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Bornes TD, Puri S, Neitzke CC, Chandi SK, Gausden EB, Sculco PK, Chalmers BP. High Rates of Early Septic Failure, but Low Rates of Aseptic Loosening After Revision Total Knee Arthroplasty With Contemporary Rotating-Hinge Prostheses. J Arthroplasty 2024:S0883-5403(24)00836-2. [PMID: 39147074 DOI: 10.1016/j.arth.2024.08.013] [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: 01/07/2024] [Revised: 08/06/2024] [Accepted: 08/08/2024] [Indexed: 08/17/2024] Open
Abstract
BACKGROUND The purpose of this study was to determine implant survivorship and functional outcomes for revision total knee arthroplasty (rTKA) with contemporary rotating-hinge knee implants. METHODS A retrospective review identified 115 rTKAs using contemporary rotating-hinge implants from 2014 to 2018 for the treatment of instability (34, 30%), reimplantation after periprosthetic joint infection (PJI) (33, 29%), aseptic loosening (25, 22%), arthrofibrosis (14, 12%), periprosthetic fracture (4, 3%), osteolysis (4, 3%), and femoral component fracture (1, 1%). There were 70 women (61%), and the mean age was 67 years (range, 27 to 94). The mean follow-up was 3 years (range, 2 to 6). Kaplan-Meier analysis and Cox proportional hazard models estimated survivorship. RESULTS The re-revision rate was 20% (23 of 115) at an average of 18 months postoperatively. Re-revision indications included PJI (n = 14), aseptic loosening (n = 4), arthrofibrosis (n = 2), instability/malalignment (n = 1), femoral stem fracture (n = 1), and hinge mechanism disruption (n = 1). At 2 and 5 years, survivorship free from all-cause re-revision was 86 and 64%, and survivorship free from re-revision for aseptic loosening was 100 and 87%, respectively. Use of a rotating-hinge implant in reimplantation after PJI was a risk factor for subsequent re-revision (hazard ratio = 2.4, P = 0.046). On a radiographic review of unrevised rotating-hinges, there were major radiolucent lines around 2 femoral and 5 tibial components. The mean Knee Injury and Osteoarthritis Outcomes Score for Joint Replacement increased from 43 preoperatively to 60 at 1 year (P < 0.001). CONCLUSIONS In patients treated with a rotating-hinge implant for rTKA, there were relatively poor 2-year (86%) and 5-year (64%) survivorship free from all-cause re-revision, most commonly due to PJI. Midterm survivorship free from re-revision for aseptic loosening was modest (87%). There should be a goal to mitigate complications in complex rTKAs with rotating-hinge implants, namely PJI.
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Affiliation(s)
- Troy D Bornes
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York; Division of Orthopaedic Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Simarjeet Puri
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Colin C Neitzke
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Sonia K Chandi
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Elizabeth B Gausden
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Peter K Sculco
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Brian P Chalmers
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
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Jacob B, Jacob N, Röhner E, Wassilew G, Matziolis G, Heinecke M. Reconstruction of mechanical leg axis using non-modular cemented hinged prosthesis in complex primary total knee arthroplasty. Arch Orthop Trauma Surg 2024; 144:3607-3613. [PMID: 38987503 PMCID: PMC11417076 DOI: 10.1007/s00402-024-05409-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 06/18/2024] [Indexed: 07/12/2024]
Abstract
PURPOSE Modular cementless knee arthroplasty systems are capable of precise reconstruction of the mechanical axis. However, they are considered more susceptible to complications. In contrast, non-modular cemented systems are said to be more forgiving and show good long-term results. The aim of this study was to investigate the resulting leg axis after implantation of a non-modular cemented rotating hinged knee prosthesis. Furthermore, potential risk factors for the occurrence of malalignment and complications should be identified. METHODS Between 2005 and 2015, 115 patients could be included in this monocentric retrospective cohort study. All patients underwent primary hinged non-modular cemented total knee arthroplasty. Preoperative and postoperative standardized long radiographs were analysed to determine resulting leg axis. Furthermore, epidemiological and intraoperative data as well as perioperative complications were surveyed. RESULTS Average leg axis was 5.8° varus preoperatively and 0.6° valgus postoperatively. Considering an axis deviation of 3° as the target corridor, 27% of all cases examined were outside the desired range. 21% cases showed a femoral deviation from the target corridor and 15% showed a tibial deviation. There was a significant relationship between the preoperative mLDFA and the mechanical alignment of the femoral component (R = 0.396, p < 0.001) as well as between the preoperative mMPTA and the mechanical alignment of the tibial component (R = 0.187, p = 0.045). The mean operative duration was 96 min. No periprosthetic fractures were observed within the study cohort. CONCLUSION The main result of the present work is that a non-modular cemented rotating hinged knee arthroplasty system can reconstruct the mechanical leg axis precisely and comparable to modular cementless and unconstrained total knee prostheses. Component malalignment is primarily dependent upon extraarticular deformity preoperatively. Periprosthetic fracture rates and duration of surgery were lower compared with current literature. LEVEL OF EVIDENCE Level III: Retrospective cohort study.
