Search Results
Search for other papers by Lisa Renner in
Google Scholar
PubMed
Search for other papers by Viktor Janz in
Google Scholar
PubMed
Search for other papers by Carsten Perka in
Google Scholar
PubMed
Search for other papers by Georgi I. Wassilew in
Google Scholar
PubMed
-
Navigation in primary total hip arthroplasty has a history of over 20 years. During this process, imageless computer navigation can be particularly helpful in optimally restoring the hip’s biomechanics. This involves the accurate placement of the acetabular component with the determination of the anteversion and abduction, whereby the navigated femur-first technique also allows for a calculation of the combined anteversion. Additional critical parameters such as the reconstruction of the rotation centre, as well as the femoral and acetabular offset, can also be optimally adjusted. Last but not least, an intra-operative evaluation and equalisation of the leg length is possible.
-
Nonetheless, the disadvantages of this surgical technique in terms of the high costs in the acquisition and preservation of the necessary devices, as well as the longer operation time, must be taken into account. However, economic aspects are not the only thing preventing widespread use of the navigation technique. Determining the plane of reference (APP) for the optimal orientation of the implants is based on palpation of the bony landmarks – and this is influenced by the thickness of the soft tissue layer. Furthermore, the experience of the surgeon constitutes a variable that influences the accuracy of navigation.
-
In summary, hip navigation certainly offers an interesting technique for the optimisation of total hip arthroplasty with reconstruction of proper biomechanics. At the same time, there is currently a lack of high-quality randomised controlled long-term trials that evaluate the clinical advantage for the patients, together with cost utility and survival rates.
Cite this article: Renner L, Janz V, Perka C, Wassilew GI. What do we get from navigation in primary THA? EFORT Open Rev 2016;1:205-210. 10.1302/2058-5241.1.000034.
Search for other papers by Volkmar Jansson in
Google Scholar
PubMed
Search for other papers by Alexander Grimberg in
Google Scholar
PubMed
Search for other papers by Oliver Melsheimer in
Google Scholar
PubMed
Search for other papers by Carsten Perka in
Google Scholar
PubMed
German Arthroplasty Registry (EPRD Deutsche Endoprothesenregister gGmbH), Berlin, Germany
Search for other papers by Arnd Steinbrück in
Google Scholar
PubMed
-
National joint registries are gaining more and more importance in the fields of implant monitoring/outlier detection and quality of care.
-
The German Arthroplasty Registry (EPRD) was established in 2010 for the purpose of observing the impact of primary hip and knee arthroplasty on the German population.
-
Having now over one million documentations, we introduce the structure of the EPRD and detail the process of data collection.
-
We report on some preliminary trends and contrast these with findings from other joint registries.
-
We introduce the overhauled Arthroplasty Library, that resulted from an international collaboration with National Joint Registry of England, Wales and Northern Ireland.
Cite this article: EFORT Open Rev 2019;4 DOI: 10.1302/2058-5241.4.180064
Search for other papers by Michael M. Morlock in
Google Scholar
PubMed
Search for other papers by Robert Hube in
Google Scholar
PubMed
Search for other papers by Georgi Wassilew in
Google Scholar
PubMed
Search for other papers by Felix Prange in
Google Scholar
PubMed
Search for other papers by Gerd Huber in
Google Scholar
PubMed
Search for other papers by Carsten Perka in
Google Scholar
PubMed
-
The focus on taper corrosion in modular hip arthroplasty increased around 2007 as a result of clinical problems with large-head metal-on-metal (MoM) bearings on standard stems. Corrosion problems with bi-modular primary hip stems focused attention on this issue even more.
-
Factors increasing the risk of taper corrosion were identified in laboratory and retrieval studies: stiffness of the stem neck, taper diameter and design, head diameter, offset, assembly force, head and stem material and loading.
-
The high variability of the occurrence of corrosion in the clinical application highlights its multi-factorial nature, identifying the implantation procedure and patient-related factors as important additional factors for taper corrosion.
-
Discontinuing the use of MoM has reduced the revisions due to metal-related pathologies dramatically from 49.7% (MoM > 32 mm), over 9.2% (MoM ⩽ 32 mm) to 0.8% (excluding all MoM).
-
Further reduction can be achieved by omitting less stiff Ti-alloys and large metal heads (36 mm and above) against polyethylene (PE).
-
Standardized taper assembly of smaller and ceramic heads will reduce the clinical occurrence of taper corrosion even further. If 36 mm heads are clinically indicated, only ceramic heads should be used.
-
Taper-related problems will not comprise a major clinical problem anymore if the mentioned factors are respected.
