue shear strength be increased to that achieved by its manufacturer. Level of Evidence II A retrospective evaluation of prospectively collected data.
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Wang J, Wang D, Du J, Lin Z. A new strategy to reconstruct type III acetabular bone defect associated with inflammatory pseudotumor: combined medial and lateral acetabular bone grafting: A case report. Medicine (Baltimore) 2017; 96:e8777. [PMID: 29390269 PMCID: PMC5815681 DOI: 10.1097/md.0000000000008777] [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] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Inflammatory pseudotumor has been commonly reported in patients undergoing total hip arthroplasty (THA). PATIENT CONCERNS We reported a patient who had a massive intra-pelvic pseudotumour and acetabular bone defect underwent two-stage revision THA. DIAGNOSES A new surgical strategy for pseudotumor after THA is performed. INTERVENTIONS Thorough debridement intra-pelvic pseudotumour via Smith-Petersen approach, bone grafting on iliac medial surface and plate-screw internal fixation were performed in the first stage, followed by revision of the loosened prosthesis to a cementless primary prosthesis in the second stage. OUTCOMES A follow-up for 5 years showed satisfactory recovery of function. LESSONS This surgical revision is less invasive than conventional methods, resulting in a stable and well-functioning hip joint after mid-term follow-up for 5 years.
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Cementing a polyethylene cup into a well fixed acetabular metal-on-metal resurfacing component? An experimental investigation. Hip Int 2017; 27:373-377. [PMID: 28165599 DOI: 10.5301/hipint.5000474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/20/2016] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Adverse reactions to metal debris often indicate revision surgery in metal-on-metal (MoM) hip arthroplasty and an exchange of the MoM bearing into either a metal on polyethylene or a ceramic-on-polyethylene articulation. At the moment the removal of the entire implant system is the most reasonable method. In order to avoid bone loss caused by the removal of a well-fixed acetabular component, the purpose of this study was to measure the stability of a cemented polyethylene (PE) cup in an acetabular hip resurfacing component and to examine if such a method could be suitable for clinical use. METHODS PE cups were cemented into 2 different hip resurfacing components and biomechanical tests were applied to measure failure torques under lever out and rotational load. RESULTS In all cases failure of the interface between the resurfacing components and the cement layer occurred at a very low load (0.14 Nm-61.50 Nm). DISCUSSION The early failure occurred due to lacking interdigitation of cement and the polished metal surface. Thus we warn against cementing a PE cup into acetabular hip resurfacing components for clinical use.
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Thomas S, Gouk C, Jayasakeera N, Freeman M. The Sequelae of Metallosis Resulting in Skin Pigmentation and Tattooing: A Case Presentation and Literature Review. Surg J (N Y) 2016; 2:e143-e146. [PMID: 28825008 PMCID: PMC5553500 DOI: 10.1055/s-0036-1596060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 10/26/2016] [Indexed: 11/11/2022] Open
Abstract
With advancing technologies in orthopedics and increasing demands of the population for orthopedic interventions, younger patients are now receiving joint replacements. One of the potential risks of joint replacement is metallosis, or the local and systemic release of metal ions. Metallosis is caused by the release of metallic debris, secondary to hardware failure. The phenomenon is most commonly associated with failed metal-on-metal hip prostheses and is characterized locally by heavy staining of surrounding soft tissue, metallic synovitis, joint effusion, and gradual loosening of the prosthesis. Additionally, metallic debris can also lead to periarticular superficial skin manifestations. The release of metal ions has further been known to lead to systemic upsets including neurologic deficit (declining vision, hearing, or cognition; headaches), cardiac failure, and hypothyroidism. As the number of patients seeking major orthopedic interventions grows, the incidence of metallosis-related skin tattooing will also increase. The structural components of a failed joint replacement can be revised (improving patients' pain and functioning). However, any skin tattooing secondary to metallosis presents the treating dermatologist with clinical challenge, due to lack of research regarding treatment of this condition. Our aim is to review the published literature on metallosis, including the pathophysiology. After assessing publications on the treatment of traumatic and cosmetic tattooing, we hope to stimulate further research regarding treatment. This article should also serve to remind orthopedic surgeons that with increasing patient concern regarding cosmesis, a multispecialty approach including referral to a dermatologist is valuable.
