A low dislocation rate after revision total hip arthroplasty performed through the anterior approach.

BACKGROUND: Dislocation is a major complication in revision total hip arthroplasties. This study aimed to evaluate the dislocation rate, complications, and functional scores of revision total hip arthroplasty performed through the direct anterior approach. METHODS: Between January 2014 and March 2020, 84 patients undergoing revision total hip arthroplasty were retrospectively reviewed. All operations were performed through the direct anterior approach. At the final follow-up, incidences of dislocation, reoperation, acute deep infections, periprosthetic fractures and psoas impingement were assessed. The median postoperative Oxford Hip Score was also calculated. RESULTS: At revision surgery, the mean age was 66 ± 12 years (range, 28-91). During an average follow-up of 4.2 ± 1.2 years, reoperation rate for major complications in the non-infected revisions was 15% (n = 11), including five acute deep infections (7%), four periprosthetic fractures (5%), one dislocation and one psoas impingement (1%). The median postoperative Oxford Hip Score was 39 (interquartile range = 14). CONCLUSION: In our series, revision total hip arthroplasty through direct anterior approach was associated with a very low dislocation rate, acceptable complication rates and good functional results. Our results suggest that this procedure is safe and reliable. TRIAL REGISTRATION: Ethical approval for this study was obtained, before enrollment of the first participant, by CUB Erasme's research ethics committee (P2020/323) and C.H.U Ambroise Paré's research ethics committee.

The utility of the CADISS® system in the dissection of epidural fibrosis in revision lumbar spine surgery (A case series).

Spine surgery and spinal fusion surgery are rising. Revision rates following initial surgery are between 8 and 45%. Epidural fibrosis is a common response to spine surgery for most patients and increases complications in revision surgery. Previous research suggests using MESNA (Sodium 2-mercaptoethane sulfonate) in combination with mechanical blunt dissection safely reduces surgical complications. MESNA is a mucolytic agent which selectively cleaves disulphide bonds involved in the adherence and strength of fibrosis, meaning cutting instruments are not needed. The Chemically Assisted DISSection (CADISS®) System is an optimised non-cutting surgical device, consisting of a reconstitution cartridge for MESNA preparation, irrigated surgical instruments, and a footswitch to control MESNA release. This is the first study to investigate the use of the CADISS® System in revision spine surgery. Methods: This was a prospective, open label, observational case study. We enrolled 21 patients for revision spine surgery with the CADISS® System at two Belgium sites. The primary assessment was the number of successful removals of epidural fibrosis without cutting. The amount of MESNA used, total dissection and procedure time were recorded. For secondary criterion, the surgeons assessed global satisfaction, facilitation of dissection, quickness of action, usability, bleeding reduction and visualisation of the cleavage plane using an 11-point Likert scale (0-10). Due to the exploratory nature, no formal statistical analysis was planned. We calculated the percentage and confidence interval of successful procedures, the medians and corresponding interquartile range of the Likert criterion, and the mean (±SD) of the amount of MESNA used, CADISS® dissection time and total procedure time. Results: 24 fibrosis dissections were performed in 19 patients and 23 were successful (95.8%, CI: 78.9%; 99.9%). The mean amount of MESNA used, mean dissection time and procedure time were 16 ml (±4.94), 16.5 min (±16.1) and 86.3 min (±25.1), respectively. No dural tears were reported. The mean global satisfaction score was 9.0 (8.0-9.0). All other Likert criterion had scores of 8.0 or 9.0, excluding quickness of action, which scored 7.0 (6.0-9.0). Conclusions: The CADISS® System in revision spine surgery has potential to effectively reduce dissection complications.

Adverse local tissue reaction after ceramic-on-ceramic total hip arthroplasty.

We report a rare case of symptomatic adverse local tissue reaction in a patient with a ceramic-on-ceramic total hip bearing surface and review the literature. Probably, ceramic wear debris is not entirely inert and may lead to adverse local tissue reactions.

Alpha-defensin for the intra-operative diagnosis of prosthetic joint infections.

A single-center prospective study was conducted over one-year period to determine the performance (sensitivity, specificity, positive and negative predictive values) of the synovasure test for the diagnosis of prosthetic joint infection using the MSIS consensus criteria as the reference. The study included all patients admitted for resumption of hip or knee prosthesis whatever the reason, all couples of friction, patients under antibiotic treatment, immuno-compromised or with systemic inflammatory diseases. 62 consecutive patients were preoperatively distributed into three groups (infected, uninfected and questionable). In order to determine MSIS criteria, pre-operative blood tests, as well as bacteriological, cytological and histological analyses of intraoperative tissues were performed. The synovasure test was performed following the protocol on articular fluid intraoperatively and showed a sensitivity of 83.3%, a specificity of 95.7%, a positive predictive value of 83.3% and a negative predictive value of 95.7%.

