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PubMed2005

The precision and usefulness of preoperative planning for cemented and hybrid primary total hip arthroplasty.

We evaluated the utility of a preoperative planning technique with a review of preoperative radiographs, templates, plans, charts and 6-week postoperative radiographs of 139 total hip arthroplasties (THAs) (116 cemented and 23 hybrid) to determine size, orientation of the implants, and cement column mantle, location of the planned and achieved center of rotation, and limb-length discrepancy. The acetabular component size was predicted exactly in 116 hips (83%) (within +/-1 size in 138 hips [99%]); the femoral component size was predicted exactly in 108 hips (78%) (within +/-1 size in 138 [99%]). In 75 arthroplasties (45%), the center of rotation was within 2 mm of horizontal and vertical distance from the plan, and in 127 (91%) arthroplasties, it was within 4 mm. The inclination of the cup averaged 44 degrees (range, 30 degrees -58 degrees ). The stem was in a neutral alignment in 122 hips (88%), varus in 11 hips (8%), and in 2 degrees of valgus in 6 hips (4%). In 103 arthroplasties with a normal contralateral hip or a THA, the average limb-length discrepancy was 1.71 mm. Preoperative planning is useful to predict the implant size, position, and alignment, to restore the center of rotation, and to equalize limb length.

Adult↗
PubMed2005

A 15- to 25- year follow-up study of primary Charnley low-friction arthroplasty: a single surgeon series.

Long term outcome studies are essential to determine the effectiveness and durability of a procedure. We report our 15 to 25 year clinical and radiographic follow-up with the Charnley low-friction hip arthroplasty. Four hundred and forty-seven primary Charnley hip arthroplasties were performed by a single surgeon. Ninety-eight of the 447 hips from 75 patients were available for follow up at average of 18.9 years (range 15.3 to 25.4 years). Seventy-two hips (73.5%) survived clinically. Of these 72, seventy-one stems (98.6%) and 60 sockets (83.3%) survived radiographically. Kaplan-Meier survival analysis on all 447 hips using revision as an endpoint revealed 66.2% +/- 5.7% survival at 20 years. Twenty-six hips were revised. The main reason for revision was failure of the socket. Complications included dislocation (3 of 98 hips), heterotopic ossification (7 of 98 hips), trochanteric wire breakage (6 of 98 hips), and trochanteric non-union (1 of 98 hips). Charnley low-friction hip arthroplasty is an effectiveand durable procedure. Key words: hip, arthroplasty, charnley, follow-up.

Adolescent↗
PubMed2004

Accumulation in liver and spleen of metal particles generated at nonbearing surfaces in hip arthroplasty.

Systemic migration of metal particles generated at nonbearing surfaces rather than the intended primary bearing was studied in postmortem specimens from 30 patients with total hip arthroplasty. Using light and electron microscopy with x-ray microanalysis, submicrometer metal particles were identified within macrophages in the liver and/or the spleen in 11 of 15 patients with a revised arthroplasty and in 2 of 15 patients with primary hip arthroplasty. The macrophages formed focal aggregates in the organs without apparent toxicity. Fretting at ancillary fixation devices, loose components, and modular connections can generate a substantial volume of debris. These particles are in addition to those generated at the bearing surfaces, further increasing both the local and systemic particulate burdens. While all components can be associated with the distant spread of particles and metal ions, it is the environment of revision arthroplasty that provides the greatest potential for the generation and systemic dissemination of wear debris. The long-term effects of accumulated wear particles in the liver and spleen are unknown.

Adult↗
PubMed2006

"Floating total knee": ipsilateral periprosthetic fractures of the distal femur and proximal tibia after total knee arthroplasty.

UNLABELLED: Currently, there are more than 300000 primary total knee arthroplasty (TKA) performed annually in the United States. It is estimated that 0.3% to 2.5% of these patients will sustain a periprosthetic fracture in association with a TKA [Haidukewych GJ, Jacofsky DJ, Hanssen AD. Treatment of periprosthetic fractures around a total knee arthroplasty. J Knee Surg 2003;16:111]. The first report of a periprosthetic fracture involving a TKA occurred in 1977 [Callaghan JJ. Periprosthetic fractures of the acetabulum during and following total hip arthroplasty. Instr Course Lect 1998;47:231]. The majority of periprosthetic fractures associated with a TKA are distal femoral fractures [Berry D. EPIDEMIOLOGY: hip and knee. In: Callaghan J, Duncan C, editors. Periprosthetic fractures after major joint replacement. Philadelphia: WB Saunders; 1999. p. 183]. Periprosthetic tibial fractures are rare and usually involve the medial tibial plateau in the presence of a loose component [Rand JA, Coventry MB. Stress fractures after total knee arthroplasty. J Bone Joint Surg Am 1980;62:226, Hanssen AD, Stuart MJ]. Treatment of periprosthetic tibial fractures. Clin Orthop 2000; p. 91]. The following case report describes the management of simultaneous ipsilateral distal femoral and proximal tibial periprosthetic fractures associated with a TKA. The patient was informed that data concerning the case would be submitted for publication. To our knowledge, this "floating total knee" injury has not been previously reported.

