| 1. |
- Mikhail, W. E., et al.
(författare)
-
Femoral bone regeneration subsequent to impaction grafting during hip revision : histologic analysis of a human biopsy specimen
- 1999
-
Ingår i: The Journal of Arthroplasty. - Philadelphia, USA : Elsevier. - 0883-5403 .- 1532-8406. ; 14:7, s. 849-953
-
Tidskriftsartikel (refereegranskat)abstract
- Cemented revision with impaction grafting shows encouraging early clinical results; postoperative biopsy specimens taken from the proximal femur in humans have demonstrated viable trabecular and cortical bone. Human radiographic studies also illustrate density changes within the proximal femur, consistent with remodeling of bone-graft. In an animal experiment, bone incorporation was shown in the proximal femur, but graft lysis was reported around the distal portion of the implant. We report on a patient who sustained a traumatic femoral fracture at the level of the tip of the femoral component 27 months after revision with impaction grafting and a collarless polished taper stem. At the time of open reduction and internal fixation of the fracture, we obtained circumferential biopsy specimens from the fracture site. Three distinct zones could be identified histologically: i) an inner zone consisting of bone-cement, fibrous tissue, and partially necrotic trabeculae with evidence of bone remodeling; ii) a middle zone consisting of viable trabecular bone and probable neocortex formation with fewer particles of bone-cement; and iii) an outer zone with viable cortex. Fibrous tissue was present around some of the incorporating bone-graft fragments, but no continuous fibrous membrane was present. Cement particles were identified, but no polyethylene debris was found by light microscopy. Biopsy specimens from the distal aspect of the prosthesis may not reflect changes seen proximally, but based on the available tissue, this case illustrated histological evidence of bone-graft remodeling after impaction grafting. These results are consistent with our expectations based on radiographic findings and clinical results.
|
|
| 2. |
- Stigbrand, Hampus, et al.
(författare)
-
A 2-to 16-Year Clinical Follow-Up of Revision Total Hip Arthroplasty Using a New Acetabular Implant Combined With Impacted Bone Allografts and a Cemented Cup
- 2018
-
Ingår i: The Journal of Arthroplasty. - : CHURCHILL LIVINGSTONE INC MEDICAL PUBLISHERS. - 0883-5403 .- 1532-8406. ; 33:3, s. 815-822
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Treatment of acetabular bone loss with impaction bone grafting (IBG) at revision total hip arthroplasty is highly dependent on mechanical stability and graft compression for clinical success. Here, we describe a new technique to further compress and stabilize the acetabular graft bed with a thin, perforated titanium shell.Methods: We retrospectively analyzed 170 cases of acetabular revision arthroplasty 7 years (standard deviation 2.8) after IBG combined with a graft-compressing titanium shell implant. The patients were reviewed by clinical score and radiography. Three patients were lost to follow-up. The medical journals of the 33 deceased cases were reviewed for any reoperation. Of the 170 cases, 74 had a cavitary acetabular bone defect, 93 had combined segmental and cavitary bone defects, and 3 had a pelvic dissociation. Bone graft incorporation was assessed and correction of the hip center of rotation was calculated. Results: Five cases (3%) were reoperated for mechanical loosening. One more was assessed as loose but asymptomatic and was not planned for revision. There were 3 reoperations for recurrent dislocation, 2 for deep infection and 1 for technical error. Reoperation for any reason, as the end point of survivorship, showed a survival rate of 92% after 10 years. Hip score according to Merle, d'Aubigne, and Postel increased from 10.8 (preoperatively) to 16.4 at follow-up. The clinical and radiological results were excellent.Conclusion: IBG combined with the compressing shell results in excellent results for this challenging condition.
|
|
| 3. |
- Ainslie-Garcia, Margaret, et al.
(författare)
-
International Delphi Study on Wound Closure and Dressing Management in Joint Arthroplasty: Part 1: Total Knee Arthroplasty.
