Prosthesis Complications Research Articles

Postoperative outcomes and trends in computer-navigated and robotic-assisted total hip arthroplasty.

As the volume of technology-assisted total hip arthroplasty (THA) increases, there is a need to characterise the outcomes of robotic-assisted (RA) and computer-navigated (CN) THA. The goal of this study was to assess outcomes and opioid consumption following CN-THA and RA-THA compared to conventionally-instrumented (CON) THA. The Premier Database was queried for all patients who underwent primary, elective THA from 2015-2020. Patients were divided into 3 groups: CN, RA, or CON-THA. Yearly usage trends were assessed. Univariate and multivariate analyses were performed to assess the 90-day risk of postoperative complications. Opioid consumption was reported in morphine milligram equivalents (MME) for postoperative days (POD) 0 and 1. Overall, 474,707 elective THAs were identified (95.7% CON, 2.1% CN, 2.2% RA. After accounting for confounders, CN-THA patients were at decreased risk for periprosthetic joint infection (PJI) (aOR: 0.55, p < 0.001) and dislocation (aOR 0.45, p < 0.001), but increased risk for blood transfusion (aOR 1.97, <0.001) compared to CON-THA. RA-THA patients were at decreased risk of dislocation (aOR:0.66, p < 0.001) but increased risk for transfusion (aOR 1.20, p < 0.001), prosthesis breakage (aOR 3.88, p < 0.001), and periprosthetic fracture (aOR 1.72, p < 0.001). Opioid consumption for CN-THA patients was lower on POD1 and lower for RA-THA patients POD0 and 2 compared to CON-THA. CN-THA was associated with reduced rates of PJI and dislocation, but increased rates of blood transfusion while RA-THA was associated with decreased rates of dislocation, but increased rates of blood transfusion, prosthesis complications, and periprosthetic fracture compared to CON-THA. Technology-assisted THA was associated with lower postoperative opioid consumption.

Complication and Explantation Rates of Penile Prostheses in Transmasculine Patients: A Meta-analysis

ObjectiveTo synthesize current literature on penile prosthesis implantation post-gender affirming phalloplasty to correlate implant types and complication rates. MethodsA meta-analysis of penile prosthesis in transmasculine patients was initiated in December 2022. Inclusion criteria encompassed randomized clinical trials, cohort studies, and cross-sectional studies reporting on penile prosthesis complications post-gender-affirming phalloplasty. Exclusion criteria were review articles, meta-analyses, studies that exclusively reported on cisgender patients or surgeries other than penile prosthesis implantation. An initial search of five databases yielded a total of 1593 articles. Upon screening, 15 full-text articles were eligible for inclusion. 9 studies were included in the analysis. ResultsThe overall complication rate for the inflatable prosthesis group was 38% (95% CI: 21, 59) and for the malleable prosthesis group was 37% (95% CI: 18, 62). The most probable complications in the inflatable group were infection (14.5%), dysfunction (12.9%), dislocation (5.7%), and leakage (5.4%). The most probable complications in the malleable group were dislocation (14.9%), infection (11.2%), dysfunction (9.1%), and extrusion (7.6%). There was no significant difference in the probability of any complications between the malleable and inflatable prosthesis groups.The best estimate of explantation rates for any reason for the inflatable group was 19% (95% CI: 9, 38) and for the malleable group 13% (95% CI: 4, 33). There was no significant difference in the probability of any reason for explantation between the malleable and inflatable prosthesis groups.

Reverse Shoulder Arthroplasty in the Treatment of Cuff Tear Arthropathy: Systematic Review

Purpose: In our study, we aimed to examine the results and complications of reverse shoulder prosthesis (RSA) applied after rotator cuff tear arthropathy (CTA) in the light of the current literature. Methods: The literature search was conducted simultaneously on 1 April 2024 in the Medline, Cochrane, EMBASE, Google Scholar and Ovid databases using the ''reverse total shoulder arthroplasty'', ''reverse total shoulder prosthesis'', ''cuff tear arthropathy'', ''outcomes'' and ''complications'' keywords. Only clinical review published in English in peer-reviewed journals was evaluated. The comparison between preoperative and postoperative clinical scores, as well as range of motion (ROM), was performed using the Wilcoxon–Mann–Whitney test. P values lower than 0.05 were considered statistically significant. Results: 12 articles were included in our study. When comparing the results of the pre- and postoperative examinations, a statistically significant improvement in the range of motion and the functional score was found. It was found that various complications occurred in 21.1% of patients. The most common complication is scapular notching, which occurred in 13.8% of patients. Revision surgery was required in 1.57% of patients. The most common cause of revision was a periprosthetic joint infection. Conclusion: In CTA patients, RSA can achieve both freedom from pain in the shoulder joint and an increase in function. Despite positive results, complications of varying degrees of severity can occur in around one fifth of patients. The lack of Level I studies limits a true understanding of the possibilities and limitations of RSA in the treatment of CTA patients.

