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Castagnini F, Bordini B, Cosentino M, Ancarani C, Mariotti F, Biondi F, Faldini C, Traina F. The influence of bearing surfaces on revisions due to dislocations in total hip arthroplasty. J Mater Sci Mater Med 2021; 32:123. [PMID: 34524578 PMCID: PMC8443492 DOI: 10.1007/s10856-021-06598-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 08/29/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Recurrent dislocations are still the most frequent reason for revision in total hip arthroplasty (THA). The impact of bearing surfaces on dislocations is still controversial. We hypothesized that: (1) bearing surfaces influence the revisions due to dislocations; (2) ceramic-on-ceramic reduced the revisions for dislocations in adjusted models; (3) Delta-on-Delta bearings reduced the revisions for dislocations in comparison to surfaces with cross-linked polyethylene. MATERIALS AND METHODS The regional arthroplasty registry was enquired about bearing surfaces and revisions for dislocations and instability. Unadjusted and adjusted rates were provided, including sex, age (<65 years or ≥65 years), head diameter (≤28 mm or >28 mm; <36 mm or ≥36 mm) as variables. 44,065 THAs were included. RESULTS The rate of revisions for dislocations was significantly lower in ceramic-on-ceramic and metal-on-metal bearings (unadjusted rates). After adjusting for age, sex, and head size (36 and 28 mm), hard-on-hard bearings were protective (p < 0.05): ceramic-on-ceramic had a lower risk of revisions due to dislocation than ceramic-on-polyethylene (HR 1.6, 95% CI 1.2-2.2 p = 0.0009). The rate of revisions for dislocation was similar in bearings with cross-linked polyethylene and Delta-on-Delta articulations, in unadjusted and adjusted models. CONCLUSION Bearings with conventional polyethylene were more predisposed to dislocations. Currently adopted bearings exerted no significant influence on revisions due to dislocations. These findings could be primarily related to wear, but due to the time distribution, soft tissue envelopes and surface tension may also play a role. Pre-clinical biomechanical evaluations and prospective matched cohort studies are required to draw definitive conclusions.
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Affiliation(s)
- Francesco Castagnini
- Ortopedia-Traumatologia e Chirurgia protesica e dei reimpianti d'anca e di ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy.
| | - Barbara Bordini
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy
| | - Monica Cosentino
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy
| | - Cristina Ancarani
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy
| | - Federica Mariotti
- Ortopedia-Traumatologia e Chirurgia protesica e dei reimpianti d'anca e di ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - Federico Biondi
- Ortopedia-Traumatologia e Chirurgia protesica e dei reimpianti d'anca e di ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - Cesare Faldini
- Head of Clinica Ortopedica e Traumatologica I, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
- Orthopaedics and Traumatology, University of Bologna DIBINEM, 40123, Bologna, Italy
| | - Francesco Traina
- Orthopaedics and Traumatology, University of Bologna DIBINEM, 40123, Bologna, Italy
- Head of Ortopedia-Traumatologia e Chirurgia protesica e dei reimpianti d'anca e di ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
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Damm P, Bender A, Waldheim V, Winkler T, Duda GN. Surgical cup placement affects the heating up of total joint hip replacements. Sci Rep 2021; 11:15851. [PMID: 34349160 PMCID: PMC8338953 DOI: 10.1038/s41598-021-95387-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 07/07/2021] [Indexed: 11/16/2022] Open
Abstract
The long-term success of highly effective total hip arthroplasty (THA) is mainly restricted by aseptic loosening, which is widely associated with friction between the head and cup liner. However, knowledge of the in vivo joint friction and resulting temperature increase is limited. Employing a novel combination of in vivo and in silico technologies, we analyzed the hypothesis that the intraoperatively defined implant orientation defines the individual joint roofing, friction and its associated temperature increase. A total of 38,000 in vivo activity trials from a special group of 10 subjects with instrumented THA implants with an identical material combination were analyzed and showed a significant link between implant orientation, joint kinematics, joint roofing and friction-induced temperature increase but surprisingly not with acting joint contact force magnitude. This combined in vivo and in silico analysis revealed that cup placement in relation to the stem is key to the in vivo joint friction and heating-up of THA. Thus, intraoperative placement, and not only articulating materials, should be the focus of further improvements, especially for young and more active patients.
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Affiliation(s)
- Philipp Damm
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany.
| | - Alwina Bender
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany
| | - Vivian Waldheim
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany
| | - Tobias Winkler
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Berlin Institute of Health Center for Regenerative Therapies, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Georg N Duda
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany
- Berlin Institute of Health Center for Regenerative Therapies, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Chen A, Paxton L, Zheng X, Peat R, Mao J, Liebeskind A, Gressler LE, Marinac-Dabic D, Devlin V, Cornelison T, Sedrakyan A. Association of Sex With Risk of 2-Year Revision Among Patients Undergoing Total Hip Arthroplasty. JAMA Netw Open 2021; 4:e2110687. [PMID: 34076699 PMCID: PMC8173374 DOI: 10.1001/jamanetworkopen.2021.10687] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
IMPORTANCE The worldwide population is aging and includes more female individuals than male individuals, with higher rates of total hip arthroplasty (THA) among female individuals. Although research on this topic has been limited to date, several studies are currently under way. OBJECTIVES To evaluate the association between sex and 2-year revision after THA. DESIGN, SETTING, AND PARTICIPANTS This cohort study used data from statewide databases in New York and California between October 1, 2015, and December 31, 2018. Patients 18 years or older with osteoarthritis who underwent THA and had sex recorded in the database were included in the analysis. EXPOSURE Total hip arthroplasty. MAIN OUTCOMES AND MEASURES The outcome of interest was the difference in early, all-cause revision surgery rates after primary THA between women and men. The association of sex with the revision rate was examined using Cox proportional hazards regression analysis. RESULTS Of 132 826 patients included in the study, 74 002 (55.7%) were women; the mean (SD) age was 65.9 (11.0) years, and the median follow-up time was 1.3 years (range, 0.0-3.0 years). The 2-year revision rate was 2.5% (95% CI, 2.4%-2.6%) among women and 2.1% (95% CI, 2.0%-2.2%) among men. After adjusting for demographic characteristics, comorbidities, and facility volume, a minimal clinically meaningful difference was observed in revision rates despite women having a higher risk of all-cause revision compared with men (hazard ratio, 1.16; 95% CI, 1.07-1.26; P < .001). The risk of revision was increased among women compared with men in the subgroup of patients who were younger than 55 years (hazard ratio, 1.47; 95% CI, 1.20-1.81; P < .001). CONCLUSIONS AND RELEVANCE In this cohort study, no clinically meaningful difference in all-cause revision rates after primary THA was found between men and women at 2-year follow-up. The modest difference in the risk of revision between men and women in a small subgroup of patients younger than 55 years suggests that the risk of revision in this population should be studied further.
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Affiliation(s)
- Amanda Chen
- Department of Population Health Sciences, Weill Cornell College of Medicine, New York, New York
| | - Liz Paxton
- Kaiser Permanente, San Diego, California
| | - Xinyan Zheng
- Department of Population Health Sciences, Weill Cornell College of Medicine, New York, New York
| | - Raquel Peat
- Office of Orthopedic Devices, Office of Product Evaluation and Quality, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland
| | - Jialin Mao
- Department of Population Health Sciences, Weill Cornell College of Medicine, New York, New York
| | - Alexander Liebeskind
- Department of Population Health Sciences, Weill Cornell College of Medicine, New York, New York
| | - Laura E. Gressler
- Office of Clinical Evidence and Analysis, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland
| | - Danica Marinac-Dabic
- Office of Clinical Evidence and Analysis, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland
| | - Vincent Devlin
- Office of Orthopedic Devices, Office of Product Evaluation and Quality, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland
| | - Terri Cornelison
- Health of Women Program, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland
| | - Art Sedrakyan
- Department of Population Health Sciences, Weill Cornell College of Medicine, New York, New York
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Pietiläinen S, Mäntymäki H, Vahlberg T, Reito A, Eskelinen A, Lankinen P, Mäkelä K. Repeated cobalt and chromium ion measurements in patients with bilateral large-diameter head metal-on-metal ReCap-M2A-Magnum total hip replacement. Acta Orthop 2020; 91:378-382. [PMID: 32285731 PMCID: PMC8023891 DOI: 10.1080/17453674.2020.1751940] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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 - Whole-blood (WB) chromium (Cr) and cobalt (Co) measurements are vital in the follow-up of metal-on-metal total hip replacement (MoM THR) patients. We examined whether there is a substantial change in repeated WB, Co, and Cr levels in patients with bilateral ReCap-M2A-Magnum THR. We also specified the number of patients exceeding the safe upper limit (SUL) of WB Co and Cr in the repeated measurement.Patients and methods - We identified 141 patients with bilateral ReCap-M2A-Magnum THR operated in our institution. 61 patients had repeated WB metal ion measurements with bilateral MoM implants still in situ in the second measurement. The mean time elapsing from the first measurement (initial measurement) to the second (control measurement) was 1.9 years (SD = 0.6, range 0.2-3.5). We used earlier established SUL levels for bilateral implants by Van Der Straeten et al. (2013).Results - The median (range) Co and Cr values decreased in the repeated measurement from 2.7 (0.6-25) to 2.1 (0.5-21) and 2.6 (0.8-14) to 2.1 (0.5-18) respectively. In 13% of the patients Co levels exceeded the SUL in the initial measurement and the proportion remained constant, at 13%, in the repeated measurement. In 5% of the patients, Cr levels were above SUL in the initial measurement and an equal 5% in the control measurement.Interpretation - Repeated WB metal ion levels did not increase in patients with bilateral ReCap-M2A-Magnum THR with a mean 1.9-year measurement interval. Long-term development of WB metal ion levels is still unclear in these patients.
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Affiliation(s)
- Sakari Pietiläinen
- Department of Orthopaedics and Traumatology, Turku University Hospital and University of Turku
| | - Heikki Mäntymäki
- Department of Orthopaedics, Tampere University Hospital and University of Turku
| | | | - Aleksi Reito
- Coxa Hospital for Joint Replacement, Tampere, Finland
| | | | - Petteri Lankinen
- Department of Orthopaedics and Traumatology, Turku University Hospital and University of Turku
| | - Keijo Mäkelä
- Department of Orthopaedics and Traumatology, Turku University Hospital and University of Turku
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Castagnini F, Bordini B, Biondi F, Cosentino M, Stea S, Traina F. Mixed ceramic combinations in primary total hip arthroplasty achieved reassuring mid-to-longterm outcomes. J Mater Sci Mater Med 2020; 31:56. [PMID: 32594253 DOI: 10.1007/s10856-020-06393-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 06/15/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Ceramic-on-ceramic couplings demonstrated to be reliable bearings in primary total hip arthroplasty (THA), with long-term remarkable results. Like-on-like configurations were widely described. On the contrary, mixed material combinations from the same manufacturer, Delta-on-Forte or Forte-on-Delta, were poorly studied. In particular, it is unknown whether mixed ceramic combinations are more at risk of ceramic fractures. Thus, a registry study was conducted to investigate the long-term survival rates and reasons for revision of mixed ceramic combinations. A comparison with Delta-on-Delta couplings was also performed. MATERIALS AND METHODS The regional arthroplasty registry RIPO was enquired about three cohorts of ceramic bearings (head-on-liner: Delta-on-Forte, Forte-on-Delta, Delta-on-Delta). Demographics, survival rates and reasons for revision were evaluated and compared. RESULTS In total, 346 (1.5%) implants had a Delta-on-Forte coupling (mean follow-up: 6.4 years). In total, 1163 (5%) THAs had a Forte-on-Delta articulation (mean follow-up: 8.2 years). Delta-on-Delta surfaces were implanted in 21,874 (93.5%) hips (mean follow-up: 3.9 years). Mixed material combinations were implanted between 2003 and 2007. The survival rates of the three cohorts were similar and were higher than 95% at 10 years. In Forte-on-Delta group, four liners failed (0.3% of the implants), whereas ceramic fractures occurred in 15 cases (0.1%) in Delta-on-Delta couplings (3 heads and 12 liners). Considering ceramic fracture as endpoint, there was no significant difference between the three survival rates. CONCLUSIONS Mixed ceramic bearing configurations from the same manufacturer in primary THA showed mid-to-longterm dependable outcomes, not inferior to the most recent like-on-like ceramic bearings. No additional risks of ceramic fractures were evident. Thus, closer follow-ups are not required.
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Affiliation(s)
- Francesco Castagnini
- Ortopedia-Traumatologia e Chirurgia protesica e dei reimpianti d'anca e di ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, Bologna, 40136, Italy.
| | - Barbara Bordini
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, Bologna, 40136, Italy
| | - Federico Biondi
- Ortopedia-Traumatologia e Chirurgia protesica e dei reimpianti d'anca e di ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, Bologna, 40136, Italy
| | - Monica Cosentino
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, Bologna, 40136, Italy
| | - Susanna Stea
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, Bologna, 40136, Italy
| | - Francesco Traina
- Ortopedia-Traumatologia e Chirurgia protesica e dei reimpianti d'anca e di ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, Bologna, 40136, Italy
- DIBINEM, University of Bologna, Bologna, Italy
- University of Messina, Messina, Italy
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Christensen KS, Wicker DI, Wight CM, Christensen CP. Prevalence of Postoperative Periprosthetic Femur Fractures Between Two Different Femoral Component Designs Used in Direct Anterior Total Hip Arthroplasty. J Arthroplasty 2019; 34:3074-3079. [PMID: 31383495 DOI: 10.1016/j.arth.2019.06.061] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 12/20/2018] [Revised: 06/05/2019] [Accepted: 06/28/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Periprosthetic femur fractures are a well-documented complication following direct anterior uncemented total hip arthroplasty. The purpose of this study is to compare the prevalence of postoperative periprosthetic femur fractures between 2 different femoral component designs used in direct anterior total hip arthroplasty. METHODS Beginning in February 2015, a single fellowship-trained adult reconstruction surgeon performed 361 consecutive direct anterior total hip replacements using a flat, single-taper, wedged femoral implant. In June 2016, that same surgeon, using the exact same surgical technique and postoperative weight-bearing protocol, began using a dual-taper, hydroxyapatite-coated implant for 789 consecutive hips. The patients were carefully monitored for 3 months after surgery to identify the frequency of periprosthetic femur fractures. A Fisher's exact test was used to determine if the prevalence of periprosthetic femur fractures differed between the 2 implant designs. RESULTS Five of 361 (1.4%) patients sustained proximal femur fractures at an average of 19.6 days postoperatively in the first group, all demonstrating a Vancouver type B2 periprosthetic fracture and requiring femoral revision. No patients (0/789, 0%) in the second cohort sustained a postoperative, periprosthetic fracture (P = .006). CONCLUSION In this comparison of 2 consecutive cohorts, the dual-taper, hydroxyapatite-coated implant had a statistically significant lower postoperative periprosthetic fracture rate than a flat, single-taper, wedged design.
