Revision-free Survival Research Articles

High revision rates following repeat septic revision after failed one-stage exchange for periprosthetic joint infection in total knee arthroplasty.

The outcome of repeat septic revision after a failed one-stage exchange for periprosthetic joint infection (PJI) in total knee arthroplasty (TKA) remains unknown. The aim of this study was to report the infection-free and all-cause revision-free survival of repeat septic revision after a failed one-stage exchange, and to determine whether the Musculoskeletal Infection Society (MSIS) stage is associated with subsequent infection-related failure. We retrospectively reviewed all repeat septic revision TKAs which were undertaken after a failed one-stage exchange between 2004 and 2017. A total of 33 repeat septic revisions (29 one-stage and four two-stage) met the inclusion criteria. The mean follow-up from repeat septic revision was 68.2 months (8.0 months to 16.1 years). The proportion of patients who had a subsequent infection-related failure and all-cause revision was reported and Kaplan-Meier survival for these endpoints was determined. Patients were categorized according to the MSIS staging system, and the association with subsequent infection was analyzed. At the most recent follow-up, 17 repeat septic revisions (52%) had a subsequent infection-related failure and the five-year infection-free survival was 59% (95% confidence interval (CI) 39 to 74). A total of 19 underwent a subsequent all-cause revision (58%) and the five-year all-cause revision-free survival was 47% (95% CI 28 to 64). The most common indication for the first subsequent aseptic revision was loosening. The MSIS stage of the host status (p = 0.663) and limb status (p = 1.000) were not significantly associated with subsequent infection-related failure. Repeat septic revision after a failed one-stage exchange TKA for PJI is associated with a high rate of subsequent infection-related failure and all-cause revision. Patients should be counselled appropriately to manage expectations. The host and limb status according to the MSIS staging system were not associated with subsequent infection-related failure. Cite this article: Bone Joint J2022;104-B(3):386-393.

Functional outcome in surgical fixation of fibrous dysplasia of proximal femur

<p class="abstract"><strong><span lang="EN-US">Background:</span></strong><span lang="EN-US"> Fibrous dysplasia is a rare benign intramedullary fibro-osseous lesion. Surgical management is usually indicated in pathological fractures, symptomatic patients due to pain and due to deformity. The aim of this study was to summarize the functional results and to investigate surgical treatment methods by conducting a retrospective study of patients with fibrous dysplasia (FD) in the proximal femur.</span></p><p class="abstract"><strong><span lang="EN-US">Methods:</span></strong><span lang="EN-US"> This study is a retrospective study using patient’s medical records, including analysis of 14 patients with fibrous dysplasia of proximal femur treated at Nizams Institute of Medical Sciences. The primary outcome was success of the procedure according to the Musculoskeletal tumour society score (MSTS). Secondary outcomes, which were assessed at one year and at the end of follow up in terms of revision free survival and change in femoral neck-shaft angle over time. </span></p><p class="abstract"><strong><span lang="EN-US">Results:</span></strong><span lang="EN-US"> Analysis of data showed that revision-free survival was 85% after a median follow-up of 2 years. Revision was necessary in one patient for structural failure due to a fracture distal to Dynamic hip screw and other patient due to progressive deformity after being operated with broad DCP. At the end of follow-up 85% of all patients had good walking ability and all patient were pain free. </span></p><p class="abstract"><strong><span lang="EN-US">Conclusions:</span></strong><span lang="EN-US"> Symptomatic fibrous dysplasia involving proximal femur needs to be operated to relieve pain due to biomechanical instability, to prevent and treat pathological fractures and to correct deformities.</span></p>

Megaprostheses for the revision of infected hip arthroplasties with severe bone loss

BackgroundPeriprosthetic hip infections with severe proximal femoral bone loss may require the use of limb salvage techniques, but no agreement exists in literature regarding the most effective treatment. Aim of this study is to analyze the infection eradication rate and implant survival at medium-term follow-up in patients treated with megaprostheses for periprosthetic hip infections with severe bone loss.MethodsTwenty-one consecutive patients were retrospectively reviewed at a mean 64-month follow-up (24–120). Functional and pain scores, microbiological, radiological and intraoperative findings were registered. Kaplan Meier survival analysis and log rank test were used for infection free survival and implant survival analyses.ResultsThe infection eradication rate was 90.5%, with an infection free survival of 95.2% at 2 years (95%CI 70.7–99.3) and 89.6%(95%CI 64.3–97.3) at 5 years. Only two patients required major implant revisions for aseptic implant loosening. The most frequent complication was dislocation (38.1%). The major revision-free survival of implants was 95.2% (95%CI 70.7–99.3) at 2 years and 89.6% (95%CI 64.3–97.3) at 5 years. The overall implant survival was 83.35% (CI95% 50.7–93.94) at 2 and 5 years. Subgroup analyses (cemented versus cementless MPs, coated versus uncoated MPs) revealed no significant differences at log rank test, but its reliability was limited by the small number of patients included.ConclusionsProximal femoral arthroplasty is useful to treat periprosthetic hip infections with severe bone loss, providing good functional results with high infection eradication rates and rare major revisions at medium-term follow-up. No conclusions can be drawn on the role of cement and coatings.

