bluuebunny/crossref_metadata_2025_split huggingface dataset:
Double-tapered conical taper in primary and revision surgery: rationale and short-term follow-up
Authors: Perticarini Loris , Mosconi Mario , Medetti Marta , Caliogna Laura , Benazzo Francesco M 
Published: December 2018

Background: The new double-conical tapered stem is a novel cementless modular system, which is indicated for both primary and revision surgeries. It has been designed with different angles at the proximal (5°) and distal sections (1° 36’) in order to obtain optimal fixation by proximal and distal fit and fill of the femoral canal. Aim: The aim of this prospective study was to evaluate the short-term clinical and radiographic outcomes of primary and revision hip surgery with the new double-conical stem. Methods: 61 stems were implanted (December 2013 to September 2016) in 42 cases of primary and in 19 cases of revision surgery. The mean age of patients was 64.7 (17–94; standard deviation [SD] 21.9) years. Results: The mean body mass index of the patients was 24.6 (17–34.6). In 3 cases of developmental dysplasia of the hip we performed femoral shortening osteotomy. The mean follow-up was 26 (8–40) months. 3 patients died due to causes unrelated to surgery. Postoperative complications included 3 hip dislocations, 2 infections and 1 case of stem explant for metastatic tumour. For all other cases, at the last follow-up radiographs showed no loosening, no radiolucent lines nor subsidence. The mean Harris Hip Score significantly improved from 45 (range 35–58) preoperatively to 87 (range 75–94). Leg length discrepancy was found in 10% of cases but never >1 cm. Conclusions: Radiographic analysis showed the bone-stem contact full at 2 levels of taper. The double-tapered prosthetic stem can therefore be usefully employed both in primary and in revision surgeries.
Metal ion trend in patients with metal-on-metal total hip arthroplasty: a 10-year prospective study
Authors: Sangaletti Rudy , Spreafico Andrea , Barbieri Flavio , Ferrari Roberto , Castelli Claudio Carlo 
Published: December 2018

Introduction: There have been reported adverse reactions in patients with large head metal-on-metal hip arthroplasty, therefore metal particle debris are a cause for concern. The aim of this study was to evaluate the release trend of metal ions and the correlated variables. Methods: 54 patients were prospectively enrolled into the study from 2004 to 2006. All patients had 36-mm metal head, Pinnacle acetabular component, Summit stem and Ultamet CoCr alloy liner (Depuy Inc.), and underwent clinical and radiological management. The haematic concentration of Cr-Co at 0, 6, 12, 24, 60 and 120 months after the implantation was analysed in a sub-cohort of 34 patients. Results: 10-year revision rate for each case was 8.9%. The average concentration of Co at 120 months was 3.12 μg/L (median 2.20) with 53% values >2 μg/L and 1 >7 μg/L. After 6 months the median levels of Cr and Co were higher than time 0 ( p < 0.0001); no significant differences were found between 6 and 24 months; while Co had significant increase between 60 and 120 months ( p = 0.002). Overweight, University of California at Los Angeles (UCLA) >9 and <50 years old patients have significantly higher circulating metal ions. Discussion: This is 1 of the few prospective studies on the argument. The revision rate is conforming to records. Our data shows ionic concentration is not predictive of revision or adverse reaction to metals. We described a 3-phase trend for Co probably due to the loss of integrity of the surfaces.
Surgical prevention of femoral neck fractures in elderly osteoporotic patients: a randomised controlled study on the prevention nail system device
Authors: Giannini Sandro , Chiarello Eugenio , Mazzotti Antonio , Tedesco Guiseppe , Faldini Cesare 
Published: December 2018

