Complex Revision Research Articles

Common and unique neurophysiological processes that support the stopping and revising of actions.

Inhibitory control is a crucial cognitive-control ability for behavioral flexibility, which has been extensively investigated through action-stopping tasks. Multiple neurophysiological features have been proposed as 'signatures' of inhibitory control during action-stopping, though the processes indexed by these signatures are still controversially discussed. The present study aimed to disentangle these processes by comparing simple stopping situations with those in which additional action revisions were needed. Three experiments in female and male humans were performed to characterize the neurophysiological dynamics involved in action-stopping and -changing, with hypotheses derived from recently developed two-stage 'pause-then-cancel' models of inhibitory control. Both stopping and revising an action triggered an early, broad 'pause'-process, marked by frontal EEG β-frequency bursting and non-selective suppression of corticospinal excitability. However, EMG showed that motor activity was only partially inhibited by this 'pause', and that this activity could be modulated during action-revision. In line with two-stage models of inhibitory control, subsequent frontocentral EEG activity after this initial 'pause' selectively scaled depending on the required action revisions, with more activity observed for more complex revisions. This demonstrates the presence of a selective, effector-specific 'retune' phase as the second process involved in action-stopping and -revision. Together, these findings show that inhibitory control is implemented over an extended period of time and in at least two phases. We are further able to align the most commonly proposed neurophysiological signatures to these phases and show that they are differentially modulated by the complexity of action-revision.Significance Statement Inhibitory control is one of the most important control processes by which humans can regulate their behavior. Multiple neurophysiological signatures have been proposed to index inhibitory control. However, these play out on different time scales and appear to reflect different aspects of cognitive control, which are controversially debated.Recent two-stage models of inhibitory control have proposed that two phases implement the revisions of actions: 'pause' and 'retune'. Here, we provide the first empirical evidence for this proposition: Action revisions engendered a common, low-latency 'pause' process, during which motor activity is broadly suppressed. Later activity, however, distinguishes between simple stopping of actions and more complex action revisions. These findings provide novel insights into the sequential dynamics of human action control.

When is Anterolateral Complex Augmentation Indicated? Perspectives from the 2024 Freddie Fu Panther Sports Medicine Symposium.

To determine the trends and indications for anterolateral complex augmentation during anterior cruciate ligament reconstruction (ACL-R) among international orthopaedic sports surgeons. An electronically distributed survey was sent out to international surgeons with high-volume experience in complex ligament reconstructions and revision surgery attending the 2024 Freddie Fu Panther Sports Medicine Symposium. The survey was sent prior to the meeting with questions related to the use of lateral extra-articular tenodesis (LET) or anterolateral ligament reconstruction (ALL-R) during ACL-R. Sessions pertaining to anterolateral complex augmentation were held during the symposium to inform about current clinical practices among attendees. A total of 49 surgeons were identified from 5 different geographic regions prior to the meeting date and sent an electronic survey, of which 48 responded (98% response rate). Among surgeons who reported performing anterolateral complex augmentation procedures (n=45), a total of 39 (87%) respondents reported using only the LET technique, 2 (4%) using only the ALL-R technique, and 4 (9%) using both techniques during ACL-R. The most common indication for anterolateral complex augmentation was a high-grade pivot shift, which 39/43 (91%) of respondents ranked in their top 3 indications. In the setting of primary ACL-R, respondents added a LET when using hamstring tendon autograft in 38% of cases on average compared with 34% of cases when using either bone-patellar tendon-bone autograft or quadriceps tendon autograft. In the setting of revision ACL-R, a LET was added in an average of 68% of cases for a first-time revision ACL-R and 84% of cases for a multiple revision ACL-R. The most common indication for ACL-R with anterolateral complex augmentation was a high-grade pivot shift and most respondents preferred LET over ALL-R. Respondents performed LET in a comparable percentage of cases of primary ACL-R using hamstring tendon, bone-patellar tendon-bone and quadriceps tendon autografts and this number increased with the number of revision ACL-Rs. Based on the results of this survey, surgeons may consider adding a LET in cases of revision ACL-R or in patients with a high-grade pivot shift. Level V.

Effects of personalized 3D-printed blocks in total knee arthroplasty and revision surgery for massive bone defects: a single-center retrospective study.

