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Darowski M, Ruehrmund L, Kluess D, Klinder A, Bader R, Mittelmeier W. The influence of surgical technique guidance and surgeon's experience on the femoral head assembly in total hip arthroplasty. Arch Orthop Trauma Surg 2024; 144:2391-2401. [PMID: 38563982 PMCID: PMC11093847 DOI: 10.1007/s00402-024-05282-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 03/10/2024] [Indexed: 04/04/2024]
Abstract
INTRODUCTION The importance of the assembly procedure on the taper connection strength is evident. However, existent surgical technique guides frequently lack comprehensive and precise instructions in this regard. The aim of our experimental study was to evaluate the influence of the surgical technique guide on the femoral head assembly procedure in surgeons with differing levels of experience in total hip arthroplasty. MATERIALS AND METHODS Twenty-eight participants, divided into four groups based on their lifetime experience in total hip arthroplasty, conducted a femoral head assembly procedure in a simulated intraoperative environment before and after reviewing the surgical technique guide. Demographic information and the number of hammer blows were documented. Hammer velocity and impaction angle were recorded using an optical motion capturing system, while the impaction force was measured using a dynamic force sensor within the impactor. RESULTS We observed a high variation in the number of hammer blows, maximum force, and impaction angle. Overall, the number of hammer blows decreased significantly from 3 to 2.2 after reviewing the surgical technique guide. The only significant intragroup difference in the number of hammer blows was observed in the group with no prior experience in total hip arthroplasty. No correlation was found between individual factors (age, weight, height) or experience and the measured parameters (velocity, maximum force and angle). CONCLUSIONS The present study demonstrated a high variation in the parameters of the femoral head assembly procedure. Consideration of the surgical technique guide was found to be a limited factor among participants with varying levels of experience in total hip arthroplasty. These findings underline the importance of sufficient preoperative training, to standardize the assembly procedure, including impaction force, angle, and use of instruments.
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Affiliation(s)
- Martin Darowski
- Department of Orthopaedics, Rostock University Medical Center, Doberaner Straße 142, D-18057, Rostock, Germany.
| | - Leo Ruehrmund
- Department of Orthopaedics, Rostock University Medical Center, Doberaner Straße 142, D-18057, Rostock, Germany
| | - Daniel Kluess
- Department of Orthopaedics, Rostock University Medical Center, Doberaner Straße 142, D-18057, Rostock, Germany
| | - Annett Klinder
- Department of Orthopaedics, Rostock University Medical Center, Doberaner Straße 142, D-18057, Rostock, Germany
| | - Rainer Bader
- Department of Orthopaedics, Rostock University Medical Center, Doberaner Straße 142, D-18057, Rostock, Germany
| | - Wolfram Mittelmeier
- Department of Orthopaedics, Rostock University Medical Center, Doberaner Straße 142, D-18057, Rostock, Germany
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2
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Shen L, Dong C, Chen J, Bai X, Yang F, Wang L. The mechanical and clinical influences of prosthetic index structure in Morse taper implant-abutment connection: a scoping review. BMC Oral Health 2023; 23:775. [PMID: 37865734 PMCID: PMC10590505 DOI: 10.1186/s12903-023-03545-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 10/16/2023] [Indexed: 10/23/2023] Open
Abstract
AIM The implant-abutment connection is a crucial factor in determining the long-term stability of dental implants. The use of a prosthetic index structure in the Morse taper implant-abutment connection has been proposed as a potential solution to improve the accuracy of this connection. This study aimed to provide a scoping review of the mechanical and clinical effects of the prosthetic index structure in the Morse taper implant-abutment connection. METHODS A systematic scoping review of articles related to "dental implants," "Morse taper," and "index" was conducted using PubMed/MEDLINE, Web of Science, Cochrane, and Scopus databases, as well as a comprehensive literature search by two independent reviewers. Relevant articles were selected for analysis and discussion, with a specific focus on investigating the impact of prosthetic index structure on the mechanical and clinical aspects of Morse taper implant-abutment connections. RESULTS Finally, a total of 16 articles that met the inclusion criteria were included for data extraction and review. In vitro studies have demonstrated that the use of a prosthetic index structure in the Morse taper implant-abutment connection can affect stress distribution, biomechanical stability, and reverse torque values, which may reduce stress within cancellous bone and help limit crestal bone resorption. However, retrospective clinical studies have shown that this structure is also associated with a higher risk of mechanical complications, such as abutment fracture and abutment screw loosening. CONCLUSIONS Therefore, the clinical trade-off between preventing crestal bone resorption and mechanical complications must be carefully considered when selecting appropriate abutments. The findings suggest that this structure can improve the accuracy and stability of the implant-abutment connection, but its use should be carefully evaluated in clinical practice.
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Affiliation(s)
- Liheng Shen
- Center for Plastic & Reconstructive Surgery, Department of Stomatology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Chengzhi Dong
- Department of Stomatology, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Jianping Chen
- Center for Plastic & Reconstructive Surgery, Department of Stomatology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Xiaolei Bai
- Department of Stomatology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Fan Yang
- Center for Plastic & Reconstructive Surgery, Department of Stomatology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China.
| | - Linhong Wang
- Center for Plastic & Reconstructive Surgery, Department of Stomatology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China.
