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Schreiner MM, Straub J, Apprich S, Staats K, Windhager R, Aletaha D, Böhler C. The influence of biological DMARDs on aseptic arthroplasty loosening: a retrospective cohort study. Rheumatology (Oxford) 2024; 63:970-976. [PMID: 37402609 PMCID: PMC10986799 DOI: 10.1093/rheumatology/kead304] [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: 02/11/2023] [Revised: 05/21/2023] [Accepted: 06/08/2023] [Indexed: 07/06/2023] Open
Abstract
OBJECTIVE To investigate whether biological DMARDs affect the risk of aseptic loosening after total hip/knee arthroplasty (THA/TKA) in patients with RA. METHODS We retrospectively identified all patients suffering from RA who underwent THA/TKA at our academic centre between 2002 and 2015 and linked them with an existing prospective observational RA database at our institution. The risk of aseptic loosening was estimated using radiological signs of component loosening (RCL). A time-dependent Cox regression analysis was used to compare the risk of implant loosening between patients treated with traditional DMARDS and biological DMARDs, or alternately both over time. RESULTS A total of 155 consecutive total joint arthroplasties (TJAs) (103 TKA vs 52 THA) was retrospectively included in the study. Mean age at implantation was 59 ± 13 years. Mean follow-up time was 69 ± 43 months. Overall, 48 (31%) TJAs showed signs of RCL, with 28 (27.2%) RCLs occurring after TKA compared with 20 after THA (38.5%). A significant difference regarding the incidence of RCL between the traditional DMARDs group (39 cases of RCL, 35%) and the biological DMARDs group (nine cases of RCL, 21%) (P = 0.026) was observed using the log-rank test. This was also true when using a time-dependent Cox regression with therapy as well as arthroplasty location (hip vs knee) as variables (P = 0.0447). CONCLUSION Biological DMARDs may reduce the incidence of aseptic loosening after TJA in patients with RA compared with traditional DMARDs. This effect seems to be more pronounced after TKA than THA.
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Affiliation(s)
- Markus M Schreiner
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Jennifer Straub
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Sebastian Apprich
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Kevin Staats
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Reinhard Windhager
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Daniel Aletaha
- Department of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Christoph Böhler
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
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Pan B, Zhang Z, Wu X, Xian G, Hu X, Gu M, Zheng L, Li X, Long L, Chen W, Sheng P. Macrophages-derived exosomes modulates wear particle-induced osteolysis via miR-3470b targeting TAB3/NF-κB signaling. Bioact Mater 2023; 26:181-193. [PMID: 36911207 PMCID: PMC9999169 DOI: 10.1016/j.bioactmat.2023.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 02/25/2023] [Accepted: 02/25/2023] [Indexed: 03/07/2023] Open
Abstract
Image 1.
