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Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_11 | Pages 6 - 6
1 Jul 2014
Bostrom M Courtland H Grosso M Sutherland J Stoner K Yang X van der Meulen M
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Summary Statement

The modulation of both quantity and quality of peri-implant bone with either PTH or loading may be viable options to improve implant fixation and patient outcomes.

A strong bone-implant interface is essential for successful joint replacement surgery. This study investigated the differences in bone surrounding and within a porous titanium implant after single or combined treatment with two anabolic bone therapies: intermittent parathyroid hormone (teriparatide) and mechanical loading. Porous titanium implants were inserted bilaterally on the distal lateral femurs of rabbits. The right implant was loaded daily (1 MPa, 50 cycles/day) while the left implant was not. Rabbits received daily PTH injections (20 ug/kg) or saline vehicle. Periprosthetic cancellous bone 0.5, 1.0, and 2.0 mm below the implant surface, bone at the 0.25 mm bone-implant interface and total bone within each implant were examined using tissue-level analyses (quantitative backscattered electron microscopy), cellular analyses (immunohistochemistry staining of osteoblasts with procollagen-1 and TRAP staining of osteoclasts), and shear testing (implant-bone interface).

Statistical significance was determined using GEE models (p<0.05). For tissue located 0.5 mm below the implant, significant increases in bone area per total area (BA/TA) were observed with PTH treatment (56%) and with loading (27%). Further, an 18% increase in mineralization density with PTH treatment and a 20% increase in mineralization density with loading was found. Loading effects were not present beyond the 0.5 mm periprosthetic region, but PTH significantly increased BA/TA 2.0 mm below and mineralization density 1.0 mm below the implant. Tissue-level changes were supported by increases in osteoblast activity 0.5 mm below the implant with PTH (79%) and loading (34%), as well as by minimal osteoclast changes. At the 0.25 mm implant-bone interface PTH and loading increased BA/TA (16% and 23%, respectively), but only loading increased mineralization density (7%). Further, total integrated bone area was increased 35% with PTH.

Both PTH and loading enhanced the mechanical integrity of the implant-bone; shear strength increased 34% and 60%, respectively. Although combined treatment was not synergistic, both PTH and loading individually enhanced the amount and mineralization density of bone at the implant interface and immediately below the interface, thereby increasing the mechanical strength of the metal-bone interface. This research suggests that modulation of both quantity and quality of peri-implant bone may be viable options to improve implant fixation and patient outcomes.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_34 | Pages 472 - 472
1 Dec 2013
Padgett DE Stoner K Nassif N Nawabi D Wright T Elpers M
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Introduction:

Large diameter metal on metal total hip arthroplasty (MOM THA) have shorter lengths of implantation due to increased failure caused by wear either at the articulating surface as well as the taper-trunnion interface. Taper-trunnion wear may be worse in large diameter MOM THA due the increased torque at the taper-trunnion interface. However little has been done to understand how differences in taper-trunnion geometry and trunnion engagement effects wear. The purpose of this study was to (1) measure the differences in taper geometry and trunnion engagement on the head-taper of 11/13, 12/14, and Type 1 taper designs and (2) to determine if taper geometry affects fretting, corrosion, and wear at the taper interface.

Methods:

We identified 54 MOM THA primary revision implants with head diameters greater than 36 mm from our retrieval archive. Patients' charts were queried for demographic information and pre-revision radiographs were measured for cup inclination and cup anteversion. To measure taper geometry and wear the head tapers were imaged using Redlux©. The point clouds obtained from this were analyzed in Geomagic©. Taper angles and contact length where the trunnion engaged with the female taper of the head-tapers were measured. The diameter of the taper at the most distal visual area of trunnion engagement was also measured. Best fit cones were fit to the unworn regions to approximate the pristine surface. Differences between the raw data and the unworn surface were measured and volumetric wear rates were calculated. Fretting and corrosion of the head-taper was graded using the Goldberg Scoring.