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Martínez Villén G, Espada Blasco C, Rodríguez Nogué L, García González E. Long-term results of the Aptis TM total distal radioulnar joint prosthesis after previous failed surgical procedures. J Hand Surg Eur Vol 2024; 49:82-90. [PMID: 37747488 DOI: 10.1177/17531934231192375] [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] [Indexed: 09/26/2023]
Abstract
We present a prospective study with the results of ten Aptis total distal radioulnar joint replacements in patients who had one to five previous operations. The mean postoperative follow-up was 9.7 years (range 3-14.7). The mean postoperative range of motion of the wrist improved by 9° for extension, 15° for flexion, 10° for pronation and 14° for supination, achieving values equivalent to 88%, 78%, 97% and 88% of those of the non-operated hand. There were minimal changes in radial and ulnar deviations. Grip strength improved by 7 kg, pain decreased by 8 points, QuickDASH and Mayo wrist scores improved by 51 and 53 points, respectively. Two implants had radiolucency less than 1 mm. Serum titanium ion levels were slightly elevated in two patients. Three prostheses required revision surgery for heterotopic ossification, a prominent radial screw and a periprosthetic fracture. No prostheses were removed. Six patients returned to their former professional activities and four patients adapted their jobs.Level of evidence: IV.
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Affiliation(s)
- Gregorio Martínez Villén
- Department of Orthopaedic and Traumatology (Hand and Reconstructive Surgery Unit), Miguel Servet University Hospital, Zaragoza, Spain
| | - Carlos Espada Blasco
- Department of Orthopaedic and Traumatology (Hand and Reconstructive Surgery Unit), Miguel Servet University Hospital, Zaragoza, Spain
| | - Luis Rodríguez Nogué
- Department of Orthopaedic and Traumatology, University Hospital Royo Villanova, Zaragoza, Spain
| | - Elena García González
- Department of Clinical Biochemistry, Miguel Servet University Hospital, Zaragoza, Spain
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Weissman BN, Palestro CJ, Fox MG, Bell AM, Blankenbaker DG, Frick MA, Jawetz ST, Kuo PH, Said N, Stensby JD, Subhas N, Tynus KM, Walker EA, Kransdorf MJ. ACR Appropriateness Criteria® Imaging After Total Hip Arthroplasty. J Am Coll Radiol 2023; 20:S413-S432. [PMID: 38040462 DOI: 10.1016/j.jacr.2023.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 08/22/2023] [Indexed: 12/03/2023]
Abstract
This article reviews evidence for performing various imaging studies in patients with total hip prostheses. Routine follow-up is generally performed with radiography. Radiographs are also usually the initial imaging modality for patients with symptoms related to the prosthesis. Following acute injury with pain, noncontrast CT may add information to radiographic examination regarding the presence and location of a fracture, component stability, and bone stock. Image-guided joint aspiration, noncontrast MRI, and white blood cell scan and sulfur colloid scan of the hip, are usually appropriate studies for patients suspected of having periprosthetic infection. For evaluation of component loosening, wear, and/or osteolysis, noncontrast CT or MRI are usually appropriate studies. Noncontrast MRI is usually appropriate for identifying adverse reaction to metal debris related to metal-on-metal articulations. For assessing patients after hip arthroplasty, who have trochanteric pain and nondiagnostic radiographs, ultrasound, or MRI are usually appropriate studies. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
| | | | | | - Angela M Bell
- Rush University Medical Center, Chicago, Illinois; American College of Physicians
| | - Donna G Blankenbaker
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | | | | | - Phillip H Kuo
- University of Arizona, Tucson, Arizona; Commission on Nuclear Medicine and Molecular Imaging
| | - Nicholas Said
- Duke University Medical Center, Durham, North Carolina
| | | | | | - Katherine M Tynus
- Northwestern Memorial Hospital, Chicago, Illinois; American College of Physicians
| | - Eric A Walker
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania; Uniformed Services University of the Health Sciences, Bethesda, Maryland
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Martínez Villén G, Rodríguez Nogué L, García González E. Postoperative assessment and management of metallosis and periprosthetic osteolysis in patients treated with metal-on-polyethylene total wrist prostheses. J Hand Surg Eur Vol 2022; 47:952-958. [PMID: 35866419 DOI: 10.1177/17531934221113723] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We analysed the relationship between serum metal ions, radiological periprosthetic osteolysis and the clinical features in a series of 25 patients treated with fourth-generation metal-on-polyethylene total wrist prostheses. The mean implant follow-up was 7 years. Our results show that titanium was the main elevated serum metal ion in patients with the prostheses that we used; elevated serum cobalt or chromium values were infrequent. The risk of loosening was higher in an implant older than 6 years, with more than five periprosthetic osteolysis points according to our radiograph zone system, and serum titanium values between 26 to 31 µg/L. The presence of metallosis pseudotumours does not guarantee but increases the risk of implant failure, which may be asymptomatic or associated with little pain.Level of evidence: IV.
