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Dubin J, Hameed D, Moore MC, Bains SS, Patel S, Nace J, Mont MA, Delanois RE. Methodological Assessment of the 100 Most-Cited Articles in Total Knee Arthroplasty in the Last Decade Compared to the All-Time List. J Arthroplasty 2024; 39:1434-1443.e5. [PMID: 38135168 DOI: 10.1016/j.arth.2023.12.030] [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: 11/09/2023] [Revised: 12/04/2023] [Accepted: 12/15/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Recent advances in total knee arthroplasty (TKA) have been driven by a growing focus on evidence-based medicine. This transition is reflected in the critical appraisal of both, the quality of work and the potential impact on the orthopedic community. The purpose of our study was to (1) identify the top 100 most-cited articles in TKA in the last decade and from all-time, and (2) compare methodological rigor of the most-cited articles in TKA in the last decade to articles all-time by level of evidence. METHODS The top 100 cited articles were recorded for manuscripts from the last decade, January 1, 2012 to December 31, 2022, and manuscripts from all-time for TKA. We collected authors, year of publication, journal of the article, country of origin of authors, article type (basic science article, clinical research article), level of evidence, methodological index for non-randomized studies score, physiotherapy evidence database scale, and citation density (total citations/years published). RESULTS The largest number of studies for all-time TKA (53.0%) and decade TKA (42.0%) were Level III. The average methodological index for non-randomized studies score for comparative studies was 18.7 for all-time TKA and 20.7 for decade TKA (P < .001). The average physiotherapy evidence database score was 6.1 for all-time TKA and 8.1 for decade TKA (P > .05). The highest citation density for all-time TKA was 111 and for past decade was 63. The number of level II studies in TKA increased from 19.0% from all time to 38.0% from the last decade (P < .05). CONCLUSIONS Our findings of improved methodologies over time reflect positive steps toward evidence-based practice in TKA. A continued focus on producing methodologically sound studies may guide evidence-based clinical decision-making.
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Affiliation(s)
- Jeremy Dubin
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Daniel Hameed
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Mallory C Moore
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Sandeep S Bains
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Saarang Patel
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - James Nace
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Michael A Mont
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Ronald E Delanois
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
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Agarwal AR, Kuyl EV, Gu A, Golladay GJ, Thakkar SC, Siram G, Unger A, Rao S. Trend of using cementless total knee arthroplasty: a nationwide analysis from 2015 to 2021. ARTHROPLASTY 2024; 6:24. [PMID: 38581037 PMCID: PMC10998332 DOI: 10.1186/s42836-024-00241-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 02/05/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Modern cementless total knee arthroplasty (TKA) fixation has shown comparable long-term outcomes to cemented TKA, but the trend of using cementless TKA remains unclear. This study aimed to investigate the trend of using cementless TKA based on a national database. METHODS The patients undergoing cementless TKA between 2015 and 2021 were retrospectively extracted from the PearlDiver (Mariner dataset) Database. The annual percentage of cementless TKA was calculated using the following formula: annual number of cementless TKA/annual number of TKA. The trend of the number of patients undergoing cementless TKA was created according to a compounded annual growth rate (CAGR) calculation of annual percentages. Patient age, comorbidity, region, insurance type, etc., were also investigated. Differences were considered statistically significant at P < 0.05. RESULTS Of the 574,848 patients who received TKA, 546,731 (95%) underwent cemented fixation and 28,117 (5%) underwent cementless fixation. From 2015 to 2021, the use of cementless TKA significantly increased by 242% from 3 to 9% (compounded annual growth rate (CAGR): + 20%; P < 0.05). From 2015 to 2021, we observed a CAGR greater than 15% for all age groups (< 50, 50-59, 60-69, 70-74, 75 +), insurance types (cash, commercial, government, Medicare, Medicaid), regions (Midwest, Northeast, South, West), sex (male and female), and certain comorbidities (osteoporosis, diabetes mellitus, tobacco use, underweight (BMI < 18.5), rheumatoid arthritis) (P < 0.05 for all). Patients undergoing TKA with chronic kidney disease, prior fragility fractures, and dementia demonstrated a CAGR of + 9%-13% from 2015 to 2021 (P < 0.05). CONCLUSION From 2015 to 2021, the use of cementless TKA saw a dramatic increase in all patient populations. However, there is still no consensus on when to cement and in whom. Clinical practice guidelines are needed to ensure safe and effective use of cementless fixation.
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Affiliation(s)
- Amil R Agarwal
- Department of Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC, 20052, USA.
| | - Emile-Victor Kuyl
- Department of Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC, 20052, USA
| | - Alex Gu
- Department of Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC, 20052, USA
| | - Gregory J Golladay
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA, 23298, USA
| | - Savyasachi C Thakkar
- Department of Orthopaedic Surgery, Johns Hopkins Medicine, Baltimore, MD, 21205, USA
| | | | - Anthony Unger
- Washington Orthopaedics and Sports Medicine, Washington, DC, 20006, USA
| | - Sandesh Rao
- Washington Orthopaedics and Sports Medicine, Washington, DC, 20006, USA
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Dong Z, Guo Z, Guan M, Zhang Y, Xie P. FDG-Avid Periprosthetic Particle Disease Mimicking Osteosarcoma Recurrence. Clin Nucl Med 2024; 49:356-358. [PMID: 38271228 DOI: 10.1097/rlu.0000000000005061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
ABSTRACT A 24-year-old man with a history of osteosarcoma presented with swelling in his right thigh for more than 1 year. 18 F-FDG PET/CT demonstrated increased FDG uptake in multiple juxtacortical masses around the prosthesis, which highly suggested the possibility of osteosarcoma recurrence. A biopsy was performed, and the pathology confirmed the diagnosis of particle disease. The current case indicates that particle disease should be considered when interpreting the PET/CT images with high FDG uptake around the prosthesis.
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Affiliation(s)
- Ziqian Dong
- From the Department of Nuclear Medicine, The Third Hospital, Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
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Keun Seon J, Anwar Ayob K, Giun Noh M, Yeol Yang H. Peculiar reaction of oxidized zirconium from a total knee arthroplasty prosthesis: A case report. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2024; 58:68-72. [PMID: 38525513 PMCID: PMC11059476 DOI: 10.5152/j.aott.2024.23115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 12/05/2023] [Indexed: 03/26/2024]
Abstract
Oxidized zirconium (OxiniumTM) prostheses, made up of a metallic alloy of zirconium with a ceramic surface formed by oxidizing the outer layer, were developed as an alternative bearing surface to reduce polyethylene wear and decrease failure of total knee arthroplasty (TKA). We report a unique catastrophic failure of an Oxinium TKA with consequent accelerated wear and severe metallosis. Intraoperatively, we observed extensive wear grooving of the femoral component with exposure of the underlying silver layers and the complete wear of polyethylene on the medial side. Metallic debris had a peculiar arthrogram appearance, noted within the cut surface of the femur and tibia, indicative of the osteolysis that occurred, leading up to the failure of the implants. The histopathologic examination revealed a collection of macrophages with foreign-body reactions and black-pigmented metal-induced wear particles. Oxinium has clear benefits regarding superior wear properties; however, surgeons need to be aware that there is a risk of exposure to the underlying layers that may precede accelerated wear, deformation, and metallosis. Uncovering the deeper layers could result in the appearance of an arthrogram on plain radiographs. Early identification of polyethylene wear and prompt revision is crucial to avoid the rapid progression of subsequent metallosis and catastrophic implant failure, specifically when using oxidized zirconium components for TKA. To the best of our knowledge, this is the first report presenting a detailed histologic analysis to provide insight into the mechanisms of the failed Oxinium components.
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Affiliation(s)
- Jong Keun Seon
- Department of Orthopaedic Surgery, Chonnam National University Medical School and Hwasun Hospital, Hwasun-gun, Republic of Korea
| | - Khairul Anwar Ayob
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), University of Malaya, Faculty of Medicine, Kuala Lumpur, Malaysia
| | - Myung Giun Noh
- Department of Pathology, Chonnam National University Medical School and Hwasun Hospital, Hwasun-gun, Republic of Korea
| | - Hong Yeol Yang
- Department of Orthopaedic Surgery, Chonnam National University Medical School and Hwasun Hospital, Hwasun-gun, Republic of Korea
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Reif TJ, Greenstein MD, Greenberg M, Rozbruch SR. Distal Femoral Osteotomy for the Management of Coronal Deformity Following Total Knee Arthroplasty: A Report of 2 Cases. JBJS Case Connect 2024; 14:01709767-202403000-00007. [PMID: 38207074 DOI: 10.2106/jbjs.cc.23.00378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
CASE We present 2 cases demonstrating the management of coronal malalignment with an existing total knee arthroplasty using opening wedge distal femur osteotomy. The mechanical axis was corrected, and the primary total knee implants were maintained. Patients resumed full activity 3 to 4 months after surgery. CONCLUSION In certain cases, opening wedge distal femoral osteotomy is an option to correct coronal malalignment with an existing total knee arthroplasty without revising the implant.
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Affiliation(s)
- Taylor J Reif
- Limb Lengthening and Complex Reconstruction Service, Hospital for Special Surgery, New York, New York
| | - Michael D Greenstein
- Limb Lengthening and Complex Reconstruction Service, Hospital for Special Surgery, New York, New York
| | - Michael Greenberg
- Limb Lengthening and Complex Reconstruction Service, Hospital for Special Surgery, New York, New York
- Weill Cornell Medical College, New York, New York
| | - S Robert Rozbruch
- Limb Lengthening and Complex Reconstruction Service, Hospital for Special Surgery, New York, New York
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Sobhi S, Finsterwald MA, Häckel S, Holzer LA, Yates PJ. Medialized Dome and Anatomic Onlay Patella Designs in the Modern Posterior Stabilized Rotating Platform Total Knee Arthroplasty Demonstrate No Clinical or Radiological Differences at One Year. J Arthroplasty 2024; 39:87-95. [PMID: 37321517 DOI: 10.1016/j.arth.2023.06.005] [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: 03/24/2023] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND A successful outcome after total knee arthroplasty (TKA) includes the restoration of patellofemoral function. Modern patella component designs in TKA include a medialized dome and more recently, an anatomic design. There is a paucity of literature comparing these 2 implants. METHODS This prospective nonrandomized study examined 544 consecutive TKAs with patella resurfacing using a posterior-stabilized, rotating platform knee prothesis performed by a single surgeon. A medialized dome patella design was used in the first 323 cases and an anatomic design in the subsequent 221 cases. Patients were assessed preoperatively, at 4 weeks and 1-year post-TKA for Oxford Knee Score (OKS) (total, pain, and kneeling components) and range of movement (ROM). Radiolucent lines (RLLs), patellar tilts and displacements, as well as reoperations were assessed at 1-year post-TKA. RESULTS At 1-year post-TKA, both groups demonstrated similar improvements in ROM, OKS, pain, and kneeling scores, and had a similar incidence of fixed-flexion deformity (all P > .05). Radiographically, there was no clinically significant difference in the incidence of RLLs, patellar tilts, and displacements. The prevalence of reoperations (1.8 versus 3.2%, P = .526) was similar between the designs with no patella-related complications. CONCLUSION Both medialized dome and anatomic patella designs result in improved ROM and OKS with no patella-related complications. However, our study showed no differences between the designs at 1 year.
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Affiliation(s)
- Salar Sobhi
- Orthopaedic Research Foundation of Western Australia, Perth, Western Australia, Australia; Department of Orthopaedic Surgery, Fiona Stanley Fremantle Hospitals Group, Murdoch, Western Australia, Australia
| | - Michael A Finsterwald
- Orthopaedic Research Foundation of Western Australia, Perth, Western Australia, Australia; Department of Orthopaedic Surgery, Fiona Stanley Fremantle Hospitals Group, Murdoch, Western Australia, Australia
| | - Sonja Häckel
- Orthopaedic Research Foundation of Western Australia, Perth, Western Australia, Australia; Department of Orthopaedic Surgery, Fiona Stanley Fremantle Hospitals Group, Murdoch, Western Australia, Australia
| | - Lukas A Holzer
- Orthopaedic Research Foundation of Western Australia, Perth, Western Australia, Australia; Department of Orthopaedic Surgery, Fiona Stanley Fremantle Hospitals Group, Murdoch, Western Australia, Australia
| | - Piers J Yates
- Orthopaedic Research Foundation of Western Australia, Perth, Western Australia, Australia; Department of Orthopaedic Surgery, Fiona Stanley Fremantle Hospitals Group, Murdoch, Western Australia, Australia; School of Surgery (Orthopaedics), University of Western Australia, Perth, Western Australia, Australia; Department of Orthopaedic Surgery, St John of God Hospital, Murdoch, Perth, Western Australia, Australia
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7
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Wimmer MA, Rad EM, Laurent MP, Pourzal R. Striated Pattern on Worn Surface of a Retrieved TKR Tibial Insert Stems from Microstructural Changes in the UHMWPE. BIOTRIBOLOGY (OXFORD) 2023; 35-36:100256. [PMID: 38053775 PMCID: PMC10695354 DOI: 10.1016/j.biotri.2023.100256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
Polyethylene wear has been a concern for the longevity of total knee replacements (TKR). A characteristic wear feature often observed on the articular surfaces of retrieved polyethylene tibial inserts is a striated pattern of hills and troughs. This pattern is of interest because its surface area has been found to correlate with increased tibial insert wear. We therefore addressed the following two research questions: (1) What is the prevalence of the striated pattern on a contemporary tibial insert design made from conventional ultra-high-molecular-weight polyethylene (UHMWPE)? (2) Are the peaks and troughs of the striated pattern connected with differences in crystallinity developed during the wear process? The prevalence and area coverage of the striated patterns were determined on a set of 81 retrieved tibial inserts of a cruciate-retaining TKR design. The striated areas were mapped using an optical coordinate measuring machine. Differences in crystallinity between troughs and hills were determined on a representative tibial insert using Raman spectroscopy. The striated pattern was observed on 61 out of 81 (75%) of the retrieved tibial inserts, covering an average of 32% of the total articular area. In the representative insert that was evaluated, the hills exhibited higher crystallinity (68%) than the troughs (54%) (p = 0.001). Conversely, the troughs exhibited higher amorphous phase content (22%) than the hills (19%) (p = 0.04). In conclusion, this pattern of hills and troughs is another example of microstructural changes in UHMWPE stemming from tribological stresses.
