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BACKGROUND: The Oxford Knee Score (OKS) has been designed for patients with knee osteoarthritis and has a widespread use. It has 12 questions, with each question having the same weight for the overall score. Some authors have observed a significant ceiling effect, especially when distinguishing slight postoperative differences. We hypothesized that each questions' weight will depend significantly on the patient's sociodemographic data and lifestyle. METHODS: In this international multicentric prospective study, we included patients attending a specialist outpatient knee clinic. Each patient filled out 3 questionnaires: (a) demographic data and data pertaining to the OKS, (b) the standard OKS, and (c) the patient gave a mark on the weight of the importance of each question, using a 5-point Likert scale (G OKS). Linear regression models were used for the analysis. RESULTS: In total 203 patients (106 female and 97 male) with a mean age of 64.5 (±12.7) years and a mean body mass index (BMI) of 29.34 (±5.45) kg/m2 were included. The most important questions for the patients were the questions for pain, washing, night pain, stability, and walking stairs with a median of 5. In the regression models, age, gender, and driving ability were the most important factors for the weight of each of the question. CONCLUSION: The questions in the OKS differ significantly in weight for each patient, based on sociodemographic data, such as age, self-use of a car, and employment. With these differences, the Oxford Knee Score might be limited as an outcome measure. Adjustment of the OKS that incorporates the demographic differences into the final score might be useful if the ceiling effect is to be mitigated. LEVEL OF EVIDENCE: Level II prospective prognostic study.
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Empleo , Osteoartritis de la Rodilla , Humanos , Femenino , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Articulación de la Rodilla , Osteoartritis de la Rodilla/cirugía , DolorRESUMEN
Guideline-based surgical cartilage therapy for focal cartilage damage offers highly effective possibilities to sustainably reduce patients' complaints and to prevent or at least delay the development of early osteoarthritis. In the knee joint, it has the potential to reduce almost a quarter of the arthroses requiring joint replacement caused by cartilage damage. Biologically effective injection therapies could further improve these results. Based on the currently available literature and preclinical studies, intra- and postoperative injectables may have a positive effect of platelet-rich plasma/fibrin (PRP/PRF) and hyaluronic acid (HA) on cartilage regeneration and, in the case of HA injections, also on the clinical outcome can be assumed. The role of a combination therapy with use of intra-articular corticosteroids is lacking in the absence of adequate study data and cannot be defined yet. With regard to adipose tissue-based cell therapy, the current scientific data do not yet justify any recommendation for its use. Further studies also regarding application intervals, timing and differences in different joints are required.
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BACKGROUND: Total knee arthroplasties (TKAs) for patients aged ≤35 years are rare but necessary for patients who have diseases such as juvenile idiopathic arthritis, osteonecrosis, osteoarthritis, and rheumatoid arthritis. Few studies have examined the 10-year and 20-year survivorship and clinical outcomes of TKAs for young patients. METHODS: A retrospective registry review identified 185 TKAs in 119 patients aged ≤ 35 years performed between 1985 and 2010 at a single institution. The primary outcome was implant survivorship free of revision. Patient-reported outcomes were assessed at 2 time points: 2011 to 2012 and 2018 to 2019. The average age was 26 years (range, 12 to 35). Mean follow-up was 17 years (range, 8 to 33). RESULTS: Survivorship decreased from 84% (95% confidence interval [CI]: 79 to 90) at 5 years to 70% (95% CI: 64 to 77) at 10 years and to 37% (95% CI: 29 to 45) at 20 years. The most common reasons for revision were aseptic loosening (6%) and infection (4%). Risk factors for revision included increasing age at time of surgery (Hazards Ratio [HR] 1.3, P = .01) and use of constrained (HR 1.7, P = .05) or hinged prostheses (HR 4.3, P = .02). There were 86% of patients reporting that their surgery resulted in "a great improvement" or better. CONCLUSION: Survivorship of TKAs in young patients is less favorable than expected. However, for the patients who responded to our surveys, TKA demonstrated substantial pain relief and improvement in function at 17-year follow-up. Revision risk increased with older age and higher levels of constraint.
