Type Of Endoprosthesis Research Articles

Discussing on the Aortic Coverage in Type B Aortic Dissection Treatment: A Comprehensive Scoping Review.

The objective of this study is to investigate and address the question surrounding the determination of the optimal endograft length of coverage during TEVAR for type B aortic dissection (TBAD), with a particular emphasis on the distal landing zone (DLZ). MEDLINE, Scopus, and Web of Science databases were used. The PRISMA-ScR statement was followed. Several variables can contribute to the length of coverage during TEVAR in TBAD patient. Baseline patient's characteristics, TBAD-related features, the type of endoprosthesis, and postoperative graft behaviour may contribute to the choice of coverage. No robust data have been published regarding the optimal length of TEVAR. Therefore, reporting the percentage of covered aorta and improving computational studies should be valorised to improve postoperative outcomes.

Is analog preoperative planning still applicable?-comparison of accuracy of analog and computer preoperative planning methods in total hip arthroplasty.

BackgroundPreoperative planning is an integral part of total hip arthroplasty and has a significant impact on surgical technique and clinical outcome. The variety of types and sizes of endoprosthesis components makes the procedure more demanding and generates a need for accurate preoperative planning. The objective of this study was to analyze an analog method of preoperative planning of primary total hip arthroplasty based on templates overlaying on preoperative radiograms and compare its accuracy for predicting the size, both the stem and cup, with computer planning methods.MethodsA retrospective cohort study based on 360 X-ray images of hip joints in 348 patients qualified for total hip arthroplasty between 2018 and 2019. The study group consisted of 136 men and 212 women, with an average age of 65 years (56 to 85 years). Material included both cementless and cemented endoprostheses.ResultsIn the analyzed material, the accuracy of cup planning using the analog method was 85% (P<0.001) and 77% (P<0.001) in the planning of stem size. However, using the computer method, planning accuracy was 82% (P<0.001) for the cup and 72% (P<0.001) for the stem.ConclusionsBoth methods of preoperative planning remain effective. The analog method of preoperative planning is simple, precise, and repeatable in choosing the type and size of endoprosthesis components with an accuracy of 85% and 77% for the cup and stem respectively. The accuracy of planning depends on the type of endoprosthesis and in the case of the cemented endoprosthesis, it is lower than in cementless.

Effect of endoprostheses on pulse wave velocity and its long-term outcomes after thoracic endovascular aortic repair.

The purpose of this study was to evaluate the changes in pulse wave velocity and left ventricular dimensions in patients undergoing stent-graft treatment for aortic arch aneurysm. From July 2008 to February 2019, 86 patients underwent thoracic endovascular aortic repair of an aortic arch aneurysm. Changes in pulse wave velocity (PWV), echocardiogram findings, and long-term outcomes were compared between endoskeleton type (n = 60) and exoskeleton type stent-graft (n = 26). There was no significant difference in patient demographics except for diabetes which was more observed in endoskeleton type (p = 0.017). There was a significant increase in PWV in exoskeleton type after surgery, which further progressed at a median follow-up of 32months (before: 2047cm/s vs. after: 2259cm/s vs. follow-up: 2486cm/s, p = 0.010, p = 0.017). No significant difference was observed in endoskeleton type (before: 1980cm/s vs. after: 2058cm/s, vs. follow-up: 2042cm/s, p = 0.25, p = 0.34). Echocardiogram performed at a median period of 46.3months, revealed a significant increase in left ventricular diastolic volume (LVDV) (before: 107.4 ± 20.6ml vs. follow-up: 127.7 ± 27.5ml, p = 0.003) and decrease in e' (before: 5.5 ± 1.78cm/s vs. follow-up: 4.7 ± 1.72cm/s, p = 0.012) in exoskeleton type, while no significant change was observed in endoskeleton type (LVDV: before: 102.6 ± 32.3ml vs. follow-up: 96.9 ± 35.4ml, p = 0.74; e': before: 4.4 ± 1.21cm/s vs. follow-up: 4.8 ± 1.40cm/s, p = 0.68). At the median period of 61.3months, there was no significant difference in long-term mortality (p = 0.89). However, the endoskeleton type was associated with a lower incidence of a cardiac event (p = 0.034) and cerebrovascular event (p = 0.029). Types of endoprosthesis might affect differently on physiological changes and its accommodated risk factors after surgery.

