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Hadley ML, Harmer JR, Wright BH, Larson DR, Abdel MP, Berry DJ, Lewallen DG. Porous Tantalum Tibial Metaphyseal Cones in Revision Total Knee Arthroplasty: Excellent 10-Year Survivorship. J Arthroplasty 2024:S0883-5403(24)00382-6. [PMID: 38677340 DOI: 10.1016/j.arth.2024.04.059] [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: 11/13/2023] [Revised: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Highly porous metal tibial metaphyseal cones (TMCs) are commonly utilized in revision total knee arthroplasty (TKA) to address bone loss and obtain biologic fixation. Mid-term (5 to 10 year) studies have previously demonstrated excellent survivorship and high rates of osseointegration, but longer-term studies are lacking. We aimed to assess long-term (≥ 10 year) implant survivorship, complications, and clinical and radiographic outcomes after revision TKA with TMCs. METHODS Between 2004 and 2011, 228 revision TKAs utilizing porous tantalum TMCs with stemmed tibial components were performed at a single institution and were retrospectively reviewed. The mean age at revision was 65 years, the mean body mass index was 33, and 52% were women. Implant survivorship, complications, and clinical and radiographic outcomes were assessed. The mean follow-up was 6.3 years. RESULTS The 10-year survivorship free of aseptic loosening leading to TMC removal was 97%, free of any TMC removal was 88%, free of any re-revision was 66%, and free of any reoperation was 58%. The most common indications for re-revision were periprosthetic joint infection, instability, and aseptic femoral component loosening. The 10-year nonoperative complication rate was 24%. The mean Knee Society scores increased from 38 preoperatively to 69 at 10 years. There were 8 knees that had evidence of partial, progressive tibial radiolucencies at 10 years. CONCLUSIONS Porous tantalum TMCs demonstrated persistently durable longer-term survivorship with a low rate of implant removal. The rare implant removals for component loosening or instability were offset by those required for periprosthetic joint infection, which accounted for 80% of cone removals. Porous tantalum TMCs provide an extremely reliable tool to address tibial bone loss and achieve durable long-term fixation in revision TKA. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Matthew L Hadley
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Joshua R Harmer
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Breydan H Wright
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Dirk R Larson
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Daniel J Berry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - David G Lewallen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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Ul Haq I, Khan TA, Krukiewicz K. Etiology, pathology, and host-impaired immunity in medical implant-associated infections. J Infect Public Health 2024; 17:189-203. [PMID: 38113816 DOI: 10.1016/j.jiph.2023.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/20/2023] [Accepted: 11/21/2023] [Indexed: 12/21/2023] Open
Abstract
Host impaired immunity and pathogens adhesion factors are the key elements in analyzing medical implant-associated infections (MIAI). The infection chances are further influenced by surface properties of implants. This review addresses the medical implant-associated pathogens and summarizes the etiology, pathology, and host-impaired immunity in MIAI. Several bacterial and fungal pathogens have been isolated from MIAI; together, they form cross-kingdom species biofilms and support each other in different ways. The adhesion factors initiate the pathogen's adherence on the implant's surface; however, implant-induced impaired immunity promotes the pathogen's colonization and biofilm formation. Depending on the implant's surface properties, immune cell functions get slow or get exaggerated and cause immunity-induced secondary complications resulting in resistant depression and immuno-incompetent fibro-inflammatory zone that compromise implant's performance. Such consequences lead to the unavoidable and straightforward conclusion for the downstream transformation of new ideas, such as the development of multifunctional implant coatings.
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Affiliation(s)
- Ihtisham Ul Haq
- Department of Physical Chemistry and Technology of Polymers, Silesian University of Technology, M. Strzody 9, 44-100 Gliwice, Poland; Joint Doctoral School, Silesian University of Technology, Akademicka 2A, 44-100 Gliwice, Poland; Programa de Pós-graduação em Inovação Tecnológica, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil.
| | - Taj Ali Khan
- Division of Infectious Diseases & Global Medicine, Department of Medicine, University of Florida, Gainesville, FL, United States; Institute of Pathology and Diagnostic Medicine, Khyber Medical University, Peshawar, Pakistan.
| | - Katarzyna Krukiewicz
- Department of Physical Chemistry and Technology of Polymers, Silesian University of Technology, M. Strzody 9, 44-100 Gliwice, Poland; Centre for Organic and Nanohybrid Electronics, Silesian University of Technology, Konarskiego 22B, 44-100 Gliwice, Poland.
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Wilson BJ, Owston HE, Iqbal N, Giannoudis PV, McGonagle D, Pandit H, Philipose Pampadykandathil L, Jones E, Ganguly P. In Vitro Osteogenesis Study of Shell Nacre Cement with Older and Young Donor Bone Marrow Mesenchymal Stem/Stromal Cells. Bioengineering (Basel) 2024; 11:143. [PMID: 38391629 PMCID: PMC10886325 DOI: 10.3390/bioengineering11020143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 01/22/2024] [Accepted: 01/26/2024] [Indexed: 02/24/2024] Open
Abstract
Bone void-filling cements are one of the preferred materials for managing irregular bone voids, particularly in the geriatric population who undergo many orthopedic surgeries. However, bone marrow mesenchymal stem/stromal cells (BM-MSCs) of older-age donors often exhibit reduced osteogenic capacity. Hence, it is crucial to evaluate candidate bone substitute materials with BM-MSCs from the geriatric population to determine the true osteogenic potential, thus simulating the clinical situation. With this concept, we investigated the osteogenic potential of shell nacre cement (SNC), a bone void-filling cement based on shell nacre powder and ladder-structured siloxane methacrylate, using older donor BM-MSCs (age > 55 years) and young donor BM-MSCs (age < 30 years). Direct and indirect cytotoxicity studies conducted with human BM-MSCs confirmed the non-cytotoxic nature of SNC. The standard colony-forming unit-fibroblast (CFU-F) assay and population doubling (PD) time assays revealed a significant reduction in the proliferation potential (p < 0.0001, p < 0.05) in older donor BM-MSCs compared to young donor BM-MSCs. Correspondingly, older donor BM-MSCs contained higher proportions of senescent, β-galactosidase (SA-β gal)-positive cells (nearly 2-fold, p < 0.001). In contrast, the proliferation capacity of older donor BM-MSCs, measured as the area density of CellTrackerTM green positive cells, was similar to that of young donor BM-MSCs following a 7-day culture on SNC. Furthermore, after 14 days of osteoinduction on SNC, scanning electron microscopy with energy-dispersive spectroscopy (SEM-EDS) showed that the amount of calcium and phosphorus deposited by young and older donor BM-MSCs on SNC was comparable. A similar trend was observed in the expression of the osteogenesis-related genes BMP2, RUNX2, ALP, COL1A1, OMD and SPARC. Overall, the results of this study indicated that SNC would be a promising candidate for managing bone voids in all age groups.
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Affiliation(s)
- Bridget Jeyatha Wilson
- Division of Dental Products, Department of Biomaterial Science and Technology, Biomedical Technology Wing, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram 695 012, India
| | - Heather Elizabeth Owston
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS9 7JT, UK
| | - Neelam Iqbal
- School of Chemical and Process Engineering, University of Leeds, Leeds LS2 9JT, UK
| | - Peter V Giannoudis
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS9 7JT, UK
- Leeds Orthopaedic & Trauma Sciences, Leeds General Infirmary, University of Leeds, Leeds LS2 9JT, UK
- Leeds Musculoskeletal Biomedical Research Centre, Chapel Allerton Hospital, Leeds LS7 4SA, UK
| | - Dennis McGonagle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS9 7JT, UK
- Leeds Musculoskeletal Biomedical Research Centre, Chapel Allerton Hospital, Leeds LS7 4SA, UK
| | - Hemant Pandit
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS9 7JT, UK
- Leeds Musculoskeletal Biomedical Research Centre, Chapel Allerton Hospital, Leeds LS7 4SA, UK
| | - Lizymol Philipose Pampadykandathil
- Division of Dental Products, Department of Biomaterial Science and Technology, Biomedical Technology Wing, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram 695 012, India
| | - Elena Jones
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS9 7JT, UK
| | - Payal Ganguly
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS9 7JT, UK
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Dzidzishvili L, Sáez D, Calvo E. Metaphyseal cones combined with diaphyseal impaction grafting provide good outcomes and survival in a complex revision total knee arthroplasty: a matched comparative analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:577-583. [PMID: 37656276 DOI: 10.1007/s00590-023-03659-y] [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: 05/25/2023] [Accepted: 07/25/2023] [Indexed: 09/02/2023]
Abstract
PURPOSE To compare clinical and radiological outcomes, implant survivorship at a minimum of 1-year follow-up using metaphyseal trabecular cones with or without impaction grafting in a complex revision TKA. METHODS A retrospective comparative matched analysis was performed and 15 patients who underwent revision surgery using the combination of porous trabecular metaphyseal cone and diaphyseal impaction grafting (MC-IBG) were matched with a group of 13 patients who also underwent revision surgery using metaphyseal cone (MC) without impaction grafting. All included patients presented severe bone defect (AORI 2,3) and a rotating-hinge prosthesis were implanted. RESULTS Both groups were comparable regarding the baseline demographic and clinical data. Patients had previously undergone a mean of 4 (range, 2-12) and 3 (range, 2-5) previous procedures in the MC-IBG and MC groups, respectively. The indications for revision were aseptic loosening in 11 (73.3%) and 11 (84.6%) patients; prosthetic joint infection in 4 (26.7%) and 2 (15.4%) in the MC-IBG and MC groups, respectively. There was no significant difference in the mean postoperative Knee Society Score between the study groups (p = 0.806). Overall, 4 patients had further revision. Two patients were revised in the MC-IBG group, one patient for aseptic loosening and the second one after 2 episodes of instability. Two patients in the MC group presented prosthetic joint infection and underwent a two-stage reimplantation. No significant difference was observed between the study groups at comparison (p = 0.92). CONCLUSION Trabecular metal cones with diaphyseal impaction grafting provide an alternative technique in a complex revision TKA surgery with early clinical and radiographic success.
