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BMJ (Clinical Research Ed.) Apr 2024
Topics: Humans; Arthroplasty, Replacement, Shoulder; Shoulder Joint; Shoulder Prosthesis; Prosthesis Design
PubMed: 38688527
DOI: 10.1136/bmj.q952 -
Journal of Stomatology, Oral and... Sep 2023Alloplastic total temporomandibular joint replacement (TMJR) is the treatment of choice for end-stage temporomandibular joint diseases. Extended TMJR (eTMJR) is a... (Review)
Review
Alloplastic total temporomandibular joint replacement (TMJR) is the treatment of choice for end-stage temporomandibular joint diseases. Extended TMJR (eTMJR) is a modification of the standard alloplastic fossa-condyle joint that includes components extending further to the skull base or the mandible. The aim of this study is to review the use of the eTMJR prosthesis for the treatment of large craniomaxillofacial defects. Data mining was performed according to the PRISMA statement using online search in databases such as PubMed (Medline), Google Scholar, Dimensions, Semantic Scholar and Web of Science. A total of 19 case reports, 08 case series and 03 retrospective studies were identified. A total of 49 patients were presented in the case reports and case series, who were implanted with 56 eTMJR prostheses (07 bilateral and 42 unilateral procedures). The mean age of the patients was 36.02±16.54 years, the male to female patient ratio was 1:1.72 and the mean follow-up time was 23.74 ± 19.83 months. The eTMJR prosthesis was most frequently used to treat ameloblastoma and hemifacial microsomia. Analysis of the retrospective studies was performed in three domains: the baseline characteristic of patients, treatment outcomes in terms of functional variables and complications after eTMJR prostheses implantation. This study concluded that the implantion of the eTMJR prosthesis was uncommon, that appropriate class of eTMJR prosthesis was not reported, and that the width of the mandibular component (like the length) of eTMJR prosthesis has substantial variations.
Topics: Adult; Female; Humans; Male; Middle Aged; Young Adult; Arthroplasty, Replacement; Joint Prosthesis; Retrospective Studies; Temporomandibular Joint; Temporomandibular Joint Disorders
PubMed: 36720364
DOI: 10.1016/j.jormas.2023.101404 -
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 -
Hand Clinics Aug 2023Small joint arthroplasty of the hand has been an established means of joint preservation and pain relief for over a half a century. Despite this, metacarpophalangeal... (Review)
Review
Small joint arthroplasty of the hand has been an established means of joint preservation and pain relief for over a half a century. Despite this, metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joint arthroplasty has not achieved the long-term success seen with hip and knee arthroplasty. Problems following MCP, PIP, and carpometacarpal (CMC) joint arthroplasty can include intraoperative fracture, postoperative dislocation, recurrent pain, limitation of motion, and instability. The hand surgeon needs to be prepared for these problems and their management. This article addresses the management of the most common complications seen following MCP, PIP, and CMC arthroplasty.
Topics: Humans; Joint Prosthesis; Arthroplasty, Replacement, Finger; Arthroplasty; Finger Joint; Joint Dislocations; Range of Motion, Articular; Treatment Outcome
PubMed: 37453759
DOI: 10.1016/j.hcl.2023.02.006 -
The Bone & Joint Journal Nov 2023The number of revision total ankle arthroplasties (TAAs) which are undertaken is increasing. Few studies have reported the survival after this procedure. The primary aim...
AIMS
The number of revision total ankle arthroplasties (TAAs) which are undertaken is increasing. Few studies have reported the survival after this procedure. The primary aim of this study was to analyze the survival of revision ankle arthroplasties using large datasets. Secondary aims were to summarize the demographics of the patients, the indications for revision TAA, further operations, and predictors of survival.
METHODS
The study combined data from the National Joint Registry and NHS Digital to report the survival of revision TAA. We have previously reported the failure rates and risk factors for failure after TAA, and the outcome of fusion after a failed TAA, using the same methodology. Survival was assessed using life tables and Kaplan Meier graphs. Cox proportional hazards regression models were fitted to compare failure rates.
