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The Bone & Joint Journal Jan 2017To demonstrate, with concrete examples, the value of in-depth exploration and comparison of data published in National Joint Arthroplasty registry reports. (Review)
Review
AIMS
To demonstrate, with concrete examples, the value of in-depth exploration and comparison of data published in National Joint Arthroplasty registry reports.
PATIENTS AND METHODS
The author reviewed published current reports of National Joint Arthroplasty registries for findings of current significance to current orthopaedic practice.
RESULTS
A total of six observations that demonstrate actionable or unexpected findings from joint registries are described. These include: one third to one half of all arthroplasty failures in the first decade occur in the first one to two years; infection rates after arthroplasty have not declined in the last three decades; infection after TKA is more common in men than women; outcomes of TKA are more variable in young compared with older patients; new technologies (uncemented implants and crosslinked polyethylene) have improved results of THA and a real-time shift in use of ceramic femoral heads is occurring in THA.
CONCLUSION
These six observations may be used to better understand current practice, stimulate practice improvements or suggest topics for further study. Cite this article: Bone Joint J 2017;99-B(1 Supple A):3-7.
Topics: Age Factors; Arthroplasty, Replacement; Humans; Joint Prosthesis; Professional Practice; Prosthesis Failure; Prosthesis-Related Infections; Registries; Reoperation; Sex Factors
PubMed: 28042111
DOI: 10.1302/0301-620X.99B1.BJJ-2016-0353.R1 -
Clinical Orthopaedics and Related... Dec 2014Wear and corrosion in joint arthroplasty are important causes of failure. From the standpoint of current clinical importance, there are four main categories of wear and... (Review)
Review
Wear and corrosion in joint arthroplasty are important causes of failure. From the standpoint of current clinical importance, there are four main categories of wear and tribocorrosion: polyethylene wear, ceramic-on-ceramic (CoC) bearing wear, metal-on-metal (MoM) bearing wear, and taper tribocorrosion. Recently, problems with wear in the knee have become less prominent as have many issues with hip polyethylene (PE) bearings resulting from the success of crosslinked PE. However, MoM articulations and taper tribocorrosion have been associated with soft tissue inflammatory responses, and as a result, they have become prominent clinical concerns. WHERE ARE WE NOW?: For PE wear in the hip, several advances include improved locking mechanisms and data supporting highly crosslinked polyethylenes (HXLPE). Edge-loading in CoC articulations can contribute to stripe wear and subsequent squeaking. For MoM articulations, the relationship of wear-to-edge loading, sensitivity to component positioning, typical soft tissue response, and use of imaging is increasingly understood. Taper tribocorrosion (from femoral head-neck junctions and other modular elements) and associated soft tissue inflammatory responses appear to be serious clinical issues that are not fully understood. WHERE DO WE NEED TO GO?: In the knee, clinical concerns remain with the efficacy of HXLPE, modular connections, and metal allergies. For PE wear in the hip, concerns remain regarding how to increase crosslinking of PE while minimizing PE fractures. With CoC articulations, questions remain on how to prevent noises, chipping, and impingement and if enhanced designs can contribute to improved results. For MoM articulations, we need to improve imaging tests for soft tissue reactions, determine best practices in terms of monitoring protocols, and better define if, how, and when to act on serum metal levels. For taper tribocorrosion, we need to use modularity wisely and also understand how to improve tapers and materials in the future. For patients at risk for tribocorrosion, we need to define realistic diagnostic and monitoring protocols. We also need to enhance revision methods, and the threshold of acceptable soft tissue damage, to minimize complications associated with soft tissue damage such as hip instability. HOW DO WE GET THERE?: HXLPE and other bearing surfaces will likely continue to be refined. We need to develop tapers with more resistance to tribocorrosion through improved understanding of the manufacturing process and ongoing engineering improvements. Revision procedures for wear and tribocorrosion can be enhanced by determining when partial component retention is appropriate and how best to manage soft tissue damage. For CoC articulations, enhanced designs are required to minimize noises, chipping, and impingement. Importantly, we must continue to promote and analyze joint replacement registries to identify early failures and analyze long-term successes.
