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 4519

Special Issue Editors


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Guest Editor
Guglielmo da Saliceto Polichirurgico Hospital AUSL Piacenza, 29121 Piacenza, Italy
Interests: knee arthroplasty; hip arthroplasty; trauma
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Guest Editor
Guglielmo da Saliceto Polichirurgico Hospital AUSL Piacenza, 29121 Piacenza, Italy
Interests: knee arthroplasty; hip arthroplasty; arthroscopy

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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

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Keywords

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

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Published Papers (3 papers)

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Research

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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
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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
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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
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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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