scholarly journals Cementless Highly Porous Titanium Tibial Base Plate in Total Knee Arthroplasty – Midterm Outcomes.

2021 ◽  
Vol 11 ◽  
Author(s):  
Smit Shah ◽  
Nicholas Coulshed ◽  
Rami Sorial
Keyword(s):  
Femoral Component ◽  
Bone Ingrowth ◽  
Young Patients ◽  
Base Plate ◽  
Womac Score ◽  
Porous Titanium ◽  
Tibial Tray ◽  
Tibial Fixation ◽  
Joint Registry

Introduction & Aims TKA in more active and young patients has prompted the interest in more durable and biological methods of Osteo-integration with cementless components. With the emergence of improved biomaterials like porous titanium and the success, search for a cementless TKA with long-term durability and survivorship may have ended. This is a retrospective study of 492 consecutive TKAs using Cementless tibial fixation, reporting on the early 4 years clinical and radiological outcomes. Method We studied 492 TKAs performed consecutively by a single surgeon between 1stJan. 2010 and 31stDec. 2015 using a cementless, fixed bearing tibial tray (porous–Regenerex, Vanguard, Zimmer-Biomet) and a cementless femoral component (Vanguard) with no exclusion criteria. Clinical and radiological follow-up was done on these patients and in addition a comprehensive joint registry review was performed on the whole cohort (Level II evidence). Results  The average Knee Society Score at final follow-up was 89.33, average pre-op being 42.06. Average post-op WOMAC score was 43.45 and average pre-op was 77.78. On radiological examination, no patients had osteolysis around tibial base plate. In our series 9 patients were revised, out of which only 4 patients had the tibial tray and femoral component revised and 5 patients had patella resurfacing or liner exchange. Overall survivorship of the cementless tibial component is excellent with a survivorship of 99.4% at 5.9 years based on a comprehensive AOANJRR data. Conclusions Cementless tibial fixation using a porous titanium construct  can provide stable bone ingrowth fixation on the tibial side with excellent and predictable early 4 to 5 year clinical and radiological outcomes.

Sequelae of the Hip Joint Infection Treated with a Modern Alumina-on-Alumina THA

2007 ◽  
Vol 330-332 ◽  
pp. 1247-1250 ◽  
Author(s):  
Jeong Joon Yoo ◽  
Hee Joong Kim ◽  
Young Min Kim ◽  
Kang Sup Yoon ◽  
Kyung Hoi Koo ◽  
...  
Keyword(s):  
Hip Joint ◽  
Soft Tissues ◽  
Bone Ingrowth ◽  
Joint Infection ◽  
Young Patients ◽  
Clinical Results ◽  
Harris Hip Score ◽  
Attractive Alternative ◽  
Reliable Solution

Total hip arthroplasty (THA) in patients with sequelae of the hip joint infection is a technically challenging procedure. In addition, the majority of such patients are less than fifty years old, so it has been reported that they have higher prevalence of complication and failure of component fixation. Alumina-on-alumina couplings are an attractive alternative and may offer a promising option for such young active patients. We analyzed 33 primary cementless alumina-onalumina THAs (PLASMACUP®SC-BiCONTACT® system incorporating BIOLOX® forte) that had been performed in patients who had sequelae of the hip joint infection. The average age of the patients was 37.8 years (range, 19-68 years) and 26 patients were younger than 50 years old. They were followed-up for more than 5 years (average, 74 months; range, 60-93 months). All hips had no recurrence of hip joint infection. The mean Harris hip score improved from 59.8 points to 93.5 points. All of the implants had radiographic evidence of a bone ingrowth and no radiological loosening was found. During the follow-up period, no cup or stem was revised and no periprosthetic osteolysis was observed. Nonunion of the osteotomized greater trochanter occurred in one hip, but no postoperative infection or ceramic failure was observed. The 5-year minimum follow-up clinical results of modern alumina-on-alumina THAs performed in patients with sequelae of the hip joint infection were encouraging with regard to osteolysis and implant stability. Our findings show that this alternative articulation offers a reliable solution for these young patients with long-standing anatomic abnormalities of the bone and soft tissues.

