Component Revision Research Articles

Increased Metal Component Failure with STAR Total Ankle

Category: Ankle Arthritis Introduction/Purpose: With the increasing total ankle arthroplasty (TAA) literature, there is a need to further examine the outcomes across a wide variety of implants. The purpose of this study is to review the existing literature and identify trends among current individual TAA implants. Methods: A comprehensive search of MEDLINE for all articles published between 1996 and 2021 was conducted with a minimum two-year mean follow-up. Two reviewers evaluated each study to determine whether it was eligible for inclusion and abstracted the data of interest. Meta-analytic pooling of group results across studies was performed, examining for individual implant survival and component failure. Seventy-three implant groups met inclusion criteria (3rd and 4th generation implants only), composed of STAR (20), Salto (mobile bearing) (10), Salto Talaris (11), Hintegra (8), Zimmer (6), INBONE II (6), INBONE I (4), Infinity (4), Cadence (4). 41 groups (56.2%) were implanted with mobile bearing devices and 32 (43.8%) with fixed bearing implants. In total, 6498 subjects were included with a mean age of 61.77 years and mean BMI of 28.5 kg/m2. At mean follow-up of 62.2 months, the overall reoperation rate was 21.13% and metal component revision rate was 10.16%. Results: Multivariate analysis of all implants, controlling for follow-up duration, found a statistically significant difference in the metal component survival rate (p=.036) and reoperation rate (p=.007) with the STARs TAAs surviving significantly worse and undergoing reoperation at a significantly higher rate than all other implants. There was no statistically significant difference in the rate of metal component revision (p=.768), tibial component failure rate (p=.095), or talar component failure rate (p=.089). Analysis of the Salto Talaris vs Salto found a significant difference in metal component survival rate (Salto=90.68%, Salto Talaris=97.81%; p=.002). Lastly, analysis of the INBONE I vs II implants found INBONE I had a significantly greater rate of revision due to metal component failure (INBONE I=9.8%, INBONE II=3.4%; p=.002). Conclusion: Based on current literature, it appears that the STAR total ankle implant has a statistically significantly lower rate of metal component survival and higher rate of reoperation than the other 3rd and 4th generation implants examined, even when controlling for study follow-up duration. The fixed bearing Salto Talaris had statistically significantly better survival rate than the mobile bearing Salto. These findings are important to physicians when considering implants for total ankle arthroplasty.

Early to Mid-Term Follow-up of Total Ankle Arthroplasty in Patients <35 Years

Category: Ankle Arthritis; Ankle Introduction/Purpose: Younger age remains at the forefront of discussion when deciding between total ankle arthroplasty (TAA) and the ankle arthrodesis (AA) for treatment of end stage ankle arthritis. Unlike in the hip and knee, ankle arthritis is typically post-traumatic and presents at a much younger patient age. With the goal of preserving ankle motion, improving function and limiting adjacent joint degeneration, TAA has been shown to be safe and effective in patients < 55 years of age. However, it is not uncommon for debilitating ankle arthritis to occur in individuals within their fourth or even third decade of life resulting in significant patient comorbidity. The purpose of our study was to evaluate patient reported outcome measures and survivorship after primary TAA in patients < 35 years old. Methods: A retrospective chart review was conducted of patients < 35 years old who underwent primary TAA at a single institution from 2007-2020. Patient demographics, outcome measures, and complications were recorded. All patients had a minimum clinical follow up of 2 years. Patient reported outcome measures collected included VAS, SMFA dysfunction index, SF-36 and AOFAS hindfoot scores. Outcome measures were evaluated preoperative, 1 year postoperative, and at final follow up. Paired t-tests were performed to compare individual patients’ changes in PRO from preoperative to postoperative timepoints. Implant survivorship was evaluated as well as complications related to the index procedure. Implant survivorship based on need for complete revision of either the tibial or talar component Results: Twelve patients were included in the study. Average age at surgery was 28.5 years. Mean follow-up was 7.2 years. Mean VAS improved from 53.8 preoperatively to 14.7 (p= 0.152) at 1-year and 12.5 (p= 0.045) at final follow up, respectively. Mean SMFA improved from 40.0 preoperatively to 27.1 (p= 0.018) at 1-year and 24.0 (p= 0.006) at final follow up, respectively. SF-36 and AOFAS hindfoot scores also improved at 1 year and final follow-up compared to preoperative values [SF-36: 45.3 to 60.2 (p=0.06) and 67.0 (p=0.016); AOFAS: 40.6 to 70 (p= 0.08) and 68.9 (p=0.068)]. One patient required talar component revision due to aseptic loosening. One patient required subsequent removal of heterotopic bone due to impingement. No patients developed infection requiring surgical intervention. Conclusion: The onset of ankle arthritis typically occurs at a much younger age compared with that of the hip and knee and has a detrimental impact on patient quality of life. Despite a young age and increased activity demands, our results demonstrated that patients < 35 with end-stage ankle arthritis undergoing TAA demonstrated improved patient-reported outcomes greater than 2 years after surgery. Survivorship of TAA in our study was 91.7% at a mean follow-up of 7.2 years. We believe that TAA is a safe, effective and durable option for very young patients with high patient satisfaction at early to mid-term follow up.

