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Hatamleh MM, Hatamlah HM, Nuseir A. Maxillofacial prosthetics and digital technologies: Cross-sectional study of healthcare service provision, patient attitudes, and opinions. J Prosthodont 2024; 33:231-238. [PMID: 37218377 DOI: 10.1111/jopr.13718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/18/2023] [Indexed: 05/24/2023] Open
Abstract
PURPOSE Digital technologies are continuously improving the accuracy and quality of maxillofacial prosthetics, but their impact on patients remains unclear. This cross-sectional study aimed to analyze the impact of facial prosthetics service provision, patients' perception, and digital technology on prostheses construction. MATERIALS AND METHODS All patients who presented for evaluation and management of facial defects between January 2021 and December 2021 at the ENT clinic were eligible for study enrollment. Patients requiring prosthetic reconstruction of their missing facial parts were included in the study. Forty-five questionnaires were delivered, inquiring about the patients' prosthetic demographics, prosthesis manufacture using 3D technologies, and their perceptions and attitudes. RESULTS A total of 37 patients responded (29 males, eight females; mean age 20.50 years). The congenital cause was the highest among other causes (p = 0.001) with auricular defects being the highest (p = 0.001). A total of 38 prostheses were constructed and 17 prostheses were retained by 36 craniofacial implants (p = 0.014). The auricular and orbital implants success rates were 97% and 25%, respectively. The implant locations were digitally planned pre-operatively. Digital 3D technologies of defect capture, data designing, and 3D modeling were used and perceived as helpful and comfortable (p = 0.001). Patients perceived their prosthesis as easy to handle, suited them, and they felt confident with it (p = 0.001). They wore it for more than 12 h daily (p = 0.001). They were not worried that it would be noticed, and found it comfortable and stable during various activities (p = 0.001). Implant-retained prosthesis patients were more satisfied with it, and found it easy to handle and stable (p = 0.001). CONCLUSIONS Congenital defects are the main cause of facial defects in the study country. The overall acceptance of maxillofacial prostheses was good, showing high patient perception and satisfaction. Ocular and implant-retained silicone prostheses are better handled, more stable, and the latter is more satisfying than traditional adhesive prostheses. Digital technologies save time and effort invested in manufacturing facial prostheses.
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Affiliation(s)
| | - Heba Mohammad Hatamlah
- Department of Hospital Management, Faculty of Business, Philadelphia University, Amman, Jordan
| | - Amjad Nuseir
- ENT Department, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Al Qahtani WM. Comparative Finite Element Analysis of Endocrowns and Traditional Restorations for Endodontically Treated Mandibular First Molars. Med Sci Monit 2023; 29:e941314. [PMID: 37941316 PMCID: PMC10644702 DOI: 10.12659/msm.941314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/24/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND This study evaluated 2 endocrown designs and traditional restoration with a conventional crown using post and core to find the best restoration design for endodontically treated mandibular first molars. MATERIAL AND METHODS Three 3D finite element models were constructed: (1) post and core restoration, (2) endocrown butt joint margin design, and (3) endocrown with shoulder finish line. The intact tooth geometry was extracted with computed tomography, then modified to the selected restoration designs. Bone and mucosa geometry was simplified and represented as 3 cylinders. Two loading cases were examined on E-max crowns as 400N and 200N vertically and 45º oblique, respectively, that were located at buccal cusp tips and central fossa by nodal force distributed on circular areas with 0.5-mm diameter in each location. RESULTS Traditional restoration kept crown deformation and stresses at lower levels than did endocrowns. Results of the butt joint margin design were comparable to that of shoulder finish line design. Cement had the lowest stress values under shoulder finish line design, while the remaining tooth indicated the superiority of butt joint margin design, with less stresses by 20% and 24%, compared with traditional and shoulder finish line restorations, respectively. CONCLUSIONS The 3 tested restoration designs worked well. Although the differences were small, according to stress analysis results, conventional restoration by post and core achieved the best performance, followed by butt joint margin, which ensures lowest level of stresses on dentine. Finally, the shoulder finish line endocrown can replace the other designs but with higher stress levels.
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Zhang ZH, Qi YS, Wei BG, Bao HRC, Xu YS. Application strategy of finite element analysis in artificial knee arthroplasty. Front Bioeng Biotechnol 2023; 11:1127289. [PMID: 37265991 PMCID: PMC10230366 DOI: 10.3389/fbioe.2023.1127289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 03/27/2023] [Indexed: 06/03/2023] Open
Abstract
Artificial knee arthroplasty, as the most effective method for the treatment of end-stage joint diseases such as knee osteoarthritis and rheumatoid arthritis, is widely used in the field of joint surgery. At present, Finite element analysis (FEA) has been widely used in artificial knee replacement biomechanical research. This review presents the current hotspots for the application of FEA in the field of artificial knee replacement by reviewing the existing research literature and, by comparison, summarizes guidance and recommendations for artificial knee replacement surgery. We believe that lower contact stress can produce less wear and complications when components move against each other, in the process of total knee arthroplasty (TKA), mobile-bearing prostheses reduce the contact surface stress of the tibial-femoral joint compared with fixed-bearing prostheses, thus reducing the wear of the polyethylene insert. Compared with mechanical alignment, kinematic alignment reduces the maximum stress and maximum strain of the femoral component and polyethylene insert in TKA, and the lower stress reduces the wear of the joint contact surface and prolongs the life of the prosthesis. In the unicompartmental knee arthroplasty (UKA), the femoral and tibial components of mobile-bearing prostheses have better conformity, which can reduce the wear of the components, while local stress concentration caused by excessive overconformity of fixed-bearing prostheses should be avoided in UKA to prevent accelerated wear of the components, the mobile-bearing prosthesis maintained in the coronal position from 4° varus to 4° valgus and the fixed-bearing prosthesis implanted in the neutral position (0°) are recommended. In revision total knee arthroplasty (RTKA), the stem implant design should maintain the best balance between preserving bone and reducing stress around the prosthesis after implantation. Compared with cemented stems, cementless press-fit femoral stems show higher fretting, for tibial plateau bone defects, porous metal blocks are more effective in stress dispersion. Finally, compared with traditional mechanical research methods, FEA methods can yield relatively accurate simulations, which could compensate for the deficiencies of traditional mechanics in knee joint research. Thus, FEA has great potential for applications in the field of medicine.
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Affiliation(s)
- Zi-Heng Zhang
- Orthopedics Center, Inner Mongolia People’s Hospital, Hohhot, China
- Graduate School, Inner Mongolia Medical University, Hohhot, China
| | - Yan-Song Qi
- Orthopedics Center, Inner Mongolia People’s Hospital, Hohhot, China
| | - Bao-Gang Wei
- Orthopedics Center, Inner Mongolia People’s Hospital, Hohhot, China
| | - Hu-Ri-Cha Bao
- Orthopedics Center, Inner Mongolia People’s Hospital, Hohhot, China
| | - Yong-Sheng Xu
- Orthopedics Center, Inner Mongolia People’s Hospital, Hohhot, China
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Anderson CB, Fatone S, Mañago MM, Swink LA, Hager ER, Kittelson AJ, Christiansen CL, Magnusson DM. Improving shared decision-making for prosthetic care: A qualitative needs assessment of prosthetists and new lower-limb prosthesis users. Prosthet Orthot Int 2023; 47:26-42. [PMID: 35622457 PMCID: PMC9691789 DOI: 10.1097/pxr.0000000000000142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 03/14/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Prosthesis design is complex and multiple appropriate options exist for any individual with lower-limb amputation. However, there is insufficient evidence for guiding decision-making. Shared decision-making (SDM) offers an opportunity to incorporate patient-specific values and preferences where evidence is lacking for prosthesis design decisions. To develop resources to facilitate SDM, and consistent with the International Patient Decision Aid Standards, it is necessary to identify the decisional needs of prosthetists and prosthesis users for prosthesis design decisions. OBJECTIVES To assess the needs of prosthetists and new prosthesis users for SDM about the first prosthesis design. STUDY DESIGN Qualitative descriptive design. METHODS Six focus groups were conducted with 38 prosthetists. Individual semistructured interviews were conducted with 17 new prosthesis users. Transcripts were analyzed using directed content analysis, with codes defined a priori using existing frameworks for SDM: the Three Talk Model for SDM and the Ottawa Decision Support Framework. RESULTS Four main themes were identified among prosthetists and prosthesis users: acknowledging complexity in communication, clarifying values, recognizing the role of experience to inform preferences , and understanding the prosthetic journey . CONCLUSIONS Resources that support SDM for the first prosthesis design should consider methods for identifying individual communication needs, support with clarifying values, and resources such as experience for achieving informed preferences, within the context of the overall course of rehabilitation and recovery following lower-limb amputation. The themes identified in this work can inform SDM to promote collaborative discussion between prosthetists and new prosthesis users when making prosthesis design decisions.
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Affiliation(s)
- Chelsey B. Anderson
- Department of Physical Medicine and Rehabilitation, Physical Therapy Program, University of Colorado, Aurora, CO, USA
- Department of Research, Geriatric Research, Education, and Clinical Center, VA Eastern Colorado Healthcare System, Aurora, CO, USA
| | - Stefania Fatone
- Department of Rehabilitation Medicine, Division of Prosthetics and Orthotics, University of Washington, Seattle, WA, USA
| | - Mark M. Mañago
- Department of Physical Medicine and Rehabilitation, Physical Therapy Program, University of Colorado, Aurora, CO, USA
- Department of Research, Geriatric Research, Education, and Clinical Center, VA Eastern Colorado Healthcare System, Aurora, CO, USA
| | - Laura A. Swink
- Department of Physical Medicine and Rehabilitation, Physical Therapy Program, University of Colorado, Aurora, CO, USA
- Department of Research, Geriatric Research, Education, and Clinical Center, VA Eastern Colorado Healthcare System, Aurora, CO, USA
| | - Emily R. Hager
- Department of Physical Medicine and Rehabilitation, Physical Therapy Program, University of Colorado, Aurora, CO, USA
- Department of Research, Geriatric Research, Education, and Clinical Center, VA Eastern Colorado Healthcare System, Aurora, CO, USA
| | - Andrew J. Kittelson
- Department of Physical Therapy and Rehabilitation Science, University of Montana, Missoula, MT, USA
| | - Cory L. Christiansen
- Department of Physical Medicine and Rehabilitation, Physical Therapy Program, University of Colorado, Aurora, CO, USA
- Department of Research, Geriatric Research, Education, and Clinical Center, VA Eastern Colorado Healthcare System, Aurora, CO, USA
| | - Dawn M. Magnusson
- Department of Physical Medicine and Rehabilitation, Physical Therapy Program, University of Colorado, Aurora, CO, USA
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Tang S, Zheng L, Luo Y, Wu R, Tian Q, Wang L. Validation of an MRI Technique for the 6-DOF Knee Kinematics Measurement. Front Bioeng Biotechnol 2022; 10:904012. [PMID: 36601392 PMCID: PMC9806800 DOI: 10.3389/fbioe.2022.904012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 06/09/2022] [Indexed: 01/07/2023] Open
Abstract
Background: For total knee arthroplasty (TKA), the optimal rotational position of the femoral component is felt to be critically important. The current knee joint kinematics measurement technology is unable to identify the exact rotation axis of the knee joint, the main reasons being low measurement accuracy and insufficient three-dimensional data (2D-3D image matching technology). In order to improve the effect of TKA surgery, we proposed a knee joint kinematics measurement method, based on the MRI technology, and verified its measurement accuracy. We then employed this method to identify the personalized optimal rotation axis of the knee joint for TKA patients. Purposes: The purpose of the study was 1) to propose a method for measuring knee joint kinematics and verify its accuracy and 2) to propose a method for determining the optimal rotation axis of knee joint for TKA surgery, based on accurate kinematic measurement results. Materials and Methods: The experiment was divided into two parts: in vitro and in vivo. The purpose of the in vitro experiment was to verify the measurement accuracy of our method. We fixed two aquarium stones (approximately 10 cm * 10 cm * 10 cm in size, close to the size of the distal femur and proximal tibia) firmly on the fixed and moving arms of the goniometer/vernier caliper with glue and immersed the aquarium stones in the water to capture MRI images. The MRI images were then processed with MATLAB software, and the relative motion of the two aquarium stones was measured. The measurement accuracy of our method was verified via the scale reading of the moving arm on the goniometer/vernier caliper. In vivo, 36 healthy elderly participants (22 females, 14 males) were recruited from the local community; our method was then employed to measure the relative motion of the tibia and femur and to observe the rollback and screw home motion of the medial/lateral condyle of the femur, which was identified as specific kinematic features of the knee joint. Results: In vitro, all measurements were accurate to <1 mm and <1°. In vivo, all knee measurements showed rollback motion (the rollback distance of the medial femoral condyle was 18.1 ± 3.7 mm and that of the lateral condyle was 31.1 ± 7.3 mm) and screw home motion. Conclusion: In the application scenario of knee joint kinematics measurement, our method has an accuracy of <1° of rotation angle and <1 mm of translation for all reference points, and it can be employed to identify the most stable axis of the knee joint. Significance: Using our method to accumulate data on the knee rotation axis of more subjects to establish an average rotation axis of a given population may help in knee prosthesis design and reduce the patient dissatisfaction rate. Individually measuring the patient's rotation axis before TKA surgery and adjusting the prosthesis installation in TKA may further reduce the patient dissatisfaction rate, and automatic computer measurement may be realized in the future, but it is still time-consuming for now.
