Surgical technology international最新文献

Introduction: While dual mobility systems in total hip replacements have demonstrated reduced dislocation and revision occurrences, concerns persist about the potential elevation of metal ions in the bloodstream, leading to negative tissue reactions. Notably, there's a scarcity of research spanning over five years post-surgery that examines cobalt and chromium levels after such implants. This study aimed to delve into these metal ion concentrations after a five-year period, building on previous metal-ion findings. We focused on: (1) cobalt concentrations in blood and urine; (2) chromium concentrations in blood and urine; (3) cobalt variations based on follow-up duration and specific implant metrics (e.g., offset, cup dimension, stem, and neck inclination); and (4) chromium variations based on the same parameters.

Materials and methods: We tracked 57 individuals who received THA using modular dual mobility systems from January 1, 2011, to December 31, 2016, for an average span of six years (ranging from five to 10 years). At the final check-up, we measured cobalt and chromium levels in serum, plasma, blood, and urine. We also evaluated parameters like head composition and dimension, stem offset, cup dimension, and stem-neck inclination.

Results: Cobalt concentrations remained minimal, with average blood and urine values being 0.8+0.6mcg/L (standard <1.8mcg/L) and 1.2+1.0mcg/L (standard <2.8mcg/L), respectively. Two individuals exhibited a slight increase in blood cobalt concentration by 0.1 and 0.2mcg/L. Chromium averages in blood and urine were also minimal, with readings of 0.9+0.2mcg/L (standard <1.2mcg/L) and 1.3 + 0.5mcg/L (standard <2mcg/L), respectively. One individual had a marginally increased blood chromium concentration of 1.3mcg/L. Evaluations considering ceramic or cobalt-chrome heads, up to a decade of follow up, or varying implant metrics showed negligible variations in metal ion concentrations.

Conclusion: The findings reveal that over a minimum of five years (average = six years; span, five to 10 years), cobalt and chromium concentrations in patients' systems remained within normal limits and were clinically insignificant, irrespective of the follow-up duration, head material, or implant specifications. This underscores the efficacy of dual mobility systems in ensuring minimal metal ion presence.

Revision total hip arthroplasty (THA) is a procedure with many challenges, especially when patients exhibit femoral bone defects. The causes of these defects vary, ranging from removal of prior implants to aseptic loosening. As surgeons navigate these challenges, a reliable surgical system is important. One modular fluted tapered system provides surgeons with tools to address complex hip revision cases. Introduced in 2003, this system has been utilized in over 180,000 procedures, demonstrating its reliability and effectiveness. Previously, the body stem came in sizes 155mm to 235mm. In the discussed case series, we present six distinct patient cases that highlight the advantages and efficacy of a newly introduced modification of the system; that is the use of smaller stemmed components (now 115mm). With each patient presenting unique challenges, we have demonstrated the use of this new short-stem version for multiple applications for various revision scenarios.

Introduction: Manual techniques for total hip arthroplasty (THA) have been widely utilized and proven to be clinically successful. However, the use of advanced computed tomography (CT) scan-based planning and haptically-bounded reamers in robotic-arm assisted total hip arthroplasty (RTHA) holds promise for potentially limiting surrounding soft-tissue damage. This cadaver-based study aimed to compare the extent of soft-tissue damage between a robotic-arm assisted, haptically-guided THA (RTHA) and a manual, fluoroscopic-guided THA (MTHA) direct anterior approach.

Materials and methods: There were six fresh-frozen torso-to-toe cadaver specimens included, with two surgeons each performing three RTHA and three MTHA procedures. One hip underwent an RTHA and the other hip received an MTHA in each cadaver. Postoperatively, one additional surgeon, blinded to the procedures, assessed and graded damage to nine key anatomical structures using a 1 to 4 grading scale: (1) complete soft-tissue preservation to <5% of damage; (2) 6 to 25% of damage; (3) 26 to 75% of damage; and (4) 76 to 100% of damage. Kruskal-Wallis hypothesis tests were used to compare soft-tissue damage between RTHA and MTHA cases and adjusted for ties.

Results: Pooled analysis of the gluteus minimus, sartorius, tensor fascia lata, and vastus lateralis muscle grades demonstrated that cadaver specimens who underwent RTHA underwent less damage to these structures than following MTHA (median, IQR: 1.0, 1.0 to 2.0 vs. 3.0, 2.0 to 3.0; p=0.003). Pooled analysis of the calculated volumetric damage (mm3) for the gluteus minimus, sartorius, tensor fascia lata, and vastus lateralis muscles demonstrated that the cadaver specimens that underwent RTHA underwent less damage to these structures than those that followed MTHA (median, IQR: 23, 2 to 586 vs. 216, 58 to 3,050; p=0.037).

Conclusion: This cadaver-based study suggests that utilizing RTHA may lead to reduced soft-tissue damage compared with MTHA, likely due to enhanced preoperative planning with robotic-arm assisted software, real-time intraoperative feedback, haptically-bounded reamer usage, reduced surgical steps, as well as ease of use with reaming. These findings should be carefully considered when evaluating the utilization of robotic-arm assisted THA in practice.

Periprosthetic joint infections (PJI) are devastating complications following total hip arthroplasty (THA) and are the most common reason for revision following primary arthroplasty. Although several devices, techniques, and procedures have been developed to combat this serious complication, there is little consensus as to how to prevent the development of PJI at the time of index arthroplasty. This article reviews the concept and implementation of a novel antimicrobial agent to substantially reduce the incidence of PJI. The regular implementation of this infection prophylaxis should be successful in drastically reducing the rate of PJI following primary THA.

