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Arthroplasty - Top 30 Publications

Massive Rotator Cuff Tear: When to Consider Reverse Shoulder Arthroplasty.

The purpose of this review is to discuss the indications for reverse shoulder arthroplasty (RSA) in the treatment of massive rotator cuff tear (MCT), review the reported outcomes in the literature, and outline our approach and surgical technique for treating these patients.

Femoral component alignment in unicompartmental knee arthroplasty leads to biomechanical change in contact stress and collateral ligament force in knee joint.

In recent years, the popularity of unicompartmental knee arthroplasty (UKA) has increased. However, the effect of femoral component positioning in UKA continues to invite a considerable debate. The purpose of this study involved assessing the biomechanical effect of mal-alignment in femoral components in UKA under dynamic loading conditions using a computational simulation.

The effect of humeral-fenestration diameter in Outerbridge-Kashiwagi arthroplasty on failure load of the distal humerus: a cadaveric biomechanical study.

Outerbridge-Kashiwagi ulnohumeral arthroplasty is an effective method in treating elbow osteoarthritis; however, distal humerus fracture after surgery can become a critical issue. A previous biomechanical study has shown that the failure load of the distal humerus decreases after a fenestration, but the size of the fenestration hole has not yet been discussed.

How to accurately determine the distal femoral valgus cut angle in the valgus knee arthroplasty.

Distal femoral resection in total knee arthroplasty (TKA) is commonly performed using intramedullary jigs with a pre-operatively planned valgus cut angle (VCA). For valgus knees with lateral femoral condyle hypoplasia, the method of determining the accurate VCA has not been clarified. The aim of the present study is to introduce a method that can accurately determine the distal femoral VCA in the valgus knee arthroplasty.

Impact of a new cryotherapy device on early rehabilitation after primary total knee arthroplasty (TKA): a prospective randomised controlled trial.

The aim of this prospective, randomised and single blinded study was to evaluate the efficiency and safety of a new cryotherapy device in patients undergoing unilateral, primary total knee arthroplasty (TKA). Our hypothesis was that patients administered to the new cryotherapy device would perform better than patients receiving a conventional standard cold therapy regimen.

Potential presence of metals in patients treated with metal-metal coupling prostheses for hip arthroplasty at 7 and 10 years of follow-up.

Beginning in 2008, metal-on-metal prostheses have been in the spotlight owing to much higher revision rates than expected. Adverse local tissue reactions have been well described in the literature as potential complications.

Opioid Use Disorders are Associated with Perioperative Morbidity and Mortality in the Hip Fracture Population.

To determine if opioid use disorders are associated with adverse perioperative outcomes in patients undergoing surgical fixation for proximal femur fractures.

Staged Prone/Supine Fixation of High-Energy Multicolumnar Tibial Plateau Fractures: A Multicenter Analysis.

We present a surgical strategy to manage multicolumnar tibial plateau fracture variants by addressing the predominant posterior fragment employing a Lobenhoffer approach in the prone position followed by supine patient repositioning for anterolateral column access.

Traumatic Obturator Dislocation Following Total Hip Arthroplasty Managed with Closed Reduction: A Case Report and Review of the Literature.

A 30-year-old man sustained an obturator dislocation of a left total hip prosthesis with a concomitant ipsilateral fracture of the greater trochanter following a high-energy motor-vehicle accident. With the patient under general anesthesia, the hip was successfully treated with closed reduction, as confirmed with intraoperative fluoroscopy and postoperative radiographs. Postreduction, the patient was able to mobilize with abduction restrictions and had no additional instability. Short-term follow-up showed evidence of healing of the greater trochanter.

Do screws and screw holes affect osteolysis in cementless cups using highly cross-linked polyethylene? A 7 to 10-year follow-up case control study.

The use of screws and the presence of screw holes may cause acetabular osteolysis and implant loosening in cementless total hip arthroplasty (THA) using conventional polyethylene. In contrast this issue is not fully understood using highly cross-linked polyethylene (HXLPE), particularly in large comparative study. Therefore, we performed a case-control study to assess the influence of screw usage and screw holes on: (1) implant fixation and osteolysis, and (2) polyethylene steady-state wear rate, using cases with HXLPE liners followed up for 7-10 years postoperatively.

Focal hypermobility observed in cervical arthroplasty with Mobi-C.

