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Gulraj S Matharu, Andrew Judge, David W Murray, Hemant G Pandit
BACKGROUND: Metal-on-metal hip replacement (MoMHR) revision surgery for adverse reactions to metal debris (ARMD) has been associated with an increased risk of early complications and reoperation and inferior patient-reported outcome scores compared with non-ARMD revisions. As a result, early revision specifically for ARMD with adoption of a lower surgical threshold has been widely recommended with the goal of improving the subsequent prognosis after ARMD revisions. However, no large cohorts have compared the risk of complications and reoperation after MoMHR revision surgery for ARMD (an unanticipated revision indication) with those after non-ARMD revisions (which represent conventional modes of arthroplasty revision)...
February 2018: Clinical Orthopaedics and related Research
Yoshinubo Uchihara, George Grammatopoulos, Mitsuru Munemoto, Gulraj Matharu, Yusuke Inagaki, Hemant Pandit, Yasuhito Tanaka, Nick A Athanasou
Metal-on-metal hip resurfacing arthroplasties (MoMHRAs) have a high failure rate due to pseudotumour formation. It is not certain whether pseudotumours in bilateral MoMHRAs form on the basis of an adverse reaction to metal debris (ARMD) that is entirely due to a local innate and adaptive immune response to Cobalt-Chrome (Co-Cr) wear particles. To determine if there is a systemic component to ARMD in bilateral MoMHRAs, we examined the histology of ARMD in unilateral and bilateral MoMHRAs revised for pseudotumour and determined whether implant survival differed between these two groups...
March 7, 2018: Journal of Materials Science. Materials in Medicine
Gulraj S Matharu, Antti Eskelinen, Andrew Judge, Hemant G Pandit, David W Murray
Background and purpose - The initial outcomes following metal-on-metal hip arthroplasty (MoMHA) revision surgery performed for adverse reactions to metal debris (ARMD) were poor. Furthermore, robust thresholds for performing ARMD revision are lacking. This article is the second of 2. The first article considered the various investigative modalities used during MoMHA patient surveillance (Matharu et al. 2018a ). The present article aims to provide a clinical update regarding ARMD revision surgery in MoMHA patients (hip resurfacing and large-diameter MoM total hip arthroplasty), with specific focus on the threshold for performing ARMD revision, the surgical strategy, and the outcomes following revision...
March 1, 2018: Acta Orthopaedica
Andrijana Kopić, Dubravka Biuk, Josip Barać, Maja Vinković, Tvrtka Benašić, Vlatko Kopić
Over the past decade, intravitreal injections of anti-VEGF agents have been widely used and intensively developed as a treatment option for many ophthalmological indications. Due to its availability and low cost, the most frequently used anti-VEGF agent is bevacizumab. This type of therapy is often indicated in patients with exudative age-related macular degeneration (ARMD) and diabetic macular edema (DME). If, in addition to these two conditions, patients have a diagnosis of primary open angle glaucoma (POAG), they also present with optic nerve head (ONH) retinal nerve fiber layer (RNFL) thinning...
September 2017: Acta Clinica Croatica
Ran Tao, Fan Liu, Ya-Ke Liu, Yue Lu, Hua Xu, Yi Cao, Zhen-Yu Zhou, Wei Wang
INTRODUCTION: Both hip resurfacing arthroplasty (HRA) and large-diameter head metal-on-metal total hip arthroplasty (LDH MoM THA) are generally used for young and active patients. A number of comparative studies of HRA and total hip arthroplasty have been published in the literature. However, studies that have compared HRA with LDH MoM THA are rare. The purpose of this study is to compare the mid-term results of HRA with those of LDH MoM THA in young patients. PATIENTS AND METHODS: Between 2007 and 2011, 68 patients were enrolled in the study and randomized into two groups: HRA group (28 hips) and LDH MoM THA group (40 hips)...
February 18, 2018: International Orthopaedics
Richard de Steiger, Andrea Peng, Peter Lewis, Stephen Graves
BACKGROUND: Large-head metal-on-metal (MoM) bearing hip replacements have been shown to have a much higher rate of revision than other bearing surfaces. However, small-head (≤ 32 mm) MoM bearing surfaces have been in use for many years with several reports of satisfactory mid- to long-term survivorship. It is unclear whether the long-term survival of small-head MoM devices will continue to be satisfactory or whether the same concerns seen with the large-head MoM devices will ultimately become more prevalent...
