Functional Medium-Term Results After Autologous Matrix-Induced Chondrogenesis for Osteochondral Lesions of the Talus: A 5-Year Prospective Cohort Study.

Autologous matrix-induced chondrogenesis (AMIC) has gained popularity in the treatment of osteochondral lesions of the talus. Previous studies have presented promising short-term results for AMIC talar osteochondral lesion repair, a 1-step technique using a collagen type I/III bilayer matrix. The aim of the present study was to investigate the mid-term effects. The 5-year results of a prospective cohort study are presented. All patients underwent an open AMIC procedure for a talar osteochondral lesion. Data analysis included general demographic data, preoperative magnetic resonance imaging findings, intraoperative details, and German version of the Foot Function Index (FFI-D) scores preoperatively and at 1 and 5 years after surgery. The primary outcome variable was the longitudinal effect of the procedure, and the influence of various variables on the outcome was tested. Of 47 consecutive patients, 21 (45%) were included. Of the 21 patients, 8 were female (38%) and 13 were male (62%), with a mean age of 37 ± 15 (range 15 to 62) years and a body mass index of 26 ± 5 (range 20 to 38) kg/m2. The defect size was 1.4 ± 0.9 (range 0.2 to 4.0) cm2. The FFI-D decreased significantly from preoperatively to 1 year postoperatively (56 ± 18 versus 33 ± 25; p = .003), with a further, nonsignificant decrease between the 1- and 5-year follow-up examination (33 ± 25 versus 24 ± 21; p = .457). Similar results were found for the FFI-D subscales of function and pain. The body mass index and lesion size showed a positive correlation with the preoperative FFI-D overall and subscale scores. These results showed a significant improvement in pain and function after the AMIC procedure, with a significant return to sports by the 5-year follow-up point. The greatest improvement overall was seen within the first year; however, further clinical satisfaction among the patients was noticeable after 5 years.

Study of Preoperative Radiotherapy for Sarcomas of the Extremities with Intensity-Modulation, Image-Guidance and Small Safety-margins (PREMISS).

BACKGROUND: The aim of the trial is to demonstrate that with the use of modern IMRT/IGRT and reduction of safety margins postoperative wound complications can be reduced. METHODS/ DESIGN: The trial is designed as a prospective, monocentric clinical phase II trial. The treatment is performed with helical IMRT on the Tomotherapy HiArt System© or with RapidArc© IMRT as available. All treatments are performed with 6 MV photons and daily online CT-based IGRT. A dose of 50 Gy in 2 Gy single fractions (5 fractions per week) is prescribed. Restaging including MRI of the primary tumor site as well as CT of the thorax/abdomen is planned 4 weeks after RT. PET-examinations or any other imaging can be performed as required clinically. In cases of R1 resection, brachytherapy is anticipated in the 2nd postoperative week. Brachytherapy catheters are implanted into the tumor bed depending on the size and location of the lesion. Surgery is planned 5-6 weeks after completion of neoadjuvant RT. All patients are seen for a first follow-up visit 2 weeks after wound healing is completed, thereafter every 3 months during the first 2 years. The endpoints of the study are evaluated in detail during the first (2 weeks) and second (3 months) follow-up. Functional outcome and QOL are documented prior to treatment and at year 1 and 2. Treatment response and efficacy will be scored according to the RECIST 1.1 criteria. A total patient number of 50 with an expected 20% rate of wound complications were calculated for the study, which translates into a 95% confidence interval of 10.0-33.7% for wound complication rate in a binomial distribution. DISCUSSION: The present study protocol prospectively evaluates the use of IMRT/IGRT for neoadjuvant RT in patients with soft tissue sarcomas of the extremity with the primary endpoint wound complications, which is the major concern with this treatment sequence. Besides complications rates, local control rates and survival rates, as well as QOL, functional outcome and treatment response parameters (imaging and pathology) are part of the protocol. The data of the present PREMISS study will enhance the current literature and support the hypothesis that neoadjuvant RT with IMRT/IGRT offers an excellent risk-benefit ratio in this patient population. TRIAL REGISTRATION: NCT01552239.

8-year follow-up after cementless hip arthroplasty with a second generation spongy metal total hip replacement.

We studied a consecutive series of 81 cementless total hip arthroplasties in 80 patients using the second generation ESKA cementless spongy metal hip replacement. The study end-point was implant revision and both function as well as satisfaction with treatment outcome were assessed.Mean age at the time of surgery was 50.9 years [range 23-73]. No patient was lost to follow-up and 75 patients (76 hips) could be included in the final analysis at a mean follow-up of 7.9 years [range 7.0-10.0]. Survival rate without loosening as the end-point was 100% for the femoral component and 99% for the acetabular component (one cup revision). Two cups and one stem had to be revised for recurrent dislocation, resulting in a total implant survival at follow-up of 99% for the femoral component and 96% for the acetabular component. Very good functional results were obtained with a mean Merle d' Aubigné score of 15.5 +/- 2.9 at 7.9 years after surgery. Satisfaction with treatment outcome was reported in 88%. 95% of patients would recommend the performed procedure to a friend. Peri-operative complications without revision occurred in eleven patients (14%).We report excellent survival rates of the cementless spongy metal hip arthroplasty at a mean follow-up of eight years, particularly considering the young age of many of the patients.

Functional residual capacity and compliance of the respiratory system after surfactant treatment in premature infants with severe respiratory distress syndrome.

UNLABELLED: To understand the mechanisms behind improved oxygenation after intratracheal surfactant instillation, the immediate and late effects on lung volume and compliance of the respiratory system (CRS) were analysed. Infants received modified porcine surfactant (Curosurf) or modified bovine surfactant (Alveofact). Measurements of functional residual capacity (FRC) and CRS were successfully performed in 90 ventilated preterm infants (birth weight 1264 +/- 435 g; gestational age 28.2 +/- 2.5 weeks) with severe respiratory distress syndrome. FRC and CRS were measured during mechanical ventilation prior to and 1, 3, 6, 24, 48, 72, 96, 120 and 168 h after surfactant replacement. Oxygenation rapidly improved. FRC increased significantly from 7.64 +/- 1.58 ml/kg to 15.35 +/- 3.27 ml/kg (P < 0.01) at 1 h after surfactant instillation. CRS remained virtually unchanged during the first hours after surfactant replacement and a concomitant decrease in specific compliance was seen. CONCLUSION: the changes in lung function following surfactant treatment can only be explained by initial stabilisation of already aerated alveoli followed by recruitment of new gas exchange units as mechanisms involved in mediating the effect of surfactant on gas exchange. However, since no significant correlation between changes in functional residual capacity and improvement in arterial-to-alveolar oxygen tension ratio was seen, other effects of surfactant must be considered. These include local and/or systemic changes in haemodynamics.