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The Journal of Hand Surgery Mar 2022To evaluate the clinical and radiographic outcomes of patients who underwent semiconstrained distal radioulnar joint arthroplasty.
PURPOSE
To evaluate the clinical and radiographic outcomes of patients who underwent semiconstrained distal radioulnar joint arthroplasty.
METHODS
A retrospective analysis was performed on a series of patients who underwent distal radioulnar joint arthroplasty with more than a 23-month follow up. The quantitative outcome variables included the visual analog scale for pain; Disability of the Arm, Shoulder, and Hand (DASH) score; Patient-Rated Wrist Evaluation (PRWE); and Mayo wrist score. The range of motion, grip strength, torque, and lifting capacity were measured at final follow up and compared with that of the nonsurgical extremity. Complications related to the prosthesis were assessed.
RESULTS
Twenty-one patients (mean age 57 years) were assessed at an average 41-month follow up (23-73 months). Fifteen underwent prior hand, wrist, or elbow procedures. Four patients required 5 reoperations. The postoperative median visual analog scale pain score was 0.6 at rest and 2.1 with activity. The median postoperative DASH score was 26.7, PRWE 41, and Mayo wrist score was 65. Upon comparing the supination torque of the operative and intact sides, the operative side was found to average 87% of the intact side on a work simulator and 77% on the simulator's D-ring. Eight of 20 patients had lysis around the collar of the ulnar component (40%), as detected using radiography. Three of 21 (14%) radial plates were malpositioned, with 2 resulting in a fracture. The overall complication rate was 29%.
CONCLUSIONS
Distal radioulnar joint arthroplasty using the Scheker prosthesis demonstrated good patient pain scores and the restoration of supination strength. The collar lysis resulted in weaker supination and grip strength. Still, the patients experienced mild levels of pain and moderate disability. A moderate complication rate persisted, as reported by other authors. Accurate radial component placement is important.
TYPE OF STUDY/LEVEL OF EVIDENCE
Therapeutic IV.
Topics: Arthroplasty, Replacement; Humans; Joint Prosthesis; Middle Aged; Range of Motion, Articular; Retrospective Studies; Treatment Outcome; Wrist Joint
PubMed: 34266682
DOI: 10.1016/j.jhsa.2021.04.034 -
The Bone & Joint Journal Aug 2019There has been a recent resurgence in interest in combined partial knee arthroplasty (PKA) as an alternative to total knee arthroplasty (TKA). The varied terminology...
AIMS
There has been a recent resurgence in interest in combined partial knee arthroplasty (PKA) as an alternative to total knee arthroplasty (TKA). The varied terminology used to describe these procedures leads to confusion and ambiguity in communication between surgeons, allied health professionals, and patients. A standardized classification system is required for patient safety, accurate clinical record-keeping, clear communication, correct coding for appropriate remuneration, and joint registry data collection.
MATERIALS AND METHODS
An advanced PubMed search was conducted, using medical subject headings (MeSH) to identify terms and abbreviations used to describe knee arthroplasty procedures. The search related to TKA, unicompartmental (UKA), patellofemoral (PFA), and combined PKA procedures. Surveys were conducted of orthopaedic surgeons, trainees, and biomechanical engineers, who were asked which of the descriptive terms and abbreviations identified from the literature search they found most intuitive and appropriate to describe each procedure. The results were used to determine a popular consensus.
RESULTS
Survey participants preferred "bi-unicondylar arthroplasty" (Bi-UKA) to describe ipsilateral medial and lateral unicompartmental arthroplasty; "medial bi-compartmental arthroplasty" (BCA-M) to describe ipsilateral medial unicompartmental arthroplasty with patellofemoral arthroplasty; "lateral bi-compartmental arthroplasty" (BCA-L) to describe ipsilateral lateral unicompartmental arthroplasty with patellofemoral arthroplasty; and tri-compartmental arthroplasty (TCA) to describe ipsilateral patellofemoral and medial and lateral unicompartmental arthroplasties. "Combined partial knee arthroplasty" (CPKA) was the favoured umbrella term.
CONCLUSION
We recommend bi-unicondylar arthroplasty (Bi-UKA), medial bicompartmental arthroplasty (BCA-M), lateral bicompartmental arthroplasty (BCA-L), and tricompartmental arthroplasty (TCA) as the preferred terms to classify CPKA procedures. Cite this article: 2019;101-B:922-928.
