Interpositional arthroplasty has gained in success and popularity in non load bearing joints in recent years. All of the joints that have had great success have been sheer force joints and not in load bearing joints. Any thoughts or experience in performing this procedure in load bearing joints as to integration of graft or graft breakdown due to loads. Is there any graft that is more durable with load than others?
Mr. Carpenter,
In my opinion conventional interpositional arthroplasty has lost its importance for the load bearing joints in the era of joint replacement. In my 42 years of surgical practice I have never done such a procedure. However, some 80-90 years ago the interpositional arthroplasty of knee joint has been very popular also in my country. You may see our historical review of the first steps of arthroplasty in Bulgaria on ResearchGate:
www.researchgate.net/profile/Panayot_Tanchev/publications?sorting=newest&page=5
The longevity of graft would always be questionable and it's difficult to ascertain whether it works in the first place in vivo. Fascia based grafts in my view are better.
Interesting question.
There are some people who are experimenting by inserting implants between the surgically prepared articular surfaces of the knee and they call their technique as interposition arthroplasty. It is very early to know the use of such Implant.
For the hip I am attaching an old paper when the authors made interposition arthroplasties in handicapped children to facilitate their care and ambulation.
M E Castle; C Schneider (1978) Proximal femoral resection-interposition arthroplasty. J Bone Joint Surg (Am), 60 (8): 1051 -1054
My belief is that we are far away of such a technique to be used routinely.
Thank you to all who answered and you knowledge as well as experience. We will see how the patients that I have done will do with time. There is this subset of patients who aren't good candidates for arthrodesis or arthroplasty so in my humble opinion this procedure burns no bridges.
Very interesting paper. Enjoyed it. From the manufacturing company's prospective of this material what is the success and survivorship of the "prosthetic"? When do you think you will see the potential "first failure" results? For example in joint replacements the earliest failures are expected to be after the first 5 years. Thank you very much for the experience
As to the manufacturers they have no experience in load bearing joints. They do have years of experience with interpositional arthroplasty of the shoulder. I personally have a humeral head hemi of my shoulder that Dr Burkhead did and reamed the glenoid to fit the implant and did a interposition with graft jacket. I am 6 years post op and have perfect smooth motion with it. I really have no idea when it will wear out or/fail or does it become fibrous scar in the joint that is vascularized? My first case has told me he would have surgery and repeat the procedure every year if needed because of how he has felt. He is now 24 months out. I have 17 patients that have had the procedure to date and am looking forward to see how it performs or fails over the next few years. One thing for certain to date is that they are all happy and I haven't burned any bridges for future procedures if it fails.
Thank you very much for the information. I would be waiting for further results even as an audit if not paper. I believe that the procedure went through ethical committee and is scheduled as experimental, isn't it?
Yes the procedure went through IRB/ethical committee. It isn't considered as experimental since it has been used extensively in the elbow, shoulder, first MPJ of the foot, and many other small joints. We just don't have long term data as of yet in a load bearing joint but I will be doing a larger group of patients in a few years with the results that will either show it works for the long term or the timing to failure. This is being done by several other surgeons in the US so hopefully we can make it a multicenter study for better data
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