In recent decades cervical arthroplasty, or cervical disc replacement, has been steadily increasing in popularity as a procedure for the treatment of degenerative pathologies of the cervical spine. This is based on an evolving body of literature that documents superior outcomes in cervical disc replacement over fusion, for both single and double level pathologies, in well selected patients. One of the more recent and popular implants currently on the market is the Mobi-C cervical artificial disc (LDR Medical; Troyes, France). In this paper we report on two cases where focal hypermobility was observed following total disc replacement using the Mobi-C cervical artificial disc. This is followed by a discussion as to potential contributing factors to this hypermobility in relation to both implant design, and operative technique, suggesting potential changes that might prevent this in future patients.

National outcomes following single-level cervical disc arthroplasty versus anterior cervical discectomy and fusion.

To compare the differences in the thirty-day postoperative outcomes between cervical disc arthroplasty (CDA) and anterior cervical discectomy and fusion (ACDF).

Arthroscopic Iliopsoas Release at the Level of the Lesser Trochanter Following Total Hip Arthroplasty.

Iliopsoas impingement is an uncommon cause of pain after total hip arthroplasty. If pain persists after a trial of conservative treatment, surgical intervention can alleviate the patient's symptoms. Multiple advantages exist to release the iliopsoas tendon at the level of the lesser trochanter. The purpose of this Technical Note is to demonstrate a technique for arthroscopic release of the iliopsoas tendon at the lesser trochanter after total hip arthroplasty.

Validation of a new classification for periprosthetic shoulder fractures.

Successful treatment of periprosthetic shoulder fractures depends on the right strategy, starting with a well-structured classification of the fracture. Unfortunately, clinically relevant factors for treatment planning are missing in the pre-existing classifications. Therefore, the aim of the present study was to describe a new specific classification system for periprosthetic shoulder fractures including a structured treatment algorithm for this important fragility fracture issue.

Differential Proteomic Analysis of Synovial Fluid from Hip Arthroplasty Patients with a Pseudotumor vs. Periprosthetic Osteolysis.

Adverse tissue reactions to metal implants, including pseudotumors, can compromise implant functionality and survivorship. The identification of specific proteins in the synovial fluid (SF) of hip arthroplasty patients with a pseudotumor may lead to a better understanding of the underlying pathomechanisms. The objective of the present study was to compare the protein content of SF from patients with a short-term metal-on-metal hip implant associated with a pseudotumor and patients with a long-term metal-on-polyethylene hip implant associated with periprosthetic osteolysis. Discovery proteomics was used to identify differentially abundant proteins in albumin-depleted SF. In toto, 452 distinct proteins were identified. Thirty (30) of these 452 proteins were differentially abundant between the two groups, including two potential biomarkers: 6-phosphogluconate dehydrogenase (which plays a major protective role against oxidative stress) for the pseudotumor group, and scavenger receptor cysteine-rich type-1 protein M130 (which is involved in low-grade inflammation) for the periprosthetic osteolysis group. Other differentially abundant proteins identified suggest the presence of an adaptive immune response (particularly a type-IV hypersensitivity reaction), necrosis, and greater oxidative stress in patients with a pseudotumor. They also suggest the presence of an innate immune response, oxidative stress, tissue remodeling, and apoptosis in both patient groups, although differences in the specific proteins identified in each group point to differences in the pathomechanisms. Overall, results provide insights into the molecular mechanisms underlying metal-related pseudotumors and periprosthetic osteolysis, and may ultimately help elucidate pseudotumor etiology and assess the risk that asymptomatic pseudotumors will develop into an aggressive lesion. This article is protected by copyright. All rights reserved.

Diagnostic Utility of Histological Analysis for Detecting Ongoing Infection During Two-Stage Revision Arthroplasty in Patients With Inflammatory Arthritis.

Surgeons often rely on intra-operative histology (frozen sections [FS]) to determine the next step in surgical management during the second stage (re-implantation surgery) of 2-stage revision arthroplasty. The purpose of the study is to assess the accuracy of permanent sections (PS) and FS in the diagnosis of persistent infection during re-implantation in patients with an inflammatory arthritis.

Morbidity and Safety of Iliac Crest Reference Array Pins in Navigated Total Hip Arthroplasty: A Prospective Cohort Study.

Navigated total hip arthroplasty (THA) can employ intra-osseous pins through a separate incision to secure reference arrays to the iliac crest. This study is the first to investigate the consequences of pin use in THA in vivo.

The Association Between Readmission and Patient Experience in a Total Hip Arthroplasty Population.

