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Sample records for metal-on-metal cementless total

  1. Metal-on-metal total hip arthroplasty: the concerns.

    PubMed

    MacDonald, S J

    2004-12-01

    The metal-on-metal bearing couple is having a resurgence in clinical applications seen in total hip and hip resurfacing technologies. The most noteworthy advantage of a metal-on-metal implant is the improved wear characteristics seen in vitro on wear simulators and in vivo with retrieved implants. All bearings have disadvantages, and a metal-on-metal bearing is no exception. Concerns exist regarding the generation of metal ions seen in the blood and urine of patients with metal-on-metal implants. These elevated metal ions have theoretical, although not proven, risks related to carcinogenic and biologic concerns. Additionally, concerns exist regarding hypersensitivity, increased incidence of instability and increased costs. Specific patient selection issues arise with metal-on-metal implants. The current generation of implants has only early and mid-term results available, with no long-term series yet published. Therefore, although a metal-on-metal bearing may be considered a viable alternative to either polyethylene or ceramic implants, outstanding and unresolved issues continue to exist with this bearing, as they do with the alternatives. PMID:15577471

  2. Cementless total hip arthroplasty.

    PubMed

    Morscher, E W

    1983-12-01

    The differences between prostheses fixed with and without cement are mainly in the design and nature of the surface implant. The shapes of the sockets to be implanted without cement show a wide variety: cylinder, square, conus, and ellipsoid with and without threads. The hemispheric shape, however, which was chosen for the acetabular component of the isoelastic hip joint, does not disturb the natural form and function of the hip joint since the outer surface is closely adapted to the original subchondral bone layer. The noncemented cup is secured by threads, pegs, screws, etc., and by ingrowth of bony tissue in the grooves of the surfaces. Most femoral stems are based on the self-locking principle. All prosthetic models incorporate attempts to increase the surface of the stem (ribs, wings, corrugations, rims, etc.). There is a tendency to use less rigid elastic implants instead of the well known rigid metallic prostheses. The aim is to overcome the problems of stress protection and stress concentration observed with rigid implants. For the biomechanical integration of an implant, the properties of the surface, especially macroporosity and microporosity, are important. Most European models of noncemented endoprostheses are based on macroporosity (porometal, madreporic, etc.). The increase in implant surface area achieved with macroscopic perforations and recesses is relatively minor compared with the possibilities offered by microporosity ("alumine fritée," Proplast, fiber-metal, etc.). The best indication for use of a cementless hip endoprosthesis is in revision arthroplasty. The lost bone stock is replaced by bone grafts, thereby creating a situation comparable with that of a primary arthroplasty. Clinical experience with noncemented hip endoprostheses is, to date, promising, although the observation time for most models is short. PMID:6357588

  3. Metal-on-Metal Total Hip Resurfacing Arthroplasty

    PubMed Central

    2006-01-01

    Executive Summary Objective The objective of this review was to assess the safety and effectiveness of metal on metal (MOM) hip resurfacing arthroplasty for young patients compared with that of total hip replacement (THR) in the same population. Clinical Need Total hip replacement has proved to be very effective for late middle-aged and elderly patients with severe degenerative diseases of the hips. As indications for THR began to include younger patients and those with a more active life style, the longevity of the implant became a concern. Evidence suggests that these patients experience relatively higher rates of early implant failure and the need for revision. The Swedish hip registry, for example, has demonstrated a survival rate in excess of 80% at 20 years for those aged over 65 years, whereas this figure was 33% by 16 years in those aged under 55 years. Hip resurfacing arthroplasty is a bone-conserving alternative to THR that restores normal joint biomechanics and load transfer. The technique has been used around the world for more than 10 years, specifically in the United Kingdom and other European countries. The Technology Metal-on-metal hip resurfacing arthroplasty is an alternative procedure to conventional THR in younger patients. Hip resurfacing arthroplasty is less invasive than THR and addresses the problem of preserving femoral bone stock at the initial operation. This means that future hip revisions are possible with THR if the initial MOM arthroplasty becomes less effective with time in these younger patients. The procedure involves the removal and replacement of the surface of the femoral head with a hollow metal hemisphere, which fits into a metal acetabular cup. Hip resurfacing arthroplasty is a technically more demanding procedure than is conventional THR. In hip resurfacing, the femoral head is retained, which makes it much more difficult to access the acetabular cup. However, hip resurfacing arthroplasty has several advantages over a

  4. Cementless total knee arthroplasty

    PubMed Central

    Risitano, Salvatore; Sabatini, Luigi; Giachino, Matteo; Agati, Gabriele; Massè, Alessandro

    2016-01-01

    Interest for uncemented total knee arthroplasty (TKA) has greatly increased in recent years. This technique, less used than cemented knee replacement in the last decades, sees a revival thanks an advance in prosthetic design, instrumentation and operative technique. The related literature in some cases shows conflicting data on survival and on the revision’s rate, but in most cases a success rate comparable to cemented TKA is reported. The optimal fixation in TKA is a subject of debate with the majority of surgeons favouring cemented fixation. PMID:27162779

  5. The Clinical Performance of Metal-on-Metal as an Articulation Surface in Total Hip Replacement

    PubMed Central

    Long, William T

    2005-01-01

    The metal-on-metal articulations in total hip arthroplasty (THA) were widely used between 1960 and 1975. The McKee-Farrar and other first-generation prostheses failed at a high rate because impingement caused early component loosening. The problem of early component loosening was corrected by improved component design and better manufacturing quality. Second-generation metal-on-metal total hip replacements have experienced short and medium-term success as assessed by Harris Hip Scores and patient selfassessment. The combined annual linear wear of the metal-on-metal femoral head and acetabular insert is less than 10 mm and osteolysis has only rarely been observed in association with well-fixed metal-on-metal total hip replacements. Hypersensitivity is not a common cause of loosening with second-generation hip replacements and remains to be proven as a definitive diagnosis in unusual cases of unexplained pain. More than 40 years of use has demonstrated no increase in the incidence of renal failure or cancer in patients with metal-on-metal total hip replacements. The scientific evidence of the results using the metal-on-metal articulations would recommend its continued use in any patient who does not have compromised renal function. PMID:16089065

  6. Comparison of synovial fluid, urine, and serum ion levels in metal-on-metal total hip arthroplasty at a minimum follow-up of 18 years.

    PubMed

    Lass, Richard; Grübl, Alexander; Kolb, Alexander; Stelzeneder, David; Pilger, Alexander; Kubista, Bernd; Giurea, Alexander; Windhager, Reinhard

    2014-09-01

    Diagnosis of adverse reactions to metal debris in metal-on-metal hip arthroplasty is a multifactorial process. Systemic ion levels are just one factor in the evaluation and should not be relied upon solely to determine the need for revision surgery. Furthermore, the correlation between cobalt or chromium serum, urine, or synovial fluid levels and adverse local tissue reactions is still incompletely understood. The hypothesis was that elevated serum and urine metal-ion concentrations are associated with elevated local metal-ion concentrations in primary total hip arthroplasties (THA) and with failure of metal-on-metal articulations in the long-term. In our present study, we evaluated these concentrations in 105 cementless THA with metal-on-metal articulating surfaces with small head diameter at a minimum of 18 years postoperatively. Spearman correlation showed a high correlation between the joint fluid aspirate concentration of cobalt and chromium with the serum cobalt (r = 0.81) and chromium level (r = 0.77) in patients with the THA as the only source of metal-ions. In these patients serum metal-ion analysis is a valuable method for screening. In patients with more than one source of metal or renal insufficiency additional investigations, like joint aspirations are an important tool for evaluation of wear and adverse tissue reactions in metal-on-metal THA. PMID:24841922

  7. Cementless fixation in total knee arthroplasty: past, present, and future.

    PubMed

    Meneghini, R Michael; Hanssen, Arlen D

    2008-10-01

    Cementless fixation in total knee arthroplasty (TKA) has had limited use in recent decades due to past failures in the early generation of cementless designs. Screw track osteolysis, poor polyethylene, and metal-backed patellar component failures contributed to a controversial track record and created a reluctance to embrace cementless fixation in TKA; however, these failure mechanisms are correctable. In addition, there is renewed interest in cementless fixation due to the recent development of improved biomaterials, particularly highly porous metals and highly crosslinked polyethylene, as well as time-saving advantages and long-term osseointegration of cementless fixation. There are long-term reports of successful designs of cementless knee arthroplasty that are nearly equal to the results of cemented designs. This article discusses the past history, current long-term results, and future of cementless fixation in TKA. PMID:18979934

  8. Short-term results with the Zweymueller-SL metal-on-metal total hip arthroplasty.

    PubMed

    Korovessis, Panagiotis; Petsinis, Georgios; Repanti, Maria; Papazisis, Zisis; Iliopoulos, Panagiotis; Soucacos, Panagiotis N

    2002-01-01

    In a prospective study we followed 266 consecutive patients who received 350 Zweymueller-SL uncemented total hip replacements with metal-on-metal articulation for osteoarthritis. Mean follow-up was 52 (range 37-92) months. Patient age at the time of surgery was 55±9 (25-70) years. Pre-operative Harris score of 45±19 was increased post-operatively to 96±4. Pre-operative invalidity was significantly improved post-operatively (P<0.001), and 97% of the patients were either satisfied or very satisfied with the results. There was no aseptic loosening of either component. Revision was made in six hips (1.8%) because of either septic loosening (five, 1.5%) or technical error (one, 0.3%). At revision, surgical microscopic evidence for metalosis (Mirra grades 1 and 2) was shown in all revised hips. The reasons for early loosening were unrelated to the metal-on-metal bearing but rather were the result of either low-grade deep infection or inadequate surgical technique. Survival rate for Zweymueller screw socket and stem 7.6 years after implantation was 99.4% and 96.8% respectively. There was no evidence that metal-on-metal articulation gives rise to new problems or complications. PMID:24570158

  9. Complications Related to Metal-on-Metal Articulation in Trapeziometacarpal Joint Total Joint Arthroplasty

    PubMed Central

    Frølich, Christina; Hansen, Torben Bæk

    2015-01-01

    Adverse reactions to metal-on-metal (MoM) prostheses are well known from total hip joint resurfacing arthroplasty with elevated serum chrome or cobalt, pain and pseudo tumor formation. It may, however, also be seen after total joint replacement of the trapeziometacarpal joint using MoM articulation, and we present two cases of failure of MoM prostheses due to elevated metal-serum levels in one case and pseudo tumor formation in another case. Furthermore, we suggest a diagnostic algorithm for joint pain after MoM trapeziometacarpal joint replacement based on published experiences from MoM hip prostheses and adverse reactions to metal. PMID:26020592

  10. Comparison of cementless and hybrid cemented total knee arthroplasty.

    PubMed

    Lass, Richard; Kubista, Bernd; Holinka, Johannes; Pfeiffer, Martin; Schuller, Spiro; Stenicka, Sandra; Windhager, Reinhard; Giurea, Alexander

    2013-04-01

    Cementless total knee arthroplasty (TKA) implants were designed to provide long-term fixation without the risk of cement-associated complications. The purpose of this study was to evaluate the outcome of titanium-coated cementless implants compared with hybrid TKA implants with a cemented tibial and a cementless femoral component. The authors performed a case-control, single-center study of 120 TKAs performed between 2003 and 2007, including 60 cementless and 60 hybrid cemented TKAs. The authors prospectively analyzed the radiographic and clinical data and the survivorship of the implants at a minimum follow-up of 5 years. Ninety patients who underwent TKA completed the 5-year assessment. Knee Society Scores increased significantly in both groups (P<.001). In both groups, 2 patients underwent revision due to aseptic tibial component loosening, resulting in a 96% implant survival rate. Radiographs showed significantly less radiolucent lines around the tibial baseplate in the cementless group (n=12) than in the hybrid cemented group (n=26) (P=.009).At 6-year mean follow-up, no significant difference existed between the cementless and hybrid cemented tibial components in TKA in terms of clinical and functional results and postoperative complications. The significantly smaller number of radiolucent lines in the cementless group is an indicator of primary stability with the benefit of long-term fixation durability of TKA. PMID:23590780

  11. High Re-Operation Rates Using Conserve Metal-On-Metal Total Hip Articulations

    PubMed Central

    Mogensen, S.L.; Jakobsen, T.; Christoffersen, H.; Krarup, N.

    2016-01-01

    Introduction: Metal-on-metal hip articulations have been intensely debated after reports of adverse reactions and high failure rates. The aim of this study was to retrospectively evaluate the implant of a metal-on.metal total hip articulation (MOM THA) from a single manufacture in a two-center study. Materials and Methods: 108 CONSERVE® MOM THA were implanted in 92 patients between November 2005 and December 2010. Patients had at time of retrospective evaluation their journals reviewed for re-operations and adverse reactions. Results: 20 hips were re-operated (18.4%) at a mean follow up of 53 months. 4 pseudotumors were diagnosed at time of follow up but no substantiated link was made between adverse reactions and re-operations. Conclusion: The high re-operation rates found in this study raised concern about the usage of the MOM THA and subsequently lead to the termination of implantation of this MOM THA at the two orthopaedic departments. PMID:27099640

  12. Friction in metal-on-metal total disc arthroplasty: effect of ball radius.

    PubMed

    Moghadas, Parshia; Mahomed, Aziza; Hukins, David W L; Shepherd, Duncan E T

    2012-02-01

    Total disc arthroplasty (TDA) can be used to replace a degenerated intervertebral disc in the spine. There are different designs of prosthetic discs, but one of the most common is a ball-and-socket combination. Contact between the bearing surfaces can result in high frictional torque, which can then result in wear and implant loosening. This study was designed to determine the effects of ball radius on friction. Generic models of metal-on-metal TDA were manufactured with ball radii of 10, 12, 14 and 16 mm, with a radial clearance of 0.015 mm. A simulator was used to test each sample in flexion-extension, lateral bending and axial rotation at frequencies of 0.25, 0.5, 0.75, 1, 1.25, 1.5, 1.75 and 2 Hz under loads of 50, 600, 1200 and 2000 N, in new born calf serum. Frictional torque was measured and Stribeck curves were plotted to illustrate the lubrication regime in each case. It was observed that implants with a smaller ball radius showed lower friction and showed boundary and mixed lubrication regimes, whereas implants with larger ball radius showed boundary lubrication only. This study suggests designing metal-on-metal TDAs with ball radius of 10 or 12 mm, in order to reduce wear and implant loosening. PMID:22177670

  13. Poor mid-term survival of the low-carbide metal-on-metal Zweymüller-plus total hip arthroplasty system: a concise follow-up, at a minimum of ten years, of a previous report*.

    PubMed

    Repantis, Thomas; Vitsas, Vasilis; Korovessis, Panagiotis

    2013-03-20

    Between 1994 and 1999, 217 metal-on-metal total hip arthroplasties with a low-carbide bearing surface were performed with use of the cementless Zweymüller SL-Plus stem and the Bicon-Plus threaded cup in 194 consecutive patients. After a minimum follow-up of ten years, 181 living patients (203 hips) were available for evaluation. The revision rate after an average of twelve years was 18% (thirty-six hips in thirty-six patients were revised). The main reason for revision was aseptic loosening of one or both components. The probability of survival of the stem at fifteen years was 77% (95% confidence interval [CI], 65% to 86%). The probability of survival of the cup was 80% (95% CI, 62% to 90%). These high failure rates at mid-term follow-up led us to abandon the use of low-carbide metal-on-metal total hip arthroplasty components. PMID:23515994

  14. Metal-on-metal total hip arthroplasty: is there still a role in 2016?

    PubMed

    Silverman, Edward J; Ashley, Blair; Sheth, Neil P

    2016-03-01

    The use of metal-on-metal (MoM) bearings in total hip arthroplasty (THA) was popularized due to its enhanced wear profile and the ability to use large femoral heads to reduce post-operative instability. However, enthusiasm for the bearing declined following serious complications encountered at the primary articulation. This review discusses the development of MoM and the subsequent unexpected downstream challenges, most notably elevated serum metal ion levels, aseptic lymphocyte-dominated vasculitis-associated lesions (ALVAL), pseudotumor formation, and subsequent soft tissue and bone destruction. Both patient centered risk factors as well as component design led to high early failure rates resulting in product recalls and an overall decline in the use of MoM. In 2016, there is not a role for large-head MoM bearing in THA. Alternatively, the bearing has shown promise in hip resurfacing procedures for carefully selected patients. PMID:26791173

  15. Cemented versus cementless fixation in total knee arthroplasty.

    PubMed

    Matassi, Fabrizio; Carulli, Christian; Civinini, Roberto; Innocenti, Massimo

    2013-01-01

    The question of whether to use cemented or cement-less fixation for a total knee arthroplasty (TKA) is still debated. Discouraging preliminary results of cement-less TKAs have determined the worldwide use of cemented implants. However, with the development of biotechnologies and new biomaterials with high osteoconductive properties, biological fixation is now becoming an attractive option for improving the longevity of TKAs, especially in young patients. There is no evidence in the current literature to support the use of one method of fixation. The extensive clinical experience with cemented implants gathered over the years justifies their widespread use. New randomized clinical trials are necessary to compare cementless fixation based on the new ingrowth surfaces with standard cemented implants. PMID:25606521

  16. Cemented versus cementless fixation in total knee arthroplasty

    PubMed Central

    MATASSI, FABRIZIO; CARULLI, CHRISTIAN; CIVININI, ROBERTO; INNOCENTI, MASSIMO

    2013-01-01

    The question of whether to use cemented or cement-less fixation for a total knee arthroplasty (TKA) is still debated. Discouraging preliminary results of cement-less TKAs have determined the worldwide use of cemented implants. However, with the development of biotechnologies and new biomaterials with high osteoconductive properties, biological fixation is now becoming an attractive option for improving the longevity of TKAs, especially in young patients. There is no evidence in the current literature to support the use of one method of fixation. The extensive clinical experience with cemented implants gathered over the years justifies their widespread use. New randomized clinical trials are necessary to compare cementless fixation based on the new ingrowth surfaces with standard cemented implants. PMID:25606521

  17. Metallic debris from metal-on-metal total hip arthroplasty regulates periprosthetic tissues

    PubMed Central

    Lohmann, Christoph H; Singh, Gurpal; Willert, Hans-Georg; Buchhorn, Gottfried H

    2014-01-01

    The era of metal-on-metal (MoM) total hip arthroplasty has left the orthopaedic community with valuable insights and lessons on periprosthetic tissue reactions to metallic debris. Various terms have been used to describe the tissue reactions. Sometimes the nomenclature can be confusing. We present a review of the concepts introduced by Willert and Semlitsch in 1977, along with further developments made in the understanding of periprosthetic tissue reactions to metallic debris. We propose that periprosthetic tissue reactions be thought of as (1) gross (metallosis, necrosis, cyst formation and pseudotumour); (2) histological (macrophage-dominated, lymphocyte-dominated or mixed); and (3) molecular (expression of inflammatory mediators and cytokines such as interleukin-6 and tumor necrosis factor-alpha). Taper corrosion and modularity are discussed, along with future research directions to elucidate the antigen-presenting pathways and material-specific biomarkers which may allow early detection and intervention in a patient with adverse periprosthetic tissue reactions to metal wear debris. PMID:25405095

  18. Poor short term outcome with a metal-on-metal total hip arthroplasty.

    PubMed

    Levy, Yadin D; Ezzet, Kace A

    2013-08-01

    Metal-on-metal (MoM) bearings for total hip arthroplasty (THA) have come under scrutiny with reports of high failure rates. Clinical outcome studies with several commercially available MoM THA bearings remain unreported. We evaluated 78 consecutive MoM THAs from a single manufacturer in 68 patients. Sixty-six received cobalt-chrome (CoCr) monoblock and 12 received modular titanium acetabular cups with internal CoCr liners. Femoral components were titanium with modular necks. At average 2.1 years postoperatively, 12 THAs (15.4%) demonstrated aseptic failure (10 revisions, 2 revision recommended). All revised hips demonstrated capsular necrosis with positive histology reaction for aseptic lymphocytic vasculitis-associated lesions/adverse local tissue reactions. Prosthetic instability following revision surgery was relatively common. Female gender was a strong risk factor for failure, though smaller cups were not. Both monoblock and modular components fared poorly. Corrosion was frequently observed around the proximal and distal end of the modular femoral necks. PMID:23538122

  19. Acute delayed infection: increased risk in failed metal on metal total hip arthroplasty.

    PubMed

    Prieto, Hernan A; Berbari, Elie F; Sierra, Rafael J

    2014-09-01

    Adverse local tissue reactions occurring in metal-on-metal total hip arthroplasty (MoM THA) could potentially lead to secondary failure modes such as dislocation or infection. The authors report a series of 124 patients treated with MoM hip arthroplasty between 2006 and 2010 with a minimum follow-up of 3 years. Eight hips presented with acute delayed or late periprosthetic joint infection (PJI) (defined as an infection occurring after 3 months in an otherwise well functioning implant). The rate of infection observed was higher than expected, almost 4 times higher (5.6%) compared to previous historical cohorts from our institution (1.3%). This high risk of infection in patients with DePuy ASR implants requires further study but we theorize that the increased prevalence of infection could be due to a combination of particulate debris, molecular (rather than particulate) effects of Co and Cr ions on soft tissues, and/or products of corrosion that may change the local environment predisposing to infection. PMID:24851788

  20. Midterm results of 36 mm metal-on-metal total hip arthroplasty

    PubMed Central

    Akrawi, Hawar; Hossain, Fahad S; Niculescu, Stefan; Hashim, Zaid; Ng, Arron Biing; Shetty, Ajit

    2016-01-01

    Background: Despite the many perceived benefits of metal-on-metal (MoM) articulation in total hip arthroplasty (THA), there have been growing concerns about metallosis and adverse reaction to metal debris (ARMD). Analysis of size 36 mm MoM articulation THAs is presented. These patients were evaluated for patient characteristics, relationship between blood metal ions levels and the inclination as well as the version of acetabular component, cumulative survival probability at final followup and functional outcome at final followup. Materials and Methods: 288, size 36 mm MoM THAs implanted in 269 patients at our institution from 2004 to 2010 were included in this retrospective study. These patients were assessed clinically for hip symptoms, perioperative complications and causes of revision arthroplasty were analysed. Biochemically, blood cobalt and chromium metal ions level were recorded and measurements of acetabular inclination and version were examined. Radiological evaluation utilizing Metal Artefact Reduction Sequence (MARS) MRI was undertaken and implant cumulative survivorship was evaluated. Results: The mean followup was 5 years (range 2–7 years), mean age was 73 years and the mean Oxford hip score was 36.9 (range 5–48). Revision arthroplasty was executed in 20 (7.4%) patients, of which 15 patients underwent single-stage revision THA. The causes of revision arthroplasty were: ARMD changes in 6 (2.2%) patients, infection in 5 (1.9%) patients and aseptic loosening in 5 (1.9%) patients. Three (1.1%) patients had their hips revised for instability, 1 (0.3%) for raised blood metal ions levels. The implant cumulative survival rate, with revision for any reason, was 68.9% at 7 years. Conclusions: Although medium-sized MoM THA with a 36 mm head has a marginally better survivorship at midterm followup, compared to larger size head MoM articulating THA, our findings nonetheless are still worryingly poor in comparison to what has been quoted in the literature

  1. Long-duration metal-on-metal total hip arthroplasties with low wear of the articulating surfaces.

    PubMed

    Schmalzried, T P; Peters, P C; Maurer, B T; Bragdon, C R; Harris, W H

    1996-04-01

    The 20-year performance of metal-on-metal hip articulations has not been reported. Five McKee-Farrar total hip prostheses and one Sivash prosthesis were obtained at revision surgery after a mean implantation time of 21.3 years. A radiographic, histologic, implant, and wear analysis was performed on these total hip implants with cobalt-chrome metal-on-metal articulations. All cases were associated with femoral component loosening, but the bearing surfaces performed remarkably well. The worst case estimate of combined femoral and acetabular linear wear was 4.2 microns per year, about 25 times less than that typically seen with polyethylene. Metal particles and foreign-body inflammation were seen in all cases, but the volume of reactive tissue was small compared with what is generally seen at revision of hips with a polyethylene acetabular bearing. This may be due to a reduced particle burden or a decreased inflammatory reaction to particulate metal, or both. In addition to articular wear, other sources of metal particles included femoral neck impingement on the acetabular rim, stem burnishing, and corrosion. Prosthetic hip reconstructions can fail for many reasons, including suboptimal femoral stem and/or acetabular cup design and/or fixation. By today's standards, the McKee-Farrar and Sivash stem and acetabular component designs are suboptimal; however, after more than 20 years of use, the metal-on-metal bearing surfaces in these cases demonstrated low wear and do not appear to be the cause of failure. Recent advances in total hip arthroplasty, which include improved implant design, materials, manufacturing, and fixation, combined with a better understanding of the mechanisms of implant loosening and failure, suggest that the cobalt-chrome metal-on-metal bearing be reexamined as an alternative to polyethylene when exceptional durability is required. PMID:8713913

  2. Cutaneous manifestation of metallosis in a metal-on-metal total hip arthroplasty after acetabular liner dissociation.

    PubMed

    Sporer, Scott M; Chalmers, Peter N

    2012-09-01

    In this case report, we describe a cutaneous manifestation of extensive metallosis in a patient 4 months post-metal-on-metal total hip arthroplasty with a Pinnacle cup with dissociation of the liner from the shell and resultant stripe burnishing of the shell and notch wear of the femoral neck. Dissociation of a metal liner has not been previously reported with this implant. Cutaneous metallosis has only been reported once in the literature. Clinicians should heighten their suspicion for metallosis secondary to hardware failure when encountering patients with skin discoloration in the setting of a painful and poorly functioning hip arthroplasty. In patients with failure of a metal-on-metal prosthesis with a modular metal liner in the acetabular component, liner dissociation must be considered. PMID:22397858

  3. Gender is a significant factor for failure of metal-on-metal total hip arthroplasty.

    PubMed

    Latteier, Michael J; Berend, Keith R; Lombardi, Adolph V; Ajluni, Andrew F; Seng, Brian E; Adams, Joanne B

    2011-09-01

    Metal-on-metal (MoM) articulations offers low wear, larger head size, and increased stability. Reports of early failure are troubling and include failure of ingrowth and metal articulation problems such as metallosis, hypersensitivity, pseudotumor, and unexplained pain. This study investigates the survivorship of modern MoM articulations by gender. We reviewed 1589 primary MoM THA in 1363 patients, with minimum 2-year follow-up for 1212 hips. Follow-up averaged 60 months. There were 643 female patients and 719 male patients. The incidence of cup revision was significantly higher in women than in men (8.2% vs 2.7%; P = .0000), as was incidence of aseptic loosening (4.3% vs 1.1%; P = .0006), and failure for metal-bearing complications (2.2% vs 0.6%; P = .0126). There appear to be gender factors influencing the success of MoM THA, which may include hormonal, anatomic, or functional differences. PMID:21641761

  4. Understanding the differences between the wear of metal-on-metal and ceramic-on-metal total hip replacements.

    PubMed

    Figueiredo-Pina, C G; Yan, Y; Neville, A; Fisher, J

    2008-04-01

    Hip simulator studies have been carried out extensively to understand and test artificial hip implants in vitro as an efficient alternative to obtaining long-term results in vivo. Recent studies have shown that a ceramic-on-metal material combination lowers the wear by up to 100 times in comparison with a typical metal-on-metal design. The reason for this reduction remains unclear and for this reason this study has undertaken simple tribometer tests to understand the fundamental material loss mechanisms in two material combinations: metal-on-metal and ceramic-on-ceramic. A simple-configuration reciprocating pin-on-plate wear study was performed under open-circuit potential (OCP) and with applied cathodic protection (CP) in a serum solution using two tribological couples: firstly, cobalt-chromium (Co-Cr) pins against Co-Cr plates; secondly, Co-Cr pins against alumina (Al2O3) plates. The pin and plate surfaces prior to and after testing were examined by profilometry and scanning electron microscopy. The results showed a marked reduction in wear when CP was applied, indicating that total material degradation under the OCP condition was attributed to corrosion processes. The substitution of the Co-Cr pin with an Al2O3 plate also resulted in a dramatic reduction in wear, probably due to the reduction in the corrosion-wear interactions between the tribological pair. PMID:18491698

  5. Cement or cementless fixation in total knee arthroplasty?

    PubMed

    Rand, J A

    1991-12-01

    A prospectively studied group of 59 knees with cementless fixation were compared to a retrospectively studied but matched group of 59 knees with cement fixation using a Press Fit Condylar prosthesis. The only significant preoperative difference between the patient groups was mean age; the cemented group was on average nine years older than the cementless group (p less than 0.0001). At an average of 2.8 years after surgery, there were no significant differences in knee scores between the two groups. Radiolucent lines adjacent to the tibial component were similar in both groups. The complication rate of 20% in the cementless knees was higher than the 12% rate in the cemented knees; this was primarily related to polyethylene wear of metal-backed patellar components. Cement or cementless fixation of this prosthesis appears to provide equivalent early results. PMID:1959287

  6. Mortality rates at 10 years after metal-on-metal hip resurfacing compared with total hip replacement in England: retrospective cohort analysis of hospital episode statistics

    PubMed Central

    Kendal, Adrian R; Prieto-Alhambra, Daniel; Arden, Nigel K; Judge, Andrew

    2013-01-01

    Objectives To compare 10 year mortality rates among patients undergoing metal-on-metal hip resurfacing and total hip replacement in England. Design Retrospective cohort study. Setting English hospital episode statistics database linked to mortality records from the Office for National Statistics. Population All adults who underwent primary elective hip replacement for osteoarthritis from April 1999 to March 2012. The exposure of interest was prosthesis type: cemented total hip replacement, uncemented total hip replacement, and metal-on-metal hip resurfacing. Confounding variables included age, sex, Charlson comorbidity index, rurality, area deprivation, surgical volume, and year of operation. Main outcome measures All cause mortality. Propensity score matching was used to minimise confounding by indication. Kaplan-Meier plots estimated the probability of survival up to 10 years after surgery. Multilevel Cox regression modelling, stratified on matched sets, described the association between prosthesis type and time to death, accounting for variation across hospital trusts. Results 7437 patients undergoing metal-on-metal hip resurfacing were matched to 22 311 undergoing cemented total hip replacement; 8101 patients undergoing metal-on-metal hip resurfacing were matched to 24 303 undergoing uncemented total hip replacement. 10 year rates of cumulative mortality were 271 (3.6%) for metal-on-metal hip resurfacing versus 1363 (6.1%) for cemented total hip replacement, and 239 (3.0%) for metal-on-metal hip resurfacing versus 999 (4.1%) for uncemented total hip replacement. Patients undergoing metal-on-metal hip resurfacing had an increased survival probability (hazard ratio 0.51 (95% confidence interval 0.45 to 0.59) for cemented hip replacement; 0.55 (0.47 to 0.65) for uncemented hip replacement). There was no evidence for an interaction with age or sex. Conclusions Patients with hip osteoarthritis undergoing metal-on-metal hip resurfacing have reduced mortality in

  7. Preparation of the proximal femur in cementless total hip revision.

    PubMed

    Mallory, T H

    1988-10-01

    With an increased incidence of revision for the failed cemented total hip arthroplasty, techniques of revision surgery need meticulous attention to detail. Although the causes of the failed cemented total hip arthroplasty are many, they tend to follow characteristic patterns. The proximal femur can be exposed through an extensive muscle split incision, which offers a complete circumferential view of the femur. The cement removal is enhanced by controlled perforation using high-speed drills. Classification of bony deficits of the proximal femur can be divided into Type I, including intact cortex and medullary content; Type II, in which there is intact cortex but deficient medullary content; and Type III, in which deficits of both the cortex and medullary canal are present. Prosthetic selection is based on residual bone stock. In general, cementless fixation is advocated, with distal fixation using long-stem devices. Augmentation of bone deficits requires the use of segmental prosthetic replacement or fresh-frozen allografts. One hundred sixty patients were followed for two to six years. Satisfactory results have occurred in over 90% of the patients; better results are anticipated in patients with minimal bone deficits. Aseptic loosening requiring rerevision has occurred in 5% of the patient population. Understanding the dynamics of failure and the residual bone deficits allows one to manage the failed cemented total hip arthroplasty with greater efficiency and predictability. PMID:3416541

  8. Perfusion MRI in hips with metal-on-metal and metal-on-polyethylene total hip arthroplasty

    PubMed Central

    Anwander, H.; Cron, G. O.; Rakhra, K.

    2016-01-01

    Objectives Hips with metal-on-metal total hip arthroplasty (MoM THA) have a high rate of adverse local tissue reactions (ALTR), often associated with hypersensitivity reactions. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) measures tissue perfusion with the parameter Ktrans (volume transfer constant of contrast agent). Our purpose was 1) to evaluate the feasibility of DCE-MRI in patients with THA and 2) to compare DCE-MRI in patients with MoM bearings with metal-on-polyethylene (MoP) bearings, hypothesising that the perfusion index Ktrans in hips with MoM THA is higher than in hips with MoP THA. Methods In this pilot study, 16 patients with primary THA were recruited (eight MoM, eight MoP). DCE-MRI of the hip was performed at 1.5 Tesla (T). For each patient, Ktrans was computed voxel-by-voxel in all tissue lateral to the bladder. The mean Ktrans for all voxels was then calculated. These values were compared with respect to implant type and gender, and further correlated with clinical parameters. Results There was no significant difference between the two bearing types with both genders combined. However, dividing patients by THA bearing and gender, women with MoM bearings had the highest Ktrans values, exceeding those of women with MoP bearings (0.067 min−1 versus 0.053 min−1; p-value < 0.05) and men with MoM bearings (0.067 min−1 versus 0.034 min−1; p-value < 0.001). Considering only the men, patients with MoM bearings had lower Ktrans than those with MoP bearings (0.034 min−1 versus 0.046 min−1; p < 0.05). Conclusion DCE-MRI is feasible to perform in tissues surrounding THA. Females with MoM THA show high Ktrans values in DCE-MRI, suggesting altered tissue perfusion kinematics which may reflect relatively greater inflammation. Cite this article: Dr P. E. Beaule. Perfusion MRI in hips with metal-on-metal and metal-on-polyethylene total hip arthroplasty: A pilot stud. Bone Joint Res 2016;5:73–79. DOI: 10

  9. Twenty-year survivorship of cementless anatomic graduated component total knee arthroplasty.

    PubMed

    Ritter, Merrill A; Meneghini, R Michael

    2010-06-01

    There is a renewed interest in cementless total knee arthroplasty (TKA) due to improved biomaterials, desire for decreased surgical times and the potential increased longevity. Seventy-three cementless TKAs (AGC, Biomet, Warsaw, Ind) were performed from 1984 to 1986. All components were implanted without cement and without screws and obtained minimum 10 years of follow-up. No patient was lost to follow-up. Fifteen failures occurred, including 12 failed metal-backed patellae, and survivorship for aseptic loosening of any component was 76.4% at 20 years. Two tibial components failed of aseptic loosening at 1.1 and 2.2 years. Excluding patella failures, the survivorship for the cementless tibial component was 96.8% at 20 years. There were no femoral component failures. After eliminating patella failures, this cementless monoblock tibial component without screws demonstrated excellent 20-year survivorship. PMID:19427163

  10. Pseudotumour incidence, cobalt levels and clinical outcome after large head metal-on-metal and conventional metal-on-polyethylene total hip arthroplasty: mid-term results of a randomised controlled trial.

    PubMed

    van der Veen, H C; Reininga, I H F; Zijlstra, W P; Boomsma, M F; Bulstra, S K; van Raay, J J A M

    2015-11-01

    We compared the incidence of pseudotumours after large head metal-on-metal (MoM) total hip arthroplasty (THA) with that after conventional metal-on-polyethylene (MoP) THA and assessed the predisposing factors to pseudotumour formation. From a previous randomised controlled trial which compared large head (38 mm to 60 mm) cementless MoM THA with conventional head (28 mm) cementless MoP THA, 93 patients (96 THAs: 41 MoM (21 males, 20 females, mean age of 64 years, standard deviation (sd) 4) and 55 MoP (25 males, 30 females, mean age of 65 years, sd 5) were recruited after a mean follow-up of 50 months (36 to 64). The incidence of pseudotumours, measured using a standardised CT protocol was 22 (53.7%) after MoM THA and 12 (21.8%) after MoP THA. Women with a MoM THA were more likely to develop a pseudotumour than those with a MoP THA (15 vs 7, odds ratio (OR) = 13.4, p < 0.001). There was a similar incidence of pseudotumours in men with MoM THAs and those with MoP THAs (7 vs 5, OR = 2.1, p = 0.30). Elevated cobalt levels (≥ 5 microgram/L) were only associated with pseudotumours in women with a MoM THA. There was no difference in mean Oxford and Harris hip scores between patients with a pseudotumour and those without. Contrary to popular belief, pseudotumours occur frequently around MoP THAs. Women with a MoM THA and an elevated cobalt level are at greatest risk. In this study, pseudotumours had no effect on the functional outcome after either large head MoM or conventional MoP THA. PMID:26530649

  11. 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

    PubMed Central

    Meessen, J. M. T. A.; Fiocco, M.; van der Heide, H. J. L.; Sedrakyan, A.; Nelissen, R. G. H. H.

    2016-01-01

    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

  12. Does bearing size influence metal ion levels in large-head metal-on-metal total hip arthroplasty? A comparison of three total hip systems

    PubMed Central

    2014-01-01

    Background The purpose of the study was twofold: first, to determine whether there is a statistically significant difference in the metal ion levels among three different large-head metal-on-metal (MOM) total hip systems. The second objective was to assess whether position of the implanted prostheses, patient demographics or factors such as activity levels influence overall blood metal ion levels and whether there is a difference in the functional outcomes between the systems. Methods In a cross-sectional cohort study, three different metal-on-metal total hip systems were assessed: two monoblock heads, the Durom socket (Zimmer, Warsaw, IN, USA) and the Birmingham socket (Smith and Nephew, Memphis, TN, USA), and one modular metal-on-metal total hip system (Pinnacle, Depuy Orthopedics, Warsaw, IN, USA). Fifty-four patients were recruited, with a mean age of 59.7 years and a mean follow-up time of 41 months (12 to 60). Patients were evaluated clinically, radiologically and biochemically. Statistical analysis was performed on all collected data to assess any differences between the three groups in terms of overall blood metal ion levels and also to identify whether there was any other factor within the group demographics and outcomes that could influence the mean levels of Co and Cr. Results Although the functional outcome scores were similar in all three groups, the blood metal ion levels in the larger monoblock large heads (Durom, Birmingham sockets) were significantly raised compared with those of the Pinnacle group. In addition, the metal ion levels were not found to have a statistically significant relationship to the anteversion or abduction angles as measured on the radiographs. Conclusions When considering a MOM THR, the use of a monoblock large-head system leads to higher elevations in whole blood metal ions and offers no advantage over a smaller head modular system. PMID:24472283

  13. Prediction of contact mechanics in metal-on-metal Total Hip Replacement for parametrically comprehensive designs and loads.

