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Knee Surgery, Sports Traumatology,... Dec 2023In revision total knee arthroplasty (TKA) ligament instability and bone defects might require more constraint implants such as a condylar constrained knee (CCK) or... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
In revision total knee arthroplasty (TKA) ligament instability and bone defects might require more constraint implants such as a condylar constrained knee (CCK) or rotating hinged knee (RHK). When both implants are suitable, the choice remains controversial. The purpose of this systematic review and meta-analysis was to compare the survivorship and clinical outcome between CCK and RHK in revision TKA.
METHODS
Systematic literature research was performed. Studies analysing the clinical outcome and/or survivorship of CCK and/or RHK in revision TKA were included. Clinical outcomes included the Knee Society Score, both clinical (KSCS) and functional (KSFS), range of motion (ROM) and reoperations. Survival was defined as the time free from removal or revision of the femoral and/or tibial component.
RESULTS
A total of 40 articles analysing 4.555 knees were included. Survival did not differ between RHK and CCK implants (p = 0.6058), with, respectively, 91.6% and 89.8% survival after 5 years. Postoperative KSCS and KSFS were, respectively, 79.2 (SD 10.7) and 61.1 (SD 21.8) for the CCK group. Similar scores were noted for the RHK group with a KSCS of 80.2 (SD 14.1) and KSFS of 58.5 (SD 17.3). Postoperative ROM was similar for CCK (105.3°, SD 17.1°) and RHK patients (104.1°, SD 16.9°).
CONCLUSION
This meta-analysis revealed that both survivorship and clinical outcome are similar for CCK and RHK patients for whom both designs are technically suitable and indicated.
LEVEL OF EVIDENCE
IV.
Topics: Humans; Arthroplasty, Replacement, Knee; Survivorship; Prosthesis Design; Knee Prosthesis; Knee Joint; Reoperation; Treatment Outcome; Retrospective Studies; Prosthesis Failure
PubMed: 37747534
DOI: 10.1007/s00167-023-07572-z -
Hip International : the Journal of... 2012Debridement and irrigation has been proposed as a salvage procedure for early post-operative and late acute haematogenous periprosthetic hip and knee infections, however... (Review)
Review
Debridement and irrigation has been proposed as a salvage procedure for early post-operative and late acute haematogenous periprosthetic hip and knee infections, however the effective ability of this procedure to avoid recurrent infection is still debated. In this systematic review of the literature we reviewed full-text papers published from 1970 through 2011, that reported the success rate of infection eradication after debridement and irrigation with prosthesis retention for the treatment of early septic complications (within six weeks from surgery) or late acute haematogenous infections after hip or knee prosthesis. In all, 14 original articles, reporting the results of 710 patients were retrieved. The average success rate has been, respectively, 45.9% and 52% after a single or repeated debridement and irrigation procedures, at a mean follow-up of 53.3 months. The methodological limitations of this study and the heterogeneous material in the reviewed papers notwithstanding, this systematic review shows that debridement and irrigation procedure is associated with a rather poor outcome, even in a population of patients selected on the basis of symptoms' duration and patients should be adequately informed prior to undergo this salvage procedure.
Topics: Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Debridement; Hip Joint; Hip Prosthesis; Humans; Infection Control; Knee Joint; Knee Prosthesis; Limb Salvage; Prosthesis Failure; Prosthesis-Related Infections; Secondary Prevention; Therapeutic Irrigation; Treatment Outcome
PubMed: 22956381
DOI: 10.5301/HIP.2012.9566 -
The Journal of Arthroplasty Oct 2013Periprosthetic infections of hip and knee joints are now treated by two-stage revision arthroplasty with an infection control rate of 91%. The present systematic review... (Review)
Review
Periprosthetic infections of hip and knee joints are now treated by two-stage revision arthroplasty with an infection control rate of 91%. The present systematic review studied the reported incidence of acute kidney injury (AKI) and infection recurrence from January 1989 to June 2012 to assess the risk-benefit ratio of antibiotic spacer use. Ten observational studies (n=544 patients) with clinical outcomes showed an average incidence of AKI of 4.8%. The average reported persistence or recurrence rate of infection was 11% during a follow-up period that ranged from 13 to 108 months. The risk-benefit ratio presently favors treatment although there appears to be higher complication rates and incidence of AKI than previously reported. Marked heterogeneity in practice and lack of detail in reporting precluded more robust quantitative synthesis. Clinicians need to be aware of the potential risk of AKI, particularly in high-risk patients; practice patterns for the use of antibiotic spacers need to be standardized.
