RESUMEN
Use of SPECT/CT (Single Photon Emission Computed Tomography/Computed Tomography) is increasing providing additional information in patients with inconclusive clinical examination and unremarkable imaging findings presenting with chronic pain after total ankle arthroplasty. To differentiate the cause of pain after total ankle arthroplasty can be challenging. SPECT/CT combines structural and metabolic imaging as a hybrid tool leading to higher specificity and overall diagnostic accuracy presumably in cases of gutter impingement, prosthetic loosening, and osteoarthritis of adjacent joints. Moreover, SPECT/CT can complement diagnostic work up in periprosthetic joint infections. Basal tracer enhancement has to be considered for the interpretation of imaging findings.
Asunto(s)
Articulación del Tobillo , Artroplastia de Reemplazo de Tobillo , Humanos , Artroplastia de Reemplazo de Tobillo/efectos adversos , Articulación del Tobillo/cirugía , Articulación del Tobillo/diagnóstico por imagen , Tomografía Computarizada por Tomografía Computarizada de Emisión de Fotón Único , Osteoartritis/cirugía , Osteoartritis/diagnóstico por imagen , Tomografía Computarizada de Emisión de Fotón Único , Falla de Prótesis , Infecciones Relacionadas con Prótesis/diagnóstico por imagen , Infecciones Relacionadas con Prótesis/etiología , Prótesis Articulares/efectos adversosRESUMEN
Total ankle arthroplasty (TAA) is an effective alternative for treating patients with end-stage ankle degeneration, improving mobility, and providing pain relief. Implant survivorship is constantly improving; however, complications occur. Many causes of pain and dysfunction after total ankle arthroplasty can be diagnosed accurately with clinical examination, laboratory, radiography, and computer tomography. However, when there are no or inconclusive imaging findings, magnetic resonance imaging (MRI) is highly accurate in identifying and characterizing bone resorption, osteolysis, infection, osseous stress reactions, nondisplaced fractures, polyethylene damage, nerve injuries and neuropathies, as well as tendon and ligament tears. Multiple vendors offer effective, clinically available MRI techniques for metal artifact reduction MRI of total ankle arthroplasty. This article reviews the MRI appearances of common TAA implant systems, clinically available techniques and protocols for metal artifact reduction MRI of TAA implants, and the MRI appearances of a broad spectrum of TAA-related complications.
Asunto(s)
Artroplastia de Reemplazo de Tobillo , Prótesis Articulares , Imagen por Resonancia Magnética , Humanos , Artroplastia de Reemplazo de Tobillo/efectos adversos , Imagen por Resonancia Magnética/métodos , Prótesis Articulares/efectos adversos , Articulación del Tobillo/cirugía , Articulación del Tobillo/diagnóstico por imagen , Dolor Postoperatorio/etiología , Diseño de Prótesis , Masculino , Artefactos , Femenino , Falla de PrótesisRESUMEN
Diamond-like carbon (DLC) wear debris, which is often composed of different types of structures, is generated from DLC-modified artificial joints in the human body, and its biocompatibility evaluation is especially important to prevent wear-debris-induced implant failure. Here, RAW 264.7 macrophages (inflammatory-reaction assay) and primary mouse osteoblasts (osteoblastogenesis assay) were employed to investigate the toxicity of DLC wear particles (DWPs) by evaluation of cell viability and morphology, enzyme-linked immunosorbent assays, and quantitative reverse-transcription polymerase chain reaction (PCR). Relevant histopathological analysis of rat joints was also performed in vivo. We found that DWPs with a relatively high sp2/sp3 ratio (graphite-phase tendency) manifested a higher cytotoxicity and significant inhibition of osteoblastogenesis. DWPs with a relatively low sp2/sp3 ratio (diamond-phase tendency) showed good biocompatibility in vivo. The DWPs exhibiting a low sp2/sp3 ratio demonstrated reduced secretion of TNF-α and IL-6, along with increased secretion of TIMP-1, resulting in the downregulation of MMP-2 and MMP-9 and upregulation of interleukin-10 (IL-10), thereby attenuating the inflammatory response. Moreover, coculturing osteoblasts with DWPs exhibiting a low sp2/sp3 ratio resulted in an elevated OPG/RANKL ratio and increased expression of OPG mRNA. Because of the absence of electrostatic repulsion, DWPs with a relatively low sp2/sp3 ratio enhanced bovine serum albumin adsorption, which favored cellular activities. Cytotoxicity assessment of DWPs can help establish an evaluation system for particle-related joint disease and can facilitate the clinical application of DLC-coated prostheses.