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Affiliation(s)
- Benjamin Jacob
- Orthopaedic Department Waldkliniken Eisenberg, University Hospital Jena, Campus Eisenberg, Eisenberg, Germany.
| | - Nadja Jacob
- Orthopaedic Department Waldkliniken Eisenberg, University Hospital Jena, Campus Eisenberg, Eisenberg, Germany
| | - Eric Röhner
- Orthopaedic Department of the Heinrich-Braun-Hospital Zwickau, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany
| | - Georgi Wassilew
- Department of Orthopaedic Surgery, University Hospital Greifswald, Greifswald, Germany
| | - Georg Matziolis
- Orthopaedic Department Waldkliniken Eisenberg, University Hospital Jena, Campus Eisenberg, Eisenberg, Germany
| | - Markus Heinecke
- Orthopaedic Department Waldkliniken Eisenberg, University Hospital Jena, Campus Eisenberg, Eisenberg, Germany
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Urbain A, Putman S, Migaud H, Pasquier G, Girard J, Dartus J. Long-term results (after a mean 11.3years, and up to 22years, of follow-up) of the Legacy Constrained Condylar Knee (LCCK™) in primary total knee arthroplasty. Orthop Traumatol Surg Res 2024; 110:103795. [PMID: 38081358 DOI: 10.1016/j.otsr.2023.103795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 07/24/2023] [Accepted: 08/30/2023] [Indexed: 12/31/2023]
Abstract
INTRODUCTION The use of a sliding prosthesis in total knee arthroplasty (TKA) with increased stress is an intermediate solution in primary surgery, between posteriorly stabilized prostheses and hinged prostheses, in cases of ligamentous laxity and/or loss of bone substance. Favorable results have been reported in the medium term but to our knowledge, this type of prosthesis has not been evaluated in Europe beyond 10 years of follow-up. We therefore conducted a retrospective study in order to carry out: 1) the study of the survival of the Legacy Constrained Condylar Knee (LCCK™) prosthesis in primary surgery, 2) the analysis of complications, functional scores and radiographic data, 3) the analysis of the link between the diaphyseal filling rate and prosthetic loosening. HYPOTHESIS The LCCK™ sliding prosthesis with increased constraint has equivalent long-term survival and clinical results to standard posteriorly stabilized TKA and superior to hinged TKA. MATERIAL AND METHOD A retrospective series of 141 LCCK™ implanted in 134 patients between 1997 and 2010 was analyzed. Survival was assessed with censoring through an evaluation of partial or total revision of the implants. The functional results were evaluated using the IKS and Oxford 12 scores. Data regarding the Canal Fill Ratio (CFR) and the presence of pathological periprosthetic lines were also collected. RESULTS The average follow-up was 11.3±5.3years with a maximum follow-up of 22.7years. Survival at 20years was 90.8% [95% CI: 83.7-95.7]. The rate of early complications was 13.5% (19/141), predominantly comprised of venous thrombosis (6/141), hematomas (3/141 including two requiring surgical drainage), stiffness (3/141) and early infections (3/141). The rate of late complications was 17% (24/141), led by stiffness (4.4%; 6/141), infections (2.9%; 4/141) and hardware failure (2. 2%; 3/141). Ten of the 141 patients (7.1%) had LCCK failure, including 3 (2.1%) for stiffness, 3 (2.1%) for hardware failure, 2 (1.4%) for infection, 1 (0.7%) for laxity and 1 (0.7%) for a periprosthetic fracture. No aseptic loosening was found. The total IKS score went from 65 [0-116] to 143 [79-200] at follow-up, the IKS knee score went from 30 [0-66] to 85 [44-100], and the IKS function score went from 35 [0-70] to 57 [0-100]. The Oxford score went from 14 [2-25] to 34 [15-48] at follow-up. Only two patients (1.4%) presented with a partial periprosthetic line. The tibial CFR was 0.81 and the femoral CFR was 0.76. The influence of the CFR could not be analyzed due to the absence of loosening. DISCUSSION The LCCK™ prosthesis in primary surgery has good medium-term survival, a significant improvement in functional scores and a complication rate comparable to posteriorly stabilized prostheses. The complication rate is lower than that of hinged prostheses. LEVEL OF EVIDENCE IV; single-center retrospective study.