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Artroplastia de Reemplazo de Rodilla , Prótesis de la Rodilla , Humanos , Adulto , Artroplastia de Reemplazo de Rodilla/efectos adversos , Prótesis de la Rodilla/efectos adversos , Estudios Retrospectivos , Supervivencia , Falla de Prótesis , Resultado del Tratamiento , Reoperación , Articulación de la Rodilla/cirugía , Diseño de PrótesisRESUMEN
BACKGROUND: Antimicrobial resistance is recognized as a major public health threat. It occurs naturally; however, an excessive antibiotic use and misuse of antibiotics accelerate the process. Periprosthetic joint infections (PJI) are becoming harder to treat as the efficacy of antibiotics is becoming lower. The aim of this study was to compare the resistance of coagulase-negative staphylococci (CNS) to antibiotics identified after revision TKAs for PJI between two major orthopedic centers. METHODS: A review of all revision TKAs, undertaken between 2006 and 2018 in two orthopedic centers, was performed, including all those meeting the consensus criteria for PJI, in which CNS were identified. There were no major differences in surgical approach and tissue sampling between both centers. Thirteen commonly used antibiotics were tested at both centers. RESULTS: The 132 strains were analyzed for their resistance to 13 different antibiotics. Staphylococcus epidermidis was identified in 70.5% cultures, followed by Staphylococcus capitis in 8.3% cultures. The comparison of antibiotic resistance between two centers was statistically significant to penicillin (P = .001), oxacillin (P = .011), cefuroxime (P = .044), levofloxacin (P = .006), moxifloxacin (P = .008), tetracycline (P < .001), rifampicin (P < .001) and vancomycin (P < .001). The difference of resistance of CNS was not statistically significant to fosfomycin, clindamycin, teicoplanin, erythromycin and ampicillin. CONCLUSIONS: The resistance of CNS to antibiotics differs significantly between two major orthopedic centers that are geographically fairly close. Monitoring of bacteriological analyses in each referral center should be continuously performed. Close monitoring is needed for more efficient antibiotic treatment of and prophylaxis against PJI.
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Artritis Infecciosa , Artroplastia de Reemplazo de Rodilla , Infecciones Relacionadas con Prótesis , Antibacterianos/uso terapéutico , Artritis Infecciosa/cirugía , Artroplastia de Reemplazo de Rodilla/efectos adversos , Coagulasa/uso terapéutico , Farmacorresistencia Bacteriana , Humanos , Infecciones Relacionadas con Prótesis/tratamiento farmacológico , Infecciones Relacionadas con Prótesis/prevención & control , Infecciones Relacionadas con Prótesis/cirugía , Estudios Retrospectivos , StaphylococcusRESUMEN
PURPOSE: Goal of this study was the assessment of long-term outcome of arthroscopically assisted repair of Palmer 1B/Atzei 1 triangular fibrocartilage complex tears and the comparison with short- and mid-term results. METHODS: The study included nineteen patients (mean 49.2 years of age) with a mean follow-up time of 13.6 years (13.1-14.3 years). Examination parameters included disabilities of arm, shoulder, and hand (DASH) questionnaire, modified Mayo Wrist Score (MMWS), Krimmer Score, determination of range of motion in comparison to the contralateral extremity. Grip and pinch grip strength measurement and pain level assessment was performed, as well. RESULTS: The mean MMWS after at least 13.1 years was 95.8 (85-100, SD 5.6). Mean DASH Score was 10.2 (0-55.8, SD 13.6). Mean Krimmer Score was 97.2 (85-100, SD 4.8). Grip strength reached 101% of the contralateral unaffected hand. Range of motion did not differ significantly in comparison to the healthy contralateral extremity. None of the patients suffered from major complications. Fourteen of nineteen patients regarded pain level reduction as excellent. Five patients reported a relevant pain level reduction. Sixteen of nineteen patients regarded functional outcome as excellent, the other three patients reported on a pleasing improvement of the functional outcome. CONCLUSION: Arthroscopically assisted repair of Palmer 1B/Atzei 1 triangular fibrocartilage complex tears may be an efficacious and safe surgical technique for ulnar-sided TFCC tears in the long term.
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Fibrocartílago Triangular , Traumatismos de la Muñeca , Artroscopía/métodos , Humanos , Dolor/etiología , Rango del Movimiento Articular , Estudios Retrospectivos , Resultado del Tratamiento , Fibrocartílago Triangular/lesiones , Fibrocartílago Triangular/cirugía , Traumatismos de la Muñeca/cirugíaRESUMEN
AIMS: The management of periprosthetic joint infection (PJI) after total knee arthroplasty (TKA) is challenging. The correct antibiotic management remains elusive due to differences in epidemiology and resistance between countries, and reports in the literature. Before the efficacy of surgical treatment is investigated, it is crucial to analyze the bacterial strains causing PJI, especially for patients in whom no organisms are grown. METHODS: A review of all revision TKAs which were undertaken between 2006 and 2018 in a tertiary referral centre was performed, including all those meeting the consensus criteria for PJI, in which organisms were identified. Using a cluster analysis, three chronological time periods were created. We then evaluated the antibiotic resistance of the identified bacteria between these three clusters and the effectiveness of our antibiotic regime. RESULTS: We identified 129 PJIs with 161 culture identified bacteria in 97 patients. Coagulase-negative staphylococci (CNS) were identified in 46.6% cultures, followed by Staphylococcus aureus in 19.8%. The overall resistance to antibiotics did not increase significantly during the study period (p = 0.454). However, CNS resistance to teicoplanin (p < 0.001), fosfomycin (p = 0.016), and tetracycline (p = 0.014) increased significantly. Vancomycin had an 84.4% overall sensitivity and 100% CNS sensitivity and was the most effective agent. CONCLUSION: Although we were unable to show an overall increase in antibiotic resistance in organisms that cause PJI after TKA during the study period, this was not true for CNS. It is concerning that resistance of CNS to new antibiotics, but not vancomycin, has increased in a little more than a decade. Our findings suggest that referral centres should continuously monitor their bacteriological analyses, as these have significant implications for prophylactic treatment in both primary arthroplasty and revision arthroplasty for PJI. Cite this article: Bone Joint J 2021;103-B(6 Supple A):171-176.