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Affiliation(s)
- Stephen Thomas
- Division of Dermatology, Department of Orthopaedics, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Conor Gouk
- Division of Dermatology, Department of Orthopaedics, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Narlaka Jayasakeera
- Division of Dermatology, Department of Orthopaedics, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Michael Freeman
- Division of Dermatology, Department of Orthopaedics, Gold Coast University Hospital, Southport, Queensland, Australia
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Gaillard MD, Gross TP. Reducing the failure rate of hip resurfacing in dysplasia patients: a retrospective analysis of 363 cases. BMC Musculoskelet Disord 2016; 17:251. [PMID: 27267594 PMCID: PMC4897880 DOI: 10.1186/s12891-016-1095-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Accepted: 05/24/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Arthritis secondary to developmental hip dysplasia often mandates implant surgery at a relatively young age. Hip resurfacing arthroplasty (HRA), compared with standard stemmed total hip arthroplasty (THA), affords a more active lifestyle including extreme-motion activities but stimulates concerns pertaining to implant failure. METHODS We addressed the primary modes of failure through a series of interventions, including a new guideline for achieving proper implant alignment through intraoperative x-rays. We then compared two sequential cohorts in a single-surgeon practice: patients with developmental dysplasia who underwent HRA before (Group 1; 121 hips in 105 patients) and after (Group 2; 242 hips in 210 patients) June 2008, at which time the four interventions were all in place. RESULTS Implants in Group 2 failed less frequently within two years (0.8 % vs. 6.6 %, p = 0.002) and were more likely to have projected seven-year Kaplan-Meier survivorship (99 % vs. 89 %, p < 0.0001 by log-rank test). Patients in Group 2 were more likely to have normal metal ion levels (77 % vs. 56 %, p = 0.0008) and optimum metal ion levels (99 % vs. 86 %, p = 0.0008). Patients in Group 2 also benefited from a 19-min decrease in mean operation time, a 45 % decrease in mean estimated blood loss, and a 0.9-day decrease in mean hospital stay (p < 0.0001 in each instance). CONCLUSIONS We believe the interventions reported here, combined with sufficient surgeon experience and properly designed implants, afford patients with mild developmental dysplasia a more active lifestyle with favorable implant survival.
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MESH Headings
- Adult
- Arthroplasty, Replacement, Hip/adverse effects
- Arthroplasty, Replacement, Hip/instrumentation
- Arthroplasty, Replacement, Hip/methods
- Female
- Follow-Up Studies
- Hip Dislocation, Congenital/complications
- Hip Dislocation, Congenital/surgery
- Hip Joint/diagnostic imaging
- Hip Joint/physiopathology
- Hip Joint/surgery
- Hip Prosthesis/adverse effects
- Humans
- Intraoperative Care/methods
- Ions/blood
- Life Style
- Male
- Metal-on-Metal Joint Prostheses/adverse effects
- Metals/blood
- Middle Aged
- Osteoarthritis, Hip/etiology
- Osteoarthritis, Hip/surgery
- Postoperative Complications/epidemiology
- Practice Guidelines as Topic
- Prospective Studies
- Prosthesis Design
- Prosthesis Failure
- Radiography
- Range of Motion, Articular
- Reoperation/statistics & numerical data
- Retrospective Studies
- Risk Factors
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Affiliation(s)
- Melissa D Gaillard
- Midlands Orthopaedics & Neurosurgery PA, 1910 Blanding Street, Columbia, SC, USA.
| | - Thomas P Gross
- Midlands Orthopaedics & Neurosurgery PA, 1910 Blanding Street, Columbia, SC, USA
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van Dijk JD, Groothuis-Oudshoorn CGM, Marshall DA, IJzerman MJ. An Empirical Comparison of Discrete Choice Experiment and Best-Worst Scaling to Estimate Stakeholders' Risk Tolerance for Hip Replacement Surgery. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2016; 19:316-322. [PMID: 27325322 DOI: 10.1016/j.jval.2015.12.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 11/02/2015] [Accepted: 12/30/2015] [Indexed: 06/06/2023]
Abstract
BACKGROUND Previous studies have been inconclusive regarding the validity and reliability of preference elicitation methods. OBJECTIVE The aim of this study was to compare the metrics obtained from a discrete choice experiment (DCE) and profile-case best-worst scaling (BWS) with respect to hip replacement. METHODS We surveyed the general US population of men aged 45 to 65 years, and potentially eligible for hip replacement surgery. The survey included sociodemographic questions, eight DCE questions, and twelve BWS questions. Attributes were the probability of a first and second revision, pain relief, ability to participate in sports and perform daily activities, and length of hospital stay. Conditional logit analysis was used to estimate attribute weights, level preferences, and the maximum acceptable risk (MAR) for undergoing revision surgery in six hypothetical treatment scenarios with different attribute levels. RESULTS A total of 429 (96%) respondents were included. Comparable attribute weights and level preferences were found for both BWS and DCE. Preferences were greatest for hip replacement surgery with high pain relief and the ability to participate in sports and perform daily activities. Although the estimated MARs for revision surgery followed the same trend, the MARs were systematically higher in five of the six scenarios using DCE. CONCLUSIONS This study confirms previous findings that BWS or DCEs are comparable in estimating attribute weights and level preferences. However, the risk tolerance threshold based on the estimation of MAR differs between these methods, possibly leading to inconsistency in comparing treatment scenarios.
