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1.

Background

Malseating of ceramic liner appeared as a matter of concern in multibearing metal, although multibearing cup can be coupled with hard liners as well as polyethylene liner. In this metal shell, the inner taper angle should be 10° for the modularity, while standard metal shells for ceramic liner have an inner taper angle of 18°. However, there has been no study in the effect of taper angle to the risk of malseating. We evaluated whether the taper angle of metal shell might affect the malseating of ceramic liner, and dissociation force of ceramic liner from metal shell.

Methods

Three surgeons manually inserted ceramic liners into two designs of metal shell with different tapers angles (10° and 18°). We compared malseating rates of ceramic liners and push-out strengths, which means dissociation force of the ceramic liner from the metal shell, between these two metal shell designs.

Results

The malseating rates in 10° metal shell were higher than those in 18° metal shell (23.3% vs 0%, P < .05). The mean dissociation force (1148.8 ± 46.7 N) in 10° taper cup was higher than that (389.7 ± 108.3 N) in 18° taper cup (P < .01).

Conclusion

Our results suggest that surgeon should be cautious about malseating of ceramic liner when using multi-bearing metal shell with inner taper angle of 10°.

Clinical relevance

When surgeon use multi-bearing metal shell with inner taper angle of 10°, our results suggest that surgeon should be cautious about malseating of ceramic liner.  相似文献   

2.

Background

The R3 acetabular system used with its metal liner has higher revision rates when compared to its ceramic and polyethylene liner. In June 2012, the medical and healthcare products regulatory agency issued an alert regarding the metal liner of the R3 acetabular system.

Methods

Six retrieved R3 acetabular systems with metal liners underwent detailed visual analysis using macroscopic and microscopic techniques.

Results

Visual analysis discovered corrosion on the backside of the metal liners. There was a distinct border to the areas of corrosion that conformed to antirotation tab insertions on the inner surface of the acetabular shell, which are for the polyethylene liner. Scanning electron microscopy indicated evidence of crevice corrosion, and energy-dispersive X-ray analysis confirmed corrosion debris rich in titanium.

Conclusion

The high failure rate of the metal liner option of the R3 acetabular system may be attributed to corrosion on the backside of the liner which appear to result from geometry and design characteristics of the acetabular shell.  相似文献   

3.
《Injury》2014,45(11):1674-1680
The incidence of periprosthetic fractures has been reported to be between 1 and 20.9% and appears to be on the rise. Fractures that occur around the femoral stem, particularly when the stem is loose or there is a loss of bone stock pose a technical challenge. These are rare injuries and there is considerable debate regarding their optimal treatment. Reconstruction with large segment endoprosthetic replacement is an acceptable solution for elderly patients who have limited functional demands and where the prosthesis is expected to outlive the patient. The younger patient poses a much greater challenge, the bone must be reconstituted and the femoral canal geometry must sufficiently restored to allow the stable insertion of a prosthesis. There are very few techniques that exist in this scenario. One such technique is impaction bone grafting and revision to a long smooth tapered cemented stem. This allows the restoration of bone stock and the stable insertion of a prosthesis. The aim of this article is to discuss the theory behind impaction bone grafting, the technical aspects and challenges of this technique, including fracture reduction methods, and to appraise all the literature available on impaction bone grafting for periprosthetic fractures.  相似文献   

4.
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 6.5 years (range, 5–7.7 years). 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.  相似文献   

5.
ObjectiveTo investigate the application of impaction bone grafting (IBG) combined with Ti‐alloy mesh for acetabular bone defect reconstruction in total hip arthroplasty (THA) revision and follow up the clinical outcomes and imaging findings.MethodsThe clinical and imaging data of patients who were admitted to our hospital from January 2000 to December 2020 and underwent acetabular bone defects reconstruction using IBG combined with titanium mesh were retrospectively analyzed. Preoperative and post‐revision Oxford and Harris scores, and post‐revision complications were evaluated. Radiographs were used to determine center of rotation (COR) of the hip joint, transparency line, bone graft fusion, and bone mineral density (BMD) around the hip joint.ResultsSignificant improvement was observed in both Oxford and Harris scores (P < 0.05). The radiographs taken at the last follow‐up examination showed no significant differences in the acetabulum COR, offsets, inclination angle, mean ratio of vertical value, and BMD analysis between the post‐revision side and contralateral side (P > 0.05). The follow‐up data showed restoration of the mesh implant and graft bone fusion.ConclusionsThe application of IBG combined with titanium‐alloy mesh in revision THA patients with acetabular defects was found to provide satisfactory outcomes. However, large‐scale studies are still needed to further elucidate the long‐term outcomes.  相似文献   

