Complications of vasectomy: results from a prospective audit of 105 393 procedures.

OBJECTIVES: To provide up-to-date complication rates for vasectomy in the UK using 15 years of data collected by the Association of Surgeons in Primary Care (ASPC). PATIENTS AND METHODS: Data were collected between 2007 and March 2022. A patient questionnaire was completed on the day of surgery and at 4 months postoperatively. Rates of early and late failure, infection, hospital admission or re-admission, haematoma and post-vasectomy pain syndrome (PVPS) were recorded. There were no specific exclusion criteria. Complication rates were compared to those published by major urological organisations. Descriptive statistics were utilised, without formal statistical analysis. RESULTS: Over the 15-year study period, data from 105 393 vasectomies were collected, performed by >150 surgeons. In 2022, 94.4% of surgeons used one test to prove sterility. In all, 65% of patients used a postal sperm test after vasectomy to confirm sterility. Early failure rates were available for 69 500 patients. Early failure occurred in 648 patients (0.93%). Of 99 124 patients, late failure occurred in 41 (0.04%). Of 102 549 vasectomies, postoperative infection was reported in 1250 patients (1.22%), haematoma in 1599 patients (1.56%), and PVPS was reported in 139 patients (0.14%). CONCLUSIONS: Vasectomy remains a safe and reliable contraceptive method. The rates of complication were generally lower than those published by major urological organisations. This large, prospective audit provides accurate, contemporaneous complication rates that can form the basis for pre-vasectomy counselling.

Reducing edge loading and alignment outliers with image-free robotic-assisted unicompartmental knee arthroplasty: a case controlled study.

BACKGROUND: Survivorship of medial unicompartmental knee arthroplasty (UKA) is technique-dependent. Correct femoral-tibial component positioning associates with improved survivorship. Image-free robotic-assisted unicompartmental knee arthroplasty enables preoperative and intraoperative planning of alignment and assessment of positioning prior to execution. This study aimed to compare the radiological outcomes between robotic-assisted UKA (R-UKA) and conventional UKA (C-UKA). METHODS: This retrospective case control study involved 140 UKA (82 C-UKA and 58 R-UKA) performed at an academic institution between March 2016 to November 2020, with a mean follow-up of 3 years. Postoperative radiographs were evaluated for mechanical axis and femoral-tibial component position. Component position was measured by two methods: (1) femoral-tibial component contact point with reference to four medial-to-lateral quadrants of the tibial tray and (2) femoral-tibial component contact point deviation from the center of the tibial tray as a percentage of the tibial tray width. Baseline demographics and complications were recorded. RESULTS: There was a higher mean component deviation in C-UKA compared with R-UKA using method 2 (17.2% vs. 12.8%; P = 0.007), but no difference in proportion of zonal outliers using method 1 (4 outliers in C-UKA, 5.1% vs. 1 outlier in R-UKA, 1.8%; P = 0.403). R-UKA showed no difference in mean mechanical alignment (C-UKA 5° vs. R-UKA 5°; P = 0.250). 2-year survivorship was 99% for C-UKA and 97% for R-UKA. Mean operative time was 18 min longer for R-UKA (P < 0.001). CONCLUSION: Image-free robotic-assisted UKA had improved component medio-lateral alignment compared with conventional technique.

A Study of the Associated Risk Factors for Early Failure and the Effect of Photofunctionalisation in Full-Arch Immediate Loading Treatment Based on the All-on-Four Concept.

