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Orthopaedic Proceedings
Vol. 101-B, Issue SUPP_6 | Pages 25 - 25
1 May 2019
Langton D Sidaginamale R Wells S Wainwright B Holland J Deehan D Joyce T Jafri A Nargol A Natu S
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Introduction

We aimed to identify genes associated with the development of ALVAL at relatively low levels of wear.

Methods

At our unit all patients undergoing revision of a MoM hip prosthesis have periprosthetic tissue samples graded for ALVAL. Explants undergo volumetric wear testing of the bearing and taper surfaces. We identified patients with moderate/severe ALVAL who had been exposed to lower than the median wear rate of all recorded patients who had developed ALVAL (<3mm3/year). This was termed the “ALVAL” group. We then identified all patients whose tissues had shown no signs of ALVAL. The patients in the two groups were sent buccal DNA collection kits. DNA was examined using next generation sequencing. Alleleic frequencies in the two groups were compared using Fisher's test and compared to a background UK population group (n=8514). We then conducted binary logistic regression with patient age, sex, primary source of debris (taper/bearing) and HLA genotype as the predictors. With the hypothesis that a cobalt/albumin metalloprotein acts as the epitope, we used validated binding prediction software to determine the relative affinities of the binding grooves created by different DQA1/DQB1 genetic combinations for albumin derived peptides. Given the protection that male sex and younger age appears to confer against ALVAL, we hypothesized that testosterone peptides may compete for these binding sites.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_11 | Pages 4 - 4
1 Jun 2016
O'Hare J Langton D Nargol A Joyce T Brewster N Cooke N Jafri A Lord J Duffy P Holland J
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Introduction

Historical studies have reported incidences of taper corrosion in retrieved MoP hips of 20–50%. These studies relied on visual assessments, rather than using modern analytical techniques.

Patients/Materials and Methods

The Northern Retrieval Registry was initiated to routinely analyse all retrieved hips. The volumetric wear rates of retrieved Exeter head tapers were measured using a coordinate measuring machine using validated methods and compared to the available results obtained from an ongoing study of failed MoM prostheses. Power analysis suggested that we would need at least fifty Exeter head tapers to provide significant results. Non-parametric tests were used to assess differences. We have previously identified head diameter/offset/taper angle and taper surface roughness as variables associated with taper wear. The effect of bearing material combination remains unquantified. These design variables were entered into a multiple regression model following log normalisation of taper wear.


Orthopaedic Proceedings
Vol. 88-B, Issue SUPP_III | Pages 365 - 365
1 Oct 2006
Jafri A Green S McCaskie A Partington P Muller S
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Introduction: Aseptic loosening is the commonest complication of cemented total hip arthroplasy. Gaseous voids within the cement mantle are thought to act as stress concentrators and points of origin and preferential fracture propagation at the cement stem interface. Assuming a bone tempereature of 37°C, Bishop recommended heating the prosthesis to 44°C, thereby effecting a reduction in cement-prosthesis interface porosity.

The aim of this study was to (I) determine the intra-operative temperature of the femoral cancellous bed prior to insertion of prosthesis, (II) to investigate whether the magnitude of the temperature gradient effects interface porosity (III) to develop clinically relevant recommendations.

Materials and Methods: (I) The intra-operative determination of femoral cancellous boney bed temperature. Sterile, single use thermocouples (Mon-a-therm) were used to record interface temperature in six patients, after canal preparation and lavage. (II) A simulated femoral model was designed consisting of a waterbath, set at temperature determined by (I) with an inner water-tight chamber formed by 19mm diameter polyethylene tubing. Cement (Palacos) was non-vacuum mixed (to exaggerate porosity) for 1 minute and injected in a retrograde manner into the inner tube at 3 minutes. Femoral stems (Exeter) were pre-heated in a second waterbath to 18, 32,35,37,40,44°C, were thoroughly dried and lowered into the inner tube by a Lloyd universal testing machine via a custom jig. The cement was left to polymerise.

The cement mantle was sectioned transversely, then longitudinally to expose the cement-prosthesis interface. This was stained with acrylic dye to facilitate image analysis. Three mantles for each temperature were produced.

Results: (I) The mean femoral canal temperature was 32.3°C, (II) the effect of stem temperature on interface porosity is shown in fig1.

Conclusions: Bone temperature is 32°C after canal preparation using contemporary cementing techniques. Heating to 35°C reduces interface porosity, heating to 40°C is optimal.