RESUMO
BACKGROUND: Several modern designs of metal-backed glenoids (MBG) have been devised to overcome flaws such as loosening and a high failure rate. This review aimed to compare rates of complications and revision surgeries between cemented polyethylene glenoid (PEG) and three examples of modern MBG designs. METHODS: Literature search was carried out using PubMed, Cochrane Library, EMBASE, and Google Scholar using MeSH terms and natural keywords. A total of 1186 articles were screened. We descriptively analyzed numerical data between the groups and statistically analyzed the categorical data, such as the presence of radiolucent line, loosening, and revision surgery (failure). Articles were divided into three groups based on follow-up duration: < 36-month, 36-72-month, and > 72-month subgroups. RESULTS: This study included 35 articles (3769 shoulders); 25 on cemented PEG and ten on the modern MBG. Mean age was 66.4 (21-93) and 66.5 years (31-88). The mean duration of follow-up was 73.1 (12-211) and 56.1 months (24-100). Overall, the rate of the radiolucent line was 354/1302 (27%) and 47/282 (17%), the loosening rate was 465/3185 (15%) and 22/449 (5%), and the failure rate was 189/3316 (6%) and 11/457 (2%), for PEG and MBG, respectively. The results of < 36-month and 36-72-month subgroups showed lower rates of radiolucency and loosening in the cemented PEG group, but there was no significant difference in failure rate (P = 0.754 and 0.829, respectively). In the > 72-month subgroup, MBG was better in terms of loosening (P < 0.001) and failure rates (P = 0.006). CONCLUSIONS: The modern MBG component, especially TM glenoid, seems to be a promising alternative to cemented PEGs, based on subgroup revision rates according to the follow-up duration and overall results of ROM and clinical scores. All polyethylene glenoids tend to increase loosening and failure over time. Three modern MBG designs seem to have no difference in failure, at least in the < 36-month and 36-72-month subgroups compared to the cemented PEG. More long-term follow-up studies on modern MBG should be ultimately conducted. LEVEL OF EVIDENCE: Level IV, systematic review.
Assuntos
Artroplastia do Ombro/tendências , Cimentos Ósseos , Prótese Articular/tendências , Desenho de Prótese/tendências , Reoperação/tendências , Articulação do Ombro/cirurgia , Artroplastia do Ombro/efeitos adversos , Artroplastia do Ombro/normas , Cimentos Ósseos/normas , Humanos , Prótese Articular/normas , Metais/normas , Polietileno/normas , Desenho de Prótese/normasRESUMO
BACKGROUND: The aims of this study were to propose a novel implant design for the proximal interphalangeal joint (PIPJ) of the hand using a rolling contact joint (RCJ) mechanism and to derive an optimal implant design based on human PIPJ kinematics. METHODS: In total, 10 participants with normal PIPJs were enrolled in this study. True lateral finger radiographs were obtained in 10° increments from 0º (full extension) to 120° flexion of PIPJ. Radiographs were used to determine the average center of rotation, which formed the basis of a mathematical expression of the PIPJ kinematics. The variations in extensor tendon excursions in relation to the range of motion of PIPJ were determined using results from previous cadaveric studies. As the next step, a PIPJ implant design using an RCJ mechanism that was most consistent with the mathematically expressed PIPJ kinematics and tendon excursions was determined using a constrained optimization algorithm. RESULTS: The final proposed PIPJ implant had a relatively constant center of rotation over the entire PIPJ range of motion among the participants. In addition, the extensor tendon excursions of the proposed implant as applied to the phalangeal bones were similar to those of the human tendon. The proposed PIPJ implant achieved an acceptable position of the RCJ surface on the proximal and middle phalanges, which was derived from the constrained optimization algorithm. CONCLUSIONS: A novel PIPJ implant design using an RCJ mechanism demonstrated acceptable outcomes in terms of PIPJ human kinematics and tendon excursions.
