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1.
Bone Joint J ; 102-B(6_Supple_A): 3-9, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32475278

RESUMEN

AIMS: The aim of this study was to determine if a three-month course of microorganism-directed oral antibiotics reduces the rate of failure due to further infection following two-stage revision for chronic prosthetic joint infection (PJI) of the hip and knee. METHODS: A total of 185 patients undergoing a two-stage revision in seven different centres were prospectively enrolled. Of these patients, 93 were randomized to receive microorganism-directed oral antibiotics for three months following reimplantation; 88 were randomized to receive no antibiotics, and four were withdrawn before randomization. Of the 181 randomized patients, 28 were lost to follow-up, six died before two years follow-up, and five with culture negative infections were excluded. The remaining 142 patients were followed for a mean of 3.3 years (2.0 to 7.6) with failure due to a further infection as the primary endpoint. Patients who were treated with antibiotics were also assessed for their adherence to the medication regime and for side effects to antibiotics. RESULTS: Nine of 72 patients (12.5%) who received antibiotics failed due to further infection compared with 20 of 70 patients (28.6%) who did not receive antibiotics (p = 0.012). Five patients (6.9%) in the treatment group experienced adverse effects related to the administered antibiotics severe enough to warrant discontinuation. CONCLUSION: This multicentre randomized controlled trial showed that a three-month course of microorganism-directed, oral antibiotics significantly reduced the rate of failure due to further infection following a two-stage revision of total hip or knee arthroplasty for chronic PJI. Cite this article: Bone Joint J 2020;102-B(6 Supple A):3-9.


Asunto(s)
Antibacterianos/administración & dosificación , Artroplastia de Reemplazo de Cadera , Artroplastia de Reemplazo de Rodilla , Prótesis de Cadera/efectos adversos , Prótesis de la Rodilla/efectos adversos , Falla de Prótesis , Infecciones Relacionadas con Prótesis/etiología , Infecciones Relacionadas con Prótesis/prevención & control , Reoperación , Administración Oral , Anciano , Enfermedad Crónica , Femenino , Humanos , Masculino , Persona de Mediana Edad , Falla de Prótesis/etiología , Infecciones Relacionadas con Prótesis/cirugía , Factores de Tiempo
2.
Zhonghua Wai Ke Za Zhi ; 58(6): 416-419, 2020 Jun 01.
Artículo en Chino | MEDLINE | ID: mdl-32498478

RESUMEN

Bearing dislocation is a special complication of mobile-bearing unicompartmental arthroplasty, caused by many factors, such as imbalance of the flexion and extension gap, malposition of components, impingement by the remaining osteophytes and cement, damage or delayed chronic laxity of medial collateral ligament, traumatic accident and habitual high knee flexion. It can be reduced by strictly controlling the operation indications before operation, osteotomy and implanting the prosthesis accurately while protecting the medial collateral ligament during operation, actively guiding the appropriate rehabilitation actions and activity intensity of patients after operation. Treatment should be individualized according to the causes and individual conditions of patients.


Asunto(s)
Artroplastia de Reemplazo de Rodilla/efectos adversos , Artropatías/cirugía , Prótesis de la Rodilla/efectos adversos , Falla de Prótesis , Artroplastia de Reemplazo de Rodilla/instrumentación , Humanos , Artropatías/etiología , Artropatías/prevención & control , Articulación de la Rodilla/cirugía , Diseño de Prótesis , Falla de Prótesis/etiología
3.
Medicine (Baltimore) ; 99(20): e20069, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32443315

RESUMEN

RATIONALE: Although intraocular lens (IOL) dislocations have been reported after uneventful cataract surgeries, no sequential changes have ever been demonstrated. Our case showed the sequential changes to IOL dislocation caused by vigorous ocular massage. PATIENT CONCERNS: A 42-year-old man complained of blurred vision in the left eye 8 years after uneventful phacoemulsification. The IOL was still well-centered, but curvilinear tears of the anterior and posterior capsule along the optic border of IOL and vitreous herniation were noted. In the following month, the IOL subluxated inferiorly. A careful history taking revealed a recent habit of vigorous ocular massage. The subluxation was stable for 2 years after avoiding ocular massage, but dislocation into vitreous occurred after taking a spring water bath (spa) bath with massage. DIAGNOSIS: IOL dislocation. INTERVENTIONS: Pars plana vitrectomy to remove the dislocated IOL and implantation of a 3-piece IOL into sulcus were performed. OUTCOMES: The IOL was well-centered. The visual acuity returned to 20/20. LESSONS: Ocular massage might cause tear of the intact fibrotic capsule and dislocation of IOL. The capsule along the border of the optics might be a weak point against ocular massage.