Aseptic Acetabular Revisions ≤90 Days, 91 Days to 2 Years, and >2 Years After Total Hip Arthroplasty: Comparing Etiologies, Complications, and Postoperative Outcomes

BackgroundIsolated acetabular component revision is an effective treatment for revision total hip arthroplasty patients who have well-fixed femoral implants. We aimed to evaluate the modes of acetabular failure following primary total hip arthroplasty and to identify factors associated with increased morbidities and postoperative outcomes. MethodsWe conducted a retrospective analysis and identified 318 isolated aseptic acetabular revisions. We separated patients by ≤90 days, 91 days to 2 years, and >2 years for acetabular revisions and compared demographics, reasons for revision, 90-day readmissions, rerevisions, and postrevision infections. Revisions ≤90 days, 91 days to 2 years, and >2 years accounted for 10.7, 19.2, and 70.1% of revisions, respectively. Revisions ≤90 days, 91 days to 2 years, and >2 years had their primary total hip arthroplasty at a mean age of 66, 63, and 55 years (P < .001), respectively. ResultsRevisions within 90 days were mainly indicated for dislocation/instability (58.8%) or periprosthetic fracture (23.5%) while revisions over 2 years were indicated for polyethylene wear/osteolysis (37.2%). Patients with revisions past 90 days were more likely to require rerevision compared to patients with revisions within 90 days (P < .001). There were no differences in readmissions (P = .28) or infection rates (P = .37). ConclusionsAcetabular revisions within 90 days were more commonly indicated for instability and periprosthetic fracture, while those over 2 years were indicated for polyethylene wear. Revisions past 90 days were more likely to require subsequent rerevisions without increased 90-day readmissions or infections. Level III EvidenceRetrospective cohort study.

Isolated Liner Exchange Versus All-Component Revision for Instability After Total Knee Arthroplasty

BackgroundInstability is a common cause for revision total knee arthroplasty (TKA). The risks and benefits of polyethylene liner exchange (LE) as compared to full metal component revision continue to be debated. The purpose of this study was to investigate the success rate and complication profiles of revision TKA for instability based on surgical procedure. MethodsThis was a retrospective study of patients undergoing revision TKA for instability from 2015 to 2019. Patients with prior revisions were excluded. 42 patients undergoing isolated polyethylene LE without an increase in constraint were compared with 48 patients undergoing full component revision revision (FCR) of both tibial and femoral components. The primary outcome was differences in rerevision for instability. Noninstability reoperations, 90-day readmissions, and lengths-of-stay were also compared. ResultsLEs had a 10.1% higher rerevision for instability rate that approached statistical significance (LE 14.3% versus FCR 4.2%, P = .092). Additionally, FCR had a 4.2% rate of aseptic loosening and a 4.2% rate of periprosthetic-joint-infection, whereas LE had none (P = .181). FCR also had a longer length-of-stay (FCR 3.0 ± 1.3 versus LE: 1.8 ± 0.9 days, P < .001). No differences were found in 90-day readmissions (LE 7.1% versus FCR 4.2%, P = .661). ConclusionAll component revision may have a higher success rate than isolated LE in addressing instability but is associated with higher rates of surgical complications. With appropriate patient selection and risk-benefit discussion, isolated LE may be a reasonable surgical option for TKA instability with a lower complication profile and length-of-stay.

Mid-Term Outcomes of Modular Dual Mobility Bearings in Total Hip Arthroplasty

AbstractModular dual mobility (MDM) prostheses in which a cobalt–chromium liner is inserted into a titanium acetabular shell have the potential for corrosion. This has raised concern. While these constructs have been shown to effectively reduce the risk of dislocation in revision and high-risk primary total hip arthroplasty (THA), previous studies have been limited by the length of follow-up. The purpose of the study is to review the mid-term clinical outcomes of MDM implants with a minimum of 5-year follow-up. A retrospective, observational study was conducted on all consecutive patients who underwent THA with a MDM implant from June 2011 and March 2017 at an urban, tertiary academic medical center. Descriptive statistics were used to describe baseline patient characteristics. Primary endpoints included revision rates, dislocations rates, and implant component survivorship. Implant survival was analyzed using the Kaplan–Meier method. A total of 92 cases (61 primary, 31 revision) underwent THA with a MDM implant at an average follow-up of 6.90 ± 1.48 years (range: 5.01–10.53 years). The mean patient age at the time of surgery was 58.20 ± 11.85 years. Six patients were revised (6.5%, 6/92), two for periprosthetic joint infection (2.2%, 2/92), one due to aseptic loosening (1.1%, 1/92), one due to periprosthetic fracture (1.1%, 1/92), and the remaining two for metallosis (2.2%, 2/92). Kaplan–Meier survivorship analysis showed a 93.5% survival rate for all-cause revisions and 98.9% survival for acetabular component revision. MDM components reliably decrease the risk of dislocation after THA. However, the occurrence of two revisions due to metallosis demonstrates the necessity for continued surveillance in this cohort. Larger trials with long-term follow-up may be required to further elucidate the long-term outcomes and performance of these bearings.

