Abstract Objective As the number of UKA performed in the world continues to increase, so will the number of failures. A better understanding of the outcomes after revision UKAto TKA is warranted. The ...objective of this study is to report the outcomes of modern UKA revised to TKA in three US centers. Methods A total of 175 revisions of medial UKA in 168 patients (81 males, 87 females; average age of 66 years) performed from 1995 to 2009 in three institutions and with a minimum of 2-year clinical follow-up were reviewed. Individual joint registries and chart reviews were performed to collect data regarding reasons for revision, type of implants used, and re-revision rates. Results The average time from UKA to revision TKA was 71.5 months (range 2 months to 262 months). The four most common reasons for failure of the UKA were femoral or tibial loosening (55%), progressive arthritis of the lateral or patellofemoral joints (34%), polyethylene failure (4%) and infection (3%). The average follow-up after revision was 75 months. Nine of 175 knees (4.5%) were subsequently revised at an average of 48 months (range 6 months to 123 months.) The rate of revision was 1.23 revisions per 100 observed component years. The average Knee Society pain and function score increased to 75 and 66, respectively. Conclusions In the present series, the re-revision rate after revision TKA from UKA was 4.5 % at an average of 75 months or 1.2 revisions per 100 observed component years. Compared to published individual institution and national registry data, re-revision of a failed UKA is equivalent to revision rates of primary TKA and substantially better than re-revision rates of revision TKA. These data should be used to counsel patients undergoing revision UKA to TKA.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Long-term cardiovascular (CV) events are a frequent cause of death and disability after liver transplant (LT). Although a more in-depth, risk-adapted control of CV risk factors may result in improved ...post-LT CV outcomes, an accurate stratification of the CV risk of LT recipients to better implement preventive strategies is lacking. Aortic pulse wave velocity (aPWV) is a surrogate of arterial stiffness that has been suggested as a biomarker of CV risk; it has never been evaluated in adult LT recipients.
In a single-center prospective study, we included 122 LT recipients at 12 (n = 39), 60 (n = 45), or 120 (n = 38) mo after LT. aPWV estimation by oscillometry, clinical assessment of CV risk factors, and CV risk estimation by standard clinical scores (systematic coronary risk evaluation and pooled cohort equation) were performed. The incidence of CV events during prospective follow-up was registered.
aPWV was independently associated with age and the grade of control of blood pressure. After a median follow-up of 35 mo, 15 patients (12%) presented a CV event. Higher aPWV, diabetes, past or present smoking habit, previous CV events, lower eGFR, being in systematic coronary risk evaluation or pooled cohort equation high-risk groups, and higher levels of total cholesterol, LDL-cholesterol, creatinine, and triglycerides were associated with the incidence of CV events at univariate analysis; aPWV, past or present smoking habit, and triglycerides were independent predictors of CV events.
According to our results, aPWV mirrors CV risk in LT recipients and thus may be a useful CV risk biomarker in this population. Considering these preliminary results, its accuracy in stratifying risk requires confirmation in further studies.
Abstract Background Recent trials have documented no benefit from small reductions in blood pressure measured in the clinical office. However, ambulatory blood pressure is a better predictor of ...cardiovascular events than office-based blood pressure. We assessed control of ambulatory blood pressure in treated hypertensive patients at high cardiovascular risk. Methods We selected 4729 patients from the Spanish Ambulatory Blood Pressure Monitoring Registry. Patients were aged ≥55 years and presented with at least one of the following co-morbidities: coronary heart disease, stroke, and diabetes with end-organ damage. An average of 2 measures of blood pressure in the office was used for analyses. Also, 24-hour ambulatory blood pressure was recorded at 20-minute intervals with a SpaceLabs 90207 device. Results Patients had a mean age of 69.6 (±8.2) years, and 60.8% of them were male. Average time from the diagnosis of hypertension to recruitment into the Registry was 10.9 (±8.4) years. Mean blood pressure in the office was 152.3/82.3 mm Hg, and mean 24-hour ambulatory blood pressure was 133.3/72.4 mm Hg. About 60% of patients with an office-pressure of 130-139/85-89 mm Hg, 42.4% with office-pressure of 140-159/90-99 mm Hg, and 23.3% with office-pressure ≥160/100 mm Hg were actually normotensive, according to 24-hour ambulatory blood pressure criteria (<130/80 mm Hg). Conclusion We suggest that the lack of benefit of antihypertensive therapy in some trials may partly be due to some patients having normal pressure at trial baseline. Ambulatory monitoring of blood pressure may allow for a better assessment of trial eligibility.
To identify whether new ipsilateral weakness after hip surgery may be due to an inflammatory as opposed to a mechanical process.
