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Taliercio MJ, Alnabulsi RK, Uppal PA, Shaw IM, Semenza KM, Pasha MA. Metal implant allergy: A retrospective cohort analysis at a university allergy practice. Allergy Asthma Proc 2024; 45:186-194. [PMID: 38755777 DOI: 10.2500/aap.2024.45.240005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
Background: Concern of metal sensitization in pre- and postsurgical evaluation is growing, with the recent guidelines remaining the criterion standard for consideration of patch testing. Information remains scarce on surgical screening in the groups of patients who reported a history of metal sensitivity versus those with no reported history. Objective: The objective of this study was to assess the utility of patch testing in surgical candidates based on reported metal allergy history. The secondary objective was to evaluate the utility and outcomes in postsurgical patch testing. Methods: Nine hundred and thirty-one patient charts of patients with the diagnosis of "contact dermatitis" who underwent an evaluation at a single allergy clinic site between January 2013 and December 2022 were identified and reviewed as part of a retrospective chart review study. Patients were included in subgroups based on the time of patch testing and history of reported metal allergy. Results: In all, 67 patients underwent patch testing, 10 (14.9%) of whom were surgical candidates without a history of metal sensitivity, 31 (46.2%) of whom were surgical candidates with a history of metal sensitivity, and 26 (38.8%) of whom were postsurgical patients. Twenty-nine (43.3%) of patients had positive patch testing results, with only one (10%) in the presurgical group, 17 (54.8%) in the presurgical with a history of metal sensitivity, and 11 (42.3%) in the postsurgical group. Zero patients in our cohort without metal sensitivity who were undergoing the Nuss procedure had positive reactions on patch testing, whereas two of four (50%) with reported metal sensitivity who were undergoing the Nuss procedure had positive relevant metal reactions. Conclusion: Ambiguity in the utility of patch testing for surgical decision making remains, despite common utilization. Recent guidelines along with coordination of care among the surgeon, allergist, and patient remains the criterion standard of care.
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Affiliation(s)
- Mark J Taliercio
- From the Department of Internal Medicine, Albany Medical Center, Albany, New York
| | - Rawaa K Alnabulsi
- Division of Allergy and Immunology, Department of Internal Medicine, Albany Medical Center, Albany, New York
| | | | - Ian M Shaw
- Department of Pediatrics, Albany Medical Collage, Albany, New York, and
| | - Kristy M Semenza
- Department of Allergy and Immunology, Bassett Medical Center, Cooperstown, New York
| | - Muhammad A Pasha
- Division of Allergy and Immunology, Department of Internal Medicine, Albany Medical Center, Albany, New York
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2
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Fröschen FS, Wirtz DC, Schildberg FA. [Physiological reactions in the interface between cementless implants and bone]. ORTHOPADIE (HEIDELBERG, GERMANY) 2023; 52:178-185. [PMID: 36749380 DOI: 10.1007/s00132-023-04347-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/12/2023] [Indexed: 02/08/2023]
Abstract
BACKGROUND Surgical treatment of patients with osteoarthritis of the hip and persisting symptoms under conservative therapy has become increasingly important against the background of an aging population. OBJECTIVES What are the physiological reactions in the interface between cementless implants and bone? METHODS The literature is reviewed, expert opinions and animal models are analyzed and discussed. RESULTS Surface coating of implants with hydroxyapatite or titanium can have positive effects on osteointegration. Additional local application of mediators might be beneficial for osteointegration in the future. CONCLUSION Early peri-implant bone healing directly after implantation and late remodeling of the bone-implant interface are essential for secondary implant stability.
