Implantation Of Endoprosthesis Research Articles

Comparison of Different Methods of Semiquantitative Assessment and Subjective Scores for Retropatellar Articular Cartilage Evaluation in Advancing Osteoarthritis.

cartilage layer thickness, composition of the extracellular matrix (ECM), geometry and configuration of retropatellar cartilage partially differ significantly from those found at other locations and are essential for patellofemoral biomechanics. 119 serial medial and lateral patella facet samples of patients undergoing implantation of a total knee endoprosthesis of areas showing mild (Group A, macroscopically ICRS Grade 1b) respectively advanced (Group B, macroscopically ICRS Grade 3a/3b) (38 each) osteoarthritis according to the histological-histochemical grading system (HHGS) were compared with 22 healthy biopsies by means of immunohistochemistry and histology investigations. We quantified our results on the gene expression of collagen type I and II and aggrecan with real-time (RT)-PCR rsp using colourimetry for proteoglycan content. The digitized images of histology and immunohistochemistry staining with Safranin O, Alcian blue, PAS, Masson Goldner, immunostaining, e.g. for collagen I and II were also analyzed with Photoshop software. The most significant decrease in staining intensity was revealed for Safranin-O staining in Group B at the lateral patellar facet, and the most relevant increase was for Col I staining at the same site. The lateral patella site in Group B also showed the highest increase in the ratio of expression indices for the genes Col1A1 and the reference gene following the equation 2-ΔCt with a quotient of 29.6. 1. Comparisons of our retropatellar cartilage analysis with femoral and tibial studies utilizing similar techniques show significant differences. 2. Cartilage layer thickness, ECM composition, geometry and configuration are essential for patellofemoral biomechanics. 3. Consequently, there is a need for diversified approaches towards retropatellar surface during TKA as well as for advanced cartilage restoration techniques.

Ácido acetilsalicílico versus inibidores dos receptores P2Y12 para prevenção secundária em pacientes tratados por meio de intervenção coronária percutânea

Currently, percutaneous coronary intervention with a drug-eluting stent implantation is the main method of myocardial revascularization in tertiary care hospitals, regardless of the clinical presentation of coronary artery disease. It is well known that to be effective, it requires the use of a dual antiplatelet therapy, which is a combination of acetylsalicylic acid and a P2Y12 platelet receptor inhibitor, which plays a key role in preventing thromboses after endoprosthesis implantation and is also indicated to prevent atherothrombotic events in the late clinical course, regardless of the stent model used. After a variable period of time, depending on some factors, such as the clinical presentation of coronary artery disease and the type of stent implanted, this therapy is discontinued, and the main current guidelines recommend interrupting the P2Y12 receptor inhibitor and maintaining acetylsalicylic acid in the long term, as one of the main pharmacological measures for secondary prevention of atherosclerosis. However, recently, due to their greater antiplatelet potency and probable lower potential for significant bleeding, especially in the digestive tract, P2Y12 inhibitors have been considered a valid and attractive option as an antiplatelet agent for long-term use; but this alternative has not been endorsed by guidelines yet. This review discusses the details related to this important decision that must be made by cardiologists when discontinuing the different antithrombotic therapies initially used after percutaneous coronary intervention. In principle, the scarcity of conclusive and normative clinical studies, especially in the population treated by percutaneous intervention, means that acetylsalicylic acid is the only antiplatelet agent with class I indication for secondary prevention of atherosclerosis.

Preoperative dental screening can reduce periprosthetic infections of hip and knee endoprostheses in the first month after surgery: results of a cohort study.

