Search

BACKGROUND: Infection rates in revision total hip arthroplasty are lower when antibiotic loaded cemented stems are utilized. Inspired by this technique, a point-of-care coating of antibiotic-loaded calcium sulfate (CaSO4) was applied to cementless revision stems in aseptic revision and 2nd stage reimplantation total hip arthroplasty. METHODS: One hundred eleven consecutive femoral stems were coated. Just prior to insertion, 10 cc of CaSO4 was mixed with 1 g vancomycin and 240 mg tobramycin with the paste applied to the stem. The results were compared to a matched cohort (N = 104) performed across the previous 5 years. The surgical methods were comparable, but for the stem coating. The study group was followed for a minimum of 3 years. RESULTS: In the study cohort of 111 patients, there were 69 aseptic revisions with one periprosthetic joint infection (PJI) (1.4%) and 42 second-stage reimplantations with 2 PJIs (4.8%). In the control cohort of 104 patients, there were 74 aseptic revisions with one PJI (1.4%) and 30 second-stage reimplantations with 7 PJIs (23.3%). There was no significant reduction in PJI rate in the aseptic revision subgroup (1.4% study vs 1.4% control group), P = 1.000. Antibiotic stem coating reduced PJI rate in the 2nd stage reimplantation subgroup (23.3% control vs 4.8% study group), P = .028. In both groups, there were no cases of aseptic stem loosening. CONCLUSIONS: Point-of-care antibiotic coating of cementless revision femoral stems reduces PJI infection rate in 2nd stage reimplantations only. We theorize that microbes persist in the endosteal cortices after resection and may contribute to infection recurrence.

Objectives: The increase in the number of arthroplasty surgeries worldwide also leads to an increase in revision surgeries. This study examines the costs of primary and revision arthroplasty treatments in a tertiary university hospital's orthopedics and traumatology clinic. It also explores the impact of revision surgeries on the healthcare system. Methods: Seventy-six patients who had total knee arthroplasty at a university hospital between 01.01.2017 and 30.09.2022 were included in the study. The patients were divided into three groups: primary (n=25), aseptic reasons one-stage revision (n=27), and septic reasons two-stage revisions (n=24). For each patient included in the study, detailed documents regarding medical supplies, anesthesia, operating room, intensive care, consultation, medicine/serum, medical treatment, laboratory, blood and blood products, microbiology, radiology, food, bed, and attendant fees were provided separately by the hospital purchasing and statistics departments. Results: When comparing the costs of primary, one-stage revision, and two-stage revision surgeries, the average costs were 5689 Turkish Lira (₺), 8294.97 ₺, and 40919.67 ₺, respectively. In patients with septic reasons, the group that underwent two-stage revisions had significantly higher costs than the aseptic group in terms of surgery time, hospital stay duration, medication, treatment, surgery, anesthesia, intensive care, laboratory tests, imaging, blood center services, consultations, visits, meal expenses, and invoiced amount (P<0.001). Conclusion: Preventing and treating periprosthetic infections is costly and challenging. We need more research to develop effective protocols and reduce costs. As the number of patients undergoing knee arthroplasty is expected to rise, healthcare systems must ensure the sustainability of public financial resources, especially in public university hospitals. [ABSTRACT FROM AUTHOR]

Purpose: To validate the New Zealand Anterior Cruciate Ligament (ACL) Registry's capture rate of revisions by cross‐referencing Registry data with reoperations data recorded by the Accident Compensation Corporation (ACC) and identify risk factors for all‐cause reoperation. Methods: Primary ACL reconstructions performed between April 2014 and September 2019 were individually matched on a record‐by‐record basis between the two databases. The ACC database was used to identify patients who underwent a reoperation with manual review of operation notes to identify whether a revision or other procedure was performed. This was combined with the number of revisions separately recorded in the New Zealand ACL Registry, which was used as the denominator value to calculate the Registry's capture rate of revisions. Patient and surgical data recorded in the Registry were analysed to identify independent predictors for all‐cause reoperation. Results: A total of 8046 primary ACL reconstructions were matched between the New Zealand ACL Registry and the ACC databases. The reoperation rate was 8.9% (n = 715) at a mean follow‐up of 2.5 years. Meniscal‐related procedures were the most common reoperation (n = 299, 3.7%), followed by revision ACL reconstruction (n = 219, 2.7%), arthrofibrosis (n = 185, 2.3%), cartilage (n = 56, 0.7%) and implants (n = 32, 0.4%). The New Zealand ACL Registry captured 96% of revisions. Younger age (hazard ratio [HR] > 1.4, p < 0.001), earlier surgery (HR > 1.3, p = 0.05), concurrent meniscal repair (medial meniscus HR = 1.9, p < 0.001 and lateral meniscus HR = 1.3, p = 0.022) and hamstring tendon autografts (HR = 1.4, p = 0.001) were associated with a higher risk of reoperation. Conclusion: The New Zealand ACL Registry captured 96% of revisions. Risk factors for all‐cause reoperation included younger age, earlier surgery, meniscal repair and hamstring tendon autografts. Level of Evidence: Level III. [ABSTRACT FROM AUTHOR]

In transgender or non-binary patients (TGNB) with failed penile inversion vaginoplasty (PIV), peritoneal flap vaginoplasty (PFV) and intestinal segment vaginoplasty (ISV) facilitate restoration of neovaginal depth and sexual function. This study compared the outcomes of revision PFV and ISV in TGNB patients with failed PIV. TGNB patients who underwent secondary PFV or ISV from December 2018 to April 2023 were reviewed. Twenty-one (5.8%) patients underwent secondary PFV and 24 (6.6%) underwent secondary ISV, due to vaginal stenosis (n = 45, 100.0%). Mean duration to first successful dilation and average vaginal depth were comparable between the groups. Seven (33.3%) PFV patients experienced short-term complications, including introital dehiscence (n = 2, 9.5%), vaginal stenosis (n = 2, 9.5%), vaginal bleeding (n = 2, 9.5%), and reoperation (n = 2, 9.5%). Nine (42.9%) experienced long-term complications, including urethrovaginal fistula formation (n = 2, 9.5%), hypergranulation (n = 2, 9.5%), vaginal stenosis (n = 7, 33.3%), and reoperation (n = 6, 28.6%). Ten (41.7%) ISV patients experienced short-term complications, including dehiscence (n = 4, 19.0%), ileus (n = 2, 8.3%), introital stenosis (n = 2, 9.5%), and reoperation due to vaginal bleeding (n = 2, 8.3%). Six (25.0%) experienced long-term complications, including introital stenosis (n = 3, 12.5%), mucosal prolapse (n = 2, 8.3%), and reoperation due to mucosal prolapse (n = 4, 16.7%). Secondary PFV had a higher rate of vaginal stenosis (p = 0.003). There were no cases of partial or full-thickness flap necrosis. Revision PFV and ISV represent viable techniques for addressing vaginal stenosis secondary to PIV. Although PFV and ISV had comparable rates of short-term complications, ISV demonstrated a lower incidence of recurrent vaginal stenosis, which may inform operative decision-making. [ABSTRACT FROM AUTHOR]

Several studies have suggested that spinal anesthesia gives superior outcomes for primary total joint arthroplasty (TJA). However, there is a lack of available data regarding contemporary general anesthesia (GA) approaches for revision TJA utilized at high-volume joint arthroplasty centers. We retrospectively reviewed a series of 850 consecutive revision TJAs (405 revision total hip arthroplasties and 445 revision total knee arthroplasties) performed over 4 years at a single institution that uses a contemporary GA protocol and reported on the lengths of stay, early recovery rates, perioperative complications, and readmissions. Of the revision arthroplasty patients, 74.4% (632 of 850) were discharged on postoperative day 1 and 68.5% (582 of 850) of subjects were able to participate in physical therapy on the day of surgery. Only 6 patients (0.7%) required an intensive care unit stay postoperatively. The 90-day readmission rate over this time was 11.3% (n = 96), while the reoperation rate was 9.4% (n = 80). While neuraxial anesthesia is commonly preferred when performing revision TJA, we have demonstrated favorable safety and efficiency metrics utilizing GA in conjunction with contemporary enhanced recovery pathways. Our data support the notion that modern GA techniques can be successfully used in revision TJA. [ABSTRACT FROM AUTHOR]

The translation attempts to re-express messages from one language into another by prioritizing the equivalence of meaning, primarily determined by the translator's ability to understand the source text and the target text. Translators use revision to solve problems in the text to be translated. Revision is part of a translator's cognitive ability, which includes re-examining the translation results and looking for internal and external reading sources to get the right message or information in the source text. This study aims to explain the revisions made by the translator to the source text, namely Mandarin into Indonesian as the target text, and the reading sources they used in translating the text. This qualitative descriptive study employs a triangulation strategy: interviews, observations, and field notes with two students in the 7th semester of the Mandarin Language study program, Universitas Sumatera Utara, as participants. The findings show that student translators perform several revisions, such as Word substitution, Meaning Correction, Word addition, Grammar Correction, Deletion, and Spelling Correction. During the revision, they used online reading sources to find the terms used in the target text, such as Google Translate, KBBI, and Wikipedia. In translation, the revision of the source text aims to make the information in the target text easy for readers to understand. [ABSTRACT FROM AUTHOR]

