Management Of Arthroplasty Research Articles

Cemented Radial Head arthroplasty in management of unreconstructable radial head fractures

Cemented Radial Head arthroplasty in management of unreconstructable radial head fractures

Total knee arthroplasty versus unicompartmental knee arthroplasty in management of anteromedial knee osteoarthritis: a randomized clinical trial

Background: Both total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA) are options to manage anteromedial knee osteoarthritis. This study’s aim was to determine the functional outcome, time taken to walk without support, and postoperative complications after either TKA or UKA in treatment of anteromedial knee osteoarthritis. Methods: A prospective randomized cohort study was performed at a level 1 academic center on 60 patients with mean age of 56.2 yr who had isolated anteromedial knee osteoarthritis. Thirty patients were managed by UKA (group 1), and the other thirty patients were managed by TKA (group 2). Diagnosis was confirmed by plain radiographs (anteroposterior standing, lateral, skyline, stress varus, and valgus views). Follow-up was done for at least 12 mo postoperatively. Results: Mean preoperative functional Knee Society Score (KSS) was 65.83 and 62.67 for group 1 and group 2, respectively. Mean functional KSS after 1 yr was 86.3 for group 1 and 84.6 for group 2. In group 1, one patient developed lateral joint line pain, and another patient developed postoperative blood loss of more than 400 mL. In group 2, one patient developed pattelofemoral pain, and another patient developed postoperative blood loss of more than 400 mL. The mean time that it took for patients to walk without support was 1.6 wk in group 1 and 1.93 wk for group 2. Conclusions: Both UKA and TKA have the same functional outcome for treatment of anteromedial knee osteoarthritis and the same rate of complications, but early postoperative rehabilitation is better in patients managed by UKA. Level of Evidence: Level I.

The role of hip arthroplasty in management of the hip fracture patient

Hip fractures are becoming increasingly common in a growing elderly population, and are associated with significant morbidity and mortality. Displaced intracapsular femoral neck fractures are usually treated with either total hip arthroplasty (THA) or hemiarthroplasty, although the indication for each operation remains an area for debate. THA has been associated with longer operative time, increased risk of dislocation and a slight increase in general complications compared with hemiarthroplasty. However, it has also been associated with a modest improvement in functional outcomes and quality of life. Guidelines have been created within the UK to aid the decision-making process based upon current available literature. The principal focus of these has been to identify patients suitable for THA, and include patients who are cognitively intact, mobile outside their home with the use of no more than one stick, and who are medically fit enough for the procedure. However, implant selection must also be taken into consideration in order to achieve the best outcomes for patients. Options for implants include use of dual mobility cups and choice of femoral head size in THA, bipolar versus unipolar hemiarthroplasty, and cemented versus uncemented implants. Further research is required into this area to make additional recommendations.

What Are the Indications for One-Stage Versus Two-Stage Exchange Arthroplasty in Management of the Infected Total Ankle Arthroplasty (TAA)?

Two-stage exchange arthroplasty is recommended in the majority of cases following infected TAA. One-stage arthroplasty is only indicated in a limited patient population with acute infection, preoperatively identified low-virulence organisms, and low-risk patient factors. Consensus. Agree: 92%, Disagree: 8%, Abstain: 0% (Super Majority, Strong Consensus).

The Role of Reverse Shoulder Arthroplasty in Management of Proximal Humerus Fractures with Fracture Sequelae: A Systematic Review of the Literature.

Fracture sequelae of the proximal humerus poses a complex management decision due to the frequent deformity and its consequences on the peri-articular soft tissues. These patients are frequently elderly with significant medical comorbidities. Due to the age of the patient there is frequently rotator cuff deficiency and therefore the reverse shoulder arthroplasty (RSA) becomes the arthroplasty of choice. We have performed a systematic review of the literature and report nine studies presenting RSA for the treatment of fracture sequelae of the proximal humerus. It is clear that RSA can improve the range of movement and function following proximal humerus fracture sequelae. However, there is a risk of significant complications including dislocation (16.7%), infection (6.7%), intra-operative fracture (3%) and neurological injury (2.6%). There is a need to invest in future prospective comparative studies and randomised trials to further test RSA in fracture sequelae patients. This will provide us with information regarding the longevity of different prosthesis, outcomes and cost-effectiveness of treatment.

