Outcome of Debridement,Antibiotics, and Implant Retention With Modular Component Exchange in Acute Culture-Negative Periprosthetic Joint Infections

BackgroundModular component exchange and culture-directed antibiotic treatment is routinely employed for acute periprosthetic joint infection (PJI). However, as many as 7%-23% of PJIs have been reported to yield negative culture results. The efficacy of debridement, antibiotics, and implant retention (DAIR) with modular component exchange in the setting of acute culture negative PJI remains largely unknown. The aim of our study is to evaluate the outcomes of DAIR with modular component exchange in acute culture-positive and culture-negative PJI.MethodsA total of 149 consecutive patients with primary total joint replacements (90 total knee arthroplasties and 59 total hip arthroplasties) who underwent DAIR with modular component exchange for acute PJI with at least 3 years of follow-up were evaluated: (1) 46 culture-negative PJI patients and (2) 103 culture-positive PJI patients. Reinfection and aseptic revision rates along with complication rates were compared.ResultsThe reinfection rate for DAIR in acute culture-negative PJI was 13.0% compared to 19.4% in culture-positive PJI (P = .48). Mean survival time from reinfection between culture-negative (7.7 ± 0.4 years) and culture-positive (7.4 ± 0.3 years) PJI groups did not differ significantly (P = .40). Aseptic revision rates were 8.7% and 4.9% (P = .46), respectively, with loosening being the primary reason for implant failure in both cohorts.ConclusionsDespite lack of an identifying organism to guide postoperative antibiotic therapy, DAIR with modular component exchange for acute culture-negative PJI was associated with similar reinfection rates compared to acute culture-positive PJI, suggesting that culture negativity may not be a contraindication to DAIR in patients with acute PJI.     

Is a Titanium Implant for Total Knee Arthroplasty Better? A Randomized Controlled Study

BackgroundLighter weight and lower modulus are potential advantages of titanium (Ti) implants over cobalt chrome (CoCr) implants in total knee arthroplasty (TKA). This study was conducted to determine whether Ti implants in TKA resulted in better clinical outcomes and radiologic results.MethodsOne hundred and eight patients (216 knees) with knee arthritis warranting bilateral primary TKA were randomly allocated to undergo Ti rotating-platform TKA in one knee and CoCr rotating-platform TKA in the contralateral knee. The mean follow-up period was 5.3 years (range, 1-7 years). The weight of Ti implants was one-third lighter than that of CoCr implants (133.9 g vs 390.1 g, P < .01). Clinical outcomes were evaluated using clinical scores, patient preferences (lightness, comfort, naturalness, and satisfaction), gait analysis (kinetic and kinematic data), range of motion, and degree of pain. Radiologic results were evaluated based on the radiolucent line (RLL), degree of medial tibial bone loss, and loosening as seen on X-ray.ResultsNo significant differences were observed in clinical scores or patient preference. Regarding implant weight, approximately 70% of patients did not perceive the Ti implant as lighter. No significant differences were observed in gait analysis, range of motion, or degree of pain. The RLL was seen in 9% of the Ti implant group and 19% of the CoCr implant group.ConclusionThe lighter Ti implant did not show any clinical benefit over CoCr implants. The lightness of the Ti implant is not sufficient to matter or be noticeable. However, the Ti implant showed lower rate of RLL than the CoCr implant.Level of Evidencelevel I, randomized controlled trial.     

In vitro characterization of peptide-modified p(AAm-co-EG/AAc) IPN-coated titanium implants.

Interpenetrating polymer networks (IPNs) of poly(acrylamide-co-ethylene glycol/acrylic acid) [p(AAm-co-EG/AAc)] functionalized with an -Arg-Gly-Asp- containing peptide derived from rat bone sialoprotein [bsp-RGD(15)] were grafted to titanium implants in an effort to modulate osteoblast behavior in vitro. Surface characterization data were consistent with the presence of an IPN, and ligand density measurements established that the range of peptide density on the modified implants spanned three orders of magnitude (0.01-20 pmol/cm2). In vitro biological characterization of the modified implants employing the primary rat calvarial osteoblast (RCO) model resulted in the identification of a critical ligand density (0.01相似文献   

