Early Prosthesis Research Articles

Comparison of outcomes after total hip arthroplasty between patients with osteonecrosis of the femoral head in Association Research Circulation Osseous stage III and stage IV: a five-year follow-up study

BackgroundNo large cohort study has evaluated the surgical outcomes of THA between different stages of ONFH patients. This study aimed to compare the surgical outcomes of ONFH patients who underwent THA in ARCO stage III versus IV, in terms of operative parameters, one-year hip function assessments and postoperative at least five-year complications, to inform optimized management of ONFH.MethodFrom our prospectively collected database, 876 patients undergoing THA between October 2014 and April 2017 were analyzed and divided into ARCO stage III group (n = 383) and ARCO stage IV group(n = 493). Details of demographics, medical record information, adverse events and clinical scores of both groups were collected and compared. Proper univariate analysis was used for the analysis.ResultThere were no statistically significant differences in baseline characteristics between the two groups. Compared to ARCO stage IV patients, ARCO stage III patients showed a shorter operative time (p < 0.01), less bleeding (p < 0.01), fewer one-year readmissions (p = 0.026) and complications (p = 0.040), and significantly higher HHS (p < 0.01) one year after THA. In addition, ARCO stage IV patients seem more likely to suffer prosthesis dislocation (p = 0.031).ConclusionAlthough ARCO stage IV patients in the study cohorts appeared to suffer more one-year complications, no significant difference was observed at long-term follow-up. Enhanced clinical guidance on preventing early prosthesis dislocation may help improve the prognosis of final-stage ONFH patients.

Exploring the Role of Free Tissue Transfers in the Preservation of Bone Length and Knee Joint Function after Lower Limb Trauma: A Retrospective Analysis.

Lower limb trauma often results in mangled extremities, and in some cases, complete amputation may be necessary. However, limiting the extent of amputation and preserving the major knee joint are crucial to enhance mobility and overall functionality. By providing painless soft tissue coverage on the stump, early prosthesis use and the initiation of physiotherapy become more feasible. Soft tissue transfers hold the potential to benefit patients in two essential aspects: first, resolving soft tissue deficiencies without causing bone shortening, and second, preparing the stump to enhance overall functionality. A retrospective study conducted at Chang Gung Memorial Hospital (2009-2016) focused on lower limb amputation patients who underwent soft tissue transfers at different time periods compared to those without stump reconstruction. Out of the 2391 cases of lower limb injuries treated operatively, 117 amputations were performed in 110 patients (44 above the knee and 73 below the knee). Among them, 12 patients received soft tissue transfers for limb salvage and soft tissue deficiency after amputations. It was observed that patients in this group were typically younger, predominantly female, had longer hospital stays, and underwent a greater number of surgical procedures (p < 0.05). Through the use of soft tissue transfers, successfully preserved tibial bone length and functional knee joint in selected patients was achieved. This approach effectively resolved soft tissue deficiencies following lower limb amputations, optimizing physiotherapy and facilitating functional rehabilitation.

Comparing Rates of Radiographic Baseplate Loosening Between Cement and Cementless INFINITY Total Ankle Prostheses