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Lee WS, Shin YB, Lee HD. Rotation of the eccentric glenosphere after reverse total shoulder arthroplasty: a case report. JSES Rev Rep Tech 2023; 3:376-381. [PMID: 37588501 PMCID: PMC10426588 DOI: 10.1016/j.xrrt.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Affiliation(s)
- Woo-Seung Lee
- Department of Orthopaedic Surgery, VHS (Veterans Health Service) Medical Center, Seoul, Republic of Korea
| | - Young-Bin Shin
- Department of Orthopaedic Surgery, VHS (Veterans Health Service) Medical Center, Seoul, Republic of Korea
| | - Hee Dong Lee
- Department of Orthopaedic Surgery, VHS (Veterans Health Service) Medical Center, Seoul, Republic of Korea
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4
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Zhang WT, Cheng KJ, Liu YF, Wang R, Chen YF, Ding YD, Yang F, Wang LH. Effect of the prosthetic index on stress distribution in Morse taper connection implant system and peri-implant bone: a 3D finite element analysis. BMC Oral Health 2022; 22:431. [PMID: 36180871 PMCID: PMC9523891 DOI: 10.1186/s12903-022-02465-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 09/19/2022] [Indexed: 11/23/2022] Open
Abstract
Background The combination of a prosthetic index with Morse taper connection was developed, with the purpose of making prosthetic procedures more precise. However, the presence of the index may compromise the mechanical performance of the abutment. The aim of this study is to evaluate the effect of prosthetic index on stress distribution in implant–abutment-screw system and peri-implant bone by using the 3D finite element methodology. Methods Two commercial dental implant systems with different implant–abutment connections were used: the Morse taper connection with platform switching (MT-PS) implant system and the internal hex connection with platform matching (IH-PM) implant system. Meanwhile, there are two different designs of Morse taper connection abutment, namely, abutments with or without index. Consequently, three different models were developed and evaluated: (1) MT-PS indexed, (2) MT-PS non-indexed, and (3) IH-PM. These models were inserted into a bone block. Vertical and oblique forces of 100 N were applied to each abutment to simulate occlusal loadings. Results For the MT-PS implant system, the maximum stress was always concentrated in the abutment neck under both vertical and oblique loading. Moreover, the maximum von Mises stress in the neck of the MT-PS abutment with index even exceed the yield strength of titanium alloy under the oblique loading. For the IH-PM implant system, however, the maximum stress was always located at the implant. Additionally, the MT-PS implant system has a significantly higher stress level in the abutment neck and a lower stress level around the peri-implant bone compared to the IH-PM implant system. The combined average maximum stress from vertical and oblique loads is 2.04 times higher in the MT-PS indexed model, and 1.82 times for the MT-PS non-indexed model than that of the IH-PM model. Conclusions MT-PS with index will cause higher stress concentration on the abutment neck than that of without index, which is more prone to mechanical complications. Nevertheless, MT-PS decreases stress within cancellous bone and may contribute to limiting crestal bone resorption.
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Affiliation(s)
- Wen-Tao Zhang
- Center for Plastic and Reconstructive Surgery, Department of Stomatology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), No. 158 Shangtang Rd., Hangzhou, 310014, China
| | - Kang-Jie Cheng
- College of Mechanical Engineering, Zhejiang University of Technology, Hangzhou, 310023, China.,Key Laboratory of Special Purpose Equipment and Advanced Processing Technology, Ministry of Education and Zhejiang Province, Zhejiang University of Technology, Hangzhou, 310023, China.,National International Joint Research Center of Special Purpose Equipment and Advanced Processing Technology, Zhejiang University of Technology, Hangzhou, 310023, China
| | - Yun-Feng Liu
- College of Mechanical Engineering, Zhejiang University of Technology, Hangzhou, 310023, China.,Key Laboratory of Special Purpose Equipment and Advanced Processing Technology, Ministry of Education and Zhejiang Province, Zhejiang University of Technology, Hangzhou, 310023, China.,National International Joint Research Center of Special Purpose Equipment and Advanced Processing Technology, Zhejiang University of Technology, Hangzhou, 310023, China
| | - Russell Wang
- Department of Comprehensive Care, Case Western Reserve University School of Dental Medicine, Cleveland, OH, 44106-4905, USA
| | - Yun-Fang Chen
- Center for Plastic and Reconstructive Surgery, Department of Stomatology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), No. 158 Shangtang Rd., Hangzhou, 310014, China
| | - Yu-de Ding
- Center for Plastic and Reconstructive Surgery, Department of Stomatology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), No. 158 Shangtang Rd., Hangzhou, 310014, China
| | - Fan Yang
- Center for Plastic and Reconstructive Surgery, Department of Stomatology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), No. 158 Shangtang Rd., Hangzhou, 310014, China.
| | - Lin-Hong Wang
- Center for Plastic and Reconstructive Surgery, Department of Stomatology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), No. 158 Shangtang Rd., Hangzhou, 310014, China.
