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Leitner L, Hauer G, Rasic L, Clar C, Leithner A, Sadoghi P. Development of application and surgical technique of total knee arthroplasties: a systematic comparative analysis using worldwide registers. Arch Orthop Trauma Surg 2024; 144:855-859. [PMID: 37843609 PMCID: PMC10822784 DOI: 10.1007/s00402-023-05089-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/25/2023] [Indexed: 10/17/2023]
Abstract
PURPOSE The aim was to compare total knee arthroplasty (TKA) between countries with regard to epidemiologic data and surgical technique by the use of worldwide registers and compare findings with a previous report after one decade. METHODS A systematic search was carried out in November 2022 and compared to previous reports from 2010. We extracted data regarding implanted TKAs, patients' age distribution, procedure types, fixation and revision rates. After identification of 28 national arthroplasty registers, 8of them, namely Australia, Canada, Denmark, England and Wales, New Zealand, Norway, Scotland and Sweden, offered sufficient data and were included in final analysis. RESULTS A large variation was found in the annual number of implantations per 100,000 inhabitants with a range from 77 to 210.2 (mean 132.8). The fixation type varied strongly as well, e.g. over 95% of totally cemented TKAs in Sweden versus 61.2% cemented fixation in Denmark. Another significant difference was the use of patellar resurfacing in TKA, ranging from 47.3% (Canada) using a patellar button in TKA to less than 5% (Sweden). Within the period of one decade, the mean overall number of annual implantations increased (10%), whilst relative number of revisions decreased, the use of cemented TKA decreased from 87 to 74%, and the use of patella button remained largely inhomogeneous. CONCLUSION Comparison of arthroplasty registers revealed large differences regarding the annual number of primary TKAs per inhabitant as well as primary TKA procedure types with an increase of annual implantations, decrease of relative number of revisions, and a decrease of the use of cemented systems over the period of one decade.
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Affiliation(s)
- Lukas Leitner
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Georg Hauer
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Laura Rasic
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Clemens Clar
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Andreas Leithner
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Patrick Sadoghi
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria.
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Palumbo BT, Shen V, Andrews R, Scott R. Case Report of Successful Bilateral Total Knee Arthroplasty: 46 Years and Still Going. JBJS Case Connect 2023; 13:01709767-202309000-00002. [PMID: 37418566 DOI: 10.2106/jbjs.cc.23.00019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2023]
Abstract
CASE A 63-year-old woman with 46-year-old bilateral cemented total knee arthroplasty (TKA) presented to our clinic for routine evaluation. She was diagnosed with idiopathic juvenile arthritis at the age of 17. Radiographically she had well-fixed implants bilaterally without bone-cement lucency. She is ambulating without a limp, pain, or an assistance aid. CONCLUSION We report TKA implants that lasted for 46 years. Literature suggests that most TKAs can last up to 20 to 25 years, but there are few reports that document implant survivorship longer than that. Our report demonstrates the possibility of long survivorship in TKA implants.
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Affiliation(s)
- Brian T Palumbo
- Florida Orthopaedic Institute, Temple Terrace, Florida
- University of Southern Florida Health Morsani College of Medicine, Tampa, Florida
| | - Victor Shen
- Florida Orthopaedic Institute, Temple Terrace, Florida
- University of Southern Florida Health Morsani College of Medicine, Tampa, Florida
| | - Reed Andrews
- Florida Orthopaedic Institute, Temple Terrace, Florida
- University of Southern Florida Health Morsani College of Medicine, Tampa, Florida
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3
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Voskuilen R, Boonen B, Tilman P, Schotanus M, Most J. Demographics are no clinically relevant predictors of patient-reported knee osteoarthritis symptoms - Comprehensive multivariate analysis. J Orthop 2023; 35:85-92. [PMID: 36420352 PMCID: PMC9676430 DOI: 10.1016/j.jor.2022.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/22/2022] [Accepted: 11/05/2022] [Indexed: 11/13/2022] Open
Abstract
Aims & objectives In clinical practice, arthroplasties are predominantly indicated by clinical and radiological assessment of osteoarthritis. Pain and function are individually considered, but a comprehensive analysis of differences in symptom reporting by pre-operative factors is lacking. In the present study, we determined differences in patient reported outcome measures between demographic groups among patients admitted to total knee arthroplasty. Materials & methods Between 2010 and 2019, we collected pre-operative Oxford Knee Scores, Western Ontario and McMaster University Osteoarthritis Index, quality of life in 2555 patients undergoing primary, osteoarthritis-indicated total knee arthroplasty at Patients were categorized by sex, age (<70, 70-80, >80 years), body mass index (BMI <25, 25-30, 30-35, >35 kg/m2), American Society of Anesthesiologists -classification (ASA 1, 2, ≥3) and Charnley score (A, B1, B2, C). Symptom scores (median, IQR) were compared using bivariate and multivariate methods. Results The cohort was 60% female, 70.0 years old (69.4-70.1), and BMI was 28.9 kg/m2 (29.6-30.0). As compared to bivariate analyses, between-group differences in multivariate analyses were consistently smaller. BMI and sex remain significant predictors after adjustment for age, ASA, and Charnley. Age, ASA, and Charnley were no independent predictors of symptom scores. A group of patients (30%) reported no physical dysfunction, and less symptom severity in pain and stiffness. Conclusion This study is the first to show that differences in symptom reporting between demographic groups are partly colinear, and are negligible for prediction of symptoms. Lastly, for a significant proportion of patients, patient-reported outcome measures do not adequately present disease severity.
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Affiliation(s)
- Robin Voskuilen
- Department of Orthopaedic Surgery, Zuyderland Medical Centre, Sittard-Geleen/Heerlen, the Netherlands
| | - Bert Boonen
- Department of Orthopaedic Surgery, Zuyderland Medical Centre, Sittard-Geleen/Heerlen, the Netherlands
| | - Pieter Tilman
- Department of Orthopaedic Surgery, Zuyderland Medical Centre, Sittard-Geleen/Heerlen, the Netherlands
| | - Martijn Schotanus
- Department of Orthopaedic Surgery, Zuyderland Medical Centre, Sittard-Geleen/Heerlen, the Netherlands
| | - Jasper Most
- Department of Orthopaedic Surgery, Zuyderland Medical Centre, Sittard-Geleen/Heerlen, the Netherlands
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Li H, Hu Y, Zeng M, Yang J, Fan X, Wang Y, Xie J. Exosomes From Human Urine-Derived Stem Cells Encapsulated Into PLGA Nanoparticles for Therapy in Mice With Particulate Polyethylene-Induced Osteolysis. Front Med (Lausanne) 2021; 8:781449. [PMID: 34938750 PMCID: PMC8685253 DOI: 10.3389/fmed.2021.781449] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 11/17/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Periprosthetic osteolysis is the primary reason for arthroplasty failure after total joint replacement because of the generation of wear particles and subsequent bone erosion around the prosthesis, which leads to aseptic loosening. Periprosthetic osteolysis is often treated with revision surgery because of the lack of effective therapeutic agents. As key messengers of intercellular interactions, exosomes can be independently used as therapeutic agents to promote tissue repair and regeneration. In this study, we fabricated poly(lactic-co-glycolic acid) (PLGA) nanoparticles (NPs) that carry exosomes derived from human urine stem cells (USC-Exos) and explored their effects on polyethylene-induced osteolysis. Methods: USCs were identified by multipotent differentiation and flow cytometry analyses. USC-Exos were isolated and identified by transmission electron microscopy (TEM), dynamic light scattering (DLS), and western blotting. PLGA microspheres containing USC-Exos were fabricated to synthesize NPs using the mechanical double-emulsion method. The obtained NPs were characterized in terms of stability, toxicity, exosome release, and cell uptake. Then, these NPs were implanted into the murine air pouch model, and their effects on polyethylene-induced osteolysis were evaluated by microcomputed tomography (micro-CT) and histological analyses. Results: The average NP diameter was ~282 ± 0.4 nm, and the zeta potential was -2.02 ± 0.03 mV. After long-term storage at room temperature and 4°C, the NP solution was stable without significant coaggregation. In vitro release profiles indicated sustained release of exosomes for 12 days. In vivo, injection of NPs into the murine air pouch caused less osteolysis than that of USC-Exos, and NPs significantly reduced bone absorption, as indicated by histology and micro-CT scanning. Conclusion: Our findings suggest that USC-Exo-based PLGA NPs can prevent particulate polyethylene-induced osteolysis and bone loss.
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Affiliation(s)
- Hui Li
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China.,Hunan Engineering Research Center of Biomedical Metal and Ceramic Implants, Xiangya Hospital, Central South University, Changsha, China
| | - Yihe Hu
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China.,Hunan Engineering Research Center of Biomedical Metal and Ceramic Implants, Xiangya Hospital, Central South University, Changsha, China
| | - Min Zeng
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China.,Hunan Engineering Research Center of Biomedical Metal and Ceramic Implants, Xiangya Hospital, Central South University, Changsha, China
| | - Junxiao Yang
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China.,Hunan Engineering Research Center of Biomedical Metal and Ceramic Implants, Xiangya Hospital, Central South University, Changsha, China
| | - Xiaolei Fan
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China.,Hunan Engineering Research Center of Biomedical Metal and Ceramic Implants, Xiangya Hospital, Central South University, Changsha, China
| | - Yinan Wang
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China.,Hunan Engineering Research Center of Biomedical Metal and Ceramic Implants, Xiangya Hospital, Central South University, Changsha, China
| | - Jie Xie
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China.,Hunan Engineering Research Center of Biomedical Metal and Ceramic Implants, Xiangya Hospital, Central South University, Changsha, China
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Goldberg SS, Baranek ES, Korbel KC, Blaine TA, Levine WN. Anatomic total shoulder arthroplasty using a stem-free ellipsoid humeral implant in patients of all ages. J Shoulder Elbow Surg 2021; 30:e572-e582. [PMID: 33486059 DOI: 10.1016/j.jse.2020.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 12/02/2020] [Accepted: 12/05/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Stem-free shoulder arthroplasty has recently been shown to have comparable results to stemmed arthroplasty, though stemless designs are typically used in a younger patient population. Additionally, although the native humeral head is elliptical in shape, clinical results with ellipsoid implants in shoulder arthroplasty have not been reported on previously. This case series reports on the outcomes of a recently introduced anatomic total shoulder arthroplasty with an ellipsoid-shaped articular surface and unique multiplanar platform type of stemless fixation. METHODS This retrospective case series examines the initial cohort of patients who received an anatomic total shoulder arthroplasty using an ellipsoid stem-free humeral prosthesis and an all-polyethylene glenoid component from the Catalyst CSR Total Shoulder System (Catalyst OrthoScience) over a 1-year period. Inclusion criteria were patients with a diagnosis of advanced glenohumeral joint arthritis with an intact rotator cuff, regardless of patient age. Clinical outcomes including shoulder range of motion and patient-reported outcome measures, as well as radiographs, were evaluated at multiple time points postoperatively, with minimum 2-year follow-up. RESULTS Sixty-three shoulders in 57 patients with a mean age of 73.0 years (range 60-85 years) were included in the study with a mean follow-up period of 30.5 months (range 24-41 months). Forward elevation improved from 121° to 150° (P < .0001), external rotation improved from 28° to 48° (P < .0001), and internal rotation improved from L3 to L1 (P < .001). There were statistically significant improvements exceeding the minimal clinically important difference (MCID) in the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score (37 to 94, P < .001), Single Assessment Numeric Evaluation (SANE) (40 to 93, P < .001), visual analog scale (6.3 to 0.4, P < .001), and Patient-Reported Outcomes Measurement Information System physical domain T score (44 to 57, P < .001). The improvement in the ASES score also exceeded the threshold for the substantial clinical benefit. Age, sex, and preoperative glenoid morphology did not appear to have an effect on the clinical outcome scores. There were no implant failures or evidence of radiographic loosening of the humerus component in any patients. CONCLUSION At 2-year minimum follow-up, this stem-free ellipsoid humerus total shoulder arthroplasty provides very good results with high patient satisfaction, clinical improvement in all outcome measures studied, and no signs of loosening.