Asunto(s)
Osteoblastos , Animales , Ratones , Osteoblastos/metabolismo , Osteoblastos/efectos de los fármacos , Células RAW 264.7 , Ratas , Diamante/química , Supervivencia Celular/efectos de los fármacos , Masculino , Prótesis Articulares/efectos adversos , Ratas Sprague-Dawley , Artroplastia de Reemplazo/efectos adversos , Carbono/efectos adversos , Materiales Biocompatibles/química , Ensayo de MaterialesRESUMEN
Total ankle replacement (TAR) is an effective operative treatment of end-stage ankle osteoarthritis (OA) in the appropriate patient, conferring improved kinematic function, decreased stress across adjacent joints, and offering equivalent pain relief in comparison to ankle arthrodesis (AA). It is important to consider patient age, weight, coronal tibiotalar deformity, joint line height, and adjacent joint OA to maximize clinical and patient outcomes. Both mobile-bearing and fixed-bearing implants have demonstrated favorable clinical outcomes, marked improvement in patient-reported outcomes, and good survivorship; however, implant survivorship decreases with longer term follow-up, necessitating constant improvement of primary and revision TAR options.
Asunto(s)
Articulación del Tobillo , Artroplastia de Reemplazo de Tobillo , Osteoartritis , Humanos , Artroplastia de Reemplazo de Tobillo/métodos , Artroplastia de Reemplazo de Tobillo/instrumentación , Osteoartritis/cirugía , Articulación del Tobillo/cirugía , Resultado del Tratamiento , Prótesis Articulares , Diseño de Prótesis , Medición de Resultados Informados por el PacienteRESUMEN
Diamond-like Carbon (DLC) has been used as a coating material of choice for a variety of technological applications owing to its favorable bio-tribo-thermo-mechanical characteristics. Here, the possibility of bringing DLC into orthopedic joint implants is examined. With ever increasing number of patients suffering from osteoarthritis as well as with the ingress of the osteoarthritic joints' malaise into younger and more active demographics, there is a pressing need to augment the performance and integrity of conventional total joint replacements (TJRs). Contemporary joint replacement devices use metal-on-polymer articulations to restore function to worn, damaged or diseased cartilage. The wear of polymeric components has been addressed using crosslinking and antioxidants; however, in the context of the metallic components, complications pertaining to corrosion and metal ion release inside the body still persist. Through this review article, we explore the use of DLC coatings on metallic bearing surfaces and elucidate why this technology might be a viable solution for ongoing electrochemical challenges in orthopedics. The different characteristics of DLC coatings and their feasibility in TJRs are examined through assessment of tribo-material characterization methods. A holistic characterization of the coating-substrate interface and the wear performance of such systems are discussed. As with all biomaterials used in TJRs, we need mindful consideration of potential in-vivo challenges. We present a few caveats for DLC coatings including delamination, hydrophobicity, and other conflicting as well as outdating findings in the literature. We recommend prudently exploring DLC films as potential coatings on metallic TJR components to solve the problems pertaining to wear, metal ion release, and corrosion. Ultimately, we advise bringing DLC into clinical use only after addressing all challenges and concerns outlined in this article.
