RESUMO
BACKGROUND: For improved outcomes in total knee arthroplasty (TKA) correct implant fitting and positioning are crucial. In order to facilitate a best possible implant fitting and positioning patient-specific systems have been developed. However, whether or not these systems allow for better implant fitting and positioning has yet to be elucidated. For this reason, the aim was to analyse the novel patient-specific cruciate retaining knee replacement system iTotal™ CR G2 that utilizes custom-made implants and instruments for its ability to facilitate accurate implant fitting and positioning including correction of the hip-knee-ankle angle (HKA). METHODS: We assessed radiographic results of 106 patients who were treated with the second generation of a patient-specific cruciate retaining knee arthroplasty using iTotal™ CR G2 (ConforMIS Inc.) for tricompartmental knee osteoarthritis (OA) using custom-made implants and instruments. The implant fit and positioning as well as the correction of the mechanical axis (hip-knee-ankle angle, HKA) and restoration of the joint line were determined using pre- and postoperative radiographic analyses. RESULTS: On average, HKA was corrected from 174.4° ± 4.6° preoperatively to 178.8° ± 2.2° postoperatively and the coronal femoro-tibial angle was adjusted on average 4.4°. The measured preoperative tibial slope was 5.3° ± 2.2° (mean +/- SD) and the average postoperative tibial slope was 4.7° ± 1.1° on lateral views. The joint line was well preserved with an average modified Insall-Salvati index of 1.66 ± 0.16 pre- and 1.67 ± 0.16 postoperatively. The overall accuracy of fit of implant components was decent with a measured medial overhang of more than 1 mm (1.33 mm ± 0.32 mm) in 4 cases only. Further, a lateral overhang of more than 1 mm (1.8 mm ± 0.63) (measured in the anterior-posterior radiographs) was observed in 11 cases, with none of the 106 patients showing femoral notching. CONCLUSION: The patient-specific iTotal™ CR G2 total knee replacement system facilitated a proper fitting and positioning of the implant components. Moreover, a good restoration of the leg axis towards neutral alignment was achieved as planned. Nonetheless, further clinical follow-up studies are necessary to validate our findings and to determine the long-term impact of using this patient- specific system.
Assuntos
Artroplastia do Joelho , Prótese do Joelho , Osteoartrite do Joelho , Artroplastia do Joelho/efeitos adversos , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Perna (Membro) , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/cirurgia , Tíbia/cirurgiaRESUMO
BACKGROUND: While multiple in vitro studies examined mesenchymal stromal cells (MSCs) derived from bone marrow or hyaline cartilage, there is little to no data about the presence of MSCs in the joint capsule or the ligamentum capitis femoris (LCF) of the hip joint. Therefore, this in vitro study examined the presence and differentiation potential of MSCs isolated from the bone marrow, arthritic hyaline cartilage, the LCF and full-thickness samples of the anterior joint capsule of the hip joint. METHODS: MSCs were isolated and multiplied in adherent monolayer cell cultures. Osteogenesis and adipogenesis were induced in monolayer cell cultures for 21 days using a differentiation medium containing specific growth factors, while chondrogenesis in the presence of TGF-ß1 was performed using pellet-culture for 27 days. Control cultures were maintained for comparison over the same duration of time. The differentiation process was analyzed using histological and immunohistochemical stainings as well as semiquantitative RT-PCR for measuring the mean expression levels of tissue-specific genes. RESULTS: This in vitro research showed that the isolated cells from all four donor tissues grew plastic-adherent and showed similar adipogenic and osteogenic differentiation capacity as proven by the histological detection of lipid droplets or deposits of extracellular calcium and collagen type I. After 27 days of chondrogenesis proteoglycans accumulated in the differentiated MSC-pellets from all donor tissues. Immunohistochemical staining revealed vast amounts of collagen type II in all differentiated MSC-pellets, except for those from the LCF. Interestingly, all differentiated MSCs still showed a clear increase in mean expression of adipogenic, osteogenic and chondrogenic marker genes. In addition, the examination of an exemplary selected donor sample revealed that cells from all four donor tissues were clearly positive for the surface markers CD44, CD73, CD90 and CD105 by flow cytometric analysis. CONCLUSIONS: This study proved the presence of MSC-like cells in all four examined donor tissues of the hip joint. No significant differences were observed during osteogenic or adipogenic differentiation depending on the source of MSCs used. Further research is necessary to fully determine the tripotent differentiation potential of cells isolated from the LCF and capsule tissue of the hip joint.
