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Distraction Implantation. A New Technique in Total Joint Arthroplasty and Direct Skeletal Attachment.

ABSTRACT: Background:Using the marrow canal of a tubular bone as a holding compartment for implant stems has been the paradigm in total joint arthroplasty for more than a century, and for direct skeletal attachment of limb prostheses for about forty years. Both interventions rely on the osteogenesis in the inner walls of the marrow canal in a direction radially inwards. It so remains despite the frequent aseptic loosening of the implant stems caused by the resorption of the marrow canal's inner walls which increases the canal's diameter and reduces its capacity to hold the implant. Materials and Methods:To improve the bone-device bond, we suggest an implantation methodology that activates positive osteogenic remodeling in the circular direction rather than radially inwards. The rationale is that circular osteogenesis is a component of natural healing of bone fractures and its activating may mitigate the consequences of resorption caused by stress shielding, bone developmental growth and other factors. Results:Circular osteogenesis occurs in response to the distraction of slots precut into the bone tube. We call this methodology distraction implantation (DI) because of its debt to Ilizarov type distraction osteogenesis (DO). The methodology is accompanied by a design of an implant stem, and has been investigated in a previous pilot animal study. Conclusion:Distraction implantation is based on a component of natural healing of bone fractures and therefore has merit to be investigated further.

SUBMITTER: Pitkin M

PROVIDER: S-EPMC6124505 | biostudies-literature | 2018 May

REPOSITORIES: biostudies-literature

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Distraction Implantation. A New Technique in Total Joint Arthroplasty and Direct Skeletal Attachment.

Pitkin Mark M

EC orthopaedics 20180426 5

<h4>Background</h4>Using the marrow canal of a tubular bone as a holding compartment for implant stems has been the paradigm in total joint arthroplasty for more than a century, and for direct skeletal attachment of limb prostheses for about forty years. Both interventions rely on the osteogenesis in the inner walls of the marrow canal in a direction radially inwards. It so remains despite the frequent aseptic loosening of the implant stems caused by the resorption of the marrow canal's inner wa ...[more]

PMID: 30198026

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Project description:BackgroundUtilization of arthroplasty is increasing, but there are little data exploring the causes of this increase. The objective of this study was to examine the relationship between new programs for arthroplasty of the lower extremity joints and the utilization of arthroplasty.MethodsWe identified twenty-four markets (hospital referral regions) that experienced the entry of new physician-owned specialty hospitals, using 1991 to 2005 Medicare data. We matched each market with a new specialty hospital to two different control markets (one market with a new arthroplasty program in a general hospital and one market without a new arthroplasty program), using a propensity score that accounted for market supply and demand for orthopaedic surgery and the regulatory environment. We compared the utilization of arthroplasty of the lower extremity joints (total hip arthroplasty and total knee arthroplasty) in each group of markets over a five-year window, extending from two years before to three years after the entry of new orthopaedic surgery programs.ResultsThe twenty-four markets with new specialty orthopaedic hospitals had higher utilization of arthroplasty at baseline (10.9 arthroplasties per 1000 Medicare beneficiaries per year) and follow-up (12.7 per 1000 beneficiaries) compared with the twenty-four markets with new arthroplasty programs in general hospitals (9.7 and 11.4, respectively) and the twenty-four markets with no new programs (9.9 and 11.3), although the differences were not significant (p > 0.05). Growth in the utilization of arthroplasty was similar in markets with new specialty hospitals before (an increase of 0.63 procedure per 1000 beneficiaries per year) and after the entry of new specialty hospitals (an increase of 0.39) compared with markets with new surgery programs in general hospitals (an increase of 0.24 before and 0.43 after) and markets with no new programs (an increase of 0.38 before and 0.33 after the entry of new specialty hospitals) (p > 0.05 for all comparisons).ConclusionsThe utilization of arthroplasty is increasing at similar rates in markets with and without new arthroplasty programs.

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Distraction Implantation. A New Technique in Total Joint Arthroplasty and Direct Skeletal Attachment.

Publications

Distraction Implantation. A New Technique in Total Joint Arthroplasty and Direct Skeletal Attachment.

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