Revision Strategies Research Articles

An energy consumption optimization strategy for Wireless sensor networks via multi-objective algorithm

Deploying relay nodes is a significant mechanism to prolong the network lifetime of wireless sensor networks (WSNs). However, most existing studies overlook the energy consumption of relay nodes, leading to imperfections in the optimization process. Additionally, there is also a lack of analysis of conflicts between different optimization objectives. In this regard, a multi-objective antlion with fuzzy clustering algorithm (MOALO-FCM) is designed to obtain a better trade-off between different optimization objectives. And an adaptive membership function revision strategy is introduced to improve the energy balance of relay nodes. To verify the performance of the proposed algorithm, simulation experiments are set in 2-dimensional and 3-dimensional scenes with correlative algorithms, respectively. The main evaluation indexes include performance of Pareto optimal solution sets, the life cycle of network, the energy consumption of sensor nodes, the energy consumption of relay nodes, the number of living nodes, and the running time of algorithms. The results indicate that the proposed algorithm has better performance in various indexes.

Surgical Failure and Revision Strategy for Atlantoaxial Dislocation: A Retrospective Study of 109 Cases.

Retrospective study. To classify surgical failures following atlantoaxial dislocation, present strategies for revisions, and evaluate the clinical results of revision surgery. With the increase in atlantoaxial dislocation surgery, the number of surgical failures has gradually risen. However, current reports on atlantoaxial surgical revision are limited in scope. There remains a lack of summary regarding the causes of surgical failure, a detailed classification system, and no proposed strategy for revision surgery. A total of 109 cases of failed surgery following atlantoaxial dislocation were classified according to the reduction immediately after surgery and the fusion status before revision. The reduction, decompression, fusion status, and outcomes following revision surgery were evaluated by x-ray, computed tomography, magnetic resonance imaging, and the Japanese Orthopaedic Association score. The data were analyzed statistically with a paired-samples t test and multivariable logistic regression analysis. The 109 patients were classified into three categories of failure: nonreduction with nonfusion (NR-NF, 73 cases), nonreduction with fusion (NR-F, 19 cases), and reduction with nonfusion (R-NF, 17 cases). Sixty-four patients underwent anterior revision, 21 posterior revision, and 24 anteroposterior revision. Postoperative complications were the primary cause of early revisions. After revision, complete decompression was achieved in all cases, anatomical reduction in 89 cases, significant improvement of Japanese Orthopaedic Association score in 77 cases, and fusion achieved in 86 cases. Twelve cases experienced surgical complications and three underwent a second revision. The authors found that NR-NF was the most common type of failure following surgery for atlantoaxial dislocation. Revision strategies can be guided according to the descriptive classification of failure, and revision surgery should focus on achieving adequate reduction, appropriate fixation, and reliable fusion to optimize postsurgical outcomes.

Simultaneous Tunnel Grafting and Anterior Cruciate Ligament Reconstructions Revision Using Double Suspensory Fixation: A Single-Stage Solution

The anterior cruciate ligament (ACL) is often vulnerable to sports-related injuries, leading to numerous ACL reconstructions (ACLRs) annually in the United States. Although largely successful, these procedures face the risk of recurrent instability due to graft failure. ACLR failures are typically attributed to technical errors and patient-related factors, with improper positioning of the tibial and femoral tunnels as the most common technical mistake. Current 2-stage revision techniques involve primary bone grafting followed by secondary tendon graft placement, resulting in increased costs and extended rehabilitation times. This article proposes a single-stage revision strategy involving simultaneous tunnel grafting and ACLR revision. The method employs double suspensory fixation by adjustable loop buttons, thereby eliminating the dependence on metaphyseal bone stock for stable graft fixation. This new procedure may offer a more efficient and cost-effective approach, reducing the need for a second surgery and potentially allowing patients to return to normal activities more quickly.

Which revision strategy is the best for non-mechanical failure of male artificial urinary sphincter?

