BACKGROUND:Uncemented total knee arthroplasty (TKA) components were developed to improve fixation relative to cemented implants. While uncemented femoral components have yielded favorable results, outcomes for earlier uncemented tibial and patellar designs have been inconsistent. Contemporary trabecular-metal implants aim to enhance biological fixation by optimizing osseointegration, yet randomized data comparing fully uncemented constructs, including the patella, are limited. We conducted a prospective, single-blinded randomized controlled trial comparing 5-year radiological, clinical, and patient-reported outcomes of fully cemented and fully uncemented trabecular-metal TKA with patella resurfacing. METHODS:Between 2017 and 2020, 316 knees (280 patients) were randomized 1:1 to fully cemented (n = 158) or fully uncemented (n = 158) TKA with patella resurfacing. There were 15 patients randomized to the uncemented group who required cementation of at least one component. The primary outcome was implant fixation at five years, assessed on standardized radiographs for progressive and nonprogressive radiolucent lines. The secondary outcomes included revisions, other reoperations, and patient-reported outcome measures at five years. Risk ratios, t-tests, and Chi-square tests were performed using a modified intention-to-treat approach. RESULTS:Follow-up was 97% at five years. Uncemented TKA had fewer nonprogressive radiolucent lines than cemented TKA (two versus 27 cases, relative risk [RR]: 0.50, 95% confidence interval [CI]: 0.42 to 0.59, P < 0.001). There was one progressive radiolucency that occurred in the cemented group. There were no differences between the groups for revisions (one cemented versus two uncemented, RR 1.52, CI: 0.31 to 7.56, P = 0.55), other reoperations (10 cemented versus eight uncemented, RR: 0.90, CI 0.59 to 1.39, P = 0.66), or patient-reported outcome measures (Oxford Knee Score, EuroQol-5 Dimensions, International Knee Society Score, Pain Visual Analog Scale, Forgotten Joint Score, and Satisfaction). CONCLUSIONS:At five years, fully uncemented TKA using trabecular metal with patella resurfacing demonstrated equivalent clinical and patient-reported outcomes and similar revision/reoperation rates to fully cemented TKA, with fewer nonprogressive radiolucent lines. Longer-term follow-up is required to determine whether radiographic differences affect implant survivorship and longevity overall.

Cemented fixation remains the gold standard for total knee arthroplasty (TKA). Introduction of cementless implants was intended to improve fixation and reduce risk of aseptic loosening, which is a leading cause of TKA failure. While use of cementless TKA has increased over the last decade, comparative mid to long-term data is lacking. This randomised controlled trial (RCT) aimed to compare clinical and radiographic outcomes between cemented and cementless TKA at five years. In this prospective RCT, 316 patients undergoing primary TKA were randomised to receive either fully cemented (n=158) or fully cementless (n=158) implants including patella resurfacing. All patients in the cemented arm received the allocated intervention, whereas 15 patients in the cementless arm required cementation of at least one component. Primary study outcomes included revisions and reoperation rates, patient-reported outcome measures (PROMs) and incidence of radiolucent lines assessed from standardised radiographs. Outcomes were compared using risk ratios, t-tests and Chi-squared tests. There was 95% follow-up at five years. There were no differences between the groups for incidence of revisions (1 cemented vs. 2 cementless, relative risk (RR): 1.4, 95% confidence interval (CI): 06-3.2, p=0.49; all periprosthetic infections) or other reoperations (10 cemented vs. 7 cementless, RR: 0.9, CI 0.5-1.6, p=0.62). Similarly, no differences were found in PROMs (Oxford Knee Score, EuroQol-5Dimensions, International Knee Society Score, Pain Visual Analog Scale, Forgotten Joint Score, or satisfaction). Compared with cementless TKA, cemented TKA had a higher incidence of non-progressive radiolucencies (27 cases, RR: 1.9, CI: 1.6-2.2, p<0.001), and longer surgical time of four minutes (73.4 vs. 69.7, p=0.04). At five years, cemented and cementless TKA demonstrated equivalent clinical outcomes, including revision rates, reoperation rates and PROMs. Additionally, the incidence of non-progressive radiolucencies detected on standardised radiographs were decreased with use of cementless compared with cemented TKA implants.

IntroductionAcetabular component loosening with associated bone loss is a challenge in revision hip arthroplasty. Trabecular Metal (TM) by Zimmer Biomet has been shown to have greater implant survivorship for all-cause acetabular revision in small cohort retrospective studies. Our study aims to review outcomes of acetabular TM implants locally.MethodThis is a retrospective observational study using data from Auckland City and North Shore Hospitals from 1st of January 2010 to 31st of December 2020. Primary outcome is implant survivorship (re-revision acetabular surgery for any cause) demonstrated using Kaplan-Meier analysis. Secondary outcome is indication for index revision and re-revision surgery. Multivariate analysis used to identify statistically significant factors for re-revision surgery.Results225 cases used acetabular TM implants (shells and/or augments) over 10 years. Indications include aseptic loosening (63%), instability (15%) and infection (13%). Of these, 12% (n=28) had further re-revision for infection (54%) and instability (21%). Median time to re-revision was 156 days (range 11 – 2022). No cases of re-revision were due to failure of bony ingrowth or acetabular component loosening. Ethnicity, smoking status, and age were not risk factors for re-revision procedures. Additionally, previous prosthetic joint infection, ethnicity, sex and age were not significant risk factors for re-revision due to infection. Implant survivorship was 80% at 1 year, 71% at 5 years and 64% at 10 years.DiscussionMain indications for re-revision were infection and instability. Demographic factors and co-morbidities did not correlate with increased re-revision risk. Survivorship is poorer compared to cumulative survivorship reported by the New Zealand Joint Registry (NZJR). Explanations are multifactorial and possibly contributed by underestimation of true revision rates by registry data.ConclusionsWe need to identify alternate causes for poorer survivorship and review the role of TM implants in acetabular revision within our specified population.

