scholarly journals High rates of implant fracture of a generic polished tapered femoral stem

2020 ◽  
pp. 112070002092573
Author(s):  
Jens Vanbiervliet ◽  
Annabel Braem ◽  
Jean-Pierre Simon ◽  
Jan Van Humbeek ◽  
Jonas Brouwers ◽  
...  
Keyword(s):  
Failure Analysis ◽  
Femoral Stem ◽  
High Rate ◽  
Obese Patients ◽  
Stem Design ◽  
Premature Failure ◽  
Stress Riser ◽  
Hip Replacements ◽  
Modular Revision Stem ◽  
Cemented Stem

Objectives: Cemented polished tapered stems have demonstrated excellent long-term outcomes. Based on this concept, many generic tapered stems have been released into the market. The aim of this study was to evaluate implant-related complications of 1 specific stem design. Methods: Between 2010 and 2017, 315 total hip replacements were performed using a Fortress stem (Biotechni, La Ciotat, France). Patient records and radiology were retrospectively reviewed for implant-related complications. A failure analysis was performed on the failed Fortress stems in order to determine the cause of premature failure. Results: 7 (2.2%) patients sustained a fracture of the neck of the implant after a mean of 5 years (range 50–81 months). All fractures were atraumatic, originating at the introducer inlet of the stem. All fractured occurred in obese patients (BMI >33 kg/m2) with a small sized prosthesis. Of these, there were 5 135° and 2 125° stems. Fracture risk was 23% (7/30) for patients with a small sized stem and a BMI >30 kg/m2. All cases were revised using a cement-in-cement technique or a cementless modular revision stem. Failure analysis on the retrieved stems revealed a stress riser at the bottom of the introducer inlet. Conclusions: An alarmingly high rate of early implant fractures was seen using this specific type of cemented stem, particularly when using smaller implant sizes in obese patients. Although based on a proven design, a specific modification led to a stress riser in the neck area, which resulted in a high incidence of implant failure. This series underlines the importance of a stepwise introduction into the market of new orthopaedic devices even when based on established concepts. Generic stems may not behave as the original stem upon which it was designed.

Does the femoral offset affect replacements? The results from a National Joint Registry

2018 ◽  
Vol 29 (3) ◽  
pp. 289-298 ◽  
Author(s):  
Michael C Wyatt ◽  
David C Kieser ◽  
Mark A Kemp ◽  
Gavin McHugh ◽  
Chris M A Frampton ◽  
...  
Keyword(s):  
Femoral Component ◽  
Revision Rate ◽  
Femoral Stem ◽  
Joint Registry ◽  
Total Hip Replacements ◽  
Significant Difference ◽  
Hip Replacements ◽  
Cemented Stem ◽  
And Gender ◽  
Low Offset

Background: Femoral component offset influences the torque forces exerted on a femoral stem and may therefore adversely affect femoral component survival. This study investigated the influence of femoral component offset on revision rates for primary total hip replacements (THR) registered on the New Zealand Joint Registry (NZJR). Methods: There were 106,139 primary THRs registered, resulting in 4960 revisions for any cause. There were 46,242 THRs performed using the five commonest femoral components listed on the NZJR. A total of 41,100 were done for primary osteoarthritis of which 40,548 had all the offset information available for analysis. We defined low offset as < 42 mm, standard as 42–48 mm and high offset as > 48 mm offset and examined revision rates according to the reasons for revision. We performed survival analyses for both cemented and uncemented femoral components grouped by the different offsets. Results: The all-cause revision rate was 0.54/100 component years (cys). Stems with < 42 mm offset had a revision rate of 0.58/100 cys (mean 0.58; 95% confidence interval (CI) 0.53–0.63), 42–48 mm offset 0.47 (95% CI 0.43–0.52) and > 48 mm offset 0.67 (95% CI 0.57–0.79). There was no significant difference in all-cause revision rates between varying stem offsets in uncemented stems adjusting for age and gender. In cemented stems both high and low offset stems were more likely to be revised. Uncemented stems of all offsets were more likely to undergo revision for femoral fracture. Conclusions: Femoral component offset affects the overall all-cause revision rate of the most commonly used cemented stem, but not uncemented stem designs. In cemented stems offset influences the rate of revision for loosening and periprosthetic fractures.

