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Plastic and Reconstructive Surgery Dec 2014Substantial effort has been directed at the development of small joint prostheses for the hand. Despite advances in prosthetic joint design, outcomes have been... (Review)
Review
Substantial effort has been directed at the development of small joint prostheses for the hand. Despite advances in prosthetic joint design, outcomes have been relatively unchanged over the past 60 years. Pain relief and range of motion achieved after surgery have yet to mirror the success of large joint arthroplasty. Innovations in biotechnology and stem cell applications for damaged joint surfaces may someday make prostheses obsolete. The purpose of this review is to describe the current status, ongoing advances, and future of small joint arthroplasty of the hand.
Topics: Arthroplasty, Replacement, Finger; Humans; Joint Prosthesis; Osteoarthritis; Treatment Outcome
PubMed: 25415093
DOI: 10.1097/PRS.0000000000000733 -
Orthopadie (Heidelberg, Germany) Feb 2023The ankle joint has to bear the entire body weight on a relatively small joint surface. Incongruities, instabilities and deformities lead to painful arthrosis and...
The ankle joint has to bear the entire body weight on a relatively small joint surface. Incongruities, instabilities and deformities lead to painful arthrosis and considerable restrictions in everyday life. For many years, arthrodesis has proven to be the gold standard for end stage arthrosis; however, considering modern endoprostheses for the ankle joint it is no longer appropriate to offer only arthrodesis. The very good results of the 3rd generation 3‑component prostheses and the 4th generation 2‑component prostheses show how much the surgical treatment options for the ankle joint are currently changing. The simplified implantation techniques enable access to arthroplasty of the ankle joint for a broader spectrum of surgeons and explain the increasing implantation rates in recent years. Decisive for postoperative success are correct planning with knowledge of the leg axes and foot position, correct patient selection and exact surgical placement of the components.
Topics: Humans; Ankle Joint; Arthroplasty, Replacement; Joint Diseases; Joint Prosthesis; Osteoarthritis
PubMed: 36745219
DOI: 10.1007/s00132-022-04344-4 -
The Bone & Joint Journal Jan 2017To demonstrate, with concrete examples, the value of in-depth exploration and comparison of data published in National Joint Arthroplasty registry reports. (Review)
Review
AIMS
To demonstrate, with concrete examples, the value of in-depth exploration and comparison of data published in National Joint Arthroplasty registry reports.
PATIENTS AND METHODS
The author reviewed published current reports of National Joint Arthroplasty registries for findings of current significance to current orthopaedic practice.
RESULTS
A total of six observations that demonstrate actionable or unexpected findings from joint registries are described. These include: one third to one half of all arthroplasty failures in the first decade occur in the first one to two years; infection rates after arthroplasty have not declined in the last three decades; infection after TKA is more common in men than women; outcomes of TKA are more variable in young compared with older patients; new technologies (uncemented implants and crosslinked polyethylene) have improved results of THA and a real-time shift in use of ceramic femoral heads is occurring in THA.
CONCLUSION
These six observations may be used to better understand current practice, stimulate practice improvements or suggest topics for further study. Cite this article: Bone Joint J 2017;99-B(1 Supple A):3-7.
Topics: Age Factors; Arthroplasty, Replacement; Humans; Joint Prosthesis; Professional Practice; Prosthesis Failure; Prosthesis-Related Infections; Registries; Reoperation; Sex Factors
PubMed: 28042111
DOI: 10.1302/0301-620X.99B1.BJJ-2016-0353.R1 -
The Journal of the American Academy of... Jan 2024Since the Food and Drug Administration (FDA) approval nearly two decades ago, the indications for and utilization of reverse shoulder arthroplasty (RSA) have expanded...
