1
|
Zgouridou A, Kenanidis E, Potoupnis M, Tsiridis E. Global mapping of institutional and hospital-based (Level II-IV) arthroplasty registries: a scoping review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1219-1251. [PMID: 37768398 PMCID: PMC10858160 DOI: 10.1007/s00590-023-03691-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 08/13/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE Four joint arthroplasty registries (JARs) levels exist based on the recorded data type. Level I JARs are national registries that record primary data. Hospital or institutional JARs (Level II-IV) document further data (patient-reported outcomes, demographic, radiographic). A worldwide list of Level II-IV JARs must be created to effectively assess and categorize these data. METHODS Our study is a systematic scoping review that followed the PRISMA guidelines and included 648 studies. Based on their publications, the study aimed to map the existing Level II-IV JARs worldwide. The secondary aim was to record their lifetime, publications' number and frequency and recognise differences with national JARs. RESULTS One hundred five Level II-IV JARs were identified. Forty-eight hospital-based, 45 institutional, and 12 regional JARs. Fifty JARs were found in America, 39 in Europe, nine in Asia, six in Oceania and one in Africa. They have published 485 cohorts, 91 case-series, 49 case-control, nine cross-sectional studies, eight registry protocols and six randomized trials. Most cohort studies were retrospective. Twenty-three per cent of papers studied patient-reported outcomes, 21.45% surgical complications, 13.73% postoperative clinical and 5.25% radiographic outcomes, and 11.88% were survival analyses. Forty-four JARs have published only one paper. Level I JARs primarily publish implant revision risk annual reports, while Level IV JARs collect comprehensive data to conduct retrospective cohort studies. CONCLUSIONS This is the first study mapping all Level II-IV JARs worldwide. Most JARs are found in Europe and America, reporting on retrospective cohorts, but only a few report on studies systematically.
Collapse
Affiliation(s)
- Aikaterini Zgouridou
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece
| | - Eustathios Kenanidis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece.
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece.
| | - Michael Potoupnis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece
| | - Eleftherios Tsiridis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece
| |
Collapse
|
2
|
Cowell K, Statham P, Sagoo GS, Chandler JH, Herbert A, Rooney P, Wilcox RK, Fermor HL. Cost-effectiveness of decellularised bone allograft compared with fresh-frozen bone allograft for acetabular impaction bone grafting during a revision hip arthroplasty in the UK. BMJ Open 2023; 13:e067876. [PMID: 37802609 PMCID: PMC10565200 DOI: 10.1136/bmjopen-2022-067876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 09/11/2023] [Indexed: 10/10/2023] Open
Abstract
OBJECTIVES Fresh-frozen allograft is the gold-standard bone graft material used during revision hip arthroplasty. However, new technology has been developed to manufacture decellularised bone with potentially better graft incorporation. As these grafts cost more to manufacture, the aim of this cost-effectiveness study was to estimate whether the potential health benefit of decellularised bone allograft outweighs their increased cost. STUDY DESIGN A Markov model was constructed to estimate the costs and the quality-adjusted life years of impaction bone grafting during a revision hip arthroplasty. SETTING This study took the perspective of the National Health Service in the UK. PARTICIPANTS The Markov model includes patients undergoing a revision hip arthroplasty in the UK. INTERVENTION Impaction bone grafting during a revision hip arthroplasty using either decellularised bone allograft or fresh-frozen allograft. MEASURES Outcome measures included: total costs and quality-adjusted life years of both interventions over the lifetime of the model; and incremental cost-effectiveness ratios for both graft types, using base case parameters, univariate sensitivity analysis and probabilistic analysis. RESULTS The incremental cost-effectiveness ratio for the base case model was found to be £270 059 per quality-adjusted life year. Univariate sensitivity analysis found that changing the discount rate, the decellularised bone graft cost, age of the patient cohort and the revision rate all had a significant effect on the incremental cost-effectiveness ratio. CONCLUSIONS As there are no clinical studies of impaction bone grafting using a decellularised bone allograft, there is a high level of uncertainty around the costs of producing a decellularised bone allograft and the potential health benefits. However, if a decellularised bone graft was manufactured for £2887 and lowered the re-revision rate to less than 64 cases per year per 10 000 revision patients, then it would most likely be cost-effective compared with fresh-frozen allograft.
