Vertical full-colour micro-LEDs via 2D materials-based layer transfer.

Micro-LEDs (µLEDs) have been explored for augmented and virtual reality display applications that require extremely high pixels per inch and luminance1,2. However, conventional manufacturing processes based on the lateral assembly of red, green and blue (RGB) µLEDs have limitations in enhancing pixel density3-6. Recent demonstrations of vertical µLED displays have attempted to address this issue by stacking freestanding RGB LED membranes and fabricating top-down7-14, but minimization of the lateral dimensions of stacked µLEDs has been difficult. Here we report full-colour, vertically stacked µLEDs that achieve, to our knowledge, the highest array density (5,100 pixels per inch) and the smallest size (4 µm) reported to date. This is enabled by a two-dimensional materials-based layer transfer technique15-18 that allows the growth of RGB LEDs of near-submicron thickness on two-dimensional material-coated substrates via remote or van der Waals epitaxy, mechanical release and stacking of LEDs, followed by top-down fabrication. The smallest-ever stack height of around 9 µm is the key enabler for record high µLED array density. We also demonstrate vertical integration of blue µLEDs with silicon membrane transistors for active matrix operation. These results establish routes to creating full-colour µLED displays for augmented and virtual reality, while also offering a generalizable platform for broader classes of three-dimensional integrated devices.

Heterogeneous integration of single-crystalline complex-oxide membranes.

Complex-oxide materials exhibit a vast range of functional properties desirable for next-generation electronic, spintronic, magnetoelectric, neuromorphic, and energy conversion storage devices1-4. Their physical functionalities can be coupled by stacking layers of such materials to create heterostructures and can be further boosted by applying strain5-7. The predominant method for heterogeneous integration and application of strain has been through heteroepitaxy, which drastically limits the possible material combinations and the ability to integrate complex oxides with mature semiconductor technologies. Moreover, key physical properties of complex-oxide thin films, such as piezoelectricity and magnetostriction, are severely reduced by the substrate clamping effect. Here we demonstrate a universal mechanical exfoliation method of producing freestanding single-crystalline membranes made from a wide range of complex-oxide materials including perovskite, spinel and garnet crystal structures with varying crystallographic orientations. In addition, we create artificial heterostructures and hybridize their physical properties by directly stacking such freestanding membranes with different crystal structures and orientations, which is not possible using conventional methods. Our results establish a platform for stacking and coupling three-dimensional structures, akin to two-dimensional material-based heterostructures, for enhancing device functionalities8,9.

Optoelectronic Synapse Based on 2D Electron Gas in Stoichiometry-Controlled Oxide Heterostructures.

Emulating synaptic functionalities in optoelectronic devices is significant in developing artificial visual-perception systems and neuromorphic photonic computing. Persistent photoconductivity (PPC) in metal oxides provides a facile way to realize the optoelectronic synaptic devices, but the PPC performance is often limited due to the oxygen vacancy defects that release excess conduction electrons without external stimuli. Herein, a high-performance optoelectronic synapse based on the stoichiometry-controlled LaAlO3/SrTiO3 (LAO/STO) heterostructure is developed. By increasing La/Al ratio up to 1.057:1, the PPC is effectively enhanced but suppressed the background conductivity at the LAO/STO interface, achieving strong synaptic behaviors. The spectral noise analyses reveal that the synaptic behaviors are attributed to the cation-related point defects and their charge compensation mechanism near the LAO/STO interface. The short-term and long-term plasticity is demonstrated, including the paired-pulse facilitation, in the La-rich LAO/STO device upon exposure to UV light pulses. As proof of concepts, two essential synaptic functionalities, the pulse-number-dependent plasticity and the self-noise cancellation, are emulated using the 5 × 5 array of La-rich LAO/STO synapses. Beyond the typical oxygen deficiency control, the results show how harnessing the cation stoichiometry can be used to design oxide heterostructures for advanced optoelectronic synapses and neuromorphic applications.