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Affiliation(s)
- Lika Dzidzishvili
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Fundación Jiménez Díaz, Av. de los Reyes Católicos, 2, 28040, Madrid, Spain.
| | - David Sáez
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Rey Juan Carlos, C. Gladiolo, s/n, 28933, Móstoles, Madrid, Spain
| | - Emilio Calvo
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Fundación Jiménez Díaz, Av. de los Reyes Católicos, 2, 28040, Madrid, Spain
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Eder-Halbedl M, Fink A, Pietsch M, Djahani O, Hofmann S. Excellent mid- to long-term survival of tantalum metal cones in a case series of revision knee arthroplasty with severe bony defects. Knee Surg Sports Traumatol Arthrosc 2023; 31:5496-5506. [PMID: 37819600 PMCID: PMC10719141 DOI: 10.1007/s00167-023-07593-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 09/11/2023] [Indexed: 10/13/2023]
Abstract
PURPOSE Severe metaphyseal bone defects remain a challenge and represent a growing problem in revision total knee arthroplasty (RTKA). The purpose of this study was to examine the survival of first-generation tantalum metal cones (TMC) and to assess clinical and radiographic data obtained from mid- to long-term follow-ups (FU) after RTKA with severe bony defects. METHODS This retrospective case series included 100 consecutive patients of the same centre, who underwent RTKA surgery with TMC for tibia and/or femur bone defects between January 2011 and December 2015. Fourteen patients had died and six were lost for FU, leaving a total of eighty patients (one hundred and twelve TMC) for final evaluation. Clinical parameters including the Knee Society Score (KSS), visual analogue scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and range of motion (ROM) were determined preoperatively based on the patients' medical charts, and assessed again during the final FU after an average of 6.1 (5-9) years postoperative. Standardised postoperative X-rays were analysed during the final FU visit for osseointegration of the cones, and any signs of implant loosening were assessed with the modified Knee Society Radiographic review criteria. Perioperative and postoperative complications, reoperations, as well as implant and cone re-revisions were analysed. Survivorship analysis was performed with (a) cone-related revision for any reason and (b) implant component revision for any reason. RESULTS Previous RTKA had to be performed due to 64 (80%) aseptic and 16 (20%) septic failures. At the final FU, 75 (94%) tibia and 76 (95%) femur TMCs and implants were clinically stable. One patient experienced loosening of cones and implants at the femur and tibia but denied re-revision surgery. There were eight (10%) reoperations including two early wound healing problems, two inlay changes, two periprosthetic fractures, one debridement, antibiotics and implant retention (DAIR), and one secondary patella replacement. The six (7.5%) re-revisions included two aseptic loosening's of the opposite implant without TMC, one arthrodesis for recurrent instability, and three deep infections managed by two two-stage exchanges, and one amputation for persistent infection. At re-revision, all TMC cones were osteointegrated without signs of loosening. The determined clinical parameters showed significant (p < 0.001) postoperative improvement, and objective KSS was rated as excellent in 51%, and as good in 22% of patients at the final FU. The estimated 8-year Kaplan-Meier survival was 95% for TMC and 92.5% for implant components. CONCLUSION Tantalum metal cones (TMC) demonstrate a secure fixation for treatment of severe femoral and tibial metaphyseal bone defects during RTKA. This fixation concept showed excellent mid- to long-term clinical and radiographic outcomes with promising 8-year survival rates for cones and implant components. LEVEL OF EVIDENCE Retrospective cohort study, Level IV.
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Affiliation(s)
- Michael Eder-Halbedl
- Department of Orthopedics and Traumatology, LKH Feldbach-Fürstenfeld, Ottokar-Kernstock-Straße 18, 8330, Feldbach, Austria.
| | - Andrea Fink
- Department of Orthopedics and Traumatology, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Martin Pietsch
- Department of Orthopedics, LKH-Murtal, Stolzalpe, Stolzalpe 38, 8852, Murau, Austria
| | - Oliver Djahani
- Department of Orthopedics, LKH-Murtal, Stolzalpe, Stolzalpe 38, 8852, Murau, Austria
| | - Siegfried Hofmann
- Department of Orthopedics and Traumatology, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
- Department of Orthopedics, LKH-Murtal, Stolzalpe, Stolzalpe 38, 8852, Murau, Austria
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Tang Q, Guo S, Deng W, Zhou Y. Using novel porous metal pillars for tibial bone defects in primary total knee arthroplasty. BMC Musculoskelet Disord 2023; 24:829. [PMID: 37864175 PMCID: PMC10588064 DOI: 10.1186/s12891-023-06962-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 10/13/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND The optimal method to treat tibial bone defects during primary total knee arthroplasty (TKA) is still unclear. A novel technique of porous metal pillar augmentation has been applied recently. This study aimed to assess the short-term outcomes of primary TKA with the use of novel porous metal pillars for tibial bone defects. METHODS A total of 24 cases (22 patients) of primary TKA between January 2019 and December 2020 using porous metal pillars for tibial bone defects were reviewed. Clinical results were evaluated using the Knee Society knee score (KSKS) and function score (KSFS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and range of motion (ROM). Hip-knee-ankle angle (HKAA), femorotibial angle (FTA), and radiolucent lines were assessed radiologically. RESULTS The median follow-up period was 36.0 months (interquartile range: 31-37 months). The KSKS, KSFS, WOMAC score, and ROM improved significantly at the final follow-up assessment compared with the preoperative evaluation. Both of the HKAA and FTA were corrected after surgery. Only one knee had a nonprogressive radiolucent line at the bone-cement interface. No radiolucent lines were detected around the pillar in any of the cases. There were no cases of prosthesis loosening and revision. CONCLUSIONS The use of novel porous metal pillars yielded satisfactory clinical outcomes and reliable radiological evidence of fixation in this study with a minimum 2-year follow-up. Porous metal pillar augmentation can be considered as a valuable and easy-to-use method for the management of tibial bone defects in primary TKA.
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Affiliation(s)
- Qiheng Tang
- Department of Orthopedics, Beijing Jishuitan Hospital, Capital Medical University, The Fourth Clinical Medical College of Peking University, No. 31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China
| | - Shaoyi Guo
- Department of Orthopedics, Beijing Jishuitan Hospital, Capital Medical University, The Fourth Clinical Medical College of Peking University, No. 31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China
| | - Wang Deng
- Department of Orthopedics, Beijing Jishuitan Hospital, Capital Medical University, The Fourth Clinical Medical College of Peking University, No. 31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China
| | - Yixin Zhou
- Department of Orthopedics, Beijing Jishuitan Hospital, Capital Medical University, The Fourth Clinical Medical College of Peking University, No. 31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China.
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Longo UG, De Salvatore S, Intermesoli G, Pirato F, Piergentili I, Becker R, Denaro V. Metaphyseal cones and sleeves are similar in improving short- and mid-term outcomes in Total Knee Arthroplasty revisions. Knee Surg Sports Traumatol Arthrosc 2023; 31:861-882. [PMID: 35234976 DOI: 10.1007/s00167-022-06914-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 02/04/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of this systematic review and metanalysis was to assess clinical and radiological outcomes of metaphyseal sleeves and cones and to identify their possible advantages and disadvantages. METHODS A comprehensive search from the inception of the databases to March 2021 was performed on Medline, Scopus, CINAHL, Cochrane, Embase, Ovid, and Google scholar databases. Coleman Methodology Score was used for quality assessment. Author, year of publication, type of study, level of evidence, sample size, number of patients, number of knees treated, mean age, gender, mean follow-up, clinical outcomes, complications, the reason for revision and, type of prosthesis were extracted for analysis. Clinical studies providing data about patient's outcomes after the primary and Total Knee Arthroplasty revision with the usage of sleeves or cones and a minimum of 2 years of follow-up were included. RESULTS The literature search and cross-referencing resulted in a total of 93 articles, but only 30 articles were appropriate for the systematic review. Comparable clinical results were reported between cones and sleeves. The meta-analysis showed a greater incidence of intraoperative fractures in patients treated with sleeves (1.6%, [95% CI 0.7; 3.4] in cones and 4.6%, [95% CI 3.3; 6.4] in sleeves, p = 0.01), while the risk of postoperative fractures (4.3%, [95% CI 2.7; 7] in cones and 2.1%, [95% CI 1.2; 3.5] in sleeves, p = 0.04) and infections (8.5%, [95% CI 6; 12] in cones and 3.7%, [95% CI 2.1; 7.3] in sleeves, p = 0.03) was higher with cones. CONCLUSION A higher incidence of intraoperative fracture was reported in patients treated with sleeves, while a higher rate of postoperative fractures and infections was described in patients treated with cones. Nonetheless, complications were reported in both groups. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Umile Giuseppe Longo
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy. .,Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery), Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy.
| | - Sergio De Salvatore
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy.,Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery), Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
| | - Giovanni Intermesoli
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy.,Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery), Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
| | - Francesco Pirato
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy.,Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery), Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
| | - Ilaria Piergentili
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy.,Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery), Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
| | - Roland Becker
- Department of Orthopaedic and Traumatology, Brandenburg Medical School Theodor Fontane, Hochstrasse 29, 14770, Brandenburg/Havel, Germany
| | - Vincenzo Denaro
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy.,Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery), Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
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Tantalum Cones for Severe Bone Defects in Revision Knee Arthroplasty: A Minimum 10-Year Follow-Up. J Arthroplasty 2022; 38:886-892. [PMID: 36481282 DOI: 10.1016/j.arth.2022.11.013] [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: 08/24/2022] [Revised: 11/14/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Two-to 6-year results of reconstruction of severe bone defects in revision total knee arthroplasty (TKA) with highly porous tantalum cones have been encouraging, but 10-year follow-up is lacking. The purpose of this study was to determine the minimum 10-year results of tantalum cones in revision TKA. METHODS From 2005 to 2010, 30 consecutive patients (30 knees) underwent revision TKA with the use of cones. All patients were followed clinically and radiographically for a minimum of 10 years. A total of 42 cones (25 tibial and 17 femoral) were used to reconstruct massive bone defects classified as Anderson Orthopaedic Research Institute Types 2A (10), 2B (12), and 3 (19). The mean age of the patients was 73 years (range, 55 to 84) at the time of revision. The indication for the revision included aseptic loosening (15 patients) and second-stage reimplantation for deep infection (15 patients). Six patients were lost to follow-up. RESULTS In total, 6 cones had to be revised. Minimum 10-year cone survivorship for any reason was 81% (25 of 31 cones). With cone revision for aseptic loosening as the end point, survivorship was 96% (30 of 31). No evidence of loosening or migration of any implant was noted on the most recent radiographs. CONCLUSION Metaphyseal fixation with tantalum cones in revision TKA demonstrated excellent survivorship and fixation at a minimum follow-up of 10 years. This type of metaphyseal reconstruction can be a durable option for revision TKA in patients who have massive bone defects.
