Hideya Ito

Wear resistance of artificial hip joints with poly(2-methacryloyloxyethyl phosphorylcholine) grafted polyethylene: comparisons with the effect of polyethylene cross-linking and ceramic femoral heads.

Aseptic loosening of artificial hip joints induced by wear particles from the polyethylene (PE) liner remains the ruinous problem limiting their longevity. We reported here that grafting with a polymer, poly(2-methacryloyloxyethyl phosphorylcholine (MPC)) (PMPC), on the PE liner surface dramatically decreased the wear production under a hip joint simulator condition. We examined that the effect of properties of both PE by cross-linking and femoral head by changing the materials on wearing properties of PE. The PMPC grafting on the liners increased hydrophilicity and decreased friction torque, regardless of the cross-linking of the PE liner or the difference in the femoral head materials. During the hip joint simulator experiments (5 x 10(6) cycles of loading), cross-linking caused a decrease of wear amount and a reduction of the particle size, while the femoral head materials did not affect it. The PMPC grafting abrogated the wear production, confirmed by almost no wear of the liner surface, independently of the liner cross-linking or the femoral head material. We concluded that the PMPC grafting on the PE liner surpasses the liner cross-linking or the change of femoral head materials for extending longevity of artificial hip joints.

Biomimetic hydration lubrication with various polyelectrolyte layers on cross-linked polyethylene orthopedic bearing materials

Natural joints rely on fluid thin-film lubrication by the hydrated polyelectrolyte layer of cartilage. However, current artificial joints with polyethylene (PE) surfaces have considerably less efficient lubrication and thus much greater wear, leading to osteolysis and aseptic loosening. This is considered a common factor limiting prosthetic longevity in total hip arthroplasty (THA). However, such wear could be mitigated by surface modification to mimic the role of cartilage. Here we report the development of nanometer-scale hydrophilic layers with varying charge (nonionic, cationic, anionic, or zwitterionic) on cross-linked PE (CLPE) surfaces, which could fully mimic the hydrophilicity and lubricity of the natural joint surface. We present evidence to support two lubrication mechanisms: the primary mechanism is due to the high level of hydration in the grafted layer, where water molecules act as very efficient lubricants; and the secondary mechanism is repulsion of protein molecules and positively charged inorganic ions by the grafted polyelectrolyte layer. Thus, such nanometer-scaled hydrophilic polymers or polyelectrolyte layers on the CLPE surface of acetabular cup bearings could confer high durability to THA prosthetics.

Long-term hip simulator testing of the artificial hip joint bearing surface grafted with biocompatible phospholipid polymer

To prevent periprosthetic osteolysis and subsequent aseptic loosening of artificial hip joints, we recently developed a novel acetabular highly cross‐linked polyethylene (CLPE) liner with graft polymerization of 2‐methacryloyloxyethyl phosphorylcholine (MPC) on its surface. We investigated the wear resistance of the poly(MPC) (PMPC)‐grafted CLPE liner during 20 million cycles in a hip joint simulator. We extended the simulator test of one liner to 70 million cycles to investigate the long‐term durability of the grafting. Gravimetric, surface, and wear particle analyses revealed that PMPC grafting onto the CLPE liner surface markedly decreased the production of wear particles and showed that the effect of PMPC grafting was maintained through 70 million cycles. We believe that PMPC grafting can significantly improve the wear resistance of artificial hip joints.

Clinical and radiographic outcomes of total hip replacement with poly(2-methacryloyloxyethyl phosphorylcholine)-grafted highly cross-linked polyethylene liners: Three-year results of a prospective consecutive series

Abstract Objectives. This study aimed to evaluate the clinical safety and wear-resistance of the novel highly cross-linked polyethylene (HXLPE) acetabular liner with surface grafting of poly(2-methacryloyloxyethyl phosphorylcholine) (PMPC) at 3 years after total hip replacement (THR). Methods. Eighty consecutive patients underwent cementless THR using a 26-mm diameter cobalt–chromium–molybdenum alloy femoral head and a PMPC-grafted HXLPE liner for the bearing couplings. We evaluated the clinical and radiographic outcomes of 76 patients at 3 years after the index surgery. Results. The clinical results at 3 years were equivalent to a Harris hip score of 95.6 points. No adverse events were associated with the implanted PMPC-grafted HXLPE liner, and no periprosthetic osteolysis was detected. The mean femoral head penetration rate was 0.002 mm/year, representing marked reduction compared with other HXLPE liners. Conclusions. A PMPC-grafted HXLPE liner is a safe option in THR and probably reduces the generation of wear particles.