Survival analysis of one-stage exchange of infected unicompartmental knee arthroplasty: a single-center study with minimum 3years follow-up.

The rates of unicompartmental knee arthroplasty (UKA) are increasing yet little data exists regarding management of periprosthetic joint infections (PJI) after UKA, particularly utilizing one-stage revision. The aim of this study was to determine the septic and all-cause revision-free survival of UKA PJIs treated with one-stage revision, as well as functional outcomes and risk factors for failure. A retrospective review of one-stage septic revisions with a hinged or rotating hinged implant between 2000 and 2015 at a single institution was performed. Results of 15 patients with a minimum of 3-year follow-up (mean = 93months; range 37-217) were evaluated by means of infection control, survivorship, patient reported functional score and possible causal factors for a re-revision. Kaplan-Meier curves and Cox regression analysis were used. After a mean of 8years of follow-up infection control rate was 93.3%, the survivorship free of any reoperation, including both septic and aseptic causes, was 80% at 5years and 64.2% at ten years and average Lysholm score was 72.7 ± 21.3 (33-100). One-stage revision for PJI of UKA using a hinged knee design has excellent infection-free survival at mid to long-term follow-up. Likewise, patient reported functional outcomes are promising. However, one-third of patients required aseptic reoperation and aseptic loosening was the dominant etiology.

Early outcomes of a novel bicruciate-retaining knee system: a 2-year minimum retrospective cohort study.

Bicruciate retaining (BCR) total knee arthroplasty (TKA) was designed to simulate natural knee kinematics and improve proprioception by retaining both the ACL and PCL. While the prospect of the design appears favorable to patients, previous designs have demonstrated modest survivorship rates compared to traditional designs. This study aims to report the early functional outcomes and implant survivorship of a novel BCR design. A multi-center, retrospective study was conducted identifying BCR TKA patients from 2016 to 2017. Patient demographics, quality outcomes, and post-operative complications were collected. A Kaplan-Meier analysis was used to evaluate revision-free survival. One-hundred thirty-three patients with a mean follow-up time of 2.35 ± 0.25years (range: 2.00-2.87years) were identified. Patients receiving BCR TKA were, on average, 61.46 ± 9.27years-old, obese (BMI = 31.80 ± 6.01kg/m2), predominantly white (71.4%), and female (69.9%). The device was most often implanted using standard instruments (85.7%) compared to computer-assisted navigation (13.5%). Average length-of-stay was 1.77 ± 0.97days. Six patients had a reoperation; three (2.5%) full revisions occurred for: infection (n = 1), arthrofibrosis (n = 1), and ACL rupture (n = 1); one (0.8%) tibial revision occurred for: arthrofibrosis; two (1.5%) liner exchanges occurred for: infection (n = 1) and arthrofibrosis (n = 1). Kaplan-Meier survivorship analysis of cumulative failure at 2-year showed a survival rate of 96.2% (95% confidence interval, 91.2-98.4%) for all-cause reoperation, 97.3% (91.6-99.1%) for aseptic revision, and 100% for mechanical failure. Survivorship was 96.2% for all-cause reoperation, 97.3% for aseptic revision, and 100% for mechanical implant failure at 2-years. This novel BCR TKA demonstrated no implant-related complications and excellent survivorship outcomes over 2years with comparable revision rates to those previously reported in the literature.

Survival of primary ankle replacements: data from global joint registries

BackgroundAnkle arthroplasty, commonly known as ankle replacement, is a surgical procedure for treating end-stage ankle osteoarthritis. Whilst evidence shows good clinical results after surgery, little is known of the long-term survival of ankle replacements and the need for ankle revision. Using more recent implant data and long-term data, there is now opportunity to examine at a population-level the survival rate for ankle implants, to examine between-country differences in ankle revision surgery, and to compare temporal trends in revision rates between countries.MethodsFour national joint registries from Australia, New Zealand, Norway and Sweden provided the necessary data on revision outcome following primary ankle replacement, for various periods of observation – the earliest starting in 1993 up to the end of 2019. Data were either acquired from published, online annual reports or were provided from direct contact with the joint registries. The key information extracted were Kaplan-Meier estimates to plot survival probability curves following primary ankle replacement.ResultsThe survival rates varied between countries. At 2 years, across all registries, survival rates all exceeded 0.9 (range 0.91 to 0.97). The variation widened at 5 years (range 0.80 to 0.91), at 10 years (range 0.66 to 0.84) and further at 15-years follow-up (0.56 to 0.78). At each time point, implant survival was greater in Australia and New Zealand with lower rates in Sweden and Norway.ConclusionsWe observed variation in primary ankle replacement survival rates across these national registries, although even after 5 years, these population derived data show an 80% revision free survival. These data raise a number of hypotheses concerning the reasons for between-country differences in revision-free survival which will require access to primary data for analysis.Supplementary InformationThe online version contains supplementary material available at 10.1186/s13047-022-00539-2.

