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PubMed2001

Light microscopic and scanning electron microscopic retrieval analyses of implanted biomaterials retrieved from humans and experimental animals.

This paper reports analysis obtained from 200 implant cases retrieved from humans and submitted to the American Academy of Implant Dentistry Research Foundation, Medical College of Georgia implant retrieval center. The samples that were not decalcified were embedded in polymethylmethacrylate and examined with scanning electron microscopy and routine light, polarized, or Nomarski microscopy. Cases included both orthopedic and dental implants, as well as entire mandibles and portions of maxillae obtained at autopsy. A significant number of submitted implants had substantial amounts of adhered bone, which permitted evaluation of human bone remodeling to osseointegrated implants. These implants failed because of implant fracture. As was observed with animal studies, healthy bone supported these implants, with the bone containing an interdigitating canaliculi network that provided communication between interfacial osteocytes and osteocytes deeper within the remodeled osteonal and trabecular bone. Early dental implants containing a coating of beads showed a connective tissue interface, which corresponded to the bead surface of specific orthopedic implants that underwent some degree of micromovement. This is in contrast with the excellent response reported for successful contemporary beaded implants. Significant numbers of osseointegrated fractured hydroxyapatite (HA)-coated dental implants demonstrated the adequate serviceability of these implants before biomaterial fracture. In contrast, the HA coating was dissociated from retrieved orthopedic implants, leading to extensive cup loosening and case failure. This study, therefore, underscores the need for evaluation of failed human dental and orthopedic implants. Correlations can be drawn between human retrieval and experimental animal studies.

Aluminum Oxide↗
PubMed1997

Complications of total hip arthroplasty associated with the use of an acetabular component with a Hylamer liner.

We observed early failure and radiographic signs of accelerated wear as early as one to three years after insertion, without cement, of a metal-backed acetabular component with a liner made of Hylamer (DePuy). This finding prompted us to review a larger cohort of patients in whom that liner had been used. Two hundred and thirty-three components with a Hylamer liner, evaluated at a minimum of two years, had a mean rate of wear of 0.27 millimeter per year compared with 0.12 millimeter per year for a contemporaneous group of fifty acetabular cups with a conventional ultra-high molecular weight polyethylene liner made by another manufacturer. At a mean of 3.2 years, we found a significant difference (p < 0.000000006) between the mean rate of wear (0.20 millimeter per year) when the Hylamer liner articulated with a DePuy modular cobalt-chromium femoral head and the mean rate (0.29 millimeter per year) when the liner articulated with an Osteonics modular cobalt-chromium femoral head. Radiographic evaluation revealed a significant correlation between the total linear wear and the prevalence of osteolytic lesions (r2 = 0.76, linear regression analysis). We found that wear of 1.5 millimeters or more could be detected by the unaided eye. Because of the positive correlation between osteolysis and wear of 1.5 millimeters or more, we defined a hip with a liner that had that amount of wear as a hip at risk. We concluded that the wear characteristics of a Hylamer liner in vivo are inferior to those of a conventional ultra-high molecular weight polyethylene liner. Also, the rate of wear of the liner is greater when the femoral head is from a manufacturer other than DePuy. A patient who has a total hip replacement that includes a Hylamer liner should be monitored frequently for signs of wear and osteolytic changes. Additional investigations, with longer durations of follow-up and larger populations, are needed to understand fully the importance of our findings.

Adult↗
PubMed2003

The effect on wear of lift-off in total knee arthroplasty.

Femoral lift-off has been reported in total knee arthroplasty using dynamic fluoroscopic analysis. However, the effect of femoral lift-off on ultra-high-molecular-weight polyethylene (UHMWPE) is not clear. The objective of this study was to evaluate the effect of lift-off movement on the wear of UHMWPE using a pin-on-disc testing machine. Using oxidised UHMWPE, delamination was observed in 70% of the discs with lift-off movement, as against none in without lift-off movement (p=0.0603). In non-oxidised UHMWPE the depth of the wear track was increased in the impact area after lift-off, but there was no delamination and no increase in wear as measured by weight loss. UHMWPE can sustain the impact of after lift-off with neither delamination nor wear by other mechanisms. In contrast, degraded (i.e., oxidised) UHMWPE undergoes delamination after lift-off. Since it is probable that lift-off cannot be prevented, oxidised UHMWPE should never be used in TKA.