Asunto(s)
Carbono , Materiales Biocompatibles Revestidos , Diamante , Ensayo de Materiales , Humanos , Diamante/química , Materiales Biocompatibles Revestidos/química , Carbono/química , Artroplastia de Reemplazo , Estudios de Factibilidad , Prótesis Articulares , Propiedades de Superficie , Corrosión , Diseño de Prótesis , Metales/química , Osteoartritis/cirugía , Materiales Biocompatibles/químicaRESUMEN
PURPOSE: The aim of this study is to reveal the morphometry of the distal tibia and posterior malleolus and to generate morphometric reference data for the tibial component of total ankle prosthesis. METHODS: This study was performed on 121 human dry tibiae (47 right, 74 left). The morphometric measurements of distal tibial structures, tibial length and the distance between the medial and posterior malleolus were measured in this study. Measurements on 44 tibiae were repeated three times and averaged for minimizing intra-observer error. RESULTS: The tibial length was found 34.19 ± 2.31 cm. Mean values of width of fibular notch at tibial plafond and 10 mm proximal to the tibial plafond were 25.71 ± 2.44 mm and 17.81 ± 2.46 mm, respectively. Mean depth of fibular notch at tibial plafond and 10 mm proximal to the tibial plafond were 3.60 ± 1.04 mm and 3.37 ± 1.24 mm, respectively. Mean height of fibular notch was found 48.21 ± 10.51 mm. Mean width and height of medial malleolus were 25.08 ± 2.13 mm and 14.73 ± 1.85 mm, respectively. Mean width and length of tibial plafond were 27.71 ± 2.74 mm and 26.96 ± 2.62 mm, respectively. Mean values of width and height of posterior malleolus were measured 21.41 ± 3.26 mm and 6.74 ± 1.56 mm, respectively. Mean distance between medial and posterior malleolus was found 37.17 ± 3.53 mm. Mean width and depth of malleolar groove were 10.26 ± 1.84 mm and 1.73 ± 0.75 mm, respectively. The mean intra-class correlation values were found between the 0.959 and 0.999. CONCLUSIONS: Knowing the distal tibial morphometry is crucial for designing convenient ankle replacement implants for Turkish population. To our knowledge, this study is the first in the literature that identifies posterior malleolar morphometry on dry tibiae. We believe that this study will make a significant contribution to the literature about distal tibial morphometry and especially the posterior malleolus and the data of our study can be used for designing total ankle prosthesis in Turkish population.
Asunto(s)
Articulación del Tobillo , Artroplastia de Reemplazo de Tobillo , Cadáver , Tibia , Humanos , Tibia/anatomía & histología , Tibia/cirugía , Articulación del Tobillo/anatomía & histología , Articulación del Tobillo/cirugía , Artroplastia de Reemplazo de Tobillo/métodos , Artroplastia de Reemplazo de Tobillo/instrumentación , Masculino , Femenino , Prótesis Articulares , Persona de Mediana Edad , AncianoRESUMEN
For pediatric patients with refractory temporomandibular joint (TMJ) ankylosis, reconstruction with autologous techniques such as costochondral grafts or distraction osteogenesis has long been considered the gold standard. Many surgeons believed the use of alloplastic joint replacement to be contraindicated in pediatric patients due to concerns for growth restriction and the limited lifespan of the implants. However, recent data has supported TMJ prostheses in skeletally immature patients. This study aims to present a case series of pediatric patients undergoing bilateral TMJ reconstruction with custom-made implants and evaluate their postoperative results. A retrospective chart review was performed of all consecutive pediatric patients undergoing bilateral alloplastic TMJ reconstruction for refractory ankylosis. All patients underwent bilateral TMJ release and total joint replacement with custom-made implants. Preoperative and postoperative cephalometric and volumetric airway data was obtained using cone-beam computed tomography. Three patients, aged 8 to 17, underwent bilateral TMJ replacement with custom-made implants. There were no postoperative complications, and no implants required explantation or replacement. Postoperatively, all patients had increases in maximal interincisal opening, which was stable over months/years of follow-up. The patients also subjectively reported improved speech and mastication; 1 patient had significant improvements in sleep apnea symptoms. Volumetric airway analysis revealed an average airway size increase of 25.6%. Alloplastic TMJ reconstruction is a safe, effective solution for refractory ankylosis in pediatric patients and represents a promising new frontier in craniofacial surgery. Continued long-term evaluation will provide further evidence of the utility of this procedure.