Total, hemi, or dual-mobility arthroplasty for the treatment of femoral neck fractures in patients with neurological disease : analysis of 9,638 patients from the Swedish Hip Arthroplasty Register.

The aim of this study was to investigate the potentially increased risk of dislocation in patients with neurological disease who sustain a femoral neck fracture, as it is unclear whether they should undergo total hip arthroplasty (THA) or hemiarthroplasty (HA). A secondary aim was to investgate whether dual-mobility components confer a reduced risk of dislocation in these patients. We undertook a longitudinal cohort study linking the Swedish Hip Arthroplasty Register with the National Patient Register, including patients with a neurological disease presenting with a femoral neck fracture and treated with HA, a conventional THA (cTHA) with femoral head size of ≤ 32 mm, or a dual-mobility component THA (DMC-THA) between 2005 and 2014. The dislocation rate at one- and three-year revision, reoperation, and mortality rates were recorded. Cox multivariate regression models were fitted to calculate adjusted hazard ratios (HRs). A total of 9,638 patients with a neurological disease who also underwent unilateral arthroplasty for a femoral neck fracture were included in the study. The one-year dislocation rate was 3.7% after HA, 8.8% after cTHA < 32 mm), 5.9% after cTHA (= 32 mm), and 2.7% after DMC-THA. A higher risk of dislocation was associated with cTHA (< 32 mm) compared with HA (HR 1.90 (95% confidence interval (CI) 1.26 to 2.86); p = 0.002). There was no difference in the risk of dislocation with DMC-THA (HR 0.68 (95% CI 0.26 to 1.84); p = 0.451) or cTHA (= 32 mm) (HR 1.54 (95% CI 0.94 to 2.51); p = 0.083). There were no differences in the rate of reoperation and revision-free survival between the different types of prosthesis and sizes of femoral head. Patients with a neurological disease who sustain a femoral neck fracture have similar rates of dislocation after undergoing HA or DMC-THA. Most patients with a neurological disease are not eligible for THA and should thus undergo HA, whereas those eligible for THA could benefit from a DMC-THA. Cite this article: Bone Joint J2022;104-B(1):134-141.

Favourable outcomes of repeat one-stage exchange for periprosthetic joint infection of the hip.

One-stage exchange for periprosthetic joint infection (PJI) in total hip arthroplasty (THA) is gaining popularity. The outcome for a repeat one-stage revision THA after a failed one-stage exchange for infection remains unknown. The aim of this study was to report the infection-free and all-cause revision-free survival of repeat one-stage exchange, and to investigate the association between the Musculoskeletal Infection Society (MSIS) staging system and further infection-related failure. We retrospectively reviewed all repeat one-stage revision THAs performed after failed one-stage exchange THA for infection between January 2008 and December 2016. The final cohort included 32 patients. The mean follow-up after repeat one-stage exchange was 5.3 years (1.2 to 13.0). The patients with a further infection-related failure and/or all-cause revision were reported, and Kaplan-Meier survival for these endpoints determined. Patients were categorized according to the MSIS system, and its association with further infection was analyzed. A total of eight repeat septic revisions (25%) developed a further infection-related failure, and the five-year infection-free survival was 81% (95% confidence interval (CI) 57 to 92). Nine (28%) underwent a further all-cause revision and the five-year all-cause revision-free survival was 74% (95% CI 52 to 88). Neither the MSIS classification of the host status (p = 0.423) nor the limb status (p = 0.366) was significantly associated with further infection-related failure. Repeat one-stage exchange for PJI in THA is associated with a favourable five-year infection-free and all-cause revision-free survival. Notably, the rate of infection control is encouraging when compared with the reported rates after repeat two-stage exchange. The results can be used to counsel patients and help clinicians make informed decisions about treatment. With the available number of patients, further infection-related failure was not associated with the MSIS host or limb status. Cite this article: Bone Joint J2022;104-B(1):27-33.

Ten-year results of a prospective cohort of large-head metal-on-metal total hip arthroplasty : a concise follow-up of a previous report.

