The purpose of this study was to undertake a meta-analysis to determine whether there is lower polyethylene wear and longer survival when using mobile-bearing implants in total knee replacement when compared with fixed-bearing implants. Of 975 papers identified, 34 trials were eligible for data extraction and meta-analysis comprising 4754 patients (6861 knees). We found no statistically significant differences between the two designs in terms of the incidence of radiolucent lines, osteolysis, aseptic loosening or survival. There is thus currently no evidence to suggest that the use of mobile-bearing designs reduce polyethylene wear and prolong survival after total knee replacement.

Cite this article: Bone Joint J 2013;95-B:1057–63.

Aim. There is controversy regarding the use of Antibiotic-loaded cement (ALBC) as compared to non-antibiotic-loaded cement (NALBC) to reduce the overall infection rate without affecting implant survival or adding additional risks on fixation for primary total knee arthroplasty (TKA). Method. To conduct the analysis, we utilized the Catalan Arthroplasty Registry (RACat) for the TKAs implanted between 2005 and 2017. The primary variable recorded was the use of cement with or without antibiotics. Other recorded variables included were age, sex, diabetes mellitus, obesity, Charlson index and type of hospital. We analyzed the effect of ALBC vs. NALBC in reducing the risk of prosthetic infection at 3, 6, 12, and 24 months as well as prosthetic survival due to mechanical causes at 1, 5, and 10 years. Univariate and multivariable analyses of risk factors were conducted. Thereby, an interactive predictive model that determines the risk of prosthetic infection based on each patient's characteristics was created. Results. A total of 28,287 TKAs from the RACat were analyzed. In that total, there were 19,788 NALBC and 8,499 ALBC. The infection rates for TKAs with NALBC vs. those with ALBC at 3, 6, 12, and 24 months were respectively: 1.69% vs. 1.39% (p=0.132); 1.81% vs. 1.56% (p=0.147); 2.14% vs. 1.73% (p=0.030); 2.51% vs. 1.86% (p=0.001). A statistically significant reduction in periprosthetic infection rate was observed in the ALBC group at 12 and 24 months. No differences were observed between the two groups in terms of prosthetic mechanical survival. Being younger, male and having had previous knee surgery or having a high comorbidity index all led to a higher risk of prosthetic revision due to infection. Conclusions. The use of ALBC as a fixation method for TKA leads to a reduction in the risk of prosthetic infection without altering the mechanical survival of the implant. The creation of a predictive model helps determine the individualized risk of prosthetic infection based on the patient's characteristics

Aims. Metal and ceramic humeral head bearing surfaces are available choices in anatomical shoulder arthroplasties. Wear studies have shown superior performance of ceramic heads, however comparison of clinical outcomes according to bearing surface in total shoulder arthroplasty (TSA) and hemiarthroplasty (HA) is limited. This study aimed to compare the rates of revision and reoperation following metal and ceramic humeral head TSA and HA using data from the National Joint Registry (NJR), which collects data from England, Wales, Northern Ireland, Isle of Man and the States of Guernsey. Methods. NJR shoulder arthroplasty records were linked to Hospital Episode Statistics and the National Mortality Register. TSA and HA performed for osteoarthritis (OA) in patients with an intact rotator cuff were included. Metal and ceramic humeral head prostheses were matched within separate TSA and HA groups using propensity scores based on 12 and 11 characteristics, respectively. The primary outcome was time to first revision and the secondary outcome was non-revision reoperation. Results. A total of 4,799 TSAs (3,578 metal, 1,221 ceramic) and 1,363 HAs (1,020 metal, 343 ceramic) were included. The rate of revision was higher for metal compared with ceramic TSA, hazard ratio (HR) 3.31 (95% confidence interval (CI) 1.67 to 6.58). At eight years, prosthesis survival for ceramic TSA was 98.7% (95% CI 97.3 to 99.4) compared with 96.4% (95% CI 95.2 to 97.3) for metal TSA. The majority of revision TSAs were for cuff insufficiency or instability/dislocation. There was no significant difference in the revision rate for ceramic compared with metal head HA (HR 1.33 (95% CI 0.76 to 2.34)). For ceramic HA, eight-year prosthetic survival was 92.8% (95% CI 86.9 to 96.1), compared with 91.6% (95% CI 89.3 to 93.5) for metal HA. The majority of revision HAs were for cuff failure. Conclusion. The rate of all-cause revision was higher following metal compared with ceramic humeral head TSA in patients with OA and an intact rotator cuff. There was no difference in the revision rate for HA according to bearing surface. Cite this article: Bone Joint J 2024;106-B(5):482–491