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Affiliation(s)
- Steven S Goldberg
- Division of Orthopedic Surgery, Physicians Regional Medical Center, Naples, FL, USA.
| | - Eric S Baranek
- Department of Orthopedic Surgery, New York Presbyterian-Columbia University Medical Center, New York, NY, USA
| | - Kayla C Korbel
- Division of Orthopedic Surgery, Physicians Regional Medical Center, Naples, FL, USA
| | - Theodore A Blaine
- Hospital for Special Surgery, Weill Cornell Medicine, New York, NY, USA
| | - William N Levine
- Department of Orthopedic Surgery, New York Presbyterian-Columbia University Medical Center, New York, NY, USA
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6
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Sonn KA, Deckard ER, Aasar AR, Wolf LK, Meneghini RM. Utility and Prognostic Ability of a Diagnostic Injection Before Revision Total Knee Arthroplasty. J Arthroplasty 2021; 36:2116-2120. [PMID: 33518360 DOI: 10.1016/j.arth.2020.12.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 12/06/2020] [Accepted: 12/30/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Diagnostic injections are commonly utilized in the workup of painful total knee arthroplasties (TKA), particularly when the diagnosis remains unclear. However, current literature provides limited evidence regarding the utility and prognostic capability of anesthetic injections in this scenario. This study sought to establish the role of diagnostic injections in predicting successful revision TKA. METHODS A retrospective review was conducted on 144 consecutive aseptic revision TKAs receiving diagnostic anesthetic injections. Instability (57.6%) and aseptic loosening (33.3%) comprised most revision etiologies. Patient-reported percentage pain relief after the injection was statistically correlated with KOOS JR, Knee Society Score, UCLA Activity Level, and satisfaction scores. RESULTS About 74.3% (107/144) of revision TKAs reported >50% pain relief after injection. There were no differences in pain relief based on revision indication (P = .841). Improvement from preoperative activity level was greater in the >50% pain relief group (P = .024). Four-month patient satisfaction did not differ between patients who reported >50% and ≤50% pain relief (67% vs. 66%, P = .130). About 64% of patients who reported >50% pain relief were satisfied at minimum 1-year follow-up, compared with only 47% of those who reported ≤50% pain relief after diagnostic injection (P < .001). CONCLUSION Study results show that patients reporting >50% pain relief after diagnostic injection have improvements in activity level and maintain greater satisfaction at minimum 1-year than those reporting ≤50% pain relief. Expectations for improvement after revision TKA should be tempered if diagnostic anesthetic injection yields minimal subjective pain relief.
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Affiliation(s)
- Kevin A Sonn
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN; IU Health Hip & Knee Center, IU Health Saxony Hospital, Fishers, IN
| | - Evan R Deckard
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Abdul R Aasar
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Lily K Wolf
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - R Michael Meneghini
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN; IU Health Hip & Knee Center, IU Health Saxony Hospital, Fishers, IN
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Silman AJ, Combescure C, Ferguson RJ, Graves SE, Paxton EW, Frampton C, Furnes O, Fenstad AM, Hooper G, Garland A, Spekenbrink-Spooren A, Wilkinson JM, Mäkelä K, Lübbeke A, Rolfson O. International variation in distribution of ASA class in patients undergoing total hip arthroplasty and its influence on mortality: data from an international consortium of arthroplasty registries. Acta Orthop 2021; 92:304-310. [PMID: 33641588 PMCID: PMC8231354 DOI: 10.1080/17453674.2021.1892267] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - A challenge comparing outcomes from total hip arthroplasty between countries is variation in preoperative characteristics, particularly comorbidity. Therefore, we investigated between-country variation in comorbidity in patients based on ASA class distribution, and determined any variation of ASA class to mortality risk between countries.Patients and methods - All arthroplasty registries collecting ASA class and mortality data in patients with elective primary THAs performed 2012-2016 were identified. Survival analyses of the influence of ASA class on 1-year mortality were performed by individual registries, followed by meta-analysis of aggregated data.Results - 6 national registries and 1 US healthcare organization registry with 418,916 THAs were included. There was substantial variation in the proportion of ASA class III/IV, ranging from 14% in the Netherlands to 39% in Finland. Overall, 1-year mortality was 0.93% (95% CI 0.87-1.01) and increased from 0.2% in ASA class I to 8.9% in class IV. The association between ASA class and mortality measured by hazard ratios (HR) was strong in all registries even after adjustment for age and sex, which reduced them by half in all registries. Combined adjusted HRs were 2.0, 6.1, and 22 for ASA class II-IV vs. I, respectively. Associations were moderately heterogeneous across registries.Interpretation - We observed large variation in ASA class distribution between registries, possibly explained by differences in background morbidity and/or international variation in access to surgery. The similar, strong mortality trends by ASA class between countries enhance the relevance of its use as an indicator of comorbidity in international registry studies.
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Affiliation(s)
- Alan J Silman
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, UK; ,Correspondence:
| | | | - Rory J Ferguson
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, UK;
| | - Stephen E Graves
- Australian Orthopaedic Association National Joint Replacement Registry, Australia;
| | | | - Chris Frampton
- Department of Medicine, University of Otago, Christchurch, New Zealand;
| | - Ove Furnes
- The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway; ,Department of Clinical Medicine, University of Bergen, Norway;
| | - Anne Marie Fenstad
- The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway;
| | - Gary Hooper
- Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand;
| | - Anne Garland
- Department of Orthopaedics, Visby lasarett Institute of Surgical Scienses, Uppsala Universitet, Uppsala, Sweden;
| | | | - J Mark Wilkinson
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK; ,National Joint Registry for England, Wales, Northern Ireland, and Isle of Man, London, UK;
| | - Keijo Mäkelä
- Department of Orthopaedics and Traumatology, Turku University Hospital and University of Turku, Turku, Finland;
| | - Anne Lübbeke
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, UK; ,Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals, Switzerland;
| | - Ola Rolfson
- Department of Orthopaedics, Institute of Clinical Sciences Sahlgrenska Academy, University of Gothenburg, Sweden; ,The Swedish Hip Arthroplasty Register, Gothenburg, Sweden
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Lewis PL, Robertsson O, Graves SE, Paxton EW, Prentice HA, W-Dahl A. Variation and trends in reasons for knee replacement revision: a multi-registry study of revision burden. Acta Orthop 2021; 92:182-188. [PMID: 33263453 PMCID: PMC8159200 DOI: 10.1080/17453674.2020.1853340] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Studies describing time-related change in reasons for knee replacement revision have been limited to single regions or institutions, commonly analyze only 1st revisions, and may not reflect true caseloads or findings from other areas. We used revision procedure data from 3 arthroplasty registries to determine trends and differences in knee replacement revision diagnoses.Patients and methods - We obtained aggregated data for 78,151 revision knee replacement procedures recorded by the Swedish Knee Arthroplasty Register (SKAR), the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), and the Kaiser Permanente Joint Replacement Registry (KPJRR) for the period 2003-2017. Equivalent diagnosis groups were created. We calculated the annual proportions of the most common reasons for revision.Results - Infection, loosening, and instability were among the 5 most common reasons for revision but magnitude and ranking varied between registries. Over time there were increases in proportions of revisions for infection and decreases in revisions for wear. There were inconsistent proportions and trends for the other reasons for revision. The incidence of revision for infection showed a uniform increase.Interpretation - Despite some differences in terminology, comparison of registry-recorded revision diagnoses is possible, but defining a single reason for revision is not always clear-cut. There were common increases in revision for infection and decreases in revision for wear, but variable changes in other categories. This may reflect regional practice differences and therefore generalizability of studies regarding reasons for revision is unwise.
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Affiliation(s)
- Peter L Lewis
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, Australia; ,Lund University, Faculty of Medicine, Clinical Science Lund, Department of Orthopedics, Lund, Sweden,Correspondence:
| | - Otto Robertsson
- Swedish Knee Arthroplasty Register, Lund, Sweden;; ,Lund University, Faculty of Medicine, Clinical Science Lund, Department of Orthopedics, Lund, Sweden
| | - Stephan E Graves
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, Australia;
| | | | | | - Annette W-Dahl
- Swedish Knee Arthroplasty Register, Lund, Sweden;; ,Lund University, Faculty of Medicine, Clinical Science Lund, Department of Orthopedics, Lund, Sweden
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Probasco WV, Cefalu C, Lee R, Lee D, Gu A, Dasa V. Prevalence of idiopathically elevated ESR and CRP in patients undergoing primary total knee arthroplasty as a function of body mass index. J Clin Orthop Trauma 2020; 11:S722-S728. [PMID: 32999546 PMCID: PMC7503783 DOI: 10.1016/j.jcot.2020.05.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 05/22/2020] [Accepted: 05/26/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are commonly used inflammatory markers utilized to aid in the diagnosis of periprosthetic infection (PJI). Patients with obesity, however, are known to have elevated baseline levels of these inflammatory markers. Therefore, this retrospective study aimed to determine the relationship between elevated ESR and CRP and body mass index (BMI) in patients undergoing total knee arthroplasty (TKA). In doing so, physicians can better determine whether BMI should be taken into account when evaluating the prognostic value of elevated preoperative ESR and CRP levels for risk of PJI in primary TKA patients. METHODS This is a retrospective case series of 181 patients who had undergone primary TKA at a single institution. Patients undergoing primary unilateral TKA were eligible unless they had undergone previous TKA, contralateral knee symptoms, or elevated white blood cell (WBC) count. A linear regression model was utilized to demonstrate the relationship between proportions of patients with elevated biomarker values and categories of BMI. Analysis of variance and independent two-sample t-tests were utilized to assess differences in mean ESR, CRP, and WBC levels between the "healthy patients" and "patients with comorbidities" subgroups within each BMI category. RESULTS Eligible patients (n = 181) were stratified by BMI category. Elevated ESR was associated significantly with BMI (ESR: r2 = 0.89, P < 0.001) unlike elevated CRP (r2 = 0.82, P = 0.133) and WBC count (r2 = .01; P = .626). No statistically significant differences in ESR values and WBC count between the "healthy patients" versus "patients with comorbidities" were demonstrated within any BMI category. In patients of normal weight (BMI 20-25 kg/m2), "healthy patients" had a statistically significantly higher mean CRP level than "patients with comorbidities" (1.73 mg/L vs. 0.70 mg/L, P < 0.001). There were no other statistically significant differences in mean CRP levels by health status. CONCLUSION Caution is advised when utilizing ESR and CRP to diagnose periprosthetic joint infection without considering BMI given that increasing preoperative levels of ESR and CRP are correlated with higher BMI.
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Affiliation(s)
- William V. Probasco
- Department of Orthopedic Surgery, George Washington University, 2300 M Street NW, Washington DC, 20037, USA
- Department of Orthopedic Surgery, Louisiana State University Health Sciences Center, 1542 Tulane Avenue, New Orleans, LA, 70112, USA
| | - Charles Cefalu
- Department of Orthopedic Surgery, Harvard University, 55 Fruit Street, Boston, MA, 02114, USA
- Department of Orthopedic Surgery, Louisiana State University Health Sciences Center, 1542 Tulane Avenue, New Orleans, LA, 70112, USA
| | - Ryan Lee
- Department of Orthopedic Surgery, George Washington University, 2300 M Street NW, Washington DC, 20037, USA
| | - Danny Lee
- Department of Orthopedic Surgery, George Washington University, 2300 M Street NW, Washington DC, 20037, USA
| | - Alex Gu
- Department of Orthopedic Surgery, George Washington University, 2300 M Street NW, Washington DC, 20037, USA
| | - Vinod Dasa
- Department of Orthopedic Surgery, Louisiana State University Health Sciences Center, 1542 Tulane Avenue, New Orleans, LA, 70112, USA
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10
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Re-intervention and revision rates following primary reverse total shoulder arthroplasty - review of a local shoulder arthroplasty registry. INTERNATIONAL ORTHOPAEDICS 2020; 44:2365-2370. [PMID: 32661636 DOI: 10.1007/s00264-020-04721-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/07/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Our primary aim was to describe the re-intervention and revision rates after primary reverse shoulder arthroplasty (RSA) documented in a local shoulder arthroplasty registry. We also identify the main indication for revision and re-intervention, which may be relevant for patient outcome post-RSA. METHODS Since July 2006, RSAs are consecutively documented in our clinic registry and prospectively controlled with follow-ups. Any intervention after primary RSA requiring a return to the operating room for any shoulder-related indication was termed a re-intervention. Revisions were defined as surgeries involving any exchange, removal, or addition of at least one component. The study endpoints were survival rates at two, five and ten years follow-up for both definitions. RESULTS Until July 2017, 63 from a total of 1480 primary RSAs required at least one re-intervention and 33 patients had a revision. Open reduction and internal fixation for fractures around the implant (n = 14) were the predominating indications for re-intervention. The re-intervention rate for instability was 0.5%. For re-interventions, survival rates were 97.7, 95.4 and 90.8% at two, five and ten years, respectively, and the respective rates for revisions were 98.7, 97.5 and 95.3%. CONCLUSION The revision rate after primary RSA for our patient registry is low. A relevant number of additional interventions were noted that did not require any component revision but may impair the final outcome post-RSA. By only reporting revision rates, the number of post-RSA re-interventions is clearly underestimated. We recommend the documentation of all events leading to any re-intervention in arthroplasty registries.
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Heckmann N, Ihn H, Stefl M, Etkin CD, Springer BD, Berry DJ, Lieberman JR. Early Results From the American Joint Replacement Registry: A Comparison With Other National Registries. J Arthroplasty 2019; 34:S125-S134.e1. [PMID: 30711371 DOI: 10.1016/j.arth.2018.12.027] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 12/16/2018] [Accepted: 12/18/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The American Joint Replacement Registry (AJRR) was created to capture knee and hip arthroplasty data in the United States. The purpose of this study was to compare early reports from the AJRR to other national registries to identify topics for future analysis. METHODS Hip and knee arthroplasty data were extracted from the AJRR, Australia, New Zealand, United Kingdom, Norway, and Sweden from 2014 to 2016. Hip arthroplasty data including femoral and acetabular fixation, bearing surface, head size, dual-mobility bearings, resurfacing, and revision burden were compared. Knee arthroplasty data including polyethylene type, unicondylar arthroplasty, mobile bearings, cruciate-retaining implants, patella resurfacing, and revision burden were compared. Registry characteristics and patient demographics were reported using descriptive statistics. RESULTS In 2016, the AJRR captured 28% of arthroplasty procedures performed in the United States compared with 95%-98.3% among other registries. Cementless femoral fixation was 96.7% in the AJRR compared with 21.8%-63.4%. Ceramic and 36-mm heads were most common in AJRR; all other registries reported that metal and 32-mm heads were most popular. Dual-mobility articulations were used in 8% of primary and 28% of revision total hip arthroplasty procedures in the AJRR. The AJRR reported a unicondylar knee arthroplasty rate of 3.2% compared with 5.1%-13.3% in other registries, but the highest rates of posterior-stabilized total knee arthroplasties (48.5% compared to 8.2%-28.7%) and patella resurfacing (93.9% compared to 2.4%-51.6%). CONCLUSION Several differences in hip and knee arthroplasty practices exist between the United States and other countries. Future studies should focus on understanding why differences in practice trends exist and assess outcomes associated with these practices. LEVEL OF EVIDENCE Level III, retrospective.