Early Postoperative Results in Robotic-Arm-Assisted Total Knee Replacement versus Conventional Technique: First Latin American Experience.

Early results with robotic-arm-assisted total knee arthroplasty (TKA) are encouraging; nevertheless, literature might be unrepresentative, as it comes mostly from American, European, and Asian countries. There is limited experience and no comparative clinical reports in Latin America, a region of mainly low- and middle-income countries with limited access to these promising technologies. This study aims to compare the early postoperative results of the first Latin American experience with robotic-arm-assisted TKA versus conventional TKA. A cohort study was performed, including 181 consecutive patients (195 knees) with advanced symptomatic knee osteoarthritis (OA) undergoing primary TKA between March 2016 and October 2019. The cohort included 111 consecutive patients (123 knees) undergoing conventional TKA, followed by 70 consecutive patients (72 knees) undergoing robotic-arm-assisted TKA. The same surgical team (surgeon 1 and surgeon 2) performed all procedures. Patients with previous osteotomy, posttraumatic OA, and revision components were not considered. The same anesthetic and rehabilitation protocol was followed. The investigated clinical outcomes (for the first 60 postoperative days) were: surgical tourniquet time, time to home discharge, time to ambulation, postoperative daily pain (Visual Analog Scale), opioid use, range of motion, blood loss, complications, and postoperative mechanical axis. The early clinical postoperative results of this first Latin American comparative experience of robotic-arm-assisted TKA versus conventional technique showed lower opioids requirements and faster functional recovery of ambulation in those patients operated with the robotic system; nevertheless, surgical times were higher, without differences in total postoperative complications and other clinical outcomes.

Survivorship analysis of CAD-CAM total shoulder replacement.

Glenoid bone loss represents a challenge in shoulder arthroplasty and often precludes standard implants. The CAD-CAM total shoulder replacement (TSR) is an option in these cases. This study aimed to assess survivorship and long-term patient outcomes of the CAD-CAM TSR. Fifty-eight patients that underwent a CAD-CAM TSR by three surgeons at a single tertiary referral centre between 2009 and 2017 were reviewed. The mean follow-up was 70 months (28-130). Data was collected on survivorship, range of movement, Oxford shoulder score (OSS, 0-48), subjective shoulder value (SSV, 0-100%), pain score (0-10), and overall patient satisfaction. CAD-CAM TSR was undertaken as a primary procedure in 28% (n = 16) for end-stage arthritis with severe glenoid bone loss, and as a revision procedure in 72% (n = 42). Of the total, 17% (n = 10) required component revision at a mean of 24 months (4x prosthesis loosening, 3x infection, 3x periprosthetic fracture). Forward elevation improved from 45° ± 27° to 59° ± 29° (P = 0.0056), abduction from 43° ± 29° to 55° ± 26° (P = 0.034) and external rotation from 8° ± 11° to 16° ± 14° (P = 0.031). OSS improved from 15 ± 8 to 29 ± 9 (P = 0.0009), SSV from 18 ± 16 to 62 ± 23 (P < 0.0001), and pain score from 8 ± 2 to 2 ± 2 (P < 0.0001). 88% of patients would undergo the procedure again. CAD-CAM TSR is reserved for complex cases involving severe glenoid bone loss, offering significant improvements in pain and function with overall positive patient satisfaction.

No difference in the use of revision components and rerevision rate in conversion to total knee replacement following Oxford Partial Knee Microplasty Instrumentation: a registry study of 529 conversions.

Microplasty Instrumentation was introduced to improve Oxford Mobile Partial Knee placement and preserve tibial bone in partial knee replacement (PKR). This might therefore reduce revision complexity. We aimed to assess the difference in use of revision total knee replacement (TKR) tibial components in failed Microplasty versus non-Microplasty instrumented PKRs. Data on 529 conversions to TKR (156 Microplasty instrumented and 373 non-Microplasty instrumented PKRs) from the Dutch Arthroplasty Register (LROI) between 2007 and 2019 was used. The primary outcome was the difference in use of revision TKR tibial components during conversion to TKR, which was calculated with a univariable logistic regression analysis. The secondary outcomes were the 3-year re-revision rate and hazard ratios calculated with Kaplan-Meier and Cox regression analyses. Revision TKR tibial components were used in 29% of the conversions to TKR after failed Microplasty instrumented PKRs and in 24% after failed non-Microplasty instrumented PKRs with an odds ratio of 1.3 (CI 0.86-2.0). The 3-year re-revision rates were 8.4% (CI 4.1-17) after conversion to TKR for failed Microplasty and 11% (CI 7.8-15) for failed non-Microplasty instrumented PKRs with a hazard ratio of 0.77 (CI 0.36-1.7). There was no difference in use of revision tibial components for conversion to TKR or in re-revision rate after failed Microplasty versus non-Microplasty instrumented PKRs nor in the 3-year revision rate.