Category: Ankle Arthritis Introduction/Purpose: Total ankle replacement has risen in popularity as the contemporary treatment-of-choice for end-stage ankle osteoarthritis. INFINITY™ Total Ankle System (Stryker, Kalamazoo, MI) is one of the most frequently used ankle prostheses. Prior studies established positive functional outcomes; however, aseptic baseplate loosening has reported to occur in approximately one-third of patients. Aseptic baseplate loosening is seen radiographically either as shift in talar or tibial components or evidence of periprosthetic lucency. Aseptic baseplate loosening with persistent pain defines prosthesis failure, thus an indication for early surgical revision. Implementing bone cement may fixate and stabilize prostheses, potentially reducing incidence of aseptic baseplate loosening. This study aimed to determine if patients with cemented INFINITY total ankle prostheses had different incidence of aseptic baseplate loosening than those with cementless prostheses. Methods: Patients who underwent total ankle arthroplasty using the INFINITY total ankle prosthesis system between January 2016 and May 2022 (n = 28) were retrospectively identified using keyword search for “infinity” and Current Procedural Terminology (CPT) code 27702. Fourteen patients had prostheses affixed with cement, and fourteen patients had prostheses that were not cemented. Preoperative, immediate postoperative, and most recently available anteroposterior (AP), mortise, and lateral ankle X- rays were reviewed. Tibiotalar angle, talar tilt, and presence of visible postoperative lucency were assessed independently by two reviewers. Wilcoxon rank-sum test on quantitative variables and chi-square test on categorical variables were performed with 0.05 significance level. Results: Inter-rater reliability was above 94% for all measurements. Comparing the cemented to cementless sample group, difference in average age (59.5 years vs. 56.5 years, p=0.32) and sex (57.1% vs. 50.0% female, p=0.70) were not statistically significant. Pre-operative and immediate post-operative tibiotalar and talar tilt angles were not statistically significantly different between cement and cementless groups (p&gt;0.31 for all comparisons). Only one patient in the cement group had evidence of periprosthetic lucency in the immediate postoperative period. Median follow-up was 362.5 days and 544.5 days in the cement and cementless group, respectively (p=0.52). Follow-up tibiotalar angles and talar tilt angle between cement and cementless groups were not significantly different (p&gt;0.51 for all comparisons). Periprosthetic lucency occurred in 50% of both groups in the follow- up period (p=1.0). Conclusion: Patients with cemented INFINITY total ankle prostheses had equal incidence of aseptic baseplate loosening compared to patients with cementless prostheses. Continuing to examine methods for reducing incidence of baseplate loosening is significant for potentially reducing rate of early prosthesis revision and prosthesis failure, consequently improving quality of life for patients.

Quality of Life in People With Unilateral Lower Limb Amputation at a Tertiary Rehabilitation Centre in Northern India: A Cross-Sectional Study.

Background and purpose The patients after amputation undergo a sudden transformation in their quality of life. In India, amputation done at the appropriate time is a rare phenomenon because usually, the patients present themselves at the later stages. The surgeons, however, while performing amputation surgeries, primarily consider saving the life of a patient under adverse conditions when patients report to them very late that the surgeries are carried out urgently. Assessing the quality of life (QOL) and the various sociodemographic factors affecting the QOL paves the way for future rehabilitation programs. Aims and objectives To evaluate the quality of life of subjects with unilateral lower limb amputation among the North Indian population. Materials and methods This cross-sectional study was conducted in the tertiary rehabilitation center. A total of 106 Subjects were recruited. Informed consent was taken. WHOQOL-BREF contains 26 items covering four important aspects of QOL. The WHOQOL-BREF self-administered free questionnaire was used as a data collection tool, and the Hindi version downloaded from the WHO website was also used for those who can't understand English. Results The range of the physical domain, psychological domain, social domain, and environmental domain were 0 and 100. The mean score of different QOL transformed domain scores (on a scale of 100) were 47.91±20.12, 57.37±20.46, 59.36±25.32 and 51.50±21.96, respectively. Trauma was the leading cause of amputation, followed by diabetes mellitus, cancer, peripheral vascular disease, and other causes. Transtibial amputees were more in number compared to transfemoral. The percentage of male and female amputees was 78.30%, and 21.70%, respectively. Conclusion The physical domain was the most affected domain, followed by the psychological, social, and environmental domains. A delay in the prosthesis fitment aggravates the physical burden of amputees. Early prosthesis & psychological counseling will improve the QOL significantly.

Feasibility testing of a novel prosthetic socket sensor system

Purpose Poorly fitting prosthetic sockets contribute to decreased quality of life, health, and well-being for persons with amputations. Therefore, improved socket fit is a high clinical priority. Methods In this study, we describe the design and testing of a novel sensor system that can be incorporated into a prosthetic socket to measure distal end weight bearing in the socket and can alert a prosthesis user if poor socket fit is suspected. We present the results of testing this device with three Veterans who were new prosthesis users and three Veterans who were experienced prosthesis users. Results and conclusions We collected sensor data during walking trials while participants wore varying numbers of sock plies and qualitative feedback on the design of the socket fit sensor system. For analysis, peak sensor measurements during walking cycles were identified and combined with socket fit data (i.e., a clinician-determined level of “good,” “too tight,” or “too loose” and the number of sock ply worn each trial). We found consistent relationships between peak sensor measurements and socket fit in our sample. Also, all users expressed an interest in the device, highlighting its potential benefits during early prosthesis training. Implications for Rehabilitation Ensuring socket fit is challenging for many prosthesis users. A novel wearable sensor system can be used to identify socket fit issues for some prosthesis users. This type of system could be most helpful for new prosthesis users and those with sensory and cognitive challenges.

