Background
Porous tantalum is an option of cementless fixation for TKA, but there is no randomized comparison with a cemented implant in a mid-term followup.
Questions/purposes
We asked whether a ...tibial component fixed by a porous tantalum system might achieve (1) better clinical outcome as reflected by the Knee Society Score (KSS) and WOMAC Osteoarthritis Index, (2) fewer complications and reoperations, and (3) improved radiographic results with respect to aseptic loosening compared with a conventional cemented implant.
Methods
We randomized 145 patients into two groups, either a porous tantalum cementless tibial component group (Group 1) or cemented conventional tibial component in posterior cruciate retaining TKA group (Group 2). Patients were evaluated preoperatively and 15 days, 6 months, and 5 years after surgery, using the KSS and the WOMAC index. Complications, reoperations, and radiographic failures were tallied.
Results
At 5-year followup the KSS mean was 90.4 (range, 68–100; 95% CI, ± 1.6) for Group 1, and 86.5 (range, 56–99; 95% CI, ± 2.4) for Group 2. The effect size, at 95% CI for the difference between means, was 3.88 ± 2.87. The WOMAC mean was 15.1 (range, 0–51; 95% CI, ± 2.6) for the Group 1, and 19.1 (range, 4–61; 95% CI, ± 2.9) for Group 2. The effect size for WOMAC was −4.0 ± 3.9. There were no differences in the frequency of complications or in aseptic loosening between the two groups.
Conclusions
Our data suggest there are small differences between the uncemented porous tantalum tibial component and the conventional cemented tibial component. It currently is undetermined whether the differences outweigh the cost of the implant and the results of their long-term performance.
Level of Evidence
Level I, therapeutic study. See Instructions to Authors for a complete description of levels of evidence.
Background
Surgical navigation in TKA facilitates better alignment; however, it is unclear whether improved alignment alters clinical evolution and midterm and long-term complication rates.
...Questions/purposes
We determined the alignment differences between patients with standard, manual, jig-based TKAs and patients with navigation-based TKAs, and whether any differences would modify function, implant survival, and/or complications.
Patients and Materials
We retrospectively reviewed 97 patients (100 TKAs) undergoing TKAs for minimal preoperative deformities. Fifty TKAs were performed with an image-free surgical navigation system and the other 50 with a standard technique. We compared femoral angle (FA), tibial angle (TA), and femorotibial angle (FTA) and determined whether any differences altered clinical or functional scores, as measured by the Knee Society Score (KSS), or complications. Seventy-three patients (75 TKAs) had a minimum followup of 8 years (mean, 8.3 years; range, 8–9.1 years).
Results
All patients included in the surgical navigation group had a FTA between 177° and 182º. We found no differences in the KSS or implant survival between the two groups and no differences in complication rates, although more complications occurred in the standard technique group (seven compared with two in the surgical navigation group).
Conclusions
In the midterm, we found no difference in functional and clinical scores or implant survival between TKAs performed with and without the assistance of a navigation system.
Level of Evidence
Level II, therapeutic study. See the Guidelines online for a complete description of levels of evidence.
In recent years, the use of surgically implanted biological aortic valves has been favored over mechanical prosthesis in patients between 50 and 70 years of age. However, outcomes on long-term ...survival are contradictory. The objective of this study was to determine if patients with mechanical valves have worse long-term survival than patients with biological prostheses.
We systematically searched published studies that: (1) were propensity score-matched or randomized controlled trials; (2) provided survival data with a minimum follow-up of 5 years; and (3) included patients older than 50 and younger than 70 years of age. Review articles, case reports, and editorials were excluded. We conducted a meta-analysis on the basis of 2 types of analysis. A reconstruction of the database of each study to simulate a patient-level meta-analysis was performed. Log rank test of Kaplan–Meier curves was recalculated. Hazard ratio (HR) was calculated using a univariate Cox regression. In addition, we calculated a pooled HR using the fixed-effect inverse variance method.
Four propensity score-matched studies and 1 randomized controlled trial met the inclusion criteria. Data of 4686 patients were analyzed. Survival rates for mechanical versus biological valves at 10 and 15 years of follow-up were: 76.78% (95% confidence interval CI, 74.72%-78.69%) versus 74.09% (95% CI, 71.96%-76.08%), and 61.58% (95% CI, 58.29%-64.69%) versus 58.04% (95% CI, 54.57%-61.35%). Log rank test was statistically significant (P = .012) and the pooled HR was 0.86 (95% CI, 0.76-0.97; P = .01).
Compared with biological aortic valves, mechanical valves are associated with a long-term survival benefit for patients between 50 and 70 years.
Transcatheter aortic valve implantation (TAVI) is a rapidly evolving therapeutic modality currently available for patients with severe aortic stenosis (AS) that are unsuitable for surgery because of ...technical/anatomical issues or high-estimated surgical risk. Transfemoral approach is the preferred TAVI delivery route when possible. Alternative non-transfemoral access options include transaortic, trans-subclavian and transapical access. Other approaches are also feasible (transcarotid, transcaval, and antegrade aortic) but are restricted to operators and hospitals with experience. The peculiarities of each of the vascular approaches designed for TAVI delivery make it necessary to carefully assess patient's atherosclerotic load and location, arterial size and tortuosity, and presence of mural thrombus. Several clinical trials are currently ongoing and in the near future the indications for these approaches will likely be better defined and extended to a broader spectrum of TAVI candidates.
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