Removal Of Prosthesis Research Articles

Applying 3D-Printed Porous Ti6Al4V Prostheses to Repair Osteomyelitis-Induced Partial Bone Defects of Lower Limbs: Finite Element Analysis and Clinical Outcomes.

The clinical management of partial bone defects in lower limbs, particularly those resulting from osteomyelitis, remains a significant challenge. This study aimed to systematically evaluate the effectiveness of 3D-printed porous Ti6Al4V prostheses in addressing osteomyelitis-induced partial bone defects. We established a comprehensive protocol for utilizing 3D-printed prostheses for bone defect repair, encompassing 3D simulation of prosthesis implantation and internal fixation, finite element analysis (FEA), and clinical implementation. Mimics software facilitated simulation of fixation patterns and screw lengths. FEA modeled bone defects in the distal metaphyseal femur and distal diaphyseal tibia to assess changes in stress conduction pre- and post-prosthesis implantation. The clinical study involved eight patients (average age: 56.3 years) with an average defect length of 14.9 cm. Postoperative outcomes were evaluated using X-rays and the Lower Extremity Functional Scale (LEFS). FEA demonstrated that the implanted prostheses effectively shared stress and reduced the load on residual bone in both models, thus lowering the risk of fractures under external forces. The average follow-up period was 24.5 months, with patients initiating weight-bearing activities on average 7.8 days post-surgery. Serial postoperative X-rays demonstrated long-term stability of the prostheses, with progressive bone regeneration around and integration with the prostheses. While two patients experienced infection recurrence requiring prosthesis removal and debridement, the remaining six showed significant improvement in LEFS scores, increasing from 31.5 preoperatively to 61.0 at the last follow-up. 3D-printed porous Ti6Al4V prostheses effectively restore anatomical integrity and optimize stress conduction in lower limbs, resulting in substantial functional recovery. This innovative approach shows promise for wider clinical adoption and warrants further investigation in medical practice.

Revision of Press-Fit Bone-Anchored Prosthesis After Implant Failure.

The present video article describes the revision of a bone-anchored prosthesis in patients who received an osseointegration implant after transfemoral amputation. Clinical follow-up studies have shown that approximately 5% of all patients who receive press-fit cobalt-chromium alloy femoral implants experience failure of the intramedullary stem component as a result of septic loosening or stem breakage. For stem breakage, stem diameter and the occurrence of infectious events were identified as risk factors. We began regularly utilizing the standard German press-fit endo-exo cast cobalt-chrome implant in 2009, but changed to the forged titanium version in 2014 (BADAL X, OTN Implants) because of the breakages associated with the former implant. No breakages have been reported since making the switch, and as such we currently still utilize the titanium implant. Current Commission Européenne-certified bone-anchored implants for transfemoral amputation include a screw-type stem and a press-fit stem. The revision technique demonstrated in the present article may apply to both types of implant system, but this video is limited to demonstrating the use of a press-fit implant. We describe the 3 stages of debridement, removal, and subsequent implantation of a bone-anchored prosthesis in a revision setting. We perform this procedure in up to 3 stages, with 10 to 12 weeks between removal of the failed implant and implantation of the revision prosthesis. For stage 1, in case of mechanical failure, the broken remnants of the implant, which may dangle in the soft tissues, are removed. The stoma is debrided, after which spontaneous stoma healing is achieved. In cases of septic loosening, stage 1 includes removal of the implant by retrograde hammering, followed by multiple debridements with flexible reamers and jet lavage until negative cultures are obtained. In stage 2, the broken osseointegration implant is removed with use of a custom-made titanium water-cooled hollow drill. With the use of this drill, we have always been successful in removing the broken implant while maintaining sufficient bone stock for future implant revision. If the corer fails, a larger approach is needed to remove the implant. The corer drill should have a wall that is as thin but as robust as possible in order to avoid cortical perforation, and should be manufactured from a strong material in order to resist the usage against the implant. We utilized a steel corer when initially performing this procedure, which was frequently unsuccessful, necessitating a larger approach to remove the implant. We currently utilize a 3D-printed corer drill with integrated water-cooling system with greater success (Xilloc Medical). This corer is custom-made and needs about 6 weeks for designing and manufacturing. This tool is utilized in the present video article. Stage 3 includes revision implantation of an osseointegration prosthesis, utilizing similar templating as in the primary surgical procedure. The time needed for the bone to recover from explantation is arbitrary, but we allow around 2 to 3 months before implanting a new intramedullary component. In cases of poor bone stock, a bone impaction graft can be applied prior to insertion of revision implant. A return to the prior mobilization level is an alternative to revision of the failed implant. Failure due to stem breakage can occur in cases utilizing small-diameter cobalt-chromium implants. Such cases can be revised with use of large-diameter titanium implants, provided there is sufficient bone stock. Failure due to septic loosening may occur in patients who are not properly indicated for this procedure, such as those with severe dysvascular disease or diabetes mellitus. A revised implant is also at increased risk for recurrent failure. Revision of bone-anchored prostheses includes up to 3 stages depending on whether the revision is for septic loosening or stem breakage. Although we allow 10 to 12 weeks before implanting a new intramedullary component, the time needed for the bone to recover from the explantation is arbitrary. During this interval, a temporary socket can be manufactured to allow mobilization with use of an artificial limb; however, most patients use just crutches and/or a wheelchair during this interval. Be aware of the type of implant that needs to be removed.Prepare for long operative times, especially in cases in which implants need to be cut or when dense cortical bone is expected.Account for 1.5 to 2 mm of extra diameter of the coring drill on either side in order to allow for the curvature of the press-fit implant.Plan for and acquire the right tools. Make sure to have at least 2 corer drills present in case of damage or malfunction.Utilize a fluoroscope frequently during initial drilling around the stem remnant.In case of poor bone stock, prepare for future bone impaction grafting when planning for revision implantation of a bone-anchored prosthesis. OI = osseointegration implantBAP = bone-anchored prosthesisBIG = bone impaction grafting.

