The Rationale for CAD-CAM Uncemented Custom Hips: An Interim Assessment

1995 ◽  
Vol 5 (2) ◽  
pp. 52-62 ◽  
Author(s):  
J. Hua ◽  
P.S. Walker ◽  
W. Muirhead-Allwood ◽  
G. Bentley ◽  
C.J. McCullough
Keyword(s):  
Stem Length ◽  
Long Term Results ◽  
Ha Coating ◽  
Standard Design ◽  
Cad Cam ◽  
Early Primary ◽  
Torsional Stability ◽  
Lateral Flare ◽  
Close Fit

The purpose of this paper is to examine whether the rationale for CAD-CAM Custom Hips is realised in clinical practice. Previous studies demonstrated that custom uncemented stems, with a close fit proximally and a sliding fit distally, produced stresses closer to normal than for other stem types, which should result in the preservation of proximal bone. Custom stems showed less micromotion, especially in torsional loading, and hence should demonstrate interface osseointegration. The hips are designed and manufactured using specially written software. The standard design includes proximal macro-grooves with HA coating, an anterior flare, a lateral flare, a collar, and a smooth distal stem for a sliding fit. Elective features are added such as proximal stem twist and neck retroversion in CDH, increased stem length to bypass defects, curvatures in AP and ML views, and distal cutting flutes when extra torsional stability is required. From 1989 to 1994, 411 cases were carried out, approximately one-third in each of the categories of OA, JCA/CDH, and revision. Studies were made of the available radiographs at yearly intervals, while DEXA scans were taken of the RNOHT patients pre-operatively, at 6 months and then yearly. There were four failures requiring revision, three of the early primary design without HA coating, and one a revision design. The radiographs in primary hips showed complete proximal bone-implant apposition in 81% of all cases. The DEXA scans showed that the mean bone mass after two years for all seven Gruen zones was greater than 90%. It was concluded that the CAD-CAM HA-coated Custom Hips showed bone and interface stability up to this time. The hip has played a useful role in providing the ideal stem for each particular case, which may result in an improvement of long-term results, compared with the use of off-the-shelf implants.

scholarly journals Long-term results following titanium cranioplasty of large skull defects

2009 ◽  
Vol 26 (6) ◽  
pp. E10 ◽  
Author(s):  
Mario Cabraja ◽  
Martin Klein ◽  
Thomas-Nikolas Lehmann
Keyword(s):  
Decompressive Craniectomy ◽  
Titanium Implants ◽  
Long Term Results ◽  
Computer Assisted ◽  
Skull Defects ◽  
Visual Analog Scales ◽  
Alloplastic Materials ◽  
Cad Cam

Object Decompressive craniectomy is an established procedure to lower intracranial pressure. Therefore, cranioplasty remains a necessity in neurosurgery as well. If the patient's own bone flap is not available, the surgeon can choose between various alloplast grafts. A review of the literature proves that 4–13.8% of polymethylmethacrylate plates and 2.6–10% of hydroxyapatite-based implants require replacement. In this retrospective study of large skull defects, the authors compared computer-assisted design/computer-assisted modeled (CAD/CAM) titanium implants for cranioplasty with other frequently used materials described in literature. Methods Twenty-six patients underwent cranioplasty with CAD/CAM titanium implants (mean diameter 112 mm). With the aid of visual analog scales, the patients' pain and cosmesis were evaluated 6–12 years (mean 8.1 years) after insertion of the implants. Results None of the implants had to be removed. Of all patients, 68% declared their outcomes as excellent, 24% as good, 0.8% as fair, and 0% as poor. There was no resulting pain in 84% of the patients, and 88% were satisfied with the cosmetic result, noting > 75 mm on the visual analog scale of cosmesis. All patients would have chosen cranioplasty again, stating an improvement in their quality of life by the calvarial reconstruction. Nevertheless, follow-up images obtained in 4 patients undergoing removal of meningiomas was only suboptimal. Conclusions With the aid of CAD technology, all currently used alloplastic materials are suited even for large skull defect cranioplasty. Analysis of the authors' data and the literature shows that cranioplasty with CAD/CAM titanium implants provides the lowest rate of complications, reasonable costs, and acceptable postoperative imaging. Polymethylmethacrylate is suited for primary cranioplasty or for long-term follow-up imaging of tumors. Titanium implants seem to be the material of choice for secondary cranioplasty of large skull defects resulting from decompressive craniectomy after trauma or infarction. Expensive HA-based ceramics show no obvious advantage over titanium or PMMA.