- 2024
-
Ingår i: The Journal of arthroplasty. - 0883-5403 .- 1532-8406. ; 39:4, s. 878-883
-
Tidskriftsartikel (refereegranskat)abstract
- The purpose of this modified Delphi study was to obtain consensus on wound closure and dressing management in total knee arthroplasty (TKA).The Delphi panel included 20 orthopaedic surgeons from Europe and North America. There were 26 statements identified using a targeted literature review. Consensus was developed for the statements with up to three rounds of anonymous voting per topic. Panelists ranked their agreement with each statement on a five-point Likert scale. An a priori threshold of ≥ 75% was required for consensus.All 26 statements achieved consensus after three rounds of anonymous voting. Wound closure-related interventions that were recommended for use in TKA included: 1) closing in semi-flexion versus extension (superior range of motion); 2) using aspirin for venous thromboembolism prophylaxis over other agents (reduces wound complications); 3) barbed sutures over non-barbed sutures (lower wound complications, better cosmetic appearances, shorter closing times, and overall cost savings); 4) mesh-adhesives over other skin closure methods (lower wound complications, higher patient satisfaction scores, lower rates of readmission); 5) silver-impregnated dressings over standard dressings (lower wound complications, decreased infections, fewer dressing changes); 6) in high-risk patients, negative pressure wound therapy over other dressings (lower wound complications, decreased reoperations, fewer dressing changes); and 7) using triclosan-coated over non-antimicrobial-coated sutures (lower risks of surgical site infection).Using a modified Delphi approach, the panel achieved consensus on 26 statements pertaining to wound closure and dressing management in TKA. This study forms the basis for identifying critical evidence supported by clinical practice for wound management to help reduce variability, advance standardization, and ultimately improve outcomes during TKA. The results presented here can serve as the foundation for knowledge, education, and improved clinical outcomes for surgeons performing TKAs.
|
|
| 4. |
- Ainslie-Garcia, Margaret, et al.
(författare)
-
International Delphi Study on Wound Closure and Incision Management in Joint Arthroplasty Part 2: Total Hip Arthroplasty.
- 2024
-
Ingår i: The Journal of arthroplasty. - 0883-5403 .- 1532-8406. ; 39:6, s. 1524-1529
-
Tidskriftsartikel (refereegranskat)abstract
- This modified Delphi study aimed to develop a consensus on optimal wound closure and incision management strategies for total hip arthroplasty (THA). Given the critical nature of wound care and incision management in influencing patient outcomes, this study sought to synthesize evidence-based best practices for wound care in THA procedures.An international panel of 20 orthopedic surgeons from Europe, Canada, and the United States evaluated a targeted literature review of 18 statements (14 specific to THA and 4 related to both THA and total knee arthroplasty). There were 3 rounds of anonymous voting per topic using a modified 5-point Likert scale with a predetermined consensus threshold of ≥ 75% agreement necessary for a statement to be accepted.After 3 rounds of voting, consensus was achieved for all 18 statements. Notable recommendations for THA wound management included (1) the use of barbed sutures over non-barbed sutures (shorter closing times and overall cost savings); (2) the use of subcuticular sutures over skin staples (lower risk of superficial infections and higher patient preferences, but longer closing times); (3) the use of mesh-adhesives over silver-impregnated dressings (lower rate of wound complications); (4) for at-risk patients, the use of negative pressure wound therapy over other dressings (lower wound complications and reoperations, as well as fewer dressing changes); and (5) the use of triclosan-coated sutures (lower risk of surgical site infection) over standard sutures.Through a structured modified Delphi approach, a panel of 20 orthopedic surgeons reached consensus on all 18 statements pertaining to wound closure and incision management in THA. This study provides a foundational framework for establishing evidence-based best practices, aiming to reduce variability in patient outcomes and to enhance the overall quality of care in THA procedures.
|
|
| 5. |
- Al-Amiry, Bariq Sh. 1976-, et al.
(författare)
-
The Influence of Radiological Severity and Symptom Duration of Osteoarthritis on Postoperative Outcome After Total Hip Arthroplasty : A Prospective Cohort Study
- 2018
-
Ingår i: The Journal of Arthroplasty. - : CHURCHILL LIVINGSTONE INC MEDICAL PUBLISHERS. - 0883-5403 .- 1532-8406. ; 33:2, s. 436-440
-
Tidskriftsartikel (refereegranskat)abstract
- Background: We aimed to investigate the influence of preoperative radiological severity and symptom duration of hip osteoarthritis (OA) on the postoperative functional outcome, quality of life, as well as abductor muscle strength after total hip arthroplasty (THA). Methods: In this prospective cohort study, we studied 250 patients. Preoperatively, we evaluated the function with the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index and quality of life with euroqol-5D (EQ-5D). At 1 year after THA, the same scores and also hip abductor muscle strength were measured in 222 patients. We divided the cohort twice, first according to the radiological OA severity [Kellgren-Lawrence classification (KL)] and then according to the OA symptom duration. We investigated whether the preoperative KL class and symptom duration influenced the 1-year WOMAC (primary outcome measure) or EQ-5D and abductor muscle strength (secondary outcome measures). Results: The crude results showed that KL class and symptom duration had no influence (P = .90 and P = .20, respectively) on the 1-yearWOMAC. Younger age, male gender, and lower body mass index were associated with a better function. Regarding 1-year EQ-5D, the crude results showed that body mass index and KL class had no influence (P = .83 and P = .39, respectively). The adjusted results showed that only age and gender influenced the postoperative EQ-5D. No influence of the tested factors was found on the 1-year abductor muscle strength. Conclusion: Preoperative radiological OA severity and symptom duration had no influence on the outcome of THA and should probably not affect the decision about timing the operative intervention.