Assuntos
Adipogenia/genética , Células da Medula Óssea/metabolismo , Cartilagem Hialina/patologia , Cápsula Articular/patologia , Células-Tronco Mesenquimais/metabolismo , Osteoartrite do Quadril/patologia , Ligamento da Cabeça do Fêmur/patologia , Adulto , Antígenos CD/metabolismo , Artroplastia de Quadril , Células Cultivadas , Condrogênese/genética , Feminino , Expressão Gênica , Humanos , Pessoa de Meia-Idade , Osteoartrite do Quadril/cirurgia , Osteogênese/genética , Doadores de TecidosRESUMO
PURPOSE: As the correct rotational and sagittal alignment of the tibial tray are of key importance for optimal total knee arthroplasty (TKA) function, the objective of this study was to determine these individual variations in the proximal tibial geometry in terms of posterior tibial slope (PTS) and tibial surface asymmetry by analysing a large dataset of computer tomography (CT) information. METHODS: A retrospective two-part review was performed on 15,807 datasets that were generated during the design phase for a customized TKA implant. First, 15807 CAD (computer-aided-design) models derived from CT data were used to conduct the analysis on the variation of the PTS. Second, the axial cut of each proximal tibia in a consecutively selected subset of 2202 datasets was used to measure the tibial asymmetry. RESULTS: The majority (65.5%) of tibiae had a posterior slope between 5° and 10°, while 26.5% of knees had a slope > 10°. The asymmetry measured as offset between the lateral and medial posterior boundaries was highly variable, with overall an increasing proportion of patients with high asymmetry with increasing tibial ML width. Only 14% of tibiae exhibited symmetric (< 2 mm offset) lateral and medial plateaus, and 22% had an offset > 5 mm. CONCLUSION: This study from an extraordinary large data base reveals that tibial posterior slope and asymmetry of the tibial profile vary largely between patients receiving TKA with increasing tibial asymmetry with ML width. CT scans might help to preoperatively better select the best fitting TKA, otherwise surgeons intraoperatively will often have to deal with compromises regarding fitting, sizing and rotational issues. LEVEL OF EVIDENCE: Retrospective case series, Level IV.
Assuntos
Artroplastia do Joelho , Osteoartrite do Joelho/patologia , Osteoartrite do Joelho/cirurgia , Tíbia/patologia , Desenho Assistido por Computador , Análise de Dados , Feminino , Humanos , Masculino , Osteoartrite do Joelho/diagnóstico por imagem , Estudos Retrospectivos , Tíbia/diagnóstico por imagem , Tíbia/cirurgia , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Previous studies analyzing femoral components of TKAs have demonstrated the limited ability of these components to accommodate size variations seen in the patient population, particularly width and femoral offset. QUESTIONS/PURPOSES: The purpose of this study was to use a large data set of knee CT scans (1) to determine the variations in the distal and posterior femoral geometries and to determine whether there is a correlation between distal condylar offset and posterior femoral offset as a potential parameter for symmetry/asymmetry; and (2) to evaluate what proportion of knees would have a substantial mismatch between the implant's size or shape and the patient's anatomy if a femoral component of a modern standard TKA of symmetric (sTKA) or asymmetric (asTKA) designs were to be used. METHODS: A retrospective study was performed on 24,042 data sets that were generated during the design phase for a customized TKA implant. This data set was drawn from European and US-American patients. Measurements recorded for the femur included the overall AP and mediolateral (ML) widths, widths of the lateral condyle and the medial condyle, the distal condylar offset (DCO) between the lateral and medial condyles in the superoinferior direction, and the posterior femoral offset (PFO) as the difference between the medial and lateral posterior condylar offset (PCO) measured in the AP direction. A consecutively collected subset of 2367 data sets was further evaluated to determine the difference between the individual AP and ML dimensions of the femur with that of modern TKA designs using two commercially available implants from different vendors. RESULTS: We observed a high degree of variability in AP and ML widths as well as in DCO and PFO. Also, we found no correlation between DCO and PCO of the knees studied. Instances of a patient having a small DCO and higher PCO were commonly seen. Analysis of the DFOs revealed that overall, 62% (14,906 of 24,042) of knees exhibited DCO > 1 mm and 83% (19,955 of 24,042) of femurs exhibited a > 2-mm difference between the lateral and medial PCO. Concerning AP and ML measurements, 23% (544 of 2367) and 25% (592 of 2367) would have a mismatch between the patient's bony anatomy and the dimensions of the femoral component of ± 3 mm if they would have undergone a modern standard sTKA or asTKA design, respectively. CONCLUSIONS: Analysis of a large number of CT scans of the knee showed that a high degree of variability exists in AP and ML widths as well as in DCO and PFO. CLINICAL RELEVANCE: These findings suggest that it is possible that a greater degree of customization could result in surgeons performing fewer soft tissue releases and medial resections than now are being done to fit a fixed-geometry implant into a highly variable patient population. However, as an imaging study, it cannot support one approach to TKA over another; comparative studies that assess patient-reported outcomes and survivorship will be needed to help surgeons decide among sTKA, asTKA, and customized TKA.
