State of Art in Hip and Knee Replacement

A special issue of Prosthesis (ISSN 2673-1592).

Deadline for manuscript submissions: closed (30 September 2023) | Viewed by 27718

Special Issue Editors


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Department of Basic Medical Sciences, Neuroscience and Organs of Sense, School of Medicine, Uo Orthopaedics and Traumatology, Aou Policlinico, Università Di Bari "Aldo Moro", 70124 Bari, Italy
Interests: primary and revision hip and knee replacement; treatment of femoral fractures
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Guest Editor
AO Ordine Mauriziano Hospital, Department of Orthopaedics and Traumatology, University of Torino, Largo Turati 62, 10128 Torino, Italy
Interests: hip and knee arthroplasty; knee surgery
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Hip and knee prostheses are incredibly effective procedures whose incidence rate has increased in the last few decades. Their effectiveness has also led to an expansion in the eligible population in terms of age and activity level.

Patients with indication for joint replacement today are either young active patients with high functional expectations or old patients with low activity level but multiple comorbidities and higher perioperative risks. In all cases, it is mandatory for the surgeon, who must have the right skills and knowledge, to perform a time-saving, tissue-sparing, and highly effective procedure that can offer patients better and faster recovery, reducing the risk of infection or complications.

In this equation involving patient and surgeon, the materials, robotic surgery, the development of tissue-sparing or minimally invasive procedures, and pain management have evolved significantly, with modern surgery moving towards increased reproducibility and a tailored procedure.

Indeed, the field of joint prosthesis surgery is undergoing significant change, and the only way to stay up to date with developments is to collaborate with and understand what opinion leaders are thinking and how it affects their clinical practice.

This Special Issue is intended to investigate the state of the art in hip and knee replacement surgery, with the contributions from a significant number of excellent surgeons and other scientists.

This is a great opportunity to provide a guide for young surgeons and help them to have a general understanding of the greatest and most important issues in this field today.

Prof. Dr. Giuseppe Solarino
Dr. Umberto Cottino
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Prosthesis is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

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Published Papers (20 papers)

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Research

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10 pages, 1260 KiB  
Article
Mid-Term Outcomes of a Modern Zweymüller Monolithic Femoral Stem in Primary Total Hip Arthroplasty
by Vincenzo Ciriello, Michela Saracco, Enrico Leonardi, Lucio Piovani, Allison Fetz-Palazola, Chase Mareno and Giandomenico Logroscino
Prosthesis 2024, 6(1), 53-62; https://doi.org/10.3390/prosthesis6010004 - 23 Dec 2023
Viewed by 749
Abstract
Background: Prosthetic hip replacement is a widely practiced surgical procedure with excellent results. Hip stems based on the Zweymüller design have a long history and their philosophy focuses on achieving long-term stability promoting physiological load transfer. The aim of this study is to [...] Read more.
Background: Prosthetic hip replacement is a widely practiced surgical procedure with excellent results. Hip stems based on the Zweymüller design have a long history and their philosophy focuses on achieving long-term stability promoting physiological load transfer. The aim of this study is to evaluate outcomes, survivorship, and complication rates in a cohort of patients treated with this stem. Methods: A retrospective review was conducted to identify patients who underwent primary THA with Zweymüller stems. A total of 86 hips (43%) were implanted in men, and 114 hips (57%) in women. The mean follow-up time was 5.4 years. Patient charts were reviewed for adverse events occurring after primary THA as well as for revision and indication for revision. Patients still implanted with the hip stem were asked to complete the HOOS JR survey. Results: Ten hips (5.0%) were lost to follow up. The mean HOOS JR score at final evaluation was 96.3 points (range, 60.0–100.0). Two revisions were performed during the study for femoral stem loosening due to a periprosthetic Vancouver B2 fracture and for multiple hip dislocations. Conclusions: The Zweymüller design hip stem showed excellent survivorship and favorable clinical outcomes at a mean follow-up of 5.4 years. Full article
(This article belongs to the Special Issue State of Art in Hip and Knee Replacement)
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17 pages, 4506 KiB  
Article
Smart Design of Hip Replacement Prostheses Using Additive Manufacturing and Machine Learning Techniques
by Dario Milone, Danilo D’Andrea and Dario Santonocito
Prosthesis 2024, 6(1), 24-40; https://doi.org/10.3390/prosthesis6010002 - 20 Dec 2023
Cited by 1 | Viewed by 1023
Abstract
The field of additive manufacturing, particularly 3D printing, has ushered in a significant transformation in the realm of joint arthritis treatment through prosthetic surgery. This innovative technology allows for the creation of bespoke prosthetic devices that are tailored to meet the specific needs [...] Read more.