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Affiliation(s)
| | - Daniel I Wicker
- Department of Orthopaedics, Bluegrass Orthopaedics, Lexington, KY
| | - Christian M Wight
- Department of Regulatory Affairs, Signature Orthopaedics, Sydney, Australia
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Penfold CM, Blom AW, Sayers A, Wilkinson JM, Hunt L, Judge A, Whitehouse MR. Understanding the uptake of new hip replacement implants in the UK: a cohort study using data from the National Joint Registry for England and Wales. BMJ Open 2019; 9:e029572. [PMID: 31772087 PMCID: PMC6886938 DOI: 10.1136/bmjopen-2019-029572] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Primary: describe uptake of new implant components (femoral stem or acetabular cup/shell) for total hip replacements (THRs) in the National Joint Registry for England and Wales (NJR). Secondary: compare the characteristics of: (a) surgeons and (b) patients who used/received new rather than established components. DESIGN Cohort of 618 393 primary THRs performed for osteoarthritis (±other indications) by 4979 surgeons between 2008 and 2017 in England and Wales from the NJR. We described the uptake of new (first recorded use >2008, used within 5 years) stems/cups, and variation in uptake by surgeons (primary objectives). We explored surgeon-level and patient-level factors associated with use/receipt of new components with logistic regression models (secondary objectives). OUTCOMES Primary outcomes: total number of new cups/stems, proportion of operations using new versus established components. SECONDARY OUTCOMES odds of: (a) a surgeon using a new cup/stem in a calendar-year, (b) a patient receiving a new rather than established cup/stem. RESULTS Sixty-eight new cups and 72 new stems were used in 47 606 primary THRs (7.7%) by 2005 surgeons (40.3%) 2008-2017. Surgeons used a median of one new stem and cup (25%-75%=1-2 both, max=10 cups, max=8 stems). Surgeons performed a median total of 22 THRs (25%-75%=5-124, range=1-3938) in the period 2008-2017. Surgeons used new stems in a median of 5.0% (25%-75%=1.3%-16.1%) and new cups in a median of 9.4% (25%-75%=2.8%-26.7%) of their THRs. Patients aged <55 years old versus those 55-80 had higher odds of receiving a new rather than established stem (OR=1.83, 95% CI=1.73-1.93) and cup (OR=1.31, 95% CI=1.25-1.37). Women had lower odds of receiving a new stem (OR=0.87, 95% CI=0.84-0.90), higher odds of receiving a new cup (OR=1.06, 95% CI=1.03-1.09). CONCLUSIONS Large numbers of new THR components have been introduced in the NJR since 2008. 40% of surgeons have tried new components, with wide variation in how many types and frequency they have been used.
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Affiliation(s)
- Chris M Penfold
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Ashley W Blom
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Adrian Sayers
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - J Mark Wilkinson
- Metabolic Bone Unit, Sorby Wing, Northern General Hospital, Sheffield, UK
- Department of Oncology and Metabolism and The Mellanby Centre for Bone Research, University of Sheffield, Sheffield, UK
| | - Linda Hunt
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Andrew Judge
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Michael R Whitehouse
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
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Shah RR, Cipparrone NE, Parilla FW, Robinson MG, Gordon AC, Goldstein WM. Survivorship of the Modular Femoral Revision Stem. Orthopedics 2019; 42:294-298. [PMID: 31185119 DOI: 10.3928/01477447-20190604-09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 10/25/2018] [Indexed: 02/03/2023]
Abstract
The geriatric population represents a rapidly growing segment of society with prolonged life expectancies and more active lifestyles. Many of these patients have already undergone primary total hip arthroplasty (THA) and are presenting with aseptic loosening, polyethylene wear, osteolysis, or periprosthetic fractures. Therefore, the demand for hip revision procedures is expected to grow. Currently, there are many modular implant options available for use in complicated revision THA. Early results of modular femoral revision systems are promising for the treatment of the deficient femur in complex revision THA. The objective of this study was to evaluate component survivorship of a modular femoral revision system in revision THA. A retrospective review was conducted using electronic health records of patients who underwent revision THA performed by 1 of 3 surgeon investigators from 2010 through 2014. The authors included all patients who underwent a revision THA using a specific modular femoral revision system. The authors evaluated component survivorship and time to re-revision THA. Fifty-one revision THAs were included. Seven patients required a second revision THA (13.7%; 95% confidence interval, 4%-23%). Mean time to re-revision THA was 4.88±3.9 months. Kaplan-Meier survivorship using re-revision for any reason was 86.3% at 60 months. This study showed excellent component survivorship of the specific modular femoral revision system in revision THA. [Orthopedics. 2019; 42(5):294-298.].
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Suraci A, Louati H, Culliton KN, Beaulé PE. Comparing In Vivo Performance of Two Highly Cross-Linked Polyethylene Thermal Treatments: Remelting vs Annealing in Acetabular Liners. J Arthroplasty 2019; 34:1509-1513. [PMID: 30956047 DOI: 10.1016/j.arth.2019.03.025] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/13/2019] [Accepted: 03/07/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The introduction of highly cross-linked polyethylene (HXLPE) acetabular liners has greatly improved the wear performance of metal-on-PE bearing surfaces used in total hip arthroplasty. Changing the sterilization environment and adding thermal treatments, such as remelting or annealing, were introduced to limit on-shelf and in vivo oxidation of cross-linked liners. This study compares the wear properties of the remelted A-CLASS (MicroPort) HXLPE liner to a sequentially annealed HXLPE. METHODS This retrospective study assessed linear and volumetric wear rates using Martell Hip Analysis Suite, and clinical performance through incidences of revision surgeries. A total of 80 remelted and 53 annealed liners were included in the wear analysis. All hips were reviewed for revisions. RESULTS There were no significant differences in steady-state linear or volumetric wear rates for remelted and annealed liners, 0.01 (-0.07 to 0.14) vs -0.01 (-0.11 to 0.1) mm/y (P = .28) and -1.03 (-30.99 to 45.43) vs -1.31 (-32.23 to 23.70) mm3/y (P = .30), respectively. Both cohorts were below the 0.1 mm/y linear wear threshold. The wear rates for patients with femoral head sizes ≥36 mm were not significantly different than those with 32 and 28 mm femoral head sizes (P = .60). Similarly, wear rates for patients with an excessively vertical acetabular component (>50°) were not significantly different than those with standard acetabular component orientations (P = .97). No hips were revised due to liner-related complications. CONCLUSION The wear rates of the A-CLASS remelted HXLPE acetabular liner wear rates were comparable to those of a sequentially annealed HXLPE. Further long-term studies are required to ensure acceptable resistance to fatigue and in vivo oxidation.
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Affiliation(s)
- Alison Suraci
- Division of Orthopaedic Surgery, The Ottawa Hospital, General Campus, Ottawa, Ontario, Canada
| | - Hakim Louati
- Orthopaedic Biomechanics Laboratory, Division of Orthopaedic Surgery, The Ottawa Hospital Research Institute, Civic Campus, Ottawa, Ontario, Canada
| | - Kathryn N Culliton
- Orthopaedic Biomechanics Laboratory, Division of Orthopaedic Surgery, The Ottawa Hospital Research Institute, Civic Campus, Ottawa, Ontario, Canada
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, The Ottawa Hospital, General Campus, Ottawa, Ontario, Canada; Faculty of Medicine, The University of Ottawa, Ottawa, Ontario, Canada
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Park CW, Eun HJ, Oh SH, Kim HJ, Lim SJ, Park YS. Femoral Stem Survivorship in Dorr Type A Femurs After Total Hip Arthroplasty Using a Cementless Tapered Wedge Stem: A Matched Comparative Study With Type B Femurs. J Arthroplasty 2019; 34:527-533. [PMID: 30545654 DOI: 10.1016/j.arth.2018.11.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [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: 09/19/2018] [Revised: 10/16/2018] [Accepted: 11/02/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND There is a lack of understanding on relationship between the femoral geometry and outcomes of total hip arthroplasty (THA). We investigated clinical and radiographic outcomes of THA using a cementless tapered wedge stem in patients with Dorr type A proximal femoral morphology and compared with those of type B femurs at a minimum follow-up of 5 years. METHODS We analyzed 1089 hips (876 patients) that underwent THA using an identical cementless tapered wedge stem. We divided all femurs into 3 types (Dorr type A, B, and C). Type A and B femurs were statistically matched with age, gender, body mass index, and diagnosis by using propensity score matching. Clinical, radiographic results, and stem survivorship were compared between the matched 2 groups. RESULTS A total of 611 femurs (56%) were classified as type A, 427 (39%) as type B, and 51 (5%) as type C. More radiolucent lines around femoral stems were found in type A femurs (7.8%) than in type B femurs (2.5%) (P < .001). Patients with radiolucency showed worse Harris Hip Score (86.2 points) compared with those without radiolucency (93.0 points) (P < .001). The stem survivorship of type A femur (97.8%) was lower than that of type B femur (99.5%) (P = .041). The reasons for femoral revision in type A femurs were periprosthetic fracture (67%), aseptic loosening (22%), and deep infection (11%). CONCLUSIONS This study showed a higher rate of complications after THAs using a cementless tapered wedge stem in Dorr type A femurs than those performed in type B femurs.
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Affiliation(s)
- Chan-Woo Park
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hyeon-Jun Eun
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sung-Hak Oh
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hyun-Jun Kim
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Seung-Jae Lim
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Youn-Soo Park
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Martin A, Vanhegan I, Dean B. Hip hemiarthroplasty for fractured neck of femur; a freedom of information study to assess national variation in implant selection and procurement. Surgeon 2019; 17:346-350. [PMID: 30639336 DOI: 10.1016/j.surge.2018.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 12/09/2018] [Accepted: 12/12/2018] [Indexed: 11/17/2022]
Abstract
INTRODUCTION During 2016, according to the National Hip Fracture Database (NHFD), over 65,000 patients suffered a hip fracture of which approximately half underwent hemiarthroplasty. Clear guidelines exist on the usage of proven cemented implants. The Getting It Right First Time (GIRFT) Report highlighted the financial implications of 'unwarranted variation' and stressed the importance of rationalising and standardising service provision, in particular implant usage. The primary aims of this study were to investigate the variation in hip hemiarthroplasty implant usage and associated costs. We hypothesised there to be large variation in implants used and procurement costs. METHODS Freedom of Information Requests (FOI) were sent to all 177 hospitals listed in the 2017 NHFD Report as treating hip fracture patients. All hospitals were asked for their most commonly used hemiarthroplasty implant and the cost of this, per patient. RESULTS One hundred sixty six (94%) responses were received. Eighty four (51%) provided implant name and cost, 78 (47%) provided implant name but refused costs and 4 (3%) refused to provide any details. Nineteen different prostheses were used nationally with 20 hospitals using a non-ODEP (Orthopaedic Data Evaluation Panel) 10A implant. Average total cost was £725.00 (range £71-£1378). Significant cost variation was demonstrated for the same implants; one implant was £978.19 at it's most costly and £285.59 at it's cheapest. DISCUSSION The aims of this study have been met. We have demonstrated huge variation in the implants used for hip hemiarthroplasty and their costs. Notwithstanding the nuances of departmental procurement processes, the financial implications for this variation are significant. CONCLUSIONS This article demonstrates a requirement for rationalisation of implant usage and procurement in order to potentially improve patient outcomes and provide opportunities for significant cost saving in an already overstretched health service.
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Sodhi N, Khlopas A, Sultan AA, Newman JM, Jaggard C, Mont MA, Kolisek F. Linear Wear Rates of a Highly Cross-Linked Polyethylene Hip Liner. Surg Technol Int 2018; 33:265-270. [PMID: 30276781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION To help limit wear, newer polyethylene liners, such as the highly cross-linked polyethylene (HXLPE) liners, have been developed. These newer liners undergo an alternating irradiation process, resulting in a stronger, longer-lasting liner. The purpose of this study was to analyze the wear rates of patients who underwent THA and received a newer generation HXLPE acetabular insert. Specifically, we compared: 1) linear vector wear amount and 2) linear vector wear rates in patients as an overall cohort and by gender. We also assessed patient satisfaction outcomes comparing preoperative Harris Hip Scores (HHS) to seven-week, one-year, and three-year HHS scores. MATERIALS AND METHODS A total of 23 patients who underwent total hip arthroplasty (THA) with direct superior approach by a fellowship-trained orthopaedic surgeon at a private practice institution were analyzed after receiving institutional review board approval. Patients had a minimum two-year follow up, with the mean follow up being four years (range, three to five years). All patients received a 36-mm ceramic femoral head with an HXLPE liner. 2D radiographic polyethylene wear analysis was performed using the Martell Hip Analysis Suite (HAS; University of Chicago, Illinois), which has been previously validated in the literature. Outcomes were assessed using Harris Hip Scores. RESULTS A five-year linear wear rate of 0.073 mm/year (range, 0 to 0.160 mm/year) and an overall mean linear wear rate of 0.096 mm/year (range, 0 to 0.277 mm/year) were found. No significant differences in wear were seen between genders. Additionally, patients reported significantly better results at seven-weeks (83 points [range, 59 to 100 points]) and one-year (94 points [range, 85 to 100 points]) than preoperative (52 points [range, 34 to 73 points]) HSS scores (p<0.05). No patients underwent revision THA. CONCLUSION The results from this study highlight the benefits of using an HXLPE polyethylene liner in THA patients and further validates previously reported wear rates of HXLPE liners. After an early "wear in" period during the first year, the wear rates steadily decreased over time. This liner showed excellent early outcomes as no patients underwent revision THA. Furthermore, even as early as seven postoperative weeks, patients reported significantly better HHS scores. Future studies should track the same patient cohort over time to help develop a wear-rate prediction model.
