Prosthesis Failure Research Articles

Osteoblastic ferroptosis inhibition by small-molecule promoting GPX4 activation for peri-prosthetic osteolysis therapy

Peri-prosthesis osteolysis (PPO) represents the most severe complication of total joint arthroplasty (TJA) surgery and imposes the primary cause of prosthesis failure and subsequent revision surgery. Antiresorptive therapies are usually prescribed to treat PPO, especially for elderly people. Nevertheless, the efficacy of anti-osteoporotic medications remains constrained. Recent therapeutic strategies to promote periprosthetic osseointegration by restoring osteoblast function are considered more effective approaches. However, the precise mechanism underlying the inhibition of osteogenesis triggered by wear particles remains enigmatic. Herein, we demonstrate that wear particles inhibit osteoblast function by inducing ferroptosis to sabotage extracellular mineralization and arouse periprosthetic osteolysis. The suppression of ferroptosis could significantly rescue osteogenesis thus alleviating PPO. Furthermore, Glutathione Peroxidase 4 (GPX4) has been identified as a key target in regulating osteoblastic ferroptosis. By utilizing virtual screening techniques, we have successfully conducted a comprehensive screening of a natural compound known as Urolithin A (UA), which exhibits remarkable inhibition of osteoblastic ferroptosis while simultaneously promoting the process of osteogenesis through its precise targeting mechanism on GPX4. Meanwhile, UA improves the osteolytic conditions significantly in vivo even when the adjunction of titanium (Ti) nanoparticles. This strategy has great potential in treating peri-prosthesis osteolysis and potentially broadens the scope of clinical therapy.Graphical

The influence of PEEK acetabular shell on the mechanical stability of total hip replacements under gait loading and motion.

The demand for total hip replacement surgery is increasing year by year. However, the issue of hip prosthesis failure, particularly the modular acetabular cup, still exists. The performance and functional requirements of modular acetabular cups have not yet met clinical expectations. This study focused on poly-ether-ether-ketone (PEEK) shells, using finite element methods to investigate their mechanical stability under gait loads and motion, including parameters such as deformation, micromotion, and bone strain. The results showed that a compromise was required among the mechanical performance, stability, and bone integration capabilities of the PEEK shell. As the shell rigidity increased, deformation decreased. However, increased rigidity also increased micromotion at the bone-prosthesis interface, reducing the area that promoted bone ingrowth. Additionally, potential bone absorption areas were also increased, reducing bone preservation and reconstruction capabilities. Compromises need to be made among mechanical performance, stability, and bone integration to achieve optimal mechanical stability. In this study, a 6mm wall thickness PEEK shell was found to provide good overall mechanical stability.

A retrospective single cohort study on the 5-13 year clinical outcomes of implant-supported cross-arch fixed dental prostheses with monolithic zirconia-based frameworks.

To investigate the mid-to-long term clinical outcomes of the implant-supported cross-arch fixed dental prostheses (IFCDPs) with monolithic zirconia-based frameworks and related risk factors of success and survival. This retrospective study encompassed individuals exhibiting terminal dentition or edentulism in the maxilla and/or mandible who underwent treatment involving IFCDPs with monolithic zirconia frameworks. Inclusion criteria required a documented follow-up period of at least five years post-definitive prosthesis delivery. Evaluation of outcomes focused on the survival rates of implant and prosthesis, along with the incidence of biological and technical complications. The mixed-effects Cox regression model was employed to analyze the risk factors associated with prosthesis failure and peri-implantitis. A cohort of 47 patients, consisting of 14 women and 33 men with a mean age of 55.2 ± 12.5 years (range: 25-83), was included in this study. The mean follow-up period was 71.6 ±13.2 months (mean ± SD, range: 60-147). A total of 51 cross-arch prostheses supported by 302 implants, distributed between the maxilla (27 prostheses) and mandible (24 prostheses), were assessed. By the end of the follow-up period, 289 (97.64%) of the 302 implants remained functional. Peri-implantitis was observed in 27 implants (24 in mandible), yielding an overall implant-related success rate of 91.06%. Nine frameworks experienced fractures (eight in mandible), resulting in an overall prosthesis-related survival rate of 82.35%. Subsequent analysis revealed the mandible to be a significant risk factor for framework fracture (HR = 11.64, p = 0.024) and peri-implantitis (HR = 10.88, p = 0.003). The implant-supported cross-arch fixed dental prostheses featuring monolithic zirconia-based frameworks demonstrated favorable clinical outcomes throughout a 5-13-year observation period. Notably, in the design of monolithic zirconia-based framework prostheses, the mandible emerged as a significant risk factor for framework fractures and an independent risk factor for peri-implantitis.