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Key Words
- APL, Aseptic prothesis loosening
- Aseptic prothesis loosening
- Bglap, Osteocalcin
- CTSK, Cathepsin K
- Exosome
- Inflammatory osteolysis
- Macrophage
- NF-κB, nuclear factor kappa-light-chain-enhancer of activated B cells
- NFATc-1, Nuclear factor of activated T-cells, cytoplasmic 1
- Non-coding RNA
- OB, Osteoblast
- OC, Osteoclast
- P-P65, phospho-P65
- P65, NF-κB signaling
- Runx2, Runt-related transcription factor 2
- TAB3, TGF-β-activated kinase 1 (MAP3K7) binding protein 3
- ncRNA, non-coding RNA
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Affiliation(s)
- Baiqi Pan
- Department of Joint Surgery, The First Affiliated Hospital of Sun Yat-sen University, China.,Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology, The First Affiliated Hospital of Sun Yat-Sen University, China
| | - Ziji Zhang
- Department of Joint Surgery, The First Affiliated Hospital of Sun Yat-sen University, China.,Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology, The First Affiliated Hospital of Sun Yat-Sen University, China
| | - Xiaoyu Wu
- Department of Joint Surgery, The First Affiliated Hospital of Sun Yat-sen University, China.,Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology, The First Affiliated Hospital of Sun Yat-Sen University, China
| | - Guoyan Xian
- Department of Joint Surgery, The First Affiliated Hospital of Sun Yat-sen University, China.,Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology, The First Affiliated Hospital of Sun Yat-Sen University, China.,Université de Paris, CNRS, INSERM, B3OA, Paris, France
| | - Xuantao Hu
- Department of Joint Surgery, The First Affiliated Hospital of Sun Yat-sen University, China.,Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology, The First Affiliated Hospital of Sun Yat-Sen University, China
| | - Minghui Gu
- Department of Joint Surgery, The First Affiliated Hospital of Sun Yat-sen University, China.,Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology, The First Affiliated Hospital of Sun Yat-Sen University, China
| | - Linli Zheng
- Department of Joint Surgery, The First Affiliated Hospital of Sun Yat-sen University, China.,Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology, The First Affiliated Hospital of Sun Yat-Sen University, China
| | - Xiang Li
- Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology, The First Affiliated Hospital of Sun Yat-Sen University, China.,Department of Spine Surgery, The first affiliated hospital of Sun Yat-sen University, China
| | - Lingli Long
- Research Center of Translational Medicine, The First Affiliated Hospital of Sun Yat-sen University, China
| | - Weishen Chen
- Department of Joint Surgery, The First Affiliated Hospital of Sun Yat-sen University, China.,Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology, The First Affiliated Hospital of Sun Yat-Sen University, China
| | - Puyi Sheng
- Department of Joint Surgery, The First Affiliated Hospital of Sun Yat-sen University, China.,Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology, The First Affiliated Hospital of Sun Yat-Sen University, China
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Di Laura A, Henckel J, Hart A. Custom 3D-Printed Implants for Acetabular Reconstruction: Intermediate-Term Functional and Radiographic Results. JB JS Open Access 2023; 8:JBJSOA-D-22-00120. [PMID: 37197697 PMCID: PMC10184995 DOI: 10.2106/jbjs.oa.22.00120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/19/2023] Open
Abstract
The management of massive acetabular defects at the time of revision hip surgery is challenging. Severe pelvic bone loss and the heterogeneity and quality of the remaining bone stock can compromise the fixation and mechanical stability of the implant. Methods We reviewed a database of consecutive patients who had undergone acetabular reconstruction with the use of a custom 3D-printed implant with a dual-mobility bearing for the treatment of Paprosky type-3B defects between 2016 and 2019. Functional and radiological outcomes were assessed. Results A total of 26 patients (17 women and 9 men) with a minimum follow-up of 36 months (median, 53 months; range, 36 to 77 months) were identified. The median age at surgery was 69 years (range, 49 to 90 years), and 4 patients had pelvic discontinuity. The cumulative implant survivorship was 100%. The median Oxford Hip Score improved significantly from 8 (range, 2 to 21) preoperatively to 32 (range, 14 to 47) postoperatively (p = 0.0001). One patient had a transient sciatic nerve palsy, 1 hip dislocated 6 months postoperatively and was managed nonoperatively, and 1 infection recurred. No patient had a fracture. Radiographic evaluation showed bone ingrowth at the bone-implant interface in 24 patients (92%) at ≥12 months of follow-up and showed no evidence of implant loosening or migration at the latest follow-up (3 to 6 years). Conclusions Excellent functional improvement, implant survivorship, and osseointegration were recorded in the patient cohort. Accurate preoperative planning and the adoption of custom 3D-printed implants showed promising results in complex revision hip surgery. Level of Evidence Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Anna Di Laura
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, United Kingdom
- Department of Mechanical Engineering, University College London, London, United Kingdom
| | - Johann Henckel
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, United Kingdom
| | - Alister Hart
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, United Kingdom
- Institute of Orthopaedics and Musculoskeletal Science, University College London, London, United Kingdom
- Email for corresponding author:
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Ramasamy B, Abrahams JM, Clothier RJ, Solomon LB, Callary SA. RSA Measurements of Implant Instability in a Paprosky III Pelvic Defect with Discontinuity: A Case Report. JBJS Case Connect 2022; 12:01709767-202212000-00048. [PMID: 36820637 DOI: 10.2106/jbjs.cc.22.00296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 10/14/2022] [Indexed: 02/24/2023]
Abstract
CASE We report a case of acetabular reconstruction for a large defect with pelvic discontinuity that underwent 4 revisions for dislocations over a 3-year period. This allowed assessment of implant stability both on imaging, using measurements on plain radiographs and radiostereometric analysis (RSA) against both ilium and ischium, and direct assessment during each surgery. Only implant stability measured with RSA correlated with intraoperative revision findings. CONCLUSION This case underlines the role of RSA in assessing early acetabular implant stability in pelvic discontinuity and the importance of assessing the stability of the implant against both ilium and ischium.
