Roles of inflammatory cell infiltrate in periprosthetic osteolysis.

Classically, particle-induced periprosthetic osteolysis at the implant-bone interface has explained the aseptic loosening of joint replacement. This response is preceded by triggering both the innate and acquired immune response with subsequent activation of osteoclasts, the bone-resorbing cells. Although particle-induced periprosthetic osteolysis has been considered a foreign body chronic inflammation mediated by myelomonocytic-derived cells, current reports describe wide heterogeneous inflammatory cells infiltrating the periprosthetic tissues. This review aims to discuss the role of those non-myelomonocytic cells in periprosthetic tissues exposed to wear particles by showing original data. Specifically, we discuss the role of T cells (CD3+, CD4+, and CD8+) and B cells (CD20+) coexisting with CD68+/TRAP- multinucleated giant cells associated with both polyethylene and metallic particles infiltrating retrieved periprosthetic membranes. This review contributes valuable insight to support the complex cell and molecular mechanisms behind the aseptic loosening theories of orthopedic implants.

International Perception of Perioperative Risk for Arthroplasty-Experience of the Colombian Health System.

BACKGROUND: Following a recent publication of the American Association of Hip and Knee Surgeons (AAHKS) which found that 95% of respondents address risk factors before surgery and the challenges in the ultimate access to care, the authors proposed an international collaboration in order to gain insight on how performance measures affect access to care as well as what medical and/or socioeconomic factors are considered obstacles to good outcomes from an international perspective. The aim of this study was to poll Colombia's arthroplasty surgeons regarding their approach to patients who have modifiable risk factors. METHODS: The survey used in the AAHKS study was adapted for use in the Colombian context and distributed to the members of the Colombian Society of Hip and Knee Surgeons (SOCCAR) via a collaborative format online, and it was completed by 109 out of 163 members, a response rate of 67%. RESULTS: Overall, 67% limit or restrict surgery in patients with specific modifiable risk factors. Those factors most likely to delay or restrict treatment were malnutrition/hypoalbuminemia (95.9%), poor diabetic control (89%), and active smoking (61.6%). Limited social support was considered a liability by 82.2% of surgeons. Over 80% of respondents decide based on personal experience or literature review. Low socioeconomic status was considered a factor for limiting access by 53.4% of polled surgeons. 91.8% believe some patient populations would benefit with better access to care if payment systems provided better risk adjustment. CONCLUSION: Only 67% of Colombian arthroplasty surgeons limit or restrict elective surgery in patients with modifiable risk factors, mainly considering malnutrition and poorly controlled diabetes as a cause for restriction, and half of the surgeons consider low socioeconomic status as a limitation to arthroplasty surgery. These findings contrast dramatically to the practice patterns of American AAHKS members.

Patients Achieving 90°/45°/0° Intraoperative Stability Do Not Require Hip Precautions Following Posterior Approach Total Hip Arthroplasty: A Prospective Randomized Study.

BACKGROUND: Hip precautions are traditionally employed after posterior total hip arthroplasty (THA). The primary purpose was to investigate the necessity of hip precautions after posterior approach THA. We hypothesized that eliminating precautions in patients that achieved appropriate intraoperative stability would not increase the dislocation rate. METHODS: Randomized controlled trial of 346 consecutive eligible patients undergoing primary THA with a mean follow-up of 2.3 years (range 11 months to 3.7 years). EXCLUSION CRITERIA: lumbar fusion, scoliosis, abductor insufficiency, inability to achieve intraoperative stability with combined 90° flexion and 45° internal rotation in 0° adduction. Fisher's exact test was used to compare dislocation rates between the hip precaution (HP) control group and no hip precaution (NP) study group. In addition, Mann-Whitney U test was used to compare differences in HOOS JR scores at 2, 6, 12 weeks between groups. RESULTS: The dislocation rate was not increased in the NP (0/172: 0%) group compared to the HP group 4/174 (2.29%) (P = .418). All dislocations occurred in the precautions group, two of which required revision. There were no differences in mean HOOS Jr. scores at any 2, 6, or 12 weeks (P > .05 at all timepoints) (secondary outcome). CONCLUSION: Eliminating hip precautions in patients undergoing posterior approach THA that achieve 90°/45°/0° intraoperative stability does not increase the rate of dislocation. In fact, every dislocation occurred in patients receiving hip precautions. Short-term patient-reported outcome measures were not affected by hip precautions. Surgeons may discontinue the use of hip precautions as the standard of care in patients achieving 90°/45°/0° stability.

Patient Perception Regarding Potential Effectiveness of Cannabis for Pain Management.

BACKGROUND: Self-reported cannabis use has increased since its recent legalization in many states. The primary objective of this study is to describe patients' beliefs regarding the potential effectiveness of cannabis and gauge patient acceptance of these compounds if prescribed by a physician. METHODS: Five hundred fifty-five consecutive new patients in a total joint arthroplasty (TJA) practice completed a questionnaire at their new patient or preoperative encounter. Questions regarding their beliefs about the potential effectiveness of cannabis for pain management were presented to the patient. Each question was scored in accordance to the agreement of the patient. Data were also collected on patient demographics, and current cannabis, tobacco, and/or alcohol use. RESULTS: Current cannabis use was reported in 20.2% (112/555) of respondents. Patients were interested in using cannabis if prescribed by a physician for acute (75.3%, 418/515) and chronic (74.4%, 415/555) pain. Seventy-seven percent (428/555) of patients believe (strongly agree or agree) that cannabis should be legalized for medical use, whereas only 39% (217/555) strongly agree or agree that cannabis should be legalized for recreational use. Patients strongly agree or agree that cannabis can help with sleep or anxiety, 44.9% (249/555) and 49.4% (274/555) respectively. Most patients had never smoked (53%, 294/555) and drink one or less alcoholic beverage per week (52.1%, 299/555). CONCLUSION: Patients believe that cannabis may be helpful for pain management after TJA and are willing to use if prescribed by their orthopedic provider. Further research is warranted to determine if cannabis is a helpful adjunct to pain management in this patient population.

