Canine Total Hip Arthroplasty Research Articles

The wear of a polyethylene socket articulating with a zirconia ceramic femoral head in canine total hip arthroplasty

Wear of yttria-zirconia (zirconia) in the femoral head was investigated in mature mongrel dogs weighing 10 to 13 kg. Two dogs, which were used as a control group, were sacrificed 18 months after implantation of the uncemented modular hip system with an alumina ceramic (alumina) femoral head. A zirconia femoral head was implanted in five dogs: one was sacrificed 12 months after implantation, two at 18 months, and two at 24 months. In each femoral head and polyethylene (PE) socket, the surface was observed by means of scanning electron microscopy (SEM); the mean articulation surface roughness on the femoral head and PE socket and the thickness of the PE socket were measured. Wear was not seen on the surface of either the zirconia or the alumina heads. In both groups, minute white spots on the smooth surface of the PE socket were visible by SEM. In the alumina and zirconia groups the mean roughness was 0.1 microm. The mean thickness of the PE socket was reduced by 0.2 mm in the alumina group. In the zirconia group it was reduced by 0.2 to 0.3 mm. However, the mechanical strength of zirconia is known to be greater than that of alumina and it may be possible to reduce the diameter of the femoral head. The smaller zirconia head may contribute to the reduction of the wear of the PE socket in an uncemented modular total hip system.

Effect of Flexibility of the Femoral Stem on Bone-Remodeling and Fixation of the Stem in a Canine Total Hip Arthroplasty Model without Cement*

The purpose of this study was to compare, with regard to fixation of the implant and femoral bone resorption, two fully porous-coated stems of different stiffnesses in a canine total hip arthroplasty model. A bilateral arthroplasty was carried out with insertion of a titanium-alloy stem (which had stiffness properties comparable with those of the canine femur) on one side and with insertion of a composite stem (which was three to fivefold more flexible than the canine femur) on the contralateral side. Eight femora were evaluated at six months and eight, at eighteen months after the operation, to determine the extent of bone ingrowth, periprosthetic cortical area, intracortical porosity, and bone-remodeling. Despite the markedly greater flexibility of the composite stems, no significant difference could be detected (with the numbers available), with regard to the overall degree of femoral stress-shielding, cortical area, or cortical porosity, between these stems and the stiffer, titanium-alloy stems at either time-period. However, the composite stems had less bone ingrowth and more formation of radiopaque lines than did the titanium-alloy stems. At eighteen months, the values for bone ingrowth were 9.7 +/- 5.38 percent (mean and standard deviation) for the composite stems compared with 28.1 +/- 5.31 percent for the titanium-alloy stems (p = 0.003). Furthermore, the histological sections from the femora containing a composite stem showed radiopaque lines indicative of fibrous ingrowth approximately threefold more often than did those from the femora containing a titanium-alloy stem (p = 0.02).

Inhibition of Wear Debris Mediated Osteolysis in a Canine Total Hip Arthroplasty Model

In this study the efficacy of an oral bisphosphonate therapy to inhibit wear debris mediated bone resorption was evaluated in a canine total hip replacement model. Adult canines were randomized to three groups (n = 8 each) with a right uncemented total hip replacement performed on each animal. Group I (control) received no particulate debris. In Groups II and III, a mixture of 1×109 particles were introduced into the proximal femoral gap intraoperatively. The particle mixture consisted of fabricated ultra high molecular weight polyethylene (mean 2.3 μm, 90% by number), titanium alloy (mean 3.1 μm, 5%), and cobalt chrome alloy (mean 0.8 μm, 5%). Group III canines additionally received oral drug therapy (5 mg once a day, alendronate sodium) which was begun on postoperative Day 7 and continued until the time of sacrifice. Post-operatively, all animals were allowed 24 weeks of full ambulation before euthanasia. Radiographs obtained preoperatively, postoperatively, and at time of sacrifice were evaluated for periprosthetic osteolysis. Interfacial tissues were examined histologically and placed in organ culture and the supernatants were assayed for prostaglandin E2 and interleukin-1. One animal receiving debris (Group II) suffered a periprosthetic fracture and was sacrificed from the study. Radiographically, one of eight Group I (control) and six of seven canines from Group II (debris) had periprosthetic radiolucencies with endosteal scalloping develop. In contrast, only one of eight animals from Group III (debris + alendronate) had periprosthetic radiolucencies develop. Whereas tissues from control animals were mostly fibrous and acellular, tissues from both experimental groups had significant macrophage infiltration. Levels of prostaglandin E2 and interleukin-1 were elevated significantly in periprosthetic tissues from both experimental groups compared with controls. Continuous administration of alendronate effectively inhibited bone lysis for the 24-week duration of the study. This is consistent with the literature indicating that alendronate is incorporated in the mineralizing matrix making it refractory to osteoclastic resorption. This report has significant clinical implications for controlling the most common cause of implant failure.

