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Venäläinen MS, Panula VJ, Eskelinen AP, Fenstad AM, Furnes O, Hallan G, Rolfson O, Kärrholm J, Hailer NP, Pedersen AB, Overgaard S, Mäkelä KT, Elo LL. Prediction of Early Adverse Events After THA: A Comparison of Different Machine-Learning Strategies Based on 262,356 Observations From the Nordic Arthroplasty Register Association (NARA) Dataset. ACR Open Rheumatol 2024; 6:669-677. [PMID: 39040016 PMCID: PMC11471944 DOI: 10.1002/acr2.11709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 04/20/2024] [Accepted: 06/08/2024] [Indexed: 07/24/2024] Open
Abstract
OBJECTIVE Preoperative risk prediction models can support shared decision-making before total hip arthroplasties (THAs). Here, we compare different machine-learning (ML) approaches to predict the six-month risk of adverse events following primary THA to obtain accurate yet simple-to-use risk prediction models. METHODS We extracted data on primary THAs (N = 262,356) between 2010 and 2018 from the Nordic Arthroplasty Register Association dataset. We benchmarked a variety of ML algorithms in terms of the area under the receiver operating characteristic curve (AUROC) for predicting the risk of revision caused by periprosthetic joint infection (PJI), dislocation or periprosthetic fracture (PPF), and death. All models were internally validated against a randomly selected test cohort (one-third of the data) that was not used for training the models. RESULTS The incidences of revisions because of PJI, dislocation, and PPF were 0.8%, 0.4%, and 0.3%, respectively, and the incidence of death was 1.2%. Overall, Lasso regression with stable iterative variable selection (SIVS) produced models using only four to five input variables but with AUROC comparable to more complex models using all 32 variables available. The SIVS-based Lasso models based on age, sex, preoperative diagnosis, bearing couple, fixation, and surgical approach predicted the risk of revisions caused by PJI, dislocations, and PPF, as well as death, with AUROCs of 0.61, 0.67, 0.76, and 0.86, respectively. CONCLUSION Our study demonstrates that satisfactory predictive potential for adverse events following THA can be reached with parsimonious modeling strategies. The SIVS-based Lasso models may serve as simple-to-use tools for clinical risk assessment in the future.
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Affiliation(s)
- Mikko S Venäläinen
- Turku University Hospital, University of Turku and Åbo Akademi University, Turku, Finland
| | | | - Antti P Eskelinen
- Coxa Hospital for Joint Replacement and University of Tampere, Tampere, Finland, and the Finnish Arthroplasty Register, Finnish Institute for Health and Welfare, Helsinki, Finland
| | | | - Ove Furnes
- Haukeland University Hospital and University of Bergen, Bergen, Norway
| | - Geir Hallan
- Haukeland University Hospital and University of Bergen, Bergen, Norway
| | - Ola Rolfson
- University of Gothenburg, Gothenburg, Sweden
| | | | | | - Alma B Pedersen
- Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | - Søren Overgaard
- Copenhagen University Hospital and University of Copenhagen, Copenhagen, Denmark
| | - Keijo T Mäkelä
- Turku University Hospital and University of Turku, Turku, Finland, and the Finnish Arthroplasty Register, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Laura L Elo
- University of Turku and Åbo Akademi University, Turku, Finland
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Cordero-Ampuero J, Velasco P, Payo-Rodríguez J, Peñalver-Andrada P, González-Fernández E. Ceramic-on-ceramic vs metal-on-crosslink polyethylene in a fully hydroxyapatite-coated total hip arthroplasty: Survivorship, complications and long-term results. J Clin Orthop Trauma 2024; 57:102555. [PMID: 39430648 PMCID: PMC11483472 DOI: 10.1016/j.jcot.2024.102555] [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: 08/30/2023] [Revised: 08/08/2024] [Accepted: 09/27/2024] [Indexed: 10/22/2024] Open
Abstract
Background Few studies compare complications and results in ceramic-ceramic (CeCe) vs metal-on-crosslink polyethylene (Me-XLPE) hip prosthesis. Methods Prospective, non-randomized, observational analysis of 2 series of hydroxyapatite-coated Furlong Active implanted with identical protocol by 1 surgeon in 1 hospital from 2006 to 2014. Bearing surface CeCe (Biolox Forte/Delta) in 35 cases of 53.7 ± 10.6 years (25-69) (21 males, 60 %), Me-XLPE in 65 of 69.0 ± 8.9 years (42-81) (36 males, 55 %); age was different (p < 0.00001), but not sex (p = 0.6565). Head diameter: 28 mm in 19, 32 mm in 9 and 36 mm in 7 CeCe hips; 28 mm in 63, 32 mm in 1 and 36 mm in 1 Me-XLPe hips. Follow-up 10.5 ± 3.1 years (1-15) in ceramic, 9.8 ± 3.8 years (2-15) in Me-XLPE. Results Survivorship without additional surgery or closed reduction at 15 years: 91.0 % in ceramic, 83.8 % in Me-XLPE joints. Survivorship without component exchange at 15 years: 93.9 % in ceramic, 93.6 % in Me-XLPE joints. Complications CeCe joints suffered 2 infections, 1 isolated dislocation, and 1 Vancouver-C fracture. Me-XLPE joints presented 2 infections (p = 0.6101), 5 isolated (p = 0.6621) and 2 recurrent dislocations (p = 0.5454), and 4 Vancouver-B fractures (p = 0.6548).At final follow-up, Harris Hip Score averaged 93.2 ± 13.7 (23-100) in ceramic and 94.3 ± 8.7 (65-100) in XLPE joints (p = 0.64552).Measured radiographic wear reached 0.06 ± 0.38 mm (0-1.5) (0.0057 mm/year) in CeCe and 0.16 ± 0.5 mm (0-2) (0.0163 mm/year) in Me-XLPE (p = 0.30302). At final radiographic follow-up, osteolysis was present in 8 Charnley-De Lee zones (6 patients) (17 %) of ceramic cups and in 25 zones (15 patients) (23 %) of XLPE cups (p = 0.980127). Conclusion At 10 years follow-up, metal-XLPE and ceramic-ceramic joints in Furlong-H-A.C. Active present no significant differences in complications, clinical score, wear, acetabular osteolysis, or survivorship without component exchange.Nevertheless, survivorship without any surgery or closed reduction is different because of the high rate of dislocation in 28 mm metal-poly joints.
