Is reverse total shoulder arthroplasty (rTSA) more advantageous than anatomic TSA (aTSA) for osteoarthritis with intact cuff tendon? A systematic review and meta-analysis

Purpose We aimed to compare the outcomes and complications of anatomical shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA) for primary glenohumeral osteoarthritis with intact cuff tissue. Materials and methods The MEDLINE, Embase, and Cochrane Library databases were systematically searched for studies published before March 2, 2021 using the PRISMA guidelines. Studies were included if they directly compared aTSA and rTSA for treating primary glenohumeral arthritis. A meta-analysis was performed using six studies that compared radiologic outcomes, functional scores, and range of motion (ROM). All the data were pooled using a random-effects model. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated as dichotomous data, while continuous data were analyzed using mean differences with 95% CIs. Results Two independent researchers reviewed 1,061 studies. Six studies met the inclusion criteria. The range of motion, especially external rotation, was better for aTSA than for rTSA (MD = − 10.28, 95% CI: − 16.69 to − 3.88, P = 0.002). Functional scores showed no difference between aTSA and rTSA. Glenoid loosening (OR = 0.17, 95% CI: 0.06–0.50, P = 0.001) was more common with aTSA, and scapula notching (OR = 10.63, 95% CI: 1.73–65.27, P = 0.01) with rTSA. In the mid-term follow-up, the overall revision rate showed no difference between aTSA and rTSA, with a pooled OR of 0.33 (95% CI: 0.07–1.57, P = 0.16). Conclusion A better ROM was achieved after aTSA than after rTSA. There was no difference in the revision rate at mid-term follow-up between aTSA and rTSA. Glenoid loosening was more common with aTSA, and scapula notching with rTSA. Level of evidence: Level IV, Meta-analysis.

Higher risk of 2-year cup revision of ceramic-on-ceramic versus ceramic-on-polyethylene bearing: analysis of 33,454 primary press-fit total hip arthroplasties registered in the Dutch Arthroplasty Register (LROI)

Background and purpose: The influence of bearing on short-term revision in press-fit total hip arthroplasty (THA) remains under-reported. The aim of this study was to describe 2-year cup revision rates of ceramic-on-ceramic (CoC) and ceramic-on-polyethylene (CoPE). Patients and methods: Primary press-fit THAs with one of the three most used cups available with both CoC or CoPE bearing recorded in the Dutch Arthroplasty Register (LROI) were included (2007–2019). Primary outcome was 2-year cup revision for all reasons. Secondary outcomes were: reasons for revision, incidence of different revision procedures and use of both bearings over time. Results: 2-year Kaplan-Meier cup revision rate in 33,454 THAs (12,535 CoC; 20,919 CoPE) showed a higher rate in CoC (0.67% [95% CI, 0.54–0.81]) compared to CoPE (0.44% [95% CI, 0.34–0.54]) ( p = 0.004). Correction for confounders (age, gender, cup type, head size) resulted in a hazard ratio (HR) of 0.64 [95%CI, 0.48–0.87] ( p = 0.019). Reasons for cup revision differed only by more cup revision due to loosening in CoC (26.2% vs.1 3.2%) ( p = 0.030). For aseptic loosening a revision rate of 0.153% [95% CI, 0.075–0.231] was seen in CoC and 0.058% [95%CI 0.019–0.097] in CoPE ( p = 0.007). Correction for head size resulted in a HR of 0.475 [95% CI, 0.197–1.141] ( p = 0.096). Incidence of different revision procedures did not differ between bearings. Over time the use of CoPE has increased and CoC decreased. Conclusions: A higher 2-year cup revision rate in press-fit THA was observed in CoC compared to CoPE. Cup loosening was the only significantly different reason for revision and seen more often in CoC and mostly aseptic. Future randomised controlled trials need to confirm causality, since the early cup revision data provided has the potential to be useful when choosing the bearing in press-fit THA, when combined with other factors like bone quality and patient and implant characteristics.