To analyze the early- to mid-term clinical efficacy of personalized 3D-printed structural metal spacer technology in reconstructing massive bone defects during complex total knee arthroplasty (TKA) and revision surgery. A single-center retrospective study was conducted on nine patients with severe bone defects who underwent TKA between 2018 and 2024. The general condition, surgical details, and clinical improvement of these patients were recorded and analyzed by clinical doctors. The average surgical duration was 183.9 minutes (range, 125-240 minutes), with intraoperative blood loss of 133.3 mL (range, 100-200 mL). The average hospital stay was 18.2 days (range, 10-42 days), and the follow-up duration was 13.2 months (range, 2-57 months). The preoperative average American Knee Society Score of 51.2 points (range, 15-74 points) improved significantly to 95.0 points (range, 81-106 points) at the last follow-up. No cases of vascular or nerve injury, infection, fracture, or prosthetic loosening were observed. The precise manufacturing of customized spacers that seamlessly integrate with the patient's skeletal structure ensures stability, adaptability, and improved surgical outcomes.

Outcomes of primary and revision total knee arthroplasty with constrained condylar knee prosthesis: A retrospective review

Background The constrained condylar knee (CCK) implants are becoming more frequently used but the long-term outcomes are inadequately reported. A retrospective review of complex primary and revision total knee arthroplasty (TKA) with use of Legacy Constrained Condylar Knee prosthesis (LCCK; Zimmer) was performed to evaluate the functional and radiological outcomes, identify complications, and ascertain prosthesis survival. Methods A cohort of 54 primary TKA and 37 revision TKA cases were performed between December 2002 and March 2021 using the second-generation CCK prosthesis. The cases without using the constrained insert were excluded. Functional outcome comparison includes flexion and extension range of movement (ROM), Knee Society knee score (KSKS), function score (KSFS) and complications. Radiological outcome comparison includes tibiofemoral angle, hip-knee-ankle (HKA) angle and prosthesis components alignment. Survival analysis was performed using revision surgery for any reason as censoring criteria. Results The mean follow-up duration was 4.8 years (1.0–9.9 years) in primary TKA group and 6.2 years (1.0–18.6 years) in revision TKA group. The mean KSKS improved from 40.5 to 86.6 in primary TKA group and from 58.8 to 79.6 in revision TKA group. The mean KSFS improved from 41.8 to 58.9 in primary TKA group and from 34.1 to 58.2 in revision TKA group. The overall complication rate was 7.5% in primary TKA group and 35.1% in revision TKA group. Aseptic loosening was found in 6 cases and periprosthetic joint infection was found in 5 cases. Kaplan-Meier survivorship analysis estimated the overall mean survival was 17.9 years and 10-year survival rate was 93%. Conclusions Complex primary and revision TKA with use of LCCK prosthesis yielded significant reproducible improvement of clinical outcomes. The failure rate was low in primary TKA but relatively higher in revision cases.

Case–control Comparative Study of Porous Metal Augments versus Bone Graft in Management of Segmental Acetabular Defect in Hip Arthroplasty Procedures

Abstract Introduction: Acetabular bone loss represents a great challenge during hip arthroplasty procedures. This study aims at evaluating the efficacy and functional outcome of cost-friendly alternatives (autograft or allograft) when compared to the porous metal augments during reconstruction of acetabular defects in either complex primary or revision total hip replacement. Patients and Methods: This is a retrospective matched control study for evaluation of short and midterm results of metal augments versus bone graft during hip arthroplasty procedures. Inclusion criteria included adult patients who suffered from segmental acetabular defect and underwent hip arthroplasty procedure. The study included 34 cases divided into 2 groups. Group 1 cases were reconstructed with augment reconstruction. Group 2 was the control group which was reconstructed using graft reconstruction. Results: The mean age for Group 1 was 52.29 years (range: 30–68) and for Group 2 was 52.1 years, (range from 32 to 71 years). The mean follow-up period was 74.8 months in Group 1 (range: 66–85 months) and 71.5 months in Group 2 (range: 60–102 months). Both the groups included 13 males and 4 females. Group 1 had a mean postoperative Harris Hip Score (HHS) of 90.5 (range from 85 to 94), and Group 2 had a mean postoperative HHS of 88.7 (range from 80 to 94) with P = 0.236. Conclusion: Acetabular reconstruction using cost-friendly alternatives shows similar short-to-midterm results when compared to trabecular metal augments in a budget-conscious health setting.