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Affiliation(s)
- Joris D van Dijk
- Department of Health Technology & Services Research, MIRA Institute for Biomedical Technology & Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Catharina G M Groothuis-Oudshoorn
- Department of Health Technology & Services Research, MIRA Institute for Biomedical Technology & Technical Medicine, University of Twente, Enschede, The Netherlands.
| | - Deborah A Marshall
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Maarten J IJzerman
- Department of Health Technology & Services Research, MIRA Institute for Biomedical Technology & Technical Medicine, University of Twente, Enschede, The Netherlands
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Comparison of Patient-Reported Outcome from Neck-Preserving, Short-Stem Arthroplasty and Resurfacing Arthroplasty in Younger Osteoarthritis Patients. Adv Orthop 2015; 2015:817689. [PMID: 26101669 PMCID: PMC4460199 DOI: 10.1155/2015/817689] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 05/05/2015] [Indexed: 01/19/2023] Open
Abstract
Hip resurfacing has been considered a good treatment option for younger, active osteoarthritis patients. However, there are several identified issues concerning risk for neck fractures and issues related to current metal-on-metal implant designs. Neck-preserving short-stem implants have been discussed as a potential alternative, but it is yet unclear which method is better suited for younger adults. We compared hip disability and osteoarthritis outcome scores (HOOS) from a young group of patients (n = 52, age 48.9 ± 6.1 years) who had received hip resurfacing (HR) with a cohort of patients (n = 73, age 48.2 ± 6.6 years) who had received neck-preserving, short-stem implant total hip arthroplasty (THA). Additionally, durations for both types of surgery were compared. HOOS improved significantly preoperatively to last followup (>1 year) in both groups (p < 0.0001, η (2) = 0.69); there were no group effects or interactions. Surgery duration was significantly longer for resurfacing (104.4 min ± 17.8) than MiniHip surgery (62.5 min ± 14.8), U = 85.0, p < 0.0001, η (2) = 0.56. The neck-preserving short-stem approach may be preferable to resurfacing due to the less challenging surgery, similar outcome, and controversy regarding resurfacing implant designs.
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de Haan R, Buls N, Scheerlinck T. Impact of implant size on cement filling in hip resurfacing arthroplasty. Proc Inst Mech Eng H 2013; 228:3-10. [PMID: 24170701 DOI: 10.1177/0954411913507660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Larger proportions of cement within femoral resurfacing implants might result in thermal bone necrosis. We postulate that smaller components are filled with proportionally more cement, causing an elevated failure rate. A total of 19 femoral heads were fitted with polymeric replicas of ReCap (Biomet) resurfacing components fixed with low-viscosity cement. Two specimens were used for each even size between 40 and 56 mm and one for size 58 mm. All specimens were imaged with computed tomography, and the cement thickness and bone density were analyzed. The average cement mantle thickness was 2.63 mm and was not correlated with the implant size. However, specimen with low bone density had thicker cement mantles regardless of size. The average filling index was 36.65% and was correlated to both implant size and bone density. Smaller implants and specimens with lower bone density contained proportionally more cement than larger implants. According to a linear regression model, bone density but not implant size influenced cement thickness. However, both implant size and bone density had a significant impact on the filling index. Large proportions of cement within the resurfacing head have the potential to generate thermal bone necrosis and implant failure. When considering hip resurfacing in patients with a small femoral head and/or osteoporotic bone, extra care should be taken to avoid thermal bone necrosis, and alternative cementing techniques or even cementless implants should be considered. This study should help delimiting the indications for hip resurfacing and to choose an optimal cementing technique taking implant size into account.
