Background: Loosening is a major cause for failure of total hip and total knee arthroplasties (THAs/TKAs). Preemptive diagnostics of asymptomatic loosening could open strategies to prevent gross... Show moreBackground: Loosening is a major cause for failure of total hip and total knee arthroplasties (THAs/TKAs). Preemptive diagnostics of asymptomatic loosening could open strategies to prevent gross loosening. A multitude of biomarkers may discriminate between loosened and stable implants, but it is unknown which have the best performance. The present systematic review aimed to assess which biomarkers have shown the most promising results in discriminating between stable and aseptic loosened THAs and TKAs.Methods: PubMed, Embase, Web of Science, Cochrane Library, and Academic Search Premier were systematically searched up to January 2020 for studies including THA/TKA and biomarkers to assess loosening. Two reviewers independently screened records, extracted data, and assessed the risk of bias using the ICROMS tool to classify the quality of the studies.Results: Twenty-eight (three high-quality) studies were included, reporting on a median of 48 patients (interquartile range 28-69). Serum and urine markers were evaluated in 22 and 10 studies, respectively. Tumor necrosis factor alpha and osteocalcin were significantly higher in loosened compared with stable implants. Urinary N-terminal telopeptide had significantly elevated levels in loosened prostheses.Conclusion: Several serum and urine markers were promising in discriminating between loosened and stable implants. We recommend future studies to evaluate these biomarkers in a longitudinal fashion to assess whether progression of loosening is associated with a change in these biomarkers. In particular, high-quality studies assessing the usability of these biomarkers are needed. Show less
PurposeTo determine the course of adherence to physical activity (PA) recommendation in hip/knee osteoarthritis patients before and after hip/knee arthroplasty (THA/TKA). Moreover, we explored... Show morePurposeTo determine the course of adherence to physical activity (PA) recommendation in hip/knee osteoarthritis patients before and after hip/knee arthroplasty (THA/TKA). Moreover, we explored predictors for non-adherence 12 months postoperatively.Materials and methodsPrimary THA/TKA were included in a multicenter observational study. Preoperatively and 6/12 months postoperatively, patients reported engagement in moderate-intensity PA in days/week in the past 6 months (PA-recommendation (& GE;30 min of moderate-intensity & GE;5 days/week)). We included predictors stratified by preoperative adherence: sex, age, BMI, comorbidities, smoking, living/working status, season, mental health, HOOS/KOOS subscales before and 6 months postoperatively, and 6-month adherence.Results(1005 THA/972 TKA) Preoperatively, 50% of the population adhered. Adherence increased to 59% at 6 and 12 months. After 12 months, most patients remained at their preoperative PA level, 11% of the preoperative adherers decreased, while 20% of the preoperative non-adherers increased their PA level. In all different groups, adherence to the PA recommendation at 6 months was identified as a predictor (OR-range: 0.16-0.29). In addition, BMI was identified as predictor in the THA adherent (OR = 1.07; 95%CI [1.02-1.15]) and TKA non-adherent groups (OR = 1.08; 95%CI [1.03-1.12]). THA non-adherent group not having paid work (OR = 0.53; 95%CI [0.33-0.85]), and in the TKA adherent group, lower KOOS subscale symptoms (OR = 1.03; 95%CI [1.01-1.05]) were associated with non-adherence.ConclusionsMajority of patients remained at their preoperative PA level. Non-adherence at 6 months was highly predictive for 12-month non-adherence. Show less
Study Design. Retrospective analysis was performed on data from 251 patients that were included in two randomized, double-blinded clinical trials comparing clinical results of anterior cervical... Show moreStudy Design. Retrospective analysis was performed on data from 251 patients that were included in two randomized, double-blinded clinical trials comparing clinical results of anterior cervical discectomy and arthroplasty (ACDA) to anterior cervical discectomy and fusion (ACDF), and anterior cervical discectomy (ACD), for single-level disc herniation. Objective. This study aimed to investigate whether the ACDA procedure offers superior clinical results 2 years after surgery, to either ACDF or ACD without instrumentation, in the entire group of patients or in a particular subgroup of patients. Summary of Background Data. The cervical disc prosthesis was introduced to provide superior clinical outcomes after ACD. Methods. Neck Disability Index (NDI), and subscales of the 36-item short-form health survey (SF-36) and McGill pain score were collected at baseline, 1 year and 2 years after surgery. Reoperations and complications were also evaluated. A preliminary subgroup analysis was performed for age, disc height, body mass index (BMI), smoking, and sex. Results. The NDI decreased comparably in all treatment arms to circa 50% of the baseline value and marginal mean NDI differences varied from 0.4 to 1.1 on a 100 point NDI scale, with confidence intervals never exceeding the 20-point minimal clinical important difference (MCID). Secondary outcome parameters showed comparable results. Preliminary subgroup analysis could not demonstrate clinically relevant differences in NDI between treatments after 2 years. Conclusion. After combining data from two Randomized Controlled Trials it can be concluded that there is no clinical benefit for ACDA, when compared with ACDF or ACD 2 years after surgery. Preliminary subgroup analysis indicated outcomes were similar between treatment groups, and that no subgroup could be appointed that benefited more from either ACD, ACDF, or ACDA. Show less
