Mapping existing hip and knee replacement registries in Europe.

The general shortage of evidence regarding benefits and harms of medical devices has been highlighted following the serious safety concerns with metal-on-metal hip replacements and silicone breast implants and was again pointed out in a recent survey of European Health Technology Assessment institutions. In this context the new European medical device regulation will enforce post-marketing surveillance of existing and new implants. The usefulness of registry data as a source of information for medical device real-world clinical performance and safety has been demonstrated. However, these data might be under-used by researchers and policy makers. One reason for this is the insufficient awareness of their existence. The aim of this review is to provide information to relevant stakeholders on the extent and breadth of the data currently collected in European joint replacement registries. We identified 24 registries, most of them of national coverage. Total numbers of primary total hip and knee replacements included were over 3.1 and 2.5 million records, respectively. The current focus of these registries is on whole-lifespan implant surveillance via revision rate monitoring, quality assessment of surgical and perioperative care, and hospital performance assessment. More recently, national and international comparison and benchmarking have increasingly become part of their endeavors.

Influence of patient activity on femoral osteolysis at five and ten years following hybrid total hip replacement.

We conducted a longitudinal study including patients with the same type of primary hybrid total hip replacement and evaluated patient activity and femoral osteolysis at either five or ten years post-operatively. Activity was measured using the University of California, Los Angeles scale. The primary outcome was the radiological assessment of femoral osteolysis. Secondary outcomes were revision of the femoral component for aseptic loosening and the patients' quality of life. Of 503 hip replacements in 433 patients with a mean age of 67.7 years (30 to 91), 241 (48%) were seen at five and 262 (52%) at ten years post-operatively. Osteolytic lesions were identified in nine of 166 total hip replacements (5.4%) in patients with low activity, 21 of 279 (7.5%) with moderate activity, and 14 of 58 (24.1%) patients with high activity. The risk of osteolysis increased with participation in a greater number of sporting activities. In multivariate logistic regression adjusting for age, gender, body mass index and the inclination angle of the acetabular component, the adjusted odds ratio for osteolysis comparing high vs moderate activity was 3.6 (95% confidence interval 1.6 to 8.3). Stratification for the cementing technique revealed that lower quality cementing increased the effect of high activity on osteolysis. Revision for aseptic loosening was most frequent with high activity. Patients with the highest activity had the best outcome and highest satisfaction. In conclusion, of patients engaged in high activity, 24% had developed femoral osteolysis five to ten years post-operatively.

Cuidados de enfermería en la atención intraoperatoria de la prostatectomía radical / No disponible

La próstata es un órgano interno que se encuentra en la pelvis, situado delante del recto e inmediatamente por debajo de la vejiga dela orina. Envuelve y rodea la primera porción de la uretra (uretra prostática) como una especie de”flotador» en el punto donde seconecta a la vejiga. Estas características anatómicas hacen fácilmente entendible que todos aquellos cambios y procesos patológicos, tantobenignos como malignos, que se produzcan en esta glándula van a provocar alteraciones, más o menos notables, en la forma de evacuarla orina. Los conductos deferentes son unos tubos finos que van desde cada uno de los testículos hasta la uretra prostática, encargándosedel transporte de los espermatozoides. Las vesículas seminales son unas estructuras con forma de saco que están por encimade la próstata y detrás de la vejiga.Vacían sus secreciones (líquido seminal y espermatozoides) en la uretra prostática mediante un conductocomún, llamado conducto eyaculador que atraviesa la próstata. De aquí saldrán al exterior junto con la secreción de la próstata,constituyendo el semen (1).Aunque el tamaño de la próstata varia con la edad, se aceptan como normales unas dimensiones de 4 cm.de largo por 3 cm. De ancho. Clásicamente se ha dicho que tiene forma de castaña. Si aumenta su tamaño, habitualmente a partir dela edad adulta, desarrolla ciertas patologías benignas que influirán en mayor o menor grado en el proceso de excreción de orina. O sipor el contrario existiera una proliferación anormal de células malignas nos encontramos ante una neoplasia de próstata. La prostatectomíaradical es el método de opción para el tratamiento de dicha enfermedad en su etapa localizada en hombres jóvenes que gocende buena salud (2, 3, 4). Consiste en la extirpación completa de la próstata junto a las vesículas seminales (..) (AU)