Asunto(s)
Lentes Intraoculares , Masaje/efectos adversos , Falla de Prótesis/etiología , Adulto , Lesiones Oculares/etiología , Lesiones Oculares/cirugía , Humanos , Implantación de Lentes Intraoculares , Masculino , Facoemulsificación , Vitrectomía
4.
Bone Joint J ; 102-B(4): 414-422, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32228075

RESUMEN

AIMS: To compare long-term survival of all-cemented and hybrid total hip arthroplasty (THA) using the Exeter Universal stem. METHODS: Details of 1,086 THAs performed between 1999 and 2005 using the Exeter stem and either a cemented (632) or uncemented acetabular component (454) were collected from local records and the New Zealand Joint Registry. A competing risks regression survival analysis was performed with death as the competing risk with adjustments made for age, sex, approach, and bearing. RESULTS: There were 61 revisions (9.7%; 0.82 revisions/100 observed component years, (OCYs)) in the all-cemented group and 18 (4.0%; 0.30/100 OCYs) in the hybrid group. The cumulative incidence of revision at 18 years was 12.1% for cemented and 5.2% for hybrids. There was a significantly greater risk of revision for all-cemented compared with hybrids (unadjusted sub-hazard ratio (SHR) 2.44; p = 0.001), and of revision for loosening, wear, or osteolysis (unadjusted SHR 3.77; p < 0.001). After adjustment, the increased risk of all-cause revision did not reach significance at age 70 years and above. The advantage for revision for loosening, wear, and osteolysis remained at all ages. CONCLUSION: This study supports the use of uncemented acetabular fixation when used in combination with the Exeter stem with improved survivorship for revision for aseptic loosening, wear, and osteolysis at all ages and for all-cause revision in patients less than 70 years. Cite this article: Bone Joint J 2020;102-B(4):414-422.


Asunto(s)
Acetábulo/cirugía , Artroplastia de Reemplazo de Cadera/métodos , Cementación/métodos , Factores de Edad , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Cadera/efectos adversos , Cementos para Huesos , Cementación/efectos adversos , Femenino , Prótesis de Cadera , Humanos , Masculino , Persona de Mediana Edad , Osteólisis/etiología , Osteólisis/cirugía , Complicaciones Posoperatorias/cirugía , Diseño de Prótesis , Falla de Prótesis/etiología , Sistema de Registros , Reoperación/estadística & datos numéricos , Factores de Riesgo , Análisis de Supervivencia
5.
Bone Joint J ; 102-B(4): 434-441, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32228078

RESUMEN

AIMS: There are comparatively few randomized studies evaluating knee arthroplasty prostheses, and fewer still that report longer-term functional outcomes. The aim of this study was to evaluate mid-term outcomes of an existing implant trial cohort to document changing patient function over time following total knee arthroplasty using longitudinal analytical techniques and to determine whether implant design chosen at time of surgery influenced these outcomes. METHODS: A mid-term follow-up of the remaining 125 patients from a randomized cohort of total knee arthroplasty patients (initially comprising 212 recruited patients), comparing modern (Triathlon) and traditional (Kinemax) prostheses was undertaken. Functional outcomes were assessed with the Oxford Knee Score (OKS), knee range of movement, pain numerical rating scales, lower limb power output, timed functional assessment battery, and satisfaction survey. Data were linked to earlier assessment timepoints, and analyzed by repeated measures analysis of variance (ANOVA) mixed models, incorporating longitudinal change over all assessment timepoints. RESULTS: The mean follow-up of the 125 patients was 8.12 years (7.3 to 9.4). There was a reduction in all assessment parameters relative to earlier assessments. Longitudinal models highlight changes over time in all parameters and demonstrate large effect sizes. Significant between-group differences were seen in measures of knee flexion (medium-effect size), lower limb power output (large-effect size), and report of worst daily pain experienced (large-effect size) favouring the Triathlon group. No longitudinal between-group differences were observed in mean OKS, average daily pain report, or timed performance test. Satisfaction with outcome in surviving patients at eight years was 90.5% (57/63) in the Triathlon group and 82.8% (48/58) in the Kinemax group, with no statistical difference between groups (p = 0.321). CONCLUSION: At a mean 8.12 years, this mid-term follow-up of a randomized controlled trial cohort highlights a general reduction in measures of patient function with patient age and follow-up duration, and a comparative preservation of function based on implant received at time of surgery. Cite this article: Bone Joint J 2020;102-B(4):434-441.


Asunto(s)
Artroplastia de Reemplazo de Rodilla/métodos , Prótesis de la Rodilla , Osteoartritis de la Rodilla/cirugía , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Rodilla/instrumentación , Método Doble Ciego , Femenino , Estudios de Seguimiento , Humanos , Articulación de la Rodilla/fisiopatología , Articulación de la Rodilla/cirugía , Extremidad Inferior/fisiopatología , Masculino , Persona de Mediana Edad , Osteoartritis de la Rodilla/fisiopatología , Dolor Postoperatorio/etiología , Satisfacción del Paciente , Periodo Posoperatorio , Diseño de Prótesis , Falla de Prótesis/etiología , Rango del Movimiento Articular , Reoperación/estadística & datos numéricos , Índice de Severidad de la Enfermedad
6.
Bone Joint J ; 102-B(4): 458-462, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32228079

