Incidence and Preoperative Risk Factors for Major Complications After Capsulectomy: Analysis of 3,048 Patients

Background While there are many indications for periprosthetic breast capsulectomy, heightened public attention surrounding breast implant illness has resulted in increased rates of capsulectomy. Objectives This study aims to identify the incidence of major complications and risk factors associated with capsulectomy. Methods Using a prospectively enrolled cosmetic surgery insurance database, CosmetAssure (Birmingham, AL, USA), patients undergoing capsulectomy between January 2, 2017 and July 31, 2019 were identified. Outcomes measured included the occurrence of and risk factors for major complication(s) necessitating an emergency department visit, hospitalization, or reoperation within 45 postoperative days. Results Among 76,128 patients evaluated, 3048 (4.0%) underwent capsulectomy. There was a significant increase in number of capsulectomies following January 6, 2019 (2.7/day vs 5.2/day, p<0.05). Capsulectomy patients had more likely to have any complication and specifically hematoma than those undergoing breast implant removal or replacement without capsulectomy (2.8% vs 1.9% and 1.6% vs 0.9%, respectively, p<0.05). Eighty-four (2.8%) developed at least one complication. The most common complications included hematoma (1.6%) followed by infection (0.5%). ASA class III/IV was an independent risk factor for any complication and BMI ≥30 and office-based surgical suites were risk factors for infection. Conclusions There is a growing number of capsulectomies being performed. The most common major complication is hematoma. Patients undergoing capsulectomy confer a higher complication rate compared to those undergoing breast implant removal or replacement without capsulectomy. Patients should be counseled regarding the potential for major complications.

Clinical use of Anti-Müllerian Hormone to Monitor Resumption of Ovarian Activity following Removal of a 4.7 mg Deslorelin Implant in Queens.

Objective: The use of deslorelin implantsto control reproduction in cats is increasing but because of its prolonged duration, cat breeders oftenrequest implant removal before the end of the treatment. Assaying Anti Mullerian Hormone (AMH) concentrations might be useful to predict time of resumption of ovarian activity in deslorelin-treated queens following implant removal. In queens a minimum of 3 weeks during increasing photoperiod after implant removal has been described for resumption of ovarian activity but no information about AMH concentrations were observed for determining ovarian activity.Animals: Sixteen queens in whichdeslorelinimplants were surgically removed after3, 6 or 9 months (n= 6, 4 and 6 queens, respectively) were used in this study. Procedures: A general and reproductive health check with a GnRH stimulation test were performed before the treatment.After implant removal queens were checked every 1-2 weeks withreproductive ultrasonography, a vaginal smear and blood collection to assay AMHconcentrations. Results: AMH concentrations decreased significantly during treatment to < 2.5+0.6 ng/ml (p<0.05) and reached a nadir at 1.9+0.9 (p<0.05) one-week post-removal.Following implant removal AMH concentrations started to rise reaching a value of 4.3+1.2 ng/ml on the third week and were not different from pre-treatment levels on week 6 post-removal (5.8 ng/ml +0.9, p>0.05).AMH values did not differ depending on duration of deslorelin treatment but were lower in adult queens (p<0.05).Clinical relevance: AMH assay can be a useful tool to follow resumption of feline ovarian function following a deslorelin treatment.

Reversal of Osseointegration as a Novel Perspective for the Removal of Failed Dental Implants: A Review of Five Patented Methods

Osseointegration is the basis of successful dental implantology and the foundation of cementless arthroplasty and the osseointegrated percutaneous prosthetic system. Osseointegration has been considered irreversible thus far. However, controlled heating or cooling of dental implants could selectively damage the bone at the bone–implant interface, causing the reversal of osseointegration or “osseodisintegration”. This review compares five methods for implant removal, published as patent documents between 2010 and 2018, which have not yet been discussed in the scientific literature. We describe these methods and evaluate their potential for reversing osseointegration. The five methods have several technical and methodological similarities: all methods include a handpiece, a connecting device for coronal access, and a controlling device, as well as the application of mechanical and/or thermal energy. The proposed method of quantifying the temperature with a sensor as the sole means for regulating the process seems inadequate. A database used in one of the methods, however, allows a more precise correlation between a selected implant and the energy needed for its removal, thus avoiding unnecessary trauma to the patient. A flapless, microinvasive, and bone-conserving approach for removing failed dental implants, facilitating successful reimplantation, would benefit dental implantology. These methods could be adapted to cementless medical implants and osseointegrated percutaneous prosthetics. However, for some of the methods discussed herein, further research may be necessary.

