Trabecular Metal™ Acetabular Revision System

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For surgeons who want to treat acetabular defects,1 Zimmer Biomet’s Trabecular Metal Acetabular Revision System (TMARS) is easy to use, durable, and utilizes proven Trabecular Metal Technology . With clinical history of 17+ years,2-4 it addresses the need for initial stability and long term biologic fixation. Our Trabecular Metal Acetabular Revision System allows surgeons to treat acetabular defects with confidence. 

Easy to Use
The need for allograft preparation is virtually eliminated, saving precious surgical time. The Trabecular Metal Modular Acetabular Revision System (TMARS) has the flexibility to combine various size and style implants and augments for  intraoperatively, enabling more efficient case management and execution in the O.R., relative to what other implant systems can offer.5-8 Important time savings is realized before and during surgery. 

Durable
Use of the TMARS system eliminates the concern about graft vascularization and resorption and eventual collapse. This also eliminates the need for a future revision due to lack of graft incorporation. Use of TMARS alleviates concerns about disease transmission that may be caused by use of a donor graft. Additionally, Zimmer Biomet’s Trabecular Metal Technology offers a high coefficient of friction, which helps reduce micromotion . Its three-dimensional architecture provides for a high level of porosity and potential for osteoconductivity which allows for more rapid in-growth supporting a vascularized structure to maintain healthy bone .  Its three-dimensional architecture  Implant durability leads to longevity and reduced risk for future surgeries . 

Proven Technology
Revision cases from simple to extremely complex have been effectively treated with Trabecular Metal implants. The clinical success of Trabecular Metal Technology provides additional confidence ― confidence that rests on more than 17 years of clinical history, which has been documented in over 75 peer-reviewed journal publications.2-4 

 

No other prosthetic material simulates bone like Trabecular Metal™ Material . It's a 3-dimensional, porous material, not merely a coating. Additionally, it's created from Tantalum, one of the most biocompatible materials in the orthopedics industry . 

Trabecular Metal Revision Shell
The shell is designed for use in revision and primary cases, and it is placed in best position for maximum host bone contact, while 0 degree neutral and 10 degree oblique liners allow for preferred version. Created by cementing the liner, the one-piece construct of the Trabecular Metal Revision Shell eliminates concerns about backside wear . The low modulus of elasticity of the Trabecular Metal Material can produce more normal physiological loading and reduce stress shielding.5 The features of the shell include:

  • Elliptical geometry to maximize bone contact for initial stability6
  • Dome screw holes to allow for additional fixation into 
  • Longevity® Highly Crosslinked Polyethylene liners in various configurations are available to best meet patient needs

Trabecular Metal Buttress
The Trabecular Metal Acetabular Revision System sets new standards in the way surgeons perform revision surgery. It combines Trabecular Metal Technology with the ability to tailor individualized solutions for each patient— a combination no other competitive system offers. The Trabecular Metal Buttress:

  • Is made entirely of Trabecular Metal Material—no substrate
  • Addresses extensive superior segmental defects (Paprosky Type IIIA)
  • Serves as an alternative to allograft, without potential for bone resorption or disease transmission
  • Provides a technically simpler procedure, compared to using structural allograft 
  • Creates a monolithic construct without concerns for micromotion  by using cemented interfaces
  • Conserves host bone while implant size, position, and orientation are determined by the defect
  • Allows head center to be restored for optimization of patient kinetics

Trabecular Metal Cup Cage
Used in conjunction with the Trabecular Metal Revision Shell to provide adequate stability by spanning acetabular defects and pelvic discontinuities to provide mechanical stability of the Cup-Cage construct until biological ingrowth occurs. Cementing the Longevity Highly Crosslinked Polyethylene Liners, Cages, and Trabecular Metal Revision Shells together creates a single construct, without concerns of micromotion.  The Trabecular Metal Cup Cage is:

  • Made from commercially pure titanium construction for optimized mechanical strength
  • Available in left and right configurations
  • Long-flange and short-flange
  • Designed for inferior flange to be spiked into ischium
  • Shaped to fit individual patient anatom

