Radiographic analysis in Thoroughbreds reveals morphological changes in healthy maturing stifle joints and possible association between subchondral lesions and femoral condyle width.

OBJECTIVE: Assess femorotibial features in foals with and without medial femoral condyle (MFC) subchondral radiolucencies (SR+ and SR-). METHODS: 3 independent, sequential radiographic studies were performed. Study 1 retrospectively measured femorotibial morphological parameters in repository radiographs (SR- and SR+). Study 2 qualitatively compared drawings of intercondylar notch shape in postmortem radiographs (SR-). Study 3 prospectively measured femorotibial parameters in 1-month-old foals (SR-). In studies 1 and 3, 13 morphologic parameters were measured. Limb directional asymmetry was assessed in 2 age groups (< 7 or ≥ 7 months). RESULTS: Study 1 (SR- group; n = 183 radiographs) showed increased femoral measurements with maturation, except the distal femoral intercondylar notch width (FINwal), which decreased. In contrast, in SR+ stifles (53 radiographs), 3 femoral parameters (MFC width [MFCwpf], MFC height, or FINwal) showed no changes. Tibial plateau width alone increased with maturation in both groups. Interobserver reliability was good to excellent. Study 2 (n = 53 radiographs) confirmed a distal FINw decrease in SR- foals. In study 1, left SR- stifles in greater than or equal to 7-month-old fillies had significantly larger femoral bicondylar width and FINw, while right SR+ stifles in fillies greater than or equal to 7 months had a significantly larger MFCw. In study 3 of 1-month-old foals (n = 94 SR- radiographs), the MFCw, femoral condyle bicondylar width, and lateral femoral condyle height were all greater on the left, whereas the intercondylar intereminence space width was larger on the right. CLINICAL RELEVANCE: In SR+ stifles, the distal femur exhibited divergent maturation, indicating a wider MFC in the right stifle in older foals. As SR lesions are more common on the right, this suggests a potential association with MFC morphology.

Assessment of Mesiobuccal Canals in Endodontically Treated Teeth in Indore Population by Cone Beam Computed Tomography: A Cross-Sectional Study.

BACKGROUND: Owing to the complicated anatomical nature of maxillary molars, untreated root canals may directly affect the outcome of root canal therapy. Therefore, cone beam computed tomography (CBCT) scan is an important tool in the evaluation of root canal systems, particularly for the detection of the second mesiobuccal (MB2) canal in maxillary molars. AIMS AND OBJECTIVES: The current study was undertaken to detect and evaluate filled/unfilled MB2 canals in endodontically treated, asymptomatic maxillary molars, and its correlation with periapical pathology by utilizing cone beam computed tomography (CBCT). MATERIAL AND METHOD: A retrospective study of 80 CBCTs of patients underwent scanning for various treatment modalities, with asymptomatic endodontically treated permanent maxillary first molars selected. Data collection occurred between January and June 2023. CBCT machine used was KODAK 9000 (Rochester, NY: Carestream Health) (Complementary Metal Oxide Semiconductor {CMOS} sensor, continuous mode and 12-28 sec scan time, 90-500 µm voxel size, and 5x3.5 cm field of view {FOV}). The axial images at mid-root level were used to assess the presence of the MB2 canal. RESULT: The study included 39 (48.8%) right maxillary first molars and 41 (51.3%) left maxillary first molars. Overall, in 62 (77.5%) maxillary first molars, MB2 was missed by the practicing dentist, and in 13 (16.3%) maxillary first molars MB2 canal was not present. Of all the maxillary first molars with MB2 canal (n=67), 53 (79.1%) canals had a periapical infection, five (7.5%) showed widening of periodontal ligament space whereas nine (13.4%) had no abnormality. CONCLUSION: MB2 canals were present in the majority of cases and most of the unfilled MB2 canals showed evidence of periapical radiolucencies and showed a direct impact on the prognosis.

Central Mucoepidermoid Carcinoma in the Mandible Mimicking Dentigerous Cyst: A Report of a Rare Case.