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Artroplastia de Reemplazo de Rodilla , Farmacorresistencia Microbiana , Infecciones Relacionadas con Prótesis/tratamiento farmacológico , Infecciones Relacionadas con Prótesis/microbiología , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reoperación , Estudios RetrospectivosRESUMEN
BACKGROUND: There are a number of factors that influence blood loss during and after primary total knee arthroplasty (TKA) and revision TKA (rTKA). The purpose of this study was to provide a factorial assessment that would aid surgeons in managing expected blood loss in rTKA, when compared to TKA. The first question asked was the blood loss and transfusions between TKA and rTKA and the second question was risk factors for blood loss after rTKA. HYPOTHESIS: Blood loss in any rTKA is higher than in TKA by a factor of 2. PATIENTS AND METHODS: A retrospective single-centre consecutive series of rTKA between 2006 and 2018 was performed. Based on the rTKA types identified in joint registries, 4 rTKA cohorts were created: aseptic minor rTKA, aseptic major rTKA, 1st stage, and 2nd stage septic rTKA. A consecutive TKA cohort from the same study period was used to create a propensity score matched cohort with the aseptic major rTKA cohort. RESULT: A total of 622 rTKA were identified. Aseptic major rTKA had double the median blood loss than TKA. The lowest blood loss was observed in the TKA group followed by aseptic minor rTKA, and the highest in 2nd stage septic rTKA. The median total blood loss was higher in all rTKA by a factor ranging between 1.38 and 2.17. Higher age, female gender, lower preoperative hemoglobin, chronic heart disease and history of myocardial infarction were risk factors for increased blood loss. The type of rTKA performed was not predictive of blood loss in the linear regression analysis. DISCUSSION: Blood loss after rTKA is 1.38 to 2.17-fold higher than after TKA. The blood loss observed in 2nd stage septic rTKA and aseptic major rTKA was the highest. Older female patients, with a low preoperative hemoglobin, were identified to be at the highest risk of blood loss after rTKA. Strategies for further blood loss reductions need to be utilised to the fullest extent for these procedures. LEVEL OF EVIDENCE: III; retrospective prognostic study.
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Artroplastia de Reemplazo de Rodilla , Artroplastia de Reemplazo de Rodilla/efectos adversos , Femenino , Hemorragia , Humanos , Sistema de Registros , Reoperación , Estudios RetrospectivosRESUMEN
INTRODUCTION: Major gastrointestinal complications after arthroplasty are rare, but can have detrimental effects on the patient and can substantially increase the overall cost of treatment. This systematic review provides an overview of ileus, gastrointestinal bleeding and C. difficile colitis after total hip and knee arthroplasty. MATERIALS AND METHODS: We followed the PRISMA guidelines and searched 3 databases for the period between 1 January 2000 and 31 December 2018. The manual search included references in retrieved articles. We extracted data on the cohort size, study level, arthroplasty procedure, complications and their incidence, and recommendations by the study. RESULTS: Twenty-five studies that analyzed these complications after total knee arthroplasty (TKA) and total hip arthroplasty (THA) were identified. These complications have an incidence of up to 2% each. According to some of the studies, an incidence of 0% is possible. While the risk factors for ileus varied greatly, those for C. difficile colitis were more consistent. There are some recommendations for reducing the incidence of ileus and C. difficile. This heterogeneity does not allow us to draw any conclusion regarding which thromboprophylaxis agent has the lowest incidence of gastrointestinal bleeding. CONCLUSION: The complications investigated in this systematic review are rare and have a reported incidence of up to 2% each. Even though there are some recommendations for reducing the complication rate, due to the complex nature of the arthroplasty setting, there is a need for further investigation of these risk factors and how they can be reduced.
