The Application of an Allogenic Bone Screw for Stabilization of a Modified Chevron Osteotomy: A Prospective Analysis.

Background: Distal first metatarsal osteotomies are commonly performed operative procedures for hallux valgus deformity, and usually involve fixation with a metal screw. However, various bioabsorbable osteosynthesis materials have been in use for a number of years. One recent innovation is the Shark Screw®, a human cortical bone allograft. This study aimed to evaluate the efficacy and safety of this allogeneic screw in the stabilization of Reversed L-Shaped osteotomy, a modified Chevron osteotomy. Methods: In a prospective study, 15 patients underwent a Reversed L-Shaped osteotomy stabilized with the allogenic bone screw Radiological data on osteointegration of the screw and correction of the intermetatarsal angle were recorded. Furthermore, each follow-up examination included the collection of clinical data, the American Orthopedic Foot and Ankle Society (AOFAS) score, evaluation of pain level, and patient's overall satisfaction. Results: Full osseous fusion of the osteotomy was seen in all patients. The bone screws were radiographically integrated after approximately 6.5 (±2.6) months. Neither nonunion nor failure occurred in any of our cases. Furthermore, we did not find any potential graft reaction. The AOFAS score improved significantly from 51.6 (±15.2) points to 90.9 (±10.3) (p < 0.001). The preoperative hallux valgus angle and intermetatarsal angle decreased significantly from 24.8 (±4.9) degrees to 7.2 (±4.4) degrees (p < 0.001) and 12.6 (±3.2) degrees to 4.8 (±1.3) degrees (p < 0.001), respectively. Conclusions: With this study, we demonstrated the efficiency of the allogenic bone screw (Shark Screw®) in regard to clinical and radiological short-term outcomes.

Prospective Mid-Term Results of a Completely Metal-Free Ceramic Total Knee Endoprosthesis: A Concise Follow-Up of a Previous Report.

BACKGROUND: Hypersensitivity reactions are suspected to cause premature aseptic loosening in susceptible patients after total knee arthroplasty. In response, metal-free implants have been developed. The aim of this prospective, observational midterm study was the assessment of a completely metal-free ceramic knee replacement system as a concise follow-up of a previous report. METHODS: Thirty-eight patients, with anamnestic suspected or documented allergy to the metal used in prosthetic alloys, participated in this 4-year follow-up of the metal-free BPK-S (Peter Brehm) total knee replacement system with ceramic femoral and tibial components. Clinical assessment included Knee Society Score (KSS), Oxford Knee Score, Euro Quol-5D-Visual Analogue Scale (EQ-5D-VAS), and perioperative or postoperative complications and need for revision. The position of the implant, signs of loosening, and leg alignment were assessed radiographically. RESULTS: All postoperative clinical scores improved significantly from baseline to 48-month follow-up examination. The Oxford Knee Score improved from 39 to 15 points. The KSS improved from 99 to 195 points (the KSS knee score 42.5 to 96 and the KSS function score 60 to 100). The EQ-5D improved from 12 to 7 points; the EQ-VAS improved from 52.5 to 97 points. No allergic reactions could be detected. Radiologically, a median preoperative varus deformity of 5° improved to 0° at 4-year follow-up. Radiolucent lines appeared around uncemented areas with no clinical symptoms. CONCLUSION: The fully metal-free BPK-S Integration ceramic knee replacement system exhibits excellent immuno-allergological compatibility, offering a safe option for patients with prior hypersensitivity reactions to metallic materials. Full cementation of all components is recommended to avoid radiolucent lines around the implant.

Prospective Short-Term and Return-to-Sports Results of a Novel Uncemented Short-Stem Hip Prosthesis with Metaphyseal Anchorage.

Short-stem hip prostheses were developed to treat active patients requiring total hip arthroplasty (THA). This study provides short-term data about a short-stem total hip arthroplasty system. Functional and radiological outcomes as well as return to sports and activity level were assessed. A series of 55 patients was primarily included. Data were available for 47 patients at an average follow-up of 38 ± 4.6 months. The back-to-sports analysis showed a 98% return-to-sports rate (46/47 patients). The average time for return to sports was 13 weeks (± 8) postoperatively. Five patients (10.6%) were more active postoperatively. The Harris Hip Score (HHS) improved from 34.8 (±9.4) preoperatively to 94.7 (±8.4, p ≤ 0.001) and the University of California, Los Angeles (UCLA) score improved from 4.5 (±1.8) to 6.9 (±1.9) (p ≤ 0.001). The High Activity Arthroplasty Score (HAAS) was 12 (± 3.6) at 3-year follow-up. Pre- and postoperative UCLA and postoperative HHS and HAAS scores had a positive influence on the return-to-sports rate (p ≤ 0.05). The collection of radiographic data during all postoperative follow-ups showed no signs of radiolucent lines or bone fissures. The complication rate was at 5%. Short-stem systems are equaling conventional prostheses and offer benefits regarding soft tissue and bone stock preservation. Fast recovery and return to sports can be achieved.

