Long-term Survivorship Research Articles

Abstract 4147601: Associations between Accelerated Aging Phenotypes with Cancer-Specific and Cardiovascular-Specific Mortality in Long-Term Cancer Survivorship

Background: The consequences of cancer and anti-cancer treatments are often described as representing an “accelerated aging” phenotype. However, little is known about how the “accelerated aging” phenotype affects mortality risks in long-term cancer survivors. Purpose: To investigate the association between accelerated aging phenotype and cause-specific mortality in a sample of long-term cancer survivors Methods: Data for cancer survivors (CS) were extracted from the National Health and Nutrition Examination Survey between the years 1999-2010. Participants missing vital data and those diagnosed with multiple cancers, childhood cancers, cancer within the previous 5 years, or skin cancer were excluded. Mortality outcomes were collected from the National Death Index through December 2019. The Phenotype Age score was derived from blood biochemistry measures such as albumin, creatinine, and c-reactive protein. Accelerated Aging (AA) was defined as a Phenotype Age greater than the participants’ chronological age. CS were grouped by time since diagnosis: 5-10, 10-15, 15-20, and ≥20 years. Within each group, hazard ratios (HR) were derived from competing-risk hazard regression for the AA phenotype association with cancer-specific and cardiovascular-specific mortality. Regressions were modeled with participant age as the time-scale to account for the predictive nature of chronological age. Results: A total of 875 CS (65.6±12.9 years, 62% female, 31% non-white, 15.6±9.4 years from cancer diagnosis) were included. The most common cancer types were prostate (16%) and breast (21%) cancer. There were 107 cancer and 113 cardiovascular deaths over a 10.8±4.6 year follow-up. The AA phenotype was significantly associated with cardiovascular-specific mortality in each survivor group (all p<0.05). Conversely, the AA phenotype was only significantly associated with cancer-specific mortality in the 5-10 years of survivorship group (p=0.01). Results are displayed in Figure 1, along with cubic splines fit to the HR of each survivorship group. Conclusions: Present results suggest that the AA phenotype may demonstrate time-dependent associations with cancer-specific and cardiovascular-specific risks, two leading causes of death in CS.

Sexual dysfunction among long-term survivors of Hodgkin lymphoma.

Survival rates from childhood cancer continue to increase, with an ongoing interest in long-term survivorship. Although infertility and gonadal failure are well recognized in Hodgkin lymphoma (HL) survivors, sexual dysfunction is less studied. The objective of this study was to compare the prevalence of sexual dysfunction in HL survivors with that in matched community controls. Long-term survivors of HL (n=186; female, 51.61%; mean age at diagnosis. 14.41 years [range, 3.01-22.60 years]; current mean±standard deviation age, 36.73±7.93 years) and matched community controls (n=182; female, 50.55%; mean±standard deviation age, 36.41±9.02 years) completed a comprehensive, in-person clinical assessment, laboratory battery, and the International Index of Erectile Function or the Female Sexual Function Index questionnaire. Male survivors had increased levels of erectile dysfunction (18.89% vs. 6.67%; p=.0239) but indicated no difference in sexual desire. Female survivors had a higher prevalence of sexual dysfunction compared with female controls (46.88% vs. 15.22%; p<.0001) and an increased prevalence of moderate-to-severe loss of sexual desire (38.04% vs. 23.26%; p=.0361). Female survivors with sexual dysfunction indicated increased levels of anxiety (p=.0184), depression (p=.0153), and worse physical and mental health (p=.0141 and p=.0419, respectively). Male survivors with erectile dysfunction had higher rates of anxiety and impaired physical health (p=.0147 and p=.0266, respectively). Sexual dysfunction was prevalent in this childhood and adolescent Hodgkin lymphoma survivor cohort and was associated with effects on quality of life. Health care providers must recognize the need for screening and intervention in this group to hopefully contribute to improved overall quality of life.

Enhancing Capacity for Primary Care Research in Cancer Survivorship: National Cancer Institute Meeting Report.