Cementless Versus Cemented Total Knee Arthroplasty of the Same Design: Shorter Operative Times and Minimal Differences in Early Outcomes.

Introduction: Modern primary cementless total knee arthroplasty (TKA) is increasingly popular, but there is limited evidence on its benefits, early complications, and failures. Purpose: We sought to evaluate operative time, early survivorship, and outcomes of cementless versus cemented TKA of the same design. Methods: As part of this single-center, multisurgeon, retrospective cohort study, we reviewed 598 primary, unilateral TKAs (170 cementless, 428 cemented) of the same design from 2016 to 2018. The cementless cohort was younger (63 vs 67 years) and had more cruciate-retaining implants (17% vs 12%) compared with the cemented cohort. We compared operative time, length of stay, and complications. Survivorship curves were generated via the Kaplan-Meier method. Results: Patients with cementless TKA (using the Triathlon implant, Stryker) had a 24% reduction in operative time (83 vs 109 minutes) but similar length of stay compared with those with cemented TKA (57 vs 61 hours). Cementless TKA had a higher rate of postoperative manipulation for stiffness compared with cemented TKA (8% vs 3%), but there were notable demographic differences between the cohorts. Despite 2 cases (1%) of early cementless tibial aseptic loosening requiring component revision compared with none in the cemented cohort, there was no difference in revision-free survivorship at 2 years (96% and 98%, respectively). Conclusion: This retrospective cohort study found that cementless TKA had a 24% reduction in operative time compared with cemented TKA and similar short-term survivorship. There was a slightly higher rate of aseptic revision and manipulation in the cementless cohort. Further study is warranted on the long-term durability of cemented and cementless TKAs to determine if cementless fixation proves more durable in the midterm to long term.

The Role of Constraint in Revision Total Knee Replacement for Instability: Full Component Revision Vs Isolated Polyethylene Exchange in Selected Patients.

Instability is a common indication for revision after total knee arthroplasty. Replacement of multiple components is the current standard, but isolated polyethylene liner exchange (IPE) may present a less-morbid alternative. This study aims to determine (1) whether IPE results in similar rerevision frequency to component revision in select patients with symptomatic instability and (2) the effect of increasing constraint on the outcome. We retrospectively reviewed 117 patients revised for symptomatic total knee arthroplasty instability from January 2016 to December 2017. The component revision (60 patients) or IPE (57 patients) cohorts were further stratified based on whether constraint was increased or not. The primary objective was to compare rerevision rates 2 years after component revision vs IPE. The secondary objectives consisted of evaluating reasons for rerevision, preoperative and postoperative patient-reported outcome measures, and range of motion. The rerevision rate was 18%, with no statistical difference between component and IPE cohorts. Cases where level of constraint increased due to revision, a significantly lower rate of rerevision was detected (9 of 77) (12%) than in cases where constraint did not increase (12 of 39) (31%) (P=0.012). This association was also noted in the component revision cohort but not in the IPE cohort (P=0.011). Rerevision occurred at similar frequencies 2 years after IPE or component revision for total knee arthroplasty instability. For component revision, increased constraint was associated with significantly fewer rerevisions.

A Simple Technique to Remove an Incarcerated Ceramic Liner in Revision Hip Arthroplasty

Extraction of a well-fixed ceramic liner during revision total hip arthroplasty can be technically challenging, particularly when acetabular fixation screws prevent en bloc removal of the shell and insert without causing collateral damage to the adjacent pelvic bone. It is also important to remove the ceramic liner intact, as ceramic debris left in the joint may cause third body wear with premature articular wear of the revised implants. We describe a novel technique to extract an incarcerated ceramic liner when previously described strategies prove ineffective. Knowledge of this technique will help surgeons avoid unnecessary damage to the acetabular bone and optimize prospects for stable implantation of revision components.

Revision Total Hip Arthroplasty Utilizing an Acetabular Reinforcement Ring with a Metal Augment: A Minimum Eight-Year Follow-Up Study.