Introduction Methods Findings Discussion Arteriovenous fistulas (AVFs) and grafts are essential for long‐term hemodialysis access in patients with end‐stage renal disease. However, complications and access failure often necessitate re‐intervention. In this study, we aim to delineate the factors associated with earlier failure of permanent hemodialysis access warranting revision procedures.This retrospective study aimed to identify factors associated with increased revision rates in AVFs and arteriovenous grafts, using multivariate survival analysis. A cohort of 136 patients who underwent initial arteriovenous access creation between 2005 and 2022 was analyzed. Patient characteristics, including age, comorbidities, access type, and vascular anatomy, were extracted, and hazard ratios (HR) were calculated to identify independent predictors of needing revision.A total of 119 patients were included in the final cohort, with a mean age of 55.2 years. Over 40% of patients had a previous central venous catheter placement, while 15% had a previous AVF. The majority of procedures were performed on the left side (74%), and brachiocephalic fistulas were most commonly created (41%). Univariate and multivariate Cox regression revealed that age (adjusted HR = 1.02, p = 0.01) and prior central venous catheter placement (adjusted HR = 1.77, p = 0.01) were independent predictors of earlier revision, while other variables such as sex, hypertension, and diabetes did not show significant associations. Patients with prior central venous catheter placement had a 77% increased risk of revision, even when adjusted for confounders.Understanding predictors of successful long‐term access outcomes can guide decision‐making regarding access type and alternative strategies. In our cohort, increased age and prior central venous catheter placement are associated with a shorter time to failure of permanent hemodialysis access and an increased risk of needing revision. [ABSTRACT FROM AUTHOR]

In the uneven publishing landscape between Africa and the global north publishing industry, almost all editorial rejections or requests for revision are initially narcissistically injurious. They compel one to pause, to revisit their views, and perhaps they make writers second guess themselves. In this paper, I focus on review feedback as a productive pause. I think with the affects and potentialities that follow the initial injury. I posit that if we look past the wounding, most revisions can be transformed into practices of care. I contemplate what it means for one’s work to be attended to by others and the generative possibilities that different lenses might enable. This thrust to focus on the positive is not to dismiss the epistemic violences that being revised and corrected might enact. Instead, I suggest that as writers committed to our craft and ideas, we might mine the review process for glimmers of care even if this entails rummaging through the dregs of callous feedback. Focusing on two writing projects, I think about iterative review as involving a wide network of readers that include formal reviewers and informal readers that are part of a reading community of practice. I suggest that conceived of broadly, reviewers might mediate the writing process in ways that nurse underdeveloped ideas, push us beyond parochial reading practices, and widen the resonance of our work beyond our initial imaginaries. To read the review and publication process through body politics and geopolitics as potentially inhibiting and enabling, propels us beyond binaries and broadens the scope of review to consider the roles of our informal readers. Conceived of this way, review is an important part of the practice of writing. It enhances our craft, ideas and political commitments. [ABSTRACT FROM AUTHOR]

Background: The use of a single anastomosis duodeno-ileal bypass (SADI) as a revisional procedure in patients with pre-operative GERD is not well understood. Thirty-day outcomes in patients with pre-existing GERD undergoing revision with an SADI have not been previously reported. Methods: The Metabolic and Bariatric Accreditation and Quality Improvement Program registry was consulted to identify patients undergoing revisional bariatric surgery with an SADI between 2020 and 2021. Our analysis sought to determine if preoperative GERD had significant impact on thirty-day outcomes. Bivariate and multivariable logistic regression analyses were used to identify independent predictors of 30-day morbidity. Results: Preoperative GERD was seen in 342 patients (36.7%). Preoperative GERD was not associated with anastomotic leak (2.5% non-GERD cohort vs. 1.2% GERD cohort; p = 0.2) nor bleeding (1% non-GERD cohort vs. 1.8% GERD cohort; p = 0.33). There was no difference in thirty-day readmission (5.6% vs. 5.9%, p = 0.9), reintervention (2.4% vs. 1.2%, p = 0.2), or reoperation (3.6% vs. 2.05%; p = 0.19) rates. The multivariable regression analysis revealed that a history of myocardial infarction was associated with a significantly elevated risk of serious complication (OR 12.2; 95% CI 2.79–53.23; p = 0.001), as was dyslipidemia (OR 2.2; 95% CI 1.04–4.56; p = 0.04). Conclusions: Pre-operative GERD does not have any association with anastomotic leak, bleeding, thirty-day readmission, reintervention, or reoperation in patients undergoing revisional bariatric surgery to SADI. A history of myocardial infarction and dyslipidemia are independent predictors of post-operative thirty-day morbidity, irrespective of the presence of preoperative GERD. [ABSTRACT FROM AUTHOR]

Study design. Retrospective database review. Objective. The aim of this study was to analyze revisions of CDAs reported to the MAUDE database. Summary of Background Data. Cervical disk arthroplasty (CDA) has emerged as a motion-preserving alternative to anterior cervical discectomy and fusion (ACDF) for degenerative cervical disease, demonstrating comparable outcomes. Despite the availability of variable CDA designs, there is limited data on the specific complications of individual CDAs. The Drug Administration's Manufacturer and User Facility Device Experience (MAUDE) database has been used to systematically report complications associated with CDAs. However, data on specific reasons for CDA revision remains scarce. The purpose of this study is to compare common complications associated with revision for different CDAs. Methods. The MAUDE database was queried from January 2005 to September 2023, including all nine FDA-approved CDAs. The full-text reports of each complication were categorized based on whether revision surgery was performed, the complications and the type of CDA collected and compared. Results. A total of 678 revisions for nine CDAs were reported: Mobi-C (239), M6 (167), Prodisc-C (88), Prestige (60), PCM (44), Bryan (35), Secure (23), Simplify (21), and Discover (1). The top three complications associated with revision were migration (23.5%), neck pain (15.5%), and heterotopic ossification (6.6%). The most common complications per device were migration for Mobi-C (26.4%), Prodisc-C (21.3%), Prestige (24.6%), PCM (84.1%), Bryan (48.6%), Secure (30.4%), and Discover (100%). For M6, the most common complications associated with revision surgery were osteolysis (18.6%) and neck pain (18.6%), while neck pain (23.8%) was the most common for the Simplify. Conclusions. The MAUDE database highlights complications related to CDA revision in which the primary complications consistently include implant migration, neck pain, and heterotopic ossification, varying in their rerelvance depending on the CDA. [ABSTRACT FROM AUTHOR]

Background: Robotic-assisted technologies have been developed to increase surgical precision and reduce surgical variability in total knee arthroplasty (TKA). Several different robotic systems have been introduced in the last decade for TKA. The DePuy Synthes VELYS™ Robotic-Assisted Solution (VRAS) is an imageless system designed to eliminate the need for preoperative CT scans and is one of the latest entrants in the rapidly evolving field of robotic technology in TKA. This study compared the clinical and economic outcomes associated with VRAS and other robotic-assisted technologies for primary TKA. Methods: A retrospective cohort study using the Premier Healthcare Database included patients who underwent primary TKA with VRAS or other robotic-assisted technologies from January 1, 2022, to April 30, 2023. The primary outcome for the study was hospital follow-up visits (revisits) within 90 days post-TKA. Secondary outcomes included readmission and revision rates within 90 days post-TKA, operating room time, length of stay, discharge status and hospital costs. Cohorts were balanced using propensity score fine stratification, and generalized linear models were constructed to evaluate outcomes. Results: This study included 827 VRAS TKA patients and 16,428 TKA patients treated with other robotic-assisted technologies. The 90-day all-cause and knee-related revisit rates were significantly lower for VRAS than for other robotic-assisted technologies (all-cause 13.9% vs. 22.8% and knee-related 2.8% vs. 5.4%, respectively; p value < 0.01). The all-cause and knee-related 90-day readmission rates were also lower for VRAS, although the differences were not statistically significant. The 90-day revision rates were similar for VRAS and other robotic-assisted technologies (0.48% vs. 0.45%), as was the operating room time (138 vs. 137 min). The 90-day knee-related cost for the VRAS cohort was $15,048 compared to $16,867 for other robotic technologies. Conclusions: This database study demonstrated that early postoperative revisit rates and total cost of care are lower for VRAS than for all other robotic-assisted technologies for TKA, while operating room time and discharge status were similar. These are important findings in ever-evolving healthcare systems that are increasingly cost conscious and cognizant of principles associated with value-based care. [ABSTRACT FROM AUTHOR]

