Unexpected varus deformity and concomitant metal ion release and MRI findings of modular-neck hip stems: descriptive RSA study in 75 hips with 8 years’ follow-up

Kiernan, Sverrir; Kaptein, Bart L; Flivik, Carl; Sundberg, Martin; Flivik, Gunnar

doi:10.1080/17453674.2020.1853387

Cited by 4 publications

(5 citation statements)

References 30 publications

(48 reference statements)

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“…These damage products may promote ALTR. However, ALTR similar to those described in short/medium-term studies involving mixed-metal NSJs (at least one component made of Co-alloy) [ 9 , 24 , 25 ], have never been reported in the clinical records of this patient cohort. The only case of tissue reaction (metallosis) was likely related neck–rim impingement.…”

Section: Discussionsupporting

confidence: 57%

“…Therefore, it is not possible to determine to which extent the NSJ contributes to ion release in vivo. However, the present Ti ion concentration exceeds the range of blood Ti ion concentration (0.6–1.0 µg/l) measured at 5 years for well-working monolithic stem, i.e., Ti-alloy stem including a 36 mm Co-alloy head and crosslinked polyethylene liner [ 22 ]. Therefore, a contribution of the Ti-alloy/Ti-alloy NSJ to blood ion concentration must be acknowledged even in well-working EN hip prostheses, although no significant differences were found in serum Ti ion concentration between EN and monolithic stem design [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

“…This drawback is described in detail in several case reports and is included among general complications in some patient cohorts [ 4 – 6 ]. Another drawback is the potential biological impact of released damage products (fretting-corrosion debris and metal ions) both at local and systemic levels [ 7 – 9 ].…”

Section: Introductionmentioning

confidence: 99%

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Long-term survivorship of an exchangeable-neck hip prosthesis with a Ti-alloy/Ti-alloy neck–stem junction

Baleani

Toni

Ancarani

et al. 2022

Arch Orthop Trauma Surg

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Introduction Breakage of exchangeable-neck (EN) and adverse local tissue reactions (ALTRs) to neck–stem junction (NSJ) damage products are responsible for increasing the revision rate of EN hip prostheses. We investigated the survivorship of an EN hip prosthesis including a NSJ with both components made of titanium alloy (Ti-alloy/Ti-alloy) to assess whether, and to what extent, EN breakage and NSJ damage affected implant survivorship. Materials and methods Using data from a hip replacement registry, we determined survivorship of 2857 EN prostheses. Long-offset configurations of head and EN were implanted in heavy (> 90 kg) patients only in 23 hips. We investigated under which conditions EN breakages or ALTRs occurred. We also measured titanium (Ti) and vanadium (V) blood concentrations in 24 patients with a unilateral well-working prosthesis. Results The 17-year survival rates for any reason and aseptic loosening of any component were 88.9% (95%CI 87.5–90.1; 857 hips at risk) and 96.9% (95%CI 96.0–97.6), respectively. There were two cases of EN breakage and one case of ALTR (metallosis), due to rim-neck impingement, out of 276 revisions. After an average period of 9.8 years (range 7.8–12.8 years), the maximum Ti and V blood concentrations in patients with a well-working prosthesis were 5.0 µg/l and 0.16 µg/l, respectively. Conclusion The present incidence of EN breakage or ALTR is lower than those reported in other studies evaluating EN hip prosthesis survivorship. This study suggests that (i) the risk of EN breakage is reduced by limiting the use of long-offset configurations in heavy patients and (ii) Ti-alloy/Ti-alloy NSJ damage products do not promote ALTR nor significantly alter the rate of implant loosening. Since design decisions and implant configuration determine the NSJ strength, the NSJ strength in working conditions must be thoroughly investigated to proper define the clinical indications for any EN design.

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Section: Discussionsupporting

confidence: 57%

Section: Discussionmentioning

confidence: 99%

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Long-term survivorship of an exchangeable-neck hip prosthesis with a Ti-alloy/Ti-alloy neck–stem junction

Baleani

Toni

Ancarani

et al. 2022

Arch Orthop Trauma Surg

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“… 3 , 5 - 8 Reported complications of modular stems include increased risk of femoral fracture and stem fractures at the modular junction compared to monoblock stems. 12 , 39 - 41 Feng et al 12 found that their cohort of 108 modular stems had a statistically significant increase in incidence (16.7%) of intraoperative femoral fractures compared to their cohort of 110 nonmodular stems (4.5%; p = 0.004). Similar studies have corroborated these results.…”

Section: Discussionmentioning

confidence: 97%

Monoblock tapered stems in management of UCS B2 and B3 periprosthetic fractures in revision total hip arthroplasty

