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State-of-the-Art and Research on Joint Arthroplasties

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: closed (30 June 2022) | Viewed by 27724

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Prof. Dr. Enrique Gómez Barrena

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Department of Orthopaedic Surgery and Traumatology, Autonomous University of Madrid, Knee Unit at Hospital Universitario La Paz, Madrid, Spain
Interests: total hip arthroplasty; total knee arthroplasty; prosthetic joint infection; revision hip surgery; revision knee surgery
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Dr. Eduardo García-Rey

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Department of Orthopaedic Surgery and Traumatology, Autonomous University of Madrid, Hip Unit at Hospital Universitario La Paz, Madrid, Spain
Interests: total hip arthroplasty; total knee arthroplasty; prosthetic joint infection; revision hip surgery; revision knee surgery
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Total joint arthroplasties are amongst the most frequent and appreciated surgical interventions. The evolution in the techniques has been significant in the past decades, leading to the state-of-the-art in major joint reconstruction at the highest consideration.

Research on perioperative management has fostered significant improvements in patient outcomes. From blood management to fast-track surgery, many patients now receive standardized, highly refined procedures allowing for earlier recovery and better functional outcomes.

Materials, designs, and surgical concepts have significantly evolved through basic and clinical research, offering excellent techniques that provide grounds for durable, consistent, and reliable implants and operations.

Furthermore, revision surgery in cases of failure and complications have also been developed through research, now offering new surgical concepts and robust constructs that will expand the functional life of patients for many more years.

In this context, research is supporting new developments through navigation, robotics, or virtual reality that may pave the future of more precise, reproducible arthroplasties, closer to the normal anatomy. New concepts about the knee and lower limb alignment, and the influence of spinopelvic alignment in the hip, are aspects under debate. Joint stability and the influence of rotational alignment and constraint are also carefully evaluated. The currently excellent state-of-the-art on joint arthroplasties will be outperformed, and the intensive research in the field will substantiate further refinement. Eventually, better tolerated and more physiological artificial joints may be the result, enabling patients to recover functional life for many years.

Prof. Dr. Enrique Gómez Barrena
Dr. Eduardo García-Rey
Guest Editors

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Keywords

State-of-the-art total hip arthroplasty
Revision of hip replacement reconstructive procedures
State-of the-art total knee arthroplasty
Navigation and robotics
Revision of knee replacement fixation and bone defects
Mechanical versus patient-specific total knee alignment
Constrained and hinged total knee replacement
Joint reconstruction after infection
Anatomical and reverse total shoulder arthroplasties
Elbow arthroplasty
Ankle arthroplasty

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Published Papers (10 papers)

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Research

10 pages, 709 KiB

Open AccessArticle

Influence of Accelerated Aging on the Wear Behavior of Cross-Linked Polyethylene Liners—A Hip Simulator Study

by Rebecca H. Dammer, Carmen Zietz, Jörn Reinders, Michael Teske and Rainer Bader

J. Clin. Med. 2022, 11(15), 4487; https://doi.org/10.3390/jcm11154487 - 1 Aug 2022

Cited by 1 | Viewed by 1707

Abstract

Sequential cross-linked and annealed ultra-high-molecular-weight polyethylene (SX-PE) is known as a low-wear articulating partner, especially for total hip endoprostheses. Aging of polymeric materials, irrespective of if induced by shelf or in vivo life, can degrade their tribological and mechanical properties. However, changes in wear behavior of aged SX-PE liners have not been not quantified so far. An accelerated aging procedure, to simulate shelf and in vivo aging, was performed on thin SX-PE liners after five million load cycles using a simulator (“worn-aged”) as well as on new SX-PE liners (“new-aged”). A subsequent hip simulator test was performed with both thin SX-PE liner sets in combination with large-diameter ceramic femoral head, representing a combination known as advantageous for treatment after revision because of dislocation. Oxidation indices were measured on the liners after each step of the procedure. SX-PE liners after accelerated aging show bedding-in phases during simulator test, which was a characteristic only known from clinical investigations. Hence, the wear rates of the “new-aged” ((1.71 ± 0.49) mg/million cycles) and of the “worn-aged” ((9.32 ± 0.09) mg/million cycles) SX-PE were increased in the first period compared to new unaged SX-PE liners. Subsequently, the wear rates decreased for “new-aged” and “worn-aged” inserts to (0.44 ± 0.48) mg/million cycles and (2.72 ± 0.05) mg/million cycles, respectively. In conclusion, the results show promising effects of accelerated aging on SX-PE liners in simulator testing and for potential long-term use in clinical applications. Full article

(This article belongs to the Special Issue State-of-the-Art and Research on Joint Arthroplasties)

