Statins may help improve hip replacement outcomes

Washington, May 4 (ANI): Cholesterol-lowering drugs statins may play an important role in decreasing complications among patients undergoing total hip replacement (THR), according to a new study.

The study has been published in the May 2010 issue of The Journal of Bone and Joint Surgery (JBJS).

“We found that use of statins substantially reduced the risk of revision after hip replacement surgery, indicating that the biological effects of statins may play a role in the sustainability of hip implants,” said Theis Thillemann, MD, fellow in the department of orthopaedic surgery, Aarhus University Hospital, Denmark.

Using records from the Danish Hip Arthroplasty Registry, a national database of patients who had hip replacement, Dr. Thillemann and his colleagues evaluated the effect of statin use on the need for revision surgery and found that patients who were taking statins for cholesterol control postoperatively had a significantly lower risk of revision during the 10-year period following THR. In addition, the researchers noted the risk of revision decreased with longer use of the statins.

“In hip replacement surgery, nearly 80 percent of patients are older than 60 years,” he noted. “As a result, many of these patients have chronic medical diseases for which they are taking medicine. Although it’s recognized that many of these drugs affect bone metabolism, currently there is limited information on the implications of other medical treatments on implant survival after THR.”

“The survival of a hip implant is related to many different mechanisms,” Dr. Thillemann noted. “Statins have been associated with improved bone metabolism, improved anti-inflammatory effects and improved prognosis after infections,” added Dr. Thillemann. (ANI)

Mums with metal-on-metal implants pass metal ions to kids

Washington, March 10 (ANI): A new American research has found that women with metal-on-metal (MoM) implants pass metal ions to their offspring.

The study, presented at the 2010 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS), found elevated levels of cobalt and chromium in offspring of patients with metal-on-metal hip implants where both the socket and hip ball are metal.

Joshua J. Jacobs, Professor and Chairman of Orthopaedic Surgery at Rush University Medical Center in Chicago, said: “Although the affects of metal ions in maternal and fetal subjects are unknown, the fact that the placenta is not a complete barrier to the transport of these metals is noteworthy.

“As metal-on-metal implants increase in popularity and use, especially among young, active patients, women of child-bearing age and their doctors should be aware of these findings when considering their hip replacement implant options.”

For the study, scientists evaluated three patients who had either a unilateral (only on one hip) MoM primary total hip arthroplasty or unilateral MoM hip resurfacing joint replacement and no other metal implant in the body. The implant group”s metal ion levels were compared within the group, between mothers and their infants, and to those of a Control Group comprising seven women of child-bearing age (mean age of about 32 years) who did not have any metal implants and their infants.

For all subjects, maternal and umbilical cord blood was obtained at the time of delivery and tested for blood serum concentrations of titanium, nickel, cobalt and chromium using inductively coupled plasma mass spectrometry (ICP-MS), a highly sensitive technique that can detect trace amounts of metals in biological samples.

The data showed that mothers with MoM implants and their offspring had elevated Chromium and cobalt levels compared to the cohort without metal implants; a correlation existed between maternal and infant cobalt and chromium levels in the Implant Group, while the Control Group showed no correlation; offspring of women with MoM implants had about half the levels of cobalt in their bloodstream as their mothers and approximately 15 percent of their mother”s chromium levels, while there was no significant difference among ion levels between mothers and infants in the Control Group; there was no statistically significant differences in levels of titanium or nickel among any of the cohorts.

Dr. Jacobs said: “The next step is to find out what, if any affect metal ions have on fetal or infant development.” (ANI)

Laser-based processes may help create better artificial joints, arterial stents

Washington, September 16 (ANI): Scientists hope that laser-based processes may help create arterial stents and longer-lasting medical implants 10 times faster, and less expensively.

Yung Shin, a professor of Mechanical Engineering and director of Purdue’s Center for Laser-Based Manufacturing, stresses the need for new technologies to meet the huge global market for artificial hips and knees, insisting that the worldwide population of people younger than 40 who receive hip implants is expected to be 40 million annually by 2010, and double to 80 million by 2030.

