Differences in highly cross-linked polyethylene wear between zirconia and cobalt-chromium femoral heads in Japanese patients: a prospective, randomized study.

The purpose of this study was to compare highly cross-linked polyethylene wear between the zirconia head and the cobalt-chromium head in Japanese patients. A prospective, randomized study was performed to evaluate the outcomes in 32 hips that had zirconia heads and in 30 hips that had cobalt-chromium heads. The mean follow-up periods of both groups were same (5 years). There were no significant differences between the zirconia head and the cobalt-chromium head in the mean polyethylene linear wear per year and the mean volumetric polyethylene wear per year in the steady phase. This study indicates that zirconia head offers no benefits over metal head in terms of wear reduction at 5 years in Japanese patients who have lightweight and thin polyethylene liners.

Inorganic antimicrobial coating for titanium alloy and its effect on bacteria.

BACKGROUND: For orthopedic implants, infection is a serious problem. Therefore, we considered an implant with antimicrobial ability can prevent infection. We tried to coat a titanium alloy surface with Novaron, a commercially available inorganic antimicrobial. The purpose of this study was to analyze the differences among the surfaces of materials coated using different processing pressures of the working gas and analysis of the antimicrobial activity. METHODS: One of the inorganic antimicrobials Novaron (grade VZ 600) was applied to titanium alloy (Ti6Al4V) plates. This antimicrobial has limited heat resistance, so we used cold spray technology to coat the titanium alloy with it. The principle of cold spray technology is spraying a powder in a high-velocity gas jet, accelerated by adiabatic expansion, against a substrate. Scanning electron microscopy (SEM) and energy dispersive X-ray spectrometry (EDS) were used to analyze the differences among the surfaces of materials coated using different processing pressures of the working gas. The Japanese Industrial Standard (JIS) method (JIS Z2801: 2000) was used to analyze the antimicrobial activity against Staphylococcus aureus, Pseudomonas aeruginosa, and Klebsiella pneumoniae. Antimicrobial activity was analyzed only for the sample coated at 3.0 MPa. RESULTS: The SEM and EDS results indicated that when the pressure of the working gas was increased, the antimicrobial coated the titanium adequately. This material showed good effects against S. aureus and P. aeruginosa and some effect for K. pneumoniae. CONCLUSIONS: Antimicrobial implants represent a preventive method against infection. There is a possibility of using them not only for clean operations but also for operations with suspected bacterial contamination, such as fixation of slight compound fractures.

Indications for free vascularized fibular grafting for the treatment of osteonecrosis of the femoral head.

BACKGROUND: The present study aimed to determine the indications for free vascularized fibular grafting for the treatment of osteonecrosis of the femoral head. METHODS: Seventy-one hips (60 patients) were clinically followed for a minimum of 3 years. Average follow-up period was 7 years. Etiologies were alcohol abuse in 31 hips, steroid use in 27, idiopathic in 7 and trauma in 6. Preoperative staging of the necrotic lesion was done using the Steinberg's classification system. The outcomes of free vascularized fibular grafting were determined clinically using the Harris hip-scoring system, radiographically by determining progression, and survivorship by lack of conversion to total hip replacement. RESULTS: The average preoperative Harris hip score was 56 points and the average score at the latest follow-up examination was 78 points. Forty-seven hips (67%) were clinically rated good to excellent, 4 hips (6%) were rated fair, and 20 hips (28%) were rated poor. Thirty-six hips (51%) did not show radiographic progression while 35 hips (49%) did, and with an overall survivorship of 83% at 7 years. Steroid-induced osteonecrosis was significantly associated with poor scores and survival rate (68%). Preoperative collapse was significantly associated with poor scores, radiographic progression and poor survival rate (72%). A large extent of osteonecrosis greater than 300 degrees was significantly associated with poor scores, radiographic progression and poor survival rate (67%). There was no relationship between the distance from the tip of the grafted fibula to the subchondral bone of the femoral head and postoperative radiographic progression. CONCLUSION: In conclusion, small osteonecrosis (less than 300 degrees of the femoral head) without preoperative collapse (Steinberg's stages I and II) is the major indication for free vascularized fibular grafting. Steroid-induced osteonecrosis is a relative contraindication. Large osteonecrosis (greater than 300 degrees) with severe preoperative collapse (greater than 3 mm) is a major contraindication. Hips with 2 negative factors such as severe preoperative collapse and a large extent of osteonecrosis, require hip replacements.

Tissue-engineered approach for the treatment of steroid-induced osteonecrosis of the femoral head: transplantation of autologous mesenchymal stem cells cultured with beta-tricalcium phosphate ceramics and free vascularized fibula.

Autologous mesenchymal stem cells (MSCs) cultured with beta-tricalcium phosphate (beta-TCP) ceramics and with a free vascularized fibula were transplanted into three patients with steroid-induced osteonecrosis of the femoral head. The average follow-up period was 34 months and the average patient age at the time of surgery was 28 years old. Fifteen milliliters of bone marrow was obtained from the patients 4 weeks before surgery, and was used for in vitro proliferation of MSCs. beta-TCP granules were immersed in the MSC suspension and the cells were further cultured for 2 weeks. Cultured MSCs/beta-TCP composite granules were implanted into the cavity that remained after curettage of necrotic bone; and finally, a free vascularized fibula was grafted. All hips showed preoperative collapse and radiographic progression was observed in two hips postoperatively. Osteonecrosis did not progress any further and early bone regeneration was observed. This tissue-engineered approach has potentials for the treatment of osteonecrosis. However, our results suggested that the present procedure could not be used for cases with severe preoperative collapse.