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Koettnitz J, Isbeih J, Peterlein CD, Migliorini F, Götze C. A Comparative Analysis of Perioperative Complications in Octogenarians and Patients under 60 Years of Age after Primary Cemented Total Knee Arthroplasty. Clin Med Res 2023; 21:136-143. [PMID: 37985169 PMCID: PMC10659135 DOI: 10.3121/cmr.2023.1810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 05/03/2023] [Accepted: 07/12/2023] [Indexed: 11/22/2023]
Abstract
Introduction: Knee arthroplasty is exposed to demographic changes as patients age. An analysis of risk factors for surgical treatment decisions in patients over 80 years old is crucial. This study compared perioperative complications between groups of patients undergoing primary knee arthroplasty, under 60 years old and over 80 years old.Materials and Methods: For this retrospective study, data from 400 patients with primary cemented bi- and unicondylar total knee endoprosthesis during inpatient stay from 2017 to 2018 were analyzed. Patients aged 61-79 years (257) were excluded. An analysis of the remaining 143 patients was performed. The incidence of surgery-related and systemic complications (eg, urinary tract infections, electrolyte imbalances, and cases of pneumonia), the blood supply and C-reactive protein (CRP) as well as hemoglobin progression were compared across both age groups. Furthermore, a correlation between prevalent diseases and systemic complications were investigated. Statistical analysis was performed using IBM SPSS (Armonk, US).Results: Data analyses showed a significant difference in the occurrence of systemic complications and blood transfusion between the age groups (P = 0.001, phi = 0.44; phi= 0.55, P = 0.001). Surgical complications did not differ significantly between the age groups. Age-typical pre-existing conditions, especially arterial hypertension (P = 0.003), showed a significant association with the occurrence of systemic complications. In addition, high postoperative CRP values in elderly patients revealed an association to systemic complications (P = 0.008).Discussion and Conclusion: The study shows that primary cemented knee arthroplasty is a safe procedure without an increased incidence of surgical complications, even in elderly patients. The increased incidence of internal complications in octogenarians, in turn, should receive more attention in the perioperative course. The interdisciplinary preoperative optimization of pre-existing conditions and drug therapy, as well as close interdisciplinary assessments of elderly patients, should be ensured.
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Affiliation(s)
- Julian Koettnitz
- Department of General Orthopaedics, Auguste-Viktoria-Clinic Bad Oeynhausen, University Hospital of RUB-Bochum, Am Kokturkanal, 32545 Bad Oeynhausen, Germany
| | - Jan Isbeih
- Department of General Orthopaedics, Auguste-Viktoria-Clinic Bad Oeynhausen, University Hospital of RUB-Bochum, Am Kokturkanal, 32545 Bad Oeynhausen, Germany
| | - Christian D Peterlein
- Department of General Orthopaedics, Auguste-Viktoria-Clinic Bad Oeynhausen, University Hospital of RUB-Bochum, Am Kokturkanal, 32545 Bad Oeynhausen, Germany
| | - Filippo Migliorini
- Department of Orthopaedics and Trauma Surgery, University Clinic Aachen, RWTH Aachen University Clinic, 52064 Aachen
| | - Christian Götze
- Department of General Orthopaedics, Auguste-Viktoria-Clinic Bad Oeynhausen, University Hospital of RUB-Bochum, Am Kokturkanal, 32545 Bad Oeynhausen, Germany
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Lu H, Zhu N, Ling T, Cao J, Xu H, Zhou K, Zhao E, Zhou Z. Total hip arthroplasty for failed internal fixation of femoral neck fracture: a retrospective study with 2-14 years' follow-up of 345 patients. J Orthop Surg Res 2023; 18:341. [PMID: 37161494 PMCID: PMC10169472 DOI: 10.1186/s13018-023-03827-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 05/04/2023] [Indexed: 05/11/2023] Open
Abstract
OBJECTIVES The purpose of this study was to analyze mid- to long-term outcomes of total hip arthroplasty (THA) following failed internal fixation of femoral neck fracture. METHODS This study retrospectively analyzed 345 patients with femoral neck fracture who underwent THA after failure of internal fixation at our hospital between January, 2003 and December, 2019. Patients older than 55 years (n = 175) and patients no older than 55 years (n = 170) were compared in terms of complications and survival rates during follow-up, which lasted a mean of 6 years. RESULTS The two age groups showed similarly low incidence of complications and similarly long periods of survival without revision surgery. Only three younger patients and two older patients underwent revision surgery during follow-up. The two groups showed similarly high survival rates at the end of follow-up (> 93%). Younger patients showed significantly bettter Harris hip score at last follow-up (90.2 vs. 88.1 points, p < 0.001) without clinically significant difference, but they required THA significantly earlier after internal fixation (4.4 vs. 6.8 years, p < 0.001). CONCLUSIONS THA after failed internal fixation of femoral neck fracture is a well tolerated and effective procedure in older and younger patients.