References

  1. Bobyn JD, Hacking SA, Chan SP, et al. Characterization of a new porous tantalum biomaterial for reconstructive orthopaedics. Scientific Exhibit, Proc of AAOS, Anaheim, CA. 1999.
  2. JD Bobyn, GJ Stackpool, SA Hacking, M Tanzer, JJ Krygier, Characteristics of Bone In-Growth and Interface Mechanics of a New Porous Tantalum Biomaterial, The Journal of Bone and Joint Surgery (British Version), Sept, 1999, 81-B No. 5 pp 907-914.
  3. Zhang Y, Ahn PB, Fitzpatrick DC, Heiner AD, Poggie RA, Brown TD, "Interfacial frictional behavior: Cancellous bone, cortical bone, and a novel porous tantalum biomaterial", Journal of Musculoskeletal Research, 3(4): 245-251, 1999. 
  4. A Shirazi-Adl, M Dammak, G Paiement, "Experimental determination of friction characteristics at the Trabecular bone / porous-coated metal interface in Cementless implants", the J of Biomedical Research, Vol 27, 1993, pp 167-175.
  5. Pedersen DR, Brown TD, Poggie RA. Finite element analysis of periarticular stress of cemented, metal-backed, and porous tantalum backed acetabular components. 45th Annual Orthopaedic Research Society Meeting, Anaheim, CA. 1999.
  6. Sculco TP: The Acetabular component: an elliptical monoblock alternative. J Arthroplasty 17, No. 4, Suppl. 1:118, 2002. 

 

Longevity Crosslinked Polyethylene

Crosslinking has been shown to reduce the wear rate of polyethylene by up to 89% in laboratory studies.6 Clinical experience with highly crosslinked polyethylenes has also demonstrated a substantial reduction in the rate of wear.7,8 This remarkable process creates a three-dimensional structure that is more resistant to abrasion.9,10
Longevity Highly Crosslinked Polyethylene was developed to address the issue of wear in total hip arthroplasty. To help ensure optimal wear resistance, Zimmer employs a proprietary process based in part on patents licensed from Massachusetts General Hospital and the Massachusetts Institute of Technology. Using high-dose electron-beam radiation, this process fully crosslinks broken molecular polyethylene chains, leaving virtually no free radicals to promote oxidation.

The process produces a 10-fold wear rate reduction—an average 89% reduction of debris generated—compared to standard polyethylene control samples.6 The material also meets all of the mechanical property requirements of the ASTM and ISO standards. Longevity Crosslinked Polyethylene is available with the Continuum ® Acetabular System, Trabecular Metal™ Modular Acetabular System, and Trilogy ® Acetabular System, which is based on the long Zimmer tradition of clinical success with the Harris-Galante™ and HGP II porous cups.

Technology References

  1. Bobyn JD, Hacking SA, Chan SP, et al. Characterization of a new porous tantalum biomaterial for reconstructive orthopaedics. Scientific Exhibit, Proc of AAOS, Anaheim, CA. 1999.
  2. Goldberg VM, Stevenson S, Feighan J, et al. Biology of grit blasted titanium alloy implants. Clin Orthop. 1995;319:122-129.
  3. Hacking SA, Bobyn JD, Toh K-K, et al. The osseous response to corundum blasted implant surfaces in a canine total hip arthroplasty model. Clin Orthop. 1999;364:240-253.
  4. Bobyn JD, Hacking SA, Chan SP, et al. Characterization of new porous tantalum biomaterial for reconstructive orthopaedics. Scientific Exhibition: 66th Annual Meeting of the American Academy of Orthopaedic Surgeons; 1999; Anaheim, CA.
  5. Bobyn JD, Stackpool G, Toh K-K, et al. Characteristics of bone ingrowth and interface mechanics of a new porous tantalum biomaterial. J Bone Joint Surg.1999;81-B:907-914.
  6. Data on file at Zimmer, Inc.
  7. Oonishi H, Saito M, Kadoya Y. Wear of high-dose gamma irradiated polyethylene in total joint replacement – longterm radiological evaluation. 44th Annual Meeting, Orthopaedic Research Society, March 16-19, 1998.
  8. Wroblewski BM, Siney PD, Fleming PA. Low-friction arthroplasty of the hip using alumina ceramic and crosslinked polyethylene. J Bone Joint Surg (Br). 1999; 81-B: 54-5.
  9. Grobbelaar CJ, DuPlessis TA, Marais F. The radiation improvement of polyethylene prosthesis. J Bone Joint Surg. 1978;60-B(3):370-374.
  10. Oonishi H, Kuno M, Ikada Y, et al. Super low wear crosslinked UHMWPE by heavy high-dose gammaradiation. Proceedings from the 2nd Congress of Hip Section of Western Pacific Orthopaedic Assn. 1996;4.
  11. Bragdon, CR, et al., Seven to Ten Year Follow-Up of Highly Crosslinked Polyethylene Liners in Total Hip Arthroplasty, Poster No. 2444, 55th Annual Meeting of the Orthopaedic Research Society, Las Vegas, 2009.
  12. Data on File at Zimmer.
  13. Muratoglu OK, et al., The comparison of the wear behavior of four different types of crosslinked acetabular components. 46th Annual Meeting of the Orthopaedic Research Society. Paper 0566. 2000.

