Cases Of Aseptic Loosening Research Articles

Long-Term Outcomes and a Radiological Assessment of Hydroxyapatite-Tricalcium Phosphate-Coated Total Hip Arthroplasty (Trilogy/Zimmer): A Long-Term Follow-Up Study.

Background and Objectives: Favorable short- and mid-term results for hydroxyapatite (HA)-tricalcium phosphate (TCP)-coated total hip arthroplasty (THA) (Trilogy/Zimmer) have been reported in the literature; however, the long-term results beyond 15 years have not been documented. Therefore, this study evaluated the long-term postoperative results, radiological bone changes, and implant fixation of the acetabular component of HA-TCP-coated THA. Materials and Methods: This is a retrospective cohort study of 212 patients who underwent primary HA-TCP-coated THA (Trilogy/Zimmer) at our institution between 1 October 2002, and 31 March 2008; 166 who were available for follow-up at least 15 years postoperatively were included (capture rate: 78.3%). All implants were Trilogy/Zimmer. We investigated the survival rate, with aseptic loosening as the endpoint. Clinical evaluations included the presence of dislocation and a modified Harris Hip Score (mHHS) preoperatively and at the final observation. Results: The mean age at surgery and at the follow-up period were 57.7 ± 9.6 and 17.1 ± 1.5 years, respectively. The survival rate was 99.4% (165/166), with aseptic loosening as the endpoint. Dislocation was observed in 4/166 (2.4%) patients. The mHHS improved significantly from 46.1 points preoperatively to 82.2 points during the last survey (p < 0.05). The results revealed that fixation was favorable in all cases except for one case of aseptic loosening. The Trilogy implant coated with HA-TCP was highly effective in bone induction, and bone ingrowth was considered to have occurred without failure, further indicating its usefulness. The long-term results of cementless THA using an HA-TCP coating (Trilogy/Zimmer), with a mean follow-up period of 17.1 years, revealed a commendable survival rate of 99.4%, considering aseptic loosening as the endpoint. Conclusions: HA-TCP-coated THA (Trilogy/Zimmer) had good long-term results. However, further long-term observation is required in patients who have undergone this surgery, and the stem side should be evaluated and investigated, including comorbidities.

A novel quantitative grading system for implant fixation in revision total knee arthroplasty.

Obtaining solid implant fixation is crucial in revision total knee arthroplasty (rTKA) to avoid aseptic loosening, a major reason for re-revision. This study aims to validate a novel grading system that quantifies implant fixation across three anatomical zones (epiphysis, metaphysis, diaphysis). Based on pre-, intra-, and postoperative assessments, the novel grading system allocates a quantitative score (0, 0.5, or 1 point) for the quality of fixation achieved in each anatomical zone. The criteria used by the algorithm to assign the score include the bone quality, the size of the bone defect, and the type of fixation used. A consecutive cohort of 245 patients undergoing rTKA from 2012 to 2018 were evaluated using the current novel scoring system and followed prospectively. In addition, 100 first-time revision cases were assessed radiologically from the original cohort and graded by three observers to evaluate the intra- and inter-rater reliability of the novel radiological grading system. At a mean follow-up of 90 months (64 to 130), only two out of 245 cases failed due to aseptic loosening. Intraoperative grading yielded mean scores of 1.87 (95% confidence interval (CI) 1.82 to 1.92) for the femur and 1.96 (95% CI 1.92 to 2.0) for the tibia. Only 3.7% of femoral and 1.7% of tibial reconstructions fell below the 1.5-point threshold, which included the two cases of aseptic loosening. Interobserver reliability for postoperative radiological grading was 0.97 for the femur and 0.85 for the tibia. A minimum score of 1.5 points for each skeletal segment appears to be a reasonable cut-off to define sufficient fixation in rTKA. There were no revisions for aseptic loosening at mid-term follow-up when this fixation threshold was achieved or exceeded. When assessing first-time revisions, this novel grading system has shown excellent intra- and interobserver reliability.

Contemporary Aseptic Revision Total Hip Arthroplasty in Patients ≤50 Years of Age: Results of >500 Cases.

