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Clinical, radiological, histological and retrieval findings of Activ-L and Mobidisc total disc replacements: a study of two patients

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Abstract

Introduction

This study evaluates the short-term clinical outcome, radiological, histological and device retrieval findings of two patients with second generation lumbar total disc replacement (TDR).

Materials and methods

The first patient had a single level L4-L5 Activ-L TDR, the second patient a L4-L5 Mobidisc and L5-S1 Activ-L TDR. The TDRs were implanted elsewhere and had implantation times between 1.3 and 2.8 years.

Results

Plain radiographs and CT-scanning showed slight subsidence of the Activ-L TDR in both patients and facet joint degeneration. The patients underwent revision surgery because of recurrent back and leg pain. After removal of the TDR and posterolateral fusion, the pain improved. Histological examination revealed large ultrahigh molecular weight polyethylene (UHMWPE) particles and giant cells in the retrieved tissue surrounding the Mobidisc. The particles in the tissue samples of the Activ-L TDR were smaller and contained in macrophages. Retrieval analysis of the UHMWPE cores revealed evidence of minor adhesive and abrasive wear with signs of impingement in both TDR designs.

Conclusion

Although wear was unrelated to the reason for revision, this study demonstrates the presence of UHMWPE particles and inflammatory cells in second generation TDR. Long-term follow-up after TDR is indicated for monitoring wear and implant status.

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References

  1. Yajun W, Yue Z, Xiuxin H, Cui C (2010) A meta-analysis of artificial total disc replacement versus fusion for lumbar degenerative disc disease. Eur Spine J 19:1250–1261

    Article  PubMed  Google Scholar 

  2. Bono CM, Garfin SR (2004) History and evolution of disc replacement. Spine J 4:145S–150S

    Article  PubMed  Google Scholar 

  3. Kurtz SM (2009) Ultra high molecular weight polyethylene in total joint replacement and medical devices. In: UHMWPE Biomaterials Handbook, 2nd edn. Academic Press, New York

  4. Harrop JS, Youssef JA, Maltenfort M, Vorwald P, Jabbour P, Bono CM, Goldfarb N, Vaccaro AR, Hilibrand AS (2008) Lumbar adjacent segment degeneration and disease after arthrodesis and total disc arthroplasty. Spine (Phila Pa 1976) 33:1701–1707

    Article  Google Scholar 

  5. Chung SK, Kim YE, Wang KC (2009) Biomechanical effect of constraint in lumbar total disc replacement: a study with finite element analysis. Spine (Phila Pa 1976) 34:1281–1286

    Article  Google Scholar 

  6. Huang RC, Girardi FP, Cammisa FP Jr, Wright TM (2003) The implications of constraint in lumbar total disc replacement. J Spinal Disord Tech 16:412–417

    Article  PubMed  Google Scholar 

  7. Steib J, Aubourg L, Beaurain J (2008) Mobidisc prosthesis. In: Yue JJ (ed) Motion preservation surgery of the spine. Saunders, Philadelphia, pp 326–329

    Chapter  Google Scholar 

  8. van den Eerenbeemt KD, Ostelo RW, van Royen BJ, Peul WC, van Tulder MW (2010) Total disc replacement surgery for symptomatic degenerative lumbar disc disease: a systematic review of the literature. Eur Spine J 19:1262–1280

    Article  PubMed  Google Scholar 

  9. Ha SK, Kim SH, Kim DH, Park JY, Lim DJ, Lee SK (2009) Biomechanical study of lumbar spinal arthroplasty with a semi-constrained artificial disc (activ L) in the human cadaveric spine. J Korean Neurosurg Soc 45:169–175

    Article  PubMed  Google Scholar 

  10. Zander T, Rohlmann A, Bergmann G (2009) Influence of different artificial disc kinematics on spine biomechanics. Clin Biomech (Bristol, Avon) 24:135–142