scholarly journals Fixation of the Cemented Stem: Clinical Relevance of the Porosity and Thickness of the Cement Mantle

2009 ◽  
Vol 3 (1) ◽  
pp. 8-13 ◽  
Author(s):  
Philippe Hernigou ◽  
Gildasio Daltro ◽  
Charles Henri Flouzat Lachaniette ◽  
Xavier Roussignol ◽  
Martin Mukisi Mukasa ◽  
...  
Keyword(s):  
Hip Arthroplasty ◽  
Review Paper ◽  
Mechanical Stability ◽  
Femoral Stem ◽  
Clinical Results ◽  
Cement Mantle ◽  
Frictional Torque ◽  
Stem Design ◽  
Cement Interface ◽  
Cemented Stem

The aim of this review paper is to define the fixation of the cemented stem. Polymethyl methacrylate, otherwise known as “bone cement”, has been used in the fixation of hip implants since the early 1960s. Sir John Charnley, the pioneer of modern hip replacement, incorporated the use of cement in the development of low frictional torque hip arthroplasty. In this paper, the concepts of femoral stem design and fixation, clinical results, and advances in understanding of the optimal use of cement are reviewed. The purpose of this paper is to help understanding and discussions on the thickness and the porosity of the cement mantle in total hip arthroplasty. Cement does not act as an adhesive, as sometimes thought, but relies on an interlocking fit to provide mechanical stability at the cement–bone interface, while at the prosthesis– cement interface it achieves stability by optimizing the fit of the implant in the cement mantle, such as in a tapered femoral stem.

Alarmingly High Rate of Implant Fractures in One Modular Femoral Stem Design: A Comparison of Two Implants

2017 ◽  
Vol 32 (10) ◽  
pp. 3157-3162 ◽  
Author(s):  
Ritesh R. Shah ◽  
Jeffrey M. Goldstein ◽  
Nancy E. Cipparrone ◽  
Alexander C. Gordon ◽  
Matthew L. Jimenez ◽  
...  
Keyword(s):  
Femoral Stem ◽  
High Rate ◽  
Stem Design

Risk factors for femoral stem breakage: an analysis of the AOANJRR results

2019 ◽  
Vol 30 (3) ◽  
pp. 319-326
Author(s):  
Mark S Rickman ◽  
Peter L Lewis ◽  
Daud TS Chou ◽  
William Donnelly ◽  
Stephen E Graves ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hip Replacement ◽  
Femoral Stem ◽  
Large Data ◽  
Cementless Stem ◽  
Stem Design ◽  
Stem Breakage ◽  
Cemented Stem ◽  
Patient Groups ◽  
Manufacturing Techniques

Introduction: Breakage of the femoral stem component of a total hip replacement is now uncommon but continues to be seen with certain stem designs and in certain patient groups. Data previously published on this topic has been limited, either gathered from a single surgeon or centre, or included only a single stem design. Methods: We reviewed the data from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), identified and analysed 143 stem breakages over a period of 16 years, covering 44 different stem designs. Results: Our data confirms previously published findings that risk factors for stem breakage include patient age at implantation of under 70, male gender, as well as the use of exchangeable necks. We found no association with initial diagnosis, or type of acetabular component implanted. We did however also find, excluding exchangeable neck designs, that after 4.5 years a cemented stem had a significantly higher risk of breakage then a cementless stem. Discussion: To our knowledge this is the 1st paper to suggest cemented fixation as a specific risk factor for stem breakage. The analysis of rare complications such as stem breakage is only possible through large data collection systems such as the AOANJRR. Whilst there have been recent advances in materials and manufacturing techniques, we recommend that surgeons are aware of all the specific risks when considering implant choices for individual patients.

Interfacial Delamination in Plastic Encapsulated Integrated Circuits (Pics)

1996 ◽  
Vol 445 ◽  
Author(s):  
Nickolaos Strifas ◽  
Aris Christou
Keyword(s):  
Integrated Circuits ◽  
Failure Analysis ◽  
Stress Corrosion ◽  
Integrated Circuit ◽  
Point Of View ◽  
Acoustic Microscopy ◽  
Electrical Performance ◽  
Premature Failure ◽  
Interfacial Delamination ◽  
Die Surface