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Affiliation(s)
- Frank Sebastian Fröschen
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland.
| | - Dieter Christian Wirtz
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - Frank Alexander Schildberg
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
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3
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Abstract
There are very few reports of eczema and other prosthetic-related allergic skin complications following arthroplasty. We aimed to assess the risk of eczema after joint replacement.We performed a retrospective population-based cohort study in 2024 joint replacement patients using the Longitudinal Health Insurance Database. For comparison, 8096 controls were selected, with 4 control subjects for each joint replacement patient matched for age, sex, and index year, to assess eczema risk. We examined 14-year cumulative eczema incidence associated with age, sex, immunity, disease history, and joint replacement location.Eczema rates in the joint replacement patients were 38% higher than in the control group (57.90 vs 41.84 per 1000 person-years, respectively). Compared with the control group, joint replacement patients showed a 1.35-fold increased risk of eczema according to the multivariable Cox model (95% Confidence interval [CI] = 1.23-1.49). Knee replacement patients had higher eczema risk compared with the control group (Hazard ratio [HR] = 1.45, 95% CI = 1.33-1.70). Stratified by study period, the joint replacement cohort had a higher eczema risk after the 3-month follow-up.Our study revealed that joint arthroplasty increased risk of eczema in this 14-year follow-up study, and this was not related to personal atopic history or gender.
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Affiliation(s)
- Po-Yuan Wu
- Department of Dermatology, China Medical University Hospital
- School of Medicine, China Medical University
| | | | - Chun-Hao Tsai
- School of Medicine, China Medical University
- Department of Orthopedics, China Medical University Hospital
- Department of Sports Medicine/School of Medicine, China Medical University, Taichung, Taiwan
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4
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Abstract
Routine implant removal is frequently performed although evidence-based guidelines are lacking. But routinely planned implant removal has significant economic implications and shows considerable complication rates. In general, clinical outcome seems to improve but pain relief after operation is often unpredictable. Even in patients reporting implant-related pain, implant removal does not guarantee relief and may be associated with further complications. The intra- and postoperative complication rate remains very high. Implant removal demonstrates a significant learning curve and unsupervised junior surgeons tend to cause more complications. The need for implant removal may be questioned. Even with the implant in place, contact activities can be resumed. However, a new adequate trauma can create a new fracture independently if there is an implant in-situ or not. It is important to understand the complications and outcomes to be expected with hardware removal to carefully evaluate its indication.
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Affiliation(s)
- Yves P Acklin
- Universitätsspital Basel, Department of Orthopaedics and Traumatology, Basel, Switzerland.
| | - Andreas Bircher
- University Hospital Basel, Department of Infectiology and Allergology, Basel, Switzerland
| | - Mario Morgenstern
- Universitätsspital Basel, Department of Orthopaedics and Traumatology, Basel, Switzerland
| | | | - Christoph Sommer
- Kantonsspital Graubünden, Department of Traumatology, Chur, Switzerland
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5
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Thomsen M, Krenn V, Thomas P. [Adverse reactions to metal orthopedic implants after knee arthroplasty]. Hautarzt 2017; 67:347-51. [PMID: 27116434 DOI: 10.1007/s00105-016-3793-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Based on several clinical examples, the range of adverse or hypersensitive reactions to metal implants especially after total knee replacement are presented. In general, we found the patients to generally be women who present with pain, swelling, and local or generalized eczema. Some also present with early aseptic loosening mainly in the first 4 years after implantation. For these patients, a detailed allergy-specific history should be taken and a patch test should be performed; if necessary, blood ion levels should be evaluated to exclude cobaltism. Before revision surgery and exchange of the implant we always perform arthroscopic inspection to obtain biopsies for microbiology and histopathology. Using the Consensus Classification a good evaluation for planning revision with the different implant options is possible.
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Affiliation(s)
- M Thomsen
- Klinik für Orthopädie und Unfallchirurgie, Klinikum Mittelbaden Baden-Baden, Balger Str. 50, 76532, Baden-Baden, Deutschland.