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Artroplastia de Reemplazo de Cadera , Artroplastia de Reemplazo de Rodilla , Clostridioides difficile , Colitis , Ileus , Tromboembolia Venosa , Anticoagulantes , Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Rodilla/efectos adversos , Hemorragia Gastrointestinal/epidemiología , Hemorragia Gastrointestinal/etiología , Humanos , Complicaciones Posoperatorias/epidemiología , Factores de RiesgoRESUMEN
PURPOSE: The goal of this study was the assessment of long-term outcome of dorsal capsular imbrication of the distal radioulnar joint (DRUJ) in dorsal instability. METHODS: The study included ten patients (mean 38.7 years of age) with a mean follow-up time of 11.2 years (9.3 years to 14.3 years). Examination parameters included Disabilities of Arm, Shoulder, and Hand (DASH) questionnaire, modified Mayo Wrist Score (MMWS), determination of range of motion in comparison with the healthy extremity, pre- and post-operative pain level assessment, and examination of DRUJ stability. RESULTS: Eight of ten DRUJs proved to be stable after the above-mentioned follow-up. Mean MMWS was 92.5 (65-100; SD: 11.1). Mean DASH Score was 8.8 (0-60; SD: 18.4). Grip strength reached 93.5% of the contralateral unaffected hand. Range of motion did not differ significantly in comparison with the healthy contralateral extremity. Nine of ten patients regarded pain level reduction as excellent. Eight of ten patients regarded DRUJ stability as excellent after surgery. CONCLUSION: Dorsal capsular imbrication of the DRUJ is an efficacious surgical technique for post-traumatic dorsal instability in the long-term.
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Inestabilidad de la Articulación , Traumatismos de la Muñeca , Humanos , Inestabilidad de la Articulación/etiología , Inestabilidad de la Articulación/cirugía , Rango del Movimiento Articular , Resultado del Tratamiento , Articulación de la Muñeca/diagnóstico por imagen , Articulación de la Muñeca/cirugíaRESUMEN
INTRODUCTION: Tibial component design and positioning contribute more to patient satisfaction than previously realized. A surgeon needs to decide on the size and rotation, bearing in mind that coverage should be as high as possible, whilst malrotation and overhang should be avoided. No study investigates the impact of each of these components on clinical outcomes in a single cohort. MATERIALS AND METHODS: This is a retrospective analysis of 1-year postoperative outcomes measured with the Knee Injury and Osteoarthritis Outcome (KOOS) Score, as well as a previously validated rotational CT protocol. Coverage, rotation from Insall's axis, and overhang of an asymmetric tibial baseplate were measured, and positive and negative correlations to clinical outcomes were calculated. RESULTS: A total of 499 knees were analyzed. Patient average age was 68.4 years. Rotation within 7° internal and 5° external from Insall's axis was a "safe zone". Mean coverage was 76%. A total of 429 knees (94%) had a coverage of at least 70% and 102 knees (22%) greater than 80%. Overhang was detected in 23% of the cohort. Increased coverage was correlated to increased KOOS score and overhang correlated with a decreased KOOS score (p = 0.008). CONCLUSIONS: This study demonstrates the individual role of three aspects of tibial component implantation properties in postoperative pain and short-term functional outcomes. Upsizing to the point of overhang with rotational tolerance of 7° internal and 3° external to Insall's axis demonstrates best patient reported outcomes. Overhang decreases the clinical outcome by the same margin as loss of 16% of coverage.
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Artroplastia de Reemplazo de Rodilla , Articulación de la Rodilla , Tibia , Anciano , Humanos , Articulación de la Rodilla/fisiología , Articulación de la Rodilla/cirugía , Estudios Retrospectivos , Rotación , Tibia/fisiología , Tibia/cirugía , Resultado del TratamientoRESUMEN
