Establishing minimal clinically important differences and patient acceptable symptom state thresholds following birmingham hip resurfacing.

INTRODUCTION: Birmingham Hip Resurfacing (BHR) has emerged as a compelling and innovative alternative to total hip arthroplasty (THA), especially among young, active patients. However, the Minimal Clinically Important Difference (MCID) and the Patient Acceptable Symptom State (PASS) thresholds have not yet been determined for patients undergoing BHR. Therefore, the current study aimed to (1) determine the MCID and PASS thresholds for both the Hip disability and Osteoarthritis Outcome Score (HOOS)-Pain and HOOS physical function shortform (PS), for patients who underwent BHR; and (2) identify factors influencing the achievement of MCID and PASS for HOOS-Pain and HOOS-PS. METHODS: Prospectively collected data from patients undergoing BHR was analyzed. Patients with osteoarthritis and completed preoperative and 1-year postoperative PROMs were included. Distribution-based and anchored-based approaches were used to estimate MCID and PASS, respectively. The optimal cut-off point for PASS thresholds was calculated using the Youden index. RESULTS: MCID for HOOS-Pain and PS were calculated to be 9.2 and 9.3, respectively. The PASS threshold for HOOS-Pain and PS were ≥ 77.7 and ≥ 87.3, respectively. The current study identified several factors affecting postoperative achievement of thresholds. Baseline Mental Component Summary (MCS) scores were a predictor for achieving MCID for postoperative HOOS-Pain, achieving MCID for postoperative HOOS-PS, achieving PASS for postoperative HOOS-Pain, and achieving PASS for postoperative HOOS-PS. Furthermore, baseline HOOS-Pain was a significant predictor for achieving MCID for postoperative HOOS-PS, achieving PASS for postoperative HOOS-Pain, and achieving PASS for postoperative HOOS-PS. CONCLUSIONS: MCID and PASS thresholds were established for HOOS-Pain and PS domains following BHR with most patients achieving these clinically meaningful benchmarks. Additionally, several factors affecting achievement of MCID and PASS were identified, including modifiable risk factors that may allow clinicians to implement optimization strategies and further improve outcomes.

Examining the "revisability" benefit of hip resurfacing arthroplasty.

BACKGROUND: Hip resurfacing arthroplasty (HRA) is an alternative to total hip arthroplasty (THA) that is typically reserved for young active patients because it preserves bone. However, the benefits of HRA only hold true if conversion THA after failed HRA provides acceptable outcomes. AIM: To compare patient reported outcomes for conversion THA after HRA failure to primary THA. METHODS: A retrospective review of 36 patients (37 hips) that underwent conversion THA for failed HRA between October 2006 and May 2019 by a single surgeon was performed. Patient reported outcomes [modified Harris Hip Score (mHHS), University of California Los Angeles (UCLA) activity score] were obtained via an email-based responder-anonymous survey. Outcomes were compared to normative data of a primary THA cohort with similar demographics. Subgroup analysis was performed comparing outcomes of conversion THA for adverse local tissue reaction (ALTR) vs all other causes for failure. RESULTS: The study group had a lower mHHS than the control group (81.7 ± 13.8 vs 90.2 ± 11.6, P < 0.01); however, both groups had similar UCLA activity levels (7.5 ± 2.3 vs 7.2 ± 1.6, P = 0.51). Patients that underwent conversion for non-ATLR causes had similar mHHS (85.2 ± 11.5 vs 90.2 ± 11.6, P = 0.11) and higher UCLA activity levels (8.5 ± 1.8 vs 7.2 ± 1.6, P < 0.01) compared to the control group. Patients that underwent conversion for ATLR had worse mHHS (77.1 ± 14.5 vs 90.2 ± 11.6, P < 0.01) and UCLA activity levels (6.1 ± 2.3 vs 7.2 ± 1.6, P = 0.05) when compared to the control group. CONCLUSION: Patient outcomes equivalent to primary THA can be achieved following HRA conversion to THA. However, inferior outcomes were demonstrated for ALTR-related HRA failure. Patient selection and perhaps further studies examining alternative HRA bearing surfaces should be considered.