6.
Unlike traditional bipolar constrained liners, the Osteonics Omnifit constrained acetabular insert is a tripolar device, consisting of an inner bipolar bearing articulating within an outer, true liner. Every reported failure of the Omnifit tripolar implant has been by failure at the shell-bone interface (Type I failure), failure at the shell-liner interface (Type II failure), or failure of the locking mechanism resulting in dislocation of the bipolar-liner interface (Type III failure). In this report we present two cases of failure of the Omnifit tripolar at the bipolar-femoral head interface. To our knowledge, these are the first reported cases of failure at the bipolar-femoral head interface (Type IV failure). In addition, we described the first successful closed reduction of a Type IV failure.  相似文献   

7.
The present study was undertaken to document outcomes of cementation of a highly cross-linked polyethylene (PE) liner into a well-fixed acetabular metal shell in 36 hips. All operations were performed by a single surgeon using only one type of liner. Patients were followed for a mean of 6.1 years (range, 3–8 years). Mean Harris hip score improved from 58 points preoperatively to 91 points postoperatively. There were no cases of PE liner dislodgement or progressive osteolysis. 1 hip (2.8%) required revision surgery for acetabular cup loosening with greater trochanteric fracture. Complications included 1 peroneal nerve palsy and 1 dislocation. The results of this study and previous reports demonstrated that cementation of highly cross-linked PE liner into well-fixed metal shell could provide good midterm durability.  相似文献   

8.
9.
目的:对应用颗粒松质骨打压植骨联合金属钛网于伴有中度髋臼骨缺损的全髋关节翻修术中髋臼重建方法进行早期临床效果分析;比较该方法用于不同类型骨缺损的效果差异。 研究对象及方法:整理筛选我院2008年7月-2015年3月间金属钛网联合颗粒骨打压植骨技术行髋臼骨缺损重建的19例(19例髋,男8,女11)。骨缺损采用Paprosky分型:IIB型7例,IIC型11例,IIIA型1例。术后定期复查髋部X线,并于复查时行髋关节恢复情况的评估。 研究结果:19例均获得临床及影像结果的完整随访,平均随访时长4.7年。除去一例行再次翻修,所有患者髋臼旋转中心均得到了良好重建;移植骨状况良好,和宿主骨不同程度的整合;影像学资料未见明显假体松动。HHS评分由翻修前平均47.51分提高至末次随访时平均90.3分。术后假体4.7年以再次翻修为研究终点的生存率为94.7%。SF-36生活质量评分得到了提高。IIB和IIC型之间对比无统计学差异。 研究结论:金属钛网联合颗粒松质骨打压植骨用于伴有骨缺损的髋关节翻修,适用于Paprosky IIB和IIC型髋臼缺损,两者疗效相当,早期临床效果良好。 关键词:全髋关节翻修术;金属钛网;髋臼缺损;颗粒打压植骨  相似文献   

10.
目的:比较陶瓷头对陶瓷髋臼和陶瓷头对聚乙烯髋臼的临床效果。方法:对32例患者采用陶瓷头对陶瓷髋臼和陶瓷头对聚乙烯髋臼的全髋人工关节置换。术后对所有患者拍摄了X线片和髋臼顶部的比较性CT。结果:对25例进行了随访。时间为12-42个月(平均40个月)。发现陶瓷头对陶瓷髋臼的全部病例骨结构正常,无骨质溶解和无骨外囊肿。陶瓷-聚乙烯组影像学表现。骨盆和关节置换的X线片,头部位于中心者7例。偏离中心者1例(1mm)。在新一代陶瓷-聚乙烯压配式技术固定证实,关节置换术后磨损1mm(直线磨损率0.2mm/年)。CT表现:8例骨结构正常,无骨外囊肿或骨化表现。髋臼顶部假体周围的X线和CT表现都正常。结论:陶瓷-陶瓷假体植入后未发现颗粒存在。而在陶瓷-聚乙烯假体中则存在。陶瓷-陶瓷的关节置换在植入后的4年里无任何骨质溶解的表现。也无磨损和骨质融合的证据。陶瓷-陶瓷人工关节摩擦系数最小及寿命最长。  相似文献   