AbstractThe reliability of plastic packaged integrated circuits was assessed from the point of view of interfacial mechanical integrity. It is shown that the effect of structural weaknesses caused by poor bonding, voids, microcracks or delamination may not be evident in the electrical performance characteristics, but may cause premature failure. Acoustic microscopy (C-SAM) was selected for nondestructive failure analysis of the plastic integrated circuit (IC) packages. Integrated circuits in plastic dual in line packages were initially subjected to temperature (25 °C to 85 °C) and humidity cycling (50 to 85 %) where each cycle was of one hour duration and for over 100 cycles and then analyzed. Delamination at the interfaces between the different materials within the package, which is a major cause of moisture ingress and subsequent premature package failure, was measured. The principal areas of delamination were found along the leads extending from the chip to the edge of the molded body and along the die surface itself. Images of the 3-D internal structure were produced that were used to determine the mechanism for a package failure. The evidence of corrosion and stress corrosion cracks in the regions of delamination was identified.

scholarly journals The Olympia anatomic polished cemented stem is associated with a high survivorship, excellent hip-specific functional outcome, and high satisfaction levels: follow-up of 239 consecutive patients beyond 15 years

2021 ◽  
Author(s):  
Gareth S. Turnbull ◽  
Claire Marshall ◽  
Jamie A. Nicholson ◽  
Deborah J. MacDonald ◽  
Nicholas D. Clement ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Femoral Stem ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
High Satisfaction ◽  
Age At Surgery ◽  
Patient Reported ◽  
Cemented Stem ◽  
Oxford Hip Score

Abstract Introduction The Olympia femoral stem is a stainless steel, anatomically shaped, polished and three-dimensionally tapered implant designed for use in cemented total hip arthroplasty (THA). The primary aim of this study was to determine the long-term survivorship, radiographic outcome, and patient-reported outcome measures (PROMs) of the Olympia stem. Patients and methods Between May 2003 and December 2005, 239 patients (264 THAs) underwent a THA with an Olympia stem in our institution. Patient-reported outcome measures were assessed using the Oxford Hip Score (OHS), EuroQol-5 dimensions (EQ-5D) score, and patient satisfaction at mean 10 years following THA. Patient records and radiographs were then reviewed at a mean of 16.5 years (SD 0.7, 15.3–17.8) following THA to identify occurrence of complications or revision surgery for any cause following surgery. Radiographs were assessed for lucent lines and lysis according to Gruen’s zones Results Mean patient age at surgery was 68.0 years (SD 10.9, 31–93 years). There were 156 women (65%, 176 THAs). Osteoarthritis was the indication for THA in 204 patients (85%). All cause stem survivorship at 10 years was 99.2% (95% confidence interval [CI], 97.9%–100%) and at 15 years was 97.5% (94.6%–100%). The 15-year stem survival for aseptic loosening was 100%. Analysis of all-cause THA failure demonstrated a survivorship of 98.5% (96.3%–100%) at 10 years and 95.9% (92.4%–99.4%) at 15 years. There were 9 THAs with non-progressive lucent lines in a single Gruen zone and 3 had lines in two zones, and no patient demonstrated signs for lysis. At a mean of 10-year (SD 0.8, 8.7–11.3) follow-up, mean OHS was 39 (SD 10.3, range 7–48) and 94% of patients reported being very satisfied or satisfied with their THA. Conclusions The Olympia stem demonstrated excellent 10-year PROMs and very high rates of stem survivorship at final follow-up beyond 15 years.

Complications with the Zurich Canine Total Hip Replacement System in an Initial Series of Cases Performed by a Single Surgeon

2021 ◽  
Author(s):  
Samuel P. Franklin ◽  
Nathan A. Miller ◽  
Todd Riecks
Keyword(s):  
Total Hip Replacement ◽  
Hip Replacement ◽  
Weight Bearing ◽  
Normal Function ◽  
High Rate ◽  
Total Hip ◽  
Initial Series ◽  
Major Complications ◽  
Hip Replacements ◽  
Replacement System

