Total Joint Replacement Surgery Research Articles

Development and validation of an acoustic emission device to measure wear in total hip replacements in-vitro and in-vivo

Abstract An increasing demand for total joint replacement surgeries has provided a great need for more effective diagnostic procedures for monitoring and identifying wear, loosening, and other failure modes in total joint replacement implants. Significant recent research attention has been focussed on the contributing factors to wear and audible squeaking of total hip replacement (THR) implants and in particular those with hard-on-hard bearing combinations. An acoustic emission (AE) monitoring prototype diagnostic device has been developed for the assessment of implant wear and stability in THR patients. Implant vibrations have been recorded by AE monitoring during in-vivo patient testing from 90 patients with a range of age, implant type, and implant conditions. A number of these patients have gone on to have subsequent revision surgery and in-vitro testing of implant components previously tested in-vivo has been possible. The AE monitoring device has been able to detect a significant number of acoustic events, including audible squeaking, from both the in-vivo and in-vitro environments. This manuscript focusses on the data from five patients with ceramic-on-ceramic bearing interfaces for whom significant audible squeaking occurred and both in-vivo and in-vitro AE monitoring was undertaken. Preliminary results from the in-vitro monitoring data show audible squeaking AEs have similar characteristics to in-vivo audible squeaking AEs and both have primary frequencies in the 1–4 kHz range. This study has indicated that the AE device shows promise as a potential diagnostic tool for assessing the condition of THR implants. In addition, the in-vitro technique was shown to be useful at providing further insight into the mechanisms of wear and acoustic emissions of THR implants. The study also provides important initial results for the assessment of the AE device as a diagnostic tool through the unique contribution of the testing and analysis of the same implant components in both in-vivo and in-vitro environments.

Assessment of cardiovascular risk in patients undergoing total joint alloplasty: the CRASH-JOINT study.

Risk assessment is of particular importance for patients undergoing surgical interventions. Orthopaedic procedures, especially total joint alloplasty, are major procedures associated with high perioperative risk, as well as one of the highest rates of complications. The aim of the present study was to establish the prevalence of classical and non-classical cardiovascular risk factors in patients undergoing total hip or knee alloplasty. The CRASH-JOINT (Cardiovascular Risk Assessment ScHeme in JOINT alloplasty) was a prospective, epidemiological study performed in consecutive patients scheduled for total joint (hip or knee) replacement surgery. Patients enrolled into the study were screened for cardiovascular risk factors and had ambulatory blood pressure performed for the diagnosis of hypertension. The present study enrolled 98 patients. During initial screening eight patients were disqualified from the study and the surgery, in the majority due to the cardiac causes. Sixty-five patients had a hip joint replacement and 25 had knee joint replacement (mean age 63.7 ± 12.2 years, 62.2% female). Fifty (55.6%) patients were diagnosed with arterial hypertension in the past, ten (11.1%) patients had diabetes mellitus, two (2.2%) had a history of myocardial infarction, and family history of cardiovascular disease was present in 24 (26.7%) cases. Mean body mass index (BMI) was 28.0 ± 5.1 kg/m² and 39 (43.3%) patients were overweight, while 28 (31.1%) were obese. Patients undergoing hip replacement were significantly younger (61.8 ± 12.6 vs. 68.5 ± 10.0 years; p = 0.02), were more often current smokers (24.6% vs. 4.0%; p = 0.03), had significantly lower BMI (26.8 ± 4.5 vs. 31.2 ± 5.3 kg/m²; p < 0.0001), and were less often obese (18.5% vs. 64.0%; p < 0.0001). There were no significant differences between patients scheduled for primary surgery and reoperation. The study showed that classical cardiovascular risk factors in patients undergoing total hip or knee alloplasty have a higher prevalent than in the general population, which can potentially contribute to the higher risk of development of perioperative complications.