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Affiliation(s)
- Roel de Haan
- Department of Orthopaedic Surgery and Traumatology, Tergooi Ziekenhuizen, Blaricum, The Netherlands
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Vundelinckx BJ, Verhelst LA, De Schepper J. Taper corrosion in modular hip prostheses: analysis of serum metal ions in 19 patients. J Arthroplasty 2013; 28:1218-23. [PMID: 23523216 DOI: 10.1016/j.arth.2013.01.018] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2012] [Revised: 12/23/2012] [Accepted: 01/13/2013] [Indexed: 02/01/2023] Open
Abstract
Recently, concerns have been raised about the use of metal-on-metal (MoM) implants. This has led to the recall of several resurfacing and large-diameter total hip arthroplasties (THA). Any MoM interface can be the cause of metal debris and adverse tissue reactions. We analyzed serum metal ions and HOOS scores in 19 of 306 patients treated with a THA with modular neck section. The only MoM interface in this particular implant is the taper between the neck and the stem. The articulating surface consists of a ceramic-on-polyethylene or ceramic-on-ceramic interface. As such, this study looks at the metal ion production from the modular neck section. One of 306 implants needed revision at 52-month follow-up because of an adverse reaction to metal debris (ARMD).
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Affiliation(s)
- Bart J Vundelinckx
- Orthopaedic Surgery and Traumatology, Catholic University of Leuven, Belgium
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Verhelst LA, Van der Bracht H, Vanhegan IS, Van Backlé B, De Schepper J. Revising the well-fixed, painful resurfacing using a double-mobility head: a new strategy to address metal-on-metal complications. J Arthroplasty 2012; 27:1857-62. [PMID: 22770851 DOI: 10.1016/j.arth.2012.05.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Accepted: 05/06/2012] [Indexed: 02/01/2023] Open
Abstract
Isolated revision of the femoral component of hip resurfacings to metal-on-metal (MoM) total hip arthroplasties has shown inferior results. We present a case series of well-fixed, painful MoM hips with elevated chromium and cobalt levels. An isolated femoral revision using a noncemented femoral component and a double-mobility head was performed. Patients were followed up for 6 months and showed excellent improvements in visual analog score and Hip dysfunction and Osteoarthritis Outcome Score (HOOS). Cobalt and chromium levels dropped at 6 weeks and were normal at 6 months. Although our follow-up is short, we feel that it is important to highlight this as a potential treatment strategy. This revision is less aggressive than traditional methods, eliminates the concerns from MoM bearings, and results in a stable construct.
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Affiliation(s)
- Luk A Verhelst
- AZ Groeninge Kortrijk, Burgemeester Vercruysselaan 5, 8500 Kortrijk, Belgium
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Migaud H, Putman S, Combes A, Berton C, Bocquet D, Vasseur L, Girard J. Metal-on-Metal Bearing: Is This the End of the Line? We Do Not Think So. HSS J 2012; 8:262-9. [PMID: 24082870 PMCID: PMC3470659 DOI: 10.1007/s11420-012-9300-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2011] [Accepted: 07/05/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Recent studies have recommended the discontinuation of metal-on-metal (MoM) components in total hip arthroplasty (THA) because of adverse effects reported with large-diameter MoM THA. This is despite favorable long-term results observed with 28 and 32 mm MoM bearings. QUESTIONS/PURPOSES The aim of this study was to assess the value of calls for an end to MoM bearings as THA components. Specifically, we wish to address the risks associated with MoM bearings including adverse soft tissue reactions, metal ion release, and carcinogenic risk. METHODS The study evaluates the arguments in the literature reporting on MoM (adverse soft tissue reactions, metal ion release, and carcinogenic risk) and the experience of the current authors who re-introduced these bearings in 1995. They are balanced by a benefit-risk review of the literature and the authors' experience with MoM use. RESULTS Adverse reactions to metallic debris as well as metal ion release are predictable and can be prevented by adequate design (arc of coverage, clearance), metallurgy (forged instead of cast alloy, high-carbide content), and appropriate component orientation. There is no scientific evidence that carcinogenicity is increased in subjects with MoM hip prostheses. MoM articulations appear to be attractive allowing safe hip resurfacing, decreasing the risk of THA revision in active patients, and providing secure THA fixation with cement in cages in severely deformed hips. MoM bearings in women of child-bearing age are controversial, but long-term data on metallic devices in adolescents undergoing spinal surgery seem reassuring. DISCUSSION Adequate selection of MoM articulations ensures their safe use. These articulations are sensitive to orientation. Fifteen years of safe experience with 28- and 32-mm bearings of forged alloy and high-carbide content is the main reason for retaining them in primary and revision THA.
