Document Detail


The effect of poly sterilization on wear, osteolysis and survivorship of a press-fit cup at 10-year followup.
MedLine Citation:
PMID:  21904891     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: During the mid-1990s when our institution was using a press-fit porous-coated cup without supplemental initial fixation for primary THA, the manufacturer transitioned from gamma irradiation to gas plasma for the terminal sterilization of their polyethylene liners.
QUESTIONS/PURPOSES: At minimum 10-year followup, we asked whether the fixation achieved by solely relying on a press-fit would be durable and how different liner sterilization methods affected radiographic wear, osteolysis, and survivorship.
PATIENTS AND METHODS: We retrospectively reviewed 373 patients who underwent 398 primary THAs with a press-fit porous-coated cup between March 1995 and December 1996. Mean age at time of surgery was 61.5 ± 13.3 years and mean followup was 10.4 ± 3.7 years. We determined reasons for revision, survivorship, femoral head penetration, osteolysis, and wear-related complications.
RESULTS: Among 20 revisions involving any component, seven were associated with wear and osteolysis. Kaplan-Meier survivorship, using component revision for any reason as an end point, was 95.7% (95% confidence interval, 93.6%-97.9%) at 10 years. Noncrosslinked liners sterilized with gas plasma demonstrated a mean head penetration rate of 0.20 ± 0.09 mm/year compared with 0.13 ± 0.07 mm/year for liners sterilized with gamma irradiation in air and 0.09 ± 0.04 mm/year for liners sterilized with gamma-irradiation with barrier packaging without oxygen. THAs with increased volumetric wear tended to demonstrate larger osteolytic lesions (r = 0.40) and there tended to be less osteolysis among the liners sterilized with gamma-irradiation with barrier packaging without oxygen. However, there was no difference in survivorship among the sterilization groups and there has been no cup or stem loosening associated with osteolysis.
CONCLUSIONS: Durable biologic fixation through 10-year followup can be achieved by solely relying on an initial press-fit. Noncrosslinking gas plasma for terminal sterilization of the polyethylene liners was associated with greater head penetration rate than gamma irradiation.
LEVEL OF EVIDENCE: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Authors:
Charles A Engh; Cara C Powers; Henry Ho; Sarah E Beykirch-Padgett; Robert H Hopper; C Anderson Engh
Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study    
Journal Detail:
Title:  Clinical orthopaedics and related research     Volume:  470     ISSN:  1528-1132     ISO Abbreviation:  Clin. Orthop. Relat. Res.     Publication Date:  2012 Feb 
Date Detail:
Created Date:  2012-01-11     Completed Date:  2012-02-27     Revised Date:  2013-06-27    
Medline Journal Info:
Nlm Unique ID:  0075674     Medline TA:  Clin Orthop Relat Res     Country:  United States    
Other Details:
Languages:  eng     Pagination:  462-70     Citation Subset:  AIM; IM    
Affiliation:
Anderson Orthopaedic Research Institute, PO Box 7088, Alexandria, VA 22307, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Arthroplasty, Replacement, Hip / adverse effects,  instrumentation*
Chi-Square Distribution
Female
Gamma Rays / adverse effects
Hip Joint / radiography,  surgery*
Hip Prosthesis*
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Osteolysis / etiology,  prevention & control*,  radiography
Plasma Gases / adverse effects
Polyethylene* / radiation effects
Prosthesis Design
Prosthesis Failure*
Reoperation
Retrospective Studies
Risk Assessment
Risk Factors
Sterilization* / methods
Stress, Mechanical
Time Factors
Treatment Outcome
Virginia
Young Adult
Chemical
Reg. No./Substance:
0/Plasma Gases; 9002-88-4/Polyethylene
Comments/Corrections

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