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15 pages, 7290 KiB

Open AccessArticle

Experimental Investigation of Material Transfer on Bearings for Total Hip Arthroplasty—A Retrieval Study on Ceramic and Metallic Femoral Heads

by Jessica Hembus, Lisa Rößler, Armin Springer, Marcus Frank, Annett Klinder, Rainer Bader, Carmen Zietz and Andreas Enz

J. Clin. Med. 2022, 11(14), 3946; https://doi.org/10.3390/jcm11143946 - 7 Jul 2022

Cited by 2 | Viewed by 2093

Abstract

Metallic deposition is a commonly observed phenomenon on the surface of revised femoral heads in total hip arthroplasty and can lead to increased wear due to third bodies. In order to find out the origin and composition of the transfer material, 98 retrieved femoral heads of different materials were examined with regard to the cause of revision, localization, pattern and composition of the transfer material by energy dispersive X-ray spectroscopy. We found that in 53.1%, the deposition was mostly in the region of the equator and the adjacent pole of the femoral heads. The most common cause for revision of heads with metallic deposition was polyethylene wear (43.9%). Random stripes (44.9%), random patches (41.8%) and solid patches (35.7%) were most prevalent on retrieved femoral heads. Random patches were a typical pattern in ceramic-on-ceramic bearing couples. The solid patch frequently occurred in association with dislocation of the femoral head (55%). The elemental analysis of the depositions showed a variety of different materials. In most cases, titanium was an element of the transferred material (76.5%). In addition to metallic components, several non-metallic components were also detected, such as carbon (49%) or sulfur (4.1%). Many of the determined elements could be assigned with regard to their origin with the help of the associated revision cause. Since the depositions lead to an introduction of third-body particles and thus to increased wear, the depositions on the bearing surfaces should be avoided in any case. Full article

(This article belongs to the Special Issue State-of-the-Art and Research on Joint Arthroplasties)

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9 pages, 816 KiB

Open AccessArticle

Effects of Pre-Donated Autologous Blood Transfusion on Peri-Operative Hemoglobin Concentration and Mid-Term Health Outcomes in Primary Total Knee Arthroplasty

by Jun Tomura, Daichi Morikawa, Masahiko Nozawa, Muneaki Ishijima and Sung-Gon Kim

J. Clin. Med. 2022, 11(8), 2252; https://doi.org/10.3390/jcm11082252 - 18 Apr 2022

Cited by 1 | Viewed by 1986

Abstract

The effects of auto-BT in primary TKA on the perioperative hemoglobin (Hb) concentration and mid-term health outcomes are unknown. This study was performed to analyze the detailed changes in the perioperative Hb concentration before and after the operation (days 0–14 postoperatively), cardiovascular events, and mortality rate within 1 and 5 years postoperatively. One hundred patients undergoing primary TKA with auto-BT using 800 mL of preoperatively collected blood at the authors’ institution were included. The mean Hb concentration before and after autologous blood collection was 12.7 ± 1.1 and 11.7 ± 1.2 g/dL, respectively. After primary TKA with auto-BT, the mean Hb concentration on day 0, 1, 3, 7, and 14 was 10.2 ± 1.2, 9.9 ± 1.2, 10.4 ± 1.3, 10.5 ± 1.3, and 11.0 ± 1.3 g/dL, respectively. Only one (1%) patient required additional allogenic blood transfusion. No patients developed cardiovascular events, and the 1- and 5-year postoperative mortality rate was 1.0% and 2.0%, respectively. Primary TKA with auto-BT showed relatively small perioperative changes in the Hb concentration, a low incidence of cardiovascular events, and a low mortality rate within 1 and 5 years postoperatively. These findings suggest that auto-BT, in which blood is preoperatively collected, is beneficial for patient safety and health, even if its cost-effectiveness may be debatable. Full article

(This article belongs to the Special Issue State-of-the-Art and Research on Joint Arthroplasties)

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8 pages, 781 KiB

Open AccessArticle

Stress Radiographs in the Posterior Drawer Position at 90° Flexion Should Be Used for the Evaluation of the PCL in CR TKA with Flexion Instability

by Lukas B. Moser, Matthias Koch, Silvan Hess, Ponnaian Prabhakar, Helmut Rasch, Felix Amsler and Michael T. Hirschmann

