Prosthesis Group Research Articles

Kırk Yedi Hastada Fiksasyon veya Endoprotez ile Proksimal Femur Metastazı Tedavisi

Objective: Purpose of the present study was to compare patients with proximal femur metastasis with actual or impending fractures who were treated by fixation or prosthetic hip replacement. Method: Twenty-seven patients underwent fixation treatment (IM nail, DHS), and 20 patients prosthetic (endoprosthesis or total hip arthroplasty) replacement. Data were analyzed regarding patient demographics, cancer type, localization and type of metastasis, actual or impending fracture, number of bone metastasis, presence of spinal or visceral metastasis and treatment data (ASA class, length of hospital stay or surgery or survival, cement usage, adjuvant treatment, postoperative walking status). Results: Fixation group (63 years) was younger than prosthesis group (70 years) (p: 0.03). Fixation was more preferred at subtrochanteric area (p˂0.001). Cementation of the lesion was more preferred and surgery time was longer at fixation group (p: 0.01). Greater number of complications (mostly medical) were more likely to be seen in the fixation group (6 ‘1 loosening’ vs 3 ‘1 dislocation’). Conclusion: It is not still clear whether one implant is clearly superior to other one, however it was revealed again that nailing was mostly preferred for the subtrochanteric area and tended to have more complications although mostly medical and unrelated to implant placement as previously reported

Comparison of clinical efficacy of femoral calcar prosthesis replacement and intramedullary nail in the treatment of elderly patients with intertrochanteric fracture

To analyze the clinical efficacy of hip arthroplasty with femoral calcar prosthesis and proximal femoral nail fixation(PFNA) in the treatment of elderly patients(≥80 years old) with unstable intertrochanteric fractures(Evans Ⅲ, Ⅳ). From June 2016 to March 2018, 60 elderly patients with unstable intertrochanteric fractures treated with prosthetic replacement and PFNA were retrospectively analyzed. According to the surgical methods, they were divided into PFNA group and prosthesis group. In PFNA group there were including 21 males and 15 females, with an average age of(84.3± 2.9) years old;in the prosthetic group, there were 10 males and 14 females with an average age of (82.9±2.4) years old. The operation time, hemoglobin difference between preoperative and postoperative 1 day, postoperative ambulation time, hospitalization time and complications were observed and compared between the two groups. Harris hip score was performed 3 and 12 months after operation. All patients were followed up for 12 to 24 months (19.3±4.8) months. One patient in the prosthesis group died of lung cancer one year later and the follow-up was terminated. The operation time of prosthetic group was longer than that of PFNA group(P<0.05);hemoglobin difference before and after operation had no difference between prosthetic group and PFNA group(P>0.05);the time of ambulation in prosthetic group was earlier than that in PFNA group(P<0.05); the number of complications in prosthetic group was less than that in PFNA group(P<0.05);there was no significant difference in Harris score between prosthetic group and PFNA group before treatment, but scores of both groups were significantly increased after treatment (P <0.05). After 3 months of follow-up, the score of prosthesis group was higher than that of intramedullary nail group(P<0.05), but there was no significant difference at 12 months after operation(P>0.05). The elderly patients with intertrochanteric arthroplasty can reduce the burden of intertrochanteric arthroplasty and improve the quality of life.

Voice Onset Time in Patients Using Speech Prosthesis After Total Laryngectomy

Our study was carried out to investigate the presence of known differences in voice and articulation quality after total laryngectomy. Patients provided phonation with tracheoesophageal speech prosthesis. We recorded patients' voice onset time (VOT) values - an important parameter of acoustic analysis. The study included 18 patients with total laryngectomy who received valvular speech prosthesis via a primary or secondary tracheoesophageal fistula between 2009 and 2011 at the Istanbul Training and Research Hospital Otorhinolaryngology Clinic. Twenty healthy male volunteers were included as the control group. All subjects produced the /pa/, /ta/, /ka/ syllables three times, and the VOT values were determined by recording the voices on a computer. A total of 38 male patients, 18 of which were patients with total laryngectomy and tracheoesophageal speech prosthesis (aged between 46 and 75 years, mean: 59) and 20 controls (aged between 50 and 70 years, mean: 58), were included in the study. The age distribution of the groups did not differ statistically (P > 0.05). In the total laryngectomy and tracheoesophageal speech prosthesis group, the VOT mean values of the /ka/ syllable were significantly lower than the control group, whereas the /pa/ (P=0.848) and /ta/ VOT mean values (P=0.809) were similar between groups. This study shows that there is no significant difference in the articulation of voiceless plosives, except for the /ka/ sound, between patients using speech prostheses after total laryngectomy and controls. For standardization of these measured values and their use in clinical practice, it may be beneficial to support this study with studies that involve more patients and examine different indicators showing the quality and intelligibility of other voice characteristics.

