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Elliott J, Ahedi H, Parker D. Anatomical site of radiographic degeneration is an independent variable influencing outcome of total knee arthroplasty. J ISAKOS 2024; 9:253-257. [PMID: 38185248 DOI: 10.1016/j.jisako.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 12/26/2023] [Accepted: 01/02/2024] [Indexed: 01/09/2024]
Abstract
OBJECTIVES We aimed to determine whether the site of anatomical degenerative change could be identified as an independent risk factor influencing clinical outcome of total knee arthroplasty (TKA) 12 months postoperatively. METHODS We compared preoperative, postoperative and the change observed in Oxford Knee Score (OKS) amongst TKA patients categorised as primarily medial, lateral or patellofemoral osteoarthritis (PFJOA). Multivariable regression analysis was conducted on 434 consecutive knees in 333 patients, adjusting for sex, age and body mass index (BMI). RESULTS Adjusted estimates showed that preoperatively, patients with medial and lateral osteoarthritis (OA) had a lower mean OKS of 2.1 (p = 0.049) and 2.3 (p = 0.056) points respectively, while those with PFJOA had mean scores 2.7 points higher (p = 0.062). There was no statistically significant difference between compartments in absolute postoperative OKS. The greatest improvement of 30.1 points (95% confidence interval (CI) 16.9-36.0, p = 0.012) in OKS was observed for those with lateral OA, followed by 28.9 points (95% CI 16.7-35.3, p = 0.049) for those with medial OA. The improvement observed postoperatively in patients with PFJOA was less than that observed for the average of the cohort at 24.5 (95% CI 11.5-29.7, p = 0.088). CONCLUSIONS The site of compartmental involvement in knee OA is an independent factor influencing clinical outcome of TKA. With arthroplasty registry adoption of patient-reported outcome measures (PROMs), this study supports precise anatomical categorisation of knee OA in outcome studies. LEVEL OF EVIDENCE Level III, Retrospective consecutive clinical study.
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Affiliation(s)
- Johanna Elliott
- Sydney Orthopaedic Research Institute Landmark Orthopaedics, Level 2, 500 Pacific Highway, St Leonards, NSW 2065, Australia; St Vinzenz Hospital, 31-33 Dr. Otto-Seidel Strasse, Dinslaken, 46535, Germany.
| | - Harbeer Ahedi
- Sydney Orthopaedic Research Institute Landmark Orthopaedics, Level 2, 500 Pacific Highway, St Leonards, NSW 2065, Australia
| | - David Parker
- Sydney Orthopaedic Research Institute Landmark Orthopaedics, Level 2, 500 Pacific Highway, St Leonards, NSW 2065, Australia
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Maslaris A, Grimberg A, Melsheimer O, Tsiridis E, Matziolis G. Aseptic midterm survival rates between different cemented tibial stem designs in hinged total knee arthroplasty: a 6-year evaluation from the German Arthroplasty Registry. Arch Orthop Trauma Surg 2024; 144:2283-2295. [PMID: 38625551 PMCID: PMC11093826 DOI: 10.1007/s00402-024-05273-x] [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: 10/06/2023] [Accepted: 03/05/2024] [Indexed: 04/17/2024]
Abstract
INTRODUCTION The rate of revision TKA and thus the use of hinged implants (HI) steadily rises. Aseptic loosening lies on the top of the failure patterns. However, no evidence exists until now based on national scale high-caseloads that analyzes the impact of cemented HI stem-design on aseptic survival rates. METHODS Data on aseptic HI-revisions with full-cemented tibia-stems were conducted from the German Arthroplasty Registry. Cases were divided in primary HI (PHI) and HI used in revision operations (RHI). Endpoint was a new revision following either a PHI or an RHI. The impact of stem conicity (conical vs. cylindrical), diameter (≤ 13 mm vs. > 13 mm), length (≤ 90 mm vs. > 90 mm) and offset on the 6-Year-Cumulative-Aseptic-Revision-Rate (6Y-CARR) was estimated via Kaplan-Meier curve and compared between groups via Log-Rank-Tests. RESULTS 3953 PHI and 2032 RHI fulfilled inclusion-criteria. Stem conicity had no impact on 6Y-CARR (p = 0.08 and p = 0.8). Diameter > 13 mm hat an impact on PHI (p = 0.05) with lower 6Y-CARR but not on RHI (p = 0.2). Length > 90 mm showed significantly worst 6Y-CARR in PHI (p = 0.0001) but not in RHI (p = 0.3). Offset-stems showed significantly better 6Y-CARR in PHI (p = 0.04), but not in RHI (p = 0.7). CONCLUSION There was no significant impact of the cemented tibia-stem conicity on 6Y-CARR, neither in PHI nor in RHI. The effect of length, diameter and offset on the 6Y-CARR observed in the PHI, was not detectable in the more complex RHI-cases reflecting its limited clinical relevance by itself in more multifactorial backgrounds. Therefore, results must be interpreted with caution due to considerable system-effects and different utilization-scenarios.