Healing Donor Defect States in CVD-Grown MoS2 Field-Effect Transistors Using Oxygen Plasma with a Channel-Protecting Barrier.

Molybdenum disulfide (MoS2 ), a metal dichalcogenide, is a promising channel material for highly integrated scalable transistors. However, intrinsic donor defect states, such as sulfur vacancies (Vs ), can degrade the channel properties and lead to undesired n-doping. A method for healing the donor defect states in monolayer MoS2 is proposed using oxygen plasma, with an aluminum oxide (Al2 O3 ) barrier layer that protects the MoS2 channel from damage by plasma treatment. Successful healing of donor defect states in MoS2 by oxygen atoms, even in the presence of an Al2 O3 barrier layer, is confirmed by X-ray photoelectron spectroscopy, photoluminescence, and Raman spectroscopy. Despite the decrease in 2D sheet carrier concentration (Δn2D = -3.82×1012 cm-2 ), the proposed approach increases the on-current and mobility by 18% and 44% under optimal conditions, respectively. Metal-insulator transition occurs at electron concentrations of 5.7×1012 cm-2 and reflects improved channel quality. Finally, the activation energy (Ea ) reduces at all the gate voltages (VG ) owing to a decrease in Vs , which act as a localized state after the oxygen plasma treatment. This study demonstrates the feasibility of plasma-assisted healing of defects in 2D materials and electrical property enhancement and paves the way for the development of next-generation electronic devices.

In-situtemperature-dependent sheet resistance study of Cu films in oxygen ambient for heterogeneous integrations.

Controlling and preventing Cu oxidation is crucial for improving the performance and reliability of Cu-Cu bonding. Ni-B films were selectively deposited on Cu films to block the Cu oxidation. The resistivity changes of the Cu films in N2and O2ambient were measured by using a four-point probe in thein situtemperature-dependent resistance measurements at the temperature from room temperature to 400 °C. The resistivity changes of the 100 nm thick Cu films without Ni-B increased rapidly at a higher temperature (284 °C) in the O2ambiance. The change of resistivity-increase of 100 nm thick Cu with ∼50 nm thick Ni-B (top) film was lower than the Cu films without Ni-B films due to the blocking diffusion of O2atoms by the Ni-B films. The resistivity-change and oxidation barrier properties were studied using scanning electron microscopy, FIB, transmission electron microscopy, EDX, and secondary ion mass spectroscopy tools. The proposed article will be helpful for the upcoming advancement in Cu-Cu bonding using selected-area deposition.

Reversible Photomodulation of Two-Dimensional Electron Gas in LaAlO3/SrTiO3 Heterostructures.

Long-lived photoinduced conductance changes in LaAlO3/SrTiO3 (LAO/STO) heterostructures enable their use in optoelectronic memory applications. However, it remains challenging to quench the persistent photoconductivity (PPC) instantly and reproducibly, which limits the reversible optoelectronic switching. Herein, we demonstrate a reversible photomodulation of two-dimensional electron gas (2DEG) in LAO/STO heterostructures with high reproducibility. By irradiating UV pulses, the 2DEG at the LAO/STO interface is gradually transformed to the PPC state. Notably, the PPC can be completely removed by water treatment when two key requirements are met: (1) the moderate oxygen deficiency in STO and (2) the minimal band edge fluctuation at the interface. Through our X-ray photoelectron spectroscopy and electrical noise analysis, we reveal that the reproducible change in the conductivity of 2DEG is directly attributed to the surface-driven electron relaxation in the STO. Our results provide a stepping-stone toward developing optically tunable memristive devices based on oxide 2DEG systems.

Collective Control of Potential-Constrained Oxygen Vacancies in Oxide Heterostructures for Gradual Resistive Switching.

