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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 -
Orthopaedics & Traumatology, Surgery &... Nov 2019Rotating-hinge knee replacements are usually reserved for revision surgeries, when the extent of soft tissue loss makes a constrained implant more suitable. They remain... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Rotating-hinge knee replacements are usually reserved for revision surgeries, when the extent of soft tissue loss makes a constrained implant more suitable. They remain an uncommon choice in primary surgery when the soft tissue loss is not as extensive.
METHODS
We completed a systematic review and meta-analysis to assess patients who underwent a Total Knee Replacement (TKR) with the rotating-hinge prosthesis in the primary setting. We searched PubMed and Embase for articles published in the ten years prior June 2017: Prosthesis survival rates, causes of failure, and clinical/functional scores were the primary outcomes. Twenty-one articles met the inclusion criteria for meta-analysis. Articles were grouped into (1) non-tumour (n=11) and (2) tumour indications (n=10). Survival data was summarized in forest plots, generated using Stata.
RESULTS
We found that for certain indications the prosthesis has impressive survival rates and functional outcomes. Short-term (1-5 year) prosthesis survival in non-tumour cases was 92% (95% CI, 87-98%) and 77% (95% CI, 68-87%) in tumour cases. Mid-term (6-10 year) survival was 82% (95% CI, 74-89%) and 69% (95% CI, 57-81%) in non-tumour and tumour studies respectively. In analysis of clinical scores, patients showed a significant improvement in their pain score. Infection was the most commonly cited cause of prosthesis failure in both non-tumour and tumour studies, attributing to 31.5% and 37.6% of failures respectively. Aseptic loosening, dislocation and fracture were also commonly cited complications.
CONCLUSION
We concluded that the rotating-hinge knee prosthesis is a viable option in primary surgery when there is extensive soft tissue destruction surrounding the joint.
LEVEL OF EVIDENCE
I.
Topics: Arthroplasty, Replacement, Knee; Humans; Knee Joint; Knee Prosthesis; Prosthesis Design
PubMed: 31588033
DOI: 10.1016/j.otsr.2019.08.012 -
The Knee Mar 2023
Topics: Humans; Arthroplasty, Replacement, Knee; Knee Joint; Osteoarthritis, Knee; Treatment Outcome; Knee Prosthesis
PubMed: 37088519
DOI: 10.1016/j.knee.2023.03.013 -
The Journal of Hand Surgery, European... Jun 2023This prospective study evaluated outcomes after trapeziometacarpal joint replacement with a dual mobility prosthesis (Touch®) in 55 thumbs (52 patients) with a mean...
This prospective study evaluated outcomes after trapeziometacarpal joint replacement with a dual mobility prosthesis (Touch®) in 55 thumbs (52 patients) with a mean follow-up of 25 months (range 12-36). Pre- and postoperative assessments included pain, range of motion, the Kapandji index, pinch- and grip strength, as well as functional scores and radiological parameters. Mean preoperative metacarpophalangeal joint hyperextension of 19° (range 15°-28°) showed a significant correction after 1 year with a mean value of 2° (range 0°-5°). Mean Quick Disabilities of the Hand, Shoulder and Arm score was 14 (range 6-28), and Michigan Hand Questionnaire 82 (range 67-92). No revisions due to infection, loosening, dislocation or material failure occurred during follow-up. The dual mobility trapeziometacarpal joint prosthesis was a reliable treatment option to decrease pain, improve motion, strength and pre-existing metacarpophalangeal joint hyperextension at short-term follow-up. IV.
Topics: Humans; Arthroplasty, Replacement; Carpometacarpal Joints; Follow-Up Studies; Joint Prosthesis; Osteoarthritis; Pain; Prospective Studies; Range of Motion, Articular; Thumb; Trapezium Bone
PubMed: 36855785
DOI: 10.1177/17531934231156280 -
Foot and Ankle Surgery : Official... Jul 2022The National Institute for Health and Care Excellence criterion for hip replacements is a (projected) revision rate of less than 5% after 10 years. No such criterion is... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The National Institute for Health and Care Excellence criterion for hip replacements is a (projected) revision rate of less than 5% after 10 years. No such criterion is available for ankle prostheses. The objective of the current study is to compare survival rates of contemporary primary ankle prostheses to the hip-benchmark.
