Skip to main content
Top
Published in: Clinical Orthopaedics and Related Research® 12/2014

01-12-2014 | Symposium: ABJS Carl T. Brighton Workshop on Implant Wear and Tribocorrosion of Total Joint Replacements

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

Authors: Sai Y. Veruva, BS, Marla J. Steinbeck, MT(ASCP), PhD, Jeffrey Toth, PhD, Dominik D. Alexander, PhD, MSPH, Steven M. Kurtz, PhD

Published in: Clinical Orthopaedics and Related Research® | Issue 12/2014

Login to get access

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.
Appendix
Available only for authorised users
Literature
1.
go back to reference Anderson PA, Rouleau JP, Toth JM, Riew KD. A comparison of simulator-tested and -retrieved cervical disc prostheses. Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004. J Neurosurg Spine. 2004;1:202–210.PubMedCrossRef Anderson PA, Rouleau JP, Toth JM, Riew KD. A comparison of simulator-tested and -retrieved cervical disc prostheses. Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004. J Neurosurg Spine. 2004;1:202–210.PubMedCrossRef
2.
go back to reference Austen S, Punt IM, Cleutjens JP, Willems PC, Kurtz SM, MacDonald DW, van Rhijn LW, van Ooij A. Clinical, radiological, histological and retrieval findings of Activ-L and Mobidisc total disc replacements: a study of two patients. Eur Spine J. 2012;21(Suppl 4):S513–520.PubMedCrossRef Austen S, Punt IM, Cleutjens JP, Willems PC, Kurtz SM, MacDonald DW, van Rhijn LW, van Ooij A. Clinical, radiological, histological and retrieval findings of Activ-L and Mobidisc total disc replacements: a study of two patients. Eur Spine J. 2012;21(Suppl 4):S513–520.PubMedCrossRef
3.
go back to reference Baxter RM, Macdonald DW, Kurtz SM, Steinbeck MJ. Severe impingement of lumbar disc replacements increases the functional biological activity of polyethylene wear debris. J Bone Joint Surg Am. 2013;95:e751–759.PubMedCrossRef Baxter RM, Macdonald DW, Kurtz SM, Steinbeck MJ. Severe impingement of lumbar disc replacements increases the functional biological activity of polyethylene wear debris. J Bone Joint Surg Am. 2013;95:e751–759.PubMedCrossRef
4.
go back to reference Cavanaugh DA, Nunley PD, Kerr E Jr, Werner DJ, Jawahar A. Delayed hyper-reactivity to metal ions after cervical disc arthroplasty: a case report and literature review. Spine (Phila Pa 1976). 2009;34:E262–265. Cavanaugh DA, Nunley PD, Kerr E Jr, Werner DJ, Jawahar A. Delayed hyper-reactivity to metal ions after cervical disc arthroplasty: a case report and literature review. Spine (Phila Pa 1976). 2009;34:E262–265.
5.
go back to reference Choma TJ, Miranda J, Siskey R, Baxter R, Steinbeck MJ, Kurtz SM. Retrieval analysis of a ProDisc-L total disc replacement. J Spinal Disord. 2009;22:290–296.CrossRef Choma TJ, Miranda J, Siskey R, Baxter R, Steinbeck MJ, Kurtz SM. Retrieval analysis of a ProDisc-L total disc replacement. J Spinal Disord. 2009;22:290–296.CrossRef
6.
go back to reference Chung SK, Kim YE, Wang KC. Biomechanical effect of constraint in lumbar total disc replacement: a study with finite element analysis. Spine (Phila Pa 1976). 2009;34:1281–1286. Chung SK, Kim YE, Wang KC. Biomechanical effect of constraint in lumbar total disc replacement: a study with finite element analysis. Spine (Phila Pa 1976). 2009;34:1281–1286.
8.