| | - V Krenn
- Zentrum für Histologie, Zytologie und Molekulare Diagnostik, Max-Planck-Str. 5, 54296, Trier, Deutschland
| | - P Thomas
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität München, Frauenlobstr. 9-11, 80337, München, Deutschland
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6
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Lohmann CH, Hameister R, Singh G. Allergies in orthopaedic and trauma surgery. Orthop Traumatol Surg Res 2017; 103:S75-S81. [PMID: 28043850 DOI: 10.1016/j.otsr.2016.06.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 05/26/2016] [Accepted: 06/07/2016] [Indexed: 02/02/2023]
Abstract
Hypersensitivity reactions to implants in orthopaedic and trauma surgery are a rare but devastating complication. They are considered as a delayed-type of hypersensitivity reaction (type IV), characterized by an antigen activation of sensitized T-lymphocytes releasing various cytokines and may result in osteoclast activation and bone resorption. Potential haptens are originated from metal alloys or bone-cement. A meta-analysis has confirmed a higher probability of developing a metal hypersensitivity postoperatively and noted a greater risk of failed replacements compared to stable implants. Hypersensitivity to implants may present with a variety of symptoms such as pain, joint effusion, delayed wound/bone healing, persistent secretion, allergic dermatitis (localized or systemic), clicking noises, loss of joint function, instability and failure of the implant. Various diagnostic options have been offered, including patch testing, metal alloy patch testing, histology, lymphocyte transformation test (LTT), memory lymphocyte immunostimulation assay (MELISA), leukocyte migration inhibition test (LIF) and lymphocyte activation test (LAT). No significant differences between in vivo and in vitro methods have been found. Due to unconvincing evidence for screening methods, predictive tests are not recommended for routine performance. Infectious aetiology always needs to be excluded. As there is a lack of evidence on large-scale studies with regards to the optimal treatment option, management currently relies on individual case-by-case decisions. Several options for patients with (suspected) metal-related hypersensitivity exist and may include materials based on ceramic, titanium or oxinium or modified surfaces. Promising results have been reported, but long-term experience is lacking. More large-scaled studies are needed in this context. In patients with bone-cement hypersensitivity, the component suspected for hypersensitivity should be avoided. The development of (predictive) biomarkers is considered as a major contribution for the future.
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Affiliation(s)
- C H Lohmann
- Department of Orthopaedic Surgery, Otto-von-Guericke University, 44, Leipziger Strasse, 39120 Magdeburg, Germany.
| | - R Hameister
- Department of Orthopaedic Surgery, Otto-von-Guericke University, 44, Leipziger Strasse, 39120 Magdeburg, Germany; Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, 4, Medical Drive, 117594, Singapore
| | - G Singh
- Division of Musculoskeletal Oncology, University Orthopaedics, Hand and Reconstructive Microsurgery Cluster, National University Health System, 1E, Kent Ridge Road, 119228, Singapore
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7
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Krenn V, Perino G, Krenn VT, Wienert S, Saberi D, Hügle T, Hopf F, Huber M. [Histopathological diagnostic work-up of joint endoprosthesis-associated pathologies]. DER HAUTARZT 2016; 67:365-72. [PMID: 26987961 DOI: 10.1007/s00105-016-3778-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Increasing classes of joint implants and the combination of materials results in increased and wear-associated pathologies. According to the revised consensus classification, the following types can be recognized at conventional histological examination: Type I, particle-induced type; Type II, infection type; Type III, combination type; Type IV, indifferent type; Type V arthrofibrotic type; Type VI, allergic/immunological/toxic adverse reactions and Type VII, bone pathologies. Wear particles are histopathologically characterized according to the Krenn particle algorithm which focuses on a descriptive identification of wear particles and the differentiation of other nonwear-related particles. Type VII is considered histologically when there is evidence of a perivascular/interstitial lymphocytic CD20- and CD3-positive infiltrate, presence of mast cells and eosinophils, and tissue necrosis/infarction associated with implant wear material. Since wear particle-induced toxicity cannot be differentiated with certainty from hypersensitivity/allergic reaction on histological examination, immunological-allergological and clinical data should be used as supplementary criteria for the differential diagnosis. Tissue sampling should be performed from periprosthetic soft tissue with location mapping and when feasible also from bone tissue. Additional information regarding the type of implant and clinical, radiological, immunological, and microbiology data should be available to the pathologist. Further immunohistochemical studies are recommended in the following settings: infection (CD15, CD20, CD68); prosthesis-associated arthrofibrosis (β‑catenin); allergic/immunologic/toxic adverse reactions (CD20, CD3, CD4, CD8, CD117 and for T‑cell characterization T‑bet, GATA-3, and FOXP3).