There has been a paucity of long-term outcomes data on aseptic revision total hip arthroplasties (THAs) in the young adult population. The purpose of this study was to evaluate implant survivorship, complications, and clinical outcomes in a large cohort of contemporary aseptic revision THAs in patients ≤50 years of age at the time of the surgical procedure. We identified 545 aseptic revision THAs performed at a single academic institution from 2000 to 2020 in patients who were 18 to 50 years of age. Patients who underwent conversion THAs and patients with a history of any ipsilateral hip infection were excluded. The mean age was 43 years, the mean body mass index (BMI) was 29 kg/m 2 , and 63% were female. The index indication for revision THA was aseptic loosening in 46% of cases, polyethylene wear or osteolysis in 28% of cases (all revisions of conventional polyethylene), and dislocation in 11% of cases. There were 126 hips (23%) that had undergone at least 1 previous revision (median, 1 revision [range, 1 to 5 revisions]). The mean follow-up was 10 years. In the entire cohort, the 20-year survivorship free of any re-revision was 76% (95% confidence interval [95% CI], 69% to 82%). There were 87 re-revisions, with 31 dislocations, 18 cases of aseptic loosening of the femoral component, and 16 periprosthetic joint infections (PJIs) being the most common reasons for re-revision. Dislocation as the indication for the index revision was associated with an increased risk of re-revision (hazard ratio, 2.9; p < 0.001). The 20-year survivorship free of any reoperation was 73% (95% CI, 66% to 78%). There were 75 nonoperative complications (14%), including 32 dislocations. The mean Harris hip score significantly improved (p < 0.001) from 65 preoperatively to 81 at 10 years postoperatively. Contemporary aseptic revision THAs in patients ≤50 years of age demonstrated a re-revision risk of approximately 1 in 4 at 20 years. Dislocation, aseptic loosening of the femoral component, and PJI were the most common reasons for re-revision. Index revision THAs for dislocation had a 3 times higher risk of re-revision. Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.

Uncemented reverse shoulder arthroplasty in proximal humeral fractures: comparative study of two different press fit stems

BackgroundReverse shoulder arthroplasty (RSA) has extended its indications in recent years to include complex proximal humerus fractures (PHFs) in elderly patients. The traditional approach in cases of PHF has been to cement the stem but, as in orthopedic surgery, the current trend in PHF is to avoid cementing the humeral stem as well. MethodsWe evaluated 63 patients (representing 63 shoulders) who underwent RSA with uncemented stem after acute fracture of the proximal humerus. We analyzed the clinical and radiological outcomes, as well as medium-term complications, using two different prosthesis models. ResultsThe mean postoperative follow-up period was 21-23 months, and the mean age of the patients was 74.5 years. The average Constant Score was 56.94 points; there were no statistical significant differences in Constant Score depending on the prosthesis model used. No cases of aseptic loosening were observed. However, there was evidence of stress-shielding in prostheses with diaphyseal fixation, although this phenomenon did not appear to have functional or clinical consequences for the patients. Intraoperative complications occurred in 6.35% of cases, and postoperative complications were noted in 4.92%. ConclusionBased on the results of this study, we can affirm that the use of RSA with cementless stems in PHF can be a safe alternative, providing satisfactory clinical, functional, and radiographic results in the short term without the need to use cement in their fixation. The choice of prosthesis model may influence the occurrence of radiographic phenomena but does not seem to affect clinical outcome.

Dual-mobility tripod cup for revision hip arthroplasty: long-term (five to fourteen years) evaluation of a new generation cementless implant.

The aims of this study were to evaluate the survivorships of a new generation cementless DMC with tripod additional fixation in revision total hip arthroplasty and complications at a minimum fiveyear follow-up. One hundred and fifteen revisions (THA) treated with tripod DMC performed between 2009 and 2015 were included in this retrospective study. Acetabular defects were classified as Paprosky 1 (n = 38, 33%), 2 (n = 75, 65%) or 3 (n = 2, 2%). Unipolar or bipolar revision was performed for the following indications: aseptic acetabular loosening (63%), infection (14%), aseptic bipolar loosening (11%), instability (4%), aseptic femoral loosening (3%), ALVAL (3%) and iliopsoas impingement (2%). Mean follow-up was 9.4years ± two (range, 5 to 14). At the final follow-up, a single episode of dislocation occurred within threemonths after the procedure (0.8%) with no revision. Three cases of aseptic loosening were diagnosed (2.6%). Four infections (3.5%) required reoperation: three required a twostage bipolar revision; one was treated by DAIR procedure. At the latest follow-up, the survivorship of the acetabular cup for aseptic loosening was 98% [95% CI (91.2-99.4)] and for any reasons was 94.4% [95% CI (90.1%-98.9%)]; the mean HHS improved from 60 points (range, 18-94 points) to 83 points (range, 37-100 points) (p < .001). This study reports a low complication rate in favour of the use of a tripod DMC in revision THA with a satisfactory survivorship at a tenyear follow-up.

