Bart G Pijls

Leiden University Medical Centre | LUMC · Department of Orthopedic Surgery

Summary The aim of this thesis is to evaluate the clinical value of migration measured with RSA in TKP and THP. The first aim was on the association of short term (two year) migration and the likelihood for long term (10 year) revision for aseptic loosening. The latter is important in the context of a phased introduction of new TKP and THP. The sec...

At present, most new designs for total knee (TKP) and total hip prostheses (THP) are approved and distributed on the market without extensive safety and effectiveness testing via the 510(k) pathway in the United States and regulation via notified bodies in Europe (Directive 93/42/EEC).[1][1],[2][2]

Importance: There are concerns about increased mortality in patients with metal-on-metal bearings in total hip arthroplasty (THA). Objective: To determine the mortality and the morbidity in patients with metal-on-metal articulations (MOM THA) compared to patients with non-metal-on-metal articulations (non-MOM THA) after primary total hip arthrop...

Purpose We performed two parallel systematic reviews and meta-analyses to determine the association between early migration of tibial components and late aseptic revision. Methods One review comprised early migration data from radiostereometric analysis (RSA) studies, while the other focused on revision rates for aseptic loosening from long-term s...

To study the feasibility and effectiveness of non-contact induction heating of a metal implant in reducing bacterial load in vitro. „ We designed an in vitro model to test the effect of heating duration and temperature of non-contact induction heating titanium cylinders inoculated with five types of microorganisms. „ The hypothesis is that non-cont...

Metal-implant associated bacterial infections are a major clinical problem due to antibiotic treatment failure. As an alternative, we determined the effects of bacteriophage ISP on clinical isolates of Staphylococcus aureus in various stages of its life cycle in relation to biofilm formation and maturation. ISP effectively eliminated all planktonic...

Opening remarks: These guidelines are the result of discussions within a diverse group of RSA researchers. They were approved in December 2023 by the board and selected members of the International Radiostereometry Society to update the guidelines by Valstar et al. [1]. By adhering to these guidelines, RSA studies will become more transparent and c...

Background Prosthetic joint infection is a serious complication that can arise after total joint replacement surgery. When bacteria colonise an orthopaedic implant, they form biofilms that protect them from their environment, making them difficult to remove. Treatment is further complicated by a global rise of antimicrobial resistance. These protec...

Background and purpose: We conducted a systematic review and meta-analysis of RSA studies to investigate the early and long-term migration patterns of acetabular cups and the influence of implant factors on cup migration over time.Methods: We performed a systematic search of PubMed, Embase, and Scopus databases to identify all RSA studies of cup mi...

Background and purpose: While registry studies have suggested a higher risk of revision for posterior-stabilized (PS) compared with posterior cruciate-retaining (CR) total knee replacements (TKR) using cement, it is unknown whether this is also the case for uncemented TKR. We aimed to compare the revision rates of PS and CR designs in patients rec...

Background and purpose This updated meta-analysis evaluates the migration pattern of the tibial component of primary total knee replacements measured with radiostereometric analysis (RSA). We aimed to evaluate whether 6-month maximum total point motion (MTPM) values could be used instead of 1-year MTPM for RSA threshold testing and to present the p...

Introduction: Total knee replacement (TKR) reduces pain, it increases quality of life and it generally lasts a long time with revision rates of less than 5% at 10 years. Some authors have suggested that outcomes may be further improved by technology assistance. Areas covered: Technology assistance in primary TKR includes technologies such as nav...

Purpose: This is a systematic review and meta(regression) analysis to assess the performance of custom triflange acetabular components (CTAC) in total hip arthroplasty (THA) revision surgery. Implant-related complications, failure rate, functional outcomes and implant and surgical technique-related predictors for outcome were assessed. Methods:...

Aims The primary objective of this study was to compare the five-year tibial component migration and wear between highly crosslinked polyethylene (HXLPE) inserts and conventional polyethylene (PE) inserts of the uncemented Triathlon fixed insert cruciate-retaining total knee arthroplasty (TKA). Secondary objectives included clinical outcomes and pa...

In this systematic review, the antimicrobial effect of ion-substituted calcium phosphate biomaterials was quantitatively assessed. The literature was systematically searched up to the 6th of December 2021. Study selection and data extraction was performed in duplo by two independent reviewers with a modified version of the OHAT tool for risk of bia...