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Affiliation(s)
- Boopalan Ramasamy
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia.,Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia
| | - John Matthew Abrahams
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia.,Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia
| | - Robyn Janice Clothier
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia.,Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia
| | - Lucian Bogdan Solomon
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia.,Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia
| | - Stuart Adam Callary
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia.,Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia
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5
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Yang J, Bryan AJ, Drabchuk R, Tetreault MW, Calkins TE, Della Valle CJ. Use of a monoblock dual-mobility acetabular component in primary total hip arthroplasty in patients at high risk of dislocation. Hip Int 2022; 32:648-655. [PMID: 33566709 DOI: 10.1177/1120700020988469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Dislocation is amongst the most common complications following total hip arthroplasty (THA). Dual-mobility bearings have been suggested as one way to reduce the risk of dislocation, particularly among patients at increased risk. The purpose of this study was to determine the outcomes of a monoblock dual-mobility shell for patients at high risk for dislocation following primary THA. METHODS A total of 155 primary THAs with a monoblock, cementless dual-mobility acetabular component were performed in patients at high risk for dislocation. Two patients died prior to their two-year follow-up. The remaining 153 THAs were followed for a mean of 5.1 years (range: 2.1 to 9.3). RESULTS There were no dislocations; however, four patients underwent revision surgery: one for an early periprosthetic acetabular fracture, one for an early periprosthetic femoral fracture, one for a late periprosthetic femoral fracture, and one for leg-length discrepancy. Intraoperative complications included one periprosthetic acetabular fracture treated with protected weight-bearing and one intraoperative proximal femoral fracture treated with cerclage wiring. Harris Hip Scores improved from a mean of 42.4 points preoperatively to a mean of 82.4 points postoperatively (p < 0.001). No cups were radiographically loose. At a mean follow-up of 5.1 years, survivorship of the acetabular component was 99.3% (95% CI, 98.1-100%) and survivorship without any reoperation was 97.4% (95% CI, 95.9-100%). DISCUSSION Although there were no dislocations in this high-risk population, periprosthetic fractures of the femur and acetabulum were common with the implants utilised.
