Background: Porous tantalum augments are versatile tools in reconstructing complex acetabular defects during revision total hip arthroplasty (THA). This study examines the clinical and radiographic outcomes of porous tantalum augments placed in the type I (flying buttress) configuration at two to 17-year followup in the largest cohort to-date in the literature. Methods: We retrospectively analyzed 59 consecutive revision THAs involving the use of flying buttress augments between 2003 and 2018. The mean patient age and follow-up duration were 63.9 ± 11.6 years (range, 35-87) and 8 years (range, 2-17), respectively. The Oxford hip score was used to assess clinical outcome. The modified Moore classification was used to assess acetabular augment and shell osseointegration. Kaplan-Meier survival analysis with 95% confidence interval (CI) was used to assess implant survivorship. Results: The mean Oxford hip score improved from 15.9 ± 6.2 preoperatively to 35.0 ± 6.5 at a mean follow-up of eight years (P < .0001). Radiographic assessment using the modified Moore classification demonstrated five signs of osseointegration in 49 hips (83.1%), four signs in six hips (10.2%), three signs in one hip (1.7%), and one sign in one hip (1.7%). Kaplan-Meier analysis demonstrated ten-year survivorship of 88.9% (95% CI 74.4-95.4) with all-cause revision as end point and 94.3% (95% CI 83.1-98.2) with revision for acetabular aseptic loosening as end point. Conclusion: Treatment of superolateral acetabular defects during revision THA using porous tantalum augments placed in the type I (flying buttress) configuration provides excellent implant survivorship and favorable clinical outcomes at mid-term follow-up.
Background As the healthcare system faced an acute shortage of personal protective equipment (PPE) during the COVID-19 pandemic, the use of 3D printing technologies became an innovative method of increasing production capacity to meet this acute need. Due to the emergence of a large number of 3D printed face shield designs and community-led PPE printing initiatives, this case study examines the methods and design best optimized for community printers who may not have the resources or experience to conduct such a thorough analysis. Case presentation We present the optimization of the production of 3D printed face shields by community 3D printers, as part of an initiative aimed at producing PPE for healthcare workers. The face shield frames were manufactured using the 3DVerkstan design and were coupled with an acetate sheet to assemble a complete face shield. Rigorous quality assurance and decontamination protocols ensured community-printed PPE was satisfactory for healthcare use. Conclusion Additive manufacturing is a promising method of producing adequate face shields for frontline health workers because of its versatility and quick up-start time. The optimization of stacking and sanitization protocols allowed 3D printing to feasibly supplement formal public health responses in the face of a global pandemic.
The COVID-19 pandemic has led to persistent supply shortages of respiratory protective equipment in many jurisdictions. Reusable industrial respirators have been proposed and deployed as an alternative, but also face severe supply limitations. In addition, industrial respirators do not filter the user’s expired breath, a major limitation in health care settings where bidirectional protection is required. We present the development and quantitative testing of a reusable silicone respirator that can be locally manufactured using low-cost desktop infrastructure. Using standardized quantitative fit-testing (QNFT including resting and activity components according to CSA Z94.4-18) in a cohort of 41 healthcare workers (HCWs), we compared the performance of the mask to the individually-fitted disposable N95 masks that the HCWs had been assigned by our institution. Overall QNFT pass rates for disposable N95 respirators were 58.5% vs. 100% for the reusable mask. For a production run of 1000 masks, unit cost is approximately $25 CAD in materials and 35 minutes in labor per mask. The device requires further testing to assess flow resistance, carbon dioxide rebreathing, and full conformance with technical standards required for regulatory approval.
Introduction The COVID-19 pandemic has led to widespread shortages of N95 respirators and other personal protective equipment (PPE). An effective, reusable, locally-manufactured respirator can mitigate this problem. We describe the development, manufacture, and preliminary testing of an open-hardware-licensed device, the “simple silicone mask” (SSM). Methods A multidisciplinary team developed a reusable silicone half facepiece respirator over 9 prototype iterations. The manufacturing process consisted of 3D printing and silicone casting. Prototypes were assessed for comfort and breathability. Filtration was assessed by user seal checks and quantitative fit-testing according to CSA Z94.4–18. Results The respirator originally included a cartridge for holding filter material; this was modified to connect to standard heat-moisture exchange (HME) filters (N95 or greater) after the cartridge showed poor filtration performance due to flow acceleration around the filter edges, which was exacerbated by high filter resistance. All 8 HME-based iterations provided an adequate seal by user seal checks and achieved a pass rate of 87.5% (N = 8) on quantitative testing, with all failures occurring in the first iteration. The overall median fit-factor was 1662 (100 = pass). Estimated unit cost for a production run of 1000 using distributed manufacturing techniques is CAD $15 in materials and 20 minutes of labor. Conclusion Small-scale manufacturing of an effective, reusable N95 respirator during a pandemic is feasible and cost-effective. Required quantities of reusables are more predictable and less vulnerable to supply chain disruption than disposables. With further evaluation, such devices may be an alternative to disposable respirators during public health emergencies. The respirator described above is an investigational device and requires further evaluation and regulatory requirements before clinical deployment. The authors and affiliates do not endorse the use of this device at present.
Surgical complications were classified as arterial, venous, ureteral, lymphatic, suture dehiscence, and/or need for early graft removal (defined as removal in the first 3 months after transplantation). The cause of early graft removal was noted and categorized as either a surgical or non-surgical complication.RESULTS: A total of 100 kidneys were implanted from DCD/ ECMO, 108 from DBD/SCD and 115 from DBD/ECD.Despite a higher rate of DGF in DCD/ECMO groups vs DBD/SCD and DBD/EDC (65,9% vs 28,1% vs 30,8%; p<0,001), there were no differences in renal function between groups 12 months after transplantation. There were no statistically significant differences in surgical complications. Early graft removal was lower in DBD-SCD group. DCD/ECMO group had a significantly more early graft removals of non-surgical cause due to tubular necrosis, humoral rejection or infection, while DBD/ECD had a significantly more early graft removals of surgical cause due to arterial/ venous thrombosis and hemorrhage.CONCLUSIONS: Kidney transplantation from DCD/ECMO can be a viable option. Despite higher rates of DGF in DCD/ECMO, those whose grafts survive have a similar renal function in the medium-to-long term. Early graft removal was mainly associated with a non-surgical cause, probably related to ischemia lesion caused by prolonged warm ischemia time and/or ischemia-reperfusion injury induced by the ECMO.
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