Preoperative coagulation biomarkers associate with survival and pulmonary embolism after surgical treatment of non-spinal skeletal metastases

Peer reviewe

Outcomes of the rotating hinge knee in revision total knee arthroplasty with a median follow-up of 6.2years

BackgroundThe purpose of this study was to determine the mid-term clinical, radiographic and health-related quality of life (HRQoL) outcomes and define the survival rate in patients who had undergone revision total knee arthroplasty (TKA) using the single rotating hinged knee (RHK) design.MethodsBetween January 2004 and December 2013, 125 revision TKAs were performed at our institution using the single RHK implant. We conducted both a retrospective analysis of prospectively collected outcome data of these patients and a prospective follow-up study of all 39 living patients (41 knees). The follow-up phase included an optional extra follow-up visit, PROM questionnaires, and plain radiographs.ResultsThe ten-year Kaplan-Meier survival rate of the revision RHK knees was 81.7% (95% CI 71.9-91.6%) with re-revision for any reason as the endpoint. Overall, 15 knees (12% of the total) underwent re-revision surgery during the follow-up. The median follow-up was 6.2years (range, 0-12.7years) post-operatively for the baseline group. One mechanical hinge mechanism-related failure occurred without any history of trauma or infection. At the time of the final follow-up, the majority of patients evinced a fairly good clinical outcome measured with patient-reported outcome measures and none of the components were radiographically loose.ConclusionWe found that in patients undergoing complex revision TKA, fairly good functional outcome and quality of life can be achieved using an RHK implant. Further, it seems that in this type of patient cohort, revision TKA using an RHK implant relieves pain more than it improves ability to function. The NexGen (R) RHK design can be regarded as a suitable option in complex revision TKA.Peer reviewe

Good mid-term outcome of the rotating hinge knee in primary total knee arthroplasty - Results of a single center cohort of 106 knees with a median follow-up of 6.3 years

Background: The prognosis of complex primary total knee arthroplasty (TKA) with severe deformity and ligament deficiency is not clear. There is a paucity of evidence in the current literature on treatment outcomes of the rotating hinge knee implants in primary TKA. The aim of this study was to determine the mid-term clinical, radiographic, and health-related quality of life (HRQoL) outcomes in patients who had undergone complex primary TKA using single hinged knee replacement. Methods: In total, 106 complex primary TKAs (101 patients) were performed using the single rotating hinged knee (RHK) implant design at our institution between January 2004 and December 2013. We conducted a retrospective analysis of prospectively collected outcome data of these patients, obtaining also information on all possible revision surgeries from the Finnish Arthroplasty Register, and conducted a prospective follow-up study of all living patients. Results: The 10-year Kaplan-Meier survival rate of the RHK knees was 91.6% (95% CI 86.0% to 97.2%) with revision for any reason as the endpoint. Overall, eight knees (7.5 %) underwent revision surgery during the follow-up. None of the unrevised RHK knees were radio-graphically loose. The majority of patients evinced good clinical outcome and quality of life as measured with patient reported outcome measures. Conclusion: The hinge knee replacement which was assessed current study can be regarded as a suitable option in complex primary TKA, provided adequate attention is paid to the correct indications and patient selection. (C) 2020 Elsevier B.V. All rights reserved.Peer reviewe