Cite this article: EFORT Open Rev 2020;5:776-784. DOI: 10.1302/2058-5241.5.200013
Search for other papers by Karl Stoffel in
Google Scholar
PubMed
Search for other papers by Tamara Horn in
Google Scholar
PubMed
Search for other papers by Luigi Zagra in
Google Scholar
PubMed
Search for other papers by Michael Mueller in
Google Scholar
PubMed
Search for other papers by Carsten Perka in
Google Scholar
PubMed
Search for other papers by Henrik Eckardt in
Google Scholar
PubMed
-
The majority of periprosthetic femoral fractures are treated surgically.
-
Surgical treatment may be revision only, revision in combination with open reduction and internal fixation (ORIF), or ORIF only.
-
The treatment decision is dependent on whether the stem is loose or not, but loose stems are not always identified, resulting in unsatisfactory treatments.
-
This article presents an algorithmic approach to identifying loose stems around proximal femoral periprosthetic fractures, taking patient history, stem design, and plain radiographs into consideration. This approach may help identifying loose stems and increase the probability of effective treatments.
Cite this article: EFORT Open Rev 2020;5:449-456. DOI: 10.1302/2058-5241.5.190086
Search for other papers by Carsten Perka in
Google Scholar
PubMed
Orthopedics, Faculty of Medicine, Department of Clinical Sciences, Lund University, Malmö, Sweden
Search for other papers by Maziar Mohaddes in
Google Scholar
PubMed
Search for other papers by Luigi Zagra in
Google Scholar
PubMed
BG Kliniken – Klinikverbund der gesetzlichen Unfallversicherung gGmbH, Berlin, Germany
Search for other papers by Axel Ekkernkamp in
Google Scholar
PubMed
Search for other papers by Niklas Keller in
Google Scholar
PubMed
Search for other papers by Dirk Stengel in
Google Scholar
PubMed
Purpose
-
To assess utility, benefits, and risks of 4th-generation alumina–zirconia ceramic pairings in elective total hip arthroplasty (THA).
Methods
-
A comprehensive mixed-methods best-evidence synthesis using data from systematic reviews, randomized controlled trials (RCTs), prospective and retrospective cohort studies, as well as joint replacement registries, was conducted to estimate overall revision and survival rates, periprosthetic infection, bearing fractures, and noise phenomena with 4th-generation alumina–zirconia ceramic versus other tribological couplings in elective THA. The systematic review part across multiple databases was registered with PROSPERO (CRD42023418076), and individual study data were extracted for statistical re-analysis.
Results
-
Twenty overlapping systematic reviews, 7, 17, and 8 references from RCTs, cohort studies, and joint replacement registries form the basis of this work. According to current best evidence, it is (i) 15–33 times more likely that 4th-generation alumina–zirconia pairings avoid a revision for infection than causing a revision for audible noise, (ii) 38–85 times more likely that 4th-generation alumina–zirconia pairings avoid a revision for infection than causing a revision for ceramic head fractures, and (iii) three to six times more likely that 4th-generation alumina–zirconia pairings avoid a revision for infection than cause a revision for ceramic liner fractures.
Conclusion
-
Fourth-generation alumina–zirconia pairings in THA show a favorable benefit–risk ratio, with rare compound-specific adverse events and complications significantly outbalanced by long-term advantages, such as a markedly lower incidence of revision for infection.
Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany
Berlin Institute of Health Center for Regenerative Therapies, Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany
Search for other papers by Tobias Winkler in
Google Scholar
PubMed
Berlin Institute of Health Center for Regenerative Therapies, Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany
Search for other papers by Sven Geissler in
Google Scholar
PubMed
Trauma Orthopaedic Research Copenhagen Hvidovre (TORCH), Department of Orthopaedic Surgery, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
Search for other papers by Tazio Maleitzke in
Google Scholar
PubMed
Search for other papers by Carsten Perka in
Google Scholar
PubMed
Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany
Berlin Institute of Health Center for Regenerative Therapies, Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany
Search for other papers by Georg N Duda in
Google Scholar
PubMed
Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany
Search for other papers by Alexander Hildebrandt in
Google Scholar
PubMed
-
Advanced therapies are expected to play a crucial role in supporting repair after injury, halting the degeneration of musculoskeletal tissue to enable and promote physical activity.
-
Despite advancements, the progress in developing advanced therapies in orthopaedics lags behind specialties like oncology, since innovative regenerative treatment strategies fall short of their expectations in musculoskeletal clinical trials.
-
Researchers should focus on understanding the mechanism of action behind the investigated target before conducting clinical trials.
-
Strategic research networks are needed that not only enhance scientific exchange among like-minded researchers but need to include early on commercial views, companies and venture perspectives, regulatory insights and reimbursement perspectives. Only in such collaborations essential roadblocks towards clinical trials and go-to-patients be overcome.
