SHORT-TERM EVALUATION BETWEEN POLYETHYLENE THICKNESS IN PRIMARY TOTAL KNEE ARTHROPLASTY.

Objective: The objective of the research was to carry out a comparative study between Smith & Nephew ® or Zimmer ® prostheses with thick versus thin polyethylene, in patients undergoing primary total knee arthroplasty, during a short-term follow-up. Thus, the objective was to analyze the survival of the implants in question under the clinical and radiographic aspect. Methods: The sample was divided into two groups: Group 1 with thick polyethylene and group 2 with thin polyethylene. A clinical analysis of the patients was carried out and the implants were checked for loosening. Results: The groups were similar when compared. According to the Ahlbäck classification, 83% of the patients were in groups IV and V. The median functional score in the postoperative period was similar between the two groups. Postoperatively, the tibiofemoral angle fluctuated between 5 and 6 0 valgus on average. Two complications were observed in each group. None of the evaluated patients presented implant loosening. Conclusion: Patients treated with thick polyethylene had the same functional score as the control group, as well as the absence of radiographic changes in this short-term follow-up, with implant survival and a similar rate of complications between both groups. Level of evidence III, Retrospective study.

Objetivo: O objetivo desta pesquisa foi realizar um estudo comparativo entre as próteses Smith & Nephew ® e Zimmer ®, com polietileno espesso versus o fino, em pacientes submetidos à artroplastia total primária do joelho, durante um seguimento de curto prazo. Dessa forma, foi analisada a sobrevida dos implantes em questão sob o aspecto clínico e radiográfico. Métodos: A amostra foi dividida em dois grupos: grupo 1 com polietileno espesso e grupo 2 com polietileno fino. Foi realizada análise clínica dos pacientes e verificado se ocorreu soltura dos implantes. Resultados: Os grupos tiveram resultados semelhantes quando comparados. Segundo a classificação de Ahlbäck, 83% dos pacientes eram dos grupos IV e V. A mediana do escore funcional no pós-operatório foi similar entre os grupos. No pós-operatório o ângulo tíbio-femoral oscilou na média entre 5 e 6 0 de valgo. Foram observadas duas complicações em cada grupo. Nenhum dos pacientes avaliados apresentou soltura do implante. Conclusão: Os pacientes tratados com o polietileno espesso apresentaram o mesmo escore funcional do grupo controle, assim como ausência de alterações radiográficas nesse seguimento de curto prazo, com sobrevida do implante e índice de complicações similar entre ambos os grupos. Nível de evidência III, Estudo retrospectivo.

One-Year Outcomes of Transseptal Mitral Valve-in-Valve in Intermediate Surgical Risk Patients.

BACKGROUND: Transcatheter mitral valve-in-valve replacement offers a less-invasive alternative for high-risk patients with bioprosthetic valve failure. Limited experience exists in intermediate-risk patients. We aim to evaluate 1-year outcomes of the PARTNER 3 mitral valve-in-valve study. METHODS: This prospective, single-arm, multicenter study enrolled symptomatic patients with a failing mitral bioprosthesis demonstrating greater than or equal to moderate stenosis and regurgitation and Society of Thoracic Surgeons score ≥3% and <8%. A balloon-expandable transcatheter heart valve (SAPIEN 3, Edwards Lifesciences) was used via a transeptal approach. The primary end point was the composite of all-cause mortality and stroke at 1 year. RESULTS: A total of 50 patients from 12 sites underwent mitral valve-in-valve from 2018 to 2021. The mean age was 70.1±9.7 years, mean Society of Thoracic Surgeons score was 4.1%±1.6%, and 54% were female. There were no primary end point events (mortality or stroke) through 1 year, and no left-ventricular outflow tract obstruction, endocarditis, or mitral valve reintervention was reported. Six patients (12%) required rehospitalization, including heart failure (n=2), minor procedural side effects (n=2), and valve thrombosis (n=2; both resolved with anticoagulation). An additional valve thrombosis was associated with no significant clinical sequelae. From baseline to 1 year, all subjects with available data had none/trace or mild (grade 1+) mitral regurgitation and the New York Heart Association class improved in 87.2% (41/47) of patients. CONCLUSIONS: Mitral valve-in-valve with a balloon-expandable valve via transseptal approach in intermediate-risk patients was associated with improved symptoms and quality of life, adequate transcatheter valve performance, and no mortality or stroke at 1-year follow-up. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03193801.