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Affiliation(s)
- Antoine Urbain
- Université de Lille, Hauts-de-France, 59000 Lille, France; Service d'orthopédie II, hôpital Roger-Salengro, CHU de Lille, place de Verdun, 59000 Lille, France.
| | - Sophie Putman
- Université de Lille, Hauts-de-France, 59000 Lille, France; Service d'orthopédie II, hôpital Roger-Salengro, CHU de Lille, place de Verdun, 59000 Lille, France
| | - Henri Migaud
- Université de Lille, Hauts-de-France, 59000 Lille, France; Service d'orthopédie II, hôpital Roger-Salengro, CHU de Lille, place de Verdun, 59000 Lille, France
| | - Gilles Pasquier
- Université de Lille, Hauts-de-France, 59000 Lille, France; Service d'orthopédie II, hôpital Roger-Salengro, CHU de Lille, place de Verdun, 59000 Lille, France
| | - Julien Girard
- Université de Lille, Hauts-de-France, 59000 Lille, France; Service d'orthopédie II, hôpital Roger-Salengro, CHU de Lille, place de Verdun, 59000 Lille, France; Université de Artois, Université Littoral Côte d'Opale, EA 7369 - Unité de Recherche Pluridisciplinaire Sport Santé Société (URePSS), 59000 Lille, France
| | - Julien Dartus
- Université de Lille, Hauts-de-France, 59000 Lille, France; Service d'orthopédie II, hôpital Roger-Salengro, CHU de Lille, place de Verdun, 59000 Lille, France
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Chantelot C, Saab M, Martin T, Begue T, Ehlinger M, Flecher X. Revision total knee arthroplasty with periprosthetic distal femoral fracture. Orthop Traumatol Surg Res 2024:103856. [PMID: 38438108 DOI: 10.1016/j.otsr.2024.103856] [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: 10/03/2022] [Revised: 01/29/2024] [Accepted: 02/07/2024] [Indexed: 03/06/2024]
Abstract
Treatment strategies for periprosthetic distal femoral fracture depend on the type of fracture, level with respect to the prosthesis, and prosthesis fixation. The usual treatment is internal fixation by nail or locking plate. This can be more difficult when the fracture is close to the joint, is destabilizing the prosthesis or is associated with reduced bone stock, and implant exchange should be considered, depending on the patient's health status. The aim is to obtain the fastest possible recovery while limiting complications and minimizing surgery time for often frail and elderly patients. The present study details the implant revision technique in periprosthetic distal femoral fracture, which requires experience in traumatology and prosthetic revision and material adapted to the situation. LEVEL OF EVIDENCE: V, expert opinion.
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Affiliation(s)
- Christophe Chantelot
- Service de traumatologie, hôpital Salengro, CHU de Lille, avenue du Professeur Emile-Laine, 59000 Lille, France.