Persistence or recurrence of stress urinary incontinence (prSUI) after artificial urinary sphincter (AUS) implantation may be secondary to non-mechanical failure (NOMECA). It have for long been assumed to result from urethral atrophy. Its existence is now debated. As the pathophysiology of NOMECA is not elucidated, the most appropriate management remains unclear. We aimed to compare the several revision techniques for NOMECA of AUS in men. NOMECA was defined as prSUI, with normally functioning device, no erosion, infection or fluid loss. Exclusion criteria were neurogenic SUI, revision or explantation for other causes. From 1991 to 2022, 143 AUS revisions for NOMECA, including 99 cuff DOWNSIZING, 10 cuff repositioning (RELOC), 13 TANDEM-CUFF placement, 18 cuff changing (CHANGE), three increasing balloon pressure (BALLOON-UP), were performed in 10 centers. BALLOON-UP patients weren't included in comparative analysis due to small sample size. All components could be changed during the revision. Patients were also categorized in COMPLETE-CHANGE vs. PARTIAL-CHANGE of the device. The three-months complete continence rate was 70.8% with a significant difference between RELOC and DOWNSIZING groups (p = 0.04). COMPLETE CHANGE was significantly associated with complete continence status at three months in multivariate analysis (83.3% vs.63.3%, OR = 2.7; CI 95% [1.1-7.1], p = 0.03). Estimated five-year reoperation-free and explantation-free survival were respectively 63.4% and 75.9% (p = 0.16; p = 0.30). Those were significantly longer in COMPLETE-CHANGE vs PARTIAL-CHANGE (82.2% vs.69.6%, p = 0.03); (71.2% vs. 58.2%, p = 0.047). AUS revision for prSUI due to NOMECA yields satisfactory outcomes regardless of the technique used. We observed better functional outcomes when repositioning the new cuff. COMPLETE-CHANGE may improve functional outcomes, explantation-free and reoperation-free survivals.

Illuminating Student Voices in Research: What 7th Graders Report Learning After a Revision Unit of Study

ABSTRACT Revision is a complex cognitive task and an integral component of the writing process. Students benefit from understanding the value of and how to revise their own writing. The purpose of this study was to turn to students to investigate their understandings of revision. We posed the following question: What are 7th graders’ perceptions and understandings of revision following a unit of study on revision? Using Qualtrics, we surveyed 345 seventh grade students (52% male, 48% female) about their understanding of revision after revising a piece of writing they had previously composed and considered “finished.” Within the unit, students were taught to replace, add, delete, and reorder their writing. Findings indicate that prior to the unit students confused editing tasks for revision moves. Following the unit, students’ understanding of the purpose of and how to revise grew and they felt their knowledge and use of revision strategies improved their writing. In addition, students found that distance from their piece helped them to see their writing in more critical ways. Student voices and experiences are needed to shed light on what students really know and understand about revision.

Revision Strategies for Cervical Disc Arthroplasty.

Narrative review. To review indications and strategies for revision of cervical disc arthroplasty (CDA). No data were generated as part of this review. A narrative review of the literature was performed. No results were generated as part of this review. CDA is a proven, motion-sparing surgical option for the treatment of myelopathy or radiculopathy secondary to cervical degenerative disc disease. As is the case with any operation, a small percentage of CDA will require revision, which can be a technically demanding endeavor. Here we review available revision strategies and associated indications, a thorough understanding of which will aid the surgeon in finely tailoring their approach to varying presentations.

Percutaneous Juxtapedicular Cement Salvage of Failed Spinal Instrumentation? Institutional Experience and Cadaveric Biomechanical Study.