The Analysis Studies of Causes and Frequencies of Reoperations after Endoprosthesis Reconstructions for Extremity Tumor Surgery: A Comprehensive Systematic Review

Introduction: Recent advancements in endoprosthetic implant designs and fixation methods have greatly enhanced the options available for reconstructing osseous defects following tumor excision. Endoprosthetic reconstruction offers multiple benefits, including versatility, improved ambulatory function, and early rehabilitation, while allowing for complete tumor resection and reducing the risk of recurrence. This systematic review aims to aggregate evidence on the complications and outcomes of primary extremity tumor endoprosthetic reconstructions to guide clinical decision-making. Methods: This review follows the PRISMA 2020 guidelines, analyzing studies published between 2004 and 2024 that address complications like infection, structural failure, and prosthesis survival in primary extremity tumor endoprosthetic reconstructions. A comprehensive search strategy across databases like PubMed, ScienceDirect, and Cochrane Library will identify eligible studies. Results: Eight studies meeting the inclusion criteria were analyzed for complications in endoprosthetic reconstructions. The studies highlighted complications such as infection, reoperation rates, and prosthesis survival. Discussion: The study discusses key articles examining complications, emphasizing factors like bone resection, implant fixation types, and tumor characteristics, which influence reoperation rates and prosthesis failure. Despite promising functional outcomes, the risk of complications, particularly infection and mechanical failure, remains significant. Surgical technique, postoperative care, and tumor characteristics are critical in optimizing outcomes. Conclusion: This review identifies key complications in primary extremity tumor endoprosthetic reconstructions, emphasizing the need for long-term follow-up, standardized reporting, and personalized surgical approaches. Further research with homogeneous cohorts is required to enhance understanding and improve patient outcomes.

Endoprosthetic treatment of femoral neck fractures in Germany : Cumulative analysis of EPRD registry data from 2013 to 2020

The German Arthroplasty Registry (EPRD) recorded nearly 52,000 femoral neck fractures treated with arthroplasty by 2020. This study aimed to identify survival rates and risk factors for hip prosthesis failure. The study included all patients with arthroplasty after hip fractures documented in the EPRD. Data were analyzed with focus on failure rate regarding implant, implantation technique, age, BMI, and comorbidities. For more complex analysis of dependencies, the machine learning algorithm (MLA) XGBoost (Extreme Gradient Boosting) was used. The study included 51,938 patients. The failure rate was 3.7% for HEs and 5.6% for THA. The failure rate increased in male patients (p < 0.0001), those with higher BMI, young patients with a high Elixhauser Comorbidity Score (ECS) and a cementless technique. The timepoint of surgery, i.e. ,working day vs. weekend or holiday had no influence on the outcome. The feature importance (FI) generated by MLA demonstrated factors with the highest impact on failure, i.e., survival time (1029), BMI (722), and age (481). For younger patients with comorbidities, acemented implantation technique should be considered. Failure rates of arthroplasties did not differ on workdays compared to weekends or holidays. MLA are suitable to analyze registry data for complex correlations of factors.

Factors associated with mechanical complications following primary total hip arthroplasty through a modified direct anterior approach using custom stems.