Mucoepidermoid carcinoma is a rare neoplasm of the salivary gland of which the intraosseous variety is commonly observed with a female predilection and the affected side is more commonly in the mandible. It is usually perceived as an asymptomatic swelling that increases in volume over a few months to a year. They more frequently present as a cortical bulging and are mostly discovered as an accidental finding in a routine radiograph as a well-defined unilocular or multilocular radiolucency resembling an odontogenic cyst. The most widely accepted treatment is radical surgical resection due to its recurrence or metastatic nature. The current case is quite unusual developing in the posterior jaw as a result of an impacted third molar in a 22-year-old female patient.

The Knee-Fix study: study protocol for a randomised controlled trial evaluating cemented and cementless components in total knee arthroplasty.

BACKGROUND: Total knee arthroplasty (TKA) is an effective procedure for patients with a variety of knee conditions. The main cause of aseptic TKA failure is implant loosening, which has been linked to poor cement mantle quality. Cementless components were introduced to offer better longer-term biological fixation through osseointegration; however, early designs led to increased rate of revision due to a lack of initial press-fit and bony ingrowth. Newer highly porous metal designs may alleviate this issue but randomised data of fully uncemented TKA (tibial, femoral, patella) is lacking. The aim of the Knee-Fix study is to investigate the long-term implant survival and patient outcomes of fully uncemented compared with cemented fixation in TKA. Our study hypothesis was that uncemented TKA would be as clinically reliable and durable as the gold-standard cemented TKA. METHODS: The Knee-Fix study is a two-arm, single-blinded, non-inferiority randomised controlled trial with 160 patients in each arm and follow-up at 6 weeks, 6 months, 12 months, 24 months, 5 years and 10 years. The primary outcome of interest is implant fixation, which will be measured by assessment of postoperative progressive radiolucencies with the Knee Society Total Knee Arthroplasty Roentgenographic Evaluation and Scoring System. Secondary outcome measures are patient-reported outcomes, measured using Oxford Knee Score (OKS), International Knee Society System (IKSS), Forgotten Joint Score-12 (FJS-12), EuroQol (EQ-5D-5L), VAS Pain, Patient Satisfaction Score and Net Promoter Score. DISCUSSION: While cemented fixation remains the gold standard, a growing proportion of TKA are now implanted cementless. Highly porous metal cementless components for TKA can offer several benefits including potentially improved biological fixation; however, long-term outcomes need further investigation. This prospective study will help discern long-term differences between the two techniques. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12616001624471 . Registered trial name: Knee-Fix study (Cemented vs Uncemented Total Knee Replacement). Registered on 24 November 2016.

The effect of a deep-learning tool on dentists' performances in detecting apical radiolucencies on periapical radiographs.

OBJECTIVES: To determine the efficacy of a deep-learning (DL) tool in assisting dentists in detecting apical radiolucencies on periapical radiographs. METHODS: Sixty-eight intraoral periapical radiographs with CBCT-proven presence or absence of apical radiolucencies were selected to serve as the testing subset. Eight readers examined the subset, denoted the positions of apical radiolucencies, and used a 5-point confidence scale to score each radiolucency. The same subset was assessed by readers under two conditions: with and without Denti.AI DL tool predictions. For the two sessions, the performance of the readers was compared. The comparison was performed with the alternate free response receiver operating characteristic (AFROC) methodology. RESULTS: Localization of lesion accuracy (AFROC-AUC), specificity and sensitivity (by lesion) detection demonstrated improvements in the DL aided session in comparison with the unaided reading session. Subgroup performance analysis revealed an increase in sensitivity for small radiolucencies and in radiolucencies located apical to endodontically treated teeth.. CONCLUSION: The study revealed that the DL technology (Denti.AI) enhances dental professionals' abilities to detect apical radiolucencies on intraoral radiographs. ADVANCES IN KNOWLEDGE: DL tools have the potential to improve diagnostic efficacy of dentists in identifying apical radiolucencies on periapical radiographs.

