Excellent results with the cemented Lubinus SP II 130-mm femoral stem at 10 years of follow-up: 932 hips followed for 5–15 years

Background and purpose

The Lubinus SP II stem is well documented in both orthopedic registries and clinical studies. Worldwide, the most commonly used stem lengths are 150 mm and 170 mm. In 1995, the 130-mm stem was introduced, but no outcome data have been published. We assessed the long-term survival of the Lubinus SP II 130-mm stem in primary total hip arthroplasty.

Patients and methods

In a retrospective cohort study, we evaluated 829 patients with a Lubinus SP II primary total hip arthroplasty (932 hips). The hips were implanted between 1996 and 2001. The primary endpoint was revision for any reason. The mean follow-up period was 10 (5–15) years.

Results

Survival analysis showed an all-cause 10-year survival rate of the stem of 98.7% (95% CI: 99.7–97.7), and all-cause 10-year survival of the total hip arthroplasty was 98.3% (95% CI: 99.3–97.3).

Interpretation

Excellent long-term results can be achieved with the cemented Lubinus SP II with the relatively short 130-mm stem. This stem has potential advantages over its 150-mm and 170-mm siblings such as bone preservation distal to the stem, better proximal filling around the prosthesis, and easier removal.The Lubinus SP II stem is a well-documented prosthesis (Annaratone et al. 2000, Lubinus et al. 2002, Catani et al. 2005, Wierer et al. 2013). The anatomical-shaped SP stem was introduced in 1982 as a monoblock prosthesis, and since 1984 it has been available as the modular SP II system. The anatomical-shaped stem provides a uniform cement mantle surrounding the prosthesis, which reduces the risk of contact between the prosthesis and cortical bone. It has been hypothesized that this more uniform cement mantle improves the survival of the prosthesis (Lubinus et al. 2002). Worldwide, the most commonly used stem lengths are 150 and 170 mm. In 1995, the 130-mm stem was introduced and since its introduction this has been the most frequently used stem in our hospital. This shorter stem has several theoretical advantages, such as preservation of bone stock and possibly a better filling of the proximal femur, subsequently leading to better options for revision. Theoretically, however, the shorter stem has less rotational stability.There is no literature specifically about the SP II 130-mm stem. Reports on 150-mm and 170-mm SP II stems show survival rates ranging from 90% to 98%, with a minimum of 10 years of follow-up (Annaratone et al. 2000, Lubinus et al. 2002, Catani et al. 2005, Makela et al. 2008, Espehaug et al. 2009, Wierer et al. 2013). The Swedish registry data are almost uniformly (> 98%) based on the 150-mm stem (Swedish register database 2013). We hypothesized that the long-term survival of the Lubinus SP II 130-mm stem in primary total hip arthroplasty would be no different from the reported survival of the 150-mm and 170-mm SP II femoral stems. This hypothesis was tested in a retrospective cohort study using revision for any reason as the primary endpoint.     

FDG PET as a predictor of response to resynchronisation therapy in patients with ischaemic cardiomyopathy

Purpose Although resynchronisation therapy (CRT) is a promising addition to heart failure therapy, a substantial number of patients do not respond to CRT. As FDG PET has routinely been used for prediction of improvement after revascularisation in ischaemic cardiomyopathy, it was hypothesised that there is also a relationship between the extent of viable tissue and improvement as a result of CRT. Methods Thirty-nine patients with ischaemic cardiomyopathy (ejection fraction 27 ± 9%) and a wide QRS complex underwent temporary pacing to determine the optimal pacing combination, i.e. that with the highest increase in cardiac index (CI) compared with baseline (measured by Doppler echocardiography). All patients also underwent FDG PET imaging. In 19 patients, CI measurements were repeated 10–12 weeks after permanent biventricular pacemaker implantation. Results Echocardiography (13-segment model) showed a mean of 9.8 ± 1.6 dyssynergic segments, with preserved FDG uptake in 4.1 ± 2.4 segments. CI improvement at the optimal pacing site was 20 ± 9%. There was a linear relationship between the extent of viable tissue and CI improvement during pacing (p < 0.001). Using a cut-off value of more than three viable segments (ROC analysis), FDG PET had a sensitivity of 72% and a specificity of 71% for detection of the presence of haemodynamic improvement (i.e. a CI improvement >15%). The relation between CI improvement and viable tissue was similar at follow-up. Conclusion A correlation was found between the extent of viable tissue and the haemodynamic response to CRT in patients with ischaemic cardiomyopathy, suggesting that FDG PET imaging may be useful to discriminate between responders and non-responders to CRT.     