“What Matters to You?”: A pilot project for implementing patient-centered care

This project was intended to enhance the delivery of patient-centered care by asking patients what matters to them before and after total joint replacement (TJR) surgery. In Phase I, pre-operatively, patients undergoing total joint replacement (TJR) surgery were asked, “What matters to you before surgery, during your hospital stay, and in the first 3 months following surgery?” and “What matters to you moving forward after you’ve recovered from your joint replacement?” Four weeks post-operatively they were asked, “Now that that you’ve been through the surgery and first 4 weeks of recovery, can you identify new concerns that you didn’t have before?” and “What matters to you moving forward after you’ve recovered?” In Phase 2, 49 patients were asked pre-operatively, “Thinking ahead in this process...what matters to you?” Four weeks post-operatively, they were told, “Now that you’ve gained experience from going through a joint replacement, rank the categories in terms of how important it would have been to know in your pre-operative interview what you know now.” In Phase 1, 98% of patients answered the questions the same way preand post-operatively. The 2% who did not reported greater than expected surgical pain. In Phase 2, patients ranked the 3 most important categories preand post-operatively surgical results, quality of life, and reduction in pain. The WMTY project may increase patients’ engagement in their care, show providers how to better understand what matters to their patients, and help surgeons to define outcomes more broadly.

Is there a risk of permanent renal dysfunction after primary total hip and knee joint replacements?

BackgroundPermanent renal dysfunction is considered as being a serious complication which may occur after major surgery and which furthermore may lead to increased morbidity and mortality. The objective of this study was to analyze the incidence of long-term postoperative renal dysfunction after primary total hip and knee joint replacements.MethodsLong-term postoperative renal dysfunction was analyzed in a retrospective study of 1301 consecutive primary total hip and knee joint replacements performed between January 2009 and December 2013. According to the RIFLE criteria, increased serum creatinine was an indicative of postoperative renal injury. The highest serum creatinine during the first postoperative week was chosen as a sign for maximum acute renal injury and was compared to the highest serum creatinine during the following 4–12 months.ResultsOne hundred and forty two patients with an increase in postoperative serum creatinine were included in the follow-up study. Six patients (4.2 %) died due to non-renal causes during the follow-up period. One patient died of severe renal injury, which was relatively very early postoperatively, and another patient had a rise in serum creatinine to 316 μmol/l during the follow-up period. All the remaining 132 patients (94 %) had full recovery with serum creatinine which returned to preoperative levels.ConclusionsThis study did not confirm that patients who underwent primary total hip and knee joint replacement surgery were at risk of developing permanent renal dysfunction up to 1 year after the index surgery.

Total hip arthroplasty following failure of core decompression and tantalum rod implantation.

One method of femoral head preservation following avascular necrosis (AVN) is core decompression and insertion of a tantalum rod. However, there may be a high failure rate associated with this procedure. The purpose of this study was to document the clinical and radiological outcomes following total hip arthroplasty (THA) subsequent to failed tantalum rod insertion. A total of 37 failed tantalum rods requiring total hip arthroplasty were identified from a prospective database. There were 21 hips in 21 patients (12 men and nine women, mean age 37 years, 18 to 53) meeting minimum two year clinical and radiographic follow-up whose THAs were carried out between November 2002 and April 2013 (mean time between tantalum rod implantation and conversion to a THA was 26 months, 6 to 72). These were matched by age and gender to individuals (12 men, nine women, mean age 40 years, 18 to 58) receiving THA for AVN without prior tantalum rod insertion. There were no functional outcome differences between the two groups. Tantalum residue was identified on all post-operative radiographs in the tantalum group. Linear wear rates were comparable between groups with no evidence of catastrophic wear in either group. In the short term, tantalum rod implantation does not demonstrate an adverse effect on subsequent total joint replacement surgery. There is however, a high rate of retained tantalum debris on post-operative radiographs and thus there is an unknown risk of accelerated articular wear necessitating longer term study. Cite this article: Bone Joint J 2016;98-B:1175-9.

Occupational Activity in Patients 10 Years after Hip Replacement Surgery.