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Byttebier P, Dhont T, Pintelon S, Rajgopal A, Burssens A, Victor J. Comparison of Different Strategies in Revision Arthroplasty of the Knee with Severe Bone Loss: A Systematic Review and Meta-Analysis of Clinical Outcomes. J Arthroplasty 2022; 37:S371-S381.e4. [PMID: 35271982 DOI: 10.1016/j.arth.2022.02.103] [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: 11/30/2021] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND In revision total knee arthroplasty large bone lesions can jeopardize correct implant orientation and fixation. Different strategies have been proposed to tackle this issue. The purpose of this review and meta-analysis is to evaluate the midterm clinical and survivorship results of porous cones and porous-coated sleeves compared to morselized and structural grafts. METHODS We performed a systematic review of the literature on the different strategies targeting moderate to large metaphyseal bone defects. The literature was evaluated for methodological quality. We analyzed results on survivorship using logistic regression correcting for follow-up time and number of knees. We compared these results using forest plots for early and midterm follow-up. Clinical outcome was evaluated by comparing standardized mean difference of patient-related outcome measures. RESULTS A total of 77 articles analyzing 4,391 knees were included. The logistic regression curve showed a nonsignificant odds ratio (OR) at 10 years of 0.91 (95% confidence interval [CI] 0.699-1.192, P = .49) for failure comparing all porous implants with all grafting procedures. The available clinical reports show a bigger standardized mean difference increase for tantalum cones (OR 3.04, 95% CI 1.71-4.37) than for porous sleeves (OR 1.72, 95% CI 0.88-2.57). CONCLUSION Our analysis shows that the size and quality of the literature on metaphyseal bone defects is progressively improving. Porous implants are effective in tackling metaphyseal bone defects showing good survivorship outcome at midterm follow-up. In younger patients with less constrained prosthetic implants, surgeons might still consider the use of grafts without risking worse outcomes.
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Affiliation(s)
- Paul Byttebier
- Department of Orthopaedics and Trauma Surgery, UZ Gent, Medical University of Ghent, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Thibaut Dhont
- Department of Orthopaedics and Trauma Surgery, UZ Gent, Medical University of Ghent, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Sam Pintelon
- Department of Orthopaedics and Trauma Surgery, UZ Gent, Medical University of Ghent, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Ashok Rajgopal
- Institute of Musculoskeletal Disorders and Orthopaedics, Medanta- The Medicity Hospital Gurugram, Haryana, India
| | - Arne Burssens
- Department of Orthopaedics and Trauma Surgery, UZ Gent, Medical University of Ghent, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Jan Victor
- Department of Orthopaedics and Trauma Surgery, UZ Gent, Medical University of Ghent, Corneel Heymanslaan 10, 9000 Ghent, Belgium
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Cemented Versus Hybrid Technique of Fixation of the Stemmed Revision Total Knee Arthroplasty: A Literature Review. J Am Acad Orthop Surg 2022; 30:e703-e713. [PMID: 35041632 DOI: 10.5435/jaaos-d-21-00913] [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] [Received: 09/04/2021] [Accepted: 12/22/2021] [Indexed: 02/01/2023] Open
Abstract
Stems are required during revision total knee arthroplasty to bypass damaged periarticular bone and transfer stress to healthier diaphyseal bone. The mode of stem fixation, whether fully cemented or hybrid, remains controversial. Improvements in surgical technique and implant and instrument technology have improved our ability to deal with many of the challenges of revision total knee arthroplasty. Recent publications that reflect contemporary practice has prompted this review of literature covering the past 20 years to determine whether superiority of one fixation mode over the other can be demonstrated. We reviewed single studies of each type of fixation, studies directly comparing both types of fixation, systematic reviews, international registry data, and studies highlighting the pros and cons of each mode of stem fixation. Based on the available literature, we conclude that using both methods of fixation carries comparable outcomes with marginal superiority of the hybrid fixation method, which is of nonstatistical significance, although on an individual case basis, all fixation methods should be kept in mind and the appropriate method implemented when suitable.
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11
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Chuang CA, Lee SH, Chang CH, Hu CC, Shih HN, Ueng SWN, Chang Y. Application of structural allogenous bone graft in two-stage exchange arthroplasty for knee periprosthetic joint infection: a case control study. BMC Musculoskelet Disord 2022; 23:325. [PMID: 35382827 PMCID: PMC8985362 DOI: 10.1186/s12891-022-05228-6] [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: 08/06/2021] [Accepted: 03/14/2022] [Indexed: 12/03/2022] Open
Abstract
Background Knee prosthetic joint infection (PJI) is a common but devastating complication after knee arthroplasty. The revision surgeries for knee PJI may become more challenging when it is associated with large bone defects. The application of structural bone allograft in knee revision surgeries with large bone defects is not a new technique. However, there is a lack of literature reporting its efficacy in PJI cases. This study aimed to investigate the outcome of structural fresh frozen allogenous bone grafts in treating patients in knee PJI with large bone defects. Methods We performed a retrospective cohort analysis of knee PJI cases treated with two-stage exchange arthroplasty at our institution from 2010 to 2016. 12 patients with structural allogenous bone graft reconstructions were identified as the study group. 24 patients without structural allograft reconstructions matched with the study group by age, gender, and Charlson comorbidity index were enrolled as the control group. The functional outcome of the study group was evaluated with the Knee Society Score (KSS). Treatment success was assessed according to the Delphi-based consensus definition. The infection relapse rate and implant survivorship were compared between groups. Results Revision knees with structural allograft presented excellent improvement in the KSS (33.1 to 75.4). There was no significant difference between infection relapse-free survival rate and prosthesis survival rate in the two groups. The 8-year prosthesis survival rate was 90.9% in the study group and 91% in the control group (p = 0.913). The 8-year infection relapse-free survival rate was 80 and 83.3% in the study group and control group, respectively (p = 0.377). Conclusion The structural fresh frozen allogenous bone graft provided an effective way for bone defect reconstruction in knee PJI with an accountable survival rate. Meanwhile, using structural allografts did not increase the relapse rate of infection.
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Affiliation(s)
- Chieh An Chuang
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, 5, Fu-Hsin St., Kweishan, Taoyuan, Linko, Taiwan
| | - Sheng-Hsun Lee
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, 5, Fu-Hsin St., Kweishan, Taoyuan, Linko, Taiwan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linko, Taoyuan, Taiwan
| | - Chih-Hsiang Chang
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, 5, Fu-Hsin St., Kweishan, Taoyuan, Linko, Taiwan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linko, Taoyuan, Taiwan
| | - Chih-Chien Hu
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, 5, Fu-Hsin St., Kweishan, Taoyuan, Linko, Taiwan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linko, Taoyuan, Taiwan
| | - Hsin-Nung Shih
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, 5, Fu-Hsin St., Kweishan, Taoyuan, Linko, Taiwan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linko, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Steve W N Ueng
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, 5, Fu-Hsin St., Kweishan, Taoyuan, Linko, Taiwan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linko, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yuhan Chang
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, 5, Fu-Hsin St., Kweishan, Taoyuan, Linko, Taiwan. .,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linko, Taoyuan, Taiwan. .,College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Rodríguez-Merchán EC, Gómez-Cardero P, Encinas-Ullán CA. Management of bone loss in revision total knee arthroplasty: therapeutic options and results. EFORT Open Rev 2021; 6:1073-1086. [PMID: 34909226 PMCID: PMC8631235 DOI: 10.1302/2058-5241.6.210007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The treatment of small to moderate size defects in revision total knee arthroplasty (rTKA) has yielded good results with various techniques (cement and screws, small metal augments, impaction bone grafting and modular stems). However, the treatment of severe defects remains problematic. Severe defects have typically been treated with large allograft and metaphyseal sleeves. The use of structural allograft has decreased in recent years due to increased long-term failure rates and the introduction of highly porous metal augments (cones and sleeves). A systematic review of level IV evidence studies on the outcomes of rTKA metaphyseal sleeves found a 4% rate of septic revision, and a rate of septic loosening of the sleeves of 0.35%. Aseptic re-revision was required in 3% of the cases. The rate of aseptic loosening of the sleeves was 0.7%, and the rate of intraoperative fracture was 3.1%. The mean follow-up was 3.7 years. Another systematic review of tantalum cones and sleeves found a reoperation rate of 9.7% and a 0.8% rate of aseptic loosening per sleeve. For cones, the reoperation rate was 18.7%, and the rate of aseptic loosening per cone was 1.7%. The reported survival of metal sleeves was 99.1% at three years, 98.7% at five years and 97.8% at 10 years. The reported survival free of cone revision for aseptic loosening was 100%, and survival free of any cone revision was 98%. Survival free of any revision or reoperation was 90% and 83%, respectively.
Cite this article: EFORT Open Rev 2021;6:1073-1086. DOI: 10.1302/2058-5241.6.210007
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Affiliation(s)
- E Carlos Rodríguez-Merchán
- Department of Orthopaedic Surgery, La Paz University Hospital, Madrid, Spain.,Osteoarticular Surgery Research, La Paz Hospital Health Research Institute - IdiPAZ (La Paz University Hospital - Autonomous University of Madrid), Madrid, Spain
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13
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[Bone defect management in revision knee arthroplasty]. DER ORTHOPADE 2021; 50:1004-1010. [PMID: 34654936 DOI: 10.1007/s00132-021-04181-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/24/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND In 2019, 124,677 primary total knee arthroplasties and 14,462 revision TKA were performed in Germany. This corresponds to a percentage of 11.6%. According to the EPRD, the probability of further revision surgery after the first exchange operation is around 15%. REASONS The most common reason for revision surgery is still aseptic loosening with 23.9%. One possible cause could be the difficult fixation of revision total knee arthroplasty. If the bone quality is insufficient, cement-free or cemented diaphyseal anchoring of the prosthesis is often not sufficient to ensure adequate fixation. As a rule, defect management and fixation of the implant are based on the defect situation and the quality of the bone. Therefore, revision total knee arthroplasties based on the fixation principle of Jones et al. should be sufficiently fixed in at least 2 zones. TECHNIQUES There are various techniques for stable anchoring of revision implants. In addition to cemented or cementless stem anchoring, bone allografts, wedges and blocks and, in recent years, cones and sleeves have become increasingly popular. In the present work, the various options for a stable anchoring of revision implants are presented and evaluated. In addition, the clinical and radiological outcome of cones vs. sleeves in bone defect management in revision knee arthroplasty will be compared.
