Recent Advances in Arthroplasty - Part I

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: closed (15 August 2021) | Viewed by 49311

Special Issue Editor


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Guest Editor
sporthopaedicum
Interests: process digitalisation; innovations arthroplasty; robotic; navigation; implant design; implant components

Special Issue Information

Dear colleagues,

Even if in the current time other topics like the covid-crisis dominate our everyday life, we must nevertheless direct the view also into the future and discuss critically the recent advances and innovations in the field of total joint replacement.

There are few areas of medicine in which technological progress and digitalization are as closely linked to surgical therapy as in endoprosthetics. It is therefore not surprising that over the past decades, innovations and technical advancements have been particularly evident in this area and have repeatedly been part of the scientific discussion.

On the one hand, this concerns the evolution of the implants themselves. Here, attempts have been made to improve function, biomechanics and durability in the field of implant design as well as implant materials. As a good example, current polyethylene inlays seem allowing higher loads in the long term without the severe wear patterns that are known from the past.

On the other hand, there is a clear trend towards innovation in the field of surgical assistance systems and technologies, which should enable the surgeon to better implement surgical planning.

As a third area, process optimization of the surgical and non-surgical treatment steps has also become the focus of discussion. Standardization and optimization of processes also appear to improve the outcome and reduce complication rates.

In contrast to other areas, where implant improvements, mechanization and digitalization are often subjectively a constantly progressing process, this is clearly less of a hindrance in the field of endoprosthetics: new technologies are being introduced, are heavily advertised and disappear again after a relatively short time. Often, after their optimization or simply after a certain period of time, a renaissance with a renewed attempt at implementation becomes apparent.

The biggest criticism of technological innovations is that in recent years none of the current innovations has been able to prove a clinical relevant improvement in patient satisfaction. Therefore, the current discussion focuses not only on the technical implementation of established "conventional surgical techniques", but also on new strategies for process optimization and implantation philosophy in order to achieve an improvement in patient satisfaction.

Dr. Philipp von Roth
Guest Editor

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Keywords

  • Process digitalisation
  • Innovations arthroplasty

Published Papers (16 papers)