Background and Objectives: An acetabular reinforcement ring (ARR) with a structural allograft is conventionally used to treat large acetabular bone defects or discontinuity during revision hip arthroplasty. However, ARR is prone to failure due to bone resorption and lack of incorporation. Here, we investigated the surgical outcomes of the patients who underwent revision total hip arthroplasty (THA) using ARR combined with a metal augment (MA). Materials and Methods: We retrospectively reviewed data from 10 consecutive patients who had a minimum 8-year follow-up after revision hip arthroplasty using ARR with MA in Paprosky type III acetabular defect. We collected patient demographics, surgical details, clinical scores (including Harris Hip Score (HHS)), postoperative complications, and 8-year survival rates. Results: Six male and four female patients were included. The mean age was 64.3 years, and the mean follow-up duration was 104.3 months (96.0-112.0 months). Trauma-related diagnosis was the most common reason for index surgery. Three patients underwent all component revision, and seven underwent cup revision. Six were confirmed as Paprosky type IIIA and four as type IIIB. The mean HHS at the final follow-up was 81.5 (72-91). One patient was diagnosed with prosthetic joint infection at the 3-month follow-up; therefore, the minimum 8-year survival rate with our technique was 90.0% (95% confidence interval, 90.3-118.5%). Conclusions: The satisfactory mid- to long-term results of revision THA suggest that ARR combined with tantalum MA is a viable revision option for treating severe acetabular defects with pelvic discontinuity.

(115) Mechanical and Anatomic Indications for Inflatable Penile Prosthesis Revision

Abstract Introduction Implantation of an inflatable penile prosthesis (IPP) is considered the gold standard for definitive treatment of men with refractory erectile dysfunction. As mechanical devices, IPPs have a finite lifespan, thus often requiring surgical revision or replacement of components over time. Objective To characterize the location of IPP mechanical component failure in patients presenting for revision or explant and stratify them by device manufacturer [Boston Scientific (BSc) and Coloplast (CP)]. Methods A retrospective chart review of our large, single-surgeon, tertiary referral center penile prosthesis database between 2007-2022 was completed to identify all men who underwent IPP revision (partial or full device) or explant. Only cases having intraoperative documentation of cause for IPP failure and device manufacturer were included. Reasons for revision or replacement surgery were categorized into mechanical (tubing, cylinder, or reservoir leak and pump malfunction) and non-mechanical (component herniation, erosion, or crossover). All revisions performed due to non-mechanical reasons were excluded from analysis. Chi-square analysis was used to assess failure rates and causes. A Student’s T-test was used to assess time to revision and demographics. Results Among 933 IPP cases, we identified 133 patients who underwent 272 revision procedures; 154 met inclusion criteria (96 BSc and 58 CP). Forty-four (29%) of those surgeries were revisions of devices placed by outside surgeons, and 110 (71%) were revisions of IPPs inserted at our institution. Average patient age was 67 years for BSc and 63 years for CP (p = 0.086), and the average BMI was 28.7 for BSc and 30.8 for CP (p = 0.122). Time to revision was similar between brands at an average of 39 months for BSc and 56 months for CP (p = 0.11). Eighty-one (53%) of the surgeries were revisions of one affected implant component, 56 (36%) were full device removal/replacement, and 17 (11%) were full explants. Coloplast devices required revision more frequently due to tubing fracture (p &amp;lt; 0.01), and BSc devices required revision more frequently due to pump malfunction (p = 0.02). Both devices rarely failed due to cylinder or reservoir defects (Figure). Conclusions Although time to revision was similar between the two brands, CP devices malfunctioned more often due to tubing fracture whereas BSc devices failed more often due to pump malfunction. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific, Coloplast

(421) Partial versus Complete Component Exchange in Revision of the Non-Infected Inflatable Penile Prosthesis: A Multicenter Analysis.