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Affiliation(s)
- José Cordero-Ampuero
- Department of Orthopaedic Surgery, University Hospital La Princesa, c/ Diego de León 62, 28006, Madrid, Spain
- Medicine School, Universidad Autónoma de Madrid, c/ Arzobispo Morcillo s/n, Madrid, Spain
| | - Paula Velasco
- Department of Orthopaedic Surgery, University Hospital La Princesa, c/ Diego de León 62, 28006, Madrid, Spain
| | - Jorge Payo-Rodríguez
- Department of Orthopaedic Surgery, University Hospital La Princesa, c/ Diego de León 62, 28006, Madrid, Spain
| | - Pablo Peñalver-Andrada
- Department of Orthopaedic Surgery, University Hospital La Princesa, c/ Diego de León 62, 28006, Madrid, Spain
| | - Enrique González-Fernández
- Department of Orthopaedic Surgery, University Hospital La Princesa, c/ Diego de León 62, 28006, Madrid, Spain
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Wu T, Jiang Y, Shi W, Wang Y, Li T. Comparative postoperative prognosis of ceramic-on-ceramic and ceramic-on-polyethylene for total hip arthroplasty: an updated systematic review and meta-analysis. PeerJ 2024; 12:e18139. [PMID: 39346065 PMCID: PMC11438439 DOI: 10.7717/peerj.18139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 08/30/2024] [Indexed: 10/01/2024] Open
Abstract
Objective To compare the clinical outcomes between ceramic-on-ceramic (CoC) and ceramic-on-polyethylene (CoP) bearing surfaces in patients undergoing total hip arthroplasty (THA) through a pooled analysis and evidence update. Methods We performed a systematic literature search using PubMed, Embase, Cochrane Library and Web of Science up to March 2023 for studies that compared the bearing surfaces of CoC and CoP in patients undergoing THA. The primary outcomes were the incidence of common postoperative complications and the rate of postoperative revision. The secondary outcome was the Harris Hip Score. Results A total of 10 eligible studies involving 1,946 patients (1.192 CoC-THA versus 906 CoP-THA) were included in the evidence synthesis. Pooled analysis showed no significant difference in the rates of common postoperative complications (dislocation, deep vein thrombosis, infection, wear debris or osteolysis) and of revision. After eliminating heterogeneity, the postoperative Harris Hip Score was higher in the CoC group than in the CoP group. However, the strength of evidence was moderate for the Harris Hip Score. Conclusion CoC articulations are more commonly used in younger, healthier, and more active patients. While the performance of conventional polyethylene is indeed inferior to highly cross-linked polyethylene, there is currently a lack of sufficient research comparing the outcomes between highly cross-linked polyethylene and CoC bearing surfaces. This area should be a focal point for future research, and it is hoped that more relevant articles will emerge. Given the limited number of studies included, the heterogeneity and potential bias of those included in the analysis, orthopaedic surgeons should select a THA material based on their experience and patient-specific factors, and large multicentre clinical trials with >15 years of follow-up are needed to provide more evidence on the optimal bearing surface for initial THA.
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Affiliation(s)
- Tingyu Wu
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Yaping Jiang
- Department of Oral Implantology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Weipeng Shi
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Yingzhen Wang
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Tao Li
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
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Ward SA, Habibi AA, Ashkenazi I, Arshi A, Meftah M, Schwarzkopf R. Innovations in the Isolation and Treatment of Biofilms in Periprosthetic Joint Infection: A Comprehensive Review of Current and Emerging Therapies in Bone and Joint Infection Management. Orthop Clin North Am 2024; 55:171-180. [PMID: 38403364 DOI: 10.1016/j.ocl.2023.10.002] [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] [Indexed: 02/27/2024]
Abstract
Periprosthetic joint infections (PJIs) are a devastating complication of joint arthroplasty surgeries that are often complicated by biofilm formation. The development of biofilms makes PJI treatment challenging as they create a barrier against antibiotics and host immune responses. This review article provides an overview of the current understanding of biofilm formation, factors that contribute to their production, and the most common organisms involved in this process. This article focuses on the identification of biofilms, as well as current methodologies and emerging therapies in the management of biofilms in PJI.
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Affiliation(s)
- Spencer A Ward
- NYU Langone Orthopedic Hospital, NYU Langone Health, 301 East 17th Street, Room 1402, New York, NY 10003, USA
| | - Akram A Habibi
- NYU Langone Orthopedic Hospital, NYU Langone Health, 301 East 17th Street, Room 1402, New York, NY 10003, USA
| | - Itay Ashkenazi
- NYU Langone Orthopedic Hospital, NYU Langone Health, 301 East 17th Street, Room 1402, New York, NY 10003, USA
| | - Armin Arshi
- NYU Langone Orthopedic Hospital, NYU Langone Health, 301 East 17th Street, Room 1402, New York, NY 10003, USA
| | - Morteza Meftah
- NYU Langone Orthopedic Hospital, NYU Langone Health, 301 East 17th Street, Room 1402, New York, NY 10003, USA
| | - Ran Schwarzkopf
- NYU Langone Orthopedic Hospital, NYU Langone Health, 301 East 17th Street, Room 1402, New York, NY 10003, USA.