Seven patients (8 hip surgeries) seen between July 1, 2008, and June ...30, 2011, developed unexplained ipsilateral leg weakness and pain within 1 month of hip surgery, mimicking mechanical etiologies. Cutaneous sensory nerve biopsy distant from the site of surgery was performed on all the patients. Patient medical records were reviewed for the clinical, electrophysiologic, radiologic, and pathologic features of the new neuropathy.
Results of all the nerve biopsies were abnormal, showing axonal damage (7 patients), inflammation (7 patients), signs of ischemic injury (7 patients), and nerve microvasculitis (6 patients). Six patients were treated with intravenous methylprednisolone. At median follow-up of 6 months, 6 patients showed improvement in function and pain.
In this case series, we demonstrate that inflammatory neuropathy is an important etiologic consideration in some patients with ipsilateral weakness and pain after hip surgery. In these patients, the inflammatory mechanism was ischemic injury due to microvasculitis. Identification of these patients through clinical suspicion and subsequent nerve biopsy may lead to improved outcomes with prompt initiation of immunotherapy.
There is a paucity of literature examining patients’ and health-care providers’ perception of surgical scars after total hip arthroplasty (THA). This study examined perception of surgical scars after ...direct anterior (DAA) or posterior approach (PA) for THA using validated scar-assessment scales.
Seventy-five DAA and 75 PA THA patients underwent scar assessment using the Patient Observer Scar Assessment Scale (POSAS) and Stony Brook Scar Evaluation Scales. Mean age was different between the cohorts (DAA 67 vs PA 62 years, P = .01). All patients had subcuticular running closure, secured with skin adhesive glue. Mean time from THA to scar assessment was 3.1 and 3.6 years for the DAA and PA groups, respectively (P = .18).
Scar opinion on the POSAS patient-reported scale was graded closer to normal skin more often for DAA than for PA patients (P = .03). More irregularities were graded for the DAA scars on the POSAS observer scale (P = .02) and the Stony Brook Scar Evaluation Scales (P = .04). Age did not predict scar opinion on any of the scales (P > .05). Female gender and a history of keloids predicted poorer scar appearance (P = .001 and P = .02). Overall scar appearance was rated as “good” in 93% of the DAA and 91% of the PA patients (P = .63).
Differences exist in DAA and PA scar perception based on validated scales. Future randomized trials in scar assessment may control for confounding variables such as age and gender, as well as potential biases when using scar assessment scales.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Abstract Background Open and arthroscopic approaches have been described to address femoroacetabular impingement (FAI). Despite good outcomes, there is a subset of patients who subsequently require ...total hip arthroplasty (THA). However, there is a paucity of data on the outcomes of THA after surgery for FAI. The purpose of this study was to determine whether clinical outcomes of THA are affected by prior open or arthroscopic treatment of FAI. Methods This case-matched retrospective review included 23 patients (24 hips) that underwent THA after previous surgery for FAI (14 arthroscopic and 10 open) and compared them to 24 matched controls with no history of prior surgery on the operative hip. The controls were matched for age, sex, surgical approach, implants used, and preoperative modified Harris hip score (mHHS) did not differ between groups. The primary outcome measure was the mHHS. Operative time, blood loss, and the presence of heterotopic ossification after THA were also compared between groups. Results There was no significant difference in mean mHHS between the FAI treatment group 92.9 ± 12.7 and controls 95.2 ± 6.6 ( P = .43) at a mean follow-up after THA of 33 (24-70) months. Increased operative times were noted for THA after surgical hip dislocation (SHD; mean 109.3 ± 29.8) compared to controls (mean 88.0 ± 24.2; P < .05). There was no significant difference in blood loss between groups. The occurrence of heterotopic ossification was significantly higher after SHD compared to controls ( P < .05). Conclusions Clinical outcomes after THA are not affected by prior open or arthroscopic procedures for FAI. However, increased operative times and an increased risk of heterotopic ossification were noted after SHD.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Abstract Background Addressing recurrent instability in patients with poor bone stock and inadequate abductor tensioning remains a challenge in revision total hip arthroplasty (THA). One treatment ...method is implantation of a constrained liner. The purpose of this study was to determine clinical outcomes, re-dislocation rate, and revisions of a focally constrained liner in a high risk patient cohort. Methods 58 hips between 2008 and 2011 underwent implantation of a focally constrained liner. 19 were placed concurrent with acetabular component revision and 39 were placed into a well-fixed acetabular shell. Mean age was 69 years and mean number of previous ipsilateral hip surgeries was 4.2. At mean follow-up of 3.5 years, we analyzed clinical outcomes, re-dislocation, and revisions. Results Mean HHS was 74. 14 hips (24%) were revised and 3 hips (5%) required reoperation at final follow-up. 11 hips (19%) re-dislocated at a mean time to dislocation of 12.2 months. 31% (11 of 36 patients) that underwent modular exchange specifically for instability re-dislocated. Risk factors for re-dislocation included number of previous surgeries (p=0.013), implantation of a 28-mm femoral head (HR 12.8), revision indication of instability (p=0.04), and modular exchange with constrained liner implantation without acetabular shell revision (p=0.01). Discussion Implantation of a focally constrained liner in revision THA for recurrent instability has a high failure rate, especially with a modular exchange. While concurrent acetabular revision had a lower re-dislocation rate, the decision to revise a well fixed cup should be weighed with potential complications associated with cup revision.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