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Affiliation(s)
- Nathanael Heckmann
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, CA
| | - Hansel Ihn
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, CA
| | - Michael Stefl
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, CA
| | - Caryn D Etkin
- Department of Surgery, Northwestern University Feinberg School of Medicine, Evanston, IL
| | | | - Daniel J Berry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Jay R Lieberman
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, CA
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12
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Malchau H, Garellick G, Berry D, Harris WH, Robertson O, Kärrlholm J, Lewallen D, Bragdon CR, Lidgren L, Herberts P. Arthroplasty implant registries over the past five decades: Development, current, and future impact. J Orthop Res 2018; 36:2319-2330. [PMID: 29663575 DOI: 10.1002/jor.24014] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 03/30/2018] [Indexed: 02/04/2023]
Abstract
Local, regional, and national registries have played an important role in the development of hip and knee arthroplasty and the treatment of patients with various maladies of these joints. Four arthroplasty registries stand out as leading forces behind the drive to popularize the use of registries and pursue the concept of evidence based medicine. The Mayo registry, started by Mark Coventry, is recognized as the oldest continuing registry for arthroplasty. The Harris Registry at Massachusetts General Hospital, along with the Mayo Registry, has greatly contributed to the advancement of arthroplasty surgery and have served an important role of identifying poorly performing implants and techniques in the United States. The Swedish Knee Arthroplasty Registry is the oldest national registry dedicated to joint arthroplasty and along with the Swedish Hip Arthroplasty Registry have established the infrastructure, analysis and reporting mechanisms, and leadership that has enabled other countries to subsequently develop national registries around the world. As more countries have adopted the concept of national registries, a new area of research is possible by pooling the resources of large registries as is now occurring with the Nordic countries. Several international organizations have been formed to promote future collaboration and develop international standards. The process of globalization of registries is a result of continued efforts over the past 50 years in improving and disseminating the knowledge gained from the early registries. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2319-2330, 2018.
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Affiliation(s)
- Henrik Malchau
- Sahlgrenska University Hospital, Molndal, Sweden.,Swedish Hip Arthroplasty Register Goteborg, Sweden.,Massachusetts General Hospital, Boston, Massachusetts
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13
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Matsumoto T, Nakano N, Lawrence JE, Khanduja V. Current concepts and future perspectives in computer-assisted navigated total knee replacement. INTERNATIONAL ORTHOPAEDICS 2018; 43:1337-1343. [PMID: 29752509 DOI: 10.1007/s00264-018-3950-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 04/16/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND Total knee replacements (TKR) aim to restore stability of the tibiofemoral and patella-femoral joints and provide relief of pain and improved quality of life for the patient. In recent years, computer-assisted navigation systems have been developed with the aim of reducing human error in joint alignment and improving patient outcomes. METHODS We examined the current body of evidence surrounding the use of navigation systems and discussed their current and future role in TKR. RESULTS The current body of evidence shows that the use of computer navigation systems for TKR significantly reduces outliers in the mechanical axis and coronal prosthetic position. Also, navigation systems offer an objective assessment of soft tissue balancing that had previously not been available. Although these benefits represent a technical superiority to conventional TKR techniques, there is limited evidence to show long-term clinical benefit with the use of navigation systems, with only a small number of studies showing improvement in outcome scores at short-term follow-up. Because of the increased costs and operative time associated with their use as well as the emergence of more affordable and patient-specific technologies, it is unlikely for navigation systems to become more widely used in the near future. CONCLUSIONS Whilst this technology helps surgeons to achieve improved component positioning, it is important to consider the clinical and functional implications, as well as the added costs and potential learning curve associated with adopting new technology.
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Affiliation(s)
- Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, Japan.
| | - Naoki Nakano
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, Japan.,Department of Trauma & Orthopaedic Surgery, Addenbrooke's Cambridge University Hospital, Cambridge, UK
| | - John E Lawrence
- Department of Trauma & Orthopaedic Surgery, Addenbrooke's Cambridge University Hospital, Cambridge, UK
| | - Vikas Khanduja
- Department of Trauma & Orthopaedic Surgery, Addenbrooke's Cambridge University Hospital, Cambridge, UK
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14
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Kutzner I, Hallan G, Høl PJ, Furnes O, Gøthesen Ø, Figved W, Ellison P. Early aseptic loosening of a mobile-bearing total knee replacement. Acta Orthop 2018; 89:77-83. [PMID: 29105532 PMCID: PMC5810837 DOI: 10.1080/17453674.2017.1398012] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 09/29/2017] [Indexed: 01/31/2023] Open
Abstract
Background and purpose - Registry-based studies have reported an increased risk of aseptic tibial loosening for the cemented Low Contact Stress (LCS) total knee replacement compared with other cemented designs; however, the reasons for this have not been established. We made a retrieval analysis with the aim of identifying the failure mechanism. Patients and methods - We collected implants, cement, tissue, blood, and radiographs from 32 failed LCS Complete cases. Damage to the tibial baseplate and insert was assessed. Exposure to wear products was quantified in 11 cases through analysis of periprosthetic tissue and blood. Implant alignment and bone cement thickness was compared with a control group of 43 non-revised cases. Results - Loosening of the tibial baseplate was the reason for revision in 25 retrievals, occurring at the implant-cement interface in 16 cases. Polishing was observed on the lower surface of the baseplate and correlated to the level of cobalt, chromium, and zirconium in the blood. No evidence of abnormally high polyethylene wear was present. For each 1 mm increase in cement thickness the odds of failure due to aseptic loosening decreased by 61%. Greater varus alignment was associated with a shorter time to failure. The roughness, Ra, of a new LCS baseplate's lower surface was 3.7 (SD 0.7) µm. Interpretation - Debonding of the tibial component at the implant-cement interface was the predominant cause of tibial aseptic loosening. A thin cement layer may partly explain the poor performance. Furthermore, the comparatively low tibial surface roughness and the lack of a keeled stem may have played a role in the failures observed.
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Affiliation(s)
- Ines Kutzner
- Department of Clinical Medicine, University of Bergen, Norway
- Julius Wolff Institute, Charité—Universitätsmedizin Berlin, Germany
| | - Geir Hallan
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Paul Johan Høl
- Department of Clinical Medicine, University of Bergen, Norway
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Ove Furnes
- Department of Clinical Medicine, University of Bergen, Norway
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Øystein Gøthesen
- Department of Clinical Medicine, University of Bergen, Norway
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
- Haugesund Hospital, Haugesund, Norway
| | - Wender Figved
- Orthopedic Department, Baerum Hospital, Vestre Viken Hospital Trust, Norway
| | - Peter Ellison
- Department of Clinical Medicine, University of Bergen, Norway
- Department of Mechanical Engineering, Imperial College London, UK
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15
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Sim JA, Na YG, Go JY, Lee BK. Clinical and radiologic evaluation of medial epicondylar osteotomy for varus total knee arthroplasty. Knee 2018; 25:177-184. [PMID: 29325838 DOI: 10.1016/j.knee.2017.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 10/09/2017] [Accepted: 11/02/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND In varus total knee arthroplasty (TKA), a pathologic contracture of the medial soft tissue should be released for ligament balancing. A medial epicondylar osteotomy has been performed as an alternative method for this. The purpose of this study was to demonstrate the clinical and radiologic results of medial epicondylar osteotomy for varus TKA, focusing on the union type of osteotomy site. METHODS The study retrospectively evaluated 61 cases with a mean femorotibial angle of 10.4° varus and a mean flexion contracture angle of 8.5±9.8°. Intraoperative medial and lateral gap difference in extension and 90° flexion was accepted at <2mm. Clinical outcomes (Knee Society Scores, range of motion) and radiologic outcomes (coronal alignment and valgus stability) were compared between the two groups divided by the union type of osteotomy site (bony union or fibrous union). RESULTS The clinical and radiologic outcomes were significantly improved at the latest follow-up. Bony union was achieved in 39 (63.9%) patients, whereas 22 patients showed fibrous union. There was no difference in the varus-valgus angle on the stress radiographs between the bony union and fibrous union group (1.6±1.2° vs. 1.6±0.8°, P<0.916). The Knee Society Scores (knee, function), range of motion and radiographic alignment did not differ between the two groups. CONCLUSION Medial epicondylar osteotomy was a good option for gap balancing during TKA, as it provided satisfactory clinical and radiological results, regardless of union type of the osteotomy site.
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Affiliation(s)
- Jae Ang Sim
- Department of Orthopaedic Surgery, Gachon University Gil Medical Center, 21, Namdong-daero 774 beon-gil, Namdong-gu, Incheon, Republic of Korea
| | - Young Gon Na
- Department of Orthopaedic Surgery, Gachon University Gil Medical Center, 21, Namdong-daero 774 beon-gil, Namdong-gu, Incheon, Republic of Korea
| | - Jae Yun Go
- Department of Orthopaedic Surgery, Gachon University Gil Medical Center, 21, Namdong-daero 774 beon-gil, Namdong-gu, Incheon, Republic of Korea
| | - Beom Koo Lee
- Department of Orthopaedic Surgery, Armed Forces Capital Hospital, 81, Saemaeul-ro 177 beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea.
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16
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Dunbar MJ, Laende EK, Collopy D, Richardson CG. Stable migration of peri-apatite-coated uncemented tibial components in a multicentre study. Bone Joint J 2017; 99-B:1596-1602. [PMID: 29212682 DOI: 10.1302/0301-620x.99b12.bjj-2016-1118.r2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 07/10/2017] [Indexed: 11/05/2022]
Abstract
AIMS Hydroxyapatite coatings for uncemented fixation in total knee arthroplasty can theoretically provide a long-lasting biological interface with the host bone. The objective of this study was to test this hypothesis with propriety hydroxyapatite, peri-apatite, coated tibial components using component migration measured with radiostereometric analysis over two years as an indicator of long-term fixation. PATIENTS AND METHODS A total of 29 patients at two centres received uncemented PA-coated tibial components and were followed for two years with radiostereometric analysis exams to quantify the migration of the component. RESULTS While there was significant variation in individual migration patterns, the overall migration of the tibial component in the study group demonstrated a pattern of initial migration followed by stabilisation after one year, with mean maximum total point motion (MTPM) of 0.02 mm (standard deviation (sd) 0.20) between one and two years post-operatively. The direction of greatest motion was subsidence, which stabilised at three months post-operatively (mean translation of 0.21 mm, sd 0.40). CONCLUSION The tibial component migration pattern of stabilisation in the second post-operative year is indicative of successful long-term fixation for this PA-coated tibial component. Cite this article: Bone Joint J 2017;99-B:1596-1602.
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Affiliation(s)
- M J Dunbar
- Dalhousie University, Division of Orthopaedics, Department of Surgery, Dalhousie University, and Halifax Infirmary, QEII Health Sciences Centre, Nova Scotia Health Authority, 1796 Summer St, Halifax NS B3H 3A7, Canada
| | - E K Laende
- Halifax Infirmary, Division of Orthopaedics, Department of Surgery, Dalhousie University, and Halifax Infirmary, QEII Health Sciences Centre, Nova Scotia Health Authority, 1796 Summer St., Halifax NS B3H 3A7, Canada
| | - D Collopy
- Perth Hip and Knee Clinic, Suite 1/1 Wexford Street, Subiaco, Western Australia 6008, Australia
| | - C G Richardson
- Dalhousie University, Division of Orthopaedics, Department of Surgery, Dalhousie University, and Halifax Infirmary, QEII Health Sciences Centre, Nova Scotia Health Authority, 1796 Summer St., Halifax NS B3H 3A7, Canada
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17
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Gothesen O, Lygre SHL, Lorimer M, Graves S, Furnes O. Increased risk of aseptic loosening for 43,525 rotating-platform vs. fixed-bearing total knee replacements. Acta Orthop 2017; 88:649-656. [PMID: 28929828 PMCID: PMC5694810 DOI: 10.1080/17453674.2017.1378533] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Given similar functional outcomes with mobile and fixed bearings, a difference in survivorship may favor either. This study investigated the risk of aseptic loosening for the most used subtypes of mobile-bearing rotating-platform knees, in Norway and Australia. Patients and methods - Primary TKRs reported to the Norwegian and Australian joint registries, between 2003 and 2014, were analyzed with aseptic loosening as primary end-point and all revisions as secondary end-point. We hypothesized that no difference would be found in the rate of revision between rotating-platform and the most used fixed-bearing TKRs, or between keeled and non-keeled tibia. Kaplan-Meier estimates and curves, and Cox regression relative risk estimates adjusted for age, sex, and diagnosis were used for comparison. Results - The rotating-platform TKRs had an increased risk of revision for aseptic loosening compared with the most used fixed-bearing knees, in Norway (RR =6, 95% CI 4-8) and Australia (RR =2.1, 95% CI 1.8-2.5). The risk of aseptic loosening as a reason for revision was highest in Norway compared with Australia (RR =1.7, 95% CI 1.4-2.0). The keeled tibial component had the same risk of aseptic loosening as the non-keeled tibia (Australia). Fixation method and subtypes of the tibial components had no impact on the risk of aseptic loosening in these mobile-bearing knees. Interpretation - The rotating-platform TKRs in this study appeared to have a higher risk of revision for aseptic loosening than the most used fixed-bearing TKRs.