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Mödinger Y, Anttila ED, Baker GM, Gross DC, Porporati AA. Magnetic Resonance Safety Evaluation of a Novel Alumina Matrix Composite Ceramic Knee and Image Artifact Comparison to a Metal Knee Implant of Analogous Design. Arthroplast Today 2023; 22:101170. [PMID: 37521740 PMCID: PMC10374871 DOI: 10.1016/j.artd.2023.101170] [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: 05/22/2023] [Accepted: 06/08/2023] [Indexed: 08/01/2023] Open
Abstract
Background Image artifacts caused by metal knee implants in 1.5T and 3T magnetic resonance imaging (MRI) systems complicate imaging-based diagnosis of the peri-implant region after total knee arthroplasty. Alternatively, metal-free knee prostheses could effectively minimize MRI safety hazards and offer the potential for higher quality diagnostic images. Methods A novel knee arthroplasty device composed of BIOLOX delta, an alumina matrix composite (AMC) ceramic, was tested in a magnetic resonance (MR) environment. American Society for Testing and Materials test methods were used for evaluating magnetically induced displacement force, magnetically induced torque, radiofrequency-induced heating, and MR image artifact. Results Magnetically induced displacement force and magnetically induced torque results of the AMC ceramic knee indicated that these effects do not pose a known risk in a clinical MR environment, as assessed in a 3T magnetic field. Moreover, minimal radiofrequency-induced heating of the device was observed. In addition, the AMC ceramic knee demonstrated minimal MR image artifacts (7 mm) in comparison to a cobalt-chromium knee (88 mm). The extremely low magnetic susceptibility of AMC (2 ppm) underlines that it is a nonmetallic and nonmagnetic material well suited for the manufacturing of MR Safe orthopaedic implants. Conclusions The AMC ceramic knee is a novel metal-free total knee arthroplasty device that can be regarded as MR Safe, as suggested by the absence of hazards from the exposure of this implant to a MR environment. The AMC ceramic knee presents the advantage of being scanned with superior imaging results in 3T MRI systems compared to alternative metal implants on the market.
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Affiliation(s)
- Yvonne Mödinger
- Medical Products Division, CeramTec GmbH, Plochingen, Germany
| | | | | | | | - Alessandro A. Porporati
- Medical Products Division, CeramTec GmbH, Plochingen, Germany
- Department of Engineering and Architecture, University of Trieste, Trieste, Italy
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Lee YK, Ha YC, Won SJ, Kim JH, Park JW, Koo KH. Mid-term Results of Revision Total Hip Arthroplasty Using Delta Ceramic-on-Ceramic Bearing. Clin Orthop Surg 2023; 15:20-26. [PMID: 36778987 PMCID: PMC9880509 DOI: 10.4055/cios21192] [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: 11/08/2021] [Revised: 02/18/2022] [Accepted: 02/18/2022] [Indexed: 11/06/2022] Open
Abstract
Background Delta ceramic-on-ceramic (CoC) articulation affords excellent outcomes in primary total hip arthroplasty (THA). However, the safety and reliability of this bearing in revision THA need more evidence. This study aimed to report complications, radiological changes, clinical results, and survivorship of revision THA using Delta CoC articulation at minimum 5-year follow-up. Methods We reviewed 118 revision THAs (113 patients: 68 men and 45 women) performed with use of Delta CoC bearing. Their mean age was 58.7 years (range, 30-90 years) and their mean body mass index was 24.6 kg/m2 (range, 15.2-32.5 kg/m2). These patients were followed up for 5-12 years (mean, 7.2 years). We evaluated squeak, grinding sensation, ceramic fracture, dislocation, periprosthetic joint infection (PJI), periprosthetic fracture, prosthetic loosening, ceramic wear, osteolysis, modified Harris hip score (mHHS), and survivorship with any reoperation after the revision as the endpoint. Results Two patients (1.7%) had grinding sensation, but no patient had ceramic fracture. Reoperations were necessary in 9 hips (7.6%) due to PJIs in 2, stem loosening in 2, cup loosening in 2, recurrent dislocation in 2, and periprosthetic fracture in 1. No hip had measurable wear or osteolysis. The average mHHS improved from 53.3 points before the revision to 82.3 points at the final follow-up. Survivorship was 91.6% (95% confidence interval, 86.3%-96.9%) at 12 years. Conclusions The Delta ceramic bearing appeared a reliable option for revision THA, showing encouraging mid-term results with acceptable survivorship and a low complication rate.
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Affiliation(s)
- Young-Kyun Lee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Chung-Ang University Hospital, Seoul, Korea
| | - Samuel Jaeyoon Won
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jin-Hak Kim
- Department of Orthopaedic Surgery, Chung-Ang University Hospital, Seoul, Korea
| | - Jung-Wee Park
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyung-Hoi Koo
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
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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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Fang Y, Shang X. Comparison of Ceramic-on-Ceramic vs. Ceramic-on-Polyethylene for Primary Total Hip Arthroplasty: A Meta-Analysis of 15 Randomized Trials. Front Surg 2021; 8:751121. [PMID: 34977138 PMCID: PMC8716688 DOI: 10.3389/fsurg.2021.751121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 11/15/2021] [Indexed: 12/02/2022] Open
Abstract
Objective: This meta-analysis aimed to compare ceramic-on-ceramic (COC) components and ceramic-on-polyethylene (COP) components during total hip arthroplasty (THA). Settings: A meta-analysis of randomized controlled trials (RCTs) comparing COC and COP during primary THA was conducted. Electronic searches were current to March 2021. Participants: Trials were included for meta-analysis if they compared at least the bearing surfaces of COC and COP for patients undergoing primary THA and if they reported the outcomes of THA after a certain period of follow-up and only RCTs in English were included. Primary and Secondary Outcome Measures: The primary endpoints consist of audible noise, prosthesis fracture, and revision. Secondary endpoints include dislocation, deep infection, osteolysis, and prosthesis loosening. Extracted data were statistically analyzed with the Stata11.0. Results: A total of 15 RCTs containing 2,702 patients (2,813 hips) were included in this study. The audible noise [odds ratio (OR) = 5.919; 95% CI: 2.043, 17.146; p ≤ 0.001] and prosthesis fracture (OR = 35.768; 95% CI: 8.957, 142.836; p = 0.001) were significantly higher in the COC group. Hip function, revision rate, dislocation rate, deep infection rate, osteolysis rate, and prosthesis loosening rate were comparable between these two groups, while the wear rate was higher in the COP group. Conclusion: This study indicated comparable outcomes of COC and COP bearing surfaces in primary THA; high-quality RCTs with a long-term follow-up are still urgently needed to provide more evidence on the optimal bearing surfaces in primary THA.