| | - Marc Saab
- Service de traumatologie, hôpital Salengro, CHU de Lille, avenue du Professeur Emile-Laine, 59000 Lille, France
| | - Théo Martin
- Service de traumatologie, hôpital Salengro, CHU de Lille, avenue du Professeur Emile-Laine, 59000 Lille, France
| | - Thierry Begue
- Service de traumatologie, hôpital Antoine-Béclère, 157, rue de la Porte de Trivaux, 92140 Clamart, France
| | - Matthieu Ehlinger
- Service de traumatologie, hôpital de Hautepierre, avenue Molière, 67200 Strasbourg, France
| | - Xavier Flecher
- Service de traumatologie, hôpital Nord, chemin des Bourrely, 13015 Marseille, France
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Xiao X, Xu J, Wang C, Jin Z, Qiang Yuan, Zhou L, Shan L. Porcine platelet lysates exert the efficacy of chondroregeneration and SMAD2-mediated anti-chondrofibrosis on knee osteoarthritis. Int Immunopharmacol 2024; 128:111509. [PMID: 38262159 DOI: 10.1016/j.intimp.2024.111509] [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: 11/01/2023] [Revised: 12/29/2023] [Accepted: 01/04/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND The lack of self-repairability in cartilage and the formation of fibrocartilage pose significant challenges in treating knee osteoarthritis, and there is still no ideal solution. Autologous platelet lysates have been clinically applied to treat kOA and exert satisfactory cartilage-repair efficacy, but the preparation of human PL brings damage to patients and is hardly standardized. METHODS In this study, porcine PL was developed to replace hPL, and its chondroregenerative and anti-chondrofibrosis effects were explored. Enzyme-Linked Immunosorbent Assay was applied to qualify the PL products. In vivo, partial-thickness cartilage defects were created on rats as a kOA model, and the von Frey test, histopathological observation, immunohistochemical analysis, and western blot analysis were conducted. In vitro, CCK-8 assay, real-time PCR analysis, immunofluorescence test, and WB analysis were conducted for the mechanism study of pPL. RESULTS The in vivo data showed that pPL significantly repaired the cartilage defect by improving matrix synthesis and also ameliorated the pain response in the kOA model of rats. In addition, pPL exerted an anti-fibrosis effect on cartilage by suppressing the expressions of COL1, COL3, α-SMA, VIMENTIN, SMAD2, p-SMAD2, and CTGF in cartilage. The in vitro data verified these effects and indicated that the SMAD2 pathway mediated the anti-fibrosis mechanism of pPL. Moreover, the comparable effects between pPL and rat PL indicate that there is no immune rejection from pPL. CONCLUSIONS This study firstly demonstrated the anti-kOA effects of pPL on both cartilage-repair and anti-chondrofibrosis. It developed pPL as a promising alternative to autologous PL for clinical applications.
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Affiliation(s)
- Xiujuan Xiao
- College of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310053, China; The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, Zhejiang 310053, China
| | - Jiaan Xu
- College of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310053, China; The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, Zhejiang 310053, China
| | - Chen Wang
- College of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310053, China; The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, Zhejiang 310053, China
| | - Zhijiang Jin
- The 9th People's Hospital of Hangzhou, Hangzhou, Zhejiang 310012, China
| | - Qiang Yuan
- College of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310053, China.
| | - Li Zhou
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, Zhejiang 310053, China.
| | - Letian Shan
- The Second Affiliated Hospital of Zhejiang Chinese Medical University (Xinhua Hospital of Zhejiang Province), Hangzhou, Zhejiang 310053, China; Fuyang Research Institute, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310053, China; Cell Resource Bank and Integrated Cell Preparation Center of Xiaoshan District, Hangzhou Regional Cell Preparation Center (Shangyu Biotechnology Co., Ltd), Hangzhou, Zhejiang 311200, China.
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Dragosloveanu S, Petre MA, Cretu B, Mihailescu AA, Cergan R, Scheau C. Etiology of Total Knee Arthroplasty Revisions: A Two-Decade Institutional Perspective. Cureus 2024; 16:e55263. [PMID: 38425332 PMCID: PMC10904024 DOI: 10.7759/cureus.55263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2024] [Indexed: 03/02/2024] Open
Abstract
Total knee arthroplasty (TKA) implant survival time is determined by various patient and implant-related factors and varies significantly in recent worldwide reports. In our study, we have included 247 TKA revisions in 203 patients performed in our hospital over the last 20 years. Multiple etiologies of revisions were identified and classified into 10 categories. Time to failure was analyzed with regard to etiology, patient demographics, and other relevant data. The overall average time to revision was 44.08 months (95% confidence interval (CI) between 33.34 and 49.82 months). Age at primary implant was negatively correlated with time to revision (hazard ratio (HR) = 1.0521 and 95% CI of HR = 1.0359 to 1.0685) and female patients showed a 1.59 times higher risk of implant failure than males. Periprosthetic joint infection was the cause of 46.56% (n=115) of revisions (out of which 12.55% (n=31) were early infections, diagnosed within the first three months), while aseptic loosening was found in 31.98% (n=79) of cases. Infection correlated with a shorter time to revision compared to aseptic loosening (p<0.05). These findings emphasize the need to intensify efforts to deliver the best patient care, select the best antibiotic regimen, and improve surgical techniques to decrease the incidence of infectious complications.
