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Percutaneous cementoplasty of periprosthetic loosening: can interventional radiologists offer an alternative to revision surgery?
Objective To evaluate feasibility and validate both safety and efficiency of radiological percutaneous periprosthetic bone cementoplasty (RPPBC) performed under local anesthesia as an alternative minimally invasive treatment of aseptic implant loosening. Methods In this case series, seven patients (...
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| Published in: | European radiology 2021-06, Vol.31 (6), p.4221-4231 |
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| creator | Prestat, A. J. Dalili, D. Rudel, A. Torre, F. Pavan, L. J. Boileau, P. Amoretti, N. |
| description | Objective
To evaluate feasibility and validate both safety and efficiency of radiological percutaneous periprosthetic bone cementoplasty (RPPBC) performed under local anesthesia as an alternative minimally invasive treatment of aseptic implant loosening.
Methods
In this case series, seven patients (mean age 81 years, range 73 to 89 years, 2 men and 5 women) were enrolled between February 2011 and January 2020 with confirmed aseptic loosening of orthopedic implants. One patient presented with tibial component loosening of an unicompartmental knee arthroplasty, one with glenoid component loosening from a reverse shoulder arthroplasty, one femoral gamma nail, and four presented with pedicle screw loosening after staged posterior lumbar interbody fusion. All patients underwent clinical, biochemical, and imaging assessments to confirm the diagnosis of aseptic loosening. All benefited from RPPBC under dual CT and fluoroscopic guidance. All procedures were performed under local anesthesia by an experienced radiologist. Preprocedural, immediate and 6-month post-cementoplasty pain levels on a visual analogue scale (VAS), and functional outcomes were evaluated. Immediate and 6-month postprocedural CTs were performed to evaluate the treated region.
Results
All RPPBC were well tolerated by patients throughout the procedure. None of the patients suffered from local or systemic infection post-RPPBC, or periprosthetic fractures. No recurrent implant loosening was observed. Six patients were pain free at 6 months. All patients expressed functional improvements during validated outcome score evaluations.
Conclusion
RPPBC appears to be an efficient and reliable treatment strategy for aseptic loosening of orthopedic implants in elderly patients deemed unfit for revision surgery.
Key Points
• Radiological percutaneous periprosthetic bone cementoplasty offers immediate and long-lasting pain relief in elderly frail patients, or those deemed unfit for revision surgery despite presenting with symptomatic aseptic loosening of orthopedic implants.
• Radiological percutaneous periprosthetic bone cementoplasty brings quick and long-lasting improvements in clinical functional outcomes and offer effective pain reduction, thereby improving the overall quality of life.
• Radiological percutaneous periprosthetic bone cementoplasty is a safe, quick, reliable, and well-tolerated minimally invasive procedure which can be easily performed under simple locoregional anesthesia and requires shor |
| doi_str_mv | 10.1007/s00330-020-07463-8 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2461394397</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2461394397</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-c23fce1a7c0da7d1ed5b629290a59c0ef8cb6070e425f7dd7e067fb1f226aa083</originalsourceid><addsrcrecordid>eNp9kUGPFCEQhYnRuLOrf8CDIfHipbWA7qbxYjYbV0020YOeCUMXIxsGRqAnmaP_XNZeNfHggXDge0W99wh5xuAVA5CvC4AQ0AFvR_aj6KYHZMN6wTsGU_-QbECJqZNK9WfkvJRbAFCsl4_JmRAcGJ_Ehvz4jNku1URMS6EW9xhrOgRT6okmRw-Y_SGnUr9h9ZaGlApGH3dvqDWR-lgxH5vCp2gCzWb2KaSdL7U0scNMG2RCg6Kp_oi0Jprx6EvjaVnyDvPp7RPyyJlQ8On9fUG-Xr_7cvWhu_n0_uPV5U1nhRxqZ7lwFpmRFmYjZ4bzsB254grMoCygm-x2BAnY88HJeZYIo3Rb5jgfjYFJXJCX69zm5_uCpeq9LxZDWL1r3o9MqF4o2dAX_6C3aWkeQqOGFlvLWA2N4itlW0Alo9OH7PcmnzQDfVeQXgvSrSD9qyB9t8Xz-9HLdo_zH8nvRhogVqC0p9gS-vv3f8b-BJ7wn0U</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2528314395</pqid></control><display><type>article</type><title>Percutaneous cementoplasty of periprosthetic loosening: can interventional radiologists offer an alternative to revision surgery?</title><source>Springer Nature</source><creator>Prestat, A. J. ; Dalili, D. ; Rudel, A. ; Torre, F. ; Pavan, L. J. ; Boileau, P. ; Amoretti, N.</creator><creatorcontrib>Prestat, A. J. ; Dalili, D. ; Rudel, A. ; Torre, F. ; Pavan, L. J. ; Boileau, P. ; Amoretti, N.</creatorcontrib><description>Objective
To evaluate feasibility and validate both safety and efficiency of radiological percutaneous periprosthetic bone cementoplasty (RPPBC) performed under local anesthesia as an alternative minimally invasive treatment of aseptic implant loosening.