    PubMed

    Donaldson, Finn E; Nyman, Edward; Coburn, James C

    2015-07-16

    Manufacturers and investigators of Total Hip Replacement (THR) bearings require tools to predict the contact mechanics resulting from diverse design and loading parameters. This study provides contact mechanics solutions for metal-on-metal (MoM) bearings that encompass the current design space and could aid pre-clinical design optimization and evaluation. Stochastic finite element (FE) simulation was used to calculate the head-on-cup contact mechanics for five thousand combinations of design and loading parameters. FE results were used to train a Random Forest (RF) surrogate model to rapidly predict the contact patch dimensions, contact area, pressures and plastic deformations for arbitrary designs and loading. In addition to widely observed polar and edge contact, FE results included ring-polar, asymmetric-polar, and transitional categories which have previously received limited attention. Combinations of design and load parameters associated with each contact category were identified. Polar contact pressures were predicted in the range of 0-200 MPa with no permanent deformation. Edge loading (with subluxation) was associated with pressures greater than 500 MPa and induced permanent deformation in 83% of cases. Transitional-edge contact (with little subluxation) was associated with intermediate pressures and permanent deformation in most cases, indicating that, even with ideal anatomical alignment, bearings may face extreme wear challenges. Surrogate models were able to accurately predict contact mechanics 18,000 times faster than FE analyses. The developed surrogate models enable rapid prediction of MoM bearing contact mechanics across the most comprehensive range of loading and designs to date, and may be useful to those performing bearing design optimization or evaluation. PMID:25980556

  14. No association between serum metal ions and implant fixation in large-head metal-on-metal total hip arthroplasty

    PubMed Central

    Søballe, Kjeld; Jakobsen, Stig Storgaard; Lorenzen, Nina Dyrberg; Mechlenburg, Inger; Stilling, Maiken

    2014-01-01

    Background The mechanism of failure of metal-on-metal (MoM) total hip arthroplasty (THA) has been related to a high rate of metal wear debris, which is partly generated from the head-trunnion interface. However, it is not known whether implant fixation is affected by metal wear debris. Patients and methods 49 cases of MoM THA in 41 patients (10 women) with a mean age of 52 (28–68) years were followed with stereoradiographs after surgery and at 1, 2, and 5 years to analyze implant migration by radiostereometric analysis (RSA). Patients also participated in a 5- to 7-year follow-up with measurement of serum metal ions, questionnaires (Oxford hip score (OHS) and Harris hip score (HHS)), and measurement of cup and stem positions and systemic bone mineral density. Results At 1–2 years, mean total translation (TT) was 0.04 mm (95% CI: –0.07 to 0.14; p = 0.5) for the stems; at 2–5 years, mean TT was 0.13 mm (95% CI: –0.25 to –0.01; p = 0.03), but within the precision limit of the method. For the cups, there was no statistically significant TT or total rotation (TR) at 1–2 and 2–5 years. At 2–5 years, we found 4 cups and 5 stems with TT migrations exceeding the precision limit of the method. There was an association between cup migration and total OHS < 40 (4 patients, 4 hips; p = 0.04), but there were no statistically significant associations between cup or stem migration and T-scores < –1 (n = 10), cup and stem positions, or elevated serum metal ion levels (> 7µg/L (4 patients, 6 hips)). Interpretation Most cups and stems were well-fixed at 1–5 years. However, at 2–5 years, 4 cups and 5 stems had TT migrations above the precision limits, but these patients had serum metal ion levels similar to those of patients without measurable migrations, and they were pain-free. Patients with serum metal ion levels > 7 µg/L had migrations similar to those in patients with serum metal ion levels < 7 µg/L. Metal wear debris does not appear to influence the

  15. Particle characterisation and cytokine expression in failed small-diameter metal-on-metal total hip arthroplasties.

    PubMed

    Singh, G; Nuechtern, J V; Meyer, H; Fiedler, G M; Awiszus, F; Junk-Jantsch, S; Bruegel, M; Pflueger, G; Lohmann, C H

    2015-07-01

    The peri-prosthetic tissue response to wear debris is complex and influenced by various factors including the size, area and number of particles. We hypothesised that the 'biologically active area' of all metal wear particles may predict the type of peri-prosthetic tissue response. Peri-prosthetic tissue was sampled from 21 patients undergoing revision of a small diameter metal-on-metal (MoM) total hip arthroplasty (THA) for aseptic loosening. An enzymatic protocol was used for tissue digestion and scanning electron microscope was used to characterise particles. Equivalent circle diameters and particle areas were calculated. Histomorphometric analyses were performed on all tissue specimens. Aspirates of synovial fluid were collected for analysis of the cytokine profile analysis, and compared with a control group of patients undergoing primary THA (n = 11) and revision of a failed ceramic-on-polyethylene arthroplasty (n = 6). The overall distribution of the size and area of the particles in both lymphocyte and non-lymphocyte-dominated responses were similar; however, the subgroup with lymphocyte-dominated peri-prosthetic tissue responses had a significantly larger total number of particles. 14 cytokines (interleukin (IL)-1ß, IL-2, IL-4, IL-5, IL-6, IL-10, IL-13, IL-17, interferon (IFN)-γ, and IFN-gamma-inducible protein 10), chemokines (macrophage inflammatory protein (MIP)-1α and MIP-1ß), and growth factors (granulocyte macrophage colony stimulating factor (GM-CSF) and platelet derived growth factor) were detected at significantly higher levels in patients with metal wear debris compared with the control group. Significantly higher levels for IL-1ß, IL-5, IL-10 and GM-CSF were found in the subgroup of tissues from failed MoM THAs with a lymphocyte-dominated peri-prosthetic response compared with those without this response. These results suggest that the 'biologically active area' predicts the type of peri-prosthetic tissue response. The cytokines IL-1ß, IL-5

  16. Cementless porous-coated anatomic medullary locking total hip prostheses.

    PubMed

    Kim, Y H; Kim, V E

    1994-06-01

    The authors studied 50 consecutive and nonselected patients (52 hips) who were followed for a minimum of 7 years (range, 84-89 months) after they had a primary total hip arthroplasty with an uncemented Anatomic Medullary Locking (DePuy, Warsaw, IN) hip system. The average age of the patients at operation was 47.6 years (range, 19-88 years). The operative diagnoses were: avascular necrosis of the femoral head in 18 hips (34%), osteoarthritis in 16 (31%), fracture of the femoral neck in 14 (27%), and miscellaneous in 4 (8%). The average preoperative Harris hip score was 59 points (range, 6-67 points) that improved to 91 points (range, 69-100 points) at the 7-year follow-up examination. To assess the adequacy of intramedullary fit, the fit of the stem at the proximal canal and isthmus level was evaluated. Forty-one hips (79%) had a good press-fit at both the proximal canal and isthmus level, five hips (10%) had a good press-fit at the proximal canal only, and the remaining six hips (11%) had a poor fit at both the proximal canal and isthmus level. Of the 46 hips that had a good press-fit at the proximal canal and/or isthmus level or proximal canal only, 32 (70%) had bone ingrowth and 14 (30%) had stable fibrous tissue ingrowth. Of the remaining six hips with a poor press-fit at both the proximal canal and isthmus level, three (6%) had stable fibrous tissue ingrowth and another three (6%) were unstable. Of the three hips (6%) with femoral component loosening, one was revised and the other two were asymptomatic. There was an alarmingly high incidence of perioprosthetic osteolysis in our series: 16 hips (31%) had acetabular and femoral osteolysis and 13 hips (25%) had femoral osteolysis only. Also, there was a strikingly high incidence of polyethylene-liner wear (12 hips or 23%). Although the incidence of component loosening was low, a high incidence of periprosthetic osteolysis and excessive wear in the polyethylene linear remain challenging problems after insertion of

  17. Outcomes of a Newer-Generation Cementless Total Knee Arthroplasty Design.

    PubMed

    Harwin, Steven F; Elmallah, Randa K; Jauregui, Julio J; Cherian, Jeffrey J; Mont, Michael A

    2015-10-01

    Newer-generation cementless total knee arthroplasties (TKAs) aim to improve durability, function, and longevity. In a large series of cementless TKAs at a mean 4-year follow-up, the authors evaluated (1) survivorship, (2) range of motion, (3) patient-reported outcomes, and (4) complications. Mean age was 66 years (range, 34-88 years) and mean body mass index was 32.5 kg/m(2) (range, 20-54 kg/m(2)). Aseptic and septic implant survivorships were 99.6% and 99.5%, respectively. Mean extension, flexion, and Knee Society scores improved significantly. There were 3 septic failures. Aseptic failures included 3 aseptic loosenings, 1 polyethylene revision, and 1 revision to a cemented patella. This study showed excellent clinical and patient-reported outcomes of cementless TKA. PMID:26488775

  18. Ten to twelve-year results with the Zweymüller cementless total hip prosthesis.

    PubMed

    Vervest, Ton M J S; Anderson, Patricia G; Van Hout, Freek; Wapstra, Frits-Hein; Louwerse, Robert T; Koetsier, Juriaan W A

    2005-04-01

    Between January 1987 and December 1990, 221 Zweymüller cementless total hip arthroplasties were performed in 211 patients with idiopathic osteoarthritis. A total of 136 patients (142 prostheses) were evaluated at a mean follow-up of 134 months (SD 9.5). The study group consisted of 78 Hochgezogen and 64 Stepless stem prostheses, all with a threaded titanium cup and ceramic head. No clinical and radiological differences were found between the 2 stem prostheses. Seven cups had been revised because of aseptic loosening; 17 cups showed radiolucent lines, osteolysis, or migration. Mean linear polyethylene wear of 105 (74%) cups was 0.46 mm (SD 0.27), with an annual wear of 0.04 mm (SD 0.02). Wear did not correlate with pain, cup migration, radiolucent lines, or osteolysis. Cumulative survival was 96%. Zweymüller cementless total hip arthroplasty showed good midterm results. PMID:15809956

  19. Evaluation of the wear properties of a metal-on-metal total joint replacement system and in vitro macrophage response to resultant wear particles

    NASA Astrophysics Data System (ADS)

    St. John, Kenneth Raymond

    The wear of the polyethylene in total joint prostheses has been a source of morbidity and early device failure which has been extensively reported in the last ten to twelve years. While research continues to attempt to reduce the wear of polyethylene joint bearing surfaces by modifications in polymer processing, there is a renewed interest in the use of metal-on-metal bearing couples for hip replacement devices. This study investigated the in vitro wear resistance of two cobalt/chromium/molybdenum alloys, which differed primarily in the carbon content, as potential alloys for use in such a metal-on-metal hip bearing couple. The results showed that the alloy with the higher (0.25%) carbon content was more wear resistant and this alloy was chosen for testing in a hip simulator system which modeled the loads and motions which might be exerted on a clinically implanted hip replacement. Comparison of the results of metal-on-polyethylene specimens to metal-on-metal specimens showed that the volumetric wear of the metal-on-polyethylene bearing couple over 5,000,000 cycles was 110--180 times as great as that for the metal bearing couple. Polyethylene and metal particles retrieved from either pin-on-disk testing lubricant or hip simulator testing lubricant were cleaned and examined for consistency with the particles reported by other laboratories for particles from periprosthetic tissues and found to be similar. The particles were then added to macrophage (J774a) cell cultures and the release of Prostaglandin E2, Interleukin-6, and Tumor Necrosis Factor alpha measured for each experiment in response to the particles. The cell mediators released by the cells was found to correlate with the dosage of particles and the chemical identity of the particles. Most of the cellular response to the polyethylene particles seemed to be as a result of phagocytosis of the particles while most of the response to metal particles seemed to be related to cytotoxicity of the particles. Based

  20. Cancer incidence and causes of death among total hip replacement patients: a review based on Nordic cohorts with a special emphasis on metal-on-metal bearings.

    PubMed

    Visuri, T I; Pukkala, E; Pulkkinen, P; Paavolainen, P

    2006-02-01

    All patients with total hip arthroplasty (THA) are exposed to soluble or particulate forms of Co and Cr. Adverse effects of these wear products are not known. Data from Nordic registries is used to estimate adverse effects on a large scale, based mostly on metal-on-polyethylene bearings. Cancer incidence was in line with the general population when the patients were operated on for all indications and significantly decreased when the indication was primary osteoarthritis. Stomach cancer and colorectal cancers were significantly reduced and prostate cancer and skin melanoma significantly increased. There was no significant excess of cancer in target organs, i.e. liver, kidney, or haematopoietic cancers. THA patients had reduced mortality and extended life expectancy compared with standard Nordic populations. All-site cancer incidence of the first-generation metal-on-metal McKee-Farrar patients operated on for primary osteoarthritis was in line with the general population after follow-up for up to 28 years. General mortality of these patients was also reduced and they also had an extended life expectancy. Temporary increases in haematopoietic cancers at different follow-up periods were seen in some cohorts. This malignancy deserves a special record linkage monitoring while large numbers of young patients are provided with the second generation of metal-on-metal prostheses. PMID:16669405

  1. Total knee arthroplasty using cementless keels and cemented tibial trays: 10-year results

    PubMed Central

    Kolisek, Frank R.; Mont, Michael A.; Seyler, Thorsten M.; Marker, David R.; Jessup, Nenette M.; Siddiqui, Junaed A.; Monesmith, Eric

    2008-01-01

    The problem of early mechanical stability of cemented and cementless keels of the tibial component in total knee arthroplasty (TKA) is controversial. The purpose of this study was to assess clinical and radiographic outcomes of a cohort of 51 TKAs using a cemented platform with cementless keel fixation. At a mean follow-up of 10.4 years (range, 7 to 14 years), the mean Knee Society Score (KSS) was 93 points (range, 59 to 100 points), and the mean functional score was 73 points (range, 0 to 100 points). Only one patient demonstrated progressive tibial radiolucencies at 13.1 years follow-up, which resolved with a revision with an exchange of components. The results of this study suggest that a proximally cemented tibial tray with a press-fit keel TKA provides excellent mean 10-year outcomes. PMID:18185931

  2. Bone scans after total knee arthroplasty in asymptomatic patients. Cemented versus cementless

    SciTech Connect

    Hofmann, A.A.; Wyatt, R.W.; Daniels, A.U.; Armstrong, L.; Alazraki, N.; Taylor, A. Jr. )

    1990-02-01

    The natural history of bone scans after total knee arthroplasty (TKA) was studied in 26 patients with 28 cemented TKAs and 29 patients with 31 cementless TKAs. The bone scans were examined at specified postoperative intervals. Radionuclide activity of the femoral, tibial, and patellar regions was measured. Six patients who developed pain postoperatively were excluded. Bone scans immediately postoperative and at three months demonstrated increased uptake, which gradually decreased to baseline levels at ten to 12 months. Radioisotope uptake was comparable in the cemented and cementless groups, but was highly variable in individual patients and in each of the follow-up periods. A single postoperative bone scan cannot differentiate component loosening from early bone remodeling. Sequential bone scans, as a supplement to the clinical examination and conventional radiography, may prove useful in the diagnosis of TKA failure.

  3. Risk factors for intraoperative calcar fracture in cementless total hip arthroplasty

    PubMed Central

    Miettinen, Simo S A; Mäkinen, Tatu J; Kostensalo, Inari; Mäkelä, Keijo; Huhtala, Heini; Kettunen, Jukka S; Remes, Ville

    2016-01-01

    Background and purpose — Intraoperative periprosthetic femoral fracture is a known complication of cementless total hip arthroplasty (THA). We determined the incidence of—and risk factors for—intraoperative calcar fracture, and assessed its influence on the risk of revision. Patients and methods — This retrospective analysis included 3,207 cementless THAs (in 2,913 patients). 118 intraoperative calcar fractures were observed in these hips (3.7%). A control group of 118 patients/hips without calcar fractures was randomly selected. The mean follow-up was 4.2 (1.8–8.0) years. Demographic data, surgical data, type of implant, and proximal femur morphology were evaluated to determine risk factors for intraoperative calcar fracture. Results — The revision rates in the calcar fracture group and the control group were 10% (95% CI: 5.9–17) and 3.4% (CI: 1.3–8.4), respectively. The revision rate directly related to intraoperative calcar fracture was 7.6%. The Hardinge approach and lower age were risk factors for calcar fracture. In the fracture group, 55 of 118 patients (47%) had at least one risk factor, while only 23 of118 patients in the control group (20%) had a risk factor (p = 0.001). Radiological analysis showed that in the calcar fracture group, there were more deviated femoral anatomies and proximal femur bone cortices were thinner. Interpretation — Intraoperative calcar fracture increased the risk of revision. The Hardinge approach and lower age were risk factors for intraoperative calcar fracture. To avoid intraoperative fractures, special attention should be paid when cementless stems are used with deviant-shaped proximal femurs and with thin cortices. PMID:26541230

  4. Influence of cementless cup surface on stability and bone fixation 2 years after total hip arthroplasty.

    PubMed

    Urbański, Wiktor; Krawczyk, Artur; Dragan, Szymon Ł; Kulej, Mirosław; Dragan, Szymon F

    2012-01-01

    Loss of fixation between bone and implant surface is one of the main treatment problems in total hip arthroplasty. It might lead to implant instability, bone loss and treatment failure resulting in revision surgery. Surface modification is a method for improving bone response to implant and increasing implant osseointegration. However, the currently applied modifications such as hydroxyapatite coatings do not meet expectation and do not provide good clinical result. The object of the study was to evaluate the influence of acetabular cup surface modification on fixation and bone remodelling in total hip arthroplasty. Clinical and radiological outcomes were evaluated in patients two years after cementless total hip replacement. Two groups were compared: patients with acetabular component with uncoated titanium surface and patients with hydroxyapatite-coated acetabular surface. Hips X-rays were analysed for early signs of losing stability of acetabular cups. Two years after surgery the analysis of X-rays did not reveal any statistical differences in stability, migration of acetabular components of endoprosthesis between both groups. No differences were also observed in bone remodelling around implants. Particularly high percentage of cups, i.e. 17.64%, were classified into the group with high risk of early implant loosening, i.e., the group with HA coatings. Hydroxyapatite coatings on titanium cementless acetabular cups implanted by press-fit technique have no influence on their stability, bone-implant fixation and the remodelling of bone surrounding an implant two years after surgery. PMID:22793261

  5. Cementless Revision Total Hip Arthroplasty with Ceramic Articulation

    PubMed Central

    Yang, Jong-Hyuck; Yang, Seong-Jo; Kang, Joon-Soon

    2015-01-01

    Purpose The results of ceramic-on-ceramic (CoC) bearing surfaces in primary total hip arthroplasty (THA) were well known. However, it was not known in revision THA. The purpose of this study is to report the results of revision THA with ceramic articulation. Materials and Methods A total of 112 revision THAs were evaluated. The mean age at the time of surgery was 51.6 years (27.7 to 84.2 years). The mean duration of the follow-up periods was 6.3 years (2.3 to 11.4 years). Results The Harris hip scores improved from an average of 56.2 at the index surgery to an average of 93.3 at the last follow-up (P<0.001). None of hips showed osteolysis or ceramic head fracture. One hip showed aseptic loosening in the acetabular component with squeaking that caused a re-revision. There were nine cases of dislocation. The survivorship at 5 years was 94.5% (95% confidence interval, 87.9% to 97.6%) with revision for any reason as the endpoint and 100% with femoral revision. Conclusion The ceramic articulation is one of good bearing options for revision THA in patients with a long life expectancy. PMID:27536630

  6. Cementless hemispheric acetabular component in total hip replacement.

    PubMed

    Weber, D; Schaper, L A; Pomeroy, D L; Badenhausen, W E; Curry, J I; Smith, M W; Suthers, K E

    2000-01-01

    A series of 198 total hip arthroplasties was performed using a porous-coated, hemispheric press-fit cup. One hundred and twenty-seven cups were available for clinical and radiological examination at mean follow-up of 10.6 years. The mean age at the index procedure was 61.2 years. The mean Harris hip score at final follow-up was 89.8. Three cups were revised for aseptic loosening and two liners were changed for eccentric wear and pelvic osteolysis. Nine additional patients showed mild or suspected osteolysis. Two cups were rated "fibrous" stable. There was no correlation between additional screw fixation of the press-fit cup and osteolysis or revision. PMID:10990381

  7. The Latest Lessons Learned from Retrieval Analyses of Ultra-High Molecular Weight Polyethylene, Metal-on-Metal, and Alternative Bearing Total Disc Replacements

    PubMed Central

    Kurtz, Steven M.; Toth, Jeffrey M.; Siskey, Ryan; Ciccarelli, Lauren; MacDonald, Dan; Isaza, Jorge; Lanman, Todd; Punt, Ilona; Steinbeck, Marla; Goffin, Jan; van Ooij, André

    2012-01-01

    Knowledge regarding the in vivo performance and periposthetic tissue response of cervical and lumbar total disc replacements (TDRs) continues to expand. This review addresses the following four main questions: 1) What are the latest lessons learned from polyethylene in large joints and how are they relevant to current TDRs? 2) What are the latest lessons learned regarding adverse local tissue reactions from metal-on-metal, CoCr bearings in large joints and how are they relevant to current TDRs? 3) What advancements have been made in understanding the in vivo performance of alternative biomaterials, such as stainless steel and polycarbonate urethane, for TDRs in the past five years? 4) How has retrieval analysis of all these various artificial disc bearing technologies advanced the state of the art in preclinical testing of TDRs? The study of explanted artificial discs and their associated tissues can help inform bearing selection as well as the design of future generations of disc arthroplasty. Analyzing retrieved artificial discs is also essential for validating preclinical test methods. PMID:22904606

  8. Does Choice of Head Size and Neck Geometry Affect Stem Migration in Modular Large-Diameter Metal-on-Metal Total Hip Arthroplasty? A Preliminary Analysis

    PubMed Central

    Georgiou, CS; Evangelou, KG; Theodorou, EG; Provatidis, CG; Megas, PD

    2012-01-01

    Due to their theoretical advantages, hip systems combining modular necks and large diameter femoral heads have gradually gained popularity. However, among others, concerns regarding changes in the load transfer patterns were raised. Recent stress analyses have indeed shown that the use of modular necks and big femoral heads causes significant changes in the strain distribution along the femur. Our original hypothesis was that these changes may affect early distal migration of a modular stem. We examined the effect of head diameter and neck geometry on migration at two years of follow-up in a case series of 116 patients (125 hips), who have undergone primary Metal-on-Metal total hip arthroplasty with the modular grit-blasted Profemur®E stem combined with large-diameter heads (>36 mm). We found that choice of neck geometry and head diameter has no effect on stem migration. A multivariate regression analysis including the potential confounding variables of the body mass index, bone quality, canal fill and stem positioning revealed only a negative correlation between subsidence and canal fill in midstem area. Statistical analysis, despite its limitations, did not confirm our hypothesis that choice of neck geometry and/or head diameter affects early distal migration of a modular stem. However, the importance of correct stem sizing was revealed. PMID:23284597

  9. Clinical outcome study and radiological findings of Zweymuller metal on metal total hip arthroplasty. a follow-up of 6 to 15 years.

    PubMed

    Paleochorlidis, Ilias S; Badras, Leonidas S; Skretas, Efstathios F; Georgaklis, Vasilios A; Karachalios, Theofilos S; Malizos, Konstantinos N

    2009-01-01

    We report the clinical and radiological outcome of 99 Zweymuller metal on metal total hip arthroplasties in 84 patients followed up prospectively for a mean period of 9.5 (range, 6-15) years. There were 29 (34.5%) male and 55 (65.5%) female patients with a mean age of 62.85 years (range, 50-70 years) at the time of surgery. All patients had osteoarthritis. One acetabular component and one stem were revised due to aseptic loosening. One femoral stem was revised due to a periprosthetic fracture. HHS score improved from a preoperative mean of 62.56 points (SD 8.87) to a final postoperative follow-up mean of 93.48 (SD 7.7). Cumulative success rate for both implants at 13 years, with aseptic loosening as the end point, was 97.05%, while for both implants at 13 years, with revision for any reason as the end point, it was 91.17%. Satisfactory results were observed with the use of this prosthesis. PMID:20041375

  10. Survival analysis of cementless grit-blasted titanium total hip arthroplasties.

    PubMed

    Delaunay, C; Kapandji, A I

    2001-04-01

    Although about 200000 cementless Zweymüller-Alloclassic total hip arthroplasties (THAs) were carried out worldwide in the last decade, the survival analysis of these prostheses was not available in the 2000 report of the Swedish national hip arthroplasty registry. We report a prospective survivorship analysis of 200 consecutive grit-blasted cementless Alloclassic primary THAs carried out since 1988. Using surgical, clinical and radiological endpoints for the stem and the threaded cup the ten-year survivorship was 91.5% for reoperation for any cause, 96.4% for hip pain (Merle d'Aubigné score < 5 points, clinical failure), 99.4% for definite aseptic loosening (radiological failure) and 99.3% for revision for aseptic loosening. Using the Swedish registry criteria of primary osteoarthritis and revision for aseptic loosening as the endpoint, the survival rate of 99.1% at ten years for the subgroup of 157 Alloclassic THAs in osteoarthritis compares favourably with that of the best modern cemented hip replacements reported in the Swedish arthroplasty registry. PMID:11341429

  11. Adverse reaction to metal debris after ReCap-M2A-Magnum large-diameter-head metal-on-metal total hip arthroplasty

    PubMed Central

    2013-01-01

    Background and purpose The clinical findings of adverse reaction to metal debris (ARMD) following large-diameter-head metal-on-metal total hip arthroplasty (LDH MoM THA) may include periarticular fluid collections, soft tissue masses, and gluteal muscle necrosis. The ReCap-M2a-Magnum LDH MoM THA was the most commonly used hip device at our institution from 2005 to 2012. We assessed the prevalence of and risk factors for ARMD with this device. Methods 74 patients (80 hips) had a ReCap-M2a-Magnum LDH MoM THA during the period August 2005 to December 2006. These patients were studied with hip MRI, serum chromium and cobalt ion measurements, the Oxford hip score questionnaire, and by clinical examination. The prevalence of ARMD was recorded and risk factors for ARMD were assessed using logistic regression models. The mean follow-up time was 6.0 (5.5–6.7) years. Results A revision operation due to ARMD was needed by 3 of 74 patients (3 of 80 hips). 8 additional patients (8 hips) had definite ARMD, but revision was not performed. 29 patients (32 hips) were considered to have a probable or possible ARMD. Altogether, 43 of 80 hips had a definite, probable, or possible ARMD and 34 patients (37 hips) were considered not to have ARMD. In 46 of 78 hips, MRI revealed a soft tissue mass or a collection of fluid (of any size). The symptoms clicking in the hip, local hip swelling, and a feeling of subluxation were associated with ARMD. Interpretation ARMD is common after ReCap-M2a-Magnum total hip arthroplasty, and we discourage the use of this device. Asymptomatic patients with a small fluid collection on MRI may not need instant revision surgery but must be followed up closely. PMID:24171688

  12. Good short-term outcome of primary total hip arthroplasty with cementless bioactive glass ceramic bottom-coated implants

    PubMed Central

    2012-01-01

    Background and purpose Cementless total hip arthroplasty is currently favored by many orthopedic surgeons. The design of the porous surface is critically important for long-term fixation. We examined the clinical and radiographic outcome of the cementless titanium hip implant with a bottom coating of apatite-wollastonite containing bioactive glass ceramic. Methods We retrospectively reviewed 109 hips (92 patients) that had undergone primary cementless total hip arthroplasty with bioactive glass ceramic bottom-coated implants. The mean follow-up period was 7 (3–9) years. Hip joint function was evaluated with the Merle d’Aubigné and Postel hip score, and radiographic changes were determined from anteroposterior radiographs. Results The mean hip score improved from 9.7 preoperatively to 17 at the final follow-up. The overall survival rate was 100% at 9 years, when radiographic loosening or revision for any reason was used as the endpoint. 3 stems in 2 patients subsided more than 3 mm vertically within 1 year after implantation. Radiographs of the interface of the stem and femur were all classified as bone ingrowth fixation. Conclusions The short-term results of this study show good outcome for cementless implants with a bottom coating of apatite-wollastonite containing bioactive glass ceramic. PMID:23043270

  13. Biomechanical Study on Distal Filling Effects in Cementless Total Hip Replacement

    NASA Astrophysics Data System (ADS)

    Chae, Soo-Won; Lee, Jun-Hyoung; Choi, Hyung-Yun

    In cementless total hip replacement, initial stability of the femoral component is important in the long term fixation of the femoral stem. Initial stability is closely related to the relative displacement between the prosthesis and the cancellous bone of the proximal femur. After implantation of the prosthesis, the surrounding bone is partially shielded from load carrying and starts to resorb. Stress shielding causes the loss of the proximal bone. The stress distribution of femur must be assessed to predict stress shielding. The initial stability and the stress shielding were investigated for two loading conditions approximating a single leg stance and stair climbing. Two types of stems involving a distal filling and a distal short stem were studied by the finite element method to investigate the biomechanical distal filling effects. The distal short stem produced less stress shielding at the proximal bone than the distal filling stem, while both types of stems seemed to satisfy the initial stability requirement.

  14. Clinical results of cementless total hip arthroplasty with shortening osteotomy for high dislocation with developmental dysplasia.

    PubMed

    Desteli, Engin Eren; Imren, Yunus; Tan, Erkan; Erdoğan, Murat; Özcan, Hüseyin

    2015-03-01

    Total hip arthroplasty for severe developmental dysplasia of the hip is a technically challenging procedure. Subtrochanteric femoral osteotomy enables reducing the femoral head and restoring abductor muscle strength without compromising proximal femoral bone stock in advanced dysplasia.We aimed to retrospectively evaluate Crowe type III or IV developmental dysplasia of the hip who underwent reconstruction with cementless total hip arthroplasty combined with a transverse subtrochanteric femoral osteotomy. Sixty hips of 52 patients (11 male, 49 female) with Crowe type III (n: 37) or IV (n: 23) developmental dysplasia of the hip were included. The average age was 51.4 years. Surgery was performed in lateral decubitis position with posterolateral approach. Subtrochanteric transverse femoral osteotomy were used with cementless components. 40 of the femoral components were Secur-Fit type, and 20 of them were secur-fit plus max type. Ceramic-ceramic coupling was used in 24 cases and metal-polyethylene coupling was used in 36 cases. Merle D'Aubigne and Harris Hip score were used to rate the clinical outcome at the final follow up. All femoral shortening osteotomies were united at a mean of 5.7 months. Mean Merle D'Aubigne pain score was increased from 3.1 to 5.4, and mean Harris Hip score improved from 39 to 92.8, postoperatively (p<0.01). There was no significant difference in time to union between different types of stems. 4 femoral stems had asymptomatic radiolucent lines. There was no significant difference in time to union between different types of stems. PMID:26280851

  15. Computer-based gait analysis of dogs: evaluation of kinetic and kinematic parameters after cemented and cementless total hip replacement.

    PubMed

    Drüen, S; Böddeker, J; Meyer-Lindenberg, A; Fehr, M; Nolte, I; Wefstaedt, P

    2012-01-01

    To date it is unclear whether cementless total hip replacement (THR) in dogs is of clinical advantage in comparison to cemented THR with regard to lameness improvement. Thus the aim of this study was to compare objectively the development of the gait pattern after cemented and cementless THR in dogs. For this purpose, 18 adult dogs with hip dysplasia underwent computer-based gait analysis on an instrumented treadmill prior to unilateral THR and then again ten days, four weeks and four months after surgery. Analysed kinetic parameters were symmetry indices (SI) of vertical ground reaction forces (GRF), which included peak vertical forces (PFz), mean vertical forces (MFz), vertical impulse (IFz), and vertical ground reaction forces of the arthroplasty limbs only. Analysed kinematic parameters were range-of-motion and the flexion and extension angles of hip, stifle and hock joints. The symmetry indice for PVF, MFz and IFz decreased to a value less than six in both THR groups four months after surgery, which is defined as not lame. Improvement in lameness of the arthroplasty limbs during the examination period of four months was not significantly different between the cemented and cementless groups. The results suggest that within a short-term observation period of four months after surgery, neither cementless nor cemented THR have a greater advantage with regard to lameness improvement. Additional studies with larger pools of subjects and longer time periods for follow-up examinations are necessary to verify these findings. PMID:22828804

  16. Cementless porous-coated total knee arthroplasty: 10-year results in a consecutive series.

    PubMed

    Schrøder, H M; Berthelsen, A; Hassani, G; Hansen, E B; Solgaard, S

    2001-08-01

    We report the results of 114 AGC 2000 porous-coated, cementless total knee arthroplasties (TKA) performed consecutively in 102 patients during the period 1984-1986. After 10 years, 58 TKAs in 52 patients were evaluated with patient assessment, Hospital for Special Surgery knee score, weight-bearing radiographs done under fluoroscopic control, and survivorship analysis. All dropouts within the first 9 years were patients dying with a functioning TKA except 1 revision secondary to a supracondylar fracture after 8.5 years. Of the patients, 53 (92%) were satisfied or very satisfied with their TKA, and 55 (95%) of the knees were rated good or excellent. There was no pain in 53 knees, and the median knee flexion was 110 degrees. Six radiolucencies >1 mm were found beneath parts of the tibial component, and 5 radiolucencies were seen beneath the femoral component. None had progressed compared with the 5-year follow-up, and in all cases trabeculae could be seen reaching the prosthetic component. No migrations had occurred since the 5-year follow-up. No obvious joint space reduction was seen. Osteolysis presenting as an isolated cyst was found in 1 knee in the lateral tibial condyle and was not progressive. Two tibial components had been revised because of aseptic loosening and 1 because of septic loosening, all within the first 3 years. No femoral or patellar components were revised. The cumulative prosthesis survival rate after 10 to 11 years was 97%. When pain and radiographic loosening also were considered, the success rate was 87%. Cementless insertion of a nonmodular, porous-coated TKA resulted in a long-term durable bone-prosthesis interface. The flat-on-flat articulation did not result in catastrophic polyethylene wear or osteolysis within the first 10 years. PMID:11503114

  17. [Cementless total hip arthroplasty--results of 8-year follow-up study].

    PubMed

    Wall, Andrzej; Dragan, Szymon

    2006-01-01

    The subjects of the clinical examinations were 382 patients who from 1994 to 1999 were treated with the method of total cementless arthroplasty. The observation time ranged from 3 to 8 years. In the examined group the secondary cause of degenerative changes was identified in 210 (55%) patients. In the remaining 172 cases (45%) the primary cause of degenerative changes in the hip was diagnosed. Four types of cementless endoprostheses, varied in their construction, structure of their surfaces and material they were made of, were used to carry out the postoperative treatment of the degenerative changes in the hip: Antega, Zweymüller SL PLUS (Endoprosthetic) or Alloclasic type of stem, GSS-CL and PM-Plasmapore. The findings of the clinical investigation made it possible to determine the probability of surviving of an endoprosthesis up to the 8th year after an operation depending on a type of implanted stem, which according to Kaplan-Meier's method, amounted to 0.9603. The results of Harris scale evaluation of the function of the operated joints demonstrated the existence of the relationship between the function and the course of bone osteointegration and growth process. The detailed analysis of the X-ray examinations, and especially of the roentgenometric ones, taking into account stability of the endoprosthesis stem enabled to distinguish two stages of the clinical and roentgenological changes: the early stage (up to 6 months after an operation) characterised by settling and micromotions of the stem and the late stage (starting 6-9 months after an operation) with slowly gradual increasing of the function and holding back of stem settling. PMID:17017478

  18. Mid-term Results of Revision Total Hip Arthroplasty Using Modular Cementless Femoral Stems

    PubMed Central

    Jang, Hyung-Gyu; Min, Byung-Woo; Ye, Hee-Uk; Lim, Kyung-Hwan

    2015-01-01

    Purpose The purpose of this study was to evaluate the clinical and radiological results of revision total hip arthroplasty using modular distal fixation stems for proximal femoral deficiency. Materials and Methods Forty-five patients (47 hips) were analyzed more than 24 months after revision total hip arthroplasty that used modular distal fixation stems and was performed between 2006 and 2012. There were proximal femoral defects in all cases. Preoperative femoral defect classification revealed Paprosky type II in 31 cases, type IIIA in 7, and type IIIB in 9. The mean duration of follow-up was 53.4 (25-100) months. We evaluated the Harris hip score (HHS), walking ability according to Koval as clinical parameters, stem stability, and stem position change as radiographic parameters. Kaplan-Meier survival analysis was performed. Results The average HHS improved form 39.5 points to 91.3 points and walking ability also improved in most cases; all patients had stable fixation of the femoral stem. Postoperative complications included 5 cases of infection and 2 cases of dislocation. The survival rate with the end point of re-revision surgery due to infection or dislocation was 86% after 8-year follow-up. Conclusion Cementless revision total hip arthroplasty using modular femoral stems is useful because the stems can be stably fixed on the diaphyseal portion of the femur, which has relatively good bone quality at mid-term follow-up. PMID:27536616

  19. Prospective study of the cementless "New Wave" total knee mobile-bearing arthroplasty: 8-year follow-up.

    PubMed

    Normand, Xavier; Pinçon, Jean-Louis; Ragot, Jean-Marie; Verdier, Régis; Aslanian, Thierry

    2015-02-01

    One of the main factors affecting the survival of a total knee arthroplasty (TKA) is the fixation method. The constraints placed on the bone-implant interface of a mobile-bearing TKA must be taken in account during the design and evaluation phases. For more than two decades, calcium phosphate ceramics, particularly hydroxyapatitis, have been used in Europe to accelerate the bone integration of cementless implants. A prospective study of patients continuously recruited by three senior surgeons at three French private hospitals has been carried out. There were no exclusion criteria. Eighty-four (84) cementless mobile-bearing total knee prosthesis of the brand "New Wave" were implanted in 74 patients over a 2-year period (2004-2005). Implant survival at 8 years was 95% [with a confidence interval of 95%: 80.2-96.4%] when revision for any cause was defined as the endpoint. Five implants required surgical revision to exchange all or part of the implant: two for aseptic loosening of tibial component, one for osteolysis, one for persistent flessum (30°) and one for tibial periprosthetic fracture. Completely integrated implants and event-free outcomes were recorded in 91.4% of the cases at eight-year follow-up. The Hospital for Special Surgery score significantly improved from 56.8/100 points before the surgery to 83.9/100 points at the last follow-up (p < 0.05). Radiologically, only one patient had radiolucent lines around the tibial and femoral components. This cementless total knee prosthesis yielded good medium-term survival. Cementless arthroplasty can generate solid and durable bone fixation in this total weight-bearing implant, and it seems that the hidroxyapathitis surface in this series stimulate the bone integration at the bone-implant interface. PMID:24858380

  20. Cementless total knee arthroplasty with Profix: a 8- to 10-year follow-up study.

    PubMed

    Hardeman, François; Vandenneucker, Hilde; Van Lauwe, Johan; Bellemans, Johan

    2006-12-01

    A consecutive series of 115 cementless Profix (Smith and Nephew, Memphis, USA) Total Knee Arthroplasties performed in 113 patients were followed in order to determine the functional results and survivorship at 8 to 10 years. All patients were included in a prospective database and were reviewed annually until final follow-up. Patients overall satisfaction was excellent or good in 91.3% of cases. The mean Knee Society's knee and function scores increased respectively from 49.3 and 36.7 preoperatively to 93.1 and 82.2 postoperatively. The Kaplan-Meier estimate of implant survival at 10 years was 97.1%. Two patients underwent revision and were considered as failures. One patient had a fracture of the medial condyle at 4 days post-surgery, and the other was revised for aseptic loosening of the tibial component at 6 years post-surgery. On the basis of this long-term follow-up study, we can conclude that the Profix Total Knee System is effective and safe. PMID:17064905

  1. Etiology of osteolysis around porous-coated cementless total hip arthroplasties.

    PubMed

    Jasty, M; Bragdon, C; Jiranek, W; Chandler, H; Maloney, W; Harris, W H

    1994-11-01

    The prosthetic components and tissues retrieved from 12 hips with osteolysis in association with well-fixed cementless porous-coated total hip prostheses (5 Porous Coated Anatomic, 6 Harris-Galante Porous, and 1 Omniflex) were examined using a variety specific techniques including electron microscopy, standard histology, immunohistochemistry, and particle identification. The patients were young and active. Extensive osteolysis developed in all 12 femurs and 3 acetabula between 36 and 84 months after arthroplasty (mean, 63 months). All of the polyethylene liners were noted to be worn substantially (mean volumetric wear, 1140 +/- 810 mm3). The wear was unrelated to the head diameter in this small number of cases. In all 12 cases, the articulating surfaces were wear polished and contained numerous fine multidirectional scratches, suggesting 3-body abrasive wear mechanisms in addition to adhesive wear liberating very small (micron to submicron) wear particles. In 4 cases, surface delamination and flaking of polyethylene were also found, suggesting fatigue wear liberating larger wear particles. Nine of 10 cobalt alloy heads showed numerous fine scratches with sharp edges presumably from 3-body abrasive wear. Corrosion and fretting at the femoral head-neck junction in 5 cases, burnishing of the femoral stem against bone in 4 cases, and metal staining of tissues opposite the porous coatings in 7 cases provided evidence for the liberation of fine metal particles from outside the articulation. Histologic and immunohistochemical studies of tissue in the regions of osteolysis in all cases showed numerous focal aggregates of KP1 antibody positive activated macrophages containing large amounts of submicron intracellular particles of polyethylene (presumably related to the 3-body abrasive wear polishing) and giant cells within a fibrous stroma. In 5 cases, some of the macrophages also contained submicron metal particles but smaller in numbers. T lymphocytes, plasma cells, and

  2. Comparison of Whole-Blood Metal Ion Levels Among Four Types of Large-Head, Metal-on-Metal Total Hip Arthroplasty Implants: A Concise Follow-up, at Five Years, of a Previous Report.

