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Jannelli E, Boggio E, Castelli A, Pasta G, Grassi FA, Mosconi M. Trabecular titanium acetabular cup in patients with medial femoral neck fracture: Survivorship analysis and clinical and radiological outcomes. World J Orthop 2025; 16:100481. [DOI: 10.5312/wjo.v16.i3.100481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2024] [Revised: 12/08/2024] [Accepted: 02/19/2025] [Indexed: 03/12/2025] Open
Abstract
BACKGROUND Clinical studies using Trabecular Titanium™ acetabular cups have shown promising short and medium-term results. This material, due to its macro and micro surface roughness, provides a substrate for osseointegration and enhances implant stability. However, there is a lack of evidence in the literature on the use of this material in patients with femoral neck fracture.
AIM To evaluate the short-term clinical-functional and radiographic outcomes in patients with femoral neck fractures undergoing total hip arthroplasty (THA) with Trabecular Titanium™ acetabular cup implants.
METHODS The study included 104 patients with medial femoral neck fractures who underwent THA between January 2020 and December 2020 with the Delta TT acetabular cup (Lima Corporate, Villanova di San Daniele del Friuli, Italy). The mean age of the patients was 69.57 ± 10.16 years (range: 36-85 years). The follow-up period ranged from a minimum of 3 to a maximum of 4 years. Three questionnaires (Harris Hip Score, Oxford Hip Score, and EQ5D) were administered along with radiographic evaluations. Statistical methods included the Student's t-test and one-way analysis of variance for comparisons (with significance set at 0.05), and the Kaplan-Meier curve for prosthetic implant survival.
RESULTS The mean follow-up was 41.5 months. The Harris Hip Score (HHS) showed a mean increase of 2.74 points (mean HHS 88.52 at 6 months postoperatively and mean HHS 91.26 at the last follow-up) with statistical significance. Similarly, the Oxford Hip Score demonstrated a statistically significant difference between follow-up groups. However, the EQ5D did not show statistically significant differences among the three groups (preoperative, 6-month follow-up, and last follow-up). Revision surgery was required in 6 patients. According to Moore's criteria, 96% of the acetabular components were radiographically stable and well-integrated at the last follow-up. The Kaplan-Meier curve showed a 96% survival rate.
CONCLUSION The clinical and radiographic results obtained in the short to medium term confirm the excellent performance of the Delta TT acetabular cup in terms of osseointegration, providing an optimal solution both for young patients with high functional recovery demands and for fragile patients requiring optimal stability of the acetabular component to reduce the risk of implant failure.
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Affiliation(s)
- Eugenio Jannelli
- Orthopedics and Traumatology Clinical Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia 27100, Lombardy, Italy
| | - Ester Boggio
- Orthopedics and Traumatology Clinical Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia 27100, Lombardy, Italy
| | - Alberto Castelli
- Department of Orthopedic and Traumatology Clinic, IRCCS Policlinico San Matteo Foundation, Pavia 27100, Lombardy, Italy
| | - Gianluigi Pasta
- Department of Orthopedic and Traumatology Clinic, IRCCS Policlinico San Matteo Foundation, Pavia 27100, Lombardy, Italy
| | - Federico Alberto Grassi
- Orthopedics and Traumatology Clinical Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia 27100, Lombardy, Italy
| | - Mario Mosconi
- Orthopedics and Traumatology Clinical Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia 27100, Lombardy, Italy
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Li W, Liu D, Liu X, Li X. Application of Intraoperative Individualized Cup Combination-Cup-on-Cup Technique in Severe Acetabular Defects. Orthop Surg 2024; 16:2853-2861. [PMID: 39311082 PMCID: PMC11541136 DOI: 10.1111/os.14248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 08/29/2024] [Accepted: 09/01/2024] [Indexed: 11/08/2024] Open
Abstract
This study aimed to investigate the application of the cup-on-cup technique in revision total hip arthroplasty (THA) and report clinical and radiographic outcomes from a series of case follow-ups. Retrospective analysis of 10 patients who underwent acetabular prosthesis revision with cup-on-cup technique. According to the Paprosky classification of acetabular bone defects, there were 2 cases of type II C, 3 cases of type III A, and 5 cases of type III B. The average follow-up was 54.8 ± 5.1 months, and the Harris score of the hip joint increased from 37.0 ± 9.9 preoperatively to 80.5 ± 3.1 postoperatively at the final follow-up (p < 0.001). Comparing the surgical side's hip center of rotation (COR) to the contralateral side, the preoperative average upward displacement was 33.8 ± 15.0 mm, while the postoperative average upward displacement was 0.2 ± 3.3 mm (p < 0.001). Similarly, the preoperative average inward displacement was 9.1 ± 5.1 mm, while the postoperative average outward displacement was 1.8 ± 1.6 mm (p < 0.001). There was no significant difference (p = 0.71) between the average density values of the contralateral and surgical sides at the final follow-up, which were 127.4 ± 13.7 and 125.0 ± 14.8, respectively. During the follow-up period, all patients achieved satisfactory radiographic outcomes, and no prosthetic loosening was observed. The cup-on-cup technique can reconstruct acetabular bone defects and restore hip COR in revision THA, with favorable clinical and radiographic outcomes.
