13^th International Conference on
Arthroplasty

Biography:

Dr. Herbert Resch is affiliated to the Department of Department of Traumatology, Paracelsus Medical University Salzburg. Dr. Herbert Resch is currently providing services as Professor. Dr. Herbert Resch has authored and co-authored multiple peer-reviewed scientific papers and presented works at many national and International conferences. Dr. Herbert Resch contributions have acclaimed recognition from honourable subject experts around the world. Dr. Herbert Resch is actively associated with different societies and academies. Dr. Herbert Resch academic career is decorated with several reputed awards and funding. Dr. Herbert Resch research interests include Trauma and Orthopedics

Abstract:

Introduction: Fractures of the acetabulum in elderly patients pose a major problem as osteosynthesis may not provide sufficient stability due to poor bone quality. Additionally, the fracture pattern is often quite different compared to younger people not allowing perfect reduction. Prosthetic replacement would be desirable in the acute phase in these patients. Unfortunately, commonly available prosthetic implants do not allow stable fixation of the acetabulum component. 

Material and Method: A new fixation implant for the stable fixation of the acetabulum component in a fractured acetabulum was developed. The key element is a metallic titanium ring with an integrated plate enabling the stable fixation of the ring on the ala of the ilium bone with numerous angle stable screws. The direction of the screws is such that high primary stability of the implant is provided. The resected femoral head is used for bone grafting on the bottom of the fractured acetabulum. In the metallic ring a commonly available polyethylene socket is cemented.

So far 30 patients were operated on between 2009 and 2014. The av. age was 79 years (68 to 92). All patients were suffering from an acute acetabulum fracture, 6 of them were periprosthetic. 29 of the 30 patients were operated on within one week after injury.

Results: All patients except four were followed up prospectively with an av. time of 18 months (range, 6 to 46). Four patients died within 3 months after surgery.  All patients were allowed to be mobilised with full weight bearing within one week after surgery. No signs of loosening were observed. 26 patients could be followed up radiologically for at least 6 months showing bony healing around the metallic ring.

Conclusion: This implant offers the opportunity of early mobilisation despite a fracture  which is disastrous for old patients.   

Biography:

Abstract:

This paper describes step by step a modified Far Medial Subvastus approach, the Eeklo Modified Subvastus approach (EMS) for the placement of a Total Knee Arthroplasty (TKA). The EMS approach is a modified subvastus The EMS approach provides excellent exposure of the knee joint with preservation of all peri-articular soft tissues .The incision of the EMS approach evades any bony prominence, which causes less chance of skin necrosis. The blood supply of the patella is kept intact, with less chance of patellar necrosis, fracture and loosening of the patellar component. The extensor mechanism is intact which gives less anterior knee pain, maintenance of quadriceps strength and function. The combination of all former advantages ensures more rapid recovery and better short term knee range of motion. With closure of the EMS approach the periarticular soft tissue strains are restored to those typical of the native knee and bleeding stops quickly due to complete sealing of the joint. Indications of the EMS approach are primary TKA, medial unilateral arthroplasty, patellofemoral arthroplasty, arthrotomy for other intra-articular pathologies and revision surgery in selected patients. With enough experience, obesity, contractures, deformities and revision surgery, where previous scar tissue on the medial side of the knee can make the definition of the different planes more difficult, are only relative contraindications so this EMS approach offers access to the complete knee joint in nearly each knee. The EMS approach is an improved modification of the Far Medial Subvastus Approach and can be the new golden standard for TKA, medial unilateral arthroplasty and surgery for other intra-articular knee pathologies.

Biography:

Abstract:

Background

Metal sensitivity as a cause for painful joint replacement has become increasingly prevalent; however, there is a lack of reported clinical outcome data from total knee arthroplasty patients with metal allergies. The purpose of this study was to determine whether patients presenting with a painful total knee arthroplasty with a positive metal sensitivity have improved outcomes following revision to a hypoallergenic implant.

