Failed Arthroplasty Research Articles

Feasibility of acoustic arthrometry in arthroplasty

A registers shows an annual increase in the volume of primary arthroplasties, and the number of revision surgeries is increasing respectively. In the long-term results, the number of revisions due to aseptic loosening or failure of the implant (fracture, cracking) is the overwhelming majority. The relevance for early detection of loosening endoprostheses components has become one of the priority research areas in orthopedics. Recently, the interest to the medical community in a diagnostic method based on acoustic or vibration arthrometry has been growing again. The method of acoustic arthrometry (AA), being non-invasive, portable and safe, is more informative under certain conditions in recognizing and displaying the destruction of the implant or the bone-implant system in more detail, contributing to the early diagnosis of implant failures. Aim of this study is to review a state of the art and role of diagnostic acoustic arthrometry (AA) in the hip arthroplasty. Thirty-one technologies have been proposed and despite efforts, none of them has been included in the number of generally accepted medical studies, as all of them have significant limitations, such as: dependence on the density of soft tissues surrounding the endoprosthesis, unresolved issue of the location of sensors. Moreover, most of them have not been tested in vivo, which would show their real potential for further integration into the medical system. Nevertheless, most experimental studies have demonstrated positive results in the diagnosis of loosening, cement mantle failure and component breakage in hip arthroplasty. To overcome these limitations, further studies both in vitro and in vivo, recruitment of a defined cohort of subjects and formation of a database are needed.

Therapeutic Potential of Targeting Ferroptosis in Periprosthetic Osteolysis Induced by Ultra-High-Molecular-Weight Polyethylene Wear Debris

Background/Objectives: Periprosthetic osteolysis is the primary cause of arthroplasty failure in the majority of patients. Mechanistically, wear debris released from the articulating surfaces of a prosthesis initiates local inflammation and several modes of regulated cell death programs, such as ferroptosis, which represents a promising therapeutic target in various chronic inflammatory diseases. Thus, the current study aimed at exploring the therapeutic potential of targeting ferroptosis in a polyethylene-wear-debris-induced osteolysis model. Methods: Inverted cell culture model was used for stimulating the cells with wear debris in vitro, and calvarial osteolysis model was used for evaluating the therapeutic effects of inhibitors in vivo. Results: The immunostaining of periprosthetic bone tissues demonstrated a number of osteocytes expressing ferroptosis markers. Likewise, the expressions of ferroptosis markers were confirmed in polyethylene-wear-debris-stimulated osteocyte-like cells and primary osteoblasts in a direct stimulation model but not in an indirect stimulation model. Furthermore, polyethylene wear debris was implanted onto calvarial bone and mice were treated with the ferroptosis inhibitors DFO and Fer-1. These treatments alleviated the inflammatory and pathological bone resorption induced by the wear debris implantation. Conclusions: Our data broaden the knowledge of the pathogenesis of periprosthetic osteolysis and highlight ferroptosis as a promising therapeutic target.

The Etiology of Total Knee Arthroplasty Failure Influences on Improvement in Knee Function: A Follow-Up Study.

Background: Outcomes following total knee arthroplasty (TKA) revisions are variable, and it is hypothesized that the underlying cause of primary TKA failure impacts postoperative outcomes. This study analyzes the results of TKA revisions seven years after surgery, in relation to the etiology of primary failure and other influencing factors. A previous study conducted in 2013 examined the same cohort of patients three months after revision surgery. Methods: From the original study, 97 patients were followed up, and 49 patients were eligible for inclusion. Patients were classified into four groups: "periprosthetic infection" (PPI), "aseptic loosening," "instability," and "arthrofibrosis." Outcomes were analyzed using established scores (the Knee Society Score (KSS), New Knee Society Score (nKSS), and the Western Ontario and McMaster Universities (WOMAC) index) and considering factors such as age, gender, BMI, and ASA classification. The outcomes were analyzed using three time intervals: "Outcome Short" (preoperative to 3 months postoperative); "Outcome Long" (preoperative to 7 years postoperative); and "Delta PostOP" (3 months postoperative to 7 years postoperative). Results: Significant improvements were observed in all time intervals, especially in the "Outcome Short" (p < 0.001) and "Delta PostOP" (p < 0.001) periods. The "instability" and "aseptic loosening" groups showed better outcomes in terms of range of motion and knee scores than the "arthrofibrosis" and "infection" groups (p < 0.05). A lower BMI and an ASA status of II were associated with better outcomes (p < 0.05). Women also showed superior results in the nKSS (p < 0.05). Discussion: Patients with "aseptic loosening" and "instability" had the best long-term outcomes. Lower BMI and better ASA status also correlated with improved results. These findings can inform patients of the potential outcomes of revision surgery, thereby facilitating informed decision-making.