Comparison of long-stemmed cementless hemiarthroplasty with proximal femur nail in unstable intertrochanteric femur fractures over 85 years of age

Aim: The most appropriate treatment option for intertrochanteric femoral fractures is still controversial. While there are articles showing that proximal femoral nails are superior to partial prostheses, other studies claim that partial prostheses result in better patient outcomes. We aimed to compare long-stemmed cementless hemiarthroplasty (LFS-BPH) and proximal femur nail (PFN), which are the treatment options applied in unstable intertrochanteric hip fractures in patients over 85 years of age. Methods: The records of 64 patients with unstable intertrochanteric femur fractures who were operated between May 2016 and December 2018 in the Orthopedics and Traumatology Clinic of Maltepe University Medical Faculty Hospital were evaluated. A retrospective cohort study was conducted and 42 patients who met the inclusion criteria were included in the study. The patients were divided into 2 groups as the proximal nail group and the prosthesis group, and evaluated in terms of total hospitalization time, operation time, amount of blood transfusion, time until the patient walked independently, postoperative complications, and Harris hip scores. Results: There were statistically significant differences in favor of the PP group in terms of total length of stay, fully independent mobilization time, deep vein thrombosis and decubitus development in the postoperative period. There was no difference between LFS-BPH and PFN in terms of total hospitalization time, blood transfusion amount, and Harris hip scores in unstable intertrochanteric hip fractures occurring above 85 years of age. Conclusion: LFS-BPH was superior to PFN in terms of operation time, early independent mobilization, reduction of deep vein thrombosis and decubitus development rate in the postoperative period.

Quality of life of persons with transfemoral amputation: Comparison of socket prostheses and osseointegrated prostheses.

Until recently, no study had compared the quality of life of persons with transfemoral amputation treated with osseointegration to socket prosthesis users. Comparison of quality of life in two types of prostheses users: a cohort of patients with osseointegration and patients equipped with a socket prosthesis who were group-matched for age, body mass index and mobility grade. A cross-sectional study that compared METHODS:: The quality of life of 39 participants (22 in the osseointegration group and 17 in the socket prosthesis group) was measured using the Questionnaire for Persons with Transfemoral Amputation (Q-TFA) and European Questionnaire 5-dimension 3-level (EQ-5D-3L) surveys. Compared with the socket prosthesis group, the osseointegration group had a significantly higher 'Global' score (p = 0.022) and a significantly lower 'Problem' score (p < 0.001) of the Q-TFA. The 'Mobility' (p = 0.051) and 'Use' scores (p = 0.146) of the Q-TFA, the EQ-5D-3L index (p = 0.723), and EQ-5D visual analog scale (p = 0.497) showed no significant differences between groups. Patients with osseointegration experienced less prosthesis-associated problems than socket prosthesis users and had a higher prosthesis-associated quality of life when assessed with the Q-TFA. General quality of life, as assessed with the EQ-5D-3L, was not different between groups.

In patients undergoing dialysis who require a valve replacement is a bioprosthetic valve superior to a mechanical prosthesis in terms of long-term survival and morbidity?

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'In [dialysis patients undergoing a valve replacement] is [a bioprosthetic valve superior to a mechanical prosthesis] for [long-term survival and morbidity]'. Altogether more than 501 papers were found using the reported search, of which five represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. There was limited high-quality evidence with all studies being retrospective. One meta-analysis and four cohort studies provided the evidence that there was no significant difference in long-term survival based on prosthesis type. However, the majority of studies demonstrated a significantly higher rate of valve-related complications including bleeding and thromboembolism, and readmission to hospital in the mechanical valve prosthesis group, likely related to the requirement for long-term anticoagulation. We conclude that overall long-term survival in dialysis-dependent patients is poor. While prosthesis type does not play a significant contributing role to long-term survival, bioprosthetic valves were associated with significantly fewer valve-related complications. Based on the available evidence, a bioprosthetic valve may be more suitable in this high-risk group of patients as it may avoid the complications associated with long-term anticoagulation without any reduction in long-term survival.