Besides speeding production to meet the anticipated demand, Shin says that another goal is to create implants that last longer than the ones that are made presently.

“We have 200,000 total hip replacements in the United States. They last about 10 years on average. That means if you receive an implant at 40, you may need to have it replaced three or four times in your lifetime,” he said.

In one of their techniques, the researchers deposit layers of a powdered mixture of metal and ceramic materials, melting the powder with a laser and then immediately solidifying each layer to form parts.

Shin says that, given that the technique enables parts to be formed one layer at a time, it is ideal for coating titanium implants with ceramic materials that mimic the characteristics of natural bone.

“Titanium and other metals do not match either the stiffness or the nature of bones, so you have to coat it with something that does. However, if you deposit ceramic on metal, you don’t want there to be an abrupt change of materials because that causes differences in thermal expansion and chemical composition, which results in cracks. One way to correct this is to change the composition gradually so you don’t have a sharp boundary,” Shin said.

The gradual layering approach is called a “functionally gradient coating”.

The researchers have revealed that they used their laser deposition processes to create a porous titanium-based surface and a calcium phosphate outer surface, both designed to better match the stiffness of bone than conventional implants.

The laser deposition process enables researchers to make parts with complex shapes that are customized for the patient.

“Medical imaging scans could just be sent to the laboratory, where the laser deposition would create the part from the images. Instead of taking 30 days like it does now because you have to make a mold first, we could do it in three days. You reduce both the cost and production time,” Shin said.

According to the researchers, the laser deposition technique lends itself to the requirement that each implant be designed specifically for each patient.

“These are not like automotive parts. You can’t make a million that are all the same,” Shin said.

He says that the process creates a strong bond between the material being deposited and the underlying titanium, steel or chromium.

The researcher further reveals that tests have shown that the bond is at least seven times as strong as industry standards require.

Using computational modelling, the researchers simulate, study and optimise the processes.

The researchers, however, admit that more studies are required before the techniques are ready for commercialisation.

They have revealed that their future work will involve studying “shape-memory” materials that are similar to bone and also have a self-healing capability for longer-lasting implants.

They are also working on a technique that uses an “ultra short pulse laser” to create arterial stents, which are metal scaffolds inserted into arteries to keep them open after surgeries to treat clogs.

Since the laser pulses last only a matter of picoseconds, or quadrillionths of a second, they do not cause heat damage to the foil-thin stainless steel and titanium material used to make the stents.

The laser removes material in precise patterns in a process called “cold ablation”, which turns solids into a plasma. The patterns enable the stents to expand properly after being inserted into a blood vessel. (ANI)

Cementless hip implants last at least for 20 years

Washington, May 2 (ANI): Researchers at Rush University Medical Centre have revealed that cementless hip implants, previously believed to be exchanged after 10 years, are twice as durable as thought.

They have found that that the devices are extremely durable for 20 years after surgery.

Evidence showed that 96 percent of the 124 cementless metal components assessed remained securely fixed in place 20 years post surgery.

“Our results confirm earlier work done at Rush and at other institutions: that cementless acetabular components work very well and that long-term biological fixation can be obtained,” said Dr. Craig Della Valle, an orthopedic surgeon and principal author of the study.

In the present study, the researchers analyzed results for 124 hip replacements in the 111 patients who were still alive 20 years or more after surgery.

Since the previous report at 15 years, two metal cup implants, in addition to the three noted earlier, were found to be loose, or 4 percent of the 124 implants.

Of the original 204 hip replacements, five cases, or 2.5 percent of the total, had failed. Two of these five implants were revised, but three were left intact because the patients did not suffer significant symptoms.

However, in nearly 20 percent of the patients still living 20 years post surgery, the plastic lining of the metal shell had worn enough that repeat, but less involved, surgery was required or recommended. (ANI)