Aseptic looseningis is one of the most frequent long-term complications after joint replacement, which limits the service lire of prosthesis. A lot of studies have been focused on macrophage, osteoblast, osteoclast and fibroblast in interface membranes around prostheses recently. Aseptic loosening of orthopedic implants used in joint replacement results from bone loss that occurs through the resorptive activity of inflammatory cells activated by the presence of wear particles. Apoptosis has been observed in the periprosthetic site and it has been interpreted as a sign of resolution of inflammation suggesting that apoptosis-related events are indeed associated with periprosthetic osteolysis,targeting the Apoptosis pathway may lead to novel therapeutic approaches for the treatment of aseptic prosthesis loosening. In this thesis,the relationship between wear debris-induced apoptosis and aseptic loosening of prostheses are expounded in detail.
Apoptosis ; Humans ; Joint Prosthesis ; adverse effects ; Osteolysis ; Prosthesis Failure ; etiology

Total wrist arthroplasty are not used as widely as total knee and hip replacement. The functional hands are requiring surgeons to design a durable and functional satisfying prosthesis. This article will list the main reasons that cause the failure of the prosthesis. Some remarkable and representative prostheses are listed to show the devolvement of total wrist prosthesis and their individual special innovations to fix the problems. And the second part we will discuss the part that biomechanical elements act in the total wrist replacement (TWA). Summarize and find out what the real problem is and how we can find a way to fix it.
Arthroplasty, Replacement ; adverse effects ; methods ; Biomechanical Phenomena ; Humans ; Joint Instability ; therapy ; Joint Prosthesis ; adverse effects ; Wrist Joint ; surgery

OBJECTIVESTo provide a cumulative data about the complications of second or third generation ankle prostheses in the literature, and to provide a summary high-grade complications associated with implant failure.

METHODSA comprehensive search for all relevant articles published in English from January 1995 to December 2010 was conducted. Two reviewers evaluated each study to determine whether it was eligible for inclusion and collected the data of interest. Meta-analytic pooling of results across studies was performed for the complications and failure rate.

RESULTSThirty-five primary studies with 4395 implants were identified. The three highest complications of total ankle arthroplasty were aseptic loosening (12.51%), intra-operative bone fracture (11.97%) and bony impingement (11.27%). The three high-grade complications associated with implant failure were aseptic loosening (45.00%), infection (33.00%) and malalignment (29.00%). The pooled mean failure rate was 10.98% (95%CI: 8.80% - 13.16%), and the pooled mean failure rate of STAR implant was 14.20% (95%CI: 10.64% - 17.76%).

CONCLUSIONSIt is found that aseptic loosening, infection and malalignment are high-grade complications associated with implant failure in total ankle arthroplasty. The orthopaedic surgeons should be more careful in the operation, and the patients should coordinate with the post-operative rehabilitation plan.

The choice of friction interface has always been a controversial topic in hip arthroplasty. Although the metal-on-metal (MoM) interface has gradually faded out of our vision, its revision is a clinical difficulty. Adverse reactions to metal debris (ARMD) is the most common indication for MoM hip arthroplasty revision, and the clinical results of hip arthroplasty due to ARMD are not satisfactory. At present, the indications and suggestions for revision of ARMD are not uniform. In this article, the clinical diagnosis, indications of revision, risk factors of prognosis, intraoperative suggestions and reasons for revision of ARMD were summarized. This article briefly introduces the diagnosis and treatment strategies and precautions of hip arthroplasty due to ARMD, in order to provide reference for such patients in clinical practice.
Arthroplasty, Replacement, Hip/adverse effects* ; Hip Prosthesis/adverse effects* ; Humans ; Metal-on-Metal Joint Prostheses/adverse effects* ; Prosthesis Design ; Prosthesis Failure ; Reoperation

We report the case of a polyethylene tibial post fracture in a 72-year-old woman 14 months after a Scorpio posterior-stabilized (PS) total knee arthroplasty. The polyethylene wear was found around the fracture site of the post, especially over the anterior aspect of the post base. The failure mechanism of the post fracture in the present case was anterior impingement with excessive wear over the base of the anterior aspect of the tibial post, which became a stress-riser of post and cam articulation. This is the first report of a polyethylene tibial post fracture of a Scorpio PS prosthesis.
Aged ; *Arthroplasty, Replacement, Knee ; Female ; Humans ; Knee Joint/radiography ; Knee Prosthesis/*adverse effects ; Osteoarthritis, Knee/surgery ; *Polyethylenes ; *Prosthesis Failure ; Reoperation

Arthroplasty, Replacement, Hip ; adverse effects ; Hemangiosarcoma ; diagnosis ; Hip Joint ; pathology ; surgery ; Hip Prosthesis ; Humans

Aseptic loosening is one of the most frequent long-term complications after joint replacement,which limits the service life of prostheses. A lot of studies have been focused on interface membranes around prostheses recently. In interface membranes, there are plenty of macrophagocytes and desmocytes,which play vital roles in osteolysis. This study gave a review of interface membrane including its formation, cellulosity, osteolysis factor, immunity reaction and turnover. The advances of interface membranes will help us to comprehend the pathogenesy and treatment of the aseptic loosening.
Humans ; Joint Prosthesis ; adverse effects ; Membranes ; Osteolysis ; RANK Ligand ; physiology ; T-Lymphocytes ; immunology

