Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Published in
Clinical Orthopaedics and Related Research®
Volume 474 | Issue 11 | Nov, 2016

CORR® ORS Richard A. Brand Award: Clinical Trials of a New Treatment Method for Adhesive Capsulitis

Marie A. Badalamente, Edward D. Wang

Conservative and even surgical management of adhesive capsulitis often is prolonged and painful. Management of adhesive capsulitis is lacking evidence-based controlled clinical trials.

Clinical Faceoff

Clinical Faceoff: Where Are We Going With Femoral Stem Fixation in THA?

Joseph T. Moskal MD, Susan G. Capps PhD, C. Anderson Engh MD, Anders Troelsen MD, PhD, DMSc

Does PEEK/HA Enhance Bone Formation Compared With PEEK in a Sheep Cervical Fusion Model?

William R. Walsh PhD, Matthew H. Pelletier PhD, Nicky Bertollo PhD, Chris Christou BVSc, PhD, Chris Tan BVSc

Polyetheretherketone (PEEK) has a wide range of clinical applications but does not directly bond to bone. Bulk incorporation of osteoconductive materials including hydroxyapatite (HA) into the PEEK matrix is a potential solution to address the formation of a fibrous tissue layer between PEEK and bone and has not been tested.

Do Surface Porosity and Pore Size Influence Mechanical Properties and Cellular Response to PEEK?

F. Brennan Torstrick BSc, Nathan T. Evans BSc, Hazel Y. Stevens BSc, Ken Gall PhD, Robert E. Guldberg PhD

Despite its widespread use in orthopaedic implants such as soft tissue fasteners and spinal intervertebral implants, polyetheretherketone (PEEK) often suffers from poor osseointegration. Introducing porosity can overcome this limitation by encouraging bone ingrowth; however, the corresponding decrease in implant strength can potentially reduce the implant’s ability to bear physiologic loads. We have previously shown, using a single pore size, that limiting porosity to the surface of PEEK implants preserves strength while supporting in vivo osseointegration. However, additional work is needed to investigate the effect of pore size on both the mechanical properties and cellular response to PEEK.

The Biotribology of PEEK-on-HXLPE Bearings Is Comparable to Traditional Bearings on a Multidirectional Pin-on-disk Tester

Doruk Baykal PhD, Ryan S. Siskey MSc, Richard J. Underwood PhD, Adam Briscoe PhD, Steven M. Kurtz PhD

All-polymer bearings involving polyetheretherketone (PEEK) have been proposed for orthopaedic applications because they may reduce stress shielding, reduce weight of the implants, reduce wear and risk of osteolysis, and prevent release of metal ions by replacing the metal articulating components. Little is known about the biotribology of all-polymer PEEK bearings, including the effects of cross-shear, which are relevant for implant longevity, especially in the hip, and increased temperature that may affect lubricant proteins and, hence, lubrication in the joint.

The Biologic Response to Polyetheretherketone (PEEK) Wear Particles in Total Joint Replacement: A Systematic Review

Ashley A. Stratton-Powell MSc, Kinga M. Pasko MSc, Claire L. Brockett PhD, Joanne L. Tipper PhD

Polyetheretherketone (PEEK) and its composites are polymers resistant to fatigue strain, radiologically transparent, and have mechanical properties suitable for a range of orthopaedic applications. In bulk form, PEEK composites are generally accepted as biocompatible. In particulate form, however, the biologic response relevant to joint replacement devices remains unclear. The biologic response to wear particles affects the longevity of total joint arthroplasties. Particles in the phagocytozable size range of 0.1 µm to 10 µm are considered the most biologically reactive, particularly particles with a mean size of < 1 µm. This systematic review aimed to identify the current evidence for the biologic response to PEEK-based wear debris from total joint arthroplasties.

Does a PEEK Femoral TKA Implant Preserve Intact Femoral Surface Strains Compared With CoCr? A Preliminary Laboratory Study

Kathryn E. Rankin PhD, Alexander S. Dickinson PhD, Adam Briscoe PhD, Martin Browne PhD

Both the material and geometry of a total knee arthroplasty (TKA) component influence the induced periprosthetic bone strain field. Strain, a measure of the local relative deformation in a structure, corresponds to the mechanical stimulus that governs bone remodeling and is therefore a useful in vitro biomechanical measure for assessing the response of bone to new implant designs and materials. A polyetheretherketone (PEEK) femoral implant has the potential to promote bone strains closer to that of natural bone as a result of its low elastic modulus compared with cobalt-chromium (CoCr).

Properties and Corrosion Performance of Self-reinforced Composite PEEK for Proposed Use as a Modular Taper Gasket

Eric S. Ouellette BS, Jeremy L. Gilbert PhD

Fretting corrosion in medical alloys is a persistent problem, and the need for biomaterials that can effectively suppress mechanically assisted crevice corrosion in modular taper junctions or otherwise insulate metal-on-metal interfaces in mechanically demanding environments is as yet unmet.

Are PEEK-on-Ceramic Bearings an Option for Total Disc Arthroplasty? An In Vitro Tribology Study

Ryan Siskey MS, Lauren Ciccarelli MS, Melissa K. C. Lui MS, Steven M. Kurtz PhD

Most contemporary total disc replacements (TDRs) use conventional orthopaedic bearing couples such as ultrahigh-molecular-weight polyethylene (polyethylene) and cobalt-chromium (CoCr). Cervical total disc replacements incorporating polyetheretherketone (PEEK) bearings (specifically PEEK-on-PEEK bearings) have been previously investigated, but little is known about PEEK-on-ceramic bearings for TDR.

