The aim of the thesis was to contribute to a better understanding of the influence of differences in implant design and surgical techniques on the migration of total knee arthroplasties (TKAs) and,... Show moreThe aim of the thesis was to contribute to a better understanding of the influence of differences in implant design and surgical techniques on the migration of total knee arthroplasties (TKAs) and, more broadly, the effect of using Radiostereometric Analysis (RSA) and other markers to detect early loosening. In this thesis, we compared various types of TKAs in different randomized controlled trials. Additionally, we investigated whether the positioning of TKAs relative to the patient's specific leg axis (e.g., neutral, varus, or valgus alignment) affects the stability of the prosthesis. We also analyzed, by combining registry data with data from a meta-analysis, whether TKAs evaluated with migration analysis (radiostereometric analysis; RSA) yield better results than TKAs that have not been previously examined with RSA. Finally, we conducted a systematic review to explore whether there are markers that can indicate loosening/failure of a prosthesis. Show less
Background: A tourniquet is often used to create a bloodless surgical field during total knee arthroplasty (TKA). It is still debated whether tourniquet use improves durability of cemented implant... Show moreBackground: A tourniquet is often used to create a bloodless surgical field during total knee arthroplasty (TKA). It is still debated whether tourniquet use improves durability of cemented implant fixation and thereby prosthesis survival. Some studies showed tourniquet application has a negative impact on post-operative wound healing, pain and function, whilst other publications contradict this. However, no previous studies evaluated the effect of tourniquet use on prosthesis survival and mid-term functional outcome specifically. Methods: In this longitudinal observational cohort study 115 patients (116 knees) undergoing TKA without tourniquet use were compared with 374 patients (395 knees) with a tourniquet. Prosthesis survival, revision risks and complications were analysed through chart review after a mean follow-up period of 5.3 years. Additionally, patient reported outcome measures regarding knee functionality and health status (PROMs; KOOS, OKS, EQ-5D, SF-12) were collected prospectively. Results: Both groups had an equal overall re-operation rate of 4.3% and showed similar revision rates for aseptic loosening as well as for other causes. In the tourniquet group a higher complication rate (14.7% vs 10.3%) was observed. The majority was urinary retention requiring bladder catheterization. Both groups showed comparable, improved post-operative functional results compared to the pre-operative state for all PROMs at all time points. Conclusions: In this study TKA without tourniquet use yielded similar mid-term results as TKA with tourniquet use with regard to prosthesis survival, reoperations, complications, knee functionality and health status.(c) 2022 Elsevier B.V. All rights reserved. Show less
Improving implant longevity is an eminent challenge in joint replacement surgery with aseptic loosening as the major reason for early failure necessitating revision surgery in both total hip and... Show moreImproving implant longevity is an eminent challenge in joint replacement surgery with aseptic loosening as the major reason for early failure necessitating revision surgery in both total hip and total knee arthroplasty (THA and TKA). Analysis of implant fixation by measuring migration with roentgen stereophotogrammetric analysis (RSA) has shown that the loosening process starts at very early onset after implantation. Implants showing relative high migration during the first post-operative year are prone to failure and subsequent revision later on. However, it is still not crystallized how specific implant characteristics or the surgical procedure affect the implant migration pattern and what degree of initial migration is acceptable without jeopardizing longevity of implant fixation at 10-20 years. In this thesis the migration pattern in relation to longevity of both cemented and cementless stems in THA, the influence of mobile-bearings in TKA on migration and survival, and methods to instantly evaluate implant fixation by inducible displacement have been studied. Show less