Jurgens-Lahnstein, J.H.; Petersen, E.T.; Laursen, M.; Iversen, C.H.; Kaptein, B.L.; Lindgren, L.; Stilling, M. 2021
Radiostereometric analysis (RSA) is an accurate and precise radiographic method that can be used to measure micromotion of implants and study joint kinematics in vivo. A calibration cage with... Show moreRadiostereometric analysis (RSA) is an accurate and precise radiographic method that can be used to measure micromotion of implants and study joint kinematics in vivo. A calibration cage with radiopaque markers is used to calibrate the RSA images; however, the thickness (250 mm) of the calibration cage restricts the available area for the patient and equipment during RSA recordings. A thinner calibration cage would increase the recording area, facilitate handling of the cage, and ease integration of the cage with the RSA system. We developed a thinner calibration cage without compromise of accuracy and precision. First, we performed numerical simulations of an RSA system, and showed that the calibration cage thickness could be decreased to 140 mm maintaining accuracy and precision using 40 fiducial and 30 control markers. Second, we constructed a new calibration cage (NRT cage) according to the simulation results. Third, we validated the new calibration cage against two state-of-the-art calibration cages (Umeaa cage and Leiden cage) in a phantom study. All cages performed similar for marker-based analysis, except for y-rotation, where the Umeaa cage (SD = 0.064 mm) was less precise compared to the NRT (SD = 0.038 mm) and Leiden cages (0.042 mm) (p = .01). For model-based analysis the NRT cage had superior precision for translations (SD <= 0.054 mm) over the Leiden cage (SD <= 0.118 mm) and Umeaa cage (SD <= 0.093 mm) (p < .01). The combined study confirmed that the new and thinner calibration cage maintained accuracy and precision at the level of existing thicker calibration cages. Show less
Loef, M.; Gademan, M.G.J.; Latijnhouwers, D.A.J.M.; Kroon, H.M.; Kaptijn, H.H.; Marijnissen, W.J.C.M.; ... ; LOAS Study Grp 2021
Background: We aimed to investigate the application of the Knee Injury and Osteoarthritis Outcome Score (KOOS) percentile curves, using preoperative and postoperative data of patients with knee... Show moreBackground: We aimed to investigate the application of the Knee Injury and Osteoarthritis Outcome Score (KOOS) percentile curves, using preoperative and postoperative data of patients with knee osteoarthritis undergoing total knee arthroplasty (TKA).Methods: We used Longitudinal Leiden Orthopedics Outcomes of Osteo-Arthritis study data of patients between 45 and 65 years and undergoing primary TKA. KOOS scores (0-100) were obtained preoperatively and 6, 12, and 24 months after TKA. Preoperative knee radiographs were assessed according to Kellgren-Lawrence (KL) in a subset (37%) of patients. Comorbidities were self-reported using a standardized questionnaire. The median (interquartile range) population-level KOOS scores were plotted on previously developed population-based KOOS percentile curves. In addition, we assessed the application of the curves on patient level and investigated differences in scores between patients with preoperative KL scores <= 2 and >= 3 and presence (vs absence) of comorbidities.Results: The study population consisted of 853 patients (62% women, mean age 59 years, body mass index 30 kg/m(2)) with knee osteoarthritis undergoing primary TKA. Preoperatively, median KOOS scores of all subscales were at or below the 2.5th percentile. Scores increased to approximately the 25th percentile 12 months postoperatively. Greater improvements were observed in pain and less improvements in sport and recreational function and quality of life. Patients with higher preoperative KL scores and without comorbidities showed greater improvements.Conclusion: The KOOS percentile curves provided visual insights in knee complaints of patients relative to the general population. Furthermore, the KOOS percentile curves give insight in how preoperative patient characteristics are correlated with postoperative results. (C) 2021 The Author(s). Published by Elsevier Inc. Show less
Objective: To compare the 24-month risk of mortality between arthroplasty and internal fixation for undisplaced femoral neck fractures (FNFs). Design: Retrospective cohort study. Setting: Secondary... Show moreObjective: To compare the 24-month risk of mortality between arthroplasty and internal fixation for undisplaced femoral neck fractures (FNFs). Design: Retrospective cohort study. Setting: Secondary data analysis of 2 multinational randomized controlled trials. Participants: Patients aged 50 years or older with a FNF. Intervention: Arthroplasty (n = 1441), including total hip arthroplasty and hemiarthroplasty, performed for a displaced FNF versus internal fixation (n = 734), including sliding hip screw or multiple cancellous screws, performed for an undisplaced FNF. Main Outcome Measurement: The primary outcome was mortality within 24 months of injury. Secondary outcomes included reoperation and health-related quality of life. Results: The 24-month mortality rate was 15.0% (n = 327). Arthroplasty was associated with a significant reduction in the odds of mortality [adjusted odds ratio (aOR): 0.56, 95% confidence interval (CI): 0.44-0.72, P < 0.01] compared with treatment with internal fixation. 