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Affiliation(s)
- Oystein Gothesen
- Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen,Department of Clinical Medicine (K1), Faculty of Medicine and Dentistry, University of Bergen, Bergen,Department of Orthopaedic Surgery, Haugesund Hospital, Helse Fonna HF, Haugesund,Correspondence:
| | - Stein Hakon L Lygre
- Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen,Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway
| | - Michelle Lorimer
- AOA (Australian Orthopaedic Association) National Joint Replacement Registry, SAHMRI (South Australia Health and Research Institute), Adelaide, Australia
| | - Stephen Graves
- AOA (Australian Orthopaedic Association) National Joint Replacement Registry, SAHMRI (South Australia Health and Research Institute), Adelaide, Australia
| | - Ove Furnes
- Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen,Department of Clinical Medicine (K1), Faculty of Medicine and Dentistry, University of Bergen, Bergen
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18
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Cyndari KI, Goodheart JR, Miller MA, Oest ME, Damron TA, Mann KA. Peri-Implant Distribution of Polyethylene Debris in Postmortem-Retrieved Knee Arthroplasties: Can Polyethylene Debris Explain Loss of Cement-Bone Interlock in Successful Total Knee Arthroplasties? J Arthroplasty 2017; 32:2289-2300. [PMID: 28285038 PMCID: PMC5469692 DOI: 10.1016/j.arth.2017.01.047] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 01/06/2017] [Accepted: 01/25/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Loss of mechanical interlock between cement and bone with in vivo service has been recently quantified for functioning, nonrevised, cemented total knee arthroplasties (TKAs). The cause of interlocking trabecular resorption is not known. The goal of this study is to quantify the distribution of PE debris at the cement-bone interface and determine if polyethylene (PE) debris is locally associated with loss of interlock. METHODS Fresh, nonrevised, postmortem-retrieved TKAs (n = 8) were obtained en bloc. Laboratory-prepared constructs (n = 2) served as negative controls. The intact cement-bone interface of each proximal tibia was embedded in Spurr's resin, sectioned, and imaged under polarized light to identify birefringent PE particles. PE wear particle number density was quantified at the cement-bone interface and distal to the interface, and then compared with local loss of cement-bone interlock. RESULTS The average PE particle number density for postmortem-retrieved TKAs ranged from 8.6 (1.3) to 24.9 (3.1) particles/mm2 (standard error) but was weakly correlated with years in service. The average particle number density was twice as high as distal (>5mm) to the interface compared to at the interface. The local loss of interlock at the interface was not related to the presence, absence, or particle density of PE. CONCLUSION PE debris can migrate extensively along the cement-bone interface of well-fixed tibial components. However, the amount of local bone loss at the cement-bone interface was not correlated with the amount of PE debris at the interface, suggesting that the observed loss of trabecular interlock in these well-fixed TKAs may be due to alternative factors.
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Affiliation(s)
- Karen I Cyndari
- Department of Orthopaedic Surgery, State University of New York Upstate Medical University, Syracuse, New York
| | - Jacklyn R Goodheart
- Department of Orthopaedic Surgery, State University of New York Upstate Medical University, Syracuse, New York
| | - Mark A Miller
- Department of Orthopaedic Surgery, State University of New York Upstate Medical University, Syracuse, New York
| | - Megan E Oest
- Department of Orthopaedic Surgery, State University of New York Upstate Medical University, Syracuse, New York
| | - Timothy A Damron
- Department of Orthopaedic Surgery, State University of New York Upstate Medical University, Syracuse, New York
| | - Kenneth A Mann
- Department of Orthopaedic Surgery, State University of New York Upstate Medical University, Syracuse, New York
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19
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Dyrhovden GS, Lygre SHL, Badawy M, Gøthesen Ø, Furnes O. Have the Causes of Revision for Total and Unicompartmental Knee Arthroplasties Changed During the Past Two Decades? Clin Orthop Relat Res 2017; 475:1874-1886. [PMID: 28299718 PMCID: PMC5449334 DOI: 10.1007/s11999-017-5316-7] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 03/07/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND Revisions after knee arthroplasty are expected to increase, and the epidemiology of failure mechanisms is changing as new implants, technology, and surgical techniques evolve. QUESTIONS/PURPOSES (1) Was there improvement in survival for TKA and unicompartmental knee arthroplasty (UKA) when comparing two consecutive 11-year periods with similar followups in a national registry? (2) Were there changes in the causes of revision during the two times? (3) Could the changes in revision causes be attributed to patient or implant characteristics? METHODS A total of 60,623 TKAs (2426 revisions) and 7648 UKAs (725 revisions) were selected from the Norwegian Arthroplasty Register and analyzed based on year of primary surgery: 1994 to 2004 (Period 1) and 2005 to 2015 (Period 2). TKAs had median followup of 3.5 years in Period 1 and 4.2 years in Period 2. Median followup for UKAs was 2.7 years in Period 1 and 4.6 years in Period 2. Of the patients included in the registry, 99.6% were accounted for at the time of analysis, whereas 0.4% had moved abroad. We used Kaplan-Meier analyses and log-rank test to investigate changes in survival. Relative risk of revision in Period 2 relative to Period 1 was calculated for each registered revision cause in a Cox regression model adjusted for age, sex, diagnosis, fixation, and patella resurfacing. RESULTS For TKAs, the 10-year Kaplan-Meier survival free from revision improved from Period 1 to Period 2 from 91% (95% CI, 90%-92%) to 94% (95% CI, 94%-95%; p < 0.001). Revisions resulting from aseptic loosening of the femoral component, polyethylene wear/breakage, patellar dislocation, and unexplained pain decreased, whereas revisions resulting from early infection increased. Patients in Period 2 were younger and more often men compared with patients in Period 1. A higher risk of revision was found for male sex (relative risk [RR], 1.1; 95% CI, 1.0-1.2; p = 0.048) and age younger than 65 years (RR, 1.7; 95% CI, 1.6-1.9; p < 0.001). With UKAs, the 10-year survival free from revision was 80% (95% CI, 76%-84%) in Period 1 and 81% (95% CI, 79%-83%; p = 0.261) in Period 2. Revisions resulting from tibial aseptic loosening, polyethylene wear/breakage, and periprosthetic fractures decreased, but there were more revisions resulting from progression of osteoarthritis. In Period 2, there were more men and the average age was younger than for patients in Period 1. For UKAs, age younger than 65 years had a higher risk of revision (RR, 1.7; 95% CI, 1.5-2.0; p < 0.001), whereas sex did not affect the risk of revision. CONCLUSIONS We found an improvement in survival free from revision for TKA in the last period, but no similar improvement for UKA, and the survivorship for UKAs remains rather dramatically lower than that observed for TKAs. The decision to perform a UKA should be made with the explicit awareness that its survivorship is substantially inferior to that of TKA; any perceived advantages of UKA should be balanced against this issue of its decreased durability. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Gro S Dyrhovden
- Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Møllendalsbakken 11, 5021, Bergen, Norway.
- Department of Clinical Medicine (K1), Faculty of Medicine and DentistryUniversity of Bergen, Bergen, Norway.
| | - Stein Håkon L Lygre
- Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Møllendalsbakken 11, 5021, Bergen, Norway
- Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway
| | - Mona Badawy
- Department of Clinical Medicine (K1), Faculty of Medicine and DentistryUniversity of Bergen, Bergen, Norway
- Coastal Hospital in Hagevik, Hagavik, Norway
| | - Øystein Gøthesen
- Department of Clinical Medicine (K1), Faculty of Medicine and DentistryUniversity of Bergen, Bergen, Norway
- Department of Orthopedic Surgery, Haugesund Hospital, Haugesund, Norway
| | - Ove Furnes
- Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Møllendalsbakken 11, 5021, Bergen, Norway
- Department of Clinical Medicine (K1), Faculty of Medicine and DentistryUniversity of Bergen, Bergen, Norway
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20
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NiemeläInen MJ, MäKelä KT, Robertsson O, W-Dahl A, Furnes O, Fenstad AM, Pedersen AB, Schrøder HM, Huhtala H, Eskelinen A. Different incidences of knee arthroplasty in the Nordic countries. Acta Orthop 2017; 88:173-178. [PMID: 28056570 PMCID: PMC5385112 DOI: 10.1080/17453674.2016.1275200] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - The annual number of total knee arthroplasties (TKAs) has increased worldwide in recent years. To make projections regarding future needs for primaries and revisions, additional knowledge is important. We analyzed and compared the incidences among 4 Nordic countries Patients and methods - Using Nordic Arthroplasty Register Association (NARA) data from 4 countries, we analyzed differences between age and sex groups. We included patients over 30 years of age who were operated with TKA or unicompartmental knee arthroplasty (UKA) during the period 1997-2012. The negative binomial regression model was used to analyze changes in general trends and in sex and age groups. Results - The average annual increase in the incidence of TKA was statistically significant in all countries. The incidence of TKA was higher in women than in men in all 4 countries. It was highest in Finland in patients aged 65 years or more. At the end of the study period in 2012, Finland's total incidence was double that of Norway, 1.3 times that of Sweden and 1.4 times that of Denmark. The incidence was lowest in the youngest age groups (< 65 years) in all 4 countries. The proportional increase in incidence was highest in patients who were younger than 65 years. Interpretation - The incidence of knee arthroplasty steadily increased in the 4 countries over the study period. The differences between the countries were considerable, with the highest incidence in Finland. Patients aged 65 years or more contributed to most of the total incidence of knee arthroplasty.
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Affiliation(s)
| | - Keijo T MäKelä
- Department of Orthopaedics and Traumatology, Turku University Hospital, Turku, Finland
| | - Otto Robertsson
- The Swedish Knee Arthroplasty Register, Department of Orthopedics, Skåne University Hospital, Lund, and Department of Clinical Sciences, Orthopedics, Lund University, Lund, Sweden
| | - Annette W-Dahl
- The Swedish Knee Arthroplasty Register, Department of Orthopedics, Skåne University Hospital, Lund, and Department of Clinical Sciences, Orthopedics, Lund University, Lund, Sweden
| | - Ove Furnes
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen;,Department of Clinical Medicine, University of Bergen, Haukeland University Hospital, Bergen, Norway
| | - Anne M Fenstad
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen
| | - Alma B Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, and the Danish Knee Arthroplasty Registry
| | | | - Heini Huhtala
- School of Health Sciences, University of Tampere, Tampere, Finland
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21
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Aunan E, Kibsgård T, Röhrl SM. Minimal effect of patella eversion on ligament balancing in cruciate-retaining total knee arthroplasty. Arch Orthop Trauma Surg 2017; 137:387-392. [PMID: 28168644 DOI: 10.1007/s00402-017-2625-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE The effect of patellar eversion on ligament laxity measurements is still unclear. The purpose of this study was to investigate the influence of patellar eversion on medial and lateral ligament laxity measurements performed intra-operatively in total knee arthroplasty (TKA). METHODS A total of 49 knees (27 female) with mean age 70 years (42-83) and mean body mass index of 28.5 were operated consecutively with a cruciate-retaining prosthesis. Medial and lateral ligament laxity in extension and in 90° of flexion was measured with the spatula-method intra-operatively after implantation of the prosthetic components with the patella everted and thereafter with the patella repositioned. The corresponding changes in gap height and inclination were calculated. RESULTS A statistically significant increase of 0.6 mm (p < 0.001) in ligament laxity (condylar lift-off) laterally in flexion was found with the patella repositioned compared to everted. No differences were found in extension or medially in flexion. Correspondingly, the flexion gap increased by 0.4 mm (p < 0.001) and the flexion gap inclination increased by 0.6° (p = 0.002) when the patella was repositioned. CONCLUSIONS Earlier research has shown that ligament laxity must be at least 1-2 mm to cause inferior function after TKA. In the current study, we found that the effect of patellar eversion on ligament laxity measurements is too small to be considered clinically relevant. PROSPECTIVE STUDY EVALUATING THE EFFECT OF PATIENT CHARACTERISTICS: Level II.