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Affiliation(s)
- Nipun Sodhi
- Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell, Health, New York, New York, Department of Orthopaedic Surgery, Cleveland Clinic Cleveland, Ohio
| | - Anton Khlopas
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Assem A Sultan
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Jared M Newman
- Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, New York
| | - Charles Jaggard
- Department of Orthopaedic Surgery, OrthoIndy, Greenwood, Indiana
| | - Michael A Mont
- Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell, Health, New York, New York, Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Frank Kolisek
- Department of Orthopaedic Surgery OrthoIndy, Greenwood, Indiana
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Feng JE, Novikov D, Chen K, Kim K, Bookman J, Anoushiravani AA, Hamula M, Snir N, Schwarzkopf R. Up to 18-Year Follow-Up Wear Analysis of a First-Generation Highly Cross-Linked Polyethylene in Primary Total Hip Arthroplasty. J Arthroplasty 2018; 33:3325-3328. [PMID: 30041989 DOI: 10.1016/j.arth.2018.06.013] [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: 01/30/2018] [Revised: 05/23/2018] [Accepted: 06/07/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The advent of highly cross-linked polyethylene (HCLPE) has significantly improved total hip arthroplasty survivorship. HCLPE has been shown to improve wear properties in midterm outcomes when compared to traditional polyethylene liners; however, there is a paucity of studies evaluating long-term outcomes. In addition, there is concern that wear rates may accelerate as the implant ages. Thus, the aims of this study are to report on the longest-to-date follow-up of a specific first-generation HCLPE liner and to determine whether there is a change in the annual wear rate over time. METHODS Forty hips in 38 patients which were previously reported on in a midterm study were included in this long-term follow-up study. Patients in this cohort all received total hip arthroplasty between March 1999 and August 2004 using the Crossfire HCLPE liner. Annual wear rates (mm/y) were calculated for this cohort. Patients were contacted and asked about complications or revision procedures they may have had since the index procedure. RESULTS Clinical follow-up averaged 12.9 years with a range of 7-18 years. The average follow-up duration was 12.5 years with a range of 10-17 years. Linear wear was found to be 0.056 ± 0.036 mm/y. Osteolysis was not observed in any of the patients with greater than 10-year radiographic follow-up. Furthermore, only 1 patient required revision surgery following a mechanical fall. CONCLUSION Our study demonstrates the long-term wear rates associated with HCLPE liners continue to match rates published in midterm studies. Previously, we have reported that this cohort had an average annual wear rate of 0.05 mm/y over 10 years. This most recent report demonstrates a similar wear rate with up to 18-year follow-up.
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Affiliation(s)
- James E Feng
- Division of Adult Reconstructive Surgery, NYU Langone Orthopedics, NYU Langone Health, New York, NY
| | - David Novikov
- Division of Adult Reconstructive Surgery, NYU Langone Orthopedics, NYU Langone Health, New York, NY
| | - Kevin Chen
- Division of Adult Reconstructive Surgery, NYU Langone Orthopedics, NYU Langone Health, New York, NY
| | - Kelvin Kim
- Division of Adult Reconstructive Surgery, NYU Langone Orthopedics, NYU Langone Health, New York, NY
| | - Jared Bookman
- Division of Adult Reconstructive Surgery, NYU Langone Orthopedics, NYU Langone Health, New York, NY
| | | | - Matthew Hamula
- Division of Adult Reconstructive Surgery, NYU Langone Orthopedics, NYU Langone Health, New York, NY
| | - Nimrod Snir
- Division of Adult Reconstruction, Department of Orthopaedics, Sorasky Medical Center, Tel-Aviv University, Tel Aviv, Israel
| | - Ran Schwarzkopf
- Division of Adult Reconstructive Surgery, NYU Langone Orthopedics, NYU Langone Health, New York, NY
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Abstract
Aims This study aimed to evaluate implant survival of reverse hybrid total hip arthroplasty (THA) at medium-term follow-up. Patients and Methods A consecutive series of 1082 THAs in 982 patients with mean follow-up of 7.9 years (5 to 11.3) is presented. Mean age was 69.2 years (21 to 94). Of these, 194 (17.9%) were in patients under 60 years, 663 (61.3%) in female patients and 348 (32.2%) performed by a trainee. Head size was 28 mm in 953 hips (88.1%) or 32 mm in 129 hips (11.9%). Survival analysis was performed and subgroups compared using log rank tests. Results Ten-year survival (122 hips at risk) was 97.2% (95% confidence interval (CI) 95.77 to 98.11) for all-cause revision. There was no difference in survival by age (p = 0.50), gender (p = 0.78), head size (p = 0.63) or surgeon grade (p = 0.36). No acetabular components underwent revision for aseptic loosening in the entire series. Four (0.4%) aseptic stem failures occurred early at a mean of 2.5 years (0.6 to 4.8) and were associated with age under 60 years (p = 0.015). There was no difference in survival by gender (p = 0.12), head size (p = 0.43) or surgeon grade (p = 0.77) for stem revision. Conclusion This is the largest reported study into reverse hybrid THA and it confirms successful outcomes, irrespective of age, gender, head size and surgeon grade. Cite this article: Bone Joint J 2018;100-B:1010-17.
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Affiliation(s)
- S Jain
- Department of Orthopaedic Surgery, Chapel Allerton Hospital, Leeds, UK
| | - M Magra
- Department of Orthopaedic Surgery, Chapel Allerton Hospital, Leeds, UK
| | - B Dube
- University of Leeds, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital
| | - V T Veysi
- Department of Orthopaedic Surgery, Chapel Allerton Hospital, Leeds, UK
| | - G S Whitwell
- Department of Orthopaedic Surgery, Chapel Allerton Hospital, Leeds, UK
| | - J B Aderinto
- Department of Orthopaedic Surgery, Chapel Allerton Hospital, Leeds, UK
| | - M E Emerton
- Department of Orthopaedic Surgery, Chapel Allerton Hospital, Leeds, UK
| | - M H Stone
- Department of Orthopaedic Surgery, Chapel Allerton Hospital, Leeds, UK
| | - H G Pandit
- University of Leeds, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, Leeds, UK
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Deckard ER, Azzam KA, Meneghini RM. Contemporary Dual Mobility Head Penetration at Five Years: Concern for the Additional Convex Bearing Surface? J Arthroplasty 2018; 33:S280-S284. [PMID: 29602536 DOI: 10.1016/j.arth.2018.02.061] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 12/01/2017] [Revised: 01/28/2018] [Accepted: 02/15/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Dual mobility (DM) bearings are increasingly popular and second-generation designs contain highly cross-linked polyethylene. The purpose of this study is to report head penetration rates in modern DM bearings. METHODS A review of 63 consecutive DM bearings was performed. Radiographs were analyzed for head penetration using Martell methodology at regular postoperative intervals. RESULTS Thirty-four DM bearings were analyzed. Mean linear head penetration was 1.59 mm/y at 1 year, 1.07 mm/y at 2 years, and 0.27 mm/y at 5 years following an exponential regression model (R2 = 0.999). Mean volumetric wear was 783 mm3/y at 1 year, 555 mm3/y at 2 years, and 104 mm3/y at 5 years following an exponential regression model (R2 = 0.986). CONCLUSION Initial head penetration of DM bearings is larger than contemporary cross-linked polyethylene bearings; however, rates approach steady state after 2 years, analogous to traditional bearings. The larger "bedding-in" head penetration may be due to the additional convex bearing surface, creating 2 surfaces for deformation/wear.
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Affiliation(s)
- Evan R Deckard
- Indiana University School of Medicine, Department of Orthopaedic Surgery, Indianapolis, Indiana
| | - Khalid A Azzam
- Indiana University School of Medicine, Department of Orthopaedic Surgery, Indianapolis, Indiana; Indiana University Health Physicians, Orthopedics & Sports Medicine, IU Health Hip & Knee Center, Fishers, Indiana
| | - R Michael Meneghini
- Indiana University School of Medicine, Department of Orthopaedic Surgery, Indianapolis, Indiana; Indiana University Health Physicians, Orthopedics & Sports Medicine, IU Health Hip & Knee Center, Fishers, Indiana
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Abstract
BACKGROUND Large-head metal-on-metal (MoM) bearing hip replacements have been shown to have a much higher rate of revision than other bearing surfaces. However, small-head (≤ 32 mm) MoM bearing surfaces have been in use for many years with several reports of satisfactory mid- to long-term survivorship. It is unclear whether the long-term survival of small-head MoM devices will continue to be satisfactory or whether the same concerns seen with the large-head MoM devices will ultimately become more prevalent. QUESTIONS/PURPOSES We analyzed a large national registry to ask: (1) What is the 15-year Kaplan-Meier survivorship of primary conventional THA using small-head (≤ 32 mm) MoM bearing surfaces compared with large-head MoM bearing surfaces in primary THA? (2) Is there an increased rate of revision for adverse reaction to metal debris (ARMD) in this group of patients over time? METHODS The Australian Orthopaedic Association National Joint Replacement Registry longitudinally maintains data on all primary and revision joint arthroplasties with nearly 100% capture. We analyzed all conventional primary THAs performed from Registry inception in September 1999 until December 31, 2015, in patients with a diagnosis of osteoarthritis and using MoM bearing surfaces ≤ 32 mm in diameter, defined as small-head MoM. The study group included 4838 primary THA with ≤ 32-mm MoM bearing surfaces. There were 2506 (51.8%) male patients and the median age of patients undergoing THA with a small-head MoM bearing surface was 64 years (range, 20-92 years of age). The outcome measure was the cumulative percent revision defined as the time to first revision using Kaplan-Meier estimates of survivorship at 15 years; reasons for revision and type of revision were also examined. We specifically investigated whether there was an increased risk of revision for ARMD in this MoM group compared with all other bearing surfaces. We compared these results with large-head MoM THAs (femoral head size > 32 mm). RESULTS The cumulative percent revision for small-head MoM designs at 15 years was 8.5% (95% confidence interval [CI], 7.3-9.9). The cumulative percent revision for large-head MoM at 14 years was 27.4% (95% CI, 24.8-30.2). Prostheses with a large-head MoM articulation have a higher rate of revision than small-head MoM bearing surfaces (hazard ratio after 6 years, 5.14; 95% CI, 4.1-6.5; p < 0.001). Over time, there was a gradual increase in the diagnosis of ARMD for small-head MoM and the cumulative incidence of revision for ARMD was 0.8% at 15 years. CONCLUSIONS Despite survival that is substantially greater than that of large-head MoM THAs, there has been a marked decrease in the use of small-head MoM designs in our registry. Although the reasons for this are likely multifactorial, the increasing incidence of revisions for ARMD among small-head MoM THAs is concerning. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Richard de Steiger
- R. de Steiger, Department of Surgery, Epworth Healthcare, University of Melbourne, Richmond, Victoria, Australia A. Peng, South Australian Health and Medical Research Institute, Adelaide, Australia P. Lewis, S. Graves, Australian Orthopaedic Association National Joint Replacement Registry, South Australian Health and Medical Research Institute, Adelaide, Australia This work was performed at the Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, South Australia, Australia
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Giardina F, Castagnini F, Stea S, Bordini B, Montalti M, Toni A. Short Stems Versus Conventional Stems in Cementless Total Hip Arthroplasty: A Long-Term Registry Study. J Arthroplasty 2018; 33:1794-1799. [PMID: 29395723 DOI: 10.1016/j.arth.2018.01.005] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [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: 11/08/2017] [Revised: 12/26/2017] [Accepted: 01/05/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Short stems in total hip arthroplasty (THA) have recently gained increasing popularity, allowing mini-invasive exposures and bone-sparing approaches. However, long-term studies and recommendations for the routine use are not available. The aim of this report was to compare the survival rates and the reasons for revision of short stems versus conventional stems in cementless THAs, in a registry-based population. METHODS The Registry of Prosthetic Orthopedic Implants (RIPO) was inquired about cementless THAs performed since 2000 to 2016. The stems were divided into short (<12 cm) and conventional ones, and then, classified according to the classification by Feyen and Shimmin: short stems with neck-retaining osteotomy (group A: 1684 hips), short stems with standard osteotomy (group B: 2727 THAs), and conventional stems (group C: 57,359 cases). Demographics, survivorships, and reasons for revision were investigated and compared. RESULTS Short stems were preferentially implanted in younger patients and normal morphologies. Short and conventional stems showed comparable survival rates at long-term follow-up (>90% at 15 years). The rates of stem aseptic loosening, intraoperative fractures, and periprosthetic fractures were similar in the 3 groups. Group B had higher rates of revisions due to primary instability (early dislocations and impingement-related events; P < .05). Revisions due to pain were nonsignificantly higher in group B. CONCLUSION Short stems are reliable implants at long-term follow-up. The comparison with conventional stems showed no additional risk of premature aseptic loosening and intraoperative and periprosthetic fractures. However, the high rate of revisions due to pain and, mostly, primary instability should be investigated in clinical trials.
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Affiliation(s)
- Federico Giardina
- Hip and Knee Surgery Department, Rizzoli Orthopedic Institute, Bologna, Italy
| | | | - Susanna Stea
- Medical Technology Laboratory, Rizzoli Orthopedic Institute, Bologna, Italy
| | - Barbara Bordini
- Medical Technology Laboratory, Rizzoli Orthopedic Institute, Bologna, Italy
| | - Maurizio Montalti
- Hip and Knee Surgery Department, Rizzoli Orthopedic Institute, Bologna, Italy
| | - Aldo Toni
- Hip and Knee Surgery Department, Rizzoli Orthopedic Institute, Bologna, Italy
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Kim YH, Park JW, Kim JS. Short-Term Results of Ultra-Short Anatomic vs Ultra-Short Non-Anatomic Proximal Loading Uncemented Femoral Stems. J Arthroplasty 2018; 33:149-155. [PMID: 28847665 DOI: 10.1016/j.arth.2017.07.042] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 07/17/2017] [Accepted: 07/26/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Question arises as to whether rigid fixation of ultra-short anatomic or ultra-short non-anatomic proximal loading uncemented femoral stem can be obtained without diaphyseal stem fixation. The purpose of this study is to compare the short-term clinical results, radiographic results, revision and survival rates, and complication rates of ultra-short anatomic versus ultra-short non-anatomic uncemented femoral stems. METHODS This study consisted of 50 patients (56 hips) in the ultra-short anatomic uncemented stem group (mean age 61.4 ± 14.7 years) and 50 patients (56 hips) in the ultra-short non-anatomic uncemented stem group (mean age 59.5 ± 15.2 years). The mean follow-up was 3.4 years (range 3-4) in the ultra-short anatomic stem group and 3.5 years (range 3-4) in the ultra-short non-anatomic stem group. RESULTS At the final follow-up, the mean Harris hip scores (92 vs 93 points), Western Ontario and McMaster Universities Osteoarthritis scores (16 vs 15 points), University of California at Los Angeles activity scores (6.5 vs 6.8 points), the incidence of thigh pain (0% vs 4%), revision rates (0% vs 4%), aseptic loosening rate (0% vs 2%), and complication rates (2% vs 4%) were not significantly different between 2 groups. CONCLUSION Both ultra-short anatomic and ultra-short non-anatomic proximal loading uncemented femoral stems obtained rigid fixation without diaphyseal stem fixation in the short-term follow-up. This finding suggests that an ultra-short anatomic uncemented femoral stem can be replaced with an ultra-short non-anatomic uncemented stem to reduce inventory of the femoral stems, and consequently reduce manufacturing and delivery cost of these femoral stems.
