Mid-term outcomes of tantalum cup– a single centre study

Introduction The cementless acetabular implants are commonly used in primary and revision hip arthroplasty. Reconstruction of acetabulum in case of bone defects can be challenging. The aims of this single center study are to review the mid-term outcomes of porous tantalum cups (TM) and evaluate complications. Methods The midterm outcome of a trabecular metal tantalum modular uncemented cup was evaluated in 59 hips in 58 patients. In our group, we had 23 males and 35 females. The mean age was 70.11 years (range, 30 to 87 years). Four patients were lost to follow-up and 13 died during the period without having further surgeries attributed to the hip arthroplasty. The remaining 41 patients (42 revision hip arthroplasties) had complete data available. Results The mean follow-up was 87 months, ranging from 24 to 144 months. Standard pelvic anteroposterior (AP) radiographs were used to assess and preoperatively classify acetabular defects as per Paprosky classification. The serial radiographs showed excellent stability, bone opposition and graft incorporation. Four patients had further surgeries. Two of these were due to infection (one superficial and one deep infection). One of the patients had washout and then removal of metal work, the other patient only had a washout and symptoms settled. One patient had vascular compromise and went for surgery to stem the bleeding. One patient had re-revision due to stem loosening and hence required surgery but the revision cup remained stable. We noted a 96% survival at an average of 7.2 years follow-up. Conclusion The mid-term results with the trabecular metal cementless cup appeared to be promising in both primary and revision hip arthroplasty, even in the presence of considerable bone loss which requires bone grafting and augments. Level of evidence IV.

Two-year results of a multi-centre, randomized controlled trial comparing a second-generation uncemented trabecular metal-backed versus cemented polyethylene glenoid component in total shoulder arthroplasty

Aims To report early (two-year) postoperative findings from a randomized controlled trial (RCT) investigating disease-specific quality of life (QOL), clinical, patient-reported, and radiological outcomes in patients undergoing a total shoulder arthroplasty (TSA) with a second-generation uncemented trabecular metal (TM) glenoid versus a cemented polyethylene glenoid (POLY) component. Methods Five fellowship-trained surgeons from three centres participated. Patients aged between 18 and 79 years with a primary diagnosis of glenohumeral osteoarthritis were screened for eligibility. Patients were randomized intraoperatively to either a TM or POLY glenoid component. Study intervals were: baseline, six weeks, six-, 12-, and 24 months postoperatively. The primary outcome was the Western Ontario Osteoarthritis Shoulder QOL score. Radiological images were reviewed for metal debris. Mixed effects repeated measures analysis of variance for within and between group comparisons were performed. Results A total of 93 patients were randomized (46 TM; 47 POLY). No significant or clinically important differences were found with patient-reported outcomes at 24-month follow-up. Regarding the glenoid components, there were no complications or revision surgeries in either group. Grade 1 metal debris was observed in three (6.5%) patients with TM glenoids at 24 months but outcomes were not negatively impacted. Conclusion Early results from this RCT showed no differences in disease-specific QOL, radiographs, complication rates, or shoulder function between uncemented second-generation TM and cemented POLY glenoids at 24 months postoperatively. Revision surgeries and reoperations were reported in both groups, but none attributed to glenoid implant failure. At 24 months postoperatively, Grade 1 metal debris was found in 6.5% of patients with a TM glenoid but did not negatively influence patient-reported outcomes. Longer-term follow-up is needed and is underway. Cite this article: Bone Jt Open 2021;2(9):728–736.

Minimum five-year outcomes of reverse total shoulder arthroplasty using a trabecular metal glenoid base plate