Partial laryngectomy for recurrent glottic carcinoma after radiotherapy

BACKGROUND: Early laryngeal cancer is treated with surgery or radiotherapy. A partial laryngectomy instead of a total laryngectomy can be used for treating patients with radiation failures. METHODS: Patients were grouped by the two types of partial laryngectomies we performed: group I, endoscopic laser surgery (n = 42); and group II, frontolateral partial laryngectomy (n = 21). RESULTS: With CO2 laser treatment, 14 of 24 patients (no involvement of the anterior commissure) and eight of 18 patients (involvement of the anterior commissure) were cured. With the frontolateral partial laryngectomy, we achieved local control in 15 of 21 patients. CONCLUSIONS: If the surgeon is familiar with the different techniques of, and indications for, partial laryngectomy, this can be a good and satisfying treatment in selected patients with radiation failure for glottic cancer     

High revision rate after treatment of femoral neck fractures with an optionally (un)cemented stem

Background  The advantages of uncemented and cemented components in hip arthroplasty have been subject of debate. We have studied on a hemiprosthesis, which can be optionally implanted with or without cement. Since the stem geometry and surface in cemented arthroplasty differs from the uncemented one and cannot be fused into one general design, we hypothesised that this hemiprosthesis used without cement has a considerable high revision rate, based on aseptic loosening. Methods  A hemiprosthesis, which is designed for both cemented and uncemented fixation, was used (Conquest, Smith&Nephew). Preoperatively, the choice of whether to use cement or not was based on the shape and bone quality of the femoral canal. Revision rate and indication, mortality, perioperative complications and radiographic features of 151 consecutive hips in 146 patients were evaluated. Results  Twenty-three stems (15%) were implanted with cement and 128 (85%) without. After a mean follow-up of 2 years, a revision rate of 8.6% and a survival percentage of 90% (CI 85–95) were observed. Twelve uncemented stems warranted revision, compared with one cemented stem. Revision because of aseptic loosening was necessary in 7 (6%) stems, all uncemented. No differences in operation-related mortality and morbidity were observed. Conclusion  Because of the rather high revision rate, the authors advice not to use this hemiprosthesis without cement.     

The reliability of four widely used patellar height ratios

Purpose

The objective of this study was to evaluate the inter-observer reliability and the intra-observer reliability of four patellar height ratios: Insall-Salvati (IS), modified Insall-Salvati (MIS), Blackburne-Peel (BP) and Caton-Deschamps (CD).

Methods

The patellar height ratios were assessed by four independent examiners using weight-bearing lateral knee radiographs in 30° flexion. Intra-class correlation coefficients and Fleiss’ kappa’s were determined.

Results

The inter-observer reliability was excellent for the IS and moderate for the other ratios. When the ratio values were categorized, the inter-observer reliability was strong for the IS, moderate for the MIS and BP, and poor for the CD. The intra-observer reliability was excellent for the IS, MIS and CD, and strong for the BP. When the ratio values were categorized, the intra-observer reliability was strong for the IS and MIS, and moderate for the other ratios.

Conclusion

Although the IS showed best reliability, we advise to use the MIS as it showed the second best reliability but is, according to the literature, associated with better validity.