11.
ObjectiveIn revision total hip arthroplasty (THA), reconstruction of severe acetabular bone defect continues to be problematic for orthopedic surgeons. This study reports the mid‐ to long‐term survivorship, radiological outcomes, and complications of impaction bone grafting (IBG) and metal mesh with a cemented acetabular component in the reconstruction of severe acetabular bone defects in revision THA.MethodsThis retrospective consecutive study included 26 patients (29 hips: type II B, four; type II C, three; type III A, 10; and type III B, 12) who underwent revision THA, which was performed using IBG and metal mesh, between 2007 and 2014 in our institution. All patients were followed up regularly for clinical and radiographical assessments. Migration and loosening of prosthesis graft integration and complications were observed and analyzed. Survival analysis was performed using a Kaplan–Meier survival analysis.ResultsAt the time of revision, 75.9% of the hips (22 hips) were classified as type III bone defects. The average follow‐up period was 9.4 ± 2.8 (range, 2.4–14.0) years. Of the 29 hips, four hips (13.8%) were assessed as clinical failures; at the last follow‐up, two had undergone re‐revision THA, and two had not been scheduled for re‐revision THA despite radiological failure of the acetabular component. Among them, three clinical failures (10.3%) were due to aseptic loosening, and one (3.4%) was due to infection. Radiographic evaluation showed bone graft integration in all hips during the follow‐up. The Kaplan–Meier survivorship analysis revealed an acetabular reconstruction survival rate of 86.5% (95% confidence interval, 61.4%–95.7%) at 10 years.ConclusionIBG and metal mesh with a cemented acetabular component for revision THA is an effective technique for treating severe acetabular bone defects, with effective mid‐ to long‐term outcomes due to the solid reconstruction of the acetabular bone defect and restoration of the hip rotation center.  相似文献   

12.
BackgroundWear cannot be completely prevented after total hip arthroplasty. If severe polyethylene (PE) liner wear develops, the so-called catastrophic failure occurs and metallosis develops. We postulated that longevity of the new implant may be affected after revision surgery for metallosis following a catastrophic failure of a PE liner due to the substantial amount of PE wear particles and infiltration of the metal particles in this catastrophic condition.MethodsTwenty-three hips of 23 patients were identified because they showed metallosis during revision total hip arthroplasties performed in Seoul National University Hospital between January 1996 and August 2004. They were followed for at least 6.5 years after the index revision total hip arthroplasty. The clinical and radiological results of revision total hip arthroplasties in these patients were evaluated.ResultsThe median Harris hip score increased from 60 points before revision total hip arthroplasties to 90 points at the final follow-up. Osteolysis was detected at an average of 9.3 years after revision total hip arthroplasties in 13 hips and acetabular cup loosening at average 9.8 years after revision total hip arthroplasties in 9 hips. With radiographic evidence of osteolysis and loosening as the end points, the 15-year survival rates were 28.2% and 56.0%, respectively.ConclusionsThe survival rate of revision total hip arthroplasty in patients with metallosis following a catastrophic failure of a PE liner was low.  相似文献   

13.
14.

Background

To evaluate the effectiveness of minimally invasive surgery total hip arthroplasty (THA) using the two-incision technique as described by Mears.

Methods

From January 2003 to December 2006, sixty-four patients underwent total hip arthroplasty using the one-incision (group I) and two-incision (group II) technique by one surgeon. There were 34 hips in group I and 30 hips in group II. There was no difference in age, gender, and causes of THA between the two groups. We evaluated the operation time, bleeding amount, incision length, ambulation, hospital stay, and complications between the two groups.