go back to reference Cunningham BW, Dmitriev AE, Hu N, McAfee PC. General principles of total disc replacement arthroplasty: seventeen cases in a nonhuman primate model. Spine (Phila Pa 1976). 2003;28:S118–124. Cunningham BW, Dmitriev AE, Hu N, McAfee PC. General principles of total disc replacement arthroplasty: seventeen cases in a nonhuman primate model. Spine (Phila Pa 1976). 2003;28:S118–124.
9.
go back to reference David T. Revision of a Charite artificial disc 9.5 years in vivo to a new Charite artificial disc: case report and explant analysis. Eur Spine J. 2005;14:507–511.PubMedCentralPubMedCrossRef David T. Revision of a Charite artificial disc 9.5 years in vivo to a new Charite artificial disc: case report and explant analysis. Eur Spine J. 2005;14:507–511.PubMedCentralPubMedCrossRef
10.
go back to reference Devin CJ, Myers TG, Kang JD. Chronic failure of a lumbar total disc replacement with osteolysis. Report of a case with nineteen-year follow-up. J Bone Joint Surg Am. 2008;90:2230–2234.PubMedCrossRef Devin CJ, Myers TG, Kang JD. Chronic failure of a lumbar total disc replacement with osteolysis. Report of a case with nineteen-year follow-up. J Bone Joint Surg Am. 2008;90:2230–2234.PubMedCrossRef
11.
go back to reference Fan H, Wu S, Wu Z, Wang Z, Guo Z. Implant failure of Bryan cervical disc due to broken polyurethane sheath: a case report. Spine (Phila Pa 1976). 2012;37:E814–816. Fan H, Wu S, Wu Z, Wang Z, Guo Z. Implant failure of Bryan cervical disc due to broken polyurethane sheath: a case report. Spine (Phila Pa 1976). 2012;37:E814–816.
12.
go back to reference Francois J, Coessens R, Lauweryns P. Early removal of a Maverick disc prosthesis: surgical findings and morphological changes. Acta Orthop Belg. 2007;73:122–127.PubMed Francois J, Coessens R, Lauweryns P. Early removal of a Maverick disc prosthesis: surgical findings and morphological changes. Acta Orthop Belg. 2007;73:122–127.PubMed
13.
go back to reference Gallo J, Raska M, Mrazek F, Petrek M. Bone remodeling, particle disease and individual susceptibility to periprosthetic osteolysis. Physiol Res. 2008;57:339–349.PubMed Gallo J, Raska M, Mrazek F, Petrek M. Bone remodeling, particle disease and individual susceptibility to periprosthetic osteolysis. Physiol Res. 2008;57:339–349.PubMed
14.
go back to reference Golish SR, Anderson PA. Bearing surfaces for total disc arthroplasty: metal-on-metal versus metal-on-polyethylene and other biomaterials. Spine J. 2012;12:693–701.PubMedCrossRef Golish SR, Anderson PA. Bearing surfaces for total disc arthroplasty: metal-on-metal versus metal-on-polyethylene and other biomaterials. Spine J. 2012;12:693–701.PubMedCrossRef
15.
go back to reference Gornet MF, Burkus JK, Dryer RF, Peloza JH. Lumbar disc arthroplasty with Maverick disc versus stand-alone interbody fusion: a prospective, randomized, controlled, multicenter investigational device exemption trial. Spine (Phila Pa 1976). 2011;36:E1600–1611. Gornet MF, Burkus JK, Dryer RF, Peloza JH. Lumbar disc arthroplasty with Maverick disc versus stand-alone interbody fusion: a prospective, randomized, controlled, multicenter investigational device exemption trial. Spine (Phila Pa 1976). 2011;36:E1600–1611.
16.
go back to reference Gornet MF, Burkus JK, Harper ML, Chan FW, Skipor AK, Jacobs JJ. Prospective study on serum metal levels in patients with metal-on-metal lumbar disc arthroplasty. Eur Spine J. 2013;22:741–746.PubMedCentralPubMedCrossRef Gornet MF, Burkus JK, Harper ML, Chan FW, Skipor AK, Jacobs JJ. Prospective study on serum metal levels in patients with metal-on-metal lumbar disc arthroplasty. Eur Spine J. 2013;22:741–746.PubMedCentralPubMedCrossRef
