Implant survival following primary total hip arthroplasty : With special interest in uncemented acetabular components and liners

Total hip arthroplasty (THA) isregarded as the operation of the century. A successful THA is a combination of adequate surgical technique with appropriate implants performed for carefully selected patients. Orthopedic devices are undergoing continual development towards longer survival and better outcomes. However, development is demanding and time-consuming, because complications can become apparent years after a successful THA. Arthroplasty registers allow us to analyze the survival of implants in large volumes of patients, detect outlier implants, and avoid complications. This study is based on the Finnish Arthroplasty register. The aims of this thesis were: 1) to compare implant survival and revision risk of a Continuum cup (ZimmerBiomet, Warsaw, USA) with other uncemented cup devices in primary THA; 2) assess the survivorship of ultraporous Tritanium cups (Mahwah, NJ, USA) compared to conventional uncemented cups in primary THA; 3) evaluate revision rates between vitamin E-infused polyethylene liners and moderately crosslinked polyethylene (ModXLPE) liners from the same manufacturer in primary THA; and 4) describe a case report of trunnion corrosion and component failure and clarify risk factors based on the current literature. We found the Continuum cup component to be associated with an increased risk of revision compared to other uncemented cups in primary THA, mainly due to revisions for dislocation. The risk of dislocation decreased when an elevated liner was used with the Continuum cup. The ultraporous-coated Tritanium cup component for primary THA did not provide an advantage over traditional uncemented cups and was associated with increased revision risk for aseptic loosening of the cup. Vitamin E-infused liners are a durable option; however, we were unable to detect any advantages of this material associated with decreased wear, and further studies with longer follow-up are needed. Mechanically assisted crevice corrosion of the trunnion is a multifactorial phenomenon. Affecting factors can be divided into patient-related, component-related, and surgery-related. Severe trunnion corrosion due to mechanically assisted crevice corrosion (MACC) is a rare complication.Lonkan tekonivelen kuppikomponentit ja liukupinnat ensivaiheen tekonivelleikkauksessa – tarkastelussa sementittömät kupit ja muoviliukupinnat Lonkan tekonivelleikkausta on pidetty yhtenä vuosisadan lääketieteellisistä toimenpiteistä. Oikea leikkaustekniikka yhdistettynä tarkoituksenmukaisiin tekonivelkomponentteihin tarkkaan valituilla potilailla on menestyksen edellytys. Tekoniveliin kehitetään jatkuvasti uusia ratkaisuja, joilla pyritään vähentämään komplikaatioita ja pidentämään tekonivelten elinkaarta, mutta kehitystyö on haastavaa ja aikaa vievää. Tämän tutkimuksen tarkoituksena oli analysoida lonkan tekonivelinnovaatioiden toimivuutta ja tuloksia. Erityisenä mielenkiinnon kohteena olivat sementittömät kuppikomponentit ja niissä käytettävät polyeteenistä valmistetut liukupinnat. Aineisto kerättiin Suomen Tekonivelrekisteristä. Vertasimme lonkan tekonivelen tantaalimetallisten Continuum -kuppikomponenttien sijoiltaanmenon ilmaantuvuutta suhteessa muihin yleisesti käytettyihin sementittömiin kuppikomponentteihin. Tutkimme titaanisen Tritanium kuppikomponentin uusintaleikkausmääriä suhteessa muihin sementittömiin primaari kuppikomponentteihin. Selvitimme lonkan tekonivelen E-vitamiinia sisältävän liukupinnan vaikutusta lonkkamaljan muoviliukupintaisten tekonivelten pysyvyyteen ja uusintaleikkausten syihin. Lisäksi raportoimme tapausselostuksen tekonivelen kartioliitoksen korroosiosta ja tekonivelen rikkoutumisesta ja sen riskitekijöistä kirjallisuuden ja oman tapauksemme perusteella. Tutkimuksessamme Continuum-kupeilla todettiin suurentunut riski uusintaleikkaukseen sijoiltaanmenon vuoksi. Korotettu liukupinta kuitenkin vähensi sijoiltaanmenon riskiä ja sen käyttö on suositeltavaa Continuum kuppia käytettäessä. Tritanium -kuppeihin liittyi tilastollisesti merkittävästi suurentunut uusintaleikkausriski kupin irtoamisen vuoksi. E-vitamiinia sisältävä polyeteeni liukupinta on kestävä valinta lonkan tekonivelleikkauksessa, mutta sen potentiaaliset edut eivät tulleet esiin 7 vuoden seuranta-aikana. Kartioliitoksen korroosio on monitekijäinen ilmiö, jonka riskitekijät voidaan jakaa potilaskohtaisiin, komponenttikohtaisiin ja toimenpidekohtaisiin