Many components of long-term cancer follow-up and survivorship care are managed in the primary care context. Given the important role that primary care has in survivorship care, it is critical to ensure that teams in these settings are prepared to address long-term needs. Evidence-based strategies to deliver survivorship care in primary care settings in the US remain limited. The National Cancer Institute (NCI) Office of Cancer Survivorship (OCS) conducted a day-long virtual event, Enhancing Capacity for Primary Care Research in Cancer Survivorship: A Workshop for Action, on February 28, 2024, to discuss research needs addressing the intersection between primary care and cancer survivorship. Topics discussed to advance this area of research included: system-level interventions, methods and measurement, and mentorship and research team building, especially for early career researchers. The purpose of this report is to provide a summary of the key findings. Gaps and opportunities include: (1) health systems-level research that investigates primary care practice-level capacity, (2) identification and characterization of the targeted cancer survivor populations for primary care research; (3) leveraging electronic medical records to track relevant patient outcomes throughout survivorship; and (4) development/creation of communities of practice to support and build research capacity. Team science approaches were identified as a core strategy to advance survivorship research. The meeting closed with a reflection and call to action focused on building collaborations that span different research areas, disciplines, and organizations and building a broad network of a primary care practice focused research.

Long-term Survival After Cancer: A Scoping Review of the Health Care Landscape in Germany

Abstract Background Cancer remains a global health concern, with a significant increase in new cases projected in the coming years. Although cancer treatment and diagnosis have advanced, leading to improved survival, survivors often face complex physical, emotional, and cognitive challenges. The objective of this scoping review is to provide an overview of the current landscape of specialized long-term survivorship care services in North Rhine-Westphalia (NRW) with a focus on vulnerable groups. Methods The scoping review involves two search approaches: a manual search performed by two review authors and a systematic search performed by an information specialist following Scoping Review guidance. The protocol was published on the OSF platform. The systematic search was conducted in databases such as LIVIVIO, MEDLINE and Scopus. The manual search involves identifying key categories of survivorship services and conducting online searches based on these categories in duplicate. Data extraction and synthesis is conducted using EPPI-Reviewer software, and focuses on services characteristics, patient demographics, program format, and accessibility. Results The study has identified more than 300 survivorship care services across North Rhine-Westphalia. According to preliminary results some services offer comprehensive care, while others have significant gaps, particularly in addressing the needs of vulnerable groups. One example of these gaps is the lack of tailored services specifically designed for people with a migration background. Most of the services are not available in multiple languages or gender-specific oriented. The results will be presented on the congress in detail. Conclusions This scoping review underscores the importance of tailored survivorship care, especially for vulnerable groups. Public health actions should focus on addressing disparities in access to survivorship services, enhancing existing programs, and developing new policies to support cancer survivors. Key messages • Effective survivorship care requires attention to vulnerable groups. • The care of long-term cancer survivors should receive more attention in research.

Role function in postmenopausal women during aromatase inhibitor therapy for breast cancer.

Few studies have examined aromatase inhibitor therapy relating to role function in breast cancer survivors of working age. Our study sought to identify how pre-therapy sociodemographic and health/treatment-related characteristics, as well as patient-reported symptoms measured every six-months, influence role function during 18months of AI therapy for early-stage breast cancer. We performed a secondary analysis of longitudinal study data using linear mixed-effects modeling to examine role physical (RP) and role emotional (RE) functioning measured with the Medical Outcome Study Short Form 36 v2. The sample of postmenopausal women (N = 351) consisted of three cohorts: chemotherapy followed by anastrozole (CFAI), anastrozole only (AI only), and non-cancer controls. Our choice of variables and interpretation of findings was theoretically based on the Cancer Survivorship and Work Model. Stepwise backward deletion determined which predictors to include in the final model, accounting for treatment group. Both treatment groups were associated with greater limitations in RP functioning than controls. CFAI had twice the impact on RP compared to AI only. While the RP model displayed significant predictors across sociodemographic, health/treatment, and symptom characteristics, only symptoms were associated with greater limitations in RE functioning. Findings were significant at p < .05. Transitioning from acute to extended survivorship is a critical juncture in which multiple factors place breast cancer survivors at risk of diminished role function. Early interventions to address role function limitations during systemic treatment may lead to better work outcomes and improve the quality of long-term survivorship.

Long-Term Outcomes of Airway Management in 6 Children With Campomelic Dysplasia.

This case series describes the outcomes of airway management, including airway reconstruction, in 6 patients with campomelic dysplasia and tracheostomy/ventilator dependence secondary to multilevel airway obstruction. Case series and clinical guidelines are provided for the airway management of patients with campomelic dysplasia. Average age of individuals is 19.4 years. Mean follow-up was 12.2 years. Four individuals underwent open airway reconstruction and achieved decannulation. One patient underwent airway reconstruction with improvement of a complete subglottic stenosis but remains ventilator dependent due to severe scoliosis. The remaining 2 patients did not require additional airway reconstruction, have been liberated from ventilator support, and are under evaluation for tracheostomy tube decannulation. Although campomelic dysplasia was historically considered a lethal form of congenital skeletal dysplasia, with many patients succumbing to respiratory failure due to tracheobronchomalacia in the neonatal period, airway reconstruction and long-term survivorship is feasible in children with campomelic dysplasia and significant airway disease.