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14 pages, 2757 KiB  
Article
The Safety of Bilateral Simultaneous Hip and Knee Arthroplasty versus Staged Arthroplasty in a High-Volume Center Comparing Blood Loss, Peri- and Postoperative Complications, and Early Functional Outcome
by Michael Najfeld, Thomas Kalteis, Christian Spiegler, Christophe Ley and Robert Hube
J. Clin. Med. 2021, 10(19), 4507; https://doi.org/10.3390/jcm10194507 - 29 Sep 2021
Cited by 11 | Viewed by 1615
Abstract
Purpose: In recent years, there has been increasing interest in the use of simultaneous hip and knee arthroplasty compared to staged procedures in patients with bilateral pathology. The aim of this study was to compare simultaneous and staged hip and knee arthroplasty in [...] Read more.
Purpose: In recent years, there has been increasing interest in the use of simultaneous hip and knee arthroplasty compared to staged procedures in patients with bilateral pathology. The aim of this study was to compare simultaneous and staged hip and knee arthroplasty in patients with bilateral pathology by assessing the transfusion rate, postoperative hemoglobin drop, length of stay (LOS), in-hospital complications, 30-day readmissions and early functional outcome. Methods: We conducted a retrospective cohort study that included all patients who were undergoing primary TKA, THA and UKA by a single surgeon in a high-volume arthroplasty center between 2015 and 2020 as simultaneous or staged procedures. Staged bilateral arthroplasties were performed within 12 months and were stratified by the time between procedures. Data were acquired through the electronic files at the Orthopädische Chirurgie München (OCM). For functional outcome, the ability of the patients to walk independently on the ward was compared with the ability to walk a set of stairs alone, which was recorded daily by the attending physiotherapist. Results: In total n = 305 patients were assessed for eligibility and included in this study. One hundred and forty-five patients were allocated to the staged arthroplasty group. This group was subdivided into a hip and a knee group, whereas the knee group was split into TKA and UKA. The second staged procedure was performed within 12 months of the first procedure. One hundred and sixty patients were allocated to the simultaneous arthroplasty group. This group was also subdivided into a hip and knee group, whereas the knee group was split again into a TKA and UKA group. No statistical difference was found between the two groups regarding demographic data. Primary outcome measurements: There was no significant difference in the transfusion rate or complication rate. Secondarily, no statistically significant difference was found between the postoperative hemoglobin drop and the functional outcome, or in the length of stay (LOS) between both groups. Walking the stairs showed a significant difference in the knee group. Conclusions: There were no significant differences observed in the transfusion rate in-hospital complications, or readmission rate between both groups. The early functional outcome showed no significant difference in mobility for all groups. Simultaneous arthroplasty for knee or hip is as safe as a staged procedure, with no higher risk for the patient, in a specialized high-volume center. Level of evidence: Level IV. Full article
(This article belongs to the Special Issue Recent Advances in Arthroplasty - Part I)
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10 pages, 24903 KiB  
Article
Using MRI Measurement to Improve Accuracy of Femoral Component Sizing in Oxford Unicompartmental Knee Arthroplasty
by Cheng-Pang Yang, Ying-Chieh Lai, Chen-Te Wu, Kung-Tseng Hung, Yi-Sheng Chan, Alvin Chao-Yu Chen and Kuo-Yao Hsu
J. Clin. Med. 2021, 10(18), 4284; https://doi.org/10.3390/jcm10184284 - 21 Sep 2021
Cited by 1 | Viewed by 2130
Abstract
Unicompartmental knee arthroplasty (UKA) can achieve better kinematics and faster recovery than total knee arthroplasty. The Phase III Oxford UKA system has five sizes of femoral components to approximate the normal knee geometry. However, these different sizes may also induce problems, such as [...] Read more.
Unicompartmental knee arthroplasty (UKA) can achieve better kinematics and faster recovery than total knee arthroplasty. The Phase III Oxford UKA system has five sizes of femoral components to approximate the normal knee geometry. However, these different sizes may also induce problems, such as the misselection of component size. Different criteria have been proposed to predict the ideal size preoperatively. However, no single method can be applied universally. Therefore, this study aimed to develop a preoperative measurement using knee magnetic resonance imaging (MRI) to predict femoral component size. A total of 68 patients who underwent UKA were investigated from June 2019 to April 2020. 16 knees using a different MRI protocol were excluded. We developed an MRI measurement method to determine femoral size instead of gender- and height-based methods. The accuracy of different methods was compared using postoperative true lateral view radiographs. Three different kinds of gender- and height-based criteria, preoperative templating and intraoperative spoon measurement were compared. The accuracy of MRI measurement was 90.3%. Therefore, a significant difference was found between MRI measurements and all other methods, such as templating or gender- and height-based methods. In conclusion, the MRI measurement method can be concluded to accurately predict femoral component size in UKA. This method could be used regardless of different ethnic groups, individual knee geometry, or soft tissue tension. Full article
(This article belongs to the Special Issue Recent Advances in Arthroplasty - Part I)
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10 pages, 9030 KiB  
Article
The Disproportionate Increase of the Intraoperative Flexion and Extension Gap Space after Posterior Cruciate Ligament Resection in Total Knee Arthroplasty
by Kao-Chang Tu, Han-Ting Shih, Shih-Chieh Tang, Cheng-Hung Lee, Wei-Jen Liao and Shun-Ping Wang
J. Clin. Med. 2021, 10(18), 4228; https://doi.org/10.3390/jcm10184228 - 17 Sep 2021
Cited by 1 | Viewed by 1807
Abstract
Purpose: Maintaining gap balance is critical for total knee arthroplasty (TKA). This study aimed to elucidate if the extension–flexion gaps would be changed with posterior cruciate ligament (PCL) intact (PI) and PCL resection (PR) during TKA. The flexion gaps were measured using two [...] Read more.
