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International Journal of Oral and... Aug 2022The aim of this study was to evaluate the revision rate after total alloplastic temporomandibular joint replacement (TMJR) and determine whether there is a higher risk... (Meta-Analysis)
Meta-Analysis Review
The aim of this study was to evaluate the revision rate after total alloplastic temporomandibular joint replacement (TMJR) and determine whether there is a higher risk of revision surgery with stock or custom-fitted prostheses (the two most current TMJR prosthesis types). A systematic review was performed, with a search of PubMed, Google Scholar, and the Cochrane Library in November 2020. Overall, 27 articles were included in this study, describing Biomet and TMJ Concepts prostheses and including postoperative data on complications requiring a return to the operating room. A total of 2247 prostheses were analysed: 1350 stock Biomet prostheses and 897 custom-fitted TMJ Concepts and custom-fitted Biomet prostheses. The global revision rate was 1.19 per 100 prosthesis-years. The most common reason for revision was heterotopic bone formation. Stock prostheses appeared to have a lower risk of revision compared to custom prostheses: rate ratio 0.52 (95% confidence interval 0.33-0.81, P-value 0.003). Regarding causes of revision, the only significant difference between the types of devices was a higher rate of heterotopic bone formation for custom-made prostheses (P = 0.001). The results of this study revealed a low revision rate post TMJR revision, with stock devices even less prone to such risk. Nevertheless, these results can be explained by the fact that custom-made prostheses are more likely to be used for cases in which the anatomy is significantly abnormal or there is a history of multiple joint surgeries, which carry a greater risk of complications and heterotopic bone formation.
Topics: Arthroplasty, Replacement; Cimetidine; Humans; Joint Prosthesis; Ossification, Heterotopic; Temporomandibular Joint; Temporomandibular Joint Disorders
PubMed: 35012826
DOI: 10.1016/j.ijom.2021.12.012 -
Der Orthopade Sep 2020Wrist arthroplasty is still an exceptional indication in the field of hand surgery. In recent years, it has become increasingly accepted as an alternative to wrist... (Review)
Review
BACKGROUND
Wrist arthroplasty is still an exceptional indication in the field of hand surgery. In recent years, it has become increasingly accepted as an alternative to wrist arthrodesis as the ultima ratio for panarthrosis or similar destruction of the wrist. In particular, the patient's desire for functional integrity also plays an important role.
COMPLICATIONS
While there were often complications with earlier prosthesis designs of the older generations and only a short survival rate could be achieved, this has improved, if the indication of the so-called fourth generation prostheses is done properly. Survival rates of over 10 years are no longer uncommon, even without revision operations. Currently, the indication for hemiarthroplasty has been increasing, particularly in the case of post-traumatic destruction. Those who are seriously interested in endoprosthesis should also be able to treat the associated complications. The present article is intended to provide an overview of common or potential complications in the context of wrist arthroplasty and to demonstrate possible solutions by presenting case studies. The basics of primary implantation are, therefore, not discussed. Reference is made to further literature.
Topics: Arthroplasty, Replacement; Hemiarthroplasty; Humans; Joint Prosthesis; Prosthesis Design; Reoperation; Wrist; Wrist Joint
PubMed: 32776275
DOI: 10.1007/s00132-020-03968-8 -
Journal of Orthopaedic Research :... Sep 2021Over the last three decades, there have been significant advancements in knee and hip replacement technology. The implants and the surgical technology we now have to... (Review)
Review
Over the last three decades, there have been significant advancements in knee and hip replacement technology. The implants and the surgical technology we now have to aid in their implantation are advancing and improving functional outcomes and survivorship. Despite these advancements, there are still issues with patient satisfaction, functional limitations, and early revisions due to instability and aseptic loosening. This article reviews the state of current technology in hip and knee replacement implant design and surgical technique, and reviews some of the current implant designs and surgical technologies that may be able to solve some of the most common issues in the knee and hip replacement surgery.
