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Journal of Orthopaedic Research :... Nov 2018Radiostereometric analysis (RSA) is a method for measuring micromotion in joint arthroplasties. RSA has never been used in total wrist arthroplasties. We evaluated: (i)... (Randomized Controlled Trial)
Randomized Controlled Trial
Radiostereometric analysis (RSA) is a method for measuring micromotion in joint arthroplasties. RSA has never been used in total wrist arthroplasties. We evaluated: (i) the precision of model-based RSA in total wrist arthroplasties measured in a phantom model and in patients; (ii) the number of bone markers necessary to ensure the precision; and (iii) the accuracy of model-based RSA in a phantom model. Reverse engineered models of radial and carpal/metacarpal components of two wrist arthroplasties (ReMotion® and Motec®) were obtained by laser scanning. Precision and accuracy of each arthroplasty were analyzed with regards to translation and rotation along the three coordinate axes. Precision was analyzed in 10 phantom and 30 clinical double examinations for each arthroplasty, and was expressed by a repeatability coefficient. The precision of different numbers and configurations of bone markers in the phantom model were compared. Accuracy was tested in a phantom model where the implants were attached to a micrometer, and was defined as the mean difference between measured and true migration. In the phantom model the precision for translations ranged from 0.03 to 0.14 mm and for rotations from 0.18 to 1.52°. In patients the precision for translations ranged from 0.06 to 0.18 mm, and for rotations from 0.32 to 2.18°. Less than four bone markers resulted in inferior precision. Accuracy ranged from -0.06 to 0.04 mm, and from -0.38 to -0.01°. Y-rotations could not be obtained from the Motec® due to rotational symmetry about the longitudinal axis. We conclude that model-based RSA in total wrist arthroplasties is precise, accurate, and feasible to use for clinical evaluation of micromotion in wrist arthroplasties. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:3053-3063, 2018.
Topics: Arthroplasty, Replacement; Humans; Phantoms, Imaging; Radiostereometric Analysis; Wrist Joint
PubMed: 29873422
DOI: 10.1002/jor.24063 -
Orthopaedic Surgery Jul 2023Locked shoulder dislocations account for up to 5% of shoulder dislocations. These relatively rare injuries are characterized by dislocation of the humeral head from the... (Meta-Analysis)
Meta-Analysis Review
Systematic Review and Meta-Analysis of Locked Posterior Dislocation of the Shoulder Treated with Shoulder Arthroplasty: Improved Outcomes for Total Shoulder Arthroplasty are Associated with Increased Age.
Locked shoulder dislocations account for up to 5% of shoulder dislocations. These relatively rare injuries are characterized by dislocation of the humeral head from the scapular glenoid cavity with the humeral head incarcerated on the glenoid in a "locked" fashion. Diagnosis is often delayed because of the complexity of clinical presentation and subtle radiographic findings, resulting in locking of the humeral head out of the glenoid cavity with severe functional deficits. Most commonly, there are bony injuries to the glenoid and humeral head that engage and prevent closed reduction. Since few patients present with this injury, evidence-based treatment guidelines have not been established. The objective of this review is to assess postoperative outcomes following shoulder arthroplasty for locked posterior shoulder dislocations (LPSD) to guide best practices for treatment. This systematic review was conducted following PRISMA guidelines, searching the PubMed and Web of Science databases for original articles assessing outcomes following arthroplasty for locked posterior shoulder dislocations. Seven publications that evaluated 102 patients were included. Additionally, nine case studies were included, assessing 20 shoulder arthroplasties. Overall, the analysis demonstrated significant improvement in shoulder pain following total shoulder arthroplasty (TSA) (P = 0.0003). Older operative patient ages for TSA resulted in significantly improved modified Neer outcomes scores and patient satisfaction compared to younger patients (P = 0.047). A positive correlation was noted for the duration of dislocation and necessity for revision surgery following hemiarthroplasty (HSA) and TSA combined and TSA separately. The risk ratios assessing the incidence of postoperative complications (RR = 0.56, 95% CI = 0.28-1.11) and necessity for revision surgery (RR = 0.58, 95% CI = 0.24-1.39) were insignificant but noted outcomes favoring TSA. Data from the included studies show that both TSA and HSA are efficacious at treating locked posterior shoulder dislocation. Postoperative outcomes following TSA versus HSA are similar. TSA may be a more efficacious surgical treatment in elderly patients, with improved outcomes and patient satisfaction scores compared to younger patients. Early diagnosis and treatment of posterior locked dislocations may lead to reduced postoperative complications and revision surgery, signaling the importance of proper injury investigation and early treatment. The role of RSA in the management of locked posterior shoulder dislocation remains to be determined, as there is insufficient clinical outcome data currently in the literature.
