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British Medical Bulletin 2015Small joints replacement is a valid treatment for moderate to severe osteoarthritis of the hand. Several design and materials are now available for prostethic procedures... (Review)
Review
INTRODUCTION
Small joints replacement is a valid treatment for moderate to severe osteoarthritis of the hand. Several design and materials are now available for prostethic procedures with very different clinical and functional outcomes.
SOURCES OF DATA
An online search was carried out using Medline, Cochrane and Google scholar online databases, searching for studies on small joints replacement in hand surgery.
AREAS OF AGREEMENT
Good functional and clinical outcomes can be achieved with silicone and pyrolitic carbon implants, either for trapeziometacarpal and metacarpophalangeal joints. In particular, the silicone spacer seems to be very effective for trapeziometacarpal osteoarthrosis, while the pyrolitic carbon total joint prosthesis produces excellent outcomes if used for metacarpophalangeal replacement. Major complications, such as persistent pain and implant loosening, have still a variable rate of occurrence.
AREAS OF CONTROVERSY
Heterogeneity in the methodology of the assessments in the studies reviewed and the implants and techniques involved makes it difficult to carry out a complete and effective comparative analysis of the data collected.
GROWING POINTS
Larger cohorts treated with the same implant should be investigated in better designed trials, to draw more clinically relevant conclusions from the evidences presented. Better methodology is also a goal to achieve, since the average Coleman Methodology Score measured for the articles included was 54.9 out of 100.
RESEARCH
More and better designed studies are needed to produce clear guidelines to define the better implant in terms of clinical outcomes, function and complications for trapeziometacarpal and metacarpophalangeal joints.
Topics: Arthroplasty, Replacement; Hand Joints; Humans; Joint Prosthesis; Osteoarthritis; Prosthesis Design; Range of Motion, Articular; Treatment Outcome
PubMed: 25990961
DOI: 10.1093/bmb/ldv024 -
The Journal of Arthroplasty May 2016Failure rates are higher in medial unicompartmental knee arthroplasty (UKA) than total knee arthroplasty. To improve these failure rates, it is important to understand... (Review)
Review
BACKGROUND
Failure rates are higher in medial unicompartmental knee arthroplasty (UKA) than total knee arthroplasty. To improve these failure rates, it is important to understand why medial UKA fail. Because individual studies lack power to show failure modes, a systematic review was performed to assess medial UKA failure modes. Furthermore, we compared cohort studies with registry-based studies, early with midterm and late failures and fixed-bearing with mobile-bearing implants.
METHODS
Databases of PubMed, EMBASE, and Cochrane and annual registries were searched for medial UKA failures. Studies were included when they reported >25 failures or when they reported early (<5 years), midterm (5-10 years), or late failures (>10 years).
RESULTS
Thirty-seven cohort studies (4 level II studies and 33 level III studies) and 2 registry-based studies were included. A total of 3967 overall failures, 388 time-dependent failures, and 1305 implant design failures were identified. Aseptic loosening (36%) and osteoarthritis (OA) progression (20%) were the most common failure modes. Aseptic loosening (26%) was most common early failure mode, whereas OA progression was more commonly seen in midterm and late failures (38% and 40%, respectively). Polyethylene wear (12%) and instability (12%) were more common in fixed-bearing implants, whereas pain (14%) and bearing dislocation (11%) were more common in mobile-bearing implants.
CONCLUSION
This level III systematic review identified aseptic loosening and OA progression as the major failure modes. Aseptic loosening was the main failure mode in early years and mobile-bearing implants, whereas OA progression caused most failures in late years and fixed-bearing implants.