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Affiliation(s)
- V Krenn
- MVZ-Zentrum für Histologie, Zytologie und Molekulare Diagnostik, Max-Planck-Str. 5, 54296, Trier, Deutschland.
| | - G Perino
- Department of Pathology and Laboratory Medicine, Hospital for Special Surgery, New York, USA
| | - V T Krenn
- Sigmund Freud PrivatUniversität Berlin, Berlin, Deutschland
| | - S Wienert
- VMscope GmbH Berlin, Berlin, Deutschland
| | - D Saberi
- MVZ-Zentrum für Histologie, Zytologie und Molekulare Diagnostik, Max-Planck-Str. 5, 54296, Trier, Deutschland
| | - T Hügle
- Universitätsspital Basel, Basel, Schweiz
| | - F Hopf
- MVZ-Zentrum für Histologie, Zytologie und Molekulare Diagnostik, Max-Planck-Str. 5, 54296, Trier, Deutschland
| | - M Huber
- Pathologisch-bakteriologisches Institut, Otto Wagner Spital, Wien, Österreich
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8
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Morawietz L, Krenn V. [The spectrum of histomorphological findings related to joint endoprosthetics]. DER PATHOLOGE 2015; 35 Suppl 2:218-24. [PMID: 25230805 DOI: 10.1007/s00292-014-1976-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Approximately 230,000 total hip and 170,000 knee joint endoprostheses are implanted in Germany annually of which approximately 10% (i.e. 40,000 interventions per year) are cases of revision surgery. These interventions involve removal of a previously implanted prosthesis which has resulted in complaints and replacement with a new prosthesis. There are manifold reasons for revision surgery, the most common indication being so-called endoprosthesis loosening, which is subdivided into septic and aseptic loosening. Histomorphological studies revealed that periprosthetic tissue from endoprosthesis loosening can be classified into four types (I) wear-particle induced type, (II) infectious type, (III) combined type and (IV) fibrous type. Types I and IV represent aseptic loosening and types II and III septic loosening. Recently, the topic of implant allergy has emerged. The detection of cellular, mostly perivascular lymphocytic infiltrates is discussed as being a sign of an allergic tissue reaction. It has most frequently been observed in type I periprosthetic membranes with a dense load of metal wear, which occurs with metal-on-metal bearings. Apart from endoprosthesis loosening, arthrofibrosis is another complication of joint endoprosthetics and can cause pain and impaired function. Histopathologically, arthrofibrosis can be evaluated by a three-tiered grading system. Furthermore, bone pathologies, such as ossification, osteopenia or osteomyelitis can occur as complications of joint endoprosthetics. This review gives an overview of the whole spectrum of pathological findings in joint endoprosthetics and offers a comprehensive and standardized classification system for routine histopathological diagnostics.
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Affiliation(s)
- L Morawietz
- Institut für Pathologie, Diagnostik Ernst von Bergmann GmbH, Charlottenstr. 72, 14467, Potsdam, Deutschland,
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9
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Nickel Hypersensitivity in Patients with Inferior Vena Cava Filters: Case Report and Literature and MAUDE Database Review. J Vasc Interv Radiol 2014; 25:1187-91. [DOI: 10.1016/j.jvir.2014.04.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 04/13/2014] [Accepted: 04/21/2014] [Indexed: 12/22/2022] Open
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10
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Singhal R, Warburton T, Charalambous CP. Reducing same day cancellations due to patient related factors in elective orthopaedic surgery: experience of a centre in the UK. J Perioper Pract 2014; 24:70-74. [PMID: 24855716 DOI: 10.1177/175045891602400402] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Cancellations on the day of surgery represent a major wastage of resources and can impose significant distress on patients. Minimising same day cancellations can improve cost effectiveness of operating theatre running. The aim of the study was to determine the impact of administering a questionnaire, by phone to elective orthopaedic patients, the week prior to surgery. This questionnaire was aimed at identifying factors that could lead to same day cancellation for patient related reasons. The questionnaire was administered to elective orthopaedic patients over a nine month period. The rate of same day cancellations due to patient related reasons in this cohort (Phase 2) was compared with a previous cohort assessed over a five month period when the questionnaire was not in place (Phase 1). Administering the questionnaire reduced the same day cancellations due to patient reasons from 11 out of 110 (10%) to 2 out of 118 (1.60%) (p = 0.01). Theatre wastage in terms of national tariff lost due to cancellations was reduced from 25,881 sterling pounds to 1,650 sterling pounds (p<0.001). The study concludes that administering a questionnaire aimed at addressing patient related reasons can significantly reduce same day cancellations.
