Multi-centre study of cement-in-cement and in-cement femoral revision total hip arthroplasty using polished, stainless steel stems.

BACKGROUND: Exposure of the acetabular component during revision total hip arthroplasty is often difficult and stems are often difficult to remove. Polished and tapered cemented stems are easily removed and can be easily reconstructed by either cement-in-cement or in-cement technique. This study was a retrospective review of the medium-term outcomes of revision total hip arthroplasty conducted with the Exeter stem fixed by cement-in-cement or in-cement method in four institutions. METHODS: This study included hips (n = 103) reconstructed by cement-in-cement or in-cement technique on the femoral side during revision total hip arthroplasty in four institutions between 2003 and 2015. The mean age at surgery was 71.1 years (range, 43-86 years), and the mean follow-up period was 5.6 years (range, 0-13 years). RESULTS: Revision arthroplasty was required for acetabular component complications in 69 hips, for dislocation in 25, for infection in eight, and for stem fracture in one hip. Re-revision was required in 10 hips for: infection (n = 6), acetabular component complications (n = 3), and dislocation (n = 1). No radiographic loosening, cement fractures, or osteolysis of the femoral components were observed. Ten-year survival rate was 99% with the endpoint of femoral revision surgery, and 100% with the endpoint of femoral aseptic loosening. CONCLUSIONS: The medium-term outcomes of revision total hip arthroplasty on the femoral side conducted using the cement-in-cement or in-cement technique were favourable, with no cases of aseptic loosening. As long as the bone-cement interface remains robust, there is no need to remove all the cement, and the cement-in-cement or in-cement technique should be used for reconstruction.

Income from nutrition and oral health management among long-term care insurance facilities in Niigata Prefecture, Japan.

OBJECTIVE: To determine recent insurance claim rates for, facility income from, and the roles of professionals associated with management of nutrition, oral ingestion and oral health maintenance in long-term care insurance facilities (LTCIFs) in Niigata Prefecture. METHODS: A questionnaire on current staffing, oral health professional (OHP) utilisation, and claims for insured benefits for the investigated services was mailed to all LTCIFs in Niigata Prefecture, Japan (n = 304). Claim rates for and average facility income from these benefits were calculated. Facility income was compared between facilities with and without employed OHPs. Statistically significant factors associated with claims for investigated benefits were identified by logistic regression. RESULTS: Responses from 111 facilities indicated that they made insurance claims for nutrition management (95%), transition from tube feeding to oral ingestion (9%), basic maintenance of oral ingestion (39%), additional services for maintenance of oral ingestion (23%), oral health management system (68%), and oral health management (17%). Most facilities established collaborations with private dental clinics, but only 16% of facilities employed OHPs. Facility income was significantly higher (P = 0.005) for facilities that employed OHPs. OHP employment by facilities was associated with claims for four of the six benefits (P < 0.05). CONCLUSIONS: Most facilities consulted with private dental clinics, and 16% of the facilities employed dentists or dental hygienists to help residents manage oral ingestion problems and oral health maintenance. The facility income associated with management of these problems was significantly higher in facilities employing dental professionals.

Peri-prosthetic bone remodeling and change in bone mineral density in the femur after cemented polished tapered stem implantation.

OBJECTIVE: We examined longitudinal changes in bone mineral density (BMD) around the femur for 5 years after total hip arthroplasty (THA) using cemented collarless polished double-tapered stem implantation and investigated the influence of BMD changes on radiological remodeling of the femur. MATERIALS AND METHODS: Sixty hips from 56 patients who underwent cemented THA with a collarless polished double-tapered stem were included. BMD was measured 2 weeks postoperatively (baseline), 3 months, 6 months, 1 year and annually thereafter until 5 years after surgery using dual-energy X-ray absorptiometry on the lumbar spine and proximal femur of the operated side according to the Gruen's zone classification. We analyzed predictable factors for BMD preservation in the proximal femur and compared radiological remodeling of the femur and changes in BMD. RESULTS: BMD at 5 years in zone 7 decreased less than 10%, whereas BMD in zone 1 increased to over the baseline (+ 1.9%). Multiple linear regression analyses revealed that body weight was a predictor for positive BMD change in the proximal femur. The frequency of radiolucency of the femur was significantly lower in patients who exhibited an increase in BMD at 5 years compared with BMD at 2 weeks in zone 7. CONCLUSION: BMD preservation of the proximal femur after cemented collarless polished double-tapered stem implantation was more effective in heavier patients. Furthermore, the frequency of radiolucency around the stem was significantly lower in patients who exceeded 100% of the baseline BMD in zone 7 at 5 years.