Collapse
Affiliation(s)
- Kern Cowell
- Institute of Medical and Biological Engineering, Faculty of Engineering and Physical Sciences, University of Leeds, Leeds, UK
| | - Patrick Statham
- Institute of Medical and Biological Engineering, Faculty of Engineering and Physical Sciences, University of Leeds, Leeds, UK
| | - Gurdeep Singh Sagoo
- Academic Unit of Health Economics, University of Leeds, Leeds, UK
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - James H Chandler
- Institute of Design, Robotics and Optimisation, Faculty of Engineering and Physical Sciences, University of Leeds, Leeds, UK
| | - Anthony Herbert
- Institute of Medical and Biological Engineering, Faculty of Engineering and Physical Sciences, University of Leeds, Leeds, UK
| | - Paul Rooney
- Research and Development, NHS Blood and Transplant Tissue and Eye Services, Speke, UK
| | - Ruth K Wilcox
- Institute of Medical and Biological Engineering, Faculty of Engineering and Physical Sciences, University of Leeds, Leeds, UK
| | - Hazel L Fermor
- Institute of Medical and Biological Eningeering, School of Biomedical Sciences, University of Leeds, Leeds, UK
| |
Collapse
|
3
|
Abu-Zeid MY, Habib MES, Marei SM, Elbarbary ANE, Ebied AA, Mesregah MK. Impaction bone grafting for contained acetabular defects in total hip arthroplasty. J Orthop Surg Res 2023; 18:671. [PMID: 37697375 PMCID: PMC10494409 DOI: 10.1186/s13018-023-04154-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 08/31/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Acetabular bone loss is a technical challenge in total hip arthroplasty (THA). This study sought to report the functional and radiological results of acetabular reconstruction using impaction bone grafting (IBG) in patients with acetabular bone deficiency undergoing primary or revision THA. METHODS In this prospective study, full history taking, preoperative clinical and radiological evaluation, and preoperative planning and templating were performed. The Paprosky classification and the American Academy of Orthopaedic Surgeons classification were used to assess the acetabular deficiencies. Clinical outcomes were assessed utilizing the Harris hip score (HHS) and a 4-question satisfaction questionnaire. Graft incorporation was evaluated in the last follow-up X-rays. RESULTS This study included 50 patients with a mean age of 46.7 ± 15.3 years. The THA was primary in 14 (28%) patients and revision in 36 (72%) patients. The mean HHS improved significantly from 28.8 ± 24.1 preoperatively to 76.6 ± 6.1, with a mean follow-up period of 23 months. Overall, 88% of patients were very satisfied. Complete radiological graft incorporation to host bone was achieved in 35 (70%) patients, and the remaining patients had partial incorporation. Complete graft incorporation was associated more frequently with primary THA, autografts, cementless cups, decreased defect size, and decreased graft layer thickness. CONCLUSIONS IBG for acetabular reconstruction in THA can achieve excellent clinical and radiological outcomes with a low complication rate. LEVEL OF EVIDENCE Level IV.