The field of additive manufacturing, particularly 3D printing, has ushered in a significant transformation in the realm of joint arthritis treatment through prosthetic surgery. This innovative technology allows for the creation of bespoke prosthetic devices that are tailored to meet the specific needs of individual patients. These devices are constructed using high-performance materials, including titanium and cobalt-chrome alloys. Nevertheless, the routine physical activities of patients, such as walking, sitting, and running, can induce wear and tear on the materials comprising these prosthetic devices, subsequently diminishing their functionality and durability. In response to this challenge, this research has endeavored to leverage novel techniques. The primary focus of this study lies in the development of an algorithm designed to optimize hip replacement procedures via the mechanical design of the prosthesis. This optimization process exploits the capabilities of machine learning algorithms, multi-body dynamics, and finite element method (FEM) simulations. The paramount innovation in this methodology is the capacity to design a prosthetic system that intricately adapts to the distinctive characteristics of each patient (weight, height, gait cycle). The primary objective of this research is to enhance the performance and longevity of prosthetic devices by improving their fatigue strength. The evaluation of load distribution on the prosthetic device, facilitated by FEM simulations, anticipates a substantial augmentation in the useful life of the prosthetic system. This research holds promise as a notable advancement in prosthetic technology, offering a more efficacious treatment option for patients suffering from joint arthritis. The aim of this research is to make meaningful contributions to the enhancement of patient quality of life and the long-term performance of prosthetic devices. Full article
(This article belongs to the Special Issue State of Art in Hip and Knee Replacement)
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12 pages, 1061 KiB  
Article
Unlocking the Secrets of Post-Surgical Flexion: The Vital Role of Rehabilitation in Total Knee Arthroplasty Recovery
by Gelu Florin Murvai, Calin Tudor Hozan, Timea Claudia Ghitea and Simona Cavalu
Prosthesis 2023, 5(4), 1357-1368; https://doi.org/10.3390/prosthesis5040093 - 14 Dec 2023
Cited by 1 | Viewed by 1045
Abstract
This article delves into the critical aspect of postoperative flexion, particularly in the context of total knee arthroplasty (TKA), commonly known as total knee replacement. Postoperative flexion serves as a pivotal metric for assessing the success of the procedure and a patient’s ability [...] Read more.
This article delves into the critical aspect of postoperative flexion, particularly in the context of total knee arthroplasty (TKA), commonly known as total knee replacement. Postoperative flexion serves as a pivotal metric for assessing the success of the procedure and a patient’s ability to regain functional knee movement. The exploration encompasses the desired range of post-surgery flexion, the surgical factors influencing it, and the indispensable role of rehabilitation in facilitating patients in achieving functional flexion. The study tracks the progress of 713 patients who underwent total knee arthroplasty utilizing the cemented technique, categorizing them based on whether they received non-steroidal anti-inflammatory drugs for postoperative treatment. The monitoring of prosthetic and knee complications, along with the evaluation of the Knee Association Score (KSS) for functional assessment, revealed postoperative complications in approximately 18.23% of the patient cohort. These complications were predominantly associated with a restricted range of motion (ROM < 90°) and patellar clunk syndrome. Significantly, the KSS scale exhibited notable enhancements in the quality of life at 12 months post-surgery compared to preoperative and 6-month assessments. The majority of patients achieved scores classified as good or excellent, underlining the positive impact of the surgical approach and postoperative management on functional outcomes and overall patient well-being. Full article
(This article belongs to the Special Issue State of Art in Hip and Knee Replacement)
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12 pages, 3639 KiB  
Article
Medial Ball-in-Socket Posterior Cruciate-Sacrificing Total Knee Arthroplasty: Clinical, Functional and Radiographic Evaluation of 100 Consecutive Implants
by Stefano Giannotti, Nicholas Crippa Orlandi, Elisa Troiano, Matteo Cacioppo, Tiziano Giacché, Tommaso Greco, Carlo Perisano and Nicola Mondanelli
Prosthesis 2023, 5(4), 1275-1286; https://doi.org/10.3390/prosthesis5040087 - 22 Nov 2023
Viewed by 746
Abstract
The number of performed total knee arthroplasty (TKA) operations is constantly growing. This study proposes an evaluation of a series of patients undergoing medial pivot (MP) TKA surgery from a subjective, clinical and biomechanical point of view. A consecutive series of 100 TKAs [...] Read more.
The number of performed total knee arthroplasty (TKA) operations is constantly growing. This study proposes an evaluation of a series of patients undergoing medial pivot (MP) TKA surgery from a subjective, clinical and biomechanical point of view. A consecutive series of 100 TKAs implanted in a single centre, by the same surgeon, with a medial parapatellar approach with the sacrifice of the posterior cruciate ligament and cemented components were evaluated. All patients underwent standardized radiographic and functional clinical evaluation, with standing antero-posterior, lateral and patellar axial views; pre-operatively and post-operatively at 1, 3, 6 and 12 months; and then annually. Results were evaluated using three different patient-related outcome measurement scores (PROMs): the Knee Osteoarthritis Outcome Score (KOOS), the new Knee Society Score (nKSS) and the Short Form Health Survey 36 (SF-36). Excellent results in all treated knees were documented using the PROMs: the mean nKSS was 199.8, the mean KOOS was good to excellent in every subscale, and the mean was SF-36 82%. There were no cases of septic or aseptic loosening, vascular damage, neurological damage, or revision surgery for any reason. According to the experience gained, MP implants demonstrated excellent results, being clinically functional in both objective and subjective terms as well as radiographic evaluations, thus resulting in a winning strategy for obtaining a TKA that makes the patient satisfied and able to perform their daily life activities. Full article
(This article belongs to the Special Issue State of Art in Hip and Knee Replacement)
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9 pages, 716 KiB  
Article
Patient-Specific Instrumentation with Laser-Guide-Navigated THA: Clinical and CT Evaluation of the First 100 Cases
by Leonardo Previ, Edoardo Viglietta, Veronica Giuliani, Federico Corsetti, Andrea Redler, Attilio Speranza, Angelo De Carli and Raffaele Iorio
Prosthesis 2023, 5(4), 1111-1119; https://doi.org/10.3390/prosthesis5040077 - 24 Oct 2023
Cited by 1 | Viewed by 863
Abstract
Obtaining a proper position for total hip arthroplasty components is a crucial aspect of implant performance and consequently of patient outcomes. Restoring the original hip center and maintaining the limb length are key factors in reaching the optimal implant positioning. The aim of [...] Read more.