RESULTS
A total of 228 patients underwent revision TAA. The mean follow-up was 2.6 years (SD 2.0). The mean time between the initial procedure and revision was 2.3 years (SD 1.8). The most commonly used implant was the Inbone which was used in 81 patients. A total of 29 (12.7%) failed; nine (3.9%) patients underwent a further revision, 19 (8.3%) underwent a fusion, and one (0.4%) had an amputation. The rate of survival was 95.4% (95% confidence interval (CI) 91.6 to 97.5) at one year, 87.7% (95% CI 81.9 to 91.7; n = 124) at three years and 77.5% (95% CI 66.9 to 85.0; n = 57) at five years. Revision-specific implants had a better survival than when primary implants were used at revision. A total of 50 patients (21.9%) had further surgery; 19 (8.3%) underwent reoperation in the first 12 months. Cox regression models were prepared. In crude analysis the only significant risk factors for failure were the use of cement (hazard ratio (HR) 3.02 (95% CI 1.13 to 8.09)) and the time since the primary procedure (HR 0.67 (95% CI 0.47 to 0.97)). No risk factors for failure were identified in multivariable Cox regression modelling.
CONCLUSION
Revision TAAs have good medium term survival and low rates of further surgery. New modular revision implants appear to have improved the survival compared with the use of traditional primary implants at revision.
Topics: Humans; Ankle; Retrospective Studies; Arthroplasty, Replacement, Ankle; Ankle Joint; Joint Prosthesis; Reoperation; Prosthesis Design; Prosthesis Failure; Treatment Outcome
PubMed: 37909151
DOI: 10.1302/0301-620X.105B11.BJJ-2023-0199.R1 -
The Orthopedic Clinics of North America Jan 2024Total knee arthroplasty (TKA) is a widely accepted surgical procedure for managing end-stage knee osteoarthritis. Among the various TKA techniques, kinematic alignment... (Review)
Review
Total knee arthroplasty (TKA) is a widely accepted surgical procedure for managing end-stage knee osteoarthritis. Among the various TKA techniques, kinematic alignment has gained increasing popularity as it can potentially restore a more natural joint function. However, despite its theoretical advantages, kinematic total knee replacement presents several operative challenges that necessitate a thorough understanding and analysis of patient-specific anatomy during surgical planning and execution. This review article aims to critically evaluate the operative challenges associated with kinematic TKA and explore potential strategies to optimize surgical outcomes. The challenges encompass multiple aspects including patient selection, preoperative planning, bone cuts, soft tissue balancing, and component positioning.
Topics: Humans; Biomechanical Phenomena; Knee Joint; Arthroplasty, Replacement, Knee; Osteoarthritis, Knee; Knee Prosthesis
PubMed: 37980101
DOI: 10.1016/j.ocl.2023.07.001 -
The Journal of Hand Surgery... Oct 2023Literature investigating the long-term outcomes of prosthesis options for proximal interphalangeal (PIP) joint arthroplasty is scarce, with most reports combining... (Meta-Analysis)
Meta-Analysis
Literature investigating the long-term outcomes of prosthesis options for proximal interphalangeal (PIP) joint arthroplasty is scarce, with most reports combining indications and underlying pathologies in analyses. In this study, we aim to compare silicone, pyrocarbon and metal prostheses in PIP joint arthroplasty for primary degenerative osteoarthritis (OA). A review of scientific literature published between 1990 and 2021 was conducted. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Relevant studies were screened and the appropriate data was extracted. An evaluation of clinical outcomes (range of motion [ROM] and pain), complications (reoperation) and survival rates for each prosthesis was performed. Twelve studies were included for analysis with a total of 412 PIP joints. ROM was 66.6°, 55.8° and 46.4° for metal, silicone and pyrocarbon implants, respectively. Silicone implants had the best pain score on the visual analogue scale (1.2) followed by the pyrocarbon (2.6) and metal (3.9) groups. Complication rates were lowest in silicone implants (11.3%) compared to 18.5% in pyrocarbon and 22.4% in metal prostheses. Survival did not differ significantly amongst the three groups. Our findings suggest that for patients with primary degenerative OA, PIP joint arthroplasty using a silicone prosthesis can provide greater pain relief with lower complication rates compared to other implant options. Level III (Therapeutic).
Topics: Humans; Joint Prosthesis; Finger Joint; Arthroplasty, Replacement, Finger; Osteoarthritis; Arthroplasty; Silicones; Pain
PubMed: 37881822
DOI: 10.1142/S2424835523500571 -
European Journal of Trauma and... Oct 2023There are numerous operative procedures to treat osteoarthritic changes or a significant instability of the distal radioulnar joint (DRUJ). The key problem of most...
PURPOSE
There are numerous operative procedures to treat osteoarthritic changes or a significant instability of the distal radioulnar joint (DRUJ). The key problem of most methods is the destabilization of the forearm leading to secondary painful impingement between the radius and ulna, as well as a significant limitation of forearm rotation. The Aptis-Prosthesis designed by Scheker represents a complete substitute for the DRUJ. It is mostly used after the failure of various treatment options to solve the primary problems (arthritis, instability). We have used this type of prosthesis mostly after multiple operative treatments for more than 25 years.
