Relationship between polyethylene wear, pelvic osteolysis, and clinical symptomatology in patients with cementless acetabular components

Hozack, William J.; Mesa, Joseph J.; Carey, Christopher; Rothman, Richard H.

doi:10.1016/s0883-5403(96)80175-6

Cited by 100 publications

(45 citation statements)

References 10 publications

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“…3,4 The use of a larger femoral head has been historically avoided because of the association with increased polyethylene (PE) wear, 5 and thus the potential to contribute to implant loosening. 6 Altthough an increase in the head size, for a given shell size, will lead to an increase in bearing contact area and a subsequent decrease in contact pressure, there is also a concurrent increase in the sliding distance at the articulating surface, which could elevate the overall wear. Because highly crosslinked PE has demonstrated significantly reduced wear rates compared to conventional PE, [7][8][9][10] large femoral heads could be used effectively with thinner highly crosslinked PE.…”

mentioning

confidence: 99%

Biomechanical modeling of acetabular component polyethylene stresses, fracture risk, and wear rate following press‐fit implantation

Ong

Rundell

Liepins

et al. 2009

Journal Orthopaedic Research

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Press-fit implantation may result in acetabular component deformation between the ischial-ilial columns (''pinching''). The biomechanical and clinical consequences of liner pinching due to press-fit implantation have not been well studied. We compared the effects of pinching on the polyethylene fracture risk, potential wear rate, and stresses for two different thickness liners using computational methods. Line-to-line (''no pinch'') reaming and 2 mm underreaming press fit (''pinch'') conditions were examined for Trident cups with X3 TM polyethylene liner wall thicknesses of 5.9 mm (36E) and 3.8 mm (40E). Press-fit cup deformations were measured from a foam block configuration. A hybrid material model, calibrated to experimentally determined stress-strain behavior of sequentially annealed polyethylene, was applied to the computational model. Molecular chain stretch did not exceed the fracture threshold in any cases. Nominal shell pinch of 0.28 mm was estimated to increase the volumetric wear rate by 70% for both cups and peak contact stresses by 140 and 170% for the 5.9 and 3.8 mm-thick liners, respectively. Although pinching increases liner stresses, polyethylene fracture is highly unlikely, and the volumetric wear rates are likely to be low compared to conventional polyethylene. ß

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mentioning

confidence: 99%

Biomechanical modeling of acetabular component polyethylene stresses, fracture risk, and wear rate following press‐fit implantation

Ong

Rundell

Liepins

et al. 2009

Journal Orthopaedic Research

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“…We found high functional scores and no differences between the patients with and without these MRI findings. Periprosthetic osteolysis has been described by Marshall et al [32] as ''a silent disease that can progress without symptoms until catastrophic structural failure or mechanical loosening of the implant components occur,'' and this claim has been substantiated in other studies [12,18,21]. If this reactive synovitis does represent early particle disease, it should not be unexpected that we failed to associate its presence to clinical outcomes at this early stage.…”

Section: Discussionmentioning

confidence: 64%

Early Reactive Synovitis and Osteolysis after Total Hip Arthroplasty

Cooper

Ranawat

Potter

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Background Little is known about intraarticular pathology following THA prior to the radiographic appearance of osteolysis, primarily due to imaging limitations. MRI has recently been applied to imaging the postarthroplasty hip with the ability to detect periarticular bony and soft tissue pathology; specifically, it is able to detect abnormal synovial patterns and focal bone loss well before the radiographic appearance of osteolysis. Questions/purposes We therefore used MRI to determine the incidence of early reactive synovitis and osteolysis in asymptomatic patients after THA, and whether there is an association between these MRI findings and clinical outcomes or radiographic wear measurements at this early stage. Methods We recruited 31 patients (33 hips) who underwent routine noncemented THA with one of three types of bearing surfaces: metal-on-cross-linked polyethylene (n = 7), ceramic-on-ceramic (n = 12), and ceramic-on-cross-linked polyethylene (n = 14). Patients underwent specialized MRI at a minimum of 12 months (mean, 23 months; range, 12-37 months) after surgery. MR images were analyzed for the presence of synovitis or osteolysis. WOMAC scores, patient assessment questionnaires, and radiographic wear measurements were correlated with MRI findings. Results Reactive synovitis was observed in 13 of 33 patients (39%) and focal osteolysis in one of 33 (3%). The presence of synovitis did not correlate with pain, activity level, patient satisfaction or clinical outcome scales, nor did it correlate with radiographic wear measurements at early followup. Conclusions Our observations suggest reactive synovitis is common yet asymptomatic at short-term followup. We do not know either the etiology or the long-term implications of these observations.

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“…Progressive osteolysis is a threat to the longevity of a hip arthroplasty and regular followup of patients with serial radiographs ensures changes are monitored even in the absence of symptoms [4,19,39,43]. The measurement of the area of osteolysis on radiographs has not been achieved easily [9,12].…”

Section: Discussionmentioning

confidence: 99%

“…It may develop silently [1,22], but the associated deterioration of the host bone predisposes the patient to periprosthetic fracture or aseptic loosening and may compromise the success of a revision procedure [19,43]. Consequently, periodic review of patients is recommended and should include radiographs to record progressive changes [4,22,28].…”

Section: Introductionmentioning

confidence: 99%

Use of Morphometry to Quantify Osteolysis after Total Hip Arthroplasty

Smith

Cramp

Palmer

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Background Progressive osteolysis threatens the longevity of hip arthroplasties and radiographic review is recommended. Measurement of osteolytic lesions in a clinical setting has not been achieved easily in the past. Other radiologic investigations provide accurate information but cost and risk to the patient prohibit their use in routine review. Questions/purposes We developed a simple, reliable tool to be used in hip arthroplasty review to quantify osteolytic changes seen on plain film radiographs. Methods A morphometric grid was developed and tested on simulated and actual osteolytic lesions. Four health professionals measured lesions on each of two occasions. Intraclass correlation coefficients (ICC) for interobserver and intraobserver reliabilities were calculated and BlandAltman plots were constructed for graphic analysis. ResultsThe ICCs for interobserver reliability on the simulated and actual osteolytic lesions were in the range 0.90 to 0.96. The values for intraobserver (test-retest) reliability were 0.97 to 0.98. The Bland-Altman plots confirmed agreement and in each case, proximity of the mean to zero indicated no significant bias. Conclusions The data show a morphometric grid is reliable for measuring osteolytic changes after hip arthroplasty. Clinical Relevance This tool has potential to improve monitoring processes for hip arthroplasty and to be useful in future research studies. Additional work is needed to test for validity and clinical importance of the measurements obtained.

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Relationship between polyethylene wear, pelvic osteolysis, and clinical symptomatology in patients with cementless acetabular components

Cited by 100 publications

References 10 publications

Biomechanical modeling of acetabular component polyethylene stresses, fracture risk, and wear rate following press‐fit implantation

Biomechanical modeling of acetabular component polyethylene stresses, fracture risk, and wear rate following press‐fit implantation

Early Reactive Synovitis and Osteolysis after Total Hip Arthroplasty

Use of Morphometry to Quantify Osteolysis after Total Hip Arthroplasty

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