Real-World Immune-Related Adverse Events in Patients With Early Triple-Negative Breast Cancer Who Received Pembrolizumab.

The addition of pembrolizumab to chemotherapy in high-risk early triple-negative breast cancer (TNBC) improves cancer outcomes. However, pembrolizumab induces varied immune-related adverse events (irAEs) where some can be severe or lifelong. This retrospective study describes real-world patterns of irAEs in patients with TNBC who received pembrolizumab. We evaluated irAEs in patients with TNBC from a comprehensive cancer center and a community hospital who received pembrolizumab with chemotherapy between 2021 and 2023, excluding those enrolled in clinical trials. We used national guidelines to grade toxicities. Logistic regression assessed the effect of clinicopathologic variables on irAEs adjusting for covariates. We identified 233 patients with a median age of 51 years, 62% had stage II TNBC, 35% had stage III TNBC, 25% were Hispanic, 21% were Black, and 42% were White. Eighty patients (34%) developed 100 separate irAEs. The most common irAEs were endocrinopathies (52%) and GI (23%); there were 26 grade ≥3 irAEs, which all resulted in hospitalization, the most common being GI (13 instances); 45 required systemic steroids, 16 required additional immunosuppressive therapy, and 32 patients discontinued pembrolizumab because of irAEs. Two patients who developed colitis eventually died due to complications. Most (67 instances) irAEs were unresolved at the time of last follow-up, but 55% (37/67) had improved to grade 1. No clinicopathologic factors were associated with the development or severity of irAEs. In this real-world diverse population, we observed rates of irAEs comparable with KEYNOTE-522, where endocrinopathies were the most prevalent, but GI irAEs were also prevalent and severe. This emphasizes a critical issue as pembrolizumab is increasingly being used in early TNBC and could have long-term survivorship implications.

A qualitative study of specialist multidisciplinary clinician perspectives on barriers/facilitators to care for children with brain cancer and their families: "We're a little bit different to our adult counterparts".

Children with brain cancer and their families have complex care needs throughout diagnosis, active treatment, long-term survivorship, and the palliative phase of illness. This study aimed to explore the perspectives of Australian specialist clinicians on barriers and facilitators to health care for children with brain cancer and their families. A qualitative approach was taken using semi-structured interviews. Eligible participants were clinicians of any discipline providing care to children with brain cancer and their families in Australia. Interviews were conducted by telephone and asked about perceived strengths and weaknesses in health care and available resources for this population. Qualitative content analysis used a directed approach with inductive refinement. Eleven clinicians participated, 5 of whom were medical, 3 nursing, and 3 allied health. The overarching theme was that the rarity and diversity of brain tumors in children confers challenges to care that lead to variation in practice. Participants reported having to adapt care from guidelines and patient/family resources designed for adults with brain cancer and children with other cancers, and rely on clinical and research networks. Specialist comprehensive cancer care was generally perceived to offer the best model for accommodating the unique needs of each child/family, but barriers to access were highlighted for children in remote Australia, and long-term follow-up was perceived to be inadequate regardless of where children lived. Until further brain cancer-specific paediatric guidelines become available, our findings highlight the need for communities of practice to share resources and reduce unwarranted variation. Future research should focus on developing and evaluating guidelines and other resources specific to children with brain cancer, as well as informing suitable models for long-term follow-up care for survivors.

Estimating Long-Term Survivorship Rates Among Patients With Resected Stage III/IV Melanoma: Analyses From CheckMate 238 and European Organization for Research and Treatment of Cancer 18071 Trials.

