Evaluation of cementless acetabular component migration: An experimental study
Abstract
Roentgenograms of two human cadaveric pelves with three implanted acetabular components were taken in anatomic, tilted, and rotated positions to determine their effect on the measurement of cup migration. The best landmark for measuring migration along a vertical axis was the distance between the center of the cup and the teardrop line. The best measurement for cup migration along an horizontal axis was the distance between the center of the cup and the vertical line through the teardrop. When the teardrop is not visible, one should use the distance between the bottom of the cup and the obturator line, and the distance between the center of the cup and Kohler's line. Guidelines for roentgenographic comparability are as follows: at 10% magnification, the variation in distance between the obturator line and the teardrop line should be less than 5 mm, and the distance between the middle of the sacroiliac line and the vertical line through the pubis should be less than 0.5 cm.
References (5)
- BobynJD et al.
Radiography and histology of a threaded acetabular component
J Bone Joint Surg
(1988) - CallaghanMJ et al.
The uncemented porous-coated anatomic total hip prosthesis: two year results of a prospective consecutive series
J Bone Joint Surg
(1988)
Cited by (454)
Use of dual mobility cup cemented into a tantalum acetabular shell for hip revision with large bone loss can decrease dislocation risk without increasing the risk of mechanical failure
2024, Orthopaedics and Traumatology: Surgery and ResearchPorous tantalum components and augments have demonstrated short to midterm fixation stability in acetabular total hip arthroplasty (THA) revision but do not offer a novel option to decrease the postoperative dislocation rate. Recently, dual mobility (DM) cups have gained interest to decrease the prevalence of recurrent hip instability after revision hip arthroplasty, but this issue was not confirmed combined with use of tantalum reconstruction devices. Therefore, we did a retrospective study aiming to: (1) evaluate at a 5-year minimum follow-up period the dislocation rate (and other intra- and postoperative complications), (2) assess radiographic results specifically looking at osseointegration and restoration of the hip center, (3) and also clinical results in a cohort of patients who underwent complex acetabular reconstruction with trabecular metal revision components associated with a cemented DM socket.
Using a DM socket cemented in porous tantalum components can reach the low risk of hip dislocation reported with DM components in revision setting without increasing the risk of a mechanical failure.
A cross-sectional study identified 174 THA revision including an acetabular revision. Were excluded 118 revisions with acetabular defects Type 1, 2a or 2B according to Paprosky's classification, as well as 18 hips revised without a dual mobility and 3 patients (3 hips) lost to follow-up. Were thus included in this study 35 hips (35 patients) implanted with uncemented total hip arthroplasty revision using both trabecular metal acetabular cup-cage reconstruction and a cemented DM cup. Seven hips were classified Paprosky types 2C, 15 type 3A and 13 types 3B. Patients were followed with clinical and radiological evaluation regarding dislocation rate, infection, reoperation or re-revision, osseointegration and restoration of the hip center, and functional results according to the Harris hip score and psoas impingement presence.
At a mean follow-up of 8.1 ± 1.8 years (5.1–12.6), one dislocation was recorded, and one acute deep infection. No patient required a cup re-revision for septic or aseptic loosening. The survivorship at 8 years regarding revision for any cause as an endpoint was 96.5% (CI95%: 92–99). Osseointegration of TM implants was analyzed and found no acetabular migration at the last follow-up in the cohort. The mean hip center position was optimized from 48 ± 7 mm (37–58) to 34 ± 5 mm (29–39) vertically and from 26 ± 5 mm (–18–36) to 24 ± 8 mm (7–31) horizontally without reaching significance (p = 0.1). On the last follow-up X-rays, the mean acetabular inclination was 47̊ ± 9̊ (32̊–61̊). According to the criteria of Hirakawa, 97.1% (34/35) of the hip centers were restored. One cup (2.9%) was more than 5 mm proximally from the hip center, and none more than 10 mm. Clinical results assessed a Harris Hip Score improved from 36 ± 17 (23–62) preoperatively to 82 ± 15 (69–93) at last follow-up (p < 0.0001). Two patients (2/35, 5.7%) complained of psoas impingement.
This study suggests effectiveness of DM cups in association with a tantalum-made acetabular shell for reconstruction of large bone defect in THRs for both solving postoperative instability and aseptic loosening without increasing the re-revision rate for any reason in a midterm follow-up.
IV; observational study.
Wear rate and osteolysis in two types of second-generation annealed highly cross-linked polyethylene in total hip arthroplasty: A retrospective comparative study with a minimum of five years
2023, Orthopaedics and Traumatology: Surgery and ResearchAs no previous study has directly compared the linear wear rate in two types of second-generation annealed highly cross-linked polyethylene, we performed a retrospective study with a minimum of 5-year follow-up to assess primary arthroplasties in the (1) wear rates and (2) incidence of osteolysis of the two types of HXLPE.