Obtaining a proper position for total hip arthroplasty components is a crucial aspect of implant performance and consequently of patient outcomes. Restoring the original hip center and maintaining the limb length are key factors in reaching the optimal implant positioning. The aim of this study was to assess the accuracy and safety of a computed dynamic analysis system that, through patient-specific guides, tries to improve implant positioning and functional orientation according to patients’ spinopelvic mobility and anatomy. A total of 100 consecutive patients were prospectively enrolled. All patients received an Optimized Positioning System dynamic hip preoperative planning schedule. A CT scan protocol follow-up analysis was performed 6 months after surgery. The mean deviations from the planned acetabular inclination and anteversion were 4.3° and 3.8°, respectively. In total, 98% of cases were within ± 10° of the Lewinnek safe zone, both for inclination and anteversion. The height of osteotomy deviated, on average, 1.6 mm. In total, 100% of cases were included within 4 mm of osteotomy. Patient-specific and laser-guided instrumentation was found to be safe and accurately reproduced dynamic planning in terms of the component orientation, osteotomy level, leg length and offset. Full article
(This article belongs to the Special Issue State of Art in Hip and Knee Replacement)
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17 pages, 1363 KiB  
Article
Is It Possible to Create an “Ideal Endoprosthesis” for an “Ideal Total Hip Replacement”?
by Valentin L. Popov, Aleksandr M. Poliakov and Vladimir I. Pakhaliuk
Prosthesis 2023, 5(4), 1020-1036; https://doi.org/10.3390/prosthesis5040071 - 13 Oct 2023
Cited by 1 | Viewed by 1039
Abstract
Since the end of the 19th and the beginning of the 20th centuries, technological equipment, implant designs (endoprosthesis) and the surgical technique of total hip replacement (THR) have been constantly improved and reached a high level of functionality and quality. Therefore, at present, [...] Read more.
Since the end of the 19th and the beginning of the 20th centuries, technological equipment, implant designs (endoprosthesis) and the surgical technique of total hip replacement (THR) have been constantly improved and reached a high level of functionality and quality. Therefore, at present, THR is one of the most high-tech, reliable and popular surgical operations that allow a large number of people suffering from osteoarthritis and other serious diseases of the hip joint to return to an active lifestyle. At the same time, it is known that even operations at this level do not always guarantee the achievement of the desired result and can lead to various complications. The question arises: are there potential opportunities for creating an “ideal endoprosthesis” that allows one to perform an “ideal THR”? In this paper, based on a critical analysis of modern endoprosthesis designs for THR, technologies for their implantation and systemic postoperative complications, the most probable, according to the authors, ways of their development are formulated, which allow asymptotically approaching the “ideal”. Full article
(This article belongs to the Special Issue State of Art in Hip and Knee Replacement)
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9 pages, 580 KiB  
Article
Perioperative Blood Management Programme in Jehovah’s Witnesses Undergoing Total Hip Arthroplasty
by Giuseppe Solarino, Giovanni Vicenti, Davide Bizzoca, Domenico Zaccari, Walter Ginestra, Davide Ferorelli, Matteo D’aprile and Biagio Moretti
Prosthesis 2023, 5(4), 1011-1019; https://doi.org/10.3390/prosthesis5040070 - 6 Oct 2023
Viewed by 981
Abstract
Total hip arthroplasties aim to improve quality of life and reduce pain in patients suffering from late-stage hip osteoarthritis. On the other hand, it may represent a risky surgical procedure in people who refuse blood products because of religious beliefs, such as Jehovah’s [...] Read more.
