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Journal of ISAKOS : Joint Disorders &... Oct 2023The reverse shoulder arthroplasty conceived by Paul Grammont in 1985 has gradually gained popularity as a treatment for multiple shoulder diseases. Unlike previous... (Review)
Review
The reverse shoulder arthroplasty conceived by Paul Grammont in 1985 has gradually gained popularity as a treatment for multiple shoulder diseases. Unlike previous reverse shoulder prosthesis characterized by unsatisfactory results and a high glenoid implant failure rate, the Grammont design has immediately shown good clinical outcomes. This semi constrained prosthesis solved the issues of the very first designs by medializing and distalizing the center of rotation with an increased stability of the replacement of the component. The indication was initially limited to cuff tear arthropathy (CTA). It has then been expanded to irreparable massive cuff tears and displaced humeral head fractures. The most frequent problems of this design are a limited postoperative external rotation and scapular notching. Different modifications to the original Grammont design have been proposed with the aim of decreasing the risk of failure and complications and improving the clinical outcomes. Both the position and version/inclination of the glenosphere and the humeral configuration (e.g. neck shaft angle) influence the RSA outcomes. A lateralized glenoid (whether with bone or metal) and a 135° Inlay system configuration leads to a moment arm which is the closest to the native shoulder. Clinical research will focus on implant designs reducing bone adaptations and revision rate, strategies to prevent more effectively infections. Furthermore, there is still room for improvement in terms of better postoperative internal and external rotations and clinical outcomes after RSA implanted for humeral fracture and revision shoulder arthroplasty.
Topics: Humans; Arthroplasty, Replacement, Shoulder; Shoulder Joint; Shoulder Prosthesis; Joint Prosthesis; Rotator Cuff Tear Arthropathy
PubMed: 37301479
DOI: 10.1016/j.jisako.2023.05.007 -
The Journal of Arthroplasty Jul 2023In an effort to increase satisfaction among total knee arthroplasty (TKA) patients, emphasis has been placed on implant positioning and limb alignment. Traditionally,... (Review)
Review
BACKGROUND
In an effort to increase satisfaction among total knee arthroplasty (TKA) patients, emphasis has been placed on implant positioning and limb alignment. Traditionally, the aim for TKA has been to achieve a neutral mechanical alignment (MA) to maximize implant longevity. However, with the recent spike in interest in individualized alignment techniques and with the advent of new technologies, surgeons are slowly evolving away from classical MA.
METHODS
This review elucidates the differences in alignment techniques for TKA, describes the concept of knee phenotypes, summarizes comparative studies between MA and individualized alignment, and provides a simple way to incorporate the latter into surgeons' practice.
RESULTS
In order to manage patients by applying these strategies in day-to-day practice, a basic understanding of the aforementioned concepts is essential. Transition to an individualized alignment technique should be done gradually with caution in a stepwise approach.
CONCLUSION
Alignment and implant positioning are now at the heart of the debate and surgeons are investigating a more personalized approach to TKA.
Topics: Humans; Arthroplasty, Replacement, Knee; Knee Prosthesis; Biomechanical Phenomena; Knee Joint; Knee; Osteoarthritis, Knee
PubMed: 36773657
DOI: 10.1016/j.arth.2023.01.060 -
Zeitschrift Fur Rheumatologie Dec 2023Arthrosis and autoimmune arthritis frequently lead to major impairment of hand function. Primary therapy consists of well- tried conservative treatments and joint... (Review)
Review
Arthrosis and autoimmune arthritis frequently lead to major impairment of hand function. Primary therapy consists of well- tried conservative treatments and joint preserving surgical options for special indications. In advanced stages silicon spacers remain the gold standard surgical option for replacement of proximal interphalangeal and metacarpophalgeal joints of the fingers. Alternatively, surface replacement prostheses can restore the biomechanical properties of these joints more porperly. In case of the carpometacarpal (CMC) joint of the thumb, arthroplasty is gaining popularity as modern implants show excellent mid-term outcome. Although current forth generation implants for wrist replacement are promising, total wrist arthroplasty is currently reserved for exceptional indications.