RESUMEN

AIMS: Varus-valgus constrained (VVC) implants are often used during revision total knee arthroplasty (TKA) to gain coronal plane stability. However, the increased mechanical torque applied to the bone-cement interface theoretically increases the risk of aseptic loosening. We assessed mid-term survivorship, complications, and clinical outcomes of a fixed-bearing VVC device in revision TKAs. METHODS: A total of 416 consecutive revision TKAs (398 patients) were performed at our institution using a single fixed-bearing VVC TKA from 2007 to 2015. Mean age was 64 years (33 to 88) with 50% male (199). Index revision TKA diagnoses were: instability (n = 122, 29%), aseptic loosening (n = 105, 25%), and prosthetic joint infection (PJI) (n = 97, 23%). All devices were cemented on the epiphyseal surfaces. Femoral stems were used in 97% (n = 402) of cases, tibial stems in 95% (n = 394) of cases; all were cemented. In total, 93% (n = 389) of cases required a stemmed femoral and tibial component. Femoral cones were used in 29%, and tibial cones in 40%. Survivorship was assessed via competing risk analysis; clinical outcomes were determined using Knee Society Scores (KSSs) and range of movement (ROM). Mean follow-up was four years (2 to 10). RESULTS: The five-year cumulative incidence of subsequent revision for aseptic loosening and instability were 2% (95% confidence interval (CI) 0.2 to 3, number at risk = 154) and 4% (95% CI 2 to 6, number at risk = 153), respectively. The five-year cumulative incidence of any subsequent revision was 14% (95% CI 10 to 18, number at risk = 150). Reasons for subsequent revision included PJI (n = 23, of whom 12 had previous PJI), instability (n = 13), and aseptic loosening (n = 11). The use of this implant without stems was found to be a significant risk factor for subsequent revision (hazard ratio (HR) 7.58 (95% CI 3.98 to 16.03); p = 0.007). KSS improved from 46 preoperatively to 81 at latest follow-up (p < 0.001). ROM improved from 96° prerevision to 108° at latest follow-up (p = 0.016). CONCLUSION: The cumulative incidence of subsequent revision for aseptic loosening and instability was very low at five years with this fixed-bearing VVC implant in revision TKAs. Routine use of cemented and stemmed components with targeted use of metaphyseal cones likely contributed to this low rate of aseptic loosening. Cite this article: Bone Joint J 2020;102-B(4):458-462.


Asunto(s)
Artroplastia de Reemplazo de Rodilla/métodos , Prótesis de la Rodilla , Adulto , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Rodilla/efectos adversos , Artroplastia de Reemplazo de Rodilla/instrumentación , Cementación/métodos , Femenino , Estudios de Seguimiento , Humanos , Inestabilidad de la Articulación/etiología , Articulación de la Rodilla/fisiopatología , Articulación de la Rodilla/cirugía , Prótesis de la Rodilla/efectos adversos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Diseño de Prótesis , Falla de Prótesis/etiología , Infecciones Relacionadas con Prótesis/etiología , Rango del Movimiento Articular , Recuperación de la Función , Reoperación/métodos , Factores de Riesgo , Resultado del Tratamiento
7.
Bone Joint J ; 102-B(4): 423-425, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32228082

RESUMEN

AIMS: Dislocation remains a significant complication after total hip arthroplasty (THA), being the third leading indication for revision. We present a series of acetabular revision using a dual mobility cup (DMC) and compare this with our previous series using the posterior lip augmentation device (PLAD). METHODS: A retrospective review of patients treated with either a DMC or PLAD for dislocation in patients with a Charnley THA was performed. They were identified using electronic patient records (EPR). EPR data and radiographs were evaluated to determine operating time, length of stay, and the incidence of complications and recurrent dislocation postoperatively. RESULTS: A total of 28 patients underwent revision using a DMC for dislocation following Charnley THA between 2013 and 2017. The rate of recurrent dislocation and overall complications were compared with those of a previous series of 54 patients who underwent revision for dislocation using a PLAD, between 2007 and 2013. There was no statistically significant difference in the mean distribution of sex or age between the groups. The mean operating time was 71 mins (45 to 113) for DMCs and 43 mins (21 to 84) for PLADs (p = 0.001). There were no redislocations or revisions in the DMC group at a mean follow-up of 55 months (21 to 76), compared with our previous series of PLAD which had a redislocation rate of 16% (n = 9) and an overall revision rate of 25% (n = 14, p = 0.001) at a mean follow-up of 86 months (45 to 128). CONCLUSION: These results indicate that DMC outperforms PLAD as a treatment for dislocation in patients with a Charnley THA. This should therefore be the preferred form of treatment for these patients despite a slightly longer operating time. Work is currently ongoing to review outcomes of DMC over a longer follow-up period. PLAD should be used with caution in this patient group with preference given to acetabular revision to DMC. Cite this article: Bone Joint J 2020;102-B(4):423-425.


Asunto(s)
Acetábulo/cirugía , Artroplastia de Reemplazo de Cadera/instrumentación , Luxación de la Cadera/cirugía , Prótesis de Cadera , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Cadera/métodos , Registros Electrónicos de Salud , Femenino , Luxación de la Cadera/etiología , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Tempo Operativo , Diseño de Prótesis , Falla de Prótesis/etiología , Reoperación/métodos , Estudios Retrospectivos
8.
Bone Joint J ; 102-B(4): 463-469, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32228083

