Objective: The aim of this cross-sectional cohort study was to evaluate a comprehensive dental examination and referral concept for patients prior to endoprosthesis (EP) implantation in an interdisciplinary setting. Methods: Patients, who were prepared for EP surgery in the clinic for orthopaedics, were referred to the dental clinic for a dental examination. Thereby, dental and periodontal treatment need, radiographic and temporomandibular joint findings were assessed. Based on oral and radiographic investigation, a risk classification for potential source of prosthetic infection was performed. If potential oral foci of EP infection were present (e.g., apically radiolucent teeth, severe periodontitis or additional inflammatory findings), patients were classified as at high risk for EP infection with oral origin. Those individuals were allocated to their family dentist or special clinic for dental treatment prior to EP surgery. Results: A total of 311 patients were included (mean age: 67.84 ± 10.96 years, 51% male). A dental treatment need of 33% was found, while the periodontal treatment need was 83%. Thirty-one percent of patients showed at least one apical radiolucency (a sign of chronic infection/inflammation). Furthermore, additional findings such as radiographic signs of sinusitis maxillaris were found in 24% of patients. Temporomandibular disease was probable in 17% of individuals. One-third (34%) were assigned to the high risk group for an EP infection with oral origin. Conclusion: German patients before EP have a high periodontal treatment need and show frequently (34%) a potential oral focus of infection, underlining the necessity of including dental examination and risk stratification as part of the pre-operative assessment prior to EP implantation. Therefore, an approach as applied in this study appears reasonable for those individuals.
Up till now, only a weak connection could be shown between patient-related outcome measures (PROMs) and measurements obtained by gait analysis (e.g. speed, step length, cadence, ground reaction force, joint moments and ranges of motion) after total knee arthroplasty (TKA). This may result from the methodical problem that regression analyses are performed using data that are not normalized against a healthy population. It does appear reasonable to assume that patients presenting a physiological gait pattern are content with their joint. The more the gait parameters differ from a normal gait pattern the worse the clinical outcome measured by PROMs should be expected to be. In this retrospective study, 40 patients were enrolled who had received a gait analysis after TKA, and whose PROMs had been evaluated. A gender- and age-matched control group was formed out of a group of test persons who had already undergone gait analysis. Gait analysis was undertaken using the motion analysis system 3D Vicon with ten infrared cameras and three strength measuring force plates. The physiological gait analysis parameters were deduced from arithmetic mean values taken from all control patients. The deviances of the operated patients' gait analysis parameters from the arithmetic mean values were squared. From these values, the Pearson correlation coefficients for different PROMs were then calculated, and regression analyses were performed to elucidate the correlation between the different PROMs and gait parameters. In the regression analysis, the normalized cadence, relative gait speed of the non-operated side, and range of the relative knee moment of the operated side could be identified as factors which influence the Forgotten Joint Score (FJS-12). The explanation model showed an increase of the FJS-12 with minimisation of these normalized values corresponding to an approximation of the gait pattern seen in the healthy control group. The connection was strong, having a correlation coefficient of 0.708. A physiological gait pattern after TKA results in better PROMs, especially the FJS-12, than a non-physiological gait pattern does.