Lonkkamurtumien leikkausmenetelmien komplikaatiot alkoholin väärinkäyttäjillä

English abstrac

Paras käyttökelpoinen tekniikka (BAT) - Yhdyskuntien jätevedenpuhdistamot

Selvityksen tarkoituksena oli määritellä paras käyttökelpoinen tekniikka (BAT) yhdyskuntien jätevedenpuhdistamoille. Ympäristönsuojeluasetuksen (169/2000) mukaan ympäristölupahakemuksissa tulee esittää arvio parhaan käyttökelpoisen tekniikan soveltamisesta. BAT:n käsite on kuitenkin jätevedenpuhdistuksen osalta ollut epäselvä ja tämä on hankaloittanut ympäristölupahakemuksien laatimista ja käsittelyä. Jätevedenpuhdistamoiden prosessien ja toiminnan kartoittamiseksi tehtiin kysely valituille eri puolilla Suomea sijaitseville puhdistamolle. Kyselyyn osallistui 57 puhdistamoa ja ne jaettiin virtaaman mukaan kolmeen kokoluokkaan seuraavasti: 20 kpl suuria (Q > 10 000 m3/d), 24 kpl keskisuuria (1 000 < Q < 10 000 m3/d) ja 13 kpl pieniä (Q < 1 000 m3/d) puhdistamoja. Puhdistamoiden tehokkuudesta ja kuormituksesta saatuja tietoja käytettiin arvioitaessa parasta käyttökelpoista tekniikkaa asiantuntijatyöryhmässä. Raportti on kansallinen BAT-selvitys, mutta sen sisältö mukailee virallisten BAT-dokumenttien sisältöä. Aluksi luvussa 2 esitellään yleistä tietoa jätevesien ympäristövaikutuksia ja niihin liittyvästä lainsäädännöstä. Luvussa 3 tarkastellaan jätevedenpuhdistamoille tulevia kuormitusjakeita. Neljännessä luvussa tarkastellaan nykyisiä kulutus- ja päästötasoja jätevedenpuhdistamoille tehdyn kyselyn pohjalta. Luvussa 5 esitellään BAT:n määrittämisessä huomioon otettavia, nykyisin yleisesti käytössä olevia tekniikoita, joiden avulla saavutettavia kulutus- ja päästötasoja esitellään luvussa 6. Näiden tietojen ja työryhmän kokemuksien pohjalta on muodostettu luvussa 7 esiteltävät BAT-päätelmät. 8. luvussa esitellään lupaavia tekniikoita, joista on vain jonkin verran kokemuksia, mutta joiden arvellaan vakiintuvan käyttöön tulevaisuudessa. BAT-raportin on tarkoitus toimia ympäristöluvan hakijoiden ja lupakäsittelijöiden käsikirjana

Surgical and patient-reported outcomes after total knee arthroplasty requiring soft tissue flap reconstruction – A 12-year experience from high-volume arthroplasty hospital

Publisher Copyright: © 2022 Elsevier LtdBackground: This study investigates the outcomes of complex knee joint reconstructions performed by an orthoplastic surgery team at a tertiary referral hospital. Methods: Retrospective review of all the total knee arthroplasty (TKA)/revision TKA (rTKA) procedures with soft tissue flap reconstruction performed between 2008 and 2019 was conducted. Patients were stratified into two groups according to the urgency of surgery: scheduled non-complicated (SNC) and emergent complicated (EC). The whole study cohort was also categorized into non-infected and infected groups. Results: Of 20,184 TKAs operated, 58 patients required flap reconstruction (SNC group n = 27; EC group n = 31). The most common reconstruction was medial gastrocnemius flap (74%). Mean follow-up time was 31.9 months. Functional knee joint salvage was achieved in 96.3% the SNC group and in 80.6% the EC group patients (p = 0.07). Transfemoral amputation rates were 3.7% in the SNC group vs. 6.5% in the EC group (p = 0.36). Oxford Knee Score was 34.5 vs. 25.5 (p = 0.21), and range of motion was 100⁰ vs. 93⁰ (p = 0.37) in the SNC and EC groups, respectively. Superior functional knee joint salvage rates were achieved in the non-infected group compared to the infected group (97.1% vs. 75.0%, p = 0.004). However, the transfemoral amputation rate was nearly three-fold in the infected group (8.3% vs. 2.9%, p = 0.36). Estimated five-year survival with functional knee joint was higher in the non-infected group (p = 0.03). Conclusions: Both the SNC and EC groups had similar acceptable limb salvage rates, and functional and PROM outcomes. Infection reduces the probability of a functional knee joint after TKA and flap reconstruction.Peer reviewe

