No component loosening of a cementless deep dish rotating platform knee at a 5-year follow-up.

PURPOSE: Cemented fixation remains the gold standard in total knee arthroplasty. With an increasing number of younger patients undergoing total knee arthroplasty and a growing patient population demanding higher physical activity, a rising interest in discussion of cementless fixation is notable. The current scientific literature does not give a clear recommendation for or against uncemented total knee arthroplasty. The purpose of this study was the investigation of the 5-year clinical and radiographic outcomes of a cementless deep-dish rotating platform implant. METHODS: A total of 91 primary cementless total knee arthroplasties were included in this single-centre prospective observational study. The primary outcome was revision rate due to aseptic component loosening. Further outcome measures were assessment of the of the radiographic outcome as well as the clinical outcome based on Range of Motion and scores such as American Knee Society Score, Oxford Knee Score, Knee Injury and Osteoarthritis Outcome Score and European Quality of Life 5 Dimension 3 Level at a follow-up of 5 years. RESULTS: Mean age of the study population was 67.3 ± 6.6 years with 49.5% of the participants being female. Aseptic component loosening occurred in none of the patients. Implant survival with revision for any reason as endpoint was 97.8% (95% CI 100-96%) and 95.6% (95% CI 100-94%) with reoperation of any cause as endpoint. Radiolucent lines were detected in a total of eight cases (8.8%) and disappeared within the first year after surgery in five cases. Total Range of Motion improved significantly from 106° ± 15° preoperatively to 118° ± 10° at final FU (p < 0.001). All investigated scores improved significantly after total knee arthroplasty. CONCLUSION: The results of this study reveal excellent mid-term performance of a cementless deep dish rotating platform total knee implant, with no component loosening, very low overall revision rate, only temporarily present radiolucent lines in a minority of patients and excellent clinical results. Therefore, cementless total knee arthroplasty is an appropriate treatment option for patients with severe osteoarthritis of the knee. LEVEL OF EVIDENCE: Level II (prospective cohort study).

Vb Cyclones Synchronized With the Arctic-/North Atlantic Oscillation.

Vb cyclones typically emerge in the Western Mediterranean and propagate to the Northeast into Central Europe. This paper explores the temporal characteristics of Vb cyclone occurrence based on cyclone tracks identified at the atmospheric levels of Z700 and sea level pressure, using JRA-55 reanalysis data for the period 1959-2015. The risk of Vb occurrence was significantly high in the 1960s and has remained at a lower level since then. Vb cyclones do not occur fully randomly according to a Poisson point process. Eleven well-separated and distinct clusters as well as 11 hiatus periods are identified, with average occurrence rates of 21.5 and 5.2 yrea-1, respectively. During the event of Vb, the large-scale atmospheric circulation is changed into a state favoring the development of successive Vb cyclones. Clustering is very prominent in the case of Genoan Vb cyclones in summer as well as those Vb cyclones developing over the Iberian Peninsula or the North African Coast in winter. Superposition of the polar and the subtropical jet stream over the Western Mediterranean is identified as a main feature at the onset of Vb cyclones. Vb cyclone occurrence appears to be synchronized with the Northern Atlantic Oscillation (NAO; at Z500) and Arctic Oscillation (AO; at Z1000). Clusters have occurred when both NAO and AO were negative. This relation applies to Western Mediterranean cyclones not following a Vb track as well, however to a much weaker extent. In contrast, Vb cyclone frequency was particularly low from 1988 to 1997 during a sustained positive phase of both NAO and AO.

Disentangling Drivers of Meteorological Droughts in the European Greater Alpine Region During the Last Two Centuries.

This study investigates the atmospheric drivers of severe precipitation deficits in the Greater Alpine Region during the last 210 years utilizing a daily atmospheric circulation type reconstruction. Precipitation deficit tends to be higher during periods with more frequent anticyclonic (dry) and less frequent cyclonic (wet) circulation types, as would be expected. However, circulation characteristics are not the main drivers of summer precipitation deficit. Dry soils in the warm season tend to limit precipitation, which is particularly the case for circulation types that are sensitive to a soil moisture-precipitation feedback. This mechanism is of specific relevance in explaining the major drought decades of the 1860s and 1940s. Both episodes show large negative precipitation anomalies in spring followed by increasing frequencies of circulation types sensitive to soil moisture precipitation feedbacks. The dry springs of the 1860s were likely caused by circulation characteristics that were quite different from those of recent decades as a consequence of the large spatial extent of Arctic sea ice at the end of the Little Ice Age. On the other hand, the dry springs of the 1940s developed under a persistent positive pressure anomaly across Western and Central Europe, triggered by positive sea surface temperatures in the western subtropical Atlantic.