Aim. Despite a preoperative workup with no evidence to suspect a prosthetic joint infection (PJI) before revision surgery, routinely obtained intraoperative cultures still can be unexpectedly positive. The purpose of this study was (1) to assess the incidence of unexpected positive intraoperative cultures in presumed aseptic knee and hip revisions and (2) to determine whether a difference exists between the infection-free implant survival rate of patients with and without unexpected positive intraoperative cultures. Method. We selected patients who underwent a one-stage revision total knee arthroplasty (TKA) or total hip arthroplasty (THA) for different reasons. Three or more separate intraoperative cultures were obtained during each procedure. A negative result was defined as less than two positive cultures with the same microorganism. An unsuspected PJI was defined as having two or more positive cultures with the same microorganism. Patients’ medical records were reviewed to collect demographics, preoperative laboratory results, culture results, and the occurrence of infection during follow-up. Results. A total of 340 and 339 patients with a presumed aseptic knee and hip revision, respectively, were analyzed. The incidence of unsuspected PJIs was 7.9% and 12.1% in the knees and hips, respectively. Of these unsuspected PJIs, the infection-free prosthetic survival rate at 2 year follow-up was 88% (95%CI 59–97) and 92% (95%CI 73–98) in knees and hips, respectively. In the knee group, the infection-free prosthetic survival rate of patients with an unsuspected PJI was significantly lower compared to that of patients with negative intraoperative culture results (88% (95%CI 59–97) versus 97% (95%CI 93–99) with p=0.01). In the hip group, there was no such a difference (92% (95%CI 73–98) versus 93% (95%CI 88–96) with p=0.41). Conclusions. We found incidences of unsuspected PJI and infection-free prosthetic survival rates that are comparable with previous studies. During follow-up after one-stage revision TKA, a higher incidence of infection was observed in patients with an unsuspected PJI. This difference was not observed in the hip revisions

Background. The clinical benefit of chronic suppression with oral antibiotics as a salvage treatment for periprosthetic joint infection is unclear. The purpose of this study was to compare infection-free prosthetic survival rates between patients who received chronic oral antibiotics and those who did not following irrigation and debridement with polyethylene exchange or two-stage revision for periprosthetic joint infection. Methods. We reviewed the records on all irrigation and debridement procedures with polyethylene exchange and two-stage revisions performed at our institution from 1996 to 2010 for hip or knee periprosthetic joint infection. Of 625 patients treated with a total of 655 eligible revisions, ninety-two received chronic oral antibiotics for a minimum of six months and were eligible for inclusion in our study. These patients were compared with a matched cohort (ratio of 1:3) who did not receive chronic oral antibiotics. Results. The five-year infection-free prosthetic survival rate was 68.5% (95% confidence interval = 59.2% to 79.3%) for the antibiotic-suppression group and 41.1% (95% CI = 34.9% to 48.5%) for the non-suppression group (hazard ratio = 0.63, p = 0.008). Stratification by the type of surgery and the infecting organism showed a higher five-year survival rate for the patients in the suppression group who underwent irrigation and debridement with polyethylene exchange (64.7%) compared with those in the non-suppression group who underwent irrigation and debridement with polyethylene exchange (30.4%, p < 0.0001) and a higher five-year survival rate for the patients in the suppression group who had a Staphylococcus aureus infection (57.4%) compared with those in the non-suppression group who had a Staphylococcus aureus infection (40.1%, p = 0.047). Conclusions. Chronic suppression with oral antibiotics increased the infection-free prosthetic survival rate following surgical treatment for periprosthetic joint infection. Patients who underwent irrigation and debridement with polyethylene exchange and those who had a Staphylococcus aureus infection had the greatest benefit

