The Ringloc liner compared with the Hexloc liner in total hip arthroplasty

The aim of this study was to compare the 10-year survival rate, pelvic osteolysis frequency and linear head penetration rate of the Hexloc and Ringloc liners used together with a partially threaded porous and hydroxyapatite coated cup and the Bi-Metric uncemented femoral stem. The 15-year results for the cup with the Hexloc liner are also reported. We included 332 consecutive hips (166 Hexloc and 166 Ringloc) on 281 patients in the study. Revisions of prosthesis components were recorded and pelvic osteolytic lesions were assessed using radiographs and computed tomography. The linear head penetration rate was measured using the Martell method. The 10-year survival rate of the liner with revision due to liner wear and/or osteolysis as endpoint was 88% for the Hexloc liner and 98% for the Ringloc liner. The 15-year survival rate of the Hexloc liner was 67%. Pelvic osteolysis was found in 27% of the Hexloc and 19% of the Ringloc hips. After 15 years, 53% of the Hexloc hips had developed an osteolytic lesion. The linear head penetration rate was 0.16 mm/year for the Hexloc liner and 0.12 mm/year for the Ringloc liner. This paper is the first to describe the rapidly deteriorating survival up to 15 years with the old generation gamma-in-air sterilized polyethylene used in Hexloc liners. The newer Ringloc liner with the ArCom™ polyethylene has superior clinical results but a linear wear rate and frequency of osteolytic lesions that is higher than expected

Пойкилодермия пигментная сетчатая Сиватта: клинический случай

КОЖНЫЕ БОЛЕЗНИМЕЛАНОЗСиватта пойкилодерми

Whole-genome genotyping and resequencing reveal the association of a deletion in the complex interferon alpha gene cluster with hypothyroidism in dogs

Background: Hypothyroidism is a common complex endocrinopathy that typically has an autoimmune etiology, and it affects both humans and dogs. Genetic and environmental factors are both known to play important roles in the disease development. In this study, we sought to identify the genetic risk factors potentially involved in the susceptibility to the disease in the high-risk Giant Schnauzer dog breed. Results: By employing genome-wide association followed by fine-mapping (top variant p-value=5.7x10(-6)), integrated with whole-genome resequencing and copy number variation analysis, we detected a similar to 8.9 kbp deletion strongly associated (p-value=0.0001) with protection against development of hypothyroidism. The deletion is located between two predicted Interferon alpha (IFNA) genes and it may eliminate functional elements potentially involved in the transcriptional regulation of these genes. Remarkably, type I IFNs have been extensively associated to human autoimmune hypothyroidism and general autoimmunity. Nonetheless, the extreme genomic complexity of the associated region on CFA11 warrants further long-read sequencing and annotation efforts in order to ascribe functions to the identified deletion and to characterize the canine IFNA gene cluster in more detail. Conclusions: Our results expand the current knowledge on genetic determinants of canine hypothyroidism by revealing a significant link with the human counterpart disease, potentially translating into better diagnostic tools across species, and may contribute to improved canine breeding strategies

Anterior cruciate ligament reconstruction : patellar tendon, Gore-Tex, Kennedy LAD and tibia tunnel ingrowth

