Search Results (29)

This is a retrospective, single-center cohort study comparing the long-term radiographic osseointegration and aseptic loosening between a 3D-printed EPORE^® collar and a prior generation HA-coated collar in endoprosthetic reconstructions. Achieving stable bone integration in endoprosthetic reconstructions remains challenging, with hydroxyapatite (HA)-coated collars being the only option available in the past. Earlier studies from our center have shown reliable and accelerated osseointegration at the bone–collar interface using a novel highly porous 3D-printed EPORE^® collar system compared to a previously used HA-coated collar. Methods: Twenty-eight patients who underwent an implantation of endoprostheses utilizing the novel 3D-printed EPORE^® collar system were case-matched to 24 patients who had previously undergone surgeries using a HA-coated collar. The mean age at surgery was 65.2 years (range: 17–95 years). Patients in the HA-coated collar group had a mean age of 63.8 years (range: 17–86 years), while those in the 3D-printed collar group had a mean age of 66.7 years (range: 32–95 years), with no statistically significant difference between groups (p = 0.876). A minimum radiological and clinical follow-up of 2 years was available in all included cases. Osseointegration was evaluated using postoperative plain radiographs in two planes based on a previously validated semi-quantitative score. Results: When aseptic loosening was used as the primary endpoint, no failures occurred in the 3D-printed EPORE^® group during the study period. The overall rate of stem loosening (including both aseptic and septic causes) was 7% (2/28) in the 3D-printed group and 16% (4/24) in the HA-coated group. All cases of loosening in the 3D-printed cohort were related to septic failure. This translates into a 2-year aseptic-loosening-free survival of 100% in the 3D-printed group. When the radiographic osseointegration was analyzed as the endpoint, the rate of successful osseointegration was significantly higher in the 3D-printed group (92.9%, 26/28; 95% CI 76.5–99.1%) compared with the HA-coated group (70.8%, 17/24; 95% CI 48.9–87.4%; p = 0.04). The distribution of ongrowth scores also differed significantly between groups. The highest ongrowth score (grade 4) was achieved in 82.14% of 3D-printed implants (23/28; 95% CI 63.1–93.9%), compared with 37.5% of HA-coated implants (9/24; p = 0.0002). The time to achieve grade 4 ongrowth was significantly shorter in the 3D-printed cohort, with a median of 470 days (IQR 360–610), compared with 1482 days (IQR 1020–1860) in the HA-coated group (p < 0.0001). In addition, patients in the 3D-printed implant group had a significantly higher mean body mass index compared with the HA-coated group (32.51 vs. 28.36, p = 0.01). Conclusions: These results show that the novel highly porous 3D-printed EPORE^® collars reduce aseptic loosening and accelerate extracortical bridging in endoprosthetic replacements. This benefit persisted even in higher BMI or revision contexts when compared to the previously used HA-coated collars. Full article

Background and Objectives: Total femoral replacement (TFR) was originally developed for limb salvage following the resection of malignant tumors. Over time, its indications have expanded, now serving as a reconstructive option for failed endoprosthetic replacements and severe trauma cases. Despite its advantages, TFR is a highly complex surgical procedure associated with significant complication rates. This study aims to analyze the management of complications and propose strategies to mitigate associated risks. Materials and Methods: This is a retrospective study conducted on patients from two independent hospitals who underwent TFR for different reasons. Results: Nineteen patients were included: eight underwent TFR for oncological indications, while 11 had the procedure as a revision following failed endoprosthetic arthroplasty or trauma. Postoperative complications were observed in 10 patients (53%), including hip dislocation (21%), mechanical implant failure (11%), infection (21%), wound healing complications (26%), and metal allergy symptoms (5%). Revision surgery was required in six patients (32%), but no cases necessitated amputation. Conclusions: TFR is associated with a high risk of complications, with infection and wound healing issues being the most prevalent. In our experience effective complication management strategies should include early intervention, considering TFR at an earlier stage in non-oncological patients to minimize multiple revision surgeries; allergy screening, assessing for potential metal hypersensitivity preoperatively; dislocation prevention, implementing dual mobility bearings to reduce instability; infection control, utilizing intraoperative local antibiotic therapy in revision cases; and wound management, applying vacuum-assisted closure (VAC) therapy postoperatively to enhance wound healing. Implementing these strategies may improve patient outcomes and reduce the burden of complications associated with TFR. Full article