Periaortic gas and signs of dissection of amycotic aneurysm in the descending thoracic aorta due to Clostridium septicum

The case of 92-year-old male with ahistory of sepsis due to Clostridium septicum is described. Since the bacteria were also found at the site of joint aspiration, the patient underwent knee prosthesis removal. Due to the association between colorectal cancer and Clostridium septicum, acolonoscopy was performed. An adenocarcinoma was extracted in situ. At 5months, the patient presented again with shortness of breath, acute retrosternal pain and fever. CT revealed amycotic aneurysm of the descending aorta with StanfordB dissection and periaortic gas. Due to the fragility of the patient, conservative treatment was initiated.

Complex chest wall reconstruction after failure: a literature review.

Primary and secondary chest wall tumors (bone, breast, and soft tissue), congenital defects, and chest wall osteoradionecrosis often require extensive full-thickness local excisions to guarantee safe oncological margins (in cases of tumors) and complex reconstruction to provide stabilization and good biomechanical results avoiding postoperative respiratory failure. Thus, a personalized approach is required when dealing with chest wall defects, and reconstruction is planned. This review summarizes failed chest wall reconstruction procedures, identifies causes of failure, and highlights principles for complex chest wall reconstruction post-failure. We performed a narrative review of the literature on PubMed, Scopus, ScienceDirect, and Google Scholar, including all the relevant studies published from 1970. The available experiences in literature are only anecdotic and no current guidelines or rules exist on this topic, also given to its rarity. Proper pre-surgical planning and a multidisciplinary team (MDT) discussion are crucial for complex cases such as infections and radiation-induced chest ulcers after previous surgical treatment. Procedures should eventually include thoracic wall debridement, necrotic tissue excision, pulse-jet lavage, prosthesis removal, and vacuum assisted closure (VAC) therapy as a bridge for chest wall re-reconstruction. Sternotomy wounds require wire and prosthesis removal, and the use of meshes or bone allografts. This review aims to summarize experiences and highlight surgical and oncologic principles for complex chest wall reconstruction after failure. This review summarizes literature experiences to identify common key points for chest wall reconstruction after failure and to give some advice to surgeons managing this rare, challenging surgery.

Is it safe to implant a penile prosthesis in a solid organ transplant recipient? A systematic review.

Solid organ transplant recipients exhibit an elevated incidence of erectile dysfunction, attributed to comorbidities and specific factors associated with organ failure. While treatment mirrors the general population's, response rates are lower, and there is a heightened concern about implanting a penile prosthesis in immunocompromised patients due to the potential occurrence of severe complications. The aim of this study was to assess the safety of penile prostheses in this population. Among fourteen included studies, ten were case reports or series of cases, and four were non randomized case-control studies with non-transplanted patients as controls. Complications affected 34 patients (11.15%), with mechanical device failures in 18 cases (5.9%) and infections in 13 cases (4.26%). Most infections required hospitalization, antibiotic treatment, and prosthesis removal, with two cases of life-threatening Fournier's gangrene. Case-control studies revealed no differences in overall reoperation rates between transplant recipients and controls. However, pelvic organ transplant recipients undergoing three-piece prosthesis implantation showed higher complications rates related to reservoir issues. Despite limited evidence, case-control studies demonstrated a generally low/moderate risk of bias within each specific domain, although overall bias was moderate/severe. As a result, clinicians may mitigate concerns regarding penile prosthesis implantation in solid organ transplant recipients.

