Modular implant design affects metal ion release following metal-on-metal hip arthroplasty: a retrospective study on 75 cases

Metal-on-Metal (MoM) total hip arthroplasty (THA) has been associated to wear and metal-ions release, controversially related to a variety of clinical complications. Little is known about the relevant design-dependent parameters involved in this process. The present study investigated the correlation between metal ion release in blood and revision rate as a function of: (i) specific MoM implant modular design parameters, (i.e. acetabular cup and femoral head diameters, taper adapter material and size, femoral neck material and modularity and stem size); (ii) MoM bilaterality. Co and Cr ions concentration levels in blood of 75 patients were retrospectively-evaluated with a mean follow-up of 4.8 years (range: 1.8-6.3). Patients were divided in a unilateral and a bilateral group. Statistical analysis was performed to find any significant difference related to acetabular cup diameter, femoral head diameter, taper adapter material/size, neck material/size and stem size. The bilateral MoM group had 4-times higher metal ion levels in blood than the unilateral one (p=0.017 only Cr), related to a higher revision rate (30% vs 20%): differences were 10-times higher particularly with a 48 mm femoral head diameter (p=0.012) and a Ti-alloy neck (p=0.041). Within the monolateral group using a shorter taper adapter and a shorter neutrally-oriented neck demonstrated higher ion levels (p=0.038 only Cr and p=0.008 only Co, respectively). The aforementioned design-features and MoM bilaterality are important risk-factors for metal-ion release in modular MoM THA

Evidence of lipofuscin accumulation in the deep-water red shrimp Aristaeomorpha foliacea (Risso, 1827)

Lipofuscin, a non-degradable, degenerative fluorescent pigment which accumulates in post-mitotic cells, represents a promising method for ageing marine crustaceans. The presence and accumulation of lipofuscin has been studied in the deep-water red shrimp Aristaeomorpha foliacea (Risso, 1827) to assess its use as a tool for ageing larger (i.e., older) specimens and thus improve knowledge of the growth and longevity of this species. Specimens, gathered during experimental trawl surveys carried out in the Strait of Sicily (Mediterranean Sea), were stored directly on-board in 10% buffered formaldehyde solution; their brain was thereafter removed, prepared with various current histological techniques and examined with a binocular microscope. Thin sections of the olfactory lobe cell mass were also analyzed using fluorescence microscopy, and the lipofuscin concentration was measured through image analysis. Various indices were computed for each individual by pooling data from many images: number and coverage of the lipofuscin granules per unit area, and mean individual area of the granules. Lipofuscin was detected in all specimens investigated with characteristics (grain typology and dimension) strictly resembling those already described in other crustacean species. The present preliminary results encourage further studies to develop and validate a methodology based on the use of lipofuscin for improving the relative ageing of large A. foliacea shrimps

Characterization of articular chondrocytes isolated from 211 osteoarthritic patients

We analyzed specific features of chondrocytes as cellular yield, cell doubling rates and the dependence between these parameters and patient-related data in a set of 211 osteoarthritic (OA) patients undergoing total joint replacement. For each patient the data available were joint type, age and gender. Knee samples chosen randomly among all biopsies were graded according to ICRS score. Patients\u2019 age ranged between 30 and 90 years with a mean age of 66 \ub1 9.7 years. Patients were divided into age classes and statistically significant differences in proliferation rate at passage 1 were found between chondrocytes derived from young and old donors, with the last ones characterized by a lower proliferation rate. A similar trend was observed for proliferation rate at passage 2. For all the samples, cellular yields ranged between 0.1 and 5.5 million cells/g of tissue. No significant correlation was observed between the level of cartilage degeneration (ICRS score) and cellular yield and proliferation rates. However, in samples with a high degree of cartilage degeneration (ICRS score 4) the cellular yield was lower compared to the other three groups (ICRS scores 1\u20133). In this study we performed a systematic characterization of basic parameters of chondrocytes originating from a wide group of OA patients. Considering the use of autologous chondrocytes in chondral treatments, the characterization of cell basic features may represent an important step to determine the quality of the cell source which is a major determinant in the outcome of cell-based therapies

EFORT recommendations for off-label use, mix & match and mismatch in hip and knee arthroplasty