To determine the rate and risk factors of mechanical complications (MCs) within two years following total hip arthroplasty (THA) through direct anterior approach (DAA) using custom stems, and to compare findings to other surgical approaches in the literature. The study included a consecutive series of 479 patients (529 hips) that had undergone primary THA through the DAA using uncemented custom stems between 02/2014 and 04/2017. There were 301 men and 228 women, with a mean age of 55.9 ± 11.6, and a mean body mass index (BMI) of 25.8 ± 4.3kg/m2. All patients were contacted by phone at a minimum follow-up of two years, and those who reported complications were prescribed radiographic imaging and asked to attend clinical assessment. MCs were defined as periprosthetic fracture, aseptic loosening, dislocations, prosthesis failure, prosthesis malposition, or subsidence. At two years follow-up, the rate of MCs was 3.2% (17 hips).The MCs comprised four femoral fractures, three aseptic stem loosening, three cup malpositions, three subsidences, two acetabular fractures, one stem malposition, and one dislocation. Ten hips (1.9%) required revision due to MCs. Compared to patients with no MCs, patients with MCs had significantly greater native femoral anteversion (16.7 ± 7.5º vs. 21.1 ± 9.7º, p = 0.042), more Charnley class C (13% vs. 41%, p = 0.008), fewer diameter 36mm heads (45% vs. 18%, p = 0.044), and performed less intense physical activity (49% vs. 12%, p = 0.006) and sports (66% vs. 35%, p = 0.048). Multivariable analyses suggested that MCs were associated with greater native femoral anteversion (Odds Ratio [OR] = 1.08, p = 0.020) and Charnley class C (OR = 3.47,p = 0.027), but were inversely associated with intense physical activity (OR = 0.19, p = 0.047). The rate of MCs within 2 years following THA through DAA using custom stems was 3.2% and the rate of revision due to MCs was 1.9%, which is within the range reported in the literature on other surgical approaches for THA. Furthermore, the presence of MCs was associated with greater native femoral anteversion and Charnley class C, but was inversely associated with intense physical activity.

Isolated aseptic loosening in total knee arthroplasty: a comprehensive 10-year review of partial vs. total component revisions

BackgroundIn total knee arthroplasty (TKA), isolated aseptic loosening (IAL) requires the replacement of prosthetic components, with ongoing debate regarding the effectiveness of partial component revision (PCR) compared to total component revision (TCR). This study aims to compare implant survival and surgical outcomes between PCR and TCR in the context of IAL.MethodsThis retrospective study analyzed data from 285 patients who underwent revision TKA for IAL between January 2000 and December 2013. After applying exclusion criteria, 112 patients were included in the analysis—60 undergoing TCR and 52 undergoing PCR.ResultsPCR was associated with shorter operative times and hospital stays compared to TCR, alongside significant differences in the choice of revision prostheses. Although the prosthesis failure rates were comparable between the groups (13.6% for TCR and 18.33% for PCR), significant risk factors for failure were identified, including a canal filling ratio (CFR) below 0.8 and a discrepancy over 0.2 between CFR views. However, no significant differences in overall survivorship were observed between the groups.ConclusionsBoth PCR and TCR provide similar survival rates and clinical outcomes for managing IAL in TKA. PCR provides advantages in terms of surgical efficiency and patient recovery, while reducing the need for more constrained prosthetic solutions. The study identifies CFR as a critical predictor of prosthesis failure, highlighting the importance of detailed preoperative planning and implant selection. These findings contribute valuable insights for improving revision strategies in IAL, enhancing surgical outcomes in TKA.Level of evidenceIII.

Leveraging transfer learning for predicting total knee arthroplasty failure from post-operative radiographs.

The incidence of both primary and revision total knee arthroplasty (TKA) is expected to rise, making early recognition of TKA failure crucial to prevent extensive revision surgeries. This study aims to develop a deep learning (DL) model to predict TKA failure using radiographic images. Two patient cohorts who underwent primary TKA were retrospectively collected: one was used for the model development and the other for the external validation. Each cohort encompassed failed and non-failed subjects, according to the need for TKA revision surgery. Moreover, for each patient, one anteroposterior and one lateral radiographic view obtained during routine TKA follow-up, were considered. A transfer learning fine-tuning approach was employed. After pre-processing, the images were analyzed using a convolutional neuronal network (CNN) that was originally developed for predicting hip prosthesis failure and was based on the Densenet169 pre-trained on Imagenet. The model was tested on 20% of the images of the first cohort and externally validated on the images of the second cohort. Metrics, such as accuracy, sensitivity, specificity and area under the receiving operating characteristic curve (AUC), were calculated for the final assessment. The trained model correctly classified 108 out of 127 images in the test set, providing a classification accuracy of 0.85, sensitivity of 0.80, specificity of 0.89 and AUC of 0.86. Moreover, the model correctly classified 1547 out of 1937 in the external validation set, providing a balanced accuracy of 0.79, sensitivity of 0.80, specificity of 0.78 and AUC of 0.86. The present DL model predicts TKA failure with moderate accuracy, regardless of the cause of revision surgery. Additionally, the effectiveness of the transfer learning fine-tuning approach, leveraging a previously developed DL model for hip prosthesis failure, has been successfully demonstrated. Level III, diagnostic study.