Standard-of-care treatments for patients with resected stage III/IV melanoma include the immuno-oncology (IO) agents nivolumab (NIVO) and ipilimumab (IPI). This study used mixture cure models (MCMs) to estimate cure rates among patients treated with NIVO or IPI in the phase III CheckMate 238 (ClinicalTrials.gov identifier: NCT02388906) and European Organization for Research and Treatment of Cancer (EORTC) 18071 (ClinicalTrials.gov identifier: NCT00636168) trials, and to assess the impact of use of adjuvant immunotherapy on cure rates versus watchful waiting. MCMs were applied to patient-level recurrence-free survival data from CheckMate 238 and EORTC 18071. Cured patients were assumed to experience no disease recurrence and mortality risks similar to the general population. Uncured patients were at risk of disease recurrence and all-cause death. The survival trend of the cured patients was estimated using life expectancy data for a general population with the same baseline demographic characteristics. A regression model assessed the odds ratios (ORs) of cure across key subgroups on the basis of baseline characteristics of the study populations. In CheckMate 238, estimated cure rates were 48.3% (95% CI, 41.8 to 54.9) with NIVO and 38.2% (95% CI, 32.7 to 44.1) with IPI. In EORTC 18071, estimated cure rates were 38.0% (95% CI, 32.1 to 44.2) with IPI and 29.2% (95% CI, 24.4 to 34.6) with placebo. In the indirect comparison of the two trials, the odds of cure were significantly higher with NIVO than with placebo (OR, 2.33 [95% CI, 1.49 to 3.65]). Analyses involving two large phase III trials investigating adjuvant IO treatment for resected melanoma demonstrate higher cure rates for both NIVO and IPI than placebo, with NIVO providing the highest cure rate. Similar cure rates were estimated for patients treated with IPI in both trials, despite staging and dosing differences.

Empowering survivors, elevating care: The vital role of oncology primary care clinics.

362 Background: Due to increasing numbers of cancer survivors, there is a greater focus on the longitudinal management of treatment-related comorbidities. Cancer survivors have increased risk of cardiovascular (CV) disease, CV-related mortality, and second primary cancers (SPCs). Primary care providers (PCPs) are responsible for most of the care of long-term survivors, however, many report uncertainty around long-term effects and survivorship guidelines. While fostering strong primary care-oncology relationships is one approach to support those impacted by cancer, the development of oncology primary care clinics enhances patient outcomes and ensures patients receive comprehensive survivorship care. Despite this, few tertiary cancer care centers offer such clinics. Methods: In 2021, the University of Cincinnati Cancer Center established an oncology primary care clinic. Patients are eligible if they have a current or prior cancer diagnosis or cancer hereditary syndrome (CHS). The clinic is comprised of two-family medicine physicians, one with survivorship experience, and one fellowship-trained in palliative and hospice medicine. Clinical team members include an RN with oncology experience, medical assistants, a clinical service specialist, two oncology clinical pharmacists, and an oncology social worker. A clinical registry was developed to longitudinally measure patient outcomes. Electronic medical records of patients (n=683) seen between 1/2021 and 1/2024 were extracted and entered in REDCap. Data was summarized using SAS. Results: The mean age was 56 years (range 20-93), and 12% received a diagnosis in the pediatric/adolescent/young adult age range (0-39 years). The most common types included breast (23%),hematologic cancers (15%), and CHS (16%). Notably 43% of patients are on active treatment and 53% completed or are on maintenance treatment. Over 61% struggle with obesity, while 45% report being a current or former smoker. Comorbidities were common with 79% of patients having at least one CV diagnosis. Of 57% patients eligible for cardiomyopathy screening, 78% received recommended echocardiograms. Many patients received their recommended screenings including breast (79%), colon (43%), cervical (56%), prostate (46%), and lung (55%). Patients were referred to a variety of supportive services including physical therapy (42%), cancer exercise (18%) and psychiatry (14%). Conclusions: This model of care is a viable option for connecting cancer survivors with PCPs knowledgeable about survivorship care. CV-related comorbidities were common, and their management is a critical need during and after cancer. Survivors have increased risk of SPCs, and while the number of patients up to date on recommended cancer screenings is low, screenings are on the rise with ongoing efforts. Patient registries enable objective measurement of outcomes and can inform future research and care.

Reimagining fertility preservation guidance for AYA patients: A quality improvement initiative.