Shoulder joint arthroplasty in young patients: Analysis of 8742 patients from the Australian Orthopaedic Association National Joint Replacement Registry

Background Shoulder replacement is a reliable treatment for the relief of pain and improvement of function in patients with glenohumeral arthritis, rotator cuff arthropathy, osteonecrosis and fracture. Limited data is available comparing revision rates for the different types of shoulder replacement when used in younger patients. This study aims to compare the survivorship of hemi resurfacing, stemmed hemiarthroplasty, total shoulder arthroplasty and reverse total shoulder arthroplasty in younger patients using data from a large national arthroplasty registry. Methods Data from the Australian Orthopaedic Association National Joint Replacement Registry was obtained for the period 16 April 2004–31 December 2018. The study population included all shoulder arthroplasty patients aged <65 years. These were stratified into two groups: <55 years and 55–64 years. A total of 8742 primary shoulder arthroplasty procedures were analysed (1936 procedures in the <55 years and 6806 in the 55–64 years age group). Results In the <55 years age group, there was no difference in revision rate for total shoulder arthroplasty versus reverse total shoulder arthroplasty at any time point. Reverse total shoulder arthroplasty had a lower revision rate after six months when compared to hemi resurfacing (HRA) (p = 0.031). Also, reverse total shoulder arthroplasty had a higher early rate of revision in the first 12 months compared to hemiarthroplasty (p = 0.018). However, from 2 years reverse total shoulder arthroplasty had a lower revision rate overall (p = 0.029). In the 55–64 years patient age group, reverse total shoulder arthroplasty had a lower earlier revision rate. This was statistically significant compared to hemi resurfacing (HRA) (p = 0.028), hemiarthroplasty (p = 0.049) and total shoulder arthroplasty (p < 0.001). Conclusion This study demonstrated that for patients aged <55 years there was no significant difference in the rate of revision when total shoulder arthroplasty and reverse total shoulder arthroplasty were compared. reverse total shoulder arthroplasty had a lower rate of revision when compared to hemi resurfacing and hemiarthroplasty after 2 years. reverse total shoulder arthroplasty had the lowest comparative revision rate in patients aged 55–64 years overall.

Vitamin E-Enhanced Liners in Primary Total Hip Arthroplasty: A Systematic Review and Meta-Analysis

Objective. Adding vitamin E to highly cross-linked polyethylene liners is frequently performed in clinical practice, aiming at reducing liner wear, increasing liner survival, and delaying revision surgery. This study is aimed at evaluating the revision rate, total femoral head penetration, and postoperative clinical function of highly cross-linked polyethylene liners with and without vitamin E in total hip arthroplasty. Methods. We conducted a systematic literature search to identify the use of highly cross-linked vitamin E liners compared to other liners in patients who received total hip arthroplasty (THA) before April 2021. The study quality assessment and data collection were conducted by two independent reviewers. Studies were artificially grouped, and vitamin E-enhanced liners (VE-PE) were compared with vitamin E-free liners (non-VE-PE). Analyses were executed using Review Manager version 5.4.1. Results. From the preliminary screening of 568 studies, fourteen studies met the research criteria. Compared to non-VE-PE, using VE-PE reduced the all-cause revision rate ( odds ratio = 0.54 ; 95% confidence interval (CI) 0.40, 0.73; P < 0.0001 ). The total femoral head penetration of the VE-PE was lower than that of the non-VE-PE ( mean difference = − 0.10 ; 95% CI -0.17, -0.03; P = 0.007 ). However, there was no difference in clinical function, including the Harris Hip Score and EuroQol Five-Dimension Questionnaire scores. Conclusion. Compared to the liners without vitamin E, the addition of vitamin E to liners could reduce the all-cause revision rate by approximately 46% in the short-term follow-up. In addition, even though addition of vitamin E could also slow down femoral head penetration, there is no contribution to clinical function.

Older age increases the risk of revision and perioperative complications after high tibial osteotomy for unicompartmental knee osteoarthritis

