Risk factors for long-term mortality after acute aortic dissection-results of the German registry for acute aortic dissection type a long-term follow-up.

Objectives: Several short-term analyses from German Registry for Acute Aortic Dissection Type A (GERAADA) have been published. This study investigated whether short-term risk factors are transferable to the long-term prognosis of patients.

Methods: Thirty-three centres with 2686 patients participated in the long-term follow-up.

Capsule elongation occurs after first time shoulder dislocation A biomechanical in-vitro investigation on human cadaveric specimen.

Purpose: As capsule elongation is assumed to weaken the static stability of the shoulder joint, the purpose of this biomechanical study was to demonstrate that capsule elongation occurs immediately after a first-time shoulder dislocation and not just after recurrent dislocation events. We hypothesize an increment in joint clearance due to joint capsule elongation after a first-time dislocation.

Methods: An experimental in-vitro study was conducted on 6 paired fresh frozen human shoulders (4 females; 2 males; 12 specimen) with a mean age of 80 (Range 67-89) years.

Is taper corrosion in modular revision hip stem junctions associated with patient or implant specific factors? A retrieval analysis.

Implant modularity within revision total hip arthroplasty (THA) offers multiple implant configurations and allows surgeons a high intraoperative flexibility to restore functionality to the patients joint, even in complex revision cases. However, a rare but devastating complication for patients, clinicians and manufacturers presenting a breakage of the taper junction between the distal stem and the proximal implant part. Aside from implant and patient specific risk factors, corrosion and fretting at the stem junctions have been associated with taper failure.

[Current design and cement mantle thickness in hip arthroplasty : Theory and analysis of register data].

Background: In this article, an overview and comparison of the most commonly used cemented hip stems, grouped into different stem types and cement mantle thickness, is given to see which combination performs well.

Methodology: Revision rates of cemented stem types were categorized from the Endoprosthesis Register-Germany, and 3‑ and 5‑year revision rates were reported and analyzed. For the research, the focus was on the Exeter, C‑Stem, MS-30, Excia, Bicontact, Charnley, Müller straight stem, Twinsys, Corail, Avenir, Quadra, and the Lubinus SP II stems.

Primary bone graft stability after Latarjet surgery: biomechanical evaluation of a fixation technique with metal-free all-suture cerclage vs. cortical screws.

Background: To reduce hardware-related complications in coracoid graft fixation to the anterior aspect of the glenoid, a metal-free Latarjet technique was recently introduced. The aim of this study was to compare the primary stability of a classic Latarjet procedure with 2 metal screws to a novel metal-free, all-suture cerclage method. It is hypothesized that fixation of the coracoid graft with 2 malleolar screws will provide higher primary stability compared with an all-suture cerclage technique.

CUX1-related neurodevelopmental disorder: deep insights into phenotype-genotype spectrum and underlying pathology.

Heterozygous, pathogenic CUX1 variants are associated with global developmental delay or intellectual disability. This study delineates the clinical presentation in an extended cohort and investigates the molecular mechanism underlying the disorder in a Cux1 mouse model. Through international collaboration, we assembled the phenotypic and molecular information for 34 individuals (23 unpublished individuals).

Stability of ceramic coatings on retrieved knee prostheses.

Background: In total knee arthroplasty, femoral components with coated or oxidized surfaces are commonly used as alternative to CoCrMo in metal sensitive patients. Data on the in vivo behaviour of different coating types is, however, rare. Aim of the study was the investigation of coating stability with respect to implant and patient specific parameters.

Precision of slot widths and torque transmission of in-office 3D printed brackets : An in vitro study.

Purpose: To investigate a novel in-office three-dimensionally (3D) printed polymer bracket regarding slot precision and torque transmission.

Methods: Based on a 0.022″ bracket system, stereolithography was used to manufacture brackets (N = 30) from a high-performance polymer that met Medical Device Regulation (MDR) IIa requirements.

Is TKA femoral implant stability improved by pressure applied cement? a comparison of 2 cementing techniques.