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Affiliation(s)
- Alexander Maslaris
- Orthopaedic Department at Campus Eisenberg, University Hospital Jena, Klosterlausnitzer Str. 81, 07607, Eisenberg, Germany.
| | - Alexander Grimberg
- German Arthroplasty Registry gGmbH (EPRD), EPRD Deutsche Endoprothesenregister gGmbH, Straße des 17. Juni 106-108 (Eingang Bachstraße), 10623, Berlin, Germany
| | - Oliver Melsheimer
- German Arthroplasty Registry gGmbH (EPRD), EPRD Deutsche Endoprothesenregister gGmbH, Straße des 17. Juni 106-108 (Eingang Bachstraße), 10623, Berlin, Germany
| | - Elefterios Tsiridis
- Academic Orthopaedic Department, Papageorgiou General Hospital, Aristotle University Medical School, Thessaloníki, Greece
| | - Georg Matziolis
- Orthopaedic Department at Campus Eisenberg, University Hospital Jena, Klosterlausnitzer Str. 81, 07607, Eisenberg, Germany
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Ramos MT, Chang G, Wilson C, Gilbertie J, Krieg J, Parvizi J, Chen AF, Otto CM, Schaer TP. Dogs can detect an odor profile associated with Staphylococcus aureus biofilms in cultures and biological samples. FRONTIERS IN ALLERGY 2024; 5:1275397. [PMID: 38414670 PMCID: PMC10896932 DOI: 10.3389/falgy.2024.1275397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 01/23/2024] [Indexed: 02/29/2024] Open
Abstract
Introduction The study investigated the utilization of odor detection dogs to identify the odor profile of Staphylococcus aureus (S. aureus) biofilms in pure in vitro samples and in in vivo biosamples from animals and humans with S. aureus periprosthetic joint infection (PJI). Biofilms form when bacterial communities aggregate on orthopedic implants leading to recalcitrant infections that are difficult to treat. Identifying PJI biofilm infections is challenging, and traditional microbiological cultures may yield negative results even in the presence of clinical signs. Methods Dogs were trained on pure in vitro S. aureus biofilms and tested on lacrimal fluid samples from an in vivo animal model (rabbits) and human patients with confirmed S. aureus PJI. Results The results demonstrated that dogs achieved a high degree of sensitivity and specificity in detecting the odor profile associated with S. aureus biofilms in rabbit samples. Preliminary results suggest that dogs can recognize S. aureus volatile organic compounds (VOCs) in human lacrimal fluid samples. Discussion Training odor detection dogs on in vitro S. aureus, may provide an alternative to obtaining clinical samples for training and mitigates biosecurity hazards. The findings hold promise for culture-independent diagnostics, enabling early disease detection, and improved antimicrobial stewardship. In conclusion, this research demonstrates that dogs trained on in vitro S. aureus samples can identify the consistent VOC profile of PJI S. aureus biofilm infections. The study opens avenues for further investigations into a retained VOC profile of S. aureus biofilm infection. These advancements could revolutionize infectious disease diagnosis and treatment, leading to better patient outcomes and addressing the global challenge of antimicrobial resistance.
