Dual-mobility socket in challenging total hip arthroplasty : 2-6 years follow-up.

The success of dual-mobility sockets in achieving implant stability in primary hip replacement is already well established. However, stability cannot always be achieved, especially when dealing with more difficult indications. At our department, 104 dual-mobility sockets (92 uncemented and 12 cemented) were implanted for primary total hip arthroplasty in 97 patients between 2009 and 2013. Indications for hip arthroplasty included primary and secondary coxarthrosis, acetabular and subcapital fractures, avascular necrosis, tumor surgery and metastatic fractures. Although no loosenings were observed, 2 dislocations and 1 infection occurred shortly after surgery. In this challenging group of patients no fixation problems or intraprosthetic dislocations have been observed. The design therefore seems to be a valid alternative to constrained implants, especially in high-risk cases, although dislocation cannot be prevented at all times. Although the findings are very promising, long-term survival studies are mandatory to evaluate intraprosthetic stability and fixation longevity of dual-mobility sockets

Natalizumab treatment shows low cumulative probabilities of confirmed disability worsening to EDSS milestones in the long-term setting.

Abstract Background Though the Expanded Disability Status Scale (EDSS) is commonly used to assess disability level in relapsing-remitting multiple sclerosis (RRMS), the criteria defining disability progression are used for patients with a wide range of baseline levels of disability in relatively short-term trials. As a result, not all EDSS changes carry the same weight in terms of future disability, and treatment benefits such as decreased risk of reaching particular disability milestones may not be reliably captured. The objectives of this analysis are to assess the probability of confirmed disability worsening to specific EDSS milestones (i.e., EDSS scores ≥3.0, ≥4.0, or ≥6.0) at 288 weeks in the Tysabri Observational Program (TOP) and to examine the impact of relapses occurring during natalizumab therapy in TOP patients who had received natalizumab for ≥24 months. Methods TOP is an ongoing, open-label, observational, prospective study of patients with RRMS in clinical practice. Enrolled patients were naive to natalizumab at treatment initiation or had received ≤3 doses at the time of enrollment. Intravenous natalizumab (300 mg) infusions were given every 4 weeks, and the EDSS was assessed at baseline and every 24 weeks during treatment. Results Of the 4161 patients enrolled in TOP with follow-up of at least 24 months, 3253 patients with available baseline EDSS scores had continued natalizumab treatment and 908 had discontinued (5.4% due to a reported lack of efficacy and 16.4% for other reasons) at the 24-month time point. Those who discontinued due to lack of efficacy had higher baseline EDSS scores (median 4.5 vs. 3.5), higher on-treatment relapse rates (0.82 vs. 0.23), and higher cumulative probabilities of EDSS worsening (16% vs. 9%) at 24 months than those completing therapy. Among 24-month completers, after approximately 5.5 years of natalizumab treatment, the cumulative probabilities of confirmed EDSS worsening by 1.0 and 2.0 points were 18.5% and 7.9%, respectively (24-week confirmation), and 13.5% and 5.3%, respectively (48-week confirmation). The risks of 24- and 48-week confirmed EDSS worsening were significantly higher in patients with on-treatment relapses than in those without relapses. An analysis of time to specific EDSS milestones showed that the probabilities of 48-week confirmed transition from EDSS scores of 0.0–2.0 to ≥3.0, 2.0–3.0 to ≥4.0, and 4.0–5.0 to ≥6.0 at week 288 in TOP were 11.1%, 11.8%, and 9.5%, respectively, with lower probabilities observed among patients without on-treatment relapses (8.1%, 8.4%, and 5.7%, respectively). Conclusions In TOP patients with a median (range) baseline EDSS score of 3.5 (0.0–9.5) who completed 24 months of natalizumab treatment, the rate of 48-week confirmed disability worsening events was below 15%; after approximately 5.5 years of natalizumab treatment, 86.5% and 94.7% of patients did not have EDSS score increases of ≥1.0 or ≥2.0 points, respectively. The presence of relapses was associated with higher rates of overall disability worsening. These results were confirmed by assessing transition to EDSS milestones. Lower rates of overall 48-week confirmed EDSS worsening and of transitioning from EDSS score 4.0–5.0 to ≥6.0 in the absence of relapses suggest that relapses remain a significant driver of disability worsening and that on-treatment relapses in natalizumab-treated patients are of prognostic importance