    PubMed

    Hutt, Jonathan; Lavigne, Martin; Lungu, Eugen; Belzile, Etienne; Morin, François; Vendittoli, Pascal-André

    2016-02-17

    Few studies of total hip arthroplasty (THA) implants with a large-diameter femoral head and metal-on-metal design have directly compared the progression of metal ion levels over time and the relationship to complications. As we previously reported, 144 patients received one of four types of large-diameter-head, metal-on-metal THA designs (Durom, Birmingham, ASR XL, or Magnum implants). Cobalt, chromium, and titanium ion levels were measured over five years. We compared ion levels and clinical results over time. The Durom group showed the highest levels of cobalt (p ≤ 0.002) and titanium ions (p ≤ 0.03). Both the Durom and Birmingham groups demonstrated significant ongoing cobalt increases up to five years. Eight patients (seven with a Durom implant and one with a Birmingham implant) developed adverse local tissue reaction. Six Durom implants and one Birmingham implant required revision, with one pseudotumor under surveillance at the time of the most recent follow-up. We found that ion generation and related complications varied among designs. More concerning was that, for some designs, ion levels continued to increase. Coupling a cobalt-chromium adapter sleeve to an unmodified titanium femoral trunnion along with a large metal-on-metal bearing may explain the poor performances of two of the designs in the current study. PMID:26888673

  3. Migration pattern of cementless press fit cups in the presence of stabilizing screws in total hip arthroplasty.

    PubMed

    Zilkens, C; Djalali, S; Bittersohl, B; Kälicke, T; Kraft, C N; Krauspe, R; Jäger, Marcus

    2011-03-28

    The aim of this study was to evaluate the initial acetabular implant stability and late acetabular implant migration in press fit cups combined with screw fixation of the acetabular component in order to answer the question whether screws are necessary for the fixation of the acetabular component in cementless primary total hip arthroplasty. One hundred and seven hips were available for follow-up after primary THA using a cementless, porous-coated acetabular component. A total of 631 standardized radiographs were analyzed digitally by the "single-film-x-ray-analysis" method (EBRA). One hundred and one (94.4 %) acetabular components did not show significant migration of more than 1 mm. Six (5.6%) implants showed migration of more than 1 mm. Statistical analysis did not reveal preoperative patterns that would identify predictors for future migration. Our findings suggest that the use of screw fixation for cementless porous-coated acetabular components for primary THA does not prevent cup migration. PMID:21486725

  4. The effect of stem fit on bone hypertrophy and pain relief in cementless total hip arthroplasty.

    PubMed

    Whiteside, L A

    1989-10-01

    This study was designed to clinically evaluate the effects of a tight distal fit and collar seating in hips with a cylindrical distal stem, collar, and proximal porous coating. A clinical assessment of pain and a roentgenographic assessment of patterns of proximal femoral hypertrophy were made in 105 patients. Intraoperative evaluations of the distal stem fit were performed so that a tight distal fit was ensured in 67 patients. Thirty-eight patients who did not have intraoperative sizing were determined roentgenographically to have a loose distal fit. Pain was significantly more likely to occur in those patients with a loose distal fit (20 of 38) than in those with a tight distal fit (two of 67). Collar seating was associated with hypertrophy under the seated portion of the collar in all cases, and failure to seat the collar was associated with recession and rounding of the upper femoral cortical edge. Distal hypertrophy occurred in 24 of the 67 hips with a tight distal fit, and a tight distal fit did not prevent proximal hypertrophy. It was concluded that a tight distal fit is associated with more complete pain relief in cementless total hip arthroplasty and that a tight distal fit of a cylindrical stem does not prevent proximal load bearing. PMID:2791383

  5. Total hip arthroplasty in patients with avascular necrosis of the hip. Follow-up observations on cementless and cemented operations.

    PubMed

    Katz, R L; Bourne, R B; Rorabeck, C H; McGee, H

    1992-08-01

    Thirty-one patients with avascular necrosis of the hip were treated by 34 total hip arthroplasties (THAs). All patients were observed prospectively with a minimum two-year follow-up evaluation (average, 46 months; range, 24-84 months). Twenty had cemented arthroplasties using contemporary cementing techniques. This included insertion of a medullary plug, cleansing of the canal with a medullary brush, pulsatile lavage irrigation, and insertion of the cement with a cement gun. In 14 hips, a cementless prosthesis was used. Patients were rated using a modified Harris hip score. Sequential postoperative roentgenograms were analyzed in each patient. The overall Harris hip score ratings were 88 in the cemented and 84 in the noncemented groups. Mechanical failure with loosening of the femoral component occurred in one patient who developed deep sepsis. Significant thigh pain occurred in four patients in the noncemented group. Previous studies in the literature have generally reported unfavorable results in patients with avascular necrosis of the hip treated with THA. Using cementless and cemented fixation with contemporary cementing techniques, improved results can be expected. A high incidence of thigh pain (29%) in the cementless group remains a problem. PMID:1499201

  6. The dimensional accuracy of preparation of femoral cavity in cementless total hip arthroplasty*

    PubMed Central

    Wu, Li-dong; Hahne, HJ; Hassenpflug, J

    2004-01-01

    Objective: To observe the accuracy of femoral preparation and the position of the cementless prosthesis in femoral cavity, and to compare the results between the computer-assisted surgical group (CASPAR) and the conventional group. Methods: Ten femoral components were implanted either manually or by CASPAR in cadaver femurs. The specimens were cut to 3 mm thick slices. Microradiograms of every slice were sent to a computer for analysis with special software (IDL). The gaps and the medullary cavities between component and bone, the direct bone contact area of the implant surface, the gap width and the percentage of gap and bone contact area were measured in every slice. Results: In the proximal implant coated with HA of the CASPAR group, the average percentage of bone contact reached 93.2% (ranging from 87.6% to 99.7%); the average gap percentage was 2.9% (ranging from 0.3% to 7.8%); the maximum gap width was 0.81 mm and the average gap width was only 0.20 mm. While in the conventional group, the average percentage of bone contact reached 60.1% (ranging from 49.2% to 70.4%); the average gap percentage was 32.8% (ranging from 25.1% to 39.9%); the maximum gap width was 2.97 mm and the average gap width was 0.77 mm. The average gap around the implant in the CASPAR group was only 9% of that in the manual group; the maximum and average gap widths were only about 26% of those in the manual group. On the other hand, the CASPAR group showed 33% higher bone contact than the manual group. Conclusion: With the use of robotics-assisted system, significant progress can be achieved for femoral preparation in total hip arthroplasty. PMID:15362200

  7. To Cement or Not? Two-Year Results of a Prospective, Randomized Study Comparing Cemented Vs. Cementless Total Knee Arthroplasty (TKA).

    PubMed

    Fricka, Kevin B; Sritulanondha, Supatra; McAsey, Craig J

    2015-09-01

    The optimal mode of fixation in total knee arthroplasty (TKA) is a subject of debate. We enrolled 100 TKA patients randomized to cemented or cementless fixation. Knee Society Scores (KSS), Oxford scores and pain visual analog scales (VAS) were collected pre-operatively and post-operatively. Two-year follow-up was obtained for 93 patients. The mean VAS trended higher for the cementless group at 4 months (P=0.06). At 2 years, the KSS functional scores, Oxford scores, and self-reported questions for satisfaction, less pain and better function were similar but the cemented group had higher KSS clinical scores (96.4 vs. 92.3, P=0.03). More radiolucencies were seen in cementless knees (P<0.001). The cementless group had one revision for instability and one cemented knee was revised for infection. Cementless TKA showed equivalent survivorship (revision for any reason as the endpoint) compared to cemented TKA at this early follow-up. Close monitoring of radiolucencies is important with continued follow-up. PMID:26118567

  8. Biomechanical evaluation of adjunctive cerclage wire fixation for the prevention of periprosthetic femur fractures using cementless press-fit total hip replacement.

    PubMed

    Christopher, Scott A; Kim, Stanley E; Roe, Simon; Pozzi, Antonio

    2016-08-01

    Periprosthetic femoral fractures are a common complication associated with cementless press-fit total hip arthroplasty. The use of prophylactic cerclage wire fixation has been advocated to reduce this complication. The objective of this study was to evaluate whether a double loop cerclage wire, used as adjunctive fixation, increased the peak torsional load to failure in femora implanted with press-fit cementless stems. Peak torsional load to failure was compared between femora without adjunctive fixation and femora receiving a 1 mm double loop cerclage wire placed proximally to the lesser trochanter. Femora treated with adjunctive cerclage wire fixation failed at 20% greater peak torque (P = 0.0001). In conclusion, a double loop cerclage wire may aid in the prevention of periprosthetic fractures associated with press-fit cementless femoral stems. PMID:27387718

  9. Neck fracture of a cementless forged titanium alloy femoral stem following total hip arthroplasty: a case report and review of the literature

    PubMed Central

    Grivas, Theodoros B; Savvidou, Olga D; Psarakis, Spyridon A; Bernard, Pierre-Francois; Triantafyllopoulos, George; Kovanis, Ioannis; Alexandropoulos, Panagiotis

    2007-01-01

    Introduction Fractures of the neck of the femoral component have been reported in uncemented total hip replacements, however, to our knowledge, no fractures of the neck of a cementless forged titanium alloy femoral stem coated in the proximal third with hydroxy-apatite have been reported in the medical literature. Case presentation This case report describes a fracture of the neck of a cementless forged titanium alloy stem coated in the proximal third with hydroxy-apatite. Conclusion The neck of the femoral stem failed from fatigue probably because of a combination of factors described analytically below. PMID:18062807

  10. Cementless total hip arthroplasty in developmental dysplasia of the hip with end stage osteoarthritis: 2-7 years' clinical results.

    PubMed

    Yildirim, Tugrul; Guclu, Berk; Karaguven, Dogac; Kaya, Alper; Akan, Burak; Cetin, Ilker

    2015-01-01

    Between 2006 and 2011, 102 hips of 78 patients with end-stage osteoarthritis secondary to developmental dysplasia of the hip (DDH) underwent cementless total hip arthroplasty (THA). According to the Crowe's classification, 22 hips (21%) were type 1, 19 hips (18%) were type 2, 22 hips (21%) were type 3 and 39 hips (38%) were type 4 respectively. Functional and clinical analyses were performed by Harris Hip Scores (HHS). There were 73 (71%) excellent or good results according to HHS. The postoperative HHS was significantly lower in patients who underwent femoral shortening (p<0.01). We observed 25 (24.5%) complications in total, 15 (14.7%) of which required revision surgery. The authors concluded that THA for DDH is a safe and a reliable procedure with good clinical outcomes. PMID:25907395

  11. Transverse Subtrochanteric Shortening Osteotomy During Cementless Total Hip Arthroplasty in Crowe Type-III or IV Developmental Dysplasia.

    PubMed

    Sofu, Hakan; Kockara, Nizamettin; Gursu, Sarper; Issin, Ahmet; Oner, Ali; Sahin, Vedat

    2015-06-01

    The purpose of this study was to review the outcomes of transverse subtrochanteric shortening osteotomy during cementless total hip arthroplasty in Crowe Type-III or IV developmental dysplasia. Seventy-three osteotomies were included in our study. Mean follow-up was 61 months. Harris hip score, leg length discrepancy, neurological status, union status of the osteotomy, and femoral component stability were the criteria for evaluation. All complications were noted. The mean Harris hip score improved from 38.6 points to 83.7 points. The mean leg length discrepancy decreased from 56.5 mm to 10.7 at the latest follow-up. The mean union time was 5.2 months. We observed 4 non-unions. Transverse subtrochanteric shortening osteotomy is an effective and reliable method in restoration of a more normal limb. PMID:25707993

  12. Pseudotumour formation and subsequent resolution in metal-on-metal total hip arthroplasty following revision: Instructional review and an illustrative case report with revision using a dual mobility design.

    PubMed

    Sassoon, A A; Barrack, R L

    2016-06-01

    The use of large-diameter metal-on-metal (MoM) components in total hip arthroplasty (THA) is associated with an increased risk of early failure due to adverse local tissue reaction to metal debris (ARMD) in response to the release of metal ions from the bearing couple and/or head-neck taper corrosion. The aim of this paper was to present a review of the incidence and natural history of ARMD and the forms of treatment, with a focus on the need for and extent of resection or debulking of the pseudotumour. An illustrative case report is presented of a patient with an intra-pelvic pseudotumour associated with a large diameter MoM THA, which was treated successfully with revision of the bearing surface to a dual mobility couple and retention of the well-fixed acetabular and femoral components. The pseudotumour was left in situ Resolution of the intra-pelvic mass and normalisation of metal ion levels was observed seven months post-operatively. Cite this article: Bone Joint J 2016;98-B:736-40. PMID:27235513

  13. Adverse local tissue reaction (ALTR) associated with corrosion products in metal-on-metal and dual modular neck total hip replacements is associated with upregulation of interferon gamma-mediated chemokine signaling.

    PubMed

    Kolatat, Kritti; Perino, Giorgio; Wilner, Gabrielle; Kaplowitz, Elianna; Ricciardi, Benjamin F; Boettner, Friedrich; Westrich, Geoffrey H; Jerabek, Seth A; Goldring, Steven R; Purdue, P Edward

    2015-10-01

    Adverse local tissue reactions (ALTR) associated with tribocorrosion following total hip arthroplasty (THA) have become a significant clinical concern in recent years. In particular, implants featuring metal-on-metal bearing surfaces and modular femoral stems have been reported to result in elevated rates of ALTR. These tribocorrosion-related tissue reactions are characterized by marked necrosis and lymphocytic infiltration, which contrasts sharply with the macrophagic and foreign body giant cell inflammation associated with polyethylene wear particle induced peri-implant osteolysis. In this study, we characterize tribocorrosion-associated ALTR at a molecular level. Gene expression profiling of peri-implant tissue around failing implants identifies upregulation of numerous inflammatory mediators in ALTR, including several interferon gamma inducible factors, most notably the chemokines MIG/CXCL9 and IP-10/CXCL10. This expression profile is distinct from that associated with polyethylene wear induced osteolysis, which is characterized by induction of markers of alternative macrophage activation, such as chitotriosidase (CHIT-1). Importantly, MIG/CXCL9 and IP-10/CXCL10 are also elevated at the protein level in the synovial fluid and, albeit more moderately, the serum, of ALTR patients, raising the possibility that these factors may serve as circulating biomarkers for the early detection of ALTR in at-risk patients. PMID:25940887

  14. Eleven- to 14-year follow-up results of cementless total hip arthroplasty using a third-generation alumina ceramic-on-ceramic bearing.

    PubMed

    Sugano, Nobuhiko; Takao, Masaki; Sakai, Takashi; Nishii, Takashi; Miki, Hidenobu; Ohzono, Kenji

    2012-05-01

    To analyze long-term survivorship of cementless total hip arthroplasties (THAs) with the third-generation alumina ceramic-on-ceramic bearing, 100 consecutive THAs between 1996 and 1998 were reviewed. One cup and 2 stems were revised due to aseptic loosening. Another cup showed chipping of the acetabular liner at 8 years and required cup revision. The remaining hips showed stable bone ingrowth fixation with no osteolysis at the final follow-up. The 14-year survivorship as the end point of revision was 97.9% for the cup, 97.8% for the stem, and 95.7% for the overall implants, respectively. We conclude that cementless THA with the third-generation ceramic-on-ceramic hip bearing provided an excellent survivorship and eliminated periprosthetic osteolysis for 11 to 14 years. PMID:21978563

  15. Surface composition analysis of failed cementless CoCr- and Ti-base-alloy total hip implants.

    PubMed

    Decking, R; Reuter, P; Hüttner, M; Puhl, W; Claes, L E; Scharf, H P

    2003-02-15

    The surfaces of retrieved failed cementless total hip implants made of cobalt-chromium-molybdenum casting alloy and of wrought titanium 6-aluminum 4-vanadium alloy were studied with the use of scanning-electron microscopy (SEM), energy-dispersive X-ray analysis (EDX) and X-ray photoelectron spectroscopy (XPS). New implants of the same make served as controls. The XPS scans revealed a dense carbon layer on the entire analyzed specimen. The relative composition of the titanium alloy implants showed an overall agreement with the international standards for implants for surgery, and the overall surface composition did not change over the period of the implantation. However, an inhomogeneous distribution of the constituents could be demonstrated in the retrieved as well as in the new MEC-screw rings made of TiAl6V4 alloy, an implant that has been linked to a high early failure rate. In the CoCr-alloy components (Lord-screw rings) a high percentage of aluminum, mainly organized in aluminum inclusions, was found in the retrieved as well as in the new implants. PMID:12516084

  16. Three-Dimensional Analysis of the Contact Pattern between the Cortical Bone and Femoral Prosthesis after Cementless Total Hip Arthroplasty

    PubMed Central

    Mishima, Hajime; Sugaya, Hisashi; Nishino, Tomofumi; Yamazaki, Masashi

    2016-01-01

    The cementless stem Excia (B. Braun, Melsungen, Germany) implant has a rectangular cross-sectional shape with back-and-forth flanges and a plasma-sprayed, dicalcium phosphate dihydrate coating from the middle to proximal portion to increase initial fixation and early bone formation. Here, the conformity of the Excia stem to the femoral canal morphology was three-dimensionally assessed using computed tomography. Forty-three patients (45 hips) were examined after primary total hip arthroplasty with a mean follow-up of 27 ± 3 months (range: 24–36 months). Spot welds occurred at zone 2 in 16 hips and at zone 6 in 24 hips, with 83% (20/24 hips) of those occurring within 3 months after surgery. First- (n = 12 hips), second- (n = 32), and third- (n = 1) degree stress shielding were observed. The stem was typically in contact with the cortical bone in the anterolateral mid-portion (100%) and posteromedial distal portions (85%). Stress shielding did not progress, even in cases where the stems were in contact with the distal portions. The anterior flange was in contact with the bone in all cases. The stability of the mid-lateral portion with the dicalcium phosphate dihydrate coating and the anterior flange may have inhibited the progression of stress shielding beyond the second degree. PMID:26881087

  17. The effect of patient age, gender, and tibial component fixation on pain relief after cementless total knee arthroplasty.

    PubMed

    Whiteside, L A

    1991-10-01

    Cementless total knee arthroplasties (TKAs) were prospectively evaluated for pain relief in 1110 knees. The effect of screws in the tibial component, the age of the patients, and the gender of the patients were studied to determine the effect of these parameters on pain relief one and two years postsurgery. The group with screws in the tibial component (Ortholoc II) had a significantly higher percentage of pain-free knees at one year than at two years postsurgery, and the older patients had a significantly higher rate of pain-free knees at one- and two years postsurgery than the younger patients. Older female patients with Ortholoc I TKAs had a significantly higher percentage of pain-free knees than did older male patients at one-year postsurgery, but not at two years. The group with screws in the tibial components (Ortholoc II) had a higher percentage of pain-free knees at one-year postsurgery than did the Ortholoc I knees, but there was no difference between Ortholoc I and II at two-years postsurgery. In the Ortholoc II group, there was also no difference in results among sexes or between patients older and younger than 65 years old. The correlation coefficient was calculated to evaluate the relationship between body weight and the degree of pain after TKA. No significant correlation could be found at one and two years after surgery. PMID:1914298

  18. Similar incidence of periprosthetic fluid collections after ceramic-on-polyethylene total hip arthroplasties and metal-on-metal resurfacing arthroplasties: results of a screening metal artefact reduction sequence-MRI study.

    PubMed

    Bisseling, P; de Wit, B W K; Hol, A M; van Gorp, M J; van Kampen, A; van Susante, J L C

    2015-09-01

    Patients from a randomised trial on resurfacing hip arthroplasty (RHA) (n = 36, 19 males; median age 57 years, 24 to 65) comparing a conventional 28 mm metal-on-metal total hip arthroplasty (MoM THA) (n = 28, 17 males; median age 59 years, 37 to 65) and a matched control group of asymptomatic patients with a 32 mm ceramic-on-polyethylene (CoP) THA (n = 33, 18 males; median age 63 years, 38 to 71) were cross-sectionally screened with metal artefact reducing sequence-MRI (MARS-MRI) for pseudotumour formation at a median of 55 months (23 to 72) post-operatively. MRIs were scored by consensus according to three different classification systems for pseudotumour formation. Clinical scores were available for all patients and metal ion levels for MoM bearing patients. Periprosthetic lesions with a median volume of 16 mL (1.5 to 35.9) were diagnosed in six patients in the RHA group (17%), one in the MoM THA group (4%) and six in the CoP group (18%). The classification systems revealed no clear differences between the groups. Solid lesions (n = 3) were exclusively encountered in the RHA group. Two patients in the RHA group and one in the MoM THA group underwent a revision for pseudotumour formation. There was no statistically significant relationship between clinical scoring, metal ion levels and periprosthetic lesions in any of the groups. Periprosthetic fluid collections are seen on MARS-MRI after conventional CoP THA and RHA and may reflect a soft-tissue collection or effusion. Currently available MRI classification systems seem to score these collections as pseudotumours, causing an-overestimatation of the incidence of pseudotumours. PMID:26330582

  19. [Results of cementless hip arthroplasty].

    PubMed

    Grübl, A

    2006-09-01

    Hip arthroplasty is performed nowadays according to the needs of the patients irrespective of their age. Tapered rectangular stems for cementless fixation are chosen in most cases in central Europe. They provide primary stability by press-fit implantation into a precisely rasped osseous bed and secondary stability by bone ingrowth into the highly biocompatible titanium alloy with a microrough surface. The 10-year survival of such devices is 92%. Typical radiographic patterns include cortical atrophy and radiolucent lines in Gruen zones 1 and 7. They are due to stress shielding with these distally fixed implants. The number one reason for revision is polyethylene wear and subsequent osteolysis. Metal-on-metal and ceramic-on-ceramic bearings show less wear but osteolysis continues to be a problem. PMID:16552511

  20. Metal-on-Metal Hip Resurfacing Arthroplasty

    PubMed Central

    Sehatzadeh, S; Kaulback, K; Levin, L

    2012-01-01

    Background Metal-on-metal (MOM) hip resurfacing arthroplasty (HRA) is in clinical use as an appropriate alternative to total hip arthroplasty in young patients. In this technique, a metal cap is placed on the femoral head to cover the damaged surface of the bone and a metal cup is placed in the acetabulum. Objectives The primary objective of this analysis was to compare the revision rates of MOM HRA using different implants with the benchmark set by the National Institute of Clinical Excellence (NICE). The secondary objective of this analysis was to review the literature regarding adverse biological effects associated with implant material. Review Methods A literature search was performed on February 13, 2012, to identify studies published from January 1, 2009, to February 13, 2012. Results The revision rates for MOM HRA using 6 different implants were reviewed. The revision rates for MOM HRA with 3 implants met the NICE criteria, i.e., a revision rate of 10% or less at 10 years. Two implants had short-term follow-ups and MOM HRA with one of the implants failed to meet the NICE criteria. Adverse tissue reactions resulting in failure of the implants have been reported by several studies. With a better understanding of the factors that influence the wear rate of the implants, adverse tissue reactions and subsequent implant failure can be minimized. Many authors have suggested that patient selection and surgical technique affect the wear rate and the risk of tissue reactions. The biological effects of high metal ion levels in the blood and urine of patients with MOM HRA implants are not known. Studies have shown an increase in chromosomal aberrations in patients with MOM articulations, but the clinical implications and long-term consequences of this increase are still unknown. Epidemiological studies have shown that patients with MOM HRA implants did not have an overall increase in mortality or risk of cancer. There is insufficient clinical data to confirm the

  1. Comparison of the risk of revision in cementless total hip arthroplasty with ceramic-on-ceramic and metal-on-polyethylene bearings

    PubMed Central

    Varnum, Claus; Pedersen, Alma B; Kjærsgaard-Andersen, Per; Overgaard, Søren

    2015-01-01

    Background and purpose Ceramic-on-ceramic (CoC) bearings were introduced in total hip arthroplasty (THA) to reduce problems related to polyethylene wear. We compared the 9-year revision risk for cementless CoC THA and for cementless metal-on-polyethylene (MoP) THA. Patients and methods In this prospective, population-based study from the Danish Hip Arthroplasty Registry, we identified all the primary cementless THAs that had been performed from 2002 through 2009 (n = 25,656). Of these, 1,773 THAs with CoC bearings and 9,323 THAs with MoP bearings were included in the study. To estimate the relative risk (RR) of revision, we used regression with the pseudo-value approach and treated death as a competing risk. Results 444 revisions were identified: 4.0% for CoC THA (71 of 1,773) and 4.0% for MoP THA (373 of 9,323). No statistically significant difference in the risk of revision for any reason was found for CoC and MoP bearings after 9 years of follow-up (adjusted RR = 1.3, 95% CI: 0.72–2.4). Revision rates due to component failure were 0.5% (n = 8) for CoC bearings and 0.1% (n = 6) for MoP bearings (p < 0.001). 6 patients with CoC bearings (0.34%) underwent revision due to ceramic fracture. Interpretation When compared to the “standard” MoP bearings, CoC THA had a 33% higher (though not statistically significantly higher) risk of revision for any reason at 9 years. PMID:25637339

  2. Cementless cup fixation in total hip arthroplasty after 5-8 years.

    PubMed

    Spicer, D D; Schaper, L A; Pomeroy, D L; Badenhausen, W E; Curry, J I; Suthers, K E; Smith, M W

    2001-01-01

    A series of 199 total hip arthroplasties was performed using a porous-coated, hemispherical press-fit acetabular cup. At a mean follow-up of 91.5 months 158 cups were available for clinical and radiological review. The mean age of the patients at the time of the index arthroplasty was 62.5 years. The mean Harris Hip score at final follow-up was 87.3. No shells were revised although eccentric polyethylene wear prompted liner replacement in two cases. Osteolysis was noted in six cases but predominantly in relation to the femoral stem. Focal pelvic osteolytic lesions were rare. All the cups were classified as stable on radiography. PMID:11794260

  3. Cementless fixation in total knee arthroplasty: down the boulevard of broken dreams - opposes.

    PubMed

    Drexler, M; Dwyer, T; Marmor, M; Abolghasemian, M; Sternheim, A; Cameron, H U

    2012-11-01

    In this study we present our experience with four generations of uncemented total knee arthroplasty (TKA) from Smith & Nephew: Tricon M, Tricon LS, Tricon II and Profix, focusing on the failure rates correlating with each design change. Beginning in 1984, 380 Tricon M, 435 Tricon LS, 305 Tricon 2 and 588 Profix were implanted by the senior author. The rate of revision for loosening was 1.1% for the Tricon M, 1.1% for the Tricon LS, 0.5% for the Tricon 2 with a HA coated tibial component, and 1.3% for the Profix TKA. No loosening of the femoral component was seen with the Tricon M, Tricon LS or Tricon 2, with no loosening seen of the tibial component with the Profix TKA. Regarding revision for wear, the incidence was 13.1% for the Tricon M, 6.6% for the Tricon LS, 2.3% for the Tricon 2, and 0% for the Profix. These results demonstrate that improvements in the design of uncemented components, including increased polyethylene thickness, improved polyethylene quality, and the introduction of hydroxyapatite coating, has improved the outcomes of uncemented TKA over time. PMID:23118390

  4. Long-term results of cementless primary total hip arthroplasty with a threaded cup and a tapered, rectangular titanium stem in rheumatoid arthritis and osteoarthritis.

    PubMed

    Zwartele, Rob; Peters, Anil; Brouwers, Johannes; Olsthoorn, Paul; Brand, Ronald; Doets, Cornelis

    2008-10-01

    The aim of this study was to assess the outcome of primary cementless total hip arthroplasty in rheumatoid arthritis patients and to compare the results with osteoarthritis patients. Sixty-four patients (77 hips) with rheumatoid arthritis and 120 patients (135 hips) with osteoarthritis had a conical-shaped Zweymueller threaded cup and a tapered, rectangular Zweymueller stem implanted and were assessed after an average of 12.5 years. The endpoints for survival analysis were failure of one or both components due to radiographic loosening or revision. Revision was defined as exchange of cup, stem or both. When the PE-insert or the ceramic ball head were exchanged leaving cup and stem in place, e.g. for PE-wear or dislocation, this was not considered a revision but a re-intervention. No differences were found in survival rates; however, in the rheumatoid arthritis group there was an increased rate of malposition of the cup, avulsions of the greater trochanter, and increased bone resorption in the trochanteric region. This study shows that despite altered biomechanical properties of rheumatoid bone, mechanical stability and osseous integration of cementless prosthesis are not compromised and, although a higher complication rate did occur, long-term survival is excellent. PMID:17609955

  5. Ibandronate and cementless total hip arthroplasty: densitometric measurement of periprosthetic bone mass and new therapeutic approach to the prevention of aseptic loosening

    PubMed Central

    Muratore, Maurizio; Quarta, Eugenio; Quarta, Laura; Calcagnile, Fabio; Grimaldi, Antonella; Orgiani, M. Antonio; Marsilio, Antonio; Rollo, Giuseppe

    2012-01-01

    Summary Studies of the mechanisms of periprosthetic bone loss have led to the development of pharmacologic strategies intended to enhance bone mass recovery after surgery and consequently prevent aseptic loosening and prolong the implant survival. Bisphosphonates, potent anti-resorptive drugs widely used in the treatment of osteoporosis and other disorders of bone metabolism, were shown to be particularly effective in reducing periprosthetic bone resorption in the first year after hip and knee arthroplasty, both cemented and cementless. Based on these results, we investigated the inhibitory effects of ibandronate on periprosthetic bone loss in a 2-year study of postmenopausal women that underwent cementless total hip arthroplasty. In the first 6 months both groups (A, treated with ibandronate 3 mg i.v. within five days after surgery and then with oral ibandronate 150 mg/month, plus calcium and vitamin D supplementation; and B, treated with calcium and vitamin D supplementation only) experienced bone loss, though to a lesser extent in group A. After 12 months, group A showed a remarkable BMD recovery, that was statistically significant versus baseline values (about +1, 74% of global BMD) and most evident in region R1 (+3, 81%) and R2 (+4, 12%); in group B, on the contrary, BMD values were unchanged compared with those at 6 months post-surgery. Quality of life scores also showed a greater improvement in group A, both at 6 and 12 months after surgery, likely because of the pain-reducing effects of ibandronate treatment. PMID:22783337

  6. Cementless Total Hip Arthroplasty in Hip Dysplasia with an Extensively Porous-Coated Cylindrical Stem Modified for Asians: A 12-Year Follow-Up Study.

    PubMed

    Kato, Tsutomu; Otani, Takuya; Sugiyama, Hajime; Hayama, Tetsuo; Katsumata, Souichi; Marumo, Keishi

    2015-06-01

    Long-term outcomes of primary cementless total hip arthroplasty were examined for 198 hips of Asian patients with developmental dysplasia of the hip. AML stems were modified for patients' relatively small physique. Stable fixation was achieved despite various proximal femoral deformities. At follow up (mean 12.1 years), radiographs demonstrated fixation in all hips, with 100% stem survivorship. Radiographic changes revealed that the severity of stress-shielding was mild in 55% of hips, moderate in 26%, and severe in 19%. Longer follow up is needed to determine whether these changes will develop into clinical manifestations. A distal fixation stem can be a useful reconstruction option when application of a proximal fixation stem in primary total hip arthroplasty is difficult for various reasons. PMID:25677937

  7. A Case Series of Total Hip Arthroplasty Using Cementless Hip Stem Customized for Patients of a Specific Race: 10- to 15-Year Results.

    PubMed

    Tsukada, Sachiyuki; Wakui, Motohiro

    2016-01-01

    We report a minimum of 10-year results of patients undergoing total hip arthroplasty (THA) using the cementless BiCONTACT N stem, which was developed to fit the femur in a specific race in which the predominant etiology of hip diseases was developmental dysplasia. A total of 108 hips were evaluated with a mean follow-up of 11.9 ± 1.4 years. The etiology for THA was secondary osteoarthritis due to developmental dysplasia in 90.3% of patients. No evidence of aseptic loosening of the BiCONTACT N stem was observed. The survivorship with the end point as revision surgery for any reason was 94.4% (95% confidence interval 88.7%-97.3%) at 15.0 years postoperatively. BiCONTACT N stem may be an effective alternative for patients with developmental dysplasia of the hip. PMID:26321076

  8. Cementless total hip arthroplasty with the rectangular titanium Zweymuller stem. A concise follow-up, at a minimum of fifteen years, of a previous report.

    PubMed

    Grübl, Alexander; Chiari, Catharina; Giurea, Alexander; Gruber, Martin; Kaider, Alexandra; Marker, Martina; Zehetgruber, Harald; Gottsauner-Wolf, Florian

    2006-10-01

    Between October 1986 and November 1987, 208 total hip arthroplasties were performed with use of the cementless Zweymüller stem and a threaded cup in 200 consecutive patients. Of 102 patients (108 hips) who were available for follow-up at a minimum of 180 months postoperatively, eighty-three (eighty-nine hips) had the primary joint replacement still intact. No stem had been revised because of aseptic loosening, but we found various degrees of osteolysis around sixteen (18%) of the implants. The probability of survival of the stem at fifteen years was 0.98 (95% confidence interval, 0.96 to 1.00). The probability of survival of the cup was 0.85 (95% confidence interval, 0.79 to 0.91). PMID:17015598

  9. Shorter, rough trunnion surfaces are associated with higher taper wear rates than longer, smooth trunnion surfaces in a contemporary large head metal-on-metal total hip arthroplasty system.

    PubMed

    Brock, Timothy M; Sidaginamale, Raghavendra; Rushton, Steven; Nargol, Antoni V F; Bowsher, John G; Savisaar, Christina; Joyce, Tom J; Deehan, David J; Lord, James K; Langton, David J

    2015-12-01

    Taper wear at the head-neck junction is a possible cause of early failure in large head metal-on-metal (LH-MoM) hip replacements. We hypothesized that: (i) taper wear may be more pronounced in certain product designs; and (ii) an increased abductor moment arm may be protective. The tapers of 104 explanted LH-MoM hip replacements revised for adverse reaction to metal debris (ARMD) from a single manufacturer were analyzed for linear and volumetric wear using a co-ordinate measuring machine. The mated stem was a shorter 12/14, threaded trunnion (n=72) or a longer, smooth 11/13 trunnion (n=32). The abductor moment arm was calculated from pre-revision radiographs. Independent predictors of linear and volumetric wear included taper angle, stem type, and the horizontal moment arm. Tapers mated with the threaded 12/14 trunnion had significantly higher rates of volumetric wear (0.402 mm3/yr vs. 0.123 mm3/yr [t=-2.145, p=0.035]). There was a trend to larger abductor moment arms being protective (p=0.055). Design variation appears to play an important role in taper-trunnion junction failure. We recommend that surgeons bear these findings in mind when considering the use of a short, threaded trunnion with a cobalt-chromium head. PMID:26135357

  10. The influence of contact ratio and its location on the primary stability of cementless total hip arthroplasty: A finite element analysis.

    PubMed

    Reimeringer, M; Nuño, N

    2016-05-01

    Cementless hip stems are fixed to the surrounding bone by means of press-fit. To ensure a good press-fit, current surgical technique specifies an under-reaming of the bone cavity using successively larger broaches. Nevertheless, this surgical technique is inaccurate. Several studies show that the contact ratio (percentage of stem interface in contact with bone) achieved after surgery can vary between 20% and 95%. Therefore, this study aimed to investigate the influence of the contact ratio and its location on the primary stability of a cementless total hip arthroplasty using finite element analysis. A straight tapered femoral stem implanted in a composite bone was subjected to stair climbing. Micromotion of 7600 nodes at the stem-bone interface was computed for different configurations of contact ratios between 2% and 98%) along the hip stem. Considering the 15 configurations evaluated, the average micromotion ranges between 27μm and 54μm. The percentage of the porous interface of the stem having micromotion below 40μm that allows bone ingrowth range between 25-57%. The present numerical study shows that full contact (100%) between stem and bone is not necessary to obtain a good primary stability. The stem primary stability is influenced by both the contact ratio and its location. Several configurations with contact ratio lower than 100% and involving either the proximal or the cortical contact provide better primary stability than the full contact configuration. However, with contact ratio lower than 40%, the stem should be in contact with cortical bone to ensure a good primary stability. PMID:26920509

  11. Retrospective cohort study of the performance of the Pinnacle metal on metal (MoM) total hip replacement: a single-centre investigation in combination with the findings of a national retrieval centre

    PubMed Central

    Langton, David John; Sidaginamale, Raghavendra Prasad; Avery, Peter; Waller, Sue; Tank, Ghanshyabhai; Lord, James; Joyce, Thomas; Cooke, Nick; Logishetty, Raj; Nargol, Antoni Viraf Francis

    2016-01-01

    Objectives To determine risk factors for revision in patients implanted with a commonly used metal on metal (MoM) hip replacement. Design Retrospective cohort study in combination with a prospective national retrieval study (Northern Retrieval Registry (NRR)). Setting Combined orthopaedic unit in combination with the NRR. Participants All patients implanted with a DePuy Pinnacle MoM hip prostheses by the 2 senior authors were invited to attend for a review which included clinical examination, blood metal ion measurements, radiographs and targeted imaging. Explanted components underwent wear analysis using validated methodology and these results were compared with those obtained from the NRR. Results 489 MoM Pinnacle hips were implanted into 434 patients (243 females and 191 males). Of these, 352 patients attended the MoM recall clinics. 64 patients had died during the study period. For the purposes of survival analysis, non-attendees were assumed to have well-functioning prostheses. The mean follow-up of the cohort as a whole was 89 months. 71 hips were revised. Prosthetic survival for the whole cohort was 83.6% (79.9–87.3) at 9 years. The majority of explanted devices exhibited signs of taper junction failure. Risk factors for revision were bilateral MoM prostheses, smaller Pinnacle liners, and implantation in 2006 and later years. A significant number of devices were found to be manufactured out of their specifications. This was confirmed with analysis of the wider data set from the NRR. Conclusions This device was found to have an unacceptably high revision rate. Bilateral prostheses, those implanted into female patients and devices implanted in later years were found to be at greater risk. A significant number of explanted components were found to be manufactured with bearing diameters outside of the manufacturer's stated tolerances. Our findings highlight the clinical importance of hitherto unrecognised variations in device production. PMID:27130159

  12. No superiority of cemented metal-on-metal vs metal-on-polyethylene THA at 5-year follow-up.

    PubMed

    Zijlstra, Wierd P; Cheung, John; Sietsma, Maurits S; van Raay, Jos Jam; Deutman, Robert

    2009-07-01

    A randomized controlled trial was performed to compare the cemented Stanmore metal-on-metal (Biomet, Warsaw, Indiana) total hip arthroplasty (THA; 102 hips) to the cemented Stanmore metal-on-polyethylene (Biomet) THA (98 hips). The primary outcome was clinical performance. Radiological performance, serum cobalt analysis, and prosthetic survival were secondary outcome measures. At a mean follow-up of 5.6 years, 5 patients were lost to follow-up, 18 died, and 4 were revised (3 metal-on- metal, 1 metal-on-polyethylene). Harris Hip Scores improved from 48 to 90 in the metal-on-metal patients (P<.001) and from 46 to 87 in the metal-on-polyethylene patients (P<.001). Oxford Hip Scores changed from 40 to 19 in the metal-on-metal group (P<.001) and from 40 to 18 in the metal-on-polyethylene group (P<.001). For both Harris and Oxford Hip Scores, there was no significant difference between the 2 groups. Five-year survival with revision for any reason was 97% (95% CI 93%-100%) in the metal-on-metal group and 99% (95% CI 97%-100%) in the metal-on-polyethylene group. All revisions were indicated for aseptic loosening (metal-on-metal: 3 cup revisions; metal-on-polyethylene: 1 total revision). At 5-year follow-up, cemented metal-on-metal THA showed no clinical superiority over metal-on-polyethylene THA. PMID:19634856

  13. REVISION TOTAL HIP ARTHROPLASTY USING A MODULAR CEMENTLESS DISTAL FIXATION PROSTHESIS: THE ZMR® HIP SYSTEM. CLINICAL AND RADIOGRAPHIC ANALYSIS OF 30 CASES

    PubMed Central

    Canella, Richard Prazeres; de Alencar, Paulo Gilberto Cimbalista; Ganev, Gerson Gandhi; de Vincenzi, Luiz Fernando

    2015-01-01

    Objective: To evaluate the clinical and radiographic results from 30 cases of revision of total hip arthroplasty using a modular cementless distal fixation prosthesis: the ZMR® Hip System. Method: Between July 2005 and December 2008, 30 operations were performed, on 14 men and 14 women. Two male patients had bilateral surgery. The mean age was 59.2 years (29-81 years), with a mean follow-up of 24 months. The Paprosky classification was used for periprosthetic bone loss, and the Harris Hip Score (HHS) was used to evaluate clinical results. On radiographs, distal migration of the femoral stem was defined in accordance with Sporer. Proximal bone remodeling was classified using the Callaghan criteria. Results: The mean preoperative HHS was 39, and there was a significant increase to 93 points in the final evaluation, which indicated excellent clinical results. No femoral stem migration greater than 5 mm (Sporer) was observed on radiographs, thus suggesting that all the femoral prostheses presented osseointegration and remained stable from the time of the surgery until the final evaluation. The proximal femoral remodeling was either type B or type C in 29 hips, according to Callaghan. Seven patients had complications, but without interfering with osseointegration of the femoral components. Conclusion: Our results from revision of total hip arthroplasty using the ZMR® Hip System were extremely encouraging, and all the components became osseointegrated and remained fixed at the time of the final evaluation. PMID:27022553

  14. Cancer incidence and cause-specific mortality in patients with metal-on-metal hip replacements in Finland

    PubMed Central

    2014-01-01

    Background and purpose Metal-on-metal hip implants have been widely used, especially in the USA, Australia, England and Wales, and Finland. We assessed risk of death and updated data on the risk of cancer related to metal-on-metal hip replacements. Patients and methods A cohort of 10,728 metal-on-metal hip replacement patients and a reference cohort of 18,235 conventional total hip replacement patients were extracted from the Finnish Arthroplasty Register for the years 2001–2010. Data on incident cancer cases and causes of death until 2011 were obtained from the Finnish Cancer Registry and Statistics Finland. The relative risk of cancer and death were expressed as standardized incidence ratio (SIR) and standardized mortality ratio (SMR). SIR/SIR ratios and SMR/SMR ratios, and Poisson regression were used to compare the cancer risk and the risk of death between cohorts. Results The overall risk of cancer in the metal-on-metal cohort was not higher than that in the non-metal-on-metal cohort (RR = 0.91, 95% CI: 0.82–1.02). The risk of soft-tissue sarcoma and basalioma in the metal-on-metal cohort was higher than in the non-metal-on-metal cohort (SIR/SIR ratio = 2.6, CI: 1.02–6.4 for soft-tissue sarcoma; SIR/SIR ratio = 1.3, CI: 1.1–1.5 for basalioma). The overall risk of death in the metal-on-metal cohort was less than that in the non-metal-on-metal cohort (RR = 0.78, CI: 0.69–0.88). Interpretation The overall risk of cancer or risk of death because of cancer is not increased after metal-on-metal hip replacement. The well-patient effect and selection bias contribute substantially to the findings concerning mortality. Arthrocobaltism does not increase mortality in patients with metal-on-metal hip implants in the short term. However, metal-on-metal hip implants should not be considered safe until data with longer follow-up time are available. PMID:24397743

  15. Metal-on-metal: history, state of the art (2010)

    PubMed Central

    2011-01-01

    The history of metal-on-metal bearing began with K. Mc Kee. Several "episodes" have marked the history of metal-on-metal articulations, and each has contributed to a better understanding of this type of tribology. But to date the indications for this bearing are debated and are subject to reservations because of the existence of permanently elevated levels of circulating metal ions. It therefore appears that the monitoring of our patients, the documentation of our revisions and the collaboration with our industry partners as well as communicating with our biology and pathology colleagues is necessary to help us solve these problems. PMID:21234564

  16. Taper junction failure in large-diameter metal-on-metal bearings

    PubMed Central

    Langton, D. J.; Sidaginamale, R.; Lord, J. K.; Nargol, A. V. F.; Joyce, T. J.