Accidental Falls↗
PubMed2005

Total knee arthroplasty in patients with Paget's disease of bone at the knee.

The purpose of this study was to identify the technical difficulties, complications, and long-term outcome of total knee arthroplasty in patients with Paget's disease. Twenty consecutive patients (21 knees) with Paget's disease at the knee who underwent primary total knee arthroplasty were retrospectively reviewed. All arthroplasties employed cemented condylar implants. Two patients died at less than 2 years and one was lost to follow-up; the remaining 17 (18 knees) were followed for an average of 9 years. Mean Knee Society scores for pain and function improved from 41 and 36 points preoperatively to 87 and 67 points, respectively, postoperatively. One patient underwent femoral revision for aseptic loosening at 10 years. None developed substantial heterotopic ossifications or deep infection. Total knee arthroplasty in patients with Paget's disease can provide good clinical results with low revision rate and good implant durability, despite technical challenges.

Aged↗
PubMed2006

Lateral unicompartmental knee arthroplasty: survivorship and technical considerations at an average follow-up of 12.4 years.

Successful medial unicompartmental knee arthroplasty is becoming standard; however, the "screw-home" mechanism, internal femoral rotation on a fixed tibia as the knee is fully extended, should be taken into account with lateral compartment arthroplasty. Twenty-nine consecutive lateral unicompartmental arthroplasties were performed with our unique tibial component positioning in 10 degrees to 15 degrees of internal rotation to compensate for the "screw-home" mechanism. The Hospital for Special Surgery knee score and serial radiographs were used in the evaluation of each patient. The mean duration of follow-up was 12.4 years with no revisions. The HSS score was excellent or good in all knees. The average postoperative femoral-tibial alignment was 5 degrees of valgus, and the average posterior tibial slope was 6 degrees . Lateral unicompartmental arthroplasty can provide excellent long-term results with modified positioning of the tibial component.

Aged↗
PubMed2006

Fracture of a ceramic femoral head after ceramic-on-ceramic total hip arthroplasty.

A case of fracture of the ceramic head of a total hip arthroplasty is presented, which was a total cementless arthroplasty with ceramic-on-ceramic articulation. No history of trauma was observed. The arthroplasty was revised, and a new cementless arthroplasty with a polyethylene insert and a metal head was inserted. The result has been satisfactory.

Adult↗
PubMed2006

The use of antifibrinolytic agents in total hip arthroplasty: a meta-analysis.

Total hip arthroplasty is associated with significant blood loss that often requires allogenic blood transfusions. Tranexamic acid and aprotinin have been shown to reduce blood loss and transfusions in clinical trials with variable results. This meta-analysis evaluates whether tranexamic acid and aprotinin significantly reduces blood loss and transfusion requirements in total hip arthroplasty. Thirteen clinical trials were identified. Combined, these agents were significant across all outcome measures in reducing blood loss and transfusions. Separately, only aprotinin was found to be significant. The data also showed that aprotinin (tranexamic acid is inconclusive) is only beneficial in revision total hip arthroplasty. Therefore, only aprotinin is effective in reducing both blood loss and transfusion requirements without an increase in thromboembolic complications in patients undergoing revision total hip arthroplasty.

Antifibrinolytic Agents↗
PubMed2004

Composition of joint fluid in patients undergoing total knee replacement and revision arthroplasty: correlation with flow properties.