Templated Synthesis of Hollow RuO2 Nanospheres for Alleviating Metal Wear Particle-Induced Osteoclast Activation and Bone Loss.

Wear particulate debris-induced osteoclast over-activation is a major causative factor in periprosthetic osteolysis and aseptic loosening, resulting in the non-infectious failure of total joint arthroplasty. To mitigate such pathological bone loss, various therapeutic targets have been identified. Oxidative stress is one of the main contributing factors in the promotion of osteoclastogenesis. Herein, using a template-assisted approach, hollow ruthenium oxide (RuO2) nanospheres are synthesized as an effective antioxidant for the treatment of CoCrMo alloy particles-induced osteolysis. Hollow RuO2 significantly suppressed receptor activator of nuclear factor kappa-B ligand (RANKL)-induced osteoclastogenesis, bone resorption, and the expression of specific markers (including NFATc1, c-Fos, MMP9, CTSK, and DC-STAMP) of bone marrow-derived macrophages via inhibition of the nuclear factor kappa-B (NF-κB) and tumor necrosis factor (TNF)-α pathways. In mouse calvaria, hollow RuO2 nanozymes demonstrate an appreciable attenuation in osteoclast differentiation, bone loss, and soft tissue malformations induced by CoCrMo alloy particles. This study envisions that the antioxidant nanozymes may be further applied as a therapeutic entity in the prevention and treatment of other inflammatory and oxidative stress-related ailments.

A SPECIALIZED SYSTEM FOR IN VITRO TEST OF ANATOMIC GLENOIDS BASED ON ASTM F2028-14

Glenoid loosening, primarily induced by the “rocking horse” phenomenon from humeral head load on the glenoid rim, is the foremost complication and cause of failure in anatomic total shoulder arthroplasty. The dynamic load exerted by universal fatigue testing machines significantly deviates from the standard ASTM F2028-14 in the rocking test. To accurately conduct the in vitro loosening test on anatomic glenoids, a specialized system and customized test methods are developed to achieve anatomic glenoid rocking and subluxation tests. The horizontal and vertical loading can be achieved synchronously or asynchronously by two self-developed high-performance electromagnetic linear motors. In addition, the subluxation tests on anatomic glenoids are verified by finite element simulation. The results show that the subluxation load and translation of anatomic glenoids in the subluxation tests are consistent with those in numerical simulations. The error of the applied axial force in the rocking tests is only 5[Formula: see text]N, strictly meeting the standard of ASTM F2028-14. During the rocking tests, the system runs smoothly and the software works well, indicating the feasibility of the in vitro shoulder joint test system. This study provides an approach to accurate dynamic evaluation of glenoid loosening or disassociation.

Outcomes following revision of a failed primary reverse shoulder arthroplasty.

Reverse shoulder arthroplasty (RSA) has become the most common type of shoulder arthroplasty used in the UK, and a better understanding of the outcomes after revision of a failed RSA is needed. The aim of this study was to review the current evidence systematically to determine patient-reported outcome measures and the rates of re-revision and complications for patients undergoing revision of a RSA. MEDLINE, Embase, CENTRAL, and the Cochrane Database of Systematic Reviews were searched. Studies involving adult patients who underwent revision of a primary RSA for any indication were included. Those who underwent a RSA for failure of a total shoulder arthroplasty or hemiarthroplasty were excluded. Pre- and postoperative shoulder scores were evaluated in a random effects meta-analysis to determine the mean difference. The rates of re-revision and complications were also calculated. The initial search elicited 3,166 results and, following removal of duplicates and screening, 13 studies with a total of 1,042 RSAs were identified. An increase in shoulder scores pre- to postoperatively was reported in all the studies. Following revision of a RSA to a further RSA, there was a significant increase in the American Shoulder and Elbow Surgeons Score (mean difference 20.78 (95% CI 8.16 to 33.40); p = 0.001). A re-revision rate at final follow-up ranging from 9% to 32%, a one-year re-revision rate of 14%, and a five-year re-revision rate of 23% were reported. The complication rate in all the studies was between 18.5% and 36%, with a total incidence of 29%. This is the largest systematic review of the outcomes following revision of a RSA. We found an improvement in functional outcomes after revision surgery, but the rates of re-revision and complications are high and warrant consideration when planning a revision procedure.

