Does the Ingrowth Surface Make a Difference? A Retrieval Study of 423 Cementless Acetabular Components

Swarts, Eric; Bucher, Thomas A.; Phillips, Michael; Yap, Francis H.X.

doi:10.1016/j.arth.2014.10.028

Cited by 24 publications

(23 citation statements)

References 19 publications

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“…Compared with porous-coated acetabular cups retrieved post mortem, the potential ingrowth areas found in this study were similar to the bone ingrowth areas found by Bloebaum et al 43 in seven cups (mean 12%, range 4-21%), higher than found by Sumner et al 44 in 25 cups (median 3.6%, range 0-85%) but lower than reported by Engh et al 45 in nine cups (mean 32%, range 3-84%). The potential ingrowth area of compared well with the distribution of bone ingrowth area in 23 Pinnacle 1 shells retrieved by Swarts et al 46 and there was agreement in the proportion of cups with an ingrowth area below 5% (23% vs.26% in Swarts et al).…”

supporting

confidence: 59%

Primary stability of a cementless acetabular cup in a cohort of patient‐specific finite element models

O’Rourke

Al-Dirini

Taylor

2017

Journal Orthopaedic Research

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The primary stability achieved during total hip arthroplasty determines the long-term success of cementless acetabular cups. Pre-clinical finite element testing of cups typically use a model of a single patient and assume the results can be extrapolated to the general population. This study explored the variability in predicted primary stability of a Pinnacle cementless acetabular cup in 103 patient-specific finite element models of the hemipelvis and examined the association between patient-related factors and the observed variability. Cups were inserted by displacement-control into the FE models and then a loading configuration simulating a complete level gait cycle was applied. The cohort showed a range of polar gap of 284-1112 μm and 95th percentile composite peak micromotion (CPM) of 18-624 μm. Regression analysis was not conclusive on the relationship between patient-related factors and primary stability. No relationship was found between polar gap and micromotion. However, when the patient-related factors were categorised into quartile groups, trends suggested higher polar gaps occurred in subjects with small and shallow acetabular geometries and cup motion during gait was affected most by low elastic modulus and high bodyweight. The variation in primary stability in the cohort for an acetabular cup with a proven clinical track record may provide benchmark data when evaluating new cup designs. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1012-1023, 2018.

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supporting

confidence: 59%

Primary stability of a cementless acetabular cup in a cohort of patient‐specific finite element models

O’Rourke

Al-Dirini

Taylor

2017

Journal Orthopaedic Research

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“…Postmortem retrieval analysis of acetabular and tibial components can provide a reliable framework for confirming skeletal attachment in cementless implants used in TJR . Retrieval studies have also reported similar results when compared to in vivo animal implant studies performed in the weight bearing intracondylar model .…”

Section: Introductionmentioning

confidence: 78%

“…A human study using cancellous bone in an implant weight bearing intracondylar model has demonstrated that cancellous bone ingrowth occurs more slowly than previously reported, which could explain why materials demonstrating bone ingrowth in the transcortical model did not achieve the same fixation when used clinically in cancellous bone . Retrieval data (Table ) suggest that the healing capacity of cancellous bone and its ability to use ingrowth as a means of attachment have been overestimated in TJR …”

Section: Introductionmentioning

confidence: 96%

“…This has been especially true in anatomical sites where the predominant bone tissue is cancellous bone. These include mainly the total knee replacements (TKR) and acetabular components in total hip replacement (THR) …”

Section: Introductionmentioning

confidence: 99%

“…These include mainly the total knee replacements (TKR) [23][24][25] and acetabular components in total hip replacement (THR). [26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] A review of clinical studies and joint replacement registries has indicated that the principles for achieving cementless fixation in TJR had been established. [34][35][36][37][38][39][40]44 In a study by Anderson et al, 1 to evaluate skeletal attachment onto carboncoated porous titanium implant placed in the mid-diaphyseal region of the femur, 73.7% bone ingrowth had been reported.…”

Section: Introductionmentioning

confidence: 99%

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Transcortical or intracondylar? Which model is accurate for predicting biomaterial attachment in total joint replacement?

et al. 2017

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Despite four decades of research on material and porous coatings intended for cementless fixation in total joint replacement (TJR), aseptic mechanical loosening unrelated to particulate disease remains a concern. One main question asked is how translational are the animal models used to screen material and porous coatings intended for TJR fixation? Another question is how specific are the translational models at targeting the cementless TJR components that have the highest loosening rates? The hypothesis tested was that the bone response would be different between the two bone types-cortical and cancellous-used in translational animal modeling. The osteoblastic jumping distance (OJD), percent ingrowth, and appositional bone response were measured to assess the response between cancellous and cortical bone at two different anatomical locations, within the same limb. With 500 µm inset, titanium porous coated implants and negative control dinosaur (coprolite) implants were investigated. The data demonstrated that cortical bone had 7 times OJD than cancellous bone. The bone ingrowth data demonstrated 16 times higher bone ingrowth than the cancellous bone. Light microscopy showed predominately fibrous tissue attachment (98%) in cancellous bone. Screening of materials intended for TJR require a translational model predictive of the clinical condition. The results demonstrated that the transcortical model rendered false-positive data. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 578-588, 2018.

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Healing in peri‐implant gap with BMP‐2 and systemic bisphosphonate is dependent on BMP‐2 dose—A canine study

Cleemann

Sørensen

Bechtold

et al. 2017

Journal Orthopaedic Research

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The bone-implant interface of cementless orthopedic implants can be described as a series of uneven sized gaps with discontinuous areas of direct bone-implant contact. Bridging these voids and crevices by addition of an anabolic stimulus to increase new bone formation can potentially improve osseointegration of implants. Bone morphogenetic protein 2 (BMP-2) stimulates osteoblast formation to increase new bone formation but also indirectly stimulates osteoclast activity. In this experiment, we investigate the hypothesis that osseointegration, defined as mechanical push-out and histomorphometry, depends on the dose of BMP-2 when delivered as an anabolic agent with systemic administration of the anti-resorptive agent zoledronate to curb an increase in osteoclast activity. Four porous coated titanium implants (one with each of three doses of surface-applied BMP-2 (15 µg; 60 µg; 240 µg) and untreated) surrounded by a 0.75 mm empty gap, were inserted into the distal femurs of each of twelve canines. Zoledronate IV (0.1 mg/kg) was administered 10 days into the observation period of 4 weeks. Bone-implant specimens were evaluated by mechanical push-out test and histomorphometry. The 15 µg implants had the best fixation on all mechanical parameters and largest surface area covered with new bone compared to the untreated, 60 and 240 µg implants, as well as the highest volume of new bone in the implant gap compared to 60 and 240 µg implants. The results in a canine implant model demonstrated that a narrow range of BMP-2 doses have opposite effects in bridging an empty peri-implant gap with bone, when combined with systemic zoledronate. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1406-1414, 2018.

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Does the Ingrowth Surface Make a Difference? A Retrieval Study of 423 Cementless Acetabular Components

Cited by 24 publications

References 19 publications

Primary stability of a cementless acetabular cup in a cohort of patient‐specific finite element models

Primary stability of a cementless acetabular cup in a cohort of patient‐specific finite element models

Transcortical or intracondylar? Which model is accurate for predicting biomaterial attachment in total joint replacement?

Healing in peri‐implant gap with BMP‐2 and systemic bisphosphonate is dependent on BMP‐2 dose—A canine study

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