Topics: Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Humans; Knee Joint; Knee Prosthesis; Prosthesis Design; Prosthesis Failure; Reoperation
PubMed: 33002224
DOI: 10.1002/jor.24873 -
International Orthopaedics Oct 2015The purpose of this review was to assess the ten to 15-year outcomes of metal-on-metal hip resurfacing (MoM HR) when performed at designing and independent centres, and... (Review)
Review
PURPOSE
The purpose of this review was to assess the ten to 15-year outcomes of metal-on-metal hip resurfacing (MoM HR) when performed at designing and independent centres, and make recommendations for the future use of MoM HR.
METHODS
Studies reporting ten to 15-year outcomes for modern MoM HR devices from both designing and independent centres were reviewed. Outcomes from these studies were assessed to allow the formulation of recommendations for the future use of MoM HR.
RESULTS
Two MoM HR designs, the Birmingham Hip Resurfacing (BHR) and Conserve Plus, have outcomes reported at a minimum of ten years. The BHR was the only device with outcomes reported at a minimum of ten years by both designing (overall survival of up to 95.8 % at 15 years) and independent surgeons (overall survival of 87.1-94.5 % at ten years). Implant survival in these seven BHR studies was influenced by the pre-operative diagnosis (primary osteoarthritis had better outcomes), gender (male patients had better outcomes), and femoral component head size (larger sizes had better outcomes). In contrast to independent centres, designing surgeons reported acceptable outcomes in female patients undergoing BHR.
CONCLUSIONS
There remains a role for MoM HR in young active male patients with primary osteoarthritis, provided the surgeon has sufficient experience in the procedure, the implant has an established record, and the patient is aware of the potential risks associated with MoM bearings and HR. Very experienced HR surgeons may also consider this procedure in females provided they meet the refined inclusion criteria described (including femoral head sizes of 46 mm and above).
Topics: Arthroplasty, Replacement, Hip; Forecasting; Hip Prosthesis; Humans; Metal-on-Metal Joint Prostheses; Treatment Outcome
PubMed: 25708400
DOI: 10.1007/s00264-015-2692-z -
Foot and Ankle Clinics Jun 2017
Topics: Ankle Joint; Arthritis; Arthroplasty, Replacement, Ankle; Humans; Joint Prosthesis
PubMed: 28502360
DOI: 10.1016/j.fcl.2017.01.015 -
Journal of Shoulder and Elbow Surgery Sep 2014Since the original Neer humeral replacement in the 1950s, the standard primary anatomic total shoulder arthroplasty design has slowly evolved. Most recently, the humeral... (Review)
Review
BACKGROUND
Since the original Neer humeral replacement in the 1950s, the standard primary anatomic total shoulder arthroplasty design has slowly evolved. Most recently, the humeral stem has become progressively shorter to help combat stem-related complications. Currently, there are several companies who have developed and marketed a stemless humeral arthroplasty component.
MATERIALS AND METHODS
Manufacturers' data for 5 stemless shoulder arthroplasty components currently on the market were analyzed and reviewed. A literature review of short-term results for stemless shoulder arthroplasty was completed.
RESULTS
Of the stemless shoulder arthroplasty systems available on the market, 3 are currently undergoing clinical trials in the United States. The Tornier Simpliciti (Tornier, Edina, MN, USA) clinical trial began in 2011. The study with 2-year minimum follow-up results is scheduled for completion in November 2014. The Arthrex Eclipse (Arthrex, Naples, FL, USA) clinical trial was started in January 2013. The tentative study completion date is 2017. The Biomet Nano (Biomet, Warsaw, IN, USA) clinical trial began in October 2013 and also has a tentative completion date of 2017. No other clinical trial is currently under way in the United States. Early results for stemless shoulder arthroplasty indicate clinical results similar to standard stemmed shoulder arthroplasty. Radiographic analysis indicates implant stability without migration or subsidence at 2- to 3-year minimum follow-up..
CONCLUSIONS
Several stemless shoulder arthroplasty implants are available outside the United States. Early clinical and radiographic results are promising, but well-designed clinical studies and midterm results are lacking. Three clinical trials are currently under way in the United States with initial availability for use anticipated in 2015.
