Accuracy of methods to measure femoral head penetration within metal-backed acetabular components

Callary, Stuart A.; Solomon, Lucian B.; Holubowycz, Oksana T.; Campbell, D.; Howie, Donald W.

doi:10.1002/jor.23356

Cited by 22 publications

(35 citation statements)

References 47 publications

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“…Firstly, the annual wear rate comparison of an immediate postoperative film to most recent follow-up imaging does not uniquely represent true wear (removal of polyethylene) and instead if a combination of true wear with the creep or bedding-in that occurs in the first few months due to non-elastic deformation of the polyethyelene [42]. Secondly, we acknowledge that the computer software utilized for wear analysis is not as sensitive as RSA, widely considered to be the gold standard [43]. Nevertheless, the Martell Hip Analysis software has been widely utilized and in a recent comparative study, was found to be less expensive, less cumbersome, and comparably accurate to both RSA and CT-based wear measurement techniques [44].…”

Section: Discussionmentioning

confidence: 99%

Long-term performance of oxidized zirconium on conventional and highly cross-linked polyethylene in total hip arthroplasty

Carli

Patel

Cross

et al. 2020

SICOT-J

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Introduction: Polyethylene wear and subsequent osteolysis remain obstacles to the long-term survivorship of total hip arthroplasty (THA). Highly cross-linked polyethylene (XLPE) with radical quenching represents a massive leap forward with dramatically improved wear rates compared to ultra-high molecular weight polyethylene (UHMWPE). In this study we evaluate the wear of UHMWPE and XLPE coupled with oxidized zirconium (OxZr) femoral heads. Methods: A longitudinal, retrospective analysis was performed identifying consecutive patients who received a 28-mm OxZr-on-polyethylene primary THA from 2003 to 2004 by a single, high-volume arthroplasty surgeon. Patients were divided into two groups: those that received (1) UHMWPE liner and (2) a highly XLPE liner. Patients were included if clinical follow-up was complete to 2014 or later. Radiographic analysis was performed by two blinded observers. Measures included cup position, annual linear wear rate, and presence of osteolysis. Pairwise comparisons, correlations, and inter-rater reliability were calculated. Results: Eighty patients were in the UHMWPE group with an average follow-up of 10 ± 1.23 years and 88 patients in the XLPE group with an average of 10 ± 1.03-year follow-up. Average age (68) was similar between groups (p = 0.288). Observer reliability was excellent for cup abduction (ICC = 0.940), anteversion (ICC = 0.942), and detection of osteolysis (ICC = 0.811). Annual linear wear rates were significantly higher (p = 1 × 10−19) with UHMWPE (0.21 ± 0.12 mm/year) compared to XLPE (0.05 ± 0.03 mm/year). Linear wear rate was significantly correlated to decreasing acetabular abduction (p = 0.035). Osteolysis was noted only in the UHMWPE group, with 17 patients (21.2%) exhibiting acetabular osteolysis and 37 (46.3%) patients exhibiting femoral osteolysis. Conclusions: OxZr coupled with XLPE showed minimal wear and no osteolysis at 10-year follow up. The yearly linear penetration rate is similar to that seen in other studies of XLPE THA. A careful longitudinal follow-up will be required to determine if advanced bearings such as OxZr or ceramic can show improved performance in the second decade of implantation.

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Section: Discussionmentioning

confidence: 99%

Long-term performance of oxidized zirconium on conventional and highly cross-linked polyethylene in total hip arthroplasty

Carli

Patel

Cross

et al. 2020

SICOT-J

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“…The EBRA‐Cup measurement accuracy when assessing uncemented acetabular components used at revision THR is not known. In an optimal setting, accuracy would be determined using a phantom model 15,16 . However, the variation in pelvic tilt and subsequent identification of pelvic bone landmarks in AP radiographs after revision THR are not able to be replicated in a phantom study.…”

Section: Introductionmentioning

confidence: 99%

Accuracy of EBRA‐cup measurements after reconstruction of severe acetabular defects at revision THR