Total Hip Arthroplasty After Rotational Acetabular Osteotomy

In this study, we aimed to determine whether the outcomes of total hip arthroplasty (THA) after rotational acetabular osteotomy (RAO) are equal to those of primary THA, and to elucidate the characteristics of THA after RAO. The clinical and radiographic findings of THA after RAO (44 hips), with minimum 24 months of follow-up, were compared with a matched control group of 58 hips without prior RAO. We found that the outcomes in terms of functional scores and complication rates did not differ between THA after RAO and THA without previous pelvic osteotomy, indicating that the results of THA after RAO are equivalent to those of primary THA. Although THA after RAO requires technical considerations, similar clinical outcomes to primary THA can be expected.

Grafting of poly(2-methacryloyloxyethyl phosphorylcholine) on polyethylene liner in artificial hip joints reduces production of wear particles.

Despite improvements in the techniques, materials, and fixation of total hip arthroplasty, periprosthetic osteolysis, a complication that arises from this clinical procedure and causes aseptic loosening, is considered to be a major clinical problem associated with total hip arthroplasty. With the objective of reducing the production of wear particles and eliminating periprosthetic osteolysis, we prepared a novel hip polyethylene (PE) liner whose surface graft was made of a biocompatible phospholipid polymer-poly(2-methacryloyloxyethyl phosphorylcholine (MPC)). This study investigated the wear resistance of the poly(MPC)-grafted cross-linked PE (CLPE; MPC-CLPE) liner during 15×10(6) cycles of loading in a hip joint simulator. The gravimetric analysis showed that the wear of the acetabular liner was dramatically suppressed in the MPC-CLPE liner, as compared to that in the non-treated CLPE liner. Analyses of the MPC-CLPE liner surface revealed that it suffered from no or very little wear even after the simulator test, whereas the CLPE liners suffered from substantial wears. The scanning electron microscope (SEM) analysis of the wear particles isolated from the lubricants showed that poly(MPC) grafting dramatically decreased the total number, area, and volume of the wear particles. However, there was no significant difference in the particle size distributions, and, in particular, from the SEM image, it was observed that particles with diameters less than 0.50μm were present in the range of the highest frequency. In addition, there were no significant differences in the particle size descriptors and particle shape descriptors. The results obtained in this study show that poly(MPC) grafting markedly reduces the production of wear particles from CLPE liners, without affecting the size of the particles. These results suggest that poly(MPC) grafting is a promising technique for increasing the longevity of artificial hip joints.

Autonomous penetration detection for bone cutting tool using demonstration-based learning

In orthopedic surgery, bone-cutting procedures are frequently performed. However, bone-cutting procedures are very risky in cases where vital organs or nerves exist beneath the target bones. In such cases, surgeons are required to determine the depth of the penetration into the bone by using only their haptic senses. Thus, we developed a handheld bone-cutting-tool system that detects the penetration of the cutting material. The developed system autonomously detects the penetration before total penetration and stops the actuation of the cutting tool, leaving a very thin remnant of work material. The developed system estimates the cutting resistance by using its motors current and rotational speed. On the basis of data collected preoperatively, the system estimates the cutting state by using a support vector machine (SVM). According to the SVM outputs, the system detects the penetration of the work material and autonomously stops the actuation of the cutting tool. The proposed method was verified through experiments, and the results showed that the developed system successfully detected the penetrations of work materials and stopped autonomously immediately before total penetration. This study showed that the autonomous detection of bone penetration with a hand-held bone-cutting tool is feasible by using the proposed scheme.