Assuntos
Artroplastia do Joelho , Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Tomografia Computadorizada por Raios X , Artroplastia do Joelho/efeitos adversos , Artroplastia do Joelho/instrumentação , Tomada de Decisão Clínica , Humanos , Prótese do Joelho , Valor Preditivo dos Testes , Desenho de Prótese , Estudos Retrospectivos , Resultado do TratamentoRESUMO
The effect of doubling the immersion fluid (eluate) volume on antibiotic concentrations and on mechanical stability from vancomycin and gentamicin loaded bone cements was investigated in vitro. Antibiotic loaded bone cements containing premixed 1.34% gentamicin antibiotic concentration in the cement powder (wt), premixed 1.19% gentamicin wt and 4.76% vancomycin wt and premixed 1.17% wt gentamicin additionally manually blended with 4.68% wt vancomycin were tested. Six specimens per group were immersed in 4 ml and 8 ml for 6 weeks while the eluate was exchanged every 24 h. The antibiotic concentrations were repeatedly measured. Then the specimens were tested for compressive strength. Doubling the eluate volume significantly decreased gentamicin and vancomycin concentrations from 6 h and 24 h on, except for the gentamicin concentration of the additionally manually blended formulation after 3 weeks. The additionally manually blended vancomycin formulation produced significantly higher gentamicin concentrations in 8 ml compared to the other formulations. The reduction ratios of the vancomycin concentrations were significantly smaller than the reduction ratios of the gentamicin concentrations for the manually blended vancomycin formulation. Vancomycin containing formulations showed significantly lower compressive strengths than the vancomycin free formulation after immersion. Doubling the eluate volume lead to significant compressive strength reduction of the vancomycin containing formulations. Eluate volume change influences antibiotic elution dependent on the antibiotic combination and loading technique. The reducing effect is higher on vancomycin than on gentamicin elution. Compressive strength of gentamicin/vancomycin loaded bone cements after immersion is eluate volume dependent.
Assuntos
Antibacterianos/farmacocinética , Cimentos Ósseos , Força Compressiva/fisiologia , Gentamicinas/farmacocinética , Vancomicina/farmacocinética , Antibacterianos/administração & dosagem , Cimentos Ósseos/química , Cimentos Ósseos/farmacocinética , Implantes de Medicamento , Liberação Controlada de Fármacos , Gentamicinas/administração & dosagem , Humanos , Imersão , Teste de Materiais , Polimetil Metacrilato/química , Polimetil Metacrilato/farmacocinética , Implantação de Prótese/efeitos adversos , Infecções Relacionadas à Prótese/prevenção & controle , Estresse Mecânico , Vancomicina/administração & dosagemRESUMO
There is an ongoing debate about whether to resect or preserve the subacromial bursa during surgical treatment of rotator cuff tears. Neer was the first to systematically describe bursitis as a component of subacromial impingement syndrome that may extend to rotator cuff disease, often discussed as a point of controversy with Uhthoff who first identified the bursa as a contributor to rotator cuff healing, both experimentally and clinically. Because the subacromial bursa provides the gliding mechanism of the shoulder and regenerates itself after surgical removal, interest evolved on the role of the bursa in the healing of rotator cuff tears for evolution of regenerative therapies as a support of arthroscopic repair techniques. In vitro work could identify human subacromial bursa as a source of mesenchymal stem cells, which revealed lineage-specific differentiation capacity, including the tendon and a marker profile that was highly similar to, although in some aspects distinct from, marrow-derived mesenchymal stem cells. Only recently, this knowledge was used in controlled experimental work in vivo to demonstrate superior engraftment of bursal cells within tendon tissue. These findings shed new light on the biology of the subacromial space and provides novel prospects for the clinical use of local stem cells in rotator cuff repair.
Assuntos
Lesões do Manguito Rotador , Síndrome de Colisão do Ombro , Bolsa Sinovial , Humanos , Manguito Rotador , OmbroRESUMO
BACKGROUND: To prevent bone loss in hip arthroplasty, several short stem systems have been developed, including the Mayo conservative hip system. While there is a plethora of data confirming inherent advantages of these systems, only little is known about potential complications, especially when surgeons start to use these systems. METHODS: In this study, we present a retrospective analysis of the patients' outcome, complications and the complication management of the first 41 Mayo conservative hips performed in 37 patients. For this reason, functional scores, radiographic analyses, peri- and postoperative complications were assessed at an average follow-up of 35 months. RESULTS: The overall HHS improved from 61.2 pre-operatively to 85.6 post-operatively. The German Extra Short Musculoskeletal Function Assessment Questionnaire (XSFMA-D) improved from 30.3 pre-operatively to 12.2 post-operatively. The most common complication was an intraoperative non-displaced fracture of the proximal femur observed in 5 cases (12.1%). Diabetes, higher BMI and older ages were shown to be risk factors for these intra-operative periprosthetic fractures (p < 0.01). Radiographic analysis revealed a good offset reconstruction in all cases. CONCLUSION: In our series, a high complication rate with 12.1% of non-displaced proximal femoral fractures was observed using the Mayo conservative hip. This may be attributed to the flat learning curve of the system or the inherent patient characteristics of the presented cohort.
