Revision knee surgery: the practical approach

Revision total knee arthroplasty (rTKA) is a challenging procedure with often unreproducible results. A step-by-step approach is fundamental to achieving good outcomes. Successful surgery requires a correct diagnosis of the original cause of failure. Only with an accurate and detailed plan can surgeons overcome difficulties presented in this scenario. Any bone loss should be prevented during prosthetic component removal. Efficient tools must be chosen to avoid time-consuming manoeuvres. Joint reconstruction based on a ‘dual-zone’ fixation is essential to provide a long-term survivorship of the implant. The use of relatively short fully cemented stems combined with a biological metaphyseal fixation is highly recommended by authors. Flexion and extension gaps are accurately balanced after the establishment of the tibial platform. Varus-valgus laxity is commonly managed with a condylar constrained prosthesis. If hinged implants are required, a stronger implant fixation is needed to counteract constraints forces. Cite this article: EFORT Open Rev 2021;6:495-500. DOI: 10.1302/2058-5241.6.210018

Reabilitação dentária em região anterior com implante imediato e reconstrução alveolar por meio de enxertos conjuntivo autógeno e ósseo xenógeno

The immediate implant, in addition to provide reduction of clinical treatment time, aims to promote preservation of marginal bone ridges and maintain the emergency profile of the dental crown. The present study shows a clinical procedure involving minimally traumatic extration, followed by the immediate installation of a morse taper implant (Alvim 3,5 x 13 mm, Neodent®) in addition to the use of subepithelial connective tissue graft (SCTG). In order to remedy a loss of remnant alveolar bone tissue, bovine biomaterial (Geistlich Bio-Oss®) was used in alveolar reconstruction also with the intention of covering implant’s spires and promoving stability for the recently grafted soft tissue. After the surgical installation of the implant was completed, an initial 30N locking was obtained, what made impossible the immediate installation of a provisional over the implant. Then fixed temporary restoration was carried out, using a pontic with cervical ovoid format to maintain height, emergency profile, and interdental papilla contour. After 4 months of postoperative, was carried out surgery of implant reopening, with a new graft of connective tissue using the technique called pediculated, aiming the gain of vestibular tissue volume. Universal abutment type prosthetic component morse taper was used (measuring 3,3 x 4 x 6,5 mm Neodent®) and was carried out the confection and cementation of implant supported provisional. After a few weeks, the definitive crown was installed. With those procedures, for proper planning, and highly regarded techniques, a highly satisfactory functional and aesthetic result could be obtained.

THE USE OF PHYSICAL ACTIVITY OUTCOMES IN REHABILITATION INTERVENTIONS FOR LOWER LIMB AMPUTEES: A SYSTEMATIC REVIEW

BACKGROUND: Interventions which have focused on improving the physical activity of individuals with lower limb amputation can be mostly categorized into behavioural-based and prosthetic-based interventions. The aim of this review was to assess the quality of these interventions, and to identify the key gaps in research in this field. METHODOLOGY: The databases of Scopus, Pubmed, Embase, Medline and Web of Science were searched between September and December of 2019 for articles relating to physical activity, amputees and interventions. Articles were assessed quantitively based on internal validity, external validity and intervention intensity. FINDINGS: Sixteen articles (5 behavioural, 11 prosthetic) were assessed. Both approaches had comparable methodological quality and mixed efficacy for producing a significant change in physical activity outcomes. Almost all interventions used a simplistic measurement of activity as their outcome. CONCLUSIONS: There is an insufficient amount of studies to assess the overall efficacy of behavioural interventions in regard to how they impact on physical activity behaviour. However, the increase of quality of the methodology in the more recent studies could indicate that future interventions will retain similar levels of quality. Prosthetic interventions have shown no major improvement in efficacy compared to similar reviews and may need to utilise more advanced prosthetic components to attain significant changes in physical activity. Activity outcomes should expand into more complex activity measurements to properly understand the physical activity profile of people with lower limb amputation. Layman’s Abstract: The purpose of this review was to identify original research which tried to improve the physical activity behaviours of individuals with lower extremity amputation. Through multiple databases, the review article identified a mixture of 5 behavioural and 11 prosthetic-based interventions which aligned with the search criteria of the review. The behavioural-based interventions used behavioural change techniques controlled by healthcare professionals to try and promote a change in physical activity behaviours. The prosthetic-based interventions employed a prosthetic component, with the intention being that if the prosthetic component had superior design, the individual would feel more encouraged to be physically active. This review article concludes that, prosthetic interventions do not appear to have a consistent significant impact on the physical activity behaviours, and though behavioural interventions also had mixed efficacy, there were not enough interventions of their design to make a conclusive statement. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/33931/26330 How To Cite: Jamieson A.G., Murray L., Buis A. The use of physical activity outcomes in rehabilitation interventions for lower limb amputees: A systematic review. Canadian Prosthetics & Orthotics Journal. 2020;Volume3, Issue1, No.2. https://doi.org/ 10.33137/cpoj.v3i1.33931 Corresponding Author: Dr. Arjan Buis,Department of Biomedical Engineering, University of Strathclyde, Wolfson Centre, 106 Rottenrow, Glasgow, G4 0NW, Scotland, UK.E-Mail: [email protected]: https://orcid.org/0000-0003-3947-293X

