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2.
Medicine (Baltimore) ; 99(15): e19735, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32282732

RESUMEN

INTRODUCTION: The increase in the number of patients with prosthetic joints will entail a rise in the absolute number of infections associated with these procedures. Although less frequent, infections by Candida species are also expected to increase, and the clinical and surgical management of these cases is based on case reports and opinion of specialists. The objective of the present study was to review the available literature and describe the cases of prosthetic joint infection caused by Candida species in patients of the Institute of Orthopedics and Trauma of the University of São Paulo Faculty of Medicine Clinics Hospital (IOT-HCFMUSP) between 2007 and 2014. PATIENT CONCERNS: Eleven patients were diagnosed with prosthetic joint infection due to Candida with mean age of 65 years. The most frequent comorbidities were heart disease and diabetes mellitus, and the main personal antecedent was previous bacterial infection in the prosthetic joint. At least one risk factor for fungal infection was present in 73% of the patients. There was no difference between the prevalence of infections caused by Candida albicans and non-albicans Candida species, and there was bacterial co-infection in 55% of the cases. DIAGNOSIS: For building up the case series, patients with cultures of bone and joint specimens that were positive for Candida species and had a clinical diagnosis of prosthetic joint infection were included in the case series. INTERVENTIONS: Surgical debridement with removal of the prosthesis was the most frequently used surgical approach (45%). All patients were treated with monotherapy, and the most frequently used antifungal agent was fluconazole. The total duration of antifungal therapy was 6 months in 73% of the cases. OUTCOMES: After the initial management, 73% of the patients achieved clinical remission. CONCLUSION: The most indicated initial management was debridement with removal of the prosthesis, and the most used treatment regimen was fluconazole monotherapy. The most prevalent treatment duration was 6 months. The initial management led to a favorable outcome in 73% of the cases. DESCRIPTORS: Prosthetic joint infection, Candida, treatment, and diagnosis.


Asunto(s)
Candida albicans/aislamiento & purificación , Prótesis Articulares/microbiología , Osteoartritis/cirugía , Infecciones Relacionadas con Prótesis/tratamiento farmacológico , Infecciones Relacionadas con Prótesis/microbiología , Infecciones Relacionadas con Prótesis/cirugía , Anciano , Anciano de 80 o más Años , Antifúngicos/uso terapéutico , Infecciones Bacterianas/tratamiento farmacológico , Infecciones Bacterianas/epidemiología , Infecciones Bacterianas/cirugía , Coinfección/epidemiología , Comorbilidad , Desbridamiento/métodos , Femenino , Fluconazol/uso terapéutico , Humanos , Prótesis Articulares/efectos adversos , Masculino , Persona de Mediana Edad , Micosis/tratamiento farmacológico , Micosis/epidemiología , Micosis/cirugía , Osteoartritis/complicaciones , Prevalencia , Infecciones Relacionadas con Prótesis/epidemiología , Estudios Retrospectivos , Resultado del Tratamiento
5.
J Orthod ; 47(2): 156-162, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32126863

RESUMEN

This case report describes the successful second surgical treatment of a 26-year-old white female patient with a retrognathic mandible and previous bilateral total joint prostheses placement. The patient had previously presented with bilateral idiopathic condylar resorption (ICR) which caused clockwise mandibular rotation and resulted in anterior open bite and a retrognathic mandible. The patient had undergone definitive corrective for the ICR where condylectomies were performed bilaterally. In addition, total joint prostheses using 'stock joints' were used to restore the condyle and glenoid fossa on both sides. Although the previous surgery corrected the anterior open bite and restored the condyles, the patient was still suffering from joint symptoms (significant pain), restricted mandibular movements, increased overjet (12 mm) and a retrognathic mandible. The treatment plan included a combined orthodontic surgical approach: (1) bimaxillary orthognathic surgery: a surgical procedure on the mandible to reposition the prosthetic joints and correct the mandible position, and a segmental LeFort I to expand the maxilla; and (2) post-surgical orthodontics treatment to detail the occlusion. At the end of the treatment, good aesthetic and functional results were obtained with the cooperation of two specialties. This case emphasises the importance of three-dimensional planning and multidisciplinary treatment when addressing complex jaw movements. It also emphasises the importance orthodontic planning and collaboration with the orthodontist.