Comparison of short-stem with conventional-stem prostheses in total hip arthroplasty: an 8-year follow-up study

PurposeCoxarthrosis is a common disease of the adult hip joint. Elderly patients have mainly been treated with total hip arthroplasty (THA); however, younger patients are increasingly affected. Short-stem prostheses were developed for this special patient group. There have been few studies on the clinical outcomes of this type of prosthesis. This study compared the mid-term results of a short-stem prosthesis and a standard-stem prosthesis 8 years after implantation.MethodsAccording to our clinical registry, patients who received a short-stem prosthesis before 2011 were identified. Patients in the standard-stem prosthesis group were matched based on the sex, age, height, weight, and degree of arthrosis. At the follow-up time, the modified Harris Hip Score (mHHS), University of California Los Angeles (UCLA) activity score and visual analog scale (VAS) pain score were collected and compared with the preoperative values.ResultsFifty-five patients could be matched and analyzed for both groups. No patients needed revision surgery. In both groups, there were significant improvements at the follow-up time. The pre- and postoperative mHHSs, UCLA scores, and VAS scores were 41.9 and 95 (p < 0.0001), 3.75 and 7.9 (p < 0.0001), and 7.6 and 0.9 (p < 0.0001), respectively, in the short-stem group and 44.8 and 96.25 (p < 0.0001), 3.6 and 7.7 (p < 0.0001), and 7.7 and 0.9 (p < 0.0001), respectively, in the control group, with no significant differences between the groups at the follow-up time.ConclusionThe short-stem prosthesis provides mid-term results comparable to those of a standard-stem prosthesis. In both groups, excellent patient-reported outcomes were achieved after an average of 8 years.Level of evidenceIV.

Total arthroplasty with Ivory\xae prosthesis versus resection\u2013suspension arthroplasty: a retrospective cohort study on 82 carpometacarpal-I osteoarthritis patients over 4 years

BackgroundTo elucidate the performance of carpometacarpal-I joint prostheses in comparison with the current gold standard treatment, resection–suspension arthroplasty (RA), we conducted a study comparing outcomes of the Ivory prosthesis to those of a cohort of patients receiving RA.MethodsInitially, we had enrolled 34 prosthesis patients and 48 RA patients, of which 5 and 11 were lost to follow-up. We defined Eaton/Littler stage 3 osteoarthritis, no previous surgery, no concomitant arthrosis, no rheumatic arthritis, no history of trauma and a minimum follow-up period of 2 years as inclusion criteria. We assessed patient demographics, disability of the arm, shoulder, and hand score, pain via visual analogue scale, subjective strength of the thumb, range of motion (radial and palmar abduction and opposition), and patient satisfaction. All occurring complications were recorded.ResultsFollow-up included a mean period of 4.5 years (2–7.4) in the prosthesis cohort and 4.1 years (2–6.8) in the RA group. Disability of the arm, shoulder, and hand scores, pain scores, palmar abduction and opposition, and subjective satisfaction showed no significant differences between the two cohorts. Postoperative loss of strength was significantly less in the prosthesis group (p = 0.01). Moreover, we were able to demonstrate better range of motion in terms of radial abduction in the prosthesis group (p = 0.001). The overall complication rate was significantly higher in the prosthesis cohort (41.4% vs. 10.8%) (p = 0.008). Nevertheless, the Ivory prosthesis group showed a survival rate of 93.1%.ConclusionAs the high complication rate is compensated by a better functional outcome (enhanced range of motion and strength), we believe that prosthesis implantation can be a reasonable treatment option for carpometacarpal-I osteoarthritis in a particular patient group.Level of Evidence IIIl: Retrospective cohort study.