Topics: Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Biomechanical Phenomena; Ceramics; Corrosion; Foreign-Body Reaction; Hip Joint; Hip Prosthesis; Humans; Knee Joint; Knee Prosthesis; Metal-on-Metal Joint Prostheses; Polyethylene; Prosthesis Design; Prosthesis Failure; Risk Factors; Stress, Mechanical; Time Factors; Treatment Outcome
PubMed: 24711136
DOI: 10.1007/s11999-014-3610-1 -
Journal of Orthopaedic Research :... Jul 2020Over the last three decades there have been significant advancements in the knee and hip replacement technology that has been driven by an issue in the past concerning... (Review)
Review
Over the last three decades there have been significant advancements in the knee and hip replacement technology that has been driven by an issue in the past concerning adverse local tissue reactions, aseptic and septic loosening. The implants and the materials we utilize have improved over the last two decades and in knee and hip replacement there has been a decrease in the failures attributed to wear and osteolysis. Despite these advancements there are still issues with patient satisfaction and early revisions due to septic and aseptic loosening in knee replacement patients. This article reviews the state of current implant material technology in hip and knee replacement surgery, discusses some of the unmet needs we have in biomaterials, and reviews some of the current biomaterials and technology that may be able to solve the most common issues in the knee and hip replacement surgery.
Topics: Arthroplasty, Replacement; Biocompatible Materials; Ceramics; Hip Prosthesis; Humans; Knee Prosthesis
PubMed: 32437026
DOI: 10.1002/jor.24750 -
Journal of Orthopaedic Research :... Sep 2021Over the last three decades, there have been significant advancements in knee and hip replacement technology. The implants and the surgical technology we now have to... (Review)
Review
Over the last three decades, there have been significant advancements in knee and hip replacement technology. The implants and the surgical technology we now have to aid in their implantation are advancing and improving functional outcomes and survivorship. Despite these advancements, there are still issues with patient satisfaction, functional limitations, and early revisions due to instability and aseptic loosening. This article reviews the state of current technology in hip and knee replacement implant design and surgical technique, and reviews some of the current implant designs and surgical technologies that may be able to solve some of the most common issues in the knee and hip replacement surgery.
Topics: Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Humans; Knee Joint; Knee Prosthesis; Prosthesis Design; Prosthesis Failure; Reoperation
PubMed: 33002224
DOI: 10.1002/jor.24873 -
The Bone & Joint Journal May 2017
Topics: Arthroplasty, Replacement, Hip; Hip Prosthesis; Humans; Joint Instability; Prosthesis-Related Infections; Reoperation; Salvage Therapy
PubMed: 28455462
DOI: 10.1302/0301-620X.99B5.38087 -
European Spine Journal : Official... Jan 2008Artificial disc prosthesis show fair to good short- and mid-term results. Long-term results are becoming apparent now, however, the incidence of late complications with...
Artificial disc prosthesis show fair to good short- and mid-term results. Long-term results are becoming apparent now, however, the incidence of late complications with this procedure remain poorly understood. In this report we will analyse late complications and discuss our experiences with salvage operations in patients with persistent pain after SB Charité disc prosthesis implantation. Seventy-five patients with persistent leg and back pain after insertion of an artificial disc prosthesis were enrolled in the study. In this negative selection frequently occurring late-complications were subsidence, wear, adjacent disc degeneration, facet joint degeneration and migration. In 15 patients we performed a posterior fusion without disc removal, and in 22 patients we removed 26 prostheses and performed a posterior and anterior fusion. The visual analogue scale (VAS) and Oswestry were examined before the salvage operation and after a follow-up period of at least 1 year, which is not yet available in all patients. The VAS and Oswestry decreased in the posterior group (n = 10) respectively from 8.0 (SD 0.9) to 6.3 (SD 2.1) and from 57.0 (SD 17.0) to 44.6 (SD 20.4); and in the disc removal group (n = 14) respectively from 8.0 (SD 0.9) to 5.6 (SD 2.7) and from 56.3 (SD 14.0) to 43.0 (SD 20.7). Serious late complications may occur following total disc replacement. Removal of the SB Charité artificial disc is feasible but with inherent risks. Removal of the disc prosthesis gives slightly better results than posterior fusion alone after a follow-up of at least 1 year.