283 Background: Infertility can be a devastating consequence for adolescent or young adult (AYA) patients, posing distinct challenges for healthcare providers striving to deliver high-quality, equitable cancer care. The rising incidence of cancer and growing population of AYA cancer survivors necessitates innovative, streamlined, and efficient processes to promote fertility preservation. While guidelines from organizations like American Society of Clinical Oncology (ASCO) and Agency for Healthcare Research and Quality (AHRQ) provide valuable recommendations, ensuring consistent adherence to these standards remains an ongoing challenge. Methods: The aim of this quality improvement project was to increase fertility preservation counseling and documentation, by 20% within 6 months without delaying chemotherapy start for newly diagnoses AYA patients (age 18-39) within a large academic medical center. Utilizing a Define, Measure, Analyze, Improve, Control (DMAIC) methodology, interventions were conducted through a series of Plan-Do-Study-Act (PDSA) cycles that included provider and staff education, referral process standardization, implementation of a best practice advisory (BPA) within the electronic health record (EHR), revision of organizational policy, and establishment of nurse touchpoints to facilitate communication. Results: The percentage of counseling and documentation in AYA cancer patients (n=83) increased by 52%, exceeding the project aim. Statistical significance was calculated using a chi-square test. Contrary to initial concerns of potential delays in beginning chemotherapy while awaiting preservation, the average time to starting chemotherapy decreased by 43%. Conclusions: Fertility preservation counseling is a critical aspect of quality outcomes for AYA cancer patients. Strategic planning of automated methods to facilitate documentation and referral was an ideal method of building quality into a large healthcare system. Establishing methods of process improvement engrained best practices, allowing for enrichment of data collection, while driving continuous quality improvement. Increased utilization of the BPA facilitated tracking of quality metrics, while promoting a patient-centered approach to fertility preservation. Interdisciplinary collaboration between physicians, nurses, and reproductive specialists fosters holistic care to enhance long-term survivorship. Fertility preservation counseling and documentation Results. Month Month Count (%) QuarterlyCount (%) 95% CI Change 95% CI P Mean days to begin chemotherapy Baseline 17 of 41 (41%) 17 of 41 (41%) 0.27 to 0.58 42 October 19 of 20 (95%) November 10 of 12 (83%) December 9 of 14 (64%) 38 of 46 (83%) 0.68 to 0.92 0.41 0.20 to 0.62 &lt;0.001 January 10 of 12 (83%) February 7 of 7 (100%) March 12 of 12 (100%) 29 of 31 (94%) 0.77 to 0.99 0.52 0.32 to 0.72 &lt;0.001 24 April 6 of 6 (100%)

Avoiding Complications in Medial Unicompartmental Knee Arthroplasty

Medial unicompartmental knee arthroplasty (mUKA) is a highly effective treatment for the management of isolated osteoarthritis in the medial compartment. While favorable long-term survivorship is seen in most series, the long-term rate of revision after mUKAs remains higher than that for total knee arthroplasty. Poor indications and poor surgical technique are often responsible for mUKA failure. Understanding why these complications occur and how to avoid them will optimize clinical outcomes, reduce revision rates, and lead to lower healthcare costs. This review will discuss the five most common causes of mUKA failure including progression of arthritis, aseptic loosening, bearing dislocation, periprosthetic fracture, and polyethylene wear and how to avoid them with proper patient selection and meticulous surgical technique.

The Million Dollar Question: Can I Return to Sports After Unicompartmental Knee Arthroplasty, Doc?

Knee osteoarthritis (OA) is a widespread and potentially debilitating condition that can interfere with the growing demand for a healthy and active lifestyle. In people under the age of 55, the prevalence of OA is expected to increase substantially in the coming decades. High tibial osteotomy and cartilage repair operations have been used to treat OA in young, active individuals; however, these procedures require lengthy rehabilitation periods and result in poor return to preoperative levels of activity that make them unsuitable for the young, active patient. Unicompartmental knee arthroplasty (UKA) is a less invasive treatment alternative, especially for younger, active, middle-aged persons with a desire to return to sporting activities. UKA yields successful return to activities with excellent functional outcomes and mid- to long-term survivorship. This article will review the ability of patients to return to sports after UKA, the type and nature of the sporting activities, as well as the timing to return to these sports.

Clinical Outcomes and Long-term Survivorship After Osteochondral Autologous Transfer Combined With Valgus High Tibial Osteotomy: An Analysis After 19 Years With 56 Patients

