Cause Of Late Failure Research Articles

Conversion of Failed Anatomic Total Shoulder Replacement With Severe Glenoid Bone Defect to Humeral Hemiarthroplasty

IntroductionGlenoid component loosening is a common cause of late failure after anatomic total shoulder arthroplasty (aTSA) and revision can be challenging due to glenoid bone loss. Revision to reverse shoulder arthroplasty (RSA) requiring glenoid bone graft is associated with relatively high failure rates. Revision to humeral hemiarthroplasty (HHA) is an alternative. The purpose of this study was to evaluate the outcomes of revision of failed aTSA, with severe glenoid bone loss and intact rotator cuff to HHA. MethodsThis was a retrospective study of 18 patients (12 males) with failed aTSA, intact rotator cuff, and severe glenoid bone loss who were revised to HHA at a mean age of 68.9 ± 9.2 years and 9.0 ± 4.1 years after index aTSA. Mean follow-up was 7.6 ± 5.7 years. Glenoid defects were uncontained in 6 (33%). Glenoid bone grafting was performed in 11 (61%). A larger humeral head was used in 15 (83%) cases. Outcomes were assessed with the Simple Shoulder Test (SST), VAS pain, VAS quality of life (QoL), and shoulder range of motion. Plain radiographs were analyzed. ResultsThere were significant improvements in SST (p=0.005) and VAS pain (p<0.001). Mean active forward elevation improved from 106 ± 36° to 120° ± 21° (p=0.062). MCID for SST was met in 7 (39%) and VAS pain in 11 (61%). At final follow-up, 11 patients (61%) were satisfied with their current symptoms, two (11%) rated their satisfaction as neutral, and five (28%) were dissatisfied. There was progressive humeral medialization in 8 that was not significantly associated with the use of glenoid bone grafting (p=0.912). Greater humeral medialization was strongly correlated with less improvement in SST (ρ= 0.68) and VAS QoL (ρ=-0.64). Seven patients had ≥ 2 positive intraoperative cultures, all Cutebacterium acnes. Three patients (17%) underwent subsequent revision to treat persistent pain and dysfunction; 1 to HHA, 2 to RSA. ConclusionRevision of failed aTSA with severe glenoid bone loss and functional rotator cuff to HHA can provide improved pain and patient reported outcome with low complication and re-revision rates, and should be considered in selected cases.

CD73 inhibits titanium particle-associated aseptic loosening by alternating activation of macrophages.

Aseptic inflammation is a major cause of late failure in total joint arthroplasty, and the primary factor contributing to the development and perpetuation of aseptic inflammation is classical macrophage activation (M1 phenotype polarization) induced by wear particles. CD73 (ecto-5'-nucleotidase) is an immunosuppressive factor that establishes an adenosine-induced anti-inflammatory environment. Although CD73 has been shown to suppress inflammation by promoting alternate macrophage activation (M2 phenotype polarization), its role in wear particle-induced aseptic inflammation is currently unknown. Our experiments were based on metabolomic assay results in a mouse model of aseptic loosening, and studied the function of CD73 in vivo and in vitro using a mouse aseptic loosening model and a mouse bone marrow derived macrophage (BMDM) inflammation model. Results show that aseptic loosening (AL) reduces the purine metabolic pathway and decreases the native expression of the metabolite adenosine. In vivo, CD73 expression was low in the bone tissue surrounding the titanium nail and synovial-like interface tissue, while in vitro experiments demonstrated that CD73 knockdown promoted titanium particles-induced aseptic inflammation. CD73 overexpression mitigated the titanium particle-mediated enhancement of LPS-induced M1 polarization while promoting the titanium particle-mediated attenuation of IL-4-induced M2 polarization. In BMDM exposed to titanium particles, CD73 promotes M2 polarization via the p38 pathway. Meanwhile, local injection of recombinant mouse CD73 protein slightly alleviated the progression of AL. Collectively, our data suggest that CD73 alleviates the process of AL, and this function is achieved by promoting alternate activation of macrophages.

