Performance of the resurfaced hip. Part 1: the influence of the prosthesis size and positioning on the remodelling and fracture of the femoral neck

Hip resurfacing is an established treatment for osteoarthritis in young active patients. Failure modes include femoral neck fracture and prosthesis loosening, which may be associated with medium-term bone adaptation, including femoral neck narrowing and densification around the prosthesis stem.Finite element modelling was used to indicate the effects of prosthesis sizing and positioning on the bone remodelling and fracture strength under a range of normal and traumatic loads, with the aim of understanding these failure modes better.The simulations predicted increased superior femoral neck stress shielding in young patients with small prostheses, which required shortening of the femoral neck to give an acceptable implant–bone interface. However, with a larger prosthesis, natural femoral head centre recreation in the implanted state was possible; therefore stress shielding was restricted to the prosthesis interior, and its extent was less sensitive to prosthesis orientation. With valgus orientation, the implanted neck strength was, at worst, within 3 per cent of its intact strength.The study suggests that femoral neck narrowing may be linked to a reduction in the horizontal femoral offset, occurring if the prosthesis is excessively undersized. As such, hip resurfacing should aim to reproduce the natural femoral head centre, and, for valgus prosthesis orientation, to avoid femoral neck fracture

Different Loading Times for Dental Implants: No Clinically Important Differences?

Data sources The Cochrane Oral Health Group\u27s Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline, and Embase databases were searched. Reference lists of identified articles were also scanned for relevant papers. There were no restrictions on language or date of publication. Study selection Randomised controlled trials (RCTs) of parallel group design and of split-mouth design including root-form osseointegrated dental implants having a follow-up of four months to one year after loading were included. Data extraction and synthesis Data were independently extracted, in duplicate, by at least two review authors. The outcome measures were prosthesis and implant failures and radiographic marginal bone level changes. Risk of bias was assessed for each trial by at least two review authors. Results were combined using fixed-effect models with mean differences (MD) for continuous outcomes and risk ratios (RR) for dichotomous outcomes with 95% confidence intervals (CI). Results Twenty-six trials involving a total of 1217 participants and 2120 implants were included. The risk of bias was low in three trials, high in 12 and unclear for the remaining eleven. In nine studies there were no prosthetic failures within the first year, with no implant failures in seven studies and the mean rate of implant failure in all 26 trials was a low 2.5%. From 15 RCTs comparing immediate with conventional loading there was no evidence of a difference in either prosthesis failure (RR 1.87; 95% CI 0.70 to 5.01; 8 trials) or implant failure (RR 1.65; 95% CI 0.68 to 3.98; 10 trials) in the first year. However, there is some evidence of a small reduction in bone loss favouring immediate loading (MD -0.10 mm; 95% CI -0.20 to -0.01; P = 0.03; 9 trials), but this very small difference may not be clinically important. From three RCTs which compared early loading with conventional loading, there is insufficient evidence to determine whether or not there is a clinically important difference in prosthesis failure, implant failure or bone loss. Six RCTs compared immediate and early loading and found insufficient evidence to determine whether or not there is a clinically important difference in prosthesis failure, implant failure or bone loss. From the two trials that compared occlusal loading with non-occlusal loading there is insufficient evidence to determine whether there is a clinically important difference in the outcomes of prosthesis failure, implant failure or bone loss. No trials were identified which evaluated progressive loading of implants. Conclusions Overall there was no convincing evidence of a clinically important difference in prosthesis failure, implant failure or bone loss associated with different loading times of implants. More well-designed RCTs are needed and should be reported according to the CONSORT guidelines

Explant Analysis of Total Disc Replacement

Explant analysis of human disc prostheses allow early evaluation of the host response to the prosthesis and the response of the prosthesis from the host. Furthermore, early predictions of failure and wear can be obtained. Thus far, about 2-3% of disc prostheses have been removed. Observed wear patterns are similar to that of appendicular prostheses including abrasions/scratching, burnishing, surface deformation, fatigue, and embedded debris. Chemically the polymeric components have shown little degradation in short-term implantation. In metal on metal prostheses the histologic responses consist of large numbers of metallic particles with occasional macrophages and giant cells. Only rare cases of significant inflammatory response from polymeric debris have been seen

The Effects of Interlocking a Universal Hip Cementless Stem on Implant Subsidence and Mechanical Properties of Cadaveric Canine Femora.

ObjectiveTo determine if an interlocking bolt would limit subsidence of the biological fixation universal hip (BFX(®)) femoral stem under cyclic loading and enhance construct stiffness, yield, and failure properties.Study designEx vivo biomechanical study.AnimalsCadaveric canine femora (10 pairs).MethodsPaired femora implanted with a traditional stem or an interlocking stem (constructs) were cyclically loaded at walk, trot, and gallop loads while implant and bone motions were captured using kinematic markers and high-speed video. Constructs were then loaded to failure to evaluate failure mechanical properties.ResultsImplant subsidence was greater (P = .037) for the traditional implant (4.19 mm) than the interlocking implant (0.78 mm) only after gallop cyclic loading, and cumulatively after walk, trot, and gallop cyclic loads (5.20 mm vs. 1.28 mm, P = .038). Yield and failure loads were greater (P = .029 and .002, respectively) for the interlocking stem construct (1155 N and 2337 N) than the traditional stem construct (816 N and 1405 N). Version angle change after cyclic loading was greater (P = .020) for the traditional implant (3.89 degrees) than for the interlocking implant (0.16 degrees), whereas stem varus displacement at failure was greater (P = .008) for the interlocking implant (1.5 degrees) than the traditional implant (0.17 degrees).ConclusionAddition of a stabilizing bolt enhanced construct stability and limited subsidence of a BFX(®) femoral stem. Use of the interlocking implant may decrease postoperative subsidence. However, in vivo effects of the interlocking bolt on osseointegration, bone remodeling, and stress shielding are unknown