Assuntos
Artroplastia de Quadril/efeitos adversos , Fraturas do Fêmur/cirurgia , Prótese de Quadril/efeitos adversos , Complicações Intraoperatórias/epidemiologia , Fraturas Periprotéticas/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Centros Médicos Acadêmicos/estatística & dados numéricos , Fatores Etários , Idoso , Artroplastia de Quadril/instrumentação , Índice de Massa Corporal , Feminino , Fraturas do Fêmur/diagnóstico por imagem , Seguimentos , Alemanha/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Fraturas Periprotéticas/diagnóstico por imagem , Radiografia , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Universidades/estatística & dados numéricosRESUMO
Antibiotic loaded bone cements are used as drug delivery systems for the treatment of periprosthetic joint infections. They can be loaded with antibiotics during industrial component production (premixing) and during cement preparation (manually blending). Although double premixed antibiotic loaded bone cements are available, manually blending of a gentamicin premixed antibiotic loaded bone cement with vancomycin is still popular. We compared in vitro antibiotic elution and compressive strength of 0.5 g gentamicin premixed bone cement (PALACOS® R + G), 0.5 g gentamicin premixed bone cement (PALACOS® R + G) manually blended with 2.0 g vancomycin, 0.5 g gentamicin and 2.0 g vancomycin premixed bone cement (COPAL® G + V), 1 g gentamicin and clindamycin premixed bone cement (COPAL® G + C) and bone cement without an antibiotic (PALACOS® R) as control. Antibiotic concentration measurements were performed for 6 weeks and then compression strength was tested. Concentrations of gentamicin showed no significant differences between PALACOS® R + G, PALACOS® R + G with vancomycin and COPAL G® + V. After 48 h COPAL G® + C produced significantly higher gentamicin concentrations than the other formulations. After 12 h PALACOS® R + G with vancomycin produced significantly higher vancomycin concentrations, but had the lowest compression strength. We found no influence of vancomycin addition on gentamicin elution, irrespectively of the loading method. However, the manually vancomycin blended ALBC produced higher vancomycin concentrations. Compression strength after aging is reduced by loading with vancomycin.
Assuntos
Cimentos Ósseos/química , Implantes de Medicamento/administração & dosagem , Gentamicinas/administração & dosagem , Gentamicinas/química , Vancomicina/administração & dosagem , Vancomicina/química , Absorção Fisico-Química , Antibacterianos/administração & dosagem , Antibacterianos/química , Cimentos Ósseos/uso terapêutico , Força Compressiva , Difusão , Combinação de Medicamentos , Implantes de Medicamento/síntese química , DurezaRESUMO
BACKGROUND: Calcification of the medial collateral ligament (MCL) of the knee is a very rare disease. We report on a case of a patient with a calcifying lesion within the MCL and simultaneous calcifying tendinitis of the rotator cuff in both shoulders. CASE PRESENTATION: Calcification of the MCL was diagnosed both via x-ray and magnetic resonance imaging (MRI) and was successfully treated surgically. Calcifying tendinitis of the rotator cuff was successfully treated applying conservative methods. CONCLUSION: This is the first case report of a patient suffering from both a calcifying lesion within the medial collateral ligament and calcifying tendinitis of the rotator cuff in both shoulders. Clinical symptoms, radio-morphological characteristics and macroscopic features were very similar and therefore it can be postulated that the underlying pathophysiology is the same in both diseases. Our experience suggests that magnetic resonance imaging and x-ray are invaluable tools for the diagnosis of this inflammatory calcifying disease of the ligament, and that surgical repair provides a good outcome if conservative treatment fails. It seems that calcification of the MCL is more likely to require surgery than calcifying tendinitis of the rotator cuff. However, the exact reason for this remains unclear to date.
Assuntos
Calcinose/diagnóstico por imagem , Ligamento Colateral Médio do Joelho/patologia , Doenças Raras/diagnóstico por imagem , Manguito Rotador/patologia , Tendinopatia/diagnóstico por imagem , Analgésicos/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Artroscopia , Calcinose/complicações , Calcinose/terapia , Terapia por Estimulação Elétrica , Tratamento por Ondas de Choque Extracorpóreas , Feminino , Humanos , Articulação do Joelho/cirurgia , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Dor/etiologia , Manejo da Dor/métodos , Radiografia , Doenças Raras/complicações , Lesões do Manguito Rotador/cirurgia , Ombro/cirurgia , Tendinopatia/complicações , Tendinopatia/terapia , Resultado do TratamentoRESUMO
BACKGROUND: The key for successful delivery in minimally-invasive hip replacement lies in the exact knowledge about the surgical anatomy. The minimally-invasive direct anterior approach to the hip joint makes it necessary to clearly identify the tensor fasciae latae muscle in order to enter the Hueter interval without damaging the lateral femoral cutaneous nerve. However, due to the inherently restricted overview in minimally-invasive surgery, this can be difficult even for experienced surgeons. METHODS AND SURGICAL TECHNIQUE: In this technical note, we demonstrate for the first time how to use the tensor fasciae latae perforator as anatomical landmark to reliably identify the tensor fasciae latae muscle in orthopaedic surgery. Such perforators are used for flaps in plastic surgery as they are constant and can be found at the lateral third of the tensor fasciae latae muscle in a direct line from the anterior superior iliac spine. CONCLUSION: As demonstrated in this article, a simple knowledge transfer between surgical disciplines can minimize the complication rate associated with minimally-invasive hip replacement.
