Reducing dislocations of total hip arthroplasty

Dislocation is one of the most common complications following total hip arthroplasty (THA). There are several concepts that can be used to reduce the number of dislocations, including elevated liners, larger femoral heads, dual mobility devices and constrained acetabular devices. However, the data on their success has been somewhat contradictory. In studies I and IV, we aimed to assess the implant survival of a constrained acetabular device, the Biomet Freedom constrained liner (Biomet, Warsaw, IN, USA), in primary THA based on data from the Finnish Arthroplasty Register (FAR) and Turku University Hospital. We also aimed to assess the failure rate of this device, either in revision surgery for recurrent dislocation, or as a preventive method in high dislocationrisk revision THA patients, based on medical records from Turku University Hospital. Metal-on-metal (MoM) THA and hip resurfacing arthroplasty (HRA) allow the use of large diameter femoral heads, that prevent THA dislocation. It is now well known that adverse reaction to metal debris (ARMD) are associated with HRAs, not only with large-diameter MoM THAs. The aim of the study II was to assess the medium- to long-term survivorship of HRA based on the FAR. Special attention was paid to dislocation revisions. The use of Trabecular Metal (TM) cups for primary THA is increasing due to their better osteointegration and theoretical lower risk of aseptic loosening. Some recent data suggest that the use of TM in primary THA might be associated with an increased risk of revision. In study III, we compared the implant survival of Continuum acetabular cups (Zimmer Biomet, Warsaw, IN, USA), with other commonly used uncemented cups. Special attention was paid to revision for dislocation and the effect of elevated liners on dislocation revision risk. In studies I and IV, we found that the mechanical failure rate of a Freedom constrained device was low. This device had good survival in primary THA, and our results support its continued use even in high-risk patients and in revision surgery. In study II, we found that the 10-year implant survival of MoM HRAs is 86% in Finland. According to new recommendations from NICE (National Institute for Health and Care Excellence), an HRA/THA should have a revision rate of 5% or less at 10 years. None of the HRAs studied achieved this goal. However, the dislocation revision rate using HRA was very low. In study III, we found that THA with Continuum cups are associated with an increased risk of revision compared with other uncemented cups, due to revisions because of dislocation. Our results support the use of an elevated liner when Continuum cups are used for primary THA.Lonkan kokotekoniveleen liittyvien sijoiltaanmenojen ehkäisy Lonkan kokotekonivelen sijoiltaanmeno on yksi merkittävimmistä komplikaatioista liittyen lonkan tekonivelleikkaukseen. On useita tekonivelkomponenttikohtaisia tekijöitä, joilla voidaan estää dislokaatioita. Korotelinerit, isonuppiset proteesit, dual mobility linerit ja -kupit, lukkolinerit ja -kupit on kehitetty estämään tekonivelen sijoiltaanmenoja. Näiden komponenttien tulokset pysyvyyden, kestävyyden ja toimivuuden suhteen ovat olleet kuitenkin osin ristiriitaisia. Osatöissä I ja IV selvitimme, nykyään suositun lukkokupin (Biomet Freedom, Warsaw, IN, USA), tuloksia pysyvyyden ja kestävyyden suhteen, perustuen Suomen tekoniverekisterin (FAR) ja Turun yliopistollisen keskussairaalan dataan. Tulokset kartoitettiin liittyen lonkan ensi tekonivelleikkauksiin korkean riskin potilailla, sijoiltaanmenon hoidoksi tehtyihin uusintaleikkauksiin sekä sijoiltaanmenon suhteen korkean riskin potilaille, muusta syystä tehtyihin uusintaleikkauksiin. Metalli metalli -liukupintainen (MoM) kokotekonivel ja pinnoitetekonivel (HRA) sallivat tekonivelen ison nuppikoon käytön ja näin ollen pienentävät sijoiltaanmenon riskiä. On kuitenkin jo aiemmin todistettu, että MoM liukupintoihin liittyvä metallihierrekomplikaatio (ARMD), liittyy myös pinnoitetekoniveliin. Tutkimuksen II tarkoitus oli selvittää keskipitkän- ja pitkän aikavälin tulokset erimallisilla lonkan pinnoitetekonivelillä, perustuen FAR-dataan. Erityishuomio kiinnitettiin dislokaatiorevisioihin. Trabekulaari metalli (TM) -pintaisten acetabulum kuppien käyttö on lisääntynyt lonkan tekonivelkirurgiassa perustuen parempaan osteointegraatioon ja näin ollen teoreettisesti pienempään aseptisen irtoamisen riskiin. Jotkin viimeaikaiset tutkimukset ovat osoittaneet, että TM-pintaisten kuppien käyttö saattaisi olla yhteydessä lisääntyneeseen uusintaleikkausriskiin. Osatyössä III vertasimme yleisesti käytetyn Continuum -kupin (Zimmer Biomet, Warsaw, IN, USA) tuloksia muihin yleisesti käytettyihin sementittömiin acetabulum -kuppeihin, perustuen FAR-dataan. Erityishuomiota kiinnitettiin dislokaatiorevisioihin ja korotelinerin vaikutusta dislokaatiorevisio riskiin. Osatöiden I ja IV tuloksena totesimme, että Freedom tekonivelkomponentilla on hyvät lyhyen aikavälin tulokset kestävyyden ja pysyvyyden suhteen, liittyen lonkan kokotekonivelen sijoiltaanmenojen ehkäisyyn, niin korkean riskin ensi tekonivelpotilailla kuin haastavammissakin tapauksissa, erittäin korkean riskin uusintaleikkauksissa. Osatyön II tuloksena totesimme, että pinnoitetekonivelten 10 –vuotistulokset pysyvyyden suhteen, ovat keskimäärin 86 %. Uusimman NICE –suosituksen mukaisesti, tekonivelen pysyvyys 10 vuoden ajalla täytyy olla vähintään 95 %. Yksikään tutkimuksen pinnoitetekonivel ei pääse tähän. Tässä ryhmässä kuitenkin sijoiltaanmenojen vuoksi tehtyjen uusintaleikkausten määrä oli hyvin alhainen. Osatyön III tuloksena totesimme, että Continuum kupeilla, käytettäessä neutraalia lineria, on lisääntynyt revisioriski liittyen sijoiltaanmenon suhteen tehtyihin uusintaleikkauksiin. Tulokset suosittelevat korotelinerin käyttöä