    Article  Google Scholar 

  11. Moumene M, Geisler FH (2007) Comparison of biomechanical function at ideal and varied surgical placement for two lumbar artificial disc implant designs: mobile-core versus fixed-core. Spine (Phila Pa 1976) 32:1840–1851

    Article  Google Scholar 

  12. Delécrin J, Allain J, Steib J, Beucrain J, Dufour T, Chataigner H, Gau M, Huppert J, Onimus M, Zeegers W (2008) Mobidisc lumbar arthroplasty: Multi-center study with 2 years follow-up. In: 9th Congress of the European Federation of National Associations of Orthopaedics and Traumatology Nice, France

  13. Yue JJ (2010) A prospective clinical comparison of 3 biomechanical types of lumbar total disc replacements: A semi-constrained device, a controlled translation device, and an unconstrained device, minimum 2 year follow-up. In: Annual Conference of the International Society for the Advancement of Spine Surgery. Perpignan, France

  14. Punt IM, Cleutjens JP, de Bruin T, Willems PC, Kurtz SM, van Rhijn LW, Schurink GW, van Ooij A (2009) Periprosthetic tissue reactions observed at revision of total intervertebral disc arthroplasty. Biomaterials 30:2079–2084

    Article  PubMed  CAS  Google Scholar 

  15. Kurtz SM, van Ooij A, Ross R, de Waal Malefijt J, Peloza J, Ciccarelli L, Villarraga ML (2007) Polyethylene wear and rim fracture in total disc arthroplasty. Spine J 7:12–21

    Article  PubMed  Google Scholar 

  16. Punt I, Baxter R, van Ooij A, Willems P, van Rhijn L, Kurtz S, Steinbeck M (2011) Submicron sized ultra-high molecular weight polyethylene wear particle analysis from revised SB Charite III total disc replacements. Acta Biomater 7:3404–3411

    Article  PubMed  CAS  Google Scholar 

  17. Punt IM, Austen S, Cleutjens JP, Kurtz SM, Ten Broeke RH, van Rhijn LW, Willems PC, Ooij AV (2011) Are periprosthetic tissue reactions observed after revision of total disc replacement comparable to the reactions observed after total hip or knee revision surgery? Spine (Phila Pa 1976) (in press)

  18. Gallo J, Raska M, Mrazek F, Petrek M (2008) Bone remodeling, particle disease and individual susceptibility to periprosthetic osteolysis. Physiol Res 57:339–349

    PubMed  CAS  Google Scholar 

  19. Dumbleton JH, Manley MT, Edidin AA (2002) A literature review of the association between wear rate and osteolysis in total hip arthroplasty. J Arthroplast 17:649–661

    Article  Google Scholar 

  20. Mirra JM, Amstutz HC, Matos M, Gold R (1976) The pathology of the joint tissues and its clinical relevance in prosthesis failure. Clin Orthop Relat Res 117:221–240

    PubMed  Google Scholar 

  21. de Maat GH, Punt IM, van Rhijn LW, Schurink GW, van Ooij A (2009) Removal of the Charite lumbar artificial disc prosthesis: surgical technique. J Spinal Disord Tech 22:334–339

    Article  PubMed  Google Scholar 

  22. Kurtz SM, MacDonald D, Ianuzzi A, van Ooij A, Isaza J, Ross ER, Regan J (2009) The natural history of polyethylene oxidation in total disc replacement. Spine (Phila Pa 1976) 34:2369–2377

    Article  Google Scholar 

  23. Costa L, Bracco P, Brach del Prever EM, Kurtz SM, Gallinaro P (2006) Oxidation and oxidation potential in contemporary packaging for polyethylene total joint replacement components. J Biomed Mater Res B Appl Biomater 78:20–26