Total Shoulder Arthroplasty is associated With Less Pain and Better Functional Outcomes, but Humeral Head Resurfacing may be Preferred in Younger, Higher Demand Patients: A Short-Term Outcomes Study in Patients with Glenohumeral Osteoarthritis.

Objectives: This study aimed to compare short-term outcomes following Total Shoulder Arthroplasty (TSA) and Humeral Head Resurfacing (HHR) in patients with glenohumeral osteoarthritis (GHOA). Methods: A retrospective analysis included patients who had undergone either TSA or HHR for GHOA at a single institution. Baseline demographics, complications, range of motion (active forward flexion, FF and active external rotation, ER), visual analog scores (VAS), and Subjective Shoulder Values (SSV) were collected. Results: A total of 69 TSA and 56 HHR patients were analyzed. More HHR patients were laborers (44% versus 21%, P=0.01). There were more smokers in the TSA group (25% versus 11%, P=0.04) and more cardiovascular disease in the HHR cohort (64% versus. 6%, p<0.0001). Postoperative FF was similar, but ER was greater in the HHR (47° ± 15°) vs. TSA group (40° ± 12°, P = 0.01). VAS was lower after TSA vs. HHR (median 0, IQR 1 versus median 3.7, IQR 6.9, p<0.0001), and SSV was higher after TSA (89% ± 13% vs. 75% ± 20% after HHR; p<0.0001). Post-operative impingement was more common after HHR (32% vs. 3% for TSA, p<0.0001). All other complications were equivalent. Conclusion: While younger patients and heavy laborers had improved ER following HHR, their pain relief was greater after TSA. Decisions on surgical technique should be based on patient-specific demographic and anatomic factors.

Evaluation of a Novel Ablative 1940 nm Pulsed Laser for Skin Rejuvenation.

BACKGROUND: Skin rejuvenation is a widely sought-after goal, prompting advancements in laser technology for noninvasive and effective treatments. Ablative lasers, in particular, have evolved to address diverse skin concerns, with fractional ablative lasers offering better-tolerated outcomes. The introduction of a novel ablative Thulium pulsed laser, based on Thulium-doped Yttrium aluminum Perovskite (Tm:YAP) crystal, delivers precise and controlled skin rejuvenation by allowing customization of ablative microcolumns. METHODS: A pilot in vivo study was conducted on the abdominal skin of a live female pig. Using the Laser Team Medical (LTM) prototype laser, treatments were administered with varying coagulation settings (minimal and maximum) and energies (32, 80, 120, and 160 mJ per microcolumn). Biopsies were harvested, fixed, and stained for subsequent analysis. The penetration depth and width of the microcolumns were evaluated. RESULTS: Low coagulation settings produced ablative microcolumns with thermal affected zones of 160 µm width, while high coagulation settings resulted in wider zones of 400-530 µm. The ablation cavities' width was estimated to be less than 100 µm in both settings. The novel 1940 nm pulsed laser demonstrated superior microcolumn properties, offering potential advantages such as shorter downtime and increased efficacy compared to existing fractional ablative lasers. CONCLUSION: This study presents encouraging preliminary results regarding the efficacy and safety of the first ablative 1940 nm pulsed laser. The results show ablative microcolumns thinner than the counterpart devices, showing the device safety and potential higher efficacy along with short downtime. The LTM novel ablative 1940 nm pulsed laser holds immense potential for enhancing skin rejuvenation treatments due to its superior microcolumns properties. The versatility of this laser can open new treatment procedures and may extend to different areas of dermatology.

Altering CO2 Laser Pulse Energy Settings Did Not Influence Differential Gene Transcription in Normal Skin in a Red Duroc Pig Model.

