Are trabecular metal cones a valid option to treat metaphyseal bone defects in complex primary and revision knee arthroplasty?

Purpose Metaphyseal bone defects are a challenge in complex primary and revision total knee arthroplasty (TKA). Recently, several studies have been published with promising results about the use of Trabecular Metal (TM) cones to address bone defects. The aim of this study is to review the literature to assess the efficacy of TM cones to address metaphyseal bone loss. Methods A comprehensive search was performed on PubMed, Medline, CINAHL, Cochrane, Embase, and Google Scholar databases using various combinations of the following keywords: \u201cmetaphyseal,\u201d \u201ccones,\u201d \u201ctantalum,\u201d \u201cknee,\u201d and \u201crevision.\u201d Only papers reporting clinical data about the use of trabecular metal cones were included in the analysis. In vitro studies, case reports, surgical technique, or other studies where it was not possible to collect clinical data were excluded. Patients characteristics, details of the surgical procedures, outcome, and complications were collected from each included study. Results No controlled studies were available in the literature and all the papers were case series. In 16 studies included, the records of 442 patients with 447 implants and 523 TM cones were reported. The mean follow-up was 42 months (range: 5\u2013105) for 360 procedures. Among 437 procedures, 30.4% were septic revisions. The Anderson Orthopaedic Research Institute (AORI) classification was available for 352 defects: 13 type 1, 69 type 2A, 115 type 2B, and 155 type 3. To manage these 352 defects, 360 TM cones were implanted. Intraoperative fractures occurred 13 times (10 femoral/3 tibial), 6 required surgical fixation. The overall infection rate was 7.38%, and the infection rate for the aseptic procedures was 0.99%. An aseptic exchange was performed 13 times, among these procedures twoTM cones were loose. Signs of loosening were found just in 1.3% of the 523 TM cones implanted (5 femoral/2 tibial) during 447 procedures

Persistent Wound Drainage After Total Joint Arthroplasty: A Narrative Review

Background: Persistent wound drainage after total joint arthroplasty (TJA) is an important complication with potential substantial adverse consequences, in particular periprosthetic joint infection. Methods: This review evaluated the available literature regarding several issues in the field of persistent wound drainage after TJA and offers a classification of persistent wound drainage and an algorithmic approach to the decision-making process. Results: Available literature addressing the diagnosis and treatment of persistent wound drainage after TJA is scarce and an evidence-based clinical guideline is lacking. This is partially caused by the absence of a universally accepted definition of persistent wound drainage. In patients with persistent wound drainage, clinical signs and serological tests can be helpful in the diagnosis of a developing infection. Regarding the treatment of persistent wound drainage, nonsurgical treatment consists of absorbent dressings, pressure bandages, and temporary joint immobilization. Surgical treatment is advised when wound drainage persists for more than 5-7 days and consists of open debridement with irrigation and exchange of modular components and antimicrobial treatment. Conclusion: Based on this literature review, we proposed a classification and algorithmic approach for the management of patients with persistent wound drainage after TJA. Hopefully, this offers the orthopedic surgeon a practical clinical guideline by finding the right balance between overtreatment and undertreatment, weighing the risks and benefits. However, this classification and algorithmic approach should first be evaluated in a prospective trial. (C) 2018 The Author(s). Published by Elsevier Inc

Total hip arthroplasty with acetabular reconstruction using a bulk autograft for patients with developmental dysplasia of the hip results in high loosening rates at mid-term follow-up

PURPOSE: Managing a deficient acetabulum in patients with developmental dysplasia of the hip (DDH) can be challenging. The purpose of the study was to determine the mid-term results of total hip arthroplasty (THA) using a bulk structural autograft for reconstruction of the acetabular roof in patients with DDH. METHODS: Between 1982 and 1999, 112 patients underwent THA with acetabular roof-plasty using a bulk structural autograft for secondary osteoarthritis related to DDH. A total of 106 patients (115 hips) met inclusion criteria and were followed for an average of 11.6 years (seven to 24 years). The mean age was 52.5 years at the index operation. Clinical and radiological evaluations were performed according to the methods of Merle d'Aubigne and Postel, Johnston et al. and DeLee and Charnley. RESULTS: The overall Merle d'Aubigne hip score significantly improved (3.7 vs 10.4, p < 0.01). The limb length discrepancy decreased from 30 to 6 mm (p < 0.01). The average distance that the hip centre was distalised was 22.3 mm (0-56 mm). However, radiolucent lines were observed in 27 % of patients at final follow-up, and the overall rate of revision for aseptic loosening was 16 %. Further, Kaplan-Meier survivorship curves predicted a rapid increase in the failure rate at 15 years. CONCLUSIONS: The mid-term functional outcome of THA with an acetabular roof-plasty using a bulk autograft is satisfactory; however, the long-term results are questionable