The protein, phospholipid and hyaluronic acid (HA) contents of joint fluid samples were determined in specimens obtained from patients undergoing total knee arthroplasty (TKA) and revision TKA. It was hypothesized that these components would vary widely among patients undergoing TKA, and that the composition of joint fluid in patients undergoing revision would differ from that in patients undergoing revision. It was further hypothesized that HA concentration and molecular weight would principally determine the flow properties previously reported. Biochemical assays were used to assess protein and phospholipid content, and size exclusion chromatography was used to determine HA concentration and molecular weight. Sixty samples were included in the study. HA, protein, and phospholipid concentrations all varied widely in patients undergoing index TKA and revision TKA. HA concentration was lower in patients undergoing revision arthroplasty due to wear-related failure compared to patients undergoing the index procedure (0.9 +/- 0.4 mg/ml versus 1.3 +/- 0.5 mg/ml, mean +/- standard deviation, p = 0.04). Other components were not different between the groups. Flow properties at high shear rates were correlated with HA concentration and, to a lesser extent, HA molecular weight, but neither protein nor phospholipid concentration. The composition of joint fluid is highly variable in the context of arthroplasty. Much of the variation in flow properties, especially at high shear rate, is explained by large variation in HA concentration and small variation in HA molecular weight. The variation in composition and lower HA concentration in joints necessitating revision may relate to variation in arthroplasty lubrication leading to highly variable wear rates and clinical outcomes.

Aged↗
PubMed2005

The effect of shoulder arthroplasty on humeral strength: an in vitro biomechanical investigation.

BACKGROUND: Periprosthetic humeral fractures are a serious complication of shoulder arthroplasty. While adequate reaming of the canal and insertion of an oversized implant optimizes fit, such maneuvers also weaken the bone and predispose it to fracture. METHODS: The impact of the humeral arthroplasty was assessed in vitro on human cadaveric specimens. Strain gauges were attached to the distal diaphyses and the specimens were mounted in a torsion-loading fixture throughout the tests. An initial series examined the effect of reaming of the canal to its clinically appropriate diameter using uniaxial strain gauges. A second series utilized strain rosettes to evaluate the cumulative effects of reaming, broaching, and implant insertion. FINDINGS: Reaming of the canal to its clinically appropriate diameter significantly increased (P=0.007) uniaxial strain measurements by a mean of 30% with five of eight specimens showing increases of over 49% on at least one of four diaphyseal locations. In the second series, the surface strain was significantly affected by arthroplasty (P<0.008). Post-hoc analysis showed that the maximum in-plane shear strain following implant insertion was significantly increased relative to strain levels following reaming and broaching (P<0.009). The direction of the principal strain axes did not significantly change (P>0.46). Unexpected decreases in some strain measurements were observed as the arthroplasty procedure progressed perhaps reflecting overt mechanical failure within the humeral shaft. INTERPRETATION: The strain increase following reaming suggests a reduction in torsional strength by over 33% which is further reduced following broaching and implant insertion. For the practicing surgeon, post-operative strength can be adversely affected by both canal preparation and implant insertion.

Adult↗
PubMed2006

The case against first metatarsal phalangeal joint implant arthroplasty.

This article argues the practice of first metatarsal phalangeal joint (MPJ) implant arthroplasty. Intermediate and long-term studies raise concerns about implant failure and longevity. Other causes for concern are silicone-induced synovitis and lymphadenopathy. This article presents evidence against the practice of first metatarsal phalangeal implant arthroplasty. Intermediate and long-term studies raise concerns about implant failure and longevity. Furthermore, the lack of any significant long-term results and the documented metallic breakdown from two-piece metallic implants make their use in hallux rigidus questionable. Meanwhile, a comparative study shows the superiority of arthrodesis to implant arthroplasty. Also, alternatives to joint-destructive procedures are emerging. These include arthrodiastasis and the osteochondral autograft transfer procedure. This evidence proves that implant arthroplasty is not the best treatment for patients with hallux rigidus or other first-MPJ pathology.

Arthrodesis↗
PubMed2004

Ligament reconstruction with trapezium retention arthroplasty for carpometacarpal arthritis.

PURPOSE: The purpose of this study is to provide a qualitative and quantitative assessment of results in a consecutive series of patients with carpometacarpal arthritis using a trapezium-retaining interposition arthroplasty. METHODS: Between 1999 and 2002, 16 patients with basal joint arthritis were treated with a trapezium-retaining interposition arthroplasty. Fourteen of these patients were evaluated at a mean follow-up time of 20 months (minimum, 12 months) and were compared based on clinical outcome, presurgical and postsurgical x-ray evaluation, and range of motion, grip-strength, and pinch-strength values. RESULTS: Average trapezial height values as quantified by the trapezial space to proximal phalanx ratio were very similar before and after surgery. Average grip-strength values improved significantly. Although average pinch-strength and average range of motion values improved neither of these comparison values were significant. Thirteen of the 14 patients (93%) were satisfied with their results as quantified by postsurgical Disabilities of the Arm, Shoulder, and Hand questionnaires. CONCLUSIONS: Ligament reconstruction with trapezium retention arthroplasty of the basal joint not only successfully maintains trapezial height but also yields patient satisfaction rates comparable to those achieved with other forms of basal joint arthroplasty.

