Early Results of a New Highly Porous Modular Acetabular Cup in Revision Arthroplasty

Ramappa, Manjunath; Bajwa, Ali; Kulkarni, Ashwin; McMurtry, Ian; Port, A.

doi:10.1177/112070000901900309

Cited by 31 publications

(24 citation statements)

References 13 publications

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“…When compared to previous reports this showed that there was a statistically significant difference in aseptic loosening between hips with major and minor bone loss (2.9 % and 0.4 %; P =0.005). At this time to the best of our patients who had AAOS type 1 to type 4 acetabular defects using titanium based highly porous metals [40]. At a mean follow-up of 18.2 months (13-24 months), the authors found that 98 % of the cups (n = 42) had osseointegration at 12 weeks follow-up.…”

Section: Discussionmentioning

confidence: 79%

“…Metal augments were used concurrently with the highly-porous acetabular components in 26 % of the 1,152 reported revisions, and bone grafting was used in 60 % of the patients (n =789). There was only one study reporting the use of titanium-based highlyporous metals for acetabular reconstruction while the remaining studies were on tantalum [40]. None of the studies except one analysed in this review reported on complications related to metal debris at final follow-up.…”

Section: Study Characteristicsmentioning

confidence: 97%

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Systematic review on outcomes of acetabular revisions with highly-porous metals

Banerjee

Issa

Kapadia

et al. 2013

International Orthopaedics (SICOT)

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Purpose The purpose of this study was to systematically review the literature and report the clinical and radiographic outcomes of highly-porous acetabular cups in revision settings. Method A literature search of four electronic databases of EMBASE, CINAHL-plus, PubMed, and SCOPUS yielded 25 studies reporting the outcomes of 2,083 revision procedures with highly-porous acetabular components. There was lack of high quality evidence (level I and level II studies) and only two studies with level III evidence, while the remainder were all level IV studies. In addition, a majority of the studies had small sample sizes and had short to mid-term follow-up. The mean age of the patients was 65 years (range, 58-72 years) and the mean follow-up was 3.6 years (range, two to six years). Outcomes evaluated were aseptic survivorship, Harris hip scores, migration rates, incidence of peri-acetabular radiolucencies and radiographic restoration of the hip centre. Results The mean aseptic survivorship was 97.2 % (range, 80-100 %). The Harris hip scores improved from a mean preoperative score of 42 points, (range, 29-75 points), to a mean postoperative score of 79 points (range, 69-94 points). The mean incidence of cup migration and prevalence of periacetabular radiolucencies was 2.4 % (range, 0-8.8 %) and 4.6 % (range, 0-19 %), respectively, at final follow-up. The vertical hip centre-of-rotation was restored significantly from a mean of 39.2 mm (range, 27.6-50 mm) pre-operatively, to a mean of 24.1 mm (range, 7.4-47 mm), postoperatively. Conclusion The short-term clinical and radiographic results of highly-porous metals in revision hip arthroplasty are excellent with a low rate of loosening in the presence of both major and minor bone loss.

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Section: Discussionmentioning

confidence: 79%

Section: Study Characteristicsmentioning

confidence: 97%

Systematic review on outcomes of acetabular revisions with highly-porous metals

Banerjee

Issa

Kapadia

et al. 2013

International Orthopaedics (SICOT)

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“…Canine and human studies using Tritanium (60-70% porous Ti scaffold manufactured using LTAVD) with a similar nano/microtexture as Trabecular Metal TM demonstrated optimistic but not as successful results compared to Ta in vivo. 36,37 Therefore, the chemistry and topography of Ta has a profound effect on osteoblast behavior, however, the exact mechanism for the dramatic increase in cell proliferation on Ta needs further exploration since it may have therapeutic potential in cases of compromised bone formation, such as in aging.…”

Section: Tantalum Stimulates Proliferationmentioning

confidence: 99%

Porous tantalum stimulates the proliferation and osteogenesis of osteoblasts from elderly female patients