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Affiliation(s)
- Young-Hoo Kim
- The Joint Replacement Center, Ewha Womans University, Seonam Hospital, Seoul, Republic of Korea
| | - Jang-Won Park
- The Joint Replacement Center, Ewha Womans University, Mokdong Hospital, Seoul, Republic of Korea
| | - Jun-Shik Kim
- The Joint Replacement Center, Ewha Womans University, Mokdong Hospital, Seoul, Republic of Korea
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Domb BG, Chandrasekaran S, Gui C, Yuen LC, Lodhia P, Suarez C. Can Stem Version Consistently Correct Native Femoral Version Using Robotic Guidance in Total Hip Arthroplasty? Surg Technol Int 2017; 31:389-395. [PMID: 29310147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The purpose of this study is to investigate whether robotic guidance in total hip arthroplasty (THA) can consistently correct native femoral version. One hundred seventy-five consecutive patients who underwent MAKO® (Stryker, Kalamazoo, Michigan) robotic-guidance THA were included in the study. The study population had a mean age of 57.9 years and a mean body mass index (BMI) of 30.41. Forty-eight percent of the population was male and 74% of the procedures were performed through an anterior approach. Robotic guidance in THA was effective in correcting native femoral version toward a target of 15°. This can be achieved using both the anterior and posterior approach; it is not affected by BMI.
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Affiliation(s)
- Benjamin G Domb
- Hinsdale Orthopaedics, American Hip Institute, Westmont, Illinois
| | | | - Chengcheng Gui
- Hinsdale Orthopaedics, American Hip Institute, Westmont, Illinois
| | - Leslie C Yuen
- Hinsdale Orthopaedics, American Hip Institute, Westmont, Illinois
| | - Parth Lodhia
- Hinsdale Orthopaedics, American Hip Institute, Westmont, Illinois
| | - Carlos Suarez
- Hinsdale Orthopaedics, American Hip Institute, Westmont, Illinois
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20
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Manocchio AG, Berend KR, Morris MJ, Adams JB, Lombardi AV. Early Experience with a Tapered Titanium Porous Plasma Sprayed Stem with Updated Design. Surg Technol Int 2017; 31:231-235. [PMID: 29313319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION The Taperloc® Complete femoral stem (Zimmer Biomet, Warsaw, Indiana) builds on the widespread clinical success of the original Taperloc design used since 1982. Enhancements to the Complete design include a lowered caput-collum-diaphyseal (CCD) angle from 138° to 133° for improved offset, optimized neck taper with polished neck flats to increase range of motion, reduced distal geometry to improve proximal canal fill, and gradual off-loading that is the goal of tapered geometry. A retrospective review was conducted to assess our early experience with the updated design. MATERIALS AND METHODS A query of our practice's arthroplasty registry revealed 97 consented patients (103 hips) who underwent primary cementless THA performed with a Taperloc® Complete femoral component between November 2010 and March 2011. A high offset option, accomplished by a constant 7.8mm medial shift of the trunnion, was utilized in 94 hips (91%). Mean age was 61.8 years and body mass index (BMI) was 31.3 kg/m2. Underlying diagnoses were osteoarthritis in 96 (93%), four avascular necrosis, two post-traumatic arthritis, and one acute fracture. RESULTS Mean follow-up was 5.3 years (2-7). Harris hip scores improved from 53.6 preoperatively to 87.9 at most recent. One stem was revised for periprosthetic fracture. Other reoperations were one cup revised for iliopsoas impingement, one lateral femoral cutaneous neurectomy, and one incision and debridement for a non-healing wound. Postoperative radiographs revealed satisfactory position and alignment of components with no radiolucencies observed in all patients with no evidence of osteolysis, distal hypertrophy, or pedestal formation. CONCLUSION In this group, good results with a low frequency of complications and stem revision were achieved with a tapered titanium porous plasma-sprayed femoral component with updated design features. No aseptic loosening or osteolysis occurred. Radiographic findings were excellent in all hips.
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Affiliation(s)
- Antonio G Manocchio
- Joint Implant Surgeons, Inc., New Albany, Ohio, Orthopedic Surgeons of Southwest Ohio, Dayton, Ohio
| | - Keith R Berend
- Joint Implant Surgeons, Inc., New Albany, Ohio, White Fence Surgical Suites, New Albany, Ohio, Mount Carmel Health System, Columbus, Ohio
| | - Michael J Morris
- Joint Implant Surgeons, Inc., New Albany, Ohio, Mount Carmel Health System, Columbus, Ohio
| | | | - Adolph V Lombardi
- Joint Implant Surgeons, Inc., New Albany, Ohio, Department of Orthopaedics, The Ohio State University, Wexner Medical Center, Columbus, Ohio, Mount Carmel Health System, Columbus, Ohio
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Harwin SF, Mistry JB, Chughtai M, Khlopas A, Gwam C, Newman JM, Higuera CA, Bonutti PM, Malkani AL, Kolisek FR, Delanois RE, Mont MA. Dual Mobility Acetabular Cups in Primary Total Hip Arthroplasty in Patients at High Risk for Dislocation. Surg Technol Int 2017; 30:251-258. [PMID: 28395391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Postoperative dislocation occurs in approximately 2% of primary total hip arthroplasties (THAs). Risk factors associated with dislocation include: age of 70 years or older, body mass index (BMI) of 30 kg/m2 or greater, alcohol abuse, and neuro-degenerative diseases such as multiple sclerosis or Parkinson's disease. As a result, dual-mobility articulations, which have been typically used for revision procedures, have become an increasingly popular option for these "at risk" primary THAs. Few studies have assessed their use in this complex patient population. Therefore, the purpose of this study was to assess: 1) survivorship; 2) radiographic outcomes (cup migration, progressive radiolucencies, and changes in component position); 3) Harris Hip Scores; and 4) complications of the dual-mobility articulation in the setting of primary THA for patients at high risk for dislocation. MATERIALS AND METHODS Five participating surgeons performed 495 primary cementless THAs between January 2011 and December 2013. During this time, four of the five surgeons used dual-mobility articulations whenever the acetabular cup size was 52 mm or greater to allow for a 28 mm head, while one surgeon used it when the cup size was less than 52 mm to allow for an effective head size of 38 mm. The remaining surgeon used it for all THAs. Of the 495 patients, 453 (92%) received dual-mobility articulations, of which, 43 patients (10%) were lost to follow-up before the two year minimum. The remaining 410 patients were further assessed to determine those who were considered high risk for dislocation (age = 70 years, BMI =30 kg/m2, had a diagnosis of alcohol abuse, or had a neuro-degenerative disorder). Two hundred forty-nine patients were included in the analysis (103 men, 146 women) who had a mean age of 66 years (range, 24 to 90 years). The mean follow-up was 3.3 years (range, 2 to 5 years). Kaplan-Meier analysis was performed to assess aseptic and all-cause acetabular cup survivorship. Radiographs were evaluated for cup migration, progressive radiolucencies, and any changes in component position. Clinical outcomes were assessed using the Harris Hip Score (HHS), and any surgery-related complications were recorded. RESULTS The survivorship to aseptic failure (n= 1) and all-cause (aseptic, n= 1; septic, n= 1) Kaplan-Meier acetabular component survivorships were 99.6% (95% confidence interval [CI], 99.1% to 99.9%) and 99.2% (95% CI, 98.5% to 99.9%), respectively. One hip had impingement of an anteverted cup, resulting in trunnion notching, and required revision of the cup and stem. Another hip had a deep infection, which was treated with a two-stage revision procedure. There were no dislocations in this cohort. No progressive radiolucencies or component positional changes were seen on radiographic assessment. Patients reported a mean HHS of 92.5 (range, 47 to 100 points) at final follow-up. Surgical complications included one polyethylene liner that was incompletely seated, and one loose femoral stem, which required revision of only the femoral component. CONCLUSIONS At short-term follow-up, dual-mobility articulations in primary THA offer survivorship, outcomes, and complications comparable to conventional THA designs in patients who are at increased risk for postoperative dislocation. Serious complications, such as polyethylene wear and intraprosthetic dislocations, have occasionally been reported with the use of these components. Therefore, future studies should be prospective, multi-center, and have longer-term follow-up to determine the true benefit of modular dual-mobility articulations in patients who are at high risk for dislocation.
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Affiliation(s)
- Steven F Harwin
- Center for Reconstructive Joint Surgery, Mount Sinai Beth Israel Medical Center, New York, New York
| | - Jaydev B Mistry
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Morad Chughtai
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Anton Khlopas
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Chukwuweike Gwam
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Jared M Newman
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Carlos A Higuera
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | | | - Arthur L Malkani
- Orthopaedic Surgery Department, University of Louisville, Louisville, Kentucky
| | | | - Ronald E Delanois
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Michael A Mont
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
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Parchi PD, Ciapini G, Castellini I, Mannucci C, Nucci AM, Piolanti N, Maffei S, Lisanti M. Evaluation of the Effects of the Metha® Short Stem on Periprosthetic Bone Remodelling in Total Hip Arthroplasties: Results at 48 Months. Surg Technol Int 2017; 30:346-351. [PMID: 28277592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Total hip arthroplasty is one of the most performed procedures in orthopaedic surgery. Implantation of a prosthesis determines changes in the distribution of loads on the host bone, and this phenomenon, known as stress shielding, is related to the biomechanical characteristics of the implant. Usually stress shielding involves the proximal portion of the femur by reducing the mechanical strength and ability to withstand the transmitted loads. The aim of our study is to demonstrate how the use of a short hip stem reduces the stress shielding phenomenon to the proximal femur. MATERIALS AND METHODS The study analyzed 20 patients undergoing hip prosthesis surgery with a short stem (Metha<, B. Braun Medical, Inc., Bethlehem, Pennsylvania) at the Ist Orthopaedic Division of Pisa University (between December 2008 and January 2010). Each patient was subjected to analysis of periprosthetic bone mineral density by a bone densitometry (dual emission X-ray absorptiometry [DEXA] with the metal removal software) at 0, 6, 12, 18, 24, and 36 months, following a protocol based on the evaluation of the changes of bone density in the seven Gruen zones. RESULTS We recorded minimal changes in bone mineral density (BMD) at the level of the greater trochanter (-1.44%) and at the level of the calcar (-3.7%). BMD increased significantly after four years at the level of the lateral distal regions (R2 +9.6% - R3 + 12.4%) and at the level of the distal medial regions (R5 + 8.2% - R6 + 13.1%). We compared the results obtained with the literature data at 12 and 24 months with the same stem (Metha<). At 12 months follow up, we did not see a significant difference between our data and the data published in the literature. However, after 48 months of follow-up, we recorded significant differences in the curves of periprosthetic bone reabsorption at the level of the greater trochanter (Zone 1) and at the level of the calcar (Zone 7). DISCUSSION The data obtained from our study are in agreement with other studies in the literature, which demonstrates how the use of short stems preserves the metaphyseal bone stock at the level of the proximal femur, reducing the stress shielding phenomenon. From our data, obtained at 24 months and confirmed at 36, stress shielding seems to minimally occur at the level of the calcar. At the level of the great trochanter, we saw a good load distribution that maintained the baseline BMD; these data are in opposition to the literature data that showed a high increase of BMD at the level of the calcar (+12.9%) and a decrease at the level of the great trochanter. From the analysis of the radiographic images of our cases, and of the cases published with the same stem, these differences in load transfer encountered between the great trochanter and the calcar seems to be related to the level of the femoral neck osteotomy and the consequent stem position (varus/valgus). CONCLUSION We conclude that the amount of periprostetic bone reabsorption around the Metha< stem seems to be strictly related to the surgical technique and the final implant position.
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Affiliation(s)
- Paolo D Parchi
- 1st Orthopedic Division, Department of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Gianluca Ciapini
- 1st Orthopedic Division, Department of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Iacopo Castellini
- 1st Orthopedic Division, Department of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Claudia Mannucci
- 1st Orthopedic Division, Department of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Anna Maria Nucci
- 1st Orthopedic Division, Department of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Nicola Piolanti
- 1st Orthopedic Division, Department of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Silvia Maffei
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Michele Lisanti
- 1st Orthopedic Division, Department of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy
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23
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Marshall DJ, Berend KR, Morris MJ, Adams JB, Lombardi AV. Results of a Modular Femoral Revision System Before and After Taper Roller Hardening in Total Hip Arthroplasty. Surg Technol Int 2017; 30:336-340. [PMID: 28395388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Modular component options can aid in addressing complex femoral reconstructions in total hip arthroplasty (THA) by allowing for customization of version control and proximal to distal sizing. However, component breakage at the modular junction has occurred, particularly in the presence of poor bone stock. A taper roller hardening (RH) process was developed to strengthen the modular junction to reduce breakage. The purpose of this study is to review THA patients before and after taper roller hardening to compare stem survival and frequency of breakage. MATERIALS AND METHODS A query of our practice registry revealed 183 consented patients (202 THA) who underwent THA with a modular femoral revision component between January 1993 and September 2010. Forty THA were done before (non-RH) and 162 were done after taper roller hardening. RESULTS Mean follow-up was seven and 17 years in the RH and non-RH groups respectively. In the non-RH group, 15% were revised for component breakage versus 2% in the RH group. Overall, 35% non-RH versus 8% RH stems have been revised. Kaplan-Meier survival at 10 years with endpoint of stem revision for breakage revealed 84.2% ( ±6.0%) non-RH compared with 95.5% ( ±2.2%) RH (p=0.0033), and with endpoint of stem revision for any reason, 65.0% ( ±7.5%) non-RH compared with 80.3% ( ±3.7%) RH (p=0.0022). CONCLUSIONS Results indicate that the taper roller hardening process was successful in improving durability of a modular femoral revision system and reducing frequency of component breakage for patients who require treatment of the deficient femur in complex primary and revision THA.
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Affiliation(s)
| | - Keith R Berend
- Joint Implant Surgeons, Inc., New Albany, Ohio, Chief Executive Officer and President, White Fence Surgical Suites, White Fence Surgical Suites, New Albany, Ohio, Mount Carmel Health System, Columbus, Ohio
| | - Michael J Morris
- Joint Implant Surgeons, Inc., New Albany, Ohio, Mount Carmel Health System, Columbus, Ohio
| | | | - Adolph V Lombardi
- Joint Implant Surgeons, Inc., New Albany, Ohio, Department of Orthopaedics, The Ohio State University, Wexner Medical Center, Columbus, Ohio, Mount Carmel Health System, Columbus, Ohio
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Tauriainen TJT, Niinimäki TT, Niinimäki JL, Nousiainen TOP, Leppilahti JI. Poor Acetabular Component Orientation Increases Revision Risk in Metal-on-Metal Hip Arthroplasty. J Arthroplasty 2017; 32:2204-2207. [PMID: 28291650 DOI: 10.1016/j.arth.2017.02.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 09/11/2016] [Revised: 01/28/2017] [Accepted: 02/05/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The rate of and the reasons for the failure of metal-on-metal (MoM) bearings have recently been discussed in literature. The aim of this study was to evaluate the influence of acetabular cup inclination and version angles on revision risk in patients with MoM hip arthroplasty. METHODS We retrospectively reviewed 825 patients (976 hips) who underwent a MoM hip arthroplasty between 2000 and 2013. There were 474 men and 351 women, with a mean age of 58 (19-86) years. Acceptable cup orientation was considered to be inside the Lewinnek's safe zone. RESULTS The mean acetabular inclination angle was 48.9° (standard deviation, 8.1°; range, 16°-76°) and version angle 20.6° (standard deviation, 9.9°; range, -25 to 46°). The cup was found to be outside the Lewinnek's safe zone in 571 hips (58.5%). Acetabular cup revision surgery was performed in 157 hips (16.1%). The cup angles were outside Lewinnek's safe zone in 69.2% of the revised hips. The mean interobserver reliability and intraobserver repeatability of the measurements of cup inclination and version angles were excellent (intraclass correlation coefficients >0.90). The odds ratio for revision in hips outside vs inside the Lewinnek's safe zone was 1.82 (95% confidence interval, 1.26-2.62; P = .0014). CONCLUSION Our findings provide compelling evidence that a cup position outside the Lewinnek's safe zone is associated with increased revision risk in patients with MoM arthroplasty.
