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The Journal of Knee Surgery Nov 2018Unicompartmental knee arthroplasty (UKA) is a bone conserving and ligament-sparing procedure that reliably restores normal knee kinematics and function for arthritis... (Review)
Review
Unicompartmental knee arthroplasty (UKA) is a bone conserving and ligament-sparing procedure that reliably restores normal knee kinematics and function for arthritis limited either to the medial or the lateral compartment of the knee. Although there is enough evidence to demonstrate that the UKA offers good medium to long-term success given the correct patient selection, prosthesis design, and implantation technique, there are several reports to suggest inferior survival rates in comparison with the total knee arthroplasty (TKA). Furthermore, it is a specialized procedure which works well in the hands of the experienced operator and therefore different authors' tend to draw different conclusions based on the same evidence, and as a result, there is great variability in the usage of the UKA. The aim of this current concept's review is to present to the readers the history of the UKA especially with reference to implant design, discuss current controversies, and outline the future perspectives of this novel procedure.
Topics: Arthroplasty, Replacement, Knee; History, 20th Century; History, 21st Century; Humans; Knee Joint; Knee Prosthesis; Osteoarthritis, Knee; Prosthesis Design
PubMed: 29514367
DOI: 10.1055/s-0038-1625961 -
The Bone & Joint Journal Apr 2018Unicompartmental knee arthroplasty (UKA) has numerous advantages over total knee arthroplasty (TKA) and one disadvantage, the higher revision rate. The best way to... (Review)
Review
Unicompartmental knee arthroplasty (UKA) has numerous advantages over total knee arthroplasty (TKA) and one disadvantage, the higher revision rate. The best way to minimize the revision rate is for surgeons to use UKA for at least 20% of their knee arthroplasties. To achieve this, they need to learn and apply the appropriate indications and techniques. This would decrease the revision rate and increase the number of UKAs which were implanted, which would save money and patients would benefit from improved outcomes over their lifetime. Cite this article: Bone Joint J 2018;100-B:432-5.
Topics: Arthroplasty, Replacement, Knee; Hemiarthroplasty; Humans; Knee Prosthesis; Osteoarthritis, Knee; Patient Selection; Practice Patterns, Physicians'; Registries; Reoperation; Treatment Outcome; United Kingdom
PubMed: 29629577
DOI: 10.1302/0301-620X.100B4.BJJ-2017-0716.R1 -
Anales Del Sistema Sanitario de Navarra 2012This review analyzes the existing studies on home care rehabilitation and physiotherapy in patients with a knee prosthesis intervention, identifying and synthesising the... (Comparative Study)
Comparative Study Review
This review analyzes the existing studies on home care rehabilitation and physiotherapy in patients with a knee prosthesis intervention, identifying and synthesising the results of the interventions measured in terms of muscular strength, function, extension of the joint, walking, patient's quality of life and cost of the service, compared with other alternative treatments. Nine databases have been analysed: IME, ENFISPO, CUIDEN PLUS, PUBMED, EMBASE, CINAHL, PEDro, COCHRANE library Plus and TRIP DATA BASE where 18 studies met the criteria for inclusion with information on 4,996 patients. Home care rehabilitation varies from one place to another and between studies (forms of care, application, duration, variable measures); but the idea is supported that this is as effective and acceptable as that received in an outpatients' department. It accelerates the attainment of functional achievements in the short and medium term, entailing very brief hospital stays and a reduction in costs.
Topics: Arthroplasty, Replacement, Knee; Home Care Services; Humans; Knee Prosthesis; Physical Therapy Modalities
PubMed: 22552131
DOI: 10.4321/s1137-66272012000100009 -
Journal of ISAKOS : Joint Disorders &... Oct 2023The reverse shoulder arthroplasty conceived by Paul Grammont in 1985 has gradually gained popularity as a treatment for multiple shoulder diseases. Unlike previous... (Review)
Review
The reverse shoulder arthroplasty conceived by Paul Grammont in 1985 has gradually gained popularity as a treatment for multiple shoulder diseases. Unlike previous reverse shoulder prosthesis characterized by unsatisfactory results and a high glenoid implant failure rate, the Grammont design has immediately shown good clinical outcomes. This semi constrained prosthesis solved the issues of the very first designs by medializing and distalizing the center of rotation with an increased stability of the replacement of the component. The indication was initially limited to cuff tear arthropathy (CTA). It has then been expanded to irreparable massive cuff tears and displaced humeral head fractures. The most frequent problems of this design are a limited postoperative external rotation and scapular notching. Different modifications to the original Grammont design have been proposed with the aim of decreasing the risk of failure and complications and improving the clinical outcomes. Both the position and version/inclination of the glenosphere and the humeral configuration (e.g. neck shaft angle) influence the RSA outcomes. A lateralized glenoid (whether with bone or metal) and a 135° Inlay system configuration leads to a moment arm which is the closest to the native shoulder. Clinical research will focus on implant designs reducing bone adaptations and revision rate, strategies to prevent more effectively infections. Furthermore, there is still room for improvement in terms of better postoperative internal and external rotations and clinical outcomes after RSA implanted for humeral fracture and revision shoulder arthroplasty.