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14
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Preliminary clinical results of coated porous tibia cones in septic and aseptic revision knee arthroplasty. Arch Orthop Trauma Surg 2021; 141:555-560. [PMID: 32274569 DOI: 10.1007/s00402-020-03434-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Indexed: 10/24/2022]
Abstract
PURPOSE To analyze the first results of calcium-phosphate-coated porous tibia cones. METHODS Patients treated with TrabecuLink®-CaP Cones were retrospectively recruited from January 2016 to December 2017. These custom-made cones were produced using titanium alloy Ti-6Al-4 V (Tilastan®) and using additive manufacturing with a special calcium-phosphate coating (HX®-coating). Clinical outcome was evaluated using Oxford Knee Score. For radiological evaluation of the implants, patients sent us outpatient taken radiographs. A minimum follow-up of one year was required. Lastly, we analyzed postoperative complications and revision rates. RESULTS 52 patients with revision knee arthroplasty (RKA) were recruited for final analysis, of whom, we had 17 septic RKAs (33%) and 35 aseptic cases of RKA (67%). The bone defects were grouped into 17 AORI Type 2A (32.7%), 14 Type 2B (26.9%) and 21 Type 3 (40.4%). After a mean follow-up of 22 months (13.2-34.8; SD = ± 10), we had 4 surgical revisions (7.7%), 2 septic and 2 aseptic cases. The mean Oxford Knee Score was 28.6 points (8-47; SD = ± 10). 22 of 28 radiographs (78.6%) showed regular positioning of the cones and TKAs at a mean follow-up of 16.8 months (13.2-34.8; SD = ± 6). Three patients (10.7%) showed slight radiolucencies in the bone-cement interfaces and 3 patients (10.7%) had beginning heterotopic ossifications. CONCLUSIONS This study shows the initial clinical results of calcium-phosphate-coated tibia cones showing a good functional outcome. Further research should focus on long-term clinical and radiological follow-up.
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15
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Rajgopal A, Kumar S, Aggarwal K. Midterm Outcomes of Tantalum Metal Cones for Severe Bone Loss in Complex Primary and Revision Total Knee Arthroplasty. Arthroplast Today 2021; 7:76-83. [PMID: 33521201 PMCID: PMC7818605 DOI: 10.1016/j.artd.2020.12.004] [Citation(s) in RCA: 3] [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: 09/02/2020] [Revised: 12/02/2020] [Accepted: 12/07/2020] [Indexed: 11/03/2022] Open
Abstract
Background Managing severe periarticular bone loss poses a major challenge in complex primary and revision total knee arthroplasty (TKA). Impaction bone graft, structural allografts, metal augments, and mega prosthesis are some of the methods used to address major bone loss. Tantalum metal (TM) Cones (Zimmer, Warsaw, IN) were introduced as an alternative to address this cohort of patients. The advantages of these cones include excellent biocompatibility, high porosity with osteoconductive potential, and a modulus of elasticity between cortical and cancellous bone. In addition, it is bioactive and offers an intrinsically high friction fit. Methods A cohort of 62 patients with severe distal femoral and proximal tibial bone loss were operated for primary and revision TKA between January 2007 and December 2014 and followed up for a mean period of 108.5 months (range: 60-156 months). Preoperative and postoperative range of motion and Knee Society score were documented. Postoperatively long leg X-rays were performed at each follow-up visit to determine osteointegration, evidence of loosening, and migration. Results The range of motion and Knee Society score improved considerably from preoperative a value of 63.9 ± 13.9° and 52 ± 14.9 to 102.1 ± 9.9° and 76.1 ± 10.03, respectively, at the final follow-up visit in the primary cohort and 52.14 ± 13.3° and 38.1 ± 9.1 to 92 ± 8° and 68.5 ± 4.3, respectively, in the revision cohort. Serial radiographs demonstrated complete osteointegration of the TM cones at the final follow-up. Conclusions Our study demonstrates excellent midterm survivorship of TM cones with predictable osteointegration and good outcomes (clinical and radiological) in treatment of severe femoral and tibial metaphyseal bone defects in complex primary and revision TKAs.
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Affiliation(s)
- Ashok Rajgopal
- Institute of Musculoskeletal disorders and Orthopaedics, Medanta- The Medicity Hospital Gurugram, Haryana, India
| | - Sumit Kumar
- Institute of Musculoskeletal disorders and Orthopaedics, Medanta- The Medicity Hospital Gurugram, Haryana, India
| | - Kalpana Aggarwal
- Institute of Musculoskeletal disorders and Orthopaedics, Medanta- The Medicity Hospital Gurugram, Haryana, India
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Trabecular Metal Cones Combined With Short Cemented Stem Allow Favorable Outcomes in Aseptic Revision Total Knee Arthroplasty. J Arthroplasty 2021; 36:657-663. [PMID: 32978026 DOI: 10.1016/j.arth.2020.08.058] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/26/2020] [Accepted: 08/28/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The purpose of this study was to compare the functional outcomes and implant survivorship at a minimum of 5 years of follow-up of several reconstruction techniques with or without metaphyseal cone and stems of variable length. METHODS A retrospective comparative matched analysis was performed from 2 prospectively collected databases. Only patients who underwent revision total knee arthroplasty procedures for aseptic causes using a single design of rotating hinge knee with a minimum of 5 years of follow-up were analyzed. Patients were separated into 3 groups: trabecular metal (TM) cones + short cemented stems (TM + short stem [SS]), TM cones + long uncemented stems (TM + long stem [LS]), and no cone (NC) + long uncemented stems (NC + LS). A matching process based on age (±5 years) was realized. RESULTS About 99 patients were included; 33 in the TM + SS group, 33 in the TM + LS group, and 33 in the NC + LS group. The mean time of follow-up was 9.3 years. A significant difference of the improvement of subscale pain, symptom, activities of daily living, quality of life of the Knee Injury and Osteoarthritis Outcome score and knee, function of the Knee Society Score was observed in favor of TM + SS group compared with the 2 other groups. At 8 years of survivorship, the components free of revision for any cause were 90.9% for the TM + SS group, 84.9% for the TM + LS group, and 90.6% for the NC + LS group. CONCLUSION The use of a short cemented tibial stem combined with a TM cone in revision total knee arthroplasty offers identical survival rate with better functional outcome compared with the use of a long uncemented stem associated with TM cones or metallic augments at a minimum of 5 years of follow-up.
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17
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Zoller SD, Hegde V, Burke ZDC, Park HY, Ishmael CR, Blumstein GW, Sheppard W, Hamad C, Loftin AH, Johansen DO, Smith RA, Sprague MM, Hori KR, Clarkson SJ, Borthwell R, Simon SI, Miller JF, Nelson SD, Bernthal NM. Evading the host response: Staphylococcus "hiding" in cortical bone canalicular system causes increased bacterial burden. Bone Res 2020; 8:43. [PMID: 33303744 PMCID: PMC7728749 DOI: 10.1038/s41413-020-00118-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 08/22/2020] [Accepted: 09/17/2020] [Indexed: 02/07/2023] Open
Abstract
Extremity reconstruction surgery is increasingly performed rather than amputation for patients with large-segment pathologic bone loss. Debate persists as to the optimal void filler for this "limb salvage" surgery, whether metal or allograft bone. Clinicians focus on optimizing important functional gains for patients, and the risk of devastating implant infection has been thought to be similar regardless of implant material. Recent insights into infection pathophysiology are challenging this equipoise, however, with both basic science data suggesting a novel mechanism of infection of Staphylococcus aureus (the most common infecting agent) into the host lacunar-canaliculi network, and also clinical data revealing a higher rate of infection of allograft over metal. The current translational study was therefore developed to bridge the gap between these insights in a longitudinal murine model of infection of allograft bone and metal. Real-time Staphylococci infection characteristics were quantified in cortical bone vs metal, and both microarchitecture of host implant and presence of host immune response were assessed. An orders-of-magnitude higher bacterial burden was established in cortical allograft bone over both metal and cancellous bone. The establishment of immune-evading microabscesses was confirmed in both cortical allograft haversian canal and the submicron canaliculi network in an additional model of mouse femur bone infection. These study results reveal a mechanism by which Staphylococci evasion of host immunity is possible, contributing to elevated risks of infection in cortical bone. The presence of this local infection reservoir imparts massive clinical implications that may alter the current paradigm of osteomyelitis and bulk allograft infection treatment.
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Affiliation(s)
- Stephen D Zoller
- Department of Orthopedic Surgery, University of California, Los Angeles, 1250 16th St Suite 2100, Santa Monica, CA, 90404, USA
| | - Vishal Hegde
- Department of Orthopedic Surgery, University of California, Los Angeles, 1250 16th St Suite 2100, Santa Monica, CA, 90404, USA
| | - Zachary D C Burke
- Department of Orthopedic Surgery, University of California, Los Angeles, 1250 16th St Suite 2100, Santa Monica, CA, 90404, USA
| | - Howard Y Park
- Department of Orthopedic Surgery, University of California, Los Angeles, 1250 16th St Suite 2100, Santa Monica, CA, 90404, USA
| | - Chad R Ishmael
- Department of Orthopedic Surgery, University of California, Los Angeles, 1250 16th St Suite 2100, Santa Monica, CA, 90404, USA
| | - Gideon W Blumstein
- Department of Orthopedic Surgery, University of California, Los Angeles, 1250 16th St Suite 2100, Santa Monica, CA, 90404, USA
| | - William Sheppard
- Department of Orthopedic Surgery, University of California, Los Angeles, 1250 16th St Suite 2100, Santa Monica, CA, 90404, USA
| | - Christopher Hamad
- Department of Orthopedic Surgery, University of California, Los Angeles, 1250 16th St Suite 2100, Santa Monica, CA, 90404, USA
| | - Amanda H Loftin
- Department of Orthopedic Surgery, University of California, Los Angeles, 1250 16th St Suite 2100, Santa Monica, CA, 90404, USA
| | - Daniel O Johansen
- Department of Orthopedic Surgery, University of California, Los Angeles, 1250 16th St Suite 2100, Santa Monica, CA, 90404, USA
| | - Ryan A Smith
- David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA
| | - Marina M Sprague
- Department of Internal Medicine, University of California, Los Angeles, 757 Westwood Plaza, Suite 7501, Los Angeles, CA, 90095, USA
| | - Kellyn R Hori
- Department of Orthopedic Surgery, University of California, Los Angeles, 1250 16th St Suite 2100, Santa Monica, CA, 90404, USA
- David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA
| | - Samuel J Clarkson
- David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA
| | - Rachel Borthwell
- David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA
| | - Scott I Simon
- Department of Biomedical Engineering, University of California, Davis, Davis, CA, 95616, USA
| | - Jeff F Miller
- California NanoSystems Institute, University of California, Los Angeles, 570 Westwood Plaza, Los Angeles, CA, 90095, USA
- Department of Microbiology, Immunology, and Molecular Genetics, David Geffen School of Medicine, University of California, Los Angeles, 90095, USA
| | - Scott D Nelson
- Department of Pathology, University of California, Los Angeles, 1250 16th St Suite 3450, Santa Monica, CA, 90404, USA
| | - Nicholas M Bernthal
- Department of Orthopedic Surgery, University of California, Los Angeles, 1250 16th St Suite 2100, Santa Monica, CA, 90404, USA.