OBJECTIVES: Fractional ablative CO2 lasers are used clinically to treat cutaneous burn scars with reported varying degrees of effectiveness. It was hypothesized that different laser pulse energy settings may lead to differential gene transcription in a porcine model. METHODS: Uninjured skin from red Duroc pigs was treated with a fractional ablative CO2 laser set to 70, 100, or 120 mJ across the abdomen (n = 4 areas per treatment). Punch biopsies of both treated and untreated sites were taken before treatment (baseline), at 30 min, and at each hour for 6 h and stored in All-Protect tissue reagent. The biopsies were then used to isolate RNA, which was subsequently used in qRT-PCR for eight genes associated with wound healing and the extracellular matrix: CCL2, IL6, FGF2, TIMP1, TIMP3, COL1A2, MMP2, and DCN. RPL13a was used as a housekeeping gene to normalize the eight genes of interest. One-way ANOVA tests were used to assess for differences among laser pulse energies and two-way ANOVA tests were used to assess the differences between treated and untreated areas. RESULTS: While six of the eight genes were upregulated after treatment (p < 0.05), there were no significant differences in gene expression between the different laser pulse energies for any of the eight genes. CONCLUSION: While laser treatment is correlated with a positive and significant upregulation for six of the eight genes 4 h after intervention, the pulse energy settings of the laser did not lead to a statistically significant difference in gene transcription among the treatment areas. Different laser pulse energies may not be required to induce similar cellular responses in a clinical setting.

Minimally Invasive Male Facial Rejuvenation: Energy-Based Devices.

The development of minimally invasive, non-surgical, and office-based procedures that have minimal downtime has stimulated an interest among men who may seek cosmetic treatments to increase competitiveness and appear youthful in the workplace. There has also been greater media attention on the male appearance and grooming along with increasing acceptance of cosmetic procedures within society. Achieving a successful cosmetic treatment in a male patient requires the physician to recognize the gender differences that exist. These include anatomy, skin aging, and skin biology, as well as behavioral patterns that exist in this population.

Endovascular stenting using a sagittal sinus approach for sigmoid sinus wall dehiscence related to intractable pulsatile tinnitus: a case series.

BACKGROUND: Sigmoid sinus wall dehiscence can lead to pulsatile tinnitus with a significant decrease in quality of life, occasionally leading to psychiatric disorders. Several surgical and endovascular procedures have been described for resolving dehiscence. Within endovascular procedures, the sagittal sinus approach could be a technical alternative for tracking and accurate stent positioning within the sigmoid sinus when the jugular bulb anatomy is unfavorable. CASE PRESENTATION: A retrospective case series of three patients with pulsatile tinnitus due to sigmoid sinus wall dehiscence without intracranial hypertension was reviewed from January 2018 to January 2022. From the participants enrolled, the median age was 50.3 years (range 43-63), with 67% self-identifying as female and 33% as male. They self-identified as Hispanic. Sigmoid sinus dehiscence was diagnosed using angiotomography, and contralateral transverse sinus stenosis was observed in all patients. Patients underwent surgery via a navigated endovascular sagittal sinus approach for sigmoid sinus stenting. No neurological complications were associated with the procedure. Pulsatile tinnitus improved after the procedure in all patients. CONCLUSIONS: Superior sagittal sinus resection for sigmoid sinus wall stenting is a safe and effective technique. Pulsatile tinnitus due to sigmoid sinus wall dehiscence could be treated using the endovascular resurfacing stenting technique. However, further research is needed to evaluate the potential benefit of contralateral stenting for removing sinus dehiscence when venous stenosis is detected. However, resurfacing sigmoid sinus wall dehiscence results in symptomatic improvement.

Two-Year Results of Ceramic-on-Ceramic Hip Resurfacing in an International Multicenter Cohort.