AimsLarge-diameter metal-on-metal (MoM) total hip arthroplasty (THA) has demonstrated unexpected high failure rates and pseudotumour formation. The purpose of this prospective cohort study is to report ten-year results in order to establish revision rate, prevalence of pseudotumour formation, and relation with whole blood cobalt levels.MethodsAll patients were recalled according to the guidelines of the Dutch Orthopaedic Association. They underwent clinical and radiographical assessments (radiograph and CT scan) of the hip prosthesis and whole blood cobalt ion measurements. Overall, 94 patients (95 hips) fulfilled our requirements for a minimum ten-year follow-up.ResultsMean follow-up was 10.9 years (10 to 12), with a cumulative survival rate of 82.4%. Reason for revision was predominantly pseudotumour formation (68%), apart from loosening, pain, infection, and osteolysis. The prevalence of pseudotumour formation around the prostheses was 41%, while our previous report of this cohort (with a mean follow-up of 3.6 years) revealed a 39% prevalence. The ten-year revision-free survival with pseudotumour was 66.7% and without pseudotumour 92.4% (p < 0.05). There was poor discriminatory ability for cobalt for pseudotumour formation.ConclusionThis prospective study reports a minimum ten-year follow-up of large-head MoM THA. Revision rates are high, with the main reason being the sequelae of pseudotumour formation, which were rarely observed after five years of implantation. Blood ion measurements show limited discriminatory capacity in diagnosing pseudotumour formation. Our results evidence that an early comprehensive follow-up strategy is essential for MoM THA to promptly identify and manage early complications and revise on time. After ten years follow-up, we do not recommend continuing routine CT scanning or whole cobalt blood measurements, but instead enrolling these patients in routine follow-up protocols for THA.Cite this article: Bone Jt Open 2022;3(1):61–67.

Factors correlating with patients\u2019 satisfaction after undergoing cartilage repair surgery\u2014data from the German Cartilage Registry (KnorpelRegister DGOU)

Subjective patient satisfaction is the most relevant parameter for assessing the success of treatment after orthopaedic surgery. The aim of the present study was to correlate patient-reported outcome parameters (i.e., absolute KOOS, KOOS increase) and revision-free survival with patient’s satisfaction. Furthermore, the study aimed on the identification of pre-operative factors that are associated with patient’s satisfaction after the surgery.For the present study, 6305 consecutive patients from the German Cartilage Registry (KnorpelRegister DGOU) were analyzed. Patient characteristics and outcome were correlated with patients’ satisfaction after a follow-up of three years by Spearman correlation. P values < 0.05 were considered statistically significant.Mean age was 37 ± 12.5 years, 59.7% patients were male, and 40.3% female. Most patients (46.7%) were treated with an autologous chondrocyte implantation (ACI). The strongest correlation of subjective satisfaction and the subscore quality of life (r = 0.682; p < 0.001) was found, whereas the post-operative increase in KOOS from the pre-operative value showed only a moderate correlation (r = 0.520; p < 0.001). There was also a significant correlation with the absolute KOOS value (r = 0.678; p < 0.001), the subscores pain (r = 0.652; p < 0.001), quality of life (r = 0.682; p < 0.001), and sports (r = 0.633; p < 0.001), whereas symptoms (r = 0.504, p < 0.001) and activities of daily life (r = 0.601; p < 0.001) showed a weaker correlation. Pain also correlated highly significant with the patient satisfaction 24 months after surgery (r = − 0.651, p < 0.001). The correlation between satisfaction after the 2nd and 3rd year (r = 0.727; p < 0.001) is stronger than correlation after six months and three years (r = 0.422, p < 0.001). All pre-operative parameters show a very weak correlation (r < 0.1).The use of standardized measuring instruments (KOOS and Pain) is a relevant outcome parameter in science and clinical practice, whereas absolute values represent satisfaction better than the individual increase. The subscores “pain,” “quality of life,” and “sports” represent satisfaction better than the subscores “symptoms” and “activity of daily life.” Early satisfaction has only a moderate predictive value for satisfaction after 3 years, which is of great practical relevance in particular for the assessment of potential treatment failures. It is remarkable to note that a revision surgery is only very mildly associated with increased dissatisfaction. Pre-operative factors are not reliable prediction factors for post-operative patient satisfaction.

Oral and IV Antibiotic Administration After Single-Stage Revision Shoulder Arthroplasty: Study of Survivorship and Patient-Reported Outcomes in Patients without Clear Preoperative or Intraoperative Infection.

