What are the influencing factors on hip and knee arthroplasty survival? Prospective cohort study on 63619 arthroplasties

Boyer, Bertrand; Bordini, Barbara; Caputo, Dalila; Néri, Thomas; Stea, Susanna; Toni, Aldo

doi:10.1016/j.otsr.2019.07.020

Cited by 31 publications

(18 citation statements)

References 35 publications

(38 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A registry-based population study has been conducted by reporting and analyzing data collected by the Emilia Romagna orthopaedic arthroplasty implants register (called RIPO) [ 3 , 4 , 6 ]. Emilia Romagna (ER) is an Italian region with 4.5 million inhabitants and reports data about hip, knee and shoulder arthroplasty procedures performed inside the region are collected in the register RIPO (Registro Implantologia Protesica Ortopedica).…”

Section: Methodsmentioning

confidence: 99%

Unicompartmental knee arthroplasty has higher revisions than total knee arthroplasty at long term follow-up: a registry study on 6453 prostheses

Martino

Bordini

Barile

et al. 2020

Knee Surg Sports Traumatol Arthrosc

View full text Add to dashboard Cite

Purpose The purpose of this study is to analyse long-term unicompartmental knee arthroplasty (UKA) focusing on survivorship, causes of failure and revision strategy. Methods This study is a retrospective analysis of data from a regional arthroplasty registry for cases performed between 2000 and 2017. A total of 6453 UKAs were identified and the following information was analysed: demographic data, diagnosis leading to primary implant, survivorship, complication rate, causes of failure, revision strategies. UKA registry data were compared with total knee arthroplasty (TKA) registry data of 54,012 prostheses, which were implanted in the same time period. Results 6453 UKAs were included in the study: the vast majority of them (84.4%) were implanted due to primary osteoarthritis followed by deformity (7.1%) and necrosis of the condyle (5.1%). When compared to TKA, UKA showed lower perioperative complication rate (0.3% compared to 0.6%) but higher revision rate (18.2% at 15 years, compared to 6.2% for TKA). No correlation was found between diagnosis leading to primary implant and prosthesis survival. The most frequent cause of failure was total aseptic loosening (37.4%), followed by pain without loosening (19.8%). Of the 620 UKAs requiring revision, 485 were revised with a TKA and 61 of them required a re-revision; on the other hand, of the 35 cases where another UKA was implanted, 16 required a re-revision. Conclusion UKA is associated with fewer perioperative complications but higher revision rates when compared to TKA. Its survivorship is not affected by the diagnosis leading to primary implant. Revision surgery of a failed UKA should be performed implanting a TKA, which is associated with a lower re-revision rate when compared to another UKA. Level of evidence Level 3, therapeutic study.

show abstract

Section: Methodsmentioning

confidence: 99%

Unicompartmental knee arthroplasty has higher revisions than total knee arthroplasty at long term follow-up: a registry study on 6453 prostheses

Martino

Bordini

Barile

et al. 2020

Knee Surg Sports Traumatol Arthrosc

View full text Add to dashboard Cite

show abstract

“…The result of a long-term activation of the inflammatory response in the tissue surrounding the implant is the activation of osteoclast at the bone-implant interface and the consequent bone resorption, eventually resulting in periprosthetic osteolysis a prosthetic loosening. Aseptic loosening is one of the major complications of arthroplasty, in particular hip and knee arthroplasty, limiting the implant longevity, according to for at least 50% of the cases of prosthetic revision surgery [5,12,[50][51][52]. The chronic inflammation is triggered by wear debris originated from the prosthetic biomaterial [53].…”

Section: Oxidative Stress In Aseptic Periprosthetic Osteolysismentioning

confidence: 99%

Effect of Oxidative Stress on Bone Remodeling in Periprosthetic Osteolysis

Galliera

Massaccesi

Banfi

et al. 2021

Clinic Rev Bone Miner Metab

View full text Add to dashboard Cite

The success of implant performance and arthroplasty is based on several factors, including oxidative stress-induced osteolysis. Oxidative stress is a key factor of the inflammatory response. Implant biomaterials can release wear particles which may elicit adverse reactions in patients, such as local inflammatory response leading to tissue damage, which eventually results in loosening of the implant. Wear debris undergo phagocytosis by macrophages, inducing a low-grade chronic inflammation and reactive oxygen species (ROS) production. In addition, ROS can also be directly produced by prosthetic biomaterial oxidation. Overall, ROS amplify the inflammatory response and stimulate both RANKL-induced osteoclastogenesis and osteoblast apoptosis, resulting in bone resorption, leading to periprosthetic osteolysis. Therefore, a growing understanding of the mechanism of oxidative stress-induced periprosthetic osteolysis and anti-oxidant strategies of implant design as well as the addition of anti-oxidant agents will help to improve implants’ performances and therapeutic approaches.

show abstract

“…Unfortunately, a prosthetic joint eventually requires revision, either due to mechanical failure (i.e. instability, malalignment or malpositioning) or loosening of the prosthesis [1,2]. Published records describe that around 10-20% of patients undergoing revision surgery have unexpected positive cultures during revision [3][4][5][6], and these patients have a worse outcome compared with aseptic cases [7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Should all hip and knee prosthetic joints be aspirated prior to revision surgery?

Staphorst

Jutte

Boerboom

et al. 2021

Arch Orthop Trauma Surg

View full text Add to dashboard Cite

Aims It is essential to exclude a periprosthetic joint infection (PJI) prior to revision surgery. It is recommended to routinely aspirate the joint before surgery. However, this may not be necessary in a subgroup of patients. The aim of our study was to investigate if specific clinical and implant characteristics could be identified to rule out a PJI prior to revision surgery. Methods We retrospectively evaluated clinical and implant characteristics of patients who underwent a hip or knee revision surgery between October 2015 and October 2018. Patients were diagnosed with a PJI according to the MSIS diagnostic criteria. Results A total of 156 patients were analyzed, including 107 implants that were revised because of prosthetic loosening and 49 because of mechanical failure (i.e. instability, malalignment or malpositioning). No PJI was diagnosed in the group with mechanical failure. In the prosthetic loosening group, 20 of 107 were diagnosed with a PJI (19%). Although there was a significantly lower chance of having a PJI with an implant age of > 5 years combined with a CRP < 5 mg/L, an infection was still present in 3 out of 39 cases (8%). Conclusion Implants with solely mechanical failure without signs of loosening and low inflammatory parameters probably do not require a synovial fluid aspiration. These results need to be confirmed in a larger cohort of patients. In case of prosthetic loosening, all joints need to be aspirated before surgery as no specific characteristic could be identified to rule out an infection.

show abstract

What are the influencing factors on hip and knee arthroplasty survival? Prospective cohort study on 63619 arthroplasties

Cited by 31 publications

References 35 publications

Unicompartmental knee arthroplasty has higher revisions than total knee arthroplasty at long term follow-up: a registry study on 6453 prostheses

Unicompartmental knee arthroplasty has higher revisions than total knee arthroplasty at long term follow-up: a registry study on 6453 prostheses

Effect of Oxidative Stress on Bone Remodeling in Periprosthetic Osteolysis

Should all hip and knee prosthetic joints be aspirated prior to revision surgery?

Contact Info

Product

Resources

About