Retrospective study: The diagnostic accuracy of conventional forceps biopsy of gastric epithelial compared to endoscopic submucosal dissection (STROBE compliant).

Human tissue is structured mainly of self-assembled polymers (proteins) and ceramics (bone minerals), with metals present as trace elements with molecular scale functions. However, metals and their alloys have played a predominant role as structural biomaterials in reconstructive surgery, especially orthopedics, with more recent uses in non-osseous tissues, such as blood vessels. With the successful routine use of a large variety of metal implants clinically, issues associated with long-term maintenance of implant integrity have also emerged. This review focuses on metallic implant biomaterials, identifying and discussing critical issues in their clinical applications, including the systemic toxicity of released metal ions due to corrosion, fatigue failure of structural components due to repeated loading, and wearing of joint replacements due to movement. This is followed by detailed reviews on specific metallic biomaterials made from stainless steels, alloys of cobalt, titanium and magnesium, as well as shape memory alloys of nickel–titanium, silver, tantalum and zirconium. For each, the properties that affect biocompatibility and mechanical integrity (especially corrosion fatigue) are discussed in detail. Finally, the most critical challenges for metallic implant biomaterials are summarized, with emphasis on the most promising approaches and strategies.

Metallic implant biomaterials

https://research-information.bris.ac.uk/files/185259318/1_s2.0_S0140673618325315_main.pdf

How long does a knee replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up.

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(12)60353-5.pdf

Failure rates of stemmed metal-on-metal hip replacements: analysis of data from the National Joint Registry of England and Wales

Background: Periprosthetic joint infection continues to potentially complicate an otherwise successful joint replacement. The treatment of this infection often requires multiple surgical procedures associated with increased complications and morbidity. This study examined the relationship between periprosthetic joint infection and mortality and aimed to determine the effect of periprosthetic joint infection on mortality and any predictors of mortality in patients with periprosthetic joint infection. Methods: Four hundred and thirty-six patients with at least one surgical intervention secondary to confirmed periprosthetic joint infection were compared with 2342 patients undergoing revision arthroplasty for aseptic failure. The incidence of mortality at thirty days, ninety days, one year, two years, and five years after surgery was assessed. Multivariate analysis was used to assess periprosthetic joint infection as an independent predictor of mortality. In the periprosthetic joint infection population, variables investigated as potential risk factors for mortality were evaluated. Results: Mortality was significantly greater (p < 0.001) in patients with periprosthetic joint infection compared with those undergoing aseptic revision arthroplasty at ninety days (3.7% versus 0.8%), one year (10.6% versus 2.0%), two years (13.6% versus 3.9%), and five years (25.9% versus 12.9%). After controlling for age, sex, ethnicity, number of procedures, involvedjoint,bodymassindex,andCharlsonComorbidityIndex,revisionarthroplastyforperiprostheticjointinfectionwas associated with a fivefold increase in mortality compared with revision arthroplasty for aseptic failures. In the periprosthetic joint infection population, independent predictors of mortality included increasing age, higher Charlson Comorbidity Index, history of stroke, polymicrobial infections, and cardiac disease. Conclusions: Although it is well known that periprosthetic joint infection is a devastating complication that severely limits joint function and is consistently difficult to eradicate, surgeons must also be cognizant of the systemic impact of periprosthetic joint infection and its major influence on fatal outcome in patients. Level of Evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

/pdf/periprosthetic-joint-infection-increases-the-risk-of-one-46bjb6e584.pdf

Periprosthetic Joint Infection Increases the Risk of One-Year Mortality

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140673607604577.pdf

The operation of the century: total hip replacement

The principle of management of any fracture is to reduce the fracture, immobilize until bony union is achieved and then rehabilitate the patient. There are various methods of fracture immobilization varying from simple custom-made splints or plaster application for non-operative methods to various different operative techniques.

Principles of plaster application

An unusual situation in which a below knee cast was removed after 28 months is reported. To the best of our knowledge no similar cases have been reported in the literature. The cast was removed from the leg of a 45-year-old Caucasian woman. Significant muscle atrophy and dense skin scales were present but the underlying skin surface was relatively healthy with only small pitted 1-2 mm ulcers. No pathogenic organisms were cultured from this environment. It seems likely that skin can tolerate cast immobilization for prolonged duration.

/pdf/removal-of-a-below-knee-plaster-cast-worn-for-28-months-a-udda0qyidc.pdf

Claire F Young

Papers

The operation of the century: total hip replacement

Principles of plaster application

Removal of a below knee plaster cast worn for 28 months: a case report