1
|
LaCour MT, Dessinger GM, Haas SB, Komistek RD. In Vivo Weight-Bearing Kinematics for Constrained Versus Traditional Bicruciate Stabilized Total Knee Arthroplasty Cohorts Compared to the Normal Knee. J Arthroplasty 2023:S0883-5403(23)01176-2. [PMID: 38040066 DOI: 10.1016/j.arth.2023.11.033] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 11/21/2023] [Accepted: 11/27/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND Constrained inserts in total knee arthroplasty (TKA) may offer additional stability, but can this insert type allow unrestricted movements or will the extra conformity cause kinematic conflict with the cam-post mechanism in deeper flexion? The objective of this study was to evaluate the weight-bearing kinematics of both traditional and constrained bicruciate stabilized (BCS) TKA inserts to determine if the rollback induced by the cam-post mechanism will work in unison with the constrained polyethylene insert. METHODS This study used previously published 3-dimensional model fitting techniques to compare weight-bearing flexion and femoro-tibial condylar motion patterns for 20 patients who had a traditional insert, 20 patients who had a constrained insert, and 10 previously published nonimplanted knees, all performing a deep knee bend activity while under fluoroscopic surveillance. RESULTS The results from this study indicate that subjects having a bicruciate stabilized TKA experienced similar postoperative kinematics for both constrained and unconstrained insert options, comparable to normal knees. CONCLUSIONS Subjects in this study having either a constrained or traditional insert experienced progressive rollback of both condyles, with the lateral condyle rolling more posterior than the medial condyle, leading to axial rotation. Although less in magnitude, these results were comparable to the normal knee in pattern, indicating that kinematic conflict did not occur for subjects having a constrained insert.
Collapse
Affiliation(s)
- Michael T LaCour
- Center for Musculoskeletal Research, University of Tennessee-Knoxville, Knoxville, Tennessee
| | - Garett M Dessinger
- Center for Musculoskeletal Research, University of Tennessee-Knoxville, Knoxville, Tennessee
| | - Steven B Haas
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Richard D Komistek
- Center for Musculoskeletal Research, University of Tennessee-Knoxville, Knoxville, Tennessee
| |
Collapse
|
2
|
Callary SA, Sharma DK, D’Apollonio TM, Campbell DG. Large articulations do not increase wear rates of thin second-generation highly cross-linked polyethylene liners at ten years. Bone Jt Open 2023; 4:839-845. [PMID: 37926113 PMCID: PMC10625862 DOI: 10.1302/2633-1462.411.bjo-2023-0124.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Abstract
Aims Radiostereometric analysis (RSA) is the most accurate radiological method to measure in vivo wear of highly cross-linked polyethylene (XLPE) acetabular components. We have previously reported very low wear rates for a sequentially irradiated and annealed X3 XLPE liner (Stryker Orthopaedics, USA) when used in conjunction with a 32 mm femoral heads at ten-year follow-up. Only two studies have reported the long-term wear rate of X3 liners used in conjunction with larger heads using plain radiographs which have poor sensitivity. The aim of this study was to measure the ten-year wear of thin X3 XLPE liners against larger 36 or 40 mm articulations with RSA. Methods We prospectively reviewed 19 patients who underwent primary cementless THA with the XLPE acetabular liner (X3) and a 36 or 40 mm femoral head with a resultant liner thickness of at least 5.8 mm. RSA radiographs at one week, six months, and one, two, five, and ten years postoperatively and femoral head penetration within the acetabular component were measured with UmRSA software. Of the initial 19 patients, 12 were available at the ten-year time point. Results The median proximal, 2D, and 3D wear rates calculated between one and ten years were all less than 0.005 mm/year, with no patient recording a proximal wear rate of more than 0.021 mm/year. Importantly, there was no increase in the wear rate between five and ten years. Conclusion The very low wear rate of X3 XLPE liners with larger articulations remains encouraging for the future clinical performance of this material.