The oral cavity and, in particular, potential oral foci might pose a risk of periprosthetic joint infection (PJI). The aim of this cohort study was to determine whether practical preoperative dental screening would reduce the prevalence of early PJI in the first month after surgery. Patients attending a specialized endoprosthesis implantation clinic between 2018 and 2022 were recruited. Two groups were examined. The test group consisted of patients attending the clinic between 2020 and 2022 and who were referred to their family dentist using a standardized form. The comparison group consisted of patients who were treated in the clinic between 2018 and 2020. They were not referred to their family dentist. The two groups were compared for the prevalence of PJI. Univariate analysis followed by multiple logistic regression was performed to confirm risk factors for PJI in this cohort. 2560 individuals (test group: 1227, comparison group: 1333) were included. The prevalence of PJI was significantly lower in the test group (0.8% vs. 1.8%, p = 0.04). Multiple logistic regression with PJI as the dependent variable showed that a dental referral was a strong predictor of a lower prevalence of PJI (OR: 0.43, CI95 0.205-0.917, p = 0.03). Male gender was also strongly associated with a higher frequency of PJI (OR: 2.68, CI95 1.32-5.42, p = 0.01). Age (OR: 1.06, CI95 1.01-1.10, p = 0.01) and BMI (OR: 1.11, CI95 1.05-1.17, p < 0.01) had little effect on the risk of PJI. Dental referral using a standardized form can reduce the prevalence of early PJI. Accordingly, orthopedists and dentists should collaborate in this practical way.

Caesarean Section for Orthopedic Indications

Background: The increasing number of late complications described after cesarean sections is prompting a reexamination of the indications for them in pregnant women. The high percentage of pregnancies terminated by preventive cesarean section for non-obstetric reasons also largely involves orthopedic conditions. A challenge for obstetricians is pregnant patients with orthopedic conditions both before and during pregnancy. Pregnant women with a history of orthopedic surgery require special attention. The lack of consensus in this area, physicians’ fear of patients’ claims and the skewing of patients’ requests for surgical termination of pregnancy have prompted an analysis and systematization of existing knowledge in this field. Methods: References published up to 30 June 2023 in five databases Pubmed, Embase are included. Keywords have been checked for the following: pubic symphysis diastasis, lumbar disc herniation, past hip arthroplasty and fractures in the pelvic bones. In the described conditions complicating pregnancy, the mode of delivery was taken into account. Results: All included studies were screened and reviewed by at least two authors until an overall consensus of 50 articles was reached. Conclusions: Orthopedic indications for cesarean section in many cases should not be treated imperatively, since natural delivery after correct fusion of a pelvic fracture, implantation of a hip endoprosthesis or a limited dissection of the pubic symphysis is possible and is not associated with a higher risk of obstetric or orthopedic complications. Extra-obstetric indications for cesarean section should be determined individually for each pregnant woman in a multidisciplinary team, since orthopedic conditions may overlap with obstetric pathology in the pelvis.

Structured approach for infected prosthesis

Endoprosthesis infections represent amajor challenge for doctors and patients. Due to the increase in endoprosthesis implantation because of the increasing life expectancy, an increase in endoprosthesis infections is to be expected. In addition to infection prophylaxis, methods of infection control become highly relevant, especially in the group of geriatric and multimorbid patients. The aim is to reduce the high 1‑year mortality from prosthesis infections through astructured algorithm. Prosthesis infections can basically be divided into early and late infections. According to the criteria of the International Consensus Meeting, alate infection is defined as the occurrence more than 30days after implantation. With respect to the planned approach, the (p)TNM classification offers an orientation. In the early postoperative interval the clinical appearance is crucial as in this phase neither laboratory parameters nor an analysis of synovial fluid show ahigh sensitivity. It is fundamental that, apart from patients with sepsis, environment diagnostics should be initiated. If alate infection is suspected, in addition to radiological diagnostics (X-ray, skeletal scintigraphy and if necessary, computed tomography, CT), laboratory (C-reactive protein, CRP, leukocytes, blood sedimentation, and if necessary, interleukin‑6, procalcitonin) and microbiological diagnostics (arthrocentesis with synovial analysis and microbiology) are indicated; however, in addition to the arthrocentesis result, the clinical appearance is crucial in cases where an exclusion cannot be confirmed by laboratory parameters. If an infection is confirmed, the treatment depends on the spectrum of pathogens, the soft tissue situation and the comorbidities, including amultistage procedure with temporary explantation and, if necessary, implantation of an antibiotic-containing spacer is necessary. Aprosthesis preservation using the debridement, antibiotics and implant retention (DAIR) regimen is only appropriate in an acute infection situation. Basically, radical surgical debridement should be carried out to reduce the pathogen load and treatment of apossible biofilm formation for both early and late infections. The subsequent antibiotic treatment (short or long interval) should be coordinated with the infectious disease specialists. Astructured approach for prosthesis infections oriented to an evidence-based algorithm provides asufficient possibility of healing. An interdisciplinary approach involving cooperation between orthopedic and infectious disease specialists has proven to be beneficial. Surgical treatment with the aim of reducing the bacterial load by removing the biofilm with subsequent antibiotic treatment is of intrinsic importance.