Prediction of lifespan and assessing risk factors of large-sample implant prostheses: a multicenter study.

PURPOSE: This study aimed to analyze factors influencing the success and failure of implant prostheses and to estimate the lifespan of prostheses using standardized evaluation criteria. An online survey platform was utilized to efficiently gather large samples from multiple institutions. MATERIALS AND METHODS: During the one-year period, patients visiting 16 institutions were assessed using standardized evaluation criteria (KAP criteria). Data from these institutions were collected through an online platform, and various statistical analyses were conducted. Risk factors were assessed using both the Cox proportional hazard model and Cox regression analysis. Survival analysis was conducted using Kaplan-Meier analysis and nomogram, and lifespan prediction was performed using principal component analysis. RESULTS: The number of patients involved in this study was 485, with a total of 841 prostheses evaluated. The median survival was estimated to be 16 years with a 95% confidence interval. Factors found to be significantly associated with implant prosthesis failure, characterized by higher hazard ratios, included the 'type of clinic', 'type of antagonist', and 'plaque index'. The lifespan of implant prostheses that did not fail was estimated to exceed the projected lifespan by approximately 1.34 years. CONCLUSION: To ensure the success of implant prostheses, maintaining good oral hygiene is crucial. The estimated lifespan of implant prostheses is often underestimated by approximately 1.34 years. Furthermore, standardized form, online platform, and visualization tool, such as nomogram, can be effectively utilized in future follow-up studies.

Long-Term Outcomes of High-Flexion Design Total Knee Arthroplasty with a Short Posterior Flange.

Background: The purpose of this study was to evaluate the clinical and radiological outcomes of high-flexion total knee arthroplasty (TKA) using Vega Knee System (B. Braun, Aesculap) at a long-term follow-up and to analyze the implant survivorship. Methods: We enrolled 165 patients (232 knees) with a minimum 7-year follow-up after TKA (VEGA Knee System). For clinical assessment, range of motion (ROM), Knee Injury and Osteoarthritis Outcome Score (KOOS), and Western Ontario and McMaster University Osteoarthritis Index (WOMAC) were used. For radiologic assessment, hip-knee-ankle angle, component position, and the existence of radiolucent lines and loosening were used. Survival analysis was conducted using the Kaplan-Meier method. Results: The mean follow-up period was 9.8 years. The mean ROM increased from 124.4° to 131.4° at the final follow-up. The WOMAC score decreased from 38.5 to 17.4 at the final follow-up (p < 0.001). All 5 subscales of the KOOS improved at the final follow-up (all subscales, p < 0.001). Revision TKA was performed in 10 cases (4.3%), which included 9 cases of aseptic loosing and 1 case of periprostatic joint infection. Of the 9 aseptic loosening cases (3.9%), 8 cases (3.4%) were loosening of the femoral component and 1 case (0.4%) was loosening of the tibial component. When revision for any reason was considered an endpoint, the 10-year survivorship was 96.2% (95% confidence interval [CI], 93.9%-98.5%). On the other hand, when revision for aseptic loosening was considered the endpoint, the 10-year survivorship was 96.6% (95% CI, 94.4%-98.8%). Conclusions: The Vega Knee System provided good clinical results in the long-term follow-up period. Although the VEGA Knee System showed acceptable implant survivorship, loosening of the femoral component occurred in about 3.4% of the patients. For more accurate evaluation of the survivorship of high-flexion design TKA with a short posterior flange, it is necessary to conduct more long-term follow-up studies targeting diverse races, especially Asians who frequently perform high-flexion activities.

Distal femoral megaprosthesis fracture treated by RescueSleeve MEGASYSTEM-C.

Escalating revision surgery after megaprosthesis knee replacement sometimes raises the question of "limb salvage". Here we present a salvage technique for megaprosthesis fracture at the junction between the stem and the metaphyseal component. In this young active patient, the short residual proximal femur was not loose and was difficult to extract without prosthetic escalation. The technique described here conserved the well-fixed primary stem and used a custom-made RescueSleeve MEGASYSTEM-C connection sleeve (Link, Hamburg, Germany) plus spacer and a standard epiphyseal implant. This semi-conservative procedure avoided femorotomy or larger morbid segmental femoral resection. It conserved maximal bone stock and achieved rapid functional recovery. To our knowledge, this is the first reported case of this technique using a custom-made connecting part to manage megaprosthesis fracture. LEVEL OF EVIDENCE: IV.