Retrospective study on the clinical and radiographic outcomes of 2.8 mm diameter implants supporting fixed prostheses up to 11 years.

This study aimed to report the clinical and radiographic results of 2.8 mm two-piece narrow diameter implant (NDI) supporting fixed restorations. Clinical and radiographic data of 54 NDIs in 32 patients were retrospectively assessed after 2 to 11 (mean 8.17) years of follow-up. Clinical and radiographic measurements were taken. Survival rate, implant and prosthesis failure, pink aesthetic scores (PES), white aesthetic scores (WES), bleeding on probing (BOP), probing depth (PD), marginal bone loss (MBL), and mechanical and biological complications were evaluated. An implant failed during the follow-up period, resulting in a cumulative survival rate of 98.15% at the implant level and 96.88% in the patient. The total mean values of PES and WES for 2.8 mm NDIs were 7.09 ± 1.15 (range: 3.33-9.00) and 7.42 ± 1.03 (range: 3.67-9.33). The prevalence of sites with positive BOP was 38.14 ± 29.77%. The mean PD value was 2.46 ± 0.62 mm. The average MBL was 1.15 ± 0.74 mm (range: 0.25-4.03 mm). No implant or abutment fracture was detected. A veneer chipping was present in one patient, and a loose crown appeared in another patient. Two implants (3.7%) and two patients (6.3%) were diagnosed with peri-implantitis. Within the limitation of the study, the results indicate that the use of two-piece 2.8 mm NDI for the fixed prosthetic rehabilitation of edentulous regions with reduced interdental and/or buccal-lingual width is viable.

Albiflorin inhibits osteoclastogenesis and titanium particles-induced osteolysis via inhibition of ROS accumulation and the PI3K/AKT signaling pathway

Periprosthetic osteolysis (PPO), caused by wear particles, is a significant complication of total joint replacement, leading to prosthesis failure. Previous research has highlighted the crucial role of osteoclast-induced bone destruction in PPO progression. Albiflorin (AF), a monoterpene glycoside from Paeonia lactiflora, is a key active ingredient known for its antioxidant and anti-inflammatory properties. Although AF has shown promise in treating various conditions, its impact on osteoclasts and PPO remains unexplored. Our study revealed that AF could effectively inhibit osteoclast differentiation to reduce overactivated bone resorption and effectively inhibit the accumulation of reactive oxygen species (ROS) induced by wear particles. In vitro experiments also confirmed that AF could effectively inhibit the PI3K/AKT signaling pathway and inhibit inflammation to regulate osteoclast generation. Studies in animal models have also verified the antioxidant and anti-inflammatory properties of AF. In summary, the above studies indicate that AF inhibits osteoclastogenesis via inhibiting ROS accumulation and the PI3K/AKT signaling pathway, which may be a potential therapeutic method for PPO.

Surgical explantation of transcatheter heart valves: A single institution experience

ObjectiveOver the past decade, there has been a dramatic growth in the utilization and diversity of available transcatheter devices for the replacement and repair of all heart valves. The aim of this study is to examine temporal trends, failure profiles, and clinical outcomes involved in the surgical explantation of transcatheter valve prostheses. MethodsAdult patients undergoing surgical explantation of transcatheter valve prostheses between 2014 and 2022 at a single institution were identified. Retrospective cohort review and survival analysis were performed to assess patient characteristics, indications for explant, and operative outcomes. ResultsFrom 2014 to 2022, 8 surgeons at a single institution performed explantation of transcatheter valve prostheses in 44 patients. Among explanted devices, 50% were removed within 1 year of transcatheter implantation. Surgical explantation was performed on an urgent or emergent basis in 57% of patients. Indications for explantation included valve prosthesis failure (57%), iatrogenic injury (16%), and endocarditis (11%). Operative mortality was 11%, with a mean Society of Thoracic Surgeons mortality risk of 12%. Patients undergoing elective explantation had improved survival compared with those undergoing urgent or emergent explantation (P = .03). Overall survival was 77% at 3 years following transcatheter valve explantation. ConclusionsThere is a rising annual incidence of transcatheter valve explantation in all valve positions. Surgical explantation performed on both elective and non-elective bases is increasingly common in adult cardiac surgical practice. The clinical impact of transcatheter valve explantation is significant and should be strongly considered by multidisciplinary heart teams in the lifetime management strategy of cardiac valvular disease.