Early implant failure occurring within 1 year after implantation has been attributed to various factors. Particularly, early failure can lead to challenges in maintaining a full-arch prosthetic device, necessitating prompt intervention, including reoperation. This study aimed to retrospectively examine implant- and patient-related factors and the effects of photofunctionalisation associated with early failure in patients who underwent treatment using the all-on-four concept in both the maxilla and mandible. We conducted this retrospective study comprising 561 patients with 2364 implants who underwent implant-supported immediate loading with fixed full-arch rehabilitation using the all-on-four concept. We aimed to assess the survival rate within 1 year after implantation and determine the risk factors influencing early failure. The 1-year survival rates after implantation were 97.1% (patient level) and 98.9% (implant level) for the maxilla and 98.5% (patient level) and 99.6% (implant level) for the mandible. There was a significant difference in the implant-level survival rates between the maxilla and mandible, with a lower rate in the maxilla (p = 0.043). The risk factors associated with early implant failure according to the all-on-four concept included the maxilla (implant level) and smoking (patient level). We could not find a significant effect of photofunctionalisation on early failure (p = 0.25) following this treatment protocol.

Factors associated with early failure of the femoral neck system (FNS) in patients with femoral neck fractures.

BACKGROUND: Femoral neck system (FNS) is a new type of internal fixation system which has been widely used for treating femoral neck fractures (FNFs).Compared with other internal fixation methods, FNS is minimally invasive and stable, and often achieves satisfactory short-term efficacy.Early failure of FNS (EFFNS) is not uncommon, however, there are few literatures and reports on factors associated with EFFNS.This study aimed to survey the prevalence and risk factors of EFFNS. METHODS: We retrospectively analysed 62 patients with FNFs and underwent FNS fixation between 2019 and 2021. Demographic data, clinical characteristics, radiographic features and treatment process were described. Multifactor logistic regression analysis was used to analyse the different influencing factors. RESULTS: Out of the 62 FNFs patients, 10 patients (16.1%) developed EFFNS, including 6 cases of severe femoral neck shortening, 2 cases of screw-out, 1 case of avascular necrosis of the femoral head and 1 case of nonunion. In the failure group, all patients were younger than 65 years old, which was significantly higher than 59.6% in the healing group (P = 0.012). There were no significant differences in sex(P = 0.490), BMI (P = 0.709), injured side (P = 0.312), injury mechanism (P = 0.617), reduction method(P = 0.570),femoral neck-shaft angle(P = 0.545), Pauwels classification (P = 0.564) and Garden classification (P = 0.195). Moreover, we not found that Garden classification (P = 0.464) and age (P = 0.128) were statistically significant risk factors for EFFNS at multivariate analysis. CONCLUSION: In this study, sex, BMI, injury side, injury mechanism, reduction method, Pauwels angle, femoral neck-shift angle, Pauwels classification and Garden classification were excluded as EFFNS risk factors. Moreover, our study demonstrated that age and Garden classification were not significant risk factors at multivariate analysis. TRIAL REGISTRATION: ChiCTR, ChiCTR2100051360. Registered on 21 September, 2021. https://www.chictr.org.cn/index.aspx .

A Condition-Monitoring Method for Rolling Bearings Based on Dynamic Asynchronous Peak-Factor Ratios.

In response to issues such as the lack of capability for timely early warning and the difficulty in monitoring the status of rolling bearings, a condition-monitoring method for rolling bearings based on the Honey Badger Algorithm (HBA) for optimizing dynamic asynchronous periods is proposed. This method is founded on the peak factor and involves comparing peak factors at different periods to construct a dynamic asynchronous peak-factor-ratio-monitoring index, which is then optimized using the HBA. Simulated experiments were carried out using the XJTU-SY dataset. The results indicate that, compared to the early warning times defined by international standards, the warning times provided using this method are consistently over 33 min in advance within the test dataset. Additionally, an envelope spectrum analysis of the warning data confirms the existence of early faults. This demonstrates that the monitoring indicator developed in this paper is capable of delivering earlier and more accurate early fault warnings and condition monitoring for rolling bearings.

An Unusual Case of Onlay Reverse Shoulder Arthroplasty Disassembly Due to Cement Interposition. A Case Report.