BACKGROUND: Unexplained pain in the medial proximal tibia frequently leads to revision after unicondylar knee arthroplasty (UKA). As one of the most important factors for osteogenic adaptive response, increased bone strain following UKA has been suggested as a possible cause. QUESTIONS/PURPOSES: In this study we: (1) performed a cadaver-based kinematic analysis on paired cadaveric specimens before and after mobile-bearing and fixed-bearing UKA; and (2) simultaneously characterized the strain distribution in the anterior and posterior proximal tibia during squatting. METHODS: Five pairs of fresh, frozen full-leg cadaver specimens (four male, one female, 64 years to 87 years) were subjected to a dynamic squatting motion on a kinematic rig to simulate joint loading for a large ROM. Forces were applied to the quadriceps and hamstrings during the simulation while an infrared camera system tracked the location of reflective markers attached to the tibia and femur. Tibial cortical bone strain was measured with stacked strain gauge rosettes attached at predefined anterior and posterior positions on the medial cortex. Pairwise implantation of mobile-bearing (UKAMB) and fixed-bearing implants (UKAFB) allowed a direct comparison of right and left knees from the same donor through a linear mixed model. RESULTS: UKAMB more closely replicated native kinematics in terms of tibial rotation and in AP and mediolateral translation. Maximum principal bone strain values were consistently increased compared with native (anteromedial, mean [± SD] peak strain: 311 µÎµ ± 190 and posterior, mean peak strain: 321 µÎµ ± 147) with both designs in the anteromedial (UKAFB, mean peak strain: 551 µÎµ ± 381, Cohen's d effect size 1.3 and UKAMB, mean peak strain: 596 µÎµ ± 564, Cohen's d effect size 1.5) and posterior (UKAFB, mean peak strain: 505 µÎµ ± 511, Cohen's d effect size 1.3 and UKAMB, mean peak strain: 633 µÎµ ± 424, Cohen's d effect size 2.1) region. However, in the anterolateral region of the medial tibial bone, UKAFB demonstrated the overall largest increase in strain (mean peak strain: 1010 µÎµ ± 787, Cohen's d effect size 1.9), while UKAMB (613 µÎµ ± 395, Cohen's d effect size 0.2) closely replicated values of the native knee (563 µÎµ ± 234). CONCLUSION: In this in vitro cadaver study both UKAMB and UKAFB led to an increase in bone strain in comparison with the native knee. However, in the anterolateral region of the medial tibial plateau, proximal tibial bone strain was lower after UKAMB and UKAFB. Both UKAMB and UKAFB lead to comparable increases in anteromedial and posterior tibial strain in comparison with the native knee. In the anterolateral region of the medial tibial plateau UKA, proximal tibial bone strain was closer to the native knee after UKAMB than after UKAFB. In an attempt to link kinematics and strain behavior of these designs there seemed to be no obvious relation. CLINICAL RELEVANCE: Further clinical research may be able to discern whether the observed differences in cortical strain after UKA is associated with unexplained pain in patients and whether the observed differences in cortical bone strain between mobile-bearing and fixed unicondylar designs results in a further difference in unexplained pain.
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Artroplastia de Reemplazo de Rodilla/métodos , Complicaciones Posoperatorias/cirugía , Reoperación/métodos , Esguinces y Distensiones/cirugía , Tibia/lesiones , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Rodilla/efectos adversos , Fenómenos Biomecánicos , Cadáver , Femenino , Humanos , Rodilla/fisiopatología , Rodilla/cirugía , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/fisiopatología , Rango del Movimiento Articular , Esguinces y Distensiones/etiología , Esguinces y Distensiones/fisiopatología , Tibia/fisiopatologíaRESUMEN
BACKGROUND: There is a clear tendency towards cementless acetabular components in primary total hip arthroplasty. OBJECTIVE: The aim of this study was to assess the long-term clinical and radiological outcome of titanium cementless acetabular cups when combined with a highly crosslinked polyethylene liner. METHODS: This study is a retrospective follow-up of 67 cups in 64 patients. Clinical outcomes were assessed using the Harris Hip Score. Radiolucent lines, osteolysis and loosening were assessed radiologically. Implant survival was determined using the Kaplan-Meier analysis. RESULTS: The average Harris Hip Score at follow-up was 80.3 ± 14.5. Signs of osteolysis were observed in 7.1% of the radiographs. No aseptic loosening of the cup was reported. Survival of the cup with aseptic loosening as an endpoint was 100%. A comparison with 19 other studies using the same material combination demonstrated very similar results. All manufacturers with available studies have at least one report of 100% survivorship at 10-year follow-up for their titanium cup and highly crosslinked polyethylene acetabular component combination with aseptic loosening as an endpoint. CONCLUSIONS: The data suggests that the rate of aseptic loosening of a titanium cup combined with a highly-crosslinked polyethylene liner at 10-year follow-up could be as low as 0%.