Methicillin-resistant Staphylococcus aureus colonization in patients undergoing primary total hip arthroplasty.

Introduction. Nasal and skin colonization by methicillin-resistant Staphylococcus aureus (MRSA) are linked to a higher incidence of infection after total joint replacement. The prevalence of colonization is poorly defined in Latin American countries.Aim. The aim of the present study was to determine the prevalence of MRSA colonization in the nostrils and groin using real-time polymerase chain reaction (RT-PCR) in patients undergoing total hip arthroplasty (THA).Methodology. In this cross-sectional study, 146 patients undergoing THA between December 2015 and March 2017 in a tertiary-care university-affiliated hospital in Chile were screened for MRSA colonization before the procedure using RT-PCR independently in the nostrils and groin. Risk factors for colonization were documented.Results. Seven of the 146 (5 %) patients undergoing THA were carriers of MRSA in the nostrils and/or the groin. Recent antibiotic use was identified as a risk factor for colonization, OR=4.86 [95 % confidence interval (CI): 1.56-13.96]. Patients reporting at least one of the seven surveyed risk factors had an OR of 2.39 (95 % CI: 0.37-25.77) for colonization. MRSA colonization frequency was twofold higher in the groin as opposed to the nostrils (P=0.014).Conclusion. Five percent of the patients undergoing THA were identified as carriers of MRSA. Recent antibiotic use is a relevant risk factor for MRSA colonization in patients undergoing primary total hip arthroplasty.

Total joint prosthesis for ankylosis after multiples condylar traumas.

Temporomandibular joint (TMJ) ankylosis is a disease commonly associated with facial trauma, especially in the condylar region. Described as a heterotopic bone growth that causes mouth opening limitation, it may occur in trauma cases misdiagnosed or mistreated. We present the case of a 37-year-old female, with decreased mouth opening after three traumas in the region of the right condyle by a motorcycle accident. We performed custom-made total joint replacement of the TMJ to rehabilitate the patient post arthroplasty. TMJ Concepts® protocol was followed to perform the patient's rehabilitation. She is being followed since then by a physical therapist to regain the pre-pathosis status of mouth opening, speech, and mastication function.

Osteochondroma of mandibular ramus and condylar neck: simultaneous resection and reconstruccion with personalized alloplastic joint prosthesis / Osteocondroma de la rama mandibular y cuello del cóndilo: resección y reconstrucción simultánea con prótesis articular personalizada aloplástica

Osteochondromas are benign osteogenic tumors that can attain great size, which may require resection and additional treatment to restore the jaw's shape and function. In this report, an osteochondroma located on the mandibular ramus and neck of the condyle was resected and reconstructed simultaneously through a total joint replacement. After the surgery, the patient remains asymptomatic and recovers opening and closing ranges, phonation and the masticatory function. The immediate reconstruction after resection is a good alternative to avoid a second operation and the presurgical virtual planning ensures the complete removal of the lesion using cutting guides and covering the entire defect with a customized alloplastic joint prosthesis.

Los osteocondromas son tumores osteogénicos benignos que pueden alcanzar grandes tamaños, los cuales requieren de resección quirúrgica y generalmente de algún tratamiento adicional para restaurar la forma y la función mandibular. En este caso, un osteocondroma localizado en la rama mandibular y el cuello del cóndilo fue reseccionado y reconstruido simultáneamente a través de un reemplazo articular total. Después de la cirugía, el paciente permanece asintomático y recupera los intervalos de apertura y cierre, la fonación y la función masticatoria. La reconstrucción inmediata después de la resección es una buena alternativa para evitar una segunda operación, y la planificación virtual prequirúrgica garantiza la eliminación completa de la lesión utilizando guías de corte y cubriendo todo el defecto con una prótesis articular aloplástica personalizada.

Pain management among Dominican patients with advanced osteoarthritis: a qualitative study.

BACKGROUND: Advanced osteoarthritis and total joint replacement (TJR) recovery are painful experiences and often prompt opioid use in developed countries. Physicians participating in the philanthropic medical mission Operation Walk Boston (OpWalk) to the Dominican Republic have observed that Dominican patients require substantially less opioid medication following TJR than US patients. We conducted a qualitative study to investigate approaches to pain management and expectations for postoperative recovery in patients with advanced arthritis undergoing TJR in the Dominican Republic. METHODS: We interviewed 20 patients before TJR about their pain coping mechanisms and expectations for postoperative pain management and recovery. Interviews were conducted in Spanish, translated, and analyzed in English using content analysis. RESULTS: Patients reported modest use of pain medications and limited knowledge of opioids, and many relied on non-pharmacologic therapies and family support to cope with pain. They held strong religious beliefs that offered them strength to cope with chronic arthritis pain and prepare for acute pain following surgery. Patients exhibited a great deal of trust in powerful others, expecting God and doctors to cure their pain through surgery. CONCLUSION: We note the importance of understanding a patient's individual pain coping mechanisms and identifying strategies to support these coping behaviors in pain management. Such an approach has the potential to reduce the burden of chronic arthritis pain while limiting reliance on opioids, particularly for patients who do not traditionally utilize powerful analgesics.