Aims Reverse total shoulder arthroplasty (RTSA) using trabecular metal (TM)-backed glenoid implants has been introduced with the aim to increase implant survival. Only short-term reports on the outcomes of TM-RTSA have been published to date. We aim to present the seven-year survival of TM-backed glenoid implants along with minimum five-year clinical and radiological outcomes. Methods All consecutive elective RTSAs performed at a single centre between November 2008 and October 2014 were reviewed. Patients who had primary TM-RTSA for rotator cuff arthropathy and osteoarthritis with deficient cuff were included. A total of 190 shoulders in 168 patients (41 male, 127 female) were identified for inclusion at a mean of 7.27 years (SD 1.4) from surgery. The primary outcome was survival of the implant with all-cause revision and aseptic glenoid loosening as endpoints. Secondary outcomes were clinical, radiological, and patient-related outcomes with a five-year minimum follow-up. Results The implant was revised in ten shoulders (5.2%) with a median time to revision of 21.2 months (interquartile range (IQR) 9.9 to 41.8). The Kaplan-Meier survivorship estimate at seven years was 95.9% (95% confidence interval (CI) 91.7 to 98; 35 RTSAs at risk) for aseptic mechanical failure of the glenoid and 94.8% (95% CI 77.5 to 96.3; 35 RTSAs at risk) for all-cause revision. Minimum five-year clinical and radiological outcomes were available for 103 and 98 RTSAs respectively with a median follow-up time of six years (IQR 5.2 to 7.0). Median postoperative Oxford Shoulder Score was 38 (IQR 31 to 45); median Constant and Murley score was 60 (IQR 47.5 to 70); median forward flexion 115° (IQR 100° to 125°); median abduction 95° (IQR 80° to 120°); and external rotation 25° (IQR 15° to 40°) Scapular notching was seen in 62 RTSAs (63.2%). Conclusion We present the largest and longest-term series of TM-backed glenoid implants demonstrating 94.8% all-cause survivorship at seven years. Specifically pertaining to glenoid loosening, survival of the implant increased to 95.9%. In addition, we report satisfactory minimum five-year clinical and radiological outcomes. Cite this article: Bone Joint J 2021;103-B(8):1333–1338.

Use of Tantalum Trabecular Metal Cones for Management of Nonunion of the Distal Femur with Segmental Bone Defects: Technique and Case Series

Introduction: Segmental bone loss in the distal femur presents a challenge for reconstruction regardless of etiology. Use of tantalum trabecular metal cones with intramedullary fixation and autologous bone graft may be used as a salvage technique in difficult situations where other options have either been exhausted or are unavailable. Case Report: Surgical planning and technique for this approach to reconstruction are described. A retrospective review of five cases with >1 year of follow-up was performed to provide radiographic and clinical outcomes. All five patients had satisfactory outcomes with clinical union and retention of implants at final follow-up (average >4 years). Conclusions: Use of tantalum metal cones for reconstruction of distal femur nonunion with segmental bone defects can be a successful technique in a complex group of patients. Keywords: Femur, bone defect, non-union, induced membrane, tantalum.

Low Rate of Peri-implant Osteolysis in Trabecular Metal Total Ankle Replacement on Short- to Midterm Follow-up

Background: Peri-implant osteolysis is one of the major complications related to total ankle replacement. The aim of this study was to investigate the short- to midterm incidence of peri-implant osteolysis using computed tomography (CT) as imaging method for the Trabecular Metal Total Ankle (TMTA) implant representing a novel total ankle replacement (TAR) implant design regarding material and surgical technique. Methods: In total, 104 consecutive patients who had a primary TMTA replacement between March 2013 and October 2017 were included in the study. The radiographic evaluation included weightbearing anteroposterior and lateral views at baseline and after 3, 6, and every 12 months postoperatively. A helical CT was undertaken preoperatively and of the 80 patients available to follow up at least 12 months postoperatively, with average time interval between the TAR operation and the latest CT of 39 (range, 12-85) months. Results: Eight of 80 patients had altogether 11 osteolytic lesions around the components on CT images. Seven lesions were found in tibia, 3 in talus, and 1 in distal fibula. Four of the tibial lesions were situated in the medial malleolus and were not in contact with the prosthesis component. The sizes of the osteolytic lesions ranged between 7 and 20 mm, and the average volume of the lesions was 689 mm3. Conclusion: We conclude that the risk of peri-implant osteolysis with the TMTA implant is minimal in short to midterm. The anatomic configuration, unique material, and surgical technique may all contribute to the TMTA implant having a low rate of peri-implant osteolysis. Level of Evidence: Level IV, case series.