Purpose: Maintaining gap balance is critical for total knee arthroplasty (TKA). This study aimed to elucidate if the extension–flexion gaps would be changed with posterior cruciate ligament (PCL) intact (PI) and PCL resection (PR) during TKA. The flexion gaps were measured using two methods, open-(Fo) and closed-chain position (Fc), based on the definition of kinetic chain position, respectively. Methods: This retrospective study enrolled a total of 33 patients who underwent posterior-stabilized (PS) TKA for symptomatic advanced osteoarthritis of knees. After bone cuts were completed, the extension–flexion gaps before and after PCL resection during TKA were measured using a calibrated tensioning device set at a 100 Nm distraction force. To further differentiate the effect of thigh weight on the 90° flexion gap, two varied methods of examination, either in closed chain (Fc) or open chain (Fo) were performed. Results: The increases in the 90° knee flexion gap after PCL resection were measured by both methods, i.e., ΔFc (PR-Fc—PI-Fc): 2.04 ± 2.06 mm, p < 0.001; and mean ΔFo (PR-Fo—PI-Fo): 1.64 ± 1.36 mm, p < 0.001. However, there were no differences between ΔFc and ΔFo before and after PCL resection. A greater amount of flexion gap was identified in open chain than in closed chain after PCL resection, and the PR-Fo and PR-Fc were 14.36 ± 3.13 and 11.40 ± 3.47 (p < 0.001), respectively. Conclusions: The resection of PCL during TKA distinctly increased the flexion gap, but not the extension gap. This disproportionate increase of the gap will cause a gap balance mismatch. The tensioning maneuver in open-chain was more effective to detect the gap differences than in closed-chain before and after PCL resection during TKA. Full article
(This article belongs to the Special Issue Recent Advances in Arthroplasty - Part I)
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10 pages, 1345 KiB  
Article
TOUCH® Prosthesis for Thumb Carpometacarpal Joint Osteoarthritis: A Prospective Case Series
by Stefan M. Froschauer, Matthias Holzbauer, Julian A. Mihalic and Oskar Kwasny
J. Clin. Med. 2021, 10(18), 4090; https://doi.org/10.3390/jcm10184090 - 10 Sep 2021
Cited by 9 | Viewed by 5803
Abstract
The dual mobility concept currently represents the newest generation of thumb carpometacarpal prostheses. The aim of this study was to evaluate the short-term outcomes of TOUCH® prosthesis. From September 2019 to July 2020, 40 prosthesis were implanted in 37 patients suffering from [...] Read more.
The dual mobility concept currently represents the newest generation of thumb carpometacarpal prostheses. The aim of this study was to evaluate the short-term outcomes of TOUCH® prosthesis. From September 2019 to July 2020, 40 prosthesis were implanted in 37 patients suffering from symptomatic stage III osteoarthritis. All included patients with a median age of 57.7 (IQR: 13.6) finished the systematic follow-up regimen (4, 8, 16 weeks, 6, and 12 months postoperatively). All parameters significantly improved (p < 0.0001) compared to the preoperative status. At 1 year follow-up, median DASH Scores decreased from 54 (IQR 22) to 12 (IQR 28) and pain levels improved from 8 (IQR 2) to 1 (IQR 2). Moreover, key-pinch strength increased from 3.8 (2.0) to 5.8 (2.5), while palmar abduction, radial abduction, and opposition also significantly improved. 35/37 patients were satisfied with the functional outcomes. We observed 10 complications, of which 6 were tendon-related issues, and 2 were due to an inappropriate choice of neck size. We could detect one dislocation but no evidence of cup loosening, tilting or subsidence in any patient. Despite the occurrence of some complications, we recommend implantation of this prosthesis type due to favorable clinical and radiological performance. Full article
(This article belongs to the Special Issue Recent Advances in Arthroplasty - Part I)
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10 pages, 1539 KiB  
Article
Pinless Navigation in Unicompartmental Knee Arthroplasty
by Sarah Keuntje-Perka, Philipp von Roth, Michael Worlicek, Matthias Koch, Volker Alt and Moritz Kaiser
J. Clin. Med. 2021, 10(11), 2422; https://doi.org/10.3390/jcm10112422 - 30 May 2021
Viewed by 2059
Abstract
Purpose: In contrast to total knee arthroplasty (TKA), unicompartmental knee arthroplasty (UKA) is a true resurfacing procedure, as none of the ligaments are replaced or released, and the pre-arthritic leg alignment is the major goal. As such, the alignment of the tibial component [...] Read more.
Purpose: In contrast to total knee arthroplasty (TKA), unicompartmental knee arthroplasty (UKA) is a true resurfacing procedure, as none of the ligaments are replaced or released, and the pre-arthritic leg alignment is the major goal. As such, the alignment of the tibial component plays a crucial role in postoperative knee function and long-term survival. Pinless navigation has shown reliable results in total knee arthroplasty. To the best of our knowledge, the use of pinless navigation has not been investigated for UKA. Therefore, the present study investigated whether implantation of the tibial component in 3° varus, which is closer to the anatomical axis, is feasible with a pinless optical navigation system. Methods: 60 patients with the diagnosis of an unicompartmental arthritis, were eligible for UKA and treated with implantation in 3° varus alignment of the tibial component. Two groups were established. In the treatment group the tibial component was aligned using a pinless navigation technique. In the control group, a conventional extramedullary alignment guide was used. A clinical and radiographic follow up took place within 1 year of operation. Results: 57 Patients were eligible for analysis. No clinical incidents were noted in the follow up period. The desired target value, the position of the tibial component, was accurately achieved with an average of 3° medial inclination using the pinless navigation as well as using the conventional technique. Mean incision to suture time was negligible between the two techniques. The mean suture time was 43.2 min with pinless navigation and 42.7 min with the conventional technique. Conclusions: With pinless navigation in UKA, a method was presented that made it possible to achieve sled prosthesis alignment at the level of a high-volume surgeon. These results were achieved with an irrelevant increase of surgical time and without placement of pins. Full article
(This article belongs to the Special Issue Recent Advances in Arthroplasty - Part I)
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11 pages, 1400 KiB  
Article
