Revision Surgery in Total Joint Replacement Is Cost-Intensive

Weber, Markus; Renkawitz, Tobias; Voellner, Florian; Craiovan, Benjamin; Greimel, Felix; Worlicek, Michael; Grifka, Joachim; Benditz, Achim

doi:10.1155/2018/8987104

Cited by 98 publications

(76 citation statements)

References 36 publications

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“…THR is a frequently performed procedure in orthopaedic surgery [2, 35]. Since clinical resources are limited [5], preoperative predictors of outcome for THR play an important role when counselling patients in the office [12].…”

Section: Discussionmentioning

confidence: 99%

Predicting Outcome after Total Hip Arthroplasty: The Role of Preoperative Patient-Reported Measures

Weber

Zeman

Craiovan

et al. 2019

BioMed Research International

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Choosing the appropriate patient for surgery is crucial for good outcome in total hip arthroplasty (THA). Therefore, parameters predicting outcome preoperatively are of major interest. In the current study, we compared the predictive power of different presurgical measures in minimally invasive THA. In the course of a prospective clinical trial preoperative HOOS, EQ-5D and SF-36 were obtained in 140 patients undergoing THA. Responder rate was defined by the modified OMERACT-OARSI criteria at six-month-, one-year, two-year, and three-year follow-up. Logistic regression was performed to compare the different questionnaires regarding their power of predicting positive responders. ROC-curve analysis was used to define benchmarks in preoperative measures associated with good outcome. Preoperative HOOS (p<0.001), EQ-5D (p=0.007), and PCS of SF-36 (p<0.001) were higher in responders than in nonresponders whereas no differences between responders and nonresponders were found for preoperative MCS (p=0.96) of SF-36. However, preoperative HOOS revealed best predictive power (OR=0.84 95%CI=0.78-0.90, p<0.001, Pseudo R-Squared according to Nagelkerke=0.48, effect size according to Cohen=0.96) compared to all other preoperative measures. Multivariable analysis confirmed preoperative HOOS as an independent parameter correlating with postoperative responder status (OR=0.76, 95% CI=0.66–0.88, p<0.001). In ROC-curve analysis nonresponders were identified with a sensitivity of 91.7% and specificity of 68.9% using a cutoff in preoperative HOOS of 40.3. Presurgical HOOS can predict outcome in THA better than other preoperative outcome measures. Patients with a preoperative HOOS value less than 40.3 have the highest probability of a positive response in terms of pain and function after THA.

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Section: Discussionmentioning

confidence: 99%

Predicting Outcome after Total Hip Arthroplasty: The Role of Preoperative Patient-Reported Measures

Weber

Zeman

Craiovan

et al. 2019

BioMed Research International

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“…Currently, revision surgery is the only procedure available to manage AL. Nevertheless, revision surgeries have been associated to high clinical and surgical risks and are not as effective as the primary surgeries, comprising lower outcomes and higher infection rates (Weber et al, 2018).…”

Section: Common Causes Of Joint Replacement Implant Failurementioning

confidence: 99%

“…The same study projects that about 7 and 15% of knee and hip arthroplasties, respectively, are still expected to fail, causing the need for a revision surgery (Kurtz et al, 2007). The revision surgeries, in addition to the significant healthcare costs, are associated with a high risk of infection and poor clinical outcomes (Vanhegan et al, 2012;Weber et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

The Mechanisms Underlying the Biological Response to Wear Debris in Periprosthetic Inflammation

et al. 2020

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Joint replacement surgery is the gold-standard therapeutic approach to treat patients with end-stage hip and knee arthritis, providing pain relief and joint function recovery. Despite the improvements in implant design and surgical techniques, revisions after total joint replacement are expected to grow. The periprosthetic inflammation, featured by the sustained inflammatory response to the implant debris, elicits the activation of osteoclasts and consequent periprosthetic osteolysis (PPOL), ultimately leading to implant aseptic loosening, which is the most common cause of long-term implant failure. There are currently no effective strategies to control periprosthetic inflammation, and long-term implant survival remains a major challenge in orthopedics. A broad knowledge of the mechanisms underlying the biological response to implant debris would support the development of novel and effective pharmacological strategies to manage PPOL and promote implant lifespan. In this review, a detailed description of the cellular and the molecular mechanisms underlying the biological response to implant debris is provided, highlighting the most recent findings. Furthermore, we reviewed novel therapeutic strategies that are being investigated to prevent inflammatory periprosthetic osteolysis.

