Liner type has no impact on bone mineral density changes around a 3D printed trabecular titanium acetabular component.

BACKGROUND: Three-dimensional printing of implants allows the ability to produce implants and interfaces which theoretically better mimic "normal" bone behaviour, leading to a possible reduction in stress shielding thus maintaining bone mineral density (BMD). This issue was not investigated in vivo using bone scan and different bearings; therefore, we did a prospective study aiming to answer: 1) is there a loss of BMD around the 3D printed trabecular titanium cup, when compared to the native hip?; 2) does liner type influence the BMD changes around the acetabulum when a 3D printed trabecular titanium cup is used? HYPOTHESIS: BMD changes around the acetabulum are not influenced by the liner type, and the cup will be associated with a reduction in BMD when compared to the native hip. MATERIAL AND METHODS: This is a prospective observational study of patients receiving a primary total hip arthroplasty. A 3D printed trabecular titanium uncemented acetabular component was used in all cases. All patients received a ceramic femoral head, with either a ceramic or polyethylene acetabular liner. BMD measurements using DXA were performed at 6 weeks, 6, 12 and 24 months after surgery to evaluate remodeling changes. The 3 acetabular regions of interest (ROI) of DeLee and Charnley were used for serial comparisons of peri-acetabular BMD. The study was powered as a non-inferiority study with the principle variables compared using a two-step repeated analysis of variance. RESULTS: A total of 48 consecutive patients were included in the study, with all patients completing their 2 year follow-up. There were no failures, revisions or complications within this cohort. We found no statistically significant difference in the BMD change scores between the operated and the native hip in any of the 3 ROI zones. We found no differences in BMD scores when comparing ceramic to polyethylene acetabular liners, head sizes and BMI. DISCUSSION: This study shows a similar pattern of BMD behaviour around a 3D printed cup when compared to the contralateral native hip. We were unable to show a clinical or radiological difference between the bearing material, head size, or BMI when used with this type of acetabular component. LEVEL OF EVIDENCE: III; prospective comparative study.

Fat Embolism Syndrome: The Ambiguity of Diagnosis in the Postarthroplasty Patient: A Case Report.

CASE: We present the case of an otherwise healthy, 74-year-old woman, who underwent bilateral hip arthroplasty and subsequently presented with decreased level of consciousness, mimicking a severe postoperative delirium. After several days and investigations, the diagnosis of fat embolism syndrome (FES) was reached, and appropriate management was given. CONCLUSION: Orthopedic surgeons and their teams should consider FES as a differential diagnosis of prolonged post-operative delirium. With supportive management these patients can make a full recovery without lasting neurological symptoms. Our patient has shown no subsequent sequelae after 10-month follow-up.