Ultrasound-enhanced electrospinning

Electrospinning is commonly used to produce polymeric nanofibers. Potential applications for such fibers include novel drug delivery systems, tissue engineering scaffolds, and filters. Electrospinning, however, has shortcomings such as needle clogging and limited ability to control the fiber-properties in a non-chemical manner. This study reports on an orifice-less technique that employs high-intensity focused ultrasound, i.e. ultrasound-enhanced electrospinning. Ultrasound bursts were used to generate a liquid protrusion with a Taylor cone from the surface of a polymer solution of polyethylene oxide. When the polymer was charged with a high negative voltage, nanofibers jetted off from the tip of the protrusion landed on an electrically grounded target held at a constant distance from the tip. Controlling the ultrasound characteristics permitted physical modification of the nanofiber topography at will without using supplemental chemical intervention. Possible applications of tailor-made fibers generated by ultrasound-enhanced electrospinning include pharmaceutical controlled-release applications and biomedical scaffolds with spatial gradients in fiber thickness and mechanical properties.Peer reviewe

Modified Harrington's procedure for periacetabular metastases in 89 cases : a reliable method for cancer patients with good functional outcome, especially with long expected survival

Background and purpose - The pelvis is the 3rd most common site of skeletal metastases. In some cases, periacetabular lesions require palliative surgical management. We investigated functional outcome, complications, and implant and patient survival after a modified Harrington's procedure. Patients and methods - This retrospective cohort study included 89 cases of surgically treated periacetabular metastases. All patients were treated with the modified Harrington's procedure including a restoration ring. Lesions were classified according to Harrington. Functional outcome was assessed by Harris Hip Score (HHS) and Oxford Hip Score (OHS). Postoperative complications, and implant and patient survival are reported. Results - The overall postoperative functional outcome was good to fair (OHS 37 and HHS 76). Sex, age, survival > 6 and 12 months, and diagnosis of the primary tumor affected functional outcome. Overall implant survival was 96% (95% Cl 88-100) at 1 year, 2 years, and 5 years; only 1 acetabular implant required revision. Median patient survival was 8 months (0-125). 10/89 patients had postoperative complications: 6 major complications, leading to revision surgery, and 4 minor complications. Interpretation - Our modified Harrington's procedure with a restoration ring to achieve stable fixation, constrained acetabular cup to prevent dislocation, and antegrade iliac screws to prevent cranial protrusion is a reliable reconstruction for periacetabular metastases and results in a good functional outcome in patients with prolonged survival. A standardized procedure and low complication rate encourage the use of this method for all Harrington class defects.Peer reviewe

Total hip arthroplasty, combined with a reinforcement ring and posterior column plating for acetabular fractures in elderly patients : good outcome in 34 patients

Background and purpose Low-energy acetabulum fractures are uncommon, and mostly occur in elderly patients. Determining the optimal operative treatment for such fractures is challenging. Here we investigated whether acutely performed total hip arthroplasty plus posterior column plating (THA) reduced complications and reoperations compared with open reduction and internal fixation (ORIF) in elderly patients with acetabular fractures.Patients and methods We retrospectively reviewed the records of 59 patients, > 55 years of age, with complex acetabular fractures, caused by low-energy trauma, treated between January 2008 and September 2017. Of these patients, 34 underwent acute THA, and 25 ORIF alone. Patient and implant survival were compared between groups using Kaplan-Meier survival analysis and Cox multiple regression. Functional outcomes assessed by Oxford Hip Score (OHS) were compared between the THA patients and those 9 ORIF patients who underwent secondary THA due to posttraumatic hip osteoarthritis (OA) during follow-up.Results Overall patient survival was 90% (95% CI 82-98) at 12 months, and 64% (CI 47-81) at 5 years. Of 25 ORIF patients, 9 required secondary THA due to posttraumatic OA. Large fragments on the weight-bearing acetabular dome upon imaging predicted ORIF failure and secondary THA. The acute THA group and secondary THA group had similar 12-month OHS.Interpretation Acute THA including a reinforcement ring resulted in fewer reoperations than ORIF alone in elderly patients with acetabular fractures. These findings support acute THA as first-line treatment for complex acetabular fractures in elderly patients.Peer reviewe