Comparison of re-revision rate and radiological outcomes between Kerboull-type plate and metal mesh with impaction bone grafting for revision total hip arthroplasty.

BACKGROUND: This study compared the re-revision rate and radiographic outcomes of revision total hip arthroplasty (THA) using a Kerboull-type acetabular reinforcement device (KT plate) with bulk structural allograft and metal mesh with impaction bone grafting (IBG). METHODS: Ninety-one hips of 81 patients underwent revision THA for American Academy of Orthopedic Surgeons (AAOS) classification type III defects from 2008 to 2018. Of these, seven hips of five patients and 15 hips of 13 patients were excluded due to insufficient follow-up information (< 24 months) and large bone defects with a vertical defect height ≥ 60 mm, respectively. The current study compared the survival and radiographic parameters of 45 hips of 41 patients using a KT plate (KT group) and 24 hips of 24 patients using a metal mesh with IBG (mesh group). RESULTS: Eleven hips (24.4%) in the KT group and 1 hip (4.2%) in the mesh group exhibited radiological failure. Moreover, 8 hips in the KT group (17.0%) required a re-revision THA, while none of the patients in the mesh group required a re-revision. The survival rate with radiographic failure as the endpoint in the mesh group was significantly higher than that in the KT group (100% vs 86.7% at 1-year and 95.8% vs 80.0% at 5-years, respectively; p = 0.032). On multivariable analysis evaluating factors associated with radiographic failure, there were no significant associations with any radiographic measurement. Of the 11 hips with radiographic failure, 1 (11.1%), 3 (12.5%), and 7 (58.3%) hips were of Kawanabe classification stages 2, 3, and 4, respectively. CONCLUSIONS: The findings of this study suggest that revision THA using KT plates with bulk structure allografts could provide poorer clinical outcomes than revision THA using a metal mesh with IBG. Although revision THA using KT plates with bulk structural allografts could set the true hip center, there is no association between a high hip center and clinical outcomes. The relationship between the position of the KT plate and the host bone might be considered more carefully.

Long-Term Clinical and Radiological Outcomes of Primary Total Hip Arthroplasty with Modular Femoral Stem in Middle-Aged Asian Patients.

BACKGROUND: There is insufficient information regarding the outcome of primary total hip arthroplasty (THA) with the modular femoral stem in middle-aged patients. This study aimed to assess long-term clinical and radiological outcomes of primary THA using the original or modified modular hip system (S-ROM) in middle-aged Asian patients. METHODS: A retrospective review identified 98 primary THAs that used a modular stem and were undertaken between 1997 and 2009 in patients younger than 58 years, for whom at least 5 years of follow-up data were available. Clinical data and radiograph assessments were reviewed to analyze differences between the original and modified modular stem groups. RESULTS: The mean patient follow-up duration was 148.3 months, and the follow-up ratio was 89.1%. The Kaplan-Meier analysis revealed that the survival rate of both stems was 98.9% at 10 years and 89.8% at 15 years. Although no statistically significant differences in the survival rate were observed between the stem designs, the original stem group had increased incidence of thigh pain compared with the modified stem group. In total, 12 and 54 hips showed change in stem alignment and osteolysis, respectively. CONCLUSION: The findings of this study show that the modular stems have a high survival rate, and results suggest positive outcomes among the Asian population over the long term. Although there were very few differences between the stem designs, the results suggest that the modified modular stem could prevent thigh pain and that selection of the implant based on the bone shape is important for THA.

High sensitivity X-ray analysis for a low accelerating voltage scanning electron microscope using a transition edge sensor.