Collapse
Affiliation(s)
- Mohamed Yousry Abu-Zeid
- Department of Orthopaedic Surgery, Faculty of Medicine, Menoufia University, Shebin-El-Kom, Menoufia, Egypt
| | - Mohamed El-Sawy Habib
- Department of Orthopaedic Surgery, Faculty of Medicine, Menoufia University, Shebin-El-Kom, Menoufia, Egypt
| | - Sameh Mohamed Marei
- Department of Orthopaedic Surgery, Faculty of Medicine, Menoufia University, Shebin-El-Kom, Menoufia, Egypt
| | - Ahmed Nasr-Eldin Elbarbary
- Department of Orthopaedic Surgery, Faculty of Medicine, Menoufia University, Shebin-El-Kom, Menoufia, Egypt
| | - Ahmed Ali Ebied
- Department of Orthopaedic Surgery, Faculty of Medicine, Menoufia University, Shebin-El-Kom, Menoufia, Egypt
| | - Mohamed Kamal Mesregah
- Department of Orthopaedic Surgery, Faculty of Medicine, Menoufia University, Shebin-El-Kom, Menoufia, Egypt.
| |
Collapse
|
4
|
McPherson EJ, Stavrakis AI, Chowdhry M, Curtin NL, Dipane MV, Crawford BM. Biphasic bone graft substitute in revision total hip arthroplasty with significant acetabular bone defects : a retrospective analysis. Bone Jt Open 2022; 3:991-997. [PMID: 36545948 PMCID: PMC9783269 DOI: 10.1302/2633-1462.312.bjo-2022-0094.r1] [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] [Indexed: 12/24/2022] Open
Abstract
AIMS Large acetabular bone defects encountered in revision total hip arthroplasty (THA) are challenging to restore. Metal constructs for structural support are combined with bone graft materials for restoration. Autograft is restricted due to limited volume, and allogenic grafts have downsides including cost, availability, and operative processing. Bone graft substitutes (BGS) are an attractive alternative if they can demonstrate positive remodelling. One potential product is a biphasic injectable mixture (Cerament) that combines a fast-resorbing material (calcium sulphate) with the highly osteoconductive material hydroxyapatite. This study reviews the application of this biomaterial in large acetabular defects. METHODS We performed a retrospective review at a single institution of patients undergoing revision THA by a single surgeon. We identified 49 consecutive patients with large acetabular defects where the biphasic BGS was applied, with no other products added to the BGS. After placement of metallic acetabular implants, the BGS was injected into the remaining bone defects surrounding the new implants. Patients were followed and monitored for functional outcome scores, implant fixation, radiological graft site remodelling, and revision failures. RESULTS Mean follow-up was 39.5 months (36 to 71), with a significant improvement in post-revision function compared to preoperative function. Graft site remodelling was rated radiologically as moderate in 31 hips (63%) and strong in 12 hips (24%). There were no cases of complete graft site dissolution. No acetabular loosening was identified. None of the patients developed clinically significant heterotopic ossification. There were twelve reoperations: six patients developed post-revision infections, three experienced dislocations, two sustained periprosthetic femur fractures, and one subject had femoral component aseptic loosening. CONCLUSION Our series reports bone defect restoration with the sole use of a biphasic injectable BGS in the periacetabular region. We did not observe significant graft dissolution. We emphasize that successful graft site remodelling requires meticulous recipient site preparation.Cite this article: Bone Jt Open 2022;3(12):991-997.