RESUMEN

AIMS: Prosthetic joint infection (PJI) remains a major clinical challenge. Neutrophil CD64 index, Fc-gamma receptor 1 (FcγR1), plays an important role in mediating inflammation of bacterial infections and therefore could be a valuable biomarker for PJI. The aim of this study is to compare the neutrophil CD64 index in synovial and blood diagnostic ability with the standard clinical tests for discrimination PJI and aseptic implant failure. METHODS: A total of 50 patients undergoing revision hip and knee arthroplasty were enrolled into a prospective study. According to Musculoskeletal Infection Society (MSIS) criteria, 25 patients were classified as infected and 25 as not infected. In all patients, neutrophil CD64 index and percentage of polymorphonuclear neutrophils (PMN%) in synovial fluid, serum CRP, ESR, and serum CD64 index levels were measured preoperatively. Receiver operating characteristic (ROC) curves and the area under the curve (AUC) were analyzed for each biomarker. RESULTS: Serum CD64 index showed no significant difference between the two groups (p = 0.091). Synovial fluid CD64 index and PMN% discriminated good differentiation between groups of PJI and aseptic failure with AUC of 0.946 (95% confidence interval (CI) 0.842 to 0.990) and 0.938 (95% CI 0.832 to 0.987) separately. The optimal threshold value of synovial CD64 index for the diagnosis of PJI was 0.85, with a sensitivity of 92.00%, a specificity of 96.00%, and diagnostic odds ratio (DOR) of 227.11. CONCLUSION: The present study demonstrates that CD64 index in synovial fluid could be a promising laboratory marker for screening PJI. The cut-off values of 0.85 for synovial CD64 index has the potential to distinguish aseptic failure from PJI. Cite this article: Bone Joint J 2020;102-B(4):463-469.


Asunto(s)
Prótesis de Cadera/efectos adversos , Prótesis de la Rodilla/efectos adversos , Neutrófilos/inmunología , Infecciones Relacionadas con Prótesis/diagnóstico , Receptores de IgG/análisis , Líquido Sinovial/inmunología , Artroplastia de Reemplazo de Cadera , Artroplastia de Reemplazo de Rodilla , Biomarcadores/análisis , Sedimentación Sanguínea , Proteína C-Reactiva/análisis , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Osteoartritis de la Cadera/cirugía , Osteoartritis de la Rodilla/cirugía , Estudios Prospectivos , Falla de Prótesis/etiología , Infecciones Relacionadas con Prótesis/etiología , Curva ROC , Reoperación , Sensibilidad y Especificidad
9.
Bone Joint J ; 102-B(2): 170-176, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32009432

RESUMEN

AIMS: We aimed to examine the long-term mechanical survivorship, describe the modes of all-cause failure, and identify risk factors for mechanical failure of all-polyethylene tibial components in endoprosthetic reconstruction. METHODS: This is a retrospective database review of consecutive endoprosthetic reconstructions performed for oncological indications between 1980 and 2019. Patients with all-polyethylene tibial components were isolated and analyzed for revision for mechanical failure. Outcomes included survival of the all-polyethylene tibial component, revision surgery categorized according to the Henderson Failure Mode Classification, and complications and functional outcome, as assessed by the Musculoskeletal Tumor Society (MSTS) score at the final follow-up. RESULTS: A total of 278 patients were identified with 289 all-polyethylene tibial components. Mechanical survival was 98.4%, 91.1%, and 85.2% at five, ten and 15 years, respectively. A total of 15 mechanical failures were identified at the final follow-up. Of the 13 all-polyethylene tibial components used for revision of a previous tibial component, five (38.5%) failed mechanically. Younger patients (< 18 years vs > 18 years; p = 0.005) and those used as revision components (p < 0.001) had significantly increased rates of failure. Multivariate logistic regression modelling showed revision status to be a positive risk factor for failure (odds ratio (OR) 19.498, 95% confidence interval (CI) 4.598 to 82.676) and increasing age was a negative risk factor for failure (OR 0.927, 95% CI 0.872 to 0.987). Age-stratified risk analysis showed that age > 24 years was no longer a statistically significant risk factor for failure. The final mean MSTS score for all patients was 89% (8.5% to 100.0%). CONCLUSION: The long-term mechanical survivorship of all-polyethylene tibial components when used for tumour endoprostheses was excellent. Tumour surgeons should consider using these components for their durability and the secondary benefits of reduced cost and ease of removal and revision. However, caution should be taken when using all-polyethylene tibial components in the revision setting as a significantly higher rate of mechanical failure was seen in this group of patients. Cite this article: Bone Joint J. 2020;102-B(2):170-176.


Asunto(s)
Neoplasias Óseas/cirugía , Fémur/cirugía , Prótesis e Implantes/efectos adversos , Implantación de Prótesis/efectos adversos , Tibia/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Materiales Biocompatibles , Niño , Análisis de Falla de Equipo , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Polietileno , Diseño de Prótesis , Falla de Prótesis/etiología , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Adulto Joven
10.
Acta Orthop ; 91(2): 165-170, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-31928096

RESUMEN

Background and purpose - The increasing use of hip arthroplasties in young patients will inevitably lead to more revision procedures at younger ages, especially as the outcome of their primary procedures is inferior compared with older patients. However, data on the outcome of revision hip arthroplasty in young patients are limited. We determined the failure rates of revised hip prostheses performed in patients under 55 years using Dutch Arthroplasty Register (LROI) data.Patients and methods - All 1,037 revised hip arthroplasty procedures in patients under 55 years at the moment of revision registered in the LROI during the years 2007-2018 were included. Kaplan-Meier survival analyses were used to calculate failure rates of revised hip arthroplasties with endpoint re-revision for any reason. Competing risk analyses were used to determine the probability of re-revision for the endpoints infection, dislocation, acetabular and femoral loosening, while other reasons for revisions and death were considered as competing risks.Results - Mean follow-up of revision procedures was 3.9 years (0.1-12). 214 re-revisions were registered. The most common reason for the index revision was dislocation (20%); the most common reason for re-revision was infection (35%). The 5-year failure rate of revised hip prostheses was 22% (95% CI 19-25), and the 10-year failure rate was 28% (CI 24-33). The 10-year cumulative failure rates of index revisions with endpoint re-revision for infection was 7.8% (CI 6.1-9.7), acetabular loosening 7.0% (CI 4.1-11), dislocation 3.8% (CI 2.6-5.2), and femoral loosening 2.7% (CI 1.6-4.1). The 10-year implant failure rate of index revisions for infection was 45% (CI 37-55) with endpoint re-revision for any reason.Interpretation - Failure rate of revised hip prostheses in patients under 55 years is worrisome, especially regarding index revisions due to infection. This information facilitates realistic expectations for these young patients at the time of primary THA.