Topics: Acute Kidney Injury; Aged; Aged, 80 and over; Anti-Bacterial Agents; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Female; Humans; Incidence; Joint Prosthesis; Male; Middle Aged; Prosthesis-Related Infections; Recurrence; Risk Assessment; Treatment Outcome
PubMed: 23578491
DOI: 10.1016/j.arth.2013.02.035 -
International Journal of Surgery... May 2018The debate over the use of cemented or cementless fixation in total knee arthroplasty (TKA) has never stopped since cementless fixation was introduced. We undertook a... (Meta-Analysis)
Meta-Analysis Review
No difference in implant survivorship and clinical outcomes between full-cementless and full-cemented fixation in primary total knee arthroplasty: A systematic review and meta-analysis.
BACKGROUND
The debate over the use of cemented or cementless fixation in total knee arthroplasty (TKA) has never stopped since cementless fixation was introduced. We undertook a systematic review and meta-analysis to evaluate the optimal mode of fixation (full-cementless vs. full-cemented) in TKA.
METHODS
PubMed, Embase, and the Cochrane Library databases up to July 2017 were searched to identify randomised controlled trials (RCTs) and quasi-RCTs comparing full-cementless TKA and full-cemented TKA. The primary outcome was implant survivorship. Secondary outcomes included radiological outcomes (maximum total point-motion [MTPM], radiolucent line, rotation degree) and clinical outcomes (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC] score, Knee Society Score [KSS] score, postoperative range of movement, blood loss and complications).
RESULTS
Seven studies were included in the systematic review and meta-analysis. The mean follow-up was 7.1 years (range from 2 to 16.6 years). There was no difference in implant survivorship (RR, 0.98; 95% CI, 0.95-1.01; p = 0.25; I = 0%), MTPM (weighted mean difference [WMD], 0.13 mm; 95% CI, -0.69-0.95; p = 0.75; I = 89.3%) and radiolucent line (RR, 1.36; 95% CI, 0.57-3.23; p = 0.48; I = 54%) between the cementless and cemented methods. There was a mean 0.22° more rotation in the full-cementless fixation group (95% CI, 0.13-0.32; p < 0.01; I = 28.5%). There were no significant differences relating to clinical outcomes (WOMAC score, KSS score, postoperative range of movement, blood loss and complications) between the two fixation groups.
CONCLUSIONS
Although more overall component rotation is found in full-cementless fixation, the implant survivorship and clinical efficacy are likely similar between full-cementless and full-cemented fixation. However, future RCTs with similar cementless prosthetic coating and longer-term follow-up are still needed to confirm our findings.