17.
go back to reference Guyer RD, Shellock J, MacLennan B, Hanscom D, Knight RQ, McCombe P, Jacobs JJ, Urban RM, Bradford DS, Ohnmeiss DD. Early failure of metal-on-metal artificial disc prostheses associated with lymphocytic reaction: diagnosis and treatment experience in four cases. Spine (Phila Pa 1976). 2011;36:E492–497. Guyer RD, Shellock J, MacLennan B, Hanscom D, Knight RQ, McCombe P, Jacobs JJ, Urban RM, Bradford DS, Ohnmeiss DD. Early failure of metal-on-metal artificial disc prostheses associated with lymphocytic reaction: diagnosis and treatment experience in four cases. Spine (Phila Pa 1976). 2011;36:E492–497.
18.
go back to reference Heuer F, Schmidt H, Klezl Z, Claes L, Wilke HJ. Stepwise reduction of functional spinal structures increase range of motion and change lordosis angle. J Biomech. 2007;40:271–280.PubMedCrossRef Heuer F, Schmidt H, Klezl Z, Claes L, Wilke HJ. Stepwise reduction of functional spinal structures increase range of motion and change lordosis angle. J Biomech. 2007;40:271–280.PubMedCrossRef
19.
20.
21.
go back to reference Kurtz SM, Steinbeck M, Ianuzzi A, Van Ooij A, Punt IM, Isaza J, Ross ERS. Retrieval analysis of motion preserving spinal devices and periprosthetic tissues. SAS. 2009;3:161–177.CrossRef Kurtz SM, Steinbeck M, Ianuzzi A, Van Ooij A, Punt IM, Isaza J, Ross ERS. Retrieval analysis of motion preserving spinal devices and periprosthetic tissues. SAS. 2009;3:161–177.CrossRef
22.
go back to reference Kurtz SM. The UHMWPE Biomaterials Handbook. Burlington, MA, USA: Academic Press; 2009. Kurtz SM. The UHMWPE Biomaterials Handbook. Burlington, MA, USA: Academic Press; 2009.
23.
go back to reference Kurtz SM, MacDonald D, Ianuzzi A, van Ooij A, Isaza J, Ross ER, Regan J. The natural history of polyethylene oxidation in total disc replacement. Spine (Phila Pa 1976). 2009;34:2369–2377. Kurtz SM, MacDonald D, Ianuzzi A, van Ooij A, Isaza J, Ross ER, Regan J. The natural history of polyethylene oxidation in total disc replacement. Spine (Phila Pa 1976). 2009;34:2369–2377.
24.
go back to reference Kurtz SM, Toth JM, Siskey R, Ciccarelli L, Macdonald D, Isaza J, Lanman T, Punt I, Steinbeck M, Goffin J, van Ooij A. The latest lessons learned from retrieval analyses of ultra-high molecular weight polyethylene, metal-on-metal, and alternative bearing total disc replacements. Semin Spine Surg. 2012;24:57–70.PubMedCentralPubMedCrossRef Kurtz SM, Toth JM, Siskey R, Ciccarelli L, Macdonald D, Isaza J, Lanman T, Punt I, Steinbeck M, Goffin J, van Ooij A. The latest lessons learned from retrieval analyses of ultra-high molecular weight polyethylene, metal-on-metal, and alternative bearing total disc replacements. Semin Spine Surg. 2012;24:57–70.PubMedCentralPubMedCrossRef
25.
go back to reference Lazennec J-Y, Even J, Skalli W, Rakover J-P, Brusson A, Rousseau M-A. Clinical outcomes, radiologic kinematics, and effects on sagittal balance of the 6-degrees-of-freedom LP-ESP® lumbar disc prosthesis. Spine J. 2013 Nov 19 [Epub ahead of print]. Lazennec J-Y, Even J, Skalli W, Rakover J-P, Brusson A, Rousseau M-A. Clinical outcomes, radiologic kinematics, and effects on sagittal balance of the 6-degrees-of-freedom LP-ESP® lumbar disc prosthesis. Spine J. 2013 Nov 19 [Epub ahead of print].