Topics: Humans; Arthroplasty, Replacement, Shoulder; Shoulder Joint; Shoulder Prosthesis; Joint Prosthesis; Rotator Cuff Tear Arthropathy
PubMed: 37301479
DOI: 10.1016/j.jisako.2023.05.007 -
Orthopaedics & Traumatology, Surgery &... Nov 2017In spite of improvements in implant designs and surgical precision, functional outcomes of mechanically aligned total knee arthroplasty (MA TKA) have plateaued. This... (Review)
Review
In spite of improvements in implant designs and surgical precision, functional outcomes of mechanically aligned total knee arthroplasty (MA TKA) have plateaued. This suggests probable technical intrinsic limitations that few alternate more anatomical recently promoted surgical techniques are trying to solve. This review aims at (1) classifying the different options to frontally align TKA implants, (2) at comparing their safety and efficacy with the one from MA TKAs, therefore answering the following questions: does alternative techniques to position TKA improve functional outcomes of TKA (question 1)? Is there any pathoanatomy not suitable for kinematic implantation of a TKA (question 2)? A systematic review of the existing literature utilizing PubMed and Google Scholar search engines was performed in February 2017. Only studies published in peer-reviewed journals over the last ten years in either English or French were reviewed. We identified 569 reports, of which 13 met our eligibility criteria. Four alternative techniques to position a TKA are challenging the traditional MA technique: anatomic (AA), adjusted mechanical (aMA), kinematic (KA), and restricted kinematic (rKA) alignment techniques. Regarding osteoarthritic patients with slight to mid constitutional knee frontal deformity, the KA technique enables a faster recovery and generally generates higher functional TKA outcomes than the MA technique. Kinematic alignment for TKA is a new attractive technique for TKA at early to mid-term, but need longer follow-up in order to assess its true value. It is probable that some forms of pathoanatomy might affect longer-term clinical outcomes of KA TKA and make the rKA technique or additional surgical corrections (realignment osteotomy, retinacular ligament reconstruction etc.) relevant for this sub-group of patients. Longer follow-up is needed to define the best indication of each alternative surgical technique for TKA. Level I for question 1 (systematic review of Level I studies), level 4 for question 2.
Topics: Arthroplasty, Replacement, Knee; Biomechanical Phenomena; Humans; Knee Joint; Knee Prosthesis
PubMed: 28864235
DOI: 10.1016/j.otsr.2017.07.010 -
Bulletin of the Hospital For Joint... 2014Patellofemoral arthroplasty has been described as an appropriate treatment for isolated patellofemoral arthritis. With the aging population and the increasing number of... (Review)
Review
Patellofemoral arthroplasty has been described as an appropriate treatment for isolated patellofemoral arthritis. With the aging population and the increasing number of total joint arthroplasties, both patients and surgeons are on the lookout for alternatives to total joint arthroplasty. With appropriate patient selection, well-designed implants, and precise surgical technique, the outcomes of patellofemoral arthroplasty can be excellent. The main indication for patellofemoral arthroplasty is isolated patellofemoral arthritis.
Topics: Arthroplasty, Replacement, Knee; Biomechanical Phenomena; Humans; Knee Prosthesis; Patellofemoral Joint; Patient Selection; Postoperative Complications; Prosthesis Design; Recovery of Function; Risk Factors; Treatment Outcome
PubMed: 25150332
DOI: No ID Found -
Orthopaedic Surgery Nov 2016Patient-specific orthopaedic implants are emerging as a clinically promising treatment option for a growing number of conditions to better match an individual's anatomy.... (Review)
Review
Patient-specific orthopaedic implants are emerging as a clinically promising treatment option for a growing number of conditions to better match an individual's anatomy. Patient-specific implant (PSI) technology aims to reduce overall procedural costs, minimize surgical time, and maximize patient outcomes by achieving better biomechanical implant fit. With this commercially-available technology, computed tomography or magnetic resonance images can be used in conjunction with specialized computer programs to create preoperative patient-specific surgical plans and to develop custom cutting guides from 3-D reconstructed images of patient anatomy. Surgeons can then place these temporary guides or "jigs" during the procedure, allowing them to better recreate the exact resections of the computer-generated surgical plan. Over the past decade, patient-specific implants have seen increased use in orthopaedics and they have been widely indicated in total knee arthroplasty, total hip arthroplasty, and corrective osteotomies. Patient-specific implants have also been explored for use in total shoulder arthroplasty and spinal surgery. Despite their increasing popularity, significant support for PSI use in orthopaedics has been lacking in the literature and it is currently uncertain whether the theoretical biomechanical advantages of patient-specific orthopaedic implants carry true advantages in surgical outcomes when compared to standard procedures. The purpose of this review was to assess the current status of patient-specific orthopaedic implants, to explore their future direction, and to summarize any comparative published studies that measure definitive surgical characteristics of patient-specific orthopaedic implant use such as patient outcomes, biomechanical implant alignment, surgical cost, patient blood loss, or patient recovery.
