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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 -
Seminars in Musculoskeletal Radiology Jun 2024The prevalence of total knee arthroplasty (TKA) is increasing with the aging population. Although long-term results are satisfactory, suspected postoperative... (Review)
Review
The prevalence of total knee arthroplasty (TKA) is increasing with the aging population. Although long-term results are satisfactory, suspected postoperative complications often require imaging with the implant in place. Advancements in computed tomography (CT), such as tin prefiltration, metal artifact reduction algorithms, dual-energy CT with virtual monoenergetic imaging postprocessing, and the application of cone-beam CT and photon-counting detector CT, allow a better depiction of the tissues adjacent to the metal. For magnetic resonance imaging (MRI), high bandwidth (BW) optimization, the combination of view angle tilting and high BW, as well as multispectral imaging techniques with multiacquisition variable-resonance image combination or slice encoding metal artifact correction, have significantly improved imaging around metal implants, turning MRI into a useful clinical tool for patients with suspected TKA complications.
Topics: Humans; Arthroplasty, Replacement, Knee; Postoperative Complications; Magnetic Resonance Imaging; Knee Prosthesis; Knee Joint; Tomography, X-Ray Computed
PubMed: 38768593
DOI: 10.1055/s-0044-1781470 -
Zhongguo Gu Shang = China Journal of... Nov 2023The correct alignment of the knee joint is considered to be one of the most influential factors in determining the long-term prognosis after total knee... (Review)
Review
The correct alignment of the knee joint is considered to be one of the most influential factors in determining the long-term prognosis after total knee arthroplasty(TKA). In order to achieve the correct alignment goal, many different alignment concepts and surgical techniques have been established. For example, mechanical alignment(MA), kinematic alignment(KA) and functional alignment(FA) have their own characteristics. MA focuses on achieving neutral alignment of the limbs, parallel and equal bone gaps during stretching and flexion. KA aims to restore the patient 's natural joint line, make the joint level and angle normal and improve the physiological soft tissue balance, and strive to reproduce the normal knee function;among them, functional alignment(FA) developed with robot-assisted surgery technology is a relatively new alignment concept. It not only considers the alignment of the body, but also aims to achieve flexion and extension balance, while respecting the native soft tissue capsule. It not only restores the plane and slope of the in situ joint line accurately during the operation, but also takes into account the balance of soft tissue, which is a better alignment method. Therefore, it is of great significance to correctly construct the lower limb force line of patients, which is helpful to restore knee joint function, relieve pain symptoms and prolong the service life of prosthesi. However, compared with traditional TKA, the operation time of robot-assisted FA-TKA is prolonged, which means that the probability of postoperative infection will be greater. At present, most studies of FA technology report short-term results, and the long-term efficacy of patients is not clear. Therefore, long-term research results are needed to support the application of this technology. Therefore, the author makes a review on the research status of functional alignment.
Topics: Humans; Arthroplasty, Replacement, Knee; Robotics; Knee Joint; Osteoarthritis, Knee; Knee; Knee Prosthesis; Biomechanical Phenomena
PubMed: 38012884
DOI: 10.12200/j.issn.1003-0034.2023.11.019 -
Orthopaedics & Traumatology, Surgery &... Feb 2024Current trends in total hip replacement aim at soft tissue and bone stock conservation. At the same time, mean patient age has been decreasing from decade to decade,... (Review)
Review
Current trends in total hip replacement aim at soft tissue and bone stock conservation. At the same time, mean patient age has been decreasing from decade to decade, raising the issue of iterative revision. Short stems seek to resolve the problem on the femoral side. Hopefully, revision of a short stem will be easier and bone stock depletion will be less than with a standard stem. Short stems also seem to have other advantages: automatically personalized biomechanical reconstruction, easier minimally invasive strategies, very low rate of hip pain, more harmonious distribution of bone stress, etc. Despite these advantages, however, use of short stems since their introduction in the late 1980s has varied from country to country, and is not widespread in France. The present study addressed several questions concerning these implants. Firstly, what is a "short" stem? Then, what are the indications and contraindications? Shortened standard stems do not come under the concept of short stem and will not be dealt with here. Furthermore, the learning curve and specificities of short stems need to be acquired. Implantation technique differs greatly from standard stems, and short stem implantation requires particular rigor. Results also need to be assessed, and especially the rate of complications as compared to standard stems. And lastly, it needs to be determined whether the advantages are real or only theoretical: this will determine their usefulness and role in the armamentarium, in which short stems are a new paradigm. LEVEL OF EVIDENCE: Expert opinion.