Assuntos
Pontos de Referência Anatômicos , Artroplastia de Quadril , Nervo Femoral/anatomia & histologia , Articulação do Quadril/anatomia & histologia , Articulação do Quadril/cirurgia , Músculo Esquelético/anatomia & histologia , Músculo Esquelético/cirurgia , Artroplastia de Quadril/efeitos adversos , Cadáver , Dissecação , Feminino , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/prevenção & controle , Resultado do TratamentoRESUMO
PURPOSE: Two-stage revision hip arthroplasty using an antibiotic-loaded spacer is the most widely performed procedure for infected hip arthroplasties. The clinical outcome of this type of surgery compared with aseptic joint revision with exchange of femoral and acetabular components is still controversial due to the relative lack of medium- to long-term follow-up. Therefore, we analysed clinical and radiological outcomes of septic two-stage revisions compared with aseptic hip revision surgeries. METHODS: In this retrospective study we assessed 82 consecutive patients who underwent two-stage revision for septic total hip (45 patients) or one-stage aseptic revision arthroplasty (37 patients). The average follow-up was 53 months for the aseptic group and 55 months for the septic group. For clinical evaluation, we used the Harris Hip Score (HHS) and the Merle d'Aubigné and Postel score. The postoperative pain level was determined with the visual analogue pain scale. RESULTS: The surgeries were performed 124 months (aseptic group) and 119 months (septic group) after primary total hip arthroplasty on average. The main indications for aseptic revision surgeries were aseptic loosening (96%), dislocation (2.2%), and periprosthetic fracture (2.2%). In the clinical outcome patients achieved 75.5 points in the aseptic group and 73.4 points in the septic group in the Harris Hip Score. The Merle d'Aubigné and Postel Score revealed 12.5 points for the aseptic group and 13.1 points for the septic group. Mean level of persisting pain was 0.8 (aseptic group) and 0.4 (septic group) on the visual analogue scale (VAS). Overall survival in the aseptic group was 85.6% at 9.8 years 82.7% at 10.1 years for the septic group, with a repeat revision rate of 8.1% and 6.7%, respectively. CONCLUSIONS: Performing aseptic acetabular and femoral revision hip arthroplasty showed equal clinical outcomes in relation to septic two-stage revision hip surgeries. Our results showed a tendency for better outcome in comparison with the information given in the literature for septic and nonseptic exchange arthroplasties, including a lower rate of re-revisions.
Assuntos
Artroplastia de Quadril/métodos , Complicações Pós-Operatórias , Infecções Relacionadas à Prótese/cirurgia , Reoperação/métodos , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/efeitos adversos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Falha de Prótese , Estudos Retrospectivos , Resultado do TratamentoRESUMO
This article describes the concept and surgical technique of patient-specific total knee arthroplasty. Patient-specific implants and instruments are designed and fabricated based on computed tomography (CT) data of the leg. The disposable patient-specific drill guides and cutting-jigs are manufactured taking into consideration the anatomical and biomechanical axes of the knee joint and mediating the efficient pre-navigation of the osseous saw-cuts, without the need for additional navigation or balancing aids. The surgical plan is made on the basis of the CT data. The implantation technique comprises the following steps: distal femoral resection, tibial resection, balancing and femur preparation, tibia preparation, optional patellar resurfacing, trialling of the test components, and implantation of the final components. By using this patient-specific implant system, which includes not only personalized, single-use instruments, but also individualized implants, the surgeon is able to provide endoprosthetic treatment that broadly restores the patient's own knee anatomy and knee kinematics. Preliminary studies have proven the concept and data on this technology are promising so far; however, like a new implant, they are usually limited. In particular, comparative long-term clinical data are still to come.