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Affiliation(s)
- Henri Migaud
- Department of Orthopedic Surgery, Roger Salengro Hospital, University of Lille, 2 Av Oscar Lambret, 59037 Lille Cedex, France ,Orthopaedics Department, University of Lille, 2 avenue Oscar Lambret, 59037 Lille Cedex, France
| | - Sophie Putman
- Department of Orthopedic Surgery, Roger Salengro Hospital, University of Lille, 2 Av Oscar Lambret, 59037 Lille Cedex, France ,Orthopaedic Department, Lille University Hospital, 2 avenue Oscar Lambret, 59037 Lille Cedex, France
| | - Antoine Combes
- Department of Orthopedic Surgery, Roger Salengro Hospital, University of Lille, 2 Av Oscar Lambret, 59037 Lille Cedex, France ,Orthopaedics Department, University of Lille, 2 avenue Oscar Lambret, 59037 Lille Cedex, France
| | - Charles Berton
- Department of Orthopedic Surgery, Roger Salengro Hospital, University of Lille, 2 Av Oscar Lambret, 59037 Lille Cedex, France ,Orthopaedics Department, University of Lille, 2 avenue Oscar Lambret, 59037 Lille Cedex, France
| | - Donatien Bocquet
- Department of Orthopedic Surgery, Roger Salengro Hospital, University of Lille, 2 Av Oscar Lambret, 59037 Lille Cedex, France ,Orthopaedics Department, University of Lille, 2 avenue Oscar Lambret, 59037 Lille Cedex, France
| | - Laurent Vasseur
- Department of Orthopedic Surgery, Roger Salengro Hospital, University of Lille, 2 Av Oscar Lambret, 59037 Lille Cedex, France ,Orthopaedics Department, University of Lille, 2 avenue Oscar Lambret, 59037 Lille Cedex, France
| | - Julien Girard
- Department of Orthopedic Surgery, Roger Salengro Hospital, University of Lille, 2 Av Oscar Lambret, 59037 Lille Cedex, France ,Department of Sport and Medicine, University of Lille 2, Lille, France ,Orthopaedics Department, University of Lille, 2 avenue Oscar Lambret, 59037 Lille Cedex, France
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Breer S, Krause M, Busse B, Hahn M, Rüther W, Morlock MM, Amling M, Zustin J. Analysis of retrieved hip resurfacing arthroplasties reveals the interrelationship between interface hyperosteoidosis and demineralization of viable bone trabeculae. J Orthop Res 2012; 30:1155-61. [PMID: 22180341 DOI: 10.1002/jor.22035] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Accepted: 11/04/2011] [Indexed: 02/04/2023]
Abstract
Retrieved hip resurfacing arthroplasties (HRA) revised for causes other than osteonecrosis enable further insights into bone-cement interactions within the interface with only minimal biomechanical stresses. Our primary objective was to investigate the mineralization changes at the trabecular bone interface in retrieved hips using bright field and polarized light microscopy and by quantitative backscattered electron imaging. Because superficial seams of non-mineralized bone tissue varied substantially, we defined hyperosteoidosis as an osteoid seam of more than 20 µm thickness. We hypothesized that interface hyperosteoidosis might be caused by the demineralization of previously mineralized bone tissue. One hundred and thirty-one retrieved HRAs with viable bone remnant tissue were analyzed. Bone mineral density distribution obtained from backscattered signal intensities of the trabecular bone at the bone-cement interface was assessed in cases with and without interface hyperosteoidosis. In cases with interface hyperosteoidosis, the degree of trabecular mineralization was also analyzed in deeper areas of the femoral remnants. Thirty-four cases showed hyperosteoidosis at the bone-cement interface, mostly in female patients. Bone trabeculae with hyperosteoidosis displayed a mineral density distribution pattern suggestive of the demineralization of a previously mineralized bone matrix. Our results demonstrate the localized disorder of the mineralization pattern of bone trabeculae at the bone-cement interface in a group of retrieved HRAs. In previously well-fixed femoral components, potential adverse effects on the load-bearing bone due to a decreased degree of mineralization at the bone-cement interface may affect the durability of the implant's function.
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Affiliation(s)
- Stefan Breer
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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