Background: Osteochondral defects of the medial femoral condyle combined with varus malalignment in young and active patients are a debilitating condition, which can result in early osteoarthritis. Osteochondral autologous transfer (OAT) combined with valgus high tibial osteotomy (HTO) might therefore be a comprehensive solution to maintain long-term knee function. Purpose/Hypothesis: The purpose of this study was to report clinical results and survivorship after combined OAT and valgus HTO for symptomatic osteochondral defects of the medial femoral condyle in the setting of varus malalignment at a long-term follow-up. It was hypothesized that undergoing combined OAT and valgus HTO would produce favorable clinical results along with a low rate of conversion to arthroplasty. Study Design: Case series; Level of evidence, 4. Methods: All patients treated between 1998 and 2008 with combined valgus HTO and OAT for deep osteochondral defects of the medial femoral condyle and concomitant varus malalignment >2° without meniscal repair/transplantation, osteoarthritis, or ligamentous instability/reconstruction were included. The survival rates of this combined procedure were evaluated. Failure was defined as conversion to knee joint arthroplasty during the follow-up period. Patient-reported outcomes were collected pre- and postoperatively, including the Lysholm score, visual analog scale score, Knee injury and Osteoarthritis Outcome Score (KOOS), Tegner Activity Scale score, and subjective level of satisfaction (scale 0-10). Results: Of 74 patients who were included for 10-year follow-up, 3 had died. A total of 15 patients were lost to follow-up, so 56 patients could be reevaluated, for a follow-up rate of nearly 80%. The mean age at surgery was 38.8 ± 9.9 years (range, 19.9-62.4 years), and the mean follow-up time was 18.9 ± 3.0 years (median, 18.8 years; range, 14.1-24.8 years). The survival rates were 87% at 10 years, 86% at 15 years, and 77% at 19 years after surgery. At final follow-up, the Lysholm score showed a mean increase of 39 points (95% CI, 25.4-50.0 points; P < .001) from 40 points to 79 points, representing a significant improvement. Overall, 96% of patients surpassed the minimal clinically important difference (MCID) for the Lysholm score. The visual analog scale score decreased by a mean of 4.8 points (range, 5-10 points) from 7.5 points to 2.7 points (P < .001), and 80% of patients surpassed the MCID. The mean Tegner Activity Scale score was 4.5 ± 1.6, and the mean KOOS subscale scores at final follow-up were as follows: Pain: 81 ± 21 (range, 19-100), Symptoms: 80 ± 22 (range, 21-100), Activities of Daily Living: 85 ± 21 (range, 18-100), Sports: 68 ± 32 (range, 0-100), and Quality of Life: 67 ± 28 (range, 0-100). Overall, 78% of the patients were satisfied with the results of the operation. Conclusion: The combination of OAT and valgus HTO presents a viable treatment option for patients affected by osteochondral defects of the medial femoral condyle and concurrent varus malalignment. A sustained and substantial improvement in clinical outcomes, significantly reduced pain severity, and a high rate of long-term survivorship can be anticipated in the long-term follow-up.

Clinical outcomes and complications of a non-modular dual-mobility acetabular device, minimum 2 years follow-up.

Non-modular dual-mobility (DM) acetabular bearing constructs are becoming more popular due to their potential advantages for addressing range of motion (ROM) and stability. The objective of this post-market clinical study was to assess clinical outcomes, including patient satisfaction, pain and function, survivorship, and component positioning, in patients ⩾2 years after primary THA using non-modular DM acetabular components. This retrospective, multicentre study evaluated complications and functional outcomes in recipients of non-modular DM acetabular constructs at least 2 years post-THA. Our primary outcomes included the dislocation rate and mean Hip disability and Osteoarthritis Outcomes Score (HOOS). Secondary outcomes included radiographic measurements, patient satisfaction, Forgotten Joint Score (FJS), Harris Hip Score (HHS), and survivorship. 316 eligible patients enrolled in this study across 3 sites, including 168 men (53%) and 148 women (47%). The cohort averaged 5.37 years post-THA (range 2.2-10.1 years) at the study visit. The mean FJS, HHS, and HOOS were good to excellent, with values of 82.3, 90.7, and 92.0, respectively. Patient satisfaction averaged 4.68, between "Very Good" (4) and "Excellent" (5). Minimal radiolucent lines (RLL) surrounded the acetabulum. More RLL surrounded the femur, but most lines were less than 1 mm (4.7% of the study population). There were few adverse events (4 events, 1.3%). Three revisions were performed (0.9%), with one patient requiring removal of the acetabular cup. The high mid- to long-term survivorship and low to no dislocation and reoperation rates indicate this acetabular DM device is a viable option for THA patients. The patient metrics reflect satisfaction, alleviated pain, and restored function with a low risk of adverse outcomes.

Evaluation of a radiological grading system for the early detection of total knee arthroplasties at risk for revision surgery.