Instrumented spinal fusion constructs sometimes fail because of fatigue loading, frequently necessitating open revision surgery. Favorable outcomes after percutaneous juxtapedicular cement salvage (perc-cement salvage) of failing instrumentation have been described; however, this approach is not widely known among spine surgeons, and its biomechanical properties have not been evaluated. We report our institutional experience with perc-cement salvage and investigate the relative biomechanical strength of this technique as compared with 3 other common open revision techniques. A retrospective chart review of patients who underwent perc-cement salvage was conducted. Biomechanical characterization of revision techniques was performed in a cadaveric model of critical pedicle screw failure. Three revision cohorts involved removal and replacement of hardware: (1) screw upsizing, (2) vertebroplasty, and (3) fenestrated screw with cement augmentation. These were compared with a cohort with perc-cement salvage performed using a juxtapedicular trajectory with the failed primary screw remaining engaged in the vertebral body. Ten patients underwent perc-cement salvage from 2018 to 2022 to address screw haloing and/or endplate fracture threatening construct integrity. Pain palliation was reported by 8/10 patients. Open revision surgery was required in 4/10 patients, an average of 8.9 months after the salvage procedure (range 6.2-14.7 months). Only one revision was due to progressive hardware dislodgement. The remainder avoided open revision surgery through an average of 1.9 years of follow-up. In the cadaveric study, there were no significant differences in pedicle screw pullout strength among any of the revision cohorts. Perc-cement salvage of failing instrumentation is reasonably efficacious. The technique is biomechanically noninferior to other revision strategies that require open surgery for removal and replacement of hardware. Open revision surgery may be avoided by perc-cement salvage in select cases.

Implant failure and revision strategies after total spondylectomy for spinal tumors

BackgroundAlthough there have been several risk factors reported for implant failure (IF), little consensus exists. Potential applicable measures to protect patients from IF are relatively few. This study aimed to discover new risk factors for IF and explore potential protective measures from IF after total spondylectomy for spinal tumors. MethodsA total of 145 patients undergoing total spondylectomy for thoracic and lumbar spinal tumors between 2010 and 2021 were included from three tertiary university hospitals. Patient demographic and surgical characteristics and follow-up outcomes were collected. ResultsDuring a mean follow-up of 53.77 months (range, 12 to 149 months), 22 of 145 patients (15.17%) developed IF. Patients undergoing thoracolumbar junctional region (T12/L1) resection were more likely to develop IF compared to those undergoing surgery at other vertebral levels (HR = 21.622, 95% CI = 3.567–131.084, P = 0.001). Patients undergoing titanium mesh cage reconstruction were more likely to develop IF compared to patients undergoing expandable titanium cage reconstruction (HR = 8.315, 95% CI = 1.482–46.645, P = 0.016). Patients with bone cement augmentation around the cage were less likely to develop IF compared to those not receiving bone cement augmentation (HR = 0.015, 95% CI = 0.002–0.107, P < 0.001). Of the 22 patients with IF, 14 (63.63%) accepted personalized revision surgery. ConclusionThe use of an expandable cage and the use of bone cement augmentation around the anterior column support cage are protective measures against IF after total spondylectomy.

The importance of a structured failure analysis in revision acromioclavicular joint surgery: A multi-rater agreement on the causes of stabilization failure from the ISAKOS shoulder committee