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Affiliation(s)
- Markus A Wimmer
- Rush University Medical Center, Chicago, Illinois, USA
- University of Illinois at Chicago, Chicago, Illinois, USA
| | - Elmira M Rad
- University of Illinois at Chicago, Chicago, Illinois, USA
| | | | - Robin Pourzal
- Rush University Medical Center, Chicago, Illinois, USA
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Dreyer MJ, Weisse B, Contreras Raggio JI, Zboray R, Taylor WR, Preiss S, Horn N. The influence of implant design and limb alignment on in vivo wear rates of fixed-bearing and rotating-platform knee implant retrievals. J Orthop Res 2023. [PMID: 37975250 DOI: 10.1002/jor.25734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 10/11/2023] [Accepted: 11/14/2023] [Indexed: 11/19/2023]
Abstract
Analysis of polyethylene (PE) wear in knee implants is crucial for understanding the factors leading to revision in total knee arthroplasty. Importantly, current experimental and computational methods for predicting insert wear can only be validated against true in vivo measurements from retrievals. This study quantitatively investigated in vivo PE wear rates in fixed-bearing (FB) (n = 21) and rotating-platform (n = 53) implant retrievals. 3D surface geometry of the retrievals was measured using a structured light scanner. Then, a reference surface that included the deformation, but not the wear that the retrievals had experienced in vivo, was constructed using a fully automatic surface reconstruction algorithm. Finally, wear volume was calculated from the deviation between the worn and reconstructed surfaces. The measurement and analysis techniques were validated and the algorithm was found to produce errors of only 0.2% relative to the component volumes. In addition to quantifying cohort-level wear rates, the effect of mechanical axis limb alignment on mediolateral wear distribution was examined for a subset of the retrievals (n = 14 + 26). Our results show that FB implants produce significantly (p = 0.04) higher topside wear rates (24.6 ± 10.1 mm3 /year) than rotating-platform implants (15.3 ± 8.0 mm3 /year). This effect was larger than that of limb alignment, which had a smaller and nonsignificant influence on overall wear rates (+4.5 ± 11.6 mm3 /year, p = 0.43). However, increased varus alignment was associated significantly with greater medial compartment wear in both the FB and rotating-platform designs (+1.7 ± 1.3%/° and +1.8 ± 1.6%/°). Our findings emphasize the importance of implant design and limb alignment on wear outcomes, providing reference data for improving implant performance and longevity.
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Affiliation(s)
- Michael J Dreyer
- Laboratory for Movement Biomechanics, Institute for Biomechanics, ETH Zürich, Zürich, Switzerland
- Laboratory for Mechanical Systems Engineering, Empa, Dübendorf, Switzerland
| | - Bernhard Weisse
- Laboratory for Mechanical Systems Engineering, Empa, Dübendorf, Switzerland
| | - José Ignacio Contreras Raggio
- Laboratory for Mechanical Systems Engineering, Empa, Dübendorf, Switzerland
- Facultad de Ingeniería y Ciencias, Universidad Adolfo Ibáñez, Viña del Mar, Chile
| | - Robert Zboray
- Center for X-ray Analytics, Empa, Dübendorf, Switzerland
| | - William R Taylor
- Laboratory for Movement Biomechanics, Institute for Biomechanics, ETH Zürich, Zürich, Switzerland
| | - Stefan Preiss
- Department of Lower Extremities, Schulthess Clinic, Zürich, Switzerland
| | - Nils Horn
- Department of Lower Extremities, Schulthess Clinic, Zürich, Switzerland
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9
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Nakagawa Y, Koga H, Nakamura T, Horie M, Katagiri H, Ozeki N, Ohara T, Sekiya I, Muneta T, Watanabe T. Mid-term clinical outcomes of a posterior stabilized total knee prosthesis for Japanese patients: A minimum follow-up of 5 years. J Orthop Sci 2023; 28:1325-1330. [PMID: 36462994 DOI: 10.1016/j.jos.2022.09.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 08/24/2022] [Accepted: 09/21/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND A high-flexion posterior-stabilized total knee prosthesis has been developed for the Asian population. The component design was based on computed tomography images of Japanese osteoarthritic knees. The femoral component is composed of zirconia ceramics, which exhibit low friction and high durability. The present study aimed to evaluate the mid-term clinical outcomes of this implant. METHODS This study included 334 knees of 210 patients who underwent primary total knee arthroplasty with this implant at our hospital between October 2010 and December 2014. The patients comprised 28 men and 172 women with an average age of 73 years. The average follow-up period was 5.9 years, and the follow-up rate was 71.1%. Clinical outcomes were assessed using the Knee Society scoring system, 2011 Knee Society questionnaire, and Knee Injury and Osteoarthritis Outcome Score. Kaplan-Meier survivorship analysis was performed to determine the cumulative prosthesis survival rate. RESULTS In terms of clinical outcomes at the final follow-up, the average ranges of motion were -2.0 in extension and 126.7 in flexion. The Knee Society knee and function scores were 94.2% and 72.6%, respectively. With revision surgery or radiographic failure for any reason as the endpoint, the survival rates at 5 and 9 years were 98.2% and 95.5%, respectively. The most common reason for revision surgery or radiological failure was aseptic loosening. CONCLUSIONS Despite several revision cases mainly due to aseptic loosening, the present study found that this new high-flexion posterior-stabilized total knee arthroplasty prosthesis design showed comparable results for Asian populations with other PS prosthesis. LEVELS OF EVIDENCE Level Ⅱ (Prospective cohort study).
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Affiliation(s)
- Yusuke Nakagawa
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Hideyuki Koga
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Tomomasa Nakamura
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Masafumi Horie
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Hiroki Katagiri
- Second Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minami-Koshigaya, Koshigaya-shi, 343-8555 Saitama, Japan
| | - Nobutake Ozeki
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Toshiyuki Ohara
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Ichiro Sekiya
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Takeshi Muneta
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Toshifumi Watanabe
- Second Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minami-Koshigaya, Koshigaya-shi, 343-8555 Saitama, Japan.
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10
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Ganz MP, Mannino A, Scuderi GR. The Double-Patella Sign: A Patellar Implant Loosening Case Report. JBJS Case Connect 2023; 13:01709767-202312000-00022. [PMID: 37917772 DOI: 10.2106/jbjs.cc.23.00292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
CASE A 79-year-old man status post total knee arthroplasty (TKA) sustained atraumatic nondisplaced fracture of the inferior pole of the patella 1 year postoperatively. The patient had full radiographic healing and clinical resolution. Two years after injury, the patient reported new-onset knee pain and was found to have atraumatic inferior migration of the patellar component. The lateral radiograph appeared to demonstrate 2 patellae, coined "the double-patella sign." CONCLUSION Nondisplaced patellar fractures after TKA should be monitored even after full osseous healing for component loosening. Inferior migration of a loose patellar component can mimic 2 patellae on the lateral radiograph, mimicking a double patella.
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Affiliation(s)
- Maximillian P Ganz
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Angelo Mannino
- Department of Orthopedic Surgery, Northwell Health, Lenox Hill Hospital, New York, New York
| | - Giles R Scuderi
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
- Department of Orthopedic Surgery, Northwell Health, Lenox Hill Hospital, New York, New York
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11
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Olšovská E, Čabanová K, Motyka O, Kryštofová HB, Matějková P, Voves J, Židlík V, Madeja R, Demel J, Halfar J, Kukutschová J. Simple method for quantification of metal-based particles in biopsy samples of patients with long bone implants - Pilot study. ENVIRONMENTAL TOXICOLOGY AND PHARMACOLOGY 2023; 103:104282. [PMID: 37769889 DOI: 10.1016/j.etap.2023.104282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 09/19/2023] [Accepted: 09/23/2023] [Indexed: 10/02/2023]
Abstract
The presence of particles fixed in tissue samples due to implant degradation or disintegration plays an important role in post-operative complications. The ability to determine the size, shape, chemical composition and, above all, the number of these particles can be used in many areas of medicine. This study presents a novel, simple metal-based particle detection method using scanning electron microscopy with energy dispersive spectrometer (SEM-EDS). The presence of metal particles in biopsy specimens from long bone nail-fixated implants (10 patients with titanium steel nails and 10 patients with stainless steel nails) was studied. The samples were analysed using automated area analysis based on image binarization and brightness to 255 grayscale. The results were supplemented with histological data and statistically analysed. The method based on the software used was found to be accurate and easy to use and, thus, appears to be very suitable for particle detection in similar samples.
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Affiliation(s)
- Eva Olšovská
- Nanotechnology Centre, CEET, VSB - Technical University of Ostrava, 17. listopadu 2172/15, Ostrava-Poruba 708 00, Czech Republic; Faculty of Material Science and Technology, Center for Advanced Innovation Technologies, VSB - Technical University of Ostrava, 17. listopadu 2172/15, Ostrava-Poruba 708 00, Czech Republic.
| | - Kristina Čabanová
- Faculty of Material Science and Technology, Center for Advanced Innovation Technologies, VSB - Technical University of Ostrava, 17. listopadu 2172/15, Ostrava-Poruba 708 00, Czech Republic; Faculty of Mining and Geology, VSB-Technical University of Ostrava, 17. listopadu 2172/15, Ostrava-Poruba 708 00, Czech Republic
| | - Oldřich Motyka
- Nanotechnology Centre, CEET, VSB - Technical University of Ostrava, 17. listopadu 2172/15, Ostrava-Poruba 708 00, Czech Republic; Faculty of Mining and Geology, VSB-Technical University of Ostrava, 17. listopadu 2172/15, Ostrava-Poruba 708 00, Czech Republic
| | - Hana Bielniková Kryštofová
- Faculty of Material Science and Technology, Center for Advanced Innovation Technologies, VSB - Technical University of Ostrava, 17. listopadu 2172/15, Ostrava-Poruba 708 00, Czech Republic; Institute of Molecular and Clinical Pathology and Medical Genetics, University Hospital Ostrava and Faculty of Medicine, 17. listopadu 1790/5, Ostrava-Poruba 708 52, Czech Republic; Institute of Emergency, Medicine Faculty of Medicine, University of Ostrava, Syllabova 19, Ostrava 703 00, Czech Republic
| | - Petra Matějková
- Faculty of Material Science and Technology, Center for Advanced Innovation Technologies, VSB - Technical University of Ostrava, 17. listopadu 2172/15, Ostrava-Poruba 708 00, Czech Republic
| | - Jiří Voves
- Department of Trauma Surgery, University Hospital Ostrava, 17. listopadu 1790/5, Ostrava-Poruba 708 52, Czech Republic; Institute of Emergency, Medicine Faculty of Medicine, University of Ostrava, Syllabova 19, Ostrava 703 00, Czech Republic
| | - Vladimír Židlík
- Institute of Molecular and Clinical Pathology and Medical Genetics, University Hospital Ostrava and Faculty of Medicine, 17. listopadu 1790/5, Ostrava-Poruba 708 52, Czech Republic; Institute of Emergency, Medicine Faculty of Medicine, University of Ostrava, Syllabova 19, Ostrava 703 00, Czech Republic
| | - Roman Madeja
- Department of Trauma Surgery, University Hospital Ostrava, 17. listopadu 1790/5, Ostrava-Poruba 708 52, Czech Republic; Institute of Emergency, Medicine Faculty of Medicine, University of Ostrava, Syllabova 19, Ostrava 703 00, Czech Republic
| | - Jiří Demel
- Department of Trauma Surgery, University Hospital Ostrava, 17. listopadu 1790/5, Ostrava-Poruba 708 52, Czech Republic; Institute of Emergency, Medicine Faculty of Medicine, University of Ostrava, Syllabova 19, Ostrava 703 00, Czech Republic; Faculty of Medicine, Masaryk University, Kamenice 753/5, Brno 625 00, Czech Republic
| | - Jan Halfar
- Faculty of Material Science and Technology, Center for Advanced Innovation Technologies, VSB - Technical University of Ostrava, 17. listopadu 2172/15, Ostrava-Poruba 708 00, Czech Republic; Faculty of Mining and Geology, VSB-Technical University of Ostrava, 17. listopadu 2172/15, Ostrava-Poruba 708 00, Czech Republic
| | - Jana Kukutschová
- Faculty of Material Science and Technology, Center for Advanced Innovation Technologies, VSB - Technical University of Ostrava, 17. listopadu 2172/15, Ostrava-Poruba 708 00, Czech Republic
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12
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Kormi S, Koivu H, Kohonen I, Mäkelä K, Tiusanen H, Saltychev M. The ceramic coated implant (CCI). Evolution total ankle replacements: a retrospective analysis of 40 ankles with 8 years follow-up. Acta Orthop Belg 2023; 89:515-524. [PMID: 37935237 DOI: 10.52628/89.3.11585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
Diminutive data is available on the outcome of several previously used total ankle replacement implants. The purpose of this study was to investigate the medium-term functional and radiological outcome and implant survival of the CCI Evolution implant. Consecutive series of 40 ankles operated in our hospital with primary TAR using the CCI Evolution implant in 2010-2013 were available for follow-up. The prospective clinical and radiographic data including the Kofoed score, subjective satisfaction and standard radiographs were collected preoperatively and at fixed time-points postoperatively. A CT was obtained in cases where osteolysis or loosening were suspected. The improvement of the Kofoed score and subjective satisfaction were statistically significant (p<0.0001). The implant survival was 97% (95% confidence interval (CI) 81%-100 %) at 5 years, and 81 % (95% confidence interval (CI) 60 %-92%) at 8 years. There were altogether 25 (64%) complications. Overall revision rate was 28% and failure rate 13%. The CCI implant outcome was not acceptable. The malposition of prosthetic components, subsidence, and peri-implant osteolysis were recorded often. Although the patient reported outcome measures improved, mostly due to positive changes in pain severity, overall revision and failure rates were high and comparable with previous findings of the CCI implant.