X-rays are regularly performed after primary total knee arthroplasty (TKA). While soft tissue management and ligament tension cannot be evaluated, important information, such as inadequate component positioning and loose cement location, as well as subsequent loosening, can be detected. The aim of this study was to correlate radiological findings, referring to the radiological grading system (previously published by the same study group, henceforth abbreviated as "RGS"), with long-term outcomes and implant survival. A total of 266 patients who underwent titanium-coated TKA were included. In addition to implant survival, visual analogue scale score, Tegner activity score, knee society score (KSS), Western Ontario and McMaster Universities Osteoarthritis Index, and short form-12 score as well as range of motion were evaluated. Clinical examination as well as anterior-posterior, lateral, full-length weight bearing, and patellar view radiographs were performed pre- and postoperatively, at the 3-, 6-, and 12-month postoperative follow-ups and at the final follow-up. The radiological grading system was evaluated and correlated with long-term outcome and survivorship. The revision-free survival rate was 88.4% at a median follow-up of 9.8 years (IQR: 9.3-10.3 years; range: 0.1-11.8 years). Revision surgery was required in 31 TKAs (11.7%). The multivariate Cox regression model showed a significant association between an RGS score ≥ 3 deviation points (DP) and an increased risk for revision (hazard ratio: 2.092; 95% CI: 1.020-4.290; p = 0.044). Moreover, the KSS for pain was significantly worse in patients with a RGS score ≥ 3 DP (median, 85 [74-92] vs. 90 [80-94]; p = 0.007). This is the first study indicating that deviation in component positioning, having an inadequate long leg axis, the presence of free cement or residual bony structures on postoperative X-rays significantly correlate with TKA outcome and implant survival. Therefore RGS can be of high predicable value for the survivorship of the prosthesis. Level IV - retrospective cohort study.

A high-flexion design total knee prosthesis: a ten to twelve-year follow-up study

BackgroundThe purpose of this study was to investigate the clinical and radiographic outcomes and to determine the survivorship of a high-flexion design total knee arthroplasty (TKA) prosthesis, the LOSPA knee system, over a follow-up period of 10–12 years.MethodsThe study included 386 patients (503 TKAs) who were treated with TKA from 2011 to 2013 (follow-up period 10–12 years).The patients were assessed clinically using range of motion (ROM) of the knee, the Knee Society scoring system (KSS), and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). For radiographic analysis, the positions of femoral and tibial implants as α, β, γ, and δ angles, hip knee ankle (HKA) angle, and radiolucent lines were used. Kaplan–Meier survival analysis was performed.ResultsMean ROM improved significantly from the preoperative baseline of 117.3° to 126.5° at the final follow-up (p < 0.001). The mean KSS and WOMAC scores also both showed significant improvement after surgery (all p < 0.001). A non-progressive radiolucent line less than 2 mm was observed in 23 cases (4.7%). Nine patients underwent revision surgery on the knee during the follow-up period. Revision surgery was performed on four patients due to aseptic loosening, three patients due to infection, one patient due to ankylosis, and one patient due to instability. When the endpoint of survival was the entire surgical cases, the survival rate was 96.2%. The survival rate, with revision for any reason as the endpoint, was 97.2%, and 97.8% for aseptic causes.ConclusionsThe LOSPA knee system, a high-flexion design total knee prosthesis, showed excellent long-term survivorship and improvements in clinical outcomes at 10- to 12-year follow-up.

An integrated framework for the study of exercise across the postdiagnosis cancer continuum.

Exercise plays many important roles across the entire cancer continuum that have been described in previous frameworks. These frameworks, however, have generally provided a simplified description of the roles of exercise postdiagnosis. The modern cancer treatment landscape has become complex and often consists of multiple lines of multimodal treatments combined concurrently and/or sequentially and delivered over many months or years. This complexity requires a more multifaceted and targeted approach to the study of exercise after a cancer diagnosis. Here, we propose a new integrated framework-Exercise Across the Postdiagnosis Cancer Continuum (EPiCC)-that highlights the distinct roles of exercise for disease treatment and supportive care from diagnosis until death. We also propose new terminology to clarify the distinct roles of exercise that emerge in the context of the modern cancer treatment landscape. The EPiCC Framework is structured around multiple sequential cancer treatments that highlight six distinct cancer treatment-related time periods for exercise-before treatments, during treatments, between treatments, immediately after successful treatments, during longer term survivorship after successful treatments, and during end of life after unsuccessful treatments. The EPiCC Framework proposes that the specific roles of exercise as a disease treatment and supportive care intervention will vary depending on its positioning within different cancer treatment combinations. As a cancer treatment, exercise may serve as a "priming therapy", primary therapy, neoadjuvant therapy, induction therapy, "bridging therapy", adjuvant therapy, consolidation therapy, maintenance therapy, and/or salvage therapy. As a supportive care intervention, exercise may serve as prehabilitation, intrahabilitation, interhabilitation, rehabilitation, "perihabilitation", health promotion/disease prevention, and/or palliation. To date, exercise has been studied during all of the cancer treatment-related time periods but only in relation to some cancer treatments and combinations. Moreover, fewer studies have examined exercise across multiple cancer treatment-related time periods within any cancer treatment combination. Future research is needed to study exercise as a disease treatment and supportive care intervention within and across the distinct cancer treatment-related time periods contained within different cancer treatment combinations. The aim of the EPiCC Framework is to stimulate a more targeted, integrated, and clinically-informed approach to the study of exercise after a cancer diagnosis.

