- Email: [email protected]
Adverse reaction to local metal debris does not always come from metal on metal bearing wear
S92
Résumés des communications particulières / Revue de chirurgie orthopédique et traumatologique 103S (2017) S27–S145
Déclaration de liens d’intérêts de liens d’intérêts.
Les auteurs déclarent ne pas avoir
https://doi.org/10.1016/j.rcot.2017.09.161 CO-147
Adverse reaction to local metal debris does not always come from metal on metal bearing wear La réaction locale aux débris métalliques n’est pas toujours secondaire à l’usure des surfaces de friction métal sur métal Pascal-André Vendittoli ∗ , Martin Lavigne , Daniel Lusignan 4403 rue Saint-Hubert, Montréal, Canada ∗ Corresponding author. E-mail address: [email protected] (P.-A. Vendittoli) Introduction Abnormal metal ion release from wear of metal-onmetal (MoM) bearing in total hip arthroplasty (THA) is associated with adverse local reactions to metal debris (ARMD). Metal particles may also arise from wear and corrosion of the implant’s modular junction. The aim of this study was to compare ion levels and rate of ARMD between patients with THA sharing the same MoM bearing but one group having monoblock stems versus another group having modular stems. Matériel et méthodes This study included 45 patients who underwent primary MoM THA using the same acetabular component and large diameter metallic modular femoral head. 32 hips received a modular stem and 13 hips received a monoblock stem. Cobalt (Co) and chromium (Cr) ion concentrations, ARMD rate and function measured by UCLA and WOMAC scores were compared between groups. Résultats ARMD rate was significantly lower in the monoblock group (16%) compared to the modular group (46%, P = 0.031). Revision for ARMD was performed at 115 ± 5.9 months after primary THA in the monoblock group versus 63 ± 2.3 months in the modular group. ARMD cases had severe wear and corrosion of the junction between stem and femoral head trunnion in all monoblock cases and the junction between stem and modular neck in all the modular ones. Cr and Co ions levels were significantly lower in the monoblock stem group: 2.0 ± 1.0 g/L vs. 7.2 ± 11.4 g/L (P < 0.001) for Cr and 6.3 ± 31.2 g/L vs. 11.4 ± 11.6 g/L (P < 0.001) for Co. There were no differences between groups in functional evaluation. Discussion The rate of ARMD was significantly higher in the modular stem group and this group required revision earlier. Although both groups had MoM bearings, corrosion at stem/neck or neck/head junctions were seen as the source of excessive metal ions release lea. Conclusion In the presence of ARMD, MoM bearing wear may not be the main source of failure. Modular junction’s poor performances may be more deleterious than the bearing. To avoid such complication, THA femoral stem modular junctions should be eliminated (return to a full monoblock implant) or have improved junction design. Disclosure of interest Recherches cliniques/travaux scientifiques : oui [Medacta, Microport, Stryker, Smith and Nephew, Zimmer]. Consultant, expert : oui [Medacta, Microport, Stryker]. Cours, formations : oui [Medacta, Microport, Stryker]. Détention d’un brevet ou inventeur d’un produit : oui [Micrioport]. https://doi.org/10.1016/j.rcot.2017.09.162 CO-148
Early results of 500 primary total hip arthroplasties with a large diameter bearing ceramic monoblock acetabular components Résultats encourageants du couple céramique de grand diamètre avec un implant acétabulaire monobloc
Pascal-André Vendittoli ∗ , Jihad Matta , Martin Lavigne , Vincent Massé , Pascal Mailhot , Alain Roy 4403, rue Saint-Hubert, Montréal, Canada ∗ Corresponding author. E-mail address: [email protected] (P.-A. Vendittoli) Introduction Ceramic on ceramic (CoC) bearings in total hip arthroplasty (THA) with 32 or 36 mm head sizes have good reported long-term track record. Current manufacturing advancement allow the use of larger head diameters with ceramic monoblock acetabular components. We present the early results of 500 delta ceramic monoblock acetabular components THA with a minimum of 2 years follow up. Matériel et méthodes We report the radiographic and clinical follow up of our first consecutive 500 primary THAs where a delta ceramic large diameter bearing monoblock acetabular component was implanted. The acetabular component consists of a titanium (Ti) shell with a biolox delta ceramic liner inserted & locked into the cup by the manufacturer. The bearing diameters corresponds with the acetabular component’s size (36–48 mm). Résultats The 500 components have been implanted in 442 patients (250 women, 192 men) with a