Angle-Adjustable Dynamic Hip Screw Plate for Unstable Trochanteric Fractures in Middle-Aged Patients: Mid-Term Outcomes and Return to Sport.

There are conflicting results in the literature regarding the superiority of proximal femoral nails over dynamic hip screw (DHS) plates. The primary aim of this study is to evaluate mid-term post-injury patient-reported outcome measures (PROMs) and return to sport (RTS) in middle-aged patients treated with the DHS plate for unstable trochanteric fractures. Fifty-seven middle-aged patients (35-64 years) treated for proximal femoral fractures of type 31-A2 and 31-A3 according to the AO/OTA classification with the DMS Dynamic Martin Screw (KLS Martin Group, Jacksonville, FL, USA) between January 2017 and December 2019 were enrolled. Forty-nine patients were included in this retrospective study, and the average age was 54.1 years (SD 8.4). The average follow-up duration at final follow-up was 60.5 months (SD 8.6). Post-operative complications included only one case of aseptic loosening of the implant, with a complication rate of 2%. There were no infections, peri-implant fractures, or other complications reported. Two out of the forty-nine patients (4.1%) required treatment with a total hip arthroplasty due to post-traumatic arthritis. The Harris Hip Score at final follow-up was 77.1 (SD 20.1), and the Western Ontario and McMaster Universities Osteoarthritis Index was 21.6 (SD 13.7). The overall rate of RTS was 57.7%. Treatment with DHS for unstable trochanteric fractures is a safe option in middle-aged patients, ensuring a good functional recovery.

MID-TERM SURVIVORSHIP AND OUTCOMES FOR HANDHELD ROBOTIC-ASSISTED UNICOMPARTMENTAL KNEE ARTHROPLASTY AND ITS LEARNING CURVE: A SINGLE-SURGEON STUDY OF 100 KNEES

Robotic assistance in knee arthroplasty has become increasingly popular due to improved accuracy of prosthetic implantation. However, literature on the mid-term outcomes is limited especially that of hand-held robotic-assisted devices. We present one of the longest follow-up series to date using this novel technology and discuss the learning curve for introducing robotic technology into our practice.The purpose of this single-surgeon study is to evaluate the survival, patient-reported outcomes and learning curve for handheld boundary-controlled robotic-assisted unicompartmental knee arthroplasties (HBRUKAs) at our hospital.This retrospective study evaluates 100 cases (94 Medial, 6 Lateral) performed by a single surgeon between October 2012 and July 2018. 52% were males, mean age was 64.5y (range 47.3y-85.2y) and mean BMI was 31.3 (range 21.8–43). Both inlay (40%) and onlay (60%) designs were implanted. Patients were followed up routinely at 1 and 5 years with Oxford Knee Scores (OKS) recorded. The learning curve was determined by tourniquet times.At a mean follow-up of 4.3 years (range 1.6y–7.3y), survivorship was 97%. There were three revisions: One case of aseptic loosening (1.5y), one case of deep-infection (3.8y) and one case of contralateral compartment osteoarthritis progression (5y). Mean 5-year OKS was 39.8. A 14.3% reduction in mean tourniquet times between the first 25 cases (105.5minutes) and subsequent cases (90.4minutes) was seen.This single-surgeon study showed good survivorship and patient-reported outcomes for HBRUKAs at our hospital. A learning curve of approximately 25 cases was shown, with significant decreases in tourniquet times with respect to increased surgeon experience.

Long-Term Outcomes of High-Flexion Design Total Knee Arthroplasty with a Short Posterior Flange.