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Affiliation(s)
- Tuomas J T Tauriainen
- Division of Orthopaedic and Trauma Surgery, Department of Surgery, Oulu University Hospital, Medical Research Center, University of Oulu, Oulu, Finland
| | - Tuukka T Niinimäki
- Division of Orthopaedic and Trauma Surgery, Department of Surgery, Oulu University Hospital, Medical Research Center, University of Oulu, Oulu, Finland
| | - Jaakko L Niinimäki
- Department of Diagnostic Radiology, Institute of Diagnostics, Oulu University Hospital, Medical Research Center, University of Oulu, Oulu, Finland
| | - Tomi O P Nousiainen
- Division of Orthopaedic and Trauma Surgery, Department of Surgery, Oulu University Hospital, Medical Research Center, University of Oulu, Oulu, Finland
| | - Juhana I Leppilahti
- Division of Orthopaedic and Trauma Surgery, Department of Surgery, Oulu University Hospital, Medical Research Center, University of Oulu, Oulu, Finland
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25
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Schilcher J, Ivarsson I, Perlbach R, Palm L. No Difference in Periprosthetic Bone Loss and Fixation Between a Standard-Length Stem and a Shorter Version in Cementless Total Hip Arthroplasty. A Randomized Controlled Trial. J Arthroplasty 2017; 32:1220-1226. [PMID: 27993496 DOI: 10.1016/j.arth.2016.11.015] [Citation(s) in RCA: 28] [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: 06/27/2016] [Revised: 10/27/2016] [Accepted: 11/09/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Cementless femoral stems in total hip arthroplasty provide dependable clinical and radiographic results in the treatment of osteoarthritis. Stem length might affect the preservation of proximal bone stock and stability. We hypothesized that a shorter stem decreases proximal bone loss without affecting implant stability. METHODS We randomly assigned 60 patients aged between 50 and 70 years to either a standard cementless femoral stem or a 35-mm shorter version. Patients were followed with dual-energy X-ray absorptiometry, radiostereometric analysis, Harris hip score, Western Ontario and McMaster Universities Osteoarthritis Index score, and clinical follow-up at 3, 6, 12, and 24 months. The trial is registered on ClinicalTrials.gov/. RESULTS After 24 months, short stems had on average 3.8% (95% confidence interval, 1.2%-8.9%) more bone loss in zone 1 compared to standard stems (P = .14). In zone 7, the bone loss was on average 6.5% (95% confidence interval, 6.6%-19.7%) higher compared to standard stems (P = .33). After 24 months, standard stems had migrated 0.93 mm (range, 0.25-4.66 mm) and short stems 0.93 mm (range, 0.17-2.96 mm; Student t-test after log transformation, P = .3). Patient-reported outcome measures were similar in both groups. One patient in the standard stem group was diagnosed with infection, one with a posterior dislocation, and one with a deep venous thrombosis. No stems were revised. CONCLUSION There were no statistically significant differences in periprosthetic bone loss or fixation between the stems at 24 months.
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Affiliation(s)
- Jörg Schilcher
- Department of Experimental and Clinical Medicine and the Department of Orthopedics, Faculty of Health Science, Linköping University, Linköping, Sweden
| | - Ingemar Ivarsson
- Department of Experimental and Clinical Medicine and the Department of Orthopedics, Faculty of Health Science, Linköping University, Linköping, Sweden
| | - Rico Perlbach
- Department of Experimental and Clinical Medicine and the Department of Orthopedics, Faculty of Health Science, Linköping University, Linköping, Sweden
| | - Lars Palm
- Department of Experimental and Clinical Medicine and the Department of Orthopedics, Faculty of Health Science, Linköping University, Linköping, Sweden
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26
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Frew N, Johnson G. Survival of the Birmingham hip resurfacing in young men up to 13 years post-operatively. Acta Orthop Belg 2017; 83:67-73. [PMID: 29322897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The aim of this study was to determine the medium to long term survivorship of the Birmingham Hip Resurfacing prosthesis in an independent series of young men. The medical records and radiographs of all men aged 55 and under who had undergone Birmingham hip resurfacing by the senior author were reviewed. Patients who had not attended recent follow-up or had been previously discharged were contacted by telephone. Between 1999 and 2011 a total of 147 hips were resurfaced in 155 patients (mean age 47 years (19 to 55)) with minimum 5 year follow-up (mean 8.2, range 5 to 13.9 years). Eleven hips were revised giving overall cumulative survival of 88.8% at 13 years. In conclusion, this independent, single surgeon series demonstrates acceptable survival of the Birmingham Hip resurfacing in young men. It remains a valid option in certain cases but we believe alternative bearings are more suitable for most patients.
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27
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Varnum C. Outcomes of different bearings in total hip arthroplasty - implant survival, revision causes, and patient-reported outcome. Dan Med J 2017; 64:B5350. [PMID: 28260601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Total hip arthroplasty (THA) is a common and successful treatment of patients suffering from severe osteoarthritis that significantly reduces pain and improves hip function and quality of life. Traditionally, the outcome of THA has been evaluated by orthopaedic surgeons and assessed in morbidity and mortality rates, and implant survival. As patients and surgeons may assess outcome after THA differently, patient-reported outcomes (PROMs) have gained much more interest and are today recognized as very important tools for evaluating the outcome and satisfaction after THA. One of the prognostic factors for the outcome of THA is the type of bearings. This PhD thesis focuses on the influence of different types of bearings on implant survival, revision causes, PROMs, and noises from THA. The aims of the thesis were: Study I: To examine the revision risk and to investigate the causes of revision of cementless ceramic-on-ceramic (CoC) THAs comparing them to those of "standard" metal-on-polyethylene (MoP) THAs. Study II: To compare the six-year revision risk for metal-on-metal (MoM) with that for MoP bearings in cementless stemmed THA, and further to study the revision risk for different designs of stemmed MoM THAs and the causes of revision. Study III: To examine the association between CoC, MoM, and MoP bearings and both generic and disease-specific PROMs, and furthermore to examine the incidence and types of noises from the three types of bearings and identify the effect of noises on PROM scores. In study I and III, we used data from the Danish Hip Arthroplasty Registry combined with data from the Civil Registration System and the Danish National Patient Registry. In study II, data from the Nordic Arthroplasty Register Association, containing data from hip arthroplasty registries in Denmark, Norway, Sweden, and Finland, was used. In study I, 11,096 patients operated from 2002 through 2009 with cementless THA were included. Of these, 16% had CoC THA and 84% had MoP THA. At 8.7-year follow-up, no difference in RR of revision for any cause was found for CoC compared to MoP THA. One cause of revision related only to CoC THA is ceramic fracture. Medical records were reviewed for patients who had revision surgery due to component failure, and six patients (0,34%) had been revised due to ceramic fracture. No other difference in prevalence of causes of revision was found when comparing CoC to MoP THA. Study II included 32,678 patients who were operated from 2002 through 2010 with cementless stemmed THA with either MoM bearings (11,567 patients, 35%) or MoP bearings (21,111 patients, 65%). At six-year follow-up, the RR of revision for any cause was significantly higher for MoM compared to MoP THA. When comparing different combinations of cup/stem with MoM to MoP bearings, there was an increased RR of revision for any cause for the ASR/Summit, ASR/Corail, and "other" combinations. There was a higher prevalence of revision due to aseptic loosening for MoM compared to MoP THA. In contrast, the prevalence of revision due to dislocation was lower for MoM THA. In study III, a set of questionnaires including HOOS, EQ-5D, UCLA activity score, and a questionnaire about noises from the THA was sendt to patients having THA with CoC, MoM, or MoP bearings. The response rate was 85% and among the 3,089 patients responding, 45% received CoC, 17% MoM, and 38% MoP THA. No differences in mean subscale scores were found for CoC and MoM compared to MoP THA, except for CoC THA that had a lower mean HOOS symptoms score than MoP THA. 27% of patients with CoC, 29% of patients with MoM, and 12% of patients with MoP bearings had experienced noises from the THA. For the three types of bearings, PROM scores from patients with noisy THA were significantly lower when compared to silent MoP THA, except for noisy CoC and MoM THA that had the same mean UCLA activity score as silent MoP THA.
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28
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Grant TW, Lovro LR, Licini DJ, Warth LC, Ziemba-Davis M, Meneghini RM. Cementless Tapered Wedge Femoral Stems Decrease Subsidence in Obese Patients Compared to Traditional Fit-and-Fill Stems. J Arthroplasty 2017; 32:891-897. [PMID: 27793497 DOI: 10.1016/j.arth.2016.09.023] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 08/01/2016] [Accepted: 09/08/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Femoral component stability and resistance to subsidence is critical for osseointegration and clinical success in cementless total hip arthroplasty. The purpose of this study was to radiographically evaluate the anatomic fit and subsidence of 2 different proximally tapered, porous-coated modern cementless femoral component designs. METHODS A retrospective cohort study of 126 consecutive cementless total hip arthroplasties was performed. Traditional fit-and-fill stems were implanted in the first 61 hips with the remaining 65 receiving morphometric tapered wedge stems. Preoperative bone morphology was radiographically assessed by the canal flare index. Canal fill in the coronal plane, subsidence, and the sagittal alignment of stems was measured digitally on immediate and 1-month postoperative radiographs. RESULTS Demographics and canal flare indices were similar between groups. The percentage of femoral canal fill was greater in the tapered wedge compared to the fit-and-fill stem (P = .001). There was significantly less subsidence in the tapered wedge design (0.3 mm) compared to the fit-and-fill design (1.1 mm) (P = .001). Subsidence significantly increased as body mass index (BMI) increased in the fit-and-fill stems, a finding not observed in the tapered wedge design (P = .013). CONCLUSION An anatomically designed morphometric tapered wedge femoral stem demonstrated greater axial stability and decreased subsidence with increasing BMI than a traditional fit-and-fill stem. The resistance to subsidence, irrespective of BMI, is likely due to the inherent axial stability of a tapered wedge design and may be the optimal stem design for obese patients.
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Affiliation(s)
- Tanner W Grant
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Luke R Lovro
- IU Health Saxony Hospital, Orthopedics, Indiana University Health Physicians Orthopedics and Sports Medicine, Fishers, Indiana
| | - David J Licini
- IU Health Bloomington Hospital, Orthopedics, Indiana University Health Southern Indiana Physicians, Bloomington, Indiana
| | - Lucian C Warth
- IU Health Saxony Hospital, Orthopedics, Indiana University Health Physicians Orthopedics and Sports Medicine, Fishers, Indiana
| | - Mary Ziemba-Davis
- IU Health Saxony Hospital, Orthopedics, Indiana University Health Physicians Orthopedics and Sports Medicine, Fishers, Indiana
| | - Robert M Meneghini
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana; IU Health Saxony Hospital, Orthopedics, Indiana University Health Physicians Orthopedics and Sports Medicine, Fishers, Indiana
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29
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Schnurr C, Schellen B, Dargel J, Beckmann J, Eysel P, Steffen R. Low Short-Stem Revision Rates: 1-11 Year Results From 1888 Total Hip Arthroplasties. J Arthroplasty 2017; 32:487-493. [PMID: 27639304 DOI: 10.1016/j.arth.2016.08.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [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: 04/18/2016] [Revised: 07/11/2016] [Accepted: 08/08/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND In total hip arthroplasty, short stems were developed as a bone-conserving alternative to traditional cementless stems. So far, there have been very few recorded medium to long-term results of these comparatively new implants. The aim of our retrospective study was to report on the survival of calcar-loading short stems. METHODS All Metha stem implantations from 2004 to 2014 were recorded from the operation protocols (n = 1888). Due to the chronological development of the stem, 3 different versions were implanted: modular titanium stems with neck adapters from titanium or cobalt-chrome and monoblock stems. Patients were questioned by post about revision, dislocation, and satisfaction. RESULTS Data were complete for 93% of the procedures (1090 monoblock stems, 314 modular stems with titanium neck, and 230 modular stems with cobalt chrome neck). Mean follow-up was 6 years (1-11 years). Fifteen modular titanium implants were affected by cone fractures (4%). Therefore, monoblock, modular cobalt chrome, and modular titanium implants were analyzed separately. The 7-year revision rate for monoblock stems was 1.5%; for modular cobalt-chrome stems it was 1.8%, and for modular titanium stems it was 5.3%. CONCLUSION Our data show the midterm survival of the monoblock and modular cobalt-chrome implants equivalent to the traditional cementless stems. These might, therefore, be considered as a bone-conserving alternative for young and active patients.
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Affiliation(s)
- Christoph Schnurr
- Clinic of Orthopedic Surgery, St. Vinzenz Hospital Düsseldorf, Düsseldorf, Germany
| | - Bernd Schellen
- Clinic of Orthopedic Surgery, St. Vinzenz Hospital Düsseldorf, Düsseldorf, Germany
| | - Jens Dargel
- Clinic for Orthopedic Surgery and Traumatology, University of Cologne, Cologne, Germany
| | - Johannes Beckmann
- Department for Endoprosthetics Lower extremity, Sportklinik Stuttgart, Stuttgart, Germany
| | - Peer Eysel
- Clinic for Orthopedic Surgery and Traumatology, University of Cologne, Cologne, Germany
| | - Reinhard Steffen
- Clinic of Orthopedic Surgery, Marienkrankenhaus Kaiserswerth, Düsseldorf, Germany
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30
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Berend KR, Adams JB, Morris MJ, Lombardi AV. Three-Year Results with a Ringless Third-Generation Porous Plasma Sprayed Acetabular Component in Primary Total Hip Arthroplasty. Surg Technol Int 2017; 30:295-299. [PMID: 28072898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION We previously reported promising early results in patients undergoing primary total hip arthroplasty (THA) with a third-generation cementless acetabular system that has a porous plasma-sprayed coating on a titanium alloy substrate shell, a ringless barb and groove locking mechanism, and a vitamin E-infused highly crosslinked polyethylene insert. The purpose of this study was to examine the outcomes and need for revision in a subset of patients previously reviewed who now have potential for three-year follow-up. PATIENTS AND METHODS A query of our practice registry revealed 235 consented patients (241 hips) who underwent cementless primary THA performed by three surgeons with the G7® Acetabular System (Zimmer Biomet, Warsaw, Indiana) between April 2013 and September 2013. All liners were vitamin E-infused highly crosslinked polyethylene with a neutral face. Mean patient age was 65.8 years and mean BMI was 31.3 kg/m2. Heads used were 179 Biolox® delta (74%; CeramTec AG, Plochingen, Germany) and 62 cobalt-chromium (26%), with diameters of 32mm in 105 (41%) and 36mm in 136 (56%). RESULTS A minimum three-year follow-up was available for 152 hips in 146 patients. Harris Hip Scores improved from 47.8 to 88.2, and UCLA activity scale from 3.9 to 5.4. One patient from this study period required cup revision secondary to failure of biological fixation at 15.1 months postoperative. There have been no dislocations or other revisions of the acetabular component. Kaplan-Meier survival with endpoint of acetabular revision was 99.5% (95% CI: 99.0% to 100%) at 3.4 years. Radiographic findings in all cases were satisfactory position and alignment with no radiolucencies observed. CONCLUSION In this study, with minimum three-year follow-up, good results with 99.5% survival were achieved using a third-generation cementless acetabular system with a ringless barb and groove locking mechanism.