Asunto(s)
Anquilosis , Prótesis Articulares , Trastornos de la Articulación Temporomandibular , Humanos , Niño , Trastornos de la Articulación Temporomandibular/cirugía , Adolescente , Estudios Retrospectivos , Anquilosis/cirugía , Masculino , Femenino , Tomografía Computarizada de Haz Cónico , Articulación Temporomandibular/cirugía , Diseño de Prótesis , Resultado del Tratamiento , Artroplastia de Reemplazo/métodos , Procedimientos de Cirugía Plástica/métodos , CefalometríaRESUMEN
The Cartiva implant is a synthetic polyvinyl alcohol hydrogel cartilage substitute that is used as a treatment of first metatarsophalangeal joint arthritis. The implant was designed to relieve the pain associated with hallux rigidus while preserving or restoring range of motion. A summary of outcomes, reasons for these outcomes, and technique pearls will be reviewed here. Seminal articles and current evidence are all included in this article. The aim is for the surgeon to understand all the literature, allowing the surgeon to counsel their patients appropriately, optimize patient selection and to deal with complications.
Asunto(s)
Hallux Rigidus , Humanos , Hallux Rigidus/cirugía , Diseño de Prótesis , Articulación Metatarsofalángica/cirugía , Prótesis Articulares , Alcohol PolivinílicoRESUMEN
First metatarsophalangeal joint (MTPJ) arthroplasty provides hallux rigidus patients with pain relief and preserved motion, offering an alternative to arthrodesis. Recent advancements in implant technology and surgical techniques have broadened treatment options. Although good outcomes have been documented in the literature, concerns persist regarding increased complications, uncertain long-term efficacy, and challenges in managing failed arthroplasties. Addressing bone loss resulting from the procedure further complicates salvage procedures. Larger cohorts and extended studies are necessary to establish efficacy of first MTPJ arthroplasty. Decisions must weigh the trade-offs between pain relief and potential complications, requiring thorough patient-surgeon discussions.
Asunto(s)
Hallux Rigidus , Articulación Metatarsofalángica , Humanos , Hallux Rigidus/cirugía , Hallux Rigidus/diagnóstico por imagen , Articulación Metatarsofalángica/cirugía , Artroplastia/métodos , Artroplastia de Reemplazo/métodos , Artroplastia de Reemplazo/efectos adversos , Prótesis Articulares/efectos adversos , Resultado del TratamientoRESUMEN
PURPOSE: Total joint arthroplasty (TJA) has often been used to treat thumb carpometacarpal (CMC) osteoarthritis (OA). However, guidelines for the CMC prosthesis shape remain unclear. This study aimed to identify the effective shape of a ball-and-socket prosthesis in restoring the range of thumb motion after TJA. METHODS: The participants were 10 healthy young adult men (22-32 years; 26.8 ± 3.57 [mean ± SD]). CT scans were performed in eight static limb positions during abduction and flexion. We defined three design variables (offset R, height H, and neck rotation angle Φ) as the variables that determine the basic shape of the ball-and-socket prosthesis. The ideal values of these design variables were examined based on the results of a 3D motion analysis, which evaluated the change in the posture of the first metacarpal (r, h, and φ corresponding to R, H, and Φ, respectively) relative to the center of rotation (COR) during abduction and flexion. We also simulated the effect of these design variables on the range of thumb motion after TJA using 3D CAD. RESULTS: We found that the values of r and h averaged over all limb positions were 6.92 ± 1.60 mm and 51.02 ± 1.67 mm, respectively, showing that these values remained constant regardless of limb position. In contrast, φ changed significantly. The simulation results indicated that Φ affected the range of thumb motion after TJA, and Φ = 0° relatively reproduced all limb positions compared to other values. CONCLUSION: Our results suggested that the desirable values of R and H were the average of r and h over several limb positions and that Φ = 0° was effective in restoring the range of thumb motion after TJA. Our results will provide surgeons with new guidelines for selecting a prosthesis.