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Affiliation(s)
- Shixiong Tang
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, China,Clinical Research Center for Medical Imaging in Hunan Province, Changsha, China
| | - Liwen Zheng
- Department of Rehabilitation, The Second Xiangya Hospital, Central South University, Changsha, China,*Correspondence: Liwen Zheng,
| | - Yongheng Luo
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Ren Wu
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Qunyan Tian
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Lei Wang
- School of Information Science and Engineering, Central South University, Changsha, China
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Bae EJ, Kim JH, Lim JY. Evaluation of internal fit of press ceramic and porous structured cobalt-chromium crown fabricated by additive manufacturing. Dent Res J (Isfahan) 2022; 19:65. [PMID: 36159048 PMCID: PMC9490247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 06/19/2021] [Accepted: 09/06/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The purpose of this in vitro study is to fabricate a novel metal-ceramic prosthesis with a porous structure, to compensate for the disadvantages associated with the design of existing prostheses, and to measure the internal fit of this prosthesis. MATERIALS AND METHODS In this in vitro study, the mandibular first molar was scanned from the dental computer-aided-design to design a 3 mm porous structure frame. The frame was produced using the lamination method and fired in a pressed ceramic. For comparison, pore-free specimens were fabricated by selective laser sintering (SLS) as described above, and porous specimens were fabricated by casting (total n = 30). The internal fit was then measured using a digital microscope (at 100× magnification), and the data were analyzed using one-way ANOVA (α = 0.05). RESULTS The total mean internal discrepancies for each group were 42.32 ± 22.50 μm for the porous structure SLS group (PS-group), 107.54 ± 38.75 μm for no-porous casting group (group), and 121.36 ± 50.19 μm for the no-porous SLS group (group), with significant differences (P < 0.05) among all groups. CONCLUSION The internal discrepancies of porous structure crown fabricated by SLS were smaller than that of no-porous crown fabricated by casting and SLS. Based on these laboratory findings, further studies should be conducted to evaluate the feasibility of the newly designed porous structure and press ceramic prosthesis to determine whether they can be applied in clinical practice.
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Affiliation(s)
- Eun-Jeong Bae
- 3D Printer Team, Cybermed Inc., Yuseong-gu, Daegeon, Republic of Korea
| | - Ji-Hwan Kim
- Department of Dental Laboratory Science and Engineering, Korea University, Seongbuk-gu, Seoul, Republic of Korea
| | - Joong Yeon Lim
- Department of Mechanical Robotics and Energy Engineering, Dongguk University, Jung-Gu, Seoul, Republic of Korea,Address for correspondence: Dr. Joong Yeon Lim, Dongguk University, Pildong-ro 1-Gil 30, Jung-Gu, Seoul 04620, Republic of Korea. E-mail:
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Guerrero A, Heitz-Mayfield LJA, Beuer F, Blanco J, Roccuzzo M, Ruiz-Magaz V, Sanz-Martín I, Schlee M, Schliephake H, Soetebeer M, Sculean A, Zabalegui I, Zucchelli G, Al-Nawas B. Occurrence, associated factors and soft tissue reconstructive therapy for buccal soft tissue dehiscence at dental implants: Consensus report of group 3 of the DGI/SEPA/Osteology Workshop. Clin Oral Implants Res 2022; 33 Suppl 23:137-144. [PMID: 35763017 DOI: 10.1111/clr.13952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 05/01/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To systematically assess the literature and report on (1) the frequency of occurrence of buccal soft tissue dehiscence (BSTD) at implants, (2) factors associated with the occurrence of BSTD and (3) treatment outcomes of reconstructive therapy for the coverage of BSTD. MATERIALS AND METHODS Two systematic reviews addressing focused questions related to implant BSTD occurrence, associated factors and the treatment outcomes of BSTD coverage served as the basis for group discussions and the consensus statements. The main findings of the systematic reviews, consensus statements and implications for clinical practice and for future research were formulated within group 3 and were further discussed and reached final approval within the plenary session. RESULTS Buccally positioned implants were the factor most strongly associated with the risk of occurrence of BSTD, followed by thin tissue phenotype. At immediate implants, it was identified that the use of a connective tissue graft (CTG) may act as a protective factor for BSTD. Coverage of BSTD may be achieved with a combination of a coronally advanced flap (CAF) and a connective tissue graft, with or without prosthesis modification/removal, although feasibility of the procedure depends upon multiple local and patient-related factors. Soft tissue substitutes showed limited BSTD coverage. CONCLUSION Correct three-dimensional (3D) positioning of the implant is of utmost relevance to prevent the occurrence of BSTD. If present, BSTD may be covered by CAF +CTG, however the evidence comes from a low number of observational studies. Therefore, future research is needed for the development of further evidence-based clinical recommendations.
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Affiliation(s)
| | - Lisa J A Heitz-Mayfield
- International Research Collaborative - Oral Health and Equity, School of Anatomy, Physiology and Human Biology, The University of Western Australia, West Perth, WA, Australia
| | - Florian Beuer
- Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Juan Blanco
- Department of Surgery and Medical-Surgical Specialties, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Mario Roccuzzo
- Division of Maxillofacial Surgery, University of Torino, Torino, Italy
| | - Vannesa Ruiz-Magaz
- Department of Periodontology, School of Dentistry, International University of Cataluña (UIC), Barcelona, Spain
| | | | - Markus Schlee
- Private practice and Department of Maxillofacial surgery, Goethe Universität Frankfurt am Main, Germany
| | - Henning Schliephake
- Department of Oral and Maxillofacial Surgery, University of Göttingen, Göttingen, Germany
| | - Maren Soetebeer
- Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | | | - Giovanni Zucchelli
- Department of Biomedical and Neuromotor Sciences University of Bologna, Bologna, Italy
| | - Bilal Al-Nawas
- Department for Oral and Maxillofacial Surgery, Plastic Surgery, University Medical Center of the J. Gutenberg University Mainz, Mainz, Germany
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Salazar-Gamarra R, Cárdenas-Bocanegra A, Masch U, Da Costa Moraes CA, Seelaus R, Lopes Da Silva JV, Lauria Dib L. Color translation from monoscopic photogrammetry +ID Methodology into a Polyjet final 3D printed facial prosthesis. F1000Res 2022; 11:582. [PMID: 38434006 PMCID: PMC10904947 DOI: 10.12688/f1000research.111196.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/05/2022] [Indexed: 03/05/2024] Open
Abstract
Background: The artistic techniques necessary to fabricate facial prostheses mainly depend on individual skill and are not a resource easily reproduced. Digital technology has contributed to improved outcomes, often combining analog and new digital techniques in the same workflow. Methods: This article aims to present an innovative workflow to produce a final colored 3D printed and facial prosthesis by UV-map color translation into colored resin 3D printing. A modified +ID Methodology was used to obtain 3D models with the calibrated 3D printable patient's skin color. No hands-on physical molding, manual sculpture, or intrinsic silicone coloration was used. Results: The outcome resulted in acceptable aesthetics, adaptation, and an approximate color match after extrinsic coloration. The patient reported good comfort and acceptance. Conclusions: A direct resin 3D printed prosthesis may be a viable alternative, especially for rapid delivery as an immediate prosthesis or an option when there is no experienced anaplastogist to manufacture a conventional prosthesis.
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Affiliation(s)
- Rodrigo Salazar-Gamarra
- Norbert Wiener University - Digital Transformation Research Centre, Lima, 15046, Peru
- Plus Identity (+ID) Institute, São Paulo, 04057-000, Brazil
| | | | | | | | - Rosemary Seelaus
- The Craniofacial Center, Department of Surgery, University of Illinois at Chicago, Chicago, 60612, USA
| | | | - Luciano Lauria Dib
- Plus Identity (+ID) Institute, São Paulo, 04057-000, Brazil
- Paulista University, São Paulo, 04057-000, Brazil
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Pan Y, Tsoi JK, Lam WY, Chen Z, Pow EH. Does the geometry of scan bodies affect the alignment accuracy of computer-aided design in implant digital workflow: an in vitro study? Clin Oral Implants Res 2021; 33:313-321. [PMID: 34971468 DOI: 10.1111/clr.13890] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 12/02/2021] [Accepted: 12/27/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To compare 2 implant scan bodies with different geometry on the accuracy of the virtual alignment process in the digital workflow. MATERIALS AND METHODS A master model of the edentulous maxilla with 6 implants and multi-unit abutments (MUA) inserted was fabricated. Six dome-shaped and cuboidal scan bodies were mounted on the MUAs respectively and consecutively scanned by a laboratory scanner 10 times. The original scans were imported to a dental-specific CAD software and virtually aligned with the default CAD model in the implant library. Thus, 10 aligned models were created. Both the original scans and the aligned models were evaluated by an inspection software for deviation of the scan body surfaces, the centroids of scan body and MUA, the scan body centre-axis and the inter-MUA distances/angles. The two-sample T-test/Mann Whitney U test were used to analyse the data with the level of significance set at 0.05. RESULTS The cuboidal group showed significant greater deviations of the model surface (13.9 µm vs 10.7 µm) and the MUA centroids (31.7µm vs 22.8 µm) but smaller deviation of the inter-MUA angle (0.047° vs 0.070°) than those of the dome-shaped group (P<0.05). No significant differences in the deviation of scan body centroids, centre-axis and the inter-MUA distances between the 2 groups were found. CONCLUSIONS Virtual alignment of implant scan body affected the accuracy of the digital workflow for complete-arch implant-supported prostheses (up to ~30 µm/0.09°). Different geometries of the implant scan body could also influence the transfer accuracy in the CAD process.
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Affiliation(s)
- Yu Pan
- Faculty of Dentistry, The University of Hong Kong, SAR, Hong Kong, China
| | - James Kh Tsoi
- Faculty of Dentistry, The University of Hong Kong, SAR, Hong Kong, China
| | - Walter Yh Lam
- Faculty of Dentistry, The University of Hong Kong, SAR, Hong Kong, China
| | - Zhuofan Chen
- Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Edmond Hn Pow
- Faculty of Dentistry, The University of Hong Kong, SAR, Hong Kong, China
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Nabergoj M, Denard PJ, Collin P, Trebše R, Lädermann A. Radiological changes, infections and neurological complications after reverse shoulder arthroplasty related to different design types and their rates: Part II. EFORT Open Rev 2021; 6:1109-1121. [PMID: 34909229 PMCID: PMC8631237 DOI: 10.1302/2058-5241.6.210040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Early reported complication rates with the Grammont-type reverse shoulder arthroplasty (RSA) were very high, up to 24%.A 'problem' is defined as an intraoperative or postoperative event that is not likely to affect the patient's final outcome, such as intraoperative cement extravasation and radiographic changes. A 'complication' is defined as an intraoperative or postoperative event that is likely to affect the patient's final outcome, including infection, neurologic injury and intrathoracic central glenoid screw placement.Radiographic changes around the glenoid or humeral components of the RSA are very frequently observed and described in the literature.High complication rates related to the Grammont RSA design led to development of non-Grammont designs which led to a dramatic fall in the majority of complications.The percentage of radiological changes after RSA is not negligible and remains unsolved, despite a decrease in its occurrence in the last decade. However, such changes should be now considered as simple problems because they rarely have a negative influence on the patient's final outcome, and their prevalence has dramatically decreased.With further changes in indications and designs for RSA, it is crucial to accurately track the rates and types of complications to justify its new designs and increased indications. Cite this article: EFORT Open Rev 2021;6:1109-1121. DOI: 10.1302/2058-5241.6.210040.