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Affiliation(s)
- Weihua Li
- Orthopedic Hospital, The First Affiliated Hospital, Jiangxi Medical CollegeNanchang UniversityNanchangChina
- Artificial Joints Engineering and Technology Research Center of Jiangxi Province, The First Affiliated Hospital, Jiangxi Medical CollegeNanchang UniversityNanchangChina
| | - Daobi Liu
- JiuJiang No.171 HospitalJiujiangChina
| | - Xuqiang Liu
- Orthopedic Hospital, The First Affiliated Hospital, Jiangxi Medical CollegeNanchang UniversityNanchangChina
- Artificial Joints Engineering and Technology Research Center of Jiangxi Province, The First Affiliated Hospital, Jiangxi Medical CollegeNanchang UniversityNanchangChina
| | - Xiaofeng Li
- Orthopedic Hospital, The First Affiliated Hospital, Jiangxi Medical CollegeNanchang UniversityNanchangChina
- Artificial Joints Engineering and Technology Research Center of Jiangxi Province, The First Affiliated Hospital, Jiangxi Medical CollegeNanchang UniversityNanchangChina
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Ohta Y, Sugama R, Minoda Y, Mizokawa S, Takahashi S, Ikebuchi M, Nakatsuchi T, Nakamura H. Highly Porous Titanium Cups Frequently Presenting with Radiolucent Lines in Cementless Primary Total Hip Arthroplasty: A Retrospective Cohort Study. J Clin Med 2024; 13:3297. [PMID: 38893007 PMCID: PMC11173321 DOI: 10.3390/jcm13113297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/30/2024] [Accepted: 06/01/2024] [Indexed: 06/21/2024] Open
Abstract
Background/Objectives: A highly porous titanium cup with a three-dimensional metal interface was recently introduced to improve biological fixation and survival. However, radiography has revealed concerns regarding these cups, despite their excellent short- and mid-term clinical outcomes. This study compared the clinical and radiographic results of a highly porous titanium cup with those of a hydroxyapatite-coated porous titanium cup after primary total hip arthroplasty (THA). Methods: Fifty-one primary THAs were investigated. A highly porous titanium cup was used in 17 hips, and a hydroxyapatite-coated porous titanium cup was used in 34 hips. No significant differences in preoperative patient demographic characteristics were observed between the two groups. The 2-year postoperative clinical and radiographic results were compared. Results: Radiolucent lines were observed in 13 (76%) of 17 hips with highly porous titanium cups and in none (0%) of 34 hips with hydroxyapatite-coated porous titanium cups (p < 0.001). In the highly porous titanium cup group, radiolucent lines were observed in five hips (29%) in one zone, two hips (11%) in two zones, and six hips (35%) in three zones. No cup loosening was observed in either group. Conclusions: Radiolucent lines were significantly more frequent in highly porous titanium cups. This study suggests that, compared to the three-dimensional structure of porous titanium, the hydroxyapatite coating of porous titanium had a greater influence on bone ingrowth in the short term. The meaning of these findings in the long-term is unclear yet.