    PubMed  Google Scholar 

  24. Kurtz SM (2008) Wear in highly crosslinked polyethylenes. Curr Orthop 22:392–399

    Article  Google Scholar 

  25. Minoda Y, Kobayashi A, Iwaki H, Miyaguchi M, Kadoya Y, Ohashi H, Takaoka K (2004) Characteristics of polyethylene wear particles isolated from synovial fluid after mobile-bearing and posterior-stabilized total knee arthroplasties. J Biomed Mater Res B Appl Biomater 71:1–6

    Article  PubMed  Google Scholar 

  26. Hirakawa K, Bauer TW, Stulberg BN, Wilde AH, Borden LS (1996) Characterization of debris adjacent to failed knee implants of 3 different designs. Clin Orthop Relat Res 331:151–158

    Article  PubMed  Google Scholar 

  27. Kurtz SM, Austin MS, Azzam K, Sharkey PF, MacDonald DW, Medel FJ, Hozack WJ (2010) Mechanical properties, oxidation, and clinical performance of retrieved highly cross-linked Crossfire liners after intermediate-term implantation. J Arthroplast 25(614–623):e611–e612

    Google Scholar 

  28. Currier BH, Currier JH, Mayor MB, Lyford KA, Collier JP, Van Citters DW (2007) Evaluation of oxidation and fatigue damage of retrieved crossfire polyethylene acetabular cups. J Bone Joint Surg Am 89:2023–2029

    Article  PubMed  Google Scholar 

  29. Nam D, Kepler CK, Nho SJ, Craig EV, Warren RF, Wright TM (2010) Observations on retrieved humeral polyethylene components from reverse total shoulder arthroplasty. J Shoulder Elb Surg 19:1003–1012

    Article  Google Scholar 

  30. Day JS, Macdonald DW, Olsen M, Getz C, Williams GR, Kurtz SM (2011) Polyethylene wear in retrieved reverse total shoulder components. J Shoulder Elbow Surg (in press)

  31. Scholz J, Woolf CJ (2007) The neuropathic pain triad: neurons, immune cells and glia. Nat Neurosci 10:1361–1368

    Article  PubMed  CAS  Google Scholar 

  32. Thacker MA, Clark AK, Marchand F, McMahon SB (2007) Pathophysiology of peripheral neuropathic pain: immune cells and molecules. Anesth Analg 105:838–847

    Article  PubMed  Google Scholar 

  33. Siepe CJ, Zelenkov P, Sauri-Barraza JC, Szeimies U, Grubinger T, Tepass A, Stabler A, Mayer MH (2010) The fate of facet joint and adjacent level disc degeneration following total lumbar disc replacement: a prospective clinical, X-ray, and magnetic resonance imaging investigation. Spine (Phila Pa 1976) 35:1991–2003

    Article  Google Scholar 

  34. Schmidt H, Midderhoff S, Adkins K, Wilke HJ (2009) The effect of different design concepts in lumbar total disc arthroplasty on the range of motion, facet joint forces and instantaneous center of rotation of a L4–5 segment. Eur Spine J 18:1695–1705

    Article  PubMed  Google Scholar 

  35. Siepe CJ, Korge A, Grochulla F, Mehren C, Mayer HM (2008) Analysis of post-operative pain patterns following total lumbar disc replacement: results from fluoroscopically guided spine infiltrations. Eur Spine J 17:44–56

    Article  PubMed  Google Scholar 

  36. Cunningham BW, Gordon JD, Dmitriev AE, Hu N, McAfee PC (2003) Biomechanical evaluation of total disc replacement arthroplasty: an in vitro human cadaveric model. Spine (Phila Pa 1976) 28:S110–S117

    Article  Google Scholar 

  37. Ahn DK, Park HS, Choi DJ, Kim KS, Yang SJ (2010) Survival and prognostic analysis of adjacent segments after spinal fusion. Clin Orthop Surg 2:140–147

    Article  PubMed  Google Scholar 

  38. Lee CS, Hwang CJ, Lee SW, Ahn YJ, Kim YT, Lee DH, Lee MY (2009) Risk factors for adjacent segment disease after lumbar fusion. Eur Spine J 18:1637–1643

