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Saad A, Mayne A, Pagkalos J, Ollivier M, Botchu R, Davis E, Sharma A. Comparative analysis of radiation exposure in robot-assisted total knee arthroplasty using popular robotic systems. J Robot Surg 2024; 18:120. [PMID: 38492073 DOI: 10.1007/s11701-024-01896-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 02/28/2024] [Indexed: 03/18/2024]
Abstract
Robotic-assisted TKA (RATKA) is a rapidly emerging technique that has been shown to improve precision and accuracy in implant alignment in TKA. Robotic-assisted TKA (RATKA) uses computer software to create a three-dimensional model of the patient's knee. Different types of preoperative imaging, including radiographs and CT scans, are used to create these models, each with varying levels of radiation exposure. This study aims to determine the radiation dose associated with each type of imaging used in RATKA, to inform patients of the potential risks. A retrospective search of our clinical radiology and arthroplasty database was conducted to identify 140 knees. The patients were divided into three groups based on the type of preoperative imaging they received: (1) CT image-based MAKO Protocol, (2) Antero-posterior long leg alignment films (LLAF), (3) standard AP, lateral, and skyline knee radiographs. The dose of CT imaging technique for each knee was measured using the dose-length product (DLP) with units of mGycm2, whereas the measurement for XRAY images was with the dose area product (DAP) with units of Gycm2. The mean radiation dose for patients in the CT (MAKO protocol) image-based group was 1135 mGy.cm2. The mean radiation dose for patients in the LLAF group was 3081 Gycm2. The mean radiation dose for patients undergoing knee AP/lateral and skyline radiographs was the lowest of the groups, averaging 4.43 Gycm2. Through an ANOVA and post hoc analysis, the results between groups was statistically significant. In this study, we found a significant difference in radiation exposure between standard knee radiographs, LLAF and CT imaging. Nonetheless, the radiation dose for all groups is still within acceptable safety limits.
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Affiliation(s)
- Ahmed Saad
- Royal Orthopaedic Hospital, Birmingham, UK.
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Mayne AI, Rajgor H, Munasinghe C, Agrawal Y, Pagkalos J, Davis ET, Sharma AD. The ROSA robotic-arm system reliably restores joint line height, patella height and posterior condylar offset in total knee arthroplasty. Knee 2024; 48:1-7. [PMID: 38461736 DOI: 10.1016/j.knee.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 12/26/2023] [Accepted: 02/18/2024] [Indexed: 03/12/2024]
Abstract
INTRODUCTION There is growing interest in the use of robotic TKA to improve accuracy of component positioning in Total Knee Arthroplasty (TKA). The aim of this study was to investigate the accuracy of implant component position using the ROSA® knee system with specific reference to Joint Line Height, Patella Height and Posterior Condylar Offset (PCO). METHODS This was a retrospective review of a prospectively-maintained database of the initial 100 consecutive TKAs performed by a high volume surgeon using the ROSA® knee system. Both the image-based and imageless workflow were used and two prosthesis types were implanted. To determine the accuracy of component positioning, the immediate post-operative radiograph was reviewed and compared with the immediate pre-operative radiograph with regards to Joint Line Height, Patella Height and Posterior Condylar Offset. RESULTS 100 consecutive patients undergoing TKA using the ROSA system were included; mean age 70 years (range 49-95 years). Mean change in joint line height was 0.2 mm, patella height (Insall-Salvati ratio) 0.01 and posterior condylar offset 0.02 mm; there was no statistically significant difference between the pre and post-operative values. No difference was demonstrated between image-based or imageless workflows, or between implant design (Persona versus Vanguard) regarding joint line height, patella height and PCO. CONCLUSION This study validates the use of the ROSA® knee system in accurately restoring Joint Line Height, Patella Height and Posterior Condylar Offset in TKA surgery. No significant differences were found between imageless and image-based groups, or between implant designs (Persona versus Vanguard).
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Affiliation(s)
- Alistair Iw Mayne
- Arthroplasty Department, Royal Orthopaedic Hospital, Bristol Road South, Birmingham B31 2AP, UK.
| | - Harshadkumar Rajgor
- Arthroplasty Department, Royal Orthopaedic Hospital, Bristol Road South, Birmingham B31 2AP, UK
| | - Chathura Munasinghe
- Arthroplasty Department, Royal Orthopaedic Hospital, Bristol Road South, Birmingham B31 2AP, UK
| | - Yuvraj Agrawal
- Arthroplasty Department, Royal Orthopaedic Hospital, Bristol Road South, Birmingham B31 2AP, UK
| | - Joseph Pagkalos
- Arthroplasty Department, Royal Orthopaedic Hospital, Bristol Road South, Birmingham B31 2AP, UK
| | - Edward T Davis
- Arthroplasty Department, Royal Orthopaedic Hospital, Bristol Road South, Birmingham B31 2AP, UK
| | - Akash D Sharma
- Arthroplasty Department, Royal Orthopaedic Hospital, Bristol Road South, Birmingham B31 2AP, UK
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Rajgor HD, Mayne A, Munasinghe C, Pagkalos J, Agrawal Y, Davis ET, Sharma AD. Mako versus ROSA: comparing surgical accuracy in robotic total knee arthroplasty. J Robot Surg 2024; 18:33. [PMID: 38231299 DOI: 10.1007/s11701-023-01786-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 10/14/2023] [Indexed: 01/18/2024]
Abstract
There is increasing adoption of robotic surgical technology in Total Knee Arthroplasty. The ROSA® knee system can be used in either image-based mode (using pre-operative calibrated radiographs) or imageless modes (using intra-operative bony registration). The Mako knee system is an image-based system (using a pre-operative CT scan). This study aimed to compare surgical accuracy between the ROSA and Mako systems with specific reference to joint line height, patella height, posterior condylar offset and tibial slope. This was a retrospective review of a prospectively collected data of the initial 50 consecutive ROSA TKAs and the initial 50 consecutive Mako TKAs performed by two high-volume surgeons. To determine the accuracy of component positioning, the immediate post-operative radiograph was reviewed and compared with the immediate pre-operative radiograph with regards to joint line height (JLH), patella height (PH), tibial slope (TS) and posterior condylar offset (PCO). Mean difference between pre- and post-operative radiographs using the ROSA knee system of joint line height was 0.47 mm (SD 0.95) posterior condylar offset 0.16 mm (SD 0.76), tibial slope 0.9 degrees (SD 1.6) and patella height 0.01 (SD 0.05). Mean difference using the MAKO knee system of joint line height was 0.26 (SD 1.08), posterior condylar offset -0.26 mm (SD 0.78), tibial slope 1.8 degrees and patella height 0.03. No significant difference was demonstrated between the accuracy of component positioning of the ROSA or MAKO knee systems. Our study is the first study to compare the accuracy of the ROSA and MAKO knee systems in total knee arthroplasty. Both systems are highly accurate in restoring native posterior condylar offset, joint line height, tibial slope and patella height in TKA with no significant difference demonstrated between the two groups.