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Affiliation(s)
- Yoichi Ohta
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka 545-8585, Japan; (R.S.); (Y.M.); (S.M.); (S.T.); (M.I.); (H.N.)
| | - Ryo Sugama
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka 545-8585, Japan; (R.S.); (Y.M.); (S.M.); (S.T.); (M.I.); (H.N.)
| | - Yukihide Minoda
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka 545-8585, Japan; (R.S.); (Y.M.); (S.M.); (S.T.); (M.I.); (H.N.)
| | - Shigekazu Mizokawa
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka 545-8585, Japan; (R.S.); (Y.M.); (S.M.); (S.T.); (M.I.); (H.N.)
| | - Shinji Takahashi
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka 545-8585, Japan; (R.S.); (Y.M.); (S.M.); (S.T.); (M.I.); (H.N.)
| | - Mitsuhiko Ikebuchi
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka 545-8585, Japan; (R.S.); (Y.M.); (S.M.); (S.T.); (M.I.); (H.N.)
| | - Tamotsu Nakatsuchi
- Tsuji-geka Rehabilitation Hospital, 3-24 Ikutamamaemachi, Tennnouji-ku, Osaka 543-0072, Japan;
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka 545-8585, Japan; (R.S.); (Y.M.); (S.M.); (S.T.); (M.I.); (H.N.)
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Yoshida K, Fukushima K, Sakai R, Uchiyama K, Takahira N, Ujihira M. A novel primary stability test method for artificial acetabular shells considering vertical load during level walking and shell position. PLoS One 2024; 19:e0296919. [PMID: 38421998 PMCID: PMC10903903 DOI: 10.1371/journal.pone.0296919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 12/22/2023] [Indexed: 03/02/2024] Open
Abstract
Uncemented acetabular shell primary stability is essential for optimal clinical outcomes. Push-out testing, rotation testing, and lever-out testing are major evaluation methods of primary stability between the shell and bone. However, these test methods do not consider shell loads during daily activity and shell installation angle. This study proposes a novel evaluation method of acetabular shell primary stability considering load during level walking and acetabular installation angles such as inclination and anteversion. To achieve this, a novel primary stability test apparatus was designed with a shell position of 40° acetabular inclination and 20° anteversion. The vertical load, corresponding to walking load, was set to 3 kN according to ISO 14242-1, which is the wear test standard for artificial hip joints. The vertical load was applied by an air cylinder controlled by a pressure-type electro-pneumatic proportional valve, with the vertical load value monitored by a load cell. Torque was measured when angular displacement was applied in the direction of extension during the application of vertical load. For comparison, we also measured torque using the traditional lever-out test. The novel primary stability test yielded significantly higher primary stabilities; 5.4 times greater than the lever-out test results. The novel primary stability test failure mode was more similar to the clinical failure than the traditional lever-out test. It is suggested that this novel primary stability test method, applying physiological walking loads and extension motions to the acetabular shell, better reflects in vivo primary stability than the traditional lever-out test.