Mobile Robot-Based Gait Training after Total Hip Arthroplasty (THA) Improves Walking in Biomechanical Gait Analysis
by Eric Röhner, Anke Mayfarth, Christian Sternitzke, Frank Layher, Andrea Scheidig, Horst-Michael Groß, Georg Matziolis, Sabrina Böhle and Klaus Sander
J. Clin. Med. 2021, 10(11), 2416; https://doi.org/10.3390/jcm10112416 - 29 May 2021
Cited by 6 | Viewed by 3135
Abstract
There are multiple attempts to decrease costs in the healthcare system while maintaining a high treatment quality. Digital therapies receive increasing attention in clinical practice, mainly relating to home-based exercises supported by mobile devices, eventually in combination with wearable sensors. The aim of [...] Read more.
There are multiple attempts to decrease costs in the healthcare system while maintaining a high treatment quality. Digital therapies receive increasing attention in clinical practice, mainly relating to home-based exercises supported by mobile devices, eventually in combination with wearable sensors. The aim of this study was to determine if patients following total hip arthroplasty (THA) could benefit from gait training on crutches conducted by a mobile robot in a clinical setting. Method: This clinical trial was conducted with 30 patients following total hip arthroplasty. Fifteen patients received the conventional physiotherapy program in the clinic (including 5 min of gait training supported by a physiotherapist). The intervention group of 15 patients passed the same standard physiotherapy program, but the 5-min gait training supported by a physiotherapist was replaced by 2 × 5 min of gait training conducted by the robot. Length of stay of the patients was set to five days. Biomechanical gait parameters of the patients were assessed pre-surgery and upon patient discharge. Results: While before surgery no significant difference in gait parameters was existent, patients from the intervention group showed a significant higher absolute walking speed (0.83 vs. 0.65 m/s, p = 0.029), higher relative walking speed (0.2 vs. 0.16 m/s, p = 0.043) or shorter relative cycle time (3.35 vs. 3.68 s, p = 0.041) than the patients from the control group. Conclusion: The significant higher walking speed of patients indicates that such robot-based gait training on crutches may shorten length of stay (LOS) in acute clinics. However, the number of patients involved was rather small, thus calling for further studies. Full article
(This article belongs to the Special Issue Recent Advances in Arthroplasty - Part I)
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11 pages, 1681 KiB  
Article
Proximal Row Carpectomy with Total Scapoidectomy vs. Conventional Carpal Resection for ReMotion Total Wrist Arthroplasty
by Stefan M. Froschauer, Matthias Holzbauer, Dietmar Hager, Oskar Kwasny and Dominik Duscher
J. Clin. Med. 2021, 10(9), 1865; https://doi.org/10.3390/jcm10091865 - 26 Apr 2021
Cited by 4 | Viewed by 5355
Abstract
High complication rates in total wrist arthroplasty (TWA) still lead to controversy in the medical literature, and novel methods for complication reduction are warranted. In the present retrospective cohort study, we compare the outcomes of the proximal row carpectomy (PRC) method including total [...] Read more.
High complication rates in total wrist arthroplasty (TWA) still lead to controversy in the medical literature, and novel methods for complication reduction are warranted. In the present retrospective cohort study, we compare the outcomes of the proximal row carpectomy (PRC) method including total scaphoidectomy (n = 22) to the manufacturer’s conventional carpal resection (CCR) technique, which retains the distal pole of the scaphoid (n = 25), for ReMotion prosthesis implantation in non-rheumatoid patients. Mean follow-up was 65.8 ± 19.8 and 80.0 ± 28.7 months, respectively. Pre- and postoperative clinical assessment included wrist flexion-extension and radial-ulnar deviation; Disability of Arm, Shoulder, and Hand scores; and pain via visual analogue scale. At final follow-up, grip strength and satisfaction were evaluated. All complications, re-operations, and revision surgeries were noted. Clinical complications were significantly lower in the PRC group (p = 0.010). Radial impaction was detected as the most frequent complication in the CCR group (n = 10), while no PRC patients suffered from this complication (p = 0.0008). Clinical assessment, grip strength measurements, and the log rank test evaluating the re-operation as well as revision function showed no significant difference. All functional parameters significantly improved compared to preoperative values in both cohorts. In conclusion, we strongly recommend PRC for ReMotion prosthesis implantation. Full article
(This article belongs to the Special Issue Recent Advances in Arthroplasty - Part I)
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13 pages, 616 KiB  
Article
Patient-Specific Instrumentation Accuracy Evaluated with 3D Virtual Models
by Vicente J. León-Muñoz, Andrea Parrinello, Silvio Manca, Gianluca Galloni, Mirian López-López, Francisco Martínez-Martínez and Fernando Santonja-Medina
J. Clin. Med. 2021, 10(7), 1439; https://doi.org/10.3390/jcm10071439 - 1 Apr 2021
Cited by 1 | Viewed by 2248
Abstract
There have been remarkable advances in knee replacement surgery over the last few decades. One of the concerns continues to be the accuracy in achieving the desired alignment. Patient-specific instrumentation (PSI) was developed to increase component placement accuracy, but the available evidence is [...] Read more.
There have been remarkable advances in knee replacement surgery over the last few decades. One of the concerns continues to be the accuracy in achieving the desired alignment. Patient-specific instrumentation (PSI) was developed to increase component placement accuracy, but the available evidence is not conclusive. Our study aimed to determine a PSI system’s three-dimensional accuracy on 3D virtual models obtained by post-operative computed tomography. We compared the angular placement values of 35 total knee arthroplasties (TKAs) operated within a year obtained with the planned ones, and we analyzed the possible relationships between alignment and patient-reported outcomes. The mean (SD) discrepancies measured by two experienced engineers to the planned values observed were 1.64° (1.3°) for the hip–knee–ankle angle, 1.45° (1.06°) for the supplementary angle of the femoral lateral distal angle, 1.44° (0.97°) for the proximal medial tibial angle, 2.28° (1.78°) for tibial slope, 0.64° (1.09°) for femoral sagittal flexion, and 1.42° (1.06°) for femoral rotation. Neither variables related to post-operative alignment nor the proportion of change between pre-and post-operative alignment influenced the patient-reported outcomes. The evaluated PSI system’s three-dimensional alignment analysis showed a statistically significant difference between the angular values planned and those obtained. However, we did not find a relevant effect size, and this slight discrepancy did not impact the clinical outcome. Full article