The objective of this study was to compare the results of two consecutive series of patients with either intra-medullary uncemented stems (UCS) distal femoral endoprosthetic replacement or the Compress. ®. (CMP) distal femoral implant. Patients were divided into two groups: those who received UCS prosthesis (Group-1: 54 patients) and those who received CMP prosthesis (Group-2: 42 patients).The most frequent diagnosis was osteosarcoma. Age and gender were similar both groups. In Group-1, at a mean follow-up of 144 months, 37 prostheses were still in place. The overall Kaplan-Meier prosthetic survival rates were 79% at five and 62 % at ten years. Most of failures were long term complications. Aseptic loosening was the primary cause of late prosthetic failure. On Cox regression analysis, prosthetic stem diameter under 13mm was a significant negative prognostic factor for prosthetic survival (p=0.016). In Group-2, at a mean follow-up of 84 months, 36 prostheses were still in place. The overall rate of CMP prosthesis survival was 86% at 5 years. All complications were during the first postoperative year, being femoral fracture the main revision cause. The patients who retained the prosthesis had mainly good or excellent MSTS functional results in both groups

Introduction. Periprosthetic joint infection (PJI) represents the costliest complication in Orthopedics. Studies of mixing vancomycin to bone graft at Impaction Bone Grafting (IBG) have shown high local concentration for 3 weeks. Patients and methods. 55 consecutive revisions PJI, age 68 (SD 10.9), (9 one-stage and 46 two-stage) were retrospectively analyzed. All cases were revised using IBG. Most cases had vancomycin mixed in graft or added locally in joint. All had bone cement containing Gentamycin and Vancomycin. Follow up 2–16 years included clinical Merle d'Aubigne-Postel score, radiology and laboratory tests. We analyzed surgical time, bleeding, hospitalization time, infection eradication and prosthetic survival for one- and two-stage revision procedures. One patient was lost to follow up and 6 died (2 one- and 4 2-stage) before 2 years. Values are mean and SD. Analyses done by students t-test. Results. Preoperatively scores for 1- and 2-stage groups were 11.7 (0.79) and 10.2 (1.27) respectively. Follow up scores were 17.5 (0.38) and 15.9 (0.73) respectively. Total intra-operative blood loss (ml) for one- and two-stage procedures were 1638 (780) and 2764 (828) respectively p<0.05. Total surgery time (minutes): 238 (206) and 409 (108) respectively p<0.05. Total hospitalization time (days): 13 (6.2) and 34 (13) p<0.05. Radiology at follow-up showed no signs of PJI, signs of mechanical loosening in one. There were no persistent or new PJI, no revision for mechanical loosening. Two revision for any reason in the 2-stage and one in the 1-stage group. Five reoperations without component exchange for periprosthetic fracture, all in the 2-stage group. Conclusion. No mechanical loosening and no persistent or new PJI are favourable results. Blood loss, hospitalization- and surgery-time were substantially increased for the two-stage group. Muscle atrophy, osteoporotic development and decrease general physical condition are all well-known side effects of two-stage procedure. Revision one-stage hip PJI using IBG avoids increased suffering and resources connected to the two-stage procedure. Literatures have not shown eradication of PJI, to be clearly superior after two- compared to one-stage procedures. Reconstitution of bone defects and the possibility of very high local antibiotic concentration are substantial advantages when using IBG. We recommend a careful one-stage IBG procedure using antibiotic loaded graft for none “difficult to treat” cases

The October 2023 Oncology Roundup³⁶⁰ looks at: Are pathological fractures in patients with osteosarcoma associated with worse survival outcomes?; Spotting the difference: how secondary osteosarcoma manifests in retinoblastoma survivors versus conventional cases; Accuracy of MRI scans in predicting intra-articular joint involvement in high-grade sarcomas around the knee; Endoprosthetic reconstruction for lower extremity soft-tissue sarcomas with bone involvement; Local relapse of soft-tissue sarcoma of the extremities or trunk wall operated on with wide margins without radiation therapy; 3D-printed, custom-made prostheses in patients who had resection of tumours of the hand and foot; Long-term follow-up for low-grade chondrosarcoma; Evaluation of local recurrence and diagnostic discordance in chondrosarcoma patients undergoing preoperative biopsy; Radiological scoring and resection grade for intraosseous chondrosarcoma.

Aims

Dual-mobility acetabular components (DMCs) have improved total hip arthroplasty (THA) stability in femoral neck fractures (FNFs). In osteoarthritis, the direct anterior approach (DAA) has been promoted for improving early functional results compared with the posterolateral approach (PLA). The aim of this study was to compare these two approaches in FNF using DMC-THA.