Collapse
Affiliation(s)
- Stuart A. Callary
- Centre for Orthopaedic and Trauma Research, The University of Adelaide and Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia
| | - Deepti K. Sharma
- Centre for Orthopaedic and Trauma Research, The University of Adelaide and Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia
| | - Taisha M. D’Apollonio
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia
| | | |
Collapse
|
3
|
Grimberg AW, Grupp TM, Elliott J, Melsheimer O, Jansson V, Steinbrück A. Ceramic Coating in Cemented Primary Total Knee Arthroplasty is Not Associated With Decreased Risk of Revision due to Early Prosthetic Joint Infection. J Arthroplasty 2021; 36:991-997. [PMID: 33012599 DOI: 10.1016/j.arth.2020.09.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 07/09/2020] [Revised: 08/31/2020] [Accepted: 09/08/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Prosthetic joint infection (PJI) is one of the most frequent and devastating causes of short-term revision total knee arthroplasty (TKA). In vitro evidence suggests ceramic surfaces demonstrate resistance to biofilm, but the clinical effect of bearing surface modifications on the risk of PJI remains unclear. This premier registry-based study examines the influence of ceramic bearing surface coatings on the outcome in cemented primary TKA. METHODS In total, 117,660 cemented primary TKAs in patients with primary osteoarthritis recorded in the German arthroplasty registry since 2012 were followed up for a maximum of 3 years. The primary endpoint was risk of revision for PJI on ceramic coated and uncoated cobalt-chromium-molybdenum femoral components. Propensity score matching for age, gender, obesity, diabetes mellitus, depression and Elixhauser comorbidity index, and substratification on common design twins with and without coating was performed. RESULTS In total, 4637 TKAs (85.1% female) with a ceramic-coated femoral component were identified, 42 had been revised for PJI and 122 for other reasons at 3 years. No survival advantage due to the risk of revision for PJI could be determined for ceramic-coated components. Revision for all other reasons demonstrated a significant higher rate for TKAs with ceramic-coated components. However, the results of this were confounded by a strong prevalence (20.7% vs 0.3%) of metal sensitivity in the ceramic-coated group. CONCLUSION No evidence of reduced risk for PJI due to ceramic-coated implants in cemented primary TKA was found. Further analysis for revision reasons other than PJI is required.
Collapse
Affiliation(s)
- Alexander W Grimberg
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Munich, Germany; German Arthroplasty Registry (EPRD Deutsche Endoprothesenregister gGmbH), Berlin, Germany
| | - Thomas M Grupp
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Munich, Germany; German Arthroplasty Registry (EPRD Deutsche Endoprothesenregister gGmbH), Berlin, Germany
| | - Johanna Elliott
- German Arthroplasty Registry (EPRD Deutsche Endoprothesenregister gGmbH), Berlin, Germany; Department of Orthopaedic Surgery and Traumatology, St Vinzenz Hospital, Dinslaken, Germany
| | - Oliver Melsheimer
- German Arthroplasty Registry (EPRD Deutsche Endoprothesenregister gGmbH), Berlin, Germany
| | - Volkmar Jansson
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Munich, Germany; German Arthroplasty Registry (EPRD Deutsche Endoprothesenregister gGmbH), Berlin, Germany
| | - Arnd Steinbrück
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Munich, Germany; German Arthroplasty Registry (EPRD Deutsche Endoprothesenregister gGmbH), Berlin, Germany; Orthopaedic Surgical Competence Center Augsburg (OCKA), Augsburg, Germany
| |
Collapse
|
4
|
Miller KC, Morrow BR, Sorrels JH, Arnholt CM, Mihalko WM. Electrocautery Induced Damage of Total Knee Implants. J Arthroplasty 2021; 36:1126-32. [PMID: 33067092 DOI: 10.1016/j.arth.2020.09.