Asunto(s)
Artroplastia de Reemplazo de Cadera/efectos adversos , Falla de Prótesis/etiología , Reoperación/métodos , Adolescente , Adulto , Factores de Edad , Artroplastia de Reemplazo de Cadera/métodos , Femenino , Estudios de Seguimiento , Luxación de la Cadera/epidemiología , Luxación de la Cadera/etiología , Luxación de la Cadera/cirugía , Prótesis de Cadera/efectos adversos , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Países Bajos/epidemiología , Fracturas Periprotésicas/epidemiología , Fracturas Periprotésicas/etiología , Fracturas Periprotésicas/cirugía , Infecciones Relacionadas con Prótesis/epidemiología , Infecciones Relacionadas con Prótesis/etiología , Infecciones Relacionadas con Prótesis/cirugía , Sistema de Registros , Reoperación/efectos adversos , Reoperación/estadística & datos numéricos , Resultado del Tratamiento , Adulto Joven
11.
Acta Orthop ; 91(2): 184-190, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-31928097

RESUMEN

Background and purpose - Cemented fixation is regarded as the gold standard in total knee arthroplasty (TKA). Among working-age patients, there has been controversy regarding the optimal fixation method in TKA. To address this issue, we conducted a register-based study to assess the survivorship of cemented, uncemented, hybrid, and inverse hybrid TKAs in patients aged < 65 years.Patients and methods - We used the Nordic Arthroplasty Register Association data of 115,177 unconstrained TKAs performed for patients aged < 65 years with primary knee osteoarthritis over 2000-2016. Kaplan-Meier (KM) survival analysis with 95% confidence intervals (CI) and Cox multiple-regression model with adjustment for age, sex, and nation were used to compare fixation methods in relation to revision for any reason.Results - The 10-year KM survivorship of cemented TKAs was 93.6% (95% CI 93.4-93.8), uncemented 91.2% (CI 90.1-92.2), hybrid 93.0% (Cl 92.2-93.8), and inverse hybrid 96.0% (CI 94.1-98.1). In the Cox model, hybrid TKA showed decreased risk of revision after 6 years' follow-up compared with the reference group (cemented) (hazard ratio [HR] 0.5 [CI 0.4-0.8]), while uncemented TKAs showed increased risk of revision both < 1 year (HR 1.4 [1.1-1.7]) and > 6 years' (HR 1.3 [1.0-1.7]) follow-up compared to the reference.Interpretation - Both cemented and hybrid TKAs had 10-year survival rates exceeding 92->93% in patients aged < 65 years. Cemented TKA, however, was used in the vast majority (89%) of the operations in the current study. As it performs reliably in the hands of many, it still deserves the status of gold standard for TKA in working-age patients.


Asunto(s)
Artroplastia de Reemplazo de Rodilla/métodos , Osteoartritis de la Rodilla/cirugía , Adulto , Factores de Edad , Artroplastia de Reemplazo de Rodilla/efectos adversos , Artroplastia de Reemplazo de Rodilla/estadística & datos numéricos , Cementación , Femenino , Estudios de Seguimiento , Humanos , Estimación de Kaplan-Meier , Prótesis de la Rodilla/efectos adversos , Masculino , Persona de Mediana Edad , Osteoartritis de la Rodilla/epidemiología , Diseño de Prótesis , Falla de Prótesis/etiología , Sistema de Registros , Reoperación/estadística & datos numéricos , Medición de Riesgo/métodos , Factores de Riesgo , Países Escandinavos y Nórdicos/epidemiología , Resultado del Tratamiento
12.
Acta Orthop ; 91(2): 191-196, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-31928101

RESUMEN

Background and purpose - We have previously reported on the prosthetic survival of total ankle replacements (TAR) in Sweden performed between 1993 and 2010. Few other reports have been published on 5- and 10-year survival rates. Furthermore, there is a lack of long-term outcome data on modern prosthetic designs. Therefore, we compared early and current prosthetic designs after a mean 7-year follow-up.Patients and methods - On December 31, 2016, 1,230 primary TARs had been reported to the Swedish Ankle Registry. We analyzed prosthetic survival, using exchange or permanent extraction of components as endpoint for 1,226 protheses with mean follow-up of 7 years (0-24). Differences between current (Hintegra, Mobility, CCI, Rebalance, and TM Ankle) and early prosthetic designs (STAR, BP, and AES) were examined by log rank test.Results - 267/1,226 prostheses (22%) had been revised by December 31, 2016. We found an overall prosthetic survival rate at 5 years of 0.85 (95% CI 0.83-0.87), at 10 years 0.74 (CI 0.70-0.77), at 15 years 0.63 (CI 0.58-0.67), and at 20 years 0.58 (CI 0.52-0.65). For early prosthetic designs the 5- and 10-year survival rates were 0.81 (CI 0.78-0.84) and 0.69 (CI 0.64-0.73) respectively, while the corresponding rates for current designs were 0.88 (CI 0.85-0.91) and 0.84 (CI 0.79-0.88). Current prosthetic designs had better survival (log rank test p < 0.001).Interpretation - Our results point to a positive time trend of prosthetic survival in Sweden; use of current prosthetic designs was associated with better prosthetic survival. Improved designs and instrumentation, more experienced surgeons, and improved patient selection may all have contributed to the better outcome.