A Short-Term Multicenter Analysis of Radiolucent Lines in a Single Uncemented Rotating Platform Implant for Total Knee Arthroplasty.

Background: Uncemented total knee arthroplasty is increasing as a potential solution for aseptic loosening via biologic fixation and to increase operative efficiency. However, postoperative radiolucent lines (RLLs) remain a concern for some clinicians. We report on a multicenter analysis of these RLLs over a 2-year period to identify their incidence, progression, and clinical significance. Material and methods: Institutional review board approval was obtained for this retrospective, multicenter case series. A total of 312 patients treated with a single cruciate-retaining, fully porous coated femoral and tibial component design were included in the study. All patients were evaluated clinically and radiographically in the early postoperative period and at final follow-up (average 2.0 years). Average age of the study group was 58.2 years, and average body mass index was 30.7. Of the total, 66% were male, and 34% were female. Two independent surgeons evaluated the radiographs at the initial postoperative visit and at the most recent follow-up for RLLs. Knee Society Scores and range of motion (ROM) were collected at each visit. Results: We identified RLLs in 25% of patients. All RLLs were less than 1 mm in size and located at the periphery of the tibial implant. None of the RLLs were progressive. At the final follow-up, compared with early postoperative imaging, no new RLLs were identified. Average ROM in flexion was 124 degrees, and the average Knee Society Scores at the most recent clinical follow-up was 96. Conclusion: RLLs are commonly seen following cementless TKA, most commonly underneath the tibial tray. Based on this data set, there does not appear to be progression of these RLLs with time, and they do not appear to have an effect on ROM or clinical outcome at 2 years.

5-Year Clinical and Radiographic Results of the Direct Anterior Approach for Total Hip Arthroplasty Using a Collared Cementless Femoral Short-Stem Prosthesis.

The aim of this study was to investigate the radiological and clinical outcome of the direct anterior approach (DAA) in total hip arthroplasty (THA) using a collared cementless femoral short-stem. This retrospective study included 124 patients with 135 THAs operated from 2014 to 2016 using a collared cementless triple tapered hydroxyapatite-coated femoral short-stem (AMIStem H Collared®, Medacta International, Castel San Pietro, Switzerland) implanted with a DAA. Follow-up was performed at three months, 12 months, and five years. Clinical outcome was assessed using the hip osteoarthritis outcome score (HOOS) and radiological analysis was done using conventional radiographs, which included evaluation of the femur morphology based on Dorr classification, of radiolucencies based on the Gruen zone classification and of stem subsidence. The mean age was 67.7 ± 11.3 years and the mean body mass index (BMI) was 27.4 ± 4.4 kg/m2. The stem survival rate at five years was 99.1% with one revision due to recurrent dislocations. Mean HOOS score improved from 40.9 ± 18.3 preoperatively to 81.5 ± 19.7 at three months, 89.3 ± 10.9 at 12 months, and 89.0 ± 14.0 at five years (all with p < 0.001). No significant correlations were found between age, femoral bone morphology, BMI and HOOS, and the appearance of relevant radiolucencies.

Mid-term results of Eclipse total shoulder arthroplasty.

