Double-Crown Prosthesis Retention Using Polyetherketoneketone (PEKK): An In Vitro Study.

PURPOSE: To assess the retentive force of telescopic crowns using polyetherketoneketone (PEKK) high-performance polymer in relation to conventional materials over a long period of time in an in vitro setting. MATERIALS AND METHODS: Thirty-six sets of primary and secondary crowns were fabricated as per the double crown-retained prostheses approach. Six samples were included in each of the five test groups (1: zirconia/PEKK [Zr/PEKK]; 2: titanium/PEKK [Ti/PEKK]; 3: cobalt-chrome/PEKK [CoCr/PEKK]; 4: PEKK/PEKK; and 5: gold/PEKK [Au/PEKK]) and the single control group (gold/galvano-gold [Au/GA]). The insertion-removal test was performed for 20,000 cycles, and the surface condition was observed. Retentive forces were analyzed using two-way ANOVA (α<0.05). RESULTS: The retention forces in groups Zr/PEKK and Ti/PEKK significantly decreased over time (group 1: p = 0.035 and group 2: p = 0.001), whereas retentive force increased significantly in groups PEKK/PEKK, Au/PEKK, and control (group 4: p = 0.001, group 5: p = 0.008, and control: p = 0.042). Similar wear was observed on the primary crown in groups PEKK/PEKK, gold/PEKK, and control. CONCLUSIONS: Groups PEKK/PEKK and Au/PEKK showed a transition of retentive force similar to the control group. Groups PEKK/PEKK and Au/PEKK had similar wear on the surface compared to control. Therefore, PEKK has a promising clinical potential.

Técnica endocrown como alternativa restauradora para dentes tratados endodonticamente: relato de caso clínico / Endocrown technique as a restorative alternative for endodontically treated teeth: a case report

Este trabalho teve como objetivo apresentar um relato de caso clínico de uma restauração do tipo coroa endocrown cerâmica em um dente molar tratado endodonticamente. Paciente com 45 anos de idade, sexo feminino, procurou a clínica do Centro Universitário da Serra Gaúcha (FSG) relatando a necessidade de reabilitação protética no primeiro molar inferior do lado esquerdo. Com base no exame radiográfico e exame clínico foi constatado um primeiro molar inferior do lado esquerdo com tratamento endodôntico satisfatório, mas uma extensa destruição coronária. Após a aprovação da paciente e indicações para a utilização da técnica, optou-se pela confecção de uma coroa endocrown em cerâmica reforçada por dissilicato de lítio. Foi realizado o preparo do remanescente dentário, envolvendo a câmara pulpar, com ângulos arredondados e expulsivos e, após a moldagem do mesmo com silicone de adição, utilizando a técnica simultânea e duplo fio. O provisório foi realizado com resina quimicamente ativada na cor 62 e, na sessão seguinte a coroa endocrown foi ajustada e polida. Após receber o protocolo de condicionamento adequado da peça, a mesma foi cimentada com cimento autopolimerizável Multilink N. Pode-se concluir que a alternativa restauradora Endocrown é um tratamento conservador e favorável para dentes com extensa destruição coronária, permitindo adequada estética e função(AU)

This study aimed to present a clinical case report of an endocrown ceramic crown restoration in na endodontically treated molar tooth. A 45-year-old female patient sought the clinic at the Centro Universitário da Serra Gaúcha (FSG), reporting the need for prosthetic rehabilitation on the lower left first molar. Based on the radiographic and clinical examination, the first molar presented satisfactory endodontic treatment, but extensive coronary destruction. After the approval of the patient and indications for the use of the technique, it was decided to make an endocrown with reinforced ceramic by lithium disilicate. The remaining tooth was prepared, involving the pulp chamber, with rounded and expulsive angles and, after the impression with silicone using the simultaneous and double wire technique was taken. The provisional was made with chemically activated resin in color 62 and, in the following session, the endocrown crown was adjusted and polished. After receiving the proper conditioning protocol, it was lutted with Multilink N self-curing cement. It can be concluded that the Endocrown restorative alternative is a conservative and favorable treatment for teeth with extensive coronary destruction, allowing adequate aesthetics and function(AU)

Biconvex Patellar Components: 96% Durability at 10 Years in 262 Revision Total Knee Arthroplasties.