Abstract Introduction Management of malfunctioning inflatable penile prostheses (IPPs) is varied, with some patients undergoing complete exchange of the entire device and others undergoing exchange of non-functioning components only. The impact of partial component exchange versus complete device exchange on infectious and non-infectious complications is unknown. Objective To describe the infectious and non-infectious complications in men undergoing IPP revision with partial and complete component exchange for device malfunction. Methods We performed a multicenter retrospective cohort study of patients who underwent IPP revision. Men undergoing procedures for implant infection were excluded. Patients were divided into two groups based on whether they had complete exchange of the entire device or partial exchange of only one or two components (i.e. pump revision only, or pump and/or reservoir exchanged but cylinders left in situ). Differences between baseline demographics were assessed with two tailed student t-tests and Fisher’s exact tests. Time to revision was log transformed to reduce deviation from normality. Multivariate analysis was performed controlling for significant covariates and clinically relevant variables. A descriptive analysis was performed of non-infectious complications. Results 466 men underwent IPP revision. Of these, 377 had complete exchange of the entire device and 89 had partial component exchange. Men undergoing partial exchange had a significantly higher infection rate (6.7% vs 2.1%, p=0.034). Although the partial exchange group was more likely to receive antifungals (52.8 vs 17.8%, p&amp;lt;0.001) and have a modified salvage washout (78.4 vs 61.2%, p=0.003), this cohort was less likely to receive vancomycin and gentamicin for antimicrobial prophylaxis (60.7 vs 81.7%, p&amp;lt;0.001). Time to revision from original implantation was significantly shorter in the partial exchange group (46 vs 168 months, p&amp;lt;0.001). In multivariate analysis, partial exchange surgery (OR 2.6, 95%CI 0.7-9.5, p=0.15), vancomycin and gentamicin antimicrobial prophylaxis (OR 0.4, 95%CI 0.1-1.5, p=0.20), modified salvage washout (OR 1.6, 95%CI 0.3-8.4, p=0.54), and antifungal prophylaxis (OR 2.7, 95%CI 0.7-10.3, p=0.13) were no longer associated with postoperative infections. The partial exchange group had greater rates of mechanical complications (20.2% vs 10.6%, p=0.019) such as pump malfunction and tubing breakage. Conclusions While patients undergoing partial component revision were more likely to receive non-standard antibiotics, antifungal prophylaxis, and undergo a modified salvage washout, they had more infectious and mechanical/non-infectious complications. These findings suggest that partial component exchange increases the risks in men undergoing IPP revision for non-infectious indications. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, Boston Scientific, Antares Pharma, Clarus Therapeutics, Cynosure, Promescent, Sprout, Viome

Patellofemoral arthroplasty conversion to total knee arthroplasty: An updated retrieval analysis and clinical outcomes

BackgroundA prior retrieval analysis found high rates of infection after conversion of PFA to TKA, but was limited by a small sample size. The purpose of this study is to perform a retrieval analysis with clinical correlation on an expanded group of patients to better understand conversion of PFA to TKA. MethodA retrospective review of an implant retrieval registry identified 62 conversions of PFA to TKA between 2004–2021. Implants were analyzed for wear pattern and cement fixation. Patient charts were reviewed for demographic information, perioperative data, prior and subsequent surgical procedures, complications and outcomes. Radiographs performed prior to index PFA and conversion procedures were assessed for KL grading. ResultsCement fixation was present on 86% of retrieved components and wear was more pronounced on the lateral side. The most common indication for conversion to TKA was progression of OA in 46.8% of patients, followed by unexplained pain in the absence of radiographic or clinical changes (37.1%), loosening (8.1%), mechanical symptoms (4.8%), traumatic (3.2%). Thirteen patient experienced complications requiring additional procedures including arthrofibrosis (n = 4, 7.3%), PJI (n = 3, 5.5%), instability (n = 3, 5.5%), hematoma (n = 2, 3.6%) and loosening (n = 1, 1.8%). Revision components were used in 1.8% of cases and average post-conversion arc of motion was 119 degrees. ConclusionsThe most common reason for PFA conversion to TKA was progression of osteoarthritis. PFA conversion to TKA is technically similar to primary TKA, but complication rates are more consistent with revision TKA in this study.

Does Acetabular Bone Loss Severity Associate With Patient-Reported Outcome Measures and Reoperation Rate in Revision Total Hip Arthroplasty?

BackgroundAcetabular bone loss is a challenging clinical problem when performing revision total hip arthroplasty (rTHA). This study aimed to evaluate how acetabular bone loss severity influences (1) clinical outcomes and (2) patient-reported outcome measures (PROMs) in rTHA patients. MethodsPatients who underwent rTHA with acetabular component revision from January 2016 to February 2022 were included. Treating surgeons determined Paprosky acetabular bone loss classification intraoperatively. Patients were grouped based on numeric classification (PI, PII, or PIII) to categorize severity. Hip disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS, JR.) and Lower Extremity Activity Scale (LEAS) score were collected preoperatively and 1 year postoperatively. There were 197 patients included. Paprosky classification was PI for 47 patients (23.9%), PII for 113 patients (57.4%), and PIII for 37 patients (18.8%). Mean clinical follow-up was 29 months (range, 1 to 69). ResultsReoperation rate was 0% (0 patients), 6.2% (7 patients), and 10.8% (4 patients) for PI, PII and PIII groups respectively (P = .052). Mean preoperative HOOS, JR. and LEAS for PI, PII and PIII groups were significantly different, but 1-year postoperative HOOS, JR. and LEAS did not differ significantly. Rates of HOOS, JR. minimal clinically important difference achievement differed significantly between bone loss groups. ConclusionIn this study of rTHA patients, greater acetabular bone loss severity was associated with worse preoperative PROMs and trended toward higher reoperation rate. Postoperative PROMs for bone loss severity groups were statistically similar. Patients who had worse acetabular bone loss were more likely to achieve HOOS, JR. minimal clinically important difference postoperatively. Level of EvidenceIII.