Since the Food and Drug Administration (FDA) approval nearly two decades ago, the indications for and utilization of reverse shoulder arthroplasty (RSA) have expanded considerably. Stemless RSA designs have been used in Europe since 2005, but have only recently been introduced in domestic Investigational Device Exemption trials. Potential advantages of stemless RSA are similar to those of stemless anatomic total shoulder arthroplasty, which may include fewer shaft-related complications, avoidance of stress shielding, bone preservation, and easier revision surgery. European data support similar outcomes between certain stemless RSA prostheses compared with that of stemmed RSA implants at early and mid-term follow-up. However, long-term outcomes remain to be seen and differences exist between the stemless RSA designs used in Europe and those being studied in domestic clinical trials. An understanding of the potential advantages and disadvantages of stemless RSA, differences between existing designs, and reported clinical outcomes is prudent for the safe and meaningful implementation of this new technology in the United States.
Topics: Humans; Arthroplasty, Replacement, Shoulder; Shoulder Joint; Arthroplasty; Joint Prosthesis; Reoperation; Prosthesis Design; Treatment Outcome
PubMed: 37816186
DOI: 10.5435/JAAOS-D-23-00075 -
JBJS Reviews Apr 2021The true incidence of pseudotumors in association with total joint arthroplasty is underestimated.
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The true incidence of pseudotumors in association with total joint arthroplasty is underestimated.
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Pseudotumors occur with metal-on-metal, metal-on-polyethylene, and metal-on-ceramic articulations.
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Metal ion levels should not be the only factor in decision-making regarding revision surgery.
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Revision surgery is only indicated in symptomatic patients with clinical and radiographic findings and elevated metal ion levels.
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Revision to a non-metal articulation is strongly suggested.
Topics: Arthroplasty, Replacement, Hip; Hip Prosthesis; Humans; Metal-on-Metal Joint Prostheses; Prosthesis Design; Reoperation
PubMed: 33819203
DOI: 10.2106/JBJS.RVW.20.00125 -
Seminars in Musculoskeletal Radiology Apr 2019Arthritis involving the hand and wrist can significantly impair functions of daily living. Although arthrodesis provides pain relief, it limits range of motion at the... (Review)
Review
Arthritis involving the hand and wrist can significantly impair functions of daily living. Although arthrodesis provides pain relief, it limits range of motion at the affected joint. Arthroplasty is an alternative surgical treatment for hand and wrist arthritis, providing both pain relief and restoration of a range of motion. Over the past decade, several advances have occurred in hand and wrist arthroplasty designs. This article reviews component design, normal imaging appearance, and common complications of arthroplasty used in the wrist and hand. It also introduces readers to newer arthroplasty designs.
Topics: Arthroplasty, Replacement; Hand Joints; Humans; Joint Prosthesis; Wrist Joint
PubMed: 30925628
DOI: 10.1055/s-0038-1677464 -
Clinical Orthopaedics and Related... Dec 2014Wear and corrosion in joint arthroplasty are important causes of failure. From the standpoint of current clinical importance, there are four main categories of wear and... (Review)
Review
Wear and corrosion in joint arthroplasty are important causes of failure. From the standpoint of current clinical importance, there are four main categories of wear and tribocorrosion: polyethylene wear, ceramic-on-ceramic (CoC) bearing wear, metal-on-metal (MoM) bearing wear, and taper tribocorrosion. Recently, problems with wear in the knee have become less prominent as have many issues with hip polyethylene (PE) bearings resulting from the success of crosslinked PE. However, MoM articulations and taper tribocorrosion have been associated with soft tissue inflammatory responses, and as a result, they have become prominent clinical concerns. WHERE ARE WE NOW?: For PE wear in the hip, several advances include improved locking mechanisms and data supporting highly crosslinked polyethylenes (HXLPE). Edge-loading in CoC articulations can contribute to stripe wear and subsequent squeaking. For MoM articulations, the relationship of wear-to-edge loading, sensitivity to component positioning, typical soft tissue response, and use of imaging is increasingly understood. Taper tribocorrosion (from femoral head-neck junctions and other