Topics: Arthroplasty, Replacement, Knee; Disease Progression; Equipment Failure Analysis; Humans; Knee Joint; Knee Prosthesis; Osteoarthritis, Knee; Prosthesis Design; Prosthesis Failure; Registries; Reoperation; Treatment Outcome
PubMed: 26725134
DOI: 10.1016/j.arth.2015.11.030 -
The Journal of Knee Surgery Apr 2018The aim of this systematic review is to compare clinical outcome scores, rate of complications, and range of motion (ROM) of posterior-stabilized (PS) and... (Comparative Study)
Comparative Study Review
The aim of this systematic review is to compare clinical outcome scores, rate of complications, and range of motion (ROM) of posterior-stabilized (PS) and cruciate-retaining (CR) total knee arthroplasties (TKAs) both pre- and postoperatively to establish which of the two kinds of implants have the best efficiency. A comprehensive search was performed of studies comparing CR and PS TKAs on PubMed, OVID/Medline, Cochrane, CINAHL, Google scholar, and Embase databases. Finally, 37 studies were selected with a total of 5,407 knees in 4,445 patients. For the PS knees, the Knee Society Functional Score (KSFS) improved from 44.6 to 77.6 ( = 0.04), extension decreased from 6.6 to 1.8 degrees (-value), and flexion increased from 115.2 to 119.4 degrees ( < 0.00001), compared with the CR knees. No significant difference in the Knee Society objective score (KSOS) ( = 0.82) or complication rates ( = 0.29) was found. The overall complication rate was 3.9%, 213 in 5,407 knees. Surgeons must be careful in interpreting these results, as an improved ROM for the PS group may not correlate to better patient outcomes. This meta-analysis has demonstrated that PS TKA has a statistically significant greater postoperative improvement of KSFS ( = 0.04), flexion ( < 0.00001), and extension ( = 0.02), compared with the CR group. These findings seem to lead the surgeons to prefer the PS design for TKAs especially to achieve a higher postoperative ROM in patients with high functional demands. On the contrary, the CR and PS TKAs have similar results in terms of complications and most of clinical outcomes analyzed in the included studies. Therefore, the long-term follow-up of high-quality randomized controlled trials is needed to clarify which of the two types of prosthesis provide the better clinical outcome and the lower rate of complications for osteoarthritis patients in particular cohorts. This is a systematic review (level II).
Topics: Arthroplasty, Replacement, Knee; Humans; Knee Joint; Knee Prosthesis; Osteoarthritis, Knee; Posterior Cruciate Ligament; Prosthesis Design; Range of Motion, Articular; Treatment Outcome
PubMed: 28666292
DOI: 10.1055/s-0037-1603902 -
Knee Surgery, Sports Traumatology,... Nov 2015Two design concepts are currently used for unicondylar knee arthroplasty (UKA) prostheses: fixed bearing (FB) and mobile bearing (MB). While MB prostheses have... (Comparative Study)
Comparative Study Meta-Analysis Review
PURPOSE
Two design concepts are currently used for unicondylar knee arthroplasty (UKA) prostheses: fixed bearing (FB) and mobile bearing (MB). While MB prostheses have theoretical advantages over their FB counterparts, it is not clear whether they are associated with better outcomes. A systematic review was conducted to examine survivorship differences and differences in failure modes of between FB and MB designs.
METHODS
PubMed, Scirus and Cochrane library databases were searched for medial UKA outcome studies. A total of 44 papers, involving 9,463 knees, were eligible. Outcomes examined included knee function, survivorship and the reasons for, and incidence of, revision for FB and MB prostheses. Random effects meta-analysis was employed to obtain pooled revision rate estimates. Where available, cause-specific time to revision was extracted.
RESULTS
Mean follow-up was 8.7 years for FB and 5.9 years for MB prostheses. There were no other relevant baseline differences. The overall crude revision rate for FB and for MB prostheses was 0.90 (95 % confidence interval (CI) 0.65-1.21) and 1.51 (95 % CI 1.11-1.93) per 100 component years, respectively. After stratification on follow-up time and age, the revision rates were not substantially different, aside for younger patients in short term from studies with short-term follow-up.
CONCLUSION
No essential differences between the two designs were observed. MB and FB UKA designs have comparable revision rates. As our study is based on predominantly observational data, with large variations in reporting standards, inferences should be drawn with caution.
LEVEL OF EVIDENCE
IV.