Asunto(s)
Artroplastia de Reemplazo de Tobillo/instrumentación , Prótesis Articulares , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Articulación del Tobillo/cirugía , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Diseño de Prótesis , Falla de Prótesis/etiología , Sistema de Registros , Reoperación/estadística & datos numéricos , Suecia , Resultado del Tratamiento , Adulto Joven
13.
Acta Orthop ; 91(2): 177-183, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-31928105

RESUMEN

Background and purpose - Both medial unicompartmental knee arthroplasties (UKA) and high tibial osteotomies (HTO) are reliable treatments for isolated medial knee osteoarthritis. However, both may with time need conversion to a total knee arthroplasty (TKA). We conducted the largest nationwide registry comparison of the survival of TKA following UKA with TKA following HTO.Patients and methods - From the Danish Knee Arthroplasty Registry, aseptic conversions to TKA from UKA and TKA converted from HTO within the period of 1997-2018 were retrieved. The Kaplan-Meier method and the Cox proportional hazards regression were used to estimate the survival and hazard ratio (HR) for revision, considering confounding by indication utilizing propensity-score based inverse probability of treatment weighting (PS-IPTW).Results - PS-IPTW yielded a well-balanced pseudo-cohort (standard mean difference (SMD) < 0.1 for all covariates, except implant supplementation) of 963.8 TKAs following UKA and 1139.1 TKAs following HTO. The survival of TKA following UKA was significantly less than that of TKA following HTO with a 5-year estimated survival of 0.88 (95% confidence interval (CI) 0.85-0.90) and 0.94 (CI 0.93-0.96), respectively. The differences in survival corresponded to an implant-supplementation adjusted HR of 2.7 (CI 2.4-3.1) for TKA following UKA compared with TKA following HTO.Interpretation - Previous UKA more than doubled the revision risk of a subsequent TKA compared with previous HTO. This potential risk should be considered in the shared treatment decision of patients who are candidates for both UKA and HTO.


Asunto(s)
Artroplastia de Reemplazo de Rodilla/métodos , Osteoartritis de la Rodilla/cirugía , Osteotomía/métodos , Falla de Prótesis/etiología , Tibia/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Rodilla/efectos adversos , Estudios de Cohortes , Dinamarca , Femenino , Humanos , Estimación de Kaplan-Meier , Prótesis de la Rodilla , Masculino , Persona de Mediana Edad , Osteotomía/efectos adversos , Puntaje de Propensión , Sistema de Registros , Reoperación/estadística & datos numéricos , Medición de Riesgo/métodos
14.
Acta Orthop ; 91(2): 159-164, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-31928120

RESUMEN

Background and purpose - The uncemented Symax hip stem has shown early proximal ingrowth as result of the BONIT-hydroxyapatite (HA) coating and the distal DOTIZE surface treatment. We evaluated 2-year postoperative radiostereometric analysis (RSA) migration of the Symax hip stem in THA patients. We also investigated the correlation between migration at 4 weeks and clinical outcomes after 2 years.Patients and methods - Patients in a 2-year clinical follow-up single-centre RSA randomized controlled trial were randomized to 2 different cup designs. All 45 patients received a Symax hip stem. RSA migration patterns of the Symax hip stem is presented here as a single cohort. RSA examinations were performed postoperatively, but before weight-bearing, and subsequently after 1, 3, 6, 12, and 24 months. Clinical outcomes and radiographic evaluations were assessed 3, 6, 12, and 24 months postoperatively.Results - During the first 4 weeks, the Symax hip stem subsided, rotated into retroversion, and translated posteriorly, after which the migration ceased and the prosthesis stabilized. All clinical outcomes improved from preoperatively to 2 years. There was no clinically or statistically significant correlation between subsidence and retroversion at 4 weeks and clinical outcomes after 2 years.Interpretation - RSA evaluation of the uncemented Symax hip stem confirms that the design principles and coating properties lead to early stabilization of the stem, as early as 4 weeks postoperatively. There was no correlation between subsidence and retroversion at 4 weeks and clinical outcomes after 2 years. Based on the predictive potential of the RSA technique, we anticipate excellent long-term survival of this hip stem.