Following revision shoulder arthroplasty, postoperative antibiotics are selected before the results of intraoperative cultures become available. We determined infection-free survival, revision-free survival, complications, and patient-reported outcomes for patients selected to receive oral or intravenous (IV) antibiotics after revision arthroplasty. This study included 92 patients who had revision shoulder arthroplasty. IV antibiotics were administered if the surgeon had a high index of suspicion for infection, and oral antibiotics were given if there was a low suspicion. Antibiotic therapy was modified based on intraoperative culture results. Patient-reported outcomes and adverse events were documented at a mean of 4.1 years. In selecting antibiotic therapy, surgeons correctly predicted the presence or absence of multiple positive cultures of specimens from the revision surgery in 72% of the 92 cases. Subsequent re-revision surgery was required in 17 (18%) of the patients; 8 of these 17 patients had ≥2 positive cultures at re-revision. Patients who initially received IV antibiotics and those who initially received oral antibiotics had similar revision-free (p = 0.202) and infection-free (p = 0.155) survivorship. Patients requiring a change from oral to IV antibiotics based on positive cultures had similar survivorship compared with those initially treated with IV antibiotics. The IV and oral antibiotic groups had similar postoperative Simple Shoulder Test (SST), American Shoulder and Elbow Surgeons (ASES), and satisfaction scores. Patients receiving IV antibiotics had a higher rate of antibiotic-related adverse events. Post-revision antibiotic therapy was associated with an infection-free survival rate of 91% at a mean of >4 years of follow-up. Infection-free survival, revision-free survival, and patient-reported outcomes were similar in high-risk patients placed on IV antibiotics and low-risk patients placed on oral antibiotics. Further study is needed to define the indications for IV or oral antibiotics after revision arthroplasty. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Sex-related differences in stemless total shoulder arthroplasty.

BackgroundThe use of stemless humeral implants for shoulder arthroplasty is becoming increasingly widespread. However, little is known about the difference in clinical, functional, and radiographic outcomes of stemless shoulder arthroplasty between men and women. Men and women do have reported differences in size, strength, and bone quality. As such, the purpose of this study was to evaluate sex-related differences in outcomes when using stemless humeral implants.MethodsA retrospective review of 227 patients (men = 143 and women = 84) undergoing stemless shoulder arthroplasty was compared for sex-related differences. Clinical, functional, and radiographic outcomes were compared, including American Shoulder and Elbow Surgeons (ASES) scores, visual analog scale pain scores, range of motion, radiolucencies, operative data, implant data, and complications. Statistical analysis included descriptive statistics, t-tests, chi-square tests, and logistic regression.ResultsPreoperatively, men had a statistically significant greater range of motion of forward elevation (P < .01), external rotation (ER) at adduction (P = .04), ER at 90° abduction (P = .03), and baseline ASES scores (P < .01). At 2 years, there were no differences between men and women in ASES score (P = .12), visual analog scale pain score (P = .74), active ER (P = .98), implant migration, or radiolucencies (P > .99). Mean operating time was 9 minutes longer in male patients (P < .01). There was no significant difference in surgical complications, including dislocation, fracture, infection, or loosening. The three-year revision-free survival was 98.8% for women and 97.9% for men.ConclusionPatient sex is not predictive of postoperative functional outcomes after stemless shoulder arthroplasty. The operative time was significantly shorter in female patients, and there was no significant difference in surgical complications between men and women.

Salvage of limb salvage in oncological reconstructions of the lower limb with megaprosthesis: how much to push the boundaries?

IntroductionMegaprosthesis represent the most commonly used limb salvage method after musculoskeletal tumor resections. Nevertheless, they are burdened by high complication rate, requiring several surgical revisions and eventually limb amputation. The aims of this study were to evaluate the effect of rescuing the limb with subsequent revisions on complication rates (a), incidence of amputations (b), and whether complications reduce functional outcome after the first surgical revision (c).Materials and methodsWe retrospectively reviewed 444 lower limb megaprosthesis implanted for primary musculoskeletal tumors or metastatic lesions, from February 2000 to November 2017. 59 patients received at least one revision megaprosthesis surgery. MSTS score was used to assess final functional results. Complication-revision-amputation free survival rates were calculated both at 5 and 10 years of follow-up.ResultsComplication free survival, revision free survival and amputation free survival at 10 years were 47% and 53%, 61% and 67%, 90% and 86% among all 444 patients and the group of 59 revised patients, respectively. The incidence of further complications after the first complication was 26% in the group treated with no subsequent revision surgeries and 51% in the group with at least one revision surgery. We found a trend of inverse linear relationship between the number of complications needing subsequent revision surgeries and the final MSTS.ConclusionThe number of further revision surgeries after limb salvage with megaprosthesis increases the incidence of complications. Repeated surgical revisions, in particular after infection, increase the amputation rate. The most frequent causes of failure were structural failures and infections. MSTS score was superior for patients undergoing limb salvage than amputees. However, MSTS progressively decreased with multiple revisions becoming inferior to the functional score of an amputated patient.