BackgroundAcromioclavicular joint (ACJ) stabilizations are associated with a high overall failure rate with 9.5% of these patients requiring subsequent revision surgery. Consequently, understanding the specific cause of primary ACJ stabilization failure is paramount to improving surgical decision-making in this challenging patient cohort. PurposeTo (1) identify risk factors and mechanisms for failure following primary arthroscopically-assisted ACJ stabilization to highlight the importance of conducting a detailed failure analysis and to (2) establish revision strategies based on real-life cases of primary failed ACJ stabilization. Study designLevel of evidence IV. MethodsA survey was shared internationally among members of the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) shoulder committee. The survey contained failure analysis of 11 real-life cases of failed primary arthroscopically-assisted ACJ stabilization. For each case, a thorough patient history, standardized radiographs, and CT scans were provided. Participants were asked to give their opinion on bone tunnel placement, cause of failure (biological, technical, traumatic, or combined), the stabilization technique used, as well as give a recommendation for revision. ResultsSeventeen members of the ISAKOS shoulder committee completed the survey. Biological failure was considered the most common cause of failure (47.1%), followed by technical (35.3%) and traumatic (17.6%) failure. The majority deemed two modifiable factors (i.e., patient's profession and sport) as well as non-modifiable factors (i.e., patient's age and time from trauma to initial surgery) to be risk factors for failure. In 10 of 11 cases, the correct fixation device was used in the primary setting (90.9%; 52.8–82.4% agreement); however, in eight of those cases, the technique was not performed correctly (80.0%; 58.8–100% agreement). In 8 of all 11 cases, the majority recommended an arthroscopically assisted technique with graft augmentation for revision (52.9–58.8% agreement). ConclusionBiological failure and technical failure are the most common reason for failure in primary ACJ stabilization followed by traumatic failure. Besides, biological failure can be triggered by technical errors such as clavicular or coracoidal tunnel misplacement. Consequently, a detailed failure analysis including preoperative CT should be conducted on the causes of primary ACJ failure, and, if possible, an arthroscopically-assisted technique with graft augmentation should be prioritized in revision ACJ surgery. Clinical relevanceACJ stabilizations are associated with a high overall failure rate - potentially due to biological and technical properties. When encountering failed arthroscopically-assisted ACJ stabilization, a detailed failure analysis should be conducted on the causes of primary ACJ failure. Furthermore, an arthroscopically-assisted revision stabilization is feasible in most cases.

Increasing risk of revision due to infection after primary total hip arthroplasty: results from the Nordic Arthroplasty Register Association.

The incidence of periprosthetic joint infection after total hip arthroplasty (THA) may be increasing. We performed time-trend analyses of risk, rates, and timing of revision due to infection after primary THAs in the Nordic countries from the period 2004-2018. 569,463 primary THAs reported to the Nordic Arthroplasty Register Association from 2004 to 2018 were studied. Absolute risk estimates were calculated by Kaplan-Meier and cumulative incidence function methods, whereas adjusted hazard ratios (aHR) were assessed by Cox regression with the first revision due to infection after primary THA as primary endpoint. In addition, we explored changes in the time span from primary THA to revision due to infection. 5,653 (1.0%) primary THAs were revised due to infection during a median follow-up time of 5.4 (IQR 2.5-8.9) years after surgery. Compared with the period 2004-2008, the aHRs for revision were 1.4 (95% confidence interval [CI] 1.3-1.5) for 2009-2013, and 1.9 (CI 1.7-2.0) for 2014-2018. The absolute 5-year rates of revision due to infection were 0.7% (CI 0.7-0.7), 1.0% (CI 0.9-1.0), and 1.2% (CI 1.2-1.3) for the 3 time periods respectively. We found changes in the time span from primary THA to revision due to infection. Compared with 2004-2008, the aHR for revision within 30 days after THA was 2.5 (CI 2.1-2.9) for 2009-2013, and 3.4 (CI 3.0-3.9) for 2013-2018. The aHR for revision within 31-90 days after THA was 1.5 (CI 1.3-1.9) for 2009-2013, and 2.5 (CI 2.1-3.0) for 2013-2018, compared with 2004-2008. The risk of revision due to infection after primary THA almost doubled, both in absolute cumulative incidence and in relative risk, throughout the period 2004-2018. This increase was mainly due to an increased risk of revision within 90 days of THA. This may reflect a "true" increase (i.e., frailer patients or more use of uncemented implants) and/or an "apparent" increase (i.e., improved diagnostics, changed revision strategy, or completeness of reporting) in incidence of periprosthetic joint infection. It is not possible to disclose such changes in the present study, and this warrants further research.

Satellite Rod Fixation around Rod-fracture Area in Revision Surgery after Three-column Osteotomy for Severe Kyphoscoliosis.