Topics: Arthroplasty, Replacement, Knee; Bibliometrics; Hemiarthroplasty; Humans; Knee Prosthesis; Osteoarthritis, Knee; Terminology as Topic
PubMed: 31362558
DOI: 10.1302/0301-620X.101B8.BJJ-2019-0125.R1 -
Zeitschrift Fur Orthopadie Und... Jun 2020Given the close functional connection between the hip and the spine, their simultaneous degenerative pathology is a common problem seen in orthopedic patients and has...
Given the close functional connection between the hip and the spine, their simultaneous degenerative pathology is a common problem seen in orthopedic patients and has been termed the "hip spine syndrome". Demographic change and an increasing number of operations have led to more patients who have undergone both total hip arthroplasty and spondylodesis especially of the lumbar spine. Studies have shown significant dislocation rates in this cohort of as high as almost 30%. Biomechanical studies and considerations show that spinal surgery directly influences the functional acetabular position and, consequently, the position of the acetabular cup, making the correct implantation challenging for the hip surgeon. Spinal fusion affects not only the biomechanics of the spine but also of the hip joint and, for that reason, must accordingly be taken into account when planning total hip arthroplasty.
Topics: Acetabulum; Arthroplasty, Replacement, Hip; Hip Joint; Hip Prosthesis; Humans; Lumbar Vertebrae; Spinal Fusion
PubMed: 31167252
DOI: 10.1055/a-0889-8704 -
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 -
Foot and Ankle Clinics Mar 2023The present review paper aimed at discussing the current major issues in total ankle replacement, both the technical and biomechanical concepts, and the surgical and... (Review)
Review
The present review paper aimed at discussing the current major issues in total ankle replacement, both the technical and biomechanical concepts, and the surgical and clinical concerns. Designers shall target at the same time restoration of natural ankle kinematics and congruity of the artificial surfaces throughout the range of motion. Surgeons are recommended to expand biomechanical knowledge on ankle joint replacement, and provide appropriate training and key factors to make arthroplasty a good alternative to arthrodesis. Moreover, adequate selection of patients and careful rehabilitation are critical. In the future, custom-made prosthesis components and patient-specific instrumentation are major developments for more complex cases.
Topics: Humans; Arthroplasty, Replacement, Ankle; Biomechanical Phenomena; Treatment Outcome; Ankle Joint; Joint Prosthesis; Prosthesis Design; Arthrodesis
PubMed: 36935170
DOI: 10.1016/j.fcl.2023.01.001 -
Der Orthopade May 2020
Review
Topics: Arthroplasty, Replacement, Knee; Humans; Knee Joint; Knee Prosthesis; Precision Medicine; Prosthesis Design; Prosthesis Fitting
PubMed: 32232522
DOI: 10.1007/s00132-020-03899-4 -
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 -
Surgical Infections Sep 2022To evaluate systematically the failure rate of short versus long courses of antibiotic agents for prosthetic joint infections (PJIs). PubMed, Embase, and Cochrane... (Meta-Analysis)
Meta-Analysis Review
To evaluate systematically the failure rate of short versus long courses of antibiotic agents for prosthetic joint infections (PJIs). PubMed, Embase, and Cochrane Library databases were searched for controlled studies of short- and long-course antibiotic agents for joint prosthesis infections, all from the time of database creation to April 2022. Literature search, quality evaluation, and data extraction were performed independently by two researchers, and the primary outcome was the rate of surgical failure after antibiotic treatment. Stata 11.0 software was then applied for meta-analysis. Publication bias was assessed using Begg test. Heterogeneity was assessed using the test, and fixed or random effects models were used accordingly. Meta-regression was used to determine the causes of heterogeneity. A total of 14 articles involving 1,971 participants met the inclusion criteria, including 12 observational studies and two randomized controlled trials. Meta-analysis showed no difference between short and long courses of antibiotic agents (relative risk, 1.08; 95% confidence interval [CI], 0.89-1.32). The results of the subgroup analysis showed no differences between the failure rates of patients with PJI treated with short and long courses of antibiotic agents in studies with different study areas, different treatment modalities, and different locations of the artificial joints. Patients with PJIs may not require long-term or lifelong antibiotic agents after surgical treatment, and short-term (four to six weeks) antibiotic therapy is usually safe.
Topics: Anti-Bacterial Agents; Arthritis, Infectious; Arthroplasty, Replacement; Humans; Joint Prosthesis
PubMed: 35950957
DOI: 10.1089/sur.2022.157 -
Journal of Shoulder and Elbow Surgery Jul 2023Modification of total elbow arthroplasty (TEA) implants may be necessary in selected patients with substantial anatomic bone deformity or those undergoing revision...
