Long-term survival and radiological results of the Duracon™ total knee arthroplasty

Purpose

The aim of this study was to analyse the long-term (>ten years) survival rate and radiological results of the Duracon TKA.

Methods

Between 1992 and 1999 159 Duracon TKA were implanted at our institution. A Kaplan-Meier survival analysis for the endpoints exchange, addition or removal of any component for any reason, revision due to aseptic loosening and mechanical failure was performed. Radiological long-term (>ten years) follow-up (FU) analysis was performed according to the Knee Society Radiographic Evaluation and Scoring System.

Results

Mean age at surgery was 74.3 years, 28 % were male, and 89 % had primary osteoarthritis as diagnosis. Mean FU for survival analysis was 10.9 years (SD 4.2). A total of 58 % of the patients died during follow-up. Three patients (2.1 %) were lost to follow-up and five TKA (3.1 %) were revised. After ten years the mean survival was 97.7 %, 99.4 % and 98.3 % for the aforementioned endpoints, respectively. Mean radiological FU was 11.8 years (SD 2.3). We found no significant change in alignment of the components or axis over time. Progressive radiolucencies were found in nine TKA (17 %), mainly around the tibial component (95 %).

Conclusion

The Duracon TKA showed excellent long-term survival comparable to data from national registers and to other successful designs. Radiological changes found on plain radiographs were scarce after almost 12 years of radiological follow-up indicating good implant stability.     

Long-term results of total joint arthroplasty and phalangeal hemiarthroplasty of the first metatarsophalangeal joint using the ToeFit Plus™ system

BackgroundThis paper compares long term success rate of MTP joint replacement for hallux rigidus. We provide long term results of MTP joint replacement with the use of the ToeFit Plus? System.Materials and methodsOur group consisted of 19 total joint replacements and 12 hemiarthroplasties in 18 and 11 patients respectively, performed between 2005?2009. The average follow-up period was 12.2 years (range 9.8–13.7, SD 1.1) for total arthroplasty group and 11.1 years (range 9.5–13.9, SD 1.7) for hemiarthroplasty group. In all followed patients AOFAS score was calculated along with the range of motion assessment.ResultsAverage AOFAS score improved from 37 preoperatively to 79 at the time of last follow-up in total arthroplasty group and from 45 to 86 in the hemiarthroplasty group, with consideration to the statistically considerable difference of both groups. The total range of motion improved on average from 14° to the current 32° in patients with total arthroplasty and from 15° to 32° with hemiarthroplasty. The total number of cases that required surgical revision was 7 (37%) in total arthroplasty group and 2 (17%) in hemiarthroplasty group.ConclusionDue to the high percentage of failure that was shown in our long term results, we no longer utilise the ToeFit Plus? System.     

Total hip replacement arthroplasty with Mallory-Head system—minimum ten-year follow-up results

Purpose

The purpose of this study was to assess the clinical and radiographic results of a total hip arthroplasty with the double tapered Mallory-Head system.

Methods

The clinical and radiographic results of a consecutive series of 81 total hip replacements in 75 patients were reviewed 10–15?years (average 11.4?years) postoperatively. The patients’ underlying conditions were avascular necrosis in 46 hips (57?%), osteoarthritis in 12 hips (15?%), RA in nine hips (11?%), and others. Clinical results were evaluated based on the modified Harris hip score and modified Merle d’Aubigné-Postel score. A radiographic analysis was performed.

Results

The average modified Harris hip score improved from a preoperative score of 56 points to a postoperative 92 points. The average modified Merle d’Aubigné-Postel score was 15 points at the latest follow up, and 55 hips (68?%) were classified as the clinical grades of excellent or good results. One acetabular component was revised because of loosening, and one was revised for recurrent dislocation.

Conclusion

The clinical and radiological evaluations of the total hip replacements using the Mallory-Head system showed good results.     