PD42-02 PARTIAL COMPONENT EXCHANGE OF A NON-INFECTED IPP IS ASSOCIATED WITH A HIGHER COMPLICATION RATE

You have accessJournal of UrologyCME1 Apr 2023PD42-02 PARTIAL COMPONENT EXCHANGE OF A NON-INFECTED IPP IS ASSOCIATED WITH A HIGHER COMPLICATION RATE David Barham, Muhammed Hammad, Edward Choi, Daniel Swerdloff, Brittany Berk, Eric Chung, Jonathan Clavell-Hernandez, Martin Gross, Tung-Chin Hsieh, James Jones, Martin Kathrins, Aaron Lentz, Patrick Selph, Jay Simhan, Robert Welliver, and Faysal Yafi David BarhamDavid Barham More articles by this author , Muhammed HammadMuhammed Hammad More articles by this author , Edward ChoiEdward Choi More articles by this author , Daniel SwerdloffDaniel Swerdloff More articles by this author , Brittany BerkBrittany Berk More articles by this author , Eric ChungEric Chung More articles by this author , Jonathan Clavell-HernandezJonathan Clavell-Hernandez More articles by this author , Martin GrossMartin Gross More articles by this author , Tung-Chin HsiehTung-Chin Hsieh More articles by this author , James JonesJames Jones More articles by this author , Martin KathrinsMartin Kathrins More articles by this author , Aaron LentzAaron Lentz More articles by this author , Patrick SelphPatrick Selph More articles by this author , Jay SimhanJay Simhan More articles by this author , Robert WelliverRobert Welliver More articles by this author , and Faysal YafiFaysal Yafi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003352.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Management of malfunctioning inflatable penile prostheses (IPPs) is varied. The impact of partial component exchange versus complete device exchange on complications is unknown. We sought to describe the infectious and non-infectious complications in men undergoing IPP revision with partial and complete component exchange for device malfunction. METHODS: We performed a multicenter retrospective cohort study of patients who underwent IPP revision. Men undergoing procedures for implant infection were excluded. Patients were divided into two groups based on whether they had complete exchange of the entire device or partial exchange of only one or two components (i.e. pump revision only, or pump and reservoir exchanged but cylinders left in situ). Differences between baseline demographics were assessed with two tailed student t-tests and Fisher’s exact tests. Multivariable analysis was performed controlling for significant covariates and clinically relevant variables. A descriptive analysis was performed of non-infectious complications. RESULTS: 453 men underwent IPP revision. 368 had complete exchange of the entire device and 85 had partial component exchange. Men undergoing partial exchange had a significantly higher infection rate (7.1% vs 2.2%, p=0.031). The partial exchange group also was more likely to receive antifungals (51.8 vs 16.8%, p<0.001), have a modified salvage washout (77.4 vs 60.2%, p=0.004), and less likely to receive vancomycin and gentamicin (63.5 vs 83.7%, p<0.001). Time to revision was significantly shorter in the partial exchange group (44.9 vs 168.2 months, p<0.001). In multivariable analysis, partial exchange surgery (OR 2.6, 95% CI 0.7-9.3, p=0.17), vancomycin and gentamicin prophylaxis (OR 0.3, 95% CI 0.1-1.2, p=0.11), modified salvage washout (OR 1.8, 95% CI 0.3-9.2, p=0.48), and antifungal prophylaxis (OR 2.7, 95% CI 0.7-10.3, p=0.13) were no longer associated with postoperative infections. The partial exchange group had greater rates of non-infectious complications (21.2% vs 9.5%, p=0.005) such as pump malfunction and tubing breakage. CONCLUSIONS: While patients undergoing partial component revision were more likely to receive non-standard antibiotics, antifungal prophylaxis, and undergo a modified salvage washout, they had more infectious and mechanical/non-infectious complications. These findings suggest that partial component exchange increases risks in men undergoing IPP revision for non-infectious indications. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1111 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information David Barham More articles by this author Muhammed Hammad More articles by this author Edward Choi More articles by this author Daniel Swerdloff More articles by this author Brittany Berk More articles by this author Eric Chung More articles by this author Jonathan Clavell-Hernandez More articles by this author Martin Gross More articles by this author Tung-Chin Hsieh More articles by this author James Jones More articles by this author Martin Kathrins More articles by this author Aaron Lentz More articles by this author Patrick Selph More articles by this author Jay Simhan More articles by this author Robert Welliver More articles by this author Faysal Yafi More articles by this author Expand All Advertisement PDF downloadLoading ...

One-stage complete eradication and revision hip due to pseudotumor in metal-on-metal hip arthroplasty.