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Affiliation(s)
- Marko Nabergoj
- Valdoltra Orthopaedic Hospital, Ankaran, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | | | - Philippe Collin
- Centre Hospitalier Privé Saint-Grégoire (Vivalto Santé), Saint- Grégoire, France
| | - Rihard Trebše
- Valdoltra Orthopaedic Hospital, Ankaran, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Alexandre Lädermann
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital
- Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
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Nabergoj M, Denard PJ, Collin P, Trebše R, Lädermann A. Mechanical complications and fractures after reverse shoulder arthroplasty related to different design types and their rates: part I. EFORT Open Rev 2021; 6:1097-1108. [PMID: 34909228 PMCID: PMC8631242 DOI: 10.1302/2058-5241.6.210039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The initial reverse shoulder arthroplasty (RSA), designed by Paul Grammont, was intended to treat rotator cuff tear arthropathy in elderly patients. In the early experience, high complication rates (up to 24%) and revision rates (up to 50%) were reported.The most common complications reported were scapular notching, whereas clinically more relevant complications such as instability and acromial fractures were less commonly described.Zumstein et al defined a 'complication' following RSA as any intraoperative or postoperative event that was likely to have a negative influence on the patient's final outcome.High rates of complications related to the Grammont RSA design led to development of non-Grammont designs, with 135 or 145 degrees of humeral inclination, multiple options for glenosphere size and eccentricity, improved baseplate fixation which facilitated glenoid-sided lateralization, and the option of humeral-sided lateralization.Improved implant characteristics combined with surgeon experience led to a dramatic fall in the majority of complications. However, we still lack a suitable solution for several complications, such as acromial stress fracture. Cite this article: EFORT Open Rev 2021;6:1097-1108. DOI: 10.1302/2058-5241.6.210039.
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Affiliation(s)
- Marko Nabergoj
- Valdoltra Orthopaedic Hospital, Ankaran, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Patrick J. Denard
- Department of Orthopaedic & Rehabilitation, Oregon Health & Science University, Portland, Oregon, USA
| | - Philippe Collin
- Centre Hospitalier Privé Saint-Grégoire (Vivalto Santé), Saint-Grégoire, France
| | - Rihard Trebše
- Valdoltra Orthopaedic Hospital, Ankaran, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Alexandre Lädermann
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland
- Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
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12
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Lu T, Gao Z, Li J, Liu N, Wang Y, Liu C, He X. Construction of a new cervical anatomically adaptive titanium mesh cage based on measurements of cervical geometry: A morphological and cadaveric study. Exp Ther Med 2021; 22:1256. [PMID: 34603524 PMCID: PMC8453342 DOI: 10.3892/etm.2021.10691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 07/22/2021] [Indexed: 11/29/2022] Open
Abstract
Mismatch between the titanium mesh cage and cervical geometries is an important factor that induces subsidence in anterior cervical corpectomy and fusion (ACCF). The aim of the present study was to construct a new quadrate anatomically adaptive titanium mesh cage (AA-TMC) that matches well with the cervical geometries and segmental alignment in one- and two-level ACCF. Computed tomography (CT) scans of 54 individuals were used to measure the cervical endplate geometries. X-rays of 74 young individuals were used to measure the intervertebral body angle (IBA) and intervertebral body height (IBH) of the surgical segments. The AA-TMC was designed based on these measured parameters. A total of 18 cervical cadaveric specimens underwent successive one- and two-level ACCF using the AA-TMC. Postoperatively, the specimens underwent CT scanning to assess the degree of matching of the TMC-endplate interface (TEI), IBA and IBH. A TEI interval <0.5 mm was considered well matching. In the sagittal plane, 93.8% of the inferior endplates were arched, whereas 94.8% of the superior endplates were flat. In the coronal plane, 82.9% of the inferior endplates and 93.8% of the superior endplates were flat. A total of 91.7 and 94.4% of the TEIs were well matched in one- and two-level ACCF, respectively. The postoperative IBA and IBH values were consistent with the values of young individuals. The AA-TMC achieved good matching with cervical geometries and segmental alignment in one- and two-level ACCF, and is proposed for use in ACCF to increase the contact at the TEI and achieve sufficient lordosis restoration.
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Affiliation(s)
- Teng Lu
- Department of Orthopedics, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710004, P.R. China
| | - Zhongyang Gao
- Department of Orthopedics, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710004, P.R. China
| | - Jialiang Li
- Department of Orthopedics, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710004, P.R. China
| | - Ning Liu
- Department of Spine Surgery, Hanzhong Central Hospital, Hanzhong, Shaanxi 723000, P.R. China
| | - Yibin Wang
- Department of Orthopedics, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710004, P.R. China
| | - Chao Liu
- Department of Education, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710004, P.R. China
| | - Xijing He
- Department of Orthopedics, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710004, P.R. China
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13
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Abstract
The biomechanics of the shoulder relies on careful balancing between stability and mobility. A thorough understanding of normal and degenerative shoulder anatomy is necessary, as the goal of anatomic total shoulder arthroplasty is to reproduce premorbid shoulder kinematics.With reported joint reaction forces up to 2.4 times bodyweight, failure to restore anatomy and therefore provide a stable fulcrum will result in early implant failure secondary to glenoid loosening.The high variability of proximal humeral anatomy can be addressed with modular stems or stemless humeral components. The development of three-dimensional planning has led to a better understanding of the complex nature of glenoid bone deformity in eccentric osteoarthritis.The treatment of cuff tear arthropathy patients was revolutionized by the arrival of Grammont's reverse shoulder arthroplasty. The initial design medialized the centre of rotation and distalized the humerus, allowing up to a 42% increase in the deltoid moment arm.More modern reverse designs have maintained the element of restored stability but sought a more anatomic postoperative position to minimize complications and maximize rotational range of motion. Cite this article: EFORT Open Rev 2021;6:918-931. DOI: 10.1302/2058-5241.6.210014.
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Affiliation(s)
- Patrick Goetti
- Division of Orthopaedics and Trauma Surgery, Centre Hospitalier |Universitaire Vaudois, Lausanne, Switzerland
| | - Patrick J. Denard
- Denard Department of Orthopaedic & Rehabilitation, Oregon Health & Science University, Portland, Oregon, United States
| | - Philippe Collin
- Collin Centre Hospitalier Privé Saint-Grégoire (Vivalto Santé), Saint- Grégoire, France
| | - Mohamed Ibrahim
- Mohamed Ibrahim, Department of Orthopaedics and Trauma Surgery, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Adrien Mazzolari
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland
| | - Alexandre Lädermann
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland
- Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
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14
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Jo O, Borbas P, Grubhofer F, Ek ET, Pullen C, Treseder T, Ernstbrunner L. Prosthesis Designs and Tuberosity Fixation Techniques in Reverse Total Shoulder Arthroplasty: Influence on Tuberosity Healing in Proximal Humerus Fractures. J Clin Med 2021; 10:jcm10184146. [PMID: 34575254 PMCID: PMC8468418 DOI: 10.3390/jcm10184146] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/10/2021] [Accepted: 09/10/2021] [Indexed: 12/04/2022] Open
Abstract
Reverse total shoulder arthroplasty (RTSA) is increasingly used for the treatment of complex proximal humerus fractures and fracture sequelae. In 2021, half a dozen models of fracture stems are commercially available, reflecting its growing utility for fracture management. Prosthesis designs, bone grafting and tuberosity fixation techniques have evolved to allow better and more reliable fixation of tuberosities and bony ingrowth. Patients with anatomical tuberosity healing not only have an increased range of active anterior elevation and external rotation, but also experience fewer complications and longer prosthesis survival. This review provides an overview of recent evidence on basic and fracture-specific RTSA design features as well as tuberosity fixation techniques that can influence tuberosity healing.
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Affiliation(s)
- Olivia Jo
- Department of Orthopaedic Surgery, Royal Melbourne Hospital, Parkville, Melbourne, VIC 3050, Australia; (O.J.); (C.P.); (T.T.)
| | - Paul Borbas
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland; (P.B.); (F.G.)
| | - Florian Grubhofer
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland; (P.B.); (F.G.)
| | - Eugene T. Ek
- Melbourne Orthopaedic Group, Windsor, Melbourne, VIC 3181, Australia;
| | - Christopher Pullen
- Department of Orthopaedic Surgery, Royal Melbourne Hospital, Parkville, Melbourne, VIC 3050, Australia; (O.J.); (C.P.); (T.T.)
| | - Thomas Treseder
- Department of Orthopaedic Surgery, Royal Melbourne Hospital, Parkville, Melbourne, VIC 3050, Australia; (O.J.); (C.P.); (T.T.)
| | - Lukas Ernstbrunner
- Department of Orthopaedic Surgery, Royal Melbourne Hospital, Parkville, Melbourne, VIC 3050, Australia; (O.J.); (C.P.); (T.T.)
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland; (P.B.); (F.G.)
- Melbourne Orthopaedic Group, Windsor, Melbourne, VIC 3181, Australia;
- Department of Biomedical Engineering, University of Melbourne, Parkville, Melbourne, VIC 3010, Australia
- Correspondence: ; Tel.: +41-44386-1111
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15
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Lee YS, Kim SY, Oh KC, Moon HS. A Comparative Study of the Accuracy of Dental CAD Programs in Designing a Fixed Partial Denture. J Prosthodont 2021; 31:215-220. [PMID: 34310790 DOI: 10.1111/jopr.13406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2021] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Error testing at each stage of prosthetic manufacturing remains relatively underdeveloped for computer-aided design/computer-aided manufacturing methods, and no experimental studies have validated the computer-aided design programs. This study aimed to test the accuracy and trueness of the computer-aided design of a three-unit fixed prosthesis. MATERIALS AND METHODS Three computer-aided design programs (Exocad, Dental System™, and inLab 16) were tested on the designs of a three-unit fixed partial denture, and a three-dimensional analysis program was used to calculate the internal clearance error for the computer-aided design prostheses. The Kruskal-Wallis and Dunn's post hoc tests were used to reveal significant differences in trueness between the three computer-aided design programs (α < 0.05). RESULTS Dental System™ showed the lowest mean error values for #24 and #26 at the mesial margin (both 0 µm), mesial wall (0.10, 0.12 µm, respectively), occlusal surface (-0.05, 0.10 µm), distal wall (0.23, -0.02 µm), and distal margin (both 0 µm). In sum, except for the mesial margin and distal margin site of tooth #26, the mean error value of Dental System™ was statistically the lowest, followed by those of Exocad and inLab 16 (p < 0.003). CONCLUSIONS The accuracy of computer-aided design differed according to the type of computer-aided design program. Dental System™ achieved the best trueness at the margins, axial walls, and occlusal surface, followed by Exocad and inLab 16.