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Affiliation(s)
- Meghan T Ramos
- Penn Vet Working Dog Center, Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Gerard Chang
- Department of Orthopaedics, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Clara Wilson
- Penn Vet Working Dog Center, Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Jessica Gilbertie
- Center for One Health Research Edward Via College of Osteopathic Medicine, Blacksburg, VA, United States
| | - James Krieg
- Rothman Orthopaedic Institute, Philadelphia, PA, United States
| | - Javad Parvizi
- Rothman Orthopaedic Institute, Philadelphia, PA, United States
| | - Antonia F Chen
- Department of Orthopaedics, Harvard Medical School, Brigham and Women's Hospital, Harvard University, Boston, MA, United States
| | - Cynthia M Otto
- Penn Vet Working Dog Center, Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Thomas P Schaer
- Department of Clinical Studies New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA, United States
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Tille E, Beyer F, Lützner C, Postler A, Thomas P, Summer B, Lützner J. No difference in patient reported outcome and inflammatory response after coated and uncoated total knee arthroplasty - a randomized controlled study. BMC Musculoskelet Disord 2023; 24:968. [PMID: 38098024 PMCID: PMC10720193 DOI: 10.1186/s12891-023-07061-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 11/24/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Allergies against implant materials are still not fully understood. Despite controversies about its relevance, some patients need treatment with hypoallergenic implants. This study compared coated and standard total knee arthroplasty (TKA) regarding inflammatory response and patient-reported outcome measures (PROMs). METHODS 76 patients without self-reported allergies against implant materials were included in a RCT and received a coated or standard TKA of the same cemented posterior-stabilized knee system. 73 patients completed the 3-year follow-up. Two patients died and there was one revision surgery. Serum levels of cytokines with a possible role in implant allergy were measured in patient`s serum (IL-1beta, IL-5, IL-6, IL-8, IL-10, IFN γ, TNF α) prior to, one and three years after surgery. Furthermore, PROMs including knee function (Oxford Knee Score, Knee Society Score) and health-related quality of life (QoL, EuroQuol questionnaire) were assessed. Additionally, 8 patients with patch-test proven skin allergy against implant materials who received the coated implant were assessed similarly and compared to a matched-pair group receiving the same implant. RESULTS There were no differences in function and QoL between the assessed groups at any follow-up. The majority of patients demonstrated no elevation of the measured blood cytokines. Cytokine patterns showed no differences between study groups at any follow-up. The allergy patients demonstrated slower functional improvement and minor differences in cytokine pattern. Yet these results were not significant. There were no differences in the matched-pair analysis. CONCLUSION We observed no relevant increase in serum cytokine levels in any group. The inflammatory response measured seems limited, even in allergy patients. Furthermore, there were no differences between coated and standard TKA in non-allergy patients in the 3-year Follow-Up period. TRIAL REGISTRATION The study protocol was registered in the US National Institutes of Health's database ( http://www. CLINICALTRIALS gov ) registry under NCT03424174 on 03/17/2016.
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Affiliation(s)
- Eric Tille
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, TU Dresden, Fetscherst. 74, 01307, Dresden, Germany.
| | - Franziska Beyer
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, TU Dresden, Fetscherst. 74, 01307, Dresden, Germany
| | - Cornelia Lützner
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, TU Dresden, Fetscherst. 74, 01307, Dresden, Germany
| | - Anne Postler
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, TU Dresden, Fetscherst. 74, 01307, Dresden, Germany
| | - Peter Thomas
- Department of Dermatology und Allergology, Ludwig-Maximilians-University, Munich, Germany
| | - Burkhard Summer
- Department of Dermatology und Allergology, Ludwig-Maximilians-University, Munich, Germany
| | - Jörg Lützner
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, TU Dresden, Fetscherst. 74, 01307, Dresden, Germany
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Grimberg AW, Steinbrück A. [10 Years of the German Arthroplasty Registry-EPRD: what has been achieved?]. ORTHOPADIE (HEIDELBERG, GERMANY) 2023:10.1007/s00132-023-04385-3. [PMID: 37221298 DOI: 10.1007/s00132-023-04385-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/11/2023] [Indexed: 05/25/2023]
Abstract
The German Arthroplasty Registry (EPRD) has been accumulating data on hip and knee arthroplasty procedures for 10 years. Even though the EPRD is a voluntary registry, it currently includes more than 2 million documented surgical procedures in Germany. This ranks the EPRD as the third largest registry in the world. The highly granular classification of the EPRD product database, which currently includes more than 70,000 components, is set to become the international standard. The linkage of hospital case data with specific implant component data and routine data from health insurance providers enables robust arthroplasty survival analyses. This provides hospitals, manufacturers, and the specialist community with access to specific results that contribute to improving arthroplasty quality. The registry is gaining increasing international recognition by publishing in peer-reviewed journals. An application procedure also allows "third-party" data access. Furthermore, the EPRD has also established an early warning system to detect anomalies in outcome. Software-based detection of potential implant component mismatches allows notification of hospitals concerned. In 2023, the EPRD will trial extending its data collection to include patient satisfaction surveys (i.e., patient-reported outcome measures), and subsequently to surgeon-specific data.