Management of fresh odontoid fractures using posterior C1–2 fixation without fusion: a long-term clinical follow-up study

OBJECTIVE Posterior C1–2 fixation without fusion makes it possible to restore atlantoaxial motion after removing the implant, and it has been used as an alternative technique for odontoid fractures; however, the long-term efficacy of this technique remains uncertain. The purpose of the present study was to explore the long-term follow-up outcomes of patients with odontoid fractures who underwent posterior C1–2 fixation without fusion. METHODS A retrospective study was performed on 62 patients with type II/III fresh odontoid fractures who underwent posterior C1–2 fixation without fusion and were followed up for more than 5 years. The patients were divided into group A (23 patients with implant removal) and group B (39 patients without implant removal) based on whether they underwent a second surgery to remove the implant. The clinical outcomes were recorded and compared between the two groups. In group A, the range of motion (ROM) of C1–2 was calculated, and correlation analysis was performed to explore the factors that influence the ROM of C1–2. RESULTS A solid fracture fusion was found in all patients. At the final follow-up, no significant difference was found in visual analog scale score or American Spinal Injury Association Impairment Scale score between the two groups (p > 0.05), but patients in group A had a lower Neck Disability Index score and milder neck stiffness than did patients in group B (p < 0.05). In group A, 87.0% (20/23) of the patients had atlantoodontoid joint osteoarthritis at the final follow-up. In group A, the C1–2 ROM in rotation was 6.1° ± 4.5° at the final follow-up, whereas the C1–2 ROM in flexion-extension was 1.8° ± 1.2°. A negative correlation was found between the C1–2 ROM in rotation and the severity of tissue injury in the atlantoaxial region (r = –0.403, p = 0.024) and the degeneration of the atlantoodontoid joint (r = –0.586, p = 0.001). CONCLUSIONS Posterior C1–2 fixation without fusion can be used effectively for the management of fresh odontoid fractures. The removal of the implant can further improve the clinical efficacy, but satisfactory atlantoaxial motion cannot be maintained for a long time after implant removal. A surgeon should reconsider the contribution of posterior C1–2 fixation without fusion and secondary implant removal in preserving atlantoaxial mobility for patients with fresh odontoid fractures.

Effect of Prophylactic Antibiotics in Orthopaedic Surgery

Background: Orthopaedic surgeries require sensitive protocol for prevention of infection pre and post-surgery. Antibiotic-prophylaxis has been reported for reducing risk of infection in orthopaedic surgeries such as removal of implants. Aim: To assess the effect of prophylactic antibiotics in orthopaedic surgery. Study design: Retrospective study Place and duration of study: Dept. of Orthopaedics, Khyber Teaching Hospital, Peshawar from 1-1-2020 to 31-12- 2020. Methodology: One hundred and ten patients within 18-75 years were divided into two groups. Each group had 55 patients. Group 1 were given prophylactic antibiotics pre-operative as a single dose while group 2 were given only saline. All patients were admitted for removal of orthopaedic implants in foot, ankle or leg. Patients 30 days record was observed for any surgical-site infection. Results: The mean age of patient was 42.95±10.8 years. Group 1 and Group 2 had more males than females. There were 10.9% and 9.09% diabetic patients within group 1 and group 2. The 30 days assessment of post implant removal orthopaedic surgery showed a decrease of surgical-site infection in group 1. Surgical-site infection decreased by a rate of 5.4% among patients who were given cefazolin antibiotic. Conclusion: The effect of prophylactic antibiotic reduces chance of surgical-site infection in orthopaedic surgery. Keywords: Antibiotic-prophylaxis, Orthopaedic surgery, Implant-removal, Surgical-site infection

Hemiepiphysiodesis for the Correction of Distal Femoral Valgus in Growing Dogs

Objectives The aim of this study was to describe hemiepiphysiodesis for the treatment of distal femoral valgus in immature dogs and to evaluate its effect on the anatomical lateral distal femoral angle (aLDFA). Methods Skeletally immature dogs with distal femoral valgus deformities that had undergone hemiepiphysiodesis between November 2012 and March 2020 at two private veterinary practices were included. Criteria for inclusion in the study were a preoperative aLDFA below the previously published reference range (94 ± 3.3 degrees) and radiographs of the femur taken preoperatively and at growth plate closure. Results A total of 11 dogs fulfilled the inclusion criteria, and a total of 17 limbs were treated. The mean aLDFA was 82.1 ± 3.2 degrees (range: 76–87 degrees) preoperatively and 93.1 ± 5 degrees (range: 76–99 degrees) at the final re-evaluation. The mean difference between the preoperative and final aLDFA was +11 degrees, which was significant. Undercorrection occurred in 2/17 cases, whereas overcorrection was not recorded. The implants were removed in 12/17 cases, and rebound growth occurred in 3 of these. Clinical Significance Hemiepiphysiodesis for the treatment of distal femoral valgus is a technique that allows for increase in aLDFA and should be considered as an early treatment in affected immature dogs. Monitoring for possible overcorrection using serial radiography is important. Implant removal when the desired aLDFA has been achieved is recommended because the incidence of rebound growth is uncommon in dogs.

An unusual complication after augmentation genioplasty: odontogenic infection requiring implant removal

Augmentation genioplasty is a common surgical procedure with extremely low infection rates. We present the case of a healthy middle-aged woman who experienced years of chronic infection after chin implantation due to a fractured mandibular canine root, which is exceedingly rare. Awareness of this potential complication will reduce patient morbidity.