Asunto(s)
Prótesis Articulares , Procedimientos Quirúrgicos Ortognáticos , Adulto , Femenino , Humanos , Mandíbula , Cóndilo Mandibular , Reoperación , Articulación Temporomandibular
6.
Orthop Clin North Am ; 51(2): 141-146, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32138852

RESUMEN

Prosthetic joint infection is still a rare but devastating complication following total hip and knee arthroplasty. The incidence of prosthetic joint infection ranges from 2% to 4% in primary procedures as opposed to nearly 20% in revisions. The challenges that arise here include mainly diagnostic uncertainty, management in immunocompromised patients, recurrent infection, infection around a well-fixed implant, and substantial bone loss, and require careful preoperative assessment and well-defined management plans. This article summarizes recent developments in the diagnosis and management of this increasingly prevalent issue specifically focusing on outcomes following debridement, antibiotics, and implants retention and one-stage revision procedures.


Asunto(s)
Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Rodilla/efectos adversos , Infecciones Relacionadas con Prótesis/diagnóstico , Infecciones Relacionadas con Prótesis/terapia , Antibacterianos/uso terapéutico , Biomarcadores/análisis , Desbridamiento , Remoción de Dispositivos , Humanos , Prótesis Articulares/efectos adversos , Prótesis Articulares/microbiología , Infecciones Relacionadas con Prótesis/etiología , Infecciones Relacionadas con Prótesis/microbiología , Reino Unido
7.
Orthop Clin North Am ; 51(2): 265-277, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32138864

RESUMEN

Distal humerus hemiarthroplasty is a good surgical option for nonreconstructable intraarticular distal humerus fractures in selected lower-demand patients. The lifetime activity restrictions have not been determined, but are likely less than a total elbow arthroplasty. From a technical standpoint, distal humeral prostheses should be implanted at the correct depth and rotation. The collateral ligaments, condyles, and epicondyles should be preserved and/or repaired to maintain joint stability. Short- to midterm retrospective studies have shown promising results.


Asunto(s)
Artroplastia de Reemplazo de Codo , Articulación del Codo/cirugía , Hemiartroplastia , Fracturas del Húmero/cirugía , Fracturas Intraarticulares/cirugía , Humanos , Prótesis Articulares , Cuidados Posoperatorios , Cuidados Preoperatorios , Resultado del Tratamiento
8.
Orthop Clin North Am ; 51(2): 293-302, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32138866

RESUMEN

Brazil experiences a late participation in total ankle arthroplasty, which could have positive and negative aspects. The positive view argues about the modern implants that Brazil has received in the past years, skipping the early total ankle replacement generation who present more complications and low survival rate in the literature. The negative aspects are related to gap of experience with Brazilian surgeons unable to participate in the development of the technique and implant designs during these years. This article discusses the aspects of the Brazilian experience with total ankle replacement since the earliest procedures performed.


Asunto(s)
Articulación del Tobillo/cirugía , Artritis/cirugía , Artroplastia de Reemplazo de Tobillo , Prótesis Articulares , Adulto , Anciano , Articulación del Tobillo/diagnóstico por imagen , Artritis/diagnóstico por imagen , Artroplastia de Reemplazo de Tobillo/efectos adversos , Brasil , Femenino , Humanos , Prótesis Articulares/efectos adversos , Masculino , Persona de Mediana Edad , Diseño de Prótesis
9.
Plast Reconstr Surg ; 145(3): 746-754, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-32097319

RESUMEN

Research bias, or the systematic errors of a study, can arise before, during, or after a trial ends. These biases hinder the internal validity of the study, which is the accuracy of a study's conclusions regarding the effects of an intervention on a given group of subjects. With the growing use of evidence-based medicine, there is a demand for high-quality evidence from the research community. Systematic reviews and meta-analyses of randomized controlled trials are considered the highest level of evidence, followed by individual randomized controlled trials. However, most surgical trials cannot be conducted as randomized controlled trials because of factors such as patient preferences and lack of equipoise among surgeons. Therefore, surgical trials may lack features that are held as important standards for high-quality evidence, such as randomization and blinding. To demonstrate the biases that surgical trials may encounter, the authors examined a prospective cohort study, the Silicone Arthroplasty in Rheumatoid Arthritis study. The authors focus on the challenges that arise during a surgical trial, including the design, implementation, and methods used to report the clinical evidence. By recognizing and addressing obstacles that exist in research, investigators will provide health care providers with high-quality evidence needed to make well-informed, evidence-based clinical decisions.