New materials and complications of prostheses in humans: situation in Spain.

Prostheses or implantable medical devices (IMDs) are parts made of natural or artificial materials intended to replace a body structure and therefore must be well tolerated by living tissues. The types of IMDs currently available and usable are very varied and capable of replacing almost any human organ. A high but imprecise percentage of Spaniards are carriers of one or more IMDs to which they often owe their quality of life or survival. IMDs are constructed with different types of materials that are often combined in the same prosthesis. These materials must combine harmlessness to human tissues with high wear resistance. Their durability depends on many factors both on the host and the type of prosthesis, but the vast majority last for more than 10-15 years or remain in function for the lifetime of the patient. The most frequently implanted IMDs are placed in the heart or great vessels, joints, dental arches or breast and their most frequent complications are classified as non-infectious, particularly loosening or intolerance, and infectious. Complications, when they occur, lead to a significant increase in morbidity, their repair or replacement multiplies the health care cost and, on occasions, can cause the death of the patient. The fight against IMD complications is currently focused on the design of new materials that are more resistant to wear and infection and the use of antimicrobial substances that are released from these materials. Their production requires multidisciplinary technical teams, but also a willingness on the part of industry and health authorities that is not often found in Spain or in most European nations. Scientific production on prostheses and IMD in Spain is estimated to be less than 2% of the world total, and probably below what corresponds to our level of socio-economic development. The future of IMDs involves, among other factors, examining the potential role of Artificial Intelligence in their design, knowledge of tissue regeneration, greater efficiency in preventing infections and taking alternative treatments beyond antimicrobials, such as phage therapy. For these and other reasons, the Ramón Areces Foundation convened a series of experts in different fields related to prostheses and IMDs who answered and discussed a series of questions previously formulated by the Scientific Council. The following lines are the written testimony of these questions and the answers to them.

Surgical Outcomes and Complications of Custom-Made Prostheses in Upper Limb Oncological Reconstruction: A Systematic Review.

Bone tumors of the upper limb are a common cause of bone pain and pathological fractures in both old and young populations. Surgical reconstruction and limb salvage have become valid options for these patients despite this kind of surgery being challenging due to the need for wide bone resection and the involvement of surrounding soft tissues. Computer-assisted technology helps the surgeon in pre-operative planning and in designing customized implants. The aim of this study was to investigate the surgical outcomes and complications of custom-made prostheses in oncologic reconstruction of the upper limb and if they are reliable options for patients suffering from aggressive tumors. An electronic search on PubMed, Google Scholar, and Web of Knowledge was conducted to identify all available articles on the use of custom-made prostheses in oncological resections of the upper limb. Twenty-one studies were included in the review, comprising a total of 145 patients with a mean age of 33.68 years. The bone involved was the humerus in 93 patients, and the radius was involved in 36 patients. There were only six cases involving proximal ulna, three cases involving the scapula, and seven cases involving the elbow as well as soft tissues around it. The most frequent primary tumor was the giant cell tumor, with 36 cases, followed by osteosarcoma with 25 cases, Ewing Sarcoma with 17 cases, and Chondrosarcoma with 7 total cases. Forty patients were affected by bone metastases (such as renal cell cancer, breast cancer, melanoma, and rectal cancer) or hematologic diseases involving bone (lymphoma, myeloma, or non-Hodgkin disease). Custom-made prostheses are a viable option for patients who suffer from malignant tumors in their upper limbs. They are a reliable aid for surgeons in cases of extensive resections.

Long-Term Complications of Tracheoesophageal Voice Prosthesis.