Long-term results after operative treatment of osteochondritis dissecans of the knee joint—30 year results

Osteochondritis dissecans (OD) mostly appears at the knee joint on the weight-bearing part of the medial femoral condyle. A multi-factorial event is most likely responsible for the triggering of OD. The aim of this retrospective study was to carry out long-term assessment of the results of operative treatment. Between 1959 and 1976, 148 patients were treated for OD by an open technique. For this purpose, a total number of 38 patients were analysed after approximately 30 years. Twenty-six patients were evaluated clinically by means of standardised questionnaires and also radiologically; 12 patients were analysed only by questionnaire. In order to verify the clinical findings and the subjective assessment, radiographs were done and analysed according the Kannus score. The Brückl score was used to evaluate the results of the OD. Twenty-four knee joints were analysed by radiographs. Sixty percent of the operated joints showed poor results in the analysis according to Kannus. Only four patients showed an excellent result by using the clinical scoring system. Nevertheless, we were able to prove a markedly higher rate of osteoarthrosis. The causal explanation for this lies in the patient selection. Most of the patients were above average age, and the OD was discovered quite late, and thus the disease had already progressed to a higher degree. In 74% of all cases, an extirpation of the osteochondral fragment was performed, whereas today there are several operative options. In our view, therefore, the need arises to conduct further follow-up examinations with comparative time spans, as well as to conduct a parallel analysis of corresponding control groups in order to evaluate the aetiology of the increased rate of osteoarthrosis.     

Indications and technique of central pancreatectomy—early and late results

BACKGROUND AND AIM: Central pancreatectomy (CP) is an operation that allows one to resect benign or low grade malignant tumours located in the pancreatic isthmus that are not suitable for enucleation. The main advantage of this operation compared with major resections is that it permits to spare normal pancreatic parenchyma. PATIENTS AND METHODS: The operation is carried out by exposition of the pancreatic neck involved by the lesion. Thereafter, the gland is dissected from the splenic artery and porto-mesenteric axis and divided with a 1 cm clear margin. The cephalic stump is sutured, and the distal stump is anastomosed end-to-end or end-to-side with a Roux-en-Y jejunal loop. We treated 20 patients with this technique. The indications for CP were: serous cystadenoma in seven patients, mucinous in three, solid cystic papillary tumour in one, metastasis from renal cancer in one and endocrine tumour in eight patients. RESULTS: Mortality rate was 0% and morbidity rate was 35%; pancreatic fistulas occurred in 25% of the cases and were treated conservatively. Results of postoperative endocrine and exocrine function tests were normal in all controlled patients. All the patients are alive without evidence of local recurrence. CONCLUSION: CP is a safe technique for benign or low-grade malignant tumours of the pancreatic neck that allows one to cure the tumour with evident functional results without increasing the risk to the patient.     

Percutaneous surgery of the forefoot compared with open technique — Functional results,complications and patient satisfaction

BackgroundThe use of percutaneous surgery is currently very common in foot and ankle surgery. The following prospective open-label patient-preference based study compares the traditional open technique versus the percutaneous surgery technique.MethodsThe current study describes the results of 287 patients operated due to forefoot deformities either by open surgery or percutaneously. 96 of them underwent hallux valgus corrective surgery. The rest had lesser toe deformities. They were followed for a period of up to 24 months, to assess the surgery related pain, complications, and patient satisfaction. 112 patients were operated using a conventional open technique were compared to 175 patients treated using a percutaneous technique. Technique choice was left to the patient preference, though older patients with disturbed blood flow, were advised to undergo percutaneous surgery.ResultsThere is less pain using the percutaneous techniques relative to the open technique during the first 6 post-operative weeks. The 6, and 24 months FAOS score is similar in both groups. Complications are rare in any of the groups, with a significantly higher ASEPSIS score in the open surgery group.CondclusionsPercutaneous forefoot surgery appears safe and efficacious, demonstrating equal radiographic (in a 96 strong cohort of hallux valgus patients) and clinical results at six and 24 months. Due to less post-operative pain, and less infection risk it appears that percutaneous techniques are superior to open technique in some respects of treatment and indeed the PGIC of patients was significantly higher in this group.     