Assuntos
Articulações dos Dedos/cirurgia , Prótese Articular/tendências , Desenho de Prótese/métodos , Desenho de Prótese/tendências , Fraturas do Rádio/cirurgia , Adulto , Feminino , Articulações dos Dedos/diagnóstico por imagem , Articulações dos Dedos/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Fraturas do Rádio/diagnóstico por imagem , Amplitude de Movimento Articular/fisiologia , Adulto JovemRESUMO
BACKGROUND: As the clinical and financial environments of total joint arthroplasty (TJA) have evolved over the last several decades so has the role of the surgeon in providing this care to patients. Our objective was to examine current practices and influential factors among fellowship-trained arthroplasty surgeons. METHODS: An electronic survey was sent to all surgeons who had completed one of the three high-volume adult reconstruction fellowships from the years 2007-2016. The survey consisted of 34 questions regarding current practice characteristics, case volumes for primary and revision total hip arthroplasty (THA) and total knee arthroplasty (TKA), use of advanced technologies, choice of surgical approach and implant design, factors influencing their choices, and their involvement in implant selection and contract negotiations. RESULTS: Questionnaires were sent to 53 surgeons; 52 were completed. Sixty percent of respondents performed at least 100 TKAs and 84% performed at least 50 THAs annually. Ninety-four percent use a single company's implant for more than 90% of primary TKA and THA. Fellowship or residency experience was the most significant influence on TKA and THA implant selection for 62% and 45% of surgeons, respectively, while contracts of their current institution were the primary influence for 17% and 12%, respectively. Fifty-five percent of surgeons used some advanced technology of which 16% said this influenced their implant choice. Eighty-six percent perform the majority of cases at centers performing at least 200 TJAs per year, and 39% participate in implant contract negotiations. CONCLUSION: Despite changes in the economic environment of TJA, this study demonstrates that experience with a specific implant during training, particularly fellowship, is the most influential factor for implant selection among fellowship-trained arthroplasty surgeons.
Assuntos
Artroplastia de Quadril/normas , Artroplastia do Joelho/normas , Bolsas de Estudo/normas , Padrões de Prática Médica/tendências , Cirurgiões/normas , Adulto , Artroplastia de Quadril/educação , Artroplastia de Quadril/estatística & dados numéricos , Artroplastia do Joelho/educação , Artroplastia do Joelho/estatística & dados numéricos , Bolsas de Estudo/estatística & dados numéricos , Feminino , Pesquisas sobre Atenção à Saúde , Humanos , Internato e Residência/normas , Internato e Residência/estatística & dados numéricos , Prótese Articular/normas , Prótese Articular/estatística & dados numéricos , Prótese Articular/tendências , Masculino , Pessoa de Meia-Idade , Padrões de Prática Médica/normas , Padrões de Prática Médica/estatística & dados numéricos , Cirurgiões/educação , Cirurgiões/estatística & dados numéricosRESUMO
Objective: To summarize the research progress of the artificial wrist joint prosthesis. Methods: Domestic and abroad literature concerning artificial wrist joint prosthesis was reviewed and analyzed thoroughly. Results: Artificial wrist joint prosthesis has been developed to the 4th generation. The artificial wrist joint arthroplasty has advantages of pain relief and functional improvement and can achieve ideal short-term effectiveness. But there are some problems, such as loosening, subsidence, fracture, and dislocation of prosthesis. The long-term effectiveness of the 3rd and 4th generation prosthesis still need to be followed up. Conclusion: The biomechanics of wrist joint is extremely complicated, which results in less application and slow development of artificial wrist joint prosthesis. Early-term effectiveness of artificial wrist joint arthroplasty is basically satisfactory, but there are still some long-term complications. So the artificial wrist joint prosthesis remains to be developed.
Assuntos
Artroplastia , Prótese Articular , Desenho de Prótese/tendências , Articulação do Punho/cirurgia , Feminino , Fraturas Ósseas/cirurgia , Humanos , Luxações Articulares , Prótese Articular/tendências , Masculino , Pessoa de Meia-Idade , Pesquisa , PunhoRESUMO
This article reviews the emerging role of 3D printing in arthroplasty and orthopedics, a topic of growing relevancy. It discusses the evolution of the technology, the value offered by the technology, current trends and factors impacting adoption in orthopedics, and areas of current and potential future use in arthroplasty and orthopedics.