Topics: Adult; Aged; Arthritis; Arthroplasty, Replacement, Knee; Equipment Failure Analysis; Female; Humans; Knee Joint; Knee Prosthesis; Male; Middle Aged; Outcome Assessment, Health Care; Prosthesis Design; Prosthesis Failure; Randomized Controlled Trials as Topic; Reoperation
PubMed: 24957911
DOI: 10.1007/s00167-014-3131-1 -
Hand Surgery & Rehabilitation Apr 2024Thumb osteoarthritis is a frequent pathology, mainly affecting the elderly. The surgical treatment initially described and having proved its worth is total... (Review)
Review
OBJECTIVE
Thumb osteoarthritis is a frequent pathology, mainly affecting the elderly. The surgical treatment initially described and having proved its worth is total trapeziectomy. Since the advent of trapeziometacarpal prostheses, several studies showed the non-inferiority of this technique on clinical criteria, with superiority in bone sparing, although neither technique demonstrated overall superiority. We therefore examined the specific complications of each surgical technique by analyzing their nature and prevalence through a review of the literature to compare them on these new parameters.
METHODS
Seventy-four of the 320 articles reviewed were included, 38 of which concerned trapeziectomy, and 36 concerned prostheses, for a total of 4,865 patients. They were original studies, involving adults undergoing trapeziometacarpal arthroplasty or trapeziectomy, published after 2015, reporting at least one well-described complication.
RESULTS
6.13% of trapeziectomies presented severe complications (in particular thumb collapse and metacarpophalangeal hyperextension), 3.31% moderate complications and 1.90% minor complications, leading to a 2.0% revision rate. 23.88% of prostheses had severe complications (loosening, dislocation and wear), 5.06% moderate complications and 1.36% minor complications, leading to a 12.8% revision rate. In addition, we analyzed more recent prosthesis designs separately, and found lower prevalence of severe complications (16.56%) and revision surgery (4.3%).
CONCLUSION
Revision surgery for trapeziometacarpal prostheses is usually only a standard trapeziectomy with the same follow-up as first-line trapeziectomy, whereas revision surgery for trapeziectomies is much more complex and the results are uncertain. For this reason, we would reserve total trapeziectomy for revision surgeries and patients with low functional demand for whom a second surgery is not desirable. Further studies could confirm this attitude, especially focusing on the latest generation of dual mobility implants.
Topics: Humans; Trapezium Bone; Osteoarthritis; Joint Prosthesis; Carpometacarpal Joints; Postoperative Complications; Thumb; Arthroplasty, Replacement; Prosthesis Failure; Reoperation
PubMed: 38408727
DOI: 10.1016/j.hansur.2024.101672 -
Hip International : the Journal of... Nov 2020The major joint registries report better survivorship for ceramic on polyethylene over metal on polyethylene bearings in total hip arthroplasty and it is generally... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The major joint registries report better survivorship for ceramic on polyethylene over metal on polyethylene bearings in total hip arthroplasty and it is generally accepted that this is due to a lower polyethylene wear rate. We used evidence synthesis to compare survivorship, polyethylene wear rates and metal ion levels for metal-on-polyethylene (MoP) and ceramic-on-polyethylene (CoP) bearings. If wear rates are not dissimilar this difference in revision rate may have another cause. Modular junctions are a potential source of corrosion and it is postulated that this may result in higher revision rates.
METHODS
We performed a systematic review and meta-analysis comparing the survivorship of MoP and CoP bearings. Odds ratio (95% CI) of revision was calculated. Mean difference (MD) and 95% confidence intervals (CI) were used to compare secondary outcomes of polyethylene wear and metal ion levels. Meta-analysis was performed with a Mantel-Haenszel Random-Effects Model.
RESULTS
6 randomised controlled trials were included. There was no statistically significant difference between MoP and CoP revision rate (OR 1.04; 95% CI, 0.37-2.90, I = 0%, 0.94), linear bearing wear (MD 0.00 mm; 95% CI, -0.05 -0.05, I = 98%, 0.90), nor volumetric bearing wear (MD 33.57 mm; 95% CI, -215.56-282.70, I = 98%, 0.79). No studies evaluated metal ion levels.