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13
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Andersen MR, Winther N, Lind T, Schrøder H, Flivik G, Petersen MM. Tibial Component Undersizing Is Related to High Degrees of Implant Migration Following Cementless Total Knee Arthroplasty: A Study of Radiostereometric Analysis Data for 111 Patients with 2-Year Follow-up. JB JS Open Access 2023; 8:e23.00032. [PMID: 37575962 PMCID: PMC10412432 DOI: 10.2106/jbjs.oa.23.00032] [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] [Indexed: 08/15/2023] Open
Abstract
Radiostereometric analysis (RSA) studies have shown that the continuous migration of tibial components is predictive of aseptic loosening following total knee arthroplasty (TKA). In the present study, we investigated whether accurate sizing and placement of tibial components are related to the degree of implant migration as measured with use of RSA. Methods A total of 111 patients who underwent TKA surgery with a cementless tibial component were followed for a period of 2 years postoperatively, during which implant migration was assessed with use of RSA. RSA was performed within 7 days postoperatively and after 3, 6, 12, and 24 months. Postoperative radiographs were evaluated for component size and placement in the tibia. The evaluations were performed by experienced knee surgeons who were blinded to the migration data and clinical outcomes. A multivariable linear regression analysis was conducted. Results Continuous implant migration (i.e., migration occurring between 12 and 24 months postoperatively) had a negative association with tibial component size (coefficient [B], -0.2; 95% confidence interval [CI], -0.33 to -0.08). Subsidence was associated with the absence of posterior cortical bone support (B, -0.7; 95% CI, -1.09 to -0.28), the absence of lateral cortical bone support (B, 0.8; 95% CI, 0.29 to 1.37), frontal-plane varus malalignment (B, 0.6; 95% CI, 0.12 to 1.16), and component undersizing (B, -0.4; 95% CI, -0.06 to -0.68). Posterior tilt was associated only with undersizing (B, 0.6; 95% CI, 0.27 to 1.11). Conclusions Undersized cementless tibial components are at a higher risk for poor fixation with continuous migration following TKA. Therefore, a higher risk of aseptic loosening should be expected. Level of Evidence Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Mikkel Rathsach Andersen
- Department of Orthopedics, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Nikolaj Winther
- Department of Orthopedics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Lind
- Department of Orthopedics, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Schrøder
- Department of Orthopedics, Næstved Sygehus, Syddansk Universitet, Odense, Denmark
| | - Gunnar Flivik
- Department of Orthopedics, Skåne University Hospital, Lund University, Lund, Sweden
| | - Michael Mørk Petersen
- Department of Orthopedics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Prodromidis AD, Chloros GD, Thivaios GC, Sutton PM, Pandit H, Giannoudis PV, Charalambous CP. High rate of radiolucent lines following the cemented original design of the ATTUNE total knee arthroplasty. Bone Joint J 2023; 105-B:610-621. [PMID: 37259548 DOI: 10.1302/0301-620x.105b6.bjj-2022-0675.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Aims Loosening of components after total knee arthroplasty (TKA) can be associated with the development of radiolucent lines (RLLs). The aim of this study was to assess the rate of formation of RLLs in the cemented original design of the ATTUNE TKA and their relationship to loosening. Methods A systematic search was undertaken using the Cochrane methodology in three online databases: MEDLINE, Embase, and CINAHL. Studies were screened against predetermined criteria, and data were extracted. Available National Joint Registries in the Network of Orthopaedic Registries of Europe were also screened. A random effects model meta-analysis was undertaken. Results Of 263 studies, 12 were included with a total of 3,861 TKAs. Meta-analysis of ten studies showed high rates of overall tibial or femoral RLLs for the cemented original design of the ATTUNE TKA. The overall rate was 21.4% (95% confidence interval (CI) 12.7% to 33.7%) for all types of design but was higher for certain subgroups: 27.4% (95% CI 13.4% to 47.9%) for the cruciate-retaining type, and 29.9% (95% CI 15.6% to 49.6%) for the fixed-bearing type. Meta-analysis of five studies comparing the ATTUNE TKA with other implants showed a significantly higher risk of overall tibial or femoral RLLs (odds ratio (OR) 2.841 (95% CI 1.219 to 6.623); p = 0.016) for the ATTUNE. The rates of loosening or revision for loosening were lower, at 1.2% and 0.9% respectively, but the rates varied from 0% to 16.3%. The registry data did not report specifically on the original ATTUNE TKA or on revision due to loosening, but 'all-cause' five-year revision rates for the cemented ATTUNE varied from 2.6% to 5.9%. Conclusion The original cemented ATTUNE TKA has high rates of RLLs, but their clinical significance is uncertain given the overall low associated rates of loosening and revision. However, in view of the high rates of RLLs and the variation in the rates of loosening and revision between studies and registries, close surveillance of patients who have undergone TKA with the original ATTUNE system is recommended.
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Affiliation(s)
- Apostolos D Prodromidis
- Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, Leeds, UK
| | - George D Chloros
- Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, Leeds, UK
| | | | - Paul M Sutton
- Department of Orthopaedics, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Hemant Pandit
- Department of Orthopaedics, Chapel Allerton Hospital, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Peter V Giannoudis
- Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, Leeds, UK
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
| | - Charalambos P Charalambous
- Department of Orthopaedics, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
- School of Medicine, University of Central Lancashire, Preston, UK
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15
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Jabbal M, Simpson AHR, Walmsley P. Mechanisms of bone loss in revision total knee arthroplasty and current treatment options. Orthop Rev (Pavia) 2023; 15:75359. [PMID: 37405274 PMCID: PMC10317505 DOI: 10.52965/001c.75359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/06/2023] Open
Abstract
Purpose Primary total knee arthroplasty (TKA) is an effective treatment which is increasing in use for both elderly and younger patients. With the overall increasing life span of the general population, the rate of revision TKA is projected to increase significantly over the coming decades. Analyses from the national joint registry of England and Wales support this prediction with an increase in primary TKA of 117% and an increase in revision TKA of 332% being forecast by 2030. Bone loss presents a challenge in revision TKA so an understanding of the aetiology and principles behind this is essential for the surgeon undertaking revision. The purpose of this article is to review the causes of bone loss in revision TKA, discuss the mechanisms of each cause and discuss the possible treatment options. Methods The Anderson Orthopaedic Research Institute (AORI) classification and zonal classification of bone loss are commonly used in assessing bone loss in pre-operative planning and will be used in this review. The recent literature was searched to find advantages and limitations of each commonly used method to address bone loss at revision TKA. Studies with the highest number or patients and longest follow-up period were selected as significant. Search terms were: "aetiology of bone loss", "revision total knee arthroplasty", "management of bone loss". Results Methods for managing bone loss have traditionally been cement augmentation, impaction bone grafting, bulk structural bone graft and stemmed implants with metal augments. No single technique was found to be superior. Megaprostheses have a role as a salvage procedure when the bone loss is deemed to be too significant for reconstruction. Metaphyseal cones and sleeves are a newer treatments with promising medium to long term outcomes. Conclusion Bone loss encountered at revision TKA presents a significant challenge. No single technique currently has clear superiority treatment should be based on a sound understanding of the underlying principles.
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Jiao Z, Chai H, Wang S, Sun C, Huang Q, Xu W. SOST gene suppression stimulates osteocyte Wnt/β-catenin signaling to prevent bone resorption and attenuates particle-induced osteolysis. J Mol Med (Berl) 2023; 101:607-620. [PMID: 37121919 PMCID: PMC10163143 DOI: 10.1007/s00109-023-02319-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 04/01/2023] [Accepted: 04/11/2023] [Indexed: 05/02/2023]
Abstract
The most common cause for prosthetic revision surgery is wear particle-induced periprosthetic osteolysis, which leads to aseptic loosening of the prosthesis. Both SOST gene and its synthetic protein, sclerostin, are hallmarks of osteocytes. According to our previous findings, blocking SOST induces bone formation and protects against bone loss and deformation caused by titanium (Ti) particles by activating the Wnt/β-catenin cascade. Although SOST has been shown to influence osteoblasts, its ability to control wear-particle-induced osteolysis via targeting osteoclasts remains unclear. Mice were subjected to development of a cranial osteolysis model. Micro CT, HE staining, and TRAP staining were performed to evaluate bone loss in the mouse model. Bone marrow-derived monocyte-macrophages (BMMs) made from the C57BL/6 mice were exposed to the medium of MLO-Y4 (co-cultured with Ti particles) to transform them into osteoclasts. Bioinformatics methods were used to predict and validate the interaction among SOST, Wnt/β-catenin, RANKL/OPG, TNF-α, and IL-6. Local bone density and bone volume improved after SOST inhibition, both the number of lysis pores and the rate of skull erosion decreased. Histological research showed that β-catenin and OPG expression were markedly increased after SOST inhibition, whereas TRAP and RANKL levels were markedly decreased. In-vitro, Ti particle treatment elevated the expression of sclerostin, suppressed the expression of β-catenin, and increased the RANKL/OPG ratio in the MLO-Y4 cell line. TNF-α and IL-6 also elevated after treatment with Ti particles. The expression levels of NFATc1, CTSK, and TRAP in osteoclasts were significantly increased, and the number of positive cells for TRAP staining was increased. Additionally, the volume of bone resorption increased at the same time. In contrast, when SOST expression was inhibited in the MLO-Y4 cell line, these effects produced by Ti particles were reversed. All the results strongly show that SOST inhibition triggered the osteocyte Wnt/β-catenin signaling cascade and prevented wear particle-induced osteoclastogenesis, which might reduce periprosthetic osteolysis. KEY MESSAGES: SOST is a molecular regulator in maintaining bone homeostasis. SOST plays in regulating bone homeostasis through the Wnt/β-catenin signaling pathway. SOST gene suppression stimulates osteocyte Wnt/β-catenin signaling to prevent bone resorption and attenuates particle-induced osteolysis.
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Affiliation(s)
- Zixue Jiao
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, Jiangsu, China
| | - Hao Chai
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, Jiangsu, China
- Department of Orthopedics, Taiyuan Central Hospital of Shanxi Medical University, Taiyuan, 030009, Shanxi, China
| | - Shendong Wang
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, Jiangsu, China
| | - Chunguang Sun
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, Jiangsu, China
- Department of Orthopedics, Funing People's Hospital, Yancheng, 224400, Jiangsu, China
| | - Qun Huang
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, Jiangsu, China
- Department of Orthopedics, Zhangjiagang City First People's Hospital, Zhangjiagang, 215699, Jiangsu, China
| | - Wei Xu
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, Jiangsu, China.
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de Ridder R, Kaptein BL, Pijls BG, Nelissen RGHH, Kaptijn HH. Five-year migration and insert wear of uncemented tibial components with either conventional polyethylene or sequentially annealed highly crosslinked polyethylene inserts: a blinded randomized controlled trial using radiostereometric analysis. Bone Joint J 2023; 105-B:518-525. [PMID: 37121577 DOI: 10.1302/0301-620x.105b5.bjj-2022-0986.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
The primary objective of this study was to compare the five-year tibial component migration and wear between highly crosslinked polyethylene (HXLPE) inserts and conventional polyethylene (PE) inserts of the uncemented Triathlon fixed insert cruciate-retaining total knee arthroplasty (TKA). Secondary objectives included clinical outcomes and patient-reported outcome measures (PROMs). A double-blinded, randomized study was conducted including 96 TKAs. Tibial component migration and insert wear were measured with radiostereometric analysis (RSA) at three, six, 12, 24, and 60 months postoperatively. PROMS were collected preoperatively and at all follow-up timepoints. There was no clinically relevant difference in terms of tibial component migration, insert wear, and PROMs between the HXLPE and PE groups. The mean difference in tibial component migration (maximal total point migration (MTPM)) was 0.02 mm (95% confidence interval (CI) -0.07 to 0.11), which is below the value of 0.2 mm considered to be clinically relevant. Wear after five years for HXLPE was 0.16 mm (95% CI 0.05 to 0.27), and for PE was 0.23 mm (95% CI 0.12 to 0.35). The mean difference in wear rate was 0.01 mm/year (95% CI -0.02 to 0.05) in favour of the HXLPE group. Wear is mainly present on the medial side of the insert. There is no clinically relevant difference in tibial component migration and insert wear for up to five years between the HXLPE conventional PE inserts. For the implant studied, the potential advantages of a HXLPE insert remain to be proven under clinical conditions at longer-term follow-up.
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Affiliation(s)
- Ruud de Ridder
- Department of Orthopaedics, Lange Land Hospital Zoetermeer, Zoetermeer, Netherlands
- Reinier Haga Orthopaedic Centre, Zoetermeer, Netherlands
- Department of Orthopaedics, Leiden University Medical Centre, Leiden, Netherlands
| | - Bart L Kaptein
- Department of Orthopaedics, Leiden University Medical Centre, Leiden, Netherlands
| | - Bart G Pijls
- Department of Orthopaedics, Leiden University Medical Centre, Leiden, Netherlands
| | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Centre, Leiden, Netherlands
| | - Herman H Kaptijn
- Department of Orthopaedics, Lange Land Hospital Zoetermeer, Zoetermeer, Netherlands
- Reinier Haga Orthopaedic Centre, Zoetermeer, Netherlands
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Lu Y, Xu X, Yang C, Hosseinkhani S, Zhang C, Luo K, Tang K, Yang K, Lin J. Copper modified cobalt-chromium particles for attenuating wear particle induced-inflammation and osteoclastogenesis. BIOMATERIALS ADVANCES 2023; 147:213315. [PMID: 36746101 DOI: 10.1016/j.bioadv.2023.213315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 12/28/2022] [Accepted: 01/22/2023] [Indexed: 01/30/2023]
Abstract
The nature of aseptic prosthetic loosening mainly relates to the wear particles that induce inflammation and subsequent osteoclastogenesis. The ideal approach to impede wear particle-induced osteolysis should minimize inflammation and osteoclastogenesis. In this work, Co29Cr9W3Cu particles were used as a research model for the first time to explore the response of Co29Cr9W3Cu particles to inflammatory response and osteoclast activation in vitro and in vivo by using Co29Cr9W particles as the control group. In vitro studies showed that the Co29Cr9W3Cu particles could promote the generation of M2-phenotype macrophages and increase the expression level of anti-inflammatory factor IL-10, while inhibiting the formation of M1-phenotype macrophages and down-regulating the expression of inflammatory factors TNF-α, IL-6 and IL-1β; More importantly, the Co29Cr9W3Cu particles reduced the expression of NF-κB and downstream osteoclast related-specific transcription marker genes, such as TRAP, NFATc1, and Cath-K; In vivo results indicated that the Co29Cr9W3Cu particles exposed to murine calvarial contributed to decreasing the amount of osteoclast and osteolysis area. These findings collectively demonstrated that Cu-bearing cobalt-chromium alloy may potentially delay the development of aseptic prosthetic loosening induced by wear particles, which is expected to provide evidence of Co29Cr9W3Cu alloy as an alternative material of joint implants with anti-wear associated osteolysis.
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Affiliation(s)
- Yanjin Lu
- Key Laboratory of Optoelectronic Materials Chemistry and Physics, Fujian Institute of Research on the Structure of Matter, Chinese Academy of Sciences, Fuzhou 350001, China; Key Laboratory of Opto-Electronic Science and Technology for Medicine of Ministry of Education, Fujian Provincial Key Laboratory of Photonics Technology, College of Photonic and Electronic Engineering, Fujian Normal University, Fuzhou 350117, China; Fujian Science & Technology Innovation Laboratory for Optoelectronic Information of China, Fuzhou, Fujian 350108, China
| | - Xiongcheng Xu
- Research Center of Oral Tissue Engineering, School and Hospital of Stomatology, Fujian Medical University, Fuzhou 350001, China
| | - Chunguang Yang
- Institute of Metal Research, Chinese Academy of Sciences, 110000 Shenyang, China
| | | | - Chenke Zhang
- Sports Medicine Center, Department of Orthopedic Surgery, Southwest Hospital, Army Military Medical University, Chongqing 40000, China.
| | - Kai Luo
- Research Center of Oral Tissue Engineering, School and Hospital of Stomatology, Fujian Medical University, Fuzhou 350001, China.
| | - Kanglai Tang
- Sports Medicine Center, Department of Orthopedic Surgery, Southwest Hospital, Army Military Medical University, Chongqing 40000, China
| | - Ke Yang
- Institute of Metal Research, Chinese Academy of Sciences, 110000 Shenyang, China
| | - Jinxin Lin
- Key Laboratory of Optoelectronic Materials Chemistry and Physics, Fujian Institute of Research on the Structure of Matter, Chinese Academy of Sciences, Fuzhou 350001, China; Fujian Science & Technology Innovation Laboratory for Optoelectronic Information of China, Fuzhou, Fujian 350108, China.