Short-term evaluation between polyethylene thickness in primary total knee arthroplasty / Avaliação a curto prazo entre a espessura do polietileno na artroplastia total primária do joelho

ABSTRACT Objective: The objective of the research was to carry out a comparative study between Smith & Nephew ® or Zimmer ® prostheses with thick versus thin polyethylene, in patients undergoing primary total knee arthroplasty, during a short-term follow-up. Thus, the objective was to analyze the survival of the implants in question under the clinical and radiographic aspect. Methods: The sample was divided into two groups: Group 1 with thick polyethylene and group 2 with thin polyethylene. A clinical analysis of the patients was carried out and the implants were checked for loosening. Results: The groups were similar when compared. According to the Ahlbäck classification, 83% of the patients were in groups IV and V. The median functional score in the postoperative period was similar between the two groups. Postoperatively, the tibiofemoral angle fluctuated between 5 and 6 0 valgus on average. Two complications were observed in each group. None of the evaluated patients presented implant loosening Conclusion: Patients treated with thick polyethylene had the same functional score as the control group, as well as the absence of radiographic changes in this short-term follow-up, with implant survival and a similar rate of complications between both groups. Level of evidence III, Retrospective study.

RESUMO Objetivo: O objetivo desta pesquisa foi realizar um estudo comparativo entre as próteses Smith & Nephew ® e Zimmer ®, com polietileno espesso versus o fino, em pacientes submetidos à artroplastia total primária do joelho, durante um seguimento de curto prazo. Dessa forma, foi analisada a sobrevida dos implantes em questão sob o aspecto clínico e radiográfico. Métodos: A amostra foi dividida em dois grupos: grupo 1 com polietileno espesso e grupo 2 com polietileno fino. Foi realizada análise clínica dos pacientes e verificado se ocorreu soltura dos implantes. Resultados: Os grupos tiveram resultados semelhantes quando comparados. Segundo a classificação de Ahlbäck, 83% dos pacientes eram dos grupos IV e V. A mediana do escore funcional no pós-operatório foi similar entre os grupos. No pós-operatório o ângulo tíbio-femoral oscilou na média entre 5 e 6 0 de valgo. Foram observadas duas complicações em cada grupo. Nenhum dos pacientes avaliados apresentou soltura do implante. Conclusão: Os pacientes tratados com o polietileno espesso apresentaram o mesmo escore funcional do grupo controle, assim como ausência de alterações radiográficas nesse seguimento de curto prazo, com sobrevida do implante e índice de complicações similar entre ambos os grupos. Nível de evidência III, Estudo retrospectivo.

Mitral re-valve-in-valve as a new perspective for high-risk patients with prosthetic valve dysfunction: case reports.

Background: Mitral valve diseases are a common medical condition, and surgery is the most used therapeutic approach. The need for less invasive interventions led to the development of transcatheter valve implantation in high-risk patients. However, the treatment to the dysfunctions of these prosthetic valves is still uncertain, and the yield and safety of repeated transcatheter valve implantations remain unclear. Cases summary: A 69-year-old Caucasian woman with three previous mitral valve procedures performed due to rheumatic valve disease (currently with a biological prosthetic mitral valve) and a 76-year-old Latin woman with previous liver transplantation (due to metabolic-associated fatty liver disease) and biological mitral prosthesis due to mitral valve prolapse with severe regurgitation underwent mitral valve-in-valve (ViV) transcatheter implantation at the time of dysfunction of their surgical prostheses. Later, these patients developed prosthetic valve dysfunction and clinical worsening, requiring another invasive procedure. Due to maintained high-risk status and unfavourable clinical conditions for surgery, re-valve-in-valve (re-ViV) was performed. Discussion: Valve-in-valve transcatheter mitral valve implantation was approved in 2017, and, since then, it has been used in several countries, mainly in high-risk patients. Nevertheless, these prosthetic valves may complicate with stenosis or regurgitation, demanding reinterventions. Although there are favourable data for mitral ViV, re-ViV still lacks robust data to support its performance, with only case reports in the literature so far. It is possible that in high-risk patients, there is a greater benefit from re-ViV when compared with the surgical strategy. However, this hypothesis must be studied in future controlled trials.