Methods

A retrospective review was conducted for patients that underwent a revision total knee arthroplasty after metal sensitivity testing over a 3-year period from January 1, 2015, to December 31, 2017. Based on the results of sensitivity testing, patients underwent revision total knee arthroplasty to a hypoallergenic component or a standard component. Following revision, patients returned to the clinic at an interval of 6 weeks, 5 months, and 12 months for functional, pain, and satisfaction assessment. Outcomes were compared within and between sensitivity groups.

Results

Of the included patients, 78.3% (39/46) were positive for metal sensitivity. The most common metal sensitivity was to nickel (79.5%, 32/39). Both non-reactive and reactive patients significantly improved in range of motion after revision arthroplasty. The reactive group saw a 37.8% decrease in pain at 6 weeks post-revision (p < 0.001) Whereas, the non-reactive group only saw a moderate, non-significant improvement in pain reduction at 6 weeks post-revision (27.0%; p = 0.29). Frequency of pain experienced did not vary significantly between groups. Maximum metal lymphocyte transformation test (LTT) sensitivity score did not correlate with pain level at the time of revision (R² = 0.02, p = 0.38) or percent improvement after revision (R² = 0.001, p = 0.81). Overall, all patients reported being very satisfied after revision total knee arthroplasty; there was no difference between positive and negative sensitivity groups (W = 62, p = 0.89).

Conclusions

Patients presenting with a painful knee arthroplasty and positive metal LTT have improved pain scores, walking function, and range of motion following revision to a hypoallergenic component. This study also provides a treatment algorithm for patients presenting with a painful knee replacement, in order to provide effective and timely diagnosis and management.

Biography:

Dr. Chun has expertise in knee joint replacement and its supportive surgeries.  He was a guest professor in UCLA (1994) and Indiana university medical center (2002~2004). He is a board member of Korean orthopaedic association, was the chairman of Korean knee society, Korean society of sports medicine and Korean society of arthroscopy. He has published various theses on many world-known journals such as Cell, Nature, the Journal of arthroplasty, the American Journal of Sports Medicine and Knee surgery & related research. He works in the orthopaedic department of Wonkwang university hospital, Iksan, Korea, as a chief professor specializing in the knee joint.

Abstract:

We compared using trabecular metal cones or femoral head allografts in revision TKA patients with large bone defect.

Methods: Total 53 patients who underwent revision TKA from July 2013 to March 2017 were enrolled in this study. Among them, 24 used trabecular metal cones (3 males and 21 females), and 29 used femoral head allografts (4 males and 25 females). The mean age was 70.2 years (range, 51-80) in the allograft group and 79.1 (range, 73-85) in the cone group.

Bone defect was classified with AORI classification and clinical outcomes were evaluated with VAS, HSS, WOMAC, KOOS and ROM. We checked operation time and used radiographs to check loosening. Shapiro-Wilk test was used to check normality and Student T-test and Mann Whitney U-test for comparison between two groups.

Results: The mean follow-up period was 3.75 years (Range; 2.1 ~ 5.75). The mean VAS in the allograft and cone groups were 2.1 ± 0.87 and 1.8 ± 0.53, respectively (p = 0.16). The mean HSS scores were 76.3 ± 5.51 and 79.2 ± 4.12 (p = 0.13), the mean WOMAC scores were 15.1 ± 3.25 and 14.8 ± 3.31 (p = 0.06), the mean KOOS scores were 27.8 ± 4.77 and 25.5 ± 4.84 (p = 0.07), and the mean ROM ranges were 100.6 ± 17.54 and 101.3 ± 19.22 (p = 0.09). Complications with implants were not found in both groups. But the mean operation time of the allograft and trabecular metal cone groups was 137 minutes (Range; 111-198) and 102 minutes (Range; 93 -133) (p=0.02) respectively, which showed statistical significance.

Conclusion: Using whichever means did not affect clinical outcomes. However, operation time was significantly shorter in cone group. In patients with poor general condition, using trabecular metal cone can help shorten operation time and ease postoperative care.

Biography:

Dr. Chun has expertise in knee joint replacement and its supportive surgeries.  He was a guest professor in UCLA (1994) and Indiana university medical center (2002~2004). He is a board member of Korean orthopaedic association, was the chairman of Korean knee society, Korean society of sports medicine and Korean society of arthroscopy. He has published various theses on many world-known journals such as Cell, Nature, the Journal of arthroplasty, the American Journal of Sports Medicine and Knee surgery & related research. He works in the orthopaedic department of Wonkwang university hospital, Iksan, Korea, as a chief professor specializing in the knee joint.