FINITE ELEMENT ANALYSIS OF THE STRESS-STRAIN STATE OF 3D COMPUTER GENERATED IMAGING OF REVERSE TOTAL SHOULDER ENDOPROSTHESES

Objective. To conduct a finite element analysis of the stress-strain state (STS) of the elements of the shoulder joint after implantation reverse shoulder endoprostheses. Material and methods. After 3Dscanning of the composite model of the scapula and humerus, geometric models of the shoulder joint were built in the SolidWorks 2019 SP 1.0 program, followed by mathematical modeling and FEA. For the comparative analysis of the STS of the «bone – reverse endoprosthesis» s ystem, t hree-dimensional m odels o f two types of reverse shoulder endoprostheses were created, which were then transformed into a finite-element model and implanted into the developed three-dimensional mathematical model of the shoulder joint without cement. The STS calculations of the elements of endoprostheses were carried out for two positions: abduction 90° and flexion 90° with a load of 5 kg. Results. Compared to the healthy shoulder joint, models with reverse shoulder endoprosthesis have significantly different contact stresses and contact areas. It was established that the maximum stress in the details of the contact parts of the endoprosthesis when retracted at an angle of 90° did not exceed +1.78 MPa, when bending +5.8 MPa. The maximum stresses on the liner during shoulder abduction are +8.6 MPa, the minimum –7.38 MPa, during flexion +2.3 MPa and –2.45 MPa, respectively. It has been proven that the contact areas of the hemisphere and inserts of both reverse endoprostheses during abduction and flexion of the limb by 90° are significantly larger (573 mm2 vs. 1809–2081 mm2) when compared with a healthy shoulder joint, while changes in the area between the endoprostheses are insignificant and equal to 2...3 %. Conclusions. Analysis of the STS load of elements of reverse shoulder endoprosthesis showed that the greatest stresses occur in the contact zones. It has been proven that the maximum stresses on the contact structures of endoprostheses are less than on the head of a healthy joint, but the contact area during implantation of a reversible endoprosthesis of the shoulder joint increases significantly (more than 3 times).

Type 2 Endoleak Hybrid Repair with Open Approach and Endovascular Angioembolization on a 10 Centimeters Aortoiliac Aneurysm: Case Report and Literature Review

Type 2 endoleak after endovascular aneurysm repair of abdominal aortic aneurysms remains the most prevalent type of endoleak. Depending on the time of appearance, can be classified as primary, or secondary, those that appear after the first month after endoprosthesis implantation. Type II endoleaks, due to retrograde filling of the aneurysmal sac from a collateral artery, constitute the most frequent subgroup. Most of the type II endoleaks resolve spontaneously. Which is why they must be treated. The surgical treatment of type 2 endoleaks is through a transarterial approach, In this case, This technique is complicated even in expert hands, and migration of the coils proximally or distally is not uncommon. In general, EVAR is associated, for the moment, with a non-negligible risk of other postoperative complications, such as ischemic complications, those associated with rupture or mobilization of the endoprosthesis, and endoleaks. These complications can affect up to 35% Of the patients who undergo EVAR compared to 8% After CAC. Of cases, and in addition, in the long-term evolution, failures may occur due to material fatigue, with it, the pressurization of the sac and eventually the evolution towards rupture. Follow-up is something inherent to EVAR.

Dental Therapy of Patients Prior to Endoprostheses: A Retrospective, Telephone-Based Cohort Study.

