Advertisement for orthosearch.org.uk
Results 1 - 20 of 22
Results per page:
The Bone & Joint Journal
Vol. 103-B, Issue 12 | Pages 1791 - 1801
1 Dec 2021
Bhalekar RM Nargol ME Shyam N Nargol AVF Wells SR Collier R Pabbruwe M Joyce TJ Langton DJ

Aims

The aim of this study was to investigate whether wear and backside deformation of polyethylene (PE) tibial inserts may influence the cement cover of tibial trays of explanted total knee arthroplasties (TKAs).

Methods

At our retrieval centre, we measured changes in the wear and deformation of PE inserts using coordinate measuring machines and light microscopy. The amount of cement cover on the backside of tibial trays was quantified as a percentage of the total surface. The study involved data from the explanted fixed-bearing components of four widely used contemporary designs of TKA (Attune, NexGen, Press Fit Condylar (PFC), and Triathlon), revised for any indication, and we compared them with components that used previous generations of PE. Regression modelling was used to identify variables related to the amount of cement cover on the retrieved trays.


Orthopaedic Proceedings
Vol. 101-B, Issue SUPP_5 | Pages 47 - 47
1 Apr 2019
Joyce TJ Smith SL Forbes L Rushton PRP Bowey AJ Gibson MJ
Full Access

Background

Established hip and knee arthroplasty registers exist in many countries but this is not the case with spinal implants. Moreover, in the case of a rod intended to guide spinal growth in a child and then be removed, the definition of ‘failure’ (revision) used for hip or knee arthroplasty is inappropriate. How can the performance of such spinal implants be judged?

Methods

Ninety-six MAGnetic Expansion Control (MAGEC) spinal rods were obtained from multiple centres after removal from the spines of 52 children with scoliosis. Clinical details were assessed and divided between unplanned revision operations (‘failures’) and those which were planned. Of the explanted rods, 49 were tested for the amount of force they could output, using the manufacturer's supplied test jig. Sixty-five rods were cut apart so that the internal components (bearings, O-ring seals, drive pins) could be assessed, alongside if there was evidence of internal wear.


The Bone & Joint Journal
Vol. 100-B, Issue 10 | Pages 1310 - 1319
1 Oct 2018
Langton DJ Wells SR Joyce TJ Bowsher JG Deehan D Green S Nargol AVF Holland JP

Aims

There are limited published data detailing the volumetric material loss from tapers of conventional metal-on-polyethylene (MoP) total hip arthroplasties (THAs). Our aim was to address this by comparing the taper wear rates measured in an explanted cohort of the widely used Exeter THA with those measured in a group of metal-on-metal (MoM) THAs.

Patients and Methods

We examined an existing retrieval database to identify all Exeter V40 and Universal MoP THAs. Volumetric wear analysis of the taper surfaces was conducted using previously validated methodology. These values were compared with those obtained from a series of MoM THAs using non-parametric statistical methodology. A number of patient and device variables were accounted for using multiple regression modelling.


Bone & Joint Research
Vol. 7, Issue 6 | Pages 388 - 396
1 Jun 2018
Langton DJ Sidaginamale RP Joyce TJ Bowsher JG Holland JP Deehan D Nargol AVF Natu S

Objectives

We have encountered patients who developed large joint fluid collections with massive elevations in chromium (Cr) and cobalt (Co) concentrations following metal-on-metal (MoM) hip arthroplasties. In some cases, retrieval analysis determined that these ion concentrations could not be explained simply by the wear rates of the components. We hypothesized that these effects may be associated with aseptic lymphocyte-dominated vasculitis-associated lesion (ALVAL).

Patients and Methods

We examined the influence of the ALVAL grade on synovial fluid Co and Cr concentrations following adjustment for patient and device variables, including volumetric wear rates. Initially restricting the analysis to include only patients with one MoM hip resurfacing device, we performed multiple regression analyses of prospectively collected data. We then repeated the same statistical approach using results from a larger cohort with different MoM designs, including total hip arthroplasties.


