Vitamin E-diffused liners show less head penetration than cross-linked polyethylene liners in total hip arthroplasty: a ten-year multi-arm randomized trial.

Aims: The primary outcome was investigating differences in wear, as measured by femoral head penetration, between cross-linked vitamin E-diffused polyethylene (vE-PE) and cross-linked polyethylene (XLPE) acetabular component liners and between 32 and 36 mm head sizes at the ten-year follow-up. Secondary outcomes included acetabular component migration and patient-reported outcome measures (PROMs) such as the EuroQol five-dimension questionnaire, 36-Item Short-Form Health Survey, Harris Hip Score, and University of California, Los Angeles Activity Scale (UCLA). Methods: A single-blinded, multi-arm, 2 × 2 factorial randomized controlled trial was undertaken. Patients were recruited between May 2009 and April 2011. Radiostereometric analyses (RSAs) were performed from baseline to ten years. Of the 220 eligible patients, 116 underwent randomization, and 82 remained at the ten-year follow-up. Eligible patients were randomized into one of four interventions: vE-PE acetabular liner with either 32 or 36 mm femoral head, and XLPE acetabular liner with either 32 or 36 mm femoral head. Parameters were otherwise identical except for acetabular liner material and femoral head size. Results: A total of 116 patients participated, of whom 77 were male. The median ages of the vE-PE 32 mm and 36 mm groups were 65 (interquartile range (IQR) 57 to 67) and 63 years (IQR 56 to 66), respectively, and of the XLPE 32 mm and 36 mm groups were 64 (IQR 58 to 66) and 61 years (IQR 54 to 66), respectively. Mean total head penetration was significantly lower into vE-PE acetabular liner groups than into XLPE acetabular liner groups (-0.219 mm (95% confidence interval -0.348 to -0.090); p = 0.001). There were no differences in wear according to head size, acetabular component migration, or PROMs, except for UCLA. There were no cases of aseptic loosening or failures requiring revision at long-term follow-up. Conclusion: Significantly lower wear was observed in vE-PE acetabular liners than in XLPE acetabular liners. No difference in wear was observed between different head size or PROMs except for the UCLA at ten years.

[Alkaptonuria detected during knee arthroplasty treatment].

Alkaptonuria (AKU) is a rare autosomal-recessive disease in the tyrosine metabolism pathway. AKU is due to a mutation of a gene coding for homogentisate dioxygenase, causing accumulation of homogentisic acid leading to a painful multisystemic disease. Damage to cartilage tissue is especially significant, and weight-bearing joints often require arthroplasty. Nitisinone, a drug already used in treatment of hereditary tyrosinaemia, could be approved for treatment of AKU. This case report describes the occurrence of AKU discovered in two brothers in connection with hip and knee arthroplasty.

Vitamin E-doped total hip arthroplasty liners show similar head penetration to highly cross-linked polyethylene at five years: a multi-arm randomized controlled trial.

AIMS: The most frequent indication for revision surgery in total hip arthroplasty (THA) is aseptic loosening. Aseptic loosening is associated with polyethylene liner wear, and wear may be reduced by using vitamin E-doped liners. The primary objective of this study was to compare proximal femoral head penetration into the liner between a) two cross-linked polyethylene (XLPE) liners (vitamin E-doped (vE-PE)) versus standard XLPE liners, and b) two modular femoral head diameters (32 mm and 36 mm). METHODS: Patients scheduled for a THA were randomized to receive a vE-PE or XLPE liner with a 32 mm or 36 mm metal head (four intervention groups in a 2 × 2 factorial design). Head penetration and acetabular component migration were measured using radiostereometric analysis at baseline, three, 12, 24, and 60 months postoperatively. The Harris Hip Score, University of California, Los Angeles (UCLA) Activity Score, EuroQol five-dimension questionnaire (EQ-5D), and 36-Item Short-Form Health Survey questionnaire (SF-36) were assessed at baseline, three, 12, 36, and 60 months. RESULTS: Of 220 screened patients, 127 were included in this study. In all, 116 received the allocated intervention, and 94 had their results analyzed at five years. Head penetration was similar between liner materials and head sizes at five years, vE-PE versus XLPE was -0.084 mm (95% confidence interval (CI) -0.173 to 0.005; p = 0.064), and 32 mm versus 36 mm was -0.020 mm (95% CI -0.110 to 0.071; p = 0.671), respectively. No differences were found in acetabular component migration or in the patient-reported outcome measures. CONCLUSION: No significant difference in head penetration was found at five years between vE-PE and XLPE liners, nor between 32 mm and 36 mm heads. Cite this article: Bone Joint J 2020;102-B(10):1303-1310.