Assocation between trapezium size and failure of total trapeziometacarpal prosthesis. A survival analysis

AimsTo assess the survival function of cementless total trapezium metacarpal prostheses (TTMPs) at 20 years, to compare survival functions by trapezium size, and to evaluate the association between the instantaneous risk of TTMP failure and small trapezium size using a multivariate Cox regression model.MethodsThis observational cohort study included 221 consecutive patients with a mean follow-up after TTMP of 137.3 months (maximum of 246 months). Kaplan-Meier and actuarial life-table methods were used to evaluate the survival function of thecohort. Kaplan-Meier survival curves were compared by trapezium size. Multivariate Cox regression analysis was used to determine the effect of potential confounders on the association between small trapezium and the instantaneous risk of TTMP failure.ResultsAt the end of follow-up, there was a 89.01% chance of the TTMP surviving for 246 months or more. There was an association between TTMP survival time and trapezium size showing a significant trend such that the survival curves weresignificantly higher with larger trapezium size (Mantel-Cox test, p = 0.0001; WilcoxonBreslow test, p = 0.0002; Tarone-Ware test, p = 0.0001).The unadjusted Cox regression model showed a significant association between small trapezium size (smaller than 9 mm) and the instantaneous risk of TTPM failure (HR: 7.37, 95% CI: 2.46-22.07). In the multivariate Cox analysis, “age”, “trapezium morphology”, and “complications” were confounders in the association between small trapezium size and the hazard ratio of prosthetic failure (HR = 3.76; 95% CI 0.96 to 13.82).ConclusionThese results confirm the long-term functional survival of TTMP prostheses and reveal a significant increase in trend of the survival curve with larger trapezium size. Patient age, trapezium morphology, and the presence of post-surgical complications are confounders in the association between small trapezium size and the hazard ratio of TTMP failure.

Outcomes of Birmingham Hip Resurfacing Based on Clinical Aspects and Retrieval Analysis of Failed Prosthesis.

This research aims to identify the prevalence of failure for Birmingham Hip Prosthesis (BHR) in total hip arthroplasty and to analyze its reasons from biomaterials and biofunctional perspectives. We present our current analysis and tests on a series of different BHR-retrieved prostheses after premature failure. Relevant clinical data, such as X-ray investigations and intraoperative images for clinical case studies, were analyzed to better understand all factors involved in BHR prosthesis failure. A detailed analysis of the failures highlighted uneven cement distribution, overloading in certain areas, and void formation in the material. A closer investigation using microscopical techniques revealed the presence of a crack originating from the gap between the cement mantle and human bone. Additionally, scanning electron microscopy analyses were conducted as part of the investigation to examine bone cement morphology in detail and better understand the interactions at the interfaces between implant, cement, and bone. In conclusion, this research emphasizes the importance of surgical technique planning and the cementation procedure in the success rate of BHR prostheses. It also underscores the need to carefully evaluate patient characteristics and bone quality to minimize the risk of BHR prosthesis failure. The cementation procedure seems to be essential for the long-term functionality of the BHR prosthesis.

Failure of Surgical Aortic Valve Prostheses: An Analysis of Heart Team Decisions and Postoperative Outcomes.

