Evaluation of a 3D-printed total knee arthroplasty using radiostereometric analysis: assessment of highly porous biological fixation of the tibial baseplate and metal-backed patellar component.

AIMS: Our intention was to investigate if the highly porous biological fixation surfaces of a new 3D-printed total knee arthroplasty (TKA) achieved adequate fixation of the tibial and patellar components to the underlying bone. PATIENTS AND METHODS: A total of 29 patients undergoing primary TKA consented to participate in this prospective cohort study. All patients received a highly porous tibial baseplate and metal-backed patella. Patient-reported outcomes measures were recorded and implant migration was assessed using radiostereometric analysis. RESULTS: Patient function significantly improved by three months postoperatively (p < 0.001). Mean difference in maximum total point motion between 12 and 24 months was 0.021 mm (-0.265 to 0.572) for the tibial implant and 0.089 mm (-0.337 to 0.758) for the patellar implant. The rate of tibial and patellar migration was largest over the first six postoperative weeks, with no changes in mean tibia migration occurring after six months, and no changes in mean patellar migration occurring after six weeks. One patellar component showed a rapid rate of migration between 12 and 24 months. CONCLUSION: Biological fixation appears to occur reliably on the highly porous implant surface of the tibial baseplate and metal-backed patellar component. Rapid migration after 12 months was measured for one patellar component. Further investigation is required to assess the long-term stability of the 3D-printed components and to determine if the high-migrating components achieve fixation. Cite this article: Bone Joint J 2019;101-B(7 Supple C):40-47.

Two-centre radiological survivorship of acetabular distraction technique for treatment of chronic pelvic discontinuity: mean five-year follow-up.

Aims The aim of this study was to examine the results of the acetabular distraction technique in achieving implantation of a stable construct, obtaining biological fixation, and producing healing of chronic pelvic discontinuity at revision total hip arthroplasty. Patients and Methods We identified 32 patients treated between 2006 and 2013 who underwent acetabular revision for a chronic pelvic discontinuity using acetabular distraction, and who were radiographically evaluated at a mean of 62 months (25 to 160). Of these patients, 28 (87.5%) were female. The mean age at the time of revision was 67 years (44 to 86). The patients represented a continuous series drawn from two institutions that adhered to an identical operative technique. Results Of the 32 patients, one patient required a revision for aseptic loosening, two patients had evidence of radiographic loosening but were not revised, and three patients had migration of the acetabular component into a more stable configuration. Radiographically, 22 (69%) of the cohort demonstrated healing of the discontinuity. The Kaplan-Meier construct survivorship was 83.3% when using revision for aseptic acetabular loosening as an endpoint. At the time when one patient failed due to aseptic loosening (at 7.4 years), there were a total of seven patients with a follow-up of seven years or longer who were at risk of failure. Conclusion The acetabular distraction technique demonstrates encouraging radiographic outcomes, with healing of the discontinuity in over two-thirds of our series. This surgical technique permits biological fixation and intraoperative customization of the construct to be implanted based on the pattern of the bone loss identified following component removal. Cite this article: Bone Joint J 2018;100-B:909-14.

Biomonitoring studies and susceptibility markers for acrolein congeners and allylic and benzyl compounds.

The importance of genotoxic acrolein congeners and allylic and benzyl compounds as industrial compounds, ubiquitous environmental pollutants, and naturally occurring substances necessitates the availability of adequate biomonitoring techniques. Endogenously formed acrolein congeners are considered to play an important role in carcinogenesis. Our studies have demonstrated that acrolein congeners react with DNA components and form adducts with the guanine moiety. We have identified and characterized cyclic 1,N2-deoxyguanosine adducts, cyclic 7,8-guanine adducts, linear 7-guanine adducts, 1,N2,7,8-bis-cyclic adducts, and 1,N2-cyclic, 7-linear bis adducts. Both the reactivity of the acroleins toward nucleosides and their mutagenicity in S. typhimurium TA100 decrease with increasing degree of alkyl substitution. Adducts are now available as reference substances for developing sensitive detection methods. Of the biomonitoring methods investigated for allylic and benzyl compounds, the detection of cysteine and histidine adducts isolated from hemoglobin seems to be the most sensitive. Gas chromatography with electron capture detection of heptafluorobutyric acid derivatives allows a detection limit in the femtomole range, HPLC-fluorescence detection of O-phthalic dialdehyde derivatives allows a limit in the picomole range, and detection of 9-fluorenylmethyl-chlorofomiate derivatives allows a limit in the femtomole range.