Background and purpose: Assessing peri-acetabular bone quality is valuable for optimizing the outcomes of primary total hip arthroplasty (THA) as preservation of good quality bone stock likely affects implant stability. The aim of this study was to perform a meta-analysis of peri-acetabular bone mineral density (BMD) changes over time measured usi...

Introduction One of the main causes of treatment failure in bacterial prosthetic joint infections (PJI) is biofilm formation. The topography of the biofilm may be associated with susceptibility to antimicrobial treatment. The aims of this study were to assess differences in topography of biofilms on different implant materials and the correlation t...

Prosthetic Joint Infection (PJI) is a devastating complication that can occur after total joint replacement surgery. With increasing antimicrobial resistance, there is a need for non-antibiotic approaches to treat and prevent PJI. Doping calcium phosphates with antimicrobial ions shows promise for these purposes. This systematic review aims to sear...

Introduction Patient-specific instrumentation (PSI) for primary total knee arthroplasty (TKA) surgery has been shown to increase accuracy of component positioning. However, it is unclear whether this potential improved accuracy of component positioning also translates to actual benefits for patients in terms of better outcomes (efficacy) or less co...

Aims Arthroplasty surgery of the knee and hip is performed in two to three million patients annually. Periprosthetic joint infections occur in 4% of these patients. Debridement, antibiotics, and implant retention (DAIR) surgery aimed at cleaning the infected prosthesis often fails, subsequently requiring invasive revision of the complete prosthetic...

Aims Here we used a mature seven-day biofilm model of Staphylococcus aureus, exposed to antibiotics up to an additional seven days, to establish the effectiveness of either mechanical cleaning or antibiotics or non-contact induction heating, and which combinations could eradicate S. aureus in mature biofilms. Methods Mature biofilms of S. aureus (...

The perioperative use of certain medication may influence the risk of developing a periprosthetic joint infection (PJI). Inhaled corticosteroids (ICSs) and cardiovascular drugs are widely used against pulmonary and cardiovascular diseases. While oral corticosteroids and anticoagulants have been shown to increase the risk of developing PJI, this is...

Background: This review aims to investigate the association of sex with the risk of multiple COVID-19 health outcomes, ranging from infection to death. Methods: Pubmed and Embase were searched through September 2020. We considered studies reporting sex and coronavirus disease 2019 (COVID-19) outcomes. Qualitative and quantitative data were extracte...

Importance Aseptic loosening is a major cause of failure for unicondylar knee arthroplasty (UKA). In total knee arthroplasty (TKA), early migration as measured with radiostereometric analysis (RSA) is a strong predictor of late revision for aseptic loosening of the tibial component. Migration in the first two years provides information on the fixat...

Introduction Early literature on the COVID-19 pandemic indicated striking ethnic inequalities in SARS-CoV-2-related outcomes. This systematic review and meta-analysis aimed to describe the presence and magnitude of associations between ethnic groups and COVID-19-related outcomes. Methods PubMed and Embase were searched from December 2019 through S...

There is controversy whether IL-6 (receptor) antagonists are beneficial in treating COVID-19 patients. We therefore update our systematic review to answer the following research questions: (1) Do patients hospitalized for COVID-19 treated with IL-6 (receptor) antagonists have lower mortality compared to standard of care? (2) Do patients hospitalize...

The aim of this meta-analysis is to assess the association between exchange of modular parts in debridement, antibiotics, and implant retention (DAIR) procedure and outcomes for hip and knee periprosthetic joint infection (PJI). Methods We conducted a systematic search on PubMed, Embase, Web of Science, and Cochrane library from inception until May...

Aims The aim of this meta-analysis is to assess the association between exchange of modular parts in debridement, antibiotics, and implant retention (DAIR) procedure and outcomes for hip and knee periprosthetic joint infection (PJI). Methods We conducted a systematic search on PubMed, Embase, Web of Science, and Cochrane library from inception unt...

Implant-associated infections are the primary cause of complications following orthopaedic surgery. Due to biofilm and persister formation, current treatments, i.e. surgical debridement followed by antibiotics, often fail. There is an urgent need for alternative strategies to combat such infections. Therefore, the present study investigated the eff...

