Outcomes of secondary trapeziectomy after revision of trapeziometacarpal implants: a retrospective comparative matched study

We evaluated secondary trapeziectomy for revision of trapeziometacarpal implants and compared this to primary trapeziectomy with a matched retrospective single centre study performed between October 2003 and February 2015. Thirty-one patients with trapeziometacarpal prosthesis failure who had a secondary trapeziectomy were matched with a primary trapeziectomy regarding sex, date of the operation and age. We evaluated function, mobility, autonomy, pain, strength, complications and shortening of the thumb on radiographs. The median time until removal of the implant was 37 months. The median age in both groups was similar. Median follow-up was more than 7 years in both groups. There was no statistically significant difference in terms of function, mobility, autonomy, pain, strength, complications and shortening of the thumb. Secondary trapeziectomy after revision of trapeziometacarpal implants provides results comparable with primary trapeziectomy. Level of evidence: III

Influence of Gender on Occurrence of Aseptic Loosening and Recurrent PJI after Revision Total Knee Arthroplasty

Background: Periprosthetic joint infection (PJI) is a common yet severe complication after total knee arthroplasty (TKA). Surgical intervention and antibiotic therapy are obligatory to achieve successful, infection-free outcome. Compared to the outcomes after primary TKA, prosthesis failure rates are drastically increased after PJI-dependent revision surgery. Recurrent PJI and aseptic loosening are the most common reasons for prosthesis failure after revision TKA. An open question is the influence of the patients’ gender on long-term prosthesis survival after revision surgery. Additionally, it is unknown whether gender-related parameters and risk factors or differences in treatment are responsible for potential differences in outcome after revision arthroplasty. Patients and Methods: In this report, 109 patients that received TKA revision surgery due to PJI were retrospectively analyzed. We used clinical, paraclinical and radiological examinations to study the influence of gender on the long-term complications aseptic loosening and recurrent PJI after PJI-dependent revision arthroplasty. Results: While overall prosthesis failure rates and risk of recurrent PJI did not differ between genders, the long-term risk of aseptic loosening was significantly elevated in female patients. Postoperative coronal alignment was significantly more varus for women later diagnosed with aseptic loosening. Besides coronal alignment, no gender-dependent differences in clinical presentation or treatment were observed. Conclusions: Female patients displayed a significantly increased risk for aseptic loosening after PJI-dependent revision TKA. The observed gender-dependent differences in long-term outcome in our study support theories surrounding the role of bone metabolism in the development of aseptic loosening. Our data suggest that further research on a female design for PJI-dependent revision prostheses is warranted.

Pulmonary valve replacement following repair of tetralogy of Fallot: comparison of outcomes between bio- and mechanical prostheses

OBJECTIVES The aims of this study were to evaluate and compare the outcomes after pulmonary valve replacement (PVR) with a mechanical prosthesis (MP) and a bioprosthesis (BP). METHODS From 2004 through 2017, a total of 131 patients, who had already been repaired for tetralogy or Fallot or its variants, underwent their first PVR with an MP or a BP. Outcomes of interests were prosthesis failure (stenosis >3.5 m/s, regurgitation >mild or infective endocarditis) and reintervention. RESULTS The median age at PVR was 19 years. BP and MP were used in 88 (67.2%) and 43 (32.8%) patients, respectively. The median follow-up duration was 7.4 years, and the 10-year survival rate was 96.4%. Risk factors for prosthesis failure were smaller body surface area [hazard ratio (HR) 0.23 per 1 m2, P = 0.047] and smaller prosthesis size (HR 0.73 per 1 mm, P = 0.039). Risk factors for prosthesis reintervention were smaller body surface area (HR 0.11 per 1 m2, P = 0.011) and prosthesis size (HR 0.67 per 1 mm, P = 0.044). Probability of prosthesis failure and reintervention at 10 years were 24.6% (19.5% in BP vs 34.8% in MP, P = 0.34) and 7.8% (5.6% in BP vs 11.9% in MP, P = 0.079), respectively. Anticoagulation-related major thromboembolic events were observed in 4 patients receiving an MP. CONCLUSIONS MP might not be superior to BP in terms of prosthesis failure or reintervention. MP should be carefully considered for highly selected patients in the era of transcatheter PVR.