BACKGROUND: Hip resurfacing arthroplasty (HRA) is a bone-conserving alternative to total hip arthroplasty. We present the 2-year clinical and radiographic follow-up of a novel ceramic-on-ceramic HRA in an international multicenter cohort. METHODS: Patients undergoing HRA between September 2018 and January 2021 were prospectively included. Patient-reported outcome measures (PROMs) in the form of the Forgotten Joint Score, Hip Disability and Osteoarthritis Outcome Score Jr., Western Ontario and McMaster Universities Arthritis Index, Oxford Hip Score, and University of California, Los Angeles, Activity Score were collected preoperatively, and at 1 and 2 years postoperation. Serial radiographs were assessed for migration, component alignment, evidence of osteolysis or loosening, and heterotopic ossification formation. RESULTS: The study identified 200 patients who reached a minimum 2-year follow-up (mean 3.5 years). Of these, 185 completed PROMs follow-up at 2 years. There was a significant improvement in Hip Disability and Osteoarthritis Outcome Score (P < .001) and Oxford Hip Score (P < .001) between the preoperative, 1-year, and 2-year outcomes. Patients had improved activity scores on the University of California, Los Angeles, Active Score (P < .001), with 45% reporting a return to high-impact activity at 2 years. At 1 and 2 years, the Forgotten Joint Score was not significantly different (P = .38). There was no migration, osteolysis, or loosening of any of the implants. No fractures were reported over the 2-year follow-up, with only 1 patient reporting a sciatic nerve palsy. There were 2 revisions, 1 for unexplained pain at 3 months due to acetabular component malposition and 1 at 33.5 months for acetabular implant failure. CONCLUSIONS: The ceramic-on-ceramic resurfacing at 2 years postoperation demonstrates promising results with satisfactory outcomes in all recorded PROMs. Further long-term data are needed to support the widespread adoption of this prosthesis as an alternative to other HRA bearings.

Surgical decision-making in superior canal dehiscence syndrome with concomitant otosclerosis.

OBJECTIVE: The diagnosis and management of Superior Canal Dehiscence Syndrome (SCDS) with concomitant otosclerosis can be a challenge. Otosclerosis can mask SCDS symptoms and stapes surgery may reveal or exacerbate vestibular symptoms. Our aim is to present four cases of SCDS with concomitant otosclerosis and thereby informing the reader about the possibility of this dual occurrence and its implications for treatment. CASES: Four patients with SCDS and concomitant otosclerosis are presented. Two patients underwent surgical treatment for both SCDS and otosclerosis and two patients opted for conservative management. OUTCOMES: The main differences between surgically and non-surgically treated cases are the presence of autophony and pressure-induced vertigo and a more severe experience of symptoms in surgically treated cases. Surgically treated cases achieved a sizeable reduction in postoperative air-bone gap and resolution of vestibular symptoms. CONCLUSION: The subjective severity of symptoms in combination with shared decision-making is key in determining the appropriate treatment plan for SCDS and concomitant otosclerosis.

Minimally Invasive Post-Acne Scars Treatment with the Hybrid Filler HArmonyCa™.