Accolade TMZF trunnion corrosion and mechanical failure 9 yr after primary surgery: A case report and treatment options

Preserving patient anatomy in total hip arthroplasty (THA) is important to achieve good functionality and satisfied patients. Modular femoral heads are designed to help achieve this aim by managing limb-length, offset, and soft-tissue balance. Normal anatomy can be more easily preserved, and acetabular component exposure is achieved with removal of the femoral head in revision surgery. However, modularity increases the risk for mechanically assisted crevice corrosion (MACC) (also called trunnion corrosion) and may lead to trunnionosis, adverse local tissue reaction (ALTR), early femoral head dissociation, and implant failure. MACC is a multifactorial and poorly understood phenomenon. Affecting factors can be divided into patient-related, component-related, and surgery-related factors. Patient-related factors include male gender and high body mass index (BMI). Component-related factors include stem design, high-offset implants, head-neck angle, femoral head diameter, and the metal alloy. Surgical-related factors include damage to the head-neck surfaces and inappropriate surgical technique. It has been estimated that 3% of all hip revision procedures worldwide are currently performed due to trunnion corrosion. Femoral head dissociation with implant failure still remains a rare complication, and there are only a few reports of that complication that have been published.The patient was informed that data concerning the case would be submitted for publication, and he provided consent.</p

No difference in implant survival between 28-mm M2a RingLoc metal-on-metal and metal-on-polyethylene total hip arthroplasty : results from the Finnish Arthroplasty Register

Publisher Copyright: © 2022 The Author(s).Background and purpose — Long-term outcome of small head (28 mm) metal-on-metal (MoM) total hip arthroplasty (THA) is available mainly for Metasul devices (Sulzer Medica, Winterthur, Switzerland). Biomet MoM THA was frequently used in Finland. Therefore, we assessed long-term survivorship of the M2a 28-mm RingLoc MoM THA (Biomet, Warsaw, IN, USA) and compared it with the metal-on-polyethylene (MoP) RingLoc THA from the same manufacturer. Patients and methods — We conducted a register study based on THAs from the Finnish Arthroplasty Register performed between January 1, 2000 and December 31, 2007. 290 28-mm head M2a MoM THAs and 1,647 28-mm head MoP THAs (reference group) were included. The endpoint was revision for any reason, or revision for aseptic loosening, osteolysis, liner wear, or metallosis as one group. Kaplan– Meier survival estimates were calculated, and revision risks were assessed using a Cox multiple regression model, both with 95% confidence intervals (CI). Results — No difference was found in the 15-year Kaplan–Meier survivorship between the 28-mm head M2a RingLoc MoM THA and the reference group for any reason for revision (87.7% [82.9–92.1] and 83.3% [81.0–85.3], respectively). The adjusted hazard ratio (HR) for any reason for revision for the MoM THA group compared with the reference group was at least equal or better (0.70 [0.48–1.02]). Both groups presented similar survival for revision for aseptic loosening of the cup, osteolysis, liner wear, or metallosis, at 96.2% (92.7–98.0) and 95.4% (93.9–96.5), respectively. Interpretation — In the long-term survival there was no difference between the M2a 28-mm RingLoc MoM THA and 28-mm MoP THA. Further follow-up regimens for M2a 28-mm RingLoc THA patients may be unnecessary, but long-term metal ion and radiological data is needed before any formal suggestions.Peer reviewe

Implant survival of 2,723 vitamin E-infused highly crosslinked polyethylene liners in total hip arthroplasty: data from the Finnish Arthroplasty Register

