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PubMed2004

[Sensitivity to constituents of bone cement in a patient with joint prosthesis].

Failure to tolerate prosthetic material can lead to a variety of clinical findings. A 55-year-old woman had a total replacement of the right knee. Two weeks later she developed pruritic skin lesions over the joint, as well as pain and impaired function. Allergic testing showed clinically relevant Type IV sensitization to methylmethacrylate, as well as to various formulations of the bone cement, including one with an added antibiotic. The symptom complex of pruritic skin lesions in the area of the prosthesis, pain and disability, as well as relevant Type IV sensitization justified replacing the prosthesis.

Bone Cements↗
PubMed1993

A case of massive osteolysis after knee prosthesis polyethylene failure.

A case of massive osteolysis of the distal femur in response to particulate polyethylene from a broken uncemented tibial component is described. The osteolysis was so extensive that it made the revision arthroplasty extremely difficult. Early detection and early revision is recommended.

Femur↗
PubMed2003

[Damage of hip prosthesis causing failure in arthroplasty].

Analysis of retrieved hip joint was presented. Bone remodeling considering the distribution of friction products was discussed. Scanning electron microscopy methods were used to perform on structural analysis. We expressed a surface changing prosthetic head as Ra (roughness average). X-Ray Microanalysis was applied to study products of degradation.

Arthroplasty, Replacement, Hip↗
PubMed1975

Incidence of metal sensitivity in patients with total joint replacements.

Sensitivity to chromium, cobalt, nickel, molybdenum, vanadium, and titanium was studied by patch tests in 50 patients who had received total joint replacements. Nineteen (38%) were sensitive to one or more of the metals. In 23 patients non-traumatic failure of the prosthesis had occurred, and 15 of these patients were sensitive to metal. Out of 27 patients with no evidence of prosthesis loosening, four were sensitive to nickel and cobalt or nickel only. Dermatological reactions occurred in 13 patients after surgery; in only eight, however, was there evidence of metal sensitivity. These findings indicate that metal-on-metal total joint replacements may sensitise the patient to metals contained in the prosthesis. Although there is a high incidence of prosthesis failure among metal-sensitive patients it remains uncertain whether the loosening causes the sensitisation or vice versa.

Chromium↗
PubMed1986

Reoperation for prosthetic heart valve replacement.

From 1974 to 1984, 847 heart valve replacement operations were performed with 1005 prosthetic valves. Thirty-nine (4.6%) were reoperations with 43 prosthetic valve replacements (PVR), on 38 patients. Thirty-three patients had received their initial valve replacement in our hospital and 5 elsewhere. Twenty additional cardiac procedures were required, concomitantly with the prosthesis replacement. Twenty-three patients underwent replacement of a mechanical prosthesis (61%) an average of 4.3 years after initial implantation and 15 patients a bioprosthesis (39%) after 2.8 years. Indications for PVR were endocarditis in 15 patients (39%), prosthesis failure in 13 (34%), periprosthetic leak in 7 (18%), thrombosis in 2 (5%), and a left ventricle subannular aneurysm in 1 (3%). Preoperatively 4 patients were in NYHA functional class II (11%), 15 in class III (39%) and 19 in class IV (50%). Six patients died early postoperatively (15.8%) Various risk factors were analyzed. The early mortality rate was 22% for mechanical prosthesis replacement and 7% for bioprosthesis; 11% for aortic position, 13% for mitral position and 50% to 100% for double valve replacement; 23% for non-elective and 6% for elective operations; 10% for patients with only an initial valve replacement and 43% with additional previous valve operations; 18% for active endocarditis, 15% for prosthesis failure, 14% for periprosthetic leak, 0% for thrombosis and 100% for subannular aneurysm; 0% for patients in class II, 7% in class III and 26% in class IV; 6% in patients with an aortic cross-clamp time less than 2 hours and 24% with more; 27% prior to 1981 and 9% during the last 4 years; and finally 50% in patients over the age of 60.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1980

Metal sensitivity causing loosened joint prostheses.

Metal sensitivity, as measured by an in-vitro assay on peripheral blood lymphocytes, was evaluated in patients with failed joint prostheses. Lymphocyte transformation to chromium, cobalt, and nickel was measured in 24 patients having revision surgery for a painful or loose prosthesis and compared with that in 11 patients who had a successful hip prothesis in situ for at least 2 years previously. A positive response (lymphocyte stimulation index greater than 3) to at least one of the metals was found in 71% of the revision group compared to 9% of controls (P < 0.01). The positive correlation between prosthesis failure and in-vitro metal sensitivity suggests that cell-mediated immunity to metals to metals may play a role in prosthesis failure. Furthermore, this simple in-vitro test may provide the basis of a useful diagnostic test for an often difficult clinical problem.