RADIOGRAPHIC EVALUATION OF EARLY OUTCOME AFTER TWO TYPES OF CEMENTLESS HIP ARTHROPLASTY

Introduction Total Hip Arthroplasty is one of the most common orthopaedic procedures. Its outcome is assessed by radiographic evaluation. Two principal radiographic parameters are cup inclination and stem position angle. Aim The study aimed to compare radiological outcomes of two total hip arthroplasty techniques: Alloclassic Zweymüller versus Corail Pinnacle endoprostheses. Material and methods Medical histories of 345 patients who had a hip replacement between 2007 and 2017 were reviewed. Patients with primary total hip arthroplasty with both of mentioned systems were included in the research. Seven observers individually evaluated the radiological images of the 67 endoprostheses (39 Alloclassic Zweymüller and 26 Corail Pinnacle). The cup inclination and the stem position angle were measured using MB-Ruler programme. Results There was no statistical difference (p &gt; 0.338) in cup inclination angle between Alloclassic Zweymüller and Pinnacle cups, with the angle ranging from 31.01° to 58.80° (45.20° on average) and from 30.61° to 59.1° (43.60° on average), respectively. Femoral stem position did not differ between both types of endoprosthesis (p &gt; 0.932), ranging from −1.05° to 7.87° (3.09° on average) for Alloclassic Zweymüller and 0.35° to 7.79° (3.06° on average) for Corail Pinnacle stem. ICC (Intraclass Coefficient Correlation) was estimated and their 95% confident intervals were calculated for cup inclination and stem position showing good reliability of cup inclination measurements. Conclusions Both types of endoprostheses presented similar radiological outcomes. Cup inclination can be used by non-experienced medical staff to reliably assess the postoperative radiograms. Keywords: cementless hip replacement, radiological outcomes, imaging.

Predicting Functional Outcomes in Patients with Femoral Neck Fractures Treated by Hemiarthroplasty.

A femoral neck fracture leads to serious health-related, social and economic consequences and, according to the con-temporary doctrine of medical management, should be treated surgically. Data provided by the Agency for Health Technology Assessment and Tariff System indicate that there were 1534 patients with femoral neck fractures treated by arthroplasty with a Moore's endoprosthesis and 4744 with a bipolar endoprosthesis in Poland in 2014. Since the risk of femoral neck fracture increases exponentially with the patient's age, and population aging is undoubtedly a real demographic trend, we believe that there is a need to develop criteria for taking treatment decisions to ensure the best possible outcomes. The aim of this paper is to identify factors influencing the functional outcomes of hemiarthroplasty measured with the Harris Hip Score (HHS) in patients with femoral neck fractures. The first part of study data consisted of clinical data derived from the medical treatment records of 161 patients with femoral neck fractures who were treated by hemiarthroplasty in the Orthopaedic Department of the Regional Hospital in Sieradz in 2009-2011. The age, sex, overall health status of the patients qualified for surgical treatment, time between injury and surgery, type of endoprosthesis, and length of stay at the department were determined. The second part was data from an outcome assessment using the Harris Hip Score (HHS) at two-year follow-up visits of 90 patients of the original group. The mean outcome of all the patients was defined as satisfactory (HHS score of 73.37 points). Examination of one-factor correlations between the outcome and the patient's sex and the type of endoprosthesis revealed significantly superior outcomes in men and patients who received the bipolar endoprosthesis. A multiple factor statistical analysis, which additionally included the variables of patient age and baseline overall health status, demonstrated that only overall health status (ASA score) had a statistically significant effect on the functional outcome of arthroplasty among all factors examined. 1. Evaluation of the quality of life of patients who underwent surgery after femoral neck fractures utilising the Harris Hip Score (HHS) in one-fac-tor correlations (age, sex, type of endoprosthesis, general condition) revealed significantly superior results for men who received the bipolar endo-prosthesis. There was also a moderately strong and negative correlation with the patients' age. 2. The functional outcomes in patients with low energy femoral neck fractures treated with two types of partial hip endoprosthesis at the Ortho-paedic Department of the Regional Hospital in Sieradz, assessed by multiple factor analysis, showed a significant correlation only with the patient's baseline overall health status.