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19
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Mozella ADP, Cobra HADAB. Bone Defects in Revision Total Knee Arthroplasty. Rev Bras Ortop 2020; 56:138-146. [PMID: 33935308 PMCID: PMC8075647 DOI: 10.1055/s-0040-1713392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 04/15/2020] [Indexed: 12/14/2022] Open
Abstract
The increase in the number of revision total knee arthroplasty surgeries has been observed in recent years, worldwide, for several causes. In the United States, a 601% increase in the number of total knee arthroplasties, between 2005 and 2030, is estimated. Among the enormous challenges of this complex surgery, the adequate treatment of bone defects is essential to obtain satisfactory and lasting results. The adequate treatment of bone defects aims to build a stable and lasting support platform for the implantation of the definitive prosthetic components and, if possible, with the reconstruction of bone stock. Concomitantly, it allows the correct alignment of the prosthetic and limb components, as well as restoring the height of the joint interline and, thus, restoring the tension of soft parts and load distribution to the host bone, generating a joint reconstruction with good function, stable, and painless. There are several options for the management of these bone defects, among them: bone cement with or without reinforcement with screws, modular metallic augmentations, impacted bone graft, structural homologous graft and, more recently, metal metaphyseal cones, and metaphyseal sleeves. The objective of the present article was to gather classic information and innovations about the main aspects related to the treatment of bone defects during revision surgeries for total knee arthroplasty.
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Affiliation(s)
- Alan de Paula Mozella
- Centro de Cirurgia do Joelho, Instituto Nacional de Traumatologia e Ortopedia (INTO), Rio de Janeiro, RJ, Brasil.,Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brasil
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Abdelaziz H, Biewald P, Anastasiadis Z, Haasper C, Gehrke T, Hawi N, Citak M. Midterm Results After Tantalum Cones in 1-Stage Knee Exchange for Periprosthetic Joint Infection: A Single-Center Study. J Arthroplasty 2020; 35:1084-1089. [PMID: 31813812 DOI: 10.1016/j.arth.2019.11.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 10/31/2019] [Accepted: 11/09/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The use of tantalum cones to reconstruct extensive bone defects in revision total knee arthroplasty has been established. We aimed to evaluate the midterm results after 1-stage knee exchange for periprosthetic joint infection using tantalum cones. METHODS Seventy-two patients (mean age, 70 ± 8.2 years) treated with a 1-stage exchange for infected total knee arthroplasty using porous tantalum cones, between 2011 and 2016, were retrospectively included. Either rotating or pure hinge system in combination with femoral and/or tibial cones was used. Survivorship analysis (septic and aseptic) was performed. Prospectively, functional outcome was assessed at a mean follow-up of 49.9 ± 18.8 months (range, 24-88). RESULTS A total of 15 patients (21%) were rerevised, 8 (11.1%) for infection and 7 (10%) for aseptic loosening, requiring cone exchange in 12 patients (17%). Cone-related survival free from any revision was 83% ± 3.8 standard deviation (95% confidence interval, 74-90), and infection-free survival was 89% ± 4.2 standard deviation (95% confidence interval, 76-93). No significant correlation was reported between the types of prosthesis used (P = .8) or implanted cones and failure (P = .6). History of a previous septic revision increased the risk of cone revision after the index surgery (P < .001). Preoperative Hospital for Special Surgery knee score improved from 47 ± 16 (range, 14-87) to 60 ± 17 (range, 24-84) points at the latest follow-up. CONCLUSION First study reports on outcomes of the 1-stage exchange using tantalum cones for knee periprosthetic joint infection with additional severe bone loss. Midterm cone-related and infection-free survival offered good results and provided reasonable functional outcomes.
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Affiliation(s)
- Hussein Abdelaziz
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany
| | - Philipp Biewald
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany
| | - Zoy Anastasiadis
- Department of Orthopaedic Surgery, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Carl Haasper
- Department of Orthopaedic Surgery, AMEOS Klinikum Seepark, Geestland, Germany
| | - Thorsten Gehrke
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany
| | - Nael Hawi
- Department of Trauma Surgery, Hannover Medical School, Hannover, Germany
| | - Mustafa Citak
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany
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21
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Clinical Survivorship of Aseptic Revision Total Knee Arthroplasty Using Hinged Knees and Tantalum Cones at Minimum 10-Year Follow-Up. J Arthroplasty 2019; 34:3018-3022. [PMID: 31351856 DOI: 10.1016/j.arth.2019.06.057] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 06/25/2019] [Accepted: 06/26/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The reconstruction of severe bone loss utilizing porous tantalum cones in patients undergoing revision total knee arthroplasty (TKA) has been established in the last years. However, reports on a long-term follow-up to assess the durability of such implants when combined with hinged knee designs are lacking. The current study aimed to evaluate the results of a previous study cohort at a minimum follow-up of 10 years. METHODS A retrospective review was performed. The initial study cohort comprised of 38 patients who underwent aseptic revision TKA between 2007 and 2009 at a single institution. After exclusion of the deceased patients and patients who were lost to follow-up, 25 patients with hinged knees and 32 cones implanted were included with a minimum follow-up of 10 years (mean = 126.5 months, range 120-142, standard deviation [SD] = 5.92). Survivorship was determined, and re-revisions were observed. Functional Knee Society Score was assessed. RESULTS After a minimum of 10 years, 24 of 32 cones (75%) had survived without any exchange in 18 patients. Reasons for cone revision included aseptic loosening (5/32 cones; 15.6%) and periprosthetic joint infection (3/32 cones; 9.4%). In 4 of the five revisions due to aseptic loosening, pure hinged knees had been implanted. The mean functional Knee Society Score of the survivors was 69.6 points (range 10-100, SD = 30.85), and the average flexion ability of the knee was 92° (range 30°-120°, SD = 22.09). CONCLUSION Porous tantalum cones in revision TKA exhibited no favorable but reasonable long-term durability. Rotating-hinge designs should be used whenever possible to reduce the risk of aseptic loosening. Further comparative long-term analyses with other techniques or implants could inform us about the best treatment method.
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Abstract
Hinged implants are the most constrained knee replacement prostheses. They are very useful in complex cases of total knee arthroplasty (TKA) revision. Hinged implants have evolved with rotating bearings and modularity that allows local joint reconstruction or segmental bone replacement. They are required when significant instability persists in cases with inadequate collateral ligaments and significant flexion laxity. They are now used when a large bone defect is reconstructed, or when bone fixation of the implant is questionable especially in the metaphyseal zone. The use of hinged implants in TKA revision is associated with high complication rates. Published outcomes differ based on the patients’ aetiology. The outcomes of rotating-hinged implants used in septic revisions or salvage situations are poorer than other types of revision and have a higher complication rate. The poor general health of these patients is often a limitation. Despite these relatively poor results, hinged implants continue to have a place in revision surgery to solve major instability or to obtain stable bone fixation of an implant when the metaphysis is filled with bone grafts or porous devices.
Cite this article: EFORT Open Rev 2019;4 DOI: 10.1302/2058-5241.4.180070
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Affiliation(s)
- Gilles Pasquier
- Service de Chirurgie Orthopedique, Centre-Hospitalo-Universitaire de Lille, France
| | - Matthieu Ehlinger
- Service de Chirurgie Orthopedique et de Traumatologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, France
| | - Didier Mainard
- Service de Chirurgie Orthopédique, Cente Hospitalo-Universitaire de Nancy, Centre Hospitalo-Universitaire de Nancy, France
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Guo L, Du Y, Zhang M, Sun J, Jin Z, Peng Y, Shen J, Zhou Y. [Short-term effectiveness of revision total knee arthroplasty with porous-coated metaphyseal Sleeve and MBT implant]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:302-306. [PMID: 30874385 DOI: 10.7507/1002-1892.201810026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To evaluate short-term effectiveness of revision total knee arthroplasty (TKA) with porous-coated metaphyseal Sleeve and MBT implant. Methods A clinical data of 23 patients (24 knees) who underwent revision TKA by using porous-coated metaphyseal Sleeve combined with MBT implant between March 2015 and April 2017 was retrospectively analyzed. There were 8 males (8 knees) and 15 females (16 knees). The age ranged from 48 to 85 years (mean, 65.4 years). The cause of revision TKA included infection in 14 knees, aseptic loosening in 8 knees, instability in 1 knee, and stiff knee in 1 knee. Bone defects were classified according to the Anderson Orthopaedic Research Institute (AORI) bone defect classification. The femoral defect was rated as type ⅡA in 5 knees, type ⅡB in 17 knees, and type Ⅲ in 2 knees; the tibial defect was rated as type ⅡA in 2 knees, type ⅡB in 20 knees, and type Ⅲ in 2 knees. The mean time between primary TKA and revision TKA was 30.6 months (range, 6-86 months). The preoperative range of motion (ROM) was (56.0±24.9)°. The preoperative Hospital for Special Surgery (HSS) total score was 41.9±14.2; and the pain and function scores were 8.5±5.2 and 33.4±13.5, respectively. Results All patients were followed up 12-39 months (mean, 25.6 months). The mean operation time was 2.2 hours (range, 1.6-2.9 hours). The mean intraoperative blood loss was 580 mL (range, 400-1 000 mL). There were 2 knees (8.3%) of intraoperative fracture associated with Sleeve insertion and 1 knee (4.2%) of acute postoperative infection at 25 days after revision TKA. All incisions healed by first intention. No deep venous thrombosis of lower extremity occurred. X-ray film showed that all implants were stable. At last follow-up, slight discomfort after exercise occurred in 4 knees (16.7%); end-of-stem pain in the tibia occurred in 1 knee (4.2%). The ROM was (114.6±5.1)°, which had significant improvement compared with the preoperative result ( t=11.698, P=0.000). The HSS total score (89.0±10.9), pain score (26.9±6.6), and function score (62.1±5.8) also had significant improvement compared with the preoperative results ( t=15.616, P=0.000; t=12.522, P=0.000; t=10.076, P=0.000). Conclusion The porous-coated metaphyseal Sleeve combined with MBT implant in revision TKA has a significant improvement in short-term effectiveness and no signs of implant loosening.