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Affiliation(s)
- Gregorio Martínez Villén
- Department of Orthopaedic and Traumatology (Hand and Reconstructive Surgery Unit), Miguel Servet University Hospital, Zaragoza, Spain
| | - Luis Rodríguez Nogué
- Department of Orthopaedic and Traumatology (Hand and Reconstructive Surgery Unit), Miguel Servet University Hospital, Zaragoza, Spain
| | - Elena García González
- Department of Clinical Biochemistry, Miguel Servet University Hospital, Zaragoza, Spain
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Ozan F, Kahraman M, Baktır A, Gençer K. Catastrophic failure and metallosis of the acetabular component in total hip arthroplasty. J Orthop Surg Res 2021; 16:349. [PMID: 34051798 PMCID: PMC8164279 DOI: 10.1186/s13018-021-02492-5] [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: 04/14/2021] [Accepted: 05/23/2021] [Indexed: 11/10/2022] Open
Abstract
Background To evaluate the clinical features and results of the revision total hip arthroplasties (THA) in patients with catastrophic failures and metallosis. Methods Fifteen hips of 14 patients with catastrophic failure and metallosis in hip arthroplasties were evaluated. They were followed for at least 4.2 years after the revision THA. Clinical evaluation was performed using Harris hip score. Osteolysis, loosening or presence of metallosis was evaluated with standard radiographs. Metallosis was evaluated intraoperatively according to the metallosis severity classification. Results The mean time from failure until revision surgery was 9.4 years. It was observed that in the primary THA, metal-on-ceramic (MoC), ceramic-on-ceramic (CoC) and metal-on-conventional polyethylene (MoCPE) bearings were used in 1, 3 and 11 hips, respectively. Grade III metallosis was observed in all patients during revision surgeries. The mean Harris hip score increased from 55 points before revision THA to 75 points at the final follow-up. In revision arthroplasty, MoCPE and CoC bearings were used in 13 and 2 hips, respectively. The femoral stem was replaced in 5 hips. All acetabular cups, except that of one hip, were revised. Conclusions Revisions of THAs with catastrophic failures and metallosis are quite challenging. Routine follow-up of arthroplasty patients is beneficial to examine for osteolysis, loosening, and asymmetric wear.
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Affiliation(s)
- Fırat Ozan
- Department of Orthopedics and Traumatology, Kayseri City Hospital, Kayseri, Turkey.
| | - Murat Kahraman
- Department of Orthopedics and Traumatology, Kayseri City Hospital, Kayseri, Turkey
| | - Ali Baktır
- Department of Orthopedics and Traumatology, Dünyam Hospital, Kayseri, Turkey
| | - Kürşat Gençer
- Department of Orthopedics and Traumatology, Kayseri City Hospital, Kayseri, Turkey
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Osteocytes respond to particles of clinically-relevant conventional and cross-linked polyethylene and metal alloys by up-regulation of resorptive and inflammatory pathways. Acta Biomater 2019; 87:296-306. [PMID: 30690207 DOI: 10.1016/j.actbio.2019.01.047] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 01/18/2019] [Accepted: 01/24/2019] [Indexed: 02/06/2023]
Abstract
Periprosthetic osteolysis is a major cause of implant failure in total hip replacements. Aseptic loosening caused by osteolytic lesions is associated with the production of bioactive wear particles from the articulations of implants. Wear particles infiltrate the surrounding tissue of implants, promoting inflammation as well as bone resorption. Osteocytes have been shown to both regulate physiological osteoclastogenesis and directly remodel their perilacunar bone matrix by the process of osteocytic osteolysis. We hypothesise that osteocytes respond to wear debris of orthopaedic implant materials by adopting a pro-catabolic phenotype and thus contribute to periprosthetic osteolysis through the known pathways of bone loss. Osteocyte responses to