Abstract Objective The aim of this study was to quantify the complications using the Zurich total hip replacement system in an initial series of cases performed by a single surgeon who had experience with other total hip replacement systems. Materials and Methods This was a retrospective study in which complications were classified as major if any treatment was needed or if the outcome was less than near-normal function. Complications that did not warrant treatment and that did not result in function that was inferior to near-normal were considered minor. Outcomes were assessed by radiographic review, physical examination, subjective gait evaluation or, in one case, by objective gait analysis. Bilateral total hip replacements were considered separate procedures. Results The first 21 procedures in 19 dogs performed by a single surgeon were included. The mean time to follow-up was 48 weeks (range: 8–120 weeks; standard deviation: 36 weeks). Two cases (of 21) experienced major complications including one dog with excess internal femoral rotation during weight bearing and one dog having luxation. One case (of 21) had a minor complication; femoral fracture in the presence of an intact bone plate that maintained alignment and healed without treatment. Clinical Significance A high rate of successful outcomes with few major complications can be obtained in the initial cases treated using the Zurich total hip replacement system for surgeons with prior experience with other total hip replacement systems.

scholarly journals Massive Pseudotumor in a 28mm Ceramic-Polyethylene Revision THA: A Case Report

2014 ◽  
Vol 4 (1) ◽  
pp. 11-17 ◽  
Author(s):  
Edward McPherson, M.D., FACS ◽  
Matthew Dipane, BA ◽  
Sherif Sherif, MD
Keyword(s):  
Soft Tissues ◽  
Polyethylene Wear ◽  
Femoral Stem ◽  
High Rate ◽  
Zirconia Ceramic ◽  
Porous Coating ◽  
Metal Debris ◽  
Ultrafine Metal Particles ◽  
Revision Tha ◽  
Therapeutic Study

This report reviews the findings of a massive pseudotumor detected pre-operatively in a 13-year-old revision total hip arthroplasty. The case is unique in that the bearing involved was a 28mm zirconia ceramic head on a polyethylene liner. We propose that the pseudotumor arose from ultrafine titanium particles liberated from the proximal porous coating of the femoral stem. We suspect that the osteolysis produced from polyethylene wear exposed the proximal porous coating and, via a process of mechanical abrasion with the surrounding soft tissues, liberated ultrafine titanium particles. We believe the pseudotumor formed because the patient was pre-sensitized to metal debris based upon a pre-operative lymphocyte T-cell proliferation test (LTT). Based upon this unique case, we feel that pseudotumors more likely form when there is a high rate of ultrafine metal particles generated in a pre-sensitized patient. Finally, we introduce what we believe are the main biologic wear responses in THA. Further research is needed to validate this proposed model.Keywords: pseudotumor, ceramic, polyethylene, osteolysis, THA, bearing wear eesponse, titanium debrisLevel of Evidence:  AAOS Therapeutic Study Level IV

Enhanced Failure Analysis (FA) of Organic Contamination Using Submicron Simultaneous IR and Raman Spectroscopy: Breakthrough Developments of Optical Photothermal IR (O-PTIR)

2020 ◽  
Author(s):  
D. Jay Anderson ◽  
Mustafa Kansiz ◽  
Michael Lo ◽  
Eoghan Dillon ◽  
Curtis Marcott
Keyword(s):  
Raman Spectroscopy ◽  
Failure Analysis ◽  
Semiconductor Manufacturing ◽  
Rapid Identification ◽  
Organic Contamination ◽  
Premature Failure ◽  
Specific Element ◽  
Ir And Raman Spectroscopy ◽  
Semiconductor Manufacturer ◽  
Ir And Raman

Abstract Rapid identification of organic contamination in the semi and semi related industry is a major concern for research and manufacturing. Organic contamination can affect a system or subsystem’s performance and cause premature failure of the product. As an example, in February 2019 the Taiwan Semiconductor Manufacturing Company (TMSC), a major semiconductor manufacturer, reported that a photoresist it used included a specific element which was abnormally treated, creating a foreign polymer in the photoresist resulting in an estimated loss of $550M [1].

Displacement of Femoral Stem during Closed Reduction of Total Hip Arthroplasty

1997 ◽  
Vol 7 (3) ◽  
pp. 125-127
Author(s):  
J. Cordes ◽  
K. Sperling ◽  
M. Kramhøft
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Closed Reduction ◽  
Femoral Stem ◽  
Stem Design ◽  
Total Hip ◽  
Straight Stem ◽  
Image Intensification

In the literature, only one case of displacement of a cemented femoral stem from its cement bed during closed reduction of a dislocation has been reported. In that case, it was suggested that the stem design may in part be the explanation for the displacement. Another case with a cemented Müller straight stem is now presented, emphasizing the use of image intensification if reduction proves difficult.

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