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Affiliation(s)
- Yong-Sang Lee
- Department of Prosthodontics, Veterans Health Service Medical Center, Seoul, Republic of Korea
| | - Sung Yong Kim
- Department of Prosthodontics, Veterans Health Service Medical Center, Seoul, Republic of Korea
| | - Kyung Chul Oh
- Department of Prosthodontics, Yonsei University College of Dentistry, Seoul, Republic of Korea
| | - Hong-Seok Moon
- Department of Prosthodontics, Yonsei University College of Dentistry, Seoul, Republic of Korea
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16
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Tel A, Tuniz F, Sembronio S, Costa F, Bresadola V, Robiony M. Cubik system: maximizing possibilities of in-house computer-guided surgery for complex craniofacial reconstruction. Int J Oral Maxillofac Surg 2021; 50:1554-1562. [PMID: 34312041 DOI: 10.1016/j.ijom.2021.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 05/06/2021] [Accepted: 07/13/2021] [Indexed: 11/19/2022]
Abstract
Craniofacial reconstruction represents a major challenge due to the complex anatomical morphology. Although implant production has often been outsourced to external companies, in-house planning and manufacturing has developed in many centres. This note introduces a conceptualized modular mould system to perform any desired craniofacial reconstruction, named 'Cubik', inspired by the famous Rubik's cube. A sophisticated virtual process is described that simulates realistic cranio-orbital resections, and the workflow to create multi-component moulds in order to achieve intraoperatively moulded implants is presented. The description focuses on the appropriate definition of interfaces between the subdivision surfaces of the planned implant, which is the key element to successful design and function of the moulds during surgery and is the peculiarity of the Cubik system. The use of Cubik does not prolong the overall duration of surgery, and it appears to be a very versatile tool, allowing personalized implants with different morphology to be created, which are suitable to cover every potential defect of the skull and the orbital region. This study extends the potential of in-house production, allowing highly accurate implantable craniofacial implants to be fabricated, and in the future this might represent a solution to achieve in-house replacement of other segments of the facial skeleton.
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Affiliation(s)
- A Tel
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, Udine, Italy
| | - F Tuniz
- Neurosurgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, Udine, Italy
| | - S Sembronio
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, Udine, Italy
| | - F Costa
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, Udine, Italy
| | - V Bresadola
- Simulation Centre, General Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, Udine, Italy
| | - M Robiony
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, Udine, Italy.
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17
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Kim DJ, Lee S, Joo HC, Youn YN, Yoo KJ, Lee SH. A Retrospective Comparison of Hemodynamic and Clinical Outcomes between Two Differently Designed Aortic Bioprostheses for Small Aortic Annuli. J Clin Med 2021; 10:1063. [PMID: 33806531 DOI: 10.3390/jcm10051063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/20/2021] [Accepted: 02/27/2021] [Indexed: 11/17/2022] Open
Abstract
The Trifecta valve has externally mounted leaflets; it differs from classic internally mounted valves (e.g., Carpentier-Edwards [C-E]). We evaluated post-implantation hemodynamics and clinical outcomes of these bioprostheses in small aortic annuli. From January 2015 to April 2019, 490 patients who underwent aortic valve replacement (AVR) were reviewed retrospectively. Altogether, 183 patients received 19 or 21 mm diameter C-E (n = 121) or Trifecta (n = 62) prostheses. To minimize confounding variables, we performed propensity-score matching analysis. The mean transvalvular pressure gradient (TVPG) was significantly lower in the Trifecta than in the C-E group at discharge (12.9 ± 4.8 vs. 15.0 ± 5.3 mmHg, p = 0.044). TVPG change over time was not significantly different between groups (p = 0.357). Left ventricular mass index decreased postoperatively (reduction: C-E, 28.1%; Trifecta, 30.1%, p = 0.879). No late mortality, severe patient–prosthesis mismatch, moderate-to-severe paravalvular leakage, structural valve degeneration, or valve thromboses were observed. Freedom from valve-related events at 3 years were similar for C-E (97.9% ± 2.1%) and Trifecta (97.7% ± 2.2%) patients (log-rank p = 0.993). Bioprosthesis design for small annuli significantly affected TVPG immediately after AVR. However, hemodynamics over time and clinical outcomes did not differ between the two designs.
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18
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Tamagnini G, Bourguignon T, Rega F, Verbrugghe P, Lamberigts M, Langenaeken T, Meuris B. Device profile of the Inspiris Resilia valve for aortic valve replacement: overview of its safety and efficacy. Expert Rev Med Devices 2021; 18:239-244. [PMID: 33583313 DOI: 10.1080/17434440.2021.1886921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The Inspiris Resilia tissue valve was recently introduced into clinical practice. This review summarizes the pre-clinical and clinical studies leading to this new bioprosthesis. AREAS COVERED The novel Resilia tissue was tested extensively in a large animal model. The clinical use of the tissue started in 2011 with the European Feasibility study, followed by a North-American multi-center study. Since 2017, the Inspiris Resilia valve has been in full commercial use. Further prospective evaluations and registries are ongoing. EXPERT OPINION The Inspiris Resilia valve was clinically introduced after pre-clinical tests revealed superiority compared to contemporary therapy such as the Perimount valve. Prospective long-term follow-up studies on Resilia are ongoing since 2011 and reveal no major complications. Full 5-year data show no signs of early degeneration, but longer follow-up is certainly still needed. Several prospective registries are actively monitoring the outcome with the Inspiris Resilia valve now. The novel tissue, designed to mitigate calcification and increase durability, together with the expandable stent, facilitating potential future valve-in-valve (ViV) procedures, are the cutting-edge aspects. Clinical use in younger patients is currently ongoing: their follow-up and outcome will determine the added value of this valve.
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Affiliation(s)
- G Tamagnini
- Department of Cardiovascular Surgery -, Villa Torri Hospital, GVM Care&Research, Bologna, Italy
| | - T Bourguignon
- Department of Cardiac Surgery, Tours University Hospital, Tours, France
| | - F Rega
- Department of Cardiovascular Diseases, Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - P Verbrugghe
- Department of Cardiovascular Diseases, Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - M Lamberigts
- Department of Cardiovascular Diseases, Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - T Langenaeken
- Department of Cardiovascular Diseases, Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Bart Meuris
- Department of Cardiovascular Diseases, Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
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19
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Pécora JR, Romero V. Evaluation of Polyethylene Wear in a Brazilian Ultracongruent Knee Prosthesis with a Rotating Platform. Rev Bras Ortop 2021; 56:42-46. [PMID: 33627898 PMCID: PMC7895618 DOI: 10.1055/s-0040-1712491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 03/02/2020] [Indexed: 11/17/2022] Open
Abstract
Objective
To evaluate the wear of polyethylene in a Brazilian ultracongruent knee prosthesis with a rotating platform (Rotaflex, Víncula, Rio Claro, SP, Brasil).
Methods
We used the test method with the loading and preparation parameters mentioned in the standards regulation
ISO 14243-1:2009
, and the measurement methods mentioned in the standards regulation
ISO 14243-2:2009
, for the evaluation of the wear behavior of a Brazilian prosthesis with a rotating platform. The equipment used for the wear test was the ISO 14243–1 gait simulator (EndoLab, Riedering, Germany).
Results
After 10 million cycles, the evaluation of the polyethylene wear showed a regular appearance of surface wear at a mean rate of 2.56 mg per million cycles.
Conclusion
The wear of the polyethylene of the evaluated prosthesis was minimal after the tests performed and with safety limits higher than those recommended by biomechanical engineering.
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Affiliation(s)
- José Ricardo Pécora
- Grupo do Joelho, Departamento de Ortopedia e Traumatologia, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brasil
| | - Valéria Romero
- Faculdade de Medicina, Universidade de Campinas, Campinas, SP, Brasil
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20
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Abstract
The human-prosthesis interface is one of the most complicated challenges facing the field of prosthetics, despite substantive investments in research and development by researchers and clinicians around the world. The journal of the International Society for Prosthetics and Orthotics, Prosthetics and Orthotics International, has contributed substantively to the growing body of knowledge on this topic. In celebrating the 50th anniversary of the International Society for Prosthetics and Orthotics, this narrative review aims to explore how human-prosthesis interfaces have changed over the last five decades; how research has contributed to an understanding of interface mechanics; how clinical practice has been informed as a result; and what might be potential future directions. Studies reporting on comparison, design, manufacturing and evaluation of lower limb prosthetic sockets, and osseointegration were considered. This review demonstrates that, over the last 50 years, clinical research has improved our understanding of socket designs and their effects; however, high-quality research is still needed. In particular, there have been advances in the development of volume and thermal control mechanisms with a few designs having the potential for clinical application. Similarly, advances in sensing technology, soft tissue quantification techniques, computing technology, and additive manufacturing are moving towards enabling automated, data-driven manufacturing of sockets. In people who are unable to use a prosthetic socket, osseointegration provides a functional solution not available 50 years ago. Furthermore, osseointegration has the potential to facilitate neuromuscular integration. Despite these advances, further improvement in mechanical features of implants, and infection control and prevention are needed.
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Affiliation(s)
- Reza Safari
- Health and Social Care Research Centre, University of Derby, Derby, UK
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21
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Kennon JC, Songy C, Bartels D, Statz J, Cofield RH, Sperling JW, Sanchez-Sotelo J. Primary reverse shoulder arthroplasty: how did medialized and glenoid-based lateralized style prostheses compare at 10 years? J Shoulder Elbow Surg 2020; 29:S23-S31. [PMID: 32044250 DOI: 10.1016/j.jse.2019.11.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 11/06/2019] [Accepted: 11/07/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to compare long-term outcomes, complications, and reoperation rates of primary reverse total shoulder arthroplasty (RTSA) performed at a single institution using 2 implant designs: a Grammont medialized prosthesis (medialized [M] group) and a Frankle glenoid-based lateralized prosthesis (glenoid-lateralized [GL] group). METHODS Between 2004 and 2008, 100 consecutive single-institution primary RTSAs were performed by reconstructive shoulder surgeons who were not design consultants, with the aim of obtaining 10-year follow-up: 56 in the M group and 44 in the GL group. Patients were followed up until death, until revision surgery, or for a minimum of 10 years. RESULTS Of 100 patients, 87 had more than 2 years' follow-up (mean, 77 months). A subset analysis of 41 patients with an average of 10.2 years' follow-up showed sustained long-term outcomes. RTSA provided clinical improvements without significant differences between the M and GL groups, except for improved active forward elevation in the M group (144° in M group vs. 115° in GL group, P = .002). Reoperation was required in 6 shoulders (10-year cumulative incidence of 3 [5%] in M group vs. 3 [8%] in GL group) for a total of 16 complications (10-year cumulative incidence of 8 [14%] in M group vs. 8 [20%] in GL group). Notching rates were significantly higher in the M group (77% in M group vs. 47% in GL group, P = .013); differences in severe notching (grade 3 or 4) were clinically relevant but did not reach statistical significance (23% in M group vs. 9% in GL group, P = .22). CONCLUSION Primary RTSA using these first 2 prosthesis designs was associated with good outcomes and low reoperation (5%-8%) and complication (14%-20%) rates at 10 years. The M group had higher rates of notching. These results may provide a benchmark for comparison with newer implants, especially considering that these results include the early RTSA implantation learning curve.
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Affiliation(s)
- Justin C Kennon
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Chad Songy
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Douglas Bartels
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Joseph Statz
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Robert H Cofield
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - John W Sperling
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
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22
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Abstract
Due to the prevalence of rheumatic heart disease in the developing world, mechanical heart valves in the younger patient population remain the prostheses of choice if repair is not feasible. Despite their durability, mechanical valves are burdened by coagulation and thromboembolism. Modern design tools can be utilized during the design process of mechanical valves, which allow a more systematic design approach and more detailed analysis of the blood flow through and around valves. These tools include computer-aided design, manufacturing, and engineering, such as computational fluid dynamics and finite element analysis, modern manufacturing techniques such as additive manufacturing, and sophisticated in-vitro and in-vivo tests. Following this systematic approach, a poppet valve was redesigned and the results demonstrate the benefits of the method. More organized flow patterns and fewer complex fluid structures were observed. The alternative trileaflet valve design has also been identified as a potential solution and, if a similar design approach is adopted, it could lead to the development of an improved mechanical heart valve in the future. It is imperative that researchers in developing countries continue their search for a mechanical heart valve with a reduced thromboembolic risk, requiring less or no anticoagulation.
