“It would be a pity if the design failures of others would jeopardize the idea of large headed metal-on-metal

hip arthroplasty, and we would have to go back to the known disadvantages of metal-on-polyethylene bearings“

L ARGE H EA D META L- ON- ME TAL ARTICULATIO N
ADVANTAGES | WORRIES | SOLUTIONS

The Solutions
Advanc ed Cerami c Coat e d Implant System
Ceramic Surface Engineering Better initial cup stability Reduced Wear
The ACCIS® system consists of CrCoMO components whose surfaces have been engineered with the ceramic Titanium-Niobium-Nitride (TiNbN) by physical vapor deposition (PVD) in order to minimize metal particulate wear and to prevent corrosion, thus preventing metal ion release.

Literature
(1) Crowningshield R: “Biomechanics of Large Femoral Heads” CORR 1994 Vol 429 pp 102-107 (2) Beaulé, Schmalzried, Amstutz : ” Jumbo Femoral Head for the Treatment of Recurrent Dislocations” JBJS 2002 Vol 84A pp 256-264 (3) Thomas Smith Metal on Metal Total Hip Arthroplasty with Large Heads may Prevent Early Dislocation CORR 2005 Vol 441 pp 137-143.pdf (4) Saffatato Toni:”Large Diameter Bearings Reduce Wear in M-on-M Hip Implants” CORR 2006 vol 456 pp 153158.pdf (5) Australian Orthopaedic Register Yearbook 2008. Available at www.dmac. adelaide.edu.au/aoanjrr (6) Visuri -- Reduced Cancer Risk in Patients who Received a THA or TKA Acta Orrth 2003 Vol 74 No 3 pp 351-360 (7) De Smet K: ”Metal Ion Measurement as a Diagnostic Tool in Problems in M-on-M Resurfacing” JBJS 2009 Vol. 90S pp 202-208. (8) Pandit - Pseudotumours associated with M-on-M Resurfacing JBJS 2008 Vol 90B pp 847 (9) Hamelynck K.J. : ” Ceramic Engineered M-o-M Hip System for THA and RHA. White paper November 2009. rat sed (10) Patil S, Woodnutt D, :”” MISHRMetal Ion Study in Hip Resurfacing “. Presented at the EFORT Meeting in Vienna 2009 (11) [ 21 ] Witzleb -Günther:” Exposure to Cr Co and Mo from M-on-M THR and HRA - Act Orth 2006 Vol 77 No 5 pp 697-705

Higher Joint Stability
(a)

Advantages

Large diameter components provide enhanced stability.(1) The larger jump distance (fig a) reduces the chance of dislocation. This the reason why large femoral heads are also used to treat recurrent dislocation. (2)

Early Component Failures

Worries

Better Range of Motion Less wear

Hip prostheses with large femoral heads provide the hip with a better range of motion (fig b) without the risk of dislocation.(3) (b) Large diameter metal-on-metal components has proven reduced wear characteristics.(4)

The Australian Hip Register has annualy, since 2006, reported higher-thanexpected revision rates in some of the metal-on-metal total hips and resurfacing hips. The reported early failure may be attributed to lack of primary fixation (5)

Press fit fixation by equatorial over-sizing in cups with a three radial design (fig d) is enhanced by compression forces only. It provides better and more reliable primary fixation than a pure spherical configuration as seen in many current designs . Pre-clincial testing has shown a dramatic reduction in wear of the ACCIS® articulations over non-ceramic engineered articulations. Retrievals 6-10 years postoperatively confirm the patency of the applied technique. Pathological examination of the biopsies of the synovium, taken during the revision demonstrated the complete absence of any adverse reactions: no signs of hyper-sensitivity and no signs of inflammation. (9)

metal ion release

Resurfacing Possible
(c)

Although the literature may not be conclusive,(6) the mere presence of un-physiologically high serum levels of cobalt and chromium in the blood of patients after metal-onmetal hip arthroplasty remains a matter of concern. Extreme levels of more than 50 µg/L of Cobalt or Chromium have been reported, mainly in smaller size implants and in less than optimal angles of abduction. (7)

Reduced Metal Ion Release

As polyethylene requires a minimal thickness, it is not suited for the manufacturing of thin shells. Metal-onMetal articulation is, till now, the only bearing surface that allows for hip resurfacing.

local reactions: ALVAL

A clinical multi-centre follow-up study was done on 200 ACCIS®Resurfacing implants, Blood samples of 60 randomly selected patients were analysed before, immediately after surgery and at intervals of 3, 6, 12 and 24 months post-op . None of the patients at any point has shown any increase of cobalt and chrome ions in the blood and none of the blood ion levels has been over the normal values. (9) Diagrams comparing the clincial ion measurements after surfaced engineered resurfacing hips with non-coated implants are shown on page 4 .

Originally named “pseudo-tumors” now known under the acronym, ALVAL, are tumor-like proliferations of soft tissues around the hip, It is believed to be a dose related, local reaction on the metal wear debris. It is especially seen in smaller size implants and in acetabular components placed in a steep position. (8)

not even in steep positions or smaller sizes

Analysis of a group of patients within the study, with less than optimal conditions (abduction < 400 or > 500 , anteverted placements and small sizes, suggests that the ACCIS® principle protects also against the worst conditions: no increase in metal ions and no occurence of ALVAL were reported. (10)

(d)

“ Novel techniques for surface treatment and deposition can be used to modify the surface of the implant to protect the implant from degradation and corrosion, to improve the surface structure or chemistry.... or to increase wear resistance and to control friction at the interfaces .” . Reijo Lappalainen, PhD and Seppo S. Santavirta MD, PhD: CORR 2005 No 430, pp. 72–79

Cemented Large Head Total Hip arthroplasty

Cementless Large Head Total Hip Arthtoplasty

Hybrid Resurfacing Arthroplasty

metal ion study

A clinical multi-centre follow-up study on 200 ACCIS® Resurfacing implants (Morriston Hospital, Swansea, UK: David J Woodnutt, MD, FRCS, FRCS (Orth); Neville Hall Hospital, Abergevanny, UK: Robin Rice, MD,BMBS,FRCS; Arthro Clinic Hamburg: Genio Bongaerts, MD) is performed. Blood samples of 60 patients are analysed before, immediately after surgery and at intervals of 3, 6, 12 and 24 monts after surgery. The data were compared to those published by Witzleb (11). Metal ion analysis in both studies were performed under the same parameters in the same laboratory.

ACCI S ®

ACCIS® is a concept of Accis BV and implantcast GmbH and is protected by international patents. Further information at: • http://www.accis.nl • http://www.implantcast.de • http://www.crystalclearmedicalsolutions.com • Request for reprints can be addressed to: Accis BV • Eemnesserweg 92B • 3741 GC Baarn • Netherlands or at info@accis.nl

m a n u fac t u r e d a n d d i st r i b u t e d by u k e d u c at i o n a n d s e l l i n g ag e n t
Crystal Clear Medical Solutions Ltd 4 The Courtyard Butts Farm Cricklade Street Poulton Gloucestershire GL7 5HY Tel: 00 44 1285 850 860 Fax: 00 44 1285 850 530 implantcast GmbH Lüneburger Schanze 26 D-21614 Buxtehude Germany Phone:+ 49-4161 744 100 E-mail: info@implantcast.de www.implantcast.de