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Affiliation(s)
- Alexander W Grimberg
- EPRD Deutsche Endoprothesenregister gGmbH, Str. des 17. Juni 106-108, 10623, Berlin, Deutschland.
| | - Arnd Steinbrück
- EPRD Deutsche Endoprothesenregister gGmbH, Str. des 17. Juni 106-108, 10623, Berlin, Deutschland
- Orthopädisch-Chirurgisches Kompetenzzentrum Augsburg (OCKA), Augsburg, Deutschland
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Banci L, Balato G, Salari P, Baldini A. "Systematic review and meta-analysis of ceramic coated implants in total knee arthroplasty. Comparable mid-term results to uncoated implants.". Knee Surg Sports Traumatol Arthrosc 2023; 31:839-851. [PMID: 34714355 DOI: 10.1007/s00167-021-06775-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 10/08/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Nitride-based ceramic coatings, such as titanium nitride (TiN) and titanium niobium nitride (TiNbN), have been introduced in total knee arthroplasty (TKA) to enhance the mechanical properties and biocompatibility of knee components, harden the metal surface and reduce CoCrMo exposure and metal ion release. However, the theoretical advantages of these ceramic coatings in TKA have yet to be fully elucidated. This systematic review aimed to provide clinical evidence on mid-term outcomes of ceramic-coated knee prostheses in comparison with uncoated standard CoCrMo knee prostheses in primary TKA. The hypothesis was that ceramic-coated implants can be used in primary TKA with no inferior outcomes compared to uncoated CoCrMo implants. METHODS A systematic review of the literature was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to find all clinical studies regarding primary TKA with ceramic-coated knee prostheses. MEDLINE (PubMed), Embase and Cochrane Library were searched from 1990 to October 2020 to identify relevant studies for the first qualitative analysis. Using PICOS eligibility criteria, a subgroup of the selected studies was used to perform a meta-analysis. RESULTS Fifteen studies were included in this systematic review, of which six were included in the meta-analysis: 3 randomized controlled trials, 2 retrospective comparative studies and 1 prospective cross-sectional study. Pooled data overall included 321 coated TKAs vs. 359 uncoated TKAs and a mean follow-up of 4.6 years (range, 2-10 years). No significant difference in the implant survival risk ratio with revision or reoperation due to any reason was found between coated and uncoated TKAs, even considering the RCT study subgroup with a risk ratio of 1.02 (P = 0.34). No significant differences were found for postoperative complications, clinical scores, or metal blood concentrations at 1 year. CONCLUSION The findings of this systematic review and meta-analysis support the statement that ceramic-coated TKAs are not inferior to uncoated TKAs, showing comparable survival rates, complication rates and clinical outcomes. There is strong evidence that ceramic-coated TKA does not improve the clinical results or survival rate in comparison with uncoated TKA. LEVEL OF EVIDENCE II, Therapeutic.