BACKGROUND: The optimal strategy to address osseous deficiencies of the patella during revision total knee arthroplasty (TKA) remains controversial. One possible solution is a cemented biconvex patellar component used such that the non-articular convexity both improves fixation and makes up for bone loss. The aim of this study was to determine the outcomes of the use of biconvex patellar components in a large series of revision TKAs. METHODS: From 1996 to 2014, 262 revision TKAs were performed at a single institution using a biconvex patellar component. Implant survivorship, clinical and radiographic results, and complications were assessed. The mean patient age at the TKA revision was 69 years, and 53% of the patients were female. The mean follow-up was 7 years. RESULTS: The 10-year survivorship free of revision of the biconvex patellar component due to aseptic loosening was 96%. The 10-year survivorship free of any revision of the biconvex patellar component was 87%. The 10-year survivorship free of any rerevision and free of any reoperation was 75% and 70%, respectively. The mean Knee Society Score (KSS) improved from 45.4 before the index revision to 67.7 after it. The mean residual composite thickness seen on the most recent radiographs was 18.1 mm. In addition to the complications leading to revision, the most common complications were periprosthetic patellar fracture (6%), of which 3 required revision; superficial wound infection (6%) requiring antibiotic therapy only or irrigation and debridement; and arthrofibrosis (3%). CONCLUSIONS: In this cohort of 262 revision TKAs, biconvex patellar components used to treat marked patellar bone loss demonstrated excellent durability with a 10-year survivorship free of patellar rerevision due to aseptic loosening of 96%. The biconvex patellar components were reliable as evidenced by substantial improvements in clinical outcomes scores and a low risk of complications. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Validez de las escalas KLIC y CRIME80 en la predicción del fracaso en la infección aguda tardía tratada mediante desbridamiento y retención de implantes / Validity of the KLIC and CRIME80 scores in predicting failure in late acute infection treated by debridement and implant retention

En las infecciones protésicas es muy importante realizar un tratamiento correcto con el que podamos asegurar una mayor tasa de éxito. Si bien es cierto que el desbridamiento con retención de implante (DAIR) es una cirugía muy utilizada en infecciones agudas y agudas tardías, se sabe que los pacientes que no logran el éxito en este tipo de cirugías presentan mayor riesgo de fracaso en cirugías posteriores. Es por ello que es importante encontrar una escala que nos permita predecir el riesgo de fracaso de DAIR. Así nacieron la escala KLIC y CRIME80 para infecciones agudas e infecciones agudas tardías, respectivamente. Con este estudio hemos analizado la validez de ambas escalas en infecciones periprotésicas de rodilla agudas tardías y se ha observado que el KLIC no tiene valor predictivo para este tipo de infecciones, pero sí la escala CRIME80

It is very important to treat prosthetic infections correctly in order to ensure a higher success rate. Debridement with implant retention (DAIR) is widely used in acute and late infections, however patients who fail after this surgery are known to have a higher risk of failure in subsequent surgeries. Therefore, it is important to find a scale that enables us to predict the risk of DAIR failure. Hence the KLIC and CRIME80 scores for acute and late acute infections, respectively. This study analysed the validity of both scores in acute late periprosthetic knee infections. We observed that the KLIC score has no predictive value for this type of infection, but the CRIME80 score does

Femoral Periprosthetic Fracture Nonunion Management and Outcomes with Nonunion Repair and Retention of Primary Components.