Proximal Femur Salvage in Revision Knee Arthroplasty Due to Oncologic Indications: Long-term Results of Onlay and Overlapping Allograft in Revision Surgeries.

Background: Mechanical failures of tumor endoprosthesis in the distal femur usually require revision surgery. We investigated if the proximal femur host bone can be salvaged by onlay and overlapping allograft in revision surgeries due to aseptic loosening and stem fractures. Methods: We retrospectively reviewed 18 patients (7 men and 11 women) with osteosarcoma around the knee. The entire cohort was classified into three subgroups (no bone graft: 6, onlay allograft: 7, and overlapping allograft: 5) according to our treatment strategy. Results: The median interval from the initial surgery to the revision was 94.5 months (range, 21-219 months), and the median follow-up period from the revision surgery was 88.0 months (range, 24-179 months). At the last follow-up, 9 of the 18 patients maintained their endoprostheses, and the 5-year prosthesis survival rate was 57.9%. Limb survival was 100%. Five-year prosthesis survival rate was 66.7% in the no bone graft group, 85.7% in the onlay allograft group while 30.0% in the overlapping allograft group. In the no bone graft group and onlay allograft group, 66.7% (4/6) and 57.1% (4/7) maintained their revision prostheses while no prostheses survived in the overlapping allograft group. Recurrent stem loosening was observed in 14.2% (1/7) and 60.0% (3/5) of the onlay allograft and overlapping allograft groups, respectively, despite allograft bone union. The complication rate was 66.7% (12/18) in the entire cohort. The most common type of complication was infection (n = 6), followed by aseptic loosening (n = 4) and mechanical failure (n = 2). Conclusions: This study indicates that onlay allograft can be used as a supportive method in revising failed endoprosthesis if the extent of host bone destruction is extensive. However, applying overlapping allograft to secure bone stock showed a high rate of mechanical failures and infection in the long term. Future studies with a larger cohort are necessary to assess the prognostic factors for the higher complication rate in overlapping allograft and the need for overlapping allograft. Surveillance with consideration of the risk of anteromedial osteolysis in allograft and efforts for prevention of periprosthetic infection are essential.

Metallic artifact suppression with MAVRIC-SL in magnetic resonance imaging for assessing chronic pain after hip or knee arthroplasty / Supressão do artefato metálico na ressonância magnética com MAVRIC-SL na avaliação da dor crônica em artroplastia de quadril ou joelho

Abstract Objective: To analyze the association between osteolysis at the prosthesis interfaces, as determined by magnetic resonance imaging (MRI) with multiacquisition variable-resonance image combination selective (MAVRIC-SL) sequences, and clinical severity after knee or hip arthroplasty, as well as to assess interobserver and intraobserver agreement on periprosthetic bone resorption. Materials and Methods: This was a cross-sectional study of 47 patients (49 joints) under postoperative follow-up after knee or hip arthroplasty, with chronic pain, between March 2019 and August 2020. All of the patients completed the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire. The component interfaces were evaluated and ordered into two groups: osseointegrated and osteolytic. Nonparametric tests were used. Results: There were significant differences between the two groups in terms of the mean WOMAC scores: total (p = 0.010); stiffness domain (p = 0.047); and function (p = 0.011) domains. There was substantial interobserver and intraobserver agreement for most analyses of the components. Conclusion: Periprosthetic osteolysis appears to be associated with clinical complaints of pain in the post-arthroplasty scenario, and MAVRIC-SL provides reproducible assessments. It could prove to be an important tool for orthopedists to use in the evaluation of challenging cases of chronic pain after arthroplasty.

Resumo Objetivo: Analisar associação entre osteólise nas interfaces protéticas por ressonância magnética com sequências MAVRIC-SL e a gravidade clínica dos pacientes submetidos a artroplastias de joelho ou quadril. Determinar concordância intraobservador e interobservador na reabsorção óssea peri-implante. Materiais e Métodos: Foi realizado estudo transversal entre março de 2019 e agosto de 2020, com 47 pacientes (49 articulações) em seguimento pós-operatório de artroplastias de joelho ou quadril, com dor crônica, que responderam ao questionário WOMAC. As interfaces dos componentes foram avaliadas e definiram dois grupos: osteointegrado e osteólise. Testes não paramétricos foram usados. Resultados: Houve diferença significativa na média do escore WOMAC entre os grupos (p = 0,010), assim como nos domínios rigidez (p = 0,047) e função (p = 0,011). Houve concordância substancial interobservador e intraobservador para a maioria dos componentes analisados. Conclusão: Osteólise periprótese parece estar associada com a queixa clínica de dor pós-artroplastia, com avaliação reprodutível pela MAVRIC-SL. Isto pode ser uma importante ferramenta para o ortopedista na avaliação de casos desafiadores de dor crônica pós-artroplastia.

