Outcomes of Birmingham Hip Resurfacing Based on Clinical Aspects and Retrieval Analysis of Failed Prosthesis
Abstract
:1. Introduction
- To identify the prevalence of failure for Birmingham Hip Prosthesis (BHR) in total hip arthroplasty;
- To analyze the reasons for BHR failure from biomaterials and biofunctional perspectives;
- To conduct a detailed analysis and tests on a series of different BHR-retrieved prostheses after premature failure;
- To analyze relevant clinical data like X-ray investigations and intraoperative images for clinical case studies to better understand all factors involved in BHR prosthesis failure;
- To investigate the importance of surgical technique planning and the cementation procedure in the success rate of BHR prostheses;
- To evaluate patient characteristics and bone quality to minimize the risk of BHR prosthesis failure.
2. Materials and Methods
2.1. The Study Group
2.2. Investigation Methods
3. Results and Discussion
3.1. Clinical Aspects Based on X-rays and Intraoperative Images
3.2. Explant Analysis
3.3. Limitations of the Study
4. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Property | Remarks | Ref. |
---|---|---|
Adhesion | The cement must adhere well to the implant to prevent micromotion, which can lead to implant loosening. Surface treatments of implants, such as roughening or coating with bioactive materials, can enhance this adhesion | [32] |
Load transfer | The cement must allow uniform mechanical load transfer between the bone and the prosthesis. | [33] |
Mechanical properties | The mechanical properties of the cement must be compatible with the implant and the surrounding bone. The mechanical mismatch between the rigid PMMA and the more elastic bone can lead to stress concentrations, potentially causing microcracks and long-term failure. | [34] |
Mechanical interlock | To accomplish interlock, the surface of the bones must be rough and irregular. The strength of the cement-bone interaction increases with deeper cement penetration. | [31] |
Thermal effects | Because of the potential for thermal necrosis of bone tissue resulting from the exothermic reaction of PMMA curing, the ISO 5833 (2002) standard sets a 90 °C restriction on the hardening temperature of bone cement. Controlling the polymerization temperature is crucial to mitigate these effects. | [31,36] |
Biocompatibility | PMMA is biocompatible, but it can cause a mild inflammatory response. The exothermic polymerization process can determine thermal necrosis. The presence of residual monomer can be cytotoxic. | [32] |
Osseointegration | Osseointegration relies on mechanical interlock rather than chemical bonding. While PMMA itself is not osteoinductive, the surface texture and porosity can be modified to enhance integration with bone. | [35] |
Gender | Diagnosis | Total | |||||||
---|---|---|---|---|---|---|---|---|---|
P.C. | N.A.C.F. | S.C. | D.S.P. | B.C. | O.F.H. | O.D. | P.T. | ||
Women | 25 | 53 | 3 | 16 | 0 | 0 | 0 | 1 | 98 |
Men | 44 | 122 | 12 | 21 | 1 | 1 | 1 | 0 | 202 |
Total | 69 | 175 | 15 | 37 | 1 | 1 | 1 | 1 | 300 |
Mode of Failure | Total (%) | Men | Women | p-Estimated Value |
---|---|---|---|---|
All revisions | 30 (10.0) | 20 | 10 | <0.001 |
Fracture of the femoral neck | 9 (3.0) | 6 | 3 | 0.005 |
Loosening of the acetabular component | 6 (2.0) | 4 | 2 | 0.02 |
Head collapse | 5 (1.7) | 3 | 2 | 0.03 |
Femoral loosening | 3 (1.0) | 2 | 1 | 0.06 |
Infection | 3 (1.0) | 2 | 1 | 0.06 |
Pain/(ALVAL)/metalloids | 2 (0.7) | 1 | 1 | 0.11 |