Asunto(s)
Artritis Reumatoide/cirugía , Artroplastia/efectos adversos , Prótesis Articulares/efectos adversos , Evaluación de Resultado en la Atención de Salud/normas , Proyectos de Investigación/normas , Artritis Reumatoide/epidemiología , Artroplastia/instrumentación , Artroplastia/normas , Sesgo , Toma de Decisiones Clínicas , Ensayos Clínicos como Asunto/normas , Medicina Basada en la Evidencia/normas , Estudios de Seguimiento , Humanos , Evaluación de Resultado en la Atención de Salud/métodos , Selección de Paciente , Estudios Prospectivos , Siliconas/efectos adversos
10.
Bone Joint J ; 102-B(2): 220-226, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32009425

RESUMEN

AIMS: Arthroplasty for end-stage hallux rigidus (HR) is controversial. Arthrodesis remains the gold standard for surgical treatment, although is not without its complications, with rates of up to 10% for nonunion, 14% for reoperation and 10% for metatarsalgia. The aim of this study was to analyze the outcome of a double-stemmed silastic implant (Wright-Medical, Memphis, Tennessee, USA) for patients with end-stage HR. METHODS: We conducted a retrospective review of 108 consecutive implants in 76 patients, between January 2005 and December 2016, with a minimum follow-up of two years. The mean age of the patients at the time of surgery was 61.6 years (42 to 84). There were 104 females and four males. Clinical, radiological, patient reported outcome measures (PROMS) data, a visual analogue score (VAS) for pain, and satisfaction scores were collected. RESULTS: The survivorship at a mean follow-up of 5.3 years (2.1 to 14.1) was 97.2%. The mean Manchester Oxford Foot and Ankle Questionnaire (MOXFQ) scores improved from 78.1 to 11.0, and VAS scores for pain from 7/10 to 1.3/10. The rate of satisfaction was 90.6%. Three implants (2.8%) required revision; one for infection, one-month postoperatively, and two for stem breakage at 10.4 and 13.3 years postoperatively. There was a 1.9% reoperation rate other than revision, 23.1% of patients developed a minor complication, and 21.1% of patients had non-progressive and asymptomatic cysts on radiological review. CONCLUSION: We report a 97.2% survivorship at a mean follow-up of 5.3 years with this implant. We did not find progressive osteolysis, as has been previously reported. These results suggest that this double-stemmed silastic implant provides a predictable and reliable alternative with comparable outcomes to arthrodesis for the treatment of end-stage HR. Cite this article: Bone Joint J 2020;102-B(2):220-226.


Asunto(s)
Artroplastia de Reemplazo/métodos , Hallux Rigidus/cirugía , Prótesis Articulares , Articulación Metatarsofalángica/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Materiales Biocompatibles , Dimetilpolisiloxanos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
11.
Comput Methods Biomech Biomed Engin ; 23(5): 182-190, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-31910663

RESUMEN

Glenoid perforation is not the intended consequence of the surgery and must be avoided. The analysis on biomechanical aspect of glenoid vault perforation remains unknown. The purpose of this study is to determine the impact of glenoid perforation towards stress distribution and micromotion at the interfaces. Eight glenoid implant models had been constructed with various size, number and type of fixation. A load of 750 N was applied to centre, superior-anterior and superior-posterior area. Implant perforation had minimal impact on stress distribution and micromotion at the interfaces. However, cement survival rate for implant without perforation was the highest with a difference of up to 37% compared to other perforated models. Besides that, implant fixation and high stresses at the implant had more of an impact on implant instability than implant perforation. As a conclusion, glenoid perforation did not influence the stress distribution and micromotion, but, it reduced cement survival rate and increase the stress critical volume.


Asunto(s)
Artroplastía de Reemplazo de Hombro , Simulación por Computador , Prótesis Articulares , Movimiento (Física) , Articulación del Hombro/cirugía , Perforación Espontánea/cirugía , Estrés Mecánico , Fenómenos Biomecánicos , Análisis de Elementos Finitos , Humanos , Probabilidad , Diseño de Prótesis
13.
Acta Orthop ; 91(2): 191-196, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-31928101