The influence of 'potassium orotate' on neocollagenogenesis in implantation of polypropylene endoprosthesis and polypropylene combined with polylactic acid endoprosthesis

To study neocollagenogenesis after implantation of polypropylene endoprosthesis and polypropylene combined with polylactic acid endoprosthesis on background of «potassium orotate» administration. We used two different types of endoprosthesis in the experiment. The first type was made of just polypropylene, the second type was made of polypropylene combined with polylactic acid. Histological examination was performed using polarizing microscopy. Collagen types I and III ratio in connective tissue around the prosthesis was analyzed according to the color that was individual for each type. The results were significantly better in case of collagenogenesis stimulation with Potassium orotate within 30 days and later for one type of endoprosthesis. Also we revealed that collagenogenesis and paraprosthesis capsule formation were more active in case of combined endoprosthesis. We revealed stimulating action of «Potassium Orotate» for collegenogenesis process, this fact was proved by increased collagen I/III ratio. Optimization of collagenogenesis was based on persistent 1,37-fold increase of collagen I/III ratio in case of combined endoprosthesis after 90 days. It was manifested by accelerated formation of connective tissue capsule and facilitated early isolation of the implant from surrounding tissues.

The effect of vitamin C on the ratio of collagen types I and III in the periprosthesis area in mice

The aim of this study was to examine the collagen-stimulating effect of ascorbic acid on the growth of the Parieten ProGrip implanted synthetic hernia prosthesis. The characteristics of collagenogenesis in the anterior abdominal wall were assayed with polarized microscopy. We suggest a new way to stimulate a reparation process with ascorbic acid that will help to optimize forming functionally matured structures of connective tissue of the anterior abdominal wall surrounding endoprosthesis. The results of our investigation show that vitamin C has a positive effect on the collagen synthesis in the periprosthetic capsule for any type of endoprosthesis. This was proven by the statistically significant increase in the ratio of collagen I and III types with vitamin C to the animal diet.

Occupational Activity in Patients 10 Years after Hip Replacement Surgery.

Advanced hip osteoarthritis requires total joint replacement surgery to improve daily activity, including occupational activity. The purpose of this study was to evaluate employment status among patients 10 years after hip replacement surgery. A total of 63 patients who underwent total hip replacement surgery at the Department of Orthopedics and Traumatology between 2003 and 2005 were enrolled in the study. At the time of the study (2014), all patients from the study group were of working age. Ultimately, 32 patients participated in the study. Each participant completed a questionnaire with questions about the place of residence, age, type of endoprosthesis, employment status, type of work performed, reason for arthroplasty, postoperative course of rehabilitation and subjective health status. Functional capacity was evaluated using Harris' 100-point scale. 88% of the respondents had been employed prior to surgery, compared to only 46% one year after surgery and only 40% at 10 years after surgery. A positive outcome was that 17% of the respondents receiving a disability pension prior to surgery were able to return to work after surgery. 1. Hip replacement surgery may affect the employment status of patients. 2. The most significant factors influencing cessation of work were a high BMI, living in a rural environment and being female.