Long-Term Outcomes of Primary Cemented Total Hip Arthroplasty with Acetabular Bone Graft for Protrusio Acetabuli: Minimum 10-Year Follow-Up.

Background: This study reports the long-term survivorship of primary total hip arthroplasty (THA) for protrusio acetabuli. Methods: Patients undergoing THA utilising cement and bone graft acetabular reconstruction for protrusio acetabuli in a university teaching hospital during the period 2003 to 2014 were included. Kaplan-Meier survival estimates were calculated with 95% confidence intervals (CI) up to 15 years following surgery. PROMs were collected pre- and post-operatively for hip-specific function (Oxford Hip Score [OHS]) and health-related quality of life (HRQoL) using the EQ-5D-3L. Results: 129 consecutive THAs (96 patients) performed for protrusio acetabuli were identified (median age 69, IQR 61-75; female 115 [89.1%]; 38 [29.5%] inflammatory arthritis) with a mean follow-up of 15.7 years (range: 10.1-20.1 years). At the final follow-up, fifty-six (43.4%) patients had died and there were eleven (8.5%) reoperations, of which eight (6.2%) involved the revision of the acetabular component. The fifteen-year Kaplan-Meier any-reoperation survival estimate was 91.3% (95% CI 85.9-97.0). When considering all-cause acetabular revision only, the 15-year survival estimate was 93.1% (95% CI 88.2-98.3). The median pre-operative OHS improved significantly from baseline to 1 year post-THA, beyond the minimal important change (mean difference 28, 95% CI 25-30, p < 0.001). Similarly, there were clinically relevant improvements in HRQoL at 1 year post surgery (mean difference 0.10, 95% CI 0.06-0.15, p < 0.001). Conclusions: This study demonstrates that primary cemented THA utilising acetabular bone graft for reconstruction in patients with protrusio acetabuli was associated with 15-year survival rates of 93.1% and clinically relevant improvements in hip-specific function and HRQoL.

Excellent results of restricted kinematic alignment total knee arthroplasty at a minimum of 10 years of follow-up.

While restricted kinematic alignment (rKA) total knee arthroplasty (TKA) with cemented implants has been shown to provide a similar survivorship rate to mechanical alignment (MA) in the short term, no studies have reported on the long-term survivorship and function. One hundred four consecutive cemented cruciate retaining TKAs implanted using computer navigation and following the rKA principles proposed by Vendittoli were reviewed at a minimum of 10 years after surgery. Implant revisions, reoperations and clinical outcomes were assessed using knee injury and osteoarthritis outcome score (KOOS), forgotten joint score (FJS), patients' satisfaction and joint perception questionnaires. Radiographs were analyzed to identify signs of osteolysis and implant loosening. Implant survivorship was 99.0% at a mean follow-up of 11.3 years (range: 10.3-12.9) with one early revision for instability. Patients perceived their TKA as natural or artificial without limitation in 50.0% of cases, and 95.3% were satisfied or very satisfied with their TKA. The mean FJS was 67.6 (range: 0-100). The mean KOOS were as follows: pain 84.7 (range: 38-100), symptoms 85.5 (range: 46-100), function in daily activities 82.6 (range: 40-100), function in sport and recreation 35.2 (range: 0-100) and quality of life 79.1 (range: 0-100). No radiological evidence of implant aseptic loosening or osteolysis was identified. Cemented TKA implanted with the rKA alignment protocol demonstrated excellent long-term implant survivorship and is a safe alternative to MA to improve patient function and satisfaction. IV, continuous case series with no comparison group.