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Lazarinis, Stergios
Publications (10 of 12) Show all publications
Lazarinis, S., Mäkelä, K. T., Eskelinen, A., Havelin, L., Hallan, G., Overgaard, S., . . . Hailer, N. (2017). Does hydroxyapatite coating of uncemented cups improve long-term survival?: An analysis of 28,605 primary total hip arthroplasty procedures from the Nordic Arthroplasty Register Association (NARA). Osteoarthritis and Cartilage, 25(12), 1980-1987, Article ID S1063-4584(17)31137-8.
Open this publication in new window or tab >>Does hydroxyapatite coating of uncemented cups improve long-term survival?: An analysis of 28,605 primary total hip arthroplasty procedures from the Nordic Arthroplasty Register Association (NARA)
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2017 (English)In: Osteoarthritis and Cartilage, ISSN 1063-4584, E-ISSN 1522-9653, Vol. 25, no 12, p. 1980-1987, article id S1063-4584(17)31137-8Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: It is unclear whether hydroxyapatite (HA) coating of uncemented cups used in primary total hip arthroplasty (THA) improves bone ingrowth and reduces the risk of aseptic loosening. We therefore investigated survival of different uncemented cups that were available with or without HA coating.

METHOD: We investigated three different cup types used with or without HA coating registered in the Nordic Arthroplasty Register Association (NARA) database that were inserted due to osteoarthritis (n = 28,605). Cumulative survival rates and adjusted hazard ratios (HRs) for the risk of revision were calculated.

RESULTS: Unadjusted 13-year survival for cup revision due to aseptic loosening was 97.9% (CI: 96.5-99.4) for uncoated and 97.8% (CI: 96.3-99.4) for HA-coated cups. Adjusted HRs were 0.66 (CI 0.42-1.04) for the presence of HA coating during the first 10 years and 0.87 (CI 0.14-5.38) from year 10-13, compared with uncoated cups. When considering the endpoint cup revision for any reason, unadjusted 13-year survival was similar for uncoated (92.5% [CI: 90.1-94.9]) and HA-coated (94.7% [CI: 93.2-96.3]) cups. The risk of revision of any component due to infection was higher in THA with HA-coated cups than in THA with uncoated cups (adjusted HR 1.4 [CI 1.1-1.9]).

CONCLUSIONS: HA-coated cups have a similar risk of aseptic loosening as uncoated cups, thus the use of HA coating seems to not confer any added value in terms of implant stability. The risk of infection seemed higher in THA with use of HA-coated cups, an observation that must be investigated further.

Keywords
Arthroplasty, Cup, Hip, Hydroxyapatite, NARA, Uncemented
National Category
Orthopaedics Rheumatology and Autoimmunity
Identifiers
urn:nbn:se:uu:diva-334157 (URN)10.1016/j.joca.2017.08.001 (DOI)000414873800007 ()28802851 (PubMedID)
Available from: 2017-11-21 Created: 2017-11-21 Last updated: 2018-02-20Bibliographically approved
Borens, O., Corona, P. S., Frommelt, L., Lazarinis, S., Reed, M. R. & Romano, C. L. (2016). Algorithm to Diagnose Delayed and Late PJI: Role of Joint Aspiration. Advances in Experimental Medicine and Biology
Open this publication in new window or tab >>Algorithm to Diagnose Delayed and Late PJI: Role of Joint Aspiration
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2016 (English)In: Advances in Experimental Medicine and Biology, ISSN 0065-2598, E-ISSN 2214-8019Article in journal (Refereed) Epub ahead of print
Abstract [en]

Total Joint Arthroplasty (TJA) continues to gain acceptance as the standard of care for the treatment of severe degenerative joint disease, and is considered one of the most successful surgical interventions in the history of medicine. A devastating complication after TJA is infection. Periprosthetic joint infection (PJI), represents one of the major causes of failure and remains a significant challenge facing orthopaedics today. PJI usually requires additional surgery including revision of the implants, fusion or amputations causing tremendous patient suffering but also a heavy health economics burden. PJI is at the origin of around 20-25 % of total knee arthroplasty (Bozic et al. 2010; de Gorter et al. 2015; Sundberg et al. 2015) and 12-15 % of total hip arthroplasty (Bozic et al. 2009; Garellick et al. 2014; de Gorter et al. 2015) failures.