mean age of 55y. The mean acetabular and femoral head sizes were 54 mm and 44 mm. At a minimum of 2y follow-up (mean 3.8y): 5 (1%) patients have been revised. Causes for revision were: 4 peroperative, undetected, fractures of the femur and only 1 due to early displacement of the acetabular component (0.2%). Other adverse events without revision were: 12 (2.4%) cases of intermittent squeaking which resolved spontaneously, 4 (0.8%) occasional clicking and 1 (0.2%) symptomatic heterotopic ossification. Three (0.6%) suffered from infection. Two (0.4%) had a traumatic hip dislocation without recurrence after closed reduction. The mean postoperative UCLA score was 6.9. The WOMAC score improved from 57.4 to 4.4 postoperatively (P < 0.001). Sixty-one percent of patients perceived their joint as either ‘natural’ or ‘artificial without limitation’. No ceramic component fracture was recorded. Discussion Early problems reported with CoC are intraoperative liner fracture (handling problem) or postoperative implant fracture secondary to poor taper junction or implant impingement. Noise generation was also a significant problem with some devices. Our resul. Conclusion This prospective study shows the excellent early results of a new design delta ceramic monoblock acetabular component with large diameter CoC bearing which is an alternative to large femoral head metal on metal implants to avoid adverse local reaction to metal debris. Disclosure of interest Recherches cliniques/travaux scientifiques : oui [Medacta, Microport, Stryker, Zimmer]. Consultant, expert : oui [Medacta, Microport, Stryker]. Cours, formations : oui [Medacta, Microport, Stryker]. Détention d’un brevet ou inventeur d’un produit : oui [Microport]. https://doi.org/10.1016/j.rcot.2017.09.163 CO-149
Évaluation IRM des muscles périarticulaires après prothèse totale de hanche, pertinence du choix de la coupe MRI evalution of the hip muscles in patients with total hip arthroplasty, relevance of axial or frontal CT-plane choice Rémy Coulomb ∗ , Pierre Emmanuel Chammas , Olivier Mares , Nicolas Cellier , Gérard Asencio , Pascal Kouyoumdjian 683, chemin du Golf-de-Vacquerolles, 30900 Nîmes, France ∗ Auteur correspondant. Adresse e-mail : [email protected] (R. Coulomb) Introduction La compréhension des modifications musculaires après prothèse totale de la hanche (PTH) est capitale pour son ana-
Résumés des communications particulières / Revue de chirurgie orthopédique et traumatologique 103S (2017) S27–S145
Déclaration de liens d’intérêts de liens d’intérêts.
Les auteurs déclarent ne pas avoir
https://doi.org/10.1016/j.rcot.2017.09.161 CO-147
Adverse reaction to local metal debris does not always come from metal on metal bearing wear La réaction locale aux débris métalliques n’est pas toujours secondaire à l’usure des surfaces de friction métal sur métal Pascal-André Vendittoli ∗ , Martin Lavigne , Daniel Lusignan 4403 rue Saint-Hubert, Montréal, Canada ∗ Corresponding author. E-mail address: [email protected] (P.-A. Vendittoli) Introduction Abnormal metal ion release from wear of metal-onmetal (MoM) bearing in total hip arthroplasty (THA) is associated with adverse local reactions to metal debris (ARMD). Metal particles may also arise from wear and corrosion of the implant’s modular junction. The aim of this study was to compare ion levels and rate of ARMD between patients with THA sharing the same MoM bearing but one group having monoblock stems versus another group having modular stems. Matériel et méthodes This study included 45 patients who underwent primary MoM THA using the same acetabular component and large diameter metallic modular femoral head. 32 hips received a modular stem and 13 hips received a monoblock stem. Cobalt (Co) and chromium (Cr) ion concentrations, ARMD rate and function measured by UCLA and WOMAC scores were compared between groups. Résultats ARMD rate was significantly lower in the monoblock group (16%) compared to the modular group (46%, P = 0.031). Revision for ARMD was performed at 115 ± 5.9 months after primary THA in the monoblock group versus 63 ± 2.3 months in the modular group. ARMD cases had severe wear and corrosion of the junction between stem and femoral head trunnion in all monoblock cases and the junction between stem and modular neck in all the modular ones. Cr and Co ions levels were significantly lower in the monoblock stem group: 2.0 ± 1.0 g/L vs. 7.2 ± 11.4 g/L (P < 0.001) for Cr and 6.3 ± 31.2 g/L vs. 11.4 ± 11.6 g/L (P < 0.001) for Co. There were no differences between groups in functional evaluation. Discussion The rate of ARMD was significantly higher in