Asunto(s)
Artroplastia de Reemplazo de Cadera/métodos , Prótesis de Cadera/efectos adversos , Falla de Prótesis/etiología , Adulto , Anciano , Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Cadera/instrumentación , Cementación , Materiales Biocompatibles Revestidos , Durapatita , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Osteoartritis de la Cadera/cirugía , Complicaciones Posoperatorias/diagnóstico por imagen , Diseño de Prótesis , Radiografía , Análisis Radioestereométrico , Rotación , Resultado del Tratamiento
15.
Acta Orthop ; 91(2): 171-176, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-31960731

RESUMEN

Background and purpose - Compressive osseointegration fixation is an alternative to intramedullary fixation for endoprosthetic reconstruction. Mechanical failure of compressive osseointegration presents differently on radiographs than stemmed implants, therefore we aimed to develop a reliable radiographic method to determine stable integration.Patients and methods - 8 reviewers evaluated 11 radiographic parameters from 29 patients twice, 2 months apart. Interclass correlation coefficients (ICCs) were used to assess test-retest and inter-rater reliability. We constructed a fast and frugal decision tree using radiographic parameters with substantial test-retest agreement, and then tested using radiographs from a new cohort of 49 patients. The model's predictions were compared with clinical outcomes and a confusion matrix was generated.Results - 6 of 8 reviewers had non-significant intra-rater ICCs for ≥ one parameter; all inter-rater ICCs were highly reliable (p < 0.001). Change in length between the top of the spindle sleeve and bottom of the anchor plug (ICC 0.98), bone cortex hypertrophy (ICC 0.86), and bone pin hypertrophy (ICC 0.81) were used to create the decision tree. The sensitivity and specificity of the training cohort were 100% (95% CI 52-100) and 87% (CI 74-94) respectively. The decision tree demonstrated 100% (CI 40-100) sensitivity and 89% (CI 75-96) specificity with the test cohort.Interpretation - A stable spindle length and at least 3 cortices with bone hypertrophy at the implant interface predicts stable osseointegration; failure is predicted in the absence of bone hypertrophy at the implant interface if the pin sites show hypertrophy. Thus, our decision tree can guide clinicians as they follow patients with compressive osseo-integration implants.


Asunto(s)
Interfase Hueso-Implante/diagnóstico por imagen , Árboles de Decisión , Extremidad Inferior/cirugía , Oseointegración , Falla de Prótesis/etiología , Estudios de Cohortes , Fémur/diagnóstico por imagen , Fémur/cirugía , Humanos , Hiperostosis , Extremidad Inferior/diagnóstico por imagen , Variaciones Dependientes del Observador , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/etiología , Pronóstico , Implantación de Prótesis/efectos adversos , Implantación de Prótesis/métodos , Radiografía/métodos , Sensibilidad y Especificidad , Estrés Mecánico
16.
Eur J Ophthalmol ; 30(1): 212-216, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30832506

RESUMEN

A new technique of correcting tube-corneal touch is described in a case of Ahmed glaucoma valve implantation. This technique repositions the intracameral tube without externalization unlike the standard procedures which aim to correct tube-corneal touch. The technique makes use of a transscleral supracapsular anchor suture to facilitate repositioning of the tube within the ciliary sulcus. Feasible only in pseudophakic and aphakic patients, either a preexisting iridectomy or intraoperative iridectomy is an essential prerequisite to perform this procedure. The final positioning of the tube within the sulcus potentially prevents chronic rubbing of the iris by polypropylene suture as opposed to a transcameral suture.


Asunto(s)
Epitelio Posterior/patología , Implantes de Drenaje de Glaucoma , Glaucoma/cirugía , Falla de Prótesis/etiología , Implantación de Prótesis/métodos , Tacto , Afaquia Poscatarata/etiología , Afaquia Poscatarata/cirugía , Preescolar , Glaucoma/etiología , Humanos , Presión Intraocular , Masculino , Reoperación , Colgajos Quirúrgicos , Técnicas de Sutura
17.
J Orthop Res ; 38(2): 417-421, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31529732

RESUMEN

Our aim was to investigate the association of inflammasome polymorphisms NLRP3 rs35829419 (p. Q705K) and CARD8 rs2043211 (p. C10X) with aseptic loosening of total hip endoprostheses. We asked whether patients with the loosening of total hip arthroplasty earlier than 15 years after primary implantation had a higher proportion of the polymorphisms Q705K and C10X in comparison to subjects without loosening. A retrospective case-control study compared 36 patients with total hip endoprosthesis loosening earlier than 15 years after primary implantation and 51 control subjects with unloosened total hip endoprostheses, matched for gender, age, and follow-up period. Buccal mucosa samples were used for genomic DNA analysis and genotyped for NLRP3 rs35829419 and CARD8 rs2043211 using a fluorescence-based competitive allele-specific real-time polymerase chain reaction. The proportion of subjects with both wild-type NLRP3 and CARD8 (i.e., without Q705K or C10X) was considerably higher in the control group when compared with patients with early total hip arthroplasty loosening (49% vs. 28%; p = 0.05). After adjustment for gender, age, and follow-up, patients with combined wild type of both NLRP3 and CARD8 had significantly smaller odds for early implant loosening (odds ratio 0.33, p = 0.02). Investigated polymorphisms may influence several inflammatory pathways and contribute to the loosening of artificial implants with potential clinical significance for the appropriate selection of patients and endoprostheses when planning elective total hip arthroplasty. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:417-421, 2020.