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Affiliation(s)
- Yan Fang
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaobin Shang
- Department of Orthopaedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Dobria P, Patel A, Levine B. Catastrophic intraoperative failure of a ceramic femoral head. Arthroplast Today 2021; 11:234-238. [PMID: 34692961 PMCID: PMC8515067 DOI: 10.1016/j.artd.2021.08.017] [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: 06/23/2021] [Revised: 08/04/2021] [Accepted: 08/29/2021] [Indexed: 11/18/2022] Open
Abstract
Approximately 17 years after a primary metal-on-metal total hip arthroplasty, a 59-year-old female developed pain, swelling, and weakness in her right hip accompanied by laboratory findings and imaging suggestive of an adverse local tissue reaction. Acetabular revision was performed to upsize the femoral head and improve hip stability. Upon impaction of the new, non-option ceramic femoral head onto the unsleeved retained stem, the head split into two pieces without fragmentation. The surgery was completed using a cobalt-chromium head, which was impacted without issue onto the stem’s taper. Although BIOLOX delta femoral heads do not require titanium sleeves, we believe that careful consideration should be given to their use in revision total hip arthroplasty with ceramic heads, regardless of the extent of trunnion damage noted intraoperatively.
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Affiliation(s)
- Paul Dobria
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
- Corresponding author. 3333 Green Bay Rd, North Chicago, IL 60064, USA. Tel.: +1 773 750 1369.
| | - Arpan Patel
- Department of Orthopedics, Rush University Medical Center, Chicago, IL, USA
| | - Brett Levine
- Department of Orthopedics, Rush University Medical Center, Chicago, IL, USA
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Holleyman RJ, Critchley RJ, Mason JM, Jameson SS, Reed MR, Malviya A. Ceramic Bearings Are Associated With a Significantly Reduced Revision Rate in Primary Hip Arthroplasty: An Analysis From the National Joint Registry for England, Wales, Northern Ireland, and the Isle of Man. J Arthroplasty 2021; 36:3498-3506. [PMID: 34238620 DOI: 10.1016/j.arth.2021.05.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/11/2021] [Accepted: 05/13/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Prosthetic joint infection (PJI) is a devastating complication. Studies have suggested reduction in PJI with the use of ceramic bearings. METHODS Adult patients who underwent total hip arthroplasty (THA) using an uncemented acetabular component with ceramic-on-ceramic (CoC), ceramic-on-polyethylene (CoP), or metal-on-polyethylene (MoP) bearing surfaces between 2002 and 2016 were extracted from the National Joint Registry for England, Wales, Northern Ireland, and the Isle of Man. A competing risk regression model to investigate predictors of each revision outcome was used. Time-to-event was determined by duration of implantation since primary surgery with competing risks being death or revision. The results were adjusted for age, gender, American Association of Anaesthesiologists grade, body mass index, surgical indication, intraoperative complications, and implant data. RESULTS In total, 456,457 THAs (228,786 MoP, 128,403 CoC, and 99,268 CoP) were identified. Multivariable modeling showed that the risk of revision for PJI was significantly lower with CoC (risk ratio 0.748, P < .001) and CoP (risk ratio 0.775, P < .001) compared to MoP. Significant reduction in risk of aseptic and all-cause revision was also seen. The significant protective effect of ceramic bearing was predominantly seen 2 years after implantation. Aseptic revision beyond 2 years reduced by 18.1% and 24.8% for CoC and CoP (P < .001), respectively. All-cause revision rate beyond 2 years reduced by 21.6% for CoC and 27.1% for CoP (P < .001) CONCLUSION: This study demonstrates an association between the use of ceramic as part of the bearing, with lower rates of revision for all causes, revision for infection, and revision for aseptic causes, supporting ceramic bearings in THA.
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Affiliation(s)
- Richard J Holleyman
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Rebecca J Critchley
- Northumbria Healthcare NHS Foundation Trust, Wansbeck General Hospital, Ashington, United Kingdom
| | - James M Mason
- Centre for Heath Economics at Warwick, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Simon S Jameson
- The James Cook University Hospital, Middlesbrough, United Kingdom
| | - Mike R Reed
- Northumbria Healthcare NHS Foundation Trust, Wansbeck General Hospital, Ashington, United Kingdom
| | - Ajay Malviya
- Northumbria Healthcare NHS Foundation Trust, Wansbeck General Hospital, Ashington, United Kingdom; Newcastle University, Newcastle upon Tyne, United Kingdom
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Ren X, Ling L, Qi L, Liu Z, Zhang W, Yang Z, Wang W, Tu C, Li Z. Patients' risk factors for periprosthetic joint infection in primary total hip arthroplasty: a meta-analysis of 40 studies. BMC Musculoskelet Disord 2021; 22:776. [PMID: 34511099 PMCID: PMC8436433 DOI: 10.1186/s12891-021-04647-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 08/21/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Periprosthetic joint infection (PJI) is a catastrophic complication after total hip arthroplasty (THA). Our meta-analysis aimed to identify the individual-related risk factors that predispose patients to PJI following primary THA. METHODS Comprehensive literature retrieval from Pubmed, Web of Science, and the Cochrane Library was performed from inception to Feb 20th, 2021. Patient-related risk factors were compared as per the modifiable factors (BMI, smoke and alcohol abuse), non-modifiable factors (gender, age), and medical history characteristics, such as diabetes mellitus (DM), avascular necrosis (AVN) of femoral head, femoral neck fracture, rheumatoid arthritis (RA), cardiovascular disease (CVD), and osteoarthritis (OA) etc. The meta-analysis was applied by using risk ratios with 95% corresponding intervals. Sensitivity analysis and publication bias were performed to further assess the credibility of the results. RESULTS Overall, 40 studies with 3,561,446 hips were enrolled in our study. By implementing cumulative meta-analysis, higher BMI was found associated with markedly increased PJI risk after primary THA [2.40 (2.01-2.85)]. Meanwhile, medical characteristics including DM [1.64 (1.25-2.21)], AVN [1.65 (1.07-2.56)], femoral neck fracture [1.75 (1.39-2.20)], RA [1.37 (1.23-1.54)], CVD [1.34 (1.03-1.74)], chronic pulmonary disease (CPD) [1.22 (1.08-1.37)], neurological disease [1.19 (1.05-1.35)], opioid use [1.53 (1.35-1.73)] and iron-deficiency anemia (IDA) [1.15 (1.13-1.17)] were also significantly correlated with higher rate of PJI. Conversely, dysplasia or dislocation [0.65 (0.45-0.93)], and OA [0.70 (0.62-0.79)] were protective factors. Of Note, female gender was protective for PJI only after longer follow-up. Besides, age, smoking, alcohol abuse, previous joint surgery, renal disease, hypertension, cancer, steroid use and liver disease were not closely related with PJI risk. CONCLUSION Our finding suggested that the individual-related risk factors for PJI after primary THA included high BMI, DM, AVN, femoral neck fracture, RA, CVD, CPD, neurological disease, opioid use and IDA, while protective factors were female gender, dysplasia/ dislocation and OA.
