Autophagy inhibitors 3-MA and LY294002 repress osteoclastogenesis and titanium particle-stimulated osteolysis

Metal allergy is an unusual complication of joint replacement that may cause aseptic loosening and necessitate joint revision surgery. We present the case of nickel allergy causing aseptic loosening following patellofemoral joint replacement (PFJR) in a 54-year-old male. Joint revision surgery to a nickel-free total knee replacement was performed with good results. Our literature review shows that there is no evidence to guide the management of metal allergy in PFJR. The evidence from studies of total knee replacement is limited to retrospective case series and case reports and gives contradictory recommendations. The optimal management strategy for metal allergy in PFJR is not clear. We recommend allergy testing in patients with history of metal allergy and use of an allergen-free implant in those with positive tests. As there is no gold standard test to establish metal allergy, the choice of test should be guided by availability and recommendation from the local unit of dermatology and allergy testing. We recommend investigation for metal allergy in patients with implant loosening where other causes have been excluded.

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Development of Methodology to Assess the Effect of Stem Surface Finish on Implant Loosening

ASME 2010 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2010-19603 ◽

2010 ◽

Author(s):

Yara K. Hosein ◽

Stewart D. McLachlin ◽

Graham J. W. King ◽

Cynthia E. Dunning

Keyword(s):

Bone Cement ◽

Surface Finish ◽

Joint Replacement ◽

Revision Surgery ◽

Relative Displacement ◽

Common Complication ◽

Implant Loosening ◽

Joint Replacement Surgery ◽

Replacement Surgery ◽

Orthopaedic Procedure

Joint replacement surgery is a common orthopaedic procedure used for the treatment of diseased or damaged joints. The majority of these replacement systems incorporate a stemmed portion which is inserted into the bone canal, either with or without bone cement, to achieve fixation to the host bone. Although this procedure has proven effective, relative displacement at the bone-cement and/or cement-stem interfaces (i.e., implant loosening) is a common complication, leading to pain and the need for revision surgery.

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The Effect of Intramedullary Stem Curvature on the Torsional Stability of Cemented Joint Replacement Systems

ASME 2011 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2011-53530 ◽

2011 ◽

Author(s):

Yara K. Hosein ◽

Meghan P. Clynick ◽

Sarah E. Takaki ◽

Stewart D. McLachlin ◽

Cynthia E. Dunning

Keyword(s):

Bone Cement ◽

Joint Replacement ◽

Revision Surgery ◽

Host Bone ◽

Common Complication ◽

Implant Loosening ◽

Torsional Stability ◽

Stem Curvature

Joint replacement surgeries are a common treatment for diseased or damaged joints. The procedure typically involves the insertion of a metal stemmed component into the bone canal, either with or without bone cement, to achieve fixation to the host bone. Although this procedure has proven effective, implant loosening remains a relatively common complication, leading to pain and the eventual need for revision surgery.

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Evaluation of aseptic loosening of knee prostheses by quantitative bone scintigraphy

Nuklearmedizin ◽

10.3413/nukmed-0123 ◽

2008 ◽

Vol 47 (04) ◽

pp. 163-166 ◽

Cited By ~ 6

Author(s):

D. Steiner ◽

S. Laurich ◽

R. Bauer ◽

J. Kordelle ◽

R. Klett

Keyword(s):

Aseptic Loosening ◽

Bone Scintigraphy ◽

Revision Surgery ◽

Predictive Value ◽

Knee Prostheses ◽

Treatment Regimes ◽

Golden Standard ◽

The Difference ◽

Sensitivity Specificity ◽

Asymptomatic Control

SummaryIn not infected knee prostheses bone scintigraphy is a possible method to diagnose mechanical loosening, and therefore, to affect treatment regimes in symptomatic patients. However, hitherto studies showed controversial results for the reliability of bone scintigraphy in diagnosing loosened knee prostheses by using asymptomatic control groups. Therefore, the aim of our study was to optimize the interpretation procedure and to evaluate the accuracy using results from revision surgery as standard. Methods: Retrospectively, we were able to examine the tibial component in 31 cemented prostheses. In this prostheses infection was excluded by histological or bacteriological examination during revision surgery. To quantify bone scintigraphy, we used medial and lateral tibial regions with a reference region from the contralateral femur. Results: To differentiate between loosened and intact prostheses we found a threshold of 5.0 for the maximum tibia to femur ratio of the both tibial regions and a threshold of 18% for the difference of the ratio of both tibial regions. Using these thresholds, values of 0.9, 1, 0.85, 1, and 0.94 were calculated for sensitivity, specificity, negative predictive value, positive predictive value, and accuracy, respectively. To get a sensitivity of 1, we found a lower threshold of 3.3 for the maximum tibia to femur ratio. Conclusion: Quantitative bone scintigraphy appears to be a reliable diagnostic tool for aseptic loosening of knee prostheses with thresholds evaluated by revision surgery results being the golden standard.