Keywords
Algorithm, Alpha-defensin, Diagnosties, Infection, Joint aspiration, Total Joint Arthroplasty (TJA)
National Category
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-316523 (URN)10.1007/5584_2016_153 (DOI)27757937 (PubMedID)
Available from: 2017-03-02 Created: 2017-03-02 Last updated: 2018-01-13Bibliographically approved
Hailer, N. P., Lazarinis, S., Mäkelä, K. T., Eskelinen, A., Fenstad, A. M., Hallan, G., . . . Kärrholm, J. (2015). Hydroxyapatite coating does not improve uncemented stem survival after total hip arthroplasty!: An analysis of 116,069 THAs in the Nordic Arthroplasty Register Association (NARA) database. Acta Orthopaedica, 86(1), 18-25
Open this publication in new window or tab >>Hydroxyapatite coating does not improve uncemented stem survival after total hip arthroplasty!: An analysis of 116,069 THAs in the Nordic Arthroplasty Register Association (NARA) database
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2015 (English)In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 86, no 1, p. 18-25Article in journal (Refereed) Published
Abstract [en]

Background and purpose

It is still being debated whether HA coating of uncemented stems used in total hip arthroplasty (THA) improves implant survival. We therefore investigated different uncemented stem brands, with and without HA coating, regarding early and long-term survival.

Patients and methods

We identified 152,410 THA procedures using uncemented stems that were performed between 1995 and 2011 and registered in the Nordic Arthroplasty Register Association (NARA) database. We excluded 19,446 procedures that used stem brands less than 500 times in each country, procedures performed due to diagnoses other than osteoarthritis or pediatric hip disease, and procedures with missing information on the type of coating. 22 stem brands remained (which were used in 116,069 procedures) for analysis of revision of any component. 79,192 procedures from Denmark, Norway, and Sweden were analyzed for the endpoint stem revision. Unadjusted survival rates were calculated according to Kaplan-Meier, and Cox proportional hazards models were fitted in order to calculate hazard ratios (HRs) for the risk of revision with 95% confidence intervals (CIs).

Results

Unadjusted 10-year survival with the endpoint revision of any component for any reason was 92.1% (CI: 91.8-92.4). Unadjusted 10-year survival with the endpoint stem revision due to aseptic loosening varied between the stem brands investigated and ranged from 96.7% (CI: 94.4-99.0) to 99.9% (CI: 99.6-100). Of the stem brands with the best survival, stems with and without HA coating were found. The presence of HA coating was not associated with statistically significant effects on the adjusted risk of stem revision due to aseptic loosening, with an HR of 0.8 (CI: 0.5-1.3; p = 0.4). The adjusted risk of revision due to infection was similar in the groups of THAs using HA-coated and non-HA-coated stems, with an HR of 0.9 (CI: 0.8-1.1; p = 0.6) for the presence of HA coating. The commonly used Bimetric stem (n = 25,329) was available both with and without HA coating, and the adjusted risk of stem revision due to aseptic loosening was similar for the 2 variants, with an HR of 0.9 (CI: 0.5-1.4; p = 0.5) for the HA-coated Bimetric stem.

Interpretation

Uncemented HA-coated stems had similar results to those of uncemented stems with porous coating or rough sand-blasted stems. The use of HA coating on stems available both with and without this surface treatment had no clinically relevant effect on their outcome, and we thus question whether HA coating adds any value to well-functioning stem designs.

