Search Results (8)

Background: There is no consensus on the optimal type of antibiotic-loaded bone cement (ALBC) spacer for ue in the first stage of revision total hip arthroplasty (THA) as a method for treating/managing periprosthetic joint infection (PJI) following THA. The purpose of this study was to determine the influence of ALBC spacer type on a collection of outcome metrics for revision THA (rHA). We hypothesized that infectious complications would be comparable across spacer types, while mechanical complications would be more common with the use of hemiarthroplasty ALBC spacer designs in rHA. Methods: This was a multicenter retrospective review of 144 patients who underwent a planned two-stage revision for THA for PJI between 2011 and 2022. Patients were stratified into three groups: pre-molded articulating hemiarthroplasty ALBC (PHA) spacers, custom articulating hemiarthroplasty ALBC (CHA) spacers, and custom ALBC THA (CTHA) spacers. The types and incidence of complications that arose during the time that the spacer was in situ were obtained. In total, 29 (20.1%) PHA, 11 (7.6%) CHA, and 104 (72.2%) CTHA patients were included. Results: CHA patients were significantly younger (mean age: 54.1 years) than PHA (mean age: 63.9) and CTHA (mean age: 63.9) patients (p = 0.011). The proportion of patients discharged home was significantly higher in the CHA group (81.8%) compared to that in both the CTHA group (64.4%) and the PHA group (34.5%) (p = 0.02). The re-revision rate for hip PJI was higher for CHA (18.2%), followed by PHA (13.8%) and CTHA (5.8%), while hemiarthroplasty spacers had the highest dislocation rate (13.8% in PHA and 18.2% in CHA vs. 3.8% in CTHA, p = 0.055). The vast majority of the outcome metrics did not differ among the three spacer groups, with examples being the incidence of dislocations, the incidence of all types of unplanned procedures for treating/managing re-infection, the time to the second stage in the rHA, and the proportion of spacers that were not removed until the second stage in the rHA. Conclusions: For the vast majority of the outcome metrics determined, the difference among the three study groups was not significant. Thus, the present results suggest that antibiotic-loaded cement spacer type does not influence outcomes when a spacer is used in the first stage of a two-stage protocol for the revision of a THA. Full article

The HepACAGA (Hepatic Arteriography and C-arm CT-Guided Ablation) technique, which integrates C-arm CT guidance with transcatheter C-arm CT hepatic arteriography (C-arm CTHA), significantly improves liver tumor ablation outcomes by enhancing tumor visualization, navigation, and the intraprocedural assessment of ablation margins. The two key advantages of using C-arm CT over conventional CT for image guidance are firstly that the entire procedure can be performed in the angiography suite, eliminating the need for patient transfer between the angiography suite (catheterization) and CT-room (ablation), and secondly, that integrated C-arm needle guidance software can greatly reduce the difficulty of needle placement. Beyond these advantages, the HepACAGA technique offers additional benefits across four domains: (1) the direct conversion of ablation to intra-arterial liver-directed therapies (e.g., radioembolization or chemoembolization) upon the intraprocedural detection of disease progression; (2) the direct combination of ablation with intra-arterial treatments or portal vein embolization in one session; (3) the enhanced ablation effect through heat sink effect reduction with adjunct bland embolization or balloon occlusion; and (4) the immediate hemorrhage control through direct embolization. This pictorial essay demonstrates the advantages of combining C-arm CT guidance with real-time C-arm CTHA in the percutaneous thermal ablation of liver tumors, with clinical cases illustrating each of the aforementioned four key domains. Full article