Asunto(s)
Articulaciones Carpometacarpianas , Prótesis Articulares , Diseño de Prótesis , Rango del Movimiento Articular , Pulgar , Humanos , Masculino , Pulgar/cirugía , Pulgar/fisiología , Pulgar/diagnóstico por imagen , Articulaciones Carpometacarpianas/cirugía , Articulaciones Carpometacarpianas/diagnóstico por imagen , Articulaciones Carpometacarpianas/fisiopatología , Adulto , Adulto Joven , Imagenología Tridimensional , Tomografía Computarizada por Rayos X , Osteoartritis/cirugía , Osteoartritis/fisiopatología , Osteoartritis/diagnóstico por imagen , Artroplastia de Reemplazo/instrumentación , Artroplastia de Reemplazo/métodosRESUMEN
CASE: A 64-year-old man presented with a 3-year history of right wrist pain and swelling 33 years after a silicone scaphoid arthroplasty for chronic scaphoid nonunion. Radiographs demonstrated a deformed scaphoid implant, carpal and distal radius cysts, and mild carpal collapse. He elected to undergo a wrist arthrodesis with a dorsal fusion plate after failing conservative management. CONCLUSION: Although carpal bone silicone implant arthroplasties of the wrist have long been abandoned, our patient was pain free and fully functional for 3 decades. He was pleased to undergo serial examinations with radiographs for 30 years without any therapeutic intervention.
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Hueso Escafoides , Siliconas , Humanos , Masculino , Persona de Mediana Edad , Hueso Escafoides/cirugía , Hueso Escafoides/diagnóstico por imagen , Hueso Escafoides/lesiones , Siliconas/efectos adversos , Artroplastia de Reemplazo/efectos adversos , Articulación de la Muñeca/cirugía , Articulación de la Muñeca/diagnóstico por imagen , Prótesis Articulares/efectos adversos , Artrodesis/métodos , Estudios de SeguimientoRESUMEN
The authors aim to present an updated protocol for mandibular reconstruction in nongrowing patients with Pruzansky/Kaban type IIb/III congenital craniofacial microsomia with customized temporomandibular joint (TMJ) prosthesis to reduce facial nerve (FN) damage and improve surgical accuracy. This is illustrated (using 3 cases) and is based on preoperative mapping of the FN using MRI for better virtual surgical planning of custom-made TMJ prosthesis. Intraoperative FN mapping and monitoring, as well as verification of the final result with intraoperative cone-beam computed tomography (CBCT) and 3D-reconstructed images is also achieved. All 3 patients presented mild transient postoperative facial palsy due to surgical soft tissue stretching which resolved within 2 months of surgery. All patients presented proper occlusion and mouth opening without pain, with an average incisal opening of 38.8 mm (range 35.5-42 mm) at two months of follow-up. Moreover, superposition of intraoperative and preoperative 3D reconstruction images ensured surgical accuracy and avoided the need for a potential reintervention. In conclusion, the proposed surgical protocol for mandibular reconstruction with customized alloplastic TMJ prosthesis in nongrowing patients with type IIb/III Pruzansky-Kaban congenital mandibular hypoplasia may reduce FN morbidity, improve surgical accuracy and final outcomes.
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Síndrome de Goldenhar , Prótesis Articulares , Reconstrucción Mandibular , Articulación Temporomandibular , Humanos , Reconstrucción Mandibular/métodos , Articulación Temporomandibular/cirugía , Articulación Temporomandibular/diagnóstico por imagen , Articulación Temporomandibular/anomalías , Síndrome de Goldenhar/cirugía , Síndrome de Goldenhar/diagnóstico por imagen , Femenino , Masculino , Imagenología Tridimensional/métodos , Tomografía Computarizada de Haz Cónico , Imagen por Resonancia Magnética , Niño , Diseño de Prótesis , Adolescente , Trastornos de la Articulación Temporomandibular/cirugía , Trastornos de la Articulación Temporomandibular/diagnóstico por imagen , Nervio Facial/cirugía , Nervio Facial/diagnóstico por imagen , Nervio Facial/anomalíasRESUMEN
Different aspects of the learning curve in total ankle replacement (TAR) have been studied in the short to mid-term, with 30 cases often considered critical. However, its impact on long-term (10- and 15-year) survival remains unclear. Therefore, we retrospectively analyzed 77 consecutive TARs performed by one orthopedic surgeon. The main outcome was long-term survival between cases 1-30 and 31-77 using the Kaplan-Meier with Competing Risk Analyses. Secondarily, we used Moving Average Method with LOESS regression to confirm the learning curve based on the perioperative complications. Thirdly, associations between perioperative complications and operation time on long-term survival were assessed using Cox proportional hazard models. The 10-year survival of cases 1-30 was 89.9% (95% CI 70.4-96.5), and of 31-77, 92.4% (95% CI 7745- 97.5) (p = .58). The 15-year survival was 81.8% (95% CI 59.5-91.8) and 74.8% (95% CI 52.4-86.6), respectively (p = .97). The long-term survival rate for the TAR that endured perioperative complication was 96.70% (95% CI 90.28-103.12), and for the uncomplicated TAR 87.50% (95% CI 77.12-97.88%) (p = .24). Operating time nor occurrence of perioperative fractures were significantly associated with long-term survival (p = .11 and 0.26, respectively). However, moving average method revealed a significant decreasing trend with a cut-off value of 33 procedures regarding the marginal probability of perioperative osseous complications (p < .01). In conclusion, surgeons should note a learning curve when adapting arthroplasty procedures. After the prosthesis design switch, the learning curve regarding perioperative osseous complications was confirmed at 33 TAR. The switch did not affect long-term survival.