Loon, J. van; Sierevelt, I.N.; Spekenbrink-Spooren, A.; Opdam, K.T.M.; Poolman, R.W.; Kerkhoffs, G.M.M.J.; Haverkamp, D. 2022
Background and purpose: The influence of bearing on short-term revision in press-fit total hip arthroplasty (THA) remains under-reported. The aim of this study was to describe 2-year cup revision... Show moreBackground and purpose: The influence of bearing on short-term revision in press-fit total hip arthroplasty (THA) remains under-reported. The aim of this study was to describe 2-year cup revision rates of ceramic-on-ceramic (CoC) and ceramic-on-polyethylene (CoPE). Patients and methods: Primary press-fit THAs with one of the three most used cups available with both CoC or CoPE bearing recorded in the Dutch Arthroplasty Register (LROI) were included (2007-2019). Primary outcome was 2-year cup revision for all reasons. Secondary outcomes were: reasons for revision, incidence of different revision procedures and use of both bearings over time. Results: 2-year Kaplan-Meier cup revision rate in 33,454 THAs (12,535 CoC; 20,919 CoPE) showed a higher rate in CoC (0.67% [95% CI, 0.54-0.81]) compared to CoPE (0.44% [95% CI, 0.34-0.54]) (p = 0.004). Correction for confounders (age, gender, cup type, head size) resulted in a hazard ratio (HR) of 0.64 [95%CI, 0.48-0.87] (p = 0.019). Reasons for cup revision differed only by more cup revision due to loosening in CoC (26.2% vs.1 3.2%) (p = 0.030). For aseptic loosening a revision rate of 0.153% [95% CI, 0.075-0.231] was seen in CoC and 0.058% [95%CI 0.019-0.097] in CoPE (p = 0.007). Correction for head size resulted in a HR of 0.475 [95% CI, 0.197-1.141] (p = 0.096). Incidence of different revision procedures did not differ between bearings. Over time the use of CoPE has increased and CoC decreased. Conclusions: A higher 2-year cup revision rate in press-fit THA was observed in CoC compared to CoPE. Cup loosening was the only significantly different reason for revision and seen more often in CoC and mostly aseptic. Future randomised controlled trials need to confirm causality, since the early cup revision data provided has the potential to be useful when choosing the bearing in press-fit THA, when combined with other factors like bone quality and patient and implant characteristics. Show less
Loon, J. van; Sierevelt, I.N.; Spekenbrink-Spooren, A.; Opdam, K.T.M.; Poolman, R.W.; Kerkhoffs, G.M.M.J.; Haverkamp, D. 2022
Background and purpose: The influence of bearing on short-term revision in press-fit total hip arthroplasty (THA) remains under-reported. The aim of this study was to describe 2-year cup revision... Show moreBackground and purpose: The influence of bearing on short-term revision in press-fit total hip arthroplasty (THA) remains under-reported. The aim of this study was to describe 2-year cup revision rates of ceramic-on-ceramic (CoC) and ceramic-on-polyethylene (CoPE). Patients and methods: Primary press-fit THAs with one of the three most used cups available with both CoC or CoPE bearing recorded in the Dutch Arthroplasty Register (LROI) were included (2007-2019). Primary outcome was 2-year cup revision for all reasons. Secondary outcomes were: reasons for revision, incidence of different revision procedures and use of both bearings over time. Results: 2-year Kaplan-Meier cup revision rate in 33,454 THAs (12,535 CoC; 20,919 CoPE) showed a higher rate in CoC (0.67% [95% CI, 0.54-0.81]) compared to CoPE (0.44% [95% CI, 0.34-0.54]) (p = 0.004). Correction for confounders (age, gender, cup type, head size) resulted in a hazard ratio (HR) of 0.64 [95%CI, 0.48-0.87] (p = 0.019). Reasons for cup revision differed only by more cup revision due to loosening in CoC (26.2% vs.1 3.2%) (p = 0.030). For aseptic loosening a revision rate of 0.153% [95% CI, 0.075-0.231] was seen in CoC and 0.058% [95%CI 0.019-0.097] in CoPE (p = 0.007). Correction for head size resulted in a HR of 0.475 [95% CI, 0.197-1.141] (p = 0.096). Incidence of different revision procedures did not differ between bearings. Over time the use of CoPE has increased and CoC decreased. Conclusions: A higher 2-year cup revision rate in press-fit THA was observed in CoC compared to CoPE. Cup loosening was the only significantly different reason for revision and seen more often in CoC and mostly aseptic. Future randomised controlled trials need to confirm causality, since the early cup revision data provided has the potential to be useful when choosing the bearing in press-fit THA, when combined with other factors like bone quality and patient and implant characteristics. Show less