Difference in daily tasks execution and elbow joint load: a comparison between patients after total elbow arthroplasty and healthy controls

BackgroundOverloading of the elbow joint is one of the mechanisms responsible for failure of total elbow arthroplasty (TEA). Different activities of daily living (ADL) affect joint loading. However, the alteration in task execution and its impact on joint loads after TEA are not well understood. This study investigates differences between TEA patients and healthy controls in task execution and associated joint loads during simulated ADL. MethodTEA patients (n=7) and healthy controls (n=18) performed eight simulated ADL tasks. Using musculoskeletal modelling software (OpenSim) joint angles and moments were calculated, and joint power was assessed. A mixed model statistical design was performed to determine group and tasks differences. ResultsTEA patients showed reduced flexion-extension (FE) range of motion (60.6° ± 25.6 vs. 44.9° ± 19.9, p = 0.003). Interaction effects between groups and tasks for joint load and peak power were observed. Particularly during rising from a chair, patients showed reduced FE moment (5.7 Nm vs. 14.5 Nm, p = 0.026), varus-valgus (VV) moment (6.0 Nm vs. 14.3 Nm, p = 0.036), and peak power (3.6 Watt vs. 20.1 Watt, p = 0.036) compared to healthy controls. ConclusionTEA patients differ from healthy controls in task execution of ADL-tasks regarding the functional elbow FE angle over all eight ADL tasks and in joint load and peak power for the more straining tasks. The power-plots visualizes differences in movement strategy that are of interest for future research on possible training of TEA patients, or prosthesis design, aimed to improve ADL function and enhance prosthesis survival rates.

Clinical and radiological results of reverse total shoulder arthroplasty with or without lateralization as revision procedure for failed arthroplasty

BackgroundAs reverse total shoulder arthroplasty (rTSA) becomes a common treatment option in the revision setting, common problems associated with Grammont’s design such as scapular notching, instability, and rotator cuff weakening occur. Design changes associated with superior outcomes in primary rTSA, such as glenoid or humeral lateralization have not yet been examined in the revision settings. The purpose of this consecutive series of revision rTSA is to evaluate the clinical and radiological short-term results after aseptic and septic revision rTSA and explore potential benefits of metallic glenoid and humerus lateralization. MethodsIn this study, patients treated with a rTSA between 2014 and 2020 after failed shoulder arthroplasty were included. Fifty-nine consecutive patients were divided into comparative groups using lateralized rTSA with metallic baseplate augmentation (latrTSA) and additional humeral lateralization using a 145° onlay curved stem (bi-latrTSA); or no baseplate offset with a Grammont-type 155° stem (non-latrTSA). Further, outcome of post-infection revision rTSAs was compared to aseptic loosening. Constant-Murley-Score (CS), Subjective-Shoulder-Value (SSV), shoulder range of motion (ROM) including Apley’s scratch test, abduction strength and pain levels were assessed. Radiographs were reviewed for implant loosening, scapular notching, fractures and osteolysis. Lateralization (LSA) and Distalization Shoulder Angle (DSA) were measured at final follow-up. ResultsThirty-eight patients showed significant improvement in all functional measurements at final two-year follow-up compared to baseline (p<0.01). There were no significant differences in favor of glenoid or bipolar lateralization. However, no scapular notching was seen in patients with both humeral and glenoid lateraliazion (non-latrTSA: 33%; latrTSA: 8%; bi-latrTSA: 0%; p=0.103), with no signs of implant loosening. Patients with bi-latrTSA showed significantly greater LSA (p=0.017); DSA was lower, but not significantly (p=0.230). Post-infectious rTSA (n=17; 45%) presented better internal rotation (p=0.036). The overall complication rate was 16% and 8% leading to revision. ConclusionRTSA is a viable option for revision cases and presents good results after failed shoulder arthroplasty, including the infected shoulder. The effect of metallic augmentation on clinical results is not comparable to those in literature in primary rTSA setting due to advanced preoperative medialization. However, scapular notching was prevented in all cases with bipolar lateralization.

Linear and Volumetric Polyethylene Wear Patterns after Primary Cruciate-Retaining Total Knee Arthroplasty Failure: An Analysis Using Optical Scanning and Computer-Aided Design Models.