Background: Limb-salvage surgery using extendable distal femoral endoprostheses has become the standard reconstruction following tumor resection in skeletally immature patients, allowing continued growth and improved function. However, mechanical complications, particularly tibial pain, remain challenging and poorly understood. This study aimed to identify radiographic predictors of tibial pain and evaluate their potential utility in early risk detection. Methods: A retrospective cohort study was conducted of 29 skeletally immature patients (mean age 10.4 years) who underwent expandable distal femoral endoprosthetic replacement between 2008 and 2018 at a tertiary orthopedic oncology center. Standardized radiographs were analyzed at 6 months and final follow-up (mean 75 months) to assess cortical thickness, stem-to-cortex distances, stem migration, stress shielding, pedestal formation, and periosteal reaction. Associations between radiographic parameters and tibial pain were assessed using multivariable logistic regression, t-tests, and chi-square analyses. Results: Seventeen patients (58.6%) developed activity-limiting tibial pain requiring analgesics, as documented during follow-up. Mean medial and lateral cortical thickness increased from 3.0 mm and 3.4 mm to 4.1 mm and 5.1 mm, respectively. The logistic regression model demonstrated strong explanatory power (Pseudo R² = 0.57, p = 0.004). Medial cortical thickness at last follow-up was the only significant independent predictor of tibial pain (p = 0.042), and was significantly associated with tibial pain. Patients with tibial pain exhibited greater medial cortical thickening (p < 0.001). Stem migration (φ = 0.421, p = 0.065), stress shielding (φ = 0.476, p = 0.044), pedestal formation (φ = 0.608, p = 0.004), and periosteal reaction (φ = 0.569, p = 0.008) were also associated with pain. Conclusions: Medial cortical hypertrophy emerged as a potential radiographic biomarker for tibial pain. after expandable distal femoral endoprosthesis in growing patients. The findings suggest that cortical remodeling, stress shielding, and pedestal formation collectively reflect stem micromotion and bone adaptation. Early radiographic surveillance of these parameters warrants further investigation in prospective studies to determine their clinical utility. Larger multicenter studies are warranted to validate these predictors and refine postoperative monitoring protocols. Full article

Background/Objectives: Osteosarcoma and Ewing sarcoma are the predominant malignant bone tumors of the lower limbs in children. With 5-year survival rates of 70–77% for localized disease, limb salvage with growth-compatible reconstruction has replaced amputation as the standard. This review aimed to synthesize current reconstruction strategies, propose an age-and defect-based decision algorithm, and highlight growth-preserving innovations for skeletally immature patients. Methods: This narrative review of surgical techniques—including rotationplasty, biological reconstruction (vascularized/non-vascularized fibula, allograft, recycled autograft, “hot dog” composite), bone transport, and endoprosthetic replacement (modular, extendable, 3D-printed)—was conducted, with a literature search covering January 1990 to October 2025 and emphasized pediatric studies published after 2020, emphasizing pediatric outcomes, complication profiles, and functional scores. Results: Across pediatric and mixed-age cohorts (typically n ≈ 10–30 per technique; median follow-up 3–10 years), rotationplasty demonstrated high durability with Musculoskeletal Tumor Society (MSTS) scores of 21–28/30, especially in children < 6 years. Biological reconstruction achieved >80% union in defects < 6 cm, while vascularized fibula grafts yielded 82–95% union for 6–15 cm defects. Bone transport produced reliable union for 3–15 cm defects but required prolonged fixation (40–60 days/cm) and had high pin-tract infection rates (50–60%). Extendable endoprostheses demonstrated 5-year prosthesis survival of 54–87%, while early joint-preserving 3D-printed implants improved MSTS scores from 17 to 28 points in a pediatric series (n = 7, mean follow-up 30 months). Conclusions: Personalized reconstruction guided by a child-centered algorithm optimizes oncologic control, skeletal growth, and long-term function. Emerging 3D-printed joint-preserving implants and noninvasive lengthening technologies promise further reduction in revisions and complications in pediatric limb salvage. Full article

