Comparison of Ceramic-on-Ceramic vs. Ceramic-on-Polyethylene for Primary Total Hip Arthroplasty: A Meta-Analysis of 15 Randomized Trials

Objective: This meta-analysis aimed to compare ceramic-on-ceramic (COC) components and ceramic-on-polyethylene (COP) components during total hip arthroplasty (THA).Settings: A meta-analysis of randomized controlled trials (RCTs) comparing COC and COP during primary THA was conducted. Electronic searches were current to March 2021.Participants: Trials were included for meta-analysis if they compared at least the bearing surfaces of COC and COP for patients undergoing primary THA and if they reported the outcomes of THA after a certain period of follow-up and only RCTs in English were included.Primary and Secondary Outcome Measures: The primary endpoints consist of audible noise, prosthesis fracture, and revision. Secondary endpoints include dislocation, deep infection, osteolysis, and prosthesis loosening. Extracted data were statistically analyzed with the Stata11.0.Results: A total of 15 RCTs containing 2,702 patients (2,813 hips) were included in this study. The audible noise [odds ratio (OR) = 5.919; 95% CI: 2.043, 17.146; p ≤ 0.001] and prosthesis fracture (OR = 35.768; 95% CI: 8.957, 142.836; p = 0.001) were significantly higher in the COC group. Hip function, revision rate, dislocation rate, deep infection rate, osteolysis rate, and prosthesis loosening rate were comparable between these two groups, while the wear rate was higher in the COP group.Conclusion: This study indicated comparable outcomes of COC and COP bearing surfaces in primary THA; high-quality RCTs with a long-term follow-up are still urgently needed to provide more evidence on the optimal bearing surfaces in primary THA.

Analysis of the Early Clinical Effect of Simultaneous Ipsilateral Total Hip and Knee Arthroplasty in the Treatment of End-stage Hemophilic Arthritis

ObjectiveTo evaluate the clinical efficacy of simultaneous ipsilateral total hip arthroplasty (THA) and total knee arthroplasty (TKA) in the treatment of advanced hemophilic arthritis. Methodthe clinical data of 8 patients with advanced hemophilic arthritis, with ages of 31.6±6.2 years (ranging from 25-38 years, who underwent ipsilateral THA and TKA at the ** Hospital from January 2018 to May 2021 were retrospectively analyzed. There were 6 cases of hemophilia A and 2 cases of hemophilia B. The preoperative level of coagulation factor VIII was 1.8(±1.3)%，activated partial prothrombin time (aPTT) was 131.2 (±35.3) s. A comparison of the Harris score before and 0.3-1 year after operation was performed to evaluate hip function, American hospital for special surgery (HSS) knee score and American Knee society score (KSS) score. ResultDuring the follow-up period of 1.4 (± 1.1) years, no intra-articular bleeding and skin dehiscence were found in the early postoperative period, and no joint infection, bleeding, prosthesis loosening and sinking were found in the last follow-up visit. The Harris score increased from 16.8 (± 4.4) preoperatively to 77.6 (± 7.1) postoperatively, HSS knee score increased from 41.8 (± 4.2) preoperatively to 76.0 (± 5.8) postoperatively, the clinical KSS increased from 35.6 (± 10.8) preoperatively to 79.2 (± 6.9) postoperatively. The KSS increased from 22.8 (± 8.4) preoperatively to 72.0 (± 5.9) postoperatively at the last follow-up visit. The differences were statistically significant (P < 0.05).ConclusionsIpsilateral THA and TKA in the treatment of advanced hemophilic arthritis can effectively relieve pain, and improve hip and knee joint function, as well as the quality of life, and can thus be recommended as a safe and effective measure for the treatment of advanced hemophilic arthritis.

Rotation-hinged knee prosthesis for the treatment of Charcot arthropathy: a case report and literature review

Charcot arthropathy is a type of destructive osteoarthropathy characterized by neurotrophic and sensory disorders. The condition is relatively rare, with an insidious onset, and it is easily misdiagnosed. Total knee arthroplasty (TKA) can cause excessive joint wear, continuous inflammatory stimulation of the prosthesis, postoperative residual cavity, prosthesis loosening and subsidence, peripheral fracture, infection, and other complications. Furthermore, these complications are more likely to occur in patients with Charcot arthropathy because of disease-specific pathological characteristics, when TKA is performed. Therefore, Charcot arthropathy was once a contraindication to TKA. Recently, with the optimization of joint prostheses and the maturity of surgical techniques, more studies have reported successful cases of TKA in patients with Charcot arthropathy. We report a case of Charcot arthropathy in our hospital, and describe the patient’s medical history, clinical symptoms, signs, imaging findings, diagnosis, and the entire TKA process, to explore the TKA strategy and prosthesis selection in a patient with Charcot arthropathy.