The Bone & Joint Journal
Vol. 99-B, Issue 10 | Pages 1304 - 1312
1 Oct 2017
Langton DJ Sidaginamale RP Joyce TJ Meek RD Bowsher JG Deehan D Nargol AVF Holland JP

Aims

We sought to determine whether cobalt-chromium alloy (CoCr) femoral stem tapers (trunnions) wear more than titanium (Ti) alloy stem tapers (trunnions) when used in a large diameter (LD) metal-on-metal (MoM) hip arthroplasty system.

Patients and Methods

We performed explant analysis using validated methodology to determine the volumetric material loss at the taper surfaces of explanted LD CoCr MoM hip arthroplasties used with either a Ti alloy (n = 28) or CoCr femoral stem (n = 21). Only 12/14 taper constructs with a rough male taper surface and a nominal included angle close to 5.666° were included. Multiple regression modelling was undertaken using taper angle, taper roughness, bearing diameter (horizontal lever arm) as independent variables. Material loss was mapped using a coordinate measuring machine, profilometry and scanning electron microscopy.


Bone & Joint Research
Vol. 6, Issue 2 | Pages 113 - 122
1 Feb 2017
Scholes SC Hunt BJ Richardson VM Langton DJ Smith E Joyce TJ

Objectives

The high revision rates of the DePuy Articular Surface Replacement (ASR) and the DePuy ASR XL (the total hip arthroplasty (THA) version) have led to questions over the viability of metal-on-metal (MoM) hip joints. Some designs of MoM hip joint do, however, have reasonable mid-term performance when implanted in appropriate patients. Investigations into the reasons for implant failure are important to offer help with the choice of implants and direction for future implant designs. One way to assess the performance of explanted hip prostheses is to measure the wear (in terms of material loss) on the joint surfaces.

Methods

In this study, a coordinate measuring machine (CMM) was used to measure the wear on five failed cementless Biomet Magnum/ReCap/ Taperloc large head MoM THAs, along with one Biomet ReCap resurfacing joint. Surface roughness measurements were also taken. The reason for revision of these implants was pain and/or adverse reaction to metal debris (ARMD) and/or elevated blood metal ion levels.


The Bone & Joint Journal
Vol. 98-B, Issue 7 | Pages 925 - 933
1 Jul 2016
Sidaginamale RP Joyce TJ Bowsher JG Lord JK Avery PJ Natu S Nargol AVF Langton DJ

Aims

We wished to investigate the influence of metal debris exposure on the subsequent immune response and resulting soft-tissue injury following metal-on-metal (MoM) hip arthroplasty. Some reports have suggested that debris generated from the head-neck taper junction is more destructive than equivalent doses from metal bearing surfaces.

Patients and Methods

We investigated the influence of the source and volume of metal debris on chromium (Cr) and cobalt (Co) concentrations in corresponding blood and hip synovial fluid samples and the observed agglomerated particle sizes in excised tissues using multiple regression analysis of prospectively collected data. A total of 199 explanted MoM hips (177 patients; 132 hips female) were analysed to determine rates of volumetric wear at the bearing surfaces and taper junctions.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_1 | Pages 114 - 114
1 Jan 2016
Dold P Bone M Flohr M Preuss R Joyce TJ Deehan D Holland J
Full Access

INTRODUCTION

Deformation of modular acetabular press-fit shells is a topic of much interest for surgeons and manufacturer. Such modular components utilise a titanium shell with a liner manufactured from metal, polyethylene or ceramic. Initial fixation is achieved through a press-fit between shell and acetabulum with the shell mechanically deforming upon insertion. Shell deformation may disrupt the assembly process of inserting the bearing liner into the acetabular shell for modular systems. This may adversely affect the integrity and durability of the components and the tribology of the bearing.

OBJECTIVE

Most clinically relevant data to quantify and understand such shell deformation can be achieved by cadaver measurements. ATOS Triple Scan III was identified as a measurement system with the potential to perform those measurements. The study aim was to validate an ATOS Triple Scan III optical measurement system against a co-ordinate measuring machine (CMM) using in-vitro testing and to check capability/ repeatability under cadaver lab conditions.


