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1.
Medicine (Baltimore) ; 98(47): e18083, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31764842

RESUMO

It remains unclear if computer-assisted surgery (CAS) technique actually improves the clinical outcomes of total knee arthroplasty (TKA) and decreases the failure rate. The purpose of this retrospective study was to compare the functional results of TKA in a series of patients who underwent staged bilateral TKAs with CAS TKA in 1 knee and conventional TKA in the contralateral knee.From January 1997 to December 2010, we collected 60 patients who were randomly assigned to receive CAS TKA in 1 limb and conventional TKA in the other. The Brainlab Vector Vision navigation system was used for CAS TKA, and the DePuy press-fit condylar sigma guide system was used for conventional TKA. Patients were assessed before surgery, 3 months and 1 year after surgery, and annually thereafter. IKS criteria were used for radiographic evaluation. Clinical and functional evaluation using the scoring system of hospital for special surgery (HSS), international knee society (IKS), Western Ontario and McMaster University osteoarthritis index (WOMAC), and short form-36 (SF-36) were obtained on each knee, before surgery, and at each follow-up visit. Pertinent statistical methods were adopted for data analysis.Fifty-six patients were available for analysis and 44 of the patients were female. The mean duration of follow-up was 8.1 years. Less blood loss (P = .007) and longer operation time were noted for CAS TKAs when compared with conventional TKAs. Precise alignment and fewer outliers of the lower limb and prosthetic component positions were found for CAS TKAs (P < .001). There were no differences between the 2 groups before surgery and at the latest follow-up with regard to scores for HSS, IKS, WOMAC, and SF-36 as well as active range of motion.The clinical outcomes of CAS TKAs at the 8-year follow-up were similar to those of conventional TKAs despite the better radiographic alignment and fewer outliers achieved with navigation assistance.


Assuntos
Artroplastia do Joelho/instrumentação , Artroplastia do Joelho/métodos , Cirurgia Assistida por Computador , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
2.
Bone Joint J ; 101-B(11): 1348-1355, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31674253

RESUMO

AIMS: A retrospective study was conducted to measure short-term in vivo linear and volumetric wear of polyethylene (PE) inserts in 101 total knee arthroplasty (TKA) patients using model-based radiostereometric analysis (MBRSA). PATIENTS AND METHODS: Nonweightbearing supine RSA exams were performed postoperatively and at six, 12, and 24 months. Weightbearing standing RSA exams were performed on select patients at 12 and 24 months. Wear was measured both linearly (joint space) and volumetrically (digital model overlap) at each available follow-up. Precision of both methods was assessed by comparing double RSA exams. Patient age, sex, body mass index, and Oxford Knee Scores were analyzed for any association with PE wear. RESULTS: Linear wear occurred at 0.015 mm/year (supine) and 0.220 mm/year (standing). Volumetric wear occurred at 10.3 mm3/year (supine) and 39.3 mm3/year (standing). Wear occurred primarily on the medial side of the joint. Weightbearing imaging greatly improved the reliability of measurement. Clinical precision of volumetric wear was 34 mm3. No significant associations were found between patient demographics or function scores and measured wear. CONCLUSION: In vivo volumetric wear of TKAs can be assessed at short-term follow-up using MBRSA. Cite this article: Bone Joint J 2019;101-B:1348-1355.


Assuntos
Artroplastia do Joelho/normas , Prótese do Joelho/normas , Falha de Prótese , Artroplastia do Joelho/instrumentação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Análise Radioestereométrica , Estudos Retrospectivos , Posição Ortostática , Decúbito Dorsal
3.
Eklem Hastalik Cerrahisi ; 30(3): 233-40, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31650919

RESUMO

OBJECTIVES: This study aims to investigate the long-term clinical outcomes, complications and survival rates of cemented Oxford medial unicompartmental knee arthroplasty (UKA) and to compare the findings with the reported outcomes of UKA and total knee arthroplasty (TKA) in the literature. PATIENTS AND METHODS: In the study, 133 knees of 115 patients (16 males, 99 females; mean age 65.5±8.3 years; range, 50 to 88 years) who underwent Oxford medial UKA between May 2007 and August 2013 were followed-up for an average of 126 months. Prosthetic complications and revisions were evaluated. While Kaplan-Meier method was used to evaluate implant survival, Knee Society, Functional Knee Society and visual analog scale scores were used for determining final functional outcomes. RESULTS: Totally 29 prosthetic complications (21.6% of total patients) were observed and the most common one was insert dislocation observed in 17 knees (12.6%). Revision surgeries were performed for all of these patients. Among the 17 patients who underwent insert replacement surgeries, the inserts were stable in eight during the follow-up while insert dislocation reoccurred in nine. Revision surgeries were performed in a total of 21 patients (15.6%). There were statistically significant improvements in final follow-up functional knee scores of patients without complications compared to preoperative scores. CONCLUSION: According to our findings, while reoperation and early aseptic revision rates of Oxford medial UKA are high compared to the TKA results reported in the literature, functional results are satisfactory for patients with no revision.


