86 research outputs found
A systematic review of the evidence for single stage and two stage revision of infected knee replacement
BACKGROUND:
Periprosthetic infection about the knee is a devastating complication that may affect between 1% and 5% of knee replacement. With over 79 000 knee replacements being implanted each year in the UK, periprosthetic infection (PJI) is set to become an important burden of disease and cost to the healthcare economy. One of the important controversies in treatment of PJI is whether a single stage revision operation is superior to a two-stage procedure. This study sought to systematically evaluate the published evidence to determine which technique had lowest reinfection rates.
METHODS:
A systematic review of the literature was undertaken using the MEDLINE and EMBASE databases with the aim to identify existing studies that present the outcomes of each surgical technique. Reinfection rate was the primary outcome measure. Studies of specific subsets of patients such as resistant organisms were excluded.
RESULTS:
63 studies were identified that met the inclusion criteria. The majority of which (58) were reports of two-stage revision. Reinfection rated varied between 0% and 41% in two-stage studies, and 0% and 11% in single stage studies. No clinical trials were identified and the majority of studies were observational studies.
CONCLUSIONS:
Evidence for both one-stage and two-stage revision is largely of low quality. The evidence basis for two-stage revision is significantly larger, and further work into direct comparison between the two techniques should be undertaken as a priority
Stiffness in total knee arthroplasty
Stiffness is a relatively uncommon complication after total knee arthroplasty. It has been defined as a painful limitation in the range of movement (ROM). Its pathogenesis is still unclear even if some risk factors have been identified. Patient-related conditions may be difficult to treat. Preoperative ROM is the most important risk factor, but an association with diabetes, reflex sympathetic dystrophy, and general pathologies such as juvenile rheumatoid arthritis and ankylosing spondylitis has been demonstrated. Moreover, previous surgery may be an additional cause of an ROM limitation. Postoperative factors include infections, arthrofibrosis, heterotrophic ossifications, and incorrect rehabilitation protocol. Infections represent a challenging problem for the orthopaedic surgeon, and treatment may require long periods of antibiotics administration. However, it is widely accepted that an aggressive rehabilitation protocol is mandatory for a proper ROM recovery and to avoid the onset of arthrofibrosis and heterotrophic ossifications. Finally, surgery-related factors represent the most common cause of stiffness; they include errors in soft-tissue balancing, component malpositioning, and incorrect component sizing. Although closed manipulation, arthroscopic and open arthrolysis have been proposed, they may lead to unpredictable results and incomplete ROM recovery. Revision surgery must be proposed in the case of well-documented surgical errors. These operations are technically demanding and may be associated with high risk of complications; therefore they should be accurately planned and properly performed
Bone regeneration: current concepts and future directions
Bone regeneration is a complex, well-orchestrated physiological process of bone formation, which can be seen during normal fracture healing, and is involved in continuous remodelling throughout adult life. However, there are complex clinical conditions in which bone regeneration is required in large quantity, such as for skeletal reconstruction of large bone defects created by trauma, infection, tumour resection and skeletal abnormalities, or cases in which the regenerative process is compromised, including avascular necrosis, atrophic non-unions and osteoporosis. Currently, there is a plethora of different strategies to augment the impaired or 'insufficient' bone-regeneration process, including the 'gold standard' autologous bone graft, free fibula vascularised graft, allograft implantation, and use of growth factors, osteoconductive scaffolds, osteoprogenitor cells and distraction osteogenesis. Improved 'local' strategies in terms of tissue engineering and gene therapy, or even 'systemic' enhancement of bone repair, are under intense investigation, in an effort to overcome the limitations of the current methods, to produce bone-graft substitutes with biomechanical properties that are as identical to normal bone as possible, to accelerate the overall regeneration process, or even to address systemic conditions, such as skeletal disorders and osteoporosis
Deciphering osteoarthritis genetics across 826,690 individuals from 9 populations
Osteoarthritis affects over 300 million people worldwide. Here, we conduct a genome-wide association study meta-analysis across 826,690 individuals (177,517 with osteoarthritis) and identify 100 independently associated risk variants across 11 osteoarthritis phenotypes, 52 of which have not been associated with the disease before. We report thumb and spine osteoarthritis risk variants and identify differences in genetic effects between weight-bearing and non-weight-bearing joints. We identify sex-specific and early age-at-onset osteoarthritis risk loci. We integrate functional genomics data from primary patient tissues (including articular cartilage, subchondral bone, and osteophytic cartilage) and identify high-confidence effector genes. We provide evidence for genetic correlation with phenotypes related to pain, the main disease symptom, and identify likely causal genes linked to neuronal processes. Our results provide insights into key molecular players in disease processes and highlight attractive drug targets to accelerate translation
Bone scaffolds: The role of mechanical stability and instrumentation
Osteoconductive bone scaffolds are increasingly used today for
regeneration of bone defects. Research is mainly focused on the scaffold
material, its macro and micro architecture and mechanical properties.