modular elements) and associated soft tissue inflammatory responses appear to be serious clinical issues that are not fully understood. WHERE DO WE NEED TO GO?: In the knee, clinical concerns remain with the efficacy of HXLPE, modular connections, and metal allergies. For PE wear in the hip, concerns remain regarding how to increase crosslinking of PE while minimizing PE fractures. With CoC articulations, questions remain on how to prevent noises, chipping, and impingement and if enhanced designs can contribute to improved results. For MoM articulations, we need to improve imaging tests for soft tissue reactions, determine best practices in terms of monitoring protocols, and better define if, how, and when to act on serum metal levels. For taper tribocorrosion, we need to use modularity wisely and also understand how to improve tapers and materials in the future. For patients at risk for tribocorrosion, we need to define realistic diagnostic and monitoring protocols. We also need to enhance revision methods, and the threshold of acceptable soft tissue damage, to minimize complications associated with soft tissue damage such as hip instability. HOW DO WE GET THERE?: HXLPE and other bearing surfaces will likely continue to be refined. We need to develop tapers with more resistance to tribocorrosion through improved understanding of the manufacturing process and ongoing engineering improvements. Revision procedures for wear and tribocorrosion can be enhanced by determining when partial component retention is appropriate and how best to manage soft tissue damage. For CoC articulations, enhanced designs are required to minimize noises, chipping, and impingement. Importantly, we must continue to promote and analyze joint replacement registries to identify early failures and analyze long-term successes.
Topics: Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Biomechanical Phenomena; Ceramics; Corrosion; Foreign-Body Reaction; Hip Joint; Hip Prosthesis; Humans; Knee Joint; Knee Prosthesis; Metal-on-Metal Joint Prostheses; Polyethylene; Prosthesis Design; Prosthesis Failure; Risk Factors; Stress, Mechanical; Time Factors; Treatment Outcome
PubMed: 24711136
DOI: 10.1007/s11999-014-3610-1 -
Journal of Orthopaedic Research :... Jul 2020Over the last three decades there have been significant advancements in the knee and hip replacement technology that has been driven by an issue in the past concerning... (Review)
Review
Over the last three decades there have been significant advancements in the knee and hip replacement technology that has been driven by an issue in the past concerning adverse local tissue reactions, aseptic and septic loosening. The implants and the materials we utilize have improved over the last two decades and in knee and hip replacement there has been a decrease in the failures attributed to wear and osteolysis. Despite these advancements there are still issues with patient satisfaction and early revisions due to septic and aseptic loosening in knee replacement patients. This article reviews the state of current implant material technology in hip and knee replacement surgery, discusses some of the unmet needs we have in biomaterials, and reviews some of the current biomaterials and technology that may be able to solve the most common issues in the knee and hip replacement surgery.
Topics: Arthroplasty, Replacement; Biocompatible Materials; Ceramics; Hip Prosthesis; Humans; Knee Prosthesis
PubMed: 32437026
DOI: 10.1002/jor.24750 -
Foot and Ankle Clinics Jun 2016Total ankle arthroplasty use has increased across Canada over the last two decades. Multiple implant designs are readily available and implanted across Canada. Although... (Review)
Review
Total ankle arthroplasty use has increased across Canada over the last two decades. Multiple implant designs are readily available and implanted across Canada. Although arthrodesis is a reliable procedure for treating end-stage ankle arthritis, ankle replacement is often the preferred surgical treatment by patients. A recent prospective study evaluated intermediate-term outcomes of ankle replacement and arthrodesis at multiple centers across Canada, with variability in prosthesis type, surgeon, and surgical technique. Intermediate-term clinical outcomes of total ankle replacement and ankle arthrodesis were comparable in a diverse cohort in which treatment was tailored to patient presentation; however, rates of reoperation and major complications were higher after ankle replacement.
Topics: Ankle Joint; Arthritis; Arthrodesis; Arthroplasty, Replacement, Ankle; Canada; Humans; Joint Prosthesis; Prosthesis Design
PubMed: 27261806
DOI: 10.1016/j.fcl.2016.01.011 -
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