SUMMARY Shear wave velocity (Vs) is a fundamental property of elastic media whose estimation from PS converted waves is challenging and requires modelling the boundary where P to S conversion occurs. ...This paper presents a PS tomography where seismic wave conversion/reflection points correspond to reflectors modelled with the level-set function set to zero ϕ(x, z) = 0. The proposed method aims for stable Vs inversion in a seismic acquisition setting using multicomponent receivers. Synthetic models simulating true Vs, Vp and the location of the geological reflector are used in the study. The inversion starts by locating a flat reflector, ϕ(x, z) = 0, which defines the zone Ω1 between the surface and the reflector, where the initial Vs and Vp fields are also set. To calculate the traveltimes of incident PT (P wave that propagates in Ω1 from source to the reflector), converted PS and reflected PP waves, for both observed and modelled data (forward problem), the methodology proposed by Rawlinson and Sambridge is adopted. This method uses the arrival times of the P waves, Tpt, from the seismic source at each reflector point as secondary sources generating the times Tps and Tpp. These times are calculated as a solution to the eikonal equation by using the Fast Marching method. The PS and PP residual times are minimized by updating Vs, Vp and ϕ(x, z) = 0 through adjoint variables designed from a formulation using Lagrange Multipliers in a variational context. The performance of the algorithm is evaluated for models with synclinal, sinusoidal and monoclinal reflector geometries using numerical tests considering the inversion of: (1) ϕ, given the true values of Vs and Vp; (2) ϕ and Vs, given the true value of Vp; (3) ϕ and Vp, given the true value of Vs and (4) the three parameters ϕ, Vs and Vp, simultaneously. Good results are obtained by inverting Vs and ϕ, given the true value of Vp. The simultaneous inversion of the three parameters exhibits promising results, despite the illumination problems caused by the different distribution of the PS, PP and PT time gradients due to the geometry of the reflectors and the acquisition setting (sources–receivers in the same plane). The proposed tomography estimates Vs and reflector positions which could help in statics corrections and improve the lithological characterization of near surface.
We aimed to determine the prevalence of hypotension and factors associated with the presence of this condition in treated hypertensive patients undergoing ambulatory blood pressure monitoring (ABPM). ...Data were taken from the Spanish ABPM Registry. Office blood pressure (BP) and ABPM were determined using validated devices under standardized conditions. Based on previous studies, hypotension was defined as office systolic/diastolic BP <110 and/or 70 mm Hg, daytime ABPM <105 and/or 65 mm Hg, nighttime ABPM <90 and/or 50 mm Hg, and 24-hour ABPM <100 and/or 60 mm Hg. Multivariable logistic regression was performed to determine the variables associated with the presence of hypotension. A total of 70,997 hypertensive patients on treatment (mean age 61.8 years, 52.5% men) were included in the study. The prevalence of hypotension was 8.2% with office BP, 12.2% with daytime ABPM, 3.9% with nighttime ABPM, and 6.8% with 24-hour ABPM. Low diastolic BP values were responsible for the majority of cases of hypotension. Some 68% of the hypotension cases detected by daytime ABPM did not correspond to hypotension according to office BP. The variables independently and consistently associated with higher likelihood of office, daytime, and 24 hour-based hypotension were age, female gender, history of ischemic heart disease, and body mass index <30 kg/m(2) (P < .05). In conclusion, in this large cohort of patients in usual daily practice, one in eight treated hypertensive patients are at risk of hypotension according to daytime BP. Two-thirds of them are not adequately identified with office BP. ABPM could be especially helpful for identifying ambulatory hypotension, in particular in patients who are older, women, or with previous ischemic heart disease where antihypertensive treatment should be especially individualized and cautious.
Socially Assistive Robotics has emerged as a potential tool for rehabilitating cognitive and developmental disorders in children with autism. Social robots found in the literature are often able to ...teach critical social skills, such as emotion recognition and physical interaction. Even though there are promising results in clinical studies, there is a lack of guidelines on selecting the appropriate robot and how to design and implement the child-robot interaction.
This work aims to evaluate the impacts of a social robot designed with three different appearances according to the results of a participatory design (PD) process with the community. A validation study in the emotion recognition task was carried out with 21 children with autism.
Spectrum disorder results showed that robot-like appearances reached a higher percentage of children's attention and that participants performed better when recognizing simple emotions, such as happiness and sadness.
This study offers empirical support for continuing research on using SAR to promote social interaction with children with ASD. Further long-term research will help to identify the differences between high and low-functioning children.
PDF