The correct management and treatment of pseudotumors due to metal-on-metal (MOM) hip arthroplasty are still debated. The purpose of this study is to analyze the surgical treatment and the clinical and radiographic 3-year outcomes of MOM arthroplasty revisions due to pseudotumor treated with a strategy of excision and revision. Consecutive, retrospective series of 21 patients (8 males/13 females) with pseudotumor due to MOM hip arthroplasty was surgically treated at a single tertiary center. Demographic, clinical, radiological and implant-related features were collected pre-operatively. Post-revision clinical and radiographic parameters were evaluated. Chromium (Cr) and cobalt (Co) blood samples were collected before and after surgery. Three patients (14.2%) with pseudotumor underwent a resection arthroplasty due to infection (perioperative finding) and could not be reimplanted due to septic relapses. Twenty (95.2%) pseudotumors were completely resected. Revisions [2 total hip reimplantations (11.1%) and 16 isolated component revisions (88.9%)] were performed with non-MOM couplings. A clinical improvement at a mean post-revision follow-up 3.3 years [standard deviation (SD), ±2.2 years] was observed, from 50.3 (SD, ±4.6) to 88.3 (SD, ±9.2) Harris hip score (HHS) points (P<0.001). Among revisions, there were 5 complications (23.8%): 1 dislocation, 1 psoas impingement, and 3 infections (14.2%). No re-revision was carried out. Three (14.2%) pseudotumors recurred: 1 was surgically treated, 1 was treated with selective arterial embolization, and 1 clinically followed. At the final follow-up, Cr and Co blood ions beyond the threshold decreased from 85.7% cases to 0% in the seven patients that could be evaluated. The one-stage strategy of radical excision and revision with non-MOM couplings in pseudotumors due to MOM hip arthroplasty achieved good 3-year outcomes. However, complications were frequent (23%). Recurrences were not rare (14%) and did not require implant re-revision.

Minimum 25-Year Results of a Tapered Titanium Porous Plasma Spray Coated Femoral Component

BackgroundPrevious studies have reported excellent results with tapered, titanium, porous plasma-sprayed components in patients undergoing uncemented primary total hip arthroplasty (THA). The purpose of this study was to examine survival and clinical results at a minimum 25-year follow-up. MethodsWe reviewed all patients who underwent primary THA at our center through 1995 with a specific femoral component that was essentially unchanged since its 1984 introduction, except porous coating was continued circumferentially in 1987, a hydroxyapatite-coated option was offered in 1988, and an offset option was added in 1999. There were 332 patients (396 THA) who had a minimum 25-year follow-up (range, 25 to 37). Mean age at surgery was 48 years (range, 21 to 70 years). Mean follow-up in nonfailed patients was 29 years (range, 25 to 37 years). ResultsThere were 31 femoral revisions (7.8%): 9 infections, 3 failures of ingrowth, 5 aseptic loosening, 8 osteolysis well-fixed, 2 periprosthetic fractures, 2 polyethylene wear with trochanteric avulsion, 1 component breakage, and 1 malalignment well-fixed. Kaplan-Meier survival with the endpoint of all-cause stem revision was 94.8% (95% confidence interval: ±0.9%) at 37 years, and with the endpoint of aseptic loosening/failure of ingrowth was 98.7% (95% confidence interval: ±0.5) at 37 years. Harris hip scores improved significantly from 43 preoperatively to 76 most recently. ConclusionThis tapered, titanium, porous plasma spray-coated femoral component continues to demonstrate high long-term survival with a low rate of femoral component revision for any reason or aseptic loosening/failure of ingrowth.

Outcomes After Revision Total Knee Arthroplasty From a Specific, Now-Recalled Implant System

BackgroundA specific total knee arthroplasty (TKA) implant system was recently recalled for high incidence of early polymeric wear and osteolysis. We analyzed the early outcomes of aseptic revision with these implants. MethodsWe identified 202 aseptic revision TKAs of this implant system performed at a single institution between 2010 and 2020. Revision indications included aseptic loosening (n = 120), instability (n = 55), and polymeric wear/osteolysis (n = 27). Components were revised in 145 cases (72%) and isolated polyethylene insert exchange occurred in 57 cases (28%). Kaplan-Meier and Cox proportional hazards analyses were used to determine survivorship free from all-cause rerevision and rerevision risk factors. ResultsAt 2 and 5 years, survivorship free from all-cause rerevision was 89 and 76% in the polyethylene exchange cohort versus 92 and 84% in the component revision cohort (P = .5). At 2 and 5 years, survivorship in revision with components from the same manufacturer was 89 and 80% compared to 95 and 86% in revision with components from a different manufacturer (P = .2). Among re-revisions (n = 30), cones (37%), sleeves (7%), hinge/distal femoral replacement implants were frequently used (13%). Men had increased risk for rerevision (hazard ratio = 2.3, P = .04). ConclusionIn this series of aseptic revision TKAs performed on a now-recalled implant system, survivorship free from rerevision was lower than expected when components from the same manufacturer were utilized, but comparable to contemporary reports when both the components were revised with an alternative implant system. Metaphyseal fixation with cones and sleeves as well as highly constrained implants was frequently utilized at time of rerevision TKA. Level of evidenceLevel IV.