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Background: This retrospective study investigates the complications, particularly subacromial osteolysis (SAO), associated with hook plate (HP) fixation, in the treatment of unstable distal clavicle fractures characterized by complete coracoclavicular (CC) ligament rupture. The decision-making process for employing HP in fractures of this nature, such as Neer types IIB and V and Cho classification IIC, involves considerations of distal fragment size and displacement. While HP offers advantages in clinical practice, it is not without complications, with SAO being a notable concern. Factors such as non-anatomic hook tip placement and fracture classification may influence the risk of SAO., Methods: The study comprises a retrospective analysis of unstable distal clavicle fractures treated with HP at our institution from 2019 to 2022. Exclusions include non-displaced fractures, those treated with other locking plates, and pathologic fractures. A total of 91 patients with displaced distal clavicle fractures underwent open reduction and internal fixation with HP. Cho classification was employed to differentiate cases with CC ligament rupture. Patient demographics, classifications, postoperative radiographs, distal fragment size, plate position, timing of implant removal, and complications, including SAO, were recorded., Results: Among the 91 patients, 32 were classified as Cho IIB, 43 as Cho IIC, and 16 as Cho IID. Ninety-one percent exhibited solid union before implant removal. The prevalence of SAO was 43.8%, 76.7%, and 62.5% in Cho IIB, IIC, and IID, respectively. Univariate analysis revealed a significant difference only in Cho classification ( p = 0.014). Binary logistic regression identified Cho classification type IIC as the sole risk factor for SAO ( p = 0.021; odds ratio, 4.48; 95% confidence interval, 1.56-12.87)., Conclusions: Cho type IIC fractures, characterized by CC ligament deficiency causing horizontal instability, demonstrated the highest SAO rate. In contrast, Neer type IIB fractures retained the trapezoid ligament, and Neer type V fractures had intact CC ligaments, resulting in lower SAO rates. Biomechanically, combining HPs with CC ligament reconstruction provided better structural stability than using HPs alone in treating Cho type IIC fractures., Competing Interests: CONFLICT OF INTEREST: No potential conflict of interest relevant to this article was reported., (Copyright © 2024 by The Korean Orthopaedic Association.)

Background: Clavicular hook plates are extensively used in the treatment of acromioclavicular dislocation. Subacromial osteolysis is a typical complication following hook plate fixation. We performed a systematic review and meta-analysis to determine the incidence of subacromial osteolysis and analyzed the associated characteristics of subacromial osteolysis to guide surgeons., Methods: PubMed, EMBASE, and Cochrane Library databases were comprehensively searched for relevant literature. We screened the literature based on the eligibility criteria, extracted relevant data, and assessed the quality of the included studies. Pooled odds ratios or mean differences with 95% confidence intervals (CIs) were calculated by a fixed-effects or random-effects model. Heterogeneity was evaluated by the chi-squared test and I 2 statistics. A meta-regression analysis was performed to explore the potential source of heterogeneity., Results: Thirty-two studies met the inclusion criteria. The total pooled incidence of subacromial osteolysis was 29% and the only covariate that could influence the incidence of subacromial osteolysis was the radiological measurement method (P = .017). Patients in the hook plate fixation with coracoclavicular ligament reconstruction group had lower odds of subacromial osteolysis (odds ratio, 2.54, 95% CI 1.54-4.18; P < .001). There were no significant differences in the Constant-Murley scores at the final follow-up between patients with and without subacromial osteolysis (standardized mean difference, -0.17; 95% CI, -0.50 to 0.15; P = .294)., Conclusions: Subacromial osteolysis has a relatively high and variable incidence, and the primary factor influencing the reported incidence is the radiological assessment method. The current analysis suggests coracoclavicular ligament reconstruction as an effective surgical approach for decreasing the incidence of subacromial osteolysis. The presence or absence of subacromial osteolysis did not significantly impact the functional outcomes observed during the final follow-up period., (Copyright © 2024 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Introduction: A recent study reported a 34% mid-term revision rate after M6-C™ cervical total disc replacement (CTDR) for wear-related osteolysis. Here, we aim to investigate the prevalence, risk factors, and radiographic characteristics of periprosthetic bony changes and implant failure of the M6-C™ artificial disc., Methods: We retrospectively analysed radiographic (conventional X-ray, CT scan) and clinical outcomes (EQ-5D-5L, Neck Disability Index (NDI), and Visual Analog Scale (VAS) for neck and arm pain) data collected during routine follow-up of patients who underwent CTDR with the M6-C™ between 2011 and 2015., Results: In total, 85 patients underwent CTDR with the M6-C™. Follow-up data were available for 43 patients (54% female, mean age 44 years) with 50 implants and a mean follow-up of 8.1 years (6.5-11 years). Implant failure with the presence of severe osteolysis was identified in 5 (12%) patients who were all male (p = 0.016) and implanted at the C5/6 level (p = 0.11). All failed implants required revision surgery. The overall prevalence of osteolysis was 44% (22/50 implants) and 34% (17/50 implants) for significant heterotopic ossification. Patients with high-grade osteolysis showed higher VAS arm pain (p = 0.05) and lower EQ-5D-VAS health VAS (p = 0.03)., Conclusion: We report a lower reoperation rate for failed M6-C™ implants than previously published, but confirmed that osteolysis and heterotopic ossification are common following CTDR with the M6-C™ and may be asymptomatic. Therefore, we strongly recommend ongoing clinical and radiographic monitoring after CTDR with the M6-C™, particularly for male patients implanted at the C5/6 level., (© 2024. The Author(s).)

Background: Stress shielding and osteolysis around the humeral stem after reverse shoulder arthroplasty causes loosening and periprosthetic fractures and reduces bone stock during revision surgery. In Japanese patients, who have relatively small bodies, different characteristics may exist regarding the occurrence of these changes compared with the characteristics of Westerners, who have relatively larger frames. The purpose of this multicenter study was to investigate the incidence and clarify the predictors of stress shielding and osteolysis in Japanese individuals who underwent reverse shoulder arthroplasty., Methods: The occurrence of stress shielding and osteolysis was investigated in 135 shoulders that had undergone reverse shoulder arthroplasty at least 2 years prior in five Japanese hospitals. During post-surgical follow-up, which was conducted every 3 months, the locations of the stress shielding occurrences, such as cortical thinning and osteopenia (which primarily occurred in zones 1, 2, and 7, where 1 is the greater tuberosity and 7 is the calcar part), spot weld, and condensation lines, were recorded. Cases without any abnormal findings on radiographs obtained up to ≥2 years after surgery were regarded as having no abnormalities. Finally, the predictors of cortical thinning and proximal humeral osteolysis were assessed using univariate and multivariate regression analyses., Results: Cortical thinning and osteopenia occurred in 68 shoulders, a condensation line occurred in 37 shoulders, and spot weld occurred in 23 shoulders. In particular, greater tuberosity and calcar osteolysis occurred in 40 and 47 shoulders, respectively. Long stem, cementless stem, and a larger proximal filling ratio were independent predictors of cortical thinning and osteopenia, whereas a cementless stem, larger metaphysis diameter, and a larger proximal filling ratio were associated with proximal humeral osteolysis., Conclusions: The predictors of stress shielding and osteolysis included the use of long stems, cementless stems, larger proximal filling ratios, and larger metaphysis diameters., Level of Evidence: retrospective comparative study (Level III)., Competing Interests: Declaration of competing interest None., (Copyright © 2023 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.)

Diminutive data is available on the outcome of several previously used total ankle replacement implants. The purpose of this study was to investigate the medium-term functional and radiological outcome and implant survival of the CCI Evolution implant. Consecutive series of 40 ankles operated in our hospital with primary TAR using the CCI Evolution implant in 2010-2013 were available for follow-up. The prospective clinical and radiographic data including the Kofoed score, subjective satisfaction and standard radiographs were collected preoperatively and at fixed time-points postoperatively. A CT was obtained in cases where osteolysis or loosening were suspected. The improvement of the Kofoed score and subjective satisfaction were statistically significant (p<0.0001). The implant survival was 97% (95% confidence interval (CI) 81%-100 %) at 5 years, and 81 % (95% confidence interval (CI) 60 %-92%) at 8 years. There were altogether 25 (64%) complications. Overall revision rate was 28% and failure rate 13%. The CCI implant outcome was not acceptable. The malposition of prosthetic components, subsidence, and peri-implant osteolysis were recorded often. Although the patient reported outcome measures improved, mostly due to positive changes in pain severity, overall revision and failure rates were high and comparable with previous findings of the CCI implant.