Acne, a chronic inflammatory condition of the pilo-sebaceous unit, often results in scarring with significant aesthetic and psychological consequences for patients. While various treatments exist, including surgical and non-surgical approaches, a combined method has shown promise in effectively addressing acne scarring. Lipofilling, with its adipose-derived stem cells, has emerged as a promising technique for volume restoration and collagen stimulation but may not be suitable for all patients, especially those who prefer non-surgical treatments. Recently, a novel approach involving simultaneous injection of hyaluronic acid (HA) and calcium hydroxyapatite (CaHa) has been introduced in the literature, showing lifting properties, improving dermal thickness and skin texture, and inducing neocollagenesis. HArmonyCa™ (Allergan Aesthetics, an AbbVie Company) is a hybrid filler combining HA (20 mg/mL) and CaHa 55.7% (microspheres 25-45 µm) with 0.3% lidocaine in a 1.25-ml syringe. It has demonstrated volumizing, lifting, and skin-tightening effects, along with increased fullness, elasticity, and turgor of the skin. It has also shown an increase in viscoelasticity, suggesting new collagen formation, making it suitable for treating conditions like solar elastosis. Compared to lipofilling, HArmonyCa™ offers a non-surgical alternative with comparable outcomes and patient satisfaction. These findings have led us to employ this hybrid filler for the treatment of post-acne scarring. We present a case of a 35-year-old woman with post-acne scarring, treated with HArmonyCa™ combined with Volite™ injections, CO2 laser resurfacing, and chemical peels. Significant improvement in skin texture, reduction of shadowing effect, and restoration of tissue elasticity were observed, resulting in high patient satisfaction. While HArmonyCa™ presents a promising solution for post-acne scarring, further research is needed to comprehensively evaluate its efficacy and suitability. This study contributes to the growing body of literature exploring the potential applications of hybrid fillers, particularly in addressing post-acne scarring.Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Minimum 15-Year Survival of a Biconvex Inlay Patellar Component in Primary Total Knee Arthroplasty: An Analysis of 2,530 Total Knee Arthroplasties From a Single Institution.

BACKGROUND: Routine patellar resurfacing during primary total knee arthroplasty (TKA) remains controversial. To our knowledge, there are no studies reporting the long-term performance of a cemented biconvex all-polyethylene inlay component implanted at the time of primary TKA. The purpose of this study was to examine the 15-year survivorship and long-term clinical outcomes of this biconvex inlay patella used at our institution. METHODS: We retrospectively reviewed our prospectively collected institutional database and identified 2,530 patients who underwent cemented TKA with a single prosthetic design (from 1996 to 2007) where the patella was resurfaced using this cemented biconvex inlay patella. The mean age at surgery was 68 years (range, 29 to 93). The mean body mass index was 33.0 (range, 16.4 to 76.3), with 61.9% women. At the time of analysis, the mean time from surgery was 20.4 years (range, 15 to 26). We used Kaplan-Meier analysis to calculate survivorship at 15 years. We analyzed clinical outcomes using 3 patient-reported outcome measures collected prospectively. RESULTS: The 15-year survivorship with revision surgery for all causes as the end point was 97.1% (95% confidence interval 96.1 to 98.1%). The 15-year survivorship with revision surgery for a patella-related complication as the end point was 99.7% (95% confidence interval 99.4 to 1.0). At the final follow-up, patients showed significant improvement in scores for the Knee Society Clinical Rating System (P < .001), Western Ontario and McMaster University Osteoarthritis Index (P < .001), and Veterans Rand 12-Item Health Survey physical component (P < .001). CONCLUSIONS: Routine patellar resurfacing using a biconvex inlay patellar component has excellent survivorship and a low rate of complications at 15 years post-TKA.

Bilateral simultaneous total knee arthroplasty with and without patellar resurfacing. A prospective single surgeon series with a minimum follow-up of 7 years.