Results

There was no difference in the bleeding amount between the two groups. Operation time was longer in the two-incision group than in the one-incision group. Operation time of the two-incision technique could be reduced after 15 cases. Patients started ambulation after surgery earlier in group II than group I, and the hospital stay was shorter in group II than in group I. There was no difference in clinical results between the two groups. There was no difference in component position of the acetabular cup and femoral stem between the two groups. Intraoperative periprosthetic fracture occurred in four cases (13.3%) in group II.

Conclusions

Two-incision THA has the advantage of rapid recovery and shorter hospital stay. However, longer operation time and a high complication rate compared to one-incision are problems that need to be solved in the two-incision technique.  相似文献   

15.
目的:比较陶瓷-陶瓷(ceramic on ceramic,CoC)界面与聚乙烯-陶瓷(ceramic on polyethylene,CoP)界面在初次全髋关节置换术中的长期随访效果及并发症,提供临床依据。方法:检索PubMed、EMBase、CoChrane图书馆、Web of science、万方数据库和中国知网,检索时间2000年1月至2021年9月,筛选纳入关于比较陶瓷-陶瓷界面和聚乙烯-陶瓷界面在全髋关节置换长期疗效和并发症的随机对照试验的随机临床研究(randomized controlled trial,RCTs),根据纳入与排除标准进行文献筛选、质量评价及数据提取,采用Review Manager 5.3统计学软件对采用CoC或CoP术后关节功能、翻修、假体骨折、脱位、关节异响及假体磨损率进行统计分析。结果:纳入7个RCTs研究,其中CoC人工关节390髋,CoP人工关节384髋。CoC和CoP人工关节长期关节功能改善相近,差异无统计学意义[MD=0.63,95%CI(-1.81,3.07)],P=0.61;在术后并发症方面CoC人工关节有着较高的关节异响发生率[OR...  相似文献   

16.
《The Journal of arthroplasty》2021,36(11):3697-3702
BackgroundHistorically, aseptic loosening and osteolysis were responsible for most of the revisions among young and more active patients. Ceramic-on-ceramic bearings reduced wear but presented mechanical issues such ceramic fracture or liner chipping during insertion. To prevent this from happening a titanium-encased alumina liner was developed. The aim of this study is to address long-term results of this specific ceramic design.MethodsAll patients received an uncemented acetabular component with ceramic-on-ceramic bearing (94 hips in 77 patients). Patients were prospectively followed over 15 years. Clinical evaluation included the Harris Hip Score and Visual Analog Scale pain scale. Radiographic analysis included integration, osteolysis, and ceramic-related mechanical issues, such as malseating of the insert.ResultsThe studied acetabular design survivorship was 98.9% at a mean follow-up of 17.2 years. One arthroplasty was revised secondary to infection but no cup had loosened or migrated during the study. Only 1 cup showed complete radiolucent lines. There was no fracture of any ceramic component in the study group. Malseating was present in 12 acetabular components (12.8%). No osteolysis was observed with over 15 years of follow-up.ConclusionIn conclusion, this acetabular component demonstrates a favorable clinical and radiological outcome with over 15 years of follow-up. Osteolysis was not observed and incomplete seating of the titanium-sleeved ceramic liner did not lead to mechanical problems.  相似文献   