Endovascular Treatment of Aortic Aneurysms and Blood Transfusion. What do We Need?

Comparatively to open repair, endovascular aneurysm repair has reduced transfusion rates but thereâs no recommendation about number of red blood cells units to be crossmatched preoperatively. Our aim is contribute to the analysis of red blood cells units needs in endovascular and hybrid aortic aneurysm repair and developing a protocol for maximum surgical blood orders schedule. We retrospectively analyzed our prospective database of elective endovascular aneurysm repair from 2001 to 2012. We analyzed patients' age, gender, ASA classification, maximum surgical blood orders schedule, red blood cells units transfused and timings, types of endoprosthesis, red blood cells units consumption/endoprosthesis' type ratio, crossmatch to transfusion ratio, conversion to open repair, hemoglobin concentrations before surgery and discharge. We selected 187 patients, 90% men, mean age 73.1, ASA mode III. The endoprosthesis were aorto-bi-iliac in 71%, aorto-uni-iliac in 23% and thoracic in 6%. Of these, 72,6% of the patients did not require blood transfusion. We transfused 171 red blood cells units. Crossmatch to transfusion ratio was 10.1 until 2010 and 7.3 after. The ratio of red blood cells units consumption/endoprosthesis in the first 24 hours was 0.21 red blood cells units/aorto-bi-iliac, 0.46 red blood cells units/aorto-uni-iliac, 0.8 red blood cells units/thoracic, 1.3 red blood cells units/hybrid-thoracic and 2 red blood cells units/hybrid-aorto-bi-iliac. A statistical correlation was observed between red blood cells units transfused postoperatively and type of endoprosthesis (p < 0.001) and between ASA classification and red blood cells units transfused after 24 hours (p < 0.01). Guidelines from the British Society of Haematology are based on a crossmatch to transfusion ratio of 2:1. Our crossmatch to transfusion ratio was 10.1 until 2010 and 7.3 from 2011 to 2012. These results changed our policy of maximum surgical blood orders schedule for endovascular aneurysm repair. We now type and screen aorto-bi-iliac and aorto-uni-iliac. We crossmatch two red blood cells units for thoracic, three red blood cells units for hybrid thoracic and four red blood cells units for hybrid abdominal procedures. This may lead to financial savings, improved efficiency and reduce workload in hematology department.

Intraperitoneal and retromuscular abdominal wall repair using ultra-light and titanium-containing polypropylene mesh (experimental research)

To study experimental possibility of light, ultra-light and titanium-containing endoprostheses implantation for postoperative hernias correction. Abdominal wall repair was simulated in 72 rabbits. In the first group polypropylene mesh with fibers diameter of 90 microns and surface density of 36 g/m2 was used. In the second group we applied polypropylene mesh with fibers diameter of 65 microns and thin layer of titanium. Their surface density was 16 g/m2. Intraperitoneal onlay mesh (IPOM) and sublay retromuscular (SRM) techniques were used in group 1 and 2 respectively. Animals were taken out from the experiment in 30 and 60 days. Adhesive process in implantation area was evaluated using the method of Egiev V.N. and Lyadov V.K. The most pronounced adhesive process was observed in IPOM series. Type of endoprosthesis and terms of postoperative period did not significant effect adhesive process. SRM method was associated with significantly less pronounced adhesions. Analysis of all data showed that severity of adhesive process was significantly higher in IPOM series compared with SRM technique. Our study showed that severity of abdominal adhesive process associated with repair using ultra-light mesh is completely determined by surgical technique and did not depend on type of endoprosthesis and terms of postoperative period. Described implants should be used for retromuscular implantation rather intraperitoneal position.