Apatelodidae is a family of New World bombycoids distributed mainly in the Neotropical region, with 14 genera, 222 valid species and 8 subspecies. These moths are medium-sized with a wingspan ranging from 2 to 8 cm, generally greyish, straw-yellow or reddish-brown, with darker spots and lines on the dorsal side of the wings. We combine adult morphology and molecular data to test, under a probabilistic framework, the monophyly of apatelodid genera and the placement of Tamphana (Bombycidae). We sampled the type species of 12 of the 14 valid genera of Apatelodidae, including the type species of synonymised genera. We sampled ~75% of the species from all valid genera in the family and outgroups from Bombycidae, Brahmaeidae, Eupterotidae and Phiditiidae, totalling 195 terminals. Examination of the specimens resulted in a matrix of 138 morphological characters (116 from male; 22 from female) from the head (7 from male; 1 from female), thorax (37 from male; 4 from female), abdomen (5 from male) and genitalia (66 from male; 17 from female). For the molecular analyses, we used four genes: DDC (647 bp) for 14% of terminals; CAD (2486 bp) for 23% of terminals, Wgl (409 bp) for 38% of terminals and COI (658 bp) for 75% of terminals. Species of Tamphana were recovered in Apatelodidae as two independent clades. The genera Arotros , Crastolliana , Drepatelodes , Pantelodes , and Prothysana were recovered as monophyletic. The remaining apatelodid genera were polyphyletic. We propose a new genus-level classification: Tamphana is transferred to Apatelodidae; 16 new genera are proposed: Aymara gen. nov. , Campesina gen. nov. , Caribas gen. nov. , Cecile gen. nov. , Kaweskar gen. nov. , Lempira gen. nov. , Misak gen. nov. , Mocambo gen. nov. , Nhanderu gen. nov. , Peabiru gen. nov. , Raoni gen. nov. , Tapuia gen. nov. , Tibira gen. nov. , Tupac gen. nov. , Tuyvae gen. nov. and Zapata gen. nov. Two new species are described: Mocambo lauracensis sp. nov. , and Nhanderu takua sp. nov. We revalidate the genus Hygrochroa stat. rev. and three species: Carnotena perlineata stat. rev., Tupac bombycina stat. rev., comb. nov. and Zanola vivax stat. rev. Overall, we propose 82 new generic combinations, synonymise 16 species, and restore the status of 3 species: Apatelodes floramia stat. rest. , Carnotena rectilinea comb. nov. , stat. rest. and Ephoria nubilosa stat. rest. Additionally, we summarise data on the natural history and distribution of each Apatelodidae species. ZooBank: We sampled ~75% of Apatelodidae species from all valid genera and combined morphological and molecular data to test monophyly of its genera. Our findings demonstrate that most Apatelodidae genera, as currently understood, are not monophyletic and revealed that groups of species with similar characters may constitute valid genera. We propose a new genus-level classification for Apatelodidae and include data on its natural history and geographical distribution. (Image credit: Guilherme Fischer.) [ABSTRACT FROM AUTHOR]

Background: The increasing incidence of reverse total shoulder arthroplasties (RTSA) has led to an increase in revision surgery. We aimed to compare patients undergoing re-revision RTSA to a matched cohort undergoing first-revision RTSA. Methods: A retrospective review of all revision RTSAs was performed at a single institution. Sixteen shoulders that underwent re-revision RTSA were matched 1:3 to shoulders that underwent revision RTSA with a minimum two-year follow-up. Outcome scores including the American Shoulder and Elbow Surgeons Shoulder Score (ASES), Short-Form 12 (SF-12), Shoulder Pain and Disability Index (SPADI), and Simple Shoulder Test (SST) scores, range of motion (ROM), and improvement from preoperative to postoperative outcomes after re-revision RTSA were assessed. Additionally, postoperative outcomes after re-revision RTSA were compared to patients that underwent first revision RTSA and subsequently compared to the minimal clinically important difference (MCID) values for the outcome scores and ROM measurements assessed. Results: Sixteen shoulders that underwent re-revision RTSA and 78 revision RTSAs met the final inclusion criteria to be included in this study. Significant improvement from preoperative to postoperative re-revision RTSA was seen in the ASES score (p = 0.046), SPADI score (p = 0.044), SST (p = 0.008), abduction (p = 0.016), and elevation (p = 0.025), but not the SF-12 score (p = 0.396), external rotation (p = 0.449), or internal rotation (p = 0.451). Outcomes after revision RTSA were found to be superior to outcomes after re-revision RTSA for all outcome scores (ASES p = 0.029, SF-12 p = 0.018, SPADI p = 0.003) except the SST score (p = 0.080) and all ROM measures (p > 0.05 for all). Internal rotation was equivalent postoperatively between both groups. From preoperative to postoperative re-revision RTSA, the mean improvement exceeded the MCID for the SST score, abduction, forward elevation, and external rotation. When comparing postoperative revision RTSA to postoperative re-revision RTSA, the mean difference between revision and re-revision RTSA exceeded the MCID for the SPADI score and external rotation. The complication rate was 19% in shoulders undergoing first revision and 41% in shoulders undergoing re-revision RTSA. Conclusion: Patients undergoing re-revision RTSA receive improvement in clinical outcomes, but do not achieve outcomes comparable to those achieved after first revision RTSA. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to investigate if patient's gender significantly affected the long‐term outcome of patients undergoing total knee arthroplasty (TKA) and to provide a cross‐gender comparison of a large patient sample from a single regional register. Methods: The Registry of Prosthetic Orthopedic Implant of Emilia Romagna (RIPO) investigated all primary TKAs performed from July 2000 to December 2020 by collecting data of men and women separately. Primary bicompartmental and tricompartmental TKAs were included. The survival rates and the reasons for revision were assessed to check if any other factor could have influenced implant failure. Results: In total, 66,032 TKAs were included and analysed, comprising 46,774 women and 19,258 men. The 15‐year Kaplan–Meier survival percentage was 93.6% for women and 92.5% for men (p = 0.001). Men exhibited a higher revision risk following primary TKA (p = 0.012), particularly when the primary diagnosis was arthritis resulting from rheumatic disorders (p = 0.018) and arthritis following high‐tibial osteotomy (p = 0.024). Failure risk was also higher for men below the age of 60 years (p = 0.038). Conclusion: The long‐term outcome in TKA showed significant differences between men and women, with a significantly lower survival rate in men at 15 years, especially when they are under 60 years old or with a diagnosis of rheumatic disorders or arthritis following high‐tibial osteotomy. It is necessary to design specific studies to have relevant data concerning gender differences in prosthetic surgery and to customise treatments to improve outcome and patient satisfaction. Level of Evidence: Level III. [ABSTRACT FROM AUTHOR]

Background: Posterior tibial slope (PTS) has been identified as a possible modifiable risk factor for anterior cruciate ligament (ACL) injury and ACL reconstruction (ACLR) failure. However, the findings in the literature are inconsistent. This may be explained by several different reasons, including different measurement methods, differing definitions of ACLR failure, and possible inclusion of suboptimal films. Purpose: To compare PTS values obtained using plain radiographs (XR-PTS) in a young (≤21 years of age), skeletally mature patient population with those obtained using magnetic resonance imaging (MRI), as well as to quantify the number of suboptimal lateral knee radiographs obtained across an integrated health care system and determine the potential effect of including these radiographs on summary statistics of XR-PTS. Study Design: Case-control study; Level of evidence, 3. Methods: Skeletally mature adolescent and young adult patients ≤21 years of age were identified from the ACLR registry of Kaiser Permanente. The cases of concern were patients requiring revision ACLR. The controls were patients who had an ACLR and did not require a revision procedure. The XR-PTS measurements were made on plain radiographs by a single blinded reviewer. These results were compared with measurements obtained using MRI. The quality of each plain radiograph was evaluated by measuring posterior/distal femoral condylar overlap and length of tibial diaphysis captured on the radiograph. Summary statistics with and without inclusion of measurements made on suboptimal radiographs were calculated. Results: Of the initial 634 patients with ACLR (317 case-control pairs), 561 (88.5%) had radiographs available and were included for the analysis comparing radiograph to MRI slope measurements. For the evaluation of slope between case and control pairs with radiograph information available, there were 257 case-control pairs; there were 124 pairs when those with suboptimal radiographs were excluded. There was no difference in MRI-measured lateral tibial posterior slope or medial tibial posterior slope for the 257 case-control pairs with XR-PTS information and for the 124 pairs with optimal radiographs. XR-PTS in the revision cohort was significantly steeper than in the control group when suboptimal radiographs were included in the analysis. There was no difference when patients with suboptimal radiographs were excluded. PTS measurements made on plain radiographs were larger than those made on MRI. There was a poor correlation between measurements made using these 2 modalities (r = 0.22 for radiograph and medial PTS). Conclusion: This study did not find a significantly steeper XR-PTS in patients who had to undergo revision ACLR when suboptimal radiographs were not included in the analysis. The present study's results confirmed the findings from a previous study of the same patient population that used MRI. However, there was poor correlation between PTS measurements made using plain radiograph and MRI. [ABSTRACT FROM AUTHOR]

Purpose: Scoliosis surgery is becoming increasingly frequent. Rate of readmission is little discussed in the literature. It is an interesting data for the patient's information and for public authorities to calculate cost-effectiveness. Aim of the study was to evaluate rate and causes of short and long-term readmissions in patients > 45 years old operated on for a scoliosis primary cases, then to look for predictors of these readmissions. Methods: In this monocentric retrospective cohort study, over 45 years-old scoliosis primary cases operated on between 2015 and 2018 and with a minimum of 2 years follow-up were included. The number of readmissions and their causes were analyzed. Rehospitalized patients (RH) were then compared to non-rehospitalized patients (NRH). Risk factors were sought using a multivariate analysis by logistic regression. Results: 105 patients were included (90% female; 64 ± 8 years). 56% were readmitted at least once. Main cause of readmission as pseudarthrosis (70%). Among the RH patients, fifty-eight required at least one revision. We found no significant difference between RH and NRH, apart from the rate of immediate post-operative medical complications which was significantly higher in RH (17% (n = 11) vs. 4% (n = 2), p = 0.04). According to multivariate analysis, BMI and age were found as predictors of readmission of mechanical origin, and BMI for readmissions of septic origin. Conclusion: The readmission rate after scoliosis surgery was 56%. The main cause was pseudarthrosis. Rehospitalized patients had more immediate post-operative medical complications. The elderly and overweight patients are more likely to be readmitted for mechanical or septic reasons. [ABSTRACT FROM AUTHOR]