26.
go back to reference Lebl DR, Cammisa FP, Girardi FP, Wright T, Abjornson C. In vivo functional performance of failed Prodisc-L devices: retrieval analysis of lumbar total disc replacements. Spine (Phila Pa 1976). 2012;37:E1209–1217. Lebl DR, Cammisa FP, Girardi FP, Wright T, Abjornson C. In vivo functional performance of failed Prodisc-L devices: retrieval analysis of lumbar total disc replacements. Spine (Phila Pa 1976). 2012;37:E1209–1217.
27.
go back to reference Lebl DR, Cammisa FP Jr, Girardi FP, Wright T, Abjornson C. The mechanical performance of cervical total disc replacements in vivo: prospective retrieval analysis of prodisc-C devices. Spine (Phila Pa 1976). 2012;37:2151–2160. Lebl DR, Cammisa FP Jr, Girardi FP, Wright T, Abjornson C. The mechanical performance of cervical total disc replacements in vivo: prospective retrieval analysis of prodisc-C devices. Spine (Phila Pa 1976). 2012;37:2151–2160.
28.
go back to reference Lehman R, Bevevino AJ, Brewer DD, Skelly AC, Anderson PA. A systematic review of cervical artificial disc replacement wear characteristics and durability. Evid Based Spine Care J. 2012;3:31–38.PubMedCentralPubMedCrossRef Lehman R, Bevevino AJ, Brewer DD, Skelly AC, Anderson PA. A systematic review of cervical artificial disc replacement wear characteristics and durability. Evid Based Spine Care J. 2012;3:31–38.PubMedCentralPubMedCrossRef
29.
go back to reference Link HD, Keller A. Biomechanics of total disc replacement. In: Buttner-Janz K, Hochschuler SH, McAfee PC, eds. The Artificial Disc. Berlin, Germany: Springer; 2003:33–52.CrossRef Link HD, Keller A. Biomechanics of total disc replacement. In: Buttner-Janz K, Hochschuler SH, McAfee PC, eds. The Artificial Disc. Berlin, Germany: Springer; 2003:33–52.CrossRef
30.
go back to reference McAfee PC, Cunningham B, Holsapple G, Adams K, Blumenthal S, Guyer RD, Dmietriev A, Maxwell JH, Regan JJ, Isaza J. A prospective, randomized, multicenter Food and Drug Administration investigational device exemption study of lumbar total disc replacement with the CHARITE artificial disc versus lumbar fusion: part II: evaluation of radiographic outcomes and correlation of surgical technique accuracy with clinical outcomes. Spine (Phila Pa 1976). 2005;30:1576–1583; discussion E1588–1590. McAfee PC, Cunningham B, Holsapple G, Adams K, Blumenthal S, Guyer RD, Dmietriev A, Maxwell JH, Regan JJ, Isaza J. A prospective, randomized, multicenter Food and Drug Administration investigational device exemption study of lumbar total disc replacement with the CHARITE artificial disc versus lumbar fusion: part II: evaluation of radiographic outcomes and correlation of surgical technique accuracy with clinical outcomes. Spine (Phila Pa 1976). 2005;30:1576–1583; discussion E1588–1590.
32.
go back to reference O’Leary P, Nicolakis M, Lorenz MA, Voronov LI, Zindrick MR, Ghanayem A, Havey RM, Carandang G, Sartori M, Gaitanis IN, Fronczak S, Patwardhan AG. Response of Charite total disc replacement under physiologic loads: prosthesis component motion patterns. Spine J. 2005;5:590–599.PubMedCrossRef O’Leary P, Nicolakis M, Lorenz MA, Voronov LI, Zindrick MR, Ghanayem A, Havey RM, Carandang G, Sartori M, Gaitanis IN, Fronczak S, Patwardhan AG. Response of Charite total disc replacement under physiologic loads: prosthesis component motion patterns. Spine J. 2005;5:590–599.PubMedCrossRef