Zygoma fixture in the management of advanced atrophy of the maxilla: technique and long‐term results

Despite refinements in surgical technique, including bone grafting and sophisticated prosthetic reconstructions, there are limitations to what can be achieved with bone‐anchored fixed prostheses in patients with advanced atrophy of the maxillae. A new approach was suggested by a long‐term study on onlay bone grafting and simultaneous placement of a fixture based on a new design: the zygoma fixture, and the aim of this study was to assess its potential. Twenty‐eight consecutive patients with severely resorbed edentulous maxillae were included, 13 of whom had previously had multiple fixture surgery in the jawbone that had failed. A total of 52 zygoma fixtures and 106 conventional fixtures were installed. Bone grafting was deemed necessary in 17 patients. All patients have been followed for at least five years, and nine for up to 10 years. All patients were followed up with clinical and radiographic examinations, and in some cases rhinoscopy and sinoscopy as well. Three zygoma fixtures failed; two at the time of connection of the abutment and the third after six years. Of the conventional fixtures placed at the time of the zygoma fixture, 29 (27%) were lost. The overall prosthetic rehabilitation rate was 96% after at least five years of function. There were no signs of inflammatory reaction in the surrounding antral mucosa. Four patients with recurrent sinusitis recovered after inferior meatal antrostomy. To conclude, the zygoma fixture seems to be a valuable addition to our repertoire in the management of the compromised maxilla.     

The patellofemoral joint in total knee arthroplasty: is the design of the trochlea the critical factor?

The outcome at 10 years is reported of a prospective study of 2 cohorts of total knee arthroplasties treated with (center A) or without (center B) patellar replacement. The same tibiofemoral components were used in all knees. The cohorts were demographically similar. A total of 124 patellae were treated by replacement, and 143 were treated without replacement. The clinical outcome and the patellofemoral revision rates were the same in the 2 cohorts: 1 patient required analgesia for anterior knee pain after replacement, and 1 without replacement required patellar replacement for pain. In the replaced group, patellofemoral survival on a best-case scenario was 100% at 10 years; on a worst-case scenario, 96%. One of the unreplaced patellae had been resurfaced for pain by 10 years. In view of the satisfactory and similar outcomes with and without replacement, we suggest that an appropriate design for the prosthetic trochlea, rather than the replacement or otherwise of the patella, is the main determinant of patellofemoral outcome in total knee arthroplasty. Patella replacement may be optional. Desirable trochlea design features are described.     

In vivo comparisons of patellofemoral kinematics before and after ADVANCE? Medial-Pivot total knee arthroplasty

Purpose

ADVANCE? Medial-Pivot (MP) (Wright Medical Technology, Arlington, TN, USA) total knee arthroplasty (TKA) was developed to replicate normal tibiofemoral knee joint kinematics, allowing medial-pivot knee motion. The design concept of the prosthesis is unique; therefore, the influence on the patellofemoral knee joint remains unclear at present. The purpose of this study was to determine the in vivo patellofemoral kinematics with ADVANCE? MP TKA and compare them with the pre-operative conditions.

Methods

ADVANCE? MP TKA was performed in ten subjects with osteoarthritis (OA). At before and one?month after surgery, lateral radiographs with weight-bearing at maximum extension, 30, 60 and 90° were taken, and patella flexion angle (PF), tibiopatellar angle (TP) and estimated patellofemoral contact point (PC) were evaluated, according to a previously reported method.

Results

In PF and TP, there was no statistically significant change between pre-operative and postoperative values. Pre-operative PC reached its peak at 90°; however, its peak was at 60° at one?month after surgery. Postoperative PC at maximum extension was significantly higher compared to before surgery.

Conclusions

The results in this study indicated that ADVANCE? MP TKA changed patellofemoral joint kinematics compared to before surgery. Early postoperative evaluation is the limitation of this study; however, we consider that the results in this study might be one of the keys to resolving the kinematic features of this prosthesis, helping clinicians to comprehend this prosthesis.     