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Affiliation(s)
- Hanpeng Lu
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No.37, Guoxue Road, Wuhou District, Chengdu, 610041, Sichuan, People's Republic of China
| | - Niu Zhu
- Precision Medicine Center, West China Hospital, Sichuan University, No.37, Guoxue Road, Wuhou District, Chengdu, 610041, Sichuan, People's Republic of China
| | - Tingxian Ling
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No.37, Guoxue Road, Wuhou District, Chengdu, 610041, Sichuan, People's Republic of China
| | - Jian Cao
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No.37, Guoxue Road, Wuhou District, Chengdu, 610041, Sichuan, People's Republic of China
| | - Hong Xu
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No.37, Guoxue Road, Wuhou District, Chengdu, 610041, Sichuan, People's Republic of China
| | - Kai Zhou
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No.37, Guoxue Road, Wuhou District, Chengdu, 610041, Sichuan, People's Republic of China
| | - Enze Zhao
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No.37, Guoxue Road, Wuhou District, Chengdu, 610041, Sichuan, People's Republic of China
| | - Zongke Zhou
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No.37, Guoxue Road, Wuhou District, Chengdu, 610041, Sichuan, People's Republic of China.
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Salaha ZFM, Ammarullah MI, Abdullah NNAA, Aziz AUA, Gan HS, Abdullah AH, Abdul Kadir MR, Ramlee MH. Biomechanical Effects of the Porous Structure of Gyroid and Voronoi Hip Implants: A Finite Element Analysis Using an Experimentally Validated Model. MATERIALS (BASEL, SWITZERLAND) 2023; 16:ma16093298. [PMID: 37176180 PMCID: PMC10179376 DOI: 10.3390/ma16093298] [Citation(s) in RCA: 33] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 04/12/2023] [Accepted: 04/20/2023] [Indexed: 05/15/2023]
Abstract
Total hip arthroplasty (THA) is most likely one of the most successful surgical procedures in medicine. It is estimated that three in four patients live beyond the first post-operative year, so appropriate surgery is needed to alleviate an otherwise long-standing suboptimal functional level. However, research has shown that during a complete THA procedure, a solid hip implant inserted in the femur can damage the main arterial supply of the cortex and damage the medullary space, leading to cortical bone resorption. Therefore, this study aimed to design a porous hip implant with a focus on providing more space for better osteointegration, improving the medullary revascularisation and blood circulation of patients. Based on a review of the literature, a lightweight implant design was developed by applying topology optimisation and changing the materials of the implant. Gyroid and Voronoi lattice structures and a solid hip implant (as a control) were designed. In total, three designs of hip implants were constructed by using SolidWorks and nTopology software version 2.31. Point loads were applied at the x, y and z-axis to imitate the stance phase condition. The forces represented were x = 320 N, y = -170 N, and z = -2850 N. The materials that were used in this study were titanium alloys. All of the designs were then simulated by using Marc Mentat software version 2020 (MSC Software Corporation, Munich, Germany) via a finite element method. Analysis of the study on topology optimisation demonstrated that the Voronoi lattice structure yielded the lowest von Mises stress and displacement values, at 313.96 MPa and 1.50 mm, respectively, with titanium alloys as the materials. The results also indicate that porous hip implants have the potential to be implemented for hip implant replacement, whereby the mechanical integrity is still preserved. This result will not only help orthopaedic surgeons to justify the design choices, but could also provide new insights for future studies in biomechanics.