Background and purpose - The use of crosslinked polyethylene in total hip arthroplasty (THA) has decreased wear remarkably. It has been suggested that the antioxidative effects of vitamin E may enhance the wear properties of polyethylene even further. This study evaluates revision rates between vitamin E-infused polyethylene liners (E1 and E-poly, ZimmerBiomet, Warsaw, IN, USA) versus moderately crosslinked polyethylene (ModXLPE) liners from the same manufacturer used in primary THA.Patients and methods - We conducted a study based on data from the Finnish Arthroplasty Register. The study group consisted of 2,723 THAs with a vitamin E-infused liner and a reference group of 2,707 THAs with a moderately crosslinked polyethylene liner. Survivorship, revision risk, and re-revision causes were compared between groups.Results - The 7-year survival of the vitamin E-infused polyethylene liner group and of the reference group with revision for any reason as the endpoint was comparable (94% [95% CI 92.9-94.9] and 93% [CI 91.9-93.9], respectively). The adjusted hazard ratio (HR) for any revision was similar between the groups (0.7 [CI 0.4-1.1]). When revision for aseptic loosening was studied as the endpoint, the survival for the study group was 99% (CI 98.6-99.4) and for the reference group 99% (CI 98.7-99.5), and the risk of revision was comparable between the study groups (HR 1.3 [CI 0.7-2.5]).Interpretation - After an observation period of 7 years vitamin E-infused liners shows results equal to results obtained with crosslinked polyethylene liners

Implant Survival of 6,080 Tritanium Cups in Primary Total Hip Arthroplasty Data from the Finnish Arthroplasty Register from 2009 to 2017

Background: To enhance osseointegration in total hip arthroplasty (THA), ultraporous or highly porous-coated cups were introduced. Implant survival data on these new devices have been scarce. The aim of our study was to assess the survivorship of ultraporous Tritanium cups (Stryker) in a population-based register study.Methods: In this study, we collected data on 6,080 primary THAs using a Tritanium cup and 25,670 THAs using a conventional cup (control group) from the Finnish Arthroplasty Register; these procedures were performed from January 1, 2009, to December 31, 2017. We calculated the Kaplan-Meier survival estimates with 95% confidence intervals (CIs). The end point was revision for any reason or for aseptic loosening of the cup. The revision risks were assessed with use of the Cox multiple regression model. The variables assessed in the Cox model were femoral head size, age group, involved side, operation year, sex, diagnosis, and fixation of the stem. The proportional hazards assumption of the Cox model was not fulfilled, so the follow-up time was divided into 3 time periods: 0 to 2 years, >2 to 4 years, and >4 years.Results: When comparing the 2 groups with regard to revision for any reason, the 5-year Kaplan-Meier survivorship of the Tritanium group (94.7% [95% CI, 94.0% to 95.4%]) was inferior to that of the control group (96.0% [95% CI, 95.7% to 96.3%]). In the Cox regression analysis of the 2 groups for the time period of >4 years, the Tritanium group had an increased risk of revision for any reason compared with the control group (hazard ratio [HR], 3.12 [95% CI, 1.82 to 5.35]; p 2 to 4 years (HR, 11.2 [95% CI, 3.28 to 38.0]; p Conclusions: There was no advantage to using the ultraporous-coated Tritanium cup for primary THA compared with conventional uncemented cups. However, wide CIs for some HR estimates may point to a lack of precision. Therefore, further research on subject is needed.</div

Rintakipupotilaan hoidon osaaminen perustason sairaankuljetuksessa : Kuosce-hanke