Aged↗
PubMed1996

Cellular basis for failure of joint prosthesis.

In recent times, loosening of joint prosthesis resulting in failure, is of grave concern to orthopedicians. It is estimated that 50% of total hip replacements become loose after 15 years, and most of them require either revision surgery or resection orthoplasty. Neither, newer operative techniques, change in design, use of novel materials, nor surface modifications have helped to circumvent the problem. It is in this context, that attention has been focussed on the role of tissue surrounding the implant, in the loosening of the prosthesis. Tissue response around prosthesis results in either formation of a fibrous layer around the implant, ingrowth into fenestrations on implant or direct bone apposition on prosthesis. Long-term implantation results in implant debris being released into surrounding tissue. These particles initiate a chronic granulonatous inflammation with a significant number of activated macrophages and foreign body type of giant cells, all engaged in attempts to get rid of the debris. These features have been found to be invariably associated with peri-prosthetic lysis of bone. Since such bone resorption is also observed around non-cemented prosthesis, possibly causes other than cement are responsible for the osteolysis. Retrospective studies on failed implants suggest that peri-prosthetic osteolysis is mediated by activated macrophages. Cytokines are capable of stimulating bone resorbing cells, the osteoclasts. Bone resorption results in further loosening of the prosthesis, changes in stress, frictional wear, release of more wear debris and recruitment of more macrophages. Bone death and proliferation of macrophages, thus appear to be the cause for pain and loosening of prosthesis.

Biocompatible Materials↗
PubMed2001

Orbital amputation neuroma causing failure of prosthesis wear.

PURPOSE. To describe an orbital amputation neuroma that developed following enucleation and led to the patient 's inability to wear an oc- ular prosthesis. METHODS. This is a retrospective case report in a private practice setting. An elderly woman underwent enucleation of the right eye,and subsequently developed orbital pain and inflammation. Systemic and local steroids proved of no benefit, and the socket became increasingly painful,contracted and frozen. She was unable to wear her prosthesis. An orbital mass was noted,and subsequently biopsied. RESULTS. The biopsy specimen demonstrated orbital amputation neuroma. Her pain was relieved. CONCLUSION. Orbital amputation neuroma should be a diagnostic con- sideration when a patient develops a painful orbital mass following enucleation.

Journal Article↗
PubMed2006

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

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.

Biocompatible Materials↗
PubMed1987

Survivorship comparison of THARIES and conventional hip arthroplasty in patients younger than 40 years old.

Early and high failure rates for conventional hip replacements in young and active patients are well documented. The hypothesis tested in this study is total hip articular replacement by internal eccentric shells (THARIES) resurfacing hip arthroplasty is a sufficiently durable alternative to conventional total hips in patients younger than 40 years old. Survivorship analysis techniques were applied to 106 THARIES and 98 conventional hip replacements. The primary outcome variable investigated was time to failure, as measured by the need for revision of the prosthesis in the absence of sepsis. Other definitions of prosthesis failure were also investigated. Analysis revealed that even within this young, high-risk population there were subpopulations with different risks for failure. The lowest risk patients comprised all rheumatoid arthritis (RA) and juvenile rheumatoid arthritis (JRA) patients, regardless of age. The intermediate risk patients comprised all non-RA, non-JRA patients older than 30 years of age and the highest-risk patients were all non-RA, non-JRA patients younger than 30 years of age. A comparison of THARIES and conventional prostheses within each of these three subpopulations revealed similar patterns of failure over time, with the conventional total hip replacement having significantly better hip function than the THARIES group only in the highest-risk population, when using a failure definition of revision surgery for aseptic loosening. A broader and more important conclusion was that all acrylic-fixed implants, THARIES or THRs are predicted to undergo early mechanical loosenings in younger-than-30, non-RA, non-JRA patients. In patients younger than 30 years age acrylic fixation of THA is inadvisable.

Adult↗
PubMed2005

NeuFlex metacarpophalangeal prostheses tested in vitro.

This paper describes the testing of three single-piece silicone NeuFlex metacarpophalangeal prostheses in a finger function simulator and describes the resulting modes of prosthesis failure. In all cases, failure was due to imminent fracture of the prosthesis across the pivot of the central hinge section. This result is in contrast with previous in-vitro and in-vivo experience with single-piece silicone Swanson and Sutter metacarpophalangeal prostheses, which both tend to fracture at the junction of the distal stem and the hinge. In comparison with earlier in-vitro simulator tests of the Sutter metacarpophalangeal prosthesis, the NeuFlex prostheses showed a greater longevity before fracture. To date, no other reports of fracture of the NeuFlex metacarpophalangeal prosthesis have been reported, either in vitro or in vivo.