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Affiliation(s)
- Zatul Faqihah Mohd Salaha
- Bone Biomechanics Laboratory (BBL), Department of Biomedical Engineering and Health Sciences, Faculty of Electrical Engineering, Universiti Teknologi Malaysia, Johor Bahru 81310, Johor, Malaysia
- Bioinspired Devices and Tissue Engineering (BIOINSPIRA) Research Group, Universiti Teknologi Malaysia, Johor Bahru 81310, Johor, Malaysia
| | - Muhammad Imam Ammarullah
- Department of Mechanical Engineering, Faculty of Engineering, Universitas Pasundan, Bandung 40153, West Java, Indonesia
- Biomechanics and Biomedics Engineering Research Centre, Universitas Pasundan, Bandung 40153, West Java, Indonesia
- Undip Biomechanics Engineering & Research Centre (UBM-ERC), Universitas Diponegoro, Semarang 50275, Central Java, Indonesia
| | - Nik Nur Ain Azrin Abdullah
- Bone Biomechanics Laboratory (BBL), Department of Biomedical Engineering and Health Sciences, Faculty of Electrical Engineering, Universiti Teknologi Malaysia, Johor Bahru 81310, Johor, Malaysia
- Bioinspired Devices and Tissue Engineering (BIOINSPIRA) Research Group, Universiti Teknologi Malaysia, Johor Bahru 81310, Johor, Malaysia
| | - Aishah Umairah Abd Aziz
- Bone Biomechanics Laboratory (BBL), Department of Biomedical Engineering and Health Sciences, Faculty of Electrical Engineering, Universiti Teknologi Malaysia, Johor Bahru 81310, Johor, Malaysia
- Bioinspired Devices and Tissue Engineering (BIOINSPIRA) Research Group, Universiti Teknologi Malaysia, Johor Bahru 81310, Johor, Malaysia
| | - Hong-Seng Gan
- School of AI and Advanced Computing, XJTLU Entrepreneur College (Taicang), Xi'an Jiaotong-Liverpool University, Suzhou 215400, China
| | - Abdul Halim Abdullah
- School of Mechanical Engineering, College of Engineering, Universiti Teknologi MARA, Shah Alam 40450, Selangor, Malaysia
| | - Mohammed Rafiq Abdul Kadir
- Bioinspired Devices and Tissue Engineering (BIOINSPIRA) Research Group, Universiti Teknologi Malaysia, Johor Bahru 81310, Johor, Malaysia
- Medical Devices and Technology Centre (MEDiTEC), Institute of Human Centered Engineering (iHumEn), Universiti Teknologi Malaysia, Johor Bahru 81310, Johor, Malaysia
| | - Muhammad Hanif Ramlee
- Bone Biomechanics Laboratory (BBL), Department of Biomedical Engineering and Health Sciences, Faculty of Electrical Engineering, Universiti Teknologi Malaysia, Johor Bahru 81310, Johor, Malaysia
- Bioinspired Devices and Tissue Engineering (BIOINSPIRA) Research Group, Universiti Teknologi Malaysia, Johor Bahru 81310, Johor, Malaysia
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Fröschen FS, Wirtz DC, Schildberg FA. [Physiological reactions in the interface between cementless implants and bone]. ORTHOPADIE (HEIDELBERG, GERMANY) 2023; 52:178-185. [PMID: 36749380 DOI: 10.1007/s00132-023-04347-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/12/2023] [Indexed: 02/08/2023]
Abstract
BACKGROUND Surgical treatment of patients with osteoarthritis of the hip and persisting symptoms under conservative therapy has become increasingly important against the background of an aging population. OBJECTIVES What are the physiological reactions in the interface between cementless implants and bone? METHODS The literature is reviewed, expert opinions and animal models are analyzed and discussed. RESULTS Surface coating of implants with hydroxyapatite or titanium can have positive effects on osteointegration. Additional local application of mediators might be beneficial for osteointegration in the future. CONCLUSION Early peri-implant bone healing directly after implantation and late remodeling of the bone-implant interface are essential for secondary implant stability.