Arthroplasty, Replacement, Knee↗
PubMedDate not supplied

Failure analysis of composite femoral components for hip arthroplasty.

In this research, a numerical method was developed for predicting the progressive failure of thick laminated composite femoral components. A three-dimensional (3-D) global/ 3-D local technique was developed to capture the overall structural response of this system, while also enabling the 3-D ply-level stress state to be determined efficiently and accurately. Different failure criteria and material degradation models were incorporated in the method, giving it the flexibility to model a wide range of materials and structures. Numerical modeling was also conducted to design experimental test methods to simulate in vivo loading conditions for component fatigue tests. Parametric studies were then conducted with the numerical model of the experimental system. Next, we compared the results to the damage behavior of the experimentally determined laminated composite femoral component to assess which parameter set most accurately predicted the actual damage development behavior. We then applied the best-fitting parameter set to analyze simulated in situ composite femoral components. Results showed that this methodology efficiently and accurately predicted damage initiation and propagation. This research demonstrates how analytical and numerical models may be used before conducting extensive experimental tests as initial tools to evaluate components for the design of composite hip implants that possess a high level of damage resistance and damage tolerance.

Equipment Failure Analysis↗
PubMed2004

[Review and analysis of revision of total hip replacement].

OBJECTIVE: To evaluate the clinical value of the revision of total hip replacement(THR), to analyse the reason of the revisions, and to discuss the main difficulties and measures to manage it. METHODS: From June 1998 to January 2002, 15 cases (15 hips) were revised on total hip replacement. The reasons for revision in the cases were as follows: failure of primary operative techenique, loosening and sinking of the components, displacement of the prosthesis, erosion of the acetabulum, as well as fracture of the femoral stem. The main difficulties of the revision were poor health condition of the patients; the remove of the prosthesis of the primary THR, especially the broken femoral stem and the cements; the loss of local bone. The measures to remove the broken femoral stem were described. RESULTS: All cases were followed up 2. 4 years on average: 2 patients died from heart disease and cerebrovascular disease respectively, while the good results were achieved in the others. No infection, dislocation, loosening, and other complications occurred. The good effects were related with following factors: mild degree of illness; no severe bone defect; most of the first femoral head replacement. CONCLUSION: The revision of THR is a more difficult operation, so that the special instrument and equipment and operative experience are required.

Aged↗
PubMed2006

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

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.

Arthroplasty, Replacement, Hip↗
PubMed1986

Failures and reoperations following low-friction arthroplasty of the hip. A five- to fifteen-year follow-up study.

One thousand nine Charnley low-friction arthroplasties performed by one surgeon were investigated for occurrence of failure from five to 15 years after operation. Six hundred ninety-six of the arthroplasties, 499 operations for primary and 197 for secondary surgery, qualified for study. Eleven hips of the 499 primary arthroplasties (2.2%) and five hips of 197 secondary surgery (2.5%) required reoperation. Six hips (of five patients) in primary and four hips in secondary surgery were identified as "pending failure," for which further surgical correction may be imminent. There were six deep infections (1%), one in primary and five in secondary surgery. Five patients (0.7%) required reoperations other than revision of arthroplasty. Combining the actual and pending failures resulting from mechanical failures and deep infection, there were 31 failures in 696 arthroplasties (4.5%).

Adult↗
PubMed1993

Revision of failed unicompartmental total knee arthroplasty.