BACKGROUND: The aim of this study was to evaluate causes of unstable total knee arthroplasty and results of revision surgery. METHODS: We retrospectively reviewed 24 knees that underwent a revision arthroplasty for unstable total knee arthroplasty. The average follow-up period was 33.8 months. We classified the instability and analyzed the treatment results according to its cause. Stress radiographs, postoperative component position, and joint level were measured. Clinical outcomes were assessed using the Hospital for Special Surgery (HSS) score and range of motion. RESULTS: Causes of instability included coronal instability with posteromedial polyethylene wear and lateral laxity in 13 knees, coronal instability with posteromedial polyethylene wear in 6 knees and coronal and sagittal instability in 3 knees including post breakage in 1 knee, global instability in 1 knee and flexion instability in 1 knee. Mean preoperative/postoperative varus and valgus angles were 5.8degrees/3.2degrees (p = 0.713) and 22.5degrees/5.6degrees (p = 0.032). Mean postoperative alpha, beta, gamma, delta angle were 5.34degrees, 89.65degrees, 2.74degrees, 6.77degrees. Mean changes of joint levels were from 14.1 mm to 13.6 mm from fibular head (p = 0.82). The mean HSS score improved from 53.4 to 89.2 (p = 0.04). The average range of motion was changed from 123degrees to 122degrees (p = 0.82). CONCLUSIONS: Revision total knee arthroplasty with or without a more constrained prosthesis will be a definite solution for an unstable total knee arthroplasty. The solution according to cause is very important and seems to be helpful to avoid unnecessary over-constrained implant selection in revision surgery for total knee instability.
Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Knee/*adverse effects ; Female ; Humans ; Joint Instability/*etiology ; Knee Joint/*surgery ; Knee Prosthesis ; Male ; Middle Aged ; *Prosthesis Failure ; Reoperation ; Retrospective Studies

This paper is aimed to focus on the joint prosthesis failure event, to collect the statistic data about the failure of artificial joints issued by authoritative organizations at home and aboard, and to compare the functions of different types of the artificial joints. We generalized and compared current study analyzing the failure reason and type of joint prosthesis, and categorized the failure events according to the failure occurring time, i. e. short-term, medium-term and long-term. This paper could be helpful for improving and summarizing of artificial joint replacement surgery, and could put forward the requirements for the future artificial joints.
Arthroplasty, Replacement ; adverse effects ; statistics & numerical data ; Arthroplasty, Replacement, Hip ; adverse effects ; statistics & numerical data ; Arthroplasty, Replacement, Knee ; adverse effects ; statistics & numerical data ; Humans ; Joint Prosthesis ; Prosthesis Failure ; etiology

BACKGROUND: This study examined the clinical and radiologic mid-term results of patients treated by Oxford minimally invasive unicompartmental knee arthroplasty. METHODS: One hundred and eighty-eight knees of unicompartmental knee arthroplasties with Oxford Uni(R) in 166 patients (16 males and 150 females), which were performed between 2002 and 2005, were reviewed. The mean age was 65.3 years (range, 44 to 82 years) and the mean follow-up period was 79.8 months (range, 56 to 103 months). The preoperative diagnosis was osteoarthritis in 166 patients, osteonecrosis of the medial femoral condyle in 20 and chondrocalcinosis in 2. RESULTS: The mean Hospital for Special Surgery (HSS) knee score was 67.5 (range, 52 to 75) preoperatively and 89.9 (range, 85 to 100) at the final follow-up. The mean preoperative flexion contracture was 6.5degrees (range, 0 to 15degrees) and 0.8degrees (range, 0 to 5degrees) at the final follow-up. The mean full flexion increased from 135degrees (range, 90 to 150degrees) preoperatively to 150degrees (range, 140 to 165degrees) at the final follow-up. Active full flexion was possible within 2 postoperative months. The squatting and cross-leg postures were possible in 133 patients (80.1%) and 152 patients (91.6%) at the final follow-up. The mean tibiofemoral angle was improved from varus 1.5degrees to valgus 4.8degrees. Complications were encountered in 18 cases (9.5%). A bearing dislocation occurred in 10 cases (5.3%), tibial component loosening in 4 cases (2.1%), femoral loosening in 3 cases (1.6%) and lateral translation in 1 case (0.5%). The mean time for a bearing dislocation was 22.6 months (range, 3 to 70 months) postoperatively. Seven cases returned to the predislocation level of activity with the insertion of a thicker bearing and 3 cases converted to total knee arthroplasty. CONCLUSIONS: Minimally invasive unicompartmental knee arthroplasty with Oxford Uni(R) provided rapid recovery, good pain relief and excellent function suitable for the Korean lifestyle. In contrast, the high complication rates of Oxford Uni(R) encountered in the mid-term results suggested less reliability than total knee arthroplasty.
Adult ; Aged ; Aged, 80 and over ; *Arthroplasty, Replacement, Knee/adverse effects ; Female ; Humans ; Knee Joint/physiopathology/radiography ; *Knee Prosthesis ; Male ; Middle Aged ; Prosthesis Failure ; Range of Motion, Articular