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Affiliation(s)
- Xiaolei Ren
- Department of Orthopaedics, Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
| | - Lin Ling
- Department of Orthopaedics, Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
| | - Lin Qi
- Department of Orthopaedics, Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
| | - Zhongyue Liu
- Department of Orthopaedics, Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
| | - Wenchao Zhang
- Department of Orthopaedics, Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
| | - Zhimin Yang
- Department of Orthopaedics, Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
| | - Wanchun Wang
- Department of Orthopaedics, Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
| | - Chao Tu
- Department of Orthopaedics, Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China.
| | - Zhihong Li
- Department of Orthopaedics, Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China.
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Khalifa AA, Bakr HM, Farouk OA. Biomaterials and technologies in the management of periprosthetic infection after total hip arthroplasty: An updated review. JOURNAL OF MUSCULOSKELETAL SURGERY AND RESEARCH 2021; 5:142-151. [DOI: 10.25259/jmsr_51_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Although total hip arthroplasty (THA) is considered one of the most efficacious procedures for managing various hip conditions, failures due to different mechanisms are still being reported. Periprosthetic joint infection (PJI) is one of the devastating causes of failure and revision of THA. PJI carries a burden on the patient, the surgeon, and the health-care system. The diagnosis and management of PJIs carry many morbidities and increased treatment costs. The development of PJI is multifactorial, including issues related to the patient’s general condition, the surgeon’s efficiency, surgical technique, and the implants used. Recent advances in the area of diagnosis and predicting PJI as well as introducing new technologies and biomaterials update for the prevention and treatment of PJI. Local implant coatings, advancement in the bearing surfaces technologies, and new technologies such as immunotherapy and bacteriophage therapy were introduced and suggested as contemporary PJI eradication solutions. In this review, we aimed at discussing some of the newly introduced materials and technologies for the sake of PJI control.
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Affiliation(s)
- Ahmed A. Khalifa
- Department of Orthopedics, Qena Faculty of Medicine and University Hospital, South Valley University, Qena, Egypt
| | - Hatem M. Bakr
- Department of Orthopedics and Traumatology, Assiut University Hospital, Assiut, Egypt,
| | - Osama A. Farouk
- Department of Orthopedics and Traumatology, Assiut University Hospital, Assiut, Egypt,
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Lucchini S, Castagnini F, Giardina F, Tentoni F, Masetti C, Tassinari E, Bordini B, Traina F. Cementless ceramic-on-ceramic total hip arthroplasty in post-traumatic osteoarthritis after acetabular fracture: long-term results. Arch Orthop Trauma Surg 2021; 141:683-691. [PMID: 33417021 DOI: 10.1007/s00402-020-03711-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 12/06/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Total hip arthroplasty (THA) is the standard procedure for post-traumatic osteoarthritis (OA) of the hip after acetabular fracture. However, it is not as simple as a primary THA, challenging the surgeon with anatomical deformity and intra and postoperative complications. In the current literature, there is a lack of studies reporting long-term results. May ceramic-on-ceramic (CoC) bearings provide good clinical and radiological outcomes at a long-term follow-up in patients undergoing THA following acetabular fracture? MATERIALS AND METHODS We retrospectively analyzed 68 patients (mean age 47 years [range 22-75)] who underwent cementless modular neck stem THA, all implants CoC bearings (50 previously operatively treated and 18 non-operatively treated) after a specific CT study protocol at our Institute since 2000-2008. Clinical outcomes, prosthetic components' osseointegration, survival rate, and reasons for revision were analyzed. Minimum clinical and radiological follow-up was 10 years. RESULTS HHS improved significantly after surgery from 37.6 ± 14.1 to 88.4 ± 11.6. 8 revision surgeries were performed, none for infection: we reported 2 stem aseptic loosening, 2 periprosthetic femoral fractures and 4 modular neck fractures. One implant noise (third-generation ceramic coupling) was described. Cup osseointegration was present (according to Moore the presence of at least 3 radiological criteria defines an effective osseointegration) in 67 patients (98.5%). After a 10 years follow-up, survival rate resulted 88.4%, sensibly higher than most of results reported in the current literature. CONCLUSION The high survival rate may be related to CoC: no osteolysis and no infections were reported. Also acetabular cup loosening incidence was sensibly lower (1.47%) among loosening rate described by other authors. Clinical and radiological outcomes were decent, probably due to modular prosthesis design. Modular necks are a solution which can help achieving a proper functional reconstruction of the hip (offset, center of rotation), but should be avoided in young and overweight patients because of the high risk of fracture. CoC bearings in THAs in post-traumatic OA after acetabular fracture showed good results despite the fact that specific ceramic-related issues have to be considered.
