Percutaneous Skeletal Fixation of Painful Subchondral Bone Marrow Edema Utilizing an Injectable, Synthetic, Biocompatible Hyaluronic Acid-Based Bone Graft Substitute.
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SUBMITTER: Stark M
PROVIDER: S-EPMC7695546 | biostudies-literature | 2020 Nov
REPOSITORIES: biostudies-literature
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Percutaneous Skeletal Fixation of Painful Subchondral Bone Marrow Edema Utilizing an Injectable, Synthetic, Biocompatible Hyaluronic Acid-Based Bone Graft Substitute.
Stark Michael M DeBernardis Dennis D McDowell Chris C Ford Elizabeth E McMillan Sean S
Arthroscopy techniques 20201022 11
Subchondral bone marrow edema (SBME) represents a pathologic alteration of subchondral bone. A strong correlation exists between its presence and the progression of osteoarthritis. Very few treatment options exist between the spectrum of conservative management and the definitive treatment of total knee arthroplasty (TKA). Tactoset® is an injectable synthetic, biocompatible hyaluronic acid-based bone graft substitute that allows for a minimally invasive treatment for painful SBME via percutaneou ...[more]
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Project description:PurposeTo investigate the change in patient-reported pain after percutaneous skeletal fixation (PSF) and to determine the success rate of PSF in the prevention of additional intervention for the treatment of painful subchondral bone marrow edema (SBME) of the knee over a 2-year postoperative period.MethodsThis was a retrospective, single-surgeon analysis of patients undergoing PSF for painful, atraumatic SBME of the knee confirmed on preoperative magnetic resonance imaging with a minimum 2-year follow-up. Inclusion criteria were age >18 years, pain localized to the area of edema, failure of nonsurgical intervention (4 weeks of physical therapy and non-steroidal medication use), and absence of tricompartmental Kellgren-Lawrence grade 4 osteoarthritis. All patients underwent arthroscopy, followed by isolated PSF without additional chondral procedures. Pre- and postoperative visual analog scale scores were compared. The primary outcome measure of success was defined as a lack of additional intervention. This included viscosupplementation, corticosteroid injection, or conversion to arthroplasty.ResultsA total of 74 patients with a mean age of 47.2 years and average follow-up time of 38.9 months (range 24-61 months) were evaluated. Successful treatment was noted in 61 patients (82.4%). Of the 13 patients who did not respond to PSF, 5 (6.8%) had been converted to arthroplasty, 11 received viscosupplementation, and 8 required cortisone injections. The average visual analog scale score decreased from 7.55 preoperatively to 3.16 at 2-year follow-up (P < .001). The average body mass index of successfully treated patients (28.2) was significantly less than that of the patients experiencing failure (32.2) (P = .001).ConclusionsPatients undergoing PSF for the treatment of painful SBME may expect a decrease in knee pain and low rates of additional intervention over a 2-year postoperative period.Level of evidenceLevel IV; Therapeutic Case Series.
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Project description:BACKGROUND: In joint prosthetic surgery, various methods are used to provide implant stability. We used an injectable bone substitute, composed of calcium sulfate/hydroxyapatite, as bone defect filler to stabilize a tibia prosthesis in an experimental rabbit model. The aim of the study was to investigate and compare the stability of prosthetic fixation with and without the use of an injectable bone substitute. METHODS: Sixteen rabbits were used and the tibia prostheses were implanted bilaterally, one side with the prosthesis alone and the other side with the prosthesis and calcium sulfate/hydroxyapatite (Cerament™). The rabbits were randomly divided into two groups and euthanized after 6 and 12 weeks, respectively. The prosthesis was extracted measuring the pull-out force in an Instron tester, and the bone surrounding the former prosthesis site was analyzed by histology, histomorphometry, and micro-computed tomography. RESULTS: At 6 weeks no difference in maximum pull-out force was found between the prostheses fixed with or without Cerament™. At 12 weeks the maximum pull-out force for the prostheses with Cerament™ was significantly higher than that for the prostheses without Cerament™ (p = 0.04). The maximum pull-out force at 12 weeks was significantly higher than that at 6 weeks for the prostheses fixed with Cerament™ (p = 0.03) but not for the prostheses without. CONCLUSION: We conclude that early prosthesis-bone interface strength is not influenced by a bone substitute. However, during remodeling, the bone substitute might provide improved mechanical support for the prosthesis. The results support further studies of the use of injectable calcium sulfate/hydroxyapatite in fixation of prosthetic joint implants.
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