Periprosthetic osteolysis after total hip replacement: molecular pathology and clinical management

Periprosthetic osteolysis is a serious complication of total hip replacement (THR) in the medium to long term. Although often asymptomatic, osteolysis can lead to prosthesis loosening and periprosthetic fracture. These complications cause significant morbidity and require complex revision surgery. Here, we review advances in our understanding of the cell and tissue response to particles produced by wear of the articular and non-articular surfaces of prostheses. We discuss the molecular and cellular regulators of osteoclast formation and bone resorptive activity, a better understanding of which may lead to pharmacological treatments for periprosthetic osteolysis. We describe the development of imaging techniques for the detection and measurement of osteolysis around THR prostheses, which enable improved clinical management of patients, provide a means of evaluating outcomes of non-surgical treatments for periprosthetic osteolysis, and assist in pre-operative planning for revision surgery. Finally, there have been advances in the materials used for bearing surfaces to minimise wear, and we review the literature regarding the performance of these new materials to date.Donald W. Howie, Susan D. Neale, David R. Haynes, Oksana T. Holubowycz, Margaret A. McGee, Lucian B. Solomon, Stuart A. Callary, Gerald J. Atkins, David M. Findla

The influence of total hip arthroplasty metallurgy on migration: A RSA study.

Third generation alumina-on-alumina ceramic bearings in cementless total hip arthroplasty in patients 55 years and younger: A 10 year follow-up

The histological and elemental characterisation of corrosion particles from taper junctions

© 2016 Munir et al. Objectives: This study aimed to characterise and qualitatively grade the severity of the corrosion particles released into the hip joint following taper corrosion. Methods: The 26 cases examined were CoC/ABG Modular (n = 13) and ASR/SROM (n = 13). Blood serum metal ion levels were collected before and after revision surgery. The haematoxylin and eosin tissue sections were graded on the presence of fibrin exudates, necrosis, inflammatory cells and corrosion products. The corrosion products were identified based on visible observation and graded on abundance. Two independent observers blinded to the clinical patient findings scored all cases. Elemental analysis was performed on corrosion products within tissue sections. X-Ray diffraction was used to identify crystalline structures present in taper debris. Results: The CoC/ABG Modular patients had a mean age of 64.6 years (49.4 to 76.5) and ASR/SROM patients had a mean age of 58.2 years (33.3 to 85.6). The mean time in situ for CoC/ABG was 4.9 years (2 to 6.4) and ASR/SROM was 6.1 years (2.5 to 8.1). The blood serum metal ion concentrations reduced following revision surgery with the exception of Cr levels within CoC/ABG. The grading of tissue sections showed that the macrophage response and metal debris were significantly higher for the ASR/SROM patients (p < 0.001). The brown/red particles were significantly higher for ASR/SROM (p < 0.001). The taper debris contained traces of titanium oxide, chromium oxide and aluminium nitride. Conclusion: This study characterised and qualitatively graded the severity of the corrosion particles released into the hip joint from tapers that had corrosion damage

Osteolysis with a cementless second generation metal-on-metal cup in total hip replacement

This study examined the long-term results of a metal-on-metal total hip replacement with a Metasul-lined cup. Twenty-nine total hip arthroplasties were performed in 27 young patients (mean age 49 years). Twenty-two patients (23 hips) were available for clinical and radiographic analysis after a mean duration of 99 months. Mean preoperative Harris hip score of 60 improved to 93 at most recent follow-up. One patient required revision of his cup for periacetabular osteolysis. Radiographic analysis showed osteolysis in another four hips. The high rate of osteolysis found in this series has not previously been reported with this type of implant. The length of follow-up in this series is greater than other reports in the literature and may explain this difference

Two knees or not two knees? Patient costs and outcomes following bilateral and unilateral total knee joint replacement surgery for OA

Aims: This study aims to address medical and non-medical direct costs and health outcomes of bilateral and unilateral total knee replacement from the patients' perspective during the first year post-surgery. Methods: Osteoarthritis patients undergoing primary unilateral total knee or bilateral total knee replacement (TKR) surgery at three Sydney hospitals were eligible. Patients completed questionnaires pre-operatively to record expenses during the previous three months and health status immediately prior to surgery. Patients then maintained detailed prospective cost diaries and completed SF-36 and WOMAC Index each three months for the first post-operative year. Results: Pre-operatively, no significant differences in health status were found between patients undergoing unilateral TKR and bilateral TKR. Both unilateral and bilateral TKR patients showed improvements in pain, stiffness and function from pre-surgery to 12 months post-surgery. Patients who had bilateral TKR spent an average of 12.3 days in acute hospital and patients who had unilateral TKR 13.6 days. Totally uncemented prostheses were used in 6% of unilateral replacements and 48% of bilateral replacements. In hospital, patients who had bilateral TKR experienced significantly more complications, mainly thromboembolic, than patients who had unilateral TKR. Regression analysis showed that for every one point increase in the pre-operative SF-36 physical score (i.e. improving physical status) out-of-pocket costs decreased by 94%. Out-of-pocket costs for female patients were 3.3 times greater than for males. Conclusion: Patients undergoing bilateral TKR and unilateral TKR had a similar length of stay in hospital and similar out-of-pocket expenditures. Bilateral replacement patients reported better physical function and general health with fewer health care visits one year post procedure. Patients requiring bilateral TKR have some additional information to aid their decision making. While their risk of peri-operative complications is higher, they have an excellent chance of good health outcomes at 12 months and are not going to be doubly 'out-of-pocket' for the experience. (C) 2004 OsteoArthritis Research Society International. Published by Elsevier Ltd. All rights reserved

Long-term results of the standard Wagner cup

Cementless acetabular components gained popularity because of the increased rate of loosening associated with cemented cups after intermediate and long-term follow-up. There are few long-term follow-up studies of cementless acetabular components. This study aims to evaluate the clinical and radiological long-term results of the press-fit standard Wagner Cup. Between January 1, 1994 and June 30, 1994, 118 implantations of a standard Wagner Cup were performed, and 102 implants were clinically and radiographically followed-up after a mean of 12.0 years. The Merle d’Aubigné score improved from a preoperative mean of 9.5 to 17.2 at latest follow-up. Early postoperative complications included two deep haematomata requiring needle aspiration, two deep vein thromboses, one pulmonary embolism, two temporary lesions of the sciatic nerve, one single event of THR dislocation and one recurrent dislocation. Two isolated cup revisions and five more complete total hip replacements were performed for aseptic loosening. The overall survival rate at 12 years was 93.1% (95/102). The standard Wagner cup yields very good long-term results