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Medicina
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Cutting-Edge Topics in Joint Arthroplasties
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Cutting-Edge Topics in Joint Arthroplasties

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: closed (15 September 2024) | Viewed by 8217

Special Issue Editors

Dr. Corrado Ciatti

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Guest Editor
Guglielmo da Saliceto Polichirurgico Hospital AUSL Piacenza, 29121 Piacenza, Italy
Interests: knee arthroplasty; hip arthroplasty; trauma
Special Issues, Collections and Topics in MDPI journals
Dr. Fabrizio Quattrini

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Guest Editor
1. Guglielmo da Saliceto Polichirurgico Hospital AUSL Piacenza, Piacenza, Italy
2. Department of Medicine and Surgery, University of Parma, Parma, Italy
Interests: knee arthroplasty; hip arthroplasty; arthroscopy; trauma surgery
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Pietro Maniscalco

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Guest Editor
Orthopedics and Traumatology Department, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy
Interests: orthopedics and traumatology; trauma; fractures; arthroplasty; arthroscopic; knee; hip; elbow
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues, 

Nowadays, joint replacement is one of the most frequent orthopedic surgery procedures. The progressive aging of the population, combined with the increase in the functional demands of elderly subjects, will lead to more and more prosthetic replacement operations. The objectives to be achieved in all replacements are: to provide total or at least partial pain relief, to achieve good stability, and to permit a wide range of motion (ROM) with minimal wear. This field is constantly evolving in terms of prosthetic components, surgical techniques, and rehabilitation protocols. Every year, we witness the evolution of prosthetic components, with the use of new materials, different shapes, and best-performing instruments; surgical techniques also evolve and modernize according to the needs of the population. Finally, patients are increasingly demanding: they want to return to their normal activities as quickly as possible, the pain to be resolved, and to start walking again immediately; sometimes, they request the use of particular surgical techniques or surgical approaches.

This Special Issue welcomes original research and review papers with a focus on the recent advances in joint arthroplasties; we aim to present the state of the art of the most modern surgical techniques and most recent perioperative and rehabilitation protocols.

Dr. Corrado Ciatti
Dr. Fabrizio Quattrini
Prof. Dr. Pietro Maniscalco
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

 

Keywords

  • arthroplasty
  • knee
  • hip
  • shoulder
  • bearing
  • outcome
  • revision surgery

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Published Papers (5 papers)