Topics: Humans; Hip Prosthesis; Prosthesis Design; Arthroplasty, Replacement, Hip; Femur; Arthralgia; Reoperation
PubMed: 38040113
DOI: 10.1016/j.otsr.2023.103779 -
Radiographics : a Review Publication of... Jan 2024Ankle arthritis can result in significant pain and restriction in range of motion. Total ankle replacement (TAR) is a motion-preserving surgical option used as an...
Ankle arthritis can result in significant pain and restriction in range of motion. Total ankle replacement (TAR) is a motion-preserving surgical option used as an alternative to total ankle arthrodesis to treat end-stage ankle arthritis. There are several generations of TAR techniques based on component design, implant material, and surgical technique. With more recent TAR implants, an attempt is made to minimize bone resection and mirror the native anatomy. There are more than 20 implant devices currently available. Implant survivorship varies among prosthesis types and generations, with improved outcomes reported with use of the more recent third- and fourth-generation ankle implants. Pre- and postoperative assessments of TAR are primarily performed by using weight-bearing radiography, with weight-bearing CT emerging as an additional imaging tool. Preoperative assessments include those of the tibiotalar angle, offset, and adjacent areas of arthritis requiring additional surgical procedures. US, nuclear medicine studies, and MRI can be used to troubleshoot complications. Effective radiologic assessment requires an understanding of the component design and corresponding normal perioperative imaging features of ankle implants, as well as recognition of common and device-specific complications. General complications seen at radiography include aseptic loosening, osteolysis, hardware subsidence, periprosthetic fracture, infection, gutter impingement, heterotopic ossification, and syndesmotic nonunion. The authors review several recent generations of TAR implants commonly used in the United States, normal pre- and postoperative imaging assessment, and imaging complications of TAR. Indications for advanced imaging of TAR are also reviewed. RSNA, 2023 Supplemental material is available for this article. Test Your Knowledge questions for this article are available through the Online Learning Center.
Topics: Humans; Arthroplasty, Replacement, Ankle; Treatment Outcome; Ankle Joint; Arthritis; Radiography; Retrospective Studies; Joint Prosthesis
PubMed: 38096110
DOI: 10.1148/rg.230111 -
Foot & Ankle International Oct 2023Outcome reports for Alpha Ankle Arthroplasty (AAA), a third-generation implant relying on a mobile bearing design for total ankle replacement, are sparse. This...
BACKGROUND
Outcome reports for Alpha Ankle Arthroplasty (AAA), a third-generation implant relying on a mobile bearing design for total ankle replacement, are sparse. This retrospective study evaluated the midterm survivorship, clinical, and radiologic outcomes after implantation of this implant.
METHODS
For 64 patients who received 65 Triple A ankle implants between 2009 and 2020, implant survival was calculated using the Kaplan-Meier curve. Clinical outcomes were evaluated by measuring the range of motion, stability, Western Ontario and McMaster Universities Osteoarthritis Questionnaire score (WOMAC), and American Orthopaedic Foot & Ankle Society ankle-hindfoot score (AOFAS). The average pain level and satisfaction with the postoperative result were rated on a numeric rating scale (0-10). Additionally, radiologic analysis was performed using anteroposterior and lateral radiographs and tibiotalar alignment was assessed.
RESULTS
The implant-survival rate was 61.5% at a mean follow-up of 8.2 years. Twenty-five patients (38.5%) required revision surgery (average time to revision, 3.1 years, 95% CI 2.1-4.1 years). For patients without revisions, the average range of motion in dorsiflexion and plantarflexion were 3.6 ± 4.2 degrees and 21.9 ± 7.8 degrees, respectively. The mean WOMAC and AOFAS scores were 44.7 ± 47.5 and 75.1 ± 14.0, respectively. The average pain and subjective satisfaction scores were 2.0 ± 1.7 and 8.5 ± 1.9, respectively. Mean alignment values did not differ significantly for patients who required revision surgery.
CONCLUSION
We found a high revision rate with use of the AAA. However, patients who did not require revision surgery had, on average, high satisfaction and good functional outcomes.
LEVEL OF EVIDENCE
Level IV, case series.
Topics: Humans; Ankle; Joint Prosthesis; Retrospective Studies; Arthroplasty, Replacement, Ankle; Ankle Joint; Reoperation; Pain; Treatment Outcome
PubMed: 37655685
DOI: 10.1177/10711007231186375 -
BMC Musculoskeletal Disorders Apr 2024Total joint arthroplasty as a surgical treatment option for trapeziometacarpal joint arthritis is recently revived. The aim of this study is to report on mid- and...