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Extended Routine Follow-up of Primary Uncomplicated Hip and Knee Arthroplasty is not Necessary

The Open Orthopaedics Journal ◽

10.2174/1874325001913010266 ◽

2019 ◽

Vol 13 (1) ◽

pp. 266-271

Author(s):

Georgina Kakra Wartemberg ◽

Thomas Goff ◽

Simon Jones ◽

James Newman

Keyword(s):

Aseptic Loosening ◽

Revision Surgery ◽

Revision Arthroplasty ◽

Cost Effective ◽

Face To Face ◽

Primary Surgery ◽

Effective System ◽

Knee Revision Surgery ◽

Knee Revision

Aims: To create a more effective system to identify patients in need of revision surgery. Background: There are over 160,000 total hip and knee replacements performed per year in England and Wales. Currently, most trusts review patients for up to 10 years or more. When we consider the cost of prolonged reviews, we cannot justify the expenditure within a limited budget. Study Design & Methods: We reviewed all patients' notes that underwent primary hip and knee revision surgery at our institution, noting age, gender, symptoms at presentation, referral source, details of the surgery, reason for revision and follow up history from primary surgery. Results: There were 145 revision arthroplasties (60 THR and 85 TKR) that met our inclusion criteria. Within the hip arthroplasty group, indications for revision included aseptic loosening (37), dislocation (10), and infection (3), periprosthetic fracture, acetabular liner wear and implant failure. All thirty-seven patients with aseptic loosening presented with pain. Twenty-five were referred from general practice with new symptoms. The remaining were clinic follow-ups. The most common reason for knee revision was aseptic loosening (37), followed by infection (21) and then progressive osteoarthritis (8). Most were referred from GP as a new referral or were clinic follow-ups. All patients were symptomatic. Conclusion: All the patients that underwent revision arthroplasty were symptomatic. Rather than yearly follow up, we recommend a cost-effective system. We are implementing a 'non face-to-face' system. Patients would be directly sent a questionnaire and x-ray form. The radiographs and forms will be reviewed by an experienced arthroplasty surgeon. The concerning cases will be seen urgently in a face-to-face clinic.

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Impaction bone grafting in hip re-revision surgery

The Bone & Joint Journal ◽

10.1302/0301-620x.103b3.bjj-2020-1228.r1 ◽

2021 ◽

Vol 103-B (3) ◽

pp. 492-499

Author(s):

Eduardo Garcia-Rey ◽

Laura Saldaña ◽

Eduardo Garcia-Cimbrelo

Keyword(s):

Aseptic Loosening ◽

Acetabular Component ◽

Revision Surgery ◽

Bone Grafting ◽

Bone Defects ◽

Bone Stock ◽

Impaction Bone Grafting ◽

Acetabular Bone ◽

Acetabular Bone Defects

Aims Bone stock restoration of acetabular bone defects using impaction bone grafting (IBG) in total hip arthroplasty may facilitate future re-revision in the event of failure of the reconstruction. We hypothesized that the acetabular bone defect during re-revision surgery after IBG was smaller than during the previous revision surgery. The clinical and radiological results of re-revisions with repeated use of IBG were also analyzed. Methods In a series of 382 acetabular revisions using IBG and a cemented component, 45 hips (45 patients) that had failed due to aseptic loosening were re-revised between 1992 and 2016. Acetabular bone defects graded according to Paprosky during the first and the re-revision surgery were compared. Clinical and radiological findings were analyzed over time. Survival analysis was performed using a competing risk analysis. Results Intraoperative bone defect during the initial revision included 19 Paprosky type IIIA and 29 Paprosky type IIIB hips; at re-revision, seven hips were Paprosky type II, 27 type IIIA and 11 were type IIIB (p = 0.020). The mean preoperative Harris Hip Score was 45.4 (SD 6.4), becoming 80.7 (SD 12.7) at the final follow-up. In all, 12 hips showed radiological migration of the acetabular component, and three required further revision surgery. The nine-year cumulative failure incidence (nine patients at risk) of the acetabular component for further revision surgery was 9.6% (95% confidence interval (CI) 2.9 to 21.0) for any cause, and 7.5% (95% CI 1.9 to 18.5) for aseptic loosening. Hips with a greater hip height had a higher risk for radiological migration (odds ratio 1.09, 95% CI 1.02 to 1.17; p = 0.008). Conclusion Bone stock restoration can be obtained using IBG in revision hip surgery. This technique is also useful in re-revision surgery; however, a better surgical technique including a closer distance to hip rotation centre could decrease the risk of radiological migration of the acetabular component. A longer follow-up is required to assess potential fixation deterioration. Cite this article: Bone Joint J 2021;103-B(3):492–499.

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