scholarly journals Revision of Metal-on-metal Hip Arthroplasty with Well Fixed and Positioned Acetabular Component Using a Dual-mobility Head and Review of Literature

2016 ◽  
Vol 10 (1) ◽  
pp. 512-521 ◽  
Author(s):  
Guillem Figueras ◽  
Ramón Vives Planell ◽  
Ramón Serra Fernàndez ◽  
Joan Camí Biayna
Keyword(s):  
Femoral Component ◽  
Acetabular Component ◽  
Young Patients ◽  
Bone Stock ◽  
Cobalt Chromium ◽  
Hip Revision ◽  
Dual Mobility ◽  
Metal On Metal ◽  
Hip Arthroplasties

Background: As a consequence of use of metal-on-metal hip arthroplasties some patients have precised revision for pain or metal hipersensivity reactions among other causes. We propose to salvage monoblock acetabular component and femoral component using a dual-mobility head and perform a lower morbidity operation in young patients preserving host bone stock in cases with well fixed and positioned components. Objective: (1) What clinical problems have been reported in patients with Metal-on-metal hip arthroplasties? (2) Could the tribocorrosion potentially cause a fracture of neck femoral component? (3) Can be the dual-mobility head a recourse in metal-on-metal hip revision? Methods: Ten patients were revised for pain or/and raised Cobalt/Chromium levels between August 2012 and December 2015. In three cases femoral neck component was fractured and femoral revision was necessary. In four hips, acetabular and femoral components could be maintained. Age, body index mass, ion levels, acetabular position, size of acetabular component and femoral head, approach, blood transfunsion and time of hospitalization were analized. Results: At a mean follow-up of 25,6 months (6 to 45) the mean postoperative HHS was 92. It was not statistically significant because several patients were low sintomatic before surgery, but had raised Cobalt/Chromium levels in the blood. All patients had near-normal levels of Cobalt/Chromium during the first 6 months after revision surgery. No relevant complications were reported. Conclusion: The use of dual-mobility head can be an acceptable option to revise metal-on-metal arthroplasties correctly oriented with abscence of loosening or infection signs and keeping bone stock in young patients.

Three-year Results with the Cementless Bicontact total Hip Arthroplasty Femoral Component

1996 ◽  
Vol 6 (2) ◽  
pp. 63-68 ◽  
Author(s):  
M.I. Gusso ◽  
L. Piso ◽  
B. Caddeo ◽  
A. Capone ◽  
C. Pintus ◽  
...  
Keyword(s):  
Femoral Component ◽  
Bone Ingrowth ◽  
Stress Shielding ◽  
Time To Failure ◽  
Cementless Stem ◽  
Total Hip ◽  
Special Surgery ◽  
Hip Arthroplasties ◽  
Hospital For Special Surgery

Between 1990 and 1993, 65 consecutive primary total hip arthroplasties were performed using the cementless Bicontact femoral component. Of these, 56 hips in 51 patients were clinically and radiologically reviewed at an average follow-up of 35.4 months (24-53 m). The patients’ mean age was 65.9 years. There were three revision procedures (5.4%) with an average time to failure of 18.2 months. Using the Hospital for Special Surgery hip rating system, 67.9% of the hips were rated excellent, 17.9% as good, 10.7% as fair and 1.8% as poor at final evaluation. At follow-up four patients (12.5%) had mid-thigh pain and 38 hips (67.9%) were free from any observable limp. Radiolucent lines greater than 2 mm were identified in seven femora (12.5%) and stress shielding was seen in nine (16.1%). Using the fixation scale assessment of Engh the femoral component was classified as fixed by bone ingrowth or stable fibrous fixation in 87.5% of hips. Retrospective analysis of these results showed the efficacy of the Bicontact cementless stem and confirmed the importance of patient's age and femur morpho-cortical index in clinical and radiographic results with the cementless total hip.