Comparison between Early Loaded Single Implants with Internal Conical Connection or Implants with Transmucosal Neck Design: A Non-Randomized Controlled Trial with 1-Year Clinical, Aesthetics, and Radiographic Evaluation.

To evaluate the implant and prosthetic of two implants with different surfaces and neck design. Enrolled patients received bone level, 12° conical connection implants (Nobel Parallel, Nobel Biocare; NOBEL group) with anodized surface (TiUnite) and roughness of 1.35 μm, or transmucosal implant system (Prama, Sweden and Martina; PRAMA group) with convergent collar, ZIrTi surface, and roughness 1.4–1.7 μm. Both implants were made of pure grade IV titanium, with similar diameter and length, chosen according to the dentistry department availability and patient’s request. After early prosthesis delivery, patients were filled for at least one year. Outcome measures were: implant and prosthetic survival and success rates, physiological marginal bone remodeling, periodontal parameters and pink esthetic score (PES). Results: Fifteen patients were allocated and treated in each group. At the one-year follow-up, three patients dropped out, one in the NOBEL group and two in the PRAMA group. During the entire time of investigation, all implants survived and the prostheses were successful. No statistically significant differences were found in term of marginal bone loss, periodontal parameters, and aesthetics (p > 0.05). Conclusion: With the limitations of the present study, both implant systems showed successful clinical results. Finally, many other clinical and surgical variables may influenced marginal bone levels, implant survival, and periodontal parameters. More homogenous clinical trials with larger samples are needed to confirm these preliminary conclusions.

Transcatheter mitral valve-in-valve implantation: a 10-year single center experience

Abstract Background Transcatheter mitral valve-in-valve (TMVIV) appears a reasonable alternative to surgical redo mitral valve replacement in patients with degenerated mitral prosthesis and high surgical risk with favorable early and mid-terms outcomes. Long-term outcomes are limited by high mortality in a comorbid population. Purpose We aimed to evaluate early prosthesis hemodynamic performance and late clinical outcomes following TMVIV. Methods All patients who underwent TMVIV for degenerated surgical mitral bioprostheses from 2011 to 2020 in our center were included. Prospectively collected demographic, clinical, procedural, and imaging variables were analyzed. Clinical and echocardiographic outcomes were defined according to Mitral Valve Academic Research Consortium (MVARC) definitions and assessed at 30-day and at the latest follow-up available. Results A total of 67 patients were included; mean age 76.9±9.6 years, mean STS score 11.0±6.2%, 53.7% male (n=36). Mechanisms of bioprosthetic failure were mitral stenosis (n=32, 47.8%), mitral regurgitation (n=24, 35.8%), and mixed (n=11, 16.4%). Mean time from mitral valve surgery to TMVIV was 10.2±4.3 years. Access was mostly transapical (n=45; 67.2%), followed by transseptal (n=22; 32.8%). Following the first transseptal procedure in 2016; transseptal access accounted for the majority of procedures (22 of 37 cases, 59.4%). Technical success was achieved in 65 patients (97.0%). Mean hospitalization was 9.2±10.0 days; shorter with the transseptal as opposed to the transapical approach (6.3±8.1 days versus 11.0±10.5 days, p=0.001). At 30-day echographic follow-up, mean mitral valve gradient was 7.3±2.7 and 1 patient (1.9%) had mitral regurgitation &amp;gt;mild. At 30-day follow-up, 3 patients had died (4.5%); due to left ventricular outflow tract obstruction (1), heart failure (1), and stroke (1). New pacemakers were required in 2 patients (3.0%) and pacemaker lead dislodgement occurred in 1 patient (1.5%), 4 patients (6.2%) were hospitalized for heart failure. At a median follow-up of 3.8 years [1.7–5.1], 29 patients had died (43.3%), valve thrombosis was found in 6 (8.9%) and endocarditis in 4 patients (6.2%). Mitral valve reintervention was performed in 4 patients (6.2%); redo TMVIV due to valve migration in 1 (1.9%), surgical valve replacement in 1 (1.9%), and delayed redilation with a non-compliant balloon due to underexpansion in 2 patients (3.8%). Conclusion TMVIV is associated with acceptable 30-day mitral valve hemodynamics. Long-term mortality remains high in this high-surgical risk comorbid group. Funding Acknowledgement Type of funding sources: None.

Early Joint Replacement in Juvenile Idiopathic Arthritis: Trend Over Time and Factors Influencing Implant Survival.