Filamentary resistive switching in oxides is one of the key strategies for developing next-generation non-volatile memory devices. However, despite numerous advantages, their practical applications in neuromorphic computing are still limited due to non-uniform and indeterministic switching behavior. Given the inherent stochasticity of point defect migration, the pursuit of reliable switching likely demands an innovative approach. Herein, a collective control of oxygen vacancies is introduced in LaAlO3 /SrTiO3 (LAO/STO) heterostructures to achieve reliable and gradual resistive switching. By exploiting an electrostatic potential constraint in ultrathin LAO/STO heterostructures, the formation of conducting filaments is suppressed, but instead precisely control the concentration of oxygen vacancies. Since the conductance of the LAO/STO device is governed by the ensemble concentration of oxygen vacancies, not their individual probabilistic migrations, the resistive switching is more uniform and deterministic compared to conventional filamentary devices. It provides direct evidence for the collective control of oxygen vacancies by spectral noise analysis and modeling by Monte-Carlo simulation. As a proof of concept, the significantly-improved analog switching performance of the filament-free LAO/STO devices is demonstrated, revealing potential for neuromorphic applications. The results establish an approach to store information by point defect concentration, akin to biological ionic channels, for enhancing switching characteristics of oxide materials.

Accelerating 3D Convolutional Neural Network with Channel Bottleneck Module for EEG-Based Emotion Recognition.

Deep learning-based emotion recognition using EEG has received increasing attention in recent years. The existing studies on emotion recognition show great variability in their employed methods including the choice of deep learning approaches and the type of input features. Although deep learning models for EEG-based emotion recognition can deliver superior accuracy, it comes at the cost of high computational complexity. Here, we propose a novel 3D convolutional neural network with a channel bottleneck module (CNN-BN) model for EEG-based emotion recognition, with the aim of accelerating the CNN computation without a significant loss in classification accuracy. To this end, we constructed a 3D spatiotemporal representation of EEG signals as the input of our proposed model. Our CNN-BN model extracts spatiotemporal EEG features, which effectively utilize the spatial and temporal information in EEG. We evaluated the performance of the CNN-BN model in the valence and arousal classification tasks. Our proposed CNN-BN model achieved an average accuracy of 99.1% and 99.5% for valence and arousal, respectively, on the DEAP dataset, while significantly reducing the number of parameters by 93.08% and FLOPs by 94.94%. The CNN-BN model with fewer parameters based on 3D EEG spatiotemporal representation outperforms the state-of-the-art models. Our proposed CNN-BN model with a better parameter efficiency has excellent potential for accelerating CNN-based emotion recognition without losing classification performance.

Regulation of the Gut Microbiota and Inflammation by ß-Caryophyllene Extracted from Cloves in a Dextran Sulfate Sodium-Induced Colitis Mouse Model.

Ulcerative colitis is an inflammatory bowel disease characterized by symptoms such as abdominal pain, diarrhea, bleeding, and weight loss. Ulcerative colitis is typically treated with anti-inflammatory drugs; however, these drugs are associated with various side effects, limiting their use. ß-Caryophyllene (BCP), a natural compound derived from cloves, has antioxidant, antibacterial, and anti-inflammatory activities. In this study, we aimed to investigate the effects of BCP on colitis in a dextran sulfate sodium (DSS)-induced colitis mouse model. BCP was administered for seven days, followed by 2.5% DSS for additional seven days to induce colitis. Changes in stool weight, recovery of gut motility, colon length, colon histology, myeloperoxidase activity, inflammatory cytokines (TNF-α, IL-1ß, IL-6, IgA, and IgG), and the gut microbiota were observed. Administration of BCP increased stool weight, restored gut motility, and considerably increased colon length compared to those in the untreated colitis mouse model. In addition, the amount of mucin and myeloperoxidase activity in the colon increased, whereas the concentrations of IL-1ß, IL-6, and TNF-α decreased following the administration of BCP. Furthermore, BCP reduced the abundance of Proteobacteria which can cause intestinal immune imbalance. These results suggest that BCP has a potential to be developed as a preventive agent for colitis.

Spontaneous Spine Fracture in Patient with Ankylosing Spondylitis under Spinal Anesthesia: A Case Report and Review of the Literature.