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Acetábulo , Artroplastia de Reemplazo de Cadera , Acetábulo/cirugía , Estudios de Seguimiento , Prótesis de Cadera , Humanos , Polietileno , Diseño de Prótesis , Falla de Prótesis , Estudios Retrospectivos , TitanioRESUMEN
OBJECTIVES: Periprosthetic femoral fractures (PFFs) have a higher incidence with cementless stems. The highest incidence among various cementless stem types was observed with double-wedged stems. Short stems have been introduced as a bone-preserving alternative with a higher incidence of PFF in some studies. The purpose of this study was a direct load-to-failure comparison of a double-wedged cementless stem and a short cementless stem in a cadaveric fracture model. METHODS: Eight hips from four human cadaveric specimens (age mean 76 years (60 to 89)) and eight fourth-generation composite femurs were used. None of the cadaveric specimens had compromised quality (mean T value 0.4 (-1.0 to 5.7)). Each specimen from a pair randomly received either a double-wedged stem or a short stem. A materials testing machine was used for lateral load-to-failure test of up to a maximal load of 5000 N. RESULTS: Mean load at failure of the double-wedged stem was 2540 N (1845 to 2995) and 1867 N (1135 to 2345) for the short stem (p < 0.001). All specimens showed the same fracture pattern, consistent with a Vancouver B2 fracture. The double-wedged stem was able to sustain a higher load than its short-stemmed counterpart in all cases. Failure force was not correlated to the bone mineral density (p = 0.718). CONCLUSION: Short stems have a significantly lower primary load at failure compared with double-wedged stems in both cadaveric and composite specimens. Surgeons should consider this biomechanical property when deciding on the use of short femoral stem.Cite this article: A. Klasan, M. Bäumlein, P. Dworschak, C. Bliemel, T. Neri, M. D. Schofer, T. J. Heyse. Short stems have lower load at failure than double-wedged stems in a cadaveric cementless fracture model. Bone Joint Res 2019;8:489-494. DOI: 10.1302/2046-3758.810.BJR-2019-0051.R1.
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INTRODUCTION: Studies using conventional radiographical signs and computerized tomography (CT) for retroversion of the acetabulum have reported a prevalence of up to 25%. The purpose of this study was to provide a detailed report on acetabular version, gender, age and side differences in a large cohort. MATERIALS AND METHODS: A total of 404 patients receiving a whole-body CT scan, aged between 16 and 40 years, have been included in the study. The measurement was performed in the transversal plane on three levels: cranial, central and caudal. RESULTS: The retroverted acetabulum on all three levels had a prevalence of 0.25% (95% confidence interval 0-0.7%). The average central anteversion in men was 16.46° (±4.42) and that in women was 19.31° (±5.04) (p < 0.001). Version increases with age, but a cluster analysis showed this to be a trend (p = 0.068). CONCLUSION: Women have a higher average acetabular version than men. Retroversion in a young adult population has a low prevalence when measured with conventional CT. About a tenth of the population has a significantly different contralateral acetabular version. THE TRANSLATIONAL POTENTIAL OF THIS ARTICLE: Global acetabular retroversion has a much lower prevalence than previously reported.
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Background and purpose - To date, there is not a single clinical or mechanical study directly comparing a cemented and a cementless version of the same stem. We investigated the load-to-failure force of a cementless and a cemented version of a double tapered stem. Material and methods - 10 femurs from 5 human cadaveric specimens, mean age 74 years (68-79) were extracted. Bone mineral density (BMD) was measured using peripheral quantitative computed tomography. None of the specimens had a compromised quality (average T value 0.0, -1.0 to 1.4). Each specimen from a pair randomly received a cemented or a cementless version of the same stem. A material testing machine was used for lateral load-to-failure test of up to a maximal load of 5.0 kN. Results - Average load-to-failure of the cemented stem was 2.8 kN (2.3-3.2) and 2.2 kN (1.8-2.8) for the cementless stem (p = 0.002). The cemented version of the stem sustained a higher load than its cementless counterpart in all cases. Failure force was not statistically significantly correlated to BMD (p = 0.07). Interpretation - Implanting a cemented version of the stem increases the load-to-failure force by 25%.
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Artroplastia de Reemplazo de Cadera/métodos , Cementación , Fracturas del Fémur/etiología , Prótesis de Cadera , Fracturas Periprotésicas/etiología , Falla de Prótesis/etiología , Anciano , Artroplastia de Reemplazo de Cadera/efectos adversos , Cementos para Huesos , Densidad Ósea/fisiología , Cadáver , Femenino , Fracturas del Fémur/diagnóstico por imagen , Fracturas del Fémur/fisiopatología , Fémur/fisiopatología , Humanos , Masculino , Ensayo de Materiales/métodos , Fracturas Periprotésicas/diagnóstico por imagen , Fracturas Periprotésicas/fisiopatología , Diseño de Prótesis , Estrés Mecánico , Tomografía Computarizada por Rayos X , Soporte de Peso/fisiologíaRESUMEN
INTRODUCTION: Impingement of the prominent anterior inferior iliac spine (AIIS) against the femoral neck has recently been described as another type of impingement. The purpose of this study is to provide a distribution of AIIS types using the classification proposed by Hetsroni and thus report on the prevalence of prominent types. MATERIALS AND METHODS: A total of 400 patients were included in the study with an average age 27.3 ± 6.9 years (range 18-40). All patients received a whole-body polytrauma computer tomography (CT) scan in the emergency room (ER) upon arrival. The classification of AIIS proposed by Hetsroni et al., which describes three morphological types, was used. Type II and III were grouped as prominent types. The measurements were performed in all three planes by two examiners. RESULTS: Male to female ratio was 71:29. Type I was observed in 367 (91.7%) patients. Type II was observed in 31 (7.8%) patients and type III was observed in 2 (0.5%) patients, unilaterally. Prominent types were much more prevalent in men (10.5%) than in women (2.6%). The CT assessment demonstrated excellent intra- and interreliability (overall: 0.926, I/II: 0.906, III: 1.000). CONCLUSION: A young population demonstrates a prevalence of a prominent AIIS of 11.5%. Prominent AIIS is more common in men than in women.