Lessons learnt from the impact of COVID-19 on arthroplasty services in Hong Kong: how to prepare for the next pandemic?

Background Arthroplasty services worldwide have been significantly disrupted by the pandemic of coronavirus disease 2019 (COVID-19). This retrospective comparative study aimed to characterize its impact on arthroplasty services in Hong Kong. Methods From January 1 to June 30, 2020, the patients of “COVID-19 cohort” underwent elective total hip or knee replacement in Hong Kong public hospitals. The cohort was compared to the “control cohort” during the same period in 2019. Data analysis was performed to compare the two cohorts’ numbers of operations, hospital admission, orthopaedic clinic attendances, and waiting time. Results A total of 33,111 patient episodes were analyzed. During the study period, the elective arthroplasty operations and hospitalizations decreased by 53 and 54%, respectively (P < 0.05). Reductions were most drastic from February to April, with surgical volume declining by 86% (P < 0.05). The primary arthroplasty operations decreased by 91% (P < 0.05), while the revision operations remained similar. Nevertheless, 14 public hospitals continued performing elective arthroplasty for patients with semi-urgent indications, including infection, progressive bone loss, prosthesis loosening, dislocation or mechanical failure of arthroplasty, and tumor. At the institution with the highest arthroplasty surgical volume, infection (28%) was the primary reason for surgery, followed by prosthesis loosening (22%) and progressive bone loss (17%). The orthopaedic clinic attendances also decreased by 20% (P < 0.05). Increases were observed in waiting time and the total number of patients on the waiting list for elective arthroplasty. Conclusions Despite the challenges, public hospitals in Hong Kong managed to continue providing elective arthroplasty services for high-priority patients. Arthroplasty prioritization, infection control measures, and post-pandemic service planning can enhance hospital preparedness to mitigate the impact of current and future pandemics.

IRAK-4 in macrophages contributes to inflammatory osteolysis of wear particles around loosened hip implants

TLRs recognizing PAMPS play a role in local immunity and participate in implant-associated loosening. TLR-mediated signaling is primarily regulated by IL-1 receptor associated kinase-M (IRAK-M) negatively and IRAK-4 positively. Our previous studies have proved that wear particles promote endotoxin tolerance in macrophages by inducing IRAK-M. However, whether IRAK-4 is involved in inflammatory osteolysis of wear particles basically, and the specific mechanism of IRAK-4 around loosened hip implants, is still unclear. IRAK-4 was studied in the interface membranes from patients in vivo and in particle-stimulated macrophages to clarify its role. Also, IL-1β and TNF-α levels were measured after particle and LPS stimulation in macrophages with or without IRAK-4 silenced by siRNA. Our results showed that the interface membranes around aseptic and septic loosened prosthesis expressed more IRAK-4 compared with membranes from osteoarthritic patients. IRAK-4 in macrophages increased upon particle and LPS stimulation. In the former, IL-1β and TNF-α levels were lower compared with those of LPS stimulation, and IRAK-4 siRNA could suppress production of pro-inflammatory cytokines. These findings suggest that besides IRAK-M, IRAK-4 also plays an important role in the local inflammatory reaction and contributes to prosthesis loosening.

Investigation of the effect of the angle between femoral and prosthesis mechanical axes on bone remodeling of femur in total knee arthroplasty

The bone remodeling is the process in which the bone adapts its structure to the variation of environmental loads. The joint might be broken or damaged as a result of aging or an accident. To remedy this situation, Total Knee Arthroplasty (TKA) and prosthesis implantation is recommended. The main goal of this research is to investigate the effects of femur implanting angle on the bone remodeling process after TKA in the Coronal, Sagittal and horizontal planes over seven years. First, the 3D CAD model from CT images is created then the bone behavior is simulated using a model with a USDFLD subroutine. The results show that as the implant rotates in one direction, the stress and density distribution increases in the same direction whereas the load and consequently the bone density decrease substantially in the opposite direction. Consequently, the bone density might even decrease 77 and 31 percent in the coronal and sagittal plane respectively, so in the total knee arthroplasty, the mechanical axes of prosthesis and femur should be parallel. The active bone which occurs as a result of mechanical axes of prosthesis and femur parallelism and consequently uniform load distribution, can protect the implant from prosthesis loosening and fracture.