Biomechanical study of stress-strain states of the system «endoprosthesis humerus» in terms of tumor resection

Objective : To compare the stress-strain state of the «prosthesis – humerus» system with loading on tension, bending and torsion in the case of resection in the upper, middle and lower thirds of the humeral diaphysis. Methods : It was developed a mathematical model that simulated cases of defects in the upper third, half and 2/3 of the proximal humerus formed after resection of the tumor and substituted with endoprosthesis. We investigated two types of implants: the first was fixed exclusively by intramedullary stem, the second had a combined mounting system and was fixed not only with the help of intramedullary stem but with the help of extracor­tical plates attached to the body of the endoprostesis and fixedly embraced the distal humerus. We tested models with three types of loadins — tension, bending and torsion. Results : Having examined the first type of endoprosthesis we found that under tensile loading maximal stresses occur in the distal part of the bone at the level of the end of the intramedullary stem, and the most favorable situa­tion is the resection of the humerus at the level of the upper third. Research on flexing showed that the maximal loading concentrates in the central part of the model and does not depend on the level of resection of the humerus. The worst option was resection of the upper half of the humerus due to the critical area of maximum stress occurring in the basis of endoprosthesis at the junction of the body of the implant into the bone. The study of the second type of endoprosthesis revealed that for all kinds of loading additional extracortical plates give an opportunity to reduce the level of stresses in the bone tissue as well as the loading onto the critical zone. This combined system of fixing of the endoprosthesis will al­low to significantly reduce the amount of complications associated with the implant and the bone in the early and late postoperative period.

Comportamiento del saco aneurismático después del tratamiento endovascular (EVAR). Revisión de una serie de casos (periodo 2009-2012)

IntroductionEndovascular aneurysm repair (EVAR) is an increasingly used technique, but its results need to be evaluated as regards morbidity, mortality and behavior of the aneurysm. There are few studies that examine the behavior of the aneurysm sac. ObjectiveTo perform an analysis of the aneurysm sac changes after EVAR. Material and methodsBetween February 2009-February 2012 a total of 73 patients, selected according to age (> 75 years) or surgical risk, received EVAR treatment for AAA and/or iliac aneurysms (77 procedures). All patients were followed up at 1, 6, 12 months, and then annually using CT angiography. Those patients who had at least one CT angiography at the end of one year and performed in the same hospital were analyzed. A total of 28 patients (100 AngioCTs) were included, and those still awaiting the 12 month follow up, deaths and losses (mainly performed in other AngioCT sites), were excluded. All axial measurements were made by the same practitioner and computer equipment. Four different devices (8 Endurant, 11 Excluder, Zenith 8 and 1 Anaconda) were implanted and analyzed. ResultsA reduction in the aneurysm sac was observed in all patients. The average decrease by type of endoprosthesis was: Endurant 10.6mm, Excluder 7.8mm, Zenith 7.83mm, and Anaconda 1mm. ConclusionsIn this first analysis, the technique has not associated with aneurysm rupture, and aneurysm sac reduction was present in all the devices studied, which seems to have been favorably influenced by the new generation of graft materials. The relationship between the morphology of the aneurysm and the long-term effects on aortic stents still has to be determined and we must continue to analyze the data and results.