Total hip arthroplasties aim to improve quality of life and reduce pain in patients suffering from late-stage hip osteoarthritis. On the other hand, it may represent a risky surgical procedure in people who refuse blood products because of religious beliefs, such as Jehovah’s Witnesses (JW). Preoperative optimisation protocols of these patients allow medical professionals to perform arthroplasties in a safer manner, avoiding allogeneic blood transfusion. In our retrospective study, two groups of patients were evaluated. Group 1 included JW patients who underwent a preoperative Hb optimisation program; Group 2 included non-JW patients authorizing transfusion in case of necessity. Differences in Hb levels were as follows: before surgery (JW 14.24 ± 1.10 vs. non-JW 12.48 ± 1.00, p-value ≤ 0.05), and after surgery (day 1 Hb: JW 12.88 ± 0.90 vs. non-JW 10.04 ± 1.30, p-value ≤ 0.05; day 3 Hb: JW 14.65 ± 0.80 vs. non-JW 9.10 ± 0.90 p-value ≤ 0.05). Moreover, cost-effectiveness strategies were evaluated in both groups. Our findings support that patient blood management programs are a safe and good strategy in hip prosthetic surgery, decreasing risks and transfusion overuse. Full article
(This article belongs to the Special Issue State of Art in Hip and Knee Replacement)
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10 pages, 1118 KiB  
Article
Is Gentamicin Elution Influenced by the Timing of Antibiotic Addition to the Bone Cement? An In Vitro Study on Articulating Hip Spacers
by Giorgio Cacciola, Francesco Bosco, Fortunato Giustra, Federico De Meo, Antongiulio Bruschetta, Luigi Sabatini, Stefano Artiaco, Diogenes Giraldo, Alessandro Massè and Pietro Cavaliere
Prosthesis 2023, 5(3), 952-961; https://doi.org/10.3390/prosthesis5030066 - 12 Sep 2023
Viewed by 1012
Abstract
Periprosthetic Joint Infection (PJI) is a challenging complication after joint replacements, and cement spacers are standard treatment in two-stage revision surgery. This experimental in vitro study aimed to evaluate the elution properties of different gentamicin formulations from commercially available intraoperative molded hip cement [...] Read more.
Periprosthetic Joint Infection (PJI) is a challenging complication after joint replacements, and cement spacers are standard treatment in two-stage revision surgery. This experimental in vitro study aimed to evaluate the elution properties of different gentamicin formulations from commercially available intraoperative molded hip cement spacers. The study compared spacers prepared with premixed antibiotic bone cement, spacers with antibiotic powder added during preparation, spacers stored for two months, and spacers with an additional antibiotic. The results showed that the timing of antibiotic addition influenced gentamicin elution, with immediate elution resulting in higher levels than stored spacers. Spacers with antibiotic powder added during preparation exhibited higher elution than premixed antibiotic spacers. Furthermore, adding vancomycin to the bone cement significantly increased gentamicin elution. These findings suggest that optimizing the timing and method of antibiotic addition in cement spacers may enhance the effectiveness of antibiotic treatment in PJI. However, further research is needed to validate these findings and explore their clinical implications. Full article
(This article belongs to the Special Issue State of Art in Hip and Knee Replacement)
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16 pages, 5789 KiB  
Article
Evaluation of Rotational Stability and Stress Shielding of a Stem Optimized for Hip Replacements—A Finite Element Study
by Mario Ceddia and Bartolomeo Trentadue
Prosthesis 2023, 5(3), 678-693; https://doi.org/10.3390/prosthesis5030048 - 26 Jul 2023
Viewed by 1465
Abstract
The natural distribution of stress in the femur is altered when total hip arthroplasty (THA) is performed. In fact, when a stem is inserted inside the femur, there is a variation in stress due to the difference in rigidity between the material with [...] Read more.
The natural distribution of stress in the femur is altered when total hip arthroplasty (THA) is performed. In fact, when a stem is inserted inside the femur, there is a variation in stress due to the difference in rigidity between the material with which the stem is made and the femur. This generates the phenomenon of stress shielding. The aim of this study is to design an optimized prosthesis that guarantees an excellent rotational stability and a reduced stress shielding. Methods: Through the finite element method (FEM), the mechanical behavior of the stem subjected to the loads described by ISO 7206-4:2010 is studied. Results: Through topological optimization, there is a reduction in stress shielding in the proximal zone of 31.46%. The addition of ridges on the dorsal side of the stem also improves rotational stability by 27.82%. Conclusions: The decrease in stiffness that is recorded with the optimized stem guarantees a greater distribution of stress on the bone. The presence of dorsal ridges also favors the corticalization of the bone as it loads the bone near the dorsal, ensuring further stability. The perforated prosthesis presented in this study shows an increase in primary stability and an improvement in rotational stability as there is also a bone regrowth inside the prosthesis. Full article
(This article belongs to the Special Issue State of Art in Hip and Knee Replacement)
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Review

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18 pages, 5427 KiB  
Review
Robotic Systems in Knee Surgery: Current Concepts and Future Perspectives
by Antonino Cantivalli, Umberto Cottino, Davide Edoardo Bonasia, Federica Rosso and Roberto Rossi
Prosthesis 2023, 5(4), 1257-1274; https://doi.org/10.3390/prosthesis5040086 - 21 Nov 2023
Cited by 2 | Viewed by 2493
Abstract
Total knee arthroplasty (TKA) is a successful and highly effective procedure in most patients with tricompartmental knee arthritis. Despite the innovations in surgical techniques due to planning software and technological innovations, patients’ dissatisfaction after TKA is still high, at up to 20%. Robotic-assisted [...] Read more.