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Affiliation(s)
- Serban Dragosloveanu
- Department of Orthopaedics and Traumatology, The "Carol Davila" University of Medicine and Pharmacy, Bucharest, ROU
- Department of Orthopaedics, "Foisor" Clinical Hospital of Orthopaedics, Traumatology, and Osteoarticular Tuberculosis, Bucharest, ROU
| | - Mihnea-Alexandru Petre
- Department of Orthopaedics, "Foisor" Clinical Hospital of Orthopaedics, Traumatology, and Osteoarticular Tuberculosis, Bucharest, ROU
| | - Bogdan Cretu
- Department of Orthopaedics, Bucharest Emergency University Hospital, Bucharest, ROU
| | - Alexandra Ana Mihailescu
- Department of Anesthesiology and Critical Care, "Foisor" Clinical Hospital of Orthopaedics, Traumatology, and Osteoarticular Tuberculosis, Bucharest, ROU
| | - Romica Cergan
- Department of Anatomy, The "Carol Davila" University of Medicine and Pharmacy, Bucharest, ROU
- Department of Radiology and Medical Imaging, "Foisor" Clinical Hospital of Orthopaedics, Traumatology, and Osteoarticular Tuberculosis, Bucharest, ROU
| | - Cristian Scheau
- Department of Physiology, The "Carol Davila" University of Medicine and Pharmacy, Bucharest, ROU
- Department of Radiology and Medical Imaging, "Foisor" Clinical Hospital of Orthopaedics, Traumatology, and Osteoarticular Tuberculosis, Bucharest, ROU
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Schnetz M, Hofmann L, Ewald L, Klug A, Hoffmann R, Gramlich Y. Midterm results of modular hinge total knee arthroplasty using cementless osseointegrating stems: low fixation associated complications and good functional outcome in primary and revision knee arthroplasty. Arch Orthop Trauma Surg 2024; 144:831-845. [PMID: 38063882 DOI: 10.1007/s00402-023-05148-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 11/11/2023] [Indexed: 01/30/2024]
Abstract
PURPOSE This study aimed to investigate functional outcome and complications after primary and revision modular H-TKA using hybrid fixation with cementless stems. METHODS Between 2015 and 2018, 48 patients with 50 implants were included after hybrid implantation of a single design H-TKA system using cementless osseointegrating stems and modular components. Complications and clinical outcome were analysed using Knee Society Score (KSS), the Western Ontario McMasters Universities Osteoarthritis Index (WOMAC) and the Short-Form Health Survey 12 (SF-12) score. RESULTS Indications for implantation were aseptic revision (n = 29, 58%), primary TKA (n = 19, 38%) and two-stage septic revisions (n = 2, 4%). Complications were reported in 26% (n = 12), whereas complications associated with hybrid fixation occurred in 5 (10%) cases, with 2 (4%) requiring revision surgery for aseptic loosening and 3 (6%) treated with an adapted postoperative protocol for perioperative fractures. Implant survivorship was 84% after a mean follow-up of 54 months. Postoperative KSS significantly improved from 51.50 (12-100) to 78.36 (41-99; p < 0.001). The mean WOMAC score was 19.26 (0-55), SF-12 PCS was 41.56 points (22.67-57.66) and SF-12 MCS was 49.21 points (23.87-63.21). CONCLUSION Hybrid modular implantation in H-TKA provides satisfactory clinical and functional results in primary and revision TKA. Clinical outcomes significantly improve with reduced pain, increased mobility, and good-to-excellent functional scores after implantation. Whilst implant survival is comparable to previous studies and complications associated with hybrid fixation are low, general complication rates are comparably high.
