scholarly journals Prevalence of Cobalturia Among Adults With Joint Replacements

2021 ◽  
Vol 4 (8) ◽  
pp. e2121758
Author(s):  
Stephen S. Tower ◽  
Christina S. Cho ◽  
Robert L. Bridges ◽  
Bradford D. Gessner
Keyword(s):  
Joint Replacements

scholarly journals POS1143 GOUT AND JOINT REPLACEMENTS IN THE US

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 851.1-851
Author(s):  
G. Singh ◽  
M. Sehgal ◽  
A. Mithal
Keyword(s):  
Knee Joint ◽  
Confidence Intervals ◽  
Knee Replacement ◽  
Joint Replacement ◽  
Economic Burden ◽  
Hip Replacement ◽  
Average Charge ◽  
Joint Replacements ◽  
Increased Risk ◽  
The Us

Background:Irreversible joint damage in gout has been linked to a possible increase in knee and hip joint replacements1. In addition, the strong association between gout and osteoarthritis2,3 could also lead to an increased risk of joint replacements in patients with gout. Population-based data from the UK and Taiwan have shown hazard rates of 1.14 and 1.16 respectively for knee replacements in patients with gout compared to age and gender matched controls1. However, there is little national data in the US on clinical and economic burden of joint replacements in patients with gout.Objectives:To evaluate total or partial hip and knee joint replacements in patients with gout in the US and to estimate their economic impactMethods:The Nationwide Inpatient Sample (NIS) is a stratified random sample of all US community hospitals. It is the only US national hospital database with information on all patients, regardless of payer, including persons covered by Medicare, Medicaid, private insurance, and the uninsured. Detailed information including clinical and nonclinical data elements on each hospital stay including International Classification of Diseases (ICD)10 diagnosis and procedure codes, age, gender, length of stay, payer, charges, comorbidities etc. is available. We examined hospitalizations in patients with gout with hip and knee joint replacements in NIS 2018, the most recent year of data.Results:In 2018, there were 914,510 hospitalizations with primary or secondary diagnosis of gout in the US. Of these 43,615 were for joint replacement surgeries (knee (24,840) and hip (18,755)). Patients with knee replacement were on an average 68.5 years old (95% confidence intervals 68.2 years -68.8 years). Patients with hip replacement were slightly older (mean age 70.3 years, 95% confidence intervals 69.8 years -70.7 years). Unlike general population statistics, men formed a majority of these joint replacements (68% for the knee and 72% for the hip). The average charge per hospitalization was $69,279 and $72,944 for knee and hip replacement respectively. The total annual national cost estimate was $3.09 billion, with government insurances (Medicare and Medicaid) responsible for 67% of knee replacement and 70% of hip replacement costs.Conclusion:Joint replacements in gout patients have a large clinical and economic burden in the US. This calls for an increased awareness and management of associated hip and knee arthritis in patients with gout.References:[1]Kuo CF, Chou IJ, See LC, et al. Urate-lowering treatment and risk of total joint replacement in patients with gout. Rheumatology. Dec 1 2018;57(12):2129-2139.[2]Howard RG, Samuels J, Gyftopoulos S, et al. Presence of gout is associated with increased prevalence and severity of knee osteoarthritis among older men: results of a pilot study. Journal of clinical rheumatology: practical reports on rheumatic & musculoskeletal diseases. Mar 2015;21(2):63-71.[3]Roddy E, Zhang W, Doherty M. Are joints affected by gout also affected by osteoarthritis? Annals of the rheumatic diseases. Oct 2007;66(10):1374-1377.Disclosure of Interests:Gurkirpal Singh Shareholder of: Pfizer, Merck, Sanofi, Grant/research support from: Horizon, Maanek Sehgal: None declared, Alka Mithal: None declared.

scholarly journals Oxide Bioceramic Composites in Orthopedics and Dentistry

2021 ◽  
Vol 5 (8) ◽  
pp. 206
Author(s):  
Piconi Corrado ◽  
Sprio Simone
Keyword(s):  
Mechanical Behavior ◽  
Hip Replacement ◽  
Ceramic Composites ◽  
Clinical Applications ◽  
Wide Field ◽  
Joint Replacements ◽  
Composite Systems ◽  
Third Phase ◽  
Main Component ◽  
Zirconia Toughened Alumina

Ceramic composites based on alumina and zirconia have found a wide field of application in the present century in orthopedic joint replacements, and their use in dentistry is spreading. The development of this class of bioceramic composites was started in the 1980s, but the first clinical applications of the total hip replacement joint were introduced in the market only in the early 2000s. Since then, several composite systems were introduced in joint replacements. These materials are classified as Zirconia-Toughened Alumina if alumina is the main component or as Alumina-Toughened Zirconia when zirconia is the main component. In addition, some of them may contain a third phase based on strontium exa-aluminate. The flexibility in device design due to the excellent mechanical behavior of this class of bioceramics results in a number of innovative devices for joint replacements in the hip, the knee, and the shoulder, as well in dental implants. This paper gives an overview of the different materials available and on orthopedic and dental devices made out of oxide bioceramic composites today on the market or under development.

