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The Journal of Bone and Joint Surgery.... Jun 2009Cervical spinal disc replacement is used in the management of degenerative cervical disc disease in an attempt to preserve cervical spinal movement and to prevent...
Cervical spinal disc replacement is used in the management of degenerative cervical disc disease in an attempt to preserve cervical spinal movement and to prevent adjacent disc overload and subsequent degeneration. A large number of patients have undergone cervical spinal disc replacement, but the effectiveness of these implants is still uncertain. In most instances, degenerative change at adjacent levels represents the physiological progression of the natural history of the arthritic disc, and is unrelated to the surgeon. Complications of cervical disc replacement include loss of movement from periprosthetic ankylosis and ossification, neurological deficit, loosening and failure of the device, and worsening of any cervical kyphosis. Strict selection criteria and adherence to scientific evidence are necessary. Only prospective, randomised clinical trials with long-term follow-up will establish any real advantage of cervical spinal disc replacement over fusion.
Topics: Arthroplasty, Replacement; Case-Control Studies; Cervical Vertebrae; Clinical Trials as Topic; Disease Progression; Humans; Intervertebral Disc Displacement; Joint Prosthesis; Prosthesis Design; Range of Motion, Articular; Treatment Outcome
PubMed: 19483221
DOI: 10.1302/0301-620X.91B6.22025 -
Zhongguo Xiu Fu Chong Jian Wai Ke Za... Feb 2024To summarize the influencing factors on the effectiveness of reverse total shoulder arthroplasty (RTSA), so as to provide reference for clinical treatment.
OBJECTIVE
To summarize the influencing factors on the effectiveness of reverse total shoulder arthroplasty (RTSA), so as to provide reference for clinical treatment.
METHODS
The related research literature of RTSA at home and abroad was extensively consulted, and the factors that may affect the effectiveness were summarized from the aspects of surgical technique, muscle condition, general condition of patients, psychological expectation, and lifestyle.
RESULTS
For surgical techniques, different surgical approaches have their own advantages. The glenoid notch, poor bone ingrowth, increased bone resorption, and infection would lead to the loosening of glenoid prosthesis. In addition, the neck shaft angle and inclination angle of humeral prosthesis affect the occurrence of glenoid notch and the range of motion of joint internal/external rotation after operation, respectively. For muscle condition, the quality of teres minor and deltoid muscle has an important influence on joint stability after operation. Moderate increase of deltoid muscle tension can improve joint mobility after operation, and suture repair of subscapular tendon during operation can relieve joint pain and improve function, range of motion, and strength. For the general condition of patients, gender, age, and body mass index are all related to postoperative joint function and complications, and different occupations and postoperative exercise levels affect the recovery. The patients with severe degenerative diseases, poor preoperative function, and long disease duration have lower expectations and higher satisfaction with the effectiveness, and bad lifestyle has a negative impact on the effectiveness.
CONCLUSION
The effectiveness of RTSA is related to surgical technique, muscle condition, general condition of patients, psychological expectation, and lifestyle. In order to avoid the loosening of glenoid prosthesis, the operator should choose humeral prosthesis with small neck shaft angle and large glenoid ball and put them down and inclined inferiorly during operation, and choose appropriate approach to eliminate space with drainage to reduce the risk of infection. After operation, patients should avoid activities that generate high anterior and posterior shear forces. In addition, the humeral prosthesis with a inclination angle of 10°-20° can achieve the best balance between the range of internal rotation and external rotation after operation. Proper deltoid tension can maintain joint stability and good range of motion. Suture of subscapular tendon is recommended.
Topics: Humans; Arthroplasty, Replacement, Shoulder; Shoulder Joint; Arthroplasty; Joint Prosthesis; Scapula; Range of Motion, Articular; Treatment Outcome
PubMed: 38385235
DOI: 10.7507/1002-1892.202310088 -
Bulletin of the Hospital For Joint... 2013Revision of a shoulder arthroplasty often requires removal of a well fixed humeral component. Revision of this component can be quite easy in the case of a non-infected... (Review)
Review
Revision of a shoulder arthroplasty often requires removal of a well fixed humeral component. Revision of this component can be quite easy in the case of a non-infected platform stem or be very difficult when removal of a well cemented or on-growth stem with distal texturing is required. The purpose of this paper is to provide a series of techniques designed for revision of the humeral component in shoulder arthroplasty. Revision of the stem can be easy with a non-infected platform stem only requiring exchange of the epiphyseal component. Some stems, usually uncemented, can readily be removed from a proximal only approach. Stems with excellent cement mantles may require a longitudinal only split in the humerus done with minimal stripping of the brachialis. If complete cement removal is needed for infection or there is distal stem on growth, then a vascularized door technique is indicated. These techniques are explained in detail in this manuscript.