Abstract:

We assessed the clinical and radiological results of using chip bone graft in non-contained type bone defect in primary or revision TKA patients.

Methods: We investigated 32 patients (5 males and 27 females) underwent primary or revision TKA from March 2014 to February 2017, with non-contained type of defect. The mean age was 73.1 years. 7 were primary TKA patients, while 25 were revision patients. 8 had chip bone graft used both in the femur and tibia, 9 only in the tibia, and the other 15 only in the femur. Wire-mesh was used in the 9 patients who had chip bone graft used only in the medial side of the tibia. We used KOOS, HSS and WOMAC scores to assess the clinical result, before the surgery and at the last follow-up. In addition, we had follow-up x-ray and CT done for the patients to check the mean bone union period. Also, overall radiologic imaging studies were used for complications such as loosening, osteolysis and lesions with radiolucency.

Results: The Mean follow-up period was 2.7 years (range; 2.1 to 5). The Mean preoperative KOOS was 102.8 (range; 47 to 132), while postoperative was 31.8 (range; 20 to 45). The mean HSS was 13.1 (range; 6 to 35), while postoperative was 35.9 (range; 24 to 64). The mean WOMAC was 82.9 (range; 62 to 92), while postoperative was 22.5 (range; 13 to 30). According to follow-up x-ray and CT, mean bone union period was 10.6 months (range: 10 to 13). There was no radiologic complication such as loosening and osteolysis, and no complication such as infection.

Conclusion: Chip bone graft in primary or revision TKA with non-contained type bone defect showed favorable result for the subject patients. Therefore, we can consider it as one of the effective methods to manage bone defect.

Biography:

Abstract:

The “Patella in Place Balancer” (PIPB) is an intra-articular knee balancer with the patella in physiological (anatomical) position. This balancer gives the surgeon an indication of the natural hight of the “flexion gap” and the native length of both (the medial and lateral) collateral ligaments in the 90° flexion position of the knee. This technique allows a measuring of the flexion gap before any bony resection on the femur has been made. The technique makes it possible to maximally preserve the bone and avoid any ligament release. Severe varus and valgus deformities can be corrected with this technique without any ligament release. The PCL is preserved in all the cases.The PIPB can also be used while preserving both cruciate ligaments for placement of bicruciate ligament sparing TKA’s. Because the collateral ligaments are isometric a single radius femoral component is preferred. Avoiding release of the ligaments gives better knee stability, better post pain scores, ensures more rapid recovery and better short- and long therm knee range of motion. Placing a TKP with the PIPB is a ligament balancing technique which avoids any ligament releases and can improve the outcome after total knee arthroplasty. This talk describes step by step the use of a “Patella In Place Balancer” (PIPB) during Total Knee Arthroplasty (TKA)

Biography:

Abstract:

Introduction: The technique of direct anterior total hip arthroplasty (DA THA) has increased in popularity.  The benefits of DA THA have been debated.  One of the reported advantages has been the reduction in the complication risk of postoperative dislocation. The rate of dislocation in a single-surgeon DA THA patient cohort was assessed in this study. 

Materials and Methods: From October 2012 through October 2018, all patients undergoing primary THA via a direct anterior approach were prospectively enrolled in this study. Baseline data, including age, gender, BMI was recorded for all subjects. Operative data, including surgical times, implant information, and implant position, was recorded for all cases Surgical technique was consistent across all cases. All cases were performed in the supine position on the HANA table, with the use of intra-operative fluoroscopy. Anesthetic technique, multi-modality pain management protocol, and post-operative mobilization was consistent for all patients enrolled in the study. Dislocation occurrence within the first twelve months postoperatively was recorded for all patients retrospectively.

Results: No patients were lost to follow up during the twelve-month study period. Patient demographics were similar to previously reported THA study cohorts. Average surgical time was 51.0 minutes (range 34-87 minutes). Average acetabular cup position noted 42.4 degrees of abduction and 23.3 degrees of anteversion. The dislocation rate recorded in this study was 0.08% (1/1220).