Complications of revision knee arthroplasty

Due to the growing scale of arthroplasty and the widening of indications for knee joint replacement, the durability of joint functioning has become a critical issue. Untimely diagnosis and inadequate treatment of patients with endoprosthesis component loosening leads to major bone defects. This problem arises from repeated joint interventions, large bone defects and duration of revision surgeries, that is fraught with catastrophic consequences for patients – revision prosthesis removal or even limb amputation. The project aims to improve the treatment for patients with instability of components after knee joint arthroplasty. The aim of the study is to analyze the results of revision knee arthroplasty and identify the causes of mistakes and complications of revision arthroplasty with the intention of prevention. Materials and methods. A retrospective analysis of 50 revision knee arthroplasties performed at the Centre for Arthroplasty of the State Institution “Institute of Traumatology and Orthopedics of the National Academy of Medical Sciences of Ukraine” was conducted. Clinical and radiological findings were evaluated for all patients. All revision prostheses used in this study were of the semi-constrained type. Cementation technique was used for all implants. In the revision of the septic complication group, a full cementation technique with antibiotics according to a sensitivity profile were used, while in the aseptic complication group, a surface cementation technique with antibiotics according to sensitivities were used. Results. The authors of the project have analyzed the results of treatment of 50 revision arthroplasty procedures performed between 2013 and 2022 for instability of the endoprosthesis components. The structure of complications has been examined and the causes of failure in revision knee arthroplasty have been identified. This study has shown promise in preventing complications and developing personalized approaches to revision arthroplasty. Conclusions. The analysis of revision knee arthroplasty failure has shown the prevalence of septic complications (56.0 %). In the case of septic complications after revision arthroplasty, Staphylococcus aureus prevailed (57.1 %), gram (-) microorganisms were causative agents in other cases. Factors resulting in aseptic complications included those associated with the surgical intervention (81.8 %), the patient (45.4 %) and the combination thereof (72.7 %). Significant causes of the femoral revision component loosening were residual valgus deformity, medial instability in the frontal plane; significant causes of the tibial component loosening were residual varus deformity and lateral instability in the frontal plane.

Clinical application of endoscopic radical mastectomy for breast cancer combined with total pectoral muscle reconstruction with breast implants

To investigate the effectiveness of endoscopic radical mastectomy for breast cancer combined with total pectoral muscle reconstruction with breast implants. The clinical data of 138 female patients with breast cancer who met the selection criteria between April 2019 and December 2023 were retrospectively analyzed. The mean age of the patients was 43.8 years (range, 27-61 years). The maximum diameter of the tumors ranged from 1.00 to 7.10 cm, with an average of 2.70 cm. Pathological examination showed that 108 cases were positive for both estrogen receptor and progesterone receptor, and 40 cases were positive for human epidermal growth factor receptor 2. All patients underwent endoscopic radical mastectomy for breast cancer combined with total pectoral muscle reconstruction with breast implants. The operation time, intraoperative blood loss, prosthesis size, and occurences of nipple-areola complex (NAC) ischemia, flap ischemia, infection, and capsular contracture were recorded. The Breast-Q2.0 score was used to evaluate breast aesthetics, patient satisfaction, and quality of life (including the social mental health score, breast satisfaction score, and chest pain score). Patients were divided into two groups based on the time of operation after the technique was implemented: group A (within 1 year, 25 cases) and group B (after 1 year, 113 cases). The above outcome indicators were compared between the two groups. Furthermore, based on the postoperative follow-up duration, patients were classified into a short-term group (follow-up time was less than 1 year) and a long-term group (follow-up time was more than 1 year). The baseline data and postoperative Breast-Q2.0 scores were compared between the two groups. The average operation time was 120.76 minutes, the average intraoperative blood loss was 23.77 mL, and the average prosthesis size was 218.37 mL. Postoperative NAC ischemia occurred in 21 cases (15.22%), flap ischemia in 30 cases (21.74%), infection in 23 cases (16.67%), capsular contracture in 33 cases (23.91%), and prosthesis removal in 2 cases (1.45%). The operation time of group A was significantly longer than that of group B ( P<0.05), and there was no significant difference in intraoperative blood loss, prosthesis size, and related complications between the two groups ( P>0.05). All patients were followed up 3-48 months (mean, 20 months). There were 33 cases in the short-term group and 105 cases in the long-term group. There was no significant difference in baseline data such as age, body mass index, number of menopause cases, number of neoadjuvant chemotherapy cases, number of axillary lymph node dissection cases, breast cup size, degree of breast ptosis, and postoperative radiotherapy constituent ratio between the two groups ( P>0.05). At last follow-up, the breast satisfaction score in the patients' Breast-Q2.0 score ranged from 33 to 100, with an average of 60.9; the social mental health score ranged from 38 to 100, with an average of 71.3; the chest pain score ranged from 20 to 80, with an average of 47.3. The social mental health score of the long-term group was significantly higher than that of the short-term group ( P<0.05); there was no significant difference in breast satisfaction scores and chest pain scores between the two groups ( P>0.05). No patient died during the follow-up, and 2 patients relapsed at 649 days and 689 days postoperatively, respectively. The recurrence-free survival rate was 98.62%. Endoscopic radical mastectomy for breast cancer combined with total pectoral muscle reconstruction with breast implants has fewer complications and less damage, and the aesthetic effect of reconstructed breast is better.