Equipment Failure Analysis↗
PubMed1996

Primary and secondary Charnley-Hastings hemiarthroplasty in displaced femoral neck fractures and their sequelae.

298 women and 36 men, median age 80 (range 40-95) years with 340 femoral neck fractures were treated with Charnley-Hastings hemiarthroplasty and followed for 41 (range 12-86) months. 107 replacements were primary because of poor reduction and 233 were secondary, performed during 60 months after the injury because of disturbed fracture healing. The results of primary and secondary replacements regarding morbidity, mortality, prosthesis failure and survival were similar. The major postoperative complications were: early wound infection (10 cases, 2.9%), dislocation of the prosthesis (16 cases, 4.7%), fracture of femoral shaft (nine cases, 2.7%), and loosening of components with reoperation (six cases, 1.8%). In total 33 reoperations (9.7%) were performed. When failure of the prosthesis was defined as dislocation, fracture or removal of part or whole prosthesis, the three-year and six-year survival rates were 89 and 80%, respectively. Defining the failure as removal of prosthesis component(s) only, the success rates were 96 and 94%, respectively. We conclude that cemented bipolar prosthesis offers a good alternative for salvage of displaced or failed femoral neck fracture.

Adult↗
PubMed2005

In vitro leakage susceptibility of tracheoesophageal shunt prostheses in the absence and presence of a biofilm.

Although leakage through a tracheoesophageal shunt prosthesis is the main cause of prosthesis failure in a laryngectomy patient, this has never been the subject of in vitro evaluation. The aim of this study was to compare three commercially available voice prostheses by comparison of their in vitro leakage patterns, in absence or presence of a biofilm. To compare in vitro leakage patterns, a model comprised of an artificial throat equipped with a single prosthesis coupled to a water reservoir was developed. By varying the height of the water reservoir, different pressures on the voice prosthesis can be obtained. Both in absence and presence of a biofilm, the Blom Singer voice prosthesis demonstrated the lowest leakage, followed by Groningen Low Resistance. The Provox2 showed significantly the most leakage, however, in presence of a biofilm the leakage of the Provox2 significantly decreased. Regular airflow during biofilm formation significantly increased leakage through the Provox2. Out of 746 clinical replacements, Provox2 showed 76% and Groningen Low Resistance 57% replacements due to leakage. The model used in this study showed significant differences in leakage of the three types of voice prostheses used. Leakage occurred more readily through Provox2 than through Groningen Low Resistance and Blom Singer prostheses, which is in line with clinical observations and enforces the model.

Area Under Curve↗
PubMed1991

Dissociation of the tibial component in total knee replacements.

Dissociation of the polyethylene component from its metal backing in total knee arthroplasty is a recognized problem regarding the patella. Two cases of dissociation of the metal-backed tibial component from its polyethylene articulating surface presented symptoms of prosthesis failure: persistent pain, swelling, sensations of instability, and gait difficulty. Investigations ruled out prosthesis malalignment, loosening, and sepsis. Precise diagnosis of dissociation of the tibial component was made by diagnostic arthroscopy.

Adult↗
PubMed1990

The radiographic resolution of beads from porous coated joint prostheses.

While there have been reports of the 750 microns chrome-cobalt beads disassociating from the PCA type prosthesis, failure of the 200 microns bead has not been documented despite reports of failed prosthesis, which use the smaller bead. As a result of the negative reports, the hypothesis was posed as to the limit of resolution in the image of the standard clinical radiographical film. To test the hypothesis, chrome-cobalt beads, ranging in size from 200 to 700 microns, in differing configurations were placed adjacent to a femoral prosthesis that had been implanted into a cadaveric specimen. Using standard clinical radiographic technique, differing exposures were made of the configurations. The results demonstrated that beads or a conglomerate of beads smaller than 300 microns could not be resolved and were therefore invisible and unrecordable. The clinical significance is to question whether all porous-coated prostheses shed metal alloy particles, some of which are radiographically undetectable due to the limitations of their resolvable size.

Arthrography↗
PubMed1984

Failures with Plasti-Pore ossicular replacement prostheses.

Plasti-Pore ossicular prosthesis failures found in our series of 246 patients with regular follow-up are reported and analyzed. Extrusions as well as poor functional results (postoperative air-bone gap greater than 25 dB) of the prostheses with and without cartilage on top have been reviewed. The overall extrusion rate was 9.3%: a higher extrusion rate occurred with prostheses without cartilage (18.4%) than with cartilage (4.4%). Thirty-six patients among those with poor postoperative hearing improvement have undergone revision surgery: the main causes of failure were a short prosthesis, a fixed stapes or footplate, adhesions of the prosthesis to surrounding structures, and the displacement of the prosthesis.

Cochlear Implants↗