Objectives: To analyze Heart Team decisions and outcomes following failure of surgical aortic valve replacement (SAVR) prostheses. Methods: Patients undergoing re-operations following index SAVR (Redo-SAVR) and those undergoing valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) following SAVR were included in this study. Patients who underwent index SAVR and/or Redo-SAVR for endocarditis were excluded. Data are presented as medians and 25th-75th percentiles, or absolute numbers and percentages. Outcomes were analyzed in accordance to the VARC-3 criteria. Results: Between 01/2015 and 03/2021, 53 patients underwent Redo-SAVR, 103 patients ViV-TAVR. Mean EuroSCORE II was 5.7% (3.5-8.5) in the Redo-SAVR group and 9.2% (5.4-13.6) in the ViV group. In the Redo-SAVR group, 12 patients received aortic root enlargement (22.6%). Length of hospital and ICU stay was longer in the Redo-SAVR group (p < 0.001; p < 0.001), PGmax and PGmean were lower in the Redo-SAVR group as compared to the ViV-TAVR group (18 mmHg (10-30) vs. 26 mmHg (19-38), p < 0.001) (9 mmHg (6-15) vs. 15 mmHg (9-21), p < 0.001). A higher rate of paravalvular leakage was seen in the ViV-TAVR group (p = 0.013). VARC-3 Early Safety were comparable between the two populations (p = 0.343). Survival at 1 year and 5 years was 82% and 36% in the ViV-TAVR cohort and 84% and 77% in the Redo-SAVR cohort. The variables were patient age (OR 1.061; [95% CI 1.020-1.104], p = 0.004), coronary heart disease (OR 2.648; [95% CI 1.160-6.048], p = 0.021), and chronic renal insufficiency (OR 2.711; [95% CI 1.160-6.048], p = 0.021) showed a significant correlation to ViV-TAVR. Conclusions: Heart Team decisions are crucial in the treatment of patients with degenerated aortic bioprostheses and lead to a low mortality in both treatment paths thanks to patient-specific therapy planning. ViV-TAVR offers a treatment for elderly or intermediate-risk profile patients with comparable short-term mortality. However, this therapy is associated with increased pressure gradients and a high prevalence of paravalvular leakage. Redo-SAVR enables the surgical treatment of concomitant cardiac pathologies and allows anticipation for later VIV-TAVR by implanting the largest possible valve prostheses.

Surgical outcome of extra sinus zygomatic implants in comparison to conventional implants for the rehabilitation of atrophic maxilla: a systematic review and meta-analysis

Posterior maxillary atrophy in particular presents a challenge for implant-supported dental rehabilitation. The discovery of the zygomatic implant by Branemark and its modifications has brought a much-needed window of hope to most patients with atrophic maxilla. The conventional approach to is believed to be the intra sinus technique but the use of the extra sinus zygomatic implants has advantages like reducing surgical time, the risk of sinus adverse events and improving surgical visualization. A systematic literature search in five databases: Proquest, Google Scholar, PubMed, OVID, Cochrane and a hand search of relevant scientific journals was performed. The meta-analysis done on the included five studies, revealed that the primary outcome, i.e, implant survival rate and prosthesis failure showed no statistically significant difference between the test and the control group. The overall difference between the control (intra sinus zygomatic implants) and test group (extra sinus zygomatic implant) was statistically significant for chronic sinusitis (p=0.0002) and periimplantitis (p=0.01). The use of the extra sinus technique for the placement of zygomatic implants simplified the surgical procedure, improved the prosthetic outcome and reduced the risk of sinusitis and periimplantitis as compared to conventional or intra sinus technique of zygomatic implant placement.

Crowns and Bridges Failure: Reasons and Type of Disassembly

Background: Crowns and fixed partial dentures are widely used for esthetics and function all over the world. During their service life such prostheses fail for various reasons where a need arise for removal or disassembly. Objectives: Objective of the study was to determine the reasons and types of crown and fixed partial denture disassembly.Materials and Methods: This cross-sectional study was conducted at Prosthodontics Department, Peshawar Dental College, Peshawar from April 1st 2022 to September 28th 2023. A total of 140 patients including males and females, who reported to department for disassembly of their failed metal-ceramic crowns and bridges, were included in the study. Fixed prostheses already decemented and who reported for re-cementation were excluded. Before performing disassembly of prostheses data was recorded about the age, gender, service life of prosthesis, location in either arch, place of preparation and reasons for removal. At the end technique of removal was observed to categorize it as conservative, semi-conservative and destructive. Frequencies and percentages were calculated for various variables of the study.Results: The study had 46% males (n=65) and 54% female (n=75) with a ratio of 0.85. Patients had an age ranging from 20 to 65 years (mean 44 years, SD ± 13.8 years). Failed crowns were more than bridges. Failed prostheses were found more in mandibular arch (59%, n=83) and mostly in posterior segments (74%, n=103) of arches. Majority of prostheses were porcelain fused to metal and biological failure (66%, n=93) was the main reason for prosthesis disassembly. In more than two thirds of cases prostheses were removed conservatively. Conclusions: Carious and pulpal involvement of abutments teeth was the main reason for removal of majority of porcelain fused to metal restorations. In majority of cases disassembly was performed conservatively.Keywords: Crown/bridge disassembly, Fixed partial dentures, Prosthesis failure, Survival of crown/ bridges

Tibio-Talo-Calcaneal Arthrodesis: Evaluation of the Effectiveness of a Specific Surgical Technique in 17 Cases.

