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Conventional techniques for hip and knee arthroplasty have led to good long-term clinical outcomes, but complications remain despite better surgical precision and improvements in implant design and quality.
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Technological improvements and a better understanding of joint kinematics have facilitated the progression to ‘personalized’ implant positioning (kinematic alignment) for total hip (THA) and knee (TKA) arthroplasty, the true value of which remains to be determined.
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By achieving a true knee resurfacing, the kinematic alignment (KA) technique for TKA aims at aligning the components with the physiological kinematic axes of the knee and restoring the constitutional tibio-femoral joint line frontal and axial orientation and soft-tissue laxity.
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The KA technique for THA aims at restoring the native ‘combined femoro-acetabular anteversion’ and the hip’s centre of rotation, and occasionally adjusting the cup position and design based on the assessment of the individual spine-hip relation.
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The key element for optimal prosthetic joint kinematics (hip or knee) is to reproduce the femoral anatomy.
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The transverse acetabular ligament (TAL) is the reference landmark to adjust the cup position.
Cite this article: EFORT Open Rev 2018;3:98-105. DOI: 10.1302/2058-5241.3.170022
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In patients with metastatic or unresectable soft tissue and bone sarcoma of extremities and pelvis, survival is generally poor. The aim of the current systematic review was to analyse recent publications on treatment approaches in patients with inoperable and/or metastatic sarcoma.
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Original articles published between 1st January 2011 and 2nd May 2020, using the search terms ‘unresectable sarcoma’, ‘inoperability AND sarcoma’, ‘inoperab* AND sarcoma’, and ‘treatment AND unresectable AND sarcoma’ in PubMed, were potentially eligible. Out of the 839 initial articles (containing 274 duplicates) obtained and 23 further articles identified by cross-reference checking, 588 were screened, of which 447 articles were removed not meeting the inclusion criteria. A further 54 articles were excluded following full-text assessment, resulting in 87 articles finally being analysed.
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Of the 87 articles, 38 were retrospective (43.7%), two prospective (2.3%), six phase I or I/II trials (6.9%), 22 phase II non-randomized trials (27.6%), nine phase II randomized trials (10.3%) and eight phase III randomized trials (9.2%). Besides radio/particle therapy, isolated limb perfusion and conventional chemotherapy, novel therapeutic approaches, including immune checkpoint inhibitors and tyrosine kinase inhibitors were also identified, with partially very promising effects in advanced sarcomas.
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Management of inoperable, advanced or metastatic sarcomas of the pelvis and extremities remains challenging, with the optimal treatment to be defined individually. Besides conventional chemotherapy, some novel therapeutic approaches have promising effects in both bone and soft tissue subtypes. Considering that only a small proportion of studies were randomized, the clinical evidence currently remains moderate and thus calls for further large, randomized clinical trials.
Cite this article: EFORT Open Rev 2020;5:799-814. DOI: 10.1302/2058-5241.5.200069
Region Västra Götaland, Sahlgrenska University Hospital, Department of Orthopaedics, Gothenburg, Sweden
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Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
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Region Västra Götaland, Sahlgrenska University Hospital, Department of Orthopaedics, Gothenburg, Sweden
The Swedish Hip Arthroplasty Register, Gothenburg, Sweden
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Choice of articulating materials, head size and the design of the articulation will become decisive for the long-term performance of a total hip arthroplasty (THA) and especially in terms of risk for dislocation and wear-related problems. Here we account for common alternatives based on available studies and the evidence that can be derived from them.
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Metal or ceramic femoral heads articulating against a liner or cup made of highly cross-linked polyethylene and ceramic-on-ceramic articulations have about similar risk for complications leading to revision, whereas the performance of metal-on-metal articulations, especially with use of big heads, is inferior. The clinical significance of problems related to ceramic-on-ceramic articulations such as squeaking remains unclear. With use of current technology ceramic fractures are rare.