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Affiliation(s)
- JaeWon Yang
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Andrew J Bryan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Roman Drabchuk
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Matthew W Tetreault
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Tyler E Calkins
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Craig J Della Valle
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
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6
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Custom Made Monoflange Acetabular Components for the Treatment of Paprosky Type III Defects. J Pers Med 2021; 11:jpm11040283. [PMID: 33917821 PMCID: PMC8068245 DOI: 10.3390/jpm11040283] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/02/2021] [Accepted: 04/06/2021] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Patient-specific, flanged acetabular components are used for the treatment of Paprosky type III defects during revision total hip arthroplasty (THA). This monocentric retrospective cohort study analyzes the outcome of patients treated with custom made monoflanged acetabular components (CMACs) with intra- and extramedullary iliac fixation. METHODS 14 patients were included who underwent revision THA with CMACs for the treatment of Paprosky type III defects. Mechanism of THA failure was infection in 4 and aseptic loosening in 10 patients. Seven patients underwent no previous revision, the other seven patients underwent three or more previous revisions. RESULTS At a mean follow-up of 35.4 months (14-94), the revision rate of the implant was 28.3%. Additionally, one perioperative dislocation and one superficial wound infection occurred. At one year postoperatively, we found a significant improvement of the Western Ontario and McMaster Universities Arthritis Index (WOMAC) score (p = 0.015). Postoperative radiographic analysis revealed good hip joint reconstruction with a mean leg length discrepancy of 3 mm (-8-20), a mean lateralization of the horizontal hip center of rotation of 8 mm (-8-35), and a mean proximalization of the vertical hip center of rotation of 6 mm (13-26). Radiolucency lines were present in 30%. CONCLUSION CMACs can be considered an option for the treatment of acetabular bone loss in revision THA. Iliac intra- and extramedullary fixation allows soft tissue-adjusted hip joint reconstruction and improves hip function. However, failure rates are high, with periprosthetic infection being the main threat to successful outcome.
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7
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Abrahams JM, Callary SA, Jang SW, Hewitt J, Howie DW, Solomon LB. Accuracy of EBRA-cup measurements after reconstruction of severe acetabular defects at revision THR. J Orthop Res 2020; 38:1497-1505. [PMID: 32039492 DOI: 10.1002/jor.24623] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 01/30/2020] [Indexed: 02/04/2023]
Abstract
Radiostereometric analysis (RSA) is the most accurate method of measuring component migration using radiographs but is restricted to use in prospective studies. Ein-Bild-Roentgen-analyze (EBRA)-Cup can be used retrospectively, but its accuracy to measure component migration following revision is unknown. This study aimed to determine the accuracy of EBRA-Cup measurements of uncemented acetabular component migration after revision total hip replacement (THR). The secondary aim was to compare the number of cases identified using EBRA-Cup and RSA as having proximally migrated above and below 1 mm at 2 years postoperatively. EBRA-Cup measurements were performed on plain antero-posterior pelvic radiographs taken at the same time as RSA radiographs in a prospective cohort of 53 hips undergoing acetabular revision. At 2 years, the mean difference between the RSA and EBRA-Cup measurements for 17 components used to treat pelvic discontinuity was 0.90 mm, significantly greater than the mean difference of 0.28 mm for 36 components without discontinuity (P = .0001). The mean difference between the RSA and EBRA-Cup measurements at 2 years for hips that were reconstructed with an acetabular component alone, 0.28 mm, was significantly lower than hips that were reconstructed with an acetabular component in combination with an augment and/or cage, 0.74 mm (P = .0005). In conclusion, EBRA-Cup can accurately measure migration of uncemented acetabular components used at revision THR. The presence of pelvic discontinuity, and addition of augments and cages, significantly influenced the accuracy of EBRA-Cup measurements. EBRA-Cup and RSA had good agreement on classification of components that migrated proximally above or below 1 mm at 2 years, with 100% sensitivity, and 87% specificity.
