Isolated all-polyethylene patellar revisions for metal-backed patellar failure.
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ABSTRACT:
SUBMITTER: Garcia RM
PROVIDER: S-EPMC2565034 | biostudies-other | 2008 Nov
REPOSITORIES: biostudies-other
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Project description:IntroductionAnatomical total shoulder arthroplasty (TSA) is an effective treatment adopted for patients with glenohumeral osteoarthritis (OA). The glenoid component failure is the main risk that occurs in this therapeutic choice; however, doubts remain regarding the selection of the best implant for avoiding complication. This systematic review aims to evaluate the glenoid component in TSA by comparing the complications of different types of implants.Methods and analysisA systematic review of randomised clinical trials or quasi-randomised trials will be performed by applying the Preferred Reporting Items for Systematic Review and Meta-Analysis protocols and comparing polyethylene (keeled and pegged) versus metal-backed implants in adult patients with glenohumeral OA. Our search strategy will be performed using MEDLINE, PubMed, Cochrane Central Register of Controlled Trials, EMBASE and Web of Science. Data management and extraction will be performed using a data withdrawal form and by analysing study method characteristics, participant characteristics, intervention characteristics, results and methodological domains. The database search will be performed by February 2021. The Grading of Recommendations Assessment, Development and Evaluation will be used for assessing the quality of evidence of each study selected; however, some critical and important outcomes were determined such as the shoulder function through functional scores (Constant-Murley and American Shoulder and Elbow Surgeons), complications represented by pain (Visual Analogue Scale), surgical revision, radiograph radiolucency and loosening. The confidence in estimated effects for these outcomes will be applied as the overall confidence. The outcomes will be defined as early or late, according to the postoperative follow-up of less than or greater than 1 year, respectively, for complications and radiographs. For the shoulder function, follow-ups will be divided into 6, 12 and 24 months. Heterogeneity is expected in systematic reviews; therefore, the selection of outcomes, as well as the sample size, and specific statistical analysis can lead to meta-analysis; however, if it fails, narrative evidence synthesis will be conducted. Other analyses such as descriptive, subgroup and sensitivity analyses will be performed whenever possible. This systematic review will, therefore, provide evidence concerning the best clinical practice for avoiding complications.Ethics and disseminationThis study has been approved by the Institutional Review Board of Universidade Federal de São Paulo (protocols 0725/2017, 2.157.415 and 70473017.5.0000.5505), and the findings will be disseminated through peer-reviewed publication and conference presentations.Prospero registration numberCRD42018079537.
| S-EPMC7768953 | biostudies-literature
Project description:Isolated patellar resurfacing served as an early treatment for patellofemoral arthritis but was abandoned because of erosion of the native femoral trochlear groove over time. We present the case of a large native tibial osteolytic lesion 20 years after isolated patellar resurfacing with a cemented polyethylene component. The patient had severe tricompartmental arthritic changes. The patellar component was very worn, and the resultant particle debris produced a large cavitary lesion in the proximal tibia. Osteolysis is a rare complication in patellofemoral arthroplasty, and, to our knowledge, this is the first reported case of native tibial osteolysis after isolated patellar resurfacing. The patient was treated with initial curettage and bone grafting of the lesion followed by total knee arthroplasty with a tibial cone and stemmed tibial fixation.
| S-EPMC8076617 | biostudies-literature
Project description:Alumina-on-alumina bearings for THA have markedly improved in mechanical properties through advances in technology; however, alumina fracture is still a concern. We retrospectively reviewed 77 patients (82 hips) with cemented alumina-on-alumina THAs to identify factors relating to alumina failure. The mean age of the patients at surgery was 63 years. The prostheses had a cemented polyethylene-backed acetabular component with an alumina inlay and a 28-mm alumina head. Revision surgery was performed because of alumina inlay failure in four hips (three fractures and one dissociation; 5.6%), deep infection in two, and recurrent dislocation in one. The 8-year survival rate was 90.7% with revision for any reason and 94.4% with revision for alumina failure as the end point. There were no differences in age, body mass index, gender, mobility, function, abduction angle, or size of component among the four hips with alumina failure and the remaining 68 hips without it; however, radiolucent lines in the sockets were more apparent in four cases with alumina inlay failure. This alumina-on-alumina THA thus yielded unsatisfactory medium-term results because we observed a high rate of catastrophic alumina inlay failure.