scholarly journals Trends and developments in hip and knee arthroplasty technology

2021 ◽  
Vol 8 ◽  
pp. 205566832095204
Author(s):  
Martin Marsh ◽  
Simon Newman
Keyword(s):  
Knee Arthroplasty ◽  
Standard Of Care ◽  
Hip Resurfacing ◽  
Implant Survival ◽  
Dual Mobility ◽  
Joint Replacements ◽  
Robotic Assisted Surgery ◽  
Hip And Knee Arthroplasty ◽  
Hip Stems ◽  
Hip And Knee Surgery

The developments in hip and knee arthroplasty over recent years have aimed to improve outcomes, reduce complications and improve implant survival. This review describes some of the most interesting trends and developments in this important and fast-moving field. Notable developments have included ceramic hip resurfacing, mini hip stems, cementless knee replacement and the wider adoption of the dual mobility articulation for hip arthroplasty. Advances in additive manufacturing and the surface modification of joint replacements offer increasing options for more challenging arthroplasty cases. Robotic assisted surgery is one of the most interesting developments in hip and knee surgery. The recent growth in the use of this technology is providing data that will help determine whether this approach should become the standard of care for hip and knee arthroplasty in the future.

scholarly journals Effect of synthetic bone replacement material of different size on shear stress resistance within impacted native and thermodisinfected cancellous bone: an in vitro femoral impaction bone grafting model

2021 ◽  
Author(s):  
C. Fölsch ◽  
P. Sahm ◽  
C. A. Fonseca Ulloa ◽  
G. A. Krombach ◽  
M. Kampschulte ◽  
...  
Keyword(s):  
Cancellous Bone ◽  
Bone Grafting ◽  
Shear Force ◽  
Distal Region ◽  
Impaction Bone Grafting ◽  
Proximal Point ◽  
Local Antibiotics ◽  
Joint Replacements ◽  
Native Bone

AbstractAntibiotic carrier particles of variable size might influence mechanic properties within impacted thermodisinfected and native cancellous bone different. Herafill®G containing calciumsulfate and calciumcarbonate provides high local concentrations of gentamicin being important for revision surgery in infected joint replacements. Native and thermodisinfected cancellous bone derived from 6 to 7 months old piglets was used for in vitro impaction bone grafting and supplemented each with Herafill®G granules of two different sizes. Micromovement of implants related to shear force was measured in 29 specimens distributed in 6 groups. Thermodisinfected cancellous bone revealed a significant higher shear force resistance than native bone with a mean difference of 423.8 mdeg/Nm (p < 0.001) ranging within 95% confidence interval from 181.5 to 666.0 mdeg/Nm. Adding small granules to thermodisinfected bone did not reduce shear force resistance significantly since adding large granules to native bone improved it by 344.0 mdeg/Nm (p < 0.003). Shear force resistance was found higher at the distal region of the implant compared to a proximal point of measurement throughout all specimens. Less impaction impulses were necessary for thermodisinfected bone. Thermodisinfected cancellous bone might achieve a higher degree of impaction compared with native bone resulting in increased resistance against shear force since impaction was found increased distally. Supplementation of thermodisinfected bone with small granules of Herafill®G might be considered for application of local antibiotics. Large granules appeared more beneficial for supplementation of native bone. Heterogeneity of bone graft and technical aspects of the impaction procedure have to be considered regarding the reproducibility of femoral impaction bone grafting.

Nursing considerations for patients undergoing robotic-arm assisted joint replacements

2021 ◽  
Vol 30 (10) ◽  
pp. 580-587
Author(s):  
Ajay Asokan ◽  
Joanna Baawa-Ameyaw ◽  
Babar Kayani ◽  
Ganan T Radhakrishnan ◽  
Ahmed A Magan ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Nursing Care ◽  
Functional Outcomes ◽  
Multidisciplinary Approach ◽  
Robotic Arm ◽  
Surgical Trauma ◽  
Pragmatic Approach ◽  
Joint Replacements ◽  
The Past ◽  
Implant Positioning

Robotic-arm assisted arthroplasty (RAA) has gained popularity over the past decade because of its ability to provide more accurate implant positioning with less surgical trauma than conventional manual arthroplasty. It has shown better early functional outcomes, less postoperative pain and shorter inpatient stays. A multidisciplinary approach is crucial in improving overall outcomes and ensuring this technology is implemented efficiently and safely, but there is limited published literature on the nursing considerations for managing patients undergoing RAA. This article aims to provide a pragmatic approach for nursing care in the pre-, intra-, and postoperative phases of RAA.

scholarly journals Periprosthetic Osteolysis: Mechanisms, Prevention and Treatment

2019 ◽  
Vol 8 (12) ◽  
pp. 2091 ◽  
Author(s):  
Stuart B. Goodman ◽  
Jiri Gallo
Keyword(s):  
Nuclear Factor Κb ◽  
Nuclear Factor ◽  
Activator Protein 1 ◽  
Periprosthetic Osteolysis ◽  
Bone Implant ◽  
Joint Replacements ◽  
In Vivo Experiments ◽  
Mechanical Factors

