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Fiedler B, Patel V, Lygrisse KA, Kelly ME, Turcotte JJ, MacDonald J, Schwarzkopf R. The effect of reduced bone mineral density on elective total hip arthroplasty outcomes. Arch Orthop Trauma Surg 2023; 143:5993-5999. [PMID: 36920526 DOI: 10.1007/s00402-023-04830-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 02/28/2023] [Indexed: 03/16/2023]
Abstract
INTRODUCTION Reduced bone mineral density (BMD) and disruption of normal bony architecture are the characteristics of osteopenia and osteoporosis and in patients undergoing total hip arthroplasty (THA) may cause failure of trabecular ingrowth. The purpose of this study is to evaluate the impact of reduced BMD on outcomes following primary elective THA. METHODS A retrospective chart review of 650 elective THAs with a DEXA scan in their electronic health record (EHR) from 2011 to 2020 was conducted at an urban, academic center and a regional, health center. Patients were separated into three cohorts based on their t-score and the World Health Organizations definitions: normal (t-score ≥ - 1), osteopenia (t-score < - 1.0 and > - 2.5), and osteoporosis (t-score ≤ - 2.5). Demographic and outcome data were assessed. Subsidence was assessed for patients with non-cemented THAs. Regression models were used to account for demographic differences. RESULTS 650 elective THAs, of which only 11 were cemented, were included in the study. Patients with osteopenia and osteoporosis were significantly older than those without (p = 0.002 and p < 0.0001, respectively) and had a lower BMI (p < 0.0001 and p < 0.0001, respectively). PFx was significantly greater in patients with osteoporosis when compared to those with normal BMD (6.5% vs. 1.0%; p = 0.04). No such difference was found between osteoporotic and osteopenic patients. The revision rate was significantly higher for osteoporotic patients than osteopenic patients (7.5% vs. 1.5%; p = 0.04). No such difference was found between the other comparison groups. CONCLUSION Patients with osteoporosis were older with reduced BMI and had increased PFx after non-cemented elective THA. Understanding this can help surgeons formulate an appropriate preoperative plan for the treatment of patients with osteoporotic bone undergoing elective THA.
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Affiliation(s)
- Benjamin Fiedler
- Department of Orthopedic Surgery, NYU Langone Health, 301 E 17th St, New York, NY, 10003, USA
| | - Vaidehi Patel
- Department of Orthopedic Surgery, NYU Langone Health, 301 E 17th St, New York, NY, 10003, USA
| | - Katherine A Lygrisse
- Department of Orthopedic Surgery, NYU Langone Health, 301 E 17th St, New York, NY, 10003, USA
| | - McKayla E Kelly
- Adult Reconstructive Division, Anne Arundel Medical Center, Annapolis, MD, USA
| | - Justin J Turcotte
- Adult Reconstructive Division, Anne Arundel Medical Center, Annapolis, MD, USA
| | - James MacDonald
- Adult Reconstructive Division, Anne Arundel Medical Center, Annapolis, MD, USA
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, 301 E 17th St, New York, NY, 10003, USA.
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Rana M, Karmakar S, Bandyopadhyay A, Roychowdhury A. Design and manufacturing of patient-specific Ti6Al4V implants with inhomogeneous porosity. J Mech Behav Biomed Mater 2023; 143:105925. [PMID: 37244075 DOI: 10.1016/j.jmbbm.2023.105925] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/12/2023] [Accepted: 05/20/2023] [Indexed: 05/29/2023]
Abstract
Stress shielding remains a challenge in orthopaedic implants, including total hip arthroplasty. Recent development in printable porous implants offers improved patient-specific solutions by providing adequate stability and reducing stress shielding possibilities. This work presents an approach for designing patient-specific implants with inhomogeneous porosity. A novel group of orthotropic auxetic structures is introduced, and their mechanical properties are computed. These auxetic structure units were distributed at different locations on the implant along with optimized pore distribution to achieve optimum performance. A computer tomography (CT) based finite element (FE) model was used to evaluate the performance of the proposed implant. The optimized implant and the auxetic structures were manufactured using laser powder bed-based laser metal additive manufacturing. Validation was done by comparing FE results with experimentally measured directional stiffness and Poisson's ratio of the auxetic structures and strain on the optimized implant. The correlation coefficient for the strain values was within a range of 0.9633-0.9844. Stress shielding was mainly observed in Gruen zones 1, 2, 6, and 7. The average stress shielding on the solid implant model was 56%, reduced to 18% when the optimized implant was used. This significant reduction in stress shielding can decrease the risk of implant loosening and create an osseointegration-friendly mechanical environment on the surrounding bone. The proposed approach can be effectively applied to the design of other orthopaedic implants to minimize stress shielding.