Causes, risk factors and complications of dental implant failure

Osseointegration, which refers to the direct attachment of dental implants (DIs) to the neighboring host bone, is a great predictor of the therapeutic efficacy of DIs. The factors that determine whether DIs are successful have been evolving over time. Presently, these factors comprise the lack of mobility at the beginning of the prosthetic stage. DIs have a high chance of success; however, they occasionally fail. The failure of properly implanted DIs has been attributed to inappropriate patient identification; inadequate dental hygiene associated with microbial plaque buildup. The three most significant factors that lead to early implant failure appear to be a paucity of basic stability, surgical injury, and infection. Due to disruption of the basic bone recovery process, initial symptoms of infection may portend a far more serious outcome than if similar issues arise later. It appears that peri-implantitis and occlusal overloading are the main causes of late failure. Among the predisposing variables for implant problems and failure include poor prosthesis fabrication and subpar implant design.

Periprosthetic fracture as a late mode of failure of the Anatomique Benoist Girard II femoral prosthesis.

AimThe Anatomique Benoist Girard (ABG) II femoral implant was a commonly used stem for primary total hip replacement (THR) at our institution (Launceston, Tasmania Australia). We identified peri‐prosthetic fracture as the main cause of late failure.MethodsThe late periprosthetic fracture rate for ABG II implants was reviewed with national statistics, using Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) data. National revision rates for periprosthetic fracture were used to compare ABG II with all other cementless femoral stems.ResultABG II stems accounted for 1% (2719 implants) of all femoral stem implants in Australia during the 12‐year review period, compared to 23% (587 implants) in Launceston Hospitals. Although the Launceston cumulative percent revision rate for the ABG II stem was lower than the National rate at all time points, the reasons for revision were similar. The most common reason for revision of ABG II was fracture (56.8%), followed by loosening (15.3%). This differs from the reasons for revision in other cementless prostheses (loosening 23.9%, fracture 20.8%, dislocation 18.7%). Cumulative percent revision rates from late periprosthetic fracture, were higher for the ABG II stem than other cementless femoral prostheses.ConclusionThis review of the AOANJRR has confirmed a local and national higher revision rate of the ABG II stem due to late periprosthetic fracture compared with other cementless stems. Stem design must be considered to reduce the risk of late periprosthetic fracture.

Experimental modeling of desensitization: What have we learned about preventing AMR?

During the past 5 decades, short-term outcomes in kidney transplant have significantly improved, in large part due to reduced rates and severity of acute rejection. Development of better immunosuppressive maintenance agents, as well as new induction therapies, helped make these advances. Nonhuman primate models provided a rigorous testing platform to evaluate candidate biologics during this process. However, antibody-mediated rejection remains a major cause of late failure of kidney allografts despite advances made in pharmacologic immunosuppression and strategies developed to facilitate improved donor-recipient matching. Our laboratory has been actively working to develop strategies to prevent and treat antibody-mediated rejection and immunologic sensitization in organ transplant, relying largely on a nonhuman primate model of kidney transplant. In this review, we will cover outcomes achieved by managing antibody-mediated rejection or sensitization in nonhuman primate models and discuss promises, limitations, and future directions for this model.

Classifications in Brief: The Dorr Classification of Femoral Bone.

Classifications in Brief: The Dorr Classification of Femoral Bone.

Possible Intraluminal Obstruction of the XEN45 Gel Stent Observed With Anterior Segment Optical Coherence Tomography.

We herein describe possible intraluminal obstruction because of a hyperreflective material found in anterior segment optical coherence tomography (AS-OCT) in 16 of 46 cases with XEN45 gel stent. This is a retrospective case series of 46 eyes of 39 patients with noncomplicated XEN45 gel stent surgery, analyzed with AS-OCT and slit-lamp photography after at least 6 postoperative months. Possible luminal obstruction in the subconjunctival segment of the implant was observed in 16 eyes of 15 patients, characterized by hyperreflective material on AS-OCT, which was not visible in slit-lamp photography. This was found in 15 eyes following combined procedures and in 1 eye following XEN45 alone. None showed signs of filtering bleb on AS-OCT or slit-lamp photography. In 1 case, the discontinuity between the hyperreflective material and subconjunctival opening of the implant tube was evidenced, and in another case, a focal deposit in the intracameral end of the implant was seen. We have successfully described the lumen implant deposit of material as a possible cause of late failure of the implant. AS-OCT allows the identification of such cases and may be useful to plan further postoperative interventions for better patient outcomes.