The prostate is an internal organ that is in the pelvis, situated in front of the rectum and immediately below the bladder of the urine. Itwraps and surrounds the first portion of the urethra (prostatic urethra) as a sort of "rubber ring" in the point where it is connected tothe bladder.These anatomical characteristics do easily understood that all those changes and pathological processes, benign as well asmalignant, that they are produced in this gland provoke alterations, more or less remarkable, in the way of evacuating the urine.The deferent ducts are some fine tubes that go from each of the testicles up to the prostatic urethra, being in charge of the transportof the spermatozoids.The seminal vesicles are some structures with form of bag that are above the prostate and behind the bladder.They empty their secretions (seminal liquid and spermatozoids) in the prostatic urethra through a common conduct called ejaculatoryduct that goes through the prostate. From that point, they will go out to the exterior together with the secretion of the prostate, constitutingthe semen (1).Although the size of prostate changes depending on age, some dimensions of 4 cm long per 3cm wide are acceptedas normal. In a classic way it has been said that it has form of chestnut. If it increases its size, usually from the adult age, develops certainbenign pathologies that will influence in greater or smaller degree in the process of excretion of urine. Or, if, on the contrary, therewere an abnormal proliferation of malignant cells we find a neoplasia of prostate.The radical prostatectomy is the optional method forthe treatment of this illness in its located stage in young men that have good health (2, 3, 4). It consists of the complete extirpation ofthe prostate besides the seminal (..) (AU)

Anatomy of the anterior cruciate ligament.

The anterior cruciate ligament (ACL) is a band of dense connective tissue which courses from the femur to the tibia. The ACL is a key structure in the knee joint, as it resists anterior tibial translation and rotational loads. When the knee is extended, the ACL has a mean length of 32 mm and a width of 7-12 mm. There are two components of the ACL, the anteromedial bundle (AMB) and the posterolateral bundle (PLB). They are not isometric with the main change being lengthening of the AMB and shortening of the PLB during flexion. The ACL has a microstructure of collagen bundles of multiple types (mostly type I) and a matrix made of a network of proteins, glycoproteins, elastic systems, and glycosaminoglycans with multiple functional interactions. The complex ultrastructural organization and abundant elastic system of the ACL allow it to withstand multiaxial stresses and varying tensile strains. The ACL is innervated by posterior articular branches of the tibial nerve and is vascularized by branches of the middle genicular artery.

Anatomic variation of the mechanical properties of the glenoid.

Finite element analysis modeling is an important tool in the design of total joint replacements. However, to use a finite element analysis the material properties of the studied bone must be known. The aim of the study was to measure the elastic properties of the glenoid bone in the axial, coronal, and sagittal planes with an ultrasound transmission technique. The relative density and Houndsfield computed tomography numbers were also assessed. Three pairs of scapulas were obtained from unembalmed human cadavers. Seventy-four cubic cancellous bone specimens of 6 mm were used for ultrasonic measurements. The study showed significant differences with anatomic location. Mechanical properties of cancellous bone were found to be higher near the direction of application of the resultant force, perpendicular to the articular surface of the glenoid. Mechanical properties were found to be significantly higher at the center and posterior edge of the glenoid (p < 0.01). Significant differences were also found in the three planes studied. The lateromedial Young's modulus (E1) was higher than the anteroposterior modulus (E2) and the superoinferior modulus (E3) (E1 = 372 +/- 164 MPa, E2 = 222 +/- 79 MPa, E3 = 198 +/- 75 MPa).