Introduction: Cochlear implantation has become an increasingly common strategy for aural rehabilitation in patients with severe to profound hearing loss who no longer benefit from conventional amplification. In conjunction, immunosuppressive therapies (e.g. disease-modifying anti rheumatic drugs (DMARDs) have become the keystone of management in numerous autoimmune conditions. Given the increasing prevalence of both, a greater proportion of patients will undergo cochlear implantation while on immune-modulating medications. While these medications are usually well tolerated, immunosuppression may put patients a higher risk for device infections. At present, this is not extensively studied within the cochlear implant literature. Methods: We conducted a retrospective chart review and review of the literature. Results: We present the case of an 81-year-old male who experienced wound dehiscence and infection secondary to leflunomide use for treatment of rheumatoid arthritis. Resolution of these issues was noted with a therapeutic drug holiday, and the patient has subsequently undergone re-implantation without issue. Conclusions: The case highlights a potential CI-associated wound complication in the setting of DMARD therapy. Given the increasing prevalence of both CIs and immunosuppressive therapy, future study on the potential for interaction is warranted to identify the best management strategy in the perioperative setting. [ABSTRACT FROM AUTHOR]

Mastoid surgeries are surgical procedures, wherein surgical failures are prevalent due to the fundamental complexities involved, especially in the understanding of microscopy and pathophysiology of the disease. A revision mastoidectomy is an utmost, a post-procedure decision, wherein the patient continues to exhibit signs and symptoms that are concerning. This is proved by a prospective, cross-sectional research which was conducted upon a group of patients who were referred to a tertiary health care centre. This selection of twenty-three (23) patients who underwent mastoidectomy prior to their participation in this research, were exhibiting signs of recurrent diseases. The observations of trends seen in revision mastoidectomy are detailed and inferences gleaned from it. These trends and observations direct us towards the understanding that the majority of failure of previous mastoidectomy was due to persistent diseased air cells and recurrent or residual cholesteatoma. This is further corroborated by the trends observed from exhausting literature readings of previous similar studies. Revision mastoid surgeries are an important follow-up process, after the mastoidectomy, if the patients continue to exhibit diseased states. [ABSTRACT FROM AUTHOR]

Purpose: Fractures and dislocations of the pelvic ring are complex injuries that when treating require meticulous attention to detail and often specialized technical skill. These injuries can be the result of high-energy trauma, particularly in younger patients, or low energy trauma more often found in the elderly. Regardless of mechanism, these injuries lie on a spectrum of severity and can be treated conservatively or surgically. Percutaneous fixation under fluoroscopic guidance is the preferred standard technique when treating these fractures. This technique can be challenging for a variety of reasons including patient characteristics, intra-operative image quality, fracture morphology, among others. Methods: This retrospective study evaluated the use of intra-operative computed tomography (CT) using an O-arm imaging system for critical evaluation of fluoroscopic-guided screw placement in twenty-three patients. We retrospectively reviewed all cases of patients who were treated by three fellowship-trained orthopaedic traumatologists during a one-year span. Patients undergoing percutaneous pelvis fixation using both standard fluoroscopy and intraoperative CT with the Medtronic O-arm® (Minneapolis, MN) imaging system. Additionally, procedures performed included open reduction internal fixation (ORIF) of the pelvic ring, acetabulum, and associated extremity fractures. Results: Twenty-three patients were included in this study. On average, the use of intraoperative CT added 24.4 min in operative time. Five patients (21.7%) required implant adjustment after O-arm spin. Fourteen patients underwent additional post-operative CT. No secondary revision surgeries were attempted after any post-operative CT. Conclusions: Our study suggests that intra-operative CT scan, compared to post-operative CT scan, can be utilized to prevent take-back surgery for misplaced implants and allow for adjustment in real-time. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to define a subset of complex rTKA in terms of preoperative, intraoperative, and postoperative outcomes and complications. The secondary outcome of the authors is to propose a simple and easy-to-use guide for clinical network in rTKA management. Methods: Complex rTKAs were defined according to the presence of at least two of the following features: periprosthetic joint infection, re- revision, femoral and/or tibial massive bone defects, soft tissue impairment, stiffness, fracture requiring fixed component revision. Results: Twenty-six patients underwent a standard rTKA (group A) while 24 had a complex rTKA (group B). The mean follow-up was 50.2 ± 16.4 months in group A and 49.5 ± 16.8 in group B (p = 0.44). The operative time was longer in group B (200.4 ± 131.4 min vs 110.2 ± 59.8 min). A greater intraoperative total blood loss (3014.2 ± 740.0 vs 2328.5 ± 620.6 ml, p < 0.001), intra and postoperative blood infusion (3.6 ± 1.2 vs 2.1 ± 1.2 units, p < 0.001) was reported in group B. Significant difference was obtained for global complication rate (11.5% group A vs 37.5% group B, p = 0.04), reoperation (7.7% group A vs 33.3% group B, p = p = 0.03) and re-revision (3.8% group A vs 25% group B, p = p = 0.04). Conclusion: This study describes a specific entity of rTKA that require higher surgical effort and increased surgical challenge (measured as increased surgical time, need of transfusions and complications). The proposed classification could provide an easy-to-use tool for quick grading of complexity in rTKA. [ABSTRACT FROM AUTHOR]

Purpose: A tibial cement spacer (TCS) with spikes offers better initial stability than a conventional TCS and reduces spacer-related problems in two-stage revision total knee arthroplasty (R-TKA) for infection. We compared the clinical outcomes of two-stage revision arthroplasty for infected TKA using spiked TCS with that of conventional TCS. Methods: This retrospective cohort study included 29 patients who underwent two-stage revision arthroplasty using an articulating cement spacer and who could be followed up for at least one year. Group S comprised 14 patients using spiked TCS, whereas Group C comprised 15 patients using conventional TCS. Demographic data, the interval from first to second stage revision, motion arc, numerical rating scale (NRS), Knee Society (KS) score, serum levels of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), and frequency of repeating the first-stage and infection recurrence after R-TKA between the groups were analyzed. Results: No significant differences were observed in the female ratio and mean age between both groups. The mean interval between the first and second stage revision was significantly shorter in Group S than in Group C. The mean motion arc was significantly larger in Group S than in Group C. The mean NRS was significantly lower in Group S than in Group C. The mean KS score in Group S was significantly higher than that in Group C. Serum ESR and CRP levels did not differ between the groups. The frequency of repeating the first stage was lower in Group S than in Group C. However, the recurrence rate after R-TKA was higher in Group S than in Group C. Conclusion: Compared with conventional TCS, spiked TCS shortened the period until R-TKA and improved pain and function levels. However, no significant difference existed in the rate of infection recurrence after R-TKA. [ABSTRACT FROM AUTHOR]

The effect of metabolic syndrome (MetS) on the risk of revision after hip and knee arthroplasty is debated. The aim of our study was to investigate the risk of short-term (minimum 2.7 years) revision due to periprosthetic joint infection (PJI) after hip and knee arthroplasty. Secondly, we aimed to investigate the risk of revision due to any cause and mortality. During May 2017 to November 2019, a cohort of 2,901 patients undergoing a total of 3,024 hip and knee arthroplasties was established. In the cohort, 62.1% met the criteria for MetS. Data from national registries and a local database were used to determine the presence of MetS and revision surgeries, with a follow-up of at least two years and eight months. Cox regression was applied to the present hazard ratio (HR), associated 95% confidence intervals, and P values. Survival analyses were presented in a Kaplan-Meier plot. The risk of PJI (HR 1.6 (0.5 to 4.9), P =.380), any revision (HR 0.8 (0.4 to 1.3), P =.295), and death (HR 1.3 (0.8 to 2.1), P =.282) was not increased in patients suffering from MetS compared with patients who did not have MetS. There was no PJI in patients not having MetS and receiving a knee arthroplasty. The risk of death was increased in the MetS group receiving a knee arthroplasty (HR 2.7 (1.3 to 5.9), P =.010), but not different from the MetS group receiving a hip arthroplasty. There was no elevated risk of PJI when analyzing morbid obesity (body mass index over 40), men, or diabetes as the exposures. Patients suffering from MetS do not have an increased risk of revision caused by PJI. In general, performing hip and knee arthroplasty in patients suffering from MetS is without increased risk of revision surgery. [ABSTRACT FROM AUTHOR]

Outcomes and safety of "mix and match" in total hip arthroplasty (THA) using universal head-neck adapters (UHNA) are a matter of ongoing discussion and concern due to legal affairs. This study aimed at analyzing the "mix and match" use of UHNA and evaluating complication and reoperation rates, possible risk factors, and the implant's survival. A total of 306 patients treated with THA (94.1% revisions) using a UHNA at our institution between 2006 and 2022 were identified and included. Diagnoses, comorbidities, implants, and UHNA specifications were retrospectively recorded. Outcomes, complications, and survival analyses were evaluated, taking into account various possible risk factors. There were 19.9% of the 306 included cases (58.5% women; median age 74 years; median follow-up 57 months) that had at least 1 complication. There were 43 patients (14.1%) who had to receive ≥1 rerevision surgery. The most common complication was postoperative recurrent dislocation (n = 27, 8.8%). There was one case of a prosthetic stem-neck fracture that was registered. Statistically significant risk factors for postoperative recurrent dislocations and postoperative aseptic loosening were, respectively, dislocation as an indication for UHNA implantation (P <.001) and oversized neck lengths (≥2XL; P =.004). The overall revision-free survival was 92% after 1 year and 82% at ten years. Statistically significant better survival rates were registered in patients ≥60 years old, who had fewer comorbidities (<2), and normal neck lengths (S to XL). The results of this study underline the overall safety of UHNA use in THA through "mix and match." Only one case of a stem-neck fracture was identified. The highlighted risk factors for failure must be kept in mind during the decision-making process with patients. [ABSTRACT FROM AUTHOR]