Assuntos
Artroplastia do Joelho/instrumentação , Cimentos para Ossos , Prótese do Joelho , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/cirurgia , Medidas de Resultados Relatados pelo Paciente , Complicações Pós-Operatórias , Reoperação , Estudos Retrospectivos , Escala Visual Analógica
4.
Orthopade ; 48(11): 963-968, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31506824

RESUMO

Total knee arthroplasty (TKA) is a frequent operation in Germany and in 2017 a total of 191,272 interventions were carried out. These interventions are associated with high costs and involve complex clinical workflow organization and time-consuming instrument logistics. With this in mind, the aim of this study was to identify the economic potential of the instrument configuration in order to optimize the entire process in TKA. Changing the composition of the set of instruments used in the operating theater for TKA resulted in time and cost saving for the complete TKA procedure, including all personnel and off-shoot procedures. In addition, the operating time saved by the introduction of a patient-specific instrumentation set meant that the operating theater could be used for more or other surgical procedures, also generating additional revenue.


Assuntos
Artroplastia do Joelho/instrumentação , Salas Cirúrgicas/organização & administração , Osteoartrite do Joelho/cirurgia , Instrumentos Cirúrgicos/economia , Artroplastia do Joelho/economia , Artroplastia do Joelho/métodos , Redução de Custos , Custos e Análise de Custo , Eficiência , Alemanha , Custos Hospitalares , Humanos , Salas Cirúrgicas/economia
5.
Knee ; 26(5): 1010-1019, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31402095

RESUMO

BACKGROUND: Determine whether the tibiofemoral motion and electromyographic activity of the knee differs in patients with a medial pivot implant, compared to those with cruciate-retaining and posterior-stabilised designs, during knee extension after Total Knee Arthroplasty (TKA). METHODS: An observational study was conducted on a cohort of patients that had undergone TKA for a minimum of 12 months prior. Three matched groups (n = 18) were categorised based on implant type: medial-pivot (MP), posterior-stabilised (PS) and cruciate-retaining (CR). Kinematics, with motion analysis (Vicon, USA) and surface electromyography (Delsys, USA) were assessed during step-ascent and walking tasks. RESULTS: All groups displayed a similar amount of knee extension in both tasks. They also paradoxically produced an average mean internal rotation movement during knee extension in both the step-ascent and walking tasks. The only significant difference was found in the step-ascent task, in which the MP group produced a larger absolute amount of rotation than the CR implant group (P = 0.007), but neither group differed from the PS implant group. The groups did not differ in rotation during the walking task (P > 0.05). The MP group displayed significantly (P < 0.01) greater knee extensor activation during the step-ascent than the PS group. CONCLUSION: The MP design was only significantly different to another implant design for the step-ascent task. Patients with either knee implant types were not strictly limited to producing the traditional "screw-home" mechanism, defined by external rotation during extension. Furthermore, comparison with the non-implant contralateral limb suggested that rotation is not necessarily dictated by implant design.


Assuntos
Artroplastia do Joelho/instrumentação , Artropatias/cirurgia , Articulação do Joelho/cirurgia , Prótese do Joelho , Idoso , Idoso de 80 Anos ou mais , Artroplastia do Joelho/métodos , Fenômenos Biomecânicos , Feminino , Fêmur/fisiopatologia , Fêmur/cirurgia , Humanos , Articulação do Joelho/fisiopatologia , Masculino , Pessoa de Meia-Idade , Movimento , Desenho de Prótese , Amplitude de Movimento Articular , Rotação , Tíbia/fisiopatologia , Tíbia/cirurgia , Caminhada
6.
BMC Musculoskelet Disord ; 20(1): 374, 2019 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-31416443

RESUMO

BACKGROUND: The number of hip, knee and shoulder arthroplasties continues to rise worldwide. The Organization for Economic Cooperation and Development has launched an initiative (called PaRIS Initiative) for the systematic collection of Patient Reported Outcome Measures (PROMs) in patients undergoing elective hip and knee arthroplasty. The Rizzoli Orthopedic Institute (IOR) was selected as a pilot center for the launch of the Initiative in Italy given that IOR hosts the Registry of Orthopedic Prosthetic Implants (RIPO), a region-wide registry which collects joint implant data from all the hospitals in the Emilia-Romagna Region. In this specific geographic area information related to PROMs after joint replacement is unknown. This paper describes the protocol of a study (PaRIS-IOR) that aims to implement the collection of a set of PROMs within an existing implant registry in Italy. The study will also investigate the temporal trend of PROMs in relation to the type of prosthesis and the type of surgical intervention. METHODS: The PaRIS-IOR study is a prospective, single site, cohort study that consists of the administration of PROMs questionnaires to patients on the list for elective arthroplasty. The questionnaires will be administered to the study population within 30 days before surgery, and then at 6 and 12 months following surgery. The study population will consist of consecutive adult patients undergoing either hip, knee or shoulder arthroplasty. The collected data will be linked with those routinely collected by the RIPO in order to assess the temporal trend of PROMs in relation to the type of prosthesis and the type of surgical intervention. DISCUSSION: The PaRIS-IOR study could have important implications in targeting the factors influencing functional outcomes and quality of life reported by patients after hip, knee and shoulder arthroplasty, and will also represent the first systematic collection of PROMs related to arthroplasty in Italy. TRIAL REGISTRATION: Protocol version (1.0) and trial registration data are available on the platform www.clinicaltrial.gov with the identifier NCT03790267 , first posted on December 31, 2018.


