Significant Reduction of Radiation Exposure Using Specific Settings of the O-Arm for Percutaneous Cementoplasty in Accordance With the ALARA Principle.

BACKGROUND: Three-dimensional (3D) navigation has become routinely used in spine surgery, allowing more accurate and safe procedures. However, radiation exposure related to the use of imaging is an unresolved issue, and information about it is relatively scarce. The "as low as reasonably achievable" (ALARA) principle aims to reduce the radiation exposure for the patients as low as possible. The objective of this study was to compare the effective dose related to the use of the O-arm in standard settings with adapted features for dose reduction during percutaneous cementoplasty. METHODS: From March 2021 to October 2022, all consecutive patients who underwent navigated percutaneous cementoplasty with the use of the O-arm were prospectively included. Demographic, operative, irradiation, and radiological data were collected. The main outcome was the effective dose (E) in millisievert (mSv). Secondary outcomes were the absolute risk of cancer (AR) in percent equivalent to a whole-body exposition, operative time, and radiological results according to Garnier. In group A, patients were operated on with standard settings of the O-arm, whereas in group B, navigation on the field of view, collimation, and low-dose settings were used. RESULTS: A total of 70 patients were included in the study: 43 in group A and 27 in group B. Also, 109 vertebrae were operated: 59 in group A and 50 in group B. Mean E was significantly higher in group A than in group B (9.94 and 4.34 mSv, respectively; P < 0.01). The 3D-related E followed the same trend (7.82 and 3.97 mSv, respectively), as did 2-dimensional-related E (2.12 and 0.37 mSv, respectively; P < 0.01). Average AR was also significantly higher in group A than in group B (5.10-4% and 2.10-4% respectively; P < 0.01). Operative time was similar in both groups, but the rate of satisfactory radiological results was higher in group A than in group B (95% and 84%, respectively; P = 0.11), and we found similar rates of cement leakage (22% and 24%, respectively; P = 0.71). CONCLUSIONS: The application of settings of the O-arm in accordance with the ALARA principle helped to significantly reduce the radiation exposure and should be routinely used for O-arm-assisted cementoplasty procedures. CLINICAL RELEVANCE: This study details technical aspects and settings that may help users of the O-arm to decrease radiation exposure to patients and surgeons alike, especially in cementoplasty procedures, as well as in other procedures performed under O-arm guidance.

Major acetabular prosthetic protrusion following total hip arthroplasty: a case report of a reconstruction challenge.

Background: Acetabular protrusion is an acetabular defect caused by the shift of the femoral head through the pelvic bone. Because of bone loss, usual anatomical landmarks may be confusing or absent, leading to a particularly high demanding surgical reconstruction in case of total hip arthroplasty (THA) implantation, without adequate support of the acetabulum due to major acetabular defect. To our knowledge, no article has dealt with acetabular defects to this extent and associated femoral osteolysis, which we will attempt to do in this case report. That's why we would like to share this case in order to propose an interesting alternative for the management of these challenging pathologies. Case Description: We hereby present the case of a rare pattern of severe acetabular prosthetic protrusion through the pelvic ring on a 77-year-old patient without any trauma. He was surgically treated with acetabular metal augment and a wide femoral modular reconstruction prosthesis. An instability was revealed after 6 weeks, so he underwent an early surgical revision with a constraint cup, overwhelming the absence of abductor apparatus. After this, his recovery was complete and uneventful, with effective function of the reconstructed hip joint and adequate stability of the prosthesis. Conclusions: Although acetabular protrusion is a rare complication in total hip replacement patients, we would like to draw attention to the challenging nature of this complication, both in terms of initial assessment and surgical management. The described strategy showed effective function of the reconstructed hip joint and final adequate stability of the prosthesis despite the absence of a competent abductor apparatus.

Aesthetic demand of French seniors: a large-scale study.

OBJECTIVES: The needs of seniors for oral health and aesthetics are growing, as are their demands for aesthetics. This large-scale study aims to identify the demand for aesthetics for a population aged over 55, and the influence of age and gender. METHODS: A 15-item questionnaire was placed on the web in partnership with a major magazine dedicated to seniors. It reflected practitioners' questions with regard to senior patient expectations: aesthetic demand assessment, most commonly expressed complaints, the importance given to tooth colour, knowledge of available therapeutic treatments and motivation levels for treatment. RESULTS: The survey generated 3868 responses, 61% from women; 77% of respondents declared being satisfied to very satisfied with their smile. Their highest priority to improve their smile was tooth alignment, followed by their shape, length and shade. Although 60% of respondents were satisfied with their current shading, 53% would prefer to have them whitened. Aesthetic treatments were well-known to seniors. Over four-fifths of them had heard of dental implants and ceramic crowns. Two-thirds of those who wished to improve their smile were considering dental treatment. CONCLUSION: The high number of collected questionnaires confirms the strong interest shown by seniors for dental aesthetics, particularly from women. Baby-boomers seem more attentive to the appearance of their smile than their elders. However, the importance of appearance decreases with age, as it becomes less of a priority, with attention more focused on general health.

Bone height measurements around a dental implant after a 6-month space flight: a case report.

PURPOSE: In space, astronauts are subject to microgravity, which reduces skeletal loading and osteoblast function and can cause bone resorption and a decrease in bone density. No known research to date has studied the effect of microgravity on dental implants. This study evaluated peri-implant bone changes around a dental implant placed in a French astronaut who spent 6 months in Russia's Mir Space Station. MATERIALS AND METHODS: Measurements were performed by 2 examiners before the flight (baseline), after the flight (stage 1), and following a recovery period (stage 2). Standardized periapical radiographs were taken, and data were recorded using a photomicroscope and a measuring scale. RESULTS: Cumulatively, the implant sustained 0.43 mm of mesial bone gain and 0.31 mm of distal bone loss. DISCUSSION: The observed peri-implant bone height changes were within normal limits and the implant appeared very stable during the course of this study. CONCLUSION: Peri-implant bone levels remained stable after 6 months in microgravity, and the implant continued to function without complications.