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Artralgia/fisiopatología , Cuello Femoral/fisiopatología , Ilion/fisiopatología , Artropatías/fisiopatología , Adolescente , Adulto , Femenino , Cuello Femoral/diagnóstico por imagen , Articulación de la Cadera/diagnóstico por imagen , Articulación de la Cadera/fisiopatología , Humanos , Ilion/diagnóstico por imagen , Imagenología Tridimensional , Artropatías/clasificación , Artropatías/diagnóstico por imagen , Masculino , Prevalencia , Factores Sexuales , Tomografía Computarizada por Rayos X , Imagen de Cuerpo Entero , Adulto JovenRESUMEN
BACKGROUND: Elevated serum levels of chromium and cobalt ions in metal-on-metal (MoM) bearing surfaces is a well-known phenomenon in THA. However, few studies have addressed this issue in complex primary and revision knee arthroplasty using a MoM hinged mechanism, and no study, to our knowledge, has investigated knees with MoM hinges in patients without megaprostheses (tumor prostheses). QUESTIONS/PURPOSES: We analyzed a series of patients who received MoM hinged revision knee prostheses and asked: (1) What are the serum metal ion levels at short-term followup? (2) Is there any correlation between metal ion levels and the Knee Society Score (KSS) at this followup? METHODS: Between 2013 and 2017, we performed 198 revision knee arthroplasties, of which 32 (17.7%) were performed with a latest-generation MoM hinge knee design. In addition, three complex primary TKAs utilizing the same design were included in this study. The device features a metal-on-polyethylene bearing with a MoM hinge. During that period, our general indications for using a hinge were single-stage and two-stage revision surgeries, revisions with large bone defects, and primary TKA with > 20° mechanical malalignment or collateral ligament insufficiency. Of the 35 patients who received this device, 23 patients (65% of the overall group who received this implant; 11 males, 12 females) were available for followup at a median of 28 months (range, 13-61 months), and the remaining 12 (35%) patients were lost to followup. Our rationale for reporting before the more typical 2-year minimum was the finding of elevated serum ion levels with unclear clinical significance. Median age at the time of surgery was 68 years (range, 52-84 years). None of the patients included in the study had other implants with MoM bearings. Serum ion levels of chromium (III) and cobalt were assessed using mass spectrometry. Ion levels > 5 ppb were considered elevated. Clinical outcome was assessed using the original KSS. RESULTS: Median chromium serum level was 6.3 ppb (range, 0.6-31.9 ppb) and median cobalt serum level was 10.5 (range, 1.0-47.5 ppb). Of the 23 patients, 16 had elevated serum ion levels. There was a moderate correlation between KSS and both chromium (p = 0.029, r = 0.445) and cobalt (p = 0.012, r = 0.502) levels. CONCLUSIONS: Elevated metal ion levels and radiolucent lines are common after surgery with this MoM hinge design at short-term followup, and we believe this finding is of great concern. Although no patient has yet been revised, these patients will be closely monitored. We recommend that serum ion analysis become a routine part of followup after any hinge TKA in an attempt to better understand the potential consequences of this phenomenon. LEVEL OF EVIDENCE: Level IV, therapeutic study.
Asunto(s)
Cromo/sangre , Cobalto/sangre , Iones/sangre , Prótesis de la Rodilla/efectos adversos , Prótesis Articulares de Metal sobre Metal/efectos adversos , Cuidados Posteriores , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Rodilla/instrumentación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Periodo Posoperatorio , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: The direct anterior approach (DAA) has gained popularity in total hip arthroplasty (THA) over the past decade. A large number of studies have compared the DAA to other approaches with inclusion of a learning curve phase. The aim of this study was to compare the complication rate and bleeding between the DAA and the anterolateral approach after the learning curve phase. METHODS: For this retrospective, single-institutional study, propensity score matching was performed, from an initial cohort of 1408 patients receiving an elective THA. Two matching groups were created, comprising of 396 patients each. After matching, both groups were similar in age, gender, body mass index, anesthesiologist's score and surgeon's experience. RESULTS: Average age in the matched groups was 68.7 ± 10.3 years. The total blood loss was similar in both groups, 450 vs 469 mL (p = 0.400), whereas the transfusion rate (14.1 vs 5.8%, p < 0.001) and the overall complication rate (17.6 vs 12.1%, p = 0.018) were lower in the DAA group. The overall fracture rate was comparable, 1.5 vs 1% (p = 0.376), as well as the early infection rate, 0.3 vs 1% (p = 0.162). The dislocation rate was significantly increased in the DAA group, 2.2 vs 0.5% (p = 0.032). CONCLUSIONS: The direct anterior approach has comparable short-term surgical complications with reduced transfusion and general complication rates. LEVEL OF EVIDENCE: Level III retrospective study.