     

No evidence for the effectiveness of bracing in patients with thoracolumbar fractures: A systematic review

Background and purpose The use of braces is widespread in patients with thoracolumbar fractures. The effectiveness of bracing, however, is controversial. We sought evidence for the effect of bracing in patients with traumatic thoracolumbar fractures based on outcome and length of hospital stay (LOS). Furthermore, we evaluated the incidence of complications of bracing.Methods An electronic search strategy with extensive MeSH headings was used in various databases to identify studies that compared bracing and non-bracing therapies. Two reviewers independently selected systematic reviews, randomized controlled trials (RCTs), controlled clinical trials, and observational studies, and both assessed the methodological quality and extracted the data.Results No systematic reviews or RCTs were found. 7 retrospective studies were included. None of these studies showed an effect of bracing. Because of poor methodological quality, no best-evidence synthesis could be performed. One observational study was selected in which a complication of bracing was reported.Interpretation In the present literature, there is no evidence for the effectiveness of bracing in patients with traumatic thoracolumbar fractures. The lack of high-quality studies prevents relevant conclusions from being drawn.     

Hemodynamic changes with right lateral decubitus body positioning in the tilted porcine heart

Background. In beating-heart coronary surgical procedures, exposure of posterior vessels through sternotomy causes cardiac function to deteriorate. We hypothesized that turning the subject to the right lateral decubitus position before cardiac retraction improves exposure of posterior vessels and preserves cardiac pump function on displacement.

Methods. Eight 80-kg open-chest pigs were instrumented with catheter-tip manometers. After a stepwise 60-degree turn to the right lateral decubitus position of the body, the heart was retracted anteriorly to 90 degrees with a suction stabilizer.

Results. Right lateral body positioning caused an approximately 45-degree right deviation of the apex, thereby exposing the left atrial groove. Stroke volume, mean arterial pressure, right atrial pressure, and right ventricular end-diastolic pressure increased to 106% ± 5% (mean ± standard error of the mean, p = 0.31), 106% ± 3% (p = 0.01), 129% ± 8% (p = 0.001), and 171% ± 14% (p = 0.002), respectively, compared with control values. In contrast, left atrial pressure decreased to 73% ± 6% (p = 0.007), whereas left ventricular preload remained unchanged (110% ± 8%, p = 0.26). Additional anterior displacement to 90 degrees fully exposed the posterior vessels, and stroke volume decreased to 90% ± 3% (p = 0.01) and mean arterial pressure to 93% ± 5% (p = 0.07) at the expense of further increased right ventricular preload (256% ± 28%, p < 0.001).

Conclusions. By placing the subject in the right lateral decubitus position, exposure through sternotomy of posterior vessels in the beating porcine heart was facilitated while mean arterial pressure was maintained.     

MRI of carotid atherosclerosis to identify TIA and stroke patients who are at risk of a recurrence

Purpose:

To evaluate the potential of carotid plaque MRI to predict transient ischemic attack (TIA) and stroke recurrence in previously symptomatic patients.

Materials and Methods:

One hundred twenty‐six TIA/stroke patients with ipsilateral 30–69% carotid stenosis underwent multisequence carotid plaque MRI. The presence of a lipid‐rich necrotic core (LRNC), fibrous cap (FC) status, and intraplaque hemorrhage (IPH) were assessed. Patients were followed to determine the recurrence of ipsilateral TIA and/or stroke within 1 year after inclusion.

Results:

Thirteen patients suffered from recurrent ipsilateral clinical ischemic events (10 TIAs and 3 strokes). Carotid stenosis grade was not associated with recurrent events (hazard ratio [HR] for 50–69% versus 30–49% stenosis = 1.198; 95% confidence interval [CI], 0.383 to 3.749; P = 0.756). The presence of an LRNC (HR = 3.2001; 95% CI, 1.078 to 9.504; P = 0.036), a thin and/or ruptured FC (HR = 5.756; 95% CI, 1.913 to 17.324; P = 0.002), and IPH (HR = 3.542; 95% CI, 1.058 to 11.856; P = 0.040) were associated with recurrence.

Conclusion:

The presence of MRI‐depicted LRNC, a thin and/or ruptured FC, and IPH are associated with the recurrence of clinical cerebrovascular ischemic events in TIA and stroke patients with carotid atherosclerosis. J. Magn. Reson. Imaging 2013;37:1189–1194. © 2013 Wiley Periodicals, Inc.