Methods
In this case series, seven patients (mean age 81 years, range 73 to 89 years, 2 men and 5 women) were enrolled between February 2011 and January 2020 with confirmed aseptic loosening of orthopedic implants. One patient presented with tibial component loosening of an unicompartmental knee arthroplasty, one with glenoid component loosening from a reverse shoulder arthroplasty, one femoral gamma nail, and four presented with pedicle screw loosening after staged posterior lumbar interbody fusion. All patients underwent clinical, biochemical, and imaging assessments to confirm the diagnosis of aseptic loosening. All benefited from RPPBC under dual CT and fluoroscopic guidance. All procedures were performed under local anesthesia by an experienced radiologist. Preprocedural, immediate and 6-month post-cementoplasty pain levels on a visual analogue scale (VAS), and functional outcomes were evaluated. Immediate and 6-month postprocedural CTs were performed to evaluate the treated region.
Results
All RPPBC were well tolerated by patients throughout the procedure. None of the patients suffered from local or systemic infection post-RPPBC, or periprosthetic fractures. No recurrent implant loosening was observed. Six patients were pain free at 6 months. All patients expressed functional improvements during validated outcome score evaluations.
Conclusion
RPPBC appears to be an efficient and reliable treatment strategy for aseptic loosening of orthopedic implants in elderly patients deemed unfit for revision surgery.
Key Points
• Radiological percutaneous periprosthetic bone cementoplasty offers immediate and long-lasting pain relief in elderly frail patients, or those deemed unfit for revision surgery despite presenting with symptomatic aseptic loosening of orthopedic implants.
• Radiological percutaneous periprosthetic bone cementoplasty brings quick and long-lasting improvements in clinical functional outcomes and offer effective pain reduction, thereby improving the overall quality of life.
• Radiological percutaneous periprosthetic bone cementoplasty is a safe, quick, reliable, and well-tolerated minimally invasive procedure which can be easily performed under simple locoregional anesthesia and requires short-term hospital stay.</description><identifier>ISSN: 0938-7994</identifier><identifier>EISSN: 1432-1084</identifier><identifier>DOI: 10.1007/s00330-020-07463-8</identifier><identifier>PMID: 33201283</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Aged ; Aged, 80 and over ; Anesthesia ; Arthroplasty (knee) ; Arthroplasty, Replacement, Knee ; Bone implants ; Bone surgery ; Cementoplasty ; Computed tomography ; Diagnostic Radiology ; Disseminated infection ; Evaluation ; Female ; Fluoroscopy ; Fractures ; Glenoid components ; Humans ; Imaging ; Internal Medicine ; Interventional ; Interventional Radiology ; Joint surgery ; Local anesthesia ; Loosening ; Male ; Medicine ; Medicine & Public Health ; Minimally invasive surgery ; Neuroradiology ; Older people ; Orthopaedic implants ; Orthopedics ; Pain ; Patients ; Pedicle screws ; Quality of Life ; Radiologists ; Radiology ; Recurrent infection ; Reoperation ; Revisions ; Surgery ; Tibial components ; Transplants & implants ; Treatment Outcome ; Ultrasound</subject><ispartof>European radiology, 2021-06, Vol.31 (6), p.4221-4231</ispartof><rights>European Society of Radiology 2020</rights><rights>European Society of Radiology 2020.