Clinical studies, as well as in vitro and in vivo experiments have demonstrated that byproducts from joint replacements induce an inflammatory reaction that can result in periprosthetic osteolysis (PPOL) and aseptic loosening (AL). Particle-stimulated macrophages and other cells release cytokines, chemokines, and other pro-inflammatory substances that perpetuate chronic inflammation, induce osteoclastic bone resorption and suppress bone formation. Differentiation, maturation, activation, and survival of osteoclasts at the bone–implant interface are under the control of the receptor activator of nuclear factor kappa-Β ligand (RANKL)-dependent pathways, and the transcription factors like nuclear factor κB (NF-κB) and activator protein-1 (AP-1). Mechanical factors such as prosthetic micromotion and oscillations in fluid pressures also contribute to PPOL. The treatment for progressive PPOL is only surgical. In order to mitigate ongoing loss of host bone, a number of non-operative approaches have been proposed. However, except for the use of bisphosphonates in selected cases, none are evidence based. To date, the most successful and effective approach to preventing PPOL is usage of wear-resistant bearing couples in combination with advanced implant designs, reducing the load of metallic and polymer particles. These innovations have significantly decreased the revision rate due to AL and PPOL in the last decade.

Experimental and Theoretical Study of the Contact Mechanics of Five Total Knee Joint Replacements

1995 ◽  
Vol 209 (4) ◽  
pp. 225-231 ◽  
Author(s):  
T Stewart ◽  
Z M Jin ◽  
D Shaw ◽  
D D Auger ◽  
M Stone ◽  
...  
Keyword(s):  
Plastic Deformation ◽  
Knee Joint ◽  
Contact Pressure ◽  
Contact Stress ◽  
Linear Elasticity ◽  
Contact Area ◽  
Elasticity Analysis ◽  
Joint Replacements ◽  
Total Knee ◽  
Maximum Contact

The tibio-femoral contact area in five current popular total knee joint replacements has been measured using pressure-sensitive film under a normal load of 2.5 kN and at several angles of flexion The corresponding maximum contact pressure has been estimated from the measured contact areas and found to exceed the point at which plastic deformation is expected in the ultra-high molecular weight polyethylene (UHMWPE) component particularly at flexion angles near 90°. The measured contact area and the estimated maximum contact stress have been found to be similar in magnitude for all of the five knee joint replacements tested. A significant difference, however, has been found in maximum contact pressure predicted from linear elasticity analysis for the different knee joints. This indicates that varying amounts of plastic deformation occurred in the polyethylene component in the different knee designs. It is important to know the extent of damage as knees with large amounts of plastic deformation are more likely to suffer low cycle fatigue failure. It is therefore concluded that the measurement of contact areas alone can be misleading in the design of and deformation in total knee joint replacements. It is important to modify geometries to reduce the maximum contact stress as predicted from the linear elasticity analysis, to below the linear elastic limit of the plastic component.

scholarly journals Novel biological strategies for treatment of wear particle-induced periprosthetic osteolysis of orthopaedic implants for joint replacement

2014 ◽  
Vol 11 (93) ◽  
pp. 20130962 ◽  
Author(s):  
S. B. Goodman ◽  
E. Gibon ◽  
J. Pajarinen ◽  
T.-H. Lin ◽  
M. Keeney ◽  
...  
Keyword(s):  
Pathologic Fracture ◽  
Wear Particle ◽  
Wear Particles ◽  
Implant Loosening ◽  
Orthopaedic Implants ◽  
Periprosthetic Osteolysis ◽  
Joint Replacements ◽  
Local Inhibition ◽  
Tissue Healing ◽  
Chronic Inflammatory Reaction

Wear particles and by-products from joint replacements and other orthopaedic implants may result in a local chronic inflammatory and foreign body reaction. This may lead to persistent synovitis resulting in joint pain and swelling, periprosthetic osteolysis, implant loosening and pathologic fracture. Strategies to modulate the adverse effects of wear debris may improve the function and longevity of joint replacements and other orthopaedic implants, potentially delaying or avoiding complex revision surgical procedures. Three novel biological strategies to mitigate the chronic inflammatory reaction to orthopaedic wear particles are reported. These include (i) interference with systemic macrophage trafficking to the local implant site, (ii) modulation of macrophages from an M1 (pro-inflammatory) to an M2 (anti-inflammatory, pro-tissue healing) phenotype in the periprosthetic tissues, and (iii) local inhibition of the transcription factor nuclear factor kappa B (NF-κB) by delivery of an NF-κB decoy oligodeoxynucleotide, thereby interfering with the production of pro-inflammatory mediators. These three approaches have been shown to be viable strategies for mitigating the undesirable effects of wear particles in preclinical studies. Targeted local delivery of specific biologics may potentially extend the lifetime of orthopaedic implants.

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