    2012-01-01

    Objectives An ongoing prospective study to investigate failing metal-on-metal hip prostheses was commenced at our centre in 2008. We report on the results of the analysis of the first consecutive 126 failed mated total hip prostheses from a single manufacturer. Methods Analysis was carried out using highly accurate coordinate measuring to calculate volumetric and linear rates of the articular bearing surfaces and also the surfaces of the taper junctions. The relationship between taper wear rates and a number of variables, including bearing diameter and orientation of the acetabular component, was investigated. Results The measured rates of wear and distribution of material loss from the taper surfaces appeared to show that the primary factor leading to taper failure is the increased lever arm acting on this junction in contemporary large-diameter metal-on-metal hip replacements. Conclusions Our analysis suggests that varus stems, laterally engaging taper systems and larger head diameters all contribute to taper failure. PMID:23610672

  17. Graphitic Tribological Layers in Metal-on-Metal Hip Replacements

    NASA Astrophysics Data System (ADS)

    Liao, Y.; Pourzal, R.; Wimmer, M. A.; Jacobs, J. J.; Fischer, A.; Marks, L. D.

    2011-12-01

    Arthritis is a leading cause of disability, and when nonoperative methods have failed, a prosthetic implant is a cost-effective and clinically successful treatment. Metal-on-metal replacements are an attractive implant technology, a lower-wear alternative to metal-on-polyethylene devices. Relatively little is known about how sliding occurs in these implants, except that proteins play a critical role and that there is a tribological layer on the metal surface. We report evidence for graphitic material in the tribological layer in metal-on-metal hip replacements retrieved from patients. As graphite is a solid lubricant, its presence helps to explain why these components exhibit low wear and suggests methods of improving their performance; simultaneously, this raises the issue of the physiological effects of graphitic wear debris.

  18. CoCrMo metal-on-metal hip replacements.

    PubMed

    Liao, Yifeng; Hoffman, Emily; Wimmer, Markus; Fischer, Alfons; Jacobs, Joshua; Marks, Laurence

    2013-01-21

    After the rapid growth in the use of CoCrMo metal-on-metal hip replacements since the second generation was introduced circa 1990, metal-on-metal hip replacements have experienced a sharp decline in the last two years due to biocompatibility issues related to wear and corrosion products. Despite some excellent clinical results, the release of wear and corrosion debris and the adverse response of local tissues have been of great concern. There are many unknowns regarding how CoCrMo metal bearings interact with the human body. This perspective article is intended to outline some recent progresses in understanding wear and corrosion of metal-on-metal hip replacement both in vivo and in vitro. The materials, mechanical deformation, corrosion, wear-assisted corrosion, and wear products will be discussed. Possible adverse health effects caused by wear products will be briefly addressed, as well as some of the many open questions such as the detailed chemistry of corrosion, tribochemical reactions and the formation of graphitic layers. Nowadays we design almost routinely for high performance materials and lubricants for automobiles; humans are at least as important. It is worth remembering that a hip implant is often the difference between walking and leading a relatively normal life, and a wheelchair. PMID:23196425

  19. CoCrMo Metal-on-Metal Hip Replacements

    PubMed Central

    Liao, Yifeng; Hoffman, Emily; Wimmer, Markus; Fischer, Alfons; Jacobs, Joshua; Marks, Laurence

    2012-01-01

    After the rapid growth in the use of CoCrMo metal-on-metal hip replacements since the second generation was introduced circa 1990, metal-on-metal hip replacements have experienced a sharp decline in the last two years due to biocompatibility issues related to wear and corrosion products. Despite some excellent clinical results, the release of wear and corrosion debris and the adverse response of local tissues have been of great concern. There are many unknowns regarding how CoCrMo metal bearings interact with the human body. This perspective article is intended to outline some recent progresses in understanding wear and corrosion of metal-on-metal hip replacement both in-vivo and in-vitro. The materials, mechanical deformation, corrosion, wear-assisted corrosion, and wear products will be discussed. Possible adverse health effects caused by wear products will be briefly addressed, as well as some of the many open questions such as the detailed chemistry of corrosion, tribochemical reactions and the formation of graphitic layers. Nowadays we design almost routinely for high performance materials and lubricants for automobiles; humans are at least as important. It is worth remembering that a hip implant is often the difference between walking and leading a relatively normal life, and a wheelchair. PMID:23196425

  20. Impaction grafting in the femur in cementless modular revision total hip arthroplasty: a descriptive outcome analysis of 243 cases with the MRP-TITAN revision implant

    PubMed Central

    2013-01-01

    Background We present a descriptive and retrospective analysis of revision total hip arthroplasties (THA) using the MRP-TITAN stem (Peter Brehm, Weisendorf, GER) with distal diaphyseal fixation and metaphyseal defect augmentation. Our hypothesis was that the metaphyseal defect augmentation (Impaction Bone Grafting) improves the stem survival. Methods We retrospectively analyzed the aggregated and anonymized data of 243 femoral stem revisions. 68 patients with 70 implants (28.8%) received an allograft augmentation for metaphyseal defects; 165 patients with 173 implants (71.2%) did not, and served as controls. The mean follow-up was 4.4 ± 1.8 years (range, 2.1–9.6 years). There were no significant differences (p > 0.05) between the study and control group regarding age, body mass index (BMI), femoral defects (types I-III as described by Paprosky), and preoperative Harris Hip Score (HHS). Postoperative clinical function was evaluated using the HHS. Postoperative radiologic examination evaluated implant stability, axial implant migration, signs of implant loosening, periprosthetic radiolucencies, as well as bone regeneration and resorption. Results There were comparable rates of intraoperative and postoperative complications in the study and control groups (p > 0.05). Clinical function, expressed as the increase in the postoperative HHS over the preoperative score, showed significantly greater improvement in the group with Impaction Bone Grafting (35.6 ± 14.3 vs. 30.8 ± 15.8; p ≤ 0.05). The study group showed better outcome especially for larger defects (types II C and III as described by Paprosky) and stem diameters ≥ 17 mm. The two groups did not show significant differences in the rate of aseptic loosening (1.4% vs. 2.9%) and the rate of revisions (8.6% vs. 11%). The Kaplan-Meier survival for the MRP-TITAN stem in both groups together was 93.8% after 8.8 years. [Study group 95.7% after 8.54 years ; control group 93.1% after 8

  1. Cementless total hip arthroplasty using a threaded cup and a rectangular tapered stem. Follow-up for ten to 17 years.

    PubMed

    Pospischill, M; Knahr, K

    2005-09-01

    We carried out a clinical and radiological review of 103 cementless primary hip arthroplasties with a tapered rectangular grit-blasted titanium press-fit femoral component and a threaded conical titanium acetabular component at a mean follow-up of 14.4 years (10.2 to 17.1). The mean Harris hip score at the last follow-up was 89.2 (32 to 100). No early loosening and no fracture of the implant were found. One patient needed revision surgery because of a late deep infection. In 11 hips (10.7%), the reason for revision was progressive wear of the polyethylene liner. Exchange of the acetabular component because of aseptic loosening without detectable liner wear was carried out in three hips (2.9%). After 15 years the survivorship with aseptic loosening as the definition for failure was 95.6% for the acetabular component and 100% for the femoral component. PMID:16129743

  2. Metal-on-metal joint bearings and hematopoetic malignancy

    PubMed Central

    2012-01-01

    Abstract This is a review of the hip arthroplasty era. We concentrate on new metal bearings, surface replacements, and the lessons not learned, and we highlight recent reports on malignancies and joint implants. A low incidence of blood malignancies has been found in bone marrow taken at prosthetic surgery. The incidence is increased after replacement with knee implants that release very low systemic levels of metal ions. A carcinogenic effect of the high levels of metal ions released by large metal-on-metal implants cannot be excluded. Ongoing Swedish implant registry studies going back to 1975 can serve as a basis for evaluation of this risk. PMID:23140092

  3. Mid-term clinical results of total hip arthroplasty using a Wagner standard cup for dysplastic hip

    PubMed Central

    Maezawa, Katsuhiko; Nozawa, Masahiko; Yuasa, Takahito; Aritomi, Kentaro; Ogawa, Seiki; Maruyama, Yuichiro; Kaneko, Kazuo

    2014-01-01

    Background The outcome of cementless total hip arthroplasty depends on many factors. We must not forget fundamental things those are design of outer surface of the component, that leads bone ingrowth into the prosthesis, better initial stability, and better insertional techniques. The purpose of this study was to review our experience with metal-on-metal total hip arthroplasty with a Wagner standard cup for patients who had acetabular dysplasia. Patients and methods Fifty-four patients with 55 hips underwent primary metal-on-metal total hip arthroplasty (Metasul prosthesis) with a Wagner standard cup (44–48 mm in outer diameter) and were followed for a minimum of 10 years. All patients received the same type of cementless femoral component (Natural hip stem) and femoral head (28 mm in diameter). Results Seventeen of the 55 Wagner standard cups (30.9%) showed aseptic loosening over a mean period of 3.6 years after surgery, and there were no bone anchors on the outer surface of the 16 retrieved cups. Conclusion From our experience, the small Wagner standard cup does not achieve sufficient osteointegration and we do not recommend the use of this cup, especially for patients with acetabular dysplasia and/or those with a small stature. PMID:25561751

  4. Effects of femoral component material properties on cementless fixation in total hip arthroplasty. A comparison study between carbon composite, titanium alloy, and stainless steel.

    PubMed

    Otani, T; Whiteside, L A; White, S E; McCarthy, D S

    1993-02-01

    Carbon-fiber-reinforced-carbon composite material is an attractive implant material because its modulus of elasticity can be made similar to that of cortical bone. This study investigated the effect of femoral prosthesis elastic modulus on cementless implant fixation. Distal, as well as proximal, relative micromovements between implant and bone were measured in two testing protocols (axial-load and torsional-load), comparing identically shaped carbon composite (modulus of elasticity = 18.6 GPa), Ti6Al4V (100 GPa), and 630 stainless steel (200 GPa) prostheses. In the axial-load test, proximal mediolateral micromotions were significantly larger in the flexible composite stem than in the two metals. In the torsional-load test, rotational micromotions and "slop" displacements in the flexible stem were significantly larger proximally and significantly smaller distally than in the two metals. While these results suggest that proximal stress transfer may be improved by a flexible stem, they raise the possibility of increased proximal micromotion, and suggest that improved proximal fixation may be necessary to achieve clinical success with flexible composite femoral components. PMID:8436992

  5. Investigation on stick phenomena in metal-on-metal hip joints after resting periods.

    PubMed

    Wimmer, M A; Nassutt, R; Sprecher, C; Loos, J; Täger, G; Fischer, A

    2006-02-01

    Insufficient understanding of tribological behaviour in total joint arthroplasty is considered as one of the reasons for prosthesis failure. Contrary to the continuous motion input profiles of hip simulators, human locomotion contains motion interruptions. These occurring resting periods can cause stick phenomena in metal-on-metal hip joints. The aim of the present study was to investigate the tribological sensitivity of all-metal bearings to motion interruptions on in vitro test specimens and retrieved implants. Friction and wear with and without resting periods were quantified. Unlike the metal-on-polyethylene joints, the static friction of metal-on-metal joints increased up to micros = 0.3 with rest, while wear appeared to be unaffected. This effect is caused by the interlocking of firmly adhered carbon layers, which were generated from the protein-containing lubricant through tribochemical reactions. Since more than 80 per cent of the retrieved implants exhibited macroscopically visible carbon layers, the increase in friction presumably also occurs under physiological conditions, which is then transferred to the bone-implant interface. These recurrent tangential stress peaks should be considered for the design features of the cup-bone interface, in particular when larger-sized implant heads are used. PMID:16669389

  6. On the inflammatory response in metal-on-metal implants

    PubMed Central

    2014-01-01

    Background Metal-on-metal implants are a special form of hip endoprostheses that despite many advantages can entail serious complications due to release of wear particles from the implanted material. Metal wear particles presumably activate local host defence mechanisms, which causes a persistent inflammatory response with destruction of bone followed by a loosening of the implant. To better characterize this inflammatory response and to link inflammation to bone degradation, the local generation of proinflammatory and osteoclast-inducing cytokines was analysed, as was systemic T cell activation. Methods By quantitative RT-PCR, gene expression of cytokines and markers for T lymphocytes, monocytes/macrophages and osteoclasts, respectively, was analysed in tissue samples obtained intraoperatively during exchange surgery of the loosened implant. Peripheral T cells were characterized by cytofluorometry before surgery and 7 to 10 days thereafter. Results At sites of osteolysis, gene expression of cathepsin K, CD14 and CD3 was seen, indicating the generation of osteoclasts, and the presence of monocytes and of T cells, respectively. Also cytokines were highly expressed, including CXCL8, IL-1ß, CXCL2, MRP-14 and CXCL-10. The latter suggest T cell activation, a notion that could be confirmed by detecting a small, though conspicuous population of activated CD4+ cells in the peripheral blood T cells prior to surgery. Conclusion Our data support the concept that metallosis is the result of a local inflammatory response, which according to histomorphology and the composition of the cellular infiltrate classifies as an acute phase of a chronic inflammatory disease. The proinflammatory environment, particularly the generation of the osteoclast-inducing cytokines CXCL8 and IL1-ß, promotes bone resorption. Loss of bone results in implant loosening, which then causes the major symptoms of metallosis, pain and reduced range of motion. PMID:24650243

  7. Cementless Hydroxyapatite Coated Hip Prostheses

    PubMed Central

    Herrera, Antonio; Mateo, Jesús; Gil-Albarova, Jorge; Lobo-Escolar, Antonio; Ibarz, Elena; Gabarre, Sergio; Más, Yolanda

    2015-01-01

    More than twenty years ago, hydroxyapatite (HA), calcium phosphate ceramics, was introduced as a coating for cementless hip prostheses. The choice of this ceramic is due to its composition being similar to organic apatite bone crystals. This ceramic is biocompatible, bioactive, and osteoconductive. These qualities facilitate the primary stability and osseointegration of implants. Our surgical experience includes the implantation of more than 4,000 cementless hydroxyapatite coated hip prostheses since 1990. The models implanted are coated with HA in the acetabulum and in the metaphyseal area of the stem. The results corresponding to survival and stability of implants were very satisfactory in the long-term. From our experience, HA-coated hip implants are a reliable alternative which can achieve long term survival, provided that certain requirements are met: good design selection, sound choice of bearing surfaces based on patient life expectancy, meticulous surgical technique, and indications based on adequate bone quality. PMID:25802848

  8. Implant Design in Cementless Hip Arthroplasty

    PubMed Central

    Kim, Jung Taek

    2016-01-01

    When performing cementless hip arthroplasty, it is critical to achieve firm primary mechanical stability followed by biological fixation. In order to achieve this, it is essential to fully understand characteristics of implant design. In this review, the authors review fixation principles for a variety of implants used for cementless hip replacement and considerations for making an optimal selection. PMID:27536647

  9. Influence of cup-center-edge angle on micro-motion at the interface between the cup and host bone in cementless total hip arthroplasty: three-dimensional finite element analysis.

    PubMed

    Kaku, Nobuhiro; Tabata, Tomonori; Tsumura, Hiroshi

    2015-12-01

    We verified the index cup position required for bulk bone grafting instead of morcellized grafting immediately after cementless total hip arthroplasty. Three-dimensional finite element analysis was used to evaluate changes in the volume of the slippage of the cup-host bone interface as micro-motion of the cup at the acetabular bone defect site depending on the cup-center-edge (CE) angle. The conditions of bulk bone grafts were similar to those of cortical bone. Slippage increased with decreasing cup-CE angle. A bulk bone graft tightly fixed to the host bone prevented considerably larger slippage between the cup and host bone. A smaller cup-CE angle increased the impact of the bulk bone graft on slippage. When the cup-CE angle was 0° or -10°, the criterion for slippage in favorable initial fixation in all conditions was <40 μm. Even if transplanted bulk bone is used, unless good fixation is obtained between the host bone, and the cup and bone graft, it is impossible to obtain reliable fixation of the cup with a cup-CE angle <-10° and slippage exceeding 40 μm. Bulk bone grafting tightly fixed to the host bone improves initial the cup-host bone fixation, especially when the cup-CE angle is small, such as <-10°. In clinical practice, negative factors are implicated in the initial fixation of various cups, and sufficient fixation between the host bone and cup or bulk bone graft using a screw is effective when the cup-CE angle is extremely small. PMID:26319002

  10. Bearing surfaces for hip arthroplasty - is metal-on-metal a passing fancy?

    PubMed

    Lee, Reginald K; Nevelos, Jim; Vigdorchik, Jonathan; Markel, David C

    2012-12-01

    Metal-on-metal bearings have had popularity that has waxed and waned over the years. The advantages realized relative to wear resistance and strength had been offset by early failures, manufacturing difficulty, and most recently by adverse soft tissue responses to the metallic debris. The bearing's history, evolution, advantages and disadvantages will be discussed in attempt to answer the question: is metal-on-metal a passing fancy? PMID:23065801

  11. An analysis of screw fixation of the femoral component in cementless hip arthroplasty.

    PubMed

    Martin, J W; Sugiyama, H; Kaiser, A D; Van Hoech, J; Whiteside, L A

    1990-01-01

    A cementless hip stem that allows screw fixation of the collar to cortical bone in the calcar region was found to achieve enhanced rotational stability when implanted in preserved cadaveric human femora. Although the implants with screws showed less tendency for subsidence than the implants without screws, rotational micromotion was not found to be statistically different under light loading conditions. When implanted in composite bone, the addition of screws in the configuration tested was associated with significant metal-on-metal wear during combined compression and rotational cyclic loading. This finding is of concern due to potential wear particle toxicity and possible lowered fatigue life of the prosthesis. Therefore, specific design changes are recommended. PMID:2243211

  12. Two-Stage Progressive Femoral Lowering Followed by Cementless Total Hip Arthroplasty for Treating Crowe IV-Hartofilakidis Type 3 Developmental Dysplasia of the Hip.

    PubMed

    Binazzi, Roberto

    2015-05-01

    High developmental dysplasia of the hip is commonly treated with total hip arthroplasty and shortening osteotomy. We present a two stage technique, consisting of progressive femoral lowering followed by total hip arthroplasty. The clinico-radiographic results of eleven patients (twelve hips) who were operated on with the two-stage technique were evaluated at a mean follow-up of 11 ± 5 years. At the final follow-up, ten patients (eleven hips) had a mean Harris hip score of 85 ± 5 points with no implant loosening. One patient (one hip) was revised at 5 years due to infection. No neurovascular complications were observed in any patients. With this technique, we could place the cup in the anatomical position and obtain complete limb symmetry with excellent clinical results at long-term. PMID:25599863

  13. Ultrasound screening of periarticular soft tissue abnormality around metal-on-metal bearings.

    PubMed

    Nishii, Takashi; Sakai, Takashi; Takao, Masaki; Yoshikawa, Hideki; Sugano, Nobuhiko

    2012-06-01

    Although metal hypersensitivity or pseudotumors are concerns for metal-on-metal (MoM) bearings, detailed pathologies of patterns, severity, and incidence of periprosthetic soft tissue lesions are incompletely understood. We examined the potential of ultrasound for screening of periarticular soft tissue lesions around MoM bearings. Ultrasound examinations were conducted in 88 hips (79 patients) with MoM hip resurfacings or MoM total hip arthroplasties with a large femoral head. Four qualitative ultrasound patterns were shown, including normal pattern in 69 hips, joint-expansion pattern in 11 hips, cystic pattern in 5 hips, and mass pattern in 3 hips. Hips with the latter 3 abnormal patterns showed significantly higher frequency of clinical symptoms, without significant differences of sex, duration of implantation, head sizes, and cup abduction/anteversion angles, compared with hips with normal pattern. Ultrasound examination provides sensitive screening of soft tissue reactions around MoM bearings and may be useful in monitoring progression and defining treatment for periarticular soft tissue abnormalities. PMID:22047978

  14. Management of metal-on-metal hip implant patients: Who, when and how to revise?

    PubMed Central

    Berber, Reshid; Skinner, John A; Hart, Alister J

    2016-01-01

    The debate on how best to manage patients with metal-on-metal (MOM) hip implants continues. With over 1 million patients affected worldwide, the impact is far reaching. The majority of the aggressive failures of MOM hip implants have been dealt with by revision hip surgery, leaving patients with a much more indolent pattern of failure of devices that have been in situ for more than 10 years. The longer-term outcome for such patients remains unknown, and much debate exists on how best to manage these patients. Regulatory guidance is available but remains open to interpretation due to the lack of current evidence and long-term studies. Metal ion thresholds for concern have been suggested at 7 ppb for hip resurfacing arthroplasty and below this level for large diameter total hip arthroplasties. Soft tissue changes including pseudotumours and muscle atrophy have been shown to progress, but this is not consistent. New advanced imaging techniques are helping to diagnose complications with metal hips and the reasons for failure, however these are not widely available. This has led to some centres to tackle difficult cases through multidisciplinary collaboration, for both surgical management decisions and also follow-up decisions. We summarise current evidence and consider who is at risk, when revision should be undertaken and how patients should be managed. PMID:27190754

  15. Tribolayer Formation in a Metal-on-Metal (MoM) Hip Joint: An Electrochemical Investigation

    PubMed Central

    Mathew, MT; Nagelli, C; Pourzal, R; Fischer, A; Laurent, MP; Jacobs, JJ; Wimmer, MA

    2013-01-01

    The demand for total hip replacement (THR) surgery is increasing in the younger population due to faster rehabilitation and more complete restoration of function. Up to 2009, metal-on-metal (MoM) hip joint bearings were a popular choice due to their design flexibility, post-operative stability and relatively low wear rates. The main wear mechanisms that occur along the bearing surface of MoM joints are tribochemical reactions that deposit a mixture of wear debris, metal ions and organic matrix of decomposed proteins known as a tribolayer. No in-depth electrochemical studies have been reported on the structure and characteristics of this tribolayer or about the parameters involved in its formation. In this study, we conducted an electrochemical investigation of different surfaces (bulk-like: control, nano-crystalline: new implant and tribolayer surface: retrieved implant) made out of two commonly used hip CoCrMo alloys (high-carbon and low-carbon). As per ASTM standard, cyclic polarization tests and electrochemical impedance spectroscopy tests were conducted. The results obtained from electrochemical parameters for different surfaces clearly indicated a reduction in corrosion for the tribolayer surface (Icorr: 0.76 μA/cm2). Further, polarization resistance (Rp:2.39±0.60MΩ/cm2) and capacitance (Cdl:15.20±0.75 μF/cm2) indicated variation in corrosion kinetics for the tribolayer surface, that attributed to its structure and stability in a simulated body environment. PMID:24099949

  16. Management of metal-on-metal hip implant patients: Who, when and how to revise?

    PubMed

    Berber, Reshid; Skinner, John A; Hart, Alister J

    2016-05-18

    The debate on how best to manage patients with metal-on-metal (MOM) hip implants continues. With over 1 million patients affected worldwide, the impact is far reaching. The majority of the aggressive failures of MOM hip implants have been dealt with by revision hip surgery, leaving patients with a much more indolent pattern of failure of devices that have been in situ for more than 10 years. The longer-term outcome for such patients remains unknown, and much debate exists on how best to manage these patients. Regulatory guidance is available but remains open to interpretation due to the lack of current evidence and long-term studies. Metal ion thresholds for concern have been suggested at 7 ppb for hip resurfacing arthroplasty and below this level for large diameter total hip arthroplasties. Soft tissue changes including pseudotumours and muscle atrophy have been shown to progress, but this is not consistent. New advanced imaging techniques are helping to diagnose complications with metal hips and the reasons for failure, however these are not widely available. This has led to some centres to tackle difficult cases through multidisciplinary collaboration, for both surgical management decisions and also follow-up decisions. We summarise current evidence and consider who is at risk, when revision should be undertaken and how patients should be managed. PMID:27190754

  17. Cementless total hip arthroplasty with the rectangular titanium Zweymüller stem: a concise follow-up, at a minimum of twenty years, of previous reports.

    PubMed

    Kolb, Alexander; Grübl, Alexander; Schneckener, Charlotte-Dorothé; Chiari, Catharina; Kaider, Alexandra; Lass, Richard; Windhager, Reinhard

    2012-09-19

    In 2002 and 2006, we reported the long-term results of 208 total hip replacements performed with the Zweymüller stem and a threaded cup in 200 patients. The present study gives an update on this patient cohort. At a minimum of twenty years postoperatively, seventy-three patients (seventy-five hips) were available for follow-up; twelve patients were lost to follow-up. The key findings of our previous reports were the absence of aseptic femoral stem loosening and a poor rate of survival of the threaded cup. Since then, two revisions have been performed because of aseptic stem loosening. We observed osteolytic lesions around the proximal part of the femoral component on twenty-four (47%) of fifty-one radiographs, but no stem was deemed at risk for loosening. The probability of survival of the stem at twenty years was 0.96 (95% confidence interval, 0.91 to 0.99), and the probability of survival of the cup at twenty years was 0.67 (95% confidence interval, 0.57 to 0.75). The Zweymüller femoral stem, a tapered, rectangular implant, continues to give excellent long-term results. PMID:22992879

  18. Initial mechanical stability of cementless highly-porous titanium tibial components

    SciTech Connect

    Stone, Timothy Brandon; Amer, Luke D; Warren, Christopher P; Cornwell, Phillip; Meneghini, R Michael

    2008-01-01

    Cementless fixation in total knee replacement has seen limited use since reports of early failure surfaced in the late 80s and early 90s. However the emergence of improved biomaterials, particularly porous titanium and tantalum, has led to a renewed interest in developing a cementless tibial component to enhance long-term survivorship of the implants. Cement is commonly employed to minimize micromotion in new implants but represents a weak interface between the implant and bone. The elimination of cement and application of these new biomaterials, which theoretically provide improved stability and ultimate osseointegration, would likely result in greater knee replacement success. Additionally, the removal of cement from the procedure would help minimize surgical durations and get rid of the time needed for curing, thereby the chance of infection. The purpose of this biomechanical study was twofold. The first goal was to assess whether vibration analysis techniques can be used to evaluate and characterize initial mechanical stability of cementless implants more accurately than the traditional method of micromotion determination, which employs linear variable differential transducers (LVDTs). Second, an evaluative study was performed to determine the comparative mechanical stability of five designs of cementless tibial components under mechanical loading designed to simulate in vivo forces. The test groups will include a cemented Triathlon Keeled baseplate control group, three different 2-peg cementless baseplates with smooth, mid, and high roughnesses and a 4-peg cement/ess baseplate with mid-roughness.

  19. European experience with cementless total hip replacements.

    PubMed

    Morscher, E W

    1983-01-01

    The differences between prostheses fixed with and without cement consist mainly of the design and the nature of the surface of the implant. The shapes of the sockets to be implanted without cement show a wide variety--cylinder, square, conus, ellipsoid with and without threads. The hemispherical shape, which was chosen for the acetabular component of the isoelastic hip joint, does not disturb the natural form and function of the hip joint since the outer surface is closely adapted to the original subchondral bone layer. Undesired stress concentrations therefore are eliminated. The fixation of the noncemented cup is secured by threads, pegs, screws, etc. and by ingrowth of bony tissue in the grooves of the surfaces. Except for some special forms, most of the stems are based on the self-locking principle. All prosthesis models show preparations that increase the surface area (ribs, wings, corrugations, or rims). PMID:6368478

  20. Balancing innovation and medical device regulation: the case of modern metal-on-metal hip replacements.

    PubMed

    Howard, Jason J

    2016-01-01

    Due to problems with wear particle generation and subsequent loosening using conventional metal-on-polyethylene total hip replacements, there has been a shift toward alternative bearing systems, including metal-on-metal (MoM), for younger, more active patients with degenerative joint disease. Based on positive results from early short-term clinical studies, MoM hip replacements were readily adopted by orthopedic surgeons with thousands being implanted worldwide over the past decade. Unacceptably high revision rates reported by two national joint registries called into question the rigorousness of the regulatory approval process for these implants, particularly with respect to premarket data requirements to prove safety, effectiveness, and the appropriateness of the regulatory pathway chosen. The purpose of this review was to investigate the balance between facilitating the introduction of new medical technologies and the need to ensure safety and effectiveness through comprehensive regulatory assessment. The case of MoM hip replacement devices was used to frame the investigation and subsequent discussions. The regulatory approval processes and post-market surveillance requirements associated with three common MoM hip replacements (two resurfacings: the Birmingham and articular surface replacement and the articular surface replacement XL total hip replacement) were investigated. With respect to modern MoM hip replacement devices, the balance between facilitating the introduction of these new medical technologies and the need to ensure safety and effectiveness through comprehensive regulatory assessment was not achieved. The lessons learned from these experiences have application beyond joint replacements to the introduction of new medical technologies in general, particularly for those who have a significant potential for harm. In this regard, a series of recommendations have been developed to contribute to the evolution of the medical device regulatory process

  1. Balancing innovation and medical device regulation: the case of modern metal-on-metal hip replacements

    PubMed Central

    Howard, Jason J

    2016-01-01

    Due to problems with wear particle generation and subsequent loosening using conventional metal-on-polyethylene total hip replacements, there has been a shift toward alternative bearing systems, including metal-on-metal (MoM), for younger, more active patients with degenerative joint disease. Based on positive results from early short-term clinical studies, MoM hip replacements were readily adopted by orthopedic surgeons with thousands being implanted worldwide over the past decade. Unacceptably high revision rates reported by two national joint registries called into question the rigorousness of the regulatory approval process for these implants, particularly with respect to premarket data requirements to prove safety, effectiveness, and the appropriateness of the regulatory pathway chosen. The purpose of this review was to investigate the balance between facilitating the introduction of new medical technologies and the need to ensure safety and effectiveness through comprehensive regulatory assessment. The case of MoM hip replacement devices was used to frame the investigation and subsequent discussions. The regulatory approval processes and post-market surveillance requirements associated with three common MoM hip replacements (two resurfacings: the Birmingham and articular surface replacement and the articular surface replacement XL total hip replacement) were investigated. With respect to modern MoM hip replacement devices, the balance between facilitating the introduction of these new medical technologies and the need to ensure safety and effectiveness through comprehensive regulatory assessment was not achieved. The lessons learned from these experiences have application beyond joint replacements to the introduction of new medical technologies in general, particularly for those who have a significant potential for harm. In this regard, a series of recommendations have been developed to contribute to the evolution of the medical device regulatory process

  2. Progressive Cardiomyopathy in a Patient With Elevated Cobalt Ion Levels and Bilateral Metal-on-Metal Hip Arthroplasties.

    PubMed

    Mosier, Brian A; Maynard, Lance; Sotereanos, Nicholas G; Sewecke, Jeffrey J

    2016-01-01

    Systemic cobalt toxicity is a rare complication after metal-on-metal (MOM) total hip arthroplasty. Here we present a case of progressive cardiomyopathy, as evidenced by biopsy and cardiac magnetic resonance imaging (MRI), in a patient with bilateral MOM total hip arthroplasties. To our knowledge, it is one of the first cases in which cardiomyopathy resulting from systemic cobalt disease has been shown on MRI. While there is no guideline to unequivocally diagnose cobalt cardiomyopathy, the constellation of findings, including pathologic, biologic, blood levels, imaging, and surgical, all uniformly indicate a unifying diagnosis. The lack of improvement after removal of the prosthetic device supports a diagnosis of permanent myocardial damage, which is consistent with cardiomyopathy of advanced toxic etiology. PMID:26991580

  3. Massive failure of TiNbN coating in surface engineered metal-on-metal hip arthroplasty: Retrieval analysis.

    PubMed

    Łapaj, Łukasz; Markuszewski, Jacek; Wendland, Justyna; Mróz, Adrian; Wierusz-Kozłowska, Małgorzata

    2016-07-01

    This article presents examination of a failed total hip replacement with surface engineered metal-on-metal (MoM) articulation. The implant was coated with a thin TiNbN film (Physical Vapor Deposition), and at retrieval 53 months after implantation the coating was abraded on weight-bearing part of the head and acetabular component. Scanning electron microscopy of bearing surfaces demonstrated multifocal crack formation, delamination of small film fragments, and formation of aggregates containing nanometer sized wear debris. We also observed coating damage in third body mechanism. Complex failure mechanism of TiNbN coating demonstrated in this study suggests insufficient bonding strength between the coating and substrate alloy and raise concerns regarding the use of such coatings in total hip arthroplasty with MoM bearing. © 2015 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 104B: 1043-1049, 2016. PMID:25980456

  4. Does Ion Release Differ Between Hip Resurfacing and Metal-on-metal THA?

    PubMed Central

    Moroni, Antonio; Cadossi, Matteo; Baldini, Nicola; Giannini, Sandro

    2008-01-01

    Modern metal-on-metal hip resurfacing was introduced as a bone-preserving method of joint reconstruction for young and active patients; however, the large diameter of the bearing surfaces is of concern for potential increased metal ion release. We hypothesized there were no differences in serum concentrations of chromium, cobalt, and molybdenum between patients who had metal-on-metal hip resurfacing (Group A; average head diameter, 48 mm; median followup, 24 months) and patients who had 28-mm metal-on-metal THA (Group B; median followup, 25 months). Serum concentrations also were compared with concentrations in healthy subjects. We identified no differences in ion levels between Groups A and B. A distinction was made according to gender. Women showed a higher chromium release in Group A whereas men had a higher cobalt release in Group B. Values obtained from Group A were higher than those of the control subjects. Our data suggest metal-on-metal bearings for THA should not be rejected because of concern regarding potential increased metal ion release; however, patients with elevated ion levels, even without loosening or toxicity, could be at higher risk and should be followed up periodically. Level of Evidence: Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence. PMID:18196364

  5. The Inflammatory Phenotype in Failed Metal-On-Metal Hip Arthroplasty Correlates with Blood Metal Concentrations

    PubMed Central

    Paukkeri, Erja-Leena; Korhonen, Riku; Hämäläinen, Mari; Pesu, Marko; Eskelinen, Antti; Moilanen, Teemu; Moilanen, Eeva

    2016-01-01

    Introduction Hip arthroplasty is the standard treatment of a painful hip destruction. The use of modern metal-on-metal (MOM) bearing surfaces gained popularity in total hip arthroplasties during the last decade. Recently, worrisome failures due to adverse reaction to metal debris (ARMD), including pseudotumor response, have been widely reported. However, the pathogenesis of this reaction remains poorly understood. The aim of the present study was to investigate the ARMD response by flow cytometry approach. Methods Sixteen patients with a failed Articular Surface Replacement (ASR) hip prosthesis were included in the study. Samples of pseudotumor tissues collected during revision surgery were degraded by enzyme digestion and cells were typed by flow cytometry. Whole blood chromium and cobalt concentrations were analyzed with mass spectrometry before revision surgery. Results Flow cytometry analysis showed that the peri-implant pseudotumor tissue expressed two principal phenotypes, namely macrophage-dominated and T-lymphocyte-dominated response; the average portions being 54% (macrophages) and 25% (T-lymphocytes) in macrophage-dominated inflammation and 20% (macrophages) and 54% (T-lymphocytes) in T-lymphocyte-dominated response. The percentages of B-lymphocytes and granulocytes were lower in both phenotypes. Interestingly, the levels of blood chromium and cobalt were significantly higher in patients with macrophage-dominated response. Conclusions The results suggest that the adverse tissue reactions induced by MOM wear particles contain heterogeneous pathogeneses and that the metal levels are an important factor in the determination of the inflammatory phenotype. The present results support the hypothesis that higher metal levels cause cytotoxicity and tissue injury and macrophages are recruited to clear the necrotic debris. On the other hand, the adverse response developed in association with lower metal levels is T-lymphocyte-dominated and is likely to reflect

  6. New Insights into Wear and Biological Effects of Metal-on-Metal Bearings

    PubMed Central

    Catelas, Isabelle; Wimmer, Markus A.