INTRODUCTION: Nonunion of a femoral periprosthetic fracture is a rare occurrence in orthopedic practice. Failure of a periprosthetic fracture to heal can lead to substantial disability and pain for patients as well as the potential need for component revision. Relatively little literature exists describing their management and outcome. METHODS: Eleven patients with femoral periprosthetic fracture nonunion who presented for tertiary care were enrolled in a prospective data registry. Patients were considered to have developed nonunion following failure of progression in radiographic and clinical healing for a 6-month period. All patients were seen at standard postoperative intervals, and outcomes were recorded using the Short Musculoskeletal Function Assessment (SMFA), visual analog scale (VAS) for pain, physical examination, and radiographic examination. Preoperative radiographs were reviewed for classification. RESULTS: Eleven patients had periprosthetic femoral fracture nonunion associated with prior hip (five patients) or knee (six patients) arthroplasty and were included in our study. Mean follow-up time was 30 months. Mean age at time of nonunion surgery was 64.5 years (range: 41.8 to 78.2 years). All patients underwent removal of previous fracture hardware at time of nonunion surgery. Ten (91%) of 11 received autogenous iliac crest bone grafting at time of nonunion surgery. Ten (91%) of the 11 patients went on to union without further intervention. Mean time to union was 7.9 months (SD: 8.0). The one patient that developed a persistent nonunion was complicated by infection requiring multiple irrigation and debridement procedures and total hip explant. The mean improvement in total SMFA score from baseline to final follow-up was 22.6 (p = 0.030). The greatest functional improvement was in the bothersome index at 28.0 (p = 0.028). The mean improvement in VAS pain score from baseline to final follow-up was 4.5 (p = 0.013). DISCUSSION: Periprosthetic fracture nonunions can be successfully treated with operative intervention aimed at compression plating with bone graft and retention of primary components. In addition, successful periprosthetic nonunion repair improves function and pain in these patients.

Biomechanics of Implant Fixation in Osteoporotic Bone.

PURPOSE OF REVIEW: The purpose of this review is to critically evaluate the current literature regarding implant fixation in osteoporotic bone. RECENT FINDINGS: Clinical studies have not only demonstrated the growing prevalence of osteoporosis in patients undergoing total joint replacement (TJR) but may also indicate a significant gap in screening and treatment of this comorbidity. Osteoporosis negatively impacts bone in multiple ways beyond the mere loss of bone mass, including compromising skeletal regenerative capacity, architectural deterioration, and bone matrix quality, all of which could diminish implant fixation. Recent findings both in preclinical animal models and in clinical studies indicate encouraging results for the use of osteoporosis drugs to promote implant fixation. Implant fixation in osteoporotic bone presents an increasing clinical challenge that may be benefitted by increased screening and usage of osteoporosis drugs.

[Periprosthetic joint infections : Latest developments, strategies and treatment algorithms]. / Periprothetische Früh- und Spätinfektionen : Neuste Entwicklungen, Strategien und Behandlungsalgorithmen.

BACKGROUND: Due to their multidimensional consequences, periprosthetic joint infections are a serious complication in arthroplasty. There are disagreements in the literature regarding their classification. At the same time, a consequence for the practical procedure cannot always be derived. THERAPEUTIC PROCEDURES: In addition to debridement with antibiotics and implant retention, there are options for a one or two-stage change in the therapeutic procedure. Although the preservation of implants is only possible in the case of acute infections with a short duration of symptoms, prosthesis changes are indicated with a longer symptom duration. For both procedures, there are interinstitutional deviating indication criteria, weighing pros and cons. Both have specific problems, such as, in particular, the duration of the antibiotics course, the question of anchoring the prosthesis and, in the case of a two-stage procedure, the shape of the spacer.

Screw fixation in stemless shoulder arthroplasty for the treatment of primary osteoarthritis leads to less osteolysis when compared to impaction fixation.

