Diakonie-Klinikum Stuttgart

The demand for revision hip and knee arthroplasty (rTHA/rTKA) is increasing, while they continue to be associated with greater perioperative risks, higher resource demands, and greater variability in outcomes compared with primary procedures. Identifying precise risk factors is essential for effective perioperative management and resource planning. A retrospective analysis of 2,123 revision total hip (rTHA, n = 1,301) and knee arthroplasties (rTKA, n = 822) performed from 2010 to 2019 at a tertiary German centre was conducted. Adverse events (AE), length of hospital stay (LOS), and predictors including age, Elixhauser Comorbidity Index (EI), joint type, and indication were analysed using multivariate regression models. The overall AE rate was 13.1%, significantly higher in rTHA than in rTKA (12.6% vs. 8.8%; p = 0.008), particularly for infections and mechanical complications. Mean LOS was 19 ± 14 days. Infection, age, EI, joint type, dislocation, and periprosthetic fracture independently predicted AE and LOS. Infection was the strongest predictor overall (AE: OR 5.4; LOS: Coefficient 1.6), with periprosthetic fractures being highly predictive in rTKA (OR 9.8). Infection (in all revisions), periprosthetic fractures (in rTKA), advanced age, and high comorbidity burden were critical determinants of perioperative adverse events and hospital utilisation. Focused perioperative care strategies targeting these risk groups are essential to mitigate adverse outcomes and optimise healthcare resources.

Zusammenfassung Hintergrund Die Behandlung der Kubitalarthrose gerade bei jüngeren Patienten ist herausfordernd. Eine endoprothetische Versorgung sollte aufgrund des hohen Komplikationsrisikos möglichst lange herausgezögert oder vermieden werden. Bei Versagen der konservativen Therapie können operative Interventionen erwogen werden. Behandlungsziel Ziel der Therapie ist eine bestmögliche Funktion bei akzeptablen Schmerzen zu erzielen, ohne dabei zukünftige Therapieoptionen zu verbauen. Therapie Patienten mit endgradigem Extensions- und/oder Flexionsschmerz und Bewegungseinschränkung eignen sich für ein arthroskopisches oder offenes Débridement. Bei isolierter radiokapitellarer Arthrose und stabilem Ellenbogengelenk ist eine Radiuskopfresektion mit oder ohne Anconeusinterpositionsarthroplastik zu erwägen. Patienten mit fortgeschrittener Arthrose und Schmerzen über dem gesamten Bewegungsbogen, die noch zu jung für eine Ellenbogenprothese sind, kann die Interpositionsarthroplastik angeboten werden. Die Ellenbogenarthrodese führt zu massiven Funktionseinschränkungen und ist daher nur in Ausnahmesituationen empfohlen.

Background/Objectives: Limited data exist regarding the influence of total hip arthroplasty (THA) on the alignment of the lower limb. Therefore, the objective of this study was to investigate potential alterations in lower limb alignment (LLA) following total hip arthroplasty, with a focus on the comparison of two different short-stem implant designs. Methods: This retrospective study compares pre- and postoperative hip-knee-ankle angle (HKA), femoral offset, and leg length data of 115 consecutive hips with two different implant types (Mathys Optimys® stem and Implantec Alpha proxy® stem). Results: There was not a significant difference between the pre- and postoperative HKA angles regarding the entire study population (p = 0.293), nor after comparing the two short-stem implant designs (p = 0.433). Hip offset almost remained unchanged in the entire study cohort (p = 0.662), as well as when comparing the two short-stem implant designs (p = 0.206). Conclusions: Modern short-stem THA does not significantly affect overall LLA.

Cerebral sinus thrombosis, which constitutes a small percentage of all strokes, usually affects young individuals and can lead to venous stroke. Ischemic and hemorrhagic Stroke are associated with Spreading Depolarization (SD) waves in brain tissue, which propagate through the affected areas and cause a transient disruption of ionic homeostasis and neuronal function. This interaction highlights the complexity of the neurological consequences associated with SD. In this study, we investigated the occurrence of SDs following the occlusion of the superior sagittal sinus (SSS) in a gyrencephalic model, specifically swine. To instigate an occlusion, we surgically clipped the middle third of the SSS. The animals were grouped and monitored using one of three methods: electrocorticography (ECoG) alone, ECoG with intrinsic optical signal (IOS) imaging, or ECoG in conjunction with laser speckle contrast and oxygen imaging (LSCI). Post-mortem, the brains were analyzed using 2,3,5-triphenyl tetrazolium chloride (TTC) staining to check for venous infarction. Our results confirmed the spontaneous occurrence of SDs in the gyrencephalic swine brain after SSS occlusion, which was detectable via all monitoring methodologies. SD activity was most frequent in the first hour post-occlusion, subsequently diminishing. IOS imaging identified four unique hemodynamic responses, while TTC staining indicated no infarction. This research is the first to document SDs in the gyrencephalic swine brain following SSS occlusion, laying the groundwork for future investigations in both animal models and human clinical studies.

715 Background: The prospective phase 3 study EV-302 demonstrated superiority regarding efficacy of Enfortumab vedotin plus Pembrolizumab (EVP) compared to platinum-based chemotherapy in patients (pts) that received first-line (1L) therapy for metastatic urothelial carcinoma (mUC). Since presentation of the data in September 2023 EVP was considered a new standard of care (SOC) however only approved in Europe in August 2024. We analyzed efficacy and safety outcomes of pts treated with EVP outside of clinical trials. Methods: Retrospective data were collected from 19 German academic and community hospitals for pts with metastatic UC who received EVP as off-label therapy when reimbursed by their insurance company before European Medicines Agency (EMA) approval, or as SOC treatment after EMA approval. Imaging and therapy management were in accordance with local standards. Adverse events (AEs) were reported according to Common Terminology Criteria for Adverse Events (CTCAE) version 5.0 criteria. Median progression-free survival (mPFS) and overall survival (mOS) were estimated using the Kaplan-Meier method by local investigators. Results: We identified 215 pts for the safety cohort (all pts who received EVP at least once) and 164 pts for the efficacy cohort (all pts who received at least one staging or died prior to first planned imaging).The median age for the eligible patients was 71 yr (range 25-89). The Eastern Cooperative Oncology Group performance status (ECOG PS) was 0/1/2/3-4/unknown for 46.0/31.6/17.2/4.7/0.5% of patients. The overall response rate was 60.7% (partial response 51.0%, complete response 9.7%). mOS was not reached and mPFS was 13 mo (95% confidence interval 4.5-21.5). Any-grade AEs were observed in 73.0% and CTCAE grade ≥3 AEs in 30.2%. Any-grade immune-related AEs were observed in 37.7% and CTCAE grade ≥3 AEs in 16.7%. The most common AEs were peripheral sensory neuropathy (all grade: 30.2%) and skin toxicity (all grade:24.2%). No treatment-related fatal event occurred. Limitations include the retrospective design and short follow-up. Conclusions: Administration of EVP in a real-world patient population showed promising effectiveness and an acceptable toxicity profile. No new safety signals were reported. Our results support the use of EVP in 1L in pts with mUC. Updated data with longer follow-up will be presented at the meeting.