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11
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Ezechieli M, Diekmann J, Weizbauer A, Becher C, Willbold E, Helmecke P, Lucas A, Schavan R, Windhagen H. Biodegradation of a magnesium alloy implant in the intercondylar femoral notch showed an appropriate response to the synovial membrane in a rabbit model in vivo. J Biomater Appl 2014; 29:291-302. [DOI: 10.1177/0885328214523322] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Degradable magnesium alloys are promising biomaterials for orthopedic applications. The aim of this study was to evaluate the potential effects on both the synovial membrane (synovialis) and the synovial fluid (synovia) of the degradation products of a MgYREZr-pin implanted in the intercondylar femoral notch in a rabbit model. Thirty-six animals were randomized into two groups (MgYREZr or Ti6Al4V alloy) of 18 animals each. Each group was then divided into three subgroups with implantation periods of 1, 4, and 12 weeks, with six animals in each subgroup. The initial inflammatory reaction caused by the surgical trauma declined after 12 weeks of implantation, and elucidated a progressive recovery of the synovial membrane. Compared with control Ti6Al4V pins, there were no significant differences between the groups. However, after 12 weeks, recovery of the synovial membrane was more advanced in the titanium group, in which 92% showed no signs of synovitis, than in the magnesium group. A cytotoxicity test with L929 cells and human osteoblasts (HOB) was also conducted, according to EN ISO 10993-5/12, and no toxic leachable products were observed after 24 h of incubation. In conclusion, the MgYREZr alloy seems to be a suitable material for intra-articular degradable implants.
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Affiliation(s)
- Marco Ezechieli
- Department of Orthopedic Surgery, Hannover Medical School, Hannover, Germany
| | - Julia Diekmann
- Department of Orthopedic Surgery, Hannover Medical School, Hannover, Germany
- CrossBIT, Center for Biocompatibility and Implant-Immunology, Department of Orthopedic Surgery, Hannover Medical School, Hannover, Germany
| | - Andreas Weizbauer
- Department of Orthopedic Surgery, Hannover Medical School, Hannover, Germany
- CrossBIT, Center for Biocompatibility and Implant-Immunology, Department of Orthopedic Surgery, Hannover Medical School, Hannover, Germany
| | - Christoph Becher
- Department of Orthopedic Surgery, Hannover Medical School, Hannover, Germany
| | - Elmar Willbold
- Department of Orthopedic Surgery, Hannover Medical School, Hannover, Germany
| | - Patrick Helmecke
- Institute of Production Engineering and Machine Tools (IFW), Leibniz Universität Hannover, Garbsen, Germany
| | - Arne Lucas
- Syntellix AG, Schiffgraben 11, Hannover, Germany
| | | | - Henning Windhagen
- Department of Orthopedic Surgery, Hannover Medical School, Hannover, Germany
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Krenn V, Morawietz L, Kienapfel H, Ascherl R, Matziolis G, Hassenpflug J, Thomsen M, Thomas P, Huber M, Schuh C, Kendoff D, Baumhoer D, Krukemeyer MG, Perino G, Zustin J, Berger I, Rüther W, Poremba C, Gehrke T. [Revised consensus classification. Histopathological classification of diseases associated with joint endoprostheses]. Z Rheumatol 2014; 72:383-92. [PMID: 23446461 DOI: 10.1007/s00393-012-1099-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The revised classification of the periprosthetic membrane (synovial-like interface membrane SLIM) encompasses all pathological alterations which can occur as a result of endoprosthetic replacement of major joints and lead to a reduction in durability of prostheses. This also includes the established consensus classification of SLIM by which aseptic and septic prosthetic loosening can be subdivided into four histological types and histopathological criteria for additional pathologies: endoprosthesis-associated arthrofibrosis, immunological/allergic alterations and osseous pathologies. This revision represents the foundation for the histopathological diagnostics of the total spectrum of diseases associated with joint prostheses, is a suitable basis for a standardized diagnostic procedure and etiological clarification of endoprosthesis failure and also as a data standard for endprosthesis registers, in particular for registers based on routine data (e.g. German endoprosthesis register).