Pancreatic fistula: A proposed percutaneous procedure

To propose a percutaneous treatment for otherwise intractable pancreatic fistula (PF). From 2005 to 2011, 12 patients (9 men and 3 women, mean age 59 years, median 63 years, range 33-78 years) underwent radiological treatment for high-output PF associated with peripancreatic fluid collection. The percutaneous procedures were performed after at least 4 wk of unsuccessful conservative treatments. We chose either a one or two step procedure, depending on the size and characteristics of the fistula and the fluid collection (with an arbitrary cut-off of 2 cm). Initially, 2 to 6 pigtail drainages of variable size from 8.3 (8.3-Pig Duan Cook, Bloomington, Indiana, United States) to 14 Fr (Flexima, Boston Scientific, Natick, United States) were positioned inside the collection using a transgastric approach. In a second procedure, after 7-10 d, two or more endoprostheses (cystogastrostomic 8 Fr double-pigtail, Cook, Bloomington, Indiana, United States in 10 patients; covered Niti-S stent, TaeWoong Medical Co, Seoul, South Korea in 2 patients) were placed between the collection and the gastric lumen. In all cases the metal or plastic prostheses were removed within one year after positioning. Four out of 12 high-output fistulas fistulas were external while 8/12 were internal. The origin of the fistulous tract was visualised by computer tomography (CT) imaging studies: in 11 patients it was at the body, and in 1 patient at the tail of the pancreas. Single or multiple drainages were positioned under CT guidance. The catheters were left in place for a varying period (0 to 40 d - median 10 and 25(th)-75(th) percentile 0-14). In one case external transgastric drainages were left in place for a prolonged time (40 d) due to the presence of vancomycin-resistant bacteria (Staphylococcus) and fluconazole-resistant fungi (Candida) in the drained fluid. In this latter case systemic and local antibiotic therapy was administered. In both single and two-step techniques, when infection was present, we carried out additional washing with antibiotics to improve the likelihood of the procedure's success. In all cases the endoprostheses were left in situ for a few weeks and endoscopically removed after remission of collections, as ascertained by CT scan. Procedural success rate was 100% as the resolution of external PF was achieved in all cases. There were no peri-procedural complications in any of the patients. The minimum follow-up was 18 mo. In two cases the procedure was repeated after 1 year, due to the onset of new fluid collections and the development of pseudocysts. Indeed, this type of endoprosthesis is routinely employed for the treatment of pseudocysts. Endoscopy was adopted both for control of the positioning of the endoprosthesis in the stomach, and for its removal after resolution of the fistula and fluid collection. The resolution of the external fistula was assessed clinically and CT scan was employed to demonstrate the resolution of peripancreatic collections for both the internal and external fistulae. The percutaneous placement of cistogastrostomic endoprostheses can be used for the treatment of PF that cannot be treated with other procedures.

Quality of Life After Endovascular Abdominal Aortic Aneurysm Repair: Nellix Sac-Anchoring Endoprosthesis Versus Open Surgery

An increasing number of patients with abdominal aortic aneurysms are treated using endovascular rather than open surgical techniques. The Vascular Surgery Center, P. Stradins Clinical University Hospital, has the largest worldwide experience using a new type of endoprosthesis, which fills and anchors the device in the aneurysm sac. Within the framework of a clinical trial, the quality-of-life evaluation of patients treated using this type of device was carried out. A cohort study was conducted from 2008 to 2011 comparing the quality of life (QOL) of patients after abdominal aortic aneurysm repair with either the new endovascular treatment method (EVAR) or open surgery (OS). Each group comprised 20 patients, and the quality-of life-evaluation was performed using the SF-36 questionnaire before operation, 1 month after operation, and 1 year after operation. One month after operation, an improved QOL was documented in the EVAR group (47 [SD, 3] in the EVAR group vs. 38 [SD, 3] in the OS group, P<0.001). One year after operation, a significant improvement in QOL persisted although the difference between the groups diminished (48 [SD, 4] in the EVAR group vs. 42 [SD, 3] in the OS group, P<0.001). The patients with abdominal aortic aneurysms who underwent EVAR using the new sac-anchoring endoprosthesis have improved health-related quality of life compared to the patients undergoing open surgical repair. The improvement in quality of life remained slightly better in the EVAR group 1 year after operation.

Theoretical Study on Stem Implants Behaviour

The paper presents a complex study on hip joint endoprosthesis. The model for the femur was obtained by CT scanner and Mimics, the endoprosthesis was designed in proEngineer. This study has two stages: obtaining the 3D model for the bone and endoprosthesis, analysing the model in Ansys to obtain stress and strain state information. The paper also presents some interesting aspects of the contact between the bone and the implant in case of different types of endoprosthesis (two standardized types and one personalized). A good contact between the bone and the stem indicates a long life solution for an endoprosthesis. A personalized stem is very useful for persons with disabilities is designed taking in consideration the particularities of the patient. The contact results from Ansys illustrate the aspects from the bone stem interface. With this information the orthopaedist can take better decisions for a proper hip joint endoprosthesis used for a named patient.