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Kim S, Lee JW, Kim JH, Truong VM, Park YS. The impact of Morse taper implant design on microleakage at implant-healing abutment interface. Dent Mater J 2022; 41:767-773. [PMID: 35858791 DOI: 10.4012/dmj.2022-022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The microbial leakage at the implant-abutment interface (IAI) is one cause of peri-implant infection that puts long-term implant stability at risk. The present study compared two types of Morse taper implants in terms of sealing performance at the implanthealing abutment interface. Three implant systems, one of which exhibited a partial face-contact design (TSO) and the other two a line-contact design (TSM and BLT), were analyzed in vitro using two quantitative implant leakage measuring techniques: air-injection pressure measurement test and microbial examination. An in-house-developed device was used to determine implant leakage by recording the initial drop in pressure while injecting air through the implant. The microbial examination measured the absorbances of culture mediums in which the inoculated implants were contained. Significant difference was found between the partial face- and line-contact groups (p<0.001). Both tests revealed that partial face-contact implants are more prone to leakage than line-contact implants.
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Affiliation(s)
- Soyeon Kim
- Department of Oral Anatomy and Dental Research Institute, School of Dentistry, Seoul National University
| | - Joo Won Lee
- Department of Oral Anatomy and Dental Research Institute, School of Dentistry, Seoul National University
| | - Jae-Heon Kim
- Department of Oral Anatomy and Dental Research Institute, School of Dentistry, Seoul National University
| | - Van Mai Truong
- Department of Oral Anatomy and Dental Research Institute, School of Dentistry, Seoul National University
| | - Young-Seok Park
- Department of Oral Anatomy and Dental Research Institute, School of Dentistry, Seoul National University.,Center for Future Dentistry, School of Dentistry, Seoul National University
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Bagegni A, Weihrauch V, Vach K, Kohal R. The Mechanical Behavior of a Screwless Morse Taper Implant-Abutment Connection: An In Vitro Study. Materials (Basel) 2022; 15. [PMID: 35591715 DOI: 10.3390/ma15093381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 04/19/2022] [Accepted: 05/04/2022] [Indexed: 12/13/2022]
Abstract
The use of screwless Morse taper implant−abutment connections (IAC) might facilitate the clinician’s work by eliminating the mechanical complications associated with the retention screw. The aim of this study is to evaluate the effect of artificial chewing on the long-term stability of screwless Morse taper IACs. Thirty-two implant abutments restored with an upper central incisor zirconia crown were used and divided into four groups according to the implant−abutment assembling manner (C1,H: screw retained (20 Ncm); C2: tapped; or C3: torqued (20 Ncm; the screws were removed before the dynamic loading)). All specimens were subjected to a cyclic loading (98 N) for 10 million chewing cycles. The survived samples were exposed to a pull-off force until failure/disassembling of the connection. All the samples revealed a 100% survival. Regarding the pull-off test, the screw-retained internal hexagonal IAC revealed significantly higher resistance to failure/disassembling (769.6 N) than screwless conical IACs (171.6 N−246 N) (p < 0.0001). The retention forces in the Morse taper groups were not significantly different (p > 0.05). The screw-retained hexagonal IAC showed the highest retention stability. The screw preload/retention in the conical IAC was lost over time in the group where the screws were kept in place during loading. Nevertheless, the screwless Morse taper IACs were stable for an extended service time and might represent a valid form of treatment for single-tooth replacement.
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7
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Díaz-Dilernia F, Sanchez-Mele H, Zanotti G, Comba F, Piccaluga F, Buttaro M. Fracture of a triple-polished tapered cemented femoral stem at the Morse taper after metal-on-metal primary total hip arthroplasty. Ann R Coll Surg Engl 2022; 104:e128-e132. [PMID: 34939858 PMCID: PMC9773908 DOI: 10.1308/rcsann.2021.0187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Total hip arthroplasty, one of the most successful orthopaedic procedures, is influenced by several variables. Corrosion at the modular junction is known as trunnionosis. Despite being reported infrequently, corrosion between the femoral head and the Morse taper can result in severe complications. Fracture of the femoral component in primary metal-on-metal (MoM) total hip arthroplasty at the Morse taper is an extremely rare event and can be associated with several risk factors. We report a case of corrosion at the Morse taper in a hybrid primary MoM total hip arthroplasty, resulting in Morse taper fracture with consequent femoral head entrapment inside the acetabular component. We hypothesise that some risk factors, such as age over 60years, active male patients, body mass index above 30kg/m2, large femoral heads, high-offset stems, 9/10 Morse taper and MoM-bearing surfaces, are associated with this mode of failure.