AIMS: The use and variety of stemless humeral components in anatomical total shoulder arthroplasty (TSA) have proliferated since their advent in 2004. Early outcomes are reassuring but independent mid-term results are scarce. This independent study reports a consecutive series of 143 Eclipse stemless shoulder prostheses with a minimum five-year (5 to 10) follow-up. METHODS: Outcomes of 143 procedures undertaken for all indications in 131 patients were reviewed, with subset analysis of those for osteoarthritis (OA) (n = 99). The primary outcome was the Oxford Shoulder Score (OSS) at a minimum of five years. Secondary outcomes were ranges of motion and radiological analysis of humeral radiolucency, rotator cuff failure, and glenoid loosening. RESULTS: Mean OSS at mean follow-up of 6.67 years (5.0 to 10.74) was 40.12 (9 to 48), with no statistically significant difference between those implanted for a non-OA indication and those for OA (p = 0.056) or time-dependent deterioration between two years and five years (p = 0.206). Ranges of motion significantly improved compared with preoperative findings and were maintained between two and five years with a mean external rotation of 38° (SD 18.1, 0 to 100) and forward elevation of 152° (SD 29.9, 90 to 180). Of those components with radiographs suitable for analysis (n = 83), 23 (28%) were found to have a least one humeral radiolucent line, which were predominantly incomplete, less than 2 mm, and in a single anatomical zone. No humeral components were loose. A radiolucent line was present around 22 (15%) of glenoid components, and 15 (10%) of components had failed. Rotator cuff failure was found in 21 (15%) components. The mean time to either glenoid or rotator cuff failure was greater than three years following implantation. Survivorship was 96.4% (95% CI 91.6 to 98.5, number at risk 128) at five years, and 94.3% (95% CI 88.2 to 97.3, number at risk 76) at seven years, both of which compare favourably with best results taken from available registries. CONCLUSION: Functional and radiological outcomes of the Eclipse stemless TSA are excellent, with no loose humeral components at minimum five-year follow-up. The presence of radiolucent lines is of interest and requires long-term observation but does not impact on the clinical results. Of the eight revisions required, this was predominantly for glenoid and rotator cuff failure. Cite this article: Bone Joint J 2022;104-B(1):83-90.

Appearance of Mandibular Para-radicular Third Molar Radiolucencies on Cone-Beam Computed Tomography.

AIMS: Mandibular para-radicular third molar radiolucencies (MPRs) may be mistaken for pathological lesions, leading to misdiagnosis and mistreatment. This study sought to assess the appearance of MPRs on cone-beam computed tomography (CBCT). SETTINGS AND DESIGN: This was a descriptive, cross-sectional study. MATERIALS AND METHODS: This study evaluated 770 CBCT of patients presenting to the dental school of Hamadan University of Medical Sciences. Demographic information, unilateral or bilateral presence, shape and prevalence of MPRs observed on axial and sagittal sections, their density, thinning of cortical margin, internal trabeculation, bony expansion, and mean height and width of MPRs were all evaluated. STATISTICAL ANALYSIS USED: Data were analyzed using SPSS version 22.0 and descriptive statistics. Chi-square test was used. RESULTS: Seventy (9.1%) patients had a total of 82 MPRs, including 51 (72.86%) females. The prevalence of MPRs in females was more than males (P = 0.011). The majority of MPRs were unilateral 58 (70.73%), mostly round in shape 48 (58.54%), and were mostly associated with third molars with distoangular impaction 47 (57.31%); this difference was statistically significant (P < 0.001). Furthermore, in 47 (57.32%) patients, MPRs had less density than the surrounding bone. MPRs were not associated with expansion or root resorption in any patient. CONCLUSION: Differentiation of MPRs from the pathological lesions is important to make a decision about further imaging or referral for surgical treatment. MPRs are often considered normal since they do not cause root resorption or bone expansion and do not affect the lamina dura. MPRs are more commonly found adjacent to third molars with distoangular impaction.

Multiple radiolucencies in the mandible: A diagnostic dilemma.

Diagnosis and treatment planning of maxillofacial pathologies is an art. It requires careful evaluation and correlation of clinical presentation and radiologic investigations. When the pathology concerned is an intraosseous lesion, the radiographic findings assume a significantly more important role. While carrying out the radiographic assessment, we rely on typical findings regarding the number, location, and appearance of radiolucent areas which point towards certain types of pathologies. Whenever these findings are atypical or at variance with the clinical presentation, it creates a diagnostic dilemma for the clinician. We report a case of a 34-year-old man who presented with a simple clinical history but multiple radiolucencies on the radiograph.

Multiple calcifying hyperplastic dental follicles: a major diagnostic consideration in multiple pericoronal lesions - report of two cases.