Three-column osteotomy (3CO) is considered valuable and increasingly utilized in the surgical treatment of severe spine deformity while associated with high implant-related complications and revision risks. This study aims to evaluate the feasibility and clinical outcomes of satellite rod fixation used around the rod-fracture area in revision surgery due to rod fracture after 3CO. Twenty-five patients applying satellite rod fixation in revision surgery from August 2012 to May 2016 were retrospectively reviewed as the SR group. Patients undergoing revision surgery with traditional strategy after 3CO due to rod-fracture were selected as the TR group. Cobb angle, distance between C7 plumb line and center sacral vertical line (C7 PL-CSVL), global kyphosis (GK) and sagittal vertical axis (SVA) were assessed. Patients were required to fulfill the Scoliosis Research Society-22 questionnaire (SRS-22) at pre-revision and the last follow-up. The paired t test was used to analyze the difference among pre-revision, post-revision and last follow-up. There was no statistical difference in terms of age, gender, body mass index (BMI), fusion level at 1st surgery, and follow-up period between SR and TR group (all P > 0.05). The operation time (1.5 ± 0.7 h vs 3.2 ± 0.9 h, P < 0.001) and intraoperative blood loss (178 ± 51 mL vs 324 ± 96 mL, P < 0.001) were significantly higher in the TR group. Patients in both groups obtained obvious deformity correction after revision surgery. For patients in SR group, the coronal Cobb angle significantly improved from 27.9 ± 21.5° at pre-revision to 21.8 ± 16.6° at post-revision (P = 0.034). The C7 PL-CSVL decreased from 22.6 ± 14.3 mm to 21.3 ± 10.9 mm (P = 0.719). Similarly, improvement was attained in post-revision GK (25.8 ± 17.0° vs 20.2 ± 15.1°, P = 0.061). SVA was corrected from 35.6 ± 33.9 mm to 30.8 ± 24.3 mm after revision (P = 0.182). At the last follow-up, no significant correction loss was observed in both coronal and sagittal parameters (all P > 0.05). All patients responded to the SRS-22 questionnaire and all the domains showed improvements in different levels. As compared to the TR group, the SR group had significantly better pain and management satisfaction scores (all P < 0.05). Additionally, there was no reoccurrence of implant failure during follow-up and all patients achieved solid bony fusion in SR group. Satellite rod fixation around rod-fracture area is indicated for patients in the requirement of revision surgeries due to rod fracture after 3CO. Compared with traditional revision strategies, revision surgery with satellite rods, if patients are selected adequately, is a simpler procedure with less intraoperative blood loss and shorter operating time.

Mortality and re-revision following single-stage and two-stage revision surgery for the management of infected primary hip arthroplasty in England and Wales.

We compared the risks of re-revision and mortality between two-stage and single-stage revision surgeries among patients with infected primary hip arthroplasty. Patients with a periprosthetic joint infection (PJI) of their primary arthroplasty revised with single-stage or two-stage procedure in England and Wales between 2003 and 2014 were identified from the National Joint Registry. We used Poisson regression with restricted cubic splines to compute hazard ratios (HRs) at different postoperative periods. The total number of revisions and re-revisions undergone by patients was compared between the two strategies. In total, 535 primary hip arthroplasties were revised with single-stage procedure (1,525 person-years) and 1,605 with two-stage procedure (5,885 person-years). All-cause re-revision was higher following single-stage revision, especially in the first three months (HR at 3 months = 1.98 (95% confidence interval (CI) 1.14 to 3.43), p = 0.009). The risks were comparable thereafter. Re-revision for PJI was higher in the first three postoperative months for single-stage revision and waned with time (HR at 3 months = 1.81 (95% CI 1.22 to 2.68), p = 0.003; HR at 6 months = 1.25 (95% CI 0.71 to 2.21), p = 0.441; HR at 12 months = 0.94 (95% CI 0.54 to 1.63), p = 0.819). Patients initially managed with a single-stage revision received fewer revision operations (mean 1.3 (SD 0.7) vs 2.2 (SD 0.6), p < 0.001). Mortality rates were comparable between these two procedures (29/10,000 person-years vs 33/10,000). The risk of unplanned re-revision was lower following two-stage revision, but only in the early postoperative period. The lower overall number of revision procedures associated with a single-stage revision strategy and the equivalent mortality rates to two-stage revision are reassuring. With appropriate counselling, single-stage revision is a viable option for the treatment of hip PJI.