Proximal femoral reconstruction with impaction bone grafting and circumferential metal mesh.

INTRODUCTION: Impaction bone grafting (IBG) using a circumferential metal mesh is one of the options that allow restoration of the femoral bone stock and stability of the implant in revision hip arthroplasty. Here we examine the clinical and radiographic outcome of this procedure using a cemented stem, including experimental analysis of the initial stability of mesh-grafted bone-cemented stem complexes. METHODS: We retrospectively reviewed six hips (six patients) that had undergone femoral revisions with a circumferential metal mesh, impacted bone allografts, and a cemented stem. The mean follow-up period was 3.9 years (range 2.4-4.8 years). Hip joint function was evaluated using the Japanese Orthopaedic Association hip score, and radiographic changes were determined from radiographs. The initial resistance of mesh-grafted bone-cemented stem complexes to axial and rotational force was measured in a composite bone model with various segmental losses of the proximal femur. RESULTS: The hip score improved from 50 (range 10-84) preoperatively to a mean of 74 (range 67-88) at the final follow-up. The overall implant survival rate was 100 % at five years when radiological loosening or revision for any reason was used as the endpoint. No stem subsided more than 3 mm vertically within one year after implantation. Computed tomography showed reconstitution of the femoral canal in a metal mesh. In mechanical analyses, there was no relationship between IBG reconstruction rates under axial compression and stem subsidence or failure load. In contrast, under rotational load, the rotation angles of the stem to the stainless steel mesh were strongly affected by the IBG reconstruction rate. CONCLUSIONS: The short-term results show good outcomes for reconstruction of proximal bone loss with IBG and a circumferential mesh. The procedure should be applied in cases where the circumferential proximal bone loss is less than half the length of the implanted stem.

Outcomes of Charnley total hip arthroplasty using improved cementing with so-called second- and third-generation techniques.

BACKGROUND: Techniques of cemented total hip arthroplasty have developed over time. We present the outcomes of Charnley total hip arthroplasty performed using improved second- and third-generation cementing techniques. METHODS: We reviewed the radiologic results of 91 Charnley total hip arthroplasties performed using second- and third-generation cementing techniques. Second-generation techniques involved making multiple anchor holes, a double-cementing method on the acetabular side and an intramedullary plug, and retrograde filling with a cement gun on the femoral side in 57 hips. Third-generation techniques involved additional vacuum mixing and cement pressurization in 34 hips. RESULTS: Joint survival rates at 20 years when using second-generation techniques were 89% for the socket and 94% for the stem with aseptic loosening as the end point; the survival rates at 10 years when using third-generation techniques were 97 and 100%, respectively. According to our radiographic evaluation system for the clear zone at 5 years, there was less clear zone in the acetabular side with the third-generation techniques than with second-generation techniques. In the femoral side, there was very little development of the clear zone, but the difference between generations was not significant. CONCLUSIONS: Second- and third-generation cementing techniques showed excellent survivorship. The clear zone scores at 5 years indicated that third-generation techniques were effective, especially in the acetabular side, and may produce better long-term results than second-generation techniques.

A survey of oral health status, subjective oral symptoms and oral health behaviors among first-year dental students at a Japanese university.