Asunto(s)
Artroplastia de Reemplazo de Cadera , Proteínas Adaptadoras de Señalización CARD/genética , Proteína con Dominio Pirina 3 de la Familia NLR/genética , Proteínas de Neoplasias/genética , Falla de Prótesis/etiología , Anciano , Femenino , Humanos , Inflamasomas/genética , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
18.
Acta Orthop ; 91(2): 133-138, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-31735103

RESUMEN

Background and purpose - Total hip arthroplasty (THA) is increasing as treatment of displaced femoral neck fractures. Several studies compare hemiarthroplasty (HA) with THA, but results vary and few studies report on medical complications. We examined the outcome of THA and HA with a focus on medical complications, hip complications, and death.Patients and methods - Data from the Swedish Hip Arthroplasty Register on 30,953 acute hip fracture patients treated with cemented THA or HA in 2005-2011 were cross-matched with Statistics Sweden for socioeconomic data and with the National Patient Register for diagnostic codes representing medical complications within 180 days or hip complications within the study period. Propensity score matching was used to create comparable groups based on age, sex, income, level of education, marital status, Elixhauser index, and year of surgery. Logistic regression models were created for each outcome.Results - 81% were treated with HA, 73% and 71% were female (HA and THA respectively). Matching resulted in 2 groups of 5,815 patients each. THA was associated with fewer medical complications (OR = 0.83; 95% CI 0.76-0.91) and lower 1-year mortality (OR = 0.42; CI 0.38-0.48), but more hip complications (OR = 1.31; CI 1.20-1.43).Interpretation - THA as treatment of hip fracture was associated with more hip-related complications than HA. The results on mortality and medical complications are, rather, influenced by residual confounding than by the implant design per se. An expansive use of THAs for hip fracture treatment, at the expense of HAs, is not recommended based on our findings if hip complications are to be avoided.


Asunto(s)
Artroplastia de Reemplazo de Cadera/efectos adversos , Fracturas del Cuello Femoral/cirugía , Hemiartroplastia/efectos adversos , Distribución por Edad , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Cadera/métodos , Artroplastia de Reemplazo de Cadera/estadística & datos numéricos , Femenino , Fracturas del Cuello Femoral/epidemiología , Hemiartroplastia/estadística & datos numéricos , Prótesis de Cadera/efectos adversos , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Diseño de Prótesis , Falla de Prótesis/etiología , Sistema de Registros , Factores Socioeconómicos , Suecia/epidemiología
19.
Eur J Ophthalmol ; 30(1): NP11-NP15, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30328376

RESUMEN

PURPOSE: To describe the case and the follow-up of an inadvertently damaged XEN gel implant during needling procedure. METHODS: Case report. RESULTS: A 60-year-old African American patient underwent an uncomplicated combined phacoemulsification with the insertion of a XEN gel implant. Two months postoperatively, a needling procedure was required. During the needling procedure, a fragment of the XEN gel implant was inadvertently damaged. One month postoperatively, the intraocular pressure was still controlled and the bleb was functioning well. CONCLUSION: This case report reveals a previously unreported complication concerning XEN gel implant. It is important for the surgeon to pay attention during needling procedure, especially if there is a subconjunctival hemorrhage impairing the view, to defer the procedure until good visibility exists.


Asunto(s)
Punción Seca/efectos adversos , Implantes de Drenaje de Glaucoma , Glaucoma de Ángulo Abierto/cirugía , Complicaciones Intraoperatorias , Falla de Prótesis/etiología , Angiografía con Fluoresceína , Glaucoma de Ángulo Abierto/diagnóstico por imagen , Glaucoma de Ángulo Abierto/fisiopatología , Gonioscopía , Humanos , Presión Intraocular/fisiología , Masculino , Microscopía Acústica , Persona de Mediana Edad , Facoemulsificación , Stents , Tomografía de Coherencia Óptica , Tonometría Ocular , Resultado del Tratamiento
20.
J Knee Surg ; 33(1): 78-83, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30562833

RESUMEN

The purpose of the present study was to measure the effects of gap balancing and resection techniques on migration of a single total knee replacement implant design. A total of 23 patients (24 knees) were recruited on referral to either a surgeon performing gap balancing or a surgeon performing measured resection and followed prospectively. All patients received a fixed bearing, posterior stabilized total knee replacement implant of a single radius femoral component design with cement fixation, and all aspects of care outside of resection technique were identical. Patients underwent radiostereometric analysis (RSA) at 2 weeks (baseline), 6 weeks, 3 months, 6 months, 1 year, and 2 years. Migration of the tibial and femoral components was compared between groups. Tibial component migration was greater at 2 years in the gap balancing group (mean difference = 0.336 mm, p = 0.036), but there was no difference at 1 year. One measured resection and three gap balancing tibial components demonstrated continuous migration > 0.2 mm between years 1 and 2. There was no difference in femoral component migration. Small differences in tibial component migration were found between the gap balancing and measured resection techniques. However, comparing the migration to established predictive thresholds for long-term loosening risk, implants performed with both techniques were found to have equally low revision risk.


Asunto(s)
Artroplastia de Reemplazo de Rodilla/efectos adversos , Articulación de la Rodilla/cirugía , Prótesis de la Rodilla/efectos adversos , Rodilla/cirugía , Osteoartritis de la Rodilla/cirugía , Falla de Prótesis/etiología , Anciano , Artroplastia de Reemplazo de Rodilla/métodos , Femenino , Fémur/diagnóstico por imagen , Fémur/cirugía , Humanos , Rodilla/diagnóstico por imagen , Articulación de la Rodilla/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Osteoartritis de la Rodilla/diagnóstico por imagen , Análisis Radioestereométrico , Tibia/diagnóstico por imagen , Tibia/cirugía
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