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Affiliation(s)
- Lorenzo Banci
- Permedica Orthopaedics S.P.A, Via Como 38, Merate, 23807, Lecco, Italy.
| | - Giovanni Balato
- Department of Public Health, Section of Orthopaedic Surgery, "Federico II" University, Naples, Italy
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Deroche E, Batailler C, Shatrov J, Gunst S, Servien E, Lustig S. No clinical difference at mid-term follow-up between TiN-coated versus uncoated cemented mobile-bearing total knee arthroplasty: a matched cohort study. SICOT J 2023; 9:5. [PMID: 36757220 PMCID: PMC9910165 DOI: 10.1051/sicotj/2023001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 01/05/2023] [Indexed: 02/10/2023] Open
Abstract
INTRODUCTION Nitride-based ceramic coating was introduced into surgical implants to improve hardness, reduce abrasion, and decrease the risk of metal-induced adverse reactions, especially for patients with suspected or identified metal hypersensitivity. The study aimed to evaluate the effectiveness and safety of a titanium nitride (TiN) coated prosthesis with a mobile bearing design. METHODS This was a retrospective matched-cohort study from a single center, comparing clinical outcomes between patients receiving either a TiN-coated versus an uncoated cobalt-chromium-molybdenum (CoCrMo) prostheses for primary total knee replacement. Seventeen patients received the TiN prosthesis between 2015 and 2019. These were matched 1:2 with patients receiving uncoated mobile-bearing knee prostheses with the same design manufacturer. RESULTS Fourteen patients in the TiN group had complete 5-year follow-up data and were compared with 34 patients from the CoCrMo group. The Knee Society Score was 170.6 ± 28.0 (Function subscore 83.7 ± 17.5 and Knee subscore 86.9 ± 13.8) in the TiN group and 180.7 ± 49.4 (Function subscore 87.5 ± 14.3 and Knee subscore 93.2 ± 9.6) in CoCrMo group, with no statistically significant difference (p = 0.19). One patient underwent a revision for instability requiring the removal of the implant in the TiN group and none in the CoCrMo group. The survival rates were 92.9% (CI95% 77.3-100.0) and 100.0% in the TiN group and CoCrMo group respectively (p = 1.0). DISCUSSION TiN-coated TKA with mobile bearing resulted in satisfactory clinical outcomes, and a low revision rate, and there was no complication related to the coated implant. The use of TiN-coated prostheses in case of confirmed or suspected metal allergy provides satisfactory short-term clinic outcomes.
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Affiliation(s)
- Etienne Deroche
- Orthopaedic Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital 69004 Lyon France,Corresponding author:
| | - Cécile Batailler
- Orthopaedic Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital 69004 Lyon France
| | - Jobe Shatrov
- Sydney Orthopaedic Research Institute (SORI) at Landmark Orthopaedics 500 Pacific Hwy St. Leonards NSW Australia
| | - Stanislas Gunst
- Orthopaedic Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital 69004 Lyon France
| | - Elvire Servien
- Orthopaedic Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital 69004 Lyon France,LIBM – EA 7424, Interuniversity Laboratory of Biology of Mobility, Claude Bernard Lyon 1 University 69622 Lyon France
| | - Sébastien Lustig
- Orthopaedic Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital 69004 Lyon France,University of Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406 69622 Lyon France
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Lodge CJ, Matar HE, Berber R, Radford PJ, Bloch BV. Ceramic Coatings Confer No Survivorship Advantages in Total Knee Arthroplasty-A Single-Center Series of 1641 Knees. Arthroplast Today 2023; 19:101086. [PMID: 36688095 PMCID: PMC9851869 DOI: 10.1016/j.artd.2022.101086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 10/06/2022] [Accepted: 12/08/2022] [Indexed: 01/19/2023] Open
Abstract
Background Ceramic coatings in total knee arthroplasty have been introduced with the aim of reducing wear and consequently improving implant survivorship. We studied both cobalt-chrome-molybdenum (CoCrMo) and ceramic-coated components of the same implant design from a single center to identify if the ceramic coating conferred any benefit. Methods We identified 1641 Columbus total knee arthroplasties (Aesculap AG, Tüttlingen, Germany) from a prospectively collected arthroplasty database. Of the 1641, 983 were traditional CoCrMo, and 659 had the Columbus AS ceramic coating. Patients were followed up until death or revision of any component of the implant. Results There was no significant difference in implant survivorship using any component revision as the endpoint between the CoCrMo femur and the ceramic-coated femur at a mean of 9.2 years in follow-up for the CoCrMo group and 5 years for the ceramic-coated group (37 vs 14; P = .76). There was no reduction in the proportion of components revised for aseptic loosening or infection in the ceramic-coated cohort. Conclusions At midterm follow-up, there was no benefit in terms of implant survivorship in using a ceramic coating.
