Total knee arthroplasty in young patients: Factors predictive of aseptic failure in the 2nd–4th decade

Camus, Tristan; Long, William J.

doi:10.1016/j.jor.2017.11.004

Cited by 11 publications

(3 citation statements)

References 29 publications

(36 reference statements)

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“…Eines der wichtigsten spezifischen Risiken bei jungen Patienten nach Knietotalprothesenimplantation ist die Gestaltung ihrer körperlichen Aktivität. Während bei Camus und Kollegen [ 9 ] ein klarer Zusammenhang zwischen Aktivität und dem Auftreten einer aseptischen Lockerung bestand, zeigen andere Studien gegensätzliche Resultate: Huch et al. [ 18 ] fanden hinsichtlich der Langzeitergebnisse (Follow-Up ≥ 5 Jahre) keinen negativen Einfluss von „Non-Impact“-Sportarten auf das Versagensrisiko.…”

Section: Versagensgründe Für Die Ktep Beim Jungen Patienten – Spezifische Aspekteunclassified

Bikondylärer Oberflächenersatz des Kniegelenkes beim jungen Patienten – ein Update

Egloff¹,

Hirschmann

Moret

et al. 2021

Orthopäde

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ZusammenfassungDie Zahl der durchgeführten Knietotalendoprothesen (KTEP) nimmt jedes Jahr kontinuierlich zu. Ungefähr 10 % davon betreffen Patienten unter 55 Jahren, obwohl bekannt ist, dass in dieser Altersgruppe die Zufriedenheit und die funktionellen Ergebnisse geringer und die Revisionsrate höher ausfällt. Vermehrte Aktivität und erhöhtes Anspruchsdenken machen die Endoprothetik in dieser Altersgruppe zu einer besonderen Herausforderung. Gleichzeitig ist der Anteil posttraumatischer Gonarthrosen deutlich erhöht, was in Anbetracht ligamentärer und knöcherner Vorschäden eine schwierigere operative Versorgung bedeutet. Bei fortgeschrittenen Arthrosen in mehreren Kompartimenten mit/ohne begleitender ligamentärer Instabilität muss jedoch ein totalendoprothetischer Ersatz auch bei jüngeren Patienten erwogen werden. Die sorgfältige Indikationsstellung für die KTEP und die eingehende Patientenaufklärung (Chancen, Risiken, erreichbare Leistungsfähigkeit in Beruf und Alltag) sind gerade bei jüngeren Patienten starke Prädiktoren für ein gutes Resultat.

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Section: Versagensgründe Für Die Ktep Beim Jungen Patienten – Spezifische Aspekteunclassified

Bikondylärer Oberflächenersatz des Kniegelenkes beim jungen Patienten – ein Update

Egloff¹,

Hirschmann

Moret

et al. 2021

Orthopäde

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“…The aseptic loosening of endoprosthetic implants occurs in about 15–20% of all patients within 20 years after joint replacement (TJR) [ 1 ]. Due to the increasing number of TJR implantations, especially in younger patients, it is thought that the problem of aseptic loosening will increase in the future [ 2 , 3 , 4 ]. The most common revision diagnoses in total knee replacements are loosening (39.9%), infection (27.4%), instability (7.5%), a periprosthetic fracture (4.7%) and arthrofibrosis (4.5%) [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

CoNiCrMo Particles, but Not TiAlV Particles, Activate the NLRP3 Inflammasome in Periprosthetic Cells

Brunken

Senft

Herbster

et al. 2023

IJMS

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Aseptic loosening is the main reason for arthroplasty failure. The wear particles generated at the tribological bearings are thought to induce an inflammatory tissue response, leading to bone loss and the subsequent loosening of the implant. Different wear particles have been shown to activate the inflammasome, thereby contributing to an inflammatory milieu in the direct vicinity of the implant. The aim of this study was to investigate whether the NLRP3 inflammasome is activated by different metal particles in vitro and in vivo. Three different cell lines representing periprosthetic cell subsets (MM6, MG63 and Jurkat) were incubated with different amounts of TiAlV or CoNiCrMo particles. The activation of the NLRP3 inflammasome was determined through the detection of the caspase 1 cleavage product p20 in a Western blot. The formation of the inflammasome was also investigated in vivo using immunohistological staining for ASC in primary synovial tissues as well as tissues containing TiAlV and CoCrMo particles and in vitro after the stimulation of the cells. The results show that the CoCrMo particles induced ASC more markedly, as a readout for inflammasome formation in vivo, compared to TiAlV particular wear. The CoNiCrMo particles also induced ASC-speck formation in all the tested cell lines, which was not induced by the TiAlV particles. The Western blot shows that NRLP3 inflammasome activation, measured through caspase 1 cleavage, was increased only by the CoNiCrMo particles in the MG63 cells. We conclude from our data that the activation of the inflammasome is mainly driven by CoNiCrMo particles and less by TiAlV particles, indicating that different inflammatory pathways are activated by the different alloys.