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Affiliation(s)
- Elsmari Wium
- Robert WM Frater Cardiovascular Research Centre, Department of Cardiothoracic Surgery, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa.,Department of Mechanical and Mechatronic Engineering, Faculty of Engineering, Stellenbosch University, Stellenbosch, South Africa
| | - Christiaan Johannes Jordaan
- Robert WM Frater Cardiovascular Research Centre, Department of Cardiothoracic Surgery, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Lezelle Botes
- Department of Health Sciences, Central University of Technology, Bloemfontein, South Africa
| | - Francis Edwin Smit
- Robert WM Frater Cardiovascular Research Centre, Department of Cardiothoracic Surgery, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
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23
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van den Hout JA, Koenraadt KL, Wagenmakers R, Bolder SB. The Accolade TMZF stem fulfils the demands of modern stem design: Minimum 5-year survival in a cohort of 937 patients. J Orthop Surg (Hong Kong) 2019; 26:2309499018807747. [PMID: 30352541 DOI: 10.1177/2309499018807747] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
PURPOSE Modern hip stem design includes a prosthesis that has a predictable outcome in all total hip arthroplasty (THA) patients, regardless of approach, surgeon or patient characteristics. Introduction without a learning curve and, in cases of problems, the possibility for a simple revision are other prerequisites. The purpose of this study is to evaluate whether the Accolade TMZF stem (Stryker Orthopedics, Mahwah, New Jersey, USA) is suitable to fulfil these demands. We report our mid-term survival of the Accolade TMZF hip stem in all patients from the first implantation at our institute. METHODS From the start of using the Accolade TMZF stem (March 2009) until February 2011, 937 THA were performed by 12 surgeons using a posterolateral or anterolateral approach. Survival of the stem was calculated using Kaplan-Meier analysis. Effect of approach, patient age and comorbidity were analysed with a Cox proportional hazards' model. The learning effect was determined by comparing the number of revisions in the surgeons' first 20 THAs with their next 30 THAs and the subsequent THAs. RESULTS At 5 years, cumulative stem survival was 97.9% based on revisions for all reasons and 98.8% with aseptic loosening as endpoint. We found no effect of surgical approach, patient age or comorbidity on stem survival. No learning effect was found. CONCLUSION The Accolade TMZF stem fulfilled the demands of modern stem design.
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Affiliation(s)
| | - Koen Lm Koenraadt
- 2 Foundation for Orthopedic Research, Care and Education, Amphia Hospital, Breda, The Netherlands
| | - Robert Wagenmakers
- 1 Department of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands
| | - Stefan Bt Bolder
- 1 Department of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands
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Busato TS, Barbosa GMR, Velho AEK, Matioski Filho GR, Godoi LD, Capriotti JRV. Is The Size of the Currently Available Implants for Total Hip Arthroplasty Adequate for Our Population? Rev Bras Ortop 2019; 54:447-452. [PMID: 31435113 PMCID: PMC6701970 DOI: 10.1055/s-0039-1694713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 02/02/2019] [Indexed: 11/18/2022] Open
Abstract
Objective
To determine if the dimensions of selected national and imported implants used in total hip arthroplasty surgeries are adequate regarding the anthropometric profile of the Brazilian population.
Methods
A retrospective study of patients submitted to primary total hip arthroplasty. Patients with femoral or acetabular morphological deformities that could influence the choice of implant size, including dysplasia and previous fractures, were excluded from the study. Two national implants and six imported implants were included in the study. Every patient was treated by the same group, with one of the four senior authors or under their strict supervision, following the same surgical technique. The data were analyzed regarding gender, age, fixation type and implant model.
Results
The analysis of 682 hips submitted to total hip arthroplasty demonstrated that 2 models of cemented femoral stems and 1 of non-cemented stem did not seem to be perfectly adequate for the femoral morphology of the studied population, since these 3 implants were mostly used in the smallest size available, resulting in a non-Gaussian curve. The mean diameter of the native acetabulum was 54 mm in men and 52 mm in women.
Conclusion
Out of the eight models studied, five were deemed adequate for the studied population. The other three models available in our market (two national models and one imported model) apparently require more appropriate sizing. We emphasize that anthropometric studies of the Brazilian hip are necessary to give scientific subsidies to the ideal implant design for our market.
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Affiliation(s)
- Thiago Sampaio Busato
- Serviço de Cirurgia do Quadril, Hospital Angelina Caron, Campina Grande do Sul, Paraná, PR, Brasil
| | | | | | | | - Lucas Dias Godoi
- Serviço de Cirurgia do Quadril, Hospital Angelina Caron, Campina Grande do Sul, Paraná, PR, Brasil
| | - Juan R V Capriotti
- Serviço de Cirurgia do Quadril, Hospital Angelina Caron, Campina Grande do Sul, Paraná, PR, Brasil
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Higuchi Y, Seki T, Morita D, Komatsu D, Takegami Y, Ishiguro N. Comparison of Wear Rate between Ceramic-on-Ceramic, Metal on Highly Cross-linked Polyethylene, and Metal-on-Metal Bearings. Rev Bras Ortop 2019; 54:295-302. [PMID: 31363284 PMCID: PMC6597422 DOI: 10.1055/s-0039-1691762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 07/10/2018] [Indexed: 11/17/2022] Open
Abstract
Objective
Currently, there is a lack of evidence on the medium-term follow-up of cementless total hip arthroplasty (THA) using metal on highly cross-linked polyethylene (MoP), ceramic-on-ceramic (CoC), and metal-on-metal (MoM) bearings. Our aim was to calculate the 5- to 10-year wear rate and the incidence rate of osteolysis for 3 types of bearings.
Methods
A total of 77 patients underwent MoP, 105 underwent ceramic CoC, and 55 underwent MoM THAs. The average patient age at the time of surgery was 64.7, 55.9, and 59.9 years old in the MoP, CoC, and MoM bearings, respectively. Clinical and radiologic measurements at a mean follow-up of 7.6 years were analyzed.
Results
The mean postoperative Harris hip scores showed no difference among the groups. The mean annual liner wear rates were 0.0160, 0.0040 and 0.0054 mm/year in MoP, CoC bearings, and MoM bearings, with that of CoC bearings being significantly lower than the others. Osteolysis (14.5%) among MoM bearings was significantly more frequently observed compared with the others. Kaplan-Meier survival at 10 years with implant loosening, or revision THA as the endpoint, was 96.1% (95% confidence interval [CI]: 88.4–98.7) for MoP, 98.6% (95% CI: 90.3–98.6) for CoC bearing, and 98.2% (95% CI: 88.0–99.7) for MoM bearings (
p
= 0.360).
Conclusion
Excellent clinical and radiological outcomes were obtained for MoP and CoC bearings.
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Affiliation(s)
- Yoshitoshi Higuchi
- Departamento de Cirurgia Ortopédica, Nagoya University Graduate School of Medicine, Tsurumai-cho, Showa-ku, Nagoya, Japão
| | - Taisuke Seki
- Departamento de Cirurgia Ortopédica, Nagoya University Graduate School of Medicine, Tsurumai-cho, Showa-ku, Nagoya, Japão
| | - Daigo Morita
- Departamento de Cirurgia Ortopédica, Nagoya University Graduate School of Medicine, Tsurumai-cho, Showa-ku, Nagoya, Japão
| | - Daigo Komatsu
- Departamento de Cirurgia Ortopédica, Nagoya University Graduate School of Medicine, Tsurumai-cho, Showa-ku, Nagoya, Japão
| | - Yasuhiko Takegami
- Departamento de Cirurgia Ortopédica, Nagoya University Graduate School of Medicine, Tsurumai-cho, Showa-ku, Nagoya, Japão
| | - Naoki Ishiguro
- Departamento de Cirurgia Ortopédica, Nagoya University Graduate School of Medicine, Tsurumai-cho, Showa-ku, Nagoya, Japão
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Chen RC, Kwon M, Levi D, Moriarty JM. Use of a Covered CP Stent to Exclude an Aortic-Brachiocephalic Conduit Pseudoaneurysm. Tex Heart Inst J 2019; 46:143-146. [PMID: 31236083 DOI: 10.14503/thij-17-6422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
A 63-year-old woman was incidentally found to have a thoracic aortic aneurysm. We performed hybrid repair involving aortic arch debranching and endovascular stent-graft placement. Four months later, an asymptomatic pseudoaneurysm had formed at the aortic conduit-brachiocephalic artery anastomosis. To exclude the pseudoaneurysm, we deployed a Covered CP Stent across the anastomosis through a surgically created right axillary artery conduit. We discuss the patient's case and our choice of treatment.
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Cui Y, Li Z, Wan Q, Wang X, Li S, Ren Z, Wang Z, Yang F, Liu H, Wu D. [Clinical application of three-dimensional printed metal prosthesis in joint surgery]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2019; 33:774-777. [PMID: 31198009 DOI: 10.7507/1002-1892.201901022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To summarize the application progress of three-dimensional (3D) printed metal prosthesis in joint surgery. Methods The related literature was extensively reviewed. The effectiveness of 3D printed metal prosthesis in treatment of joint surgery diseases were discussed and summarized, including the all key issues in prosthesis transplantation such as prosthesis stability, postoperative complications, bone ingrowth, etc. Results 3D printed metal prosthesis has good matching degree, can accurately reconstruct and restore joint function, reduce operation time, and achieve high patient satisfaction in short- and medium-term follow-up. Its application in joint surgery has made good progress. Conclusion The personalized microporous structure prostheses of different shapes produced by 3D printing can solve the problem of poor personalized matching of joints for special patients existing in traditional prostheses. Therefore, 3D printing technology is full of hope and will bring great potential to the reform of orthopedic practice in the future.
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Affiliation(s)
- Yutao Cui
- Orthopaedic Medical Center, the Second Hospital of Jilin University, Changchun Jilin, 130041, P.R.China
| | - Zuhao Li
- Orthopaedic Medical Center, the Second Hospital of Jilin University, Changchun Jilin, 130041, P.R.China
| | - Qian Wan
- Orthopaedic Medical Center, the Second Hospital of Jilin University, Changchun Jilin, 130041, P.R.China;Clinical Medical College of Jilin University, Changchun Jilin, 130041, P.R.China
| | - Xianggang Wang
- Orthopaedic Medical Center, the Second Hospital of Jilin University, Changchun Jilin, 130041, P.R.China;Clinical Medical College of Jilin University, Changchun Jilin, 130041, P.R.China
| | - Shengyang Li
- Orthopaedic Medical Center, the Second Hospital of Jilin University, Changchun Jilin, 130041, P.R.China
| | - Zhenxiao Ren
- Orthopaedic Medical Center, the Second Hospital of Jilin University, Changchun Jilin, 130041, P.R.China;Clinical Medical College of Jilin University, Changchun Jilin, 130041, P.R.China
| | - Zhonghan Wang
- Orthopaedic Medical Center, the Second Hospital of Jilin University, Changchun Jilin, 130041, P.R.China
| | - Fan Yang
- Orthopaedic Medical Center, the Second Hospital of Jilin University, Changchun Jilin, 130041, P.R.China
| | - He Liu
- Orthopaedic Medical Center, the Second Hospital of Jilin University, Changchun Jilin, 130041,
| | - Dankai Wu
- Orthopaedic Medical Center, the Second Hospital of Jilin University, Changchun Jilin, 130041,
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Galiñanes EL, Hernandez-Vila EA, Krajcer Z. EndoAnchors Minimize Endoleaks in Chimney-Graft Endovascular Repair of Juxtarenal Abdominal Aortic Aneurysms. Tex Heart Inst J 2019; 46:183-188. [PMID: 31708700 DOI: 10.14503/thij-17-6520] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Juxtarenal abdominal aortic aneurysms (AAAs) are difficult to treat because they often have little or no proximal aortic neck. Patients with this complex anatomy are not usually candidates for an endovascular aneurysm repair (EVAR). Chimney-graft EVAR has been introduced, but type Ia endoleak is a typical risk. We have begun using EndoAnchors to determine whether this risk can be reduced. From July 2013 through July 2014, we used the chimney-graft EVAR technique in 5 patients whose juxtarenal AAAs had a short or no proximal aortic neck. During the procedure, we implanted EndoAnchors as needed. Postprocedurally, at 30 days, and through end of follow-up (duration, 11-18 mo), all patients had patent endografts without type Ia endoleak (our primary endpoint), visceral stent-graft thrombosis, or renal complications. One patient who received 4 chimney grafts had a postprocedural type II endoleak, which was treated with embolization. We found it feasible to use EndoAnchors with the chimney-graft technique to prevent type Ia endoleaks in the treatment of juxtarenal AAAs. Further studies are needed to validate this adjunctive technique and to determine its durability.