33.
go back to reference Punt I, Baxter R, van Ooij A, Willems P, van Rhijn L, Kurtz S, Steinbeck M. Submicron sized ultra-high molecular weight polyethylene wear particle analysis from revised SB Charite III total disc replacements. Acta Biomater. 2011;7:3404–3411.PubMedCentralPubMedCrossRef Punt I, Baxter R, van Ooij A, Willems P, van Rhijn L, Kurtz S, Steinbeck M. Submicron sized ultra-high molecular weight polyethylene wear particle analysis from revised SB Charite III total disc replacements. Acta Biomater. 2011;7:3404–3411.PubMedCentralPubMedCrossRef
34.
go back to reference Punt IM, Austen S, Cleutjens JP, Kurtz SM, ten Broeke RH, van Rhijn LW, Willems PC, van Ooij A. 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). 2012;37:150–159. Punt IM, Austen S, Cleutjens JP, Kurtz SM, ten Broeke RH, van Rhijn LW, Willems PC, van Ooij A. 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). 2012;37:150–159.
35.
go back to reference Scholz J, Woolf CJ. The neuropathic pain triad: neurons, immune cells and glia. Nat Neurosci. 2007;10:1361–1368.PubMedCrossRef Scholz J, Woolf CJ. The neuropathic pain triad: neurons, immune cells and glia. Nat Neurosci. 2007;10:1361–1368.PubMedCrossRef
36.
go back to reference Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J. Methodological Index for Non-randomized Studies (MINORS): development and validation of a new instrument. ANZ J Neurosurg. 2003;73:712–716. Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J. Methodological Index for Non-randomized Studies (MINORS): development and validation of a new instrument. ANZ J Neurosurg. 2003;73:712–716.
37.
go back to reference Stieber JR, Donald III GD. Early failure of lumbar disc replacement: case report and review of the literature. J Spinal Disord. 2006;19:55–60.CrossRef Stieber JR, Donald III GD. Early failure of lumbar disc replacement: case report and review of the literature. J Spinal Disord. 2006;19:55–60.CrossRef
38.
go back to reference Tumialan LM, Gluf WM. Progressive vertebral body osteolysis after cervical disc arthroplasty. Spine (Phila Pa 1976). 2011;36:E973–978. Tumialan LM, Gluf WM. Progressive vertebral body osteolysis after cervical disc arthroplasty. Spine (Phila Pa 1976). 2011;36:E973–978.
39.
go back to reference van den Broek PR, Huyghe JM, Wilson W, Ito K. Design of next generation total disk replacements. J Biomech. 2012;45:134–140.PubMedCrossRef van den Broek PR, Huyghe JM, Wilson W, Ito K. Design of next generation total disk replacements. J Biomech. 2012;45:134–140.PubMedCrossRef
40.
go back to reference van Ooij A, Kurtz SM, Stessels F, Noten H, van Rhijn L. Polyethylene wear debris and long-term clinical failure of the Charite disc prosthesis: a study of 4 patients. Spine (Phila Pa 1976). 2007;32:223–229. van Ooij A, Kurtz SM, Stessels F, Noten H, van Rhijn L. Polyethylene wear debris and long-term clinical failure of the Charite disc prosthesis: a study of 4 patients. Spine (Phila Pa 1976). 2007;32:223–229.
41.
go back to reference van Ooij A, Oner FC, Verbout AJ. Complications of artificial disc replacement: a report of 27 patients with the SB Charite disc. J Spinal Disord. 2003;16:369–383.CrossRef van Ooij A, Oner FC, Verbout AJ. Complications of artificial disc replacement: a report of 27 patients with the SB Charite disc. J Spinal Disord. 2003;16:369–383.CrossRef
42.