Comparing Trabecular Metal Versus Fiber Mesh Cementless Acetabular Components: A Single-Center Study of 6,563 Hips

Trabecular metal is being increasingly used in primary total hip arthroplasty. This study compared medium-term (< 15 years) outcomes of fiber mesh titanium and trabecular metal acetabular components. This study included 6,563 patients who underwent primary THA with either fiber mesh titanium or trabecular metal-backed acetabular components. Data was sourced from a prospectively maintained local arthroplasty database and linked with the National Joint Registry. There were 5,603 fiber mesh and 960 trabecular metal acetabular components that were included with a mean follow-up of 6.5 and 7.1 years, respectively. The above highlighted should be moved to Methods. The 10-year survivorship was 97.3% for fiber mesh and 98.9% for porous tantalum groups (P = 0.009). Multivariate analysis showed no significant variable associated with reduced revision rates. Both fiber mesh titanium and trabecular metal acetabular components demonstrated high survivorship in THA, with trabecular metal showing statistically significant though marginally better survival. Despite the increased cost associated with trabecular metal, its use may be justified in complex primary and revision cases where increased primary stability may be required. Future research should focus on cost analysis and include patient-reported outcomes to guide implant selection further.

3D Model Simulation in Preoperative Planning of Complex and Revision Hip Replacement

Complex and revision hip arthroplasty has remained one of the most discussed orthopedic topics in recent years. With the advancement of printing technologies 3D preoperative planning and live model simulation provides us with “hands on” procedures without any risk for the patient. Modern computer technologies present the possibility for preoperative planning of Total Hip Arthroplasty (THA) in digital environment. 3D printing of anatomical models in real size allows accurate assessment of the pathological deviations of the anatomy, precise preoperative planning of the reconstruction and simulation of the operative intervention ex-vivo. We present a series of 3D simulations for planning hip replacement, illustrating the technique, discussing its advantages and disadvantages, in complex primary and revision hip arthroplasty. In the complex and revision surgery of the hip joint, a correct assessment of bone defects is mandatory. Reconstructing the biomechanical parameters – centre of rotation, femoral offset and leg length discrepancy, is also of great significance. The 3D reconstruction with biomodel simulations offers exceptional accuracy in this respect. The method can be an excellent tool for education of surgeons in training and residents.

Key Takeaways From ISASS Webinar Series on Endoscopic Spine Surgery Techniques | Part 4: Advancing the Curve on Surgeons' Experience With Complex Lumbar Revision Scenarios, Grades 1 to 3 Spondylolytic Spondylolisthesis, Cervical Foraminotomy, and Cervical Spondylotic Myelopathy.

The fourth webinar in a 4-part series hosted by the International Society for the Advancement of Spine Surgery explored contemporary endoscopic spine surgery techniques. This session covered complex revision strategies, endoscopic management of grades 1-3 spondylolytic spondylolisthesis, cervical foraminotomy, and decompression techniques for cervical spondylotic myelopathy (CSM). The aim was to assess surgeon endorsement of the discussed endoscopic spine surgery techniques both before and after the webinar using polytomous Rasch analysis. Additionally, the analysis sought to determine how these insights might shape clinical guideline recommendations. Before the webinar, which was attended by 868 potential participants, a survey was distributed to collect data on the level of support for various techniques using a Likert scale. The polytomous Rasch model analyzed these responses by evaluating decision complexity relative to surgeon expertise. This approach helped develop a logarithmic scale to objectively analyze categorical responses, distinguish between congruent and incongruent items, and contribute to the enhancement of clinical guidelines. Of the 868 surgeons, 263 accessed, 150 started, and 118 completed the prewebinar survey, with a completion rate of 78.7%. The participants were mainly orthopedic surgeons (59.3%) and neurosurgeons (34.7%) but also included residents (2.5%), fellows (1.7%), and interventional radiologists (1.7%). In the postwebinar phase, 298 participants accessed the survey, 169 started it, and 128 completed it, achieving a 75.7% completion rate. The demographics of postwebinar participants closely mirrored the initial group: 66.4% orthopedic surgeons, 23.4% neurosurgeons, 3.6% residents, 2.9% fellows, 0.7% medical students, and 2.9% interventional radiologists. The Rasch analysis confirmed high surgeon confidence for the posterior cervical foraminotomy and endoscopic treatment of spondylolytic spondylolisthesis grades 1 to 3 and posterior endoscopic decompression for CSM. Both pre- and postwebinar responses showed a good fit to the Rasch model for these endoscopic techniques, indicating minimal bias, supported by differential item functioning analysis. The application of the endoscopic surgery platform for procedures such as lumbar revision surgery for adjacent segment disease or failed interbody fusion cages and posterior decompression of CSM saw little shift in endorsement, as evidenced both in descriptive and the logarithmically transformed Rasch statistics. This webinar highlighted the evolving consensus on best practices in endoscopic spine surgery, displaying wide acceptance of endoscopic debridement of spondylolytic spondylolisthesis, cervical foraminotomy for herniated disc and bony stenosis, and posterior endoscopic decompression for CSM. Assessing surgeon confidence and acceptance of endoscopic spinal surgeries using polytomous Rasch analysis. Level 2 (inferential) and 3 (observational) evidence because Rasch analysis provides statistical validation of instruments rather than direct clinical outcomes.