J. Clin. Med. 2022, 11(4), 1013; https://doi.org/10.3390/jcm11041013 - 15 Feb 2022

Cited by 2 | Viewed by 2213

Abstract

The purpose of this study was to define a cut-off value for the posterior drawer position in stress radiography that confirms an insufficiency of the posterior cruciate ligament (PCL) in cruciate-retaining (CR) total knee arthroplasty (TKA). In this retrospective study, 20 symptomatic patients with flexion instability and suspected PCL insufficiency in CR TKA were included. Asymptomatic patients served as an age- and sex-matched control group. All of the patients had undergone stress radiography, and the posterior translation was measured in a posterior drawer position at 30° and 90° flexion. The two groups were compared using t-tests and chi-square tests. The stress radiographs showed significantly more posterior translation in the symptomatic group (p < 0.01). Stress radiographs at 90° flexion more effectively discriminated between the patients with and without PCL insufficiency compared with those carried out at 30° flexion. Sensitivity and specificity testing revealed the best sensitivity (90.5%) and the best specificity (94.7%) at 90° posterior drawer radiographs at a cut-off value of 10 mm. Stress radiographs including the posterior drawer position at 90° flexion should be part of the diagnostic algorithm in patients with suspected flexion instability. A posterior translation of more than 10 mm in CR TKA strongly indicates an insufficiency of the PCL. Full article

(This article belongs to the Special Issue State-of-the-Art and Research on Joint Arthroplasties)

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12 pages, 386 KiB

Open AccessArticle

Prevention of Periprosthetic Joint Infection in Total Hip and Knee Replacement: One European Consensus

by Enrique Gómez-Barrena, Timothy Warren, Ian Walker, Neil Jain, Nanne Kort, François Loubignac, Simon Newman, Carsten Perka, Antonio Spinarelli, Michael R. Whitehouse, Luigi Zagra and Basilio J. De la Torre

J. Clin. Med. 2022, 11(2), 381; https://doi.org/10.3390/jcm11020381 - 13 Jan 2022

Cited by 7 | Viewed by 5121

Abstract

Periprosthetic joint infection (PJI) is a devastating complication in total hip and knee replacement. Its prevention is key to decrease the incidence and avoid some consequences that seriously impact patients and health systems. In view of the variety of recommendations and guidelines, we decided to conduct an expert, peer-reviewed European consensus analysis about the pre-, intra-, and postoperative prevention of PJI. A multinational group of practicing orthopedic experts developed a series of 47 consensus statements in 6 main groups of intervention, and a 2-stage Delphi approach was launched with a threshold for agreement at 75% and for very high agreement at more than 90%. A total of 306 orthopedic surgeon responses were gathered from 9 countries. Consensus was reached for 42/47 statements, 31/47 of which achieved a very high consensus. Many preoperative actions gathered strong consensus, although areas like the use of alcoholic chlorhexidine or the timing of hair removal did not attain strong consensus, despite available evidence. Intra- and postoperative actions showed more variability regarding incise drapes, skin suturing techniques, and wound follow-up. This study confirms an important consensus among orthopedic surgeons across Europe in many areas well known to contribute to the prevention of PJI; however, there are still grounds for improvement. Full article

(This article belongs to the Special Issue State-of-the-Art and Research on Joint Arthroplasties)

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14 pages, 3916 KiB

Open AccessArticle

Pulsatile Lavage Systems with High Impact Pressure and High Flow Produce Cleaner Cancellous Bone Prior to Cementation in Cemented Arthroplasty

by Kevin Knappe, Rudi G. Bitsch, Mareike Schonhoff, Tilman Walker, Tobias Renkawitz and Sebastian Jaeger

J. Clin. Med. 2022, 11(1), 88; https://doi.org/10.3390/jcm11010088 - 24 Dec 2021

Cited by 3 | Viewed by 2850

Abstract

In cemented joint arthroplasty, state-of-the-art cementing techniques include high-pressure pulsatile saline lavage prior to cementation. Even with its outstanding importance in cementation, there are surprisingly few studies regarding the physical parameters that define pulsatile lavage systems. To investigate the parameters of impact pressure, flow rate, frequency and the cleaning effect in cancellous bone, we established a standardized laboratory model. Standardized fat-filled carbon foam specimens representing human cancellous bone were cleaned with three different high-pressure pulsatile lavage systems. Via CT scans before and after cleaning, the cleaning effect was evaluated. All systems showed a cleaning depth of at least 3.0 mm and therefore can be generally recommended to clean cancellous bone in cemented joint arthroplasty. When comparing the three lavage systems, the study showed significant differences regarding cleaning depths and volume, with one system being superior to its peer systems. Regarding the physical parameters, high impact pressure in combination with high flow rate and longer distance to the flushed object seems to be the best combination to improve the cleaning of cancellous bone and therefore increase the chances of a deeper cement penetration that is required in cemented joint arthroplasty. In summary, this study provides the first standardized comparison of different lavage systems and thus gives initial guidance on how to optimally prepare cancellous bone for cemented joint arthroplasty. Full article

