The purposes of this study were to evaluate the accuracy and feasibility of a robotic preparation for acetabular metal
During revision total knee arthroplasty (rTKA), proximal tibial bone loss is frequently encountered and can result in a less-stable bone-implant fixation. A 3D printed titanium alloy (Ti6Al4V) revision
Objectives. In order to address acetabular defects, porous metal revision acetabular components and
Aims. Adenosine, lidocaine, and Mg. 2+. (ALM) therapy exerts differential immuno-inflammatory responses in males and females early after anterior cruciate ligament (ACL) reconstruction (ACLR). Our aim was to investigate sex-specific effects of ALM therapy on joint tissue repair and recovery 28 days after surgery. Methods. Male (n = 21) and female (n = 21) adult Sprague-Dawley rats were randomly divided into ALM or Saline control treatment groups. Three days after ACL rupture, animals underwent ACLR. An ALM or saline intravenous infusion was commenced prior to skin incision, and continued for one hour. An intra-articular bolus of ALM or saline was also administered prior to skin closure. Animals were monitored to 28 days, and joint function, pain, inflammatory markers, histopathology, and tissue repair markers were assessed. Results. Despite comparable knee function, ALM-treated males had reduced systemic inflammation, synovial fluid angiogenic and pro-inflammatory mediators, synovitis, and fat pad fibrotic changes, compared to controls. Within the ACL graft, ALM-treated males had increased expression of tissue repair markers, decreased inflammation, increased collagen organization, and improved graft-bone healing. In contrast to males, females had no evidence of persistent systemic inflammation. Compared to controls, ALM-treated females had improved knee extension, gait biomechanics, and elevated synovial macrophage inflammatory protein-1 alpha (MIP-1α). Within the ACL graft, ALM-treated females had decreased inflammation, increased collagen organization, and improved graft-bone healing. In articular cartilage of ALM-treated animals, matrix metalloproteinase (MMP)-13 expression was blunted in males, while in females repair markers were increased. Conclusion. At 28 days, ALM therapy reduces inflammation,
Introduction. In revision TKA, the management of bone loss depends on location, type, and extent of bony deficiency. Treatment strategies involve cement filling, bone grafting and
Background. Total shoulder arthroplasty is technically demanding in regards to implantation of the glenoid component, especially in the setting of increased glenoid deformity and posterior glenoid wear. Augmented glenoid implants are an important and innovative option; however, there is little evidence accessible to surgeons to guide in the selection of the appropriate size
The amount of bone loss due to implant failure, loosening, or osteolysis can vary greatly and can have a major impact on reconstructive options during revision total knee arthroplasty (TKA). Massive bone loss can threaten ligamentous attachments in the vicinity of the knee and may require use of components with additional constraint to compensate for associated ligamentous instability. Classification of bone defects can be helpful in predicting the complexity of the reconstruction required and in facilitating pre-operative planning and implant selection. One very helpful classification of bone loss associated with TKA is the Anderson Orthopaedic Research Institute (AORI) Bone Defect Classification System as it provides the means to compare the location and extent of femoral and tibial bone loss encountered during revision surgery. In general, the higher grade defects (Type IIb or III) on both the femoral and tibial sides are more likely to require stemmed components, and may require the use of either structural graft or large
The amount of bone loss due to implant failure, loosening, or osteolysis can vary greatly and can have a major impact on reconstructive options during revision total knee arthroplasty (TKA). Massive bone loss can threaten ligamentous attachments in the vicinity of the knee and may require use of components with additional constraint to compensate for associated ligamentous instability. Classification of bone defects can be helpful in predicting the complexity of the reconstruction required and in facilitating preoperative planning and implant selection. One very helpful classification of bone loss associated with TKA is the Anderson Orthopaedic Research Institute (AORI) Bone Defect Classification System as it provides the means to compare the location and extent of femoral and tibial bone loss encountered during revision surgery. In general, the higher grade defects (Type IIb or III) on both the femoral and tibial sides are more likely to require stemmed components, and may require the use of either structural graft or large
The amount of bone loss due to implant failure, loosening, or osteolysis can vary greatly and can have a major impact on reconstructive options during revision total knee arthroplasty. Massive bone loss can threaten ligamentous attachments in the vicinity of the knee and may require use of components with additional constraint to compensate for associated ligamentous instability. Classification of bone defects can be helpful in predicting the complexity of the reconstruction required and in facilitating preoperative planning and implant selection. One very helpful classification of bone loss associated with TKA is the Anderson Orthopaedic Research Institute (AORI) Bone Defect Classification System. This system provides the means to compare the location and extent of femoral and tibial bone loss encountered during revision surgery. In general, the higher grade defects (Type IIb or III) on both the femoral and tibial sides are more likely to require stemmed components, and may require the use of either structural graft or large
The major causes of revision total knee are associated with some degree of bone loss. The missing bone must be accounted for to insure success of the revision procedure, to achieve flexion extension balance, restore the joint line to within a centimeter of its previous level, and to assure a proper sizing especially the anteroposterior diameter of the femoral component. In recent years, clinical practice has evolved over time with a general move away from a structural graft with an increase in utilisation of metal