The "Octopus Head" Dermoglandular Flap: A Novel Technique for Breast Tissue Rearranging after Implant Removal.

Patients with previous breast augmentation may need implant removal for mechanical complications or other causes. After prosthesis removal, the residual parenchyma can be reshaped through a mastopexy with rearrangement of breast tissue. Several techniques have been described in the literature, but none of them can be considered the gold standard. In this study, we present our preliminary experience in breast tissue rearranging after implant removal through a novel technique: the "octopus head" dermoglandular flap. From January 2019 to October 2022, nine patients (18 breasts) underwent implant removal and simultaneous breast remodeling with the tissue obtained from the dermoglandular excess of the breast and shaped like an octopus head. Patient's demographic and clinical characteristics, postoperative complications, and patient-reported satisfaction were recorded. Mean age was 46.7 years. Body mass index ranged between 22.5 and 27.6 kg per m2. The majority of patients had moderate ptosis (67%). Breast implants were removed due to bilateral capsular contracture (n = 3), unilateral implant rupture with contralateral capsular contracture (n = 2), bilateral implant rupture (n = 3), and unilateral periprosthetic seroma (n = 1). We observed two minor complications: one postoperative hemorrhage with subsequent hematoma that was managed conservatively, and one nipple-areola complex malposition that underwent revision surgery. All patients were satisfied with the aesthetic and functional result. The octopus head dermoglandular flap has proved to be a safe and reliable option for breast tissue rearranging after implant removal, providing a good and stable cosmetic result, a low complication rate, and high patient-reported satisfaction.

Decision-making on peri-implant mucositis management and treatment approaches.

Peri-implant mucositis is characterised by inflammation of soft tissues surrounding a dental implant without associated bone loss beyond initial remodelling. Early detection and timely intervention are critical to prevent its progression to peri-implantitis. This paper focuses on various treatment options for treating peri-implant mucositis. The cornerstone of professional treatment lies in the mechanical disruption and removal of microbial biofilms around the implant. This can be achieved through careful use of manual or powered instruments, such as ultrasonic scalers or air polishing devices. However, there is a need for further research to determine the most effective single approach for treating peri-implant mucositis. Current evidence does not support the combination of mechanical debridement with locally administered antibiotics. Contrarily, evidence strongly supports the removal, cleaning, and modifications of prostheses to improve both self-performance and professional cleanability. The use of adjunctive therapies like photodynamic therapy and diode laser, in conjunction with mechanical instrumentation, is not currently recommended due to the limited strength of available evidence. Preventive measures emphasise the importance of comprehensive oral hygiene care, encompassing professional guidance and at-home practices, to manage biofilms effectively. This encompasses oral hygiene instruction, regular debridement, and maintenance care. Supporting peri-implant therapy is also vital for ongoing implant monitoring, preventing the recurrence of mucositis, and halting its progression to peri-implantitis. This multifaceted approach is key to effectively managing and treating peri-implant mucositis.

An upconverted afterglow color conversion strategy for in-situ activated persistent luminescent imaging of medical implants

Upconverted afterglow imaging presents a promising avenue for long-term auto-fluorescence-free imaging applications without the necessity of expensive time-resolved equipment. In this research, inspired by LED design, we devised a straightforward ternary upconverted afterglow conversion (UAC) strategy that amalgamates upconversion NaYbF4: Tm0.005 (UP), afterglow ZnS:Cu,Co (AP), and color conversion CaAlSiN3:Eu phosphors (CP). This fusion resulted in a UAC composite that displays a deep-red to near-infrared (NIR) afterglow with a peak at 663 nm, following a brief activation period by 980 nm light. Importantly, an enhancement of 116 times was realized by using the UAC strategy when comparing with a typical single phase afterglow phosphor, Zn3Ga2SnO8:Cr,Yb,Er. The NIR-rechargeable afterglow sustained for a minimum of 100 min after a mere 3 s of NIR wireless charging process and is chemically stable. This makes it highly suitable for long-term luminescence imaging applications. To demonstrate its potential, we employed our ternary UAC phosphor to image medical plastic prostheses through pig skin in vitro and simulated a plastic surgery on a mouse model in vivo. Such luminescent information could prove invaluable for planning future surgical interventions, such as prosthesis replacement, removal, or necessary debris cleaning.

Narrative review of immediate salvage for penile prosthesis infection.