Topics: Arthroplasty, Replacement; Bone Cements; Cementation; Humans; Humerus; Joint Prosthesis; Prosthesis Failure; Reoperation; Shoulder Joint; Treatment Outcome
PubMed: 24328586
DOI: No ID Found -
Hand Surgery & Rehabilitation Sep 2022Semiconstrained arthroplasty of the distal radioulnar joint (DRUJ) (Scheker prosthesis, Aptis Medical, Glenview, KY, USA) is a treatment option in case of irreparable...
Semiconstrained arthroplasty of the distal radioulnar joint (DRUJ) (Scheker prosthesis, Aptis Medical, Glenview, KY, USA) is a treatment option in case of irreparable destruction of the DRUJ. In our unit, a Scheker endoprosthesis was implanted in 5 wrists in 4 patients. 3/5 wrists (60%) in 3/4 patients (75%) underwent revision surgery. Reasons for revision surgery were implant loosening, periprosthetic fracture of the radius and suspicion of periprosthetic infection. Asymptomatic loosening of the screw of the radial head cover was detected in one wrist. Scheker arthroplasty is technically demanding. The prosthesis is prone to failure over the long term. Before implantation, all patients should be informed of the high risk of revision surgery.
Topics: Arthroplasty, Replacement; Elbow Joint; Humans; Joint Prosthesis; Reoperation; Wrist Joint
PubMed: 35460957
DOI: 10.1016/j.hansur.2022.03.001 -
Annals of the Royal College of Surgeons... Jul 2001To assist surgeons select a suitable prosthesis, we have undertaken a detailed review of all shoulder and elbow replacements currently marketed in the UK. Twenty... (Review)
Review
To assist surgeons select a suitable prosthesis, we have undertaken a detailed review of all shoulder and elbow replacements currently marketed in the UK. Twenty shoulder and 8 elbow implants, manufactured by 16 companies, have been identified. Twelve of the shoulder and one of the elbow implants have been introduced or modified in the last 8 years and have no clinical results published in peer-reviewed journals. Only the Biomodular, Bipolar, Copeland, Isoelastic, Neer hemi, Neer II, Roper-Day and Select shoulders accounting for less than 40% of the UK shoulder market, possess published results. The Capitello-condylar, Coonrad-Morrey, GSB III, Kudo, Liverpool, Roper-Tuke and Souter-Strathclyde elbows all have published results. These account for over 95% of all UK elbow replacements. The implications of these findings in an era of evidence-based medicine is discussed. Reviewing the clinical results should be of primary importance in the selection of a suitable prosthesis. Implants with a proven long-term record must represent the 'gold standard'. New or modified implants should only be used if they are part of a properly conducted clinical trial.
Topics: Arthroplasty, Replacement; Elbow Joint; Evidence-Based Medicine; Follow-Up Studies; Humans; Joint Prosthesis; Prosthesis Design; Prosthesis Failure; Recovery of Function; Shoulder Joint; United Kingdom
PubMed: 11518374
DOI: No ID Found -
Clinical Orthopaedics and Related... Jun 2020
Topics: Arthroplasty, Replacement; Humans; Joint Prosthesis; Postoperative Complications; Registries; Treatment Outcome
PubMed: 32332243
DOI: 10.1097/CORR.0000000000001274 -
The Journal of Bone and Joint Surgery.... May 2004Total hip and total knee arthroplasties are well accepted as reliable and suitable surgical procedures to return patients to function. Health-related quality-of-life... (Comparative Study)
Comparative Study Review
BACKGROUND
Total hip and total knee arthroplasties are well accepted as reliable and suitable surgical procedures to return patients to function. Health-related quality-of-life instruments have been used to document outcomes in order to optimize the allocation of resources. The objective of this study was to review the literature regarding the outcomes of total hip and knee arthroplasties as evaluated by health-related quality-of-life instruments.