Enhanced stability of uncemented canine femoral components by bone ingrowth into the porous coatings

The following questions were answered in this study: (1) What is the initial stability of proximally porous-coated canine femoral components? (2) Does bone ingrowth occur under these conditions? (3) Is the stability enhanced by tissue ingrowth in vivo? The stability of proximally porous-coated femoral components of canine total hip arthroplasties after 6 months to 2 years of in vivo service in dogs was measured in vitro using displacement transducers under loads simulating canine midstance. This was compared with the stability of identical components under the same loading conditions immediately after implantation in vitro in the contralateral femurs. The femurs were then sectioned and bone ingrowth into the porous coatings was quantified. The results showed that immediately after implantation the implants can move as much as 50 μm, but that the bone ingrowth into porous coatings of canine femoral components can occur even under such conditions. These data also suggested that the relative motion existing at the time of insertion can be reduced to very small amounts (< 10 μm) by bone ingrowth.

A study of micromotion and appositional bone growth to a canine madreporic-surfaced femoral component

A canine total hip arthroplasty model was used to examine micromotion and bone apposition to a proximally two-thirds madreporic-surfaced femoral prosthesis. Micromotion was also measured following initial press-fit implantation into canine cadaveric femora. After initial press-fit fixation and either 6 or 24 months of biologic fixation, micromotion was less than 23 μm in the proximal and midstem regions, a magnitude consistent with bone apposition. Bone apposition was greatest near the junction of the madreporic and smooth surfaces and was not significantly different between 6 and 24 months (51% at 6 months and 47% at 24 months). The quality of the interface tissue appears to be conducive to long-term fixation.

Glass ceramic augmentation of the acetabulum. Total hip arthroplasties in 24 dogs.

Implants made of glass-ceramic containing apatite and wollastonite were used for reconstruction of large bone defects of the weight-bearing acetabulum in canine total hip arthroplasties. 24 dogs underwent replacements and were killed after 3, 6, and 12 months. The interface between the prosthesis and bone was examined radiographically, histologically, and mechanically. Bone bonding with the prosthesis occurred in all the implants. Glass ceramic containing apatite and wollastonite implants seem promising for use in total hip arthroplasty as filling materials for large defects in weight-bearing bone.

Subsidence of an uncemented canine femoral stem.

Factors contributing to subsidence were analyzed by radiographic evaluation and mechanical testing of 36 canine cadaver femora during and after insertion of an uncemented porous-coated femoral stem and by radiographic evaluation of 35 canine total hip arthroplasties. Mean percentage of canal fill in immediate postoperative radiographs, and percentage of canal fill at midimplant and distal implant locations, were accurate predictors of subsidence. Force required to implant the femoral stem was strongly correlated with force required for implant subsidence. Femoral morphology and percentage of canal fill at the middle and distal sites were accurate predictors of subsidence. Implants in femora with a stovepipe morphology (canal flare index less than or equal to 1.8) were six times more likely to subside than implants in femora that had a normal appearance (canal flare index 1.8 to 2.5), and 72 times more likely to subside than implants in champagne-fluted femora (canal flare index greater than or equal to 2.5). Femora with more than 85% mean, middle, or distal canal fill were less likely to subside.