Introduction Revision arthroplasty involving mega-implants is associated with a high complication rate. In particular, infection is a serious complication of revision arthroplasty of hip and knee joints and has been reported to have an average rate of 18%, and for mega-implants, the range is from 3 to 36%. This study was designed to analyze the strategy of treatment of infection of mega-endoprostheses of the lower extremities in our patient cohort, particularly the management of chronic infection. Material and Methods This was a retrospective study that focused on the results of the treatment of periprosthetic infections of mega-implants of the lower extremities. We identified 26 cases with periprosthetic infections out of 212 patients with 220 modular mega-endoprostheses of the lower extremities who were treated in our department between September 2013 and September 2019. As a reinfection or recurrence, we defined clinical and microbiological recurrences of local periprosthetic joint infections after an antibiotic-free period. Results In this study, 200 cases out of 220 were investigated. The average follow-up period was approximately 18 months (6 months to 6 years). Endoprosthesis infections after implantation of mega-implants occurred in 26 cases (13%). This group comprised 2 early infections (within the first 4 weeks) and 24 chronic infections (between 10 weeks and 6 years after implantation). Nineteen cases out of the identified 26 cases with infection (73.1%) belong to the group of patients who were operated on due to major bone loss following explantation of endoprosthetic components due to previous periprosthetic joint infection. The remaining seven cases with infection comprised four cases following management of periprosthetic fracture, two cases following treatment of aseptic loosening, and one case following tumor resection. All infections were treated surgically. In all cases, the duration of continuous antibiotic treatment did not exceed 6 weeks. Both cases with early infection were treated by exchanging polyethylene inlays and performing debridement with lavage (two cases). In two (7.7%) cases with chronic infection, one-stage surgery was performed. In all remaining cases with chronic infection (22 cases; 84.6%), explantation of all components and temporary implantation of cement spacers were carried out prior to reimplantation. Conclusion There is still no gold standard therapeutic regimen for the management of periprosthetic infection of mega-implants, though radical surgical debridement and lavage accompanied by systemic antibiotic therapy are the most important therapeutic tools in all cases of periprosthetic infections, regardless of the time of onset. Further studies are needed to standardize management strategies of such infections. Nevertheless, it is not uncommon for compromises to be made based on the particular condition of the individual.
Clonal hematopoiesis (CH) is characterized by somatic mutations in blood cells of individuals without hematologic disease. While the mutational landscape of CH in peripheral blood (PB) has been well characterized, detailed analyses addressing its spatial and cellular distribution in the bone marrow (BM) compartment are sparse. We studied CH driver mutations in healthy individuals (n = 261) across different anatomical and cellular compartments. Variant allele frequencies were higher in BM than PB and positively correlated with the number of driver variants, yet remained stable during a median of 12 months of follow-up. In CH carriers undergoing simultaneous bilateral hip replacement, we detected ASXL1-mutant clones in one anatomical location but not the contralateral side, indicating intra-patient spatial heterogeneity. Analyses of lineage involvement in ASXL1-mutated CH showed enriched clonality in BM stem and myeloid progenitor cells, while lymphocytes were particularly involved in individuals carrying the c.1934dupG variant, indicating different ASXL1 mutations may have distinct lineage distribution patterns. Patients with overt myeloid malignancies showed higher mutation numbers and allele frequencies and a shifting mutation landscape, notably characterized by increasing prevalence of DNMT3A codon R882 variants. Collectively, our data provide novel insights into the genetics, evolution, and spatial and lineage-specific BM involvement of CH.
Objectives Aim of this cross-sectional study was the assessment of oral health-related quality of life (OHRQoL) health-related quality of life (HRQoL), oral health behaviour and oral health status in patients before hip and knee endoprosthesis (EP) surgery. Moreover, associations between OHRQoL, HRQoL and oral health should be examined. Methods Consecutive patients before hip and/or knee EP implantation were recruited and referred to the dental clinic for oral examination including: number of remaining teeth, dental findings (DMF-T-Index), periodontal condition (periodontal treatment need, Staging/Grading) and temporomandibular joint screening. OHRQoL was assessed by the German short form of oral health impact profile (OHIP G14), HRQoL by short-form 36 survey. Results Hundred and sixty two patients with a mean age of 66.80 ± 11.10 years were included, which had on average 18.22 ± 8.57 remaining teeth and a periodontal treatment need of 84.5%. The OHIP G14 sum score revealed a median of 1 (mean: 2.7 ± 4.4, 25–75th percentile: 0–4) and its dimension oral function of 0 (mean: 0.8 ± 1.8, 25–75th percentile: 0–1), what was also found for psychosocial impact (median: 0, mean: 1.4 ± 2.6, 25–75th percentile: 0–2). The OHIP G14 sum score and both dimensions were significantly associated with mental component summary (p < 0.01). A higher number of remaining teeth as well as remaining molars/premolars were associated with lower OHIP G14 sum score (p = 0.02). This was also found for the dimension oral function (p < 0.01). Conclusion Patients prior to hip and knee EP had an unaffected OHRQoL, although they had an insufficient oral health. Individuals before EP implantation need increased attention in dental care, fostering information, sensibilization and motivation of the patients.
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