There was no significant difference in the linear wear rate and the incidence of osteolysis between the two types of second-generation annealed highly cross-linked polyethylene.
In this single-center study, we reviewed 257 cases of primary cementless total hip arthroplasties between 2011 and 2015, which were performed with 32 mm delta ceramic on second-generation annealed highly cross-linked polyethylene (X3 and E1 were used in 105 and 103 cases, respectively.). The mean wear rate was evaluated using a computer-assisted method, and the incidence of osteolysis was evaluated based on the appearance of a localized area with loss of trabecular bone or cortical erosion adjacent to the implants during the latest follow-up.
In total, we evaluated 208 cases, followed postoperatively for over 5 years (mean, 6.1 years, range: 5.0-8.0). There were no significant differences between the two groups with respect to age (list in order of Group X, Group E, p value) (61.2 ± 12.3, 62.7 ± 12.1, p = 0.36), sex (ratio of male: 17.1%, 14.6%, p = 0.61), body mass index (22.9 ± 3.7, 22.8 ± 4.0, p = 0.91), pre- (49.9 ± 14.8, 48.5 ± 13.8, p = 0.49) and post-operative (91.3 ± 9.1, 92.7 ± 7.0, p = 0.23) Japanese Orthopaedic Association Hip Score, cup size (50.8 ± 3.0, 50.9 ± 2.2, p = 0.70), cup inclination (38.7 ± 4.8, 37.6 ± 4.8, p = 0.10), and cup anteversion (18.7 ± 6.9, 18.5 ± 7.6, p = 0.80). The mean linear wear rates of the X3 and E1 groups were 0.057 ± 0.039 (range: 0–0.16) and 0.054 ± 0.037 mm/year (range: 0–0.15), respectively (p = 0.61). No osteolysis was found on the final plain radiographs in both groups.
This study revealed that both types of highly cross-linked polyethylene have excellent linear wear rates and were equally safe to use. However, the difference between the two materials in terms of the long-term wear rate should be further validated.
III; retrospective case control study.
Accuracy and precision of the measurement of liner orientation of dual mobility cup total hip arthroplasty using ultrasound imaging
2022, Medical Engineering and PhysicsThe Dual Mobility Cup (DMC) was created in 1974 to prevent dislocation and decrease wear. However, the movement of the polyethylene liner in vivo remains unclear. The aims of this study were to visualise liner positions and quantify the accuracy of the liner plane orientation for static positions, using ultrasound imaging. DMC reconstruction and angle between cup and liner were evaluated on isolated submerged DMCs by comparing 3D laser scans and ultrasound imaging. Moreover, the abduction and anteversion angles of the liner plane relative to the pelvis orientation were calculated via combined motion analysis and 3D ultrasound imaging on four fresh post-mortem human subjects with implanted DMC. On submerged DMC, the mean angle error between ultrasound imaging and 3D scan was 1.2°. In cadaveric experiments, intra-operator repeatability proved satisfactory, with low range value (lower than 2°) and standard deviation (lower than 1°). The study demonstrates the feasibility of measuring liner orientation on submerged and ex vivo experiments using ultrasound imaging, and is a first step towards in vivo analysis of DMC movement.
Pairing 40-mm Femoral Heads With the Smallest Compatible Acetabular Components in Total Hip Arthroplasty: Mid-Term Outcomes in 177 Cases
2022, Journal of ArthroplastyContemporary total hip arthroplasty (THA) often employs larger femoral heads to optimize hip stability. However, pairing 40-mm femoral heads with the smallest compatible acetabular components poses a potential risk for implant failure. The purpose of this study is to evaluate the outcomes of primary THAs using 40-mm femoral heads and the smallest compatible acetabular components.
Between 2007 and 2018, 177 primary THAs involving 40-mm femoral heads and acetabular components ≤56 mm with highly cross-linked polyethylene liners were identified. Mean age was 61 years, 56% were females, and mean body mass index was 32 kg/m2. Cumulative incidences of dislocation, any revision, and any reoperation were determined utilizing a competing risk model. Osteolysis and femoral head penetration were assessed at minimum 8-year follow-up (n = 16). Mean follow-up was 6 years.
There were no cases of liner fractures or dissociations. The 10-year cumulative incidences of dislocation, any revision, and any reoperation were 3.6%, 4.2%, and 6.8%, respectively. Mean linear femoral head penetration was 0.01 mm/y and mean volumetric wear rate was 50 mm3/y. One THA demonstrated stable, asymptomatic periacetabular radiolucent lines at most recent follow-up.
In 177 primary THAs pairing 40-mm femoral heads with the smallest compatible acetabular components, there were no liner fractures or dissociations. The cumulative incidence of dislocation was modest at 10 years. The cumulative incidences of any revision and any reoperation were low at mid-term.
IV.