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-c23fce1a7c0da7d1ed5b629290a59c0ef8cb6070e425f7dd7e067fb1f226aa083</citedby><cites>FETCH-LOGICAL-c375t-c23fce1a7c0da7d1ed5b629290a59c0ef8cb6070e425f7dd7e067fb1f226aa083</cites><orcidid>0000-0003-4703-1544</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33201283$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Prestat, A. J.</creatorcontrib><creatorcontrib>Dalili, D.</creatorcontrib><creatorcontrib>Rudel, A.</creatorcontrib><creatorcontrib>Torre, F.</creatorcontrib><creatorcontrib>Pavan, L. J.</creatorcontrib><creatorcontrib>Boileau, P.</creatorcontrib><creatorcontrib>Amoretti, N.</creatorcontrib><title>Percutaneous cementoplasty of periprosthetic loosening: can interventional radiologists offer an alternative to revision surgery?</title><title>European radiology</title><addtitle>Eur Radiol</addtitle><addtitle>Eur Radiol</addtitle><description>Objective
To evaluate feasibility and validate both safety and efficiency of radiological percutaneous periprosthetic bone cementoplasty (RPPBC) performed under local anesthesia as an alternative minimally invasive treatment of aseptic implant loosening.
Methods
In this case series, seven patients (mean age 81 years, range 73 to 89 years, 2 men and 5 women) were enrolled between February 2011 and January 2020 with confirmed aseptic loosening of orthopedic implants. One patient presented with tibial component loosening of an unicompartmental knee arthroplasty, one with glenoid component loosening from a reverse shoulder arthroplasty, one femoral gamma nail, and four presented with pedicle screw loosening after staged posterior lumbar interbody fusion. All patients underwent clinical, biochemical, and imaging assessments to confirm the diagnosis of aseptic loosening. All benefited from RPPBC under dual CT and fluoroscopic guidance. All procedures were performed under local anesthesia by an experienced radiologist. Preprocedural, immediate and 6-month post-cementoplasty pain levels on a visual analogue scale (VAS), and functional outcomes were evaluated. Immediate and 6-month postprocedural CTs were performed to evaluate the treated region.
Results
All RPPBC were well tolerated by patients throughout the procedure. None of the patients suffered from local or systemic infection post-RPPBC, or periprosthetic fractures. No recurrent implant loosening was observed. Six patients were pain free at 6 months. All patients expressed functional improvements during validated outcome score evaluations.
Conclusion
RPPBC appears to be an efficient and reliable treatment strategy for aseptic loosening of orthopedic implants in elderly patients deemed unfit for revision surgery.
Key Points
• Radiological percutaneous periprosthetic bone cementoplasty offers immediate and long-lasting pain relief in elderly frail patients, or those deemed unfit for revision surgery despite presenting with symptomatic aseptic loosening of orthopedic implants.
• Radiological percutaneous periprosthetic bone cementoplasty brings quick and long-lasting improvements in clinical functional outcomes and offer effective pain reduction, thereby improving the overall quality of life.