Introduction: Hip fractures represent an enormous challenge for our health care system. The aim of this randomised controlled trial was to assess both efficacy and safety of a novel device called Prevention Nail System (PNS) and developed for the surgical prevention of a contralateral femoral neck fracture (FNF) in elderly osteoporotic patients. Methods: Primary outcome was to evaluate, in patients suffering from osteoporotic FNF, the effectiveness of PNS in reducing the incidence of a contralateral hip fracture. Secondary outcome was to evaluate the safety of this device therefore intra- and postoperative complications were recorded. Results: 72 patients, with an age ⩾65 years old, were enrolled (38 study group (group A) and 34 control group (group B). 3 and 5 contralateral FNF were recorded respectively in group A and B. An interim analysis showed a non-effectiveness of the device therefore enrollment was suspended. Discussion: In all group A failures a difficult positioning of the PNS was recorded: surgical techniques errors may have affected the result. Nevertheless, it is improbable to hypothesise that, without substantial modifications to the PNS design, this could significantly reduce the incidence of FNF. Considering that current pharmacological approach can achieve, at best, a marginal reduction in FNF especially in patients at high risk, complementary approaches to provide immediate prevention of hip fractures may need to be developed. Clinical Trial Protocol: N° 263. 03 June 2008.
Double-trabecular metal cup technique for the management of Paprosky type III defects without pelvic discontinuity
Authors: Loppini Mattia , Schiavi Paolo , Rocca Antonello Della , Traverso Francesco , Rocca Federico Della , Mazziotta Giuseppe , Astore Franco , Grappiolo Guido 
Published: December 2018

Introduction: Modular reconstruction systems based on trabecular metal (TM) prosthetic components have been increasingly used in the last decade for the management of severe acetabular bone defects. The aim of this study was to assess the clinical and radiographic outcomes of double-cup technique for the management of Paprosky type III defects without pelvic discontinuity. Methods: A retrospective review was performed for all patients undergoing acetabular reconstruction with 2 TM cups at a tertiary referral centre between 2010 and 2015. Harris Hip Scores (HHS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were evaluated preoperatively and at the latest follow-up. Radiographic assessment of the hip centre of rotation (COR) position and leg length discrepancy (LLD) was performed preoperatively and postoperatively. Osteolysis and radiolucencies, loosening of the implants, and heterotopic ossifications were evaluated with the latest follow-up radiographs. Results: Patients included 5 men and 11 women (16 hips) with an average age of 68 (45–81) years. Acetabular bone defects included 9 Paprosky type IIIB and 7 type IIIA defects. No pelvic discontinuities were registered. The mean follow-up was 34 (24–72) months. HHS and WOMAC scores, LLD and COR position significantly improved after surgery. In only 1 (6.3%) hip a not progressive radiolucent line adjacent the acetabular construct was noted. Heterotopic ossifications were found in 2 (12.5%) hips. No patients underwent acetabular components revision surgery for any reason. Conclusion: The double-cup technique could be considered an effective management of selected Paprosky type III defects without pelvic discontinuity providing excellent clinical and radiographic outcomes in the short term.
Tension-free closure with capsular lengthening in mini posterior total hip replacement
Authors: Santori Nicola 
Published: December 2018

Purpose: Choice of the best mini invasive surgical approach for total hip replacement remains a controversial topic. The posterior approach is traditionally associated with a higher dislocation rate and the obligation of postoperative restrictions. Soft tissue repair reduces the risk of dislocation yet, posterior closure it is often challenging because of capsular and external rotator contractures. In this article, an original procedure of capsular lengthening and tension-free closure is described and the results of a retrospective single surgeon series of minimally invasive posterior total hip replacement (THR) with capsular repair are presented. Methods: A total of 925 mini posterior total hip replacements performed between 2009 and 2015 were retrospectively reviewed. 2 original types of capsulorrhaphy to decrease tension of the repaired tissues were employed. Absence of posterior envelope stretch during flexion and internal rotation was confirmed intraoperatively with a dynamic test. No postoperative restrictions were used. Results: Capsular lengthening with 1 of the described techniques was required in over 50% of cases for a tension-free closure. 3 patients dislocated in the 867 reviewed procedures (0.35%), 1 requiring revision for instability (0.11%). Conclusions: This soft tissue repair technique after mini posterior approach THR is technically easy, provides a tension-free closure and a low dislocation rate.
A minimum 20-year outcome of 100 consecutive alumina-on-alumina arthroplasties performed by a single surgeon
Authors: Solarino Giuseppe , Piazzolla Andrea , Moretti Lorenzo , Vicenti Giovanni , Moretti Biagio 
Published: December 2018