(1) Background: Analyses of retrieved inserts allow for a better understanding of TKA failure mechanisms and the detection of factors that cause increased wear. The purpose of this implant retrieval study was to identify whether insert volumetric wear significantly differs among groups of common causes of total knee arthroplasty failure, whether there is a characteristic wear distribution pattern for a common cause of failure, and whether nominal insert size and component size ratio (femur-to-insert) influence linear and volumetric wear rates. (2) Methods: We digitally reconstructed 59 retrieved single-model cruciate-retaining inserts and computed their articular load-bearing surface wear utilizing an optical scanner and computer-aided design models as references. After comprehensively reviewing all cases, each was categorized into one or more of the following groups: prosthetic joint infection, osteolysis, clinical loosening of the component, joint malalignment or component malposition, instability, and other isolated causes. The associations between volumetric wear and causes of failure were estimated using a multiple linear regression model adjusted for time in situ. Insert linear penetration wear maps from the respective groups of failure were further processed and merged to create a single average binary image, highlighting a potential wear distribution pattern. The differences in wear rates according to nominal insert size (small vs. medium vs. large) and component size ratio (≤1 vs. >1) were tested using the Kruskal-Wallis test and the Mann-Whitney test, respectively. (3) Results: Patients with identified osteolysis alone and those also with clinical loosening of the component had significantly higher volumetric wear when compared to those without both causes (p = 0.016 and p = 0.009, respectively). All other causes were not significantly associated with volumetric wear. The instability group differentiated from the others with a combined peripheral antero-posterior wear distribution. Linear and volumetric wear rates showed no significant differences when compared by nominal insert size (small vs. medium vs. large, p = 0.563 and p = 0.747, respectively) or by component (femoral-to-insert) size ratio (≤1 vs. >1, p = 0.885 and p = 0.055, respectively). (4) Conclusions: The study found increased volumetric wear in cases of osteolysis alone, with greater wear when combined with clinical loosening compared to other groups. The instability group demonstrated a characteristic peripheral anterior and posterior wear pattern. Insert size and component size ratio seem not to influence wear rates.

Does the Sequence of Same-Patient Total Ankle and Total Knee Impact Arthroplasty Failure Rates?

Category: Ankle Arthritis; Ankle Introduction/Purpose: Over the past decade, the incidence of total ankle arthroplasty (TAA) has markedly risen – particularly in relation to the incidence of total knee arthroplasty (TKA). Relatedly, individual patients have increasingly opted to undergo both procedures. Previous studies have elucidated differences in ankle biomechanics and symptomatology after TKA, however, there is a dearth of evidence in the existing literature suggesting whether sequencing of TAA or TKA may impact arthroplasty failure rate. This study examines how variable sequences of same-patient TAA and TKA impact arthroplasty failure rates. We hypothesized that rates of TAA and TKA failure would be higher in patients undergoing both procedures, and that the sequence of procedures would impact arthroplasty failure rates. Methods: The TriNetX Global Collaborative Network was queried for patients undergoing TAA only, TKA only, TAA followed by TKA, and TKA followed by TAA. All database queries were constructed using corresponding CPT and ICD codes in the TriNetX Query Builder interface. Rates of failure were compared between cohorts as defined by the following parameters: (1) TKA failures – revision TKA only; (2) TAA failures – revision TAA and/or ankle arthrodesis and fusion. Rates of failure were compared using chi-squared statistical testing. Cohort balancing was performed using propensity score matching according to age, race, and sex. Results: Non-sequenced comparison between those undergoing TAA and TKA, and those undergoing TKA only showed a significant increase in TKA failure in both unmatched (2.66% vs. 1.53%, p&lt;.01) and matched (2.66% vs. 1.47%, p = .05) cohorts. Non-sequenced comparison showed no significant difference in TAA failure in both unmatched (2.93% vs. 2.67%, p=.60) and matched (2.93% vs. 3.02%, p=.89) cohorts. Sequenced comparison using unmatched cohorts showed a significant increase in TKA failure among patients who had TAA, then TKA, (2.81% vs. 1.57%, p=.032), but not among patients who underwent TKA then TAA (1.61% vs. 1.57%, p=.53). (Table 1). Using matched cohorts, there was no significant difference in TKA or TAA failure, irrespective of sequencing, however, balancing reduced cohort sizes below a database-defined floor of 10. Conclusion: We observed a higher rate of TKA failure in patients who also had TAA – specifically those who underwent TAA before TKA. Indications for TAA may alter knee biomechanics, predisposing subsequent TKA to failure. Previous studies have suggested identification of ankle center during TKA may be complicated by TAA. Gait disturbances found post-TAA may play a role. Some knee complaints may result from referred pain or mechanical disturbances at the ankle. Procedure laterality was not included in this study due to database constraints, thus, we suspect the effect of more biomechanically-consequential ipsilateral procedures may be larger than demonstrated here. ≤10 represents a database limitation whereby values between 1-10 all are represented as 10 p-values represent comparison against baseline values; significant &lt;.05 Ø - neither TKA nor TAA Abstract Details Continued

Leveraging transfer learning for predicting total knee arthroplasty failure from post-operative radiographs.