Assuntos
Estudos Observacionais como Assunto , Medidas de Resultados Relatados pelo Paciente , Projetos de Pesquisa , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/instrumentação , Artroplastia de Quadril/estatística & dados numéricos , Artroplastia do Joelho/efeitos adversos , Artroplastia do Joelho/instrumentação , Artroplastia do Joelho/estatística & dados numéricos , Artroplastia do Ombro/efeitos adversos , Artroplastia do Ombro/instrumentação , Artroplastia do Ombro/estatística & dados numéricos , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Procedimentos Cirúrgicos Eletivos/instrumentação , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Feminino , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Estudos Prospectivos , Qualidade de Vida , Sistema de Registros/estatística & dados numéricos , Resultado do Tratamento , Adulto Jovem
7.
Bone Joint J ; 101-B(8): 960-969, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31362543

RESUMO

AIMS: The aim of this study was to give estimates of the incidence of component incompatibility in hip and knee arthroplasty and to test the effect of an online, real-time compatibility check. MATERIALS AND METHODS: Intraoperative barcode registration of arthroplasty implants was introduced in Denmark in 2013. We developed a compatibility database and, from May 2017, real-time compatibility checking was implemented and became part of the registration. We defined four classes of component incompatibility: A-I, A-II, B-I, and B-II, depending on an assessment of the level of risk to the patient (A/B), and on whether incompatibility was knowingly accepted (I/II). RESULTS: A total of 26 524 arthroplasties were analyzed. From 12 307 procedures that were undertaken before implementation of the compatibility check, 21 class A incompatibilities were identified (real- or high-risk combinations; 0.17%; 95% confidence interval (CI) 0.11 to 0.26). From 5692 hip and 6615 knee procedures prior to implementation of the compatibility check, we found rates of class A-I incompatibility (real- or high-risk combinations unknowingly inserted) of 0.14% (95% CI 0.06 to 0.28) and 0.17% (95% CI 0.08 to 0.30), respectively. From 14 217 procedures after the introduction of compatibility checking (7187 hips and 7030 knees), eight class A incompatibilities (0.06%; 95% CI 0.02 to 0.11) were identified. This difference was statistically significant (p = 0.008). CONCLUSION: Our data presents validated estimates of the baseline incidence of incompatibility events for hip and knee arthroplasty procedures and shows that a significant reduction in class A incompatibility events is possible using a web-based recording system. Cite this article: Bone Joint J 2019;101-B:960-969.


Assuntos
Artroplastia de Quadril/instrumentação , Artroplastia do Joelho/instrumentação , Prótese de Quadril/efeitos adversos , Prótese do Joelho/efeitos adversos , Erros Médicos/prevenção & controle , Desenho de Prótese/efeitos adversos , Falha de Prótese/etiologia , Estudos de Coortes , Sistemas de Computação , Dinamarca , Humanos , Erros Médicos/efeitos adversos , Erros Médicos/estatística & dados numéricos , Falha de Prótese/efeitos adversos , Sistema de Registros
8.
Bone Joint J ; 101-B(8): 915-921, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31362550

RESUMO

AIMS: Altered alignment and biomechanics are thought to contribute to the progression of osteoarthritis (OA) in the native compartments after medial unicompartmental knee arthroplasty (UKA). The aim of this study was to evaluate the bone activity and remodelling in the lateral tibiofemoral and patellofemoral compartment after medial mobile-bearing UKA. PATIENTS AND METHODS: In total, 24 patients (nine female, 15 male) with 25 medial Oxford UKAs (13 left, 12 right) were prospectively followed with sequential 99mTc-hydroxymethane diphosphonate single photon emission CT (SPECT)/CT preoperatively and at one and two years postoperatively, along with standard radiographs and clinical outcome scores. The mean patient age was 62 years (40 to 78) and the mean body mass index (BMI) was 29.7 kg/m2 (23.6 to 42.2). Mean osteoblastic activity was evaluated using a tracer localization scheme with volumes of interest (VOIs). Normalized mean tracer values were calculated as the ratio between the mean tracer activity in a VOI and background activity in the femoral diaphysis. RESULTS: Significant reduction of normalized tracer activity was observed one year postoperatively in tibial and femoral VOIs adjacent to the joint line in the lateral compartment. Patellar VOIs and remaining femoral VOIs demonstrated a significant, diminished normalized tracer activity at final follow-up. CONCLUSION: The osteoblastic bone activity in the native compartments decreased significantly after treatment of medial end-stage OA with a UKA, implying reduced stress to the subchondral bone in the retained compartments after a UKA. Cite this article: Bone Joint J 2019;101-B:915-921.