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Affiliation(s)
- M Schnetz
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstr. 430, 60389, Frankfurt am Main, Germany.
| | - L Hofmann
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstr. 430, 60389, Frankfurt am Main, Germany
| | - L Ewald
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstr. 430, 60389, Frankfurt am Main, Germany
| | - A Klug
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstr. 430, 60389, Frankfurt am Main, Germany
| | - R Hoffmann
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstr. 430, 60389, Frankfurt am Main, Germany
| | - Y Gramlich
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstr. 430, 60389, Frankfurt am Main, Germany
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Chen W, Zhang H. An experimental study on the impact of prosthesis temperature on the biomechanical properties of bone cement fixation. BMC Surg 2023; 23:191. [PMID: 37407954 DOI: 10.1186/s12893-023-02079-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 06/14/2023] [Indexed: 07/07/2023] Open
Abstract
PURPOSE To investigate the effect of the femoral component and tibial plateau component temperature on the strength of cement fixation during total knee arthroplasty (TKA). METHODS Femoral prosthesis, tibial plateau prosthesis, and polypropylene mold base were used to simulate TKA for bone cement fixation. Pre-cooling or pre-warming of femoral and tibial plateau components at different temperatures (4 °C, 15 °C, 25 °C, 37 °C, 45 °C), followed by mixing and stirring of bone cement at laboratory room temperature (22 °C), were performed during research. The prosthesis and the base adhered together, and the bone cement was solidified for 24 h at a constant temperature of 37 °C to verify the hardness of the bone cement with a push-out test. RESULTS The push-out force of the femoral prosthesis after fixation was higher than that of the tibial plateau prosthesis, and with the increase of the prosthesis temperature, the push-out force after fixation of the bone cement also increased linearly and the porosity of the prosthetic cement in the tibia and femur decreased as the temperature increased. CONCLUSION Without changing the mixing temperature and solidification temperature, the fixation strength of the femoral prosthesis is higher than that of the tibial plateau prosthesis. Properly increasing the temperature of the prosthesis can increase the push-out force of the fixation strength.
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Affiliation(s)
- Wanzhuo Chen
- Department of Joint Surgery, the Affiliated Hospital of Qingdao University, Qingdao, 266000, China
| | - Haining Zhang
- Department of Joint Surgery, the Affiliated Hospital of Qingdao University, Qingdao, 266000, China.
- State Key Discipline: Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong Province, China.
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Miralles-Muñoz FA, Pineda-Salazar M, Rubio-Morales M, González-Parreño S, Ruiz-Lozano M, Lizaur-Utrilla A. Similar outcomes of constrained condylar knee and rotating hinge prosthesis in revision surgery for extension instability after primary total knee arthroplasty. Orthop Traumatol Surg Res 2022; 108:103265. [PMID: 35257946 DOI: 10.1016/j.otsr.2022.103265] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 12/08/2021] [Accepted: 01/04/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Instability is one of the most common reasons for total knee arthroplasty (TKA) failure. Constrained prosthesis can be used for significant ligamentous laxity, but there is not much evidence on the appropriate level of restriction for unstable varus-valgus TKA. The objective of this study was to compare the outcome and survival at a minimum follow-up of five years between rotating hinge knee prosthesis (RHK) and constrained condylar knee prosthesis (CCK) for extension instability following primary TKA. HYPOTHESIS For symptomatic extension instability after primary TKA, good functional outcomes and survival can be achieved with both designs. MATERIAL AND METHODS Consecutive patients with unstable primary TKA who underwent revision with either RHK (n=34) or CCK (n=30) were retrospectively compared. Assessments were performed by the Knee Society Scores (KSS), and visual analogue scales (VAS) for pain and patient satisfaction. Radiological evaluation was made. Complications and re-operations were analyzed. RESULTS Mean post-operative follow-up was 10.3 (range 5-16) years for both groups. At the final follow-up, there was no significant difference between groups in the KSS-knee (p=0.228) or KSS-function (p=0.324) score, VAS-pain (p=0.563), VAS-satisfaction (p=0.780), major complication rate (p=0.194), or TKA survival at 10 years (p=0.091). CONCLUSION The present study showed comparable good functional outcomes and survival at long-term between RHK and CCK arthroplasties. Both designs can be recommended for revision of total knee arthroplasty with symptomatic extension instability. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Francisco A Miralles-Muñoz
- Department of Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax s/n, Elda 03600, Alicante, Spain.