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Affiliation(s)
- Harshadkumar D Rajgor
- Royal Orthopaedic Hospital, Bristol Rd S, The Woodlands, Northfield, Birmingham, B31 2AP, UK.
| | - Alistair Mayne
- Royal Orthopaedic Hospital, Bristol Rd S, The Woodlands, Northfield, Birmingham, B31 2AP, UK
| | | | - Joseph Pagkalos
- Royal Orthopaedic Hospital, Bristol Rd S, The Woodlands, Northfield, Birmingham, B31 2AP, UK
| | - Yuvraj Agrawal
- Royal Orthopaedic Hospital, Bristol Rd S, The Woodlands, Northfield, Birmingham, B31 2AP, UK
| | - Edward T Davis
- Royal Orthopaedic Hospital, Bristol Rd S, The Woodlands, Northfield, Birmingham, B31 2AP, UK
- University of Birmingham Medical School, Birmingham, UK
| | - Akash D Sharma
- Royal Orthopaedic Hospital, Bristol Rd S, The Woodlands, Northfield, Birmingham, B31 2AP, UK
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Saad A, Mayne AIW, Pagkalos J, Ollivier M, Botchu R, Davis ET, Sharma AD. An evaluation of factors influencing the adoption and usage of robotic surgery in lower limb arthroplasty amongst orthopaedic trainees: a clinical survey. J Robot Surg 2024; 18:2. [PMID: 38175317 DOI: 10.1007/s11701-023-01811-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 12/23/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND The rise of robotics in orthopaedic training, driven by the demand for better training outcomes and patient care, presents specific challenges for junior trainees due to its novelty and steep learning curve. This paper explores how orthopaedic trainees perceive and adopt robotic-assisted lower limb arthroplasty. METHODS The study utilised the UTUAT model questionnaire as the primary data collection tool, employing targeted questions on a five-point Likert scale to efficiently gather responses from a large number of participants. Data analysis was conducted using partial least squares (PLS), a well-established method in previous technology acceptance research. RESULT The findings indicate a favourable attitude amongst trainees towards adopting robotic technology in orthopaedic training. They acknowledge the potential advantages of improved surgical precision and patient outcomes through roboticassisted procedures. Social factors, including the views of peers and mentors, notably influence trainees' decision-making. However, the availability of resources and expert mentors did not appear to have a significant impact on trainees' intention to use robotic technology. CONCLUSION The study contributes to the understanding of factors influencing trainees' interest in robotic surgery and emphasises the importance of creating a supportive environment for its adoption.
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Affiliation(s)
- Ahmed Saad
- Department of Trauma & Orthopaedics, Royal Orthopaedic Hospital, Bristol Rd S, Northfield, Birmingham, B31 2AP, UK.
| | - Alistair I W Mayne
- Department of Trauma & Orthopaedics, Royal Orthopaedic Hospital, Bristol Rd S, Northfield, Birmingham, B31 2AP, UK
| | - Joseph Pagkalos
- Department of Trauma & Orthopaedics, Lower Limb Reconstruction Unit, Royal Orthopaedic Hospital, Bristol Rd S, Northfield, Birmingham, B31 2AP, UK
| | - Matthieu Ollivier
- Institute Movement Science, Aix Marseille University, CNRS, Marseille, France
| | - Rajesh Botchu
- Department of MSK Radiology, Royal Orthopaedic Hospital, Bristol Rd S, Northfield, Birmingham, B31 2AP, UK
| | - Edward T Davis
- Department of Trauma & Orthopaedics, Lower Limb Reconstruction Unit, Royal Orthopaedic Hospital, Bristol Rd S, Northfield, Birmingham, B31 2AP, UK
| | - Akash D Sharma
- Department of Trauma & Orthopaedics, Lower Limb Reconstruction Unit, Royal Orthopaedic Hospital, Bristol Rd S, Northfield, Birmingham, B31 2AP, UK
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Navacchia A, Pagkalos J, Davis ET. Defining the optimal position of the lipped liner in combination with cup orientation and stem version. Bone Joint Res 2023; 12:571-579. [PMID: 37727965 PMCID: PMC10509720 DOI: 10.1302/2046-3758.129.bjr-2022-0471.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/21/2023] Open
Abstract
Aims The aim of this study was to identify the optimal lip position for total hip arthroplasties (THAs) using a lipped liner. There is a lack of consensus on the optimal position, with substantial variability in surgeon practice. Methods A model of a THA was developed using a 20° lipped liner. Kinematic analyses included a physiological range of motion (ROM) analysis and a provocative dislocation manoeuvre analysis. ROM prior to impingement was calculated and, in impingement scenarios, the travel distance prior to dislocation was assessed. The combinations analyzed included nine cup positions (inclination 30-40-50°, anteversion 5-15-25°), three stem positions (anteversion 0-15-30°), and five lip orientations (right hip 7 to 11 o'clock). Results The position of the lip changes the ROM prior to impingement, with certain combinations leading to impingement within the physiological ROM. Inferior lip positions (7 to 8 o'clock) performed best with cup inclinations of 30° and 40°. Superior lip positions performed best with cup inclination of 50°. When impingement occurs in the plane of the lip, the lip increases the travel distance prior to dislocation. Inferior lip positions led to the largest increase in jump distance in a posterior dislocation provocation manoeuvre. Conclusion The lip orientation that provides optimal physiological ROM depends on the orientation of the cup and stem. For a THA with stem anteversion 15°, cup inclination 40°, and cup anteversion 15°, the optimal lip position was posterior-inferior (8 o'clock). Maximizing jump distance prior to dislocation while preventing impingement in the opposite direction is possible with appropriate lip positioning.
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Affiliation(s)
| | - Joseph Pagkalos
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Edward T. Davis
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
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Davis ET, Pagkalos J, Kopjar B. Using an asymmetric crosslinked polyethylene liner in primary total hip arthroplasty is associated with a lower risk of revision surgery : an analysis of the National Joint Registry. Bone Joint J 2021; 103-B:1479-1487. [PMID: 34465151 PMCID: PMC9948452 DOI: 10.1302/0301-620x.103b9.bjj-2021-0365.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AIMS The aim of our study was to investigate the effect of asymmetric crosslinked polyethylene liner use on the risk of revision of cementless and hybrid total hip arthroplasties (THAs). METHODS We undertook a registry study combining the National Joint Registry dataset with polyethylene manufacturing characteristics as supplied by the manufacturers. The primary endpoint was revision for any reason. We performed further analyses on other reasons including instability, aseptic loosening, wear, and liner dissociation. The primary analytic approach was Cox proportional hazard regression. RESULTS A total of 213,146 THAs were included in the analysis. Overall, 2,997 revisions were recorded, 1,569 in THAs with a flat liner and 1,428 in THAs using an asymmetric liner. Flat liner THAs had a higher risk of revision for any reason than asymmetric liner THAs when implanted through a Hardinge/anterolateral approach (hazard ratio (HR) 1.169, 95% confidence interval (CI) 1.022 to 1.337) and through a posterior approach (HR 1.122, 95% CI 1.108 to 1.346). There was no increased risk of revision for aseptic loosening when asymmetric liners were used for any surgical approach. A separate analysis of the three most frequently used crosslinked polyethylene liners was in agreement with this finding. When analyzing THAs with flat liners only, THAs implanted through a Hardinge/anterolateral approach were associated with a reduced risk of revision for instability compared to posterior approach THAs (HR 0.561 (95% CI 0.446 to 0.706)). When analyzing THAs with an asymmetric liner, there was no significant difference in the risk of revision for instability between the two approaches (HR 0.838 (95% CI 0.633 to 1.110)). CONCLUSION For THAs implanted through the posterior approach, the use of asymmetric liners reduces the risk of revision for instability and revision for any reason. In THAs implanted through a Hardinge/anterolateral approach, the use of an asymmetric liner was associated with a reduced risk of revision. The effect on revision for instability was less pronounced than in the posterior approach. Cite this article: Bone Joint J 2021;103-B(9):1479-1487.