To describe early prosthesis implantations in a cohort of patients with juvenile idiopathic arthritis (JIA) followed in a tertiary referral hospital and to analyze possible factors influencing implant survival. This was a retrospective cohort study. Charts of all patients with JIA who underwent total joint replacement at Gaetano Pini Hospital, Milan, Italy from January 1992 to June 2019 were retrieved, and relevant data were analyzed. Eighty-five patients met the inclusion criteria for this study, with a median follow-up period of 17.2 years. The median age at first prosthesis was 22.7 years. The total number of replaced joints was 198 over a period of 27 years. The hip was the most frequently replaced joint, accounting for almost two-thirds of the total number of implants; the other one-third refers mostly to knee implants. Polyarticular JIA and systemic JIA were the most represented JIA categories in the study cohort. A significant upward trend of the age at arthroplasty and of disease duration before arthroplasty over decades was found. The rates of implant survival at 5, 10, and 15 years were comparable (from 84% to 89%); 50% of implants lasted ≥20 years. We reported retrospective data on early joint replacement in a cohort of patients with JIA. We observed a progressive and significant upward trend of both age at arthroplasty and disease duration before the first arthroplasty over time. The JIA category, year of implant, and presence of complications significantly affected implant survivorship.

Bone and joint infections caused by Clostridium perfringens: a case series.

The objective of this study was to evaluate antimicrobial therapy outcomes of bone and joint infections (BJI) caused by Clostridium perfringens. We investigated remission of symptoms and the absence of relapse or reinfection during follow-up. Among the 8 patients with C. perfringens BJI, the type of infection was early prosthesis infection (n = 2), osteosynthetic device infection (n = 4), and chronic osteomyeletis (n = 2). Clindamycin-rifampicin combination was given in 4 cases and metronidazole in 4 cases. The overall success rate was 87.5%. Among the 7 patients who completed antibiotic treatment, the success rate was 100%. The clindamycin-rifampicin combination appeared to be effective in patients with C. perfringens BJI.

Inflammatory rheumatic diseases in patients with ochronotic arthropathy

Background Ochronotic arthropathy (OcA) refers to excessive homogentisic acid (HGA) deposition in the musculoskeletal system. Our current understanding of OcA is limited, as there are less than a thousand alkaptonuria (AKU) cases reported in the literature. Herein, we investigated the rheumatological manifestations of OcA in a group of adult AKU patients. Methods Adult AKU patients with symptoms suggestive of OcA were included. Patients underwent a detailed rheumatological assessment. Laboratory testing, including autoantibodies and radiological investigations such as conventional X-rays, and magnetic resonance imaging (MRI) were performed. Results Eight out of 12 (66%) patients had symptoms consistent with OcA. The median age at OcA symptoms was 36 (27–48) years, and the presenting symptom was back pain in 87.5% of the patients. All patients had chronic back pain, and three (37.5%) had an inflammatory type of pain character. Radiographic sacroiliitis based on X-rays was present in 2 (25%) cases. MRI of the sacroiliac joints documented bone marrow edema in five (62.5%), and spinal MRI identified corner inflammatory lesions in three patients (37.5%). One patient (12.5%) had rheumatoid arthritis. Extra-articular involvement, including enthesitis (n = 1; 12.5%), interstitial lung disease (n = 1; 12.5%), and scleritis (n = 1; 12.5%), was also noted. Conclusion The frequent occurrence of OcA-related inflammatory manifestations in our patients contradicts the conventional concept of OcA as a non-inflammatory disorder. The activation of inflammatory pathways, possibly by the HGA products, may responsible for this condition. Significance and innovations About three-fourths of adult ochronotic arthropathy (OcA) patients in our group had associated inflammatory disease. OcA associated inflammatory diseases were showing a severe phenotype Nearly half of the OcA patients required early prosthesis operations compared to their healthy counterparts.

Computer-Aided Rehabilitation Supported by Zygomatic Implants: A Cohort Study Comparing Atrophic with Oncologic Patients after Five Years of Follow-Up.