The effects of surface roughness and polymethylmethacrylate precoating on the radiographic and clinical results of the Iowa hip prosthesis. A study of patients less than fifty years old.

BACKGROUND: The purpose of the present study was to compare the results associated with two different surface finishes (bead-blasted and grit-blasted) for Iowa femoral components used in total hip arthroplasties performed between January 1979 and June 1991 in patients who were less than fifty years old. METHODS: Between January 1979 and December 1985, thirty-six primary total hip replacements were performed in twenty-five patients with insertion of a bead-blasted Iowa femoral component (average surface roughness, 0.8 micrometer) with cement and insertion of a titanium-backed acetabular component (thirty-five hips) or non-metal-backed acetabular component (one hip) with cement. Between January 1986 and June 1991, forty-five primary total hip replacements were performed in thirty-seven patients with use of a precoated grit-blasted Iowa femoral component (average surface roughness, 2.1 micrometers) and a Harris-Galante-I porous ingrowth acetabular component (forty-one hips) or an Osteonics component (four hips). The only change in the design of the femoral component (other than the surface finish) between the two consecutive series was the addition of polymethylmethacrylate precoating to the proximal third of all forty-five grit-blasted stems and modularity of the femoral head of the last eight grit-blasted stems. RESULTS: No hip was lost to follow-up. The duration of radiographic follow-up of the hips treated with the bead-blasted component averaged 11.3 years (range, ten to sixteen years) postoperatively, whereas that of the hips treated with the precoated grit-blasted component averaged 8.2 years (range, five to eleven years). Two (6 percent) of the bead-blasted femoral components were revised because of aseptic loosening compared with eight (18 percent) of the precoated grit-blasted components. Four bead-blasted components (11 percent) were either radiographically loose or were revised because of loosening compared with eleven precoated grit-blasted components (24 percent). Kaplan-Meier survivorship curves evaluated with log-rank analysis revealed that the bead-blasted Iowa femoral components were revised because of aseptic loosening (p = 0.0184) and were radiographically loose (p = 0.0068) less often than the precoated grit-blasted Iowa femoral components. CONCLUSIONS: The findings of the present study have led the senior ones of us to resume using femoral components with a polished surface and fixed with cement.

Deep--deeper--deepest? Encoding strategies and the recognition of human faces.

Various encoding strategies that supposedly promote deeper processing of human faces (e.g., character judgments) have led to better recognition than more shallow processing tasks (judging the width of the nose). However, does deeper processing actually lead to an improvement in recognition, or, conversely, does shallow processing lead to a deterioration in performance when compared with naturally employed encoding strategies? Three experiments systematically compared a total of 8 different encoding strategies manipulating depth of processing, amount of elaboration, and self-generation of judgmental categories. All strategies that required a scanning of the whole face were basically equivalent but no better than natural strategy controls. The consistently worst groups were the ones that rated faces along preselected physical dimensions. This can be explained by subjects' lesser task involvement as revealed by manipulation checks.

Fatality from disseminated intravascular coagulation complicating total hip arthroplasty: a case report.

Following a routine hybrid total hip arthroplasty in an eighty-two year-old female, profuse bleeding occurred through the suction drain immediately postoperatively. The patient was found to have acute disseminated intravascular coagulation. Despite early recognition and treatment the patient died fourteen days later.

Acetabular distraction: an alternative approach to pelvic discontinuity in failed total hip replacement.