BACKGROUND: Total knee arthroplasty (TKA) is the most effective treatment for end-stage adult knee osteoarthritis, but it has been reported that patient satisfaction may vary. A malfunction of the patellofemoral joint may produce anterior knee pain (AKP) for several reasons. While some surgeons systematically resurface the patella despite the risk of potential complications such as fracture, loosening, or wear of the patella, others prefer to preserve it to reduce AKP and revision rates. This study aimed to evaluate whether patellar resurfacing had better clinical and functional outcomes, complications, and revision rates in patients undergoing simultaneous bilateral total knee arthroplasty. METHODS: We conducted a prospective cohort study, including patients who underwent bilateral simultaneous TKA in which the patella was replaced in one knee and preserved in the other, with a minimum follow-up of 7 years. We assessed clinical and functional outcomes with the Knee Society Score (KSS) and Visual Analogue Scale (VAS); complications and revision rates were also registered. RESULTS: The final series consisted of 43 patients with 86 knee arthroplasties. After a mean of 7.6 years of follow-up, no significant differences were found regarding KSS (clinical: 82.8 ± 7.4 versus 83.2 ± 3.4, p = 0.92; functional 89.1 ± 8.2: versus 90.4 ± 6.8; p = 0.99), VAS (2.0 ± 0.9 versus 1.8 ± 1.0; p = 0.84), complications (10.5% versus 8.1%; p = 0.57), or revision rates (2.3% versus 2.3%; p = 0.99) when comparing patellar resurfacing versus retention. CONCLUSION: In the context of total knee arthroplasty, patellar replacement did not demonstrate statistically significant differences concerning patellar retention in clinical nor functional outcomes, AKP, complications, or revision rates after a minimum of 7 years of follow-up.

Effect of Elevated Acetabular Cup on Contact and Failure Analysis in Hip Implants for Different Microseparations and Cup Inclinations Under Routine Gait Activities Using In Silico Approach.

Objectives: The acetabular cup design plays a critical role in reducing contact stress between femur head acetabular cup. Many studies used ellipsoidal and spheroidal geometry in acetabular cup design to effectively reduce contact stress. The present study focuses on elevated acetabular cup rim with round corner design to reduce contact stress with round corner geometry. Methods: The cobalt chromium femur head and cup are considered for finite element (FE) model of hip resurfacing. The gait loads of routine activities of humans like normal walking, stair ascending and descending and sitting down and getting up gait activities are applied to the developed 3D FE model. Five microseparations of 0.5, 1, 1.5, 2 and 2.5 mm are considered in the present study. The acetabular cup inclination angle considered for this study are 35°, 45°, 55°, 65° and 75°. The contact stress and von Mises stress plot for each gait activities under these microseparations are analyzed for betterment of longevity of implants. Results: Overall elevated cup rim design helped in reducing contact stress to a greater extent than conventional cup with different geometries. Also, the predicted von Mises stress for all the parameters considered in the current study are well within the yield strength of CoCr material. Therefore, elevated cup rim could be used as a better alternative to spline and, ellipsoidal and circular geometries of cup.

Advances in imaging for pre-surgical planning in hip resurfacing arthroplasty.

BACKGROUND: Accurate preoperative templating is essential for the success of hip resurfacing arthroplasty (HRA). While digital radiograph is currently considered the gold standard, stereoradiograph and CT converted 3D methods have shown promising results. However, there is no consensus in the literature regarding the preferred modality for HRA templating, and angular measurements are often overlooked. Thus, this study aimed to: (1) compare the performances of different modality in implant sizing and angle measurements, (2) evaluate the measurement reproducibility, (3) assess the impact of severe osteoarthritis on femoral head sizing, and (4) based on the analysis above, explore the optimal imaging and planning strategy for HRA. HYPOTHESIS: An optimal imaging modality exists for HRA planning regarding implant sizing and angular measurements. MATERIALS AND METHODS: Preoperative imaging data from seventy-seven HRA surgeries were collected. Three raters performed templating using digital radiograph, stereoradiograph, and CT converted 3D models. Measurements for femoral head size, neck-shaft angle, and calcar-shaft angle were obtained. The femoral head sizing was compared to the intraoperative clinical decision. The reproducibility of measurements was assessed using the intraclass correlation coefficient (ICC). Correlations were examined between sizing disagreement and osteoarthritis grade (Tonnis Classification). RESULTS: Digital radiograph, stereoradiograph, and 3D techniques predicted one size off target in 27/77 (35%), 49/70 (70%), and 75/77 (97%) of cases, respectively, corresponding to 1.8±1.6 (0 to 5.67), 0.9±0.7 (0 to 2.67), and 0.4±0.4 (0 to 1.67) sizes off target, indicating statistically significant differences among all three modalities, with p-values all below 0.01. There were no statistically significant differences among the different modalities for angular measurements. Measurements showed moderate to excellent reproducibility (ICC=0.628-0.955). High-grade osteoarthritis did not impact image sizing in any modality (r=0.08-0.22, all p>0.05). DISCUSSION: CT converted 3D models were more accurate for implant sizing in HRA, but did not significantly outperform other modalities in angular measurements. Given the high costs and increased radiation exposure associated with CT, the study recommended using CT scans selectively, particularly for precise femoral head sizing, while alternative imaging methods can be effectively used for angular measurements. LEVEL OF EVIDENCE: III; retrospective comparative diagnostic study.