The aim of this study was to evaluate the survival and clinical success rate, complications, and patients’ quality of life after computer-aided rehabilitation supported by zygomatic implants in cases of severe maxillary atrophy (ten patients) and in bone defects in oncologic patients (ten patients). All patients underwent computer-aided planning and surgery. Seventy-three zygomatic implants were placed. The mean follow-up period was 39.9 months. Implant survival and clinical success rate, the effectiveness of planning the implant length, biological and prosthetic complications, and the quality of life were evaluated. The five-year implant survival rate for patients with maxillary atrophy and oncologic patients was 97.4% and 96.7%, respectively. The prosthetic survival rate was 100%. Two implant failures occurred in the first year. One implant failure was observed in each group. Minor biological and prosthetic complications occurred in both groups without significant differences. All complications were managed without affecting the treatment. The quality of life increased by 71.3% in the atrophic group and by 82.9% in the oncologic group. Zygomatic implant rehabilitation seems to be a reliable technique for patients with maxillary atrophy and for oncologic patients. The three-dimensional computer-aided approach allows the surgeon to plan the surgery and increase its predictability. Early prosthesis loading certainly allows for better functional outcomes.

Clinical effect of one-stage total knee arthroplasty for knee osteoarthritis with femoral extra-articular deformity

Objective: To investigate the application and efficacy of the one-stage total knee arthroplasty (TKA) of intra-articular compensation osteotomy in knee osteoarthritis(KOA) patients with extra-articular deformity (EAD). Methods: A retrospective study of 9 patients with end-stage KOA and EAD undergoing one-stage TKA from January 2014 to December 2017 in the First Affiliated Hospital of Zhejiang Chinese Medical University was performed. There were 3 males and 6 females with an average age of 56 years(range, 19-77 years);5 cases of simple coronal deformity (varus 10°-27°, mean 18.2°), 3 cases of sagittal deformity (recurvatum15°-35°, mean 22.6°), 1 case combined with coronal and sagittal deformity (varus 16°, recurvatum 31°); hemophilia dysplasia in 1 case, fracture malformation in 8 cases. Main outcome measures included the mechanical axis, range of motion (ROM) and Hospital for Special Surgery Knee Score (HSS). Results: The mean follow-up period was 33.2 months (range, 25-47 months). The mechanical axis angle was restored from 12.4°±4.1°to 1.4°±0.9°(t=7.954, P<0.01). The HSS was improved from 28±14 preoperatively to 87±7 postoperatively (t=-11.174, P=0.013). The ROM increased from 56°±22°to 99°±8° (t=-5.480, P=0.010). There was no complications such as joint instability, infection, fracture, common peroneal nerve injury and early prosthesis loosening. Conclusions: For KOA patients with femoral EAD, one-stage TKA with intra-articular compensatory osteotomy can effectively restore the mechanical axis and obtain satisfying joint function. Through a series of measures such as preoperative measurement, soft tissue evaluation and 3D printing, the accuracy of surgery can be improved and the difficulty of surgery can be reduced.

A custom, functional and lifelike passive prosthetic hand for infants and small toddlers: Clinical note.

For infants and small toddlers with congenital upper limb deficiencies, terminal devices mainly provide either cosmesis or functionality. We report a clinical note about fitting a child with a low-cost passive hand targeting both functionality and cosmesis. An elastomeric, alloy-wire-reinforced hand was fabricated using additive manufacturing to allow independent positioning of the digits. A clinical pilot in-home evaluation was conducted on a child with upper limb loss. The fabricated hand met the functional requirements but required a cover for cosmesis due to a poor surface finish associated with the fabrication technique. The participant child was comfortable using the prosthesis for various tasks. The parents were satisfied with the hand's function and cosmesis when covered with a cosmetic glove. This work demonstrated a new design and process that may in the future improve the utilization of prosthetic hands to promote early prosthesis use and a child's development. Early prosthesis use is important for infants and toddlers. Additive manufacturing may enable the fabrication of custom passive prosthetic hands that provide both cosmesis and functionality.