Off-label use is frequently practiced in primary and revision arthroplasty, as there may be indications for the application of implants for purposes outside the one the manufacturers intended.Under certain circumstances, patients may benefit from selective application of mix & match. This can refer to primary hip arthroplasty (if evidence suggests that the combination of devices from different manufacturers has superior results) and revision hip or knee arthroplasty (when the exchange of one component only is necessary and the invasiveness of surgery can be reduced).Within the EFORT 'Implant and Patient Safety Initiative', evidence-and consensus-based recommendations have been developed for the safe application of off-label use and mix & match in primary as well as revision hip and knee arthroplasty.Prior to the application of a medical device for hip or knee arthroplasty off-label and within a mix & match situation, surgeons should balance the risks and benefits to the patient, obtain informed consent, and document the decision process appropriately.Nevertheless, it is crucial for surgeons to only combine implants that are compatible. Mismatch of components, where their sizes or connections do not fit, may have catastrophic effects and is a surgical mistake.Surgeons must be fully aware of the features of the components that they use in off-label indications or during mix & match applications, must be appropriately trained and must audit their results.Considering the frequent practice of off-label and mix & match as well as the potential medico-legal issues, further research is necessary to obtain more data about the appropriate indications and outcomes for those procedures.Orthopaedics, Trauma Surgery and Rehabilitatio

Resuming elective hip and knee arthroplasty after the first phase of the SARS-CoV-2 pandemic: the European Hip Society and European Knee Associates recommendations

The Covid-19 pandemic has disrupted health care systems all over the world. Elective surgical procedures have been postponed and/or cancelled. Consensus is, therefore, required related to the factors that need to be in place before elective surgery, including hip and knee replacement surgery, which is restarted. Entirely new pathways and protocols need to be worked out. Methods A panel of experts from the European Hip Society and European Knee Association have agreed to a consensus statement on how to reintroduce elective arthroplasty surgery safely. The recommendations are based on the best available evidence and have been validated in a separate survey. Results The guidelines are based on five themes: modification and/or reorganisation of hospital wards. Restrictions on orthopaedic wards and in operation suite(s). Additional disinfection of the environment. The role of ultra-clean operation theatres. Personal protective equipment enhancement. Conclusion Apart from the following national and local guidance, protocols need to be put in place in the patient pathway for primary arthroplasty to allow for a safe retur

Recommendations for resuming elective hip and knee arthroplasty in the setting of the SARS‑CoV‑2 pandemic: the European Hip Society and European Knee Associates Survey of Members

The COVID-19 pandemic has disrupted the health care system around the entire globe. A consensus is needed about resuming total hip and knee procedures. The European Hip Society (EHS) and the European Knee Association (EKA) formed a panel of experts that have produced a consensus statement on how the safe re-introduction of elective hip and knee arthroplasty should be undertaken. Methods A prospective online survey was done among members of EHS and EKA. The survey consisted of 27 questions. It includes basic information on demographics and details the participant’s agreement with each recommendation. The participant could choose among three options (agree, disagree, abstain). Recommendations focussed on pre-operative, perioperative, and post-operative handling of patients and precautions. Results A total of 681 arthroplasty surgeons participated in the survey, with 479 fully completing the survey. The participants were from 44 countries and 6 continents. Apart from adhering to National and Local Guidelines, the recommendations concerned how to make elective arthroplasty safe for patients and staf. Conclusion The survey has shown good-to-excellent agreement of the participants with regards to the statements made in the recommendations for the safe return to elective arthroplasty following the frst wave of the COVID-19 pandemi

Alumina-on-alumina total hip replacement for femoral neck fracture in healthy patients

<p>Abstract</p> <p>Background</p> <p>Total hip replacement is considered the best option for treatment of displaced intracapsular fractures of the femoral neck (FFN). The size of the femoral head is an important factor that influences the outcome of a total hip arthroplasty (THA): implants with a 28 mm femoral head are more prone to dislocate than implants with a 32 mm head. Obviously, a large head coupled to a polyethylene inlay can lead to more wear, osteolysis and failure of the implant. Ceramic induces less friction and minimal wear even with larger heads.</p> <p>Methods</p> <p>A total of 35 THAs were performed for displaced intracapsular FFN, using a 32 mm alumina-alumina coupling.</p> <p>Results</p> <p>At a mean follow-up of 80 months, 33 have been clinically and radiologically reviewed. None of the implants needed revision for any reason, none of the cups were considered to have failed, no dislocations nor breakage of the ceramic components were recorded. One anatomic cementless stem was radiologically loose.</p> <p>Conclusions</p> <p>On the basis of our experience, we suggest that ceramic-on-ceramic coupling offers minimal friction and wear even with large heads.</p

Increased Mortality in Metal-on-Metal versus Non-Metal-on-Metal Primary Total Hip Arthroplasty at 10 Years and Longer Follow-Up: A Systematic Review and Meta-Analysis

Analysis and Stochastic