Begell House Inc.
Journal of Long-Term Effects of Medical Implants
JLT
1050-6934
25
3
2015
Total Knee Arthroplasty after Complete Patellectomy: A Review
163-170
10.1615/JLongTermEffMedImplants.2014010499
D. Alex
Stroh
Department of Orthopedics, Union Memorial Hospital, Baltimore, MD
Kimona
Issa
School of Health and Medical Sciences, Department of Orthopaedics, Seton Hall University, 400 S Orange Ave, South Orange, New Jersey
Anthony J.
Scillia
Seton Hall University, School of Health and Medical Sciences, Department of Orthopaedics, 400 S Orange Ave, South Orange, NJ 07079
Sargoun
Issa
Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD
Anthony
Festa
School of Health and Medical Sciences, Department of Orthopaedics, Seton Hall University, 400 S Orange Ave, South Orange, New Jersey
Michael A.
Mont
Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
patellectomy
knee
arthroplasty
autograft
allograft
extensor mechanism
The absence or dysfunction of the knee extensor mechanism accelerates degenerative joint disease and complicates knee arthroplasty. Various treatment strategies have been suggested to improve outcomes in total knee arthroplasties after patellectomy (semi- or constrained components, autograft, allograft, prosthetic reconstruction), but the optimal management of this condition is not known. The purpose of this report is to review the relevant basic biology and biomechanics of the patella and the extensor mechanism, and to review the current literature on the management of complete patellectomy during total knee arthroplasty. Tissue engineered heart valves, BMMSCs, oscillatory shear stress, nicotine, F-actin filaments, cell differentiation, endothelial cells
Implant Fracture after Long-Stemmed Cemented Hemiarthroplasty for Oncologic Indications
171-178
10.1615/JLongTermEffMedImplants.2014010812
Aditya V.
Maheshwari
Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York, Downstate Health Sciences University, Brooklyn, NY, USA
Corey
Gilbert
Department of Orthopedic Oncology, Washington Hospital Center, 110 Irving Street, Washington DC 20010; Department of Orthopaedics, Howard University Hospital, 2041 Georgia Avenue, Washington DC 20060
Jenna
Noveau
Department of Orthopedic Oncology, Washington Hospital Center, 110 Irving Street, Washington DC 20010
Robert
Pivec
Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center/University Hospital Brooklyn, Brooklyn, NY
Robert M.
Henshaw
Orthopaedic Oncology, Washington Cancer Institute, Georgetown University School of Medicine, Washington, DC
long-stemmed cemented
hemiarthroplasty
fatigue fracture
implant fai
Although a long-stemmed cemented hemiarthroplasty is frequently recommended for oncologic lesions of proximal femur, we have observed an alarming number of spontaneous stem fractures. The purpose of this retrospective study was to identify the associated risk factors for stem fractures in a study cohort of 60 (61 prostheses) during 1983−2007. At a mean follow-up of 41 months, 4/61 (6.6%) stems had fractured after a mean of 36 (12−92) months after surgery. All failed implants were Osteonics Omnifit (4/27; 14.8%) and multivariate analysis did not show any correlation with other studied variables. While the failures were successfully salvaged by conversion to a modular proximal femoral replacement, any implant failure in this population is devastating. Spontaneous onset of thigh pain in patients with long stems, particularly if associated with other risk factors, should raise suspicion of a fatigue fracture of the stem.