The aim of this study was to assess, whether patients prior to endoprosthesis (EP) visit their dentist for need-oriented therapy and whether this would be associated with the occurrence of complications. Based on a cohort of patients, which was orally investigated prior to EP surgery between 04/2020 and 12/2021, a telephone interview was performed at least six months after EP implantation. Patients were classified into either low-risk (LR), moderate-risk (MR), or high-risk (HR) groups. Participants were interviewed based on a structured questionnaire regarding dental visits, dental therapy, and potential complications during the observational period. Out of the 311 patients from the baseline cohort, 96 patients after EP implantation could be included (participation rate of 31%). Nineteen patients were in LR (20%), 41 in MR (43%), and 36 in the HR group (37%). Overall, 79% (n = 76) of the patients followed the recommendation to visit their dentist; 94% of patients within the HR group visited the dentist (p = 0.02). Dental treatment procedures included tooth cleaning (57%), periodontal treatment (31%), restorative therapy/filling (28%), and tooth extraction (28%). In 64% of the HR patients (n = 23), the potential oral foci with a risk of EP infection were eliminated by their general dentist. Fourteen different complications occurred within the observation period, without any group effect (p > 0.05). In conclusion, most patients prior to EP visit their general dentist following referral, especially if they have a potential oral focus. The effect of dental clearance on infectious complications of EP remains unclear, whereby further clinical studies are needed.

Oral Health Screening for Risk Reduction for Early Periprosthetic Joint Infections of Hip and Knee Endoprostheses—Results of a Prospective Cohort Study

This prospective observational study had two aims: (I) to assess whether a preoperative dental screening before endoprosthesis (EP) implantation with need-based dental intervention would decrease the prevalence of periprosthetic joint infection (PJI) and (II) to evaluate whether instructed orthopedic surgeons would achieve similar results in oral screening as dentists. The preoperative oral health statuses of the patients, prior to EP insertion, were either evaluated by the patients’ general dentists (Ia) or, if the patient had not visited a general dentist, by an instructed orthopedic surgeon (Ib). Both the dentist and orthopedic surgeon used standardized risk estimation (low risk, moderate risk, and high risk) for an oral-health-related infectious complication after EP insertion, including a recommendation for further management of the patient. If required, a need-based dental rehabilitation was performed. In addition, retrospective data evaluation of a comparison group (II) was performed, which had not been screened orally preoperatively. A total of 777 patients (screening group (I): n = 402, of which 229 were screened by a dentist (Ia), 173 were screened by an orthopedic surgeon (Ib); comparison group (II): n = 375) were included. No general association between early infection rate and preoperative oral screening in general was found (1% PJI in screening group (I), 1.6% PJI in comparison group (II); p = 0.455). However, screening performance (dentist vs. orthopedic surgeon) had a significant impact on the prevalence of developed PJIs (p = 0.021). Thereby, 100% of observed infections in the screening group (I) occurred in the group with previous oral screening by an orthopedic surgeon (Ib). Furthermore, the C-reactive protein (CRP) value at discharge was significantly lower when general preoperative oral screening had been performed (group I vs. group II, p = 0.03). Only preoperative oral screening by a dentist had the potential to reduce oral-focus-associated EP infections; therefore, increased attention should be paid to the further promotion of interdisciplinary work between dentists and orthopedic surgeons. Dental screenings, using objectifiable criteria, as applied in this study, seem reasonable but require further validation in larger cohorts.

INFLUENCE OF ANTIBACTERIAL IMPLANT COATINGS ON THE VIABILITY OF GRAM-POSITIVE AND GRAM-NEGATIVE BACTERIA AND THE IN VITRO MINERALIZATION

The implantation of endoprosthesis is a routine procedure in orthopaedics. Endoprosthesis are mainly manufactured from ceramics, polymers, metals or metal alloys. To ensure longevity of the implants they should be as biocompatible as possible and ideally have antibacterial properties, to avoid periprosthetic joint infections (PJI). Various antibacterial implant materials have been proposed, but have so far only been used sporadically in patients. PJI is one of the main risk factors for revision surgeries. The aim of the study was to identify novel implant coatings that both exhibit antibacterial properties whilst having optimal biocompatibility.Six different novel implant coatings and surface modifications (EBM TiAl6V4, strontium, TiCuN, TiNbN, gentamicin phosphate (GP), gentamicin phosphate+cationic polymer (GP+CP)) were compared to standard CoCrMo-alloy. The coatings were further characterized with regard to the surface roughness. E. coli and S. capitis were cultured on the modified surfaces to investigate the antibacterial properties. To quantify bacterial proliferation the optical density (OD) was measured and viability was determined using colony forming units (CFU). Murine bone marrow derived macrophages (BMMs) were cultured on the surfaces and differentiated into osteoblasts to quantify the mineralisation using the alizarin red assay.All novel coatings showed reduced bacterial proliferation and viability compared to standard CoCrMo-alloy. A significant reduction was observed for GP and GP+CP coated samples compared to CoCrMo (ODGP,E.coli = 0.18±0.4; ODGP+CP,E.coli = 0.13±0.3; p≤0.0002; N≥7-8). An increase in osteoblast-mediated mineralisation was observed on all surfaces tested compared to CoCrMo. Furthermore, GP and GP+CP coated samples showed a statistically significant increase (MGP = 0.21±0.1; MGP+CP = 0.25±0.2; p&lt;0.0001; N≥3-6).The preliminary data indicates that the gentamicin containing surfaces have the most effective antibacterial property and the highest osseointegrative capacity. The use of antibiotic coatings on prostheses could reduce the risk of PJI while being applied on osseointegrative implant surfaces.