Factures in ankylosing spondylitis (AS) patients tend to occur due to the absence of motion between vertebrae, poor bone quality, and a long lever arm that generates extension force. However, most patients have a history of at least minor trauma. The aim of this report was that a vertebral fracture in a patient with AS can be caused not only by minor trauma, but also by position changes or maintenance of position for examination due to structural weakness. A 75-year-old woman with AS visited her local hospital on foot for back pain. She usually had back pain. However, she had increased back pain after falling over three weeks prior. In plain radiographs, no fracture was apparent. The doctor tried to perform magnetic resonance imaging (MRI) for further evaluation. However, several attempts of MRI failed due to continuous movement arising from pain. As a result, MRI was performed under spinal anesthesia for pain control. However, complete paraplegia developed during the MRI examination. MRI showed extension-type vertebral fracture with displacement and the patient was transferred to our hospital. We performed emergency posterior fusion, but neurological symptoms did not improve. This case suggests the need for careful positioning, sedation, or anesthesia when performing an examination or surgery in AS patients. We recommend that all patients with AS should be carefully positioned at all times during testing or surgery.

Polymer Analog Memristive Synapse with Atomic-Scale Conductive Filament for Flexible Neuromorphic Computing System.

With the advent of artificial intelligence (AI), memristors have received significant interest as a synaptic building block for neuromorphic systems, where each synaptic memristor should operate in an analog fashion, exhibiting multilevel accessible conductance states. Here, we demonstrate that the transition of the operation mode in poly(1,3,5-trivinyl-1,3,5-trimethyl cyclotrisiloxane) (pV3D3)-based flexible memristor from conventional binary to synaptic analog switching can be achieved simply by reducing the size of the formed filament. With the quantized conductance states observed in the flexible pV3D3 memristor, analog potentiation and depression characteristics of the memristive synapse are obtained through the growth of atomically thin Cu filament and lateral dissolution of the filament via dominant electric field effect, respectively. The face classification capability of our memristor is evaluated via simulation using an artificial neural network consisting of pV3D3 memristor synapses. These results will encourage the development of soft neuromorphic intelligent systems.

Inhibitory Effects of ß-Caryophyllene on Helicobacter pylori Infection In Vitro and In Vivo.

The human specific bacterial pathogen Helicobacter pylori (H. pylori) is associated with severe gastric diseases, including gastric cancer. Recently, the increasing resistance makes the usage of antibiotics less effectively. Therefore, development of a new antimicrobial agent is required to control H. pylori infection. In the current study, the inhibitory effect of ß-caryophyllene on H. pylori growth, as well as the antibacterial therapeutic effect, has been demonstrated. ß-caryophyllene inhibited H. pylori growth via the downregulation of dnaE, dnaN, holB, and gyrA and also downregulated virulence factors such as CagA, VacA, and SecA proteins. ß-caryophyllene inhibited expression of several T4SS components, so that CagA translocation into H. pylori-infected AGS gastric cancer cells was decreased by ß-caryophyllene treatment. ß-caryophyllene also inhibited VacA entry through the downregulation of T5aSS. After ß-caryophyllene administration on Mongolian gerbils, the immunohistochemistry (IHC) and Hematoxylin&Eosin stains showed therapeutic effects in the treated groups. Hematological data, which was consistent with histological data, support the therapeutic effect of ß-caryophyllene administration. Such a positive effect of ß-caryophyllene on H. pylori infection potently substantiates the natural compound as being capable of being used as a new antimicrobial agent or functional health food to help patients who are suffering from gastroduodenal diseases due to H. pylori infection.

Revision total hip arthroplasty with metal on metal bearing for ceramic bearing fractures.