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Affiliation(s)
- Lingfei Guo
- Department of Orthopedics, General Hospital of Chinese PLA, Beijing, 100853, P.R.China;Department of Orthopedics, the 316th Military Hospital of China, Beijing, 100093, P.R.China
| | - Yinqiao Du
- Department of Orthopedics, General Hospital of Chinese PLA, Beijing, 100853, P.R.China
| | - Mingchao Zhang
- Department of Orthopedics, General Hospital of Chinese PLA, Beijing, 100853, P.R.China;Department of Orthopedics, the First Affiliated Hospital of Jinzhou Medical University, Jinzhou Liaoning, 121000, P.R.China
| | - Jingyang Sun
- Department of Orthopedics, General Hospital of Chinese PLA, Beijing, 100853, P.R.China
| | - Zhigang Jin
- Department of Orthopedics, Northeast International Hospital, Shenyang Liaoning, 110000, P.R.China
| | - Yawen Peng
- Department of Orthopedics, General Hospital of Chinese PLA, Beijing, 100853, P.R.China
| | - Junmin Shen
- Department of Orthopedics, General Hospital of Chinese PLA, Beijing, 100853, P.R.China
| | - Yonggang Zhou
- Department of Orthopedics, General Hospital of Chinese PLA, Beijing, 100853,
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Lei PF, Hu RY, Hu YH. Bone Defects in Revision Total Knee Arthroplasty and Management. Orthop Surg 2019; 11:15-24. [PMID: 30809942 PMCID: PMC6430493 DOI: 10.1111/os.12425] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 09/19/2016] [Accepted: 09/28/2016] [Indexed: 11/29/2022] Open
Abstract
This article reviews the recent updates in revision of total knee arthroplasty (RTKA). We reviewed the recent articles on RTKA in databases including PubMed, Google Scholar, and SCOPUS. Total knee arthroplasty (TKA) involves the replacement of all three compartments of the knee in surgery of the knee joint to restore capacity and function. TKA is one of the most common and reliable surgical treatment options for the treatment of knee diseases. However, some patients require revision of TKA (RTKA) after primary TKA for various reasons, including mechanical wear, implant loosening or breakage, malalignment, infection, instability, periprosthetic fracture, and persistent stiffness. Unfortunately, the overall outcome of RTKA is not as satisfactory as for primary TKA due to the uncertainty regarding the actual success rate and the risk factors for failure. Cementation, modular metal augmentation, bone grafting, autologous bone grafting, allogenic bone grafting, impactation bone grafting, structural bone allografting, metaphyseal fixation, using porous titanium coated press fit metaphyseal sleeves and porous tantalum structural cones, and megaprostheses or customized prostheses are the currently available management options for RTKA. However, most of the management systems possess specific complications. Novel approaches should be developed to improve functional capacity, implant survival rates, and quality of life in a cost‐efficient manner.
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Affiliation(s)
- Peng-Fei Lei
- Department of Orthopaedic Surgery, Xiangya Hospital of Central South University, Changsha, China
| | - Ru-Yin Hu
- Department of Orthopaedic Surgery, Guizhou Provincial People's Hospital, Guiyang, China
| | - Yi-He Hu
- Department of Orthopaedic Surgery, Xiangya Hospital of Central South University, Changsha, China
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Aalirezaie A, Abolghasemian M, Busato T, Dennis D, Ghazavi M, Holst DC, Kelly M, Kissin YD, Kuijpers M, Lange J, Lichstein P, Moojen DJ, Poolman R, Schreurs BW, Velázquez Moreno JD, Veltman ES. Hip and Knee Section, Treatment, Two-Stage Exchange: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S439-S443. [PMID: 30348583 DOI: 10.1016/j.arth.2018.09.028] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Gao X, Wang S, Xu Y, Li H, Zhao H, Pan X. Ferulic acid and PDMS modified medical carbon materials for artificial joint prosthesis. PLoS One 2018; 13:e0203542. [PMID: 30183771 PMCID: PMC6124784 DOI: 10.1371/journal.pone.0203542] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 08/22/2018] [Indexed: 12/20/2022] Open
Abstract
Medical carbon material has been extensively studied due to their excellent biological and mechanical properties. However, the dissociation of the surface carbon particles greatly limited the application of medical carbon material (MCM). To overcome this defect, we introduced the polydimethylsiloxane, a polymer-coating material (PCM) that possesses acceptable biocompatibility, into medical carbon material to prevent the shedding of carbon debris. Additionally, to reduce inflammatory reactions and increase surface hydrophilicity, ferulic acid, also called Chinese medicine coating material (CCM), was used to modify the surface of polymer-coating material. We investigated the proliferation and adhesion of NIH-3T3 cells onto MCM, PCM and CCM in vitro. We showed that CCM exhibited excellent biological activity to promote cell growth. Twelve weeks after CCM implantation, bone defects were repaired, and the material showed acceptable chemical stability. The results indicated that the CCM composite possesses excellent mechanical property and favorable biocompatibility, which can be used for clinical bone repair.
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Affiliation(s)
- Xianlei Gao
- Department of Orthopaedics, Qilu Hospital of Shandong University, Jinan, China
| | - Songgang Wang
- Department of Orthopaedics, Qilu Hospital of Shandong University, Jinan, China
| | - Yeyang Xu
- Cancer Research Center Shandong University, Jinan, China
| | - Hao Li
- Department of Orthopaedics, Qilu Hospital of Shandong University, Jinan, China
| | - Hua Zhao
- Department of Orthopaedics, Qilu Hospital of Shandong University, Jinan, China
| | - Xin Pan
- Department of Orthopaedics, Qilu Hospital of Shandong University, Jinan, China
- * E-mail:
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Bonanzinga T, Gehrke T, Zahar A, Zaffagnini S, Marcacci M, Haasper C. Are Trabecular Metal Cones a Valid Option to Treat Metaphyseal Bone Defects in Complex Primary and Revision Knee Arthroplasty? JOINTS 2017; 6:58-64. [PMID: 29675508 PMCID: PMC5906107 DOI: 10.1055/s-0037-1608950] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 10/29/2017] [Indexed: 12/04/2022]
Abstract
Purpose
Metaphyseal bone defects are a challenge in complex primary and revision total knee arthroplasty (TKA). Recently, several studies have been published with promising results about the use of Trabecular Metal (TM) cones to address bone defects. The aim of this study is to review the literature to assess the efficacy of TM cones to address metaphyseal bone loss.
Methods
A comprehensive search was performed on PubMed, Medline, CINAHL, Cochrane, Embase, and Google Scholar databases using various combinations of the following keywords: “metaphyseal,” “cones,” “tantalum,” “knee,” and “revision.” Only papers reporting clinical data about the use of trabecular metal cones were included in the analysis. In vitro studies, case reports, surgical technique, or other studies where it was not possible to collect clinical data were excluded. Patients characteristics, details of the surgical procedures, outcome, and complications were collected from each included study.
Results
No controlled studies were available in the literature and all the papers were case series. In 16 studies included, the records of 442 patients with 447 implants and 523 TM cones were reported. The mean follow-up was 42 months (range: 5–105) for 360 procedures. Among 437 procedures, 30.4% were septic revisions. The Anderson Orthopaedic Research Institute (AORI) classification was available for 352 defects: 13 type 1, 69 type 2A, 115 type 2B, and 155 type 3. To manage these 352 defects, 360 TM cones were implanted. Intraoperative fractures occurred 13 times (10 femoral/3 tibial), 6 required surgical fixation. The overall infection rate was 7.38%, and the infection rate for the aseptic procedures was 0.99%. An aseptic exchange was performed 13 times, among these procedures two TM cones were loose. Signs of loosening were found just in 1.3% of the 523 TM cones implanted (5 femoral/2 tibial) during 447 procedures.
Conclusion
The TM cones are an effective solution to manage bone defects in complex primary and revision TKA at intermediate follow-up. The incidence of complications was low; however, the femoral metaphysis proved to be more susceptible to complications.
Level of Evidence
Level IV, systematic review of level IV studies.
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Affiliation(s)
- Tommaso Bonanzinga
- Istituto Clinico Humanitas, Rozzano, Milano, Italy.,Dipartimento Scienze Biomediche e Neuromotorie, DIBINEM, Università di Bologna, Bologna, Italy.,Istituto Ortopedico Rizzoli, Laboratorio di Biomeccanica e Innovazione Tecnologica, Bologna, Italy
| | | | | | - Stefano Zaffagnini
- Dipartimento Scienze Biomediche e Neuromotorie, DIBINEM, Università di Bologna, Bologna, Italy.,Istituto Ortopedico Rizzoli, Laboratorio di Biomeccanica e Innovazione Tecnologica, Bologna, Italy.,Istituto Ortopedico Rizzoli, Clinica Ortopedica e Traumatologica I, Bologna, Italy
| | - Maurilio Marcacci
- Istituto Clinico Humanitas, Rozzano, Milano, Italy.,Humanitas University, Rozzano, Milano, Italy
| | - Carl Haasper
- Dipartimento Scienze Biomediche e Neuromotorie, DIBINEM, Università di Bologna, Bologna, Italy
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Mancuso F, Beltrame A, Colombo E, Miani E, Bassini F. Management of metaphyseal bone loss in revision knee arthroplasty. ACTA BIO-MEDICA : ATENEI PARMENSIS 2017. [PMID: 28657571 PMCID: PMC6178990 DOI: 10.23750/abm.v88i2-s.6520] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background and aim of the work: Revision total knee arthroplasty (TKA) is usually made more complex by the presence of bone defects, which may be caused by periprosthethic infection, polyethylene wear, implant loosening or fractures. The main aim of the present work is to review the available literature to understand the current options to manage with the bone loss during knee revisions. Methods: Available English literature for bone defects in revision TKAs has been evaluated looking at treatment options and their results in terms of clinical and radiological outcomes and failure rates. Results: Anderson Orthopaedic Research Institute (AORI) classification is the most frequently used because it helps in the choice of the most suitable treatment. Several options are available in the management of metaphyseal bone loss in revision knee arthroplasty. For small and contained defects (AORI type 1) cement with or without screws and auto- or allograft morcellized bone are available. In uncontained but mild defects (AORI type 2A) metal augments should be use while large and uncontained defects (AORI type 2B and 3) are best addressed with structural allograft or metal filling devices (cones and sleeves). Stemmed components, either cemented or cementless, are recommended to reduce the strain at the interface implant-host. Conclusions: The treatment of bone defects in revision TKAs has evolved during the last years providing different options with good results at a short/medium term follow up. With the increasing revision burden, further scientific evidence is requested to identify the best approach for each patient. Long-term clinical outcome as well as implant survival after revision TKA are still sub-optimal and depend upon many factors including cause for revision, surgical approach, type of implants used and various patient factors. (www.actabiomedica.it)
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Mancuso F, Beltrame A, Colombo E, Miani E, Bassini F. Management of metaphyseal bone loss in revision knee arthroplasty. ACTA BIO-MEDICA : ATENEI PARMENSIS 2017; 88:98-111. [PMID: 28657571 DOI: 10.23750/abm.v88i2 -s.6520] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 06/01/2017] [Indexed: 01/16/2023]
Abstract
BACKGROUND AND AIM OF THE WORK Revision total knee arthroplasty (TKA) is usually made more complex by the presence of bone defects, which may be caused by periprosthethic infection, polyethylene wear, implant loosening or fractures. The main aim of the present work is to review the available literature to understand the current options to manage with the bone loss during knee revisions. METHODS Available English literature for bone defects in revision TKAs has been evaluated looking at treatment options and their results in terms of clinical and radiological outcomes and failure rates. RESULTS Anderson Orthopaedic Research Institute (AORI) classification is the most frequently used because it helps in the choice of the most suitable treatment. Several options are available in the management of metaphyseal bone loss in revision knee arthroplasty. For small and contained defects (AORI type 1) cement with or without screws and auto- or allograft morcellized bone are available. In uncontained but mild defects (AORI type 2A) metal augments should be use while large and uncontained defects (AORI type 2B and 3) are best addressed with structural allograft or metal filling devices (cones and sleeves). Stemmed components, either cemented or cementless, are recommended to reduce the strain at the interface implant-host. CONCLUSIONS The treatment of bone defects in revision TKAs has evolved during the last years providing different options with good results at a short/medium term follow up. With the increasing revision burden, further scientific evidence is requested to identify the best approach for each patient. Long-term clinical outcome as well as implant survival after revision TKA are still sub-optimal and depend upon many factors including cause for revision, surgical approach, type of implants used and various patient factors.