February 8, 2018: Clinical Orthopaedics and related Research
Fermin Rodrigo, José María Ruiz-Moreno, Juan Bernabé García, María Eugenia Torregrosa, José Vicente Segura, David P Piñero
PURPOSE: To evaluate preliminarily and compare the level of plasmatic biomarkers of vascular risk in patients with and without exudative age-related macular degeneration (ARMD) and to relate it to vascular resistance alterations in the ophthalmic artery (OA), central retinal artery (CRA), posterior temporal ciliary artery (PTCA), and posterior nasal ciliary artery (PNCA). METHODS: Color Doppler imaging of the OA, CRA, PTCA, and PNCA was performed in 30 eyes of 30 cataract patients (control group) as well as in 30 eyes of 30 patients with naive exudative ARMD (study group), measuring the peak systolic velocity, end-diastolic velocity (EDV), and Pourcelot resistive index (RI)...
January 2018: Indian Journal of Ophthalmology
Erik Aro, Marko Seppänen, Keijo T Mäkelä, Pauliina Luoto, Anne Roivainen, Hannu T Aro
Metal-on-metal (MoM) bearings in total hip arthroplasties and hip resurfacing arthroplasties have recently shown a new type of complication: adverse reactions to metal debris (ARMD). ARMD is characterized by local severe inflammation and tissue necrosis leading to implant failures. The gluteal muscle region is important for the patient outcome after revision surgery. This prospective positron emission tomography/computed tomography (PET/CT) study was undertaken to evaluate the characteristics of 2-deoxy-2-[18 F]fluoro-d-glucose ([18 F]FDG) and [68 Ga]Gallium citrate ([68 Ga]Citrate) PET/CT in ARMD patients...
December 27, 2017: Clinical Physiology and Functional Imaging
Lari Lehtovirta, Aleksi Reito, Jyrki Parkkinen, Harry Hothi, Johann Henckel, Alister Hart, Antti Eskelinen
BACKGROUND: Adverse Reaction to Metal Debris (ARMD) is still a major reason for revision surgeries in patients with metal-on-metal (MoM) hip replacements. ARMD consists of a wide range of alterations in periprosthetic tissues, most important of which are metallosis, inflammation, pseudotumors and necrosis. Studies investigating histopathological findings and their association to implant wear or indirect measures of wear have yielded inconsistent results. Therefore, we aimed to investigate bearing surface wear volume, whole blood and synovial fluid metal ion concentrations, histopathological findings in periprosthetic tissues and their associations...
December 11, 2017: BMC Musculoskeletal Disorders
Krishna Kant Singh, Stephane Redon
Adaptively restrained molecular dynamics (ARMD) allows users to perform more integration steps in wall-clock time by switching on and off positional degrees of freedoms. This article presents new, single-pass incremental force updates algorithms to efficiently simulate a system using ARMD. We assessed different algorithms for speedup measurements and implemented them in the LAMMPS MD package. We validated the single-pass incremental force update algorithm on four different benchmarks using diverse pair potentials...
March 30, 2018: Journal of Computational Chemistry
Samina Khalid, M Usman Akram, Taimur Hassan, Amina Jameel, Tehmina Khalil
Age-related macular degeneration (ARMD) is one of the most common retinal syndromes that occurs in elderly people. Different eye testing techniques such as fundus photography and optical coherence tomography (OCT) are used to clinically examine the ARMD-affected patients. Many researchers have worked on detecting ARMD from fundus images, few of them also worked on detecting ARMD from OCT images. However, there are only few systems that establish the correspondence between fundus and OCT images to give an accurate prediction of ARMD pathology...
December 4, 2017: Journal of Digital Imaging: the Official Journal of the Society for Computer Applications in Radiology
Donatella Granchi, Lucia Maria Savarino, Gabriela Ciapetti, Nicola Baldini
Metals and metal alloys are the most used materials in orthopedic implants. The focus is on total hip arthroplasty (THA) that, though well tolerated, may be associated with local and remote adverse effects in the medium-long term. This review aims to summarize data on the biological consequences of the metal implant degradation that have been attributed predominantly to metal-on-metal (MoM) THA. Local responses to metals consist of a broad clinical spectrum ranging from small asymptomatic tissue lesions to severe destruction of bone and soft tissues, which are designated as metallosis, adverse reactions to metal debris (ARMD), aseptic lymphocytic vasculitis associated lesion (ALVAL), and pseudotumors...
November 13, 2017: Critical Reviews in Toxicology
Gulraj S Matharu, Andrew Judge, Antti Eskelinen, David W Murray, Hemant G Pandit
The unexpected high revision rates of large-diameter (femoral head sizes of 36 mm or greater) metal-on-metal hip arthroplasties (MoMHAs) have led to worldwide regulatory authorities recommending regular surveillance, even for asymptomatic individuals. However, these recommendations are not evidence-based and are very costly. The rapidly evolving evidence base requires an update regarding the investigation and management of MoMHA patients. This article is the first of 2 (the second article in this series will consider the threshold for performing revision, and the outcomes following ARMD revision surgery: Matharu et al...