Results of surgical treatment and rehabilitation of patients with post-traumatic subatrophy and anophthalmic syndrome in combination with bone deformities of the orbit

BACKGROUND: Ocular prosthetics remains an important and actual task in the rehabilitation of patients with anophthalmos of various origins.&#x0D; AIM: To increase the effectiveness of cosmetic prosthetics in patients at the formation of a primary and/or delayed supporting stump with simultaneous reconstructive procedures on the orbital bone structures.&#x0D; MATERIALS AND METHODS: A retrospective analysis of patients with subatrophy and anophthalmos with deformities of the orbital walls was carried out. Results were analyzed according to the criteria for the severity of clinical signs enophthalmos, deepening of the superior orbitopalpebral sulcus, prosthesis mobility.&#x0D; RESULTS: 22 patients with orbital bone deformities were operated and examined; they underwent surgery on the orbital walls in combination with evisceration with posterior scleral pole resection, neurectomy and implantation of a spherical endoprosthesis (in modifications) in 12 patients and delayed stump plasty in 10 patients with anophthalmos. It was possible to eliminate enophthalmos in 18 patients, to correct the retraction of the upper eyelid on the prosthesis side in 19 patients, and to significantly increase the mobility of the prosthesis in 9 patients.&#x0D; CONCLUSIONS: Carrying out a combined surgical procedure aimed at restoring a voluminous mobile primary or delayed supporting stump and eliminating the deformation of the orbital walls with restoring the lost volume creates conditions for optimal individual ocular prosthetics, significantly reduces prosthesis enophthalmos, increases its mobility and improves cosmetic results of rehabilitation.

574 DOUBLE VASCULAR COMPLICATION IN THE SITE OF PUNCTURE AFTER TAVI: A CASE REPORT

Abstract Hemorrhages represent one of the most frequent complications during TAVI. Their rapid recognition and a prompt treatment are necessary to avoid hemorrhagic shock, which can lead the patient to death in a short time. We report the case of a 79-year-old woman affected by severe and symptomatic aortic stenosis, who underwent TAVI in our Cath-lab. Through a right femoral echo-guided arterial access, implantation of a 26 mm self-expandable aortic bio-prosthesis and hemostasis in the site of puncture with 18F Manta vascular closure device were performed. At the end of the procedure, through radial artery, a femoral angiography was performed, showing an important leak of contrast medium upper the site of puncture, without any change in arterial pressure or heart rate. After echo-guided cannulation of left femoral artery with 8F sheath, implantation of endoprosthesis in the site of hemorrhage and hemostasis of left femoral artery with 8F AngioSeal VIP vascular closure device were performed. In cardiac intensive care unit (CICU) low dosage of vasoactive agents and blood were administered, guaranteeing a good arterial pressure. Computed tomography (CT) was performed after two days and confirmed the presence of a retroperitoneal hematoma, without active bleeding. After six days, the patient left CICU and was admitted to the cardiological ward, starting a gradual mobilization. However, after 48 hours she reported abdominal pain and became rapidly hypotensive, tachycardic and asthenic, requiring readmission in CICU. Serum exams showed low hemoglobin concentration, an abdominal CT was perfomed, showing an active bleeding from left femoral artery and a homolateral retroperitoneal hematoma. The patient was rapidly lead in the cath lab. Angiography confirmed the hemorrage and an endoprosthesis was successfully implanted in the left femoral artery. Blood and vasoactive agents were administered with a progressive improvement in hemodynamic and clinical conditions of the patients. Post-operative course was complicated by fever and empiric antiobiotic therapy was administered until blood culture revealed no bacterial growth. A third CT showed the stability of the hematomas and the absence of active bleeding, allowing hospital discharge of the patient. Vascular complications are frequent and sneaky during TAVI procedures. A prompt treatment is of paramount importance to prevent hemorrhagic shock. TAVI operators should have experience in the field of peripheral intervention for the management of vascular complications.