The June 2024 Shoulder & Elbow Roundup³⁶⁰ looks at: Reverse versus anatomical total shoulder replacement for osteoarthritis? A UK national picture; Acute rehabilitation following traumatic anterior shoulder dislocation (ARTISAN): pragmatic, multicentre, randomized controlled trial; acid for rotator cuff repair: a systematic review and meta-analysis of randomized controlled trials; Metal or ceramic humeral head total shoulder arthroplasty: an analysis of data from the National Joint Registry; Platelet-rich plasma has better results for long-term functional improvement and pain relief for lateral epicondylitis: a systematic review and meta-analysis of randomized controlled trials; Quantitative fatty infiltration and 3D muscle volume after nonoperative treatment of symptomatic rotator cuff tears: a prospective MRI study of 79 patients; Locking plates for non-osteoporotic proximal humeral fractures in the long term; A systematic review of the treatment of primary acromioclavicular joint osteoarthritis.

Aims

The aims of this study were: 1) to describe extended restricted kinematic alignment (E-rKA), a novel alignment strategy during robotic-assisted total knee arthroplasty (RA-TKA); 2) to compare residual medial compartment tightness following virtual surgical planning during RA-TKA using mechanical alignment (MA) and E-rKA, in the same set of osteoarthritic varus knees; 3) to assess the requirement of soft-tissue releases during RA-TKA using E-rKA; and 4) to compare the accuracy of surgical plan execution between knees managed with adjustments in component positioning alone, and those which require additional soft-tissue releases.

Aims

The proximal tibia (PT) is the anatomical site most frequently affected by primary bone tumours after the distal femur. Reconstruction of the PT remains challenging because of the poor soft-tissue cover and the need to reconstruct the extensor mechanism. Reconstructive techniques include implantation of massive endoprosthesis (megaprosthesis), osteoarticular allografts (OAs), or allograft-prosthesis composites (APCs).

Oxford Unicompartmental knee arthroplasty (UKA) is now performed using a minimally invasive surgical (MIS) technique. Although early results are encouraging, the studies assessing outcome could be criticised for the restricted number of patients and limited follow-up. Aim of this study was to assess clinical outcome and prosthetic survival rate inpatients with minimally invasive Oxford medial UKA. This prospective study assessed 500 consecutive patients, who underwent cemented Oxford UKA for medial OA using MIS technique. Patients were assessed using objective and functional Knee Society Score (KSS). This study has confirmed preliminary findings that Oxford UKA using a minimally invasive approach is safe, reliable and effective

In this review of a limited series of 24 hip replacements done over a six-year period is reviewed, the rationale and theoretical motivation are discussed and the results reported. The mean follow-up is 30 months (10 to 66). There were twice as many male as female patients. Their mean age was 46.8 years. Results were scored on a Charnley/D’Aubigne system. There were technical difficulties but they were not insurmountable. Disciplined preoperative planning is required. The results are promising but some questions remain about long-term effects of metal debris and long-term prosthetic survival

Haemophilia care has steadily improved over the years and especially so during the last decade. The routine use of prophylactic treatment has undoubtedly resulted in a significant improvement in the life-style, quality of life and life expectancy of these patients. However despite our best efforts there is still a group of young adults who have a severe degree of knee joint destruction as a result of repeated articular bleeding episodes during their early years. The knee is the most common joint affected in haemophilia (50%). The repeated articular bleeding episodes during the patients' early years leads to the onset of pain and significant functional disability at a time when they require the best possible quality of life. The major objective of total joint replacement is to reduce the level of pain in the affected joint and, in addition, a significant reduction in the frequency and number of joint bleeds, which improves both function and mobility. The results of 60 primary total knee replacements performed in 42 patients with severe haemophilia between 1983 and 2003 were reviewed retrospectively. Functional results were assessed using the Hospital for Special Surgery (HSS) knee score both pre- and post-operatively. Kaplan-Meier survivorship analysis was used to calculate prosthetic survival. The mean age of patients was 43.35 (range 25-70yrs). The overall prevalence of infection was less than 2%. The HSS clinical score was excellent or good for 95% of the knees. We believe that total joint replacement is a safe and effective procedure in the management of haemophilic joint arthropathy. The latest techniques using continuous infusion and recombinant factor replacement have gone a long way to reducing the complications rate and to achieving results that match those of the general population

Aims

The aim of this study was to investigate the feasibility of application of a 3D-printed megaprosthesis with hemiarthroplasty design for defects of the distal humerus or proximal ulna following tumour resection.