(This article belongs to the Special Issue Recent Advances in Arthroplasty - Part I)
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10 pages, 2296 KiB  
Article
Abductor Muscle Force after Straight-Stem Compared to Short-Stem Total Hip Arthroplasty through a Modified Direct Lateral Approach: Functional Assessment of 70 Consecutive Patients of a Randomized Controlled Clinical Trial
by Michael Fuchs, Marie-Anne Hein, Martin Faschingbauer, Mirco Sgroi, Ralf Bieger, Heiko Reichel and Tobias Freitag
J. Clin. Med. 2021, 10(6), 1235; https://doi.org/10.3390/jcm10061235 - 16 Mar 2021
Cited by 3 | Viewed by 2065
Abstract
Because of preservation of proximal femoral bone stock and minimized soft tissue trauma, short-stem implants are becoming increasingly important in total hip arthroplasty (THA). The postulated advantage regarding the functional outcome has not been verified. We hypothesized an increased abductor muscle strength by [...] Read more.
Because of preservation of proximal femoral bone stock and minimized soft tissue trauma, short-stem implants are becoming increasingly important in total hip arthroplasty (THA). The postulated advantage regarding the functional outcome has not been verified. We hypothesized an increased abductor muscle strength by the use of a short-stem design. Seventy consecutive patients of a randomized clinical trial were included. Of these, 67 patients met the inclusion criteria after 12 months. Thirty-five patients received a standard straight stem and 32 patients a short-stem femoral component. All surgeries were performed by a modified direct lateral approach. Isometric muscle strength of the hip abductors was evaluated preoperatively 3 and 12 months after surgery. Harris hip score (HHS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were evaluated. After three months, there were no differences between the two groups; the abductor force was comparable to the preoperative initial values. After 12 months, a significant increase in muscle strength for the short stem patient group compared to preoperative baseline values was measured (straight-stem THA, 0.09 Nm/kg ± 0.4, p = 0.32; short-stem THA, 0.2 Nm/kg ± 0.3, p = 0.004). Comparison of the 12-month postoperative total HHS and WOMAC revealed no significant differences between both groups. A significant increase in hip abductor muscle strength 12 months after short-stem THA compared to conventional-stem THA was observed. Full article
(This article belongs to the Special Issue Recent Advances in Arthroplasty - Part I)
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11 pages, 15206 KiB  
Article
Secondary Patellar Resurfacing in TKA: A Combined Analysis of Registry Data and Biomechanical Testing
by Leandra Bauer, Matthias Woiczinski, Christoph Thorwächter, Oliver Melsheimer, Patrick Weber, Thomas M. Grupp, Volkmar Jansson and Arnd Steinbrück
J. Clin. Med. 2021, 10(6), 1227; https://doi.org/10.3390/jcm10061227 - 16 Mar 2021
Cited by 9 | Viewed by 1632
Abstract
The German Arthroplasty registry (EPRD) has shown that different prosthesis systems have different rates of secondary patellar resurfacing: four years after implantation, the posterior-stabilized (PS) Vega prosthesis has a 3.2% risk of secondary patellar resurfacing compared to the cruciate-retaining (CR) Columbus prosthesis at [...] Read more.
The German Arthroplasty registry (EPRD) has shown that different prosthesis systems have different rates of secondary patellar resurfacing: four years after implantation, the posterior-stabilized (PS) Vega prosthesis has a 3.2% risk of secondary patellar resurfacing compared to the cruciate-retaining (CR) Columbus prosthesis at 1.0% (both Aesculap AG, Tuttlingen, Germany). We hypothesized that PS implants have increased retropatellar pressure and a decreased retropatellar contact area compared to a CR design, which may lead to an increased likelihood of secondary patellar resurfacing. Eight fresh frozen specimens (cohort 1) were tested with an established knee rig. In addition, a possible influence of the registry-based patient collective (cohort 2) was investigated. No significant differences were found in patient data–cohort 2-(sex, age). A generally lower number of PS system cases is noteworthy. No significant increased patella pressure could be detected with the PS design, but a lower contact area was observed (cohort 1). Lower quadriceps force (100°–130° flexion), increased anterior movement of the tibia (rollback), greater external tilt of the patella, and increasing facet pressure in the Vega PS design indicate a multifactorial cause for a higher rate of secondary resurfacing which was found in the EPRD patient cohort and might be related to the PS’ principle function. Full article
(This article belongs to the Special Issue Recent Advances in Arthroplasty - Part I)
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9 pages, 815 KiB  
Article
Ceramic-on-Ceramic Bearing in Total Hip Arthroplasty Reduces the Risk for Revision for Periprosthetic Joint Infection Compared to Ceramic-on-Polyethylene: A Matched Analysis of 118,753 Cementless THA Based on the German Arthroplasty Registry
by Lisa Renner, Carsten Perka, Oliver Melsheimer, Alexander Grimberg, Volkmar Jansson and Arnd Steinbrück
J. Clin. Med. 2021, 10(6), 1193; https://doi.org/10.3390/jcm10061193 - 12 Mar 2021
Cited by 4 | Viewed by 2291
Abstract
Periprosthetic joint infection (PJI) is one of the most common complications in total hip arthroplasty (THA). The influence of bearing material on the risk of PJI remains unclear to date. This registry-based matched study investigates the role of bearing partners in primary cementless [...] Read more.