METHODS
The PRISMA methodology was used. Eligible for inclusion were clinical studies reporting revision rates of currently available primary total ankle prostheses. Data was extracted using preconstructed forms. The total and prosthesis-specific annual revision rate was calculated.
RESULTS
Fifty-seven articles of eight different ankle prostheses were included (n = 5371), totaling 513 revisions at an average 4.6 years of follow-up. An annual revision rate of 2.2 was found (i.e. an expected revision rate of 22% at 10 years).
CONCLUSIONS
The expected 10-year revision rate of contemporary ankle prostheses is lower than the current benchmark for hip prostheses.
Topics: Ankle; Arthroplasty, Replacement, Ankle; Arthroplasty, Replacement, Hip; Humans; Joint Prosthesis; Prosthesis Design; Prosthesis Failure; Reoperation
PubMed: 34116950
DOI: 10.1016/j.fas.2021.05.014 -
The British Journal of Oral &... Oct 2019Total temporomandibular joint (TMJ) replacement has been documented as a viable option for the management of end-stage TMJ disease, but data on long-term outcomes have... (Review)
Review
Total temporomandibular joint (TMJ) replacement has been documented as a viable option for the management of end-stage TMJ disease, but data on long-term outcomes have been reported for only two established systems: TMJ Concepts, and Zimmer Biomet. Other devices are now emerging globally, but reports of preclinical laboratory and clinical outcomes are limited. We retrieved information on the design, material composition, preclinical laboratory tests, regulatory status, and clinical outcomes of new TMJ replacement systems from PubMed and Google, and from personal correspondence with surgeons worldwide. Fifteen countries have developed, or are developing, 27 TMJ replacement systems, of which 21 are custom-designed, but to date, only four have been given regulatory approval. All the devices are designed to have both a skull-based glenoid fossa component and a mandibular ramus or condyle, and 22/27 are similar to the designs of the two established systems. Twenty-one devices use an ultra-high-molecular-weight polyethylene (UHMWPE) fossa-bearing surface, and 10 have a titanium alloy condyle. Nineteen manufacturers report that a titanium alloy is used for the ramus portion of the condyle/ramus component. Preclinical laboratory tests on 12 of the systems have been reported but, to our knowledge, no outcomes have yet been reported on nine of the 27 reviewed. Not all systems are equal in terms of design, material composition, preclinical laboratory testing, manufacturing methods, regulatory status, and reports of clinical outcomes.
Topics: Arthroplasty, Replacement; Humans; Joint Prosthesis; Mandible; Mandibular Condyle; Temporomandibular Joint; Temporomandibular Joint Disorders
PubMed: 31455594
DOI: 10.1016/j.bjoms.2019.08.009 -
Der Orthopade Jul 2020Compared with the current gold standard of knee endoprosthetics, the concept of kinematic alignment is more responsive to the individual anatomy of the patient as it... (Review)
Review
BACKGROUND
Compared with the current gold standard of knee endoprosthetics, the concept of kinematic alignment is more responsive to the individual anatomy of the patient as it enables the three-dimensional restoration of individual axes, joint lines and capsule tension. One point of criticism is the lack of intraoperative control over individual bone resections with conventional instrumentation. However, with the help of CT-based individual 3D-printed cutting blocks, a precise preoperative plan can be transferred to the operating room. The aim of this article is to explain the operative technique of patient-specific instrumentation (PSI)-protected kinematic alignment.
METHODS
The procedure is based on a preoperative 3D model of the bony anatomy of the patient, with the aid of which the planning of the operation, with the positioning and size of the implant, as well as the necessary bone resections, are carried out. With this information about anatomy and resection levels the individual cutting blocks are produced, aided by a 3D printer. Intraoperative control is achieved by measuring the resection by means of a gage and comparison with the digital 3D design.