Diagnostic accuracy of SPECT/CT arthrography in patients with suspected aseptic joint prostheses loosening

Purpose To evaluate the diagnostic accuracy of SPECT/CT arthrography in patients with suspected aseptic prosthesis loosening following hip and knee arthroplasty. Methods A retrospective review of 63 SPECT/CT arthrogram studies (36 knees and 27 hips) between February 1, 2013, and July 1, 2018, was conducted. All patients underwent clinical and radiologic evaluation as part of their assessment for persistent pain following hip and knee arthroplasty. The detection of tracer activity along the bone-prosthetic interface on SPECT/CT suggests aseptic loosening. Operative assessment as well as clinical/radiologic follow-up at a minimum of 1 year was used as the reference standard. Results The sensitivity and specificity of SPECT/CT for detection of aseptic loosening was 6/7 (86%) and 55/56 (98%), respectively. This gives a positive predictive value (PPV) of 6/7 (86%), a negative predictive value (NPV) of 55/56 (98%), and a diagnostic accuracy of 61/63 (97%). Conclusion SPECT/CT arthrography has a high diagnostic accuracy (97%) in the evaluation of loosening of both hip and knee arthroplasties in patients with persistent post-procedural pain.

Application of Ultrasound in Diagnosis of Prosthesis Loosening and Infection After Total Hip Arthroplasty

Objective: To explore the diagnostic efficiency of ultrasound for the identification of periprosthetic joint infection (PJI) and aspetic loosening.Methods: 50 patients with joint pain after total hip arthroplasty, who were all clinically diagnosed as aseptic prosthesis loosening or PJI, were examined by ultrasonography combined with C-reactive protein, erythrocyte sedimentation rate, bacterial culture and pathology.Results: Thirty-eight of the 50 cases were PJI (group A) , and twelve cases were aseptic loosening (group B) . Fourteen patients with extra-capsular effusion were diagnosed as PJI, while none appeared extra-capsular effusion effusion in group B. 34 cases PJI obtained joint fluid, which was more than group B (7/11) (P < 0.05). The average depth of joint effusion of group B (19.83 ± 8.9mm), was significantly less than group A (25.97±15.25mm) (P < 0.05). In group A , 21 cases (55.26%) had grade 2-3 synovial blood flow signal,which was higher than group B (8.3%) (P < 0.05). Under the circumstance that PJI was diagnosed: (1) There was a sinus tract or extra-capsular effusion; or (2) Joint fluid depth was ≥ 17.0 mm; or (3) Grade 2-3 synovial blood flow signal was detected,the positive predictive value of ultrasound diagnosis of PJI was 92.1% (35/38)，and the accuracy of aseptic loosening was 83.3% (10/12) (P < 0.05).Conclusions: Ultrasound has significant value in the differential diagnosis of PJI and aspetic loosening.

Impact of Sports Activity on Medium-Term Clinical and Radiological Outcome after Reverse Shoulder Arthroplasty in Cuff Deficient Arthropathy; An Institutional Register-Based Analysis

There is a lack of consensus on what physicians can recommend and what patients can expect concerning sports activity after reverse shoulder arthroplasty (RSA). The purpose of this retrospective register-based observational study was to investigate the association between participation in sports or physical activity involving the upper extremity and 5-year clinical and radiological outcomes for primary RSA patients. We screened the institutional arthroplasty registry for patients reporting the type and level of sports postoperatively after primary, unilateral RSA due to rotator cuff deficiency. One hundred thirty-eight patients with clinical and radiological outcomes documented at a minimum 5-year follow-up were divided into three groups comprising those who participated regularly in: sports mainly involving the upper extremity (sports upper extremities, SUE, n = 49), sports mainly involving the lower extremities (sports lower extremities, SLE, n = 21), and those who did not participate in sports at all (no sports, NS, n = 68). The participants had a mean age of 72 years (standard deviation (SD) 8) and were overall predominantly female patients (62%). Primary clinical outcomes included the Constant Score (CS) and Shoulder Pain and Disability Index (SPADI). Secondary radiographs were analyzed for radiolucent lines (RLL), signs of glenoid or humeral prosthesis loosening, bone resorption, bone formation, and scapular notching. A total number of 8 senior surgeons were involved in treatment of patients, and two types of prosthesis were used. The SUE group had non-significantly higher mean scores for CS (75 points) and SPADI (88 points) compared to SLE (71 and 78 points, respectively) and NS patients (66 and 78 points, respectively) (p ≥ 0.286). The incidence of RLL around the humeral diaphysis was higher in NS compared to SUE patients (32% versus 12%, respectively) (p = 0.025); all other radiological parameters were similar between the groups. There were no cases of loosening in the SUE group that led to revision surgery. Patients engaging in sports activities involving the upper extremity show similarly good functional scores 5 years post-RSA as the other groups, without additional signs of implant loosening as a result of increased shoulder use.