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 08/11/2020] [Revised: 09/24/2020] [Accepted: 09/25/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Pitting damage on implants has been reported and attributed to the use of electrocautery. This study aimed to determine how different total knee arthroplasty bearing surfaces are susceptible to this type of damage and whether surgeons are aware that this damage can occur. METHODS A survey was sent to Hip and Knee Society members to determine what percentage of adult reconstructive surgeons use electrocautery after implantation of components. Three bearing surfaces for total knee arthroplasty were selected: cobalt chromium, Oxinium, and zirconium nitride to be damaged by electrocautery with a monopolar (MP) and bipolar (BP) electrocautery with 3 different energy settings. A comparison of surface damage using scanning electron microscopy and elemental differences using energy dispersion spectroscopy was performed. Average roughness (Ra), maximal peak-to-valley height (Rz), kurtosis (Rk), and skewness (Rsk) were recorded for comparison using a profilometer was performed. RESULTS Median Rz and Ra measurements were larger for BP damaged areas compared to MP for all bearing surfaces. The Oxinium surface had the greatest increase in roughness parameters. Survey results indicate that a significant percentage of adult reconstructive surgeons use the electrocautery after implants are in place and are not aware of this type of damage. Backscatter scanning electron microscopy analysis found significant changes for BP damage compared to MP. CONCLUSION Surface damage caused by electrocautery can have significant effects on the bearing surfaces of implants but further study needs to be performed to determine if this is a clinical issue. Our survey determined that many arthroplasty experts are unaware that this damage can occur.
Collapse
|
5
|
Almaawi A, Alzuhair A, AlHakbani A, Benfaris D, Al-Abdullatif F, Alabdulkarim NH, Awwad W. Comparison of Ceramic-on-Ceramic and Ceramic-on-Highly-Crosslinked-Polyethylene in Primary Total Hip Arthroplasty: Findings of a Meta-Analysis. Cureus 2021; 13:e13304. [PMID: 33738155 PMCID: PMC7958929 DOI: 10.7759/cureus.13304] [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] [Indexed: 11/17/2022] Open
Abstract
Introduction An optimal hip implant is biocompatible, durable, and resistant to chemical and mechanical wear. This analysis aimed to compare failure (revision) and complication rates between ceramic-on-ceramic (CoC) and ceramic-on-highly-crosslinked-polyethylene (CoHXLPE) implants. Methods This review comprised of scientific literature published between 1995 and 2019. We included randomized controlled trials in adults (>18 years) that presented results of CoC and CoHXLPE total hip arthroplasty (THA) with more than two years of mean follow-up and drafted in English. The primary outcomes for this analysis were complications, revision rates, and loosening rates. Results Eight studies (1,689 hips) were included in this systematic review. There was no significant differences between COC and CoHXLPE for the risk of post-surgical complications (relative risk [RR]: 1.98, 95% confidence interval [CI]: 0.83-4.69, P = 0.12). Revision rates (RR: 1.25, 95% CI: 0.71-2.20, P = 0.43] and loosening rates between the two implants were not significantly different (RR: 1.17, 95% CI: 0.30-4.52, P = 0.82). Conclusion We report no significant differences between CoHXLPE and CoC in adults undergoing primary THA. Although introduced relatively recently, CoHXLPE is a cost-effective bearing that can be used for younger patients with no risk of increased complications in comparison to CoC. Further studies with longer follow-up periods are recommended to confirm the findings of this meta-analysis.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Waleed Awwad
- Orthopaedic Surgery, King Saud University, Riyadh, SAU
| |
Collapse
|
6
|
Chang JD, Kim IS, Mansukhani SA, Sharma V, Lee SS, Yoo JH. Midterm outcome of fourth-generation ceramic-on-ceramic bearing surfaces in revision total hip arthroplasty. J Orthop Surg (Hong Kong) 2019; 26:2309499018783913. [PMID: 29945472 DOI: 10.1177/2309499018783913] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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] [Indexed: 11/16/2022] Open
Abstract
