Increased risk for extended acetabular reconstruction in failed hip resurfacing as compared to failed total hip arthroplasty.

Introduction: Hip resurfacing (HR) is intended to preserve the femoral bone stock during primary arthroplasty. On the other hand, little has been reported regarding the intraoperative need of bone reconstruction for extended acetabular defects during hip resurfacing revision. Thus, the aim of the presented study was to identify whether there is an increased need for acetabular bone reconstruction in HR revision surgery.

One-Stage Revision for Infected Total Hip Arthroplasty.

Prosthetic joint infection (PJI) is a challenging complication following total hip arthroplasty (THA). Two-stage exchange arthroplasty is preferred for treating chronic PJI of THA, although specialized centers have reported comparable outcomes with protocol-based, 1-stage exchange arthroplasty. A main requirement is presurgical determination of the infecting organism's sensitivity.

The differentiation of hMSCs counteracts their migration capability and pro-angiogenic effects in vitro.

Human mesenchymal stem cells (hMSCs) have been applied therapeutically in numerous clinical trials. The pro-angiogenic effects of hMSCs, as well as their strong tumor tropism, have been shown both in vitro and in vivo. Some studies suggest using hMSCs as potential drug-carriers for tumor therapy.

Allergic reactions in arthroplasty: myth or serious problem?

Purpose: The purpose of this study was to determine the prevalence of sensitisation to chromium, cobalt, nickel, or a cement component in patients who received endoprosthetic surgery at our institution. Also, we aimed to assess the portion related to allergic reactions in endoprosthetic revisions and to follow-up those patients after allergic reaction related revisions.

Methods: We selected patients with a pre-operative known sensitisation to chromium, cobalt, nickel, or a cement component for a post-operative allergic reaction.

Bioavailability of gentamicin and vancomycin released from an antibiotic containing bone cement in patients undergoing a septic one-stage total hip arthroplasty (THA) revision: a monocentric open clinical trial.

Background: The purpose of this clinical investigation was to evaluate the systemic bioavailability of antibiotics from bone cement after implantation. This was done by determining the concentrations of gentamicin and vancomycin in plasma and urine of patients receiving a novel bone cement during one-stage revision in periprosthetic hip infections. The local concentrations of both antibiotic agents in wound exudate as well as the efficacy and tolerability were assessed as a secondary objective.

The management of an infected total knee arthroplasty.

Periprosthetic joint infection (PJI) is one of the most feared and challenging complications following total knee arthroplasty. We provide a detailed description of our current understanding regarding the management of PJI of the knee, including diagnostic aids, pre-operative planning, surgical treatment, and outcome.

Treatment of Vancouver type B2 periprosthetic femoral fractures.

Purpose: Stem loosening in both cemented and uncemented total hip arthroplasty is the hallmark of the Vancouver type B2 classification of periprosthetic hip fractures.

Methods: We discuss the technique we use at our institution for treating these fractures.

Results: Periprosthetic femoral-shaft fractures are associated with a relatively high mortality rate, approximating that of patients with hip fractures.

One-stage exchange for prosthetic joint infection of the hip.

Exchange arthroplasty remains the gold standard of treatment of established prosthetic joint infection. This can be achieved using a one or two stage approach. The ENDO-Klinik, in Hamburg, has pioneered the one-stage technique since 1970 utilising antibiotic loaded acrylic cement (ALAC).

Can Good Infection Control Be Obtained in One-stage Exchange of the Infected TKA to a Rotating Hinge Design? 10-year Results.

Background: Prosthetic joint infection (PJI) occurs in 1% to 2% of total knee arthroplasties (TKAs). Although two-stage exchange is the preferred management method of patients with chronic PJI in TKA in North America, one-stage exchange is an alternative treatment method, but long-term studies of this approach have not been conducted.

Questions/purposes: We reviewed our minimum 9-year results of 70 patients who underwent one-stage exchange arthroplasty with a rotating hinge design to determine: (1) What was the proportion of patients free of infection? (2) What was the patient rate of survival free of any reoperation? (3) What were the clinical outcomes as measured by Hospital for Special Surgery scores? (4) What proportion of patients developed radiographic evidence of loosening?