Failure due to trunnionosis with adverse local tissue reaction (ALTR) has been reported with cobalt-chrome (CoCr) heads in total hip arthroplasty (THA); however, there are limited data on the use of these heads in the revision setting. The purpose of this study was to analyze the outcomes of patients who underwent revision THA with a retained femoral component and received a CoCr femoral head on a used trunnion. In this retrospective review, we identified all patients who underwent revision THA with a retained femoral component and received a CoCr femoral head between February 2006 and March 2014. Demographic factors, implant details, and postoperative complications, including the need for repeat revisions, were recorded. In total, 107 patients were included (mean age 67 years, 74.0% women). Of the 107 patients, 24 (22.4%) required repeat revisions. Patients who required repeat revision were younger than those who did not (mean age: 62.9 versus 69, P =.03). The most common indications for repeat revision were instability (8 of 24, 33.3%), ALTR (5 of 24, 20.8%), and infection (4 of 18, 16.7%). Evidence of ALTR or metallosis was identified at the time of reoperation in 10 of the 24 patients who underwent re-revision (41.7%). The placement of a new CoCr femoral head on a used trunnion during revision THA with a retained femoral component carries a significant risk of complication (22.4%) and should be avoided when possible. [ABSTRACT FROM AUTHOR]

The purpose of this study is to systematically review the evidence in the literature to ascertain the functional outcomes, range of motion (ROM), and complication and reoperation rates after revision reverse shoulder arthroplasty (RSA) for a failed primary total shoulder arthroplasty (TSA) or hemiarthroplasty (HA). Two independent reviewers performed the literature search based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using the EMBASE, MEDLINE, and The Cochrane Library databases. Studies were included if they reported clinical outcomes for revision RSA for a failed primary TSA or HA. Our review found 23 studies including 1041 shoulders (627 TSA and 414 HA) meeting our inclusion criteria. The majority of patients were female (66.1%), with an average age of 69.0 years (range: 39-93 years) and a mean follow-up of 46.3 months. American Shoulder and Elbow Surgeons and visual analog scale pain scores improved from 32.6 to 61.9 and 6.7 to 2.7, respectively. ROM results include forward flexion, abduction, and external rotation, which improved from 59.4° to 107.7°, 50.7° to 104.4°, and 19.8° to 26.3°, respectively. Only 1 of the 10 studies reporting internal rotation found a statistically significant difference, with the mean internal rotation improving from S1-S3 preoperatively to L4-L5 postoperatively for patients undergoing HA. The overall complication rate and reoperation rate were 23.4% and 12.5%, respectively. The most common complications were glenoid component loosening (6.0%), fracture (periprosthetic, intraoperative, or other scapula fractures) (n = 4.7%), and infection (n = 3.3%). Revision RSA for a failed primary TSA and HA has been shown to result in excellent functional outcomes and improved ROM, suggesting that patients who have failed TSA or HA may benefit from a revision RSA. [ABSTRACT FROM AUTHOR]

Recurrent posterior shoulder instability after primary repair is uncommon, but presents a challenging clinical scenario. Most revisions in failed labral repair were associated with glenoid bone morphology related to critical bone loss, retroversion, or dysplasia. A variety of treatment options exist which include revision labral repair with or without capsular plication, glenoid osteotomy, humeral rotational osteotomy, or glenoid bone augmentation. No single technique has been shown to be superior and each technique has strengths and limitations. Therefore, thoughtful evaluation and planning is critical to address each patient's individual pathology to maximize success after revision surgery. [ABSTRACT FROM AUTHOR]

Objective: Describe the clinical profile of revision cochlear implantation (RCI) cases involving device manufacturer conversion (RCImc+), compare them to cases without manufacturer conversion (RCImc−), and classify the reasons for manufacturer conversion (MC). Study Design: Retrospective case review. Setting: Tertiary academic center. Methods: Data on demographics, RCI indications, medical background, surgical details, and the reasons for MC were collected for all RCIs from 1989 to 2020. Post‐RCI speech perception performance was categorized as unchanged, improved, or declined, according to clinically based criteria. Results: Of 185 RCIs, 39 (21%) involved MC, mostly in pediatric patients (67%). The leading RCImc+ indications were device‐related (59%) and medical (31%) failures. Initial implant manufacturers were Advanced Bionics (49%), Cochlear (25.5%), or Medel (25.5%). Most MC reasons were patient‐driven (64%) versus CI team recommendations (36%). The RCImc+ group demonstrated a 3‐fold higher rate of medical indications than RCImc− (31% vs 11.5%, P =.007). The time interval from symptom onset to RCI was longer in RCImc+ (43 vs 20.3 months, P =.001), and the rate of multiple revisions in the same ear was higher (25.6% vs 8.2%, P =.009). Complete reinsertion rates were high in both RCImc+ and RCImc− (94.8% vs 94.5%, P = 1) without any complications. Speech perception improved or remained unchanged in most (84%) cases, with no significant difference between the groups (P =.183). Conclusion: This retrospective study showed that RCI involving MC is safe and beneficial. Although RCImc+ patients exhibited distinct clinical characteristics, MC did not impact surgical or speech perception outcomes. This provides evidence‐based data to support informed decision‐making by CI teams and patients. [ABSTRACT FROM AUTHOR]

We compared the effects of capsule resection versus capsule suturing in patients treated with a dual-mobility trapeziometacarpal joint prosthesis. We included 131 patients with capsular resection and 57 patients with repair. The mean scores for pain and the brief Michigan Hand Outcomes Questionnaire were similar between the groups preoperatively and at 6 weeks and 1 year postoperatively. Mean key pinch strength was also similar in both groups before surgery and at 1 year, but higher in the capsular resection than in the suture group at 6 weeks. The incidence of complications reported throughout the 1-year postoperative period was not significantly different between the groups. One implant in the capsular resection group was revised for reasons most likely unrelated to capsule management. We conclude that the capsule can be safely resected during trapeziometacarpal joint implant arthroplasty. Level of evidence: III [ABSTRACT FROM AUTHOR]

Copyright of Die Orthopädie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Insufficient tuberosity healing is the most common reason for poor outcome after treatment of proximal humerus fractures (PHFs) using hemiarthroplasty (HA). In these cases, revision to reverse total shoulder arthroplasty (RTSA) can improve function and reduce pain in the short term, however, long-term results remain scarce. Aim of this study was to evaluate the clinical and radiological mid- to long-term results in patients with a revision RTSA after failed HA for PHF. Methods: In this retrospective study all patients that received a revision to RTSA after failed fracture HA between 2006 and 2018 were included. A total of 49 shoulders in 48 patients (38 female, 10 male; mean age 82 ± 9 years) were identified in our database. A total of 20 patients (17 female, 3 male; mean age was 79 ± 9 years) were available for follow-up examination after a mean time period of approximately eight years (3–14 years) after revision surgery. At final follow-up, patients were assessed using a subjective shoulder value (SSV), range of motion (ROM), visual analogue score (VAS), the Constant Score (CS) and the 12-Item Short Form Survey (SF-12). Results: At final follow-up, mean CS was 55 ± 19 (19–91), VAS averaged 3 ± 3 (0–8) and mean SSV was 61 ± 18% (18–90%). Mean SF-12 was 44 (28–57) with a mean physical component summary (PCS) of 38 (21–56) and a mean mental component summary (MCS) of 51 (29–67). On average active forward flexion (FF) was 104° (10–170°), active abduction (ABD) was 101° (50–170°), active external rotation (ER) was 19° (10–30°) and active internal rotation (IR) of the lumbosacral transition was reached. Three patients presented with a periprosthetic humeral fracture after RTSA implantation and underwent a reoperation (15%) during follow-up period. Conclusions: Revision RTSA results in promising clinical results in patients after initial failed HA after PHF. A complication and reoperation rate of 15% is tolerable in consideration of satisfactory functional and psychological outcome. Trial registration: Retrospectively registered. [ABSTRACT FROM AUTHOR]

Background: The positioning error of femoral tunnel was the key factor leading to the failure of anterior cruciate ligament (ACL) reconstruction. This study aimed to propose a new femoral tunnel classification to guide revision ACL reconstruction. Methods: Totals of 150 patients with ACL reconstruction failure from 2017 to 2023 were enrolled in this retrospective study. According to the tunnel diameter, shape, posterior wall and the positioning relationship with the Lateral Intercondylar Ridge on the three-dimensional CT imaging, we divided the femoral tunnels into four types: Type I off-target type, Type II straddled type, Type III anatomical type, and Type IV irregular type. Finally, explored the inter-observer reliability within two groups of doctors (Group A, 12 high seniorities; Group B, 12 low seniorities), and evaluated the intra-observer reliability within 6 doctors after two months. Clinical evaluation was performed using the Lysholm score, Tenger activity score, Pivot Shift and anterior knee laxity measurements. Results: Among 150 cases of femoral tunnel three-dimensional CT reconstructed imaging, 144 cases were successfully included in the classification system, and 6 cases were confirmed as uncertain type. We measured the Kappa (κ) coefficient of group A was significantly higher than that of group B (κ 0.72 VS 0.68), and the κ coefficient of group A was still higher than group B (κ 0.69 VS 0.62) after further dividing Type III anatomical type into three subtypes. In addition, the κ coefficients of intra-observer reliability were all exceeded 0.73. Clinical follow-up showed that 9 patients had good knee joint motor function and stability after operation. Conclusion: The new femoral tunnel classification was reliable and had clinical guiding significance based on three-dimensional CT imaging. Level of evidence: Level III. [ABSTRACT FROM AUTHOR]