The Mobile-bearing TKA: Is There Still a Place?

During the 1980s, fixed-bearing total knee arthroplasty (TKA) became a reliable, reproducible procedure with about 95% implant survival after 10 years. However, implant loosening and polyethylene wear became recognized as long-term causes of late failure. If loosening is related to abnormal strains at the bone-implant interface, polyethylene wear is mainly caused by the lack of congruency during implant motion, and thus surgeons tried to improve TKA’s kinematics by introducing a second degree of freedom in their implants. Mobile-bearing knee replacements are based on a mobile polyethylene insert that articulates with a metallic femoral component and a metallic tibial tray. Those TKA designs have sought to increase congruency without increasing the stresses on the implant fixation. In vitro kinematic studies have shown reduced polyethylene wear in mobile bearings because of increased implant conformity and reduced polyethylene contact. In vivo kinematic analysis tends to confirm that mobile-bearing implants allow more natural knee movement. Despite several prospective, randomized studies having been performed, there is no clinical evidence supporting mobile bearing superiority over fixed-bearing designs. Studies focusing on gait parameters, clinical scores, or implant survival failed to confirm in vitro substantial advantage of mobile-bearing implants. More, recent improvement in polyethylene materials might solve wear issues: the last generation of cross-linked polyethylene, associated with a more morphometric design will probably provide superior implant survivorship and more physiological knee biomechanics.

Outcomes of valve-sparing root replacement in acute Type A aortic dissection.

To investigate the long-term durability of aortic valves, we reviewed the outcomes of patients who underwent valve-sparing root replacement with acute Type A aortic dissection. We included patients who underwent emergent aortic repair for acute Type A aortic dissection at our university hospital between 2000 and 2016. We identified patients who underwent valve-sparing root replacement from the included cohort and assessed their survival and long-term valve durability. We identified 24 of 328 patients who underwent valve-sparing root replacement (age: mean ± SD 49 ± 11 years; 17 men). All patients underwent reimplantation procedures and 2 had concomitant cusp repairs (central plication). Prolapsed cusps caused by detached commissures in 12 cases were noted and reattached with buttress sutures with or without glue. There was no in-hospital mortality. Median follow-up period was 84 months (range 1-202 months) and survival was 100% at 5 and 10 years. Freedom from moderate or greater aortic insufficiency was 82% ± 10% at 5 years and 65% ± 13% at 10 years. Freedom from aortic valve reoperation was 83% ± 9% at 5 years and 69% ± 12% at 10 years. Valve reoperations were indicated for endocarditis in 1 patient, perforation of the aortic cusp in 1 patient and redetachment of commissures that had been attached with gelatin-resorcinol-formaldehyde glue at the initial operations in 3 patients. The durability of valve-sparing root replacement in acute aortic dissection was suboptimal. The major cause of late failure was commissure detachment after primary repair with buttress sutures and glue. Gelatin-resorcinol-formaldehyde glue should be avoided for commissural resuspension in patients with acute aortic dissection.

Oversized vein grafts develop advanced atherosclerosis in hypercholesterolemic minipigs

BackgroundAccelerated atherosclerosis is the main cause of late aortocoronary vein graft failure. We aimed to develop a large animal model for the study of pathogenesis and treatment of vein graft atherosclerosis.MethodsAn autologous reversed jugular vein graft was inserted end-to-end into the transected common carotid artery of ten hypercholesteroemic minipigs. The vein grafts were investigated 12-14 weeks later with ultrasound and angiograpy in vivo and microscopy post mortem.ResultsOne minipig died during follow up (patent vein graft at autopsy), and one vein graft thrombosed early. In the remaining eight patent vein grafts, the mean (standard deviation) intima-media thickness was 712 μm (276 μm) versus 204 μm (74 μm) in the contralateral control internal jugular veins (P < .01). Advanced atherosclerotic plaques were found in three of four oversized vein grafts (diameter of graft > diameter of artery). No plaques were found in four non-oversized vein grafts (P < .05).ConclusionsOur model of jugular vein graft in the common carotid artery of hypercholesterolemic minipigs displayed the components of human vein graft disease, i.e. thrombosis, intimal hyperplasia, and atherosclerosis. Advanced atherosclerosis, the main cause of late failure of human aortocoronary vein grafts was only seen in oversized grafts. This finding suggests that oversized vein grafts may have detrimental effects on patient outcome.

