We evaluated the rates of survival and cause of revision of seven different brands of cemented primary total knee replacement (TKR) in the Norwegian Arthroplasty Register during the years 1994 to 2009. Revision for any cause, including resurfacing of the patella, was the primary endpoint. Specific causes of revision were secondary outcomes. Three posterior cruciate-retaining (PCR) fixed modular-bearing TKRs, two fixed non-modular bearing PCR TKRs and two mobilebearing posterior cruciate-sacrificing TKRs were investigated in a total of 17 782 primary TKRs. The median follow-up for the implants ranged from 1.8 to 6.9 years. Kaplan-Meier 10-year survival ranged from 89.5% to 95.3%. Cox's relative risk (RR) was calculated relative to the fixed modularbearing Profix knee (the most frequently used TKR in Norway), and ranged from 1.1 to 2.6. The risk of revision for aseptic tibial loosening was higher in the mobile-bearing LCS Classic (RR 6.8 (95% confidence interval (CI) 3.8 to 12.1)), the LCS Complete (RR 7.7 (95% CI 4.1 to 14.4)), the fixed modular-bearing Duracon (RR 4.5 (95% CI 1.8 to 11.1)) and the fixed non-modular bearing AGC Universal TKR (RR 2.5 (95% CI 1.3 to 5.1)), compared with the Profix. These implants (except AGC Universal) also had an increased risk of revision for femoral loosening (RR 2.3 (95% CI 1.1 to 4.8), RR 3.7 (95% CI1.6 to 8.9), and RR 3.4 (95% CI 1.1 to 11.0), respectively). These results suggest that aseptic loosening is related to design in TKR.The aim of this study was to investigate the rate of survival and causes of revision for seven brands of cemented primary total knee replacement (TKR) registered in the Norwegian Arthroplasty Register (NAR) between 1994 and 2009. The brands are the currently and historically among the most commonly used both in Norway and around the world 1,2 . The study was limited to cemented implants without patellar resurfacing, and the data reflect the results of the average surgeon. We accept that pooling of data from many surgeons, with different experience, patient volumes and skills, may give good external validity but may also hide the effect of a learning curve and any positive effect that may be related to high volumes undertaken by some surgeons.We also investigated whether survival was brand specific or related to particular types of design. Patients and MethodsData from patients registered in the NAR during this time were evaluated. The registration of hip replacements in the NAR started in 1987 and was expanded to include TKRs and the replacement of other joints in 1994 3,4 . All TKRs were cemented and were inserted without patellar components. Differences between the designs were predominantly on the tibial side; two were mobile-bearing TKRs (LCS Classic and LCS Complete (DePuy, Warsaw, Indiana), both rotating platform), two were non-modular fixed bearing TKRs (AGC Universal and AGC Anatomic; both Biomet, Warsaw, Indiana), and three were modular fixed-bearing TKRs (Duracon; Stryker, Portage, Michigan; NexGen; Zimmer, Warsaw, Indiana; and Prof...

Computational methods were used to analyse the elasto-hydrodynamic lubrication of a complex rotorbearing system. The methodology employed computational fluid dynamics (CFD), based on the Navier-Stokes equation and a fluid-structure interaction (FSI) technique. A series of models representing the system were built using the CFD-FSI methodology to investigate the interaction between the lubrication of the fluid film, and elastic dynamics of the rotor and journal bearing. All models followed an assumption of isothermal behaviour. The FSI methodology was implemented by setting nodal forces and displacements to equilibrium at the fluid-structure interface, therefore allowing the lubrication of the fluid and the elastic deformation of structures to be solved simultaneously. This is significantly different to the more common techniques-such as the Reynolds equation method-that use an iterative solution to balance the imposed load and the force resulting from the pressure of the fluid film to within a set tolerance. Predictions using the CFD-FSI method were compared with the results of an experimental study and the predictions from an 'in-house' lubrication code based on the Reynolds equation. The dynamic response of the system was investigated with both rigid and flexible bodies for a range of different bearing materials and dynamic unbalanced loads. Cavitation within the fluid film was represented in the CFD-FSI method using a simplified phase change boundary condition. This allowed the transition between the liquid and vapour phases to be derived from the lubricant's properties as a function of pressure. The combination of CFD and FSI was shown to be a useful tool for the investigation of the hydrodynamic and elasto-hydrodynamic lubrications of a rotor-bearing system. The elastic deformation of the bearing and dynamic unbalanced loading of the rotor had significant effects on the position of its locus.

Wear debris-induced inflammation is considered to be the main cause for periprosthetic osteolysis in total hip replacements (THR). The objective of this retrieval study was to examine the tissue reactions and exposure to metal ions and wear particles in periprosthetic tissues and blood samples from patients with titanium (Ti)-based hip prostheses that were revised due to wear, osteolysis, and/or aseptic loosening. Semiquantitative, histological tissue evaluations in 30 THR-patients revealed numerous wear debris-loaded macrophages, inflammatory cells, and necrosis in both groups. Particle load was highest in tissues adjacent to loosened cemented Ti stems that contained mainly submicron zirconium (Zr) dioxide particles. Particles containing pure Ti and Ti alloy elements were most abundant in tissues near retrieved uncemented cups. Polyethylene particles were also detected, but accounted only for a small portion of the total particle number. The blood concentrations of Ti and Zr were highly elevated in cases with high abrasive wear and osteolysis. Our findings indicate that wear particles of different chemical composition induced similar inflammatory responses, which suggests that particle size and load might be more important than the wear particle composition in periprosthetic inflammation and osteolysis. © 2014 The Authors. Journal of Biomedical Materials Research Part B: Applied Biomaterials Published by Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 103B:709–717, 2015.

Background and purpose Despite the fact that there have been some reports on poor performance, titanium femoral stems intended for cemented fixation are still used at some centers in Europe. In this population-based registry study, we examined the results of the most frequently used cemented titanium stem in Norway.Patients and methods 11,876 cases implanted with the cemented Titan stem were identified for the period 1987–2008. Hybrid arthroplasties were excluded, leaving 10,108 cases for this study. Stem survival and the influence of age, sex, stem offset and size, and femoral head size were evaluated using Cox regression analyses. Questionnaires were sent to the hospitals to determine the surgical technique used.Results Male sex, high stem offset, and small stem size were found to be risk factors for stem revision, (adjusted RR = 2.5 (1.9–3.4), 3.3 (2.3–4.8), and 2.2 (1.4–3.5), respectively). Patients operated in the period 2001–2008 had an adjusted relative risk (RR) of 4.7 (95% CI: 3.0–7.4) for stem revision due to aseptic stem loosening compared to the period 1996–2000. Changes in broaching technique and cementing technique coincided with deterioration of the results in some hospitals.Interpretation The increased use of small stem sizes and high-offset stems could only explain the deterioration of results to a certain degree since the year 2000. The influence of discrete changes in surgical technique over time could not be fully evaluated in this registry study. We suggest that this cemented titanium stem should be abandoned. The results of similar implants should be carefully evaluated.

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