Assuntos
Artroplastia do Joelho/efeitos adversos , Fêmur/metabolismo , Hemiartroplastia/efeitos adversos , Articulação do Joelho/metabolismo , Osteoartrite do Joelho/cirurgia , Osteoblastos/metabolismo , Tíbia/metabolismo , Adulto , Idoso , Artroplastia do Joelho/instrumentação , Artroplastia do Joelho/métodos , Biomarcadores/metabolismo , Remodelação Óssea , Feminino , Fêmur/diagnóstico por imagem , Seguimentos , Hemiartroplastia/instrumentação , Hemiartroplastia/métodos , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Prótese do Joelho , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/fisiopatologia , Estudos Prospectivos , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único , Tíbia/diagnóstico por imagem , Resultado do Tratamento
9.
Bone Joint J ; 101-B(8): 922-928, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31362558

RESUMO

AIMS: There has been a recent resurgence in interest in combined partial knee arthroplasty (PKA) as an alternative to total knee arthroplasty (TKA). The varied terminology used to describe these procedures leads to confusion and ambiguity in communication between surgeons, allied health professionals, and patients. A standardized classification system is required for patient safety, accurate clinical record-keeping, clear communication, correct coding for appropriate remuneration, and joint registry data collection. MATERIALS AND METHODS: An advanced PubMed search was conducted, using medical subject headings (MeSH) to identify terms and abbreviations used to describe knee arthroplasty procedures. The search related to TKA, unicompartmental (UKA), patellofemoral (PFA), and combined PKA procedures. Surveys were conducted of orthopaedic surgeons, trainees, and biomechanical engineers, who were asked which of the descriptive terms and abbreviations identified from the literature search they found most intuitive and appropriate to describe each procedure. The results were used to determine a popular consensus. RESULTS: Survey participants preferred "bi-unicondylar arthroplasty" (Bi-UKA) to describe ipsilateral medial and lateral unicompartmental arthroplasty; "medial bi-compartmental arthroplasty" (BCA-M) to describe ipsilateral medial unicompartmental arthroplasty with patellofemoral arthroplasty; "lateral bi-compartmental arthroplasty" (BCA-L) to describe ipsilateral lateral unicompartmental arthroplasty with patellofemoral arthroplasty; and tri-compartmental arthroplasty (TCA) to describe ipsilateral patellofemoral and medial and lateral unicompartmental arthroplasties. "Combined partial knee arthroplasty" (CPKA) was the favoured umbrella term. CONCLUSION: We recommend bi-unicondylar arthroplasty (Bi-UKA), medial bicompartmental arthroplasty (BCA-M), lateral bicompartmental arthroplasty (BCA-L), and tricompartmental arthroplasty (TCA) as the preferred terms to classify CPKA procedures. Cite this article: Bone Joint J 2019;101-B:922-928.


Assuntos
Artroplastia do Joelho/métodos , Hemiartroplastia/métodos , Osteoartrite do Joelho/cirurgia , Terminologia como Assunto , Artroplastia do Joelho/instrumentação , Artroplastia do Joelho/normas , Bibliometria , Hemiartroplastia/instrumentação , Hemiartroplastia/normas , Humanos , Prótese do Joelho
10.
Bone Joint J ; 101-B(8): 929-940, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31362561

RESUMO

AIMS: Patient-specific instrumentation of total knee arthroplasty (TKA) is a technique permitting the targeting of individual kinematic alignment, but deviation from a neutral mechanical axis may have implications on implant fixation and therefore survivorship. The primary objective of this randomized controlled study was to compare the fixation of tibial components implanted with patient-specific instrumentation targeting kinematic alignment (KA+PSI) versus components placed using computer-assisted surgery targeting neutral mechanical alignment (MA+CAS). Tibial component migration measured by radiostereometric analysis was the primary outcome measure (compared longitudinally between groups and to published acceptable thresholds). Secondary outcome measures were inducible displacement after one year and patient-reported outcome measures (PROMS) over two years. The secondary objective was to assess the relationship between alignment and both tibial component migration and inducible displacement. PATIENTS AND METHODS: A total of 47 patients due to undergo TKA were randomized to KA+PSI (n = 24) or MA+CAS (n = 23). In the KA+PSI group, there were 16 female and eight male patients with a mean age of 64 years (sd 8). In the MA+CAS group, there were 17 female and six male patients with a mean age of 63 years (sd 7). Surgery was performed using cemented, cruciate-retaining Triathlon total knees with patellar resurfacing, and patients were followed up for two years. The effect of alignment on tibial component migration and inducible displacement was analyzed irrespective of study group. RESULTS: There was no difference over two years in longitudinal migration of the tibial component between the KA+PSI and MA+CAS groups (reaching median maximum total point motion migration at two years of 0.40 mm for the KA+PSI group and 0.37 mm for the MA+CAS group, p = 0.82; p = 0.68 adjusted for age, sex, and body mass index (BMI) for all follow-ups). Both groups had mean migrations below acceptable thresholds. There was no difference in inducible displacement (p = 0.34) or PROMS (p = 0.61 for the Oxford Knee Score) between groups. There was no correlation between alignment and tibial component migration or alignment and inducible displacement. These findings support non-neutral alignment as a viable option with this component, with no evidence that it compromises fixation. CONCLUSION: Kinematic alignment using patient-specific instrumentation in TKA was associated with acceptable tibial component migration, indicating stable fixation. These results are supportive of future investigations of kinematic alignment. Cite this article: Bone Joint J 2019;101-B:929-940.


