Introduction: The main aim was to analyse the series of 29 collected cemented Charnley-Muller Alivium retrievals with the meantime in situ of 27 years. In addition, the revision rate of 1425 Alivium prostheses implanted at our institution between 1977 and 1992 was calculated.
Materials And Methods: The revision percentage of the Alivium cohort was calculated up to 45 years of follow-up and compared to that of all total hip arthroplasties (THAs) implanted in the same period (No. 5535). Metal and polyethylene retrieved components were inspected in 29 cases for wear damage and roughness. Wear particles were retrieved from periprosthetic tissue using digestion protocols and their composition, morphology, and size distribution were investigated. Periprosthetic tissue was analysed histologically.
Results: The revision percentage of the Alivium cohort was 16% at 45 years of follow-up. It was comparable to all the THAs implanted at the same time (18%). The shape of polyethylene particles isolated from periprosthetic tissue corresponded to the wear pattern on polyethylene cups. Polyethylene particles were the main wear product, with the majority (68%) of particles smaller than 0.1 µm. Metal particles were rare with two types: CoCr and Cr based. Histological analysis showed that in 14 out of 18 specimens, the metal particles were graded + 1, reflecting that the metal loading in the periprosthetic tissue was low.
Conclusions: Our study represents valuable data not reported previously on the survival rate of Charnley-Muller prostheses at 45 years of follow-up and a unique insight into the collected retrievals from the materials' point of view.
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http://dx.doi.org/10.1007/s00402-023-04824-y | DOI Listing |
Germs
September 2024
MD, PhD, Professor, Department of Orthopedics, Carol Davila University of Medicine and Pharmacy, No. 8 Eroii Sanitari Boulevard, Bucharest, 050474, Romania.
Introduction: This paper examines the use of local antibiotic therapy in one-stage septic revision surgery for late periprosthetic joint infections (PJIs). This case study suggests that morselized bone allografts impregnated with antibiotics in powder form are a preferable alternative to polymethyl methacrylate (PMMA) because they can generate higher local antibiotic concentrations. Current research also recommends using vancomycin and aminoglycosides as the preferred choice of antibiotics, as they may have low diffusion in tissues when administered intravenously, but are effective when administered locally.
View Article and Find Full Text PDFJBJS Essent Surg Tech
January 2025
Shoulder and Elbow Service, Florida Orthopaedic Institute, Tampa, Florida.
Background: The incidence of revision shoulder arthroplasty continues to rise, and infection is a common indication for revision surgery. Treatment of periprosthetic joint infection (PJI) in the shoulder remains a controversial topic, with the literature reporting varying methodologies, including the use of debridement and implant retention, single-stage and 2-stage surgeries, antibiotic spacers, and resection arthroplasty. Single-stage revision has been shown to have a low rate of recurrent infection, making it more favorable because it precludes the morbidity of a 2-stage operation.
View Article and Find Full Text PDFOper Orthop Traumatol
January 2025
AOFE Clinics Oosterbeek, Oosterbeek, The Netherlands.
Objective: Transcutaneous osseointegration prosthetic systems (TOPS) offer a stable skeletal attachment for artificial limbs post-extremity amputation, serving as an alternative to socket attachment. Press-fit osseointegration implants (OI) utilized in TOPS consistently enhance quality of life and mobility for amputees, particularly those experiencing socket-related issues. Despite notable benefits, late complications such as infection and implant loosening pose challenges unique to TOPS due to their percutaneous nature.
View Article and Find Full Text PDFPharmaceuticals (Basel)
November 2024
Department of Orthopaedic Surgery and Musculoskeletal Tissue Regeneration, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr. 11, 97074 Wuerzburg, Germany.
The aim of our study was to examine the combined effects of tranexamic acid (TXA) and vancomycin powder (VP) on chondrocytes in vitro. Despite the use of TXA and VP being linked to a reduced risk of extensive postoperative blood loss and periprosthetic joint infections (PJIs) in TKA, the possible cytotoxic side effects on periarticular cell types remain unclear. Human chondrocytes were harvested from hyaline cartilage and expanded in monolayer culture before being simultaneously exposed to different concentrations of TXA and VP for varying exposure times.
View Article and Find Full Text PDFRevision total knee arthroplasty (rTKA) is an increasingly common challenge for arthroplasty surgeons. The survivorship of rTKA is significantly lower than that of primary total knee arthroplasty, resulting in an increasing incidence of repeat rTKA. These cases present multifactorial challenges including the skin and soft-tissue envelopes, bone loss, ligamentous compromise, and often a history of periprosthetic joint infection.
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