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Remily EA, Wilkie WA, Mohamed NS, Smith LS, Malkani AL, Jaggard CE, Kolisek FR, Monesmith EA, Nace J, Delanois RE. Sequentially Irradiated and Annealed Highly Cross-Linked Polyethylene: Clinical and Radiographic Outcomes in Total Knee Arthroplasty at 10-Year Follow-up. Orthopedics 2023; 46:e111-e117. [PMID: 36476288 DOI: 10.3928/01477447-20221129-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Highly cross-linked polyethylene (HXLPE) has become the preferred bearing surface in total hip arthroplasty. However, its acceptance in total knee arthroplasty (TKA) has not been as robust because of concerns pertaining to wear and its impact on implant failure. Therefore, this multicenter study was purposed to evaluate the 10-year (1) radiographic outcomes; (2) complications; and (3) implant survivorship in patients with TKA receiving a sequentially irradiated and annealed HXLPE. A retrospective, multi-center study was performed on 139 patients (171 TKAs) who underwent primary TKA with HXLPE and possessed a minimum of 10-year follow-up. Radiographs were analyzed for radiolucencies along the implant-fixation interface using the Modern Knee Society Radiographic Evaluation System. Kaplan-Meier analysis determined implant survivorship when the end points were revision for polyethylene wear and polyethylene revision for any reason. Sixteen TKAs (9.9%) demonstrated periprosthetic linear radio-lucencies. Seventeen TKAs (9.9%) required additional surgeries, 9 (5.3%) of which were revisions, with 1 (0.6%) TKA requiring revision because of polyethylene wear. Other causes of revision included instability (1.8%), infection (1.6%), and arthrofibrosis (1.6%). The mean time to revision was 5.9 years (range, 0.1-11.1 years). Survivorship pertaining to polyethylene revision for wear was 99.4%, whereas all-cause polyethylene revision was 94.7%. This study in patients undergoing primary TKA using a second-generation HXLPE demonstrated excellent results with respect to polyethylene wear characteristics and strength with a 99.4% survivorship at 10 years. [Orthopedics. 2023;46(2):e111-e117.].
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Banci L, Balato G, Salari P, Baldini A. "Systematic review and meta-analysis of ceramic coated implants in total knee arthroplasty. Comparable mid-term results to uncoated implants.". Knee Surg Sports Traumatol Arthrosc 2023; 31:839-851. [PMID: 34714355 DOI: 10.1007/s00167-021-06775-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 10/08/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Nitride-based ceramic coatings, such as titanium nitride (TiN) and titanium niobium nitride (TiNbN), have been introduced in total knee arthroplasty (TKA) to enhance the mechanical properties and biocompatibility of knee components, harden the metal surface and reduce CoCrMo exposure and metal ion release. However, the theoretical advantages of these ceramic coatings in TKA have yet to be fully elucidated. This systematic review aimed to provide clinical evidence on mid-term outcomes of ceramic-coated knee prostheses in comparison with uncoated standard CoCrMo knee prostheses in primary TKA. The hypothesis was that ceramic-coated implants can be used in primary TKA with no inferior outcomes compared to uncoated CoCrMo implants. METHODS A systematic review of the literature was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to find all clinical studies regarding primary TKA with ceramic-coated knee prostheses. MEDLINE (PubMed), Embase and Cochrane Library were searched from 1990 to October 2020 to identify relevant studies for the first qualitative analysis. Using PICOS eligibility criteria, a subgroup of the selected studies was used to perform a meta-analysis. RESULTS Fifteen studies were included in this systematic review, of which six were included in the meta-analysis: 3 randomized controlled trials, 2 retrospective comparative studies and 1 prospective cross-sectional study. Pooled data overall included 321 coated TKAs vs. 359 uncoated TKAs and a mean follow-up of 4.6 years (range, 2-10 years). No significant difference in the implant survival risk ratio with revision or reoperation due to any reason was found between coated and uncoated TKAs, even considering the RCT study subgroup with a risk ratio of 1.02 (P = 0.34). No significant differences were found for postoperative complications, clinical scores, or metal blood concentrations at 1 year. CONCLUSION The findings of this systematic review and meta-analysis support the statement that ceramic-coated TKAs are not inferior to uncoated TKAs, showing comparable survival rates, complication rates and clinical outcomes. There is strong evidence that ceramic-coated TKA does not improve the clinical results or survival rate in comparison with uncoated TKA. LEVEL OF EVIDENCE II, Therapeutic.
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Affiliation(s)
- Lorenzo Banci
- Permedica Orthopaedics S.P.A, Via Como 38, Merate, 23807, Lecco, Italy.
| | - Giovanni Balato
- Department of Public Health, Section of Orthopaedic Surgery, "Federico II" University, Naples, Italy
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21
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Anterior bone loss: A common phenomenon which should be considered as bone remodeling process existed not only in patients underwent cervical disk replacement but also those with anterior cervical diskectomy and fusion. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:977-985. [PMID: 36719518 DOI: 10.1007/s00586-022-07504-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 10/01/2022] [Accepted: 12/15/2022] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Anterior bone loss (ABL) was considered as a non-progressive process secondary only to motion-preserving implant and has been noticed recently in cervical disk replacement (CDR) let alone patients with anterior cervical diskectomy and fusion (ACDF). Our purpose is to reveal this unnoticed phenomenon in ACDF and further explore its clinical and radiological outcomes. METHODS A total of 77 patients underwent ACDF with a minimum follow-up of at least one year were retrospectively reviewed. The average follow-up time was 22.51 ± 16.31 months. There were 50 patients in group A with ABL, while there were 27 patients in group B without ABL. ABL was measured and classified into four grades according to Kieser's methods. Clinical evaluation, radiological parameters and fusion rate were recorded. RESULTS The incidence of bone ABL was 64.9% of Zero-P and 55.2% of endplates. The incidence of upper and lower endplates was 61% and 49%, respectively, and such difference was not significant. Mild ABL occurred in 22%, moderate ABL in 38% and severe ABL of 40% patients underwent ACDF with ABL. ABL would not affect both clinical outcomes and fusion rate. However, ABL would result in a higher incidence of subsidence. CONCLUSION ABL should be considered as a common phenomenon that both CDR and ACDF owned a non-progressive process which confined in one year. ABL would result in a higher incidence of subsidence. Luckily, this phenomenon does not have an effect on postoperative clinical and fusion rate.
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Vale J, Pinto LV, Barros B, Diniz S, Rodrigues F, Marques M, Belinha J, Vilaça A. Total knee arthroplasty coronal alignment and tibial base stress-a new numerical evaluation. Porto Biomed J 2023; 8:e208. [PMID: 37152633 PMCID: PMC10158898 DOI: 10.1097/j.pbj.0000000000000208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 02/07/2023] [Indexed: 05/09/2023] Open
Abstract
Background Total knee arthroplasty (TKA) is one of the most frequently performed orthopedic procedures. The correct positioning and alignment of the components significantly affects prosthesis survival. Considering the current controversy regarding the target of postoperative alignment of TKA, this study evaluated the tension at tibial component interface using two numerical methods. Methods The stress of the prosthesis/bone interface of the proximal tibial component was evaluated using two numerical methods: the finite element method (FEM) and the new meshless method: natural neighbor radial point interpolation method (NNRPIM). The construction of the model was based on Zimmers NexGen LPS-Flex Mobile® prosthesis and simulated the forces by using a free-body diagram. Results Tibiofemoral mechanical axis (TFMA) for which a higher number of nodes are under optimal mechanical tension is between 1° valgus 2° varus. For values outside the interval, there are regions under the tibial plate at risk of bone absorption. At the extremities of the tibial plate of the prosthesis, both medial and lateral, independent of the alignment, are under a low stress. In all nodes evaluated for all TFMA, the values of the effective stresses were higher in the NNRPIM when compared with the FEM. Conclusion Through this study, we can corroborate that the optimal postoperative alignment is within the values that are currently considered of 0 ± 3° varus. It was verified that the meshless methods obtain smoother and more conservative results, which may make them safer when transposed to the clinical practice.
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Affiliation(s)
- João Vale
- Department of Orthopaedics, Centro Hospitalar do Universitário do Porto, Porto, Portugal
- Corresponding author: Department of Orthopaedics, Centro Hospitalar do Universitário do Porto, Largo Professor Abel Salazar, 4099-001, Porto, Portugal. E-mail address: (João Vale)
| | - Luisa V. Pinto
- Department of Physical and Medicine Rehabilitation, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal
| | - Bianca Barros
- Department of Orthopaedics, Centro Hospitalar do Universitário do Porto, Porto, Portugal
| | - Sara Diniz
- Department of Orthopaedics, Centro Hospitalar do Universitário do Porto, Porto, Portugal
| | - Filipe Rodrigues
- Department of Orthopaedics, Centro Hospitalar do Universitário do Porto, Porto, Portugal
| | - Marco Marques
- Institute of Science and Innovation in Mechanical and Industrial Engineering, INEGI, Porto, Portugal
| | - Jorge Belinha
- Department of Mechanical Engineering, School of Engineering, Polytechnic of Porto, ISEP, Porto, Portugal
| | - Adélio Vilaça
- Department of Orthopaedics, Centro Hospitalar do Universitário do Porto, Porto, Portugal
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23
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Pechancová R, Gallo J, Baron D, Milde D, Antal P, Slobodová Z, Lemr K, Pluháček T. Detailed insight into chromium species released from failed CoCrMo implants: Ex vivo periprosthetic tissues study. J Biomed Mater Res B Appl Biomater 2023; 111:271-283. [PMID: 36507699 DOI: 10.1002/jbm.b.35149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 07/26/2022] [Accepted: 08/01/2022] [Indexed: 12/15/2022]
Abstract
This unique study provides information on Cr species and their distribution in periprosthetic tissues of patients with metal-on-polyethylene joint implants. Co-Cr-Mo alloy has been widely used in joint replacement and represents a source of metal derived species. In the case of chromium, previous studies on periprosthetic tissues revealed mainly Cr(III) distribution, whereas the potential release of carcinogenic Cr(VI) species has been still a subject of debate. Here, an analytical approach utilizing speciation and fractionation was developed to analyze periprosthetic tissue samples collected from wide range of patients with failed total hip or knee replacements. The results reveal that Cr(III) is mainly released in the form of insoluble CrPO4 and Cr2 O3 particles. The highest Cr contents were found in periprosthetic tissues of patients suffering from aseptic loosening and having more Cr-based implants in the body. Cr species penetrated tissue layers, but their levels decreased with the distance from an implant. The detailed speciation/fractionation study carried out using the set of consecutive periprosthetic tissues of a patient with extensive metallosis showed the presence of trace amounts of free Cr(III), nanoparticles, and metal-protein complexes, but the majority of Cr still occurred in CrPO4 form. Carcinogenic Cr(VI) species were not detected. Up to date, there is no published human tissue study focused on the detailed speciation of both soluble and insoluble Cr-based species in the context of failing total hip and knee replacements.
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Affiliation(s)
- Radka Pechancová
- Department of Analytical Chemistry, Faculty of Science, Palacký University Olomouc, Olomouc, Czech Republic
| | - Jiří Gallo
- Department of Orthopedics, Faculty of Medicine and Dentistry, Palacký University Olomouc, University Hospital Olomouc, Olomouc, Czech Republic
| | - Daniel Baron
- Department of Analytical Chemistry, Faculty of Science, Palacký University Olomouc, Olomouc, Czech Republic
| | - David Milde
- Department of Analytical Chemistry, Faculty of Science, Palacký University Olomouc, Olomouc, Czech Republic
| | - Peter Antal
- Department of Inorganic Chemistry, Faculty of Science, Palacký University Olomouc, Olomouc, Czech Republic
| | - Zuzana Slobodová
- Department of Clinical and Molecular Pathology, Faculty of Medicine and Dentistry, Palacký University Olomouc, Olomouc, Czech Republic
| | - Karel Lemr
- Department of Analytical Chemistry, Faculty of Science, Palacký University Olomouc, Olomouc, Czech Republic.,Institute of Microbiology of the Czech Academy of Sciences, Prague, Czech Republic
| | - Tomáš Pluháček
- Department of Analytical Chemistry, Faculty of Science, Palacký University Olomouc, Olomouc, Czech Republic
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24
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Lodge CJ, Matar HE, Berber R, Radford PJ, Bloch BV. Ceramic Coatings Confer No Survivorship Advantages in Total Knee Arthroplasty-A Single-Center Series of 1641 Knees. Arthroplast Today 2023; 19:101086. [PMID: 36688095 PMCID: PMC9851869 DOI: 10.1016/j.artd.2022.101086] [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: 07/15/2022] [Revised: 10/06/2022] [Accepted: 12/08/2022] [Indexed: 01/19/2023] Open
Abstract
Background Ceramic coatings in total knee arthroplasty have been introduced with the aim of reducing wear and consequently improving implant survivorship. We studied both cobalt-chrome-molybdenum (CoCrMo) and ceramic-coated components of the same implant design from a single center to identify if the ceramic coating conferred any benefit. Methods We identified 1641 Columbus total knee arthroplasties (Aesculap AG, Tüttlingen, Germany) from a prospectively collected arthroplasty database. Of the 1641, 983 were traditional CoCrMo, and 659 had the Columbus AS ceramic coating. Patients were followed up until death or revision of any component of the implant. Results There was no significant difference in implant survivorship using any component revision as the endpoint between the CoCrMo femur and the ceramic-coated femur at a mean of 9.2 years in follow-up for the CoCrMo group and 5 years for the ceramic-coated group (37 vs 14; P = .76). There was no reduction in the proportion of components revised for aseptic loosening or infection in the ceramic-coated cohort. Conclusions At midterm follow-up, there was no benefit in terms of implant survivorship in using a ceramic coating.
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Affiliation(s)
| | | | | | | | - Benjamin V. Bloch
- Corresponding author. Consultant Orthopaedic Surgeon, City Hospital Campus, Nottingham, NG5 1PB, UK. Tel.: +44 115 969 1169.