Assuntos
Artroplastia do Joelho/instrumentação , Prótese do Joelho , Osteoartrite do Quadril/cirurgia , Ajuste de Prótese/instrumentação , Cirurgia Assistida por Computador/instrumentação , Cirurgia Assistida por Computador/métodos , Artroplastia do Joelho/métodos , Análise de Falha de Equipamento , Humanos , Imageamento Tridimensional/instrumentação , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Osteoartrite do Quadril/diagnóstico por imagem , Seleção de Pacientes , Medicina de Precisão/instrumentação , Medicina de Precisão/métodos , Impressão Tridimensional/instrumentação , Desenho de Prótese , Ajuste de Prótese/métodos , Resultado do TratamentoRESUMO
PURPOSE: Revision hip arthroplasty using a modular head-neck adapter gives the possibility of keeping a well-fixed femoral component while revising the acetabular prosthesis or femoral head and adapt leg length and femoral offset to the individual anatomy intraoperatively. The success of this kind of surgery is still unclear due to the lack of medium- to long-term follow-up. Therefore, we analyzed the clinical and radiological outcome of the modular Merete BioBall© adapter system in revision hip surgery. METHODS: In this retrospective study, we included 95 consecutive patients with a Merete BioBall© adapter system implanted during revision hip arthroplasty. The average follow-up was 52.5 months. For clinical evaluation, we used the Harris Hip Score. The health-related quality of life was determined with the visual analog pain scale. RESULTS: The surgeries were performed 97 months after prior hip arthroplasty on average. The main indications for the Merete BioBall© adapter system were dislocation, acetabular loosening, and wear. In the clinical outcome, patients achieved 80.9 points in the Harris Hip Score. The mean level of persisting pain was 1.4 (VAS). The overall survival of the Merete BioBall© system in revision hip arthroplasty revealed 92.8 % survival at 8.17 years follow-up with a repeat revision rate of 5.2 %. CONCLUSIONS: Performing revision hip arthroplasty using the Merete BioBall
Assuntos
Artroplastia de Quadril/instrumentação , Cabeça do Fêmur/cirurgia , Prótese de Quadril , Osteoartrite do Quadril/cirurgia , Qualidade de Vida , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Reoperação , Estudos RetrospectivosRESUMO
BACKGROUND: Gene transfer technologies have the potential to fundamentally improve current therapies for arthritic conditions, although this is essentially dependent on safe and efficient vector systems. The foamy virus (FV)-based vectors have many safety features that favour their use in the treatment of arthritis. In the present study, we investigated the use of safe prototype foamy viral vectors (FVV) for indirect gene delivery to articular tissues. METHODS: We generated recombinant FVV encoding enhanced green fluorescent protein (EGFP) or human interleukin 1 receptor antagonist protein (IL1RA) cDNA under the control of the spleen focus forming virus U3 promoter and explored their transgene expression profile following ex vivo gene delivery to knee joints of Wistar and athymic nude rats. RESULTS: FVV efficiently transduced primary rat synovial fibroblasts using the EGFP and the IL1RA transgene in vitro. FVV-mediated IL1RA expression was functional in blocking IL1 effects in vitro. After the transplantation of FVV transduced synovial fibroblasts, the intra-articular transgene expression in Wistar rats was initially high and declined after approximately 3 weeks for both transgenes. By contrast, FVV-mediated expression of EGFP and IL1RA persisted for at least 12 weeks at high levels in immunocompromised nude rats. FVV-meditated gene delivery was well tolerated by all animals without extra-articular transgene expression, arguing for the safety of this approach. CONCLUSIONS: Our results indicate that FVV are capable of efficient ex vivo gene transfer to synovium and merit further investigation as a means to provide long-term intra-articular transgene expression for arthritis treatment.
Assuntos
Spumavirus/genética , Membrana Sinovial/citologia , Animais , Células Cultivadas , Fibroblastos/metabolismo , Expressão Gênica , Vetores Genéticos , Proteínas de Fluorescência Verde/genética , Humanos , Proteína Antagonista do Receptor de Interleucina 1/biossíntese , Proteína Antagonista do Receptor de Interleucina 1/genética , Articulação do Joelho/citologia , Articulação do Joelho/metabolismo , Masculino , Ratos Nus , Ratos Wistar , Transdução GenéticaRESUMO
BACKGROUND: Genetic treatments of chronic arthritic conditions are essentially dependent on safe and efficient vector systems. To combine features of the efficient transduction of adenovirus vectors with the advantage of stable integration into the host cell genome of apathogenic prototype foamy virus vectors, hybrid vectors (FAD) have been established. In the present study, we have generated and investigated the use of safe FAD vectors for direct gene delivery to joints. METHODS: We generated recombinant FAD encoding enhanced green fluorescent protein (EGFP) or human interleukin 1 receptor antagonist protein (IL1RA) cDNA, and explored their transgene expression profile, as well as the bioactivity of the IL1RA transgene in vitro. The feasibility of IL1RA gene delivery to articular tissues was investigated in a pilot study employing direct FAD injections to the knee joints of Wistar rats. RESULTS: FAD vectors efficiently transduced human or rat fibroblasts with EGFP or IL1RA transgene in vitro. Levels of IL1RA transgene expression were high, stable and functional in vitro. Transduced synovial fibroblasts and high levels of IL1RA protein (10-35 ng/ml) could be detected in vivo in the synovium of Wistar rats 3-5 days after injection of FAD vectors to the knee joints. CONCLUSIONS: Our results indicate that FAD vectors are capable of efficient in vivo gene transfer to synovium and merit further investigation as a means of providing efficient and long-term intra-articular transgene expression for treatment of the arthritides.