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Affiliation(s)
- Keith R Berend
- Joint Implant Surgeons, Inc., New Albany, Ohio, White Fence Surgical Suites, New Albany, Ohio, Mount Carmel Health System, Columbus, Ohio
| | | | - Michael J Morris
- Joint Implant Surgeons, Inc., New Albany, Ohio, Mount Carmel Health System, Columbus, Ohio
| | - Adolph V Lombardi
- Joint Implant Surgeons, Inc., New Albany, Ohio, Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, Mount Carmel Health System, Columbus, Ohio
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Cadossi M, Garcia FL, Sambri A, Andreoli I, Dallari D, Pignatti G. A 2- to 7-Year Follow-Up of a Modular Iliac Screw Cup in Major Acetabular Defects: Clinical, Radiographic and Survivorship Analysis With Comparison to the Literature. J Arthroplasty 2017; 32:207-213. [PMID: 27449716 DOI: 10.1016/j.arth.2016.06.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 03/08/2016] [Revised: 05/10/2016] [Accepted: 06/11/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Inadequate acetabular bone stock is a major issue in total hip arthroplasty, and several treatment options are available. Stemmed cups have been used in this scenario with variable results. A novel modular polyaxial uncemented iliac screw cup (HERM-BS-Sansone cup-Citieffe s.r.l., Calderara di Reno, Bologna, Italy) has been recently introduced to overcome the drawbacks of stemmed cups. In this retrospective study, we report the results of this cup in patients with large acetabular bone defects at 2- to 7-year follow-up. METHODS We evaluated a consecutive series of 121 hips (118 revisions and 3 complex primary arthroplasties) treated with this novel cup at a mean follow-up of 46 months. Kaplan-Meier survival analysis was performed with implant revision for any reason as a primary end point. Further survival analysis was performed excluding septic failures. Clinical outcome was assessed with the Harris Hip Score. RESULTS There had been 7 reoperations: 1 for aseptic loosening, 5 for deep infection, and 1 for recurrent dislocation. In 5 cases, the cup was removed; estimated survival rate at 5-year follow-up with implant removal for any reason was 95.6% (95% confidence interval = 91-99), and 98.3% (95% CI = 96-100) excluding those failed for infection. Mean Harris Hip Score at latest follow-up was 77 points (range, 44-95; standard deviation = 11.9). CONCLUSION The present findings show the short-term efficacy of the iliac screw cup with respect to implant survival. A longer follow-up and a larger number of patients are necessary to confirm the encouraging preliminary results.
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Affiliation(s)
| | - Flávio Luís Garcia
- Ribeirão Preto Medical School (University of São Paulo), Ribeirão Preto, São Paulo, Brazil
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Grosso MJ, Danoff JR, Murtaugh TS, Trofa DP, Sawires AN, Macaulay WB. Hemiarthroplasty for Displaced Femoral Neck Fractures in the Elderly Has a Low Conversion Rate. J Arthroplasty 2017; 32:150-154. [PMID: 27480829 DOI: 10.1016/j.arth.2016.06.048] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [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: 03/15/2016] [Revised: 06/19/2016] [Accepted: 06/27/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Hemiarthroplasty (HA) has been a mainstay treatment for displaced femoral neck fractures for many years. The purpose of this study was to report the conversion rate of HA to total hip arthroplasty (THA) for displaced femoral neck fractures and compare outcomes between implant constructs (bipolar vs unipolar), fixation options (cemented vs cementless stems), and age groups (<75 years vs ≥75 years). METHODS We retrospectively reviewed the results of a consecutive cohort of 686 patients who underwent HA for the treatment of femoral neck fractures at our institution between 1999 and 2013 with a minimum of 2-year follow-up. RESULTS The overall component revision rate, including conversion to THA, revision HA, revision with open reduction internal fixation, and Girdlestone procedure, was 5.6% (39/686). Seventeen patients (2.5%) were converted from HA to THA at an average of 1.9 years after index procedure. A significantly lower conversion rate of 1.4% (7/499 patients) was found in the older patient cohort (≥75 years old) compared to 5.3% (11/187) in the younger cohort. The most common causes for conversion surgery to THA were acetabular wear (5 patients), aseptic loosening (4 patients), and periprosthetic fracture (3 patients). There was a significantly lower rate of periprosthetic fracture (0.4% vs 2.5%, P value .025) in the cemented implant group compared to the cementless group. We observed a higher rate of dislocations in the bipolar vs unipolar group (3.8% vs 1%, P value .02) and no other significant differences between these groups. CONCLUSION We observed a low reoperation rate for this cohort of patients, relatively higher conversion rates for the younger population, fewer periprosthetic fractures with the use of cemented stems, and no advantage of bipolar over unipolar prostheses.
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Affiliation(s)
- Matthew J Grosso
- Center for Hip & Knee Replacement, Department of Orthopaedic Surgery, New York Presbyterian Hospital/Columbia University Medical Center, New York, New York
| | - Jonathan R Danoff
- Center for Hip & Knee Replacement, Department of Orthopaedic Surgery, New York Presbyterian Hospital/Columbia University Medical Center, New York, New York
| | - Taylor S Murtaugh
- Center for Hip & Knee Replacement, Department of Orthopaedic Surgery, New York Presbyterian Hospital/Columbia University Medical Center, New York, New York
| | - David P Trofa
- Center for Hip & Knee Replacement, Department of Orthopaedic Surgery, New York Presbyterian Hospital/Columbia University Medical Center, New York, New York
| | - Andrew N Sawires
- Center for Hip & Knee Replacement, Department of Orthopaedic Surgery, New York Presbyterian Hospital/Columbia University Medical Center, New York, New York
| | - William B Macaulay
- Center for Hip & Knee Replacement, Department of Orthopaedic Surgery, New York Presbyterian Hospital/Columbia University Medical Center, New York, New York
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Kim YH, Park JW, Kim JS. Alumina Delta-on-Highly Crosslinked-Remelted Polyethylene Bearing in Cementless Total Hip Arthroplasty in Patients Younger than 50 Years. J Arthroplasty 2016; 31:2800-2804. [PMID: 27378639 DOI: 10.1016/j.arth.2016.05.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 03/07/2016] [Revised: 05/09/2016] [Accepted: 05/09/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The purpose of this retrospective study was to determine the clinical and radiographic results, prevalence of polyethylene wear and osteolysis, and fracture of alumina delta ceramic femoral head or highly crosslinked, remelted polyethylene (HXLPE) liner associated with the use of alumina delta ceramic femoral head-on-HXLPE bearing in cementless total hip arthroplasty in patients younger than 50 years. METHODS We reviewed the cases of 119 patients (130 hips) who underwent a cementless total hip arthroplasty using alumina delta ceramic-on-HXLPE bearing when they were 50 years or younger at the time of surgery. The most common diagnoses were osteonecrosis (51%) and osteoarthritis secondary to developmental dysplastic hip (39%). Osteolysis and polyethylene wear rates were evaluated with use of radiography and computed tomography. In addition, prevalence of fracture of alumina delta ceramic head and polyethylene line was documented. The mean follow-up was 8.3 years (range, 7-9 years). RESULTS The mean Harris hip score, Western Ontario and McMaster Universities Osteoarthritis Index score, University of California, Los Angeles activity score were 94 points, 14 points, and 8.1 points, respectively, at the final follow-up. No patient had thigh pain. All acetabular components and all but one femoral components were well fixed. The mean annual penetration rate of femoral head was 0.022 ± 0.003 mm/year. No hip had osteolysis or ceramic head or HXLPE liner fracture. CONCLUSION Our average 8.3-year results with the use of alumina delta ceramic-on-HXLPE bearing in the patients younger than 50 years suggest that cementless acetabular and femoral components provide a high survival rate without evidence of osteolysis or ceramic head or AXLPE liner fracture.
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MESH Headings
- Acetabulum/surgery
- Adult
- Aluminum Oxide
- Arthroplasty, Replacement, Hip/adverse effects
- Arthroplasty, Replacement, Hip/instrumentation
- Arthroplasty, Replacement, Hip/statistics & numerical data
- Ceramics
- Female
- Femur Head/surgery
- Femur Head Necrosis/surgery
- Follow-Up Studies
- Hip Dislocation, Congenital/complications
- Hip Prosthesis/statistics & numerical data
- Humans
- Male
- Middle Aged
- Osteoarthritis, Hip/etiology
- Osteoarthritis, Hip/surgery
- Osteolysis/diagnostic imaging
- Osteolysis/epidemiology
- Osteolysis/etiology
- Polyethylene
- Postoperative Complications/epidemiology
- Postoperative Complications/etiology
- Prosthesis Design
- Republic of Korea/epidemiology
- Retrospective Studies
- Tomography, X-Ray Computed
- Treatment Outcome
- Young Adult
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Affiliation(s)
- Young-Hoo Kim
- The Joint Replacement Centers, SeoNam Hospital, Ewha Womans University, Seoul, Republic of Korea
| | - Jang-Won Park
- The Joint Replacement Centers, MokDong Hospital, Ewha Womans University, Seoul, Republic of Korea
| | - Jun-Shik Kim
- The Joint Replacement Centers, MokDong Hospital, Ewha Womans University, Seoul, Republic of Korea
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Puch JM, Derhi G, Descamps L, Verdier R, Caton JH. Dual-mobility cup in total hip arthroplasty in patients less than fifty five years and over ten years of follow-up : A prospective and comparative series. Int Orthop 2016; 41:475-480. [PMID: 27826763 DOI: 10.1007/s00264-016-3325-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 10/17/2016] [Indexed: 11/27/2022]
Abstract
PURPOSE We report clinical and radiological outcome of a dual mobility cup (DMC) of 2nd generation after a minimum of ten year-follow-up (FU). The goal of this work was to compare the results of this DMC in patients aged less than 55 years and in patients aged more than 55 years. METHODS From 2000 to 2005, a prospective and consecutive series of 119 THAs with a cementless DMC of 2nd generation (GIROS) were performed in patients aged less than 55 years and 444 in patients aged more than 55 years. RESULTS The mean FU was 11 years (8 to 15 years). Survivorships (failure of both components or cup loosening) were not different between patients aged less than 55 years and patients aged more than 55 years. There was no dislocation. DEVANE classification, Harris, PMA and Oxford scores improved after THA but no difference could be found between between < 55 years and > 55 years patients. CONCLUSION These results are better than those of first generation (BOUSQUET) DMC (77 % of survival rate at 20 years of FU). These results are in the same agreement than those of the literature: 99 % of survival rate at 14.2 years of FU for KERBOULL with a low friction arthroplasty and 96.5 % at ten years of FU for ceramic/ceramic bearing (R CHANA). The DMC for young patient is a relevant surgical option with no dislocation and excellent clinical results and survival rate at more than ten years of FU.
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Affiliation(s)
- Jean-Marc Puch
- Clinique Saint-Georges, 2 Avenue de Rimiez, 06100, Nice, France
| | - Guy Derhi
- Pôle Santé Saint-Jean, 53 avenue des alpes, 06800, Cagnes-sur-Mer, France
| | - Loys Descamps
- Clinique Saint-Georges, 2 Avenue de Rimiez, 06100, Nice, France
| | - Régis Verdier
- , 175 rue Jacquard - CS 50307, 69727, Genay Cedex, France.
| | - Jacques H Caton
- , Clinique orthopédique 103 rue Coste 69300, Caluire, France
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Del Balso C, Teeter MG, Tan SC, Howard JL, Lanting BA. Trunnionosis: Does Head Size Affect Fretting and Corrosion in Total Hip Arthroplasty? J Arthroplasty 2016; 31:2332-6. [PMID: 27067470 DOI: 10.1016/j.arth.2016.03.009] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [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: 12/23/2015] [Revised: 03/02/2016] [Accepted: 03/04/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Wear and tribocorrosion at the modular head-neck taper interface may be a cause of failure in metal-on-polyethylene total hip arthroplasty (THA). The present investigation endeavored to elucidate the effect of femoral head diameter on fretting and corrosion in retrieved head-neck tapers. METHODS A retrieval analysis of THA prostheses in vivo for a minimum of 1 year was performed. Twenty-three femoral heads of 32-mm diameter were matched with 28-mm heads based on time in vivo and head length (-3 mm to +8 mm). All included implants featured a single taper design from a single manufacturer. Fretting and corrosion damage scoring was performed for each implant under stereomicroscopic visualization. RESULTS Head diameter was observed to affect fretting (P = .01), with 32-mm femoral heads exhibiting greater total fretting scores than 28-mm heads. Fretting damage was greatest (P = .01) in the central concentric zone of the femoral head bore tapers, regardless of head diameter, length, or stem offset. No significant effect on total corrosion scores was observed for any head or stem variable. Retrieved implant total corrosion scores were positively correlated (ρ = 0.51, P < .001) with implantation time. CONCLUSION Increased femoral head diameter in THA may produce greater fretting damage owing to and increased head-neck moment arm. There is no associated increase in corrosion with 28-mm and 32-mm heads of this taper design. The longer a THA prosthesis is implanted, the greater the risk of damage due to corrosion.