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25
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Winkler T, Bell L, Bender A, Trepczynski A, Duda GN, Baur AJD, Damm P. Periarticular muscle status affects in vivo tibio-femoral joint loads after total knee arthroplasty. Front Bioeng Biotechnol 2023; 11:1075357. [PMID: 37034264 PMCID: PMC10073542 DOI: 10.3389/fbioe.2023.1075357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 03/09/2023] [Indexed: 04/11/2023] Open
Abstract
Background: Total knee arthroplasty (TKA) is a highly effective treatment for severe knee osteoarthritis that is increasingly performed in younger, more active patients. As postoperative muscular impairments may negatively affect surgical outcomes and implant longevity, functional muscle recovery gains increasing importance in meeting future patient demands. This study aimed to assess the status of periarticular muscles in the long-term follow-up after TKA and to evaluate its impact on in vivo tibio-femoral joint loads. Methods: A case series was created, with eight patients with knee osteoarthritis. All subjects received an instrumented knee implant in unilateral TKA. Native computed tomography scans, acquired pre and postoperatively, were used to evaluate distal muscle volumes and fatty infiltration. In vivo tibio-femoral joint loads were measured telemetrically during standing, walking, stair climbing and chair rising and were correlated to muscle status. Results: Postoperatively a reduction in fatty infiltration across all periarticular muscles was pronounced. High average peak loads acted in the tibio-femoral joint ranging from 264% during stand-to-sit activities up to 341% body weight (BW) during stair descent. Fatty infiltration of the m. quadriceps femoris and hamstrings were associated with increased tibio-femoral joint contact forces during walking (r = 0.542; 0.412 and 0.766). Conclusion: The findings suggest that a fatty infiltration of periarticular muscles may lead to increased tibio-femoral joint contact forces. However, we only observed weak correlations between these parameters. Improvements in functional mobility and the restoration of a pain-free joint likely explain the observed postoperative reductions in fatty infiltration. Perioperative rehabilitation approaches targeting residual impairments in muscle quality could, contribute to reduced tibio-femoral joint loads and improved long-term outcomes of TKA. However, it has to be pointed out that the study included a small number of patients, which may limit its validity.
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Affiliation(s)
- Tobias Winkler
- Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Center for Musculoskeletal Biomechanics and Regeneration (Julius Wolff Institute), Berlin, Germany
- Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Berlin Institute of Health Institute for Regenerative Therapies, Berlin, Germany
- Center for Musculoskeletal Surgery, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Louisa Bell
- Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Center for Musculoskeletal Biomechanics and Regeneration (Julius Wolff Institute), Berlin, Germany
| | - Alwina Bender
- Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Center for Musculoskeletal Biomechanics and Regeneration (Julius Wolff Institute), Berlin, Germany
| | - Adam Trepczynski
- Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Center for Musculoskeletal Biomechanics and Regeneration (Julius Wolff Institute), Berlin, Germany
| | - Georg N. Duda
- Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Center for Musculoskeletal Biomechanics and Regeneration (Julius Wolff Institute), Berlin, Germany
| | | | - Philipp Damm
- Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Center for Musculoskeletal Biomechanics and Regeneration (Julius Wolff Institute), Berlin, Germany
- *Correspondence: Philipp Damm,
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26
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Miller MA, Hardy WR, Oest ME, Mann KA. Potential for supraphysiologic fluid shear stresses in a rat cemented knee replacement model. J Orthop Res 2023; 41:94-103. [PMID: 35332943 PMCID: PMC9509496 DOI: 10.1002/jor.25326] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 02/02/2022] [Accepted: 03/13/2022] [Indexed: 02/04/2023]
Abstract
The mechano-biologic environment associated with aseptic loosening of cemented joint replacements is not fully understood. The goal of this study was to use a preclinical rat knee arthroplasty model to explore the changes in cement-bone morphology and micromotion that occur with in vivo service. Narrow gaps between cement and bone under the tibial tray were present at early time points, and with even small magnitude micromotion, resulted in large micromotion-to-gap width ratios. These data were then used to develop models of fluid flow in the cement-bone gaps to estimate potential for high fluid shear stress (FSS). Modeling results revealed supraphysiologic (>4 Pa) FSS were possible, particularly for cases in which eccentric loading applied to the implant and if the fluid in the gap consisted of marrow or synovial fluid. The early, high FSS environment, could cause fluid-induced periprosthetic osteolysis locally, resulting in progressive loss of cement-bone fixation.
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Affiliation(s)
- Mark A Miller
- SUNY Upstate Medical University, Syracuse, New York, USA
| | | | - Megan E Oest
- SUNY Upstate Medical University, Syracuse, New York, USA
| | - Kenneth A Mann
- SUNY Upstate Medical University, Syracuse, New York, USA
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27
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Novel Tuning of PMMA Orthopedic Bone Cement Using TBB Initiator: Effect of Bone Cement Extracts on Bioactivity of Osteoblasts and Osteoclasts. Cells 2022; 11:cells11243999. [PMID: 36552761 PMCID: PMC9776632 DOI: 10.3390/cells11243999] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 12/03/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
Bone cement containing benzoyl peroxide (BPO) as a polymerization initiator are commonly used to fix orthopedic metal implants. However, toxic complications caused by bone cement are a clinically significant problem. Poly (methyl methacrylate) tri-n-butylborane (PMMA-TBB), a newly developed material containing TBB as a polymerization initiator, was found to be more biocompatible than conventional PMMA-BPO bone cements due to reduced free radical generation during polymerization. However, free radicals might not be the only determinant of cytotoxicity. Here, we evaluated the response and functional phenotypes of cells exposed to extracts derived from different bone cements. Bone cement extracts were prepared from two commercial PMMA-BPO cements and an experimental PMMA-TBB. Rat bone marrow-derived osteoblasts and osteoclasts were cultured in a medium supplemented with bone cement extracts. More osteoblasts survived and attached to the culture dish with PMMA-TBB extract than in the culture with PMMA-BPO extracts. Osteoblast proliferation and differentiation were higher in the culture with PMMA-TBB extract. The number of TRAP-positive multinucleated cells was significantly lower in the culture with PMMA-TBB extract. There was no difference in osteoclast-related gene expression in response to different bone cement extracts. In conclusion, PMMA-TBB extract was less toxic to osteoblasts than PMMA-BPO extracts. Although extracts from the different cement types did not affect osteoclast function, PMMA-TBB extract seemed to reduce osteoclastogenesis, a possible further advantage of PMMA-TBB cement. These implied that the reduced radical generation during polymerization is not the only determinant for the improved biocompatibility of PMMA-TBB and that the post-polymerization chemical elution may also be important.
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28
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Kornuijt A, Kuijer PPFM, van Drumpt RA, Siebelt M, Lenssen AF, van der Weegen W. A high physical activity level after total knee arthroplasty does not increase the risk of revision surgery during the first twelve years: A systematic review with meta-analysis and GRADE. Knee 2022; 39:168-184. [PMID: 36208528 DOI: 10.1016/j.knee.2022.08.004] [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: 02/08/2022] [Accepted: 08/12/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND High physical activity (HPA) levels after total knee arthroplasty (TKA) might be related to increased wear and subsequent aseptic loosening, negatively affecting TKA survival. This systematic review studied the association between activity levels and risk of revision surgery at medium (3-10 years) and long term (>10 years) follow up in patients with TKA. METHODS Databases (PubMed, Embase) were searched up to 12 October 2021. Studies comparing low physical activity (LPA) and HPA levels in TKA patients and related risk of revision surgery were eligible for inclusion. After data extraction and evaluation of methodological quality, a meta-analysis was performed. Quality of evidence was assessed using the GRADE framework. PROSPERO registration: CRD42020194284. RESULTS Five cohort studies and one case-control study met the inclusion criteria, involving 4811 TKA procedures in 4263 patients (mean follow up 4-12 years). Five studies were of moderate methodological quality and one of low quality. Meta-analysis demonstrated no association between HPA level and an increased risk of all-cause revision surgery (risk ratio (RR) 0.62, 95 % confidence interval (CI) 0.24-1.63, level of certainty: very low) or revision surgery due to aseptic loosening (RR 1.33, 95 % CI 0.34-5.24, level of certainty: moderate). Only one study reported on survivorship, with an improved survivorship for the HPA group (odds ratio of 2.4, 95 % CI 1.2-4.7, level of certainty: low). CONCLUSION During the first 12 postoperative years after TKA, there seems to be no increased risk for revision surgery for patients with a HPA level compared with patients with an LPA level.
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Affiliation(s)
- A Kornuijt
- Sports & Orthopedics Research Centre, Anna Hospital, Geldrop, the Netherlands; Department of Physical Therapy, Anna Hospital, Geldrop, the Netherlands; Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - P P F M Kuijer
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - R A van Drumpt
- Sports & Orthopedics Research Centre, Anna Hospital, Geldrop, the Netherlands
| | - M Siebelt
- Sports & Orthopedics Research Centre, Anna Hospital, Geldrop, the Netherlands
| | - A F Lenssen
- Department of Physical Therapy, Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
| | - W van der Weegen
- Sports & Orthopedics Research Centre, Anna Hospital, Geldrop, the Netherlands
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29
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Yin J, Yin Z, Lai P, Liu X, Ma J. Pyroptosis in Periprosthetic Osteolysis. Biomolecules 2022; 12:biom12121733. [PMID: 36551161 PMCID: PMC9775904 DOI: 10.3390/biom12121733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/12/2022] [Accepted: 11/18/2022] [Indexed: 11/25/2022] Open
Abstract
Periprosthetic osteolysis (PPO) along with aseptic loosening (AL) caused by wear particles after artificial joint replacement is the key factor in surgical failure and subsequent revision surgery, however, the precise molecular mechanism underlying PPO remains unclear. Aseptic inflammation triggered by metal particles, resulting in the imbalance between bone formation by osteoblasts and bone resorption by osteoclasts may be the decisive factor. Pyroptosis is a new pro-inflammatory pattern of regulated cell death (RCD), mainly mediated by gasdermins (GSDMs) family, among which GSDMD is the best characterized. Recent evidence indicates that activation of NLRP3 inflammasomes and pyroptosis play a pivotal role in the pathological process of PPO. Here, we review the pathological process of PPO, the molecular mechanism of pyroptosis and the interventions to inhibit the inflammation and pyroptosis of different cells during the PPO. Conclusively, this review provides theoretical support for the search for new strategies and new targets for the treatment of PPO by inhibiting pyroptosis and inflammation.
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Affiliation(s)
- Jian Yin
- Department of Orthopedics, Shanghai General Hospital of Nanjing Medical University, Shanghai 201600, China
- Department of Orthopedics, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing 211100, China
| | - Zhaoyang Yin
- Department of Orthopedics, The Affiliated Lianyungang Hospital of Xuzhou Medical University (The First People’s Hospital of Lianyungang), Lianyungang 222000, China
| | - Peng Lai
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201600, China
| | - Xinhui Liu
- Department of Orthopedics, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing 211100, China
- Correspondence: (J.M.); (X.L.)
| | - Jinzhong Ma
- Department of Orthopedics, Shanghai General Hospital of Nanjing Medical University, Shanghai 201600, China
- Department of Orthopedics, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing 211100, China
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201600, China
- Correspondence: (J.M.); (X.L.)
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30
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Garabano G, Rodriguez J, Perez Alamino L, Pesciallo CA, del Sel H, Lopreite F. Stress shielding in total knee replacements: Comparative analysis between titanium and all-polyethylene bases at 10 years follow-up. J Orthop 2022; 34:276-281. [PMID: 36158038 PMCID: PMC9493296 DOI: 10.1016/j.jor.2022.09.007] [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: 04/09/2022] [Revised: 08/05/2022] [Accepted: 09/08/2022] [Indexed: 11/16/2022] Open
Abstract
Objective The aim of this retrospective study was to assess bone resorption due to stress shielding in total knee replacement (TKR), comparing titanium bases (TiB) versus all polyethylene bases (APB), analyzing its incidence, progression and mechanical consequences after 10 years of follow-up. Methods We evaluated two groups of patients undergoing TKR, one treated with TiB and the other with APB, operated consecutively between 2004 and 2009 with a diagnosis of idiopathic gonarthrosis and a minimum of 10 years of follow-up. Deen's radiographical method was used to assess tibial bone resorption. We assessed its incidence, progression, relationship with the femoro-tibial and prosthetic alignment, clinical outcomes and mechanical loosening. Results Eighty-six patients were treated with TiB and 80 with APB with a median follow-up of 11 (range 10-15) years. The bone resorption rate in TiB was 24.41% and in APB was 1.25% (p < 0.0001). The type 2 of Deen's classification was the most frequently observed. Bone resorption was strongly correlated with preoperative varus femoro-tibial alignment and varus placement of the tibial component, also showing a significant association with postoperative femoro-tibial alignment correction (p 0.009). We observed no significant differences in functional scores or revision rates due to mechanical loosening after 10 years of follow-up between the groups. Conclusion Titanium tibial bases in TKR showed a significantly higher incidence of medial tibia resorption compared to all-polyethylene bases. Our results suggest that bone resorption does not influence long-term mechanical loosening.
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Affiliation(s)
- Germán Garabano
- Department of Orthopaedic and Traumatology, British Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Joaquín Rodriguez
- Department of Orthopaedic and Traumatology, British Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Leonel Perez Alamino
- Department of Orthopaedic and Traumatology, British Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Cesar Angel Pesciallo
- Department of Orthopaedic and Traumatology, British Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Hernán del Sel
- Department of Orthopaedic and Traumatology, British Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Fernando Lopreite
- Department of Orthopaedic and Traumatology, British Hospital of Buenos Aires, Buenos Aires, Argentina
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31
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Glatzeder K, Igor K, Ambellan F, Zachow S, Potthast W. Dynamic pressure analysis of novel interpositional knee spacer implants in 3D-printed human knee models. Sci Rep 2022; 12:16853. [PMID: 36207344 PMCID: PMC9546830 DOI: 10.1038/s41598-022-20463-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 09/13/2022] [Indexed: 11/09/2022] Open
Abstract
Alternative treatment methods for knee osteoarthritis (OA) are in demand, to delay the young (< 50 Years) patient's need for osteotomy or knee replacement. Novel interpositional knee spacers shape based on statistical shape model (SSM) approach and made of polyurethane (PU) were developed to present a minimally invasive method to treat medial OA in the knee. The implant should be supposed to reduce peak strains and pain, restore the stability of the knee, correct the malalignment of a varus knee and improve joint function and gait. Firstly, the spacers were tested in artificial knee models. It is assumed that by application of a spacer, a significant reduction in stress values and a significant increase in the contact area in the medial compartment of the knee will be registered. Biomechanical analysis of the effect of novel interpositional knee spacer implants on pressure distribution in 3D-printed knee model replicas: the primary purpose was the medial joint contact stress-related biomechanics. A secondary purpose was a better understanding of medial/lateral redistribution of joint loading. Six 3D printed knee models were reproduced from cadaveric leg computed tomography. Each of four spacer implants was tested in each knee geometry under realistic arthrokinematic dynamic loading conditions, to examine the pressure distribution in the knee joint. All spacers showed reduced mean stress values by 84-88% and peak stress values by 524-704% in the medial knee joint compartment compared to the non-spacer test condition. The contact area was enlarged by 462-627% as a result of the inserted spacers. Concerning the appreciable contact stress reduction and enlargement of the contact area in the medial knee joint compartment, the premises are in place for testing the implants directly on human knee cadavers to gain further insights into a possible tool for treating medial knee osteoarthritis.