BACKGROUND: Pericoronal radiolucent lesions are a common radiographic finding, but it is rare that they occur in multiple forms. Multiple calcifying hyperplastic dental follicles (MCHDF) are entities with few cases described to date; nevertheless, they appear to have a very particular phenotypic pattern. CASES PRESENTATION: Case 1: A 10-year-old male was evaluated radiographically, revealing four impacted canines, each accompanied by unilocular pericoronal radiolucency. Case 2: A 16-year-old male was planning orthodontic treatment; following his radiological evaluation all third molars were found to be accompanied with pericoronal radiolucencies. Enucleation, and third molar removal along with the pericoronal tissue were the respective treatments. Microscopically, in both cases, the specimens shown odontogenic epithelium, and type I and II calcifications in the hyperplastic follicles, all these characteristics were consistent with MCHDF. CONCLUSION: Although MCHDF are a rare entity, they must be considered in the differential diagnosis of multiple pericoronal lesions. Under the light of the current evidence, the histological findings may be relatively heterogeneous, but their integration with both the clinical data, which are apparently particular, and with the radiographic characteristics, can lead to a definitive diagnosis.

Cementless Oxford Medial Unicompartmental Knee Replacement-Clinical and Radiological Results of 228 Knees with a Minimum 2-Year Follow-Up.

(1) Background: Studies show several advantages of unicompartmental knee replacement (UKR) over total knee replacements (TKR), whereas registry based revision rates of UKR are significantly higher than for TKA. Registry data report lower revision rates for cementless UKR compared to cemented UKR. The aim of this study was to assess clinical and radiological results of cementless Oxford UKR (OUKR) in an independent cohort. (2) Methods: This retrospective cohort study examines a consecutive series of 228 cementless OUKR. Clinical outcome was measured using functional scores (Oxford Knee Score (OKS), American Knee Society Score (AKSS), Hannover Functional Ability Questionnaire for Osteoarthritis (FFbH-OA), range of motion (ROM)), pain and satisfaction. Radiographs were analyzed regarding the incidence of radiolucent lines (RL), implant positioning, and their possible impact on clinical outcome. (3) Results: At a mean follow-up of 37.1 months, the two and three year revision free survival-rates were 97.5% and 96.9%. Reasons for revision surgery were progression of osteoarthritis, inlay dislocation and pain. All clinical outcome scores showed a significant improvement from pre- to postoperative. The incidence of RL around the implant was highest within the first year postoperatively (36%), and decreased (5%) within the second year. Their presence was not correlated with inferior clinical outcome. Implant positioning showed no influence on clinical outcome. (4) Conclusion: Cementless OUKR showed excellent clinical outcome and survival rates, with reliable osteointegration. Neither the incidence of radiolucent lines nor implant positioning were associated with inferior clinical outcome.

Radiographic performance depends on the radial glenohumeral mismatch in total shoulder arthroplasty.

BACKGROUND: Optimal radii of curvature of the articulating surfaces of the prosthetic components are factors associated with the longevity of cemented glenoid components in anatomical total shoulder arthroplasty. It was the purpose of this study, to evaluate the radiographic and clinical performance of an anatomical glenoid component of a total shoulder arthroplasty (TSA) with respect to radial mismatch of the glenoid and humeral component. METHODS: In a retrospective study 75 TSA were analyzed for their clinical and radiographic performance with computed tomography by independent examiners using an established methodology. The study group was divided in two groups, one with mismatch < 4.5 mm (n:52) the others with mismatch ≥4.5 mm (n:23) and analyzed for confounding variables as indication, primary or revision surgery, age, gender, glenoid morphology and implant characteristics. RESULTS: The mean glenohumeral radial mismatch was 3.4 mm (range 0.5-6.9). At median follow-up of 41 months (range 19-113) radiographic loosening (defined as modified Molé scores ≥6) was present in 7 cases (9.3%). Lucencies around the glenoid pegs (defined as modified Molé score ≥ 1) were present in 34 cases (45%). Radiolucencies were significantly associated with a radial mismatch < 4.5 mm (p = 0.000). The pre- to postoperative improvements in Subjective Shoulder Value and absolute Constant Score were significantly better in the group with a mismatch ≥4.5 mm (p = 0.018, p = 0.014). CONCLUSION: A lower conformity of the radii of humerus and glenoid seems to improve the loosening performance in TSA. Perhaps cut-off values regarding the recommended mismatch need to be revalued in the future.