Background: The aim of our multicenter retrospective study was to evaluate the long-term complications associated with primary and secondary tracheoesophageal puncture (TEP) in patients who underwent total laryngectomy (TL) for laryngeal cancer and were subsequently rehabilitated to phonatory function with tracheoesophageal speech (TES). Materials and Methods: To evaluate the long-term outcomes and complications of TEP, the following data were collected: mean time of prosthesis replacement, mean time of onset of complications, type of complications, and type of failure. Results: Complications occurred in 18 out of 46 patients (39.2%) with primary TEP and in 10 out of 30 patients (33.4%) with secondary TEP, out of a total of 76 enrolled patients. Common complications included prosthesis leakage, fistula leakage, granulation, and prosthesis extrusion. Prosthesis replacement due to fistula leakage or prosthesis extrusion was observed exclusively in the group of patients with primary TEP. Among the 28 patients (35.7%) who experienced complications, rehabilitation with TEP failed in 10 cases, primarily due to abandonment and spontaneous fistula closure. Conclusions: TEP, both primary and secondary, represents a valid option for vocal rehabilitation in patients undergoing TL. However, identifying prognostic factors that could influence the success of TEP would be beneficial to allow a targeted rehabilitation process.

(218) Bladder Outlet Procedures Performed in Patients with a Penile Prosthesis Do Not Increase Device Complication Rates

Abstract Introduction At present, minimal evidence exists in the literature regarding the management of benign prostatic hyperplasia (BPH) in patients with a penile prosthesis. While it is considered prudent to address BPH prior to penile prosthesis placement, no formal guidelines exist on this topic and in many instances, patients develop lower urinary tract symptoms secondary to BPH after prosthesis placement. Thus, understanding how to safely manage BPH in this patient population is key to optimal outcomes. Objective The aim of this study was to understand if patients with a penile prosthesis who subsequently underwent bladder outlet procedures (BOP) had an increased risk of prosthesis complications compared to those patients who underwent BOP prior to their penile prosthesis placement. Methods An Institutional Review Board approved retrospective chart review of all penile prosthesis patients with concomitant BPH from 2008-2023 was undertaken. Men who underwent a BOP before and after penile prosthesis placement were identified and separately analyzed for patient demographics, type of outlet procedure performed, type of prosthesis placed, and complications following penile prosthesis surgery. Complications were defined as any device infections, device malfunctions, or the need for any sort of operative interventions including explant. Statistical analysis was then conducted to identify significant differences between these two cohorts. Results A total of 424 patients with a history of penile prosthesis and BPH were identified. Of this group, a total of 61 patients were found to have undergone a BOP. Specifically, 28 patients were found to have undergone a BOP following their penile prosthesis placement, and 33 were found to have undergone a BOP prior to their penile prosthesis placement. Amongst the two cohorts, there were no statistically significant differences in age, race, prostate volume, hemoglobin A1c levels, type of outlet procedure performed, and history of hypertension, hyperlipidemia, radiation therapy, or smoking. Importantly, there was no statistically significant difference in complication rates between the two cohorts (P=0.910). Conclusions To our knowledge, this study is the largest ever analysis of penile prosthesis patients who underwent bladder outlet procedures. From this data, it seems that patients who undergo BOP after penile prosthesis surgery are not at increased risk for complications compared to those patients who undergo a BOP prior to penile prosthesis surgery. Given that this is a retrospective chart review of a multi-center, high-volume implant practice, further randomized controlled trials will be necessary to confirm these findings. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Abbvie.

A propensity score-matched analysis of intra- and postoperative penile prosthetic complications in the solid organ transplant population.

Solid organ transplant (SOT) has an anticipated higher risk of penile prosthesis (PP) complications related to immunosuppression and surgical approach post-SOT. It is still not determined if PP surgery in the SOT population incurs these same higher risks. To observe differences in intra- and postoperative PP complications between SOT and non-SOT cases from the TriNetX US Collaborative Network, a large real-world database of deidentified patient data from 56 health care organizations within the United States. We used the TriNetX database to perform a propensity score-matched cohort study comparing 10-year outcomes between patients with and without a SOT (kidney, heart, lung, liver, pancreas, and intestine) who underwent a PP procedure. Cohorts were matched on age, race/ethnicity, history of pelvic and abdominal surgery, overweight and obesity status, type 2 diabetes mellitus, atherosclerosis, substance use disorders, socioeconomic difficulties, anticoagulant/antiplatelet medications, and spinal cord injury. Outcomes included intra- and perioperative complications as well as prosthetic complications (mechanical malfunction, fibrosis, displacement, hemorrhage, pain, stenosis, removal with or without replacement, and complex [all postoperative complications]). There were 233 patients in each group after matching (SOT and non-SOT). The mean ± SD age at the prosthesis procedure was 59.7 ± 9.89 years, and 44% of patients were White (P > .05). There was no significant difference for incidence of intra- and perioperative complications (2.62% vs 2.19%, P = .76). The SOT group did not have a higher 10-year incidence of complex complications (30.58% vs 27.51%, P = .11) or mechanical malfunction (10.35% vs 11.62%, P = .25) when compared with the non-SOT group. No difference was found for other prosthetic-related complications (P > .05). In our analysis, patients with a SOT were not more likely to experience long-term complications related to PP. Surgeons performing PP surgery in the SOT population may consider this procedure a potentially safe and viable option for restoring erectile function.