The present Bayesian network meta-analysis compared different types of polyethylene liners in total hip arthroplasty (THA) in terms of wear penetration (mm/year) and rate of revision. The type of liners compared were the crosslinked ultra-high molecular weight polyethylene (CPE/UHMWPE), Vitamin E infused highly cross-linked polyethylene (HXLPE-VEPE), modified cross-linked polyethylene (MXLPE), highly cross-linked polyethylene (HXLPE), Cross-linked polyethylene (XLPE). This study was conducted according to the PRISMA extension statement for reporting systematic reviews incorporating network meta-analyses of healthcare interventions. In June 2024, PubMed, Scopus, Embase, Google Scholar, and Cochrane databases were accessed. A time constraint was set from January 2000. All investigations which compared two or more types of polyethylene liners for THA were accessed. Only studies that clearly stated the nature of the liner were included. Data from 60 studies (37,352 THAs) were collected. 56% of patients were women. The mean age of patients was 60.0 ± 6.6 years, the mean BMI was 27.5 ± 2.0 kg/m2. The mean length of follow-up was 81.6 ± 44.4 months. Comparability was found at baseline between groups. XLPE and HXLPE liners in THA are associated with the lowest wear penetration (mm/year) and the lowest revision rate at approximately 7 years of follow-up. [ABSTRACT FROM AUTHOR]

In revision total knee arthroplasty (TKA), there is little information on the magnitude of potential limb lengthening, risk factors for lengthening, or its impact on patient-reported outcome measures. We aimed to quantify limb length alteration during revision TKA and assess risk factors for lengthening. We identified 150 patients over a 3-year period who underwent revision TKA and had preoperative and postoperative EOS hip-to-ankle standing radiographs. The average patient age was 64 years, 51% were women; 68% had a preoperative varus deformity and 21% had a preoperative valgus deformity. Outcomes assessed included change in functional and anatomic limb length, risk factors for lengthening, and clinical outcome scores, including the Knee Osteoarthritis Outcome Score Joint Replacement, and the Veterans RAND 12-item Physical and Mental Scores. There were 124 patients (83%) who had functional limb lengthening, and 108 patients (72%) had anatomic limb lengthening. Patients had an average functional limb lengthening of 7 mm (range, −22 to 35) and an average anatomic limb lengthening of 5 mm (range, −16 to 31). Patients undergoing revision for instability experienced significantly greater anatomic lengthening (7.6 versus 4.6, P =.047). Patients who had ≥ 10° of deformity were more likely to be functionally lengthened (91 versus 79%) and had significantly greater average functional lengthening (12 versus 6 mm; P =.003). There was no significant change in clinical outcome scores at 6 weeks and 1 year for patients lengthened ≥ 5 or 10 mm compared to those not lengthened as substantially. There is major potential for functional and anatomic limb lengthening following revision TKA, with greater preoperative deformity and revision for instability being risk factors for lengthening. [ABSTRACT FROM AUTHOR]

Mortality is a quality indicator that may affect expenditures. Revisions for periprosthetic joint infection (PJI) are, on average, more expensive and exhibit higher morbidity than aseptic revisions, although reimbursement is similar. Therefore, we sought to determine (1) impact on mortality rates of revision total hip and/or knee arthroplasty performed for PJI diagnosis (septic) versus aseptic revisions, at any point in time, and (2) mortality predictors among PJI patients. Retrospective chart review of 978 consecutive patients who underwent revision at a single institution (January 2015 to November 2020). All revisions were evaluated, and it was determined whether patients had a revision for PJI at any point in time or not. Two groups were compared: (1) patients with septic revision(s) (n = 350) and (2) patients who only underwent aseptic revision(s) (n = 628). Demographics and mortality status at latest follow-up (mean 3 years, range: 0 to 18 years, from first revision ever) were assessed. Mortality status was also separately assessed among patients who exclusively had hip revision(s), or solely knee revision(s), or both. Multivariate regression analysis (Cox) was used to determine whether PJI diagnosis was an independent mortality predictor. Among PJI patients, potential mortality predictors were evaluated. Overall, 65 patients died (6.6%). The septic cohort had significantly more men and American Society of Anesthesiologists (ASA) class-IV patients. Mortality rates were 10.9% and 4.3% (P <.0001) for septic and aseptic revision groups, respectively. After controlling for sex, ASA, and number of revisions, PJI diagnosis was a significant mortality predictor (hazard ratio [HR]: 2.69, 95% confidence interval [CI]: 1.5 to 4.7, P =.001). Among PJI patients, age (HR: 1.05, 95% CI: 1.01 to 1.08, P =.009) and ASA (HR: 4.02, 95% CI: 1.67 to 9.67, P =.002) were independent predictors. Having a revision due to PJI diagnosis was associated with 2.5 times increased mortality. Therefore, more accurate coding capturing the complexity and morbidity of revisions for PJI diagnosis is needed. [ABSTRACT FROM AUTHOR]

Porous tantalum metaphyseal cones may facilitate reconstructions of severe bone defects during revision total knee arthroplasty (TKA), but there remains a paucity of data on their outcomes at mean 5 years of follow-up. This study reports the component survivorship, patient satisfaction, functional outcomes, radiographic osseointegration, and complications of revision TKA with porous tantalum metaphyseal cones at mid-term (mean 5-year) follow-up. This study included 152 patients who had a mean age of 66 years (range, 33 to 86 years) undergoing revision TKA with porous tantalum metaphyseal cones. Indications for surgery included aseptic loosening (n = 87, 57.3%), second-stage reimplantation for infection (n = 42, 27.6%), osteolysis with well-fixed components (n = 20, 13.2%), and periprosthetic fracture (n = 3, 2.0%). Component survivorship, clinical outcomes, radiographic outcomes, and any complications were recorded. The mean follow-up time was 5.6 years (range, 2.2 to 13.7). Survivorship was 100% when the end point was revision of the metaphyseal cone (no cones were revised) and 83.8% (95% confidence interval: 77.9 to 90.2%) when the end point was reoperation for any reason at 5-year follow-up. Reoperations were performed for infection (n = 10), instability (n = 4), periprosthetic fracture (n = 2), and quadriceps rupture/dehiscence (n = 3). The mean patient satisfaction score was 78.8 ± 11.3 and the mean Forgotten Joint Score was 62.2 ± 16.7 at the final follow-up. The preoperative median University of California at Los Angeles score improved from 2 (interquartile range 2 to 3) to 6 points (interquartile range 5 to 6) (P <.001), and the preoperative Oxford knee score improved from 15.2 ± 3.8 to 39.4 ± 5.1 points (P <.001) at the final follow-up. All metaphyseal cones showed radiographic evidence of osteointegration without any subsidence or loosening. Porous tantalum metaphyseal cones enabled robust reconstructions of severe femoral and tibial bone defects during revision TKA. These reconstructions were associated with excellent survivorship, improvements in functional outcomes, and reproducible radiographic osseointegration at mean 5-year follow-up. The most common reasons for reoperation were infection and instability. [ABSTRACT FROM AUTHOR]

The first generation of titanium nitride (TiN) coatings for orthopaedic implants was clinically introduced in the 1990s because of their promising biocompatibility, wear resistance, and corrosion resistance. This study evaluated the in vivo performance of early TiN-coated knee and hip implants, focusing on the bearing surfaces and mechanisms of in vivo damage. There were 13 TiN-coated implants (5 knee and 8 hip) retrieved from 8 patients as part of a multi-institutional implant retrieval program. The average implantation time was 4.25 years for knees and 17.5 years for hips. Implant revisions occurred for various reasons, including polyethylene wear, loosening, pain, infection, and instability. Components were examined using a semiquantitative scoring method, and surface roughness measurements were performed using white-light interferometry. Surface morphology, chemistry, and particle characterization were also assessed by scanning electron microscopy. For hips, mild corrosion was found on femoral head tapers, along with severe scratching on certain femoral heads. Knee implants exhibited low burnishing and scratching for both mechanisms. Roughness measurements (S a) were 37.3 nm (interquartile range = 22.0 to 62.4) for hips and 85.3 nm (interquartile range = 66.3 to 110) for knees. The observed scratch depth in both hip and knee implants due to third-body particles ranged from 0.3 to 1.3 μm. The coating coverage remained intact in the majority of the implants, with 2 cases of small, localized cohesive chipping and substrate exposure. The results of this study confirm the potential in vivo durability of early TiN coatings and will be useful in benchmarking wear tests for modern TiN-coated orthopaedic implants. [ABSTRACT FROM AUTHOR]