Background: The majority of knee endoprostheses are cemented. In an earlier study the effects of different cementing techniques on cement penetration were evaluated using a Sawbone model. In this study we used a human cadaver model to study the effect of different cementing techniques on relative motion between the implant and the femoral shaft component under dynamic loading.

Efficacy of an Antibiotic Loaded Ceramic-Based Bone Graft Substitute for the Treatment of Infected Non-Unions.

The treatment of non-unions is often complicated by segmental bone defects and bacterial colonization. Because of the limited availability of autologous bone grafts, tissue engineering focuses on antibiotic-loaded bone graft substitutes. HACaS+G is a resorbable calcium sulphate-hydroxyapatite loaded with gentamicin.

Pulsatile lavage systems and their potential to penetrate soft tissue.

Background: In orthopedic and trauma surgery, pulsatile lavage systems are used to clean soft tissue. This may be necessary in septic surgeries or in case of contaminated wounds after trauma. Positive features such as reduction of bacterial contamination and removal of foreign particles are counterbalanced by negative aspects such as bacterial seeding in deeper tissue layers, damage to various tissues and even cases of air embolism.

[Partial or full component exchange in hip revision? : The relevance of off-label use and mix & match].

Off-label use is frequently practiced in hip revision arthroplasty, as there may be indications for the application of implants for purposes outside the one the manufacturers intended (i.e. large bone and soft tissue defects, obesity).

Taper corrosion in total hip arthroplasty - How to assess and which design features are crucial?

Background: In total hip replacement, wear and corrosion arising from modular taper connections have increasingly become a serious clinical concern. Previous studies led to confounding results regarding the role of specific taper design features, likely due to the application of different analytical approaches. Accordingly, this study has two major objectives: first, to evaluate different analytical approaches to evaluate the fretting-corrosion behavior; and secondly to determine the effect of four specific design variables: the taper engagement situation, the stem taper length and surface topography in terms of roughness and contact ratio.

Explant analysis and implant registries are both needed to further improve patient safety.

In the early days of total joint replacement, implant fracture, material problems and wear presented major problems for the long-term success of the operation. Today, failures directly related to the implant comprise only 2-3% of the reasons for revision surgeries, which is a result of the material and design improvements in combination with the standardization of pre-clinical testing methods and the post-market surveillance required by the legal regulation. Arthroplasty registers are very effective tools to document the long-term clinical performance of implants and implantation techniques such as fixation methods in combination with patient characteristics.

Does Kinematic Alignment Increase Polyethylene Wear Compared With Mechanically Aligned Components? A Wear Simulation Study.

Background: Kinematic alignment is an alternative approach to mechanical alignment. Kinematic alignment can restore the joint line to its prearthritic condition, and its advocates have suggested it may be associated with other benefits. But this alignment approach often results in tibial components that are placed in varus and femoral components that are placed in valgus alignment, which may result in an increased risk of component loosening because of wear.

Influence of FeCl and HO in corrosion testing of modular taper connections in total hip arthroplasty: An in vitro study.

Corrosion at the modular taper junctions in total hip arthroplasty is clinically relevant because wear particles and ions generated at this interface can lead to adverse local tissue reactions or even implant failure. In vitro tribo-corrosion tests are usually accomplished in saline solutions or calf serum (CS), but the addition of HO and FeCl have been suggested to mimic inflammatory conditions in the joint. Inflammatory conditions may aggravate corrosive processes and, therefore, should lead in vitro to a more severe and realistic tribo-corrosive material attack.

Does tibial design modification improve implant stability for total knee arthroplasty? An experimental cadaver study.

Aims: One of the main causes of tibial revision surgery for total knee arthroplasty is aseptic loosening. Therefore, stable fixation between the tibial component and the cement, and between the tibial component and the bone, is essential. A factor that could influence the implant stability is the implant design, with its different variations.

Insights into Imprinting: How Is the Phenomenon of Tribocorrosion at Head-Neck Taper Interfaces Related to Corrosion, Fretting, and Implant Design Parameters?