Pattern and Complication of Reconstructed Breast Cancer Patients Who Received Postmastectomy Radiotherapy in the National Health Insurance Service Cohort

This study aimed to analyze the nationwide pattern of reconstruction after mastectomy in patients with breast cancer who received postmastectomy radiotherapy (PMRT) and to compare complications according to fractionation and reconstruction procedures. By using claim data from the National Health Insurance Service (NHIS) database, we analyzed breast cancer patients who received PMRT and underwent reconstruction between 2015 and 2020. We defined the grade ≥ 3 complications as the primary endpoint which involved hospital admission to the plastic surgery department. The complication was identified by using the procedure code for debridement and the International Classification of Diseases 10th codes for wound infections, dehiscence, necrosis, and mechanical complication of breast prosthesis and implant. The propensity score matching method was adopted to constitute the matched cohort between the hypofractionated fractionation (HF) and the conventional fractionation (CF), adjusted for age, diabetes, hypertension, obesity, smoking history, PMRT technique, use of bolus, year of PMRT delivery, and reconstruction method. Logistic regression was performed to evaluate the association between complication and variables. Altogether 4,553 patients were analyzed: 1,395 (30.6%) in the HF group and 3,158 (69.4.%) in the CF group. The use of HF has steadily increased from 20.1% in 2015 to 42.2% in 2020. Immediate implant reconstruction (36.8%) method was the most frequently used, followed by immediate autologous (33.3%) and two-stage implant reconstruction methods (19.6%). In the matched cohort (N = 2,052), the major complication rate was not significantly different between the HF group and the CF group (5.9% [60/1,026] vs. 5.4% [55/1,026], P = 0.568) with the median follow-up of 30.9 months (range, 6.0-82.1). Surgical debridement was performed in 3.3% [34/1026] of the HF group and 3.5% [36/1026] of the CF group (P = 0.808). HF was not associated with major complications (odds ratio (OR) 1.09, 95% CI 0.75-1.59, P = 0.128). In a nationwide insurance cohort, the complication rate was not significantly different between the HF group and the CF group. Our data suggest HF for reconstructed breasts is comparable to CF. However, consultation for fractionation regimen for reconstructed breast cancer patients may be still required at time of consideration of PMRT.

653 Evaluating the Effectiveness of Osseointegration for Traumatic Lower Limb Amputations: A Narrative Review

Abstract Aim Major trauma to the limbs often results in amputation and can have a debilitating effect on an individual’s physical and psychological health. Currently, the conventional management to remediate the consequences of limb amputation is a Traditional Socket-mounted Prosthesis (TSP) for the affected limbs. However, its use is associated with various complications, such as skin ulcers, increased fracture risk, nerve pain, and heterotopic ossification. To address this, a novel approach known as osseointegration; a procedure in which an artificial implant is surgically integrated and anchored into residual bone, has been developed. This narrative review aims to primarily evaluate the efficacy and functional outcomes of lower limb osseointegration compared to TSP. Method A literature review was performed to identify and analyse studies addressing the efficacy, functional outcomes, and complications of lower limb osseointegration prosthesis compared to TSP. Studies were summarised according to type of osseointegration prosthesis, number of surgeries required, and amputation location. Data on efficacy, functional outcomes, and complications of patients with osseointegrated prosthesis was extracted. Results Six studies were chosen for critical analysis of the primary and secondary aims. All studies reported osseointegration conferred significant improvements in mobility, walking capability, walking speed, quality of life, prosthesis comfortability, prosthetic control, and prosthetic use. Complications reported were mild infection, phantom limb pain and periprosthetic fractures although incidences were rare. Conclusions Osseointegration has been shown to increase prosthetic use, improve confidence, walking ability, and mobility. Complications are mild and easily treated. Overall, there is sufficient evidence to suggest osseointegration could become standard management for lower-limb amputations.

Titanium particles inhibit bone marrow mesenchymal stem cell osteogenic differentiation through the MAPK signaling pathway.

