Joint Replacement Techniques Research Articles

Advances in Minimally Invasive Joint Replacement Techniques: Redefining Precision and Recovery

Minimally invasive joint replacement (MIJR) techniques have revolutionized orthopedic surgery by significantly reducing recovery times, hospital stays, and complication rates compared to traditional methods. Enhanced by innovations like robotics, augmented reality (AR), and patient-specific instrumentation (PSI), MIJR offers greater surgical precision with less trauma to surrounding tissues. This article explores the latest advancements in MIJR, demonstrating its impact on clinical outcomes and highlighting future trends such as AI-driven surgical planning and biologic implants. MIJR has become the gold standard in joint replacement, providing patients with faster recovery and improved long-term results. Minimally invasive joint replacement (MIJR) techniques have revolutionized orthopedic surgery by significantly reducing recovery times, hospital stays, and complication rates compared to traditional methods. Enhanced by innovations like robotics, augmented reality (AR), and patient-specific instrumentation (PSI), MIJR offers greater surgical precision with less trauma to surrounding tissues. This article explores the latest advancements in MIJR, demonstrating its impact on clinical outcomes and highlighting future trends such as AI-driven surgical planning and biologic implants. MIJR has become the gold standard in joint replacement, providing patients with faster recovery and improved long-term results.

660 Trapeziectomy Versus Joint Replacement for First Carpometacarpal (CMC-1) Joint Osteoarthritis: A Systematic Review and Meta-Analysis

Abstract Aim The challenge of managing first carpometacarpal (CMC-1) joint osteoarthritis is the lack of guidance on which surgical intervention is superior. This systematic review and meta-analysis compares joint replacement (JR) and trapeziectomy techniques to provide an update. Method In August 2020, MEDLINE, Embase and Web of Science were searched for eligible studies that compared these two techniques for the treatment of CMC-1 joint osteoarthritis (PROSPERO registration ID: CRD42020189728). Primary outcomes included the Disabilities of the Arm, Shoulder and Hand (DASH), QuickDASH and pain visual analogue scale (VAS) scores. Secondary outcomes, such as total complication, dislocation, and revision surgery rates, were also measured. Results From 1909 studies identified, 14 studies (1005 patients) were eligible. Our meta-analysis found that post-operative QuickDASH score was lower for patients in the JR group, indicating decreased disability following this technique (5 studies, p = 0.0002). However, pain VAS scores were similar between the two groups (5 studies, p = 0.22). Interestingly, JR techniques had significantly greater odds of overall complications (12 studies; OR 2.27; 95% CI 1.17-4.40, p = 0.02) and significantly greater odds of revision surgery (9 studies; OR 5.14; 95% CI 2.06-12.81, p = 0.0004). Conclusions Overall, based on low to moderate quality evidence, we found that JR treatments may result in better function with less disability with comparable pain (VAS) scores; however, JR has greater odds of complications and greater odds of requiring revision surgery. More robust RCTs that compare JR and TRAP with standardised outcome measures and long-term follow-up would add to the overall quality of evidence.

Surgical treatment of complex proximal humeral fractures in elderly patients: a matched-pair analysis of angular-stable plating vs. reverse shoulder arthroplasty

To date, there is a lack of consensus regarding the type of surgical treatment for complex proximal humeral fractures (PHFs) in elderly patients, especially between joint preservation and joint replacement techniques. We matched 60 patients (aged 73.2 ± 6.4 years) with complex PHFs in terms of sex, age, and Charlson Comorbidity Index, who underwent locking-plate open reduction-internal fixation (ORIF) or reverse shoulder arthroplasty (RSA) (2011-2017). Postoperative range of motion and functional outcome were assessed using the American Shoulder and Elbow Surgeons shoulder score, Oxford Shoulder Score, Constant-Murley score, and Disabilities of the Arm, Shoulder and Hand score at a mean follow-up of 49 months (ORIF group) and 38 months (RSA group). Complications and unplanned revision surgery were recorded, and all radiographs were analyzed. ORIF resulted in numerically, although not statistically significantly, greater mean shoulder motion vs. RSA. Significantly better outcome was reported for the Oxford Shoulder Score (P = .034) and Disabilities of the Arm, Shoulder and Hand score (P = .026) in the ORIF group, although no significant differences were observed in the American Shoulder and Elbow Surgeons shoulder score and Constant-Murley score. The complication rate (30% vs. 10%) and revision rate (20% vs. 3%) were significantly higher in the ORIF group (P = .028), with patients who had complications or required revision having worse functional results. Favorable results are achievable through both angular-stable plating and RSA. Although ORIF may be associated with a superior functional outcome, exceeding the minimal clinically important difference, RSA was linked to significantly fewer complications and revisions.