Topics: Arthroplasty, Replacement; Humans; Humerus; Joint Prosthesis; Prosthesis Design; Shoulder Joint; United States
PubMed: 25027481
DOI: 10.1016/j.jse.2014.05.005 -
Joint Bone Spine Oct 2016To describe the occurrence in prosthetic joints of crystal-induced arthritis (CIA) defined as the deposition within the synovial membrane and/or joint cavity of calcium...
OBJECTIVES
To describe the occurrence in prosthetic joints of crystal-induced arthritis (CIA) defined as the deposition within the synovial membrane and/or joint cavity of calcium pyrophosphate dehydrate (CPPD) (chondrocalcinosis), sodium urate (gout), or hydroxyapatite.
METHODS
We retrospectively reviewed the 7 cases of prosthetic-joint CIA seen between 1993 and 2013 at a medical-surgical center specialized in the management of osteoarticular infections.
RESULTS
The 4 females and 3 males ranged in age from 67 to 79 years. Acute CIA occurred at the knee in 6 patients (5 with total knee arthroplasty and 1 with unicompartmental knee arthroplasty) and at the hip in 1 patient (with total hip arthroplasty). Time from arthroplasty to CIA varied from 7 days to 9 years. An abrupt onset was a consistent feature, with pain, complete loss of function, and local evidence of inflammation. A single patient had a fever and 6 patients had laboratory evidence of systemic inflammation. Joint aspiration showed hemarthrosis in 3 patients and inflammatory joint fluid with 20,000 to 79,000neutrophils/mm(3) in 6 patients. Joint fluid cultures were negative in 6 patients. CPPD crystals were evidenced in 5 patients, including 1 who also had hydroxyapatite crystals detected by electron microscopy after alizarin red staining. Monosodium urate crystals were found in 1 patient. The remaining patient had both CPPD crystals and positive cultures for Campylobacter fetus. In 5 patients, treatment with colchicine or a nonsteroidal antiinflammatory drug ensured prompt control of the symptoms and systemic inflammation. The patient with total hip arthroplasty underwent joint aspiration for hemarthrosis. In 1 patient, an intraarticular injection of triamcinolone hexacetonide improved the symptoms and systemic inflammation. The patient with Campylobacter fetus infection was treated with antibiotics, excision of the abscess, and synovectomy.
CONCLUSION
CIA may occur after arthroplasty, within synovial membrane remains or neosynovium developed around the prosthetic joint. CIA is a manifestation of a metabolic disease that persists and can reactivate after surgery. Routine testing for crystals is rarely performed in patients with sterile arthritis of a prosthetic joint, and crystals are difficult to detect in joints with hemarthrosis; consequently, the frequency of prosthetic-joint CIA may be underestimated. Although rare, CIA should be considered routinely when symptoms suggesting septic arthritis develop in a prosthetic joint, in order to avoid unnecessary prolonged antibiotic therapy and, in some cases, surgery. The treatment is usually simple.
Topics: Aged; Aged, 80 and over; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Crystal Arthropathies; Female; Hip Joint; Humans; Joint Prosthesis; Knee Joint; Male; Retrospective Studies
PubMed: 27020953
DOI: 10.1016/j.jbspin.2016.01.006 -
Operative Orthopadie Und Traumatologie Oct 2018Reduction of pathogens in the knee joint by removal of infected periprosthetic soft tissue, irrigation and modular implant exchange of the total knee arthroplasty (TKA)... (Review)
Review
OBJECTIVE
Reduction of pathogens in the knee joint by removal of infected periprosthetic soft tissue, irrigation and modular implant exchange of the total knee arthroplasty (TKA) to eliminate the infection and long-term preservation of the TKA.
INDICATIONS
Early infection of TKA (<4 weeks postoperatively); acute hematogenous TKA infection (symptom duration <3 weeks).
CONTRAINDICATIONS
Delayed (>4 weeks postoperatively) or chronic TKA infection; TKA loosening; difficult-to-treat pathogens; critical soft tissue with draining sinus tract.