scholarly journals Osteochondral autograft of patella. Experience up to 10 years of follow-up

2018 ◽  
Vol 6 (12_suppl5) ◽  
pp. 2325967118S0020
Author(s):  
David Figueroa Poblete ◽  
Jaime Esteban Espinoza Valdés ◽  
Juan José Sotomayor ◽  
Luis O´Conell
Keyword(s):  
Osteochondral Lesion ◽  
Young Patients ◽  
Womac Score ◽  
Optimal Treatment ◽  
Full Thickness ◽  
Osteochondral Transplantation ◽  
Autologous Osteochondral Transplantation ◽  
Sports Activity ◽  
The Mean

Introduction: The optimal treatment of an osteochondral patellar lesion remains controversial. Autologous osteochondral transplantation shows promising outcomes, although there is scarce evidence. Objective: Present a 10-year follow-up experience and outcomes of patients with a full-thickness defect of the patella at our institution. Methods: Retrospective analysis of all the patients treated with autologous osteochondral transplantation between 2007-2018 for a patellar osteochondral lesion (ICRS IV). We analyzed the WOMAC score and demographic characteristics with IBM SPSS (IBM Corp. Released 2017. IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY: IBM Corp). Results: A total of 14 patients (age range 15-49 years) were included. The right knee, medial facet, and the medial patellofemoral ligament (69%) were the anatomical sections and associated injuries most frequently encountered. The mean lesion area was of 1.32 cm2, with 55% requiring 2 autologous osteochondral transplantations (size range 8-10 mm2). The mean WOMAC score was 97% (91% Pain, 87% Stiffness, 95% Physical function), with a tendency of an inverse relation with age (p=0.227). Conclusion: Full-thickness defects of patellar cartilage are seen frequently in young patients. These lesions affect their quality of life, sports activity, and physical functionality. However, our outcomes at medium-term follow-up (Mean WOMAC 97), despite it is a small cohort, are promising. Long-term follow-up studies on this topic are encouraged to suggest an optimal treatment based on high-quality evidence.

Cementless 3D Printed Highly Porous Titanium-Coated Baseplate Total Knee Arthroplasty: Survivorship and Outcomes at 2-Year Minimum Follow-Up

2019 ◽  
Vol 33 (03) ◽  
pp. 279-283 ◽  
Author(s):  
Assem A. Sultan ◽  
Bilal Mahmood ◽  
Linsen T. Samuel ◽  
Kim L. Stearns ◽  
Robert M. Molloy ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Clinical Success ◽  
Base Plate ◽  
Porous Titanium ◽  
Implant Survivorship ◽  
3D Printed ◽  
Total Knee ◽  
And Function ◽  
Highly Porous

