Early Term Radiographic Follow-Up of the Trident Tritanium Acetabular Component
Keywords:Primary Total Hip Arthroplasty, Biologic Fixation, Titanium, Acetabulum, Ultra Porous Surface, Treatment Outcome, Follow-Up Study, Radiography, Retrospective Study
INTRODUCTION: The purpose of this study was to evaluate the two year clinical and radiographic outcomes of patients undergoing a primary total hip arthroplasty (THA) using the Trident Tritanium primary Cup.
METHODS: 197 patients who underwent a direct anterior THA using a Tritanium acetabular component between 2011 and 2015 were retrospectively reviewed by two surgeons from a single institution. The investigators, along with an independent physician, separately reviewed radiographs blinded to clinical data looking for radiolucent lines adjacent to the acetabular cup using the Charnley-DeLee zones. Clinical results were measured using acetabular revision surgery as an end point for failure. According to the American Academy of Orthopaedic Surgeons Levels of Evidence, this study was consistent with a Level III Therapeutic study.
RESULTS: 101 (48.73%) subjects did not exhibit any radiolucent lines around the acetabular component. 53 (26.90%) subjects displayed radiolucency in only one zone. 27 (13.71%) subjects displayed radiolucency in two zones, and 16 (8.12%) displayed radiolucency in all three zones. Radiolucency was most prevalent in zone 1 at 2 years with 83 (42.13%) subjects displaying radiolucency. There were five (2.54%) acetabular failures within two years of the index surgery. Of those 5 subjects, 3 displayed radiolucency in 1 zone, 2 displayed radiolucency in >1 zone, and 2 displayed radiolucencies >1 mm.
CONCLUSION: In our study, the Tritanium Cup demonstrated a 2.54% failure rate for aseptic loosening at 2 year follow-up. In addition, 48.73% of patients displayed a radiolucent line in at least one Charnley-DeLee zone. We also observed a progression of radiolucencies between the 6 month radiographs and the 2 year radiographs.
Naziri, Q., Issa, K., Pivec, R., Harwin, S., Delanois, R., & Mont, M. (2013). Excellent Results of Primary THA Using a Highly Porous Titanium Cup. Orthopedics, 36:e390-4.
Hosny, H., El-Bakoury, A., Srinivasan, S., Yarlagadda, R., & Keenan, J. (2018). Tritanium Acetabular Cup in Revision Hip Replacement: A Six to Ten Years of Follow-Up Study. J Arthroplasty, 33:2566-70.
Carli, A., Warth, L., de Mesy Bentley, K., & Nestor, B. (2017 Feb). Short to Midterm Follow-Up of the Tritanium Primary Acetabular Component: A Cause for Concern. Journal of Arthroplasty, 32(2): 463-469.
Kaminski, P., Szmyd, J., Ambrozy, J., Jurek, W., & Jaworski, J. (2016). Use of Trabecular Titanium Implants for Primary Hip Arthroplasty. Ortopedia Traumatologia Rehabilitacja, 18:461-70.
Sodhi, N., Izant, T., Diana, J., Del Gazio, D., Baratz, M., Levine, A., & et al. (2018). Three-Year Outcomes of a Highly Porous Acetabular Shell in Primary Total Hip Arthroplasty. Orthopedics, 41:e154-7.
Malahias, M.-A., Kostretzis, L., Greenberg, A., Nikolaou, V., Atrey, A., & Sculco, P. (2020). Highly Porous Titanium Acetabular Components in Primary and Revision Total Hip Arthroplasty: A Systemic Review. Journal of Arthroplasty, 35:1737-1749.
Perticarini, L., Zanon, G., Rossi, S., & Benazzo, F. (2015). Clinical and Readiographic Outcomes of a Trabecular Titanium Acetabular Component in Hip Arthroplasty: Results at Minimum 5 Years Follow-Up. BMC Muskuloskelet Disord, 16:1-6.
Yoshioka, S., Nakano, S., Kinoshita, Y., Nakamura, M., Goto, T., Hamada, D., & et al. (2018). Comparison of a Highly Porous Titanium Cup (Tritanium) and a Conventional Hydroxyapatite-Coated Porous Titanium Cup: A Retrospective Analysis of Clinical and Radiological Outcomes in Hip Arthroplasty Among Japanese Patients. J Orthopaedic Sci, 23:967-72.
Long, W., Nayyar, S., Chen, K., Novikov, D., Davidovitch, R., & Vigdorchik, J. (2018). Early Aseptic Loosening of the Tritanium Primary Acetabular Component with Screw Fixation. Arthroplasty Today, 4:169-174.
Massari, L., Bistolfi, A., Grillo, P., Borre, A., Gigliofiorito, G., Pari, C., & et al. (2017). Periacetabular Bone Densitometry After Total Hip Arthroplasty with Highly Porous Titanium Cups: A 2-Year Follow-Up Prospective Study. HIP Int, 27:551-7.
Bobyn, J. (4th Ed., 2011). Next Generation Porous Metals for Biologic Fixation. AAOS: Orthopaedic Knowledge Update Hip and Knee Reconstruction, 45.
Small, S., Berend, M., Howard, L., & et al. (2013). High Initial Stability in Porous Titanium Acetabular Cups: A Biomechanical Study. J Arthroplasty, 28:510.
Faizan, A. (2018). Clinical Evidence Behind Tritanium Shells. Stryker.
Muth, J., Poggie, M., Kulesha, G., & et al. (2013). Novel Highly Porous Metal Technology in Artificial Hip and Knee Replacement: Processing Methadologies and CLinical Applications. J Minor Met Mater Soc, 65(2):318.
DeLee, J., & Charnley, J. (1976). Radiological Demarcation of Cemented Sockets in Total Hip Replacement. Clin Orthop, 120:20.
National Joint Replacement Registry: Hip, Knee, and Shoulder Arthroplasty. (2017). Australian Orthopaedic Association, 88-90.
National Joint Registry of England, Wales, Northern Ireland and Isles of Man. (2017). 68-70.
Carli, A., Galmiche, R., Dobransky, J., & Beaule, P. (2020 Sep). Radiographic assessment of the dynasty biofoam acetabular component with a minimum 2 years follow-up. Hip International, doi: 10.1177/1120700020958694.
How to Cite
Copyright (c) 2021 David DeBoer, Jeffrey Hodrick, Matthew Christie
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright and License Agreement:
Authors who publish with the Reconstructive Review agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work. Reconstructive Review follows the Creative Commons Attribution-NonCommercial CC BY-NC. This license allows anyone to download works, build upon the material, and share them with others for non-commercial purposes as long as they credit the senior author, Reconstructive Review, and the Joint Implant Surgery & Research Foundation (JISRF). An example credit would be: "Courtesy of (senior author's name), Reconstructive Review, JISRF, Chagrin Falls, Ohio". While works can be downloaded and shared they cannot be used commercially.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.