Aseptic loosening and focal osteolysis are the most common reasons for knee arthroplasty failure. The best treatment remains unclear. We reviewed the literature on the treatment of revision knee arthroplasty using bony structural allografts (476 cases) and porous metal cones (223 cases) to determine if a difference in the revision failure rates was discernable. The failure rates were compared using a logistic regression model with adjustment for discrepancies in FU time and number of grafts used (femoral, tibial, or both). In this analysis, the porous implant shows a significantly decreased loosening rate in AORI 2 and 3 defects. The overall failure rate was also substantially lower in the porous metal group than the structural allograft group; little difference in the infection rates was noted.
We found that mid- to long-term survival of the ARR is acceptable. However, failure of the implant due to allograft collapse/resorption or deep infection, and also poor clinical outcome, remain major concerns in acetabular revision arthroplasty. This should be recognized when advising patients.
Total hip arthroplasty (THA) is the most successful procedure in orthopedic and trauma surgery. Patients' expectations of joint replacement surgery prior to and after the procedure are often discounted. This study investigated the expectations of patients before and 3 years after THA or total knee arthroplasty (TKA). A total of 130 patients (70 hips, 60 knees) received a modified FFbH-OA survey with 6 additional questions concerning patients' expectations before and 3 years after joint replacement surgery. The overall response rate was 78.8% (101 patients). Patients who underwent THA had a mean age of 63.7 years, and those who underwent TKA had a mean age of 67.4 years.Sixty-three percent of all respondents reported that their expectations had been fulfilled or exceeded 3 years postoperatively (THA, 65%; TKA, 61%). A high negative correlation in the THA group could be seen between patients' expectations and clinical scores: the lower the clinical score, the less the patient's expectations had been fulfilled. A statistically significant increase of change in personal relationships was found, as well as a statistically significant decrease in worries and less complications than had been expected before joint replacement.Thirty-seven percent of all respondents felt that their expectations regarding joint replacement had not been fulfilled. Looking at the results of this study, the 37% of patients whose expectations had not been fulfilled did not exhibit a lower postoperative functioning than those who were satisfied.
The model reproduced the cooling effect of perfused tissue during RFA. The ablation areas produced under perfusion conditions had smaller diameters despite longer exposure times and higher energy deposition.
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