Femoral antetorsion after calcar-guided short-stem total hip arthroplasty: A cadaver study.

Calcar-guided short stems in total hip arthroplasty (THA) permit surgeons to successfully reconstruct postoperative femoroacetabular offset, accurately restore leg length, and adequately re-establish a wide range of caput-collum-diaphyseal angles. However, their effect on femoral antetorsion is less known. Indeed, controlling antetorsion of the femoral stem can be challenging because of the differences in individual femoral geometry and curvature. Therefore, we investigated if calcar-guided short-stem THA alters femoral antetorsion and compared it with conventional-stem THA. Using 12 Thiel-fixed, full-body cadaver specimens from donors without known hip disorders, we compared an uncemented calcar-guided femoral short-stem prosthesis with an uncemented conventional straight-stem prosthesis. In a paired study setup, each specimen received a calcar-guided short stem on one side and a conventional stem on the other. On the acetabular side, all specimens received a press-fit, monobloc acetabular cup. Femoral antetorsion angles were measured using the Waidelich method, and pre- and post-operative angles of both sides were recorded. The mean preoperative femoral antetorsion angles were similar in both groups (24.8° ± 7.5° vs. 23.8° ± 6.1°, p = 0.313). Mean postoperative femoral antetorsion angles were 23.0° ± 5.5° in short-stem and 13.5° ± 7.1° in conventional-stem hips. Short-stem hips had a small but nonsignificant difference in femoral antetorsion angles pre- and post-operatively (1.8° ± 3.2°, p = 0.109), while the difference for conventional-stem hips was much larger and highly significant (10.3° ± 5.8°, p < 0.001). Calcar-guided short-stem THA effectively restores femoral antetorsion. However, how this affects long-term clinical outcomes and complications warrants further exploration.

Climate change in metacommunities: dispersal gives double-sided effects on persistence.

Climate change is increasingly affecting the structure and dynamics of ecological communities both at local and at regional scales, and this can be expected to have important consequences for their robustness and long-term persistence. The aim of the present work is to analyse how the spatial structure of the landscape and dispersal patterns of species (dispersal rate and average dispersal distance) affects metacommunity response to two disturbances: (i) increased mortality during dispersal and (ii) local species extinction. We analyse the disturbances both in isolation and in combination. Using a spatially and dynamically explicit metacommunity model, we find that the effect of dispersal on metacommunity persistence is two-sided: on the one hand, high dispersal significantly reduces the risk of bottom-up extinction cascades following the local removal of a species; on the other hand, when dispersal imposes a risk to the dispersing individuals, high dispersal increases extinction risks, especially when dispersal is global. Large-bodied species with long generation times at the highest trophic level are particularly vulnerable to extinction when dispersal involves a risk. This suggests that decreasing the mortality risk of dispersing individuals by improving the quality of the habitat matrix may greatly increase the robustness of metacommunities.

Species-rich ecosystems are vulnerable to cascading extinctions in an increasingly variable world.

Global warming leads to increased intensity and frequency of weather extremes. Such increased environmental variability might in turn result in increased variation in the demographic rates of interacting species with potentially important consequences for the dynamics of food webs. Using a theoretical approach, we here explore the response of food webs to a highly variable environment. We investigate how species richness and correlation in the responses of species to environmental fluctuations affect the risk of extinction cascades. We find that the risk of extinction cascades increases with increasing species richness, especially when correlation among species is low. Initial extinctions of primary producer species unleash bottom-up extinction cascades, especially in webs with specialist consumers. In this sense, species-rich ecosystems are less robust to increasing levels of environmental variability than species-poor ones. Our study thus suggests that highly species-rich ecosystems such as coral reefs and tropical rainforests might be particularly vulnerable to increased climate variability.

Patient-related risk factors leading to aseptic stem loosening in total hip arthroplasty: a case-control study of 5,035 patients.

BACKGROUND: We hypothesized that certain patient characteristics have different effects on the risk of early stem loosening in total hip arthroplasty (THA). We therefore conducted a case-control study using register-database records with the aim of identifying patient-specific risk factors associated with radiographic signs of aseptic loosening of the femoral component in THA. METHOD: Data were derived from a multinational European registry and were collected over a period of 25 years. 725 cases with radiographic signs of stem loosening were identified and matched to 4,310 controls without any signs of loosening. Matching criteria were type of implant, size of head, date of operation, center of primary intervention, and follow-up time. The risk factors analyzed were age at operation, sex, diagnosis and previous ipsilateral operations, height, weight, body mass index and mobility based on the Charnley classification. RESULTS: Women showed significantly lower risk of radiographic loosening than men (odds ratio (OR) 0.64). Age was also a strong factor: risk decreased by 1.8% for each additional year of age at the time of surgery. Height and weight were not associated with risk of loosening. A higher body mass index, however, increased the risk of stem loosening to a significant extent (OR 1.03) per additional unit of BMI. Charnley Class B, indicating restricted mobility, was associated with lower risk of loosening (OR 0.78). INTERPRETATION: An increased activity level, as seen in younger patients and those with unrestricted mobility, is an important factor in the etiology of stem loosening. If combined with high BMI, the risk of stem loosening within 10 years is even higher. A younger person should not be denied the benefits of a total hip arthroplasty but must accept that the risk of future failure is increased.