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Affiliation(s)
- Korbinian Glatzeder
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933, Cologne, Germany.
| | - Komnik Igor
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933, Cologne, Germany
| | - Felix Ambellan
- Zuse Institute Berlin (ZIB), Takustraße 7, 14195, Berlin, Germany.,Freie Universität Berlin, Kaiserswerther Str. 16-18, Berlin, Germany
| | - Stefan Zachow
- Zuse Institute Berlin (ZIB), Takustraße 7, 14195, Berlin, Germany
| | - Wolfgang Potthast
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933, Cologne, Germany
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32
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Holm-Glad T, Røkkum M, Röhrl SM, Roness S, Godang K, Reigstad O. A randomized controlled trial comparing two modern total wrist arthroplasties : improved function with stable implants, but high complication rates in non-rheumatoid wrists at two years. Bone Joint J 2022; 104-B:1132-1141. [PMID: 36177637 DOI: 10.1302/0301-620x.104b10.bjj-2022-0201.r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS To analyze the short-term outcome of two types of total wrist arthroplasty (TWA) in terms of wrist function, migration, and periprosthetic bone behaviour. METHODS A total of 40 patients suffering from non-rheumatoid wrist arthritis were enrolled in a randomized controlled trial comparing the ReMotion and Motec TWAs. Patient-rated and functional outcomes, radiological changes, blood metal ion levels, migration measured by model-based radiostereometric analysis (RSA), bone mineral density (BMD) measured by dual-energy X-ray absorptiometry (DXA), complications, loosening, and revision rates at two years were compared. RESULTS Patient-Rated Wrist and Hand Evaluation (PRWHE) scores, abbreviated version of the Disabilities of the Arm, Shoulder and Hand questionnaire scores, and pain improved similarly and significantly in both groups. Wrist motion improved significantly in the Motec group only, and forearm rotation in the ReMotion group only. Cobalt (Co) and chromium (Cr) blood ion levels were significantly higher in the metal-on-metal (MoM) Motec group than in the metal-on-polyethylene (MoP) ReMotion group. Mean total translation was 0.65 mm (95% confidence interval (CI) 0.26 to 1.12) and 0.27 mm (95% CI 0.14 to 0.47) for the ReMotion carpal and radial components, and 0.32 mm (95% CI 0.22 to 0.45) and 0.26 mm (95% CI 0.20 to 0.34) for the Motec metacarpal and radial components, respectively. Apart from dorsal and volar tilts, which were significantly higher for the radial ReMotion than for the Motec component, no significant differences in absolute migration occurred. BMD around the radial components never returned to baseline. Almost one-third of patients required reoperation due to complications. Two ReMotion implants were revised to Motec TWAs due to carpal component loosening, and three Motec MoM articulations were revised to metal-on-polyether ether ketone due to painful synovitis. CONCLUSION Both implants provided matched function and were stable at short-term follow-up, but with a high complication rate. This procedure should be restricted to specialist centres undertaking prospective analysis until its role is clarified.Cite this article: Bone Joint J 2022;104-B(10):1132-1141.
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Affiliation(s)
- Trygve Holm-Glad
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Magne Røkkum
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Stephan M Röhrl
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Siri Roness
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Kristin Godang
- Section of Specialized Endocrinology, Oslo University Hospital, Oslo, Norway
| | - Ole Reigstad
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Wang H, Cao X, Guo J, Yang X, Sun X, Fu Z, Qin A, Wu Y, Zhao J. BNTA alleviates inflammatory osteolysis by the SOD mediated anti-oxidation and anti-inflammation effect on inhibiting osteoclastogenesis. Front Pharmacol 2022; 13:939929. [PMID: 36249770 PMCID: PMC9559729 DOI: 10.3389/fphar.2022.939929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 09/09/2022] [Indexed: 11/15/2022] Open
Abstract
Abnormal activation and overproliferation of osteoclast in inflammatory bone diseases lead to osteolysis and bone mass loss. Although current pharmacological treatments have made extensive advances, limitations still exist. N-[2-bromo-4-(phenylsulfonyl)-3-thienyl]-2-chlorobenzamide (BNTA) is an artificially synthesized molecule compound that has antioxidant and anti-inflammatory properties. In this study, we presented that BNTA can suppress intracellular ROS levels through increasing ROS scavenging enzymes SOD1 and SOD2, subsequently attenuating the MARK signaling pathway and the transcription of NFATc1, leading to the inhibition of osteoclast formation and osteolytic resorption. Moreover, the results also showed an obvious restrained effect of BNTA on RANKL-stimulated proinflammatory cytokines, which indirectly mediated osteoclastogenesis. In line with the in vitro results, BNTA protected LPS-induced severe bone loss in vivo by enhancing scavenging enzymes, reducing proinflammatory cytokines, and decreasing osteoclast formation. Taken together, all of the results demonstrate that BNTA effectively represses oxidation, regulates inflammatory activity, and inhibits osteolytic bone resorption, and it may be a potential and exploitable drug to prevent inflammatory osteolytic bone diseases.
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Affiliation(s)
| | | | | | | | | | | | | | - Yujie Wu
- *Correspondence: Yujie Wu, ; Jie Zhao,
| | - Jie Zhao
- *Correspondence: Yujie Wu, ; Jie Zhao,
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Shen H, Kushioka J, Toya M, Utsunomiya T, Hirata H, Huang EE, Tsubosaka M, Gao Q, Li X, Teissier V, Zhang N, Goodman SB. Sex differences in the therapeutic effect of unaltered versus NFκB sensing IL-4 over-expressing mesenchymal stromal cells in a murine model of chronic inflammatory bone loss. Front Bioeng Biotechnol 2022; 10:962114. [PMID: 36046680 PMCID: PMC9421000 DOI: 10.3389/fbioe.2022.962114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 06/29/2022] [Indexed: 11/24/2022] Open
Abstract
Wear particles from joint arthroplasties induce chronic inflammation associated with prolonged upregulation of nuclear factor kappa-B (NF-κB) signaling in macrophages and osteoclasts, which leads to osteolysis and implant loosening. Mesenchymal stromal cell (MSC)-based therapy showed great potential for immunomodulation and mitigation of osteolysis in vivo, especially in the chronic phase of inflammation. We previously generated genetically modified MSCs that secrete the anti-inflammatory cytokine interleukin 4 (IL-4) in response to NF-κB activation (NFκB-IL-4 MSCs). However, whether the impact of sexual difference in the internal environment can alter the therapeutic effects of IL-4 over-secreting MSCs that simultaneously mitigate prolonged inflammation and enhance bone formation remains unknown. This study investigated the therapeutic effects of unaltered MSCs versus NFκB-IL-4 MSCs in mitigating chronic inflammation and enhancing bone formation in male and female mice. The murine model was established by continuous infusion of polyethylene particles contaminated with lipopolysaccharide (cPE) into the medullary cavity of the distal femur for 6 weeks to induce chronic inflammation. Unaltered MSCs or NFκB-IL-4 MSCs were infused into the femoral intramedullary cavity in sex-matched groups beginning 3 weeks after primary surgery. Femurs were harvested at 6 weeks, and bone marrow density was measured with micro-computational tomography. Numbers of osteoclast-like cells, osteoblasts, and macrophages were evaluated with histochemical and immunofluorescence staining. cPE infusion resulted in severe bone loss at the surgery site, increased tartrate-resistant acid phosphatase positive osteoclasts and M1 pro-inflammatory macrophages, and decreased alkaline phosphatase expression. MSC-based therapy effectively decreased local bone loss and polarized M1 macrophages into an M2 anti-inflammatory phenotype. In females, unaltered MSCs demonstrated a larger impact in enhancing the osteogenesis, but they demonstrated similar anti-inflammatory effects compared to NFκB-IL-4 MSCs. These results demonstrated that local inflammatory bone loss can be effectively modulated via MSC-based treatments in a sexually dimorphic manner, which could be an efficacious therapeutic strategy for treatment of periprosthetic osteolysis in both genders.
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Affiliation(s)
- Huaishuang Shen
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Junichi Kushioka
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Masakazu Toya
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | | | - Hirohito Hirata
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Ejun Elijah Huang
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Masanori Tsubosaka
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Qi Gao
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Xueping Li
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Victoria Teissier
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Ning Zhang
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Stuart B. Goodman
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, United States
- Department of Bioengineering, Stanford University, Stanford, CA, United States
- *Correspondence: Stuart B. Goodman,
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Dong J, Zhang L, Ruan B, Lv Z, Wang H, Wang Y, Jiang Q, Cao W. NRF2 is a critical regulator and therapeutic target of metal implant particle-incurred bone damage. Biomaterials 2022; 288:121742. [PMID: 36030105 DOI: 10.1016/j.biomaterials.2022.121742] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 08/02/2022] [Accepted: 08/09/2022] [Indexed: 11/02/2022]
Abstract
Aseptic metal implant loosening due to wear particle-induced bone damage is a major complication of total joint arthroplasty often leading to revision surgery, of which the key regulators mediating the processes are not clearly defined. Here we reported that in a mouse model of calvarial osteolysis, titanium particles (TiPs) and cobalt-chromium-molybdenum particles induced severe osteolysis accompanied by marked suppression of a master redox transcriptional factor NRF2 (Nuclear factor erythroid derived 2-related factor 2). Nfe2l2 knockout mice treated with TiPs developed worse osteolytic alterations compared with wild-type mice. On the contrary, NRF2 restoration by an NRF2 agonist TBHQ (tert-butylhydroquinone) effectively alleviated the osteolysis and the abnormal expression of NRF2 downstream antioxidant enzymes, inflammatory cytokines and osteogenic factors. Further, TiPs induced adverse osteoblastogenesis and osteoclastogenesis in cultured bone cells, which were substantially blocked by TBHQ in an NRF2 inhibition-sensitive manner. Consistently, the osteoprotective effects of TBHQ observed in wild-type mice were largely limited in Nfe2l2 knockout mice. Collectively, our data suggest that NRF2 suppression is a critical causal event of metal wear particle-incurred osteolysis, and the strategies reinstating NRF2 are effective to lessen the bone damage and potentially reduce the incidence of metal implant loosening.
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Affiliation(s)
- Jian Dong
- State Key Laboratory of Pharmaceutical Biotechnology, Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School. 321 Zhongshan Road, Nanjing 210008, China
| | - Lijun Zhang
- Nanjing University Medical School, Jiangsu Key Lab of Molecular Medicine. 22 Hankou Road, Nanjing, 210093, China
| | - Binjia Ruan
- Department of Orthopedics, Northern Jiangsu People's Hospital, 98 West Nantong Road, Yangzhou, 225001, China
| | - Zhongyang Lv
- State Key Laboratory of Pharmaceutical Biotechnology, Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School. 321 Zhongshan Road, Nanjing 210008, China
| | - Hongwei Wang
- Nanjing University Medical School, Jiangsu Key Lab of Molecular Medicine. 22 Hankou Road, Nanjing, 210093, China
| | - Yongxiang Wang
- Department of Orthopedics, Northern Jiangsu People's Hospital, 98 West Nantong Road, Yangzhou, 225001, China
| | - Qing Jiang
- State Key Laboratory of Pharmaceutical Biotechnology, Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School. 321 Zhongshan Road, Nanjing 210008, China.
| | - Wangsen Cao
- Nanjing University Medical School, Jiangsu Key Lab of Molecular Medicine. 22 Hankou Road, Nanjing, 210093, China; Department of Orthopedics, Northern Jiangsu People's Hospital, 98 West Nantong Road, Yangzhou, 225001, China.
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Marian M, Berman D, Nečas D, Emani N, Ruggiero A, Rosenkranz A. Roadmap for 2D materials in biotribological/biomedical applications – A review. Adv Colloid Interface Sci 2022; 307:102747. [DOI: 10.1016/j.cis.2022.102747] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/26/2022] [Accepted: 07/28/2022] [Indexed: 01/01/2023]
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Klemt C, Drago J, Oganesyan R, Smith EJ, Yeo I, Kwon YM. Gait and Knee Flexion In Vivo Kinematics of Asymmetric Tibial Polyethylene Geometry Cruciate Retaining Total Knee Arthroplasty. J Knee Surg 2022; 35:828-837. [PMID: 33111271 DOI: 10.1055/s-0040-1718681] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The preservation of the posterior cruciate ligament in cruciate retaining (CR) total knee arthroplasty (TKA) designs has the potential to restore healthy knee biomechanics; however, concerns related to kinematic asymmetries during functional activities still exist in unilateral TKA patients. As there is a limited data available regarding the ability of the contemporary CR TKA design with concave medial and convex lateral tibial polyethylene bearing components to restore healthy knee biomechanics, this study aimed to investigate in vivo three-dimensional knee kinematics in CR TKA patients during strenuous knee flexion activities and gait. Using a combined computer tomography and dual fluoroscopic imaging system approach, in vivo kinematics of 15 unilateral CR TKA patients (comparison of replaced and contralateral nonreplaced knee) were evaluated during sit-to-stand, step-ups, single-leg deep lunge, and level walking. The patient cohort was followed-up at an average of 24.5 months ( ± 12.6, range 13-42) from surgical procedure. Significantly smaller internal knee rotation angles were observed for the contemporary CR TKA design during step-ups (2.6 ± 5.8 vs. 6.3 ± 6.6 degrees, p < 0.05) and gait (0.6 ± 4.6 vs. 6.3 ± 6.8 degrees, p < 0.05). Significantly larger proximal and anterior femoral translations were measured during sit-to-stand (34.7 ± 4.5 vs. 29.9 ± 3.1 mm, p < 0.05; -2.5 ± 2.9 vs. -8.1 ± 4.4 mm, p < 0.05) and step-ups (34.1 ± 4.5 vs. 30.8 ± 2.9 mm, p < 0.05; 2.2 ± 3.2 vs. -3.5 ± 4.5 mm, p < 0.05). Significantly smaller ranges of varus/valgus and internal/external rotation range of motion were observed for CR TKA, when compared with the nonoperated nee, during strenuous activities and gait. The preservation of the posterior cruciate ligament in the contemporary asymmetric bearing geometry CR TKA design with concave medial and convex lateral tibial polyethylene bearing components has the potential to restore healthy knee biomechanics; however, the study findings demonstrate that native knee kinematics were not fully restored in patients with unilateral asymmetric tibial polyethylene bearing geometry CR TKA during functional activities.