Assuntos
Artroplastia do Joelho/métodos , Prótese do Joelho , Osteoartrite do Joelho/cirurgia , Falha de Prótese/etiologia , Cirurgia Assistida por Computador , Idoso , Artroplastia do Joelho/instrumentação , Fenômenos Biomecânicos , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
11.
Bone Joint J ; 101-B(7_Supple_C): 115-120, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31256657

RESUMO

AIMS: This aim of this study was to assess the feasibility of designing and introducing generic 3D-printed instrumentation for routine use in total knee arthroplasty. MATERIALS AND METHODS: Instruments were designed to take advantage of 3D-printing technology, particularly ensuring that all parts were pre-assembled, to theoretically reduce the time and skill required during surgery. Concerning functionality, ranges of resection angle and distance were restricted within a safe zone, while accommodating either mechanical or anatomical alignment goals. To identify the most suitable biocompatible materials, typical instrument shapes and mating parts, such as dovetails and screws, were designed and produced. RESULTS: Before and after steam sterilization, dimensional analysis showed that acrylonitrile butadiene styrene could not withstand the temperatures without dimensional changes. Oscillating saw tests with slotted cutting blocks produced debris, fractures, or further dimensional changes in the shape of Nylon-12 and polymethylmethacrylate (MED610), but polyetherimide ULTEM 1010 was least affected. CONCLUSION: The study showed that 3D-printed instrumentation was technically feasible and had some advantages. However, other factors, such as whether all procedural steps can be accomplished with a set of 3D-printed instruments, the logistics of delivery, and the economic aspects, require further study. Cite this article: Bone Joint J 2019;101-B(7 Supple C):115-120.


Assuntos
Artroplastia do Joelho/instrumentação , Articulação do Joelho/cirurgia , Prótese do Joelho , Impressão Tridimensional/instrumentação , Estudos de Viabilidade , Humanos , Desenho de Prótese
12.
Bone Joint J ; 101-B(7): 838-847, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31256672

RESUMO

AIMS: Robotic-assisted unicompartmental knee arthroplasty (UKA) promises accurate implant placement with the potential of improved survival and functional outcomes. The aim of this study was to present the current evidence for robotic-assisted UKA and describe the outcome in terms of implant positioning, range of movement (ROM), function and survival, and the types of robot and implants that are currently used. MATERIALS AND METHODS: A search of PubMed and Medline was performed in October 2018 in line with the Preferred Reporting Items for Systematic Review and Meta-Analysis statement. Search terms included "robotic", "knee", and "surgery". The criteria for inclusion was any study describing the use of robotic UKA and reporting implant positioning, ROM, function, and survival for clinical, cadaveric, or dry bone studies. RESULTS: A total of 528 articles were initially identified from the databases and reference lists. Following full text screening, 38 studies that satisfied the inclusion criteria were included. In all, 20 studies reported on implant positioning, 18 on functional outcomes, 16 on survivorship, and six on ROM. The Mako (Stryker, Mahwah, New Jersey) robot was used in 32 studies (84%), the BlueBelt Navio (Blue Belt Technologies, Plymouth, Minnesota) in three (8%), the Sculptor RGA (Stanmore Implants, Borehamwood United Kingdom) in two (5%), and the Acrobot (The Acrobot Co. Ltd., London, United Kingdom) in one study (3%). The most commonly used implant was the Restoris MCK (Stryker). Nine studies (24%) did not report the implant that was used. The pooled survivorship at six years follow-up was 96%. However, when assessing survival according to implant design, survivorship of an inlay (all-polyethylene) tibial implant was 89%, whereas that of an onlay (metal-backed) implant was 97% at six years (odds ratio 3.66, 95% confidence interval 20.7 to 6.46, p < 0.001). CONCLUSION: There is little description of the choice of implant when reporting robotic-assisted UKA, which is essential when assessing survivorship, in the literature. Implant positioning with robotic-assisted UKA is more accurate and more reproducible than that performed manually and may offer better functional outcomes, but whether this translates into improved implant survival in the mid- to longer-term remains to be seen. Cite this article: Bone Joint J 2019;101-B:838-847.