Introduction: Reverse shoulder arthroplasty (RSA) complication rates range between 1.4% and 28% depending on the nature of the indication. Even though glenosphere dissociation is the third most frequent complication after RSA, with an incidence that can rise to just over 12%, there is no evidence in the literature describing the disassembly between the humeral stem and its metaphysics. Case Report: It is reported a novel early failure type in a reversed shoulder arthroplasty of a healthy 72-year-old female patient, involving the disassembly of the metaphysis from an onlay tray system due to cement interposition in a reversed shoulder prosthesis. Conclusion: This case highlights a rare form of early failure after RSA as a result of a disassembly between the humeral stem and its metaphysis due to the presence of interposed cement. To prevent this complication, a two-step implantation procedure is recommended, which consists of cementing the stem before inserting the metaphyseal tray.

Early aortic valve neocuspidization failure due to xenograft leaflet tear in a young adult.

Aortic valve neocuspidization, initially described by Ozaki and colleagues, has become an increasingly popular treatment approach for aortic valve disease in both adult and paediatric populations. We report a case of an 18-year-old man with severe aortic regurgitation who underwent the Ozaki procedure using photo-oxidized bovine pericardium. Around 5 weeks after the surgery, he developed early symptomatic valve failure due to multiple leaflet tears requiring urgent reoperation.

Tear patterns and locations are different between lateral and medial compartments in patients with early anatomical failure after meniscal allograft transplantation.

PURPOSE: To investigate the characteristics of anatomically failed grafts within 1 year after meniscal allograft transplantation (MAT) and compare the differences between lateral and medial MATs. METHODS: The records of consecutive patients with anatomically failed grafts within 1 year after primary MAT between 2005 and 2018 were reviewed. Anatomical failure was defined as a tear covering > 50% of the allograft or an unstable peripheral rim. The pattern and location of the graft tears were analyzed using magnetic resonance imaging or arthroscopy. RESULTS: A total of 21 patients were included. All 21 patients had anatomical failure with tears involving > 50% of the allograft, whereas 15 had an unstable peripheral rim of the allograft. The mean failure time was 6.6 ± 3.6 months in all patients (lateral MAT, n = 15; medial MAT, n = 6). In the lateral MAT group, meniscocapsular separation was the most common pattern (n = 10, 66.7%), followed by complex (n = 3, 20.0%), radial (n = 1, 6.7%), and longitudinal (n = 1, 6.7%) tear. In the medial MAT group, a root tear was the most common pattern (n = 5, 83.3%), followed by a complex tear (n = 1, 16.7%). Meanwhile, in the lateral MAT, the midbody was the most frequently affected location (n = 9, 60.0%), followed by the posterior (n = 5, 33.3%) and anterior (n = 1, 6.7%) areas; in the medial MAT group, the posterior (n = 5, 83.3%) was the most frequently affected location, followed by the anterior area (n = 1, 16.7%). Significant differences in the pattern (P = 0.002) and location (P = 0.043) of the graft tears were found between lateral and medial MATs. CONCLUSION: In patients with early failure after MAT, meniscocapsular separation in the midbody of the lateral compartment and root tears in the posterior area of the medial compartment were the most common. Thus, surgeons are encouraged to pay extra attention to these vulnerable areas during the early period after MAT. LEVEL OF EVIDENCE: IV.

Catastrophic Early Failure and Fragmentation of a Modern Moderately Cross-linked Polyethylene Acetabular Liner.

A 60-year-old man who underwent uncomplicated staged bilateral total hip arthroplasty for femoral head osteonecrosis presented with mechanical catching of his left total hip arthroplasty 3 years after index surgery. Radiographs revealed eccentricity of the left femoral head, concerning the failure of a modern moderately cross-linked polyethylene liner. Catastrophic polyethylene liner failure with significant wear, fragmentation, and femoral head abrasion was noted during revision surgery. The original liner and head were replaced, and the patient has exhibited no complications, pain, or difficulty ambulating 6 months postoperatively. This report highlights one potential novel mechanism for the failure of the Exactech Connexion GXL liner (Exactech Inc., Gainesville, FL), an implant recently reported to have a higher-than-expected failure rate, potentially due to insufficient packaging and increased oxidative processes.

