Biomaterials View on the Complications Associated with Hip Resurfacing Arthroplasty

Abstract:

Hip resurfacing arthroplasty is an very interesting and controversial orthopedic concept in the last years [1]. In order to avoid the previous problems associated with the classical hip prosthesis type metal-polyethylene [2], different manufacturer propose the metal-metal prosthesis based on the reproducible quality of manufacturing of metallic components using Co-Cr alloys and better component fixation. Problems that have been encountered to be the reason for failing of the prosthesis can be different (dislocation, femoral neck fractures, vascular damage, avascular necrosis, raised metal ion levels), and could be related to three main aspects: factors related to the patients, surgical intervention and prosthesis [3, 4]. But a very important aspect is the biomaterials used, that will be discussed in the present paper in correlation with biomechanics and clinical aspects. Our study maked on a lot of retrieved BHR prosthesis used in one Romanian orthopaedic clinic present a higher rate of failure than the other similar studies made by other authors [5]. Starting from this point, we analyze carefully many components of the failed BHR prosthesis using stereomicroscopy, scanning electron microscopy (SEM) and EDS. Based on our experimental results especially at the interfaces metal-cement-bone, we identify different potential causes of failure but the main conclusion was that the cementation technique and poor quality of the patient bone are the reasons for most of hip resurfacing prosthesis failure. As future recommendations for the orthopaedic surgeons we could mention the carefully analysis of bone quality for each candidate using advanced techniques like DEXA and a correlation between the bone cement used for prosthesis fixation and the cementation technique.

• Periodical: Advanced Materials Research (Volume 1114)
• Pages: 247-252
• DOI: https://doi.org/10.4028/www.scientific.net/AMR.1114.247
• Online since: July 2015
• Authors: Marius Niculescu, Dan Laptoiu, Florin Miculescu, Iulian Antoniac*
• Keywords: Biomaterials, Co-Cr Alloys, Hip Prosthesis, SEM

References

[1] Amstutz HC, Beaule PE, Dorey FJ, et al. Metalon- metal hybrid surface arthropasty: two to six year follow up study. J Bone Joint Surg [Am] 2004; 86(1): 28–39.

DOI: 10.2106/00004623-200401000-00006

[2] McMinn D, Treacy R, Lin K, et al. Metal on metal surface replacement of the hip. Experience of the McMinn prosthesis. Clin Orthop 1996; 329S: S89–98.

DOI: 10.1097/00003086-199608001-00009

[3] Daniel J, Pynsent PB, McMinn DJW. Metal on metal resurfacing of the hip in patients under the age of 55 years with osteoarthritis. J Bone Joint Surg [Br] 2004; 86: 177– 84.

DOI: 10.1302/0301-620x.86b2.14600

[4] Amstutz HC, Grigoris P, Dorey FJ. Evolution and future of surface replacement of the hip. J Orthop Sci 1998; 3(3): 169 –86.

[5] Freeman MAR, Cameron HU, Brown GC. Cemented double cup arthroplasty of the hip: a 5 year experience with the ICLH prosthesis. Clin Orthop 1978; 134: 45–52.

DOI: 10.1097/00003086-197807000-00008

[6] Freeman MAR. Some anatomical and mechanical considerations relevant to the surface replacement of the femoral head. Clin Orthop 1978; 134: 19– 24.

DOI: 10.1097/00003086-197807000-00004

[7] Beaule PE, Lee JL, LeDuff MJ, et al. Orientation of the femoral component in surface arthroplasty of the hip: a biomechanical and clinical analysis. J Bone Joint Surg [Am] 2004; 86(9): 2015– 21.

[8] Skipor AK, Campbell PA, Patterson LM, et al. Serum and urine metal ion levels in patients with metal on metal surface arthroplsty. J Mater Sci Mater Med 2002; 13(12): 1227– 34.

[9] Visuri T, Pukkala E, Paavolainen P, et al. Cancer risk after metal on metal and polyethylene on metal total hip arthroplasty. Clin Orthop 1996; 329S: S280–9.

DOI: 10.1097/00003086-199608001-00025

[10] Maezawa K, Nowaza M, Hirose T, et al. Cobalt and chromium concentrations in patients with metal on metal and other cementless total hip arthroplasty. Arch Orthop Trauma Surg 2002; 122(5): 283– 7.

DOI: 10.1007/s00402-001-0382-3

[11] Jacobs JJ, Hallab NJ, Skipor AK, et al. Metal degradation products: a cause for concern in metalmetal bearings? Clin Orthop 2003; 417: 139– 47.

DOI: 10.1097/01.blo.0000096810.78689.62

[12] Hallab NJ, Jacobs JJ, Skipor A, et al. Systemic metalprotein binding associated with total joint replacement arthroplasty. J Biomed Mater Res 2000; 49(3): 353 –61.

DOI: 10.1002/(sici)1097-4636(20000305)49:3<353::aid-jbm8>3.0.co;2-t