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Affiliation(s)
- Stefano Lucchini
- Orthopaedic-Traumatology and Prosthetic Surgery and Revisions of Hip and Knee, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy.
| | - Francesco Castagnini
- Orthopaedic-Traumatology and Prosthetic Surgery and Revisions of Hip and Knee, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - Federico Giardina
- Orthopaedic-Traumatology and Prosthetic Surgery and Revisions of Hip and Knee, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - Francesco Tentoni
- Orthopaedic-Traumatology and Prosthetic Surgery and Revisions of Hip and Knee, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - Claudio Masetti
- Orthopaedic-Traumatology and Prosthetic Surgery and Revisions of Hip and Knee, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - Enrico Tassinari
- Orthopaedic-Traumatology and Prosthetic Surgery and Revisions of Hip and Knee, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - Barbara Bordini
- Medical Technology Laboratory, Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10-1/13, 40136, Bologna, Italy
| | - Francesco Traina
- Orthopaedic-Traumatology and Prosthetic Surgery and Revisions of Hip and Knee, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
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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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Grimberg AW, Grupp TM, Elliott J, Melsheimer O, Jansson V, Steinbrück A. Ceramic Coating in Cemented Primary Total Knee Arthroplasty is Not Associated With Decreased Risk of Revision due to Early Prosthetic Joint Infection. J Arthroplasty 2021; 36:991-997. [PMID: 33012599 DOI: 10.1016/j.arth.2020.09.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/31/2020] [Accepted: 09/08/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Prosthetic joint infection (PJI) is one of the most frequent and devastating causes of short-term revision total knee arthroplasty (TKA). In vitro evidence suggests ceramic surfaces demonstrate resistance to biofilm, but the clinical effect of bearing surface modifications on the risk of PJI remains unclear. This premier registry-based study examines the influence of ceramic bearing surface coatings on the outcome in cemented primary TKA. METHODS In total, 117,660 cemented primary TKAs in patients with primary osteoarthritis recorded in the German arthroplasty registry since 2012 were followed up for a maximum of 3 years. The primary endpoint was risk of revision for PJI on ceramic coated and uncoated cobalt-chromium-molybdenum femoral components. Propensity score matching for age, gender, obesity, diabetes mellitus, depression and Elixhauser comorbidity index, and substratification on common design twins with and without coating was performed. RESULTS In total, 4637 TKAs (85.1% female) with a ceramic-coated femoral component were identified, 42 had been revised for PJI and 122 for other reasons at 3 years. No survival advantage due to the risk of revision for PJI could be determined for ceramic-coated components. Revision for all other reasons demonstrated a significant higher rate for TKAs with ceramic-coated components. However, the results of this were confounded by a strong prevalence (20.7% vs 0.3%) of metal sensitivity in the ceramic-coated group. CONCLUSION No evidence of reduced risk for PJI due to ceramic-coated implants in cemented primary TKA was found. Further analysis for revision reasons other than PJI is required.
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Affiliation(s)
- Alexander W Grimberg
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Munich, Germany; German Arthroplasty Registry (EPRD Deutsche Endoprothesenregister gGmbH), Berlin, Germany
| | - Thomas M Grupp
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Munich, Germany; German Arthroplasty Registry (EPRD Deutsche Endoprothesenregister gGmbH), Berlin, Germany
| | - Johanna Elliott
- German Arthroplasty Registry (EPRD Deutsche Endoprothesenregister gGmbH), Berlin, Germany; Department of Orthopaedic Surgery and Traumatology, St Vinzenz Hospital, Dinslaken, Germany
| | - Oliver Melsheimer
- German Arthroplasty Registry (EPRD Deutsche Endoprothesenregister gGmbH), Berlin, Germany
| | - Volkmar Jansson
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Munich, Germany; German Arthroplasty Registry (EPRD Deutsche Endoprothesenregister gGmbH), Berlin, Germany
| | - Arnd Steinbrück
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Munich, Germany; German Arthroplasty Registry (EPRD Deutsche Endoprothesenregister gGmbH), Berlin, Germany; Orthopaedic Surgical Competence Center Augsburg (OCKA), Augsburg, Germany
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Kretzer JP, Uhler M, Jäger S, Bormann T, Sonntag R, Schonhoff M, Schröder S. [Tribology in hip arthroplasty : Benefits of different materials]. DER ORTHOPADE 2021; 50:259-269. [PMID: 33630110 DOI: 10.1007/s00132-021-04077-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/01/2021] [Indexed: 11/30/2022]
Abstract
When it comes to total hip replacements, choosing the suitable material combination is of clinical relevance. The present review article examines the technical differences in wear and corrosion of the relevant material combinations of ceramics, metals, ceramized metals and various types of polyethylene. The material characteristics, which were often tested under standardized conditions in the laboratory, are compared with clinical results on the basis of evidence-graded clinical studies and on the basis of register studies. This article thus represents an up-to-date snapshot of the expectations and actual clinical outcomes of the present choice of material combinations. It shows that some tendencies from the field of materials research, e.g. with regard to cross-linked polyethylene, coincide with observations from practical clinical experience, while for other materials, a proven technical superiority has not yet been confirmed as an evident advantage in clinical practice.
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Affiliation(s)
- J Philippe Kretzer
- Klinik für Orthopädie und Unfallchirurgie, Labor für Biomechanik und Implantatforschung, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland.