PURPOSE The purpose of this study is to evaluate the clinical and radiologic outcomes after revision total hip arthroplasty (THA) using fourth-generation ceramic-on-ceramic (CoC) bearing surfaces. METHODS A total of 52 revision THAs (28 men and 19 women) using the fourth-generation CoC bearing surfaces were retrospectively evaluated. Both acetabular cup and femoral stem were revised in all cases. The mean follow-up period was 7.3 years (range, 4.0-9.9 years). The clinical results with Harris hip score (HHS), Western Ontario McMaster Osteoarthritis Index (WOMAC), and radiologic outcomes were evaluated. RESULTS At the final follow-up examination, the average HHS was 90.4 (range, 67-100). The average WOMAC pain and physical function score were 2.8 (range, 0-12) and 16.4 (range, 0-42), respectively. Complications were observed in 10 hips (19.2%). However, there were no bearing surface-related complications, and no cases of dislocation and squeaking. Retroacetabular pelvic osteolysis without cup loosening was observed in one hip at the final follow-up. However, no hip showed radiographic signs of cup loosening, vertical or horizontal acetabular cup migrations, and changes of inclinations during the follow-up period. CONCLUSION Our data showed that clinical and radiologic outcomes after revision THA using fourth-generation CoC bearing were favorable. Hence, revision THA with the use of CoC bearing surfaces can be preferentially considered. Further studies with long-term follow-up data are warranted.
Collapse
Affiliation(s)
- Jun-Dong Chang
- 1 Department of Orthopaedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong-si, Gyeonggi-do, Republic of Korea
| | - In-Sung Kim
- 1 Department of Orthopaedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong-si, Gyeonggi-do, Republic of Korea
| | - Sameer Ajit Mansukhani
- 1 Department of Orthopaedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong-si, Gyeonggi-do, Republic of Korea
| | - Vishwas Sharma
- 1 Department of Orthopaedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong-si, Gyeonggi-do, Republic of Korea
| | - Sang-Soo Lee
- 2 Department of Orthopaedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Je-Hyun Yoo
- 3 Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Gyeonggi-do, Republic of Korea
| |
Collapse
|
7
|
Abstract
Management of implant corrosion remains a challenge for the revision arthroplasty surgeon. Our field continues to gain insight in to how to manage this clinical scenario but there are still gaps in what is known to be considered to be the standard of care. There is a significant amount of effort going in to determining the best means of managing this issue but more work is needed. There is no doubt more studies are needed to further delineate the appropriate treatment algorithms for this clinical problem.
Collapse
Affiliation(s)
- Michael P Bolognesi
- Division of Orthopaedics, Duke University Medical Center, Durham, North Carolina
| |
Collapse
|
8
|
Heckmann ND, Sivasundaram L, Stefl MD, Kang HP, Basler ET, Lieberman JR. Total Hip Arthroplasty Bearing Surface Trends in the United States From 2007 to 2014: The Rise of Ceramic on Polyethylene. J Arthroplasty 2018; 33:1757-1763.e1. [PMID: 29429883 DOI: 10.1016/j.arth.2017.12.040] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [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: 08/02/2017] [Revised: 12/23/2017] [Accepted: 12/28/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Wear of the bearing surface is a critical element in determining the longevity of a total hip arthroplasty (THA). Over the past decade, concerns related to modern metal-on-metal (MoM) bearings and corrosion at the femoral head-neck interface have influenced surgeon selection of bearing surfaces. The purpose of this study is to analyze trends in THA bearing surface selection from 2007 through 2014 using a large national database. METHODS The Nationwide Inpatient Sample database was used to extract bearing surface data from patients who underwent a primary THA between 2007 and 2014. Patients were grouped by bearing surface type: metal-on-polyethylene (MoP), ceramic-on-polyethylene (CoP), MoM, and ceramic-on-ceramic (CoC) bearings. Descriptive statistics were employed to describe trends. Univariate and multivariate analyses were performed to identify differences between bearing surface groups. RESULTS During the study period, 2,460,640 THA discharges were identified, of which 1,059,825 (43.1%) had bearing surface data. A total of 496,713 (46.9%) MoP, 307,907 (29.1%) CoP, 210,381 (19.9%) MoM, and 44,823 (4.2%) CoC cases were identified. MoM utilization peaked in 2008 representing 40.1% of THAs implanted that year and steadily declined to 4.0% in 2014. From 2007 to 2014, the use of CoP bearing surfaces increased from 11.1% of cases in 2007 to 50.8% of cases in 2014. In 2014, CoP utilization surpassed MoP which represented 42.1% of bearing surfaces that year. CONCLUSION During the study period, MoM bearing surfaces decreased precipitously, while CoP surpassed MoP as the most popular bearing surface used in a THA.