Endoscopic duodenal mucosa ablation techniques for diabetes and nonalcoholic fatty liver disease: A systematic review.

BACKGROUND: Type 2 diabetes mellitus (T2DM) is increasing at an alarming rate, and only 50% of patients with T2DM achieve or maintain adequate glycemic control with pharmacological therapies. Metabolic surgery demonstrated superior efficacy compared to medical therapy but is unfeasible for most patients with T2DM. Duodenal mucosal resurfacing (DMR) by hydrothermal mucosal ablation, recellularization via electroporation therapy (ReCET), and photodynamic therapy are novel endoscopic procedures that use thermal, electrical, and photochemical energy, respectively, to ablate and reset dysfunctional duodenal mucosa. We assessed the data on the effects of these techniques on glycemic control and nonalcoholic fatty liver disease (NAFLD). METHODS: We systematically searched independently and in duplicate English and non-English language publications through January 31st, 2024. Outcomes assessed were an improvement in different metabolic health parameters and the safety of duodenal mucosal ablation (DMA) procedures. Outcomes were presented descriptively. FINDINGS: We selected 12 reports reporting results from 3 randomized and 6 uncontrolled trials (seven evaluating DMR, two evaluating ReCET, all with a low risk of bias) for a total of 317 patients enrolled. DMA reduced HbA1c, fasting plasma glucose, and liver fat. When combined with newer antidiabetic drugs, it allowed insulin discontinuation in up to 86% patients. No major safety signal emerged. CONCLUSIONS: All DMA techniques improve glucose homeostasis; DMR and ReCET appear to be safe in patients with T2DM. If confirmed by future randomized trials and by trials with histological endpoints in NAFLD, then DMA appears to be a promising alternative or complement option to medications for T2DM and NAFLD treatment. FUNDING: This study received no funding.

Kuntscher nail removal: Revision of a failed hip resurfacing above an incarcerated Kuntscher nail. A case report of a smart nail extraction technique through a custom-made instrumentation.

Removal of a retained and osseointegrated intramedullary femoral nail can represent a considerable problem, especially in the case of contemporary total hip arthroplasty or, even worse, in the case of revision hip arthroplasty. Usually, complex and invasive surgical techniques are required to remove incarcerated Kuntscher nails. We described a case of an incarcerated Kuntscher nail, inserted 39 years before, in a 75-year-old woman waiting for a revision total hip arthroplasty of a failed metal-on-metal hip resurfacing. A CT-based custom-made extra-long trephine reamer was designed and successfully used to easily extract the nail, leaving the proximal femur before a revision hip arthroplasty.

Assessing the Effects and Challenges of Total Hip Arthroplasty before Pregnancy and Childbirth: A Systematic Review.