Our goal was to determine whether readmissions within 30 or 90 days following discharge are associated with Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores for total hip arthroplasty (THA) patients.

What Influence Does the Time of Year Have on Postoperative Complications Following Total Knee Arthroplasty?

The time of year might influence the occurrence of surgical complications. Therefore, this study investigated correlations between the time-of-year and 30-day postoperative complication rates following primary total knee arthroplasty (TKA). Specifically, we determined (1) postoperative complication rates across all quarters; and (2) time-of-year influence on complications using univariate and multivariate regression analyses.

Interobserver and Intraobserver Reliability of Computed Tomography-Based Three-Dimensional Preoperative Planning for Primary Total Knee Arthroplasty.

Preoperative planning is an important factor for total knee arthroplasty (TKA). The aim of this study is to document the interobserver and intraobserver reliability of computed tomography (CT)-based 3-dimensional (3D) preoperative planning for primary TKA.

Factors Associated With Posterior Cruciate Ligament Tightness During Cruciate-Retaining Total Knee Arthroplasty.

The purpose of our study was to identify factors affecting posterior cruciate ligament (PCL) tightness during cruciate-retaining total knee arthroplasty.

Long-Term Outcome of Hip Arthroplasty in the Setting of Pigmented Villonodular Synovitis.

Pigmented villonodular synovitis (PVNS) is a rare, benign, painful proliferation of the synovium previously treated successfully with total hip arthroplasty (THA). Published results come from small series; therefore, the purpose of this study is to investigate the outcomes of THA in the setting of PVNS.

Discharge to Inpatient Rehab Does Not Result in Improved Functional Outcomes Following Primary Total Knee Arthroplasty.

Monitored rehabilitation has long been considered an essential part of the recovery process in total knee arthroplasty (TKA). However, the optimal setting for rehabilitation remains uncertain. We sought to determine whether inpatient rehabilitation settings result in improved functional and patient-reported outcomes after primary TKA.

Are Allogeneic Transfusions Decreasing in Total Knee Arthroplasty Patients? National Inpatient Sample 2009-2013.

Allogeneic transfusions are commonly used for substantial blood loss in total knee arthroplasty (TKA), but have been associated with adverse effects and increased costs. The purpose of this study is to provide a detailed description of (1) trends of allogeneic blood transfusion; (2) risk factors and adverse events; and (3) discharge disposition, length-of-stay (LOS), and cost/charge analysis for primary TKA patients who received an allogeneic blood transfusion from 2009-2013.

No Consensus for Femoral Head Impaction Technique in Surgeon Education Materials From Orthopedic Implant Manufacturers.

Prior studies indicate that one factor that may contribute to total hip arthroplasty failure due to mechanically assisted crevice corrosion at the femoral head-trunnion junction is the method of femoral head fixation.

Long-term results of custom cementless-stem total hip arthroplasty performed in hip fusion.

Due to complex anatomical considerations, results of cementless-stem total hip arthroplasty (THA) in hip fusion remain controversial compared with conventional THA. We therefore aimed to analyse 3D anatomy of the fused hip based on pre-operative computed tomography (CT) scans, functional outcomes based on the Harris Hip Score (HHS) and the Hip Disability and Osteoarthritis Outcome Score (HOOS), modifications of hip anatomy based on post-operative standardised radiography, and determine complication rate and long-term survival based on Kaplan-Meier analysis.

Vanadium allergy following total knee arthroplasty.

Allergic reactions to metals following joint arthroplasty represent a rare and poorly understood phenomenon. Much is still unknown regarding the natural history of this complication, and how it can best be prevented and managed. We present a case of a 68-year-old woman who underwent a left total knee arthroplasty for treatment of osteoarthritis. After an initial uneventful postoperative course, she developed a troublesome erythematous rash both around the incision site and over her trunk. Blood testing revealed no evidence of infection and clinically her prosthesis was functioning well. Skin patch testing revealed positive results for vanadium (+) and palladium (+). Her cutaneous symptoms are currently being managed conservatively and have shown a partial response to topical steroids. Revision surgery remains a long-term treatment option should conservative therapy fail; however, it would require a custom-made prosthesis as no standard tibial component is free from vanadium.

Our Experience with the Total Replacement of the First Metatarsophalangeal Joint by Medin PH-flex.