Purpose: To review short-term results in 25 patients that underwent total ankle replacement with implantation of a second generation prosthesis. Materials and methods: We reviewed 25 patients with ankle arthritis treated by total ankle replacement (TAR). Mean age of the patients was 58.2 years and mean follow-up 29.5 months. The cause of arthritis was posttraumatic in 17 cases. In all cases a HINTEGRA prosthesis was implanted. In 6 cases Achilles tendon lengthening was also performed. Review was carried out by anamnesis, clinical examination and radiological control. The ankle and hindfoot AOFAS scale was used to quantify clinical and functional results. Results: Mean AOFAS score improved from 24.0 to 80.1 points. No significant differences were found between cases of traumatic and non-traumatic origin. Pain was the parameter with the best evolution. Mean ankle mobility went from 19° to 26°. Five cases required revision surgery: 2 ankle arthrodeses due to prosthetic loosening, 2 Achilles tendon lengthenings and one release of tibio-talar impingement. Prosthetic survival rate at 29.5 months’ follow-up was 92%. All patients, except for the 2 cases that required arthrodesis, were satisfied or very satisfied. Conclusions: Total ankle replacement is an effective method for the treatment of ankle arthritis. Short term results are similar or better than those seen with arthrodesis

Aims

Intraoperative pressure sensors allow surgeons to quantify soft-tissue balance during total knee arthroplasty (TKA). The aim of this study was to determine whether using sensors to achieve soft-tissue balance was more effective than manual balancing in improving outcomes in TKA.

Acetabular revision in patients with bone deficiency is often difficult because of the poor quality and quantity of the acetabular bone stock. The purpose of this study was to evaluate the midterm clinical and radiographic outcomes of acetabular revision with use of an impaction bone-grafting technique and a cemented polyethylene cup. Results: thirty consecutive acetabular revisions were performed with impaction bone-grafting and use of a cemented cup in twenty-eight patients with bone deficiency. The average age at the revision was sixty-eight years. The minimum duration of follow-up of all reconstructions that were still functioning or that were followed until the time of death was three years (mean, 8.1 years; range, three to fifteen years). The acetabular bone defects were classified as cavitary in fifteen hips and as combined segmental-cavitary in fifteen hips according to AAOS classification. One hip had a repeat revision. Radiographic analysis that had not been revised showed loosening in four hips. All these four hips were treated by bulk bone graft covering more than 50% of cups. Kaplan-Meier analysis demonstrated a prosthetic survival rate, with aseptic loosening as the end point, of 72% at fourteen years and, with revision as the endpoint, of 100% at ten years and 83% at fourteen years. Impaction bone-grafting was an excellent option to manage acetabular revision surgery. However, excessive bulk bonegraft should not be used

We reviewed our experience with diaphyseal endoprostheses to determine the survival of this type of reconstruction and factors affecting that survival. Method: We retrospectively studied 44 patients who underwent endoprostheticreconstruction of diaphyseal bone defects after excision of primary sarcomas between 1979 and 2002 with more than 2 years follow up. Results: There were 27 males and 17 females, the median age at diagnosis was 25 years (8–75) and the median bone defect was 18cm (10–27.6).There were 33 femoral reconstructions, 6 tibial and 5 humeral. The cumulative overall survival for all patients was 67% at 10 years and prosthetic reconstruction using revision surgery as an end point was 62% at 10 years. The cumulative risk offailure of reconstruction including; infection, fracture, aseptic loosening, local recurrence and amputation was 45% at 10 years but for amputation only was 13% at 10 years. The patient age, the type of prosthesis ;whether cemented oruncemented, site of defect (femur, tibia, and humerus) and length of defect did not influence prosthetic survival. Conclusion: We concluded that the use endoprostheses for reconstruction of diaphyseal bone defects remains a valuable method of reconstruction with predictable results and compares favourably with other forms of reconstruction of massive diaphyseal bone defects