CONCLUSIONS
We found no evidence of a difference in revision rates nor linear and volumetric wear between MoP and CoP bearings in the randomised controlled trials currently available. Our study therefore does not advocate the additional cost associated with the use of ceramic heads in combination with polyethylene bearings in order to minimise revision rates. This contrasts the findings of studies and the major joint registries.
Topics: Arthroplasty, Replacement, Hip; Ceramics; Hip Prosthesis; Humans; Polyethylene; Prosthesis Design; Prosthesis Failure; Registries; Reoperation; Risk Factors
PubMed: 32933331
DOI: 10.1177/1120700019866428 -
The Journal of Arthroplasty Sep 2014The purpose of this systematic review and meta-analysis is to compare patient-specific instrumentation (PSI) versus standard instrumentation for total knee arthroplasty... (Meta-Analysis)
Meta-Analysis Review
The purpose of this systematic review and meta-analysis is to compare patient-specific instrumentation (PSI) versus standard instrumentation for total knee arthroplasty (TKA) with regard to coronal and sagittal alignment, operative time, intraoperative blood loss, and cost. A systematic query in search of relevant studies was performed, and the data published in these studies were extracted and aggregated. In regard to coronal alignment, PSI demonstrated improved accuracy in femorotibial angle (FTA) (P=0.0003), while standard instrumentation demonstrated improved accuracy in hip-knee-ankle angle (HKA) (P=0.02). Importantly, there were no differences between treatment groups in the percentages of FTA or HKA outliers (>3 degrees from target alignment) (P=0.7). Sagittal alignment, operative time, intraoperative blood loss, and cost were also similar between groups (P>0.1 for all comparisons).
Topics: Arthroplasty, Replacement, Knee; Humans; Knee Joint; Knee Prosthesis; Osteoarthritis, Knee; Surgery, Computer-Assisted
PubMed: 24961893
DOI: 10.1016/j.arth.2014.01.039 -
The Bone & Joint Journal Feb 2017There are two techniques widely used to determine the rotational alignment of the components in total knee arthroplasty (TKA); gap balancing (GB) and measured resection... (Meta-Analysis)
Meta-Analysis Review
AIMS
There are two techniques widely used to determine the rotational alignment of the components in total knee arthroplasty (TKA); gap balancing (GB) and measured resection (MR). Which technique is the best remains controversial. We aimed to investigate this in a systematic review and meta-analysis.
MATERIALS AND METHODS
In accordance with the methods of Cochrane, databases were searched for all randomised controlled trials in the literature between January 1986 and June 2015 comparing radiographic and clinical outcomes between the use of these two tecniques. Meta-analysis involved the use of the Revman5.3 software provided by Cochrane collaboration.
RESULTS
A total of 1464 papers were initially identified, and after the application of rigourous inclusion and exclusion critera, eight were included in the study. In total they inolved 980 TKAs. The meta-analysis showed that GB techniques resulted in statistically significant improvements in the restoration of mechanical and rotational alignment and mean Knee Society Scores and Knee Society Function scores two years post-operatively, but resulted in greater elevation of the position of the joint line. There is no significant difference in the other radiographic data.
CONCLUSION
This study suggests that GB may provide better radiographic and clinical outcomes than MR when used to determine mechanical rotation in TKAs. Cite this article: Bone Joint J 2017;99-B:151-8.
Topics: Arthroplasty, Replacement, Knee; Bone Malalignment; Humans; Knee Joint; Knee Prosthesis; Osteoarthritis, Knee; Randomized Controlled Trials as Topic; Range of Motion, Articular; Rotation; Surgery, Computer-Assisted
PubMed: 28148655
DOI: 10.1302/0301-620X.99B2.BJJ-2016-0042.R2 -
Journal of Orthopaedic Surgery and... May 2022The present systematic review investigated possible factors which may influence the surgical outcome of minimally invasive surgery for total hip arthroplasty (MIS THA). (Review)
Review
INTRODUCTION
The present systematic review investigated possible factors which may influence the surgical outcome of minimally invasive surgery for total hip arthroplasty (MIS THA).