The purpose of this study was to evaluate the clinical and radiological outcomes of high-flexion total knee arthroplasty (TKA) using Vega Knee System (B. Braun, Aesculap) at a long-term follow-up and to analyze the implant survivorship. We enrolled 165 patients (232 knees) with a minimum 7-year follow-up after TKA (VEGA Knee System). For clinical assessment, range of motion (ROM), Knee Injury and Osteoarthritis Outcome Score (KOOS), and Western Ontario and McMaster University Osteoarthritis Index (WOMAC) were used. For radiologic assessment, hip-knee-ankle angle, component position, and the existence of radiolucent lines and loosening were used. Survival analysis was conducted using the Kaplan-Meier method. The mean follow-up period was 9.8 years. The mean ROM increased from 124.4° to 131.4° at the final follow-up. The WOMAC score decreased from 38.5 to 17.4 at the final follow-up (p < 0.001). All 5 subscales of the KOOS improved at the final follow-up (all subscales, p < 0.001). Revision TKA was performed in 10 cases (4.3%), which included 9 cases of aseptic loosing and 1 case of periprostatic joint infection. Of the 9 aseptic loosening cases (3.9%), 8 cases (3.4%) were loosening of the femoral component and 1 case (0.4%) was loosening of the tibial component. When revision for any reason was considered an endpoint, the 10-year survivorship was 96.2% (95% confidence interval [CI], 93.9%-98.5%). On the other hand, when revision for aseptic loosening was considered the endpoint, the 10-year survivorship was 96.6% (95% CI, 94.4%-98.8%). The Vega Knee System provided good clinical results in the long-term follow-up period. Although the VEGA Knee System showed acceptable implant survivorship, loosening of the femoral component occurred in about 3.4% of the patients. For more accurate evaluation of the survivorship of high-flexion design TKA with a short posterior flange, it is necessary to conduct more long-term follow-up studies targeting diverse races, especially Asians who frequently perform high-flexion activities.

Satisfactory medium- to long-term outcomes of cemented rotating hinge prosthesis in revision total knee arthroplasty.

The aim of this study was to evaluate medium- to long-term outcomes and complications of the Stanmore Modular Individualised Lower Extremity System (SMILES) rotating hinge implant in revision total knee arthroplasty (rTKA) at a tertiary unit. It is hypothesized that this fully cemented construct leads to satisfactory clinical outcomes. A retrospective consecutive study of all patients who underwent a rTKA using the fully cemented SMILES rotating hinge prosthesis between 2005 to 2018. Outcome measures included aseptic loosening, reoperations, revision for any cause, complications, and survivorship. Patients and implant survivorship data were identified through both prospectively collected local hospital electronic databases and linked data from the National Joint Registry/NHS Personal Demographic Service. Kaplan-Meier survival analysis was used at ten years. Overall, 69 consecutive patients (69 knees) were included with a median age of 78 years (interquartile range 69 to 84), and there were 46 females (66.7%). Indications were septic revisions in 26 (37.7%), and aseptic aetiology in the remining 43 (62.3%). The mean follow-up was 9.7 years (4 to 18), and the overall complication was rate was 7.24%, all with patellofemoral complications. Failure rate with 'any cause revision' was 5.8%. There was one case of aseptic loosening of the femoral component. At ten years, 17/69 patients (24.63%) had died, and implant survivorship was 92.2%. In our experience, the SMILES rotating hinge prosthesis achieves satisfactory long-term outcomes with ten-year implant survivorship of 92.2% and a patellofemoral complication rate of 7.24%.

Unicompartmental knee arthroplasties: does the type of tibial component selected influence implant survival?