Mid-Term Clinical and Radiographic Results of Complex Hip Revision Arthroplasty Based on 3D Life-Sized Model: A Prospective Case Series.

Background: The pre-operative three-dimensional (3D) assessment of acetabular bone defects may not be evaluated properly with conventional radiographic and computed tomography images. This paper reports mid-term clinical and radiographic outcomes of complex revision total hip arthroplasty (r-THA) based on a 3D life-sized printed model. Methods: Patients who underwent r-THA for septic or aseptic acetabular loosening with acetabular defects Paprosky types IIc, IIIa, and IIIb between 2019 and 2021 were included. The outcomes of the study were to determine clinical and radiographic assessment outcomes at the time of the last follow-up. Results: 25 patients with mean age of 62.9 ± 10.8 (18-83) years old were included. The mean Harris hip score improved from 34.8 ± 8.1 pre-operative to 81.6 ± 10.4 points (p < 0.001). The mean visual analog scale decreased from 6.7 ± 1.4 points pre-operative to 2.4 ± 1.0 points (p < 0.001). The mean limb length discrepancy improved from -2.0 ± 1.2 cm pre-operative to -0.6 ± 0.6 cm (p < 0.001). The mean vertical position of the center of rotation (COR) changed from 3.5 ± 1.7 cm pre-operative to 2.0 ± 0.7 cm (p < 0.05). The mean horizontal COR changed from 3.9 ± 1.5 cm pre-operative to 3.2 ± 0.5 cm (p < 0.05). The mean acetabular component abduction angle changed from 59.7° ± 29.6° pre-operative to 46° ± 3.9 (p < 0.05). Conclusions: A three-dimensional-printed model provides an effective connection between the pre-operative bone defects' evaluation and the intraoperative findings, enabling surgeons to select optimal surgical strategies.

Numerical simulation and analysis of fatigue performance for the humeral stem

Background and objectiveFatigue failure of the humeral stem is a severe long-term failure after shoulder arthroplasty, causing harm to patients and resulting in complex revision surgeries. However, there are few studies on humeral stem fatigue testing, and corresponding testing standards have not been established. Therefore, this study aims to investigate the fatigue performance of the humeral stem by establishing an efficient numerical simulation method. MethodsMaterial properties are obtained by uniaxial tensile and fatigue tests. A parameterized static analysis program was written, and an automated fatigue numerical simulation platform was established using Abaqus, Fe-safe, and Isight in combination, enabling the establishment of a numerical simulation method for the fatigue performance of the humeral stem. ResultStandard testing conditions include an 8 mm diameter humeral stem, a 40-21B humeral head, an 8° tilt angle, and a 2 mm fillet radius. Further research found that the fatigue life of the humeral stem decreases with increasing patient weight, and patients should control their weight after surgery. ConclusionsThe established automated fatigue numerical simulation platform avoids repetitive operations and efficiently completes large-scale calculations, guiding preoperative humeral stem selection and testing.

Perioperative Outcomes of Total Hip Arthroplasty in Trisomy 21 Patients in Comparison With a Control Population: Analysis From a Large National Sample of 367,894 Patients.

