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Clinical Orthopaedics and Related... Sep 2011
Topics: Arthroplasty, Replacement; Biomechanical Phenomena; Humans; Joint Prosthesis; Prosthesis Design; Range of Motion, Articular; Recovery of Function; Shoulder Injuries; Shoulder Joint; Treatment Outcome
PubMed: 21779867
DOI: 10.1007/s11999-011-1947-2 -
Ugeskrift For Laeger 2014In Denmark 4,456 metal-on-metal (MoM) hip prostheses have been implanted. Evidence demonstrates that some patients develope adverse biological reactions causing failures... (Review)
Review
In Denmark 4,456 metal-on-metal (MoM) hip prostheses have been implanted. Evidence demonstrates that some patients develope adverse biological reactions causing failures of MoM hip arthroplasty. Some reactions might be systemic. Failure rates are associated with the type and the design of the MoM hip implant. A Danish surveillance programme has been initiated addressing these problems.
Topics: Algorithms; Arthroplasty, Replacement, Hip; Chromium Alloys; Hip Prosthesis; Humans; Metal-on-Metal Joint Prostheses; Prosthesis Design; Reoperation; Risk Factors
PubMed: 25293565
DOI: No ID Found -
Clinical Orthopaedics and Related... Jan 2015
Topics: Arthroplasty, Replacement, Knee; Congresses as Topic; Humans; Knee Joint; Knee Prosthesis; Prosthesis Design; Societies, Medical; Treatment Outcome
PubMed: 25480122
DOI: 10.1007/s11999-014-4045-4 -
Osteoarthritis and Cartilage Apr 2017Despite a health care system that is free at the point of delivery, ethnic minorities may not always get care equitable to that of White patients in England. We examined...
OBJECTIVE
Despite a health care system that is free at the point of delivery, ethnic minorities may not always get care equitable to that of White patients in England. We examined whether ethnic differences exist in joint replacement rates and surgical practice in England.
DESIGN
373,613 hip and 428,936 knee National Joint Registry (NJR) primary replacement patients had coded ethnicity in Hospital Episode Statistics (HES). Age and gender adjusted observed/expected ratios of hip and knee replacements amongst ethnic groups were compared using indirect standardisation. Associations between ethnic group and type of procedure were explored and effects of demographic, clinical and hospital-related factors examined using multivariable logistic regression.
RESULTS
Adjusted standardised observed/expected ratios were substantially lower in Blacks and Asians than Whites for hip replacement (Blacks 0.33 [95% CI, 0.31-0.35], Asians 0.20 [CI, 0.19-0.21]) and knee replacement (Blacks 0.64 [CI, 0.61-0.67], Asians 0.86 % [CI, 0.84-0.88]). Blacks were more likely to receive uncemented hip replacements (Blacks 52%, Whites 37%, Asians 44%; P < 0.001). Black men and women aged <70 years were less likely to receive unicondylar or patellofemoral knee replacements than Whites (men 10% vs 15%, P = 0.001; women 6% vs 14%, P < 0.001). After adjustment for demographic, clinical and hospital-related factors, Blacks were more likely to receive uncemented hip replacement (OR 1.43 [CI, 1.11-1.84]).
CONCLUSIONS
In England, hip and knee replacement rates and prosthesis type given differ amongst ethnic groups. Whether these reflect differences in clinical need or differential access to treatment requires urgent investigation.
Topics: Adult; Aged; Aged, 80 and over; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Asian People; Black People; Databases, Factual; England; Ethnicity; Female; Healthcare Disparities; Humans; Joint Prosthesis; Male; Middle Aged; Osteoarthritis, Hip; Osteoarthritis, Knee; White People
PubMed: 28159557
DOI: 10.1016/j.joca.2016.12.030 -
Bulletin of the NYU Hospital For Joint... 2010Reverse total shoulder arthroplasty (rTSA) implants are intended to restore stability and function to shoulders with rotator cuff deficiency. The implant consists of a...
Reverse total shoulder arthroplasty (rTSA) implants are intended to restore stability and function to shoulders with rotator cuff deficiency. The implant consists of a glenosphere projecting from a glenoid baseplate and articulating in a socket at the proximal end of a humeral component. Despite the demonstrated clinical efficacy, little information is available regarding the joint forces about this construct and the stability of the glenoid component against these forces. Our hypotheses were that the joint forces about the rTSA were comparable to that about a normal shoulder joint, and that the micromotion between the baseplate and the scapula against these loads would be sufficiently low to induce bone ingrowth. To investigate this, a custom testing rig was constructed to simulate active shoulder elevation in fresh-frozen shoulder specimens. The forces about the rTSA were calculated and found to include compressive and shear forces up to 0.7 and 0.4 BW, respectively. In contrast to a normal shoulder, where the joint forces peak at 90° of abduction, forces about the rTSA were highest at about 60° of abduction. These forces were then applied in cyclic loading conditions to the glenoid baseplate, and the micromotion of the implant relative to the bone was measured in the four quadrants of the component. For two different rTSA designs (DePuy Delta III® and Encore RSP®) and in the entire range of the fixation testing, the cyclical micromotions were always less than 62 µm. Thus, under loading conditions similar to physiological shoulder elevation, micromotion of the glenoid component was sufficiently low and within previously published limits to induce bone ingrowth.