The longevity of total knee implants may be impaired by aseptic loosening of the components within the bone. Aseptic loosening remains the leading cause of revision surgery. In the past decades,... Show moreThe longevity of total knee implants may be impaired by aseptic loosening of the components within the bone. Aseptic loosening remains the leading cause of revision surgery. In the past decades, many implant design aspects and surgical techniques have been changed in an attempt to decrease the risk of loosening. Given that radiostereometric analysis (RSA) is a highly accurate method to detect early implant migration which is predictive for late loosening, new implant designs should ideally be tested with RSA before widespread introduction onto the market. In this thesis, we present the results of four randomized controlled trials studying the effect of such changes in design on implant migration with use of RSA. We also pooled several RSA studies to be able to analyze the effect of other possible risk factors, including patient characteristics and surgical technique. We show that slight changes in implant design may increase the risk of loosening considerably, while other factors that are often thought to be associated with an increased risk (such as a high body mass index) do not appear to have a large effect. Show less
The research in this thesis represents part of a project aimed at developing a minimally invasive treatment for aseptic loosened orthopaedic implants (e.g. hip-, knee implants). The objective of... Show moreThe research in this thesis represents part of a project aimed at developing a minimally invasive treatment for aseptic loosened orthopaedic implants (e.g. hip-, knee implants). The objective of the research described in this thesis is to increase the knowledge on the biology behind the process of aseptic loosening. For this purpose, we aim to study the loosening process from three different biological perspectives, according to the following research questions: 1. Does the cellular content of peri-prosthetic interface tissue shed new light on the mechanism of implant loosening? 2. Do peri-prosthetic interface tissue cells possess osteogenic potential, which can ultimately be used to prevent or slow loosening? 3. Does the individual host immune response relate to prosthesis migration, which can ultimately predict loosening? Ultimately, these findings may lay down the foundation for the identification of biological targets to counteract the aseptic implant loosening process. Ultimately this knowledge provides the basis for the development of therapeutic strategies for the treatment of loosened prostheses at an earlier stage, before gross loosening due to severe osteolysis is present. In the end, this will hopefully result in the redundancy of extensive revision surgery, with high risk of morbidity to the patient might be prevented. Show less
In dit proefschrift heb ik onderzocht wat de klinische waarde is van migratie van totale knie protheses (TKP) en totale heup protheses (THP) gemeten met Radiostereometrische Analyse (RSA)in de... Show moreIn dit proefschrift heb ik onderzocht wat de klinische waarde is van migratie van totale knie protheses (TKP) en totale heup protheses (THP) gemeten met Radiostereometrische Analyse (RSA)in de context van een gefaseerde klinische introductie. De studies in dit proefschrift tonen aan dat onveilige (hoog revisie percentage voor loslating) TKP en THP met RSA studies kunnen worden ge_dentificeerd in slechts 2 jaar follow-up. Vroege identificatie met RSA van deze onveilige TKP en THP voorkomt wijdverbreide gebruik. De gefaseerde klinische introductie van nieuwe implantaten op basis van RSA studies met 2 jaar follow-up kan leiden tot betere en veiligere pati_ntzorg en tot een reductie van de kosten in de zorg ten gevolge van revisie van TKP en THP. Follow-up in nationale implantaten registers is noodzakelijk om de resultaten van de implantaten te blijven vervolgen, nadat deze op de markt zijn gekomen. Show less