Topics: Adult; Aged; Arthroplasty, Replacement; Device Removal; Female; Humans; Joint Prosthesis; Lumbar Vertebrae; Male; Middle Aged; Prosthesis Failure; Reoperation; Spinal Fusion
PubMed: 17929065
DOI: 10.1007/s00586-007-0506-8 -
Journal of Orthopaedic Research :... Mar 2019Many failures in total joint replacement are associated to prosthesis-to-bone mismatch. With recent additive-manufacturing, that is, 3D-printing, custom-made prosthesis...
Many failures in total joint replacement are associated to prosthesis-to-bone mismatch. With recent additive-manufacturing, that is, 3D-printing, custom-made prosthesis can be created by laser-melting metal powders layer-by-layer. Ankle replacement is particularly suitable for this progress because of the limited number of sizes and the poor bone stock. In this study a novel procedure is presented for subject-specific ankle replacements, including medical-imaging, joint modelling, prosthesis design, and 3D-printing. Three shank-foot specimens were CT-scanned, and corresponding 3D bone models of the tibia, fibula, talus, and calcaneus were obtained. From these models, specimen-specific implant sets were designed according to three different concepts, and 3D-printed from cobalt-chromium-molybdenum powder. Accuracy of the overall procedure was assessed via distance map comparisons between original anatomical and final metal implants. Restoration of natural ankle joint mechanics was check after implantation of each of the three sets. In a special rig, a manually-driven dorsi/plantar-flexion was applied throughout the passive arc. Additionally, at three different joint positions, joint torques were imposed in the frontal and axial anatomical planes. Mean manufacturing errors were found to be smaller than 0.08 mm. Consistent motion patterns were observed over repetitions, with the mean standard deviation smaller than 1.0 degree. In each ankle specimen, mobility, and stability at the replaced joints compared well with the original natural condition. For the first time, custom-made implants for total ankle replacements were designed, manufactured with additive technology and tested. This procedure is a first fundamental step toward the development of completely personalized prostheses. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.
Topics: Ankle Joint; Arthroplasty, Replacement, Ankle; Humans; Joint Prosthesis; Precision Medicine; Printing, Three-Dimensional; Prosthesis Design
PubMed: 30537247
DOI: 10.1002/jor.24198 -
Hand Surgery & Rehabilitation Jun 2024Total joint replacement has become significantly more common as a treatment for advanced trapeziometacarpal joint osteoarthritis in recent years. The latest generation...
INTRODUCTION
Total joint replacement has become significantly more common as a treatment for advanced trapeziometacarpal joint osteoarthritis in recent years. The latest generation of prostheses with dual-mobility designs leads to very good functional results and low rates of loosening and dislocation in the short and medium term. Biomechanical studies showed that central placement and parallel alignment of the cup with respect to the proximal articular surface of the trapezium are crucial for both cup stability and prevention of dislocation. Despite correct positioning of the guidewire, incorrect placement or tilting of the inserted cup may occur, requiring immediate intraoperative revision.
METHODS
The existing spherical and conical cup models in sizes 9 mm and 10 mm were transferred to a computer-aided design dataset. Depending on the intraoperative complication (tilting or incorrect placement), the revision options resulting from the various combinations of cup type and size were simulated and analyzed according to the resulting defect area and bony contact area.