Background: A specific total knee arthroplasty (TKA) implant system was recently recalled for high incidence of early polymeric wear and osteolysis. We analyzed the early outcomes of aseptic revision with these implants., Methods: We identified 202 aseptic revision TKAs of this implant system performed at a single institution between 2010 and 2020. Revision indications included aseptic loosening (n = 120), instability (n = 55), and polymeric wear/osteolysis (n = 27). Components were revised in 145 cases (72%) and isolated polyethylene insert exchange occurred in 57 cases (28%). Kaplan-Meier and Cox proportional hazards analyses were used to determine survivorship free from all-cause rerevision and rerevision risk factors., Results: At 2 and 5 years, survivorship free from all-cause rerevision was 89 and 76% in the polyethylene exchange cohort versus 92 and 84% in the component revision cohort (P = .5). At 2 and 5 years, survivorship in revision with components from the same manufacturer was 89 and 80% compared to 95 and 86% in revision with components from a different manufacturer (P = .2). Among re-revisions (n = 30), cones (37%), sleeves (7%), hinge/distal femoral replacement implants were frequently used (13%). Men had increased risk for rerevision (hazard ratio = 2.3, P = .04)., Conclusion: In this series of aseptic revision TKAs performed on a now-recalled implant system, survivorship free from rerevision was lower than expected when components from the same manufacturer were utilized, but comparable to contemporary reports when both the components were revised with an alternative implant system. Metaphyseal fixation with cones and sleeves as well as highly constrained implants was frequently utilized at time of rerevision TKA., Level of Evidence: Level IV., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: We previously reported mid-term results of total hip arthroplasty (THA) using Delta ceramic-on-ceramic (CoC) bearings in 72 patients (86 hips) who were <30 years old. Noise was noted in 8 (9.3%) of the hips, no osteolysis or loosening was detected, and no patient required reoperation. The purpose of this study was to assess clinical and radiographic outcomes, complications, and survivorship at >10 years after THA using Delta CoC bearings in patients who were <30 years old., Methods: Cementless THA with a Delta CoC bearing was performed between March 2008 and January 2012 in 91 hips of 76 patients who were <30 years old. Eighty-five hips in 71 patients (44 men and 27 women) with a mean age of 25.9 years (range, 16 to 29 years) at surgery were followed for a mean of 10.9 years (range, 10 to 13 years)., Results: No ceramic bearings fractured. The incidence of squeaking increased to 5.9% (5 of 85), but the squeaking was not reproducible within individual patients. Periprosthetic osteolysis developed in 3 hips (3 patients): around the stem in 2 and around the metal shell in 1. The stem in 1 hip underwent revision because of a Vancouver type-B2 periprosthetic femoral fracture. One patient with systemic lupus erythematosus underwent irrigation and debridement for periprosthetic joint infection. Survivorship free of reoperation for any reason was 92.4% (95% confidence interval, 82.4% to 100%) at 13 years., Conclusions: The long-term results and survivorship of Delta CoC THA in patients <30 years old were favorable., Level of Evidence: Therapeutic Level II . See Instructions for Authors for a complete description of levels of evidence., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article ( http://links.lww.com/JBJS/H469 )., (Copyright © 2023 by The Journal of Bone and Joint Surgery, Incorporated.)

Background: As no previous study has directly compared the linear wear rate in two types of second-generation annealed highly cross-linked polyethylene, we performed a retrospective study with a minimum of 5-year follow-up to assess primary arthroplasties in the (1) wear rates and (2) incidence of osteolysis of the two types of HXLPE., Hypothesis: There was no significant difference in the linear wear rate and the incidence of osteolysis between the two types of second-generation annealed highly cross-linked polyethylene., Patients and Methods: In this single-center study, we reviewed 257 cases of primary cementless total hip arthroplasties between 2011 and 2015, which were performed with 32mm delta ceramic on second-generation annealed highly cross-linked polyethylene (X3 and E1 were used in 105 and 103 cases, respectively.). The mean wear rate was evaluated using a computer-assisted method, and the incidence of osteolysis was evaluated based on the appearance of a localized area with loss of trabecular bone or cortical erosion adjacent to the implants during the latest follow-up., Results: In total, we evaluated 208 cases, followed postoperatively for over 5 years (mean, 6.1 years, range: 5.0-8.0). There were no significant differences between the two groups with respect to age (list in order of Group X, Group E, p value) (61.2±12.3, 62.7±12.1, p=0.36), sex (ratio of male: 17.1%, 14.6%, p=0.61), body mass index (22.9±3.7, 22.8±4.0, p=0.91), pre- (49.9±14.8, 48.5±13.8, p=0.49) and post-operative (91.3±9.1, 92.7±7.0, p=0.23) Japanese Orthopaedic Association Hip Score, cup size (50.8±3.0, 50.9±2.2, p=0.70), cup inclination (38.7±4.8, 37.6±4.8, p=0.10), and cup anteversion (18.7±6.9, 18.5±7.6, p=0.80). The mean linear wear rates of the X3 and E1 groups were 0.057±0.039 (range: 0-0.16) and 0.054±0.037mm/year (range: 0-0.15), respectively (p=0.61). No osteolysis was found on the final plain radiographs in both groups., Discussion: This study revealed that both types of highly cross-linked polyethylene have excellent linear wear rates and were equally safe to use. However, the difference between the two materials in terms of the long-term wear rate should be further validated., Level of Evidence: III; retrospective case control study., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Background: Highly cross-linked polyethylene (HXLPE) liners have been developed to address the wear-related problems associated with conventional polyethylene (CPE) such as osteolysis or aseptic loosening in total hip arthroplasty (THA). In this systematic meta-analysis, we compared the long-term efficacy in preventing radiological osteolysis and revision surgery between HXLPE and CPE., Methods: We included 14 studies that compared HXLPE and CPE reporting the incidence of wear-related complications with a minimum follow-up of 10 years. We investigated 5 wear-related complications: osteolysis, excessive wear, linear wear rate, revision surgery due to wear, and progress of osteolysis/aseptic loosening. We conducted a pair-wise meta-analysis to estimate odds ratio (OR) and a proportional meta-analysis to estimate the incidence of each complication., Results: Among 1,175 THAs, 220 osteolysis and 78 wear-related revisions were detected. The use of HXLPE reduced the risk of overall osteolysis (OR 0.30; P = .001), excessive wear (OR 0.10; P < .001), linear wear rate (weighted mean difference 0.09; P < .001), the risk of overall wear-related revisions (OR 0.06; P < .001), and revisions due to aseptic loosening (OR 0.23; P = .015). As per the proportional meta-analysis, the pooled prevalence of osteolysis, excessive wear, and the overall wear-related revision rate were 14%, 8%, and 3% in HXLPE and 25%, 33%, and 20% in CPE, respectively., Conclusion: The current evidence shows that HXLPE dramatically reduced the rate of osteolysis and wear-related revision surgery. However, as polyethylene wear and osteolysis still lead to revision surgery, ongoing clinical and retrieval studies are required to analyze long-term outcomes., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: Periprosthetic osteolysis after total ankle arthroplasty (TAA) is a challenging problem. This study aimed to evaluate the prevalence of and predisposing factors for osteolysis and its effects on clinical outcomes., Methods: We enrolled 236 patients (250 ankles) who underwent primary TAA using a mobile-bearing HINTEGRA prosthesis, with a mean follow-up of 83.5 months (range, 36 to 182 months), and subsequently divided them into 2 groups: the osteolysis group (79 ankles) and non-osteolysis group (171 ankles). Clinical and radiographic outcomes were compared between the 2 groups, and a bivariable logistic regression analysis was performed to identify predisposing factors for the development of osteolysis., Results: In the osteolysis group (31.6% of the 250 ankles), the mean time of detection was 28.8 months postoperatively. Forty of these ankles were closely monitored without surgical treatment. Another 29 ankles underwent bone grafting and exchange of the polyethylene inlay, and the remaining 10 ankles underwent revision TAA or arthrodesis. All clinical outcome variables were significantly lower in patients with osteolysis, compared with those without osteolysis, at the final follow-up (p < 0.05). In the investigation of predisposing factors, only rheumatoid arthritis was identified as having a significant association with an increased prevalence of osteolysis (p = 0.030)., Conclusions: This study demonstrated that the prevalence of periprosthetic osteolysis after TAA was considerable and that the development of osteolysis negatively affected the clinical outcome. Therefore, the prevention and appropriate treatment of osteolysis are crucial for the satisfactory long-term survival of TAA., Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/H66)., (Copyright © 2022 by The Journal of Bone and Joint Surgery, Incorporated.)