Total knee arthroplasty (TKA) is a successful and highly effective procedure in most patients with tricompartmental knee arthritis. Despite the innovations in surgical techniques due to planning software and technological innovations, patients’ dissatisfaction after TKA is still high, at up to 20%. Robotic-assisted surgery (RAS) could be considered as a future option for improving outcomes due to its higher accuracy, precision, and reliability. Robotic systems can be classified as fully active, semi-active, or passive depending on the surgeon’s involvement during the procedure, and as imageless or image-based according to the necessity of radiological exams for the pre-operative planning. Three of the most well-known robotic systems for knee surgery are MAKO® (Stryker Ltd., Kalamazoo, MI, USA), NAVIO® (Smith & Nephew, Andover, TX, USA), and ROSA® (Zimmer Inc., Warsaw, IN, USA). These systems show differences in terms of surgeon involvement, the use of CT scans or X-rays for pre-operative planning, the possibility to perform both unicompartmental knee arthroplasty (UKA) and TKA (or even total hip arthroplasty THA), and in the different kinds of knee prosthesis that can be implanted. This article aims to describe the features of the most used robotic systems for knee arthroplasty, to examine their outcomes and analyze their cost-effectiveness, and to evaluate future perspectives. Full article
(This article belongs to the Special Issue State of Art in Hip and Knee Replacement)
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13 pages, 822 KiB  
Review
The Management of Bone Defects in Revision Knee Arthroplasty: The Role of Porous Metal Cones and 3D-Printed Cones
by Giuseppe Marongiu, Antonio Capone, Marco Verona, Gianluca Piovan, Claudio Zorzi, Daniel Kendoff and Marta Bandino
Prosthesis 2023, 5(4), 1171-1183; https://doi.org/10.3390/prosthesis5040082 - 16 Nov 2023
Cited by 1 | Viewed by 1271
Abstract
Worldwide, the number of revisions to total knee arthroplasty procedures is increasing. Revision surgery is a challenging procedure, required for the management of bone loss after removal of the first implant. Although further long-term follow-up studies are needed, the use of cones in [...] Read more.
Worldwide, the number of revisions to total knee arthroplasty procedures is increasing. Revision surgery is a challenging procedure, required for the management of bone loss after removal of the first implant. Although further long-term follow-up studies are needed, the use of cones in revisions of total knee arthroplasty yields reliability in fixation and stability to restore joint lines, especially in challenging surgeries with poor bone stock. The introduction of 3D-printed cones in revision surgery seems to be advantageous for AORI type III bone defects, especially in reducing intraoperative complications and procedure times. The aim of this study is to review the currently available literature to analyse clinical outcomes, complications, and radiographical results with the use of metaphyseal tantalum cones and new 3D-printed cones for the management of bone defects in the revision of total knee arthroplasty. Full article
(This article belongs to the Special Issue State of Art in Hip and Knee Replacement)
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18 pages, 7241 KiB  
Review
Radiographic Analysis of Grammont-Style and Lateralized Reverse Shoulder Arthroplasty in Gleno-Humeral Osteoarthritis
by Giovanni Merolla, Giuseppe Sircana, Antonio Padolino, Francesco Fauci, Carlo Alberto Augusti, Marco Saporito and Paolo Paladini
Prosthesis 2023, 5(4), 1075-1092; https://doi.org/10.3390/prosthesis5040075 - 19 Oct 2023
Viewed by 1452
Abstract
Reverse shoulder arthroplasty (RSA) has transformed the management of shoulder pathologies, including cuff tear arthropathy and osteoarthritis. The innovative design principles of RSA, such as the medialization and inferiorization of the joint center of rotation, distalization of the humerus, and a semi-constrained construct, [...] Read more.
Reverse shoulder arthroplasty (RSA) has transformed the management of shoulder pathologies, including cuff tear arthropathy and osteoarthritis. The innovative design principles of RSA, such as the medialization and inferiorization of the joint center of rotation, distalization of the humerus, and a semi-constrained construct, enable effective deltoid compensation for rotator cuff deficiency. The Grammont-style RSA demonstrated excellent clinical outcomes. However, complications like instability and scapular notching prompted the exploration of lateralized designs. The radiographic evaluation of RSA is paramount for understanding the biomechanics of the implant and to foresee possible complications. Radiographic assessments encompass glenoid and humeral component positions, identifying features like scapular notching, radiolucent lines, heterotopic ossifications, bone adaptations, and humeral lengthening. Lateralized designs alter muscle moment arms and improve deltoid efficiency, influencing abduction and adduction mechanics. Despite the reduction in scapular notching, lateralized RSA introduces new challenges, such as increased risk of scapular spine and acromial fractures. Understanding the radiographic features and biomechanics of lateralized RSA is crucial for optimizing patient outcomes and mitigating potential complications. Full article
(This article belongs to the Special Issue State of Art in Hip and Knee Replacement)
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11 pages, 1769 KiB  
Review
Clinical Results of the Use of Low-Cost TKA Prosthesis in Low Budget Countries—A Narrative Review
by Edoardo Bori, Clara Deslypere, Laura Estaire Muñoz and Bernardo Innocenti
Prosthesis 2023, 5(3), 840-850; https://doi.org/10.3390/prosthesis5030059 - 4 Sep 2023
Cited by 8 | Viewed by 1355
Abstract
Despite the orthopedics markets in the US and the EU reaching a plateau, the market size in countries such as Brazil, Russia, India, and China is steadily growing. As a result, major orthopedic companies are shifting their focus towards these markets and developing [...] Read more.