What are the preoperative predictors of a futile pelvic exenteration in rectal cancers?

INTRODUCTION: Early recurrences and deaths after a morbid procedure like pelvic exenteration are devastating events. The present study aimed at determining the incidence and predictors of futile pelvic exenterations. METHODS: Consecutive pelvic exenterations for advanced and recurrent rectal adenocarcinomas operated between January 2013 and January 2021 were included with a minimum of six months follow-up. Futility of exenteration was defined as recurrence or death within six months of operation. Multivariate logistic regression was used to define predictors of futility. RESULTS: Two-hundred eighty-five patients were included and 61 patients (21.4%) had a futile resection. Poorly differentiated (or signet) histology, presence of lateral pelvic nodes, M1 disease, and the need for pelvic bone resections predicted a futile resection. The probability of futility was 10%, 20%, 35-40%, 55-60%, and >75% when none, one, two, three, and all four of the predictors were present. The model was able to correctly predict futility in 70% of the cases suggesting moderate discrimination, and showed good calibration. CONCLUSIONS: Futile pelvic exenterations were observed in one-fifth of patients. Four strong predictors of futility were identified. The risk of early failures was additive when combination of these adverse features was present, and can be used for patient selection and prognostication.

High early failure rate for a new unicondylar knee system.

Background: This single-center retrospective study evaluated early failure rates for an unicompartmental knee arthroplasty (UKA) system with an anti-allergic surface. Methods: We studied 87 consecutive joints received an UKA at a single center between 2017 and 2020. All patients received a fully cemented anti-allergic Univation-Aesculap partial knee replacement implant with a corundum blasting surface. All joints had precise indication of unicompartmental arthroplasty according to the current criteria of this procedure. The current series was restricted to patients undergoing medial cemented UKA. Medial compartment osteoarthritis was the main indication. Results: We found early failure (aseptic loosening) was documented in 20 of the 87 joints (23%). The time to failure ranged from 7 weeks to 3 years, for an estimated 33% (15-46%) cumulative hazard rate for implant loosening over three years. No cases of periprosthetic joint infection were found. On average, the patients began complaining about first symptoms during the third month after surgery. In most cases (66.66%), the cement remained fixed to the bone. Conclusions: Based on these early results, the manufacturer of this implant stopped all further distribution. Continued efforts should be made to understand the clinical and radiographic outcomes of alternative and anti-allergic surface coatings in knee arthroplasty.

Early Failure of Arteriovenous Fistula (AVF): The Effect of Diabetes and Hypertension in a Cross-Sectional Study.

Background: Identification and control of clinical predictors of arteriovenous (AVF) failure can improve the long-term outcome of hemodialysis patients. The effects of these factors on the outcome of AVF are not still clear. So, we aimed this study to compare the effect of hypertension and diabetes on early failure of AVF. Methods: In this retrospective study, we evaluated 400 patients with ESRD referred to our clinic for the creation of the first AVF from July 14, 2001, through August 7, 2018. One month after AVF creation, the patients were referred to the clinic for patency control. Demographic characteristics, previous history of diabetes and hypertension, and laboratory data of all patients were recorded preoperatively. Data were entered to SPSS v.24 and Study data were analyzed with chi-square and independent student t-test. Then, early failure of AVF and its relationship with a history of diabetes and hypertension were assessed. Results: There was no statistically significant relationship between the history of diabetes and early AVF failure risk in ESRD patients (OR, 0.78; 95% CI, 0.25 to 2.43). Furthermore, the history of hypertension was significantly lower in the early failure of AVF group (OR, -2.82; 95% CI, -1.42 to -5.59). Although, this effect faded when using regression analysis (OR, -2.67; 95% CI, -0.97 to -7.36). There was a higher Body mass index in the non-early failure group (p = 0.041). There was no significant difference in age (p = 0.512), gender (p = 0.091), history of smoking (p = 0.605), treatment with insulin (p = 0.683), oral antidiabetic agents (p = 0.734), duration of diabetes (p = 0.384), and duration of hypertension (p = 0.093). Conclusion: We reported that the history of diabetes was not higher in the early failure group, while there was a lower risk of AVF failure in patients with a previous history of hypertension.