An unusual variation of radicular dentin dysplasia: A rare case report with review of literature.

Dentin dysplasia (DD) is a rare autosomal dominant disorder of dentin development, which is generally divided into two types based on the clinical and radiographic appearance of the affected dentinal tissues: Type-I (Radicular DD) and Type-II (Coronal DD). This paper reports the case of a 17-year-old female patient with both classical and atypical features of radicular DD in the permanent dentition. The present case shows clinically normal appearing crowns, localised mobility in the maxillary teeth, completely obliterated pulp chambers, widened root canals without any obliterations and the presence of multiple periapical radiolucencies. The clinical and radiographic findings observed in this present case report are different from those reported in the past literature, which suggests that the present case could be a variation of radicular DD.

Minimum 5-year outcomes of pegged versus keeled all-polyethylene glenoids.

BACKGROUND: Glenoid loosening remains one of the most common concerns at mid- to long-term follow-up after total shoulder arthroplasty (TSA). Pegged and keeled designs have been compared at short-term follow-up, but few studies have compared outcomes at mid-term follow-up. Our purpose was to compare minimum 5-year outcomes of pegged and keeled cemented, all-polyethylene glenoids in TSA. The hypothesis was that no difference in functional outcomes or loosening would be found between the 2 components. METHODS: We performed a multicenter retrospective study of TSAs with either a pegged or keeled cemented glenoid. At a minimum of 5 years postoperatively, functional outcomes and radiographic loosening were compared. RESULTS: Forty-seven TSAs were available for follow-up, including 20 pegged and 27 keeled components, at a mean of 79 months (range, 60-114 months) postoperatively. Overall, functional outcomes improved in both groups from preoperatively to postoperatively, and no difference was found between the 2 groups. Radiographic glenoid loosening (score ≥ 3) was observed in 9 of 27 keeled glenoids (33.3%) compared with 5 of 20 pegged glenoids (25%) (P = .54). Loosening was associated with lower postoperative forward flexion (P = .026), lower American Shoulder and Elbow Surgeons scores (P = .030), and higher visual analog scale pain scores (P = .007). CONCLUSION: Radiographic glenoid loosening of a cemented, all-polyethylene component was associated with decreased functional outcomes at minimum 5-year follow-up of TSAs. However, this study showed no difference in loosening rates between keeled and pegged components.

Unrevealed Caries in Unerupted Teeth: A Prevalence Study.

BACKGROUND: Preeruptive caries are an abnormal, well-circumscribed, radiolucent area, occurring within the coronal dentinal tissue close to the dentinoenamel junction of unerupted teeth. OPGs are commonly taken in children for assessing the dental age and eruption sequence. It can be used as a good diagnostic source for detection of PEIR defects. AIM: The aim of this study is to determine the prevalence of Preeruptive intracoronal dentin radiolucencies in unerupted permanent teeth from orthopantomogram. SETTINGS AND DESIGN: A total of 1000 standard orthopantomographs of children below 12 years of age were collected and examined. METHODOLOGY: The OPGs were examined for PIER defects in the unerupted teeth. The prevalence of PEIR defects was assessed with respect to age, sex, tooth, and the arch involved. STATISTICAL ANALYSIS: The data obtained were tabulated and analyzed. The prevalence was calculated in percentage. RESULTS: The participant prevalence was 13.6%. The teeth prevalence was 1.20%. The majority (38.9%) of defects were seen in the in the mandibular first premolar. Almost half of the lesions were located on the mesial side (52.3%), with a size less than one-third of dentine thickness (53%). CONCLUSION: PIER defects constitutes an important part of anomalies associated with unerupted teeth and thus needs a proper understanding of its prevalence, etiology, manifestations, and complications. These defects are usually overlooked by clinicians while interpreting radiographs; however, it is of utmost importance to promptly diagnose these defects thus preventing further complications.