AbstractNewer generation cementless total knee arthroplasty (TKA) implants continue to develop with demonstrated clinical success in multiple recent reports. The purpose of this study was to investigate (1) survivorship, (2) complications, and (3) clinical outcomes of a newer generation cementless and highly porous titanium-coated base plate manufactured using three-dimensional (3D) printing technology. We reviewed a single-surgeon, longitudinally maintained database of patients who underwent primary TKA using cementless, highly porous titanium-coated base plate implants from July 1, 2013 to December 31, 2016. A total of 523 patients were identified. Of this cohort, 496 patients had a minimum of 2-year follow-up and were included in our final analysis. Among these patients, 72 had bilateral TKA yielding a total of 568 TKAs. There were 133 men and 363 women who had a mean body mass index of 33 kg/m2 (range, 20–61 kg/m2). The mean age was 66 years (range, 33–88 years). Average follow-up was 36 months (range, 24–48 months). Indications for TKA included osteoarthritis in 432 patients (87%), rheumatoid arthritis in 40 patients (8%), and knee osteonecrosis in 24 (5%) patients. Implant survivorship was defined as any revision leading to explantation of the base plate for any reason. Kaplan–Meier analysis was performed to determine all-cause implant survivorship at final follow-up for every patient. Complications were assessed using the Knee Society standardized list of TKA complications. Clinical outcomes were determined using the Knee Society pain and function scores. Range-of-motion values were also collected. There were a total of four failures, all were due to aseptic loosening with a survivorship rate of 99% at mean follow-up of 3 years (95% confidence interval = 0.984–0.999). In addition, there were a total of 12 surgical and 10 medical complications. Surgical complications did not affect the base plate or result in any additional implant revisions. A total of nine patients had thromboembolic disease complications; all received medical treatment and recovered adequately. Radiological evaluation did not show any signs of loosening or failures in other patients at final follow-up. Knee Society Scores for pain and function improved from 55 and 56 points preoperatively to 92 and 84 points at 2 years postoperatively. Our results are in concordance with the excellent clinical outcomes and survivorship demonstrated for the newer generation cementless TKA implants. In our experience, 3D printed titanium base plates demonstrated clinical success and excellent survivorship at minimum follow-up of 2 years.

scholarly journals The lack of retropatellar resurfacing at index surgery is significantly associated with failure in patients following patellofemoral inlay arthroplasty: a multi-center study of more than 260 patients

2021 ◽  
Author(s):  
Andreas B. Imhoff ◽  
Eva Bartsch ◽  
Christoph Becher ◽  
Peter Behrens ◽  
Gerrit Bode ◽  
...  
Keyword(s):  
Risk Factors ◽  
Patient Satisfaction ◽  
Clinical Outcomes ◽  
Potential Risk ◽  
Young Patients ◽  
Womac Score ◽  
Potential Risk Factors ◽  
Multi Center Study ◽  
Center Study

Abstract Purpose To evaluate the clinical outcomes of patients with a minimum 2-year follow-up following contemporary patellofemoral inlay arthroplasty (PFIA) and to identify potential risk factors for failure in a multi-center study. Methods All patients who underwent implantation of PFIA between 09/2009 and 11/2016 at 11 specialized orthopedic referral centers were enrolled in the study and were evaluated retrospectively at a minimum 2-year follow-up. Clinical outcomes included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, the Knee Injury and Osteoarthritis Outcome Score (KOOS), the Tegner Scale, the visual analogue scale (VAS) for pain, and subjective patient satisfaction. Pre- and perioperative risk factors were compared among failures and non-failures to determine potential risk factors. Results A total of 263 patients (85% follow-up rate) could be enrolled. The mean age at the time of index surgery was 49 ± 12 years with a mean postoperative follow-up of 45 ± 18 months. The overall failure rate was 11% (28 patients), of which 18% (5 patients) were patients with patella resurfacing at index surgery and 82% (23 patients) were patients without initial patella resurfacing. At final follow-up, 93% of the patients who did not fail were satisfied with the procedure with a mean transformed WOMAC Score of 84.5 ± 14.5 points, a mean KOOS Score of 73.3 ± 17.1 points, a mean Tegner Score of 3.4 ± 1.4 points and a mean VAS pain of 2.4 ± 2.0 points. An increased BMI was significantly correlated with a worse postoperative outcome. Concomitant procedures addressing patellofemoral instability or malalignment, the lack of patellofemoral resurfacing at the index surgery and a high BMI were significantly correlated with failure in our patient cohort. Conclusion Patellofemoral inlay arthroplasty shows high patient satisfaction with good functional outcomes at short-term follow-up and thus can be considered a viable treatment option in young patients suffering from isolated patellofemoral arthritis. Patellar resurfacing at index surgery is recommended to decrease the risk of failure. Level of evidence Retrospective case series, Level IV.