Assuntos
Artroplastia do Joelho/métodos , Hemiartroplastia/métodos , Osteoartrite do Joelho/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Artroplastia do Joelho/instrumentação , Hemiartroplastia/instrumentação , Humanos , Articulação do Joelho/fisiologia , Articulação do Joelho/cirurgia , Prótese do Joelho , Falha de Prótese , Amplitude de Movimento Articular , Resultado do Tratamento
13.
Eklem Hastalik Cerrahisi ; 30(2): 70-8, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31291852

RESUMO

OBJECTIVES: This study aims to determine whether there is a difference in the rate of survival and risk of revision for mobile-bearing (MB) compared with fixed-bearing (FB) total knee replacements (TKRs). PATIENTS AND METHODS: This prospective observational study included 1,571 cemented non-posterior-stabilized TKRs without patellar resurfacing with the subsequent revision surgery in 63 patients (23 males, 40 females; mean age 69.7 years; range, 46.5 to 85.5 years). The group of FB TKRs consisted of 756 non-revised and 31 revised implants. The group of MB TKRs included 752 non-revised and 32 revised knees. We determined the survival rate of TKR with Kaplan-Meier method and the relative risk (RR) of the revision in relation to the type of the insert. The analysis of the RR was divided into subgroups based on the time to revision and the reason for revision. RESULTS: No significant difference was found between FB and MB TKRs regarding the cumulative survival rate and the RR of total revision for any reasons. In the subgroup of early revisions for any reason, 2.22-fold increased risk of revision was found in the MB (p=0.02). The risk of late revisions for any reason in MB was lower than the risk in FB (RR 0.27; p=0.009). Higher risk of revision for instability was found in the subgroup of early revisions in MB (RR 23.8; p=0.03). MB was associated with significantly lower risk of total (RR 0.46; p=0.049) and late revisions for aseptic loosening (RR 0.14; p=0.008). CONCLUSION: No differences were found in the cumulative survival rates between MB and FB TKRs. MB TKRs were associated with a lower risk of revision due to aseptic loosening in comparison with FB TKRs. MB inserts represented a significant risk factor only for early revisions due to instability.


Assuntos
Artroplastia do Joelho/instrumentação , Prótese do Joelho , Desenho de Prótese , Reoperação , Idoso , Idoso de 80 Anos ou mais , Artroplastia do Joelho/métodos , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/cirurgia , Estudos Prospectivos , Fatores de Risco , Taxa de Sobrevida , Fatores de Tempo
14.
Surg Technol Int ; 35: 336-340, 2019 11 10.
Artigo em Inglês | MEDLINE | ID: mdl-31282982

RESUMO

BACKGROUND: Since arthritis of the knee is one of the most common pathologies in industrialized nations, there has been a growing interest in fast-track total knee arthroplasty (TKA). However, while one of the main concerns is the role of a tourniquet, the available data are inconclusive. AIM: This study sought to assess the link between postoperative outcomes and use of a tourniquet in TKA. Our goal was to determine whether it is justified to forego tourniquet use as indicated by the fast-track concept. METHODS: The participants (n = 108) in this retrospective, non-randomized study were assigned into two groups after they satisfied the inclusion criteria: primary gonarthrosis or secondary gonarthrosis without previous arthrotomy. TKA was performed without (Group I, n = 55) or with (Group II, n = 53) a tourniquet. The postoperative outcome was evaluated in terms of postoperative pain, based on a numeric rating scale (NRS) and the need for pain medication, and postoperative function, based on range of motion (ROM) and walking tests. RESULTS: Overall, no significant correlations were observed between tourniquet use and postoperative pain according to the NRS. Group I required less oxycodone, but more non-opioids. There was no significant difference in the improvement in pre- to postoperative ROM with regard to tourniquet use. The final walking distance was significantly longer in Group I. CONCLUSIONS: These results suggest that there is no strongly significant link between the postoperative outcome and the use of a tourniquet. However, further studies will be needed to determine whether a tourniquet may have some other impact on TKA.


Assuntos
Artroplastia do Joelho/métodos , Osteoartrite do Joelho/cirurgia , Torniquetes , Artroplastia do Joelho/efeitos adversos , Artroplastia do Joelho/instrumentação , Protocolos Clínicos , Teste de Esforço , Humanos , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologia , Assistência Perioperatória/normas , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Estudos Retrospectivos , Resultado do Tratamento , Caminhada
15.
Surg Technol Int ; 35: 349-354, 2019 11 10.
Artigo em Inglês | MEDLINE | ID: mdl-31282984

RESUMO

BACKGROUND: Preoperative planning for implant sizes can help ensure proper implants are available as well as improve surgical efficiencies. The purpose of this study is to determine if patient gender and height can accurately predict the femoral size of the Oxford® knee. MATERIALS AND METHODS: 3986 knees (2085 female and 1901 males) that underwent a medial unicondylar knee arthroplasty (UKA) with the Oxford® mobile bearing knee (Zimmer Biomet, Warsaw, Indiana) were reviewed. Patient gender and height were compared to operative reports of the implanted femoral component. The relationship of height and femur size was then compared to create a prediction table for implant size. RESULTS: Females mean height was 64" (range, 48 to 78") and males mean height was 70" (range, 58 to 79"). In male patients, large implants were used in the majority of cases (76.6%). In female patients, small implants were used in the majority of cases (64.3%). Based on the relationship of height and femur size, two groups were created for each gender. In males: ≤66" = medium and ≥67" = large. In females: ≤64" = small and ≥65" = medium. Using these cutoffs, the correct implant would be chosen in 78.7% of cases (82.1% in males and 75.6% in females). Extra-small and extra-large sizes were used at the extremes of height in each gender, but never more commonly than small, medium, or large at any height. CONCLUSION: Patient gender and height can accurately predict femoral size of the Oxford® knee in the majority of cases. Our findings validate the original report of this method.