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Affiliation(s)
- Edward T. Davis
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK,Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK,Correspondence should be sent to Edward T. Davis. E-mail:
| | - Joseph Pagkalos
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Branko Kopjar
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK,School of Public Health, University of Washington Department of Health Services, Seattle, Washington, USA
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Davis ET, McKinney KD, Kamali A, Kuljaca S, Pagkalos J. Reduced Risk of Revision with Computer-Guided Versus Non-Computer-Guided THA: An Analysis of Manufacturer-Specific Data from the National Joint Registry of England, Wales, Northern Ireland and the Isle of Man. JB JS Open Access 2021; 6:JBJSOA-D-21-00006. [PMID: 34337286 PMCID: PMC8318654 DOI: 10.2106/jbjs.oa.21.00006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Computer-assisted total hip arthroplasty (THA) is known to improve implantation precision, but clinical data demonstrating an improvement in survivorship and patient-reported outcome measures (PROMs) are lacking. Our aim was to compare the risk of revision, PROMs, and patient satisfaction between cohorts who underwent THA with and without the use of computer guidance. Methods We used the data set and linked PROM data of the National Joint Registry of England, Wales, Northern Ireland and the Isle of Man. Our sample included THAs performed for osteoarthritis using cementless acetabular components from a single manufacturer (cementless and hybrid THAs). An additional analysis was performed limiting the sample size to cementless-only THAs. The primary end point was revision (any component) for any reason. Kaplan-Meier survivorship analysis and an adjusted Cox proportional-hazards model were used. Results There were 41,683 non-computer-guided and 871 (2%) computer-guided cases included in our analysis of the cementless and hybrid group. There were 943 revisions in the non-computer-guided group and 7 in the computer-guided group. The cumulative revision rate at 10 years was 3.88% (95% confidence interval [CI]: 3.59% to 4.18%) for the non-computer-guided group and 1.06% (95% CI: 0.45% to 2.76%) for the computer-guided group. The Cox proportional-hazards model yielded a hazard ratio of 0.45 (95% CI: 0.21 to 0.96; p = 0.038). In the analysis of the cementless-only group, the cumulative revision rate at 10 years was 3.99% (95% CI: 3.62% to 4.38%) and 1.20% (95% CI: 0.52% to 3.12%) for the 2 groups, respectively. The Cox proportional-hazards model yielded a hazard ratio of 0.47 (95% CI: 0.22 to 1.01; p = 0.053). There was no significant difference in the 6-month Oxford Hip Score, the EuroQol-5 Dimension (EQ-5D) and EQ-VAS (Visual Analogue Scale) scores, and patient-reported success rates. Patient satisfaction (single-item satisfaction outcome measure) was higher in the computer-guided group, but this finding was limited by a reduced number of responses. Conclusions In our analysis, the use of computer-guided surgery was associated with a lower rate of revision at mean follow-up of 5.6 years. This finding was upheld when the sample was restricted to cementless-only THAs. Causality cannot be inferred in view of the observational nature of the study, and additional studies are recommended to validate these findings. Level of Evidence Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Edward T Davis
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, United Kingdom.,Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
| | | | | | | | - Joseph Pagkalos
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, United Kingdom
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Snow M, Williams R, Pagkalos J, Grover L. An In Vitro Study to Determine the Feasibility of Combining Bone Marrow Concentrate with BST-CarGel as a Treatment for Cartilage Repair. Cartilage 2021; 12:226-236. [PMID: 30525942 PMCID: PMC7970369 DOI: 10.1177/1947603518812564] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE The study aims were to determine whether BST-CarGel, a chitosan scaffold for cartilage repair, can be mixed with bone marrow aspirate concentrate (BMAC) to create a cell seeded implant with comparative properties to standard BST-CarGel mixed with blood. DESIGN Whole blood and bone marrow were harvested from 12 patients who underwent cartilage repair surgery using BMAC after informed consent. A validated in vitro testing model was used to assess the following 6 conditions: (1) BST-CarGel mixed with whole blood (CG-WB), (2) BST-CarGel mixed with bone marrow (CG-BM), (3) BST-CarGel mixed with bone marrow concentrate (CG-BMAC), (4) whole blood (WB), (5) bone marrow (BM), and (6) bone marrow concentrate and batroxobin (BMAC-BTX). Cell retention and viability within the BST-CarGel/BMAC clots were investigated. RESULTS In our study, BM and BMAC (processed using the Harvest, SmartPrep2 system and reactivated with batroxibin) when combined with BST-CarGel produced a product that had similar clot contraction, macroscopic properties, and histological appearance to standard BSTCarGel mixed with blood. Mononucleated cells from the BMAC were retained within the scaffold and remained viable until clot dissolution in vitro. CONCLUSIONS By combining BST-CarGel with BMAC in the manner described, bone marrow-derived mononucleated cells can be retained within the chondral defect potentially negating the need for microfracture. Further in vivo work is required to confirm these potential benefits and determine if this combination will result in more durable cartilage repair and improved clinical outcomes.
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Affiliation(s)
- Martyn Snow
- The Royal Orthopaedic Hospital NHS
Foundation Trust, Birmingham, UK,University of Birmingham, Birmingham,
UK,Martyn Snow, Royal Orthopaedic Hospital
Birmingham NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, B31
2AP, UK.
| | | | - Joseph Pagkalos
- The Royal Orthopaedic Hospital NHS
Foundation Trust, Birmingham, UK
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England T, Pagkalos J, Jeys L, Botchu R, Carey Smith R. Additive manufacturing of porous titanium metaphyseal components: Early osseointegration and implant stability in revision knee arthroplasty. J Clin Orthop Trauma 2020; 15:60-64. [PMID: 33717918 PMCID: PMC7920135 DOI: 10.1016/j.jcot.2020.10.042] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/17/2020] [Accepted: 10/19/2020] [Indexed: 10/23/2022] Open
Abstract
AIMS Metaphyseal cones and sleeves are components used in revision knee arthroplasty to ensure load transfer, encourage bone on-growth and prevent stress shielding. Additive manufacturing of titanium alloy implants is a novel technique with limited clinical outcome reports in the literature. The aim of this study was to determine radiographic evidence of osseointegration and early results of a single manufacturer porous titanium metaphyseal components in the proximal tibia. METHODS We retrospectively reviewed the prospectively collected database of two institutions. Patients who underwent revision knee arthroplasty using porous titanium components by a single manufacturer were identified. Immediate post-operative and latest follow-up radiographs were independently analysed by 2 reviewers to determine metaphyseal bone contact and level of osseointegration in relevant Knee Society Radiographic Evaluation and Scoring System zones. RESULTS 22 patients (15 males; 7 females) with a mean age of 71 (49-92) years were included. The mean follow-up period was 14 months (2-44 months). Cones were used in 16 patients and sleeves in 6. Interobserver reliability assessment showed substantial agreement (weighted Kappa 0.71, (95% CI: 0.60, 0.81). There was significant correlation between the bone contact in the immediate postop radiograph and osseointegration at final follow-up (kendall's tau-b: 0.698, p < 0.001). Infection free prosthetic joint survival was 20/22 at final follow-up. CONCLUSION Porous titanium metaphyseal components produced with additive manufacturing provided excellent osseointegration and no early clinical failures. Partial or complete contact of the cone with native bone in the immediate postoperative radiograph resulted in osseointegration in all cases.