Evaluation of patellofemoral joint in ADVANCE® Medial-pivot total knee arthroplasty

Purpose

ADVANCE® Medial Pivot (MP) (Wright Medical) total knee arthroplasty (TKA) was established to replicate normal tibio-femoral knee joint kinematics, however, its influence on the patello-femoral (PF) joint is unclear. The purpose in this study was to assess the PF joint conditions in Advance MP TKA, via radiography and three-dimensional image-matching software.

Methods

Ten subjects with osteoarthritis were treated with the ADVANCE MP TKA. Pre-operatively and one month after surgery, skyline views at 30, 60, and 90° of flexion were taken, and patella shift and tilt were measured. With 2D–3D registration techniques using software, implant orientations were matched with the pre-operative CT and changes in the anterior part of the femoral prosthesis, condylar twist angle (CTA) for femoral rotation, and tibial rotation were evaluated. The relationships between morphological and rotational changes were evaluated.

Results

There were significant differences in patella tilt at 60° and patella shift at all angles between pre- and post-operation (p < 0.05). No correlation was found between morphological changes in the anterior femur with patella tilt and shift. A positive correlation between postoperative CTA and patella shift at 90° was found (p < 0.05); however, no correlation was found between rotational alignment of the tibial component and patella tilt and shift.

Conclusions

ADVANCE MP TKA changed patello-femoral joint kinematics, compared to that found before surgery. The kinematic features were mainly due to the design concepts for tibio-femoral joint motion, indicating the difficulty to reproduce normal patello-femoral joint kinematics after TKA.     

Comparison of the accuracy of the Binkhorst,Colenbrander, and SRK™ implant power prediction formulas

The prediction accuracy of the Binkhorst, Colenbrander, and SRK™ formulas were compared in five series from different sources totalling 654 cases. The SRK™ formula was superior to both the other formulas by having a smaller average error per case, a smaller range of error from highest minus to highest plus, and a smaller proportion of cases with greater than 2 diopters (D) of error in all five series studied. In four of the five series, the SRK™ formula also had the greatest proportion of cases with less than 1 D of error.The Colenbrander formula was superior to the Binkhorst formula in all five series with regard to average error, proportion of cases with less than 1 D of error, and proportion of cases with more than 2 D of error. The range of error from highest minus to highest plus was equivalent with the two formulas.All available published literature on the accuracy of implant power prediction formulas was reviewed and appears to support our findings.     

Comparison of Permacol™ and Strattice™ for the repair of abdominal wall defects

Background  

Incisional hernias repaired with mesh can be expected have a lower recurrence rate than with primary repair. Biologic implants have replaced synthetic meshes in certain complex settings. We compared two porcine-dermis derived implants—cross-linked Permacol™ biologic implant and non-cross linked Strattice-firm™ tissue matrix—in a ventral hernia animal model. Our hypothesis is that cross-linked biologic implants are remodeled differently and thus behave differently than non-cross-linked biologic implants.     

Congenital penile curvature： long-term results of operative treatment using the plication procedure

Aim: To determine the long-term outcome, effectiveness and patient satisfaction of congenital penile curvature correction by plication of tunica albuginea. Methods: From January 1992 to January 2002, 106 young patients underwent surgical correction of congenital penile curvature by corporeal plication. Indications for operation were difficult or impossible vaginal penetration and cosmetic problems. The technique of corporeal plication consists of placing longitudinal plication sutures of 2-zero braided polyester on the convex side of the curvature until the curvature is corrected when erection is artificially induced. Results of this procedure were obtained by retrospective chart reviews and questionnaires via mail. Long-term follow-up ranged from 11 to 132 (mean 69.3) months and data were available for 68 patients. Results: Penile straightening was excellent in 62 patients (91%) and good with less than 15 degree of residual curvature in 6 patients (9 %). Sixty-seven patients reported no change in erectile rigidity or maintenance postoperatively, while 1 described early detumescence. Shortening of the penis without functional problems was noted by 26 patients (38 %). Thirty-Five patients (51%) reported feeling palpable indurations (suture knots) on the penis. Temporary numbness of glans penis was described in 3 patients. Overall, 60 patients were very satisfied, 6 satisfied, 2 unsatisfied. Conclusion: Corporeal plication is an effective and durable procedure with a high rate of patient satisfaction. (Asian J Androl 2004 Sep; 6: 273-276)     