On the Analysis of the Contact Conditions in Temporomandibular Joint Prostheses

Temporomandibular joint replacement (TMJR) is a complex surgical procedure in which the artificial joints available must assure the anatomical reconstruction and guarantee a good range of the natural temporomandibular joint (TMJ) movements. With this aim, different types of TMJ prostheses, including the stock prosthetic system and custom-made prostheses, are being currently implanted. Although temporomandibular joint replacements (TMJRs) are expected to accomplish their function during a number of years, they might actually fail and need to be replaced. This paper analyzes different design factors affecting the contact stress distributions within the TMJ prosthesis interface, which are consequently involved in their deterioration and final failure of the prosthetic device. With this purpose, a numerical model based on finite elements has been carried out in order to evaluate the stress states attained in different prosthesis configurations corresponding to general types of TMJ prostheses. On the other hand, the actual degradation of resected implants has been evaluated via optical microscopy. The linkage between the numerical simulations performed and experimental evidence allowed the authors to establish the different wear and damage mechanisms involved in the failure of stock TMJ prostheses. Indeed, the results obtained show that the contact stresses at the interface between the mandible and the glenoid fossa components play a key role in the failure process of the TMJR devices

Prosthetic joint infections

Objectives: To review the available literature on prosthetic joint infections and provide recommendations on management particularly the importance of identifying the causative organism and starting the most appropriate antimicrobial therapy. Methods: The medical literature was searched using PubMed, employing the key words prosthetic joint infections. There appears to be no UK consensus guidelines on the management of prosthetic joint infections or the use of prophylactic antibiotics to prevent them. There is however a number of key documents and trust policies which deal with the subject extensively. We also made use of ‘The Sanford Guide to Antimicrobial therapy 2012’ for the latest recommendations on the correct antimicrobial therapy. Conclusion: Although diagnosis is often difficult, there are a number of investigations which can help us identify the organism. We recommend that the local prevalence of such infections is studied together with identification of the commonest organisms. Work is already underway between the infectious disease team and orthopaedic surgeons to devise locally adapted protocols for the identification and management of such infections. They should work in close liaison to implement the correct treatment which often involves a combination of both surgical and antimicrobial therapy.peer-reviewe

Recent Approaches for the Manufacturing of Polymeric Cranial Prostheses by Incremental Sheet Forming

This paper presents recent research experiences developed with the aim of manufacturing cranial prostheses in polymeric sheet using Incremental Sheet Forming (ISF) technologies. With this purpose, different approaches have been carried out in Single-Point Incremental Forming (SPIF) and Two-Point Incremental Forming (TPIF) in order to produce customized cranial implants using different polymeric materials. In this context, this research work provides a methodology to design and manufacture polymer customized cranial prostheses using the ISF technologies starting from a patient’s computerized tomography (CT). The results demonstrate the potential of manufacturing polymeric cranial prostheses by ISF in terms of the high formability achievable and show the appropriate geometrical accuracy at affordable manufacturing costs provided by these processes.Ministerio de Economía y Competitividad DPI2015-64047-

Mechanical Behavior and Failure Analysis of Prosthetic Retaining Screws after Long‐term Use In Vivo. Part 1: Characterization of Adhesive Wear and Structure of Retaining Screws

Purpose: The general aim of this study and those presented in Parts 2–4 of this series was to characterize the structure, properties, wear, and fracture of prosthetic retaining screws in fixed detachable hybrid prostheses after long‐term use in vivo. This part of the overall investigation addresses whether there are differences in thread wear between the screws closest to the fulcrum and those that are farthest from the fulcrum in fixed detachable hybrid prostheses. Materials and Methods: The total number of prosthetic retaining screws used in this study was 100 (10 new and 90 used). New screws (controls) from Nobel Biocare (NB) were divided into Group 1 (slotted) and Group 2 (hexed). Ninety used screws (in service 18–120 months) were retrieved from fixed detachable hybrid prostheses in 18 patients (5 screws from each patient, 60 from NB and 30 from Sterngold). The used screws were divided into 18 groups. Additionally, each group was subdivided into A and B categories. Category A contained the middle three prosthetic screws, which were considered the farthest screws from the fulcrum line. Category B contained the most posterior two screws, which were considered the screws closest to the fulcrum line. All 100 screws were subjected to thorough, nondestructive testing. Results: Light and scanning electron microscopic examination of all used screws for each group revealed surface deterioration of the active profile of the screw threads consistent with adhesive wear. The observed thread profile deterioration ranged from mild to severe. The wear was aggressive enough to cause galling, which led to thinning of the threads and, in severe cases, to knife‐edges at thread crests. In ten groups, the most anterior three screws exhibited more wear than the most posterior two screws. In addition to thread wear, severe plastic deformation was detected on the bottom part of each screw for three groups, and a long external longitudinal crack was detected in one screw of Group 2. Conclusions: The findings of this study and those presented in Parts 2–4 demonstrate that different retaining screws from the same manufacturer and/or from different manufacturers have different geometrical design, microstructures, major alloy constituents, and microhardness, and that these differences influence their preload and fractured load values. In this part of the overall investigation, the occurrence of galling as a result of wear involving prosthetic retaining screws appears to be an inevitable and unavoidable consequence of long‐term use in vivo in fixed detachable hybrid prostheses regardless of the intended/original preload value. The galling rate is greater on the middle three screws compared to the most posterior two screws in fixed detachable hybrid prostheses. The wear pattern is consistent with an adhesive wear mechanism; however, this study does not provide enough data to support a definitive analysis