Few information has been published on the survival of unicompartmental knee arthroplasty (UKA) and fixed-bearing tibial components. The aim of this study is to analyze if UKA survival varies according to UKA model used and to analyze the possible risk factors for UKA revision. A retrospective study analyzing 301 UKAs (ACCURIS, all-polyethylene tibial component, 152; Triathlon PKR, metal-backed tibial component, 149) was performed. Demographic parameters as well as implant survival and cause of prosthetic revision were analyzed. The Kaplan-Meier survival analysis, the log-rank test and the Cox multiple regression were used for the analysis. Average follow-up was 8.1 ± 3.08-years. Average age was 68.1 ± 8.6-years; 70.4% of subjects were women. The ACCURIS UKA group had a UKA revision rate higher compared to the Triathlon PKR group (16/152, 10.6% vs 5/149, 3.4%, respectively; p < 0.001). The main cause of prosthetic revision was aseptic loosening (5/21, 23.8%). All aseptic loosening cases and tibial component collapse were reported with the ACCURIS UKA group. Overall UKA survival was 98.01% (95% CI 95.62-99.1) at 1-year, 94.27% (95% CI 90.95-96.4) at 5-years and 92.38% (95% CI 88.48-94.99) at 10-years' follow-up. There were no differences in the Kaplan-Meier survival curves regarding operated side or affected tibiofemoral compartment (log-rank test = 0.614 and 0.763, respectively). However, Kaplan-Meier survival curve according to UKA model used was different (log-rank test = 0.033). The metal-backed component appeared to be a protector factor for UKA revision when adjusted for age, sex, operated side, and affected tibiofemoral compartment (Hazard Ratio 0.32, p = 0.031). Fixed-bearing UKAs showed excellent mid- and long-term survival rates. Aseptic loosening is the main cause of implant failure. PKR group (metal-backed component) seem to be a protector factor to UKA revision when it was compared with ACCURIS UKA group (all-polyethylene tibial component).

Aseptic survival of the 1.5-stage exchange arthroplasty for periprosthetic joint infection was acceptable when using an autoclaved femoral component and a new polyethylene insert.

To investigate the aseptic survival of 1.5-stage exchange arthroplasty for periprosthetic joint infection (PJI) after total knee arthroplasty (TKA). Eighty-eight cases of 1.5-stage exchange arthroplasty for PJI without reinfection were retrospectively analysed. The autoclaved femoral component and new polyethylene insert (PE) were implanted using antibiotic mixed cement. The explanted tibial component was not reinserted. The Western Ontario and McMaster Universities Osteoarthritis Index and range of motion were clinically evaluated preoperatively and at the last follow-up (the last time for the implant in situ). Radiographically, hip-knee-ankle angle (HKA) and component positions were measured preoperatively, postoperatively (1month after the 1.5-stage exchange arthroplasty), and at the last follow-up. The survival rate was analysed using the Kaplan-Meier method, in which failure was defined as reoperation due to aseptic failure. Mean period to failure and failure site were analysed. Factors affecting survival were investigated in terms of demographics and inappropriateness of the postoperative HKA (HKA > 0 ± 3°) and component positions (α angle > 95 ± 3°, β angle > 90 ± 3°, γ angle > 3 ± 3°, and δ angle > 87 ± 3°). The spacer in-situ time was 3.7years (0.2-6.4). The clinical results improved hip-knee-ankle significantly at the last follow-up. Radiographically, the average HKA was valgus 0.1° postoperatively. The average α, β, γ, and δ angles of the postoperative component positions were 95.9°, 90.4°, 3.8°, and 86.7°, respectively. The 1-, 2-, and 5-year postoperative survival rates were 90.9%, 86.4%, and 80.6%, respectively. The mean period to failure was 2.0years (0.2-5.3). There were 18 cases of aseptic loosening (20.8%), occurring on both the femur and tibial sides in 1 knee, and only on the tibial side in 17 knees. Inappropriate coronal position of the PE (β angle > 90 ± 3°) was a significant factor affecting survival (odds ratio = 5.491; p = 0.011). The aseptic survival of the 1.5-stage exchange arthroplasty was acceptable when using an autoclaved femoral component and new PE. The appropriate coronal position of the PE helps ensure favourable survival of 1.5-stage exchange arthroplasty. IV.