RESUMEN

Background and purpose - We have previously reported on the prosthetic survival of total ankle replacements (TAR) in Sweden performed between 1993 and 2010. Few other reports have been published on 5- and 10-year survival rates. Furthermore, there is a lack of long-term outcome data on modern prosthetic designs. Therefore, we compared early and current prosthetic designs after a mean 7-year follow-up.Patients and methods - On December 31, 2016, 1,230 primary TARs had been reported to the Swedish Ankle Registry. We analyzed prosthetic survival, using exchange or permanent extraction of components as endpoint for 1,226 protheses with mean follow-up of 7 years (0-24). Differences between current (Hintegra, Mobility, CCI, Rebalance, and TM Ankle) and early prosthetic designs (STAR, BP, and AES) were examined by log rank test.Results - 267/1,226 prostheses (22%) had been revised by December 31, 2016. We found an overall prosthetic survival rate at 5 years of 0.85 (95% CI 0.83-0.87), at 10 years 0.74 (CI 0.70-0.77), at 15 years 0.63 (CI 0.58-0.67), and at 20 years 0.58 (CI 0.52-0.65). For early prosthetic designs the 5- and 10-year survival rates were 0.81 (CI 0.78-0.84) and 0.69 (CI 0.64-0.73) respectively, while the corresponding rates for current designs were 0.88 (CI 0.85-0.91) and 0.84 (CI 0.79-0.88). Current prosthetic designs had better survival (log rank test p < 0.001).Interpretation - Our results point to a positive time trend of prosthetic survival in Sweden; use of current prosthetic designs was associated with better prosthetic survival. Improved designs and instrumentation, more experienced surgeons, and improved patient selection may all have contributed to the better outcome.


Asunto(s)
Artroplastia de Reemplazo de Tobillo/instrumentación , Prótesis Articulares , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Articulación del Tobillo/cirugía , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Diseño de Prótesis , Falla de Prótesis/etiología , Sistema de Registros , Reoperación/estadística & datos numéricos , Suecia , Resultado del Tratamiento , Adulto Joven
14.
Unfallchirurg ; 123(1): 29-35, 2020 Jan.
Artículo en Alemán | MEDLINE | ID: mdl-30953083

RESUMEN

BACKGROUND: The exact incidence of postoperative periprosthetic humeral fractures (PPHF) months or years after fracture-related implantation of a hemiprosthesis is unknown. The currently available literature is predominantly concerned with operative treatment approaches. As a rule, these involved older patients and severe fracture conditions so that severe complications and unsatisfactory healing results were described. This article presents an alternative conservative treatment approach which is discussed based on the results of treatment. PATIENTS AND METHODS: Between 2011 and 2016 a conservative treatment of 5 female patients with PPHF could be carried out. Of the patients 4 were clinically and radiologically controlled at a mean follow-up time of 23 months. The fifth patient died 2 months after the trauma and only partial information of the treatment was available. RESULT: There were no intrahospital complications and just one posthospital complication. In the case of the patient who later died, repeated and unauthorized removal of the upper arm brace occurred in the nursing institution resulting in a lesion of the radial nerve. Of the four patients who completed treatment, three were very satisfied with the outcome of treatment. The mean DASH (Disabilities of Arm, Shoulder and Hand) and Oxford shoulder scores were on average 74 and 25 points, respectively. At the time of the follow-up examination all patients were free of pain, without the use of analgesics; however, there were still some limitations in the activities of daily life, which in three of the four patients was similar to the results following implantation of the fracture prosthesis. CONCLUSION: The conservative treatment of PPHF can be a safe treatment option in multimorbid and chronically ill patients. A close outpatient control and good patient compliance are important. In incompliant and dementia patients, the risk of failure of conservative treatment is increased.


Asunto(s)
Tratamiento Conservador , Fracturas del Húmero , Prótesis Articulares , Fracturas Periprotésicas , Femenino , Estudios de Seguimiento , Humanos , Fracturas del Húmero/terapia , Húmero , Fracturas Periprotésicas/terapia , Resultado del Tratamiento
15.
Arch Orthop Trauma Surg ; 140(1): 51-58, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31515620