Advanced hip osteoarthritis requires total joint replacement surgery to improve daily activity, including occupational activity. The purpose of this study was to evaluate employment status among patients 10 years after hip replacement surgery. A total of 63 patients who underwent total hip replacement surgery at the Department of Orthopedics and Traumatology between 2003 and 2005 were enrolled in the study. At the time of the study (2014), all patients from the study group were of working age. Ultimately, 32 patients participated in the study. Each participant completed a questionnaire with questions about the place of residence, age, type of endoprosthesis, employment status, type of work performed, reason for arthroplasty, postoperative course of rehabilitation and subjective health status. Functional capacity was evaluated using Harris' 100-point scale. 88% of the respondents had been employed prior to surgery, compared to only 46% one year after surgery and only 40% at 10 years after surgery. A positive outcome was that 17% of the respondents receiving a disability pension prior to surgery were able to return to work after surgery. 1. Hip replacement surgery may affect the employment status of patients. 2. The most significant factors influencing cessation of work were a high BMI, living in a rural environment and being female.

Women's Experiences of Undergoing Total Knee Joint Replacement Surgery

The purpose of the study was to describe women's experiences of undergoing total knee joint replacement surgery. A qualitative approach was used. A content analysis of the text from interviews with five women was conducted. The time before surgery was marked by the experience of constant pain, which affected the women negatively in their everyday lives. During surgery, the information provided by the staff gave each woman a sense of security; the women handed over responsibility to the staff and experienced a sensation of relief. The postoperative period was characterized by a feeling of joy when the surgery was over, although a rough and tedious rehabilitation phase then began. Challenges in everyday life were a factor for motivation and confidence, although postoperative pain was experienced as discouraging. Support from health care staff is an important factor for coping with everyday life during the preoperative, perioperative and postoperative phases of undergoing knee joint replacement.

Data analytics in health promotion: Health market segmentation and classification of total joint replacement surgery patients

Providing insight into healthcare consumers' behaviors and attitudes is critical information in an environment where healthcare delivery is moving rapidly towards patient-centered care. We apply a two-stage methodology using both supervised and unsupervised machine learning methods to a patient data set from the electronic medical records of an academic medical center located in central Pennsylvania. The data are from patients who had total joint replacement surgery between December 2013 and September 2015. Two clustering methods and four classification algorithms were applied to the data set. Patients cluster into six distinct health market segments from which the cluster assignment is used as the response variable in supervised learning to classify patients. The classification model accurately predicts the cluster assignment for out-of-sample patients, while offering insight into patient behaviors and attributes to help clinicians, health marketers, and healthcare consumers move toward the goal of patient-centered and value-based healthcare.

English

English

Determining the Mineral Apposition Rate of Heterotopie Ossification in Military Healthcare System Patients after Total Joint Replacement: A Case Series

Heterotopic ossification (HO) is frequently reported following total joint replacement (TJR) surgery. Symptomatic HO may limit the range of motion, cause pain, and require surgical excision. Deciding an appropriate time for ectopic bone excision is based on clinical judgment, and a more well-defined link between clinical predictors and histological analysis is needed to minimize recurrence. A case series was performed with military healthcare system patients undergoing TJR, who required removal of periarticular ectopic bone. Patients were prescribed oxytetracycline to assess the mineral apposition rate (MAR; ie, bone growth rate) of HO, and excised specimens were analyzed using scanning electron microscopy and light microscopy. Two males and one female were enrolled in this study, with height of 69.0 ± 7.8 inches, weight of 237.7 ± 28.3 pounds, and age of 61 ± 7 years at the time of HO removal. Ectopic bone occurred in two cases following total knee arthroplasty and one total hip arthroplasty. Data indicated that MAR levels were 1.7 times higher than that reported previously for nonpathological human bone (1.7 ± 0.7 µm/day; range: 1.3–2.6 µm/day), and microscopic imaging confirmed that the osseous tissues were still actively remodeling at the time of surgical intervention. Further characterization is needed to optimize HO excision timing and to better understand this pathological bone disorder.

Synovial Neuronal Changes in Knee Joint Osteoarthritis

Purpose: The purpose is to study whether pain and inflammation in knee joint osteoarthritis (OA) are associated with local synovial neuronal changes. Methods: Synovial biopsies were harvested from the medial and lateral knee compartments from OA patients undergoing total joint replacement surgery. All patients had predominant pain at the medial joint compartment. Pain and knee joint function were evaluated by knee society score (KSS). Synovial inflammation was analyzed by histopathological analysis and expression of growth associated protein-43 (GAP-43), sensory (SP, CGRP) and autonomic (NPY, VIP, TH) neuropeptides was studied by single and double immunohistochemistry techniques. Results: We observed reduced KSS and increased inflammatory score in synovial membrane of medial knee compartment. A significant increase in GAP-43 [P = 0.001], SP [P = 0.05], CGRP [P = 0.05] and TH [P = 0.05] expression was observed and SP, CGRP and NPY were found to be co-existed predominantly with GAP-43 in synovial membrane collected from medial compared to the lateral knee compartment. Conclusions: Regenerating nerve fibers containing sensory and autonomic neuropeptides are associated with pain and inflammation in knee joint OA.