Anterior cruciate ligament injury can induce permanent functional impairment in the physically active individual. Different methods to repair or replace the tom ligament have been tried and investigated. This thesis investigates three principally different grafts used in ACL reconstruction; autogenous tendon, stent/augmentation and prosthetic. Special emphasis has been put on stability examined with KT-1 000, Lachman and pivot shift tests, functional outcome measured with Lysholm, Tegner and IKDC scores and finally radiological evaluation of the tibia-tunnel. In two studies, one on chronic (>6 months) ACL injuries and one on acute (<3 weeks) with 40 patients in each, we investigated short- and midterm results. The patients were randomised between ACL reconstruction performed with the use of autogenous patellar-tendon graft or a weaker autogenous graft that was augmented with a polypropylene braid. At follow-up after 4 and 7 years, respectively, we found no statistical difference in stability tests, functional or activity scores. Both groups showed stable improvement concerning scores and arthrometry compared to preop. No advantage was found with the addition of the LAD. In a prospective study on ten patients with a bone-patellar tendon-bone reconstruction, tibia condyle bone mineral density (BMD), bone ingrowth and changes in diameter in the tibia bone tunnel was studied by quantified computed tomography postoperatively and after 1, 3, 6 and 12 months. There was no sign of bone ingrowth in the bone tunnels. The tunnel diameter initially increased. After 1 year 5 patients had a smaller, 2 patients had the same and 2 patients had a bigger diameter compared to postoperative examination. There was a decrease in tibia condyle BMD at 3 months, after 12 months BMD had increased but was not restored completely. We concluded that: Autogenous bone-tendon-bone grafts is not, after one year, incorporated into the tibia-tunnel by bone ingrowth into the central tendon part of the graft. Although the patients were rehabilitated according to an accelerated protocol they showed the same amount of bone mineral loss as reported in patients with inactivity/posttraumatic induced osteopenia. Seventeen out of 22 patients reconstructed with the Gore-Tex prosthetic ligament were evaluated after 14 years. They were evaluated with the KT-1 000 arthrometer, CT scans of the tibia-tunnel, IKDC, Lysholm and Tegner scores, pivot shift, Lachman test and visual analogue scale (VAS) score for pain. We found osteolytic enlargement in the tibia-tunnel in 14 of the examined 17 patients. Our study showed that all osteolysis are not symptomatic and can not be detected with evaluation scores, clinical or arthrometric exams. The 80 acute and chronic patients in the 2 first studies were evaluated 14 years after reconstruction. Follow-up protocol was the same with the addition of IKDC score, radiological examination with weight bearing anteroposterior and lateral projections of the knee and quantified computed tomography (QCT) of the tibiatunnel. In this long-term follow-up we found no adverse reactions to augmentation and it is equal to the patellar tendon technique in maintaining achieved stability over time, therefore it seems to be a safe complement if a graft of inadequate strength has to be used. LAD and chronic injuries was associated with more tibia- tunnel expansions compared to PT and acute injuries. PT reconstructions had a tendency towards more patella-/femoral joint degeneration. Chronic injuries had significantly more arthrotic changes and lower Lysholm score

The Ringloc liner compared with the Hexloc liner in total hip arthroplasty

The aim of this study was to compare the 10year survival rate, pelvic osteolysis frequency and linear head penetration rate of the Hexloc and Ringloc liners used together with a partially threaded porous and hydroxyapatite coated cup and the Bi-Metric uncemented femoral stem. The 15-year results for the cup with the Hexloc liner are also reported. We included 332 consecutive hips (166 Hexloc and 166 Ringloc) on 281 patients in the study. Revisions of prosthesis components were recorded and pelvic osteolytic lesions were assessed using radiographs and computed tomography. The linear head penetration rate was measured using the Martell method. The 10-year survival rate of the liner with revision due to liner wear and/or osteolysis as endpoint was 88 % for the Hexloc liner and 98 % for the Ringloc liner. The 15-year survival rate of the Hexloc liner was 67%. Pelvic osteolysis was found in 27 % of the Hexloc and 19 % of the Ringloc hips. After 15 years, 53 % of the Hexloc hips had developed an osteolytic lesion. The linear head penetration rate was 0.16 mm/year for the Hexloc liner and 0.12 mm/year for the Ringloc liner. This paper is the first to describe the rapidly deteriorating survival up to 15 years with the old generation gamma-in-air sterilized polyethylene used in Hexloc liners. The newer Ringloc liner with the ArCom ™ polyethylene has superior clinical results but a linear wear rate and frequency of osteolytic lesions that is higher than expected