An “Uncrimped” SMart Stapes Prosthesis: A Cause of Late Hearing Deterioration in Otosclerosis

Statement of Problem. Stapedotomy is the treatment of choice for otosclerosis. Numerous techniques and prosthesis are available to perform this procedure. Success rates of surgery vary from 17% to 80%, and revision surgery carries an increased risk of complications as well as poorer hearing outcomes. Method of Study. Case report. Results. We report the first case of uncrimping of a SMart stapes prosthesis with no lateral displacement as a cause of late failure despite successful crimping and improvement in audiological outcomes after initial surgery. Conclusion. The SMart stapes prosthesis is widely used and has been shown to be safe and provide good hearing outcomes. Displacement of a stapes prosthesis is the commonest cause of failure. Our case shows that deterioration of hearing thresholds can occur from uncrimping of the prosthesis with no displacement. It is important to improve our understanding of stapedotomy failure as revision procedures are associated with poorer outcomes.

Comments regarding ‘Plasma Levels of Matrix Metalloproteinase-9: A Possible Diagnostic Marker of Successful Endovascular Aneurysm Repair’

1078-5884/$ e see front matter 2011 European So doi:10.1016/j.ejvs.2011.11.004 A more rational approach to the surveillance of patients with endovascular aneurysm repair (EVAR) is urgently needed. Recent publications have questioned the benefit of surveillance and demonstrated that significant heterogeneity of surveillance schedules exists among vascular units.1,2 Current imaging modalities reliably identify endoleak and other stent-graft related complications but are costly and some are potentially harmful. A blood test which might predict complications or the need for secondary interventions would be attractive. Endoleak is an important but not the sole cause of late failure of aortic stent-grafts. Iliac limb occlusion and stent-graft migration are important predictors of secondary intervention. Many endoleaks are entirely benign and the detection of these benign (most frequently type 2) endoleaks will not improve outcomes. Previous studies have suggested that plasma levels of MMPmay identify endoleak.3,4 This preliminary report is encouraging and builds on these studies but does not tell us whether this approach might be able to discriminate benign from dangerous endoleaks nor whether MMP levels might change in individual patients subsequent to the development or successful treatment of endoleak.5 Larger longitudinal studies, which the authors report to be already underway, are required to confirm these findings and establish whether other demographic factors or complications might impact upon the levels of various MMPs.

Aortic Regurgitation After Valve-Sparing Aortic Root Replacement: Modes of Failure

Despite the positive clinical results of valve-sparing aortic root replacement, little is known about the causes of reoperations and the modes of failure. From October 1999 to June 2010, 101 patients underwent valve-sparing aortic root replacement using the David reimplantation technique. The definition of aortic root repair failure included the following: (1) intraoperative conversion to the Bentall procedure; (2) reoperation performed because of aortic regurgitation; and (3) aortic regurgitation equal to or greater than a moderate degree at the follow-up. Sixteen patients were considered to have repair failure. Three patients required intraoperative conversion to valve replacement, 3 required reoperation within 3 months, and another 8 required reoperation during postoperative follow-up. At initial surgery 5 patients had moderate to severe aortic regurgitation, 6 patients had acute aortic dissections, 3 had Marfan syndrome, 2 had status post Ross operations, 3 had bicuspid aortic valves, and 1 had aortitis. Five patients had undergone cusp repair, including Arantius plication in 3 and plication at the commissure in 2. The causes of early failure in 6 patients included cusp perforation (3), cusp prolapse (3), and severe hemolysis (1). The causes of late failure in 10 patients included cusp prolapse (4), commissure dehiscence (3), torn cusp (2), and cusp retraction (1). Patients had valve replacements at a mean of 23 ± 20.9 months after reimplantation and survived. Causes of early failure after valve-sparing root replacement included technical failure, cusp lesions, and steep learning curve. Late failure was caused by aortic root wall degeneration due to gelatin-resorcin-formalin glue, cusp degeneration, or progression of cusp prolapse.