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Affiliation(s)
- Christopher Del Balso
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, University Hospital, London, Ontario, Canada
| | - Matthew G Teeter
- Department of Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada; Surgical Innovation Program, Lawson Health Research Institute, London, Ontario, Canada
| | - Sok Chuen Tan
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, University Hospital, London, Ontario, Canada
| | - James L Howard
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, University Hospital, London, Ontario, Canada
| | - Brent A Lanting
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, University Hospital, London, Ontario, Canada
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Kerger BD, Bernal A, Paustenbach DJ, Huntley-Fenner G. Halo and spillover effect illustrations for selected beneficial medical devices and drugs. BMC Public Health 2016; 16:979. [PMID: 27630095 PMCID: PMC5024505 DOI: 10.1186/s12889-016-3595-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 08/18/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Negative news media reports regarding potential health hazards of implanted medical devices and pharmaceuticals can lead to a 'negative halo effect,' a phenomenon whereby judgments about a product or product type can be unconsciously altered even though the scientific support is tenuous. To determine how a 'negative halo effect' may impact the rates of use and/or explantation of medical products, we analyzed the occurrence of such an effect on three implanted medical devices and one drug: 1) intrauterine contraceptive devices (IUDs); 2) silicone gel-filled breast implants (SGBI); 3) metal-on-metal hip implants (MoM); and 4) the drug Tysabri. METHODS Data on IUD use from 1965 to 2008 were gathered from the Department of Health and Human Services Vital and Health Statistics and peer-reviewed publications. Data regarding SGBI implant and explantation rates from 1989 to 2012 were obtained from the Institute of Medicine and the American Society of Plastic Surgeons. MoM implant and explantation data were extracted from the England and Wales National Joint Registry and peer-reviewed publications. Tysabri patient data were reported by Elan Corporation or Biogen Idec Inc. Data trends for all products were compared with historical recall or withdrawal events and discussed in the context of public perceptions following such events. RESULTS We found that common factors altered public risk perceptions and patterns of continued use. First, a negative halo effect may be driven by continuing patient anxiety despite positive clinical outcomes. Second, negative reports about one product can spill over to affect the use of dissimilar products in the same category. Third, a negative halo effect on an entire category of medical devices can be sustained regardless of the scientific findings pertaining to safety. Fourth, recovery of a product's safety reputation and prevalent use may take decades in the U.S., even while these products may exhibit widespread use and good safety records in other countries. CONCLUSIONS We conclude that the 'negative halo effect' associated with a stigma, rather than an objective risk-benefit assessment of medical products can increase negative health outcomes for patients due to reduced or inappropriate product usage.
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Affiliation(s)
| | - Autumn Bernal
- Cardno ChemRisk, 130 Vantis, Suite 170, Aliso Viejo, CA 92656 USA
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Pijls BG, Meessen JMTA, Schoones JW, Fiocco M, van der Heide HJL, Sedrakyan A, Nelissen RGHH. Increased Mortality in Metal-on-Metal versus Non-Metal-on-Metal Primary Total Hip Arthroplasty at 10 Years and Longer Follow-Up: A Systematic Review and Meta-Analysis. PLoS One 2016; 11:e0156051. [PMID: 27295038 PMCID: PMC4905643 DOI: 10.1371/journal.pone.0156051] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 05/09/2016] [Indexed: 11/19/2022] Open
Abstract
IMPORTANCE There are concerns about increased mortality in patients with metal-on-metal bearings in total hip arthroplasty (THA). OBJECTIVE To determine the mortality and the morbidity in patients with metal-on-metal articulations (MOM THA) compared to patients with non-metal-on-metal articulations (non-MOM THA) after primary total hip arthroplasty. DATA SOURCES Search of PubMed, MEDLINE, EMBASE, Web of Science, Cochrane, CINAHL, AcademicSearchPremier, ScienceDirect, Wiley and clinical trial registers through March 2015, augmented by a hand search of references from the included articles. No language restrictions were applied. STUDY SELECTION Two reviewers screened and identified randomised controlled trials and observational studies of primary total hip arthroplasty comparing MOM THA with non-MOM THA. DATA EXTRACTION AND SYNTHESIS Two reviewers independently extracted study data and assessed risk of bias. Risk differences (RD) were calculated with random effect models. Meta-regression was used to explore modifying factors. MAIN OUTCOMES AND MEASURES Difference in mortality and difference in morbidity expressed as revisions and medical complications between patients with MOM THA and non-MOM THA. RESULTS Forty-seven studies were included, comprising 4,000 THA in randomised trials and over 500,000 THA in observational studies. For mortality, random effects analysis revealed a higher pooled RD of 0.7%, 95%, confidence interval (CI) [0.0%, 2.3%], I-square 42%; the heterogeneity was explained by differences in follow-up. When restricted to studies with long term follow-up (i.e. 10 years or more), the RD for mortality was 8.5%, 95%, CI [5.8%, 11.2%]; number needed to treat was 12. Further subgroup analyses and meta-regression random effects models revealed no evidence for other moderator variables (study level covariates, e.g. resurfacing vs. non-resurfacing MOM) than follow-up duration. The quality of the evidence presented in this meta-analysis was characterized as moderate according to the CLEAR-NPT (for non-pharmacological trials) and Cochrane risk of bias Table. CONCLUSIONS AND RELEVANCE Meta-analysis suggests there may be an increased long-term risk of mortality and revision surgery for patients with MOM THA compared to patients with non-MOM THA. REGISTRATION PROSPERO 2014:CRD42014007417.
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Affiliation(s)
- B G Pijls
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
| | - J M T A Meessen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
| | - J W Schoones
- Walaeus Library, Leiden University Medical Centre, Leiden, The Netherlands
| | - M Fiocco
- Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands
- Mathematical Institute, Leiden University, Leiden, The Netherlands
| | - H J L van der Heide
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
| | - A Sedrakyan
- FDA Medical Device Epidemiology (MDEpiNet) Science and Infrastructure Center, U.S. Food and Drug Administration, Silver Spring, MD, United States of America
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, United States of America
| | - R G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
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Kolisek FR, Chughtai M, Mistry JB, Elmallah RK, Jaggard C, Malkani AL, Masini MA, Harwin SF, Mont MA. Outcomes of Second-Generation Tapered Wedge Femoral Stem. Surg Technol Int 2016; 28:275-279. [PMID: 27042781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Newer generation cementless femoral stems have been designed to emulate more precisely the anatomy of the native femur. However, few studies have evaluated these designs. The purpose of this study was therefore to evaluate outcomes of primary total hip arthroplasty (THA) in patients who received a second-generation, tapered wedge stem by analyzing (1) all-cause and aseptic implant survivorships; (2) clinical and patient-reported outcomes; (3) radiographic outcomes; and (4) incidence of complications. MATERIALS AND METHODS We evaluated 202 primary THA patients (37% men, 63% women) who had a mean age of 63 years (range, 18 to 88) and a mean body mass index (BMI) of 29 (range, 18 to 40). All patients underwent THA using a press-fit, tapered wedge stem with a morphometric design containing a size-specific medial curvature, which optimizes initial press-fit stability. Kaplan-Meier analysis was performed to determine implant survivorship, and Harris Hip Scores (HHS) and the Short form-36 (SF-36) were used to evaluate clinical and patient-reported outcomes. Early postoperatively and annually thereafter, pelvic radiographs were reviewed for evidence of osteolysis or loosening. Complications were identified through a comprehensive chart review and were classified as either surgical or medical. RESULTS At final follow-up, the all-cause and aseptic survivorships for the femoral stem were 99.5% and 100%, respectively. At final follow-up, the mean HHS was 87 (range, 35 to 100). The SF-36 mental and physical component scores were 47 (range, 19 to 65) and 47 (range, 23 to 65), respectively, at final follow-up. No progressive radiolucencies or loosening were observed. Surgical complications included nerve palsy, posterior trochanteric avulsion, arthrofibrosis, and periprosthetic fracture. The only medical complication was acute renal failure. CONCLUSION This second-generation stem demonstrated excellent short-term survivorship and functional outcomes. The improved patient fit of this stem may yield continued favorable results with longer-term follow-up.
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Affiliation(s)
| | - Morad Chughtai
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Jaydev B Mistry
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Randa K Elmallah
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
| | | | - Arthur L Malkani
- University of Louisville, Adult Reconstruction Program, Louisville, Kentucky
| | | | - Steven F Harwin
- Adult Reconstruction Service, Mount Sinai Beth Israel, New York, New York
| | - Michael A Mont
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
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Wu X, He BX, Tan YJ. [Progress on classification and application of artificial hip joint materials]. Zhongguo Gu Shang 2016; 29:283-288. [PMID: 27149804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The selection of the prosthetic material determine the success or failure of hip arthroplasty. Currently, the metals, ceramics, polymer composites and carbon materials are the main prosthetic materials of artificial hip joint. They have some progresses in biocompatibility, elastic modulus,mechanical properties, useful life, but they still can't reach the ideal standard of design. In this essay, we mainly review the characteristics and applications of the current artificial hip joint materials through its classification in order to provide a reference for choosing appropriate hip joint materials in clinic and increasing characteristic of materials. We consider the polymer composites has more advantages such as biocompatibility, mechanical properties, corrosion resistance and price, even if it has shortages in abrasion resistance. As the researches of polymer composites are main focus on abrasion resistance, articular surface and strength,and its performances are increased fast, it has a wide prospect in future.
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So K, Goto K, Kuroda Y, Matsuda S. Minimum 10-Year Wear Analysis of Highly Cross-Linked Polyethylene in Cementless Total Hip Arthroplasty. J Arthroplasty 2015; 30:2224-6. [PMID: 26231076 DOI: 10.1016/j.arth.2015.06.053] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [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: 04/02/2015] [Revised: 06/21/2015] [Accepted: 06/25/2015] [Indexed: 02/01/2023] Open
Abstract
Fifty-four patients (64 hips) underwent cementless total hip arthroplasty between 2000 and 2003 with a 22-mm zirconia ceramic bearing on highly cross-linked polyethylene, and were evaluated with a mean 11.9-year postoperative follow-up (range, 10-14 years). Linear wear was measured on the anteroposterior radiograph of the hip. No evidence of osteolysis and loosening was found on the final radiograph in any of the cases, and the steady-state linear wear rate was 0.017±0.018 mm/year. No significant correlation was found between the linear wear rate and age, body weight, cup inclination angle, or polyethylene thickness. Highly cross-linked polyethylene showed excellent wear resistance for >10 years when used in combination with 22-mm zirconia heads.
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Affiliation(s)
- Kazutaka So
- Department of Orthopaedics Surgery, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan
| | - Koji Goto
- Department of Orthopaedics Surgery, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan
| | - Yutaka Kuroda
- Department of Orthopaedics Surgery, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan
| | - Shuichi Matsuda
- Department of Orthopaedics Surgery, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan
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Jameson SS, Mason J, Baker PN, Gregg PJ, Deehan DJ, Reed MR. Implant Optimisation for Primary Hip Replacement in Patients over 60 Years with Osteoarthritis: A Cohort Study of Clinical Outcomes and Implant Costs Using Data from England and Wales. PLoS One 2015; 10:e0140309. [PMID: 26561859 PMCID: PMC4643061 DOI: 10.1371/journal.pone.0140309] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 09/24/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Hip replacement is one of the most commonly performed surgical procedures worldwide; hundreds of implant configurations provide options for femoral head size, joint surface material and fixation method with dramatically varying costs. Robust comparative evidence to inform the choice of implant is needed. This retrospective cohort study uses linked national databases from England and Wales to determine the optimal type of replacement for patients over 60 years undergoing hip replacement for osteoarthritis. METHODS AND FINDINGS Implants included were the commonest brand from each of the four types of replacement (cemented, cementless, hybrid and resurfacing); the reference prosthesis was the cemented hip procedure. Patient reported outcome scores (PROMs), costs and risk of repeat (revision) surgery were examined. Multivariable analyses included analysis of covariance to assess improvement in PROMs (Oxford hip score, OHS, and EQ5D index) (9159 linked episodes) and competing risks modelling of implant survival (79,775 procedures). Cost of implants and ancillary equipment were obtained from National Health Service procurement data. RESULTS EQ5D score improvements (at 6 months) were similar for all hip replacement types. In females, revision risk was significantly higher in cementless hip prostheses (hazard ratio, HR = 2.22, p<0.001), when compared to the reference hip. Although improvement in OHS was statistically higher (22.1 versus 20.5, p<0.001) for cementless implants, this small difference is unlikely to be clinically important. In males, revision risk was significantly higher in cementless (HR = 1.95, p = 0.003) and resurfacing implants, HR = 3.46, p<0.001), with no differences in OHS. Material costs were lowest with the reference implant (cemented, range £1103 to £1524) and highest with cementless implants (£1928 to £4285). Limitations include the design of the study, which is intrinsically vulnerable to omitted variables, a paucity of long-term implant survival data (reflecting the duration of data collection), the possibility of revision under-reporting, response bias within PROMs data, and issues associated with current outcome scoring systems, which may not accurately reflect level of improvement in some patients. CONCLUSIONS Cement fixation, using a polyethylene cup and a standard sized head offers good outcomes, with the lowest risks and at the lowest costs. The most commonly used cementless and resurfacing implants were associated with higher risk of revision and were more costly, while perceptions of improved function and longevity were unsupported.
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Affiliation(s)
- Simon S. Jameson
- School of Medicine, Pharmacy and Health, Durham University, Queen's Campus, University Boulevard, Stockton-on-Tees, TS17 6BH, United Kingdom
- The National Joint Registry for England and Wales, London, United Kingdom
- Department of Orthopaedic Surgery, South Tees Hospitals NHS Foundation Trust, Marton Road, Middlesbrough, TS4 3BW, United Kingdom
| | - James Mason
- School of Medicine, Pharmacy and Health, Durham University, Queen's Campus, University Boulevard, Stockton-on-Tees, TS17 6BH, United Kingdom
| | - Paul N. Baker
- The National Joint Registry for England and Wales, London, United Kingdom
- Department of Orthopaedic Surgery, South Tees Hospitals NHS Foundation Trust, Marton Road, Middlesbrough, TS4 3BW, United Kingdom
| | - Paul J. Gregg
- The National Joint Registry for England and Wales, London, United Kingdom
- Department of Orthopaedic Surgery, South Tees Hospitals NHS Foundation Trust, Marton Road, Middlesbrough, TS4 3BW, United Kingdom
| | - David J. Deehan
- Department of Orthopaedic Surgery, Newcastle Hospitals NHS Foundation Trust, Freeman Road, High Heaton, Newcastle upon Tyne, NE7 7DN, United Kingdom
| | - Mike R. Reed
- Department of Orthopaedic Surgery, Northumbria Healthcare NHS Foundation Trust, Woodhorn Lane, Ashington, Northumberland, NE63 9JJ, United Kingdom
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Boldt JG, Cartillier JC, Machenaud A, Vidalain JP. Long-term Bone Remodeling in HA-coated Stems: A Radiographic Review of 208 Total Hip Arthroplasties (THAs) with 15 to 20 Years Follow-up. Surg Technol Int 2015; 27:279-286. [PMID: 26680411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
We present a prospective study focused on radiographic long-term outcomes and bone remodeling at a mean of 17.0 years (range: 15 to 20) in 208 cementless fully HA-coated femoral stems (Corail, DePuy International Ltd, Leeds, UK). Total hip replacements in this study were performed by three members of the surgeon design group between 1986 and 1991. Radiographic evaluation focused on periprosthetic osteolysis, bone remodeling, osseous integration, subsidence, metaphyseal or diaphyseal load transfer, and femoral stress shielding. The radiographs were digitized and examined with contrast-enhancing software for analysis of the trabecular architecture. Radiographic signs of aseptic stem loosening were visible in two cases (1%). Three stems (1.4%) showed metaphyseal periprosthetic osteolysis in four of seven Gruen zones associated with eccentric polyethylene wear awaiting metaphyseal bone grafting and cup liner exchange. One stem (0.5%) was revised due to infection. No stem altered in varus or valgus alignment more than two degrees, and mean subsidence was 0.1 mm (range: 0 to 2 mm) after a mean of 17.0 years. A total of 5 stems (2.4%) required or are awaiting revision surgery. Trabecular orientation and micro-anatomy suggested main proximal load-transfer patterns in all except 3 cases (98.6%). Combined metaphyseal and diaphyseal osseointegration and bone remodeling were visible in 100 stems (48%). Diaphyseal stress shielding and cortical thickening were observed in 3 stems (1.4%). Other radiographic features are discussed in depth. This long-term study of 208 fully HA-coated Corail stems showed satisfactory osseointegration and fixation in 203 cases (97.6%) after a mean of 17.0 years follow-up. Stem failures were associated with extreme eccentric polyethylene wear.