A Floating Thrombus Anchored at the Proximal Anastomosis of a Woven Thoracic Graft Mimicking a Genuine Aortic Dissection
179-200
10.1615/JLongTermEffMedImplants.2015012263
Bin
Li
Department of Surgery, Faculty of Medicine, Laval University, Quebec, QC, Canada; Axe Medecine Regeneratrice, Centre de Recherche du CHU, Quebec, QC, Canada; Department of Vasular Surgery Changhai Hospital, Secondary Military Medical University, Shanghai, China
Bing
Liu
Key Laboratory of Textile Science and Technology of Ministry of Education and College of Textiles, Donghua University, Shanghai, China
Yijun
Fu
Key Laboratory of Textile Science and Technology of the Ministry of Education, College of Textile, Donghua University, Shanghai, China
Olexandr
Bondarenko
Department of Surgery, Faculty of Medicine, Laval University, Quebec, QC, Canada; Division of Regenerative Medicine, CHU de Quebec Research Centre, Quebec, QC, Canada
Alain
Verdant
Department of Cardiovascular Surgery, Sacre-Coeur Hospital, Montreal and Department of Surgery, Universite de Montreal, Montreal, Quebec City, Canada
Olivier
Rochette-Drouin
Department of Surgery, Laval University and Division of Regenerative Medicine CHU de Quebec Research Center, Quebec, Quebec City, Canada
Jing
Lin
Key Laboratory of Textile Science and Technology of Ministry of Education and College of Textiles, Donghua University, Shanghai, PR. China
Jean-Michel
Bourget
Departments of Surgery and Radiology, Faculty of Medicine, Laval University, Axe Medecine Regeneratrice, Centre de Recherche, CHU, Quebec, (QC) Canada
Randolph
Guzman
Vascular Surgery, St. Boniface General Hospital and Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
Lu
Wang
Key Laboratory of Textile Science and Technology of the Ministry of Education, College of Textile, Donghua University, Shanghai, China
Ze
Zhang
Department of Surgery, Faculty of Medicine, Laval University, Quebec, QC, Canada; Axe Medecine Regeneratrice, Centre de Recherche du CHU, Quebec, QC, Canada
Yvan
Douville
Departments of Surgery and Radiology, Laval University and Quebec Biomaterials Institute, CHUQ, Quebec
Lucie
Germain
Departments of Surgery and Radiology, Faculty of Medicine, Laval University, Axe Medecine Regeneratrice, Centre de Recherche, CHU, Quebec, (QC) Canada
Zaiping
Jing
Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, P.R. China
Robert
Guidoin
Department of Surgery, Faculty of Medicine, Laval University, Quebec, QC, Canada; Axe Medecine Regeneratrice, Centre de Recherche du CHU, Quebec, QC, Canada
thoracic aortic graft
false lumen
floating thrombus
CT angiography
woven graft
An aortoesophageal fistula following surgery for a ruptured 6.6-cm thoracic aneurysm in a 69-year-old female was repaired using a 34-mm woven prosthetic graft. A follow-up computed tomography (CT) scan at 10 days postoperatively revealed a dissection-like picture in the region of the graft, which was treated conservatively. The patient eventually died from sepsis and multiorgan failure. At autopsy, the graft was retrieved in situ and studied by detailed gross, microscopy, and scanning electron microscopy (SEM) examination. Gross observation confirmed that the dissection resulted from the rolling of the internal capsule downstream. A massive thrombus anchored at the proximal anastomosis and held by a narrow head was also noted. The thrombus demonstrated reorganization in the area of the anastomosis, with a false lumen in its distal half. The reminder of the thrombus consisted of layered fibrin. After gross examination, the fabric graft was found to be flawless. Additional detailed studies were also done using microscopy, SEM, and gross examination.
Use of a Flexible Intramedullary Rod and its Influence on Patient Satisfaction and Femoral Size in Total Knee Arthroplasty
201-208
10.1615/JLongTermEffMedImplants.2015013275
Kirby D.
Hitt
Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
Todd P.
Pierce
Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
Julio J.
Jauregui
Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland; Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center/University
Hospital Brooklyn, Brooklyn, NY
Jeffery J.
Cherian
Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
Randa K
Elmallah
Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
Evan
Leibowitz
Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
Scott
Logan
Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
Michael A.