Hemodynamic parameters of aortic valve prostheses - KRAK-AS registry analysis.

Introduction: The treatment of choice for aortic stenosis is a valve replacement. Some patients have post-procedural increased pressure gradient on the implanted prosthesis because of patient-prosthesis mismatch (PPM), known to adversely influence prognosis. The PPM risk should be initially predicted and effort made to avoid this complication, specifically in large body size patients. Aim: To assess the frequency of PPM taking into account the valvular prosthesis type in a real-life population of consecutive patients included in the Krakow aortic stenosis registry. Material and methods: The KRAK-AS registry was conducted in July-October 2016. Patients were assessed before and after valve surgery and during the 3-year follow-up. Patients who underwent aortic valve intervention were clinically and echocardiographically evaluated within a month after surgery and divided into groups depending on the implanted prosthesis type. Analysis of patients with a smaller (< 23 mm) and larger than median (≥ 23 mm) valve diameter was performed. Results: The valve implantation was performed in 229 patients (42 mechanical, 139 biological, 48 transcatheter). No differences between patient groups compared by PPM occurrence was seen at baseline. Median age was 70 years; 55.5% were men. At least moderate PPM (iEOA ≤ 0.85 cm2/m2) was observed in 40% of mechanical valves, 33% of biological valves, and was significantly less frequent (10%) in patients after transcatheter valve implantation, p = 0.0001. Severe PPM (iEOA < 0.65 cm2/m2) was found in 17.6% of mechanical valve PPM patients, 4.3% of biological ones, and no patients after transcatheter procedure. Conclusions: PPM is a frequent phenomenon in the real-life population of patients undergoing surgical aortic valve replacement, being significantly less frequent in the case of a transcatheter procedure.

Long-term echocardiographic data, mechanisms of failure, and reintervention outcomes of the Epic valve in mitral position-a large observational cohort.

OBJECTIVES: Long-term echocardiographic reports on mitral valve (MV) porcine xenograft bioprosthesis (Epic) are lacking, and postreintervention outcomes of failed Epic are unknown. We aimed to assess the mechanisms and independent predictors of Epic failures and to compare short- and mid-term outcomes according to reintervention type. METHODS: We included consecutive patients (n = 1397; mean age: 72 ± 8 years; 46% female; mean follow-up: 4.8 years) who received the Epic during mitral valve replacement (MVR) at our institution. Clinical, echocardiographic, reintervention, and outcomes data were retrieved from our prospective institution's database or government statistics. RESULTS: Gradients and effective orifice area of the Epic were stable over 5-years follow-up. A total of 70 (5%) patients had a MV reintervention at median follow-up of 3.0 (0.7-5.4) years due to prosthesis failure, by redo-MVR (n = 38; 54%), valve-in-valve (n = 19; 27%), paravalvular leak (PVL) closure (n = 12; 17%), or thrombectomy (n = 1). Mechanisms of failure were 27 (1.9%) structural valve deterioration (SVD; all leaflet tear); 16 (1.1%) non-SVD (15 PVL, 1 pannus); 24 (1.7%) endocarditis; and 4 (0.3%) thrombosis. Freedom from all-cause and SVD-related MV reintervention at 10 years are 88% and 92%, respectively. Independent predictors of reintervention were age, baseline atrial fibrillation, initial MV etiology, and moderate or greater PVL at discharge (all P ≤ .05). Comparison of redo-MVR and valve-in-valve revealed no significant difference in early outcomes or mid-term mortality (all P ≥ .16). CONCLUSIONS: The Epic Mitral valve has stable hemodynamics through 5 years and is associated with low incidence of SVD and reintervention, mostly due to endocarditis and leaflet tear without calcification. Reintervention type had no influence on early outcomes and mid-term mortality.