The Bone & Joint Journal
Vol. 97-B, Issue 4 | Pages 473 - 477
1 Apr 2015
Bone MC Dold P Flohr M Preuss R Joyce TJ Aspden RM Holland J Deehan D

Concerns have been raised that deformation of acetabular shells may disrupt the assembly process of modular prostheses. In this study we aimed to examine the effect that the strength of bone has on the amount of deformation of the acetabular shell. The hypothesis was that stronger bone would result in greater deformation. A total of 17 acetabular shells were inserted into the acetabula of eight cadavers, and deformation was measured using an optical measuring system. Cores of bone from the femoral head were taken from each cadaver and compressed using a materials testing machine. The highest peak modulus and yield stress for each cadaver were used to represent the strength of the bone and compared with the values for the deformation and the surgeon’s subjective assessment of the hardness of the bone. The mean deformation of the shell was 129 µm (3 to 340). No correlation was found between deformation and either the maximum peak modulus (r² = 0.011, t = 0.426, p = 0.676) or the yield stress (r² = 0.024, t = 0.614, p = 0.549) of the bone. Although no correlation was found between the strength of the bone and deformation, the values for the deformation observed could be sufficient to disrupt the assembly process of modular acetabular components.

Cite this article: Bone Joint J 2015; 97-B:473–7.


Bone & Joint Research
Vol. 3, Issue 3 | Pages 60 - 68
1 Mar 2014
Langton DJ Sidaginamale RP Holland JP Deehan D Joyce TJ Nargol AVF Meek RD Lord JK

Objectives

Wear debris released from bearing surfaces has been shown to provoke negative immune responses in the recipient. Excessive wear has been linked to early failure of prostheses. Analysis using coordinate measuring machines (CMMs) can provide estimates of total volumetric material loss of explanted prostheses and can help to understand device failure. The accuracy of volumetric testing has been debated, with some investigators stating that only protocols involving hundreds of thousands of measurement points are sufficient. We looked to examine this assumption and to apply the findings to the clinical arena.

Methods

We examined the effects on the calculated material loss from a ceramic femoral head when different CMM scanning parameters were used. Calculated wear volumes were compared with gold standard gravimetric tests in a blinded study.


Bone & Joint Research
Vol. 2, Issue 5 | Pages 84 - 95
1 May 2013
Sidaginamale RP Joyce TJ Lord JK Jefferson R Blain PG Nargol AVF Langton DJ

Objectives

The aims of this piece of work were to: 1) record the background concentrations of blood chromium (Cr) and cobalt (Co) concentrations in a large group of subjects; 2) to compare blood/serum Cr and Co concentrations with retrieved metal-on-metal (MoM) hip resurfacings; 3) to examine the distribution of Co and Cr in the serum and whole blood of patients with MoM hip arthroplasties; and 4) to further understand the partitioning of metal ions between the serum and whole blood fractions.

Methods

A total of 3042 blood samples donated to the local transfusion centre were analysed to record Co and Cr concentrations. Also, 91 hip resurfacing devices from patients who had given pre-revision blood/serum samples for metal ion analysis underwent volumetric wear assessment using a coordinate measuring machine. Linear regression analysis was carried out and receiver operating characteristic curves were constructed to assess the reliability of metal ions to identify abnormally wearing implants. The relationship between serum and whole blood concentrations of Cr and Co in 1048 patients was analysed using Bland-Altman charts. This relationship was further investigated in an in vitro study during which human blood was spiked with trivalent and hexavalent Cr, the serum then separated and the fractions analysed.


The Bone & Joint Journal
Vol. 95-B, Issue 2 | Pages 173 - 176
1 Feb 2013
Petheram TG Bone M Joyce TJ Serrano-Pedraza I Reed MR Partington PF

Recent guidance recommends the use of a well-proven cemented femoral stem for hemiarthroplasty in the management of fractures of the femoral neck, and the Exeter Trauma Stem (ETS) has been suggested as an example of such an implant. The design of this stem was based on the well-proven Exeter Total Hip Replacement stem (ETHRS). This study assessed the surface finish of the ETS in comparison with the ETHRS. Two ETSs and two ETHRSs were examined using a profilometer with a precision of 1 nm and compared with an explanted Exeter Matt stem. The mean roughness average (RA) of the ETSs was approximately ten times higher than that of the ETHRSs (0.235 μm (0.095 to 0.452) versus 0.025 μm (0.011 to 0.059); p < 0.001). The historical Exeter Matt stem roughness measured a mean RA of 0.973 μm (0.658 to 1.159). The change of the polished Exeter stem to a matt surface finish in 1976 resulted in a high stem failure rate. We do not yet know whether the surface differences between ETS and ETHRS will be clinically significant. We propose the inclusion of hemiarthroplasty stems in national joint registries.