What is the Intraarticular Concentration of Tobramycin Using Low-dose Tobramycin Bone Cement in TKA: An In Vivo Analysis?

Gregory Vrabec MD, FRCS, Willis Stevenson MD, Sameh Elguizaoui MD, Matthew Kirsch MD, John Pinkowski MD

Antibiotic-impregnated bone cement has increased in popularity as an effort to reduce the risk of infection in high-risk TKAs. However, limited data has been reported regarding antibiotic levels achieved when using tobramycin-impregnated bone cement after implanting total knee components.

Does Patella Tendon Tenodesis Improve Tibial Tubercle Distalization in Treating Patella Alta? A Computational Study

Li Yin MD, PhD, Tzu-Chieh Liao MS, PT, Liu Yang MD, PhD, Christopher M. Powers PT, PhD, FACSM, FAPTA

Patellofemoral malalignment associated with patella alta may cause pain and arthritis; because of this, the condition sometimes is treated surgically. Two common procedures are tibial tubercle distalization with or without patellar tendon tenodesis. However, the biomechanical consequences of these interventions for patella alta are not clearly understood.

Satisfying Results of Primary Hip Arthroplasty in Patients With Hip Dysplasia at a Mean Followup of 20 Years

Ena Colo MD, Wim H. C. Rijnen MD, PhD, Jean W. M. Gardeniers MD, PhD, Albert Kampen MD, PhD, B. Willem Schreurs MD, PhD

Developmental dysplasia of the hip (DDH) is a common cause of secondary osteoarthritis (OA) in younger patients, and when end-stage OA develops, a THA can provide a solution. Different options have been developed to reconstruct these defects, one of which is impaction bone grafting combined with a cemented cup. To determine the true value of a specific technique, it is important to evaluate patients at a long-term followup. As there are no long-term studies, to our knowledge, on THA in patients with DDH using impaction bone grafting with a cemented cup, we present the results of this technique at a mean of 15 years in patients with previous DDH.

Surgical Risks and Costs of Care are Greater in Patients Who Are Super Obese and Undergoing THA

Menachem M. Meller MD, PhD, Nader Toossi MD, Mark H. Gonzalez MD, PhD, Min-Sun Son PhD, Edmund C. Lau MS, Norman Johanson MD

Patients with morbid obesity, defined as a BMI greater than 40 kg/m, and super obesity, defined as a BMI greater than 50 kg/m, increasingly present for total hip replacement. There is disagreement in the literature whether these individuals have greater surgical risks and costs for the episode of care, and the magnitude of those risks and costs. There also is no established threshold for obesity as defined by BMI in identifying increased complications, risks, and costs of care. Until recently, analysis of higher BMI data was limited to small cohorts from hospital-based data banks, based on BMI or height and weight only, often as part of a multivariate analysis. On October 1, 2010 the Centers for Medicare & Medicaid Services added a fifth digit to the BMI data, V85.xx, in the Medicare data bank, which allowed data mining of cases of patients with higher BMI. To our knowledge, our study is the first large retrospective Medicare data mining study, which allows us to examine BMI levels greater than 40 and 50 kg/mto delineate risks, complications, and costs for these patients.

Economic Decision Model Suggests Total Shoulder Arthroplasty is Superior to Hemiarthroplasty in Young Patients with End-stage Shoulder Arthritis

Suneel B. Bhat MD, Mark Lazarus MD, Charles Getz MD, Gerald R. Williams MD, Surena Namdari MD, MSc

Young patients with severe glenohumeral arthritis pose a challenging management problem for shoulder surgeons. Two controversial treatment options are total shoulder arthroplasty (TSA) and hemiarthroplasty. This study aims to characterize costs, as expressed by reimbursements for episodes of acute care, and outcomes associated with each treatment.

What Factors are Predictive of Patient-reported Outcomes? A Prospective Study of 337 Shoulder Arthroplasties

Frederick A. Matsen MD, Stacy M. Russ BA, Phuong T. Vu BA, Jason E. Hsu MD, Robert M. Lucas MD, Bryan A. Comstock MS

Although shoulder arthroplasties generally are effective in improving patients’ comfort and function, the results are variable for reasons that are not well understood.

High Risk of Surgical Glove Perforation From Surgical Rotatory Instruments

Ashton H. Goldman MD, Emanuel Haug BS, John R. Owen MS, Jennifer S. Wayne PhD, Gregory J. Golladay MD

Surgical gloves can be damaged during the course of a procedure, which can place the surgeon and patient at risk. Glove perforation may not always be readily apparent, and determining the risk factors for glove perforation can aid the surgeon in deciding when a glove change is advisable. Time of wear and needle sticks have been well studied; however, other mechanisms including mechanical stress from surgical equipment have had limited evaluation to date.

Cement Augmentation in Sacroiliac Screw Fixation Offers Modest Biomechanical Advantages in a Cadaver Model

Georg Osterhoff MD, Andrew E. Dodd MD, FRCSC, Florence Unno MD, Angus Wong, Shahram Amiri MSc, PhD, Kelly A. Lefaivre MD, MSc, FRCSC, Pierre Guy MD, MBA, FRCSC

Sacroiliac screw fixation in elderly patients with pelvic fractures is prone to failure owing to impaired bone quality. Cement augmentation has been proposed as a possible solution, because in other anatomic areas this has been shown to reduce screw loosening. However, to our knowledge, this has not been evaluated for sacroiliac screws.

Classifications In Brief: Salter-Harris Classification of Pediatric Physeal Fractures

Daniel J. Cepela MD, Jason P. Tartaglione MD, Timothy P. Dooley MD, Prerana N. Patel MD
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