Design and analysis of UW-OFDM signals.

Unique word-orthogonal frequency division multiplexing (UW-OFDM) is a novel signaling concept where the guard interval is implemented as a deterministic sequence, the so-called unique word. The UW is generated by introducing a certain level of redundancy in the frequency domain. Different data estimation strategies and the favourable bit error ratio (BER) performance of UW-OFDM, as well as comparisons to competing concepts have already extensively been discussed in previous papers. This work focuses on the different possibilities on how to generate UW-OFDM signals. The optimality of the two-step over the direct approach in systematic UW-OFDM is proved analytically, we present a heuristic algorithm that allows a fast numerical optimization of the redundant subcarrier positions, and we show that our original intuitive approach of spreading the redundant subcarriers in systematically encoded UW-OFDM by minimizing the mean redundant energy is practically also optimum w.r.t. transceiver based cost functions. Finally, we derive closed form approximations of the statistical symbol distributions on individual subcarriers as well as the redundant energy distribution and compare them with numerically found results.

Revision total hip arthroplasty using a modular tapered stem with distal fixation: good short-term results in 125 revisions.

After 2 to 7 years we reviewed 125 prosthetic hip arthroplasty stem revisions using a modular tapered stem with distal fixation. Median age of these patients was 68 (33-92) years. Baseline and follow-up data were registered prospectively according to the Danish Hip Arthroplasty Registry. Survival, free of any rerevision, was 94%. Harris Hip Score improved from average 44 to 85. Bony regeneration was an early and significant finding in most cases. Complications included 4 (3%) fractures intraoperatively and 8 (6%) dislocations, 4 (3%) deep infections, and 1 (1%) stem fracture. This modular taper system is very versatile, can be used in most femoral revision cases, and allows rapid bone remodeling. We did not find an increased number of complications compared to the literature. Further long-term follow-up, however, is essential.

SH2 binding site comparison: a new application of the SURFCOMP method.

To avoid side effects, it is often desirable to increase the specificity of a drug candidate when targeting one member of a family of related proteins, whereby one exploits small differences between the structures of the binding sites. Identification of such differences can be carried out by analyzing the distributions of physicochemical properties mapped onto molecular surfaces. Here we demonstrate that SURFCOMP, our local surface similarity detection method, is able to detect differences between the binding sites of two closely related proteins. We analyzed the SH2 domains of Sap and Eat-2, two highly similar signal transduction molecules involved in inflammatory processes and found differences between their binding sites that can possibly lead to a better understanding of the different specificities of the two proteins.

SURFCOMP: a novel graph-based approach to molecular surface comparison.

Analysis of the distributions of physicochemical properties mapped onto molecular surfaces can highlight important similarities or differences between compound classes, contributing to rational drug design efforts. Here we present an approach that uses maximal common subgraph comparison and harmonic shape image matching to detect locally similar regions between two molecular surfaces augmented with properties such as the electrostatic potential or lipophilicity. The complexity of the problem is reduced by a set of filters that implement various geometric and physicochemical heuristics. The approach was tested on dihydrofolate reductase and thermolysin inhibitors and was shown to recover the correct alignments of the compounds bound in the active sites.