Prospective Comparison of a Metal-Free Ceramic Total Knee Arthroplasty with an Identical Metal System.

AIMS: The aim of this open-label, prospective, short-term study was to carry out an initial comparison of a completely metal-free ceramic with a geometrically identical metallic arthroplasty over a 1-year follow-up period. METHODS: This study investigates a completely metal-free system using a composite matrix material containing aluminum oxide (Al2O3, BPK-S Integration, Peter Brehm GmbH, Weisendorf, Germany) or zirconium oxide (ZrO2, BPK-S Integration Ceramic, Biolox Delta-CeramTec GmbH, Plochingen, Germany). Eighty patients (40 in each group) received either a completely metal-free ceramic system (matrix of aluminum and zirconium oxide) or an anatomically identical metallic knee system made of a cobalt-chromium alloy. Clinical assessment was performed preoperatively, and during follow-up at 3 and 12 months, using the Knee Society Score, Oxford Knee Score, and EQ-5D-VAS. For radiological evaluation, standard preoperative and postoperative standardized radiographs were taken at the given follow-up visits. RESULTS: The postoperative clinical scores improved significantly at the 3- and 12-month follow-ups, but did not differ statistically between the two groups. The radiologically evaluated mean postoperative mechanical and anatomical axes showed proper alignment within both groups at all times. No revision surgery had to be performed, and no complications or loosening were recorded whatsoever. CONCLUSIONS: To our knowledge, this is the first study comparing a total ceramic metal-free knee system with a geometrically identical metallic TKA (total knee arthroplasty). Longer follow-ups will be required to demonstrate the overall efficiency of this TKR and perhaps to expand its medical indication.

Interphalangeal arthrodesis using an intramedullary nitinol implant: a prospective study.

OBJECTIVES: This study aims to evaluate the nitinol (X-Fuse®) implant in arthrodesis of the distal interphalangeal and the thumb joints with respect to bone fusion and clinical efficiency. PATIENTS AND METHODS: This prospective study included 24 consecutive patients (7 males, 17 females; mean age 56.8 years; range 27 to 79 years) with nitinol (X-Fuse®) implants in their 41 joints. All patients were followed-up clinically and radiographically with respect to fusion, complications and outcome at a minimum of 14 months postoperatively (mean 28±6 months). X-rays, Disabilities of the Arm, Shoulder and Hand, and visual analog scale scores were recorded preoperatively and at postoperative fifth week, third month, first year, and subsequent visits. RESULTS: The Disabilities of the Arm, Shoulder and Hand score improved significantly from preoperative 37.7 points to postoperative 14.5 points at first year. The visual analog scale score improved significantly from preoperative 5.5 to postoperative 0.85 points at first year. Failure to fuse only occurred in two joints (5%), resulting in fusion after reoperation. No other severe complications such as deep infection, intraoperative fracture, wound healing problems or regional dystrophy were observed. CONCLUSION: The X-Fuse® implant may be a reliable alternative method for finger joint arthrodesis.

Midterm Results of Consecutive Periprosthetic Femoral Fractures Vancouver Type A and B.

Surgical treatment of periprosthetic femoral fractures has a high complication and mortality rate of more than 10%. The aim of this study is to report the outcome of a consecutive single center patient group. Thirty-four consecutive patients (mean age 81.2+/-8.5 years, 14 male, 20 female) with a periprosthetic femoral fracture Vancouver type A (n=5) or type B (n=29) were followed-up after 43.2 months, none of the patients were lost to follow-up. Nineteen of the patients were treated through change of the stem and cerclage fixation, five by plates and ten by cerclage cables. One successfully treated infection was observed. No further complications have been reported peri- or postoperatively, therefore resulting in 2.9% overall complication rate. These results demonstrate that precisely selected revision surgery protocol following periprosthetic femoral fractures within elderly multimorbid patients may lead to beneficial outcomes at a low risk of complications.