The treatment of staphylococcal prosthetic joint infection (PJI) with debridement, antibiotics and retention of the implant (DAIR) often results in failure. An important evidence gap concerns the treatment with rifampicin for PJI. A systematic review and meta-analysis were conducted to assess the outcome of staphylococcal hip and/or knee PJI after...

Background and purpose — Proton-pump inhibitors (PPI) have previously been associated with an increased risk of infections such as community-acquired pneumonia, gastrointestinal infections and central nervous system infection. Therefore, we evaluated a possible association between proton-pump inhibitor use and prosthetic joint infection (PJI) in pa...

To the Editor—We thank Richier and colleagues for their letter [1] regarding our paper and we appreciate the opportunity to respond [2]. Richier et al [1] provide a nuanced interpretation of the correspondence of Huang et al [3], who reported meta-analyses on 5 randomized controlled trials (RCTs). Based on their meta-analyses, Huang et al [3] concl...

Objective We aimed to describe the associations of age and sex with the risk of COVID-19 in different severity stages ranging from infection to death. Design Systematic review and meta-analysis. Data sources PubMed and Embase through 4 May 2020. Study selection We considered cohort and case–control studies that evaluated differences in age and s...

Background: We systematically reviewed the literature to answer the following research questions: 1) does IL-6 (receptor) antagonist therapy reduce mortality in COVID-19 patients compared to patients not treated with IL-6 (receptor) antagonists and 2) is there an increased risk of side effects in COVID-19 patients treated with IL-6 (receptor) anta...

Background: Periprosthetic joint infection (PJI) is a devastating complication following total hip replacement. The direct anterior approach for total hip replacement is becoming increasingly popular. However, little is known about the success rate of treatment with debridement, antibiotics, and implant retention (DAIR) using the direct anterior a...

Aims Induction heating is a noninvasive, nonantibiotic treatment modality that can potentially be used to cause thermal damage to the bacterial biofilm on the metal implant surface. The purpose of this study was to determine the effectiveness of induction heating on killing Staphylococcus epidermidis from biofilm and to determine the possible syner...

Background: The number of revisions after TKA is expected to rise because of aging populations in many countries and because patients are undergoing TKA at younger ages. Aseptic loosening is a major reason for late revision, which can be predicted by radiostereometric analysis (RSA) of small groups of patients at 2 years of follow-up. RSA is there...

Background Non-contact induction heating (NCIH) is a noninvasive treatment modality that can be used to cause thermal damage to bacterial biofilms on a metal implant surface in the context of a prosthetic joint infection. The purpose of this study was (1) to determine the effectiveness of NCIH on killing Staphylococcus aureus from biofilm and (2) t...

The purpose of this paper is to determine the prevalence of metal-on-metal (MoM) total hip replacement (THR) in European registries, to assess the incidence of revision surgery and to describe the national follow-up guidelines for patients with MoM THR including resurfacings. Eleven registries of the Network of Orthopaedic Registries of Europe (NOR...

Objectives Prosthetic joint infection (PJI) is a devastating complication following total joint arthroplasty. Non-contact induction heating of metal implants is a new and emerging treatment for PJI. However, there may be concerns for potential tissue necrosis. It is thought that segmental induction heating can be used to control the thermal dose an...

Purpose — We performed a systematic review and meta-analyses to evaluate the early and long-term migration patterns of tibial components of TKR of all known RSA studies. Methods — Migration pattern was defined as at least 2 postoperative RSA follow-up moments. Maximal total point motion (MTPM) at 6 weeks, 3 months, 6 months, 1 year, 2 years, 5 year...

Background Ribbing disease, or multiple diaphyseal sclerosis, is a rare benign bone dysplasia. Purpose To systematically review the literature to determine the clinical and radiological presentation of patients with Ribbing disease as well as the effects of attempted treatments. Material and Methods We considered individual patient data of patien...

Doel; Het bepalen van de mortaliteit bij patiënten met een metaal-op-metaal (MOM) heupprothese vergeleken met patiënten met een niet-metaal-op-metaal (niet-MOM) heupprothese. Opzet; Systematische review, meta-analyse en meta-regressieanalyse (registratie: PROSPERO 2014:CRD42014007417). Methode; We zochten naar relevante studies in PubMed, Medline...