Despite the orthopedics markets in the US and the EU reaching a plateau, the market size in countries such as Brazil, Russia, India, and China is steadily growing. As a result, major orthopedic companies are shifting their focus towards these markets and developing products tailored to their needs. However, a significant challenge associated with this new opportunity is the requirement for the development of more affordable prostheses compared to those sold in the US and Europe. With the introduction of these lower-cost models into the market, this article aims to assess their performance in comparison to traditional models. A literature review was conducted, analyzing four parameters—the Hospital for Special Surgery Score, Knee Society Score, Range of Motion, and Western Ontario and McMaster Universities Arthritis Index—to evaluate different models. The findings indicated that low-cost models perform either equally well or, in some cases, slightly worse than traditional ones. It is worth to mention that the existing literature on this topic is limited, resulting in a relatively small number of models and studies included in this specific study. Nevertheless, this latter serves as a valuable foundation for future in-depth analyses and investigations. Full article
(This article belongs to the Special Issue State of Art in Hip and Knee Replacement)
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18 pages, 1170 KiB  
Review
Fretting Wear and Corrosion-Related Risk Factors in Total Hip Replacement: A Literature Review on Implant Retrieval Studies and National Joint Replacement Registry Reports
by Khashayar Ghadirinejad, Christopher W. Day, Roohollah Milimonfared, Mark Taylor, Lucian B. Solomon and Reza Hashemi
Prosthesis 2023, 5(3), 774-791; https://doi.org/10.3390/prosthesis5030055 - 21 Aug 2023
Cited by 6 | Viewed by 1858
Abstract
Fretting corrosion is a known failure mechanism of total hip replacement (THR) that can lead to revision surgery. Implant retrieval studies have thoroughly documented the occurrence of fretting corrosion in THR implants and its correlation with implant- and patient-related factors. Although implant retrieval [...] Read more.
Fretting corrosion is a known failure mechanism of total hip replacement (THR) that can lead to revision surgery. Implant retrieval studies have thoroughly documented the occurrence of fretting corrosion in THR implants and its correlation with implant- and patient-related factors. Although implant retrieval studies benefit both clinicians and implant manufacturers, the limitations of these types of studies need to be acknowledged. For example, while some factors are routinely investigated for a possible correlation with failure due to fretting corrosion, other factors are often assumed to have no effect. To improve on these limitations, this review investigates the most significant patient- and implant-related risk factors for fretting corrosion of THR implants for both published retrieval studies and joint replacement registries. The findings and limitations are discussed critically. It is concluded that retrieval studies add significant insight into implant failure mechanisms and should be used in conjunction with joint replacement registry reports. It is suggested that the development of reliable predictive models based on implant failure risk factors and decision-making support systems could lead to enhanced implant longevity. Full article
(This article belongs to the Special Issue State of Art in Hip and Knee Replacement)
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13 pages, 1037 KiB  
Review
Long-Term Follow-Up of Medial Pivot Total Knee Arthroplasty: A Systematic Review of the Current Evidence
by Giorgio Cacciola, Fortunato Giustra, Francesco Bosco, Luigi Sabatini, Salvatore Risitano, Federico De Meo, Lorenzo Braconi, Pietro Cavaliere, Alessandro Massè and Giuseppe Solarino
Prosthesis 2023, 5(3), 622-634; https://doi.org/10.3390/prosthesis5030044 - 12 Jul 2023
Cited by 2 | Viewed by 1904
Abstract
Total knee arthroplasty (TKA) is a popular treatment for end-stage knee osteoarthritis. Advances in understanding knee biomechanics have led to the development of medial pivot (MP) prostheses, which aim to replicate natural knee kinematics. While short- and mid-term studies have shown favorable outcomes [...] Read more.
Total knee arthroplasty (TKA) is a popular treatment for end-stage knee osteoarthritis. Advances in understanding knee biomechanics have led to the development of medial pivot (MP) prostheses, which aim to replicate natural knee kinematics. While short- and mid-term studies have shown favorable outcomes for MP-TKA, long-term follow-up studies are limited. This systematic review aims to analyze the available evidence on long-term outcomes of MP-TKA, including survivorship, complications, and patient-reported outcome measures (PROMs). A comprehensive search was conducted in PubMed, Embase, and Cochrane Database of Systematic Reviews for English language studies reporting long-term outcomes of primary MP-TKA. Nine studies with an average follow-up of 12.4 years were included. Data on survivorship, complications, and PROMs were collected and analyzed. The overall survivorship of MP-TKA was 98.2% at an average follow-up of 12.4 years. Aseptic loosening and periprosthetic joint infection (PJI) were the most common reasons for revision, with a revision rate of 0.4% for each. The overall complication rate was 6.6%, with secondary anterior knee pain and PJI being the most frequent complications. The reoperation rate was 3.1%, primarily due to PJI and knee instability. PROMs significantly improved postoperatively. MP-TKA demonstrates favorable long-term outcomes with high survivorship, low complication rates, and enhanced PROMs. The procedure provides reliable management for end-stage osteoarthritis, offering patients improved knee function and pain relief. Further research with standardized reporting and larger sample sizes is needed to validate and compare these findings to other implant designs. Full article
(This article belongs to the Special Issue State of Art in Hip and Knee Replacement)
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14 pages, 1737 KiB  
Systematic Review
Salvage Hip Arthroplasty in Nail Failure: A Systematic Review
by Salvatore Pantè, Lorenzo Braconi, Umberto Cottino, Federico Dettoni and Roberto Rossi
Prosthesis 2023, 5(4), 1343-1356; https://doi.org/10.3390/prosthesis5040092 - 13 Dec 2023
Viewed by 671
Abstract
Background: Femoral nailing is a largely widespread procedure in the elderly population, and the number of these surgeries is rising. Hip arthroplasty is a salvage procedure performed to improve function of the hip after femoral nail failure. The aim of the study is [...] Read more.