Topics: Humans; Wrist; Joint Prosthesis; Arthroplasty; Hand; Arthroplasty, Replacement; Joint Diseases; Wrist Joint
PubMed: 37828110
DOI: 10.1007/s00393-023-01420-8 -
Dermatologie (Heidelberg, Germany) Jan 2024
Topics: Humans; Antibiosis; Arthroplasty, Replacement; Joint Prosthesis; Endocarditis, Bacterial
PubMed: 37991532
DOI: 10.1007/s00105-023-05264-w -
Expert Review of Medical Devices 2023With the increasing demand for total knee arthroplasty (TKA) and the burden of revision TKA on the healthcare system, as well as the quality of life implications for... (Review)
Review
INTRODUCTION
With the increasing demand for total knee arthroplasty (TKA) and the burden of revision TKA on the healthcare system, as well as the quality of life implications for patients, it is extremely important for surgeons to be able to anticipate and prevent TKA mechanical complications. Surgeons must be familiar with the different causes and mechanisms of TKA complications so that they can properly treat patients with failed TKAs and better avoid these complications.
AREAS COVERED
This review addresses TKA mechanical complications and provides context for the topic. A detailed review of surgical factors, implant factors, and patient factors that contribute to mechanical complications after TKA is provided. All of the literature cited in this review was gathered from the PubMed online database using different keywords based on the section of the manuscript.
EXPERT OPINION
As surgeons and engineers solve certain issues in TKA, new challenges will inevitably arise. We must continue to push forward and innovate from both a surgical technique and implant design perspective.
Topics: Humans; Arthroplasty, Replacement, Knee; Knee Prosthesis; Quality of Life; Prosthesis Failure; Reoperation; Knee Joint; Retrospective Studies
PubMed: 37950354
DOI: 10.1080/17434440.2023.2282744 -
Hand Clinics Nov 2023Proximal interphalangeal joint arthroplasties can be performed in the setting of acute comminuted fracture, chronic fracture presentations, and posttraumatic arthritis.... (Review)
Review
Proximal interphalangeal joint arthroplasties can be performed in the setting of acute comminuted fracture, chronic fracture presentations, and posttraumatic arthritis. These surgeries provide excellent pain relief and patient satisfaction but patients should be cautioned not to expect an improvement in motion postoperatively. Despite high rates of minor complications and radiographic loosening, these implants have good rates of long-term survival with most revisions occurring in the early postoperative period. They provide viable alternatives to arthrodesis, osteotomy and amputation in the appropriate patient.
Topics: Humans; Osteoarthritis; Treatment Outcome; Joint Prosthesis; Retrospective Studies; Arthroplasty, Replacement, Finger; Finger Joint; Arthroplasty; Fractures, Bone; Range of Motion, Articular
PubMed: 37827610
DOI: 10.1016/j.hcl.2023.06.004 -
The Journal of Hand Surgery, European... Feb 2024We reviewed the incidence and management of complications after total wrist arthroplasty, as reported in the literature, with so-called fourth-generation implants and... (Review)
Review
We reviewed the incidence and management of complications after total wrist arthroplasty, as reported in the literature, with so-called fourth-generation implants and other recent designs. While early intraoperative and postoperative complications, including fractures, tendon lacerations, infection, nerve compression, tendonitis, stiffness and chronic regional pain syndrome, had an acceptable incidence, late complications, such as periprosthetic osteolysis and implant loosening, occurred more frequently. Implant survival at 10 years was in the range of 70%-80% in most publications. Several of the implants have been modified or withdrawn. Instability and dislocation were frequent after a pyrocarbon spacer. Failed arthroplasties can be salvaged by revision arthroplasty or total wrist arthrodesis. Revision arthroplasty has a lower survival rate than primary arthroplasty and does not clearly offer important significant advantages over total wrist arthrodesis in terms of patient-reported outcome measures. Further development of prosthetic design, new materials and more knowledge on patient-related risk factors are needed.