Adult↗
PubMed2004

Early failures with a spheric interposition arthroplasty of the thumb basal joint.

PURPOSE: The purpose of this study is to report the early results with the Orthosphere (Wright Medical Technology Inc, Arlington, TN) spheric interpositional arthroplasty. METHODS: Six women and 1 man had Orthosphere arthroplasty between 2000 and 2001. The mean age at the time of surgery was 52 years (range, 24-73 years) and the mean duration of clinical and radiographic follow-up evaluation was 33 months (range, 29-44 months). RESULTS: Six of 7 Orthosphere implants subsided into the trapezium resulting in pain, weakness, and stiffness. There was 1 implant dislocation. Five patients have had revision surgery to trapezial excision ligament reconstruction and tendon interposition arthroplasty. Of the remaining 2 patients 1 is contemplating presently revision surgery and the other is experiencing mild residual pain. No patients were satisfied completely with their Orthosphere results. CONCLUSIONS: In our experience the early outcome of the Orthosphere interpositional arthroplasty has been unacceptable. We no longer use the device at our institutions.

Adult↗
PubMed2006

Experimental investigation of finger dynamics before and after metacarpophalangeal joint arthroplasty.

PURPOSE: The purpose of this study was to quantify the changes in the arc of digital flexion before and after metacarpophalangeal (MCP) silicone arthroplasty with a 30 degrees preflexed design. METHODS: Index, middle, and ring fingers of 4 fresh-frozen cadaver hands were used. Each hand was attached (palmar side up) to a custom test apparatus. The tendon was drawn by a small winch-type servomotor. Micropotentiometers that were attached to the centers of rotation of the MCP, distal interphalangeal, and proximal interphalangeal joints measured angular displacement before and after MCP arthroplasty as a function of tendon excursion. The data were analyzed comparing the angle of flexion initiation and the angular displacement as a function of tendon excursion before and after joint arthroplasty. RESULTS: There were no statistical differences in the angles of the MCP joints at rest, the order of initiation of joint flexion, and the overall degree of flexion between the unoperated fingers and the fingers that had surgery. There was, however, a trend toward delay in flexion initiation, an increase in the MCP angle at rest, and a decrease in torque after implant arthroplasty. CONCLUSIONS: The decrease in initiation of flexion of the MCP joint, although not statistically significant, probably was related to the 30 degrees of preflexion built into the implant. We also noted a trend of decreased flexion at the MCP joint and increased flexion at the proximal interphalangeal and distal interphalangeal joints. This trend may be advantageous in the reconstruction of hands that initially have an MCP joint flexion deformity. TYPE OF STUDY/LEVEL OF EVIDENCE: to come.

Arthroplasty, Replacement, Finger↗
PubMed2007

A new abductor pollicis longus suspension arthroplasty.

PURPOSE: Surgical treatment of osteoarthritis of the first carpometacarpal joint aims to achieve complete pain relief with restoration of thumb strength and stability. The aim of this study was to introduce a variation of the abductor pollicis longus (APL) sling arthroplasty and to determine its efficacy in comparison with other tendon sling arthroplasty procedures. METHODS: Between January 1999 and December 2003, 104 trapeziectomies in 74 consecutive patients (30 bilateral cases) were performed using a new APL sling arthroplasty. Patients were evaluated at 6 and 12 months after surgery. The outcomes were analyzed subjectively by questionnaire and objectively by clinical and radiographic evaluation. RESULTS: After 6 months, excellent results in terms of pain relief were achieved in 95 thumbs (91%) of 65 patients. The remaining 9 thumbs had ongoing pain and had a secondary surgery performed between 6 and 12 months after the initial surgery. Pain relief was achieved in 1 thumb by scaphotrapezoid arthrodesis and in the other 8 thumbs by excision of the osteophyte on the ulnar-volar surface of the base of the first metacarpal, which was impinging on the base of the second metacarpal or the trapezoid. The gap was filled with a palmaris tendon anchovy. After 12 months, the 65 patients with successful trapeziectomies and APL sling remained pain-free. In these patients tip pinch, key pinch, and power grip strength increased by 46%, 19%, and 41%, respectively, from the preoperative values. In the 35 unilateral cases, tip pinch, key pinch, and power grip strength increased from 53%, 77%, and 65% of the contralateral hand strength before surgery to 82%, 89%, and 90%, respectively. CONCLUSIONS: This modified APL sling arthroplasty is a new and effective way of creating a suspension sling with the APL tendon after trapeziectomy, with results comparable or better than other published methods, for the treatment of osteoarthritis of the first carpometacarpal joint. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level IV.

