Low Revision Rates at More Than 10 Years for Dual-Mobility Cups Cemented Into Cages in Complex Revision Total Hip Arthroplasty.

BACKGROUND: Instability and aseptic loosening are the two main complications after revision total hip arthroplasty (rTHA). Dual-mobility (DM) cups were shown to counteract implant instability during rTHA. To our knowledge, no study evaluated the 10-year outcomes of rTHA using DM cups, cemented into a metal reinforcement ring, in cases of severe acetabular bone loss. We hypothesized that using a DM cup cemented into a metal ring is a reliable technique for rTHA at 10 years, with few revisions for acetabular loosening and/or instability. METHODS: This is a retrospective study of 77 rTHA cases with severe acetabular bone loss (Paprosky ≥ 2C) treated exclusively with a DM cup (NOVAE STICK; Serf, Décines-Charpieu, France) cemented into a cage (Kerboull cross, Burch-Schneider, or ARM rings). Clinical scores and radiological assessments were performed preoperatively and at the last follow-up. The main endpoints were revision surgery for aseptic loosening or recurring dislocation. RESULTS: With a mean follow-up of 10.7 years [2.1-16.2], 3 patients were reoperated because of aseptic acetabular loosening (3.9%) at 9.6 years [7-12]. Seven patients (9.45%) dislocated their hip implant, only 1 suffered from chronic instability (1.3%). Cup survivorship was 96.1% at 10 years. No sign of progressive radiolucent lines were found and bone graft integration was satisfactory for 91% of the patients. CONCLUSION: The use of a DM cup cemented into a metal ring during rTHA with complex acetabular bone loss was associated with low revision rates for either acetabular loosening or chronic instability at 10 years.

Quantification of uncertainties in conifer sap flow measured with the thermal dissipation method.

Trees play a key role in the global hydrological cycle and measurements performed with the thermal dissipation method (TDM) have been crucial in providing whole-tree water-use estimates. Yet, different data processing to calculate whole-tree water use encapsulates uncertainties that have not been systematically assessed. We quantified uncertainties in conifer sap flux density (Fd ) and stand water use caused by commonly applied methods for deriving zero-flow conditions, dampening and sensor calibration. Their contribution has been assessed using a stem segment calibration experiment and 4 yr of TDM measurements in Picea abies and Larix decidua growing in contrasting environments. Uncertainties were then projected on TDM data from different conifers across the northern hemisphere. Commonly applied methods mostly underestimated absolute Fd . Lacking a site- and species-specific calibrations reduced our stand water-use measurements by 37% and induced uncertainty in northern hemisphere Fd . Additionally, although the interdaily variability was maintained, disregarding dampening and/or applying zero-flow conditions that ignored night-time water use reduced the correlation between environment and Fd . The presented ensemble of calibration curves and proposed dampening correction, together with the systematic quantification of data-processing uncertainties, provide crucial steps in improving whole-tree water-use estimates across spatial and temporal scales.

Advanced Workflow for Taking High-Quality Increment Cores - New Techniques and Devices.

In dendroecological research, precise dating of each single growth ring is a basic requirement for all studies, focusing on ring-width variations only, chemical or isotope analyses, or wood anatomical studies. Independent of the sampling strategy for a certain study (e.g., climatology, geomorphology), the way samples are taken is crucial for their successful preparation and analyses. Until recently, it was sufficient to use a (more or less) sharp increment corer to obtain core samples that could be sanded for further analyses. Since wood anatomical characteristics can be applied to long time series, the need to obtain high-quality increment cores has taken on a new meaning. Essentially, the corer needs to be sharp(ened) when used. When coring a tree by hand, there are some problems in handling the corer, resulting in the hidden occurrence of micro cracks along the entire core: When starting to drill by hand, the drill bit is strongly pressed against the bark and the outermost ring until the thread has fully entered the trunk. At the same time, the drill bit is moved up and down as well as sideward. Then, the corer is drilled all the way into the trunk; however, it is necessary to stop after each turn, change the grip, and turn again. All these movements, as well as the start/stop-coring, puts mechanical stress on the core. The resulting micro cracks make it impossible to create continuous micro sections, as they fall apart along all these cracks. We present a protocol to overcome these obstacles by applying a new technique using a cordless drill to minimize these problems when coring a tree, as well as its effect on the preparation of long micro sections. This protocol includes the preparation of long micro sections, as well as a procedure to sharpen corers in the field.

Total Hip Arthroplasty Using a Hemispherical Uncemented Dual-Mobility Cup Results in Satisfactory Clinical Outcomes and No Dislocations at 2 years.

BACKGROUND: The authors performed total hip arthroplasty (THA) using a novel hemispherical dual-mobility (DM) acetabular cup without a protrusive cylindro-spherical rim, intended to reduce risks of iliopsoas impingement without requiring changes to conventional intraoperative positioning as with unipolar cups. We aim to determine clinical scores and rates of dislocations, complications, and revisions of this hemispherical DM cup, with the hypothesis that this novel design would result in clinical scores and dislocation rates comparable to other contemporary DM cups with protrusive cylindro-spherical rims. METHODS: We assessed 332 consecutive uncemented THAs performed using a hemispherical DM cup, at a minimum 2-year follow-up, using modified Harris Hip Score (mHHS) and Oxford Hip Score (OHS), and noting complications and revisions. Regression analyses were conducted to determine if mHHS and OHS depended on any independent factors. RESULTS: At 2.8 ± 0.5 years (range, 2-5), 2 patients (0.6%) had stem and cup revisions, 3 patients (1%) had isolated stem revisions, 13 patients (4%) died, and none were lost to follow-up. No dislocations occurred. For the final cohort of 305 patients (314 hips) with their original implants in place, mHHS was 92 ± 12 (range, 46-100), and OHS was 57 ± 5 (range, 34-60). Multivariable analyses revealed that mHHS and OHS decreased significantly with age (ß = -0.35, P < .001, and ß = -0.15, P < .001, respectively). CONCLUSIONS: With no dislocations and satisfactory clinical scores, this sizable cohort confirms that the novel hemispherical DM cup studied is effective at preventing dislocations, although longer-term follow-up remains necessary to ascertain the longevity of clinical outcomes and radiographic stability. LEVEL OF EVIDENCE: Level IV, multicentric retrospective case series.

A technical perspective in modern tree-ring research--how to overcome dendroecological and wood anatomical challenges.

Dendroecological research uses information stored in tree rings to understand how single trees and even entire forest ecosystems responded to environmental changes and to finally reconstruct such changes. This is done by analyzing growth variations back in time and correlating various plant-specific parameters to (for example) temperature records. Integrating wood anatomical parameters in these analyses would strengthen reconstructions, even down to intra-annual resolution. We therefore present a protocol on how to sample, prepare, and analyze wooden specimen for common macroscopic analyses, but also for subsequent microscopic analyses. Furthermore we introduce a potential solution for analyzing digital images generated from common small and large specimens to support time-series analyses. The protocol presents the basic steps as they currently can be used. Beyond this, there is an ongoing need for the improvement of existing techniques, and development of new techniques, to record and quantify past and ongoing environmental processes. Traditional wood anatomical research needs to be expanded to include ecological information to this field of research. This would support dendro-scientists who intend to analyze new parameters and develop new methodologies to understand the short and long term effects of specific environmental factors on the anatomy of woody plants.