| S-EPMC2311492 | biostudies-other
Project description:We describe a small case series with severe metallosis after revision total knee arthroplasty (TKA) due to metal-backed patellar component failure. Metallosis is a rare complication after TKA, which may cause systemic and local symptoms. In our cases, diagnosis of metallosis was supported by radiographic imaging and aseptic aspiration. Two of our 3 cases were successfully revised; in the remaining case surgery was not desired because of her poor general condition. Based on these cases, we recommend performing regular checkups in case of a metal-backed patellar component to detect metallosis in an early stage, to prevent extensive revision surgery. Moreover, we recommend applying a low threshold to revise a metal-backed patellar component because of the severe consequences of metallosis that might occur.
| S-EPMC7303496 | biostudies-literature
Project description:Background and purpose - With a rapidly increasing population in need of total knee arthroplasty (TKA), there is renewed interest in cost-saving all-polyethylene designs. Differences between metal-backed and all-polyethylene designs in initial component migration assessed by radiostereometric analysis (RSA), a proven predictor for late aseptic loosening, have been scantily reported. The purpose of this study was to compare implant migration and clinical outcomes of all-polyethylene tibial components versus metal-backed trays of similar geometrical shape. Patients and methods - In this randomized controlled trial, 59 patients received a cemented Triathlon condylar-stabilizing implant (Stryker, Mahwah, NJ, USA) with either an all-polyethylene (n = 29) or a metal-backed tibial component (n = 30). RSA measurements and clinical scores (the Knee Society Score, Forgotten Joint Score, and Knee Osteoarthritis and Injury Outcome Score) were evaluated at baseline and postoperatively at 3, 12, and 24 months. A linear mixed-effects model was used to analyze the repeated measurements. Results - A statistically significant difference in mean migration after 2 years was found in favor of the all-polyethylene group, with a mean maximum total point motion of 0.61?mm (95% CI 0.49-0.74) versus 0.81?mm (95% CI 0.68-0.96) for the cemented group (p = 0.03). However, this difference was smaller and not statistically significant after post hoc adjustment for surgeon effect. Both groups showed comparable improvements on all clinical outcome scores over time. Interpretation - The Triathlon all-polyethylene tibial component showed less migration, suggesting a lower risk of late loosening as compared with its metal-backed counterpart. However, the found surgeon effect warrants further investigation.
| S-EPMC6066763 | biostudies-literature
Project description:Background and purpose - There is limited amount of evidence about optimal revision indications, technique, and implants when performing revision surgery for metal-on-metal (MoM) hip replacements due to adverse reaction to metal debris (ARMD). We assessed which factors are related to re-revisions and complications after a revision of MoM hip arthroplasty because of ARMD. We also aimed to provide information on optimal implants for these revisions.Patients and methods - 420 MoM total hip arthroplasties (THA) and 108 MoM hip resurfacings were implanted and later revised at our institution. We used Cox regression to analyze the factors associated with re-revisions and complications after a revision for ARMD.Results - A re-revision was performed on 27 THAs (6%) and 9 resurfacings (8%). The most common indication for re-revision was recurrent dislocation (20 hips, 4%). Complications not leading to re-revision were seen in 21 THAs (5%) and 6 resurfacings (6%). The most common complication was dislocation treated with closed reduction in 13 hips (2%). Use of revision head size > 36mm was associated with decreased risk for dislocations. Presence of pseudotumor, pseudotumor grade, pseudotumor size, or the choice of bearing couple were not observed to affect the risk for re-revision. Non-linear association was observed between preoperative cobalt and risk for re-revision.Interpretation - As dislocation was the most frequent post-revision complication, large head sizes should be used in revisions. Because size or type of pseudotumor were not associated with risk of re-revision, clinicians may have to reconsider, how much weight is put on the imaging findings when deciding whether or not to revise. In our data blood cobalt was associated with risk for re-revision, but this finding needs further assessment.