Total hip arthroplasty with bone grafts for protrusio acetabuli

This retrospective cohort study analyses the long-term outcomes of total hip arthroplasty (THA) in arthritis patients with various forms of acetabular protrusion. We analyse 135 consecutive cemented total hip arthroplasties in 127 patients. Mean age of the patients was 55.2 years (range: 30-72 years). The study group consisted of 119 women and 16 men who were followed up for a mean of 12.7 years. Mean preoperative function was poor, with a Harris score of 28.0 points. Clinical evaluation utilized the Harris hip score, and radiographic assessment relied on the criteria of the Joint Committee of the Hip Society, AAOS and SICOT. Clinical outcomes of the study group were as follows: excellent in 35 (25.9%), good in 78 (57.8%), fair in 17 (12.6%), and poor in 5 (3.7%). The mean postoperative Harris score was 86.6 points. The radiographic outcomes were excellent in 47 (34.8%), good in 60 (44.5%), fair in 18 (13.3%), and poor in 10 hips (7.4%). Loosening of both components was observed in 6 hips and of the acetabular component in 4 hips. Complications other than aseptic loosening were observed in 25 (18.5%) hips. Implant survival following THA in arthritis with acetabular protrusion depends mainly on proper bone stock reconstruction. 80-85% patients after THA with acetabular bone stock reconstruction achieved very good and good results following an average of 12 years of follow-up. Patients with autogenic bone grafts achieved better outcomes. There was no substantial effect of aetiology, type of endoprosthesis, grade of acetabulum migration on the final outcome.

Both Knee Re-revision Operations with Different Types of Endoprosthesis after Septic Complications

Both Knee Re-revision Operations with Different Types of Endoprosthesis after Septic Complications We report about the patient who underwent seven replacement operations in both knees during twelve years period. Different types of implants were used due to clinical situation and septic complications.

Patellofemorale Endoprothetik in Deutschland – eine Standortbestimmung und Überblick über die Literatur

Isolated patellofemoral arthroplasty is discussed controversially. The aim of this nation-wide survey in Germany and review of the literature was to determine the current status of patellofemoral arthroplasty. A standardised questionnaire was sent to 744 German departments of orthopaedic surgery, traumatology and general surgery. In the first part, surgeons were asked general questions about their department size, case numbers of knee arthroplasties per year and non-endoprosthetic treatment of isolated patellofemoral disorders. If patellofemoral arthroplasty was conducted, parameters concerning age, gender, duration of complaints, indication for surgery, surgical approach, type of endoprosthesis used, additional surgical treatments and failures were evaluated in the second part. Furthermore we asked for the reasons if no isolated patellofemoral arthroplasty was performed. A systematic review of the literature was done including studies published until October 2007. The main inclusion criterion was the presentation of results after the implantation of a patellofemoral prosthesis for isolated patellofemoral osteoarthritis. A total of 225 analysable questionnaires were returned. Of 53,420 knee arthroplasties performed per year, only 195 (0.37 %) were isolated patellofemoral arthroplasties. The majority of patients (91 %) were between 40 and 80 years old. The aetiology of isolated patellofemoral osteoarthritis was believed to be idiopathic in 41 % and traumatic in 8 %. Patellofemoral dysplasia was held to be responsible in 47 % and patellofemoral instability in 4 % of the cases. The main reason for failure and surgical revision was ongoing tibiofemoral osteoarthritis of the affected knee. Negative attitude and disbelief towards the success of isolated patellofemoral arthroplasty were stated by the majority (62 %) of non-users. A lack of appropriate indications was reported by 22 % and lacking know-how by 16 %. We analysed 12 studies (459 implantations; 390 patients) in the literature review. The treatment was considered successful in 67.8 % of cases. The overall revision rate was 30.3 %. The highest failure rates were in patients with progression of tibiofemoral osteoarthritis or malalignment. Isolated patellofemoral arthroplasty has only low significance among surgeons performing knee arthroplasty in Germany. The majority of surgeons do not believe in the success of the procedure. Almost one third of published cases in the literature needed to be revised.

