Successful Long-Term Fixation and Progression of Osteolysis Associated with First-Generation Cementless Acetabular Components Retrieved Post Mortem
ABSTRACT 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.
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.
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.
Acetabular fixation by bone ingrowth can be successful into the third decade after implantation. Osteolysis and secondary replacement of bone with particle-induced granuloma are commonly seen in the presence of excellent clinical function. Strategies designed to minimize bearing-surface wear and backside damage are important to maintain long-term bone ingrowth fixation.
There remains a large patient population with clinically successful implants at potential risk of late failure secondary to progressive osteolysis.
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ABSTRACT: BACKGROUND: Cementless total hip arthroplasty (THA) implants using alkaline and heat treatments were developed to enhance bone bonding. Although bone-bonding ability of the alkali- and heat-treated titanium surface has been demonstrated in animal studies, it remains unknown whether it enhances or provides durable bone bonding in humans. QUESTIONS/PURPOSES: We therefore (1) determined long-term survivorship, function, and radiographic signs of failure of fixation of alkali- and heat-treated THA implants; and (2) histologically examined their bone-bonding ability in two human retrievals. METHODS: We retrospectively reviewed 58 patients who underwent 70 primary THAs, of whom 67 were available for minimum followup of 8 years (average, 10 years; range, 8-12 years). Survival rate was calculated. Hip function was evaluated using the Japan Orthopaedic Association (JOA) hip scores, and radiographic signs of implant failure were determined from anteroposterior radiographs. Two retrieved implants were investigated histologically. RESULTS: Using revision for any reason as the end point, the overall survival rate was 98% (95% confidence interval, 96%-100%) at 10 years. The patients' average JOA hip scores improved from 47 points preoperatively to 91 points at the time of the last followup. No implant had radiographic signs of loosening. Histologically we observed bone in the pores 2 weeks after implantation in one specimen and apparently direct bonding between bone and the titanium surface in its deep pores 8 years after implantation. CONCLUSIONS: Cementless THA implants with alkaline and heat treatments showed a high survival rate. Further study is required to determine whether the treatment enhances direct bone bonding. LEVEL OF EVIDENCE: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.Clinical Orthopaedics and Related Research 03/2013; 471(12). DOI:10.1007/s11999-013-2945-3 · 2.88 Impact Factor
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ABSTRACT: Osteoporosis is a common condition. As the population ages, more patients with osteoporosis will require orthopedic procedures, including arthroplasty. Adverse outcomes are more likely for patients with osteoporosis requiring orthopedic procedures, for example those with intraoperative fractures, periprosthetic osteolysis with implant migration, and postoperative periprosthetic fractures. Cemented prosthetic hip replacements may be more successful among patients with poor bone quality. Femoral neck fracture is a concern during hip resurfacing among patients with osteoporosis. Vitamin D deficiency is common among patients undergoing joint arthroplasty and the ideal vitamin D level for joint arthroplasty has yet to be determined. Both bisphosphonates and teriparatide may aide successful osteointegration among patients undergoing noncemented joint arthroplasty. Focusing on bone health perioperatively should result in better outcomes for orthopedic procedures.Current Rheumatology Reports 11/2013; 15(11):371. DOI:10.1007/s11926-013-0371-x · 2.45 Impact Factor
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ABSTRACT: Wear debris-induced inflammation is considered to be the main cause for periprosthetic osteolysis in total hip replacements (THR). The objective of this retrieval study was to examine the tissue reactions and exposure to metal ions and wear particles in periprosthetic tissues and blood samples from patients with titanium (Ti)-based hip prostheses that were revised due to wear, osteolysis, and/or aseptic loosening. Semiquantitative, histological tissue evaluations in 30 THR-patients revealed numerous wear debris-loaded macrophages, inflammatory cells, and necrosis in both groups. Particle load was highest in tissues adjacent to loosened cemented Ti stems that contained mainly submicron zirconium (Zr) dioxide particles. Particles containing pure Ti and Ti alloy elements were most abundant in tissues near retrieved uncemented cups. Polyethylene particles were also detected, but accounted only for a small portion of the total particle number. The blood concentrations of Ti and Zr were highly elevated in cases with high abrasive wear and osteolysis. Our findings indicate that wear particles of different chemical composition induced similar inflammatory responses, which suggests that particle size and load might be more important than the wear particle composition in periprosthetic inflammation and osteolysis. © 2014 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 2014.Journal of Biomedical Materials Research Part B Applied Biomaterials 10/2014; 103(3). DOI:10.1002/jbm.b.33243 · 2.33 Impact Factor