Outcome of Revision Total Hip Arthroplasty in Management of Failed Metal-on-Metal Hip Arthroplasty

BackgroundThis is a retrospective review of the functional outcomes and complications of revision total hip arthroplasty (THA) of failed metal-on-metal (MoM) hip arthroplasty. MethodsA total of 20 revision THAs were performed in 19 patients. Of them, 2 cases were failed hip resurfacing, and 18 cases were failed (MoM) THA. The mean age at revision (THA) was 59.35 years (standard deviation [SD] 9.83). ResultsThe mean follow-up was 45 months (SD 13.98). The indications of revision were aseptic loosening of acetabular component without adverse local tissue reaction (ALTR; 10 hips), aseptic loosening of the acetabular and femoral components without ALTR (1 hip), painful hip associated with ALTR (6 hips), iliopsoas impingement associated with a large-diameter femoral head or malpositioned acetabular component (3 hips). The acetabular components were revised in 18 hips using Trabecular Metal Modular cups. The femoral components were revised in 3 hips. A constrained acetabular liner was used in 5 hips. The Harris hip score significantly improved from 48.4 (SD 12.98) to 83.25 (SD 10.08). There were 2 complications (1 foot drop and 1 superficial infection) and 1 failure (recurrent dislocation) that required revision to a constrained liner. ConclusionEarly results of revision THA of failed MoM hip arthroplasty showed improvement in pain and functional outcome. No case of failed bone ingrowth was noted with the use of Trabecular Metal Modular cups. Extensive soft tissue and abductor muscles dysfunctions were common. A constrained acetabular component with repair of the hip abductors might be beneficial.

Clinical investigation of transport distraction osteogenesis arthroplasty in management of adult patient with temporomandibular joint ankylosis

Clinical investigation of transport distraction osteogenesis arthroplasty in management of adult patient with temporomandibular joint ankylosis

Clinical report of cervical arthroplasty in management of spondylotic myelopathy in Chinese.

ObjectivesTo investigate clinical effects and manual operational point of Bryan cervical disc prosthesis in Chinese, to observe the stability and range of movement (ROM) post-operatively.Methods and materialsFrom 2003,12 to 2005,12, Bryan disc prosthesis replacement applied in 83 cases (102 levels) of cervical spondylotic myelopathy (CSM) after anterior decompression in our hospital. Clinical (JOA grade and Odom's scale) and radiological (X-ray of flexion, extension; left and right bending position) follow-up was performed. Systemic radiographic study about stability and ROM of replaced level post operationally were measured. CT or MRI scans were applied in all cases to evaluate the signs of the prosthesis deflexion and hetero-ossification in the replaced levels.ResultsAt least 12 months follow-up were done in 65/83 of these paients. All of 83 patients were improved according to Odsm's scale. JOA score increased from average 8.7 to 15.5. There was no prosthesis subsidence. Replaced segment achieved stability and restored partial of normal ROM 4.73°(3.7°–5.9°) early postoperation and 8.12°(5.8°–13.6°) more than 12 months postoperation in flex and extension position. No obvious loss of lordosis was found. CT or MRI follow-up shows position deflexion of the prosthesis metal endplates (<1.5 mm) in 14/77 levels and (1.5~3 mm) in 4/77. heter-ossification was found in the replaced levels only in 2 cases.ConclusionByran cervical disc prosthesis restored motion to the level of the intact segment in flexion-extension and lateral bending in post-operative images. At the same time, it can achieve good anterior decompression treatment effect and immediate stability in replaced 1 or 2 levels, and which is a new choice for the treatment of CSM.