Results of the Total Hip Arthroplasty Using 3D Printing Technology

Objectives: To study the value of 3D printing of custom THA femoral prostheses with conventional femoral prostheses in total hip arthroplasty for severe hip deformity. Methods: Total hip arthroplasty was used in the treatment of 107 severe hip joint deformity cases from June 2018 to June 2019. Fifty-six patients received conventional hip replacement stems and 51 patients received a custom 3D printed hip replacement stem designed to address their proximal deformity and leg length discrepancy. The operation time, intraoperative blood loss, postoperative weight-bearing time, Harris score before and after the operation, complications after surgery and the main angle measurement of compared to their contralateral hip were evaluated to determine the short-term efficacy of 3D printed total hip replacement femoral prosthesis compared to the common total hip replacement femoral prosthesis. Results: A total of 107 patients were followed up for an average of 12 months. The use of 3D printing technology in the preoperative design and custom prosthesis fabrication was associated with shortened operation time, less intraoperative blood loss, quicker time to postoperative full weight-bearing, and improved the Harris score in 1 year after the operation compared to conventional total hip replacement stem (p&lt;.05). Our results revealed that there was a significant reduction in the femoral anteversion with a value of 13.06 ± 1.93 degrees (mean ± SD) in the custom prosthesis group compared to the conventional hip replacement group. However, there was no significant difference in neck-shaft angle, acetabular angle, and Sharp angle between both groups (p&gt;.05). Conclusion: 3D printing technology created a virtual and realistic simulation, and personalized operation plan for patients with severe hip deformity, which was helpful for surgical treatment. The anatomical characteristics of patients with complex deformities were better addressed using the 3D printed femoral component and resulting in better patient outcomes and provided a new option for surgeons to manage these difficult cases.

Thromboembolic Events in Patients with Concomitant Aortic Valve Surgery and Left Ventricular Assist Device Implantation, an IMACS Database Analysis

Patients with significant aortic regurgitation at time of left ventricular assist device (LVAD) implantation, frequently need concomitant aortic valve (AV) replacement (AVR) or AV repair. The aim of this study was to investigate the risk for thromboembolic events (TE) in patients with concomitant continuous-flow LVAD and AV surgery. We used the international multicenter registry data from the International Society of Heart and Lung Transplantation Mechanically Assisted Circulation Support (IMACS) registry of LVAD patients, implanted between January 2013 until September 2017. Differences between AVR, AV repair and non-AVR/repair patients were analyzed. In total, 785 (5.1%) out of the total 15267 patients (mean age 56±13 years, 79% male) received concomitant AVR/repair during LVAD surgery (mean age 60±11 years, 89% male); 386(2.5%) patients had biological prosthesis, 71 (0.5%) mechanical prosthesis and 328 (2.1%) AV repair. Follow-up was complete in 644 out of 785 (82%) patients, with a median follow-up of 11.8 months [IQR 4.8-23.4]. In total, TE occurred in 3135 cases; 2976 out of 12317 (24%) in patients without AV surgery, 73 out of 316 (23%) with a biological prosthesis, 73 out of 267 (27%) with an AV repair, and 13 out of 61 (21%) with mechanical prosthesis. The Figure shows that early (90-day) post LVAD, TE rate was significantly higher in the mechanical prosthesis group compared to the remaining cohort. However, at 2-years of follow-up, none of the concomitant surgery modalities were associated with higher TE rates. In patients treated with concomitant AVR or AV repair during LVAD surgery, a significant higher rate of early TE's was found in the mechanical prosthesis group. However, after 2-year follow-up, this differences was no longer significant. Caution in the early postoperative period is warranted when concomitant mechanical prosthesis is scheduled.

Periodontal health in shortened dental arches: A 10-year RCT

Purpose: This analysis focused on periodontal health in shortened dental arches (SDAs). Methods: In a randomized controlled clinical trial, patients with missing molars in one jaw and at least one premolar and canine on both sides were eligible for participation. In the partial removable dental prosthesis (PRDP) group (n = 79), molars were replaced with a precision attachment retained PRDP. In the SDA group (n == 71), the SDA up to the second premolars was either left as is or restored with fixed dental prostheses. Outcome variables were vertical clinical attachment loss (CAL-V), pocket probing depth (PPD), bleeding on probing (BOP) and plaque index (PLI). For CAL-V and PPD, the changes at six measuring points per tooth were analyzed. For BOP and PLI, patient related rates were calculated for each point in time. Statistical methods included linear regression analyses. Results: In the intention-to-treat (ITT) analysis for CAL-V in the study jaw, the 10 year patient related mean changes were 0.66 mm in the PRDP group and −0.13 mm in the SDA group. The resulting mean patient related group difference of 0.79 mm (95% CI: 0.20 mm–1.38 mm) was significant (p = 0.01). There were no significant differences in the ITT analyses for PPD. For BOP and PLI, significant group differences with more favorable results for the SDA group were found. Conclusions: In view of lacking substantial differences for CAL-V and PPD, the overall differences were considered of minor clinical relevance. The results add confirmatory evidence to the shortened dental arch concept and its clinical viability (controlled-trials.com ISRCTN97265367).