Methods: All one-stage revision TKAs for infection between January 1 and December 31, 2002, with a minimum 9-year followup (mean, 10 years; range, 9-11 years), in which patients had been seen within the last 1 year, were included in this retrospective review.

Human mesenchymal stem cells enhance cancer cell proliferation via IL-6 secretion and activation of ERK1/2.

Human mesenchymal stem cells (hMSC) are frequently used in tissue engineering. Due to their strong tumor tropism, hMSC seem to be a promising vehicle for anticancer drugs. However, interactions between hMSC and cancer are ambiguous.

Total knee arthroplasty in patients with skeletal dysplasia.

Introduction: Dwarfism is a challenge in arthroplasty. The anatomical features provide a lot of pitfalls. The aim of this study was to follow-up growth-restricted patients after endoprosthetic treatment.

Septic single-stage knee arthrodesis after failed total knee arthroplasty using a cemented coupled nail.

Knee arthrodesis is a potential salvage procedure for limb preservation after failure of total knee arthroplasty (TKA) due to infection. In this study, we evaluated the outcome of single-stage knee arthrodesis using an intramedullary cemented coupled nail without bone-on-bone fusion after failed and infected TKA with extensor mechanism deficiency. Between 2002 and 2012, 27 patients (ten female, 17 male; mean age 68.

Modes of failure and revision of failed lateral unicompartmental knee arthroplasties.

Background: Even with the resurgence of interest in unicompartmental knee arthroplasty (UKA) in recent years, lateral UKA is still performed 10 times less frequently than medial UKA. Hence, because of the infrequency of this procedure, a paucity of outcome studies exist on lateral unicompartmental knee arthroplasty. This retrospective study was performed to analyze the main causes of failure, as well as the time to failure following lateral UKA.

Total Hip Arthroplasty in Patients with Skeletal Dysplasia.

127 patients with a height ≤ 150 cm (non metric ≤ 4 feet and 11 inches) who received hip arthroplasty surgery between July 1, 2006 and May 30, 2013 at our institution were enrolled. Retrospective data evaluation was performed for two different times of follow-up (1 year and 5 years respectively). 115 patients were evaluated for 1-year follow up.

Fungal periprosthetic joint infection of the hip: a systematic review.

Periprosthetic joint infection (PJI) is a severe complication of total joint arthroplasty with an incidence of approximately 1%. Due to the high risk of persisting infection, successful treatment of fungal PJI is challenging. The purpose of this study was to gain insight into the current management of fungal PJI of the hip and, by systematically reviewing the cases published so far, to further improve the medical treatment of this serious complication of total hip arthroplasty.

Fungal periprosthetic joint infection in total knee arthroplasty: a systematic review.

Fungal periprosthetic joint infection (PJI) is a rare but devastating complication following total knee arthroplasty (TKA). A standardized procedure regarding an accurate treatment of this serious complication of knee arthroplasty is lacking. In this systematic review, we collected data from 36 studies with a total of 45 reported cases of a TKA complicated by a fungal PJI.

[CD15 focus score for diagnostics of periprosthetic joint infections : Neutrophilic granulocytes quantification mode and the development of morphometric software (CD15 quantifier)].

Background: The aim of this project was to devise a quantification method for neutrophils within a single focal point through the development of a CD15 focus score which enables bacterial infections in synovial-like interface membranes (SLIM) to be diagnosed.

Methods: In this study a histopathological classification of 91 SLIM removed during revision surgery from the hips (n = 59) and knees (n = 32) was performed. Neutrophils were identified immunohistochemically by means of a CD15-specific monoclonal antibody.

[Revision arthroplasty : Histopathological diagnostics in periprosthetic joint infections].