Metallic implants have great application in clinical orthopedics. Implants wear out in vivo due to long-term mechanical loading. The formation of wear debris is one of the long-term complications of prosthesis. In the case of artificial joint replacement in particular, aseptic loosening is the most common reason for secondary revision surgery. Previous studies suggested that wear debris caused aseptic loosening mainly by promoting osteolysis around the prosthesis. In this study, titanium particles, the most commonly used particles in clinical practice, were selected to simulate wear debris and explore the influence of titanium particles on osteogenic differentiation of mesenchymal stem cells. Our results show that titanium particles can significantly inhibit osteogenic differentiation in a dose-dependent manner. While engaged in preliminary exploration of the underlying mechanisms, we found that titanium particles significantly affect phosphorylation of ERK1/2, a key component of MAPK signaling. This suggests that the MAPK signaling pathway is involved in the inhibition of osteogenic differentiation by titanium particles.

Two-Year Outcomes of the Reverse Humeral Reconstruction Prosthesis.

Extensive proximal humeral bone loss in the setting of shoulder arthroplasty represents a difficult challenge for the treating surgeon. Achieving adequate fixation with standard humeral prostheses can be problematic. Allograft-prosthetic composites are a viable solution for this problem, however high rates of complications have been reported. Modular proximal humeral replacement systems are another potential solution, but there is a paucity of outcome data on these implants. This study reports the two-year minimum follow-up outcomes and complications of a single system reverse proximal humeral reconstruction prosthesis (RHRP) for patients with extensive proximal humeral bone loss. We retrospectively reviewed all patients with minimum two-year follow-up who underwent implantation of a RHRP for either 1) failed shoulder arthroplasty or 2) proximal humerus fracture with severe bone loss (Pharos 2 and 3) and/or sequelae thereof. Forty-four patients met inclusion criteria (average age 68.3 ± 13.1 years). The average follow-up was 36.2 ± 12.4 months. Demographic information, operative data, and complications were recorded. Pre- and postoperative range of motion (ROM), pain, and outcome scores were assessed and compared to the MCID and SCB for primary rTSA where available. Of the 44 RHRPs evaluated, 93% (n=39) had undergone prior surgery and 70% (n=30) were performed for failed arthroplasty. ROM improved significantly in abduction by 22° (P = .006) and forward elevation by 28° (P = .003). Average pain on a daily basis and pain at worst improved significantly, by 2.0 points (P < .001) and 2.7 points (P < .001), respectively. Mean SST score improved by 3.2 (P < .001), Constant score by 10.9 (P = .030), ASES score by 29.7 (P < .001), UCLA score by 10.6 (P < .001), and SPADI score by 37.4 (P < .001). A majority of patients achieved the MCID for all outcome measures assessed (56-81%). The SCB was exceeded by half of patients for forward elevation and the Constant score (50%), and exceeded by the majority of patients for the ASES score (58%) and UCLA score (58%). The complication rate was 28%; the most common complication was dislocation requiring closed reduction. Notably, there were no occurrences of humeral loosening requiring revision surgery. This data demonstrates that the RHRP resulted in significant improvements in ROM, pain, and PROMs, without the risk of early humeral component loosening. RHRP represents another potential solution for shoulder arthroplasty surgeons when addressing extensive proximal humerus bone loss.

(247) Complication Rates After Penile Prostheses In Men with History of Priapism – A Retrospective Claims Database Cohort Analysis