Cite this article: Bone Joint J 2013;95-B:173–6.


Bone & Joint Research
Vol. 1, Issue 4 | Pages 56 - 63
1 Apr 2012
Langton DJ Sidaginamale R Lord JK Nargol AVF Joyce TJ

Objectives

An ongoing prospective study to investigate failing metal-on-metal hip prostheses was commenced at our centre in 2008. We report on the results of the analysis of the first consecutive 126 failed mated total hip prostheses from a single manufacturer.

Methods

Analysis was carried out using highly accurate coordinate measuring to calculate volumetric and linear rates of the articular bearing surfaces and also the surfaces of the taper junctions. The relationship between taper wear rates and a number of variables, including bearing diameter and orientation of the acetabular component, was investigated.


The Journal of Bone & Joint Surgery British Volume
Vol. 93-B, Issue 8 | Pages 1011 - 1016
1 Aug 2011
Langton DJ Jameson SS Joyce TJ Gandhi JN Sidaginamale R Mereddy P Lord J Nargol AVF

There is widespread concern regarding the incidence of adverse soft-tissue reactions after metal-on-metal (MoM) hip replacement. Recent National Joint Registry data have shown clear differences in the rates of failure of different designs of hip resurfacing. Our aim was to update the failure rates related to metal debris for the Articular Surface Replacement (ASR). A total of 505 of these were implanted.

Kaplan-Meier analysis showed a failure rate of 25% at six years for the ASR resurfacing and of 48.8% for the ASR total hip replacement (THR). Of 257 patients with a minimum follow-up of two years, 67 (26.1%) had a serum cobalt concentration which was greater than 7 μg/l. Co-ordinate measuring machine analysis of revised components showed that all patients suffering adverse tissue reactions in the resurfacing group had abnormal wear of the bearing surfaces. Six THR patients had relatively low rates of articular wear, but were found to have considerable damage at the trunion-taper interface. Our results suggest that wear at the modular junction is an important factor in the development of adverse tissue reactions after implantation of a large-diameter MoM THR.


The Journal of Bone & Joint Surgery British Volume
Vol. 93-B, Issue 2 | Pages 164 - 171
1 Feb 2011
Langton DJ Joyce TJ Jameson SS Lord J Van Orsouw M Holland JP Nargol AVF De Smet KA

We sought to establish the incidence of joint failure secondary to adverse reaction to metal debris (ARMD) following metal-on-metal hip resurfacing in a large, three surgeon, multicentre study involving 4226 hips with a follow-up of 10 to 142 months. Three implants were studied: the Articular Surface Replacement; the Birmingham Hip Resurfacing; and the Conserve Plus. Retrieved implants underwent analysis using a co-ordinate measuring machine to determine volumetric wear. There were 58 failures associated with ARMD. The median chromium and cobalt concentrations in the failed group were significantly higher than in the control group (p < 0.001). Survival analysis showed a failure rate in the patients with Articular Surface Replacement of 9.8% at five years, compared with < 1% at five years for the Conserve Plus and 1.5% at ten years for the Birmingham Hip Resurfacing. Two ARMD patients had relatively low wear of the retrieved components. Increased wear from the metal-on-metal bearing surface was associated with an increased rate of failure secondary to ARMD. However, the extent of tissue destruction at revision surgery did not appear to be dose-related to the volumetric wear.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_I | Pages 66 - 66
1 Jan 2011
Joyce TJ Langton DJ Nargol AVF
Full Access

Introduction: One of the latest groups of replacement hip joints are known as hip resurfacings and they consist of a relatively large diameter femoral head articulating within a thin acetabular cup. Many of these devices show good short to medium term clinical results. However there are concerns over such implants including fracture of the femur and possible wear debris related reactions. Much valuable data can be learnt from explanted prostheses which have ‘failed’ and then been removed from patients. As hip resurfacing prostheses have only recently been introduced, there are relatively few such retrieval studies.