11.4% (n = 248) of the study patients required reoperation within 24 months of injury. The odds of reoperation were 59% lower with arthroplasty treatment than with internal fixation (aOR: 0.41, 95% CI: 0.32-0.55, P < 0.01). The 24-month SF-12 physical component scores were 2.7 points higher in arthroplasty patients compared with internal fixation patients (95% CI: 1.6-3.8, P < 0.01). Conclusions: Our findings suggest arthroplasty for a FNF may reduce the risk of mortality and reoperation compared with internal fixation of undisplaced fractures. This finding is counter to many current surgical practices but consistent with a mounting body of evidence. Before widespread adoption of arthroplasty for undisplaced fractures, these results should be confirmed in a definitive comparative trial. Show less
Study Design. Retrospective analysis using data from randomized clinical trials.Objective. To compare the occurrence of heterotopic ossification ( HO) between two cervical disc prostheses. Clinical... Show moreStudy Design. Retrospective analysis using data from randomized clinical trials.Objective. To compare the occurrence of heterotopic ossification ( HO) between two cervical disc prostheses. Clinical outcome and range of motion (ROM) were also evaluated.Summary of Background Data. Cervical arthroplasty was reported to be able to maintain the segmental ROM. However, controversy exists since the difference of the occurrence of HO concerning cervical prosthesis is still huge.Methods. Patients who underwent anterior cervical discectomy with arthroplasty for a cervical radiculopathy due to a herniated disc from the The Netherlands Cervical Kinematics (NECK) trial (activC; metal endplates with a polyethylene inlay and a keel for primary stability) and the PROCON trial (Bryan; metal-on-polymer with titanium coated endplates without a keel) were analyzed for HO at 12 and 24 months postoperatively. HO was scored according to the McAfee- Mehren classification. Segmental ROM was defined by a custom developed image analysis tool, and global cervical ROM was measured by Cobb's angle. Clinical outcome was evaluated by means of the neck disability index (NDI) as well as physicalcomponent summary (PCS) and mental-component summary (MCS).Results. At 2-year follow-up, the occurrence of HO was 68% in patients treated with the activC prosthesis (severe HO 55%), which was comparable with 85% (P = 0.12) in patients with the Bryan disc (severe HO 44%; P = 0.43). The HO progression was similar between groups. Clinically, the patients had comparable NDI, PCS, and MCS at 2-year follow-up, and comparable improvement of clinical outcomes. The global ROM in the Bryan group (56.4 +/- 10.8 degrees) was significantly higher than in the activC group (49.5 +/- 14.0, P = 0.044) at 2-year follow-up.Conclusion. In comparison of two cervical disc prostheses the development of HO is independent on their architecture. Although global ROM was higher in the Bryan prosthesis group, this difference was not deemed clinically important, particularly because the clinical condition of patients with and without severe HO was comparable. Show less
Study Design. Retrospective analysis using data from RCTs.Objective. This study aimed to report on the incidence of radiological adjacent segment degeneration (ASD) in patients with cervical... Show moreStudy Design. Retrospective analysis using data from RCTs.Objective. This study aimed to report on the incidence of radiological adjacent segment degeneration (ASD) in patients with cervical radiculopathy due to a herniated disc that were randomized to receive cervical arthroplasty or arthrodesis.Summary of Background Data. Cervical disc prostheses were introduced to prevent ASD in the postsurgical follow-up. However, it is still a controversial issue.Methods. Two hundred fifty-three patients were included in two randomized, double-blinded trials comparing anterior cervical discectomy with arthroplasty (ACDA), with intervertebral cage (ACDF), or without intervertebral cage (ACD) for one-level disc herniation. Neutral lateral radiographs were obtained preoperatively, at 1- and 2-year follow-up after surgery. Radiological ASD was evaluated on X-ray and defined by a decrease in disc height and the presence of anterior osteophyte formation on both the superior and the inferior level in relation to the target level.Results. Radiological ASD was present in 34% of patients at baseline and increased to 59% at 2-year follow-up in the arthrodesis groups (ACD and ACDF combined), and to 56% in the arthroplasty group. Progression of radiological ASD was present in 29% of patients in the arthrodesis group and in 31% of patients in the arthroplasty group for 2-year follow-up.Conclusion. Radiological ASD occurs in a similar manner in patients who were subjected to arthrodesis in cervical radiculopathy and in patients who received arthroplasty to maintain motion. Current data tend to indicate that the advantage of cervical prosthesis in preventing radiological ASD is absent. Show less
