Additively manufactured porous tantalum implants

Background: A variety of diagnostic imaging techniques is available for excluding or confirming chronic osteomyelitis. Until now, an evidence-based algorithmic model for choosing the most suitable imaging technique has been lacking. The objective of this study was to determine the accuracy of current imaging modalities in the diagnosis of chronic osteomyelitis.

Methods: A systematic review and meta-analysis of the literature was conducted with a comprehensive search of the MEDLINE, EMBASE, and Current Contents databases to identify clinical studies on chronic osteomyelitis that evaluated diagnostic imaging modalities. The value of each imaging technique was studied by determining its sensitivity and specificity compared with the results of histological analysis, findings on culture, and clinical follow-up of more than six months.

Results: A total of twenty-three clinical studies in which the accuracy was described for radiography (two studies), magnetic resonance imaging (five), computed tomography (one), bone scintigraphy (seven), leukocyte scintigraphy (thirteen), gallium scintigraphy (one), combined bone and leukocyte scintigraphy (six), combined bone and gallium scintigraphy (three), and fluorodeoxyglucose positron emission tomography (four) were included in the review. No meta-analysis was performed with respect to computed tomography, gallium scintigraphy, and radiography. Pooled sensitivity demonstrated that fluorodeoxyglucose positron emission tomography was the most sensitive technique, with a sensitivity of 96% (95% confidence interval, 88% to 99%) compared with 82% (95% confidence interval, 70% to 89%) for bone scintigraphy, 61% (95% confidence interval, 43% to 76%) for leukocyte scintigraphy, 78% (95% confidence interval, 72% to 83%) for combined bone and leukocyte scintigraphy, and 84% (95% confidence interval, 69% to 92%) for magnetic resonance imaging. Pooled specificity demonstrated that bone scintigraphy had the lowest specificity, with a specificity of 25% (95% confidence interval, 16% to 36%) compared with 60% (95% confidence interval, 38% to 78%) for magnetic resonance imaging, 77% (95% confidence interval, 63% to 87%) for leukocyte scintigraphy, 84% (95% confidence interval, 75% to 90%) for combined bone and leukocyte scintigraphy, and 91% (95% confidence interval, 81% to 95%) for fluorodeoxyglucose positron emission tomography. The sensitivity of leukocyte scintigraphy in detecting chronic osteomyelitis in the peripheral skeleton was 84% (95% confidence interval, 72% to 91%) compared with 21% (95% confidence interval, 11% to 38%) for its detection of chronic osteomyelitis in the axial skeleton. The specificity of leukocyte scintigraphy in the axial skeleton was 60% (95% confidence interval, 39% to 78%) compared with 80% (95% confidence interval, 61% to 91%) for the peripheral skeleton.

Conclusions: Fluorodeoxyglucose positron emission tomography has the highest diagnostic accuracy for confirming or excluding the diagnosis of chronic osteomyelitis. Leukocyte scintigraphy has an appropriate diagnostic accuracy in the peripheral skeleton, but fluorodeoxyglucose positron emission tomography is superior for detecting chronic osteomyelitis in the axial skeleton.

Level of Evidence: Diagnostic Level III. See Instructions to Authors for a complete description of levels of evidence.

The accuracy of diagnostic imaging for the assessment of chronic osteomyelitis: a systematic review and meta-analysis.

Introduction: A variety of diagnostic imaging techniques is available for excluding or confirming chronic osteomyelitis(COM). Aim of the study was to determine the accuracy of current imaging modalities, radiography, MRT, CT, leukocyte (LS), bone (BS), and Galium (Ga) scintigraphy, and FDG-PET, for diagnosing COM. Materials and methods: Systematic review and meta-analysis of the literature for clinical studies on COM evaluating diagnostic imaging modalities by a comprehensive search of the Mediine, Embase, and Current Contents databases. The value of each imaging technique was studied through its sensitivity and specificity compared to histology / culture / clinical follow-up. Results: In total 23 clinical studies were included, describing the diagnostic accuracy of 39 imaging modalities: Radiography (2), MRI (4), CT (1), BS (5), LS (13), Ga (1), combined BS-LS (5), combined BS-Ga (3), combined LS-Ga (1), and FDG-PET (4). A high diagnostic accuracy of FDG-PET was found for detecting COM in the central and peripheral skeleton. Subgroup analyses revealed that LS is more accurate for detecting peripheral localizations of COM than for central localizations of COM. Conclusions: The available diagnostic studies for COM are characterized by a low methodological quality. Despite, FDG-PET demonstrated to be an important new imaging technique with a high diagnostic accuracy and has the potential advantage for quantitative assessment on surgical treatment of COM.