The mechanical environment and the optimal instrumentation, used to
protect and enhance bone regeneration, are multifactorial issues and
have not yet received the appropriate attention by researchers in the
field. (c) 2005 Elsevier Ltd. All rights reserved
Effectiveness of total hip arthroplasty in the management of hip osteonecrosis
Total hip replacement initially showed universally bad results when
performed in hips with advanced stages of osteonecrosis. Newer
techniques and implants remarkably improved these results. Today
cementless or hybrid total hip arthroplasty for osteonecrosis is proven
to be safe and effective and to have survivorship similar to cases with
osteoarthritis. Newer, more durable bearing surfaces will further
improve the longevity of this procedure
The effectiveness of isolated tibial insert exchange in revision total knee arthroplasty
Background: Despite improvements in the design and manufacturing of the
components used in total knee arthroplasty, wear of the polyethylene
bearing remains a potential source of failure. One theoretical advantage
of modular tibial implants is that, when the components are well fixed,
patients with wear or instability of the tibial insert can be treated
with isolated polyethylene exchange. The aim of this study was to assess
the results of isolated tibial insert exchange during revision surgery
in a relatively large, consecutive group of patients.
Methods: From 1985 through 1997, we performed fifty-six isolated tibial
insert exchanges in fifty-five patients (twenty-nine men [one man had
bilateral revision] and twenty-six women; mean age, sixty-six years)
primarily because of wear or instability. Patients with loosening of any
of the components, a history of infection, severe stiffness of the knee,
recognized malposition of any component, or problems with the extensor
mechanism were excluded. Twelve knees had had one, two, or three prior
revisions. The duration of follow-up averaged 8.3 years (range, 1.6 to
16.2 years) after the index arthroplasty and 4.6 years (range, two to
fourteen years) after the revision.
Results: The mean Knee Society knee and function scores improved from 56
and 50.9 points prior to the revision to 76 and 59 points at the time of
final follow-up. Fourteen (25%) of the fifty-six knees subsequently
required rerevision at a mean of only three years (range, 0.5 to 6.8
years) after the tibial insert exchange. The cumulative survival rate at
5.5 years was 63.5% (95% confidence interval, +/-14.4%, with nineteen
patients remaining at risk). Of the twenty-seven knees with preoperative
instability, eight were rerevised and another four were considered
failures because of severe pain. Of the twenty-four knees that were
treated with the index revision because of wear of the insert, five were
rerevised. In addition, one extremity in this group was amputated above
the knee as a result of chronic osteomyelitis of the ankle concomitant
with chronic pain at the site of the total knee arthroplasty and another
two inserts were considered failures because of severe pain.
Conclusions: Isolated tibial insert exchange led to a surprisingly high
rate of early failure. Tibial insert exchange as an isolated method of
total knee revision should therefore be undertaken with caution even in
circumstances for which the modular insert was designed and believed to
be of greatest value
OPERATIVE TREATMENT OF TYPE-C INTRAARTICULAR FRACTURES OF THE DISTAL HUMERUS - THE ROLE OF STABILITY ACHIEVED AT SURGERY ON FINAL OUTCOME
We report the results of 75 patients with type C intra-articular
fracture of the distal humerus treated operatively by two methods and
followed up for a mean period of 48.2 months. Minimal osteosynthesis
and joint immobilization was used in 21 cases while the remaining 54
patients were treated according to AO recommendations. Good or
excellent results were found in 38 per cent after minimal osteosynthesis
and in 77.8 per cent following the AO technique. 87.8 per cent of the
cases with stable osteosynthesis and early mobilization had a good or
excellent result as compared with 41.2 per cent of the cases after
unstable fixation and immobilization of the joint (P < 0.01). The type
of fracture was found to be an important factor in achieving stable
fixation (P < 0.01)
Hydatid disease of bones and joints - 8 cases followed for 4-16 years
Hydatid disease is a rare parasitic disease that seldom involves the
skeleton. Treatment is difficult because of problems with the
preoperative diagnosis, the invasive nature of the bony involvement and
the variable anaphylactic reaction to the cyst fluid antigen. We present
8 cases with osseous hydatidosis who were treated over a period of 11
years. The spine was involved in 2 cases, the ilium in 2, the hip in 2,
the tibia in 1 and the humerus in 1. We point out that diagnosis is
difficult and the prognosis is often poor
- …