Background: Ceramic-on-ceramic (CoC) is currently a viable bearing combination in primary total hip arthroplasty (THA) and, due to its mechanical properties, it can be used in young patients requiring a long-lasting implant. The aim of this study is to report the results of a series of CoC THAs at a minimum 20 years follow-up. Methods: A retrospective study was conducted on the 1st 100 consecutive alumina-on-alumina arthroplasties performed by a single surgeon on 51 females and 40 males with an average age of 60.7 years. The mean preoperative Harris Hip Score was 35. The press-fit cup consisted of a pure titanium core with a titanium alloy mesh. Both the inlay and the head were made of dense polycrystalline surgical-grade alumina. The 32-mm femoral head was anchored on 3 different femoral components. Results: 19 patients with 22 THAs were died or lost, 2 anatomic cementless stems were revised due to sinking, 1 THA was revised for periprosthetic infection. 2 patients sustained a Vancouver B1 periprosthetic femoral fracture. None of the 78 THAs eligible for this study were revised for wear, breakage, noise of the ceramic components. None of the cups, none of the cemented stems, none of the cementless straight stems failed. HHS raised up to a mean value of 95. Conclusions: The present report demonstrates that CoC coupling offers minimal wear at a long-term follow-up. Further studies are needed to evaluate whether the modern ceramic composites will confirm such excellent results in total hip replacement.
MRI findings, metal ion levels and clinical outcome of a complete series of large metal on metal THA: what’s really going on?
Authors: Marchica Daniele , Gallazzi Enrico , Materazzi Giovanni , Battaglia Giulio A , Zagra Luigi 
Published: December 2018

Introduction: Metal-on-metal (MoM) large head total hip arthroplasties (THAs) were discontinued early after their introduction because of the high number of failures due to adverse reaction to metal debris (ARMD). Aim of this study is to report the clinical outcome at a mid-term follow-up (FU) of a series of large-head MoM THA. Methods: In this prospective study, 25 hips (24 patients, 3 males, 21 females, mean age 62.44 years) who have undergone primary THA with large head (diameter ⩾36 mm) MoM prosthesis were evaluated. Each patient underwent a standard follow-up after surgery, that included blood tests with metal ion levels (Co and Cr), x-ray of the pelvis, metal artifact reduction sequence magnetic resonance imaging (MARS-MRI) and clinical evaluation. Results: At an average follow-up of 7.3 years, 4 hips have been surgically reviewed: 2 for causes not related to ARMD (1 heterotopic ossification and 1 periprosthetic fracture); the other 2 on the same patient (bilateral) with ARMD, who was eventually found to be allergic to nickel. Increased metal ions, osteolysis and severe MRI alterations were found in patients with ARMD. Asymptomatic alterations at MRI were found in 8 patients. Harris Hip Score improved after surgery from a mean of 51 points to a mean of 90 points ( p < 0.01). Conclusions: The findings of this study show that not all the patients with MoM THA will develop clear symptoms of ARMD at mid-term follow-up. Patients should be closely monitored following protocols such as that proposed in the European Consensus Statement.
Survey of non-tunneled temporary hemodialysis catheter clinical practice and training
Authors: Yuan Christina M , Oliver James D , Little Dustin J , Narayan Rajeev , Prince Lisa K , Raghavan Rajeev , Nee Robert ,   (for the Nephrology Education Research and Development Consortium—NERDC)
Published: December 2018