|
|
| 6. |
|
|
| 7. |
- Bjerke, Joakim, et al.
(författare)
-
Compensatory strategies for muscle weakness during stair ascent in subjects with total knee arthroplasty
- 2014
-
Ingår i: The Journal of Arthroplasty. - : Elsevier. - 0883-5403 .- 1532-8406. ; 29:7, s. 1499-1502
-
Tidskriftsartikel (refereegranskat)abstract
- Subjects with total knee arthroplasty (TKA) exhibit decreased quadriceps and hamstring strength. This may bring about greater relative effort or compensatory strategies to reduce knee joint moments in daily activities. To study gait and map out the resource capacity, knee muscle strength was assessed by maximal voluntary concentric contractions, and whole body kinematics and root mean square (RMS) electromyography (EMG) of vastus lateralis and semitendinosus were recorded during stair ascent in 23 unilateral TKA-subjects ~19months post-operation, and in 23 healthy controls. Muscle strength and gait velocity were lower in the TKA group, but no significant group differences were found in RMS EMG or forward trunk lean. The results suggest that reduced walking velocity sufficiently compensated for reduced knee muscle strength.
|
|
| 8. |
- Bjerke, Joakim, et al.
(författare)
-
Peak knee flexion angles during stair descent in TKA patients
- 2014
-
Ingår i: The Journal of Arthroplasty. - : Elsevier. - 0883-5403 .- 1532-8406. ; 29:4, s. 707-711
-
Tidskriftsartikel (refereegranskat)abstract
- Reduced peak knee flexion during stair descent (PKSD) is demonstrated in subjects with total knee arthroplasty (TKA), but the underlying factors are not well studied. 3D gait patterns during stair descent, peak passive knee flexion (PPKF), quadriceps strength, pain, proprioception, demographics, and anthropometrics were assessed in 23 unilateral TKA-subjects ~ 19 months post-operatively, and in 23 controls. PKSD, PPKF and quadriceps strength were reduced in the TKA-side, but also in the contralateral side. A multiple regression analysis identified PPKF as the only predictor (57%) to explain the relationship with PKSD. PPKF was, however sufficient for normal PKSD. Deficits in quadriceps strength in TKA-group suggest that strength is also contributing to smaller PKSD. Increased hip adduction at PKSD may indicate both compensatory strategy and reduced hip strength.
|
|
| 9. |
- Callary, Stuart A, et al.
(författare)
-
The 6-Year Migration Characteristics of a Hydroxyapatite-Coated Femoral Stem A Radiostereometric Analysis Study
- 2012
-
Ingår i: The Journal of Arthroplasty. - : Elsevier. - 0883-5403 .- 1532-8406. ; 27:7, s. 1344-1348
-
Tidskriftsartikel (refereegranskat)abstract
- A prospective cohort of 30 patients undergoing primary total hip arthroplasty for treatment of osteoarthritis was enrolled in a study to characterize the migration behavior of a clinically successful cementless stem. At 6 years, the mean subsidence of the stem was 0.63 mm (range, -0.33 to 3.68 mm); the mean rotation into retroversion was 1.41° (range, -1.33° to 7.48°). No stems had additional subsidence of more than 0.25 mm between 6 months and 6 years. The resultant mean subsidence between 2 and 6 years was 0.03 mm, which is below the limit measurable by radiostereometric analysis. The data demonstrate that subsidence of this cementless stem occurs within the first 6 months, after which there is persistent stabilization.
|
|
| 10. |
- Chen, Antonia, et al.
(författare)
-
Prevention of Late PJI
- 2014
-
Ingår i: The Journal of Arthroplasty. - : Elsevier BV. - 0883-5403 .- 1532-8406. ; 29:2, s. 119-128
-
Tidskriftsartikel (refereegranskat)
|
|