Opinnäytetyö on osa Metropolia Ammattikorkeakoulun ja Keski-Uudenmaan pelastuslaitoksen yhteistyönä toteuttamaa KUOSCE-hanketta. Hankkeen tarkoituksena on tunnistaa sekä työelämässä, että ensihoitoalan koulutuksessa olevat keskeiset osaamisvajeet ja niiden kautta kehittää ja vahvistaa perustason sairaankuljettajien osaamista. Opinnäytetyön tarkoituksena on arvioida perustason sairaankuljettajien tiedollista osaamista rintakipupotilaan hoidossa aiemmin kehitetyn tietotestin perusteella sekä arvioida tietotestin käyttökelpoisuutta ja luotettavuutta. Tietotestiin vastasi 19 Keski-Uudenmaan pelastuslaitoksen työntekijää. Tuloksia tarkasteltiin SPSS-ohjelman avulla, ja niistä laadittiin pylväsdiagrammit. Vastausten vähäisen määrän vuoksi ei korrelaatioita taustamuuttujien ja tiedollisen osaamisen välillä pystytty osoittamaan. Vastaajien koulutus ja kokemus vaihteli. Suurin osa vastaajista työskenteli perustason sairaankuljetusyksikössä. Tiedollinen osaaminen vaihteli eri kysymysten välillä. Kolmeentoista väittämään kolmestakymmenestä kaikki osallistujat vastasivat oikein. Tietotestistä erottui viisi väittämää, joihin vastattiin selkeästi muita kysymyksiä enemmän väärin. Näistä kahteen vastattiin useammin väärin kuin oikein. Osa-alueista ensiarvion osaaminen oli parasta, huonoiten osattiin vastata hoidon vastetta koskeviin väittämiin. Pieni otoskoko vaikutti tietotestin luotettavuuden arviointiin. Tilastollisia tunnuslukuja ei laskettu, vaan testiä arvioitiin sanallisesti keskittyen niihin väittämiin, joihin moni vastasi väärin. Osa näistä kysymyksistä oli vaikeasti ymmärrettäviä tai niistä puuttui oleellisia tietoja, kun taas osa perustui selkeästi Keski-Uudenmaan pelastuslaitoksen hoito-ohjeisiin ja oli yksiselitteisiä. Tietotestiä pitäisi edelleen kehittää, jotta se olisi käyttökelpoinen perustason sairaankuljettajien osaamisen arviointiin. Väittämistä muutama oli epäselvä ja vaatisi muokkaamista. Mikäli tietotestiä käytettäisiin muualla kuin Keski-Uudenmaan pelastuslaitoksella, tulisi tarkistaa väittämien yhteneväisyys kyseisen pelastuslaitoksen hoito-ohjeiden kanssa.This final project was conducted as a part of the KUOSCE project by Helsinki Metropolia University of Applied Sciences and the Keski-Uusimaa Rescue Department. The aim of KUOSCE project is to recognize the lack of competence in the working life and in the degree programme of emergency care and to discover the best practical methods for learning. Based on these results, a strategy to confirm and develop competences in basic level emergency care will be presented and published. The primary aim of this final project is to evaluate the knowledge of treating a chest pain patient in basic level emergency care by using a previously developed test. The secondary aim is to evaluate the usability and reliability of the test. Nineteen emergency care technicians participated in the test. The results were processed with the help of the SPSS-program, and bar charts were created based on them. No correlation between the technicians’ backgrounds and level of knowledge could be found due to the limited number of participants. Participants’ level of education and experience varied. Most of them worked in a basic level emergency care unit. Also, their knowledge varied depending on the question. Thirteen of the thirty questions were answered correctly by all of the participants. There were five questions that yielded incorrect answers clearly more often than the others. Of the five fields, primary assessment gave the best results, while response to treatment the poorest. The evaluation of the test’s reliability was affected by the small sample size. Since no key figures could be found, the evaluation was done verbally. Some of the questions might have been misleading, but most of them were understandable and clearly based on the Keski-Uusimaa Rescue Department’s manual. We would like to edit some of the questions to make the test more valid in evaluating basic level emergency care technicians. If this test would be used outside of the Keski-Uusimaa Rescue Department, more questions should be modified according to the department’s manual

Implant survival of 2,723 vitamin E-infused highly crosslinked polyethylene liners in total hip arthroplasty: data from the Finnish Arthroplasty Register

Background and purpose — The use of crosslinked polyethylene in total hip arthroplasty (THA) has decreased wear remarkably. It has been suggested that the antioxidative effects of vitamin E may enhance the wear properties of polyethylene even further. This study evaluates revision rates between vitamin E-infused polyethylene liners (E1 and E-poly, ZimmerBiomet, Warsaw, IN, USA) versus moderately crosslinked polyethylene (ModXLPE) liners from the same manufacturer used in primary THA. Patients and methods — We conducted a study based on data from the Finnish Arthroplasty Register. The study group consisted of 2,723 THAs with a vitamin E-infused liner and a reference group of 2,707 THAs with a moderately crosslinked polyethylene liner. Survivorship, revision risk, and re-revision causes were compared between groups. Results — The 7-year survival of the vitamin E-infused polyethylene liner group and of the reference group with revision for any reason as the endpoint was comparable (94% [95% CI 92.9–94.9] and 93% [CI 91.9–93.9], respectively). The adjusted hazard ratio (HR) for any revision was similar between the groups (0.7 [CI 0.4–1.1]). When revision for aseptic loosening was studied as the endpoint, the survival for the study group was 99% (CI 98.6–99.4) and for the reference group 99% (CI 98.7–99.5), and the risk of revision was comparable between the study groups (HR 1.3 [CI 0.7–2.5]). Interpretation — After an observation period of 7 years vitamin E-infused liners shows results equal to results obtained with crosslinked polyethylene liners