A retrospective comparative cohort study of radial head arthroplasty versus resection in complex elbow dislocations

IntroductionThe management of radial head fractures for the treatment of complex elbow dislocations remains controversial. Until the publication of recent therapeutic algorithms, different actions have been carried out, including resection or arthroplasty of the radial head. This study aims to compare the clinical and radiological results of these two techniques. Materials and MethodsA retrospective study was conducted between the years 2001 and 2016 in complex elbow dislocations associating comminuted fractures of the radial head (Mason type IV) for two cohorts: 20 patients who received a radial head prosthesis against 12 patients treated with resection. At the end of the follow-up, two functional valuation scales were applied: Mayo Elbow Performance Score (MEPS) and Disabilities of the Arm, Shoulder and Hand score (DASH). Radiological study included the presence of post-traumatic osteoarthritis and heterotopic ossifications in both groups; and specific complications in the group of patients treated with an arthroplasty. ResultsThe average age of the sample was 52.2 years in the prosthesis group, and 58.5 for the resection group, with a mean follow-up of 83.8 and 163 months respectively. No statistically significant differences were found in the mean values of the MEPS scale between the two groups (p = 0.5). The mean DASH score was significantly higher in the resection group (29.8 versus 10.3 with p = 0.006). A significantly higher rate of reinterventions and heterotopic ossifications was documented in the group of patients treated with radial head excision. The rate of specific radiological complications in the prosthesis group was 45%. ConclusionsAlthough radial head resection could be a valid treatment in this group of patients, radial head arthroplasty would remain as the main option for the treatment of these lesions. Level of Evidence: Level IV; Case Series; Treatment Study

The functional outcomes and complications of different reconstruction methods for Giant cell tumor of the distal radius: comparison of Osteoarticular allograft and three-dimensional-printed prosthesis

BackgroundEn bloc excision has been increasingly used for the management of giant cell tumors (GCTs) in the distal radius. An osteoarticular allograft has been used extensively for decades, and custom-made prosthesis reconstruction has been more recently applied. We aimed to compare the clinical outcomes of the two procedures.MethodsWe retrospectively analyzed 30 patients with Campanacci III or recurrent GCTs of the distal radius for follow-up at a mean of 33.2 months. In total, 15 underwent osteoarticular allograft reconstruction (allograft group) and 15 received cementless three-dimensional (3D)-printed prosthesis reconstruction (prosthesis group) between March 18, 2013, and May 20, 2018. All patients underwent by clinical and radiological examinations, including pre- and postoperative active range of motion (ROM) of the wrist, VAS score, grip strength, degenerative change of wrist, Mayo wrist score and Musculoskeletal Tumor Society (MSTS) score. Complications were evaluated using the Henderson classification.ResultsBoth groups showed significantly increased ROM, grip strength, Mayo score and MSTS score postoperatively. Furthermore, the extension, flexion, MSTS, and Mayo score were significantly higher in the prosthesis group. There was no significant difference in grip strength and VAS between the groups. In allograft group, one patient had a late infection one had resorption of allograft without allograft bone fracture. and four had wrist subluxation. All patients had degenerative changes (mean 9 months). In the prosthesis group, three patients developed wrist subluxation, three had separation of the distal radioulnar joint, and none of the patients developed wrist degeneration.ConclusionsOur study compared the objective functional outcomes and complications of two reconstructive methods for Campanacci III or recurrent GCT in the distal radius. 3D-printed prosthesis replacement can partially preserve wrist function better than allograft reconstruction in the short-term. During the design of 3D-printed prosthesis, preoperative morphological assessment of the affected proximal row carpal is helpful to control postoperative dislocation. After allograft reconstruction, wrist degeneration, which has been demonstrated in all patients, severely influence their wrist function. Therefore, compared to allograft reconstruction, 3D-printed prosthesis reconstruction has irreplaceable advantages at early-stage application, especially in wrist function, however, further studied with a larger number of cases and longer follow-up.

The Effect of Footprint Mismatch on Heterotopic Ossification After Cervical Disk Replacement.