Survival and complications of total hip arthroplasty using third-generation dual-mobility cups with non-cross-linked polyethylene liners in patients younger than 55 years
2022, Revue de Chirurgie Orthopedique et TraumatologiqueChez les patients jeunes, les prothèses totales de hanche (PTH) sont soumises à des sollicitations importantes en termes d’amplitude de mobilité et d’usure. Les cupules à double mobilité (DM) permettent de réduire efficacement le taux de luxation, mais sont exposées à un risque d’usure et d’ostéolyse qui ont été observées sur les premières générations. Cette donnée n’a pas été validée sur une population de sujets jeunes avec les dernières générations de cupule à DM qui ont permis de réduire le taux de luxations intraprothétiques (LIP). Aussi, nous avons mené une étude rétrospective sur des PTH DM dernière génération chez les sujets de moins de 55 ans avec pour objectifs d’évaluer : 1) le taux de complications ; 2) le taux de survie.
Le taux de complications des PTH à DM chez des sujets jeunes de moins de 55 ans est comparable à celui de la population générale avec ce type d’implant.
Il s’agissait d’une étude rétrospective continue incluant 91 PTH (79 patients) opérés entre 2007 et 2012. Étaient inclus tous les patients de moins 55 ans opérés d’une PTH de première intention avec cupule DM de dernière génération, et un polyéthylène non réticulé. Une évaluation clinique et radiologique a été réalisée.
Au dernier recul (recul moyen de 9,8 ans [2 à 13 ans]), aucun cas de luxation prothétique ni de LIP n’a été observé. Un patient a présenté un descellement aseptique de la cupule et un autre un descellement septique de cupule. Au total, 7 patients (7,7 %) ont nécessité une reprise chirurgicale avec changement d’au moins un des implants (les deux descellements de cupule, une fracture cervicale sur un pivot court à fixation cervicale, une fracture périprothétique fémorale, une infection et deux descellements de pivot fémoral). Le taux d’ostéolyse péri-acétabulaire était de 2,2 % (2/91). Au total, le taux de survie de la cupule pour descellement aseptique était de 98,9 % [IC95 % : 97 % à 100 %] et le taux de survie global des implants infections exclues était de 95,6 % [IC95 % : 82 à 100 %].
L’utilisation de dernières générations de cupule DM chez les patients de moins de 55 ans a montré, à moyen terme, l’absence de luxation prothétique, de LIP et un faible taux de reprise chirurgicale pour descellement acétabulaire. L’utilisation de ces implants, chez les patients jeunes, est donc une solution thérapeutique viable.
IV ; étude rétrospective.
Survival and complications of total hip arthroplasty using third-generation dual-mobility cups with non-cross-linked polyethylene liners in patients younger than 55 years
2022, Orthopaedics and Traumatology: Surgery and ResearchIn younger patients, total hip prostheses are subjected to wide motion ranges and wear-inducing forces. Dual-mobility cups (DMCs) are effective in decreasing the risk of dislocation. However, wear and osteolysis have been reported with first-generation DMCs. These complications have not been assessed in younger patients managed with third-generation DMCs associated with a lower risk of intra-prosthetic dislocation (IPD). We therefore designed a retrospective study of patients younger than 55 years at THA with third-generation DMCs. Our objectives were to evaluate (1) the complication rate, and (2) the survival rate.
The rate of complications of THA with third-generation DMCs in patients younger than 55 years of age is comparable to that in the general population of THA patients.
This retrospective study included 79 consecutive patients (91 hips) who had total hip arthroplasty (THA) between 2007 and 2012. We included all patients younger than 55 years who underwent primary THA with a third-generation DMC and a liner made of non-cross-linked polyethylene. The patients were evaluated clinically and radiologically.
Mean follow-up was 9.8 years (range: 2–13 years). At last follow-up, no patient had experienced prosthetic dislocation or IPD. Aseptic and septic cup loosening each occurred in 1 patient. In all, 7 (7.7%) patients required revision surgery with exchange of at least one component (cup loosening, n = 2; neck fracture with a short stem fixed to the neck, n = 1; peri-prosthetic femoral fracture, n = 1; infection, n = 1; and femoral-stem loosening, n = 2). Peri-acetabular osteolysis developed in 2 (2.2%) hips. Cup survival to aseptic loosening was 98.9% (95% confidence interval, 97%–100%) and survival to revision for any reason except infection was 95.6% (95% confidence interval, 82%–100%).
In patients younger than 55 years, third-generation DMCs were associated with absence of prosthetic dislocation, absence of IPD, and a low revision rate for cup loosening, in the medium term. These implants therefore constitute a viable treatment option in younger patients requiring THA.
IV, retrospective study.
- *
From Anderson Orthopaedic Research Institute, Arlington, Virginia.
- †
From University of Maryland, Baltimore, Maryland.
- ‡
From Georgetown University, Washington, D.C. and the National Hospital for Orthopaedics and Rehabilitation, Arlington, Virginia.