Background Total knee arthroplasty (TKA) is an effective procedure for patients with a variety of knee conditions. The main cause of aseptic TKA failure is implant loosening, which has been linked to poor cement mantle quality. Cementless components were introduced to offer better longer-term biological fixation through osseointegration; however, early designs led to increased rate of revision due to a lack of initial press-fit and bony ingrowth. Newer highly porous metal designs may alleviate this issue but randomised data of fully uncemented TKA (tibial, femoral, patella) is lacking. The aim of the Knee-Fix study is to investigate the long-term implant survival and patient outcomes of fully uncemented compared with cemented fixation in TKA. Our study hypothesis was that uncemented TKA would be as clinically reliable and durable as the gold-standard cemented TKA. Methods The Knee-Fix study is a two-arm, single-blinded, non-inferiority randomised controlled trial with 160 patients in each arm and follow-up at 6 weeks, 6 months, 12 months, 24 months, 5 years and 10 years. The primary outcome of interest is implant fixation, which will be measured by assessment of postoperative progressive radiolucencies with the Knee Society Total Knee Arthroplasty Roentgenographic Evaluation and Scoring System. Secondary outcome measures are patient-reported outcomes, measured using Oxford Knee Score (OKS), International Knee Society System (IKSS), Forgotten Joint Score-12 (FJS-12), EuroQol (EQ-5D-5L), VAS Pain, Patient Satisfaction Score and Net Promoter Score. Discussion While cemented fixation remains the gold standard, a growing proportion of TKA are now implanted cementless. Highly porous metal cementless components for TKA can offer several benefits including potentially improved biological fixation; however, long-term outcomes need further investigation. This prospective study will help discern long-term differences between the two techniques. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12616001624471 . Registered trial name: Knee-Fix study (Cemented vs Uncemented Total Knee Replacement). Registered on 24 November 2016.

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Stellar population and stellar kinematic studies provide unique but complementary insights into how galaxies build-up their stellar mass and angular momentum1–3. A galaxy’s mean stellar age reveals when stars were formed, but provides little constraint on how the galaxy’s mass was assembled. Resolved stellar dynamics 4 trace the change in angular momentum due to mergers, but major mergers tend to obscure the effect of earlier interactions 5 . With the rise of large multi-object integral field spectroscopic surveys, such as SAMI 6 and MaNGA 7 , and single-object integral field spectroscopic surveys (for example, ATLAS3D (ref. 8 ), CALIFA 9 , MASSIVE 10 ), it is now feasible to connect a galaxy′s star formation and merger history on the same resolved physical scales, over a large range in galaxy mass, morphology and environment4,11,12. Using the SAMI Galaxy Survey, here we present a combined study of spatially resolved stellar kinematics and global stellar populations. We find a strong correlation of stellar population age with location in the (V/σ, $${\boldsymbol{\epsilon}}_{{\boldsymbol{e}}}$$ ) diagram that links the ratio of ordered rotation to random motions in a galaxy to its observed ellipticity. For the large majority of galaxies that are oblate rotating spheroids, we find that characteristic stellar age follows the intrinsic ellipticity of galaxies remarkably well. Α combined study of spatially resolved stellar kinematics and global stellar populations with the SAMI Galaxy Survey finds a strong correlation between the characteristic stellar population age of a galaxy and its intrinsic ellipticity.

Background and purpose Acetabular impaction grafting has been shown to be very effective, but concerns regarding its suitability for larger defects have been highlighted. We report the use of this technique in a large cohort of patients, and address possible limitations of the technique. Methods We investigated a consecutive group of 339 cases of impaction grafting of the cup with morcellised impacted allograft bone for survivorship and mechanisms for early failure. Results Kaplan Meier survival was 89.1% (95% CI 83.2 to 95.0%) at 5.8 years for revision for any reason, and 91.6% (95% CI 85.9 to 97.3%) for revision for aseptic loosening of the cup. Of the 15 cases revised for aseptic cup loosening, nine were large rim mesh reconstructions, two were fractured Kerboull-Postel plates, two were migrating cages, one was a medial wall mesh failure and one had been treated by impaction alone. Interpretation In our series, results were disappointing where a large rim mesh or significant reconstruction was required. In light of these results, our technique has changed in that we now use predominantly larger chips of purely cancellous bone, 8–10 mm3 in size, to fill the cavity and larger diameter cups to better fill the aperture of the reconstructed acetabulum. In addition we now make greater use of i) implants made of a highly porous in-growth surface to constrain allograft chips and ii) bulk allografts combined with cages and morcellised chips in cases with very large segmental and cavitary defects.

为何此时问这个问题? 3D技术突然无处不在--预示着它将成为电视发展的未来并颠覆影迷们的观影体验.本周,英式橄榄球赞助商02宣布,在即将于下月开赛的六国赛中,将以3D方式向全英国40家奥迪安和世界影城影院现场直播英格兰对阵威尔士及爱尔兰的比赛.