Assessment of the endoprosthesis offset in a dysplastic coxarthrosis.

Incorrectly developed acetabulum and subluxated hip joint may cause many problems for proper implantation of endoprosthesis. The aim of this work is to assess the radiological results of offset restoration and selection of endoprosthesis implant in a dysplastic hip joint. The study group consisted of patients who had a surgery in the period between 2016 and 2018. All of them had a cementless total hip endoprosthesis. The group consisted of 91 patients (96 hip joints), with an average age of 42 years (31-47 years). 55 left and 41 right hip joints. 70 females and 21 males. The control group consisted of patients who were not diagnosed with hip joint dysplasia. The control group consisted of 70 patients (70 hip joints), with an average age of 35 years (19-55 years). 53 females and 17 males. The radiographic assessment included the measuring of medialization and distalization which describe the offset of hip joint. The joint decentration was classified according to Crowe. Based on radiographic measurements we have achieved statistically significant (p<0.05) changes in medialization and distalization parameters. We have not noticed a statistically significant difference for medialization parameter (p=0.8259) after a surgery when compared to the control group. For all patients we have achieved a restoration of correct offset in the horizontal plane. The main idea behind endoprosthesis in a dysplastic coxarthosis is the implantation of endoprosthesis cup in an anatomically correct location. Small screw- in cup and conical stem offer great possibility of restoring correct offset of a dysplastic hip joint.

Endoprosthetic replacement of the proximal tibia for oncological conditions.

AimsThe proximal tibia (PT) is the anatomical site most frequently affected by primary bone tumours after the distal femur. Reconstruction of the PT remains challenging because of the poor soft-tissue cover and the need to reconstruct the extensor mechanism. Reconstructive techniques include implantation of massive endoprosthesis (megaprosthesis), osteoarticular allografts (OAs), or allograft-prosthesis composites (APCs).MethodsThis was a retrospective analysis of clinical data relating to patients who underwent proximal tibial arthroplasty in our regional bone tumour centre from 2010 to 2018.ResultsA total of 76 patients fulfilled the inclusion criteria and were included in the study. Mean age at surgery was 43.2 years (12 to 86 (SD 21)). The mean follow-up period was 60.1 months (5.4 to 353). In total 21 failures were identified, giving an overall failure rate of 27.6%. Prosthesis survival at five years was 75.5%, and at ten years was 59%. At last follow-up, mean knee flexion was 89.8° (SD 36°) with a mean extensor lag of 18.1° (SD 24°). In univariate analysis, factors associated with better survival of the prosthesis were a malignant or metastatic cancer diagnosis (versus benign), with a five- and ten-year survival of 78.9% and 65.7% versus 37.5% (p = 0.045), while in-hospital length of stay longer than nine days was also associated with better prognosis with five- and ten-year survival rates at 84% and 84% versus 60% and 16% (p < 0.001). In multivariate analysis, only in-hospital length of stay was associated with longer survival (hazard ratio (HR) 0.23, 95% confidence interval (CI) 0.08 to 0.66).ConclusionWe have shown that proximal tibial arthroplasty with endoprosthesis is a safe and reliable method for reconstruction in patients treated for orthopaedic oncological conditions. Either modular or custom implants in this series performed well.Cite this article: Bone Jt Open 2022;3(9):733–740.