the modular stem group and this group required revision earlier. Although both groups had MoM bearings, corrosion at stem/neck or neck/head junctions were seen as the source of excessive metal ions release lea. Conclusion In the presence of ARMD, MoM bearing wear may not be the main source of failure. Modular junction’s poor performances may be more deleterious than the bearing. To avoid such complication, THA femoral stem modular junctions should be eliminated (return to a full monoblock implant) or have improved junction design. Disclosure of interest Recherches cliniques/travaux scientifiques : oui [Medacta, Microport, Stryker, Smith and Nephew, Zimmer]. Consultant, expert : oui [Medacta, Microport, Stryker]. Cours, formations : oui [Medacta, Microport, Stryker]. Détention d’un brevet ou inventeur d’un produit : oui [Micrioport]. https://doi.org/10.1016/j.rcot.2017.09.162 CO-148
Early results of 500 primary total hip arthroplasties with a large diameter bearing ceramic monoblock acetabular components Résultats encourageants du couple céramique de grand diamètre avec un implant acétabulaire monobloc
Pascal-André Vendittoli ∗ , Jihad Matta , Martin Lavigne , Vincent Massé , Pascal Mailhot , Alain Roy 4403, rue Saint-Hubert, Montréal, Canada ∗ Corresponding author. E-mail address: [email protected] (P.-A. Vendittoli) Introduction Ceramic on ceramic (CoC) bearings in total hip arthroplasty (THA) with 32 or 36 mm head sizes have good reported long-term track record. Current manufacturing advancement allow the use of larger head diameters with ceramic monoblock acetabular components. We present the early results of 500 delta ceramic monoblock acetabular components THA with a minimum of 2 years follow up. Matériel et méthodes We report the radiographic and clinical follow up of our first consecutive 500 primary THAs where a delta ceramic large diameter bearing monoblock acetabular component was implanted. The acetabular component consists of a titanium (Ti) shell with a biolox delta ceramic liner inserted & locked into the cup by the manufacturer. The bearing diameters corresponds with the acetabular component’s size (36–48 mm). Résultats The 500 components have been implanted in 442 patients (250 women, 192 men) with a mean age of 55y. The mean acetabular and femoral head sizes were 54 mm and 44 mm. At a minimum of 2y follow-up (mean 3.8y): 5 (1%) patients have been revised. Causes for revision were: 4 peroperative, undetected, fractures of the femur and only 1 due to early displacement of the acetabular component (0.2%). Other adverse events without revision were: 12 (2.4%) cases of intermittent squeaking which resolved spontaneously, 4 (0.8%) occasional clicking and 1 (0.2%) symptomatic heterotopic ossification. Three (0.6%) suffered from infection. Two (0.4%) had a traumatic hip dislocation without recurrence after closed reduction. The mean postoperative UCLA score was 6.9. The WOMAC score improved from 57.4 to 4.4 postoperatively (P < 0.001). Sixty-one percent of patients perceived their joint as either ‘natural’ or ‘artificial without limitation’. No ceramic component fracture was recorded. Discussion Early problems reported with CoC are intraoperative liner fracture (handling problem) or postoperative implant fracture secondary to poor taper junction or implant impingement. Noise generation was also a significant problem with some devices. Our resul. Conclusion This prospective study shows the excellent early results of a new design delta ceramic monoblock acetabular component with large diameter CoC bearing which is an alternative to large femoral head metal on metal implants to avoid adverse local reaction to metal debris. Disclosure of interest Recherches cliniques/travaux scientifiques : oui [Medacta, Microport, Stryker, Zimmer]. Consultant, expert : oui [Medacta, Microport, Stryker]. Cours, formations : oui [Medacta, Microport, Stryker]. Détention d’un brevet ou inventeur d’un produit : oui [Microport]. https://doi.org/10.1016/j.rcot.2017.09.163 CO-149
Évaluation IRM des muscles périarticulaires après prothèse totale de hanche, pertinence du choix de la coupe MRI evalution of the hip muscles in patients with total hip arthroplasty, relevance of axial or frontal CT-plane choice Rémy Coulomb ∗ , Pierre Emmanuel Chammas , Olivier Mares , Nicolas Cellier , Gérard Asencio , Pascal Kouyoumdjian 683, chemin du Golf-de-Vacquerolles, 30900 Nîmes, France ∗ Auteur correspondant. Adresse e-mail : [email protected] (R. Coulomb) Introduction La compréhension des modifications musculaires après prothèse totale de la hanche (PTH) est capitale pour son ana-