Topics: Arthroplasty, Replacement, Knee; Bone Cements; Humans; Knee Joint; Knee Prosthesis; Prosthesis Design; Prosthesis Failure
PubMed: 29656129
DOI: 10.1016/j.ijsu.2018.04.015 -
European Journal of Orthopaedic Surgery... Apr 2018Postoperative dislocation is a challenging complication after total hip arthroplasty (THA) that affects patient outcome worldwide. Instability is one of the main... (Meta-Analysis)
Meta-Analysis Review
Postoperative dislocation is a challenging complication after total hip arthroplasty (THA) that affects patient outcome worldwide. Instability is one of the main complications with rates exceeding 20% in some series. Currently, alternative acetabular components are available with dual mobility (DMTHA) bearing surfaces and larger femoral head size that may reduce the risk of dislocation, yet provide the functional benefit of standard single mobility (STHA) bearing surface THA. However, whether STHA, big femoral head (BTHA) and DMTHA should be used is still controversial. This systematic review and meta-analysis aim to compare postoperative dislocation and revision (aseptic loosening and infection) of BTHA, STHA and DMTHA in primary or revision THA. These clinical outcomes consist of postoperative dislocation and revision (aseptic loosening and infection). This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Relevant studies were identified from Medline and Scopus from inception to June 8, 2017, that reported postoperative dislocation and revision (aseptic loosening and infection) of either implant THA. Eleven of 677 studies (nine comparative studies and two RCTs) (N = 4084 patients) were eligible; all 11 studies were included in pooling. Intervention included dual mobility THA (N = 1068 patients), standard THA (N = 2568 patients), big head THA (N = 378 patients) and constrain THA (N = 70 patients). A network meta-analysis showed that risk of revision and dislocation of DMTHA was significantly lower with RR of 2.19 (1.36, 3.53) and 4.19 (2.04, 8.62) when compared to STHA. While there was no statistically significant risk of having revision and dislocation of DMTHA when compared to BTHA and CTHA. The SUCRA probability of DM and BTHA was in the first and second rank with 46.5 and 44.8% in the risk of revision and 46.7 and 45.1% in the risk of dislocations. In short-term outcomes (5 years or less, with follow-up of 0-5 years), the best implant of choice that has lowest risk of revision and dislocation after THA is DMTHA follow by BTHA. We recommend using dual mobility and big head as an implant for safety in THA. However, there were only two studies that reported long-term survivorship (more than 5 years, with follow-up of 5-15 years). Further research that assesses long-term survivorship is necessary to further evaluate which implants are the best for THA.
Topics: Aged; Arthroplasty, Replacement, Hip; Female; Femur Head; Hip Dislocation; Hip Prosthesis; Humans; Male; Middle Aged; Network Meta-Analysis; Postoperative Complications; Prosthesis Failure; Prosthesis-Related Infections; Randomized Controlled Trials as Topic; Reoperation; Risk Factors
PubMed: 29119371
DOI: 10.1007/s00590-017-2073-y -
Knee Surgery, Sports Traumatology,... Nov 2015Two design concepts are currently used for unicondylar knee arthroplasty (UKA) prostheses: fixed bearing (FB) and mobile bearing (MB). While MB prostheses have... (Comparative Study)
Comparative Study Meta-Analysis Review
PURPOSE
Two design concepts are currently used for unicondylar knee arthroplasty (UKA) prostheses: fixed bearing (FB) and mobile bearing (MB). While MB prostheses have theoretical advantages over their FB counterparts, it is not clear whether they are associated with better outcomes. A systematic review was conducted to examine survivorship differences and differences in failure modes of between FB and MB designs.
METHODS
PubMed, Scirus and Cochrane library databases were searched for medial UKA outcome studies. A total of 44 papers, involving 9,463 knees, were eligible. Outcomes examined included knee function, survivorship and the reasons for, and incidence of, revision for FB and MB prostheses. Random effects meta-analysis was employed to obtain pooled revision rate estimates. Where available, cause-specific time to revision was extracted.
RESULTS
Mean follow-up was 8.7 years for FB and 5.9 years for MB prostheses. There were no other relevant baseline differences. The overall crude revision rate for FB and for MB prostheses was 0.90 (95 % confidence interval (CI) 0.65-1.21) and 1.51 (95 % CI 1.11-1.93) per 100 component years, respectively. After stratification on follow-up time and age, the revision rates were not substantially different, aside for younger patients in short term from studies with short-term follow-up.
CONCLUSION
No essential differences between the two designs were observed. MB and FB UKA designs have comparable revision rates. As our study is based on predominantly observational data, with large variations in reporting standards, inferences should be drawn with caution.
LEVEL OF EVIDENCE
IV.
Topics: Adult; Aged; Arthritis; Arthroplasty, Replacement, Knee; Equipment Failure Analysis; Female; Humans; Knee Joint; Knee Prosthesis; Male; Middle Aged; Outcome Assessment, Health Care; Prosthesis Design; Prosthesis Failure; Randomized Controlled Trials as Topic; Reoperation
PubMed: 24957911
DOI: 10.1007/s00167-014-3131-1 -
Journal of Orthopaedic Surgery and... Jun 2018Postoperative squeaking in patients who applied the fourth-generation ceramic bearing in primary hip replacement has not been reported systematically; we aim to study... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Postoperative squeaking in patients who applied the fourth-generation ceramic bearing in primary hip replacement has not been reported systematically; we aim to study the squeaking incidence in the fourth-generation ceramic bearing and related risk factors for squeaking, and we also attempt to explore the relationship between squeaking and prosthetic brands.