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Affiliation(s)
| | | | | | | | - Benjamin V. Bloch
- Corresponding author. Consultant Orthopaedic Surgeon, City Hospital Campus, Nottingham, NG5 1PB, UK. Tel.: +44 115 969 1169.
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Thienpont E. Titanium niobium nitride knee implants are not inferior to chrome cobalt components for primary total knee arthroplasty at medium-term follow-up. Arch Orthop Trauma Surg 2023:10.1007/s00402-022-04754-1. [PMID: 36595031 DOI: 10.1007/s00402-022-04754-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 12/28/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Oxidized zirconium (Oxinium), titanium nitride (TiN) or titanium niobium nitride (TiNbN) coated implants became in recent years available for an increasing amount of total knee arthroplasty (TKA) systems. The hypothesis of this study was that the use of TiNbN-coated components would not lead to inferior results compared to conventional implants and that none of the metal hypersensitivity patients receiving TiNbN-coated implants would require revision for metal allergy. MATERIALS AND METHODS This retrospective study compared 53 Titanium Niobium Nitride coated TKA with 103 conventional chrome cobalt implants of the same design. Patients were evaluated at a minimal follow-up of 3 years. RESULTS No differences in clinical, radiological or patient-reported outcome measurements were observed between these groups. A survivorship of 96% without differences in revision rates was observed at medium-term follow-up of 6.5 years. DISCUSSION Metal allergy leading to contact or generalized dermatitis after TKA is very rare and usually linked to chrome or cobalt hypersensitivity. Nickel release from knee implants has not been shown to lead to cutaneous symptoms, but unexplained pain and swelling, peri-prosthetic osteolysis and component loosening remain potential issues not fully understood. The use of coated implants eliminates this factor from the diagnostic equation in case of postoperative dissatisfaction. CONCLUSION The use of titanium niobium nitride coated implants for primary knee osteoarthritis in self-reported metal hypersensitivity patients shows similar outcomes and survivorship rates as conventional chrome cobalt TKA, with no revisions for allergy at medium-term follow-up.
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Affiliation(s)
- Emmanuel Thienpont
- Cliniques Universitaires Saint Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium.
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Lützner J, Beyer F, Lützner C, Tille E, Postler AE. A Novel Multilayer-Coating for Total Knee Arthroplasty Implants is Safe - 10-Year Results From a Randomized-Controlled Trial. J Arthroplasty 2023; 38:90-95.e1. [PMID: 35921997 DOI: 10.1016/j.arth.2022.07.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/14/2022] [Accepted: 07/17/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND This randomized-controlled trial was initiated to compare a new multilayer hypoallergenic coating system with the standard implant in total knee arthroplasty (TKA) in terms of serum metal ion levels, patient-reported outcomes (PROs), and implant survival. METHODS A total of 120 patients were randomized to receive a coated or standard TKA of the same knee system. Serum metal ion levels (ie, cobalt, chromium, molybdenum, and nickel) as well as knee function (Oxford Knee Score, OKS), quality of life (SF-36), and physical activity (UCLA activity scale) were assessed before surgery and until the 10 year follow-up. A total of 24 patients died and there was one revision in each group. This resulted in 85 patients who completed follow-up. RESULTS Both groups demonstrated equally good improvement in PROs after surgery and constant score values thereafter. The majority of patients had metal ion serum levels below detection limit. Only cobalt levels demonstrated a slight increase in the standard group at 5- and 10-year follow-up. However, all patients displayed values below 3 μg/L. The cumulative 10-year survival was 98% in both groups. CONCLUSION There were no problems with the new coating system. No relevant increase in metal ion serum levels were measured. A slight increase in cobalt serum levels in the standard TKA was noted, thus not reaching critical values. The new coating system demonstrated equally good PROs as the standard TKA. Excellent implant survival was observed in both groups. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Jörg Lützner
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital, TU Dresden, Dresden, Germany
| | - Franziska Beyer
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital, TU Dresden, Dresden, Germany
| | - Cornelia Lützner
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital, TU Dresden, Dresden, Germany
| | - Eric Tille
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital, TU Dresden, Dresden, Germany
| | - Anne Elisabeth Postler
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital, TU Dresden, Dresden, Germany
