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Which Design and Biomaterial Factors Affect Clinical Wear Performance of Total Disc Replacements? A Systematic Review

  • Symposium: ABJS Carl T. Brighton Workshop on Implant Wear and Tribocorrosion of Total Joint Replacements
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Total disc replacement was clinically introduced to reduce pain and preserve segmental motion of the lumbar and cervical spine. Previous case studies have reported on the wear and adverse local tissue reactions around artificial prostheses, but it is unclear how design and biomaterials affect clinical outcomes.

Questions/purposes

Which design and material factors are associated with differences in clinical wear performance (implant wear and periprosthetic tissue response) of (1) lumbar and (2) cervical total disc replacements?

Methods

We performed a systematic review on the topics of implant wear and periprosthetic tissue response using an advanced search in MEDLINE and Scopus electronic databases. Of the 340 references identified, 33 were retrieved for full-text evaluation, from which 16 papers met the inclusion criteria (12 on lumbar disc replacement and five on cervical disc replacement; one of the included studies reported on both lumbar and cervical disc replacement), which involved semiquantitative analysis of wear and adverse local tissue reactions along with a description of the device used. An additional three papers were located by searching bibliographies of key articles. There were seven case reports, three case series, two case-control studies, and seven analytical studies. The Methodological Index for Non-randomized Studies (MINORS) Scale was used to score case series and case-control studies, which yielded mean scores of 10.3 of 16 and 17.5 of 24, respectively. In general, the case series (three) and case-control (two) studies were of good quality.

Results

In lumbar regions, metal-on-polymer devices with mobile-bearing designs consistently generated small and large polymeric wear debris, triggering periprosthetic tissue activation of macrophages and giant cells, respectively. In the cervical regions, metal-on-polymer devices with fixed-bearing designs had similar outcomes. All metal-on-metal constructs tended to generate small metallic wear debris, which typically triggered an adaptive immune response of predominantly activated lymphocytes. There were no retrieval studies on one-piece prostheses.

Conclusions

This review provides evidence that design and biomaterials affect the type of wear and inflammation. However, clinical study design, followup, and analytical techniques differ among investigations, preventing us from drawing firm conclusions about the relationship between implant design and wear performance for both cervical and lumbar total disc replacement.

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Author information

Authors and Affiliations

  1. Implant Research Center, Drexel University, 3401 Market Street, Suite 345, Philadelphia, PA, 19104, USA

    Sai Y. Veruva BS, Marla J. Steinbeck MT(ASCP), PhD & Steven M. Kurtz PhD

  2. Department of Orthopaedic Surgery, The Medical College of Wisconsin, Milwaukee, WI, USA

    Jeffrey Toth PhD

  3. Exponent, Inc, Boulder, CO, USA

    Dominik D. Alexander PhD, MSPH

  4. Exponent, Inc, Philadelphia, PA, USA

    Steven M. Kurtz PhD

Authors
  1. Sai Y. Veruva BS
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  2. Marla J. Steinbeck MT(ASCP), PhD
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  3. Jeffrey Toth PhD
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  4. Dominik D. Alexander PhD, MSPH
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  5. Steven M. Kurtz PhD
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Corresponding author

Correspondence to Steven M. Kurtz PhD.

Additional information

Funding received (MJS, SMK) from the National Institutes of Health (NIAMS) R01 AR56264.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research ® editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research ® neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA-approval status, of any drug or device prior to clinical use.

This work was performed at the Implant Research Center, Philadelphia, PA, USA.

Appendix 1. Search Syntax for Scopus Electronic Database

Appendix 1. Search Syntax for Scopus Electronic Database

(((((TITLE-ABS-KEY(corrosion) OR TITLE-ABS-KEY(wear) OR TITLE-ABS-KEY(deform*) OR TITLE-ABS-KEY(degra*) OR TITLE-ABS-KEY(fracture))) OR (((TITLE-ABS-KEY(adverse) AND TITLE-ABS-KEY(effects))))) AND ((((((TITLE-ABS-KEY(spine) OR TITLE-ABS-KEY(spinal) OR TITLE-ABS-KEY(disc) OR TITLE-ABS-KEY(disk))) AND ((((((TITLE-ABS-KEY(artificial) AND TITLE-ABS-KEY(prosthe*))) OR (((TITLE-ABS-KEY(disc) AND TITLE-ABS-KEY(arthroplast*) OR (TITLE-ABS-KEY(disc) AND TITLE-ABS-KEY(implant)) OR (TITLE-ABS-KEY(disc) AND TITLE-ABS-KEY(replace*)) OR (TITLE-ABS-KEY(disc) AND TITLE-ABS-KEY(prosthe*))))) OR TITLE-ABS-KEY(fusion)) OR (TITLE-ABS-KEY(stabilization))))) AND ((TITLE-ABS-KEY(peek) OR TITLE-ABS-KEY(polyethylene) OR TITLE-ABS-KEY(polycarbonate urethane) OR TITLE-ABS-KEY(cobalt chromium) OR TITLE-ABS-KEY(prodisc) OR TITLE-ABS-KEY(freedom) OR TITLE-ABS-KEY(charite) OR TITLE-ABS-KEY(maverick) OR TITLE-ABS-KEY(kineflex) OR TITLE-ABS-KEY(activ) OR TITLE-ABS-KEY(mobidisc) OR TITLE-ABS-KEY(flexicore) OR TITLE-ABS-KEY(xl) OR TITLE-ABS-KEY(bryan) OR TITLE-ABS-KEY(prestige) OR TITLE-ABS-KEY(cadisc) OR TITLE-ABS-KEY(nubac) OR TITLE-ABS-KEY(secure) OR TITLE-ABS-KEY(discover) OR TITLE-ABS-KEY(nunec) OR TITLE-ABS-KEY(pcm) OR TITLE-ABS-KEY(dynesys)))))))) AND NOT (TITLE-ABS-KEY(finite element) OR TITLE-ABS-KEY(biomechanical analysis) OR TITLE-ABS-KEY(biomech*) OR TITLE-ABS-KEY(model) OR TITLE-ABS-KEY(mri) OR TITLE-ABS-KEY(clinical outcome*) OR TITLE-ABS-KEY(ossification))) AND (PUBYEAR > 1999 AND PUBYEAR < 2015) AND (LIMIT-TO(LANGUAGE,“English”))

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Veruva, S.Y., Steinbeck, M.J., Toth, J. et al. Which Design and Biomaterial Factors Affect Clinical Wear Performance of Total Disc Replacements? A Systematic Review. Clin Orthop Relat Res 472, 3759–3769 (2014). https://doi.org/10.1007/s11999-014-3751-2

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  • DOI: https://doi.org/10.1007/s11999-014-3751-2

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