The Use of Highly Cross-linked Polyethylene in Total Knee Arthroplasty

Polyethylene wear, with resultant particle-induced osteolysis, is a cause of late failure of total knee arthroplasty. The causes of both wear and osteolysis are multifactorial; still, improvements in the polyethylene liner have been investigated. Available highly cross-linked polyethylene tibial liners and patellar prostheses differ greatly in the amount and method of irradiation, thermal treatments, and sterilization techniques they undergo. Several varieties of highly cross-linked polyethylene reduce the gravimetric and volumetric wear of tibial liners in knee simulator studies. However, reduced fracture toughness and the generation of smaller and possibly more reactive particles also have been reported with some varieties of polyethylene. Clinical studies of the use of highly cross-linked polyethylene in total knee arthroplasty are limited. Two nonrandomized trials of highly cross-linked polyethylene in total knee arthroplasty have reported a nonsignificant decrease in radiolucent lines at 2 and 5 years, respectively. The risks of using highly cross-linked polyethylene include fracture of the liner or of a posterior-stabilized tibial post, liner dislodgement or locking mechanism disruption, and possibly more osteolysis. Highly cross-linked polyethylene tibial liners may be considered for younger, more active patients. However, until additional clinical results are available, a cautious approach is warranted to the widespread use of highly cross-linked polyethylene in total knee arthroplasty.

Late Failure of Dacryocystorhinostomy

The authors describe a group of patients with initially successful dacryocystorhinostomy surgery with late recurrence of epiphora. The causes of late failure and its management are documented. A retrospective chart review of primary dacryocystorhinostomy cases was undertaken. Inclusion criteria were an initially successful primary dacryocystorhinostomy and recurrence of symptoms at least 12 months after surgery, together with clinical evidence of impaired lacrimal drainage. Patients' subsequent procedures were detailed and outcomes determined. Thirteen cases of late failure of dacryocystorhinostomy were identified (8 of 1,158 surgeries by A.A.M., 4 of 378 by D.S., 1 patient whose initial dacryocystorhinostomy was done by another surgeon). Most patients were female (85%), and average age at initial surgery was 57.9 years. Most cases had nasolacrimal duct obstruction as the initial cause of epiphora (10 of 13 or 76.9%). The mean time to recurrence of symptoms after initial surgery was 46.9 months (range, 15-97 months). Pre- and intraoperative findings at second lacrimal surgery identified the cause of epiphora in late failure to be common canalicular obstruction in 11 of 13 patients (84.6%). Eleven of the 13 patients avoided repeat dacryocystorhinostomy, instead undergoing probing (with or without common canalicular membranotomy/membranectomy) and silicone intubation. Twelve of the 13 patients (92.3%) remained asymptomatic at final follow-up (range, 4-131 months). Although late failure after primary dacryocystorhinostomy is rare, this newly described group appears to be a distinct clinical entity, with lacrimal system obstruction often occurring at the common canaliculus. In the large majority of cases, a less invasive surgical solution than repeat dacryocystorhinostomy is effective in resolving symptoms.

Fixed Versos Mobile Bearing Knee Arthroplasty: A Review of Kinematics and Results

There are several total knee arthroplasty designs available with wide variation in features. The long-term results of total knee replacement with a fixed bearing design have shown a high degree of clinical success. However, implant loosening and polyethylene wear became recognized as long-term causes of late failure. Mobile bearing knee replacements were designed to create a durable surface articulation by using a polyethylene insert that articulates with a metallic femoral component and a metallic tibial tray. The purpose of this article is to review clinical and basic scientific studies comparing the clinical results, the biomechanical features, and the kinematic patterns of fixed versus mobile bearing knee designs. Beside the fact that in vitro kinematic studies have shown reduced polyethylene wear in mobile bearings due to increased implant conformity and reduced polyethylene contact stresses, which should hypothetically prolong polyethylene life, various independent studies for both mobile bearing and fixed bearing prostheses have documented results that are comparable in terms of survival and performance.