Implantation of a penile prosthesis is a reliable option for men with erectile dysfunction (ED) refractory to less invasive therapies. While the frequency of penile prosthesis infections have decreased, they remain a devastating complication. Herein we discuss why immediate salvage surgery is an essential technique for the management of implant infections. We will also describe the relevant advancements to this technique. We conducted a narrative review via computer based search of PubMed for all relevant articles on penile prosthesis infection management, including guidelines, case series, reviews, and expert opinions. Search terms used included: "inflatable penile prosthesis", "IPP", "penile prosthesis", "salvage", "treatment", "delayed", "immediate". Only English peer-reviewed publications were included. Historically, patients who presented with penile prosthesis infections were exclusively managed with complete removal of the prosthesis without replacement. Although this strategy is safe, it hastens immediate ED and corporal fibrosis, resulting in loss of penile length and increased difficulty with subsequent prosthesis replacement. Previous case series have reported successful treatment of localized penile prosthesis infections with nonsurgical treatment, but the role of conservative treatment remains limited. The current standard of immediate salvage entails removal of the infected prosthesis and washout followed by immediate replacement with a new penile prosthesis. This technique has been demonstrated to be safe and effective, thus allowing patients to resume intercourse and maintain penile length. Immediate salvage surgery is safe and effective, and has emerged as the preferred strategy for the management of most patients with a penile prosthesis infection.

Biomimetic design and clinical application of Ti-6Al-4V lattice hemipelvis prosthesis for pelvic reconstruction

ObjectiveThis study aims to biomimetic design a new 3D-printed lattice hemipelvis prosthesis and evaluate its clinical efficiency for pelvic reconstruction following tumor resection, focusing on feasibility, osseointegration, and patient outcomes.MethodsFrom May 2020 to October 2021, twelve patients with pelvic tumors underwent tumor resection and subsequently received 3D-printed lattice hemipelvis prostheses for pelvic reconstruction. The prosthesis was strategically incorporated with lattice structures and solid to optimize mechanical performance and osseointegration. The pore size and porosity were analyzed. Patient outcomes were assessed through a combination of clinical and radiological evaluations.ResultsMultiple pore sizes were observed in irregular porous structures, with a wide distribution range (approximately 300–900 μm). The average follow-up of 34.7 months, ranging 26 from to 43 months. One patient with Ewing sarcoma died of pulmonary metastasis 33 months after surgery while others were alive at the last follow-up. Postoperative radiographs showed that the prosthesis’s position was consistent with the preoperative planning. T-SMART images showed that the host bone was in close and tight contact with the prosthesis with no gaps at the interface. The average MSTS score was 21 at the last follow-up, ranging from 18 to 24. There was no complication requiring revision surgery or removal of the 3D-printed hemipelvis prosthesis, such as infection, screw breakage, and prosthesis loosening.ConclusionThe newly designed 3D-printed lattice hemipelvis prosthesis created multiple pore sizes with a wide distribution range and resulted in good osteointegration and favorable limb function.

Does retained cement or hardware during 2-stage revision shoulder arthroplasty for infection increase the risk of recurrent infection?

IntroductionWhen treating chronic prosthetic joint infection (PJI) after shoulder arthroplasty, removal of the implants and cement is typically pursued because they represent a potential nidus for infection. However, complete removal can increase morbidity and compromise bone stock that is important for achieving stable revision implants. The purpose of this study is to compare the rates of repeat infection after 2-stage revision for PJI in patients who have retained cement or hardware compared to those who had complete removal. Material and MethodsWe retrospectively analyzed all two-stage revision total shoulder arthroplasties (TSAs) performed for infection at two institutions between 2011 and 2020 with minimum two-year follow-up from completion of the two-stage revision. Patients were included if they met the International Consensus Meeting (ICM) criteria for probable or definite infection2. Postoperative radiographs after the first-stage of the revision consisting of prosthesis and cement removal and placement of an antibiotic spacer were reviewed to evaluate for retained cement or hardware. Repeat infection was defined as either ≥2 positive cultures at the time of second-stage revision with the same organism cultured during the first-stage revision or repeat surgery for infection after the two-stage revision in patients that again met the ICM criteria for probable or definite infection. The rate of repeat infection among patients with retained cement or hardware was compared to the rate of infection among patients without retained cement or hardware. ResultsThirty-seven patients met inclusion criteria and were included in the analysis. Six (16%) patients had retained cement and one patient (3%) had two retained broken glenoid baseplate screws after first-stage revision. Of the ten cases of recurrent infection, one case (10%) involved retained cement/hardware. Age at revision (60.9±10.6 vs. 65.0±9.6, p=0.264), BMI (33.4±7.2 vs. 29.7±7.3, p=0.184), Charlson Comorbidity Index (2 (0-8) vs. 3 (0-6), p=0.289), male sex (7 vs. 16, p=0.420) and presence of diabetes (1 vs. 3, p=0.709) were not associated with repeat infection. Retained cement or hardware was also not associated with a repeat risk of infection (1 vs. 6, OR=0.389, p=0.374). DiscussionWe did not find an increased risk of repeat infection in patients with retained cement or hardware compared to those without. Therefore, we believe that surgeons should consider leaving cement or hardware that is difficult to remove and may lead to increased morbidity and future complications.