Forty-eight revision total knee arthroplasties (TKAs) for failed unicompartmental total knee prostheses were evaluated at 5.4 +/- 2.5 years after revision. The most frequent mode of failure of the original arthroplasty was loosening. All revisions used a condylar-type prosthesis. Fifty percent of the knees had bone defects that were filled with cement. Good or excellent results were achieved in 81% of the knees. One knee had a complete radiolucent line adjacent to the tibia at last evaluation. The surgical complication rate was 13%. Predictable salvage of the failed unicompartmental TKA can be achieved by revision arthroplasty.

Aged↗
PubMed1998

Review of 10-year results of PCA hip arthroplasty.

OBJECTIVE: To assess the long-term results of the PCA uncemented total hip replacement. DESIGN: A prospective nonrandomized clinical trial. Follow-up ranged from 8 to 11 years (mean 10.3 years). SETTING: A university hospital. PATIENTS: One hundred consecutive PCA arthroplasties were performed on 89 patients. All operations were supervised by a single surgeon. The patients' status was reviewed between September and November 1996 by an independent observer. Seventy-three total hip replacements were available for review. INTERVENTION: PCA uncemented acetabular and femoral replacement through a lateral surgical approach. MAIN OUTCOME MEASURES: The need for revision, which was classified as failure, and definite 3-zone acetabular radiolucency, which was considered radiologic evidence of loosening. RESULTS: The time to failure of the acetabulum averaged 8 years. Femoral failure occurred in 3 patients an average of 4 years postoperatively. The overall failure rate for the acetabulum was 13% and for the femur 7%. CONCLUSIONS: The acetabular failure rate is unacceptably high. Patients who have had hip replacement with the PCA prosthesis should be followed over the long term.

Adult↗
PubMed1998

Cementless femoral design concerns. Rationale for extensive porous coating.

In the early 1980s increased interest in proximally porous coated stems was sparked by first generation cemented stem failures in young patients and concerns with extensively porous coated cementless stems regarding thigh pain and stress shielding. As a result, various proximally porous coated stems were produced, each with differing clinical results. Using 5-year minimal followup as a cut off, the evolution of proximally porous coated stems during the years is presented and compared with the long term results obtained with extensively porous coated stems. Problems with some of the early proximally coated designs have been reported in the literature. Despite subsequent design modifications, the modern proximally coated stem has not eliminated thigh pain or stress shielding. Although some of the proximally porous coated stems have had good results, the question whether the push for proximally coated femoral stems resulted in significant clinical improvement versus the long term results of extensively porous coated stems remains.

Aged↗
PubMed1993

Microbial infections and occlusal overload: causes of failure in osseointegrated implants.

Microbial infections and occlusal overload are the two primary causes of failure in osseointegrated implants. This paper reviews the roles of pathogenic bacteria and occlusal overload, summarizes the types of microbes, outlines the diagnosis, and discusses how these conditions may be avoided and/or corrected. The learning objective of this article is an enhanced and updated understanding of the etiology, prevention, and correction of these two conditions.

Bite Force↗
PubMed2006

Early aseptic loosening of a total knee arthroplasty due to Gore-Tex particle-induced osteolysis.

Anterior cruciate ligament reconstruction with the use of synthetic graft material has been used as an alternative to biologic grafts. The use of these grafts has largely been abandoned in reconstruction of the anterior cruciate ligament because of mechanical failure of the graft and production of wear debris leading to synovitis and recurrent effusions. This article presents a case of early, extensive periprosthetic osteolysis around a total knee arthroplasty associated with wear debris from retained fragments of a Gore-Tex (WL Gore and associates, Inc, Flagstaff, Ariz) (polytetrafluoroethylene) anterior cruciate ligament graft.

Aged↗
PubMed1990

[A case report of successful emergency re-AVR for structural failure of a Hall-Kaster prosthesis].

A rare case of Hall-Kaster prosthetic valve dysfunction was reported. The patient was admitted with acute cardiac failure. She had previously received aortic valve replacement (AVR) using 23A Hall-Kaster prosthesis. Prosthetic valve dysfunction was diagnosed by both cinefluoroscopy and echocardiography. Emergent re-AVR was carried out and dislodgement of the pivot was revealed. Postoperative course was uneventful. Reports of structural failure of the Hall-Kaster (Medtronic-Hall) prosthesis are extremely rare. To our knowledge, this is the first reported case of dislodgement of the disc from the pivot of the Hall-Kaster prosthesis.