Complications after surgical treatment of proximal humerus fractures in the elderly—an analysis of complication patterns and risk factors for reverse shoulder arthroplasty and angular-stable plating

To date, there is a lack of consensus regarding surgical treatment recommendations for complex proximal humerus fracture (PHF) patterns, especially between joint preservation and joint replacement techniques. Between 2012 and 2017, 146 patients (aged 74.1 ± 8.0 years) with complex PHF were treated with locking plates (open reduction-internal fixation [ORIF]) or reverse total shoulder arthroplasty (RTSA). Complications and unplanned revision surgery were recorded in a mid-term follow-up. Potential patient and surgical risk factors for complications were extracted. Univariate and multivariate analyses were conducted. Follow-up data were available for 125 patients, 66 (52.8%) of whom were treated with locking plates, and 59 (41.2%) with RTSA. Both groups had comparable Charlson indices. The overall complication rate was 37.8% for ORIF and 22.0% for RTSA, with a revision rate of 12.1% and 5.1%, respectively, as driven primarily by persistent motion deficits. Multivariate analyses demonstrated no significant differences between the 2 procedures (P = .500). However, age was an independent protective factor against overall complications (P = .018). Risk factors for major complications in ORIF included osteoporosis, varus impaction fractures, posteromedial metaphyseal extensions <8 mm, head-shaft displacements >4 mm, and multifragmentary greater tuberosities. For RTSA, higher complication rates were seen in patients with higher Charlson indices, diabetes, or altered (greater) tuberosities. In contrast, Neer's classification system was not predictive in either group. RTSA led to fewer complications than ORIF and thus can be considered a valuable option in complex PHF of the elderly. Paying attention to specific prognostic factors may help to reduce the complication rate.

Development of Biomaterial for Total Hip Joint Replacement

Overall development of hip joints and associated biomaterials is a great challenge for the research engineers and orthopedic surgeons now-a-days. Various biomaterials are developed for manufacturing the hip prostheses. Some successful biomaterials are polymers like PTFE and UHMWPE, metals like 316L steel, Ti alloy and Co-Cr alloy, ceramics like Zirconia, alumina, Titanium coated ceramic alloys, high pressed Al2O3, composite and glass. In recent times, Hydroxyapatite is frequently used throughout the world for hip prosthesis components. The two types of hip joint replacement techniques are hemi-hip arthroplasty and total hip arthroplasty (THA). The first batch hip joint replacement techniques have already been represented by Charnley and other scientists in 1950s. Only few techniques were used with predictable results before 1960s. The lower friction Metal on polythene technique is of great challenge for total hip replacement method and it is also known as the modern Charnley hip prosthesis. This paper presents the chronological development of all technologies relating to the total hip replacement procedure and the associated biomaterials. The history and recent technologies for development of suitable biomaterials and different designs are covered in detail. To this end the new trend and direction in materials development in the research area have also been emphasized.

Total joint replacement and blood loss: what is the best equation?

With the population aging, total joint replacements which are an effective method to restore patient's mobility are an increasing necessity. However, such operations are known to entail serious blood loss, which may have dramatic consequences in patients with chronic diseases or when the prosthesis is revised, a situation where the blood loss is even higher. Therefore, formulas to better estimate the blood loss are available. These formulas may also be used for clinical studies to compare blood loss between different joint replacement techniques. The aim of this review is to provide a clear understanding of the formulas and to help physicians to further improve their blood loss estimation. Moreover, surgeons will then be able to choose the most accurate and user-friendly formula for more comparable data between clinical studies.