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Affiliation(s)
- Christian Klemt
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - John Drago
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ruben Oganesyan
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Evan J Smith
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ingwon Yeo
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Young-Min Kwon
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Abstract
Aims Total knee arthroplasty (TKA) is a common and safe orthopaedic procedure. Zimmer Biomet's NexGen is the second most popular brand of implant used in the UK. The primary cause of revision after the first year is aseptic loosening. We present our experience of using this implant, with significant concerns around its performance with regards early aseptic loosening of the tibial component. Methods A retrospective, single-surgeon review was carried out of all of the NexGen Legacy Posterior Stabilized (LPS) TKAs performed in this institute. The specific model used for the index procedures was the NexGen Complete Knee System (Legacy Knee-Posterior Stabilized LPS-Flex Articular Surface, LPS-Flex Femoral Component Option, and Stemmed Nonaugmentable Tibial Component Option). Results Between 2013 and 2016, 352 NexGen TKAs were carried out on 331 patients. A total of 62 TKAs have been revised to date, giving an all-cause revision rate of 17.6% at a minimum of five years. Three of these revisions were due to infection. Overall, 59 of the revisions were performed for aseptic loosening (16.7%) of the tibial component. The tibial component was removed intraoperatively without instrumentation due to significant tibial debonding between the implant-cement interface. Conclusion While overall, we believe that early aseptic loosening is multi-factorial in nature, the significantly high aseptic revision rate, as seen by an experienced fellowship-trained arthroplasty surgeon, has led us to believe that there is a fundamental issue with this NexGen implant design. Continued implant surveillance and rigorous review across all regions using this particular implant is warranted based on the concerning findings described here. Cite this article: Bone Jt Open 2022;3(6):495–501.
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Affiliation(s)
- David Keohane
- Department of Trauma and Orthopaedics, University Hospital Limerick, Limerick, Ireland
| | - Gerard A. Sheridan
- Department of Trauma and Orthopaedics, Royal College of Surgeons Ireland, Dublin, Ireland
| | - Eric Masterson
- Department of Trauma and Orthopaedics, University Hospital Limerick, Limerick, Ireland
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Ichimura R, Minamikawa T, Nakagawa H, Mori A, Midorikawa K, Sakuragi K, Minamikawa H. Fracture of the oxidized zirconium femoral component after total knee arthroplasty. Knee 2022; 36:27-32. [PMID: 35447466 DOI: 10.1016/j.knee.2022.03.014] [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: 09/21/2021] [Revised: 02/08/2022] [Accepted: 03/29/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Femoral component fracture is a rare complication of total knee arthroplasty (TKA). CASE We report a case of oxidized zirconium (Oxinium) femoral component fracture after total knee arthroplasty. The fracture site was the junction of the central and medial flanges. The patellar component and polyethylene insert had delamination at the contact point of the fracture line, and the tibial tray had loosening at the medial side. There was no cement adherence at the component fracture site, suggesting that debonding had occurred at the cement-implant interface in this area. Examination with a scanning electron microscope revealed beach marks, which are characteristic findings of metal fatigue. CONCLUSION We considered that the cause of femoral component fracture was a fatigue fracture due to poor fixation of the component to the bone caused by poor osteotomy technique or poor cementing technique. To our knowledge, this is the first case of Oxinium femoral component fracture.
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Affiliation(s)
| | | | | | - Akira Mori
- Minamikawa Orthopaedic Hospital, Fukuoka, Japan
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Wang W, Liang X, Liu X, Bai J, Zhang W, Li W, Wang T, Li M, Wu Z, Chen L, Yang H, Gu Y, Tao Y, Zhou J, Wang H, Geng D. NOX4 blockade suppresses titanium nanoparticle-induced bone destruction via activation of the Nrf2 signaling pathway. J Nanobiotechnology 2022; 20:241. [PMID: 35606794 PMCID: PMC9125939 DOI: 10.1186/s12951-022-01413-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 04/05/2022] [Indexed: 11/11/2022] Open
Abstract
Periprosthetic osteolysis (PPO) triggered by wear particles is the most severe complication of total joint replacement (TJR) surgeries, representing the major cause of implant failure, which is public health concern worldwide. Previous studies have confirmed the specialized role of osteoclast-induced progressive bone destruction in the progression of PPO. Additionally, the reactive oxygen species (ROS) induced by wear particles can promote excessive osteoclastogenesis and bone resorption. Nicotinamide adenine dinucleotide phosphate oxidase 4 (NOX4), a cellular enzyme, is considered to be responsible for the production of ROS and the formation of mature osteoclasts. However, NOX4 involvement in PPO has not yet been elucidated. Therefore, we investigated the mechanism by which NOX4 regulates osteoclast differentiation and the therapeutic effects on titanium nanoparticle-induced bone destruction. We found that NOX4 blockade suppressed osteoclastogenesis and enhanced the scavenging of intracellular ROS. Our rescue experiment revealed that nuclear factor-erythroid 2-related factor 2 (Nrf2) silencing reversed the effects of NOX4 blockade on ROS production and osteoclast differentiation. In addition, we found increased expression levels of NOX4 in PPO tissues, while NOX4 inhibition in vivo exerted protective effects on titanium nanoparticle-induced osteolysis through antiosteoclastic and antioxidant effects. Collectively, these findings suggested that NOX4 blockade suppresses titanium nanoparticle-induced bone destruction via activation of the Nrf2 signaling pathway and that NOX4 blockade may be an attractive therapeutic approach for preventing PPO.
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Korkmaz İH, Kaymaz İ, Yıldırım ÖS, Murat F, Kovacı H. Designing and in vitro testing of a novel patient-specific total knee prosthesis using the probabilistic approach. BIOMED ENG-BIOMED TE 2022; 67:295-305. [PMID: 35727116 DOI: 10.1515/bmt-2021-0136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 03/30/2022] [Indexed: 11/15/2022]
Abstract
In order to prevent failure as well as ensure comfort, patient-specific modelling for prostheses has been gaining interest. However, deterministic analyses have been widely used in the design process without considering any variation/uncertainties related to the design parameters of such prostheses. Therefore, this study aims to compare the performance of patient-specific anatomic Total Knee Arthroplasty (TKA) with off-the-shelf TKA. In the patient-specific model, the femoral condyle curves were considered in the femoral component's inner and outer surface design. The tibial component was designed to completely cover the tibia cutting surface. In vitro experiments were conducted to compare these two models in terms of loosening of the components. A probabilistic approach based on the finite element method was also used to compute the probability of failure of both models. According to the deterministic analysis results, 103.10 and 21.67 MPa von Mises stress values were obtained for the femoral component and cement in the anatomical model, while these values were 175.86 and 25.76 MPa, respectively, for the conventional model. In order to predict loosening damage due to local osteolysis or stress shield, it was determined that the deformation values in the examined cement structures were 15% lower in the anatomical model. According to probabilistic analysis results, it was observed that the probability of encountering an extreme value for the anatomical model is far less than that of the conventional model. This indicates that the anatomical model is safer than the conventional model, considering the failure scenarios in this study.
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Affiliation(s)
- İsmail H Korkmaz
- Department of Mechanical Engineering, Faculty of Engineering and Architecture, Erzurum Technical University, Erzurum, Turkey
| | - İrfan Kaymaz
- Department of Mechanical Engineering, Faculty of Engineering and Architecture, Erzurum Technical University, Erzurum, Turkey
| | - Ömer S Yıldırım
- Department of Orthopedics and Traumatology, Atatürk University, Erzurum, Turkey
| | - Fahri Murat
- Department of Mechanical Engineering, Faculty of Engineering and Architecture, Erzurum Technical University, Erzurum, Turkey
| | - Halim Kovacı
- Department of Mechanical Engineering, Atatürk University, Erzurum, Turkey
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Meng X, Zhang W, Lyu Z, Long T, Wang Y. ZnO nanoparticles attenuate polymer-wear-particle induced inflammatory osteolysis by regulating the MEK-ERK-COX-2 axis. J Orthop Translat 2022; 34:1-10. [PMID: 35531425 PMCID: PMC9046564 DOI: 10.1016/j.jot.2022.04.001] [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: 12/06/2021] [Revised: 03/30/2022] [Accepted: 04/03/2022] [Indexed: 11/25/2022] Open
Abstract
Background/Objectives Advanced thermoplastic materials, such as polyether-ether-ketone (PEEK) and highly cross-linked polyethylene (HXLPE), have been increasingly used as orthopaedic implant materials. Similar to other implants, PEEK-on-HXLPE prostheses produce debris from polymer wear that may activate the immune response, which can cause osteolysis, and ultimately implant failure. In this study, we examined whether the anti-inflammatory properties of zinc oxide nanoparticles (ZnO NPs) could attenuate polymer wear particle-induced inflammation. Methods RAW264.7 cells were cultured with PEEK or PE particles and gradient concentrations of ZnO NPs. Intracellular mRNA expression and protein levels of pro-inflammatory factors TNF-α, IL-1β, and IL-6 were detected. An air pouch mouse model was constructed to examine the inflammatory response and expression of pro-inflammatory factors in vivo. Furthermore, an osteolysis rat model was used to evaluate the activation of osteoclasts and destruction of bone tissue induced by polymer particles with or without ZnO NPs. Protein expression of the MEK-ERK-COX-2 pathway was also examined by western blotting to elucidate the mechanism underlying particle-induced anti-inflammatory effects. Results ZnO NPs (≤50 nm, 5 μg/mL) showed no obvious cytotoxicity and attenuated PEEK or PE particle-induced inflammation and inflammatory osteolysis by reducing MEK and ERK phosphorylation and decreasing COX-2 expression. Conclusion ZnO NPs (≤50 nm, 5 μg/mL) attenuated polymer wear particle-induced inflammation via regulation of the MEK-ERK-COX-2 axis. Further, ZnO NPs reduced bone tissue damage caused by particle-induced inflammatory osteolysis. The translational potential of this article Polymer wear particles can induce inflammation and osteolysis in the body after arthroplasty. ZnO NPs attenuated polymer particle-induced inflammation and inflammatory osteolysis. Topical use of ZnO NPs and blended ZnO NP/polymer composites may provide promising approaches for inhibiting polymer wear particle-induced inflammatory osteolysis, thus expanding the range of polymers used in joint prostheses.
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Liao Y, Cao L, Wang Q, Li S, Lin Z, Li W, Zhang P, Yu C. Enhanced tribological properties of
PEEK
‐based composite coatings reinforced by
PTFE
and graphite. J Appl Polym Sci 2022. [DOI: 10.1002/app.51878] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Yuwen Liao
- Institute of Advanced Wear & Corrosion Resistant and Functional Materials Jinan University Guangzhou China
| | - Lin Cao
- Shaoguan Research Institute of Jinan University Jinan University Guangzhou China
| | - Qiwei Wang
- Institute of Advanced Wear & Corrosion Resistant and Functional Materials Jinan University Guangzhou China
| | - Shuangjian Li
- Institute of Advanced Wear & Corrosion Resistant and Functional Materials Jinan University Guangzhou China
- Shaoguan Research Institute of Jinan University Jinan University Guangzhou China
| | - Zhidan Lin
- Institute of Advanced Wear & Corrosion Resistant and Functional Materials Jinan University Guangzhou China
| | - Wei Li
- Institute of Advanced Wear & Corrosion Resistant and Functional Materials Jinan University Guangzhou China
| | - Peng Zhang
- Institute of Advanced Wear & Corrosion Resistant and Functional Materials Jinan University Guangzhou China
- Shaoguan Research Institute of Jinan University Jinan University Guangzhou China
| | - Chuanyong Yu
- Institute of Advanced Wear & Corrosion Resistant and Functional Materials Jinan University Guangzhou China
- Shaoguan Research Institute of Jinan University Jinan University Guangzhou China
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The lexicon for periprosthetic bone loss versus osteolysis after cervical disc arthroplasty: a systematic review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:830-842. [PMID: 34999945 DOI: 10.1007/s00586-021-07092-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 12/10/2021] [Accepted: 12/15/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Periprosthetic bone loss is a common observation following arthroplasty. Recognizing and understanding the nature of bone loss is vital as it determines the subsequent performance of the device and the overall outcome. Despite its significance, the term "bone loss" is often misused to describe inflammatory osteolysis, a complication with vastly different clinical outcomes and treatment plans. Therefore, the goal of this review was to report major findings related to vertebral radiographic bone changes around cervical disc replacements, mitigate discrepancies in clinical reports by introducing uniform terminology to the field, and establish a precedence that can be used to identify the important nuances between these distinct complications. METHODS A systematic review of the literature was conducted following PRISMA guidelines, using the keywords "cervical," "disc replacement," "osteolysis," "bone loss," "radiograph," and "complications." A total of 23 articles met the inclusion criteria with the majority being retrospective or case reports. RESULTS Fourteen studies reported periprosthetic osteolysis in a total of 46 patients with onset ranging from 15-96 months after the index procedure. Reported causes included: metal hypersensitivity, infection, mechanical failure, and wear debris. Osteolysis was generally progressive and led to reoperation. Nine articles reported non-inflammatory bone loss in 527 patients (52.5%), typically within 3-6 months following implantation. The reported causes included: micromotion, stress shielding, and interrupted blood supply. With one exception, bone loss was reported to be non-progressive and had no effect on clinical outcome measures. CONCLUSIONS Non-progressive, early onset bone loss is a common finding after CDA and typically does not affect the reported short-term pain scores or lead to early revision. By contrast, osteolysis was less common, presenting more than a year post-operative and often accompanied by additional complications, leading to revision surgery. A greater understanding of the clinical significance is limited by the lack of long-term studies, inconsistent terminology, and infrequent use of histology and explant analyses. Uniform reporting and adoption of consistent terminology can mitigate some of these limitations. Executing these actionable items is critical to assess device performance and the risk of revision. LEVEL OF EVIDENCE IV Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.