RESUMEN

INTRODUCTION: The purpose of this study is to analyze the mid-term outcomes of a modular monopolar type of radial head arthroplasty in the treatment of complex fractures associated with acute elbow joint instability. We postulated that radiographic changes are related to the development of clinical complications. MATERIALS AND METHODS: We evaluated at last follow-up 26 radial head arthroplasties in 26 consecutive patients who were followed for at least one and a half year. All patients had suffered radial head fractures (Mason III) in the context of unstable elbow injuries. Definitive treatment of the radial fracture was performed with modular and monopolar prosthesis which was inserted as a press fit. All patients were evaluated preoperatively and postoperatively. The evaluation included a clinical examination and a protocolized imaging study (standard X-Rays and CT) of the elbow. We analyzed the incidence of: heterotopic ossifications, secondary radiocapitellar joint osteoarthritis, hardware loosening, hardware disengagement, and joint infection. Diagnosis of clinical failure of the implant was defined as the time to the second surgery due to major complications related to the prosthesis, such as persistent lateral side pain or elbow stiffness and any kind of implant instability or dislocation. RESULTS: The implant-specific reoperation rate was 15% (four reoperations). The need for the second surgery was statistically associated with heterotopic ossifications, radiocapitellar osteoarthritis and cortical resorption around radial neck (p = 0.054, p = 0.033, and p = 0.019, respectively), being periprosthetic osteolysis the most likely factor related to failure, and radial pain the main symptom leading to surgical revision. CONCLUSIONS: Our study shows a positive association between radiographic findings and patient symptoms for postoperative complications after radial head arthroplasty. Failed radial head replacements may lead to reoperation mainly due to pain, and this can be distinguished from other causes of pain in elbow region based on its radial location. Radiological loosening was prevalent in this group of failed replacement.


Asunto(s)
Artroplastia , Fracturas del Radio , Radio (Anatomía) , Artroplastia/efectos adversos , Artroplastia/estadística & datos numéricos , Estudios de Seguimiento , Humanos , Prótesis Articulares , Radio (Anatomía)/diagnóstico por imagen , Radio (Anatomía)/fisiopatología , Radio (Anatomía)/cirugía , Fracturas del Radio/diagnóstico por imagen , Fracturas del Radio/epidemiología , Fracturas del Radio/fisiopatología , Fracturas del Radio/cirugía , Tomografía Computarizada por Rayos X , Insuficiencia del Tratamiento
16.
Orthopade ; 49(3): 267-272, 2020 Mar.
Artículo en Alemán | MEDLINE | ID: mdl-31811322

RESUMEN

The combination of glenoid destruction with cuff arthropathy remains a challenge. A 75-year old woman presented with a post-traumatic loss of the glenoid and concomitant cuff arthropathy. Using CT-data a custom-made glenoid component was created by 3D printing. 6 months after reverse shoulder arthroplasty, the patient was free of pain with acceptable ROM. An individual glenoid component created by 3D printing is a feasible therapeutic option in patients with loss of the glenoid and concomitant cuff arthropathy.


Asunto(s)
Artropatías , Prótesis Articulares , Impresión Tridimensional , Articulación del Hombro , Anciano , Artroplastia , Femenino , Humanos , Lesiones del Manguito de los Rotadores , Escápula
17.
Int J Oral Maxillofac Surg ; 49(3): 356-360, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31447220

RESUMEN

The purpose of this study was to examine the outcomes of patients who received revision temporomandibular joint (TMJ) arthroplasty for the treatment of acquired metal allergy. It was hypothesized that subjects would have significant improvements in pain, swelling, and function. Patients who underwent TMJ revision due to nickel allergy were identified retrospectively. Outcomes documented included the presence or absence of facial erythema and facial swelling. Maximum incisal opening was also measured. Additional outcomes collected included age at initial surgery, initial TMJ device type, presenting symptoms, and TMJ device used for surgical revision. Four patients were identified with a nickel allergy to their TMJ prosthesis (containing nickel). All subjects experienced pain and swelling as their primary symptoms prior to the revision, with two subjects showing dermatological symptoms of overlying erythema. The four female subjects underwent exchange of their previously implanted prosthesis with a titanium alloy prosthesis. Postoperatively, all subjects showed improvements in pain score, resolution of swelling and erythema, and improvements in maximum incisal opening. This small case series suggests that revision TMJ arthroplasty with a titanium alloy prosthesis is a potential treatment for acquired metal allergy from traditional TMJ prosthesis implantation.


Asunto(s)
Artroplastia de Reemplazo , Hipersensibilidad , Prótesis Articulares , Trastornos de la Articulación Temporomandibular , Femenino , Humanos , Rango del Movimiento Articular , Estudios Retrospectivos , Articulación Temporomandibular , Resultado del Tratamiento
18.
J Orthop Res ; 38(2): 405-416, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31498470