Prevalence of pre-eruptive intracoronal radiolucencies in Thai children and adolescents: A retrospective study.

AIM: The aim of the present study was to determine the prevalence, location, size, and tooth type of pre-eruptive intracoronal radiolucencies (PEIR) from panoramic radiographs in Thai patients. METHODS: A retrospective study of PEIR was conducted on 1599 panoramic radiographs of 629 Thai males and 970 Thai females with an age range of 4-20 years (average age: 14.0 ± 4.0 years). Each radiograph was reviewed by two calibrated examiners. The age and sex of the patients, location, size, and tooth type of the lesions were recorded. The SPSS program was used for statistical analysis. RESULTS: The PEIR were found in 0.32% of tooth samples (29/9060) and 1.63% of patients (26/1599). There was no statistical difference in the presence of PEIR between both sexes. The mandibular second molars were the most affected teeth. The lesions were mostly located at the central part of the crown. The lesion sizes were mostly limited to less than one-third of dentinal thickness. CONCLUSIONS: The present study showed that the prevalence of PEIR in Thai samples is 1.63%. This could raise dentists' awareness in reviewing unerupted teeth in panoramic radiographs. Early detection of the lesions should aid in proper treatment planning of affected teeth to prevent complications from carious invasion after tooth eruption.

[Cemented stems in revision total knee arthroplasty on patients older than 75 y/o. Clinical and radiological analysis]. / Vástagos cementados en recambios de prótesis total de rodilla en pacientes mayores de 75 años. Análisis clínico y radiológico.

BACKGROUND: The purpose of this study was to analyze the clinical and radiological evolution of the total knee revision arthroplasty with cemented stems in patients over 75 years. MATERIAL AND METHODS: A retrospective analysis was performed in all the subjects who underwent revision of total knee arthroplasty with cemented stems between 2008 and 2014 in our center. Twenty-seven individuals over 75 years met the inclusion criteria. We assessed the Knee Society Score and range of motion for clinical outcome. We evaluated the implant stability with radiographs through radiolucent lines according to the modified radiological scale of the Knee Society; we registered the complications and prosthetic survival. RESULTS: With an average age of our participants of 82.6 ± 4.4 years and a follow-up of 43 ± 14.4 months, we did not find any mechanical failure of the components. The functional average score was 115 ± 32 in the total KSS, of which 77 ± 17.5 points were in the KSS knee and 42 ± 24 in the KSS function. The average range of motion was 98º ± 17. Radiologically, 18 patients presented radiolucent lines, but only three needed follow-up using the modified Knee Society radiographic scoring system. CONCLUSIONS: The results revealed that cemented stems are a good method for fixation in the revision of total knee arthroplasty in people over 75 years. We observed acceptable medium-term clinical results with a low risk of radiological failure, despite the high number of radiolucencies.

Analizar la evolución funcional y radiológica de los pacientes mayores de 75 años intervenidos de cirugía de revisión de rodilla con vástagos cementados.

Vástagos cementados en recambios de prótesis total de rodilla en pacientes mayores de 75 años. Análisis clínico y radiológico / Cemented stems in revision total knee arthroplasty on patients older than 75 y/o. Clinical and radiological analysis