Topics: Humans; Aged; Shoulder; Shoulder Dislocation; Arthroplasty, Replacement, Shoulder; Retrospective Studies; Joint Dislocations; Shoulder Joint; Treatment Outcome; Hemiarthroplasty; Postoperative Complications; Range of Motion, Articular
PubMed: 37259941
DOI: 10.1111/os.13758 -
International Journal of Molecular... Feb 2023Due to the increase in the life span and mobility at older ages, the number of implanted prosthetic joints is constantly increasing. However, the number of... (Review)
Review
Due to the increase in the life span and mobility at older ages, the number of implanted prosthetic joints is constantly increasing. However, the number of periprosthetic joint infections (PJIs), one of the most severe complications after total joint arthroplasty, also shows an increasing trend. PJI has an incidence of 1-2% in the case of primary arthroplasties and up to 4% in the case of revision operations. The development of efficient protocols for managing periprosthetic infections can lead to the establishment of preventive measures and effective diagnostic methods based on the results obtained after the laboratory tests. In this review, we will briefly present the current methods used in PJI diagnosis and the current and emerging synovial biomarkers used for the prognosis, prophylaxis, and early diagnosis of periprosthetic infections. We will discuss treatment failure that may result from patient factors, microbiological factors, or factors related to errors during diagnosis.
Topics: Humans; Prosthesis-Related Infections; Synovial Fluid; Biomarkers; Arthroplasty, Replacement, Knee; Arthroplasty, Replacement, Hip; Arthritis, Infectious
PubMed: 36901750
DOI: 10.3390/ijms24054320 -
Osteoarthritis and Cartilage May 2011Osteoarthritis (OA) is the most common type of arthritis and a major cause of chronic musculoskeletal pain and functional disability. While both pharmacologic and...
Osteoarthritis (OA) is the most common type of arthritis and a major cause of chronic musculoskeletal pain and functional disability. While both pharmacologic and non-pharmacologic modalities are recommended in the management of OA, when patients with hip or knee OA do not obtain adequate pain relief and/or functional improvement, joint replacement surgery or other surgical interventions should be considered. Total joint arthroplasties are reliable and cost-effective treatments for patients with significant OA of the hip and knee. Evidence from cohort and observational studies has confirmed substantial improvements in pain relief with cumulative revision rates at 10 years following total hip (THA) and total knee arthroplasties (TKA) at 7% and 10%, respectively. Joint replacements have been used in most every synovial joint, although results for joints other than hip and knee replacement have not been as successful. The evolution of new device designs and surgical techniques highlights the need to better understand the risk to benefit ratio for different joint replacements and to identify the appropriate methodology for evaluating the efficacy and optimal outcomes of these new devices, designed to treat OA joints.
Topics: Arthroplasty, Replacement; Device Approval; Humans; Joint Prosthesis; Osteoarthritis; Risk Assessment; Treatment Outcome
PubMed: 21396462
DOI: 10.1016/j.joca.2011.02.017 -
Arthritis and Rheumatism Aug 2007The number of individuals ages >or=100 years in the US is expected to increase considerably in the future along with the need for arthroplasties. This report focuses on...
OBJECTIVE
The number of individuals ages >or=100 years in the US is expected to increase considerably in the future along with the need for arthroplasties. This report focuses on the poorly studied epidemiology and mortality outcomes of arthroplasty among these individuals.
