Porous tantalum metaphyseal cones may facilitate reconstructions of severe bone defects during revision total knee arthroplasty (TKA), but there remains a paucity of data on their outcomes at mean 5 ...years of follow-up. This study reports the component survivorship, patient satisfaction, functional outcomes, radiographic osseointegration, and complications of revision TKA with porous tantalum metaphyseal cones at mid-term (mean 5-year) follow-up.
This study included 152 patients who had a mean age of 66 years (range, 33 to 86 years) undergoing revision TKA with porous tantalum metaphyseal cones. Indications for surgery included aseptic loosening (n = 87, 57.3%), second-stage reimplantation for infection (n = 42, 27.6%), osteolysis with well-fixed components (n = 20, 13.2%), and periprosthetic fracture (n = 3, 2.0%). Component survivorship, clinical outcomes, radiographic outcomes, and any complications were recorded. The mean follow-up time was 5.6 years (range, 2.2 to 13.7).
Survivorship was 100% when the end point was revision of the metaphyseal cone (no cones were revised) and 83.8% (95% confidence interval: 77.9 to 90.2%) when the end point was reoperation for any reason at 5-year follow-up. Reoperations were performed for infection (n = 10), instability (n = 4), periprosthetic fracture (n = 2), and quadriceps rupture/dehiscence (n = 3). The mean patient satisfaction score was 78.8 ± 11.3 and the mean Forgotten Joint Score was 62.2 ± 16.7 at the final follow-up. The preoperative median University of California at Los Angeles score improved from 2 (interquartile range 2 to 3) to 6 points (interquartile range 5 to 6) (P < .001), and the preoperative Oxford knee score improved from 15.2 ± 3.8 to 39.4 ± 5.1 points (P < .001) at the final follow-up. All metaphyseal cones showed radiographic evidence of osteointegration without any subsidence or loosening.
Porous tantalum metaphyseal cones enabled robust reconstructions of severe femoral and tibial bone defects during revision TKA. These reconstructions were associated with excellent survivorship, improvements in functional outcomes, and reproducible radiographic osseointegration at mean 5-year follow-up. The most common reasons for reoperation were infection and instability.
There is a paucity of literature regarding the mid-term (greater than 2 years) outcomes of revision for adverse local tissue reaction to metal debris due to corrosion at the head-neck junction ...(trunnionosis) in metal-on-polyethylene total hip arthroplasty (THA), and risk factors for re-revision remain largely unknown. We aimed to report the re-revision-free survival and functional outcomes for this patient population and to identify risk factors for re-revision.
A total of 80 hips (79 patients) with a metal-on-polyethylene THA who had undergone revision for trunnionosis at our institution were included. The mean study follow-up from index trunnionosis revision was 4.6 years (range, 2.0 to 9.4). Kaplan-Meier survival analysis was performed with all-cause re-revision as the end point, and multivariate logistic regression was used to identify risk factors for re-revision.
We saw that twenty-one hips (26%) underwent re-revision at a mean of 8.0 months (range, 0.03 to 36.3) after the index trunnionosis revision, most commonly for instability and infection.
The two- and five-year all-cause re-revision-free survival rates were 75.0 and 73.2%, respectively. The mean Oxford Hip Score was 33.7 (range, 11 to 48); 76% were satisfied, and 24% were dissatisfied with their hip. Multivariate analysis identified not undergoing a cup revision (odds ratio: 4.5; 95% confidence interval: 1.03 to 19.7) and time from primary THA to the index trunnionosis revision (odds ratio: 0.77; 95% confidence interval: 0.62 to 0.97) as risk factors for undergoing re-revision.
The risk of early re-revision for these patients is high (26%), mostly due to infection and instability, and functional outcomes are fair. Not performing a cup revision appears to be a risk factor for re-revision, as is the shorter time from primary THA to trunnionosis revision.
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Purpose To determine the intra- and inter-rater agreement of a mobile application, PostureScreen Mobile® (PSM), that assesses static standing posture. Subjects and Methods Three examiners with ...different levels of experience of assessing posture, one licensed physical therapist and two untrained undergraduate students, performed repeated postural assessments of 10 subjects, fully clothed or minimally clothed, using PSM on two nonconsecutive days. Anterior and right lateral images were captured and seventeen landmarks were identified on them. Intraclass correlation coefficients (ICCs) were calculated for each of 13 postural measures to evaluate inter-rater agreement on the first visit (fully or minimally clothed), as well as intra-rater agreement between the first and second visits (minimally clothed). Results Eleven postural measures were ultimately analyzed for inter- and intra-rater agreement. Inter-rater agreement was almost perfect (ICC≥0.81) for four measures and substantial (0.60<ICC≤0.80) for three measures during the fully clothed exam. During the minimally clothed exam, inter-rater agreement was almost perfect for four measures and substantial for four measures. Intra-rater agreement between two minimally clothed exams was almost perfect for two measures and substantial for five measures. Conclusion PSM is a widely available, inexpensive postural screening tool that requires little formal training. To maximize inter- and intra-rater agreement, postural screening using this mobile application should be conducted with subjects wearing minimal clothing. Assessing static standing posture via PSM gives repeatable measures for anatomical landmarks that were found to have substantial or almost perfect agreement. Our data also suggest that this technology may also be useful for diagnosing forward head posture.
