Case reporting and metal reaction: the big picture
Article published in Arthroplasty Today (open access).
Many FDA premarket approved orthopaedic devices are modified after approval
Orthopaedic surgeons should be aware that high-risk medical devices cleared via the FDA’s PMA pathway do undergo considerable postmarket device modification after reaching the market, with potential for design “drift,” ie, shifting away from the initially tested and approved device designs. Published in Clical Orthopaedics and Related Research.
One of our journal article, computational wear assessment of shoulder implants
Published in Journal of the Mechanical Behavior of Biomedical Materials.
Article published in the Journal of Functional Biomaterials.
This article was published in the Journal of Bimechanics.
Article in the Bone and Joint Jounal. This study investigated the changes seen on serial metal artefact reduction magnetic resonance imaging scans (MARS-MRI) of metal-on-metal total hip arthroplasties (MoM THAs).
Ceramic-on-ceramic THA Implants in Patients Younger Than 20 Years
Article published in Clincal Orthopaedics and Related Research.
An International Orthopaedics paper.
The authors advise systematic follow-up of patients using metal ion levels, MRI/ultrasound, and patient-reported outcome measures.
Article published in Acta Orthopedica.
Paper published in International Orthopaedics.
U.S. Spinal Implant Market to Reach $6.4 Billion by 2024
Published in Orthopedic Design and Technology. Valued at more than $5 billion in 2015, the American spinal implant market will grow to $6.4 billion over the next 10 years, representing a compound annual growth rate of 2.4 percent, according to a Q2 Metrics report.
Our latest paper: "A novel four-caster manual vehicle manoeuvring investigation"
Published in Journal of Engineering in Medicine.
Oxford Performance Materials gets FDA nod for 3-D printed spinal implant
Article published by FierceMedicalDevices.
Our latest (accepted) article in Journal of Orthopaedic Research looking at wear in metal-on-metal hips .
A systematic review of the currently available literature reveals a higher rate of complications (ALTR, dislocation, aseptic loosening, and revision) after MoM HRA in women compared with men. Article published in Clinical Orthopaedics and Related Research.
Hip fracture audit may have saved 1000 lives since 2007
Published in the BMJ. The care and survival of older people with hip fracture in England have substantially improved since the launch of a national, clinician led audit initiative, an independent evaluation has found.
Catastrophic Femoral Neck Failure after THA with the Accolade® I Stem in Three Patients
Published in Clinical Orthopaedics and Related Research.
Article published in Clinical Orthopaedics and Related Research.
Article published by Clinical Orthopaedics and Related Research.
Published in Journal of Patient Safety.
This article discusses the wear performance of highly XLPE in younger patients.
Article published in The Bone and Joint Journal.
Polyethylene Liner Dissociation Is a Complication of the DePuy Pinnacle Cup: A Report of 23 Cases
Article published in Clinical Orthopaedics and Related Research.
Article in Clinical Orthopaedics and Related Research.
Open access paper on adverse soft-tissue reaction to metal debris (ARMD). This paper asks if it is a major source of concern in large-headed (>50 mm) ASR™ XL metal-on-metal hip replacements.
Paper published in the Journal of Arthroplasty.
Metal ions as inflammatory initiators of osteolysis
Paper published in Archives of Orthopaedic and Trauma Surgery.
Setting benchmark revision rates for total hip replacement: analysis of registry evidence
This article published in BMJ discusses the comparison of the 10 year revision rates for frequently used types of primary total hip replacement to inform setting of a new benchmark rate in England and Wales that will be of international relevance.
Article published in International Orthopaedics.
Drug treatments for rheumatoid arthritis: looking backwards to move forwards
A British Medical Journal article. New combinations of older drugs can be effective and affordable. The future of treatments for rheumatoid arthritis used to be seen as progressing through research evaluating new biomarkers and testing new expensive drugs. The open label pragmatic trial (called the TACIT trial) challenges this orthodoxy and gives fresh hope to more patients around the world that they can achieve equal or better disease control with combinations of established, low cost, and easy to produce alternatives.
An article published in the Journal of Engineering in Medicine discussing the volumetric wear produced by the trunnions of metal-on-metal hip joints.
High revision rates attributable to adverse reactions to metal debris have been reported for total hip arthroplasties (THAs) with metal-on-metal implants and hip resurfacings. Revision surgery seems to be effective for removal of the systemic metal ion burden, even though blood Cr remained elevated in a few patients for more than 3 years after removal of the metal-on-metal implant. Article published in Clinical Orthopaedics and Related Research.
This CORR Insights® is a commentary on the article “The John Charnley Award: Highly Crosslinked Polyethylene in Total Hip Arthroplasty Decreases Long-term Wear: A Double-blind Randomized Trial”. The Insight discusses the Where We Are Now, Where Do We Need To Go and How Do We Get There?