METHODS
We describe the epidemiology of knee and hip arthroplasties among centenarians using data from a large hospital discharge database in the US (the Nationwide Inpatient Sample) during the period 1993 through 2002. We used nonagenarians as the comparison group with adjustment for differences in the prevalence of congestive heart failure, neurologic diseases such as dementia and stroke, renal and hepatic diseases, obesity, anemia, malignancy, coagulopathy, and depression and other psychiatric illnesses. Cox regression models were used to study the mortality outcomes following arthroplasty.
RESULTS
Overall, there were 679 hip arthroplasties and 7 knee arthroplasties among centenarians in this database. The corresponding figures for nonagenarians were 33,975 and 2,050, respectively. A vast majority (83%) of hip arthroplasty recipients were women. Risk-adjusted mortality estimates following arthroplasty for centenarians were higher than for nonagenarians (hazard ratio 1.46, 95% confidence interval 1.10-1.95). However, this was similar to differences in overall in-hospital mortality (hazard ratio 1.36, 95% confidence interval 1.32-1.40) between these 2 age categories.
CONCLUSION
In the US population, hip and knee arthroplasty are very rarely performed among centenarians. Our in-hospital mortality data suggest that arthroplasties should not be denied to centenarians solely because of short-term postoperative life expectancy estimates.
Topics: Age Factors; Aged, 80 and over; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Databases as Topic; Hospital Mortality; Humans; Osteoarthritis, Hip; Osteoarthritis, Knee; Proportional Hazards Models; Retrospective Studies; Treatment Outcome; United States
PubMed: 17665474
DOI: 10.1002/art.22888 -
Acta Orthopaedica Jan 2022Background and purpose - Most arthroplasty registers give hospital-specific feedback on revision rates after total hip and knee arthroplasties (THA/TKA). However, due to... (Review)
Review
Background and purpose - Most arthroplasty registers give hospital-specific feedback on revision rates after total hip and knee arthroplasties (THA/TKA). However, due to the low number of events per hospital, multiple years of data are required to reliably detect worsening performance, and any single indicator provides only part of the quality of care delivered. Therefore, we developed an ordered composite outcome including revision, readmission, complications, and long length-of-stay (LOS) for a more comprehensive view on quality of care and assessed the ability to reliably differentiate between hospitals in their performance (rankability) with fewer years of data. Methods - All THA and TKA performed between 2017 and 2019 in 20 Dutch hospitals were included. All combinations of the 4 indicators were ranked from best to worst to create the ordinal composite outcome for THA and TKA separately. Between-hospital variation for the composite outcome was compared with individual indicators standardized for case-mix differences, and we calculated the statistical rankability using fixed and random effects models. Results - 22,908 THA and 20,423 TKA were included. Between-hospital variation for the THA and TKA composite outcomes was larger when compared with revision, readmission, and complications, and similar to long LOS. Rankabilities for the composite outcomes were above 80% even with 1 year of data, meaning that largely true hospital differences were detected rather than random variation. Interpretation - The ordinal composite outcome gives a more comprehensive overview of quality of delivered care and can reliably differentiate between hospitals in their performance using 1 year of data, thereby allowing earlier introduction of quality improvement initiatives.
Topics: Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Hospitals; Humans; Length of Stay; Patient Readmission; Postoperative Complications; Quality Improvement
PubMed: 34984484
DOI: 10.2340/17453674.2021.861 -
Acta Orthopaedica Jun 2017Background and purpose - There is a lack of information on any associations between the functional outcome and age and diagnosis in patients who have undergone shoulder...