Total hip arthroplasty is indubitably one of the most performed operations worldwide. On the other hand, especially in the western world, the average age that women get pregnant has raised confoundedly. Consequently, a steadily increasing number of women become pregnant after they had hip arthroplasty surgery, with copious potential implications. The amount of knowledge on this particular field is considered inadequate in the existing literature. This paper aims to augment clinicians understanding surrounding this topic. A systematic literature review was conducted in accordance with the PRISMA guidelines. Papers from various computerized databases were scrutinized. Article selection was carried out by three authors independently employing specific pre-determined inclusion and exclusion criteria, while disagreements were elucidated with the contribution of other authors. A patently limited number of research articles were detected from our rigorous literature review, with only 12 papers meeting the inclusion criteria. The vast majority of studies were small-scale and examined confined population groups. Most studies had been performed in Finland, utilizing data from nationwide registries. Women with previous history of total hip arthroplasty feature increased rates of c-section delivery, although vaginal labor can be attempted with certain precautions. Hip implants' survival does not appear to be affected from gestation, which is predominately well-tolerated from these women. Metal ion circulation in mothers' blood has not been proven to trigger substantial complications concerning either mothers or offspring. It can be considered safe for women with such medical history to get pregnant; however, further multinational studies and pertinent research on this field are vital to attain more solid inferences.

Secondary Patellar Resurfacing Following Primary Unresurfaced Total Knee Arthroplasty: Beware of the Incidence of Late Patellar Erosion.

BACKGROUND: The primary aim of this study was to evaluate secondary patellar resurfacing (SPR) indications and rates in a single-surgeon series utilizing a modern TKA design and additionally, to review the functional outcomes of patients after undergoing SPR. METHODS: A retrospective review of a prospectively collected institutional database was performed. All patients undergoing primary TKA by a single surgeon between 2013 and 2021 were included. During this time, the senior surgeon resurfaced the patella selectively. Patients were divided into the primary resurfaced (PR) and the primary unresurfaced (UR). All patients undergoing SPR in the UR group were identified, their radiographs reviewed, and their clinical outcomes assessed. During the study period, 1,511 TKAs were performed, with 73.1% (1,105 TKAs) being unresurfaced. RESULTS: The all-cause revision rate was 1.2% in the PR group and 3.6% in the UR group. The rate of SPR in the UR group was 2.0% (22 of 1,105 TKAs). No patient in the PR group underwent revision surgery for a patellar complication. The mean age at primary TKA for those undergoing SPR was 65 years (range, 50 to 78). The average time for SPR from primary TKA was 3.4 years (range, 1.1 to 8.8). Postoperative radiographic progression of patellar erosion, in combination with new onset anterior knee pain, was the indication for SPR in 14 of the 22 (63.7%) SPR cases. After SPR, the Western Ontario and McMaster University Osteoarthritis Index score (P < .001) and Knee Society Score (P < .001) improved from pre-SPR. CONCLUSIONS: Secondary patellar resurfacing (SPR) was the most common (55%) reason for revision surgery after primary UR TKA in this series. An SPR improved clinical outcomes in symptomatic patients. Surgeons should consider patellar resurfacing for all patients undergoing primary TKA to reduce the burden of revision surgery post-TKA. Additionally, the paradigm that late SPR does not improve clinical outcomes needs to be revisited.

Personalized Resurfacing for Osteochondral Lesions of the Talus.

Osteochondral lesions of the talus (OLTs) are the most common cause of chronic deep ankle pain. Joint-preserving surgeries include bone marrow stimulating, chondral transporting, and cellular-based procedures. Each procedure has its advantages and disadvantages. For that reason, a focal metallic inlay was developed as a bridge between biologics and conventional joint arthroplasty. Despite promising initial results, prefabricated implants are associated with unpredictable results. This article describes a novel customized patient-specific metal inlay as a treatment option for OLTs.

Endoscopic duodenal mucosa ablation: the future of diabetes treatment?

Duodenal mucosa ablation (DMA) is a novel approach to treat diabetes, consisting of endoscopic ablation of dysfunctional diabetic duodenal mucosa, which, following the healing response, is replaced by normally functioning mucosa. Two techniques, duodenal mucosal resurfacing (DMR) and recellularization via electroporation therapy (ReCET), recently showed promise in type 2 diabetes mellitus (T2DM) patients.