Among various patient risk factors affecting survival after high tibial osteotomy (HTO), the ideal age limit for HTO is unclear. This study was performed to evaluate the effect of age on survival rate and complications after HTO for medial unicompartmental osteoarthritis. Among of 61,145 HTO patients from Korean National Health Insurance database, 41,112 patients underwent the procedure before the age of 60 years (Group A), 13,895 patients between the age of 60 and 65 years (Group B), and 6138 patients after the age of 65 years (Group C). We compared the survival rate in person-years among the three groups from the date of primary surgery until subsequent total knee arthroplasty. Perioperative complications were also recorded. The adjusted hazard ratio (HR) were calculated using the multivariable Cox proportional hazard regression model, adjusting for the potential confounders: age, sex, type of medical insurance, region of residence, hospital type, comorbidities, and Charlson comorbidity index score. The total number of HTO increased 6.5-fold, especially in patients aged > 65 years (by 8.2-fold) from 2008 to 2018. The overall revision rate was 4.2% in Group A, 6.4% in Group B, and 7.3% in Group C. The 5- and 10-year revision rate was significantly lower in Group A (p < 0.001), but no difference between Groups B and C. After adjusting for potential confounders, multivariable regression analysis revealed that revision rate was significantly lower in Group A than Group B (HR: 0.57; p < 0.0001), but no difference between Groups B and C. The incidence of complications was also significantly lower in Group A than in other groups. The inferior survival rate and more perioperative complications after HTO was found in old patients (aged ≥ 60 years) than in young patients. Therefore, the patient age is one of the predicting factors for a high risk of failure after HTO.

Comparable mortality but higher revision rate after uncemented compared with cemented total hip arthroplasties in patients 80 years and older: report of 43,053 cases of the Dutch Arthroplasty Register

Background and purpose — Mortality and revision risks are important issues during shared decision-making for total hip arthroplasty (THA) especially in elderly patients. We examined mortality and revision rates as well as associated patient and prosthesis factors in primary THA for osteoarthritis (OA) in patients ≥ 80 years in the Netherlands. Patients and methods — We included all primary THAs for OA in patients ≥ 80 years in the period 2007–2019. Patient mortality and prosthesis revision rates were calculated using Kaplan-Meier survival analyses. Risk factors for patient mortality and prosthesis revision were analyzed using multivariable Cox regression analysis adjusted for age, sex, ASA class, fixation method, head size, and approach.Results — Mortality was 0.2% at 7 days, 0.4% at 30 days, 2.7% at 1 year, and 20% at 5 years. Mortality was higher in males and higher ASA class, but did not differ between fixation methods. The 1-year revision rate was 1.6% (95% CI 1.5–1.7) and 2.6% (CI 2.5–2.7) after 5 years. Multivariable Cox regression analysis showed a higher risk of revision for uncemented (hazard ratio [HR] 1.6; CI 1.4–1.8) and reverse hybrid THAs (HR 2.9; CI 2.1–3.8) compared with cemented THAs. Periprosthetic fracture was the most frequently registeredreason for revision in uncemented THAs. Interpretation — Mortality is comparable but revision rate is higher after uncemented compared with cemented THA in patients 80 years and older, indicating that cemented THA might be a safer option in this patient group.

Comparison of Clinical Outcomes Between Ceramic-Based Total Ankle Arthroplasty with Ceramic Total Talar Prosthesis and Ceramic-Based Total Ankle Arthroplasty

Background: Total ankle arthroplasty (TAA) has become one of the standard surgical treatments for patients with end-stage ankle osteoarthritis (OA). In recent years, TAA with total talar prosthesis (combined TAA) has been used for ankle OA patients with talar osteonecrosis, with severe talar collapse, or with subtalar joint OA. The purpose of this study was to investigate the functional and clinical outcomes of combined TAA, compared with conventional TAA. Methods: Forty-six ankles (44 patients, 32 women/12 men) that underwent conventional TAA with mean follow-up of 42 months, and 26 ankles (25 patients, 18 women/7 men) that underwent combined TAA with mean follow-up of 46 months were included. Clinical outcomes, which included ankle range of motion (ROM), the Japanese Society for Surgery of the Foot (JSSF) ankle-hindfoot scale, the Self-Administered Foot Evaluation Questionnaire (SAFE-Q), and complications were compared between the groups. Results: The preoperative ROM was significantly worse in combined TAA for both dorsiflexion and plantarflexion; however, in the final ROM, there was no significant difference between the groups. There was no significant difference in JSSF scale and SAFE-Q between the groups. Revision rate was 10.9% in conventional TAA and 0% in combined TAA. Conclusion: In this small series, at an average of 3.5 years, we found no significant difference in clinical results between conventional TAA and combined TAA; however, the revision rate was higher in conventional TAA. Level of Evidence: Level III, retrospective cohort study.