Aims. Cool, evolved stars have copious, enriched winds. Observations have so far not fully constrained models for the shaping and acceleration of these winds. We need to understand the dynamics ...better, from the pulsating stellar surface to ~10 stellar radii, where radiation pressure on dust is fully effective. Asymmetric nebulae around some red supergiants imply the action of additional forces. Methods. We retrieved ALMA Science Verification data providing images of sub-mm line and continuum emission from VY CMa. This enables us to locate water masers with milli-arcsec accuracy and to resolve the dusty continuum. Results. The 658, 321, and 325 GHz masers lie in irregular, thick shells at increasing distances from the centre of expansion. For the first time this is confirmed as the stellar position, coinciding with a compact peak offset to the NW of the brightest continuum emission. The maser shells overlap but avoid each other on scales of up to 10 au. Their distribution is broadly consistent with excitation models but the conditions and kinematics are complicated by wind collisions, clumping, and asymmetries.
Islet transplantation is a feasible therapeutic alternative for metabolically labile patients with type 1 diabetes. The primary therapeutic target is stable glycemic control and prevention of ...complications associated with diabetes by reconstitution of endogenous insulin secretion. However, critical shortage of donor organs, gradual loss in graft function over time, and chronic need for immunosuppression limit the indication for islet transplantation to a small group of patients. Here we present a promising approach to address these limitations by utilization of a macrochamber specially engineered for islet transplantation. The s.c. implantable device allows for controlled and adequate oxygen supply and provides immunological protection of donor islets against the host immune system. The minimally invasive implantable chamber normalized blood glucose in streptozotocin-induced diabetic rodents for up to 3 mo. Sufficient graft function depended on oxygen supply. Pretreatment with the growth hormone-releasing hormone (GHRH) agonist, JI-36, significantly enhanced graft function by improving glucose tolerance and increasing β-cell insulin reserve in rats thereby allowing for a reduction of the islet mass required for metabolic control. As a result of hypervascularization of the tissue surrounding the device, no relevant delay in insulin response to glucose changes has been observed. Consequently, this system opens up a fundamental strategy for therapy of diabetes and may provide a promising avenue for future approaches to xenotransplantation.
We report the final results of a study of the ψ(3770) meson using a data sample collected with the KEDR detector at the VEPP-4M electron–positron collider. The data analysis takes into account ...interference between the resonant and nonresonant DD¯ production, where the latter is related to the nonresonant part of the energy-dependent form factor FD. The vector dominance approach and several empirical parameterizations have been tried for the nonresonant FDNR(s).
Our results for the mass and total width of ψ(3770) areM=3779.2−1.7+1.8−0.7+0.5−0.3+0.3 MeV,Γ=24.9−4.0+4.6−0.6+0.5−0.9+0.2 MeV, where the first, second and third uncertainties are statistical, systematic and model, respectively. For the electron partial width two possible solutions have been found:(1)Γee=154−58+79−9+17−25+13 eV,(2)Γee=414−80+72−26+24−10+90 eV. Our statistics are insufficient to prefer one solution to another. The Solution (2) mitigates the problem of non-DD¯ decays but is disfavored by potential models.
It is shown that taking into account the resonance–continuum interference in the near-threshold region affects resonance parameters, thus the results presented cannot be directly compared with the corresponding PDG values obtained ignoring this effect.
We present the analysis of all KEDR data on the determination of J/ψ and ψ(2S) masses. The data comprise six scans of J/ψ and seven scans of ψ(2S) which were performed at the VEPP-4M e+e− collider in ...2002–2008. The beam energy was determined using the resonance depolarization method. The detector and accelerator conditions during scans were very different that increases the reliability of the averaged results. The analysis accounts for partial correlations of systematic uncertainties on the masses. The following mass values were obtained:MJ/ψ=3096.900±0.002±0.006 MeV,Mψ(2S)=3686.099±0.004±0.009 MeV. These results supersede our previous measurements published in 2003 and 2012.
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