Background: Wear and corrosion at modular neck tapers in THA can lead to major clinical implications such as periprosthetic osteolysis, adverse local tissue reactions, or implant failure. The material degradation processes at the taper interface are complex and involve fretting corrosion, third-body abrasion, as well as electrochemical and crevice corrosion. One phenomenon in this context is imprinting of the head taper, where the initially smooth surface develops a topography that reflects the rougher neck taper profile.

Effect of surface topography and residual stress on the taper connection stability in total hip arthroplasty.

In the present work, the influence of the trunnion surface topography and the near-surface residual stresses on the joining process of a taper connection is examined using a replicate of the realistic taper connection as it occurs in conventional hip joint implants. The focus of the work is on the surface of the taper trunnion made of Ti6Al4V ELI and its effect on the connection stability with a CoCrMo counterpart. In this regard, the interrelation between surface topography, residual stresses, the joining behavior and the corrosion behavior under dynamic loading have been systematically investigated.

Wear investigation based on a novel, anatomic shoulder prosthesis with bearing materials inversion.

Introduction: In shoulder arthroplasty, ultra-high-molecular-weight polyethylene is used as standard material for glenoid components. The emergence of wear particles and their influence on the aseptic loosening of joint replacements are well known. The aim of the present study is to investigate the wear behaviour of the implant combinations as well as the size and morphology of the released wear particles from novel anatomic shoulder prosthesis.

EFORT recommendations for off-label use, mix & match and mismatch in hip and knee arthroplasty.

Off-label use is frequently practiced in primary and revision arthroplasty, as there may be indications for the application of implants for purposes outside the one the manufacturers intended.Under certain circumstances, patients may benefit from selective application of mix & match. This can refer to primary hip arthroplasty (if evidence suggests that the combination of devices from different manufacturers has superior results) and revision hip or knee arthroplasty (when the exchange of one component only is necessary and the invasiveness of surgery can be reduced).

Cement debonding behaviors of the various tibial components of the ATTUNE knee system and its predecessors: Is a cement-in-cement revision an alternative?

Background: Aseptic loosening remains one of the most common causes of revision of the tibial component for total knee arthroplasty. A stable bond between implant and cement is essential for appropriate long-term results. The aim of our in vitro study was to investigate the maximum failure load of tibial ATTUNE prosthesis design alternatives compared with a previous design.

Primary Stability in Hip Revision Arthroplasty: Comparison of the Stability of Cementless Fixed Augments on a Modular Acetabular Cage System with and without Cranial Straps.

The goal of this study is to evaluate the primary stability of a cementless augment-and-modular-cage system with and without the addition of cranial straps in a standardized in vitro setting. As the surrogate parameter for the evaluation of primary stability, the measurement of relative motion between the implant components themselves and the bone will be used. Acetabular revision components with a trabecular titanium augment in combination with a large fourth-generation composite left hemipelvis were assembled.

The Expression Levels of Toll-like Receptors after Metallic Particle and Ion Exposition in the Synovium of a Murine Model.

To date, the exact role of specific Toll-like receptors (TLRs) in regulating immune reactivity to metallic byproducts of orthopedic implants has not been fully clarified. In light of the situation, our objective in this investigation was to assess the expression levels of surface TLRs after metallic particle and ion exposure in an established animal model. Ten female BALB/c mice in each group received intra-articular injections of phosphate buffer (PBS) (control), metallic particles (MP), and metallic ions (MI), respectively.

[Typing and particle analysis of squeaking hip endoprostheses : First histopathological analysis to examine the squeaking pathogenesis of ceramic-on-ceramic bearings].

Background: Since the use of ceramic-on-ceramic (CoC) hip endoprostheses complications in the form of squeaking noises have occasionally occurred.

Objectives: This is the first histopathological analysis of the synovia-like interface membrane (SLIM) of ceramic squeaking hip endoprostheses with the aim to gain new insights into the squeaking pathogenesis.

Materials And Methods: Seven CoC hip endoprostheses with squeaking pathogenesis are analyzed by SLIM consensus classification, particle algorithm, CD3 quantification, semiquantitative CD68 macrophages, Oil-Red positive macrophages, hemosiderin evaluation and in two cases by energy dispersive X‑ray spectroscopy (EDX).