Topics: Humans; Wrist; Arthroplasty, Replacement; Joint Prosthesis; Postoperative Complications; Risk Factors; Reoperation
PubMed: 38315136
DOI: 10.1177/17531934231203297 -
Journal of ISAKOS : Joint Disorders &... Oct 2023Anatomical total shoulder arthroplasty in its modern form where it reproduces the normal shoulder has been utilized clinically for more than half a century. As the... (Review)
Review
Anatomical total shoulder arthroplasty in its modern form where it reproduces the normal shoulder has been utilized clinically for more than half a century. As the technology and the designs have changed to recreate the humeral and glenoid sides of the joint, the sophistication of design has resulted in the growing number of cases annually worldwide. This increase is due in part to the increasing number of indications that the prosthesis can treat with successful results. On the humeral side, there have been design changes to better reflect the proximal humeral anatomy, and humeral stems are increasingly placed safely without cement. Platform systems which allow conversion of a failed arthroplasty to a reverse configuration without stem extraction is another design change. Similarly, there has been increasing utilization of short stem and stemless humeral components. Extensive experience with shorter stem and stemless devices, however, has yet to demonstrate the purported advantages of these devices, as recent studies have demonstrated equivalent blood loss, fracture rates, operative times, and outcome scores. Easier revision with these shorter stems remains to be definitively established, with only one study comparing the ease of revision between stem types. On the glenoid side, hybrid cementless glenoids, inlay glenoids, cementless all-polyethylene glenoids, and augmented glenoids have all been investigated; however, the indications for these devices remain unclear. Lastly, innovative surgical approaches to implanting shoulder arthroplasty and the use of patient specific guides and computerized planning, while interesting concepts, still await validation before they are utilized on a widespread basis. While reverse shoulder arthroplasty has been increasingly used to reconstruct the arthritic shoulder, anatomic glenohumeral replacement maintains a significant role in the armamentarium of the shoulder surgeon.
Topics: Humans; Prosthesis Design; Arthroplasty, Replacement, Shoulder; Joint Prosthesis; Shoulder Prosthesis; Polyethylene
PubMed: 37207983
DOI: 10.1016/j.jisako.2023.05.001 -
Orthopedics 2023Hip hemiarthroplasty is a commonly performed orthopedic surgery, used to treat proximal femur fractures in the elderly population. Although hip hemiarthroplasty is... (Review)
Review
Hip hemiarthroplasty is a commonly performed orthopedic surgery, used to treat proximal femur fractures in the elderly population. Although hip hemiarthroplasty is frequently successful in addressing these injuries, complications can occur. Commonly seen complications include dislocation, periprosthetic fracture, acetabular erosion, and leg-length inequality. Less frequently seen complications include neurovascular injury and capsular interposition. This article presents a comprehensive review of the complications associated with the management of hip hemiarthroplasty. [. 2023;46(4):e199-e209.].
Topics: Humans; Aged; Hemiarthroplasty; Periprosthetic Fractures; Femur; Acetabulum; Joint Dislocations; Arthroplasty, Replacement, Hip; Femoral Neck Fractures; Treatment Outcome; Hip Prosthesis
PubMed: 36719411
DOI: 10.3928/01477447-20230125-06 -
The Journal of Hand Surgery, European... Jan 2024Total wrist arthroplasty (TWA) is gaining interest as a management option for wrist arthritis. This review article summarizes the current evidence base for TWA, focusing... (Review)
Review
Total wrist arthroplasty (TWA) is gaining interest as a management option for wrist arthritis. This review article summarizes the current evidence base for TWA, focusing on the performance and survivorship of fourth-generation implants. These appear to offer satisfactory patient-reported outcomes and survivorship over the medium term, but heterogeneity between implants and patient populations complicates data interpretation. We discuss issues facing TWA practice, including surgical competency, volume, implant development and stewardship. We acknowledge the need for further research on this topic and highlight a number of questions that need answering.
Topics: Humans; Joint Prosthesis; Wrist; Wrist Joint; Arthroplasty, Replacement; Arthritis
PubMed: 37882664
DOI: 10.1177/17531934231209638