Why Are Total Knee Replacements Revised?

Gioe, Terence J.; Killeen, Kathleen; Grimm, Katherine; Mehle, Susan; Scheltema, Karen

doi:10.1097/01.blo.0000147136.98303.9d

Cited by 113 publications

(22 citation statements)

References 19 publications

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“…During the first two years after total knee arthroplasty, infections are counted as the second most common cause for revision surgery after instability. 45 Peri-operative broad spectrum antibiotic treatments are not effective in preventing biofilm formation on the surface of the implant. Due to the slow breakdown of HA in vivo and the resulting slow Ag release from the coating, the surface of the implant where biofilms are most likely to form can remain protected for extensive periods of time.…”

Section: Discussionmentioning

confidence: 99%

Mechanical, In vitro Antimicrobial, and Biological Properties of Plasma-Sprayed Silver-Doped Hydroxyapatite Coating

Roy

Fielding

Beyenal

et al. 2012

ACS Appl. Mater. Interfaces

175

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Implant related infection is one of the key concerns in total joint hip arthroplasties. In order to reduce bacterial adhesion, silver (Ag) / silver oxide (Ag2O) doping was used in plasma sprayed hydroxyapatite (HA) coating on titanium substrate. HA powder was doped with 2.0, 4.0 and 6.0 wt% Ag, heat treated at 800 °C and used for plasma spray coating using a 30 kW plasma spray system, equipped with supersonic nozzle. Application of supersonic plasma nozzle significantly reduced phase decomposition and amorphous phase formation in the HA coatings as evident by X-ray diffraction (XRD) study and Fourier transformed infrared spectroscopic (FTIR) analysis. Adhesive bond strength of more than 15 MPa ensured the mechanical integrity of the coatings. Resistance against bacterial adhesion of the coatings was determined by challenging them against Pseudomonas Aeruginosa (PAO1). Live/Dead staining of the adherent bacteria on the coating surfaces indicated a significant reduction in bacterial adhesion due to the presence of Ag. In vitro cell-material interactions and alkaline phosphatase (ALP) protein expressions were evaluated by culturing human fetal osteoblast cells (hFOB). Present results suggest that the plasma sprayed HA coatings doped with an optimum amount of Ag can have excellent antimicrobial property without altering mechanical property of the Ag doped HA coatings.

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Section: Discussionmentioning

confidence: 99%

Mechanical, In vitro Antimicrobial, and Biological Properties of Plasma-Sprayed Silver-Doped Hydroxyapatite Coating

Roy

Fielding

Beyenal

et al. 2012

ACS Appl. Mater. Interfaces

175

View full text Add to dashboard Cite

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“…Data on implant survival, compiled through the Scandinavian Knee Arthroplasty Register, indicate that ∼90% of primary cemented TKR implants survive >10 years 5 . The most common causes of implant failure after TKR are aseptic loosening, infection, and implant wear 6,7 . Cementless fixation, despite its potential advantage in terms of the elimination of bone cement as a source of wear debris, is associated with a higher rate of revision compared with cemented TKR 5 .…”

Section: Introductionmentioning

confidence: 99%

Cemented Total Knee Replacement in 24 Dogs: Surgical Technique, Clinical Results, and Complications

et al. 2009

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“…Risk factors associated with revisions and complications have also been identified. Similar to the experience in other registries [4,8,15], quality of care has been enhanced with timely feedback to physicians on implants and techniques associated with higher rates of revisions and complications. This feedback in combination with prospective studies indicating higher revision rates in unicompartmental knees, the uncemented TKA technique, and smaller femoral head sizes has resulted in a reduction in these implant choices and techniques.…”

Section: Discussionmentioning

confidence: 99%

Kaiser Permanente National Total Joint Replacement Registry: Aligning Operations With Information Technology

Paxton

Inacio

Khatod

et al. 2010

Clinical Orthopaedics &Amp; Related Research

139

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Background A Total Joint Replacement Registry was developed in a large community-based practice to track implant utilization, monitor revisions and complications, identify patients during recalls and advisories, and provide feedback on clinical practices. Questions/purposes We describe the development, implementation, and integration of this Total Joint Replacement Registry, highlighting critical steps in aligning information technology and operations. Methods The primary Total Joint Replacement Registry data source consists of standardized electronic health record forms developed by consensus. The Total Joint Replacement Registry forms are integrated into the clinical workflow (preoperative, intraoperative, and postoperative) and produce a standardized progress note for electronic health record documentation. Secondary data are extracted from other electronic data sources using standard terminologies (ie, ICD-9 codes) to supplement the Total Joint Replacement Registry forms. Electronic screening algorithms are applied to identify complications, in combination with chart review validation and quality control mechanisms. Results Three hundred fifty surgeons voluntarily contribute to the registry with 90% participation. The registry has been used for implant recalls and advisories, contract decision making, and identification of patients at risk for revisions (eg, younger patients having total knee arthroplasty). Tracking of overall survival of implants influenced clinical practice, with feedback resulting in the reduction of the number of unicompartmental and uncemented knee arthroplasties performed, usage of femoral head sizes\28 mm, and the number of minimally invasive surgical procedures performed. Conclusions The Total Joint Replacement Registry has effectively aligned operations with information technology and leveraged that to enhance our ability to respond to recalls and advisories as well as improve quality of care, cost-effectiveness, and create research opportunities.

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Why Are Total Knee Replacements Revised?

Cited by 113 publications

References 19 publications

Mechanical, In vitro Antimicrobial, and Biological Properties of Plasma-Sprayed Silver-Doped Hydroxyapatite Coating

Mechanical, In vitro Antimicrobial, and Biological Properties of Plasma-Sprayed Silver-Doped Hydroxyapatite Coating

Cemented Total Knee Replacement in 24 Dogs: Surgical Technique, Clinical Results, and Complications

Kaiser Permanente National Total Joint Replacement Registry: Aligning Operations With Information Technology

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