Implementation of an Accelerated Rehabilitation Protocol for Total Joint Arthroplasty in the Managed Care Setting: The Experience of One Institution

Accelerated rehabilitation following total joint replacement (TJR) surgery has become more common in contemporary orthopaedic practice. Increased utilization demands improvements in resource allocation with continued improvement in patient outcomes. We describe an accelerated rehab protocol (AR) instituted at a community based hospital. All patients undergoing total knee arthroplasty (TKA) and total hip arthroplasty (THA) were included. The AR consisted of preoperative patient education, standardization of perioperative pain management, therapy, and next day in-home services consultation following discharge. Outcomes of interest include average length of stay (ALOS), discharge disposition, 42-day return to Urgent Care (UC), Emergency Department (ED), or readmission. A total of 4 surgeons performed TJR procedures on 1,268 patients in the study period (696 TKA, 572 THA). ALOS was reduced from 3.5 days at the start of the observation period to 2.4 days at the end. Discharge to skilled nursing reduced from 25% to 14%. A multifaceted and evidence based approach to standardization of care delivery has resulted in improved patient outcomes and a reduction in resource utilization. Adoption of an accelerated rehab protocol has proven to be effective as well as safe without increased utilization of UC, ER, or readmissions.

Quantifying function before and after total joint replacement surgery in patients with hip osteoarthritis

Quantifying function before and after total joint replacement surgery in patients with hip osteoarthritis

Translating genomics into mechanisms of disease: Osteoarthritis.

Osteoarthritis (OA) is the most common age-related arthritic disorder and is characterized by aberrant extracellular matrix (ECM) content and surface disruptions that range from fibrillation, clefting and delamination, leading to articular surface erosion. Worldwide, over 20% of the population is affected with OA and 80% of these patients have limitations in movement, whereas 25% experience inhibition in major daily activities of life. OA is the most common disabling arthritic disease; nevertheless, no disease-modifying treatment is available except for the expensive total joint replacement surgery at end-stage disease. Lack of insight into the underlying pathophysiological mechanisms of OA has considerably contributed to the inability of the scientific community to develop disease-modifying drugs. To overcome this critical barrier, focus should be on translation of identified robust gene deviations towards the underlying biological mechanisms.

Identification of antithrombotic drugs related to total joint replacement using anonymised free-text notes: a search strategy in the Clinical Practice Research Datalink

ObjectivesWe aimed to design and test a method to extract information on antithrombotic therapy from anonymised free-text notes in the Clinical Practice Research Datalink (CPRD).SettingGeneral practice database representative of the...

EACMFS Prizes and Awards

To describe a new glenoid fossa bone graft technique, and to evaluate its effect on the stability of stock fossa prosthesis implantation in total alloplastic joint replacement surgery.Eight patients who underwent total joint replacement surgery with a Biomet stock prosthesis (Biomet, Warsaw, IN, USA) from November 2013 to April 2014 were included in this study. ProPlan CMF 1.4 software (Materialise NV, Leuven, Belgium) was used to choose the prosthesis size and place it in the right position. The depth of the fossa was measured, and the osteotomy line was designed to cut the bone which overlapped the fossa prosthesis. A bone graft, taken from the bottom of the articular eminence or the condylar neck, was used to fill in the fossa and make a flat plane in combination with the residual eminence for the positioning of the fossa prosthesis. The stability of the fossa prosthesis was evaluated both intra-operatively and postoperatively with computed tomography (CT) scanning after at least 6 months of follow-up. The bone contact area of the fossa prosthesis and the volume of the grafted bone were measured.Fossa prostheses were intra-operatively stable after bone grafting. All patients had stable occlusion after surgery and at follow-up. Postoperative measurement showed that the bone contact area with the fossa prosthesis increased from 52.8% to 88.5% after bone grafting. Postoperative CT measurements (at an average of 9 months after surgery) showed that the bone graft volume decreased by 11.1%.Bone grafts in the glenoid fossa help to improve the stability of Biomet stock fossa prosthesis implantation.