BACKGROUND
Total joint arthroplasty as a surgical treatment option for trapeziometacarpal joint arthritis is recently revived. The aim of this study is to report on mid- and long-term results of the Elektra (single-mobility) and Moovis (dual-mobility) prosthesis for treatment of primary thumb carpometacarpal joint arthritis.
METHODS
In this retrospective, monocentric, descriptive cohort study, 31 prostheses were evaluated that were implanted by a single surgeon in 26 patients between 2009 and 2019. Indication for surgery was trapeziometacarpal joint osteoarthritis (Eaton/Littler Stage II and III). Clinical and radiological follow-up was performed at a minimum of 24 months. The postoperative assessment included range of motion, pain, strength as well as functional scores (DASH, MHQ). Implant survival and complications were the primary endpoints.
RESULTS
10 Elektra and 21 Moovis prostheses were implanted between 2009 and 2019 with a mean follow-up of 74.2 months in the Elektra and 41.4 months in the Moovis group. The average patients' age at surgery was 64 years. Postoperative pain levels (VAS 0-10) were below 2 at rest and under stress in both groups. Grip/pinch strength and range of motion showed results comparable to the contralateral hand. Opposition was excellent with an average Kapandji index of 9.6 in both groups. Elektra achieved slightly better functional scores in the DASH and MHQ score. Satisfaction was high in both groups, and 96% of the patients would recommend the procedure. Metacarpophalangeal hyperextension > 15° was seen in 3 patients per group preoperatively and was corrected to < 5° post-surgery. 3 Elektra prostheses were revised due to cup loosening and dislocation for cup and/or neck replacement or secondary trapeziectomy. 1 Moovis prosthesis was revised with an exchange of the neck to a larger size due to restricted movement. After the mean follow-up of 7.9 years in Elektra and 3.5 years in MOOVIS, cumulative survival was 68.6% vs. 95.2%, respectively.
CONCLUSIONS
In this mid- to long-term retrospective analysis, total joint arthroplasty in primary trapeziometacarpal joint arthritis results in low pain levels, excellent mobility and clinical function. Patient satisfaction is overall high. While revision due to cup loosening occurred more often in patients with single-mobility implants, no cases of dislocation or loosening of components were observed in the dual-mobility group.
TRIAL REGISTRATION
The study was conducted in accordance with the Declaration of Helsinki, and approved by the Ethics Committee of the Medical Faculty of Heidelberg University, reference number S-150/2020.
Topics: Humans; Male; Retrospective Studies; Female; Middle Aged; Carpometacarpal Joints; Aged; Joint Prosthesis; Osteoarthritis; Range of Motion, Articular; Treatment Outcome; Prosthesis Design; Follow-Up Studies; Trapezium Bone; Arthroplasty, Replacement; Thumb
PubMed: 38664698
DOI: 10.1186/s12891-024-07439-5 -
Hand Surgery & Rehabilitation Jun 2024Total joint replacement has become significantly more common as a treatment for advanced trapeziometacarpal joint osteoarthritis in recent years. The latest generation...
INTRODUCTION
Total joint replacement has become significantly more common as a treatment for advanced trapeziometacarpal joint osteoarthritis in recent years. The latest generation of prostheses with dual-mobility designs leads to very good functional results and low rates of loosening and dislocation in the short and medium term. Biomechanical studies showed that central placement and parallel alignment of the cup with respect to the proximal articular surface of the trapezium are crucial for both cup stability and prevention of dislocation. Despite correct positioning of the guidewire, incorrect placement or tilting of the inserted cup may occur, requiring immediate intraoperative revision.
METHODS
The existing spherical and conical cup models in sizes 9 mm and 10 mm were transferred to a computer-aided design dataset. Depending on the intraoperative complication (tilting or incorrect placement), the revision options resulting from the various combinations of cup type and size were simulated and analyzed according to the resulting defect area and bony contact area.
RESULTS
In well centered cups, a size 9 conical cup could be replaced by a size 9 spherical cup and still be fixed by press-fit. Conversely, a size 9 spherical cup could not be replaced by a size 9 conical cup, but only by a size 10 cup, of whatever shape. When a size 9 conical cup was tilted up to 20°, the best revision option was to resect the sclerotic margin and insert a size 10 conical cup deeper into the cancellous bone, to achieve the largest contact area with the surrounding bone. When a size 9 cup of whatever shape was poorly centered (misplaced with respect to the dorsopalmar or radioulnar line of the trapezium), placement should be corrected using a size 10 cup, combined with autologous bone grafting of the defect. Again, the size 10 conical cup showed the largest bony contact area.
