Early aseptic loosening of the Tritanium primary acetabular component with screw fixation

Abstract

Ultraporous acetabular components were developed to improve osseointegration and fit for increased longevity and better outcomes after total hip arthroplasty. There is a paucity of literature detailing this acetabular component’s clinical performance, with even less detailing those with screw fixation. We identify 5 patients at our institution who underwent revision total hip arthroplasty for early aseptic acetabular cup loosening of an ultraporous acetabular component known as the Tritanium primary cup with secondary screw fixation. They all presented with groin and hip pain after index surgery and underwent follow-up radiographic examination consistent with component loosening requiring revision surgery. This case series reports on the risk of early acetabular cup loosening and its associated clinical presentation, workup, and surgical management in patients with the Tritanium primary cup augmented with screws.

The Fate of Zone 2 Radiolucencies in Contemporary Highly Porous Acetabular Components: Not All Designs Perform Equally

“…These reports support our findings in the present study with regard to the persistence of zone 2 and circumferential radiolucent (or radiosclerotic) lines which may lead to an increased risk for aseptic loosening for a 3-dimensional highly porous titanium acetabular component with machined radial grooves (Tritanium; Stryker). In addition, to further corroborate our findings, a recent case report identified 5 cases in which this particular acetabular component with radially machined grooves demonstrated circumferential radiolucent lines and subsequent revision in all 5 cases due to aseptic loosening even with screw augmentation [ 25 ].…”

“…The HA cup group used the most acetabular screws and had the lowest proportion of radiolucent lines at 1 month (43%), 1 year (0%), and minimum 2 years (1 cup, 3.0%) compared with MRG cups which used the second most acetabular screws and had the highest proportion of radiolucent lines at 1 year and minimum 2 years (46%). The correlation of acetabular screw use and significant differences in zone 2 radiolucent lines may imply the manufacturing process with radially machined grooves may hinder osseointegration of this particular highly porous surface, regardless of adjuvant screw fixation [ 25 ]. Interestingly, MP cups used significantly less acetabular bone screws than MRG cups and demonstrated a significantly lower proportion of zone 2 radiolucent lines at 1-year (35%) and minimum 2-year follow-up (24%).…”

Comparison of Different Locking Mechanisms in Total Hip Arthroplasty: Relative Motion between Cup and Inlay

“…As already mentioned, these particles could increase the potential of a resulting inflammatory reaction, which may result in osteolysis. Compared to the in vitro data from Braun et al and Reyna et al, similar effects could be demonstrated in an in vivo study from Long et al [26]. In this study, a series of early aseptic loosenings of acetabular cups were identified, an analysis of x-ray images was realized and an optical analysis of the inlays was carried out.…”

“…In this study, a series of early aseptic loosenings of acetabular cups were identified, an analysis of x-ray images was realized and an optical analysis of the inlays was carried out. The osteolysis that occurred behind the cup could be attributed to backside wear particles in conjunction with optical wear marks on the backside of the PE inlay [26]. Due to the fact that backside wear particles are also significantly smaller than articulating wear particles, they may additionally cause stronger biological responses [9].…”

Variability of Cutting and Thermal Dynamics Between New and Used Acetabular Reamers During Total Hip Arthroplasty

“…Pressfit acetabular components require a precisely reamed acetabulum and an oversized prosthetic component for a tight fit promoting bone apposition onto the implant via osseointegration [ 6 , 7 ]. Aseptic loosening of the acetabular component remains one of the leading causes of early failure of THA, accounting for 9.5%-30% of all failures [ [8] , [9] , [10] , [11] ]. Survival of the implant can also be affected by surgical factors such as the accuracy of reaming, acetabular bone coverage, and cup position [ 7 ].…”