Why are revision knee replacements failing?

AIM: The number of knee revisions worldwide has been steadily increasing. While being complex and expensive operations, a high percentage of knee revisions fail early. This study was conducted to evaluate the causes of failure of revision knee replacements. PATIENTS AND METHODS: This study retrospectively evaluated 95 patients following knee revision surgery and who underwent further knee revision operations. Indications for index revision as well as the reason for re-revision were recorded. Follow-up was from 30 to 97 months (mean 62 months). RESULTS: The main cause of failure of revision knee replacements was infection (31 of 95, 32.6%) followed by aseptic loosening (30.5%). Indications for re-revision were instability in 12.6%, persistent stiffness in 10.5%, ongoing pain in 7.3%, extensor mechanism problems in 5.2%, and suspected metal allergy in one. CONCLUSION: Infection and loosening continue to be the main reasons for failure of knee revisions. Improving outcomes for infection management and improved fixation methods may help reduce failed knee revisions.

Outcomes of Revision Joint Arthroplasty Due to Metal Allergy and Hypersensitivity: A Systematic Review.

BACKGROUND: Lower extremity total joint arthroplasty (TJA) is one of the most successful orthopaedic procedures. However, it is estimated that as many as 10% to 20% of TJAs could fail due to various well-known causes. Furthermore, metal allergy-related complications have recently gained attention as one of the potential causes of failure when the common reasons have been excluded. Reported symptoms from metal allergy can include chronic eczema, joint effusions, joint pain, and limited range of motion. Few studies have explored the outcomes of patients undergoing revisions due to allergic complications. The aim of our study is to quantitatively evaluate the outcomes of revision joint arthroplasty due to metal allergy and hypersensitivity.

Metal hypersensitivity in patient with posterior lumbar spine fusion: a case report and its literature review.

BACKGROUND: Metal hypersensitivity, mostly documented in prosthesis implantation, is a rare complication after arthroplasty. Such cases become rarer and more difficult to diagnose when it comes to lumbar surgery. CASE PRESENTATION: We present the case of a 52-year-old female patient with reoccured low back pain and sciatica after posterior lumbar decompression and fusion (PLDF) for her lumbar disc herniation. The initial clinical and radiological examinations showed no pathologies. Further imaging and histopathological studies in later period revealed an aseptic loosening of the hardware and an aseptic inflammatory response which was diagnosed to be metal hypersensitivity. To our knowledge, few allergic cases in the matter of spinal fusion were reported so far. CONCLUSIONS: Metal hypersensitivity after spinal fusion should be considered in patients with representation of postoperative back pain. And elaborate history taking would conduce a lot to it's diagnose.

Multimodal approach for the management of Hunan hand syndrome: a case report.

Hunan hand syndrome, a form of painful contact dermatitis, is a rare case finding. It is usually seen in people with continuous and prolonged exposure to chili peppers. The main ingredient in chili peppers is capsaicin that leads to the clinical condition, Hunan hand syndrome. This is paradoxical to the use of capsaicin as local application for relief of pain in various clinical situations, such as diabetic neuropathy and postherpetic neuralgia. We report a case of Hunan hand syndrome, managed successfully by using a multimodal approach comprised of a continuous stellate ganglion block, gabapentin, local ice water, and fluocinonide application.

Ocean enemy's lasting sting: chronic cutaneous reaction after Cnidarian attack.

Cnidaria stings cause a wide range of cutaneous and systemic symptoms, normally occurring shortly after the venomous insult (1). We report a case of worsening cutaneous reaction over an eight-year period following a Cnidaria attack sustained whilst maritime swimming. The lesion was characterised by severe, ulcerating chronic inflammation that required wide local excision and skin grafting. Prevention and early identification of Cnidaria envenomation is important for those treating maritime swimmers.

Inflammatory pseudotumor complicating metal-on-highly cross-linked polyethylene total hip arthroplasty.

Inflammatory masses or cysts occurring in the pelvis, thigh, and gluteal regions, often mimicking infection, occasionally arise after total hip arthroplasty procedures. Inflammatory pseudotumors comprise a subgroup of these lesions. Pseudotumors have been associated with pain, rashes, instability, neuropathy, and premature loosening of prosthetic components, often leading to early and difficult revision surgery. The association between such pseudotumors and metal-on-metal bearings has led to questions regarding the performance of these bearings in hip arthroplasty. We present a case of pseudotumor requiring revision surgery, which occurred uniquely around a metal-on-highly cross-linked polyethylene bearing.

Digital dermatitis of the accessory digits of dairy cows / Dermatite digital nos dígitos acessórios de vacas leiteiras

This report characterizes the digital dermatitis (DD) lesions in the accessory digits of dairy cows and presents data on the applied therapy. Fifteen Holstein cattle with DD affecting the accessory digits of the hindlimbs from four dairy farms with previous history of DD were evaluated. Lesions were excised, the wounds were sutured, and a topical application of oxytetracycline powder covered by bandaging was associated with a single parenteral administration of long acting oxytetracycline IM (20mg/kg). Tissue samples were obtained for histopathology and transmission electronic microscopy (TEM). Lesions from all the animals were recuperated 15 days after surgical procedure. Overal, most DD lesions were papillomatous epidermal projections or wartlike verrucous lesions. Histopathologically, samples revealed hyperplasia of epidermis with hyperkeratosis, several mitoses in the stratum basale and elongated rete ridges in the superficial and middle dermis. TEM revealed long, thin spirochete-like bacteria. Morphologic features of lesions and its response to therapy were comparable to those described for DD.

Esse estudo caracteriza lesões de dermatite digital (DD) nos dígitos acessórios de vacas leiteiras, além de apresentar a terapia aplicada. Foram utilizados 15 bovinos leiteiros da raça Holandês com DD nos dígitos acessórios dos membros pélvicos. Os animais eram provenientes de quatro fazendas leiteiras com histórico prévio de dermatite digital (DD). Todos os quinze animais foram tratados da mesma forma: após excisão das lesões e sutura das feridas cutâneas, aplicou-se oxitetraciclina pó topicamente sob bandagem e oxitetraciclina (20mg/kg) de longa ação, via intramuscular. Obtiveram-se amostras de tecidos para histopatologia, inclusive por microscopia eletrônica de transmissão (MET). Observou-se cicatrização em todos os animais após 15 dias do procedimento cirúrgico. A maioria das lesões macroscópicas foram projeções papilomatosas ou em forma de verrugas. Os achados histopatológicos de todas as amostras revelaram hiperplasia da epiderme com hiperceratose, inúmeras mitoses no estrato basal, com invasões alongadas em forma de rede na derme superficial e intermediária. A MET evidenciou organismos com formas longas, afiladas e espiraladas, presumivelmente espiroquetas. Tanto as características morfológicas, quanto a resposta à terapia das lesões foram comparáveis às descritas para DD.

Red tattoo reactions: treatment with the carbon dioxide laser.

Cutaneous reactions to red tattoo pigment occurred in two patients who developed erythema, swelling, and severe pruritus in the area of red coloration within their tattoos. Carbon dioxide (CO2) laser vaporization of the red portions of the tattoos led to complete resolution of symptoms with an excellent cosmetic result and preservation of the tattoo design. A step-by-step guide to the use of the CO2 laser for this treatment is described.