Asunto(s)
Artroplastia de Reemplazo de Tobillo , Curva de Aprendizaje , Diseño de Prótesis , Humanos , Artroplastia de Reemplazo de Tobillo/efectos adversos , Femenino , Masculino , Estudios Retrospectivos , Persona de Mediana Edad , Anciano , Complicaciones Posoperatorias/epidemiología , Tempo Operativo , Adulto , Prótesis Articulares , Estimación de Kaplan-Meier , Resultado del Tratamiento , Anciano de 80 o más AñosRESUMEN
The delamination of ultra-high molecular weight polyethylene (UHMWPE) in artificial joints is a major cause limiting the long-term clinical results of arthroplasty. However, the conventional test method using simple reciprocation to evaluate the delamination resistance of UHMWPE materials has insufficient detection sensitivity. To reproduce delamination, the unconformity contact must be maintained throughout the test so that the maximum stress is generated below the surface. Therefore, a test method that applies a U-shaped motion comprising two long-linear and one short linear sliding motion was developed. The sensitivity, robustness, and reproducibility of the U-shaped delamination test were investigated and compared with the traditional test method. The traditional test method could reproduce delamination only in materials that had degraded considerably, whereas the U-shaped delamination test could reproduce delamination in a wide range of materials, demonstrating its superior sensitivity. Additionally, using a higher load helped accelerate the test without affecting the test results. The optimal length of the short linear sliding motion was confirmed to be 1 mm. Finally, the inter-laboratory reproducibility of the U-shaped delamination test was confirmed using the round-robin test. The U-shaped delamination test demonstrates high sensitivity, robustness, and reproducibility and contributes to the selection and development of UHMWPE materials and artificial joints with a lower risk of delamination.
