Cases reported "Prosthesis Failure"

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1/36. Aortoduodenal fistula after endovascular stent-graft of an abdominal aortic aneurysm.

    Despite satisfying short- and middle-term effectiveness and feasibility, endovascular stent-grafting for abdominal aortic aneurysm is still under evaluation. We report a case of an aortoduodenal fistula after the use of this technique. Enlargement of the upper aneurysmal neck was followed by caudal migration of the major portion of the stent-graft, which resulted in kinking of the device in the aneurysmal sac. Ulcerations were found on adjacent portions of both the aneurysmal sac and the adjacent duodenum. Only the textile portion of the prosthetic contralateral limb separated the aortic lumen from the corresponding duodenal lumen. Early detection of complications after stent-grafting is essential to allow successful treatment, either surgical or endoluminal.
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2/36. Dissociation of modular total hip arthroplasty at the femoral head-neck interface after loosening of the acetabular shell following hip dislocation.

    Modular component dissociation is a potential problem of current modular total hip arthroplasty (THA) systems. We describe a case of dissociation of the modular THA at the femoral head-neck interface after loosening of the acetabular shell during closed reduction for posterior dislocation of THA. The causes of this dissociation and acetabular shell loosening are discussed. Successful treatment was provided with surgical revision of the acetabular and the femoral head components. The present case serves as a graphic reminder that the acetabular shell overhanging the acetabular bone must be avoided when implanting modular THA components.
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3/36. "Tripolar" hip arthroplasty for failed hip resurfacing: nineteen years follow-up.

    The authors describe the case of a 37-year-old patient who sustained a subcapital femoral neck fracture six months after ICLH double-cup hip resurfacing. As the polyethylene acetabular resurfacing component was undamaged and well fixed, a standard femoral stem with a bipolar head was inserted. The outer diameter of the bipolar head was chosen to fit the resurfacing socket. The "tripolar" hip arthroplasty has functioned well for 19 years and was revised for aseptic cup loosening. The cemented femoral stem was still well fixed and was not revised. Although the "tripolar" hip has functioned well in our case, we believe it is not indicated for metal on metal bearings. In this case the use of an appropriate modular head with a correct head-socket clearance is preferred.
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4/36. Complications related to hydroxyapatite vertebral spacer in anterior cervical spine surgery.

    STUDY DESIGN: This is a report of complications related to the hydroxyapatite vertebral spacer used for anterior cervical reconstructive surgery. Compression of the spinal cord by broken fragments of hydroxyapatite spacer as well as its surrounding radiolucent clear zone were observed in seven patients. OBJECTIVES: To report complications related to the use of hydroxyapatite vertebral spacer for anterior cervical reconstructive surgery and to discuss how to prevent these complications. SUMMARY OF BACKGROUND DATA: Despite previous articles reporting the clinical applications of hydroxyapatite vertebral spacer for the cervical spine, clinical reports regarding the long-term results of hydroxyapatite spacer for anterior cervical surgery and its complications have been limited. methods: The authors reviewed patients who underwent anterior reconstructive surgery using the hydroxyapatite spacer at other hospitals and had postoperative complications related to hydroxyapatite spacer. RESULTS: Seven patients previously treated by anterior cervical spine surgery using the hydroxyapatite vertebral spacer were referred to the authors because of unsatisfactory surgical outcomes. All the patients had a radiolucent clear zone around the spacer and experienced severe neck pain. Four had fracture of the hydroxyapatite spacer, and two had compression of the spinal cord by retropulsed fragments of broken hydroxyapatite spacers. CONCLUSIONS: Although hydroxyapatite has been used in many medical fields because of its bioactive characteristics, its mechanical properties should be improved to lessen the risks of breakage and subsequent spinal cord compression. Gentle insertion maneuvers are also important to avoid the production of cracks inside the spacer.
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5/36. A dislocation of the inner head in bipolar prosthesis with a self-centering system: a case report.

    We present a case of inner head dislocation 11 years after the replacement of a bipolar prosthesis with a self-centering system. An 84-year-old woman with osteoarthritis of the left hip underwent a replacement of the Bateman UPF-II bipolar prosthesis in 1987. She fell off a chair on April 19 1998, and felt a sudden sharp pain in the left hip. Roentgenograms revealed that the inner head was dislocated from the outer head. Moreover, on June 19, when she stood up from the floor, the dislocation recurred. On July 23, a revision surgery was carried out. When the outer head was removed from the acetabulum, the bearing insert was markedly worn by the impingement of the femoral stem neck. Because there was no evidence of loosening of the femoral stem, a cemented replacement of the acetabular component was performed. At a 2-year follow-up, she had mild hip pain, but had returned fully to daily living. Our review of current published studies reveals that most inner head dislocations occurred in osteoarthritic patients. Thus, the occurrence of dislocations may be more dependent on patient selection than on failure of the bipolar prosthesis itself.
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6/36. Endovascular treatment of a multimorbid patient with late AAA rupture after stent-graft placement: 1-year follow-up.

