Analysis of 478 Revision Cases for Cervical Disc Arthroplasty Based on Their Biomechanical Design.
Academic Article
Overview
abstract
PURPOSE: To investigate the associations between cervical disc arthroplasty (CDA) design parameters (constraint and material composition) and complications necessitating revision surgery, by analyzing data from the Food and Drug Administration's Manufacturer and User Facility Device Experience reports, with the goal of identifying potential links between specific design features and complications leading to revision surgery. METHODS: Complication reports for 9 Food and Drug Administration-approved CDAs were retrospectively extracted from the Manufacturer and User Facility Device Experience database from January 2005 to September 2023. Each report was reviewed for potential revision surgery, CDA utilized, and the reported biomechanical complications. Devices were then compared for associated complications based on their constraints and material compositions. RESULTS: A total of 478 revision cases exhibiting biomechanical complications were included. The most common complication associated with revision surgery was migration, in a total of 164 cases (34.4%), followed by heterotopic ossification in 46 cases (9.6%) and osteolysis in 45 cases (9.4%). When categorizing for constraint or material composition, migration emerges as the primary complication associated with revision surgery for nonconstrained (28.4%) and semiconstrained (30.7%), as well as metal-on-metal (33.3%) and metal-on-polyethylene (41.1%) designs. Meanwhile, for polyetheretherketone-on-ceramics (PoC) and viscoelastic (VC) designs, osteolysis appeared as the most relevant complication in revision cases (PoC: 40% and VC: 28.1%). CONCLUSION: Migration emerges as the primary biomechanical complication necessitating CDA revision surgeries, regardless of constraint design. Notably, newer materials (PoC and VC designs) demonstrate a shift toward osteolysis as the predominant complication, diverging from the patterns observed in traditional materials, where migration remained the dominant complication associated with metal-on-metal and metal-on-polyethylene revision surgery. CLINICAL RELEVANCE: Knowledge of device-specific complication profiles-particularly that migration predominates in traditional CDA designs while osteolysis prevails in newer PEEK-on-ceramic and viscoelastic implants-can guide surgeons in implant selection and postoperative surveillance strategies.