METHODS
The PubMed, Embase, and Cochrane library were searched, and 14 articles were finally included. Patients' demographic data, surgical-related information, and prosthesis data were extracted. The occurrence rate of squeaking was calculated by meta-analysis, and subgroup analysis was performed based on prosthetic brands and follow-up time. Regression analysis was further applied to investigate the relationship between various risk factors and squeaking.
RESULTS
The squeaking incidence in patients with the fourth-generation ceramic bearing was 3%. Age, gender, body mass index, and abduction and anteversion angles of acetabular cup might have no influence on squeaking. The squeaking incidence was significantly high with the presence of Delta Motion cup (DePuy, Warsaw, Indiana) and Secure-Fit stem (Stryker, Kalamazoo, MI), and the overall incidence of DePuy femoral stem was relatively small except for the Summit femoral stem. And there was no significant difference of squeaking incidence between less than 5-year and more than or equal to 5-year follow-up subgroups.
CONCLUSIONS
In our study, squeaking in the fourth-generation ceramic bearing occurred at a rate of 3%; occurrence rate was high when the Delta Motion cup was applied. We hope for more relevant researches to focus on this issue.
Topics: Acetabulum; Arthroplasty, Replacement, Hip; Ceramics; Hip Prosthesis; Humans; Noise; Prosthesis Design; Prosthesis Failure
PubMed: 29859126
DOI: 10.1186/s13018-018-0841-y -
Journal of Shoulder and Elbow Surgery Nov 2022Primary reverse shoulder arthroplasty (rTSA) is an effective treatment option for reducing pain and improving function for patients with rotator cuff tear arthropathy,... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Primary reverse shoulder arthroplasty (rTSA) is an effective treatment option for reducing pain and improving function for patients with rotator cuff tear arthropathy, irreparable rotator cuff tears, glenoid deformity, and other challenging clinical scenarios, including fracture sequelae and revision shoulder arthroplasty. There has been a wide range of reported outcomes and postoperative complication rates reported in the literature. The purpose of this systematic review and meta-analysis is to provide an updated review of the clinical outcomes and complication rates following primary rTSA.
METHODS
A systematic review and meta-analysis was performed to evaluate outcomes and complications following primary rTSA according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Demographics, range of motion, patient-reported outcome measures (American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form [ASES] and Constant scores), number of complications, and revisions were extracted, recorded, and analyzed from the included articles.
RESULTS
Of the 1415 studies screened, 52 studies met the inclusion criteria comprising a total of 5824 shoulders. The mean age at the time of surgery was 72 years (range: 34-93), and the mean follow-up was 3.9 years (range: 2-16). Patients demonstrated a mean improvement of 56° in active flexion, 50° in active abduction, and 14° in active external rotation. Regarding functional outcome scores, rTSA patients demonstrated a mean clinically significant improvement of 37 in Constant score (minimal clinically important difference [MCID] = 5.7) and ASES score (42.0; MCID = 13.6). The overall complication rate for rTSA was 9.4% and revision rate of 2.6%. Complications were further subdivided into major medical complications (0.07%), shoulder- or surgical-related complications (5.3%), and infections (1.2%). The most frequently reported shoulder- or surgical-related complications were scapular notching (14.4%), periprosthetic fracture (0.8%), glenoid loosening (0.7%), and prosthetic dislocation (0.7%).
DISCUSSION
Primary rTSA is a safe and reliable procedure with low complication, revision, infection, and scapular notching rates. Additionally, patients demonstrated clinically significant improvements in both range of motion and clinical outcome scores.