PD66-10 IMPACT OF THE CENTER VOLUME ACTIVITY ON THE RESULTS OF ARTIFICIAL URINARY SPHINCTER IN NON-NEUROLOGICAL MALE PATIENTS

PD66-10 IMPACT OF THE CENTER VOLUME ACTIVITY ON THE RESULTS OF ARTIFICIAL URINARY SPHINCTER IN NON-NEUROLOGICAL MALE PATIENTS

PD04-02 PREVALENCE AND RISK FACTORS OF ARTIFICIAL URINARY SPHINCTER REVISION IN NON-NEUROLOGICAL MALE PATIENTS

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Male Incontinence: Therapy I (PD04)1 Sep 2021PD04-02 PREVALENCE AND RISK FACTORS OF ARTIFICIAL URINARY SPHINCTER REVISION IN NON-NEUROLOGICAL MALE PATIENTS Imad Bentellis, Mehdi El Akri, Jean-Nicolas Cornu, Thibaut Brierre, Tiffany Cousin, Victor Gaillard, Baptiste Poussot, Hugo Dupuis, Thibaut Tricard, Nicolas Hermieu, Damien Robin, Alice Pitout, Florian Beraud, Bertrand-Leon Priscilla, Daniel Chevallier, Frank Bruyère, Xavier Biardeau, Hervé Monsaint, Luc Corbel, Jean-François Hermieu, Pierre Lecoanet, Grégoire Capon, Xavier Game, Christian Saussine, Matthieu Durand, and Benoit Peyronnet Imad BentellisImad Bentellis More articles by this author , Mehdi El AkriMehdi El Akri More articles by this author , Jean-Nicolas CornuJean-Nicolas Cornu More articles by this author , Thibaut BrierreThibaut Brierre More articles by this author , Tiffany CousinTiffany Cousin More articles by this author , Victor GaillardVictor Gaillard More articles by this author , Baptiste PoussotBaptiste Poussot More articles by this author , Hugo DupuisHugo Dupuis More articles by this author , Thibaut TricardThibaut Tricard More articles by this author , Nicolas HermieuNicolas Hermieu More articles by this author , Damien RobinDamien Robin More articles by this author , Alice PitoutAlice Pitout More articles by this author , Florian BeraudFlorian Beraud More articles by this author , Bertrand-Leon PriscillaBertrand-Leon Priscilla More articles by this author , Daniel ChevallierDaniel Chevallier More articles by this author , Frank BruyèreFrank Bruyère More articles by this author , Xavier BiardeauXavier Biardeau More articles by this author , Hervé MonsaintHervé Monsaint More articles by this author , Luc CorbelLuc Corbel More articles by this author , Jean-François HermieuJean-François Hermieu More articles by this author , Pierre LecoanetPierre Lecoanet More articles by this author , Grégoire CaponGrégoire Capon More articles by this author , Xavier GameXavier Game More articles by this author , Christian SaussineChristian Saussine More articles by this author , Matthieu DurandMatthieu Durand More articles by this author , and Benoit PeyronnetBenoit Peyronnet More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001968.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To assess the prevalence and risk factors of male AUS mechanical failures and non-mechanical failures. METHODS: The charts of all male patients who underwent an AUS implantation between 2004 and 2020 in 16 centers were retrospectively reviewed. Patients with neurogenic stress urinary incontinence (SUI) were excluded as well as revisions/explantations for infections and/or erosions. Causes of revision were divided into mechanical failures (fluid loss or malfunction from any components of the AUS), non-mechanical failures (urethral atrophy, recurrence/persistence of SUI despite normally functioning device) and other (pump malposition, balloon herniation, hematoma, pain). Failure-free survival analysis was performed both for general and specific causes of revision. Predictors of mechanical and non-mechanical failures were determined by Cox proportional hazards model. RESULTS: Overall 1020 patients had a median follow-up of 20 months (Table 1A, 1B), the estimated 5-year and 10-year revision free survival were 60% and 40% (Figure 1A). There were 214 AUS revisions: 59 (27,6%) for mechanical failures, 121 (56,5%) for non-mechanical failures and 34 (15,8%) other causes of revision. In multivariable Cox regression analysis, larger cuff size was the only predictor of overall revisions (HR=1.04 [1.01-1.07]; p=0.01) and revision for non-mechanical failure (HR=1.05 [1.02-1.09]; p=0.004) (Table 1C). CONCLUSIONS: Half of male AUS patients undergo device revision over the first ten years after implantation. Non-mechanical failures are the primary cause of AUS revision in non-neurological men. Larger cuff size appears to be the main determinant of AUS revision’s risk. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e49-e50 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Imad Bentellis More articles by this author Mehdi El Akri More articles by this author Jean-Nicolas Cornu More articles by this author Thibaut Brierre More articles by this author Tiffany Cousin More articles by this author Victor Gaillard More articles by this author Baptiste Poussot More articles by this author Hugo Dupuis More articles by this author Thibaut Tricard More articles by this author Nicolas Hermieu More articles by this author Damien Robin More articles by this author Alice Pitout More articles by this author Florian Beraud More articles by this author Bertrand-Leon Priscilla More articles by this author Daniel Chevallier More articles by this author Frank Bruyère More articles by this author Xavier Biardeau More articles by this author Hervé Monsaint More articles by this author Luc Corbel More articles by this author Jean-François Hermieu More articles by this author Pierre Lecoanet More articles by this author Grégoire Capon More articles by this author Xavier Game More articles by this author Christian Saussine More articles by this author Matthieu Durand More articles by this author Benoit Peyronnet More articles by this author Expand All Advertisement Loading ...