Matemaattisen morfologian käyttö geometrisessa musiikinhaussa

The usual task in music information retrieval (MIR) is to find occurrences of a monophonic query pattern within a music database, which can contain both monophonic and polyphonic content. The so-called query-by-humming systems are a famous instance of content-based MIR. In such a system, the user's hummed query is converted into symbolic form to perform search operations in a similarly encoded database. The symbolic representation (e.g., textual, MIDI or vector data) is typically a quantized and simplified version of the sampled audio data, yielding to faster search algorithms and space requirements that can be met in real-life situations. In this thesis, we investigate geometric approaches to MIR. We first study some musicological properties often needed in MIR algorithms, and then give a literature review on traditional (e.g., string-matching-based) MIR algorithms and novel techniques based on geometry. We also introduce some concepts from digital image processing, namely the mathematical morphology, which we will use to develop and implement four algorithms for geometric music retrieval. The symbolic representation in the case of our algorithms is a binary 2-D image. We use various morphological pre- and post-processing operations on the query and the database images to perform template matching / pattern recognition for the images. The algorithms are basically extensions to classic image correlation and hit-or-miss transformation techniques used widely in template matching applications. They aim to be a future extension to the retrieval engine of C-BRAHMS, which is a research project of the Department of Computer Science at University of Helsinki