Literature on the outcomes of total hip arthroplasty (THA) has established the procedure as a gold standard for hip arthritis. However, postoperative outcomes after THA in specific conditions such as Down's syndrome (DS) have been sparsely described. This large database analysis of over 367,000 patients was aimed at evaluating the immediate postoperative results including morbidity and mortality rates after THA among DS patients and comparing these with a control population. Data from the National Inpatient Sample (NIS) database Healthcare Cost and Utilization Project (HCUP) was reviewed retrospectively from 2016 to 2019 on THAs. Among 367,894 patients, 129 were identified with a diagnosis of DS. Complex primaries and revisions were excluded. Demographics, admission details, and perioperative variables including morbidity and mortality rates were compared between DS patients and controls. Patients with DS were younger than the control population (43.3 versus 65.9 years, p=0.002), had a greater preponderance of men, had a lower incidence of smoking and diabetes, and had a relatively higher incidence of non-elective THA. The former also had a longer mean length of stay (LoS) and higher mean costs to healthcare. Two patients with DS died after a THA, making the mortality rate 17-fold higher in DS patients. Higher rates of postoperative anemia (31.8% versus 19.6%, p<0.001), pneumonia (2.3% versus 0.3%), and pulmonary embolism (p=0.0.12) were seen in the DS group. Also seen in the DS group were higher risks of periprosthetic fractures (p=0.020) and periprosthetic joint infections (PJIs) (p=0.047). Results from a total hip arthroplasty continue to positively transform the lives of patients with end-stage hip arthritis from varying etiologies. In the special cohort of Down's syndrome, a thorough discussion is essential with reference to the relatively higher morbidity and mortality in this group of patients. Documented conversations between patients and their families and healthcare providers should consist of detailed deliberations on the pros and cons of surgery and its potential impacts.

Superior suspensory complex of the shoulder reconstruction for acute and chronic acromioclavicular joint dislocations: the Queensland Unit for Advanced Shoulder Research 3-tunnel technique

BackgroundManagement of acromioclavicular joint (ACJ) injuries have wide variety of classification systems, surgical indications and operative techniques. Our study describes the QUASR (Queensland Unit for Advanced Shoulder Research) 3-Tunnel Technique with LARS (Ligament Augmentation and Reconstruction System; Surgical Implants and Devices, Arc sur Tille, France) artificial ligament to reconstruct the superior shoulder suspensory complex (SSSC) in acute, chronic and revision ACJ dislocations and lateral clavicle fractures. MethodsOur prospective cohort series of patients undergoing the QUASR 3-Tunnel Technique using LARS artificial ligament. This technique reconstructs the SSSC using two 4mm clavicle tunnels, one acromion tunnel, and is arthroscopically assisted to pass the artificial ligament under the coracoid. The ligament is secured with braided composite sutures and no interference screw is used. Pre and postoperative functional outcome scores were compared in patients with minimum 12-months follow-up. ResultsOf 26 patients in this series, 7 (27%) were operated within 4 weeks of injury, two (8%) were revision cases, and six (23%) were lateral clavicle fractures. Mean time to surgery was 14 weeks (2-650). Mean postoperative scores with associated 95% CI were Specific Acromioclavicular Score 87.38 (CI 75.38, 99.37), American Shoulder and Elbow Surgeons score 94.60 (87.85, 101.35), Constant 79.47 (71.87, 87.07), Simple Shoulder Test 85.44 (72.34, 98.54) and Visual Analogue Score 0.50 (-0.15, 1.15). There were two infections and one atraumatic loss of reduction, however there were no tunnel fractures. ConclusionThe QUASR 3-Tunnel Technique with LARS artificial ligament is a safe and efficient technique for both acute and chronic acromioclavicular joint reconstruction, lateral clavicle fractures with coracoclavicular ligament disruption and complex revision cases with favorable outcomes at mid-term follow-up.

A Registry Study on Acetabular Revisions Using Jumbo Cups: Do We Really Need a More Complex Revision Strategy?

BackgroundThe increasing global performance of total hip arthroplasty (THA) has led to a rise in revision surgeries, primarily due to cup failure, with aseptic loosening and periprosthetic infection being common causes. Various techniques and implants, including jumbo cups (JCs), manage residual bone loss post-cup removal, facilitating enhanced surface area for improved host bone contact, and osteointegration. The purpose of the study was to determine the outcomes of acetabular revision arthroplasty using JC implants over a 20-year follow-up period by reporting overall survivorships, complications leading to re-revision, and surgical strategies in re-revision. MethodsA cohort study based on a large regional registry was conducted, examining revision THA surgeries utilizing JCs between 2000 and 2020. The study included all the revision acetabular procedures performed with cementless JCs, identified with a diameter ≥ 62 millimeters (mm) in women or ≥ 66 mm in men. All iliac fixation cups were excluded. Data on demographics, revision surgery indications, components, fixation types, causes of failure, and reintervention strategies were collected and analyzed. A total of 541 JCs implanted from January 2000 to December 2020 were evaluated. The most common revision indications were “cup aseptic loosening” (54.5%) and “total aseptic loosening,” which included both the cup and stem (32%). ResultsThe JC survival rates were 92.5% at 5 years, 85.8% at 10 years, and 81.5% at 15 years. Among the 70 failures, the main causes were “cup aseptic loosening” (40%), “total aseptic loosening” (17.1%), and “septic loosening” (12.8%). Revisions primarily involved acetabular cup revision surgery (54 cases), component explantation (11 cases), or insert or head revision (five cases). ConclusionsThis registry-based study of JCs in revision THA demonstrates excellent 15-year survival rates and acceptable failure rates. It supports JCs as a viable option, offering relative surgical simplicity compared to alternatives like antiprotrusion cages, bone grafts, and augments.