BACKGROUND: Stemless total shoulder arthroplasty is a well-established and reliable surgical treatment option for glenohumeral osteoarthritis resulting in loss of pain and improvement of shoulder function. Currently the two methods for the fixation of the humeral component are either screw fixation or impaction. The purpose of this study is the clinical and radiological comparison of two different stemless designs (screw fixation vs impaction) for total shoulder arthroplasties in patients suffering from primary glenohumeral osteoarthritis. METHODS: A retrospective cohort study including 39 patients with a mean age of 67 years and a minimum follow-up of 2 years was performed. Patients were separated into two groups based on the selected implant. In group A (n = 18) a screw fixation design and in group B (n = 21) an impaction type design was used. For clinical examination the Constant-Murley-Score (CS) and Subjective-Shoulder-Value (SSV) were evaluated. Radiological examination was performed on true-AP, axial and Y-view radiographs. RESULTS: In group A the CS increased from 27.1 to 65.2 points and SSV from 27.3 to 76.7% (p > 0.05). No osteolysis of the medial calcar or subsidence of the humeral implant were found in this group. In group B the CS increased from 29.0 to 72.6 points and SSV from 33.1 to 85% (p < 0.05). Osteolysis of the medial calcar was present in seven patients in this group. No signs for humeral loosening were found in both groups. CONCLUSION: Impaction and screw fixation total shoulder arthroplasty for primary glenohumeral osteoarthritis using a stemless device provide reliable clinical results. The screw fixation seems to prevent osteolysis of the medial calcar.

A Vibrational Technique for In Vitro Intraoperative Prosthesis Fixation Monitoring.

OBJECTIVE: In this paper, a new vibrational modal analysis technique was developed for intraoperative cementless prosthesis fixation evaluation upon hammering. METHODS: An artificial bone (Sawbones)-prosthesis system was excited by sweeping of a sine signal over a wide frequency range. The exponential sine sweep technique was implemented to the response signal in order to determine the linear impulse response. Recursive Fourier transform enhancement (RFTE) technique was applied to the linear impulse response signal in order to enhance the frequency spectrum with sharp and distinguishable peak values indicating distinct high natural frequencies of the system (ranging from 15 kHz to 90 kHz). The experiment was repeated with 5 Sawbones-prosthesis samples. Upon successive hammering during the prosthesis insertion, variation of each natural frequency was traced. RESULTS: Compared to classical Fast Fourier Transform, RFTE provided a better tracing and enhancement of frequency components during insertion. Three different types of frequency evolving trends (monotonically increasing, insensitive, and plateau-like) were observed for all samples, as confirmed by a new finite element simulation of the prosthesis dynamic insertion. Two main mechanical phenomena (i.e., geometrical compaction and compressive stress) were shown to govern these trends in opposite ways. Follow-up of the plateau-like trend upon hammering showed that the frequency shift is a good indicator of fixation. CONCLUSION: Alongside the individual follow-up of frequency shifts, combinatorial frequency analysis provides new objective information on the mechanical stability of Sawbone-prosthesis fixation. SIGNIFICANCE: The proposed vibrational technique based on RTFE can provide the surgeon with a new assistive diagnostic technique during the surgery by indicating when the bone-prosthesis fixation is acceptable, and beyond of which further hammering should be done cautiously to avoid bone fracture.

Lower Success Rate of Débridement and Implant Retention in Late Acute versus Early Acute Periprosthetic Joint Infection Caused by Staphylococcus spp. Results from a Matched Cohort Study.

BACKGROUND: Surgical débridement, antibiotics and implant retention (DAIR) is currently recommended by international guidelines for both early acute (postsurgical) and late acute (hematogenous) periprosthetic joint infections (PJIs). However, due to a different pathogenesis of infection, a different treatment strategy may be needed. QUESTIONS/PURPOSES: (1) Compared with early acute PJIs, are late acute PJIs associated with a higher risk of DAIR failure? (2) When stratified by microorganism, is the higher risk of failure in late acute PJI associated with Staphylocococcus aureus infection? (3) When analyzing patients with S. aureus infection, what factors are independently associated with DAIR failure? METHODS: In this multicenter observational study, early acute and late acute PJIs treated with DAIR were retrospectively evaluated and matched according to treating center, year of diagnosis, and infection-causing microorganism. If multiple matches were available, the early acute PJI diagnosed closest to the late acute PJI was selected. A total of 132 pairs were included. Treatment success was defined as a retained implant during follow-up without the need for antibiotic suppressive therapy. RESULTS: Late acute PJIs had a lower treatment success (46% [60 of 132]) compared with early acute PJIs (76% [100 of 132]), OR 3.9 [95% CI 2.3 to 6.6]; p < 0.001), but the lower treatment success of late acute PJIs was only observed when caused by Staphylococcus spp (S. aureus: 34% versus 75%; p < 0.001; coagulase-negative staphylococci: 46% versus 88%; p = 0.013, respectively). On multivariable analysis, late acute PJI was the only independent factor associated with an unsuccessful DAIR when caused by S. aureus (OR 4.52 [95% CI 1.79 to 11.41]; p < 0.001). CONCLUSIONS: Although DAIR seems to be a successful therapeutic strategy in the management of early acute PJI, its use in late acute PJI should be reconsidered when caused by Staphylococcus spp. Our results advocate the importance of isolating the causative microorganism before surgery. LEVEL OF EVIDENCE: Level III, therapeutic study.