Periprosthetic joint infection (PJI) is one of the most common complications in total hip arthroplasty (THA). The influence of bearing material on the risk of PJI remains unclear to date. This registry-based matched study investigates the role of bearing partners in primary cementless THA. Primary cementless THAs recorded in the German Arthroplasty Registry since 2012 with either a ceramic-on-ceramic (CoC) or ceramic-on-polyethylene (CoP) bearings were included in the analysis. Using propensity score matching (PSM) for age, sex, obesity, diabetes mellitus, Elixhauser comorbidity index, year of surgery and head size, we compared the risk for revision for PJI for CoC and CoP. Within the 115,538 THAs (87.1% CoP; 12.9% CoC), 977 revisions were performed due to PJI. There was a significantly higher risk for revision for PJI for CoP compared with CoC over the whole study period (p < 0.01) after 2:1 matching (CoP:CoC) with a hazard ratio of 1.41 (95% confidence interval (CI), 1.09 to 1.80) After 3 years, the risk for revision for PJI was 0.7% (CI 0.5–0.9%) for CoC and 0.9% (CI 0.8–1.1%) for CoP. The risk for revision for all other reasons except PJI did not significantly differ between the two groups over the whole study period (p = 0.4). Cementless THAs with CoC bearings were less likely to be revised because of infection in mid-term follow-up. In the future, registry-embedded studies focusing on long-term follow-up, including clinical data, as well as basic science studies, may give a deeper insight into the influence of the bearing partners. Full article
(This article belongs to the Special Issue Recent Advances in Arthroplasty - Part I)
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9 pages, 1732 KiB  
Article
Public Interest in Knee Pain and Knee Replacement during the SARS-CoV-2 Pandemic in Western Europe
by Arne Kienzle, Lara Biedermann, Evgeniya Babeyko, Stephanie Kirschbaum, Georg Duda, Carsten Perka and Clemens Gwinner
J. Clin. Med. 2021, 10(5), 1067; https://doi.org/10.3390/jcm10051067 - 4 Mar 2021
Cited by 5 | Viewed by 2040
Abstract
Due to the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) pandemic, a large number of elective knee replacement procedures had to be postponed in both early and late 2020 in most western countries including Germany and the UK. It is unknown how [...] Read more.
Due to the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) pandemic, a large number of elective knee replacement procedures had to be postponed in both early and late 2020 in most western countries including Germany and the UK. It is unknown how public interest and demand for total knee arthroplasties was affected. Public interest in knee pain, knee osteoarthritis and knee arthroplasty in Germany and the UK was investigated using Google Trend Analysis. In addition, we monitored for changes in patient composition in our outpatient department. As of early March in Germany and of late March in the UK, until the lockdown measures, a 50 to 60% decrease in relative search frequency was observed in all categories investigated compared to the beginning of the year. While public interest for knee pain rapidly recovered, decreased interest for knee osteoarthritis and replacement lasted until the easing of measures. Shortly prior to and during the first lockdown mean search frequency for knee replacement was significantly decreased from 39.7% and 36.6 to 26.9% in Germany and from 47.7% and 50.9 to 23.7% in the UK (Germany: p = 0.022 prior to lockdown, p < 0.001 during lockdown; UK: p < 0.0001 prior to and during lockdown). In contrast, mean search frequencies did not differ significantly from each other for any of the investigated time frames during the second half of 2020 in both countries. Similarly, during the first lockdown, the proportion of patients presenting themselves to receive primary knee arthroplasty compared to patients that had already undergone knee replacement declined markedly from 64.7% to 46.9%. In contrast, patient composition changed only marginally during the lockdown measures in late 2020 in both Germany and the UK. We observed a high level of public interest in knee arthroplasty despite the ongoing pandemic. The absence of a lasting decline in interest in primary knee arthroplasty suggests that sufficient symptom reduction cannot be achieved without surgical care for a substantial number of patients. Full article
(This article belongs to the Special Issue Recent Advances in Arthroplasty - Part I)
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9 pages, 1675 KiB  
Article
The Inverse Spacer—A Novel, Safe, and Cost-Effective Approach in Routine Procedures for Revision Knee Arthroplasty
by Kristoff Hammerich, Jens Pollack, Alexander F. Hasse, André El Saman, René Huber, Markus Rupp, Volker Alt, Raimund W. Kinne and Joerg Mika
J. Clin. Med. 2021, 10(5), 971; https://doi.org/10.3390/jcm10050971 - 2 Mar 2021
Cited by 5 | Viewed by 2199
Abstract
Background: A major disadvantage of current spacers for two-stage revision total knee arthroplasty (R-TKA) is the risk of (sub-) luxation during mobilization in the prosthesis-free interval, limiting their clinical success with detrimental consequences for the patient. The present study introduces a novel inverse [...] Read more.
Background: A major disadvantage of current spacers for two-stage revision total knee arthroplasty (R-TKA) is the risk of (sub-) luxation during mobilization in the prosthesis-free interval, limiting their clinical success with detrimental consequences for the patient. The present study introduces a novel inverse spacer, which prevents major complications, such as spacer (sub-) luxations and/or fractures of spacer or bone. Methods: The hand-made inverse spacer consisted of convex tibial and concave femoral components of polymethylmethacrylate bone cement and was intra-operatively molded under maximum longitudinal tension in 5° flexion and 5° valgus position. Both components were equipped with a stem for rotational stability. This spacer was implanted during an R-TKA in 110 knees with diagnosed or suspected periprosthetic infection. Postoperative therapy included a straight leg brace and physiotherapist-guided, crutch-supported mobilization with full sole contact. X-rays were taken before and after prosthesis removal and re-implantation. Results: None of the patients experienced (sub-) luxations/fractures of the spacer, periprosthetic fractures, or soft tissue compromise requiring reoperation. All patients were successfully re-implanted after a prosthesis-free interval of 8 weeks, except for three patients requiring an early exchange of the spacer due to persisting infection. In these cases, the prosthetic-free interval was prolonged for one week. Conclusion: The inverse spacer in conjunction with our routine procedure is a safe and cost-effective alternative to other articulating or static spacers, and allows crutch-supported sole contact mobilization without major post-operative complications. Maximum longitudinal intra-operative tension in 5° flexion and 5° valgus position appears crucial for the success of surgery. Full article