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Affiliation(s)
- Thomas England
- University of Western Australia, Doctor of Medicine, Australia
| | - Joseph Pagkalos
- Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Lee Jeys
- Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Rajesh Botchu
- Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK,Corresponding author. Department of Musculoskeletal Radiology, The Royal Orthopedic Hospital, Bristol Road South, Northfield, Birmingham, UK.
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Davis ET, Pagkalos J, Kopjar B. A higher degree of polyethylene irradiation is associated with a reduced risk of revision for aseptic loosening in total hip arthroplasties using cemented acetabular components: an analysis of 290,770 cases from the National Joint Registry of England, Wales, Northern Island and the Isle of Man. Bone Joint Res 2020; 9:563-571. [PMID: 33005395 PMCID: PMC7502255 DOI: 10.1302/2046-3758.99.bjr-2020-0135.r1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Aims To investigate the effect of polyethylene manufacturing characteristics and irradiation dose on the survival of cemented and reverse hybrid total hip arthroplasties (THAs). Methods In this registry study, data from the National Joint Registry of England, Wales, Northern Ireland and the Isle of Man (NJR) were linked with manufacturing data supplied by manufacturers. The primary endpoint was revision of any component. Cox proportional hazard regression was a primary analytic approach adjusting for competing risk of death, patient characteristics, head composition, and stem fixation. Results A total of 290,770 primary THAs were successfully linked with manufacturing characteristics. Overall 4,708 revisions were analyzed, 1,260 of which were due to aseptic loosening. Total radiation dose was identified as a risk factor and included in the Cox model. For statistical modelling of aseptic loosening, THAs were grouped into three categories: G1 (no radiation); G2 ( > 0 to < 5 Mrad); and G3 ( ≥ 5 Mrad). G1 had the worst survivorship. The Cox regression hazard ratio for revision due to aseptic loosening for G2 was 0.7 (95% confidence interval (CI) 0.58 to 0.83), and for G3 0.4 (95% CI 0.30 to 0.53). Male sex and uncemented stem fixation were associated with higher risk of revision and ceramic heads with lower risk. Conclusion Polyethylene irradiation was associated with reduced risk of revision for aseptic loosening. Radiation doses of ≥ 5 Mrad were associated with a further reduction in risk. Cite this article: Bone Joint Res 2020;9(9):563–571.
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Affiliation(s)
- Edward T Davis
- Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK.,Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Joseph Pagkalos
- Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Branko Kopjar
- Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK.,School of Public Health, University of Washington, Seattle, Washington, USA
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Davis ET, Pagkalos J, Kopjar B. Effect of Bearing Surface on Survival of Cementless and Hybrid Total Hip Arthroplasty: Study of Data in the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man. JB JS Open Access 2020; 5:e0075. [PMID: 33123668 PMCID: PMC7418917 DOI: 10.2106/jbjs.oa.19.00075] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Modern bearing surface options have increased implant survivorship after total hip arthroplasty (THA). We utilized data from the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man (NJR) to analyze implant survivorship after THAs with uncemented acetabular components with different bearing combinations. Methods Polyethylene (PE) manufacturing properties supplied by the manufacturers were used to subdivide the NJR data set into cross-linked PE (XLPE) and conventional PE groups. Overall and cause-specific revisions for various bearing combinations were analyzed using Kaplan-Meier and multivariate Cox proportional hazard regression survival analyses. Results Of 420,339 primary THAs, 8,025 were revised during an average follow-up period of 4.4 years (maximum, 13.3 years). In the Cox regression model with metal on conventional PE as the reference, the lowest risk of revision for any reason was for ceramicized metal on XLPE (hazard ratio [HR] = 0.58, 95% confidence interval [CI] = 0.48, 0.71), followed by ceramic on XLPE (HR = 0.66, 95% CI = 0.60, 0.72), ceramic on PE (HR = 0.74, 95% CI = 0.66, 0.82), ceramic on ceramic (HR = 0.77, 95% CI = 0.72, 0.82), and metal on XLPE (HR = 0.81, 95% CI = 0.76, 0.87). A similar pattern was observed when patients under the age of 55 years were analyzed independently. Younger age, male sex, and cementless stem fixation were associated with a higher risk of revision. Conclusions In a fully adjusted model, ceramicized metal on XLPE and ceramic on XLPE were associated with the lowest risk of revision for any reason. This finding was sustained when patients under the age of 55 years were analyzed independently. On the basis of the NJR data set, use of XLPE markedly reduces the risk of revision. Level of Evidence Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Edward T Davis
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, United Kingdom.,Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
| | - Joseph Pagkalos
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, United Kingdom
| | - Branko Kopjar
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, United Kingdom.,School of Public Health, University of Washington, Seattle, Washington
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Snow M, Hussain F, Pagkalos J, Kowalski T, Green M, Massoud S, James S. The Effect of Delayed Injection of Leukocyte-Rich Platelet-Rich Plasma Following Rotator Cuff Repair on Patient Function: A Randomized Double-Blind Controlled Trial. Arthroscopy 2020; 36:648-657. [PMID: 31784365 DOI: 10.1016/j.arthro.2019.09.026] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 09/12/2019] [Accepted: 09/13/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the effect of delayed application of leukocyte-rich platelet-rich plasma (PRP) on rotator cuff repair results as assessed by outcome scores and imaging at one year. METHODS Patients with a symptomatic rotator cuff tear awaiting arthroscopic repair were approached to take part in the study. Final eligibility for the study was confirmed at the time of surgery. A total of 97 patients were randomized to an ultrasound guided injection of leukocyte-rich PRP or normal saline between 10 and 14 days postsurgery. A total of 87 patients completed clinical evaluation and underwent magnetic resonance imaging imaging at 1 year. Outcome scores included the American Shoulder and Elbow Score, Constant score, Western Ontario Rotator Cuff Index, and the Disabilities of the Arm, Shoulder and Hand Score. Structural integrity of the repair was assessed according to the Sugaya grading. Muscle fatty infiltration was assessed on magnetic resonance imaging using the Goutallier classification. RESULTS At 1 year postsurgery, there was no significant difference between the treatment groups on any of the patient-reported outcome measures or Constant score. On postoperative imaging analysis, there was no difference in the retear rates (Sugaya 4 and 5) between the groups (21% in control group vs 15.3% in PRP group). Fatty infiltration on postoperative imaging was found to be significantly higher in the normal saline group compared with the PRP group (Kendall's tau-b P = .032). CONCLUSIONS The delayed application of PRP postrotator cuff repair did not improve function as measured by patient-reported outcome measures and Constant score at 1 year postoperatively. LEVEL OF EVIDENCE Level II, prospective randomized therapeutic trial.