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Affiliation(s)
- F Díaz-Dilernia
- Institute of Orthopedics ‘Carlos E. Ottolenghi’, Italian Hospital of Buenos Aires, Argentina
| | - H Sanchez-Mele
- Institute of Orthopedics ‘Carlos E. Ottolenghi’, Italian Hospital of Buenos Aires, Argentina
| | - G Zanotti
- Institute of Orthopedics ‘Carlos E. Ottolenghi’, Italian Hospital of Buenos Aires, Argentina
| | - F Comba
- Institute of Orthopedics ‘Carlos E. Ottolenghi’, Italian Hospital of Buenos Aires, Argentina
| | - F Piccaluga
- Institute of Orthopedics ‘Carlos E. Ottolenghi’, Italian Hospital of Buenos Aires, Argentina
| | - M Buttaro
- Institute of Orthopedics ‘Carlos E. Ottolenghi’, Italian Hospital of Buenos Aires, Argentina
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Karachalios TS, Komnos GA. Morse taper and femoral head modularity: a technical note. Hip Int 2022; 32:237-238. [PMID: 35317636 DOI: 10.1177/11207000221082647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Theofilos S Karachalios
- Orthopaedic Department, University General Hospital of Larissa, School of Health Sciences, Faculty of Medicine, University of Thessalia, Larissa, Greece
| | - George A Komnos
- Orthopaedic Department, University General Hospital of Larissa, School of Health Sciences, Faculty of Medicine, University of Thessalia, Larissa, Greece
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MacAskill ML, Thomas RJ, Barnes LA. Case Report: Watching and Waiting? A Case of Incomplete Glenosphere Seating With Spontaneous Reversal in Reverse Shoulder Arthroplasty. J Shoulder Elb Arthroplast 2021; 4:2471549220949147. [PMID: 34497962 PMCID: PMC8282145 DOI: 10.1177/2471549220949147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 05/08/2020] [Accepted: 07/07/2020] [Indexed: 11/15/2022] Open
Abstract
Introduction: Reverse shoulder arthroplasty is a useful procedure
with broadening applications, but it has the best outcomes when used for rotator
cuff tear arthropathy. However, this procedure is not without complications.
While scapular notching and aseptic loosening are more common complications that
have been extensively studied in the literature, dissociation of the glenoid
component and incomplete glenosphere seating has not received much attention.
Specifically, little research has explored appropriate management of incomplete
seating of the glenosphere component, and no gold standard for treatment of this
complication has emerged. Methods: In the case described here, an elderly patient with an
incompletely seated glenosphere component post-operatively opted to pursue
conservative management in order to avoid revision surgery if possible. Results: The partially engaged, superiorly directed components in
this case exhibited spontaneous complete and symmetric seating of the
glenosphere between six and twelve months post-operatively, indicating that
conservative management of this complication in low-demand patients may be a
viable option to avoid the risks associated with revision surgery. Conclusion: Further research should be pursued to explore what
patient and prosthesis design factors may be suited to observation with serial
radiographs when incomplete seating of the glenosphere component occurs.
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Affiliation(s)
- Micah L MacAskill
- Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Rachel J Thomas
- Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Leslie A Barnes
- Department of Orthopaedic Surgery and Sports Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
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10
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Bagegni A, Zabler S, Nelson K, Rack A, Spies BC, Vach K, Kohal R. Synchrotron-based micro computed tomography investigation of the implant-abutment fatigue-induced microgap changes. J Mech Behav Biomed Mater 2021; 116:104330. [PMID: 33516129 DOI: 10.1016/j.jmbbm.2021.104330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 01/07/2021] [Accepted: 01/08/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE This study evaluates the effect of dynamic-loading on the microgap of the IAC when different supratructure heights are applied. MATERIALS AND METHODS Forty-eight dental implants (24 each of butt-joint (H) and internal-conical connections (C)) were tested in this study. Each group was further divided into three groups (n = 8) according to the applied suprastructure height (H1, C1: 10 mm, H2, C2: 14 mm and H3, C3: 18 mm). All specimens were subjected to cyclic loading in a chewing-simulator with a load of 98 N for 5 × 106 chewing cycles. The microgap at the IAC was inspected before and after loading, using synchrotron-based micro computed tomography (SRμCT) and light microscopy (LM). RESULTS SRμCT revealed an internal microgap range between 0.26 μm and 0.5 μm in the group C, whereas the group H exhibited a microgap range between 0.26 μm and 0.47 μm prior to loading. After chewing simulation, a smaller microgap size in all groups was detected ranging from 0.11 μm to 0.26 μm (group C: 0.11μm-0.26 μm; group H: 0.21μm-0.25 μm). The LM investigation showed mean microgap values at the outer IAC junction before loading from 5.8 μm to 11.3 μm and from 3.9 μm to 7.2 μm after loading. All specimens exhibited a vertical intrusion displacement of the abutment. CONCLUSION Regardless of the crown height, the microgap between the abutment and implant systematically decreased after loading in both butt-joint and internal-conical connections.
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Affiliation(s)
- Aimen Bagegni
- Medical Center - University of Freiburg, Center for Dental Medicine, Department of Prosthetic Dentistry, Faculty of Medicine - University of Freiburg, Freiburg, Germany.