November 6, 2017: Acta Orthopaedica
Anthony Deny, Janie Barry, Jonathan R B Hutt, Martin Lavigne, Vincent Massé, Pascal-André Vendittoli
INTRODUCTION: Metal ion release from wear and corrosion at the femoral head-stem taper junction can evoke local adverse reactions to metal debris (ARMD). In a specific large-diameter head (LDH) total hip arthroplasty (THA) system, ceramic femoral heads of 44 to 48 mm are available with a titanium (Ti) adaptor sleeve, while heads of 36- to 40-mm come without sleeves. The hypothesis of this study is that the Ti adaptor sleeve with LDH ceramic-on-ceramic (CoC) bearings will not cause wear or corrosion at the taper junction and, thus, will not generate high whole blood Ti ion levels...
October 16, 2017: Hip International: the Journal of Clinical and Experimental Research on Hip Pathology and Therapy
Aswin Pyakurel, Delphine Balmer, Marc K Saba-El-Leil, Caroline Kizilyaprak, Jean Daraspe, Bruno M Humbel, Laure Voisin, Yun Z Le, Johannes von Lintig, Sylvain Meloche, Raphaël Roduit
Recent work suggested that the activity of extracellular signal-regulated kinase 1/2 (ERK1/2) is increased in the retinal pigment epithelium (RPE) of age-related macular degeneration (ARMD) patients and therefore could be an attractive therapeutic target. Notably, ERK1/2 pathway inhibitors are used in cancer therapy, with severe and noncharacterized ocular side effects. To decipher the role of ERK1/2 in RPE cells, we conditionally disrupted the Erk1 and Erk2 genes in mouse RPE. The loss of ERK1/2 activity resulted in a significant decrease in the level of RPE65 expression, a decrease in ocular retinoid levels concomitant with low visual function, and a rapid disorganization of RPE cells, ultimately leading to retinal degeneration...
December 15, 2017: Molecular and Cellular Biology
Gebran Khneizer, Ahmad Al-Taee, Bahar Bastani
BACKGROUND: Monoclonal antibodies targeting vascular endothelial growth factor (VEGF), such as bevacizumab, are administered intravitreally for the treatment of wet or exudative age-related macular degeneration (ARMD). Systemic use of bevacizumab has been linked to a wide range of renal adverse effects including proteinuria and hypertension. CASE PRESENTATION: We present the case of a 77-year-old Caucasian male with a past medical history of hypertension, vitamin D deficiency and paroxysmal atrial fibrillation who presented to primary care clinic with a 2-week history of bilateral lower extremity edema, 2 months after completing four monthly intravitreal injections of bevacizumab for ARMD...
July 2017: Journal of Nephropathology
Mao-Bo Du, Shu-Zhi Liu, Kai Xu, Li-Na Liang, Ai-Ping He, Yao Yao, Ya-Mei Liu
In this review, the authors summarized the drugs in treatment of the age-related macular degeneration (AMD or ARMD), including the pathogenesis of the age-related macular degeneration at home and abroad, dosage forms used in the treatment, and the drugs research and development directions in the future. AMD disease is the third largest blinding diseases all over the world, with an incidence of 6.62%. The dosage form of the traditional medicine is mostly oral formulations, playing a role in body, while the newly dosage form is topical drug delivery formulation...
February 2017: Zhongguo Zhong Yao za Zhi, Zhongguo Zhongyao Zazhi, China Journal of Chinese Materia Medica
Tobias Reiner, Thuy D Do, Matthias C Klot, Fabian Hertzsch, Kirsten Seelmann, Matthias M Gaida, Marc-André Weber, Tobias Gotterbarm
BACKGROUND: Concern has been raised about the late onset of adverse reactions to metal debris (ARMD) in patients with a small-head metal-on-metal total hip replacement. The aims of this study were to assess the frequency and characteristic appearance of ARMD in patients with a small-head (28-mm) metal-on-metal total hip replacement and elevated blood ion levels (>1 μg/L) after a minimum follow-up of 10 years and to analyze the possible risk factors associated with the prevalence of these lesions...
September 20, 2017: Journal of Bone and Joint Surgery. American Volume
Gulraj S Matharu, Fiona Berryman, Andrew Judge, Aleksi Reito, Jamie McConnell, Olli Lainiala, Stephen Young, Antti Eskelinen, Hemant G Pandit, David W Murray
BACKGROUND: The authors of recent studies have reported newly devised implant-specific blood metal ion thresholds to predict adverse reactions to metal debris (ARMD) in patients who have undergone unilateral or bilateral metal-on-metal (MoM) hip arthroplasty. These thresholds were most effective for identifying patients at low risk of ARMD. We investigated whether these newly devised blood metal ion thresholds could effectively identify patients at risk of ARMD after MoM hip arthroplasty in an external cohort of patients...
September 20, 2017: Journal of Bone and Joint Surgery. American Volume
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