BACKGROUND: Due to concern of potential metallosis caused by residual microscopic ceramic particles, metal-on-metal (MoM) bearing is deemed undesirable in revision total hip arthroplasty (THA) for ceramic bearing fracture. We determined whether MoM bearing is suitable to be used in revision THA for ceramic fractures and also evaluated whether this treatment increases serum iron levels compared with MoM bearing revision THA for polyethylene failure. METHODS: Between 2006 and 2012, 22 patients underwent revision surgery using MoM bearing (28 mm femoral head in 18 hips and 32 mm in 4 hips) for ceramic bearing fracture and followed average 52.1 months. We assessed radiological parameter and functional outcome using Harris hip score (HHS) and WOMAC score. Also, serum cobalt (Co) and chromium (Cr) blood tests were performed and compared with the result obtained from age, sex- and follow-up duration-matched patients with MoM revision THA for failed polyethylene bearing. RESULTS: The mean HHS improved from 60.6 preoperatively to 90.3 at final follow-up. There were no changes in cup position, progression of osteolytic lesions, and measurable wear of MoM bearing articulation at final follow-up radiographs. There was one case of recurrent dislocation after surgery, which was treated with greater trochanter distal advancement and one case of deep infection, which underwent two-stage revision. Mean serum Co level (1.7 vs. 1.4 µg/dl; p = 0.211) and Cr level (0.70 vs. 1.01 µg/dl; p = 0.327) showed no significant difference. CONCLUSIONS: MoM articulation with liner cementation into the acetabular cup along with total synovectomy can be chosen in revision surgery for ceramic fracture with good midterm follow-up. However, the use of MoM bearing is indicated when the stem and metal shell can be retained and ceramic on ceramic or ceramic on polyethylene bearing cannot be selected. Also long-term outcome needs to be further evaluated.

Intrinsic Transport in 2D Heterostructures Mediated through h-BN Tunneling Contacts.

Understanding the electronic transport of monolayer transition metal dichalcogenides (TMDs) and their heterostructures is complicated by the difficulty in achieving electrical contacts that do not perturb the material. Typically, metal deposition on monolayer TMDs leads to hybridization between the TMD and the metal, which produces Schottky barriers at the metal/semiconductor interface. In this work, we apply the recently reported hexagonal boron nitride (h-BN) tunnel contact scheme to probe the junction characteristics of a lateral TMD heterostructure grown via chemical vapor deposition. We first measure the electronic properties across the junction before elucidating optoelectronic generation mechanisms via scanning photocurrent microscopy. We find that the rectification ratio measured using the encapsulated, tunnel contact scheme is almost 2 orders of magnitude smaller than that observed via conventional metal contact geometry, which implies that the metal/semiconductor Schottky barriers play large roles in this aspect. Furthermore, we find that both the photovoltaic as well as hot carrier generation effects are dominant mechanisms driving photoresponse, depending on the external biasing conditions. This work is the first time that this encapsulation scheme has been applied to lateral heterostructures and serves as a reference for future electronic measurements on this material. It also simultaneously serves as a framework to more accurately assess the electronic transport characteristics of 2D heterostructures and better inform future device architectures.

Autostereoscopic 3D display system with dynamic fusion of the viewing zone under eye tracking: principles, setup, and evaluation [Invited].

We study optical technologies for viewer-tracked autostereoscopic 3D display (VTA3D), which provides improved 3D image quality and extended viewing range. In particular, we utilize a technique-the so-called dynamic fusion of viewing zone (DFVZ)-for each 3D optical line to realize image quality equivalent to that achievable at optimal viewing distance, even when a viewer is moving in a depth direction. In addition, we examine quantitative properties of viewing zones provided by the VTA3D system that adopted DFVZ, revealing that the optimal viewing zone can be formed at viewer position. Last, we show that the comfort zone is extended due to DFVZ. This is demonstrated by a viewer's subjective evaluation of the 3D display system that employs both multiview autostereoscopic 3D display and DFVZ.

Remote Manipulation of Ligand Nano-Oscillations Regulates Adhesion and Polarization of Macrophages in Vivo.