Introduction: Screws placed in the fibula do not have a satisfactory purchase during internal fixation of an osteoporotic ankle fracture. Tibia-pro-fibula screws that extend from the fibula into the distal tibial metaphysis provide additional purchase. The purpose of this study is to investigate if purchase of these screws can be enhanced further by injecting calcium sulfate and calcium phosphate composite graft in the drill holes prior to insertion of the screws. Methods: Bone density was quantified using DEXA scan in paired cadaver legs. One leg from each pair was randomly selected for injection of composite graft into screw holes before insertion of the screws. Two screws were inserted through the fibula into the distal tibial metaphysis in each leg, at the level of the syndesmosis under fluoroscopy in a standardized fashion using a jig. The screws were pulled out using a materials testing machine. Stiffness, force, displacement, and energy required were recorded. Results: After testing 4 pairs of cadaver legs, a statistically significant difference was noted in displacement, failure load, and failure energy between
Introduction. This study investigated the binding agent Calcium/Sodium Alginate fibre gel and the addition of autogenic bone marrow aspirate (BMA) on bone growth into a porous HA scaffold implanted in an ovine femoral condyle critical-sized defect. Our hypothesis was that Alginate fibre gel would have no negative effect on bone formation and osteoconduction within the scaffold and that BMA would
Massive bone loss on both the femur and tibia during revision total knee arthroplasty (TKA) remains a challenging problem. Multiple solutions have been proposed for small osseous defects, including morselised cancellous bone grafting, small-fragment structural allograft, thicker polyethylene inserts, and the use of modular
Purpose:. To examine the performance of a novel blood plasma-based bone putty for
Introduction: Acetabular bone defects are critical and frustrating issue; indeed is possible to obtain good reconstruction with conventional Methods: (i.e. bulk graft, cage and cement) but good results are limited to short and mid term. Aim of this paper is to present reconstructive method based on filling the defect with an
Introduction. Surgeons are often confronted with large amounts of bone loss during the revision of total hip prostheses. Regularly, porous metals are applied to reconstruct the missing bone. Rapid and extensive bone infiltration into the implant's pores is essential to obtain strong and durable biological fixation. Today, specialised layered manufacturing techniques provide the flexibility to produce custom-made metallic implants with a personalized external shape and a well-controlled internal network of interconnected pores. In this study, bone ingrowth in porous titanium structures that were manufactured by selective laser melting (SLM) was evaluated in an in vivo goat model. Methods. Cylindrical Ti6Al4V constructs (Ø8mm × 14mm, porosity 75%) with or without hydroxyapatite coating were implanted in six Saanen goats. Three holes were drilled in the subchondral bone of each tibia and femur. Constructs were inserted into the holes in a press-fit manner. Resonance frequency analysis was used to measure construct stability. At 3, 6 and 9 weeks after surgery, fluorochrome labels were injected. After 6 and 12 weeks, samples were explanted. Some samples were scanned with micro-CT and subsequently sectioned for histological analysis. The others were used for pull-out tests. Results. Resonance frequency analysis indicated a noticeable increase in implant stability. Evaluation of micro-CT and histological data showed bone ingrowth for all goats at 6 and 12 weeks. Most bone ingrowth occurred during the first 6 weeks, which was followed by a slight increase between week 6 and 12. Fluorochrome labeling confirmed these results. Pull-out tests showed an increased fixation at the bone-implant interface. Conclusion. Porous titanium structures manufactured by SLM have good osseointegration characteristics. As custom-made bone
Cement-induced thermal osteonecrosis is well documented, as is the potential for nerve injury from thermal energy. Cement is often used to
The aim of this study was to report the outcomes of a series of patients with clavicle fracture non-union who had undergone open reduction and internal fixation using a contoured locking plate without the use of distant bone graft. Patients were identified using the hospital database. Records were reviewed to determine basic demographics, operative findings, and radiological outcome. Patients were contacted and details about initial injury and treatment, and return to work and sport were recorded. Disabilities of Arm, Shoulder and Hand (DASH) for both operated and non-operated shoulders were completed.Purpose
Methods
Acetabular bone structure is not the same in all patients and can be defined by the radiolucent triangle superior to the acetabulum. We ask if the acetabular anatomy determines the initial cup fixation and screws use. We have assessed 205 hips in which a Cerafit cementless cup was implanted. According to Dorr et al., acetabulae were classified as type A, in which the radiolucent triangle had an isosceles shape (86 hips), type B, in which the triangle extended into the teardrop (90 hips), and type C which had a right-angle triangle (29 hips). The use of screws was decided at the time of surgery and according to cup stability, not acetabular anatomy. Avascular necrosis and inflammatory arthritis were the most frequent diagnoses in type A hips, osteoarthritis in type B, and dysplasia in type C. Women were more frequent in types A and C (p<
0.001). The use of screws was more frequent in women (p<
0.001) and in type A (34.9%) and type C hips (62.1%) than in type B hips (20.0%) (p<
0.001). The multivariate logistic regression model showed the acetabular type (p=0.11) and gender (p=0.003) as independent factors. Acetabular types A (OR=1.98, 95% CI: 0.922–4.208, p=0.075) and C (OR=5.09, 95% CI: 1.74–14.9, p=0.003) increase the risk for screw use. Men have a lower risk for screw use (OR=0.329, 95% CI: 0.16–0.68, p=0.003). Acetabular anatomy and gender determine the use of screws in cementless cups. Continued follow-up is necessary to determine if screws results in less loosening and osteolysis.
Revision TKA patients who have severe patellar bone loss or undergo patellectomy often have inferior clinical results. Current treatments are limited and often unsatisfactory. This study reports the surgical technique and clinical follow-up (4-year minimum) for 10 patients who underwent revision or salvage TKA and received a porous tantalum implant for replacement of their patella. The prosthesis is comprised of two parts, a poroustantalum base and titanium suture ring for initial fixation, and a polyethylene surface that is cemented to the base. The surgical technique evolved over the course of the first three cases, during which the suture technique and size (non-absorbable number 2) and bone preparation were defined. The results of this study indicate that this porous tantalum patella is an effective prosthetic option that is capable of improving function and reducing pain for patients with severe patellar boneloss and complicating factors.