• Radiological percutaneous periprosthetic bone cementoplasty is a safe, quick, reliable, and well-tolerated minimally invasive procedure which can be easily performed under simple locoregional anesthesia and requires short-term hospital stay.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anesthesia</subject><subject>Arthroplasty (knee)</subject><subject>Arthroplasty, Replacement, Knee</subject><subject>Bone implants</subject><subject>Bone surgery</subject><subject>Cementoplasty</subject><subject>Computed tomography</subject><subject>Diagnostic Radiology</subject><subject>Disseminated infection</subject><subject>Evaluation</subject><subject>Female</subject><subject>Fluoroscopy</subject><subject>Fractures</subject><subject>Glenoid components</subject><subject>Humans</subject><subject>Imaging</subject><subject>Internal Medicine</subject><subject>Interventional</subject><subject>Interventional Radiology</subject><subject>Joint surgery</subject><subject>Local anesthesia</subject><subject>Loosening</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Minimally invasive surgery</subject><subject>Neuroradiology</subject><subject>Older people</subject><subject>Orthopaedic implants</subject><subject>Orthopedics</subject><subject>Pain</subject><subject>Patients</subject><subject>Pedicle screws</subject><subject>Quality of Life</subject><subject>Radiologists</subject><subject>Radiology</subject><subject>Recurrent infection</subject><subject>Reoperation</subject><subject>Revisions</subject><subject>Surgery</subject><subject>Tibial components</subject><subject>Transplants & implants</subject><subject>Treatment Outcome</subject><subject>Ultrasound</subject><issn>0938-7994</issn><issn>1432-1084</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNp9kUGPFCEQhYnRuLOrf8CDIfHipbWA7qbxYjYbV0020YOeCUMXIxsGRqAnmaP_XNZeNfHggXDge0W99wh5xuAVA5CvC4AQ0AFvR_aj6KYHZMN6wTsGU_-QbECJqZNK9WfkvJRbAFCsl4_JmRAcGJ_Ehvz4jNku1URMS6EW9xhrOgRT6okmRw-Y_SGnUr9h9ZaGlApGH3dvqDWR-lgxH5vCp2gCzWb2KaSdL7U0scNMG2RCg6Kp_oi0Jprx6EvjaVnyDvPp7RPyyJlQ8On9fUG-Xr_7cvWhu_n0_uPV5U1nhRxqZ7lwFpmRFmYjZ4bzsB254grMoCygm-x2BAnY88HJeZYIo3Rb5jgfjYFJXJCX69zm5_uCpeq9LxZDWL1r3o9MqF4o2dAX_6C3aWkeQqOGFlvLWA2N4itlW0Alo9OH7PcmnzQDfVeQXgvSrSD9qyB9t8Xz-9HLdo_zH8nvRhogVqC0p9gS-vv3f8b-BJ7wn0U</recordid><startdate>20210601</startdate><enddate>20210601</enddate><creator>Prestat, A. J.</creator><creator>Dalili, D.</creator><creator>Rudel, A.</creator><creator>Torre, F.</creator><creator>Pavan, L. J.</creator><creator>Boileau, P.</creator><creator>Amoretti, N.</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB0</scope><scope>LK8</scope><scope>M0S</scope><scope>M1P</scope><scope>M7P</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-4703-1544</orcidid></search><sort><creationdate>20210601</creationdate><title>Percutaneous cementoplasty of periprosthetic loosening: can interventional radiologists offer an alternative to revision surgery?</title><author>Prestat, A. J. ; Dalili, D. ; Rudel, A. ; Torre, F. ; Pavan, L. J. ; Boileau, P. ; Amoretti, N.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-c23fce1a7c0da7d1ed5b629290a59c0ef8cb6070e425f7dd7e067fb1f226aa083</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anesthesia</topic><topic>Arthroplasty (knee)</topic><topic>Arthroplasty, Replacement, Knee</topic><topic>Bone implants</topic><topic>Bone surgery</topic><topic>Cementoplasty</topic><topic>Computed tomography</topic><topic>Diagnostic Radiology</topic><topic>Disseminated infection</topic><topic>Evaluation</topic><topic>Female</topic><topic>Fluoroscopy</topic><topic>Fractures</topic><topic>Glenoid components</topic><topic>Humans</topic><topic>Imaging</topic><topic>Internal Medicine</topic><topic>Interventional</topic><topic>Interventional Radiology</topic><topic>Joint surgery</topic><topic>Local anesthesia</topic><topic>Loosening</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Minimally invasive surgery</topic><topic>Neuroradiology</topic><topic>Older people</topic><topic>Orthopaedic implants</topic><topic>Orthopedics</topic><topic>Pain</topic><topic>Patients</topic><topic>Pedicle screws</topic><topic>Quality of Life</topic><topic>Radiologists</topic><topic>Radiology</topic><topic>Recurrent infection</topic><topic>Reoperation</topic><topic>Revisions</topic><topic>Surgery</topic><topic>Tibial components</topic><topic>Transplants & implants</topic><topic>Treatment Outcome</topic><topic>Ultrasound</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Prestat, A. J.</creatorcontrib><creatorcontrib>Dalili, D.</creatorcontrib><creatorcontrib>Rudel, A.</creatorcontrib><creatorcontrib>Torre, F.</creatorcontrib><creatorcontrib>Pavan, L. 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J.</au><au>Dalili, D.</au><au>Rudel, A.</au><au>Torre, F.</au><au>Pavan, L. J.</au><au>Boileau, P.</au><au>Amoretti, N.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Percutaneous cementoplasty of periprosthetic loosening: can interventional radiologists offer an alternative to revision surgery?</atitle><jtitle>European radiology</jtitle><stitle>Eur Radiol</stitle><addtitle>Eur Radiol</addtitle><date>2021-06-01</date><risdate>2021</risdate><volume>31</volume><issue>6</issue><spage>4221</spage><epage>4231</epage><pages>4221-4231</pages><issn>0938-7994</issn><eissn>1432-1084</eissn><abstract>Objective
To evaluate feasibility and validate both safety and efficiency of radiological percutaneous periprosthetic bone cementoplasty (RPPBC) performed under local anesthesia as an alternative minimally invasive treatment of aseptic implant loosening.