A scanning electron microscope transition edge sensor has been developed to analyze the minor or trace constituents contained in a bulk sample and small particles on the sample under a low accelerating voltage (typically <3 keV). The low accelerating voltage enables to improve the spatial analysis resolution because the primary electron diffusion length is limited around the sample surface. The characteristic points of our transition edge sensor are 1) high-energy resolution at 7.2 eV@Al-Kα, 2) continuous operation by using a cryogen-free dilution refrigerator and 3) improvement of transmission efficiency at B-Kα by using thin X-ray film windows between the sample and detector (about 30 times better than our previous system). Our system could achieve a stabilization of the peak shift at Nd-Mα (978 eV) within 1 eV during an operation time of 27 000 s. The detection limits with B-Kα for detection times 600 and 27 000 s were 0.27 and 0.038 wt%, respectively. We investigated the peak separation ability by measuring the peak intensity ratio between the major constitute (silicon) and the minor constitute (tungsten) because the Si-Kα line differs from the W-Mα line by only 35 eV and a small W-Mα peak superimposed on the tail of the large Si-Kα peak. The peak intensity ratio (I(W-Mα)/I(Si-Kα)) was adjusted by the W particle area ratio compared with the Si substrate area. The transition edge sensor could clearly separate the Si-Kα and W-Mα lines even under a peak intensity ratio of 0.01.

Ten years change in post-fracture care for hip fracture patients.

INTRODUCTION: This multicenter, retrospective study aimed to clarify the changes in postoperative care provided by orthopaedic surgeons after hip fractures and clarify the incidence of secondary fractures requiring surgery. MATERIALS AND METHODS: Subjects were patients with hip fracture treated surgically in seven hospitals during the 10-year period from January 2008 to December 2017. Data on patient demographics, comorbidities, preoperative and postoperative osteoporosis treatments, and secondary fractures were collected from the medical records. RESULTS: In total, 4764 new hip fractures in 982 men and 3782 women (mean age: 81.3 ± 10.0 years) were identified. Approximately 10% of patients had a history of osteoporosis drug treatment and 35% of patients received postoperative drug treatment. The proportion of patients receiving postoperative drug therapy increased by approximately 10% between 2009 and 2010, 10% between 2010 and 2011, and 10% between 2011 and 2013. Although the rate of secondary fractures during the entire period and within 3 years decreased from 2011, the rate of secondary fracture within 1 year remained at around 2% every year. CONCLUSIONS: The approval of new osteoporosis drugs and the establishment of osteoporosis liaison services have had a positive effect on the use of postoperative drug therapy in the orthopedic field. Our finding that the rate of secondary fracture within 1 year of the initial fracture remained around 2% every year, despite improvements in postoperative drug therapy, suggests that both rehabilitation for preventing falls and early postoperative drug therapy are essential to prevent secondary fractures.

A two-generation reproductive toxicity study of benzophenone in rats.

The reproductive toxicity of benzophenone (BZP) was evaluated in a two generation test in which male and female Sprague-Dawley (SD) rats, parental (F0) and first generation (F1), were exposed to BZP by feeding diet containing BZP at concentrations of 0 (control), 100, 450 or 2000 ppm. With regard to the effects of BZP on the F0 and F1 parental animals, inhibition of body weight gain and food consumption, significantly elevated renal weights, dilatation of the renal proximal tubules, and regeneration of the proximal tubular epithelium were recognized at doses of 450 ppm and 2000 ppm, along with an increase in hepatic weight and centrilobular hepatocytic hypertrophy, considered as vital adaptive changes, at the doses of 100 ppm or more. Obvious effects on the endocrine system and reproductive toxicological effects were not found even at the dose of 2000 ppm in the F0 or F1 parent. There were no test substance related changes in the estrous cycle, reproductive capability, delivery and lactation, sperm parameters, serum hormone levels, or necropsy findings. As for effects on the offspring, inhibition of body weight gain was observed in both the F1 and F2 males and females of the 2000 ppm group. No effects of BZP treatment were recognized in the number of male and female F1 or F2 pups delivered, viability, anogenital distance (AGD), physical development, the results of reflex and response tests, or on the observation results of external abnormalities. From the present study of BZP administered to rats over two successive generations, the no observed effect level (NOEL) on the parental animals is concluded to be less than 100 ppm. Concerning the effects on the endocrine system and the reproductive toxicity in the parental animals, the NOEL is 2000 ppm. In terms of the effects on the offspring, the NOEL is considered to be 450 ppm.