National Category
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-232491 (URN)10.3109/17453674.2014.957088 (DOI)000348367000005 ()25175664 (PubMedID)
Available from: 2014-09-19 Created: 2014-09-19 Last updated: 2018-01-11Bibliographically approved
Lazarinis, S., Milbrink, J., Mattsson, P., Mallmin, H. & Hailer, N. P. (2014). Bone loss around a stable, partly threaded hydroxyapatite-coated cup: a prospective cohort study using RSA and DXA. HIP International, 24(2), 155-166
Open this publication in new window or tab >>Bone loss around a stable, partly threaded hydroxyapatite-coated cup: a prospective cohort study using RSA and DXA
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2014 (English)In: HIP International, ISSN 1120-7000, E-ISSN 1724-6067, Vol. 24, no 2, p. 155-166Article in journal (Refereed) Published
Abstract [en]

Study purpose: Aseptic loosening of the acetabular component is the most common reason for revision after primary THA, and periprosthetic demineralisation has been described as a potential cause for this process. The trabeculae-oriented pattern (TOP)-cup is a flat, hydroxyapatite (HA)-coated titanium shell with a threaded rim that was developed in order to minimise periprosthetic bone loss. We hypothesised that this cup provides good primary stability and improves preservation of periprosthetic bone mineral density (BMD). Basic procedures: A prospective cohort study on 30 patients receiving the TOP cup was carried out. Preoperative total hip BMD and postoperative periprosthetic BMD in five periprosthetic regions of interest were investigated by dual energy radiographic absorptiometry (DXA), cup migration was analysed by radiostereometry (RSA), and the Harris hips score (HHS) was determined. Main findings: Mean HHS increased from 49 (24-79) preoperatively to 99 (92-100) after two years. DXA after one year demonstrated substantial BMD loss in the proximal periprosthetic zones 1 (-18%), zone 2 (-16%) and zone 3 (-9%, all p<0.001 when compared with baseline BMD determined immediately postoperatively). The bone loss in these regions did not recover after two years. RSA (performed on 16 patients) showed that only very limited micromotion of the implant occurred: Mean cranial migration was 0.01 mm (95% confidence interval (CI): -0.09-0.12) and mean inclination decreased by 0.02 degrees (CI: -0.43-0.39) after two years. Conclusion: We conclude that the TOP cup provides good primary stability in the short-term. However, substantial BMD loss in proximal periprosthetic areas indicates that the design of this cup cannot prevent periprosthetic bone loss that has also been observed around other uncemented cups.

Keywords
TOP cup, DXA, RSA, Hip arthroplasty, Hydroxyapatite
National Category
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-229531 (URN)10.5301/hipint.5000104 (DOI)000338275900007 ()
Available from: 2014-08-12 Created: 2014-08-11 Last updated: 2018-01-11Bibliographically approved
Chen, A., Haddad, F., Lachiewicz, P., Bolognesi, M., Cortes, L. E., Franceschini, M., . . . Zeng, Y. (2014). Prevention of late PJI. Journal of Orthopaedic Research, 32(Suppl. 1), S158-S171
Open this publication in new window or tab >>Prevention of late PJI
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2014 (English)In: Journal of Orthopaedic Research, ISSN 0736-0266, E-ISSN 1554-527X, Vol. 32, no Suppl. 1, p. S158-S171Article in journal (Refereed) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-277037 (URN)10.1002/jor.22561 (DOI)24464891 (PubMedID)
Available from: 2016-02-17 Created: 2016-02-17 Last updated: 2017-11-30Bibliographically approved
Chen, A., Haddad, F., Lachiewicz, P., Bolognesi, M., Cortes, L. E., Franceschini, M., . . . Zeng, Y. (2014). Prevention of Late PJI. Paper presented at International Consensus on Periprosthetic Joint Infection. The Journal of Arthroplasty, 29(2), 119-128
Open this publication in new window or tab >>Prevention of Late PJI
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2014 (English)In: The Journal of Arthroplasty, ISSN 0883-5403, E-ISSN 1532-8406, Vol. 29, no 2, p. 119-128Article in journal (Refereed) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-216775 (URN)10.1016/j.arth.2013.09.051 (DOI)24370487 (PubMedID)
Conference
International Consensus on Periprosthetic Joint Infection
Available from: 2014-01-24 Created: 2014-01-24 Last updated: 2017-12-06Bibliographically approved
Lazarinis, S., Mattsson, P., Milbrink, J., Mallmin, H. & Hailer, N. P. (2013). A prospective cohort study on the short collum femoris preserving (CFP) stem using RSA and DXA: Primary stability but no prevention of proximal bone loss in 27 patients followed for 2 years. Acta Orthopaedica, 84(1), 32-39
Open this publication in new window or tab >>A prospective cohort study on the short collum femoris preserving (CFP) stem using RSA and DXA: Primary stability but no prevention of proximal bone loss in 27 patients followed for 2 years
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2013 (English)In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 84, no 1, p. 32-39Article in journal (Refereed) Published
Abstract [en]