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Affiliation(s)
- Masud Rana
- Department of Aerospace Engineering & Applied Mechanics, Indian Institute of Engineering Science and Technology, Shibpur, Howrah, 711103, India
| | - Santanu Karmakar
- Department of Mechanical Engineering, Indian Institute of Engineering Science and Technology, Shibpur, Howrah, 711103, India
| | - Amit Bandyopadhyay
- W. M. Keck Biomedical Materials Research Lab, School of Mechanical and Materials Engineering, Washington State University, Pullman, WA, 99164-2920, USA.
| | - Amit Roychowdhury
- Department of Aerospace Engineering & Applied Mechanics, Indian Institute of Engineering Science and Technology, Shibpur, Howrah, 711103, India.
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Kim HS, Park JW, Lee YK, Yoo JJ. The Early- to Mid-term Outcome of Novel Cementless Modular Femoral Stem in East Asian Patients. Clin Orthop Surg 2023; 15:211-218. [PMID: 37008979 PMCID: PMC10060786 DOI: 10.4055/cios22197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 06/30/2022] [Accepted: 07/13/2022] [Indexed: 04/04/2023] Open
Abstract
Background Early firm fixation of the femoral implant is crucial in total hip arthroplasty (THA) with unstable metaphysis or a large degree of femoral bone loss. This study aimed to evaluate the outcomes of THA using a novel cementless modular, fluted, tapered stem in such cases. Methods From 2015 to 2020, 105 hips (101 patients) had surgery performed by two surgeons at two tertiary hospitals using a cementless modular, fluted, tapered stem for periprosthetic fractures, massive bone loss, prosthetic joint infection sequelae, or tumorous condition. Clinical outcomes, radiographic results, and survivorship of the implant were evaluated. Results The average follow-up period was 2.8 years (range, 1-6.2 years). The Koval grade was 2.7 ± 1.7 preoperatively and maintained at 1.2 ± 0.8 at the latest follow-up. The plain radiograph showed bone ingrowth fixation in 89 hips (84.8%). The average stem subsidence at postoperative 1 year was 1.6 ± 3.2 mm (range, 0-11.0 mm). Five reoperations (4.8%) were needed, including 1 for acute periprosthetic fracture, 1 for recurrent dislocation, and 3 for chronic periprosthetic joint infection. Kaplan-Meier survivorship with reoperation for any reason as the endpoint was 94.1%. Conclusions The early- to mid-term results of THA with the novel cementless modular, fluted, tapered THA stem system were satisfactory clinically and radiologically. The shortcomings inherent to its modularity were not identified. This modular femoral system may provide adequate fixation and be a practical option in the setting of complicated THA.
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Affiliation(s)
- Hong Seok Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Jung-Wee Park
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young-Kyun Lee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jeong Joon Yoo
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
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Cong Y, Wang Y, Yuan T, Zhang Z, Ge J, Meng Q, Li Z, Sun S. Macrophages in aseptic loosening: Characteristics, functions, and mechanisms. Front Immunol 2023; 14:1122057. [PMID: 36969165 PMCID: PMC10030580 DOI: 10.3389/fimmu.2023.1122057] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 02/13/2023] [Indexed: 03/10/2023] Open
Abstract
Aseptic loosening (AL) is the most common complication of total joint arthroplasty (TJA). Both local inflammatory response and subsequent osteolysis around the prosthesis are the fundamental causes of disease pathology. As the earliest change of cell behavior, polarizations of macrophages play an essential role in the pathogenesis of AL, including regulating inflammatory responses and related pathological bone remodeling. The direction of macrophage polarization is closely dependent on the microenvironment of the periprosthetic tissue. When the classically activated macrophages (M1) are characterized by the augmented ability to produce proinflammatory cytokines, the primary functions of alternatively activated macrophages (M2) are related to inflammatory relief and tissue repair. Yet, both M1 macrophages and M2 macrophages are involved in the occurrence and development of AL, and a comprehensive understanding of polarized behaviors and inducing factors would help in identifying specific therapies. In recent years, studies have witnessed novel discoveries regarding the role of macrophages in AL pathology, the shifts between polarized phenotype during disease progression, as well as local mediators and signaling pathways responsible for regulations in macrophages and subsequent osteoclasts (OCs). In this review, we summarize recent progress on macrophage polarization and related mechanisms during the development of AL and discuss new findings and concepts in the context of existing work.