BACKGROUND
Modification of total elbow arthroplasty (TEA) implants may be necessary in selected patients with substantial anatomic bone deformity or those undergoing revision surgery. The purpose of this study was to investigate the prevalence and consequences of implant modifications during TEA at our institution. We hypothesized that TEA implant modification would be more common in revisions than in primary replacements, and that it would not be associated with worse clinical outcomes or increased rates of radiographic or surgical complications directly related to the implant modification.
METHODS
Elbows that had undergone TEA by any of 3 surgeons at our institution with use of intraoperative implant modification between January 1992 and October 2019 were retrospectively reviewed for the type of modification and complications. Complications were classified as definitely related, probably related, possibly related, or nonrelated to the implant's modification according to the consensus review by the 3 senior surgeons. A survey was sent out to surgeons outside of our institution to investigate whether intraoperative modification to TEA implants is a common clinical practice.
RESULTS
A total of 106 implant components were modified during 94 of 731 TEA procedures (13%) in 84 of 560 patients. Implant modifications were performed in 60 of 285 revision cases (21%) compared with 34 of 446 (8%) primary cases (P < .0001). These included shortening the stem in 40 (44%), bending the stem in 16 (15%), notching the stem in 16 (15%), tapering the stem in 9 (9%), and a combination of 2 or more of these modifications in 19 implants (17%). Among the 55 index surgeries available for complication analysis, 40 complications occurred in 28 index surgeries (11 primary and 17 revisions; 25 patients), making the overall complication rate 51%. Of these 40 complications, 23 were considered independent of any implant modification. Of the remaining 17 complications, 9 were considered nonrelated to the implant modification, 6 were possibly related, and 2 were probably related to the implant modification. Therefore, the complication rate possibly related or probably related to implant modification was 15% (8 of 55). No complication was classified as definitely related to the implant modification. No implant breakage or malfunction occurred after any modification. A total of 442 survey responses were received representing 29 countries, of which 144 surgeons (39%) performed modification to implants during TEA procedures.
DISCUSSION
This study confirmed our hypothesis that modification of TEA implants is not uncommon at our institution, particularly in revision arthroplasty. Surgeons should keep in mind that complications possibly related or probably related to implant modification were at minimum 15% and could have been as high as 30% if the patients lost to follow-up had all had complications. Implant modification may be necessary in some cases but should be exercised with thoughtful consideration and caution.
Topics: Humans; Elbow; Retrospective Studies; Arthroplasty, Replacement, Elbow; Elbow Joint; Joint Prosthesis; Reoperation; Treatment Outcome; Prosthesis Failure
PubMed: 36918118
DOI: 10.1016/j.jse.2023.02.124 -
Tidsskrift For Den Norske Laegeforening... Jan 2021A BHR (Birmingham hip resurfacing) prosthesis was implanted in 445 people in Norway. Adverse reactions can arise as a result of the release of metal ions from...
BACKGROUND
A BHR (Birmingham hip resurfacing) prosthesis was implanted in 445 people in Norway. Adverse reactions can arise as a result of the release of metal ions from metal-on-metal joint surfaces made from cobalt-chromium alloy. The aim of the study was to analyse the release of metal ions during the first five years after surgery in patients with a BHR prosthesis and to investigate whether this was linked to clinical complications.
MATERIAL AND METHOD
Forty-four male patients (median age 53 years) implanted with a BHR prosthesis at the Coastal Hospital at Hagevik in the period October 2009 to May 2013 were monitored by means of blood samples before implantation and three months, one year, three years and five years afterwards. Analyses of cobalt and chromium in whole blood were performed. Function scoring was used to clinically assess the prosthetic joint.
RESULTS
Metal ion concentrations increased between the surgery date and one year later (p < 0.001), and subsequently remained stable. After five years, the median concentrations (min.- max.) of cobalt and chromium were 1.1 µg/L (0.4-6.3 µg/L) and 1.4 µg/L (0.4-11.7 µg/L) respectively for unilateral prostheses (n = 36), and 2.3 µg/L (1.6-28.5 µg/L) and 2.6 µg/L (1.7-14.1 µg/L) respectively for bilateral prostheses (n = 8). Five patients underwent revision surgery, while other patients had good hip function.
INTERPRETATION
Patients with a BHR prosthesis had a significant increase in cobalt and chromium in their blood one to five years after surgery, but the median levels were still well below the threshold value of 7 μg/L, which indicates an increased risk of complications.
Topics: Arthroplasty, Replacement, Hip; Hip Prosthesis; Humans; Ions; Male; Metal-on-Metal Joint Prostheses; Middle Aged; Norway; Prosthesis Design; Prosthesis Failure
PubMed: 33433099
DOI: 10.4045/tidsskr.20.0344