Assuntos
Artroplastia do Joelho/instrumentação , Fêmur/cirurgia , Articulação do Joelho/cirurgia , Prótese do Joelho , Osteoartrite do Joelho/cirurgia , Pesos e Medidas Corporais , Feminino , Humanos , Masculino , Fatores Sexuais
16.
BMC Musculoskelet Disord ; 20(1): 272, 2019 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-31159792

RESUMO

BACKGROUND: The treatment strategy for evolutive septic arthritis (SA) with coexistent degenerative joint disease is not well established. The purposes of this study were to 1) investigate treatment outcome and potential risk factors of treatment failure in patients with evolutive SA following two-stage procedure, including insertion of an antibiotic-loaded spacer at the first stage and subsequent implantation of a new prosthesis; and 2) determine the performance of serum erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and Interleukin-6 (IL-6) in predicting persisting infection at second-stage procedure. METHODS: We retrospectively reviewed 74 patients with evolutive SA of hips and knees who underwent a two-stage TJA between 2008 and 2015. The treatment success was defined according to the modified Delphi criteria and Kaplan-Meier survivorship curves were constructed to determine treatment success. A Cox regression model was performed to identify risk factors for treatment failure. Receiver operating characteristic (ROC) curves were generated to determine the prognostic value of ESR, CRP, and IL-6 in predicting persistent infection before second-stage prostheses implantation. RESULTS: Overall, the treatment success rate was 93% for hips and 100% for knees after the first-stage surgery. The treatment success rate was 89% for hips and 84% for knees after second-stage prosthesis implantation with a mean follow-up of 4.7 (range, 2.2 to 10.8) years. Older age (Hazard ratio [HR] [per 10-year increase], 1.20; 95% confidential interval [CI], 1.11 to 1.62), higher preoperative CRP level (HR [per 1-mg/dL increase], 1.15; 95% CI, 1.04 to 1.28) and resistant organism (HR, 13.96; 95% CI, 3.29 to 19.20) were associated with an increased risk of treatment failure. All serologic tests presented limited values in predicting persisting infection, with the area under ROC curve of ESR, CRP, IL-6 and combination of the three markers was 57.8, 61.6, 60.3, and 62.1%, respectively. CONCLUSIONS: Two-stage TJA is an adequate management of infection control in patients with evolutive SA. The three potential risk factors (old age, high preoperative CRP, and resistant organism profile) may predict treatment failure following a two-stage procedure for evolutive SA. Additionally, serum ESR, CRP, and IL-6 had no benefit in predicting persisting infection before second-stage prostheses implantation. These findings may be useful when treating patients with evolutive SA.


Assuntos
Antibacterianos/administração & dosagem , Artrite Infecciosa/terapia , Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Adulto , Fatores Etários , Idoso , Artrite Infecciosa/sangue , Artrite Infecciosa/microbiologia , Artroplastia de Quadril/instrumentação , Artroplastia de Quadril/métodos , Artroplastia do Joelho/instrumentação , Artroplastia do Joelho/métodos , Biomarcadores/sangue , Sedimentação Sanguínea , Proteína C-Reativa/análise , Feminino , Seguimentos , Humanos , Interleucina-6/sangue , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/sangue , Osteoartrite do Quadril/microbiologia , Osteoartrite do Quadril/terapia , Osteoartrite do Joelho/sangue , Osteoartrite do Joelho/microbiologia , Osteoartrite do Joelho/terapia , Período Pré-Operatório , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Infecções Estreptocócicas/sangue , Infecções Estreptocócicas/microbiologia , Infecções Estreptocócicas/terapia , Falha de Tratamento
17.
BMC Musculoskelet Disord ; 20(1): 275, 2019 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-31159799