Exeter Universal cemented femoral component

2020 ◽  
Vol 102-B (10) ◽  
pp. 1319-1323
Author(s):  
Fouzia Khatun ◽  
Damien F. Gill ◽  
Amit Atrey ◽  
Matthew Porteous
Keyword(s):  
Femoral Component ◽  
Acetabular Component ◽  
District General Hospital ◽  
Long Term Results ◽  
Case Scenario ◽  
Worst Case ◽  
Joint Registry ◽  
Component Revision ◽  
Lost To Follow Up

Aims We present the results, in terms of survival, clinical outcome, and radiological appearance at 20 years, in a cohort of 225 cemented Exeter Universal femoral components (Stryker, Newbury, UK) implanted in 207 patients, at a district general hospital. Methods All patients in this study had a total hip arthroplasty (THA) using an Exeter Universal femoral component with a cemented (n = 215) or cementless (n = 10) acetabular component. Clinical and radiological data were collected prospectively at one year, five years, and every five years thereafter. Patients lost to radiological and clinical follow-up (five) were cross-referenced with National Joint Registry (NJR) data and general practitioner (GP) records to assess whether they had undergone revision for any reason. Results During this period of study 144 patients (157 hips) died (69.78%). Two patients were lost to follow-up, leaving 61 patients (66 hips) available for review (29.33%). Of the 225 hips, three underwent revision for femoral failure with osteolysis. One underwent femoral component revision for treatment of a periprosthetic fracture. Eight underwent revision of the acetabular component only for loosening. Two hips had both components revised, when components were found to be loose at time of revision for acetabular loosening, though no radiological femoral osteolysis. Two patients underwent revision for infection. Using femoral loosening as an endpoint, the survival of the Exeter Universal femoral component was 98.7% (n = 220, 95% confidence interval (CI) 96.1% to 100%) at 20 to 22 years. Survival with an endpoint of revision for any reason was 92.6% (n = 209, 95% CI 89.4 to 95.55), with a ‘worst-case scenario’ (considering two patients lost to follow-up to have failed), the overall survival rate was 91.7% (n = 207, 95% CI 87.8 to 95.9) at 20 to 22 years. Conclusion Our results confirm excellent long-term results for the cemented Exeter Universal femoral componentimplanted outside of the originating centre. Cite this article: Bone Joint J 2020;102-B(10):1319–1323.

Rezidivrisiko nach thyreostatischer Behandlung immunogener und nicht-immunogener Hyperthyreosen

1990 ◽  
Vol 29 (01) ◽  
pp. 1-6 ◽  
Author(s):  
E. Voth ◽  
N. Dickmann ◽  
H. Schicha ◽  
D. Emrich
Keyword(s):  
Relapse Rate ◽  
Urinary Iodine ◽  
Young Patients ◽  
Antithyroid Drugs ◽  
Urinary Iodine Excretion ◽  
Old Patients ◽  
Primary Disease ◽  
Iodine Excretion ◽  
Immunogenic Hyperthyroidism

Data of 196 patients treated for hyperthyroidism exclusively with antithyroid drugs were analyzed retrospectively concerning the relapse rate within a follow-up period of four years. Patients were subdivided for primary or recurrent disease, and for immunogenic or non-immunogenic hyperthyroidism, respectively. In immunogenic as well as in non-immunogeriic hyperthyroidism, the relapse rate was significantly lower for patients with primary disease (35% and 52%, respectively) compared to those with recurrent hyperthyroidism (82%, p <0.001 and 83%, p <0.001, respectively). In patients with primary disease, clinical, biochemical and scintigraphic parameters were tested with respect to their capability of predicting a relapse. For immunogenic hyperthyroidism the highest relapse rates were observed in young patients and in those with large goitres, whereas for non-immunogenic hyperthyroidism they were highest in old patients, in those with nodular goitres and in those without an increased urinary iodine excretion at the time of diagnosing hyperthyroidism.

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