DISCUSSION
With the aid of the 3D-printed PSI cutting blocks the preoperative plan of kinematic alignment can be implemented in a precise manner. It is a simple tool and does not require any great expense. Compared with the conventional instrumentation, the operating time is shortened. However, because of the purely CT-based design, no information about the state of the soft tissue is obtained.
Topics: Arthroplasty, Replacement, Knee; Biomechanical Phenomena; Humans; Knee Joint; Knee Prosthesis; Surgery, Computer-Assisted
PubMed: 32542426
DOI: 10.1007/s00132-020-03927-3 -
Der Orthopade May 2020With increasing numbers of primary knee arthroplasties, the relevance and frequency of prosthesis replacement operations are increasing with a time lag. Two-zone... (Review)
Review
With increasing numbers of primary knee arthroplasties, the relevance and frequency of prosthesis replacement operations are increasing with a time lag. Two-zone anchoring is important. Due to bony defects, the articular surface can often no longer be used as a possible anchoring zone, so the fixation must take place in the metaphyseal and diaphyseal area of the bone. If, for various reasons, the defect is too pronounced for regular care, individually-manufactured implants can be used. These are produced on the basis of a preoperative CT as part of a two-stage change using industrial 3D printers and so-called additive manufacturing.
Topics: Arthroplasty, Replacement, Knee; Humans; Knee Joint; Knee Prosthesis; Prosthesis Design; Prosthesis Failure; Reoperation
PubMed: 32300822
DOI: 10.1007/s00132-020-03908-6 -
The Journal of Hand Surgery Jan 2023The use of implant arthroplasty in the distal radioulnar joint is increasing. Two main types of implants are commonly used, ulnar head prosthesis (UHP) and hemi or...
PURPOSE
The use of implant arthroplasty in the distal radioulnar joint is increasing. Two main types of implants are commonly used, ulnar head prosthesis (UHP) and hemi or semi-constrained total distal radioulnar joint arthroplasty. The literature consists mainly of small patient series. The purpose of this study was to examine our long-term outcomes of distal radioulnar joint arthroplasty.
METHODS
Patient data were collected in a patient registry from 2000 to 2019. The follow-up included radiographic examination, physical examination, Mayo Wrist Scores, pain level, range of motion, and grip strength. Reoperations were recorded. The implants were a semi-constrained prosthesis and a metallic UHP. The mean age at surgery was 50 years. Patient demographics were similar, but the semi-constrained group had a higher preoperative percentage of instability (85 vs 52 percent). The median follow-up time was 30 months for the semi-constrained implants group and 102 months for the UHP group.
RESULTS
A total of 53 primary semi-constrained total joint arthroplasties and 102 UHPs were included. The grip strength and Mayo Wrist Score improved for both the implant groups. Pain reduced in 76% of the patients. Supination improved for the semi-constrained total joint arthroplasty group. Lifting capacity was better in the semi-constrained total joint arthroplasty patients. The unadjusted reoperation rate was 23% for the semi-constrained implants group and 34% for the UHP group. Twenty-two implants were bilateral; these had comparable results to unilateral implants. Kaplan-Meier survival curves demonstrated 94% survival rate for the semi-constrained implants group and 87% survival for the UHP group after 5 years. The risk factors associated with reoperation for the combined implant group included younger age at surgery, previous wrist surgery, ulnar shortening, and wrist fusion.
CONCLUSIONS
Distal radioulnar joint arthroplasty improved functional outcomes in both the implant groups, but reoperations were frequent. The semi-constrained implants group had better lifting capacity. The bilateral implants had comparable outcomes to the unilateral implants.
TYPE OF STUDY/LEVEL OF EVIDENCE
Therapeutic IV.
Topics: Humans; Middle Aged; Arthroplasty, Replacement; Joint Prosthesis; Treatment Outcome; Wrist Joint; Ulna; Range of Motion, Articular
PubMed: 35550310
DOI: 10.1016/j.jhsa.2022.02.014 -
The Journal of Arthroplasty Jul 2021
Topics: Arthroplasty, Replacement, Hip; Hip Prosthesis; Humans; Spine
PubMed: 33745798
DOI: 10.1016/j.arth.2021.02.071