Polyethylene Wear and Acetabular Component Orientation

Patil, Shantanu; Bergula, Arnie; Chen, Peter C.; Colwell, Clifford W.; D’Lima, Darryl D.

doi:10.2106/00004623-200300004-00007

Cited by 303 publications

(182 citation statements)

References 27 publications

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“…In total hip arthroplasty (THA), the orientation of the acetabular cup is an important factor in preventing postoperative complications such as dislocation, accelerated wear and loosening [1][2][3]. The level of experience of the surgeon has been suggested as one of the most important factors affecting rates of dislocation [4][5][6] and revision [7,8].…”

Section: Introductionmentioning

confidence: 99%

Accuracy of angle and position of the cup using computed tomography-based navigation systems in total hip arthroplasty

Iwana

Nakamura

Miki

et al. 2013

Computer Aided Surgery

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Objective: The objectives of this study were to evaluate the accuracy of computed tomography (CT)-based navigation and to investigate whether the level of surgeon experience affects the accuracy of cup positioning under navigation. Methods: This study investigated 117 hips in 103 patients who underwent primary total hip arthroplasty (THA) by 7 surgeons using a CT-based navigation system. Pre-and postoperative CT images were matched using a volume registration technique. Postoperative cup angles and positions were then measured using the same pelvic coordinates, and results were compared for experienced and inexperienced surgeons. Results: The mean absolute error of the cup angle was 1.8 AE 1.6 for inclination and 1.2 AE 1.1 for anteversion. The mean absolute errors of cup position were 1.9 AE 1.5 mm, 1.4 AE 1.2 mm, and 1.9 AE 1.3 mm on the x-, y-and z-axes, respectively. No significant differences in accuracy were identified between experienced and inexperienced surgeons. Conclusions:The absolute spatial error of cup position was 2 mm for each axis, and the angle error was 2 for the angles of inclination and anteversion. This navigation system could therefore help surgeons perform accurate cup placement irrespective of the surgeon's level of experience.

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Section: Introductionmentioning

confidence: 99%

Accuracy of angle and position of the cup using computed tomography-based navigation systems in total hip arthroplasty

Iwana

Nakamura

Miki

et al. 2013

Computer Aided Surgery

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“…Although authors disagree about recommendations for where the acetabular component should be positioned (for example, some would describe ideal acetabular inclination as 45°± 10°, while others would say 40°± 10°), it is agreed suboptimal acetabular positioning can lead to construct instability and detrimental wear characteristics [4,11,19,23]. Although more horizontal component positioning reportedly reduces the rate of dislocation, there appear to be higher contact stresses when the acetabulum is positioned this way [21,22], which may lead to increased PE wear [10,21,22,30]. A potential alternative to conventional metalon-PE bearing surfaces is alumina-ceramic-on-ceramic.…”

Section: Introductionmentioning

confidence: 99%

Does Acetabular Inclination Angle Affect Survivorship of Alumina-ceramic Articulations?

Johansson

Johnson

Zywiel

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background Reports in the literature have linked high acetabular inclination angles to increased wear of ceramicon-ceramic bearings. However, many of these studies were only conducted in vitro and did not address the clinical relevance of such findings. Questions/purposes We therefore determined: (1) whether the cup inclination angle influences survival or function in patients with ceramic-on-ceramic implants; (2) the incidence of radiolucencies, osteolysis, and subsidence of ceramic-on-ceramic implants; and (3) whether the survival rate higher for ceramic-on-ceramic THAs than for conventional metal-on-polyethylene THAs.Methods We retrospectively reviewed 537 THAs performed in 512 prospectively followed patients having THA between October 1996 and October 2000. Eleven patients (12 hips) were lost to followup before 2 years, leaving 501 patients (525 THAs); of these, 421 were alumina ceramic-on-ceramic articulations and 104 cobaltchromium-on-polyethylene. The mean age was 54 years. We determined acetabular cup inclination angles, Harris hip scores, Health-Status-Questionnaire-12 scores, and presence and location of any radiolucencies, osteolysis, or radiographic subsidence. We compared survival using the Kaplan-Meier method. The minimum followup was 24 months (mean, 59 months; range, 24-120 months). Results Twenty-two of the 424 THAs (4.2%) were revised. We observed no difference in clinical or radiographic outcomes with respect to cup inclination angles. Radiographically, two loose acetabular components and two femoral components had subsided. The 5-year survival rate was slightly higher for ceramic-on-ceramic bearings (98%) than for metal-on-polyethylene (92%).

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“…Furthermore, measurements using current navigation systems are based on the anterior pelvic plane and cannot be directly compared with measurements made on conventional supine or standing radiographs. These differences require further complicated translations that may result in additional possible errors [22]. Fluoroscopy has also been suggested in metal-on-metal HRA [21].…”

Section: Discussionmentioning

confidence: 99%

“…Even though femoral neck fracture and femoral loosening were formerly reported as the most common failure modes in these studies [2,4,21], revision related to the acetabular component is being recognized more frequently in recent reports [8,11]. Previously, higher dislocation rates and increased wear rates were well-documented in standard THA with improper acetabular inclination angles [12,20,22,31]. Although large metal bearings are resistant to dislocation even with relatively high angles of inclination, several clinical studies have implicated high cup inclination angles in wear-related failures after HRA [4,13,33].…”

Section: Introductionmentioning

confidence: 99%

Intraoperative Radiographs for Placing Acetabular Components in Hip Resurfacing Arthroplasty

Gross

Liu

Webb

2011

Clinical Orthopaedics &Amp; Related Research

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Background Various clinical and biomechanical studies suggest certain acetabular positions may be associated with higher wear and failure rates in modern metal-on-metal hip resurfacing arthroplasties. However, there are no widely available, reliable, and cost-effective surgical techniques that ensure surgeons are able to place an acetabular component within the safe range of inclination angles after hip resurfacing surgeries. Questions/purposes We investigated the accuracy of intraoperative radiographs to determine the acetabular inclination angle in resurfacing arthroplasty procedures. Patients and Methods The study group included the first 100 resurfacing arthroplasties performed after we started routinely checking the intraoperative acetabular inclination angles. The acetabular component was repositioned if the intraoperative acetabular inclination angle was out of the target range of 30°to 50°. The control group included the previous 100 resurfacing arthroplasties performed without the benefit of intraoperative radiographs. A posterior minimally invasive surgical approach was used in both groups. Demographics and diagnoses were similar in both groups. ResultsThe average (± SD) difference between the intraoperative and 6-week radiographs was 2.7°± 2.5°. The acetabular inclination angles at 6-week followup were within the targeted range more frequently in the study group than in the control group (outliers: 4% versus 29%). Conclusions These data suggest a single intraoperative radiograph is a quick, reliable, and cost-effective method for ensuring the acetabular inclination angle is within the targeted range. Level of Evidence Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Polyethylene Wear and Acetabular Component Orientation

Cited by 303 publications

References 27 publications

Accuracy of angle and position of the cup using computed tomography-based navigation systems in total hip arthroplasty

Accuracy of angle and position of the cup using computed tomography-based navigation systems in total hip arthroplasty

Does Acetabular Inclination Angle Affect Survivorship of Alumina-ceramic Articulations?

Intraoperative Radiographs for Placing Acetabular Components in Hip Resurfacing Arthroplasty

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