| | - Simon Zabler
- Lehrstuhl für Röntgenmikroskopie der Universität Würzburg, Josef-Martin-Weg 63 Hubland Nord, 97074 Würzburg, Germany
| | - Katja Nelson
- Medical Center - University of Freiburg, Center for Dental Medicine, Department of Oral and Craniomaxillofacial Surgery, Faculty of Medicine - University of Freiburg, Freiburg, Germany
| | - Alexander Rack
- ESRF-The European Synchrotron, 71 Avenue des Martyrs, 38000 Grenoble, France
| | - Benedikt C Spies
- Medical Center - University of Freiburg, Center for Dental Medicine, Department of Prosthetic Dentistry, Faculty of Medicine - University of Freiburg, Freiburg, Germany
| | - Kirstin Vach
- Medical Center - University of Freiburg, Institute of Medical Biometry and Statistics, Faculty of Medicine - University of Freiburg, Freiburg, Germany
| | - Ralf Kohal
- Medical Center - University of Freiburg, Center for Dental Medicine, Department of Prosthetic Dentistry, Faculty of Medicine - University of Freiburg, Freiburg, Germany
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11
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Mencia MM, Goalan R, Skeete R. Atraumatic dissociation of a modular shoulder hemiarthroplasty: a case report and literature review. JSES Int 2020; 4:400-403. [PMID: 32490434 PMCID: PMC7256893 DOI: 10.1016/j.jseint.2020.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Affiliation(s)
- Marlon M Mencia
- Department of Clinical Surgical Sciences, University of the West Indies, Trinidad
| | - Raakesh Goalan
- Department of Orthopaedics, Eric Williams Medical Sciences Complex, Trinidad
| | - Rondell Skeete
- Department of Surgery, Port of Spain General Hospital, Trinidad
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12
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Teixeira MKS, de Moraes Rego MR, da Silva MFT, Lourenço EJV, Figueredo CM, Telles DM. Bacterial Profile and Radiographic Analysis Around Osseointegrated Implants With Morse Taper and External Hexagon Connections: Split-Mouth Model. J ORAL IMPLANTOL 2019; 45:469-473. [PMID: 31536433 DOI: 10.1563/aaid-joi-d-18-00222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The aim of this clinical study was to evaluate bacterial colonization, marginal bone loss, and optical alveolar density in implants with Morse taper (MT) and external hexagon (EH) connections. Thirty-five implants were installed in 7 patients (mean age: 65.8 ± 6.7 years). Implants were divided into 2 groups, according to platform design: G1 - MT, installed 2mm infra-osseous and G2 - EH, positioned according to Branemark protocol. Patients were evaluated at baseline (T0), 21 days (T1), 3 months (T2), 6 months (T3), and 12 months (T4) after installations. Bone loss and alveolar density were evaluated by standardized periapical radiographs and bacterial profile with checkerboard DNA-DNA hybridization. Statistical analyses were performed using SPSS 23.0. To present the results, boxplots and a line graph of mean were used. P-values ≤ .05 were statistically significant. After 3 months, alveolar bone loss was significantly higher in the G2 (T2-T0: P = .006; T3-T0: P = .003; and T4-T0: P = .005). No significant differences between G1 and G2 groups were observed for optical alveolar density. Microbiological analysis showed similar profiles between studied groups; however, there were significantly higher counts of Tannerella forsythia (P = .048), Campylobacter showae (P = .038), and Actinomyces naeslundii (P = .027) in G1 after 12 months. Based on the results of this study, it can be concluded that there was less peri-implant bone loss in MT compared to EH connections, but microbiological profile did not seem to influence bone changes.
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Affiliation(s)
- Mayla Kezy Silva Teixeira
- Department of Prosthodontics, Faculty of Odontology, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | | | | | - Eduardo José Veras Lourenço
- Department of Prosthodontics, Faculty of Odontology, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Carlos Marcelo Figueredo
- Department of Periodontology, Faculty of Odontology, Rio de Janeiro State University, Rio de Janeiro, Brazil.,School of Dentistry and Oral Health, Griffith University, Gold Coast, QLD, Australia
| | - Daniel Moraes Telles
- Department of Prosthodontics, Faculty of Odontology, Rio de Janeiro State University, Rio de Janeiro, Brazil
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Hung HC, Huang CS, Pan YH. The compressive strength of implant-abutment complex with different connection designs. J Dent Sci 2019; 14:318-324. [PMID: 31528261 PMCID: PMC6739501 DOI: 10.1016/j.jds.2019.01.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 01/05/2019] [Indexed: 11/29/2022] Open
Abstract
Background/purpose Implant-abutment connection is the component responsible for the transmitting of occlusal force from the crown down to the implant fixture. Different connection geometric structure will lead to different mechanical performance. The purpose of this study was to compare the stability of internal hex Implant -abutment connection with internal hex with Morse taper implant-abutment connection by testing their compressive strength. Materials and methods This was an in vitro study. The test group and the control group had 8 specimens separately. The test group was internal hex combined with Morse taper implant connection design, and the control group was internal hex connection design. Static force was applied to the specimens at a 30° angle until failure. The testing protocol was designed according to ISO14801 regulations. We compared the compressive strength of both groups. Results The control group showed significantly higher compressive strength than the test group (p < 0.0001). Conclusions For the compressive strength of implant abutment complex, incorporating Morse taper design into internal hex connection failed to enhance its mechanical performance. According to this study, internal hex connection has higher compressive strength than internal hex connection combined with Morse taper design.