Editor's Choice - The VASCUNExplanT Project: An International Study Assessing Open Surgical Conversion of Failed Non-Infected Endovascular Aortic Aneurysm Repair.

OBJECTIVE: The need for open surgical conversion (OSC) after failed endovascular aortic aneurysm repair (EVAR) persists, despite expanding endovascular options for secondary intervention. The VASCUNExplanT project collected international data to identify risk factors for failed EVAR, as well as OSC outcomes. This retrospective cross sectional study analysed data after OSC for failed EVAR from the VASCUNET international collaboration. METHODS: VASCUNET queried registries from its 28 member countries, and 17 collaborated with data from patients who underwent OSC (2005 - 2020). Any OSC for infection was excluded. Data included demographics, EVAR, and OSC procedural details, as well as post-operative mortality and complication rates. RESULTS: There were 348 OSC patients from 17 centres, of whom 33 (9.4%) were women. There were 130 (37.4%) devices originally deployed outside of instructions for use. The most common indication for OSC was endoleak (n = 143, 41.1%); ruptures accounted for 17.2% of cases. The median time from EVAR to OSC was 48.6 months [IQR 29.7, 71.6]; median abdominal aortic aneurysm diameter at OSC was 70.5 mm [IQR 61, 82]. A total of 160 (45.6%) patients underwent one or more re-interventions prior to OSC, while 63 patients (18.1%) underwent more than one re-intervention (range 1 - 5). Overall, the 30 day mortality rate post-OSC was 11.8% (n = 41), 11.1% for men and 18.2% for women (p = .23). The 30 day mortality rate was 6.1% for elective cases, and 28.3% for ruptures (p < .0001). The predicted 90 day survival for the entire cohort was 88.3% (95% CI 84.3 - 91.3). Multivariable analysis revealed rupture (OR 4.23; 95% CI 2.05 - 8.75; p < .0001) and total graft explantation (OR 2.10; 95% CI 1.02 - 4.34; p = .04) as the only statistically significant predictive factors for 30 day death. CONCLUSION: This multicentre analysis of patients who underwent OSC shows that, despite varying case mix and operative techniques, OSC is feasible but associated with significant morbidity and mortality rates, particularly when performed for rupture.

The Dome Technique for Managing Massive Anterosuperior Medial Acetabular Bone Loss in Revision Total Hip Arthroplasty: Short-Term Outcomes.

Purpose: The dome technique is a technique used in performance of revision total hip arthroplasty (THA) involving intraoperative joining of two porous metal acetabular augments to fill a massive anterosuperior medial acetabular bone defect. While excellent outcomes were achieved using this surgical technique in a series of three cases, short-term results have not been reported. We hypothesized that excellent short-term clinical and patient reported outcomes could be achieved with use of the dome technique. Materials and Methods: A multicenter case series was conducted for evaluation of patients who underwent revision THA using the dome technique for management of Paprosky 3B anterosuperior medial acetabular bone loss from 2013-2019 with a minimum clinical follow-up period of two years. Twelve cases in 12 patients were identified. Baseline demographics, intraoperative variables, surgical outcomes, and patient reported outcomes were acquired. Results: The implant survivorship was 91% with component failure requiring re-revision in only one patient at a mean follow-up period of 36.2 months (range, 24-72 months). Three patients (25.0%) experienced complications, including re-revision for component failure, inter-prosthetic dual-mobility dissociation, and periprosthetic joint infection. Of seven patients who completed the HOOS, JR (hip disability and osteoarthritis outcome score, joint replacement) survey, five patients showed improvement. Conclusion: Excellent outcomes can be achieved using the dome technique for management of massive anterosuperior medial acetabular defects in revision THA with survivorship of 91% at a mean follow-up period of three years. Conduct of future studies will be required in order to evaluate mid- to long-term outcomes for this technique.

Mechanical indications for inflatable penile prosthesis revision: analysis and implications for revision surgery.