This was a retrospective study. The objective of this study was to analyze risk factors of heterotopic ossification (HO) after cervical disk replacement (CDR) and evaluate the effect of footprint mismatch on HO. Incidence of HO after CDR is high, but the exact related factors have not been fully elucidated. Radiographic data of patients who had undergone CDR with Prestige LP or Discover prosthesis in Tongji Hospital from July 2012 to December 2015 were reviewed. HO was graded according to McAfee classification and classified according to Jin morphologic classification. Footprint matching degree was evaluated using 3-dimensional computed tomographic images. Cervical sagittal alignment, functional spinal unit height, and range of motion were measured on radiographs. Preexisting degeneration was scored using Walraevens scoring system. Postulated risk factors including general factors, cervical sagittal alignment, functional spinal unit height, range of motion, postoperative biomechanical changes, preexisting degeneration, number of surgical levels, prosthesis type, use of nonsteroid anti-inflammatory drugs, and footprint matching degree were analyzed by first univariate tests, and then multivariate logistic regression was done to examine the relation with HO occurrence. Effect of footprint mismatch on type 1 HO of morphologic classification was evaluated. Data of 46 patients were collected; 43 were finally evaluated with a total 57 prostheses implanted, with a mean follow-up duration of 41.16±12.49 months. No significant differences in basic characteristics existed between 2 prosthesis groups, except follow-up time. Incidence of HO was 66.7%. Mean footprint matching degree in sagittal plane was 0.877±0.068 and in coronal plane was 0.852±0.092. Mean overall footprint matching degree was 0.699±0.102 (range: 0.388-0.993). Prosthesis type and footprint matching degree were significantly related with HO among all postulated risk factors in both univariate and multivariate analyses (P<0.05); the latter had larger Exp(B). Type 1 HO occurrence significantly related with footprint mismatch. Incidence of HO after CDR was high, and serious footprint mismatch existed. HO occurrence was significantly related with prosthesis type and footprint matching degree; the latter played a more important role.

Laboratory Evaluation of Novel Implant Metal-Acrylic Prosthesis Design: Influence of Monolithic Acrylic Veneer.

To test a novel implant metal-acrylic prosthesis design in comparison to a conventional prosthesis design through simulation of cyclic masticatory loading. The novel design involved digital designing and fabrication of the framework and the matched veneering acrylic resin material. Ten prostheses were fabricated for each group. All the prostheses exhibited a similar external design on two implants with a distal cantilever. The conventional group comprised a milled metal framework with mechanically retained acrylic denture teeth via vertical pins. The digital prosthesis group incorporated an inverted T-shape bar and a monolithic milled acrylic resin veneer. The resin veneer was subsequently adhesively attached on the bar. All prostheses were thermally aged and subjected to laboratory cyclic loading at the cantilever region. The load-to-failure and the number of cycles until failure were collected. Furthermore, failed specimens were analyzed to determine the mode of failure. The digital prostheses failed at significantly greater load-to-failure (1,570.0 N ± 116.0 N) and number of cycles (124,857 ± 21,608) than the conventional prostheses (load-to-failure = 1,015.0 N ± 47.4 N; number of cycles = 28,452 ± 6,559). The conventional prostheses failed by fracturing of the acrylic teeth and veneering material that led to exposure of the metal framework. Half of the digital prostheses failed by superficial chipping of the veneering material, while the other half failed by the deformation and fracture of screws. Within the limitations of this study, the digital prostheses with the novel design and monolithic veneering material showed significantly higher strength compared with the conventional prostheses. The mode of acrylic failure of the digital prostheses was more favorable.

Comparison of four-implant-retained overdentures and implant-supported fixed prostheses using the All-on-4 concept in the maxilla in terms of patient satisfaction, quality of life, and marginal bone loss: a 2-year retrospective study.

The purpose of the present study was to compare and assess maxillary edentulous patients treated with four-implant-retained overdentures and with implant-supported fixed prostheses using the All-on-4 concept in terms of patient satisfaction, oral health-related quality of life, and marginal bone loss. Thirty-three patients treated with either maxillary four-implant-retained overdentures (n = 15) or with maxillary implant-supported fixed prosthesis using the All-on-4 concept (n = 18) were compared in terms of patient satisfaction, quality of life, and marginal bone loss. Independent sample t test was used to compare the two groups in terms of satisfaction, OHIP-14 scores, and marginal bone loss. The paired sample t test was used to compare bone loss at different time intervals. The comparison of marginal bone loss with regard to implant location was accomplished with the one-way ANOVA test. P values of < .05 were considered as statistically significant. No statistically significant differences were found between the two groups' OHIP-14 scores (P > .05). When patient satisfaction scores were evaluated, hygiene maintenance (P = .001) and pain scores (P = .001) were significantly higher in the implant-retained overdenture group than in the implant-supported fixed prosthesis group (P < .05). No statistically significant difference was observed between axial and tilted implants at both the 12-month (P = .59) and 24-month (P = .77) follow-up periods in the implant-supported fixed prosthesis group. Four-implant-supported fixed prostheses with the All-on-4 concept and four-implant-retained overdentures present similar marginal bone loss and quality of life scores after 2 years of function. However, patients found overdentures easier to clean but more painful in comparison with the fixed prosthesis.