Ankle arthrodesis is a crucial surgical intervention for advanced hindfoot conditions, aiming to restore plantigrade walking and alleviate pain. This study evaluates the effectiveness of a specific surgical approach for tibiotalocalcaneal arthrodesis (TTCA), focusing on rigorous risk factor control, corticocancellous grafting, and internal fixation using an angled retrograde femoral nail in the sagittal plane, and assesses the outcomes of this approach in terms of bone fusion and reduction of postoperative complications. This retrospective analysis includes 17 patients who underwent TTCA in a trauma-orthopedic department over seven years. Data were collected from medical records, the HOSIX software, and patient consultations. Preoperative assessments, surgical techniques, postoperative care, and follow-up evaluations were documented. The mean age of patients was 42.4 years, with a male predominance. Surgical indications included post-traumatic arthropathy (53%), inflammatory arthropathy, ankle infectious pathologies, and Charcot footand ankle prosthesis failures. All patients underwent standard preoperative evaluations and received corticocancellous grafts. An angled retrograde femoral nail in the sagittal plane was used for internal fixation. Postoperative immobilization lasted 6 to 8 weeks, with subsequent rehabilitation. The bone fusion rate was 100%, with a low complication rate (23.5%). Our study showed a younger patient population with a male predominance, different from some previous studies. Surgical techniques, including the anterior approach combined with a lateral subtalar approach, were consistent with some studies but differed from others. Corticocancellous grafts and the angled retrograde femoral nail in the sagittal plane demonstrated favorable outcomes in terms of fusion. Complication rates were lower compared to some previous reports, highlighting potential improvements in postoperative management. The surgical approach described for TTCA, emphasizing rigorous risk factor control, corticocancellous grafting, and internal fixation using an angled retrograde femoral nail in the sagittal plane, led to satisfactory bone fusion and reduced postoperative complications. These results underscore the importance of this approach in achieving optimal functional outcomes in ankle arthrodesis.

Transcatheter heart valve explant with infective endocarditis-associated prosthesis failure and outcomes: the EXPLANT-TAVR international registry.

Surgical explantation of transcatheter heart valves (THVs) is rapidly increasing, but there are limited data on patients with THV-associated infective endocarditis (IE). This study aims to assess the outcomes of patients undergoing THV explant for IE. All patients who underwent THV explant between 2011 and 2022 from 44 sites in the EXPLANT-TAVR registry were identified. Patients with IE as the reason for THV explant were compared to those with other mechanisms of bioprosthetic valve dysfunction (BVD). A total of 372 patients from the EXPLANT-TAVR registry were included. Among them, 184 (49.5%) patients underwent THV explant due to IE and 188 (50.5%) patients due to BVD. At the index transcatheter aortic valve replacement, patients undergoing THV explant for IE were older (74.3 ± 8.6 vs. 71 ± 10.6 years) and had a lower Society of Thoracic Surgeons risk score [2.6% (1.8-5.0) vs. 3.3% (2.1-5.6), P = .029] compared to patients with BVD. Compared to BVD, IE patients had longer intensive care unit and hospital stays (P < .05) and higher stroke rates at 30 days (8.6% vs. 2.9%, P = .032) and 1 year (16.2% vs. 5.2%, P = .010). Adjusted in-hospital, 30-day, and 1-year mortality was 12.1%, 16.1%, and 33.8%, respectively, for the entire cohort, with no significant differences between groups. Although mortality was numerically higher in IE patients 3 years postsurgery (29.6% for BVD vs. 43.9% for IE), Kaplan-Meier analysis showed no significant differences between groups (P = .16). In the EXPLANT-TAVR registry, patients undergoing THV explant for IE had higher 30-day and 1-year stroke rates and longer intensive care unit and hospital stays. Moreover, patients undergoing THV explant for IE had a higher 3-year mortality rate, which did not reach statistical significance given the relatively small sample size of this unique cohort and the reduced number of events.

