The Avantage ® dual mobility cup in primary total hip arthroplasty: A registry study.

Background: Avantage Cup has been widely used in dual mobility implants. However, in Swedish Registry, the outcome of the Avantage Cup is reported with higher implants revision compared to control. The aim of our study was to verify if the same results are present in the Registry of Prosthetic Orthopedic Implants (RIPO) of Emilia Romagna (ER, Italy), as the Avantage cup was the most implanted dual mobility cup for a long follow-up reported in this Registry (2000-2012). Furthermore, we assessed the survival rate of the implant over the time. Methods: We included all patients that underwent a primary THA using the Avantage cup during the period 2000-2020 in RIPO Registry. The survivorship of the primary THA implants was calculated and plotted according to Kaplan-Meier method. Results: 886 Avantage cups were included in the analysis. During the observational period 44 hips were revised. The most common reasons for revision were: periprosthetic fractures (PPF) (n = 7, 0.8 %), deep infection (n = 7, 0.8 %), and cup aseptic loosening (n = 13, 1.5 %).The survival rate of the implant was 96.8 % (95.3-97.8) at 5 years, 95.7 at 10 years (94.0-97.0) and 92.1 at 15 years (88.5-94.6). Conclusion: In conclusion, this study has demonstrated that the Avantage cup in primary hip arthroplasty implanted with a "friendly" femoral stem granted satisfactory long-term survival. Therefore, in the Swedish Registry, the cause of the poor results presented for Avantage Cup could be the thick, rough neck stem of the widely used Lubinus stem.

A physico-chemical study on amphiphilic cyclodextrin/liposomes nanoassemblies with drug carrier potential.

In this paper, two medusa-like ACyDs, modified at the primary rim bearing four (ACyD4) and eight carbons (ACyD8) acyl chain length, and one bouquet-like CyD, modified at primary side with thiohexyl and at secondary one with oligoethylene moiety (SC6OH), were investigated for their ability to assemble in nanostructures or to form hybrid dipalmitoylphosphatidylcholine (DPPC)/ACyDs systems. The lipophilicity of these molecules and the different preparation methods used in this study (thin layer evaporation and nanoprecipitation method) significantly affect the aggregation behaviour in aqueous medium. Except for the shortest medusa-like ACyD4, the other ACyDs formed stable nanoaggregates for at least 45 days. The effect of ACyDs on the thermotropic behaviour of DPPC liposomes was also studied by differential scanning calorimetry analysis, thus elucidating their interaction with liposomes to afford hybrid liposome/ACyDs systems. The medusa-like ACyD4 cannot be used to realize nanosystems because it quickly aggregates or it induces a complete destabilization of the liposomes. At the highest concentration investigated (0.01 molar fraction), both ACyD8 and SC6OH interacted with DPPC liposomes, forming ACyD/DPPC or SC6OH/DPPC hybrid vesicular carriers.

A Computational Tool for the Microstructure Optimization of a Polymeric Heart Valve Prosthesis.

Styrene-based block copolymers are promising materials for the development of a polymeric heart valve prosthesis (PHV), and the mechanical properties of these polymers can be tuned via the manufacturing process, orienting the cylindrical domains to achieve material anisotropy. The aim of this work is the development of a computational tool for the optimization of the material microstructure in a new PHV intended for aortic valve replacement to enhance the mechanical performance of the device. An iterative procedure was implemented to orient the cylinders along the maximum principal stress direction of the leaflet. A numerical model of the leaflet was developed, and the polymer mechanical behavior was described by a hyperelastic anisotropic constitutive law. A custom routine was implemented to align the cylinders with the maximum principal stress direction in the leaflet for each iteration. The study was focused on valve closure, since during this phase the fibrous structure of the leaflets must bear the greatest load. The optimal microstructure obtained by our procedure is characterized by mainly circumferential orientation of the cylinders within the valve leaflet. An increase in the radial strain and a decrease in the circumferential strain due to the microstructure optimization were observed. Also, a decrease in the maximum value of the strain energy density was found in the case of optimized orientation; since the strain energy density is a widely used criterion to predict elastomer's lifetime, this result suggests a possible increase of the device durability if the polymer microstructure is optimized. The present method represents a valuable tool for the design of a new anisotropic PHV, allowing the investigation of different designs, materials, and loading conditions.