Dissektion einer Shuntprothese – Eine Blickdiagnose im Duplex

The diagnostic procedure and treatment strategy for The following case report describes the diagnostic procedure and the treatment strategy based on it for an acute loop shunt closure on the thigh, based on astemming from dissection of the an early shunt puncturable prosthesis, in a complex case is described in a complex case. with a loop shunt on the thigh made of prosthesis material that can be punctured. This rare cause of occlusion could bewas preoperatively identified preoperatively by a precise duplex sonographic examination. Based on this result, an optimal therapeutic approach could bewas planned and implemented. Due to a lack of suitable vein materialIn a 38-year-old dialysis patient, an arteriovenous prosthetic loop shunt (GORE® ACUSEAL Vascular Graft, 6 mm, W. L. Gore & Associates Inc., Flagstaff, Arizona, USA) was implanted on in the right thigh of a 38-year-old dialysis patient with a prosthesis (GORE® ACUSEAL Vascular Graft, 6 mm, W. L. Gore & Associates Inc., Flagstaff, Arizona, USA) due to a lack of suitable veins. Because of a shunt closure due to material fatigue, the prostheses prosthesis had to berequired partially replacedreplacement after only 20 months. Six weeks postoperatively The the patient presented again 6 weeks postoperatively with a new shunt closure. Using duplex sonography A a 4 cm long longitudinal dissection of the prosthesis was detected in the arterial part section of the new portion of the prosthesis portion using duplex sonography. This was confirmed intraoperatively. The remaining parts of the prosthesis were normal and intact. Dialysis had to be performed preoperatively, so that the patient received a left inguinal Shaldon catheter the day before the operationrevision of the loop shunt. At revisionFor this reason, dissection was confirmed. This part of and an early puncturable prosthesis the was resected and replaced not inserted as replacement. Instead theimplantation of early puncturable prostheses was dispensed with intraoperatively. A new prosthesis segment was inserted replaced (with a not early puncturable prosthesis (BARD VENAFLO® ll Vascular Graft, Straight, 6 mm, Bard Peripheral Vascular Inc., Tempe, USA)). The postoperative course was straightforward and discharge the patient was discharged on timetimely. This was confirmed intraoperatively. Dissection of an early-puncturable cannulation trilayered Shunt shunt prosthesesprosthesis , which allow early cannulation, is a rare complication and has not of such trilayered prostheses. such a problem has notpreviously been described in the literature. In the case ofShould occlusion occur in an early-cannulablecannulation trilayered shunt prosthesis occlusion and the presence of early cannulable trilayered prostheses a,dissection must be excluded. For this Reason, dDuplex sonography is the an appropriateexaminationdiagnostic procedure.

Establishing a measurement array to assess tissue tolerance during loading representative of prosthetic use

BackgroundIn the early stages of rehabilitation after primary amputation, residual limb soft tissues have not been mechanically conditioned to support load and are vulnerable to damage from prosthetic use. There is limited quantitative knowledge of skin and soft tissue response to prosthetic loading. MethodsAn in-vivo protocol was developed to establish suitable measures to assess tissue tolerance during loading representative of early prosthesis use. Ten participants without amputation one participant with trans-tibial amputation were recruited, and pressure applied to their calf in increments from 20 to 60 mmHg. Measurements were recorded at relevant skin sites including interface pressures, transcutaneous oxygen (TCPO2) and carbon dioxide (TCPCO2) tensions and inflammatory biomarkers. FindingsAt the maximum cuff pressure, mean interface pressures were between 66 and 74 mmHg, associated with decreased TCPO2 values. On the release of pressure, the ischaemic response was reversed. Significant upregulation (p < 0.05) in inflammatory biomarker IL-1α and its antagonist IL-1RA were observed at all sites immediately following loading. InterpretationThe protocol was successful in applying representative prosthetic loads to lower limb tissues and monitoring the physiological response, both in terms of tissue ischemia and skin inflammation. Results indicated that the measurement approaches were sensitive to changes in interface conditions, offering a promising approach to monitor tissue status for people with amputation.

Denosumab prevents periprosthetic bone mineral density loss in the tibial metaphysis in total knee arthroplasty

BackgroundPeriprosthetic bone quality is one of the most important factors preventing early prosthesis migration and long-term failure. Although denosumab, which binds to the receptor activator of nuclear factor kappa-B ligand (RANKL), has been linked with periprosthetic bone mineral density (BMD), the effectiveness of denosumab against bone loss remains unclear. We hypothesized that denosumab treatment after total knee arthroplasty (TKA) could prevent periprosthetic bone resorption. MethodsIn this prospective cohort study, 28 patients with primary knee osteoarthritis were divided into two groups: denosumab (denosumab and vitamin D) and control (vitamin D only) groups. All patients underwent TKA with the same implant model and received medication after surgery. We used dual-energy X-ray absorptiometry to measure periprosthetic BMD after TKA. ResultsIn the control group, the BMD of the proximal medial tibia decreased drastically at 12 months after TKA (−19.7%). Denosumab treatment significantly preserved this BMD loss (0.7%). The linear regression analysis revealed that denosumab intervention had the highest significantly positive relationship with BMD. ConclusionsOur results indicate that denosumab treatment significantly reduces periprosthetic BMD loss, even at the early stages after TKA. This therapeutic strategy may facilitate early stable fixation of the prosthesis which, in turn, may help to prevent early implant migration and reduce the need for revision surgery.