(101) Exploring Intraoperative and Postoperative Penile Prosthetic Complications in the Solid Organ Transplant Population: A Propensity-Score Matched Analysis

Abstract Introduction Solid-organ transplant (SOT) patients are highly susceptible to adverse post-operative outcomes given they are on one or multiple immunosuppressant medications. This makes surgeons performing elective surgeries, such as penile prosthetic implant surgery, understandably concerned given the higher risk of potential infection and perioperative complications. However, data regarding the safety and efficacy related to the penile prosthesis in the SOT population is mixed. Our study aimed to analyze adverse intraoperative and post-operative complications related to the penile prosthesis using the TriNetX database. Objective To observe whether SOT patients experienced more intraoperative and postoperative penile prosthetic complications when compared to the general population using the TriNetX US Collaborative Network, a large real-world database consisting of deidentified patient data from 56 healthcare organizations across the United States. Methods We used the TriNetX database to perform a propensity score-matched cohort study comparing five-year outcomes between SOT patients (kidney, heart, lung, liver, pancreas, and intestine by ICD-10) who underwent either an inflatable or non-inflatable penile prosthetic procedure (SOT) and non-SOT patients who underwent a similar procedure(s) (non-SOT). Patients were excluded from the analysis if they had any instance of priapism (treatment or dx) or Peyronie disease (treatment or diagnosis) in their medical record prior to the penile prosthetic procedure. Cohorts were matched on age, race/ethnicity, CKD, diseases of the prostate or prostatectomy, overweight and obesity status, T2DM, cardiovascular disease, psychiatric disorders, substance-use disorders, and spinal cord injury. Outcomes of interest included intraoperative and perioperative complications as well as post-operative complications related to the prosthetic implant (mechanical malfunction, fibrosis, displacement, hemorrhage, pain, stenosis, removal with or without replacement, and complex [all post-operative complications]). Results There were 223 patients in each group after matching (SOT, non-SOT). Mean age at penile prosthesis procedure 60.4 ± 10.2, 52% were White, and 8.9% were Hispanic/Latino. Kaplan-Meier analysis revealed that there was no significant difference found for the incidences of intraoperative complications (0.49% vs 0.53%, p = 0.99). In regards to postoperative complications, we found significantly higher incidences of complex prosthetic complications (28.76% vs 18.28%, p = 0.01) and mechanical malfunction of the penile prosthesis (8.56% vs 3.45%, p = 0.03) in the SOT cohort when compared to the non-SOT cohort. No significant difference was found between the cohorts for 5-year incidences of fibrosis (p = 0.81), hemorrhage (p = 0.97), pain (p = 0.69), stenosis (p = 0.81), infection (p =0.34), displacement (p = 0.68), removal with replacement (p = 0.72), and removal without replacement (p = 0.91). Conclusions In our analysis of this large, real-world database, we found that SOT patients were more likely to experience complex penile prosthetic complications as well as mechanical malfunction of the penile prosthesis. However, we observed no difference in 5-yr incidences of stenosis, fibrosis, hemorrhage, pain, infection, displacement, and prosthesis removal between the cohorts. Our analysis reveals that surgeons performing penile prosthetic surgeries, should be aware of potential long-term mechanical malfunction complications related to the penile prosthesis in the SOT population. Disclosure No.

(025) Laparoscopic Assisted Reservoir Removal of an Infected Inflatable Penile Prosthesis in a Patient with Ipsilateral Inguinal Hernia Mesh Implant