Exercise and Pain Neuroscience Education for Patients With Chronic Pain After Total Knee Arthroplasty

Up to 20% of patients develop chronic pain after total knee arthroplasty (TKA), yet there is a scarcity of effective interventions for this population. To evaluate whether neuromuscular exercise and pain neuroscience education were superior to pain neuroscience education alone for patients with chronic pain after TKA. A superiority randomized clinical trial was conducted at 3 outpatient clinics at Aalborg University Hospital in Denmark. Participants with moderate-to-severe average daily pain intensity and no signs of prosthesis failure at least 1 year after primary TKA were included. Participant recruitment was initiated on April 12, 2019, and completed on October 31, 2022. The 12-month follow-up was completed on March 21, 2023. The study included 24 sessions of supervised neuromuscular exercise (2 sessions per week for 12 weeks) and 2 total sessions of pain neuroscience education (6 weeks between each session) or the same pain neuroscience education sessions alone. The interventions were delivered in groups of 2 to 4 participants. The primary outcome was change from baseline to 12 months using the mean score of the Knee Injury and Osteoarthritis Outcome Score, covering the 4 subscales pain, symptoms, activity of daily living, and knee-related quality of life (KOOS4; scores range from 0 to 100, with higher scores indicating better outcomes). The outcome assessors and statistician were blinded. All randomized participants were included in the intention-to-treat analysis. Among the 69 participants (median age, 67.2 years [IQR, 61.2-71.9 years]; 40 female [58%]) included in the study, 36 were randomly assigned to the neuromuscular exercise and pain neuroscience education group, and 33 to the pain neuroscience education-alone group. The intention-to-treat analysis showed no between-group difference in change from baseline to 12 months for the KOOS4 (7.46 [95% CI, 3.04-11.89] vs 8.65 [95% CI, 4.67-12.63] points; mean difference, -1.33 [95% CI, -7.59 to 4.92]; P = .68). Among the 46 participants who participated in the 12-month assessment in the 2 groups, 16 (34.8%) experienced a clinically important improvement (a difference of ≥10 points on the KOOS4) with no between-group difference. No serious adverse events were observed. In this randomized clinical trial, the results demonstrated that neuromuscular exercises and pain neuroscience education were not superior to pain neuroscience education alone in participants with chronic pain after TKA. Approximately one-third of the participants, regardless of intervention, experienced clinically important improvements. Future studies should investigate which patient characteristics indicate a favorable response to exercises and/or pain neuroscience education. ClinicalTrials.gov Identifier: NCT03886259.

Immediate Loading of 3-Unit Posterior Fixed Dental Prostheses on 3 Vs 2 Implants, Comparison and Evaluation with up to 10-Year Follow-up.

The aim of this prospective study was to evaluate and compare the implant survival rate, marginal bone levels and prostheses failure rate, of three-unit fixed dental prostheses (FDPs) supported by three vs. two implants immediately loaded in the posterior area. Partially edentulous patients in need of a three-unit implant supported FDP in the maxillary/mandibular posterior region were recruited and randomly split into two groups: Group 1 with three-unit FDP supported by three implants (Control); Group 2 with three-unit FDP supported by two implants (Test). Implants were inserted and immediately loaded with a temporary FDP. Sixty-three patients were included in the study. A total of 178 implants were placed and immediately loaded (128 maxillary/50 mandibular) to support 74 immediate provisional fixed prostheses (52 maxillary and 22 mandibular) delivered on the same day of implant insertion/placement; 30 in Group 1 and 44 in Group 2. The comparison of three vs. two implants resulted in comparable implant survival rate, marginal bone loss, and prostheses failure rate. All implants healed uneventfully with no adverse clinical and radiographical signs or symptoms except for one implant failure in Group 1 resulting in a cumulative success rate of 99,5%, 98,9% for Group 1 and 100% for Group 2 with a follow-up of 6-to-10 (mean 7 years). Once loaded, the implants remained in function from a minimum of 6 years to 10 years. Although more studies and larger sample sizes are needed to validate this study, the results showed no difference between the two Groups, demonstrating the potential viability of both clinical options.