Internal hexagon versus conical implant–abutment connections: evaluation of 3-year postloading outcomes

Different types of internal implant–abutment connections, namely hexagon and conical, have been used for implant restoration. However, data regarding the benefits of these internal connections in terms of clinical outcomes are scarce. Accordingly, the aim of this study was to compare radiographic marginal bone loss (RMBL) and associated implant complications between implants with internal hexagon (IH) connections and those with internal conical (IC) connections. Forty-nine patients with 98 implants (two per patient) placed in the posterior mandible were recruited. All implants were inserted in pairs in solid D2 bone according to a randomized sequence; the first patient received an IH connection implant on the mesial side while the second patient received an IC connection implant on the mesial side. Each patient received one implant with an IH connection and one with an IC connection, placed side-by-side. Four months after placement, all implants were loaded with single screw-retained ceramic restorations with internal hexagon or conical connections. RMBL and complications, including implant/prosthesis failure, were recorded at the time of implant loading (baseline) and 6, 12, and 36 months after loading. The results revealed no significant between-group differences in RMBL (P = .74), gingival bleeding on probing (P = .29), and complications (P = .32). Thus, the type of internal implant–abutment connection did not affect clinical outcomes, including RMBL and implant/prosthesis failure. Future studies should additionally evaluate long-term prosthesis-related complications such as screw loosening and fracture between the two types of internal connections.

Microbiological and Cellular Evaluation of a Fluorine-Phosphorus-Doped Titanium Alloy, a Novel Antibacterial and Osteostimulatory Biomaterial with Potential Applications in Orthopedic Surgery

ABSTRACTJoint prosthesis failure is mainly related to aseptic loosening and prosthetic joint infections, both of which are associated with high morbidity and substantial costs for patients and health systems. The development of a biomaterial that is capable of stimulating bone growth while minimizing bacterial adhesion would reduce the incidence of prosthetic failure. We report antibacterial and osteostimulatory effects in a novel fluorine-phosphorus (F-P)-doped TiO2oxide film grown on Ti-6Al-4V alloy with a nanostructure of bottle-shaped nanotubes (bNT)using five bacterial species (Staphylococcus aureus,Staphylococcus epidermidis,Escherichia coli,Pseudomonas aeruginosa, andStenotrophomonas maltophilia) and MCT3T3-E1 osteoblastic cells. The interaction between the bacteria and bNT Ti-6Al-4V was complex, as the adhesion of four bacterial species decreased (two staphylococcus species,E. coli, andS. maltophilia), and the viability of staphylococci andS. maltophiliaalso decreased because of the aluminum (Al) released by bNT Ti-6Al-4V. This released Al can be recruited by the bacteria through siderophores and was retained only by the Gram-negative bacteria tested.P. aeruginosashowed higher adhesion on bNT Ti-6Al-4V than on chemically polished (CP) samples of Ti-6Al-4V alloy and an ability to mobilize Al from bNT Ti-6Al-4V. The cell adhesion and proliferation of MCT3T3-E1 osteoblastic cells significantly increased at 48 and 168 h, as did the matrix mineralization of these cells and the gene expression levels of three of the most important markers related to bone differentiation. According to our results, the bNT Ti-6Al-4V alloy could have clinical application, preventing infection and stimulating bone growth and thus preventing the two main causes of joint prosthesis failure.IMPORTANCEThis work evaluates F-P-doped bNT Ti-6Al-4V from microbiological and cellular approaches. The bacterial results highlight that the antibacterial ability of bNT Ti-6Al-4V is the result of a combination of antiadhesive and bactericidal effects exerted by Al released from the alloy. The cell results highlight that F-P bNT Ti-6Al-4V alloy increases osseointegration due to modification of the chemical composition of the alloy resulting from P incorporation and not due to the nanostructure, as reported previously. A key finding was the detection of Al release from inside the bNT Ti-6Al-4V nanostructures, a result of the nanostructure growth during the anodizing process that is in part responsible for its bactericidal effect.