Interfacial Frictional Behavior: Cancellous Bone, Cortical Bone, and a Novel Porous Tantalum Biomaterial

Zhang, Yongde; Ahn, Peter B.; Fitzpatrick, Daniel; Heiner, Anneliese D.; Poggie, Robert A.; Brown, Thomas

doi:10.1142/s0218957799000269

Cited by 137 publications

(88 citation statements)

References 8 publications

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“…Moreover, in those conventional acetabular component revisions using a highly porous trabecular metal shell, the cemented fixation strength of a dual-mobility acetabular component should be improved further due to the high coefficient of friction and volumetric porosity of highly porous structures providing benefits in terms of construct stability. 41,42 …”

Section: Discussionmentioning

confidence: 99%

Cementation of a dual‐mobility acetabular component into a well‐fixed metal shell during revision total hip arthroplasty: A biomechanical validation

Wegrzyn

Thoreson

Guyen

et al. 2013

Journal Orthopaedic Research

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Cementation of polyethylene (PE) liners into well-fixed metal shells has become a popular option during revision total hip arthroplasty (THA) particularly for older and frail patients. Although dramatic results were reported with dual-mobility acetabular components to manage hip instability during revision THA, no study evaluated the fixation strength of the cementation of dual-mobility components into well-fixed metal shells. Eight dual-mobility and eight all-PE components were cemented into a metal shell with a uniform 2-to 3-mm cement mantle. The cemented fixation strength was evaluated using lever-out and torsion testing. The interface at which failure occurred was determined. Lever-out testing showed that dual-mobility components failed at significantly higher maximum moment than the all-PE components. No direct comparison could be performed with torsion testing due to early failure of the all-PE component itself before failure of the cement fixation. However, the maximum moments measured were dramatically higher than the in vivo frictional moments classically reported in THA. In addition, failure was always observed at the metal shell/cement interface whenever it did occur. In conclusion, a dual-mobility acetabular component cemented into a well-fixed metal shell could constitute a biomechanically acceptable alternative to acetabular shell removal or PE liner cementation while simultaneously preventing instability of the THA revision. Clinical studies are warranted. Keywords: revision total hip arthroplasty; dual-mobility acetabular component; cement; fixation strength; instability Despite continuous improvements in surgical technique and implant design, the rate of revision total hip arthroplasty (THA) did not decrease over the past few decades.1 Furthermore, with increased life expectancy of THA patients and a trend toward surgical indication at younger ages, demand for THA revisions is projected to double by 2026, and case complexity is likely to increase dramatically.2 Instability constitutes the major indication for THA revision, is the most common reason for failure after revision, and represents the most common reason for isolated acetabular revision and modular component exchange.1,3 Modular component exchange has been proposed in an attempt to manage THA instability while minimizing potential morbidity due to extensive bone loss, intra-operative bleeding, and prolonged operative time accompanying formal revision procedures, particularly for older and frail patients. 4,5 Beside instability management, modular component exchange could be required in cases of wear or mechanical failure of the liner. However, liner replacement may be impossible or impractical due to damaged locking mechanisms compromising liner fixation, incompatibility of the available components, non-modularity of the metal shell, or sub-optimal positioning of the acetabular component requiring reorientation. Previous biomechanical and short-term follow-up clinical studies reported the cementation of polyethylene (PE) line...

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Section: Discussionmentioning

confidence: 99%

Cementation of a dual‐mobility acetabular component into a well‐fixed metal shell during revision total hip arthroplasty: A biomechanical validation

Wegrzyn

Thoreson

Guyen

et al. 2013

Journal Orthopaedic Research

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“…Implants in these optimal revision settings have shown excellent long-term survivorship ranging from 95% to 98% at 10 years [8,9,32]. Highly porous metal implants such as Trabecular Metal TM (TM) (Zimmer Inc, Warsaw, IN, USA) cups that offer improved bone ingrowth and biomechanical properties [3,5,14,21,33] have also shown encouraging results for acetabular revision [1,17,18,29]. However, it may be difficult or impossible to achieve stability, even with these highly porous metal implants, if the acetabular defect is large, bone quality is poor, there is limited host bone contact, or there is pelvic discontinuity.…”

Section: Introductionmentioning

confidence: 99%

Promising Mid-term Results With a Cup-cage Construct for Large Acetabular Defects and Pelvic Discontinuity