Background: Nephrologists are placing fewer non-tunneled temporary hemodialysis catheters. Requiring competence for nephrology fellow graduation is controversial. Methods: Anonymous, online survey of all graduates from a single, military nephrology training program (n = 81; 1985–2017) and all US Nephrology program directors (n = 150). Results: Graduate response and completion rates were 59% and 100%, respectively; 93% agreed they had been adequately trained; 58% (26/45) place non-tunneled temporary hemodialysis catheters, independent of academic practice or time in practice, but 12/26 did ⩽5/year and 23/26 referred some or all. The most common reason for continuing non-tunneled temporary hemodialysis catheter placement was that it is an essential emergency procedure (92%). The single most significant barrier was time to do the procedure (49%). Program director response and completion rates were 50% and 79%, respectively. The single most important barrier to fellow competence was busyness of the service (36%), followed by disinterest (21%); 55% believed that non-tunneled temporary hemodialysis catheter insertion competence should be required, with 81% indicating it was an essential emergency procedure. The majority of graduates and program directors agreed that simulation training was valuable; 76% of programs employ simulation. Graduates who had simulation training and program directors with ⩽20 years of practice were significantly more likely to agree that simulation training was necessary. Conclusion: Of the graduate respondents from a single training program, 58% continue to place non-tunneled temporary hemodialysis catheters; 55% of program directors believe non-tunneled temporary hemodialysis catheter procedural competence should be required. Graduates who had non-tunneled temporary hemodialysis catheter simulation training and younger program directors consider simulation training necessary. These findings should be considered in the discussion of non-tunneled temporary hemodialysis catheter curriculum requirements.
The Jonas Hypertension Program: An Academic–Community Partnership to Address Hypertension in Four Dominican Bateyes
Authors: Conley Tammie , Enriquez Maithe , Cheng An-Lin , Jorge Dorcas , Meristal Sandy Yan , Coe Benjamin , Logan Pamela R. , Stiles Steven , Beall Ginny , Biggs Alfred , McKinsey David S. 
Published: December 2018

Introduction: Adults living in bateyes (i.e., sugarcane plantation villages) in the Dominican Republic have minimal access to health care services. Hypertension (HTN) is a serious and often unrecognized health problem among batey residents. The Jonas Batey Hypertension Program was built on existing social networks to address the detection and treatment of HTN. Methods: An ongoing community-based participatory research endeavor involves a partnership among three organizations and collaboration with promotoras who engage their batey communities in a mobile HTN screening and treatment program. Adults are screened and, if indicated, are treated with antihypertensive medications. Data collection includes project documentation, participant observation, demographic data, blood pressure (BP) measurements, and pill counts. Results: To date, 243 adults have received HTN treatment in four batey communities. A within-group, as-treated, repeated-measures, pre-/postanalysis showed that among participants who had been receiving antihypertensive treatment for 12 months ( n = 70), there was a significant decrease in BP ( p < .005). Conclusion: Results of an interim data analysis indicate that the program model has been implemented successfully and is making a positive impact on BP control. Evaluation is ongoing with regard to the long-term HTN-related health outcomes of batey residents. Ensuring program sustainability is an important consideration for the future.
Effects of Game Characteristics and Player Positions on Concussion Incidence and Severity in Professional Football
Authors: Dai Jennifer B. , Li Adam Y. , Haider Syed F. , Tomaselli Raechel , Gometz Alex , Sobotka Stanislaw , Post Alexander F. , Adams Ryan , Maniya Akbar Y. , Lau George K. , Kaye-Kauderer Halley P. , Lovell Mark R. , Choudhri Tanvir F. 
Published: December 2018