Objective: One of the biggest advantages of robot-assisted hip replacement surgery is the reduction in dislocation rates because of proper implant positioning and accurate measurement of the leg length. Therefore, we aimed to investigate the usefulness of using the lateral epicondyle as a landmark to minimize errors in leg length measurement. Methods: This retrospective study was conducted between September 2023 and March 2025 and included 24 patients who underwent robotic-assisted total hip arthroplasty (rTHA, Group I). These procedures were performed by two experienced surgeons. The data were compared with results from two additional groups: patients who underwent rTHA using the intrapatella landmark (Group II) and those who underwent conventional total hip arthroplasty (cTHA) without robotic assistance (Group III). Leg length measurements were evaluated using postoperative X-rays and intraoperative robotic monitoring. ANOVA and Student’s t-test were used to analyze the significance of the variables (p < 0.05). Results: The mean X-ray LLD (xLLD) was 1.39 mm (−7.43–11.63 mm) and Mako LLD (mLLD) was 4.77 mm (−6–12 mm) in Group I. The mean xLLD was 3.54 mm (−5.02–13.6 mm) and mLLD was 4.20 mm (−22–14 mm) in Group II. The mean xLLD was 4.06 mm (−8.62–21.2 mm) in Group III. There was no statistical significance between the three groups (p = 0.241). Conclusions: Using the lateral femoral epicondyle as a landmark for the limb length measurement is a viable alternative to the intrapatella landmark in rTHA. This method may save time and offer and more convenient technique in measuring leg length changes during robotic-assisted total hip arthroplasty. Full article

Background/Objectives: Stress concentration around distal screw-removal holes confers a major risk for periprosthetic fractures following conversion total hip arthroplasty (cTHA) for intertrochanteric femoral fractures. Optimal stem-selection criteria and guidelines for cTHA can improve clinical outcomes. We determined the influence of the cementless stem length on the stress distribution around distal screw-removal holes. Methods: For the finite element analysis, institutional data from preoperative CT scans of contralateral femurs of patients who underwent THA were used. To replicate the post-nail-removal state, we used 3D registration of standard triangulated language data of the intramedullary nail as an unused material to simulate distal screw-removal holes, located 135 mm from the proximal end of the intramedullary nail. Cementless stems of 130, 140, 150, and 160 mm were individually registered using STL data, and cTHA models were constructed accordingly. Using simulations under load conditions representing normal walking and stair climbing, the mean and maximum equivalent stress values around the distal screw-removal holes were calculated. For multiple comparisons, repeated-measures ANOVA with Bonferroni correction was employed. Results: Compared to the 130 mm stem, the 150 mm and 160 mm stems similarly reduced the maximum equivalent stress around the distal screw-removal holes, although the 140 mm stem showed no significant difference with other stems. Conclusions: A ≥150 mm stem length reliably mitigated stress concentration around distal screw-removal holes post-cTHA; it is the optimal choice for balancing effectiveness and risk of complications and may contribute to improved long-term clinical outcomes. This study provides practical evidence for stem selection in cTHA and offers valuable insights for future treatment guidelines. Full article

Purpose: Liver metastases presenting as small hyperintense foci on diffusion-weighted imaging (DWI) pose a therapeutic challenge. Ablation is generally not possible since these lesions are often occult on ultrasound and CT. The purpose of this prospective study was to assess if small liver metastases (≤10 mm) detected on DWI can be successfully localized and ablated with the Hepatic Arteriography and C-Arm CT-Guided Ablation technique (HepACAGA). Materials and Methods: All consecutive patients with small liver metastases (≤10 mm), as measured on DWI, referred for ablation with HepACAGA between 1 January 2021, and 31 October 2023, were included. Re-ablations and ablations concomitant with another local treatment were excluded. The primary outcome was the technical success rate, defined as the intraprocedural detection and subsequent successful ablation of small liver metastases using HepACAGA. Secondary outcomes included the primary and secondary local tumor progression (LTP) rates and the complication rate. Results: A total of 15 patients (26 tumors) were included, with liver metastases from colorectal cancer (73%), neuro-endocrine tumors (15%), breast cancer (8%) and esophageal cancer (4%). All 26 tumors were successfully identified, punctured and ablated (a technical success rate of 100%). After a median follow-up of 9 months, primary and secondary LTP were 4% and 0%, respectively. No complications occurred. Conclusion: In this proof-of-concept study, the HepACAGA technique was successfully used to detect and ablate 100% of small liver metastases identified on DWI with a low recurrence rate and no complications. This technique enables the ablation of subcentimeter liver metastases detected on MRI. Full article