METHODS
In the following retrospective study, we analyzed the data of patients that received an Aptis-prosthesis between 2016 and 2021. We have implanted this prosthesis in 13 cases (11 female, 2 male). Routinely, we document the clinical outcome concerning range of motion (ROM), grip strength, and pain according to numeric rate scaling (NRS) after more than 12 months (month 12-24). In addition, complications, osseous changes, and the rate of loosening of the prosthesis were registered. Furthermore, DASH-Score and patients ' satisfaction were evaluated. Also-as with other implants-follow-up x-rays were performed.
RESULTS
Removal or significant revision of any of the prostheses was not needed. The ROM was 68.1° ± 19.7° for pronation and 72.3° ± 20.9° for supination, grip strength amounted to 27.7 kg ± 11.0 kg equaling 83% of the contralateral side. NRS was 0 at rest and 1.2 (0-2) under weight-bearing. A lysis margin of the radial tap was noted in the radiological examination in 2 patients but without any signs of loosening. The DASH-Score added up to 31.8 ± 13.8 (13-55). All patients were satisfied or very satisfied having this implant.
CONCLUSION
The semiconstrained Aptis-prosthesis is a safe and efficient treatment option after failed DRUJ surgeries. It is striking that of the 20 implanted prostheses no significant revision or explantations were necessary over a period of 25 years.
Topics: Humans; Male; Female; Arthroplasty, Replacement; Joint Prosthesis; Retrospective Studies; Joint Instability; Patient Satisfaction; Wrist Joint; Range of Motion, Articular
PubMed: 37493761
DOI: 10.1007/s00068-023-02304-x -
JBJS Reviews Oct 2023» Metallosis is a rare but significant complication that can occur after total hip arthroplasty (THA) for a variety of reasons but most commonly in patients with...
» Metallosis is a rare but significant complication that can occur after total hip arthroplasty (THA) for a variety of reasons but most commonly in patients with metal-on-metal implants.» It is characterized by the visible staining, necrosis, and fibrosis of the periprosthetic soft tissues, along with the variable presence of aseptic cysts and solid soft tissue masses called pseudotumors secondary to the corrosion and deposition of metal debris.» Metallosis can present with a spectrum of complications ranging from pain and inflammation to more severe symptoms such as osteolysis, soft tissue damage, and pseudotumor formation.» Workup of metallosis includes a clinical evaluation of the patient's symptoms, imaging studies, serum metal-ion levels, and intraoperative visualization of the staining of tissues. Inflammatory markers such as erythrocyte sedimentation rate and C-reactive protein along with intraoperative frozen slice analysis may be useful in certain cases to rule out concurrent periprosthetic joint infection.» Management depends on the severity and extent of the condition; however, revision THA is often required to prevent rapid progression of bone loss and tissue necrosis.
Topics: Humans; Arthroplasty, Replacement, Hip; Hip Prosthesis; Metals; Inflammation; Necrosis
PubMed: 37812668
DOI: 10.2106/JBJS.RVW.23.00105 -
Journal of ISAKOS : Joint Disorders &... Oct 2023Total shoulder arthroplasty (TSA) has been the gold standard of care for end-stage glenohumeral arthritis. Outcomes are varied and have been affected by both patient and... (Review)
Review
Total shoulder arthroplasty (TSA) has been the gold standard of care for end-stage glenohumeral arthritis. Outcomes are varied and have been affected by both patient and implant characteristics. Patient factors, such as age, preoperative diagnosis, and preoperative glenoid morphology, can affect the outcomes after TSA. Similarly, the different glenoid and humeral component designs significantly affect the survivorship of TSA. Significant evolution has occurred in the design of the glenoid component with the aim of decreasing the glenoid-sided causes of failure in TSA. On the other hand, focus on the humeral component has been increasing as well, with a trend towards using shorter humeral stems. This article aims to look at the outcomes of TSA as affected by the various patient characteristics and design options for the glenoid and the humeral components. This review also aims to compare survivorship data from global literature and the Australian joint replacement registry and to provide insights into the implant combination that may provide the best patient outcome.
Topics: Humans; Arthroplasty, Replacement, Shoulder; Follow-Up Studies; Shoulder Prosthesis; Treatment Outcome; Survivorship; Australia
PubMed: 37100117
DOI: 10.1016/j.jisako.2023.04.002