Resumen: Antecedentes: Analizar la evolución funcional y radiológica de los pacientes mayores de 75 años intervenidos de cirugía de revisión de rodilla con vástagos cementados. Material y métodos: Mediante análisis retrospectivo, hemos revisado a 27 individuos mayores de 75 años a quienes se les ha implantado una prótesis total de rodilla de revisión con vástagos cementados en nuestro centro entre 2008-2014. Durante el seguimiento, se realizó un análisis clínico mediante la escala Knee Society Score y de movilidad de la rodilla, un análisis radiológico de la estabilidad de los implantes por medio de la escala radiológica modificada de la Knee Society, el registro de las complicaciones y la supervivencia protésica. Resultados: Con una edad media de los participantes de 82.6 ± 4.4 años y un seguimiento medio de 43 ± 14.4 meses, no hemos observado ningún caso de aflojamiento mecánico de los componentes. La valoración funcional ha sido de 115 ± 32 puntos en la escala total KSS, de los cuales 77 ± 17.5 puntos pertenecen al KSS rodilla y 42 ± 24 puntos al KSS función. El rango medio de movilidad fue de 98o ± 17. A nivel radiológico, 18 sujetos mostraron radiolucencias periprotésicas; según los criterios de la escala radiológica de la Knee Society, solo tres requirieron seguimiento clínico-radiológico estricto. Conclusiones: La cementación de los vástagos en prótesis totales de rodilla de revisión se trata de un buen sistema de fijación en personas mayores de 75 años, con elevada supervivencia del implante, buen resultado funcional y bajo porcentaje de aflojamiento radiológico a pesar de la aparición frecuente de radiolucencias.

Abstract: Background: The purpose of this study was to analyze the clinical and radiological evolution of the total knee revision arthroplasty with cemented stems in patients over 75 years. Material and methods: A retrospective analysis was performed in all the subjects who underwent revision of total knee arthroplasty with cemented stems between 2008 and 2014 in our center. Twenty-seven individuals over 75 years met the inclusion criteria. We assessed the Knee Society Score and range of motion for clinical outcome. We evaluated the implant stability with radiographs through radiolucent lines according to the modified radiological scale of the Knee Society; we registered the complications and prosthetic survival. Results: With an average age of our participants of 82.6 ± 4.4 years and a follow-up of 43 ± 14.4 months, we did not find any mechanical failure of the components. The functional average score was 115 ± 32 in the total KSS, of which 77 ± 17.5 points were in the KSS knee and 42 ± 24 in the KSS function. The average range of motion was 98o ± 17. Radiologically, 18 patients presented radiolucent lines, but only three needed follow-up using the modified Knee Society radiographic scoring system. Conclusions: The results revealed that cemented stems are a good method for fixation in the revision of total knee arthroplasty in people over 75 years. We observed acceptable medium-term clinical results with a low risk of radiological failure, despite the high number of radiolucencies.

Stable Fixation of a Cementless, Proximally Coated, Double Wedged, Double Tapered Femoral Stem in Total Hip Arthroplasty: A 5-Year Radiostereometric Analysis.

BACKGROUND: The objective of this 5-year prospective study of 51 hips was to assess migration of a cementless tapered femoral stem using radiostereometric analysis (RSA), plain radiographs (radiolucencies), and patient-reported outcome measures (PROMs). METHODS: Forty-seven patients (51 hips) agreed to participate in this prospective RSA study. All patients received a Taperloc stem. Tantalum beads were inserted into the femoral bone surrounding the stem to measure migration using RSA. RSA films, plain radiograph, and PROM follow-up were obtained immediately after surgery, 6 months, 1, 2, 3, and 5 years after surgery. RESULTS: The median (interquartile range) subsidence was 0.03 mm (-0.23 to 0.06) at 5 years, with no significant differences over time. Four outlier stems had >1.5 mm of subsidence by 1 year. No stem showed radiolucencies in more than 3 zones during the 5 years. All PROMs remained favorable at 5 years, suggesting an excellent outcome. There were no stems revised for mechanical loosening; 1 stem was revised for an infection. CONCLUSION: After initial settling, the cementless tapered femoral stems in our series were stable. The 4 outlier stems with >1.5 mm of subsidence by 1 year remain stable at 5 years. RSA was the most sensitive method of detection for stems at greater risk for potential future failure. This report adds contributions to the positive results associated with this type of fixation. The results at 5 years showed excellent midterm survivorship in this cohort with a cementless tapered femoral component.