CONCLUSION
Our computer-based measurements suggested options for intraoperative cup revision depending on cup shape and size and on type of misalignment with resulting bone defects. These suggestions, however, need to be confirmed in anatomic specimens before introducing them into clinical practice.
Topics: Humans; Prosthesis Design; Reoperation; Joint Prosthesis; Computer Simulation; Computer-Aided Design; Carpometacarpal Joints; Arthroplasty, Replacement; Prosthesis Failure; Osteoarthritis; Trapezium Bone
PubMed: 38701947
DOI: 10.1016/j.hansur.2024.101712 -
Hand (New York, N.Y.) Sep 2023Degenerative arthritis of the proximal interphalangeal (PIP) joint of the long fingers is a common disorder affecting mainly a female middle-aged population....
BACKGROUND
Degenerative arthritis of the proximal interphalangeal (PIP) joint of the long fingers is a common disorder affecting mainly a female middle-aged population. Conservative treatment is often effective, but in some cases, pain can persist which can lead to invalidating function. Besides denervation and arthrodesis, arthroplasty is a valuable alternative treatment. The goal of this retrospective study was to determine the clinical and radiological outcomes of the TACTYS prosthesis with a mean follow-up of more than 5 years.
METHODS
Between October 2005 and August 2019 10 joints in 9 patients, one patient had two prostheses in two separate fingers (4 males and 6 women) were treated for painful degenerative arthritis of the long fingers with a TACTYS prosthesis (Stryker Inc, Kalamazoo, Michigan). Power grip and pinch force were tested preoperatively and postoperatively, and the functional outcome survey is performed using the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), recall QuickDASH, and Patient-Rated Wrist Evaluation standardized questionnaires scored of 100 and the Visual Analog Scale (VAS) from 0 to 10.
RESULTS
Mean follow-up was 65.70 months (range: 23-106). Mean age was 71.5 years (range: 64-83). QuickDASH score evolved from 68.43 to 41.92, range of motion from 37.5° to 45.1°, VAS from 6.65 to 1/10. Power grip and precision pinch evolved from 16.44 to 20.80 kg and 1.97 to 2.85 kg, respectively.
CONCLUSIONS
TACTYS arthroplasty can be proposed for people who have been treated long enough with unsuccessful conservative treatment. Infection rate is still the highest complication, which can evolve in invalidating arthrodesis. It should be proposed exceptionally if the PIP joint arthritis causes invalidating functional pain.
Topics: Middle Aged; Male; Humans; Female; Aged; Osteoarthritis; Follow-Up Studies; Retrospective Studies; Treatment Outcome; Joint Prosthesis; Prosthesis Design; Arthroplasty, Replacement, Finger; Finger Joint; Arthroplasty; Pain
PubMed: 35220793
DOI: 10.1177/15589447211030962 -
European Journal of Orthopaedic Surgery... Oct 2023International joint registries provide high volumes of information in relation to the performance of total knee arthroplasty on a global scale. Distillation of this data... (Review)
Review
INTRODUCTION
International joint registries provide high volumes of information in relation to the performance of total knee arthroplasty on a global scale. Distillation of this data can be challenging, particularly with the establishment of more arthroplasty registries on a yearly basis. We therefore aim to present key information from these registries in relation to primary total knee arthroplasty. The specific questions of interest include: Which fixation type is superior in TKA? Does the level of constraint impact on clinical performance? How do partial knee replacements perform in the registries? Does patellar resurfacing lead to superior results? Are there any specific implants which perform particularly well or poorly?
METHODS
A comprehensive review of the major English-speaking knee arthroplasty registries across the globe was performed. Given the expanding large number of registries worldwide, it was not possible to perform a comprehensive review of all registries and so, a detailed review of the major English-speaking knee arthroplasty registries was included. Key trends and developments in implant performance were identified and presented in the current article.
RESULTS
Total knee replacements have lower revision rates than both unicompartmental and patellofemoral joint replacement procedures. Patellofemoral joint replacements have the highest failure rate of all knee replacement procedures. Cruciate-Retaining (CR) TKR designs have superior outcomes to Posterior-Stabilized (PS) designs across all registries. Patellar resurfacing appears to confer an advantage over non-resurfaced patellas in primary TKR.
CONCLUSION
We present current global trends in the utility and performance of TKA based on data from English-speaking arthroplasty registries.
Topics: Humans; Arthroplasty, Replacement, Knee; Knee Prosthesis; Patella; Reoperation; Registries; Knee Joint; Osteoarthritis, Knee
PubMed: 36947314
DOI: 10.1007/s00590-023-03521-1