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Affiliation(s)
- Martyn Snow
- Royal Orthopaedic Hospital NHS Foundation Trust, Northfield, United Kingdom; Department of Chemical Engineering, University of Birmingham, Edgbaston, Birmingham, United Kingdom.
| | - Faisal Hussain
- Royal Orthopaedic Hospital NHS Foundation Trust, Northfield, United Kingdom
| | - Joseph Pagkalos
- Royal Orthopaedic Hospital NHS Foundation Trust, Northfield, United Kingdom
| | - Tomasz Kowalski
- Royal Orthopaedic Hospital NHS Foundation Trust, Northfield, United Kingdom
| | - Marcus Green
- Royal Orthopaedic Hospital NHS Foundation Trust, Northfield, United Kingdom
| | - Samir Massoud
- Royal Orthopaedic Hospital NHS Foundation Trust, Northfield, United Kingdom
| | - Steven James
- Royal Orthopaedic Hospital NHS Foundation Trust, Northfield, United Kingdom
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Davis ET, Pagkalos J, Kopjar B. Polyethylene manufacturing characteristics have a major effect on the risk of revision surgery in cementless and hybrid total hip arthroplasties. Bone Joint J 2020; 102-B:90-101. [DOI: 10.1302/0301-620x.102b1.bjj-2019-0779.r1] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Aims The aim of this study was to identify the effect of the manufacturing characteristics of polyethylene acetabular liners on the survival of cementless and hybrid total hip arthroplasty (THA). Methods Prospective cohort study using linked National Joint Registry (NJR) and manufacturer data. The primary endpoint was revision for aseptic loosening. Cox proportional hazard regression was the primary analytical approach. Manufacturing variables included resin type, crosslinking radiation dose, terminal sterilization method, terminal sterilization radiation dose, stabilization treatment, total radiation dose, packaging, and face asymmetry. Total radiation dose was further divided into G1 (no radiation), G2 (> 0 Mrad to < 5 Mrad), G3 (≥ 5 Mrad to < 10 Mrad), and G4 (≥ 10 Mrad). Results A total of 5,329 THAs were revised, 1,290 of which were due to aseptic loosening. Total radiation dose, face asymmetry, and stabilization treatments were found to significantly affect implant survival. G1 had the highest revision risk for any reason and for aseptic loosening and G3 and G4 the lowest. Compared with G1, the adjusted hazard ratio for G2 was 0.74 (95% confidence interval (CI) 0.64 to 0.86), G3 was 0.36 (95% CI 0.30 to 0.43), and G4 was 0.38 (95% CI 0.31 to 0.47). The cumulative incidence of revision for aseptic loosening at 12 years was 0.52 and 0.54 per 100 THAs for G3 and G4, respectively, compared with 1.95 per 100 THAs in G1. Asymmetrical liners had a lower revision risk due to aseptic loosening and reasons other than aseptic loosening compared with symmetric (flat) liners. In G3 and G4, stabilization with vitamin E and heating above melting point performed best. Conclusion Polyethylene liners with a total radiation dose of ≥ 5 Mrad, an asymmetrical liner face, and stabilization with heating above the melting point demonstrate best survival. Cite this article: Bone Joint J 2020;102-B(1):90–101
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Affiliation(s)
- Edward T. Davis
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Joseph Pagkalos
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Branko Kopjar
- School of Public Health, University of Washington, Seattle, Washington, USA
- Honorary Research Fellow, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
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Moazen M, Leonidou A, Pagkalos J, Marghoub A, Fagan MJ, Tsiridis E. Application of Far Cortical Locking Technology in Periprosthetic Femoral Fracture Fixation: A Biomechanical Study. J Arthroplasty 2016; 31:1849-56. [PMID: 26989031 DOI: 10.1016/j.arth.2016.02.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 01/06/2016] [Accepted: 02/08/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Lack of fracture movement could be a potential cause of periprosthetic femoral fracture (PFF) fixation failures. This study aimed to test whether the use of distal far cortical locking screws reduces the overall stiffness of PFF fixations and allows an increase in fracture movement compared to standard locking screws while retaining the overall strength of the PFF fixations. METHODS Twelve laboratory models of Vancouver type B1 PFFs were developed. In all specimens, the proximal screw fixations were similar, whereas in 6 specimens, distal locking screws were used, and in the other six specimens, far cortical locking screws. The overall stiffness, fracture movement, and pattern of strain distribution on the plate were measured in stable and unstable fractures under anatomic 1-legged stance. Specimens with unstable fracture were loaded to failure. RESULTS No statistical difference was found between the stiffness and fracture movement of the two groups in stable fractures. In the unstable fractures, the overall stiffness and fracture movement of the locking group was significantly higher and lower than the far cortical group, respectively. Maximum principal strain on the plate was consistently lower in the far cortical group, and there was no significant difference between the failure loads of the 2 groups. CONCLUSION The results indicate that far cortical locking screws can reduce the overall effective stiffness of the locking plates and increase the fracture movement while maintaining the overall strength of the PFF fixation construct. However, in unstable fractures, alternative fixation methods, for example, long stem revision might be a better option.