Macrophages play crucial roles in various immune-related responses, such as host defense, wound healing, disease progression, and tissue regeneration. Macrophages perform distinct and dynamic functions in vivo, depending on their polarization states, such as the pro-inflammatory M1 phenotype and pro-healing M2 phenotype. Remote manipulation of the adhesion of host macrophages to the implants and their subsequent polarization in vivo can be an attractive strategy to control macrophage polarization-specific functions but has rarely been achieved. In this study, we grafted RGD ligand-bearing superparamagnetic iron oxide nanoparticles (SPIONs) to a planar matrix via a long flexible linker. We characterized the nanoscale motion of the RGD-bearing SPIONs grafted to the matrix, in real time by in situ magnetic scanning transmission electron microscopy (STEM) and in situ atomic force microscopy. The magnetic field was applied at various oscillation frequencies to manipulate the frequency-dependent ligand nano-oscillation speeds of the RGD-bearing SPIONs. We demonstrate that a low oscillation frequency of the magnetic field stimulated the adhesion and M2 polarization of macrophages, whereas a high oscillation frequency suppressed the adhesion of macrophages but promoted their M1 polarization, both in vitro and in vivo. Macrophage adhesion was also temporally regulated by switching between the low and high frequencies of the oscillating magnetic field. To the best of our knowledge, this is the first demonstration of the remote manipulation of the adhesion and polarization phenotype of macrophages, both in vitro and in vivo. Our system offers the promising potential to manipulate host immune responses to implanted biomaterials, including inflammation or tissue reparative processes, by regulating macrophage adhesion and polarization.

Comparison of clinical outcomes and second-look arthroscopic findings after ACL reconstruction using a hamstring autograft or a tibialis allograft.

PURPOSE: The purpose of this prospective randomized clinical study was to compare the clinical and radiological outcomes, including tibial tunnel widening and the progression of osteoarthritis after ACL reconstruction using a hamstring autograft or a tibialis allograft. In addition, we compared the graft tear and synovial coverage of grafts in patients that underwent the second-look arthroscopy. METHODS: Among 184 patients with an ACL injury who underwent ACL reconstruction, 68 patients of autograft group and 64 patients of tibialis allograft group were included for this study after minimum of 2-year follow-up. The Lachman and pivot-shift tests, Tegner activity score, Lysholm knee score, and IKDC score were compared between the two groups. The quadriceps and hamstring isokinetic strengths using dynamometer were also compared. Degree of OA was determined using the Kellgren-Lawrence grading system on the weight-bearing radiographs. In total, 51 patients (26 patients in autograft group and 25 in the tibialis allograft group) underwent the second-look arthroscopy, in which we compared the apparent tear of graft and synovial coverage of grafts. RESULTS: At the final follow-up, there were no statistical significances in the two groups in Lachman and pivot-shift tests (n.s.). The Tegner activity, Lysholm knee score, and IKDC scores were similar in the two groups. Moreover, no significant differences were observed in the muscle power (n.s.). Some patients showed the progression of OA (five in autograft and four in allograft groups) without intergroup difference (n.s.). Regarding the findings of second-look arthroscopy, although there was no significant difference in graft tear, synovial coverage was better in autograft group than in allograft group. CONCLUSION: Even though hamstring autografts and tibialis allografts provided good functional outcomes without significant differences, the second-look arthroscopy revealed that hamstring autografts produced better synovial coverage than tibialis allograft. LEVEL OF EVIDENCE: I.

Total knee arthroplasty using ultra-congruent inserts can provide similar stability and function compared with cruciate-retaining total knee arthroplasty.

