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The Journal of Hand Surgery Apr 2015
Review
Topics: Arthroplasty, Replacement; Dermatitis, Contact; Humans; Hypersensitivity, Delayed; Joint Prosthesis; Metals; Prosthesis Design
PubMed: 25639842
DOI: 10.1016/j.jhsa.2014.11.027 -
Instructional Course Lectures 2015For more than 60 years, total elbow arthroplasty (TEA) has been successfully used to treat a variety of elbow conditions. Although first designed to treat older patients... (Review)
Review
For more than 60 years, total elbow arthroplasty (TEA) has been successfully used to treat a variety of elbow conditions. Although first designed to treat older patients with rheumatoid arthritis, the indications have expanded to include younger, higher-demand patients with a broad range of elbow pathology. Two groups of TEA currently exist. The first group includes linked or semiconstrained elbows with a mechanical connection between the humeral and ulnar components that prevents disassociation. These implants do not rely on muscular or ligamentous tissues for stability. The second group includes unlinked implants that have no physical connection between the humeral and ulnar components. They rely on bearing surface architecture as well as soft-tissue integrity for elbow stability. Critical to the success of unlinked implants is a thorough preoperative evaluation of elbow stability, including bone stock, collateral ligament integrity, and periarticular muscle function. Unlinked implants should apply less strain to the bone-cement-implant interfaces, which may theoretically decrease rates of bearing wear and aseptic loosening. For this reason, some surgeons prefer unlinked implants for younger, higher-demand patients. To date, unlinked implants have not been clinically shown to improve survivorship compared with linked devices. No prospective randomized trials comparing linked and unlinked TEAs are currently available. Historically, unlinked implants have had higher revision rates, mostly caused by instability and early design flaws. More recent series have shown no significant differences in outcomes compared with linked devices. Unlinked TEA provides reliable pain relief and improved range of motion for patients with a variety of elbow disorders. Diligent patient selection and careful surgical technique are of utmost importance when considering an unlinked TEA as a treatment option. The recent development of convertible implants now allows surgeons to make intraoperative decisions regarding elbow stability and convert to a linked implant without revising the stems.
Topics: Arthroplasty, Replacement; Elbow Joint; Humans; Joint Prosthesis; Osteoarthritis; Prosthesis Design; Treatment Outcome
PubMed: 25745909
DOI: No ID Found -
Expert Review of Medical Devices Feb 2019Historically, patients with rotator cuff arthropathy had limited reconstructive options. The early generations of reverse total shoulder arthroplasty (rTSA) designs had... (Review)
Review
INTRODUCTION
Historically, patients with rotator cuff arthropathy had limited reconstructive options. The early generations of reverse total shoulder arthroplasty (rTSA) designs had increased failure rates due to loosening of glenoid baseplates secondary to excessive torques. In 1985, Paul Grammont introduced a prosthetic design changing the center of rotation that addressed this major complication. The Grammont principles remain the foundation of modern reverse total shoulder prostheses, although the original design has undergone several adaptations. We reviewed here the various aspects of prosthetic designs including baseplates, glenospheres, humeral components, and polyethylene bearing interfaces.
AREAS COVERED
We discuss the evolution, biomechanics, prosthetic options, and future direction for rTSA. A literature search using the PubMed database including review articles, biomechanical studies, and clinical trials pertaining to rTSA prothesis and outcomes.
EXPERT COMMENTARY
Despite an expansion in the understanding of the biomechanics of the rotator cuff deficient shoulder and its effect on the reverse total shoulder prostheses, Grammont principles remain the foundation of contemporary rTSA designs. Further clinical studies are needed to assess how modern prosthetic modifications effect clinical and radiographic outcomes. Additionally, implants are being used in younger individuals with expanded indications, therefore, close clinical monitoring is needed to better evaluate their prosthetic longevity.
Topics: Arthroplasty, Replacement, Shoulder; Biomechanical Phenomena; History, 20th Century; Humans; Joint Prosthesis; Prosthesis Design; Shoulder Joint
PubMed: 30669890
DOI: 10.1080/17434440.2019.1568237 -
Foot & Ankle International Dec 2023The increasing number of total ankle arthroplasties (TAAs) has led to growing evidence on the risk factors for complications after surgery. However, the role of obesity... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The increasing number of total ankle arthroplasties (TAAs) has led to growing evidence on the risk factors for complications after surgery. However, the role of obesity in this patient group has been the subject of much debate. Therefore, this systematic review aimed to investigate the evidence for untoward effects of obesity following TAA.
METHODS
We conducted a comprehensive search on April 28, 2023, in MEDLINE (via PubMed), Embase, and CENTRAL. Eligible observational studies reported on the short- and long-term outcomes of primary TAA, comparing patients with and without obesity (defined as body mass index > 30). Using a random effects model, we calculated pooled odds ratios (ORs) with 95% confidence intervals (CIs) from 2 by 2 tables (event and nonevent in the obese and nonobese primary TAA groups).