Optical investigation of osteoarthritic human cartilage (ICRS grade) by confocal Raman spectroscopy: a pilot study.

Biomolecular changes in the cartilage matrix during the early stage of osteoarthritis may be detected by Raman spectroscopy. The objective of this investigation was to determine vibrational spectral differences among different grades (grades I, II, and III) of osteoarthritis in human osteoarthritic cartilage, which was classified according to the International Cartilage Repair Society (ICRS) grading system. Degenerative articular cartilage samples were collected during total joint replacement surgery and were classified according to the ICRS grading system for osteoarthritis. Twelve cartilage sections (4 sections of each ICRS grades I, II, and III) were selected for Raman spectroscopic analysis. Safranin-O/Fast green was used for histological staining and assignment of the Osteoarthritis Research Society International (OARSI) grade. Multivariate principal component analysis (PCA) was used for data analysis. Spectral analysis indicates that the content of disordered coil collagen increases significantly during the early progression of osteoarthritis. However, the increase was not statistically significant during later stages of the disease. A decrease in the content of proteoglycan was observed only during advanced stages of osteoarthritis. Our investigation shows that Raman spectroscopy can classify the different stage of osteoarthritic cartilage and can provide details on biochemical changes. This proof-of-concept study encourages further investigation of fresh cartilage on a larger population using fiber-based miniaturized Raman probe for the development of in vivo Raman arthroscopy as a potential diagnostic tool for osteoarthritis.

Complications Following Temporomandibular Joint Replacement: A 10-Year Retrospective Review

Temporomandibular joint replacement is indicated for advanced stage degenerative disease, tumors of the joint, and ankylosis of the joint. The aim of this study is to review the complications associated with TMJ total joint replacement (TJR) surgery performed over at 10-year period at the University of Alabama at Birmingham.

Post OP Urinary Retention: Evaluating and Redefining a Collaborative Protocol Based on Evidence

In a collaborative effort to decrease the rates of Catheter Associated Urinary Tract Infections (CAUTI) at this Magnet hospital, reducing the number of catheters placed during total joint replacement (TJR) surgery was an initiative agreed by the multidisciplinary team who belong to the Orthopedic Collaborative Practice Group. The prevalence of CAUTIs in this patient population was as high as 13%.

Application of fossa bone graft to stabilize stock total joint prosthesis in temporomandibular joint surgery.

To describe a new glenoid fossa bone graft technique, and to evaluate its effect on the stability of stock fossa prosthesis implantation in total alloplastic joint replacement surgery. Eight patients who underwent total joint replacement surgery with a Biomet stock prosthesis (Biomet, Warsaw, IN, USA) from November 2013 to April 2014 were included in this study. ProPlan CMF 1.4 software (Materialise NV, Leuven, Belgium) was used to choose the prosthesis size and place it in the right position. The depth of the fossa was measured, and the osteotomy line was designed to cut the bone which overlapped the fossa prosthesis. A bone graft, taken from the bottom of the articular eminence or the condylar neck, was used to fill in the fossa and make a flat plane in combination with the residual eminence for the positioning of the fossa prosthesis. The stability of the fossa prosthesis was evaluated both intra-operatively and postoperatively with computed tomography (CT) scanning after at least 6 months of follow-up. The bone contact area of the fossa prosthesis and the volume of the grafted bone were measured. Fossa prostheses were intra-operatively stable after bone grafting. All patients had stable occlusion after surgery and at follow-up. Postoperative measurement showed that the bone contact area with the fossa prosthesis increased from 52.8% to 88.5% after bone grafting. Postoperative CT measurements (at an average of 9 months after surgery) showed that the bone graft volume decreased by 11.1%. Bone grafts in the glenoid fossa help to improve the stability of Biomet stock fossa prosthesis implantation.