COMPARATIVE SURVIVAL OF CONTEMPORARY CEMENTLESS ACETABULAR COMPONENTS FOLLOWING PRIMARY TOTAL HIP ARTHROPLASTY

The last two decades have seen remarkable technological advances in total hip arthroplasty (THA) implant design. Porous ingrowth surfaces and highly crosslinked polyethylene (HXLPE) have been expected to dramatically improve implant survivorship. The purpose of the present study was to evaluate survival of contemporary cementless acetabular components following primary THA.16,421 primary THAs performed for osteoarthritis between 2000 and 2019 were identified from our institutional total joint registry. Patients received one of 12 contemporary cementless acetabular designs with HXLPE liners. Components were grouped based on ingrowth surface into 4 categories: porous titanium (n=10,952, mean follow-up 5 years), porous tantalum (n=1223, mean follow-up 5 years), metal mesh (n=2680, mean follow-up 6.5 years), and hydroxyapatite (HA) coated (n=1566, mean follow-up 2.4 years). Kaplan-Meier analyses were performed to assess the survivorship free of acetabular revision. A historical series of 182 Harris-Galante-1 (HG-1) acetabular components was used as reference.The 15-year survivorship free of acetabular revision was &gt;97% for all 4 contemporary cohorts. Compared to historical control, porous titanium (HR 0.06, 95% CI 0.02–0.17, p&lt;0.001), porous tantalum (HR 0.09, 95%CI 0.03–0.29, p&lt;0.001), metal mesh (HR 0.11, 95%CI 0.04–0.31, p&lt;0.001), and HA-coated (HR 0.14, 95%CI 0.04–0.48, p=0.002) ingrowth surfaces had significantly lower risk of any acetabular revision. There were 16 cases (0.1%) of acetabular aseptic loosening that occurred in 8 (0.07%) porous titanium, 5 (0.2%) metal mesh, and 3 (0.2%) HA-coated acetabular components. 7 of the 8 porous titanium aseptic loosening cases occurred in one known problematic design. There were no cases of aseptic loosening in the porous tantalum group.Modern acetabular ingrowth surfaces and HXLPE liners have improved on historical results at the mid-term. Contemporary designs have extraordinarily high revision-free survivorship, and aseptic loosening is now a rare complication.At mid-term follow-up, survivorship of contemporary uncemented acetabular components is excellent and aseptic loosening occurs in a very small minority of patients.

LONG-TERM FOLLOW-UP OF AN UNCEMENTED PROXIMALLY HYDROXYAPATITE-COATED FEMORAL STEM

Uncemented femoral components have been used in total hip arthroplasties (THAs) for over three decades. Data on long-term performance of hydroxyapatite-coated femoral stems is however limited. This study reports the survivorship of a collarless, straight, hydroxyapatite-coated femoral stem (Omnifit HA, Osteonic) with a minimum of 20 years of follow-up.We reviewed the results of 165 THAs using Omnifit HA in 138 patients performed between August 1993 and December 1999. The mean age at surgery was 46 years (range 20 – 77 years). Avascular necrosis was the most common cause of THA, followed by ankylosing spondylitis and primary osteoarthritis. The mean follow-up was 22 years (range 20–31 years). At 20 and 25 years, 113 arthroplasties (91 patients) and 63 arthroplasties (55 patients) were available for follow-up respectively, while others had deceased or were lost to follow-up.Kaplan-Meier survivorship analysis was performed to evaluate the survival of the femoral component. Radiographs were reviewed at regular intervals, and implant stability was evaluated using Engh classification.Seven out of 165 stems were revised upon the latest follow-up; that included one case of aseptic loosening with revision done at 15 years, three peri-prosthetic fractures, two infections, and one recurrent dislocation.At 20 years, survivorship with revision of the femoral stem for any cause and aseptic loosening as the endpoint was 96.0% (95% CI, 92.6 – 99.5%) and 98.4% (95% CI, 96.2 – 100%) respectively. At 25 years, the corresponding survivorship rates were 94.5% (95% CI, 91.9 – 97.3%) and 98.1% (95% CI, 95.7 – 99.6%) respectively.Radiographic findings of stable bony fixation were seen in 86 stems (76.1%) and those of loosening in 4 stems (3.5%) at 20 years. All patients with radiographic signs of loosening were asymptomatic and did not require revision.The Omnifit HA femoral stem offered promising long-term survivorship into the third decade.

Offset Acetabular Liners: Safer Than Previously Thought.

High offset liners help to restore soft tissue tension after primary total hip arthroplasty (THA). However, prior research has reported increased rates of aseptic loosening when using offset components. The purpose of this study was to examine the postoperative complication and revision rates of neutral vs offset acetabular liners at our institution. Two hundred eight primary THAs in 206 patients performed between 2016 and 2018 using neutral or offset liners were reviewed. All patients had a minimum 2-year clinical follow-up (mean, 3.3 years; range, 2.0-5.7 years). Postoperative complications and revision surgeries were reviewed. All offset liners were 4 mm in thickness. Twelve (10.0%) complications occurred in the neutral liner group, and 13 (14.8%) complications occurred in the offset liner group. Two cases of aseptic loosening occurred in the neutral liner group, with no cases reported in the offset liner group. Nine cases (7.5%) in the neutral group required revision surgery, whereas 3 cases in the offset group required revision surgery. Chi-square analysis found no difference between the groups in the rate of postoperative complications, χ2 (1, N=208)=1.09 (P>.05), or the rate of revision, χ2 (1, N=208)=1.56 (P>.05). We found no significant differences between the neutral and offset groups regarding the rates of postoperative complications, aseptic loosening, or revision surgery. Our findings suggest that contemporary high offset liners, up to 4 mm, are safe and effective when attempting to restore native hip mechanics after THA. [Orthopedics. 2023;46(5):e298-e302.].