Relevance of Topographic Parameters on the Adhesion and Proliferation of Human Gingival Fibroblasts and Oral Bacterial Strains

Dental implantology allows replacement of failing teeth providing the patient with a general improvement of health. Unfortunately not all reconstructions succeed, as a consequence of the development of infections of bacterial origin on the implant surface. Surface topography is known to modulate a differential response to bacterial and mammalian cells but topographical measurements are often limited to vertical parameters. In this work we have extended the topographical measurements also to lateral and hybrid parameters of the five most representative implant and prosthetic component surfaces and correlated the results with bacterial and mammalian cell adhesion and proliferation outcomes. Primary human oral gingival fibroblast (gum cells) and the bacterial strains: Streptococcus mutans, Streptococcus sanguinis and Aggregatibacter actinomycetemcomitans, implicated in infectious processes in the oral/implant environment were employed in the presence or absence of human saliva. The results confirm that even though not all the measured surface is available for bacteria to adhere, the overall race for the surface between cells and bacteria is more favourable to the smoother surfaces (nitrided, as machined or lightly acid etched) than to the rougher ones (strong acid etched or sandblasted/acid etched).

Análisis biomecánico del pie protésico Bioc-dm2

Walking is one of the aspects directly compromising human wellbeing, as it has a physical and emotional impact in daily life.For this study, we delve into the challenge of improving some walking conditions in a patient suffering lower limb loss, specifically at transtibialor transfemoral levels. Given that our purpose was the analysis, design and manufacture of a lower-limb prosthetic component, which fills the needsfor functionality, it became necessary to build a foot with all the quality standards associated to each and all movements required to form thecomplex fundamental pattern of walking. Besides, this foot should also easily endure weight, daily use and physical characteristics of the patientobject of this study. When performing physical validation and during human walk, a proper response is observed in terms of mechanics, materialsand dynamics of the component, thus making evident proper construction and assembly. On the other hand, it is feasible that design and verificationof the component provided a competitive element, as compared to existing elements currently in the market. The previous situation generated theneed for verification from the National Institute for Medications and Food (INVIMA), as well as the revision of the use replying device, forcomponent verification, in accordance with ISO 10328.

Experimental Investigation on ECMM With Nimonic 75 Alloy for Prosthetic Component

Electrochemical micromachining is an advanced technology of recent trends of machining of hard and electrically conductive materials in micrometer and sub-micrometer scale. This manufacturing technique finds application in many technologically demanding industries: locomotive, biomedical, electronics, etc. However, due to very small inter-electrode gap, there is some limitation in using this machining process. This chapter aims at developing an optimized model for flow analysis of electrolyte in inter-electrode gap to obtain optimal process parameter for machining. Experimentation has been done to associate the findings of optimized output in ECMM such as material removal rate (MRR), overcut, and depth. Influence of voltage, feed rate, concentration, pulse on/pulse off ratio, and IEG investigated and finally optimized using response surface method. The effect of the process parameters are also analyzed using ANOVA.

First results concerning the safety, walking, and satisfaction with an innovative, microprocessor-controlled four-axes prosthetic foot

Background: The microprocessor-controlled foot Meridium is a prosthetic component with adjustable stance-phase characteristics. Objectives: To investigate subjects’ and prosthetists’ perception of safety, walking, and satisfaction during first routine fittings. Study design: Multicenter, prospective, observational cohort study. Methods: Data regarding demographics, fitting process, safety, daily life activities, and satisfaction were obtained through questionnaires. The follow-up period was 7 months. Results: In all, 89% of 70 users were satisfactorily fitted within the first two visits. Compared to previous feet, users reported improvements in walking on level ground (54% of subjects), uneven ground (82%), ascending (97%), and descending ramps (91%). More than 45% of the users perceived an improvement in safety and stability while standing and walking. No difference was observed in concentration, exertion, and pain. Overall user satisfaction with Meridium was 50% and the foot was preferred by 40% of users. Amputation level, age and mobility grade did not influence subjects’ preference. Prosthetists recommended Meridium for 59% of subjects. A correlation analysis revealed that transfemoral amputees fitted with Genium and/or having a long residual limb strongly preferred Meridium ( p < 0.05). Conclusion: Meridium was appreciated by amputees with a preference for natural walking and requirement to safely and comfortably negotiate uneven terrain and slopes. Clinical relevance Amputees preferring Meridium perceive benefits with safe, comfortable, and natural walking. While the perception of benefits regarding the negotiation of uneven terrain and slopes is very high, the correlation to product preference is moderate. Individual assessment and trial fitting might be essential to identify patients who benefit greatly.