假体隆乳术后形态不佳的矫治

目的探讨假体置入隆乳术后形态不佳的原因和矫治方法。方法根据临床表现将乳房不佳分为5种类型：圆球型、上部膨隆型、下坠型、单侧双乳型及不规则型。通过松解纤维囊、纤维囊折叠缝合、重新分离隆乳腔隙、更换假体、乳房悬吊术等方法，进行矫治再次隆乳术。结果经过至少6个月随访观察，本组106例均获得了满意的手术效果。结论隆乳术后乳房形态不佳主要与假体体积过大、腔隙分离不到位、假体移位、乳房下皱襞过度分离、纤维囊挛缩及引流、包扎位置不当等因素有关，针对不同原因实施相应的手术方法矫治，能够获得满意的手术效果。     

Immediate rehabilitation of a rheumatoid arthritis patient with single-piece implants

Introduction and importanceThe aim of this article is to report the long-term outcome of full mouth rehabilitation with single piece, smooth surface implants following immediate loading protocol on a patient suffering with RA and severe unilateral condylar resorption.Case presentationHere, we present a challenging case of a patient suffering from Rheumatoid Arthritis who was stabilized and completed successfully with a 4 year follow-up period. Prosthetic management optimized the inter-occlusal relationship to maintain both function and esthetic integrity. Single piece implants are designed to engage and take support from the cortical bone low in metabolic activities thus promoting the force transmission through apical threads that are engaged in the cortical bone.DiscussionRheumatoid Arthritis [RA] is an auto-immune inflammatory condition in which the inflamed and hypertrophic synovial membrane grows into the articulation surfaces. The Temporomandibular Joints [TM] are frequently involved in rheumatoid arthritis. According to the literature on RA, due to frequent periodontitis, decreased salivary secretion, medication, as well as decrease in bone regenerative potential, RA is often considered as a relative contraindication in the use of implants. Atrophic jaws and cases with comorbidities like osteoporosis, diabetes, rheumatoid arthritis, periodontally infected cases are restored with high success by single piece smooth surface.ConclusionTo the best of our knowledge, this may be the first case of immediate functional loading by bi-cortical single piece implants.     

Primary versus revision implant for inflatable penile prosthesis: A propensity score-matched comparison

Inflatable penile prosthesis (IPP) provides excellent outcomes after virgin implants. However, few data on IPP after revision surgery are available. This study aimed at comparing the outcomes of IPP in patients undergoing primary or revision implant surgery. Patients who underwent revision implant surgery (Group 1) between 2013 and 2020 were identified. Overall, 20 patients (Group 1) could be matched with a contemporary matched pair cohort of surgery-naive patients (Group 2) in a 1:1 ratio. Patients in Group 2 had a significantly shorter operative time [median (IQR): 84 (65–97) vs. 65 (51–75) min; p = .01] and lower rate of overall complications (25% vs. 10%; p = .01). Of note, mean (SD) scores for the Quality of Life and Sexuality with Penile Prosthesis (QoLSPP) questionnaire demonstrated high satisfaction and IPP efficacy in both Groups 1 and 2: functional domain [3.9 (1.0) vs. 4.0 (1.2); p = .4], personal [3.9 (1.1) vs. 4.0 (1.1); p = .3], relational [3.8 (1.3) vs. 3.9 (1.1); p = .5] and social [3.9 (1.1) vs. 4.0 (1.2); p = .2]. These results suggest that in experienced hands, IPP offers high satisfaction to both patients and partners even in the setting of revision implant. However, it is mandatory to inform those patients about the increased risk of perioperative complications.     

Plain radiographs are inadequate to identify overlengthening with a radial head prosthesis

PURPOSE: A correctly sized radial head implant helps restore more normal elbow motion and load distribution and allows the collateral ligaments to heal in an anatomic position. No single method of measurement has been agreed on. We hypothesized that plain radiographs could be used to evaluate the appropriate length of a radial head prosthesis when we simulated different patterns of ligament disruption. METHODS: Osteotomies of the medial and lateral condyles were created in 6 cadaver specimens to simulate 4 conditions: ulnar collateral ligament (UCL) and lateral ulnar collateral ligament (LUCL) intact, UCL intact, LUCL intact, and UCL and LUCL disrupted. Radial heads were resected and replaced with correctly or incorrectly sized monopolar radial head implants. Radiographs were taken after simulated ligament injury with a radial head prosthesis that was either 2 mm too short, the appropriate length, or too long by either 2 or 4 mm. Measurements were recorded between radiographic markers to determine ulnohumeral joint displacement. A 4 x 4 x 2 repeated-measures analysis of variance was performed, as well as post hoc analyses using Tukey's honest significant difference test, to determine statistically significant changes in our radiographic measurements. RESULTS: Results showed that disruption of at least 1 ligament alters the ulnohumeral joint separation on the lateral but not on the anteroposterior radiograph. Overlengthening the radial head did not result in a statistically significant change in ulnohumeral space. CONCLUSIONS: Replicating radial length is an important but sometimes difficult step during radial head replacement. Standard radiographic assessment of the ulnohumeral joint will not demonstrate marked changes in the ulnohumeral space when the implant is underlengthened by 2 mm or overlengthened by as much as 4 mm, as long as the joint remains located. Disruption of at least 1 collateral ligament alters the ulnohumeral joint separation on the lateral but not on the anteroposterior radiograph.     