Comprehensive Mapping and Dynamic Monitoring of the Temporal Branch of the Facial Nerve in Complex Cranial Reconstruction Surgery and Revision Cranioplasty.

Facial nerve (FN) injury is a significant risk during complex cranial reconstruction surgeries, especially in revision cases where normal anatomy is distorted. The authors introduce a technique to mitigate FN injury, including preoperative FN mapping, intraoperative FN mapping, and continuous FN monitoring. Preoperative mapping uses a handheld ball-tip stimulator to elicit compound muscle action potentials (CMAP) in the frontalis muscle. Needle electrodes are placed above the orbital margin to record responses, starting at the stylomastoid foramen and extending until the entire temporal branch is mapped. Intraoperatively, continuous mapping is achieved using an electrified insulated suction device, allowing dynamic mapping during soft tissue dissection. Continuous monitoring involves placing stimulation electrodes near the stylomastoid foramen and recording CMAP responses from the frontalis and orbicularis oculi/orbicularis oris muscles. The authors tested this technique in 5 patients. The authors successfully mapped the temporal branch of the FN with isolated frontalis CMAP recordings in all patients. Intraoperative FN mapping and continuous monitoring were successfully performed in all cases. Two patients experienced complete cessation of FN CMAPs, which resumed upon loosening the tension on the myocutaneous flap held by fishhooks. One patient showed a 39% decrement in frontalis CMAP that did not recover. Despite these issues, all patients had intact FN function postoperatively and at follow-up. Our technique shows promise in mitigating FN injury during complex cranial reconstruction and cranioplasty revision surgery. Further research with a larger cohort is needed to confirm efficacy and statistical significance.

SHORT-TERM OUTCOME OF A MODERN MONOBLOCK TITANIUM FLUTED TAPERED REVISION STEM FOR COMPLEX PRIMARY AND REVISION TOTAL HIP ARTHROPLASTY

For over a decade, modular titanium fluted tapered (TFT) stems have demonstrated excellent clinical success for femoral revision total hip arthroplasty (THA) surgery. The aim of this study was to report the short-term outcomes of a novel modern monoblock TFT stem used for revision and complex primary THA with a minimum of 2 years follow-up.We identified 126 patients who received a single monoblock TFT stem - 26 patients for complex THA (failed fracture fixation) and 100 patients for revision THA. The reasons for revision THA included 40 for previous prosthetic joint infection (PJI), 42 for aseptic loosening, 9 for trunnionosis, 9 for periprosthetic fractures. The Paprosky grading for femoral bone loss at the time of surgery and the measured subsidence of femoral stems at 3 months follow-up were determined. We evaluated the number and indications for re-operations.The mean time from surgery was 3.9 years (range 2.0 to 6.9 years). A paired t-test analysis showed significant improvement from pre-operative versus post-operative clinical outcome scores (p&lt;0.001) for HHS (38.76 +/- 15.24vs. 83.42 +/- 15.38), WOMAC (45.6 ± 19.0 vs. 69.9 ± 21.3) and SF-12 Physical component (31.7 ± 8.1 vs. 37.8 ± 11.3) and SF-12 Mental component (48.2 ± 12.2 vs. 51.6 ± 12.5). The Paprosky grading for femoral bone loss was Grade 1 (3.9%), Grade 2 (35.7%), Grade 3A (47.6%), Grade 3B (11.1%) and Grade 4 (1.6%) cases. There were 18 re-operations (14.7%) with 13 for PJI (7 treated with implant retention, 6 treated with a two-staged revision), 4 for instability and one for acetabular aseptic loosening. There were no aseptic failures of the stem.This novel modern monoblock TFT stem provided reliable femoral fixation and has increasingly supplanted the use of modular TFT stems for complex primary and revision surgery in our institution.