Background: Graft tear is a critical complication following superior capsular reconstruction (SCR) as it directly links with clinical outcomes. No previous reports have described acromial and humeral head osteolysis following SCR. Acromial and humeral head osteolysis may incidentally occur after SCR using autologous tensor fascia lata graft. This study aimed to demonstrate the incidence of osteolysis following SCR using autologous tensor fascia lata graft and investigate the factors that affect osteolysis., Methods: This retrospective cohort study included patients who underwent SCR for irreparable rotator cuff tears between June 2014 and June 2019. The patients were divided into 2 groups-those with no osteolysis and those with osteolysis-and were compared. For subanalysis, patients in the osteolysis group were further divided into 3 groups according to the location of the osteolysis-acromial osteolysis, humeral head osteolysis, and acromial and humeral head osteolysis-to clarify the factors determining the location of osteolyses. The shoulder range of motion was evaluated preoperatively and 24 months postoperatively. Additionally, the following items were evaluated: condition of the subscapularis tendon, Hamada classification (grade 2 or 3), critical shoulder angle, acromiohumeral distance measured preoperatively and 24 months postoperatively, graft size, and graft thickness. In addition, the graft condition was evaluated using magnetic resonance imaging 12 months postoperatively., Results: In total, 57 patients were enrolled and followed up for a minimum of 2 years (follow-up rate, 92% [57 of 62 cases]). Overall, the incidence of osteolysis following SCR was 35.1% (20 of 57 cases; acromial osteolysis in 7, humeral head osteolysis in 3, and acromial and humeral head osteolysis in 10). Compared with the group with no osteolysis, the osteolysis group had no inferior clinical outcomes or higher graft tear rates. The proportions of Hamada grade 3 (P = .041) and involvement of the subscapularis tendon (P = .020) were significantly higher in the osteolysis group. The relative risks of subscapularis involvement and Hamada grade 3 for osteolysis were 2.9 and 5.1, respectively. In the subanalysis, the factors determining the location of the osteolysis could not be clarified., Conclusions: This study suggested that the progression of the Hamada classification and condition of the subscapularis tendon affect the occurrence of osteolyses. However, these osteolyses were not associated with clinical outcomes, including graft tear rate and shoulder range of motion., (Copyright © 2022 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Purpose: The cementless implantation of hip replacement cups may be performed with and without the additional use of acetabular screws. If the surgeon uses screws or not depends on variable factors. In general, the use of screws is intended to increase the primary stability of the cup. Whether screws increase the initial stability of the cup construct, or even reduce it in part, is the subject of considerable debate in the literature. It is also unclear whether the additional screws lead to increased wear or increased periacetabular osteolysis over the long-term course., Methods: Two hundred eleven patients from a previous study with a minimum follow-up of 10.7 years were included. Of these, 68 patients with 82 total hip arthroplasties (THA) were given clinical and radiological follow-up examinations. Of these, 52 had been fitted without screws and 30 with screws. On the basis of radiographs, annual wear and osteolysis were quantified. The clinical results were recorded by means of VAS, HHS, and WOMAC scores., Results: Significantly more periacetabular osteolysis was found if additive acetabular screws had been used. No difference was found in relation to the volumetric wear per year. Likewise, no difference was found with regard to the clinical scores., Conclusions: The use of additive acetabular screws leads to increased osteolysis in the periacetabular bone stock. Insofar as the primary stability of the cementless cup construct allows it, no additional acetabular screws should be used., (© 2021. The Author(s).)

Background: While recent reports have suggested that hip corticosteroid injections can hasten joint degeneration, there are few published data on the topic. The purpose of the present study was to evaluate for an association between corticosteroid injection and rapidly destructive hip disease (RDHD) and to determine the rate of, and risk factors for, occurrence., Methods: This study was conducted in 2 parts. First, to assess for a potential association between hip corticosteroid injection and RDHD, a case-control analysis was performed. Patients who developed RDHD between 2013 and 2016 served as cases, whereas those who underwent total hip arthroplasty for diagnoses other than RDHD during the same period served as controls, and the exposure of interest was prior intra-articular hip corticosteroid injection. Second, in a retrospective cohort analysis, we analyzed all patients who received a fluoroscopically guided intra-articular hip corticosteroid injection at our institution from 2013 to 2016. The rate of post-injection RDHD was determined, and logistic regression was used to identify risk factors for occurrence., Results: In the case-control analysis, hip corticosteroid injection was associated with the development of RDHD (adjusted odds ratio, 8.56 [95% confidence interval, 3.29 to 22.3], p < 0.0001). There was evidence of a dose-response curve, with the risk of RDHD increasing with injection dosage as well as with the number of injections received. In the retrospective cohort analysis, the rate of post-injection RDHD was 5.4% (37 of 688). Cases of post-injection RDHD were diagnosed at an average of 5.1 months following injection and were characterized by rapidly progressive joint-space narrowing, osteolysis, and collapse of the femoral head., Conclusions: This study documents an association between hip corticosteroid injection and RDHD. While the risk of RDHD following a single low-dose (≤40 mg) triamcinolone injection is low, the risk is higher following high-dose (≥80 mg) injection and multiple injections. These findings provide information that can be used to counsel patients about the risks associated with this common procedure. In addition, caution should be taken with intra-articular hip injections utilizing ≥80 mg of corticosteroid and multiple injections., Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/G684)., (Copyright © 2021 by The Journal of Bone and Joint Surgery, Incorporated.)

Background: The purpose of this study was to evaluate glenoid component position and radiolucency following anatomic total shoulder arthroplasty (TSA) using sequential 3-dimensional computed tomography (3D CT) analysis., Methods: In a series of 152 patients (42 Walch A1, 16 A2, 7 B1, 49 B2, 29 B3, 3 C1, 3 C2, and 3 D glenoids) undergoing anatomic TSA with a polyethylene glenoid component, sequential 3D CT analysis was performed preoperatively (CT1), early postoperatively (CT2), and at a minimum 2-year follow-up (CT3). Glenoid component shift was defined as a change in component version or inclination of ≥3° from CT2 to CT3. Glenoid component central anchor peg osteolysis (CPO) was assessed at CT3. Factors associated with glenoid component shift and CPO were evaluated., Results: Glenoid component shift occurred from CT2 to CT3 in 78 (51%) of the 152 patients. CPO was seen at CT3 in 19 (13%) of the 152 patients, including 15 (19%) of the 78 with component shift. Walch B2 glenoids with a standard component and glenoids with higher preoperative retroversion were associated with a higher rate of shift, but not of CPO. B3 glenoids with an augmented component and glenoids with greater preoperative joint-line medialization were associated with CPO, but not with shift. More glenoid component joint-line medialization from CT2 to CT3 was associated with higher rates of shift and CPO. A greater absolute change in glenoid component inclination from CT2 to CT3 and a combined absolute glenoid component version and inclination change from CT2 to CT3 were associated with CPO. Neither glenoid component shift nor CPO was associated with worse clinical outcomes., Conclusions: Postoperative 3D CT analysis demonstrated that glenoid component shift commonly occurs following anatomic TSA, with increased inclination the most common direction. Most (81%) of the patients with glenoid component shift did not develop CPO. Longer follow-up is needed to determine the relationships of glenoid component shift and CPO with loosening over time., Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence., Competing Interests: Disclosure: This study was funded by a State of Ohio grant (TIOSO), an Orthopaedic Research and Education Foundation (OREF)/American Shoulder and Elbow Surgeons (ASES) Rockwood Clinical Research Grant (OREF1403ER), and an NIH/NIAMS Research Grant (R01AR075286). On the Disclosure of Potential Conflicts of Interest forms, which are provided with the online version of the article, one or more of the authors checked “yes” to indicate that the author had a relevant financial relationship in the biomedical arena outside the submitted work (http://links.lww.com/JBJS/G459)., (Copyright © 2021 by The Journal of Bone and Joint Surgery, Incorporated.)

Purpose: To evaluate with computed tomography (CT) the incidence of implant-related osteolysis after implantation of two types of all-suture anchors during remplissage for the management of Hill-Sachs lesions in shoulder instability., Methods: Single-cohort, observational study with a minimum of 12 months follow-up. Twenty-five participants (19 males and 6 females; mean age 37.4 years [SD: 11.6]) with Hill-Sachs lesions requiring remplissage were evaluated with a CT performed a mean of 14.1 [3.74] months after surgery. Fifty-five all-suture anchors (19 2.3 mm Iconix and 36 1.7 mm Suturefix) were used. The volume of the bone defects was measured in the CT. Every anchor was classified into one of four groups: (1) no bone defect. (2) Partial bone defect (bone defects smaller than the drill used for anchor placement). (3) Tunnel enlargement (bone defect larger than the drill volume but smaller than twice that volume). (4) Cystic lesion (bone defect larger twice the drill volume)., Results: No bone defect was identified in only two anchors (3.6%, 95% CI 0.4-12.5%). A partial bone defect was found in eight anchors (14.5%, 95% CI 6.5-26.7%). In 35 anchors (63.6%, 95% CI 49.6-76.2%), there was enlargement of the bone defect that was smaller than 200% the size of the drill used. Ten anchors caused bone defects larger than twice the size of the drill used (18.2%, 95% CI 9.1-30.9%). The defect size was a mean of 89 mm 3 (SD: 49 mm 3 , minimum 0 mm 3 , maximum 230 mm 3 )., Conclusion: When using all-suture anchors in arthroscopic remplissage during instability surgery, relevant bone osteolytic defects are common at 1-year-follow-up. Cystic defects larger than twice the volume of the resected bone during implantation develop in one in six anchors and significant tunnel widening will develop in another three out of five anchors. This bone loss effectively increases the size and depth of the Hill-Sachs lesions but does not seem to affect short-term clinical outcomes., Level of Evidence: Level IV.

Background: Although highly positive results for wear reduction of highly cross-linked polyethylene (HXLPE) have been reported around the 10-year follow-up, the long-term result related to reoperation and wear-related survival is still an issue. Therefore, this study aimed to compare the follow-up results of a single manufacture's polyethylene liner for >15 years in terms of survival and wear rate., Methods: This retrospective cohort study included 134 primary total hip arthroplasties (THAs) who were followed up for at least 15 years. The mean age at the time of surgery was 50.7 years (conventional polyethylene [CPE] group = 22; HXLPE group = 112). Linear and volumetric wear rates of polyethylene were measured, and the reoperation rate and radiographic osteolysis were evaluated and Kaplan-Meier survival analysis was performed in both groups. Implant-related complications were also examined., Results: HXLPE group showed a significantly lower wear rate in both linear and volumetric wear. None of the hip radiographs showed evidence of loosening or osteolysis in the HXLPE group. The survival rates at 15- to 18-year follow-up were 90.9% and 95.5% in the CPE and HXLPE groups when all-cause reoperation was the endpoint, and 90.9% and 100.0% when the wear-related reoperation was the endpoint, respectively. Implant-related complications were not different between the 2 groups., Conclusions: Wear reduction and osteolysis showed a great advantage in HXLPE after a 15-year follow-up. Although the CPE and HXLPE showed excellent survival, wear and osteolysis were more frequent in the CPE; therefore, the high risk of reoperation in the future should be considered.