The accuracy of diagnostic imaging for the assessment of chronic osteomyelitis; systematic review and meta-analyses

The quality and state of satisfaction reporting after total knee replacement (TKR) is variable. The purposes of this systematic review were (1) to examine the available literature on patient satisfaction after TKR, (2) to evaluate the quality of available evidence, and (3) to identify predictors of patient satisfaction after TKR. A systematic review of the MEDLINE database was performed. The initial search yielded 1219 studies. The inclusion criteria were English language, clinical outcome study with primary outcome related to TKR for osteoarthritis, and patient-reported satisfaction included as an outcome measure. Studies were assessed for demographics, methodology for reporting satisfaction, and factors influencing satisfaction. Two hundred eight studies, including 95,560 patients who had undergone TKR, met all inclusion and exclusion criteria; 112 (53.8%) of these studies were published in the past 3 years. Satisfaction was most commonly measured using an ordinal scale. Twenty-seven studies (13%) used a validated satisfaction survey. Eighty-three percent of studies reported more than 80% satisfaction. The most commonly reported predictor of satisfaction was post-operative patient-reported functional outcome. Pre-operative anxiety/depression was the most common pre-operative predictor of dissatisfaction. There are numerous studies reporting patient satisfaction after TKR, and publication on the topic has been increasing over the past decade. However, the majority of studies represent lower levels of evidence and use heterogeneous methods for measuring satisfaction, and few studies use validated satisfaction instruments. In general, the majority of studies report satisfaction rates ranging from 80 to 100%, with post-operative functional outcome and relief of pain being paramount determinants for achieving satisfaction.

/pdf/patient-satisfaction-after-total-knee-replacement-a-ta0w21l5vy.pdf

Patient Satisfaction After Total Knee Replacement: A Systematic Review

Finite element modelling of the pelvis: inclusion of muscular and ligamentous boundary conditions.

There is a need for standardization of radiostereometric (RSA) investigations to facilitate comparison of outcome reported from different research groups. In this document, 6 research centers have ...

https://www.tandfonline.com/doi/pdf/10.1080/17453670510041574

Guidelines for standardization of radiostereometry (RSA) of implants

Background After more than 4 decades experience of total knee arthroplasty (TKA), there is still a group of patients who are not satisfied with the outcome. In spite of the improvement of many aspects around the procedure, for unexplainable reasons, patient dissatisfaction is still approximately the same. We conducted this study to analyze correlations between preoperative psychological aspects and dissatisfaction after TKA. Methods A total of 186 patients were operated with a primary TKA. Patients filled out the Hospital Anxiety and Depression Scale, Visual Analog Pain Scale (0-100), and Knee injury and Osteoarthritis Outcome Score preoperatively and 4 years postoperatively. Four years postoperatively, the patients also scored their satisfaction degree with the outcome of the surgery. Results Of 186 patients, 27 (15%) reported that they were dissatisfied or uncertain with the result of their TKA 4 years postoperatively. Sixteen of those 27 patients had reported anxiety/depression preoperatively compared with 11 of 159 (7%) in the satisfied or very satisfied groups. Patients with preoperative anxiety or depression had more than 6 times higher risk to be dissatisfied compared with patients with no anxiety or depression ( P P  = .03). Dissatisfied patients had 1-day longer hospital stay compared with the satisfied group ( P Conclusion Preoperative anxiety and/or depression is an import predictor for dissatisfaction after TKA. Psychological assessment and treatment preoperatively might improve degree of satisfaction.

/pdf/preoperative-anxiety-and-depression-correlate-with-4lrl4zvf2c.pdf

Preoperative Anxiety and Depression Correlate With Dissatisfaction After Total Knee Arthroplasty : A Prospective Longitudinal Cohort Study of 186 Patients, With 4-Year Follow-Up

https://portal.research.lu.se/portal/files/1455991/7374322.pdf

Generation of 3D shape, density, cortical thickness and finite element mesh of proximal femur from a DXA image.

We report on two patients with fracture of a modular, tapered and distally fixed, uncemented titanium revision hip stem, not previously described. A failure analysis revealed that the cause of the fractures was the development of fatigue cracks in the mid-stem cobalt-chromium modular junction ending in corrosion-fatigue failure. No material defects or stress risers were found in any of the implants. The diameter of the mid-stem modular junction might be undersized for use in heavy and active patients. We also report a new way of detecting an undisplaced fracture at the modular junction, using the scout image from a computed tomography (CT) scan; a technique that can be used when plain radiographs are inconclusive.

Fatigue fracture in dual modular revision total hip arthroplasty stems: failure analysis and computed tomography diagnostics in two cases.

Twenty-three patients with clinically suspected acute or chronic osteomyelitis and 21 patients with suspected joint prosthetic infection underwent scintigraphy using both 99mTc-nanocolloid and 111In-labeled leukocytes. The scintigrams of the two tracers were blindly interpreted by three independent observers. Their evaluations showed high correspondence. Patients were classified as having no infection, probable infection or proven infection according to specific criteria which included results of bacteriological cultures and histopathological examinations. For proven and probable infection taken together, the sensitivity with 99mTc-nanocolloid was 94%, the specificity 84% and the accuracy 87%, compared with 75%, 90% and 85% with 111In-labeled leukocytes. We conclude that 99mTc-nanocolloid scintigraphy is at least equivalent with 111In-leucocyte scintigraphy, and its additional advantages are shorter examination time, less complexity and better radiation dosimetry.

https://jnm.snmjournals.org/content/34/10/1646.full.pdf

Gunnar Flivik

Papers

Guidelines for standardization of radiostereometry (RSA) of implants

Preoperative Anxiety and Depression Correlate With Dissatisfaction After Total Knee Arthroplasty : A Prospective Longitudinal Cohort Study of 186 Patients, With 4-Year Follow-Up

Generation of 3D shape, density, cortical thickness and finite element mesh of proximal femur from a DXA image.

Fatigue fracture in dual modular revision total hip arthroplasty stems: failure analysis and computed tomography diagnostics in two cases.

Technetium-99m-nanocolloid scintigraphy in orthopedic infections: a comparison with indium-111-labeled leukocytes