| | - Manuel Pineda-Salazar
- Department of Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax s/n, Elda 03600, Alicante, Spain
| | - Marta Rubio-Morales
- Department of Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax s/n, Elda 03600, Alicante, Spain
| | - Santiago González-Parreño
- Department of Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax s/n, Elda 03600, Alicante, Spain
| | - Matías Ruiz-Lozano
- Department of Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax s/n, Elda 03600, Alicante, Spain
| | - Alejandro Lizaur-Utrilla
- Department of Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax s/n, Elda 03600, Alicante, Spain; Department of Traumatology and Orthopaedics, Miguel Hernandez University, San Juan de Alicante, Alicante, Spain
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Bulaïd Y, Djebara AE, Belhaouane R, Havet E, Dehl M, Mertl P. Beneficial effect of a zirconium-nitride-coated implant in total knee arthroplasty revision for suspected metal hypersensitivity. Orthop Traumatol Surg Res 2022; 108:103320. [PMID: 35577273 DOI: 10.1016/j.otsr.2022.103320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 05/03/2021] [Accepted: 05/25/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Revision of total knee arthroplasty (rTKA) for suspicion of metal hypersensitivity (MHS) may require hypoallergenic implants. Results for coated implants have not been reported. The aim of the present study was to assess short-term results and survival of rTKA for MHS using a multilayer implant coating. HYPOTHESIS Multilayer implant coating improves functional results in rTKA, with survival comparable to primary coated implants. MATERIAL AND METHODS A single-center retrospective observational study included 28 patients (30 knees) undergoing rTKA for MHS using a coated implant between May 2011 and November 2016. Exclusion criteria comprised implant malpositioning and history of infection in the affected knee. Clinical and radiological results were assessed on the International Knee Society (IKS) and SF-36 functional scores and Ewald radiological score. Survival was calculated on Kaplan-Meier estimation. RESULTS Mean follow-up was 3.8 years. Mean IKS score increased by 40.2 points (40%) [range, 28.1-52.3] (p<0.05). Mean range of motion increased by 17° [range, 9.5-24.5°] (p<0.05). Mean physical and mental SF-36 components were respectively 44.7 and 46.1. Survivorship was 93%. DISCUSSION There was significant functional improvement after rTKA for MHS. There were no short-term complications related to the zirconium nitrate coating. However, studies with longer follow-up will be needed for confirmation. LEVEL OF EVIDENCE IV; retrospective study.
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Affiliation(s)
- Yassine Bulaïd
- Service de Chirurgie Orthopédique et Traumatologie, CHU Amiens-Picardie, 80480, Salouël, France
| | - Az-Eddine Djebara
- Service de Chirurgie Orthopédique et Traumatologie, CHU Amiens-Picardie, 80480, Salouël, France.
| | - Ramy Belhaouane
- Service de Chirurgie Orthopédique et Traumatologie, CHU Amiens-Picardie, 80480, Salouël, France
| | - Eric Havet
- Service de Chirurgie Orthopédique et Traumatologie, CHU Amiens-Picardie, 80480, Salouël, France
| | - Massinissa Dehl
- Service de Chirurgie Orthopédique et Traumatologie, CHU Amiens-Picardie, 80480, Salouël, France
| | - Patrice Mertl
- Service de Chirurgie Orthopédique et Traumatologie, CHU Amiens-Picardie, 80480, Salouël, France
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11
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Li HQ, Li PC, Wei XC, Shi JJ. Effectiveness of antibiotics loaded bone cement in primary total knee arthroplasty: A systematic review and meta-analysis. Orthop Traumatol Surg Res 2022; 108:103295. [PMID: 35552043 DOI: 10.1016/j.otsr.2022.103295] [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: 02/12/2021] [Revised: 06/10/2021] [Accepted: 06/14/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The application of antibiotics loaded bone cement (ALBC) in the revision of failed total knee arthroplasty (TKA) has been widely accepted to reduce risk of peri-prosthetic infection. However, the prophylactic use of ALBC in primary TKA remains controversial. This study was aimed to identify the prophylactic effect on peri-prosthetic infection and safety of ALBC in primary TKA. HYPOTHESIS The application of ALBC could reduce the risk of peri-prosthetic infection in