Abstract Introduction Penile prostheses can be placed in men with a history of priapism who develop erectile dysfunction, or as initial management of acute ischemic priapism. However, little is known about long-term complications associated with prostheses in these men. Objective To assess the risk of penile prosthesis complications in men with a history of priapism. Methods We searched the TriNetX insurance claims database to create a cohort of men ages ≥16 years old with 1) a diagnosis of priapism (ICD-10: N48.4), 2) a diagnosis of erectile dysfunction (ICD-10: N52), and 3) had undergone prosthesis placement (insertion of penile prosthesis inflatable and self-contained [CPT: 54401], insertion of semi-rigid penile prosthesis [CPT 54400], or insertion of multiple component inflatable penile prosthesis [CPT: 54405]). Three complications were assessed: penile prosthesis infection (ICD-10: T83.61), penile prosthesis mechanical breakdown (ICD-10: T83.410A), and penile prosthesis displacement or migration (ICD-10: T83.420). Rates of and duration to IPP removal (CPT: 54415-17, 54406, 54410-11) were also assessed. To compare rates of complications, the priapism cohort was compared to a cohort of men with a diagnosis of erectile dysfunction and prosthesis placement but without a history of priapism or corpora cavernosal irrigation, matched by age, race, diabetes status, and obesity (E66). When assessing risk of prosthesis complications, we utilized 1:1 greedy nearest-neighbor propensity score matching to control for confounding variables. Results A total of 665 men were identified with a diagnosis of priapism and erectile dysfunction who subsequently received a penile prosthesis. A control group of 31,345 patients with erectile dysfunction and a penile prosthesis but without priapism or history of irrigation was identified, and ultimately 660 men in the case and control cohorts were matched by age, race, diabetes status, and obesity. Men of with a history of priapism were more likely to experience penile prosthesis infection (5.0% vs 2.7%; Risk Ratio (RR): 1.83, 95% Confidence Interval (CI) 1.04-3.22) and mechanical breakdown of the prosthesis (7.3% vs 3.8%, RR: 1.92, 95%CI 1.20-3.08). There was no difference in the rate of penile prosthesis displacement or migration (3.5% vs 2.4%, RR: 0.76, 95%CI 0.77-2.70). Overall rates of penile prosthesis explantation were higher in men with a history of priapism 14.6% vs 8.4% (RR: 1.73, 95%CI 1.27-2.36). Rates of early explantation (within 6 months of placement) were similar between the two groups, 3.3% vs 2.9% (RR: 1.16, 95%CI 0.63-2.11). Rate of explantation of semi-rigid prostheses were significantly higher in men with a history of priapism, 27% vs 9.6% (RR: 2.54, 95%CI 1.62-3.93). Of the 17 men undergoing explantation of semi-rigid prosthesis with history of priapism, only 4 men (23%) went on to have a 3-piece penile prosthesis placed. Conclusions In this US claims-based database comparison between prosthetic complications in men with and without a history of priapism, men with priapism were more likely to experience infection, mechanical breakdown and explantation. There was no difference in rate of device displacement or migration, or in timing of device explantation. This real-world data provides context for counseling men with priapism who undergo prosthesis placement. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Urogen Pharma, Janssen Global Services, Regeneron Pharmaceuticals

Success Rates of Immediately Loaded Implants in the Maxilla – A 10-year Follow-up Study

Abstract Introduction: To restore missing teeth in the mouth, dental implants are crucial. Total edentulism leaves the patient unable to chew, smile or communicate well, which can cause a psychological collapse in day-to-day activities. The objectives of this retrospective study were to report the 10-year success rates of patients with immediately loaded implants in the fully edentulous maxilla by measuring the bone level at the coronal/crestal aspect annually and also to determine the survival rates and complications of the full-arch prosthesis. Materials and Methods: Seventy-seven implants (Ankylos, Dentsply, Tulsa, OK, USA) were inserted and immediately loaded in 10 fully edentulous maxillae. Patients were rehabilitated with a cement-retained metal-reinforced provisional bridge of 10–12 units, and all implants were loaded on the same day of placement. At the 12-month follow-up and each year thereafter, the prostheses were removed, and a clinical evaluation of the peri-implant tissues and implant mobility was made for each implant. The age of the patients included in the study ranged between 45 and 77 years, with the average age being 61 years old. Radiographic bone levels were recorded post-loading at years 1–10 annually. Results: In the group of immediate loading with simultaneous augmentation, 19 of 47 implants had received vertical or horizontal augmentation due to insufficient ridge height or width. In the other group, none of the 30 immediately loaded implants received augmentation either before or simultaneous with implant placement. After a clinical and radiographic follow-up period of 12–130 months, none of these implants were lost, and the probing depths around the implants were within normal limits. None of the prostheses reported prostheses loosening, abutment screw loosening or abutment screw fracture. In one case, maxillary fixed full-arch cement-retained final prostheses had to be replaced due to a fracture of the prostheses framework, and in two cases had to be replaced due to extensive ceramic chipping; hence, the cumulative survival rate of the prostheses was 70% at the end of 10 years. Conclusion: These results seem to demonstrate that a maxillary fixed full-arch prosthesis that is supported by at least six to eight implants in uniform distribution, even with simultaneous grafting, allows good long-term success for immediately loaded implants.

Retrospective Cohort Evaluation of Full-Arch Zirconia Implant-Supported Fixed Prostheses.