Discussion/Conclusions: Dislocation rates after primary THA have been reported between 1-3%.  This study demonstrates a postoperative dislocation risk of 0.08% associated with the DA THA technique, utilizing intra-operative fluoroscopy.  This rate is significantly lower than previously reported for any surgical approach. Further, the experience in DA THA reported in this study showed no “learning curve” in regard the risk of dislocation.

Biography:

Abstract:

Osteoarthrosis is a common degenerative and progressive disease, involving the articular cartilage as well as the subchondral bone and the soft tissues in the hip and knee. The incidence of hip and knee osteoarthrosis has increased over the last twenty years and  is  expected  to  increase  even  further.  Approximately, 40% of men and  47%  of  women over 65 years old suffer from symptomatic osteoarthrosis that eventually requires surgical treatment by an orthopedic surgeon. In 2010 around 2.5 million patients were operated for total hip replacement and around 4.7 people with knee osteoarthrosis had a total knee replacement in the United States of America. Acute periprosthetic joint infection, with Staphylococcus aureus being the most common and aggressive pathogen is a very threatening complication for the  whole  health  status  of  the  patient.  The  need  for  revision  procedures  due  to  periprosthetic  hip  infection  is  expected  to  be  doubled  in  2026  and  is  already  doubled  due  to  periprosthetic  knee  infection  in  2015.The risk factors for hip and knee periprosthetic joint infections appear in the preoperative period, as well as intraoperatively and continue to be harmful both in the postoperative period and after the patient’s discharge from the hospital. The aim of our research is to present the variety of risk factors, associated with periprosthetic infections after total hip and knee replacements. Many risk factors can be controlled with the use of specific preventive and therapeutic interventions by orthopedic surgeons.

Biography:

Daniel (Dan) Li has participated in a wide variety of both basic and clinical research regarding biomaterials in the context of orthopaedic applications, such as the use of hydrogels as a novel drug-eluting mechanism to combat osteomyelitis and tuberculosis infection. He has spent significant time overseas with the orthopaedics department at the 309th Hospital of the PLA in Beijing, China, working under the team of Dr. Yuanzheng Ma, as well as completing his undergraduate degree in Materials Science and Engineering at the University of Illinois. There, he conducted research under the John Rogers Research Group investigating novel biodegradable electronics. Currently, he is performing clinical outcomes research at Northwestern University regarding the evaluation of prosthetic joint infection.

Abstract:

Neck-stem corrosion has been associated with Adverse Local Tissue Reaction (ALTR) in dual-taper femoral stems.  In this study, we examine a single surgeon’s retrospective case series of 42 hips in 38 patients who underwent primary total hip arthroplasty (THA) with a dual-taper femoral component. Evaluation consists of clinical exam, labs including metal ion levels, and MARS MRI. We propose that hip aspiration would be a beneficial adjunct. Each hip aspirate was classified into Class 1, 2, or 3, based on qualitative variables. 19/42 hips were symptomatic, 38/42 had elevated Cobalt, and 23/42 had abnormal MRI findings. 40% of aspirates were Class I (benign), 17% Class 2, and 43% Class 3. Class 2 and 3 aspirates are associated with abnormal MRI Mid-term Outcomes and Evaluation Following Implantation with a Recalled Modular Neck Femoral Stem, elevated Cobalt, and a high rate of revision (71% and 72%, respectively). A small subset of patients (2/38) with symptoms, normal labs and MRI, had abnormal aspirates with extensive tissue necrosis at revision. A significant proportion of the aspirates were unable to complete a cell count due to cellular degradation or degeneration, or inability to process a thick fluid sample. For those samples that were processed, cells counts were variable in terms of the differential of neutrophils, lymphocytes, and monocytes. We noted a much higher percentage of patients with elevated Cobalt levels (90%) versus Chromium (22%), which appears to be consistent with contemporary literature. The utility of this diagnostic test may be apparent when looking more closely at select patients.  Within the patients who have been revised, there were 2 patients who were symptomatic, yet had normal cobalt and chromium labs, as well as a normal MARS MRI, yet had Class 3 aspirates, and were noted to have moderate to severe soft tissue necrosis at the time of revision surgery. These patients may potentially be overlooked for early revision.