低温快速成形人工骨的敷贴植骨实验研究

目的：本研究采用低温冰型快速成型技术制造的PLGA-TCP人工骨行山羊颅骨贴敷移植，观察其成骨过程与性状，探讨其临床应用的可行性。方法：以PLGA和TCP为原料，依据山羊颅骨缺损的CT扫描数据，用低温快速成型机制造人工骨支架。取12只山羊随机分为实验组和对照组，实验组用复合rhBMP-2的活性人工骨支架材料进行山羊颅骨贴敷移植，对照组为未复合rhBMP-2的人工骨支架。术后4、12周进行影像学检查，术后12周取材进行组织学观察评价体内成骨。结果：大体观察、CT扫描及三维重建显示术后12周实验组成骨良好，植入人工骨体积缩小20％，紧贴颅骨表面。组织学检查可见新生骨沿人工骨支架材料形成。对照组植入物完全吸收，未发现有骨或软骨形成。两组植入物的周边均未发现炎症等异常反应。结论：低温冰型快速成型技术制造的PLGA-TCP人工骨支架，复合rhBMP-2后成为活性人工骨，在大型动物体内进行敷贴移植成骨性能良好。本研究为今后的临床应用奠定了较好的基础。     

口内支抗与微型种植体支抗近中移动下颌磨牙效果比较

目的：研究安氏I类错（牙合）患者中,分别采用微型种植体作支抗与口内前牙作支抗近移下颌磨牙进行比较,以评价两种方法的各自特点。方法：将24例成人患者随机分成两组,分别采用两种方法近移下颌磨牙。测量下颌第二磨牙在移动速度和近远中方向、垂直方向的位置变化,以衡量磨牙的位置改变,并通过下颌中切牙的位置变化,评价支抗强弱。结果：种植体作支抗组下颌第二磨牙平均近中移动8.5mm,疗程10.4个月,平均移动速度0.82mm/月,磨牙长轴向近中倾斜2.5°,磨牙垂直向压低0.28mm,下颌中切牙位置无改变。对照组下颌第二磨牙平均近中移动7.8mm,疗程10.2个月,平均移动速度0.76mm/月,磨牙长轴向近中倾斜角度7.5°,磨牙垂直向压低0.06mm,下颌中切牙发生舌向倾斜9.5°。下颌中切牙切端向舌侧移动了3.0mm。结论：两种方法比较,种植体的支抗更强,未见前牙支抗丧失。二者磨牙的移动方式有所区别。     

In vivo implant fixation of carbon fiber‐reinforced PEEK hip prostheses in an ovine model

Carbon fiber‐reinforced polyetheretherketone (CFR/PEEK) is theoretically suitable as a material for use in hip prostheses, offering excellent biocompatibility, mechanical properties, and the absence of metal ions. To evaluate in vivo fixation methods of CFR/PEEK hip prostheses in bone, we examined radiographic and histological results for cementless or cemented CFR/PEEK hip prostheses in an ovine model with implantation up to 52 weeks. CFR/PEEK cups and stems with rough‐textured surfaces plus hydroxyapatite (HA) coatings for cementless fixation and CFR/PEEK cups and stems without HA coating for cement fixation were manufactured based on ovine computed tomography (CT) data. Unilateral total hip arthroplasty was performed using cementless or cemented CFR/PEEK hip prostheses. Five cementless cups and stems and six cemented cups and stems were evaluated. On the femoral side, all cementless stems demonstrated bony ongrowth fixation and all cemented stems demonstrated stable fixation without any gaps at both the bone‐cement and cement‐stem interfaces. All cementless cases and four of the six cemented cases showed minimal stress shielding. On the acetabular side, two of the five cementless cups demonstrated bony ongrowth fixation. Our results suggest that both cementless and cemented CFR/PEEK stems work well for fixation. Cup fixation may be difficult for both cementless and cemented types in this ovine model, but bone ongrowth fixation on the cup was first seen in two cementless cases. Cementless fixation can be achieved using HA‐coated CFR/PEEK implants, even under load‐bearing conditions. © 2012 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 31: 485–492, 2013