Survival of 11,390 Continuum cups in primary total hip arthroplasty based on data from the Finnish Arthroplasty Register

Background and purpose — The use of trabecular metal (TM) cups for primary total hip arthroplasty (THA) is increasing. Some recent data suggest that the use of TM in primary THA might be associated with an increased risk of revision. We compared implant survival of Continuum acetabular cups with other commonly used uncemented cups. Patients and methods — Data on 11,390 primary THAs with the Continuum cup and 30,372 THAs with other uncemented cups (reference group) were collected from the Finnish Arthroplasty Register. Kaplan–Meier survival estimates were calculated; the endpoint was revision for any reason, for infection, or for dislocation. Revision risks were assessed with adjusted Cox multiple regression models. A subgroup analysis on the use of neutral or elevated liners in the Continuum group was made. Results — The 7-year survivorship of the Continuum group was 94.6% (95% CI 94.0–95.2) versus 95.6% (CI 95.3–95.8) in the reference group for revision for any reason. The risk for revision was higher in the Continuum group than in the reference group both for revision for any reason (HR 1.3 [CI 1.2–1.5)]) and for revision for dislocation (HR 1.9 [CI 1.5–2.3]). There was no difference in the rates of revision because of infection (HR 0.99 [CI 0.78–1.3]). Use of a neutral liner increased the risk for revision due to dislocation in comparison with the use of an elevated rim liner in the Continuum group (HR 1.7 [CI 1.2–2.5]). Interpretation — THA with Continuum cups is associated with an increased risk of revision compared with other uncemented cups, mainly due to revisions because of dislocation. Our results support the use of an elevated liner when Continuum cups are used for primary THA

No difference in implant survival between 28-mm M2a RingLoc metal-on-metal and metal-on-polyethylene total hip arthroplasty : results from the Finnish Arthroplasty Register

Publisher Copyright: © 2022 The Author(s).Background and purpose — Long-term outcome of small head (28 mm) metal-on-metal (MoM) total hip arthroplasty (THA) is available mainly for Metasul devices (Sulzer Medica, Winterthur, Switzerland). Biomet MoM THA was frequently used in Finland. Therefore, we assessed long-term survivorship of the M2a 28-mm RingLoc MoM THA (Biomet, Warsaw, IN, USA) and compared it with the metal-on-polyethylene (MoP) RingLoc THA from the same manufacturer. Patients and methods — We conducted a register study based on THAs from the Finnish Arthroplasty Register performed between January 1, 2000 and December 31, 2007. 290 28-mm head M2a MoM THAs and 1,647 28-mm head MoP THAs (reference group) were included. The endpoint was revision for any reason, or revision for aseptic loosening, osteolysis, liner wear, or metallosis as one group. Kaplan– Meier survival estimates were calculated, and revision risks were assessed using a Cox multiple regression model, both with 95% confidence intervals (CI). Results — No difference was found in the 15-year Kaplan–Meier survivorship between the 28-mm head M2a RingLoc MoM THA and the reference group for any reason for revision (87.7% [82.9–92.1] and 83.3% [81.0–85.3], respectively). The adjusted hazard ratio (HR) for any reason for revision for the MoM THA group compared with the reference group was at least equal or better (0.70 [0.48–1.02]). Both groups presented similar survival for revision for aseptic loosening of the cup, osteolysis, liner wear, or metallosis, at 96.2% (92.7–98.0) and 95.4% (93.9–96.5), respectively. Interpretation — In the long-term survival there was no difference between the M2a 28-mm RingLoc MoM THA and 28-mm MoP THA. Further follow-up regimens for M2a 28-mm RingLoc THA patients may be unnecessary, but long-term metal ion and radiological data is needed before any formal suggestions.Peer reviewe