Background: Female cosmetic genital surgery is becoming increasingly sought after by women who are concerned with the appearance of their vulva. Labiaplasty for the labia minora is undoubtedly the most commonly performed female cosmetic genital surgery. However, an increasing number of patients seen in our clinics in both Brazil and the United States are presenting with clitoral hypertrophy, specifically clitoral elongation. The elongated clitoris will usually protrude beyond the labia minora and majora and from the patient's perspective will give a less feminine appearance as they will often describe the protruding clitoris as feeling like they have a small penis. The surgical technique described here, Batalha Clitoropexy, is a minimally invasive surgical technique for clitoral length-reduction that does not require amputation or debulking. This technique is presented in the form of the detailed sequential steps needed to achieve satisfactory results. Photos taken before and after the procedure in a representative case show that the clitoral length has been shortened from 5.0 cm to 1.5 cm without the need of an invasive amputation or debulking clitoroplasty. Many patients with clitoromegaly or an elongated protruding clitoris do not need to undergo an invasive clitoroplasty. Specifically, patients with clitoral elongation or clitoral ptosis can be surgically treated with a less-invasive clitoropexy surgical procedure which can restore normal anatomic position to treat a protruding clitoris.

Diabetic foot ulcers (DFUs) are a prevalent complication of diabetes mellitus (DM) and lead to significant morbidity and mortality. Patients with DM have a lifetime risk of DFUs as high as 34%. The pathogenesis of DFUs is multifactorial, and the most common underlying causes are poor glycemic control, peripheral neuropathy, peripheral vascular disease, foot deformity, and poor foot care. Diabetic lower-extremity complications are also a significant burden in terms of healthcare costs. In the United States alone, the direct cost of diabetic foot care has been estimated to be $8,659 per patient, with total annual medical costs for managing diabetic foot disease ranging from $9 to $13 billion. Given the risk of amputation and poor wound healing, the fast, accurate diagnosis and treatment of DFUs are critical. Measures to prevent DFUs include glycemic control and annual foot inspections. For patients with DFUs, off-loading and local wound care are critical for wound healing. Debridement is the standard of care for DFU wounds, and several techniques exist. In this review, we discuss the current practices of diabetic wound care, different methods of debridement and their practical use in DFUs, and novel debridement approaches with the potential for improving wound-healing outcomes.

Introduction: Osteonecrosis of the femoral head (ONFH) poses a substantial burden to orthopaedic surgeons. However, the exact risk attributed by each specific patient factor for those who end up receiving a total hip arthroplasty (THA) are not well known. We assessed: (1) patient demographics (age and sex); (2) blood cell dyscrasias (sickle-cell disease and hypercoagulable states); and (3) substance use (oral corticosteroid use, tobacco use, and alcohol abuse).

Materials and methods: A retrospective search examined all patients who had a primary THA (n=715,100) between January 1, 2010 and April 30, 2020 using a national, all-payer database. Risk factors studied included age, sex, sickle-cell, hypercoagulable state, oral corticosteroid use, tobacco use, and alcohol abuse.

Results: Several risk factors were found to be significantly predictive for ONFH requiring THA: age <55 years (odds ratio [OR] 1.02, 95% confidence interval [CI] of 1.01 to 1.02, p<0.001), men (OR 1.07, 95% CI of 1.04 to 1.10, p<0.001), oral corticosteroid use (OR 1.21, 95% CI of 1.17 to 1.25, p<0.001), tobacco use (OR 1.15, 95% CI of 1.11 to 1.18, p<0.001), and alcohol abuse (OR 1.05, 95% CI of 1.01 to 1.08, p=0.009).

Conclusions: Based on the results of this study, young age, men, oral corticosteroid use, tobacco use, and alcohol abuse are risk factors for patients who have ONFH and had a THA. The degree of risk from greatest to least were: oral corticosteroid use, tobacco use, men, alcohol abuse, and age <55 years old.

Osteoporosis is the most common disease of bone mineral metabolism. In Spain, it affects approximately 3 million people, of whom 80% are females and 20% are males. Despite the advances that have been made in this field, we continue to witness alarming levels of fragility hip fractures. In 2010, the cost of osteoporosis in the European Union was estimated to be 37,000 million euros, which included the costs for the treatment of incident fractures (66%), pharmacological prevention (5%), and long-term fracture care (29%). A multidisciplinary care pathway supported by a surgical approach to local bone formation is needed. Recently, the International Osteoporosis Foundation (IOF) and the European Society for Clinical and Economic Aspects of Osteoporosis (ESCEO) included in their treatment guidelines a local osteo-enhancement procedure (LOEP) as a treatment option. In the Ossure™ LOEP technique (AgNovos Healthcare USA, LLC, Rockville, MD), a calcium-based triphasic osteoconductive implant material (AGN1), which has been shown to increase bone mineral density (BMD) and proximal femoral strength, is introduced percutaneously in the femoral neck and intertrochanteric region. Basically, the procedure consists of three percutaneous steps: prepare, clean, and fill the cavity with AGN1. It can be carried out with sedation and local anaesthesia or spinal anaesthesia. This report presents a clinical case and discusses how to select patients who could potentially benefit from this technique.

Recently, temporary mechanical circulatory support (tMCS) has been increasingly used for cardiogenic shock therapy. Originally designed as a bail-out option for patients who could not be weaned from cardiopulmonary bypass, the indications for tMCS have been expended and now enable us to support a wide range of patients with various cardiac pathologies. Modern tMCS devices include microaxial flow pumps (mAFP) which are small, versatile systems that can provide both acute cardiac support and cardiac protection for high-risk interventions. In this paper, we review different surgical implantation techniques with modern mAFP as well as specific aspects of preoperative indications and patient evaluation.