PURPOSE: The rapid deterioration of oral health in young adults is an alarming problem in Japan. The aim of the present study is to investigate the oral health status, subjective oral symptoms and oral health behaviors of dental students. METHODS: Participants were 108 first-year students attending dental school in 2018-2019. Oral examinations were performed to assess dental caries indices, oral hygiene status, gingival bleeding on probing (BOP) and pocket depth. A self-administered questionnaire was used to assess subjective oral symptoms and oral health behaviors. RESULTS: The prevalence of decayed teeth (DT) and gingivitis (BOP ≥ 10%) were 43.5% and 50.0%, respectively. Having DT and gingivitis were significantly associated with poorer oral hygiene. No association was observed between DT and subjective symptoms. Having gingivitis was significantly associated with xerostomia, mouth-breathing and less use of interdental cleaning tools. Multiple logistic regression analysis for gingivitis yielded an odds ratio of 1.41 (95% confidence interval: 1.19-1.67) for plaque score, and 2.75 (1.27-5.98) for xerostomia. CONCLUSION: Since a relatively high ratio of students had DT and gingivitis without clear subjective symptoms, they require regular dental visits for early treatment and oral hygiene maintenance from the start of their time at university.

Dental Hygiene Learning Outcomes Obtained Through Computer-Assisted Simulation Modules.

Purpose: Education reflecting current knowledge is required for competent health care providers but the number of educators and/or lecture/clinical contact hours are often limited. The purpose of this study was to evaluate the learning outcomes and practicality of interactive simulation modules developed for a computerized learning system in dental hygiene education.Methods: Twenty-nine Japanese fourth-year dental hygiene undergraduates were given access to five interactive modules, delivered via a learning management system (LMS), for one month. The modules provided virtual clinical settings to take learners through decision-making processes for explaining procedures and treatments, and making appointments in English. Pre- and post-tests and a questionnaire were used to evaluate the knowledge gained and to receive learner's feedback. Participants were classified into two groups (study group and non-study group), based on their use/non-use of modules made available during the five-week period for statistical analysis.Results: Post-test scores were significantly higher in the study group (n = 22) than in the non-study group (n = 6), (p = 0.024). Post-test scores were also significantly higher than the pre-test scores in the study group (p = 0.001). No significant differences in the post- versus pre-test scores were found in the non-study group. The questionnaire response rate of 100% (n = 29) indicated that participants considered the interactive modules, including the system operation, as convenient and beneficial.Conclusion: Modules made available via a LMS for self-study were beneficial for Japanese undergraduate dental hygiene students in the acquisition of knowledge and skills for clinical decision-making in English.

An Inter- and Intraprofessional Education Program in Which Dental Hygiene Students Instruct Medical and Dental Students.

The aim of this study was to develop, implement, and evaluate an inter- and intraprofessional education program with a peer support joint practice in which dental hygiene students teach medical and dental students about oral health care for older people requiring long-term care. In 2015 at Tokyo Medical and Dental University, 22 dental hygiene students in their third year at the School of Oral Health Care Sciences (OH3), 110 students in their third year at the School of Medicine (M3), and 52 students in their third year at the School of Dentistry (D3) participated in this program. The OH3 students practiced with a whole-body-type simulator to learn oral health care for older people and then taught the methods to the M3 and D3 students according to their self-designed teaching plan. All M3 and D3 students experienced being both practitioner and patient. The number of respondents and response rates on the questionnaires after the training were 22 (100%), 102 (92.7%), and 52 (100%) for the OH3, M3, and D3 students, respectively. Self-assessment by the OH3 students indicated that they could supervise other students sufficiently (77-86%), and 91% of them found the preclinical practice with the simulator efficient for the peer support joint practice. Almost all the M3 and D3 students reported that they gained understanding of the methods (99%), significance (100%), and important points of oral health care for older people (97%) in addition to the jobs and roles of dental hygienists (93%) because of this program. The M3 students understood the methods and significance of oral health care more deeply than did the D3 students (p<0.05). This study found that an interprofessional program with a peer support joint practice to cultivate practical clinical ability aided in increasing understanding and cooperation between medicine and dentistry.