Candida periprosthetic infection of the hip: a systematic review of surgical treatments and clinical outcomes.

PURPOSE: To produce a systematic analysis of types of treatment and outcomes of Candida hip periprosthetic joint infections and their correlation with specific pathogen species. METHODS: During June 2018, a literature search of candida periprosthetic hip infection in PubMed, Scopus and Embase databases was performed according to the PRISMA (Preferred Reporting Item for Systematic Reviews and Meta-Analyses) guideline. Reviewers used Oxford level of evidence (LoE) and methodological index for non-randomised studies (MINORS) score. Modal distribution of surgical, pharmacological treatment and outcome along with the correlation between types of treatment and outcomes was calculated through the chi-square test. RESULTS: Seventy-nine cases were collected through 35 articles, identifying 81 pathogens. Candida albicans was the most common pathogen. Analysis of LoE reveals 26 LoE 5 (74.29%) and nine LoE 4 (26.71%). From nine  LoE 4, ten patients (20.41%) underwent one-stage revision, 22 patients (44.90%) two-stage revision, 11 patients (22.45%) resection arthroplasty and six patients (12.24%) debridement with prosthesis retention. Global success was obtained in 31 cases (63.27%). Modal distribution revealed a preference for two-stage revision (22/49) and fluconazole as medical therapy (36/49). A significant difference was found between one-stage revision and resection arthroplasty (p = 0.031) or debridement (p = 0.003) and between two-stage revision and debridement (p = 0.013). No differences were found between Candida spp. in terms of the outcomes (p = 0.736). Methodological index showed a poor MINOR score. CONCLUSIONS: Analysis of the literature suggests better clinical outcome with one- or two-stage revision than with resection arthroplasty or debridement, but the level of evidence is low.

Experience with Minimally Invasive Ponto Surgery and Linear Incision Approach for Pediatric and Adult Bone Anchored Hearing Implants.

PURPOSE: To compare intra- and postoperative outcomes between the standard linear incision with tissue preservation and the Minimally Invasive Ponto Surgery (MIPS). STUDY DESIGN: A non-randomized retrospective cohort series. METHODS: Medical files were reviewed of adult and pediatric bone anchored hearing implant recipients. Extracted outcomes included patient characteristics, implant survival, operative time, anesthesia use, intra and postoperative complications, soft tissue tolerability assessed by the Holger's classification, and implant stability assessed by the Resonance Frequency Analysis (RFA). Outcomes were compared between two surgeries. RESULTS: A total of 59 implants were placed (21 MIPS; 38 linear). Conductive hearing loss was the most common etiology for implantation. Surgery was conducted under local anesthesia in 67% of MIPS patients and 16% of linear patients. No intraoperative complications were reported for both surgical approaches and no implants were lost. Patients undergoing implantation via the MIPS approach displayed less skin reaction postoperatively, however this was not significant (P = .2848). The most common Holgers score for both groups was grade 1. The median and mean surgical duration for the MIPS group was statistically lower than the linear group (P = .0001). Implant stability measured by the RFA implant stability quotient was greater in the MIPS cohort. CONCLUSION: The MIPS approach seems either similar or superior to the linear approach in all perioperative outcomes evaluated. Outcomes such as surgical duration, anesthesia choice and implant stability measurements support implantation through the MIPS approach for patients meeting eligibility criteria.