Background/Objective: Endoprosthetic proximal femoral replacement is a reconstructive procedure for preserving ambulatory function following tumor resection. Different prosthetic systems for endoprosthetic proximal femoral replacement may result in different stem placement techniques, especially regarding the anteversion angle of the stem. The aim of this study was to evaluate femoral rotation and stem anteversion following endoprosthetic proximal femoral replacement using two different prosthetic systems, and to investigate their influence on postoperative quality of life. Methods: We retrospectively reviewed 30 patients who underwent endoprosthetic proximal femoral replacement at our institution between 2008 and 2022. The evaluated parameters included patient demographics, anatomical and functional stem anteversion, femoral rotation, femoral resection length, implant type, and Musculoskeletal Tumor Society score. Results: The cohort comprised 16 males and 14 females with a mean age of 65.2 ± 13.5 years. Twenty patients received the Global Modular Replacement System implants and 10 received the Kyocera Modular Limb Salvage System implants. The mean anatomical stem anteversion was 17.0 ± 17.7°, and the mean femoral rotation was 14.4 ± 22.6°. The Global Modular Replacement System implants demonstrated less variability in anatomical stem anteversion (11.7 ± 15.2°) compared to the Kyocera Modular Limb Salvage System (27.6 ± 18.4°, p = 0.02). A significant negative correlation was found between anatomical stem anteversion and femoral rotation (r = −0.78, p < 0.01), and a positive correlation between femoral rotation and functional stem anteversion (r = 0.62, p < 0.01). Musculoskeletal Tumor Society scores were available in 14 patients and correlated significantly with functional stem anteversion (r = −0.62, p = 0.02) and femoral resection length (r = −0.61, p = 0.02), but not with anatomical stem anteversion or femoral rotation alone. Conclusions: This study demonstrated that stem placement angles differ between prosthetic systems. These differences are attributable to variations in surgical implantation techniques and prosthesis design philosophies. In particular, the Global Modular Replacement System incorporates built-in anteversion, and when using such prostheses, referencing the linea aspera enables more stable restoration of the anatomical stem anteversion. Excessive reduction in anatomical stem anteversion is not recommended to avoid excessive external femoral rotation. Full article

Background: Megaprosthetic replacement is widely used following tumour resection but remains challenged by periprosthetic joint infection (PJI) and variable functional outcomes. This narrative review aims to summarise current evidence on infection rates, prevention strategies, and functional outcomes following proximal humerus megaprosthetic reconstruction. We hypothesise that antibacterial coatings and improved soft-tissue techniques reduce infection rates and enhance functional recovery. Methods: A comprehensive narrative review of PubMed, Web of Science, and the Cochrane Library was performed using the terms proximal humerus, shoulder, bone tumor, sarcoma, neoplasm, infection, megaprosthesis, and endoprosthetic replacement. Reference lists were screened manually. Case reports and series with fewer than five patients were excluded. Twenty-seven clinical studies (more than 1100 patients; mainly osteosarcoma, chondrosarcoma, and metastatic lesions) were included and qualitatively analyzed. Results: The reported infection rates ranged from 4% to 20%, with higher risk in patients receiving adjuvant therapy. Silver-coated implants reduced PJI compared with uncoated designs (e.g., 11.2% → 9.2% in primary implants; 29.2% → 13.7% in revisions) without systemic toxicity. Alternative antibacterial coatings (e.g., silver- or copper-enriched hydroxyapatite) showed promising early results but remain supported by limited clinical data. Soft-tissue stabilization with Trevira tube or synthetic mesh improved joint stability and did not increase infection risk. Functional outcomes, usually assessed by MSTS or TESS, were moderate to good (≈60–80%) overall, with better scores when the deltoid and axillary nerve were preserved or when reverse total shoulder arthroplasty was possible. Conclusions: Proximal humerus megaprosthetic reconstruction benefits from meticulous soft-tissue handling, selective use of antibacterial technologies, and multidisciplinary management. The current literature is mainly retrospective, heterogeneous, and non-comparative. Prospective multicenter studies are needed to clarify the long-term effectiveness of silver or alternative coatings, soft-tissue reconstruction techniques, and emerging custom-made 3D-printed prostheses. Full article