SURGICAL TECHNIQUE
Excision of the wound or old surgical scar (= primary approach to the knee joint). Preparation of subcutaneous tissue. Opening the joint capsule. Removal of the old suture in tissue layers. Five tissue samples taken for microbiological and 1 tissue sample for histopathological examination using an unused instrument from the knee joint. Debridement of the upper recesses with complete synovectomy. Partial resection of Hoffa's fat body. Eversion of the patella. Resection of peripatellar soft tissue and infection membranes from the medial and lateral part of the capsule. Removal of the polyethylene inlay. Débridement of the posterior joint capsule with protection of vessels and nerve. Systematic removal of avital and infected periprosthetic tissue. Checking for correct fit of the femoral and tibial part of TKA. Antiseptic rinsing of the joint cavity with mechanical cleaning of the TKA. Extensive irrigation of the joint cavity by jet lavage (3-5 l saline solution). Glove change of the surgical team and new operation coverage. Inserting new polyethylene. Layerwise wound closure.
POSTOPERATIVE MANAGEMENT
Removal of redon drain on postoperative day 2. Physiotherapy and CPM. Removal of cutaneous suture about 2 weeks postoperatively. Antibiotic treatment for 12 weeks postoperatively (2 weeks intravenous, 10 weeks per oral). Checking of inflammatory markers.
RESULTS
Using correct indications and therapy, up to 90% of patients with acute periprosthetic TKA infection can be successfully treated with infection elimination and TKA preservation.
Topics: Arthroplasty, Replacement, Knee; Debridement; Device Removal; Humans; Knee Joint; Knee Prosthesis; Prosthesis-Related Infections; Reoperation; Therapeutic Irrigation; Treatment Outcome
PubMed: 30054644
DOI: 10.1007/s00064-018-0558-4 -
Sports Medicine and Arthroscopy Review Dec 2014Longevity of total anatomic and reversed shoulder arthroplasty largely depends on accurate correction of glenoid deformity and correct positioning and fixation of the... (Review)
Review
Longevity of total anatomic and reversed shoulder arthroplasty largely depends on accurate correction of glenoid deformity and correct positioning and fixation of the glenoid component. However, the morphology of the scapula is inconsistent, varying degrees of osteoarthritis cause numerous anatomic changes, and standard 2-dimensional imaging and standard surgical instrumentation are imprecise for preoperative planning and execution of glenoid reconstruction. Recently, various authors have shown that preoperative 3-dimensional surgical planning and computer navigation technology may increase the accuracy and repeatability of the implantation of the glenoid component, especially for the position and orientation of the glenosphere and screws in reversed arthroplasty. These novel techniques may allow the surgeon to better define the preoperative deformity, select the optimal implant position, and then accurately execute the plan at the time of surgery. Future studies are needed to determine the long-term effect on functional outcome and cost-effectiveness of computer-assisted technology in shoulder arthroplasty.
Topics: Arthroplasty, Replacement; Humans; Imaging, Three-Dimensional; Joint Prosthesis; Prosthesis Design; Shoulder Joint; Surgery, Computer-Assisted
PubMed: 25370882
DOI: 10.1097/JSA.0000000000000045 -
The Orthopedic Clinics of North America Apr 2020Prosthetic joint infection is still a rare but devastating complication following total hip and knee arthroplasty. The incidence of prosthetic joint infection ranges... (Review)
Review
Prosthetic joint infection is still a rare but devastating complication following total hip and knee arthroplasty. The incidence of prosthetic joint infection ranges from 2% to 4% in primary procedures as opposed to nearly 20% in revisions. The challenges that arise here include mainly diagnostic uncertainty, management in immunocompromised patients, recurrent infection, infection around a well-fixed implant, and substantial bone loss, and require careful preoperative assessment and well-defined management plans. This article summarizes recent developments in the diagnosis and management of this increasingly prevalent issue specifically focusing on outcomes following debridement, antibiotics, and implants retention and one-stage revision procedures.
Topics: Anti-Bacterial Agents; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Biomarkers; Debridement; Device Removal; Humans; Joint Prosthesis; Prosthesis-Related Infections; United Kingdom
PubMed: 32138852
DOI: 10.1016/j.ocl.2019.12.003