RESUMEN

Macrophage-mediated inflammatory reaction to implant wear particles drives bone loss around total joint replacements (TJR). Although most TJR recipients are elderly, studies linking wear particle-activated macrophages and peri-implant osteolysis have not taken into account the multiple effects that aging has on the innate immune system and, in particular, on macrophages. To address this, we compared the wear particle responses of bone marrow macrophages obtained from young (2-month) and aged (18-month) mice. Macrophages were polarized to M0, M1, or M2 phenotypes in vitro, challenged with titanium particles, and their inflammatory response was characterized at multiple time points by quantitative reverse-transcription polymerase chain reaction and enzyme-linked immunosorbent assay. In addition, age-dependent changes in activation of transcription factor nuclear factor-κB were analyzed by a lentiviral vector-based luciferase reporter system. The particle stimulation experiment was further repeated using human primary macrophages isolated from blood donors of different ages. We found that the pro-inflammatory responses were generally higher in macrophages obtained from young mice, but differences between the age groups remained small and of uncertain biological significance. Noteworthily, M2 polarization effectively suppressed the particle-induced inflammation in both young and aged macrophages. These results suggest that aging of the innate immune system per se plays no significant role in the response of macrophages to titanium particles, whereas induction of M2 polarization appears a promising strategy to limit macrophage-mediated inflammation regardless of age. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:405-416, 2020.


Asunto(s)
Envejecimiento/inmunología , Macrófagos/efectos de los fármacos , Titanio/toxicidad , Envejecimiento/metabolismo , Animales , Citocinas/metabolismo , Humanos , Prótesis Articulares/efectos adversos , Macrófagos/metabolismo , Masculino , Ratones Endogámicos C57BL , FN-kappa B/metabolismo , Óxido Nítrico Sintasa de Tipo II/metabolismo
19.
Int J Oral Maxillofac Surg ; 49(2): 224-229, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31272900

RESUMEN

This article describes the experience with the endoscopically assisted fixation of the customized total temporomandibular joint (TMJ) prosthesis in TMJ Yang's system only through a modified preauricular approach. Twenty patients (23 joints) treated with the custom-made total TMJ prosthesis were retrospectively recruited. An endoscopically assisted technique was used through a modified preauricular approach to fix the mandibular component for all these patients. These reconstructions were evaluated by surgical records, clinical examinations, and radiographic observations. All patients had successful fixation of the prosthesis. No patient had permanent weakness of the facial nerve and malocclusion or any other severe complications. The mean operative time was 111 min per joint (range, 85-133 min). The average surgical bleeding was 195 ml per side. The mean follow-up period was 16.2 months (range, 5-32 months). The mean scores were 8.3 for surgical satisfaction and 9.2 for scar healing evaluation. All patients experienced positive clinical outcomes, with a mean 75.2% reduction in pain and 53.7% increase in mouth opening with significant differences (P<0.05). The endoscopically assisted TMJ reconstruction with the customized prosthesis in TMJ Yang's system through the modified preauricular approach could produce good aesthetic and functional results.


Asunto(s)
Prótesis Articulares , Trastornos de la Articulación Temporomandibular , Estética Dental , Humanos , Rango del Movimiento Articular , Estudios Retrospectivos , Articulación Temporomandibular , Resultado del Tratamiento
20.
Expert Rev Med Devices ; 17(1): 41-56, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31810395

RESUMEN

Introduction: Total joint replacement is one of the most common, safe, and efficacious operations in all of surgery. However, one major long-standing and unresolved issue is the adverse biological reaction to byproducts of wear from the bearing surfaces and modular articulations. These inflammatory reactions are mediated by the innate and adaptive immune systems.Areas covered: We review the etiology and pathophysiology of implant debris-associated inflammation, the clinical presentation and detailed work-up of these cases, and the principles and outcomes of non-operative and operative management. Furthermore, we suggest future strategies for prevention and novel treatments of implant-related adverse biological reactions.Expert opinion: The generation of byproducts from joint replacements is inevitable, due to repetitive loading of the implants. A clear understanding of the relevant biological principles, clinical presentations, investigative measures and treatments for implant-associated inflammatory reactions and periprosthetic osteolysis will help identify and treat patients with this issue earlier and more effectively. Although progressive implant-associated osteolysis is currently a condition that is treated surgically, with further research, it is hoped that non-operative biological interventions could prolong the lifetime of joint replacements that are otherwise functional and still salvageable.


Asunto(s)
Inflamación/diagnóstico , Inflamación/etiología , Prótesis Articulares/efectos adversos , Falla de Prótesis , Quimiocinas/metabolismo , Diagnóstico Diferencial , Humanos , Inflamación/diagnóstico por imagen , Inflamación/fisiopatología , Resultado del Tratamiento
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