Methods and materials: Nineteen femoral and acetabular components from metal-on-metal hip resurfacing prostheses were obtained at revision operations. There were eight patients who had femoral fractures and the remainder experienced worsening groin pain and a characteristic sterile effusion. There were eleven head components and four pairs of matching heads and cups. Each of these was examined using a Zeiss TSK Rond-com60A roundness measuring machine and a Mitutoyo LEGEX co-ordinate measuring machine (CMM). Out of roundness measurements were taken on three planes for each acetabular and femoral component. The CMM was used to obtain 12 traces at 30° intervals for each acetabular and femoral component, allowing areas of localised wear to be identified and the maximum wear depth to be quantified.

Results: The maximum out of roundness values for the nineteen components ranged from 1.8 to 91.8 microns. A similar range of values was obtained from the CMM results. From the paired components, out of roundness was greater in the head than in the cup. All eight femoral heads which were retrieved after fracture of the femur showed out of roundness of less than 5 microns.

Discussion: Both out of roundness measurements and those from the CMM provided information about the wear of the implants. For a new component, a typical out of roundness value would be no greater than 5 microns. Therefore, from the out of roundness values it was seen that the eight ‘fracture’ components showed minimal distortion or wear after removal. In contrast the remaining components, which had a minimum out of roundness of 15 microns, showed much greater wear, thus suggesting that the groin pain was associated with relatively large volumes of wear debris. CMM scans helped to identify localised areas of wear and maximum wear depths. Values in the range of < 2 microns to 164 microns have been reported previously and show good agreement with the findings of this study. Retrieved components which had been implanted at high angles of inclination and anteversion tended to show the greatest wear, implying that correct positioning in vivo is crucial to the longevity of hip resurfacing prostheses.


The Journal of Bone & Joint Surgery British Volume
Vol. 92-B, Issue 1 | Pages 38 - 46
1 Jan 2010
Langton DJ Jameson SS Joyce TJ Hallab NJ Natu S Nargol AVF

Early failure associated with adverse reactions to metal debris is an emerging problem after hip resurfacing but the exact mechanism is unclear. We analysed our entire series of 660 metal-on-metal resurfacings (Articular Surface Replacement (ASR) and Birmingham Hip Resurfacing (BHR)) and large-bearing ASR total hip replacements, to establish associations with metal debris-related failures. Clinical and radiological outcomes, metal ion levels, explant studies and lymphocyte transformation tests were performed. A total of 17 patients (3.4%) were identified (all ASR bearings) with adverse reactions to metal debris, for which revision was required. This group had significantly smaller components, significantly higher acetabular component anteversion, and significantly higher whole concentrations of blood and joint chromium and cobalt ions than asymptomatic patients did (all p < 0.001). Post-revision lymphocyte transformation tests on this group showed no reactivity to chromium or cobalt ions. Explants from these revisions had greater surface wear than retrievals for uncomplicated fractures. The absence of adverse reactions to metal debris in patients with well-positioned implants usually implies high component wear.

Surgeons must consider implant design, expected component size and acetabular component positioning in order to reduce early failures when performing large-bearing metal-on-metal hip resurfacing and replacement.


The Journal of Bone & Joint Surgery British Volume
Vol. 91-B, Issue 10 | Pages 1287 - 1295
1 Oct 2009
Langton DJ Sprowson AP Joyce TJ Reed M Carluke I Partington P Nargol AVF

There have been no large comparative studies of the blood levels of metal ions after implantation of commercially available hip resurfacing devices which have taken into account the effects of femoral size and inclination and anteversion of the acetabular component. We present the results in 90 patients with unilateral articular surface replacement (ASR) hip resurfacings (mean time to blood sampling 26 months) and 70 patients with unilateral Birmingham Hip Resurfacing (BHR) implants (mean time 47 months).

The whole blood and serum chromium (Cr) and cobalt (Co) concentrations were inversely related to the size of the femoral component in both groups (p < 0.05). Cr and Co were more strongly influenced by the position of the acetabular component in the case of the ASR, with an increase in metal ions observed at inclinations > 45° and anteversion angles of < 10° and > 20°. These levels were only increased in the BHR group when the acetabular component was implanted with an inclination > 55°.