Background: Femoral nailing is a largely widespread procedure in the elderly population, and the number of these surgeries is rising. Hip arthroplasty is a salvage procedure performed to improve function of the hip after femoral nail failure. The aim of the study is to evaluate functional outcomes, complications and survivorship in hip arthroplasty after femoral nail failure. Methods: A systematic review of three databases (Pubmed, Embase and Cochrane) was performed using the PRISMA 2020 guidelines. After selection, four studies met the inclusion criteria, and 483 treated hips have been analyzed (476 total hip arthroplasties, 7 partial hip arthroplasties). Results: The median value of Harris Hip Score (HHS) after salvage treatment was 86.1. The main indications for salvage treatment were osteoarthrosis, avascular necrosis of the femoral head and instability of the hip. Complications are more frequent than in primary total hip arthroplasty, in particular aseptic loosening and dislocation. Good outcomes have also been achieved using revision-type stems and proximal femoral replacements (PFR). Conclusions: Conversion total hip arthroplasty is confirmed as the optimal treatment for femoral nail failure in the elderly population. Cemented or hybrid total hip arthroplasties have better outcomes than uncemented total hip arthroplasties, and the use of different types of implants widens the possible approaches to surgery in restoring the biomechanics of the hip and increases the satisfaction of patients. Full article
(This article belongs to the Special Issue State of Art in Hip and Knee Replacement)
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18 pages, 4362 KiB  
Case Report
A Combined Use of Custom-Made Partial Pelvic Replacement and Proximal Femur Megaprosthesis in the Treatment of Severe Bone Loss after Multiple Total Hip Arthroplasty Revisions
by Michele Fiore, Azzurra Paolucci, Renato Zunarelli, Marta Bortoli, Andrea Montanari, Andrea Pace, Lorenzo Di Prinzio, Stefania Claudia Parisi, Roberto De Cristofaro, Massimiliano De Paolis and Andrea Sambri
Prosthesis 2023, 5(4), 1093-1110; https://doi.org/10.3390/prosthesis5040076 - 24 Oct 2023
Viewed by 1297
Abstract
Hip arthroplasty failures (either septic or aseptic) often require multiple revisions, thus leading to severe bone defects. The most common reconstruction methods do not allow the management of severe defects. For this reason, in recent years, techniques borrowed from surgical oncology have been [...] Read more.
Hip arthroplasty failures (either septic or aseptic) often require multiple revisions, thus leading to severe bone defects. The most common reconstruction methods do not allow the management of severe defects. For this reason, in recent years, techniques borrowed from surgical oncology have been applied in the field of revision surgery to deal with both acetabular and femoral bone losses. In this article, two cases of severe bone deficiency following multiple hip arthroplasty revisions that were treated with a custom-made hip prosthesis combined with a proximal femur megaprosthesis are presented. Both implants were silver coated. A review of the literature was conducted to analyze similar cases treated with either a custom-made prosthesis or a proximal femur megaprosthesis. At the 2-year follow-up, all prostheses were in site without clinical or radiographic signs of implant loosening. No postoperative complications occurred. At the last follow-up, both patients resumed their daily life activities with an MSTS score of 23 and 21, respectively. The combined approach of a proximal femur megaprosthesis with a custom-made partial pelvic replacement is a solution that allows severe bone deficiency cases to be tackled with good functional results. Additionally, silver coating may help prevent recurrence of infection. Full article
(This article belongs to the Special Issue State of Art in Hip and Knee Replacement)
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30 pages, 18856 KiB  
Systematic Review
Minimally Invasive versus Conventional Approaches in Total Hip Arthroplasty: A Systematic Review and Meta-Analysis of 47 Randomized Controlled Trials
by Nikolai Ramadanov, Polina Marinova-Kichikova, Robert Hable and Dobromir Dimitrov
Prosthesis 2023, 5(3), 962-991; https://doi.org/10.3390/prosthesis5030067 - 16 Sep 2023
Cited by 1 | Viewed by 1167
Abstract
Background: Recent meta-analyses have shown indifferent results between minimally invasive (MI) and conventional approach (CA) total hip arthroplasty (THA), not including the superior MI approach SuperPATH. The aim was to compare the surgical, functional and radiological outcomes and postoperative complications of MI THA, [...] Read more.