Polyethylene synovitis following canine total hip arthroplasty: Histomorphometric analysis

The synovial membrane response to polyethylene wear debris was analyzed in canine total hip arthroplasties (THA). Fifty-four THAs were performed in healthy, mature dogs. None of the arthroplasties demonstrated clinical or radiographic signs of loosening. Synovial membrane biopsies were harvested 4 (n=13), 6 (n=5), 8 (n=8), 12 (n=15), and 24 (n=6) months after surgery and were scored for inflammation, polyethylene (PE) wear debris, histiocyte density, and membrane thickness. The amount of PE wear debris tended to increase with time. However, the inflammatory changes within the joint capsule and synovial membrane did not progress, and the total thickness of the alveolar and surface layers decreased ( P=.008). It appears that the amount of wear debris at 2 years in canine hip arthroplasties, without evidence of loosening, is well tolerated by the joint capsule.

A Double-Blind Study on the Effects of a Capacitively Coupled Electrical Field on Bone Ingrowth Into Porous-Surfaced Canine Total Hip Prostheses

The effect of a capacitively coupled electrical field on bone ingrowth into titanium fiber mesh porous-surfaced canine total hip arthroplasties (THAs) was investigated in a double-blind experiment. The electrical field was induced by an external source delivering a 60-kHz 5-6-V peak-to-peak sinusoid voltage through skin electrodes. No significant increase in the ingrowth of bone into the porous coating occurred at the end of six weeks of electrical stimulation. The amount of bone that grew into the porous surface, the areal density of bone within the available pore space, and the extent of the prosthesis surface area with bone ingrowth or apposition were not significantly different in the control and stimulated groups. This particular form of electrical stimulation does not improve bone ingrowth into porous-surfaced canine THAs by six weeks.

Chemical Implant Fixation Using Hydroxyl???Apatite Coatings

Sintered hydroxyl-apatite implants form very tight bonds with living bone but are susceptible to fatigue failure. Plasma-sprayed apatite coatings on titanium substrates overcome the fatigue problem. The static tensile substrate bond strength of the apatite coating is in excess of 85 megapascals (MPa) (12,000 psi). In a plug implant study designed to discount mechanical retention, a bone bonding shear strength of 64 MPa (9280 psi) was achieved, comparable to the strength of cortical bone. Histologic sections confirm the close bonding between apatite coating and living bone. In a canine total hip arthroplasty study, the apatite-coated implants proved far superior to the uncoated controls. Uncoated prostheses were surrounded by fibrous tissue and were easily extracted from the femur at any postoperative time. The apatite-coated implants were rigidly fixed within three weeks with demonstrable bone formation up to the implant surface. Bony defects up to 2 mm in depth were filled with bone within six weeks. The hypothetical mechanism of bone bonding is chemical. Hydroxyl-apatite coatings permit an implant fixation far superior to current methods using either cemented or cementless techniques. The plan is to study a human total hip prosthesis with hydroxyl-apatite coating for chemical fixation to bone.

A Clinical Study of Canine Total Hip Arthroplasty

Our intent was to evaluate clinically total hip arthroplasty in the dog using the same procedures and prostheses. We replaced 20 hips in 15 dogs of both sexes and various breeds, weights, and ages. All animals exhibited pain caused by degenerative joint disease of one or both coxofemoral joints. Using Amstutz's system of grading at a minimum of 12 months post‐operatively, none of the hips replaced were graded poor, 12.5% were graded fair, 12.5% good, and 75% excellent. Loosening of prosthetic components was by far the most common problem encountered in this study. Luxations were virtually eliminated by the use of the Richards Canine II total hip replacement system. Infections were found to be directly proportional to surgery time, number of operations performed, or both. Component failure occurred only when the size of the prosthesis was not properly matched to the size of the dog. Although these problems still must be overcome, we conclude that total hip arthroplasty is a valuable adjunct to veterinary medicine in selected cases.