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Kazemzadeh‐Narbat M, Rouwkema J, Annabi N, Cheng H, Ghaderi M, Cha B, Aparnathi M, Khalilpour A, Byambaa B, Jabbari E, Tamayol A, Khademhosseini A. Engineering Photocrosslinkable Bicomponent Hydrogel Constructs for Creating 3D Vascularized Bone. Adv Healthc Mater 2017; 6. [PMID: 28240417 DOI: 10.1002/adhm.201601122] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Revised: 12/20/2016] [Indexed: 11/11/2022]
Abstract
Engineering bone tissue requires the generation of a highly organized vasculature. Cellular behavior is affected by the respective niche. Directing cellular behavior and differentiation for creating mineralized regions surrounded by vasculature can be achieved by controlling the pattern of osteogenic and angiogenic niches. This manuscript reports on engineering vascularized bone tissues by incorporating osteogenic and angiogenic cell-laden niches in a photocrosslinkable hydrogel construct. Two-step photolithography process is used to control the stiffness of the hydrogel and distribution of cells in the patterned hydrogel. In addittion, osteoinductive nanoparticles are utilized to induce osteogenesis. The size of microfabricated constructs has a pronounced effect on cellular organization and function. It is shown that the simultaneous presence of both osteogenic and angiogenic niches in one construct results in formation of mineralized regions surrounded by organized vasculature. In addition, the presence of angiogenic niche improves bone formation. This approach can be used for engineered constructs that can be used for treatment of bone defects.
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Affiliation(s)
- Mehdi Kazemzadeh‐Narbat
- Biomaterials Innovation Research Center Department of Medicine Brigham and Women's Hospital Harvard Medical School Boston MA 02139 USA
- Harvard‐MIT Division of Health Sciences and Technology Massachusetts Institute of Technology Cambridge MA 02139 USA
| | - Jeroen Rouwkema
- Biomaterials Innovation Research Center Department of Medicine Brigham and Women's Hospital Harvard Medical School Boston MA 02139 USA
- Harvard‐MIT Division of Health Sciences and Technology Massachusetts Institute of Technology Cambridge MA 02139 USA
- Department of Biomechanical Engineering MIRA Institute for Biomedical Technology and Technical Medicine University of Twente 7522NB Enschede The Netherlands
| | - Nasim Annabi
- Biomaterials Innovation Research Center Department of Medicine Brigham and Women's Hospital Harvard Medical School Boston MA 02139 USA
- Harvard‐MIT Division of Health Sciences and Technology Massachusetts Institute of Technology Cambridge MA 02139 USA
- Wyss Institute for Biologically Inspired Engineering Harvard University Boston MA 02115 USA
- Department of Chemical Engineering Northeastern University Boston MA 02115‐5000 USA
| | - Hao Cheng
- Biomaterials Innovation Research Center Department of Medicine Brigham and Women's Hospital Harvard Medical School Boston MA 02139 USA
- Harvard‐MIT Division of Health Sciences and Technology Massachusetts Institute of Technology Cambridge MA 02139 USA
| | - Masoumeh Ghaderi
- Biomaterials Innovation Research Center Department of Medicine Brigham and Women's Hospital Harvard Medical School Boston MA 02139 USA
- Harvard‐MIT Division of Health Sciences and Technology Massachusetts Institute of Technology Cambridge MA 02139 USA
| | - Byung‐Hyun Cha
- Biomaterials Innovation Research Center Department of Medicine Brigham and Women's Hospital Harvard Medical School Boston MA 02139 USA
- Harvard‐MIT Division of Health Sciences and Technology Massachusetts Institute of Technology Cambridge MA 02139 USA
| | - Mansi Aparnathi
- Biomaterials Innovation Research Center Department of Medicine Brigham and Women's Hospital Harvard Medical School Boston MA 02139 USA
- Harvard‐MIT Division of Health Sciences and Technology Massachusetts Institute of Technology Cambridge MA 02139 USA
| | - Akbar Khalilpour
- Biomaterials Innovation Research Center Department of Medicine Brigham and Women's Hospital Harvard Medical School Boston MA 02139 USA
- Harvard‐MIT Division of Health Sciences and Technology Massachusetts Institute of Technology Cambridge MA 02139 USA
| | - Batzaya Byambaa
- Biomaterials Innovation Research Center Department of Medicine Brigham and Women's Hospital Harvard Medical School Boston MA 02139 USA
- Harvard‐MIT Division of Health Sciences and Technology Massachusetts Institute of Technology Cambridge MA 02139 USA
| | - Esmaiel Jabbari
- Biomimetic Materials and Tissue Engineering Laboratories Department of Chemical Engineering University of South Carolina Columbia SC 29208 USA
| | - Ali Tamayol
- Biomaterials Innovation Research Center Department of Medicine Brigham and Women's Hospital Harvard Medical School Boston MA 02139 USA
- Harvard‐MIT Division of Health Sciences and Technology Massachusetts Institute of Technology Cambridge MA 02139 USA
- Wyss Institute for Biologically Inspired Engineering Harvard University Boston MA 02115 USA
| | - Ali Khademhosseini
- Biomaterials Innovation Research Center Department of Medicine Brigham and Women's Hospital Harvard Medical School Boston MA 02139 USA
- Harvard‐MIT Division of Health Sciences and Technology Massachusetts Institute of Technology Cambridge MA 02139 USA
- Wyss Institute for Biologically Inspired Engineering Harvard University Boston MA 02115 USA
- Department of Physics King Abdulaziz University Jeddah 21569 Saudi Arabia
- Department of Bioindustrial Technologies College of Animal Bioscience and Technology Konkuk University Seoul 05029 Republic of Korea
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Girerd D, Parratte S, Lunebourg A, Boureau F, Ollivier M, Pasquier G, Putman S, Migaud H, Argenson JN. Total knee arthroplasty revision with trabecular tantalum cones: Preliminary retrospective study of 51 patients from two centres with a minimal 2-year follow-up. Orthop Traumatol Surg Res 2016; 102:429-33. [PMID: 27052939 DOI: 10.1016/j.otsr.2016.02.010] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 02/10/2016] [Accepted: 02/16/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Successful management of large bone defects is of crucial importance when performing revision total knee arthroplasty (TKA). Trabecular tantalum cones may improve prosthesis fixation via their potential for reconstructing a stable metaphyseal support. The objective of this study was to evaluate the clinical and radiological outcomes and the complications of tantalum cones in revision TKA. HYPOTHESIS Trabecular tantalum cones provide stable and durable metaphyseal reconstruction when used during revision TKA. MATERIAL AND METHODS Trabecular Metal™ cones (Zimmer, Warsaw, IN, USA) were used for 52 revision TKAs in 51 patients (mean age, 68±9 years) managed in two centres between 2008 and 2013. A rotating hinge prosthesis was chosen for 38 (73%) knees and a condylar constrained knee prosthesis for 14 (27%) knees, with 37 tibial and 34 femoral cones. The two most common reasons for revision surgery were aseptic loosening (n=22, 42%) and infection (n=19, 37%). The bone loss was severe in most cases. At each centre, after a mean follow-up of 34 months (range, 24-52 months), two independent observers assessed the Knee Society Score (KSS), range of motion, mechanical axis, and osteo-integration for each patient. RESULTS Mean KSS increased from 46 preoperatively to 77 (P=0.001) at last follow-up and the mean KSS function from 39 to 57 (P=0.007). Mean range of motion improved from 93° (45°-120°) to 110° (65°-130°) (P=0.001). Mean postoperative mechanical axis was 180° (172°-190°). Radiographic evaluation showed evidence of osteo-integration for all cones. Four revisions were performed for recurrence of infection but none for mechanical failure. DISCUSSION The findings of our study confirm the biomechanical and biological reliability of Trabecular Metal™ cones used to fill metaphyseal bone defects during revision TKA. LEVEL OF EVIDENCE IV, retrospective therapeutic study.
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Affiliation(s)
- D Girerd
- Université Aix-Marseille, Hôpital Sainte-Marguerite, Institut du Mouvement et de l'appareil Locomoteur, Service de chirurgie orthopédique et traumatologie, UMR CNRS 787/AMU, 270, boulevard Sainte-Marguerite, 13009 Marseille, France
| | - S Parratte
- Université Aix-Marseille, Hôpital Sainte-Marguerite, Institut du Mouvement et de l'appareil Locomoteur, Service de chirurgie orthopédique et traumatologie, UMR CNRS 787/AMU, 270, boulevard Sainte-Marguerite, 13009 Marseille, France.
| | - A Lunebourg
- Université Aix-Marseille, Hôpital Sainte-Marguerite, Institut du Mouvement et de l'appareil Locomoteur, Service de chirurgie orthopédique et traumatologie, UMR CNRS 787/AMU, 270, boulevard Sainte-Marguerite, 13009 Marseille, France
| | - F Boureau
- Centre Hospitalier Régional Universitaire, Service de chirurgie orthopédique et traumatologie, avenue Oscar-Lambret, 59037 Lille cedex, France; Université de Lille, rue Paul-Duez, 59000 Lille, France
| | - M Ollivier
- Université Aix-Marseille, Hôpital Sainte-Marguerite, Institut du Mouvement et de l'appareil Locomoteur, Service de chirurgie orthopédique et traumatologie, UMR CNRS 787/AMU, 270, boulevard Sainte-Marguerite, 13009 Marseille, France
| | - G Pasquier
- Centre Hospitalier Régional Universitaire, Service de chirurgie orthopédique et traumatologie, avenue Oscar-Lambret, 59037 Lille cedex, France; Université de Lille, rue Paul-Duez, 59000 Lille, France
| | - S Putman
- Centre Hospitalier Régional Universitaire, Service de chirurgie orthopédique et traumatologie, avenue Oscar-Lambret, 59037 Lille cedex, France; Université de Lille, rue Paul-Duez, 59000 Lille, France
| | - H Migaud
- Centre Hospitalier Régional Universitaire, Service de chirurgie orthopédique et traumatologie, avenue Oscar-Lambret, 59037 Lille cedex, France; Université de Lille, rue Paul-Duez, 59000 Lille, France
| | - J N Argenson
- Université Aix-Marseille, Hôpital Sainte-Marguerite, Institut du Mouvement et de l'appareil Locomoteur, Service de chirurgie orthopédique et traumatologie, UMR CNRS 787/AMU, 270, boulevard Sainte-Marguerite, 13009 Marseille, France
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Sculco PK, Abdel MP, Hanssen AD, Lewallen DG. The management of bone loss in revision total knee arthroplasty: rebuild, reinforce, and augment. Bone Joint J 2016; 98-B:120-4. [PMID: 26733657 DOI: 10.1302/0301-620x.98b1.36345] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The treatment of bone loss in revision total knee arthroplasty has evolved over the past decade. While the management of small to moderate sized defects has demonstrated good results with a variety of traditional techniques (cement and screws, small metal augments, impaction bone grafting or modular stems), the treatment of severe defects continues to be problematic. The use of a structural allograft has declined in recent years due to an increased failure rate with long-term follow-up and with the introduction of highly porous metal augments that emphasise biological metaphyseal fixation. Recently published mid-term results on the use of tantalum cones in patients with severe bone loss has reaffirmed the success of this treatment strategy.