Background and purpose Short femoral stems have been introduced in total hip arthroplasty in order to save proximal bone stock. We hypothesized that a short stem preserves periprosthetic bone mineral density (BMD) and provides good primary stability. Methods We carried out a prospective cohort study of 30 patients receiving the collum femoris-preserving (CFP) stem. Preoperative total hip BMD and postoperative periprosthetic BMD in Gruen zones 1-7 were investigated by dual-energy x-ray absorptiometry (DXA), stem migration was analyzed by radio-stereometric analysis (RSA), and the Harris hip score (HHS) was determined. Results 2 patients were excluded intraoperatively and 1 patient was revised due to a deep infection, leaving 27 patients for analysis. The mean HHS increased from 49 (24-79) preoperatively to 99 (92-100) after 2 years. DXA after 1 year showed substantial loss of BMD in Gruen zone 7 (-31%), zone 6 (-19%), and zone 2 (-13%, p < 0.001) compared to baseline BMD determined immediately postoperatively. The bone loss in these regions did not recover after 2 years, whereas the more moderate bone loss in Gruen zones 1, 3, and 5 partially recovered. There was a correlation between low preoperative total hip BMD and a higher amount of bone loss in Gruen zones 2, 6 and 7. RSA showed minor micromotion of the stem: mean subsidence was 0.13 (95% CI: -0.28 to 0.01) mm and mean rotation around the longitudinal axis was 0.01 (95% CI: -0.1 to 0.39) after 2 years. Interpretation We conclude that substantial loss in proximal periprosthetic BMD cannot be prevented by the use of a novel type of short, curved stem, and forces appear to be transmitted distally. However, the stems showed very small migration-a characteristic of stable uncemented implants.

National Category
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-185296 (URN)10.3109/17453674.2013.765623 (DOI)000314897500007 ()
Available from: 2012-11-21 Created: 2012-11-21 Last updated: 2018-01-12Bibliographically approved
Lazarinis, S., Lidgren, L., Stefansdottir, A. & W-Dahl, A. (2013). Consensus document on prosthetic joint infections. Acta Orthopaedica, 84(6), 507-508
Open this publication in new window or tab >>Consensus document on prosthetic joint infections
2013 (English)In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 84, no 6, p. 507-508Article in journal, Editorial material (Other academic) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-215453 (URN)10.3109/17453674.2013.867399 (DOI)000328281100001 ()
Available from: 2014-01-14 Created: 2014-01-14 Last updated: 2017-12-06Bibliographically approved
Lazarinis, S. (2013). Form and Finish of Implants in Uncemented Hip Arthroplasty: Effects of Different Shapes and Surface Treatments on Implant Stability. (Doctoral dissertation). Uppsala: Acta Universitatis Upsaliensis
Open this publication in new window or tab >>Form and Finish of Implants in Uncemented Hip Arthroplasty: Effects of Different Shapes and Surface Treatments on Implant Stability
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The design of an uncemented hip arthroplasty implant affects its long-term survival. Characteristics such as the form and the finish of the implant are crucial in order to achieve the best possible conditions for long-term implant survival. In this thesis we hypothesized that different shapes of stems and cups used in primary and revision total hip arthroplasty (THA), and their finish with hydroxyapatite (HA) coating affect implant stability and thus long-term survival.

In 2 prospective cohort studies the clinical outcome, the stability measured with radiostereometric analysis (RSA), and the periprosthetic changes in bone mineral density (BMD) measured with dual-energy x-ray absorptiometry (DXA) were investigated in 2 uncemented THA implants – the CFP stem and the TOP cup. In 3 register studies the effect of HA coating on uncemented THA implants used in primary and revision arthroplasty was investigated.

Both implants investigated in the prospective cohort studies showed an excellent short-term clinical outcome with good primary stability, but neither their novel form nor the finish with HA protected the implants from the proximal periprosthetic demineralization that usually occurs around other uncemented THA implants.