Abstract No. 38: Study of the Effect of Aortic Endovascular Graft Oversizing on Fixation in an Abdominal Aortic Aneurysm

Endovascular graft (EVG) migration is a major complication of endovascular aneurysm repair. Distal EVG migration in the aorta exposes the abdominal aortic aneurysm (AAA) sac to pressurized blood flow. Despite numerous device improvements such as addition of proximal fixation barbs, EVG migration remains the number one cause of late failure. EVG design parameters such as optimal graft oversizing, ratio of freely deployed graft dia to aorta dia at mean aortic pressure, and its relationship to proximal fixation has been subject of debate.

Clinical Performance of Highly Cross-Linked Polyethylenes in Total Hip Arthroplasty

Aseptic loosening secondary to wear-debris-induced osteolysis has been identified as the leading cause of late failure of total hip arthroplasty. Highly cross-linked polyethylene acetabular liners were developed as one approach to reducing this wear. Preclinical laboratory wear testing showed a number of cross-linked polyethylenes to have dramatically less wear than the polyethylene that had been in use for several decades. After the initial bedding-in phase (one to two years), the percent reductions in the wear rate, as indicated by the amount of penetration of the head into the socket evident on serial radiographs, have been comparable with what was predicted from preclinical hip-simulator testing of the highly cross-linked polyethylenes. To our knowledge, there have been no reports of clinically relevant osteolysis that was clearly attributable to wear of a highly cross-linked polyethylene acetabular liner. However, the clinical performance of these materials should be closely monitored with long-term follow-up.

Long‐term effects of novel biolimus eluting DEVAX AXXESS plus nitinol self‐expanding stent in a porcine coronary model

The purpose of this study was to evaluate the long-term effects of the DEVAX AXXESS biolimus eluting stent (BES) in a porcine coronary model, compared with those of bare metal stent (BMS) and polymer only stent (POS) controls. Excessive neointimal growth has been identified as a major cause of late failure of percutaneous coronary interventions. The effect of drug eluting from self-expanding stents for prevention of neointimal hyperplasia has not been studied before. The DEVAX AXXESS is a self-expanding nickel titanium stent, coated with antiproliferative compound-biolimus. Twenty juvenile farm swine, 25-35 kg in weight, 3-6 months in age were used. Each animal received a stent to the left anterior descending artery, left circumflex or right coronary arteries as permitted per anatomy. The chronic vascular response after BES implantation was compared with that after BMS and POS implantation at 28, 90, and 180 days follow-up. The 28-day outcome by quantitative coronary angiography (QCA) showed significant increase in minimal luminal diameter (MLD) in the BES (MLD: 2.90 +/- 0.97, 2.39 +/- 0.90, 1.59 +/- 0.91; P = 0.009) compared with BMS and POS, respectively. By histomorphometric analysis, there was also a corresponding significant reduction in neointimal tissue proliferation in the BES (average neointimal area: 2.78 +/- 0.07, 5.46 +/- 0.66, 8.42 +/- 0.85; P = 0.002) compared with that in BMS and POS controls, respectively at 28-days follow-up. At 90 and 180 days, the mean neointimal area was not significantly different between the BES and the controls. BES favorably modulates the neointimal tissue formation for 28 days, in the porcine coronary model. Long-term inhibition of neointimal hyperplasia is not sustained most likely because of the delayed cellular proliferation and inflammation in the vessel wall.

Nine years' experience with end-to-end arteriovenous fistula at the ‘anatomical snuffbox’ for maintenance haemodialysis

One hundred and seventy-seven end-to-end arteriovenous fistulas were created at the 'anatomical snuffbox' between 1 January 1972 and 31 December 1980. The survival rate of the fistulas was 83.1 per cent at 1 year and 46.3 per cent at 6.5 years; 10.2 per cent failed immediately. Local and general complications were virtually absent. Forty fistulas stopped functioning after a period varying from 10 days to 6.5 years following the operation. The main cause of late failure (50 per cent) was aneurysm formation due to repeated needle venepuncture at the same site and subsequent obliteration of the upper venous segment. The end-to-end anastomosis seems to be preferable to other techniques because of the absence of local vascular complications and a lower risk of cardiac embarassment. The 'anatomical snuffbox' site is convenient and spares the proximal vessels for reoperation if necessary.