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Affiliation(s)
- John M Abrahams
- Centre for Orthopaedic and Trauma Research, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia.,Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia
| | - Stuart A Callary
- Centre for Orthopaedic and Trauma Research, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia.,Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia
| | - Sung W Jang
- Department of Orthopaedic Surgery, Pohang Se Myeong Christianity Hospital, Pohang-si, Gyeongsangbuk-do, Korea
| | - Joseph Hewitt
- Centre for Orthopaedic and Trauma Research, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia.,Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia
| | - Donald W Howie
- Centre for Orthopaedic and Trauma Research, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia.,Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia
| | - Lucian B Solomon
- Centre for Orthopaedic and Trauma Research, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia.,Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia
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8
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Qin L, Hu N, Li X, Chen Y, Wang J, Huang W. Evaluation of synovial fluid neutrophil CD64 index as a screening biomarker of prosthetic joint infection. Bone Joint J 2020; 102-B:463-469. [PMID: 32228083 DOI: 10.1302/0301-620x.102b4.bjj-2019-1271.r1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
AIMS Prosthetic joint infection (PJI) remains a major clinical challenge. Neutrophil CD64 index, Fc-gamma receptor 1 (FcγR1), plays an important role in mediating inflammation of bacterial infections and therefore could be a valuable biomarker for PJI. The aim of this study is to compare the neutrophil CD64 index in synovial and blood diagnostic ability with the standard clinical tests for discrimination PJI and aseptic implant failure. METHODS A total of 50 patients undergoing revision hip and knee arthroplasty were enrolled into a prospective study. According to Musculoskeletal Infection Society (MSIS) criteria, 25 patients were classified as infected and 25 as not infected. In all patients, neutrophil CD64 index and percentage of polymorphonuclear neutrophils (PMN%) in synovial fluid, serum CRP, ESR, and serum CD64 index levels were measured preoperatively. Receiver operating characteristic (ROC) curves and the area under the curve (AUC) were analyzed for each biomarker. RESULTS Serum CD64 index showed no significant difference between the two groups (p = 0.091). Synovial fluid CD64 index and PMN% discriminated good differentiation between groups of PJI and aseptic failure with AUC of 0.946 (95% confidence interval (CI) 0.842 to 0.990) and 0.938 (95% CI 0.832 to 0.987) separately. The optimal threshold value of synovial CD64 index for the diagnosis of PJI was 0.85, with a sensitivity of 92.00%, a specificity of 96.00%, and diagnostic odds ratio (DOR) of 227.11. CONCLUSION The present study demonstrates that CD64 index in synovial fluid could be a promising laboratory marker for screening PJI. The cut-off values of 0.85 for synovial CD64 index has the potential to distinguish aseptic failure from PJI. Cite this article: Bone Joint J 2020;102-B(4):463-469.
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Affiliation(s)
- Leilei Qin
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ning Hu
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xinyu Li
- Department of pharmacy, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuelong Chen
- Department of Respiratory and critical care medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jiawei Wang
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wei Huang
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Bone remodelling and integration of two different types of short stem: a dual-energy X-ray - absorptiometry study. INTERNATIONAL ORTHOPAEDICS 2020; 44:839-846. [PMID: 32219497 DOI: 10.1007/s00264-020-04545-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 03/18/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Different kinds of bone preserving hip stems have been created to assure a more physiological distribution of the strengths on the femur. The aim of this research is to evaluate the density reaction of the periprosthetic bone while changing the conformation of the prosthetic implant on dual-energy X-ray - absorptiometry (DXA). METHODS This is a prospective, single-centre study assessing bone remodelling changes after implantation of two short hip stems, dividing the patients in two groups according to the implant used: 20 in group A, Metha (B-Braun), and 16 in group B, SMF (Smith and Nephew). All participants had a pre-operative and a post-operative (24 months) DXA evaluating the changes in bone mass density (BMD) occurred in the five Gruen's zones. RESULTS Compared to the pre-operative value, differences in BMD percentage were statistically significant only in ROI 4 (p < 0.05), with an increase in both groups (9 and 18%, respectively). The average increase in BMD was of 7.3% and 7.2% in the 2 groups. CONCLUSION According to our study, both stems have proved able to provide good load distribution across the metaphyseal region favouring proper system integration. Nonetheless, is certainly needed to perform other studies with longer follow-up and bigger populations to give strength to these conclusions.