Assuntos
Adenoviridae/genética , Artrite/terapia , Técnicas de Transferência de Genes , Terapia Genética/métodos , Vetores Genéticos/uso terapêutico , Spumavirus/genética , Membrana Sinovial/metabolismo , Animais , Western Blotting , Linhagem Celular , Primers do DNA/genética , Eletroforese em Gel de Poliacrilamida , Vetores Genéticos/genética , Proteínas de Fluorescência Verde/genética , Proteínas de Fluorescência Verde/metabolismo , Humanos , Proteína Antagonista do Receptor de Interleucina 1/genética , Proteína Antagonista do Receptor de Interleucina 1/metabolismo , Projetos Piloto , Ratos , Ratos Wistar , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Transgenes/genéticaRESUMO
PURPOSE: Hypertrophic cartilage is an important characteristic of osteoarthritis and can often be found in patients suffering from osteoarthritis. Although the exact pathomechanism remains poorly understood, hypertrophic de-differentiation of chondrocytes also poses a major challenge in the cell-based repair of hyaline cartilage using mesenchymal stromal cells (MSCs). While different members of the transforming growth factor beta (TGF-ß) family have been shown to promote chondrogenesis in MSCs, the transition into a hypertrophic phenotype remains a problem. To further examine this topic we compared the effects of the transcription growth and differentiation factor 5 (GDF-5) and the mutant R57A on in vitro chondrogenesis in MSCs. METHODS: Bone marrow-derived MSCs (BMSCs) were placed in pellet culture and in-cubated in chondrogenic differentiation medium containing R57A, GDF-5 and TGF-ß1 for 21 days. Chondrogenesis was examined histologically, immunohistochemically, through biochemical assays and by RT-qPCR regarding the expression of chondrogenic marker genes. RESULTS: Treatment of BMSCs with R57A led to a dose dependent induction of chondrogenesis in BMSCs. Biochemical assays also showed an elevated glycosaminoglycan (GAG) content and expression of chondrogenic marker genes in corresponding pellets. While treatment with R57A led to superior chondrogenic differentiation compared to treatment with the GDF-5 wild type and similar levels compared to incubation with TGF-ß1, levels of chondrogenic hypertrophy were lower after induction with R57A and the GDF-5 wild type. CONCLUSIONS: R57A is a stronger inducer of chondrogenesis in BMSCs than the GDF-5 wild type while leading to lower levels of chondrogenic hypertrophy in comparison with TGF-ß1.
RESUMO
PURPOSE: The development of minimal-incision techniques for total hip replacement with preservation of soft tissue is generally associated with faster rehabilitation, reduction of postoperative pain and increased patient comfort. The aim of this study was to compare a minimal-incision anterior approach with a transgluteal lateral technique for hip replacement surgery with respect to postoperative pain, consumption of rescue medication, length of hospital stay and time to reach a defined range of motion. METHODS: In this retrospective cohort study we investigated 100 patients with a minimal-incision anterior approach (group I) and 100 patients with a transgluteal lateral approach (group II) retrospectively undergoing unilateral hip replacement. The study variables were pain at rest and during physiotherapy, amount of rescue medication, the time to reach a defined flexion and time in hospital. RESULTS: The patients of group I consumed less rescue medication (19.6 ± 6.9 mg vs. 23.6 ± 11.3 mg; p = 0.005) and experienced less pain on the day of surgery (1.3 ± 1 vs. 2.3 ± 1.3, p = 0.0001) and the first postoperative day (0.41 ± 0.8 vs. 0.66 ± 1.1, p = 0.036). The time to reach the defined range of motion (6.4 ± 2 days vs. 7.4 ± 2.1 days; p = 0.001) and the length of hospital stay were shorter (10.2 ± 1.9 days vs. 13.4 ± 1.6 days; p = 0.0001) for group I. However, pain during physiotherapy was higher on the third and sixth through ninth days after surgery in comparison to group II (p = 0.001-0.013). CONCLUSION: The implantation of a hip prosthesis through a minimal-incision anterior approach is successful in reducing postoperative pain and consumption of pain medication. Time to recovery and length of hospital stay are also influenced positively. Pain increases during physiotherapy, and may be mitigated by adopting limited weight bearing during the early postoperative period.