| S-EPMC8023960 | biostudies-literature
Project description:BackgroundTwo commonly used tibial designs for unicompartmental knee arthroplasty (UKA) are all-polyethylene "inlay" and metal-backed "onlay" components. Biomechanical studies showed that the metal baseplate in onlay designs better distributes forces over the tibia but studies failed to show differences in functional outcomes between both designs at mid-term follow-up. Furthermore, no studies have compared both designs with total knee arthroplasty (TKA).Questions/purposesThe goal of this study was to compare outcomes of inlay UKA and onlay UKA at mid-term follow-up and compare these with TKA outcomes.MethodsIn this retrospective study, 52 patients undergoing inlay medial UKA, 59 patients undergoing onlay medial UKA, and 59 patients undergoing TKA were included. Western Ontario and McMaster Universities Arthritis Index scores were collected preoperatively and at mean 5.1-year follow-up (range 4.0-7.0 years).ResultsPreoperatively, no differences were observed in patient characteristics or outcome scores. At mid-term follow-up, patients undergoing onlay medial UKA reported significant better functional outcomes than those of inlay medial UKA (92.0 ± 10.4 vs. 82.4 ± 18.7, p = 0.010) and when compared to TKA (92.0 ± 10.4 vs. 79.6 ± 18.5, p < 0.001) while no significant differences between inlay medial UKA and TKA were noted. No significant differences in revision rates were found.ConclusionFunctional outcomes following onlay metal-backed medial UKA were significantly better compared to inlay all-polyethylene medial UKA and to TKA. Based on the results of this study and on biomechanical and survivorship studies in the literature, we recommended using metal-backed onlay tibial components for unicompartmental knee arthroplasty.
| S-EPMC5617820 | biostudies-literature
Project description:Background and purpose - The all-polyethylene tibial (APT) component, introduced in the early 1970s, was surpassed by metal-backed tibial (MBT) trays as the first choice for total knee arthroplasty (TKA). With improved polyethylene, the modern APT components can reduce costs, and have shown equivalent results in survivorship and early migration of the cruciate-retaining and cruciate-stabilizing designs. This study compares the 2-year migration of a similarly designed APT-posterior stabilized (PS) and a MBT-PS TKA, using radiostereometric analysis (RSA).Patients and methods - 60 patients were randomized to receive either an APT Triathlon PS or an MBT Triathlon PS TKA (Stryker, NJ, USA). Migration measured by RSA and clinical scores were evaluated at baseline and at 3, 12, and 24 months postoperatively. Repeated measurements were analyzed with a linear mixed model and generalized estimating equations.Results - The mean maximum total point movement (MTPM) at 3, 12, and 24 months was 0.41?mm (95% CI 0.33-0.50), 0.57?mm (0.44-0.70), and 0.56?mm (0.42-0.69) respectively in the MBT group and 0.46?mm (0.36-0.57), 0.61?mm (0.49-0.73), and 0.64?mm (0.50-0.77) in the APT group. 2 MBT and 1 APT implant were considered unstable at the 2-year follow-up. The KSS Knee score and KSS Function across 3, 12, and 24 months were comparable in both groups.Interpretation - For an APT-PS designed component, MTPM measured with RSA is comparable to the MBT-PS component after 2 years of follow-up. No differences in complications or clinical outcomes were found.