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“…More than 20% of the patients are not satisfied with the clinical outcome, resulting in about 35% of revision subjects within 2 years of the primary TKA. Increased failure rate has been attributed to several causes, including aseptic loosening, joint instability, infection, malalignment, malposition, arthrofibrosis, periprosthetic fracture, patellar complications, and so on. A femoral rotational alignment in transverse plane is necessary for postoperative flexion stability, tibiofemoral and patellofemoral kinematics.…”

Section: Introductionmentioning

confidence: 99%

Accuracy of a Novel 3D‐Printed Patient‐Specific Intramedullary Guide to Control Femoral Component Rotation in Total Knee Arthroplasty

Sun

Zhang

Peng

et al. 2020

Orthopaedic Surgery

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Objective: Total knee arthroplasty (TKA) is one of the most universal and effective means for treating terminal stage osteoarthritis (OA) of knee. Accurate intramedullary guide of femur is the basis for the distal femoral cuts. Determining the surgical transepicondylar axis (sTEA) is the key to reconstruction of the femoral rotational alignment, because the correct rotational alignment can place the femoral component in the right position, balance the flexion gap so that the inner and outer tension is equal, get stability during the flexion process of the knee, and enhance the quality of life of patients. With the development of three-dimensional printing (3DP) technology in the medical domain, the application of patient-specific instrumentation (PSI) in arthroplasty has become more common. The aim of this study was to evaluate the accuracy of a novel 3D-printed patient-specific intramedullary guide to control femoral component rotation in TKA.Methods: Eighty patients (65 females and 15 males) with knee OA were included in this prospective randomized study. The patients were divided into two groups by random number table method, 40 in each group. TKA assisted by PSI (PSI group) and conventional TKA (conventional group) was performed respectively. Clinical outcomes [operation time, postoperative drainage volume, duration of drainage, Hospital for Special Surgery knee score (HSS), American Knee Society knee score (AKS)] and radiological outcomes [hip-knee-ankle angle (HKA), posterior condylar angle (PCA), patella transverse axis-femoral transepicondylar axis angle (PFA), depth of intramedullary guide] were compared between and within the two groups.Results: PSI group had less postoperative drainage volume but longer operation time than the conventional group (P < 0.05). The AKS and HSS scores after surgery were improved compared with those before surgery in each group (P < 0.05). However, there was no significant difference in the duration of drainage and range of motion (ROM) after surgery between the two groups. For the radiological results, the HKA and PFA were improved after surgery in both groups (P < 0.05).The postoperative PFA and PCA of the PSI group were closer to 0 , which was better than that of the conventional group (P < 0.05). The depth of intramedullary guide in the PSI group was less than the conventional group (P < 0.05). But there was no significant difference in HKA before and after surgery between the two groups as well as the preoperative PFA. Conclusion:The short-term clinical efficacy of TKA assisted by PSI was similar to the conventional TKA. Although TKA assisted by PSI spent more time during operation, it could assist in intramedullary guide and align femoral rotation more accurately.

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Total knee arthroplasty in young patients: Factors predictive of aseptic failure in the 2nd–4th decade

Abstract: This study helps better identify the etiology of failed young patient TKA.

Cited by 11 publications

References 29 publications

Bikondylärer Oberflächenersatz des Kniegelenkes beim jungen Patienten – ein Update

Bikondylärer Oberflächenersatz des Kniegelenkes beim jungen Patienten – ein Update

CoNiCrMo Particles, but Not TiAlV Particles, Activate the NLRP3 Inflammasome in Periprosthetic Cells

Accuracy of a Novel 3D‐Printed Patient‐Specific Intramedullary Guide to Control Femoral Component Rotation in Total Knee Arthroplasty

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