Objective: To determine the median event-free survival and relative complication rates of monolithic and minimally layered full-arch zirconia prostheses, as well as to identify risk factors for prosthesis complications. Materials and Methods: In this retrospective cohort study, a total of 129 subjects (173 prostheses) were included in the chart review and 56 subjects (75 prostheses) participated in a clinical follow-up visit. All subjects had either single- or dual-arch monolithic or minimally layered zirconia implant-supported prostheses. Data related to patient, implant, and prosthesis factors were extracted from charts. The subgroup that presented for a clinical visit were asked to complete a satisfaction questionnaire. For this subgroup, the following clinical measures were assessed: routine intraoral examination, number of occluding units, cantilever length on each side of the prosthesis (right and left), prosthesis height, occlusal scheme, and oral hygiene methods. Periapical radiographs were obtained when the last radiographs of the patient were taken more than 12 months prior. Results: The follow-up period ranged from 12 months to 7.1 years (mean: 1.9 years). Observed complications included implant loss, peri-implantitis, mucositis, purulence, sinus tract formation, oroantral communication, implant fracture, titanium base debonding, ceramic chipping, prosthetic screw fracture or loosening, damage to opposing teeth, and clicking sounds. There was an insufficient number of complications to evaluate the effect of covariates on the risk of specific complications, such as titanium base debonding (eight events), ceramic chipping (nine events), and peri-implantitis (eight events). The unadjusted event-free median survival time was 5.8 years. The proportion of all prostheses with at least one complication was 30%. There were no observed prosthesis losses during the follow-up period. Conclusion: Monolithic and minimally layered zirconia full-arch implant-supported prostheses demonstrate an acceptable median event-free survival time. Event-free survival times were increased and the number of complications was reduced in prostheses with five to eight implants and conventional (as opposed to zygomatic) implants. There was a reduced hazard of complications with a regular recall regimen. Patient satisfaction with these prostheses was high.

Glycosylated hemoglobin (HbA1c) as a risk factor for penile implant infection: A prospective controlled trial in a tertiary center

Background: Penile implant infection is a devastating complication of penile prosthesis (PP) surgery. Diabetes mellitus (DM) is a major risk factor for PP infection. Yet, the incidence of PP infection among controlled diabetics is a matter of debate. We aimed in this study to evaluate the role of HbA1c level as a risk factor for PP infection. Methods: 68 adult patients with refractory ED were prospectively enrolled and scheduled for PP insertion. They were divided into 2 groups: Group A (37 diabetic patients), subdivided into 2 subgroups according to HbA1c level, Subgroup A1 (19 patients, Good control (HbA1c less than 7%), and Subgroup A2 (18 patients, Fair control (HbA1c 7-8%). Group B included (31 non diabetic patients). The patients in both groups were compared as regards: operative time, infection rate, and other complications. Results: The age of patients ranged from 32 to 70 years. The mean operative time in groups A and B was 54.73 ± 8.33 and 52.58 ± 8.15 minutes, respectively (p=0.289). Post-operative infection occurred in 3 patients (8.1%) in group A (all of them were in subgroup A2), and only one patient in Group B (3.2%) (p=0.620). Small subcutaneous hematoma developed in 3 patients in group A and in one patient in group B. 62 patients (91.2%) were satisfied and 6 (8.8%) were dissatisfied (3 patients in each group). Conclusions: PP insertion is a safe option for treating ED not only in non-diabetic patients but also in controlled diabetic patients.

Comparison of the outcomes and complications of three-unit porcelain-fused-to-metal tooth-implant-supported prostheses with implant-supported prostheses: A systematic review and meta-analysis

The aim of the current study was to evaluate the outcomes and complications of three-unit porcelain-fused-to-metal tooth-implant-supported prostheses in comparison with implant-supported prostheses. In this review article, the electronic databases, PubMed, Scopus, LILACS, Web of Science, EBSCO, LIVIVO, and Embase were searched over the past 20 years until December 2021. Risk ratio with 95% confidence interval (CI), fixed effect model, and Mantel-Haenszel method was calculated. The meta-analysis was performed with the statistical software Stata/MP v. 16. Two hundred and three studies were selected for reviewing the abstracts, from which the full texts of 16 studies were reviewed. Finally, five studies were selected. The risk ratio of prosthesis failure between the tooth-implant-supported prosthesis and the implant-supported prosthesis was RR (Risk Ratio)= 1.83 (0.79, 4.24), (P = 0.16) and for prosthesis complication, it was RR = 0.61 (0.35, 1.06), (P = 0.08). Risk ratio of implant failure between the mentioned groups was RR = 2.33 (0.84, 6.41), (P = 0.10), and for implant complications, this rate was 0.09 (RR, 0.09 95% CI - 1.30, 1.48; P = 0.90). The meta-analysis of the present study showed that there was no significant difference between the two groups (three-unit porcelain-fused-to-metal tooth-implant-supported prosthesis and implant-supported prosthesis reconstruction) in terms of the total failure of implants and prostheses and the complication rate of implants and prostheses.