Asunto(s)
Artroplastia de Reemplazo de Cadera/efectos adversos , Pérdida de Sangre Quirúrgica , Articulación de la Cadera/cirugía , Complicaciones Posoperatorias/etiología , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Cadera/métodos , Pérdida de Sangre Quirúrgica/prevención & control , Transfusión Sanguínea , Femenino , Alemania , Articulación de la Cadera/diagnóstico por imagen , Articulación de la Cadera/fisiopatología , Humanos , Masculino , Análisis por Apareamiento , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del TratamientoRESUMEN
INTRODUCTION: Although there is increasing evidence for the successful use of local vancomycin applied by soaked compresses during ACL reconstruction, there are still little data on its microbiological and biomechanical effects. Furthermore, exact dosage of vancomycin with respect to tendon stability and microbiological effectivity is still unknown. MATERIALS AND METHODS: 63 porcine flexor digitorum profundus tendons were harvested under sterile conditions from fresh cadaver legs. After contamination with Staphylococcus epidermidis (S. epidermidis), tendons were wrapped into sterile compresses moistened with different concentrations of vancomycin for 10 or 20 min. Sterile sodium chloride was used for control. After treatment, tendons were rolled onto blood-agar plates to test for residual bacterial contamination and tested for maximum load and stiffness using a uniaxial testing device with cryo-clamps for tendon fixation. Agar plates were checked after 1 week of culture at 36 °C for signs of bacterial growth. RESULTS: When applying vancomycin for only 10 min, bacterial contamination was found in all dosage groups ranging from 28.6% contamination (n = 2 of 7 tendons) when using 10 mg/ml up to 85.7% (n = 6 of 7 tendons) when using 1 mg/ml. Applying vancomycin-soaked compresses for 20 min, bacterial contamination was still found in the groups using 1 mg/ml and 2.5 mg/ml (contamination rate 85.7 and 42.9% respectively). When using 5 mg/ml and 10 mg/ml, no bacterial contamination could be perceived after 7 days of culture. With regard to biomechanical properties, no differences were found regarding maximum load or Young's modulus between groups. CONCLUSIONS: This study showed no signs of biomechanical impairment of porcine flexor tendons after the use of vancomycin wraps with concentration ranging from 1 to 10 mg/ml for 10 or 20 min at a time zero testing. Contamination with S. epidermidis was cleansed in 100% of tendons when using at least 5 mg/ml of vancomycin for 20 min.
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Reconstrucción del Ligamento Cruzado Anterior/métodos , Antibacterianos/farmacología , Tendones , Vancomicina/farmacología , Animales , Ligamento Cruzado Anterior/cirugía , Fenómenos Biomecánicos/fisiología , Staphylococcus epidermidis/efectos de los fármacos , Porcinos , Tendones/microbiología , Tendones/fisiología , Tendones/cirugía , Tendones/trasplanteRESUMEN
PURPOSE: Postoperative ileus (POI) is one of the complications that can occur after every surgical procedure including arthroplasty. It can have detrimental consequences for the patient and portrays an economic burden on health care systems. The risk factors for POI after arthroplasty described in the literature are scarce and include hip arthroplasty, male gender and previous abdominal surgery. The purpose of the study was to determine the risk factors for POI after hip and knee arthroplasty. METHODS: A retrospective review of 2760 patients undergoing primary hip and knee arthroplasty was performed. An in-depth analysis of patient history and physical operative and postoperative course was reviewed and statistically analyzed in a univariate and multivariate setting. RESULTS: Overall incidence of POI was 0.54%. History of myocardial infarction and chronic kidney disease were statistically significant risk factors for developing POI after arthroplasty with values of p = 0.023 and p = 0.004, respectively. Other risk factors included previous abdominal surgery (p < 0.001) and hip arthroplasty (p = 0.026). Age or gender correlations were not observed. CONCLUSIONS: Although postoperative ileus is an uncommon complication after joint arthroplasty, in addition to the known risk factors of male age, hip arthroplasty, and previous abdominal surgery, this study describes two previously unknown risk factors: chronic kidney disease and history of myocardial infarction. Patients with these risk factors should be monitored closely for developing postoperative ileus.