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Affiliation(s)
- V Krenn
- MVZ-Zentrum für Histologie, Zytologie und Molekulare Diagnostik, Max-Planck-Str. 5, 54296 Trier.
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Krenn V, Kretzer JP, Thomas P, Thomsen M, Usbeck S, Scheuber L, Boettner F, Rüther W, Schulz S, Zustin J, Huber M. Update on endoprosthesis pathology: Particle algorithm for particle identification in the SLIM. ACTA ACUST UNITED AC 2013. [DOI: 10.1053/j.sart.2014.01.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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14
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Histopathologische Differenzialdiagnostik bei gelenkimplantatallergischen Fragestellungen. DER ORTHOPADE 2013; 42:614-21. [DOI: 10.1007/s00132-012-2034-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Systemic Toxicity and Hypersensitivity. Biomater Sci 2013. [DOI: 10.1016/b978-0-08-087780-8.00047-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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16
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Diehl P, Haenle M, Bergschmidt P, Gollwitzer H, Schauwecker J, Bader R, Mittelmeier W. [Cementless total hip arthroplasty: a review]. ACTA ACUST UNITED AC 2012; 55:251-64. [PMID: 20958235 DOI: 10.1515/bmt.2010.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of total hip replacement (THR) is the restoration of a painless functioning hip joint with the main focus on the biomechanical properties. Advances in surgical techniques and biomaterial properties currently allow predictable surgical results in most patients. Despite the overwhelming success of this surgical procedure, the debate continues surrounding the optimal choice of implants and fixation. Femoral and acetabular implants with varying geometries and fixation methods are currently available. Problems inherent with acrylic bone cement, however, have encouraged surgeons to use alternative surfaces to allow biologic fixation. Optimal primary and secondary fixation of cementless hip stems is a precondition for long-term stability. Important criteria to achieve primary stability are good rotational and axial stability by press-fit fixation. The objective of the cementless secondary fixation is the biological integration of the implant by bony ingrowth. Nevertheless, current investigations show excellent results of cementless fixation even in older patients with reduced osseous quality. The main advantages of cementless fixation include biological integration, reduced duration of surgery, no tissue damage by cement polymerization and reduction of intraoperative embolisms. In comparison to cemented THR both, cementless sockets and stems provide good long-term results.
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Affiliation(s)
- Peter Diehl
- Orthopädische Klinik und Poliklinik, Universität Rostock, Rostock, Deutschland.
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17
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[Joint endoprosthesis pathology. Histopathological diagnostics and classification]. DER PATHOLOGE 2011; 32:210-9. [PMID: 21526399 DOI: 10.1007/s00292-011-1418-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Prosthesis durability has steadily increased with high 10-year rates of 88-95%. However, four pathogenetic groups of diseases can decrease prosthesis durability: (1) periprosthetic wear particle disease (aseptic loosening) (2) bacterial infection (septic loosening) (3) periprosthetic ossification, and (4) arthrofibrosis. The histopathological "extended consensus classification of periprosthetic membranes" includes four types of membranes, arthrofibrosis, and osseous diseases of endoprosthetics: The four types of neosynovia are: wear particle-induced type (type I), mean prosthesis durability (MPD) in years 12.0; infectious type (type II), MPD 2.5; combined type (type III) MPD 4.2; and indeterminate type (type IV), MPD 5.5. Arthrofibrosis can be determined in three grades: grade 1 needs clinical information to be differentiated from a type IV membrane, and grades 2 & 3 can be diagnosed histopathologically. Periprosthetic ossification, osteopenia-induced fractures, and aseptic osteonecrosis can be histopathologically diagnosed safely with clinical information. The extended consensus classification of periprosthetic membranes may be a diagnostic groundwork for a future national endoprosthesis register.