Abstract Introduction Infection is a devastating complication of penile prosthesis implantation ranging from 0.33 to 11.4%. 1 Although a salvage procedure is an option in case of infection, the rule of thumb is to remove all device components. 2 Special considerations and pre-operative planning are essential for better outcome in the management of such condition. We are presenting a video case presentation demonstrating the use of laparoscopic assisted approach to aid in the extraction of the reservoir of an infected penile prosthesis from a patient who had ipsilateral inguinal hernia mesh implant Objective To demonstrate the feasibility and efficacy laparoscopic assisted approach in the removal of difficult to extract inflatable penile prosthesis (IPP) reservoir. Methods A 72-year-old gentleman with past medical history of Diabetes and hypertension presented to our clinic 3 weeks after an IPP insertion that was done in another center. He was complaining of right inguinal bulge and scrotal pain. The bulge developed suddenly without any preceding event. Examination confirmed a prosthesis reservoir herniation in to the right groin. Plan CT abdomen&amp; pelvis confirmed the diagnosis. In three days, the herniated reservoir was managed by inguinal exploration, repositioning of the same reservoir in the right Retzius space and posterior inguinal canal wall repair using a mesh. The patient was discharged on post-operative day 1 in a stable condition, but unfortunately, he developed persistent scrotal pain that progressed into an overt scrotal infection over the early follow up period. During the examination, a scrotal collection was observed, swap was taken from the draining pus and results showed moderate growth of pseudomonas aeruginosa. On the other hand, the inguinal scar showed good healing with no tenderness, indicating the presence of an intact and non-infected inguinal mesh. Therefore, the decision was made to remove all components of the prosthesis without removing the mesh. Considering the anticipated challenges associated with removing the reservoir of the IPP through a scrotal approach, a decision was made to incorporate an additional laparoscopic-assisted abdominal approach for reservoir removal. Results Removal of the IPP cylinders and pump was performed through a scrotal incision, then a laparoscopic assisted abdominal approach was used successfully to remove the reservoir. After the IPP explant procedure, patient had an uneventful smooth recovery at the two and four weeks follow up visits, he was advised to use Vacuum erection device (VED) to alleviate possible penile fibrosis/shortening. A penile prosthesis reimplantation procedure was planned in a 6 months period Conclusions Laparoscopic assisted approach for penile prosthesis reservoir extraction is a feasible and safe technique that can be used in anticipated cases of difficult reservoir extraction. Pre-operative assessment, planning and counselling are crucial in obtaining a favorable outcome in such complex cases. Disclosure No.

(262) Salvage Penile Prosthetic Surgery, Unique Surgical Technique. Institutional Experience

Abstract Introduction `-Penile prosthesis surgery represents the end-stage treatment for erectile dysfunction. It is conventionally used only in cases of erectile dysfunction refractory to pharmacological treatments. -Penile prothesis surgery is associated with a high satisfaction rate and a low complication profile. However, it must be appreciated that the complications of surgery can have devastating consequences on a patient's quality of life and satisfaction and include infection, prosthesis malfunction, penile corporal perforation and penile length loss. -This study discusses the diagnosis and management of infected penile prosthesis with highlighting special intra-operative surgical technique that might be a valuable step in Salvage penile prosthetic surgery Objective Since its introduction in 1996 Mulcahy salvage has significantly improved outcomes for the removal and replacement of infected penile prostheses. Long-term follow up data of Mulcahy salvage show an infection-free rate of 82%. In our study we evaluated the Salvage Penile Prosthetic Surgery Cases done in our tertiary institution since (2000 up to date) and introduce the unique surgical technique that resulted in reduction the re-infetion rate. Methods This is a retrospective, institutional review Results total of 13 Salvage penile prosthetic surgeries done in our tertiary center since between 2000 and 2023 out of them only one case developed reinfection and ended with penile prosthesis removal. Therefor, the rate of re-infection is 8% comparing with latest successe rate of Mulcahy technique (18%) We applied surgical step intra- operative that might be the underling reason of decreasing the the reinfection rate that will be presented in details. Conclusions This retrospective analysis of salvage procedures and replacement of infected penile prosthesis with malleable prosthesis shows a high infection-free rate. Disclosure No.

Is Silver Addition to Scaffolds Based on Polycaprolactone Blended with Calcium Phosphates Able to Inhibit Candida albicans and Candida auris Adhesion and Biofilm Formation?

Candida spp. periprosthetic joint infections are rare but difficult-to-treat events, with a slow onset, unspecific symptoms or signs, and a significant relapse risk. Treatment with antifungals meets with little success, whereas prosthesis removal improves the outcome. In fact, Candida spp. adhere to orthopedic devices and grow forming biofilms that contribute to the persistence of this infection and relapse, and there is insufficient evidence that the use of antifungals has additional benefits for anti-biofilm activity. To date, studies on the direct antifungal activity of silver against Candida spp. are still scanty. Additionally, polycaprolactone (PCL), either pure or blended with calcium phosphate, could be a good candidate for the design of 3D scaffolds as engineered bone graft substitutes. Thus, the present research aimed to assess the antifungal and anti-biofilm activity of PCL-based constructs by the addition of antimicrobials, for instance, silver, against C. albicans and C. auris. The appearance of an inhibition halo around silver-functionalized PCL scaffolds for both C. albicans and C. auris was revealed, and a significant decrease in both adherent and planktonic yeasts further demonstrated the release of Ag+ from the 3D constructs. Due to the combined antifungal, osteoproliferative, and biodegradable properties, PCL-based 3D scaffolds enriched with silver showed good potential for bone tissue engineering and offer a promising strategy as an ideal anti-adhesive and anti-biofilm tool for the reduction in prosthetic joints of infections caused by Candida spp. by using antimicrobial molecule-targeted delivery.

Antimicrobial Activity of Glycine Air Polishing: A Clinical Split- Mouth Study on Full-Arch Implant-Supported Rehabilitations.