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Research

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12 pages, 3749 KiB  
Article
3D CT-Based Preoperative Planning and Intraoperative Navigation in Reverse Shoulder Arthroplasty: Early Clinical Outcomes
by Elisa Troiano, Azzurra Masini, Giovanni Battista Colasanti, Caterina Drago, Stefano Giannotti and Nicola Mondanelli
Medicina 2025, 61(4), 749; https://doi.org/10.3390/medicina61040749 - 18 Apr 2025
Viewed by 317
Abstract
Background and Objectives: Reverse shoulder arthroplasty (RSA) is an effective surgical procedure for treating end-stage rotator cuff arthropathy, but it is burdened by a relatively high complication rate, mainly due to glenoid component failure. Preoperative planning and intraoperative navigation based on three-dimensional [...] Read more.
Background and Objectives: Reverse shoulder arthroplasty (RSA) is an effective surgical procedure for treating end-stage rotator cuff arthropathy, but it is burdened by a relatively high complication rate, mainly due to glenoid component failure. Preoperative planning and intraoperative navigation based on three-dimensional computed tomography (3D CT) scans have proven to be efficient tools for improving the accuracy and stability of the glenoid component. However, this technology is still developing, and there is currently little available research on the subject, especially where clinical outcomes are concerned. The purpose of this retrospective observational study is to report the radiographic and clinical outcomes of a consecutive series of patients that underwent RSA with the use of these new technologies, compared to a standard procedure. Materials and Methods: A consecutive series of 80 patients underwent RSA for shoulder osteoarthritis by a single surgeon at a single institution with a mean follow-up of 41.9 ± 23.6 months (range 24–108) and were divided into two groups according to the surgical technique employed (conventional or navigated surgery), and they were clinically and radiographically assessed at 1, 3, 6, and 12 months after surgery, and then annually. Results: No statistically significant differences were highlighted among the two groups according to complication rate, radiographical glenoid notching, and clinical outcomes. However, a statistically significant difference was observed in screw number and length and surgical time. In the navigated group, fewer screws with longer lengths had been implanted, with a longer surgical time. Conclusions: The use of 3D CT-based preoperative planning and intraoperative navigation is a safe procedure and produces comparable results with respect to standard instrumentation, without an increased risk of complications. It allowed to achieve higher stability of the implant, saving bone stock due to the use of fewer and longer screws than in a conventional procedure. This could also eventually result in a higher longevity of the implant itself. Full article
(This article belongs to the Special Issue Cutting-Edge Topics in Joint Arthroplasties)
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8 pages, 275 KiB  
Article
Should We Regularly Assess Hemoglobin Levels Following Elective Total Knee Arthroplasty, with the Administration of TXA and Without the Usage Tourniquet? An Observational Study from a Single Center
by Shanny Gur, Mor Bracha Akselrad, David Segal, Yuval Fuchs, Dan Perl, Alon Fainzack, Nissim Ohana, Eyal Yaacobi, Michael Markushevich and Yaron Shraga Brin
Medicina 2024, 60(12), 1964; https://doi.org/10.3390/medicina60121964 - 28 Nov 2024
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Abstract
Background and Objectives: The aim of this study was to test whether there is a necessity for routine postoperative laboratory testing in patients undergoing primary elective unilateral total knee arthroplasty (TKA), with the administration of Tranexamic Acid (TXA) and without the use of [...] Read more.
Background and Objectives: The aim of this study was to test whether there is a necessity for routine postoperative laboratory testing in patients undergoing primary elective unilateral total knee arthroplasty (TKA), with the administration of Tranexamic Acid (TXA) and without the use of tourniquet. Materials and Methods: This observational, retrospective cohort study was conducted at Meir Medical Center. The data were collected in 2018–2022. Patients were collected in a consecutive manner. There were no exclusion criteria for this study. The inclusion criteria were individuals who underwent elective TKA due to end-stage osteoarthritis (OA). We conducted a multivariable logistic regression analysis to determine the factors associated with postoperative hemoglobin (PoOHb) < 9 g/dL and the optimal cutoff to detect those patients postoperatively. Results: A total of 271 patients were included. The mean preoperative hemoglobin (PrOHb) was 13.02 ± 1.42 g/dL, and the mean PoOHb was 11.5 ± 1.34 g/dL. The mean decrease in Hbg levels following surgery was 1.52 ± 0.91 g/dL. In all, 271 patients had a PoOHb level ≥ 9 g/dL or above. A total of 16 patients received packed red blood cells following surgery. Patients with PoOHb < 9 g/dL had a significantly lower PrOHbg. In the current study, all 11 patients who had PoOHb < 9, 10 (90.9%) had PrOHb ≤ 1011.95 55 g/dL, compared to 25 (49.6%) of the 260 patients who had PoOHb ≥ 9. The odds ratio for having PrOHb ≤ 10.9511.55 g/dL if PoOHb < 9 g/dL was 206.6710.4 (95% CI 24.427.164 to 1749.01415.97). A cut-off of 11.2510.25 would have offered a sensitivity of 99% (specificity 93.5%). Conclusions: In conclusion, this study supports using selective post-TKR Hgb monitoring rather than adhering to routine practice. An association between postoperative anemia and the need for blood transfusion was found only when the preoperative baseline hemoglobin threshold was less than 10.95 g/dL. Full article
(This article belongs to the Special Issue Cutting-Edge Topics in Joint Arthroplasties)
11 pages, 388 KiB  
Article
Topical Fibrin Sealant (Tisseel@) Does Not Provide a Synergic Blood-Conservation Effect with Tranexamic Acid in Total Knee Arthroplasty—A Prospective Randomized Controlled Trial
by Chia-Hung Liu, Chih-Hsiang Chang, Yu-Han Chang, Hsin-Nung Shih and Chih-Chien Hu
Medicina 2023, 59(12), 2078; https://doi.org/10.3390/medicina59122078 - 26 Nov 2023
Viewed by 1827
Abstract
Background and Objectives: The efficacy of tranexamic acid (TXA) in reducing perioperative blood loss during total knee arthroplasty (TKA) is well established. However, the potential synergistic blood-conservation effect of topical fibrin sealant (Tisseel@) remains unclear. This study aims to assess the effectiveness [...] Read more.
Background and Objectives: The efficacy of tranexamic acid (TXA) in reducing perioperative blood loss during total knee arthroplasty (TKA) is well established. However, the potential synergistic blood-conservation effect of topical fibrin sealant (Tisseel@) remains unclear. This study aims to assess the effectiveness of the combination of Tisseel and TXA during TKA. Materials and Methods: A single-blinded, prospective, randomized controlled trial was conducted with 100 patients (100 knees) undergoing primary TKA. Participants were randomly assigned to either the TXA group (n = 50), receiving intravenous (IV) TXA, or the Tisseel@ + TXA group (n = 50), receiving intra-articular Tisseel@ combined with IV TXA. The primary outcomes included blood transfusion rate, decrease in Hb level, calculated blood loss, and estimated total postoperative blood loss. Secondary outcomes involved assessing clinical differences between the groups. Results: The transfusion rate was zero in both groups. The average estimated blood loss in the Tisseel@ + TXA group was 0.463 ± 0.2422 L, which was similar to that of the TXA group at 0.455 ± 0.2522 L. The total calculated blood loss in the Tisseel@ + TXA group was 0.259 ± 0.1 L, compared with the TXA group’s 0.268 ± 0.108 L. The mean hemoglobin reduction in the first 24 h postoperatively was 1.57 ± 0.83 g/dL for the Tisseel@ + TXA group and 1.46 ± 0.82 g/dL for the TXA-only group. The reduction in blood loss in the topical Tisseel@ + TXA group was not significantly different from that achieved in the TXA-only group. The clinical results of TKA up to the 6-week follow-up were comparable between the groups. Conclusions: The combination of the topical fibrin sealant Tisseel@ and perioperative IV TXA administration, following the described protocol, demonstrated no significant synergistic blood-conservation effect in patients undergoing TKR. Full article
(This article belongs to the Special Issue Cutting-Edge Topics in Joint Arthroplasties)
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Review