particles derived from clinically relevant materials, ultra-high molecular weight polyethylene (UHMWPE), highly cross-linked polyethylene (XLPE) and metal alloys, Ti6Al4V and CoCrMo, were examined in vitro in human primary osteocyte-like cultures. Osteocyte-like cells exposed to both polyethylene and metal wear particle types showed upregulated expression of catabolic markers associated with osteocytic osteolysis, MMP13, carbonic anhydrase 2 (CA2) and cathepsin K (CTSK). In addition, pro-osteoclastogenesis markers RANKL and M-CSF were induced, as well as the expression of pro-inflammatory cytokines, IL-6 and TNFα, albeit with different kinetics. These findings suggest a previously unrecognised action of wear particles of multiple orthopaedic materials on osteocytes, and suggest a multifaceted role for osteocytes in periprosthetic osteolysis. STATEMENT OF SIGNIFICANCE: This study addresses periprosthetic osteolysis, a major clinical problem leading to aseptic loosening of orthopaedic implants. It is well accepted that wear particles of polyethylene and of other implant materials stimulate the activity of bone resorbing osteoclasts. Our recent work provided evidence that commercial particles of ultra-high molecular weight polyethylene (UHMWPE) stimulated osteocytes to adopt a bone catabolic state. In this study we demonstrate for the first time that particles derived from materials in clinical use, conventional UHMWPE, highly cross-linked polyethylene (XLPE), and Ti6Al4V and CoCrMo metal alloys, all stimulate human osteocyte activities of osteocyte-regulated osteoclastogenesis, osteocytic osteolysis, proinflammatory responses, osteocyte apoptosis, albeit to varying extents. This study provides further mechanistic insight into orthopaedic wear particle mediated bone disease in terms of the osteocyte, the most abundant and key controlling cell type in bone.
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Antoniac I, Negrusoiu M, Mardare M, Socoliuc C, Zazgyva A, Niculescu M. Adverse local tissue reaction after 2 revision hip replacements for ceramic liner fracture: A case report. Medicine (Baltimore) 2017; 96:e6687. [PMID: 28489745 PMCID: PMC5428579 DOI: 10.1097/md.0000000000006687] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION In younger patients, ceramic-on-ceramic (CoC) bearing surfaces are usually recommended for total hip replacement (THR) because of their low wear rate and longer expected functional life. Although technical advancements have reduced the risk of ceramic bearings fracture, this complication remains a major concern. CASE DESCRIPTION We present the case of a 56-year-old patient undergoing 3 revision hip arthroplasties of the right hip due to ceramic liner fractures. Initial THR (2008) was performed with a CoC bearing, followed by liner fracture due to trauma a year later. The acetabular component and liner were replaced, with a minor incongruence between the old head and new insert. The 2nd ceramic insert fractured 3.5 years later, following minor trauma. Upon revision, the bearing surface was changed to metal-on-polyethylene (MoP). The performed retrieval analysis demonstrated stripe and rim wear, and evidence of adhesive wear. The patient was referred to us a month later, with a fistula on the lateral side of the hip, discharging black, petroleum-like liquid. Radiology showed well-fixed implants, no dislocation and no apparent polyethylene wear. Microbiological assessment of the discharge showed no infection. Intraoperatively massive metallosis was noticed, with stable acetabular and femoral components. The metal femoral head was heavily abraded, with almost 1% volumetric wear. Hematoxylin and eosin stained frozen tissue samples showed muscular and adipose tissue necrosis, while polarized light microscopy highlighted metal, polyethylene, and ceramic particles. CONCLUSION The present case is yet another report showing the adverse outcomes of using MoP bearings for revision after ceramic liner fracture in THR.