The incidence of both primary and revision total knee arthroplasty (TKA) is expected to rise, making early recognition of TKA failure crucial to prevent extensive revision surgeries. This study aims to develop a deep learning (DL) model to predict TKA failure using radiographic images. Two patient cohorts who underwent primary TKA were retrospectively collected: one was used for the model development and the other for the external validation. Each cohort encompassed failed and non-failed subjects, according to the need for TKA revision surgery. Moreover, for each patient, one anteroposterior and one lateral radiographic view obtained during routine TKA follow-up, were considered. A transfer learning fine-tuning approach was employed. After pre-processing, the images were analyzed using a convolutional neuronal network (CNN) that was originally developed for predicting hip prosthesis failure and was based on the Densenet169 pre-trained on Imagenet. The model was tested on 20% of the images of the first cohort and externally validated on the images of the second cohort. Metrics, such as accuracy, sensitivity, specificity and area under the receiving operating characteristic curve (AUC), were calculated for the final assessment. The trained model correctly classified 108 out of 127 images in the test set, providing a classification accuracy of 0.85, sensitivity of 0.80, specificity of 0.89 and AUC of 0.86. Moreover, the model correctly classified 1547 out of 1937 in the external validation set, providing a balanced accuracy of 0.79, sensitivity of 0.80, specificity of 0.78 and AUC of 0.86. The present DL model predicts TKA failure with moderate accuracy, regardless of the cause of revision surgery. Additionally, the effectiveness of the transfer learning fine-tuning approach, leveraging a previously developed DL model for hip prosthesis failure, has been successfully demonstrated. Level III, diagnostic study.

Aseptic failure of total hip arthroplasty as an early complication requiring revision surgery: a comprehensive literature review

Background: The undertaking of hip joint endoprosthesis surgery carries the inherent risk of complications. During the perioperative and early postoperative phases, septic complications take precedence, notably those associated with infection. Conversely, aseptic complications encompass issues unrelated to infection. Accurate risk stratification for complications following hip prosthesis implantation should be grounded in research adhering to the principles of Evidence-Based Medicine.Aim of the study: This paper aimed to present a critical literature review Material and methods: The literature review was conducted using international medical databases such as PubMed, Scopus, and PEDro. The review was based on criteria that included clinical studies and full-text publications published in English. The search period covered the last decade, spanning from 2014 to 2024.Results: The review highlights aseptic loosening and dislocation as the predominant causes of early THA failures. Addressing these complications requires a multifaceted approach, including patient education, meticulous surgical techniques, and robust postoperative rehabilitation programs. Future research should focus on improving implant materials and techniques to further reduce the incidence of aseptic failures. Dislocation and loosening of the hip joint prosthesis are direct reasons for qualifying the patient for revision surgery and reconstruction of the damaged prosthesis components. Individual biomechanical characteristics of the patient, genetic predispositions, obesity, or improper positioning of the prosthesis in relation to the limb axis are also potential risk factors for dislocation.Conclusions: Aseptic complications remain a significant challenge in THA. By understanding the causes and implementing effective preventative strategies, the incidence of early failures can be reduced, improving patient outcomes and prosthesis longevity. The gradual introduction of a well-planned and individualized rehabilitation program, along with the patient's adherence to treatment recommendations, is crucial for minimizing the risk of mechanical damage.