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Morosato F, Traina F, Cristofolini L. Effect of different motor tasks on hip cup primary stability and on the strains in the periacetabular bone: An in vitro study. Clin Biomech (Bristol, Avon) 2019; 70:137-145. [PMID: 31491739 DOI: 10.1016/j.clinbiomech.2019.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/03/2019] [Accepted: 08/11/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Excessive prosthesis/bone motions and the bone strains around the acetabulum may prevent osteointegration and lead to cup loosening. These two factors depend on post-operative joint loading. We investigated how Walking (which is often simulated) and Standing-Up from seated (possibly more critical) influence the cup primary stability and periacetabular strains. METHODS Twelve composite hemipelvises were used in two test campaigns. Simplified loading conditions were adopted to simulate Walking and Standing-Up. For each motor task, a single-direction force was applied in load packages of increasing amplitude. Stable and unstable uncemented cups were implanted. Digital image correlation was used to measure implant/bone motions (three-dimensional translations and rotations, both permanent and inducible), and the strain distribution around the acetabulum. FINDINGS When stable implants were tested, higher permanent cranial translations were found during Walking (however the resultant migrations were comparable with Standing-Up); higher rotations were found for Standing-Up. When unstable implants were tested, motions were 1-2 order of magnitude higher. Strains increased significantly from stable to unstable implants. The peak strains were in the superior aspect of the acetabulum during Walking and in the superior-posterior aspect of the acetabulum and at the bottom of the posterior column during Standing-Up. INTERPRETATION Different cup migration trends were caused by simulated Walking and Standing-Up, both similar to those observed clinically. The cup mobilization pattern depended on the different simulated motor tasks. Pre-clinical testing of new uncemented cups could include simulation of both motor tasks. Our study could also translate to indication of what tasks should be avoided.
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Affiliation(s)
- Federico Morosato
- Department of Industrial Engineering, School of Engineering and Architecture, Alma Mater Studiorum - Università di Bologna, Bologna, Italy
| | - Francesco Traina
- Second Clinic of Orthopaedics and Traumatology, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Luca Cristofolini
- Department of Industrial Engineering, School of Engineering and Architecture, Alma Mater Studiorum - Università di Bologna, Bologna, Italy.
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11
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Rheumatoid arthritis disease activity and the risk of aseptic arthroplasty loosening. Semin Arthritis Rheum 2019; 50:245-251. [PMID: 31471012 DOI: 10.1016/j.semarthrit.2019.07.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 07/20/2019] [Accepted: 07/31/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To assess the influence of rheumatoid arthritis (RA) disease activity (DA) on the risk of aseptic loosening after total hip/knee arthroplasty (THA/TKA). METHODS We identified RA patients who underwent THA/TKA and determined their DA using the simplified disease activity index (SDAI). The risk of aseptic loosening was estimated using radiographic signs of component loosening (RCL). We performed Cox regression to estimate RCL based on SDAI, adjusting for therapy. We also investigated a cohort of 2:1 matched osteoarthritis (OA) patients as a control group without systemic inflammation. RESULTS We identified 49 RA patients with a history of THA/TKA, of whom 18 (36.7%) showed RCL. SDAI over time was significantly higher in patients with RCL (median; 25th and 75th percentile: 10.8 months; 8.6 and 15.8; vs 7.0 months; 2.7 and 15.5;p = 0.043). In the regression model, each unit of mean SDAI over time significantly increased the risk of RCL (HR 1.125, 95% CI 1.021-1.241;p = 0.018). Patients treated with biological had a lower risk of RCL than those treated with traditional DMARDs (HR 0.192, 95% CI 0.042-0.891;p = 0.035). In the 88 matched OA patients, the RCL rate was significantly lower than in the RA group (13.6%;p = 0.002). CONCLUSION Higher inflammatory DA increases the risk for radiographic loosening after THA/TKA in patients with RA. The significantly lower risk in patients with OA further underlines the potential role of inflammatory DA. In the context of treating RA to target, the presence of an arthroplasty might be considered as an indication for more stringent control of DA.