Tips and tricks to avoid implant failure in proximal femur fractures treated with cephalomedullary nails: a review of the literature.

Objective: To describe the surgical aspects potentially contributing to hardware failure of cephalomedullary nails. Data Sources: A search of the Embase, PubMed (MEDLINE), Web of Science, and the Cochrane library for reports of hardware failures after intramedullary fixation of proximal femur fractures. Issues of cut out and cut through phenomena related to technique were excluded. Expert opinion of 3 surgeons, each trained on several fixation systems at Level | trauma centers is reported. Data Extraction: Three authors extracted data using a predesigned form. Implant type, reported failure mechanism, and associated factors with implant failure were recorded as well as potential bias. Results: Of 2182 search results screened, 64 articles were deemed relevant for our research question and were included. The authors identified factors associated with implant failure: preoperative patient and fracture characteristics, intraoperative reduction, implant handling, and postoperative nonunion. Issues were identified as independent modifiable intraoperative risk factors: inadequate fracture reduction, varus position of femoral neck, direct damage of the cephalomedullary nail aperture by eccentric drilling related to guide sleeve handling, and implant design mechanism failures. Conclusions: Multiple factors associated with intraoperative handling can influence the healing of proximal femur fractures. Although many of these have been well described and are taught in fracture courses, surgeons should be aware of subtle intraoperative complications reported in the literature that can weaken implants and add to the likelihood of early failure.Level of Evidence: IV.

Preoperative Cardiac Index as a Predictor of Maturation and Primary Patency of Radiocephalic Arteriovenous Fistula in Hemodialysis.

BACKGROUND: Radiocephalic arteriovenous fistula (RCAVF) is the best access modality to be considered initially when planning arteriovenous fistula (AVF) for maintenance hemodialysis. Considering the higher incidence of RCAVF failed maturation (M), it is important to perform proper preoperative evaluation and identification of high-risk patients. There has been no study on the influence of preoperative cardiac function on the M and patency of AVFs. The purpose of this investigation is to determine whether preoperative cardiac index (CI) is a predictor of M and primary patency of RCAVF. METHOD: A total of 365 end-stage renal disease patients undergoing RCAVF surgery were consecutively enrolled with a median follow-up time of 20 months in this prospective cohort study. Demographics, vascular diameters measured by duplex ultrasound examination, and CI measured by echocardiography, were analyzed for effect on RCAVF primary functional M and primary patency. RESULT: Patients in the group achieving primary RCAVF functional M had a significantly larger mean CI than the group with early RCAVF failure (2.93 ± 0.77 vs. 3.57 ± 0.76 L/min/m2, p < 0.001). The receiver operating characteristic curve was plotted and demonstrated that preoperative vein diameter and CI can predict failure of RCAVF M. The AUC of CI was higher (0.745 vs. 0.666). Multivariate regression analysis, adjusted for age, sex, diabetes, preoperative dialysis status and vessel diameters, showed that decreased CI remained associated with increased risk of failure of M (FM) and worse primary unassisted patency. The Kaplan-Meier survival analysis suggested that patients with CI <3 L/min/m2 had a worse primary unassisted patency rate at all time points compared with patients with CI ≥3 L/min/m2. CONCLUSION: This study demonstrated that preoperative CI was associated with RCAVF M and long-term patency. A decreased CI may be a possible predictor of an increased risk of FM and a shorter primary patency time.

Revised International Prognostic Index and genetic alterations are associated with early failure to R-CHOP in patients with diffuse large B-cell lymphoma.