A narrative review: evaluation and surgical management of persistent and recurrent urinary incontinence after previous surgical treatment.

Urinary incontinence after prostate treatment is associated with significant morbidity and impact on quality of life. Stress urinary incontinence can be treated by insertion of a urethral sling or artificial urinary sphincter. Persistent or recurrent urinary incontinence after such treatment can be frustrating and require specific evaluation and approach to management to optimize chance of successful outcomes and patient satisfaction whilst avoiding further patient morbidity. The aim of this review is to outline the evaluation and management of persistent and recurrent urinary incontinence in men after previous surgical treatment for stress urinary incontinence by way of narrative review. A literature review was performed using PubMed, MEDLINE, and Google Scholar between 2010 to 2023. The search strategy included the following MeSH terms: device, men, urinary incontinence, persistence, recurrence, and revision. A total of 140 English-language articles were identified and reviewed; 68 articles were considered relevant to the aims and the findings have been outlined in this narrative review. There are many approaches currently practiced by surgeons in continence revision surgery. There is not clear consensus regarding optimum revision strategy for persistent and recurrent incontinence post urethral sling and artificial urinary sphincter insertion. Whilst small observational studies have reviewed different surgical approaches, there is a paucity of high volume comparative data from which to draw conclusions. However, there have been recent studies enabling a paradigm shift in the understanding of incontinence post artificial urinary sphincter insertion that may lead to improved revision strategies in future. There are various surgical modalities used to manage incontinence following urethral sling and artificial urinary sphincter insertion. There is currently no clear consensus on the optimal surgical technique for persistent or recurrent urinary incontinence after surgery. Further comparative studies would be beneficial to help guide surgeons as to which revision approaches would be suitable for select patients.

One-stage complete eradication and revision hip due to pseudotumor in metal-on-metal hip arthroplasty.

The correct management and treatment of pseudotumors due to metal-on-metal (MOM) hip arthroplasty are still debated. The purpose of this study is to analyze the surgical treatment and the clinical and radiographic 3-year outcomes of MOM arthroplasty revisions due to pseudotumor treated with a strategy of excision and revision. Consecutive, retrospective series of 21 patients (8 males/13 females) with pseudotumor due to MOM hip arthroplasty was surgically treated at a single tertiary center. Demographic, clinical, radiological and implant-related features were collected pre-operatively. Post-revision clinical and radiographic parameters were evaluated. Chromium (Cr) and cobalt (Co) blood samples were collected before and after surgery. Three patients (14.2%) with pseudotumor underwent a resection arthroplasty due to infection (perioperative finding) and could not be reimplanted due to septic relapses. Twenty (95.2%) pseudotumors were completely resected. Revisions [2 total hip reimplantations (11.1%) and 16 isolated component revisions (88.9%)] were performed with non-MOM couplings. A clinical improvement at a mean post-revision follow-up 3.3 years [standard deviation (SD), ±2.2 years] was observed, from 50.3 (SD, ±4.6) to 88.3 (SD, ±9.2) Harris hip score (HHS) points (P<0.001). Among revisions, there were 5 complications (23.8%): 1 dislocation, 1 psoas impingement, and 3 infections (14.2%). No re-revision was carried out. Three (14.2%) pseudotumors recurred: 1 was surgically treated, 1 was treated with selective arterial embolization, and 1 clinically followed. At the final follow-up, Cr and Co blood ions beyond the threshold decreased from 85.7% cases to 0% in the seven patients that could be evaluated. The one-stage strategy of radical excision and revision with non-MOM couplings in pseudotumors due to MOM hip arthroplasty achieved good 3-year outcomes. However, complications were frequent (23%). Recurrences were not rare (14%) and did not require implant re-revision.