Topics: Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Bone Plates; Computer-Aided Design; Humans; Joint Prosthesis; Magnetic Resonance Imaging; Patient-Specific Modeling; Prosthesis Design; Tomography, X-Ray Computed
PubMed: 28032697
DOI: 10.1111/os.12282 -
Orthopaedics & Traumatology, Surgery &... Feb 2015The first nationwide orthopaedic registry was created in Sweden in 1975 to collect data on total knee arthroplasty (TKA). Since then, several countries have established... (Review)
Review
The first nationwide orthopaedic registry was created in Sweden in 1975 to collect data on total knee arthroplasty (TKA). Since then, several countries have established registries, with varying degrees of success. Managing a registry requires time and money. Factors that contribute to successful registry management include the use of a single identifier for each patient to ensure full traceability of all procedures related to a given implant; a long-term funding source; a contemporary, rapid, Internet-based data collection method; and the collection of exhaustive data, at least for innovative implants. The effects of registries on practice patterns should be evaluated. The high cost of registries raises issues of independence and content ownership. Scandinavian countries have been maintaining orthopaedic registries for nearly four decades (since 1975). The first English-language orthopaedic registry was not created until 1998 (in New Zealand), and both the US and many European countries are still struggling to establish orthopaedic registries. To date, there are 11 registered nationwide registries on total knee and total hip replacement. The data they contain are often consistent, although contradictions occur in some cases due to major variations in cultural and market factors. The future of registries will depend on the willingness of health authorities and healthcare professionals to support the creation and maintenance of these tools. Surgeons feel that registries should serve merely to compare implants. Health authorities, in contrast, have a strong interest in practice patterns and healthcare institution performances. Striking a balance between these objectives should allow advances in registry development in the near future.
Topics: Arthroplasty, Replacement; Cost Savings; Humans; International Cooperation; Internationality; Joint Prosthesis; Orthopedics; Product Surveillance, Postmarketing; Registries
PubMed: 25553603
DOI: 10.1016/j.otsr.2014.06.029 -
Chinese Journal of Traumatology =... 2016Total wrist arthroplasty are not used as widely as total knee and hip replacement. The functional hands are requiring surgeons to design a durable and functional... (Review)
Review
Total wrist arthroplasty are not used as widely as total knee and hip replacement. The functional hands are requiring surgeons to design a durable and functional satisfying prosthesis. This article will list the main reasons that cause the failure of the prosthesis. Some remarkable and representative prostheses are listed to show the devolvement of total wrist prosthesis and their individual special innovations to fix the problems. And the second part we will discuss the part that biomechanical elements act in the total wrist replacement (TWA). Summarize and find out what the real problem is and how we can find a way to fix it.
Topics: Arthroplasty, Replacement; Biomechanical Phenomena; Humans; Joint Instability; Joint Prosthesis; Wrist Joint
PubMed: 27033274
DOI: 10.1016/j.cjtee.2015.12.003 -
Journal of Orthopaedic Surgery and... Jul 2015The management of irreparable rotator cuff tears associated with osteoarthritis of the glenohumeral joint has long been challenging. Reverse total shoulder arthroplasty... (Review)
Review
The management of irreparable rotator cuff tears associated with osteoarthritis of the glenohumeral joint has long been challenging. Reverse total shoulder arthroplasty (RSA) was designed to provide pain relief and improve shoulder function in patients with severe rotator cuff tear arthropathy. While this procedure has been known to reduce pain, improve strength and increase range of motion in shoulder elevation, scapular notching, rotation deficiency, early implant loosening and dislocation have attributed to complication rates as high as 62%. Patient selection, surgical approach and post-operative management are factors vital to successful outcome of RSA, with implant design and component positioning having a significant influence on the ability of the shoulder muscles to elevate, axially rotate and stabilise the humerus. Clinical and biomechanical studies have revealed that component design and placement affects the location of the joint centre of rotation and therefore the force-generating capacity of the muscles and overall joint mobility and stability. Furthermore, surgical technique has also been shown to have an important influence on clinical outcome of RSA, as it can affect intra-operative joint exposure as well as post-operative muscle function. This review discusses the behaviour of the shoulder after RSA and the influence of implant design, component positioning and surgical technique on post-operative joint function and clinical outcome.
Topics: Arthroplasty, Replacement; Humans; Joint Prosthesis; Prosthesis Design; Shoulder Joint
PubMed: 26135298
DOI: 10.1186/s13018-015-0244-2