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1.  Second-generation Highly Cross-linked X3™ Polyethylene Wear: A Preliminary Radiostereometric Analysis Study 
Background
First-generation highly cross-linked polyethylene liners have reduced the incidence of wear particle-induced osteolysis. However, failed acetabular liners have shown evidence of surface cracking, mechanical failure, and oxidative damage. This has led to the development of second-generation highly cross-linked polyethylene, which has improved wear and mechanical properties and resistance to oxidation in vitro. Owing to its recent introduction, there are no publications describing its clinical performance.
Questions/purposes
We assessed early clinical wear of a second-generation highly cross-linked polyethylene liner and compared its clinical performance with the published results of hip simulator tests and with first-generation highly cross-linked polyethylene annealed liners.
Patients and Methods
Twenty-one patients were enrolled in a prospective cohort study. Clinical outcome and femoral head penetration were measured for 19 patients at 6 months and 1 and 2 years postoperatively.
Results
The median proximal head penetration was 0.009 mm and 0.024 mm at 1 and 2 years, respectively. The median two-dimensional (2-D) head penetration was 0.083 mm and 0.060 mm at 1 and 2 years, respectively. The median proximal wear rate between 1 and 2 years was 0.015 mm/year.
Conclusions
The wear rate calculated was similar to the in vitro wear rate reported for this material; however, it was less than the detection threshold for this technique. Although longer followup is required for wear to reach a clinically quantifiable level, this low level of wear is encouraging for the future clinical performance of this material.
Level of Evidence
Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
doi:10.1007/s11999-010-1259-y
PMCID: PMC3049610  PMID: 20151231
2.  Case Report: Cementless Stem Stabilization after Intraoperative Fracture: A Radiostereometric Analysis 
We present the case of a patient with intraoperative femoral fracture during THA, which was repaired using cerclage fixation and insertion of an hydroxyapatite-coated cementless stem. The patient was evaluated postoperatively using radiostereometry during a 2-year course, and despite a large amount of subsidence and rotation, stabilization occurred and was maintained by 6 months. By evaluating the pattern of stem migration after intraoperative fracture, this case shows, even in the presence of instability, a successful clinical outcome can be achieved using an hydroxyapatite-coated cementless stem.
doi:10.1007/s11999-009-1082-5
PMCID: PMC2816748  PMID: 19760467
3.  Reintervention after Mobile-bearing Oxford Unicompartmental Knee Arthroplasty 
Background
Medial compartment osteoarthritis is a common disorder that often is treated by unicompartmental knee arthroplasty (UKA). Although the Oxford 3 prosthesis is commonly used based on revision rate and cumulative survival, our experience suggests that although there may be adequate implant survival rates, we observed a worrisome and undisclosed reintervention rate of nonrevision procedures.
Purpose
We describe the frequency and cause of repeat intervention subsequent to implanting this device.
Methods
Between 1998 and 2005, 398 patients underwent UKA using the Oxford 3 prosthesis. The minimum followup was 12 months (mean, 43 months; range, 12–102 months).
Results
Forty of the 398 (10%) patients had 55 (13.8%) repeat anesthetics (reintervention). There were 38 nonrevision reinterventions. Revision was performed in 15 patients (3.8%), but two patients had a second revision (17 revisions or 4.3%). We revised the UKA to a second UKA in seven of the 15 cases but two subsequently were rerevised to a TKA; eight were revised directly to a TKA.
Conclusions
Although our data confirm the reported revision rates for this prosthesis, we observed a substantial reintervention rate. Most of the reinterventions are minor and are diagnosed frequently and treated arthroscopically. If revision is required, a second UKA may be considered and performed successfully in patients with isolated loosening of one component.
Level of Evidence
Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
doi:10.1007/s11999-009-1089-y
PMCID: PMC2807008  PMID: 19768516

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