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Letsou GV, Anand J, Ogburn E, Shah RM, Ganapathy AV, Cohn WE, Loor G, Frazier OH. Low Incidence of Pump-Related Infections in Jarvik 2000 Ventricular Assist Device Recipients with a Subcostal Driveline Exit Site. Tex Heart Inst J 2019; 46:179-182. [PMID: 31708699 DOI: 10.14503/thij-15-5708] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Driveline infection has been a persistent problem with mechanical cardiac assist devices. The reported incidence of infection has been low in patients who receive a Jarvik 2000 continuous-flow left ventricular assist device when a skull-pedestal driveline exit site is used. We evaluated whether this is also true when a subcostal driveline exit site is used. We reviewed baseline demographic variables, postimplantation vital signs, laboratory values, and culture results in patients who underwent Jarvik 2000 implantation at our center from April 2000 through October 2009, including follow-up through June 2014. All patients had a subcostal driveline exit site. We defined device-related infection as a positive blood or wound culture associated with a medical or surgical device intervention. Event and time-to-event rates were calculated. Eighty-one patients received 89 Jarvik 2000 devices, all as bridges to transplantation. The median support duration was 69 days (interquartile range, 27-153 d; range, 2-2,249 d). Five superficial driveline infections and one incision-site infection occurred (0.002 events per patient-year of support). The median time from pump implantation to onset of driveline infection was 30 days; the incision-related infection occurred at 44 days. The Jarvik 2000 has a low incidence of infection when implanted with use of a subcostal driveline exit site. The incidence of pump infections is particularly low. Using a subcostal driveline exit site may be as effective in preventing infections as using a skull-pedestal driveline exit site. We detail our findings in this report.
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Belvedere C, Siegler S, Fortunato A, Caravaggi P, Liverani E, Durante S, Ensini A, Konow T, Leardini A. New comprehensive procedure for custom-made total ankle replacements: Medical imaging, joint modeling, prosthesis design, and 3D printing. J Orthop Res 2019; 37:760-768. [PMID: 30537247 DOI: 10.1002/jor.24198] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 11/30/2018] [Indexed: 02/04/2023]
Abstract
Many failures in total joint replacement are associated to prosthesis-to-bone mismatch. With recent additive-manufacturing, that is, 3D-printing, custom-made prosthesis can be created by laser-melting metal powders layer-by-layer. Ankle replacement is particularly suitable for this progress because of the limited number of sizes and the poor bone stock. In this study a novel procedure is presented for subject-specific ankle replacements, including medical-imaging, joint modelling, prosthesis design, and 3D-printing. Three shank-foot specimens were CT-scanned, and corresponding 3D bone models of the tibia, fibula, talus, and calcaneus were obtained. From these models, specimen-specific implant sets were designed according to three different concepts, and 3D-printed from cobalt-chromium-molybdenum powder. Accuracy of the overall procedure was assessed via distance map comparisons between original anatomical and final metal implants. Restoration of natural ankle joint mechanics was check after implantation of each of the three sets. In a special rig, a manually-driven dorsi/plantar-flexion was applied throughout the passive arc. Additionally, at three different joint positions, joint torques were imposed in the frontal and axial anatomical planes. Mean manufacturing errors were found to be smaller than 0.08 mm. Consistent motion patterns were observed over repetitions, with the mean standard deviation smaller than 1.0 degree. In each ankle specimen, mobility, and stability at the replaced joints compared well with the original natural condition. For the first time, custom-made implants for total ankle replacements were designed, manufactured with additive technology and tested. This procedure is a first fundamental step toward the development of completely personalized prostheses. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.
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Affiliation(s)
- Claudio Belvedere
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Sorin Siegler
- Department of Mechanical Engineering and Mechanics, Drexel University, Philadelphia, Pennsylvania
| | | | - Paolo Caravaggi
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Erica Liverani
- Department of Industrial Engineering, Università di Bologna, Bologna, Italy
| | - Stefano Durante
- Nursing, Technical and Rehabilitation Assistance Service, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Andrea Ensini
- 1st Orthopaedic-Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Tobias Konow
- Department of Mechanical Engineering and Mechanics, Drexel University, Philadelphia, Pennsylvania
| | - Alberto Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Abstract
BACKGROUND AND AIM A recent survey of people with lower limb absence revealed that patients' satisfaction with their foam cosmesis is lower than desired. The aim of this project was to improve the lifelike appearance, functionality and durability of the cosmesis through a user-centred design methodology. TECHNIQUE Concept development and prototyping led to a new cosmesis design which features a cut-out located at the knee, inserted with an artificial patella made of a more rigid foam. It also features a full-length zip which provides easy access for maintenance. The new cosmesis was then mechanically tested for over 1 million cycles and clinically tested by six transfemoral prosthesis users over 18 patient months. DISCUSSION The new design is significantly more durable than the current standard model and has an enhanced lifelike appearance. It has potential to improve users' body image and reduce costs for healthcare providers. Clinical relevance This study contributes to practice by offering a new cosmesis design with enhanced appearance and durability, with the potential to improve patients' body image and reduce costs associated with cosmesis fitting and maintenance.
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Affiliation(s)
| | - Jonathan Corney
- University of Strathclyde, Glasgow, UK,Jonathan Corney, Department of Design Manufacture and Engineering Management, University of Strathclyde, James Weir Building, 75 Montrose Street, Glasgow, G1 1XJ, Scotland, UK.
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Abstract
Longitudinal stent deformation, described in some older stent geometries, prompted design modifications such as reinforcing struts on the proximal end. However, distal edges of stents-also subject to longitudinal force-have not been reinforced. We report a case of guidewire entrapment that deformed the distal edge of a new-generation stent during percutaneous coronary intervention, and we describe our efforts to restore the stent to its initial length. This case highlights the risk of manipulating equipment beyond the position of a newly deployed stent, the ongoing potential for deformation of distal edges in newer stent platforms, and the advisability of treating distal lesions before proximal ones.
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Abstract
Stents and tubes to maintain the patency of the airways are commonly used for malignant obstruction and are occasionally employed in benign disease. Malignant airway obstruction usually results from direct involvement of bronchogenic carcinoma, or by extension of carcinomas occurring in the esophagus or the thyroid. External compression from lymph nodes or metastatic disease from other organs can also cause central airway obstruction. Most malignant airway lesions are surgically inoperable due to advanced disease stage and require multimodality palliation, including stent placement. As with any other medical device, stents have significantly evolved over the last 50 years and deserve an in-depth understanding of their true capabilities and complications. Not every silicone stent is created equal and the same holds for metallic stents. Herein, we present an overview of the topic as well as some of the more practical and controversial issues surrounding airway stents. We also try to dispel the myths surrounding stent removal and their supposed use only in central airways. At the end, we come to the long-held conclusion that stents should not be used as first line treatment of choice, but after ruling out the possibility of curative surgical resection or repair.
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Affiliation(s)
- Erik Folch
- Division of Pulmonary and Critical Care Medicine, Section of Interventional Pulmonary, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Colleen Keyes
- Division of Pulmonary and Critical Care Medicine, Section of Interventional Pulmonary, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Hanedan MO, Yuruk MA, Parlar AI, Ziyrek U, Arslan AK, Sayar U, Mataraci I. Sutureless versus Conventional Aortic Valve Replacement: Outcomes in 70 High-Risk Patients Undergoing Concomitant Cardiac Procedures. Tex Heart Inst J 2018; 45:11-16. [PMID: 29556145 DOI: 10.14503/thij-16-6092] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
In elderly, high-risk surgical patients, sutureless aortic valve replacement (AVR) can often be an alternative to conventional AVR; shorter aortic cross-clamp and cardiopulmonary bypass times are the chief advantages. We compared the outcomes of sutureless AVR with those of conventional AVR in 70 elderly patients who underwent concomitant cardiac surgical procedures. We retrospectively analyzed the cases of 42 men and 28 women (mean age, 70.4 ± 10.3 yr; range, 34-93 yr) who underwent cardiac operations plus AVR with either a sutureless valve (group 1, n=38) or a conventional bioprosthetic or mechanical valve (group 2, n=32). Baseline patient characteristics were similar except for worse New York Heart Association functional status and the prevalence of diabetes mellitus in group 1. In group 1, the operative, cross-clamp, and cardiopulmonary bypass times were shorter (all P=0.001), postoperative drainage amounts were lower (P=0.009), hospital stays were shorter (P=0.004), and less red blood cell transfusion was needed (P=0.037). Echocardiograms before patients' discharge from the hospital showed lower peak and mean aortic gradients in group 1 (mean transvalvular gradient, 8.4 ± 2.8 vs 12.2 ± 5.2 mmHg; P=0.012). We found that elderly, high-risk patients who underwent multiple cardiac surgical procedures and sutureless AVR had better hemodynamic outcomes and shorter ischemic times than did patients who underwent conventional AVR.
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Lozano I, Rondan J, Vegas JM, Segovia E. Stent Choice in Very Large Left Main Lesions in 3 Patients. Tex Heart Inst J 2017; 44:353-356. [PMID: 29259510 DOI: 10.14503/thij-17-6190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Interventionalists encounter widely different coronary anatomies during left main coronary artery stenting. Optimal percutaneous coronary intervention in left main disease necessitates stents that achieve adequate apposition and adapt to frequently disparate diameters in the same lesion, without the need for overexpansion. Until recently, stent designs have hampered the treatment of very large lesions in left main arteries. Postdilation of the stents beyond their recommended diameters can cause restenosis, thrombosis, or arterial dissection. We report successful angiographic outcomes after our deployment of different stents in 3 patients, present our rationale for choosing each stent, and discuss considerations that influence the percutaneous treatment of severe left main disease.
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Abstract
We describe the case of a 57-year-old man who had severe mitral valve stenosis and regurgitation without significant annular calcification. He was not a candidate for surgical valve replacement or repair because of his substantial comorbid conditions, overall frailty, and elevated surgical risk. He underwent successful transcatheter mitral valve replacement of his native mitral valve with compassionate, off-label use of an Edwards Sapien 3 valve. A search of the literature produced no other cases like ours, which represents a further evolution of the transcatheter valve implantation concept. Further studies are needed to help define accurate valve sizing, intraprocedural positioning, and long-term device stability, as well as to determine which patients might benefit from this commercially available valve. In the meantime, our findings could present a means of treating patients who have no other options.
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Loyalka P, Nascimbene A, Metz B, Gregoric ID, Raman AS, Kar B. Transcatheter Tricuspid Valve-in-Valve Replacement with an Edwards Sapien 3 Valve. Tex Heart Inst J 2017; 44:209-213. [PMID: 28761403 DOI: 10.14503/thij-15-5639] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
A few case reports and case series have documented the outcomes in patients with tricuspid bioprosthetic valvular degeneration who underwent transcatheter implantation of the Medtronic Melody and the Edwards Sapien XT and Sapien 3 valves. In this report, we describe the case of a 49-year-old woman with severe bioprosthetic tricuspid valvular stenosis and multiple comorbidities who underwent transcatheter tricuspid valve replacement with a Sapien 3 valve.