The register studies revealed that HA coating on cups used in primary and revision THA is a risk factor for subsequent revision of the implant. The use of HA coating on the stem in primary THA did not affect long-term survival. Additionally, the shape of an implant plays a crucial role for implant stability and survival.

In conclusion, this thesis highlights that the finish of implants with HA coating does not prevent periprosthetic proximal femoral bone loss and can even enhance the risk of revision of both primary and secondary cups. Importantly, the shape of uncemented THA implants affect their stability, showing that the implant form is a crucial factor for the long-term survival.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2013. p. 74
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 845
Keywords
Form, Finish, Total hip arthroplasty, Swedish Hip Arthroplasty Register, Hydroxyapatite, RSA, DXA, BMD, Stability.
National Category
Orthopaedics
Research subject
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-185299 (URN)978-91-554-8549-8 (ISBN)
Public defence
2013-01-11, Grönwallsalen, Akademiska sjukhuset, Akademiska sjukhus, Uppsala, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2012-12-21 Created: 2012-11-21 Last updated: 2018-01-12Bibliographically approved
Lazarinis, S., Kärrholm, J. & Hailer, N. P. (2012). Effects of hydroxyapatite coating of cups used in hip revisionarthroplasty: A Swedish Hip Arthroplasty Register study of 1,780 revisions. Acta Orthopaedica, 83(5), 427-435
Open this publication in new window or tab >>Effects of hydroxyapatite coating of cups used in hip revisionarthroplasty: A Swedish Hip Arthroplasty Register study of 1,780 revisions
2012 (English)In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 83, no 5, p. 427-435Article in journal (Refereed) Published
Abstract [en]

Background and purpose

Coating of acetabular revision implants with hydroxyapatite (HA) has been proposed to improve ingrowth and stability. We investigated whether HA coating of revision cups can reduce the risk of any subsequent re-revision.

Methods

We studied uncemented cups either with or without HA coating that were used at a primary acetabular revision and registered in the Swedish Hip Arthroplasty Register (SHAR). 2 such cup designs were identified: Harris-Galante and Trilogy, both available either with or without HA coating. These cups had been used as revision components in 1,780 revisions of total hip arthroplasties (THA) between 1986 and 2009. A Cox proportional hazards model including the type of coating, age at index revision, sex, cause of cup revision, cup design, the use of bone graft at the revision procedure, and the type of cup fixation at primary THA were used to calculate adjusted risk ratios (RRs with 95% CI) for re-revision for any reason or due to aseptic loosening.

Results

71% of the cups were coated with HA and 29% were uncoated. At a mean follow-up time of 6.9 (0–24) years, 159 (9%) of all 1,780 cups had been re-revised, mostly due to aseptic loosening (5%), dislocation (2%), or deep infection (1%). HA coating had no significant influence on the risk of re-revision of the cup for any reason (RR = 1.4, CI: 0.9–2.0) or due to aseptic loosening (RR = 1.1, 0.6–1.9). In contrast, HA coating was found to be a risk factor for isolated liner re-revision for any reason (RR = 1.8, CI: 1.01–3.3). Age below 60 years at the index cup revision, dislocation as the cause of the index cup revision, uncemented cup fixation at primary THA, and use of the Harris-Galante cup also increased the risk of re-revision of the cup. In separate analyses in which isolated liner revisions were excluded, bone grafting was found to be a risk factor for re-revision of the metal shell due to aseptic loosening (RR = 2.1, CI: 1.05–4.2).

Interpretation

We found no evidence to support the notion that HA coating improves the performance of the 2 studied cup designs in revision arthroplasty. In contrast, patient-related factors such as younger age and dislocation as the reason for cup revision, and technical factors such as the choice of revision cup were found to influence the risk of subsequent re-revision of the cup. The reason for inferior results after revision of uncemented cups is not known, but it is possible that these hips more often had pronounced bone loss at the index cup revision.

National Category
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-185295 (URN)10.3109/17453674.2012.720117 (DOI)000310015700001 ()22937978 (PubMedID)
Available from: 2012-11-21 Created: 2012-11-21 Last updated: 2018-01-12Bibliographically approved
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