Adult↗
PubMed2007

Pyrolytic carbon proximal interphalangeal joint arthroplasty: results with minimum two-year follow-up evaluation.

PURPOSE: To retrospectively review the surgical technique, postoperative therapy/splinting protocols, and clinical and radiographic outcomes of patients who had pyrolytic carbon proximal interphalangeal (PIP) joint arthroplasty. METHODS: A total of 50 PIP joint replacements in 35 patients were performed with a minimum follow-up period of 27 months. Indications for surgery included pain, decreased range of motion, instability, and/or deformity. The preoperative diagnosis was osteoarthritis in 14, rheumatoid arthritis in 11, and posttraumatic arthritis in 10. There were 20 women and 15 men affected. The average age at the time of surgery was 53 years. The fingers replaced included the index (15), middle (18), ring (10), and small (7). The preoperative arc of motion averaged 40 degrees (0 degrees-60 degrees ), and the pinch and grip measurements averaged 3 and 19 kg, respectively. The preoperative pain scores averaged 6 (scale, of 0-10) on a visual analog space scale. RESULTS: The arc of motion was 47 degrees after surgery, and the average pinch and grip measurements were 4 and 25 kg, respectively. Pain scores improved to 1. At the final follow-up evaluation the overall patient satisfaction was nearly 80%. The results of index finger PIP replacements are compatible with other digits. Fourteen joints (in 14 patients) to date have required additional procedures to improve or maintain joint motion/function or pain; 5 for minor reasons and 9 for major complications. The revision arthroplasty rate was 8%. No infections were noted. Although not medically necessary, 2 patients requested and had an amputation. Radiographic subsidence and subsequent settling (in accordance with Wolff's law) without apparent loosening occurred in 20 joints. CONCLUSIONS: Our 2-year minimum follow-up evaluation of pyrolytic carbon implant arthroplasty showed improved pain relief and good overall patient satisfaction. Twenty-eight percent of patients required a second procedure and 8% required a revision arthroplasty. Radiographs showed gross changes in implant and eventual settling to a stable position in 40% of the joints. A longer follow-up period will help to better determine the efficacy of this implant. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level IV.

Adult↗
PubMedDate not supplied

Shoulder arthroplasty in patients with osteoarthritis and dysplastic glenoid morphology.

Fifteen shoulders with primary osteoarthritis and dysplastic glenoid morphology underwent shoulder arthroplasty (eleven total shoulder arthroplasties and four hemiarthroplasties). Patients were evaluated at a mean of 37 months after replacement with clinical examination, Constant score, subjective patient opinion, and radiographic examination. One glenoid component was loose, necessitating removal; the remainder of the prostheses were in place at latest follow-up. Significant improvement was observed in Constant score (32 points preoperatively vs 71 points postoperatively) and active mobility (anterior elevation, 89 degrees preoperatively vs 146 degrees postoperatively; external rotation, 7 degrees preoperatively vs 45 degrees postoperatively) after arthroplasty. This study demonstrates that the rare scenario of osteoarthritis coupled with a dysplastic glenoid can be treated successfully with shoulder arthroplasty.

Aged↗
PubMedDate not supplied

Replacement arthroplasty in the weight-bearing shoulder of paraplegic patients.

We review the early results of shoulder arthroplasty in the weight-bearing shoulder of long-term paraplegic patients. We have been unable to find previously published results of this subgroup of shoulder arthroplasty patients in the literature. Five paraplegic, female patients who had undergone shoulder arthroplasty were analyzed. All patients had been prospectively assessed with the American Shoulder and Elbow Surgeons (ASES) function score and the Constant score. The mean age at the time of surgery was 70 years. Three shoulders had full-thickness rotator cuff tears, and two were repaired at the time of shoulder arthroplasty. The mean preoperative Constant score was 30 out of 100, improving to 52 out of 100 at a mean follow-up of 30 months (range, 24-36 months). The mean preoperative ASES function score was 28 out of 55, improving to 37 out of 55. One patient was pain-free after surgery, and the mean postoperative pain score was 10 out of 15. There were no features of progressive radiolucency around the glenoid or the humeral components at last review apart from one case in which glenoid implant migration occurred. In view of the satisfactory improvement in terms of pain, mobility, and independence, we believe that it is reasonable to continue to offer this procedure to this subgroup of patients. We will, however, remain vigilant with regard to any further complications arising in these prostheses in the medium to long term as a result of increased loading.

Aged↗