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Kahle JT, Highsmith MJ, Kenney J, Ruth T, Lunseth PA, Ertl J. The effectiveness of the bone bridge transtibial amputation technique: A systematic review of high-quality evidence. Prosthet Orthot Int 2017; 41:219-226. [PMID: 27913784 DOI: 10.1177/0309364616679318] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND This literature review was undertaken to determine if commonly held views about the benefits of a bone bridge technique are supported by the literature. METHODS Four databases were searched for articles pertaining to surgical strategies specific to a bone bridge technique of the transtibial amputee. A total of 35 articles were identified as potential articles. Authors included methodology that was applied to separate topics. Following identification, articles were excluded if they were determined to be low quality evidence or not pertinent. RESULTS Nine articles were identified to be pertinent to one of the topics: Perioperative Care, Acute Care, Subjective Analysis and Function. Two articles sorted into multiple topics. Two articles were sorted into the Perioperative Care topic, 4 articles sorted into the Acute Care topic, 2 articles into the Subjective Analysis topic and 5 articles into the Function topic. DISCUSSION There are no high quality (level one or two) clinical trials reporting comparisons of the bone bridge technique to traditional methods. There is limited evidence supporting the clinical outcomes of the bone bridge technique. There is no agreement supporting or discouraging the perioperative and acute care aspects of the bone bridge technique. There is no evidence defining an interventional comparison of the bone bridge technique. CONCLUSION Current level III evidence supports a bone bridge technique as an equivalent option to the non-bone bridge transtibial amputation technique. Formal level I and II clinical trials will need to be considered in the future to guide clinical practice. Clinical relevance Clinical Practice Guidelines are evidence based. This systematic literature review identifies the highest quality evidence to date which reports a consensus of outcomes agreeing bone bridge is as safe and effective as alternatives. The clinical relevance is understanding bone bridge could additionally provide a mechanistic advantage for the transtibial amputee.
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Affiliation(s)
- Jason T Kahle
- 1 School of Physical Therapy & Rehabilitation Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA.,2 OP Solutions, Tampa, FL, USA.,3 Prosthesis Design + Research, Tampa, FL, USA
| | - M Jason Highsmith
- 1 School of Physical Therapy & Rehabilitation Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA.,4 James A. Haley Veterans' Hospital, Tampa, FL, USA.,5 Research and Surveillance, Extremity Trauma and Amputation Center of Excellence, Tampa, FL, USA
| | | | - Tim Ruth
- 6 Kenney Orthopedics, Lexington, KY, USA
| | - Paul A Lunseth
- 7 Clinical Research of West Florida, Inc., Tampa, FL, USA
| | - Janos Ertl
- 8 Department of Orthopaedic Surgery, School of Medicine, Indiana University, Indianapolis, IN, USA
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Jinno T, Koga D, Asou Y, Morita S, Okawa A, Muneta T. Intraoperative evaluation of the effects of femoral component offset and head size on joint stability in total hip arthroplasty. J Orthop Surg (Hong Kong) 2017; 25:2309499016684298. [PMID: 28741411 DOI: 10.1177/2309499016684298] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To evaluate intraoperatively the effects of femoral offset and head size on stability of the hip joints in total hip arthroplasty (THA) via posterior approach. METHODS Thirty cementless THAs were included in this study. After acetabular shell and femoral broach fixation, trial reduction was repeated using a femoral neck (5- to 8-mm higher or standard offset) and a head (26 mm or 32 mm). To evaluate joint stability, range of internal rotation (IR) in hip flexion prior to posterior subluxation and range of external rotation (ER) in hip extension were measured. RESULTS The high-offset neck provided significantly (approximately 10°) greater range of IR to subluxation than the standard-offset neck. No hips ended in anterior subluxation by ER. The head size did not have significant effects on the stability. CONCLUSION Results suggest that the 5- to 8-mm greater femoral offset might be effective in preventing instability in primary THA.
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Affiliation(s)
- Tetsuya Jinno
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Daisuke Koga
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoshinori Asou
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Sadao Morita
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Atsushi Okawa
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takeshi Muneta
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
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Tanikawa H, Tada M, Harato K, Okuma K, Nagura T. Influence of Total Knee Arthroplasty on Patellar Kinematics and Patellofemoral Pressure. J Arthroplasty 2017; 32:280-5. [PMID: 27480826 DOI: 10.1016/j.arth.2016.06.044] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 06/13/2016] [Accepted: 06/27/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Patellofemoral complications are one of the main problems after total knee arthroplasty (TKA). The design of the TKA component may affect the patellar biomechanics, which may be associated with this postoperative complication. The purpose of this study was to assess the influence of TKA and prosthesis designs on the patellar kinematics and patellofemoral pressure. METHODS Using fresh-frozen cadavers, we measured the patellofemoral pressure, patella offset, and patella tilt in the following 4 conditions: normal knee (patella replacement only), cruciate-retaining TKA, condylar-stabilizing TKA, and posterior-stabilized TKA. RESULTS The patellofemoral pressure increased significantly after the cruciate-retaining TKA and condylar-stabilizing TKA compared with the normal knee. The patella offset in the normal knee decreased with increasing knee flexion angles, while the patella offset in the TKA knees did not change significantly through the full range of motion. The amount of lateral patella tilt in the normal knee was significantly larger than the TKA knees in the full range of motion. CONCLUSION Although the femoral components are designed to reproduce an anatomical patellar tracking, the physiological patellar kinematics were not observed. Relatively high patellofemoral pressure and kinematic change after TKA may be associated with postoperative complications such as the anterior knee pain.
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Celebi A, Yucel IK, Balli S, Kucuk M. Two Cases of Transcatheter Closure of Central Aortopulmonary Shunts: One with an Amplatzer Duct Occluder II and One with an Amplatzer Vascular Plug I. Tex Heart Inst J 2016; 43:241-5. [PMID: 27303241 DOI: 10.14503/thij-15-5080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
When total correction is not possible in infants who have a cyanotic congenital heart disease, creation of a palliative aortopulmonary shunt is essential. A central aortopulmonary shunt is preferable, because of its technical and hemodynamic advantages. Overcirculation, thrombosis, and stenosis of the shunt are the main postoperative sequelae that necessitate urgent reintervention. Percutaneous transcatheter closure of aortopulmonary shunts can eliminate the need for reoperation and substantially decrease postoperative morbidity and mortality rates. We report our successful transcatheter closures of central aortopulmonary shunts in a 3-month-old infant and a 15-year-old girl, with use of an Amplatzer Duct Occluder II and an Amplatzer Vascular Plug I, respectively. To our knowledge, this is the first report of the transcatheter closure of central aortopulmonary shunts with these 2 devices.
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Sensinger JW, Lipsey J, Thomas A, Turner K. Design and evaluation of voluntary opening and voluntary closing prosthetic terminal device. ACTA ACUST UNITED AC 2016; 52:63-75. [PMID: 26186081 DOI: 10.1682/jrrd.2014.03.0087] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 11/10/2014] [Indexed: 11/05/2022]
Abstract
Body-powered prostheses use a cable-operated system to generate forces and move prosthetic joints. However, this control system can only generate forces in one direction, so current body-powered prehensor designs allow the user either to voluntarily open or voluntarily close the tongs. Both voluntary opening (VO) and voluntary closing (VC) modes of operation have advantages for certain tasks, and many end-users desire a terminal device that can switch between the two modes. However, such a terminal device must maintain the same thumb position (i.e., point of Bowden cable attachment) and movement direction in both modes in order to avoid the need to readjust the harness after every mode switch. In this study, we demonstrate a simple design that fulfills these requirements while allowing the user to switch easily between modes. We describe the design concept, describe a rugged split-hook prototype, provide specifications (size, weight, efficiency, etc.), and present a pilot study in which five subjects with intact arms and two subjects with amputation used the VO and VC split-hook prehensor to perform the Southampton Hand Assessment Procedure. Subjects performed an average of 4 to 7 (+/- 0.2) points better when they could choose to switch between modes on a task-by-task basis than when they were constrained to using only VO or VC modes.
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Affiliation(s)
- Jon W Sensinger
- Institute of Biomedical Engineering, University of New Brunswick, Fredericton, Canada
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45
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Vuillermin CB, Trump ME, Barwood SA, Hoy GA. Catastrophic failure of a low profile metal-backed glenoid component after total shoulder arthroplasty. Int J Shoulder Surg 2015; 9:121-7. [PMID: 26622128 PMCID: PMC4640001 DOI: 10.4103/0973-6042.167952] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Context: The longevity of the glenoid component in total shoulder arthroplasty (TSA) continues to be problematic. All polyethylene glenoid components have been most widely used, but loosening rates with time and the need for revision has resulted in high-profile metal-backed components with the potential for a more stable prosthesis bone interface and liner exchange. High revision rates in the high profile metal backed designs led us to evaluate a low profile metal backed component. Aims: To examine the rate and mode of failure of a TSA in a single surgeon consecutive series that has been identified by the Australian National Joint Replacement Registry to have a higher than anticipated rate of revision. Materials and Methods: This is a single surgeon retrospective consecutive series of 51 arthroplasties undertaken in 50 patients (18 males and 32 females) with an average age of 70.4 ears (range 51-90) and mean follow-up of 5.5 years (range 3.7-8.1). Results: We observed a very high (29%) rate of revision of the metal-backed glenoid components in this series. The primary mode of failure was glenoid baseplate nonintegration which with a well-fixed central cage screw led to bone resorption and implant breakage or disassembly. Conclusion: Analysis of the mode of failure of implants identified by robust registries is essential for the development of new prostheses and the pursuit of prosthesis longevity. This low profile metal backed prosthesis has been withdrawn, but without a published mechanism of failure. We feel that any prosthesis withdrawal should be accompanied by appropriate published mechanisms to prevent future component design errors based on similar design problems.
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Affiliation(s)
| | - Mark E Trump
- Department of Orthopedic Surgery, Los Angeles County and University of Southern California Medical Center, Los Angeles, CA 90033, USA
| | - Shane A Barwood
- Melbourne Orthopaedic Group, Windsor 3181, Victoria, Australia ; Monash University Department of Surgery, Melbourne, Australia
| | - Gregory A Hoy
- Melbourne Orthopaedic Group, Windsor 3181, Victoria, Australia ; Monash University Department of Surgery, Melbourne, Australia
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Chatzistavrianou D, Shahdad S. An Alternative Design to Overcome the Problem of Unfavorable Implant Angulations for a Screw-Retained, Implant-Supported Fixed Prosthesis: Two Clinical Reports. J Prosthodont 2015; 24:589-593. [PMID: 26095442 DOI: 10.1111/jopr.12301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2015] [Indexed: 11/30/2022] Open
Abstract
Two clinical reports present an alternative design to address the problem of unfavorable implant angulations if a screw-retained prosthesis is desired. The restorations were designed as screw-retained prostheses, except in the area with the unfavorable implant screw emergence. The frameworks in these areas were customized to receive individual cement-retained crowns. This design offers retrievability and helps to minimize complications associated with excess cement without compromising the functional or esthetic outcome.
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Affiliation(s)
- Despoina Chatzistavrianou
- The Royal London Dental Hospital and Queen Mary University of London, Barts and the London School of Medicine and Dentistry, London, UK
| | - Shakeel Shahdad
- The Royal London Dental Hospital and Queen Mary University of London, Barts and the London School of Medicine and Dentistry, London, UK
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Concistrè G, Miceli A, Marchi F, Chiaramonti F, Glauber M, Solinas M. Regression of left ventricular mass after implantation of the sutureless 3f Enable aortic bioprosthesis. Tex Heart Inst J 2015; 42:117-23. [PMID: 25873820 DOI: 10.14503/thij-13-3943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Left ventricular hypertrophy in aortic stenosis is considered a compensatory response for the maintenance of systolic function but a risk factor for cardiac morbidity and death. We investigated the degree of left ventricular mass regression after implantation of the sutureless Medtronic 3f Enable Aortic Bioprosthesis. We studied 19 patients who, from May 2010 through July 2011, underwent isolated aortic valve replacement with the 3f Enable bioprosthetic valve, with clinical and echocardiographic follow-up at 6 months. The mean age was 77.1 ± 5.1 years (range, 68-86 yr); 14 patients were women (73.7%); and the mean logistic EuroSCORE was 15.4% ± 11.8%. Echocardiography was performed preoperatively, at discharge, and at 6 months' follow-up. The left ventricular mass was calculated by means of the Devereux formula and indexed to body surface area. The left ventricular mass index decreased from 146.1 ± 47.6 g/m(2) at baseline to 118.1 ± 39.8 g/m(2) at follow-up (P=0.003). The left ventricular ejection fraction did not change significantly. The mean transaortic gradient decreased from 57.3 ± 14.2 mmHg at baseline to 12.3 ± 4.6 mmHg at discharge and 12.2 ± 5.3 mmHg at follow-up (P <0.001), and these decreases were accompanied by substantial clinical improvement. No moderate or severe paravalvular leakage was present at discharge or at follow-up. In isolated aortic stenosis, aortic valve replacement with the 3f Enable bioprosthesis results in significant regression of left ventricular mass at 6 months' follow-up. However, this regression needs to be verified by long-term echocardiographic follow-up.