Notching of smooth ulnar stems reduces loosening after total elbow arthroplasty

Background This study aimed to validate the concept of notching of the ulna component of the first-generation latitude total elbow prosthesis to reduce the rate of aseptic loosening and improve implant survival. Methods A total of 18 total elbow arthroplasty cases were performed between June 2001 and May 2002 using the latitude first-generation ulnar stem. A total of 14 cases with at least 2 years of follow-up were evaluated following the exclusion of four infected cases. The senior author roughened the stem surface with notches in 10 cases (notched group) to prevent loosening. The effects of notching on implant failure were retrospectively analyzed. Results Average participant age and follow-up were 56 ± 20 years and 72 ± 44 months, respectively. The notched and unnotched implant groups were demographically equivalent. 3/4(75%) of unnotched group implants failed due to aseptic loosening. 1/10(10%) of the notched group implants failed. All unnotched group aseptic loosening cases occurred at the bone–cement interface within 2 years after total elbow arthroplasty. The single patient with aseptic loosening in the notched group had a history of multiple surgeries due to an open fracture preceding the primary total elbow arthroplasty. Discussion Notching of the ulna component of the first-generation latitude total elbow prosthesis reduced the rate of aseptic loosening and improved implant survival. Level of evidence Level IV, retrospective comparative study.

High flex femoral component with slanted pegs improves fixation strength of total knee arthroplasty

High incidences of early aseptic loosening cases have led to numerous analyses on fixation strength of femoral component (FC). This study consists of two objectives: (1) to analyze the correlation between articulating contact area shape conformities and fixation strength, and (2) to analyze the relationship between slanting box patterns of the FC and fixation strength. Two design analyses were constructed: first, using three different types of contact congruence with radius ratios of 0.50, 0.89 and flat. Second, box patterns of the FC were anteriorly slanted at 2, 4 and 6°. The fixation strength of the FC is significantly improved (38.59%) by slanting the box pattern anteriorly as compared to the non-slanted FC design.

LUMiC® endoprosthesis for pelvic reconstruction: A Canadian experience.

The LUMiC® prosthesis was introduced to reduce the mechanical complications encountered with periacetabular reconstruction after pelvic tumor resection. Few have evaluated the outcomes associated with its use. A retrospective study from five Orthopedic Oncology Canadian centers was conducted. All patients with a LUMiC® endoprosthesis were included. Their charts were reviewed for surgical and functional outcomes. A total of 16 patients were followed for 28 months (3-60). A total of 12 patients (75%) had a LUMiC® after a resection of a primary sarcoma. Mean surgical time was 555 min. Four patients (25%) had a two-stages procedure. MSTS score was 60.3 preoperatively and 54.3 postoperatively. Patients got a dual mobility bearing and the silver coated implant was used in 7 patients (43.7%). Five patients (31.3%) underwent capsular reconstruction using a fabric. Silver-coating was not found to reduce infection risk (p = 0.61) and capsuloplasty did not prevent dislocation (p = 0.6). Five patients had peroperative complications (31.3%). Eight patients (50%) had an infection including all four with two-stages surgery. Dislocation occurred in five patients (31.3%) whereas no cases of aseptic loosening were reported. A total of 10 patients (62.5%) needed a reoperation. LUMiC® endoprosthesis provides low rates of aseptic loosening on medium-term follow-up. Infection and dislocation are common complications but we were unable to show benefits of capsuloplasty and silver-coated implants.

What are the 2-year survivorship outcomes of custom hemipelvis reconstruction after hemipelvectomy and revision arthroplasty? The evolution of a customilium "monoflange".