Zimmer Biomet’s Trabecular MetalTM Material has material properties that are remarkably similar to those of cancellous bone. It also has a substantially higher coefficient of friction on cancellous bone than other implant materials.1 This property facilitates direct bone apposition2,3 to increase initial stability at implantation.
Bone interface shear strength (MPa) of Trabecular Metal Material is higher compared to other fixation surfaces.4,5 Trabecular Metal Material is made from Tantalum, one of the most inert elemental metal biomaterials available . Its three-dimensional architecture provides for a high level of porosity and potential for osteoconductivity which allows for more rapid in-growth supporting a vascularized structure to maintain healthy bone. 

References

  1. Bobyn JD, Hacking SA, Chan SP, et al. Characterization of a new porous tantalum biomaterial for reconstructive orthopaedics. Scientific Exhibit, Proc of AAOS, Anaheim, CA. 1999.
  2. Goldberg VM, Stevenson S, Feighan J, et al. Biology of grit blasted titanium alloy implants. Clin Orthop. 1995;319:122-129.
  3. Hacking SA, Bobyn JD, Toh K-K, et al. The osseous response to corundum blasted implant surfaces in a canine total hip arthroplasty model. Clin Orthop. 1999;364:240-253.
  4. Bobyn JD, Hacking SA, Chan SP, et al. Characterization of new porous tantalum biomaterial for reconstructive orthopaedics. Scientific Exhibition: 66th Annual Meeting of the American Academy of Orthopaedic Surgeons; 1999; Anaheim, CA.
  5. Bobyn JD, Stackpool G, Toh K-K, et al. Characteristics of bone ingrowth and interface mechanics of a new porous tantalum biomaterial. J Bone Joint Surg.1999;81-B:907-914. 

Surgical Techniques

  1. Paprosky W, Perona P, Lawrence J. Acetabular defect classification and surgical reconstruction in revision arthroplasty. A 6-year follow-up evaluation. J Arthroplasty, 1994;9:33-44. 
  2. Lakstein D, Backstein D, Safir O, Kosashvili Y, Gross A. “Trabecular Metal Cups for Acetabular Defects with 50% or Less Host Bone Contact.” Clin Orthop Relat Res. 2009; 467(9):2318-2324.
  3. Nakashima, Yasuharu, et al. “Clinical and radiographic evaluation of total hip arthroplasties using porous tantalum modular acetabular components: 5-year follow-up of clinical trial.” Modern Rheumatology. 2013;23(1):112-118.
  4. Simon, Jean-Pierre and Bellmans, Johan. “Clinical and radiological evaluation of modular trabecular metal acetabular cups- Short-term results in 64 hips.” Acta Orthop. Belg. 2009; 75:623-630.
  5. Biomet Brochure Y-BMT-977/011507/M
  6. Depuy Brochure 7.5M1007 0612-38-506
  7. Stryker Tritanium Primary Acetabular System Ad, 2008. Stryker Test ReportRD-08-000: Evaluation of Bone Response to Porous Surfaces Using a Canine Total Hip Model.
  8. Levine B. A new era in porous metals: applications in orthopaedics. Advanced Engineering Materials. August 2008; 10(9): 788-792

 

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