    2011-01-01

    Background: Despite the renewed interest in metal-on-metal implants in the past two decades, the underlying wear mechanisms and biological effects are still not fully understood. Methods: This paper first reviews the tribology of metal-on-metal bearings, bringing new insights into the interaction of wear and corrosion, and putting the characteristics and the potential origin of wear particles in perspective with the proposed wear mechanisms. It then summarizes the current knowledge on the biological effects of particles and metal ions in relation to these wear mechanisms. Results: Tribochemical reactions play an important role in the wear of metal-on-metal joints. The generated tribomaterial, which progressively forms by mechanical mixing of the uppermost nanocrystalline zone of the metal surface with proteins from the synovial fluid, governs the wear rate and influences the corrosive behavior of the bearing. Nanometer-sized wear particles may initially originate from the passivation layer covering the implant surface and then detach from this tribolayer. The inflammatory response observed surrounding metal-on-metal implants appears to be lower than that around metal-on-polyethylene implants. However, metallic byproducts, which can complex with proteins, may lead to a T lymphocyte-mediated hypersensitivity response. Conclusions: The tribolayer appears to have beneficial effects on the wear rate. Much information has been gained on wear particle characteristics, but the exact mechanisms of particle detachment remain to be further elucidated. Excessive wear along with a hypersensitivity response may be at the origin of the early adverse tissue reactions that have been recently reported in some patients with metal-on-metal implants. Clinical Relevance: Future development of new methods to improve the tribolayer retention and optimize the tribocorrosive properties of the implant may minimize the clinical impact of implant wear and immune responses. PMID:21543694

  7. The pathogenesis of osteolysis in two different cementless hip replacements.

    PubMed

    Learmonth, I D; Smith, E J; Cunningham, J L

    1997-01-01

    Wear of ultra-high molecular weight polyethylene has been incriminated in the osteolysis associated with aseptic loosening of hip implants. A variety of different factors can contribute to accelerated patterns of polyethylene wear and subsequent osteolysis. This paper examines the incidence of osteolysis observed in two different well-matched cohorts of cementless total hip arthroplasties. The patterns of osteolysis observed, which are ascribed to the generation of polyethylene debris, are interpreted with reference to the design of the individual prostheses. PMID:9141891

  8. Metal-on-Metal Hip Prostheses and Systemic Health: A Cross-Sectional Association Study 8 Years after Implantation

    PubMed Central

    Prentice, Jennifer R.; Clark, Matthew J.; Hoggard, Nigel; Morton, Allison C.; Tooth, Claire; Paley, Martyn N.; Stockley, Ian; Hadjivassiliou, Marios; Wilkinson, J. Mark

    2013-01-01

    There is public concern over the long term systemic health effects of metal released from hip replacement prostheses that use large-diameter metal-on-metal bearings. However, to date there has been no systematic study to determine which organs may be at risk, or the magnitude of any effect. We undertook a detailed cross-sectional health screen at a mean of 8 years after surgery in 35 asymptomatic patients who had previously received a metal-on-metal hip resurfacing (MoMHR) versus 35 individually age and sex matched asymptomatic patients who had received a conventional hip replacement. Total body bone mineral density was 5% higher (mean difference 0.05 g/cm2, P = 0.02) and bone turnover was 14% lower (TRAP 5b, mean difference −0.56IU/L, P = 0.006; osteocalcin, mean difference −3.08 ng/mL, P = 0.03) in the hip resurfacing versus conventional hip replacement group. Cardiac ejection fraction was 7% lower (mean absolute difference −5%, P = 0.04) and left ventricular end-diastolic diameter was 6% larger (mean difference 2.7 mm, P = 0.007) in the hip resurfacing group versus those patients who received a conventional hip replacement. The urinary fractional excretion of metal was low (cobalt 5%, chromium 1.5%) in patients with MoMHR, but creatinine clearance was normal. Diuretic prescription was associated with a 40% increase in the fractional excretion of chromium (mean difference 0.5%, P = 0.03). There was no evidence of difference in neuropsychological, renal tubular, hepatic or endocrine function between groups (P>0.05). Our findings of differences in bone and cardiac function between patient groups suggest that chronic exposure to low elevated metal concentrations in patients with well-functioning MoMHR prostheses may have systemic effects. Long-term epidemiological studies in patients with well-functioning metal on metal hip prostheses should include musculoskeletal and cardiac endpoints to quantitate the risk of clinical disease. PMID

  9. The effect of the metal-on-metal hip controversy on Internet search activity.

    PubMed

    Phelan, Nigel; Kelly, John C; Moore, David P; Kenny, Patrick

    2014-10-01

    The recall of the articular surface replacement (ASR) hip prosthesis in 2010 represents one of the most controversial areas in orthopaedic surgery in recent years. The aim of this study was to compare the impact of the metal-on-metal hip controversy on Internet search activity in four different regions and determine whether the number of related news reports affected Internet search activity. The Google Trends, Keywords and News applications were used to record the number of news articles and Internet search activity for the terms "hip recall", "metal-on-metal hip" and "ASR hip" from October 2009 to October 2012 in the USA, the UK, Australia and Ireland. There was a large increase in search activity following the official recall in August 2010 in all countries. There was significantly greater search activity after the recall in Ireland compared with the UK for the search term "hip recall" (P = 0.004). For the term "metal-on-metal hip", the UK had significantly more search activity (P = 0.0009). There was a positive correlation between the number of news stories in UK and Ireland with Internet search activity but not in the USA or Australia. Differences between countries affected by the same recall highlight the complex effects of the media on public awareness. The data demonstrates a window of opportunity prior to the official recall for the development of an awareness campaign to provide patients with accurate information. PMID:24390041

  10. Cementless bulk alumina socket: preliminary results at 6 years.

    PubMed

    Hamadouche, M; Nizard, R S; Meunier, A; Bizot, P; Sedel, L

    1999-09-01

    To avoid polyethylene wear observed in total hip replacement, an alumina-alumina combination has been used since 1977. The aim of this study is to report the results of a hybrid alumina-alumina total hip arthroplasty with a cementless press-fit bulk alumina socket and a cemented titanium alloy stem in 55 patients (62 hips) operated on between 1982 and 1990. The bearing surfaces were a 32-mm alumina head articulating within the alumina socket. Four failures occurred: 3 aseptic loosenings of the socket and 1 femoral head fracture. Considering aseptic loosening as the endpoint, the survival rate was 93.2% after 6 years. At a mean of 72.1 months' follow-up, 92.4% of the surviving hips were graded as very good or good using the Merle d'Aubigné-Postel hip score. Radiolucent lines were observed on the acetabular side in 68.1 of the hips. The future of this interface, which is probably fibrous, remains questionable. With the exception of 1 femoral head fracture, all revisions were related to failure of the bony fixation of the socket, and no problem was encountered related to the alumina-alumina friction coupling. Alumina sockets with other types of cementless fixation have therefore been designed and are presently under clinical investigation. PMID:10512442

  11. Successful hip arthroplasty using cementless titanium implants in rheumatoid arthritis.

    PubMed

    Effenberger, Harald; Ramsauer, Thomas; Böhm, Gerhard; Hilzensauer, Gerhard; Dorn, Ulrich; Lintner, Felix

    2002-03-01

    Over a period of eight years, we implanted a total of 76 cementless hip prostheses in patients with rheumatoid arthritis. The clinical results of 47 patients (70 hips) increased from a mean Harris Hip Score of 33 to 85 after an average of 49 months (range 1-11 years). One threaded cup has had to be revised because of loosening, and one stem because of femoral fracture. At the latest follow-up, 88% of Hofer-Imhof threaded cups had complete bone ingrowth (Type 0); 10% had near-complete bone ingrowth with minimal radiolucency in one third of the bone contact area (Type 1), and 2% had radiolucency in two thirds of the bone contact area (Type 2). Hemispherical push-in cups showed significantly more radiolucency around the cup. For the stems (Uni, Zweymüller SL), 83% showed no radiolucency (Type 0); 17% had radiolucency only very proximally (Type 1). Minor remodelling (Type 1) occurred in 60% of the femoral shafts; 30% had moderate femoral density loss (Type 2), and 10% had severe bone loss and cortical thinning (Type 3). There was no correlation between marked shaft atrophy and clinical symptoms. With regard to radiolucency and remodelling, there was no significant difference between the two types of stem used. Cementless hip arthroplasty using titanium implants has an excellent outcome in the medium term. PMID:11880907

  12. An integrated CAD/CAM/robotic milling method for custom cementless femoral prostheses.

    PubMed

    Wen-ming, Xi; Ai-min, Wang; Qi, Wu; Chang-hua, Liu; Jian-fei, Zhu; Fang-fang, Xia

    2015-09-01

    Aseptic loosening is the primary cause of cementless femoral prosthesis failure and is related to the primary stability of the cementless femoral prosthesis in the femoral cavity. The primary stability affects both the osseointegration and the long-term stability of cementless femoral prostheses. A custom cementless femoral prosthesis can improve the fit and fill of the prosthesis in the femoral cavity and decrease the micromotion of the proximal prosthesis such that the primary stability of the custom prosthesis can be improved, and osseointegration of the proximal prosthesis is achieved. These results will help to achieve long-term stability in total hip arthroplasty (THA). In this paper, we introduce an integrated CAD/CAM/robotic method of milling custom cementless femoral prostheses. The 3D reconstruction model uses femoral CT images and 3D design software to design a CAD model of the custom prosthesis. After the transformation matrices between two units of the robotic system are calibrated, consistency between the CAM software and the robotic system can be achieved, and errors in the robotic milling can be limited. According to the CAD model of the custom prosthesis, the positions of the robotic tool points are produced by the CAM software of the CNC machine. The normal vector of the three adjacent robotic tool point positions determines the pose of the robotic tool point. In conclusion, the fit rate of custom pig femur stems in the femoral cavities was 90.84%. After custom femoral prostheses were inserted into the femoral cavities, the maximum gaps between the prostheses and the cavities measured less than 1 mm at the diaphysis and 1.3 mm at the metaphysis. PMID:26210779

  13. Diagnosis of adverse local tissue reactions following metal-on-metal hip arthroplasty.

    PubMed

    Chalmers, Brian P; Perry, Kevin I; Taunton, Michael J; Mabry, Tad M; Abdel, Matthew P

    2016-03-01

    Metal-on-metal (MOM) bearing surfaces in hip arthroplasty have distinct advantages that led to the increase in popularity in North America in the early 2000s. However, with their increased use, concerns such as local cytotoxicity and hypersensitivity reactions leading to soft tissue damage and cystic mass formation (known collectively as adverse local tissue reactions (ALTR)) became apparent. The clinical presentation of ALTR is highly variable. The diagnosis of ALTR in MOM articulations in hip arthroplasty can be challenging and a combination of clinical presentation, physical examination, implant track record, component positioning, serum metal ion levels, cross-sectional imaging, histopathologic analysis, and consideration of alternative diagnoses are essential. PMID:26816329

  14. Metal-on-Metal Hip Arthroplasty: A Review of Adverse Reactions and Patient Management.

    PubMed

    Drummond, James; Tran, Phong; Fary, Camdon

    2015-01-01

    Recent alarming joint registry data highlighting increased revision rates has prompted further research into the area of metal-on-metal hip replacements and resurfacings. This review article examines the latest literature on the topic of adverse reactions to metal debris and summarises the most up-to-date guidelines on patient management. Adverse reactions to metal debris can cause significant damage to soft tissue and bone if not diagnosed early. Furthermore, not every patient with an adverse reaction to metal debris will be symptomatic. As such, clinicians must remain vigilant when assessing and investigating these patients in order to detect failing implants and initiate appropriate management. PMID:26132653

  15. Metal on metal surface replacement of the hip. Experience of the McMinn prothesis.

    PubMed

    McMinn, D; Treacy, R; Lin, K; Pynsent, P

    1996-08-01

    The historical failure of surface replacement has been due to the production of wear debris with subsequent bone resorption, loosening, and failure. To avoid these problems, a surface replacement using a metal on metal bearing allowing thin components and femoral design and instrumentation to avoid varus alignment has been designed. Two hundred thirty-five joints have been resurfaced with this prosthesis in almost 5 years. There have been no femoral neck fractures and no dislocations. There have been 4 designs differing in the method of fixation. In the press fit group, 6 of 70 hips had to be revised for aseptic loosening. In the cemented group, debonding of the cup occurred in 3 of 43 cases. Six patients had hydroxyapatite coated components and have had excellent clinical outcomes. The current design uses a peripherally expanded hydroxyapatite coated cup and a cemented metal head; 116 of this design have been implanted during a 19-month period with excellent outcome. Despite short followup the authors are hopeful that the combination of a polar metal on metal bearing with appropriate fixation will yield a method of preserving bone stock in the younger patient requiring arthroplasty. PMID:8769326

  16. Surface engineering: a low wearing solution for metal-on-metal hip surface replacements.

    PubMed

    Leslie, Ian J; Williams, Sophie; Brown, Chris; Anderson, James; Isaac, Graham; Hatto, Peter; Ingham, Eileen; Fisher, John

    2009-08-01

    Increased patient blood and serum levels of Co and Cr and dissemination of metal wear particles throughout organs and tissues are the primary concerns with metal-on-metal surface replacements. Surface engineering, providing a ceramic bearing surface on a metal substrate, could provide a solution. This study investigated thick (>10 microm) arc evaporation plasma vapor deposition chromium nitride (CrN) coated surface replacements in terms of wear, ion levels, and wear particles in a 10 million cycle hip simulator study, compared to a contemporary metal-on-metal surface replacement. The ion levels were measured by inductively coupled plasma mass spectroscopy. The wear particles were imaged by field emission gun scanning electron microscopy. The CrN-coated bearings had 80% lower wear than the MoM controls. The Cr and Co ion levels in the lubricant of the CrN bearings were 73 and 98% lower than in the MoM controls. The wear particles produced were in the nanometer size range and round to oval in morphology. The CrN coating could provide a reduction in the wear and ion release of MoM surface replacements, thereby reducing the perceived risks to the patient associated with these prostheses. PMID:19195030

  17. Lubrication and friction prediction in metal-on-metal hip implants

    NASA Astrophysics Data System (ADS)

    Wang, F. C.; Brockett, C.; Williams, S.; Udofia, I.; Fisher, J.; Jin, Z. M.

    2008-03-01

    A general methodology of mixed lubrication analysis and friction prediction for a conforming spherical bearing in hip implants was developed, with particular reference to a typical metal-on-metal hip replacement. Experimental measurement of frictional torque for a similar implant was carried out to validate the theoretical prediction. A ball-in-socket configuration was adopted to represent the articulation between the femoral head and the acetabular cup under cyclic operating conditions of representative load and motion. The mixed lubrication model presented in this study was first applied to identify the contact characteristics on the bearing surfaces, consisting of both fluid-film and boundary lubricated regions. The boundary lubricated contact was assumed to occur when the predicted fluid film thickness was less than a typical boundary protein layer absorbed on the bearing surfaces. Subsequently, the friction was predicted from the fluid-film lubricated region with viscous shearing due to both Couette and Poiseuille flows and the boundary protein layer contact region with a constant coefficient of friction. The predicted frictional torque of the typical metal-on-metal hip joint implant was compared with the experimental measurement conducted in a functional hip simulator and a reasonably good agreement was found. The mixed lubrication regime was found to be dominant for the conditions considered. Although the percentage of the boundary lubricated region was quite small, the corresponding contribution to friction was quite large and the resultant friction factor was quite high.

  18. Are all metal-on-metal hip revision operations contributing to the National Joint Registry implant survival curves?

    PubMed Central

    Sabah, S. A.; Henckel, J.; Koutsouris, S.; Rajani, R.; Hothi, H.; Skinner, J. A.; Hart, A. J.

    2016-01-01

    Aims The National Joint Registry for England, Wales and Northern Ireland (NJR) has extended its scope to report on hospital, surgeon and implant performance. Data linkage of the NJR to the London Implant Retrieval Centre (LIRC) has previously evaluated data quality for hip primary procedures, but did not assess revision records. Methods We analysed metal-on-metal hip revision procedures performed between 2003 and 2013. A total of 69 929 revision procedures from the NJR and 929 revised pairs of components from the LIRC were included. Results We were able to link 716 (77.1%) revision procedures on the NJR to the LIRC. This meant that 213 (22.9%) revision procedures at the LIRC could not be identified on the NJR. We found that 349 (37.6%) explants at the LIRC completed the full linkage process to both NJR primary and revision databases. Data completion was excellent (> 99.9%) for revision procedures reported to the NJR. Discussion This study has shown that only approximately one third of retrieved components at the LIRC, contributed to survival curves on the NJR. We recommend prospective registry-retrieval linkage as a tool to feedback missing and erroneous data to the NJR and improve data quality. Take home message: Prospective Registry – retrieval linkage is a simple tool to evaluate and improve data quality on the NJR. Cite this article: Bone Joint J 2016;98-B:33–9. PMID:26733513

  19. Perivascular Lymphocytic Infiltration Is Not Limited to Metal-on-Metal Bearings

    PubMed Central

    Ng, Vincent Y.; Berend, Keith R.; Skeels, Michael D.; Adams, Joanne B.

    2010-01-01

    Background Perivascular lymphocytic infiltration (PVLI) suggests an adaptive immune response. Metal hypersensitivity after THA is presumed associated with idiopathic pain and aseptic loosening, but its incidence and relationship to metallic wear leading to revision are unclear as are its presence and relevance in non-metal-on-metal arthroplasty. Questions/purposes We compared (1) incidence and severity of PVLI in failed hip metal-on-metal (MoM) to non-MoM implants and TKA; (2) PVLI in MoM and non-MoM hip arthroplasty based on reason for revision; and (3) PVLI grade to diffuse lymphocytic infiltration (DLI) and tissue reaction to metal particles. Patients and Methods We retrospectively examined incidence and severity of PVLI, DLI, and tissue reaction in periprosthetic tissue from 215 THA and 242 TKA revisions including 32 MoM hips. Results Perivascular lymphocytic infiltration was present in more TKAs (40%) than overall hip arthroplasties (24%) without difference in severity. Compared to non-MoM hips, MoM bearings were more commonly associated with PVLI (59% versus 18%) and demonstrated increased severity (41% versus 3% greater than mild). Histologically, PVLI correlated (r = 0.51) with DLI, but not tissue reaction. In THA, PVLI was most commonly associated with idiopathic pain (70%) and aseptic loosening (54%) in MoM, and infection in all hip revisions (53%). Conclusions Perivascular lymphocytic infiltration is more extensive in revisions of MoM and in aseptic loosening, idiopathic pain, or infection but is also present in TKA, non-MoM, and different reasons for revision. It correlates with other signs of metal hypersensitivity, but not with histologic measures of metal particulate load. Level of Evidence Level III, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence. PMID:20878289

  20. Cementless Hip Arthroplasty in Southern Iran, Midterm Outcome and Comparison of Two Designs

    PubMed Central

    Shahcheraghi, Gholam Hossein; Hashemi, Seyed Ali

    2015-01-01

    Background: Cementless hip prosthesis was designed to provide biologic fixation, without the use of cement. The second generation components have shown more reliable bone ingrowths and survival rates. We are reporting a midterm result of two designs of cementless prosthesis in a unique culture with different social habits and expectations. Methods: 52 primary cementless total hip arthroplasty in 42 patients with the mean age of 48.8 years were retrospectively studied. Two groups of prosthesis had been implanted: Harris-Galante II (HGII) in 15 and Versys-Trilogy (V-T) in 37 hips, both from Zimmer company. The patients were assessed clinically, radiographically and with Harris hip score, SF36, WOMAC, and MACTAR questionnaires, with 65 months (26-136) mean follow-up. Results: All the V-T prostheses had survived well. Eight of HG II were revised by the last follow-up in 19-102 months. All had undergone acetabular revision and 2 combined with femoral revision. Broken tines of HGII cups were seen in 4 radiographs. The 65 months overall survival was 96.2% for femoral and 84.6% for acetabular components. 90% had good or excellent Harris hip scores. The functional scores were poorer in the HG II group. Pain relief and improved walking were the two main patients’ expectations fulfilled in 97.6% and 92.8%, respectively. Conclusions: The outcome of cementless total hip arthroplasty (THA) is satisfactory and comparable with the literature based on the results of function and survival of this small comparative group. The use of HGII acetabular component should be abandoned. PMID:26379348

  1. The Early Result of Cementless Arthroplasty for Femur Neck Fracture in Elderly Patients with Severe Osteoporosis

    PubMed Central

    Seo, Jae-Seong; Shin, Seong-Kee; Jun, Sung-Han; Cho, Chang-Ho

    2014-01-01

    Purpose The purposes of the current study were to assess the early results of cementless hip arthroplasty (HA) for femoral neck fractures in elderly patients with severe osteoporosis and to compare the clinical outcomes between those who underwent total HA (THA) or bipolar hemiarthroplasty (BHA). Materials and Methods From April 2011 to May 2012, we performed 87 cementless HAs for displaced femoral neck fractures in elderly patients (≥65 years) with severe osteoporosis. Among them, we studied 70 hips that were able to be followed-up for >24 months. Of these, 34 underwent THA and 36 underwent BHA. Clinical results were evaluated using the Harris hip score (HHS), Koval classification, and radiographs. Results Only one instance of femoral stem loosening was observed. Additionally, no dislocations were observed and no revision surgeries were required. The mean changes in the functional items of the HHS scores were 2.8 and 5.2 for those who underwent THA and BHA, respectively (P<0.05). According to the Koval classification used for the ambulatory status analysis, the mean perioperative change in the grade was 0.8 (0-4), with no significant differences noted between the THA and BHA groups. Conclusion The early results of cementless HA for femur neck fractures in elderly patients with osteoporosis were satisfactory, and THA was found to have a functional advantage over BHA.

  2. Birmingham Hip Resurfacing--Patient reported outcomes pre and post 'Metal-on-Metal' media attention.

    PubMed

    Barke, Samuel; Malagelada, Francesc; Stafford, Giles; McMinn, Derek; Field, Richard

    2016-03-01

    We have investigated whether patient reported outcomes provided by patients with Birmingham Hip Resurfacing (BHR) changed after negative media coverage of metal-on-metal (MOM) hip replacement. We also investigated whether patients whose procedures were performed by a designer surgeon behaved differently to those performed elsewhere. 1178 consecutive BHR procedures performed between January 2002 and December 2006, by one of the designer surgeons in his private practice, were reviewed. We also reviewed 402 BHRs undertaken by two non-designer surgeons in both their NHS and private practice. 150 of the latter cohort were undertaken at an NHS hospital and 252 at an independent private hospital. All patients had annual Oxford Hip Scores (OHS) collected. We chose 2007 as pre-"media attention" and compared scores from this year against subsequent years. We found no clinically significant change in OHS between 2007 and subsequent years, at all centres. We conclude that negative media reporting does not appear to have had an impact on patients' perceived outcome after BHR. In consequence, patients who have undergone this type of hip resurfacing and show deterioration should be investigated. PMID:26984649

  3. The medical ecoculture at work: the case of the metal-on-metal hip.

    PubMed

    Gillick, Muriel R

    2013-01-01

    The United States has the most expensive, technologically intensive system of medical care in the world, but not the most effective. Reforming health care will require understanding the interactions among the many individuals and institutions that collectively constitute the health-care ecoculture, an ecosystem with a major human component. Because technology is a key driver of health-care costs and a critical component of the patient's experience of American medicine, it is fruitful to consider an example of a particular technology: why it was embraced, who benefited from its use, and the response of the ecoculture when a critical flaw in the technology emerged. The case of the introduction, diffusion, and withdrawal of metal-on-metal hip prostheses will be discussed from the perspective of patients, physicians, device manufacturers, regulators, and the legal system. Each of these groups responded to external stimuli by adaptation in an attempt to maximize its own interests. Interactions between the groups served as a further mechanism of maintaining the status quo within medicine. A single change, such as modification of the payment system or incentivizing patients, is thus unlikely to be effective in transforming health care; instead, a multi-pronged approach, along with reforms outside medicine, will likely be necessary. PMID:24769749

  4. Fast growing pseudotumour in a hairdresser after metal-on-metal hip resurfacing: a case report.

    PubMed

    Cadossi, M; Chiarello, E; Savarino, L; Mazzotti, A; Tedesco, G; Greco, M; Giannini, S

    2014-01-01

    A 44-year-old female hairdresser who underwent metal-on-metal hip resurfacing (MOMHR) for hip osteoarthritis developed a benign pelvic pseudotumour. Elevated levels of chromium and cobalt ions were detected in the blood. Patch testing after pseudotumor formation, showed positive skin reactions to cobalt and nickel. Marked hypereosinophilia was noted, as well as the presence of eosinophils in the pseudotumor mass. A revision to a ceramic-on-ceramic implant was performed. Radiographs showed no implant loosening or bone resorption. We hypothesized that a steep cup positioning as well as hypersensitivity response to the metal nanoparticles and ion release may have induced pseudotumour development. Currently there is no evidence that negative patch testing reduces the probability to develop an adverse reaction to metal debris therefore we suggest to carefully investigate patient medical history regarding occupation exposure and daily contact with jewellery, beauty and cleaning products before implanting MOMHR. The main challenge is to identify a sensitive patient candidate to MOMHR never suspected to be. PMID:24825038

  5. Wear mechanisms in metal-on-metal bearings: the importance of tribochemical reaction layers.

    PubMed

    Wimmer, Markus A; Fischer, Alfons; Büscher, Robin; Pourzal, Robin; Sprecher, Christoph; Hauert, Roland; Jacobs, Joshua J

    2010-04-01

    Metal-on-metal (MoM) bearings are at the forefront in hip resurfacing arthroplasty. Because of their good wear characteristics and design flexibility, MoM bearings are gaining wider acceptance with market share reaching nearly 10% worldwide. However, concerns remain regarding potential detrimental effects of metal particulates and ion release. Growing evidence is emerging that the local cell response is related to the amount of debris generated by these bearing couples. Thus, an urgent clinical need exists to delineate the mechanisms of debris generation to further reduce wear and its adverse effects. In this study, we investigated the microstructural and chemical composition of the tribochemical reaction layers forming at the contacting surfaces of metallic bearings during sliding motion. Using X-ray photoelectron spectroscopy and transmission electron microscopy with coupled energy dispersive X-ray and electron energy loss spectroscopy, we found that the tribolayers are nanocrystalline in structure, and that they incorporate organic material stemming from the synovial fluid. This process, which has been termed "mechanical mixing," changes the bearing surface of the uppermost 50 to 200 nm from pure metallic to an organic composite material. It hinders direct metal contact (thus preventing adhesion) and limits wear. This novel finding of a mechanically mixed zone of nanocrystalline metal and organic constituents provides the basis for understanding particle release and may help in identifying new strategies to reduce MoM wear. PMID:19877285

  6. Wear patterns of taper connections in retrieved large diameter metal-on-metal bearings.

    PubMed

    Bishop, Nicholas; Witt, Florian; Pourzal, Robin; Fischer, Alfons; Rütschi, Marcel; Michel, Markus; Morlock, Michael

    2013-07-01

    Wear of the modular taper between head and shaft has been related to clinical failure resulting from adverse reactions to metallic debris. The problem has become pronounced in large metal-on-metal bearings, but the mechanism has not yet been fully understood. We analyzed retrieved components from five patients revised with various diagnoses. Two distinct wear patterns were observed for the head tapers. Three samples demonstrated "asymmetric" wear towards the inner end of the head taper. The other two showed "axisymmetric" radial wear (up to 65 µm) presenting the largest wear volumes (up to 20 mm(3)). Stem tapers demonstrated relatively little wear, and the fine thread on the stem taper surface was observed to be imprinted on the taper inside of the head. Our findings demonstrate that the cobalt-chrome head wears preferentially to the titanium stem taper. "asymmetric" wear suggests toggling due to the offset of the joint force vector from the taper. In contrast, samples with "axisymmetric" radial wear and a threaded imprint suggested that corrosion led to head subsidence onto the stem taper with gradual rotation. PMID:23440943

  7. Prevalence of Pseudotumor in Patients After Metal-On-Metal Hip Arthroplasty Evaluated with Metal Ion Analysis and MARS-MRI.

    PubMed

    Sutphen, Sean A; MacLaughlin, Lewis H; Madsen, Adam A; Russell, Jackie H; McShane, Michael A

    2016-01-01

    The purpose of this study is to quantify the prevalence of pseudotumors in patients with well-functioning and painful metal-on-metal total hip arthroplasty, to characterize the pseudotumor with the use of MARS-MRI, and to assess the relationship between pseudotumors and metal ions. We retrospectively reviewed 102 single surgeon patients. The results showed that 68.6% developed pseudotumor with 60.9% of the asymptomatic group developing pseudotumor. The symptomatic group had a higher proportion of patients with elevated serum cobalt levels (P=0.035). There was no difference found with elevated metal ions and prevalence of pseudotumor, but elevated cobalt levels were associated with larger pseudotumor size (P=0.001). The available evidence indicated that most patients that develop pseudotumors are asymptomatic, and that elevated serum cobalt levels may be associated with symptoms and pseudotumor size. PMID:26253484

  8. Promising short-term clinical results of the cementless Oxford phase III medial unicondylar knee prosthesis

    PubMed Central

    van Dorp, Karin B; Breugem, Stefan JM; Bruijn, Daniël J; Driessen, Marcel JM

    2016-01-01

    AIM: To investigate the short-term clinical results of the Oxford phase III cementless medial unicondylar knee prosthesis (UKP) compared to the cemented medial UKP. METHODS: We conducted a cross-sectional study in a tertairy orthopedic centre between the period of May 2010 and September 2012. We included 99 medial UKP in 97 patients and of these UKP, 53 were cemented and 46 were cementless. Clinical outcome was measured using a questionnaire, containing a visual analogue scale (VAS) for pain, Oxford Knee score, Kujala score and SF-12 score. Knee function was tested using the American Knee Society score. Complications, reoperations and revisions were recorded. Statistical significance was defined as a P value < 0.05. RESULTS: In a mean follow-up time of 19.5 mo, three cemented medial UKP were revised to a total knee prosthesis. Reasons for revision were malrotation of the tibial component, aseptic loosening of the tibial component and progression of osteoarthritis in the lateral- and patellofemoral compartment. In five patients a successful reoperation was performed, because of impingement or (sub)luxation of the polyethylene bearing. Patients with a reoperation were significant younger than patients in the primary group (56.7 vs 64.0, P = 0.01) and were more likely to be male (85.7% vs 38.8%, P = 0.015). Overall the cementless medial UKP seems to perform better, but the differences in clinical outcome are not significant; a VAS pain score of 7.4 vs 11.7 (P = 0.22), an Oxford Knee score of 43.3 vs 41.7 (P = 0.27) and a Kujala score of 79.6 vs 78.0 (P = 0.63). The American Knee Society scores were slightly better in the cementless group with 94.5 vs 90.2 (P = 0.055) for the objective score and 91.2 vs 87.8 (P = 0.25) for the subjective score. CONCLUSION: The cementless Oxford phase III medial UKP shows good short-term clinical results, when used in a specialist clinic by an experienced surgeon. PMID:27114932

  9. Greater Trochanteric Fragmentation After Failed Metal-on-Metal Hip Arthroplasty.

    PubMed

    Panichkul, Phonthakorn; Fricka, Kevin B; Hopper, Robert H; Engh, C Anderson

    2015-05-01

    Adverse reaction to metal debris (ARMD) involving the hip joint has emerged as an important reason for failure and revision among patients with metal-on-metal (MOM) hip arthroplasty. To the authors' knowledge, there are no reports of adverse radiographic sequelae in the greater trochanter subsequent to revision for ARMD. The authors describe clinical and radiographic findings in 2 patients who developed greater trochanteric fragmentation 1 to 2 years after conversion of their failed MOM hips to polyethylene bearings. Both patients had solid pseudotumors with tissue necrosis. Several reports describe various clinical features of ARMD. Although poor outcomes have been demonstrated after some MOM revisions, to the authors' knowledge, no reports document greater trochanter fragmentation in ARMD. The current patients highlight the fact that tissue damage occurring with MOM bearing hips can involve bone in addition to soft tissue even after a pseudotumor has been removed and serum metal levels have decreased to normal levels after revision. Unlike the greater trochanteric fractures historically associated with polyethylene wear and osteolysis, no evidence of bone cysts or lesions was found prior to the fractures and neither fracture healed with conservative treatment. For these 2 patients, the authors believe the tissue necrosis included both soft tissue and bone. The necrotic bone resorbed gradually after removal of the MOM bearing, resulting in bone fragmentation with ongoing symptoms. These patients emphasize and remind us that damage is not only limited to soft tissues, but also includes bone. Surgeons should be aware of this radiographic finding and the associated clinical symptoms. PMID:25970376

  10. Cross-sectional imaging of metal-on-metal hip arthroplasties

    PubMed Central

    Robinson, Elizabeth; Henckel, Johann; Sabah, Shiraz; Satchithananda, Keshthra; Skinner, John; Hart, Alister

    2014-01-01

    Background and purpose — Metal artifact reduction sequence (MARS) MRI is widely advocated for surveillance of metal-on-metal hip arthroplasties (MOM-HAs). However, its use is limited by susceptibility artifact at the prosthesis-bone interface, local availability, patient compliance, and cost (Hayter et al. 2011a). We wanted to determine whether CT is a suitable substitute for MARS MRI in evaluation of the painful MOM-HA. Patients and methods — 50 MOM-HA patients (30 female) with unexplained painful prostheses underwent MARS MRI and CT imaging. 2 observers who were blind regarding the clinical data objectively reported the following outcomes: soft tissue lesions (pseudotumors), muscle atrophy, and acetabular and femoral osteolysis. Diagnostic test characteristics were calculated. Results — Pseudotumor was diagnosed in 25 of 50 hips by MARS MRI and in 11 of 50 by CT. Pseudotumors were classified as type 1 (n = 2), type 2A (n = 17), type 2B (n = 4), and type 3 (n = 2) by MARS MRI. CT did not permit pseudotumor classification. The sensitivity of CT for diagnosis of pseudotumor was 44% (95% CI: 25–65). CT had “slight” agreement with MARS MRI for quantification of muscle atrophy (κ = 0.23, CI: 0.16–0.29; p < 0.01). Osteolysis was identified in 15 of 50 patients by CT. 4 of these lesions were identified by MARS MRI. Interpretation — CT was found to be superior to MRI for detection of osteolysis adjacent to MOM-HA, and should be incorporated into diagnostic algorithms. CT was unable to classify and failed to detect many pseudotumors, and it was unreliable for assessment of muscle atrophy. Where MARS MRI is contraindicated or unavailable, CT would be an unsuitable substitute and other modalities such as ultrasound should be considered PMID:25267500

  11. Osteolytic lesion of the tibial diaphysis after cementless TKA.

    PubMed

    Vernon, Brian A; Bollinger, Alexander J; Garvin, Kevin L; McGarry, Sean V

    2011-03-01

    Biomaterial wear debris is a known contributing factor in aseptic loosening of total joint prostheses, particularly when cementless tibial trays are used in total knee arthroplasty (TKA). Local inflammatory response can lead to osteolysis and aseptic loosening of implants. The resulting lesions require careful clinical evaluation. This article presents a case of a 76-year old man with a remote history of prostate cancer and cigarette smoking who presented with acute onset left knee and tibia pain 15 years after TKA. Radiographs showed an osteolytic lesion in the distal tibial diaphysis and magnetic resonance imaging revealed a cystic lesion with evidence concerning for pathologic mid-shaft fracture. Biopsy of the lesion confirmed a foreign body reaction and revision TKA was performed. The patient was seen at 3-year follow-up without complication. The existing literature presents cases reporting osteolytic lesions of the distal femur and proximal tibial metaphysis due to polyethylene wear debris and foreign body reaction following TKA. We are unaware of case reports involving osteolysis of this etiology extending into the distal tibial diaphysis. We conclude that polyethylene wear debris with foreign body reaction should be considered in the differential diagnosis of an osteolytic lesion extending into the tibial diaphysis following TKA. PMID:21410114

  12. Microfocus study of metal distribution and speciation in tissue extracted from revised metal on metal hip implants

    NASA Astrophysics Data System (ADS)

    Hart, Alister J.; Sandison, Ann; Quinn, Paul; Sampson, Barry; Atkinson, Kirk D.; Skinner, John A.; Goode, Angela; Powell, Jonathan J.; Mosselmans, J. Frederick W.

    2009-11-01

    Unexplained tissue inflammation in metal-on-metal hip replacements is suspected to be caused by implant-derived nanoparticles. The aim of this study was to investigate the nature of the metal particles in tissue surrounding metal-on-metal (MOM) hips that has been extracted during revision. Mapping of tissue surrounding the failed MOM hips was performed using microfocus X-ray Fluorescence (XRF). This revealed mainly Cr which was localized to the cellular regions. There was co-localisation of Co, were present, to areas of high Cr abundance. XANES of the tissue and appropriate standards revealed that the most common species were Cr(III) and Co(II). EXAFS analysis of the tissue and various metal standards revealed that the most abundant implant-related species was Cr(III) phosphate. Different tissue preparation methods, including frozen sectioning, were examined but were found not to affect the distribution or speciation of the metals in the tissue.

  13. Validation of primary metal-on-metal hip arthroplasties on the National Joint Registry for England, Wales and Northern Ireland using data from the London Implant Retrieval Centre

    PubMed Central

    Sabah, S. A.; Henckel, J.; Cook, E.; Whittaker, R.; Hothi, H.; Pappas, Y.; Blunn, G.; Skinner, J. A.; Hart, A. J.

    2015-01-01

    Arthroplasty registries are important for the surveillance of joint replacements and the evaluation of outcome. Independent validation of registry data ensures high quality. The ability for orthopaedic implant retrieval centres to validate registry data is not known. We analysed data from the National Joint Registry for England, Wales and Northern Ireland (NJR) for primary metal-on-metal hip arthroplasties performed between 2003 and 2013. Records were linked to the London Implant Retrieval Centre (RC) for validation. A total of 67 045 procedures on the NJR and 782 revised pairs of components from the RC were included. We were able to link 476 procedures (60.9%) recorded with the RC to the NJR successfully. However, 306 procedures (39.1%) could not be linked. The outcome recorded by the NJR (as either revised, unrevised or death) for a primary procedure was incorrect in 79 linked cases (16.6%). The rate of registry-retrieval linkage and correct assignment of outcome code improved over time. The rates of error for component reference numbers on the NJR were as follows: femoral head category number 14/229 (5.0%); femoral head batch number 13/232 (5.3%); acetabular component category number 2/293 (0.7%) and acetabular component batch number 24/347 (6.5%). Registry-retrieval linkage provided a novel means for the validation of data, particularly for component fields. This study suggests that NJR reports may underestimate rates of revision for many types of metal-on-metal hip replacement. This is topical given the increasing scope for NJR data. We recommend a system for continuous independent evaluation of the quality and validity of NJR data. Cite this article: Bone Joint J 2015;97-B:10–18. PMID:25568407

  14. Blood metal ion testing is an effective screening tool to identify poorly performing metal-on-metal bearing surfaces

    PubMed Central

    Sidaginamale, R. P.; Joyce, T. J.; Lord, J. K.; Jefferson, R.; Blain, P. G.; Nargol, A. V. F.; Langton, D. J.

    2013-01-01

    Objectives The aims of this piece of work were to: 1) record the background concentrations of blood chromium (Cr) and cobalt (Co) concentrations in a large group of subjects; 2) to compare blood/serum Cr and Co concentrations with retrieved metal-on-metal (MoM) hip resurfacings; 3) to examine the distribution of Co and Cr in the serum and whole blood of patients with MoM hip arthroplasties; and 4) to further understand the partitioning of metal ions between the serum and whole blood fractions. Methods A total of 3042 blood samples donated to the local transfusion centre were analysed to record Co and Cr concentrations. Also, 91 hip resurfacing devices from patients who had given pre-revision blood/serum samples for metal ion analysis underwent volumetric wear assessment using a coordinate measuring machine. Linear regression analysis was carried out and receiver operating characteristic curves were constructed to assess the reliability of metal ions to identify abnormally wearing implants. The relationship between serum and whole blood concentrations of Cr and Co in 1048 patients was analysed using Bland-Altman charts. This relationship was further investigated in an in vitro study during which human blood was spiked with trivalent and hexavalent Cr, the serum then separated and the fractions analysed. Results Only one patient in the transfusion group was found to have a blood Co > 2 µg/l. Blood/Serum Cr and Co concentrations were reliable indicators of abnormal wear. Blood Co appeared to be the most useful clinical test, with a concentration of 4.5 µg/l showing sensitivity and specificity for the detection of abnormal wear of 94% and 95%, respectively. Generated metal ions tended to fill the serum compartment preferentially in vivo and this was replicated in the in vitro study when blood was spiked with trivalent Cr and bivalent Co. Conclusions Blood/serum metal ion concentrations are reliable indicators of abnormal wear processes. Important differences exist

  15. Analysis of contact mechanics in McKee-farrar metal-on-metal hip implants.

    PubMed

    Yew, A; Jagatia, M; Ensaff, H; Jin, Z M

    2003-01-01

    Contact mechanics analysis for a typical McKee-Farrar metal-on-metal hip implant was carried out in this study. The finite element method was used to predict the contact area and the contact pressure distribution at the bearing surfaces. The study investigated the effects of the cement and underlying bone, the geometrical parameters such as the radial clearance between the acetabular cup and the femoral head, and the acetabular cup thickness, as well as other geometrical features on the acetabular cup such as lip and studs. For all the cases considered, the predicted contact pressure distribution was found to be significantly different from that based upon the classical Hertz contact theory, with the maximum value being away from the centre of the contact region. The lip on the cup was found to have a negligible effect on the predicted contact pressure distribution. The presence of the studs on the outside of the cup caused a significant increase in the local contact pressure distribution, and a slight decrease in the contact region. Reasonably good agreement of the predicted contact pressure distribution was found between a three-dimensional anatomical model and a simple two-dimensional axisymmetric model. The interfacial boundary condition between the acetabular cup and the underlying cement, modelled as perfectly fixed or perfectly unbonded, had a negligible effect on the predicted contact parameters. For a given radial clearance of 0.079 mm, the decrease in the thickness of the acetabular cup from 4.5 to 1.5 mm resulted in an increase in the contact half angle from 15 degrees to 26 degrees, and a decrease in the maximum contact pressure from 55 to 20 MPa. For a given acetabular cup thickness of 1.5 mm, a decrease in the radial clearance from 0.158 to 0.0395 mm led to an increase in the contact half-angle from 20 degrees to 30 degrees, and a decrease in the maximum contact pressure from 30 to 10 MPa. For zero clearance, although the contact pressure was

  16. Survivorship of standard versus modified posterior surgical approaches in metal-on-metal hip resurfacing

    PubMed Central

    M. Takamura, K.; Maher, P.; Nath, T.; Su, E. P.

    2014-01-01

    Objectives Metal-on-metal hip resurfacing (MOMHR) is available as an alternative option for younger, more active patients. There are failure modes that are unique to MOMHR, which include loosening of the femoral head and fractures of the femoral neck. Previous studies have speculated that changes in the vascularity of the femoral head may contribute to these failure modes. This study compares the survivorship between the standard posterior approach (SPA) and modified posterior approach (MPA) in MOMHR. Methods A retrospective clinical outcomes study was performed examining 351 hips (279 male, 72 female) replaced with Birmingham Hip Resurfacing (BHR, Smith and Nephew, Memphis, Tennessee) in 313 patients with a pre-operative diagnosis of osteoarthritis. The mean follow-up period for the SPA group was 2.8 years (0.1 to 6.1) and for the MPA, 2.2 years (0.03 to 5.2); this difference in follow-up period was statistically significant (p < 0.01). Survival analysis was completed using the Kaplan–Meier method. Results At four years, the Kaplan–Meier survival curve for the SPA was 97.2% and 99.4% for the MPA; this was statistically significant (log-rank; p = 0.036). There were eight failures in the SPA and two in the MPA. There was a 3.5% incidence of femoral head collapse or loosening in the SPA and 0.4% in the MPA, which represented a significant difference (p = 0.041). There was a 1.7% incidence of fractures of the femoral neck in the SPA and none in the MPA (p = 0.108). Conclusion This study found a significant difference in survivorship at four years between the SPA and the MPA (p = 0.036). The clinical outcomes of this study suggest that preserving the vascularity of the femoral neck by using the MPA results in fewer vascular-related failures in MOMHRs. Cite this article: Bone Joint Res 2014;3:150–4 PMID:24842931

  17. No medium-term advantage of electrochemical deposition of hydroxyapatite in cementless femoral stems

    PubMed Central

    Flatøy, Bernhard; Röhrl, Stephan M; Bøe, Berte; Nordsletten, Lars

    2016-01-01

    Background and purpose Hydroxyapatite has been used for a long time as an adjunct to enhance cementless fixation. The benefit of this is still debated, but new methods of hydroxyapatite deposition have emerged, offering possible gains. In order to investigate this further, we compared the migration pattern and periprosthetic bone remodeling in a cementless femoral stem with either electrochemically deposited hydroxyapatite—called Bonemaster (BM)—or a conventional plasma-sprayed hydroxyapatite (HA) coating. Patients and methods 55 hips were randomized to either BM or HA cementless femoral stems. Patients were followed with radiostereometry (RSA), dual-energy X-ray absorptiometry (DXA), radiographic measurements, and hip questionnaires for 5 years. Results For both stems, migration occurred mainly as subsidence and retroversion during the first 3 months. The BM group had a higher retroversion rate of 0.17° per month during this period, as compared to 0.06° per month for the HA group (p = 0.006). Thereafter, there was almost no movement in any direction for both stem types. Bone resorption occurred mainly during the first year, and subsequently decreased to a rate close to what is seen in normal ageing. The greatest total decrease occurred in Gruen zones 1 and 7, similar in the groups at 5 years. There was a slightly higher resorption rate in Gruen zone 7 from 2 to 5 years in the BM group (1.3% per year; p = 0.04), but in a magnitude that would scarcely affect stem stability or survival. Interpretation There were no clinically relevant differences between the 2 stems regarding stability or periprosthetic bone loss at 5 years. Electrochemically deposited HA does not appear to affect fixation or bone remodeling when compared to conventional plasma spraying at 5 years. Thus, at this point, Bonemaster appears to be safe. PMID:26364953

  18. Meeting the demands of on-going metal-on-metal hip surveillance through nurse led services.

    PubMed

    Elliott, Sue; Langfield, Sarah

    2016-02-01

    This paper discusses the implications following a recall of all metal-on-metal hip replacements by the Medicines and Healthcare products regulatory Agency (MHRA). Issues identified were the release of metal ions from the metal implants. These ions were found to seep into local tissues and cause reactions that destroyed muscle and bone leaving some patients with long term disability. At the centre surveillance was monitored by an extension of the current Nurse Led services using existing staff and resources. There were a significant number of patients that required monitoring and there were difficulties contacting these patients and ensuring that they understood the importance of attending a clinic. PMID:26772766

  19. Clinical Usefulness of SPECT-CT in Patients with an Unexplained Pain in Metal on Metal (MOM) Total Hip Arthroplasty.

    PubMed

    Berber, Reshid; Henckel, Johann; Khoo, Michael; Wan, Simon; Hua, Jia; Skinner, John; Hart, Alister

    2015-04-01

    SPECT-CT is increasingly used to assess painful knee arthroplasties. The aim of this study was to evaluate the clinical usefulness of SPECT-CT in unexplained painful MOM hip arthroplasty. We compared the diagnosis and management plan for 19 prosthetic MOM hips in 15 subjects with unexplained pain before and after SPECT-CT. SPECT-CT changed the management decision in 13 (68%) subjects, Chi-Square=5.49, P=0.24. In 6 subjects (32%) pain remained unexplained however the result reassured the surgeon to continue with non-operative management. SPECT-CT should be reserved as a specialist test to help identify possible causes of pain where conventional investigations have failed. It can help reassure surgeons making management decisions for patients with unexplained pain following MOM hip arthroplasty. PMID:25583682

  20. A genetic algorithm based multi-objective shape optimization scheme for cementless femoral implant.

    PubMed

    Chanda, Souptick; Gupta, Sanjay; Kumar Pratihar, Dilip

    2015-03-01

    The shape and geometry of femoral implant influence implant-induced periprosthetic bone resorption and implant-bone interface stresses, which are potential causes of aseptic loosening in cementless total hip arthroplasty (THA). Development of a shape optimization scheme is necessary to achieve a trade-off between these two conflicting objectives. The objective of this study was to develop a novel multi-objective custom-based shape optimization scheme for cementless femoral implant by integrating finite element (FE) analysis and a multi-objective genetic algorithm (GA). The FE model of a proximal femur was based on a subject-specific CT-scan dataset. Eighteen parameters describing the nature of four key sections of the implant were identified as design variables. Two objective functions, one based on implant-bone interface failure criterion, and the other based on resorbed proximal bone mass fraction (BMF), were formulated. The results predicted by the two objective functions were found to be contradictory; a reduction in the proximal bone resorption was accompanied by a greater chance of interface failure. The resorbed proximal BMF was found to be between 23% and 27% for the trade-off geometries as compared to ∼39% for a generic implant. Moreover, the overall chances of interface failure have been minimized for the optimal designs, compared to the generic implant. The adaptive bone remodeling was also found to be minimal for the optimally designed implants and, further with remodeling, the chances of interface debonding increased only marginally. PMID:25392855

  1. Electrochemical instrumentation of a hip simulator: a new tool for assessing the role of corrosion in metal-on-metal hip joints.