Clinical evaluation and patient related outcomes of one- and two-piece zirconia implants at five years of loading: A case series study.

The objective of this study was to investigate the survival and biological and mechanical complications of one-piece and two-piece zirconia implants at five years of loading. Consecutive patients receiving zirconia implants were studied, collecting data at five years of loading on their clinical history, peri-implant health status, mechanical complications, esthetic results, and patient related outcomes. The study included 18 patients with 29 implants. The survival rate was 86% in implant-based analysis and 78% in patient-based analysis. There were no cases of peri-implantitis, but mucositis was present in 53% of implants. A mean of 4.1 ± 0.81 mm was obtained for probing depth and 1.6 ± 0.9 mm for crestal bone loss (radiographic assessment). There were no implant fractures. Major (10%) and minor (10%) prosthesis complications were observed. The esthetic outcome was moderate to almost perfect, with a high level of patient satisfaction. No significant association was found between survival rate and the presence of mucositis around one- or two-piece implants or any other study variable. The survival rate is low for one- and two-piece zirconia implants. Both types of implants demonstrated a low mechanical complication rate. The incidence of periimplantitis is low but mucositis is present in 50%. Patient satisfaction related to esthetics and function is moderate to high. They represent a good option for patients requiring an alternative to titanium implants. Zirconia implants appear to be an alternative to the titanium option and may be indicated for patients requiring "metal-free" restorations.

Maintenance protocols for implant-supported dental prostheses: A scoping review

Statement of the problemBiological complications of implant-supported prostheses remain a concern. Therefore, standardizing hygiene protocols to promote their maintenance is important. PurposeThe purpose of this scoping review was to identify available hygiene guidance for home care procedures, as well as periodicity and protocols for the professional maintenance of implant-supported prostheses. Material and methodsThis study was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and the study protocol was made available at: https://osf.io/5jdeh/. The search was last performed in the PubMed database on March 15, 2022 and was undertaken by 2 independent researchers. Clinical studies and reviews that evaluated home care and maintenance protocols for dental implant-supported prostheses (fixed or removable), without language restriction or year of publication, were included. A descriptive analysis was performed considering study characteristics (study design, restorative assembly, maintenance strategies, eligibility criteria, number of included studies, quality/level of evidence, and main findings). ResultsThe initial search yielded 3138 studies, of which 18 were included for descriptive analysis (6 critical reviews, 4 clinical trials, 3 systematic reviews, 2 guideline reports, 2 retrospective studies, and 1 transversal study). The main instrument recommended for home care was the use of a conventional toothbrush associated with triclosan-containing toothpaste in addition to interproximal aids (brushes or floss) for all types of restorations. The use of irrigation instruments was also frequently considered. For professional maintenance, almost all studies reported a positive effect of regular recalls every 3 months during the first year, followed by less regular recalls according to the motivation of the patient and home care efficacy. At each recall, the professional should evaluate the patient history, oral tissues, implant, abutments, and restorations, as well as perform professional cleaning of the prostheses with appropriate instruments so that the implants and abutments may be preserved. ConclusionsEstablishing an adequate hygiene protocol is indispensable for implant-supported restorations. To do so, the professional must guide and support the patient’s home care by taking into account the patient’s motivation and efficacy during the hygiene procedures. Also, for professional maintenance, the periodicity of recalls should be constant and include an evaluation of the condition of the restoration and adjacent tissues, followed by professional cleaning of prostheses, implants, and abutments, in addition to new instructions to improve patient home care.

Troubleshooting recalcitrant tracheoesophageal prosthesis site leak with internal mammary artery perforator flap: a case report

BackgroundAn enlarged tracheoesophageal puncture (TEP) site is a grave complication of voice prosthesis rehabilitation.Case presentationWe report a case of periprosthetic leakage with an enlarged tracheoesophageal fistula causing aspiration, not responding to conservative management and primary closure. Internal mammary artery perforator (IMAP) flap was subsequently used in the management. The flap was successfully taken up at the recipient site with no leak post-operatively as confirmed by barium swallow, thereby preventing further aspiration.ConclusionThough minor degrees of TEP leak usually respond to conservative management, the recalcitrant ones require active intervention which one should be aware of.