METHODS
The Medline and EMBASE medical literature databases were searched, from January 1980 to June 2003, to identify relevant studies. Studies were eligible for review if they met the following criteria: (1). the language was English or French, (2). at least one well-validated and self-reported health-related quality of life instrument was used, and (3). a prospective cohort study design was used.
RESULTS
Of the seventy-four studies selected for the review, thirty-two investigated both total hip and total knee arthroplasties, twenty-six focused on total hip arthroplasty, and sixteen focused on total knee arthroplasty exclusively. The most common diagnosis was osteoarthritis. The duration of follow-up ranged from seven days to seven years, with the majority of studies describing results at six to twelve months. The Short Form-36 and the Western Ontario and McMaster University Osteoarthritis Index, the most frequently used instruments, were employed in forty and twenty-eight studies, respectively. Seventeen studies used a utility index. Overall, total hip and total knee arthroplasties were found to be quite effective in terms of improvement in health-related quality-of-life dimensions, with the occasional exception of the social dimension. Age was not found to be an obstacle to effective surgery, and men seemed to benefit more from the intervention than did women. When improvement was found to be modest, the role of comorbidities was highlighted. Total hip arthroplasty appears to return patients to function to a greater extent than do knee procedures, and primary surgery offers greater improvement than does revision. Patients who had poorer preoperative health-related quality of life were more likely to experience greater improvement.
CONCLUSIONS
Health-related quality-of-life data are valuable, can provide relevant health-status information to health professionals, and should be used as a rationale for the implementation of the most adequate standard of care. Additional knowledge and scientific dissemination of surgery outcomes should help to ensure better management of patients undergoing total hip or total knee arthroplasty and to optimize the use of these procedures.
Topics: Age Factors; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Body Weight; Cost-Benefit Analysis; Female; Humans; Joint Diseases; Joint Prosthesis; Male; Quality of Life; Recovery of Function; Reoperation; Sex Factors; Time Factors; Treatment Outcome
PubMed: 15118039
DOI: 10.2106/00004623-200405000-00012 -
Medical Engineering & Physics Nov 2023To avoid dislocation of the shoulder joint after reverse total shoulder arthroplasty, it is important to achieve sufficient shoulder stability when placing the implant...
To avoid dislocation of the shoulder joint after reverse total shoulder arthroplasty, it is important to achieve sufficient shoulder stability when placing the implant components during surgery. One parameter for assessing shoulder stability can be shoulder stiffness. The aim of this research was to develop a temporary reverse shoulder implant prototype that would allow intraoperative measurement of shoulder stiffness while varying the position of the implant components. Joint angle and torque measurement techniques were developed to determine shoulder stiffness. Hall sensors were used to measure the joint angles by converting the magnetic flux densities into angles. The accuracy of the joint angle measurements was tested using a test bench. Torques were determined by using thin-film pressure sensors. Various mechanical mechanisms for variable positioning of the implant components were integrated into the prototype. The results of the joint angle measurements showed measurement errors of less than 5° in a deflection range of ±15° adduction/abduction combined with ±45° flexion/extension. The proposed design provides a first approach for intra-operative assessment of shoulder stiffness. The findings can be used as a technological basis for further developments.