Assuntos
Artroplastia de Quadril/reabilitação , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Dor Pós-Operatória/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Analgésicos/uso terapêutico , Artrografia , Artroplastia de Quadril/métodos , Feminino , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/fisiopatologia , Articulação do Quadril/cirurgia , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Osteoartrite do Quadril/patologia , Osteoartrite do Quadril/fisiopatologia , Osteoartrite do Quadril/cirurgia , Medição da Dor , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/fisiopatologia , Modalidades de Fisioterapia , Cuidados Pós-Operatórios , Amplitude de Movimento Articular , Estudos Retrospectivos , Fatores de TempoRESUMO
This literature review discusses the use of antibiotic loaded polymethylmethacrylate bone cements in arthroplasty. The clinically relevant differences that have to be considered when antibiotic loaded bone cements (ALBC) are used either for long-term implant fixation or as spacers for the treatment of periprosthetic joint infections are outlined. In this context, in vitro findings for antibiotic elution and material properties are summarized and transferred to clinical use.
RESUMO
PURPOSE: To treat patients with tricompartimental knee osteoarthritis (OA), a customized cruciate-retaining total knee arthroplasty (CCR-TKA) system can be used, including both individualized instrumentation and implants. The objective of this monocentric cohort study was to analyze patient-reported and functional outcomes in a series of patients implanted with the second generation of this customized implant. METHODS: At our arthroplasty center, we prospectively recruited a cohort of patients with tricompartmental gonarthrosis to be treated with total knee replacement (TKA) using a customized cruciate-retaining (CCR) implant design. Inclusion criteria for patients comprised the presence of intact posterior cruciate and collateral ligaments and a knee deformity that was restricted to <15° varus, valgus, or flexion contracture. Patients were assessed for their range of motion (ROM), Knee Society Score (KSS), Western Ontario and McMaster University osteoarthritis index (WOMAC), and short form (SF)-12 physical and mental scores, preoperatively, at 3 and 6 months, as well as at 1, 2, 3, and 5 years of follow-up (FU) postoperatively. RESULTS: The average age of the patient population was 64 years (range: 40-81), the average BMI was 31 (range: 23-42), and in total, 28 female and 45 male patients were included. Implant survivorship was 97.5% (one septic loosening) at an average follow-up of 2.5 years. The KSS knee and function scores improved significantly (p < 0.001) from, respectively, 41 and 53 at the pre-operative visit, to 92 and 86, respectively, at the 5-year post-operative time point. The SF-12 Physical and Mental scores significantly (p < 0.001) improved from the pre-operative values of 28 and 50, to 50 and 53 at the 5-year FU, respectively. Patients experienced significant improvements in their overall knee range of motion, from 106° at the preoperative visit to 122°, on average, 5 years postoperatively. The total WOMAC score significantly (p < 0.001) improved from 49.1 preoperatively to 11.4 postoperatively at 5-year FU. CONCLUSIONS: Although there was no comparison to other implants within this study, patients reported high overall satisfaction and improvement in functional outcomes within the first year from surgery, which continued over the following years. These mid-term results are excellent compared with those reported in the current literature. Comparative long-term studies with this device are needed. Level of evidence 3b (individual case-control study).
RESUMO
OBJECTIVE: Treatment of tricompartimental osteoarthritis (OA) using customized instruments and implants for cruciate-retaining total knee arthroplasty. Use of patient-specific instruments and implants (ConforMIS iTotalTM CR G2) together with a 3D-planning protocol (iView®). Retropatellar resurfacing is optional. INDICATIONS: Symptomatic tricompartmental OA of the knee (Kellgren-Lawrence stage IV) with preserved posterior cruciate ligament (PCL) after unsuccessful conservative or joint-preserving surgical treatment. CONTRAINDICATIONS: Knee ligament instabilities of the posterior cruciate or collateral ligaments. Infection. Relative contraindication: knee deformities >15° (varus, valgus, flexion); prior partial knee replacement. SURGICAL TECHNIQUE: Midline or parapatellar medial skin incision, medial arthrotomy; distal femoral resection with patient-specific cutting block; tibial resection using either a cutting jig for the anatomic slope or a fixed 5° slope. Balancing the knee in extension and flexion gap using patient-specific spacer. The final tibial preparation achieved with gap-balanced placement of the femoral cutting jigs. Kinematic testing using anatomic trial components. Final implant components are cemented in extension. Wound layers are sutured. Drainage is optional. POSTOPERATIVE MANAGEMENT: Sterile wound dressing; compressive bandage. No limitation of the active and passive range of motion. Optional partial weight bearing during the first 2 weeks, then transition to full weight bearing. Follow-up directly after surgery, at 12 and 52 weeks, then every 1-2 years. RESULTS: Overall 60 patients with tricompartmental knee OA and preserved PCL were treated. Mean age was 66 (range 45-76) years. Minimum follow-up was 12 months. There was 1 septic revision after a low-grade infection, 1 reoperation to replace the patellar due to patellar osteoarthritis and 3 manipulations under anesthesia (MUAs) to increase range of motion. Radiographic analyses demonstrated an ideal implant fit with less than 2 mm subsidence or overhang. The WOMAC score improved from 154.8 points preoperatively to 83.5 points at 1 year and 59.3 points at 2 years postoperatively. The EuroQol-5D Score also improved from 11.1 points preoperatively to 7.7 points at 1 year postoperatively.