Assuntos
Artroplastia/instrumentação , Prótese Articular/tendências , Impressão Tridimensional/tendências , Previsões , Humanos , Ortopedia/tendências , Desenho de PróteseRESUMO
The majority of transfemoral and transtibial amputees can be functionally fitted with conventional suspension sockets; however, due to socket problems using conventional stump care, 60% of the patients have limited function and even in younger patients approximately one sixth are unable to wear the prosthesis daily. After the introduction of transcutaneous osseointegrated prostheses (TOP) the inherent problems of socket-stump care can be avoided for these patients. Against this background this article reviews the recent clinical development of TOP in Sweden, Germany, the Netherlands, Australia and USA currently in nine centers. Unanimously, all groups show that TOP enables physiological weight bearing, improved range of motion in the proximal joint, as well as osseoperceptive sensory feedback and better control of the artificial limb. Likewise, there is agreement that as a rule that there is a clinically less relevant superficial contamination of the stoma. Furthermore, TOP is nowadays also used for transhumeral amputees and after thumb amputation and the development of the indications for this technique are increasing. Future aspects include novel treatment options using implanted intramedullary electrodes allowing permanent and unlimited bidirectional communication with the human body (osseointegrated human-machine gateway). This could possibly realize an innovative form of prosthesis control as well as the combination of TOP and targeted muscle reinnervation (TMR) surgery to create more advanced prosthesis systems for upper and lower extremity amputees.
Assuntos
Cotos de Amputação/cirurgia , Amputação Cirúrgica/reabilitação , Interface Osso-Implante , Exoesqueleto Energizado/tendências , Prótese Articular/tendências , Osseointegração , Amputação Cirúrgica/instrumentação , Amputação Cirúrgica/tendências , Artroplastia de Substituição/instrumentação , Artroplastia de Substituição/métodos , Membros Artificiais/tendências , Humanos , Perna (Membro)/cirurgia , Modelos Biológicos , Recuperação de Função Fisiológica , Âncoras de Sutura , Resultado do TratamentoRESUMO
OBJECTIVE: Rheumatoid arthritis (RA) causes destruction of the metacarpophalangeal (MCP) joints, leading to hand deformities, pain, and loss of function. This study prospectively assessed long-term functional and health-related quality-of-life outcomes in RA patients with severe deformity at the MCP joints. METHODS: RA patients between ages 18 to 80 years with severe deformity at the MCP joints were referred to 1 of the 3 study sites. Subjects who elected to undergo silicone metacarpophalangeal joint arthroplasty (SMPA) while continuing with medical management were followed in the SMPA cohort. Subjects who elected to continue with medical management alone without surgery were followed in the non-SMPA cohort. Objective measurements included grip and pinch strength as well as arc of motion, ulnar drift, and extensor lag of the MCP joints. Patient-reported outcomes included the Michigan Hand Questionnaire (MHQ) and the Arthritis Impact Measurement Scales questionnaire. Radiographs of SMPA implants were assessed and graded as intact, deformed, or fractured. RESULTS: MHQ scores showed large improvements post-SMPA, and baseline-adjusted expected outcomes in the SMPA group were significantly better at year 7 in function, aesthetics, satisfaction, and overall score compared to non-SMPA. SMPA subjects did not improve in grip or pinch strength, but achieved significant improvement and maintained the improvement long term in ulnar drift and extensor lag. CONCLUSION: Benefits of the SMPA procedure are maintained over 7 years with low rates of implant fracture or deformity. Non-SMPA patients remained stable in their hand function over the 7-year study duration.