Background and purpose - There is a lack of information on any associations between the functional outcome and age and diagnosis in patients who have undergone shoulder arthroplasty. We therefore evaluated the functional outcome in "young" and "old" patients treated with either hemiarthroplasty (HA) or total shoulder arthroplasty (TSA) with diverse diagnoses. Patients and methods - The functional results of 496 primary shoulder arthroplasties were analyzed using the Constant score (age- and sex-adjusted) and subjective satisfaction. Patients ≤55 years of age at surgery were defined as "young. Diagnoses were primary osteoarthritis (n = 339), posttraumatic osteoarthritis (n = 78), cuff tear arthropathy (n = 36), avascular necrosis (n = 30), and rheumatoid arthritis (n = 13). Mean length of follow-up was 4 (2-14) years. Results - 70% of the TSA patients were very satisfied with the postoperative result, as compared to 39% after HA. The Constant score and patient satisfaction were similar in the "young" and "old" groups. Pain relief was better in the "old" group. The mean improvement in the Constant score after cuff tear arthropathy (22 points) was inferior to that for primary osteoarthritis (36 points), avascular necrosis (34 points), and rheumatoid arthritis (37 points). Inferior mean Constant scores were also seen for posttraumatic osteoarthritis (29 points) compared to primary osteoarthritis (36 points). 63% of patients with primary osteoarthritis were very satisfied, as compared to only 36% of the patients with posttraumatic osteoarthritis. Interpretation - Shoulder arthroplasty is successful in the medium term for different glenohumeral diseases, irrespective of patient age at surgery. However, the appropriate treatment method for cuff tear and posttraumatic conditions of the shoulder remains to be found, particularly in young patients.
Topics: Adult; Age Factors; Aged; Aged, 80 and over; Arthritis, Rheumatoid; Arthroplasty, Replacement, Shoulder; Female; Hemiarthroplasty; Humans; Male; Middle Aged; Osteoarthritis; Osteonecrosis; Patient Satisfaction; Prospective Studies; Range of Motion, Articular; Recovery of Function; Reoperation; Rotator Cuff Injuries; Shoulder Injuries; Shoulder Joint; Treatment Outcome
PubMed: 28121220
DOI: 10.1080/17453674.2017.1280656 -
Journal of Perioperative Practice 2022Hydrogen peroxide has become more commonly used in hip arthroplasties due to high risk of periprosthetic infections. Its purported roles include irrigation, haemostasis,... (Review)
Review
Hydrogen peroxide has become more commonly used in hip arthroplasties due to high risk of periprosthetic infections. Its purported roles include irrigation, haemostasis, reduction of aseptic loosening and attachment of antibiotics. However, current literature does not provide conclusive evidence on the efficacy of hydrogen peroxide in preventing aseptic loosening, with some controversy around whether it in fact contributes to aseptic loosening. The complications of hydrogen peroxide across medicine are well distinguished; however, the risks within orthopaedic surgery and hip arthroplasties are not well known. Beyond cytotoxicity, the most dangerous reported risk associated with hydrogen peroxide in hip arthroplasties was an oxygen embolism in an unvented femoral canal and acrylic bone cement, consequentially leading to cardiac arrest. However, it may be inappropriate to solely attribute the oxygen embolism to the use of hydrogen peroxide and thus if used appropriately, hydrogen peroxide may have a justifiable role in hip arthroplasty surgery. In this narrative review, we present the current uses of hydrogen peroxide while evaluating its associated risks. We have summarised the key indications and aggregated recommendations to provide guidelines for the use of hydrogen peroxide in hip arthroplasty.
Topics: Arthroplasty, Replacement, Hip; Hip Prosthesis; Humans; Hydrogen Peroxide; Orthopedics; Oxygen; Prosthesis Failure
PubMed: 34250856
DOI: 10.1177/1750458921996259 -
Clinics in Orthopedic Surgery Mar 2022The purpose of this study was to determine the number of patients lost to follow-up yearly in shoulder arthroplasty and investigate the characteristics of the patients...
BACKGROUND
The purpose of this study was to determine the number of patients lost to follow-up yearly in shoulder arthroplasty and investigate the characteristics of the patients lost to follow-up that may differ from those not lost to follow-up.
METHODS
All shoulder arthroplasties performed from January 2008 to December 2014 were retrospectively reviewed. The number of patients lost to follow-up was determined yearly. Independent variables included age, sex, body mass index (BMI), diagnosis, type of prostheses, living condition, smoking, alcohol intake, American Society of Anesthesiologists (ASA) score, in-hospital length, surgery length, living area, preoperative Constant score, last Constant score available, and complications. Number of deaths was recorded.