A significant relationship was identified between the anteversion of the BHR acetabular component and the levels of Cr and Co (p < 0.05 for Co), with an increase observed at anteversion angles < 10° and > 20°. The median whole blood and serum Cr concentrations of the male ASR patients were significantly lower than those of the BHR men (p < 0.001). This indicates that reduced diametral clearance may equate to a reduction in metal ion concentrations in larger joints with satisfactory orientation of the acetabular component.


The Journal of Bone & Joint Surgery British Volume
Vol. 90-B, Issue 9 | Pages 1143 - 1151
1 Sep 2008
Langton DJ Jameson SS Joyce TJ Webb J Nargol AVF

Increased concentrations of metal ions after metal-on-metal resurfacing arthroplasty of the hip remain a concern. Although there has been no proven link to long-term health problems or early prosthetic failure, variables associated with high metal ion concentrations should be identified and, if possible, corrected. Our study provides data on metal ion levels from a series of 76 consecutive patients (76 hips) after resurfacing arthroplasty with the Articular Surface Replacement. Chromium and cobalt ion concentrations in the whole blood of patients with smaller (≤ 51 mm) femoral components were significantly higher than in those with the larger (≥ 53 mm) components (p < 0.01). Ion concentrations in the former group were significantly related to the inclination (p = 0.01) and anteversion (p = 0.01) of the acetabular component. The same relationships were not significant in the patients with larger femoral components (p = 0.61 and p = 0.49, respectively). Accurate positioning of the acetabular component intra-operatively is essential in order to reduce the concentration of metal ions in the blood after hip resurfacing arthroplasty with the Articular Surface Replacement implant.


Orthopaedic Proceedings
Vol. 88-B, Issue SUPP_III | Pages 412 - 413
1 Oct 2006
Joyce TJ
Full Access

Introduction First metatarsophalangeal (MTP) arthroplasty is a relatively uncommon procedure compared with hip and knee joint replacement. A range of different designs of first MTP prostheses have been proposed including metal hemi-arthroplasties, single-piece double-stem silicone designs, and multi-component designs. Of the latter group, a cobalt chrome-on-cobalt chrome prosthesis, which had a diamond like carbon (DLC) coating applied to its articulating faces and hydroxyapatite-coated stems, was implanted. However, due to poor clinical results the cohort of implants were removed and one was obtained for ex vivo analysis. In addition, calculation of predicted lubrication regimes applicable to this implant design was undertaken.

Materials and Methods The ex vivo MTP implant was examined using standard microscopy as well as by using an environmental scanning electron microscope and a non-contacting profilometer. The latter device also allowed values of surface roughness to be determined while the radii of the articulating faces were measured using a co-ordinate measuring machine. Modelling the ball and socket implant as an equivalent ball-on-plane model and employing elastohydrodynamic theory [1] allowed the minimum film thickness to be calculated and in turn the lambda value to indicate the lubrication regime [2]. These calculations were undertaken for a 0 to 800N range of loading values, and a 0 to 50mm/s range of entraining velocities. The viscosity of the synovial fluid lubricant was taken to be 0.01Pa s, while for the cobalt chrome a Young’s modulus of 210GPa and a Poisson’s ratio of 0.3 were assumed.

Results and Discussion The implant was measured to have a nominal radius of 10mm and a radial clearance of 0.1mm. Calculations showed that, for the range of entraining velocities and loads considered, the implant would almost always operate in the boundary lubrication regime. Therefore surface to surface contact would most frequently take place, with little if any separation between the articulating surfaces. This result is in contrast to resurfacing designs of hip prosthesis which can operate in the fluid film lubrication mode [3]. This outcome is due to their larger radii, greater entraining velocity and reduced surface roughness values compared with the MTP implant considered here. It is felt that these design differences, inherent in different joints around the body, should be appreciated by those concerned with such implants. The presence of scratches on the articulating faces of the ex vivo sample further implied boundary lubrication. The DLC coating had been removed from the entire face of the phalangeal component and from most of the face of the metatarsal component. From the latter it appeared as if the coating had been scratched and then flaked away parallel to the scratches. In turn this suggested a corrosion based failure of the interface between the DLC coating and the cobalt chrome subsurface, a result noted recently elsewhere [4].