Exploring Revision Total Ankle Arthroplasty Failures A Comparison Between Failed and Successful Revision Cases

This study assesses the comorbidities that are associated with failed revision total ankle arthroplasty (TAA) and explores the outcomes following a failed revision TAA. A retrospective analysis was conducted on a cohort of patients who underwent a revision TAA at a single institution from 2008 to 2022. Patients were identified as having revision failure if they required explantation, below-knee amputation (BKA), or a revision of either metal component. Statistical analysis was performed to identify any significant differences and summarize outcomes. The study included a total of 87 patients who underwent revision TAA with 12 patients who subsequently experienced revision failure. The revision TAA failure rate was 13.8%. There were higher rates of former smokers (58.3%; n = 7) and a history of diabetes (33.3%; n = 4) in the failure cohort, although these differences did not reach statistical significance. Limb salvage procedures were achieved in 11 cases (91.7%). Approaches for failed revision TAAs included arthrodesis (n = 5) with 2 isolated ankle arthrodesis (AA) and 3 tibio-talo-calcaneal (TTC) arthrodesis, an additional revision arthroplasty (n = 6), or amputation (n = 1). Ankle arthroplasty retention was successful in 6 cases (50.0%). Our results demonstrate that a second revision approach was chosen in half of the cases, underscoring its viability as a successful intervention according to patient preferences. Level of Evidence: III

Effect of pH and hydroxyapatite-like layer formation on the antibacterial properties of borophosphate bioactive glass incorporated poly(methyl methacrylate) bone cement.

Infection is a leading cause of total joint arthroplasty failure. Current preventative measures incorporate antibiotics into the poly (methyl methacrylate) (PMMA) bone cement that anchors the implant into the natural bone. With bacterial resistance to antibiotics on the rise, the development of alternative antibacterial materials is crucial to mitigate infection. Borate bioactive glass, 13-93-B3, has been studied previously for use in orthopedic applications due to its ability to be incorporated into bone cements and other scaffolds, convert into hydroxyapatite (HA)-like layer, and enhance the osseointegration and antibacterial properties of the material. The purpose of this study is to better understand how glass composition and change in surrounding pH effects the composite's antibacterial characteristics by comparing the incorporation of 30% wt/wt 13-93-B3 glass and pH neutral borophosphate bioactive glass into PMMA bone cement. We also aim to elucidate how HA-like layer formation on the cement's surface may affect bacterial adhesion. These studies showed that 13-93-B3 incorporated cements had significant reduction of bacterial growth surrounding the composite beyond 24h of exposure when compared to a neutral borate bioactive glass incorporated cement (p < 0.01) and cement only (p < 0.0001). Additionally, through soaking cement composites in simulated body fluid and then exposing them to a bioluminescent strand of staphylococcus aureus, we found that the presence of a HA-like layer on the 13-93-B3 or pH neutral glass incorporated cement disks resulted in an increase in bacterial attachment on the composite cement's surface, where p < 0.001, and p < 0.05 respectively. Overall, our studies demonstrated that borate bioactive glass incorporated PMMA bone cement has innate antimicrobial properties that make it a promising material to prevent infection in total joint arthroplasties.

Nonoperative management of glenoid baseplate failure in reverse shoulder arthroplasty

BackgroundGlenoid baseplate failure in reverse total shoulder arthroplasty (RSA) remains a challenging problem. Nonoperative management may be an option in certain patients. The purpose of this study was to evaluate outcomes following nonoperative management of glenoid baseplate failure after RSA. MethodsUtilizing a single-institution database, a retrospective review was performed to identify patients from 2010 to 2019 who sustained glenoid baseplate failures after RSA and were treated nonoperatively. The exclusion criteria included revision surgery and presence of active infection. Included patients had a minimum 2-year clinical and radiographic follow-up. Chart review captured patient demographics, surgical indications, and techniques. Radiographs were reviewed to determine the etiology of baseplate failure and other implant complications. Glenosphere inclination angle was measured on true anteroposterior radiographs immediately postoperatively and after baseplate failure. ResultsEighteen patients had glenoid baseplate failures treated nonoperatively during the study period. Five patients were deceased, leaving 13 patients who were available for clinical follow-up. Twelve (92%) patients were successfully contacted. The mean age was 77 years, body mass index was 28, and 8 out of 12 were female. The mean Charlson Comorbidity Index score was 4.1. The mean preoperative American Shoulder and Elbow Surgeons (ASES) score was 43.0, and visual analog scale (VAS) pain was 6.3. At a mean 5.7-year follow-up, patients had an ASES score of 49.2, VAS pain of 4.3, single assessment numeric evaluation of 49%, and 50% of patients were satisfied with their outcome. The preoperative and final follow-up ASES and VAS scores were similar. The average time from index surgery to baseplate failure was 19 months. Of the eighteen identified patients, 16 (89%) failures resulted in increased baseplate superior tilt (7 with concomitant broken baseplate screws). For these 16 patients, the mean glenosphere inclination angle after failure (131°) was significantly greater than the initial inclination angle (100°), P = .03. The other 2 failures resulted in increased baseplate anteversion. 8 out of 18 (44%) patients had bone grafting at the time of surgery. When comparing dissatisfied and satisfied patients, there were no specific patient characteristics or radiographic parameters that were associated with satisfaction. ConclusionNonoperative management of glenoid baseplate failure yields modest patient-reported outcomes, with 50% patient satisfaction at mid-term follow-up. The mortality rate in this cohort of patients was almost 30%. Therefore, in select patients, nonoperative treatment of RSA baseplate failure may be a reasonable option.