BACKGROUND: Despite technical advancements, inflatable penile prostheses (IPPs) are inherently at risk of mechanical failure given their nature as hydraulic devices. AIM: To characterize IPP component failure location at the time of device revision and stratify by manufacturer: American Medical Systems (Boston Scientific [BSCI]) and Coloplast (CP). METHODS: A retrospective review of penile prosthesis cases from July 2007 to May 2022 was conducted, identifying men who underwent revision surgery. Cases were excluded if documentation did not denote the cause of failure or the manufacturer. Mechanical indications for surgery were categorized by location (eg, tubing, cylinder, or reservoir leak; pump malfunction). Nonmechanical revisions were excluded (component herniation, erosion, or crossover). Categorical variables were assessed with Fisher exact or chi-square analysis; Student t-test and Mann-Whitney U test were used for continuous variables. OUTCOMES: Primary outcomes included specific location of IPP mechanical failure among BSCI and CP devices and time to mechanical failure. RESULTS: We identified 276 revision procedures, 68 of which met inclusion criteria (46 BSCI and 22 CP). Revised CP devices were longer than BSCI devices (median cylinder length, 20 vs 18 cm; P < .001). Log-rank analysis revealed a similar time to mechanical failure between brands (P = .096). CP devices failed most often due to tubing fracture (19/22, 83%). BSCI devices had no predominant site of failure. Between manufacturers, tubing failure was more common in CP devices (19/22 vs 15/46 for BSCI, P < .001), while cylinder failure was more common among BSCI devices (10/46 vs 0/22 for CP, P = .026). CLINICAL IMPLICATIONS: The distribution of mechanical failure is significantly different between BSCI and CP devices; this has implications regarding the approach to revision surgery. STRENGTHS AND LIMITATIONS: This is the first study to directly compare when and where mechanical failure occurs in IPPs and to compare the 2 main manufacturers head-to-head. This study would be strengthened by being repeated in a multi-institutional fashion to provide more robust and objective evaluation. CONCLUSION: CP devices commonly failed at the tubing and rarely elsewhere, while BSCI devices showed no predominant failure site; these findings may inform decision making regarding revision surgery.

Outcomes of Salvage Procedures for Failed Total Ankle Arthroplasty.

BACKGROUND: The number of total ankle arthroplasty (TAA) procedures increased rapidly in the last years and so have its complications. The main pillars in treating failed TAA are revision total ankle arthroplasty (RTAA), revision total ankle arthrodesis (RAA), or revision tibiotalocalcaneal fusion (RTTC). To evaluate these options, we compared clinical, radiologic, and patient-reported outcomes. METHODS: A single-center, retrospective review of 111 cases of revision procedures of failed TAA from 2006 to 2020 was performed. Patients undergoing polyethylene exchange and revision of one metallic component were excluded. Demographic data, failure, and survival rates were analyzed. The European Foot and Ankle Society (EFAS) score and radiographic changes in the subtalar joint were evaluated. The average follow-up was 67.89 ± 40.51 months. RESULTS: One hundred eleven patients underwent removal of TAA. The procedures included 40 revisions of both metallic components, 46 revision total ankle arthrodesis and 25 revision tibiotalocalcaneal fusion. The overall failure rate in the cohort was 5.41% (6/111). The failure rate after RAA was 4.35 times higher than that of RTAA, whereas RTTC did not show failures. RTAA and RTTC lead to a 1-year and 5-year survival rate of 100%. RAA resulted in a 1-year survival rate of 90% and a 5-year survival rate of 85%. The mean EFAS score in the cohort was 12.02 ± 5.83. Analysis of the EFAS score showed that RTTC provided the most reliable pain reduction, and RTAA achieved the best gait pattern. RAA resulted in poorer clinical results. Subtalar joint degeneration occurred significantly less in the RTAA group (P = .01). CONCLUSION: This retrospective study suggests lower failure rates, increased short-term survival and a better clinical outcomes of revision arthroplasty and tibiotalocalcaneal fusion than ankle arthrodesis. Revision arthroplasty is a promising solution in treating failed total ankle arthroplasty considering lower rate of subsequent adjacent joint degeneration. LEVEL OF EVIDENCE: Level III, non-randomized observational study.

Clinical and Functional Outcomes of the Exeter V40 Short Stem in Primary and Revision Arthroplasty: Does the Indication Affect Outcomes in the Short Term?