Abrahams

Callary

Jang

et al. 2020

Journal Orthopaedic Research

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Radiostereometric analysis (RSA) is the most accurate method of measuring component migration using radiographs but is restricted to use in prospective studies. Ein‐Bild‐Roentgen‐analyze (EBRA)‐Cup can be used retrospectively, but its accuracy to measure component migration following revision is unknown. This study aimed to determine the accuracy of EBRA‐Cup measurements of uncemented acetabular component migration after revision total hip replacement (THR). The secondary aim was to compare the number of cases identified using EBRA‐Cup and RSA as having proximally migrated above and below 1 mm at 2 years postoperatively. EBRA‐Cup measurements were performed on plain antero‐posterior pelvic radiographs taken at the same time as RSA radiographs in a prospective cohort of 53 hips undergoing acetabular revision. At 2 years, the mean difference between the RSA and EBRA‐Cup measurements for 17 components used to treat pelvic discontinuity was 0.90 mm, significantly greater than the mean difference of 0.28 mm for 36 components without discontinuity (P = .0001). The mean difference between the RSA and EBRA‐Cup measurements at 2 years for hips that were reconstructed with an acetabular component alone, 0.28 mm, was significantly lower than hips that were reconstructed with an acetabular component in combination with an augment and/or cage, 0.74 mm (P = .0005). In conclusion, EBRA‐Cup can accurately measure migration of uncemented acetabular components used at revision THR. The presence of pelvic discontinuity, and addition of augments and cages, significantly influenced the accuracy of EBRA‐Cup measurements. EBRA‐Cup and RSA had good agreement on classification of components that migrated proximally above or below 1 mm at 2 years, with 100% sensitivity, and 87% specificity.

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“…Migration is measured only between comparable radiographs [ 21 ]. According to Callary et al, the variability in wear measurements observed with EBRA as compared to RSA is similar when using different acetabular reference segments [ 22 ].…”

Section: Methodsmentioning

confidence: 99%

Different wear in two highly cross-linked polyethylene liners in THA: wear analysis with EBRA

Dammerer

Keiler

Putzer

et al. 2021

Arch Orthop Trauma Surg

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Introduction The purpose of this study was (1) to compare early wear rates in bedding-in periods of two highly cross-linked polyethylene liners frequently used in THA and (2) to evaluate risk factors indicating a possible higher wear rate. Materials and methods 1120 patients who received a Crossfire or a Marathon highly cross-linked (HXLPE) ultra-high-molecular-weight polyethylene liner in primary THA at our Department between 2004 and 2018 were retrospectively reviewed. Patients with (1) only alumina heads on HXLPE acetabular bearings, (2) a minimum of four radiographs per patient for EBRA analysis, (3) no osteolysis around the acetabular cup and (4) no dislocations that occurred during the study period were included. Results A total of 328 patients (female: 183; male: 145; Marathon: 179; Crossfire: 149) fulfilled the inclusion criteria. Mean follow-up was 24 (range 7–51) months. With 0.22 (SD 0.27) mm mean total wear for the Marathon was three times greater than for the Crossfire, namely 0.07 (SD 0.14) mm. Mean cup migration during the investigated follow-up period was 0.7 (SD 0.8) mm for the Pinnacle and 0.5 mm (SD 0.7) for the Trident PSL cups. Conclusion Initial early wear of highly cross-linked polyethylene in combination with alumina heads differs strongly between products. Long-term survivorship of these liners should be observed to determine whether early wear has an impact on aseptic loosening. Level of evidence Level III (retrospective comparative study with prospective cohort).

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Accuracy of methods to measure femoral head penetration within metal-backed acetabular components

Cited by 22 publications

References 47 publications

Long-term performance of oxidized zirconium on conventional and highly cross-linked polyethylene in total hip arthroplasty

Long-term performance of oxidized zirconium on conventional and highly cross-linked polyethylene in total hip arthroplasty

Accuracy of EBRA‐cup measurements after reconstruction of severe acetabular defects at revision THR

Different wear in two highly cross-linked polyethylene liners in THA: wear analysis with EBRA

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