RESULTS
This study included 251 patients. There was an accumulation of 86 patients (34.3%) lost to follow-up after a maximum of 8 years. During the first year, 9.9% of the patients were lost to follow-up, 18.3% in the second year, 25.1% in the third year, 28.7% in the fourth year, 31.5% in the fifth year, 33.9% in the sixth year, and 34.3% in the seventh year. Patients with severe obesity had 2.44 times greater risk of being lost to follow-up (hazard ratio [HR], 2.44; < 0.001). Elderly patients were also at higher risk (HR, 1.05; < 0.001). Increases in the ASA score raised the risk of being lost (HR, 1.93; < 0.001). Patients with complications had a lower risk (43%) of being lost (HR, 0.57; = 0.018) at the 8-year follow-up. At the 2-year follow-up, the patients with acute fractures and fracture sequelae had a higher risk of being lost to follow-up (HR, 2.44; = 0.002), and the patients with complications were not significantly different from those without complications (HR, 0.54; = 0.12).
CONCLUSIONS
The longer the follow-up in shoulder arthroplasty, the greater the number of patients lost to follow-up, reaching 34.3% by the seventh year. Patients lost to follow-up were not random in shoulder arthroplasty: older patients, severely obese patients, and those with higher ASA scores were at higher risk of being lost to follow-up, but reasons for being lost to follow-up changed through time and depending on when they were assessed.
Topics: Aged; Arthroplasty; Arthroplasty, Replacement, Shoulder; Humans; Lost to Follow-Up; Retrospective Studies; Shoulder Joint; Treatment Outcome
PubMed: 35251548
DOI: 10.4055/cios21034 -
Acta Orthopaedica Oct 2021Background and purpose - There is lack of knowledge concerning patient-reported long-time outcome after arthroplasty. Therefore, we investigated patient self-reported... (Comparative Study)
Comparative Study
Background and purpose - There is lack of knowledge concerning patient-reported long-time outcome after arthroplasty. Therefore, we investigated patient self-reported physical capabilities (PC) and subjective well-being (SW) up to 20 years after total hip (THA) or knee (TKA) arthroplasty.Subjects and methods - The self-reports from postal questionnaires for study checkpoints (baseline, 10-year follow-up, 20-year follow-up) were provided by the Kuopio OSTPRE study including only women aged 52-62 years (n = 6,462). The Finnish Arthroplasty Register and Care Register for Health Care provided data on arthroplasties in the OSTPRE population. The results of women with THA/TKA were compared with women without arthroplasty (control group).Results - In subjects with THA performed before the 10-year follow-up, the proportion of good PC was initially decreased by 0.6 percentage points (pp) at the 10-year follow-up and later by 19 pp at the 20-year follow-up. After TKA, the proportion of subjects with good PC decreased by 4.1 pp (10-year follow-up) and 27 pp (20-year follow-up), respectively. The proportion of controls reporting good PC decreased by 1.4 pp at the 10-year follow-up and 14 pp at the 20-year follow-up compared with the baseline. After THA, the proportion of subjects with good SW stayed on the same level at 10-year follow-up and decreased by 2.3 pp at 20-year follow-up. After TKA, the proportion of good SW increased by 9.0 pp (10-year follow-up) and decreased by 14 pp (20-year follow-up). The proportion of controls reporting good SW increased by 4.0 pp (10-year follow-up) and decreased by 8.8 pp (20-year follow-up).Interpretation - THA and TKA maintain PC and SW. The overall PC and SW are lower in women with arthroplasty, in comparison with controls without arthroplasty. THA seems to outperform TKA in maintaining PC.
Topics: Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Female; Follow-Up Studies; Humans; Middle Aged; Patient Reported Outcome Measures; Quality of Life; Recovery of Function
PubMed: 33977808
DOI: 10.1080/17453674.2021.1922039