The laparoscopic approach for radiofrequency ablation of hepatocellular carcinoma—indication, technique and results

Background

The therapeutic regimen for patients suffering of HCC in liver cirrhosis must pay attention to the underlying liver disease. Surgical resection is often limited by liver function and transplantation, as an optimal therapy for many early diagnosed HCC, by the availability of organs. Due to three prospective, randomized trials radiofrequency ablation (RFA) is the standard method of local ablation. RFA compared with resection for HCC in liver cirrhosis yields similar results concerning overall survival but a lower rate of complications. The laparoscopic approach may be advantageous concerning the major drawback of RFA which is still the rate of local failure as shown by a meta-analysis of local recurrences.

Method

Indication for RFA was HCC in liver cirrhosis either as a definite therapy or as a bridging procedure for transplantation if the expected waiting time exceeded 6 months. Laparoscopic ultrasound, standardized algorithm of laparoscopic RFA procedure, track ablation and a Trucut biopsy were performed. The postoperative follow-up was done according to institutional standards. Patient data and parameters of laparoscopic RFA were prospectively documented, analyzed and compared with the results of previously published series found in a Medline search.

Results

34 patients were treated by laparoscopic RFA. The average time of follow-up was 36.9?±?28.3 months. There was no procedure-related mortality or surgical complications. An upstaging of the tumor stage by laparoscopic ultrasound was achieved in 32 % of the patients. The overall survival of these patients was 44.7?±?6.9 months. The intrahepatic recurrence rate was 61.8 % based on the number of patients treated. The results have been analyzed and compared with six independent papers identified in a Medline search that report on the treatment of patients with HCC in a liver cirrhosis by laparoscopic RFA with a mean follow-up of 12 or more months.

Conclusions

Laparoscopic RFA is a feasible and reliable therapy for unresectable HCCs in patients with cirrhosis. The laparoscopic RFA combines the advantage of a minimally invasive procedure concerning liver dysfunction with the ability of an accurate intraoperative staging by laparoscopic ultrasound.     

Long-term histologic and mechanical results of a Permacol™ abdominal wall explant

Purpose  

We hypothesize that Permacol™ may allow controlled integration over time while providing long-term mechanical stability and native tissue remodeling. The purpose of this report is to investigate these properties in an explanted piece of Permacol™ after 2 years in vivo.     

After failed radial head arthroplasty,what are the options? Risk factors and results of revisions in a multicenter study

IntroductionFew multicenter studies have analyzed the outcome of revision surgery of radial head arthroplasties (RHA) in the medium term follow up. The objective is twofold: to determine the factors associated with revision of RHAs and to analyze the results of revision with 2 surgical techniques: isolated removal of the RHA or revision with a new RHA (R-RHA).HypothesisThere are associated factors of RHA revision and RHA revision results in satisfactory clinical and functional outcomes.MethodsTwenty-eight patients were included in this multicenter retrospective study, with all surgical indications for initial RHA being traumatic/post-traumatic. The mean age was 47 ± 13 years with a mean follow-up of 70 ± 48 months. This series included two groups: the isolated RHA removal group (n = 17) and the revision RHA with new radial head prosthesis (R-RHA) group (n = 11). Evaluation was clinical and radiological with univariate and multivariate analysis.ResultsTwo factors associated with RHA revision were identified: a pre-existing capitellar lesion (p = 0.047) and a RHA placed for a secondary indication (<0.001). Revision for all 28 patients resulted in improved pain (pre-op Visual Analog Scale 4.7 ± 3 vs. post-op 1.57 ± 2.2, p < 0.001), mobilities (pre-op flexion 118 ± 20 vs. post-op 130 ± 13, p = 0.03; pre-op extension −30 ± 21 vs post-op −20 ± 15, p = 0.025; pre-op pronation 59 ± 12 vs post-op 72 ± 17, p = 0.04; pre-op supination 48 ± 2 vs post-op 65 ± 22, p = 0.027) and functional scores. Mobility and pain control were, for stable elbows, satisfactory in the isolated removal group. When the initial or revision indication was instability, the DASH (Disabilities of the Arm, Shoulder and Hand = 10 ± 5) and MEPS (Mayo Elbow Performance score = 85 ± 16) scores were satisfactory in the R-RHA group.DiscussionIn the case of a radial head fracture, RHA is a satisfactory first-line solution without pre-existing capitellar injury, its results being much weaker in the case of ORIF failure and fracture sequelae. In case of RHA revision, isolated removal or R-RHA adapted according to the pre-operative radio-clinical exam.Level of evidenceIV.     