MP71-09 WHICH REVISION STRATEGY IS THE BEST FOR NON-MECHANICAL FAILURE OF MALE ARTIFICIAL URINARY SPHINCTER?

MP71-09 WHICH REVISION STRATEGY IS THE BEST FOR NON-MECHANICAL FAILURE OF MALE ARTIFICIAL URINARY SPHINCTER?

437 Percutaneous Juxtapedicular Cement Salvage of Failed Pedicle Screws: A Cadaveric Biomechanical Study

INTRODUCTION: Posterior spinal fixation with pedicle screw-based constructs is the gold standard for stabilizing the thoracolumbar spine; however, these constructs sometimes fail due to fatigue loading, necessitating revision surgery. A common hardware revision strategy involves open surgery for screw upsizing, with or without cement augmentation, and extension of fusion. Others have described good clinical outcomes following percutaneous juxtapedicular cement salvage of failing pedicle screws. The relative biomechanical properties of these various approaches has not been evaluated. METHODS: Thirty-two fresh, un-embalmed vertebrae from four cadaveric thoracolumbar spines were used for the study. The study was conducted in two phases. The first phase involved primary pedicle screw insertions and pullout strength testing to model critical pedicle screw failure. The second phase involved revision of failed pedicle screws followed by pullout testing. The four revision cohorts were: 1) Screw Upsizing, 2) Vertebroplasty (cement augmentation with replacement of primary screw), 3) Fenestrated Screws with cement augmentation, and 4) Juxtapedicular Cement Salvage. RESULTS: There was no statistically significant difference in primary fixation strength between the cohorts. The Screw Upsizing cohort exhibited inferior pullout strength compared to the other groups which involved cement augmentation. There was no significant difference in pullout strength between Vertebroplasty, Fenestrated Screws, or Juxtapedicular Cement Salvage cohorts. CONCLUSIONS: Cement augmentation confers superior pullout strength compared to screw upsizing only. The key finding of this study is that the technique of percutaneous juxtapedicular cement salvage is biomechanically non-inferior to other revision strategies that require an open procedure to perform.

Development of evidence-based guidelines for the treatment and management of periprosthetic hip infection.

Periprosthetic hip-joint infection is a multifaceted and highly detrimental outcome for patients and clinicians. The incidence of prosthetic joint infection reported within two years of primary hip arthroplasty ranges from 0.8% to 2.1%. Costs of treatment are over five-times greater in people with periprosthetic hip joint infection than in those with no infection. Currently, there are no national evidence-based guidelines for treatment and management of this condition to guide clinical practice or to inform clinical study design. The aim of this study is to develop guidelines based on evidence from the six-year INFection and ORthopaedic Management (INFORM) research programme. We used a consensus process consisting of an evidence review to generate items for the guidelines and online consensus questionnaire and virtual face-to-face consensus meeting to draft the guidelines. The consensus panel comprised 21 clinical experts in orthopaedics, primary care, rehabilitation, and healthcare commissioning. The final output from the consensus process was a 14-item guideline. The guidelines make recommendations regarding increased vigilance and monitoring of those at increased risk of infection; diagnosis including strategies to ensure the early recognition of prosthetic infection and referral to orthopaedic teams; treatment, including early use of DAIR and revision strategies; and postoperative management including appropriate physical and psychological support and antibiotic strategies. We believe the implementation of the INFORM guidelines will inform treatment protocols and clinical pathways to improve the treatment and management of periprosthetic hip infection.

Evaluation of the Early-Mid-Term Results of Isolated Tibial Insert Exchange After Total Knee Arthroplasty.