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Affiliation(s)
- Eirik Aunan
- Department of Surgery, Innlandet Hospital Trust, Anders Sandvigs Gate 17, 2629, Lillehammer, Norway.
| | - Thomas Kibsgård
- Department of Orthopedics, Oslo University Hospital, Postboks 4950, Oslo, Norway
| | - Stephan M Röhrl
- Department of Orthopedics, Oslo University Hospital, Postboks 4950, Oslo, Norway
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22
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Dyrhovden GS, Fenstad AM, Furnes O, Gøthesen Ø. Survivorship and relative risk of revision in computer-navigated versus conventional total knee replacement at 8-year follow-up. Acta Orthop 2016; 87:592-599. [PMID: 27775460 PMCID: PMC5119442 DOI: 10.1080/17453674.2016.1244884] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - The long-term effects of computer-assisted surgery in total knee replacement (CAS) compared to conventionally operated knee replacement (CON) are still not clear. We compared survivorship and relative risk of revision in CAS and CON based on data from the Norwegian Arthroplasty Register. Patients and methods - We assessed primary total knee replacements without patellar resurfacing reported to the Norwegian Arthroplasty Register from 2005 through 2014. The 5 most used implants and the 3 most common navigation systems were included. The groups (CAS, n = 3,665; CON, n = 20,019) were compared using a Cox regression analysis adjusted for age, sex, ASA category, prosthesis brand, fixation method, previous surgery, and diagnosis with the risk of revision for any reason as endpoint. Secondary outcomes were reasons for revision and effects of prosthesis brand, fixation method, age (± 65 years), and hospital volume. Results - Prosthesis survival and risk of revision were similar for CAS and CON. CAS had significantly fewer revisions due to malalignment. Otherwise, no statistically significant difference was found between the groups in analyses of secondary outcomes. Mean operating time was 13 minutes longer in CAS. Interpretation - At 8 years of follow-up, CAS and CON had similar rates of overall revision, but CAS had fewer revisions due to malalignment. According to our findings, the benefits of CAS at medium-term follow-up are limited. Further research may identify subgroups that benefit from CAS, and it should also emphasize patient-reported outcomes.
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Affiliation(s)
- Gro S Dyrhovden
- Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen;,Department of Clinical Medicine (K1), Faculty of Medicine and Dentristy, University of Bergen, Bergen;,Correspondence:
| | - Anne M Fenstad
- Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen
| | - Ove Furnes
- Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen;,Department of Clinical Medicine (K1), Faculty of Medicine and Dentristy, University of Bergen, Bergen
| | - Øystein Gøthesen
- Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen;,Department of Clinical Medicine (K1), Faculty of Medicine and Dentristy, University of Bergen, Bergen;,Orthopaedic Department, Haugesund Hospital, Haugesund, Norway
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23
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Sukur E, Akman YE, Ozturkmen Y, Kucukdurmaz F. Particle Disease: A Current Review of the Biological Mechanisms in Periprosthetic Osteolysis After Hip Arthroplasty. Open Orthop J 2016; 10:241-51. [PMID: 27499822 PMCID: PMC4951796 DOI: 10.2174/1874325001610010241] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 05/16/2016] [Accepted: 05/31/2016] [Indexed: 02/08/2023] Open
Abstract
Background: Inflammatory responses to wear debris cause osteolysis that leads to aseptic prosthesis loosening and hip arthroplasty failure. Although osteolysis is usually associated with aseptic loosening, it is rarely seen around stable implants. Aseptic implant loosening is a simple radiologic phenomenon, but a complex immunological process. Particulate debris produced by implants most commonly causes osteolysis, and this is called particle-associated periprosthetic osteolysis (PPO). Objective: The objective of this review is to outline the features of particle-associated periprosthetic osteolysis to allow the physician to recognise this condition and commence early treatment, thereby optimizing patient outcome. Methods: A thorough literature search was performed using available databases, including Pubmed, to cover important research published covering particle-associated PPO. Results: Although osteolysis causes bone resorption, clinical, animal, and in vitro studies of particle bioreactivity suggest that particle-associated PPO represents the culmination of several biological reactions of many cell types, rather than being caused solely by the osteoclasts. The biological activity is highly dependent on the characteristics and quantity of the wear particles. Conclusion: Despite advances in total hip arthroplasty (THA), particle-associated PPO and aseptic loosening continue to be major factors that affect prosthetic joint longevity. Biomarkers could be exploited as easy and objective diagnostic and prognostic targets that would enable testing for osteolysis after THA. Further research is needed to identify new biomarkers in PPO. A comprehensive understanding of the underlying biological mechanisms is crucial for developing new therapeutic interventions to reverse or suppress biological responses to wear particles.
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Affiliation(s)
- Erhan Sukur
- Sakarya Education and Research Hospital, 54100, Sakarya, Turkey
| | - Yunus Emre Akman
- Metin Sabancı Baltalimanı Bone Diseases Training and Research Hospital, 34470, Istanbul, Turkey
| | - Yusuf Ozturkmen
- Istanbul Education and Research Hospital, 34100, Istanbul, Turkey
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24
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McGrory BJ, Etkin CD, Lewallen DG. Comparing contemporary revision burden among hip and knee joint replacement registries. Arthroplast Today 2016; 2:83-86. [PMID: 28326404 PMCID: PMC4957265 DOI: 10.1016/j.artd.2016.04.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 04/23/2016] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Hip and knee arthroplasties are common and successful procedures, however, success and durability are not guaranteed. The revision burden, defined as the ratio of implant revisions to the total number of arthroplasties in a specific period, is a measure of the steady state of arthroplasty success in a given registry. This study examines the hypothesis that revision burden would be similar among contemporary joint replacement registries and improving over time compared with historic controls. METHODS We evaluated the national joint registries of 5 health systems (Australian Orthopaedic Association National Joint Replacement Registry [AOANJRR]; National Joint Registry of England, Wales, Northern Ireland, and the Isle of Man; New Zealand Joint Registry [NZJR]; Swedish Hip Arthroplasty Register [SHAR] and Swedish Knee Arthroplasty Register [SKAR]; and the American Joint Replacement Registry [AJRR]) for hip and knee revision burden over the past 4 years or since registry inception. Historic controls were obtained from previously published reports. RESULTS The 2014 hip revision burden varied from 9.7 percent (NJR) to 11.9 percent (NZJR), and the unweighted average was 10.4 percent. The 2011, 2012, and 2013 mean hip revision burden was 11.9, 11.9, and 11.4 percent. The 2014 knee revision burden varied from to 6.0 percent (NJR) to 8.1 percent (AJRR), and the unweighted average for the 5 registries studied was 7.0 percent. The 2011, 2012, and 2013 mean knee revision burden was 6.9, 7.0, and 7.0 percent. Historically, the observed hip revision burden was 15.8 percent and the knee revision burden 8.0 percent. CONCLUSIONS Revision burden has gradually decreased for hip replacements and has remained relatively constant for knee replacements both for the last 4 years and compared to historic controls. Knee revision burden was lower than hip revision burden for each period examined. Revision burden is one measure that may be helpful in following the effect of changes in surgical technique and implant design over time in registry populations and may be a helpful way to compare overall results between registries.
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Affiliation(s)
- Brian J. McGrory
- Maine Joint Replacement Institute, Portland, ME, USA
- Tufts University School of Medicine, Boston, MA, USA
| | | | - David G. Lewallen
- American Joint Replacement Registry, Rosemont, IL, USA
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, USA
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25
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Lacny S, Bohm E, Hawker G, Powell J, Marshall DA. Assessing the comparability of hip arthroplasty registries in order to improve the recording and monitoring of outcome. Bone Joint J 2016; 98-B:442-51. [DOI: 10.1302/0301-620x.98b4.36501] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 10/15/2015] [Indexed: 11/05/2022]
Abstract
Aims We aimed to assess the comparability of data in joint replacement registries and identify ways of improving the comparisons between registries and the overall monitoring of joint replacement surgery. Materials and Methods We conducted a review of registries that are full members of the International Society of Arthroplasty Registries with publicly available annual reports in English. Of the six registries which were included, we compared the reporting of: mean age, definitions for revision and re-operation, reasons for revision, the approach to analysing revisions, and patient-reported outcome measures (PROMs) for primary and revision total hip arthroplasty (THA) and hip resurfacing arthroplasty (HRA). Results Outcomes were infrequently reported for HRA compared with THA and all hip arthroplasties. Revisions were consistently defined, though re-operation was defined by one registry. Implant survival was most commonly reported as the cumulative incidence of revision using Kaplan-Meier survival analysis. Three registries reported patient reported outcome measures. Conclusion More consistency in the reporting of outcomes for specific types of procedures is needed to improve the interpretation of joint registry data and accurately monitor safety trends. As collecting additional details of surgical and patient-reported outcomes becomes increasingly important, the experience of established registries will be valuable in establishing consistency among registries while maintaining the quality of data. Take home message: As the volume of joint replacements performed each year continues to increase, greater consistency in the reporting of surgical and patient-reported outcomes among joint replacement registries would improve the interpretation and comparability of these data to monitor outcomes accurately. Cite this article: Bone Joint J 2016;98-B:442–51.
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Affiliation(s)
- S. Lacny
- University of Calgary, Alberta Bone and
Joint Health Institute, 3280 Hospital Drive
NW, Calgary, Alberta T2N
4Z6, Canada
| | - E. Bohm
- University of Manitoba, 301-1155
Concordia Avenue, Winnipeg, Manitoba
R2K 2M9, Canada
| | - G. Hawker
- University of Toronto, 190
Elizabeth St., RFE, 3-805, Toronto, Ontario
M5G 2C4, Canada
| | - J. Powell
- University of Calgary, 0444
3134 Hospital Drive NW, Calgary, Alberta
T2N 4Z6, Canada
| | - D. A. Marshall
- University of Calgary, Alberta Bone and
Joint Health Institute, 3280 Hospital Drive
NW, Calgary, Alberta T2N
4Z6, Canada
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26
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Aunan E, Næss G, Clarke-Jenssen J, Sandvik L, Kibsgård TJ. Patellar resurfacing in total knee arthroplasty: functional outcome differs with different outcome scores: A randomized, double-blind study of 129 knees with 3 years of follow-up. Acta Orthop 2016; 87:158-64. [PMID: 26540368 PMCID: PMC4812078 DOI: 10.3109/17453674.2015.1111075] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Recent research on outcomes after total knee arthroplasty (TKA) has raised the question of the ability of traditional outcome measures to distinguish between treatments. We compared functional outcomes in patients undergoing TKA with and without patellar resurfacing, using the knee injury and osteoarthritis outcome score (KOOS) as the primary outcome and 3 traditional outcome measures as secondary outcomes. PATIENTS AND METHODS 129 knees in 115 patients (mean age 70 (42-82) years; 67 female) were evaluated in this single-center, randomized, double-blind study. Data were recorded preoperatively, at 1 year, and at 3 years, and were assessed using repeated-measures mixed models. RESULTS The mean subscores for the KOOS after surgery were statistically significantly in favor of patellar resurfacing: sport/recreation, knee-related quality of life, pain, and symptoms. No statistically significant differences between the groups were observed with the Knee Society clinical rating system, with the Oxford knee score, and with visual analog scale (VAS) for patient satisfaction. INTERPRETATION In the present study, the KOOS--but no other outcome measure used--indicated that patellar resurfacing may be beneficial in TKA.
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Affiliation(s)
- Eirik Aunan
- Department of Surgery, Sykehuset Innlandet, Lillehammer, Norway, ,Correspondence:
| | - Grethe Næss
- Department of Physiotherapy, Sykehuset Innlandet, Lillehammer, Norway
| | - John Clarke-Jenssen
- Department of Department of Orthopaedics, Oslo University Hospital, Oslo, Norway
| | - Leiv Sandvik
- Department of Oslo Center for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
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27
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Dy CJ, Bumpass DB, Makhni EC, Bozic KJ. The Evolving Role of Clinical Registries: Existing Practices and Opportunities for Orthopaedic Surgeons. J Bone Joint Surg Am 2016; 98:e7. [PMID: 26791040 DOI: 10.2106/jbjs.o.00494] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Christopher J Dy
- Department of Orthopaedic Surgery, Washington University, 660 South Euclid Avenue, Campus Box 8233, St. Louis, MO 63112. E-mail address:
| | - David B Bumpass
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, 4301 West Markham Street, Little Rock, AR 72205. E-mail address:
| | - Eric C Makhni
- Department of Orthopaedic Surgery, Columbia University, 161 Fort Washington Avenue, New York, NY 10032
| | - Kevin J Bozic
- Department of Surgery, Dell Medical School, University of Texas at Austin, 1912 Speedway, Suite 564, Austin, TX 78712
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28
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Is a Revision a Revision? An Analysis of National Arthroplasty Registries' Definitions of Revision. Clin Orthop Relat Res 2015; 473:3421-30. [PMID: 25791442 PMCID: PMC4586197 DOI: 10.1007/s11999-015-4255-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The reported survival of implants depends on the definition used for the endpoint, usually revision. When screening through registry reports from different countries, it appears that revision is defined quite differently. QUESTIONS/PURPOSES The purposes of this study were to compare the definitions of revision among registry reports and to apply common clinical scenarios to these definitions. METHODS We downloaded or requested reports of all available national joint registries. Of the 23 registries we identified, 13 had published reports that were available in English and were beyond the pilot phase. We searched these registries' reports for the definitions of the endpoint, mostly revision. We then applied the following scenarios to the definition of revision and analyzed if those scenarios were regarded as a revision: (A) wound revision without any addition or removal of implant components (such as hematoma evacuation); (B) exchange of head and/or liner (like for infection); (C) isolated secondary patella resurfacing; and (D) secondary patella resurfacing with a routine liner exchange. RESULTS All registries looked separately at the characteristic of primary implantation without a revision and 11 of 13 registers reported on the characteristics of revisions. Regarding the definition of revision, there were considerable differences across the reports. In 11 of 13 reports, the primary outcome was revision of the implant. In one registry the primary endpoint was "reintervention/revision" while another registry reported separately on "failure" and "reoperations". In three registries, the definition of the outcome was not provided, however in one report a results list gave an indication for the definition of the outcome. Wound revision without any addition or removal of implant components (scenario A) was considered a revision in three of nine reports that provided a clear definition on this question, whereas two others did not provide enough information to allow this determination. Exchange of the head and/or liner (like for infection; scenario B) was considered a revision in 11 of 11; isolated secondary patella resurfacing (scenario C) in six of eight; and secondary patella resurfacing with routine liner exchange (scenario D) was considered a revision in nine of nine reports. CONCLUSIONS Revision, which is the most common main endpoint used by arthroplasty registries, is not universally defined. This implies that some reoperations that are considered a revision in one registry are not considered a revision in another registry. Therefore, comparisons of implant performance using data from different registries have to be performed with caution. We suggest that registries work to harmonize their definitions of revision to help facilitate comparisons of results across the world's arthroplasty registries.