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12
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Acetabular revision arthroplasty using press-fitted jumbo cups: an average 10-year follow-up study. Arch Orthop Trauma Surg 2019; 139:1149-1160. [PMID: 31187257 DOI: 10.1007/s00402-019-03214-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Acetabular revision arthroplasty using jumbo cups for moderate-to-severe acetabular defects has varied outcomes. We evaluated the clinical and radiological outcomes of acetabular revision arthroplasty using a press-fitted jumbo cup and sought to identify factors that influence outcomes during intermediate follow-up. MATERIALS AND METHODS Eighty patients (47 men, 33 women; 80 hips) who underwent acetabular revision arthroplasty using press-fitted jumbo cups were included. The mean follow-up period was 10.4 years. Harris hip score (HHS), presence of groin pain, radiographic results, and Kaplan-Meier survival curves were evaluated. Implant design and surgery-related and patient-related factors were assessed to identify influential factors for cup loosening. Migration and wear analyses were performed using Einzel-Bild-Röntgen-Analyse software. RESULTS The mean preoperative HHS of 53 had improved to 77 at the final follow-up (p = 0.005). Nine patients experienced groin pain. Acetabular cup loosening was observed in seven cups (8.7%), and one jumbo cup was replaced with a reinforcement cage. The survival rate of the acetabular cup was 91% at 16 years according to the Kaplan-Meier analysis. Osteolysis was identified around the cup in six cases (7.5%). Acetabular cup loosening occurred more frequently in patients with conventional polyethylene liners than in those with highly cross-linked polyethylene liners (p = 0.045). The mean total migration was 1.52 mm, and the mean total wear was 0.98 mm. There was a positive correlation between total migration and total wear (p = 0.023; Spearman's rho = 0.388). The mean wear rate of the patients with the cup inclination angle < 50° was significantly lower than those with the cup inclination angle > 50° (p = 0.001). There were four cases of complications (three dislocations and one infection) that did not require revision surgery. CONCLUSION Press-fitted jumbo cups for acetabular revision arthroplasty exhibited encouraging results during follow-up for an average of 10 years. Use of highly cross-linked polyethylene liners and proper placement of the acetabular component with an inclination angle < 50° may contribute to better clinical outcomes after acetabular revision arthroplasty with jumbo cups.
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Amanatullah D, Dennis D, Oltra EG, Marcelino Gomes LS, Goodman SB, Hamlin B, Hansen E, Hashemi-Nejad A, Holst DC, Komnos G, Koutalos A, Malizos K, Martinez Pastor JC, McPherson E, Meermans G, Mooney JA, Mortazavi J, Parsa A, Pécora JR, Pereira GA, Martos MS, Shohat N, Shope AJ, Zullo SS. Hip and Knee Section, Diagnosis, Definitions: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S329-S337. [PMID: 30348576 DOI: 10.1016/j.arth.2018.09.044] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Belt M, Gliese B, Muharemovic O, Malchau H, Husted H, Troelsen A, Gromov K. Sensitivity and specificity of post-operative interference gap assessment on plain radiographs after cementless primary THA. Clin Imaging 2019; 54:103-107. [PMID: 30612032 DOI: 10.1016/j.clinimag.2018.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 12/13/2018] [Accepted: 12/27/2018] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Implant performance of cementless THA is often evaluated by radiolucency on plain radiographs, often classified as interference gaps on direct post-operative radiographs. However, the diagnostic performance is unknown. The aim was to evaluate the diagnostic performance of radiographic assessment of post-operative gaps after primary THA by comparing it with CT confirmed gaps, and secondary to define optimal cut-off criteria for assessing gaps on plain radiographs compared with CT. MATERIAL AND METHODS Patients (N = 40) with a primary cementless THA performed between July 2015 and March 2016 were enrolled in the study. Radiolucency was assessed on post-operative AP pelvic digital radiographs by two observers independently. Maximum width and percentage of coverage per zone were reported. Gap volume was measured by manual segmentation on CT images. RESULTS When defining a gap as a radiolucency extending through >50% of a zone, the interrater agreement Kappa was 0.241. Sensitivity was 65.8% for observer 1 (Kappa = 0.432), and 86.8% for observer 2 (Kappa = 0.383). When defining a gap as a radiolucency with a width >1 mm, the interrater agreement Kappa was 0.302. Sensitivity was 55.3% and 50% for observer 1 and observer 2, respectively. The ROC-curve resulted in an optimal threshold of 0.65 mm (AUROC = 0.888) and 0.31 mm (AUROC = 0.961) for the two observers. CONCLUSION The diagnostic performance of observers detecting interference gaps on radiographs showed low sensitivity. Further on, the inter-rater agreement is too low to do a general recommendation about thresholds for defining gaps. Evaluating progression of radiolucency on radiographs should be performed in the light of these findings.