Periprosthetic joint infection (PJI) continues to be one of the leading causes of failure following total hip arthroplasty (THA). The objectives of the study were to (1) determine the minimum 2-year infection-free survivorship of 2-stage revision THA, (2) determine the causative organisms for repeat 2-stage revision THA, and (3) characterize the results of failed 2-stage revisions and evaluate patient-reported outcome measures (PROMs). A retrospective chart review was completed for patients who underwent 2-stage revision THA for PJI. Prospective data were collected on each patient, including demographics, causative organisms, complications, and type of reoperation. The PROMs, including Harris Hip Score, 12-item Short-Form Health Survey, and Western Ontario and McMaster Universities Osteoarthritis Index scores were obtained prior to 2-stage revision THA surgery and annually as part of standard clinical and radiographic follow-up. A total of 328 patients who underwent a 2-stage revision THA for a PJI were included in the study (mean age 67 years [range, 28 to 90], mean body mass index of 30.6 [range, 15 to 57]). The overall infection-free survivorship for 2-stage revision THA was 73.8% at a minimum of 2 years (range, 2 to 20). Overall, 194 (59.1%) patients who had successful infection eradication underwent a 2-revision THA only. The most common single organisms infected were Staphylococcus aureus (12.5%) and Staphylococcus epidermidis (11%). Higher reoperation rates were found in cases with methicillin-resistant Staphylococcus aureus and polymicrobial infections. All PROMs showed statistical improvement from preoperatively to the latest follow-up appointment. Two-stage revision THA is associated with a good success rate in the treatment of PJIs at mid-term to long-term follow-up. Polymicrobial and methicillin-resistant Staphylococcus aureus infections are poor prognostic factors, making the eradication of infection more difficult. The management of PJIs continues to be one of the most important orthopaedic challenges to treat. [ABSTRACT FROM AUTHOR]

The horizontal 'bikini' incision for direct anterior approach (DAA) total hip arthroplasty has gained popularity due to its early wound healing characteristics; however, the nonextensile nature of this approach may pose problems in treating early complications. This study sought to characterize the outcomes of early revision (<90 days) in patients who underwent anterior hip arthroplasty utilizing either a traditional longitudinal incision or a horizontal (bikini) incision. This retrospective study identified patients who underwent DAA primary total hip arthroplasty with a subsequent DAA revision within 90 days. Patients were divided into two cohorts based on the orientation of their incision: either 'longitudinal incision' (in accordance with the Smith Peterson interval) or 'horizontal bikini incision' (in accordance with the hip flexion crease). There were 74 patients who underwent DAA revision arthroplasty within 90 days of primary arthroplasty; 65 had a longitudinal incision, and 9 had a horizontal (bikini) incision. In the longitudinal incision group, 2 patients (3.1%) required plastic surgery closure, and 11 patients (16.9%) required additional operations. Of the 9 bikini incision patients, 6 patients required the assistance of plastic surgery closure, and 7 patients required multiple orthopaedic operations. Our study suggests that a horizontal bikini incision is less forgiving in the early postoperative period if a more extensile exposure is needed for revision surgery, as measured by the need for plastic surgery and additional returns to the operating room. In our cohort, the longitudinal incision allowed for the management of early surgical complications with less morbidity. [ABSTRACT FROM AUTHOR]

Porous tantalum acetabular cup and augment constructs have demonstrated favorable outcomes up to 5 years postsurgery despite severe bone loss during revision total hip arthroplasty (THA). Prior literature lacks long-term studies with substantial case numbers. This study aims to assess long-term clinical and radiographic outcomes 10 years postsurgery in patients undergoing revision THA with porous tantalum acetabular cup-augment constructs and determine factors associated with long-term survivorship. Between 2000 and 2012, 157 revision THAs were performed in cases with major acetabular defects (mainly Paprosky type IIIA and IIIB) utilizing porous tantalum cup-augment constructs. Pelvic discontinuity was noted intraoperatively in 17 hips (11%). Postoperative radiographs were evaluated at regular intervals for implant stability and radiolucent lines. There were 49 patients who had complete radiographic follow-up at 10 years or longer postsurgery. The 10-year survivorship free of revision of the cup-augment construct for aseptic loosening was 93%, free of any acetabular construct revision was 91%, free of any hip rerevision was 77%, and free of any reoperation was 75%. Pelvic discontinuity was associated with increased risk of reoperation (hazard ratio [HR] = 2.8), any hip rerevision (HR = 3.2), any cup-augment construct revision (HR = 11.8), and aseptic construct revision (HR = 10.0). Of unrevised cases with radiographs at 10 years, 4 hips showed radiographic loosening. Mean Harris hip scores improved from 47 preoperatively to 79 at 10 years. Porous tantalum acetabular cup-augment constructs used in revision THA with severe acetabular bone loss provide excellent implant survivorship at 10 years when the acetabulum is intact. Due to lower survivorship of cup-augment constructs in cases of pelvic discontinuity, additional construct fixation or stabilization methods are recommended, when a discontinuity is present. IV [ABSTRACT FROM AUTHOR]

Tapered fluted titanium (TFT) stems are the implant design of choice for managing Vancouver B2 periprosthetic femur fractures (PFFs), producing reliable results over the past few decades. The aim of this study was to compare the radiographic and clinical outcomes of Vancouver B2 PFFs treated with contemporary monoblock versus modular TFTs. A consecutive series of 113 patients (72 women, 64%, mean age 70 years [range, 26 to 96]) who had a B2 PFF were treated with either a monoblock (n = 42) or modular (n = 71) TFT stem between 2008 and 2021. The mean body mass index was 30 ± 7. The mean follow-up was 2.9 years. A radiographic review was performed to assess leg length and offset restoration, endosteal cortical contact length, and stem subsidence. Kaplan-Meier analyses were used to determine survivorship without revision, reoperation, or dislocation. There was no difference in the restoration of leg length (0.3 ± 8.0 mm) or offset (2.8 ± 8.2 mm) between the monoblock and modular cohorts (P >.05). Mean endosteal cortical contact length (47.2 ± 26.6 versus 46.7 ± 2 6.4 mm, P =.89) and stem subsidence (2.7 ± 3.5 versus 2.4 ± 3.2 mm, P =.66) did not differ. No difference in patient-reported outcome measures (Hip Disability and Osteoarthritis Outcome Score-Joint Replacement; Veterans RAND 12 Item Health Survey Physical and Mental; visual analog score; and Lower Extremity Activity Scale) between the groups was observed. Survivorship at 2 years free from reoperation, revision, and dislocation was 90.4, 90.3, and 97.6%, respectively, for the monoblock cohort; and 84.0, 86.9, and 90.0%, respectively, for the modular cohort. No significant differences in radiographic or clinical outcomes were observed between patients treated with monoblock or modular TFTs in this large series of B2 PFFs. [ABSTRACT FROM AUTHOR]

Advances in total hip arthroplasty (THA) have resulted in evolving revision indications and intraoperative techniques, which can influence the exposure of trainees to complex cases. We report 3 decades of revision experience from a tertiary referral center that trains fellows, comparing the reasons for revision and the complexity of revisions over time. We retrospectively reviewed all revision THAs performed at our institution from 1990 to 2022. Revision diagnoses, components revised, types of revision implants used, and exposure techniques were collected. A "complex" revision was defined as a case that involved an extended trochanteric osteotomy, triflange and cup-cage construct, or acetabular augment. A total of 3,556 THA revisions were identified (108 revisions/year). Aseptic loosening was the most common indication in 1990 to 1999 (45 per year), but decreased to 28.3/year in 2010 to 2019. From 1990 to 1999 and 2010 to 2019, fracture increased from 3.1 to 7.3 per year, infection from 2.9/year to 16.9/year, and metallosis from 0.1 to 13.2 per year. Both component revision were common from 1990 to 1994 (42.6 per year), while polyethylene exchange was most common in 2010 to 2019 (43.3 per year). A decrease was observed in "complex" cases over time: 14.8 extended trochanteric osteotomies/year in 2000 to 2004 compared to 5.4 per year in 2018 to 2022, 4.5 triflange and cup-cage constructs/year in 2004 to 2007 compared to 0.8 per year in 2018 to 2022, and 4 acetabular augments per year in 2009 to 2012 compared to 1 per year in 2018 to 2022. Indications for revision have changed over the decades, while the number of "complex" revisions has gradually decreased, presumably due to advances in implants and materials. If this trend extends to other training institutions, the next generation of arthroplasty surgeons will have less exposure to complex revisions during their training. [ABSTRACT FROM AUTHOR]

With increased frequency there are more transgender youths who request and require health care for issues regarding gender identity. The aim of this paper is to conduct a systematic review on the mental health of transgender adolescents and health care to which they have access regarding their discovery of transgender issues. This systematic review was undertaken by analysing international literature following PRISMA guidelines for systematic scientific reviews. The searches were conducted in the following databases: MEDLINE, SciELO, Psicodoc, PsycINFO and PubMed. A total of 24 articles complied with the inclusion criteria. The results indicate that transgender and non-conforming gender adolescents are an especially vulnerable group because they display high rates of mental health problems when compared to their cisgender peers. Hormone therapy for gender affirmation points to possible psychological benefits for this population group. In conclusion, transgender and non-conforming gender adolescents may exhibit mental health problems associated with the discrimination, rejection/repudiation, or bullying/harassment experienced in their corresponding social, health, and educational environments. This demands the need for a social change that promotes the acceptance and normalization of non-normative identities and genders. [ABSTRACT FROM AUTHOR]