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Large femoral heads have the potential to increase the range of hip movement before impingement occurs and are therefore expected to reduce dislocation rates. On the other hand, issues related to bearing wear, corrosion at the taper-trunnion junction and groin pain may arise with larger heads and jeopardize the longevity of THA. Based on current knowledge, 32-mm heads seem to be optimal for metal-on-polyethylene bearings. Patients with ceramic-on-ceramic bearings may benefit from even larger heads such as 36 or 40 mm, but so far there are no long-term reports that confirm the safety of bearings larger than 36 mm.
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Assessment of lipped liners is difficult because randomized studies are lacking, but retrospective clinical studies and registry data seem to indicate that this liner modification will reduce the rate of dislocation or revision due to dislocation without clear evidence of clinically obvious problems due to neck-liner impingement.
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The majority of studies support the view that constrained liners and dual mobility cups (DMC) will reduce the risk of revision due to dislocation both in primary and revision THA, the latter gaining increasing popularity in some countries. Both these devices suffer from implant-specific problems, which seem to be more common for the constrained liner designs. The majority of studies of these implants suffer from various methodological problems, not least selection bias, which calls for randomized studies preferably in a multi-centre setting to obtain sufficient power. In the 2020s, the orthopaedic profession should place more effort on such studies, as has already been achieved within other medical specialties, to improve the level of evidence in the choice of articulation when performing one of the most common in-hospital surgical procedures in Europe.
Cite this article: EFORT Open Rev 2020;5:763-775. DOI: 10.1302/2058-5241.5.200002
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St George’s, University of London, London, UK
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) checklist to aid with data synthesis methodology. 15 , 16 As the majority of studies were case reports/series, bias assessment was not deemed appropriate. Results A total of 169 published reports were originally identified. Fig. 1 presents
Department of Clinical Research, University of Southern Denmark, Odense, Denmark
University College Absalon, Center of Nutrition and Rehabilitation, Department of Physiotherapy, Region Zealand, Denmark
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Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Odense Patient data Explorative Network (OPEN), Odense, Denmark
Centre for Evidence-Based Medicine Odense (CEBMO), Odense University Hospital, Odense, Denmark
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Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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and research assessments. In the clinic, pelvic tilt is measured using inclinometry as the angle between a line connecting the anterior and posterior superior iliac spine (ASIS and PSIS) and in the normal healthy population, the reference value of
IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
Fondazione Livio Sciutto Onlus, Campus Savona – Università degli Studi di Genova, Savona, Italy
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Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
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Fondazione Livio Sciutto Onlus, Campus Savona – Università degli Studi di Genova, Savona, Italy
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protocol to manage patients after THA stems from a number of reasons such as the early identification of complications and the assessment of the right timing for a possible revision surgery. The latter aspect ensues due to the fact that prosthetic hip
Firoozgar Hospital, Bone and Joint reconstruction research center, Iran University of Medical Sciences, Tehran, Iran
Department of Orthopedic, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Department of Orthopedic, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Firoozgar Hospital, Bone and Joint reconstruction research center, Iran University of Medical Sciences, Tehran, Iran
Department of Orthopedic, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Firoozgar Hospital, Bone and Joint reconstruction research center, Iran University of Medical Sciences, Tehran, Iran
Department of Orthopedic, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Firoozgar Hospital, Bone and Joint reconstruction research center, Iran University of Medical Sciences, Tehran, Iran
Department of Orthopedic, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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into Rayyan QCRI data management software ( 16 ). Duplicate records were removed by two collaborators. Four reviewers conducted blind assessments of titles and abstracts, with final admissions authorized by an expert supervisor. The full text of all
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Folkhälsan Research Center, Helsinki, Finland
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Department of Reconstructive Orthopaedics, Karolinska University Hospital, Stockholm, Sweden
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. Spearman correlations (95% CI) were calculated for studies with available data for curve severity. SPSS version 27 was used for statistical analysis. Risk of bias assessment Risk of bias assessment was performed due to its potential impact on the
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-intervention) and finally outcome assessment. Patient characterization The foundation of any treatment is a thorough evaluation of the patient on presentation. Treatment is tailored to the individual patient. The patient’s medical record, including previous
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) Classes Description Rationale McTighe et al 11 (2013) • Head stabilized • Resurfacing. Assessment of length and method of achieving primary stability of the stem. • Neck stabilized • Short curved neck-sparing stems, and
