Histopathologic Retrieval Analysis of Clinically Failed Porous Tantalum Osteonecrosis Implants

Tänzer, Michael; Bobyn, J. D.; Krygier, Jan; Karabasz, Dorota

doi:10.2106/jbjs.f.00847

Cited by 81 publications

(79 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our findings showed, nevertheless, that two out of seven cases showed bony and vascular ingrowth, respectively, into the pores of the tantalum implant. Findings with a maximum bony ingrowth of 2.6 mm in a retrieved case after 12 months in situ are in accordance with the findings of Tanzer et al [22] and Fernández-Fairen et al [23] for porous tantalum osteonecrosis implants. Four rerevised cases showed a total lack of bony or vascular ingrowth although all tantalum augmentations were explanted with caution.…”

Section: Discussionsupporting

confidence: 90%

“…Tanzer et al [22] performed a histopathological retrieval analysis of 15 clinically failed specimens in 2008. Using backscattered scanning electron microscopy Tanzer et al confirmed the presence of bone ingrowth in 13 of the 15 cases.…”

Section: Discussionmentioning

confidence: 99%

“…In order to determine the extent of bony ingrowth into the porous tantalum, a number of studies tried to analyse the osteoconductive effects of trabecular metal constructions from postoperative serial radiographs [2, 6, 12-14, 16, 17]. However, studies characterising possible host bone ingrowth into trabecular metal augments in vivo are rare and to the best of our knowledge, few histological studies on porous tantalum osteonecrosis implants are available [22,23].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Histological ex vivo analysis of retrieved human tantalum augmentations

Breer

Hahn

Kendoff

et al. 2012

International Orthopaedics (SICOT)

View full text Add to dashboard Cite

Purpose The characteristics of tantalum augment osseointegration in human ex vivo specimens from re-revision procedures are unknown and limited data in this regard is available. The purpose of this study was to investigate the osseointegration pattern into porous tantalum augmentations harvested during re-revision procedures. Methods Between 2007 and 2010 a total of 324 hip and knee revisions with a tantalum augmentation were performed in our institution. Out of this cohort, seven patients (2.2 %) had to be re-revised. To analyse the status of trabecular ingrowth in the retrieved cases (four hips, three knees), all specimens were analysed by contact radiography, subjected to undecalcified processing, histology, thinsection analysis and backscattered electron imaging. Results Trabecular and vascular ingrowth could be found along the bone-augment-interface in two of seven revised specimens, respectively. The depth of bone ingrowth reached up to 2.6 mm. However, the analysis of the remaining cases revealed no bony ingrowth into trabecular metal. Rather, large parts of the implants were embedded in cement or pores were filled with autologous bone. Conclusions Although the cause for the missing bony ingrowth seems to be multifactorial, some fundamental conditions, such as the provision of the greatest possible interface between the tantalum implant and the host bone, should be met and thus, bone cement and autologous bone grafts should be used with caution.

show abstract

Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Histological ex vivo analysis of retrieved human tantalum augmentations

Breer

Hahn

Kendoff

et al. 2012

International Orthopaedics (SICOT)

View full text Add to dashboard Cite

show abstract

“…We also found that the simple insertion of the porous tantalum rod had a significant failure rate. Tanzer et al (2008) also reported 17 cases of tantalum rod failure, and suggested that single tantalum rod in the necrotic zone may be limited to conduct the formation of new bone and have a limited support to subchondral bone.…”

Section: Discussionmentioning

confidence: 99%

Porous tantalum rods for treating osteonecrosis of the femoral head

Liu¹,

Guo²,

Li³

et al. 2014

Genet. Mol. Res.