This study aimed to assess the early and mid-term results of patients who had undergone total knee arthroplasty (TKA) and then underwent an isolated tibial insert exchange due to tibial insert fracture and/or melting. A retrospective study was conducted at the Orthopedics and Traumatology Clinic in a secondary-care public hospital in Türkiye on seven knees of six patientsaged 65 years and abovewho underwent an isolated tibial insert exchange and were followed up for at least six months. Pain and functional assessments of the patients were made with the visual analog scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) performed at the last control before the treatment and at the final follow-up visit after the treatment. The median age of the patients was 70.5 years. The median length of time between the primary TKA and the isolated tibial insert exchange was 5.96 years. After isolated tibial insert exchange, the patients were followed for a median of 268 days and a mean of 414 days. The WOMAC pain, stiffness, function, and total indexes were median 15, 2, 52, and 68, respectively, before the treatment. In contrast, the final follow-up WOMAC pain, stiffness, function, and total indexes were median 3 (p = 0.01), 1 (p = 0.023), 12 (p = 0.018), and 15 (p = 0.018), respectively. It was observed that the median VAS, which was "9" preoperatively, showed a statistically significantimprovement to become "2" in the postoperative period. A strong negative correlation was found between age and the amount of decline in the total score of the WOMAC pain scale (r = -0.780; p = 0.039). There was a powerful negative correlation between the body mass index (BMI) and the amount of decline in WOMAC pain scores (r = -0.889; p = 0.007). A strong negative correlation was found between the length of time passing between two surgical procedures and the amount of decline in the WOMAC pain score (r = -0.796; p = 0.032). Individual patient factors and prosthetic conditions should be considered undoubtedly when determining the best revision strategy in TKA patients. In cases where the components are well-aligned and well-fixed, isolated tibial insert exchange is an alternative to revision TKA since it is less invasive and more cost-effective.

Second Language Learners’ Peer Interaction During Collaborative Writing in Online Platforms

The purpose of this study was to explore second language (L2) learners" peer interaction in synchronous online collaborative writing using Google Docs. This study investigated how five L2 learners in a group were engaged in peer interaction in the three stages of collaborative writing (i.e., the writing stage, the peer review stage, and the revision stage) and how they perceive their peer interaction and the use of online tools. The recordings of students" interactions in the group collaborative writing and survey responses on their perceptions were collected and analyzed qualitatively. The findings showed that the learners mostly used the cooperation revision strategy and the synchronous hands-on strategies in all three stages. Moreover, several key features of the learners" peer interaction as peer feedback in the three stages included indirect ways of asking for help, initiation of peer feedback by different proficiency level students, and contingently responsive feedback. It was also found that the learners mostly had a positive perception of synchronous online collaborative writing and the use of Google Docs. This study provides pedagogical implications for integrating online collaborative writing tasks in L2 writing classrooms.

It Is Always the Same—A Complication Classification following Angular Stable Plating of Proximal Humeral Fractures

The aim of this study was to create a novel complication classification for osteosynthesis-related complications following angular stable plating of the proximal humerus subsuming the influence of these complications on clinical outcome in relation to fracture morphology and consequent revision strategies. A total of 1047 proximal humerus fractures with overall 193 osteosynthesis-associated complications (24.5%) were included. The following complication types could be clarified: complication Type 1 is defined by mild varus (<20°) or valgus displacement of the humeral head without resulting in a screw cutout through the humeral head cortex. Type 2a is defined by varus displacement (<20°) of the humeral head associated with screw cutout through the humeral head cortex. Type 2b complication is limited to displacement of the greater tuberosity, lesser tuberosity, or both tuberosities. Complication Type 2c is defined by severe varus dislocation (>20°) of the humeral head with screw cutout at the humeral head cortex. Complication Type 3 describes a displacement of the angular stable plate in the humeral shaft region with associated shaft-sided screw cutout, while the position of the humeral head remains static. Complication Type 4 is characterized by the occurrence of AVN with or without glenoidal affection (4a/b). Clinical outcome according to the constant score was mainly affected by type 2-4, leading to a deteriorated result. Depending on the type of complication, specific revision strategies can be considered. Additionally, more complex fracture patterns fostered the incidence of complications.