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Irish SE, Langohr GDG, Willing R, King GJ, Johnson JA. Implications of radial head hemiarthroplasty dish depth on radiocapitellar contact mechanics. J Hand Surg Am 2015; 40:723-9. [PMID: 25813921 DOI: 10.1016/j.jhsa.2015.01.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 01/21/2015] [Accepted: 01/21/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the effect of radial head implant dish depth on radiocapitellar joint contact mechanics. METHODS Computed tomography images of 13 fresh-frozen cadaveric humeri were reconstructed into 3-dimensional finite element models with accurate cartilage geometry. Native humeri were paired with the corresponding native radial heads and axisymmetric radial head prosthesis models of the following dish depths: 1.0 mm, 1.5 mm, 2.0 mm, 2.5 mm, and 3.0 mm. Radiocapitellar contact mechanics were quantified at 4 different flexion angles (0°, 45°, 90°, and 135°) with a 100-N axial load applied to the radial head using a modeling protocol previously validated by cadaveric studies. The radial head was permitted to translate freely to its optimal position while the humerus was fully constrained. Output variables were contact area and peak contact stress. RESULTS All prostheses had significantly decreased contact area and increased peak contact stress at all flexion angles relative to the native radiocapitellar joint. Contact area increased with prosthesis dish depth until reaching a plateau with a predicted local maximum at a mean depth of 3.2 ± 0.7 mm. Peak contact stress was elevated for both the shallowest and deepest models and reached a predicted local minimum at a mean depth of 1.8 ± 0.3 mm. CONCLUSIONS Contact area and peak contact stress were dependent on radial head prosthesis dish depth. There was an optimal implant dish depth for radiocapitellar contact mechanics at approximately 2 mm. CLINICAL RELEVANCE Optimizing radiocapitellar contact mechanics using rigorous and systematic prosthesis design techniques may lead to better clinical outcomes due to reduced capitellar cartilage degradation.
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Affiliation(s)
- S Elizabeth Irish
- Roth McFarlane Hand and Upper Limb Centre Bioengineering, St. Joseph's Health Centre, London, Ontario, Canada.
| | - G Daniel G Langohr
- Roth McFarlane Hand and Upper Limb Centre Bioengineering, St. Joseph's Health Centre, London, Ontario, Canada
| | - Ryan Willing
- Roth McFarlane Hand and Upper Limb Centre Bioengineering, St. Joseph's Health Centre, London, Ontario, Canada
| | - Graham J King
- Roth McFarlane Hand and Upper Limb Centre Bioengineering, St. Joseph's Health Centre, London, Ontario, Canada
| | - James A Johnson
- Roth McFarlane Hand and Upper Limb Centre Bioengineering, St. Joseph's Health Centre, London, Ontario, Canada
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Scheepers LG, Storcken JO, Rings F, van Horn Y, Seelen HA. New Socket-Less Prosthesis concept facilitating comfortable and abrasion-free cycling after Van Nes rotationplasty. Prosthet Orthot Int 2015; 39:161-5. [PMID: 24429482 DOI: 10.1177/0309364613515494] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND AIM Current leg prostheses in rotationplasty typically feature a thigh cuff, which, in cycling, may cause perspiration problems and friction-related abrasions of the skin. The aim has been to develop a socket-less prosthetic device for persons with a rotationplasty to be able to engage in high-intensity cycling without contracting abrasions. TECHNIQUE The new device (Socket-Less Rotationplasty Prosthesis for Cycling) features a standard cycling shoe on the rotationplasty foot, replacing the conventional socket and thigh cuff. A reinforced 12-layer carbon fibre frame bolted to the aforementioned shoe, replacing the standard tube, connects to a prosthetic foot and a second cycling shoe. Alignment of the Socket-Less Rotationplasty Prosthesis for Cycling is done both statically and dynamically. DISCUSSION The Socket-Less Rotationplasty Prosthesis for Cycling is lightweight and more ventilated relative to conventional sockets. All components can be replaced easily. Most important, however, is that the current user now can cycle 135 km on end without skin abrasions. CLINICAL RELEVANCE The Socket-Less Rotationplasty Prosthesis for Cycling concept enables patients with a leg rotationplasty to engage in high-intensity cycling without contracting skin problems, thereby facilitating clients' participation.
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Affiliation(s)
| | | | - Frans Rings
- Livit Orthopedie BV, Hoensbroek, The Netherlands
| | | | - Henk A Seelen
- Adelante Rehabilitation Centre, Hoensbroek, The Netherlands
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50
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Hofstede SN, Nouta KA, Jacobs W, van Hooff ML, Wymenga AB, Pijls BG, Nelissen RGHH, Marang-van de Mheen PJ. Mobile bearing vs fixed bearing prostheses for posterior cruciate retaining total knee arthroplasty for postoperative functional status in patients with osteoarthritis and rheumatoid arthritis. Cochrane Database Syst Rev 2015; 2015:CD003130. [PMID: 25650566 PMCID: PMC10960232 DOI: 10.1002/14651858.cd003130.pub3] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND It is unclear whether there are differences in benefits and harms between mobile and fixed prostheses for total knee arthroplasty (TKA). The previous Cochrane review published in 2004 included two articles. Many more trials have been performed since then; therefore an update is needed. OBJECTIVES To assess the benefits and harms of mobile bearing compared with fixed bearing cruciate retaining total knee arthroplasty for functional and clinical outcomes in patients with osteoarthritis (OA) or rheumatoid arthritis (RA). SEARCH METHODS We searched The Cochrane Library, PubMed, EMBASE, CINAHL and Web of Science up to 27 February 2014, and the trial registers ClinicalTrials.gov, Multiregister, Current Controlled Trials and the World Health Organization (WHO) International Clinical Trials Registry Platform for data from unpublished trials, up to 11 February 2014. We also screened the reference lists of selected articles. SELECTION CRITERIA We selected randomised controlled trials comparing mobile bearing with fixed bearing prostheses in cruciate retaining TKA among patients with osteoarthritis or rheumatoid arthritis, using functional or clinical outcome measures and follow-up of at least six months. DATA COLLECTION AND ANALYSIS We used standard methodological procedures as expected by The Cochrane Collaboration. MAIN RESULTS We found 19 studies with 1641 participants (1616 with OA (98.5%) and 25 with RA (1.5%)) and 2247 knees. Seventeen new studies were included in this update.Quality of the evidence ranged from moderate (knee pain) to low (other outcomes). Most studies had unclear risk of bias for allocation concealment, blinding of participants and personnel, blinding of outcome assessment and selective reporting, and high risk of bias for incomplete outcome data and other bias. Knee painWe calculated the standardised mean difference (SMD) for pain, using the Knee Society Score (KSS) and visual analogue scale (VAS) in 11 studies (58%) and 1531 knees (68%). No statistically significant differences between groups were reported (SMD 0.09, 95% confidence interval (CI) -0.03 to 0.22, P value 0.15). This represents an absolute risk difference of 2.4% points higher (95% CI 0.8% lower to 5.9% higher) on the KSS pain scale and a relative percent change of 0.22% (95% CI 0.07% lower to 0.53% higher). The results were homogeneous. Clinical and functional scores The KSS clinical score did not differ statistically significantly between groups (14 studies (74%) and 1845 knees (82%)) with a mean difference (MD) of -1.06 points (95% CI -2.87 to 0.74, P value 0.25) and heterogeneous results. KSS function was reported in 14 studies (74%) with 1845 knees (82%) as an MD of -0.10 point (95% CI -1.93 to 1.73, P value 0.91) and homogeneous results. In two studies (11%), the KSS total score was favourable for mobile bearing (159 vs 132 for fixed bearing), with MD of -26.52 points (95% CI -45.03 to -8.01, P value 0.005), but with a wide 95% confidence interval indicating uncertainty about the estimate.Other reported scoring systems did not show statistically significant differences: Hospital for Special Surgery (HSS) score (seven studies (37%) in 1021 knees (45%)) with an MD of -1.36 (95% CI -4.18 to 1.46, P value 0.35); Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total score (two studies (11%), 167 knees (7%)) with an MD of -4.46 (95% CI -16.26 to 7.34, P value 0.46); and Oxford total (five studies (26%), 647 knees (29%) with an MD of -0.25 (95% CI -1.41 to 0.91, P value 0.67). Health-related quality of lifeThree studies (16%) with 498 knees (22%) reported on health-related quality of life, and no statistically significant differences were noted between the mobile bearing and fixed bearing groups. The Short Form (SF)-12 Physical Component Summary had an MD of -1.96 (95% CI -4.55 to 0.63, P value 0.14) and heterogeneous results. Revision surgeryTwenty seven revisions (1.3%) were performed in 17 studies (89%) with 2065 knees (92%). In all, 13 knees were revised in the fixed bearing group and 14 knees in the mobile bearing group. No statistically significant differences were found (risk difference 0.00, 95% CI -0.01 to 0.01, P value 0.58), and homogeneous results were reported. MortalityIn seven out of 19 studies, 13 participants (37%) died. Two of these participants had undergone bilateral surgery, and for seven participants, it was unclear which prosthesis they had received; therefore they were excluded from the analyses. Thus our analysis included four out of 191 participants (2.1%) who had died: one in the fixed bearing group and three in the mobile bearing group. No statistically significant differences were found. The risk difference was -0.02 (95% CI -0.06 to 0.03, P value 0.49) and results were homogeneous. Reoperation ratesThirty reoperations were performed in 17 studies (89%) with 2065 knees (92%): 18 knees in the fixed bearing group (of the 1031 knees) and 12 knees in the mobile group (of the 1034 knees). No statistically significant differences were found. The risk difference was -0.01 (95% CI -0.01 to 0.01, P value 0.99) with homogeneous results. Other serious adverse eventsSixteen studies (84%) reported nine other serious adverse events in 1735 knees (77%): four in the fixed bearing group (of the 862 knees) and five in the mobile bearing group (of the 873 knees). No statistically significant differences were found (risk difference 0.00, 95% CI -0.01 to 0.01, P value 0.88), and results were homogeneous. AUTHORS' CONCLUSIONS Moderate- to low-quality evidence suggests that mobile bearing prostheses may have similar effects on knee pain, clinical and functional scores, health-related quality of life, revision surgery, mortality, reoperation rate and other serious adverse events compared with fixed bearing prostheses in posterior cruciate retaining TKA. Therefore we cannot draw firm conclusions. Most (98.5%) participants had OA, so the findings primarily reflect results reported in participants with OA. Future studies should report in greater detail outcomes such as those presented in this systematic review, with sufficient follow-up time to allow gathering of high-quality evidence and to inform clinical practice. Large registry-based studies may have added value, but they are subject to treatment-by-indication bias. Therefore, this systematic review of RCTs can be viewed as the best available evidence.
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Key Words
- humans
- knee prosthesis
- arthritis, rheumatoid
- arthritis, rheumatoid/surgery
- arthroplasty, replacement, knee
- arthroplasty, replacement, knee/adverse effects
- arthroplasty, replacement, knee/instrumentation
- arthroplasty, replacement, knee/mortality
- bias
- health status
- knee joint
- osteoarthritis, knee
- osteoarthritis, knee/surgery
- prosthesis design
- prosthesis design/methods
- quality of life
- randomized controlled trials as topic
- range of motion, articular
- reoperation
- reoperation/statistics & numerical data
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Affiliation(s)
- Stefanie N Hofstede
- Department of Medical Decision Making, Leiden University Medical Center, Postzone J10-s, room J10-88, P.O. Box 9600, Leiden, Netherlands, 2300 RC.
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