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- W2902567811 abstract "Where Are We Now? Total hip arthroplasty is among the most-successful surgical procedures in medicine, with some even considering it “the operation of the century” [1]. Our present knowledge of THA implants comes from the strides made in biomechanics and the relentless improvements in biomedical materials [2]. But as with any surgical procedure, THA is not without potential complications—periprosthetic infections are a particularly pernicious class that necessitate revisions. Unfortunately, patients who undergo revision THA tend to experience a lower likelihood of clinical success and satisfaction [3]. Previously, Matharu and colleagues [5] analyzed patients who received implants coated with tantalum, referred to as trabecular metal (TM), in their primary THAs. Their findings revealed that these patients encountered lower rates of infection compared to their counterparts who did not receive TM-coated components, implying that TM played some role in this difference. While one might infer that TM components may likewise be associated with a lower risk in revision THA, a followup study found that TM was not associated with a decreased risk of all-cause repeat revision compared to non-TM acetabular components [6]. In the present study, the same authors [4] employed one of the largest THA registries in the world to determine that usage of TM components in revisions performed for infection conferred no advantage in terms of reducing the risk of repeat revision, including both all-cause repeat revision and repeat revision for periprosthetic joint infection. The topic is important because the risk of rerevision (especially following infection) increases with each subsequent operation on a patient’s hip [7]; because these procedures already are so expensive, it is helpful to know that an even-more-expensive biomaterial (tantalum) does not appear to confer any advantage. Where Do We Need To Go? While TM may not be the panacea for safeguarding against infections in the revision setting, its utility is not altogether diminished, as it remains useful in addressing other indications, such as bone-loss defects [8]. Additional studies with more data and followup at finer time resolutions would be needed to corroborate the conclusions of the current study. The lingering question is whether the results of the current study can be validated since it is a specialized topic and the first of its kind. A randomized controlled study could help answer this question, but its cost would be steep, and possibly prohibitive. How Do We Get There? In the short-term, combining data with more patients and performing a retrospective analysis could lend more power to the presented findings. A logical next step would be, as the authors suggested, increasing the cohort size by combining data from at least two more large database registries such as the Swedish Hip Arthroplasty Register (SHAR) and the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) as was done in a recent study by Laaksonen and colleagues [9]. The results presented now, however, can prove useful to the orthopaedics community for designing treatment algorithms that take into consideration TM components in an evidence-based and cost-effective manner [10]. Based on what we now know, though, and unless future studies definitively prove otherwise, I concur with the authors [4] that we should be skeptical of claims that TM reduces the risk of infection after THA or revision." @default.
- W2902567811 created "2018-12-11" @default.
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- W2902567811 date "2018-12-03" @default.
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- W2902567811 title "CORR Insights®: Do Trabecular Metal Acetabular Components Reduce the Risk of Rerevision After Revision THA Performed for Periprosthetic Joint Infection? A Study Using the NJR Data Set" @default.
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- W2902567811 doi "https://doi.org/10.1097/corr.0000000000000598" @default.
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