Purpose: A variety of short Exeter stems designed specifically for use in performance of total hip arthroplasty (THA) in primary and revision settings have recently been introduced. Some have been used 'off label' for hip reconstruction. The aim of this study is to report clinical and radiological results from the Exeter V40 125 mm stem in performance of primary THA and revision THA. Materials and Methods: This study had a retrospective design. Insertion of 58 (24 primary, 34 revision) Exeter V40 125 mm stems was performed between 2015 and 2017. The minimum follow-up period was two years. Assessment of the Oxford hip score (OHS), EuroQol-5 Dimension (EQ-5D), and radiological follow-up was performed at one and two years. Results: In the primary group, the preoperative, mean OHS was 13.29. The mean OHS was 32.86 and 23.39 at one-year and two-year post-surgery, respectively. The mean EQ-5D-3L scores were at 0.14, 0.59, and 0.35, preoperatively, at one-year follow-up and two-year follow-up, respectively. In the revision group, the mean preoperative OHS was 19.41. The mean OHS was 30.55 and 26.05 at one-year and two-year post-surgery, respectively. The mean EQ-5D-3L scores were 0.33, 0.61, and 0.48 preoperatively, at one-year follow-up and two-year follow-up, respectively. No progressive or new radiolucent lines were observed around any stem at the time of the final follow-up in all patients in both groups. Conclusion: Encouraging results regarding use of Exeter V40 125 mm stems have been reported up to two years following surgery in primary and revision THA settings.

Using an Attachment System with PEEK Matrices for Single-Implant Overdentures: In Vitro Retention Force.

Single-implant overdentures (SIOs) represent a major biomechanical challenge in terms of prosthetic retention. The Novaloc attachment system has the potential to overcome those challenges when used for SIOs, due to the use of PEEK matrices. This study compared the retentive force of the Novaloc attachment to the traditional Locator system, before and after cyclic insertion-removal cycles. Three Novaloc matrices (white, yellow, and green, corresponding to low, medium, and high retention, respectively) and Locator (medium retention) were tested, totalling four groups. Retentive force was measured using an Imada force gauge before and after 1095 insertion-removal cycles, corresponding to a year of SIO wearing. Retention was tested with the implants angulated at 0, 10, and 20°. Data for the different groups, angles, and cycling periods were tested via linear regression analysis and two-way ANOVA (α = 0.05). Although the Locator system yielded higher retention forces in general, it lost a much higher percentage of retention with cycling. This trend was similar with the three angles, with forces being inversely proportional to the implant angulation. The authors conclude that Novaloc may provide more reliable retention for SIOs due to their higher resistance to insertion-removal cycling.

Chronic abductor lesion after total hip arthroplasty in a sitting proud stem: direct repair by osteotomy of the greater trochanter.

A woman in her late 70s with bilateral total hip arthroplasty (THA) presented with left hip pain arising immediately after the last THA procedure, progressively worsening. Clinically, a severe abductor insufficiency with Trendelenburg limp was observed. Moreover, symptomatic leg length discrepancy required a contralateral heel lift of 0.5 cm. She was previously managed conservatively without any clinical benefit. Radiographs showed a well-fixed uncemented straight, sitting proud stem. MRI showed a large abductor tear. A minimally invasive proximal advancement of the greater trochanter was planned to allow direct surgical repair of the abductor lesion. The patient made a good recovery, and 12 months after surgery, wire removal was performed. The patient gained significant improvements in hip function (Harris Hip Score from 52 to 89), full limp recovery and complete pain relief at 13 months follow-up from primary surgery.

Long-term retrospective clinical study of tooth-supported fixed partial dentures: A multifactorial analysis.

PURPOSE: To assess the influence of several factors on the survival of tooth-supported fixed partial dentures (FPDs) with vital and non-vital abutments. METHODS: The present retrospective cohort study was based on the records of patients treated with 3-to-7-unit tooth-supported FPDs with a minimum follow-up time of 6 months after prosthesis delivery. Cumulative survival rate (CSR) was calculated over the maximum follow-up period. Cox regression models were used to evaluate the association between the clinical covariates and prosthesis failure. RESULTS: A total of 331 FPDs in 229 patients were included. The CSRs were 90.1% and 77.6% after 5 and 10 years and 67.9% and 52.1% after 15 and 20 years, respectively. Tooth-supported FPD failure was more prevalent within the first years of prosthesis delivery. Loss of one or more abutment teeth and loss of prosthesis retention were the main reasons for failure. Smoking and type of prosthesis material significantly influenced the survival of FPDs. Abutment vitality, position of the non-vital abutment, or prosthesis length did not show any significant influence on the occurrence of prosthesis failure. CONCLUSIONS: Smoking and the type of prosthesis material are suggested to contribute to an increased rate of FPD failure irrespective of abutment vitality.