Assuntos
Artrite Reumatoide/diagnóstico por imagem , Artrite Reumatoide/terapia , Artroplastia/métodos , Internacionalidade , Prótese Articular , Silicones/administração & dosagem , Idoso , Artrite Reumatoide/epidemiologia , Artroplastia/tendências , Estudos de Coortes , Feminino , Seguimentos , Humanos , Prótese Articular/tendências , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Tempo , Resultado do TratamentoRESUMO
As a new generation of medical metallic material, magnesium (Mg) and its alloys with or without surface coating have attracted a great deal of attention due to its biodegradability and potential for avoiding a removal operation after the implant has fulfilled its function for surgical fixation of injured musculoskeletal tissues. Although a few clinical cases on Mg-based orthopaedic implants were reported more than a century ago, it was not until recently that clinical trials using these implants with improved physicochemical properties were carried out in Germany, China and Korea for bone fracture fixation. The promising results so far suggest a bright future for biodegradable Mg-based orthopaedic implants and would warrant large scale phase II/III studies. Given the increasing interest on this emerging biomaterials and intense effort to improve its properties for various clinical applications, this review covers the evolution, current strategies, and future perspectives in the development of Mg-based orthopaedic implants. We also highlight a few clinical cases performed in China that may be unfamiliar to the general orthopaedic community.
Assuntos
Materiais Biocompatíveis/química , Fixadores Internos/tendências , Prótese Articular/tendências , Magnésio/química , Animais , Análise de Falha de Equipamento , Humanos , Desenho de Prótese/tendênciasAssuntos
Artroplastia de Substituição/tendências , Avaliação Geriátrica , Prótese Articular/tendências , Ortopedia/tendências , Traumatologia/tendências , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Substituição/economia , Feminino , Alemanha , Humanos , Prótese Articular/economia , Masculino , Traumatologia/economiaRESUMO
The replacement of hip and knee joints is one of the greatest success stories in orthopedics. Due to continuous improvement of biomaterials and implant design, patient-associated problems are now mostly multifactorial and only rarely caused by the implant. Abrasion was significantly reduced by the introduction of highly cross-linked polyethylene (PE), antioxidant stabilized PE, new ceramics and the development of ceramic and protective surfaces. It is assumed that further reduction of frictional resistance will not lead to a significantly better clinical result: however, the problem of periprosthetic infections and implant-related incompatibility is still unsolved and remains challenging for biomaterial research. For the knee joint PE will be irreplaceable for joint articulation even in the future due to the contact situation. Mobile bearings and fixed bearings are two established successful philosophies, which have shown comparably good clinical results. For the hip joint, it is forecasted that ceramic-on-ceramic will be the system of the future if the correct positioning and mounting of the components can be solved so that the problems, such as development of noise and breakage can be reduced to a minimum. An in-depth understanding and detailed knowledge of the biomaterials by the surgeon can prevent implant-related problems. For elderly patients it is assumed that the economic burden on the public healthcare system will have the strongest impact on implant selection.
Assuntos
Artroplastia de Substituição/métodos , Artroplastia de Substituição/tendências , Materiais Biocompatíveis/química , Prótese Articular/tendências , Infecções Relacionadas à Prótese/etiologia , Infecções Relacionadas à Prótese/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Substituição/efeitos adversos , Materiais Biocompatíveis/efeitos adversos , Medicina Baseada em Evidências , Feminino , Avaliação Geriátrica/métodos , Alemanha , Humanos , Prótese Articular/efeitos adversos , Prótese Articular/economia , Masculino , Ortopedia/economia , Ortopedia/métodos , Ortopedia/tendências , Traumatologia/economia , Traumatologia/métodos , Traumatologia/tendências , Resultado do TratamentoAssuntos
Artroplastia de Substituição/instrumentação , Prótese Articular , Cetonas/química , Procedimentos Ortopédicos/instrumentação , Polietilenoglicóis/química , Desenho de Prótese , Coluna Vertebral/cirurgia , Artroplastia de Substituição/tendências , Benzofenonas , Difusão de Inovações , Humanos , Prótese Articular/tendências , Procedimentos Ortopédicos/tendências , Polímeros , Desenho de Prótese/tendênciasRESUMO
Osteoarthrits is listed number one reason for adult disability. Therefore treatment of arthritis has maximum impact for the general practitioner. Disability of knee and ankle osteoarthritis causes inability to work and loss of independence. Patients will ask their physicians about expectations after total knee or ankle arthroplasty when other treatment has failed. The satisfaction rate after knee prosthesis is 75 89 % and for total ankle arthroplasty even slightly higher at 79 97 %. This is surprising because the survival in joint registry data after knee arthroplasty is 94 % compared to ankle arthroplasty significantly less at 69 % after 10 years, when a component revision is used as endpoint. In addition, knee component revision usually means exchanging to knee revision prosthesis while at the ankle it is usually prosthetic removal and conversion to ankle fusion. This difference of satisfaction is probably caused by the fact that knee arthroplasty is a standard operation and patients have very high expectations. Key to this is realistic patient education before surgery by general practitioners and specialists about the typical postoperative course with significant pain reduction not within days but rather in the first 2 postoperative years with moderate activity allowed. Candidates for total ankle replacement must be carefully selected because the prosthesis relies on a good bone stock, stable ligaments and proper limb alignment. Unlike for the knee, none of these can currently be corrected by the ankle prosthesis itself. Patients can expect significant pain reduction, better function and a slight improved range of motion after knee and ankle prosthesis. Sports activities are possible, but should be in a low-impact area. Heavy physical work or running and jumping activities are usually not possible and surely not recommended due to increased wear.