Background: Recent meta-analyses have shown indifferent results between minimally invasive (MI) and conventional approach (CA) total hip arthroplasty (THA), not including the superior MI approach SuperPATH. The aim was to compare the surgical, functional and radiological outcomes and postoperative complications of MI THA, including SuperPATH, with CA THA in patients with hip disease or femoral neck fracture. Methods: PubMed, CNKI, The Cochrane Library, clinical trials, CINAHL and Embase were searched for randomized controlled trials (RCTs) comparing MI THA and CA THA up to 31 July 2023. Mean differences (MDs) with 95% confidence intervals (CIs) were calculated for continuous outcomes and odds ratios (ORs) with 95% CIs were calculated for dichotomous outcomes using a common effect/random effects model. The random effects model was used to present the results. Heterogeneity was assessed using the Cochrane Q test and the Higgins I2 test. Results: A total of 47 RCTs with 4086 THAs in 4063 patients were included in our meta-analysis. MI THA showed better results than CA THA in 8 of 18 outcome parameters studied. MI THA showed a higher Harris Hip Score (HHS) than CA THA at 0–1.5, 3, 6 and ≥12 months postoperatively (p < 0.01; p = 0.02; p = 0.01; p = 0.01). MI THA showed an indifferent overall postoperative complication risk compared to CA THA (p = 0.61). Acetabular positioning angles were within the safe zone in all approaches. Conclusions: The results of the meta-analysis suggest that MI THA has several advantages over CA THA in terms of short-term surgical and functional outcomes, with equal postoperative complication rates. We cannot recommend a change in surgical approach based on our results, as the differences between the investigated approaches did not reach minimal clinically important differences. Level of evidence I: a systematic review of all relevant randomized controlled trials. Full article
(This article belongs to the Special Issue State of Art in Hip and Knee Replacement)
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17 pages, 7550 KiB  
Systematic Review
Comparison of Postoperative Serum Biomarkers after Total Hip Arthroplasty through Minimally Invasive versus Conventional Approaches: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
by Nikolai Ramadanov, Polina Marinova-Kichikova, Robert Hable, Dobromir Dimitrov and Roland Becker
Prosthesis 2023, 5(3), 694-710; https://doi.org/10.3390/prosthesis5030049 - 29 Jul 2023
Cited by 2 | Viewed by 1190
Abstract
Background: An effective way to objectively assess intraoperative tissue damage in total hip arthroplasty (THA) is to determine and compare postoperative serum biomarkers (laboratory parameters) such as creatine kinase (CK), C-reactive protein (CRP), and hemoglobin (Hb). This meta-analysis aims to compare the intraoperative [...] Read more.
Background: An effective way to objectively assess intraoperative tissue damage in total hip arthroplasty (THA) is to determine and compare postoperative serum biomarkers (laboratory parameters) such as creatine kinase (CK), C-reactive protein (CRP), and hemoglobin (Hb). This meta-analysis aims to compare the intraoperative tissue damage in THA through minimally invasive (MI) and conventional approaches (CAs) using postoperative serum biomarkers. Methods: We searched databases for randomized controlled trials (RCTs) comparing MI THA and CA THA. We calculated mean differences (MDs) with 95% confidence intervals (CIs) for continuous outcomes, using the Hartung–Knapp–Sidik–Jonkman method and a common effect/random effects model. Results: A total of 13 RCTs, involving 1186 THA patients, were included in our meta-analysis. In two out of eleven examined outcome parameters, MI THA showed better results than CA THA. In nine out of eleven examined outcome parameters, MI THA showed no significant difference compared to CA THA. MI THA had a 16 mg/L lower CRP value 3 days postoperatively than CA THA (I2 = 66%, p = 0.03, MD = −15.65, 95% CI −30.10 to −1.21). MI THA had a 3 mg/L lower CRP value 4 days postoperatively than CA THA (I2 = 0%, p = 0.98, MD = −3.00, 95% CI −3.27 to −2.74). Conclusions: Overall, there was no significant difference between MI THA and CA THA in terms of postoperative serum biomarkers, with a slight advantage of MI THA in CRP values. These results do not provide sufficient evidence to recommend changing the surgical approach from CA THA to MI THA. Level of evidence I: a systematic review of all relevant randomized controlled trials. Full article
(This article belongs to the Special Issue State of Art in Hip and Knee Replacement)
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12 pages, 825 KiB  
Perspective
Molecular Diagnosis of Osteoarticular Implant-Associated Infection: Available Techniques and How We Can Use Them
by Llanos Salar-Vidal, Álvaro Auñón and Jaime Esteban
Prosthesis 2023, 5(1), 1-12; https://doi.org/10.3390/prosthesis5010001 - 28 Dec 2022
Cited by 5 | Viewed by 1949
Abstract
Despite recent advances during the last few years, microbiological diagnosis of prosthetic joint infections remains a challenge. Molecular biology techniques have been developed to try to overcome this problem, and recently, many of them have become available for many laboratories. Some of them, [...] Read more.
Despite recent advances during the last few years, microbiological diagnosis of prosthetic joint infections remains a challenge. Molecular biology techniques have been developed to try to overcome this problem, and recently, many of them have become available for many laboratories. Some of them, especially commercial multiplex PCR-based assays and universal 16S rDNA homemade PCR assays, are now available in many laboratories. Moreover, new technologies have appeared, especially metagenomics and next-generation sequencing. These techniques have demonstrated their potential in many studies but appear to be experimental at present. A few studies have evaluated the possible use of these methods in the clinical routine, and a review of the critical aspects for the selection of a molecular method (accuracy, complexity, cost) was performed. Finally, a proposal for a protocol that includes molecular biology techniques was made according to the literature published in this field. In conclusion, molecular biology techniques are ready to be used in the clinical routine of a microbiology laboratory, but their use must be carried out in accordance with the many special characteristics of each laboratory. In all cases, the interpretation of the results must be conducted by a multidisciplinary team with experience in the management of these patients. Full article
(This article belongs to the Special Issue State of Art in Hip and Knee Replacement)
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