Collapse
Affiliation(s)
- Nathanael D Heckmann
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, California
| | | | - Michael D Stefl
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, California
| | - Hyunwoo Paco Kang
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, California
| | - Eric T Basler
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, California
| | - Jay R Lieberman
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, California
| |
Collapse
|
9
|
Bedard NA, Burnett RA, DeMik DE, Gao Y, Liu SS, Callaghan JJ. Are Trends in Total Hip Arthroplasty Bearing Surface Continuing to Change? 2007-2015 Usage in a Large Database Cohort. J Arthroplasty 2017; 32:3777-3781. [PMID: 28887024 DOI: 10.1016/j.arth.2017.07.044] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [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: 05/10/2017] [Revised: 07/25/2017] [Accepted: 07/26/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Bearing surface issues related to trunnionosis or metal-on-metal (MoM) articulations have likely impacted recent trends in bearing surface choice. The purpose of this study is to evaluate trends in total hip arthroplasty (THA) bearing surface use, including 2015 data, with respect to the date of operation and patient demographics. METHODS The Humana dataset was reviewed from 2007 through 2015 to analyze bearing surface usage in primary THA. Four bearing surface types were identified by International Classification of Disease, 10th Revision codes and trended throughout the years: metal-on-polyethylene (MoP), ceramic-on-ceramic (CoC), ceramic-on-polyethylene (CoP), and MoM. Prevalence was analyzed as a function of age and sex. RESULTS Of the 28,504 primary THA procedures, the most commonly used bearing was MoP (46.1%), followed by CoP (33.2%), MoM (17.1%), and ceramic-on-ceramic (3.6%). The use of CoP bearings significantly increased from 6.4% in 2007 to 52.0% in 2015, while MoM bearings decreased during this period. MoP bearings decreased over 2012-2015 (P < .001). CoP usage decreased with age, while MoP bearings increased with a transition occurring at 65-69 years of age. Women were more likely to receive MoP bearings (odds ratio [OR] 1.2), while men were more likely to receive MoM and CoP bearings (OR 1.1). Multivariate logistic regression showed age to be an independent predictor of bearing surface choice with patients 65 and older more likely to receive MoP bearings (OR 3.2). CONCLUSION Bearing surface choice in primary THA has changed tremendously from 2007 to 2015. MoM bearing use has decreased as a result of adverse effects. Age continues to remain a significant factor in bearing surface choice.