Topics: Arthroplasty, Replacement; Biomechanical Phenomena; Cadaver; Humans; Joint Instability; Joint Prosthesis; Osseointegration; Prosthesis Design; Prosthesis Failure; Range of Motion, Articular; Shoulder Joint; Tomography, X-Ray Computed; Treatment Outcome; Weight-Bearing
PubMed: 21162705
DOI: No ID Found -
BMJ (Clinical Research Ed.) Sep 2014To determine the evidence of effectiveness and safety for introduction of five recent and ostensibly high value implantable devices in major joint replacement to... (Review)
Review
OBJECTIVE
To determine the evidence of effectiveness and safety for introduction of five recent and ostensibly high value implantable devices in major joint replacement to illustrate the need for change and inform guidance on evidence based introduction of new implants into healthcare.
DESIGN
Systematic review of clinical trials, comparative observational studies, and registries for comparative effectiveness and safety of five implantable device innovations.
DATA SOURCES
PubMed (Medline), Embase, Web of Science, Cochrane, CINAHL, reference lists of articles, annual reports of major registries, summaries of safety and effectiveness for pre-market application and mandated post-market studies at the US Food and Drug Administration.
STUDY SELECTION
The five selected innovations comprised three in total hip replacement (ceramic-on-ceramic bearings, modular femoral necks, and uncemented monoblock cups) and two in total knee replacement (high flexion knee replacement and gender specific knee replacement). All clinical studies of primary total hip or knee replacement for symptomatic osteoarthritis in adults that compared at least one of the clinical outcomes of interest (patient centred outcomes or complications, or both) in the new implant group and control implant group were considered. Data searching, abstraction, and analysis were independently performed and confirmed by at least two authors. Quantitative data syntheses were performed when feasible.
RESULTS
After assessment of 10,557 search hits, 118 studies (94 unique study cohorts) met the inclusion criteria and reported data related to 15,384 implants in 13,164 patients. Comparative evidence per device innovation varied from four low to moderate quality retrospective studies (modular femoral necks) to 56 studies of varying quality including seven high quality (randomised) studies (high flexion knee replacement). None of the five device innovations was found to improve functional or patient reported outcomes. National registries reported two to 12 year follow-up for revision occurrence related to more than 200,000 of these implants. Reported comparative data with well established alternative devices (over 1,200,000 implants) did not show improved device survival. Moreover, we found higher revision occurrence associated with modular femoral necks (hazard ratio 1.9) and ceramic-on-ceramic bearings (hazard ratio 1.0-1.6) in hip replacement and with high flexion knee implants (hazard ratio 1.0-1.8).
CONCLUSION
We did not find convincing high quality evidence supporting the use of five substantial, well known, and already implemented device innovations in orthopaedics. Moreover, existing devices may be safer to use in total hip or knee replacement. Improved regulation and professional society oversight are necessary to prevent patients from being further exposed to these and future innovations introduced without proper evidence of improved clinical efficacy and safety.
Topics: Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Epidemiologic Methods; Female; Hip Prosthesis; Humans; Inventions; Knee Prosthesis; Male; Patient Safety; Prosthesis Design; Prosthesis Failure; Range of Motion, Articular; Reoperation; Sex Distribution
PubMed: 25208953
DOI: 10.1136/bmj.g5133 -
Ugeskrift For Laeger Jan 2019Total joint replacement is used for treating osteoarthritis of the trapeziometacarpal joint. The prosthesis is a ball and socket design resembling a total hip prosthesis...
Total joint replacement is used for treating osteoarthritis of the trapeziometacarpal joint. The prosthesis is a ball and socket design resembling a total hip prosthesis and with the same risk of head luxation. To reduce this risk, dual mobility articulations have also been introduced in prosthesis of the thumb, and this is a case report of luxation of the polyethylene liner in a dual mobility prosthesis, illustrating that introducing new designs in prosthesis for the basal joint of the thumb may lead to similar complications as are seen in the hip joint.