Operative treatment of pelvic metastases

Due to a rise in life expectancy as well as improved adjuvant and diagnostic measures the incidence of clinically symptomatic metastases has significantly increased. In terms of indication and operative technique in the treatment of these lesions the biologic age, general condition, diagnosis, stage and activity of the disease and the patient's prognosis are highly important. Different techniques of joint replacement have been described to treat patients suffering from metastatic disease of the periacetabular region, beeing resistant to any kind of adjuvant therapy. From 1977–1996 21 patients with a periacetabular lesion received a tumor prosthesis following internal hemipelvectomy (average age 60 years; average survival 23,1 months). Perioperative complication rate was 42 %, functional results were good (n = ), fair (n = 9) and poor (n = 2). Mobilisation and analgesia are the most important therapeutic goals. The quality of the patient's life postop is the major point.

Surgical management of pelvic metastases

Due to a rise in life expectancy as well as improved adjuvant and diagnostic measures the incidence of clinically symptomatic metastases has significantly increased. In terms of indication and operative technique in the treatment of these lesions the biologic age, general condition, diagnosis, stage and activity of the disease and the patient's prognosis are highly important. Different techniques of joint replacement have been described to treat patients suffering from metastatic disease of the periacetabular region, being resistant to any kind of adjuvant therapy. From 1977-1996 21 patients with a periacetabular lesion received a tumor prosthesis following internal hemipelvectomy (average age 60 years; average survival 23.1 months). Perioperative complication rate was 42%, functional results were good (n =), fair (n = 9) and poor (n = 2). Mobilisation and analgesia are the most important therapeutic goals. The quality of the patient's life postop is the major point.

Surgical management of foot disorders

Pathologic conditions of the metatarsophalangeal joints comprise the majority of painful conditions of the forefoot. Clinical manifestations commonly include hallux valgus (bunion), bunionette ("tailor's bunion"), and metatarsalgia. Conservative treatment remains the hallmark of initial management of these disorders. Conservative measures emphasize the adequate accommodation of the forefoot within the toe box of the shoe and the even distribution of plantar pressures by various metatarsal pads or bars and soft insoles. Numerous and sometimes controversial surgical procedures have been developed when conservative measures fail to achieve significant pain relief. In general, these procedures can be grouped as 1) soft tissue realignment procedures, 2) bony realignment procedures, 3) combined bony and soft tissue realignment procedures (ie, osteotomy), 4) bony and joint resection, 5) arthrodesis techniques, and 6) Silastic joint replacement techniques.

The costs of arthritis and the benefits of joint replacement surgery.

This paper examines first the economic costs and benefits of total hip replacement in Britain and, secondly, the general social and economic factors which may help to determine the future development of both new and established forms of joint replacement surgery. It estimates that there is a monetary benefit to cost ratio of at least ten to one associated with total hip replacement among people aged under 60 and one of at least two to one amongst individuals in the 60-70 age group. Overall, the N. H. S. s expenditure of up to £15 million (maximum) on hip replacement surgery in 1974 will probably generate a total economic return to the community of at least £60 million in 1974 terms. It is noted that joint replacement techniques can alleviate pain and handicap against which other forms of medical intervention are often of very limited value. However, significant risks are involved. The in-hospital mortality rate associated with total hip replacement is put at between 1 and 2% and the national average risk of failure, in terms of the operative outcome not being good or excellent, is estimated at marginally above 10%. For other joint replacement techniques such rates may be higher and the benefits conferred less desirable. It is suggested that the facilities available in this area of orthopaedic surgery are already carrying a maximum work load and that the N. H. S. may not be able to meet future increases in demand, given the very limited resources likely to be available for capital investment in the health services during the remainder of this decade. A lack of adequate knowledge of the social and economic impact of joint replacement techniques could exacerbate possible under-financing of or sub-optimal use of resources in this sector of medical care. It is pointed out there is a possibility that investment in more new specialist centres for orthopaedic surgery could help to reduce or keep to a minimum the hazards inevitably associated with joint replacement.