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Affiliation(s)
- P K Sculco
- Mayo Clinic, 200 First Street S.W., Rochester, Minnesota, 55905, USA
| | - M P Abdel
- Mayo Clinic, 200 First Street S.W., Rochester, Minnesota, 55905, USA
| | - A D Hanssen
- Mayo Clinic, 200 First Street S.W., Rochester, Minnesota, 55905, USA
| | - D G Lewallen
- Mayo Clinic, 200 First Street S.W., Rochester, Minnesota, 55905, USA
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Angelini FJ, Helito CP, Veronesi BA, Guimarães TM, Pécora JR, Demange MK. KNEE ARTHROPLASTY REVISION WITH A CONSTRAINED IMPLANT USING HINGE AND ROTATING TIBIAL BASIS. ACTA ORTOPEDICA BRASILEIRA 2016; 24:22-6. [PMID: 26997909 PMCID: PMC4775484 DOI: 10.1590/1413-785220162401153984] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objective: To evaluate the results of total knee arthoplasty revisions performed in high complexity cases, with large bone defects or serious ligament deficiencies using a constrained implant hinge associated to a rotating tibial basis. Methods: We evaluated 11 patients in which we used the constrained implant hinge associated to rotating tibial basis, with minimum follow-up of two years. The indications for the procedure included instability, septic loosening, late postoperative infection without loosening and periprosthetic fracture. We evaluated the knee range of movement and functional outcomes by the Knee Society Score (KSS) e Knee Injury and Osteoarthritis Outcome Score (KOOS), besides the presence of complications. Results: All patients achieved 5o to 85o minimum range of motion at 1 year postoperatively and, in the present evaluation, KSS ranged from 67 to 95. Three patients had no complications until the last evaluation and two patients required implant revision. Conclusion: Despite the complications rate observed, the functional result were acceptable for most patients, and it proved being a viable alternative, especially for patients with low functional demand. Level of Evidence IV, Case Series.
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Bovkis GY, Kulyaba TA, Kornilov NN. Management of femur and tibia metaphyseal bone defects during revision total knee arthroplasty – methods and outcomes (review). TRAUMATOLOGY AND ORTHOPEDICS OF RUSSIA 2016. [DOI: 10.21823/2311-2905-2016-0-2-101-113] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Kzhyshkowska J, Gudima A, Riabov V, Dollinger C, Lavalle P, Vrana NE. Macrophage responses to implants: prospects for personalized medicine. J Leukoc Biol 2015; 98:953-62. [PMID: 26168797 DOI: 10.1189/jlb.5vmr0415-166r] [Citation(s) in RCA: 130] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 06/15/2015] [Indexed: 01/08/2023] Open
Abstract
Implants, transplants, and implantable biomedical devices are mainstream solutions for a wide variety of human pathologies. One of the persistent problems around nondegradable metallic and polymeric implants is failure of macrophages to resolve the inflammation and their tendency to stay in a state, named "frustrated phagocytosis." During the initial phase, proinflammatory macrophages induce acute reactions to trauma and foreign materials, whereas tolerogenic anti-inflammatory macrophages control resolution of inflammation and induce the subsequent healing stage. However, implanted materials can induce a mixed pro/anti-inflammatory phenotype, supporting chronic inflammatory reactions accompanied by microbial contamination and resulting in implant failure. Several materials based on natural polymers for improved interaction with host tissue or surfaces that release anti-inflammatory drugs/bioactive agents have been developed for implant coating to reduce implant rejection. However, no definitive, long-term solution to avoid adverse immune responses to the implanted materials is available to date. The prevention of implant-associated infections or chronic inflammation by manipulating the macrophage phenotype is a promising strategy to improve implant acceptance. The immunomodulatory properties of currently available implant coatings need to be improved to develop personalized therapeutic solutions. Human primary macrophages exposed to the implantable materials ex vivo can be used to predict the individual's reactions and allow selection of an optimal coating composition. Our review describes current understanding of the mechanisms of macrophage interactions with implantable materials and outlines the prospects for use of human primary macrophages for diagnostic and therapeutic approaches to personalized implant therapy.
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Affiliation(s)
- Julia Kzhyshkowska
- *Institute of Transfusion Medicine and Immunology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; Red Cross Blood Service Baden-Württemberg-Hessen, Mannheim, Germany; Laboratory for Translational Cellular and Molecular Biomedicine, Tomsk State University, Tomsk, Russia; Protip SAS, Strasbourg, France; Institut National de la Santé et de la Recherche Médicale, INSERM Unité 1121, Strasbourg, France; and Faculté de Chirurgie Dentaire, Université de Strasbourg, Strasbourg, France
| | - Alexandru Gudima
- *Institute of Transfusion Medicine and Immunology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; Red Cross Blood Service Baden-Württemberg-Hessen, Mannheim, Germany; Laboratory for Translational Cellular and Molecular Biomedicine, Tomsk State University, Tomsk, Russia; Protip SAS, Strasbourg, France; Institut National de la Santé et de la Recherche Médicale, INSERM Unité 1121, Strasbourg, France; and Faculté de Chirurgie Dentaire, Université de Strasbourg, Strasbourg, France
| | - Vladimir Riabov
- *Institute of Transfusion Medicine and Immunology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; Red Cross Blood Service Baden-Württemberg-Hessen, Mannheim, Germany; Laboratory for Translational Cellular and Molecular Biomedicine, Tomsk State University, Tomsk, Russia; Protip SAS, Strasbourg, France; Institut National de la Santé et de la Recherche Médicale, INSERM Unité 1121, Strasbourg, France; and Faculté de Chirurgie Dentaire, Université de Strasbourg, Strasbourg, France
| | - Camille Dollinger
- *Institute of Transfusion Medicine and Immunology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; Red Cross Blood Service Baden-Württemberg-Hessen, Mannheim, Germany; Laboratory for Translational Cellular and Molecular Biomedicine, Tomsk State University, Tomsk, Russia; Protip SAS, Strasbourg, France; Institut National de la Santé et de la Recherche Médicale, INSERM Unité 1121, Strasbourg, France; and Faculté de Chirurgie Dentaire, Université de Strasbourg, Strasbourg, France
| | - Philippe Lavalle
- *Institute of Transfusion Medicine and Immunology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; Red Cross Blood Service Baden-Württemberg-Hessen, Mannheim, Germany; Laboratory for Translational Cellular and Molecular Biomedicine, Tomsk State University, Tomsk, Russia; Protip SAS, Strasbourg, France; Institut National de la Santé et de la Recherche Médicale, INSERM Unité 1121, Strasbourg, France; and Faculté de Chirurgie Dentaire, Université de Strasbourg, Strasbourg, France
| | - Nihal Engin Vrana
- *Institute of Transfusion Medicine and Immunology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; Red Cross Blood Service Baden-Württemberg-Hessen, Mannheim, Germany; Laboratory for Translational Cellular and Molecular Biomedicine, Tomsk State University, Tomsk, Russia; Protip SAS, Strasbourg, France; Institut National de la Santé et de la Recherche Médicale, INSERM Unité 1121, Strasbourg, France; and Faculté de Chirurgie Dentaire, Université de Strasbourg, Strasbourg, France
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Beckmann NA, Bitsch RG. Structural Allografts and Porous Metal Cones - Major Findings Remain Unchanged. In reply. J Arthroplasty 2015; 30:1289-90. [PMID: 25981326 DOI: 10.1016/j.arth.2015.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Accepted: 01/14/2015] [Indexed: 02/01/2023] Open
Affiliation(s)
- Nicholas A Beckmann
- Department of Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany
| | - Rudi G Bitsch
- Department of Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany
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Sculco PK, Abdel MP. Contemporary bone loss options: Rebuild, reinforce, and augment. ACTA ACUST UNITED AC 2015. [DOI: 10.1053/j.sart.2015.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Living donor bone banking: processing and discarding--from procurement to therapeutic use. Cell Tissue Bank 2015; 16:593-603. [PMID: 25814343 DOI: 10.1007/s10561-015-9507-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 03/18/2015] [Indexed: 01/07/2023]
Abstract
Skeletal muscle and osteoarticular tissue banks are responsible to procure, process, store and distribute tissues, from living and cadaveric donors. The procedures involve the application of protocols covering all aspects of the banking, ensuring the best tissue quality and maximum safety for the recipient. An analysis on the causes of bone tissue discarded by Biotar Tissue Bank between January 2005 and December 2012 was carried. Bone tissue was obtained from both hip and knee replacement (femoral heads and tibial plateau respectively) in living donors treated at different medical-surgical institutions in Argentina. These tissues were processed at the Bank to produce both frozen and lyophilized cancellous bone. Out of 3413 donated bones received by the Bank, 77.55 % resulted in final product, while the remaining 22.44 % was discarded in compliance with the quality standards of both the Bank and the regulatory authority. Comparing the last and the first year of the studied period, the number of discarded tissue increased 3.6 times, while the number of collected bones was approximately 10 times higher. Related to total disposed tissue, reactive serology was the most frequent cause (62.14 %), followed by inappropriate collection/storage of blood sample (30.81 %). A progressive reduction in the percentages of total discard was observed, and this was proportional to inappropriate collection/storage of blood sample. No significant differences were found in the discard rates due to positive serology throughout all the years studied. The success of a tissue bank requires full commitment of all the personnel especially the team members responsible for donor selection and the processing of allografts. It is important to critically screen donors in the early stages of donor recruitment. All of the procedures carried out by the tissue bank are parts of the quality control system which must be strictly carried out. Biotar Tissue Bank is continuously committed to ensure safety to the recipients.
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