Collapse
Affiliation(s)
- Nicholas A Bedard
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, Iowa
| | - Robert A Burnett
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, Iowa
| | - David E DeMik
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, Iowa
| | - Yubo Gao
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, Iowa
| | - Steve S Liu
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, Iowa
| | - John J Callaghan
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, Iowa
| |
Collapse
|
10
|
Shah SM, Walter WL, Tai SM, Lorimer MF, de Steiger RN. Late Dislocations After Total Hip Arthroplasty: Is the Bearing a Factor? J Arthroplasty 2017; 32:2852-6. [PMID: 28529109 DOI: 10.1016/j.arth.2017.04.037] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [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: 12/14/2016] [Revised: 04/01/2017] [Accepted: 04/18/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Dislocation is a leading cause of revision after primary total hip arthroplasty (THA). Although more common in the first few years after the procedure, dislocation can occur at any time. This study investigated the difference in late dislocation in ceramic-on-ceramic (CoC) bearings compared with metal-on-polyethylene and ceramic-on-polyethylene bearings in THA. METHODS Data were used from the Australian Orthopaedic Association National Joint Replacement Registry, and the cumulative percent revision for dislocation was estimated using the Kaplan-Meier method for the different bearing surfaces. There were 192,275 THAs included in the study with 101,915 metal-on-cross-linked polyethylene (MoXLPE), 30,256 ceramic-on-cross-linked polyethylene (CoXLPE), and 60,104 CoC. RESULTS The cumulative percent revision for dislocation at 13 years for MoXLPE, CoXLPE, and CoC groups was 1.2 (95% confidence interval [CI], 1.1-1.3), 1.0 (95% CI, 0.7-1.4), and 0.9 (95% CI, 0.8-1.1), respectively. There was an increased risk of revision for dislocation for MoXLPE compared with CoXLPE and CoC. When stratified for head size, there was no difference in the risk of revision for dislocation between MoXLPE, CoXLPE, and CoC in the 28- and 32-mm head sizes. With a head size of 36 mm, MoXLPE had a higher rate of dislocation compared with other materials. CONCLUSION Bearing surface has little impact on revision for dislocation.
Collapse
|
11
|
Rajaee SS, Theriault RV, Pevear ME, Smith EL. National Trends in Primary Total Hip Arthroplasty in Extremely Young Patients: A Focus on Bearing Surface Usage From 2009 to 2012. J Arthroplasty 2016; 31:63-8. [PMID: 27430185 DOI: 10.1016/j.arth.2016.01.061] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [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: 08/18/2015] [Revised: 01/21/2016] [Accepted: 01/25/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The ideal bearing surface for primary total hip arthroplasty (THA) in young patients remains a debate. Data on recent national trends are lacking. The purpose of this study is to provide an analysis on the national epidemiologic trends of bearing surface usage in patients aged ≤30 years undergoing THA from 2009 through 2012. METHODS Using the Healthcare Cost and Utilization Project Nationwide Inpatient Sample from 2009 to 2012, 9265 THA discharges (4210 coded by bearing surface) were identified in patients aged ≤30 years. Prevalence of surface type was analyzed along with patient and hospital demographic data. Statistical analysis was performed using SAS (SAS version 9.1; SAS, Inc, Cary, NC). Significance was set at P < .05. RESULTS Ceramic-on-polyethylene (CoP) bearing surfaces were most commonly used, representing 35.6% of cases, followed by metal-on-polyethylene (MoP; 28.0%), metal-on-metal (MoM; 19.3%), and ceramic-on-ceramic (CoC; 17.0%) bearing surfaces. Hard-on-hard bearing surfaces (MoM and CoC) represented only 36.4% of cases, a significant decrease from previously reported findings (2006-2009) where hard-on-hard bearing surfaces were the majority (62.2%; P < .05). Hard-on-hard bearing surface usage decreased from 2009 to 2012 (MoM: 29.7% to 10.2%; CoC: 20.0% to 14.7%), whereas hard-on-soft bearing surface usage (MoP and CoP) increased. CoP bearing surfaces saw the most significant increase from 25.7% in 2009 to 48.2% in 2012. A cost analysis revealed that CoP discharges were associated with higher hospital charges than other surface types, with an average charge of $66,457 (P < .05). CONCLUSION Use of hard-on-hard surfaces has decreased significantly in this population, whereas CoP and MoP surfaces have become increasingly common. Determining the optimal bearing surface for extremely young patients continues to be a challenge for orthopedic surgeons as they weigh the risks and benefits of each.