The first metatarsophalangeal (MTP) joint replacement ranks among the treatment methods of patients with hallux rigidus. The paper aims to evaluate the short-term to mid-term outcomes and to present clinical experience with our Medin PH-flex implant. MATERIAL AND METHODS In the period from January 2011 to 2016 we performed total replacement of the first MTP joint in 31 patients, in 4 cases bilaterally. In total, 35 implants were evaluated. The mean age of the patient at the time of surgery was 57.7 years (39-72 years). The surgery was conducted in 29 women and 2 men. The patients were evaluated using the AOFAS score (American Orthopaedic Foot and Ankle Society score), the radiographs were assessed as to the potential occurrence of radiolucent lines, with major stress put on the assessment of the mobility in MTP joint and its position. The pain was assessed based on the VAS score. RESULTS Prior to the joint replacement surgery, the mean AOFAS score in patients was 55.6 (35-65). Postoperatively, the mean AOFAS score was 80.8 (65-95). The pain suffered by patients was evaluated with the use of the Pain Visual Analogue Scale (VAS score). The preoperative mean VAS score was 5 (2-8), whereas the postoperative score improved to mean VAS 2 (0-4). The range of motion was clinically assessed with a goniometer. The mean range of motion of plantar flexion and dorsiflexion was 16.00° (5-35°) and 28.60° (10-55°), respectively. The mean range of motion was 36° (15-60°). No intraoperative complications were observed. In all the patients, the surgical wound healed per primam. In 2 female - (5.7 %) of the whole group of patients who underwent surgery a deep infection occurred, namely 10 and 21 months following the implantation. In both the female patients their condition was managed by joint revision operation and by a simple removal of the implant. DISCUSSION Joint replacement related matters were repeatedly discussed in professional literature. There are many papers published in the literature on this topic. A whole range of the first MTP joint implants of different shapes have been developed, with extremely different clinical results. CONCLUSIONS An appropriately chosen type of the implant, a fitting indication and a correctly applied implantation technique can lead to the desired good outcome. The first MTP joint replacement should be indicated after careful consideration since the management of a potential joint replacement failure can often be very technically challenging and quite mutilating for the patient. The mid-term outcomes of the Medin a.s. first MTP implant seem to be promising. It will, however, be necessary to wait for long-term outcomes in order to evaluate the final benefits of this type of implant in patients with hallux rigidus. Key words: hallux rigidus, arthroplasty of the MTP joint, hemiarthroplasty, silicone implant.

Influence of Enhanced Recovery Regime on Early Outcomes of Total Knee Arthroplasty.

PURPOSE OF THE STUDY Our study compared early outcomes of total knee arthroplasty performed in conventional and enhanced perioperative care regimes, i.e. without the use of Redon drain, with intensified perioperative analgesia and more frequent and intensive rehabilitation regime in the latter. MATERIAL AND METHODS The prospective study included 194 patients (76 men and 118 women) implanted with primary knee endoprosthesis. The mean age was 68.8 (44.7 - 88.0 years). The patients were divided into two groups - the "enhanced" and "conventional" procedures. In the first group, Redon suction drain was not inserted at the end of the surgery, and the patients commenced passive knee mobility exercise of the operated knee immediately after being brought back from the operating theatre. The general anaesthesia was supplemented by a combined femoral nerve block and wound infiltration with local anaesthetics. The second group comprised the patients who underwent conventional surgery, i.e. with the use of drain, without femoral nerve block, with no wound infiltration with local anaesthetics, and without immediate post-operative mobilization of the joint. The evaluation was carried out using regular clinical tools (subjective evaluation, objective examination, questionnaire and Knee Society Score (KSS)). Standard statistical methods were applied to data processing. RESULTS The patients under the "conventional regime" showed a significantly sharper drop in haemoglobin and haematocrit levels, higher consumption of blood transfusion and analgesics during the first three days after the surgery. The patients under the "enhanced regime" showed a better range of joint motion at hospital discharge, flexion in particular (p = 0.001). During the hospital stay no frequent swelling, secretion or wound reddening was reported in any of the monitored groups. In the "conventional" group, however, haematomas were more frequently present. The postoperative checks did not reveal any differences in satisfaction of the patients with the surgery. At the first follow-up examination at the outpatient department the "conventional" group patients more often reported knee pain and a feeling of a swollen knee. Nonetheless, their statements did not correspond with the VAS score. In the period between the 6th and 12th months following the surgery, the differences in the range of motion disappeared. The KSS showed a noticeable improvement in both the groups as against the preoperative values. In the "enhanced" group patients, the score increased dramatically at the beginning, whereas in the "conventional" group, the score was growing slowly and gradually until the last follow-up check after the surgery. The "conventional" group patients more frequently reported infectious complications (surface and deep wound infections: 4 vs. 2 patients) requiring a revision surgery (p = 0.024). DISCUSSION Recently, attention has been drawn to the rapid recovery approach, which eliminated postoperative immobilization and enabled the patient to start exercising already on the day of the surgery, with some patients even walking independently. The individual enhanced recovery regimes differ in details but mostly result in achieving the aim much sooner when compared to the conventional approaches. The patients under the enhanced recovery regimes can accomplish better functional outcomes in the first few months after the surgery than the patients undergoing the surgery under the conventional regime. The routine use of Redon drains in TKA is obviously unnecessary; it tends to be associated with a higher blood loss and a higher risk of prosthetic joint infection. CONCLUSIONS The TKA implant without suction drains combined with intensified perioperative analgesia and intensive postoperative rehabilitation is a safe way to earlier recovery of the function of the operated knee, or, by extension, the lower limb. The described approach is not associated with a higher risk of perioperative complications (bleeding, healing disorders or early infections). Patients also benefit from lower blood losses. Based on the results of our study, we recommend performing the TKA surgeries routinely without drains, with perioperative analgesia and immediate postoperative joint mobilization. Key words: total knee arthroplasty; perioperative care; rapid recovery; drainage; active movement; postoperative outcomes; pain; infection.