Structural changes of block copolymers with bi-modal orientation under fast cyclical stretching as observed by synchrotron SAXS.

Load-bearing tissues are composite materials that depend strongly on anisotropic fibre arrangement to maximise performance. One such tissue is the heart valve, with orthogonally arranged fibrosa and ventricularis layers. Their function is to maintain mechanical stress while being resilient. It is postulated that while one layer bears the applied stress, the orthogonal layer helps to regenerate the microstructure when the load is released. The present paper describes changes in the microstructure of a block copolymer with cylindrical morphology, having a bio-inspired microstructure of anisotropic orthogonally oriented layers, under uniaxial strain. To allow structural observations during fast deformation, equivalent to the real heart valve operation, we used a synchrotron X-ray source and recorded 2D SAXS patterns in only 1 ms per frame. The deformation behaviour of the composite microstructure has been reported for two arrangements of the cylinders in skin and core layers. The behaviour is very different to that observed either for uniaxially oriented or isotropic samples. Deformation is far from being affine. Cylinders aligned in the direction of stretch show fragmentation, but complete recovery of the spacing between cylinders on removal of the load. Those oriented perpendicular to the direction of stretch incline at an angle of approximately 25° to their original direction during load.

Sol-gel processing of drug delivery materials and release kinetics.

Silica, calcium (5 mol%) silicate and silica/polycaprolactone hybrid inorganic/organic amorphous materials, all mixed with sodium ampicillin, a broad-spectrum antibiotic, have been synthesized by sol-gel method. The amorphous nature of the gels was ascertained by X-ray diffraction analysis. Release kinetics in a simulate body fluid (SBF) have been subsequently investigated. The amount of sodium ampicillin released has been detected by UV-Vis spectroscopy and SEM. The release kinetics seems to occur in more than one stage. Finally FTIR measurements and SEM micrograph showed the formation of a hydroxyapatite layer on the surface of the samples soaked in SBF. All data showed that these materials could be used as drug delivery bioactive systems.

Sol-gel synthesis, structure and bioactivity of polycaprolactone/CaO . SiO2 hybrid material.

A method has been developed to cast novel organic/inorganic polymer hybrids from multicomponent solutions containing tetramethyl orthosilicate, calcium nitrate tetrahydrate, polycaprolactone, water, and methylethyketone via sol-gel process. The existence of the hydrogen bonds between organic and inorganic components of the hybrid and hydroxyapatite formation on the surface was proved by Fourier transform infrared analysis. The morphology of the hybrid material was studied by scanning electron microscopy. The structure of a molecular level dispersion was disclosed by atomic force microscopy, pore size distribution, and surface measurements. The infrared spectra of the hybrid relative to sample soaked in a fluid simulating the composition of human blood plasma suggests that polycaprolactone/CaO * SiO(2) hybrid material synthesised via sol-gel process is bioactive as well as the CaO * SiO(2) gel glass.

Antibacterial and bioactive silver-containing Na2O x CaO x 2SiO2 glass prepared by sol-gel method.

The antibacterial effect of addition of silver oxide to Na2O x CaO x 2SiO2 glass have been studied. Silver containing and silver free Na2O x CaO x 2SiO2 glasses have been prepared by sol-gel synthesis using tetramethil orthosilicate, sodium ethoxide, calcium nitrate tetrahydrate and silver nitrate as starting materials and methyl ethyl ketone as solvent. The gel was examined by differential thermal analysis, thermo gravimetric analysis, FTIR spectroscopy and X-ray diffraction analysis. Antibacterial and bioactive tests on gel glass powders, obtained after a heat treatment of 2 h at 600 degrees C of the dried gel, were carried out. High antimicrobial effects of samples against Escherichia coli and Streptococcus mutans were found. FTIR measurements and SEM micrographs have ascertained the formation of a hydroxyapatite layer on the surface of samples soaked in a simulated body fluid for different times.