METHODS
In January 2022, the Embase, Google Scholar, PubMed, and Scopus databases were accessed. All the clinical trials investigating the clinical outcome of MIS THA were considered.
RESULTS
Data from 9486 procedures were collected. Older age was moderately associated with greater Visual Analogue Scale (VAS) (P = 0.02) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) (P = 0.009) at last follow-up, and shorter surgical duration (P = 0.01). Greater body mass index (BMI) at baseline was moderately associated with greater cup anteversion (P = 0.0009), Oxford Hip Score (OHS) at last follow-up (P = 0.04), longer surgical duration (P = 0.04), increased leg length discrepancy (P = 0.02), and greater rate of infection (P = 0.04). Greater VAS at baseline was weakly associated with greater VAS at last follow-up (P < 0.0001), total estimated blood lost (P = 0.01), and lower value of Harris Hip Score (HHS) (P = 0.0005). Greater OHS at baseline was associated with greater post-operative VAS (P = 0.01). Greater WOMAC at baseline was associated with lower cup anteversion (P = 0.009) and greater VAS (P = 0.02). Greater HHS at baseline was associated with shorter hospitalisation (P = 0.001).
CONCLUSION
Older age and greater BMI may represent negative prognostic factors for MIS THA. The clinical outcome is strongly influenced by the preoperative status of patients.
Topics: Arthroplasty, Replacement, Hip; Hip Prosthesis; Humans; Leg Length Inequality; Minimally Invasive Surgical Procedures; Pain Measurement; Treatment Outcome
PubMed: 35585545
DOI: 10.1186/s13018-022-03168-4 -
The Journal of Hand Surgery... Dec 2021: Unconstrained pyrocarbon and metal-on-polyethylene (MoP) proximal interphalangeal (PIP) joint arthroplasty is an increasingly popular alternative to silicone implants...
: Unconstrained pyrocarbon and metal-on-polyethylene (MoP) proximal interphalangeal (PIP) joint arthroplasty is an increasingly popular alternative to silicone implants and arthrodesis. This systematic review appraises their outcomes. : 30 studies comprising 1,324 joints (813 pyrocarbon, 511 MoP) were included. Mean patient age was 59 years (38 to 78) and mean follow-up period was 54 months (1.2 to 380). : There were mean improvements of 4.5 points (2 to 6.9) in pain Visual Analogue Score, 10.5° (-26 to 58) in range of motion (ROM), 3.1 kg (-4 to 7) in grip strength, 0.6 kg (-1.5 to 2) in pinch strength, and 18 points (-3 to 29) in the Disabilities of the Arm, Shoulder and Hand score, with no significant differences between implant types. ROM gains, in particular, deteriorated over time. Clinical complications were frequent (23%), and significantly more common with pyrocarbon, as were radiographic complications. However, most were mild-moderate and did not necessarily correlate with negative outcomes or dissatisfaction. Overall reoperation rate was 21%, and revision rate 11%, both more frequent with pyrocarbon. Most revisions were within 24 months, beyond which survival was maintained up to ten years. : Unconstrained PIP joint arthroplasty is effective at improving pain scores, active ROM, grip/pinch strength, and patient reported outcome measures, particularly in patients with osteoarthritis. Results are generally maintained at least to the medium term, although gains diminish in the longer term. Complication and early revision rates are high, particularly with pyrocarbon implants. The majority of patients express positive attitudes to arthroplasty, with significant improvements in patient-reported outcome measures for both pyrocarbon and MoP implants. Patients with post-traumatic and inflammatory arthropathy are generally less satisfied. There is currently insufficient data to recommend one implant type over another, although the early-to-medium term results of MoP implants are promising. Prospective surveillance via small joint registries is recommended.
Topics: Arthroplasty; Arthroplasty, Replacement, Finger; Finger Joint; Humans; Joint Prosthesis; Middle Aged; Osteoarthritis; Prospective Studies; Treatment Outcome
PubMed: 34789103
DOI: 10.1142/S2424835521500661