Occurrence and Progression of Early Radiolucent Lines around Total Knee Arthroplasty.

PURPOSE OF THE STUDY Radiolucent (RL) lines may appear around the total knee arthroplasty (TKA); they occur much more frequently under the tibial component than under the femoral one. The RL lines are gaps between the TKA and the cement, or between the cement and the bone bed. They are clearly visible immediately after the surgery or may appear later. They constitute pathology of the interface and are subject to research mainly due to their potential association with aseptic loosening. The aim of this study was to assess how often they are clearly visible on the first postoperative radiograph in everyday clinical practice, how they develop during the following two years, and to compare the results with the available professional literature. Another aim was to assess the relation between RL lines and the alignment of components, the patient's habitus and clinical outcomes of the surgery. MATERIAL AND METHODS The group included 62 patients with a total number of 69 TKA implants, of which 28 were men (45.2%) and 34 women (54.8%) aged 46 to 79 years of age. The occurrence of RL lines was monitored on the first postoperative radiograph and subsequently at a one-year interval during the following 2 years. The location of RL lines and the placement of components were assessed radiographically in terms of the concept by Meneghini et al. The evaluation of surgical outcomes was done using the Knee Society Score (KSS), and the habitus was assessed with the BMI index. Subjective evaluation of the surgical outcome was done using the 4-point satisfaction scale. RESULTS The first postoperative radiographs showed a RL line at 9 (0.8%) locations in 9 (13.0%) TKAs. The control radiographs made 1 year after the surgery showed a RL line at 42 (3.8%) locations in 29 (42.0%) TKAs. During the last check conducted 2 years after the surgery, a RL line was detected at 60 (5.4%) locations in 33 (47.8%) TKAs. Throughout the follow-up period, progression of the existing RL line occurred at 6 locations in 6 (8.7%) TKAs. On the very contrary, the RL line disappeared at 8 locations in 6 (8.7%) TKAs. An association was found between the RL line occurrence and postoperative limb axis (a higher risk was posed by the varus deformity). Moreover, the frequency of RL lines increased with the growing BMI value. No relation was found between the KSS and satisfaction with the surgery and the occurrence of RL lines. DISCUSSION AND CONCLUSIONS The occurrence of RL lines corresponds roughly with the frequency stated in literature. Some lines show progression, other disappear. So far, we have been unable to distinguish the predictively significant RL lines from the insignificant ones. Important will undoubtedly also be the size of surface of RL lines and their cause. More frequent RL lines were observed in the postoperative varus deformity of TKA and with the growing BMI value. The RL lines under the anterior part of the femoral component showed a tendency to progress. In order to avoid them we recommend modifying the cementing technique. Clinically significant is the fact that the RL lines occurrence correlates neither with subjective nor with clinical outcomes of the surgery. Key words: total knee arthroplasty; total knee replacement; radiolucent lines; progression; alignment; Knee Society Score; BMI.