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Stress-Induced, Aseptic Osteolysis of the Mid-Tibia in a Revision Hinged Total Knee Arthroplasty Mimicking Infection. Arthroplast Today 2022; 14:116-120. [PMID: 35281549 PMCID: PMC8914092 DOI: 10.1016/j.artd.2022.01.030] [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: 09/15/2021] [Revised: 01/20/2022] [Accepted: 01/22/2022] [Indexed: 11/22/2022] Open
Abstract
In this report, we present the case of an 80-year-old female with pain located over the tip of her cemented tibial stem in a revision hinge total knee arthroplasty with localized osteolysis that looked suspicious for infection. A thorough workup was negative for infection. We postulate that the osteolysis at the end of her tibial stem was initiated by a modulus of elasticity mismatch at the stem tip, which generated a focal area of increased sagittal bone bending and microparticle generation. She was treated with lesional exploration, debridement, synthetic bone grafting, and tibial plating to distribute stress loads away from the tibial stem tip. Histologic analysis identified no organisms or neoplasm. Her pain ultimately resolved, and the patient returned to her customary activities.
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Wu Y, Teng Y, Zhang C, Pan Y, Zhang Q, Zhu X, Liu N, Su X, Lin J. The ketone body β-hydroxybutyrate alleviates CoCrMo alloy particles induced osteolysis by regulating NLRP3 inflammasome and osteoclast differentiation. J Nanobiotechnology 2022; 20:120. [PMID: 35264201 PMCID: PMC8905851 DOI: 10.1186/s12951-022-01320-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 02/21/2022] [Indexed: 12/13/2022] Open
Abstract
Background Aseptic Loosening (AL) following periprosthetic osteolysis is the main long-term complication after total joint arthroplasty (TJA). However, there is rare effective treatment except for revision surgery, which is costly and painful to the patients. In recent years, the ketone body β-hydroxybutyrate (BHB) has attracted much attention and has been proved to be beneficial in many chronic diseases. With respect to the studies on the ketone body β-hydroxybutyrate (BHB), its anti-inflammatory ability has been widely investigated. Although the ketone body β-hydroxybutyrate has been applied in many inflammatory diseases and has achieved considerable therapeutic efficacy, its effect on wear particles induced osteolysis is still unknown. Results In this work, we confirmed that the anti-inflammatory action of β-hydroxybutyrate (BHB) could be reappeared in CoCrMo alloy particles induced osteolysis. Mechanistically, the ketone body β-hydroxybutyrate (BHB) deactivated the activation of NLRP3 inflammasome triggered by CoCrMo alloy particles. Of note, this inhibitory action was independent of Gpr109a receptor as well as histone deacetylase (HDAC) suppression. Furthermore, given that butyrate, one kind of short chain fatty acid (SCFA) structurally related to β-hydroxybutyrate (BHB), has been reported to be an inhibitor of osteoclast, thus we also investigate the effect of β-hydroxybutyrate (BHB) on osteoclast, which was contributed to bone resorption. It was found that β-hydroxybutyrate (BHB) did not only affect osteoclast differentiation, but also inhibit its function. Unlike the inflammasome, the effect of β-hydroxybutyrate (BHB) on osteoclast may mainly rely on histone deacetylase (HDAC) suppression. Conclusions In general, our study showed that the alleviation of osteolysis may owe to the effect of β-hydroxybutyrate (BHB) on inflammasome deactivation and osteoclast. Graphical Abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s12951-022-01320-0.
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Affiliation(s)
- Yanglin Wu
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Soochow University, No. 188 Shizi Street, Suzhou, 215006, Jiangsu, China.,Orthopaedic Institute, Medical College, Soochow University, Suzhou, 215007, China
| | - Yun Teng
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Soochow University, No. 188 Shizi Street, Suzhou, 215006, Jiangsu, China
| | - Chenhui Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Soochow University, No. 188 Shizi Street, Suzhou, 215006, Jiangsu, China
| | - Ying Pan
- Department of Infectious Diseases, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qin Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Soochow University, No. 188 Shizi Street, Suzhou, 215006, Jiangsu, China
| | - Xu Zhu
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Soochow University, No. 188 Shizi Street, Suzhou, 215006, Jiangsu, China
| | - Naicheng Liu
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Soochow University, No. 188 Shizi Street, Suzhou, 215006, Jiangsu, China
| | - Xinlin Su
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Soochow University, No. 188 Shizi Street, Suzhou, 215006, Jiangsu, China
| | - Jun Lin
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Soochow University, No. 188 Shizi Street, Suzhou, 215006, Jiangsu, China.
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Hu W, Yu Y, Sun Y, Yuan F, Zhao F. MiR-25 overexpression inhibits titanium particle-induced osteoclast differentiation via down-regulation of mitochondrial calcium uniporter in vitro. J Orthop Surg Res 2022; 17:133. [PMID: 35241114 PMCID: PMC8895597 DOI: 10.1186/s13018-022-03030-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 02/18/2022] [Indexed: 11/10/2022] Open
Abstract
Background Mitochondrial calcium uniporter (MCU) is an important ion channel regulating calcium transport across the mitochondrial membrane. Calcium signaling, particularly via the Ca2+/NFATc1 pathway, has been identified as an important mediator of the osteoclast differentiation that leads to osteolysis around implants. The present study aimed to investigate whether down-regulation of MCU using microRNA-25 (miR-25) mimics could reduce osteoclast differentiation induced upon exposure to titanium (Ti) particles. Methods Ti particles were prepared. Osteoclast differentiation of RAW264.7 cells was induced by adding Ti particles and determined by TRAP staining. Calcium oscillation was determined using a dual-wavelength technique. After exposure of the cells in each group to Ti particles or control medium for 5 days, relative MCU and NFATc1 mRNA expression levels were determined by RT-qPCR. MCU and NFATc1 protein expression was determined by western blotting. NFATc1 activation was determined by immunofluorescence staining. Comparisons among multiple groups were conducted using one-way analysis of variance followed by Tukey test, and differences were considered significant if p < 0.05. Results MCU expression was reduced in response to miR-25 overexpression during the process of RAW 264.7 cell differentiation induced by Ti particles. Furthermore, osteoclast formation was inhibited, as evidenced by the low amplitude of calcium ion oscillation, reduced NFATc1 activation, and decreased mRNA and protein expression levels of nuclear factor-κB p65 and calmodulin kinases II/IV. Conclusions Regulation of MCU expression can impact osteoclast differentiation, and the underlying mechanism likely involves the Ca2+/NFATc1 signal pathway. Therefore, MCU may be a promising target in the development of new strategies to prevent and treat periprosthetic osteolysis. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-022-03030-7.
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Affiliation(s)
- Weifan Hu
- Department of Orthopedics, The People's Hospital of Jiawang District of Xuzhou, Xuzhou, 221000, People's Republic of China.,Department of Orthopedics, The Affiliated Hospital of Xuzhou Medical University, 99 Huaihai Road, Quanshan District, Xuzhou City, Jiangsu Province, 221000, People's Republic of China
| | - Yongbo Yu
- Department of Orthopedics, The People's Hospital of Jiawang District of Xuzhou, Xuzhou, 221000, People's Republic of China
| | - Yang Sun
- Department of Orthopedics, The Affiliated Hospital of Xuzhou Medical University, 99 Huaihai Road, Quanshan District, Xuzhou City, Jiangsu Province, 221000, People's Republic of China
| | - Feng Yuan
- Department of Orthopedics, The Affiliated Hospital of Xuzhou Medical University, 99 Huaihai Road, Quanshan District, Xuzhou City, Jiangsu Province, 221000, People's Republic of China
| | - Fengchao Zhao
- Department of Orthopedics, The Affiliated Hospital of Xuzhou Medical University, 99 Huaihai Road, Quanshan District, Xuzhou City, Jiangsu Province, 221000, People's Republic of China.
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Zavras AG, Sullivan TB, Singh K, Phillips FM, Colman MW. Failure in cervical total disc arthroplasty: single institution experience, systematic review of the literature, and proposal of the RUSH TDA failure classification system. Spine J 2022; 22:353-369. [PMID: 34419625 DOI: 10.1016/j.spinee.2021.08.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 08/10/2021] [Accepted: 08/13/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Cervical total disc arthroplasty (TDA) is an alternative procedure to anterior cervical discectomy and fusion that facilitates neural decompression while both preserving motion of the spinal unit and decreasing the risk for degenerative changes at adjacent segments. However, due to its more recent introduction in clinical practice and low complication rates, the modes by which TDA may fail remain to be described. PURPOSE This study sought to identify the modes and frequencies of cervical TDA failure in order to propose a novel classification system. STUDY DESIGN Retrospective cohort and systematic review. PATIENT SAMPLE Patients who underwent single or two-level TDA for cervical radiculopathy or myelopathy at a single institution and in the literature of medium and large prospective studies. OUTCOME MEASURES Cervical TDA failure, defined as subsequent surgical intervention at the index segment. METHODS This study retrospectively reviewed patients who underwent single or two-level TDA for cervical radiculopathy or myelopathy at a single institution to identify the potential implant failure modes. A systematic review and meta-analysis of prospective data in the literature was then performed to further supplement failure mode identification and to describe the rates at which the various failure types occurred. Statistical analysis included between-group comparisons of Non-Failed and Failed patients and frequencies of each failure type among Failed patients. RESULTS A retrospective review at our institution of 169 patients (201 levels) identified eight failures, for a failure rate of 4.7%. Additionally, seven patients were revised who had the primary surgery at an outside institution. The systematic review of 3976 patients (4525 levels) identified 165 (4.1%) additional failures. Using this data, six primary failure types were classified, with several subtypes. These include recurrent or persistent index-level stenosis (Type I); migration (Type II) presenting as gross extrusion (A) or endplate failure with subsidence/acute fracture (B); instability (Type III) due to mechanical loosening (A), septic loosening (B), or device fracture (C); device motion loss (Type IV) such as "locking" of the device in kyphosis; implantation error (Type V) due to malposition (A) or improper sizing (B); and wear (Type VI) either without osteolysis (A) or with wear-particle-induced osteolysis (B). Stenosis (Type I) was the most common mode of failure found both through retrospective review and in the literature. CONCLUSIONS Cervical TDA fails through six primary mechanisms. While rates of certain failures requiring subsequent surgical intervention are low, it is possible that these complications may become more prevalent upon further longitudinal observation. Thus, future application and validation of this classification system is warranted to evaluate how failure frequencies change over time and with larger patient samples.
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Affiliation(s)
- Athan G Zavras
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St., Chicago, IL 60612, USA
| | - Thomas Barrett Sullivan
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St., Chicago, IL 60612, USA
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St., Chicago, IL 60612, USA
| | - Frank M Phillips
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St., Chicago, IL 60612, USA
| | - Matthew W Colman
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St., Chicago, IL 60612, USA.
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Chacko Rajan S, Bretcanu O, Deehan DJ, Joyce TJ. Comparative retrieval analysis of contemporary mobile and fixed unicompartmental knee bearing designs. J Mech Behav Biomed Mater 2022; 127:105076. [PMID: 35042103 DOI: 10.1016/j.jmbbm.2022.105076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/24/2021] [Accepted: 01/03/2022] [Indexed: 11/24/2022]
Abstract
There are two different concepts behind Unicompartmental Knee Replacement (UKR). Mobile bearings, as exemplified by the Oxford UKR, and fixed bearings, as exemplified by the Physica ZUK. These are the two most commonly implanted UKRs in the UK. For the first time, a comparison of the tribological features of 19 explanted Oxford and 19 explanted Physica ZUK UKRs was undertaken. Surface damage on the polyethylene (PE) inserts of the Oxford and Physica ZUK cohorts were assessed using an established semi-quantitative scoring method. The femoral components of both cohorts were assessed using a non-contact 3D profilometer to measure roughness values. It was found that the PE inserts of the Oxford cohort (22.54 ± 9.14) had statistically significant greater damage scores than the Physica ZUK cohort (16.50 ± 5.17) (p = 0.04). However, the femoral components of the Oxford cohort showed lower roughness values than the Physica ZUK cohort (p = 0.00). This is the first study that reports a comparative roughness analysis between retrieved Oxford and Physica ZUK UKR designs.
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Affiliation(s)
- Shannen Chacko Rajan
- School of Engineering, Newcastle University, NE1 7RU Newcastle upon Tyne, England, UK
| | - Oana Bretcanu
- School of Engineering, Newcastle University, NE1 7RU Newcastle upon Tyne, England, UK
| | | | - Thomas Jonathan Joyce
- School of Engineering, Newcastle University, NE1 7RU Newcastle upon Tyne, England, UK.
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Kim H, Kim CH, Kim M, Lee W, Jeon IH, Lee KW, Koh KH. Is reverse total shoulder arthroplasty (rTSA) more advantageous than anatomic TSA (aTSA) for osteoarthritis with intact cuff tendon? A systematic review and meta-analysis. J Orthop Traumatol 2022; 23:3. [PMID: 34993646 PMCID: PMC8738793 DOI: 10.1186/s10195-022-00625-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 01/01/2022] [Indexed: 12/19/2022] Open
Abstract
PURPOSE We aimed to compare the outcomes and complications of anatomical shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA) for primary glenohumeral osteoarthritis with intact cuff tissue. MATERIALS AND METHODS The MEDLINE, Embase, and Cochrane Library databases were systematically searched for studies published before March 2, 2021 using the PRISMA guidelines. Studies were included if they directly compared aTSA and rTSA for treating primary glenohumeral arthritis. A meta-analysis was performed using six studies that compared radiologic outcomes, functional scores, and range of motion (ROM). All the data were pooled using a random-effects model. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated as dichotomous data, while continuous data were analyzed using mean differences with 95% CIs. RESULTS Two independent researchers reviewed 1,061 studies. Six studies met the inclusion criteria. The range of motion, especially external rotation, was better for aTSA than for rTSA (MD = - 10.28, 95% CI: - 16.69 to - 3.88, P = 0.002). Functional scores showed no difference between aTSA and rTSA. Glenoid loosening (OR = 0.17, 95% CI: 0.06-0.50, P = 0.001) was more common with aTSA, and scapula notching (OR = 10.63, 95% CI: 1.73-65.27, P = 0.01) with rTSA. In the mid-term follow-up, the overall revision rate showed no difference between aTSA and rTSA, with a pooled OR of 0.33 (95% CI: 0.07-1.57, P = 0.16). CONCLUSION A better ROM was achieved after aTSA than after rTSA. There was no difference in the revision rate at mid-term follow-up between aTSA and rTSA. Glenoid loosening was more common with aTSA, and scapula notching with rTSA. LEVEL OF EVIDENCE Level IV, Meta-analysis.
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Affiliation(s)
- Hyojune Kim
- Department of Orthopaedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Republic of Korea
| | - Chul-Ho Kim
- Department of Orthopaedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Minsoo Kim
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05535, Republic of Korea
| | - Wonsun Lee
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05535, Republic of Korea
| | - In-Ho Jeon
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05535, Republic of Korea
| | - Kwang Won Lee
- Department of Orthopaedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Republic of Korea
| | - Kyoung Hwan Koh
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05535, Republic of Korea.
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