PENGARUH KOMUNIKASI PEMASARAN DAN KERELASIAN NASABAH TERHADAP LOYALITAS NASABAH

Penelitian ini bertujuan untuk mengalisis pengaruh parsial dan simultan komunikasipemasaran dan relasi pelanggan terhadap loyalitas pelanggan. Objek penelitianadalah Usaha Kecil dan Menengah (UKM) di bank Jabar Banten. Suatu surveydilakukan untuk mengumpulkan data di kantor cabang Padalarang, dengan respondenadalah pengusaha UKM yang merupakan nasabah bank. Kuesioner menjadiinstrumen penelitian dan disebarkan kepada responden. Data yang terkumpuldianalisis menggunakan uji statistik F dan t. Hasil penelitian menunjukkan bahwakomunikasi pemasaran dan relasi pelanggan secara simultan mempengaruhi loyalitaspelanggan. Relasi pelanggan memiliki pengaruh parsial yang paling dominanterhadap loyalitas pelanggan

Implant survival of constrained acetabular device in primary total hip arthroplasty based on data from the Finnish Arthroplasty Register

Background: Constrained acetabular devices were developed to prevent dislocations after total hip arthroplasty (THA). However, the data on their success have been contradictory. In this study, we aimed to assess implant survival of the constrained acetabular device in primary THA based on the Finnish Arthroplasty Register data. Methods: A total of 373 primary THAs with constrained acetabular devices inserted from 2006 to 2017 were included. A reference group was formed on a 1:3 basis and matched for age, sex, and diagnosis, consisting of 1118 conventional THAs. Implant survival estimates using death as a competing risk were assessed with revision for any reason and for any aseptic reason as the endpoints. The Cox multiple regression models were adjusted for age, sex, and diagnosis. The mean follow-up time was 3.3 (0-12.4) years for the constrained device group and 3.8 (0-12.0) years for the reference group. Results: Overall, there were 21 revisions in the constrained device group and 49 in the reference group. The 8-year survivorship for any reason was 94% (confidence interval [CI]: 91-96) for the constrained device group and 93% (CI: 89-97) for the reference group. With revision for any aseptic reason as the endpoint, the 8-year survivorships were 97% (CI: 95-99) and 94% (CI: 90-98), respectively. During the first 1.5 years, the constrained acetabular device group had a similar revision risk (hazard ratio: 1.09 [CI: 0.57-2.07], P = .8) to that of the reference group. Conclusion: The constrained acetabular device had good survival in primary THA, and our results support its continued use even in high-risk patients. (C) 2019 The Authors. Published by Elsevier Inc.Peer reviewe

Accolade TMZF trunnion corrosion and mechanical failure 9 yr after primary surgery: A case report and treatment options

Preserving patient anatomy in total hip arthroplasty (THA) is important to achieve good functionality and satisfied patients. Modular femoral heads are designed to help achieve this aim by managing limb-length, offset, and soft-tissue balance. Normal anatomy can be more easily preserved, and acetabular component exposure is achieved with removal of the femoral head in revision surgery. However, modularity increases the risk for mechanically assisted crevice corrosion (MACC) (also called trunnion corrosion) and may lead to trunnionosis, adverse local tissue reaction (ALTR), early femoral head dissociation, and implant failure. MACC is a multifactorial and poorly understood phenomenon. Affecting factors can be divided into patient-related, component-related, and surgery-related factors. Patient-related factors include male gender and high body mass index (BMI). Component-related factors include stem design, high-offset implants, head-neck angle, femoral head diameter, and the metal alloy. Surgical-related factors include damage to the head-neck surfaces and inappropriate surgical technique. It has been estimated that 3% of all hip revision procedures worldwide are currently performed due to trunnion corrosion. Femoral head dissociation with implant failure still remains a rare complication, and there are only a few reports of that complication that have been published.The patient was informed that data concerning the case would be submitted for publication, and he provided consent.</p

