Removal of infected cemented hinge knee prostheses using extended femoral and tibial osteotomies: Six cases

SummaryExtended femoral and tibial osteotomies were performed to remove infected cemented hinged knee prostheses in five patients (six knees) with a mean age of 72 years (44–85) and a history of multiple knee surgeries. A tibial osteotomy was used to mobilise the distal quadriceps insertion and to release the tibial extension. The femoral component was extracted by downward traction and its cement mantle was cleared through an anterior osteotomy (n=4) or via the distal approach (n=2). The bone flaps were re-approximated by wire cerclage over articulating acrylic spacers. Mean time to re-implantation of a new knee prosthesis was 11 months (6–24). Revision prostheses with cement fixation restricted to the epiphyseal-metaphyseal region were used. Infection recurred in two cases at 16 and 4 months after the prosthetic re-implantation, and was managed by joint fusion for one and irrigation/lavage for the other, respectively. At last follow-up after a mean of 53 months, the mean Parker score was 4±2, the mean IKS knee score was 66±25 (28–93), and the mean IKS function score was 7±16 (0–40). This technique facilitates the removal of infected cemented components of hinge prostheses and of the cement mantle, most notably in the absence of loosening, without compromising re-implantation of a new knee prosthesis

Spousal support and relationship happiness in adults with type 2 diabetes and their spouses

Objectives The purpose of this study was to examine the association between the perceptions of spousal support self-efficacy in terms of dietary self-care and relationship happiness. Methods Forty-six couples, in which only one spouse has type 2 diabetes, completed questionnaires on perceptions of spousal support self-efficacy and relationship happiness. Results Using an actor-partner interdependence model, we found that when persons with type 2 diabetes were more confident in their spouse’s ability to provide them with support regarding their dietary self-care, they reported more relationship happiness. We also found that when their spouse without diabetes was more confident in their own abilities to provide such support to their partner, they reported more relationship happiness. However, the person with diabetes’ confidence in their spouse’s support abilities and the spouse’s confidence in their own support abilities were not associated with the other partner’s relationship happiness. Conclusions This study offers a unique dyadic perspective on the determinants of happiness for couples in which one spouse has type 2 diabetes. The perceived quality of spousal support appears to be associated with relationship happiness in committed couples managing diabetes, regardless of the actual support received or provided