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Affiliation(s)
- Yehao Cong
- Department of Joint Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Orthopaedic Research Laboratory, Medical Science and Technology Innovation Center, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Yi Wang
- Department of Joint Surgery, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Tao Yuan
- Department of Joint Surgery, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Zheng Zhang
- Department of Joint Surgery, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Jianxun Ge
- Department of Joint Surgery, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Qi Meng
- Department of Joint Surgery, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Ziqing Li
- Department of Joint Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Orthopaedic Research Laboratory, Medical Science and Technology Innovation Center, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China
- *Correspondence: Ziqing Li, ; Shui Sun,
| | - Shui Sun
- Department of Joint Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Orthopaedic Research Laboratory, Medical Science and Technology Innovation Center, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China
- Department of Joint Surgery, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
- *Correspondence: Ziqing Li, ; Shui Sun,
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Han KS, Kang SR, Yoon SJ. Does the Periprosthetic Fracture Pattern Depend on the Stem Fixation Method in Total Hip Arthroplasty? Clin Orthop Surg 2023; 15:42-49. [PMID: 36778997 PMCID: PMC9880517 DOI: 10.4055/cios22004] [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: 01/04/2022] [Revised: 05/16/2022] [Accepted: 05/23/2022] [Indexed: 11/06/2022] Open
Abstract
Background Management of periprosthetic femoral fractures (PFFs) is reportedly challenging. Different patterns of PFFs would occur based on whether stem fixation was primarily cemented or cementless and whether these patterns would be associated with clinical outcomes, such as subsidence, fracture union, and complications, after stem revision. Methods A retrospective comparative study was performed, involving 52 PFF patients treated with tapered fluted modular stems (TFMSs). In the 52 patients with Vancouver B2 or B3, including 21 cemented stems and 31 cementless stems, fracture patterns and bone stock were analyzed. Clinical outcomes after revision surgery using the TFMSs were compared between the two groups. Results Transverse or short oblique type PFFs occurred around the cemented stem with loosening at the bone-cement interface. The Paprosky type III femoral deficiency and Vancouver type B3 fracture were observed more frequently in the cemented stem group. Otherwise, spiral fractures occurred more frequently in the cementless group (p < 0.001). Excessive subsidence of > 5 mm was observed more frequently in the cemented stem group (p < 0.001). The re-revision rates were higher in the cemented group than in the cementless group (p = 0.047). Conclusions In our study, it was found that the patterns of transverse or oblique PFFs were more frequently produced with cemented stems, while long spiral fractures were more frequent with cementless stems. Stem subsidence and reoperation related to complications were more common in patients with PFFs around cemented stems than those with PFFs around cementless stems.
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Affiliation(s)
- Kap-Soo Han
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Seung-rok Kang
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Sun-Jung Yoon
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea.,Department of Orthopedic Surgery, Jeonbuk National University Medical School, Jeonju, Korea
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Yoon BH, Park JW, Lee YK, Koo KH, Chang CB. Long-Term Wear-Related Complications of Cross-Linked Versus Conventional Polyethylene After Total Hip Arthroplasty: A Meta-Analysis. J Arthroplasty 2022; 37:2308-2315.e2. [PMID: 35568139 DOI: 10.1016/j.arth.2022.05.013] [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] [Received: 03/09/2022] [Accepted: 05/04/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Highly cross-linked polyethylene (HXLPE) liners have been developed to address the wear-related problems associated with conventional polyethylene (CPE) such as osteolysis or aseptic loosening in total hip arthroplasty (THA). In this systematic meta-analysis, we compared the long-term efficacy in preventing radiological osteolysis and revision surgery between HXLPE and CPE. METHODS We included 14 studies that compared HXLPE and CPE reporting the incidence of wear-related complications with a minimum follow-up of 10 years. We investigated 5 wear-related complications: osteolysis, excessive wear, linear wear rate, revision surgery due to wear, and progress of osteolysis/aseptic loosening. We conducted a pair-wise meta-analysis to estimate odds ratio (OR) and a proportional meta-analysis to estimate the incidence of each complication. RESULTS Among 1,175 THAs, 220 osteolysis and 78 wear-related revisions were detected. The use of HXLPE reduced the risk of overall osteolysis (OR 0.30; P = .001), excessive wear (OR 0.10; P < .001), linear wear rate (weighted mean difference 0.09; P < .001), the risk of overall wear-related revisions (OR 0.06; P < .001), and revisions due to aseptic loosening (OR 0.23; P = .015). As per the proportional meta-analysis, the pooled prevalence of osteolysis, excessive wear, and the overall wear-related revision rate were 14%, 8%, and 3% in HXLPE and 25%, 33%, and 20% in CPE, respectively. CONCLUSION The current evidence shows that HXLPE dramatically reduced the rate of osteolysis and wear-related revision surgery. However, as polyethylene wear and osteolysis still lead to revision surgery, ongoing clinical and retrieval studies are required to analyze long-term outcomes.