To investigate the possible antimicrobial activity of glycine air polishing by comparing peri-implant microbiota before and after treatment. A total of 15 patients who received implant-supported full-arch fixed rehabilitations were included. After prosthesis removal (T0), Plaque Index (PI), probing depth (PD), and bleeding on probing (BOP) were recorded. In each hemiarch, the implant with the highest PD score was selected for microbiologic sample collection from the peri-implant sulcus (T0). All patients received two different hygienic protocols (randomly administered, one per each hemiarch): glycine air-polishing (G) and cleansing with cotton pellets soaked in saline (C). At 7 days (T1) and 3 months (T2) after the intervention, PI and BOP were recorded, and new microbiologic samples were taken. Traditional polymerase chain reaction (PCR) and quantitative PCR real-time were employed for microbiologic analysis to investigate how the presence of different bacterial species varied according to the hygienic treatment performed. Treatment G provided a significantly higher PI score reduction around implants compared to treatment C (P = .015). No statistical difference was found in the microbial population around G and C implant sites, with Tannerella forsythia being the most commonly detected bacterial species in both G and C groups. No statistical differences were found between the antimicrobial activity of treatments C and G. Glycine powder air polishing is a valid method for professional hygienic care of implants and was more effective in PI reduction compared to the control treatment. However, its antimicrobial efficacy cannot be confirmed by the outcomes of the present study.

Prognostic Factors for Morbidity and Mortality in Redux Valve Surgery

Objectives: Redux valve surgery is increasingly common in Algeria, and the aim of this study was to identify the risk factors for hospital morbidity and mortality in this type of surgery. Method :49 patients with a mean age of 51 years (20-67 years) and a sex ratio of 0.88 underwent redux valve surgery between January 2015 and december 2019. 79%), and in almost half of the cases (46%) the first operation was performed in our department; the most frequent reasons for repeat operations were mitral plasty dysfunction, expression of new valve damage and removal of mechanical prostheses due to infective endocarditis. The Euroscore was used to predict operative risk. Results: 80% of our patients were classified in the moderate risk group (score 3-5) with an expected mortality of between 2.90 and 2.94%. Our results show a mortality rate of 2.56% for these patients. The study of post-operative results revealed a number of cardiac complications (28.5% low output and 37% rhythm disorders), infectious complications (8% mediastinitis) and neurological complications (6%). The risk factors for operative mortality were multiple valve procedures (p=0.03), persistent atrial fibrillation or fibrillation that appeared postoperatively (p=0.05) and age over 70 (p=0.04). Conclusion: Valvular redux surgery with a single-valve procedure has an operative morbi-mortality, actuarial survival and post-operative functional benefit that are entirely comparable to those of a primary intervention; whereas in redux surgery with a multi-valvular procedure, the operative morbi-mortality is significantly higher, but the actuarial survival and functional benefit are comparable to those of a primary intervention

(144) Contemporary Trends in Testicular Prosthesis Placement: An Analysis Of U.S. Claims Data

Abstract Introduction Testicular prosthesis placement (TPP) is a procedure associated with high patient satisfaction that improves body image and quality of life following orchiectomy. However little information exists regarding contemporary TPP as placement for metastatic prostate cancer has fallen out of favor and gender affirming surgery is on the rise. Objective This study sought to describe current trends in TPP in the United States. Methods Using the IBM® MarketScan® Research Databases (DOI 10.57761/ray7-1g16) we performed a retrospective analysis from 2007 to 2021 and identified 1,059 adult men who had undergone placement of a testicular prosthesis based on ICD-9 codes. Results The median age of TPP was 34 (IQR 23-44; range 18-80). At least 433 (35.5%) men were married. A total of 536 (43.8%) men had orchiectomy concurrently at the time of TPP. Just under half of the cases prescribed antibiotics postoperatively (44.9%). The five most common indications at the time of TPP were malignancy (54.7%), gender dysphoria (10.4%), cryptorchidism (9.6%), atrophy/hypofunction (6.6%), and testicular torsion (3.9%). A total of 46 (3.8%) of men underwent subsequent removal of their prosthesis. A diagnosis of gender dysphoria was associated with prosthesis removal (odds ratio (OR) 4.51, 95% CI 2.10-9.86). No significant associations were seen for other indications, Charlson Comorbidity Index scores, post-operative antibiotic use, tobacco use, psychiatric diagnoses, or prior pain diagnoses. Rates of testicular prosthesis placement for a diagnosis of gender dysphoria are rapidly increasing while placement for prostate cancer is increasingly rare. Conclusions Among the studied population the primary indication for testicular prosthesis placement is for testicular cancer, contradicting the findings of earlier series. We also show that TPP for gender dysphoria is increasingly common. Additionally, we report rates of explanation and complications related to prosthesis that are higher than what is described in the literature. Disclosure No.