Cardiac Autonomic Function in Adults Born Preterm

Objective To evaluate cardiac autonomic function in adults born preterm. Study design We studied the association between prematurity and cardiac autonomic function using heart rate variability measurements in 600 adults (mean age of 23.3 years) from a geographically based cohort in Northern Finland. There were 117 young adults born early preterm (= 37 weeks, controls). Autonomic function was analyzed by calculating time and frequency domain heart rate variability measurements using linear regression. Results Compared with controls, the mean difference in root mean square of successive differences (indicating cardiac vagal activity) was -12.0% (95% CI -22.2%, -0.5%, adjusted for sex, age, source cohort, and season P = .04) for the early preterm group and -7.8% (-16.8%, 2.0%, P = .12) for the late preterm group. Mean differences with controls in low frequency power (indicating cardiac vagal activity, including some sympathetic- and baroreflex-mediated effects) were -13.6% (-26.7%, 1.8%, P = .08) for the early pretermgroup and -16.4% (-27.0%, -4.3%, P = .01) for the late preterm group. Mean differences in high frequency power (quantifying cardiac vagal modulation in respiratory frequency) were -19.2% (-36.6%, 2.9%, P = .09) for the early preterm group and -13.8% (-29.4%, 5.3%, P = .15) for the late preterm group. Differences were attenuated when controlled for body mass index and physical activity. Conclusions Our results suggest altered autonomic regulatory control in adults born preterm, including those born late preterm. Altered autonomic regulatory control may contribute to increased cardiovascular risk in adults born preterm.Peer reviewe

Postexercise Heart Rate Recovery in Adults Born Preterm

Objective To evaluate postexercise heart rate recovery (HRR) in adults born preterm. Study design We studied the association between preterm birth and postexercise HRR in 545 adults (267 women) at 23.3 years of age (range 19.9-26.3 years). One hundred three participants were born early preterm ( Results Mean peak HR was 159.5 bpm in the early preterm (P = .16 with controls), 157.8 bpm in the late preterm (P = .56), and 157.0 bpm in the control group. Mean HRR 30 seconds after exercise was 3.2 bpm (95% CI 1.1-5.2) lower in the early preterm group and 2.1 bpm (0.3-3.8) lower in the late preterm group than the full term controls. Mean 60s HRR was 2.5 (-0.1 to 5.1) lower in the early preterm group and 2.8 bpm (0.6-4.9) lower in the late preterm group. Mean maximum slope after exercise was 0.10 beats/s (0.02-0.17) lower in the early preterm group and 0.06 beats/s (0.00-0.12) lower in the late preterm group. Conclusions Our results suggest reduced HRR after exercise in adults born preterm, including those born late preterm. This suggests altered reactivation of the parasympathetic nervous system, which may contribute to cardiovascular risk among adults born preterm.Peer reviewe

Implant Survival of Constrained Acetabular Device in Primary Total Hip Arthroplasty Based on Data From the Finnish Arthroplasty Register

Background: Constrained acetabular devices were developed to prevent dislocations after total hip arthroplasty (THA). However, the data on their success have been contradictory. In this study, we aimed to assess implant survival of the constrained acetabular device in primary THA based on the Finnish Arthroplasty Register data.Methods: A total of 373 primary THAs with constrained acetabular devices inserted from 2006 to 2017 were included. A reference group was formed on a 1:3 basis and matched for age, sex, and diagnosis, consisting of 1118 conventional THAs. Implant survival estimates using death as a competing risk were assessed with revision for any reason and for any aseptic reason as the endpoints. The Cox multiple regression models were adjusted for age, sex, and diagnosis. The mean follow-up time was 3.3 (0-12.4) years for the constrained device group and 3.8 (0-12.0) years for the reference group.Results: Overall, there were 21 revisions in the constrained device group and 49 in the reference group. The 8-year survivorship for any reason was 94% (confidence interval [CI]: 91-96) for the constrained device group and 93% (CI: 89-97) for the reference group. With revision for any aseptic reason as the endpoint, the 8-year survivorships were 97% (CI: 95-99) and 94% (CI: 90-98), respectively. During the first 1.5 years, the constrained acetabular device group had a similar revision risk (hazard ratio: 1.09 [CI: 0.57-2.07], P = .8) to that of the reference group.Conclusion: The constrained acetabular device had good survival in primary THA, and our results support its continued use even in high-risk patients