Glenoid component cyclical failure decreases with increasing baseplate contact: a biomechanical study

BackgroundGlenoid baseplate loosening remains a common mode of failure in reverse shoulder arthroplasty. One of the key factors to baseplate stability is theorized to be maximization of baseplate backside contact. The purpose of this biomechanical study is to investigate the role of varying degrees of backside bony glenoid support in component stability for reverse total shoulder arthroplasty. MethodsTwenty synthetic scapular models were divided into 3 test groups of 5 scapulae with glenoid baseplate contacts of 40%, 60%, and 75%, and one control group with glenoid baseplate contact of 100%. Standardized application of a commercially available glenoid baseplate and glenosphere was performed. The scapulae were mounted on a linear bearing with a humeral component and polyethylene liner which were affixed to a biaxial servohydraulic fatigue testing system. Each specimen was loaded for 10,000 cycles or to failure, about a 55° arc along the glenosphere at a rate of 1 Hz as a 750 N compression load was applied. Failure was defined as fracture of the scapula with implant fixation compromise. Before and after loading, stability of the baseplate was assessed by quantifying the total motion between the model and the baseplate with digital calipers as a ramp load between 0 and 150 N was applied. Two-sample unpaired t-tests were performed with significance set at P < .05. ResultsBaseplate contacts of 40% (1623 ± 227, P = .0001), 60% (3299 ± 1170, P = .0001), and 75% (5615 ± 1587, P = .0077) demonstrated statistically significant decrease in the average number of cycles to failure in all cohorts compared to our control (8641 ± 1070). Cycles taken for initial cracks to progress to failure showed no significant differences; 40% contact (862 ± 452, P = .4751), 60% contact (1651 ± 996, P = .4318), 75% contact (2882 ± 1347, P = .0620), and 100% control (1166 ± 657). Baseplate contacts of 40% (6150.4 ± 444.0, P = .0006), 60% (4647.1 ± 552.3, P = .0072), and 75% (2927.8 ± 918.5, P = .2573) demonstrated increasing micromotion (pre-post cyclical loading) in all cohorts compared to our control (2074.7 ± 1164.6) with statistical significance at 40% and 60%. ConclusionThese biomechanical tests demonstrate that decreasing glenoid baseplate backside contact leads to increased micromotion and fewer cycles to failure. This supports the surgical goal of achieving maximal glenoid baseplate backside contact, suggesting that decreased glenoid baseplate support could contribute to significant loosening.

Evidence-based Approach for Prevention of Surgical Site Infection.

Periprosthetic joint infection (PJI) is regarded as a critical factor contributing to the failure of primary and revision total joint arthroplasty (TJA). With the increasing prevalence of TJA, a significant increase in the incidence of PJI is expected. The escalating number of cases, along with the significant economic strain imposed on healthcare systems, place emphasis on the pressing need for development of effective strategies for prevention. PJI not only affects patient outcomes but also increases mortality rates, thus its prevention is a matter of vital importance. The longer-term survival rates for PJI after total hip and knee arthroplasty correspond with or are lower than those for prevalent cancers in older adults while exceeding those for other types of cancers. Because of the multifaceted nature of infection risk, a collaborative effort among healthcare professionals is essential to implementing diverse strategies for prevention. Rigorous validation of the efficacy of emerging novel preventive techniques will be required. The combined application of these strategies can minimize the risk of infection, thus their comprehensive adoption is important. Collectively, the risk of PJI could be substantially minimized by application of a multifaceted approach implementing these strategies, leading to improvement of patient outcomes and a reduced economic burden.