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29
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Abstract
PURPOSE OF REVIEW This review presents an update on recent findings relating to the prevention, control and epidemiology of infections following orthopaedic surgery. RECENT FINDINGS Trends in population rates and characteristics of patients undergoing hip and knee replacement surgery, coupled with the reported excess infection risk in obese patients, emphasize the current and future impact of increasing population obesity on healthcare delivery. SUMMARY Prevention of orthopaedic infection is dependent on elimination or optimal management of documented risk factors. Guidelines and quality standards play a key role in translating this evidence base into a framework of practices for the prevention of surgical site infections. Increasing levels of orthopaedic infection due to Enterobacteriaceae, coupled with an increasingly obese surgical population may necessitate a reassessment of antimicrobial prophylaxis strategies.
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30
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Inacio MCS, Pratt NL, Roughead EE, Graves SE. Predicting Infections After Total Joint Arthroplasty Using a Prescription Based Comorbidity Measure. J Arthroplasty 2015; 30:1692-8. [PMID: 25987166 DOI: 10.1016/j.arth.2015.05.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 04/16/2015] [Accepted: 05/05/2015] [Indexed: 02/01/2023] Open
Abstract
This study evaluated the association and predictive ability of co-morbidities measured by RxRisk-V, Elixhauser and Charlson measures and post-total hip (THA) and total knee arthroplasties (TKA) infection. THAs and TKAs (2001-2012) were identified using the Australian Department of Veterans' Affairs data. Infections within 90 days post-surgery were the study endpoint. Co-morbidities were identified using pharmacy (RxRisk-V) and hospitalization history (Elixhauser, Charlson). Of the 11,848 THAs, 3.1% (N = 364) had infections and out of 18,972 TKAs 3.4% (N = 648). Comorbidity burden and specific conditions were associated with infection likelihood. RxRisk-V performed better than other measures, but none had high predictive ability and differences were small. The best performing infection prediction models resulted when a combination of conditions identified by all measures was used.
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Affiliation(s)
- Maria C S Inacio
- Quality Use of Medicines and Pharmacy Research Centre, Medicine and Devices Surveillance Centre of Research Excellence, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Nicole L Pratt
- Quality Use of Medicines and Pharmacy Research Centre, Medicine and Devices Surveillance Centre of Research Excellence, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Elizabeth E Roughead
- Quality Use of Medicines and Pharmacy Research Centre, Medicine and Devices Surveillance Centre of Research Excellence, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Stephen E Graves
- Australian Orthopaedic Association, National Total Joint Replacement Registry, Level 6 Bice Building, Royal Adelaide Hospital, The University of Adelaide, Adelaide, SA, Australia
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31
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Motififard M, Pesteh M, Etemadifar MR, Shirazinejad S. Causes and rates of revision total knee arthroplasty: Local results from Isfahan, Iran. Adv Biomed Res 2015; 4:111. [PMID: 26261813 PMCID: PMC4513314 DOI: 10.4103/2277-9175.157829] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Accepted: 12/16/2014] [Indexed: 01/17/2023] Open
Abstract
Background: Knee replacement is one of the most frequently performed surgical procedures in the world. Local data on revision total knee arthroplasty (TKA) are limited. This study aims to assess the rates and causes of revision TKA in Kashani Hospital (Isfahan, Iran) from 2011 to 2013. Materials and Methods: We assessed all primary TKA and revision TKA procedures performed from 2011 to 2013 for the rate and causes of failures. Demographic data, duration from primary TKA to revision TKA and underlying diagnosis for primary TKA were also assessed. Results: Overall, 353 primary TKA procedures carried out in this period. The overall revisions following primary TKA in this period was 24 cases, indicating a revision burden of 6.8%. The most common cause of revision TKA was infection, which was in 16 cases (44.4%). Other causes included patellar complications, mechanical loosening of both tibia and femur, mechanical loosening of tibia, instability, and periprosthetic fracture. The main revision procedures were all component revision, tibial component revision, isolated tibial insert exchange and patellar tendon repair. The most common revision procedure was two stage all component revision, which was carried out in 13 subjects (36.1%). Conclusion: Local indications for revision TKA are mainly similar to those in other large centers. As compared with other centers, with considering the follow-up time, revision burden is relatively higher in this center.
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Affiliation(s)
- Mehdi Motififard
- Department of Orthopedy, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohamad Pesteh
- Department of Orthopedy, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Reza Etemadifar
- Department of Orthopedy, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Somayeh Shirazinejad
- Department of Radiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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32
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Aunan E, Kibsgård TJ, Diep LM, Röhrl SM. Intraoperative ligament laxity influences functional outcome 1 year after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2015; 23:1684-92. [PMID: 24917538 PMCID: PMC4439434 DOI: 10.1007/s00167-014-3108-0] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 05/29/2014] [Indexed: 12/04/2022]
Abstract
PURPOSE To find out if there is an association between ligament laxity measured intraoperatively and functional outcome 1 year after total knee arthroplasty (TKA). METHODS Medial and lateral ligament laxities were measured intraoperatively in extension and in 90° of flexion in 108 patients [122 knees; median age 70 (range 42-83) years]. Mechanical axes were measured preoperatively and at 1-year follow-up. Outcome measures were the Knee Injury and Osteoarthritis Outcome Score (KOOS), the Knee Society Clinical Rating System, the Oxford Knee Score and patient satisfaction. The relationships between laxity and outcome scores were examined by median regression analyses. RESULTS Post-operative mechanical axis had a significant effect on the association between ligament laxity and KOOS. Therefore, the material was stratified on post-operative mechanical axis. In perfectly aligned and valgus-aligned TKAs, there was a negative correlation between medial laxity and all subscores in KOOS. The most important regression coefficient (β) was recorded for the effect of medial laxity in extension on activities of daily living (ADLs) (β = -7.32, p < 0.001), sport/recreation (β = -6.9, p = 0.017) and pain (β = -5.9, p = 0.006), and for the effect of medial laxity in flexion on ADLs (β = -3.11, p = 0.023) and sport/recreation (β = -4.18, p = 0.042). CONCLUSIONS In order to improve the functional results after TKA, orthopaedic surgeons should monitor ligament laxity and mechanical axis intraoperatively and avoid medial laxity more than 2 mm in extension and 3 mm in flexion in neutral and valgus-aligned knees. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Eirik Aunan
- Department of Orthopaedic Surgery, Sykehuset Innlandet, Lillehammer, Norway,
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33
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Namba R, Graves S, Robertsson O, Furnes O, Stea S, Puig-Verdié L, Hoeffel D, Cafri G, Paxton E, Sedrakyan A. International comparative evaluation of knee replacement with fixed or mobile non-posterior-stabilized implants. J Bone Joint Surg Am 2014; 96 Suppl 1:52-8. [PMID: 25520419 PMCID: PMC4271422 DOI: 10.2106/jbjs.n.00466] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Mobile-bearing total knee prostheses were designed to reduce wear and improve implant survivorship following total knee arthroplasty. However, the benefit of mobile-bearing total knee arthroplasty remains unproven. Both mobile-bearing and fixed-bearing total knee arthroplasty implants are available in posterior-stabilized and non-posterior-stabilized designs. With the latter, the implant does not recreate the function of the posterior cruciate ligament (PCL) with a posterior-stabilizing cam mechanism. The purpose of the present study was to compare mobile-bearing, non-posterior-stabilized devices with fixed-bearing, non-posterior-stabilized devices used in total knee arthroplasty through a novel multinational study design. METHODS Through the use of a distributed health data network, primary total knee arthroplasties performed for osteoarthritis from 2001 to 2010 were identified from six national and regional total joint arthroplasty registries. Multivariate meta-analysis was performed with use of linear mixed models, with the primary outcome of interest being revision for any reason. Survival probabilities and their standard errors were extracted from each registry for each unique combination of the covariates. RESULTS A total of 319,616 patients (60% female) underwent non-posterior-stabilized total knee arthroplasty. A fixed-bearing, non-posterior-stabilized design was used in 258,190 (81%) of the knees and a mobile-bearing, non-posterior-stabilized design in 61,426 (19%) of the knees. Sixty-nine percent of the patients who received a fixed-bearing implant were over sixty-five years of age, compared with 63% of those who received a mobile-bearing implant. Mobile-bearing designs had a higher risk of revision, with a hazard ratio of 1.43 (95% confidence interval, 1.36 to 1.51; p < 0.001). CONCLUSIONS Previous comparisons of mobile-bearing and fixed-bearing total knee arthroplasty outcomes have been inconclusive. The current study utilized an advanced, harmonized distributed analysis of six national and regional joint-replacement registries. To our knowledge, it is the largest analysis of mobile-bearing total knee arthroplasty to date. Mobile-bearing, non-posterior-stabilized designs presented a greater risk of failure than was found for fixed-bearing, non-posterior-stabilized designs. Caution should be used in the selection of the mobile-bearing non-posterior-stabilized design for total knee replacement.
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Affiliation(s)
| | - Stephen Graves
- Australian Orthopaedic Association National Joint Replacement Registry, Discipline of Public Health, MDP DX 650 511, University of Adelaide, Adelaide, SA 5005, Australia
| | - Otto Robertsson
- The Swedish Knee Arthroplasty Register, Department of Orthopedics, Clinical Sciences, SUS/Lund University Hospital, 221 85 Lund, Sweden
| | - Ove Furnes
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Mollendalsbakken 11, N-5021 Bergen, Norway
| | - Susanna Stea
- Register of the Orthopaedic Prosthetic Implants (RIPO), c/o Medical Technology Laboratory, Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy
| | - Lluis Puig-Verdié
- Department of Orthopedic Surgery and Traumatology, Hospital del Mar, Parc de Salud MAR, Passeig Maritim 25-27, 08003 Barcelona, Spain
| | - Daniel Hoeffel
- Summit Orthopedics, 2090 Woodwinds Drive, St. Paul, MN 55125
| | - Guy Cafri
- Surgical Outcomes & Analysis Department, Kaiser Permanente, 8954 Rio San Diego Drive, Suite 406, San Diego, CA 92108
| | - Elizabeth Paxton
- Surgical Outcomes & Analysis Department, Kaiser Permanente, 8954 Rio San Diego Drive, Suite 406, San Diego, CA 92108
| | - Art Sedrakyan
- Weill Cornell Medical College, 402 East 67th Street, New York, NY 10065
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Bou Monsef J, Schraut N, Gonzalez M. Failed Total Knee Arthroplasty. JBJS Rev 2014; 2:01874474-201412000-00001. [PMID: 27490508 DOI: 10.2106/jbjs.rvw.n.00025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Jad Bou Monsef
- Department of Orthopedic Surgery, University of Illinois at Chicago, 835 South Walcott Avenue, Room E270, Chicago, IL, 60612
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Total knee arthroplasty designed to accommodate the presence or absence of the posterior cruciate ligament. Adv Orthop 2014; 2014:178156. [PMID: 25374697 PMCID: PMC4206927 DOI: 10.1155/2014/178156] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Revised: 08/26/2014] [Accepted: 08/31/2014] [Indexed: 02/06/2023] Open
Abstract
Evidence for selecting the same total knee arthroplasty prosthesis whether the posterior cruciate ligament (PCL) is retained or resected is rarely documented. This study reports prospective midterm clinical, radiographic, and functional outcomes of a fixed-bearing design implanted using two different surgical techniques. The PCL was completely retained in 116 knees and completely resected in 43 knees. For the entire cohort, clinical knee (96 ± 7) and function (92 ± 13) scores and radiographic outcomes were good to excellent for 84% of patients after 5–10 years in vivo. Range of motion averaged 124° ± 9°, with 126 knees exhibiting ≥120° flexion. Small differences in average knee flexion and function scores were noted, with the PCL-resected group exhibiting an average of 5° more flexion but an average function score that was 7 points lower compared to the PCL-retained group. Fluoroscopic analysis of 33 knees revealed stable tibiofemoral translations. This study demonstrates that a TKA articular design with progressive congruency in the lateral compartment can provide for femoral condyle rollback in maximal flexion activities and achieve good clinical and functional performance in patients with PCL-retained and PCL-resected TKA. This TKA design proved suitable for use with either surgical technique, providing surgeons with the choice of maintaining or sacrificing the PCL.