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Affiliation(s)
- Iulian Antoniac
- Biomaterials Group, Materials Science and Engineering Faculty, University Politehnica of Bucharest
| | - Mihai Negrusoiu
- Colentina Clinical Hospital, Clinic of Orthopaedics and Traumatology I, Bucharest
| | - Mihai Mardare
- Victor Babeş University of Medicine and Pharmacy, Timişoara
| | - Claudiu Socoliuc
- Department of Pathology, Colentina Clinical Hospital
- Department of Anatomical Pathology, Faculty of Dental Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest
| | - Ancuţa Zazgyva
- Department of Cell and Molecular Biology, University of Medicine and Pharmacy Tîrgu Mureş, Tîrgu Mureş
| | - Marius Niculescu
- Colentina Clinical Hospital, Clinic of Orthopaedics and Traumatology I, Bucharest
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Titu Maiorescu University, Bucharest, Romania
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Lee SJ, Kwak HS, Yoo JJ, Kim HJ. Bearing Change to Metal-On-Polyethylene for Ceramic Bearing Fracture in Total Hip Arthroplasty; Does It Work? J Arthroplasty 2016; 31:204-8. [PMID: 26404851 DOI: 10.1016/j.arth.2015.08.039] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 07/28/2015] [Accepted: 08/07/2015] [Indexed: 02/01/2023] Open
Abstract
We evaluated the short-term to midterm results of reoperation with bearing change to metal-on-polyethylene (MoP) after ceramic bearing fracture in ceramic-on-ceramic total hip arthroplasty. Nine third-generation ceramic bearing fractures (6 heads and 3 liners) were treated with bearing change to MoP. Mean age at reoperation was 52.7 years. Mean follow-up was 4.3 years. During follow-up, 2 of 3 liner-fractured hips and 1 of 6 head-fractured hips showed radiologic signs of metallosis and elevated serum chromium levels. Re-reoperation with bearing rechange to a ceramic head was performed for the hips with metallosis. One liner-fractured hip had periprosthetic joint infection. Dislocation occurred in 3 hips. From our experience, bearing change to MoP is not a recommended treatment option for ceramic bearing fracture in total hip arthroplasty.
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Affiliation(s)
- Soong Joon Lee
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hong Suk Kwak
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jeong Joon Yoo
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hee Joong Kim
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea; Medical Research Center, Seoul National University, Seoul, Republic of Korea
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Wiater BP, Baker EA, Salisbury MR, Koueiter DM, Baker KC, Nolan BM, Wiater JM. Elucidating trends in revision reverse total shoulder arthroplasty procedures: a retrieval study evaluating clinical, radiographic, and functional outcomes data. J Shoulder Elbow Surg 2015. [PMID: 26212759 DOI: 10.1016/j.jse.2015.06.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to explore relationships between damage modes in explanted reverse total shoulder arthroplasty (RTSA) components, patient and radiographic risk factors, and functional data to elucidate trends in RTSA failure. METHODS Fifty RTSA systems, retrieved from 44 patients, with 50 polyethylene (PE) liners, 30 glenospheres, 21 glenoid baseplates, 13 modular humeral metaphases, and 17 humeral stems, were examined for damage modes, including abrasion, burnishing, dishing, embedding, scratching, and pitting. PE liners were also analyzed for delamination and edge deformation. Charts were reviewed for patient, surgical, and functional data. Pre-revision radiographs were analyzed for scapular notching and loosening. RESULTS Average term of implantation was 20 months (range, 0-81 months). Metallic components exhibited abrasion, burnishing, dishing, pitting, and scratching. PE liners displayed all damage modes. Damage was exhibited on 93% of glenospheres and 100% of PE liners. Of 29 aseptic shoulders, 13 showed evidence of scapular notching and 5 of humeral loosening. There was a moderate correlation between radiographically observed implant failure or dissociation and PE embedding (r = 0.496; P < .001). There were weak and moderate correlations between scapular notching severity and PE dishing (r = 0.496; P = .006), embedding (r = 0.468; P = .010), and delamination (r = 0.384; P = .040). CONCLUSIONS To date, this is the largest series of retrieved RTSA components and the first to relate damage modes to radiographic and clinical data. Most damage was observed on the PE liners, on both the articular surface and rim, and glenosphere components. Correlation of retrieval findings with radiographic and clinical data may help establish predictors of prostheses at risk for failure.
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Affiliation(s)
- Brett P Wiater
- Department of Orthopaedic Surgery, Beaumont Health System, Royal Oak, MI, USA
| | - Erin A Baker
- Department of Orthopaedic Research, Beaumont Health System, Royal Oak, MI, USA; Department of Surgery, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Meagan R Salisbury
- Department of Orthopaedic Research, Beaumont Health System, Royal Oak, MI, USA
| | - Denise M Koueiter
- Department of Orthopaedic Research, Beaumont Health System, Royal Oak, MI, USA
| | - Kevin C Baker
- Department of Orthopaedic Research, Beaumont Health System, Royal Oak, MI, USA; Department of Surgery, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Betsy M Nolan
- Department of Orthopaedic Surgery, Beaumont Health System, Royal Oak, MI, USA
| | - J Michael Wiater
- Department of Orthopaedic Surgery, Beaumont Health System, Royal Oak, MI, USA; Department of Surgery, Oakland University William Beaumont School of Medicine, Rochester, MI, USA.
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