Bearing-spesific complications of total hip arthroplasty: characterization and treatment

Hip resurfacing arthroplasty (HRA) and large head metal-on-metal total arthroplasty (LDH MoM THA) gained popularity during the last decade. Adverse reaction to metal debris (ARMD) is a unique complication of metal bearings. ARMD is a complex reaction caused by metal debris from metal-on- metal bearing surfaces and from trunnion corrosion of modular junctions. We analyzed survivorship of 8059 LDH MoM THAs based on data of the Finnish Arthroplasty Register. We found relatively high short-term survivorship for some LDH MoM THAs, but there were remarkable differences between the devices studied. After some alarming reports of failing MoM THAs, we studied the first 80 patients who had received a ReCap-M2a-Magnum implant at our institution and evaluated the prevalence of ARMD. We found a high prevalence of pseudotumors, and, because of this, we discontinued the use of MoM bearings and followed up all patients with a MoM THA. Bone loss due infection, osteolysis or fracture poses a great challenge for reconstructive and fracture surgery. Onlay allografting for both revision and fracture surgery provides mechanical stability and increases bone stock. Bone loss and implant stability must be assessed preoperatively and adequately classified; this provides guidelines for the operative treatment of periprosthetic fractures and revision THA. In our studies on structural allografts union rates were high, although the rates of infections and dislocations were marked. In summary, early results of the use of LDH MoM devices were encouraging. However, the survival of the LDH MoMs varied. The prevalence of adverse reaction to metal debris was high after application of the ReCap-Magnum THA. New implants should be introduced carefully and under close surveillance by University clinics and arthroplasty registers.

Synthesis and characterization of nanoperforated metal oxide thin films

For advanced devices in the application fields of data storage, solar cell and biosensing, one of the major challenges to achieve high efficiency is the fabrication of nanopatterned metal oxide surfaces. Such surfaces often require both precise structure at the nanometer scale and controllable patterned structure at the macro scale. Nowadays, the dominating candidates to fabricate nanopatterned surfaces are the lithographic technique and block-copolymer masks, most of which are unfortunately costly and inefficient. An alternative bottom-up approach, which involves organic/inorganic self-assembly and dip-coating deposition, has been studied intensively in recent years and has proven to be an effective technique for the fabrication of nanoperforated metal oxide thin films. The overall objective of this work was to optimize the synthesis conditions of nanoperforated TiO2 (NP-TiO2) thin films, especially to be compatible with mixed metal oxide systems. Another goal was to develop fabrication and processing of NP-TiO2 thin films towards largescale production and seek new applications for solar cells and biosensing. Besides the traditional dip-coating and drop-casting methods, inkjet printing was used to prepare thin films of metal oxides, with the advantage of depositing the ink onto target areas, further enabling cost-effective fabrication of micro-patterned nanoperforated metal oxide thin films. The films were characterized by water contact angle determination, Atomic Force Microscopy, Scanning Electron Microscopy, X-ray Photoelectron Spectroscopy and Grazing Incidence XRay Diffraction. In this study, well-ordered zinc titanate nanoperforated thin films with different Zn/Ti ratios were produced successfully with zinc precursor content up to 50 mol%, and the dominating phase was Zn2Ti3O8. NP-TiO2 structures were also obtained by a cost-efficient means, namely inkjet printing, at both ambient temperature and 60 °C. To further explore new biosensing applications of nanoperforated oxide thin films, inkjet printing was used for the fabrication of both continuous and patterned polymeric films onto NP-TiO2 and perfluorinated phosphate functionalized NP-TiO2 substrates, respectively. The NP-TiO2 films can be also functionalized with a fluoroalkylsilane, resulting in hydrophobic surfaces on both titania and silica. The surface energy contrast in the nanoperforations can be tuned by irradiating the films with UV light, which provides ideal model systems for wettability studies.