Asunto(s)
Ensayo de Materiales , Polietilenos , Polietilenos/química , Reproducibilidad de los Resultados , Prótesis Articulares , Pruebas Mecánicas , Artroplastia de Reemplazo/instrumentaciónRESUMEN
PURPOSE: Trapeziometacarpal (TMC) joint replacement has become a valid option in the therapeutic arsenal of TMC joint osteoarthritis in Europe. Good mid-term results of the MAÏA TMC joint prosthesis suggested that it is a reliable procedure. This study aimed to assess the long-term results of this modular uncemented ball-and-socket hydroxyapatite-coated implant. METHODS: This single-center retrospective study evaluated 92 MAÏA TMC joint prostheses in 76 patients with a minimum of 10 years of follow-up. Indications for the procedure were painful TMC joint osteoarthritis both at rest and during activity, despite nonsurgical treatment for more than six months. Pre- and postoperative clinical and radiographic outcomes were compared. RESULTS: Mean follow-up was 134 months (range: 120-158 months). Mean age at the time of surgery was 67 years (range: 53-84 years). The cohort comprised 86.8% of women (n = 66). The mean Quick Disabilities of the Arm, Shoulder, and Hand score improved from 61.3 ± 17.1 to 19.6 ± 16. Range of motion was restored, and postoperative mobility was comparable with that of the contralateral side. Final Kapandji opposition score was almost normal (9.2 ± 0.7). Final key pinch and grip strength improved by 26% and 39%, respectively. Eight implants were surgically revised, six for trapezium cup loosening and two for instability because of polyethylene wear. Three cases of traumatic fracture of the trapezium in older patients were successfully treated with a cast for eight weeks. Five of 26 (20.8%) cases of preoperative-reducible z-deformity were not totally corrected after surgery. The Kaplan-Meier survival over 10 years was 88% (95% confidence interval: 84-93) versus 93% (95% confidence interval: 87-98) over 5 years. CONCLUSIONS: MAÏA TMC joint prosthesis is a reliable long-term surgical procedure for TMC joint osteoarthritis, improving overall function beyond 10 years. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
Asunto(s)
Artroplastia de Reemplazo , Articulaciones Carpometacarpianas , Prótesis Articulares , Osteoartritis , Rango del Movimiento Articular , Hueso Trapecio , Humanos , Femenino , Persona de Mediana Edad , Masculino , Anciano , Osteoartritis/cirugía , Osteoartritis/diagnóstico por imagen , Estudios Retrospectivos , Estudios de Seguimiento , Anciano de 80 o más Años , Hueso Trapecio/cirugía , Hueso Trapecio/diagnóstico por imagen , Articulaciones Carpometacarpianas/cirugía , Articulaciones Carpometacarpianas/diagnóstico por imagen , Radiografía , Diseño de Prótesis , Resultado del Tratamiento , Huesos del Metacarpo/cirugía , Huesos del Metacarpo/diagnóstico por imagen , Evaluación de la DiscapacidadRESUMEN
BACKGROUND: The management of failed total ankle replacements, with significant loss of bone stock, is challenging with high rates of complications and associated morbidity. Recent technological advances have enabled the development of patient-customized 3D-printed titanium truss arthrodesis implants, which offer an alternative salvage option for failed total ankle replacements. METHODS: A prospective observational study was performed of 6 cases of failed total ankle replacements that were managed using custom patient-specific 3D-printed titanium truss arthrodesis implants. Technical tips, classification, and a treatment algorithm were developed based on our initial experience. RESULTS: Between November 2018 and March 2022, 6 patients underwent arthrodesis for failed total ankle replacements. Follow-up was available for all cases. The mean follow-up was 3.0 years (range 1-4.5). The mean MOXFQ Index improved from 73.1 to 32.3 (P < .05). The mean EQ-5D-5L Index improved from 0.366 to 0.743 (P < .05) and the EQ-VAS also improved from 53.0 to 63.3 (P = .36). The mean VAS-Pain score at final follow-up was 27.5. There were no cases of nonunion. None of the patients were smokers. The overall complication rate was 50%. Two patients returned to surgery: one for wound washout following TAR explantation and a second for removal of metalwork 2 years following surgery for a prosthetic joint infection secondary to hematogenous spread. No patients underwent revision fixation or amputation. CONCLUSION: Custom patient-specific 3D-printed titanium truss arthrodesis implants are a viable treatment option for failed total ankle replacements.
Asunto(s)
Algoritmos , Artrodesis , Artroplastia de Reemplazo de Tobillo , Impresión Tridimensional , Titanio , Humanos , Artrodesis/métodos , Artrodesis/instrumentación , Artroplastia de Reemplazo de Tobillo/métodos , Artroplastia de Reemplazo de Tobillo/instrumentación , Estudios Prospectivos , Persona de Mediana Edad , Masculino , Femenino , Anciano , Diseño de Prótesis , Reoperación , Prótesis Articulares , Articulación del Tobillo/cirugía , Falla de PrótesisRESUMEN
Base-of-thumb osteoarthritis is the most frequent osteoarthritis of the hand requiring surgical treatment, although conservative treatment options should be exhausted before surgery. If the wear process progresses with continuing pain-related loss of thumb function, thus leading to a loss of function of the whole hand, surgical treatment is indicated. In 1947, Gervis published results after trapeziectomy and heralded the development of a multitude of different surgical procedures. The long time needed for rehabilitation is a major problem of trapeziectomy with or without tendon interposition and/or suspension. After the implementation of the first CMC I prosthesis by De la Caffiniere 50 years ago, a rapid development took place, leading to the current modular bipolar implants. Especially in the German-speaking world, there is still some scepticism regarding these prostheses, which is why this review aims to illuminate both surgical procedures with a special focus placed on the aspects of indication.