17.
ObjectiveReconstruction of acetabular defects has been extremely challenging in both primary and revision total hip arthroplasty (THA). Impaction bone grafting (IBG) can restore the acetabulum bone mass and anatomically reconstruct the acetabulum. Our study aimed to report the short and medium‐term clinical and radiographic outcomes of IBG for acetabular reconstruction in the cemented THA in the Chinese population.MethodsThis was a single‐center retrospective review enrolling 57 patients between May 2013 and July 2019. The patients with acetabular defects were treated with IBG, using low dose irradiated freeze‐dried allograft bone with or without autograft bone, in the cemented THA performed by one senior surgeon. Harris hip score (HHS), standard pelvis anterior–posterior radiograph and lateral hip radiograph were obtained before operation and at 1 week, 3 months, 12 months, and yearly. Graft osteointegration was evaluated by Oswestry''s criteria, and complication was documented at the last follow‐up. Independent sample ANOVA test and Pearson chi‐square tests are used for statistical analysis.ResultsThere were 61 hips in 57 patients. The average follow‐up time was 35.59 months (5–77 months). According to AAOS classification, a total of 18 hips were identified as segmental bone deficiency (type I), with 21 and 22 hips for cavitary bone deficiency (type II) and the combined bone deficiency (type III), respectively. The average HHS was improved from 44.49 (range: 32–58) preoperatively to 86.98 (range: 78–93) postoperatively. Graft osteointegration was satisfactory (Oswestry score ≥2) in all patients. No dislocation occurred in the 57 patients (61 hips) during follow‐up. Although one cup migrated, no revision, re‐revision, radiographic loosening, graft bone lysis, or postoperative complications were detected at the final follow‐up.ConclusionsIBG with low‐dose irradiated freeze‐dried allograft bone in acetabular bone defect reconstruction is a reliable technique for restoring acetabular bone defects in THA.  相似文献   

18.

Background

Prior studies indicate that one factor that may contribute to total hip arthroplasty failure due to mechanically assisted crevice corrosion at the femoral head-trunnion junction is the method of femoral head fixation.

Methods

Up-to-date on-line surgical technique guides describing fixation of the prosthetic femoral head of common implants of the 4 largest manufacturers as well as 2 minor manufacturers were identified. The information given regarding preparation and fixation of the femoral head was evaluated and compared.

Results

A total of 24 surgical technique guides were evaluated. Most guides (22/24) addressed fixation technique; of these, 19 of 22 suggested cleaning and 20 of 22 suggested drying the trunnion prior to affixing the femoral head. The manner of fixation, however, varied widely and there was no single technique advocated.

Conclusion

The majority of surgeon education materials do not specify a single technique for assembly of the head femoral component in total hip arthroplasty. If the method of fixation is indeed important, efforts should be made to identify the best technique, and improve and unify the surgical technique instructions.  相似文献   

19.
The constrained liner is an important tool for the treatment of recurrent dislocation, which continues to represent an important challenge in total hip arthroplasty. In constrained liner design, there is a tradeoff between dislocation resistance and range of motion. However, studies investigating their sensitivity to design parameters are scant. Given the relatively high rate of failure of constrained devices, this information is critical to improving their design. This study aimed to use finite element analysis to explore the sensitivity of constrained liner‐dislocation resistance to variations in liner opening radius, for two different constraining design features found in contemporary devices. Results showed that a smaller opening radius leads to increased lever‐out moment. It was also observed that in liners with localized constraint, lever‐out resistance is more sensitive to changes in opening radius than those with circumferential constraint. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:1590–1595, 2019.  相似文献   

20.

Background

The aim of our study was to evaluate the clinical and radiographic outcomes of malseating of the acetabular liner in ceramic-on-ceramic total hip arthroplasty (THA).

Methods

Outcomes for 160 ceramic-on-ceramic THAs, contributed by 116 women and 39 men, were evaluated. Clinical and radiographic measurements were obtained over a 5- to 15-year follow-up for analysis.

Results

Liner malseating was identified in 20% of cases. Outcomes for 32 cases with liner malseating (group A) were compared to outcomes for 128 joints with correct liner seating (group B). The Harris hip score at the last follow-up was 90.1 for group A and 89.6 for group B. Osteolysis was identified in 5 cases in group A (15.6%), compared to 3 cases in group B (P < .001). No significant between-group differences were identified with regard to ceramic fracture, audible squeaking, loosening of components, and revision THA. The mean annual liner wear rate was comparable between groups, 0.0045 mm/y for group A and 0.0039 mm/y for group B. The 10-year Kaplan-Meier survivorship, based on an end point of revision THA, was 100% for group A and 99.0% for group B.

Conclusion

Over a moderate-length follow-up of 5-15 years, malseating of the acetabular liner was not associated with negative clinical outcomes or THA survivorship. Malseating did increase the incidence of osteolysis, a risk factor for adverse effects. Long-term follow-up studies are needed to fully quantify the effects of malseating of the acetabular liner.  相似文献   

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