Functional outcome of infected endoprosthesis: A 20-year retrospective analysis.

PURPOSE: Bone tumours are increasingly treated with limb-salvage surgeries. However, implant infection is a devastating complication, greatly affecting the functional outcome. Yet, data on functional outcome post-implant infection are scarce. This study aims to determine the functional outcome and implant survival of these patients. METHODS: Patients' data on endoprosthetic replacement surgeries at our institution (January 1996-December 2016) was retrospectively reviewed. Information was available for 161 patients and was analysed using SPSS and SMART Partial Least Squares. Functional outcome was determined using the Musculoskeletal Tumor Society (MSTS) and Toronto Extremity Salvage Score (TESS) scoring system. RESULTS: Both mean rank MSTS (33.14 vs 87.02) and TESS (48.17 vs 85.13) scores were significantly lower in the infected group. These differences remained statistically significant after excluding amputation and rotationplasty cases within the infected group. Even after the resolution of infection, both MSTS and TESS remained significantly higher in the non-infected group. However, analysis of the infected group showed no significant differences in functional outcome between persistent and resolved infections (implant in-situ). Age significantly impacted the functional outcome for both the non-infected and infected groups, while local recurrence and metastasis significantly impacted the non-infected cases. Local tumour recurrence was lower in infected endoprosthetic patients (8.3% vs 10.5%). 56% of infected implants were removed; the majority were treated with two-stage revision surgery. CONCLUSION: Endoprosthesis infection worsens the overall functional outcome. Additional factors affecting functional outcome were age, presence of local recurrence and metastatic disease. Local tumour recurrence was lower amongst infected endoprosthesis cases, and >50% of infected implants were removed.

Experimental and simulation study of the high-pressure behavior of squalane and poly-α-olefins.

The equation of state, dynamical properties, and molecular-scale structure of squalane and mixtures of poly-α-olefins at room temperature are studied with a combination of state-of-the-art, high-pressure experiments and molecular-dynamics simulations. Diamond-anvil cell experiments indicate that both materials are non-hydrostatic media at pressures above ∼1 GPa. The equation of state does not exhibit any sign of a first-order phase transition. High-pressure x-ray diffraction experiments on squalane show that there are no Bragg peaks, and hence, the apparent solidification occurs without crystallization. These observations are complemented by a survey of the equation of state and dynamical properties using simulations. The results show that molecular diffusion is essentially arrested above about 1 GPa, which supports the hypothesis that the samples are kinetically trapped in metastable amorphous-solid states. The shear viscosity becomes extremely large at very high pressures, and the coefficient governing its increase from ambient pressure is in good agreement with the available literature data. Finally, simulated radial distribution functions are used to explore the evolution of the molecular-scale structure with increasing pressure. Subtle changes in the short-range real-space correlations are related to a collapse of the molecular conformations with increasing pressure, while the evolution of the static structure factor shows excellent correlation with the available x-ray diffraction data. These results are of indirect relevance to oil-based lubricants, as the pressures involved are comparable to those found in engines, and hence, the ability of lubricating thin films to act as load-bearing media can be linked to the solidification phenomena studied in this work.