Introduction: During a L'Episcopo transfer procedure, the tendons of the latissimus dorsi and teres major are reinserted on the posterolateral side of the humeral shaft to restore active external rotation. The aim of this study was to monitor the radiological changes at the insertion point of this transfer and to evaluate its impact on the clinical outcomes., Materials and Methods: In this retrospective, single-center study, 13 patients (mean age 56 years; 19-84) were reviewed after a minimum follow-up of 2 years. The L'Episcopo transfer was done either alone (n=2) or in combination with reverse shoulder arthroplasty (n=11). The same transfer technique was used in both instances, with reattachment by transosseous sutures. The clinical assessment consisted of the Constant score (CS), the Activities of Daily Living Requiring Active External Rotation (ADLER) score and the Subjective Shoulder Value (SSV). Radiographs were used to look for signs of osteolysis of the cortical bone in the tendon transfer areas and classified as grade 1 (minor erosion), grade 2 (moderate erosion) and grade 3 (major erosion)., Results: At a mean follow-up of 37 months (24-72), the mean CS was 60 points (32-75), the ADLER was 21 points (15-30) and the SSV was 77% (10-95). In the radiographic analysis, 10/13 patients had osteolysis visible in the transfer area: 2 were grade 1 (15%), 1 was grade 2 (8%), 7 were grade 3 (54%). There was no statistical correlation between the presence of osteolysis and the clinical outcomes. Nevertheless, external rotation with elbow at side and forward flexion were better in the patients who had osteolysis≥grade 2., Conclusion: The L'Episcopo transfer is associated with frequent osteolysis of the humeral cortex where the transfer is attached, even though the transfer appears effective. Long-term follow-up will be needed to evaluate the impact of this osteolysis on the stability of any shoulder arthroplasty implants., Level of Evidence: IV; retrospective study., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Background: This study compared the incidence of osteolysis, aseptic loosening, and revision following use of highly cross-linked polyethylene (HXLPE) or conventional polyethylene (CPE) at medium to long-term (>5 to 15 years) follow-up in primary total hip arthroplasty (THA). Incidences were quantified and compared with regard to age and method of implant fixation., Methods: Using the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines, 12 randomized controlled trials and 18 cohort studies were investigated for evidence-based outcomes following HXPLE and CPE use in 2,539 hips over a 5 to 15-year follow-up., Results: Lower rates of osteolysis, aseptic loosening, and implant revision were reported following use of HXLPE liners. Osteolysis was reduced from 25.4% with CPE to 4.05% with HXLPE in young patients, and from 29.7% to 6.6% in the older patient cohort. Similarities in osteolysis rates were observed when cemented (24.9% for CPE and 6.5% for HXLPE) and uncemented components (32.8% for CPE and 7.1% for HXLPE) were compared. No clear advantage in the type of HXLPE used was observed., Conclusions: Over a follow-up period of up to 15 years, when compared with CPE, use of HXLPE liners reduced the incidence of osteolysis, aseptic loosening, and implant revision, regardless of the fixation method and including in younger and potentially more active patients., Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence., Competing Interests: Disclosure: The authors indicated that no external funding was received for any aspect of this work. The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/G272)., (Copyright © 2021 by The Journal of Bone and Joint Surgery, Incorporated.)

Introduction: Young patients present a challenge for total hip arthroplasty (THA) survivorship. Highly cross-linked polyethylene (HXLPE) liners have decreased the prevalence of osteolysis; however, concerns exist regarding the biologic activity of wear particles. The purpose of this study was to determine the incidence and characteristics of osteolytic lesions in young HXLPE THA patients at an average 16-year follow up and determine the ability to detect osteolysis., Methods: We performed a retrospective study involving 22 patients (26 THA) under age 50 at primary THA receiving HXLPE liners coupled with cobalt-chrome (CoCr) femoral heads. Computed tomography (CT) scans were reviewed for osteolysis. Chi-squared analysis was used for categorical variables and unpaired Kruskal-Wallis rank-sum test for continuous variables. Logistic regression was used to compare wear rates between those patients with and without osteolysis., Results: The mean age at surgery was 38.5 years. The mean time from surgery to CT scan was sixteen years (range 14.25-19.5 years). Nine of the 26 THA showed osteolysis. The mean volume of the lesions was 2.8 cm3. Linear (mean 0.008 mm/y) and volumetric (mean 4.5 mm3/year) wear rates were negligible. One-third of osteolytic lesions were visible on radiographs. Logistic regression failed to demonstrate a correlation between wear rates or UCLA activity score and osteolysis., Conclusion: We observed osteolysis in 35% of HXLPE THA in young patients at mean 16-year follow up despite zero revisions for wear-related problems and clinically insignificant wear rates., Level of Evidence: IV., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: It is often challenging to decide whether to revise only the bearing or femoral acetabular component in the setting of progressive osteolysis without component loosening in revision total hip arthroplasty (THA). In this study, we aimed to (1) compare the survivorship of isolated bearing exchange and single/both component revision for patients with periprosthetic osteolysis without component loosening, and (2) identify potential risk factors associated with failures of isolated bearing exchange., Methods: A total of 228 consecutive cases of revision THA for progressive osteolysis without component loosening was evaluated in 2 groups: (1) 124 component revision and (2) 104 isolated bearing exchange. The primary outcome was survival, with failure defined as repeat revision or reoperation for any reason. Patient risk factors, such as demographics and medical comorbidities, were also analyzed., Results: There was no significant difference in survivorship between the component revision group and the bearing exchange group at 10 years (85% vs 82%; P = .89). There was no progression of osteolysis on radiographs at last follow-up for patients with isolated bearing change. Univariate regression modeling demonstrated that renal disease was associated with failure of isolated bearing exchange after revision THA., Conclusion: This study demonstrated that isolated bearing exchange is associated with similar outcomes compared with component revision for aseptic osteolysis without loosening, demonstrating that isolated bearing exchange is a viable option for selected patients with osteolysis in the setting of well-fixed THA components. This provides clinically useful information for surgeons in the surgical treatment of THA patients with wear and osteolysis without component loosening., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Purpose: Cervical disc arthroplasty (CDA) has become an increasingly popular treatment for cervical degenerative disc disease. One potential complication is osteolysis. However, current literature on this topic appears limited. The purpose of this study is to elucidate the incidence, aetiology, consequence, and subsequent treatment of this complication., Methods: A systematic literature review was performed according to the PRISMA guidelines. Studies discussing the causes, incidence and management of osteolysis after a CA were included., Results: A total of nine studies were included. We divided these studies into two groups: (1) large case series in which an active radiological evaluation for osteolysis was performed (total = six studies), (2) case report studies, which discussed symptomatic cases of osteolysis (total = three). The incidence of asymptomatic osteolysis ranged from 8 to 64%; however, only one study reported an incidence of < 10% and when this case was excluded the incidence ranged from 44 to 64%. Severe asymptomatic bone loss (exposure of the implant) was found in less than 4% of patients. Bone loss from osteolysis appeared to occur early (< 1 year) after surgery and late (> 1 year) as well. Symptomatic patients with osteolysis often required revision surgery. These patients required removal of implant and conversion to fusion in the majority of the cases., Conclusions: Osteolysis after CDA is common; however, the majority of cases have only mild or asymptomatic presentations that do not require revision surgery. The timing of osteolysis varies significantly. This may be due to differences in the aetiology of osteolysis.