| S-EPMC6844393 | biostudies-literature
Project description:BACKGROUND:Several modern designs of metal-backed glenoids (MBG) have been devised to overcome flaws such as loosening and a high failure rate. This review aimed to compare rates of complications and revision surgeries between cemented polyethylene glenoid (PEG) and three examples of modern MBG designs. METHODS:Literature search was carried out using PubMed, Cochrane Library, EMBASE, and Google Scholar using MeSH terms and natural keywords. A total of 1186 articles were screened. We descriptively analyzed numerical data between the groups and statistically analyzed the categorical data, such as the presence of radiolucent line, loosening, and revision surgery (failure). Articles were divided into three groups based on follow-up duration: <?36-month, 36-72-month, and?>?72-month subgroups. RESULTS:This study included 35 articles (3769 shoulders); 25 on cemented PEG and ten on the modern MBG. Mean age was 66.4 (21-93) and 66.5?years (31-88). The mean duration of follow-up was 73.1 (12-211) and 56.1?months (24-100). Overall, the rate of the radiolucent line was 354/1302 (27%) and 47/282 (17%), the loosening rate was 465/3185 (15%) and 22/449 (5%), and the failure rate was 189/3316 (6%) and 11/457 (2%), for PEG and MBG, respectively. The results of <?36-month and 36-72-month subgroups showed lower rates of radiolucency and loosening in the cemented PEG group, but there was no significant difference in failure rate (P?=?0.754 and 0.829, respectively). In the >?72-month subgroup, MBG was better in terms of loosening (P?<?0.001) and failure rates (P?=?0.006). CONCLUSIONS:The modern MBG component, especially TM glenoid, seems to be a promising alternative to cemented PEGs, based on subgroup revision rates according to the follow-up duration and overall results of ROM and clinical scores. All polyethylene glenoids tend to increase loosening and failure over time. Three modern MBG designs seem to have no difference in failure, at least in the <?36-month and 36-72-month subgroups compared to the cemented PEG. More long-term follow-up studies on modern MBG should be ultimately conducted. LEVEL OF EVIDENCE:Level IV, systematic review.
| S-EPMC7035638 | biostudies-literature
Project description:BackgroundThe aseptic lymphocyte vasculitis-associated lesion (ALVAL) score and the modified Oxford ALVAL score are frequently used scoring methods to evaluate the morphologic features of periprosthetic tissues around metal-on-metal (MoM) hip implants. Except for the initial studies of these two morphology scoring methods, to our knowledge, no other studies have reported on intraclass correlation coefficient (ICC) values for interobserver reliability of these scoring methods.Questions/purposesAre the ALVAL and Oxford ALVAL scores reproducible?MethodsThe periprosthetic tissue of 37 revisions of 36 patients with failed MoM THAs were independently scored by three experienced pathologists using ALVAL and Oxford ALVAL scoring methods. All patients were included who underwent revision surgery in our hospital until January 2013, with a large-head MoM prosthesis and also met the criteria: blood serum cobalt levels, available MRI scan, and intraarticular cobalt levels. The population included 26 patients with pseudotumors diagnosed by two radiologists using the method described by Matthies et al. The ALVAL describes morphologic features of the synovial lining, tissue organization, and inflammatory cell infiltrate in periprosthetic tissues. The Oxford-ALVAL score uses a semiquantitative measure of the immune response which should be easier to score.ResultsThe ALVAL score showed an ICC of 0.38 (95% CI, 0.18-0.58) (fair) for the sum score and this improved up to 0.50 (95% CI, 0.31-0.68) (moderate) using the modified Oxford ALVAL score. The individual parameters of the ALVAL score showed an ICC for the scoring of inflammatory infiltrate of 0.37 (95% CI, 0.17-0.57), an ICC of 0.32 (95% CI, 0.12-0.53) for the scoring of tissue organization, and an ICC of 0.14 (95% CI, -0.04 to 0.34) for synovial lining.ConclusionsScoring morphologic features of MoM tissue is not reproducible using the ALVAL score or the Oxford ALVAL score. This may reflect heterogeneous morphologic features in tumor tissue and between different tumor tissue samples that cannot be reliably quantified by pathologists using the parameters of these two scoring methods. An alternative, simplified scoring system should be developed to improve the interrater agreement.Level of evidenceLevel III, diagnostic study.
| S-EPMC5670057 | biostudies-literature