A pelvic discontinuity occurs when the superior and inferior parts of the hemi-pelvis are no longer connected, which is difficult to manage when associated with a failed total hip replacement. Chronic pelvic discontinuity is found in 0.9% to 2.1% of hip revision cases with risk factors including severe pelvic bone loss, female gender, prior pelvic radiation and rheumatoid arthritis. Common treatment options include: pelvic plating with allograft, cage reconstruction, custom triflange implants, and porous tantalum implants with modular augments. The optimal technique is dependent upon the degree of the discontinuity, the amount of available bone stock and the likelihood of achieving stable healing between the two segments. A method of treating pelvic discontinuity using porous tantalum components with a distraction technique that achieves both initial stability and subsequent long-term biological fixation is described.

[Credibility and further psychological problems of young children as witnesses in criminal justice procedures: a case study]. / Zur Glaubwürdigkeit und zu weiteren psychologischen Problemen bei Zeugenaussagen junger Kinder im Strafermittlungsverfahren: Eine Fallstudie.

A pair of 3 1/2-year-old twins who had possibly witnessed their mother's murder were examined by a child psychiatrist and a child psychologist as part of a judicial inquiry. The procedure developed specially for this purpose, the actual course of the investigation and the evaluation of the findings with regard to psychological aspects of evidence are discussed. The theoretical part of the study deals with the current state of knowledge and the problems relating to evidence given by young children as witnesses. The main emphasis is on general and specific credibility, identification of people associated with the crime, suggestibility and probabilities related to guessing, perceptual and memory performance, and minimization of emotional sequelae in children who are witnesses to violent crimes. The authors conclude that preschool children can be reliable witnesses in preliminary hearings and court proceedings.

Total hip arthroplasty in the young adult.

The durability of cemented and hybrid total hip arthroplasty in the young adult was evaluated. A consecutive series of primary cemented total hip arthroplasties performed between 1970 and 1976, and a consecutive series of primary hybrid total hip arthroplasties performed between 1986 and 1991, were evaluated for revision and radiographic loosening of the components. All patients were younger than 50 years of age at the time of surgery and all surgery was performed by one surgeon. At minimum 20 years followup of the cemented group (93 hips in 69 patients) 22% of hips (21 hips) were revised for aseptic loosening (5% of femoral components, five hips, and 19% of acetabular components, 18 hips). At 5- to 10-year followup of the hybrid group (45 hips in 37 patients) 18% of hips (eight hips) were revised for aseptic loosening (18% of femoral components, eight hips, and 0% of acetabular components, 0 hips). Although the cemented femoral component used in the hybrid series showed a marked increase in revision and loosening compared with the cemented series, the excellent fixation obtained with uncemented acetabular components has encouraged the authors to continue the use of hybrid fixation in the young adult. However, the femoral component has been modified to incorporate a polished surface finish and a stem geometry similar to the Charnley flat back prosthesis used in the cemented series.

Hybrid total hip arthroplasty in patients under the age of fifty: a five- to ten-year follow-up.

In 37 patients, 45 total hip replacements were performed using contemporary cementing techniques, an uncemented Harris-Galante I acetabular component and a cemented precoated Iowa femoral component in patients under the age of 50 at the time of their surgery; 36 patients with 43 hybrid hips were living, 1 patient with 2 hybrid hips was decreased. No patients were lost to follow-up. At 5- to 10-year follow-up, eight hips were revised for aseptic loosening. No acetabular components, and eight femoral components (18%) were revised for aseptic loosening. When looking at radiographic results, including revision as well as those components that were probably or definitely loose on radiographs, 0 acetabular components and 11 femoral components (24%) were radiographically loose. These results demonstrate the excellent durability of the uncemented Harris-Galante acetabular component in the younger patient. However, the Iowa grit-blasted methyl methacrylate precoated femoral component had a magnitude increase in the prevalence of revision for aseptic femoral loosening when compared to the senior author's long-term Charnley results in this age group. The authors attribute the failure to the rough surface finish applied to the femoral component. However, the polymethyl methacrylate proximal precoating and the femoral component design may also contribute to the femoral failures.