Background: The aims of the present study are to (1) conduct the longest-to-date follow-up wear analysis of the highly cross-linked polyethylene acetabular liners, (2) assess the incidence of femoral and acetabular osteolysis, and (3) compare the surgical outcomes between standard and elevated-rim acetabular liners in primary total hip arthroplasty (THA)., Methods: In this retrospective cohort study, we evaluated 112 primary THAs performed by a single experienced arthroplasty surgeon at our institution between March 2000 and December 2003. Patients were classified based on the type of acetabular liner used: standard or elevated-rim liner. For evaluation of surgical outcomes, the following data were collected: acetabular cup position (anteversion and inclination), wear rate (linear and volumetric), presence of osteolysis, history of reoperation (all-cause and wear-related), complications (deep joint infection, dislocation, and periprosthetic fracture), and Harris hip score at last follow-up., Results: Linear and volumetric wear rates were 0.028 mm/y (0.000-0.145 mm/y) and 11.641 mm 3 /y (0.000-70.000 mm 3 /y) in the standard group and 0.026 mm/y (0.000-0.094mm/y) and 9.706 mm 3 /y (0.000-33.000 mm 3 /y) in the elevated-rim group, respectively. These rates were not significantly different between groups. One case of osteolysis was confirmed in the standard group, whereas no osteolysis was observed in the elevated-rim group., Conclusion: We suggest that elevated-rim highly cross-linked polyethylene acetabular liners might be a good implant option that can be used safely., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: Low polyethylene wear rate and low incidence of osteolysis have been reported after total hip arthroplasty (THA) using first-generation remelted highly cross-linked polyethylene (HXLPE). However, osteolysis has not been evaluated in long-term studies of these patients (15 years or more). The present study assessed computed tomography (CT) images to determine the incidence of osteolysis associated with HXLPE in THA during at least 15 years of follow-up., Methods: We evaluated 105 primary THAs in 84 patients (77 women and 7 men). Mean follow-up was 15.9 years (range, 15-18 years). All THAs used a Longevity HXLPE liner and a 26-mm zirconia femoral head. Areas of osteolysis were identified from CT images using 3D and multiplanar reconstruction views., Results: CT 3D multiplanar reconstruction images at 15-year follow-up showed no obvious osteolysis in the acetabulum or femur of any patient. No patients developed cup loosening or liner breakage., Conclusion: Our study indicates that first-generation remelted HXLPE liners do not increase the risk of osteolysis during 15-year follow-up and suggests that the wear particles from first-generation remelted HXLPE are less biologically active than those generated by conventional polyethylene devices., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: Historically, there has been excellent survivorship of total hip arthroplasty with newer implants expected to outperform prior generations. Review of our institutional database identified problems with one particular cross-linked polyethylene liner in mid-term follow-up, which has not been reported in the literature. We report on the technical aspects of this liner, as well as the clinical and radiographic factors associated with early failure of this bearing in our practice., Methods: A retrospective review of our institutional database was performed from January 2009 to June 2019 of patients who presented with significant osteolysis in the setting of prior total hip arthroplasty with a contemporary polyethylene liner. Demographic and radiographic measures were collected for all patients., Results: Twelve patients were identified, with nine undergoing revision surgery. All patients demonstrated radiographic osteolysis at the time of revision surgery. The average time to diagnosis of failure was 55.9 months (range: 12-120 months). Average cup position preoperatively was 44 degrees inclination (range: 36-53 degrees) and 21 degrees anteversion (range: 10-34 degrees). Nine patients underwent revision of the acetabular component, with two also undergoing femoral component revision. The Manufacturer and User Facility Device Experience database revealed 22 reported cases of wear-related failure from 2009 to 2019., Conclusions: Considering that no identifiable risk factors related to patient demographics or implant position were identified, the Exactech Connexion GXL liner may be prone to a high rate of early failure from wear and severe secondary osteolysis. We recommend close surveillance of patients with this bearing surface., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Introduction: Patient-specific instrumentation (PSI) has been developed for total ankle arthroplasty (TAA), with proven benefits. One concern regarding PSI is the need for more soft tissue dissection in order to accurately position the PSI guides, which has the theoretical disadvantage of increased osteolysis. The purpose of our study is to compare the incidence and magnitude of osteolysis for the INFINITY Total Ankle System between PSI and standard referencing (SR) techniques. Methods: Sixty-seven patients who underwent primary TAA using Prophecy (PSI) or SR technique between 2013 and 2015 were reviewed in a retrospective observational study. Osteolysis was assessed on radiographs at 2 years. The incidence was calculated by binomial distribution. The number of zones compromised and the magnitude of osteolysis was calculated using the median as a summary statistic and interquartile range as dispersion statistic. Fisher exact test was used to compare both groups, then a regression model was estimated to calculate the odds ratio for osteolysis. Results: Of the 67 TAAs, 51 were in the PSI group and 16 in the SR group. In the PSI group the incidence, number of compromised zones (CZ), and magnitude was 41% (25%-59%), 1 [1-2], and 2 [2-3], respectively. In the SR group these were 36% (13%-65%), 3 [2-3], and 3 [2-4], respectively. No significant differences were found ( P = .46, P = .12, P = .33). A slightly higher risk of osteolysis was found in the PSI group (odds ratio = 1.33 [0.36-4.83]) ( P = .46). The majority of lesions were in 1 zone with size of 2 to 5 mm (63% for all cohort, 64% PSI, 60% SR). Two cases underwent revision for aseptic loosening, 1 in the SR group and 1 in the PSI group. Conclusion: According to our data, there is no significant difference between PSI and SR in terms of risk, incidence, size and magnitude of osteolysis in the INFINITY Total Ankle System at 2 years. Levels of Evidence: Therapeutic, Level III, Retrospective cohort study.

Translational multidisciplinary research is important for the Center for Devices and Radiological Health's efforts for utilizing real-world data (RWD) to enhance predictive evaluation of medical device performance in patient subpopulations. As part of our efforts for developing new RWD-based evidentiary approaches, including in silico discovery of device-related risk predictors and biomarkers, this study aims to characterize the sex/race-related trends in hip replacement outcomes and identify corresponding candidate single nucleotide polymorphisms (SNPs). Adverse outcomes were assessed by deriving RWD from a retrospective analysis of hip replacement hospital discharge data from the National Inpatient Sample (NIS). Candidate SNPs were explored using pre-existing data from the Personalized Medicine Research Project (PMRP). High-Performance Integrated Virtual Environment was used for analyzing and visualizing putative associations between SNPs and adverse outcomes. Ingenuity Pathway Analysis (IPA) was used for exploring plausibility of the sex-related candidate SNPs and characterizing gene networks associated with the variants of interest. The NIS-based epidemiologic evidence showed that periprosthetic osteolysis (PO) was most prevalent among white men. The PMRP-based genetic evidence associated the PO-related male predominance with rs7121 (odds ratio = 4.89; 95% confidence interval = 1.41-17.05) and other candidate SNPs. SNP-based IPA analysis of the expected gene expression alterations and corresponding signaling pathways suggested possible role of sex-related metabolic factors in development of PO, which was substantiated by ad hoc epidemiologic analysis identifying the sex-related differences in metabolic comorbidities in men vs. women with hip replacement-related PO. Thus, our in silico study illustrates RWD-based evidentiary approaches that may facilitate cost/time-efficient discovery of biomarkers for informing use of medical products., (© 2019 The Authors. Clinical and Translational Science published by Wiley Periodicals Inc. on behalf of the American Society of Clinical Pharmacology & Therapeutics. This article has been contributed to by US Government employees and their work is in the public domain in the USA.)

Background: Patients with surgically treated osteoarthritis of the hip have an increased risk of cardiovascular morbidity and mortality many years after the operation compared with controls. Our hypothesis is that this increased risk after total hip arthroplasty (THA) is mediated by development of periprosthetic osteolysis leading to aseptic loosening of the implant., Methods: We conducted a nation-wide, nested, case-control study consisting of patients receiving a cemented THA due to osteoarthritis between the years 1992 and 2005. Our study population included a total of 14,430 subjects identified in the Swedish hip arthroplasty register and linked to the Swedish National Patient Register. The case group consisted of patients (n = 2,886) who underwent reoperation of the treated hip due to osteolysis or aseptic loosening at any time within five years after the index surgery. Each case was matched with four controls (n = 11,544) who had not undergone reoperation. The main outcomes were cardiovascular events i.e. myocardial infarction, heart failure and cerebral infarction according to ICD-codes and time to the first cardiovascular event during the exposure period. Outcomes were subgrouped into cardiac and cerebral events. We used regression models to calculate the incidence rates and adjusted our results for confounders., Findings: Overall, 5.1% of patients had cardiac events, with slightly more overall cardiovascular events occurring in the control group (8.1% vs. 6.7%, odds ratio 0.8, 95% confidence interval (CI) 0.7 to 1.0). After adjusting for confounders, the case group had an increased relative risk of 1.3 (95% confidence interval (CI) 1.1 to 1.3) for total number of cardiovascular events. Similar effect sizes were observed for time to first event., Interpretation: Patients with osteoarthritis who received THA and subsequently underwent a revision operation due to loosening had a higher relative risk of developing cardiovascular events than controls. Thus there is an association which could be explained by a common inflammatory disease pathway that requires further experimental research., Competing Interests: The authors have declared that no competing interests exist.

Osteolysis is a long-term complication of total hip arthroplasty (THA). As the projected number of THAs performed annually increases, osteolysis will likely continue to occur. However, because of advancements in prosthesis design, metallurgy, and enhanced bearing surfaces, fewer revision THAs will be linked to osteolysis and aseptic loosening. Despite these improvements, no preventative therapies are currently available for the management of osteolysis other than removing and replacing the source of bearing wear., (Copyright © 2018 Elsevier Inc. All rights reserved.)

The Mayo metaphysical conservative femoral stem (Zimmer, Warsaw, Indiana) is a wedge-shaped implant designed to transfer loads proximally, reduce femoral destruction, and enable the preservation of bone stock in the proximal femur. Thus, it is a potentially preferred prosthesis for active, non-elderly patients who may require additional future surgeries. This retrospective case study analyzed the outcomes of consecutive patients who underwent total hip replacements with this stem between May 2001 and February 2013. All patients underwent clinical assessment, radiological evaluation for the presence and development of radiolucent lines, and functional assessment (numerical analog scale, Harris hip score, and Short Form-12 questionnaire). Ninety-five hips (79 patients) were available for analysis. The patients' mean age was 43 years (range, 18-64 years), and the mean follow-up was 97 months (range, 26.9-166 months). The postoperative clinical assessments and functional assessments revealed significant improvements. Sixteen patients (20.3%) had 18 orthopedic complications, the most common of which were an intraoperative femoral fracture and implant dislocation requiring revision surgeries in 10 hips (10.5%). Radiological analysis revealed evidence of femoral remodeling in 64 (67.4%) implants, spot welds (neocortex) in 35 (36.8%), and osteolysis in 3 (3.2%). These results suggest that the conservative hip femoral implant has an unacceptable complication rate for non-elderly patients. [Orthopedics. 2018; 41(4):e516-e522.]., (Copyright 2018, SLACK Incorporated.)