Implant-assisted removable partial denture using freely removable abutment in a fully edentulous patient: A case report / 대한치과보철학회지

Implant-Assisted Removable Partial Dentures (IARPDs) treatment is being performed in a fully edentulous patient using implant surveyed prosthesis as an abutment. Implant-supported prosthesis as an abutment of IARPDs is classified into screw-retained and cement-retained type according to the retention type, and each has advantages and disadvantages. The EZ crown system (Samwon DMP, Yangsan, Korea) has a cylinder combined with abutment, and the nickel-titanium spring in this cylinder provides a constant force on the zirconia ball to obtain retention in EZ crown system. In this patient, the natural abutment teeth of the mandibular overdenture was hopeless. We planned implant assisted removable partial denture using anterior implant surveyed prosthesis considering functional and esthetical rehabilitation, cost and patient's needs. When fabricating IARPDs using implant as abutment, we could compensate for the shortcomings of existing implant-supported prosthesis retention type and made the design of removable partial denture easy due to using EZ crown system.

Retention systems used in maxillofacial prostheses: A review.

Defects in the face area caused by trauma, accident, tumor or congenital defects are treated with special facial prostheses. Besides esthetics, the most common problem with these prostheses is the retention of prostheses. In the present article review, the methods used for the retention of prostheses from past to present were researched, and the advantages of adhesives and implants, which are the most commonly used current methods, were evaluated. Current techniques, new materials, treatment options, and implementation procedures are described. The success of maxillofacial prostheses in meeting the expectations of patients and dentist doctors is increasing day by day with the development of adhesive material science, the emergence of technical knowledge, and the development of implant technology. Increasing the retention provides both ease of use and acceptance by the patient. Therefore, the chosen method for retention has great importance in the long-term prognosis of the prosthesis.

Mini-dental implants for definitive prosthesis retention - A synopsis of the current evidence.

Background: This narrative review provides an evidence-based overview of the comparison between mini-dental implants (MDI) and conventional dental implants for definitive prosthesis retention. In addition, recommendations are made on whether the use of reduced diameter dental implants is more appropriate. Method: A literature review was conducted via electronic search addressing the following topics: (1) osseointegration, (2) peri-implant soft tissue characteristics, (3) biomechanics, (4) implant survival and (5) implant success. Conclusion: The procedure for dental implant prosthetic rehabilitation should preferentially include conventional dental implants (i.e. [Formula: see text][Formula: see text]mm fixture diameter). Small (3-3.25[Formula: see text]mm) and narrow (3.3-3.5[Formula: see text]mm) dental implants should primarily be used in non-load-bearing regions. MDI ([Formula: see text][Formula: see text]mm) should be considered to retain definitive prosthesis, only for reasons of anatomy or patient-centred preferences and as a last resort. If MDI are to be used, patients should be made aware of the lack of long-term, high-quality evidence as a part of the informed consent process and that most of the prospective data available pertain to MDI retaining complete dentures.

Quantitative Stent Graft Motion in ECG Gated CT by Image Registration and Segmentation: In Vitro Validation and Preliminary Clinical Results.

OBJECTIVES: The dynamic endovascular environment of stent grafts may influence long term outcome after endovascular aneurysm repair (EVAR). The sealing and fixation of a stent graft to the aortic wall is challenged at every heartbeat, yet knowledge of the cardiac induced dynamics of stent grafts is sparse. Understanding the stent-artery interaction is crucial for device development and may aid the prediction of failure in the individual patient. The aim of this work was to establish quantitative stent graft motion in multiphasic electrocardiogram (ECG) gated computed tomography (CT) by image registration and segmentation techniques. METHODS: Experimental validation was performed by evaluating a series of ECG gated CT scans of a stent graft moving at different amplitudes of displacement at different virtual heart rates using a motion generating device with synchronised ECG triggering. The methodology was further tested on clinical data of patients treated with EVAR devices with different stent graft designs. Displacement during the cardiac cycle was analysed for points on the fixating stent rings, the branches or fenestrations, and the spine. RESULTS: Errors for the amplitude of displacement measured in vitro at individual points on the wire frame were at most 0.3 mm. In situ cardiac induced displacement of the devices was found to differ per location and also depended on the type of stent graft. Displacement during the cardiac cycle was greatest in a fenestrated device and smallest in a chimney graft sac anchoring endosystem, with maximum displacement varying from 0.0 to 1.4 mm. There was no substantial displacement measurable in the spine. CONCLUSIONS: A novel methodology to quantify and visualise stent graft motion in multiphasic ECG gated CT has been validated in vitro and tested in vivo. This methodology enables further exploration of in situ motion of different stent grafts and branch stents and their interaction with native vessels.