    PURPOSE: To report successful endovascular management of a ruptured abdominal aortic aneurysm (AAA) in a multimorbid patient 40 months after primary stent-grafting. CASE REPORT: A 64-year-old man presented with hypotension, severe back pain, and abdominal distension. Immediate computed tomography revealed a proximal type I endoleak due to distal migration of the stent-graft with subsequent rupture of the aneurysm. The patient was hemodynamically unstable, and open surgery was refused because of severe comorbidities that were the indications for initial endovascular repair. The diameter of the proximal aneurysm neck required the use of a thoracic stent-graft that was overly long, which led to occlusion of the contralateral stent-graft limb supplying not only the left leg but also a left kidney transplant. A crossover bypass was implanted to revascularize both. CONCLUSION: Minimally invasive strategies, even when challenged by complex vascular reconstructions, offer the possibility of managing ruptured aortic aneurysms in patients unsuitable for open surgery.
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7/36. Stem fracture after hemiresurfacing for femoral head osteonecrosis.

    The ideal treatment of the young patient with a large necrotic segment in the femoral head remains controversial. Hemiresurfacing is a reasonable option in the young patient with a large osteonecrotic lesion that has collapsed. Complications reported after hemiresurfacing include implant loosening, femoral neck fracture, acetabular wear, and persistent pain. We present a case of stem fracture after hemiresurfacing in a young patient with femoral head osteonecrosis.
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8/36. Treatment of a primary type IA endoleak with a liquid embolic system under conditions of aortic occlusion.

    We present the case of a primary type IA endoleak after deployment of a bifurcated Ancure endograft (Guidant Endovascular solutions, Menlo Park, Calif) to treat a 9-cm abdominal aortic aneurysm with a short angulated neck. The endoleak was treated unsuccessfully with repeat balloon angioplasty, placement of a Palmaz aortic stent (Cordis Endovascular, Miami, Fla), and deployment of an AneuRx aortic extender cuff (Medtronic AneuRx, Santa rosa, Calif). The endoleak then was sealed with injection of n-butyl cyanoacrylate into the aneurysm sac at the site of the leak with occlusion of aortic flow. We suggest the use of this liquid embolic agent be considered as an adjunct to control primary type IA endoleaks when other forms of therapy have failed.
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9/36. Aortoduodenal fistula occurring after type II endoleak treatment with coil embolization of the aortic sac.

    A bifurcated stent graft device was successfully deployed to exclude an asymptomatic abdominal aortic aneurysm (AAA) with adequate proximal aortic neck morphology. At 6 months, a type II endoleak was successfully embolized through a proximal perigraft channel with metallic coils. The patient was seen with upper gastrointestinal bleeding and a pulsatile abdominal mass 11 months later. Surgical exploration revealed an aortoduodenal fistula in the vicinity of the previous embolization. We discuss the possible causes of this complication and review the literature on the subject. We conclude that aortoduodenal fistula can occur after endovascular AAA repair despite the absence of endoleak or AAA diameter increase on follow-up computed tomographic scan.
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10/36. Fluordeoxyglucose positron emission tomography detection of inflammatory reactions due to polyethylene wear in total hip arthroplasty.

    A patient experienced chronic pain 8 years after total hip arthroplasty. radiology and bone scanning showed no signs of aseptic loosening, but fluorine-18 fluorodeoxyglucose positron-emission tomography ((18)F-FDG-PET) showed intensive glucose metabolism in the joint capsule and around the prosthesis neck. The surgical intervention revealed soft tissue reaction in this area. Histologic examination showed a granulomatous foreign body reaction against polyethylene debris particles. infection and rheumatoid arthritis could be excluded clinically, histologically, microbiologically, and with the bone scan. Therefore, FDG-PET detected inflammatory reaction caused by polyethylene wear in total hip arthroplasty and allowed clinicians to decide on interventions, including removal of granulomatous tissue and the replacement of worn artificial joint components to prevent aseptic loosening.
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