A Patient-Specific Instrument for Femoral Stem Placement During Total Hip Arthroplasty

To ensure that the femoral stem is placed in the proper position during total hip arthroplasty, the authors developed a patient-specific instrument. A total of 10 total hip arthroplasties were performed with the assistance of the patient-specific instrument during this study. The mean accuracy of stem tilt, varus/valgus, and anteversion was 2.1°±4.1°, 1.0°±0.7°, and 4.7°±1.2°, respectively. No complications were observed and no reoperations were required for any of the patients who underwent surgery included in this study. The results support the feasibility of this patient-specific instrument for use during stem placement in total hip arthroplasty. [Orthopedics. 2017; 40(2):e374-e377.].

Clinical safety and wear resistance of the phospholipid polymer-grafted highly cross-linked polyethylene liner

To reduce the production of wear particles and subsequent aseptic loosening, we created a human articular cartilage‐mimicked surface for a highly cross‐linked polyethylene liner, whose surface grafted layer consisted of a biocompatible phospholipid polymer, poly(2‐methacryloyloxyethyl phosphorylcholine). Although our previous in vitro findings showed that poly(2‐methacryloyloxyethyl phosphorylcholine)‐grafted particles were biologically inert and caused no subsequent bone resorptive responses, and poly(2‐methacryloyloxyethyl phosphorylcholine) grafting markedly decreased wear in hip joint simulator tests, the clinical safety, and in vivo wear resistance of poly(2‐methacryloyloxyethyl phosphorylcholine)‐grafted highly cross‐linked polyethylene liners remained open to question. Therefore, in the present study, we evaluated clinical and radiographic outcomes of poly(2‐methacryloyloxyethyl phosphorylcholine)‐grafted highly cross‐linked polyethylene liners 5 years subsequent to total hip replacement in 68 consecutive patients. No reoperation was required for any reason, and no adverse events were associated with the implanted liners. The average Harris Hip Score increased from 38.6 preoperatively to 96.5 5 years postoperatively, and health‐related quality of life, as indicated by the Short Form 36 Health Survey, improved. Radiographic analyses showed no periprosthetic osteolysis or implant migration. Between 1 and 5 years postoperatively, the mean steady‐state wear rate was 0.002 mm/year, which represented a marked reduction relative to other highly cross‐linked polyethylene liners, and appeared to be unaffected by patient‐related or surgical factors. Although longer follow up is required, poly(2‐methacryloyloxyethyl phosphorylcholine)‐grafted highly cross‐linked polyethylene liners improved mid‐term clinical outcomes. The clinical safety and wear‐resistance results are encouraging with respect to the improvement of long‐term clinical outcomes with poly(2‐methacryloyloxyethyl phosphorylcholine)‐grafted highly cross‐linked polyethylene liners.

Evaluation of the three-dimensional bony coverage before and after rotational acetabular osteotomy

PurposeRotational acetabular osteotomy is a type of pelvic osteotomy that involves rotation of the acetabular bone to improve the bony coverage of the femoral head for patients with acetabular dysplasia. Favourable post-operative long-term outcomes have been reported in previous studies. However, there is a paucity of published data regarding three-dimensional bony coverage. The present study investigated the three-dimensional bony coverage of the acetabulum covering the femoral head in hips before and after rotational acetabular osteotomy and in normal hips.MethodsThe computed tomography data of 40 hip joints (12 joints before and after rotational acetabular osteotomy; 16 normal joints) were analyzed. The three-dimensional bony coverage of each joint was evaluated using original software.ResultsThe post-operative bony coverage improved significantly compared with pre-operative values. In particular, the anterolateral aspect of the acetabulum tended to be dysplastic in patients with acetabular dysplasia compared to those with normal hip joints. However, greater bony coverage at the anterolateral aspect was obtained after rotational acetabular osteotomy. Meanwhile, the results of the present study may indicate that the bony coverage in the anterior aspect may be excessive.ConclusionThree-dimensional analysis indicated that rotational acetabular osteotomy achieved favorable bony coverage. Further investigations are necessary to determine the ideal bony coverage after rotational acetabular osteotomy.