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Affiliation(s)
- Mehran Moazen
- Department of Mechanical Engineering, University College London, London, UK
| | - Andreas Leonidou
- Academic Orthopaedics and Trauma Unit, Aristotle University Medical School, Thessaloniki, Greece
| | - Joseph Pagkalos
- Academic Orthopaedics and Trauma Unit, Aristotle University Medical School, Thessaloniki, Greece
| | - Arsalan Marghoub
- Department of Mechanical Engineering, University College London, London, UK
| | - Michael J Fagan
- Medical and Biological Engineering, School of Engineering, University of Hull, Hull, UK
| | - Eleftherios Tsiridis
- Academic Orthopaedics and Trauma Unit, Aristotle University Medical School, Thessaloniki, Greece; Academic Department of Orthopaedic and Trauma, University of Leeds, Leeds, UK; Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
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Knight R, Pagkalos J, Timmons C, Jose R. Reply. Re: Knight R, Pagkalos J, Timmons C et al. Caffeine consumption does not have an effect on digital microvascular perfusion assessed by laser Doppler imaging on healthy volunteers: a pilot study. J Hand Surg Eur. 2015, 40: 412-5. J Hand Surg Eur Vol 2016; 41:235-6. [PMID: 27213198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Leonidou A, Lepetsos P, Pagkalos J, Antonis K, Flieger I, Tsiridis E, Leonidou O. Treatment for spondylolysis and spondylolisthesis in children. J Orthop Surg (Hong Kong) 2015; 23:379-82. [PMID: 26715723 DOI: 10.1177/230949901502300326] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To review outcome of 44 children who underwent conservative or surgical treatment for spondylolysis or spondylolisthesis. METHODS Records of 25 male and 19 female children aged 5 to 14 (mean, 10.2) years who underwent conservative (n=39) or surgical (n=5) treatment for spondylolysis (n=19) or spondylolisthesis (n=25) were reviewed. Conservative treatment involved application of a thoracolumbosacral orthotic brace for all day except bedtime until symptoms resolved and then physiotherapy including exercises to strengthen the abdominal and back muscles and stretching exercises of the hamstrings and hip flexors. Surgery (instrumented posterolateral fusion [n=4] or Wiltse posterolateral fusion [n=1]) with allografts was indicated in patients with refractory pain (n=2) or nerve root irritation (n=1) and in patients with iatrogenic spondylolisthesis (n=2), followed by application of the brace for 3 months and then physiotherapy. Outcome was assessed using the Seitsalo scoring system. RESULTS The mean follow-up period was 6.5 (range, 3-10) years. No patient developed any postoperative complication. Outcome was excellent in 35 patients, good in 8, and fair in one. All 5 patients who underwent posterolateral fusion for refractory spondylolisthesis achieved good outcome. In 11 patients with spondylolysis, the pars defect healed. None of the spondylolysis progressed to spondylolisthesis. All displacements remained stable, without any progression. CONCLUSION Conservative treatment is effective for most patients with spondylolysis or spondylolisthesis. Instrumented posterolateral fusion is indicated in patients with persistent symptoms and for iatrogenic cases.
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Affiliation(s)
- Andreas Leonidou
- First Department of Trauma and Orthopaedic Surgery, Athens Paediatric Hospital, Agia Sophia, Greece
| | - Panagiotis Lepetsos
- First Department of Trauma and Orthopaedic Surgery, Athens Paediatric Hospital, Agia Sophia, Greece
| | - Joseph Pagkalos
- Academic Department of Orthopaedics and Trauma, Division of Surgery, Aristotle University Medical School, Thessaloniki, Greece
| | - Konstantinos Antonis
- First Department of Trauma and Orthopaedic Surgery, Athens Paediatric Hospital, Agia Sophia, Greece
| | - Ioannis Flieger
- First Department of Trauma and Orthopaedic Surgery, Athens Paediatric Hospital, Agia Sophia, Greece
| | - Eleftherios Tsiridis
- Academic Department of Orthopaedics and Trauma, Division of Surgery, Aristotle University Medical School, Thessaloniki, Greece
| | - Omiros Leonidou
- First Department of Trauma and Orthopaedic Surgery, Athens Paediatric Hospital, Agia Sophia, Greece
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Davis ET, Pagkalos J, Gallie PAM, Macgroarty K, Waddell JP, Schemitsch EH. A comparison of registration errors with imageless computer navigation during MIS total knee arthroplasty versus standard incision total knee arthroplasty: a cadaveric study. Comput Aided Surg 2015; 20:7-13. [PMID: 26290417 DOI: 10.3109/10929088.2015.1076037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Optimal component alignment in total knee arthroplasty has been associated with better functional outcome as well as improved implant longevity. The ability to align components optimally during minimally invasive (MIS) total knee replacement (TKR) has been a cause of concern. Computer navigation is a useful aid in achieving the desired alignment although it is limited by the error during the manual registration of landmarks. Our study aims to compare the registration process error between a standard and a MIS surgical approach. We hypothesized that performing the registration error via an MIS approach would increase the registration process error. Five fresh frozen lower limbs were routinely prepared and draped. The registration process was performed through an MIS approach. This was then extended to the standard approach and the registration was performed again. Two surgeons performed the registration process five times with each approach. Performing the registration process through the MIS approach was not associated with higher error compared to the standard approach in the alignment parameters of interest. This rejects our hypothesis. Image-free navigated MIS TKR does not appear to carry higher risk of component malalignment due to the registration process error. Navigation can be used during MIS TKR to improve alignment without reduced accuracy due to the approach.
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Affiliation(s)
- Edward T Davis
- a The Royal Orthopaedic Hospital NHS Foundation Trust , Northfield, Birmingham , UK
| | - Joseph Pagkalos
- a The Royal Orthopaedic Hospital NHS Foundation Trust , Northfield, Birmingham , UK
| | | | | | - James P Waddell
- d St Michael's Hospital, University of Toronto , Toronto, Ontario , Canada
| | - Emil H Schemitsch
- d St Michael's Hospital, University of Toronto , Toronto, Ontario , Canada
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Thomson LE, Pagkalos J, Prem H. Splintage following supracondylar fracture in paediatrics. Ann R Coll Surg Engl 2015; 97:317-8. [DOI: 10.1308/rcsann.2015.97.4.317b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- LE Thomson
- Birmingham Children’s Hospital NHS Foundation Trust, UK
| | - J Pagkalos
- Birmingham Children’s Hospital NHS Foundation Trust, UK
| | - H Prem
- Birmingham Children’s Hospital NHS Foundation Trust, UK
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Knight R, Pagkalos J, Timmons C, Jose R. Caffeine consumption does not have an effect on digital microvascular perfusion assessed by laser Doppler imaging on healthy volunteers: a pilot study. J Hand Surg Eur Vol 2015; 40:412-5. [PMID: 25213779 DOI: 10.1177/1753193414549519] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2013] [Accepted: 08/09/2014] [Indexed: 02/03/2023]
Abstract
UNLABELLED Caffeine is one of the most commonly consumed pharmacologically active ingredients in the Western world. It is postulated to cause peripheral vasoconstriction and decreased digital blood flow. As a result, many hand surgeons forbid caffeine consumption post-operatively by patients undergoing replantation surgery for fear of compromising healing. We hypothesized that caffeine has no effect on digital microvascular perfusion. Healthy volunteers were recruited and digital microperfusion was assessed using laser Doppler probes attached to the finger pulp, both before and after ingestion of 100 mg of caffeine. A total of 34 patients were included in the final study. The mean flow before the consumption of caffeine was 226.15 PU. The mean flow following the consumption of caffeine was 197.7 PU. This decrease was not statistically significant. This study revealed no decrease in digital blood flow following the ingestion of 100 mg of caffeine by healthy volunteers, as measured by laser Doppler flow monitoring. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- R Knight
- University Hospital Birmingham, Birmingham, UK
| | - J Pagkalos
- University Hospital Birmingham, Birmingham, UK
| | - C Timmons
- University Hospital Birmingham, Birmingham, UK
| | - R Jose
- University Hospital Birmingham, Birmingham, UK
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Pagkalos J, Chaudary MI, Davis ET. Navigating the reaming of the acetabular cavity in total hip arthroplasty: does it improve implantation accuracy? J Arthroplasty 2014; 29:1749-52. [PMID: 24848781 DOI: 10.1016/j.arth.2014.03.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 03/30/2014] [Accepted: 03/31/2014] [Indexed: 02/01/2023] Open
Abstract
Computer navigation in total hip arthroplasty is used to improve accuracy of component implantation. Reaming of the acetabular cavity during total hip arthroplasty (THA) can be navigated although this is not done routinely. We hypothesised that navigating the reaming of the acetabular cavity will improve implantation accuracy. A single surgeon series of 100 navigated THAs were analysed retrospectively. In 49 the reaming of the acetabular cavity was done using navigation and in 51 this was done freehand. The verified cup position and the error from the planned position were recorded. The mean error from planned to verified inclination was 2.20 degrees (SD 1.59°) in the navigated group versus 2.33 degrees (SD 1.96°) in the freehand group. The mean anteversion error was 1.92 degrees (SD 1.51°) for the navigated group and 1.45 degrees (SD 1.38°) for the freehand group. This was not statistically significant. This rejects our hypothesis. Navigating the reaming of the acetabular cavity did not improve the accuracy of the implantation against the set inclination and anteversion target during computer navigated THA.