Objectives: Infection of implants is a major problem in elective and trauma surgery. Heating is an effective way to reduce the bacterial load in food preparation, and studies on hyperthermia treatment for cancer have shown that it is possible to heat metal objects with pulsed electromagnetic fields selectively (PEMF), also known as induction heati...

Objective: To determine the mortality and the morbidity in patients with metal-on-metal articulations (MOM THA) when compared to patients with non-metal-on-metal articulations (non-MOM THA) after primary total hip arthroplasty. Design: Systematic review, meta-analyses and meta-regression (registration: PROSPERO 2014:CRD42014007417). Method: Se...

Search Strategy. (DOC)

Prospero Protocol. (PDF)

PRISMA Checklist. (PDF)

Purpose Arthrodesis (AD) of the knee reduces pain and provides stability, but has severe functional and social limitations. There has been ample discussion on the value of a conversion of an AD to a total knee arthroplasty (TKA). The aim of this study was to perform a review and meta-analysis of the current literature on conversion of an AD to TKA...

Background: Both the range of motion (ROM) technique and the tibial tubercle landmark (TTL) technique are frequently used to align the tibial component into proper rotational position during total knee arthroplasty (TKA). The aim of the study was to assess the intra-operative differences in tibial rotation position during computer-navigated primar...

To allow prediction of the risk of loosening prior to surgery, we investigated the relationship between innate immune cytokine response via TLR2 stimulation and early migration of 6 different knee prostheses using RSA (radiostereometry). This study included 114 patients of a prospective RSA-cohort who received a total knee arthroplasty. Whole blood...

Background and purpose — Few studies have addressed the association between early migration of femoral stems and late aseptic revision in total hip arthroplasty. We performed a meta-regression analysis on 2 parallel systematic reviews and meta-analyses to determine the association between early migration and late aseptic revision of femoral stems....

This study used the assessment of quality in lower limb arthroplasty (AQUILA) checklist to assess the quality of lower limb arthroplasty observational studies. Among 132 studies the mean reporting quality score was 5.4 (SD=1.2) out of 8 possible points. Most studies adequately reported reasons for revisions (98%) and prosthesis brand and fixation (...

Background: It is unclear whether there are differences in benefits and harms between mobile and fixed prostheses for total knee arthroplasty (TKA). The previous Cochrane review published in 2004 included two articles. Many more trials have been performed since then; therefore an update is needed. Objectives: To assess the benefits and harms of...

Many total hip implants are currently available on the market worldwide. We aimed to estimate the probability of revision surgery at ten years for each individual total hip implant and to compare these estimates with the National Institute for Health and Care Excellence (NICE) benchmark. We performed a meta-analysis of cohort studies. The methodolo...

The purpose of this study was to evaluate the natural history of rheumatoid disease of the shoulder over an eight-year period. Our hypothesis was that progression of the disease is associated with a decrease in function with time. A total of 22 patients (44 shoulders; 17 women, 5 men, (mean age 63)) with rheumatoid arthritis were followed for eigh...

Purpose To conduct a systematic review and meta-analysis of the literature evaluating treatment outcome for supination deformity in obstetric brachial plexus injury. Methods We included studies on brachial plexus and supination deformity with follow-up of at least one year and quantitative measurements of forearm mean passive pronation and positio...

The aim of this study was to develop a more accurate method to deal with patients lost to follow-up based on the competing risks approach. A cohort of 112 patients who received 143 primary cemented total knee arthroplasties forms the basis for this study. Follow-up was up to 25 years. The new method for dealing with lost to follow-up accounts for c...

Mobile-bearing (MB) total knee replacement (TKR) was introduced to reduce the risk of aseptic loosening and wear of polyethylene inserts. However, no consistent clinical advantages of mobile- over fixed-bearing (FB) TKR have been found. In this study we evaluated whether mobile bearings have an advantage over fixed bearings with regard to revision...

We welcome letters to the Editor concerning articles that have recently been published. Such letters will be subject to the usual stages of selection and editing; where appropriate the authors of the original article will be offered the opportunity to reply.