Proximal humeral osteolysis and glenoid radiolucent lines in an anatomic shoulder arthroplasty: a comparison of a ceramic and a metal humeral head component

In vitro wear studies demonstrate decreased polyethylene wear with a ceramic compared with a metal humeral head. In this invivo study, we analyzed prospectively collected 5-year data, comparing the outcomes of 2 types of humeral implants. Sixty-two anatomic total shoulder arthroplasties (TSAs) (59 patients) were performed using the same glenoid component and 2 types of modular humeral implants (metal-head long-stem prosthesis in group A vs. ceramic-head stemless prosthesis in group B). Radiographic analysis for proximal humeral osteolysis and glenoid component radiolucent lines was performed at an average of 5.5 years. Functional outcomes were prospectively evaluated according to the visual analog scale score for pain; satisfaction level; American Shoulder and Elbow Surgeons score; active elevation; Shoulder Pain and Disability Index score; and Disabilities of the Arm, Shoulder and Hand score. There were 39 TSAs in group A (mean age, 68.1 years) and 23 TSAs in group B (mean age, 67 years). Clinical improvement was similar for both groups. Some proximal humeral osteolysis occurred in 56% of all TSAs. Group A showed increased osteolysis compared with group B (72% vs. 30%, P = .005). Glenoid radiolucent lines were far more frequent in group A, and group A showed a direct relationship between the extent of humeral osteolysis and the severity of glenoid radiolucent lines (P < .001). The stemless ceramic-head replacements showed fewer glenoid radiolucent lines and less humeral osteolysis than the long-stem metal-head replacements. In the group with metal-head replacements, correlation was shown between glenoid radiolucent lines and humeral osteolysis.

Simple prosthesis versus prosthesis plus titanium-coated polypropylene mesh for implant-based immediate breast reconstruction after total mastectomy for breast cancer.

Our study compares the cosmetic effects, postoperative complications, and quality of life of immediate breast reconstruction with simple prosthesis or prosthesis plus titanium-coated polypropylene mesh (TCPM) after total mastectomy for breast cancer. In total, 69 patients who underwent total mastectomy, sentinel lymph node biopsy, and immediate prosthetic breast reconstruction from January 2015 to December 2018 in our hospital were selected, and their cosmetic effects, complications, and quality of life after reconstruction were recorded immediately after surgery and 6 months after surgery. Of these 69 patients, 29 were in the simple prosthesis group and 40 in the prosthesis + TCPM group. The incidence of surgical complications was 17.2% in the simple prosthesis group (5/29; including 4 cases of capsular contracture and 1 case of infection) 15.0% in the prosthesis + TCPM group (6/40; 1 case of flap necrosis, 2 cases of poor wound healing, 2 cases of hematomas, and 1 case of inadequate blood supply to nipple). The complications were successfully managed after symptomatic treatment in both groups. No prosthesis loss was noted. The incidence of postoperative complications showed there to be no significant differences between these two groups (P=0.06, χ2=0.80). The satisfaction rate of patients on cosmetic effects was 95.0% (38/40) in the prosthesis + TCPM group, significantly higher than that in the simple prosthesis group (75.90%, 22/29) (P=0.05, χ2=3.87). The quality of life in the simple prosthesis group at 2 weeks and six months after the operation was significantly lower than that in the prosthesis + TCPM group. The incidence rate of arm pain and fatigue at 2 weeks after operation was significantly higher than that in the prosthesis + TCPM group (P=0.04, χ2=4.42). The satisfaction of family life and sexual interest 6 months after the operation was also significantly lower in the simple prosthesis group than in the prosthesis + TCPM group (P=0.03, χ2=4.95). Breast reconstruction with prosthesis combined with TCPM does not increase surgical complications and has a good cosmetic effect and high patient satisfaction. Thus, it is a safe and reconstruction method.