Mont
Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
total knee arthroplasty; outcomes; component size; flexible intramedullary rod
Improper femoral component size remains a source of multiple postoperative complications following total knee arthroplasty (TKA). However, the use of a flexible intramedullary (IM) rod may help optimize femoral component size and therefore improve outcomes. The purpose of this study was to assess (1) patient-reported functional outcomes, (2) overall quality of life, and (3) changes in implant sizing associated with total knee arthroplasties performed with a flexible IM rod compared to a conventional, rigid rod. We reviewed 277 patients who had surgery using the rigid rod and 364 using the flexible rod to determine the tendency of each rod for selecting particular component sizes. Additionally, 100 patients were prospectively randomized (1:1) to the flexible or the conventional rigid IM rod cohorts. Outcomes were assessed using Knee Society scores (KSSs), SF-36 physical scores, and SF-36 mental scores preoperatively and at 6 weeks, 3 months, 1 year, and 2 years postoperatively. The retrospective arm of the study showed that the flexible IM rod cohort tends to have smaller component sizes than their conventional counterparts. In the prospective phase of the study, the increase in clinical KSSs from preoperative levels was better in the flexible rod cohort (160% vs. 143% increases, respectively). The functional KSSs had slightly higher increases in the flexible rod cohort from their preoperative levels (68% vs. 62% increases, respectively). With both clinical and functional KSSs, the flexible rod cohort had a higher score than the rigid rod cohort at all follow-up points. There was better postoperative range of motion (ROM) in the flexible rod cohort (28% vs. 22% increases, respectively). The SF-36 physical scores were slightly different, with the flexible IM rod cohort having a more marked improvement in scores (64% vs. 46% increases, respectively). The SF-36 mental score had a slightly better improvement at latest follow-up in the flexible IM rod cohort (12% vs. 6% increases, respectively). Those patients who underwent TKA using a flexible IM rod had better improvements in their patient-reported outcomes and decreased risk of oversizing the femoral component. The use of such a rod is not detrimental to outcomes and may have a positive impact on outcomes. Future studies should focus on alignment and long-term outcomes associated with the use of a flexible rod.
High Insertion Torque and Peri-Implant Bone Loss: Is There a Relationship?
209-213
10.1615/JLongTermEffMedImplants.2015012034
Mohsen
Bidgoli
Faculty of Dentistry, Hamadan University of Medical Sciences, Hamadan, Iran
Sara
Soheilifar
Faculty of Dentistry, Hamadan University of Medical Sciences, Hamadan, Iran
Javad
Faradmal
Department of Biostatistics, Epidemiology, and Modeling of Noncommunicable Diseases Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
Sepideh
Soheilifar
Department of orthodontics, Faculty of dentistry, Hamadan university of Medical science, Hamadan, Iran
dental implants
torque
bone resorption
Because primary stability has a critical role in implant osseointegration, greater insertion torque is more desirable. However, excessive pressure on the peri-implant bone may lead to bone resorption. This study evaluates the effect of insertion torque on crestal bone level. Periapical radiographs of 136 bone-level implants were assessed in this retrospective cohort study. Sixty-four implants were inserted with high insertion torques (45-70 N/cm) and 72 implants were placed with a torque in the range of 20 to 30 N/cm. The distance between implant shoulder and proximal bone crest was measured on radiographs taken immediately after the insertion and compared to those calculated after uncovering surgeries (inserting the healing abutment). The mean bone resorption around implants placed with high and lower insertion torques was 0.33 and 0.4, respectively; thus, the difference between the two groups was insignificant (p = 0.88). High insertion torques (up to 70 N/cm) did not significantly increase bone resorption around implants.