Asunto(s)
Articulaciones Carpometacarpianas , Prótesis Articulares , Osteoartritis , Diseño de Prótesis , Pulgar , Hueso Trapecio , Osteoartritis/cirugía , Humanos , Hueso Trapecio/cirugía , Pulgar/cirugía , Articulaciones Carpometacarpianas/cirugía , Complicaciones Posoperatorias/cirugía , Complicaciones Posoperatorias/etiologíaRESUMEN
BACKGROUND: The increasing use of thumb carpometacarpal joint prostheses for advanced CMC 1 (carpometacarpal) joint arthritis reflects the success of the latest prosthesis generations, which has been achieved through their improved functional outcomes and lower complication rates. Precise alignment of the prosthesis cup parallel to the proximal joint surface of the trapezium is essential for stability and the prevention of dislocation. This is a challenging surgical step, particularly for surgeons new to this technique. Despite adequate positioning of the guidewire, misplacements of the cup may occur, necessitating intraoperative revision. MATERIAL AND METHODS: This study examined the deviations in cup and guidewire positioning in thumb carpometacarpal joint prosthesis implantations by inexperienced and experienced surgeons through radiological analysis of 65 prostheses. RESULTS: Both inexperienced and experienced surgeons achieved precise guidewire positioning with mean deviations of<2.2°. Inexperienced surgeons showed significantly larger cup deviations in the dorsopalmar and lateral view (7.6±6.1° and 7.3±5.9°) compared with experienced surgeons (3.6±2.7° and 3.6±2.5°; p=0.012, p=0.017). The deviation of the cup position exhibited by inexperienced surgeons tends to be in the direction opposite to the initial guidewire position (p<0.0038). CONCLUSION: The results highlight the current challenges in cup positioning depending on a surgeon's level of experience, questioning the reliability of the current guidewire placement.
Asunto(s)
Articulaciones Carpometacarpianas , Pulgar , Articulaciones Carpometacarpianas/cirugía , Humanos , Pulgar/cirugía , Masculino , Femenino , Prótesis Articulares , Hilos Ortopédicos , Competencia Clínica , Persona de Mediana Edad , Anciano , Diseño de Prótesis , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/etiología , Reoperación , Osteoartritis/cirugíaRESUMEN
This article is intended to highlight one of the key roles in endoprosthetic treatment with artificial implants and the extension of service life. Like every joint, artificial joints are subject to the physical laws of friction and wear-in short, tribology. Material pairings, surfaces and mechanisms of action in particular play a decisive role here. The special features and current findings relating to the three largest synovial joints (hip, knee and shoulder) will be discussed in detail and suggestions will be made for future developments. Continuous developments in the field of the tribology of artificial joints can massively improve care for patients. The revision figures and reasons already show the success of individual improvements in recent years.
Asunto(s)
Fricción , Prótesis Articulares , Humanos , Diseño de Prótesis , Falla de Prótesis , Análisis de Falla de EquipoRESUMEN
The introduction of the new generation of thumb carpometacarpal (CMC I) joint implants for the treatment of CMC I osteoarthritis has significantly broadened the scope of hand surgery in recent years. However, the technical demands of the procedure and the many details that need to be considered require appropriate training and a learning curve. To share experiences with the Touch CMC I prosthesis, we held the first German-speaking CMC I joint prosthetics user meeting in Zurich. After some basic introductory lectures on biomechanics and the principles of prosthetic fitting of the CMC I joint, the various challenges associated with CMC I joint prosthetics were discussed in interactive expert panels. Subsequently, cases were discussed in small groups under expert guidance and the respective conclusions were discussed in plenary. The main results of this symposium are summarised in this manuscript.