Purpose: Hepatic Arteriography and C-Arm CT-Guided Ablation of liver tumors (HepACAGA) is a novel technique, combining hepatic–arterial contrast injection with C-arm CT-guided navigation. This study compared the outcomes of the HepACAGA technique with patients treated with conventional ultrasound (US) and/or CT-guided ablation. Materials and Methods: In this retrospective cohort study, all consecutive patients with hepatocellular carcinoma (HCC) or colorectal liver metastases (CRLM) treated with conventional US-/CT-guided ablation between 1 January 2015, and 31 December 2020, and patients treated with HepACAGA between 1 January 2021, and 31 October 2023, were included. The primary outcome was local tumor recurrence-free survival (LTRFS). Secondary outcomes included the local tumor recurrence (LTR) rate and complication rate. Results: 68 patients (120 tumors) were included in the HepACAGA cohort and 53 patients (78 tumors) were included in the conventional cohort. In both cohorts, HCC was the predominant tumor type (63% and 73%, respectively). In the HepACAGA cohort, all patients received microwave ablation. Radiofrequency ablation was the main ablation technique in the conventional group (78%). LTRFS was significantly longer for patients treated with the HepACAGA technique (p = 0.015). Both LTR and the complication rate were significantly lower in the HepACAGA cohort compared to the conventional cohort (LTR 5% vs. 26%, respectively; p < 0.001) (complication rate 4% vs. 15%, respectively; p = 0.041). Conclusions: In this study, the HepACAGA technique was safer and more effective than conventional ablation for HCC and CRLM, resulting in lower rates of local tumor recurrence, longer local tumor recurrence-free survival and fewer procedure-related complications. Full article

With the rapidly evolving field of image-guided tumor ablation, there is an increasing demand and need for tools to optimize treatment success. Known factors affecting the success of (non-)thermal liver ablation procedures are the ability to optimize tumor and surrounding critical structure visualization, ablation applicator targeting, and ablation zone confirmation. A recent study showed superior local tumor progression-free survival and local control outcomes when using transcatheter computed tomography hepatic angiography (CTHA) guidance in percutaneous liver ablation procedures. This pictorial review provides eight clinical cases from three institutions, MD Anderson (Houston, TX, USA), Gustave Roussy (Paris, France), and Amsterdam UMC (Amsterdam, The Netherlands), with the intent to demonstrate the added value of real-time CTHA guided tumor ablation for primary liver tumors and liver-only metastatic disease. The clinical illustrations highlight the ability to improve the detectability of the initial target liver tumor(s) and identify surrounding critical vascular structures, detect ‘vanished’ and/or additional tumors intraprocedurally, differentiate local tumor progression from non-enhancing scar tissue, and promptly detect and respond to iatrogenic hemorrhagic events. Although at the cost of adding a minor but safe intervention, CTHA-guided liver tumor ablation minimizes complications of the actual ablation procedure, reduces the number of repeat ablations, and improves the oncological outcome of patients with liver malignancies. Therefore, we recommend adopting CTHA as a potential quality-improving guiding method within the (inter)national standards of practice. Full article

We describe the clinical effects of short-term lenvatinib administration prior to conventional transarterial chemoembolization (cTACE) on tumor vasculature. Two patients with unresectable hepatocellular carcinoma underwent high-resolution digital subtraction angiography (DSA) and perfusion four-dimensional computed tomography during hepatic arteriography (4D-CTHA) before and after administration of lenvatinib treatment. The doses and periods of lenvatinib administration were, respectively, 12 mg/day for 7 days and 8 mg/day for 4 days. In both cases, high-resolution DSA revealed a decrease in dilatation and tortuosity of the tumor vessels. Furthermore, the tumor staining became more refined, and newly formed tiny tumor vessels were observed. Perfusion 4D-CTHA revealed a decrease in arterial blood flow to the tumor by 28.6% (from 487.9 to 139.5 mL/min/100 mg) and 42.5% (from 288.2 to 122.6 mL/min/100 mg) in the two cases, respectively. The cTACE procedure resulted in good lipiodol accumulation and complete response. Patients have remained recurrence-free for 12 and 11 months after the cTACE procedure, respectively. The administration of short-term lenvatinib in these two cases resulted in the normalization of tumor vessels, which likely led to improved lipiodol accumulation and a favorable antitumor effect. Full article