Ethical and Methodological Issues Surrounding the Use of Appropriate Comparators in Orthopaedic Surgery Randomized Controlled Trials
215-223
10.1615/JLongTermEffMedImplants.2015013786
Alisha
Hak
Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
Nathan
Evaniew
Division of Orthopaedic Surgery, Center for Evidence-Based Orthopaedics, McMaster University, 293 Wellington St. N., Suite 110, Hamilton, ON L8L 8E7, Canada
Mohit
Bhandari
CLARITY Research Group, Department of Orthopedic Surgery Musculoskeletal Research Unit, McMaster University, Hamilton, ON, Canada; Division of Orthopaedic Surgery and Department of Clinical Epidemiology & Biostatistics, Hamilton General Hospital, Hamilton, ON, Canada
randomized controlled trials
research ethics
research methodology
placebo
sham
control
surgery
orthopaedics
Although randomized controlled trials (RCTs) have the ability to provide researchers with more concrete evidence than that of their nonrandomized counterparts, conducting an RCT brings with it many ethical and methodological considerations. It is understood that in order to progress knowledge, and create new knowledge to benefit future patients, research must include human subjects; however, the desire to further knowledge must be placed second to the safety and respect for trial participants. An important ethical and methodological step in the design of any trial once the intervention is established is the selection of the comparator treatment. This is especially a topic of interest in orthopaedic surgery trials, in which a placebo comparator is not always possible and, arguably, sometimes never ethical. We review the use of different comparators in the treatment of orthopaedic surgery injuries and conditions, taking into consideration methodological and ethical issues. Comparators assessed are established treatments, standard-of-care treatments, conservative treatments, placebos, and sham surgeries.
Cost Effectiveness and Economic Impact of the KineSpring® Knee Implant System in the Treatment of Knee Osteoarthritis in Spain
225-235
10.1615/JLongTermEffMedImplants.2015012728
Dan
Strain
Global Research Solutions, Inc., Burlington, Ontario, Canada
Chuan Silvia
Li
Global Research Solutions, Inc., Burlington, Ontario, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
Mark
Phillips
Global Research Solutions, Inc., Burlington, Ontario, Canada
Olga
Monteagudo Piqueras
Department of Quality Research, Murcia Health Council, Murcia, Spain
Mohit
Bhandari
CLARITY Research Group, Department of Orthopedic Surgery Musculoskeletal Research Unit, McMaster University, Hamilton, ON, Canada; Division of Orthopaedic Surgery and Department of Clinical Epidemiology & Biostatistics, Hamilton General Hospital, Hamilton, ON, Canada
orthopedics
orthopedic surgeon
cost-utility
We investigated the efficacy and cost effectiveness of the KineSpring System in the Spanish healthcare system, as compared to other standard treatments methods. Cost-utility ratios were calculated using derived cost data and we calculated quality-adjusted life years (QALYs) gained for each method of treatment. Cost-utility ratios were calculated assuming lifetime and 10-year durability. Assuming lifetime durability, cost-utility ratios of total knee arthroplasty (TKA), unicompartmental knee arthroplasty (UKA), high tibial osteotomy (HTO), KineSpring System, and conservative treatments, compared to no treatment, are €2348 ± 70/QALYs, €2040 ± 61/QALYs, €2281 ± 68/ QALY, €1669 ± 268/QALYs, and €11,688 ± 2185/QALYs, respectively. Assuming a treatment durability of 10 years, the cost-utility ratio of TKA, UKA, HTO, KineSpring System, and conservative treatments, compared to no treatment, are €4884 ± 323/QALYs, €4243 ± 280/QALYs, €4744 ± 313/QALYs, €3757 ± 1353/QALYs, and €10,575 ± 4414/QALYs, respectively. In comparison to current standard-of-care treatments, the KineSpring System has a favorable cost-utility ratio, making it an effective treatment option and a suitable cost-saving alternative. The KineSpring System is associated with lower cost and increased QALYs.
