Intermediate to Long-Term Outcomes and Causes of Aseptic Failure of an At-Risk Femoral Stem

Gazendam, Aaron; Ekhtiari, Seper; Wood, Thomas J.

doi:10.2106/jbjs.21.00397

Cited by 3 publications

(2 citation statements)

References 48 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In a study of 2635 patients with Accolade I TMZF stems, trunnion failure was overall a rare complication. 20 At 11.5 years average follow-up this involved only 3 (.1%) of patients. This makes monitoring and determination of which patient is at risk for failure difficult.…”

Section: Discussionmentioning

confidence: 95%

Catastrophic Trunnion Failure in an Anatomic Titanium Alloy Stem

Pruitt

Mears

Apple

et al. 2022

Geriatr Orthop Surg Rehabil

View full text Add to dashboard Cite

Introduction Certain titanium alloy stems have been shown to be susceptible to failure at the neck with catastrophic trunnion failure. Failure has been particularly noted in the single wedge Accolade 1 stem design. Other stems also used this alloy including the anatomic designed Citation stem. Methods This case series details 3 catastrophic failures of the TMZF version of the Citation femoral stem. Results Each of these failures appear to be attributed to cyclical wear of the TMZF trunnion against the cobalt chromium femoral head. Wear resulted in ultimate implant failure and significant metal debris in the joint capsule at the time of revision surgery. Discussion While surgeons are aware of the risk of catastrophic failure for the Accolade 1 stem, failure may similarly happen in the TMZF Citation stem. Surgeons should monitor these implants with care and discuss the potential for trunnion failure with their patients.

show abstract

Section: Discussionmentioning

confidence: 95%

Catastrophic Trunnion Failure in an Anatomic Titanium Alloy Stem

Pruitt

Mears

Apple

et al. 2022

Geriatr Orthop Surg Rehabil

View full text Add to dashboard Cite

show abstract

“…Use of a cementless femoral stem in total hip arthroplasty (THA) is the main surgical option to obtain strong femoral fixation and satisfactory implant survivorship in an active and young population 1 . Nevertheless, implant stability and integration are not guaranteed for every patient 2 . Several parameters can impact this osseointegration and implant survivorship.…”

Section: Commentarymentioning

confidence: 99%

Optimizing Implant Selection: The Critical Role of Objective and Biomechanical Data in Orthopaedic Decision-Making

Batailler

2024

Journal of Bone and Joint Surgery

View full text Add to dashboard Cite

Use of a cementless femoral stem in total hip arthroplasty (THA) is the main surgical option to obtain strong femoral fixation and satisfactory implant survivorship in an active and young population 1 . Nevertheless, implant stability and integration are not guaranteed for every patient 2 . Several parameters can impact this osseointegration and implant survivorship. These parameters are related to the patient (such as osteoporosis, previous hip surgery, and metabolic diseases), to the quality of the surgery (such as downsizing and malpositioning), or to the implant (such as the shape and the coating of the femoral implant) 3,4 .The variety of uncemented stems is wide, involving various characteristics: coating types, coating location (complete or metaphyseal only), shape (anatomical or standard), cross-sectional geometry, and collared or collarless. Several criteria influence the implant choice by each surgeon: the surgeon's experience and education, the literature, and the influence of implant companies. The first criterion is based on the clinical and functional outcomes of the patients previous treated by the surgeon. The literature contains mainly functional outcomes and complication and revision rates, based mostly in either heterogeneous or selected cohorts, in the hands of experienced surgeons. The reliability and value of these studies are always tricky to evaluate. Their potential extension to other surgeons and patients worldwide remains uncertain. Moreover, the reported functional outcomes do not provide good discrimination when THAs are being assessed because most patients have good outcomes. As described in the study by Hooper et al., the functional outcomes were similar among the 3 groups. Few strong studies, with a high level of evidence, have assessed the biomechanical impact of the shape and coating of femoral stems. The influence of implant companies is probably the least objective criterion. That is why biomechanical characteristics are often neglected and not considered thoroughly before the implant is chosen by a surgeon.The strength of this study is the objective assessment of femoral stems using a randomized study design with few methodologic biases. The patient selection criteria were strict, excluding all patients with osteoporosis. The randomization allowed the creation of similar patient groups. The 3 stems in this study differed mainly in 2 parameters: the location of the coating and the shape of the stem (standard or anatomical). The stems were otherwise similar, which reduced the risk of confounding by other factors. A well-known standard stem, the Corail stem, was used as a reference against which to compare the results. However, a limitation of this study is the links between the implant companies and the authors.This study indicated that the proximally coated dual-taper wedge stem yielded a greater change in bone mineral density in Gruen zones 2 and/or 7 than the anatomical and Corail stems. The anatomical stem with a proximal coating restored the preoperative bone mineral densit...

show abstract

Calibration of Aseptic Loosening Simulation for Coatings Osteoinductive Effect

Baroni,

Oliviero,

La Mattina

et al. 2024

Ann Biomed Eng

View full text Add to dashboard Cite

The risk of aseptic loosening in cementless hip stems can be reduced by improving osseointegration with osteoinductive coatings favoring long-term implant stability. Osseointegration is usually evaluated in vivo studies, which, however, do not reproduce the mechanically driven adaptation process. This study aims to develop an in silico model to predict implant osseointegration and the effect of induced micromotion on long-term stability, including a calibration of the material osteoinductivity with conventional in vivo studies. A Finite Element model of the tibia implanted with pins was generated, exploiting bone-to-implant contact measures of cylindrical titanium alloys implanted in rabbits’ tibiae. The evolution of the contact status between bone and implant was modeled using a finite state machine, which updated the contact state at each iteration based on relative micromotion, shear and tensile stresses, and bone-to-implant distance. The model was calibrated with in vivo data by identifying the maximum bridgeable gap. Afterward, a push-out test was simulated to predict the axial load that caused the macroscopic mobilization of the pin. The bone-implant bridgeable gap ranged between 50 μm and 80 μm. Predicted push-out strength ranged from 19 N to 21 N (5.4 MPa–3.4 MPa) depending on final bone-to-implant contact. Push-out strength agrees with experimental measurements from a previous animal study (4 ± 1 MPa), carried out using the same implant material, coated, or uncoated. This method can partially replace in vivo studies and predict the long-term stability of cementless hip stems.

show abstract

Intermediate to Long-Term Outcomes and Causes of Aseptic Failure of an At-Risk Femoral Stem

Cited by 3 publications

References 48 publications

Catastrophic Trunnion Failure in an Anatomic Titanium Alloy Stem

Catastrophic Trunnion Failure in an Anatomic Titanium Alloy Stem

Optimizing Implant Selection: The Critical Role of Objective and Biomechanical Data in Orthopaedic Decision-Making

Calibration of Aseptic Loosening Simulation for Coatings Osteoinductive Effect

Contact Info

Product

Resources

About