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Lützner J, Beyer F, Lützner C, Thomas P, Summer B. Increased inflammatory response is associated with less favorable functional results 5 years after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2022; 31:1316-1322. [PMID: 35147719 PMCID: PMC10049948 DOI: 10.1007/s00167-021-06836-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 11/30/2021] [Indexed: 01/30/2023]
Abstract
PURPOSE Allergy against implant materials is discussed controversially and still not fully understood. Despite these controversies, a relevant number of patients receive hypoallergenic knee implants. The aim of this study was to compare a new coating system with the standard implant in total knee arthroplasty (TKA). Additionally, the influence of proinflammatory cytokines on patient-reported outcome measures (PROMs) was investigated. METHODS 120 patients without known metal allergy and without previous metal implants were included. The patients were randomized to receive a coated or standard TKA of the same knee system. 105 patients completed the 5 year follow-up. Patient-reported outcome measures (PROMs) including knee function (Oxford Knee Score, OKS), quality of life (SF36) and UCLA activity scale were assessed. Additionally, several cytokines with a possible role in implant allergy were measured in patient`s serum (IL-1beta, IL-5, IL-6, IL-8, IL-10, IP-10, IFN γ, TNF α). Group comparison was performed using Mann-Whitney U test for continuous values and chi-square test for categorical values. RESULTS There were no differences in PROMs between both groups at any follow-up. The majority of patients demonstrated no elevation of the measured blood cytokines. The blood cytokine pattern after 5 years demonstrated no differences between study groups. There was a significant association between elevated IL-8 values and worse results in the overall OKS (p = 0.041), the OKS function component (p = 0.004), the UCLA activity scale (p = 0.007) and the physical component of SF36 (p = 0.001). CONCLUSION There were no problems with the new coating during mid-term follow-up and no differences in PROMs between coated and standard TKA. Patients with an increased inflammatory response demonstrated worse functional results, regardless of the implant. LEVEL OF EVIDENCE I. CLINICAL TRIAL REGISTRATION The study protocol was registered in the US National Institutes of Health's database ( http://www.clinicaltrials.gov ) registry under NCT00862511.
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Affiliation(s)
- Jörg Lützner
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital, TU Dresden, Fetscherst. 74, 01307, Dresden, Germany.
| | - Franziska Beyer
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital, TU Dresden, Fetscherst. 74, 01307, Dresden, Germany
| | - Cornelia Lützner
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital, TU Dresden, Fetscherst. 74, 01307, Dresden, Germany
| | - Peter Thomas
- Department of Dermatology und Allergology, Ludwig-Maximilias-University, Frauenlobstraße 9-11, 80337, Munich, Germany
| | - Burkhard Summer
- Department of Dermatology und Allergology, Ludwig-Maximilias-University, Frauenlobstraße 9-11, 80337, Munich, Germany
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Postler A, Beyer F, Lützner C, Tille E, Lützner J. [The use of knee prostheses with a hypoallergenic coating is safe in the medium term : A randomized controlled study]. DER ORTHOPADE 2021; 51:660-668. [PMID: 34734297 PMCID: PMC9352637 DOI: 10.1007/s00132-021-04186-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/11/2021] [Indexed: 10/25/2022]
Abstract
BACKGROUND In Germany, patients with contact allergy to implant components usually receive coated joint arthroplasties. Whether the treatment using these hypoallergenic implants achieves comparable results to standard treatment with implants consisting of cobalt-chromium alloy (CoCr) implants is controversially discussed internationally and has rarely been investigated in the mid-term. OBJECTIVES Are there differences in blood metal ion concentrations, knee function, and patient-reported outcomes (PROM) between coated and standard implants? MATERIAL AND METHODS 118 patients were randomized to receive either a coated or a standard implant. Knee function as well as patient-reported outcome measures were assessed. Metal ion concentrations in blood samples were additionally determined for chromium, cobalt, molybdenum, and nickel, preoperatively, one and five years after surgery. RESULTS After five years, it was possible to analyse the results of 97 patients. In metal ion concentrations, as well as PRO, consistently good results were seen, without any difference between the groups. While in 13 patients there was an increase in chromium concentration above 2 µg/l one year after surgery, there was no measured value above 1 µg/l after five years. CONCLUSION In our study, similar mid-term results were detected for coated (TiNiN) and standard (CoCr)TKA. With respect to metal ion concentrations and PRO there are no disadvantages in using coated TKA.