Background: Increasing efforts have been made to reduce the incidence and severity of concussion in high-contact sports. Despite these efforts, a relative lack of knowledge is available regarding modulating factors affecting concussion injury. Purpose: To analyze the potential influence of game characteristics and outcomes on concussion incidence and severity in professional football. Study Design: Descriptive epidemiology study. Methods: PBS Frontline Concussion Watch was used to collect concussion injury data from regular-season games of 32 National Football League (NFL) teams from 2012 to 2015. Game characteristic variables such as rushing and passing attempts, turnovers, and margin of victory were collected from ESPN. Analysis included descriptive statistics, analysis of variance, t tests, and correlation tests. Results: Away teams demonstrated a significantly greater concussion incidence per game than home teams. Losing teams had a significantly greater concussion incidence per game than winning teams. Being both the away team and the losing team appeared to have an additive effect. The home-versus-away and win-versus-loss effects were significant for offensive but not defensive positions. Within individual positions, significantly greater concussion incidence was associated with tight ends, running backs, wide receivers, and cornerbacks. When running versus passing positions were compared, passing positions (wide receiver, tight end, cornerback, safety) had significantly greater concussion incidence. A total of 626 games were missed as a result of reported concussions. Away teams had significantly more games missed due to concussion when they lost. Play time did not significantly differ before or after concussion injury. Other game characteristic variables did not significantly affect concussion frequency or intensity. Conclusion: Position, game location, and game outcome affect concussion incidence for professional football players. In a subset of analyses, the number of games missed aligned with concussion incidence, but this appeared to be an imperfect measure. These findings highlight new factors that may modulate concussion incidence and merit further study on how they may influence concussion evaluation.
Reconstruction of the Middle Patelofemoral Ligament with Quadricipital Autoinjerto and Use of the 3D Preoperative TAC to establish Femoral Anatomic Point
Authors: Córdoba Camilo Hernández 
Published: December 2018

Objectives: In recent years, the reconstruction of the LPFM has gained importance. The most used technique is with autograft of hamstring tendons. In some series, reports of complications are greater than 26%. This work aims to demonstrate the utility of the quadriceps autograft for the reconstruction of the LPFM, without patellar tunnels and without the use of intraoperative fluoroscopy. Methods: Patients with a clinical history of at least two episodes of dislocation were included. Radiographic series, axial CT, patellae, 3D CT and MRI were taken in all patients. 24 patients, 16 women and 8 men, with an average age of 23 years, met the selection criteria. Results: In our study we observed the improvement of scores on the scales of Lysholm, Tegner and Kujala in the postoperative period with controls at 6, 12 and 18 months. No new episodes of patellar dislocation or other relevant complications. There was a return in all cases to sports activity. Conclusion: This study reaffirms that the quadriceps tendon is a graft that reproduces better the anatomy of the LPFM, presents figures comparable or better functionally with the other grafts used at present. With the preoperative protocol of TAC3D, the adductor and medial epicondyle tubules have been identified individually and with the anatomical specificity of each patient, giving greater certainty in the anatomical location of the LPFM femoral insert. With the additional advantages of decreasing surgical time, and avoiding unnecessary radiation in the surgical team.
Patellar dislocation: osteochondral graft of patella and medial patellofemoral ligament reconstruction
Authors: Nardin Lisandro , Savá Matías , Calvet Oscar , Mercier Fernando , Barck Abel , Aparicio José Luis 
Published: December 2018

Objectives: The incidence of acute femoro-patellar luxation is 6/100000 persons for year. This injury is common among young patients with predominance in women. It has high levels of recurrence (40%) after the first injury. The objective of our study is to assess post-surgical results in patients with relapsing patellar dislocation, after a reconstruction of Medial Patellofemoral Ligament (MPFL) with semitendinous autologous graft associated with autologous osteochondral transplant of patella. Methods: An observational descriptive study (cases serie) with a restrospective transversal cross section was carried out. Six male patients that were treated between March 2014 and March 2016 were evaluated. They were monitored / followed up in an average of 24 months. The functional subjective results were assessed following Kujala patellofemoral pain score. Results: Out of the six patients, all of them were male, with an average age of 19. They were followed-up for an average of 24 months. The results of the Kujala score were 86 points in the posoperative period. Conclusion: The reconstruction of Medial Patellofemoral Ligament (MPFL) with semitendinous autologous graft associated with autologous osteochondral transplant of patella has show excellent short and long-term clinical results with return of patients to their usual normal activities.