DAIR (Debridement, Antibiotics and Implant Retention) less effective in hematogenous total knee arthroplasty infections.

BACKGROUND: Debridement and irrigation with prosthetic retention followed by antibiotic therapy (DAIR) is one of the treatments of choice in acute infections after a total knee arthroplasty. However, the success rate varies widely in the literature, depending on several factors such as comorbidities of the patient, duration of infection, and microorganisms involved. The goal of this study was to assess the outcomes of this therapeutic option and to identify possible predictors of the result. METHODS: We retrospectively reviewed cases of acute postoperative (≤ 3 months from index procedure) and acute hematogenous periprosthetic knee infections treated with DAIR at our hospital between 2004 and 2016. Overall, 26 knees were included, with a mean age of 73.4 years. Several variables related to patient characteristics, infection type, and surgery were examined to evaluate their influence on outcome, and functional and radiographic outcome were assessed. The mean follow-up was 41 months. A descriptive analysis was carried out on the collected data, and a univariate analysis was performed with the objective of searching for influential factors in the resolution of the infection using the chi-square nonparametric test in the case of the categorical variables and the Wilcoxon test for the continuous ones. Moreover, univariate cox regression analysis was performed. RESULTS: The overall success rate was 77% at the last follow-up, recording a significantly greater cure in acute infections (93% acute vs 58% acute hematogenous, p = 0.03). The infections in which the Staphylococcus aureus was isolated had a significantly lower cure rate, with only 33% of success, compared to 82% of the non-aureus microorganisms (p <  0.05). CONCLUSIONS: The present study shows a considerable cure rate in the treatment of acute knee infections through DAIR, although patient comorbidities, type of infection, and causative microorganism should be considered for decision-making.

Permanent His-bundle pacing using stylet-directed, active-fixation leads placed via coronary sinus sheaths compared to conventional lumen-less system.

BACKGROUND: The use of coronary sinus (CS) sheaths to deliver stylet-driven leads (SDLs) for His-bundle pacing (HBP) has not been described. Conventionally, HBP is achieved using a stylet-less lead delivered through a customized catheter. OBJECTIVE: The purpose of this study was to characterize the acute and early-term HBP experience with stylet-driven, active-fixation leads delivered through CS sheaths compared to the conventional approach. METHODS: Delivery of Medtronic 4471 and 7742 SDLs was attempted in 27 patients. Delivery was facilitated using CS guide catheters and custom-shaped stylets. Procedural characteristics and lead performance were compared to those of a group of 17 patients in whom delivery of 3830 lumen-less leads (LLLs) was attempted. Patients had heterogeneous pacing indications. RESULTS: HBP with SDL was successful in 24 of 27 patients(89%) compared to 15 of 17 patients (88%) in the LLL group. Mean procedural and fluoroscopy times in the SDL and LLL groups were 129 ± 43 minutes vs 104 ± 43 minutes and 9.6 ± 5.2 minutes vs 8.3 ± 5.0 minutes, respectively (both P = NS). There was a significant difference in procedure and fluoroscopy times within the SDL group between the first and second halves of the series, probably secondary to a learning curve. Acute HBP thresholds were higher with SDL than with LLL (2.6 ± 1.5 V vs 1.5 ± 1.2 V; P = .02) and remained stable at 8.4 ± 5.3 months. Both SDLs exhibited similar pacing thresholds. Two crossovers between groups occurred (1 in each group). Four patients with SDL and 1 patient with LLL exhibited high thresholds during follow-up. CONCLUSION: Permanent HBP using stylet-driven, active-fixation leads delivered through conventional CS sheaths is feasible. Procedural characteristics and lead performance were clinically acceptable.