Midterm Survival of a Varus-Valgus Constrained Implant following One-Stage Revision for Periprosthetic Joint Infection: A Single-Center Study.

Revision total knee arthroplasty (TKA) is challenging to perform in patients with periprosthetic joint infection (PJI) due to the difficulty of eradicating the infection and potential for bone and ligamentous deficits. The current study aimed to evaluate the midterm survival of varus-valgus constrained (VVC) implants used in one-stage revision TKA for chronic PJI at our institution. This retrospective analysis included 132 patients with chronic PJI who underwent one-stage revision using a VVC implant. The average follow-up was 51.6 months (range: 24-85 months). Five-year survival analysis was performed to set recurrent infection and mechanical failure as the end point. Hospital for special surgery (HSS) as functional outcomes was evaluated preoperatively and at the latest follow-up. A total of 12 patients (9.1%) underwent retreatment for reinfection (nine patients) and mechanical failure (three patients). The overall 5-year revision-free survival was 82.7%, the infection-free survival was 91.1%, and the mechanical failure-free survival was 98.3%. The preoperative HSS knee score improved from 35.6 points (range: 24.3-47.7 points) preoperatively to 76.8 points (range: 57.2-87.6 points) at the latest follow-up. Complications were identified in 20 patients (15.2%) which included aseptic osteolysis in 4 cases, acceptable flexion instability in 3 cases, arthrofibrosis in 2 patients, hematomas in 2 cases, calf intermuscular venous thrombosis in 6 patients, and femoral stem tip pain in 3 cases. This is the first study to report the outcomes of one-stage revision using VVC implants for knee PJI. Improved functional outcomes and good midterm survival are demonstrated at an average follow-up of 51.6 months.

Eighty Percent Survival of Resurfacing Implants in the Knee After 10 Years: A Nationwide Cohort Study on 379 Procedures from the Danish Knee Arthroplasty Registry.

Focal cartilage injuries are debilitating and difficult to treat. Biological cartilage repair procedures are used for patients younger than 40 years, and knee arthroplasties are generally reserved for patients older than 60 years. Resurfacing implants are well suited for patients in this treatment gap. The objective was to investigate the 10-year survival of resurfacing implants in the Danish Knee Arthroplasty Registry. In this retrospective cohort study, patients treated with resurfacing implants were followed longitudinally in the Danish Knee Arthroplasty Registry from 1997 to 2020. The primary endpoint was revision surgery. The survival of the resurfacing implants was analyzed by Kaplan-Meier method. A total of 379 resurfacing implant procedures were retrieved from the Danish Knee Arthroplasty Registry. The mean age and weight of patients were 50 years (SD = 11) and 84 kg (SD = 17), respectively. The indications for surgery were as follows: secondary osteoarthritis (42%), primary osteoarthritis (32%), and osteochondral lesions (20%). Within the follow-up period, 70 (19%) of the implants were revised to arthroplasties. The 1-, 5-, and 10-year revision-free survival estimation was 0.95 (95% CI 0.93-0.97), 0.84 (95% CI 0.80-0.88), and 0.80 (95% CI 0.75-0.84), respectively. The median time to revision was 2 years. The 10-year revision-free survival rate for resurfacing implants was 80%. Based on the revision rates, this treatment offers a viable alternative to biological cartilage repair methods in patients aged 40 to 60 years with focal cartilage pathology. Improved patient selection could further improve the implant survival rate. Further studies are needed to investigate this treatment method.

Treatment strategies for hydrocephalus related to Dandy-Walker syndrome: evaluating procedure selection and success within the Hydrocephalus Clinical Research Network.