Background: Cross-linked polyethylene (XLPE) acetabular liners used in cementless total hip arthroplasty (THA) have demonstrated better wear resistance at 10 years compared with conventional polyethylene (CPE) liners. No clinical studies have compared XPLE to CPE liners beyond 10 years., Methods: We performed a 15-year retrospective cohort study on cementless THA performed in patients with developmental hip dysplasia to measure the differences in polyethylene wear rates and the presence of osteolysis. Twenty-four THAs with XLPE and 17 THAs with CPE were evaluated. The mean age of patients was 55.9 years (41-68) in the XLPE group and 54.4 years (40-67) in the CPE group. The mean follow-up period was 15.1 years (13.9-16.1) in the XLPE group and 15.2 years (14.5-16.0) in the CPE group., Results: The XLPE group had a significantly lower wear rate at 5 and 10 years compared with the CPE group; however, no significant difference was found at 15 years (XLPE group, 0.040 mm/y; CPE group, 0.034 mm/y). In addition, the incidence of osteolysis did not differ significantly between the groups. However, the incidence of excessive wear between 10 and 15 years after surgery in the XLPE group was significantly higher than that in the CPE group., Conclusion: XLPE demonstrated no advantage in the wear rate or the incidence of osteolysis at 15 years, despite having superior wear resistance up to 10 years. It is concerning that the incidence of excessive wear was higher in the XLPE group between 10 and 15 years, and this finding should alert the arthroplasty community to this possible problem with the more highly cross-linked polyethylene., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Introduction: Serum metal ions are part of the regular follow-up routine of patients with metal-on-metal total hip arthroplasties (MoM-THA). Increased cobalt levels have been suggested to indicate implant failure and corrosion., Questions: (1) Is there a correlation between the size of the osteolysis measured on a CT scan and metal ion levels? (2) Can metal ion levels predict the presence of osteolysis in MoM-THA? (3) Are cobalt and chromium serum levels or the cobalt-chromium-ratio diagnostic for osteolysis?, Materials and Methods: CT scans of patients (n = 75) with a unilateral MoM-THA (Birmingham Hip System, Smith & Nephew, TN, USA) implanted by a single surgeon were reviewed to determine the presence of osteolysis. Statistical analysis was performed to detect its association with metal ion levels at the time of the imaging exam., Results: The incidence of osteolysis was the same in men and women (35.6 vs 35.7 %). The cobalt-chromium-ratio correlates with the size of the osteolysis on the CT scan and the femoral component size in the overall study population (p = 0.050, p = 0.001) and in men (p = 0.002, p = 0.001) but not in women (p = 0.312, p = 0.344). The AUC for the cobalt-chromium-ratio to detect osteolysis was 0.613 (p = 0.112) for the overall population, 0.710 for men (p = 0.021) and 0.453 (p = 0.684) for women. The data suggest that a cut off level of 1.71 for the cobalt-chromium-ratio has a sensitivity of 62.5 % and specificity of 72.4 % to identify male patients with osteolysis., Conclusions: The disproportional increase of cobalt over chromium, especially in male patients with large component sizes can not be explained by wear alone and suggests that other processes (corrosion) might contribute to metal ion levels and might be more pronounced in patients with larger component sizes.

Objectives: To investigate the association between distal clavicular osteolysis (DCO) and bench pressing intensity., Methods: From a retrospective review of MRI shoulder reports of individuals between 20 and 40 years of age, 262 male patients with DCO and 227 age-matched male patients without DCO were selected. All patients had completed a bench pressing questionnaire. The patients' bench pressing frequency (times per week), duration (years of bench pressing), bench pressing weight (maximum bench pressing weight with one repetition = 1RM) and the ratio of bench pressing weight to body weight were compared between both groups using Chi-square and Mann-Whitney tests., Results: The results showed that 56 % (146/262) of patients with DCO were high-intensity bench pressers (1RM more than 1.5 times the body weight) compared to 6 % (14/227) in patients without DCO. High-intensity bench pressing was a risk factor for DCO (OR = 19; 95 %CI = 11-35; p < 0.001). Low-intensity bench pressing (1RM less than 1.5 times the body weight) was not a risk factor for DCO (OR = 0.6; 95 % CI = 0.4-0.8). High frequency (>1×/week) and duration (>5 years) of bench pressing were risk factors. In bench pressers who suffered from DCO, the mean 1RM was 283 lbs (±SD 57) compared to 209 lbs (±SD 60) in bench pressers not affected by DCO (p < 0.001, Mann-Whitney)., Conclusions: High-intensity, but not low-intensity bench pressing is a risk factor for DCO.

Background: The results of third-generation of alumina-on-alumina ceramic bearing in a large number of patient cohorts are limited. The purpose of this study was to determine clinical and radiologic outcome, prevalence of osteolysis detected with radiographs and computerized tomographic scan, and survivorship of a cementless total hip arthroplasty using a third-generation of alumina-on-alumina ceramic bearing in a large number of active patients aged younger than 65 years., Methods: We reviewed the cases of 871 patients (1131 hips) who underwent a cementless total hip arthroplasty when they were aged 65 years or younger at the time of surgery. The most common diagnoses were osteonecrosis (53%) and osteoarthritis (20%). Harris hip score, Western Ontario and McMaster Universities Osteoarthritis Index, and University of California, Los Angeles activity scores were recorded. Radiographic and computerized tomographic evaluations were used to evaluate implant fixation and osteolysis. The mean follow-up interval was 18.8 years (range, 15-20 years)., Results: At the time of final follow-up, the mean Harris hip score, Western Ontario and McMaster Universities Osteoarthritis Index score, and University of California, Los Angeles activity score were 90 points, 15 points, and 8 points, respectively. All the femoral stem and acetabular components were well-fixed at the time of final follow-up. No hip had aseptic loosening or osteolysis or fracture of ceramic material at the time of the final follow-up., Conclusion: The current results with the use of the third-generation of alumina-on-alumina ceramic bearings in young patients suggest that cementless acetabular and femoral components provide outstanding long-term fixation and provide a high rate of survivorship without evidence of osteolysis., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: There are limited studies to evaluate long-term clinical and radiographic outcomes of alumina delta ceramic-on-ceramic bearings in cementless total hip arthroplasty (THA). The purpose of this study was to evaluate the clinical and radiographic results, prevalence of osteolysis, squeaking, and fracture of ceramic material associated with the use of the alumina delta ceramic-on-alumina delta ceramic bearing in cementless THA in patients aged <50 years., Methods: We reviewed the cases of 277 patients (334 hips) who underwent a cementless THA using alumina delta ceramic-on-alumina delta ceramic when they were 50 years or younger at the time of surgery. Demographic data; Harris Hip Score; Western Ontario McMaster Universities Osteoarthritis Index; and University of California, Los Angeles activity score were recorded. Radiographic and computerized tomographic evaluations were used to evaluate implant fixation and osteolysis. Squeaking sound and ceramic fracture were documented. The mean follow-up was 13.1 years (range, 10-14)., Results: The mean postoperative Harris Hip Score, Western Ontario and McMaster Universities Osteoarthritis Index score, University of California, Los Angeles activity score were 93 points, 15 points, and 8.6 points, respectively. Two patients had thigh pain (grade 7 points). All acetabular components and all but 2 femoral components were well fixed. Thirty-three hips (10%) exhibited clicking sound, and 2 hips (0.6%) exhibited squeaking sound. No hip had osteolysis or ceramic head or liner fracture., Conclusion: Our minimum 10-year follow-up results with the use of alumina delta ceramic-on-alumina delta ceramic bearings in patients aged <50 years suggest that cementless THA provides a high rate of survivorship without evidence of osteolysis or fracture of ceramic material., (Copyright © 2016. Published by Elsevier Inc.)