Topics: Arthroplasty, Replacement, Hip; Hip Prosthesis; Humans; Joint Dislocations; Joint Prosthesis; Prosthesis Design; Prosthesis Failure
PubMed: 30722821
DOI: No ID Found -
Clinical Orthopaedics and Related... Oct 2012Trapeziometacarpal joint osteoarthritis is a painful, disabling condition that primarily affects women who are postmenopausal. Arthroplasty has been performed to treat... (Clinical Trial)
Clinical Trial
BACKGROUND
Trapeziometacarpal joint osteoarthritis is a painful, disabling condition that primarily affects women who are postmenopausal. Arthroplasty has been performed to treat this condition; however, subluxation has been a problem with all previous implants. We report the results of hemiarthroplasty using a prosthesis designed to address the problems associated with previous implants.
QUESTIONS/PURPOSES
We wished to (1) determine if this prosthesis results in pain relief and functional improvement and preserves the appearance of the thumb, (2) assess the prosthetic reconstruction during followup, (3) assess complications that occur with the use of this prosthesis, and (4) determine the survivorship of this prosthesis.
METHODS
We performed 159 basal joint hemiarthroplasties (138 patients) to treat osteoarthritis of the trapeziometacarpal joint. The mean age of the patients was 63 years, 78% were women, and all had Eaton-Littler Stage II or III changes. Only the damaged articular surfaces of the metacarpal and trapezium were excised; no tendon grafts or transfers were performed. Seven patients (seven thumbs) were lost to followup and seven (nine thumbs) died, leaving 124 patients (143 thumbs) for review. Clinical and radiographic assessments were made preoperatively, 12 weeks postoperatively, and annually thereafter. Minimum followup was 35 months (mean, 72.1 months; range, 35-120 months).
RESULTS
At latest followup, pain relief occurred in 135 thumbs, function improved in 138 thumbs, 139 thumbs were excellent or good in overall assessment, and 142 thumbs had good or excellent cosmetic appearance. The mean tip pinch improved from 4.9 kg preoperatively to 6.44 kg postoperatively. Mean postoperative Buck-Gramcko score was 49 (excellent); overall Kaplan-Meier analysis with revision as the end point showed 94% implant survivorship at a mean followup of 72.1 months.
CONCLUSIONS
Our results are superior to those of other implants and support continued use of this implant. Studies with longer followup are required to confirm these results.
LEVEL OF EVIDENCE
Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
Topics: Adult; Aged; Aged, 80 and over; Arthroplasty, Replacement; Carpometacarpal Joints; Female; Humans; Joint Prosthesis; Male; Middle Aged; Osteoarthritis; Prospective Studies; Prosthesis Design; Thumb
PubMed: 22585348
DOI: 10.1007/s11999-012-2367-7 -
Clinical Orthopaedics and Related... May 2017
Topics: Arthroplasty, Replacement; Biocompatible Materials; Humans; Joint Prosthesis; Polyethylene; Prosthesis Design
PubMed: 27900715
DOI: 10.1007/s11999-016-5178-4 -
Archives of Orthopaedic and Trauma... Sep 2020Coxarthrosis is a common disease of the adult hip joint. Elderly patients have mainly been treated with total hip arthroplasty (THA); however, younger patients are... (Comparative Study)
Comparative Study
PURPOSE
Coxarthrosis is a common disease of the adult hip joint. Elderly patients have mainly been treated with total hip arthroplasty (THA); however, younger patients are increasingly affected. Short-stem prostheses were developed for this special patient group. There have been few studies on the clinical outcomes of this type of prosthesis. This study compared the mid-term results of a short-stem prosthesis and a standard-stem prosthesis 8 years after implantation.
METHODS
According to our clinical registry, patients who received a short-stem prosthesis before 2011 were identified. Patients in the standard-stem prosthesis group were matched based on the sex, age, height, weight, and degree of arthrosis. At the follow-up time, the modified Harris Hip Score (mHHS), University of California Los Angeles (UCLA) activity score and visual analog scale (VAS) pain score were collected and compared with the preoperative values.
RESULTS
Fifty-five patients could be matched and analyzed for both groups. No patients needed revision surgery. In both groups, there were significant improvements at the follow-up time. The pre- and postoperative mHHSs, UCLA scores, and VAS scores were 41.9 and 95 (p < 0.0001), 3.75 and 7.9 (p < 0.0001), and 7.6 and 0.9 (p < 0.0001), respectively, in the short-stem group and 44.8 and 96.25 (p < 0.0001), 3.6 and 7.7 (p < 0.0001), and 7.7 and 0.9 (p < 0.0001), respectively, in the control group, with no significant differences between the groups at the follow-up time.
CONCLUSION
The short-stem prosthesis provides mid-term results comparable to those of a standard-stem prosthesis. In both groups, excellent patient-reported outcomes were achieved after an average of 8 years.
LEVEL OF EVIDENCE
IV.
Topics: Arthroplasty, Replacement, Hip; Follow-Up Studies; Hip Joint; Hip Prosthesis; Humans; Prosthesis Design; Treatment Outcome
PubMed: 32572595
DOI: 10.1007/s00402-020-03519-y