(This article belongs to the Special Issue Recent Advances in Arthroplasty - Part I)
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12 pages, 2130 KiB  
Article
Mobile Anatomical Total Ankle Arthroplasty—Improvement of Talus Recentralization
by Faisal Alsayel, Mustafa Alttahir, Massimiliano Mosca, Alexej Barg, Mario Herrera-Pérez and Victor Valderrabano
J. Clin. Med. 2021, 10(3), 554; https://doi.org/10.3390/jcm10030554 - 2 Feb 2021
Cited by 8 | Viewed by 5779
Abstract
Introduction: Total ankle arthroplasty (TAA) is becoming a more frequent treatment option for end-stage ankle osteoarthritis (OA) as outcomes measures are improving. However, there is concern that malalignment of TAA can result in premature failure of the implant. One of the malalignment issues [...] Read more.
Introduction: Total ankle arthroplasty (TAA) is becoming a more frequent treatment option for end-stage ankle osteoarthritis (OA) as outcomes measures are improving. However, there is concern that malalignment of TAA can result in premature failure of the implant. One of the malalignment issues is the talar sagittal malposition. However, a consensus on the significance of the sagittal translation of the talus in TAA is yet to be established. The aim of this study was, therefore, to clarify whether talus OA subluxation is normalized after the implantation of a mobile TAA. Methods: Forty-nine consecutive patients with symptomatic end-stage ankle OA underwent 50 cementless three-component mobile-bearing VANTAGE TAA with 21 right ankles (42%) and 29 left ankles (58%). Clinical and radiographic outcomes were assessed: Clinical variables: American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score (0–100), visual analogue scale (VAS, 0–10), and ankle range of motion (ROM). Radiological variables: medial distal tibial articular angle (mDTAA), anterior distal tibial articular angle (aDTAA) and lateral talar station (LTS). Results: The clinical results showed the mean improvement in AOFAS hindfoot score from 42.12 ± SE 2.42 (Range: 9–72) preoperatively, to 96.02 ± SE 0.82 (Range: 78–100) at a mean follow-up of 12 months, with a highly statistically significant difference (p < 0.00001). Pain score (VAS) was 6.70 ± SE 0.28 (Range 0–10) preoperatively, and 0.26 ± SE 0.12 (Range: 0–3) at 12-month follow-up, with a highly statistically significant difference (p < 0.00001). ROM measurements preoperatively showed a mean of 22.55° ± SE 1.51° (Range: 0–50°), which showed a statistically significant improvement (p < 0.0001) to 45.43° ± SE 1.56° (Range: 25–60°) 12 months postoperatively. The radiological analyses revealed the following results: On the coronal view, the mDTAA preoperatively was 88.61 ± SE 0.70 (Range: 78.15–101.10), which improved to 89.46 ± SE 0.40 (Range: 81.95–95.80) at 12 months (not statistically significant—p = 0.94). On the sagittal view, the preoperative values of the aDTAA showed 82.66 ± SE 0.84 (Range: 70.35–107.47), which improved to 88.98 ± SE 0.47 (Range: 82.83–96.32) at 12 months postoperatively, with a highly statistically significant difference between preoperative and 12-months values (p < 0.00001). The mean LTS values for all patients were 3.95 mm ± SE 0.78 (Range: −11.52 to 13.89) preoperatively and 1.14 mm ± SE 0.63 (Range: −10.76 to 11.75) at 12 months, with a statistically significant difference between preoperative and 12-month follow-up (p = 0.01). The review of the radiological TAA osteointegration at 12 months showed no cases of loosening of the implanted TAAs. Two cases (4%) showed a radiolucency and one case (2%) a cyst on the tibial component; no cases had a change on the talar component. No TAA complication/revision surgeries were documented. Conclusion: In the present study, the lateral talar station of anteriorly subluxated ankles showed a significant improvement, i.e., physiological centralization of the talus, in the postoperative period when a mobile-bearing TAA was performed. The anterior/posterior congruency between the talar component and the mobile polyethylene insert of the mobile-bearing VANTAGE TAA allows the sagittal translation of the talus relative to the flat tibial component, reducing the prosthesis strain and failure. Full article
(This article belongs to the Special Issue Recent Advances in Arthroplasty - Part I)
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9 pages, 721 KiB  
Article
Effect of Coronal Alignment on 10-Year Survivorship of a Single Contemporary Total Knee Arthroplasty
by Meagan E. Tibbo, Afton K. Limberg, Kevin I. Perry, Mark W. Pagnano, Michael J. Stuart, Arlen D. Hanssen and Matthew P. Abdel
J. Clin. Med. 2021, 10(1), 142; https://doi.org/10.3390/jcm10010142 - 4 Jan 2021
Cited by 10 | Viewed by 2799
Abstract
Debate remains regarding the utility of mechanical axis alignment as a predictor of durability after total knee arthroplasty (TKA). Our study aimed to assess the effects of coronal alignment on implant durability, clinical outcomes, and radiographic results with a single fixed-bearing TKA design. [...] Read more.
Debate remains regarding the utility of mechanical axis alignment as a predictor of durability after total knee arthroplasty (TKA). Our study aimed to assess the effects of coronal alignment on implant durability, clinical outcomes, and radiographic results with a single fixed-bearing TKA design. All patients undergoing primary cemented TKA of a single design (Stryker Triathlon) from 2005–2007 with >10 years of follow-up and available pre-operative and post-operative hip–knee–ankle radiographs were included (n = 89). Radiographs were measured to determine coronal alignment and assessed for loosening. Mean preoperative mechanical axis alignment was −6° ± 6.7° (varus, range, −16°–23°), while mean post-operative alignment was −1° ± 2.7° (varus, range, −3°–15°). The aligned group was defined as knees with a post-operative mechanical axis of 0° ± 3° (n = 73) and the outlier group as those outside this range (n = 16). No patients underwent revision. Ten-year survivorship free from any reoperation was 99% and 100% in the aligned and outlier groups, respectively (p = 0.64). Knee Society scores improved significantly in both groups (p < 0.001) and did not differ at final follow-up (p = 0.15). No knees demonstrated radiographic evidence of loosening. Post-operative mechanical axis alignment within 3° of neutral was not associated with improved implant durability, clinical outcomes, or radiographic results at 10 years following primary TKA. Full article
(This article belongs to the Special Issue Recent Advances in Arthroplasty - Part I)
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Review