Collapse
|
12
|
Yin S, Zhang D, Du H, Du H, Yin Z, Qiu Y. Is there any difference in survivorship of total hip arthroplasty with different bearing surfaces? A systematic review and network meta-analysis. Int J Clin Exp Med 2015; 8:21871-21885. [PMID: 26885157 PMCID: PMC4724003] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 10/27/2015] [Indexed: 06/05/2023]
Abstract
PURPOSE Although many total hip bearing implants are widely used all over the world, simultaneous comparisons across the numerous available bearing surfaces are rare. The purpose of this study was to compare the survivorship of total hip arthroplasty (THA) with six available bearing implants. METHODS We conducted a systematic review of randomized controlled trials (RCTs) reporting survivorship or revision of ceramic-on-ceramic (CoC), ceramic-on-conventional polyethylene (CoPc), ceramic-on-highly-crosslinked polyethylene (CoPxl), metal-on-conventional polyethylene (MoPc), metal-on-highly-crosslinked polyethylene (MoPxl), or metal-on-metal (MoM) bearing implants. The synthesis of present evidence was performed by both the traditional direct-comparison meta-analysis and network meta-analysis. RESULTS In total, 40 RCTs involving a total of 5321 THAs were identified. The pooled data of network meta-analysis showed no difference in relative risk (RR) of revision across CoC, CoPc, CoPxl and MoPxl bearings. However, the MoM bearing was demonstrated with a significant higher risk of revision compared with CoC (RR 5.10; 95% CI=1.62 to 16.81), CoPc (RR 4.80; 95% CI=1.29 to 17.09), or MoPxl (RR 3.85; 95% CI=1.16 to 14.29), and the MoPc bearing was indicated with a higher risk of revision compared with CoC (RR 2.83; 95% CI=1.20 to 6.63). The ranking probabilities of the effective interventions also revealed the inferiority of the MoM and MoPc implants in survivorship (both 0%, 95% CI=0% to 0%) compared with CoC (39%, 95% CI=0% to 100%), CoPc (33%, 95% CI=0% to 100%), CoPxl (7%, 95% CI=0% to 100%) or MoPxl (21%, 95% CI=0% to 100%). CONCLUSIONS The present evidence indicated the similar performance in survivorship among CoC, CoPc, CoPxl and MoPxl bearing implants, and that all likely have superiority compared with the MoM and MoPc bearing implants in THA procedures. Long-term RCT data are required to confirm these conclusions and better inform clinical decisions.
Collapse
Affiliation(s)
- Si Yin
- Department of Orthopaedic Surgery, First Affiliated Hospital of Xi’an Jiaotong universityXi’an, China
| | - Dangfeng Zhang
- Department of Orthopaedic Surgery, First Affiliated Hospital of Xi’an Jiaotong universityXi’an, China
| | - Hui Du
- Department of Network Coordination, Shaanxi Radio and TV UniversityXi’an, China
| | - Heng Du
- Department of Orthopaedic Surgery, First Affiliated Hospital of Xi’an Jiaotong universityXi’an, China
| | - Zhanhai Yin
- Department of Orthopaedic Surgery, First Affiliated Hospital of Xi’an Jiaotong universityXi’an, China
| | - Yusheng Qiu
- Department of Orthopaedic Surgery, First Affiliated Hospital of Xi’an Jiaotong universityXi’an, China
| |
Collapse
|
13
|
Ast MP, John TK, Labbisiere A, Robador N, Valle AGD. Fractures of a single design of highly cross-linked polyethylene acetabular liners: an analysis of voluntary reports to the United States Food and Drug Administration. J Arthroplasty 2014; 29:1231-5. [PMID: 24444569 DOI: 10.1016/j.arth.2013.12.022] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [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: 07/16/2013] [Revised: 12/03/2013] [Accepted: 12/13/2013] [Indexed: 02/01/2023] Open
Abstract
Polyethylene liner fracture is a risk associated with the use of highly cross-linked UHMWPE. We performed a review of the voluntary reports of fractured liners to the US Food and Drug Administration to determine if any risk factors could be identified. There have been 74 reports of fractured Trilogy, Longevity liners to the US Food and Drug Administration since 1999. Most cases utilized small acetabular shells (≤54 mm) combined with large diameter heads (≥36 mm). Liners less than 7 mm thick at the weight bearing or 4.8 mm thick at the rim should be used with caution. At revision surgery, malpositioned shells should be revised and the use of a thin liner should be avoided.