Primeiro escore de risco inflamatório das endopróteses de aorta

To purpose an inflammatory risk score for aortic aneurysm endovascular treatment. Twenty-five patients were followed-up from preoperative period to third month postoperatively (1-hour, 6-hour, 24-hour, 48-hour, 7-day, 1-month, 2- month and 3month). Inflammatory variables were C-reactive protein, hemosedimentation velocity, interleukins (IL-6, IL-8), tumor necrosis factor-Alpha, L-selectin, intercellular adhesion molecule (ICAM-1), red blood cells transfusion, volume of crystalloid, volume of contrast, type of endoprosthesis, number of endoprostheses, total count of leukocytes and lymphocytes. Spearman test defined the variables considered as candidates to higher inflammatory risk based on P < 20%. Logistic regression defined the variables considered as selected for final score based on P < 10%. ROC curve analysis revealed the cut-off values for variables selected by logistic regression. Variables defined by Spearman test were: volume of crystalloid (P=0.04), type of endoprosthesis (P=0.04), volume of contrast (P=0.02), preoperative IL-8 (P = 0.10), 1 - month ICAM-1 (P=0.03) and 1-month L-selectin (P=0.06). Logistic regression revealed that volume of crystalloid and preoperative IL-8 values are relevant for composition of inflammatory risk score for aortic aneurysm endovascular treatment. Risk score would be divided into three categories (mild, moderate and severe) based on numeric intervals of these two variables and the categories would be correlated to clinical findings. Volume of crystalloid and preoperative IL-8 are variables that might contribute to categorize inflammatory risk and thereby might play a prognostic role for aortic aneurysm endovascular treatment.

Hydroxyapatite porous coating and the osteointegration of the total hip replacement

The main purpose of this study is to evaluate the efficacy of the plasma sprayed, combined porous titanium alloy/HA coating in promoting bony ingrowth and mechanical stabilization of total hip implants. The performance of the titanium alloy/HA type coated hip prostheses and the one of the same shape but without any coating, is compared in this paper. The implants were manufactured from titanium alloy VT-6 (ASTM F-136). The hip stems utilized in the control group were identical to those subsequently coated. The coating consists of a plasma deposited first layer of porous titanium alloy (TiAl(6)V(4)), similar in composition to the forged substrate and a plasma deposited second layer of over-sprayed hydroxyapatite, Ca(10)(PO(4))6(OH)2. Coating is located in the critical area of the hip stems, where high fixation interface strength is desired, i.e. in the proximal area of the stem where the highest stresses occur. The porous titanium alloy/hydroxyapatite (HA) coated femoral stems were implanted in 50 patients. The results were compared with a control group of 50 patients with the same type of endoprosthesis, but without the porous titanium alloy/HA coating. Both groups of patients were operated on and evaluated by the same orthopedic surgeons with a mean follow up of 11.4 years in the HA group and 10.6 years in the control group. HHS in the control group was preoperatively 35.5 points (range 26-49) and 85.1 points (range 54-100) in the time of the last control. HHS in the HA group was preoperatively 34.1 points (range 27-56) and 94.4 points (range 89-100) in the time of the last control. In 28 cases (56%) of the control group a range of translucencies were obvious. These translucent lines, however, did not appear with any of the patients in the coated implant group except one infection stem migration. Experience with the HA-type coated hip implants demonstrates substantially higher degree and quality of osteointegration in the porous titanium alloy/HA type implants.