RESULTS
Nine studies with 10 388 patients were eligible for inclusion in the meta-analysis. We found significantly higher odds of revision in the obese group compared to the nonobese group (OR = 1.68, CI: 1.44-1.95). However, the odds of overall perioperative complications (OR = 1.55, CI: 0.50-4.80) and wound complications (OR = 1.34, CI: 0.29-6.20) were nonsignificantly higher in the obese group.
CONCLUSION
Based on our results, obesity may have affected long-term outcomes following TAA and may have negatively affected the prosthesis's survival.
Topics: Humans; Ankle; Reoperation; Obesity; Joint Prosthesis; Arthroplasty, Replacement, Ankle; Ankle Joint; Treatment Outcome; Retrospective Studies
PubMed: 37902184
DOI: 10.1177/10711007231201158 -
The Bone & Joint Journal Apr 2020
Topics: Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Hip Prosthesis; Humans; Joint Prosthesis; Knee Prosthesis; Osteoarthritis; Osteoarthritis, Hip; Osteoarthritis, Knee; Prosthesis Failure; Time Factors
PubMed: 32228077
DOI: 10.1302/0301-620X.102B4.BJJ-2020-0183 -
The Orthopedic Clinics of North America Jan 2016Total wrist arthroplasty (TWA) provides a motion-preserving alternative to total wrist arthrodesis for low-demand patients with debilitating pancarpal arthritis. The... (Review)
Review
Total wrist arthroplasty (TWA) provides a motion-preserving alternative to total wrist arthrodesis for low-demand patients with debilitating pancarpal arthritis. The earlier generation total wrist implants had high complication and failure rates. Advances in prosthetic design have contributed to improved clinical outcomes and implant survivorship. The current fourth-generation implants allow for expansion of indications for TWA. Careful patient selection remains critical; patients with high-demand lifestyles and poor bone stock may not be candidates. Long-term studies on implant survival and patient outcomes are critical for the current generation total wrist implants in assessing their long-term value compared with total wrist arthrodesis.
Topics: Arthritis; Arthroplasty, Replacement; Contraindications; Humans; Joint Prosthesis; Prosthesis Design; Wrist Joint
PubMed: 26614934
DOI: 10.1016/j.ocl.2015.08.018 -
The Journal of Hand Surgery, European... May 2017A variety of surgical techniques are used to treat the arthritic distal radioulnar joint, which is influenced by aetiology and previous procedures. Four types of ulnar... (Review)
Review
A variety of surgical techniques are used to treat the arthritic distal radioulnar joint, which is influenced by aetiology and previous procedures. Four types of ulnar head arthroplasty exist: total ulnar head, partial ulnar head, unlinked total distal radioulnar joint, and linked distal radioulnar joint. Although long-term outcome studies are sparse, short-term clinical and biomechanical studies have shown encouraging results, leading to expanded indications. Based on our experience and a literature review, patients are advised that pain is improved but minor pain is common after strenuous activity. Ulnar neck resorption is common, however, implant loosening is rare. Sigmoid notch erosion is concerning, but appears to stabilize and not affect outcome. A partial ulnar head replacement that retains bony architecture and soft tissue restraints may have benefit over a total ulnar head in appropriate patients. If appropriate selection criteria are met, ulnar head replacement typically produces reliable results, with low revision.
Topics: Arthroplasty, Replacement; Humans; Joint Prosthesis; Prosthesis Design; Ulna; Wrist Joint
PubMed: 28399786
DOI: 10.1177/1753193417693177 -
Acta Bio-medica : Atenei Parmensis Sep 2014Total knee replacement (TKR) procedures have evolved in the last 40 years to guarantee improvements implants life and an excellent joint function. The goals for the... (Review)
Review
Total knee replacement (TKR) procedures have evolved in the last 40 years to guarantee improvements implants life and an excellent joint function. The goals for the future evolutions are make easier prosthesis implantation and promote precision. The demand for TKR will rise for the life length increase and for the risk factors impact increase. Design evolution in total knee replacement has to satisfy these new necessities: anatomic congruence, range of motion, less material wear and better resistance to the weight bearing and to the stresses. This paper analyzes design evolution, materials development and future purposes in total knee arthroplasty. At the beginning, TKR history is treated; then we compare several prosthetic designs developed during years. At last the paper speak about recent innovations, like CAD (computer aided design) for example, born to reach the most important goal in the future: better TKR design, is the one that better imitate natural knee characteristics, and that is able to integrate it-self with capsule-ligaments and muscle-tendons patient structures.
Topics: Arthroplasty, Replacement, Knee; Humans; Knee Prosthesis; Prosthesis Design
PubMed: 25409713
DOI: No ID Found -
Acta Ortopedica Mexicana 2015
Review
Topics: Arthroplasty, Replacement; Humans; Joint Prosthesis; Prosthesis Design; Shoulder Joint
PubMed: 26999928
DOI: No ID Found -
The Journal of Arthroplasty Dec 2014
Topics: Arthroplasty, Replacement; Asia; Humans; Joint Prosthesis
PubMed: 25454704
DOI: 10.1016/j.arth.2014.09.031