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Neumann A, Kevenhoerster K. Biomaterials for craniofacial reconstruction. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2011; 8:Doc08. [PMID: 22073101 PMCID: PMC3199817 DOI: 10.3205/cto000060] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Biomaterials for reconstruction of bony defects of the skull comprise of osteosynthetic materials applied after osteotomies or traumatic fractures and materials to fill bony defects which result from malformation, trauma or tumor resections. Other applications concern functional augmentations for dental implants or aesthetic augmentations in the facial region. For ostheosynthesis, mini- and microplates made from titanium alloys provide major advantages concerning biocompatibility, stability and individual fitting to the implant bed. The necessity of removing asymptomatic plates and screws after fracture healing is still a controversial issue. Risks and costs of secondary surgery for removal face a low rate of complications (due to corrosion products) when the material remains in situ. Resorbable osteosynthesis systems have similar mechanical stability and are especially useful in the growing skull. The huge variety of biomaterials for the reconstruction of bony defects makes it difficult to decide which material is adequate for which indication and for which site. The optimal biomaterial that meets every requirement (e.g. biocompatibility, stability, intraoperative fitting, product safety, low costs etc.) does not exist. The different material types are (autogenic) bone and many alloplastics such as metals (mainly titanium), ceramics, plastics and composites. Future developments aim to improve physical and biological properties, especially regarding surface interactions. To date, tissue engineered bone is far from routine clinical application.
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Averbeck M, Gebhardt C, Simon JC, Treudler R. Resolution of both persistent eczema and implant failure following removal of nickel containing implant. J Eur Acad Dermatol Venereol 2009; 23:1215-6. [DOI: 10.1111/j.1468-3083.2009.03120.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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[Histopathologic diagnostics in endoprosthetics: periprosthetic neosynovialitis, hypersensitivity reaction, and arthrofibrosis]. DER ORTHOPADE 2009; 38:520-30. [PMID: 19448983 DOI: 10.1007/s00132-008-1400-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The durability of endoprosthetic implants of the large joints has increased over the last decades. North American studies have shown a 10-year durability of 94% for prosthetic hip implants, and European studies have shown 10-year durabilities of 88-95%. Pathologists differentiate three etiological disease patterns for the"pathology of endoprosthetics" that lead to reduction of implant durability: 1) periprosthetic particle disease (aseptic loosening), 2) infection, and 3) arthrofibrosis. Four types of neosynovitis/periprosthetic membrane have been determined in a consensus classification: particle-induced type (type I), with a mean prosthesis durability (MPD) of 12 years; infectious type (type II), MPD 2.5 years; combined type (type III), MPD 4.2 years; and indeterminate type (type IV), MPD 5.5 years. There are three histopathologic degrees of arthrofibrosis; grade 1 always needs clinical information for diagnosis, whereas grades 2 and 3 are distinct histopathologic entities.
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Haeberle M, Wittner B. Is gentamicin-loaded bone cement a risk for developing systemic allergic dermatitis? Contact Dermatitis 2009; 60:176-7. [PMID: 19260920 DOI: 10.1111/j.1600-0536.2008.01482.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Raap U, Stiesch M, Reh H, Kapp A, Werfel T. Investigation of contact allergy to dental metals in 206 patients. Contact Dermatitis 2009; 60:339-43. [DOI: 10.1111/j.1600-0536.2009.01524.x] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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