Relapsed or refractory diffuse large B-cell lymphoma (DLBCL) cases have a poor outcome. Here we analysed clinico-biological features in 373 DLBCL patients homogeneously treated with rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone (R-CHOP), in order to identify variables associated with early failure to treatment (EF), defined as primary refractoriness or relapse within 12 months from diagnosis. In addition to clinical features, mutational status of 106 genes was studied by targeted next-generation sequencing in 111 cases, copy number alterations in 87, and gene expression profile (GEP) in 39. Ninety-seven cases (26%) were identified as EF and showed significantly shorter overall survival (OS). Patients with B symptoms, advanced stage, high levels of serum lactate dehydrogenase (LDH) or ß2-microglobulin, low lymphocyte/monocyte ratio and higher Revised International Prognostic Index (R-IPI) scores, as well as those with BCL2 rearrangements more frequently showed EF, with R-IPI being the most important in logistic regression. Mutations in NOTCH2, gains in 5p15·33 (TERT), 12q13 (CDK2), 12q14·1 (CDK4) and 12q15 (MDM2) showed predictive importance for EF independently from R-IPI. GEP studies showed that EF cases were significantly enriched in sets related to cell cycle regulation and inflammatory response, while cases in response showed over-representation of gene sets related to extra-cellular matrix and tumour microenvironment.

Varus malalignment of short femoral stem not associated with post-hip arthroplasty fracture.

INTRODUCTION: Periprosthetic femoral fractures are an increasingly common post-operative complication of total hip arthroplasty (THA). Though varus malalignment is known to increase fracture risk in standard-length femoral stems, varus malalignment is not as well studied in short stems. Therefore, the purpose of this study was to determine if varus malalignment contributes to early periprosthetic fracture risk in a cementless taper-wedged, short femoral stem. MATERIALS AND METHODS: This retrospective review included 366 consecutive patients (441 THAs) having undergone THA via anterior approach by a single surgeon between July 2014 and December 2016. All patients received the same short, cementless femoral stem. Femoral component angle was measured on 6-week post-THA weight-bearing radiographs, with malalignment defined as a femoral component angle exceeding 0° ± 3°. Periprosthetic femoral fracture and aseptic loosening occurring within 2 years post-THA were recorded. RESULTS: The final data analysis included 426 hips with a mean follow-up time of 32.9 ± 10.2 months. Varus and neutral alignment occurred in 84 (19.6%) and 342 (79.9%) of stems, respectively. Three (0.7%) periprosthetic femoral fractures occurred within 2 years, all occurring in patients with neutrally aligned femoral stems. One (0.2%) stem failed due to aseptic loosening and was malaligned. CONCLUSION: Despite nearly 20% of stems placed in varus alignment, three of the four early complications occurred in a neutrally aligned stem. Based on these results, forceful intraoperative realignment of a short femoral stem with good initial fixation may present an unnecessary increased risk of intraoperative fracture.

Monitoring the Patient Following Radio-Cephalic Arteriovenous Fistula Creation: Current Perspectives.

Autogenous radial-cephalic direct wrist arteriovenous fistula (RC-AVF) in the non-dominant arm is the gold standard for dialysis vascular access. However, the RC-AVF non-maturation rate is significant (≃ 40%) due to an increasingly elderly and comorbid population incidence. A detailed identification of the biological cascade underlying arteriovenous fistula (AVF) maturation could be the key to clinical research aimed at identify the group of patients at risk of primary AVF failure. Currently, careful post-operative monitoring remains the most crucial aspect to overcome the problem of impaired maturation. Up to 80% of patients with immature RC-AVF have problems potentially solvable with early endovascular or surgical correction. Physical examination by experienced practitioners in conjunction with duplex ultrasound examination (DUS) can identify physical signs of non-maturation, understand the underlying cause, and drive for a tailored early planning to treat the complication. New approaches for the early assessment of AVF maturation are under study. Techniques to promote RC-AVF maturation performed through the administration of pre-or peri-operative drugs have missed up to now to prove an efficacy in improving fistula success. The new techniques tested after surgery appear to hold future promise for improving fistula maturation.

The risk factors of early implant failure: A retrospective study of 6113 implants.