Amenábar

Rahman

Hetaimish

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Restoring normal anatomy and achieving stable fixation of the acetabular component can be especially challenging when the surgeon must deal with severe acetabular defects and/or pelvic discontinuity. The cupcage (CC) construct, where an ilioischial cage is cemented within a biologically fixed porous metal cup, has emerged as an excellent option to treat such challenges. Questions/purposes We sought to determine (1) mid-term Kaplan-Meier survival; (2) clinical outcomes based on Merle d'Aubigné-Postel scores; (3) radiological outcomes based primarily on construct migration; and (4) the complication rate for a series of 67 CC procedures performed at our institution. Methods All hip revision procedures between January 2003 and March 2012 where a CC was used (with the exception of tumor cases or acute fracture; four total cases) that had a minimum 2-year followup and that had been seen within the last 2 years were included in this retrospective review. Acetabular bone loss and presence of pelvic discontinuity were assessed according to the Gross classification. Sixty-seven CC procedures with an average followup of 74 months (range, 24-135 months; SD, 34.3) months were identified; 26 of 67 (39%) were Gross Type IV and 41 of 67 (61%) were Gross Type V (pelvic discontinuity). Postoperative clinical and radiological evaluation was done annually. Merle d'Aubigné-Postel scores were recorded and all radiographs were compared with the 6-week postoperative radiographs to evaluate for radiographic loosening or migration. Failure was defined as revision surgery for any cause, including infection. Results The 5-year Kaplan-Meier survival rate with revision for any cause representing failure was 93% (95% confidence interval [CI], 83.1-97.4), and the 10-year survival rate was 85% (95% CI, 67.2-93

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“…Recent advances in materials and manufacturing methods have enabled the fabrication of entirely porous metal implants for skeletal repair [3][4][5]. These new materials, as opposed to sintered beads or mesh coatings, have larger porosity and provide better friction with bone [6,7]. These characteristics may enable increased bone ingress resulting in a stronger boneimplant interface which in turn may facilitate the development of improved treatments for musculoskeletal repair and reconstruction.…”

Section: Introductionmentioning

confidence: 99%

Direct visualization and quantification of bone growth into porous titanium implants using micro computed tomography

Baril

Lefebvre

Hacking

2011

J Mater Sci: Mater Med

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Direct visualization and quantification of bone growth into porous titanium implants using micro computed tomography Baril, É.; Lefebvre, L.-P.; Hacking, S. A.Contact us / Contactez nous: nparc.cisti@nrc-cnrc.gc.ca. Abstract The utility of porous metals for the integration of orthopaedic implants with host bone has been well established. Quantification of the tissue response to cementless implants is laborious and time consuming process requiring tissue processing, embedding, sectioning, polishing, imaging and image analysis. Micro-computed tomography (lCT) is a promising three dimensional (3D) imaging technique to quantify the tissue response to porous metals. However, the suitability and effectiveness of lCT for the quantification of bone ingrowth remains unknown. The purpose of this study was to evaluate and compare bone growth within porous titanium implants using both lCT and traditional hard-tissue histology techniques. Cylindrical implants were implanted in the distal femora and proximal tibiae of a rabbit. After 6 weeks, bone ingrowth was quantified and compared by lCT, light microscopy and backscattered electron microscopy. Quantification of bone volume and implant porosity as determined by lCT compared well with data obtained by traditional histology techniques. Analysis of the 3D dataset showed that bone was present in the pores connected with openings larger 9.4 lm. For pore openings greater than 28.2 lm, the size of the interconnection had little impact on the bone density within the porosity for the titanium foams.

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Interfacial Frictional Behavior: Cancellous Bone, Cortical Bone, and a Novel Porous Tantalum Biomaterial

Cited by 137 publications

References 8 publications

Cementation of a dual‐mobility acetabular component into a well‐fixed metal shell during revision total hip arthroplasty: A biomechanical validation

Cementation of a dual‐mobility acetabular component into a well‐fixed metal shell during revision total hip arthroplasty: A biomechanical validation

Promising Mid-term Results With a Cup-cage Construct for Large Acetabular Defects and Pelvic Discontinuity

Direct visualization and quantification of bone growth into porous titanium implants using micro computed tomography

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