Sagomonyants

Hakim-Zargar

Jhaveri

et al. 2010

Journal Orthopaedic Research

100

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Porous tantalum (Ta) implants have been successful in various orthopedic procedures for patients with compromised boneforming abilities. Previous studies demonstrated that human osteoblast (HOB) cultures from older female patients produced less bone on implant materials in vitro compared to HOBs from age-matched male and younger female patients. In this study, the responses of HOBs from younger (<45) and older (>60 years old) female patients were compared on Ta, titanium fiber mesh (TFM) and tissue culture plastic. Adhesion, proliferation, and mineralization were greater in cells from younger patients than from older patients. Cell adhesion was slightly higher on Ta than TFM or plastic. However, Ta highly stimulated cell proliferation with a 4-and 6-fold increase compared to TFM for cells from younger and older patients, respectively, and 12-and 16-fold increase in proliferation compared to cells on plastic ( p = 0.001). At 3 weeks, mineralization was significantly higher on Ta compared to TFM for HOBs from older patients ( p = 0.05). Expression levels of bone matrix markers demonstrated differences dependent on age and substrate. Scanning electron micrographs revealed HOBs covering the surfaces and entering the pores of both Ta and TFM. In conclusion, tantalum greatly stimulates cell proliferation, and improves the ability of HOBs from older patients to form bone. ß

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“…However, after revision THA, patients are left nonweightbearing for no longer than 12 weeks to allow for implant stabilization by bone ingrowth; therefore, bone graft substitutes taking longer than 12 weeks to be effective are not practical. Also, no prior DBM studies utilized the new higher porosity implants now common in revision THA [5,17,24,27,29], even though implant surface topography influences bone ingrowth [6,15,16,23,38].…”

Section: Introductionmentioning

confidence: 99%

The Otto Aufranc Award: Demineralized Bone Matrix Around Porous Implants Promotes Rapid Gap Healing and Bone Ingrowth

Lim

Bobyn

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Background Noncemented revision arthroplasty is often complicated by the presence of bone implant gaps that reduce initial stability and biologic fixation. Demineralized bone matrix has osteoinductive properties and therefore the potential to enhance gap healing and porous implant fixation. Questions/purposes We determined at what times and to what extent demineralized bone matrix promotes gap healing and bone ingrowth around a porous implant. Methods We inserted porous titanium implants into the proximal metaphyses of canine femora and humeri, with an initial 3-mm gap between host cancellous bone and implants. We left the gaps empty (control; n = 12) or filled them with either demineralized bone matrix (n = 6) or devitalized demineralized bone matrix (negative control; n = 6) and left them in situ for 4 or 12 weeks. We quantified volume healing of the gap with new bone using threedimensional micro-CT scanning and quantified apposition and ingrowth using backscattered scanning electron microscopy. Results The density of bone inside gaps filled with demineralized bone matrix reached 64% and 93% of surrounding bone density by 4 and 12 weeks, respectively. Compared with empty controls and negative controls at 4 and 12 weeks, gap healing using demineralized bone matrix was two to three times greater and bone ingrowth and apposition were up to 15 times greater. Conclusions Demineralized bone matrix promotes rapid bone ingrowth and gap healing around porous implants. Clinical Relevance Demineralized bone matrix has potential for enhancing implant fixation in revision arthroplasty.

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Early Results of a New Highly Porous Modular Acetabular Cup in Revision Arthroplasty

Abstract: The 'Tritanium'acetabular cup has been successful in achieving rapid osseointegration with few complications. The management of pelvic discontinuity continues to be a challenge.

Cited by 31 publications

References 13 publications

Systematic review on outcomes of acetabular revisions with highly-porous metals

Systematic review on outcomes of acetabular revisions with highly-porous metals

Porous tantalum stimulates the proliferation and osteogenesis of osteoblasts from elderly female patients

The Otto Aufranc Award: Demineralized Bone Matrix Around Porous Implants Promotes Rapid Gap Healing and Bone Ingrowth

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