scholarly journals Long-term results after early primary repair of tetralogy of Fallot

2001 ◽  
Vol 122 (1) ◽  
pp. 154-161 ◽  
Author(s):  
Emile A. Bacha ◽  
Albertus M. Scheule ◽  
David Zurakowski ◽  
Lars C. Erickson ◽  
Judy Hung ◽  
...  
Keyword(s):  
Tetralogy Of Fallot ◽  
Primary Repair ◽  
Long Term Results ◽  
Early Primary

Repairing the Cleft Lip Nasal Deformity

2000 ◽  
Vol 37 (3) ◽  
pp. 234-242 ◽  
Author(s):  
Jorge I. De La Torre ◽  
Pamela M. Gallagher ◽  
Barry K. Douglas ◽  
Mayer Tenenhaus
Keyword(s):  
Cleft Lip ◽  
Primary Repair ◽  
Surgical Revision ◽  
Long Term Results ◽  
Nasal Deformity ◽  
Nasal Defect ◽  
Early Primary ◽  
Cleft Lip Nose

Objective The repair of the cleft lip nose and nasal deformity remains a challenging endeavor for reconstructive surgeons. Psychosocially, this complex, multifaceted deformity significantly stigmatizes the patient. Numerous techniques have been advocated by multiple authors for the treatment and reconstruction of these deformities, usually requiring serial staged reconstructions. Method Described is our technique for early primary repair of the cleft lip nasal deformity. The use of multiple suspension sutures to repair the nasal defect facilitates the repair of even very wide cleft lips. Conclusions These maneuvers provide an aesthetic and functional repair of the nasal defect in conjunction with the lip repair. Long-term results have minimized the need for surgical revision.

427: Long Term Results of Laparoscopic Retroperitoneal Lymph Node Dissection in Clinical Stage I NSGCT

2005 ◽  
Vol 173 (4S) ◽  
pp. 116-117
Author(s):  
Hannes Steiner ◽  
Reinhard Peschel ◽  
Tilko Müller ◽  
Christian Gozzi ◽  
Georg C. Bartsch ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Node Dissection ◽  
Clinical Stage ◽  
Stage I ◽  
Long Term Results ◽  
Retroperitoneal Lymph Node Dissection ◽  
Node Dissection ◽  
Retroperitoneal Lymph Node

Surgical reconstruction for unilateral iliac artery lesions in patients younger than 50 years

VASA ◽  
2011 ◽  
Vol 40 (6) ◽  
pp. 474-481 ◽  
Author(s):  
Radak ◽  
Babic ◽  
Ilijevski ◽  
Jocic ◽  
Aleksic ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Limb Salvage ◽  
Iliac Artery ◽  
Graft Patency ◽  
Long Term Results ◽  
Surgical Reconstruction ◽  
Safe Procedure ◽  
Term Survival