Topics: Shoulder; Range of Motion, Articular; Arthroplasty, Replacement, Shoulder; Shoulder Joint; Joint Prosthesis
PubMed: 37985021
DOI: 10.1016/j.medengphy.2023.104059 -
Journal of ISAKOS : Joint Disorders &... Jun 2024Early periprosthetic joint infection constitutes one of the most frightening complications of joint replacement. Recently, some evidence has highlighted the potential... (Review)
Review
Early periprosthetic joint infection constitutes one of the most frightening complications of joint replacement. Recently, some evidence has highlighted the potential link between dysregulation of the gut microbiota and degenerative diseases of joints. It has been hypothesized that microbiome dysbiosis may increase the risk of periprosthetic joint infection by facilitating bacterial translocation from these sites to the bloodstream or by impairing local or systemic immune responses. Although the processes tying the gut microbiome to infection susceptibility are still unknown, new research suggests that the presurgical gut microbiota-a previously unconsidered component-may influence the patient's ability to resist infection. Exploring the potential impact of the microbiome on periprosthetic joint infections may therefore bring new insights into the pathogenesis and therapy of these disorders. For a successful therapy, a proper surgical procedure in conjunction with an antibacterial concept is essential. As per the surgical approach, different treatment strategies include surgical irrigation, debridement, antibiotic therapy, and implant retention with or without polyethylene exchange. Other alternatives could be one-stage or two-stage revisions surgery. Interventions that either directly target gut microbes as well as interventions that modify the composition and/or function of the commensal microbes represent an innovative and potentially successful field to be explored. In recent times, innovative therapeutic methods have arisen in the realm of microbiome restoration and the management of gut-related ailments. These progressive approaches offer fresh perspectives on tackling intricate microbial imbalances in the gastrointestinal tract. These emerging therapies signify a shift towards more precise and individualized approaches to microbiome restoration and the management of gut-related disorders. Once a more advanced knowledge of the pathways linking the gut microbiota to musculoskeletal tissues is gained, relevant microbiome-based therapies can be developed. If dysbiosis is proven to be a significant contributor, developing treatments for dysbiosis may represent a new frontier in the prevention of periprosthetic joint infections.
Topics: Humans; Prosthesis-Related Infections; Gastrointestinal Microbiome; Dysbiosis; Anti-Bacterial Agents; Debridement; Arthroplasty, Replacement; Joint Prosthesis
PubMed: 38272392
DOI: 10.1016/j.jisako.2024.01.011 -
BMC Musculoskeletal Disorders Oct 2015Conventional stemmed anatomical shoulder prostheses are widely used in the treatment of glenohumeral osteoarthritis. The stemless shoulder prosthesis, in contrast, is a... (Comparative Study)
Comparative Study
BACKGROUND
Conventional stemmed anatomical shoulder prostheses are widely used in the treatment of glenohumeral osteoarthritis. The stemless shoulder prosthesis, in contrast, is a new concept, and fewer outcome studies are available. Therefore, the purpose of the study was to investigate the early functional outcome and postoperative proprioception of a stemless prosthesis in comparison with a standard stemmed anatomic shoulder prosthesis.
METHODS
Twelve patients (mean age 68.3 years [SD ± 5.4]; 5 female, 7 male) with primary glenohumeral osteoarthritis of the shoulder were enrolled, who underwent total shoulder arthroplasty (TSA) with a stemless total shoulder prosthesis, Total Evolution Shoulder System (TESS; Biomed, France). The control group consisted of twelve (age and gender matched) patients (mean age 67.8 years; [SD ± 7.1]; 9 female, 3 male), getting a TSA with a standard anatomic stemmed prosthesis, Aequalis Shoulder (Tournier, Lyon, France). Patients were examined the day before and six months after surgery. The pre- and postoperative Constant Score (CS) was evaluated and proprioception was measured in a 3D video motion analysis study using an active angle-reproduction (AAR) test.
RESULTS
Comparing the postoperative CS, there was no significant difference between the groups treated with the TESS prosthesis (48.0 ± 13.8 points) and the Aequalis prosthesis (49.3 ± 8.6 points; p = 0.792). There was no significant difference in postoperative proprioception between the TESS group (7.2° [SD ± 2.8]) and the Aequalis group(8.7° [SD ± 2.7]; p = 0.196), either. Comparison of in the results of CS and AAR test pre- and postoperatively showed no significant differences between the groups.
DISCUSSION
In patients with glenohumeral osteoarthritis, treated with TSA, the functional and the proprioceptive outcome is comparable between a stemless and a standard stemmed anatomic shoulder prosthesis at early followup.
CONCLUSION
Further follow-up is necessary regarding the long-term performance of this prosthesis.
TRIAL REGISTRATION
Current Controlled Trials DRKS 00007528 . Registered 17 November 2014.
Topics: Aged; Arthroplasty, Replacement; Female; Follow-Up Studies; Humans; Joint Prosthesis; Male; Middle Aged; Osteoarthritis; Shoulder Joint; Treatment Outcome
PubMed: 26429577
DOI: 10.1186/s12891-015-0723-y