High risk of early periprosthetic fractures after primary hip arthroplasty in elderly patients using a cemented, tapered, polished stem : an observational, prospective cohort study on 1,403 hips with 47 fractures after mean follow-up time of 4 years

Background and purpose - Postoperative periprosthetic femoral fracture (PPF) after hip arthroplasty is associated with considerable morbidity and mortality. We assessed the incidence and characteristics of periprosthetic fractures in a consecutive cohort of elderly patients treated with a cemented, collarless, polished and tapered femoral stem (CPT). Patients and methods - In this single-center prospective cohort study, we included 1,403 hips in 1,357 patients (mean age 82 (range 52-102) years, 72% women) with primary osteoarthritis (OA) or a femoral neck fracture (FNF) as indication for surgery (367 hips and 1,036 hips, respectively). 64% of patients were ASA class 3 or 4. Hip-related complications and need for repeat surgery were assessed at a mean follow-up time of 4 (1-7) years. A Cox regression analysis was used to evaluate risk factors associated with PPF. Results - 47 hips (3.3%) sustained a periprosthetic fracture at median 7 (2-79) months postoperatively; 41 were comminute Vancouver B2 or complex C-type fractures. The fracture rate was 3.8% for FNF patients and 2.2% for OA patients (hazard ratio (HR) = 4; 95% CI: 1.3-12). Patients &gt; 80 years of age also had a higher risk of fracture (HR = 2; 95% CI: 1.1-4.5). Interpretation - We found a high incidence of early PPF associated with the CPT stem in this old and frail patient group. A possible explanation may be that the polished tapered stem acts as a wedge, splitting the femur after a direct hip contusion. Our results should be confirmed in larger, registry-based studies, but we advise caution when using this stem for this particular patient group

HOPE-trial : hemiarthroplasty compared to total hip arthroplasty for displaced femoral neck fractures in the elderly-elderly, a randomized controlled trial

Background: A femoral neck fracture (FNF) is a common cause of suffering and premature death in the elderly population. Optimizing the treatment for improved outcome and a reduced need for secondary surgery is important both for the patient and the society. The choice of primary total or hemiarthroplasty in patients over eighty years are controversial. We hypothesized that total hip arthroplasty has an equal or better outcome in patient-reported outcome compared with hemiarthroplasty. Methods/Design: A prospective, randomized, single-blinded trial will be conducted. We will include 120 patients, 80 years of age and over with an acute (&lt;36 h) displaced femoral neck fracture. The patients will be randomized in a 1: 1 ratio to either total hip arthroplasty or hemiarthroplasty. The primary endpoints are Harris hip Score and EQ-5D. Secondary endpoints include pain measured with visual analogue scale, surgical time, reoperations, complications and radiological measurement of erosion in patients operated with hemiarthroplasty. Follow-up will be performed postoperatively after three months, 1, 2, 4 and 10 years. Discussion: To our knowledge, this is the first randomized controlled trial comparing total hip arthroplasty and hemiarthroplasty for displaced femoral neck fracture in patients age 80 years and over

The pleasure of the eighteenth-century texts: The conflation of literary and critical discourse in the early novelistic tradition

One of the prominent characteristics of contemporary literature is its assimilation to critical discourse. The self-reflexivity in literature, which transforms literary texts into acts of criticism, is paralleled by theory’s tendency to encroach on the literary domain. One of the findings of the poststructuralist literary theory is that descriptions of reading experience elude scientific language and are more aptly conveyed by metaphors. (A good example is Roland Barthes’ The pleasure of the text.) The conflation of literary and critical discourse is not, however, peculiar to postmodernity only. The same phenomenon is observable in the eighteenth-century writings. It turns out that the self-reflexivity evident at the times of the proclaimed “death of the novel” is manifest also in the times of its birth. The aim of my paper is to analyse the metafictional reflection on readerly pleasure incorporated in early novelistic texts