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Affiliation(s)
- Hsien-Ching Hung
- Chang-Gung Memorial Hospital, Division of Craniofacial Dentistry, Taipei, Taiwan, ROC
| | - Chiung-Shing Huang
- Chang-Gung Memorial Hospital, Division of Craniofacial Dentistry, Taipei, Taiwan, ROC
| | - Yu-Hwa Pan
- Chang-Gung Memorial Hospital, Division of General Dentistry, Taipei, Taiwan, ROC.,Chang-Gung University, Taoyuan, Taiwan, ROC
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Wachtel A, Zimmermann T, Sütel M, Adali U, Abou-Emara M, Müller WD, Mühlemann S, Schwitalla AD. Bacterial leakage and bending moments of screw-retained, composite-veneered PEEK implant crowns. J Mech Behav Biomed Mater 2018; 91:32-37. [PMID: 30529984 DOI: 10.1016/j.jmbbm.2018.11.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 11/26/2018] [Accepted: 11/27/2018] [Indexed: 10/27/2022]
Abstract
Due to its elastic modulus close to bone, the high-performance material PEEK (polyetheretherketone) represents an interesting material for implant-supported dental prostheses. Besides a damping effect of masticatory forces, it might have a sealing effect against bacterial leakage of the implant-abutment interface (IAI). So far, PEEK has only been used for provisional implant crowns. Therefore, the aim of the study was the evaluation of the bacterial tightness of screw-retained PEEK crowns on titanium implants with conical IAI during masticatory simulation and subsequent bending moment testing. Ten screw-retained implant crowns in the shape of an upper central incisor consisting of a PEEK crown framework veneered with composite were connected to NobelActive RP titanium implants (4.3 × 11.5 mm, Nobel Biocare AB, Göteborg, Sweden) with a tightening torque of 15 Ncm. Prior to tightening, the interior of the implant was inoculated with a bacterial suspension of Enterococcus faecium. The specimens were overmolded with indicating agar (Kanamycin-Aesculin-Azid-Agar (KAAA), Oxoid Limited, Basingstoke United Kingdom), that turns black in contact with E. faecium. The specimens were subjected to a cyclic masticatory simulation whereby a force of 50 N cm was applied at an angle of 30° to the implant axis for 1.2 million cycles. Afterwards, the specimens were subjected to a static loading test according to ISO 14801:2007 to determine the bending moment. During masticatory simulation neither a loosening of the implant screws nor any damage to the veneer or the PEEK framework occurred. Furthermore, no bacterial leakage could be observed in any of the specimens. The average maximum bending moment was measured at 352.13 ± 48.96 N cm. Regarding masticatory forces, PEEK implant crowns seem to be applicable as definitive implant-supported restorations. Furthermore, the bacterial tightness of the IAI of screw-retained one-piece PEEK implant crowns is advantageous compared to superstructures of conventional materials. Further studies are necessary to substantiate the clinical significance of these findings.
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Affiliation(s)
- Andreas Wachtel
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Dental Materials and Biomaterial Research, Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Aßmannshauser Str. 4-6, 14197 Berlin, Germany
| | - Tycho Zimmermann
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Dental Materials and Biomaterial Research, Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Aßmannshauser Str. 4-6, 14197 Berlin, Germany
| | - Mona Sütel
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Dental Materials and Biomaterial Research, Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Aßmannshauser Str. 4-6, 14197 Berlin, Germany
| | - Ufuk Adali
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Dental Materials and Biomaterial Research, Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Aßmannshauser Str. 4-6, 14197 Berlin, Germany
| | - Mohamad Abou-Emara
- Beuth University of Applied Sciences, Luxemburger Str. 10, 13353 Berlin, Germany
| | - Wolf-Dieter Müller
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Dental Materials and Biomaterial Research, Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Aßmannshauser Str. 4-6, 14197 Berlin, Germany
| | - Sven Mühlemann
- University of Zurich, Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Plattenstrasse 11, 8032 Zürich, Switzerland
| | - Andreas Dominik Schwitalla
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Dental Materials and Biomaterial Research, Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Aßmannshauser Str. 4-6, 14197 Berlin, Germany.
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15
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Mueller U, Panzram B, Braun S, Sonntag R, Kretzer JP. Mixing of Head-Stem Components in Total Hip Arthroplasty. J Arthroplasty 2018; 33:945-951. [PMID: 29174405 DOI: 10.1016/j.arth.2017.10.047] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 10/17/2017] [Accepted: 10/21/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Implant manufacturers proclaim that the tapers of modular total hip arthroplasty are not standardized and can vary from manufacturer to manufacturer. That is why the combination of various components from different manufacturers ("Mix and Match") is not permitted. In this study, different taper combinations were investigated experimentally to assess the effect of "Mix and Match" regarding the taper connection strength. METHODS Torque-off tests using hip stems and metal femoral heads from 6 different implant manufacturers were performed. First the components were tested as intended and afterwards the stems were combined with metal heads from other manufacturers. RESULTS There was no significant difference in taper connection strength when stems from the manufacturers Link, Smith & Nephew, and Zimmer were combined with heads from other manufacturers. The Biomet stems showed a significantly reduced taper connection strength if femoral heads of Aesculap, DePuy, or Smith & Nephew were used. On the contrary, the DePuy stems in combination with the originally intended femoral heads showed a significantly lower taper connection strength compared to the use of heads from Link, Biomet, and Zimmer. The same was observed for the Aesculap stems in combination with Zimmer heads. CONCLUSION The results of this study suggest that mixing components from different manufacturers may affect the taper connection strength and could reduce the stability. As safety should be a high priority in patient treatment, any potential risks should be avoided. Therefore, mixing and matching of heads and femoral stems from different manufacturers cannot be recommended.