(This article belongs to the Special Issue State-of-the-Art and Research on Joint Arthroplasties)

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12 pages, 7927 KiB

Open AccessArticle

Glenoid Component Position Does Not Affect Short-Term Clinical and Radiologic Outcomes in Total Shoulder Arthroplasty

by Maciej J. K. Simon, Helen Crofts, Treny Sasyniuk, Kayla Johnston, Derek Plausinis, Zane D. S. Zarzour, Fay Leung, Patrick Y. K. Chin and William D. Regan

J. Clin. Med. 2021, 10(24), 5773; https://doi.org/10.3390/jcm10245773 - 9 Dec 2021

Cited by 1 | Viewed by 2522

Abstract

Background: Malpositioning of the glenoid component in total shoulder arthroplasty (TSA) remains the primary source of loosening. The purpose of this study is firstly, to quantify postoperative glenoid component position in patients having a TSA and secondly, to explore whether glenoid component radiolucency is associated with glenoid position, clinical outcomes and patient-reported measures in the short-term (two year) follow-up period. Methods: This study was a sub-study of a larger clinical trial that included patients who underwent a TSA and who were randomized into two different glenoid types with a minimum two-year follow-up period. Post-operative radiographic assessments (six weeks and two years) were used to measure glenoid component position (version, inclination, offset) and humeral head centering anterior–posterior (AP) and superior–inferior (SI), and to assess glenoid component radiolucent scoring (modified Lazarus). Pre-operative X-rays were used to measure glenoid version, inclination and Walch classification. Patient-reported measures (PROMs) included the EQ-5D health slider and the Western Ontario Osteoarthritis (WOOS) and American Shoulder and Elbow Surgeons (ASES) score and were captured at baseline and two years postoperative. Clinical outcomes including range of motion and complications were also documented. Statistical analysis included t-tests and regression modeling. Results: Ninety-one patients with an average age of 69.9 ± 6.2 years were included in this study. Glenoid component position improved significantly in version (−19.4 ± 8.6° to −17.7 ± 8.5°; p < 0.045) and inclination (11.5 ± 7.1° to 5.9 ± 6.3°; p < 0.00001) from preoperative to six weeks postoperative. Glenoid component offset in SI and humeral head centering in AP remained unchanged throughout the follow-up. Radiolucency (Lazarus classification) was recorded in 21 cases (17.3%) with a Lazarus score of 1 (15 cases) and 2 (6 cases). The EQ-5D health slider, WOOS and ASES, and ROM confirmed continuous improvements from the preoperative scores to the two-year follow-up (p < 0.05). Regression models showed no correlation between glenoid component radiolucency at two years and the postoperative week six glenoid component position; however, female gender was a significant variable. Conclusion: Glenoid component changes from its original native glenoid were observed following TSA. Glenoid inclination was improved more than version from baseline, and the humeral head remained well-centered in AP and SI at two years. Radiolucency of the glenoid at two years is not negatively associated with PROMs or component position; however, female gender was identified as a significant predictor and warrants further investigation. Complications are not associated with glenoid position or radiolucency, but longer-term follow-up is required. Full article

(This article belongs to the Special Issue State-of-the-Art and Research on Joint Arthroplasties)

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13 pages, 6028 KiB

Open AccessArticle

Does Additive Pressurized Carbon Dioxide Lavage Improve Cement Penetration and Bond Strength in Cemented Arthroplasty?

by Kevin Knappe, Christian Stadler, Moritz M. Innmann, Mareike Schonhoff, Tobias Gotterbarm, Tobias Renkawitz and Sebastian Jaeger

J. Clin. Med. 2021, 10(22), 5361; https://doi.org/10.3390/jcm10225361 - 17 Nov 2021

Cited by 1 | Viewed by 2594

Abstract

The modern cementing technique in cemented arthroplasty is a highly standardized and, therefore, safe procedure. Nevertheless, aseptic loosening is still the main reason for revision after cemented total knee or cemented total hip arthroplasty. To investigate whether an additional carbon dioxide lavage after a high-pressure pulsatile saline lavage has a positive effect on the bone–cement interface or cement penetration, we set up a standardized laboratory experiment with 28 human femoral heads. After a standardized cleaning procedure, the test implants were cemented onto the cancellous bone. Subsequently, the maximum failure load of the bone–cement interface was determined using a material testing machine to pull off the implant, and the cement penetration was determined using computed tomography. Neither the maximum failure load nor cement penetration into the cancellous bone revealed significant differences between the groups. In conclusion, according to our experiments, the additive use of the carbon dioxide lavage after the high-pressure pulsatile lavage has no additional benefit for the cleaning of the cancellous bone and, therefore, cannot be recommended without restrictions. Full article