THE ROLE OF ANTIBACTERIAL HYDROGEL COATING ON COMPLICATION RISKS AFTER COMPLEX PRIMARY AND CEMENTLESS HIP REVISION ARTHROPLASTY: A RETROSPECTIVE MATCHED COHORT STUDY

This study aimed to verify the hypothesis that an antibiotic loaded hydrogel, defensive antimicrobial coating (DAC), reduces overall complication and infection rates when used for high-risk primary and revision total hip arthroplasty (THA).This was a retrospective study matched cohort study of 238 patients, treated with cementless implants with and without DAC. A sub-group analysis of patients undergoing 2nd stage revision THA for prosthetic joint infection (PJI) was also conducted. Re-infection rates within 2 years, complications necessitating surgical intervention and radiographic analysis for aseptic loosening was assessed.The mean age was 68.3±11.5 years, with 39 (32.8%) Macpherson class A, 64 (53.8%) class B and 16 (13.4%) class C patients. 4 (3.4%) patients in the DAC group developed complications including 1 PJI and 1 delayed wound healing, while 13 (10.9%) patients in the control group developed complications including 5 PJIs and 3 delayed wound healing (p=0.032). PJI rates (p=0.136) and delayed wound healing rates (p=0.337) were not statistically significant. For 2nd stage revision THA for PJI there were 86 patients in the DAC group and 45 in the control group. 1 (1.2%) patient in the DAC group developed complications with no recurrences of infection or delayed wound healing, while 10 (22.2%) patients in the control group developed complications including 4 recurrent PJI and 1 delayed wound healing (p=0.003). Recurrent PJI rates were statistically significant (p=0.005) while delayed wound healing rates were not (p=0.165). Patients treated with DAC also had lower rates of aseptic loosening (0% vs 6.7%; p=0.015).Antibiotic impregnated hydrogel coatings on cementless implants showed decreased complication rates after complex primary or revision THA. In 2nd stage revision THA for PJI, it was associated with reduced risk of re-infection and aseptic loosening.

Common and unique neurophysiological signatures for the stopping and revising of actions reveal the temporal dynamics of inhibitory control.

Inhibitory control is a crucial cognitive-control ability for behavioral flexibility that has been extensively investigated through action-stopping tasks. Multiple neurophysiological features have been proposed to represent 'signatures' of inhibitory control during action-stopping, though the processes signified by these signatures are still controversially discussed. The present study aimed to disentangle these processes by comparing simple stopping situations with those in which additional action revisions were needed. Three experiments in female and male humans were performed to characterize the neurophysiological dynamics involved in action-stopping and - changing, with hypotheses derived from recently developed two-stage 'pause-then-cancel' models of inhibitory control. Both stopping and revising an action triggered an early broad 'pause'-process, marked by frontal EEG β-bursts and non-selective suppression of corticospinal excitability. However, partial-EMG responses showed that motor activity was only partially inhibited by this 'pause', and that this activity can be further modulated during action-revision. In line with two-stage models of inhibitory control, subsequent frontocentral EEG activity after this initial 'pause' selectively scaled depending on the required action revisions, with more activity observed for more complex revisions. This demonstrates the presence of a selective, effector-specific 'retune' phase as the second process involved in action-stopping and -revision. Together, these findings show that inhibitory control is implemented over an extended period of time and in at least two phases. We are further able to align the most commonly proposed neurophysiological signatures to these phases and show that they are differentially modulated by the complexity of action-revision.

Complications and revisions in metal-backed anatomic total shoulder arthroplasty: a comparative study of revision rates between stemless and stemmed humeral components