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“…Taking global aging into consideration, these early interventions result in a continuously increasing number of primary total joint arthroplasty and cases of loosening at an earlier age that requires revision surgery worldwide [33][34][35][36]. The number of revision surgeries of the hip is projected to increase with >300% until 2030 [37,38], which in turn will put an enormous burden on the clinical and economic situation of the national health care systems [39][40][41]. To improve implant survival in these patients has become the challenge of our century.…”

Section: Primary Total Joint Arthroplasty -The Surgery Of the Last Cementioning

confidence: 99%

Mechanisms of mechanically induced Osteoclastogenesis : in a novel in vitro model for bone implant loosening

Bratengeier

2019

Linköping University Medical Dissertations

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Total joint arthroplasty is the primary intervention in the treatment of end-stage osteoarthritis.The majority of joint arthroplasties will last the whole lifetime. However, in some patients, the replacement will fail during their lifetime requiring a revision of the implant. These revisions are strenuous for the patient and costly for health care. To avoid a revision, therefore, is the uttermost goal of modern orthopedics. Joint replacement at a younger age, in combination with a more active lifestyle, increases the need for an early revision of the joint prosthesis. The main reason for revision surgeries is aseptic loosening, a condition where the prosthesis is loosening due to bone degradation at the peri-prosthetic interface in the absence of infections. The most well-established pathological mechanism for aseptic loosening is related to wear particles, generated from different parts of the prosthesis that will trigger bone degradation and bone loss.In addition, early micromotions of the prosthesis and resulting local pressurized fluid flow in the peri-prosthetic interface (supraphysiological loading) have also been identified as a cause for aseptic loosening. However, it remains unknown what cells are the primary responders to supraphysiological loading, and what underlying physical, cellular and molecular mechanism that triggers osteoclast differentiation and osteolysis.The main goal of this thesis is to shed light on three currently unknown aspects of mechanical loading-induced peri-prosthetic osteolysis, leading to aseptic loosening of orthopedic prostheses: (1)Which cells are the primary responder to supraphysiological loading? (2)What characteristics of the mechanical stimulus induce an osteo-protective or osteo-destructive response? (3)Which cellular mechano-sensing mechanisms are involved in an osteo-destructive response?The first study focused on the creation and validation of a novel in vitro model for mechanical loading-induced bone degradation. This model simulates the mechanical (over)loading conditions around a loosening prosthesis, as observed in the clinics, and in animal models for mechanical induced osteolysis. Using the MLO-Y4 osteocyte-like cell line, we verified that osteocytes exposed to supraphysiological mechanical loading in our model induce differentiation of progenitor cells into osteoclasts by direct cell-to-cell communication and through the release of soluble factors. This was accompanied by the release of an increased concentration of nitric oxide and higher expression of membrane-bound RANKL, while the concentration of soluble RANKL was not altered. These findings confirm the successful translation of mechanical-induced bone loss to an in vitro model for bone implant loosening. Many people have supported me during my time as a Ph.D. student and I am deeply grateful. I want to highlight a few people specifically, as they contributed significantly to my success: Anna Fahlgren Thank you for giving me the opportunity to become part of your research team and guiding me to become a c...

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Revision Surgery in Total Joint Replacement Is Cost-Intensive

Cited by 98 publications

References 36 publications

Predicting Outcome after Total Hip Arthroplasty: The Role of Preoperative Patient-Reported Measures

Predicting Outcome after Total Hip Arthroplasty: The Role of Preoperative Patient-Reported Measures

The Mechanisms Underlying the Biological Response to Wear Debris in Periprosthetic Inflammation

Mechanisms of mechanically induced Osteoclastogenesis : in a novel in vitro model for bone implant loosening

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