Influence of implantation of a total hip endoprosthesis on the ipsilateral leg alignment: the effect of sex and dysplasia of the hip

IntroductionDifferences in leg and hip morphology exist between sexes and developmental hip dysplasia is known to alter proximal femoral morphology. The purpose of this study was to determine whether existing differences in leg alignment due to sex or developmental hip dysplasia have an effect on changes in leg alignment after total hip arthroplasty.Materials and methods30 hip osteoarthritis patients underwent biplanar full-length radiography in the standing position preoperatively and 3 months after total hip arthroplasty. Differences in leg alignment between men and women and between patients with primary hip osteoarthritis and patients with developmental dysplasia before and after surgery were tested using a general linear model for repeated measures.ResultsImplantation of a hip prosthesis had no differential effect on ipsilateral leg alignment in patients with hip osteoarthritis due to dysplasia and in patients with primary hip osteoarthritis. However, patients with hip osteoarthritis due to dysplasia had a 2.1° higher valgus both before and after surgery. After total hip arthroplasty, women had a significantly greater increase in varus angle (1.6° vs. 0°) and femoral offset (10.5 vs. 4.6 mm) compared with men. Because the change in acetabular offset was smaller (2.2 vs. 6.2 mm), the global femoral offset was only increased in women. Femoral torsion was constant for men (15.0° and 16.5°), whereas femoral torsion was significantly reduced in women (19.9° and 13.2°).ConclusionsHip arthroplasty has a greater effect on leg axis in women than in men. The axial leg alignment of women could change from a natural valgus to a varus alignment. Therefore, surgeons should consider the effects of total hip arthroplasty on leg alignment in patients with hip osteoarthritis. Whether these changes in leg alignment are also clinically relevant and lead to premature medial or lateral knee osteoarthritis should be investigated in future work.Trial registrationThis study was registered with DRKS (German Clinical Trials Register) under the number DRKS00015053. Registered 1st of August 2018.

Efficacy of Alendronate in Preventing Periprosthetic Bone Loss after Implantation of a Primary Hip Endoprosthesis

Total hip arthroplasty (THA) is now the gold standard for the surgical treatment of coxarthrosis. The appearance of bone loss after implantation of the hip endoprosthesis over time reduces the primary stability of the implant and leads to progressive looseningof the implant, or periprosthetic fracture, which are considered to be the most common causes of hip revision.&#x0D; The aim of this study is to evaluate the value of alendronate application in reducing periprosthetic osteolysis reduction after implantation of total cementless hip endoprosthesis.&#x0D; The study analyzed 50 patients operated on with implantation of a cementless total hip arthroplasty (THA). The first group of 25 patients recieved oral alendronate, calcium and vitamin D3 postoperatively. The second group of 25 patients were examined and followed postoperatively without any therapy.&#x0D; Patients were examined by RTG and DXA methods at 6, 12 and 18 months.&#x0D; The study showed a difference in the values of bone mineral density (BMD) and bone mineral content (BMC) in the interval of 6,12 and 18 months, using the DXA method.&#x0D; Alendronate therapy after total hip implantation reduces periprosthetic bone loss, maintains bone mineralization and strengthens the implant

Fracture analysis, indication for endoprosthesis and implant selection in proximal humeral fractures

Proximal humeral fractures (PHF) are the third most common fracture in humans and the incidence is increasing. There are basically three treatment strategies: conservative, joint-preserving reconstructive or joint-replacing procedures. In addition to fracture morphology, patient-specific and surgeon-specific factors are particularly important when deciding on treatment. The experience and training of the surgeon also play adecisive role. In the case of joint-preserving treatment, the risk of osteosynthesis failure and of sequelae of the fracture must always be assessed. If conservative or reconstructive treatment methods are not promising, the joint-replacing procedure is the treatment of choice. The anatomical fracture prosthesis is only indicated, if at all, for young patients with adestroyed humeral head with apreserved rotator cuff and large fragments of the tuberosities. In advanced age, the implantation of areverse endoprosthesis is increasingly used for dislocated, multifragmentary PHF. In both procedures, the anatomical healing of the tuberosities has asignificant impact on the functional outcome.

One Third of Patients before Endoprosthesis Implantation Show an Oral Focus as Potential Source of Infectious Complication-The Value of Pre-Operative Dental Risk Stratification in a German Cohort.