| | - Maximilian Uhler
- Klinik für Orthopädie und Unfallchirurgie, Labor für Biomechanik und Implantatforschung, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| | - Sebastian Jäger
- Klinik für Orthopädie und Unfallchirurgie, Labor für Biomechanik und Implantatforschung, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| | - Therese Bormann
- Klinik für Orthopädie und Unfallchirurgie, Labor für Biomechanik und Implantatforschung, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| | - Robert Sonntag
- Klinik für Orthopädie und Unfallchirurgie, Labor für Biomechanik und Implantatforschung, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| | - Mareike Schonhoff
- Klinik für Orthopädie und Unfallchirurgie, Labor für Biomechanik und Implantatforschung, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| | - Stefan Schröder
- Klinik für Orthopädie und Unfallchirurgie, Labor für Biomechanik und Implantatforschung, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
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Prevention of Periprosthetic Joint Infection (PJI): A Clinical Practice Protocol in High-Risk Patients. Trop Med Infect Dis 2020; 5:tropicalmed5040186. [PMID: 33322463 PMCID: PMC7768381 DOI: 10.3390/tropicalmed5040186] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 12/04/2020] [Accepted: 12/05/2020] [Indexed: 02/07/2023] Open
Abstract
Background: Periprosthetic joint infection (PJI) represents 25% of failed total knee arthroplasties (TKA). The European Knee Associates (EKA) formed a transatlantic panel of experts to perform a literature review examining patient-related risk factors with the objective of producing perioperative recommendations in PJI high-risk patients. Methods: Multiple databases (Pubmed/MEDLINE, EMBASE, Scopus, Cochrane Library) and recommendations on TKA PJI prevention measures from the International Consensus Meetings on PJI from the AAOS and AAHKS were reviewed. This represents a Level IV study. Results: Strong evidence was found on poor glycemic control, obesity, malnutrition, and smoking being all associated with increased rates of PJI. In the preoperative period, patient optimization is key: BMI < 35, diet optimization, Hemoglobin A1c < 7.5, Fructosamine < 292 mmol/L, smoking cessation, and MRSA nasal screening all showed strong evidence on reducing PJI risk. Intraoperatively, a weight-based antibiotic prophylaxis, accurate fluid resuscitation, betadine and chlorhexidine dual skin preparation, diluted povidone iodine solution irrigation, tranexamic acid administration, and monofilament barbed triclosan-coated sutures for soft tissues closure all represented effective prevention measures. In the postoperative period, failure to reach normalization of ESR, CRP, D-dimer, and IL-6 six weeks postoperatively suggested early PJI. Conclusion: The current recommendations from this group of experts, based on published evidence, support risk stratification to identify high-risk patients requiring implementation of perioperative measures to reduce postoperative PJI.
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Abstract
Rates of peri-prosthetic joint infection (PJI) in primary total hip and total knee arthroplasty range between 0.3% and 1.9%, and up to 10% in revision cases. Significant morbidity is associated with this devastating complication, the economic burden on our healthcare system is considerable, and the personal cost to the affected patient is immeasurable. The risk of surgical site infection (SSI) and PJI is related to surgical factors and patient factors such as age, body mass index (BMI), co-morbidities, and lifestyle. Reducing the risk of SSI in primary hip and knee arthroplasty requires a multi-faceted strategy including pre-operative patient bacterial decolonization, screening and avoidance of anaemia, peri-operative patient warming, skin antisepsis, povidone-iodine wound lavage, and anti-bacterial coated sutures. This article also considers newer concepts such as the influence of bearing surfaces on infection risk, as well as current controversies such as the potential effects of blood transfusion, laminar flow, and protective hoods and suits, on infection risk.
Cite this article: EFORT Open Rev 2020;5:604-613. DOI: 10.1302/2058-5241.5.200004
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Affiliation(s)
- Philip F Dobson
- Trauma and Orthopaedic Surgery, Royal Victoria Infirmary, Newcastle, UK
| | - Michael R Reed
- Trauma and Orthopaedic Surgery, Royal Victoria Infirmary, Newcastle, UK
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Castagnini F, Bordini B, Biondi F, Cosentino M, Stea S, Traina F. Mixed ceramic combinations in primary total hip arthroplasty achieved reassuring mid-to-longterm outcomes. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2020; 31:56. [PMID: 32594253 DOI: 10.1007/s10856-020-06393-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 06/15/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Ceramic-on-ceramic couplings demonstrated to be reliable bearings in primary total hip arthroplasty (THA), with long-term remarkable results. Like-on-like configurations were widely described. On the contrary, mixed material combinations from the same manufacturer, Delta-on-Forte or Forte-on-Delta, were poorly studied. In particular, it is unknown whether mixed ceramic combinations are more at risk of ceramic fractures. Thus, a registry study was conducted to investigate the long-term survival rates and reasons for revision of mixed ceramic combinations. A comparison with Delta-on-Delta couplings was also performed. MATERIALS AND METHODS The regional arthroplasty registry RIPO was enquired about three cohorts of ceramic bearings (head-on-liner: Delta-on-Forte, Forte-on-Delta, Delta-on-Delta). Demographics, survival rates and reasons for revision were evaluated and compared. RESULTS In total, 346 (1.5%) implants had a Delta-on-Forte coupling (mean follow-up: 6.4 years). In total, 1163 (5%) THAs had a Forte-on-Delta articulation (mean follow-up: 8.2 years). Delta-on-Delta surfaces were implanted in 21,874 (93.5%) hips (mean follow-up: 3.9 years). Mixed material combinations were implanted between 2003 and 2007. The survival rates of the three cohorts were similar and were higher than 95% at 10 years. In Forte-on-Delta group, four liners failed (0.3% of the implants), whereas ceramic fractures occurred in 15 cases (0.1%) in Delta-on-Delta couplings (3 heads and 12 liners). Considering ceramic fracture as endpoint, there was no significant difference between the three survival rates. CONCLUSIONS Mixed ceramic bearing configurations from the same manufacturer in primary THA showed mid-to-longterm dependable outcomes, not inferior to the most recent like-on-like ceramic bearings. No additional risks of ceramic fractures were evident. Thus, closer follow-ups are not required.