Background and purpose The association between excessive early migration of acetabular cups and late aseptic revision has been scantily reported. We therefore performed 2 parallel systematic reviews and meta-analyses to determine the association between early migration of acetabular cups and late aseptic revision. Methods One review covered early...

This single-blinded randomised controlled trial investigated whether one design of mobile-bearing (MB) total knee replacement (TKR) has any advantage over a fixed-bearing (FB) design on long-term fixation as measured by radiostereometry. The amount of wear underneath the mobile bearing was also evaluated. A series of 42 knees was randomised to MB o...

Objectives: The Kaplan-Meier estimation is widely used in orthopedics to calculate the probability of revision surgery. Using data from a long-term follow-up study, we aimed to assess the amount of bias introduced by the Kaplan-Meier estimator in a competing risk setting. Methods: We describe both the Kaplan-Meier estimator and the competing ris...

BACKGROUND: Less than 1% of all primary TKAs are performed with an all-polyethylene tibial component, although recent studies indicate all-polyethylene tibial components are equal to or better than metal-backed ones. QUESTIONS/PURPOSES: We asked whether the metal-backed tibial component was clinically superior to the all-polyethylene tibial compone...

In a previous radiostereometric (RSA) trial the uncoated, uncemented, Interax tibial components showed excessive migration within 2 years compared to HA-coated and cemented tibial components. It was predicted that this type of fixation would have a high failure rate. The purpose of this systematic review and meta-analysis was to investigate whether...

In contrast to early migration, the long-term migration of hydroxyapatite- (HA-) coated tibial components in TKA has been scantily reported. This randomized controlled trial investigated the long-term migration measured by radiostereometric analysis (RSA) of HA-coated, uncoated, and cemented tibial components in TKA. 68 knees were randomized to HA-...

Although the overall survival of knee and hip prostheses at ten years averages 90%, recent problems with several hip and knee prostheses have illustrated that the orthopaedic community, industry, and regulators can still further improve patient safety. Given the early predictive properties of roentgen stereophotogrammetric analysis (RSA) and the me...

The aim of this observational study was to investigate the optimal minimal polyethylene (PE) thickness in total knee arthroplasty (TKA) and identify other risk factors associated with revision of the insert due to wear. A total of 84 TKA were followed for 11-16 years. All patients received the same prosthesis design (Interax; Howmedica/ Stryker) wi...

There is renewed interest in the all-polyethylene tibial component in total knee arthroplasty (TKA). Long-term results of this prosthesis in rheumatoid arthritis (RA) patients, however, are limited. Therefore, we studied 104 primary cemented all-polyethylene tibial TKA in 80 consecutive RA patients for up to 25 years to determine the long-term surv...

In the light of both the importance and large numbers of case series and cohort studies (observational studies) in orthopaedic literature, it is remarkable that there is currently no validated measurement tool to appraise their quality. A Delphi approach was used to develop a checklist for reporting quality, methodological quality and generalizabil...

Experts' responses to relevance of generalizability items.

Experts' responses to the AQUILA reporting quality and methodological quality items.

The purpose of this study is to evaluate a consecutive series of proximally porous-coated hemiarthroplasty for the treatment of severe proximal humeral fractures with special emphasis on aseptic loosening and functional outcome. Observational cohort of a consecutive series of a single prosthetic design. Orthopaedic clinic, nonacademic institutional...

The take home message of the meta-analysis by Smith and colleagues as broadcast in the media was that the risk of developing a wound infection after orthopaedic surgery is significantly higher when the wound is closed with staples rather than sutures.1 However, the meta-analysis does not support this conclusion.Firstly, we found three new studies i...

The purpose of this study was to evaluate the inter- and intra-observer reliability and accuracy of sonographic (US) acromiohumeral distance (AHD) measurement for both experienced and novice operators in US in patients suffering from subacromial impingement syndrome. A total of 43 patients (50 shoulders) diagnosed with subacromial impingement syndr...

Hypothesis: We hypothesize that the sling technique provides better long term tuberosity fixation in hemiarthroplasty for severe fractures of the proximal humerus. Background: After hemiarthroplasty for proximal humeral fractures, problems exist with deterioration of shoulder function by secondary displacement of the initially fixated humeral tu...