Orthopedic Implant Value Drivers: A Qualitative Survey Study of Hospital Purchasing Administrators
237-244
10.1615/JLongTermEffMedImplants.2015012680
Chuan Silvia
Li
Global Research Solutions, Inc., Burlington, Ontario, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
Christopher
Vannabouathong
Division of Orthopaedic Surgery, Department of Surgery and Department of Clinical Epidemiology & Biostatistics. McMaster University, Ontario L8L 2X2, Canada; Global Research Solutions, Inc., Burlington, Ontario, Canada
Sheila
Sprague
Department of Clinical Epidemiology and Biostatistics, McMaster University,
Hamilton, Ontario, Canada; University of Rochester Medical Center, Orthopaedics Department, Rochester, NY
Mohit
Bhandari
CLARITY Research Group, Department of Orthopedic Surgery Musculoskeletal Research Unit, McMaster University, Hamilton, ON, Canada; Division of Orthopaedic Surgery and Department of Clinical Epidemiology & Biostatistics, Hamilton General Hospital, Hamilton, ON, Canada
orthopedics
orthopedic surgeon
osteoarthritis
Osteoarthritis (OA) is a chronic, degenerative disease that is highly prevalent in the population, yet the factors that affect purchasing decisions related to this condition are poorly understood. A questionnaire was developed and administered to hospital executives across North America to determine the factors that affect purchasing decisions related to OA. Thirty-four individuals participated in the survey. Clinical evidence and cost effectiveness were deemed to be the most important factors in the process of making purchasing decisions. The most important considerations for adopting new technology were whether there was sufficient evidence in the literature, followed by thoughts of key opinion leaders, and cost of intervention/device. Ongoing research is still needed, but the current study allowed us to identify some trends in the data, providing new insight on how hospital purchasing decisions are made, which could have an immediate impact on those currently involved with making these decisions.
Economic Impact of the Use of an Absorbable Adhesion Barrier in Preventing Adhesions Following Open Gynecologic Surgeries
245-252
10.1615/JLongTermEffMedImplants.2015012140
Sanjoy
Roy
Ethicon (Johnson & Johnson), Somerville, New Jersey 08876
Rashad
Carlton
Xcenda, Palm Harbor, Florida 34685
Martin
Weisberg
Ethicon (Johnson & Johnson), Somerville, New Jersey 08876
Ryan
Clark
Xcenda, Palm Harbor, Florida 34685
Kristen
Migliaccio-Walle
Xcenda, 4114 Woodlands Pkwy, Palm Harbor, FL 34685
Hector
Chapa
Women's Specialty Center and Department of Obstetrics and Gynecology, Methodist Medical Center, Dallas, Texas 75203
adhesions; adhesion barrier; GYNECARE INTERCEED; gynecologic surgeries
We used an economic model to assess the impact of using the GYNECARE INTERCEED® absorbable adhesion barrier for reducing the incidence of postoperative adhesions in open surgical gynecologic procedures. Caesarean section surgery, hysterectomy, myomectomy, ovarian surgery, tubal surgery, and endometriosis surgery were modeled with and without the use of GYNECARE INTERCEED® absorbable adhesion barrier. Incremental GYNECARE INTERCEED absorbable adhesion barrier material costs, medical costs arising from complications, and adhesion-related readmissions were considered. GYNECARE INTERCEED absorbable adhesion barrier use was assumed in 75% of all procedures. The economic impact was reported during a 3-year period from a United States hospital perspective. Assuming 100 gynecologic surgeries of each type and an average of one GYNECARE INTERCEED absorbable adhesion barrier sheet per surgery, a net savings of $540,823 with GYNECARE INTERCEED absorbable adhesion barrier during 3 years is estimated. In addition, GYNECARE INTERCEED absorbable adhesion barrier use resulted in 62 fewer cases of patients developing adhesions. Although the use of GYNECARE INTERCEED absorbable adhesion barrier added $137,250 in material costs, this was completely offset by the reduction in length of stay ($178,766 savings), fewer adhesion-related readmissions ($458,220 savings), and operating room cost ($41,078 savings). Adoption of the GYNECARE INTERCEED absorbable adhesion barrier for appropriate gynecologic surgeries would likely result in significant savings for hospitals, driven primarily by clinical patient benefits in terms of decreased length of stay and adhesion-related readmissions.