Malposition of the acetabular component | 1 (0.3) | 1 | 0 | 0.27 |
Dislocation | 2 (0.7) | 1 | 1 | 0.1 |
Preoperative Diagnosis | Men | Women | Potential Adverse Effect on Acetabular Component Stability |
---|---|---|---|
Osteoarthritis | 10 | 5 | No |
Acetabular Dysplasia | 1 | 1 | Yes |
Previous Shelf Procedure for Acetabular Dysplasia | 1 | 1 | Yes |
Renal Failure | 1 | 1 | Yes |
Avascular Necrosis of the Femoral Head Following Radiotherapy for Pelvic Osteosarcoma | 1 | 1 | Yes |
Unknown | 3 | 2 | Unknown |
Mode of Failure | Total (%) | Men | Women | p Estimated Value |
---|---|---|---|---|
All revisions | 2.9 (0.003 ÷ 11.0) | 1.7 (0.04 ÷ 8.2) | 4.5 (0.002 ÷ 11.0) | <0.001 |
Fracture of the femoral neck | 1.5 (0.02 ÷ 11.0) | 0.5 (0.04 ÷ 3.8) | 3.0 (0.002 ÷ 11.0) | 0.0012 |
Loosening of the acetabular component | 2.4 (0.01 ÷ 9.7) | 1.4 (0.04 ÷ 3.0) | 3.0 (0.01 ÷ 9.7) | 0.16 |
Head collapse | 3.9 (0.3 ÷ 9.8) | 3.1 (0.6 ÷ 7.8) | 5.2 (0.3 ÷ 9.8) | 0.28 |
Femoral loosening | 3.7 (0.1 ÷ 9.1) | 3.0 (0.1 ÷ 5.8) | 4.4 (0.4 ÷ 8.8) | 0.50 |
Infection | 3.1 (0.5 ÷ 9.6) | 2.2 (0.5 ÷ 4.4) | 4.0 (1.0 ÷ 9.6) | 0.53 |
Pain/ALVAL/metalloids | 5.2 (1.0 ÷ 10.2) | 3.3 (1.0 ÷ 6.5) | 6.8 (1.7 ÷ 10.2) | 0.16 |
Malposition of the acetabular component | 4.2 (1.5 ÷ 6.5) | 1.5 (N/A) | 6.0 (1.5 ÷ 6.5) | N/A |
Dislocation | 3.9 (0.003 ÷ 9.5) | 0 | 3.9 (0.003 ÷ 9.5) | N/A |
Loosening of both components | 3.4 (0.3 to 5.9) | 1.6 (0.3 to 3.0) | 4.6 (3.4 to 5.9) | 1.0 |
Surgical Simplex P (Stryker Howmedica Osteonics) | Aminofix 1 (Groupe Lepine) | Aminofix 3 (Groupe Lepine) | ||
---|---|---|---|---|
Liquid component | 18.79 g | 14.4 g | 16.4 g | |
Methyl methacrylate | Monomer | 18.33 | 12.28 | 13.99 |
Butyl methacrylate | Monomer | - | 1.90 | 2.16 |
N,N-dimethyl-p-toluidine | Activator | 0.46 | 0.22 | 0.25 |
Hydroquinone | Inhibitor | 60 ppm | 20 ppm | 20 ppm |
Powder component | 41 g | 40 g | 40 g | |
Polymethyl methacrylate | Pre-polymerized polymer | 6.00 | 33.68 | 33.52 |
Benzoyl peroxide | Initiator | 0.50 | 0.96 | 1.12 |
Methyl methacrylate-styrene copolymer | Pre-polymerized copolymer | 30.00 | - | - |
Barium sulphate | Radiopaque agent | 4 | 3.84 | 3.84 |
Gentamicin sulfate | Antibiotic | - | 1.52 | 1.52 |
Erytromycin Colistin | Antibiotic | 0.50 | - | - |
Sulphomethate | Antibiotic | 3.00 million I.U. | - | - |
Sodium EP viscosity | low | standard | low |
Sample | Zone | Average Thickness of the Cement Layer (mm) |
---|---|---|
Sample 1 | 1 | 24.86 |
2 | 15.68 | |
3 | 13.92 | |
Sample 2 | 12.83 | |
2 | 7.59 | |
3 | 5.90 | |
Sample 3 | 1 | 13.48 |
2 | 12.29 | |
3 | 9.43 |
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Antoniac, I.; Valeanu, N.; Niculescu, M.; Antoniac, A.; Robu, A.; Popescu, L.; Manescu, V.; Anusca, D.; Enachescu, C.I. Outcomes of Birmingham Hip Resurfacing Based on Clinical Aspects and Retrieval Analysis of Failed Prosthesis. Materials 2024, 17, 3965. https://doi.org/10.3390/ma17163965
Antoniac I, Valeanu N, Niculescu M, Antoniac A, Robu A, Popescu L, Manescu V, Anusca D, Enachescu CI. Outcomes of Birmingham Hip Resurfacing Based on Clinical Aspects and Retrieval Analysis of Failed Prosthesis. Materials. 2024; 17(16):3965. https://doi.org/10.3390/ma17163965
Chicago/Turabian StyleAntoniac, Iulian, Niculae Valeanu, Marius Niculescu, Aurora Antoniac, Alina Robu, Larisa Popescu, Veronica Manescu (Paltanea), Dan Anusca, and Catalin Ionel Enachescu. 2024. "Outcomes of Birmingham Hip Resurfacing Based on Clinical Aspects and Retrieval Analysis of Failed Prosthesis" Materials 17, no. 16: 3965. https://doi.org/10.3390/ma17163965