RESULTS
In well centered cups, a size 9 conical cup could be replaced by a size 9 spherical cup and still be fixed by press-fit. Conversely, a size 9 spherical cup could not be replaced by a size 9 conical cup, but only by a size 10 cup, of whatever shape. When a size 9 conical cup was tilted up to 20°, the best revision option was to resect the sclerotic margin and insert a size 10 conical cup deeper into the cancellous bone, to achieve the largest contact area with the surrounding bone. When a size 9 cup of whatever shape was poorly centered (misplaced with respect to the dorsopalmar or radioulnar line of the trapezium), placement should be corrected using a size 10 cup, combined with autologous bone grafting of the defect. Again, the size 10 conical cup showed the largest bony contact area.
CONCLUSION
Our computer-based measurements suggested options for intraoperative cup revision depending on cup shape and size and on type of misalignment with resulting bone defects. These suggestions, however, need to be confirmed in anatomic specimens before introducing them into clinical practice.
Topics: Humans; Prosthesis Design; Reoperation; Joint Prosthesis; Computer Simulation; Computer-Aided Design; Carpometacarpal Joints; Arthroplasty, Replacement; Prosthesis Failure; Osteoarthritis; Trapezium Bone
PubMed: 38701947
DOI: 10.1016/j.hansur.2024.101712 -
The Bone & Joint Journal Oct 2016
Topics: Arthroplasty, Replacement, Knee; History, 20th Century; History, 21st Century; Humans; Knee Prosthesis; Osteoarthritis, Knee; Prosthesis Design
PubMed: 27694508
DOI: 10.1302/0301-620X.98B10.38076 -
The Bone & Joint Journal Aug 2019There has been a recent resurgence in interest in combined partial knee arthroplasty (PKA) as an alternative to total knee arthroplasty (TKA). The varied terminology...
AIMS
There has been a recent resurgence in interest in combined partial knee arthroplasty (PKA) as an alternative to total knee arthroplasty (TKA). The varied terminology used to describe these procedures leads to confusion and ambiguity in communication between surgeons, allied health professionals, and patients. A standardized classification system is required for patient safety, accurate clinical record-keeping, clear communication, correct coding for appropriate remuneration, and joint registry data collection.
MATERIALS AND METHODS
An advanced PubMed search was conducted, using medical subject headings (MeSH) to identify terms and abbreviations used to describe knee arthroplasty procedures. The search related to TKA, unicompartmental (UKA), patellofemoral (PFA), and combined PKA procedures. Surveys were conducted of orthopaedic surgeons, trainees, and biomechanical engineers, who were asked which of the descriptive terms and abbreviations identified from the literature search they found most intuitive and appropriate to describe each procedure. The results were used to determine a popular consensus.
RESULTS
Survey participants preferred "bi-unicondylar arthroplasty" (Bi-UKA) to describe ipsilateral medial and lateral unicompartmental arthroplasty; "medial bi-compartmental arthroplasty" (BCA-M) to describe ipsilateral medial unicompartmental arthroplasty with patellofemoral arthroplasty; "lateral bi-compartmental arthroplasty" (BCA-L) to describe ipsilateral lateral unicompartmental arthroplasty with patellofemoral arthroplasty; and tri-compartmental arthroplasty (TCA) to describe ipsilateral patellofemoral and medial and lateral unicompartmental arthroplasties. "Combined partial knee arthroplasty" (CPKA) was the favoured umbrella term.
CONCLUSION
We recommend bi-unicondylar arthroplasty (Bi-UKA), medial bicompartmental arthroplasty (BCA-M), lateral bicompartmental arthroplasty (BCA-L), and tricompartmental arthroplasty (TCA) as the preferred terms to classify CPKA procedures. Cite this article: 2019;101-B:922-928.
Topics: Arthroplasty, Replacement, Knee; Bibliometrics; Hemiarthroplasty; Humans; Knee Prosthesis; Osteoarthritis, Knee; Terminology as Topic
PubMed: 31362558
DOI: 10.1302/0301-620X.101B8.BJJ-2019-0125.R1