primary TKA. MATERIALS AND METHODS Electronic platforms including PubMed, EMBASE, and CENTRAL were retrieved to identify studies comparing outcomes of prophylactic ALBC and plain cement in primary TKA. For outcomes reported as dichotomous variable and continuous variable, risk ratio (RR) and weighted mean difference (WMD) as well as their 95% confidence intervals (95% CI) were selected as the effect sizes for pooling. While for those outcomes reported the adjusted effect sizes such as odds ratio (OR, derived from multivariate logistic regression), and hazard ratio (HR, derived from multivariate COX proportional hazard model), the reported effect sizes were selected for pooling. RESULTS A total of 17 studies with 2,074,844 patients (1,093,920 in ALBC group and 980,924 in plain cement group) were eligible for final inclusion. No significant difference was found between ALBC and plain cement groups both for the unadjusted (RR=1.02, 95% CI: 0.86∼1.21, p=0.832) and adjusted (OR=0.94, 95% CI: 0.76∼1.17, p=0.596) peri-prosthetic infection rate. ALBC application was related to significantly increased length of hospital stay (WMD=0.13, 95% CI: 0.10∼0.17, p<0.001). There was no significance on the difference of operation related adverse events between two groups (RR=1.31, 95% CI: 0.68∼2.52, p=0.420). Significantly increased risks of acute renal failure and readmission, and temporarily increased ototoxicity in ALBC group were reported in one of the primary study. DISCUSSION There is no sufficient evidence supporting decreased peri-prosthetic infection rate with ALBC application in primary TKA. What's more, it must be taken into consideration about the safety and added cost of additional impregnated antibiotics. LEVEL OF EVIDENCE III; meta-analysis.
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Affiliation(s)
- Hao-Qian Li
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, 030000 Shanxi, China
| | - Peng-Cui Li
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, 030000 Shanxi, China
| | - Xiao-Chun Wei
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, 030000 Shanxi, China.
| | - Jun-Jun Shi
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, 030000 Shanxi, China
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12
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Xian Bo S, Chen W, Chang L, Hao Ran Y, Hui Hui G, Ya Kun Z, Wu Kun X, Hai Tao F, Wen Dan C. The Research Progress of Exosomes in Osteoarthritis, With Particular Emphasis on the Therapeutic Effect. Front Pharmacol 2022; 13:731756. [PMID: 35308214 PMCID: PMC8924513 DOI: 10.3389/fphar.2022.731756] [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: 06/28/2021] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
Exosomes participate in many physiological and pathological processes by regulating cell-to-cell communication. This affects the etiology and development of diseases, such as osteoarthritis (OA). Although exosomes in the OA tissue microenvironment are involved in the progression of OA, exosomes derived from therapeutic cells represent a new therapeutic strategy for OA treatment. Recent studies have shown that exosomes participate in OA treatment by regulating the proliferation, apoptosis, inflammation, and extracellular matrix synthesis of chondrocytes. However, studies in this field are scant. This review summarizes the therapeutic properties of exosomes on chondrocytes in OA and their underlying molecular mechanisms. We also discuss the challenges and prospects of exosome-based OA treatment.
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Affiliation(s)
- Shang Xian Bo
- Anhui Medical University, Hefei, China.,Second Hospital of Anhui Medical University, Hefei, China
| | - Wang Chen
- Anhui Medical University, Hefei, China.,Second Hospital of Anhui Medical University, Hefei, China
| | - Liu Chang
- Armed Police Corps Hospital of Anhui Province, Hefei, China
| | - Yu Hao Ran
- Second Hospital of Anhui Medical University, Hefei, China
| | - Guo Hui Hui
- Anhui Medical University, Hefei, China.,Second Hospital of Anhui Medical University, Hefei, China
| | - Zhu Ya Kun
- Fuyang Hospital of Anhui Medical University, Anhui, China
| | - Xie Wu Kun
- Second Hospital of Anhui Medical University, Hefei, China
| | - Fan Hai Tao
- Fuyang Hospital of Anhui Medical University, Anhui, China
| | - Cheng Wen Dan
- Second Hospital of Anhui Medical University, Hefei, China
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