Methods
In this case series, seven patients (mean age 81 years, range 73 to 89 years, 2 men and 5 women) were enrolled between February 2011 and January 2020 with confirmed aseptic loosening of orthopedic implants. One patient presented with tibial component loosening of an unicompartmental knee arthroplasty, one with glenoid component loosening from a reverse shoulder arthroplasty, one femoral gamma nail, and four presented with pedicle screw loosening after staged posterior lumbar interbody fusion. All patients underwent clinical, biochemical, and imaging assessments to confirm the diagnosis of aseptic loosening. All benefited from RPPBC under dual CT and fluoroscopic guidance. All procedures were performed under local anesthesia by an experienced radiologist. Preprocedural, immediate and 6-month post-cementoplasty pain levels on a visual analogue scale (VAS), and functional outcomes were evaluated. Immediate and 6-month postprocedural CTs were performed to evaluate the treated region.
Results
All RPPBC were well tolerated by patients throughout the procedure. None of the patients suffered from local or systemic infection post-RPPBC, or periprosthetic fractures. No recurrent implant loosening was observed. Six patients were pain free at 6 months. All patients expressed functional improvements during validated outcome score evaluations.
Conclusion
RPPBC appears to be an efficient and reliable treatment strategy for aseptic loosening of orthopedic implants in elderly patients deemed unfit for revision surgery.
Key Points
• Radiological percutaneous periprosthetic bone cementoplasty offers immediate and long-lasting pain relief in elderly frail patients, or those deemed unfit for revision surgery despite presenting with symptomatic aseptic loosening of orthopedic implants.
• Radiological percutaneous periprosthetic bone cementoplasty brings quick and long-lasting improvements in clinical functional outcomes and offer effective pain reduction, thereby improving the overall quality of life.
• Radiological percutaneous periprosthetic bone cementoplasty is a safe, quick, reliable, and well-tolerated minimally invasive procedure which can be easily performed under simple locoregional anesthesia and requires short-term hospital stay.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>33201283</pmid><doi>10.1007/s00330-020-07463-8</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0003-4703-1544</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0938-7994 |
| ispartof | European radiology, 2021-06, Vol.31 (6), p.4221-4231 |
| issn | 0938-7994 1432-1084 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2461394397 |
| source | Springer Nature |
| subjects | Aged Aged, 80 and over Anesthesia Arthroplasty (knee) Arthroplasty, Replacement, Knee Bone implants Bone surgery Cementoplasty Computed tomography Diagnostic Radiology Disseminated infection Evaluation Female Fluoroscopy Fractures Glenoid components Humans Imaging Internal Medicine Interventional Interventional Radiology Joint surgery Local anesthesia Loosening Male Medicine Medicine & Public Health Minimally invasive surgery Neuroradiology Older people Orthopaedic implants Orthopedics Pain Patients Pedicle screws Quality of Life Radiologists Radiology Recurrent infection Reoperation Revisions Surgery Tibial components Transplants & implants Treatment Outcome Ultrasound |
| title | Percutaneous cementoplasty of periprosthetic loosening: can interventional radiologists offer an alternative to revision surgery? |
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