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Affiliation(s)
- Kazuhiro Yoshida
- Department of Medical Engineering and Technology, Kitasato University, Sagamihara, Kanagawa, Japan
| | - Kensuke Fukushima
- Department of Orthopaedic Surgery, Kitasato University, Sagamihara, Kanagawa, Japan
| | - Rina Sakai
- Department of Medical Engineering and Technology, Kitasato University, Sagamihara, Kanagawa, Japan
| | - Katsufumi Uchiyama
- Department of Orthopaedic Surgery, Kitasato University, Sagamihara, Kanagawa, Japan
| | - Naonobu Takahira
- Department of Orthopaedic Surgery, Kitasato University, Sagamihara, Kanagawa, Japan
| | - Masanobu Ujihira
- Department of Medical Engineering and Technology, Kitasato University, Sagamihara, Kanagawa, Japan
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Kaneko T, Nakamura S, Hayakawa K, Tokimura F, Miyazaki T. Clinical and radiological outcomes of total hip arthroplasty in octogenarian patients using a three-dimensional porous titanium cup: a retrospective analysis in Japanese patients. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2022:10.1007/s00590-022-03439-0. [PMID: 36414875 DOI: 10.1007/s00590-022-03439-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 11/14/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE Osteointegration of a three-dimensional (3D) porous titanium material has been experimentally proven, but only a few studies have shown the clinical outcomes of a 3D porous titanium cup in the Japanese elderly population. The purpose of this study was to compare the short-and-medium term clinical and radiographic results of total hip arthroplasty (THA) using a 3D porous titanium cup in patients aged ≥ 80 (octogenarians) versus those aged < 80 (younger controls). METHODS A total of 104 hips that underwent THA using a 3D porous titanium cup (SQRUM TT, Kyocera Medical) were enrolled in the study and were divided into two groups according to age: the octogenarian group (≥ 80, n = 42) and the younger control group (< 80, n = 62). Furthermore, we evaluated patient characteristics, clinical outcomes determined by the Japanese Orthopedic Association score, cup alignment, and incidence of radiolucent lines around the cup. RESULTS The mean follow-up period was 4.2 and 4.0 years (p = 0.29) for octogenarians and younger controls, respectively. The clinical outcomes were excellent, and no revision surgery occurred until the last follow-up in both groups. The number of patients with radiolucent lines at the final evaluation was 21 of 62 (33.9%) in younger controls and 16 of 42 (38.1%) in octogenarians. CONCLUSION THA with 3D porous titanium cup for octogenarians had similar clinical outcomes and incidence of radiolucent lines as those of younger controls, suggesting that the 3D porous titanium cup may be useful in THA for octogenarians. Further investigations will confirm its long-term outcomes.
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Affiliation(s)
- Taizo Kaneko
- Department of Orthopaedic Surgery, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Sakae-cho 35- 2, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Shinya Nakamura
- Department of Orthopaedic Surgery, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Sakae-cho 35- 2, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Kentaro Hayakawa
- Department of Orthopaedic Surgery, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Sakae-cho 35- 2, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Fumiaki Tokimura
- Department of Orthopaedic Surgery, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Sakae-cho 35- 2, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Tsuyoshi Miyazaki
- Department of Orthopaedic Surgery, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Sakae-cho 35- 2, Itabashi-ku, Tokyo, 173-0015, Japan.
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Botterill J, Khatkar H. The role of hydroxyapatite coating in joint replacement surgery - Key considerations. J Clin Orthop Trauma 2022; 29:101874. [PMID: 35515345 PMCID: PMC9062319 DOI: 10.1016/j.jcot.2022.101874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/13/2022] [Accepted: 04/19/2022] [Indexed: 10/18/2022] Open
Abstract
The use of a porous hydroxyapatite (HA) coating has definitively increased the durability and biocompatibility of joint replacement prostheses (JRP) since its introduction. This article will contextualise the properties of porous HA and relate these characteristics to its clinical function. Novel strategies to encourage osseointegration will also be explored, alongside their clinical relevance. All major literature databases were scrutinised for literature relevant to the scope of our review. The role of Hydroxyapatite was evaluated, alongside further strategies to augment bone ingrowth. HA coatings remain the most optimal coating for widespread clinical use. Advantages are conferred due to the method of application, the tribology and the biocompatibility of the material. Further strategies are available to augment bone ingrowth, pertaining to biological modifications and implantation of external factors. An evaluation of the literature has described the relative long term performance of the HA coated JRPs both in isolation and when compared with cemented prosthesis. Metanalyses have shown HA coated JRPs to perform as well as cemented prosthesis in terms of survivability over both short and long term follow ups. Concerning strategies to augment osseointegration, consideration should be given to form and function of the coating surface, as this provides the basis for cell adherence, proliferation, and differentiation.
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Affiliation(s)
- Jonathan Botterill
- Corresponding author. 35 Wall Brown Way, HP19 9BW, Aylesbury, United Kingdom.
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