PURPOSE: Recently, ultra-congruent (UC) inserts have shown successful outcomes following total knee arthroplasty (TKA). It was hypothesized that patients in the UC group would not show significantly different in vivo stability or functional outcomes from those in the cruciate-retaining (CR) group. METHODS: The prospective study enrolled patients who had been treated with either CR or UC TKAs (38 cases in each group), after a minimum 3-year follow-up. The same surgical technique was used with the same femoral components in both groups except for the polyethylene inserts (CR or UC). The clinical outcome measures were knee range of motion (ROM), Hospital for Special Surgery (HSS) score, Knee Society (KS) score, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) subscale score. The mediolateral laxity at full extension and anteroposterior laxity at 90° flexion were measured in stress radiographs and compared between the two groups. RESULTS: Both the CR and UC groups showed significant improvements in post-operative ROM, HSS, KS, and WOMAC scores without inter-group differences between two groups. Moreover, there were no differences in mediolateral or anteroposterior laxity between the two groups (p > 0.05). CONCLUSION: TKA with posterior cruciate ligament (PCL) resection using the UC design showed comparable functional outcomes with those of CR TKA and provided similar in vivo stability. Therefore, UC inserts can be a good option in TKA without bony box cut when the PCL is damaged during an operation. LEVEL OF EVIDENCE: II.

How Much Does the Anatomical Tibial Component Improve the Bony Coverage in Total Knee Arthroplasty?

BACKGROUND: Recently, anatomical designs in total knee arthroplasty are introduced to address asymmetry of the resected tibia cutting surface. It is still not well known how much improvement would be achieved in total knee arthroplasty, especially in Asian knees. METHODS: We evaluated the bony coverage of 4 commercially available posterior-stabilized tibial designs (3 symmetrical: NexGen, Attune, and Vega; 1 anatomical: Persona) by measuring uncovered areas over 3 different regions: lateroposterior (LP), medioposterior (MP), and mediolateral (ML) areas. The implant size was chosen based on lateral anteroposterior dimension of the implant that most closely matched the corresponding surface of tibia. The knee with over coverage <1 mm and under coverage <2 mm was regarded as having optimal fit. RESULTS: The optimal fit of anatomical design in LP dimension was achieved in 76% of the cases, which was not significantly different from other symmetrical designs (P > .05). The anatomical tibial implant had a more optimal fit in MP and ML dimensions (48% and 42%, respectively) compared to all symmetric designs (P < .05). All symmetrical tibial designs had significant absolute underhang in MP (62%-78%) and ML (24%-34%) areas without difference. The anatomical tibial design had significant improvement for posteromedial coverage by about 69.8%-74.3% compared with the symmetrical designs. CONCLUSION: Recently introduced anatomical tibial design improves surface coverage at the medioposterior dimension in Asian knees. Moreover, there is small improvement in ML fit compared with the symmetrical designs.

Revision Total Hip Arthroplasty Using an Acetabular Reinforcement Ring With a Hook: A Precise Follow-Up, at Average 11.4 Years, of a Previous Report.

BACKGROUND: This study aims at determining the average long-term result of revision total hip arthroplasty (THA) using the acetabular reinforcement ring with a hook (ARRH) and bone grafting in severe acetabular bony defect. Expected 15-year survival of ARRH in revision THA is included in the study. METHODS: Retrospective review of 48 patients (48 hips) with follow-up duration of average 11.4 years (range, 6.1-21.4 years) was conducted. At each follow-up, Harris hip score was used to assess functional outcome, and radiographic acetabular component osteolysis was measured by DeLee and Charnley classification. Bone defects were assessed preoperatively and intraoperatively using American academy of orthopedic surgeons and Paprosky classification. The common modes of ARRH failures were evaluated. Bone consolidation, presence of heterotopic ossification, and complications such as infection and dislocation were recorded. RESULTS: The bone defects were varied and included cavitary, segmental, and combined defects without any pelvic discontinuity. Mean Harris hip score improved from 52.6 points preoperatively to 82.0 points postoperatively. Nine acetabular revisions and 3 stem revisions (2 concurrent with acetabular revisions and 1 isolated stem revision) were performed. There were 5 infected cases and 1 patient with recurrent dislocation. The 11.4-year survival of revision THA with ARRH was 71% as the end point for acetabular revision surgery for any reason. The expected 15-year survival of revision THA with ARRH was 60%. The most common failure mode of ARRH was superomedial migration followed by lateral migration. CONCLUSION: ARRH combined with bone grafting produces relatively good average long-term clinical results.