Collapse
Affiliation(s)
- Michael P Ast
- Department of Orthopaedic Surgery, Division of Adult Reconstruction and Joint Replacement Surgery, Hospital for Special Surgery, New York, New York
| | - Thomas K John
- Department of Orthopaedic Surgery, Division of Adult Reconstruction and Joint Replacement Surgery, Hospital for Special Surgery, New York, New York
| | - Anthony Labbisiere
- Department of Orthopaedic Surgery, Division of Adult Reconstruction and Joint Replacement Surgery, Hospital for Special Surgery, New York, New York
| | - Nicolas Robador
- Department of Orthopaedic Surgery, Division of Adult Reconstruction and Joint Replacement Surgery, Hospital for Special Surgery, New York, New York
| | - Alejandro Gonzalez Della Valle
- Department of Orthopaedic Surgery, Division of Adult Reconstruction and Joint Replacement Surgery, Hospital for Special Surgery, New York, New York
| |
Collapse
|
14
|
Bedard NA, Callaghan JJ, Liu SS, Greiner JJ, Klaassen AL, Johnston RC. Cementless THA for the treatment of osteonecrosis at 10-year follow-up: have we improved compared to cemented THA? J Arthroplasty 2013; 28:1192-9. [PMID: 23414933 DOI: 10.1016/j.arth.2012.09.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [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: 07/24/2012] [Accepted: 09/09/2012] [Indexed: 02/01/2023] Open
Abstract
Results of cementless THA for osteonecrosis were evaluated at a minimum of 10-year follow-up and compared to our previous report of cemented THA for osteonecrosis. Eighty cementless THAs in 66 patients with osteonecrosis were followed for a minimum of 10 years. Evaluation consisted of need for revision; radiographic evidence of loosening, wear and osteolysis; activity monitoring with an accelerometer; UCLA, Tegner, WOMAC, and Harris hip scores. Results were compared to 48 cemented THAs performed for osteonecrosis with comparable follow-up. At a minimum of 10 years, 10 hips required reoperation. Loosening and revision for loosening were significantly lower in the cementless group compared to the cemented historical control. Cementless fixation in THAs for osteonecrosis demonstrated durable results with bearing surface wear being the major long-term problem.
Collapse
|
15
|
Heiner AD, Kruger KM, Baer TE, Brown TD. Enhancing damage visibility on metallic bearing surfaces: a simple technique for photography and viewing. J Arthroplasty 2013; 28:543.e9-543.e12. [PMID: 23333257 PMCID: PMC3581706 DOI: 10.1016/j.arth.2012.06.029] [Citation(s) in RCA: 5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 06/13/2012] [Accepted: 06/20/2012] [Indexed: 02/01/2023] Open
Abstract
Damage to metallic bearing surfaces typically involves scratches, scrapes, metal transfer, and organic deposits. This damage can cause accelerated wear of the opposing surface and subsequent implant failure. Photography and viewing of metallic bearing surfaces, for documenting this damage, are hindered by optical reflectivity. This note demonstrates a simple, practical technique for metallic bearing surface photography and viewing that minimizes this reflectivity problem, that does not involve any modification of the bearing surface, and that allows for improved observation and documentation of overall damage. When the metallic bearing surface is placed within a tube of translucent material, the appearance of damage on that bearing surface is dramatically enhanced, showing up against a smooth, even background with excellent contrast and with fine detail achievable.
Collapse
Affiliation(s)
- Anneliese D. Heiner
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA,Department of Biomedical Engineering, University of Iowa, Iowa City, IA
| | - Karen M. Kruger
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA,Department of Biomedical Engineering, University of Iowa, Iowa City, IA
| | - Thomas E. Baer
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA
| | - Thomas D. Brown
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA,Department of Biomedical Engineering, University of Iowa, Iowa City, IA
| |
Collapse
|