Objectives: The indications for femoral endoprosthesis replacement (EPR) use in limb reconstruction have broadened over the last decade. Despite its success, loosening remains the most common reason for failure. No previous system has classified loosening based on the anatomical site in relation to the prosthesis. The aim of this study is to propose a simple reproducible classification system for EPR loosening. Methods: Adult patients that underwent a revision EPR for loosening from 1 January 2023–1 May 2025 were included. Radiographs and computed tomography (CT) images were retrospectively reviewed. The grading was developed on radiographs to classify loosening around EPRs as normal (grade 1), loosening at the shoulder (grade 2), loosening around the shaft of the peg (grade 3), loosening below the tip of the prosthesis (grade 4), associated penetration of prosthesis through the cortex (grade 5), and associated fracture (grade 6). Results: A total of 28 patients were included. The majority of patients were male (n = 17; 61%) with a mean age of 50.6 years (SD 16.1). The average time from the index surgery to diagnosis of loosening was 10.1 years (SD 7.6). The most common pattern of loosening was grade 3 (N = 16; 57.1%). Conclusions: Our classification system proposes an easily adopted way to describe all patterns of loosening around EPRs, potentially guiding revision surgical strategies. Standardizing the approach in evaluating loosening will aid in producing national guidelines for managing this complex complication and may help improve future EPR design. Full article

Background/Objectives: Resection arthroplasty is well established in treating bone defects following tumor resection, with the distal femur and proximal tibia being its most common localizations. The aim of this study was to analyze the functional outcomes and quality of life following endoprosthetic reconstruction for malignant bone tumors of the knee joint. Methods: We retrospectively included all patients treated with an endoprosthetic reconstruction following resection of a malignant bone tumor of the knee at our institution. Functional outcomes (KOOS, OKS, MSTS, and KSS) and health-related quality of life scores [QoL] (SF-36, Karnofsky Index) were evaluated. Chi-square and Fisher’s exact test was used for categorical variables, T-test and Whitney U-Mann tests for continuous variables. Survival was calculated using the Kaplan–Meier curves. Results: 32 patients were included. A total of 12 patients had died at the time of follow-up. Among the remaining 20 patients (m:w 17:3), mean follow-up was 8.1 years (range, 8.12 ± 6.8). Mean age at the time of tumor diagnosis was 50 ± 23.3 (10–83) years. According to age, patients were divided into two groups (group C1: <29 years, group C2: >29 years). Group C1 showed significantly better results regarding functional outcome (p < 0.05). The anatomic location of the replacement and a revision surgery did not influence the functional outcome (p > 0.05). QoL showed no significant differences in subgroup analysis (p > 0.05). Primary bone tumors had a significantly better survival (primary tumor: 216.90 months [168.42–265.83]; secondary tumor: 37.03 months [11.71–62.35] p = 0.01). Furthermore, pathologic fractures were associated with significantly worse survival (pathologic fracture: 50.24 months [0.00–102.43]; pathologic fracture 190.63 moths [139.28–241.45]; p = 0.007). Conclusions: Knee resection arthroplasty can offer meaningful long-term functional outcomes and acceptable quality of life in selected patients with musculoskeletal tumors. While the rarity and heterogeneity of such cases remain a challenge, our findings contribute to the growing evidence supporting this complex but limb-sparing surgical option. Full article

This study aimed to retrospectively analyze the follow-up results of cases in which the adjacent joint was preserved using a custom-made uncemented short-stem design (hollow stem) with optional external flanches in tumor endoprosthetic replacement due to bone sarcomas in 13 patients (with an average age of 9.6 years) between 2017 and 2023. Reconstructions were proximal femur (n = 6), intercalary femur (n = 4), intercalary tibia (n = 2), and proximal humerus (n = 1) tumor prostheses. The hollow body was used distally in 10 of the megaprotheses, proximally in 1, and both proximally and distally in 2 of them. The average distance from the joints was 6 cm in stems with flanches and 11.8 cm in stems without flanches. No aseptic loosening or deep infection was observed during an average follow-up of 34 months. Except for one case with a tibial intercalary prosthesis that needed a revision, all cases were well osteointegrated and all lower extremity cases could bear full weight without pain. In cases where the remaining bone stock after bone resection is insufficient for a standard stem implantation, reconstruction with a patient-specific short hollow-stem design appears to be a good alternative to protect healthy joints with high prosthesis survival and low revision rates in the short-term follow-up. Full article