    PubMed

    Yan, Y; Neville, A; Dowson, D; Williams, S; Fisher, J

    2010-11-01

    Polyethylene wear debris induced osteolysis has triggered investigations to find alternative material combinations to the well-established metal-on-polyethylene hip implants. Owing to some early successful clinical cases, metal-on-metal (MoM) hip replacements have been attracting more and more interest. There is, however, considerable concern about the propensity of MoM hip replacements to release metal ions and fine, nanometre-scale metallic wear debris. The long-term effect from released metal ions and wear particles is still not clear. To date, all the work on hip simulators focused on assessing mass losses damage has been referred to as 'wear'. However, it is known in the field of tribocorrosion that mechanical removal of the passive layer on Co-Cr alloys can significantly enhance corrosion activity. In total joint replacements, it is possible that corrosion plays a significant role. However, no one has ever tried to extract, on a hip simulator, what proportion of the damage is due to mechanical processes and the corrosion processes. This paper describes the first instrumentation of an integrated hip joint simulator to provide in-situ electrochemical measurements in real time. The open circuit potential results are reported to assess the corrosion regime in the absence and presence of movement at the bearing surfaces. The importance of these measurements is that the real damage mechanisms can be assessed as a function of the operating cycle. PMID:21218689

  2. A safe zone for acetabular component position in metal-on-metal hip resurfacing arthroplasty: winner of the 2012 HAP PAUL award.

    PubMed

    Liu, Fei; Gross, Thomas P

    2013-08-01

    A safe zone for acetabular component positioning in hip resurfacing (RAIL: Relative Acetabular Inclination Limit) was calculated based on implant size and acetabular inclination angle (AIA). For AIA below the RAIL, there were no adverse wear failures or dislocations, and only 1% of cases with ion levels above 10 μg/L. Other than high inclination angle and small bearing size, female gender was the only other factor that correlated with high ion levels in the multivariate analysis. Seven hundred sixty-one hip resurfacing cases are included in this study. The UCLA activity score, femoral shaft angle, body mass index, weight, American Society of Anesthesiologists score, combined range of motion, diagnosis, age, gender, implant brand, AIA, bearing size, and duration of implantation were analyzed to determine the potential risk factors for elevated metal ion levels. These findings apply to sub hemispheric metal-on-metal bearings with similar coverage arcs as the Biomet and Corin hip resurfacing brands. Additional problems may occur when these bearings are connected with trunions on stems for total hip arthroplasty. PMID:23540536

  3. Metal ion levels and functional results after either resurfacing hip arthroplasty or conventional metal-on-metal hip arthroplasty

    PubMed Central

    2011-01-01

    Background Modern metal-on-metal hip resurfacing was introduced as a bone-preserving method of joint reconstruction for young and active patients; however, the large diameter of the bearing surfaces is of concern for potentially increased metal ion release. Patients and methods 71 patients (< 65 years old) were randomly assigned to receive either a resurfacing (R) hip arthroplasty (n = 38) or a conventional metal-on-metal (C) hip arthroplasty (n = 33). Functional outcomes were assessed preoperatively and at 6, 12, and 24 months. Cobalt and chromium blood levels were analyzed preoperatively and at 3, 6, 12, and 24 months. Results All functional outcome scores improved for both groups. At 12 and 24 months, the median UCLA activity score was 8 in the R patients and 7 in the C patients (p < 0.05). At 24 months, OHS was median 16 in C patients and 13 in R patients (p < 0.05). However, in spite of randomization, UCLA scores also appeared to be higher in R patients at baseline. Satisfaction was similar in both groups at 24 months. Cobalt concentrations were statistically significantly higher for R patients only at 3 and 6 months. Chromium levels remained significantly higher for R patients until 24 months. No pseudotumors were encountered in either group. One R patient was revised for early aseptic loosening and in 2 C patients a cup insert was exchanged for recurrent dislocation. Interpretation R patients scored higher on UCLA, OHS, and satisfaction at some time points; however, as for the UCLA, preoperative levels were already in favor of R. The differences, although statistically significant, were of minor clinical importance. Chromium blood levels were statistically significantly higher for R patients at all follow-up measurements, whereas for cobalt this was only observed up to 6 months. The true value of resurfacing hip arthroplasty over conventional metal-on-metal hip arthroplasty will be determined by longer follow-up and a possible shift of balance between their

  4. A hierarchy of computationally derived surgical and patient influences on metal on metal press-fit acetabular cup failure.

    PubMed

    Clarke, S G; Phillips, A T M; Bull, A M J; Cobb, J P

    2012-06-01

    The impact of anatomical variation and surgical error on excessive wear and loosening of the acetabular component of large diameter metal-on-metal hip arthroplasties was measured using a multi-factorial analysis through 112 different simulations. Each surgical scenario was subject to eight different daily loading activities using finite element analysis. Excessive wear appears to be predominantly dependent on cup orientation, with inclination error having a higher influence than version error, according to the study findings. Acetabular cup loosening, as inferred from initial implant stability, appears to depend predominantly on factors concerning the area of cup-bone contact, specifically the level of cup seating achieved and the individual patient's anatomy. The extent of press fit obtained at time of surgery did not appear to influence either mechanism of failure in this study. PMID:22513086

  5. Wear of surface-engineered metal-on-metal bearings for hip prostheses under adverse conditions with the head loading on the rim of the cup.

    PubMed

    Leslie, Ian; Williams, Sophie; Isaac, Graham; Hatto, Peter; Ingham, Eileen; Fisher, John

    2013-04-01

    Clinical studies have found high wear rates, elevated ion levels and high revision rates of large-diameter metal-on-metal surface replacement bearings in some patients, which have been associated with edge loading of the head on the rim of the cup. We have simulated increased wear and ion levels in metal-on-metal bearings in vitro by introducing variations in translational and rotational positioning of the components, which reproduces stripe wear on the femoral head, cup rim wear and clinically relevant large as well as small wear particles. There is interest in technologies such as surface engineering, which might reduce metal wear and the release of wear particles and ions. Reduced wear with surface-engineered surface replacements compared to metal-on-metal controls has been reported under standard walking conditions with correctly aligned and concentric components. In this in vitro study, the wear of chromium nitride surface-engineered metal-on-metal bearings under conditions of microseparation associated with translational and rotational malpositioning of the components was investigated and the results were compared with a previously reported study of metal-on-metal bearings under the same conditions. Simulations were conducted using our unique hip simulation microseparation methodologies, which reproduce accelerated wear in metal-on-metal bearings and have previously been clinically validated with ceramic-on-ceramic bearings. Four of the six surface-engineered bearings had evidence of head contact on the rim of the cup, which produced stripe wear on the femoral head. Four of the six surface-engineered bearings (two without stripe and two with stripe wear) had lower wear than the previously reported high wearing metal-on-metal bearings. At 2 million cycles, two of the surface-engineered bearings had substantially increased wear rates, four times higher than the high wear rates previously reported for metal-on-metal bearings under the same conditions. There was

  6. Second-Generation Versus First-Generation Cementless Tapered Wedge Femoral Stems.

    PubMed

    Pierce, Todd P; Jauregui, Julio J; Kapadia, Bhaveen H; Elmallah, Randa K; Cherian, Jeffrey J; Harwin, Steven F; Mont, Michael A

    2015-09-01

    Clinical outcomes of a new second-generation proximally coated, tapered wedge cementless stem were compared with those of its predecessor regarding (1) all-cause implant survivorship; (2) objective and subjective outcomes; (3) complications; and (4) radiographic features. Patients who underwent a primary total hip arthroplasty with the second-generation stem (68 hips) were compared with those who received the first-generation stem (136 hips) at a mean follow-up of 3.5 years. Although the first-generation stem was designed in the traditional manner, the second-generation stem was shortened to accommodate all surgical approaches and designed using a computed tomography scan-based database to enhance fit. The second-generation stem had survivorship, functional, and subjective outcomes similar to those of the first-generation stem. PMID:26375526

  7. Comparison of in vivo and simulator-retrieved metal-on-metal cervical disc replacements

    PubMed Central

    Kurtz, Steven M.; Ciccarelli, Lauren; Harper, Megan L.; Siskey, Ryan; Shorez, Jacob; Chan, Frank W.

    2012-01-01

    Background Cervical disc arthroplasty is regarded as a promising treatment for myelopathy and radiculopathy as an alternative to cervical spine fusion. On the basis of 2-year clinical data for the PRESTIGE® Cervical Disc (Medtronic, Memphis, Tennessee), the Food and Drug Administration recommended conditional approval in September 2006 and final approval in July 2007; however, relatively little is known about its wear and damage modes in vivo. The main objective was to analyze the tribological findings of the PRESTIGE® Cervical Disc. This study characterized the in vivo wear patterns of retrieved cervical discs and tested the hypothesis that the total disc replacements exhibited similar surface morphology and wear patterns in vitro as in vivo. Methods Ten explanted total disc replacements (PRESTIGE®, PRESTIGE® I, and PRESTIGE® II) from 10 patients retrieved after a mean of 1.8 years (range, 0.3–4.1 years) were analyzed. Wear testing included coupled lateral bending ( ±4.7°) and axial rotation ( ±3.8°) with a 49 N axial load for 5 million cycles followed by 10 million cycles of flexion-extension ( ±9.7°) with 148 N. Implant surfaces were characterized by the use of white-light interferometry, scanning electron microscopy, and energy dispersive spectroscopy. Results The explants generally exhibited a slightly discolored, elliptic wear region of varying dimension centered in the bearing center, with the long axis oriented in the medial-lateral direction. Abrasive wear was the dominant in vivo wear mechanism, with microscopic scratches generally oriented in the medial-lateral direction. Wear testing resulted in severe abrasive wear in a curvilinear fashion oriented primarily in the medial-lateral direction. All retrievals showed evidence of an abrasive wear mechanism. Conclusions This study documented important similarity between the wear mechanisms of components tested in vitro and explanted PRESTIGE® Cervical Discs; however, the severity of wear was

  8. Gluteal muscle fatty atrophy is not associated with elevated blood metal ions or pseudotumors in patients with a unilateral metal-on-metal hip replacement

    PubMed Central

    Reito, Aleksi; Elo, Petra; Nieminen, Jyrki; Puolakka, Timo; Eskelinen, Antti

    2016-01-01

    Background and purpose There are no international guidelines to define adverse reaction to metal debris (ARMD). Muscle fatty atrophy has been reported to be common in patients with failing metal-on-metal (MoM) hip replacements. We assessed whether gluteal muscle fatty atrophy is associated with elevated blood metal ion levels and pseudotumors. Patients and methods 263 consecutive patients with unilateral ASR XL total hip replacement using a posterior approach and with an unoperated contralateral hip were included in the study. All patients had undergone a standard screening program at our institution, including MRI and blood metal ion measurement. Muscle fatty atrophy was graded as being absent, mild, moderate, or severe in each of the gluteal muscles. Results The prevalance of moderate-to-severe gluteal muscle atrophy was low (12% for gluteus minimus, 10% for gluteus medius, and 2% for gluteus maximus). Muscle atrophy was neither associated with elevated blood metal ion levels (> 5 ppb) nor with the presence of a clear (solid- or mixed-type) pseudotumor seen in MRI. A combination of moderate-to-severe atrophy in MRI, elevated blood metal ion levels, and MRI-confirmed mixed or solid pseudotumor was rare. Multivariable regression revealed that “preoperative diagnosis other than osteoarthrosis” was the strongest predictor of the presence of fatty atrophy. Interpretation Gluteal muscle atrophy may be a clinically significant finding with influence on hip muscle strength in patients with MoM hip replacement. However, our results suggest that gluteal muscle atrophy seen in MRI is not associated with either the presence or severity of ARMD, at least not in patients who have been operated on using the posterior approach. PMID:26427902

  9. In vivo response of heme-oxygenase-1 to metal ions released from metal-on-metal hip prostheses.

    PubMed

    Beraudi, Alina; Bianconi, Eva; Catalani, Simona; Canaider, Silvia; De Pasquale, Dalila; Apostoli, Pietro; Bordini, Barbara; Stea, Susanna; Toni, Aldo; Facchin, Federica

    2016-07-01

    Metal ion release and accumulation is considered to be a factor responsible for the high failure rates of metal-on-metal (MoM) hip implants. Numerous studies have associated the presence of these ions, besides other factors, including a hypoxia‑like response and changes in pH due to metal corrosion leading to the induction of the oxidative stress response. The aim of the present study was to verify whether, in patients with a MoM hip prosthesis, mRNA and protein expression of HMOX‑1 was modulated by the presence of metal ions and whether patients without prostheses exhibit a different expression pattern of this enzyme. The study was conducted on 22 matched pairs of patients with and without prostheses, for a total of 44 samples. Ion dosage was determined using inductively coupled plasma mass spectrometry equipped with dynamic cell reaction. HMOX‑1 gene expression was quantified by reverse transcription-quantitative polymerase chain reaction and HMOX‑1 protein expression was analyzed using an enzyme-linked immunosorbent assay. The results demonstrated that although there were significant differences in the metallic ion concentrations amongst the two groups of patients, there was no correlation between circulating levels of cobalt (Co) and chromium (Cr), and HMOX‑1 gene and protein expression. Additionally, there was no significant difference in the protein expression levels of HMOX‑1 between the two groups. In conclusion, it was demonstrated that circulating Co and Cr ions released by articular prosthetics do not induce an increase in HMOX‑1 mRNA and protein expression at least 3.5 years after the implant insertion. The present study suggests that involvement of HMOX‑1 may be excluded from future studies and suggests that other antioxidant enzymes, including superoxide dismutase, glutathione peroxidase and reductase should be investigated. PMID:27176599

  10. In vivo evaluation of edge-loading in metal-on-metal hip resurfacing patients with pseudotumours

    PubMed Central

    Kwon, Y-M.; Mellon, S. J.; Monk, P.; Murray, D. W.; Gill, H. S.

    2012-01-01

    Objectives Pseudotumours (abnormal peri-prosthetic soft-tissue reactions) following metal-on-metal hip resurfacing arthroplasty (MoMHRA) have been associated with elevated metal ion levels, suggesting that excessive wear may occur due to edge-loading of these MoM implants. This study aimed to quantify in vivo edge-loading in MoMHRA patients with and without pseudotumours during functional activities. Methods The duration and magnitude of edge-loading in vivo was quantified during functional activities by combining the dynamic hip joint segment contact force calculated from the three-dimensional (3D) motion analysis system with the 3D reconstruction of orientation of the acetabular component and each patient’s specific hip joint centre, based on CT scans. Results Edge-loading in the hips with pseudotumours occurred with a four-fold increase in duration and magnitude of force compared with the hips without pseudotumours (p = 0.02). Conclusions The study provides the first in vivo evidence to support that edge-loading is an important mechanism that leads to localised excessive wear (edge-wear), with subsequent elevation of metal ion levels in MoMHRA patients with pseudotumours. PMID:23610670

  11. Clinical usefulness of blood metal measurements to assess the failure of metal-on-metal hip implants

    PubMed Central

    Sampson, Barry; Hart, Alister

    2012-01-01

    In April 2010, a Medicines and Healthcare Products Regulatory Agency safety alert concerning all metal-on-metal (MOM) hip replacements recommended measuring chromium and cobalt concentrations when managing patients with painful prostheses. The need for this review is illustrated by the recent surge in requests for these blood tests from orthopaedic surgeons following this alert. The aim is to provide guidance to laboratories in assessing these requests and advising clinicians on interpretation. First, we summarize the basic terminology regarding the types of hip replacements, with emphasis on the MOM type. Second, we describe the clinical concerns over implant-derived wear debris in the local tissues and distant sites. Analytical aspects of the measurement of the relevant metal ions and what factors affect the levels measured are discussed. The application of inductively coupled plasma mass spectrometry techniques to the measurement of these metals is considered in detail. The biological effects of metal wear products are summarized with local toxicity and systemic biological effects considered, including carcinogenicity, genotoxicity and systemic toxicity. Clinical cases are used to illustrate pertinent points. PMID:22155921

  12. Assessing the material loss of the modular taper interface in retrieved metal-on-metal hip replacements

    NASA Astrophysics Data System (ADS)

    Bills, Paul J.; Racasan, R.; Tessier, P.; Blunt, L. A.

    2015-06-01

    Measuring the amount of material loss in the case of revised hip replacements is considered to be a prerequisite of understanding and assessing the true in vivo performance of the implant. This paper outlines a method developed by the authors for quantifying taper material loss as well as more general taper interface parameters. Previous studies have mostly relied on visual inspection to assess the material loss at the taper interface, whereas this method aims to characterize any surface and form changes through the use of an out-of-roundness measurement machine. Along with assessing the volumetric wear, maximum linear penetration and taper contact length can also be determined. The method was applied to retrieved large head metal-on-metal femoral heads in order to quantify the material loss at this junction. Material loss from the female femoral head taper can be characterized as a localized area that is in contact with the stem taper surface. The study showed that this method has good repeatability and a low level of interoperability variation between operators.

  13. Good sensitivity and specificity of ultrasound for detecting pseudotumors in 83 failed metal-on-metal hip replacements

    PubMed Central

    Lainiala, Olli; Elo, Petra; Reito, Aleksi; Pajamäki, Jorma; Puolakka, Timo; Eskelinen, Antti

    2015-01-01

    Background and purpose Ultrasound is used for imaging of pseudotumors associated with metal-on-metal (MoM) hips. Ultrasound has been compared with magnetic resonance imaging, but to date there have been no studies comparing ultrasound findings and revision findings. Methods We evaluated the sensitivity and specificity of preoperative ultrasound for detecting pseudotumors in 82 patients with MoM hip replacement (82 hips). Ultrasound examinations were performed by 1 of 3 musculoskeletal radiologists, and pseudotumors seen by ultrasound were retrospectively classified as fluid-filled, mixed-type, or solid. Findings at revision surgery were retrieved from surgical notes and graded according to the same system as used for ultrasound findings. Results Ultrasound had a sensitivity of 83% (95% CI: 63–93) and a specificity of 92% (CI: 82–96) for detecting trochanteric region pseudotumors, and a sensitivity of 79% (CI: 62–89) and a specificity of 94% (CI: 83–98) for detecting iliopsoas-region pseudotumors. Type misclassification of pseudotumors found at revision occurred in 8 of 23 hips in the trochanteric region and in 19 of 33 hips in the iliopsoas region. Interpretation Despite the discrepancy in type classification between ultrasound and revision findings, the presence of pseudotumors was predicted well with ultrasound in our cohort of failed MoM hip replacements. PMID:25582840

  14. A comparison of the diagnostic accuracy of MARS MRI and ultrasound of the painful metal-on-metal hip arthroplasty

    PubMed Central

    Siddiqui, Imran A; Sabah, Shiraz A; Satchithananda, Keshthra; Lim, Adrian K; Cro, Suzie; Henckel, Johann; Skinner, John A

    2014-01-01

    Background and purpose Metal artifact reduction sequence (MARS) MRI and ultrasound scanning (USS) can both be used to detect pseudotumors, abductor muscle atrophy, and tendinous pathology in patients with painful metal-on-metal (MOM) hip arthroplasty. We wanted to determine the diagnostic test characteristics of USS using MARS MRI as a reference for detection of pseudotumors and muscle atrophy. Patients and methods We performed a prospective cohort study to compare MARS MRI and USS findings in 19 consecutive patients with unilateral MOM hips. Protocolized USS was performed by consultant musculoskeletal radiologists who were blinded regarding clinical details. Reports were independently compared with MARS MRI, the imaging gold standard, to calculate predictive values. Results The prevalence of pseudotumors on MARS MRI was 68% (95% CI: 43–87) and on USS it was 53% (CI: 29–76). The sensitivity of USS in detecting pseudotumors was 69% (CI 39–91) and the specificity was 83% (CI: 36–97). The sensitivity of detection of abductor muscle atrophy was 47% (CI: 24–71). In addition, joint effusion was detected in 10 cases by USS and none were seen by MARS MRI. Interpretation We found a poor agreement between USS and MARS MRI. USS was inferior to MARS MRI for detection of pseudotumors and muscle atrophy, but it was superior for detection of joint effusion and tendinous pathologies. MARS MRI is more advantageous than USS for practical reasons, including preoperative planning and longitudinal comparison. PMID:24694273

  15. Ten-year results after cementless THA with a sandwich-type alumina ceramic bearing.

    PubMed

    Park, Youn-Soo; Park, Se-Jun; Lim, Seung-Jae

    2010-11-01

    We analyzed the long-term results of a single-surgeon series of 102 cementless total hip arthroplasties (THAs) performed using a sandwich-type alumina ceramic bearing. The prostheses involved a porous-coated acetabular socket, a polyethylene-alumina composite liner, a 28-mm alumina head, and a grit-blasted titanium-alloy stem. Mean patient age at the time of THA was 39 years (range, 18-66 years), and 76% of the patients were younger than 50 years. All procedures were performed with use of the same surgical technique and the same implant at a single center. Mean follow-up was 115 months (range, 84-133 months). When failure was defined as revision of either the acetabular or the femoral component for any reason, Kaplan-Meier survival probability at 10 years was 95.3% (95% confidence interval, 89.5%-100%). Mean Harris Hip Score improved from 47 points (range, 16-70 points) preoperatively to 95 points (range, 85-100 points) at final follow-up. No radiographically detectable osteolysis around the acetabular or femoral component was observed in any hip. No patient reported squeaking in the operated hip. During the follow-up period, 3 hips (3%) required revision surgery; 2 underwent acetabular revision because of a ceramic liner fracture and 1 underwent revision for early loosening of the acetabular cup. Ten-year results of cementless THA with a sandwich-type alumina ceramic bearing were encouraging, and no great increase in ceramic failure rate was observed, which contrasts with the findings of previously reported short-term follow-up studies. PMID:21053885

  16. Outcomes of Surgical Treatment of Periprosthetic Femoral Fractures in Cementless Hip Arthroplasty

    PubMed Central

    Kim, Min-Wook; Lee, Jung-Ho; Park, Ji-Hoon

    2015-01-01

    Purpose We aimed to evaluate the results of surgical treatment of periprosthetic femoral fractures in cementless total hip arthroplasty (THA). Materials and Methods From June 2002 to May 2012, 40 patients who could be followed-up for more than 1 year after surgery were enrolled in this study. The mean duration of follow-up was 28.5 months (range, 15-97 months) and the average age at the time of surgery was 71.5 years (range, 38-89 years). The fracture types were determined by using the Vancouver classification. Among intraoperative fractures, there were type A in 3 hips, type B2 in 2 hips and type B3 in one. Among postoperative fractures, type AG was present in 5 hips, type AL in 2 hips, type B1 in 15 hips, type B2 in 6 hips, type B3 in 3 hips, and type C in 3 hips. Evaluation of the results was based on bony union, stability of the prosthesis, postoperative complications, and Harris hip score at the final follow-up. Results Bony union was achieved in all but one case and the average time for bony union was 21 weeks. The mean Harris hip score was 86 at the final follow-up. Clinical results were above good in 34 of 40 hips (85.0%). Stem loosening occurred in one patient with a type B1 fracture treated with open reduction and plate fixation. Nonunion was observed in 1 patient with an AG type fracture. Conclusion Open reduction and fixation using a plate with a screw and cerclage wiring provided good results for periprosthetic fractures in patients who had a stable femoral stem without bone defects. Revision surgery with a cementless long stem should be considered in patients with an unstable stem or suspected stability in B1 type of THA using a proximal fixation type. PMID:27536618

  17. In vivo wear of three types of metal on metal hip prostheses during two decades of use.

    PubMed

    McKellop, H; Park, S H; Chiesa, R; Doorn, P; Lu, B; Normand, P; Grigoris, P; Amstutz, H

    1996-08-01

    Wear was analyzed on 21 metal on metal hip replacements, including McKee-Farrar, Müller, and Ring, that were retrieved from patients after as many as 25 years. Light and scanning electron microscopy indicated that early wear included substantial third body abrasion, possibly from particles generated while scratches from the original polishing were being eradicated and from dislodged surface carbides. However, the main contact zones were eventually worn smoother than the original surfaces. Wear was quantified by digitizing the shapes of the components on a coordinate measuring machine and identifying those areas that deviated from the original spheric surface. On the femoral heads, wear was typically concentrated in the superomedial region, that is, on the load axis. Three cases also had substantial wear inferiorly, but there were no cases with circumferential (equatorial) wear. The long term wear rates averaged approximately 6 micrometers per year or less and produced an average of approximately 6 mm3 of metallic wear debris per year or less. Wear rate tended to increase as clearance increased over the range of 127 to 386 micrometers, and a McKee-Farrar prosthesis with the extreme clearance of 1.7 mm wore approximately 16 times faster than the average, but there was no apparent relationship between clearance and time to revision. Larger McKee-Farrar balls had less volumetric wear, on average, than smaller balls, and the Müller balls had the greatest wear, which may have been due to contact with the edges of recesses machined into the bearing zones of the Müller cups. PMID:8769330

  18. A simulator study of adverse wear with metal and cement debris contamination in metal-on-metal hip bearings

    PubMed Central

    Halim, T.; Clarke, I. C.; Burgett-Moreno, M. D.; Donaldson, T. K.; Savisaar, C.; Bowsher, J. G.

    2015-01-01

    Objectives Third-body wear is believed to be one trigger for adverse results with metal-on-metal (MOM) bearings. Impingement and subluxation may release metal particles from MOM replacements. We therefore challenged MOM bearings with relevant debris types of cobalt–chrome alloy (CoCr), titanium alloy (Ti6Al4V) and polymethylmethacrylate bone cement (PMMA). Methods Cement flakes (PMMA), CoCr and Ti6Al4V particles (size range 5 µm to 400 µm) were run in a MOM wear simulation. Debris allotments (5 mg) were inserted at ten intervals during the five million cycle (5 Mc) test. Results In a clean test phase (0 Mc to 0.8 Mc), lubricants retained their yellow colour. Addition of metal particles at 0.8 Mc turned lubricants black within the first hour of the test and remained so for the duration, while PMMA particles did not change the colour of the lubricant. Rates of wear with PMMA, CoCr and Ti6Al4V debris averaged 0.3 mm3/Mc, 4.1 mm3/Mc and 6.4 mm3/Mc, respectively. Conclusions Metal particles turned simulator lubricants black with rates of wear of MOM bearings an order of magnitude higher than with control PMMA particles. This appeared to model the findings of black, periarticular joint tissues and high CoCr wear in failed MOM replacements. The amount of wear debris produced during a 500 000-cycle interval of gait was 30 to 50 times greater than the weight of triggering particle allotment, indicating that MOM bearings were extremely sensitive to third-body wear. Cite this article: Bone Joint Res 2015;4:29–37. PMID:25736072

  19. Validation of primary metal-on-metal hip arthroplasties on the National Joint Registry for England, Wales and Northern Ireland using data from the London Implant Retrieval Centre: a study using the NJR dataset.

    PubMed

    Sabah, S A; Henckel, J; Cook, E; Whittaker, R; Hothi, H; Pappas, Y; Blunn, G; Skinner, J A; Hart, A J

    2015-01-01

    Arthroplasty registries are important for the surveillance of joint replacements and the evaluation of outcome. Independent validation of registry data ensures high quality. The ability for orthopaedic implant retrieval centres to validate registry data is not known. We analysed data from the National Joint Registry for England, Wales and Northern Ireland (NJR) for primary metal-on-metal hip arthroplasties performed between 2003 and 2013. Records were linked to the London Implant Retrieval Centre (RC) for validation. A total of 67,045 procedures on the NJR and 782 revised pairs of components from the RC were included. We were able to link 476 procedures (60.9%) recorded with the RC to the NJR successfully. However, 306 procedures (39.1%) could not be linked. The outcome recorded by the NJR (as either revised, unrevised or death) for a primary procedure was incorrect in 79 linked cases (16.6%). The rate of registry-retrieval linkage and correct assignment of outcome code improved over time. The rates of error for component reference numbers on the NJR were as follows: femoral head category number 14/229 (5.0%); femoral head batch number 13/232 (5.3%); acetabular component category number 2/293 (0.7%) and acetabular component batch number 24/347 (6.5%). Registry-retrieval linkage provided a novel means for the validation of data, particularly for component fields. This study suggests that NJR reports may underestimate rates of revision for many types of metal-on-metal hip replacement. This is topical given the increasing scope for NJR data. We recommend a system for continuous independent evaluation of the quality and validity of NJR data. PMID:25568407

  20. Early results with the cementless Variall hip system.

    PubMed

    Suda, Arnold J; Knahr, Karl

    2009-01-01

    This study presents the early results of the Variall cementless hip system, a further development of the reliable Alloclassic Zweymüller system. In a prospective randomized study, 319 patients (333 hips) underwent the Variall cementless hip system with four different bearings and were scored using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Score and the Short Form-36 health survey form, with a follow-up period of 3 years. The patients were grouped according to age, with those in the age range 23-75 years as group one (n = 285) and those over 75 years of age as group two (n = 48). For both the Short Form-36 and WOMAC scoring, worse function was found in group two (i.e., patients >75 years). In this group, the function scores were worse in patients who received a conventional polyethylene bearing. The clinical and radiological results after 5 or more years will lead to a clearer prediction. PMID:19105776

  1. Cementless Oxford unicompartmental knee replacement shows reduced radiolucency at one year.

    PubMed

    Pandit, H; Jenkins, C; Beard, D J; Gallagher, J; Price, A J; Dodd, C A F; Goodfellow, J W; Murray, D W

    2009-02-01

    We randomised 62 knees to receive either cemented or cementless versions of the Oxford unicompartmental knee replacement. The implants used in both arms of the study were similar, except that the cementless components were coated with porous titanium and hydroxyapatite. The tibial interfaces were studied with fluoroscopically-aligned radiographs. At one year there was no difference in clinical outcome between the two groups. Narrow radiolucent lines were seen at the bone-implant interfaces in 75% of cemented tibial components. These were partial in 43%, and complete in 32%. In the cementless implants, partial radiolucencies were seen in 7% and complete radiolucencies in none. These differences are statistically significant (p < 0.0001) and imply satisfactory bone ingrowth into the cementless implants. PMID:19190051

  2. Which imaging modality is most effective for identifying pseudotumours in metal-on-metal hip resurfacings requiring revision

    PubMed Central

    Matharu, G. S.; Mansour, R.; Dada, O.; Ostlere, S.; Pandit, H. G.; Murray, D. W.

    2016-01-01

    Aims The aims of this study were to compare the diagnostic test characteristics of ultrasound alone, metal artefact reduction sequence MRI (MARS-MRI) alone, and ultrasound combined with MARS-MRI for identifying intra-operative pseudotumours in metal-on-metal hip resurfacing (MoMHR) patients undergoing revision surgery. Methods This retrospective diagnostic accuracy study involved 39 patients (40 MoMHRs). The time between imaging modalities was a mean of 14.6 days (0 to 90), with imaging performed at a mean of 5.3 months (0.06 to 12) before revision. The prevalence of intra-operative pseudotumours was 82.5% (n = 33). Results Agreement with the intra-operative findings was 82.5% (n = 33) for ultrasound alone, 87.5% (n = 35) for MARS-MRI alone, and 92.5% (n = 37) for ultrasound and MARS-MRI combined. The diagnostic characteristics for ultrasound alone and MARS-MRI alone reached similar sensitivities (90.9% vs 93.9%) and positive predictive values (PPVs; 88.2% vs 91.2%), but higher specificities (57.1% vs 42.9%) and negative predictive values (NPVs; 66.7% vs 50.0%) were achieved with MARS-MRI. Ultrasound and MARS-MRI combined produced 100% sensitivity and 100% NPV, whilst maintaining both specificity (57.1%) and PPV (91.7%). For the identification of a pseudotumour, which was confirmed at revision surgery, agreement was substantial for ultrasound and MARS-MRI combined (κ = 0.69), moderate for MARS-MRI alone (κ = 0.54), and fair for ultrasound alone (κ = 0.36). Discussion These findings suggest that ultrasound and/or MARS-MRI have a role when assessing patients with a MoMHR, with the choice dependent on local financial constraints and the availability of ultrasound expertise. However in patients with a MoMHR who require revision, combined imaging was most effective. Take home message: Combined imaging with ultrasound and MARS-MRI always identified intra-operative pseudotumours if present. Furthermore, if neither imaging modality showed a pseudotumour, one was not

  3. Ten-year follow-up of the non-porous Allofit cementless acetabular component.

    PubMed

    Zenz, P; Stiehl, J B; Knechtel, H; Titzer-Hochmaier, G; Schwagerl, W

    2009-11-01

    Cementless acetabular fixation has demonstrated superior long-term durability in total hip replacement, but most series have studied implants with porous metal surfaces. We retrospectively evaluated the results of 100 consecutive patients undergoing total hip replacement where a non-porous Allofit component was used for primary press-fit fixation. This implant is titanium alloy, grit-blasted, with a macrostructure of forged teeth and has a biradial shape. A total of 81 patients (82 hips) were evaluated at final follow-up at a mean of 10.1 years (8.9 to 11.9). The Harris Hip Score improved from a mean 53 points (23 to 73) pre-operatively to a mean of 96 points (78 to 100) at final review. The osseointegration of all acetabular components was radiologically evaluated with no evidence of loosening. The survival rate with revision of the component as the endpoint was 97.5% (95% confidence interval 94 to 100) after 11.9 years. Radiolucency was found in one DeLee-Charnley zone in four acetabular components. None of the implants required revision for aseptic loosening. Two patients were treated for infection, one requiring a two-stage revision of the implant. One femoral stem was revised for osteolysis due to the production of metal wear debris, but the acetabular shell did not require revision. This study demonstrates that a non-porous titanium acetabular component with adjunct surface fixation offers an alternative to standard porous-coated implants. PMID:19880887

  4. Fabrication of low-cost, cementless femoral stem 316L stainless steel using investment casting technique.

    PubMed

    Baharuddin, Mohd Yusof; Salleh, Sh-Hussain; Suhasril, Andril Arafat; Zulkifly, Ahmad Hafiz; Lee, Muhammad Hisyam; Omar, Mohd Afian; Abd Kader, Ab Saman; Mohd Noor, Alias; A Harris, Arief Ruhullah; Abdul Majid, Norazman

    2014-07-01

    Total hip arthroplasty is a flourishing orthopedic surgery, generating billions of dollars of revenue. The cost associated with the fabrication of implants has been increasing year by year, and this phenomenon has burdened the patient with extra charges. Consequently, this study will focus on designing an accurate implant via implementing the reverse engineering of three-dimensional morphological study based on a particular population. By using finite element analysis, this study will assist to predict the outcome and could become a useful tool for preclinical testing of newly designed implants. A prototype is then fabricated using 316L stainless steel by applying investment casting techniques that reduce manufacturing cost without jeopardizing implant quality. The finite element analysis showed that the maximum von Mises stress was 66.88 MPa proximally with a safety factor of 2.39 against endosteal fracture, and micromotion was 4.73 μm, which promotes osseointegration. This method offers a fabrication process of cementless femoral stems with lower cost, subsequently helping patients, particularly those from nondeveloped countries. PMID:24404766

  5. A finite element analysis of the vibration behaviour of a cementless hip system.

    PubMed

    Pérez, M A; Seral-García, B

    2013-01-01

    An early diagnosis of aseptic loosening of a total hip replacement (THR) by plain radiography, scintigraphy or arthography has been shown to be less reliable than using a vibration technique. However, it has been suggested that it may be possible to distinguish between a secure and a loose prosthesis using a vibration technique. In fact, vibration analysis methods have been successfully used to assess dental implant stability, to monitor fracture healing and to measure bone mechanical properties. Several studies have combined the vibration technique with the finite element (FE) method in order to better understand the events involved in the experimental technique. In the present study, the main goal is to simulate the change in the resonance frequency during the osseointegration process of a cementless THR (Zweymüller). The FE method was used and a numerical modal analysis was conducted to obtain the natural frequencies and mode shapes under vibration. The effects were studied of different bone and stem material properties, and different contact conditions at the bone-implant interface. The results were in agreement with previous experimental and computational observations, and differences among the different cases studied were detected. As the osseointegration process at the bone-implant interface evolved, the resonance frequency values of the femur-prosthesis system also increased. In summary, vibration analysis combined with the FE method was able to detect different boundary conditions at the bone-implant interface in cases of both osseointegration and loosening. PMID:22300407

  6. Design process of cementless femoral stem using a nonlinear three dimensional finite element analysis

    PubMed Central

    2014-01-01

    Background Minimal available information concerning hip morphology is the motivation for several researchers to study the difference between Asian and Western populations. Current use of a universal hip stem of variable size is not the best option for all femur types. This present study proposed a new design process of the cementless femoral stem using a three dimensional model which provided more information and accurate analysis compared to conventional methods. Methods This complete design cycle began with morphological analysis, followed by femoral stem design, fit and fill analysis, and nonlinear finite element analysis (FEA). Various femur parameters for periosteal and endosteal canal diameters are measured from the osteotomy level to 150 mm below to determine the isthmus position. Results The results showed better total fit (53.7%) and fill (76.7%) canal, with more load distributed proximally to prevent stress shielding at calcar region. The stem demonstrated lower displacement and micromotion (less than 40 μm) promoting osseointegration between the stem–bone and providing primary fixation stability. Conclusion This new design process could be used as a preclinical assessment tool and will shorten the design cycle by identifying the major steps which must be taken while designing the femoral stem. PMID:24484753

  7. Mid-term results of Copeland shoulder cementless surface replacement arthroplasty from an independent centre

    PubMed Central

    Modi, Chetan S; Drew, Stephen J; Turner, Stephen M

    2014-01-01

    Background The present study reports our experience of Copeland shoulder cementless surface replacement arthroplasty (CSRA) and whether glenoid microfracture influences the progression of glenoid erosion. Methods One-hundred-and-twelve CSRAs were performed in 101 patients between 2002 and 2007. Eighty-three patients were alive at the median follow-up time of 72 months (range 9 to 121 months; interquartile range 46 to 93 months). Assessment included an Oxford shoulder score (OSS), patient satisfaction score and plain radiographs. Results The mean (range) OSS was 27 (7 to 48) and 64 of 73 (87.7%) patients were ‘very satisfied’ or ‘satisfied’ with their shoulder. Twenty-three (20.5%) shoulders had over 2 mm of glenoid erosion. Microfracture was performed in 43 of 112 shoulders (38.4%) and did not influence the progression of glenoid erosion. Further surgery was performed in 27 (24.1%) shoulders, including 15 revisions, eight arthrolyses and four subacromial decompressions. Revision to total shoulder arthroplasty was performed in 14 : 10 for glenoid erosion; one each for loosening, periprosthetic fracture, deep infection, and chronic pain. One was revised to reverse arthroplasty for chronic pain. Conclusions CSRA performed in an independent centre reproduces the functional outcomes reported by the designer. Glenoid erosion, however, was a common occurrence and the main cause of revision – microfracture did not influence its progression.