Stress-shielding in aseptic loosening on the 3D printed acetabular cup in hip arthroplasty: review article

The increasing number of prosthetic hip replacement surgeries and their growing indication have led to a growing interest in understanding the factors that influence their long-term success. Total hip arthroplasty (THA) failure is mainly due to aseptic loosening. More rarely septic mobilization may occur. In the first case, many variables influence the bone-implant relationship and periprosthetic bone remodeling. Stress-shielding is the most evident but not fully explained manifestation of the bone implant interaction. Recently, three-dimensional (3D) printed titanium orthopedic implants have offered new perspectives in the field of hip prosthetics, enabling the customization and production of acetabular cups with enhanced biocompatibility. This review aims to evaluate the efficacy and reliability of 3D printed acetabular cups from the perspective of aseptic failure particularly related to the stress-shielding. The most recent clinical and preclinical studies will be reviewed, exploring the benefits and challenges associated with the use of these emerging technologies. Key factors, such as biocompatibility, mechanical stability, osseointegration, and wear resistance.

Characteristics of copper-containing cobalt chromium particles: Metal ion release, passive behavior, and biological response

Wear particle-induced periprosthetic osteolysis, leading to aseptic loosening, is the primary cause of total joint arthroplasty failure. Our study aimed to design Cu-containing Co29Cr9W particles (Co29Cr9W3Cu) to investigate the potential release of Cu ions from these particles in mitigating osteoclast over-activation. Analysis of Cu, Co, and Cr ion release from Co29Cr9W3Cu particles in simulated body fluid showed that Cu addition did not significantly increase metal ion release. In vitro tests confirmed the non-toxicity of Cu-containing particles to osteoblast cells, indicating minimal impact on Co, Cr, and W ion release with 3 wt% Cu addition. Importantly, Cu-containing Co29Cr9W particles demonstrated the ability to reduce osteoclast expression, potentially via inhibition of NF-κB signaling pathway. Alloying 3 wt% Cu into Co29Cr9W particle presents a promising strategy for mitigating osteoclast over-activation in wear particle-induced osteolysis.

Arthrodesis using Iliac Crest autograft in revision surgery of the first metatarsophalangeal joint total arthroplasty for the treatment of Hallux Rigidus: a retrospective study

PurposeThe treatments for hallux rigidus (HR) encompass a wide spectrum, including conservative methods and surgical approaches such as arthroplasty and arthrodesis. This study aims to evaluate the outcomes of revision with arthrodesis following the failure of the first metatarsophalangeal joint total arthroplasty (MTPJ1TA).Materials and methodsPatients who had surgery at two advanced orthopedic centers between January 1, 2020, and January 1, 2024, were reviewed. Those with at least 6 months of postoperative follow-up were assessed for demographics (gender, age, side), reoperation rates, complications, Visual Analogue Scale (VAS) scores, Foot and Ankle Disability Index (FADI) scores, and American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal and Interphalangeal Scale (AOFAS-HMI) scores. Radiological evaluations included hallux valgus angle (HVA), intermetatarsal angle (IMA), dorsiflexion angle (DFA), and first ray length (FRL) in anteroposterior and lateral views.ResultsOf 27 patients, 4 were male (15%) and 23 female (85%), with an average age of 56.18 ± 7.49 years (range 41–72). Arthrodesis was performed in 26 patients, with one requiring reoperation due to implant failure. Average VAS scores were 7.14 preoperatively and 3.55 postoperatively (p < 0.05). Average FADI scores were 50.51 preoperatively and 71.51 postoperatively (p < 0.05). Average AOFAS-HMI scores were 51.22 preoperatively and 70.59 postoperatively (p < 0.05). Average HVA was 19.7° preoperatively and 6.29° postoperatively (p < 0.05). Average IMA was 10.66° preoperatively and 11.37° postoperatively (p = 0.406). Average DFA was 34.14° preoperatively and 22.33° postoperatively (p < 0.05). Average anteroposterior FRL was 10.17 cm preoperatively and 10.77 cm postoperatively (p < 0.05). Average lateral FRL was 10.12 cm preoperatively and 10.42 cm postoperatively (p < 0.05). None of the patients in the study exhibited postoperative donor site complications or transfer metatarsalgia, while a 100% rate of bone union was observed.ConclusionWe think that revision of MTPJ1TA with arthrodesis is a safe treatment option. Additionally, the use of an iliac crest autograft can be a viable option to restore bone stock and create a biological environment conducive to fusion. This study evaluates revision surgery with arthrodesis in the largest patient group with failed MTPJ1TA, highlighting its significance in the field. However, further studies are needed to determine the ideal surgical procedure.