Background/Objectives: Acetabular fractures, traditionally linked to high-impact trauma in younger adults, are increasingly observed in the elderly due to falls and poor bone quality. This demographic shift necessitates updated treatment approaches. This study analyzes demographic trends and treatment evolution over a decade using the German pelvic fracture registry. Methods: Data on acetabular fractures were analyzed from the German pelvic fracture registry of the German Trauma Society. Parameters included classification, demographics, treatment methods, and surgical details. Trends were assessed by grouping patients based on treatment intervals and age, comparing treatment methods, surgical approaches, and reduction quality across these groups, considering fracture types and treatment volume. Results: The study included 2853 unilateral acetabular fractures with a mean patient age of 61.5 years, showing an increasing age trend. A shift from simple to complex fractures involving the anterior acetabular column was observed. Operative treatment was performed in 62.5% of cases, more common in non-geriatric patients and those with posterior column involvement. The use of anterior intrapelvic approaches increased over time, replacing the Ilioinguinal extrapelvic approach. Anatomical reduction was achieved in 47.4% of cases, with 31.7% having imperfect reductions and 20.9% poor reductions. High-volume centers had significantly better reduction outcomes, particularly for simple fractures. Geriatric patients exhibited worse reduction quality compared to younger patients. In-hospital mortality was stable at 3.3%. Conclusions: The study highlights a demographic shift towards an older patient population, leading to more complex fracture patterns. Despite advancements in surgical techniques and new implant technologies, these demographic changes have resulted in lower reduction quality for complex fractures. Emphasis is placed on careful patient selection for reconstructive surgery or endoprosthetic replacement to ensure high-quality outcomes. Full article

Objectives: This study aims to evaluate the patellar height changes after distal femur (DF) endoprosthetic replacement (EPR) and its impact on anterior knee pain (AKP) and range of motion (ROM). Methods: A retrospective review of three institutions’ databases was performed. The patellar height was determined using the modified Insall–Salvati ratio (MIS), the Blackburne–Peel (BP) and the Caton–Deschamps (CD) indexes. Data regarding AKP and ROM were collected. Results: A total of 199 patients were included. The mean age at presentation was 37.9 ± 23.1 years. The mean one-year follow-up MIS, BP and CD were 1.52 (sd: 0.41), 0.82 (sd: 0.33) and 0.93 (sd: 0.33). Patellar height decreased significantly compared to the pre-operative values according to all three scores (p < 0.001). AKP was reported by 34 (17.1%) patients at 1 year follow-up. Patients with patella baja (MIS < 1.2) or pseudo patella baja (CD < 0.6) had a higher incidence of AKP (p = 0.037 and p = 0.024, respectively). The mean flexion ROM was 91°, with a direct correlation with patellar height (MIS p = 0.020, BP p = 0.036 and CD p = 0.036). Conclusion: The restoration of the native position of the joint line in DF EPR is important to maintain optimal patellofemoral biomechanics. Despite surgeons’ tendency toward a reduction in patellar height with respect to pre-operative values, an increase in patellar height might help to achieve better knee flexion and reduce AKP. Full article

This contribution attempts to provide a state-of-the-art account of the physicochemical and biomedical properties of the plasma-sprayed hydroxylapatite (HAp) coatings that are routinely applied to the surfaces of metallic endoprosthetic and dental root implants designed to replace or restore the lost functions of diseased or damaged tissues of the human body. Even though the residence time of powder particles of HAp in the plasma jet is extremely short, the high temperature applied induces compositional and structural changes in the precursor HAp that severely affect its chemical and physical properties and in turn its biomedical performance. These changes are based on the incongruent melting behavior of HAp and can be traced, among many other analytical techniques, by high resolution synchrotron X-ray diffraction, vibrational (Raman) spectroscopy, and nuclear magnetic resonance (NMR) spectroscopy. In vivo reactions of the plasma-sprayed coatings to extracellular fluid (ECF) can be assessed and predicted by in vitro testing using simulated body fluids (SBFs) as proxy agents. Ways to safeguard the appropriate biological performance of HAp coatings in long-term service by controlling their phase content, porosity, surface roughness, residual stress distribution, and adhesion to the implant surface are being discussed. Full article