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Affiliation(s)
- Francesco Castagnini
- Ortopedia-Traumatologia e Chirurgia protesica e dei reimpianti d'anca e di ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, Bologna, 40136, Italy.
| | - Barbara Bordini
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, Bologna, 40136, Italy
| | - Federico Biondi
- Ortopedia-Traumatologia e Chirurgia protesica e dei reimpianti d'anca e di ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, Bologna, 40136, Italy
| | - Monica Cosentino
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, Bologna, 40136, Italy
| | - Susanna Stea
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, Bologna, 40136, Italy
| | - Francesco Traina
- Ortopedia-Traumatologia e Chirurgia protesica e dei reimpianti d'anca e di ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, Bologna, 40136, Italy
- DIBINEM, University of Bologna, Bologna, Italy
- University of Messina, Messina, Italy
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Castagnini F, Bordini B, Tassinari E, Stea S, Ancarani C, Traina F. Delta-on-Delta Ceramic Bearing Surfaces in Revision Hip Arthroplasty. J Arthroplasty 2019; 34:2065-2071. [PMID: 31160152 DOI: 10.1016/j.arth.2019.04.068] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/24/2019] [Accepted: 04/29/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Fourth-generation ceramic-on-ceramic couplings were developed to improve ceramic toughness and strength. Encouraging outcomes in primary total hip arthroplasty were reported. This coupling was proposed as an attractive option even in the case of revision procedures, particularly in younger patients with a longer life expectancy. However, the pertinent literature is scarce. Thus, a registry study was conducted to investigate the midterm survival rates and reasons for re-revision of the fourth-generation ceramic-on-ceramic bearing surfaces in revision hip arthroplasties. METHODS A total of 327 revision implants (all the components were exchanged) with BIOLOX Delta couplings were investigated using the regional orthopedic registry RIPO. The demographics, the survival rates, and the reasons for re-revision were assessed. Revisions with bearings other than Delta were compared. RESULTS Delta bearings achieved a survival rate of 90.5% at 7 years, with stable results. Twenty-six (8%) re-revisions occurred at a mean follow-up of 4.1 years. And 2.8% of the re-revisions were due to recurrent dislocations; 1.5% of the cases were due to cup aseptic loosening. Septic loosening occurred in 1.6% of the cases. No ceramic fractures were reported. When compared to revisions with bearings other than Delta-on-Delta, Delta coupling cohort achieved similar performances at 5 and 7 years. Lower, nonsignificant rates of aseptic and septic loosening were reported in Delta cohort. CONCLUSION Delta-on-Delta couplings demonstrated to be reliable bearing surfaces in revision settings at a midterm follow-up. Clinical studies and longer follow-ups are required to investigate potential adverse effects, like squeaking and fractures, and confirm these preliminary findings. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Francesco Castagnini
- Ortopedia-Traumatologia e Chirurgia protesica e dei reimpianti d'anca e di ginocchio, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Barbara Bordini
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Enrico Tassinari
- Ortopedia-Traumatologia e Chirurgia protesica e dei reimpianti d'anca e di ginocchio, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Susanna Stea
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Cristina Ancarani
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Francesco Traina
- Ortopedia-Traumatologia e Chirurgia protesica e dei reimpianti d'anca e di ginocchio, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Solarino G, Zagra L, Piazzolla A, Morizio A, Vicenti G, Moretti B. Results of 200 Consecutive Ceramic-on-Ceramic Cementless Hip Arthroplasties in Patients Up To 50 Years of Age: A 5-24 Years of Follow-Up Study. J Arthroplasty 2019; 34:S232-S237. [PMID: 30777621 DOI: 10.1016/j.arth.2019.01.057] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 01/02/2019] [Accepted: 01/24/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Ceramic-on-ceramic (CoC) bearings due to their mechanical properties can be used in primary total hip arthroplasty (THA) especially in young patients requiring a long-lasting implant. The goal of this study is to analyze the results of a series of 200 consecutive CoC THAs in patients aged 50 years or less at the time of surgery. METHODS A retrospective study was conducted on the first 200 consecutive CoC arthroplasties performed using the direct lateral approach on 105 females and 81 males (14 bilateral cases) with an average age of 44.2 (16-50) years. The diagnosis was primary or post-traumatic osteoarthritis in 94 cases, avascular necrosis of the femoral head in 47, displaced intracapsular femoral neck fracture in 29, osteoarthritis secondary to developmental dysplasia of the hip/Legg-Calvè-Perthes disease/slipped capital femoral epiphysis in 20, and rheumatic diseases in 10 cases. The preoperative Harris Hip Score was 32.5 on average (range 15-55). All the implants were cementless. In 177 THAs the coupling was alumina-on-alumina, and in 23 cases the coupling was AMC-on-AMC (alumina matrix composite). RESULTS Twenty-five patients with 28 THAs were lost at the final follow-up, 2 stems were revised due to subsidence, 1 cup was revised due to malposition, 1 femoral head was changed because of impingement, and 1 THA was revised for periprosthetic infection. Three patients sustained a Vancouver B1 periprosthetic femoral fracture. At the final follow-up (mean 14.9 years; minimum 5 years to maximum 24 years), 172 THAs were eligible for clinical and radiographic evaluation: none was revised for wear and/or breakage of the ceramic components. Harris Hip Score rose up to a mean value of 90.1 (52-100). CONCLUSION The present report demonstrates that CoC coupling offers excellent long-term results in THA performed in young patients with very low wear and no adverse effects caused by the material.
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Affiliation(s)
- Giuseppe Solarino
- Department of Basic Medical Sciences, Neuroscience and Organs of Sense, School of Medicine, AOU Policlinico Consorziale, Università di Bari "Aldo Moro", Bari, Italy
| | - Luigi Zagra
- Hip Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Andrea Piazzolla
- Department of Basic Medical Sciences, Neuroscience and Organs of Sense, School of Medicine, AOU Policlinico Consorziale, Università di Bari "Aldo Moro", Bari, Italy
| | - Arcangelo Morizio
- Department of Basic Medical Sciences, Neuroscience and Organs of Sense, School of Medicine, AOU Policlinico Consorziale, Università di Bari "Aldo Moro", Bari, Italy
| | - Giovanni Vicenti
- Department of Basic Medical Sciences, Neuroscience and Organs of Sense, School of Medicine, AOU Policlinico Consorziale, Università di Bari "Aldo Moro", Bari, Italy
| | - Biagio Moretti
- Department of Basic Medical Sciences, Neuroscience and Organs of Sense, School of Medicine, AOU Policlinico Consorziale, Università di Bari "Aldo Moro", Bari, Italy
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