Acute Disease↗
PubMed2002

Aortic root replacement using a homograft for recurrent valve endocarditis.

Prosthetic valve endocarditis is a relatively rare condition associated with high mortality. Endocarditis affecting 2 successive mechanical valves at the aortic position has not, to the best of our knowledge, been described. We reported such a patient whose condition was further complicated by mitral regurgitation, pulmonary hypertension, worsening heart failure, and cardiac conduction abnormalities. Considering the failure of 2 previous mechanical valves, we conducted a homograft replacement of the aortic root with coronary reattachment. Mitral regurgitation was treated by annuloplasty. The patient's early postoperative course was uneventful and he was doing well 16 months after surgery. We discuss the overall treatment strategy for recurrent prosthetic valve endocarditis and potential homograft advantages.

Adult↗
PubMed2004

Minimally invasive intervention for acute bleeding from a pseudoaneurysm after revision hip arthroplasty.

After multiple revisions of her right hip arthroplasty, an 83-year-old woman developed deep infection with a chronic draining sinus. In August 2002 severe acute bleeding occurred through this fistula. Angiography revealed a pseudoaneurysm of the right external iliac artery. Because of the multiple pathologies affecting this ASA grade IV patient, conventional surgical treatment was considered to be contra-indicated, and a stent was placed percutaneously under fluoroscopic control to seal the vascular laceration. No haematoma and no further bleeding was observed on the control CT-scan or at angiography. However the patient died with terminal renal failure forty days later. The case reported shows a rare complication of total hip arthroplasty. The method used in this case to seal the leakage, using a covered stent, is uncommon but effective in cases where conventional surgery is contra-indicated.

Acute Disease↗
PubMed1993

Reoperation after condylar revision total knee arthroplasty.

Reasons for reoperation after knee revision surgery are implant loosening, sepsis, extensor mechanism problems, fractures of bone or prosthetic components, wear debris, and limited range of motion. The purpose of this study was to review the complications requiring reoperation in a large number of condylar revision total knee arthroplasties to determine the incidence and outcome after treatment. Six hundred fifty-five condylar revision total knee arthroplasties performed during a ten-year period were retrospectively reviewed. Forty-six knees without a history of arthroplasty infection required a total of 60 reoperations after the revision surgery. A reoperation was performed for extensor mechanism or patellar problems in 19 knees (41%), component loosening in ten knees (22%), deep infection in nine knees (20%), wound problems in nine knees (20%), tibiofemoral instability in eight knees (17%), limited range of motion in four knees (8%), and particulate debris synovitis in one knee (2%). All patients were observed for an average of 7.5 years. Twenty-four knees (52%) were considered clinical failures because of pain, limited motion, instability, and sepsis. Awareness of these failure modes may help to prevent complications by strict attention at the time of revision surgery to protection of the patellar tendon attachment and collateral ligaments, balancing of the extensor mechanism, preservation of the patellar blood supply, proper component position and sizing, restoration of the mechanical axis, and use of more constrained implant designs.

Adult↗
PubMed2005

A stemmed acetabular component in the management of severe acetabular deficiency.

We evaluated the use of a stemmed acetabular component in the treatment of severe acetabular deficiency during revision and complex primary total hip arthroplasty. There were 31 hips of which 24 were revisions (20 for aseptic loosening, four for infection) and the remainder were complex primary arthroplasties. At a mean follow-up of 10.7 years (6 to 12.8), no component had been revised for aseptic loosening; one patient had undergone a revision of the polyethylene liner for wear. There was one failure because of infection. At the latest follow-up, the cumulative survival rate for aseptic loosening, with revision being the end-point, was 100%; for radiographic loosening it was 92% and for infection and radiographic loosening it was 88%. These results justify the continued use of this stemmed component for the reconstruction of severe acetabular deficiency.

Acetabulum↗