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Affiliation(s)
- Maartje Belt
- Dept. of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Copenhagen, Denmark.
| | - Bjørn Gliese
- Dept. of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Copenhagen, Denmark
| | - Omar Muharemovic
- Department of Radiology, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Denmark
| | - Henrik Malchau
- Dept. of Orthopaedic Surgery, Sahlgrenska University Hospital, Mölndal, Gothenburg, Sweden; The Harris Orthopaedic Laboratory, Orthopedic Department, Massachusetts General Hospital, Boston, USA
| | - Henrik Husted
- Dept. of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Copenhagen, Denmark
| | - Anders Troelsen
- Dept. of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Copenhagen, Denmark
| | - Kirill Gromov
- Dept. of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Copenhagen, Denmark
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Solomon LB, Abrahams JM, Callary SA, Howie DW. The Stability of the Porous Tantalum Components Used in Revision THA to Treat Severe Acetabular Defects: A Radiostereometric Analysis Study. J Bone Joint Surg Am 2018; 100:1926-1933. [PMID: 30480597 DOI: 10.2106/jbjs.18.00127] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The acetabular components used in revision total hip arthroplasty (THA) to treat severe acetabular bone defects have high rates of re-revision at mid to long-term follow-up. Early translation of acetabular components used in revision THA is a good predictor of later loosening, and radiostereometric analysis (RSA) is the most sensitive method to measure migration. The objectives of the present study were to use RSA to compare the migration of the porous tantalum acetabular components used to treat severe bone defects with the previously established acceptable proximal translation threshold of ≤1 mm within 2 years, and to determine the effect on migration of the addition of inferior screws through the component into the ischium or pubis. METHODS RSA was utilized to measure the migration of 55 porous tantalum components used to treat severe acetabular defects (28 Paprosky IIIA, 27 Paprosky IIIB; 21 hips with pelvic discontinuity) at a mean follow-up of 4 years (range, 2 to 12 years). RESULTS Forty-eight of the 55 components migrated less than the threshold that predicts later loosening (>1 mm) and 50 had not been re-revised at the time of the latest follow-up. Seven components, none of which had inferior screw fixation, exceeded the translation threshold. Of these, 6 were implanted to treat pelvic discontinuity. Of those 6 components, 5 were re-revised for loosening related to patient symptoms. At 2 years, the absolute median proximal translation of components with inferior screw fixation was |0.3| mm (range, |0.1| to |0.9| mm), compared with |0.4| mm (range, |0.03| to |16.4| mm) for those without inferior screws (p = 0.04). CONCLUSIONS As measured with use of RSA, the majority of porous tantalum acetabular components used in a revision THA to treat severe acetabular defects had acceptable early migration. This predicts good long-term survivorship of these components. The use of inferior screws further improved acetabular component fixation. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Lucian B Solomon
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia
| | - John M Abrahams
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia
| | - Stuart A Callary
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia
| | - Donald W Howie
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia
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Comparison of radiographs, tomosynthesis and CT with metal artifact reduction for the detection of hip prosthetic loosening. Eur Radiol 2018; 29:1258-1266. [DOI: 10.1007/s00330-018-5717-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 07/18/2018] [Accepted: 08/14/2018] [Indexed: 02/06/2023]
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