Treating Dandy-Walker syndrome-related hydrocephalus (DWSH) involves either a CSF shunt-based or endoscopic third ventriculostomy (ETV)-based procedure. However, comparative investigations are lacking. This study aimed to compare shunt-based and ETV-based treatment strategies utilizing archival data from the Hydrocephalus Clinical Research Network (HCRN) registry. A retrospective review of prospectively collected and maintained data on children with DWSH, available from the HCRN registry (14 sites, 2008-2018), was performed. The primary outcome was revision-free survival of the initial surgical intervention. The primary exposure was either shunt-based (i.e., cystoperitoneal shunt [CPS], ventriculoperitoneal shunt [VPS], and/or dual-compartment) or ETV-based (i.e., ETV alone or with choroid plexus cauterization [CPC]) initial surgical treatment. Primary analysis included multivariable Cox proportional hazards models. Of 8400 HCRN patients, 151 (1.8%) had DWSH. Among these, the 102 patients who underwent shunt placement (79 VPSs, 16 CPSs, 3 other, and 4 multiple proximal catheter) were younger (6.6 vs 18.8 months, p < 0.001) and more frequently had 1 or more comorbidities (37.3% vs 14.3%, p = 0.005) than the 49 ETV-treated children (28 ETV-CPC). Fifty percent of the shunt-based and 51% of the ETV-based treatments failed. Notably, 100% (4/4) of the dual-compartment shunts failed. Adjusting for age, baseline ventricular size, and comorbidities, ETV-based treatment was not significantly associated with earlier failure compared with shunt-based treatment (HR for failure 1.32, 95% CI 0.77-2.26; p = 0.321). Complication rates were low: 4.9% and 6.1% (p = 0.715) for shunt- and ETV-based procedures, respectively. There was no difference in survival between ETV-CPC- and ETV-based treatment when adjusting for age (HR for failure 0.86, 95% CI 0.29-2.55, p = 0.783). In this North American, multicenter, prospective database review, shunt-based and ETV-based primary treatment strategies of DWSH appear similarly durable. Pediatric neurosurgeons can reasonably consider ETV-based initial treatment given the similar durability and the low complication rate. However, given the observational nature of this study, the treating surgeon might need to consider subgroups that were too small for a separate analysis. Very young children with comorbidities were more commonly treated with shunts, and older children with fewer comorbidities were offered ETV-based treatment. Future studies may determine preoperative characteristics associated with ETV treatment success in this population.

Prevalence and Risk Factors of Artificial Urinary Sphincter Revision in Nonneurological Male Patients.

The main objective of this study was to assess the prevalence and risk factors of male artificial urinary sphincter (AUS) mechanical failures and nonmechanical failures. The charts of all male patients who underwent AUS implantation between 2004 and 2020 in 16 centers were retrospectively reviewed. Patients with neurogenic stress urinary incontinence (SUI) were excluded as well as revisions/explantations due to infections and/or erosions. The causes of revision were divided into mechanical failures (fluid loss or malfunction from any components of the AUS), nonmechanical failures (urethral atrophy, recurrence/persistence of SUI despite normally functioning device) and other (pump malposition, balloon herniation, hematoma, pain). Failure-free survival analysis was performed both for general and specific causes of revision. Predictors of mechanical and nonmechanical failures were determined by Cox proportional hazards model. A total of 1,020 patients met the inclusion criteria. After a median followup of 20 months, the estimated 5-year and 10-year overall revision-free survival was 60% and 40%, respectively. There were 214 AUS revisions: 59 (27.6%) for mechanical failures, 121 (56.5%) for nonmechanical failures and 34 (15.9%) other causes of revision. In multivariable Cox regression analysis, larger cuff size was the only predictor of overall revisions (HR=1.04 [1.01-1.07]; p=0.01) and revision for nonmechanical failure (HR=1.05 [1.02-1.09]; p=0.004). Half of the male AUS patients underwent device revision within the first 10 years after implantation. Nonmechanical failures are the primary cause of AUS revision in nonneurological men. Larger cuff size appears to be the main determinant of AUS revision risk.

Biological reconstruction of the proximal femur after treatment of benign lesions: comparison of functional and oncological outcomes for children and adults.

Describe and compare the functional and oncological outcomes and complications between paediatric and adult patients after intra-lesional treatment of benign tumours of the proximal femur, stabilised with an autologous non-vascularised fibular strut graft (NVFSG). Retrospective review including 54 patients with a benign histopathological diagnosis treated between 1987 and 2018. The mean age at operation was 17years (range, 3 to 37years) with a median follow-up of 39.5months (IQR 46.7months). Patients were grouped according to their age at diagnosis (< 16years versus ≥ 16years). Data collection included weight-bearing status, Musculoskeletal Tumour Society (MSTS) score, local recurrence, revision surgery and complications. Local recurrence-free survival (LRFS) and revision-free survival (RFS) were calculated and compared between groups. The median MSTS score for all patients was 98.3% (IQR 6.7%) without a statistically significant difference (p = 0.146) between both groups. The median time to full weight-bearing was 12weeks (IQR 0weeks). Local recurrence occurred in five (9%) patients. LRFS for all patients was 96% at 2years and 88% at 5years. Although local recurrence was more frequent in the paediatric group, LRFS did not significantly differ (p = 0.155, 95% CI 223.9 to 312.3) between both groups. Reoperation rate was 13% and was indicated for local recurrence, post-operative fracture, graft resorption and avascular necrosis. RFS for all patients was 90% at 2years and 85% at 5years. There was no statistically significant difference (p = 0.760, 95% CI 214.1 to 304.6) regarding RFS between both groups. The use of an autogenous NVFSG after intra-lesional curettage of benign proximal femoral lesions allows for a biological, structural stabilisation without additional osteosynthesis, hastening weight-bearing and avoiding metalwork-related complications with minimal post-operative morbidity and complications and excellent functional and oncological outcome for both children and adults.