Comparison of Ceramic-on-Ceramic and Ceramic-on-Highly-Crosslinked-Polyethylene in Primary Total Hip Arthroplasty: Findings of a Meta-Analysis.

Introduction An optimal hip implant is biocompatible, durable, and resistant to chemical and mechanical wear. This analysis aimed to compare failure (revision) and complication rates between ceramic-on-ceramic (CoC) and ceramic-on-highly-crosslinked-polyethylene (CoHXLPE) implants. Methods This review comprised of scientific literature published between 1995 and 2019. We included randomized controlled trials in adults (>18 years) that presented results of CoC and CoHXLPE total hip arthroplasty (THA) with more than two years of mean follow-up and drafted in English. The primary outcomes for this analysis were complications, revision rates, and loosening rates. Results Eight studies (1,689 hips) were included in this systematic review. There was no significant differences between COC and CoHXLPE for the risk of post-surgical complications (relative risk [RR]: 1.98, 95% confidence interval [CI]: 0.83-4.69, P = 0.12). Revision rates (RR: 1.25, 95% CI: 0.71-2.20, P = 0.43] and loosening rates between the two implants were not significantly different (RR: 1.17, 95% CI: 0.30-4.52, P = 0.82). Conclusion We report no significant differences between CoHXLPE and CoC in adults undergoing primary THA. Although introduced relatively recently, CoHXLPE is a cost-effective bearing that can be used for younger patients with no risk of increased complications in comparison to CoC. Further studies with longer follow-up periods are recommended to confirm the findings of this meta-analysis.

Vacuum-Assisted Closure in a Patient With Entero-Atmospheric Fistula: A Case Report.

The entero-atmospheric fistula (EAF) is a recognized complication of open abdomen surgeries, which causes significant morbidity and mortality. This usually causes long hospitalizations and may require many surgical operations. While different methods of treatment for EAF are used, all different methods share the same goal, which is a proper closure of the fistula and the open abdomen to avoid recurrence and complications. We report a case of a 48-year-old female with a bowel perforation following an attempted open bilateral ovarian cyst drainage with cyst wall biopsy complicated by entero-atmospheric fistula treated by wound closure with vacuum-assisted pressure. In conclusion, the use of vacuum-assisted closure (VAC) to induce spontaneous healing of EAFs can provide a safe acceptable alternative to surgical treatment.