Thomas,

Shichman,

Ohanisian

et al. 2023

Bone Jt Open

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AimsUnited Classification System (UCS) B2 and B3 periprosthetic fractures in total hip arthroplasties (THAs) have been commonly managed with modular tapered stems. No study has evaluated the use of monoblock fluted tapered titanium stems for this indication. This study aimed to evaluate the effects of a monoblock stems on implant survivorship, postoperative outcomes, radiological outcomes, and osseointegration following treatment of THA UCS B2 and B3 periprosthetic fractures.MethodsA retrospective review was conducted of all patients who underwent revision THA (rTHA) for periprosthetic UCS B2 and B3 periprosthetic fracture who received a single design monoblock fluted tapered titanium stem at two large, tertiary care, academic hospitals. A total of 72 patients met inclusion and exclusion criteria (68 UCS B2, and four UCS B3 fractures). Primary outcomes of interest were radiological stem subsidence (> 5 mm), radiological osseointegration, and fracture union. Sub-analysis was also done for 46 patients with minimum one-year follow-up.ResultsFor the total cohort, stem osseointegration, fracture union, and stem subsidence were 98.6%, 98.6%, and 6.9%, respectively, at latest follow-up (mean follow-up 27.0 months (SD 22.4)). For patients with minimum one-year of follow-up, stem osseointegration, fracture union, and stem subsidence were 97.8%, 97.8%, and 6.5%, respectively.ConclusionMonoblock fluted stems can be an acceptable modality for the management of UCS B2 periprosthetic fractures in rTHAs due to high rates of stem osseointegration and survival, and the low rates of stem subsidence, and revision. Further research on the use of this stem for UCS B3 periprosthetic fractures is warranted to determine if the same conclusion can be made for this fracture pattern.Cite this article: Bone Jt Open 2023;4(8):551–558.

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“…Between March 2015 and February 2016, 30 patients with primary OA with a mean age of 58 (41-71) years underwent THA with the Anato stem and Trident cup (Stryker, Mahwah, NJ, USA). The patients are part of an ongoing RSA project at Skåne University Hospital in Lund, Sweden [9,[18][19][20][21]. Patient inclusion criteria and demographics are summarized in Tables 1 and 2.…”

Section: Methodsmentioning

confidence: 99%

Comparison between model-based RSA and an AI-based CT-RSA: an accuracy study of 30 patients

Christensson,

Nemati,

Flivik

2024

ActaO

Self Cite

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Background and purpose: Radiostereometry (RSA) is the current gold standard for evaluating early implant migration. CT-based migration analysis is a promising method, with fewer handling requirements compared with RSA and no need for implanted bone-markers. We aimed to evaluate agreement between a new artificial intelligence (AI)-based CT-RSA and model-based RSA (MBRSA) in measuring migration of cup and stem in total hip arthroplasty (THA).Patients and methods: 30 patients with THA for primary osteoarthritis (OA) were included. RSA examinations were performed on the first postoperative day, and at 2 weeks, 3 months, 1, 2, and 5 years after surgery. A low-dose CT scan was done at 2 weeks and 5 years. The agreement between the migration results obtained from MBRSA and AI-based CT-RSA was assessed using Bland–Altman plots.Results: Stem migration (y-translation) between 2 weeks and 5 years, for the primary outcome measure, was –0.18 (95% confidence interval [CI] –0.31 to –0.05) mm with MBRSA and –0.36 (CI –0.53 to –0.19) mm with AI-based CT-RSA. Corresponding proximal migration of the cup (y-translation) was 0.06 (CI 0.02–0.09) mm and 0.02 (CI –0.01 to 0.05) mm, respectively. The mean difference for all stem and cup comparisons was within the range of MBRSA precision. The AI-based CT-RSA showed no intra- or interobserver variability.Conclusion: We found good agreement between the AI-based CT-RSA and MBRSA in measuring postoperative implant migration. AI-based CT-RSA ensures user independence and delivers consistent results.

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Unexpected varus deformity and concomitant metal ion release and MRI findings of modular-neck hip stems: descriptive RSA study in 75 hips with 8 years’ follow-up

Cited by 4 publications

References 30 publications

Long-term survivorship of an exchangeable-neck hip prosthesis with a Ti-alloy/Ti-alloy neck–stem junction

Long-term survivorship of an exchangeable-neck hip prosthesis with a Ti-alloy/Ti-alloy neck–stem junction

Monoblock tapered stems in management of UCS B2 and B3 periprosthetic fractures in revision total hip arthroplasty

Comparison between model-based RSA and an AI-based CT-RSA: an accuracy study of 30 patients

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