Introduction: The key outcome of joint registries is revision events, which inform clinical practice and identify poor‐performing implants. Registries record revision events and reasons, but accuracy may be limited by a lack of standardized definitions of revision. Our study aims to assess the accuracy and completeness of unicompartmental knee arthroplasty (UKA) revision and indications reported to the New Zealand Joint Registry (NZJR) with independent clinical review. Methods: Case record review of 2272 patients undergoing primary UKA at four large tertiary hospitals between 2000 and 2017 was performed, identifying 158 patients who underwent revision. Detailed review of clinical findings, radiographs and operative data was performed to identify revision cases and the reasons for revision using a standardized protocol. These were compared to NZJR data using chi‐squared and Fisher exact tests. Results: The NZJR recorded 150 (95%) of all UKA revisions. Osteoarthritis progression was the most common reason on the systematic clinical review (35%), however, this was underreported to the registry (8%, P < 0.001). A larger proportion of revisions reported to the registry were for 'pain' (30% of cases vs. 5% on clinical review, P < 0.001). A reason for revision was not reported to the registry for 10% of cases. Conclusion: The NZJR had good capture of UKA revisions, but had significant differences in registry‐reported revision reasons compared to our independent systematic clinical review. These included over‐reporting of 'pain', under‐reporting of osteoarthritis progression, and failing to identify a revision reason. Efforts to improve registry capture of revision reasons for UKA could be addressed through more standardized definitions of revision and tailored revision options for UKA on registry forms. [ABSTRACT FROM AUTHOR]

Functioning is a construct capturing how an individual's engagement in everyday life emerges from the interaction between the individual and their environment. The World Health Organization's International Classification of Functioning, Disability and Health (ICF) provides a biopsychosocial framework of functioning. Previously, the ICF was adapted for use in autism by developing Core Sets, a selection of ICF codes from the entire classification for specific conditions. Here, we present the first revision of the ICF of the Core sets for autism from a Delphi-like technique, based on evidence from Core Sets validation/linking studies, stakeholder feedback, and the development and piloting of the autism ICF Core Sets platform. Two ICF second-level codes were removed, and 12 were added to the comprehensive autism Core Set. The added codes reflect body functions in various sensory domains, fine hand use, and environmental factors. Changes were extensive for the age-appropriate brief Core Sets where ICF codes from the initial Core Sets were added or removed. The revisions conducted indicate a continued need for regularly updating Core Sets, based on empirical evidence and stakeholder involvement. We recommend the updated Core Sets for future use in autism research and practice in different age groups and contexts. Autistic people experience individual strengths and challenges as well as barriers and facilitators in their environment. All of these factors contribute to how well autistic people can cope in everyday life, fulfill the roles they choose, and meet their needs. The World Health Organization has developed a system aiming to capture the many factors within people (like how someone thinks and feels) and outside of people (things around a person) that influence their daily living, called the International Classification of Functioning, Disability and Health. The International Classification of Functioning, Disability and Health can be used for different purposes in research and practice to assess people's situations and plan support measures. Previously in 2019, the International Classification of Functioning, Disability and Health was adapted to autism by developing so-called Core Sets, which are shorter International Classification of Functioning, Disability and Health versions for use in specific conditions. Here, we present the first revisions of the International Classification of Functioning, Disability and Health Core Sets for autism, based on research, development results, and community feedback. Some factors influencing daily life for autistic people were added to the Core Sets, and other factors deemed less relevant were removed. Changes were also made in Core Sets designed for different age groups (0–5, 6–16, and ⩾17 years). Particularly, contents for sensory processing (like smell, touch, seeing, hearing) were added. We recommend these updated Core Sets for future use in autism research and practice. These changes to the Core Sets after 4 years indicate that there should be ongoing updates based on research and experience from practice and involvement of stakeholders. [ABSTRACT FROM AUTHOR]

Introduction: Revision lumbar fusion is most commonly due to nonunion, adjacent segment disease (ASD), or recurrent stenosis, but it is unclear if diagnosis affects patient outcomes. The primary aim of this study was to assess whether patients achieved the patient acceptable symptom state (PASS) or minimal clinically important difference (MCID) after revision lumbar fusion and assess whether this was influenced by the indication for revision. Methods: We retrospectively identified all 1–3 level revision lumbar fusions at a single institution. Oswestry Disability Index (ODI) was collected at preoperative, three-month postoperative, and one-year postoperative time points. The MCID was calculated using a distribution-based method at each postoperative time point. PASS was set at the threshold of ≤ 22. Results: We identified 197 patients: 56% with ASD, 28% with recurrent stenosis, and 15% with pseudarthrosis. The MCID for ODI was 10.05 and 10.23 at three months and one year, respectively. In total, 61% of patients with ASD, 52% of patients with nonunion, and 65% of patients with recurrent stenosis achieved our cohort-specific MCID at one year postoperatively with ASD (p = 0.78). At one year postoperatively, 33.8% of ASD patients, 47.8% of nonunion patients, and 37% of patients with recurrent stenosis achieved PASS without any difference between indication (p = 0.47). Conclusions: The majority of patients undergoing revision spine fusion experience significant postoperative improvements regardless of the indication for revision. However, a large proportion of these patients do not achieve the patient acceptable symptom state. While revision spine surgery may offer substantial benefits, these results underscore the need to manage patient expectations. [ABSTRACT FROM AUTHOR]

Objective: To compare performance in baseball pitchers before and after revision ulnar collateral ligament (UCL) surgery using performance metrics. Design: Case series. Setting: Public online database. Patients (or Participants): Players who underwent revision UCL surgery between 2015 and 2021 were identified. Players were included if they were Minor League (MiLB) or Major League (Major League baseball [MLB]) pitchers. Players were excluded if they were not pitchers, if they underwent their revision surgery as an amateur, or if there is no record of their primary reconstruction surgery. Interventions: Revision UCL surgery (repair or reconstruction). Main Outcome Measures: Return to sport (RTS) rate, RTS time, pitch velocity, and pitch spin rate. Results: Sixty-five pitchers underwent revision UCL surgery. MiLB pitchers had a shorter RTS time after their primary surgery (15.62 vs 20.77 months, P, 0.01) compared with MLB pitchers but similar RTS times after their revision reconstruction (19.64 vs 18.48 months, P 5 0.44). There was also no difference in return to play (RTP) rate overall after primary versus revision reconstruction (P 5 1.00). Major League baseball pitchers also had decreased RTS time after primary compared with revision reconstruction (15.62 vs 19.64 months, P, 0.01) but similar RTP rates (P 5 0.28). Finally, MLB pitchers had similar pitch breakdowns, velocities, and spin rates before and after their primary and revision repair or reconstruction. Conclusions: Both revision UCL repair and reconstruction can return pitchers to preinjury performance levels. Pitchers and teams should be properly counseled on realistic RTP times and postsurgery performance when discussing revision UCL surgeries. [ABSTRACT FROM AUTHOR]

Navigation in total knee arthroplasties has been recommended in recent years to facilitate the technique and improve its results. An extensive literature has compared it with conventional surgery, but its superiority has not been able to be demonstrated. Given the abundant bibliography and disparity in their conclusions, a good number of meta-analyses have been published that have attempted to summarize and schematize the results. We have reviewed 41 published meta-analyses comparing both techniques. Most of them have focused on the placement of implants and the restoration of the axes of the extremity, demonstrating the superiority of navigation. On the contrary, no clinically valuable differences have been observed when analyzing the clinical and functional results. However, navigation allows a dynamic view of the knee, an objective evaluation of the soft tissues and ligaments, and is essential for functional alignment as an individualized technique. [ABSTRACT FROM AUTHOR]

The evolution and challenges of unicompartmental knee prostheses (UNIS) are addressed, highlighting their use since the 1970s as an alternative to osteotomies. Over the years, these prostheses have gained popularity, although they initially faced criticism due to higher revision rates compared to total knee arthroplasties (TKA). Multicenter studies, such as that of Heck et al., revealed an increase in failures associated with body mass index and female sex. Despite this, recent reviews, such as that of Vasso et al., have shown a positive evolution in the results of UNIS, although with a higher percentage of revisions than TKA. The importance of adequate patient selection, meticulous surgical technique, and avoidance of overcorrection for surgical success is also emphasized. It is mentioned that external UNIS, although representing a small percentage of total prosthetic knees, have shown favorable results in terms of long-term survival. In addition, technical aspects such as minimal bone resection and polyethylene wear, which are crucial for the performance of prostheses, are discussed. In conclusion, the need for further research and improvement of techniques to optimize the results of unicompartmental arthroplasties is highlighted. [ABSTRACT FROM AUTHOR]

Background: The sleeve gastrectomy (SG) has become the most common bariatric procedure worldwide. However, insufficient weight loss or weight recidivism is frequent, which may require effective and safe revisional procedures. Objective: To determine the technical feasibility and safety of a minimally invasive, duodeno-ileal side-to-side anastomosis using a Sutureless Neodymium Anastomosis Procedure (SNAP) for patients with weight recidivism or inadequate weight loss following SG. Methods: This is a prospective, single-arm, open-label pilot study that enrolled patients with obesity to assist in weight reduction following an SG performed > 12 months prior. For the SNAP, self-assembling magnets were deployed into the ileum (laparoscopically) and duodenum (per-oral endoscopy). Magnets were coupled under laparoscopic and fluoroscopic guidance to create a compression anastomosis. The primary endpoints were technical feasibility, weight loss, and rate of serious adverse events (SAEs). Results: Successful duodeno-ileal diversions were created with SNAP in 27 participants (mean age: 50.6 ± 9.1, mean BMI: 38.1 ± 4.6 kg/m2) with no device-related serious adverse events. Upper endoscopy at 3 months confirmed patent, healthy anastomoses in all patients. At 9 months, patients (n = 24) experienced 11.9 ± 6.2%, 14.5 ± 10.8%, and 17.0 ± 13.9% TBWL at 3, 6, and 9 months, respectively. There were no device-related SAEs. Conclusion: The SNAP is technically feasible and relatively safe, with all patients presenting widely patent anastomosis at 3 months. Patients experienced a progressive, clinically meaningful weight loss. Further studies are needed to confirm our findings. [ABSTRACT FROM AUTHOR]