Innovations in machined and three-dimensionally (3D) printed implant technology have allowed for customized complex pelvic reconstructions. We sought to determine the survivorship of customhemipelvis reconstruction using ilium-only fixation at a minimum 2-year follow-up, their modes of failure, and the postoperative complications resulting from the procedure. A retrospective review identified 12 consecutive patients treated with customhemipelvis reconstruction. Indications for surgery were bone tumor requiring internal hemipelvectomy (four patients) or multiply revised, failed hip arthroplasty with massive bone loss (eight patients). All patients had a minimum of 2-year follow-up with a mean of 60.5 months. Kaplan-Meier survivorship analysis was determined for all patients. Postoperative complications and reoperations were categorized for all patients. At a mean of 60.5 months, 11 of 12 patients had retained their customimplant (92% survivorship). One implant was removed as a result of an acute periprosthetic joint infection (PJI). There were no cases of aseptic loosening. Seven of 12 patients required reoperation (threePJI; two dislocations; two superficial wound complications), with five patients going on to reoperation-free survival. Customhemipelvis reconstruction utilizing an ilium monoflange provides durable short-term fixation at a minimum 2-year follow-up. Reoperation for infection and dislocation is common.

Среднесрочные результаты применения метода аутопластики медиального дефекта большеберцовой кости при первичном эндопротезировании коленного сустава

Introduction Repair of a bone defect in primary total knee arthroplasty remains one of the most common tasks that must be addressed intraoperatively. Autologous bone grafting is a good biological option to preserve the bone tissue for conservative revision. The objective of the study was to analyze the results of autologous bone grafting of the medial tibial defect in primary total knee arthroplasty. Material and methods Results of autografting a bone defect with cancellous bone obtained when forming a groove for the intercondylar box of the femoral component of the tibia during primary total knee arthroplasty were retrospectively analyzed (main group, n = 31). The control group (n = 31) was formed by leveling the heterogeneous clinical parameters identified in the initial data using the PSM method. The mean follow-up period was 72 months. The Mann-Whitney and Wilcoxon tests were used for statistical data analysis. Lower limb realignment and bone graft reconstruction were evaluated radiographically, and KSS and WOMAC questionnaires were used for physical evaluation. Results There were no significant differences in the baseline and postoperative clinical conditions of the realigned lower limbs and the number of identified non-progressive radiolucent lines no greater than 2 mm in the groups. There were significant differences in the severity of varus deformity at baseline. Each group had one case of aseptic loosening of the tibial component. One patient of the comparison group had a late periprosthetic joint infection that was arrested with two-stage revision treatment. Discussion There were significant differences in the size of the varus deformity with no significant differences in the scores at the baseline between the groups. There were no differences in the realigned lower limbs and in the scores reported in the groups postoperatively. Conclusion The method developed was shown to be safe, affordable and effective. The result obtained was confirmed by absent differences in clinical and radiological outcomes between groups.

Clinical Outcomes and Survivorship of Hybrid Total Hip Arthroplasty Performed Through the Anterior Approach

There is growing evidence that cemented femoral stems have lower complication rates in the elderly due to lower rates of periprosthetic fracture. The main objective of this study was to analyze the survival rate of a hybrid total hip arthroplasty (THA) construct utilizing a taper-slip femoral stem implanted through the anterior approach (AA). Secondary outcome measures were the complication rate, the rate of aseptic loosening, coronal plane alignment of the stem, and the grade of the cement mantle. Patients who underwent AA hybrid THA from 2013 to 2020 were included. Indications for a cemented stem were age over 70 or patients with poor bone quality. Descriptive statistics were calculated for patient characteristics. Serial radiographs were reviewed for component alignment and for evidence of implant loosening. The survival of the femoral stem was recorded, with failure defined as femoral stem revision for any reason or radiographic evidence of implant loosening. A total of 473 hybrid THA in 426 patients were identified, with a mean age of 76 years. Mean follow-up was 38 months. Femoral stem survival was 99.2%. There were no cases of aseptic loosening of the femoral component. Mean coronal stem alignment was 0.2 degrees varus, and all were within 5 degrees of neutral. Cement mantle grade was either A or B in 94% of cases. AA hybrid THA is an excellent option in elderly patients, or patients with poor bone quality, with a femoral stem survival rate of 99.2% and a 0% rate of aseptic loosening.