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Affiliation(s)
- Byung-Ho Yoon
- Department of Orthopedic Surgery, Ewha Womans University, College of Medicine, Mokdong Hospital, Seoul, South Korea
| | - Jung-Wee Park
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea; Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Kyung-Hoi Koo
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea; Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Chong Bum Chang
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea; Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
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Improving the Endoprosthesis Design and the Postoperative Therapy as a Means of Reducing Complications Risks after Total Hip Arthroplasty. LUBRICANTS 2022. [DOI: 10.3390/lubricants10030038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
One of the most high-tech, efficient and reliable surgical procedures is Total Hip Arthroplasty (THA). Due to the increase in average life expectancy, it is especially relevant for older people suffering from chronic joint disease, allowing them to return to an active lifestyle. However, the rejuvenation of such a severe joint disease as osteoarthritis requires the search for new solutions that increase the lifespan of a Total Hip Replacement (THR). Current trends in the development of this area are primarily focused on the creation of new materials used in THR and methods for their processing that meet the requirements of biocompatibility, long-term strength, wear resistance and the absence of an immune system response aimed at rejection. This study is devoted to the substantiation of one of the possible approaches to increase the reliability and durability of THR, based on the improvement of the implant design and postoperative rehabilitation technology, potentially reducing the risk of complications in the postoperative period.
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Briguglio M, Wainwright TW, Crespi T, Southern K, Mangiavini L, Craig J, Middleton RG. Oral Hydration Before and After Hip Replacement: The Notion Behind Every Action. Geriatr Orthop Surg Rehabil 2022; 13:21514593221138665. [PMID: 36393900 PMCID: PMC9647305 DOI: 10.1177/21514593221138665] [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] [Received: 09/27/2022] [Accepted: 10/25/2022] [Indexed: 11/11/2022] Open
Abstract
Introduction Even though nearly 20 patients undergo hip replacement every hour just in
Italy and the United Kingdom, it is unclear what are the most appropriate
oral hydration practices that patients should follow before and after
surgery. Improper administration can cause postoperative fluid disturbances
or exacerbate pre-existing conditions, which are not an uncommon find in
older subjects. Significance Considering that the number of hip operations is expected to increase in the
next years as well as the age of patients, it is important to recall the
notions behind water balance, especially in light of modern surgical and
anesthetic practices. This technical perspective discusses the perioperative
changes in the hydration status that occur during hip replacement and
provides the concepts that help clinicians to better manage how much water
the patient can drink. Results The points of view of the surgeon, the anesthetist, and the nurse are offered
together with the description of mineral waters intended for human
consumption. Before surgery, water should be always preferred over
caffeinated, sugar-sweetened, and alcoholic beverages. The drinking
requirements on the day of surgery should consider the water output from
urine, feces, respiration, exudation, and bleeding along with the water
input from metabolic production and intravenous administration of fluids and
medications. Healthy eating habits provide water and should be promoted
before and after surgery. Conclusions The judgment on which is the most appropriate approach to oral hydration
practices must be the responsibility of the multidisciplinary perioperative
team. Nevertheless, it is reasonable to argue that, in the presence of a
patient with no relevant illness and who follows a healthy diet, it is more
appropriate to stay closer to dehydration than liberalizing water intake
both prior to surgery and in the early postoperative hours until the
resumption of normal physiological functions.
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Affiliation(s)
- Matteo Briguglio
- IRCCS Orthopedic Institute Galeazzi, Scientific Direction, Milan, Italy
| | - Thomas W Wainwright
- Bournemouth University, Orthopaedic Research Institute, Bournemouth, United Kingdom
- University Hospitals Dorset, NHS Foundation Trust, United Kingdom
| | - Tiziano Crespi
- IRCCS Orthopedic Institute Galeazzi, Intensive Care Unit, Milan, Italy
| | - Kate Southern
- Bournemouth University, Orthopaedic Research Institute, Bournemouth, United Kingdom
- Nuffield Health Bournemouth Hospital, Bournemouth, United Kingdom
| | - Laura Mangiavini
- IRCCS Orthopedic Institute Galeazzi, Regenerative and Reconstructive Unit, Milan, Italy
- University of Milan, Department of Biomedical Sciences for Health, Milan, Italy
| | - James Craig
- Bournemouth University, Orthopaedic Research Institute, Bournemouth, United Kingdom
- University Hospitals Dorset, NHS Foundation Trust, United Kingdom
| | - Rob G Middleton
- Bournemouth University, Orthopaedic Research Institute, Bournemouth, United Kingdom
- University Hospitals Dorset, NHS Foundation Trust, United Kingdom
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