Persistent or recurrent infection after two-stage revision total knee arthroplasty (TKA) for the treatment of an infected TKA is a dreaded complication. The purpose of the current study was to determine the ability of a second or third two-stage revision TKA to control infection, evaluate the long-term survivorship of the TKA prosthesis, and measure the functional outcome after a second or third two-stage revision TKA for reinfection.
The results of the current study suggest that a second or a third two-stage revision TKA is a reasonable option for controlling infection, relieving pain, and achieving a satisfactory level of function for patients with infected TKAs.
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The purpose of the current study was to: (1) determine the ability of a second or third two-stage revision TKA to control infection; and (2) evaluate the long-term survivorship of a TKA prosthesis and (3) measure the functional outcome after a second or third two-stage TKA for reinfection.
At each follow-up, we evaluated the patients clinically and obtained radiographs of knees. Pre-revision and post-revision review data were recorded according to the systems of the Knee Society [18]. All of the knees were evaluated by one orthopedic surgeon who was not connected with the surgery, and the data were entered into a computerized record.
Overall, 49 (75%) of 65 knees were survived free of implant removal after a second two-stage revision TKA was performed. The remaining 16 of 65 (25%) knees had a third two-stage revision TKA. At the time of a third two-stage revision TKA, femoral and tibial augmented metallic blocks were used in all of these 16 knees. None of 16 knees required a rotating hinge knee prosthesis. Twelve of 16 knees (75%) undergoing a third two-stage revision TKA had negative culture (Table 1). In four of the 16 knees where infection was not eradicated after a third two-stage revision TKA, one knee had an above-knee amputation, one knee had arthrodesis followed by fusion-taken-down and TKA using an LCCK prosthesis due to intact soft tissue sleeves one year after arthrodesis, one knee had arthrodesis, and one knee received chronic oral suppressive antibiotics because of a poor medical condition.
All but 6 knees were resurfaced patella during the second or third two-stage revision TKA. No knee suffered from periprosthetic fracture. Six of the 16 knees with a third two-stage revision TKA was not able to be resurfaced due to insufficient bone stock. The remaining 10 knees had no problem related to patella.
The aim of this study was to determine the long-term clinical and radiographic results of the second or third two-stage revision TKA for infection using modern operative techniques and implants. The risk of failure at 15.1 years caused by recurrence of infection and mechanical reasons were approximately equal (failure rate of 5% due to mechanical future and 6% due to recurrent infection).
The strengths of this study include: (1) the relatively large number of single-surgeon patients and the long-term follow-up period; (2) the uniformity of implant designs and prosthetic fixation; and (3) the fact that this study focused on infection eradication and patient function. Our study is not without some limitations: (1) we had no comparative data on whether knee arthrodesis similarly eradicates infection or provides comparable functional results; and (2) the retrospective nature of the study may have introduced recall bias, and the review was not blinded when stratifying patient characteristics.
In conclusion, the results in the current study suggest that a second or third two-stage revision TKA is likely to result in a satisfactory outcome. In contrast, patients with methicillin-resistant Staphylococcus aureus and fungus infection tended to have a higher recurrence of infection after a second or third two-stage revision TKA.
The author declare that they have no financial interests or any conflict of interest. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards: This article does not contain any studies with animals performed by any of the authors.
I would like to confirm that the content of this manuscript has not been published elsewhere or submitted simultaneously for publication elsewhere. The manuscript has been submitted and there are no special or specific issue in the publication. All the authors give our full consent for the publication of this manuscript in the journal.
I would like to declare that there have been no conflicts or competing interests during the study and no issues in the journal policies. All the authors have agreed to the submission of the manuscript.
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I'm reaching out to the community regarding an issue I've encountered in Total War: Warhammer 3 that's proving to be quite perplexing. It appears that the Minotaur units among the Beastmen faction are rendering invisible during gameplay, except for their weapons.
I've scoured forums, tried various settings adjustments, and even conducted a clean reinstallation, yet the issue persists. It seems confined specifically to the Minotaur units within the Beastmen faction.
Thanks for reaching out we've been unable to replicate this happening on our side, when posting issues on the forums it's a great idea to follow our guide ((Here)) so we can better assist you with your issue in a more timely manner.
This is the third time I've seen a post of this same bug and not one staff member responded that they have received the files that I've been posting. Trying one more time... The Minotaurs seem to turn invisible based on LOD. They're invisible for most LOD settings. Here's some screenshots of the issue in Taurox's starting battle:
@CA_Jupiter#7379
Hi, I've posted some additional info in the above comment if it is of any help. I also noticed that Gorebull heroes are also affected by the invisibility bug. If you want to see the Gorebull bug, loading into a skirmish battle with a Gorebull hero caused the issue to appear for me as well.
Update: Tonight I have tried uninstalling and reinstalling the game, verifying game files, downgrading to a previous graphics driver version (Adrenaline 23.11.1), and reinstalling to the current driver version (Adrenaline 23.12.1). Unfortunately the bug is still present.
Hi, I am having the same issue. Weirdly doesn't seem to affect the regiment of renown but all the other minotaurs have this issue. It was even happening during the cutscene for Taurox's quest battle. These images are after I downloaded the latest hotfix, 4.1.4
Okay, having now battled my way through it twice, I can categorically say that in a tough field, Phase 3 Total Body Core is the toughest of all the 80 Day Obsession workouts. And I say that as someone who is definitely better at strength workouts than cardio ones and who loves a good total body workout.
Other than the ever more complex and compound moves, the structure is the same as in previous phases: 5 rounds, focused on the shoulders, back, chest, biceps, and triceps respectively. Each round involves two moves focused on the specified body part, then one core move. As with all the strength workouts, the rep pattern changes week to week: today involved 10 reps of each move, with each series completed 3 times back to back before moving onto the next.
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The aim of this study was to dosimetrically compare three total body irradiation (TBI) techniques which can be delivered by a standard linear accelerator, and to deduce which one is preferable. Specifically, Extended Source to Surface Distance (SSD) Field-in-Field (FiF), Extended SSD Volumetric Modulated Arc Therapy (VMAT), and Standard SSD VMAT TBI techniques were dosimetrically evaluated. Percent depth dose and dose profile measurements were made under treatment conditions for each specified technique. After having generated treatment plans with a treatment planning system (TPS), dose homogeneity and critical organ doses were investigated on a Rando phantom using radiochromic films and optically stimulated luminescence dosimeters (OSLDs). TBI dose of 12 Gy in six fractions was prescribed for each technique. The gamma index (5%/5 mm) was used for the analysis of radiochromic films. Passing rates for Extended SSD FiF, Extended SSD VMAT and Standard SSD VMAT techniques were found to be 90%, 87% and 94%, respectively. OSLD measurements were within 5% agreement with TPS calculations for the first two techniques whereas the agreement was found to be within 3% for the Standard SSD VMAT technique. TPS calculations demonstrated that mean lung doses in the first two techniques were around 8.5 Gy while it was kept around 7 Gy in Standard SSD VMAT. It is concluded that Standard SSD VMAT is superior in sparing the lung tissue while all three TBI techniques are feasible in clinical practice with acceptable dose homogeneity. In the absence of VMAT-based treatment planning, Extended SSD FiF would be a reasonable choice compared to other conventional techniques. 152ee80cbc
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