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Affiliation(s)
- Ulrike Mueller
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Benjamin Panzram
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Steffen Braun
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Robert Sonntag
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - J Philippe Kretzer
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
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16
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Leuridan S, Goossens Q, Pastrav L, Van Tongel A, De Wilde L, Debeer P, Denis K, Desmet W, Vander Sloten J. A nondestructive method to verify the glenosphere-baseplate assembly in reverse shoulder arthroplasty. J Shoulder Elbow Surg 2016; 25:e156-65. [PMID: 27079218 DOI: 10.1016/j.jse.2016.01.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Revised: 01/13/2016] [Accepted: 01/22/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Glenoid dissociation is a rare postoperative complication in reverse shoulder arthroplasty that has severe consequences for the patient and requires revision in most cases. A mechanically compromised Morse taper is hypothesized to be the main cause of this complication, with bony impingements and soft tissue interpositioning being cited as the most important problems. Intraoperative assessment of the taper assembly is challenging. Current methods require applying considerable torque to the glenosphere or relying on radiographs. MATERIALS AND METHODS This in vitro study demonstrates how the assembly quality can be accurately determined in a nondestructive way by exploiting the implant-specific relation between screw and Morse taper characteristics by measuring the angular rotation-torque curve. RESULTS The feasibility of the method is demonstrated on 2 reverse implant models. Several data features that can statistically discriminate between optimal and suboptimal assemblies are proposed. CONCLUSION Suboptimal assemblies can be detected using the method presented, which could easily be integrated in the current surgical workflow. Clinical recommendations based on the method's rationale are also presented, allowing detection of the most severe defect cases with surgical instruments currently in use.
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Affiliation(s)
- Steven Leuridan
- Biomechanics Division, Department of Mechanical Engineering, KU Leuven, Leuven, Belgium.
| | - Quentin Goossens
- Health Engineering Technology, Campus Groep T, KU Leuven, Leuven, Belgium
| | - Leonard Pastrav
- Health Engineering Technology, Campus Groep T, KU Leuven, Leuven, Belgium
| | - Alexander Van Tongel
- Department of Orthopedic Surgery and Traumatology, Ghent University Hospital, Gent, Belgium
| | - Lieven De Wilde
- Department of Orthopedic Surgery and Traumatology, Ghent University Hospital, Gent, Belgium
| | - Philippe Debeer
- Department of Orthopedic Surgery, Leuven University Hospitals, Pellenberg, Belgium
| | - Kathleen Denis
- Health Engineering Technology, Campus Groep T, KU Leuven, Leuven, Belgium
| | - Wim Desmet
- Production Engineering, Machine Design and Automation Division, Department of Mechanical Engineering, KU Leuven, Leuven, Belgium
| | - Jos Vander Sloten
- Biomechanics Division, Department of Mechanical Engineering, KU Leuven, Leuven, Belgium
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17
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Macedo JP, Pereira J, Vahey BR, Henriques B, Benfatti CAM, Magini RS, López-López J, Souza JCM. Morse taper dental implants and platform switching: The new paradigm in oral implantology. Eur J Dent 2016; 10:148-154. [PMID: 27011755 PMCID: PMC4784146 DOI: 10.4103/1305-7456.175677] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The aim of this study was to conduct a literature review on the potential benefits with the use of Morse taper dental implant connections associated with small diameter platform switching abutments. A Medline bibliographical search (from 1961 to 2014) was carried out. The following search items were explored: “Bone loss and platform switching,” “bone loss and implant-abutment joint,” “bone resorption and platform switching,” “bone resorption and implant-abutment joint,” “Morse taper and platform switching.” “Morse taper and implant-abutment joint,” Morse taper and bone resorption,” “crestal bone remodeling and implant-abutment joint,” “crestal bone remodeling and platform switching.” The selection criteria used for the article were: meta-analysis; randomized controlled trials; prospective cohort studies; as well as reviews written in English, Portuguese, or Spanish languages. Within the 287 studies identified, 81 relevant and recent studies were selected. Results indicated a reduced occurrence of peri-implantitis and bone loss at the abutment/implant level associated with Morse taper implants and a reduced-diameter platform switching abutment. Extrapolation of data from previous studies indicates that Morse taper connections associated with platform switching have shown less inflammation and possible bone loss with the peri-implant soft tissues. However, more long-term studies are needed to confirm these trends.