Background: To evaluate safety, short and long-term graft patency, clinical success rates, and factors associated with patency, limb salvage and mortality after surgical reconstruction in patients younger than 50 years of age who had undergone unilateral iliac artery bypass surgery. Patients and methods: From January 2000 to January 2010, 65 consecutive reconstructive vascular operations were performed in 22 women and 43 men of age < 50 years with unilateral iliac atherosclerotic lesions and claudication or chronic limb ischemia. All patients were followed at 1, 3, 6, and 12 months after surgery and every 6 months thereafter. Results: There was in-hospital vascular graft thrombosis in four (6.1 %) patients. No in-hospital deaths occurred. Median follow-up was 49.6 ± 33 months. Primary patency rates at 1-, 3-, 5-, and 10-year were 92.2 %, 85.6 %, 73.6 %, and 56.5 %, respectively. Seven patients passed away during follow-up of which four patients due to coronary artery disease, two patients due to cerebrovascular disease and one patient due to malignancy. Limb salvage rate after 1-, 3-, 5-, and 10-year follow-up was 100 %, 100 %, 96.3 %, and 91.2 %, respectively. Cox regression analysis including age, sex, risk factors for vascular disease, indication for treatment, preoperative ABI, lesion length, graft diameter and type of pre-procedural lesion (stenosis/occlusion), showed that only age (beta - 0.281, expected beta 0.755, p = 0.007) and presence of diabetes mellitus during index surgery (beta - 1.292, expected beta 0.275, p = 0.026) were found to be significant predictors of diminishing graft patency during the follow-up. Presence of diabetes mellitus during index surgery (beta - 1.246, expected beta 0.291, p = 0.034) was the only variable predicting mortality. Conclusions: Surgical treatment for unilateral iliac lesions in patients with premature atherosclerosis is a safe procedure with a low operative risk and acceptable long-term results. Diabetes mellitus and age at index surgery are predictive for low graft patency. Presence of diabetes is associated with decreased long-term survival.

Three year results of endovascular therapy with a new generation nitinol stent for femoro-popliteal artery lesions - a single-center outcome analysis of a subcohort of MISAGO 2 study

VASA ◽  
2013 ◽  
Vol 42 (5) ◽  
pp. 340-349 ◽  
Author(s):  
Ivan Kralj ◽  
Irene Boos ◽  
Uwe Müller-Bühl
Keyword(s):  
Popliteal Artery ◽  
Clinical Success ◽  
Ankle Brachial Index ◽  
Long Term Results ◽  
Outcome Analysis ◽  
Stent Fracture ◽  
Nitinol Stent ◽  
New Generation ◽  
Stent Stenosis

Background: Advances in stent technology have widened the field of indications for stent treatment of femoro-popliteal artery lesions, however the use of stents in bending arterial segments is restricted because some first- and second-generation nitinol stent designs did not respond well to the mechanical forces of femoro-popliteal segments in motion which pose a substantial risk of stent fracture inducing in-stent-stenosis. New generation nitinol stents are supposed to overcome these limitations but long-term results are rare. Patients and methods: In forty-five patients (mean age 68 y, range 50 - 85) with peripheral arterial disease (TASC II A-C, Rutherford category 2 - 5) forty-six lesions of the superficial femoral artery (37) or popliteal artery (9) were treated [25 high-grade stenoses, mean length 53 mm (range 30 - 145 mm); 21 chronic total occlusions, mean length 74 mm (range 30 - 180 mm)]. 74 % of lesions were located in the mobile bending arterial segments in the distal femoral or the popliteal segment. Clinical reevaluation performed at discharge, at 6, 12, 24, and 36 months included at least the measurement of ankle-brachial index (ABI) and duplex sonography. Results: Procedural success rate was 100 %. At 6, 12, 24, and 36 months, cumulative primary patency rate was 93.5 %, 84.8 %, 80.5 %, and 74.3 % (SE<10); freedom from target lesion revascularization rate was 95.7 %, 89.2 %, 84.9 %, and 79.3 % (SE<10); Rutherford category and ABI improved in all patients and clinical success was maintained in more than 85 % of patients. Conclusions: Sustained technical and clinical success and good clinical long-term results were achieved with Misago™ nitinol stent implantation in femoro-popliteal lesions with moderate risk for in-stent-stenosis, and in the distal femoral and popliteal mobile segment.

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