RESUMO

BACKGROUND: Higher tourniquet pressures may be associated with an increased risk of complications. We aimed to determine (1) whether a lower tourniquet pressure [systolic blood pressure (SBP) + 120 mmHg] is as effective as conventional tourniquet pressure (SBP + 150 mmHg) in providing a bloodless surgical field and decreasing blood loss, and (2) whether lowering the tourniquet pressure decreases tourniquet-related complications compared to conventional inflation pressure. METHODS: One hundred and sixty knees in 124 patients undergoing total knee arthroplasty (TKA) were randomly allocated to either conventional (n = 80) or lower inflation pressure group (n = 80). The quality of the initial surgical field and occurrence of intraoperative blood oozing, hemoglobin drop, drained volume and calculated blood loss were assessed as efficacy variables. Safety outcome variables included post-operative pain, tourniquet site skin problems (ecchymosis, bullae, skin necrosis), and other tourniquet-related complications such as nerve palsy, venous thromboembolism, and delayed rehabilitation. RESULTS: A comparable bloodless surgical field was successfully provided in both groups (100% vs. 99%, p = 1.000). One case in the conventional pressure group and two cases in the lower pressure group showed intraoperative blood oozing (p = 1.000), which was successfully controlled after an increase of 30 mmHg in the tourniquet inflation pressure. There was no difference in the hemoglobin drop, drained volume, and calculated blood loss. The two groups did not differ in any safety outcomes such as post-operative pain, thigh complications, and other tourniquet related complications. CONCLUSION: This study demonstrates that a tourniquet inflation pressure of 120 mmHg above the SBP is effective method during TKA. TRIAL REGISTRATION: The trial was with ClinicalTrials.gov ( NCT01993758 ) on November 25, 2013.


Assuntos
Artroplastia do Joelho/métodos , Perda Sanguínea Cirúrgica/prevenção & controle , Osteoartrite do Joelho/cirurgia , Pressão/efeitos adversos , Torniquetes/efeitos adversos , Idoso , Artroplastia do Joelho/efeitos adversos , Artroplastia do Joelho/instrumentação , Pressão Sanguínea , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/epidemiologia , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Projetos Piloto , Estudos Prospectivos , Falha de Tratamento
18.
Expert Rev Med Devices ; 16(7): 555-567, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31154870

RESUMO

INTRODUCTION: Total knee arthroplasty (TKA) is one of the most commonly performed orthopedic procedures. During the past decade, patient-specific instrumentation (PSI) has been commercially introduced in order to simplify and make TKA surgery more effective, precise and efficient than conventional mechanical instrumentation (CI) and computer-assisted surgery (CAS). Nevertheless, there are critical arguments against PSI for routine use. The aim of the current manuscript is to describe advantages and limitations of PSI for primary TKA. AREAS COVERED: By means of a description of the available literature different aspects are discussed (accuracy, clinical and functional outcomes, operative time, blood loss, efficiency and costs). EXPERT OPINION: Most publications do not claim a significant increase in PSI accuracy over CI, but they also do not postulate PSIs accuracy is worse either. Regarding clinical aspects, PSI did not appear to give any advantage over standard techniques although, equally, it did not appear to show any disadvantages. PSI seems to reduce operative time, could reduce perioperative blood loss and provides logistical benefits in the operation room. Further studies will be required to more thoroughly assess all the advantages and disadvantages of this promising technology as an alternative to CI and CAS.


Assuntos
Artroplastia do Joelho/instrumentação , Articulação do Joelho/cirurgia , Artroplastia do Joelho/economia , Custos e Análise de Custo , Humanos , Articulação do Joelho/diagnóstico por imagem , Duração da Cirurgia , Cirurgia Assistida por Computador/economia , Cirurgia Assistida por Computador/instrumentação , Resultado do Tratamento
19.
Knee ; 26(4): 905-913, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31229289

RESUMO

BACKGROUND: Total knee arthroplasty (TKA) using an ultracongruent (UC) insert is widely performed. Lack of the posterior cruciate ligament or post-cam mechanism is a concern in terms of range of motion. The flexion angle of UC TKA had been well investigated; however, natural history and correlation factors of the postoperative extension angle have not been well documented. This study aimed to investigate time-dependent changes in extension after TKA using UC inserts, and to evaluate factors that correlated with the postoperative extension angle. METHODS: This study reviewed 388 gap-balanced UC TKAs (331 patients) without hyperextension at navigation and performed between November 2010 and December 2014. The extension angle (a positive number indicates hyperextension) was measured on full-extension lateral radiographs. The extension angles from five days post-operation to final follow-up were investigated. Factors correlated with the postoperative extension angle were evaluated using multiple regression analysis. RESULTS: Mean follow-up duration was 46.2 months. Until two years, the extension angle gradually increased; mean angles at five days/six months/one year/two years/and final follow-up were: -9.2°/-2.6°/0.6°/1.0°/1.0°, respectively. Female sex (ß = -0.15, P = 0.002) and pre-operative hyperextension (ß = 0.31, P < 0.001) were associated with postoperative hyperextension deformity. CONCLUSIONS: Following UC TKA, knees became gradually more extended until two years post-operation. Sex and pre-operative extension angle were predictive factors for the postoperative extension angle following UC TKA. LEVEL OF EVIDENCE: Level 4, Case series.


Assuntos
Artroplastia do Joelho/instrumentação , Articulação do Joelho/fisiopatologia , Articulação do Joelho/cirurgia , Complicações Pós-Operatórias/fisiopatologia , Amplitude de Movimento Articular/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Prótese do Joelho , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores Sexuais
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