  8. Tibial component fixation with a peri-apatite coating: evaluation by radiostereometric analysis in a canine total knee arthroplasty model.

    PubMed

    Allen, Matthew J; Leone, Kendall A; Dunbar, Michael J; Race, Amos; Rosenbaum, Paula F; Sacks, Jonathan M

    2012-06-01

    Cementless fixation for the tibial component in total knee arthroplasty (TKA) remains problematic. Peri-Apatite (PA), a solution-deposited hydroxyapatite, is under investigation as an option for improving the fixation of cementless tibial components. In this study, radiostereometric analysis was used to document implant migration in 48 dogs that underwent TKA with cementless, PA-coated, or cemented tibial components. Migration at 12 weeks was similar in the 2 groups. At 12 months, there was greater migration in the PA-coated group, but the difference between the 2 groups was below the threshold considered clinically significant. In this canine TKA model, cementless fixation with PA performed less well than did cemented fixation, but not to a degree that would make a clinical difference in the short term. PMID:22364907

  9. Morphological Study of the Newly Designed Cementless Femoral Stem

    PubMed Central

    Baharuddin, Mohd Yusof; Salleh, Sh-Hussain; Zulkifly, Ahmad Hafiz; Lee, Muhammad Hisyam; Mohd Noor, Alias

    2014-01-01

    A morphology study was essential to the development of the cementless femoral stem because accurate dimensions for both the periosteal and endosteal canal ensure primary fixation stability for the stem, bone interface, and prevent stress shielding at the calcar region. This paper focused on a three-dimensional femoral model for Asian patients that applied preoperative planning and femoral stem design. We measured various femoral parameters such as the femoral head offset, collodiaphyseal angle, bowing angle, anteversion, and medullary canal diameters from the osteotomy level to 150 mm below the osteotomy level to determine the position of the isthmus. Other indices and ratios for the endosteal canal, metaphyseal, and flares were computed and examined. The results showed that Asian femurs are smaller than Western femurs, except in the metaphyseal region. The canal flare index (CFI) was poorly correlated (r < 0.50) to the metaphyseal canal flare index (MCFI), but correlated well (r = 0.66) with the corticomedullary index (CMI). The diversity of the femoral size, particularly in the metaphyseal region, allows for proper femoral stem design for Asian patients, improves osseointegration, and prolongs the life of the implant. PMID:25025068

  10. A Two Centre Study to Assess the Long-term Performance of the Pinnacle™ Cup With a Metal-on-Metal Bearing in Primary Total Hip Replacement

    ClinicalTrials.gov

    2014-04-29

    Rheumatoid Arthritis; Osteoarthritis; Post-traumatic Arthritis; Collagen Disorders; Avascular Necrosis; Traumatic Femoral Fractures; Nonunion of Femoral Fractures; Congenital Hip Dysplasia; Slipped Capital Femoral Epiphysis

  11. Optimal acetabular component orientation estimated using edge-loading and impingement risk in patients with metal-on-metal hip resurfacing arthroplasty.

    PubMed

    Mellon, Stephen J; Grammatopoulos, George; Andersen, Michael S; Pandit, Hemant G; Gill, Harinderjit S; Murray, David W

    2015-01-21

    Edge-loading in patients with metal-on-metal resurfaced hips can cause high serum metal ion levels, the development of soft-tissue reactions local to the joint called pseudotumours and ultimately, failure of the implant. Primary edge-loading is where contact between the femoral and acetabular components occurs at the edge/rim of the acetabular component whereas impingement of the femoral neck on the acetabular component's edge causes secondary or contrecoup edge-loading. Although the relationship between the orientation of the acetabular component and primary edge-loading has been identified, the contribution of acetabular component orientation to impingement and secondary edge-loading is less clear. Our aim was to estimate the optimal acetabular component orientation for 16 metal-on-metal hip resurfacing arthroplasty (MoMHRA) subjects with known serum metal ion levels. Data from motion analysis, subject-specific musculoskeletal modelling and Computed Tomography (CT) measurements were used to calculate the dynamic contact patch to rim (CPR) distance and impingement risk for 3416 different acetabular component orientations during gait, sit-to-stand, stair descent and static standing. For each subject, safe zones free from impingement and edge-loading (CPR <10%) were defined and, consequently, an optimal acetabular component orientation was determined (mean inclination 39.7° (SD 6.6°) mean anteversion 14.9° (SD 9.0°)). The results of this study suggest that the optimal acetabular component orientation can be determined from a patient's motion and anatomy. However, 'safe' zones of acetabular component orientation associated with reduced risk of dislocation and pseudotumour are also associated with a reduced risk of edge-loading and impingement. PMID:25482661

  12. Inter-subject variability effects on the primary stability of a short cementless femoral stem.

    PubMed

    Bah, Mamadou T; Shi, Junfen; Heller, Markus O; Suchier, Yanneck; Lefebvre, Fabien; Young, Philippe; King, Leonard; Dunlop, Doug G; Boettcher, Mick; Draper, Edward; Browne, Martin

    2015-04-13

    This paper is concerned with the primary stability of the Furlong Evolution(®) cementless short stem across a spectrum of patient morphology. A computational tool is developed that automatically selects and positions the most suitable stem from an implant system made of a total of 48 collarless stems to best match a 3D model based on a library of CT femur scans (75 males and 34 females). Finite Element contact models of reconstructed hips, subjected to physiologically-based boundary constraints and peak loads of walking mode, were simulated using a coefficient of friction of 0.4 and an interference-fit of 50 μm. Maximum and average implant micromotions across the subpopulation were predicted to be 100±7 μm and 7±5 μm with ranges [15 μm, 350 μm] and [1 μm, 25 μm], respectively. The computed percentage of implant area with micromotions greater than reported critical values of 50 μm, 100 μm and 150 μm never exceeded 14%, 8% and 7%, respectively. To explore the possible correlations between anatomy and implant performance, response surface models for micromotion metrics were constructed. Detailed morphological analyses were conducted and a clear nonlinear decreasing trend was observed between implant average micromotion and both the metaphyseal canal flare indices and average densities in Gruen zones. The present study demonstrates that the primary stability and tolerance of the short stem to variability in patient anatomy were high, reducing the need for patient stratification. In addition, the developed tool could be utilised to support implant design and planning of femoral reconstructive surgery. PMID:25724937

  13. N-Acetyl-Cysteine as Effective and Safe Chelating Agent in Metal-on-Metal Hip-Implanted Patients: Two Cases

    PubMed Central

    Lonati, Davide; Ragghianti, Benedetta; Ronchi, Anna; Vecchio, Sarah; Locatelli, Carlo Alessandro

    2016-01-01

    Systemic toxicity associated with cobalt (Co) and chromium (Cr) containing metal hip alloy may result in neuropathy, cardiomyopathy, and hypothyroidism. However clinical management concerning chelating therapy is still debated in literature. Here are described two metal-on-metal hip-implanted patients in which N-acetyl-cysteine decreased elevated blood metal levels. A 67-year-old male who underwent Co/Cr hip implant in September 2009 referred to our Poison Control Centre for persisting elevated Co/Cr blood levels (from March 2012 to November 2014). After receiving oral high-dose N-acetyl-cysteine, Co/Cr blood concentrations dropped by 86% and 87% of the prechelation levels, respectively, and persisted at these latter concentrations during the following 6 months of follow-up. An 81-year-old female who underwent Co/Cr hip implant in January 2007 referred to our Centre for detection of high Co and Cr blood levels in June 2012. No hip revision was indicated. After a therapy with oral high-dose N-acetyl-cysteine Co/Cr blood concentrations decreased of 45% and 24% of the prechelation levels. Chelating agents reported in hip-implanted patients (EDTA, DMPS, and BAL) are described in few cases. N-acetyl-cysteine may provide chelating sites for metals and in our cases reduced Co and Cr blood levels and resulted well tolerable. PMID:27148463

  14. Influence of particulate and dissociated metal-on-metal hip endoprosthesis wear on mesenchymal stromal cells in vivo and in vitro.

    PubMed

    Rakow, Anastasia; Schoon, Janosch; Dienelt, Anke; John, Thilo; Textor, Martin; Duda, Georg; Perka, Carsten; Schulze, Frank; Ode, Andrea

    2016-08-01

    In hip arthroplasty the implants' articulating surfaces can be made of a cobalt-chromium-molybdenum (CoCrMo) alloy. The use of these metal-on-metal (MoM) pairings can lead to the release of wear products such as metallic particles and dissociated metal species, raising concerns regarding their safety amongst orthopedic surgeons and the public. MoM-wear particles are reported to be heterogeneous in their physicochemical properties, are capable of inducing adverse effects on a cellular level and are thought to be involved in relevant clinical problems like aseptic osteolysis. Yet, it remains elusive how MoM-wear affects bone forming cells and their progenitors: bone marrow residing mesenchymal stromal cells (MSCs). This study introduces an assessment of the in vivo exposure to particulate and dissociated Co and Cr and evaluates the effects of MoM-wear on MSCs. The exposure to MoM-wear products in vivo and in vitro leads to a decrease in MSCs' osteogenic matrix mineralization and alkaline phosphatase activity on a cellular and systemic level. In conclusion, MoM-wear products are released in the periprosthetic region and elevate bone marrow Co and Cr concentrations towards levels that impair osteogenic differentiation of MSCs. Therefore, the ongoing use of CoCrMo alloys for articulating surfaces in joint replacement implants needs critical reconsideration. PMID:27179133

  15. Influence of head size on the development of metallic wear and on the characteristics of carbon layers in metal-on-metal hip joints

    PubMed Central

    Sprecher, Christoph M; Wimmer, Markus A; Milz, Stefan; Taeger, Georg

    2009-01-01

    Background and purpose Particles originating from the articulating surfaces of hip endoprostheses often induce an inflammatory response, which can be related to implant failure. We therefore analyzed the metal content in capsular tissue from 44 McKee-Farrar metal-on-metal hip prostheses (with 3 different head sizes) and we also analyzed the morphological structure of layers located on articulating surfaces. Methods Atomic absorption spectrometry (AAS) was used to analyze the metal content in capsular tissue. Visually detectable carbon layers located on the articulating surfaces were evaluated using scanning electron microscopy (SEM), energy-dispersive Xray spectroscopy (EDX), and X-ray photoelectron spectroscopy (XPS). Results Metallic debris was detected in all capsular tissue samples but no statistically significant differences in metal content were found in relation to implant head size. The morphological characteristics of the different layer zones allowed an exact analysis of contact and non-contact areas. Furthermore, surface layers appear to have a protective function because they can prevent sharp-edged particles from damaging the prostheses surface. Interpretation The implant head size does not appear to influence the amount of metallic debris. The layers obviously act like a lubricating agent because the protection function does not occur in regions without layers where the metal surface often shows numerous scratches. As layers are not generated immediately after the implantation of hip prostheses, these findings may at least partially explain the high amount of wear early after implantation. PMID:19421914

  16. Accuracy of methods for calculating volumetric wear from coordinate measuring machine data of retrieved metal-on-metal hip joint implants.

    PubMed

    Lu, Zhen; McKellop, Harry A

    2014-03-01

    This study compared the accuracy and sensitivity of several numerical methods employing spherical or plane triangles for calculating the volumetric wear of retrieved metal-on-metal hip joint implants from coordinate measuring machine measurements. Five methods, one using spherical triangles and four using plane triangles to represent the bearing and the best-fit surfaces, were assessed and compared on a perfect hemisphere model and a hemi-ellipsoid model (i.e. unworn models), computer-generated wear models and wear-tested femoral balls, with point spacings of 0.5, 1, 2 and 3 mm. The results showed that the algorithm (Method 1) employing spherical triangles to represent the bearing surface and to scale the mesh to the best-fit surfaces produced adequate accuracy for the wear volume with point spacings of 0.5, 1, 2 and 3 mm. The algorithms (Methods 2-4) using plane triangles to represent the bearing surface and to scale the mesh to the best-fit surface also produced accuracies that were comparable to that with spherical triangles. In contrast, if the bearing surface was represented with a mesh of plane triangles and the best-fit surface was taken as a smooth surface without discretization (Method 5), the algorithm produced much lower accuracy with a point spacing of 0.5 mm than Methods 1-4 with a point spacing of 3 mm. PMID:24531891

  17. Correlative analysis of MRI-evident abductor hip muscle degeneration and power after minimally invasive versus conventional unilateral cementless THA.

    PubMed

    Vasilakis, Ioannis; Solomou, Ekaterini; Vitsas, Vasilis; Fennema, Peter; Korovessis, Panagiotis; Siamblis, Dimitrios K

    2012-12-01

    The 2 main null hypotheses of this study were: (1) the 4-year surgical trauma-related degeneration within the hip abductor muscles after a minimally invasive approach to total hip arthroplasty would be similar to that following a conventional approach; and (2) no differences in perioperative blood loss or postoperative hip pain would be observed between the minimally invasive and conventional approaches.In 40 consecutive randomly selected adult patients with unilateral primary hip osteoarthritis, a cementless Zweymüller-Plus THA (Smith & Nephew Orthopaedics, Baar, Switzerland) was implanted by a single surgeon in 1 institution during the same period. Twenty patients underwent a minimally invasive approach (group A), and 20 patients underwent a conventional anterolateral approach (group B). Four years postoperatively, the operated and contralateral nonoperated hips of 37 available patients from both groups were examined with magnetic resonance imaging to show any changes in the gluteus medius and tensor fascia latae. Simultaneously, hip abductor power was measured bilaterally in both groups. Anthropometric data, blood loss, Short Form 36 self-assessment questionnaire, visual analog pain score, and walking distance were also analyzed.The reliability of magnetic resonance imaging and hip abductor power measurements was high. No difference was found in hip abductor power on the operated side between the 2 groups, whereas hip abductor power on the nonoperated side was significantly higher in both groups. This study revealed no mechanical and functional benefits in favor of patients undergoing minimally invasive vs conventional total hip arthroplasty. PMID:23218622

  18. An investigation on the effect of groove geometry on cementless femoral stem component in hip arthroplasty.

    PubMed

    Rawal, B R; Bhatnagar, Naresh

    2013-12-15

    The optimal surface for a cementless femoral stem has been a subject of debate for the past several years. Several researchers have stressed the need for research on how an implant surface shape contributes to long-term stability after implantation, in the field of orthopaedics. The introduction of optimized grooves on an implant proximal surface may enhance long-term stability of an implant. This study thus analyzes the effect of different groove dimensions and angles in a transverse plane on stress transmission by a constant load at the femur by using Finite Element Analysis (FEA). Results suggest that the tendency of stress transmission differs depending on the size, position and angle of the grooves. An optimized groove size and inclination plays a vital role for long-term stability of cementless femoral stems. PMID:24517034

  19. Removal of a well-fixed cementless femoral component with an extended proximal femoral osteotomy.

    PubMed

    Younger, T I; Bradford, M S; Paprosky, W G

    1995-05-01

    Removal of a stable, well-fixed cementless femoral arthroplasty component occasionally is necessary because of infection, component malposition, persistent pain, or incompatibility with a femoral revision component. Restricted access to ingrowth surfaces may make implant removal exceedingly difficult and increases the risk of iatrogenic damage to the proximal femur. A new extended proximal femoral osteotomy technique is described for use in removing well-fixed cementless femoral components. Previous techniques have been modified to allow access to the bone-implant interface and to provide straight-shot access to the femoral canal for proper sizing and positioning of the revision implant. The osteotomy can be extended to accommodate the entire length of the porous coating on the revision component. If a shorter osteotomy is desired, access to the prosthesis for transection with a metal-cutting burr is possible. The osteotomy is easily repositioned with cerclage wires or cables and reliable healing has been demonstrated. PMID:10150358

  20. [An unusual early complication in cementless replacement of the hip joint. Case report].

    PubMed

    Kauschke, T; Zilch, H

    1994-12-01

    This is the first description of a dislocation of the polyethyleninlay from the cup of a cementless hip prosthesis. Due to a fall of the patient 8 months after the implantation an unspecific complaint arised. In spite of detailed diagnostic no reason could have been found. During the renewed operation we saw the dislocated inlay by mechanical anchorage of the cup and the shaft. Retrospective there were made suggestions how the described complication could be recognized earlier. PMID:7871611

  1. A cementless, elastic press-fit socket with and without screws

    PubMed Central

    2012-01-01

    Background The acetabular component has remained the weakest link in hip arthroplasty regarding achievement of long-term survival. Primary fixation is a prerequisite for long-term performance. For this reason, we investigated the stability of a unique cementless titanium-coated elastic monoblock socket and the influence of supplementary screw fixation. Patient and methods During 2006–2008, we performed a randomized controlled trial on 37 patients (mean age 63 years (SD 7), 22 females) in whom we implanted a cementless press-fit socket. The socket was implanted with additional screw fixation (group A, n = 19) and without additional screw fixation (group B, n = 18). Using radiostereometric analysis with a 2-year follow-up, we determined the stability of the socket. Clinically relevant migration was defined as > 1 mm translation and > 2º rotation. Clinical scores were determined. Results The sockets without screw fixation showed a statistically significantly higher proximal translation compared to the socket with additional screw fixation. However, this higher migration was below the clinically relevant threshold. The numbers of migratory sockets were not significantly different between groups. After the 2-year follow-up, there were no clinically relevant differences between groups A and B regarding the clinical scores. 1 patient dropped out of the study. In the others, no sockets were revised. Interpretation We found that additional screw fixation is not necessary to achieve stability of the cementless press-fit elastic RM socket. We saw no postoperative benefit or clinical effect of additional screw fixation. PMID:23083434

  2. Trade-off between stress shielding and initial stability on an anatomical cementless stem shortening: in-vitro biomechanical study.

    PubMed

    Yamako, Go; Chosa, Etsuo; Totoribe, Koji; Watanabe, Shinji; Sakamoto, Takero

    2015-08-01

    Shortened cementless femoral stems have become popular with the advent of minimally invasive total hip arthroplasty (THA). Successful THA requires initial stem stability and prevention of stress shielding-mediated bone loss, although the effect of stem shortening is controversial. Here we experimentally examined whether stem shortening affects stress shielding and initial stability. Anatomical stems (length, 120 mm) were cut to an 80 mm or 50 mm length. Ten tri-axial strain gauges measured the cortical strain on each stem-implanted femur to evaluate stress shielding. Two transducers measured axial relative displacement and rotation under single-leg stance loading. The 50 mm stem increased the equivalent strains with respect to the original stem in the proximal calcar region (31.0% relative to intact strain), proximal medial region (63.1%), and proximal lateral region (53.9%). In contrast, axial displacement and rotation increased with a decreasing stem length. However, the axial displacement of the 50 mm stem was below a critical value of 150 µm for bone ingrowth. Our findings indicate that, with regard to a reduction in stem length, there is a tradeoff between stress shielding and initial stability. Shortening the stem up to 50 mm can promote proximal load transfer, but bone loss would be inevitable, even with sufficient initial stability for long-term fixation. PMID:26117334

  3. Development and verification of a cementless novel tapered wedge stem for total hip arthroplasty.

    PubMed

    Faizan, Ahmad; Wuestemann, Thies; Nevelos, Jim; Bastian, Adam C; Collopy, Dermot

    2015-02-01

    Most current tapered wedge hip stems were designed based upon the original Mueller straight stem design introduced in 1977. These stems were designed to have a single medial curvature and grew laterally to accommodate different sizes. In this preclinical study, the design and verification of a tapered wedge stem using computed tomography scans of 556 patients are presented. The computer simulation demonstrated that the novel stem, designed for proximal engagement, allowed for reduced distal fixation, particularly in the 40-60 year male population. Moreover, the physical micromotion testing and finite element analysis demonstrated that the novel stem allowed for reduced micromotion. In summary, preclinical data suggest that the computed tomography based stem design described here may offer enhanced implant fit and reduced micromotion. PMID:25449589

  4. Cementless fixation of prosthetic components in total arthroplasty of the knee and hip.

    PubMed

    Freeman, M A; McLeod, H C; Levai, J P

    1983-06-01

    An appropriately designed implant can be fixed without cement to accurately prepared bone surfaces so as to give results comparable with those of cemented fixation in the short term. The unchanging appearance of the roentgenograms suggests that these results may be maintained in the long term. If these conclusions are valid, polymethylmethacrylate (PMMA) may be thought of as an optional alternative in joint arthroplasty. Thus, theoretically, inert materials, e.g., carbon, can be directly interfaced with the skeleton. Since the authors have achieved interlock with viable bone without relying on bony ingrowth, these materials need not be porous. It is strongly suspected (but as yet unsupported by data) that adequate fixation can be obtained without relying even on the authors' relatively unsophisticated finned peg, provided that (1) the overall shape of the implant achieves interlock on the gross scale, with acceptably low shear stresses at the interface; and (2) the surgical technique achieves a correctly positioned implant applied to accurately cut bone surfaces. However, if for any reason accurate bone cuts can not be achieved, the authors advocate use of PMMA as a valuable fixation agent. PMID:6851346

  5. Primary fit of the Lord cementless total hip. A geometric study in cadavers.

    PubMed

    Schimmel, J W; Huiskes, R

    1988-12-01

    Two Lord prostheses, bilaterally implanted in cadavers, were sectioned. The contact areas between bone and prosthesis were studied and measured using a specially developed reproducible method. Primary fixation of the femoral components appeared to be based principally on wedging of the prosthetic stem in the femoral shaft with a rather small contact surface. In both acetabuli the screw threads of the rings were only marginally in contact with the acetabular bone. PMID:3213449

  6. Prevalence of Failure due to Adverse Reaction to Metal Debris in Modern, Medium and Large Diameter Metal-on-Metal Hip Replacements – The Effect of Novel Screening Methods: Systematic Review and Metaregression Analysis

    PubMed Central

    Reito, Aleksi; Lainiala, Olli; Elo, Petra; Eskelinen, Antti

    2016-01-01

    Metal-on-metal (MoM) hip replacements were used for almost a decade before adverse reactions to metal debris (ARMD) were found to be a true clinical problem. Currently, there is a paucity of evidence regarding the usefulness of systematic screening for ARMD. We implemented a systematic review and meta-analysis to establish the prevalence of revision confirmed ARMD stratified by the use of different screening protocols in patients with MoM hip replacements. Five levels of screening were identified: no screening (level 0), targeted blood metal ion measurement and/or cross-sectional imaging (level 1), metal ion measurement without imaging (level 2), metal ion measurement with targeted imaging (level 3) and comprehensive screening (both metal ions and imaging for all; level 4). 122 studies meeting our eligibility criteria were included in analysis. These studies included 144 study arms: 100 study arms with hip resurfacings, 33 study arms with large-diameter MoM total hip replacements (THR), and 11 study arms with medium-diameter MoM THRs. For hip resurfacing, the lowest prevalence of ARMD was seen with level 0 screening (pooled prevalence 0.13%) and the highest with level 4 screening (pooled prevalace 9.49%). Pooled prevalence of ARMD with level 0 screening was 0.29% and with level 4 screening 21.3% in the large-diameter MoM THR group. In metaregression analysis of hip resurfacings, level 4 screening was superior with regard to prevalence of ARMD when compared with other levels. In the large diameter THR group level 4 screening was superior to screening 0,2 and 3. These outcomes were irrespective of follow-up time or study publication year. With hip resurfacings, routine cross-sectional imaging regardless of clinical findings is advisable. It is clear, however, that targeted metal ion measurement and/or imaging is not sufficient in the screening for ARMD in any implant concepts. However, economic aspects should be weighed when choosing the preferred screening level

  7. Prevalence of Failure due to Adverse Reaction to Metal Debris in Modern, Medium and Large Diameter Metal-on-Metal Hip Replacements--The Effect of Novel Screening Methods: Systematic Review and Metaregression Analysis.

    PubMed

    Reito, Aleksi; Lainiala, Olli; Elo, Petra; Eskelinen, Antti

    2016-01-01

    Metal-on-metal (MoM) hip replacements were used for almost a decade before adverse reactions to metal debris (ARMD) were found to be a true clinical problem. Currently, there is a paucity of evidence regarding the usefulness of systematic screening for ARMD. We implemented a systematic review and meta-analysis to establish the prevalence of revision confirmed ARMD stratified by the use of different screening protocols in patients with MoM hip replacements. Five levels of screening were identified: no screening (level 0), targeted blood metal ion measurement and/or cross-sectional imaging (level 1), metal ion measurement without imaging (level 2), metal ion measurement with targeted imaging (level 3) and comprehensive screening (both metal ions and imaging for all; level 4). 122 studies meeting our eligibility criteria were included in analysis. These studies included 144 study arms: 100 study arms with hip resurfacings, 33 study arms with large-diameter MoM total hip replacements (THR), and 11 study arms with medium-diameter MoM THRs. For hip resurfacing, the lowest prevalence of ARMD was seen with level 0 screening (pooled prevalence 0.13%) and the highest with level 4 screening (pooled prevalace 9.49%). Pooled prevalence of ARMD with level 0 screening was 0.29% and with level 4 screening 21.3% in the large-diameter MoM THR group. In metaregression analysis of hip resurfacings, level 4 screening was superior with regard to prevalence of ARMD when compared with other levels. In the large diameter THR group level 4 screening was superior to screening 0,2 and 3. These outcomes were irrespective of follow-up time or study publication year. With hip resurfacings, routine cross-sectional imaging regardless of clinical findings is advisable. It is clear, however, that targeted metal ion measurement and/or imaging is not sufficient in the screening for ARMD in any implant concepts. However, economic aspects should be weighed when choosing the preferred screening level

  8. The importance of trochanteric lag screws to achieve primary stability in cementless fixation of the RM hip prosthesis.

    PubMed

    Heitemeyer, U; Hierholzer, G; Haines, J

    1987-01-01

    To allow the bony incorporation of a cementless prosthesis it is important to achieve stability at the time of operation. To neutralize tension and torsional stresses the RM-shaft prosthesis is fixed with two lag screws in the trochanteric part of the femur. By measuring the applied torque intraoperatively we could demonstrate that the threads of the screws found a better grip when inserted from the bone to the prosthesis. Thus, the stronger fixation of the screws enhanced the primary stability of the cementless prosthesis. PMID:3566504

  9. Endo medullary extractability of cementless full HA coated femoral stem: Results from 19 cases.

    PubMed

    Lecuire, François; Melere, Gilles; Martres, Sébastien

    2015-03-01

    The Aura cementless full HA coated stem is an anatomical femoral component with a different surface treatment in the metaphyseal and diaphyseal areas. We have studied the feasibility of isolated endo-medullar extraction of the stem. 19 patients (6 infections, 6 neck fractures, 3 stems with risk of fracture, 3 head fractures, and 1 recurrent dislocation) were subjected to the removal of a stable and bone integrated implant at a mean of 4.5 years after surgery. The 19 cases represent the entire population of Aura cementless integrated stem requiring revision during the period of 2003 through 2011, excluding periprosthetic bone fracture cases. The technique consisted of a careful release of the metaphyseal part of the implant with thin osteotomes, followed by the use of a highly efficient extractor. The re-implanted procedure always utilised standard stems: 17 cementless stems full HA coated (13 had the same size as the removed implant, 4 cases had larger sizes) and two received cemented stems. The 19 stems were extracted by simple endo-medullary approach, without the need for additional action. Several complications were encountered, 1 intraoperative diaphyseal fracture, requiring a wiring, 1 fracture of the lesser trochanter at 15 days post-surgery, requiring a revision and 2 postoperative dislocations. Except for the early revision due to fracture, no other stem was revised. There was no recurrence of infection and the functional results were satisfactory (PMA 15-18). 3 patients showed metaphyseal lucent lines on X-Ray leading us to advise the use of a standard stem with larger size after distal reaming, combined with preventive circulate of the calcar. The use of dedicated instrumentation allows successful extraction of full HA coated short stem by endomedullary approach. PMID:26280859

  10. Custom Cementless Stem Improves Hip Function in Young Patients at 15-year Followup

    PubMed Central

    Flecher, Xavier; Pearce, Oliver; Parratte, Sebastien; Aubaniac, Jean-Manuel

    2009-01-01

    THA in young patients is challenging regarding restoration and survival because patients are young, active, and tend to have disturbed anatomy. We asked whether a three-dimensional custom cementless stem could restore hip function, decrease osteolysis and wear, and enhance stem survival in young patients. We retrospectively reviewed 212 patients (233 hips) younger than 50 years (mean, 40 years) at a followup of 5 to 16 years (mean, 10 years). The Merle D’Aubigné-Postel and Harris hip scores improved at last followup. No thigh pain was recorded for any of the patients; 187 of the 212 patients (88%) had full activity recovery, 206 had full range of motion, and 151 had a score greater than 80 points for all five categories of the Hip disability and Osteoarthritis Outcome score. Five patients had femoral osteolysis not associated with pain. With revision for any reason as an end point, the survivorship was 87% (range, 77%–97%) at 15 years, and considering stem revision only, the survivorship was 93% (confidence interval, 90%–97%) at 15 years. Our data compare favorably with those from series using standard cementless stems at the same followup with a high percentage of patients achieving functional restoration and a low rate of complications. Level of Evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence. PMID:19690930

  11. Loss in mechanical contact of cementless acetabular prostheses due to post-operative weight bearing: a biomechanical model.

    PubMed

    Bellini, Chiara Maria; Galbusera, Fabio; Ceroni, Roberto Giacometti; Raimondi, Manuela Teresa

    2007-03-01

    The primary stability of cementless acetabular components is a prerequisite for their clinical success. The target of the present study was to analyse possible effects of post-operative joint loading on the initial mechanical stability of a press-fitted acetabular prosthesis. For this purpose, a three-dimensional finite element model of the pelvic bone with acetabular reconstruction was set-up. The analysis included two steps: (1) simulation of the prosthesis press-fit implantation and (2) simulation of the instant of peak resultant hip loading during the one-legged stance. The difference between the contact pressures at the bone/implant interface, at the end of the second step and those at the end of the first step was calculated and assumed as an index of variation in mechanical contact due to post-operative weight bearing. The results show that, due to hip loading, contact pressures given by press-fit increase in the postero-superior acetabular region but decrease in the antero-inferior acetabular region. The calculated area in which the contact pressures decrease extend to about 30% of the total contact surface. These results imply that post-operative joint loading significantly reduces the mechanical stability given by press-fit. The decrease in contact pressures at the bone/implant interface may result in a lack of osteointegration, possibly hindering the implant secondary stability. It may also create a route for wear debris, possibly favouring periprosthetic osteolysis, which may lead to further loss in contact and clinical failure of the implant due to loosening. PMID:16569508

  12. Valgus subsidence of the tibial component in cementless Oxford unicompartmental knee replacement

    PubMed Central

    Liddle, A. D.; Pandit, H. G.; Jenkins, C.; Lobenhoffer, P.; Jackson, W. F. M.; Dodd, C. A. F.; Murray, D. W.

    2014-01-01

    The cementless Oxford unicompartmental knee replacement has been demonstrated to have superior fixation on radiographs and a similar early complication rate compared with the cemented version. However, a small number of cases have come to our attention where, after an apparently successful procedure, the tibial component subsides into a valgus position with an increased posterior slope, before becoming well-fixed. We present the clinical and radiological findings of these six patients and describe their natural history and the likely causes. Two underwent revision in the early post-operative period, and in four the implant stabilised and became well-fixed radiologically with a good functional outcome. This situation appears to be avoidable by minor modifications to the operative technique, and it appears that it can be treated conservatively in most patients. Cite this article: Bone Joint J 2014;96-B:345–9. PMID:24589789

  13. Does the ingrowth surface make a difference? A retrieval study of 423 cementless acetabular components.

    PubMed

    Swarts, Eric; Bucher, Thomas A; Phillips, Michael; Yap, Francis H X

    2015-04-01

    The effect of factors such as design, alloy and coating type on bony or fibrous tissue ingrowth was evaluated in a study of 423 retrieved cementless acetabular shells representing 16 shell designs. Small-beaded (250μm) porous coatings, either with or without hydroxyapatite (HA) coatings, proved to be the superior porous surface for bone ingrowth. Small-beaded shells that were Duofix coated had predominantly fibrous tissue ingrowth. In addition to bead size, alloy type and surface type have significant effect on bone ingrowth. In contrast, there is no significant association between bone ingrowth and time in situ, with most bone ingrowth occurring early. Although roughened, press-fit shells have acceptable clinical and Registry data, they showed some of the lowest ingrowth/ongrowth scores of all the shells tested. PMID:25515944

  14. Analysis of cementless implants using interface nonlinear friction--experimental and finite element studies.

    PubMed

    Dammak, M; Shirazi-Adl, A; Zukor, D J

    1997-02-01

    Measured interface nonlinear friction properties are used to develop models to study the short-term fixation response of smooth- and porous-surfaced posts, bone screws, and plates fixed with and without posts/screws. Experimental studies are carried out to validate the model predictions and identify the relative role of posts and screws in fixation of a plate on a polyurethane block under symmetric/eccentric axial compression loads. The idealized Coulomb's friction is also used for the sake of comparison. The incorporation of measured nonlinear, rather than the idealized Coulomb, friction is essential to compute realistic results. For plate fixation, the experimental and finite element results show that the screw fixation yields the stiffest response followed by the smooth- and then porous-coated post fixation. For example, under 1000 N eccentric axial compression, the edge of the plate opposite the loaded edge is measured to lift by 1147 +/- 72, 244 +/- 38, or 112 +/- 28 microns, respectively, for the cases with no fixation, with smooth-surfaced posts, or with screws. The corresponding models predict, respectively, values of 1538, 347, or 259 microns and also 556 microns for the plate fixed with porous coated posts. The satisfactory agreement between numerical and experimental results confirms the importance of proper interface modelling for the analysis of posts, screws, and complex fixation systems. This becomes further evident when considering cementless implants in which the bone-implant interface exhibits relatively large displacements as the maximum resistance force is reached. The developed models can be used to investigate the post-operative short-term stability of various cementless implant designs. PMID:9001932

  15. Primary Cementless Hip Arthroplasty in Unstable Intertrochanteric Femur Fracture in Elderlys: Short-term Results

    PubMed Central

    Cho, Hyung Lae; Cho, Hong

    2014-01-01

    Purpose This study was aimed to explore and report the short term results of primary cementless hip arthroplasty in treatment of unstable intertrochanteric femur fracture in elderlys. Materials and Methods Between March 2009 and Feburary 2012, 35 arthroplasty cases performed by single surgeon and followed up for more than one year were evaluated. They were 21 females and 14 males with mean age of 78 years (range, 71-92 years). Preoperative evaluation was performed by American Society of Anesthesia score. Retrospective evaluation was performed by operative time, transfusion amount, time to operation days, hospital stay and time to full weight bearing. Clinically, ambulatory ability was checked by Parker and Palmer (P&P) score and function of hip was appraised by Harris hip score (HSS). Radiologically, bone healing of fractured trochanteric fragment and presence of subsidence, stress shielding or osteolysis were checked. Results Fracture type was 11 cases of A2.2, 18 cases of A2.3 and 6 cases of A3.3. Femoral stems used were 8 cases of rectangular tapered wedge type and 27 cases of fluted modular distal fixation type. P&P score improved from mean preinjury score of 7.1 to mean postoperative last follow-up score of 6.5. Median HHS at last follow-up was 75. Mean time to full weight bearing was 47 days (24-79 days). Postoperative complications were one case of linear periprosthetic femoral fracture and one case of postoperative dislocation. Conclusion Cementless hip replacement arthroplasty could be a good option for unstable intertrochanteric femoral fracture in elderlys.

  16. Cementless Fixation of Osteoporotic VCFs Using Titanium Mesh Implants (OsseoFix): Preliminary Results

    PubMed Central

    Ender, Stephan Albrecht; Ulmar, Benjamin; Gradl, Georg

    2014-01-01

    Introduction. Vertebral compression fractures (VCFs) affect 20% of people over the age of 70 with increasing incidence. Kypho-/vertebroplasty as standard operative procedures are associated with limitations like cement leakage, limited reduction capabilities, and risk for adjacent fractures. To address these shortcomings, we introduce a new minimal invasive cementless VCF fixation technique. Methods. Four patients (72.3 years, range 70–76) with VCFs type AO/Müller A1.3 and concomitant osteoporosis were treated by minimal invasive transpedicular placement of two intervertebral mesh cages for fracture reduction and maintenance. Follow-up included functional/radiological assessment and clinical scores and averaged 27.7 months (24–28). Results. Endplate reduction was achieved in all cases (mean surgery time: 28.5 minutes). Kyphotic (KA) and Cobb angle revealed considerable improvements postoperatively (KA 14.5° to 10.7°/Cobb 10.1° to 8.3°). Slight loss of vertebral reduction (KA: 12.6°) and segment rekyphosis (Cobb: 10.7°) were observed for final follow-up. Pain improved from 8.8 to 2.8 (visual analogue scale). All cases showed signs of bony healing. No perioperative complications and no adjacent fractures occurred. Conclusion. Preliminary results in a small, selected patient collective indicate the ability of bony healing for osteoporotic VCFs. Cementless fixation using intravertebral titanium mesh cages revealed substantial pain relief, adequate reduction, and reduction maintenance without complications. Trial registration number is DRKS00005657, German Clinical Trials Register (DKRS). PMID:25110699

  17. The possible introduction of anti-osteoporosis drugs as an integrated treatment in total hip arthroplasty.

    PubMed

    Marchese, Marcella; Zarattini, Guido; Pazzaglia, Ugo E

    2011-04-01

    The anchorage of cementless total hip arthroplasty relies on a direct bone to implant bonding. Several factors including material properties and surface treatment determine the interfacial response of the host bone to a foreign material. Another factor that must be taken into account is the bone remodeling after the prosthesis introduction. Considering this bone remodeling, in the last few years the possibility of using anti-osteoporotic drugs has been introduced as a supplementary and integrated treatment in total hip replacement. PMID:21970916

  18. Bipolar Hemarthroplasty Using Cementless Conical Stem for Treatment of Dorr Type B and C Femoral Neck Fracture

    PubMed Central

    Kang, Jeong Hoon; Jung, Sung

    2015-01-01

    Purpose The current study aims to evaluate the clinical and the radiological outcome of bipolar hemiarthroplasty using cementless cone stem to treat osteoporotic femoral neck fracture and compare the results according to the proximal femur geometry. Materials and Methods Seventy-five hips (75 patients) that underwent bipolar hemiarthroplasty with cementless cone stem between September 2006 and December 2011 were analyzed. The minimum follow-up period was 3 years. Thirty-three hips were classified as type B and 41 as type C. The clinical outcome was assessed using Harris hip score and the walking ability score. Radiographic evaluation was performed to evaluate the stability of the prosthesis. Results At the most recent follow up, the mean Harris hip score was 86 (range, 70-92) and 65% recovered to preoperative ambulatory status. In the radiographic exam, stable stem fixation was achieved in all cases. For the complications, eight hips developed deep vein thrombosis while three hips showed heterotopic ossification. Dislocation and delayed deep infection occurred in one hip resepectively. There were no significance differences in Harris hip score and walking ability score when the type B group was compare with the type C. Conclusion Bipolar hemiarthroplasty with cementless cone stem showed an excellent early outcome both clinically and radiographically regardless of the shape of the proximal femur. We believe this prosthesis can provide early stability to the Dorr type B and C femur and is an effective treatment for treating osteoporotic femoral neck fracture. PMID:27536631

  19. Profiling the third-body wear damage produced in CoCr surfaces by bone cement, CoCr, and Ti6Al4V debris: a 10-cycle metal-on-metal simulator test.