Aseptic implant loosening after a total joint replacement is partially influenced by material-specific factors when cobalt–chromium alloys are used, including osteolysis induced by wear and corrosion products and stress shielding. Here, we aim to characterize a hybrid material consisting of alumina-toughened zirconia (ATZ) ceramics and additively manufactured Ti-35Nb-6Ta (TiNbTa) alloys, which are joined by a glass solder. The structure of the joint, the static and fatigue shear strength, the influence of accelerated aging, and the cytotoxicity with human osteoblasts are characterized. Furthermore, the biomechanical properties of the functional demonstrators of a femoral component for total knee replacements are evaluated. The TiNbTa-ATZ specimens showed a homogenous joint with statistically distributed micro-pores and a slight accumulation of Al-rich compounds at the glass solder–TiNbTa interface. Shear strengths of 26.4 ± 4.2 MPa and 38.2 ± 14.4 MPa were achieved for the TiNbTa-ATZ and Ti-ATZ specimens, respectively, and they were not significantly affected by the titanium material used, nor by accelerated aging (p = 0.07). All of the specimens survived 10⁷ cycles of shear loading to 10 MPa. Furthermore, the TiNbTa-ATZ did not impair the proliferation and metabolic activity of the human osteoblasts. Functional demonstrators made of TiNbTa-ATZ provided a maximum bearable extension–flexion moment of 40.7 ± 2.2 Nm. The biomechanical and biological properties of TiNbTa-ATZ demonstrate potential applications for endoprosthetic implants. Full article

Distal humeral replacement (DHR) is a limb-salvage option for the endoprosthetic reconstruction of bone defects following the resection of a primary bone sarcoma. As primary bone sarcomas are only occasionally located around the distal humerus, there is a paucity of information regarding postoperative function, and patients’ resumption of sporting activities. With advances in diagnostics and in surgical and oncological treatment leading to an increased patient life expectancy and higher quality of life, patients’ functional outcome and return to sports activities are of increasing interest. Between 1997 and 2021, a total of 24 patients underwent DHR with a single-design modular implant at a tertiary sarcoma center. A total of 14 patients who died of their disease were excluded, leaving a study cohort of 10 patients, with a median age of 30 years on the day of surgery (IQR 20–37). At the last follow-up, after a median of 230 months (IQR 165–262), the median MSTS was 19 (IQR 13–24), the median TESS was 79 (IQR 66–87), the median SEV was 38% (IQR 24–53), the median TS was 6 (IQR 4–7), and the median WAS was 3 (IQR 1–8). Among the variables of gender, surgery on the dominant extremity, intraoperative nerve resection, extra-articular tumor resection, chemotherapy, radiotherapy, and revision surgeries, none were associated with a better/lower functional outcome score or return to sports activities. However, a higher level of sports performance prior to diagnosis (WAS > 10) was associated with a higher level of sports performance postoperatively (p = 0.044). Full article

Background: Tracheoesophageal speech with a voice prosthesis is considered the rehabilitation treatment of choice in laryngectomized patients. The main reasons for prosthesis failure are endoprosthetic leakage and periprosthetic leakage. The Provox XtraSeal^® stent incorporates an additional double flange on the esophageal side to prevent periprosthetic leakage. The objective of this study is to compare the duration and costs of the Provox Vega^® and Provox XtraSeal^® prostheses used in these patients in a tertiary university hospital. Materials and methods: A prospective crossover case study of laryngectomees with Provox Vega^® who underwent Provox XtraSeal^® placement due to recurrent periprosthetic leaks and decreased theoretical prosthesis life. The duration and possible factors affecting voice prostheses were studied using Kaplan–Meier curves and Cox regression. A cost-effectiveness analysis was carried out from the perspective of the Spanish National Health System with an incremental cost-effectiveness calculation. Results: A total of 38 patients were recruited, 35 men and 3 women, with a mean age of 66.26 ± 9.36 years old. Information was collected from 551 voice prostheses, 484 Provox Vega^® and 68 Provox XtraSeal^®. The mean duration of Provox Vega^® was 119.75 ± 148.8 days and that of Provox XtraSeal^® was 181.99 ± 166.07 days (p = 0.002). The most frequent reason for replacement was endoprosthetic leakage in both groups: 283 (60.86%) in the case of Provox Vega^® and 29 (48.33%) in that of XtraSeal^® (p < 0.000). To obtain no cost differences (ICE ~ 0) between Provox Vega and Provox XtraSeal, the latter should cost EUR 551.63. Conclusions: The Provox XtraSeal^® is a cost-effective option in patients with increased prosthesis replacements due to periprosthetic leakage, reducing the number of replacements, increasing the duration of the prosthesis, and providing savings compared to Provox Vega^®. Full article