Background: Hip resurfacing is an option to consider when treating younger, more active patients. Advantages over total hip arthroplasty include a more normal gait and a lower incidence of thigh pain., Methods: In this prospective study, 190 hip resurfacing procedures (164 participants) were performed using a cobalt-chromium femoral component and a cementless acetabular cup with a 3.8-mm highly cross-linked polyethylene acetabular liner., Results: The mean follow-up was 8.5 (range, 7-10) years. Two participants were lost to follow-up and 2 died. One participant underwent successful revision surgery for acetabular loosening. Four participants underwent successful revision to a total hip arthroplasty because of femoral neck fracture (2), femoral loosening, or infection. The Kaplan-Meier survivorship was 97%. Acetabular bone conservation was assessed using computed tomography by measuring the medial acetabular wall. The mean thickness was 9 mm. Femoral bone was well preserved with a mean head:neck ratio of 1.37. There were 4 (2%) osteolytic defects up to 0.9 cm(3) on computed tomography and no instances of impending polyethylene wear-through. Seven polyethylene retrievals had a measured wear rate of 0.05 mm/y., Conclusion: Hip resurfacing using a highly cross-linked polyethylene acetabular component is a reliable procedure. Both femoral and acetabular bones are reasonably preserved compared with prior resurfacing methods. The low incidence of osteolysis and the low rate of wear found on retrievals suggest that many years of use in highly active patients is possible., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: Highly cross-linked polyethylene was introduced to decrease periprosthetic osteolysis and reoperation, but this has not been conclusively proven., Methods: One surgeon performed 513 consecutive primary total hip arthroplasties (450 patients) using 1 modern, cementless, titanium-mesh acetabular component with screw fixation. This study analyzed the differences in the rate of reoperation and incidence of osteolysis between 133 hips with standard and 112 hips with highly cross-linked polyethylene at minimum 10-year follow-up time., Results: Of the entire cohort of 513 hips, no acetabular component was removed or revised for aseptic loosening. There were significantly more reoperations in the cohort with standard polyethylene (11 of 133, 8%) than highly cross-linked polyethylene (1 of 112, 1%; P = .03). Osteolysis was seen in 24% (32 of 133 hips) with standard polyethylene, compared with 13% (15 of 112 hips) with highly cross-linked polyethylene (P = .02). These differences occurred despite the presence of patients with greater BMI and higher activity in the cohort with highly cross-linked polyethylene., Conclusion: We continue to use this acetabular component with highly cross-linked polyethylene. Longer follow-up is required to determine the progression of osteolysis., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background and purpose - Aseptic loosening is a major cause of failure in total ankle arthroplasty (TAA). In contrast to other total joint replacements, large periarticular cysts (ballooning osteolysis) have frequently been observed in this context. We investigated periprosthetic tissue responses in failed TAA, and performed an element analysis of retrieved tissues in failed TAA. Patients and methods - The study cohort consisted of 71 patients undergoing revision surgery for failed TAA, all with hydroxyapatite-coated implants. In addition, 5 patients undergoing primary TAA served as a control group. Radiologically, patients were classified into those with ballooning osteolysis and those without, according to defined criteria. Histomorphometric, immunohistochemical, and elemental analysis of tissues was performed. Von Kossa staining and digital microscopy was performed on all tissue samples. Results - Patients without ballooning osteolysis showed a generally higher expression of lymphocytes, and CD3+, CD11c+, CD20+, and CD68+ cells in a perivascular distribution, compared to diffuse expression. The odds of having ballooning osteolysis was 300 times higher in patients with calcium content >0.5 mg/g in periprosthetic tissue than in patients with calcium content ≤0.5 mg/g (p < 0.001). Interpretation - There have been very few studies investigating the pathomechanisms of failed TAA and the cause-effect nature of ballooning osteolysis in this context. Our data suggest that the hydroxyapatite coating of the implant may be a contributory factor.

Background and Purpose: There are 2 basic principles in cemented stem fixation: shape-closed and force-closed. We investigated 2 shape-closed straight stems, the Müller (MSS) and the Virtec (VSS), which differ only in geometrical cross section, to determine whether the difference in stem shape would affect the radiological results or long-term survival., Patients and Methods: We included 711 hips (in 646 patients) that were operated on between July 1996 and July 2003. Patients randomly received either an MSS (n = 356) or a VSS (n = 355) and were followed prospectively. Radiographs taken at a follow-up of > 10 years were analyzed for osteolysis. Kaplan-Meier (KM) survival analysis was performed using various endpoints. We also performed Cox regression analysis to identify risk factors for aseptic loosening and osteolysis of the stem., Results: After 10 years, KM survival with "revision of any component for any reason" was 92% (95% CI: 88-95) for the MSS and 95% (CI: 92-97) for the VSS (p = 0.1). With "revision for aseptic loosening of the stem" as the endpoint, KM survival was 96% (CI: 9-98) for the MSS and 98% (CI: 97-100) for the VSS (p = 0.2). Cox regression showed that none of the risk factors analyzed were independent regarding aseptic loosening of the stem or regarding osteolysis., Interpretation: The MSS and the VSS showed excellent survival for aseptic loosening after 10 years. For the 2 different stem designs, we did not find any independent risk factors for aseptic loosening or development of osteolysis.

Objectives: This study was performed to identify the risk factors for reduction loss after locking plate fixation of proximal humerus fractures., Design: Retrospective study., Setting: University trauma center., Patients and Intervention: We retrospectively evaluated 252 patients who had been surgically treated for proximal humeral fractures with locking plates between January 2004 and December 2011., Main Outcome Measurements: Charts and standardized x-rays (true anteroposterior and axillary lateral views) were used to evaluate the Neer and AO OTA fracture types, initial neck-shaft angle (NSA, varus displacement), medial comminution, postoperative NSA (reduction adequacy), medial support restoration, healing progress, reduction loss, and implant-related problems immediately after surgery and at 2 weeks, 1 month, 3 months, 6 months, 9 months, and at least 1 year after surgery. Reduction loss was defined as (1) ≥10 of angulation in any direction, (2) ≥5 mm of height loss of the humeral head from the plate, and (3) fixation failure., Results: Reduction loss occurred in 6.7% (17 of 252) of cases; revision surgeries were performed in all cases. Univariable logistic regression analysis revealed that older age (P = 0.023), osteoporosis (P = 0.001), varus displacement (P = 0.001), medial comminution (P = 0.001), reduction adequacy (P = 0.036), and insufficient medial support (P = 0.001) had significant correlations with reduction loss., Conclusions: Multivariable regression analysis revealed that osteoporosis (less than -2.5 bone mineral density, P = 0.015), displaced varus fracture (less than 110° of NSA, P = 0.025), medial comminution (more than 1 fragment, P = 0.018), and insufficient medial support (no cortical or screw support, P = 0.001) were independent risk factors for reduction loss in the proximal humerus fractures surgery., Level of Evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Background: Penicillium marneffei disseminates hematogenously and can infect most organs, though infection leading to osteolysis is extremely rare. We describe the clinical and laboratory features, management, and outcomes of patients with penicilliosis marneffei (PSM) with osteolytic lesions., Methods: This retrospective study was conducted between January 1, 2003 and May 1, 2014 at the First Affiliated Hospital of Guangxi Medical University. Patients who presented with culture and/or histopathologic proof of disseminated PSM within osteolytic lesions were included., Results: P. marneffei infection was diagnosed in 100 patients (65 HIV-infected and 35 HIV-negative). Fourteen patients, all HIV-negative, (14/35, 40%) had osteolytic lesions. The most common comorbidity was diabetes mellitus, though previous glucocorticoid therapy, β-thalassemia, breast cancer, and Langerhans cell histiocytosis also occurred. Five patients had no comorbidity. Fever, malaise, ostealgia, weight loss, and anemia were the most common symptoms, followed by cutaneous lesions, lymphadenopathy, hepatosplenomegaly, cough, sputum, and stethalgia. Ostealgia, joint pain, and joint disorders were also recorded. White blood cell and neutrophil counts were increased (mean 22.3 ± 7.4 × 10(9) cells/L; mean 18.84 ± 4.5 × 10(9) cells/L, respectively). The most common sites were the vertebrae, skull and femur, ribs and ilium, though the clavicle, scapula, humerus, and tibia were also involved. Radiography and computed tomography (CT) showed multiple radiolucencies with moth-eaten bone destruction, periosteal proliferation, bone fracture, and surrounding soft-tissue swelling. Emission CT showed significantly increased uptake in many skeletal regions. Positron emission tomography/CT showed generalized lymphadenopathy, bone metabolic activity, and bone destruction. The (18) F-FDG standard uptake value was increased in the entire skeleton (mean 6.16). Twelve patients received antifungal therapy, four of whom died during treatment, and eight recovered, though four of these eight relapsed within 3-24 months. Two patients discontinued treatment because of severe multiple organ failure and died., Conclusions: Osteolysis is often overlooked in HIV-negative individuals with disseminated P. marneffei infection. However, P. marneffei involving the bone and leading to osteolysis may indicate severe systemic disturbance, and is characterized by a poor prognosis, high recurrence rate, and the need for prolonged antifungal treatment.

Objective: The purpose of this article is to determine how often a malignant process presents as a lucency near a hip prosthesis, and to classify the frequency and distribution of differential diagnoses of these lytic lesions, and to determine their disposition., Materials and Methods: Hip and pelvis imaging examinations obtained from January 1998 to June 2008 were text searched (1,164,560 reports) to identify patients with hip prostheses (3508 patients); the records were then searched and individually reviewed to identify periprosthetic lucency (2036 reports; 176 patients). The most likely cause for the lucency, as determined by the interpreting radiologist, was recorded. Malignancy was confirmed in all cases. Malignancy was excluded by biopsy for some patients but by clinical follow-up or at the time of revision, if performed, for most patients. Prevalence rates and 95% CIs were calculated., Results: The overall prevalence of periprosthetic lucency was 5.02%. The prospective diagnoses suggested included loosening or infection (37.5%), degenerative cysts (19.3%), metastases (23.3%), multiple myeloma (14.8%), and metastasis of previously unknown malignancy (3.4%). The prevalence of metastases or multiple myeloma near a hip prosthesis was 1.54%; however, each of these patients had a known prior diagnosis of bone metastases, multiple myeloma, or primary bone malignancy., Conclusion: Among the 2036 examinations with periprosthetic lucency, there were no instances of new malignancy, metastasis, or myeloma. These results suggest that it is statistically unlikely that a lucency near a hip prosthesis represents the first presentation of malignancy or metastases, regardless of how large or aggressive it may appear on imaging.

