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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 -
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 -
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 -
Current Osteoporosis Reports Oct 2020The purpose of this review is to critically evaluate the current literature regarding implant fixation in osteoporotic bone. (Review)
Review
PURPOSE OF REVIEW
The purpose of this review is to critically evaluate the current literature regarding implant fixation in osteoporotic bone.
RECENT FINDINGS
Clinical studies have not only demonstrated the growing prevalence of osteoporosis in patients undergoing total joint replacement (TJR) but may also indicate a significant gap in screening and treatment of this comorbidity. Osteoporosis negatively impacts bone in multiple ways beyond the mere loss of bone mass, including compromising skeletal regenerative capacity, architectural deterioration, and bone matrix quality, all of which could diminish implant fixation. Recent findings both in preclinical animal models and in clinical studies indicate encouraging results for the use of osteoporosis drugs to promote implant fixation. Implant fixation in osteoporotic bone presents an increasing clinical challenge that may be benefitted by increased screening and usage of osteoporosis drugs.
Topics: Animals; Arthroplasty, Replacement; Biomechanical Phenomena; Bone-Implant Interface; Humans; Joint Prosthesis; Osteoporosis; Prosthesis Failure; Prosthesis Retention
PubMed: 32734511
DOI: 10.1007/s11914-020-00614-2 -
Foot and Ankle Clinics Mar 2023This article discusses the biomechanics and tribology of total ankle replacements considering the influence of implant design and generation on functional outcome,... (Review)
Review
This article discusses the biomechanics and tribology of total ankle replacements considering the influence of implant design and generation on functional outcome, before discussing the interplay between biomechanics and tribology in the clinical success of total ankle replacement. It reflects on what we know and highlights areas for further research, as well as identifying factors to consider in clinical practice.
Topics: Humans; Arthroplasty, Replacement, Ankle; Ankle Joint; Joint Prosthesis; Biomechanical Phenomena; Prosthesis Design
PubMed: 36822680
DOI: 10.1016/j.fcl.2022.10.002 -
The Journal of Bone and Joint Surgery.... Sep 2019
Topics: Arthroplasty, Replacement, Hip; Hip Prosthesis; Humans; Outcome Assessment, Health Care; Perioperative Care; Postoperative Complications; Prosthesis Design
PubMed: 31567798
DOI: 10.2106/JBJS.19.00553 -
The Journal of Hand Surgery Aug 2019Total elbow arthroplasty (TEA) has lower revision-free survivorship than other major joint replacement. Despite this, elbow replacement has remained popular. Surgical... (Review)
Review
Total elbow arthroplasty (TEA) has lower revision-free survivorship than other major joint replacement. Despite this, elbow replacement has remained popular. Surgical technique for TEA destabilizes the elbow by removing the medial and lateral collateral ligaments and, frequently, the radiocapitellar articulation. Current semiconstrained implants aim to allow for physiological varus and valgus motion by employing a sloppy hinge; however, over time, these designs fail owing to nonanatomic force transmission. Nonanatomic force transmission results from ligament release, force transmission primarily to the humeral and ulnar shafts, and radial head resection. These altered biomechanics may be the source of complications seen in semiconstrained arthroplasty. These complications perpetuate the cycle of failure and ultimately have poor salvage options.
Topics: Arthroplasty, Replacement, Elbow; Biomechanical Phenomena; Collateral Ligaments; Humans; Joint Prosthesis; Prosthesis Design; Prosthesis Failure
PubMed: 30770149
DOI: 10.1016/j.jhsa.2018.11.020 -
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 -
Clinics in Orthopedic Surgery Mar 2021Wireless intraoperative load sensors have been used to improve the quality of soft-tissue balancing during total knee arthroplasty(TKA). Recent studies using the sensors... (Review)
Review
Wireless intraoperative load sensors have been used to improve the quality of soft-tissue balancing during total knee arthroplasty(TKA). Recent studies using the sensors have demonstrated reductions in gap imbalance, as well as early improvement of patient-reported clinical outcomes and low rates of arthrofibrosis. However, well-designed prospective studies are needed to determine whether the application of the sensor technology for TKA will have clinical benefits and improve the survival of prosthesis. Knowledge of the load-sensing technology (advantages and disadvantages, potential pitfalls, and future prediction) is crucial to apply this new TKA technique successfully. Herein, we conduct a narrative review of previous studies on this technique.
Topics: Arthroplasty, Replacement, Knee; Humans; Knee Prosthesis; Surgery, Computer-Assisted
PubMed: 33747371
DOI: 10.4055/cios20034 -
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