Background: Histopathological differences in synovia and synovial-like interface membrane (SLIM) patterns can be used to differentiate periprosthetic particle-induced reactions, bacterial infections (bacterial synovitis and osteomyelitis), mechanical-induced tissue alterations, adverse reactions to implant material, and arthrofibrosis (SLIM consensus classification).

Aim: Because of differences in treatment the diagnosis of a bacterial implant infection is very important. Histopathological tests and scoring systems are important diagnostic tools in identifying deep implant infections in patients with unclear clinical history as well as radiographic and laboratory studies.

Are patients with preoperative air travel at higher risk for venous thromboembolism following primary total hip and knee arthroplasty?

Background: The advent of international medical travel has resulted in many patients travelling abroad to seek medical attention at foreign institutions. However, it is not known whether long-haul flights further increase the risk of VTE in patients who are to receive a joint replacement.

Objectives: We performed this retrospective cohort study to analyze if patients with preoperative air travel with a flight time more than four hours are at higher risk for VTE development following total knee or total hip athroplasty (THA) compared to patients without preoperative travel.

[The use of tantalum cones for reconstruction of bone defects in revision total knee arthroplasty].

Objective: Revision arthroplasty of the knee is often associated with substantial femoral and/or tibial bone loss. Tantalum cones are used to reconstruct these defects and to improve initial stability. This requires an implantation in the "press-fit" technique with maximum contact to the host bone.

Synovial C-reactive protein as a marker for chronic periprosthetic infection in total hip arthroplasty.

The aim of this study was to assess the role of synovial C-reactive protein (CRP) in the diagnosis of chronic periprosthetic hip infection. We prospectively collected synovial fluid from 89 patients undergoing revision hip arthroplasty and measured synovial CRP, serum CRP, erythrocyte sedimentation rate (ESR), synovial white blood cell (WBC) count and synovial percentages of polymorphonuclear neutrophils (PMN). Patients were classified as septic or aseptic by means of clinical, microbiological, serum and synovial fluid findings.

Overweight and obesity in hip and knee arthroplasty: Evaluation of 6078 cases.

Aim: To evaluate a possible association between the various levels of obesity and peri-operative charac-teristics of the procedure in patients who underwent endoprosthetic joint replacement in hip and knee joints.

Methods: We hypothesized that obese patients were treated for later stage of osteoarthritis, that more conservative implants were used, and the intra-and perioperative complications increased for such patients. We evaluated all patients with body mass index (BMI) ≥ 25 who were treated in our institution from January 2011 to September 2013 for a primary total hip arthroplasty (THA) or total knee arthroplasty (TKA).

Revised histopathological consensus classification of joint implant related pathology.

This extended classification of joint implant related pathology is a practical histopathologic classification based on defined morphological criteria covering the complete spectrum of pathohistologic changes in periprosthetic tissues. These changes may occur as a consequence of endoprosthetic replacement of large joints and may lead to a reduction in the prosthesis survival rate. We describe the established consensus classification of the periprosthetic membrane, in which aseptic and septic prosthetic loosening can be subdivided into four histological types, as well as histopathological criteria for additional significant pathologies including endoprosthetic-associated arthrofibrosis, particle-induced immunological, inflammatory and toxic mechanisms (adverse reactions), and bone tissue pathologies.

Vascularization of engineered cartilage constructs in a mouse model.

Tissue engineering of cartilage tissue offers a promising method for reconstructing ear, nose, larynx and trachea defects. However, a lack of sufficient nutrient supply to cartilage constructs limits this procedure. Only a few animal models exist to vascularize the seeded scaffolds.

The role of hinges in primary total knee replacement.

The use of hinged implants in primary total knee replacement (TKR) should be restricted to selected indications and mainly for elderly patients. Potential indications for a rotating hinge or pure hinge implant in primary TKR include: collateral ligament insufficiency, severe varus or valgus deformity (>20°) with necessary relevant soft-tissue release, relevant bone loss including insertions of collateral ligaments, gross flexion-extension gap imbalance, ankylosis, or hyperlaxity. Although data reported in the literature are inconsistent, clinical results depend on implant design, proper technical use, and adequate indications.