Assuntos
Artroplastia de Substituição do Tornozelo/tendências , Artroplastia do Joelho/tendências , Prótese Articular/tendências , Prótese do Joelho/tendências , Desenho de Prótese/tendências , Adulto , Idoso , Previsões , Humanos , Pessoa de Meia-Idade , Satisfação do Paciente , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Reoperação/tendências , Resultado do Tratamento , Estados UnidosRESUMO
INTRODUCTION: Temporomandibular joint disorders are extremely prevalent and there is no ideal treatment clinically for the moment. For severe cases, a discectomy often need to be performed, which will further result in the development of osteoarthritis. In the past thirty years, tissue engineering has provided a promising approach for the effective remedy of severe TMJ disease through the creation of viable, effective, and biological functional implants. METHODS: Although TMJ disc tissue engineering is still in early stage, unremitting efforts and some achievements have been made over the past decades. In this review, a comprehensive summary of the available literature on the progress and status in tissue engineering of the TMJ disc regarding cell sources, scaffolds, biochemical and biomechanical stimuli, and other prospects relative to this field is provided. RESULTS AND CONCLUSIONS: Even though research studies in this field are too few compared to other fibrocartilage (e.g., knee meniscus) and numerous, difficult tasks still exist, we believe that our ultimate goal of regenerating a biological implant whose histological, biochemical, and biomechanical properties parallel native TMJ discs for clinical therapy will be achieved in the near future.
Assuntos
Artroplastia de Substituição/tendências , Bioprótese/tendências , Prótese Articular/tendências , Disco da Articulação Temporomandibular/cirurgia , Transtornos da Articulação Temporomandibular/cirurgia , Engenharia Tecidual/tendências , Animais , Artroplastia de Substituição/instrumentação , Fenômenos Biomecânicos , Transplante de Células/tendências , Difusão de Inovações , Discotomia , Previsões , Humanos , Mecanotransdução Celular , Desenho de Prótese/tendências , Recuperação de Função Fisiológica , Disco da Articulação Temporomandibular/metabolismo , Disco da Articulação Temporomandibular/patologia , Disco da Articulação Temporomandibular/fisiopatologia , Transtornos da Articulação Temporomandibular/metabolismo , Transtornos da Articulação Temporomandibular/patologia , Transtornos da Articulação Temporomandibular/fisiopatologia , Alicerces Teciduais/tendênciasRESUMO
Orthopaedic implants improve the quality of life of patients, but the risk of postoperative surgical site infection poses formidable challenges for clinicians. Future directions need to focus on prevention and treatment of infections associated with common arthroplasty procedures, such as the hip, knee, and shoulder, and nonarthroplasty procedures, including trauma, foot and ankle, and spine. Novel prevention methods, such as nanotechnology and the introduction of antibiotic-coated implants, may aid in the prevention and early treatment of periprosthetic joint infections with goals of improved eradication rates and maintaining patient mobility and satisfaction.