go back to reference Zeh A, Becker C, Planert M, Lattke P, Wohlrab D. Time-dependent release of cobalt and chromium ions into the serum following implantation of the metal-on-metal Maverick type artificial lumbar disc (Medtronic Sofamor Danek). Arch Orthop Trauma Surg. 2009;129:741–746.PubMedCrossRef Zeh A, Becker C, Planert M, Lattke P, Wohlrab D. Time-dependent release of cobalt and chromium ions into the serum following implantation of the metal-on-metal Maverick type artificial lumbar disc (Medtronic Sofamor Danek). Arch Orthop Trauma Surg. 2009;129:741–746.PubMedCrossRef
43.
go back to reference Zeh A, Planert M, Siegert G, Lattke P, Held A, Hein W. Release of cobalt and chromium ions into the serum following implantation of the metal-on-metal Maverick-type artificial lumbar disc (Medtronic Sofamor Danek). Spine (Phila Pa 1976). 2007;32:348–352. Zeh A, Planert M, Siegert G, Lattke P, Held A, Hein W. Release of cobalt and chromium ions into the serum following implantation of the metal-on-metal Maverick-type artificial lumbar disc (Medtronic Sofamor Danek). Spine (Phila Pa 1976). 2007;32:348–352.
44.
go back to reference Zigler J, Delamarter R, Spivak JM, Linovitz RJ, Danielson GO 3rd, Haider TT, Cammisa F, Zuchermann J, Balderston R, Kitchel S, Foley K, Watkins R, Bradford D, Yue J, Yuan H, Herkowitz H, Geiger D, Bendo J, Peppers T, Sachs B, Girardi F, Kropf M, Goldstein J. Results of the prospective, randomized, multicenter Food and Drug Administration investigational device exemption study of the ProDisc-L total disc replacement versus circumferential fusion for the treatment of 1-level degenerative disc disease. Spine (Phila Pa 1976). 2007;32:1155–1162; discussion 1163. Zigler J, Delamarter R, Spivak JM, Linovitz RJ, Danielson GO 3rd, Haider TT, Cammisa F, Zuchermann J, Balderston R, Kitchel S, Foley K, Watkins R, Bradford D, Yue J, Yuan H, Herkowitz H, Geiger D, Bendo J, Peppers T, Sachs B, Girardi F, Kropf M, Goldstein J. Results of the prospective, randomized, multicenter Food and Drug Administration investigational device exemption study of the ProDisc-L total disc replacement versus circumferential fusion for the treatment of 1-level degenerative disc disease. Spine (Phila Pa 1976). 2007;32:1155–1162; discussion 1163.
Metadata
Title
Which Design and Biomaterial Factors Affect Clinical Wear Performance of Total Disc Replacements? A Systematic Review
Authors
Sai Y. Veruva, BS
Marla J. Steinbeck, MT(ASCP), PhD
Jeffrey Toth, PhD
Dominik D. Alexander, PhD, MSPH
Steven M. Kurtz, PhD
Publication date
01-12-2014
Publisher
Springer US
Published in
Clinical Orthopaedics and Related Research® / Issue 12/2014
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI
https://doi.org/10.1007/s11999-014-3751-2

Other articles of this Issue 12/2014

Clinical Orthopaedics and Related Research® 12/2014 Go to the issue

Symposium: 2013 Limb Lengthening and Reconstruction Society

Internal Lengthening Device for Congenital Femoral Deficiency and Fibular Hemimelia

Symposium: ABJS Carl T. Brighton Workshop on Implant Wear and Tribocorrosion of Total Joint Replacements

Editorial Comment: ABJS Carl T. Brighton Workshop on Implant Wear and Tribocorrosion of Total Joint Replacements

Symposium: ABJS Carl T. Brighton Workshop on Implant Wear and Tribocorrosion of Total Joint Replacements

Do Retrieval Analysis and Blood Metal Measurements Contribute to Our Understanding of Adverse Local Tissue Reactions?