Relationship between Radiographic Misfit and Clinical Outcomes in Immediately Loaded Complete-Arch Fixed Implant-Supported Prostheses in Edentulous Patients.

To examine if an uncorrected radiographically detected immediate postoperative misfit (implant level or abutment level) in immediately loaded conversion prosthesis plays a significant role in early implant or prosthesis failure. In addition, clinical characteristics related to type of arch, implant position, type of implant, implant orientation, type of connection, and type of surgery were analyzed relative to their relationship to early implant or prosthesis failure. Immediate postoperative and subsequent follow-up panoramic radiographs of 425 arches with immediately loaded complete-arch fixed implant-supported prostheses were screened in a retrospective analysis. Implants with misfit and nonmisfit within a given arch were summarized separately with respect to each clinical characteristic and the difference between misfit and nonmisfit groups was tested using a mixed-effects logistic regression model with a patient-specific random intercept. A p-value <0.05 was determined to be statistically significant. A total of 2025 implants from 311 patients were identified in the 425 arches that were screened for radiographic misfit. A total of 48 implants with misfit were found within 33 arches (23 patients) for a 2.4% prevalence rate. Among the misfit implants, two failures were documented during the healing phase for an early implant survival rate of 95.8%. Five conversion prostheses with misfit fractured during the healing phase for early prosthesis survival rate of 84.8%. None of the clinical variables analyzed were significantly associated with the misfit status (p<0.05). The results from this retrospective study showed that misfit in immediately loaded complete-arch fixed implant-supported prostheses may not play a detrimental role in the implant survival but may affect survival of the conversion prostheses.

Invited Commentary

The Trifecta aortic valve (Abbott, St Paul, MN) consists of an external single sheet of bovine pericardium mounted around a titanium stent. Favorable hemodynamic characteristics and midterm clinical outcomes after Trifecta valve implantation in the aortic position have been reported.1Goldman S. Cheung A. Bavaria J.E. Petracek M.R. Groh M.A. Schaff H.V. Midterm, multicenter clinical and hemodynamic results for the Trifecta aortic pericardial valve.J Thorac Cardiovasc Surg. 2017; 153: 561-562Abstract Full Text Full Text PDF PubMed Scopus (77) Google Scholar However, there are reports of early Trifecta structural valve deterioration (SVD).2Hamamoto M. Kobayashi T. Ozawa M. et al.Pure cusp tear of Trifecta bioprosthesis 2 years after aortic valve replacement.Ann Thorac Cardiovasc Surg. 2017; 23: 157-160Crossref PubMed Scopus (24) Google Scholar, 3Kaneyuki D. Nakajima H. Asakura T. et al.Early first-generation Trifecta valve failure: a case series and a review of the literature.Ann Thorac Surg. 2020; 109: 86-93Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar Kaneyuki and colleagues3Kaneyuki D. Nakajima H. Asakura T. et al.Early first-generation Trifecta valve failure: a case series and a review of the literature.Ann Thorac Surg. 2020; 109: 86-93Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar reviewed the timing, mode, and reason for early prosthesis failure in 7 of 107 patients (6.5 %) with Trifecta valve implantation in a single center. The mean duration of durability was 51 ± 16 months.3Kaneyuki D. Nakajima H. Asakura T. et al.Early first-generation Trifecta valve failure: a case series and a review of the literature.Ann Thorac Surg. 2020; 109: 86-93Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar End-stage renal failure and prosthesis-patient mismatch were independent predictors of early SVD. The main cause of early SVD is leaflet tear, which occurred in 59% of patients in this study; calcification and pannus ingrowth are also reported. Tensile and bending stresses at the leaflet near the commissure have been proposed as a mechanism of Trifecta leaflet tear.2Hamamoto M. Kobayashi T. Ozawa M. et al.Pure cusp tear of Trifecta bioprosthesis 2 years after aortic valve replacement.Ann Thorac Cardiovasc Surg. 2017; 23: 157-160Crossref PubMed Scopus (24) Google Scholar Early SVD with leaflet tear in Mitroflow valves (LivaNova Group, Inc, Vancouver, Canada), which have an external mounting leaflet design similar to that of the Trifecta valve, has also been reported.4Butany J. Feng T. Luk A. Law K. Suri R. Nair V. Modes of failure in explanted Mitroflow pericardial valves.Ann Thorac Surg. 2011; 92: 1621-1627Abstract Full Text Full Text PDF PubMed Scopus (47) Google Scholar We note that the results of this study differ substantially from those of other large series of the Trifecta valve that include follow-up up to 6 years.1Goldman S. Cheung A. Bavaria J.E. Petracek M.R. Groh M.A. Schaff H.V. Midterm, multicenter clinical and hemodynamic results for the Trifecta aortic pericardial valve.J Thorac Cardiovasc Surg. 2017; 153: 561-562Abstract Full Text Full Text PDF PubMed Scopus (77) Google Scholar The valve sizes used in these studies were substantially larger than those described by Kaneyuki and colleagues,3Kaneyuki D. Nakajima H. Asakura T. et al.Early first-generation Trifecta valve failure: a case series and a review of the literature.Ann Thorac Surg. 2020; 109: 86-93Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar who reported that 84 of 107 patients had a 19- or 21-mm valve. We acknowledge that the populations are different (and the indexed effective orifice areas were not dissimilar), but this may contribute to the heterogenous results. Valve-in-valve transcatheter aortic valve replacement is emerging as a treatment for bioprosthetic valve failure; the external leaflet mounting of the Trifecta makes it more prone to coronary obstruction, and the titanium frame may not allow fracturing.5Edelman J.J. Khan J.M. Rogers T. et al.Valve-in-valve TAVR: state-of-the-art review.Innovations (Phila). 2019; 14: 299-310Crossref PubMed Scopus (30) Google Scholar Surgeons implanting this valve should consider these issues in young patients in whom reintervention is likely. More data and careful follow-up of the Trifecta valve are required. Early First-Generation Trifecta Valve Failure: A Case Series and a Review of the LiteratureThe Annals of Thoracic SurgeryVol. 109Issue 1PreviewThe Trifecta valve (Abbott, St Paul, MN) has excellent hemodynamic performance with acceptable rates of freedom from structural valve degeneration. However, some recent studies have reported early Trifecta valve failure. Here, we report a case series of seven Trifecta valve failures with a review of the literature. Full-Text PDF