BACKGROUND: The risk factors of early implant failure were controversial among previous studies, especially for implants in different sites. PURPOSE: To analyze the rate and risk factors of early implant failure occurring before the placement of final prosthesis. MATERIALS AND METHODS: A retrospective study was conducted based on electrical medical records of patients who received dental implant placement from 2015 to 2019. Generalized estimation equation analyses were used to explore potential risk factors influencing early implant failure. RESULTS: Overall, 6113 implants in 3785 patients were included. The rate of early implant failure was 1.6% at patient level and 1.2% at implant level. The early implant failure was significantly associated with implants in the posterior maxilla, with specific surface modifications and in previously augmented sites (p < 0.05). Risk factors for maxillary implants included surface modification and bone augmentation procedures (p < 0.01), whereas risk factors for mandibular implants included gender and bone augmentation procedures (p < 0.05). For implants placed in previously augmented sites, implants placed in the anterior mandible had a higher risk of early failure (p < 0.05). CONCLUSIONS: The risk factors for early implant failures varied among different sites; hence, they should be comprehensively considered in presurgical treatment plan.

Ceramic-on-ceramic articulation in press-fit total hip arthroplasty as a potential reason for early failure, what about the survivors: a ten year follow-up.

PURPOSE: In press-fit total hip arthroplasty (THA), primary stability is needed to avoid micromotion and hereby aseptic loosening, the main reason for early revision. High aseptic loosening revision rates of the seleXys TH+ cup (Mathys Medical) with Ceramys ceramic-on-ceramic (CoC) bearing are seen in literature. Since CoC is presumed to overcome long-term wear-related revisions, the reason for early failure of this cup is important to clarify. The aim is to investigate its ten year outcomes and differentiate between potential causes and identify risk factors for aseptic loosening. METHODS: Retrospective screening of a prospectively documented series of 315 THAs was performed. Primary outcome was cumulative incidence of cup revision due to aseptic loosening. Secondary outcomes were component revision and reoperation. Additionally, potential predictive factors for aseptic loosening were evaluated. RESULTS: At the median follow-up of 9.7 years [IQR 4.4; 10.3], 48 TH+ (15.2%) were revised due to aseptic loosening. Competing risk analysis showed a ten year cumulative incidence of cup revision due to aseptic loosening of 15.6% (95% CI 12.0-20.2). Stabilization of early revision rates was observed, following a high rate of respectively 81.3% (n = 39) and 95.8% (n = 46) within the first two and three years. No significant predictive factors for aseptic loosening were found. CONCLUSION: The ten year results of seleXys TH+ cup with Ceramys CoC bearing showed an unacceptable high aseptic loosening rate, which stabilized over time after a high early failure incidence. This could be attributed to a problem with osseointegration during the transition of primary to definitive stability.

Preventive Antibiotic Therapy in the Placement of Immediate Implants: A Systematic Review.

Immediate implants present a high risk of early failure. To avoid this, preventive antibiotics (PAs) are prescribed; however, their inappropriate administration leads to antimicrobial resistance. The present study aims to clarify whether the prescription of PAs reduces the rate of early failure of immediate implants and to establish guidelines to avoid the overprescription of these drugs. An electronic search of the MEDLINE database (via PubMed), Web of Science, Scopus, LILACS and OpenGrey was carried out. The criteria described in the PRISMA® statement were used. The search was temporarily restricted from 2010 to 2021. The risk of bias was analysed using the SIGN Methodological Assessment Checklist for Systematic Reviews and Meta-Analyses and the JBI Prevalence Critical Appraisal Tool. After searching, eight studies were included that met the established criteria. With the limitations of this study, it can be stated that antibiotic prescription in immediate implants reduces the early failure rate. Preoperative administration of 2-3 g amoxicillin one hour before surgery followed by 500 mg/8 h for five to seven days is recommended. It is considered prudent to avoid the use of clindamycin in favour of azithromycin, clarithromycin or metronidazole in penicillin allergy patients until further studies are conducted.