Topics: Humans; Adult; Middle Aged; Aged; Aged, 80 and over; Arthroplasty, Replacement, Shoulder; Shoulder Joint; Rotator Cuff Injuries; Joint Prosthesis; Range of Motion, Articular; Treatment Outcome; Retrospective Studies
PubMed: 35870805
DOI: 10.1016/j.jse.2022.06.005 -
The Journal of Hand Surgery... Dec 2021: Unconstrained pyrocarbon and metal-on-polyethylene (MoP) proximal interphalangeal (PIP) joint arthroplasty is an increasingly popular alternative to silicone implants...
: Unconstrained pyrocarbon and metal-on-polyethylene (MoP) proximal interphalangeal (PIP) joint arthroplasty is an increasingly popular alternative to silicone implants and arthrodesis. This systematic review appraises their outcomes. : 30 studies comprising 1,324 joints (813 pyrocarbon, 511 MoP) were included. Mean patient age was 59 years (38 to 78) and mean follow-up period was 54 months (1.2 to 380). : There were mean improvements of 4.5 points (2 to 6.9) in pain Visual Analogue Score, 10.5° (-26 to 58) in range of motion (ROM), 3.1 kg (-4 to 7) in grip strength, 0.6 kg (-1.5 to 2) in pinch strength, and 18 points (-3 to 29) in the Disabilities of the Arm, Shoulder and Hand score, with no significant differences between implant types. ROM gains, in particular, deteriorated over time. Clinical complications were frequent (23%), and significantly more common with pyrocarbon, as were radiographic complications. However, most were mild-moderate and did not necessarily correlate with negative outcomes or dissatisfaction. Overall reoperation rate was 21%, and revision rate 11%, both more frequent with pyrocarbon. Most revisions were within 24 months, beyond which survival was maintained up to ten years. : Unconstrained PIP joint arthroplasty is effective at improving pain scores, active ROM, grip/pinch strength, and patient reported outcome measures, particularly in patients with osteoarthritis. Results are generally maintained at least to the medium term, although gains diminish in the longer term. Complication and early revision rates are high, particularly with pyrocarbon implants. The majority of patients express positive attitudes to arthroplasty, with significant improvements in patient-reported outcome measures for both pyrocarbon and MoP implants. Patients with post-traumatic and inflammatory arthropathy are generally less satisfied. There is currently insufficient data to recommend one implant type over another, although the early-to-medium term results of MoP implants are promising. Prospective surveillance via small joint registries is recommended.
Topics: Arthroplasty; Arthroplasty, Replacement, Finger; Finger Joint; Humans; Joint Prosthesis; Middle Aged; Osteoarthritis; Prospective Studies; Treatment Outcome
PubMed: 34789103
DOI: 10.1142/S2424835521500661 -
BMC Musculoskeletal Disorders Aug 2016The latest generation of shoulder arthroplasty includes canal-sparing respectively stemless designs that have been developed to allow restoration of the glenohumeral... (Review)
Review
BACKGROUND
The latest generation of shoulder arthroplasty includes canal-sparing respectively stemless designs that have been developed to allow restoration of the glenohumeral center of rotation independently from the shaft, and to avoid stem-related complications. The stemless prosthesis design has also recently been introduced for use in reverse arthroplasty systems.
METHODS
We systematically reviewed the literature for studies of currently available canal-sparing respectively stemless shoulder arthroplasty systems. From the identified series, we recorded the indications, outcome measures, and humeral-sided complications.
RESULTS
We identified 11 studies of canal-sparing respectively stemless anatomic shoulder arthroplasty implants, published between 2010 and 2016. These studies included 929 cases, and had a mean follow-up of 26 months (range, 6 to 72 months). The rates of humeral component-related complications ranged between 0 and 7.9 %. The studies reported only a few isolated cases of complications of the humeral component. Some arthroplasty systems are associated with radiological changes, but without any clinical relevance.
CONCLUSIONS
All of the published studies of canal-sparing respectively stemless shoulder arthroplasty reported promising clinical and radiological outcomes in short to midterm follow-up. Long-term studies are needed to demonstrate the long-term value of these kind of implants.
Topics: Arthroplasty, Replacement; Humans; Humerus; Joint Prosthesis; Osteoarthritis; Postoperative Complications; Prosthesis Design; Radiography; Shoulder Joint; Treatment Outcome
PubMed: 27577859
DOI: 10.1186/s12891-016-1235-0