Bi-functional heterogeneous catalysts for carbon dioxide conversion: enhanced performances at low temperature.

Novel heterogeneous bi-functional catalysts bearing tin or zinc inserted as single sites within the silica architecture acting as acid centres and decorated with imidazolium moieties as the nucleophile source were successfully synthesized. The materials were extensively characterized via various techniques including N2 physisorption, solid state nuclear magnetic resonance, X-ray photoelectron spectroscopy, transmission electron microscopy and adsorption microcalorimetry. The solids were tested as catalysts for the conversion of carbon dioxide, selecting the synthesis of styrene carbonate as the target reaction. Both materials exhibited improved performances compared to the analogous solids functionalized with the sole imidazolium salt as well as to other materials reported in the literature. The Sn-based catalyst displayed excellent conversion also in the presence of various epoxides. In all experiments the bi-functional solid allowed reducing the reaction temperature below 150 °C. In the presence of glycidol the temperature was decreased down to 30 °C. The short synthesis protocol of the heterogeneous catalysts, together with the 100% atom economy of the target reaction and the low reaction temperature, make the entire process highly sustainable. Moreover, the Sn-based catalyst was stable under the selected reaction conditions and reusable for multiple catalytic cycles.

High surface area zincosilicates as efficient catalysts for the synthesis of ethyl lactate: an in-depth structural investigation.

Novel Zn-MCM-41 mesoporous materials with particle diameters ranging from 20 to 120 nm were successfully prepared following a straightforward synthesis route. The structural and textural properties of the solids were characterized by N2-physisorption, X-ray diffraction, (29)Si MAS-NMR, TEM and EDX. These results allow evidencing the presence of an ordered mesoporous structure with a very high specific surface area. The insertion of zinc as single site species within the silica framework was investigated using XPS via the Auger parameter in a Wagner plot representation. This is the first time that an in-depth investigation of these types of solids using XPS techniques was performed. The presence of Brønsted and Lewis acidity was elucidated by following in the IR the interaction with ammonia and carbon monoxide. The materials were tested for the conversion of dihydroxyacetone into ethyl lactate with good results both in terms of yield and selectivity and the catalytic activity resulted in excellent agreement with IR and XPS analysis.

A comprehensive study of the reaction parameters involved in the synthesis of silica thin films with well-ordered uni-directional mesopores.

Ordered mesoporous thin films with well-orientated channels are an important feature in a series of applications including sensors, optics, photocatalysis, and solar cells. However, their preparation remains a great challenge. The structural optimization of highly organized mesoporous silica thin films, with channels perpendicularly orientated to the surface and prepared by a spin-coating technique, is reported. A large series of reaction parameters were revisited with a deep investigation such as the template, solvent, aging time, pH, rotation speed, and duration of spin-coating. The best conditions for each of these different parameters were subsequently used together to control the pore size and channel orientation of the well-organized films. Characterization of the films performed by X-ray diffraction (XRD) and transmission electron microscopy (TEM) revealed that the films had homogeneous pores with a uni-directional orientation. Atomic force microscopy (AFM) and ellipsometric porosimetry analysis (EP) were employed to determine the orientation of the channels, pore size distribution, specific surface, thickness, and the accessible porosity. The present work constitutes an overall view of the different parameters which influence the formation of silica thin films, such as the thickness and the pore size distribution of a film which can be tailored to suit a potential application. The wettability properties of thin films have been studied by measuring the contact angle with different solvents such as water, isopropanol, and toluene.

Validation of the Ottawa knee rules in an emergency teaching centre.

Our objective was to determine the value of the Ottawa knee rules when applied by users with different levels of clinical training. We used a prospective patient survey by the medical students and surgery residents of a European university trauma centre. The study group consisted of 261 eligible patients who presented with acute knee trauma during a 6-month period. Radiography or follow-up was obtained for each patient. Data were separately analysed according to the degree of qualification of the initial examiner. The Ottawa knee rules had a sensitivity and a negative predictive value of 1.00. Variable degree of medical competence of the users did not alter the accuracy of the rules. Application of the rules would have reduced knee radiography requests by 25%. The Ottawa knee rules remain highly sensitive when applied by medical users with different levels of qualification, such as encountered in a teaching setting.