BackgroundThe primary objective of this study was to evaluate and compare the incidence of complications and revision surgeries between in two of convertible metal-back glenoid systems in total shoulder arthroplasty (aTSA) groups over a follow-up period of up to five years. MethodsA retrospective analysis included 69 shoulders from 65 patients with primary aTSA. Patients were divided into Group 1 (n=31), receiving convertible cementless stemmed aTSA (Lima SMR) and Group 2 (n=38), receiving humeral head replacement aTSA (Arthrex, Eclipse) both with metal-back glenoid components. Clinical and radiological assessments were conducted at 2, 5, and 10 years postoperatively. Assessments included the following: Constant Score, DASH, SPADI, SSV, Glenohumeral Distance, Critical Shoulder Angle and Lateral Acromion Index. In addition, we compared complications, revision rates and survival rates between groups using Kaplan-Maier curves and Log-Rank-test. ResultsBaseline demographics and preoperative outcome scores showed no significant differences between groups (p≥0.05). The overall revision rate did not significantly differ between groups (Group 1:32% vs. Group 2:24%, p=0.60), nor did the mean time to revision (p=0.27). The mean follow-up was 71±41 months (Group 1: 94±48 months, Group 2: 53±23 months, p<0.001). Kaplan-Meier analysis showed similar mid-term survival probabilities (p=0.94). Revision reasons included rotator cuff insufficiency (n=4 in Group 1, n=2 in Group 2) and glenoid wear/loosening (n=5 in Group 1, n=7 in Group 2). Interestingly, Group 1 demonstrated no occurrence of glenoid metal baseplate or humeral loosening, while complex revisions were more common in the Group 2. At 2 and 5 years, non-revised patients in both groups had similar outcome scores. ConclusionMetal-backed glenoid implants in combination with both stemless and stemmed humeral components in aTSA exhibit comparable revision rates and survival probabilities. Rotator cuff insufficiency and polyethylene wear are the two most common complications leading to revision. To facilitate ongoing monitoring and optimize patient safety, we implemented a modification in the follow-up protocol, transitioning to annual appointments or earlier when necessary. This study underscores the unsolved disadvantages in metal-back components and the importance of a mid- to long-term longitudinal assessment of those patients.

A prospective randomized comparison of functional and cosmetic outcomes of a coronal zigzag incision versus a conventional straight incision pattern for craniotomy.

Wound healing problems after neurosurgical procedures can lead to serious complications and may require complex revision or even reconstructive surgery. Therefore, optimal surgical management is critical to prevent complications. In a recent experimental study in animals, the authors demonstrated the superiority of a zigzag skin incision over a straight incision pattern. In this study, the authors applied these findings to clinical situations of neurosurgical patients with an indication for a coronal skin incision. The aim of this study was to objectively assess the functional and cosmetic outcomes between straight coronal and zigzag incisions in neurosurgical procedures. This prospective, randomized, controlled, single-center trial included adult patients undergoing frontal craniotomy for cerebrovascular or tumor pathologies. The study primarily included patients who were not expected to receive adjuvant radiation or chemotherapy. The zigzag incision was standardized using a template. A common straight skin incision behind the hairline served as a control. Complication rates, functional (2-point discrimination, width of the wound, Vancouver Scar Scale [VSS], and Patient and Observer Scar Assessment Scale [POSAS]), and cosmetic outcomes were assessed postoperatively and at 3-month follow-up evaluations. Additionally, all patients answered a wound-specific questionnaire and the SF-36 questionnaire. Twenty-eight patients were randomized to the zigzag and 29 to the straight incision groups. Indications for surgery were cerebrovascular in 16 cases and tumors in 41 cases. Risk factors for wound healing were equally distributed in both groups. One patient in the zigzag group with poor postoperative compliance required surgery for secondary wound healing problems. Overall, the width of the scar was significantly smaller (p = 0.001) and local 2-point discrimination better (p = 0.005) in the zigzag group. Scores on the VSS (p = 0.003) and POSAS (p = 0.005) proved to be significantly superior in the zigzag group as well. A zigzag coronal skin incision pattern leads to significantly superior functional and cosmetic outcome scores. For certain patient groups, these findings may prove to be practice-changing.

Aesthetic-Epistemological Contradiction in the Concept of Water

The following paper highlights the contradictions that exist in the understanding of water: it is considered a marketable resource over which one can exert power and, at the same time, a common good used by the planet’s species and ecosystems. Based on this, and after an analysis of several widespread ideas, the paper proceeds to describe the paradox in the perception of water as a product of an alienated aesthetics that makes it impossible to experience the after-effects of the Westernised world. This lack of perception will be called aesthetic omission, corresponding to Eaton’s “nonperceivables” (2000). The text urges us to be aware that these kinds of aesthetics exclusions around water have global effects and ultimately determine the fate of life on Earth itself. Therefore, a complex revision of the established ontology of water is proposed in response. Keywords: water; nonperceivables; aesthetics; epistemology; Earth