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Abdel MP, Figgie MP. Surgical management of the juvenile idiopathic arthritis patient with multiple joint involvement. Orthop Clin North Am 2014; 45:435-42. [PMID: 25199416 DOI: 10.1016/j.ocl.2014.06.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Juvenile idiopathic arthritis (JIA) is recognized as a heterogenous group of disorders in which the common factor is persistent arthritis in at least 1 joint occurring before the age of 16 years. Although conservative management with nonsteroidal anti-inflammatory drugs and disease-modifying antirheumatic drugs can be effective, approximately 10% of JIA patients have end-stage degenerative changes requiring total hip arthroplasties (THAs) and total knee arthroplasties (TKAs). This article discusses the overall epidemiology, coordination of care, and medical and surgical management of JIA patients undergoing THA and TKA.
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Affiliation(s)
- Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
| | - Mark P Figgie
- Division of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
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Howard KI, Miller MA, Damron TA, Mann KA. The distribution of implant fixation for femoral components of TKA: a postmortem retrieval study. J Arthroplasty 2014; 29:1863-70. [PMID: 24845717 PMCID: PMC4164597 DOI: 10.1016/j.arth.2014.04.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 04/07/2014] [Accepted: 04/13/2014] [Indexed: 02/01/2023] Open
Abstract
Aseptic loosening of total knee arthroplasty (TKA) components is the foremost cause of implant failure in the long term. While tibial component loosening is of primary concern, femoral loosening may become a clinical problem due to younger, more active patients seeking TKA, and also high-flexion designs. In this study, we analyzed the fixation for 19 non-revised, postmortem retrieved, femoral components of TKA with time in service ranging from 1 to 22 years. We found that the average total contact fraction for cemented components was 9.5% and had a power law response (decrease) with years in service. The average initial interdigitation depth was 0.7mm, and the average current interdigitation depth was 0.13mm. Loss of interdigitation was 81%. Over all, minimal fixation seems necessary for long-term success of TKA femoral components.
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Chareancholvanich K, Pornrattanamaneewong C. Does the length of incision in the quadriceps affect the recovery of strength after total knee replacement? Bone Joint J 2014; 96-B:902-6. [DOI: 10.1302/0301-620x.96b7.33290] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We have compared the time to recovery of isokinetic quadriceps strength after total knee replacement (TKR) using three different lengths of incision in the quadriceps. We prospectively randomised 60 patients into one of the three groups according to the length of incision in the quadriceps above the upper border of the patella (2 cm, 4 cm or 6 cm). The strength of the knees was measured pre-operatively and every month post-operatively until the peak quadriceps torque returned to its pre-operative level. There was no significant difference in the mean operating time, blood loss, hospital stay, alignment or pre-operative isokinetic quadriceps strength between the three groups. Using the Kaplan–Meier method, group A had a similar mean recovery time to group B (2.0 ± 0.2 vs 2.5 ± 0.2 months, p = 0.176). Group C required a significantly longer recovery time (3.4 ± 0.3 months) than the other groups (p < 0.03). However, there were no significant differences in the mean Oxford knee scores one year post-operatively between the groups. We conclude that an incision of up to 4 cm in the quadriceps does not delay the recovery of its isokinetic strength after TKR. Cite this article: Bone Joint J 2014;96-B:902–6.
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Affiliation(s)
- K. Chareancholvanich
- Siriraj Hospital, Department
of Orthopaedic Surgery, Faculty of Medicine, Mahidol University, Bangkok, Thailand
| | - C. Pornrattanamaneewong
- Siriraj Hospital, Department
of Orthopaedic Surgery, Faculty of Medicine, Mahidol University, Bangkok, Thailand
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Maeda JLK, Lee KM, Horberg M. Comparative health systems research among Kaiser Permanente and other integrated delivery systems: a systematic literature review. Perm J 2014; 18:66-77. [PMID: 24937150 DOI: 10.7812/tpp/13-159] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
CONTEXT Because of rising health care costs, wide variations in quality, and increased patient complexity, the US health care system is undergoing rapid changes that include payment reform and movement toward integrated delivery systems. Well-established integrated delivery systems, such as Kaiser Permanente (KP), should work to identify the specific system-level factors that result in superior patient outcomes in response to policymakers' concerns. Comparative health systems research can provide insights into which particular aspects of the integrated delivery system result in improved care delivery. OBJECTIVE To provide a baseline understanding of comparative health systems research related to integrated delivery systems and KP. DESIGN Systematic literature review. METHODS We conducted a literature search on PubMed and the KP Publications Library. Studies that compared KP as a system or organization with other health care systems or across KP facilities internally were included. The literature search identified 1605 articles, of which 65 met the study inclusion criteria and were examined by 3 reviewers. RESULTS Most comparative health systems studies focused on intra-KP comparisons (n = 42). Fewer studies compared KP with other US (n = 15) or international (n = 12) health care systems. Several themes emerged from the literature as possible factors that may contribute to improved care delivery in integrated delivery systems. CONCLUSIONS Of all studies published by or about KP, only a small proportion of articles (4%) was identified as being comparative health systems research. Additional empirical studies that compare the specific factors of the integrated delivery system model with other systems of care are needed to better understand the "system-level" factors that result in improved and/or diminished care delivery.
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Affiliation(s)
- Jared Lane K Maeda
- Research Scientist at the Mid-Atlantic Permanente Research Institute in Rockville, MD.
| | - Karen M Lee
- Former Strategic Initiatives Manager for the Kaiser Foundation Research Institute in Oakland, CA.
| | - Michael Horberg
- Executive Director of Research and Community Benefit for the Mid-Atlantic Permanente Research Institute in Rockville, MD.
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Namba RS, Inacio MCS, Cafri G. Increased risk of revision for high flexion total knee replacement with thicker tibial liners. Bone Joint J 2014; 96-B:217-23. [PMID: 24493187 DOI: 10.1302/0301-620x.96b2.32625] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The outcome of total knee replacement (TKR) using components designed to increase the range of flexion is not fully understood. The short- to mid-term risk of aseptic revision in high flexion TKR was evaluated. The endpoint of the study was aseptic revision and the following variables were investigated: implant design (high flexion vs non-high flexion), the thickness of the tibial insert (≤ 14 mm vs > 14 mm), cruciate ligament (posterior stabilised (PS) vs cruciate retaining), mobility (fixed vs rotating), and the manufacturer (Zimmer, Smith & Nephew and DePuy). Covariates included patient, implant, surgeon and hospital factors. Marginal Cox proportional hazard models were used. In a cohort of 64 000 TKRs, high flexion components were used in 8035 (12.5%). The high flexion knees with tibial liners of thickness > 14 mm had a density of revision of 1.45/100 years of observation, compared with 0.37/100 in non-high flexion TKR with liners ≤ 14 mm thick. Relative to a standard fixed PS TKR, the NexGen (Zimmer, Warsaw, Indiana) Gender Specific Female high flexion fixed PS TKR had an increased risk of revision (hazard ratio (HR) 2.27 (95% confidence interval (CI) 1.48 to 3.50)), an effect that was magnified when a thicker tibial insert was used (HR 8.10 (95% CI 4.41 to 14.89)). Surgeons should be cautious when choosing high flexion TKRs, particularly when thicker tibial liners might be required.
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Affiliation(s)
- R S Namba
- Kaiser Permanente, 6670 Alton Parkway, Irvine, California 92618, USA
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Allepuz A, Martínez O, Tebé C, Nardi J, Portabella F, Espallargues M. Joint registries as continuous surveillance systems: the experience of the Catalan Arthroplasty Register (RACat). J Arthroplasty 2014; 29:484-90. [PMID: 24054907 DOI: 10.1016/j.arth.2013.07.048] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 07/24/2013] [Accepted: 07/30/2013] [Indexed: 02/01/2023] Open
Abstract
The aim was to present results on prosthesis performance in Catalonia for the period 2005-2010. All publicly funded hospitals submit in an electronic format data on hip and knee arthroplasties: patients' insurance identification number, hospital, joint (hip/knee), type of arthroplasty (primary/revision), side (right/left), date of surgery and prosthesis (manufacturer name and catalogue number). A standard survival analysis based on Kaplan-Meier estimation was carried out. Fifty-two hospitals have sent information to the RACat which has data on 36,951 knee and 26,477 hip arthroplasties. Cumulative prostheses revision risks at 3 years were 3.3% (95% CI: 3.1-3.6) for knee, 2.9% (95% CI: 2.5-3.3) for total hip and 2.5% (95% CI: 2.0-3.1) for partial hip. When compared to other registries a higher risk of revision was observed.
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Affiliation(s)
- Alejandro Allepuz
- Department of Health, Catalan Agency for Quality and Healthcare Assessment; Catalan Health Service, Barcelona, Spain; Àmbit d'Atenció Primària Costa de Ponent, Catalan Institute of Health, l'Hospitalet de Llobregat, Spain; Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas (REDISSEC), Valencia, Spain
| | - Olga Martínez
- Department of Health, Catalan Agency for Quality and Healthcare Assessment; Catalan Health Service, Barcelona, Spain
| | - Cristian Tebé
- Department of Health, Catalan Agency for Quality and Healthcare Assessment; Catalan Health Service, Barcelona, Spain; Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas (REDISSEC), Valencia, Spain
| | - Joan Nardi
- Hospital Universitari de la Vall d'Hebron, Barcelona, Spain
| | - Frederic Portabella
- Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Catalonia, Spain
| | - Mireia Espallargues
- Department of Health, Catalan Agency for Quality and Healthcare Assessment; Catalan Health Service, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
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Heyse TJ, Ries MD, Bellemans J, Goodman SB, Scott RD, Wright TM, Lipman JD, Schwarzkopf R, Figgie MP. Total knee arthroplasty in patients with juvenile idiopathic arthritis. Clin Orthop Relat Res 2014; 472:147-54. [PMID: 23761173 PMCID: PMC3889456 DOI: 10.1007/s11999-013-3095-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Total knee arthroplasty (TKA) for juvenile idiopathic arthritis is rare but is nonetheless indicated for many patients with this disease. Few reports exist on the results of TKA in patients with juvenile idiopathic arthritis. QUESTIONS/PURPOSES It was sought to determine (1) survivorship and (2) functional outcomes of TKAs in patients with juvenile idiopathic arthritis. METHODS Results were combined from patients treated by experienced surgeons at five hospitals between 1979 and 2011. Two hundred nineteen patients (349 TKAs) were identified and contacted to survey their outcomes at a minimum followup of 2 years (mean, 12 ± 8 years; range, 2-33 years). The average age at surgery was 28.9 ± 9.7 years (range, 11-58 years). Data on revision surgery and ability to perform daily activities were collected. RESULTS The 10-year survivorship was 95%, decreasing to 82% by 20 years. At latest followup, 31 of 349 TKAs (8.9%) had been revised for either polyethylene failure or loosening (18 TKAs), infection (four), stiffness (three), periprosthetic fractures (two), bilateral amputation for vascular reasons (two), patellar resurfacing (one), and instability (one). Walking tolerance was unlimited in 49%, five to 10 blocks in 23%, and less than five blocks in 28%. Eleven percent could not manage stairs, and another 59% depended on railings. A cane was used by 12% and crutches by 7%; 12% were wheelchair-dependent. CONCLUSIONS TKA survivorship in patients with juvenile idiopathic arthritis was inferior to that typically seen in younger patients with osteoarthritis or even rheumatoid arthritis confirming results of earlier studies with smaller patient numbers. This is especially disconcerting because younger patients require better durability of their TKAs.
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Affiliation(s)
| | - Michael D. Ries
- />University of California at San Francisco Medical Center, San Francisco, CA USA
| | | | | | | | - Timothy M. Wright
- />Department of Biomechanics, Hospital for Special Surgery, New York, NY USA
| | - Jospeh D. Lipman
- />Department of Biomechanics, Hospital for Special Surgery, New York, NY USA
| | - Ran Schwarzkopf
- />Orthopaedic Department, University of California, Irvine, CA USA
| | - Mark P. Figgie
- />Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, 535 E 70th Street, New York, NY 10021 USA
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Heyse TJ, El-Zayat BF, De Corte R, Scheys L, Chevalier Y, Fuchs-Winkelmann S, Labey L. Biomechanics of medial unicondylar in combination with patellofemoral knee arthroplasty. Knee 2014; 21 Suppl 1:S3-9. [PMID: 25382365 DOI: 10.1016/s0968-0160(14)50002-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 08/18/2014] [Accepted: 08/20/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE Modular bicompartmental knee arthroplasty (BKA) for treatment of medio-patellofemoral osteoarthritis (OA) should allow for close to normal kinematics in comparison with unicondylar knee arthroplasty (UKA) and the native knee. There is so far no data to support this. SCOPE Six fresh frozen full leg cadaver specimens were prepared and mounted in a kinematic rig with six degrees of freedom for the knee joint. Three motion patterns were applied with the native knee and after sequential implantation of medial UKA and patellofemoral joint replacement (PFJ): passive flexion-extension, open chain extension, and squatting. During the loaded motions, quadriceps and hamstrings muscle forces were applied. Infrared cameras continuously recorded the trajectories of marker frames rigidly attached to femur, tibia and patella. Prior computer tomography allowed identification of coordinate frames of the bones. Strains in the collateral ligaments were calculated from insertion site distances. RESULTS UKA led to a less adducted and internally rotated tibia and a more strained medial collateral ligament (MCL). Addition of a patellofemoral replacement led to a more posterior position of both femoral condyles, a more dorsally located tibiofemoral contact point and higher MCL strain with squatting. CONCLUSION In comparison to UKA modular BKA leads to a more dorsal tibial contact point, a medial femoral condyle being located more posteriorly, and more MCL strain. Mainly the changes to the trochlear anatomy as introduced by PFJ may account for these differences.