Biography:

Abstract:

A population especially in Indian subcontinent the habit of squatting for the various social and day today activities makes it more pertinent to operate bilateral AVN hips at same sitting as this not only helps economically in using the same surgical kit and antibiotics and drapes etc. reducing the cost of surgery and also helps in post-operative management. Patient becomes mobile with both the hip painless and active. Simultaneous bilateral hip replacement reveals superior outcome and fewer complications than two-stage procedures: a prospective study including 1819 patients and 5801 follow-ups from a total joint replacement registry, Melloh Markus2010-10-01

Total joint replacements represent a considerable part of day-to-day orthopaedic routine and a substantial proportion of patients undergoing unilateral total hip arthroplasty require a contralateral treatment after the first operation. This report compares complications and functional outcome of simultaneous versus early and delayed two-stage bilateral THA over a five-year follow-up period.

Material and Method -The study is a post hoc analysis of prospectively collected data is from the department of orthopaedics from a single surgeon. Total number of cases was 21, all were between the age group of 36-68 (avg. 52), operated by the posterior approach, implant used was same in all (Stryker ).follow-up is of 24-36 months (Avg 30 months)

Result -Total duration of surgery being 2.5 hours, post-operative period was non-significant all responded well, only there was unilateral infection ,one case of common peroneal nerve injury in our initial few cases ,which was give brace support and after three months that improved. 

Conclusion- Simultaneous bilateral total hip arthroplasty in India subjects seams very useful and helps economically also as this saves lot of money, time of surgeon and operation theatres time. It should be broadly recommended.

Biography:

Dr. Bertrand Kaper has been an orthopedic surgeon in Arizona since 1999 Dr. Kaper is a fellowship-trained joint replacement surgeon, specializing in treating hip pain, knee pain, and shoulder pain. He has vast clinical experience, having performed more than 10,000 surgeries. He is an attending surgeon and chairman of the Section of Orthopaedic Surgery at HonorHealth Scottsdale – Thompson Peak in Scottsdale. He also maintains consulting privileges at Yavapai Regional Medical Center in Prescott. Dr. Kaper earned his Bachelor of Arts degree in Biological Sciences, with Honors, from the University of Chicago, and his medical degree from Northwestern University Feinberg School of Medicine, in Chicago. He started his training with an Internship in General Surgery at Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire. Dr. Kaper then completed a Residency in Orthopaedic Surgery at Dartmouth-Hitchcock Medical Center. In addition to his residency training, Dr. Kaper completed an Adult Reconstructive Fellowship at the University of Western Ontario in London, Canada. This fellowship provided Dr. Kaper the opportunity to train with several internationally renowned orthopedic surgeons in the field of joint replacement surgery, providing him with the foundation of his practice today.

Abstract:

Materials and Methods: From October 2012 through October 2018, all patients undergoing primary THA via a direct anterior approach were prospectively enrolled in this study. Baseline data, including age, gender, BMI was recorded for all subjects. Operative data, including surgical times, implant information, and implant position, was recorded for all cases. Surgical technique was consistent across all cases. All cases were performed in the supine position on the HANA table, with the use of intra-operative fluoroscopy. Anesthetic technique, multi-modality pain management protocol, and post-operative mobilization was consistent for all patients enrolled in the study. Dislocation occurrence within the first twelve months postoperatively was recorded for all patients retrospectively.

Results: No patients were lost to follow up during the twelve-month study period. Patient demographics were similar to previously reported THA study cohorts. Average surgical time was 51.0 minutes (range 34-87 minutes). Average acetabular cup position noted 42.4 degrees of abduction and 23.3 degrees of anteversion. The dislocation rate recorded in this study was 0.08% (1/1220).

Discussion/Conclusions: Dislocation rates after primary THA have been reported between 1-3%.  This study demonstrates a postoperative dislocation risk of 0.08% associated with the DA THA technique, utilizing intra-operative fluoroscopy.  This rate is significantly lower than previously reported for any surgical approach. Further, the experience in DA THA reported in this study showed no “learning curve” in regard the risk of dislocation.