Although studies have reported lower radiological wear in highly crosslinked polyethylene (HXLPE) versus conventional polyethylene in total hip arthroplasty (THA), there is limited clinical evidence on the risk of revision of these polyethylene THA bearing surfaces. In this study the cumulative incidence of revision at 7 year follow-up was 5.4% (95% confidence interval [CI], 4.4%–6.7%) for metal-on-conventional and 2.8% (95% CI, 2.6%–3.2%) for metal-on-HXLPE.
Published in Clincal Orthopaedics and Related Research.
Increased Risk of Periprosthetic Femur Fractures Associated With a Unique Cementless Stem Design
Paper published in Clinical Orthopaedics and Related Research discussing postoperative periprosthetic femur fractures. It was found that the unique proximal geometry, lack of axial support from the smooth cylindrical distal stem as well as resorption of the hydroxyapatite coating and poor ongrowth with subsequent subsidence may contribute to increased risk of fracture.
The aim of this study was to establish the ten year survivorship of Birmingham hip resurfacing (BHR), to investigate whole blood (WB) metal ion levels and prevalence of adverse reactions to metal debris (ARMeD) and to determine the association of blood metal ion levels and symptoms with ARMeD in patients operated on with BHR.
It was concluded that issue of a product recall did not change the hip function threshold for revision surgery. The decision to revise a metal-on-metal hip is complex and should follow published guidelines, encompassing metal ion measurement and cross-sectional imaging where appropriate.
The British Medical Journal has published a paper entitled 'Appraisal of evidence base for introduction of new implants in hip and knee replacement: a systematic review of five widely used device technologies'.
To determine the importance of MRI abnormalities in metal-on-metal (MoM) bearings, it is important to understand the baseline features of this diagnostic tool in conventional metal-on-polyethylene (MoP) bearings. In this study MRI abnormalities were noted in nearly one-third of asymptomatic patients with MoP bearings. Therefore, decisions concerning revision of MoM bearings should not be based on isolated MRI findings because MRI abnormalities are commonly seen regardless of bearing type.
This is a paper published in the Clinical Orthopaedics and Related Research journal discussing the use of highly crosslinked polyethylene (HXLPE) in artificial hip joints. The long-term study (10 years) compares the wear of HXLPE liners to that of UHMWPE liners.
Another open access article published in Acta Orthopaedica detailing a 5-year radiostereometric study of 49 hips
Open access article published in Acta Orthopaedica. A 5-year follow-up of 52 patients.
MRI does not detect acetabular osteolysis around metal-on-metal Birmingham THA
Open access article. MRI is not a sensitive test to identify periacetabular osteolysis. The authors of this article recommend CT for the screening of implants with this failure mode
Paper published in The Bone and Joint Journal
An analysis of explanted pyrolytic carbon prostheses
Paper just published in Journal of Hand Surgery
Survivorship of standard vs modified posterior surgical approaches in metal-on-metal hip resurfacing
Published in Bone Joint Reseach. This study found a significant difference in survivorship at four years between the standard posteior (SPA) approach and the modified posterior approach (MPA) (p = 0.036). The clinical outcomes of this study suggest that preserving the vascularity of the femoral neck by using the MPA results in fewer vascular-related failures in metal-on-metal hip resurfacings.
BMJ article. Results suggest that elevated blood metal ion concentrations are associated with early failure of MoM devices secondary to adverse reactions to metal debris
The Bone and Joint Journal article discussing a significant increase in mean levels of cobalt ions in the blood in those with a 36 mm diameter femoral head
High Rate of Infection After Aseptic Revision of Failed Metal-on-Metal Total Hip Arthroplasty
Clinical Orthopaedics and Related Research article discussing the higher-than-expected rate of infection after revision of MOM THAs
MRI Predicts ALVAL and Tissue Damage in Metal-on-Metal Hip Arthroplasty
Another article from this issue of Clinical Orthopaedics and Related Research
Clinical Orthopaedics and Related Research article discussing imaging techniques
BMJ editorial: "Selecting the right hip replacement"
Requires making sense of large scale registry data
This article assesses the failure rate of cemented, uncemented, hybrid, and reverse hybrid total hip replacements in patients aged 55 years or older
Journal article discussing whether an association exists between elevated metal ion concentrations and the presence of pseudotumors
The Withdrawn ASR™ THA and Hip Resurfacing Systems How Have Our Patients Fared Over 1 to 6 Years?
Open access article from Clinical Orthpaedics and Related Research, study of 172 patients
British Medical Journal article scrutinising EC medical device regulation
Delays and Difficulties in Assessing Metal-on-Metal Hip Implants
New England Journal of Medicine open access opinion piece
Risk of cancer with metal-on-metal hip replacements: population based study
British Medical Journal (open access) study from Finland concludes no cancer risk after 4 years
Risk of cancer in first seven years after metal-on-metal hip replacement
BMJ article based on National Joint Registry (UK) data, shows no increased cancer risk