    Article  PubMed  Google Scholar 

  39. Ching AC, Birkenmaier C, Hart RA (2010) Short segment coronal plane deformity after two-level lumbar total disc replacement. Spine (Phila Pa 1976) 35:44–50

    Article  Google Scholar 

  40. Siepe CJ, Mayer HM, Heinz-Leisenheimer M, Korge A (2007) Total lumbar disc replacement: different results for different levels. Spine (Phila Pa 1976) 32:782–790

    Article  Google Scholar 

  41. Huppert J, Beaurain J, Steib JP, Bernard P, Dufour T, Hovorka I, Stecken J, Dam-Hieu P, Fuentes JM, Vital JM, Vila T, Aubourg L (2011) Comparison between single- and multi-level patients: clinical and radiological outcomes 2 years after cervical disc replacement. Eur Spine J 20:1417–1426

    Article  PubMed  CAS  Google Scholar 

  42. Gstoettner M, Heider D, Liebensteiner M, Bach CM (2008) Footprint mismatch in lumbar total disc arthroplasty. Eur Spine J 17:1470–1475

    Article  PubMed  Google Scholar 

  43. Spivak JM, Petrizzo AM (2010) Revision of a lumbar disc arthroplasty following late infection. Eur Spine J 19:677–681

    Article  PubMed  Google Scholar 

  44. Tropiano P (2010) Expert’s comment concerning Grand Rounds case entitled “Revision of a lumbar disc arthroplasty following late infection” (by Jeffrey M. Spivak and Anthony M. Petrizzo). Eur Spine J 19:682–684

    Article  PubMed  Google Scholar 

  45. Patel AA, Brodke DS, Pimenta L, Bono CM, Hilibrand AS, Harrop JS, Riew KD, Youssef JA, Vaccaro AR (2008) Revision strategies in lumbar total disc arthroplasty. Spine (Phila Pa 1976) 33:1276–1283

    Article  Google Scholar 

  46. Punt IM, Visser VM, van Rhijn LW, Kurtz SM, Antonis J, Schurink GW, van Ooij A (2008) Complications and reoperations of the SB Charite lumbar disc prosthesis: experience in 75 patients. Eur Spine J 17:36–43

    Article  PubMed  Google Scholar 

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Acknowledgments

Institutional support for two of the authors (SMK and DWM) has been received from Medtronic, LDR Spine, National Institutes of Health (NIH) R01 AR56264 and the Food and Drug Administration (FDA) Critical Path initiative (HHSF223200930112G).

Conflict of interest

None of the authors has any potential conflict of interest.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands

    Shennah Austen, Ilona M. Punt, Paul C. Willems & Lodewijk W. van Rhijn

  2. Research School CAPHRI, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands

    Shennah Austen, Ilona M. Punt, Paul C. Willems & Lodewijk W. van Rhijn

  3. Department of Pathology, Research School CARIM, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands

    Jack P. M. Cleutjens

  4. Drexel University and Exponent Inc., 3401 Market Street, Suite 300, Philadelphia, PA, 19104, USA

    Steven M. Kurtz & Daniel W. MacDonald

  5. Department of Orthopaedic Surgery, Viecuri Medical Center, P.O. Box 1926, 5900 BX, Venlo, The Netherlands

    André van Ooij

Authors
  1. Shennah Austen
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  2. Ilona M. Punt
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  5. Steven M. Kurtz
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Correspondence to Ilona M. Punt.

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Austen, S., Punt, I.M., Cleutjens, J.P.M. et al. Clinical, radiological, histological and retrieval findings of Activ-L and Mobidisc total disc replacements: a study of two patients. Eur Spine J 21 (Suppl 4), 513–520 (2012). https://doi.org/10.1007/s00586-011-2141-7

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  • DOI: https://doi.org/10.1007/s00586-011-2141-7

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