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Affiliation(s)
- Thomas J Heyse
- Department of Orthopaedics and Rheumatology, University Hospital Marburg, Germany.
| | - Bilal F El-Zayat
- Department of Orthopaedics and Rheumatology, University Hospital Marburg, Germany
| | | | - Lennart Scheys
- Department of Orthopaedics, Katholieke Universiteit Leuven, Belgium
| | - Yan Chevalier
- Klinikum Großhadern, Orthopädische Klinik und Poliklinik, Labor für Biomechanik und Experimentelle Orthopädie, München, Germany
| | | | - Luc Labey
- Mechanical Engineering Technology TC, KU Leuven, Leuven, Belgium
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van de Groes S, de Waal-Malefijt M, Verdonschot N. Probability of mechanical loosening of the femoral component in high flexion total knee arthroplasty can be reduced by rather simple surgical techniques. Knee 2014; 21:209-15. [PMID: 23731496 DOI: 10.1016/j.knee.2013.05.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Revised: 04/21/2013] [Accepted: 05/01/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND Some follow-up studies of high flexion total knee arthoplasties report disturbingly high incidences of femoral component loosening. Femoral implant fixation is dependant on two interfaces: the cement-implant and the cement-bone interface. The present finite-element model (FEM) is the first to analyse both the cement-implant interface and cement-bone interface. The cement-bone interface is divided into cement-cancellous and cement-cortical bone interfaces, each having their own strength values. The research questions were: (1) which of the two interfaces is more prone to failure? and (2) what is the effect of different surgical preparation techniques for cortical bone on the risk of early failure.? METHODS FEM was used in which the posterior-stabilized PFC Sigma RP-F (DePuy) TKA components were incorporated. A full weight-bearing squatting cycle was simulated (ROM=50°-155°). An interface failure index (FI) was calculated for both interfaces. RESULTS The cement-bone interface is more prone to failure than the cement implant interface. When drilling holes through the cortex behind the anterior flange instead of unprepared cortical bone, the area prone to early interface failure can be reduced from 31.3% to 2.6%. CONCLUSION The results clearly demonstrate high risk of early failure at the cement-bone interface. This risk can be reduced by some simple preparation techniques of the cortex behind the anterior flange. CLINICAL RELEVANCE High-flexion TKA is currently being introduced. Some reports show high failure rates. FEM can be helpful in understanding failure of implants.
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Affiliation(s)
- S van de Groes
- Department of Orthopaedics, Orthopaedic Research Laboratory, University Medical Centre Nijmegen, Nijmegen, The Netherlands.
| | - M de Waal-Malefijt
- Department of Orthopaedics, Orthopaedic Research Laboratory, University Medical Centre Nijmegen, Nijmegen, The Netherlands
| | - N Verdonschot
- Department of Orthopaedics, Orthopaedic Research Laboratory, University Medical Centre Nijmegen, Nijmegen, The Netherlands; Laboratory for Biomechanical Engineering, University of Twente, Enschede, The Netherlands
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Aguilera-Roig X, Jordán-Sales M, Natera-Cisneros L, Monllau-García J, Martínez-Zapata M. Tranexamic acid in orthopedic surgery. Rev Esp Cir Ortop Traumatol (Engl Ed) 2014. [DOI: 10.1016/j.recote.2013.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Femoral and tibial insert downsizing increases the laxity envelope in TKA. Knee Surg Sports Traumatol Arthrosc 2014; 22:3003-11. [PMID: 25274088 PMCID: PMC4237933 DOI: 10.1007/s00167-014-3339-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 09/17/2014] [Indexed: 11/17/2022]
Abstract
PURPOSE This study examines the effect of component downsizing in a modern total knee arthroplasty (TKA) system on the laxity envelope of the knee throughout flexion. METHODS A robotic testing system was utilized to measure laxity envelopes in the implanted knee by in the anterior-posterior (AP), medial-lateral (ML), internal-external (IE) and varus-valgus (VV) directions. Five fresh-frozen cadavers were tested with a modern cruciate retaining TKA implantation, a 1-mm thinner polyethylene insert and a femoral component 2 mm smaller in the AP dimension. RESULTS The downsized tibial insert was more lax throughout the flexion arc with up to 2.0 mm more laxity in the AP direction at full extension, a 43.8% increase over the original implantation. A thinner insert consistently increased laxity throughout the arc of flexion in all degrees of freedom. Downsizing the femoral component resulted in 8.5 mm increase in AP laxity at 90°, a 73.9% increase. In mid-flexion, downsizing the femur produced similar laxity values to the downsized insert in AP, ML, IE and VV directions. CONCLUSION Downsizing the TKA components had significant effects on laxity throughout flexion. Downsizing a femoral component 2 mm had an equivalent increase in laxity in mid-flexion as downsizing the tibial insert 1 mm. This study quantifies the importance of choosing the appropriate implant component size, having the appropriate size available and the effect of downsizing. The laxity of the implanted knee contributes to how the implant feels to the patient and ultimately the patient's satisfaction with their new knee.
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Tang X, Zhou ZK, Shen B, Kang PD, Yang J, Li J, Pei FX. Total knee arthroplasty in elderly patients with severe Kashin-Beck disease of the knee. INTERNATIONAL ORTHOPAEDICS 2013; 38:753-9. [PMID: 24323348 DOI: 10.1007/s00264-013-2171-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 10/25/2013] [Indexed: 02/05/2023]
Abstract
PURPOSE The treatment of elderly KBD knee remains a significant clinical challenge, and clinical data are lacking. This study aimed to prospectively determine the functional outcomes of total knee arthroplasty (TKA) in adult patients with severe Kashin-Beck disease (KBD) of the knee. METHOD Fifteen cases that included 18 occurrences of KBD of the knee were treated by primary knee arthroplasty and followed up for at least two years. Clinical assessments for each patient were performed at time zero (pre-operatively), one, three, six and 12 months and yearly thereafter. The efficacy measures included the visual analogue scale (VAS) pain score, Hospital for Special Surgery (HSS) score, and Functional Score for Adult Tibetans with Kashin-Beck Disease (FSAT-KBD) as well as radiographic findings. RESULTS All patients were followed for a mean length of 32.47±10.05 months. All force lines in the lower limbs had been improved significantly. No radiographic evidence of loosening or changes in component positioning was observed at the last follow up. The VAS decreased significantly during the first six months after surgery and was maintained until the last follow up (p < 0.01). Similar trends were found in both HSS and FSAT-KBD, which increased significantly post-operatively (p < 0.01). CONCLUSION Knee arthroplasty can reduce pain and improve function in patients with severe KBD of the knee. Additional studies will be necessary to confirm our findings.
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Affiliation(s)
- Xin Tang
- Department of Orthopaedic Surgery, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, People's Republic of China
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Portillo ME, Salvadó M, Alier A, Sorli L, Martínez S, Horcajada JP, Puig L. Prosthesis failure within 2 years of implantation is highly predictive of infection. Clin Orthop Relat Res 2013; 471:3672-8. [PMID: 23904245 PMCID: PMC3792275 DOI: 10.1007/s11999-013-3200-7] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Accepted: 07/19/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND The outcome of revision surgery depends on accurate determination of the cause of prosthesis failure because treatment differs profoundly among aseptic loosening, mechanical failure, and prosthetic joint infections (PJI). QUESTIONS/PURPOSES We sought to determine (1) the predictive role of the interval from primary to revision surgery in determining the reason for prosthesis failure of a hip, knee, shoulder, or elbow arthroplasty, and (2) whether positive cultures during revision surgery for aseptic loosening were associated with shorter event-free survival of the prosthesis. METHODS All patients undergoing revision surgery between July 2010 and January 2012 were included in a prospective cohort of 112 patients, and were classified as having had failure from aseptic loosening (56%), mechanical failure (15%), or PJI (29%). To make the diagnosis of PJI, at surgery we used a standardized enhanced diagnostic approach in all patients including sampling of five periprosthetic tissue specimens, sonication of removed prosthetic components, prolonged incubation of aerobic and anaerobic cultures, and multiplex PCR of sonication fluid in aseptic loosening cases. Kaplan-Meier survival and Cox proportional hazards regression analysis were performed. RESULTS The median time from primary to revision surgery was (p < 0.001) longer for patients with aseptic loosening (7.8 years) than for patients with mechanical failure (1.6 years) or PJI (2 years). No difference in the time to revision was observed for patients with aseptic loosening with positive or negative microbiological cultures (p = 0.594). Propionibacterium acnes was cultured below the established microbiological criteria for positivity in 12 (19%) procedures that had been presumed to have been revisions for aseptic loosening. CONCLUSIONS PJI should be considered in all revisions performed within 2 years of implantation even in the absence of clinical or laboratory findings suggestive for infection. However, the growth of low-virulence microorganisms below the cut-off in revisions for apparent aseptic loosening is not associated with early prosthesis failure.
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Affiliation(s)
- María Eugenia Portillo
- />Microbiology Laboratory, Laboratori de Referència de Catalunya, Carrer de la Selva, 10, Edifici Inblau A. Parc de Negocis Mas Blau, 08820 El Prat de Llobregat, Barcelona, Spain
| | - Margarita Salvadó
- />Microbiology Laboratory, Laboratori de Referència de Catalunya, Carrer de la Selva, 10, Edifici Inblau A. Parc de Negocis Mas Blau, 08820 El Prat de Llobregat, Barcelona, Spain
| | - Albert Alier
- />Department of Orthopedic Surgery, Hospital del Mar, Barcelona, Spain
| | - Lluisa Sorli
- />Infectious Diseases Service, Hospital del Mar, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Santos Martínez
- />Department of Orthopedic Surgery, Hospital del Mar, Barcelona, Spain
| | - Juan Pablo Horcajada
- />Infectious Diseases Service, Hospital del Mar, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Lluis Puig
- />Department of Orthopedic Surgery, Hospital del Mar, Barcelona, Spain
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Mantripragada VP, Lecka-Czernik B, Ebraheim NA, Jayasuriya AC. An overview of recent advances in designing orthopedic and craniofacial implants. J Biomed Mater Res A 2013; 101:3349-64. [PMID: 23766134 PMCID: PMC4854641 DOI: 10.1002/jbm.a.34605] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Revised: 01/11/2013] [Accepted: 01/11/2013] [Indexed: 01/22/2023]
Abstract
Great deal of research is still going on in the field of orthopedic and craniofacial implant development to resolve various issues being faced by the industry today. Despite several disadvantages of the metallic implants, they continue to be used, primarily because of their superior mechanical properties. In order to minimize the harmful effects of the metallic implants and its by-products, several modifications are being made to these materials, for instance nickel-free stainless steel, cobalt-chromium and titanium alloys are being introduced to eliminate the toxic effects of nickel being released from the alloys, introduce metallic implants with lower modulus, reduce the cost of these alloys by replacing rare elements with less expensive elements etc. New alloys like tantalum, niobium, zirconium, and magnesium are receiving attention given their satisfying mechanical and biological properties. Non-oxide ceramics like silicon nitride and silicon carbide are being currently developed as a promising implant material possessing a combination of properties such as good wear and corrosion resistance, increased ductility, good fracture and creep resistance, and relatively high hardness in comparison to alumina. Polymer/magnesium composites are being developed to improve mechanical properties as well as retain polymer's property of degradation. Recent advances in orthobiologics are proving interesting as well. This paper thus deals with the latest improvements being made to the existing implant materials and includes new materials being introduced in the field of biomaterials.
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Gordon M, Stark A, Sköldenberg OG, Kärrholm J, Garellick G. The influence of comorbidity scores on re-operations following primary total hip replacement: comparison and validation of three comorbidity measures. Bone Joint J 2013; 95-B:1184-91. [PMID: 23997129 DOI: 10.1302/0301-620x.95b9.31006] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
While an increasing amount of arthroplasty articles report comorbidity measures, none have been validated for outcomes. In this study, we compared commonly used International Classification of Diseases-based comorbidity measures with re-operation rates after total hip replacement (THR). Scores used included the Charlson, the Royal College of Surgeons Charlson, and the Elixhauser comorbidity score. We identified a nationwide cohort of 134 423 THRs from the Swedish Hip Arthroplasty Register. Re-operations were registered post-operatively for up to 12 years. The hazard ratio was estimated by Cox's proportional hazards regression, and we used C-statistics to assess each measure's ability to predict re-operation. Confounding variables were age, gender, type of implant fixation, hospital category, hospital implant volume and year of surgery. In the first two years only the Elixhauser score showed any significant relationship with increased risk of re-operation, with increased scores for both one to two and three or more comorbidities. However, the predictive C-statistic in this period for the Elixhauser score was poor (0.52). None of the measures proved to be of any value between two and 12 years. They might be of value in large cohort or registry studies, but not for the individual patient.
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Affiliation(s)
- M Gordon
- Danderyd Hospital, Division of Orthopaedics, Department of Clinical Sciences, Karolinska Institute, Danderyds Sjukhus, SE-182 88 Stockholm, Sweden.
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