Objective: The aim of this cross-sectional cohort study was to evaluate a comprehensive dental examination and referral concept for patients prior to endoprosthesis (EP) implantation in an interdisciplinary setting. Methods: Patients, who were prepared for EP surgery in the clinic for orthopaedics, were referred to the dental clinic for a dental examination. Thereby, dental and periodontal treatment need, radiographic and temporomandibular joint findings were assessed. Based on oral and radiographic investigation, a risk classification for potential source of prosthetic infection was performed. If potential oral foci of EP infection were present (e.g., apically radiolucent teeth, severe periodontitis or additional inflammatory findings), patients were classified as at high risk for EP infection with oral origin. Those individuals were allocated to their family dentist or special clinic for dental treatment prior to EP surgery. Results: A total of 311 patients were included (mean age: 67.84 ± 10.96 years, 51% male). A dental treatment need of 33% was found, while the periodontal treatment need was 83%. Thirty-one percent of patients showed at least one apical radiolucency (a sign of chronic infection/inflammation). Furthermore, additional findings such as radiographic signs of sinusitis maxillaris were found in 24% of patients. Temporomandibular disease was probable in 17% of individuals. One-third (34%) were assigned to the high risk group for an EP infection with oral origin. Conclusion: German patients before EP have a high periodontal treatment need and show frequently (34%) a potential oral focus of infection, underlining the necessity of including dental examination and risk stratification as part of the pre-operative assessment prior to EP implantation. Therefore, an approach as applied in this study appears reasonable for those individuals.

Bilateral versus unilateral total knee replacement - comparison of clinical and functional results in two-year follow-up.

Total knee replacement is one of the most common surgical methods in diagnosis of end staged osteoarthritis. In this retrospective analysis, we focus on comparison of functional and clinical outcome in patients undergoing unilateral and bilateral replacement within a single surgical procedure. 54 patients (bilateral 19, unilateral 35) underwent total knee replacement in our clinic participated in the current study. The length of hospital stay was monitored in all patients. Assessment of functional results was based on the WOMAC score, KSS 1, KSS2, range of motion and presence of complications in both groups. Both groups of patients were homogeneous with age, body mass index and sex. The length of hospital stay in the unilateral group was 4.7±1.3 and 5.6±2.0 in the bilateral group. Patients operated on unilaterally achieved flexion of 114.9±9.3 after one year, bilateral group 112.6±8.6, the difference was insignificant. In both groups, there is a significant improvement one year postoperatively at WOMAC, KSS1 and KSS2. Comparing WOMAC, KSS1 and KSS2 between the unilateral and bilateral groups 3, 6, 12 months postoperatively, the differences are insignificant. The revision of implants in two-year follow-up reached 1.5% in unilateral group and 1.4% in bilateral group. Unilateral and bilateral knee joint endoprosthesis implantation is a successful surgical method in orthopedic practice. With conscious selection of patients, bilateral implantation may be more advantageous alternative, as the patient undergoes one operation and the associated risks.

Outcomes of Unilateral Versus Bilateral Use of the Iliac Branch Endoprosthesis for Elective Endovascular Treatment of Aorto-iliac Aneurysms.

The aim of the study was to evaluate outcomes after bilateral implantation of the Gore Excluder Iliac Branch Endoprosthesis (IBE) versus those achieved after unilateral implantation. All consecutive patients electively treated in a single center for aorto-iliac aneurysm using the IBE device between January 1, 2014, and December 31, 2018, were reviewed. Early outcome measures were technical success, 30days or in-hospital mortality, and major adverse events (MAE). Late outcome measures were survival, internal iliac artery (IIA) patency, and freedom from IIA branch instability. A total of 74 patients (97% males, mean age 74 ± 7years) were included. Thirteen patients (17%) received bilateral IBE implantation for a total of 85 vessels evaluated. The technical success rate was 97% and was not significantly different between the two groups (p = .32). Two patients died within 30days, both in the unilateral group (p = 1). No significant differences were seen in the rates of 30days MAE (p = .10). At one year, the overall survival rate was 95 ± 2% vs 90 ± 3% in the unilateral and bilateral group, respectively (Log-rank = .05). There were no differences in 1-year primary and secondary patency rates between groups (Log-rank = .75 and Log-rank = .34, respectively). Freedom from IIA branch instability at one year was also not significantly different (unilateral: 94 ± 3% vs. bilateral: 82 ± 9%, Log-rank = .22).. Bilateral IBE use for elective endovascular treatment of aorto-iliac aneurysms appears safe and feasible and may achieve satisfactory short-term and mid-term outcomes. Bilateral IBE use should be employed judiciously in the context of a comprehensive risk/benefit evaluation.