How many implants can one have in a lifetime?

[LastHope]

Note that the 100% number at 5 implants was only for 2 patients. Not exactly statistically significant.

The P value is 0.01. Isn't statistical significance satisfied if < 0.05?

"The risk of specific device infection was strongly correlated and increased based on number of prior IPPs: 1st (6.8%; 3/44), 2nd (18.2%; 4/22), 3rd (33.3%; 4/12), 4th (50%; 4/8), and 5th (100%; 2/2) (R2 = 0.90, p = 0.01). Similarly, overall rates of infection positively correlated with number of prior IPP-related surgeries performed (R2 = 0.97, p < 0.01)."

https://www.nature.com/articles/s41443-018-0026-6

Their overall conclusion that "The risk of specific device infection was strongly correlated and increased based on number of prior IPPs" has p=0.01, which definitely makes sense. But this dataset doesn't really make it clear that there's a hard 100% limit at 5 revisions.

Well said.

[easymoney]

thedriver is a great example of how many times he had 4 failed IPPs in just a few years now on his first mallabble. I had my 1st 6-2023 ..30 days later they thought I had an infection cur me open from asshole to elbow never found an infection ... then 6-2024 a revesion for the implant being undersized .. I'm high risk for infection being diabetic so it is a constant worry for sure ... I'd assume the more times you slice and dice the higher the chance of getting an infection makes sense.

[LastHope]

thedriver is a great example of how many times he had 4 failed IPPs in just a few years now on his first mallabble. I had my 1st 6-2023 ..30 days later they thought I had an infection cur me open from asshole to elbow never found an infection ... then 6-2024 a revesion for the implant being undersized .. I'm high risk for infection being diabetic so it is a constant worry for sure ... I'd assume the more times you slice and dice the higher the chance of getting an infection makes sense.

A1C level above 8.5% is associated with a higher risk of infection for diabetics. If your diabetes is well-controlled, I believe you're in good shape, easymoney.

[nuance]

thedriver is a great example of how many times he had 4 failed IPPs in just a few years now on his first mallabble. I had my 1st 6-2023 ..30 days later they thought I had an infection cur me open from asshole to elbow never found an infection ... then 6-2024 a revesion for the implant being undersized .. I'm high risk for infection being diabetic so it is a constant worry for sure ... I'd assume the more times you slice and dice the higher the chance of getting an infection makes sense.

A1C level above 8.5% is associated with a higher risk of infection for diabetics. If your diabetes is well-controlled, I believe you're in good shape, easymoney.

do we know if the patient group had mostly diabetics in that study?

[LastHope]

thedriver is a great example of how many times he had 4 failed IPPs in just a few years now on his first mallabble. I had my 1st 6-2023 ..30 days later they thought I had an infection cur me open from asshole to elbow never found an infection ... then 6-2024 a revesion for the implant being undersized .. I'm high risk for infection being diabetic so it is a constant worry for sure ... I'd assume the more times you slice and dice the higher the chance of getting an infection makes sense.

A1C level above 8.5% is associated with a higher risk of infection for diabetics. If your diabetes is well-controlled, I believe you're in good shape, easymoney.

do we know if the patient group had mostly diabetics in that study?

44 revision patients
31.8% of them had diabetes
Mean A1C of 7.1%
Age range 50-88
9.1% of them were active tobacco users

[nuance]

thanks for digging this up. Did the 2 that had revisions fail 5 times diabetic?

[LastHope]

thanks for digging this up. Did the 2 that had revisions fail 5 times diabetic?

The P value for diabetics was 0.71 and didn't reach statistical significance.

Quote
There have been many studies looking for individual factors that contribute to an increased risk of IPP infection [23]. We did not identify any significant differences between the cohorts of those experiencing an infection versus those who did not, including diabetes mellitus. The only factor close to being significantly associated with infection was current smoking; however the lack of significance may be related to inadequate study power with a relatively small number of infections overall.

[LastHope]

Wolfpacker's observation about about those two patients is also mentioned in the paper:

Quote
The current series also has several notable limitations including the relatively small cohort, retrospective nature, and inclusion of non-contemporary devices and outcomes (given the historical series). This is particularly relevant in regards to the two men with five prior IPPs who experienced infections. Given the small population size, this calculates to a 100% infection rate with the fifth revision surgery. This is likely an overestimation and would be a lower value with additional patients with these characteristics. As our patient population only included those presenting for consideration of revision/salvage surgery, it is underrepresenting a percentage of men with IPPs. Notably, patients who would not be included are those whose devices malfunctioned or were infected and removed whom did not seek revision, patients who expired prior to developing an IPP issue, and those not yet experiencing an end-point with the IPP. It is unclear how inclusion of these patients would alter the percentage of infections in all categories. However, it is important to note that this would not be expected to impact the relative differences in infection rates based on increasing numbers of IPPs and each subsequent revision surgery. Therefore, the key finding of the current study that infection rates increase with each subsequent revision surgery is not affected by these limitations.