Team Approach: Modern-Day Prostheses in the Mangled Hand.

» Early prosthesis fitting enhances prosthesis acceptance and utilization.» Establishing a relationship early with the team can improve surgical planning and expedite postoperative care.» Targeted muscle reinnervation performed in the acute phases of care can greatly improve neuroma pain control and prosthesis functionality.» There is a high rate of mental health issues at various times during treatment. A high suspicion for these problems is paramount in effective treatment.» Peer-driven support has been instrumental in successful recovery in these devastating injuries.

Development and Application of a System Based on Artificial Intelligence for Transcatheter Aortic Prosthesis Selection.

IntroductionThe interest in Expert systems has increased in the medical area. Some of them are employed even for diagnosis. With the variability of transcatheter prostheses, the most appropriate choice can be complex. This scenario reveals an enabling environment for the use of an Expert system. The goal of the study was to develop an Expert system based on artificial intelligence for supporting the transcatheter aortic prosthesis selection.MethodsThe system was developed on Expert SINTA. The rules were created according to anatomical parameters indicated by the manufacturing company. Annular aortic diameter, aortic area, aortic perimeter, ascending aorta diameter and Valsalva sinus diameter were considered. After performing system accuracy tests, it was applied in a retrospective cohort of 22 patients with submitted to the CoreValve prosthesis implantation. Then, the system indications were compared to the real heart team decisions.ResultsFor 10 (45.4%) of the 22 patients there was no concordance between the Expert system and the heart team. In all cases with discordance, the software was right in the indication. Then, the patients were stratified in two groups (same indication vs. divergent indication). The baseline characteristics did not show any significant difference. Mortality, stroke, acute myocardial infarction, atrial fibrillation, atrioventricular block, aortic regurgitation and prosthesis leak did not present differences. Therefore, the maximum aortic gradient in the post-procedure period was higher in the Divergent Indication group (23.9 mmHg vs. 11.9 mmHg, P=0.03), and the mean aortic gradient showed a similar trend.ConclusionThe utilization of the Expert system was accurate, showing good potential in the support of medical decision. Patients with divergent indication presented high post-procedure aortic gradients and, even without clinical repercussion, these parameters, when elevated, can lead to early prosthesis dysfunction and the necessity of reoperation.