Collapse
Affiliation(s)
- Edward J. McPherson
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, California, USA
| | - Alexandra I. Stavrakis
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, California, USA
| | - Madhav Chowdhry
- Nuffield Department of Primary Care Health Sciences & Department of Continuing Education, Kellogg College, University of Oxford, Oxford, UK
| | - Nora L. Curtin
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, California, USA
| | - Matthew V. Dipane
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, California, USA,Correspondence should be sent to Matthew V. Dipane. E-mail:
| | - Brooke M. Crawford
- Department of Orthopedic Surgery, The University of Miami Miller School of Medicine, Miami, Florida, USA
| |
Collapse
|
5
|
Quarto E, Zanirato A, Santolini F, Formica M. Bone impaction grafting and anti-protrusio cages in high-grade acetabular defects: a 22-year single centre experience. Arch Orthop Trauma Surg 2022; 142:2083-2091. [PMID: 34297189 DOI: 10.1007/s00402-021-04081-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 07/19/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Report clinical and radiological long-term follow-up (FU) outcome of bone impaction grafting (BIG) and anti-protrusio cage (APC) technique in hip revision surgery. MATERIALS AND METHODS We analysed data on complications, as well as the clinical and radiological outcome of patients treated using this technique at our institution. We evaluated the acetabular bone stock renovation, acetabular component stability and its radiological migration. The clinical parameters considered were the Visual Analogue Scale (VAS) and the modified Harris Hip Score (mHHS). RESULTS Forty hips, with a mean 14.3-year FU, were included. This technique showed good clinical long-term results in an elderly and low-demanding population (mean age at surgery 71.4 ± 12.1 years). The radiological results were not as good as clinical results: 67.5% of cases had a radiographic evidence of resorption of less than 1/3 of the bone graft; 27.5% had a resorption ranging from 1/3 and ½ of the graft, and 5% had more than ½ of the graft. Paprosky type III B reported worse results in terms of graft resorption and a greater migration of the APC (p < 0.001). The survival rate was 95% and a 2.5% rate of septic failure was recorded. CONCLUSION Impaction grafting with femoral head and APC is an effective technique for treating high-grade acetabular defects. APC reconstructs the hip centre of rotation, avoiding loading forces on the underlying bone graft that can be correctly integrated. At long-term FU, satisfactory clinical results, not strictly correlated to radiological signs of integration, were observed; Paprosky type III B reported worse results in terms of graft resorption and a greater migration of the APC.
Collapse
Affiliation(s)
- E Quarto
- Genova, Clinica Ortopedica, IRCCS Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy.
| | - A Zanirato
- Genova, Clinica Ortopedica, IRCCS Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy
| | - F Santolini
- Genova, Ortopedia e Traumatologia d'Urgenza, IRCCS Policlinico San Martino, Genoa, Italy
| | - M Formica
- Genova, Clinica Ortopedica, IRCCS Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy
| |
Collapse
|
6
|
Rizk P, LaChaud G, Zarezadeh A, Jang E, Nasri E, Prieto HA, Spiguel A. Complex Reconstruction for Acetabular Pathologic Fracture in Unusual Chondroblastoma With Aneurysmal Bone Cyst. Arthroplast Today 2022; 14:65-70. [PMID: 35252508 PMCID: PMC8889257 DOI: 10.1016/j.artd.2022.01.002] [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: 11/04/2021] [Revised: 01/01/2022] [Accepted: 01/03/2022] [Indexed: 12/01/2022] Open
Abstract
Treating bone loss with complex arthroplasty poses a significant challenge for the arthroplasty surgeon. When considering a reconstructive case after pathologic fracture and oncologic excision, a multidisciplinary approach with reliance on arthroplasty principles is critical. An 18-year-old patient presented with a complex acetabular pathologic fracture through a chondroblastoma with a secondary aneurysmal bone cyst. An outside institution performed a biopsy and placed a hip-spanning external fixator. Multidisciplinary planning led to tumor excision, complex acetabular arthroplasty reconstruction including structural bone grafting, and internal fixation. At the third year of follow-up, there was no evidence of mechanical loosening of the hip arthroplasty, reoperation, or tumor recurrence. The structural graft was completely osseointegrated, confirmed by a computed tomography scan obtained at 2 years postoperatively. This report demonstrates an unusual location of chondroblastoma, presenting with acetabular fracture definitively treated with complex multidisciplinary reconstruction leading to an excellent outcome in a young patient.
Collapse
Affiliation(s)
- Paul Rizk
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA
- Corresponding author. Department of Orthopaedic Surgery and Sports Medicine, University of Florida, 3450 Hull Road, Gainesville, FL 32608, USA. Tel.: +1 409 223 8487.
| | - Gregory LaChaud
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Ali Zarezadeh
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Eugene Jang
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Elham Nasri
- Department of Pathology, University of Florida, Gainesville, FL, USA
| | - Hernan A. Prieto
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Andre Spiguel
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA
| |
Collapse
|