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Elmallah RK, Cherian JJ, Amin H, Jauregui JJ, Pierce TP, Mont MA. Readmission Rates in Patients Who Underwent Total Hip Arthroplasty. Surg Technol Int 2015; 27:215-217. [PMID: 26680400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Readmission rates remain a concern following total hip arthroplasty (THA). This study: 1) evaluated 30-day, 90-day, and total readmission rates after THAs; 2) assessed causes of readmission; 3) determined differences in demographic factors between those who were and were not readmitted; and 4) compared readmission rates to other large-scale studies. We retrospectively reviewed 232 primary THAs (224 patients) using the same prosthesis at 7 institutions. This included 79 men and 145 women who had a mean age of 69 years (range, 44 to 88). Descriptive analyses were used to evaluate readmission, and rates were compared with those from large cohort studies. There were 11 unplanned readmissions (4.7%) in 10 patients during the first 90 days post-discharge. Seven (3%) readmissions were due to surgical and 4 (1.7%) were due to medical reasons. Surgical causes were found in 70% of early (0 to 30 days) readmissions but none of late (60 to 90 days) readmissions. No differences existed in mean age, gender, and body mass index between readmitted patients and the remainder of the population. We observed lower readmission rates when compared with large cohort studies. The positive performance of the prosthesis may have contributed to the lower readmission rates.
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Affiliation(s)
- Randa K Elmallah
- Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Jeffrey J Cherian
- Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Hiral Amin
- Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Julio J Jauregui
- Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Todd P Pierce
- Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Michael A Mont
- Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
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Berend KR, Adams JB, Morris MJ, Lombardi AV. Early Experience with a New Porous Hemispheric Acetabular Component. Surg Technol Int 2015; 27:263-267. [PMID: 26680408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
A third-generation cementless acetabular system has been designed, building on the successes of a second-generation system that featured good congruity between the liner and hemispheric shell, and proven porous plasma-sprayed coating on titanium alloy substrate, by designing a ringless barb and groove locking mechanism and optimizing range of motion. These design features are amenable to modern, highly crosslinked polyethylenes. A retrospective review was performed to assess early outcomes. A query of our practice registry revealed 534 patients (576 hips) who underwent cementless total hip arthroplasty performed by three surgeons with the G7™ Acetabular System (Biomet, Warsaw, Indiana) between April 2013 and March 2014. All liners were vitamin E infused, highly crosslinked polyethylene with a neutral face. Heads used were 463 BIOLOX® delta (81%; CeramTec AG, Plochingen, Germany) and 112 cobalt-chromium (19%), with diameters of 32 mm in 238 (41%), 36 mm in 331 (58%), and 40 mm in 6. Minimum one-year follow-up was available for 400 hips. Mean follow-up was 15 months (range 10-24, SD 3.0). Harris hip scores improved from 50.7 preoperatively to 86.5 most recently. UCLA activity scale improved from 4.5 preoperatively to 5.4 most recently. Two patients required cup revision secondary to failure of biological fixation at 8.4 and 15.1 months respectively. Radiographic findings in all cases were satisfactory position and alignment with no radiolucencies observed. In this group, with very early follow-up, good results with a low rate of acetabular revision and no dislocations were achieved using a new hemispheric porous shell with ringless barb and groove locking mechanism and geometry.
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Affiliation(s)
- Keith R Berend
- Joint Implant Surgeons, Inc., New Albany, OH, The Ohio State University Wexner Medical Center, Columbus, OH, Mount Carmel Health System, Columbus, OH
| | | | | | - Adolph V Lombardi
- Joint Implant Surgeons, Inc., New Albany, OH, Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH
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45
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Scaglione M, Fabbri L, Bianchi N, Dell'Omo D, Guido G. Metal-on-metal hip resurfacing: correlation between clinical and radiological assessment, metal ions and ultrasound findings. Musculoskelet Surg 2015; 99:45-53. [PMID: 25537299 DOI: 10.1007/s12306-014-0344-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 12/05/2014] [Indexed: 06/04/2023]
Abstract
PURPOSE We report the clinical, radiological and wear analysis of 52 consecutive MoM hip resurfacings (performed on 49 younger patients) to a mean follow-up of 9.2 years. METHODS Every patient underwent X-ray and clinical evaluation (HHS). Ultrasonography of the hip was performed in all patients in order to identify possible cystic or solid mass in periprosthetic tissue. In case of mass >20 mm, further MRI was performed to better analyse the characteristics of lesion. RESULTS Five patients (five hips) had a revision. The overall survival rate was 90.38 %. The average HHS at follow-up examination was 95.5 points. No progressive radiolucent areas and no sclerosis or osteolysis around the implants were found. The US and RMI imaging showed a pseudotumour formation in two patients (correlated with high metal ion levels in blood and urine), both asymptomatic. CONCLUSION A significant positive correlation between inclination of the acetabular component and serum metal ion levels was found (r = 0.64 and r = 0.62 for cobalt and chromium, respectively).
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Affiliation(s)
- M Scaglione
- Department of Orthopedics, University of Pisa, Via Paradisa 2, Ed 3, 56100, Pisa, Italy,
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Mäkelä KT, Matilainen M, Pulkkinen P, Fenstad AM, Havelin LI, Engesaeter L, Furnes O, Overgaard S, Pedersen AB, Kärrholm J, Malchau H, Garellick G, Ranstam J, Eskelinen A. Countrywise results of total hip replacement. An analysis of 438,733 hips based on the Nordic Arthroplasty Register Association database. Acta Orthop 2014; 85:107-16. [PMID: 24650019 PMCID: PMC3967250 DOI: 10.3109/17453674.2014.893498] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 01/03/2014] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE An earlier Nordic Arthroplasty Register Association (NARA) report on 280,201 total hip replacements (THRs) based on data from 1995-2006, from Sweden, Norway, and Denmark, was published in 2009. The present study assessed THR survival according to country, based on the NARA database with the Finnish data included. MATERIAL AND METHODS 438,733 THRs performed during the period 1995-2011 in Sweden, Denmark, Norway, and Finland were included. Kaplan-Meier survival analysis was used to calculate survival probabilities with 95% confidence interval (CI). Cox multiple regression, with adjustment for age, sex, and diagnosis, was used to analyze implant survival with revision for any reason as endpoint. RESULTS The 15-year survival, with any revision as an endpoint, for all THRs was 86% (CI: 85.7-86.9) in Denmark, 88% (CI: 87.6-88.3) in Sweden, 87% (CI: 86.4-87.4) in Norway, and 84% (CI: 82.9-84.1) in Finland. Revision risk for all THRs was less in Sweden than in the 3 other countries during the first 5 years. However, revision risk for uncemented THR was less in Denmark than in Sweden during the sixth (HR = 0.53, CI: 0.34-0.82), seventh (HR = 0.60, CI: 0.37-0.97), and ninth (HR = 0.59, CI: 0.36-0.98) year of follow-up. INTERPRETATION The differences in THR survival rates were considerable, with inferior results in Finland. Brand-level comparison of THRs in Nordic countries will be required.
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Affiliation(s)
- Keijo T Mäkelä
- Department of Orthopaedics and Traumatology , Turku University Hospital
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47
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Vavřík P, Landor I, Popelka S, Fialka R, Hach J. The National Register of Joint Replacements of the Czech Republic. Acta Chir Orthop Traumatol Cech 2014; 81 Suppl:3-68. [PMID: 25105887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The National Register of Joint Replacements of the Czech Republic was established as part of the National Health Information System in 2002. The register's administrator is the Institute of Health Information and Statistics of the Czech Republic, the Czech Society for Orthopaedics and Traumatology acts as its guarantor of scientific quality. The register is financed from governmental sources. It was launched into full operation in 2003 and it currently focuses on hip joint replacements. Register of knee and shoulder joint replacements is in the process of preparation. The register provides aggregate epidemiological data and other statistics, including the Revision Rate (RR) and curves of cumulative survival probability (Kaplan-Meier) for the main monitored groups of patients and implants used. In years 2003-2012 there were 101,734 primary implantations and 13,459 revision surgeries registered. In terms of gender distribution there is a predominance of females amounting to 59.4% in primary implantations and to 63.49% in revision surgeries. The age structure covers the entire range of adult population; however, more than 50% of the replacements are being implanted between 60-74 years of age. Most frequent indications for primary implantation are primary coxarthrosis (69.85%), post-fracture conditions (13.41%) and post-dysplasia arthritis (8.73%). The most frequent indications for revision surgery are aseptic loosening of acetabular component (38.15%), aseptic loosening of femoral component (22.01%) and recurrent dislocation (6.5%). 45,450 (44.68%) of primary implantations were cemented, 36,477 (35.86%) uncemented, 16,559 (16.28%) hybrid with cemented femur and 656 (0.64%) hybrid with cemented acetabulum. There were also records of 2,592 cervicocapital prostheses (2.55%). Most commonly used is the classic anterolateral approach 75.86% in primary implantations and 50.06% in revision surgeries. Mini-invasive approaches in primary implantations did not exceed 3.2% of all cases. Bone grafts were used in 23.89% of primary implantations and 39.55% of revisions. Most widely used implants in primary implantations were cemented PE cup type Muller (Aesculap) 14,000 pcs, original Czech cemented steel Stem with conical neck 12/14 AK (Beznoska) 13,433 pcs, from uncemented models Plasmacup SC (Aesculap) 9,762 pcs and Stem SL "Zweymüller Alloclassic" (Zimmer) 4,337 pcs. Generally most widely used implants in revision surgeries are uncemented Czech Oval cup MO (Medin) with titanium & hydroxyapatite porous coat 956 pcs and uncemented Stem SL WAGNER, lateralised, cone 12/14 (Zimmer) 712 pcs. The Revision Rate for primary implants due to infection for period 2003-2012 represented 0.06% at the end of the followup as of June 30, 2013. Cumulative survival probability (Kaplan-Meier) in year 11 of the follow-up is 95.69% in cemented implants, 94.55% in uncemented, 92.90% in hybrids with cemented femur and 84.11% in hybrids with cemented cup.
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Affiliation(s)
- P Vavřík
- 1st Orthopaedic Clinic 1st Faculty of Medicin, Charles University Prague, (V Úvalu 84, Praha 5, 150 00)
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48
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Ulrich M, Overgaard S, Penny J. [Metal-on-metal hip arthroplasty]. Ugeskr Laeger 2014; 176:V04130235. [PMID: 25293565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
In Denmark 4,456 metal-on-metal (MoM) hip prostheses have been implanted. Evidence demonstrates that some patients develope adverse biological reactions causing failures of MoM hip arthroplasty. Some reactions might be systemic. Failure rates are associated with the type and the design of the MoM hip implant. A Danish surveillance programme has been initiated addressing these problems.
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Affiliation(s)
- Michael Ulrich
- Ortopædkirurgisk Afdeling, Aalborg Universitetshospital, Hobrovej 18-22, 9100 Aalborg.
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49
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Philippot R, Meucci JF, Boyer B, Farizon F. Modern dual-mobility cup implanted with an uncemented stem: about 100 cases with 12-year follow-up. Surg Technol Int 2013; 23:208-212. [PMID: 23686801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
We report the results of a 12-year follow-up retrospective series of 100 total hip arthroplasties using cementless, press-fit, dual-mobility acetabular cups. The aim of our study was to evaluate the clinical and radiographic results of this acetabular cup at last follow-up. This continuous and homogeneous series included 100 primary total hip arthroplasties performed during the year 2000. The THA combined a Corail® stem (Corail®, Depuy, Warsaw, IN) with a stainless steel Novae Sunfit® (Serf, Decines, France) acetabular cup. Fifteen patients died and 2 were lost to follow-up. Two cases of early dislocation were observed, and 3 cases of aseptic loosening of the acetabular component were reported. The mean stem subsidence was 0.71 mm, the mean craniopodal acetabular migration was 1.37 mm, and the mean medio-lateral acetabular migration was 1.52 mm. The 12-year survivorship is comparable to the data from the literature. The low dislocation rate at 12 years confirms the long-term, high stability of dual mobility, which should be recommended in primary THA for patients at risk for postoperative instability. The absence of true intraprosthetic dislocation events at 12-year follow-up provides evidence of the good quality of the latest generation of polyethylene liners and the necessity of combining thin-mirror, polished femoral necks with dual-mobility cups.
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50
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Preininger B, Schmorl K, von Roth P, Winkler T, Matziolis G, Perka C, Tohtz S. [More muscle mass in men: explanatory model for superior outcome after total hip arthroplasty]. Orthopade 2013; 42:107-13. [PMID: 23381894 DOI: 10.1007/s00132-012-2042-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Men show better functional results after total hip arthroplasty (THA). The aim of this study was a patient-specific analysis of the hip joint muscles in comparison to the joint geometry. METHODS In this study 93 computed tomography (CT) scans of the pelvis (45 men, 48 women) were analyzed to determine hip joint geometry and the volume of the gluteus medius (GMV), gluteus maximus (GXV) and tensor fasciae latae (TFL) muscles. The abduction muscle volumes were analyzed with respect to patient-specific adduction moments. RESULTS The absolute total volume of the hip muscular system (TMV) was larger in men than in women (1913 ccm vs. 1479 ccm; p <0.0001). Men exhibited a more progressive increase of muscle volume as the adduction moment increases. CONCLUSIONS Men have a greater abduction muscle mass in order to balance adduction moments occurring in the hip joint and therefore have more muscle mass to compensate the inevitable intraoperative muscle damage during THA. This argument supports the extraordinary importance of muscle sparing surgical techniques in women.
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Affiliation(s)
- B Preininger
- Klinik für Orthopädie, Centrum für Muskuloskeletale Chirurgie, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Deutschland.
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