Cervical radiculopathy: is a prosthesis preferred over fusion surgery? A systematic review

BackgroundMeta-analyses on the comparison between fusion and prosthesis in the treatment of cervical radiculopathy mainly analyse studies including mixed patient populations: patients with radiculopathy with and without myelopathy. The outcome for patients with myelopathy is different compared to those without. Furthermore, apart from decompression of the spinal cord, restriction of motion is one of the cornerstones of the surgical treatment of spondylotic myelopathy. From this point of view, the results for arthroplasty might be suboptimal for this category of patients. Comparing clinical outcome in patients exclusively suffering from radiculopathy is therefore a more valid method to compare the true clinical effect of the prosthesis to that of fusion surgery.AimThe objective of this study was to compare clinical outcome of cervical arthroplasty (ACDA) to the clinical outcome of fusion (ACDF) after anterior cervical discectomy in patients exclusively suffering from radiculopathy, and to evaluate differences with mixed patient populations.MethodsA literature search was completed in PubMed, EMBASE, Web of Science, COCHRANE, CENTRAL and CINAHL using a sensitive search strategy. Studies were selected by predefined selection criteria (i.a.) patients exclusively suffering from cervical radiculopathy), and risk of bias was assessed using a validated Cochrane Checklist adjusted for this purpose. An additional overview of results was added from articles considering a mix of patients suffering from myelopathy with or without radiculopathy.ResultsEight studies were included that exclusively compared intervertebral devices in radiculopathy patients. Additionally, 29 articles concerning patients with myelopathy with or without radiculopathy were studied in a separate results table. All articles showed intermediate to high risk of bias. There was neither a difference in decrease in mean NDI score between the prosthesis (20.6 points) and the fusion (20.3 points) group, nor was there a clinically important difference in neck pain (VAS). Comparing these data to the mixed population data demonstrated comparable mean values, except for the 2-year follow-up NDI values in the prosthesis group: mixed group patients that received a prosthesis reported a mean NDI score of 15.6, indicating better clinical outcome than the radiculopathy patients that received a prosthesis though not reaching clinical importance.ConclusionsACDF and ACDA are comparably effective in treating cervical radiculopathy due to a herniated disc in radiculopathy patients. Comparing the 8 radiculopathy with the 29 mixed population studies demonstrated that no clinically relevant differences were present in clinical outcome between the two types of patients.Graphic abstractThese slides can be retrieved under Electronic Supplementary Material.

P3663Prevalence of infective endocarditis in patients with a left-sided heart valve prosthesis: a nationwide study

Abstract Background Increasing attention has been given to patients with blood stream infection (BSI) and the concurrent prevalence of infective endocarditis (IE). However, there exist a gap in knowledge on the prevalence of IE among patients with a left-sided heart valve prosthesis and BSI. Purpose To examine the prevalence between different BSI and IE in patients with a left-sided heart valve prosthesis. Methods By linking Danish nationwide registries, we were able to identify patients with a left-sided prosthetic heart valve and first-time BSI of interest (Enterococcus faecalis, Staphylococcsus aureus, streptococci species (spp.), and coagulase negative staphylococci [CoNS]) in the period of 2010–2016. Concurrent admission for IE was identified from the Danish National Patient Registry in a period of up to 14 days after the BSI. Results A total of 1,465 patients with BSI were included (1,319 patients with an aortic valve prosthesis [82.6% bioprosthetic] and 146 patients with a mitral valve prosthesis [48.6% bioprosthetic]). Among the included patients, 244 had E. faecalis (median age: 78.3 years, 77.0% male), 301 had S. aureus (median age: 76.9 years, 69.1% male), 401 had streptococci spp. (median age: 78.0 years, 69.1% male) and 519 had CoNS (median age: 76.4 years, 64.2% male). The percentage of patients with a diagnosis of IE in relation to the BSI was 44.3%, 33.6%, 34.4%, and 7.9% for E. faecalis, S. aureus, streptococci spp., and CoNS, respectively. No difference in the overall results was seen by type of valve prosthesis, sex, or age group. Percentage of patients with endocarditis Conclusion In patients with a left-sided heart valve prosthesis, IE was diagnosed in almost half of the patients with E. faecalis, in 1/3 with S. aureus or streptococci spp. and in 1 in 12 with CoNS BSI. Future studies may try to explain why some microbes are more likely to cause prosthetic heart valve endocarditis, than others are.