View full text Add to dashboard Cite

ABSTRACT. This study evaluated the outcomes of using porous tantalum rods for the treatment of osteonecrosis of the femoral head (ONFH). We performed core decompression and inserted porous tantalum implants in 149 patients (168 consecutive hips) with ONFH. Hips had large (65), medium (64), or small (39) lesions; 63 lesions were lateral, 68 were central, and 35 were medial. Conversion to total hip arthroplasty (THA) was the end point of this survey. A total of 130 cases (138 hips) were followed. The mean follow-up time was 38.46 ± 5.76 months; 43 hips (31%) were converted to or needed THA. Of the 43 hips requiring THA, 33 had large lesions, including 1 medial, 3 central, and 29 lateral lesions; 9 had medium, lateral lesions, and 1 hip had a small, lateral lesion. Bone grafting was used in 59 hips, with 3 hips failing; 40 of 79 hips without bone grafts failed. The sum distances between the tops of the rods and the lateral lesion boundaries (SDTL, mm) were measured in anteroposterior and lateral radiographs. In the failure and spared groups, the average SDTLs were 7.65 ± 2.759 and 0.83 ± 2.286 mm, respectively. The survival of porous tantalum rods used for treating early-stage ONFH was affected by the size and location of the lesion, whether or not a 8343 ©FUNPEC-RP www.funpecrp.com.br Genetics and Molecular Research 13 (4): 8342-8352 (2014) Porous tantalum rods for treating osteonecrosis bone graft was used, as well as the distance between top of the rod and the lateral boundary of the lesion.

show abstract

“…48,49 In a recent study, 17 porous tantalum implants that were retrieved at the time of conversion to total hip arthroplasty were histopathologically analyzed. 50 All of them had been used for the management of stage II osteonecrosis of the femoral head according to Steinberg classification system. Osteonecrotic lesions were present in 14 of the 15 specimens (93%) that had been transected in situ near the base of the femoral head.…”

Section: Free Vascularized Fibula Graft Versus Porous Tantalum Implantmentioning

confidence: 99%

Femoral head osteonecrosis: Why choose free vascularized fibula grafting

et al. 2010

View full text Add to dashboard Cite

Osteonecrosis of the femoral head is a disease in which bone death occurs and usually progresses to articular incongruity and subsequent osteoarthritis. To delay the process of the disease and the conversion to total hip arthroplasty, many surgical techniques have been described. Core decompression, nonvascularized autologous bone grafts, porous tantalum implant procedure, and various osteotomies have been used for the management of early precollapse stage osteonecrosis of the femoral head. However, none of these procedures is neither entirely effective nor can obtain predictable results. With the progress of microsurgery, the implantation of a free vascularized fibula graft to the necrotic femoral head has provided the most consistently successful results. Although the procedure is technically demanding, there is growing recognition that the use of free vascularized fibula graft may improve patient quality of life by functional improvement and pain alleviation. The success of the procedure is related to decompression of the femoral head, excision of the necrotic bone, and addition of cancellous bone graft with osteoinductive and osteoconductive properties, which augments revascularization and neoosteogenesis of the femoral head. Free vascularized fibula graft, especially in younger patients, is a salvaging procedure of the necrotic femoral head in early precollapse stages. In postcollapse osteonecrosis, the procedure appears to delay the need for total hip arthroplasty in the majority of patients. The purpose of this review article is to update knowledge about treatment strategies in femoral head osteonecrosis and to compare free vascularized fibula grafting to traditional and new treatment modalities.

show abstract

Histopathologic Retrieval Analysis of Clinically Failed Porous Tantalum Osteonecrosis Implants

Abstract: The retrieved implants were associated with little bone ingrowth and insufficient mechanical support of subchondral bone. The implant design, the surgical technique, its application, and the clinical characteristics of candidates for this procedure should continue to be monitored closely.

Cited by 81 publications

References 8 publications

Histological ex vivo analysis of retrieved human tantalum augmentations

Histological ex vivo analysis of retrieved human tantalum augmentations

Porous tantalum rods for treating osteonecrosis of the femoral head

Femoral head osteonecrosis: Why choose free vascularized fibula grafting

Contact Info

Product

Resources

About