(This article belongs to the Special Issue State-of-the-Art and Research on Joint Arthroplasties)

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13 pages, 3882 KiB

Open AccessArticle

Primary Stability in Hip Revision Arthroplasty: Comparison of the Stability of Cementless Fixed Augments on a Modular Acetabular Cage System with and without Cranial Straps

by Max Jaenisch, Hendrik Kohlhof, Dieter Christian Wirtz, Frank Alexander Schildberg, Nicholas A. Beckmann, Jan Philippe Kretzer, Mareike Schonhoff and Sebastian Jäger

J. Clin. Med. 2021, 10(17), 4002; https://doi.org/10.3390/jcm10174002 - 4 Sep 2021

Cited by 2 | Viewed by 2459

Abstract

The goal of this study is to evaluate the primary stability of a cementless augment-and-modular-cage system with and without the addition of cranial straps in a standardized in vitro setting. As the surrogate parameter for the evaluation of primary stability, the measurement of relative motion between the implant components themselves and the bone will be used. Acetabular revision components with a trabecular titanium augment in combination with a large fourth-generation composite left hemipelvis were assembled. These constructs were divided into two groups with (S) and without cranial straps (nS). A total of 1000 cycles was applied at each of three load levels. Relative movements (RM) between the components were measured. Load levels display a significant effect on the amount of RM at all interfaces except between shell/augment. The group assignment appears to have an effect on RM due to significantly differing means at all interfaces. Between bone/shell RM increased as load increased. NS displayed significantly more RM than S. Between shell/augment RM remained constant as load increased. Between shell/cup S showed more RM than nS while both groups’ RM increased with load. We conclude a significant increase of primary stability between the shell and the bone through the addition of cranial straps. Relative motion between components (shell/cup) increases through the addition of cranial straps. A clinical impact of this finding is uncertain and requires further investigation. Finally, the cementless fixation of the augment against the rim-portion of the shell appears stable and compares favorably to prior investigation of different fixation techniques. Full article

(This article belongs to the Special Issue State-of-the-Art and Research on Joint Arthroplasties)

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9 pages, 2190 KiB

Open AccessArticle

Long-Term Outcomes of Radial Head Arthroplasty in Complex Elbow Fracture Dislocation

by Alvin Chao-Yu Chen, You-Hung Cheng, Chih-Hao Chiu, Chun-Ying Cheng and Yi-Sheng Chan

J. Clin. Med. 2021, 10(16), 3488; https://doi.org/10.3390/jcm10163488 - 7 Aug 2021

Cited by 4 | Viewed by 2783

Abstract

The purpose of the current study was to investigate the long-term outcomes of radial head arthroplasty in complex elbow injuries through radiographic analysis and functional correlation. We evaluated 24 radial head arthroplasties in 24 consecutive patients with complex elbow fracture dislocation. All patients were treated with a single type of modular monopolar prosthesis containing smooth stem in press-fit implantation. Clinical survey using the Mayo Elbow Performance Score (MEPS), self-reported scales of shortened Disabilities of the Arm, Shoulder, and Hand (QuickDASH) and the visual analog scale (VAS) at more than 10-year follow-up were reported and compared to 2-year outcomes. Periprosthetic osteolysis was measured in the 10 zones of prosthesis-cortical interface with a modified radiolucency score, which was calibrated by each prosthesis size. Pearson correlation analysis was performed to detect the association between periprosthetic radiolucency and clinical assessment. At the final follow-up, MEPS, QuickDASH score and VAS score averaged 82.5 ± 15, 14.1 ± 14.3 and 1.6 ± 1.2 respectively. A decline in functional status was noted, with decreased mean MEPS and increased mean QuickDASH and VAS scores as compared to the 2-year results while the difference was insignificant. Periprosthetic osteolysis was more prevalent around stem tip of zone 3 and zone 8. The final and 2-year radiolucency scores averaged 7.4 ± 4.2 and 2.6 ± 2.3 respectively with significant difference. Pearson correlation analysis indicated that the difference between radiolucency scores and clinical outcomes in MEPS/QuickDASH/VAS was −0.836, 0.517 and 0.464. Progression of periprosthetic osteolysis after postoperative 10 years is more prevalent around the stem tip with moderate to high correlation to clinical outcomes. Sustained follow-up is warranted to justify subsequent surgery for revision or implant removal. Full article

(This article belongs to the Special Issue State-of-the-Art and Research on Joint Arthroplasties)

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