    PubMed

    Halim, Thomas; Burgett, Michelle; Donaldson, Thomas K; Savisaar, Christina; Bowsher, John; Clarke, Ian C

    2014-07-01

    Particles of bone cement (polymethyl methacrylate), CoCr and Ti6Al4V were compared for their abrasion potential against CoCr substrates. This appears to be the first study utilizing CoCr and Ti6Al4V particulates to abrade CoCr bearings and the first study profiling the morphology of third-body abrasive wear scratches in a hip simulator. The 5 mg debris allotments (median size range 140-300 µm) were added to cups mounted both inverted and anatomically with metal-on-metal (MOM) bearings in a 10-cycle, hip simulator test. Surface abrasion was characterized by roughness indices and scratch profiles. Compared to third-body abrasion with metal debris, polymethyl methacrylate debris had minimal effect on the CoCr surfaces. In all, 10 cycles of abrasion with metal debris demonstrated that roughness indices (Ra, PV) increased approximately 20-fold from the unworn condition. The scratch profiles ranged 20-108 µm wide and 0.5-2.8 µm deep. The scratch aspect ratio (W/PV) averaged 0.03, and this very low ratio indicated that the 140 µm CoCr beads had plastically deformed to create wide but shallow scratches. There was no evidence of transfer of CoCr beads to CoCr bearings. The Ti64 particles produced similar scratch morphology with the same aspect ratio as the CoCr particulates. However, the titanium particulates also showed a unique ability to flatten and adhere to the CoCr, forming smears and islands of contaminating metal on the CoCr bearings. The morphology of scratches and metal transfer produced by these large metal particulates in the simulator appeared identical to those reported on retrieved metal-on-metal bearings. PMID:25062741

  20. Primary Stability Recognition of the Newly Designed Cementless Femoral Stem Using Digital Signal Processing

    PubMed Central

    Salleh, Sh-Hussain; Hamedi, Mahyar; Zulkifly, Ahmad Hafiz; Lee, Muhammad Hisyam; Mohd Noor, Alias; Harris, Arief Ruhullah A.; Abdul Majid, Norazman

    2014-01-01

    Stress shielding and micromotion are two major issues which determine the success of newly designed cementless femoral stems. The correlation of experimental validation with finite element analysis (FEA) is commonly used to evaluate the stress distribution and fixation stability of the stem within the femoral canal. This paper focused on the applications of feature extraction and pattern recognition using support vector machine (SVM) to determine the primary stability of the implant. We measured strain with triaxial rosette at the metaphyseal region and micromotion with linear variable direct transducer proximally and distally using composite femora. The root mean squares technique is used to feed the classifier which provides maximum likelihood estimation of amplitude, and radial basis function is used as the kernel parameter which mapped the datasets into separable hyperplanes. The results showed 100% pattern recognition accuracy using SVM for both strain and micromotion. This indicates that DSP could be applied in determining the femoral stem primary stability with high pattern recognition accuracy in biomechanical testing. PMID:24800230

  1. Primary stability recognition of the newly designed cementless femoral stem using digital signal processing.

    PubMed

    Baharuddin, Mohd Yusof; Salleh, Sh-Hussain; Hamedi, Mahyar; Zulkifly, Ahmad Hafiz; Lee, Muhammad Hisyam; Mohd Noor, Alias; Harris, Arief Ruhullah A; Abdul Majid, Norazman

    2014-01-01

    Stress shielding and micromotion are two major issues which determine the success of newly designed cementless femoral stems. The correlation of experimental validation with finite element analysis (FEA) is commonly used to evaluate the stress distribution and fixation stability of the stem within the femoral canal. This paper focused on the applications of feature extraction and pattern recognition using support vector machine (SVM) to determine the primary stability of the implant. We measured strain with triaxial rosette at the metaphyseal region and micromotion with linear variable direct transducer proximally and distally using composite femora. The root mean squares technique is used to feed the classifier which provides maximum likelihood estimation of amplitude, and radial basis function is used as the kernel parameter which mapped the datasets into separable hyperplanes. The results showed 100% pattern recognition accuracy using SVM for both strain and micromotion. This indicates that DSP could be applied in determining the femoral stem primary stability with high pattern recognition accuracy in biomechanical testing. PMID:24800230

  2. Ex vivo estimation of cementless acetabular cup stability using an impact hammer.

    PubMed

    Michel, Adrien; Bosc, Romain; Sailhan, Frédéric; Vayron, Romain; Haiat, Guillaume

    2016-02-01

    Obtaining primary stability of acetabular cup (AC) implants is one of the main objectives of press-fit procedures used for cementless hip arthroplasty. The aim of this study is to investigate whether the AC implant primary stability can be evaluated using the signals obtained with an impact hammer. A hammer equipped with a force sensor was used to impact the AC implant in 20 bovine bone samples. For each sample, different stability conditions were obtained by changing the cavity diameter. For each configuration, the inserted AC implant was impacted four times with a maximum force comprised between 2500 and 4500 N. An indicator I was determined based on the partial impulse estimation and the pull-out force was measured. The implant stability and the value of the indicator I reached a maximum value for an interference fit equal to 1 mm for 18 out of 20 samples. When pooling all samples and all configurations, the implant stability and I were significantly correlated (R(2) = 0.83). The AC implant primary stability can be assessed through the analysis of the impact force signals obtained using an impact hammer. Based on these ex vivo results, a medical device could be developed to provide a decision support system to the orthopedic surgeons. PMID:26671784

  3. Robot-assisted total hip arthroplasty.

    PubMed

    Banerjee, Samik; Cherian, Jeffery J; Elmallah, Randa K; Pierce, Todd P; Jauregui, Julio J; Mont, Michael A

    2016-01-01

    Precise and accurate biomechanical reconstruction during total hip arthroplasty (THA) is essential for durable long-term survivorship. Accurate fit of cementless hip implants is also crucial to reduce micromotion between the bone-implant interfaces to allow for stable osseointegration. Robotic technology aims to minimize potential human errors and improve implant alignment and fit, and address persisting concerns with modern-day cementless THA. Although robotic THA dates back to the early 1990s, concerns with increased operating times, costs, and complications led to its withdrawal. However, semi-active systems have renewed interest in robot-assisted joint arthroplasty. We reviewed the current technology, its potential benefits, and the reported clinical and radiographic outcomes. Early evidence suggests that robotic use may lead to more accurate reconstruction of radiographic parameters, such as implant positioning, fit, center-of-rotation, and leg-length discrepancy. Further research is needed to determine if these will translate into better outcomes and improved implant longevity to justify increased costs. PMID:26592900

  4. Hybrid component fixation in total knee arthroplasty: minimum of 10-year follow-up study.

    PubMed

    Yang, Jae-Hyuk; Yoon, Jung-Ro; Oh, Chi-Hun; Kim, Taik-Sun

    2012-06-01

    Hybrid total knee arthroplasty (TKA) (uncemented femur with cemented tibia and patella) was introduced in the late 1980s to gain the theoretical advantage of durable cementless femoral fixation while avoiding the problems noted with cementless tibial fixation. From December 1992 to July 2000, 215 patients (235 knees) who underwent hybrid TKA were enrolled in this study. Five types of prosthesis (AGC, Maxim, LCS-M, LCS-APG, and Scorpio) were used. Revision rate for aseptic loosening was 16 (6.8%) of 235 knees. At 10 and 15 years, survivorship with tibial or femoral revision as the end point was 0.95 and 0.92, respectively. Hybrid TKA provides durable fixation with clinical and radiographic performance at minimum 10 years comparable with cemented series. PMID:22019322

  5. Uneven damage on head and liner contact surfaces of a retrieved Co-Cr-based metal-on-metal hip joint bearing: An important reason for the high failure rate.

    PubMed

    Koizumi, Yuichiro; Chen, Yan; Li, Yunping; Yamanaka, Kenta; Chiba, Akihiko; Tanaka, Shun-Ichiro; Hagiwara, Yoshihiro

    2016-05-01

    Detailed metallurgical investigations have been performed on a used Co-Cr-based metal-on-metal (MoM) hip joint bearing containing a type of liner that is commonly used in such joints. The damage on the metal-liner sliding surface was considerably more severe than that on the metal head counterpart, in terms of wear-scar density and width and microcrack frequency. Cross-sectional transmission electron microscopy revealed that a thick (>3 μm) nanocrystalline layer formed on the sliding surface of the head, whereas the liner had coarse carbides embedded in it and nanocrystals were formed in a very limited region no deeper than 1 μm. Comparative investigation of an unused head and a liner of identical type showed that although the chemical compositions of the liner and head were nearly identical, their microstructures were significantly different. Specifically, the grain size in the liner was larger than that in the head on average, and the grain boundaries of the liner were decorated with coarse carbides. Moreover, X-ray diffraction analysis revealed a large tensile residual stress only in the liner. These differences are possibly responsible for the wear damage on the liner being more serious than that on the head. PMID:26952456

  6. Outcome of the cementless Taperloc stem: a comprehensive literature review including arthroplasty register data

    PubMed Central

    2011-01-01

    Background and purpose The validity of various data sources for the assessment of the outcome quality of medical devices was investigated by comparative analysis of the published data sources available for a sample of implants. It was the aim of the study to determine the performance of this implant and to identify potential bias factors inherent to the various datasets. Methods A comprehensive literature search was carried out from English-language, peer-reviewed journals and worldwide reports from national arthroplasty registers. Publications from Medline-listed journals were included. The main parameter was revision rate, calculated as “revisions per 100 observed component years” to allow adjusted direct comparison of different datasets. Results Of 16 clinical studies that met the inclusion criteria, 9 originated from the implant developer's hospital. In the clinical studies category, publications from the developer's hospital suggested considerably lower revision rates than the other datasets. In fact, the values quoted were 5.5 times below the average of all other studies, and 9.51 times lower than in the Australian arthroplasty register. These differences are statistically significant. Interpretation The cementless Taperloc stem is an implant that shows good performance regarding revision rates in registry data and in clinical studies. However, the excellent results published by the developer's clinic are generally not reproducible by other surgeons. In terms of reference data, registry data are able to make an important contribution to the assessment of clinical sample-based studies, particularly regarding evaluation of the extent to which published results are reproducible in daily routine. PMID:21463220

  7. Clinical Implication of Diabetes Mellitus in Primary Total Hip Arthroplasty

    PubMed Central

    Chun, Young-Soo; Lee, Seung-Hyuk; Lee, Sang-Hoon; Cho, Yoon-Je

    2014-01-01

    Purpose The purpose of this study was to investigate the effect of diabetes mellitus on primary total hip arthroplasty by comparing the clinical outcomes of patients diagnosed to have diabetes mellitus before the operation with those without diabetes. Materials and Methods A total 413 patients who underwent unilateral cementless total hip arthroplasty from June 2006 to May 2009 were recruited and divided into diabetic and non-diabetic groups. The comparative analysis between the two groups was made. We evaluated Harris hip score, postoperative complications such as wound problem, surgical site infection, other medical complication and length of stay in hospital as clinical parameters. Radiographic evaluations were also included to determine loosening, dislocation and osteolysis. Results Patients with diabetes had an increased incidence of orthopaedic complications including surgical site infection and mortality, but other medical complications were not increased in diabetic patients. All complications after primary total hip arthroplasty were associated with diabetes mellitus, but the degree of diabetes was not associated with complications. Conclusion Diabetes mellitus increases incidence of orthopaedic complications, particularly deep infection, after cementless primary total hip arthroplasty.

  8. The effect of extracorporeal shock wave lithotripsy on the prosthesis interface in cementless arthroplasty. Evaluation in a rabbit model.

    PubMed

    Stranne, S K; Callaghan, J J; Fyda, T M; Fulghum, C S; Glisson, R R; Weinerth, J L; Seaber, A V

    1992-06-01

    The effect of extracorporeal shock wave lithotripsy on interfacial strength between prosthesis and bone in cementless arthroplasty was examined using a rabbit model. Paired femora, each implanted with fiber mesh porous coated titanium implants, were harvested from rabbits 15 weeks after implantation. In group I, one femur from each pair was exposed to lithotripsy treatment consisting of 2,000 shocks at 20 kV. In group II, one femur from each pair was exposed to 2,000 shocks at 26 kV. Contralateral femora from each pair served as controls in both groups. Mechanical pushout tests were conducted on the implants using a 1321 Instron testing machine at a constant rate of 1 mm/minute. Shock waves generated at 20 kV were found to have no significant decrease on either the prosthesis/bone interfacial strength or energy to failure of cementless implants. Shock waves generated at 26 kV produced a mean 17.45% decrease in the prosthesis/bone interfacial strength, which approached statistical significance (P = .062), and a 7.84% mean decrease in the energy to failure (P = .268). However, in four of the seven group II specimens, cortical fractures occurred. These findings suggest that lithotripsy will not aid in the removal of uncemented porous coated devices and lithotripsy inadvertently focused at an uncemented device will not disrupt significantly the prosthesis-bone interface. PMID:1613525

  9. Loosening pattern in a cementless custom-made hip stem: X-ray analysis, finite-elements and photoelasticity measurements.

    PubMed

    Plath, J; Schuhr, T; Fethke, K; Zacharias, T; Johnson, M; Mach, J

    2000-01-01

    Thirty-three X-press cementless stems (Depuy) manufactured according to standardized X-rays were inserted from 1992 to 1994. The patients' mean age was 49 (range 15-79) years with a mean follow-up of 32 (+/-6) months. A characteristic radiographic pattern of aseptic loosening with erosion of the medial cortex by the tip of the stem occurred in 28 patients and a valgus shift of the implant in 14 cases. A radiolucent line with increased sclerosis below the tip (zone Gruen 4) was observed in 17 cases. Four stems were revised due to histologically confirmed aseptic loosening. Biomechanical investigation of one of the revised stems with the typical pattern of valgus angulation and medial cortex erosion included photoelasticity and finite-element analysis. The intertrochanteric fit and fill obviously resulted in an unfavorable distribution of contact areas, including peaks of high stress on the medial tip of the stem. These experimental findings are even evident for a postulated rotational stability. The clinical and radiographic results of the cementless X-press stems do not seem to support the fixation concept of intertrochanteric fit and fill of femoral components. PMID:10653115

  10. Have cementless and resurfacing components improved the medium-term results of hip replacement for patients under 60 years of age?

    PubMed Central

    Mason, James; Baker, Paul; Gregg, Paul J; Porter, Martyn; Deehan, David J; Reed, Mike R

    2015-01-01

    Background and purpose The optimal hip replacement for young patients remains unknown. We compared patient-reported outcome measures (PROMs), revision risk, and implant costs over a range of hip replacements. Methods We included hip replacements for osteoarthritis in patients under 60 years of age performed between 2003 and 2010 using the commonest brand of cemented, cementless, hybrid, or resurfacing prosthesis (11,622 women and 13,087 men). The reference implant comprised a cemented stem with a conventional polyethylene cemented cup and a standard-sized head (28- or 32-mm). Differences in implant survival were assessed using competing-risks models, adjusted for known prognostic influences. Analysis of covariance was used to assess improvement in PROMs (Oxford hip score (OHS) and EQ5D index) in 2014 linked procedures. Results In males, PROMs and implant survival were similar across all types of implants. In females, revision was statistically significantly higher in hard-bearing and/or small-stem cementless implants (hazard ratio (HR) = 4) and resurfacings (small head sizes (< 48 mm): HR = 6; large head sizes (≥ 48 mm): HR = 5) when compared to the reference cemented implant. In component combinations with equivalent survival, women reported significantly greater improvements in OHS with hybrid implants (22, p = 0.006) and cementless implants (21, p = 0.03) (reference, 18), but similar EQ5D index. For men and women, National Health Service (NHS) costs were lowest with the reference implant and highest with a hard-bearing cementless replacement. Interpretation In young women, hybrids offer a balance of good early functional improvement and low revision risk. Fully cementless and resurfacing components are more costly and do not provide any additional benefit for younger patients. PMID:25285617

  11. Preoperative planning and postoperative evaluation of total hip arthroplasty that takes combined anteversion.

    PubMed

    Imai, Hiroshi; Miyawaki, Joji; Kamada, Tomomi; Takeba, Jun; Mashima, Naohiko; Miura, Hiromasa

    2016-07-01

    The purpose of this study was to investigate whether postoperative combined anteversion (CA) can be kept within the safe zone while using cementless total hip arthroplasty (THA) using the operative technique which prepares the socket first for developmental dysplasia of the hip (DDH), by estimating the anteversion of the metaphyseal fit stem using preoperative three-dimensional (3D) computerized planning and by adjusting the anteversion of the socket using a navigation system that considers CA. Our subjects were 65 patients (65 hips) that had undergone cementless THA for DDH that could be observed for 1 year or more. Clinical assessments were made using the Japanese Orthopaedic Association's (JOA) hip score. For a radiological evaluation, we investigated 3D-planned stem versions, postoperative stem versions, preoperative and postoperative CA, and the relationship between CA and dislocation tendencies with temporary intraoperative reductions. JOA hip scores improved from 52.3 ± 11.4 points to 88.9 ± 8.6 points. CT evaluations revealed that 3D-planned stem versions were strongly correlated with postoperative stem versions (r = 0.80; p < 0.01). Preoperative CA was 50.5° ± 7.2°, and postoperative CA was 41.3° ± 8.6°. Postoperative CA was kept within the safe zone in 61 hips. No intraoperative dislocation tendencies were observed in any hips. By estimating the anteversion of the cementless metaphyseal fit stem using 3D planning preoperatively and adjusting the angle of anteversion of the socket using a navigation system that considers CA intraoperatively, postoperative CA can very frequently be kept within the safe zone, even with cementless THA using the operative technique which prepares the socket first for DDH. PMID:27154291

  12. The modern, hybrid total hip arthroplasty for primary osteoarthritis at the Hospital for Special Surgery.

    PubMed

    González Della Valle, A; Sharrock, N; Barlow, M; Caceres, L; Go, G; Salvati, E A

    2016-01-01

    We describe our technique and rationale using hybrid fixation for primary total hip arthroplasty (THA) at the Hospital for Special Surgery. Modern uncemented acetabular components have few screw holes, or no holes, polished inner surfaces, improved locking mechanisms, and maximised thickness and shell-liner conformity. Uncemented sockets can be combined with highly cross-linked polyethylene liners, which have demonstrated very low wear and osteolysis rates after ten to 15 years of implantation. The results of cement fixation with a smooth or polished surface finished stem have been excellent, virtually eliminating complications seen with cementless fixation like peri-operative femoral fractures and thigh pain. Although mid-term results of modern cementless stems are encouraging, the long-term data do not show reduced revision rates for cementless stems compared with cemented smooth stems. In this paper we review the conduct of a hybrid THA, with emphasis on pre-operative planning, surgical technique, hypotensive epidural anaesthesia, and intra-operative physiology. PMID:26733642

  13. CoCr wear particles generated from CoCr alloy metal-on-metal hip replacements, and cobalt ions stimulate apoptosis and expression of general toxicology-related genes in monocyte-like U937 cells.

    PubMed

    Posada, Olga M; Gilmour, Denise; Tate, Rothwelle J; Grant, M Helen

    2014-11-15

    Cobalt-chromium (CoCr) particles in the nanometre size range and their concomitant release of Co and Cr ions into the patients' circulation are produced by wear at the articulating surfaces of metal-on-metal (MoM) implants. This process is associated with inflammation, bone loss and implant loosening and led to the withdrawal from the market of the DePuy ASR™ MoM hip replacements in 2010. Ions released from CoCr particles derived from a resurfacing implant in vitro and their subsequent cellular up-take were measured by ICP-MS. Moreover, the ability of such metal debris and Co ions to induce both apoptosis was evaluated with both FACS and immunoblotting. qRT-PCR was used to assess the effects on the expression of lymphotoxin alpha (LTA), BCL2-associated athanogene (BAG1), nitric oxide synthase 2 inducible (NOS2), FBJ murine osteosarcoma viral oncogene homolog (FOS), growth arrest and DNA-damage-inducible alpha (GADD45A). ICP-MS showed that the wear debris released significant (p<0.05) amounts of Co and Cr ions into the culture medium, and significant (p<0.05) cellular uptake of both ions. There was also an increase (p<0.05) in apoptosis after a 48h exposure to wear debris. Analysis of qRT-PCR results found significant up-regulation (p<0.05) particularly of NOS2 and BAG1 in Co pre-treated cells which were subsequently exposed to Co ions+debris. Metal debris was more effective as an inducer of apoptosis and gene expression when cells had been pre-treated with Co ions. This suggests that if a patient receives sequential bilateral CoCr implants, the second implant may be more likely to produce adverse effects than the first one. PMID:25281833

  14. Is There a Benefit to Head Size Greater Than 36 mm in Total Hip Arthroplasty?

    PubMed

    Haughom, Bryan D; Plummer, Darren R; Moric, Mario; Della Valle, Craig J

    2016-01-01

    This study compares the rate of dislocation and revision for instability between 36-mm and anatomic femoral heads (large diameter metal-on-metal THA, dual-mobility bearings, and hip resurfacing arthroplasty) in patients at high risk for dislocation. A total of 501 high-risk patients, over a 10-year period, were identified (282 36-mm THA, 24 dual-mobility bearings, 83 metal-on-metal arthroplasty, and 112 hip resurfacing arthroplasty). There were 13 dislocations in the 36-mm group compared to 1 in the anatomic group (4.6% vs 0.5%; P = .005). Four patients dislocated more than once in the 36-mm group (1.4% vs 0%; P = .04), and 2 patients in the 36-mm group required a revision for instability (0.7% vs 0%; P = .11). These results suggest that anatomic head sizes significantly lower the risk of dislocation in high-risk patients. PMID:26360768

  15. Midterm results of large diameter Biolox forte ceramic head on delta ceramic liner articulation in total hip arthroplasty.

    PubMed

    Kang, Bun-Jung; Ha, Yong-Chan; Hwang, Sun-Chul; Lee, Young-Kyun; Koo, Kyung-Hoi

    2014-12-01

    Seventy-nine patients (94 hips), who underwent cementless alumina-on-alumina total hip arthroplasty (THA) with the use of a 36-mm delta ceramic liner-on-alumina ceramic femoral head, were followed for an average of 6.5years (range, 5-7.7years). All acetabular and femoral components were bone-ingrown and neither pelvic nor femoral osteolysis was identified until the latest follow-up. The survivorship with revision surgery as an endpoint was 97.9% (95% confidence interval=100%-95%). Ceramic related complications such as fracture and squeaking did not occur in any patient. The mid-term results of cementless THA with this type of ceramic articulation are encouraging. PMID:24704123

  16. Delivery of Antibiotics from Cementless Titanium-Alloy Cubes May Be a Novel Way to Control Postoperative Infections

    PubMed Central

    Bezuidenhout, Martin B.; van Staden, Anton D.; Oosthuizen, Gert A.; Dimitrov, Dimitar M.; Dicks, Leon M. T.

    2015-01-01

    Bacterial colonisation and biofilm formation onto orthopaedic devices are difficult to eradicate. In most cases infection is treated by surgical removal of the implant and cleaning of the infected area, followed by extensive treatment with broad-spectrum antibiotics. Such treatment causes great discomfort, is expensive, and is not always successful. In this study we report on the release of vancomycin through polyethersulfone membranes from channels in cementless titanium-alloy cubes. The cubes were constructed with LaserCUSING from Ti6Al4V ELI powder. Vancomycin was released by non-Fickian anomalous (constraint) diffusion. Approximately 50% of the vancomycin was released within the first 17 h. However, sustained delivery of vancomycin for 100 h was possible by reinjecting the channels. Refillable implants may be a novel way to control postoperative infections. PMID:25861649

  17. CoCr wear particles generated from CoCr alloy metal-on-metal hip replacements, and cobalt ions stimulate apoptosis and expression of general toxicology-related genes in monocyte-like U937 cells

    SciTech Connect

    Posada, Olga M.; Gilmour, Denise; Tate, Rothwelle J.; Grant, M. Helen

    2014-11-15

    Cobalt-chromium (CoCr) particles in the nanometre size range and their concomitant release of Co and Cr ions into the patients' circulation are produced by wear at the articulating surfaces of metal-on-metal (MoM) implants. This process is associated with inflammation, bone loss and implant loosening and led to the withdrawal from the market of the DePuy ASR™ MoM hip replacements in 2010. Ions released from CoCr particles derived from a resurfacing implant in vitro and their subsequent cellular up-take were measured by ICP-MS. Moreover, the ability of such metal debris and Co ions to induce both apoptosis was evaluated with both FACS and immunoblotting. qRT-PCR was used to assess the effects on the expression of lymphotoxin alpha (LTA), BCL2-associated athanogene (BAG1), nitric oxide synthase 2 inducible (NOS2), FBJ murine osteosarcoma viral oncogene homolog (FOS), growth arrest and DNA-damage-inducible alpha (GADD45A). ICP-MS showed that the wear debris released significant (p < 0.05) amounts of Co and Cr ions into the culture medium, and significant (p < 0.05) cellular uptake of both ions. There was also an increase (p < 0.05) in apoptosis after a 48 h exposure to wear debris. Analysis of qRT-PCR results found significant up-regulation (p < 0.05) particularly of NOS2 and BAG1 in Co pre-treated cells which were subsequently exposed to Co ions + debris. Metal debris was more effective as an inducer of apoptosis and gene expression when cells had been pre-treated with Co ions. This suggests that if a patient receives sequential bilateral CoCr implants, the second implant may be more likely to produce adverse effects than the first one. - Highlights: • Effects of CoCr nanoparticles and Co ions on U937 cells were investigated. • Ions released from wear debris play an important role in cellular response, • Toxicity of Co ions could be related to NO metabolic processes and apoptosis. • CoCr particles were a more effective inducer of apoptosis after cell

  18. Examination of rotational fixation of the femoral component in total hip arthroplasty. A mechanical study of micromovement and acoustic emission.

    PubMed

    Sugiyama, H; Whiteside, L A; Kaiser, A D

    1989-12-01

    Rotational loosening has recently emerged as an important cause of failure of the femoral component of total hip arthroplasties. This study was designed to investigate the role played by torsional loads in loosening of cementless femoral components and to evaluate three cementing techniques involving a combination of canal irrigation, manual insertion, and vacuum mixing combined with pressure injection of the cement for their ability to improve rotational fixation. Rotational micromotion and subsidence were measured in 24 preserved human anatomic specimen femora. Acoustic emission (AE) technique was applied as a non-destructive method for evaluating material failure during loading. From the micromovement data, torque to 50 mu subsidence and torque to failure were surprisingly low with cementless fixation and with poor cement technique but were markedly improved with pulsed irrigation. Further improvement was achieved by pressure injection and vacuum mixing of the cement. However, AE was detected even in the most carefully performed cement specimens under torsional-loading conditions commonly occurring in daily activities. These signs of microfailure of the cement mantle at relatively low torsional loads suggest that the mode of failure of deeply penetrated cement is by microfracture of the cement mantle. The poor performance suggests that cementless fixation of intramedullary stems provides unsatisfactory fixation against torsional loading. There is need for major improvements in fixation mechanisms and techniques. The signs of failure of the cement mantle at normally occurring torsional loads suggest that even the best cement technique is prone to failure in torsion when exposed to normal daily use. PMID:2582663

  19. A frictional study of total hip joint replacements

    NASA Astrophysics Data System (ADS)

    Scholes, S. C.; Unsworth, A.; Goldsmith, A. A. J.

    2000-12-01

    Polymeric wear debris produced by articulation of the femoral head against the ultra-high-molecular-weight polyethylene socket of a total hip replacement has been implicated as the main cause of osteolysis and subsequent failure of these implants. Potential solutions to this problem are to employ hard bearing surface combinations such as metal-on-metal or ceramic-on-ceramic prostheses. The aim of this study was to investigate the difference in lubrication modes and friction of a range of material combinations using synthetic and biological fluids as the lubricants. The experimental results were compared with theoretical predictions of film thicknesses and lubrication modes. A strong correlation was observed between experiment and theory when employing carboxy methyl cellulose (CMC) fluids as the lubricant. Under these conditions the ceramic-on-ceramic joints showed full fluid film lubrication while the metal-on-metal, metal-on-plastic, diamond-like carbon-coated stainless steel (DLC)-on-plastic and ceramic-on-plastic prostheses operated under a mixed lubrication regime. With bovine serum as the lubricant in the all ceramic joints, however, the full fluid film lubrication was inhibited due to adsorbed proteins. In the metal-on-metal joints this adsorbed protein layer acted to reduce the friction while in the ceramic coupling the friction was increased. The use of bovine serum as the lubricant also significantly increased the friction in both the metal-on-plastic and ceramic-on-plastic joints. The friction produced by the DLC-on-plastic joints depended on the quality of the coating. Those joints with a less consistent coating and therefore a higher surface roughness gave significantly higher friction than the smoother, more consistently coated heads.

  20. Alternative bearing surfaces in total hip arthroplasty.

    PubMed

    Inzerillo, V Christopher; Garino, Jonathan P

    2003-01-01

    Polyethylene wear and extension of indications of total hip arthroplasty into younger and younger age groups have pushed manufacturers to develop more durable bearing surfaces. Standard polyethylene, the plastic used for the first 3 decades of hip replacement, virtually ceases to exist in its original form. Modifications of the processing, including sterlization in an inert environment and cross-linking, have demonstrated some improvements in wear. Hard-on-hard bearings such as ceramic-on-ceramic and metal-on-metal also have demonstrated extremely low wear. This article reviews the pros and cons of the alternative bearing options available to assist in the proper bearing selection for a particular patient. PMID:12882250

  1. Biomaterial Hypersensitivity: Is It Real? Supportive Evidence and Approach Considerations for Metal Allergic Patients following Total Knee Arthroplasty

    PubMed Central

    Mihalko, William M.; Grupp, Thomas M.; Manning, Blaine T.; Dennis, Douglas A.; Goodman, Stuart B.; Saleh, Khaled J.

    2015-01-01

    The prospect of biomaterial hypersensitivity developing in response to joint implant materials was first presented more than 30 years ago. Many studies have established probable causation between first-generation metal-on-metal hip implants and hypersensitivity reactions. In a limited patient population, implant failure may ultimately be related to metal hypersensitivity. The examination of hypersensitivity reactions in current-generation metal-on-metal knee implants is comparatively limited. The purpose of this study is to summarize all available literature regarding biomaterial hypersensitivity after total knee arthroplasty, elucidate overall trends about this topic in the current literature, and provide a foundation for clinical approach considerations when biomaterial hypersensitivity is suspected. PMID:25883940

  2. Biomaterial hypersensitivity: is it real? Supportive evidence and approach considerations for metal allergic patients following total knee arthroplasty.

    PubMed

    Mitchelson, Andrew J; Wilson, Craig J; Mihalko, William M; Grupp, Thomas M; Manning, Blaine T; Dennis, Douglas A; Goodman, Stuart B; Tzeng, Tony H; Vasdev, Sonia; Saleh, Khaled J

    2015-01-01

    The prospect of biomaterial hypersensitivity developing in response to joint implant materials was first presented more than 30 years ago. Many studies have established probable causation between first-generation metal-on-metal hip implants and hypersensitivity reactions. In a limited patient population, implant failure may ultimately be related to metal hypersensitivity. The examination of hypersensitivity reactions in current-generation metal-on-metal knee implants is comparatively limited. The purpose of this study is to summarize all available literature regarding biomaterial hypersensitivity after total knee arthroplasty, elucidate overall trends about this topic in the current literature, and provide a foundation for clinical approach considerations when biomaterial hypersensitivity is suspected. PMID:25883940

  3. Study of bone remodeling of two models of femoral cementless stems by means of DEXA and finite elements

    PubMed Central

    2010-01-01

    Background A hip replacement with a cemented or cementless femoral stem produces an effect on the bone called adaptive remodelling, attributable to mechanical and biological factors. All of the cementless prostheses designs try to achieve an optimal load transfer in order to avoid stress-shielding, which produces an osteopenia. Long-term densitometric studies taken after implanting ABG-I and ABG-II stems confirm that the changes made to the design and alloy of the ABG-II stem help produce less proximal atrophy of the femur. The simulation with FE allowed us to study the biomechanical behaviour of two stems. The aim of this study was, if possible, to correlate the biological and mechanical findings. Methods Both models with prostheses ABG-I and II have been simulated in five different moments of time which coincide with the DEXA measurements: postoperative, 6 months, 1, 3 and 5 years, in addition to the healthy femur as the initial reference. For the complete comparative analysis of both stems, all of the possible combinations of bone mass (group I and group II of pacients in two controlled studies for ABG-I and II stems, respectively), prosthetic geometry (ABG-I and ABG-II) and stem material (Wrought Titanium or TMZF) were simulated. Results and Discussion In both groups of bone mass an increase of stress in the area of the cancellous bone is produced, which coincides with the end of the HA coating, as a consequence of the bottleneck effect which is produced in the transmission of loads, and corresponds to Gruen zones 2 and 6, where no osteopenia can be seen in contrast to zones 1 and 7. Conclusions In this study it is shown that the ABG-II stem is more effective than the ABG-I given that it generates higher tensional values on the bone, due to which proximal bone atrophy diminishes. This biomechanical behaviour with an improved transmission of loads confirmed by means of FE simulation corresponds to the biological findings obtained with Dual-Energy X

  4. Successful Long-Term Fixation and Progression of Osteolysis Associated with First-Generation Cementless Acetabular Components Retrieved Post Mortem

    PubMed Central

    Urban, Robert M.; Hall, Deborah J.; Della Valle, Craig; Wimmer, Markus A.; Jacobs, Joshua J.; Galante, Jorge O.

    2012-01-01

    Background: Primary cementless acetabular reconstruction has shown durable long-term fixation. Late failures secondary to aseptic loosening are rare but may occur in patients with previously well-fixed components. In the present study, the histopathological characteristics of postmortem specimens were correlated with wear damage and radiographic data in an attempt to better understand the long-term events in the periacetabular tissue around well-functioning devices. Methods: Seventeen primary cementless Harris-Galante I acetabular components with adjacent tissues were harvested after a mean of eleven years (range, four to twenty-five years) from patients whose implants were well functioning at the time of death. Undecalcified and paraffin sections were used to quantify the extent of bone and soft tissues within the porous coating and at the interface between the coating and the surrounding bone. Wear particles were identified with use of polarized light microscopy and energy-dispersive x-ray analysis. Bearing-surface volumetric wear and backside wear damage of the polyethylene liner were assessed. Results: All of the components were fixed by bone ingrowth (mean extent, 33% ± 21%). Particle-induced granulomas were present in the porous coating and along the interface and progressed through screw holes, ballooning into the retroacetabular bone in the longer-term specimens. Particles of femoral and acetabular origin were identified in the granulomas. Bearing-surface volumetric wear (mean, 41.6 mm3/year) increased with duration and correlated with increasing extent of granuloma in the porous coating and the increasing size of pelvic granulomas. Radiolucencies on radiographs correlated with the extent of bone and fibrous tissue ingrowth. Of the six pelvic granulomas that were identified histologically, only one was apparent on routine radiographs. Conclusions: Acetabular fixation by bone ingrowth can be successful into the third decade after implantation. Osteolysis

  5. Prostaglandin E2 level in tissue surrounding aseptic failed total hips. Effects of materials.

    PubMed

    Sedel, L; Simeon, J; Meunier, A; Villette, J M; Launay, S M

    1992-01-01

    Production of inflammatory mediators (IM) by cells and specifically macrophages around loosened implants may be responsible for their loosening. Our hypothesis was that different materials give rise to different amounts of these IM. It is thought that alumina/alumina for total hip replacement (THR), which has been used for 15 years in our orthopedic department, may produce less IM than other systems. We initiated a clinical prospective study to measure the level of prostaglandin E2 (PGE2) in tissue surrounding loosened prostheses to quantify PGE2 production regarding the types of material involved in the friction couple, i.e., alumina/alumina versus metal/polyethylene, and the type of fixation, i.e., cemented versus cementless. A total of 29 THR revisions were performed in 28 patients. Four implant groups were identified: alumina/alumina cemented, alumina/alumina cementless, metal/polyethylene cemented, and metal/polyethylene cementless. For each revision, tissues surrounding the failed implants were harvested and processed, and the PGE2 was measured in a blind manner using an immunoassay technique. As the measuring technique was difficult, at least three determinations for each sample were necessary. Some samples were excluded from the analysis for various reasons, for example, second or further revisions involving many different materials in the past, conjunction of metallic and alumina debris and samples taken from non-loosened components. Finally, 15 samples were considered adequate for inclusion in this study. Two groups were analyzed and compared: the alumina/alumina couple and the metal/polyethylene couple. Tissue surrounding the first group demonstrated a PGE2 level of 69 +/- 56 fmol/mg wet weight compared to 202 +/- 156 fmol/mg for the second.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1389776

  6. Prospective randomised clinical trial assessing subsidence and rotation, using radiostereometric analysis, of two modular cementless femoral stems (Global K2 and Apex)

    PubMed Central

    Edmondson, Mark; Ebert, Jay; Nivbrant, Oscar; Wood, David

    2014-01-01

    Aims To accurately assess subsidence, rotation and clinical scores in two cementless femoral stems. Methods 260 patients received either K2 or Apex femoral stems and were studied over 2y, with RSA and clinical scores. Results Mean Oxford Hip score for both stems was excellent (45.78 and 46.76). Very little subsidence or rotation were noted on RSA in either stem. There were no statistically significant differences in clinical scores, or radiological motion between stems. Revision rate was 0.8% over the study period. Conclusion Excellent clinical and RSA scores over the 2y study period predict good long term outcomes for these stems. PMID:25104894

  7. The patellofemoral joint in total knee prostheses. Design considerations.

    PubMed

    Freeman, M A; Samuelson, K M; Elias, S G; Mariorenzi, L J; Gokcay, E I; Tuke, M

    1989-01-01

    Some desirable design features of the patellofemoral joint in a total knee arthroplasty condylar prosthesis are proposed. These are that the femoral element should be grooved, have a high anterior flange, and be circular as viewed from the side. The groove should be about 5 mm deep and have relatively vertical walls. The patellar component should have a saddle-shaped articular surface matching the femur and should be countersunk into the patella. The components should be placed so as to position the joint automatically. Results with such a design are reported; loosening, wear, dislocation, and fracture have been rare. Osteolysis of the patella has not been seen after 9 years, so that the cementless press-fit fixation of an H.D.P. patellar prosthesis to date seems safe and efficacious. PMID:2584990

  8. Total ankle replacement. The results in 200 ankles.

    PubMed

    Wood, P L R; Deakin, S

    2003-04-01

    Between 1993 and 2000 we implanted 200 cementless, mobile-bearing STAR total ankle replacements. None was lost to follow-up for reasons other than the death of a patient. The mean follow-up was for 46 months (24 to 101). A complication requiring further surgery developed in eight ankles and 14 were revised or fused. The cumulative survival rate at five years was 92.7% (95% CI 86.6 to 98.8) with time to decision to revision or fusion as an endpoint. The most frequent complications were delayed wound healing and fracture of a malleolus. These became less common with experience of the operation. The radiological appearance of the interface of the tibial implant was significantly related to its operative fit and to the type of bioactive coating. PMID:12729104

  9. Survival of Bi-Metric femoral stems in 77 total hip arthroplasties for juvenile chronic arthritis.

    PubMed

    Lybäck, C C; Lybäck, C O; Kyrö, A; Kautiainen, H J; Belt, E A

    2004-12-01

    The survival of 77 cementless total hip arthroplasties using a Bi-Metric femoral stem and two types of acetabular components was analysed in 55 patients with juvenile chronic arthritis. The patients were treated between 1986 and 1996. Their mean age was 8.0 years at the onset of the disease and 28.1 years at the time of surgery. The mean follow-up period was 9.6 years. Follow-up evaluations were conducted 3 months and 1, 4, 8, 12 and 16 years post-operatively. The endpoints of survival analysis were revision surgery, death of the patient or the end of the year 2002. The 10-year survival was 77.6% for the Romanus cup and 49.1% for the TTAP-ST cup. In contrast to these inadequate outcomes, the cementless Bi-Metric stem yielded excellent results with a survival rate of 100% for aseptic loosening during a mean follow-up period of 10 years. PMID:15316677

  10. Modular noncemented total hip arthroplasty for congenital dislocation of the hip. Case report and design rationale.

    PubMed

    Gorski, J M

    1988-03-01

    The highest rate of failure and the greatest technical difficulty in total hip arthroplasty occurs with congenital dislocation of the hip (CDH). Predisposing factors are failure to secure special femoral components to fit an extremely narrow and straight medullary cavity with space for only a very thin mantle of cement. The acetabulum is usually atrophic, and bone grafts are commonly required to support a small-diameter cup. The young age of the average patient and high levels of activity contribute to cement failure. A new modular cementless prosthesis provides excellent immediate skeletal fixation and pain relief in CDH patients. Five modular components are screwed or press-fit into bone. The modular approach facilitates implantation, reduces inventory, and is adaptable to unforeseen problems. These advantages are ordinarily absent with standard or custom cemented components. Modular components may also permit easier revision. The prosthesis is made of titanium alloy for its superalloy strength, elastic modulus, and bioinertness. By omitting the cement mantle, press-fit is obtained with the largest possible implant. The large size minimizes stem breakage in these young, small bones. Excellent short-term results suggest that modular cementless implants are indicated in some patients with CDH. PMID:3342552