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20. Cup positioning and its effect on polyethylene wear of vitamin E- and non-vitamin E-supplemented liners in total hip arthroplasty: radiographic outcome at 5-year follow-up

Author

Baghdadi, Josef, Alkhateeb, Shareef, Roth, Alexander, Jäger, Marcus, Busch, A., Landgraeber, Stefan, Serong, S., Haversath, Marcel, von Wasen, A., Windhagen, H., Flörkemeier, T., Budde, S., Kubilay, J., Noll, Y., Delank, K.S., Willburger, R., Dücker, M., Wilke, A., and Hütter, F.

Subjects
Medizin, Orthopedics and Sports Medicine, Surgery, General Medicine
Abstract

Background Aseptic loosening remains a challenging problem after total hip arthroplasty. Accurate cup placement and supplementation of antioxidants in acetabular liners might reduce material failure rates. The aim of this study is to assess the effect of the cup position on the wear behaviour of UHMWPE-XE and UHMWPE-X liners in vivo using virtual radiographs. Methods We conducted a prospective, randomized, controlled, multicenter trial. Clinical data of 372 probands were analyzed. Anteroposterior pelvic X-rays of 324 patients immediately postoperatively and after 1 and 5 years were evaluated by the RayMatch® analysis software regarding cup position and wear behaviour. Results Mean cup anteversion was 20.3° (± 7.4) and inclination was 41.9° (± 7.0) postoperatively. 62.3% of all patients had an anteversion and inclination within the Lewinnek safe zone. Anterior and anterolateral approaches led to significantly higher cup anteversion compared to lateral approaches (27.3° ± 5.5; 20.9° ± 7.2; 17.5° ± 6.6; p p = 0.001, respectively). Mean anteversion increased to 24.6° (± 8.0) after 1 year (p p = 0.012) and this was amplified when inclination angles were ≥ 50° (23.6 µm/year ± 12.8 vs. 38.0 µm/year ± 22.7, p = 0.062). Conclusion Anterior approaches lead to the highest inaccuracy of cup placement, but cup positioning outside the Lewinnek safe zone does not necessarily cause higher dislocation rates. Moreover, mean anteversion increased by approximately four degrees within the first year after operation, which is expected to be functional due to a regularization of pelvic tilt after intervention. Mid-term wear rates of UHMWPE-X and UHMWPE-XE liners are comparable, but steep cup positions lead to significantly increased polyethylene wear. In summary, a re-evaluation of target zones for intraoperative cup positioning might be considered. In the long-term reduced oxidative embrittlement could lead to superior wear behaviour of vitamin E-blended liners.

Published
2022
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39. A pilot study: Image-less robotic-assisted revision arthroplasty shows comparable surgery time, alignment accuracy, bone preserving and early revision rate compared to robotic-assisted primary TKA

Author

Tuecking, LR, Savov, P, Windhagen, H, and Ettinger, M

Subjects
surgery time, ddc: 610, accuracy, robotic assisted revision TKA, Medicine and health, Robot assisted TKA, alignment
Abstract

Objectives: The number of revision arthroplasty operations is rising recently. Robotic arthroplasty is increasingly being used in primary arthroplasty and is already showing promising results in terms of accuracy and revision rates. The purpose of this pilot study is to investigate the operation time, [for full text, please go to the a.m. URL]

Published
2021
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40. Die Anwendung roboterassistierter Verfahren senkt überdurchschnittliche Versorgungskosten für die Implantation primärer Knie-Totalendoprothesen in komplexen Fällen

Author

Stauß, R, Savov, P, Tücking, LR, Windhagen, H, and Ettinger, M

Subjects
total knee arthroplasty, episode of care costs, ddc: 610, TKA, Medicine and health, case complexity, complex knee, readmission rate
Abstract

Fragestellung: Ökonomische Studien zeigten überhöhte Versorgungskosten (90-day Episode of Care Costs, EOC) für die Implantation primärer Knie-Totalendoprothesen (KTEP) in einem Patientenkollektiv mit größerer Fallkomplexität. Der Einfluss roboterassistierter Verfahren [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Published
2021
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41. Cup positioning and its effect on polyethylene wear of vitamin E- and non-vitamin E-supplemented liners in total hip arthroplasty: radiographic outcome at 5-year follow-up.

Author

Baghdadi, Josef, Alkhateeb, Shareef, Roth, Alexander, VITAS-Group, Jäger, M, Busch, A, Alkhateeb, S, Landgraeber, S, Serong, S, Haversath, M, vonWasen, A, Windhagen, H, Flörkemeier, T, Budde, S, Kubilay, J, Noll, Y, Delank, KS, Baghdadi, J, Willburger, R, and Dücker, M

Subjects
TOTAL hip replacement, RADIOSTEREOMETRY, POLYETHYLENE, FRACTURE mechanics, VITAMINS, MECHANICAL wear
Abstract

Background: Aseptic loosening remains a challenging problem after total hip arthroplasty. Accurate cup placement and supplementation of antioxidants in acetabular liners might reduce material failure rates. The aim of this study is to assess the effect of the cup position on the wear behaviour of UHMWPE-XE and UHMWPE-X liners in vivo using virtual radiographs. Methods: We conducted a prospective, randomized, controlled, multicenter trial. Clinical data of 372 probands were analyzed. Anteroposterior pelvic X-rays of 324 patients immediately postoperatively and after 1 and 5 years were evaluated by the RayMatch® analysis software regarding cup position and wear behaviour. Results: Mean cup anteversion was 20.3° (± 7.4) and inclination was 41.9° (± 7.0) postoperatively. 62.3% of all patients had an anteversion and inclination within the Lewinnek safe zone. Anterior and anterolateral approaches led to significantly higher cup anteversion compared to lateral approaches (27.3° ± 5.5; 20.9° ± 7.2; 17.5° ± 6.6; p < 0.001 and p = 0.001, respectively). Mean anteversion increased to 24.6° (± 8.0) after 1 year (p < 0.001). Only one revision occurred because of implant dislocation. Wear rates from UHMWPE-X and UHMWPE-XE did not differ significantly. Anteversion angles ≥ 25° correlated to increased polyethylene wear (23.7 µm/year ± 12.8 vs. 31.1 µm/year ± 22.8, p = 0.012) and this was amplified when inclination angles were ≥ 50° (23.6 µm/year ± 12.8 vs. 38.0 µm/year ± 22.7, p = 0.062). Conclusion: Anterior approaches lead to the highest inaccuracy of cup placement, but cup positioning outside the Lewinnek safe zone does not necessarily cause higher dislocation rates. Moreover, mean anteversion increased by approximately four degrees within the first year after operation, which is expected to be functional due to a regularization of pelvic tilt after intervention. Mid-term wear rates of UHMWPE-X and UHMWPE-XE liners are comparable, but steep cup positions lead to significantly increased polyethylene wear. In summary, a re-evaluation of target zones for intraoperative cup positioning might be considered. In the long-term reduced oxidative embrittlement could lead to superior wear behaviour of vitamin E-blended liners. [ABSTRACT FROM AUTHOR]

Published
2023
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