Jump to: Research

9 pages, 856 KiB  
Review
Spinopelvic Alignment and Its Use in Total Hip Replacement Preoperative Planning—Decision Making Guide and Literature Review
by Piotr Stępiński, Artur Stolarczyk, Bartosz Maciąg, Krzysztof Modzelewski, Jakub Szymczak, Weronika Michalczyk, Julia Zdun and Szymon Grzegorzewski
J. Clin. Med. 2021, 10(16), 3528; https://doi.org/10.3390/jcm10163528 - 11 Aug 2021
Cited by 5 | Viewed by 4390
Abstract
Worldwide tendencies to perform large numbers of total hip arthroplasties in the treatment of osteoarthritis are observable over a long period of time. Every year, there is an observable increase in the number of these procedures performed. The outcomes are good but not [...] Read more.
Worldwide tendencies to perform large numbers of total hip arthroplasties in the treatment of osteoarthritis are observable over a long period of time. Every year, there is an observable increase in the number of these procedures performed. The outcomes are good but not ideal, especially in groups of patients with spine problems. In recent years, a growing interest in this field may be observed, since spinopelvic alignment seems to have a significant impact on total hip replacement (THR) results. The aim of this study is to describe relations between spine and pelvic alignment and provide practical information about its impact on total hip replacement. The authors performed a literature review based on PubMed, Embase, and Medline and provide practical guidelines based on them and their own experience. Full article
(This article belongs to the Special Issue Recent Advances in Arthroplasty - Part I)
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