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Affiliation(s)
- José Paulo Macedo
- School of Dentistry, Universidade Fernando Pessoa (UFP), Porto, 4249-004, Portugal
| | - Jorge Pereira
- School of Dentistry, Universidade Fernando Pessoa (UFP), Porto, 4249-004, Portugal
| | - Brendan R Vahey
- Herman Ostrow School of Dentistry of USC, 925 W 34 St. Los Angeles, CA 90089, USA.,School of Dentistry (ODT), Federal University of Santa Catarina (UFSC), Florianopolis/SC, 88040-900, Brazil
| | - Bruno Henriques
- School of Dentistry (ODT), Federal University of Santa Catarina (UFSC), Florianopolis/SC, 88040-900, Brazil
| | - Cesar A M Benfatti
- School of Dentistry (ODT), Federal University of Santa Catarina (UFSC), Florianopolis/SC, 88040-900, Brazil
| | - Ricardo S Magini
- School of Dentistry, Universidade Fernando Pessoa (UFP), Porto, 4249-004, Portugal
| | - José López-López
- Oral Health and Masticatory System Group (Bellvitge Biomedical Research Group), School of Dentistry, L'Hospitalet de Llobregat, Universitat de Barcelona, 402 4270, Barcelona, Spain
| | - Júlio C M Souza
- School of Dentistry (ODT), Federal University of Santa Catarina (UFSC), Florianopolis/SC, 88040-900, Brazil
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18
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Cusick MC, Hussey MM, Steen BM, Hartzler RU, Clark RE, Cuff DJ, Cabezas AF, Santoni BG, Frankle MA. Glenosphere dissociation after reverse shoulder arthroplasty. J Shoulder Elbow Surg 2015; 24:1061-8. [PMID: 25655458 DOI: 10.1016/j.jse.2014.12.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 12/02/2014] [Accepted: 12/06/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Reverse shoulder arthroplasty (RSA) is gaining popularity for the treatment of debilitating shoulder disorders. Despite marked improvements in patient satisfaction and function, the RSA complication rate is high. Glenosphere dissociation has been reported and may result from multiple mechanisms. However, few RSA retrieval studies exist. METHODS We reviewed our RSA database and identified patients with glenosphere dissociation between 1999 and 2013. Prosthesis type, glenosphere size, and contributing factors to dissociation were noted. Five retrieved implants were available for analysis, and evidence of wear or corrosion on the Morse taper was documented. Further, we biomechanically investigated improper Morse taper engagement that may occur intraoperatively as a potential cause of acute dissociation. RESULTS Thirteen patients with glenosphere dissociation were identified (0.5 months to 7 years postoperatively). Glenosphere size distribution was as follows: 32 mm (n = 1), 36 mm (n = 4), 40 mm (n = 6), and 44 mm (n = 2). Incidence of dissociation was correlated to glenosphere size (P < .001). Taper damage was limited to fretting wear, and there was minimal evidence of taper corrosion. Biomechanically, improper taper engagement reduced the torsional capacity of the glenosphere-baseplate interface by 60% from 19.2 ± 1.0 N-m to 7.5 ± 1.5 N-m. CONCLUSION We identified several mechanisms contributing to glenosphere dissociation after RSA, including trauma and improper taper engagement. Limited evidence of corrosive wear on the taper interface was identified. Although it is rare, the incidence of glenosphere dissociation was higher when 40- and 44-mm glenospheres were implanted compared with smaller glenospheres (32 and 36 mm), probably because of the larger exposed surface area for potential impingement.
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Affiliation(s)
- Michael C Cusick
- Florida Orthopaedic Institute, Shoulder and Elbow Service, Tampa, FL, USA
| | - Michael M Hussey
- Florida Orthopaedic Institute, Shoulder and Elbow Service, Tampa, FL, USA
| | - Brandon M Steen
- Florida Orthopaedic Institute, Shoulder and Elbow Service, Tampa, FL, USA
| | - Robert U Hartzler
- Florida Orthopaedic Institute, Shoulder and Elbow Service, Tampa, FL, USA
| | - Rachel E Clark
- Foundation for Orthopaedic Research and Education, Phillip Spiegel Orthopaedic Research Laboratory, Tampa, FL, USA
| | - Derek J Cuff
- Suncoast Orthopaedic Surgery & Sports Medicine, Venice, FL, USA
| | - Andres F Cabezas
- Foundation for Orthopaedic Research and Education, Phillip Spiegel Orthopaedic Research Laboratory, Tampa, FL, USA
| | - Brandon G Santoni
- Foundation for Orthopaedic Research and Education, Phillip Spiegel Orthopaedic Research Laboratory, Tampa, FL, USA
| | - Mark A Frankle
- Florida Orthopaedic Institute, Shoulder and Elbow Service, Tampa, FL, USA.
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Lavernia CJ, Iacobelli DA, Villa JM, Jones K, Gonzalez JL, Jones WK. Trunnion-Head Stresses in THA: Are Big Heads Trouble? J Arthroplasty 2015; 30:1085-8. [PMID: 25724112 DOI: 10.1016/j.arth.2015.01.021] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 12/23/2014] [Accepted: 01/14/2015] [Indexed: 02/01/2023] Open
Abstract
The effects of large heads on stresses at the THA trunnion-head junction and their impact on tribocorrosion/metal ion release remain controversial. A 12/14 3D-model of a stem with different head sizes was investigated. Material properties of titanium were assigned to the trunnion and cobalt-chrome/alumina to the heads. A load simulating walking single-leg stand phase was applied to the head. A total contact head-trunnion interface was assumed. The area underneath the junction underwent significant elevations in stresses as head size increased from 28- to 40-mm. Maximum principal stress doubled between 28 and 40-mm heads, regardless of head material. Stress levels had a direct correlation to head diameter. Stress increases observed using increasingly larger heads will probably contribute to head-trunnion tribocorrosion and ion release.
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