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Affiliation(s)
- Frank Sebastian Fröschen
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland.
| | - Dieter Christian Wirtz
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - Frank Alexander Schildberg
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
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Effect of femoral stem surface coating on clinical and radiographic outcomes of cementless primary total hip arthroplasty: a patient-matched retrospective study. INTERNATIONAL ORTHOPAEDICS 2023; 47:165-174. [PMID: 36385185 PMCID: PMC9668389 DOI: 10.1007/s00264-022-05629-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 10/27/2022] [Indexed: 11/18/2022]
Abstract
PURPOSE This study aims to determine whether changing the stem coating grants superior outcomes at a minimum follow-up of five years. METHODS Retrospective review of a consecutive series of primary total hip arthroplasties (THAs) operated by direct anterior approach between 01/01/2013 and 31/12/2014. Two stems were compared, which were identical except for their surface coating; "the Original stem" was fully coated with hydroxyapatite (HA), while "the ProxCoat stem" was proximally coated with plasma-sprayed titanium and HA. Matching was performed. Clinical assessment included modified Harris hip score (mHHS), Oxford hip score (OHS), and forgotten joint score (FJS). Radiographic assessment evaluated alignment, subsidence, pedestal formation, heterotopic ossification, radiolucent lines ≥ 2 mm, spot welds, cortical hypertrophy, and osteolysis. RESULTS 232 hips received the Original stem and 167 the ProxCoat stem, from which respectively five hips (2.2%) and no hips (0%) underwent revision. Matching identified two groups of 91 patients, with comparable patient demographics. At > five years follow-up, there were no differences in OHS (16 ± 6 vs 15 ± 5; p = 0.075) nor FJS (81 ± 26 vs 84 ± 22; p = 0.521), but there were differences in mHHS (89 ± 15 vs 92 ± 12; p = 0.042). There were no differences in alignment, subsidence, pedestal formation, heterotopic ossification, cortical hypertrophy, and osteolysis. There were differences in prevalence of proximal radiolucent lines (12% vs 0%; p < 0.001) and distal spot welds (24% vs 54%; p < 0.001). CONCLUSION At a minimum follow-up of five years, this study on matched patients undergoing primary THA found that ProxCoat stems results in significantly fewer radiolucent lines, more spot welds, and less revisions than Original stems, thus suggesting better bone ingrowth.
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How to Prevent Aseptic Loosening in Cementless Arthroplasty: A Review. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12031571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aseptic loosening is the main late postoperative complication of cementless total hip arthroplasties (THAs), leading to pain and functional impairment. This article aims to update the orthopedic surgeon on the various methods by which the aseptic loosening rate can be reduced. We performed a systematic review by searching the PubMed database for hip aseptic loosening. We included meta-analysis, randomized controlled trials, reviews, and systematic reviews in the last 10 years, which provided information on techniques that can prevent aseptic loosening in total hip arthroplasty. From a total of 3205 articles identified, 69 articles (2%) met the inclusion criteria, leading to a total of 36 recommendations. A lot of research has been conducted in terms of septic loosening in the last decade. Currently, we have various techniques by which we can reduce the rate of aseptic loosening. Nevertheless, further randomized clinical trials are needed to expand the recommendations for aseptic loosening prevention.
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Jagadeeshanayaka N, Awasthi S, Jambagi SC, Srivastava C. Bioactive Surface Modifications through Thermally Sprayed Hydroxyapatite Composite Coatings: A Review over Selective Reinforcements. Biomater Sci 2022; 10:2484-2523. [DOI: 10.1039/d2bm00039c] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Hydroxyapatite (HA) has been an excellent replacement for the natural bone in orthopedic applications, owing to its close resemblance; however, it is brittle and has low strength. Surface modification techniques...
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