Assuntos
Artrite Infecciosa/prevenção & controle , Artroplastia de Substituição/efeitos adversos , Infecções Relacionadas à Prótese/prevenção & controle , Infecção da Ferida Cirúrgica/prevenção & controle , Artrite Infecciosa/etiologia , Artrite Infecciosa/terapia , Artroplastia de Substituição/instrumentação , Doenças Ósseas Infecciosas/etiologia , Doenças Ósseas Infecciosas/prevenção & controle , Doenças Ósseas Infecciosas/terapia , Humanos , Prótese Articular/tendências , Nanotecnologia/tendências , Infecções Relacionadas à Prótese/terapia , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/terapiaRESUMO
Total ankle arthroplasty was developed to reduce pain and retain motion of the ankle joint in patients with osteoarthritis much like its total hip and knee counterparts. Orthopaedic surgeons are well equipped to evaluate and treat patients with end-stage hip or knee arthritis; however, the management of patients with ankle arthritis represents a challenge to both general orthopaedic surgeons and to the foot and ankle surgeons to whom these patients are often referred. Although techniques for both hip and knee arthroplasty have evolved to provide long-term pain relief and functional improvement, neither ankle arthrodesis nor arthroplasty has demonstrated comparably favorable outcomes in long-term follow-up studies. Early ankle arthroplasty designs with highly constrained cemented components were abandoned due to unacceptably high failure rates and complications. While arthrodesis is still considered the "gold standard" for treatment of end-stage ankle arthritis, progression of adjacent joint arthrosis and diminished gait efficiency has led to a resurgence of interest in ankle arthroplasty. Long-term outcome studies for total ankle replacement found excellent or good results in 82% of patients who received a newer generation ankle device compared with 72% if undergoing ankle fusion. Continued long-term follow-up studies are necessary, but total ankle arthroplasty has become a viable option for surgical treatment of ankle arthritis.
Assuntos
Articulação do Tornozelo/cirurgia , Artroplastia de Substituição do Tornozelo/tendências , Osteoartrite/cirurgia , Articulação do Tornozelo/fisiopatologia , Artroplastia de Substituição do Tornozelo/efeitos adversos , Artroplastia de Substituição do Tornozelo/instrumentação , Fenômenos Biomecânicos , Difusão de Inovações , Humanos , Prótese Articular/tendências , Osteoartrite/diagnóstico , Osteoartrite/fisiopatologia , Complicações Pós-Operatórias/etiologia , Desenho de Prótese/tendências , Recuperação de Função Fisiológica , Resultado do TratamentoAssuntos
Membros Artificiais/tendências , Prótese Articular/tendências , Transtornos dos Movimentos/reabilitação , Próteses Neurais/tendências , Robótica/tendências , Extremidade Superior , Eletromiografia/tendências , Previsões , Humanos , Desenho de Prótese/tendências , Terapia Assistida por Computador/tendênciasRESUMO
Additive manufacturing is an industrial technology whereby three-dimensional visual computer models are fabricated into physical components by selectively curing, depositing, or consolidating various materials in consecutive layers. Although initially developed for production of simulated models, the technology has undergone vast improvements and is currently increasingly being used for the production of end-use components in various aerospace, automotive, and biomedical specialties. The ability of this technology to be used for the manufacture of solid-mesh-foam monolithic and coated components of complex geometries previously considered unmanufacturable has attracted the attention of implant manufacturers, bioengineers, and orthopedic surgeons. Currently, there is a paucity of reports describing this fabrication method in the orthopedic literature. Therefore, we aimed to briefly describe this technology, some of the applications in other orthopedic subspecialties, its present use in hip and knee arthroplasty, and concerns with the present form of the technology. As there are few reports of clinical trials presently available, the true benefits of this technology can only be realized when studies evaluating the clinical and radiographic outcomes of cementless implants manufactured with additive manufacturing report durable fixation, less stress shielding, and better implant survivorship. Nevertheless, the authors believe that this technology holds great promise and may potentially change the conventional methods of casting, machining, and tooling for implant manufacturing in the future.