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11 pages, 332 KiB  
Review
What to Know about Antimicrobial Coatings in Arthroplasty: A Narrative Review
by Francesco Onorato, Virginia Masoni, Luca Gagliardi, Luca Costanzo Comba and Fabrizio Rivera
Medicina 2024, 60(4), 574; https://doi.org/10.3390/medicina60040574 - 30 Mar 2024
Cited by 5 | Viewed by 2191
Abstract
Periprosthetic joint infections (PJIs) are one of the most worrying complications orthopedic surgeons could face; thus, methods to prevent them are evolving. Apart from systemic antibiotics, targeted strategies such as local antimicrobial coatings applied to prosthetics have been introduced. This narrative review aims [...] Read more.
Periprosthetic joint infections (PJIs) are one of the most worrying complications orthopedic surgeons could face; thus, methods to prevent them are evolving. Apart from systemic antibiotics, targeted strategies such as local antimicrobial coatings applied to prosthetics have been introduced. This narrative review aims to provide an overview of the main antimicrobial coatings available in arthroplasty orthopedic surgery practice. The search was performed on the PubMed, Web of Science, SCOPUS, and EMBASE databases, focusing on antimicrobial-coated devices used in clinical practice in the arthroplasty world. While silver technology has been widely adopted in the prosthetic oncological field with favorable outcomes, recently, silver associated with hydroxyapatite for cementless fixation, antibiotic-loaded hydrogel coatings, and iodine coatings have all been employed with promising protective results against PJIs. However, challenges persist, with each material having strengths and weaknesses under investigation. Therefore, this narrative review emphasizes that further clinical studies are needed to understand whether antimicrobial coatings can truly revolutionize the field of PJIs. Full article
(This article belongs to the Special Issue Cutting-Edge Topics in Joint Arthroplasties)

Other

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10 pages, 7297 KiB  
Case Report
Gross Taper Failure and Fracture of the True Neck in Total Hip Arthroplasty: Retrieval Scanning Electron Microscope Analysis
by Corrado Ciatti, Michelangelo Moschella, Edoardo Bori, Carlo Doria, Gianfilippo Caggiari, Bernardo Innocenti and Francesco Pisanu
Medicina 2024, 60(3), 458; https://doi.org/10.3390/medicina60030458 - 9 Mar 2024
Viewed by 2257
Abstract
Background and objectives: wear and corrosion can lead to the gross failure of the Morse taper junction with the consequent fracture of the true neck of the prosthetic stem in hip arthroplasty. Materials and Methods: 58-year-old male patient, with a BMI [...] Read more.
Background and objectives: wear and corrosion can lead to the gross failure of the Morse taper junction with the consequent fracture of the true neck of the prosthetic stem in hip arthroplasty. Materials and Methods: 58-year-old male patient, with a BMI of 38 kg/m2. Because of avascular necrosis, in 2007, a metal-on-metal total hip arthroplasty was implanted in him, with a TMZF stem and a Co-Cr head. In December 2020, he complained of acute left hip pain associated with the deterioration of his left leg and total functional impairment, preceded by the crunching of the hip. X-rays and CT scan showed a fracture of the prosthetic neck that necessitated prosthetic revision surgery. A Scanning Electron Microscope (SEM) analysis of the retrieved prosthetic components was conducted. Results: Macroscopically, the trunnion showed a typical bird beak appearance, due to a massive material loss of about half of its volume. The gross material loss apparently due to abrasion extended beyond the trunnion to the point of failure on the true neck about half a centimeter distal from the taper. SEM analysis demonstrated fatigue rupture modes, and the crack began close to the neck’s surface. On the lateral surface, several scratches were found, suggesting an intense wear that could be due to abrasion. Conclusions: The analysis we conducted on the explanted THA showed a ductile rupture, began close to the upper surface of the prosthetic neck where the presence of many scratches had concentrated stresses and led to a fatigue fracture. Full article
(This article belongs to the Special Issue Cutting-Edge Topics in Joint Arthroplasties)
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