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Affiliation(s)
- Joseph Pagkalos
- The Royal Orthopaedic Hospital NHS Foundation Trust, Northfield, Birmingham, United Kingdom
| | | | - Edward T Davis
- The Royal Orthopaedic Hospital NHS Foundation Trust, Northfield, Birmingham, United Kingdom; Dudley Group of Hospitals NHS Foundation Trust, Dudley, West Midlands
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Davis ET, Pagkalos J, Gallie PAM, Macgroarty K, Waddell JP, Schemitsch EH. Defining the errors in the registration process during imageless computer navigation in total knee arthroplasty: a cadaveric study. J Arthroplasty 2014; 29:698-701. [PMID: 23972297 DOI: 10.1016/j.arth.2013.06.034] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 06/21/2013] [Accepted: 06/24/2013] [Indexed: 02/01/2023] Open
Abstract
Computer assisted arthroplasty was introduced as a means to optimally align implants in order to improve function and longevity. The error during the manual registration of landmarks and its effect on component alignment was investigated in this study. Five fresh frozen lower limbs were used and the registration process was performed five times by five surgeons. The error range of the mechanical axis of the femur in the coronal plane was 5.2 degrees of valgus to 2.9 degrees of varus whilst the transepicondylar axis error was 11.1 degrees of external to 6.3 of internal rotation. Those figures suggest that the registration error alone can have a significant effect on the alignment of the implant.
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Affiliation(s)
- Edward T Davis
- The Royal Orthopaedic Hospital NHS Foundation Trust, Northfield, Birmingham, UK
| | - Joseph Pagkalos
- The Royal Orthopaedic Hospital NHS Foundation Trust, Northfield, Birmingham, UK
| | | | | | - James P Waddell
- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Emil H Schemitsch
- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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Leonidou A, Moazen M, Skrzypiec DM, Graham SM, Pagkalos J, Tsiridis E. Evaluation of fracture topography and bone quality in periprosthetic femoral fractures: A preliminary radiographic study of consecutive clinical data. Injury 2013; 44:1799-804. [PMID: 24011628 DOI: 10.1016/j.injury.2013.08.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2013] [Accepted: 08/10/2013] [Indexed: 02/06/2023]
Abstract
The unique configuration of periprosthetic femoral fractures (PFFs) is a major determinant of the subsequent management. The aim of this preliminary study was to investigate potential relationships between fracture angle (FA), fracture level (FL) and bone quality of Vancouver type B PFF. The FA, FL and the canal thickness ratio (CTR) were quantified for 27 patient X-rays. The CTR is an indicator of the underlying bone quality. Relationships between these factors were studied for the whole X-ray set, for a subgroup involving fracture above the tip of the stem and for subgroups with stable and unstable implants. When considering all cases, no significant correlation was found between the FA and any other measurement. Considering only cases with unstable implants, a statistically significant correlation was found between the FA and the FL (R(2)=0.489, p=0.002). No correlation was found between FA and any other measurement for stable implants suggesting that FA could be considered as an independent factor when classifying B1 fractures. Considering all cases, a weak correlation was found between CTR and FL (R(2)=0.152, p=0.044) suggesting that fractures below the tip of the stem may indicate a lower bone quality. This preliminary study suggests that the effect of FA on the optimal management of Vancouver type B1 fractures could be considered, independent of the quality of the bone or fracture position. Furthermore, fractures around or below the tip of the stem may suggest a poor bone quality. Larger number of patients is required to confirm these initial findings.
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Affiliation(s)
- Andreas Leonidou
- Academic Department of Orthopaedics and Trauma, Division of Surgery, Aristotle University Medical School, University Campus, 54 124 Thessaloniki, Greece; Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Woodhouse Lane, Leeds, LS2 9JT, UK.
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Leonidou A, Rallan R, Cox N, Pagkalos J, Luscombe J. Comparison of different warfarin reversal protocols on surgical delay and complication rate in hip fracture patients. J Orthop Surg (Hong Kong) 2013; 21:142-5. [PMID: 24014771 DOI: 10.1177/230949901302100204] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE. To compare the effects of different warfarin reversal protocols on surgical delay and complication rate in hip fracture patients. METHODS. Records of 7 men and 17 women aged 68 to 93 (mean, 82) years who were on warfarin and underwent surgery for femoral neck fractures were reviewed. The time to surgery, complication rate, and mortality were recorded, as were the International Normalised Ratio (INR) on admission and the day of operation, as well as the dose, route, and time of administration of vitamin K for reversing the anticoagulation effect of warfarin. Patients were divided into 4 groups based on the warfarin reversal treatment. Group 1 (n=4) included patients who did not receive reversal treatment, as their admission INR was 1.5 or less. Group 2 (n=6) included patients who did not receive reversal treatment even though their INR was >1.6. Group 3 (n=5) included patients who received inappropriate reversal treatment (late or low-dose oral administration). Group 4 (n=9) included patients who received appropriate reversal treatment in terms of dose, route, and time of administration. RESULTS. Among the 4 groups, the mean INR was 2.2 (range, 1.3-4.6) on admission and 1.4 (range, 1.0-1.6) on the day of surgery. Group 1 was excluded from further analysis. Respectively in groups 2, 3, and 4, the mean times to surgery were 2.3, 2.6, and 1.2 days, and the complication rates were 67%, 20%, and 11%. CONCLUSION. Early administration of intravenous vitamin K for hip fracture patients on warfarin is recommended to ensure early operative management and avoid postoperative complications.