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Affiliation(s)
- Anne Postler
- UniversitätsCentrum für Orthopädie, Unfall- und Plastische Chirurgie, Universitätsklinikum Carl Gustav Carus Dresden, TU Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland.
| | - Franziska Beyer
- UniversitätsCentrum für Orthopädie, Unfall- und Plastische Chirurgie, Universitätsklinikum Carl Gustav Carus Dresden, TU Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
| | - Cornelia Lützner
- UniversitätsCentrum für Orthopädie, Unfall- und Plastische Chirurgie, Universitätsklinikum Carl Gustav Carus Dresden, TU Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
| | - Eric Tille
- UniversitätsCentrum für Orthopädie, Unfall- und Plastische Chirurgie, Universitätsklinikum Carl Gustav Carus Dresden, TU Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
| | - Jörg Lützner
- UniversitätsCentrum für Orthopädie, Unfall- und Plastische Chirurgie, Universitätsklinikum Carl Gustav Carus Dresden, TU Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
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Jansson V, Steinbrück A, Melsheimer O. [Registry research]. DER ORTHOPADE 2021; 50:793-797. [PMID: 34498130 DOI: 10.1007/s00132-021-04149-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/04/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Volkmar Jansson
- Klinik und Poliklinik für Orthopädie, Physikalische Medizin und Rehabilitation, Klinikum der Universität München, Marchioninistraße 15, 81377, München, Deutschland.
| | - Arnd Steinbrück
- EPRD Deutsche Endoprothesenregister gGmbH, Berlin, Deutschland
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Ceramic-on-Ceramic Bearing in Total Hip Arthroplasty Reduces the Risk for Revision for Periprosthetic Joint Infection Compared to Ceramic-on-Polyethylene: A Matched Analysis of 118,753 Cementless THA Based on the German Arthroplasty Registry. J Clin Med 2021; 10:jcm10061193. [PMID: 33809212 PMCID: PMC8002089 DOI: 10.3390/jcm10061193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/05/2021] [Accepted: 03/05/2021] [Indexed: 11/28/2022] Open
Abstract
Periprosthetic joint infection (PJI) is one of the most common complications in total hip arthroplasty (THA). The influence of bearing material on the risk of PJI remains unclear to date. This registry-based matched study investigates the role of bearing partners in primary cementless THA. Primary cementless THAs recorded in the German Arthroplasty Registry since 2012 with either a ceramic-on-ceramic (CoC) or ceramic-on-polyethylene (CoP) bearings were included in the analysis. Using propensity score matching (PSM) for age, sex, obesity, diabetes mellitus, Elixhauser comorbidity index, year of surgery and head size, we compared the risk for revision for PJI for CoC and CoP. Within the 115,538 THAs (87.1% CoP; 12.9% CoC), 977 revisions were performed due to PJI. There was a significantly higher risk for revision for PJI for CoP compared with CoC over the whole study period (p < 0.01) after 2:1 matching (CoP:CoC) with a hazard ratio of 1.41 (95% confidence interval (CI), 1.09 to 1.80) After 3 years, the risk for revision for PJI was 0.7% (CI 0.5–0.9%) for CoC and 0.9% (CI 0.8–1.1%) for CoP. The risk for revision for all other reasons except PJI did not significantly differ between the two groups over the whole study period (p = 0.4). Cementless THAs with CoC bearings were less likely to be revised because of infection in mid-term follow-up. In the future, registry-embedded studies focusing on long-term follow-up, including clinical data, as well as basic science studies, may give a deeper insight into the influence of the bearing partners.
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