Early results and review of the literature of a novel hybrid surgical technique combining cervical arthrodesis and disc arthroplasty for treating multilevel degenerative disc disease: opposite or complementary techniques?

We report the clinical and radiological results on the safety and efficacy of an unusual surgical strategy coupling anterior cervical discectomy and fusion and total disc replacement in a single-stage procedure, in patients with symptomatic, multilevel cervical degenerative disc disease (DDD). The proposed hybrid, single-stage, fusion–nonfusion technique aims either at restoring or maintaining motion where appropriate or favouring bony fusion when indicated by degenerative changes. Twenty-four patients (mean age 46.7 years) with symptomatic, multilevel DDD, either soft disc hernia or different stage spondylosis per single level, with predominant anterior myeloradicular compression and absence of severe alterations of cervical spine sagittal alignment, have been operated using such hybrid technique. Fifteen patients underwent a two-level surgery, seven patients received a three-level surgery and two a four-level procedure, for a total of 59 implanted devices (27 disc prostheses and 32 cages). Follow-up ranged between 12 and 40 months (mean 23.8 months). In all but one patient clinical follow-up (neurological examination, Nurick scale, NDI, SF-36) demonstrated significant improvement; radiological evaluation showed functioning disc prostheses (total range of motion 3–15°) and fusion through cages. None of the patients needed revision surgery for persisting or recurring symptoms, procedure-related complications or devices dislocations. To the authors’ best knowledge, this is the first study with the longest available follow-up describing a different concept in the management of cervical multilevel DDD. Although larger series with longer follow-up are needed, in selected cases of symptomatic multilevel DDD, the proposed surgical strategy appears to be a safe and reliable application of combined arthroplasty and arthrodesis during a single surgical procedure.     

Is there an association between operative time and length of stay after shoulder arthroplasty?

BackgroundUnderstanding and reducing the length of stay (LOS) after orthopedic procedures has become essential with the implementation of bundled payment reimbursement models. Previous small cohort investigations have identified the risk factors for increased LOS after primary shoulder arthroplasty, such as renal insufficiency, cardiac disease, American Society of Anesthesiologists classification, and operative time >174 minutes.MethodsThe National Surgical Quality Improvement Program database was queried for all primary shoulder arthroplasty cases (Current Procedural Terminology code 23472) between 2008 and 2016, yielding 14,449 total patients. Univariate analysis using linear regression and independent sample t-tests were used to determine associations between LOS and the study variables. The outcome of interest was the association between operative time and LOS using multivariate regression models.ResultsOverall, the mean (±standard deviation) LOS was 2 (±2) days. Simple linear regression demonstrated age, gender, and operative time had significant positive correlations with the length of hospital stay (P < .001). Multivariate analysis showed that after adjusting for patient factors (age, gender, body mass index, and American Society of Anesthesiologists), longer operative times had significant associations with longer hospital stays (β = 0.109, standard error < 0.001, P value < .001).ConclusionThe results demonstrate LOS is associated with age, gender, and operative time. Operative time had the greatest effect on LOS after multivariate analysis. This study highlights the importance of operating room efficiency on healthcare quality and economics after shoulder arthroplasty.Level of evidenceLevel IV; Retrospective Case Series