Outcome of patellofemoral arthroplasty, determinants for success

The primary aim of this study is to document whether patellofemoral arthroplasty is a good treatment option for patellofemoral osteoarthritis and to identify prognostic outcome factors. Secondary aim is to investigate the influence of preoperative tibiofemoral osteoarthritis on the clinical outcome.From 2004 to 2010, 37 Avon patellofemoral prostheses were implanted in 32 patients. Clinical outcome was evaluated with five questionnaires: KOOS, Kujala, VAS, OKS and Satisfaction Score. Radiographs were analyzed using the IWANO and Kellgren-Lawrence classification. To identify determinants of outcome, subgroups were examined according to sex, age, diagnosis, BMI and prior surgery.Patellofemoral arthroplasty is a valuable treatment for patellofemoral osteoarthritis. After prosthesis placement, KOOS, Kujala, VAS and OKS improved significantly (all p<0.001). Patients with prior patellofemoral surgery were clinically worse (p<0.05). Patients with preoperative grade 2 tibiofemoral osteoarthritis had a significantly worse outcome compared to grade 1 (p<0.05). Further research is necessary to determine whether patellofemoral arthroplasty is indicated in these patients

Dual-Mobility Socket in Challenging Total Hip Arthroplasty: 2-6 Years Follow-up

The success of dual-mobility sockets in achieving implant stability in primary hip replacement is already well established. However, stability cannot always be achieved, especially when dealing with more difficult indications.At our department, 104 dual-mobility sockets (92 uncemented and 12 cemented) were implanted for primary total hip arthroplasty in 97 patients between 2009 and 2013. Indications for hip arthroplasty included primary and secondary coxarthrosis, acetabular and subcapital fractures, avascular necrosis, tumor surgery and metastatic fractures. Although no loosenings were observed, 2 dislocations and 1 infection occurred shortly after surgery. In this challenging group of patients no fixation problems or intraprosthetic dislocations have been observed. The design therefore seems to be a valid alternative to constrained implants, especially in high-risk cases, although dislocation cannot be prevented at all times. Although the findings are very promising, long-term survival studies are mandatory to evaluate intraprosthetic stability and fixation longevity of dual-mobility sockets.

Outcome of patellofemoral arthroplasty, determinants for success

The primary aim of this study is to document whether patellofemoral arthroplasty is a good treatment option for patellofemoral osteoarthritis and to identify prognostic outcome factors. Secondary aim is to investigate the influence of preoperative tibiofemoral osteoarthritis on the clinical outcome. From 2004 to 2010, 37 Avon patellofemoral prostheses were implanted in 32 patients. Clinical outcome was evaluated with five questionnaires : KOOS, Kujala, VAS, OKS and Satisfaction Score. Radiographs were analyzed using the IWANO and Kellgren-Lawrence classification. To identify determinants of outcome, subgroups were examined according to sex, age, diagnosis, BMI and prior surgery. Patellofemoral arthroplasty is a valuable treatment for patellofemoral osteoarthritis. After prosthesis placement, KOOS, Kujala, VAS and OKS improved significantly (all p < 0.001). Patients with prior patellofemoral surgery were clinically worse (p < 0.05). Patients with preoperative Kellgren-Lawrence grade 2 tibiofemoral osteoarthritis had a significantly worse outcome compared to grade 1 (p < 0.05). Further research is necessary to determine whether patellofemoral arthroplasty is indicated in these patients

The future Paediatricians in Flanders.

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