Background: Periprosthetic osteolysis in total ankle arthroplasty (TAA) is a substantial problem. We report the incidence and characteristics of periprosthetic osteolysis and its association with clinical outcomes after TAA using the HINTEGRA ankle system., Methods: Between May 2004 and April 2010, 126 primary TAA were performed on 115 patients. We excluded 27 ankles with a follow-up of less than 24 months; thus, 99 ankles in 90 patients with a mean follow-up of 40.8 (range, 24-89) months were included in the study. Pain and clinical outcomes were assessed using the visual analog scale and the American Orthopaedic Foot and Ankle Society score. Fluoroscopy was used for optimum visualization of the bone-implant interfaces on radiographs. Computed tomography (CT) was conducted on 25 ankles that exhibited progression of osteolysis., Results: Radiographs revealed that 37 of the 99 ankles showed radiologic evidence of osteolysis; of these, 10 demonstrated continuous progression over the study period. Helical CT scans were more accurate than radiographs for identifying and measuring periprosthetic osteolysis in TAA. None of the demographic parameters were substantially different between the 2 groups of subjects (with or without osteolysis). No major association was found between the presence of osteolysis and clinical and radiologic outcomes., Conclusion: Osteolysis associated with TAA may indeed be common in the postoperative period. Although most of the osteolytic lesions observed here were relatively quiescent, these lesions raise concerns in contemporary TAA because of their incidence rate and the potential for later mechanical failure as compared to arthrodesis. Early diagnosis and careful evaluation of osteolysis may provide a clinical opportunity for limited revision surgery in ankles of impending prosthesis failure., Level of Evidence: Level IV, case series.

We studied the relationship between osteolysis and polyethylene wear, age at surgery, body mass index and height in 463 subjects (180 osteolysis and 283 controls) after cemented Charnley total hip arthroplasty (THA), in order to develop a kernel-based Bayesian model to quantitate risk of osteolysis. Such tools may be integrated into decision-making algorithms to help personalize clinical decision-making. A predictive model was constructed, and the estimated posterior probability of the implant failure calculated. Annual wear provided the greatest discriminatory information. Age at surgery provided additional predictive information and was added to the model. Body mass index and height did not contain valuable discriminatory information over the range in which observations were densely sampled. The robustness and misclassification rate of the predictive model was evaluated by a five-times cross-validation method. This yielded a 70% correct predictive classification of subjects into osteolysis versus non-osteolysis groups at a mean of 11 years after THA. Finally, the data were divided into male and female subsets to further explore the relationship between wear rate, age at surgery and incidence of osteolysis. The correct classification rate using age and wear rate in the model was approximately 66% for males and 74% for females.

Patients with ASR implants (resurfacing and large-diameter (XL) metal-on-metal (MoM) total hip arthroplasty), even if asymptomatic and with a stable prosthesis, may present extremely high blood metal ion levels. We report on a consecutive series of fourteen ASR revisions, focusing on osteolysis and their radiographic correspondence and their correlation with blood metal ion levels. At revision, seven hips revealed severe periacetabular osteolysis which was radiographically undetectable in six and asymptomatic in five. Seven hips with no acetabular osteolysis had significantly lower serum Cr and Co ion concentrations (respectively 25.2, 41.1 μg/l) compared to the seven hips with severe acetabular bone loss (respectively 70.1, 147.0 μg/l). Elevated blood metal ion levels should be considered as a warning of undetectable and ongoing periprosthetic osteolysis in asymptomatic patients with ASR prosthesis., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Radiostereometry (RSA) of the cemented Scientific Hip Prosthesis (SHP) reported excessive migration and predicted high failure rates. In a prospective randomized clinical trial we compared minimum 10 years results of the SHP (n=38) with the Omnifit-stem (n=37). Two-year bone remodelling, compared with dual energy x-ray absorptiometry and assessed in regions of interest A-D based on the 7 Gruen zones, showed better periprosthetic bone preservation around the SHP in all but one regions (P<.05). At 10 years Harris Hip Score was better for the SHP (P=.0001) but Oxford Hip Score was the same (P=.79). There were no revisions in either group, but radiographic loosening was definite in 1 SHP and 1 Omnifit. Based on earlier RSA studies, the rough surface finish of the SHP was expected to cause cement abrasion, osteolysis and inferior survival. However our clinical and remodelling results could not confirm these expectations, suggesting that the link of early migration and mid-term clinical results is not sufficiently clear for the SHP., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Objective: To evaluate the use of denosumab for the prevention of skeletal-related events (SREs) in patients with osteolytic lesions associated with multiple myeloma (MM)., Data Sources: MEDLINE/Ovid (1946-April week 3, 2013), EMBASE (1980-2013 week 16), abstracts of the American Society of Clinical Oncology (1983-April 22, 2013), American Society of Hematology (2004-April 22, 2013), European Hematology Association (1994-April 22, 2013), and the European Society for Medical Oncology (1990-April 22, 2013) were searched using the terms denosumab and multiple myeloma., Study Selection and Data Extraction: Clinical trials comparing the efficacy of denosumab with that of bisphosphonates in preventing or delaying SREs in patients with MM were included. Trials solely evaluating bone turnover markers were excluded. One Phase 2 trial, 1 Phase 3 trial, and 1 post hoc Phase 3 analysis were included., Data Synthesis: A Phase 2 trial compared denosumab to bisphosphonate continuation in patients with elevated urinary N-telopeptide levels (uNTX) despite bisphosphonate therapy. Denosumab patients experienced fewer SREs; however, this was not statistically significant. A Phase 3 trial compared denosumab to zoledronic acid in patients with at least 1 osteolytic lesion. Denosumab delayed the time to a first SRE by 16% (median 20.6 vs 16.3 months; p = 0.0007 for noninferiority). Superiority of denosumab was not reached. A post hoc analysis revealed less favorable survival in MM patients treated with denosumab (HR 2.26; 95% CI 1.13-4.50). The incidence of overall adverse effects was similar between each group in both studies., Conclusions: Denosumab may be an alternative for the prevention of SREs in patients with MM with deteriorating renal function. Because of the high cost of the drug, low percentage of MM patients in the available studies, and the potential for their decreased survival, use of denosumab should be limited.

In experimental studies, statin use has been associated with reduction of osteoclastic activity and promotion of bone formation around implants. Moreover, a large clinical study recently reported a substantially reduced risk of revision for aseptic loosening among statin users with THA. Our objective was to evaluate the influence of statin use on the development of femoral osteolysis within 5 years after THA. We conducted a case-cohort study including all THAs presenting with femoral osteolysis at the 5 year visit (cases) and compared them with those without osteolysis (controls). Cases and controls were identified from a cohort of primary THAs operated between 2001 and 2005. Seven hundred thirty-five THAs were included, mean age 68 years. Five years after surgery osteolysis had developed around the femoral component of 40 THAs (5.4%). Ever-use of statins was much less frequent among cases (5 of 40, 12.5%) than among controls (199 of 695, 28.6%). The crude risk ratio of femoral osteolysis among statin users was 0.36 (95% CI 0.14; 0.92). After adjusting for age, sex, activity level, BMI, diagnosis, bearing surface, and type of stem, the adjusted risk ratio was 0.38 (95% CI 0.15; 0.99). In conclusion, statin use was associated with a reduced risk of developing femoral osteolysis 5 years after THA. Statins may be useful for reducing the risk of implant failure following THA., (Copyright © 2012 Orthopaedic Research Society.)

Background: Large (36- and 40-mm) femoral heads with highly crosslinked polyethylene liners were introduced to reduce the risk of dislocation after primary total hip arthroplasty (THA), but it is unclear whether the risk is reduced and whether there is osteolysis or liner fracture., Questions/purposes: We therefore determined (1) the incidence of early and late (> 5 years) dislocation; (2) the rate of femoral and acetabular component loosening and revision; and (3) the rate of liner fracture and pelvic osteolysis., Methods: We retrospectively reviewed 112 patients presumed at high risk for dislocation who had 122 primary THAs: 108 with 36-mm and 14 with 40-mm femoral heads. The risk factors were: age > 75 years (80 hips); proximal femur fracture (18); history of contralateral dislocation (two); history of alcohol abuse (two); large acetabulum > 60 mm (six); and other (14). Patients were evaluated for early (< 1 year) and late (> 5 years) dislocation; rate of reoperation; clinical result with Harris hip score; and standard radiographic analysis for radiolucent lines and osteolysis., Results: The rate of early dislocation was 4% (five of 122 hips), all with a 36-mm head. There were no late dislocations in 74 hips followed for 5 to 10 years, no revision for acetabular or femoral loosening, and no liner fractured. There were no hips with pelvic osteolysis and seven hips with an acetabular radiolucent line., Conclusions: The 36- and 40-mm femoral heads were associated with a low risk of dislocation in high-risk patients undergoing primary THA with no osteolysis or liner fracture., Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of level of evidence.

The best bearing to use in the young active population remains unknown because there are currently no evidence-based data to rely on. This article compares the prevalence of periacetabular osteolysis using computerized tomography in patients with metal-on-metal, ceramic-on-ceramic, and metal-on-cross-linked bearings at a minimum 5-year follow-up., (Copyright © 2012 Elsevier Inc. All rights reserved.)