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Affiliation(s)
- Andreas Leonidou
- Department of Trauma and Orthopaedics, Alexandra Hospital, Redditch, United Kingdom
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As-Sultany M, Pagkalos J, Yeganeh S, Craigs CL, Korres N, West RM, Tsiridis E. Use of Oral Direct Factor Xa Inhibiting Anticoagulants in Elective Hip and Knee Arthroplasty: A Meta-analysis of Efficacy and Safety Profiles Compared with those of Low-Molecular-Weight Heparins. Curr Vasc Pharmacol 2013; 11:366-75. [DOI: 10.2174/1570161111311030011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Revised: 05/19/2011] [Accepted: 04/23/2012] [Indexed: 11/22/2022]
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Pagkalos J, Leonidou A, As-Sultany M, Heliotis M, Mantalaris A, Tsiridis E. Prostaglandin E2 Receptors as Potential Bone Anabolic Targets – Selective EP4 Receptor Agonists. Curr Mol Pharmacol 2012; 5:174-81. [DOI: 10.2174/1874467211205020174] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2010] [Revised: 12/29/2010] [Accepted: 03/03/2011] [Indexed: 11/22/2022]
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Abstract
Dislocation of a total hip replacement (THR) is common following total hip arthroplasty (THA). When nonoperative management fails to maintain reduction, revision surgery is considered. The use of constrained acetabular liners has been extensively described. Complete removal of the old cement mantle during revision THA can be challenging and is associated with significant complications. Cement-in-cement revision is an established technique. However, the available clinical and experimental studies focus on femoral stem revision. The purpose of this study was to present a case of cement-in-cement acetabular revision with a constrained component for recurrent dislocations and to investigate the current best evidence for this technique. This article describes the case of a 74-year-old woman who underwent revision of a Charnley THR for recurrent low-energy dislocations. A tripolar constrained acetabular component was cemented over the primary cement mantle following removal of the original liner by reaming, roughening the surface, and thoroughly irrigating and drying the primary cement. Clinical and radiological results were good, with the Oxford Hip Score improving from 11 preoperatively to 24 at 6 months postoperatively. The good short-term results of this case and the current clinical and biomechanical data encourage the use of the cement-in-cement technique for acetabular revision. Careful irrigation, drying, and roughening of the primary surface are necessary.
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Affiliation(s)
- Andreas Leonidou
- Department of Trauma and Orthopaedics, Worcestershire Acute Hospitals, Alexandra Hospital, Redditch, United Kingdom.
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28
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Abstract
Statins are potent inhibitors of cholesterol synthesis. Several statins are available with different molecular and pharmacokinetic properties. Simvastatin is more lipophilic than pravastatin and has a higher affinity to phospholipid membranes than atorvastatin, allowing its passive diffusion through the cell membrane. In vitro studies on bone marrow stromal cells, osteoblast-like cells, and embryonic stem cells have shown statins to have cholesterol-independent anabolic effects on bone metabolism; alas, statins were supplemented in osteogenic medium, which does not facilitate elucidation of their potential osteoinductive properties. Embryonic stem cells (ESCs), derived from the inner cell mass of the blastocyst, are unique in that they enjoy perpetual self-proliferation, are pluripotent, and are able to differentiate toward all the cellular lineages composing the body, including the osteogenic lineage. Consequently, ESCs represent a potentially potent cell source for future clinical cellular therapies of various bone diseases, even though there are several hurdles that still need to be overcome. Herein we demonstrate, for the first time to our knowledge, that simvastatin induces murine ESC (mESC) differentiation toward the osteogenic lineage in the absence of osteoinductive supplements. Specifically, we found that a simvastatin concentration in the micromolar range and higher was toxic to the cells and that an effective concentration for osteoinduction is 0.1 nM, as shown by increased alizarin red staining as well as increased osteocalcin and osetrix gene expression. These results suggest that in the future, lipophilic simvastatin may provide a novel pharmacologic agent for bone tissue engineering applications.
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Affiliation(s)
- Joseph Pagkalos
- Biological Systems Engineering Laboratory, Department of Chemical Engineering, Imperial College London, London, United Kingdom
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29
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Papaioannou A, Fraidakis O, Volakakis N, Stefanakis G, Bimpaki E, Pagkalos J, Psarologakis C, Aggouridakis P, Askitopoulou H. Basic life support skill retention by medical students: a comparison of two teaching curricula. Arch Emerg Med 2010; 27:762-5. [DOI: 10.1136/emj.2009.077511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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30
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Tran GT, Pagkalos J, Tsiridis E, Narvani AA, Heliotis M, Mantalaris A, Tsiridis E. Growth hormone: does it have a therapeutic role in fracture healing? Expert Opin Investig Drugs 2010; 18:887-911. [PMID: 19480608 DOI: 10.1517/13543780902893069] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND The role of growth hormone (GH) in augmenting fracture healing has been postulated for over half a century. GH has been shown to play a role in bone metabolism and this can be mediated directly or indirectly through IGF-I. OBJECTIVES The use of GH was evaluated as a possible therapeutic agent in augmenting fracture healing. METHOD A literature search was undertaken on GH and its effect on bone fracture healing primarily using MEDLINE/OVID (1950 to January 2009). Key words and phrases including 'growth hormone', 'insulin like growth factor', 'insulin like growth factor binding protein', 'insulin like growth factor receptor', 'fracture repair', 'bone healing', 'bone fracture', 'bone metabolism', 'osteoblast' and 'osteoclast' were used in different combinations. Manual searches of the bibliography of key papers were also undertaken. RESULTS Current evidence suggests a positive role of GH on fracture healing as demonstrated by in vitro studies on osteoblasts, osteoclasts and the crosstalk between the two. Animal studies have demonstrated a number of factors influencing the effect of GH in vivo such as dose, timing and method of administration. Application of this knowledge in humans is limited but clearly demonstrates a positive effect on fracture healing. Concern has been raised in the past regarding the safety profile of the pharmacological use of GH when used in critically ill patients. CONCLUSION The optimal dose and method of administration is still to be determined, and the safety profile of this novel use of GH needs to be investigated prior to establishing its widespread use as a fracture-healing agent.
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Affiliation(s)
- Gui Tong Tran
- University of Leeds School of Medicine, Academic Department of Trauma and Orthopaedics, Leeds General Infirmary, Great George Street, Leeds, UK
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31
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Kontakis GM, Pasku D, Pagkalos J, Katonis PG. The natural history of a mistreated ipsilateral Galeazzi and Monteggia lesion: report of a case 39 years post-injury. Acta Orthop Belg 2008; 74:546-549. [PMID: 18811043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Galeazzi injury combined with ipsilateral Monteggia lesion is extremely rare. A 45-year-old male patient with a mistreated Galeazzi lesion combined with an ipsilateral Monteggia fracture at the age of 6 is presented. Thirty-nine years post-injury his elbow was asymptomatic and stable and his distal radioulnar and radiocarpal joints were also asymptomatic. The strength of the limb was equal to the unaffected contralateral upper limb and he was able to work manually as a waiter for the last 20 years without any problem. The only obvious defect was a 30 degrees lack of elbow flexion and a 10 degrees lack of forearm pronation in comparison to the normal side.
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32
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Abstract
Successful operative treatment of a humeral shaft non-union may be a challenge for the surgeon. Several treatment options have been reported over the years. A systematic review of the literature was performed. Twenty-three retrieved articles (level of evidence IV) fulfilled our inclusion criteria and dealt with aseptic diaphyseal humeral non-union managed by plating, intramedullary nailing and external fixation based on Ilizarov's principles. Despite an obvious superiority of plating in the treatment of humeral shaft non-unions, there is no doubt that intramedullary nailing as well as external fixation devices have a role. An algorithm of management of the humeral shaft non-unions following a rational approach is suggested.
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Affiliation(s)
- George M Kontakis
- Department of Orthopaedics - Traumatolosy, University of Crete, Greece.
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